BBH Exam 3 material
The World Health Organization (1993) has a broader definition of biomarkers, including:
"....any measurement reflecting an interaction between a biological system and a potential hazard, which may be chemical, physical or biological. The measured response may be functional and physiological, biochemical at the cellular level or a molecular interaction."
National Institutes of Health Biomarkers Definitions Working Group defined a biomarker as
"a characteristic that is objectively measured and evaluated as an indicator of normal biological processes, pathogenic processes, or pharmacologic responses to a therapeutic intervention."
The aging demographics of today's society means that more people will:
(1) need help to maintain healthy lifestyles, (2) need continued medical attention, and (3) have some difficulty understanding that they need help, how and where to get this help, and how to put sound health-promoting advice into practice.
Drug-Drug Interactions
(besides alcohol) can be dangerous or unpleasant. Administration of OTC nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil®) with concomitant administration of certain antineoplastics (e.g., methotrexate) can cause unexpected, sometimes fatal, bone marrow suppression and gastrointestinal toxicity. There are many unwanted side effects of drugs and this list shows examples of potential BBH effects which are unpleasant enough to become an obstacle in compliance and adherence especially when weighed against the individual benefits of the given drugs
Heart disease is a behavioral disease
* the leading cause of death and illness in the United States.* According to the CDC approx 610,000 people die of heart disease in the US every year 1 in 4 deaths- nearly one million Americans have a heart attack.
Drug Addiction
*Cigarette smoking is the single most preventable cause of premature death and illness* Consequently, asking habitual smokers to abstain from smoking requires the cessation of self-administration of an addictive pharmacological agent, namely nicotine. Smoking cessation results in irritability, anxiety, sleep disturbances, difficulty concentrating, and body weight gains. -These biologically based abstinence effects are powerful obstacles to adopting and maintaining a healthy lifestyle. -Abstinence from use and abuse of these substances is hindered by biological obstacles and it is important that health care providers and significant others become aware of the consequences of abstinence. *Prodding, coercion, scare tactics, and hinting are minimally effective in changing a drug-dependent individual into someone who exercises, eats right, and takes medications on the appropriate dosing schedule.*
effects of non-adherence to pharmacotherapy in cardiovascular disease are startling:
*Non-adherence causes ~30% to 50% of treatment failures and 125,000 deaths annually.* Non-adherence to statins increases relative risk for mortality (~12% to 25%) Non-adherence to cardiovascular medications increases risk of cardiovascular hospitalizations (10% to 40%) and mortality (50% to 80%). Direct cost of non-adherence is estimated at $100 billion to $289 billion annually.
An increasing source of cognitive limitations is the result of traumatic brain injuries
*Traumatic brain injuries result from automotive accidents, falls, athletic collisions, and exposure to improvised explosive devices (IEDs)* These injuries often have deleterious cognitive effects, including effects on executive function, organization skills, and memory.
Biomarkers
*a biological marker and refers to a broad category of medical signs* biomarkers are objective and indicate underlying biological processes. Additionally, biomarkers must be able to be (1) measured accurately and (2) reproducible
Barriers to adopting a healthy lifestyle
*block or prevent* access to a healthier lifestyle
Potential Solutions
*development of long-acting drugs to enhance patient adherence are coming into the forefront of preventive medicine.* For example, there have been tremendous advances in medications to treat osteoporosis, ranging from sodium alendronate (Fosamax®) and risedronate (Actonel®), taken once a week, ibandronate (Boniva®), taken once a month, and a newer drug, bisphosphonate zoledronic acid (Reclast®) administered as a single, 15-minute, intravenous infusion once a year. Medications that are taken less frequently help improve adoption and maintenance of a healthy lifestyle by minimizing the impact on quality of life.
Absence or misinterpretation of biological cues
*patient's failure to experience or correctly interpret symptoms of underlying disorders.* Premature discontinuation of therapy can be dangerous If the antibiotic regimen is not completed, then drug-resistant strains of microorganisms can multiply and create a more serious health risk to the individual and to the general public A variant of this misinterpretation obstacle to promotion of a healthy lifestyle is when people feel fine and, therefore, believe that they do not need to do anything special to promote or improve health.
Cognitive limitations
*these impairments include: senile dementias, Alzheimer's disease, Traumatic Brain Injury, acute illness-induced cognitive impairments, HIV-induced cognitive impairments, AIDS dementia, drug-induced dementias, and attentional disorders.* As we age, the likelihood and proportion of people experiencing various cognitive limitations increases because of unhealthy aging, chronic diseases, and for some people reduced, daily intellectual challenges.
Physical and behavioral limitations
-Impairment of a sensory system, such as hearing or vision, can interfere with the ability to gather or interpret information from the health care provider. These impairments also may make a patient more hesitant to ask questions of the health care provider. -Visual disabilities such as color blindness, myopia, hyperopia Drug allergies may prevent the administration of effective pharmacologic agents, and contact dermatologic reactions may interfere with the use of some medications, some medicinal soaps, and may prevent safe sex practices Respiratory allergic responses, such as extrinsic asthma or allergic rhinitis, can inhibit an individual from exercise activities, eating certain foods, and compliance with immunotherapy *These disabilities and physical challenges may require specialized attention to develop an individualized health adoption and maintenance plan across psychological and physical domains.*
Biomedical research...
...plays a key role in identifying, developing and testing biomarkers for clinical use biomarkers can make a key difference in morbidity and mortality if they are able to distinguish the disease from a non-diseased state or the efficacy of a treatment for patients
Age and gender
Age, of course, is relevant to biology, motivations, behaviors, cognitions, social interactions, and it is likely that age and gender play a role in our discussion of BBH obstacles to the adoption and maintenance of a healthy lifestyle
Other drugs... like digitalis which can improve cardiovascular disfunction also has very adverse side effects...
Anti-HIV medications like nucleoside reverse transcriptase inhibitors can also have adverse side effects
Explain the difference between a biobehavioral barrier and obstacle with regard to adopting a healthy lifestyle.
Barriers block or prevent access to a healthier lifestyle, whereas obstacles are deterrents that can be negotiated or navigated as in an obstacle course.
HPA-axis catabolic steroid hormone, cortisol, is believed to play a role in resilience, along with the anabolic steroid hormone, dehydroepiandosterone (DHEA)
Because of its anabolic properties, it is hypothesized that DHEA release from the *zona reticularis* of the adrenal cortex in response to stress protects the body from the damaging effects of *cortisol*
Familiar Biomarkers
Blood pressure Heart rate Body temperature Body mass index (weight/height^2) Blood glucose Pulse oxygen levels Prostate blood screening tests (PSA) for men aged 50 and older Mammograms for women over the age of 40
All of the following are biomarkers except:
Body weight Blood pressure Mammogram Blood glucose levels *All of the above* Recall that biomarkers are objectively measured indicators of normal or pathologic biological processes. More broadly, biomarkers are objective and indicate underlying biological processes.
Causation, Not Correlation
Dr. Federoff and his colleagues report that 10 phospholipids (that play a role in cell membrane permeability) are consistently low in individuals who go on to have cognitive deterioration and those who display the deterioration. However, it is possible that multiple disease pathways are involved in Alzheimer's disease development. Maybe this particular biomarker assay is an indirect measure of a pathway (cellular membrane permeability) that is not necessarily part of the Alzheimer's disease process.
True or False: Clinical endpoints are objective, quantifiable characteristics of biological processes.
FALSE Clinical endpoints are subjective; they represent patient/participant health and well-being from their perspective.
DHEA release from the zona reticularis of the adrenal cortex in response to stress enhances the damaging effects of cortisol
FALSE DHEA release from the zona reticularis of the adrenal cortex in response to stress protects the body from the damaging effects of cortisol
True or False: Using biomarkers as surrogate clinical endpoints wastes time and valuable resources associated with conducting clinical trials:
FALSE Using biomarkers as surrogate clinical endpoints can save precious research time and valuable resources associated with conducting clinical trials.
True or False: In her TED Talk, Dr. Angela Duckworth asserts that grit is an easier way of measuring IQ.
FALSE Dr. Duckworth suggests that grit is about something more than IQ. She argues that grit is passion and perseverance for very long-term goals. To quote Dr. Duckworth, "Grit is living life like it's a marathon, not a sprint."
In addition to medication dosing schedules, some drugs are associated with behavioral restrictions that many people find enjoyable or necessary
For example, medications that are accompanied by the instruction "Do not operate a motor vehicle or other large equipment" can be a nuisance that interferes with pleasures and conveniences, or this instruction can interfere with one's livelihood. Instructions to avoid strenuous activities (e.g., physical activity, exercise, lifting, and sexual activity) can interfere with jobs, hobbies, and general enjoyment.
Interference of healthful behaviors with quality of life
For example, restrictive diets designed to improve cardiovascular function decrease the likelihood of cancer or diabetes (e.g., high fiber or low glycemic diet), or to help lose weight (e.g., avoidance of sweet, high caloric foods) promote health but often are not experienced as enjoyable and actually may cause discomfort in some individuals who suffer from diet-related diseases such as Celiac's disease or IBS
Facts about medicine in the US
In any given year in the U.S., 20-30% of medication prescriptions are never filled. Medication is not continued as prescribed in about 50% of cases. Rates of medication adherence drop after first six months. The World Health Organization estimates that by 2020, the number of Americans affected by at least one chronic condition requiring medication therapy will grow to 157 million. Only 51% of Americans treated for hypertension are adherent to their long-term therapy. About 25% to 50% of patients discontinue statins within one year of treatment initiation
There are instances where biomarkers may not necessarily correlate with the patient's experience or perception of well-being. The implication of this lack of correlation at times is that we have measurable biological indicators that are undetectable or vary widely without an effect on health.
In these cases, clinical end points may be more useful predictors of disease presence or absence
our expectations about treatments and illnesses can be wrong
It is this expectation, however, that affects the confidence in a given healthful behavior, the credibility of a health care provider, and the likelihood of adhering to and complying with healthy behaviors.
Motivational limitations
Knowledge about nutrition, weight, exercise, long-term health, and the positive effects of taking various medications have little or no value for people who are apathetic or do not care about their current or long-term health status *Biopsychological conditions (fatigue, pain, depression, anxiety) also can weaken motivations to practice a healthy lifestyle.* motivations are separate from behaviors and cognitions which is an important distinction to make to understand how to increase motivation relevant to positive goals & decease motivations that interfere with positive goals.
Medical Signs
Objective indicators of medical signs that are observed outside of the patient Example: low pulse oxygen levels can indicate asthma
Overexposure of this transcription factor promotes resilience to stress:
Overexposure of ∆FosB in reward-relevant brain regions promotes resilience to stress.
Prescription Medications
Pharmaceutical companies certainly aim to develop and market drugs with the widest possible therapeutic range and the fewest and weakest unpleasant side effects. many therapeutically effective and lifesaving drugs have unpleasant biopsychological effects that can deter people from taking their medicine. These side effects range from mildly irritating to almost debilitating.
BBH Mechanisms of Resilience and Grit
Professor Dennis Charney of the Icahn School of Medicine at Mount Sinai in New York is a biological psychiatrist spent his scientific career investigating the neurobiology and treatment of mood disorders led him to pursue an understanding of the psychobiological mechanisms of human resilience to stress and traum
Non-Medicinal Treatments
Rehabilitation medicine has expanded in the US greatly in the past 25 years. However, PT has a variety of effects that are considered to have unpleasant biological or pyscho-biological actions that may deter patients from complying.
Unpleasant side effects of treatments to enhance a healthy lifestyle
Restrictive diets designed to improve cardiovascular function (e.g., low cholesterol diet), decrease the likelihood of cancer or diabetes (e.g., high fiber or low glycemic diet), or to help lose weight (e.g., avoidance of sweet, high caloric foods) promote health but often are not experienced as enjoyable and actually may cause discomfort in some individuals As you may know from personal experience, it is clear that eating some foods is enjoyable, that restricted diets are not, and that people often cheat on their diets. -In addition to diets and eating, people enjoy drinking, smoking, and using recreational drugs Consumption of alcohol, nicotine, marijuana, cocaine, ecstasy, amphetamines, and other psychoactive drugs is reportedly enjoyable. These drugs have various effects and become desired by the users. Even when the health messages for these substances are well-known (e.g., cigarette smoking is responsible for over half a million deaths annually in the United States; drinking alcohol while driving can be lethal), individuals are motivated by the pleasurable effects of psychoactive drugs or by the discomfort of abstinence or withdrawal of the drug and, therefore, continue to use the drug rather than give it up to adopt more healthful behaviors
Safe Sex
Sexual intercourse with condoms and abstinence from sexual intercourse are recommended to decrease the likelihood of transmission of HIV and sexually transmitted diseases (STDs). Safe sex practices, however, may decrease or prevent sensuality and pleasures of sexual intimacy. Take time to plan interfering with intimate moments
Medication Schedules and Restrictions
Some medications require administration during the night or during a sleep period. Other medications require administration either an hour before or two hours after a meal or that we sit upright for a certain amount of time after taking the drug. These modifications or inconveniences pit the health-promoting behavior against a biologically necessary state.
Medical Symptoms
Subjective reports of health and illness by the patient Example: patient reports shortness of breath when going up the stairs
True or False: According to psychologist Dr. Bonanno, people adapt surprisingly well to whatever adversities the world throws at them
TRUE According to Dr. Bonanno, people adapt surprisingly well to whatever adversities the world throws at them.
True or False: Biomarkers developed with success for one clinical endpoint do not necessarily translate broadly into other clinical populations:
TRUE Biomarkers developed with success for one clinical endpoint do not necessarily translate broadly into other clinical populations.
Growth Mindset
The belief that the ability to learn is not fixed & that it can change with your effort. Failure is not a permanent position
Types of BBH Obstacles
The biobehavioral obstacles that affect adoption and maintenance of a healthy lifestyle can be organized across eight domains: 1.) Absence of misinterpretation of biological cues 2.) Physical & Behavioral limitations 3.) Cognitive limitations 4.) Motivational Limitations 5.) Interference of healthful behaviors with quality of life 6.) Unpleasant side effects of treatments to enhance a healthy lifestyle 7.) common biopsychological obstacles 8.) Individual differences
Individual differences
There are three categories of individual differences we'll consider: 1.)Genetics 2.)Age and Gender 3.)Ethnic, cultural, and socioeconomic variables
Application: Simply Raw: Reversing Diabetes in 30 Days Video
This movie chronicles 6 individuals with diabetes who adopt a vegan diet as a non-pharmaceutical intervention. The movie highlights several obstacles discussed in this weeks' lesson.
Researchers understand the importance of investigation of biomarkers which includes developing a better understanding of other physiological processes
Traditional research underscores the value and importance of including both biomarkers and clinical endpoints
Explain how unpleasant treatment side effects can influence adherence to a healthy lifestyle.
When a healthful behavior is physically unpleasant, painful, or causes discomfort, people are less likely to adhere to the healthful behavior.
Unpleasant Side Effects of Treatments to Enhance a Healthy lifestyle
When a healthful behavior is physically unpleasant, painful, or causes discomfort, people are less likely to adhere to the healthful behavior. This category includes unpleasant biological side effects of: Non-medicinal treatments Prescription medications Over-the-counter (OTC) medications Drug interactions with alcohol Drug-drug interactions
Name 3 obstacles to adoption and maintenance of a healthy lifestyle
absence or misinterpretation of biological cues physical and behavioral limitations cognitive limitations motivational limitations interference of healthful behaviors with quality of life unpleasant side effects of treatments to enhance a healthy lifestyle common biopsychological obstacles individual differences
Neuropeptide Y (NPY)
acts as a neurotransmitter in the brain, including the hypothalamus, and in the sympathetic nervous system NYP found in the amygdala & other brain regions that regulate fear *Increased NPY levels are associated with reduced levels of anxiety and stress, as well as enhanced performance under stress* Further, higher NPY levels are linked with lower levels of PTSD symptoms.
Drug interactions with Alcohol
alcohol is also considered a non prescription drug that can interact with other drugs and medications to cause untoward side effects Alcohol with antianginal drugs (e.g., nitroglycerin) results in hypertension, dizziness, and syncope; alcohol with anticoagulants (e.g., Coumadin®, dicumarol, Panwarfin®) alters the anticoagulant action depending on acute or chronic alcohol ingestion.
Other abused substances include
alcohol, opiates, and sympathomimetics (e.g., cocaine, methamphetamine), similarly have biological effects that are reinforcing and abstinence effects that are unpleasant.
Sleep
another critically important biobehavioral obstacle to a healthy lifestyle. Between 50 and 70 million Americans have a sleep or wakefulness disorder and sleep now is recognized as playing an invaluable role in maintaining our health over a third of us are sleep-deprived and sleep less than 6 hours a night. Sleep deprivation has been linked to motor vehicle crashes, industrial disasters, medical errors other occupational errors, and chronic diseases like obesity and cancer & increased mortality
One surprising new thing you learned about raw diets
apparentlycookingvegetablesdepletesnutritionalvalue
Mammograms
are an example of a biomarker which helps detect early stage of breast cancer in women when it is still treatable. For every 1000 women screened, 10% or 100 women are recalled for additional imaging. Of these 100 women, 20% or 20 go on to have a needle biopsy, a more invasive biomarker to test for cancer, of the suspected cancer area. Now, of these 20 women who undergo needle biopsy, 25% (5 women) will be diagnosed with cancer. Going back to our original statistic, 5 out of every 1000 women are diagnosed with cancer following mammogram screening, which is a 0.05% screening rate.
Causation with translation
assuming a biomarker works well in one clinical context will also be similarly effective in a different clinical context can lead to flawed research conclusions
Development in genetics is likely relevant in several ways
biologically-based individual differences in susceptibility to each of the biobehavioral obstacles we have discussed marked biologically-based differences in the likelihood of developing biobehavioral conditions that can become obstacles to compliance. genetically-based differences in the moderation or mediation of a given set of variables ethical dilemmas that emerge as genetic mapping may allow prediction of probabilistic development of particular disease conditions
Tobacco use remains the single most important, preventable cause of death and illness in the United States
but another behavior-related epidemic is right behind it, obesity and excessive body weight
Scientists are beginning to discover the BBH underpinnings of this ability to bounce back
can lead to exciting new treatments and interventions for PTSD, anxiety, depression and other illnesses associated with trauma and adversity
Biomarkers in blood
can predict Alzheimer's disease before it starts
Other changes outside of routine such as
change in diet or exercise may result in discomfort for individuals and may act as bio-pyschological obstacles. Anything that can make the good behaviors accessible and positive would help
If the goal of a biomedical project is to improve morbidity and mortality rates from the disease, such as Alzheimer's disease,
clinical endpoints become more important than the biomarker that changes with no clear clinical outcome For example Dr. Federoff of Georgetown University, uses cognitive deterioration as his clinical endpoint.
What are at least 3 biobehavioral obstacles faced by individuals while trying to adopt this lifestyle.
cognitive, motivational,unpleasantsideeffects
the inclusion of biomarkers as surrogate endpoints allows researchers to...
design smaller studies, which shortens the time and financial expense associated with running clinical trial studies. Ex: if early and frequent blood HIV tests suggest that a new pharmacologic intervention is not reducing viral load in patients, then the clinical trial can be stopped
Tobacco Smoking
despite the health hazards of tobacco being heavily publicized, 17% of American adults continue to smoke tobacco cigarettes & use other tobacco products
obstacles to adopting a healthy lifestyle
deterrents*** that can be negotiated or navigated* as in an obstacle course
scientists now are working on a blood test to detect cancer
even earlier than mammograms or cervical pap smears, for example. The results are very promising and appear to be more accurate and reliable than current practice. Importantly, this blood test is far less expensive than the other currently available biomarkers.
Ethical dilemmas will emerge as
genetic mapping may allow prediction of probabilistic development of particular disease or conditions
The ratio of DHEA to cortisol (DHEA:Cortisol) levels in the body
have been proposed as potential mechanisms and biomarkers of resilience
More Physical disabilities such as
individuals with disabilities such as orthopedic, neuromuscular, cardiovascular, and pulmonary disorders (e.g., Parkinson's disease, injury, muscular dystrophy, multiple sclerosis, cerebral palsy, amyotrophic lateral sclerosis (ALS), pulmonary disease) must rely on assistive devices such as wheelchairs, crutches, canes, prosthetic devices (artificial limbs), and oxygen to obtain mobility These disabilities & physical challenges may require specialized attention to develop an individualized maintenance plan
DeltaFosB
is a molecular switch that turns on genes to protect against the stress of being alone. *induction of ∆FosB in the nucleus accumbens (part of reward circuity) suggests a positive adaptation to chronic stress exposure* Overexposure promotes resilience to stress
Physical therapy is a valuable adjunct to pharmacotherapy but
it may hurt and has effects that can be characterized as biopsychological obstacles that may deter patients from compliance.
Genetics
mapping of the human genome and expanding understanding about genetics has led to an increased emphasis on the importance of genetic contributions to health conditions.
In all of these cases, the interference of healthful behaviors with enjoyable behaviors is not insurmountable. However, the incompatible relationship of these behaviors and the intensity of the pleasures that are lost must be addressed by the health-care provider and cannot be ignored
most people agree that safe sex practices are important. However, the decreased pleasure and inconveniences associated with abstinence or condom use may offset concerns about STDs or AIDS, especially when the likelihood of contracting these infections is viewed as being minimal.
One thing that contributed to the ultimate success or failure of each individual
motivationmentalendurance
Oxytocin
neuropeptide released from the posterior pituitary gland in response to stress and social interactionscts as an anxiolytic and may enhance cognitive pre-frontal cortex functioning which is involved in cognitive control
OTC Medications
over-the-counter (OTC) pharmacopeia is becoming more and more impressive every day. This development helps keep prices down and makes medications more available, but often makes the medicines seem like non-medicines and the condition seem like a non-medical condition. includes: bronchodilators, cough suppressants, anti-histamines, pain-killers, sleep aids, and treatments for yeast and fungal infections, can mask biological symptoms that otherwise would motivate individuals to seek medical attention the effect of treatment, therefore, can have the paradoxical effect to deter the seeking of and adoption of health-promoting actions. can also have side effects which can be considered biological or bio-psychological obstacles to compliance
Grit
passion and perseverance in the pursuit of long-term goals. Something within ourselves that pushes us to adapt and cope with tragedy and adversity in our lives. An important component of resilience
George's findings show
people adapt surprisingly well to whatever adversities the world throws at them "Sh*t Happens" motto
Common biopsychological obstacles
physical therapy can result in: headaches, numbness, nausea, muscle aches, muscle fatigue, pain, sleep disturbances, and a cascade of other physical discomforts as physical therapy and manipulation has a domino effect on other, presumably uninjured, parts of the body.
Coping Ugly
psychologist George Bonanno spent his time untangling the "resilient experience" by focusing on individuals' reactions to the death of a loved one and what happens in the face of war, terror and disease.
Clinical end points
reflect how a patient feels, functions, and survives. These end points represent patient health and well-being from their perspective.
Left pre-frontal Cortex
resilience can be related to *activation of the left pre-frontal cortex* part of the brain which sends inhibitory signals to the amygdala Reducing anxiety and fear which allows for the frontal brain region to plan better and set goals could be an individual who is better able to cope and adapt to stressors without being overwhelmed by challenges/ challenging situations
What is the primary motivating reason for adopting this lifestyle for each individual?
stoptakingmedicationandlowerBSugar
For example
suppression of arrhythmias (irregular heartbeats) is used as a biomarker for reduced morbidity in cardiovascular disease This biomarker led to the discovery of many anti-arrhythmia medications. Unfortunately, scientists eventually learned that these drugs actually increase mortality in certain populations that were not originally tested.
Bonnano proposes an internal "resilience-stat" within us
that melancholy helps us heal after a loss or tragedy. Unrelenting grief can be too much for us to bear and our internal sensor helps us return to equilibrium. "coping ugly" to underscore the fact that this coping process is very messy.
In addition to physical therapy there are non-medical treatments
that result in discomfort and may act a biopsychological obstacles to compliance with a specific treatment of lifestyle change
Advantages of using biomarkers as clinical endpoints
the ability of biomarkers to provide interim information about safety and efficacy of treatment without having to wait for poor clinical outcomes. For example, MRIs can be used to measure the efficacy of chemotherapy by evaluating the changes in tumor growth. If no changes are occurring or the tumors are growing, for example, then doctors can alter the chemotherapeutic treatment plan for the patient.
Resilience
the ability to adapt successfully in the face of adversity, trauma, tragedy or significant threat Early definitions of resilience meant to "leap back"
When Biomarkers are used as Surrogate Clinical Endpoints
there absolutely must be solid, scientific evidence that indicates the reliability and accuracy of the biomarker to predict clinical outcomes, both positive and negative.
Genomic information will probably be used within our lifetimes
to determine the optimal pharmaceuticals that we should each take to maximize our health
Implication of these deficits suggests that patients should be screened for cognitive limitations
to optimize the likelihood of their understanding of what they need to do to engage in healthy lifestyles.
DNA can also be considered a biomarker
to test your risk for certain health conditions, giving you an opportunity to engage in preventative health care like additional screenings or changes in health behaviors For example 23 and Me where you can provide accurate and reliable information about your health, disease risks and genetic background
Obesity
today more than 2/3 of Americans are obese or overweight and the health risks of these conditions are massive. Despite the fact that the government spends more money per person on health than any other country in the world.
Interdisciplinary Approach
we examine BBH aspects of stress across multiple levels of analysis- psychological, behavioral, and physiological
The lifesaving antineoplatic cancer treatment drug may cause many unpleasant side effects
which can interfere with a patient's willingness to undergo chemotherapy some side effects include, nausea, vomiting, cerebral blindness, loss of taste and hearing, and seizures No wonder a patient might fail to completely follow a regimen of even a lifesaving drug
Communication from health care providers that is credible in reporting unpleasant side-effects
yet which presents a convincing rationale for the benefits of the procedure, can go a long way to surmount the biopsychological obstacles.
