psyc 365: chapter 10

Social ecological model

A model of acknowledging that the individual is influenced by a collection of larger, interrelated, and cumulative contexts such as organizations, communities and governments

Social ecological model: Indvidual

Knowledge, attitudes, skills

Social ecological model: Interpersonal

Family, friends, social networks

Social ecological model: Organizational

Organizations, schools, workplaces

Social ecological model: Community

Design, access, connectedness, spaces

Social ecological model: Public policy

National, provincial/territorial, local laws and policy

Epidemiology

The study of changing patterns of health and disease across populations and geographic areas

Index case

The first identified instance of a medical problem

Pandemic

A large epidemic that occurs on a worldwide basis, crossing international boundaries; usually affects a large number of people

Pre-symptomatic

Someone who is confirmed to have the virus but is not yet showing symptoms

Asymptomatic

Someone who has not had the illness confirmed and has no symptoms

Viral mutation

Alteration in the genetic material of a virus that has the potential to increase virulency

Incubation period

The time between exposure to the virus and the onset of symptoms

COVID-19 incubation period

2-14 days

Reproduction number (R)

The number of people, on average, an infected person ends up infecting

R < 1

Virus spreading is slow

R > 1

Virus spreading in increasingly

Prevalence

The number of cases that have been confirmed or presumed

Point prevalence

The number of cases present at a particular point in time

Period prevalence

The total number of cases that have occurred over the course of a time period

Current cases

The total number of cases minus those who have recovered or died from the disease

Incidence

The number of new cases that emerge in a given time period

Prevalence graph

Red line

Incidence graph

Blue line

Explanations for differences in COVID-19 cases between Canadian provinces

- Spring vacations in schools
- Shelter-in-place orders
- Number and condition of seniors' care homes
- Outbreaks in industrial workplaces

Adverse behaviours associated with pandemics

Addiction, suicidality and depression

Behavioural activation

Mechanisms focused on positive responses that enhance resilience in the face of challenge

Three Cs associated with behavioural activation

Control (e.g., secondary control), coherence (e.g., acceptance-based coping) and connectedness

Secondary control

A process where we work on the things we can control in lieu of the things we cannot

Examples of secondary control in the context of the COVID-19 pandemic

- Social distancing
- Handwashing
- Sleeping adequately
- Exercising
- Establishing a routine

Acceptance-based coping

Paying attention to how one relates to emotions rather than letting the emotions take charge of one's behaviour

Gradients of health

The often-found positive relationship between socioeconomic status and health

Strategies when providing care to vulnerable patients

- Build connection to overcome perceived distance between patient and caregiver
- Develop medical expectations that are consistent with patients' social circumstances
- Establish collaborative relationships that empower patients

Wealth distribution as a predictor for health

The smaller the gap between the richest and the poorest citizens, the better the country's general health tends to be

Canadian healthcare spending compared to developed countries

Higher (+$1000) per person than the average among OECD countries

Cancer screening where Canada performs poorly compared to other developed countries

Lung cancer screening in women

Canadian health care satisfaction

Generally satisfied with quality of care but could improve wait times

Social determinants of health

Factors such as housing, employment, socioeconomic status and food availability that affect the health of populations

Upstream health causes

Economic and political causes of health (e.g., poverty and war)

Factors leading to vulnerability

- Increased exposure to a perceived threat
- Increased likelihood that the threat will become a real problem
- Lack of resources to deal with the threat

Examples of vulnerable populations

- Elderly
- Street youth
- Those living in poverty

Challenges with the term "vulnerable" to describe populations

May detract from systemic issues such as policies and stereotypes that contribute to inequitable health outcomes

Feelings common amongst unhoused people

- Alienation/loneliness
- Learned helplessness

Health conditions that more adversely affect rural-living Canadians

- Asthma
- COPD
- Diabetes
- Hypertension
- Heart disease

Harm reduction strategy

Attempts to reduce the harmful effects of a behaviour when faced with the reality that the health-compromising behaviour cannot be eliminated from a population

Characteristics of harm reduction

- Non-judgmental
- Emphasizes trust and compassion
- Operates under belief that comprehensive health services are a right for all

Critiques of harm reduction from those accessing services

- Does not improve life circumstances of those using drugs
- Can be difficult to access centres

Pragmatic belief

Holds that if a method yields positive results, it should be employed

Moral belief

Views some methods as not appropriate, even if evidence supports their efficacy

Harm reduction programs in BC

- Needle distribution
- Peer support
- Outreach and health education
- Substitute therapies (e.g., methadone clinics)
- Supervised consumption facilities

Infections prevalent in people who use IV drugs

- HIV
- Hep C

Benefits of fixed needle exchange sites

- Provides needles
- Handles housing and clothing requests
- Makes hospital and transportation referrals
- Provides counselling and education
- Instills feeling of safety for clients
- Reduces stigma for people accessing site

Drug efficacy

The extent to which the drug has the potential to yield its intended outcome under ideal circumstances

Drug effectiveness

A drug's ability to yield intended outcomes under realistic conditions

Process of drug development that is the most time-consuming

Effectiveness testing; involves thousands of participants

Challenge associated with COVID-19 vaccine trials

There could have be participants who became COVID positive, but did not experience symptoms and therefore were not tested for the disease; these people would have been asymptomatic transmitters

Challenge with vaccines requiring more than one dose

Roughly half of those who receive a first dose do not receive a second dose

Outcome measure

A quantifiable or objective means to determine the effectiveness of treatment

COVID-19 vaccine outcome measure

Absence of symptoms

Factors contributing to vaccine adherence

- Perceptions of effectiveness
- Side effects

Number of phases of vaccine development

3