Psych 401: Exam 3

cancer treatment:

- Early Diagnosis - surgery - chemotherapy - radiation therapy - non traditional treatment

Types of Global Health Care

- national health service - national health insurance - "pay-as-you-go"/fee for service - pluralistic health care

Factors Affecting the Patient-Provider Relationship

- provider communication problems - patient communication problems - discrimination

Infections can increase a person's risk of developing cancer in at least three ways:

Some viruses can insert their own genes into healthy cells, causing them to grow out of control. Some infections trigger chronic inflammation in a part of the body, leading to changes in affected cells that can lead to cancer. Some infections can suppress the immune system and reduce its ability to protect the body from cancer.

Cancer Susceptibility: demographic aspects:

Gender (more men) Age (strongest risk factor) Ethnic background (for men, african americans have highest prevalence, then European Americans, Hispanic American, Asian. Among women, it goes European Americans, African Americans, Hispanic Americans, Asian American

AIDS optimism

HIV-negative men who have sex with men are less concerned about contracting HIV; HIV-positive men who have sex with men are less concerned about transmitting it; and both groups are more likely to engage in unsafe sex—resulting in more HIV infection

provider communication problems

Health care providers who are good communicators, are less businesslike, and meet patient expectations regarding the information that they are entitled to receive tend to have patients who are more likely to adhere to treatment recommendations. a lack of information about and a poor understanding of medical advice and the recommended treatment tend to leave patients dissatisfied. To improve the situation, communication-skills training is now an integral component of medical education. Research shows that the more time the physicians spend with their patients (even just to chat), the more satisfied the patients are and the more likely they are to follow treatment plans successfully. Some health care providers also have communication issues with patients because they fail to listen carefully or they treat patients either like medical school faculty or children.

Epidemiology of AIDS

In the United States, the AIDS epidemic has taken the greatest toll on gay, bisexual, and other men who have sex with men (MSM), particularly young African Americans The initial spread of the HIV virus among injection drug users and gay men in the United States and other Western countries is believed to have occurred because these are relatively small, closed populations in which an individual is more likely to be exposed to the virus repeatedly Ethnic and racial differences in rates of HIV transmission are thought to reflect sociocultural differences in drug use. HIV is increasingly affecting older adults. The increase in HIV among those over age 50 is partly due to advanced HIV therapy, which has increased life expectancy. The increase in HIV among those over age 50 is partly due to advanced HIV therapy, which has increased life expectancy. Also, HIV infection is harder to detect among older adults because the symptoms are sometimes masked by normal signs of aging. As a result, older adults are more likely than younger people to be diagnosed late in the course of HIV infection, which means they start treatment later and possibly have a poorer prognosis.

History of AIDS:

In the late 1970s, unrecognized cases of what we now know to be AIDS began to appear. originated in west-central Africa, spreading quickly through neighboring countries. disease was first documented in humans around 1980, when several dozen young men were diagnosed with a cluster of similar symptoms with an unknown cause Their symptoms were indicative of Kaposi's sarcoma: a rare cancer of the blood vessels that serve the skin, mucous membranes, and other glands in the body. 1983, the National Institutes of Health (NIH) in the United States and the Pasteur Institute in France concluded that a new virus was the probable cause of the disease. 1987, the CDC had established the National AIDS Clearinghouse Of the 36.7 million people living with HIV/AIDS worldwide, 30% do not know that they are infected Since 2010, new HIV infections among adults and children have decreased by an estimated 11% and 47%, respectively; AIDS-related deaths have fallen by 48%; and the United Nations has set the goal of ending the AIDS pandemic by 2030 (though it is increasing in East Europe and Central Asia)

the best way to educate people about STIs such as HIV and to change social norms that influence high-risk behaviors

Intensive, coordinated, community-wide interventions

Three Ideals of Complementary and Alternative Medicine:

Natural medicine Holistic: Many patients seek out alternative care because they prefer to work with practitioners who will see (and treat) them as a whole person. Specialization and fragmentation are predictable consequences of the analytical nature of biomedicine, which encourages doctors to focus on the fine details of the symptoms that each patient presents. Promotes wellness: Alternative practitioners believe that medication, surgery, and other mainstream interventions can fight illness but generally cannot produce an optimal state of healthy vitality.

guided imagery

The use of one or more external devices to assist in relaxation and the formation of clear, strong, positive mental images. Imagery may be beneficial for several reasons: Imagery triggers a state of relaxed concentration that enhances the person's sensitivity to health-promoting images. Imagery gives the patient an increased sense of control and a decreased sense of helplessness over stressful aspects of disease or treatment. Imagery also may work through the placebo effect. In fact, people who believe that imagery and relaxation have the potential to improve their health may experience physiological changes that enhance their ability to fight disease.

Food Supplement Therapy

The use of vitamins and food supplements is a second major emphasis of naturopathy and is perhaps the best known of all CAM treatments. There is little doubt that food supplements can have important health benefits. Food supplements are generally used in two ways: to correct dietary deficiencies (nutritional medicine) or in immense doses to trigger a specific therapeutic effect (megadose therapy)

Herbs: tonics vs effectors

Tonics, or normalizers, have a gentle, healing effect on the body, whereas effectors have potent actions and are used to treat illness.

epidemiological transition

a shift in the disease pattern of a population as mortality falls: acute, infectious diseases are reduced, while chronic, noncommunicable diseases increase in prevalence.

managed care

a system of health care in which health insurance plans contract with providers and medical facilities to provide care for members at reduced rates.

traditional Chinese medicine

an ancient, integrated herb- and acupuncture-based system of healing founded on the principle that internal harmony is essential for good health. CAM is used more by women than by men, by people with higher education levels, and by people who have been hospitalized during the previous year primarily for back problems, anxiety or depression, sleeping problems, and headaches.

evidence-based medicine

an approach to health care that promotes the collection, interpretation, and integration of the best research-based evidence in making decisions about the care of individual patients.

holistic medicine

an approach to medicine that considers not only physical health but also the emotional, spiritual, social, and psychological well-being of the person.

conventional medicine

biomedically based medicine as practiced by holders of the MD (medical doctor) or DO (doctor of osteopathy) degrees and their allied health professionals. (also called Western or allopathic medicine)

These days, patients are more likely to demand and seek out accurate and timely health information on their own, not likely to

blindly accept their doctors' recommendations, and more likely to be critical of traditional medicine and to consider (and use) alternative forms of treatment.

malignant (cancerous) tumors

consist of renegade cells that do not respond to the body's genetic controls on growth and division. In addition to growing at the site where they originated (in situ), malignant cells often have the ability to migrate and attack, invade, and destroy surrounding body tissues

central elements of the patient-provider relationship:

continuity of care Communication the overall quality of consultations

cancer treatment: radiation therapy

delivers high doses of x-rays, gamma rays, or alpha and beta particles to cancerous tumors, killing or damaging them so that they cannot grow, multiply, or spread. Although some normal cells may be affected by radiation, most of these appear to repair themselves and recover fully after the treatment. usually targeted to only the tumor and surrounding area. the preferred treatment for cancer in almost any part of the body. associated with side effects, including temporary or permanent loss of hair in the area being treated, fatigue, loss of appetite, skin rashes, and loss of white blood cells.

Individuals tend to attribute symptoms to ----- ---------, such as infection or injury, or ------ ----------, such as genetic predisposition

external symptoms, internal symptoms

communicable disease is generally about the same for

females as it is for males. Two exceptions are tuberculosis, which affects more males than females, and HIV/AIDS, which globally now ranks higher as a cause of death for women than for men

alcohol use and cancer

increases the risk of developing cancers of the oral cavity, pharynx (throat), larynx (voice box), esophagus, liver, breast, colon, and rectum. People who abuse alcohol may also suffer from poor nutrition and sleep deprivation and may be exposed to other pathogens that compromise their health.

An estimated 15% to 20% of new cancers worldwide each year are attributable to

infection. higher in developing countries where certain infections are more prevalent

sexually transmitted infections (STIs)

infections that are spread primarily through person-to-person sexual contact. Public health experts have suggested changing STD to STI because the concept of disease, as in STD, suggests a major medical problem, usually with clear symptoms. But several STDs have no symptoms, or have only signs that can easily be overlooked in the majority of those who are infected. So the sexually transmitted virus or bacterium is best described as creating an infection, which may or may not result in disease.

Malingering

making believe that one is ill in order to benefit from sick role behavior. People who score high on emotional instability and neuroticism average two to three times as many physical complaints as those who score low on these traits

cancer treatment: chemotherapy

medicines to treat cancer—can destroy cancer cells that have spread, or metastasized, to parts of the body far from the original, or primary, tumor. These systemic drugs travel through the bloodstream to reach all areas of the body. Immunotherapy: chemotherapy in which medications are used to support or enhance the immune system's ability to selectively target cancer cells. most common side effects of chemotherapy are nausea and vomiting, hair loss, and fatigue. Less common side effects include bleeding, infections, and anemia.

Providers often ----------- how well a consultation went and how likely it is that the patient will follow through on their advice.

overestimate

informational control

patients' knowledge regarding the particular procedures and physical sensations that accompany a medical treatment. Sensory information allows you to make an accurate attribution for sensations that you actually experience. Procedural information, on the other hand, may reduce stress by giving patients an increased sense of control over what their bodies are experiencing. When procedures are expected and predictable, many patients develop greater confidence and become more relaxed. procedural information appears to help the greatest number of patients

biphasic model

proposes that only the most chronic stressors cause global immunosuppression. Short-term stressors that trigger our fight-or-flight response either have no effect on immunity or might actually enhance immunity to help prepare us to defend against possible infection or injury

All medical conditions are at least partly

social constructions, meaning that their identity and diagnosis are shaped by culture, advertising, and other nonbiological forces

Variables that contribute to ethnic disparities in chronic disease incidence and mortality:

socioeconomic status (SES), knowledge about cancer and its treatment, and attitudes toward the disease, which may affect access to health care and adherence to medical advice. ethnic differences in diet, tobacco use, and other risk factors for cancer also play a role

Vitalism

the concept of a general life force, popular in some varieties of complementary and alternative medicine.

Nonadherence

the condition in which a patient refuses to complete a prescribed therapeutic regimen.

Immunocompetence

the overall ability of the immune system, at any given time, to defend the body against the harmful effects of foreign agents. depends on many factors, including our overall health, the nature of the health-threatening disease or foreign agent, and perceived stress

Rather than just seeking to remove a pathogen or to "cure" a physical condition, as biomedical practitioners do, CAM therapists emphasize

the overall quality of a patient's life, broadening their focus to include important psychological, social, emotional, and spiritual aspects.

Cancer Treatment: Early Diagnosis

the perception of risk and feelings of vulnerability ("I'd rather not know!") are key reasons why people fail to follow recommended screening schedules

Metastasis

the process by which malignant body cells proliferate in number and spread to surrounding body tissues.

Explanatory style (optimistic or pessimistic) and psychological health also influence

the reporting of symptoms

Comorbidity

the simultaneous occurrence of two or more physical and/or psychological disorders or symptoms.

Problems with hospitals:

the staff providing them with conflicting information and tests, and procedures not being done on time. Furthermore, hospitalization is not as safe as it should be. Globally, millions of people die each year from medical errors and infections linked to health care. Loss of Control and Depersonalization

very common for infected people to be

unaware that they have an STI, because symptoms are either entirely absent or are minor enough not to be noticeable

cancer treatment: non-traditional treatment

vegan diet, acupuncture, and herbal remedies aromatherapy, biofeedback, meditation, music therapy, prayer and spiritual practices, yoga, tai chi (an exercise-based form of "moving meditation"), art therapy, massage therapy, and herbal treatments

Types of cancer

1. Carcinoma 2. Sarcoma 3. Lymphoma 4. Leukemia

lack of physical activity and cancer

A sedentary lifestyle increases the risk of many types of cancer, including colon cancer, breast cancer, endometrial cancer, stomach cancer, pancreatic cancer, lung cancer, and cancers of the head and neck, rectum, and bladder.

Cancer

A set of diseases in which abnormal body cells multiply and spread in uncontrolled fashion, often forming a tissue mass called a tumor. the second-leading cause of death globally, where it causes nearly one in six deaths, and many more suffer through nonfatal varieties

hypnosis

A social interaction in which one person (the hypnotist) suggests to another person that certain thoughts, feelings, perceptions, or behaviors will occur. some people are more hypnotizable than others; anecdotally, such individuals are said to be highly suggestible, fantasy-prone, and responsive to authority figures. Hypnosis is most often used to treat pain, and it seems to be most effective in helping people manage acute pain rather than chronic pain. hypnosis is accompanied by a generalized decrease in sympathetic nervous system activity, a decrease in oxygen consumption and carbon dioxide elimination, a lowering of blood pressure and heart rate, and an increase in certain kinds of brain-wave activity. A typical hypnosis intervention for pain involves several overlapping stages: a prehypnotic stage, in which the therapist builds rapport with the subject; the use of suggestions and imagery to induce relaxation and the focused attention of the hypnotic trance; the treatment stage, which may involve various kinds of suggestions and imagery to reduce the experience of pain; a consolidation phase, which may incorporate posthypnotic suggestions to be carried out after the hypnosis session has ended; and a posthypnotic stage, in which the patient is awakened, given additional instructions, and released. In addition, the hypnotherapist may train patients in self-hypnosis so they can practice the therapy at home.

Demographic and sociocultural factors that play important roles in determining whether a person will seek medical treatment:

Age: the very young and the elderly use health services more often than do adolescents and young adults. Ageist stereotypes may also prevent older adults from seeking (or receiving) optimal preventive health care, such as cancer screenings, and serve as a barrier to adopting healthier lifestyles aimed at increasing overall health expectancy women are more likely than men to report symptoms and to use health services due in large part to pregnancy and childbirth. women have also paid more for health care than men. may be because they are exposed to more illness as a result of caring for the elderly and children, who have the highest incidence of being sick. The practice of gender rating—charging women more for the same coverage—was widespread prior to implementation of the Affordable Care Act (ACA). Gender differences in office visits vary by age, with the largest gap among men and women 18 to 44 years of age Socioeconomic status (SES) predicts both symptom reporting and the seeking of health care. High-income people generally report fewer symptoms and better health than do low-income people. However, high-SES people are more likely to seek health care when it's needed. In contrast, poor people are less likely to use health services, simply because they cannot afford to do so. People in lower-SES groups also tend to wait longer before seeking treatment, making it more likely that they will become seriously ill and require hospitalization. People who hold beliefs that conflict with Western medicine are less likely to seek traditional biomedical care and more likely to rely on a lay referral system—an informal social network of family, friends, and other nonprofessionals who offer their own impressions and experiences regarding a set of symptoms.

Another natural product that is especially popular today is probiotics:

Bacteria that help maintain the natural balance of organisms (microflora) in the intestines and help promote a healthy digestive system.

Natural diet very important in naturopaths:

But even naturopaths disagree about the elements of a healthy diet. Proponents of raw food theory, a naturopathic concept dating back more than 100 years, believe that cooking foods destroys the "vital life force" (along with the vitamins, enzymes, and micronutrients) found in food. In contrast, macrobiotics—a system of combining foods believed to maximize their nutritional value—condemns raw foods as unhealthy, considering them a cause of multiple sclerosis, rheumatoid arthritis, and other diseases. Macrobiotic nutritionists insist that all foods, including vegetables, should be cooked.

more than 30% of adults and 12% of children regularly use some form of

CAM

Risk factors for cancer

Carcinogens: agents that cause cancer less than 25% of all cancers would develop anyway as a result of uncontrollable genetic and biological processes behavioral risk factors such as smoking, poor diet, and physical inactivity play the most important role Globally, one third of cancer deaths are due to five behavioral and dietary risks: high body mass index: an estimated 40% of adult men and 30% of adult women in the United States were overweight. The exact mechanisms by which obesity and being overweight increase cancer risk are not known and may be different for different cancer. low fruit and vegetable intake (diet): lack of physical activity tobacco use alcohol use family history environmental and occupational hazards occupational carcinogens and pollution

the leading cause of disability throughout the world, including in the United States where they cause 7 of every 10 deaths

Chronic illnesses such as HIV/AIDS

Improving Patient-Provider Communication:

Communication training for health care providers: focus on active listening skills in which providers echo, restate, and seek to clarify patients' statements to achieve a shared understanding of symptoms, concerns, and treatment expectations. training in developing good rapport through appropriate eye contact and other responses designed to acknowledge patients' feelings and to help them talk freely. instruction about how to communicate with patients about sensitive or difficult health topics, as well as about how to give bad news. To help overly passive patients, some health psychologists recommend assertiveness coaching, beginning with a careful review of each patient's medical record. A psychologist helps patients formulate questions for the doctor and offers tips on entering the doctor's office with a clear sense of one's goals and telling the doctor about feelings, fears, and symptoms without being hindered by embarrassment or anxiety.

two of the more common cognitive behavioral techniques in use today for cancer patients:

Emotional Disclosure: by openly expressing one's fears—for instance, a loss of perceived control—"one may begin to distinguish what one can and cannot control [in order] to channel energy toward attainable goals, and to generate alternate pathways for bolstering control. repeated expression of emotions may decrease negative emotions and the physiological arousal that comes with them, leading cancer patients to believe that their situation is not as dire as originally thought and to derive some benefit from their adversity. Expressive Writing: a simple, low-cost, self-administered intervention that may have a therapeutic effect in some subgroups of patients. seems to benefit some patients more than others, leading some researchers to conclude that its efficacy may depend more on social support and other factors in the lives of cancer patients than on the intervention itself.

Why do people still tan despite the risks?

In a study, those with the deepest tans (who also reported spending the largest amounts of time in the sun) were least knowledgeable about skin cancer, more relaxed, more sensitive to the influence of peers who valued a good tan, more likely to take other risks, and more focused on their appearance a hopeful belief that their risk of skin cancer is minimal (comparative optimism: the tendency to think that one will experience more positive and fewer negative events than others do.)

The core principles of the original ACA include

Individual mandate. Affordable coverage: Under the ACA, lower- and some middle-income individuals and families receive financial assistance to help purchase health insurance Employer requirements: There is no employer mandate to provide health care to all workers in the ACA, but those with more than 50 employees are assessed a fee of $2,000 per full-time employee if they do not offer coverage. A tax credit for employers at smaller-sized companies is designed to encourage them to provide health care to their employees. Coverage for preventive health services.New group and individual insurance plans are required to pay for certain screenings, immunizations, and other preventive care so that patients can get these services at no cost to themselves.

relaxation and meditation

Meditation refers to a variety of techniques or practices intended to focus or control attention. mindfulness meditation: the practice of paying nonjudgmental, in-the-moment attention to changing perceptions and thoughts. in transcendental meditation, the person focuses awareness on a single object or on a word or short phrase, called a mantra. mindfulness-based stress reduction (MBSR) has been used to improve people's ability to self-regulate negative reactions to stress. for patients with chronic pain, meditation is effective. mindfulness training is also effective in preventing depression and in improving quality of life in chronic pain conditions such as fibromyalgia and lower back pain in chronic functional disorders such as irritable bowel syndrome (IBS); and in illnesses such as cancer and multiple sclerosis Tai Chi and Yoga tai chi: a form of "moving meditation" that blends exercise, dance, and concentration, and is a component of traditional Chinese medicine. Yoga: A movement-based form of relaxation and meditation that combines diet, physical postures, and breathing to promote physical and spiritual well-being. hatha yoga (physical postures and breathing) and raja yoga (relaxation and mental and spiritual mastery). How might relaxation and meditation promote health? the relaxation at the center of these therapies relieves stress, muscle tension, anxiety, and negative emotionality, all of which might exacerbate physical symptoms and increase a person's vulnerability to ill health. Researchers also have suggested that relaxation and meditation may alter a person's emotional response to symptoms such as pain Other studies have shown that MBSR training significantly reduced levels of a pro-inflammatory cytokine (interleukin-6) Despite the growing body of evidence that mindfulness interventions can improve a broad range of health outcomes, the biological pathways linking mindfulness and health are not well understood. mindfulness may decrease the likelihood of rumination about potential stressors and increase the likelihood of using problem-focused, approach-oriented coping strategies Using fMRI and other neuroimaging techniques, other research studies have begun to assemble the brain mechanisms by which meditation modulates the experience of pain. These studies indicate that mindfulness meditation engages several brain mechanisms that subjectively influence the pain experience. Perhaps most remarkable of all, scientists have reported that mindfulness meditation is linked to actual physical changes in the brain—beneficial changes that enhance the transmission of neural signals mindful people seem to remain unfazed by potential stressors for two reasons. First, they recruit increased activity in brain regions that aid emotion regulation and show less activity in brain regions, such as the amygdala, that are linked to stressful responses. Second, their sympatho-adrenal-medullary (SAM) and hypothalamic-pituitary-adrenal (HPA) axes do not go into overdrive when potential stressors are encountered. Mindful people recognize and accept stress, which buffers them from increased heart rate or excessive secretion of cortisol and other stress hormones

occupational carcinogens and pollution and cancer

Occupational cancers mostly affect the lungs, skin, bladder, and blood-forming systems of the body. those who work with asbestos, chromium, and chromium compounds are much more likely than other workers to develop lung cancer

Factors that predict adherence:

Patient variables: being in a good mood, having optimistic expectations, having trust in one's care provider, having the support of family and friends, perceived control and preference for control of treatments (However, greater preference for control predicts poorer adherence when treatments take place in a clinic or hospital). Provider variables, such as level of job satisfaction, the number of patients seen per week, and communication style, can have a powerful influence on patient adherence. In addition, personal characteristics of health care providers are very important to patients. At the top of the list are a provider's display of empathy and confidence, in addition to a forthright and respectful manner sociodemographic factors are not very accurate predictors of adherence. alcohol or drug use and depression, anxiety, and other mental health problems have been associated with nonadherence. Among other patients, it is memory and cognitive deficits or a disorganized lifestyle that contribute to nonadherence.

Patient Communication Problems:

Patients themselves are often the ones who are uninformed and unprepared, at times giving faulty information or discussing symptoms offhandedly for fear that doctors either will not be fully forthcoming about serious conditions or will confirm patients' apprehensions. patients with the most extensive and complicated health care problems are at greatest risk for misunderstanding their diagnoses, medications, and treatment instructions. Low-level reading skills among many patients also contribute to this problem. health literacy: the capacity to obtain and understand basic health information and services needed to make appropriate health decisions. The Institute of Medicine has said that eradicating low health literacy is the first public health movement of the twenty-first century One aspect of health literacy is numeracy, the ability to think and express oneself effectively in quantitative terms. It's essential for the understanding of quantitative information about health

The Internet Patient-Provider Relationship:

Patients who access authoritative medical information also visit emergency rooms and doctors' offices less frequently, cutting health care costs Telemedicine: the delivery of medical information and clinical services through interactive audiovisual media. Similar to eHealth medicine Negatives of internet health care: E-mail or text message exchanges can be impersonal and mechanical and may not communicate emotional tone and context accurately. Nonverbal cues available during a face-to-face consultation may be lost with online care.

Prevention and Treatment of STIs:

Primary prevention: The surest way to avoid contracting an STI is to abstain from sexual contact with any partner who might be carrying one of these infections. individuals are advised to avoid sexual behavior that may tear or abrade the skin or vaginal tissue. Open communication and limiting one's sexual partners are also important ways of reducing STI exposure Vaccination and Prophylaxis: Preventive vaccines exist for some STIs, including hepatitis A, hepatitis B, and HPV. HPV vaccines are safe, effective, and widely available. The CDC recommends that 11- or 12-year-old boys and girls be vaccinated before their first sexual encounter as part of standard medical care: however, this vaccine is underutilized because beliefs about sexuality, including parental concerns that getting the vaccine will encourage their adolescent son or daughter to have sex. Other barriers include the cost, perceived effectiveness, possible negative health consequences, safety of the vaccine, and the lack of information about the timing of vaccination relative to sexual activity. Additionally, racial disparities exist, including a finding that Hispanic Americans and African Americans are less likely to be vaccinated than European Americans individuals at high risk for HIV exposure are advised to take pre-exposure prophylaxis, or PrEP, a pharmacological treatment that can reduce the risk of becoming infected with the virus. Patients who report recent exposure to HIV (within the past 72 hours) are sometimes advised to take post-exposure prophylaxsis, or PEP, a related pharmacological treatment designed to reduce the risk of infection.

Food contamination

The microbes that contaminate food can also become resistant due to the use of antibiotics For some germs, such as the bacterium Salmonella, the primary factor in increased resistance is that antibiotics are being fed to animals that are raised for food.

Power of CBT illustrated in this study

The results showed that CBT had beneficial effects on all outcome measures. Patients in the TAU group stayed in the hospital longer than those in the CBT group (9.2 days compared to 7.9 days). In addition, symptoms of depression in the TAU group increased at the time of their release from the hospital, whereas patients in the intervention group had decreased symptoms of depression at the time of discharge. patients in the CBT group had greater improvements in self-reported anxiety and quality of life at the follow-up than did those in the control group

Whenever patients are treated for an illness or a health condition, any improvement may be due to one of four explanations:

The treatment may actually be effective. The illness simply improved on its own over time. This is true of most illnesses, including pain, which tend to be cyclical, self-limiting conditions. Because most people seek help when they are symptomatic, any intervention that occurs—whether inert or otherwise—is likely to be followed by improvement The patients were misdiagnosed and in fact did not have an illness at all. Patients improve on their own because of some nonspecific effect, such as their belief that the treatment will be beneficial (placebo effect).

Ironically, the surge in popularity of CAM also is due, at least in part, to the success of

Western biomedicine

"Mr. Wright,"

a cancer patient who was given only a few days to live. After hearing that scientists had discovered a horse serum called Krebiozen might be effective against cancer, he begged his doctor to administer it. the patient's physician gave Mr. Wright an injection. Three days later, the doctor found that the patient's golf-ball-sized tumors "had melted like snowballs on a hot stove." Two months later, after reading a medical report that the serum was actually a quack remedy, Mr. Wright suffered an immediate relapse and died.

Five Major Domains of complementary and alternative medicine:

Whole medical systems (Complete health care systems that evolved independently of Western biomedicine. Examples include traditional Chinese medicine, ayurveda, and homeopathy.) Mind and body medicine (Techniques designed to affect the mind's capacity to influence bodily functions and symptoms. Examples include meditation, yoga, acupuncture, deep-breathing exercises, guided imagery, hypnosis, progressive relaxation, qi gong, and tai chi.) Natural Products (This area of CAM includes use of a variety of herbal medicines (also known as botanicals), vitamins, minerals, and other "natural products." Many are sold over the counter as dietary supplements. CAM natural products also include probiotics—live microorganisms (usually bacteria) that are similar to microorganisms normally found in the human digestive tract and that may have beneficial effects. Probiotics are available in foods (e.g., yogurt) and as dietary supplements.) Manipulative and Body-based practices: Techniques that focus primarily on the structures and systems of the body, including the bones and joints, soft tissues, and circulatory and lymphatic systems. Two commonly used therapies fall within this category: Massage therapy, Spinal manipulation as practiced by chiropractors, osteopathic physicians, naturopathic physicians, and physical therapists other CAM Practices: CAM also encompasses movement therapies—a broad range of Eastern and Western movement-based approaches such as Pilates, used to promote physical, mental, emotional, and spiritual well-being. Traditional healers use methods based on indigenous beliefs and experiences handed down from generation to generation. A familiar example in the United States is the Native American healer/medicine man/woman. Other CAM practices involve manipulation of various energy fields to affect health (e.g., magnet therapy and light therapy). Practices based on putative energy fields (also called biofields) generally reflect the concept that human beings are infused with subtle forms of energy; qi gong, Reiki, and healing touch are examples of such practices.

chiropractic

a complementary and alternative medicine approach to healing that is concerned with the diagnosis, treatment, and prevention of disorders of the neuromusculoskeletal system. about 8% of adults and nearly 3% of children had received chiropractic manipulation in the previous 12 months. Before performing any type of adjustment, the chiropractor will palpate, or feel, the patient's vertebrae to detect misalignment of bones or muscular weaknesses. Critics charge that chiropractic treatments are at best useless, because misaligned vertebrae are common and harmless, and the misalignment usually clears up on its own; and at worst, chiropractic manipulation can cause severe damage to the body if fractures or tumors are present. Others question the premise that a sound nervous system is the foundation of overall health, Evidence for chiropractic's effectiveness in treating back pain has been accumulating since 1952 A 2010 review of evidence on the efficacy of chiropractic concluded that spinal manipulation may be helpful for several conditions, including back pain, migraine headaches, neck pain, upper- and lower-extremity joint conditions, and whiplash-associated disorders. Acupressure: the application of pressure rather than needles to the points used in acupuncture; shiatsu is a major form of acupressure.

alternative medicine:

a broad range of health care practices that are not taught in medical schools, not generally used in hospitals, and not usually reimbursed by insurance companies. complementary medicine: the use of "alternative medicines" in conjunction with—rather than instead of—regular medicine. For example, the combined effect of drug and relaxation-training interventions for hypertension exceeds that of either the drug or relaxation by itself, and relaxation may reduce the doses of the drug needed.

Acupuncture

a component of traditional Chinese medicine in which fine needles are inserted into the skin to relieve pain, treat addiction and illness, and promote health. acupuncturists often also incorporate herbal medicine and dietary recommendations in their treatment regimens—two other common components of traditional Chinese medicine. studies provide evidence, although not statistically conclusive, that acupuncture provides some patients with some relief from painful conditions such as osteoarthritis, fibromyalgia, neck and lower back pain, migraine headaches, tennis elbow, and postoperative dental and hemorrhoid pain Despite the inconsistency of research evidence for acupuncture's effectiveness, acupuncture's success rate is among the highest of all alternative medical interventions, and for some individuals its effectiveness with some conditions compares favorably with conventional treatments. Excluding 12-step programs, acupuncture is the most widely used CAM method for the treatment of substance abuse, especially of nicotine, alcohol, heroin, and cocaine Hard to determine if effective because hard to do controlled studies because: the highly individualized nature of acupuncture does not lend itself well to standardized tests. Acupuncturists themselves disagree about the appropriate acupuncture needle sites for a given medical condition Double-blind controls, the mainstay of clinical trials, are even more problematic. Needles can be inserted at points that are inappropriate to a patient's health problem, making the patient blind to treatment, but the acupuncturist has to know whether the points are sham or real, so the study can't be double-blind. operational definitions of successful acupuncture treatments have been inconsistent at best, and woefully vague at worst. No one really knows the mechanism by which acupuncture operates. Some theories include: Traditional acupuncturists believe that every part of the body corresponds to the whole. identifies 14 "lines of energy" (qi) on the body, called meridians. Most acupuncture points, believed to allow for corrections of blockages or deficiencies in qi, lie on these meridians. Inserting needles at one or more points along a meridian is intended to produce effects elsewhere on that meridian. many conventional doctors, including those who practice acupuncture, find it hard to accept the concept of an invisible energy path, or qi. Instead, they may explain treatment success as an example of the placebo effect Others maintain that the pain of inserting acupuncture needles simply distracts the patient from his or her original pain, or that acupuncture triggers the release of the body's own natural painkillers (endorphins) and anti-inflammatory agents

self-limiting conditions

a condition that tends to improve with the passage of time, even in the absence of treatment

collaborative care:

a cooperative form of health care in which physicians, psychologists, and other health care providers join forces to improve patient care. Optimum health care is not achieved by defining the separate responsibilities of patients and health care providers, but through their harmonious interaction.

a person who has symptoms will seek a ----- ---- ---- ---- --- --; a person who has been diagnosed (labeled) will seek -------- ------ ------ ------ ---- ----

a diagnostic label for those symptoms, symptoms that are consistent with that label.

communicable disease

a disease that is transmitted from a human to another human, from a human to an animal, or from an animal to a human. can be transmitted from one person to another, from an animal to a person, and from a person to an animal

osteopathic medicine

a form of medical practice that provides all the benefits of conventional allopathic medicine, including prescription drugs and surgery, and emphasizes the interrelationship between the structure and function of the human body.

Shaman

a general term used for the practitioner of folk medicine who often uses herbs and a range of rituals to effect cures; also referred to as "medicine man" or "medicine woman."

physician assistant (PA)

a graduate of a training program that teaches how to practice medicine under the direction of physicians and surgeons.

Nocebo

a harmless substance that nevertheless creates harmful effects in a person who takes it.

preferred-provider organization (PPO)

a managed-care network of physicians, hospitals, and other health care providers who agree to charge preestablished rates for specific services.

integrative medicine

a multidisciplinary approach to medicine that involves traditional biomedical interventions, as well as complementary and alternative medical practices that have been proven both safe and effective.

Lamaze training

a natural childbirth process designed to prepare prospective parents by enhancing their informational, cognitive, and behavioral control over childbirth. the most widely used intervention aimed at improving behavioral control. At the heart of the Lamaze technique is relaxation training that enhances the prospective mother's behavioral control over breathing and the muscles of the uterus, which push the baby out

noncommunicable disease

a noninfectious disease; one that is nontransmissible. the global burden of disease has shifted increasingly toward it

Adherence

a patient both agreeing to and then closely following a treatment regimen as advised by his or her health care provider. includes advice pertaining to medications and lifestyle changes (e.g., losing weight or quitting smoking), as well as recommendations about preventive measures (e.g., avoiding fatty foods or starting an exercise program). Adherence is both an attitude and a behavior

Biofeedback

a technique for converting certain supposedly involuntary physiological responses—such as skin temperature, muscle activity, heart rate, and blood pressure—into electrical signals and providing visual or auditory feedback about them. has proved to be somewhat beneficial in treating stress-related health problems in some people. Two limitations have emerged in clinical evaluations of biofeedback. First, people often cannot generalize the biofeedback training that they receive in clinical settings to everyday situations. Second, research has not confirmed that biofeedback itself enables people to control their internal, involuntary responses. biofeedback has been shown to be an effective complementary therapy—combined with lifestyle modifications in diet, weight, and exercise—for reducing patients' dependence on medication in managing hypertension

Some of the most widely used alternative treatments:

acupuncture, mind-body therapies, therapeutic manipulation, and naturopathic medicine.

Discrimination, prejudice, and racism in health care

adversely affect minority populations and the health care system in general. Among diabetes patients, for example, African Americans are less likely to receive influenza vaccinations or have their hemoglobin and cholesterol tested. Historically, minorities have been underrepresented in clinical trials: one impediment to minority participation in clinical trials is a lack of trust in the medical research system stemming from "experiments" such as the infamous Tuskegee Syphilis Study. Several studies have reported that physicians provide less information to and are less supportive of African American and Hispanic patients and patients of lower SES than other patients in the same health care setting. many physicians have negative perceptions of the elderly and those seeking treatment for psychological disorders, and even worse perceptions of older patients who have difficulty communicating. Gender differences are also a factor in the physician-patient relationship. female physicians demonstrate more proficient clinical performance than do their male counterparts, conducting longer office visits, asking more questions, and showing significantly more verbal and nonverbal support Patients often most comfortable communicating with health care providers who are of the same gender and similar in other ways to themselves.

hygienic movement:

advocated a strict vegetarian diet, herbal treatments, and an abundance of whole grains.. naturepath

"Pay-as-you-go,"

also known as fee-for-service: payment model in which health care services are paid for by patients out of pocket at the time of treatment. developing countries, Out of pocket financing, mixed public and private ownership, private insurance The main drawback of this model is its inequitable distribution of resources.

Nurse-practitioner

an advanced-practice nurse who, in addition to training in traditional nursing, received training in the delivery of primary health care.

family history and cancer

an estimated 5% to 10% are caused by inherited mutations of genes, with breast, prostate, ovarian, and colorectal cancers being most likely to arise from family history. approximately one third of women diagnosed with breast cancer each year in the US have a family history of the disease (daughters of women diagnosed with the disease before age 40 were more than twice as likely). Families in which breast cancer is inherited typically demonstrate the following characteristics: breast cancer in two or more close relatives, such as a mother and two sisters; early onset—often before age 50—of breast cancer in family members; history of breast cancer in more than one generation; cancer in both breasts in one or more family members; frequent occurrence of ovarian cancer; and Ashkenazi (Eastern and Central European) Jewish ancestry, with a family history of breast and/or ovarian cancer.

Hepatitis

an inflammation of the liver, most often caused by a virus. There are five main hepatitis viruses, referred to as types A, B, C, D, and E. Hepatitis A (HAV) and hepatitis E (HEV) are usually spread via contaminated food or water, not sexual contact. However, hepatitis B (HBV), hepatitis C (HCV), and hepatitis D (HDV) viruses are most commonly spread through contact with the blood, semen, or other body fluids of an infected person, or by sharing needles and even toiletries such as toothbrushes and razors (since they can come in contact with blood and open sores). Unlike hepatitis A and E, which are acute, short-term illnesses, hepatitis B, C, and D are more likely to become chronic conditions and can lead to scarring of the liver (fibrosis, and in its later stages, cirrhosis) and liver cancer. These chronic forms of hepatitis develop slowly, so their signs and symptoms often go unnoticed.

accountable care organization (ACO):

an organization of health care providers who agree to be accountable for the quality, cost, and overall care of members.

CAM practitioners, whose therapies are based on a more holistic philosophy, claim that treatment variables cannot always

be studied independently.

Depression and cancer

both a risk and result of cancer. Many of the symptoms of cancer, as well as the side effects of cancer treatment, have similarities to symptoms of depression: disturbances of sleep and appetite, fatigue, concentration difficulties, and pain. Cancer patients who are members of ethnic minorities may be at increased risk for depression. Depression is linked to a higher risk of early death among people with cancer. Patients who are depressed may be less likely to adhere to recommended preventive screening procedures, cancer treatments, and other recommendations for maintaining their health. Results such as these suggest that screening for depression should be a routine part of cancer treatment

long-term infection of the stomach with helicobacter pylori (H. pylori) and cancer

can damage the inner layer of the stomach and lead to cancer over time. About two in three adults worldwide are infected with H. pylori, with the rate of infection being higher in developing countries and in older age groups.

immune surveillance theory

cancer cells, which develop spontaneously in the body, are prevented from spreading and developing into tumors by natural killer (NK) cells and other agents of the immune system. cells of the immune system play a monitoring function in searching for and destroying abnormal cells such as those that form tumors. However, when the immune system is overwhelmed by the number of cancer cells or weakened by stress or some other factor, the immune system's surveillance is suppressed, and cancer may develop.

leukemia

cancer of the blood and blood-producing system such as bone marrow. leads to a proliferation of white blood cells in the bloodstream and bone marrow, which impairs the immune system. Although often considered a childhood disease, leukemia strikes far more adults than children.

lymphoma

cancer of the body's lymph system; includes Hodgkin's disease (spreads from single lymph node) and non-Hodgkin's lymphoma (malignant cells are found at several sites).

carcinoma

cancer of the epithelial cells that line the outer and inner surfaces of the body; includes breast, prostate, lung, and skin cancer. Most common type of cancer, specifically skin cancer

sarcoma

cancer that strikes muscles, bones, and cartilage. Much rarer than carcinoma, account for only 2% of cancers in adults

tobacco use and cancer

carcinogen, the most preventable cause of death in our society. The American Cancer Society estimates that about one in every five deaths in the United States is caused by tobacco, and most of those tobacco-related deaths were the result of cancer. Can cause cancers of the lungs, mouth, stomach, larynx (voice box), esophagus, pancreas, uterus, cervix, kidney, and bladder. consideration of future consequences: the extent to which individuals consider and are influenced by the potential future outcomes of their behavior. Research found that consideration of immediate consequences may be a more important determinant of health behaviors

Gonorrhea

caused by a bacterium that commonly infects the genitals, anus, and throat. Is spread by infected semen and vaginal fluids during unprotected vaginal sex, anal sex, and oral sex. women with gonorrhea show either no symptoms or some vaginal discharge or pain while urinating. Men usually notice a thick yellow-green discharge from the penis, and they may experience pain while urinating. If infected in the rectum, men and women have pain, bleeding, and discharge. In both women and men, untreated gonorrhea may cause arthritis, infertility, and other complications such as infections of the brain, heart muscle, or liver.

Chlamydia

caused by a bacterium that is known to create infections in the throat, genitals, and anus. the most frequently reported bacterial STI in the United States. spreads through contact with infected semen and vaginal fluids during unprotected vaginal sex, anal sex, and oral sex. women do not usually show symptoms, but some may experience pain during sex or urination. Men usually show symptoms, including a discharge or itchy feeling in the penis, painful urination, or an infection of the throat or anus. If untreated, chlamydia infection may cause infertility and arthritis in both women and men. In women, the infection may also cause pelvic pain, pelvic inflammatory disease, and ectopic pregnancy.

Syphilis

caused by a spiral-shaped form of bacteria called a spirochete. untreated syphilis follows a predictable course of stages: Primary: the infected person has a sore (usually painless, round, and hard) called a chancre at the site of infection, usually the penis, vagina or vulva, anus, or mouth Secondary: the person may develop a skin rash on the palms of the hands and soles of feet, swollen lymph nodes, and fever. Latent: symptoms disappear. Until the twentieth century, patients and their physicians commonly believed that the disease was cured when, instead, it was just latent. Tertiary: after a symptom-free incubation period that may last for several years, tertiary syphilis develops. It manifests in severe problems, including dementia and other brain conditions, and damage to the nerves, eyes, heart, blood vessels, liver, bones, and/or joints.

Trichomoniasis

caused by infection with a protozoan parasite, Trichomonas vaginalis. Most people cannot tell they are infected. Symptoms may appear within one to four weeks after a person becomes infected, or much later; and symptoms can be intermittent over a period of years. In men, symptoms: itching or irritation inside the penis, burning upon urination or ejaculation, and discharge from the penis. Women may experience itching or soreness of the genitals, discomfort upon urination, and a vaginal discharge with an unusual "fishy" odor. untreated trichomoniasis is not known to have the serious long-term complications that some other STIs can cause, by irritating the genital tract it can make individuals more vulnerable to infection with other STIs.

Tuberculosis

caused by the bacterium Mycobacterium tuberculosis and spreads through aerosolized droplets that people inhale from others who are already infected with the disease Another important factor in the development of antimicrobial resistance is the spread of resistant strains of bacteria from person to person in crowded settings such as hospitals, nursing homes, schools, and prisons.

Genital herpes

caused by the herpes simplex virus. spread through unprotected vaginal, anal, or oral sex in the form of direct skin-to-skin touch. symptoms of genital herpes (fatigue; fever; and painful blisters that redden the skin, itch, ulcerate, and may cause scarring) typically come and go sporadically. The virus is especially contagious if the infected person is having an outbreak of blisters at the time of sexual contact, but it can also be transmitted in the absence of symptoms. Over time, the virus can hide in nerve endings, causing pain in remote parts of the body such as the legs.

national health insurance

characterized by compulsory universal coverage paid for jointly by employers and employees through payroll deductions. This system uses multiple payers (numerous insurance funds that may be government or privately owned) and multiple providers (generally, private doctors and privately owned hospitals). The joint financing of health care by employers and employees and the risk-sharing nature of insurance pools are the advantages of this model. Canada, South Korea, Taiwan, General taxation, central government and/or regional government, Mixed public and private ownership, no private insurance. In France, for example, which has the most highly ranked health care system in the world, over 99% of the population are covered by at least the basic level of insurance. Other countries that follow this model include Canada, Germany, and Japan.

Two of the most common forms of Therapeutic Manipulation:

chiropractic osteopathy

acute and ongoing stressors

cognitive, emotional and behavioral responses; personal background; and social and environmental background are important factors in how well a person adjusts to a chronic condition such as ALS or HIV/AIDS

Psychological adjustment refers to a person's

cognitive, emotional, and behavioral responses to these stressors, which can be beneficial and contribute to improved health, or detrimental and contribute to worsening health

pluralistic health care

combine two or more of these approaches to health care. Until just a few decades ago, most Americans received their health care from private physicians, whom they paid directly at the time of treatment. Today, however, more than 90 million Americans receive their care through a health maintenance organization (HMO) (An organization that provides managed care, in which individuals pay a fixed monthly rate and use services as needed), a prepaid delivery system in which an employer or employee pays a monthly rate and the individual is allowed to use health services at no additional (or greatly reduced) cost. mixed financing, mixed public and private ownership. Private insurance: only the rich get healthcare. United States.

environmental and occupational hazards and cancer

depends on the concentration of the carcinogen and the amount of exposure to the toxin Toxic chemicals: Various chemicals are clearly carcinogenic, including asbestos, vinyl chloride, and arsenic. Environmental toxins in the air, soil, and water are estimated to contribute to about 2% of fatal cancers, mainly of the bladder and the lungs. Ultraviolet radiation: one in every five Americans will develop skin cancer. High-frequency radiation, ionizing radiation (IR), and ultraviolet (UV) radiation are proven carcinogens. Ultraviolet B rays, which can damage DNA, cause more than 90% of all skin cancers, including melanoma, a potentially deadly form of cancer that strikes the melatonin-containing cells of the skin. The rise in melanoma cases can be attributed to three factors: the overall frequency of sunburns during childhood; the thinning of the earth's ozone layer, which filters skin-damaging UV radiation; and the increase in suntanning and use of tanning booths, which has exposed people to greater amounts of UV radiation. In 2014, UV tanning devices were reclassified by the Food and Drug Administration from Class 1 (low to moderate risk) to Class II (moderate to high risk) devices

In terms of CAM use, ------ ------ -------- ------- -------were used most often.

diet and exercise, biofeedback, and counseling or psychotherapy

Patients who believe their illness is acute often

drop out of treatment earlier than those who believe it to be chronic.

Following a conventional medical evaluation and discussion of conventional allopathic options, patients may choose a CAM consultation. But before doing so, the physician should:

ensure that the patient recognizes and understands his or her symptoms; maintain a record of all symptoms, including the patient's own opinions; review any potential for harmful interactions; and plan for a follow-up visit to review CAM effectiveness.

Support for stage models comes from

evidence that certain individuals may profit more than others from a specific intervention. For example, younger, less knowledgeable individuals tend to benefit from educational interventions that close gaps in knowledge about how AIDS is transmitted, while older individuals in certain high-risk groups may be more likely to profit from interventions that stir them into preventive action

Social-cognitive theory

focuses on the interaction of environmental events, our internal processes, and our behaviors, has served as the framework for a number of interventions Three factors addressed by this model: (1) perceived social norms regarding peer acceptance of HIV risk-reducing behaviors; (2) self-efficacy beliefs controlling one's own thoughts, emotions, and behaviors in order to avoid unsafe behaviors; and (3) social skills, the ability to respond assertively in negotiating risky behaviors. The relevance of the social-cognitive model was demonstrated by Seth Kalichman, who found that gay men who practice high-risk behaviors also score lower on measures of perceived safer-sex norms, safer-sex self-efficacy, and social skills.

young people (ages 15-24) account for ---- of all new cases of STIs, even though they make up only 25% of the sexually experienced population

half

Childhood Adversity

has been associated with greater emotional and physiological sensitivity to stress and more pronounced cortisol and autonomic responses to stress. may promote long-term immune system dysregulation.

People living in affluent countries are more likely to

have the knowledge and ability to protect themselves from diarrhea and parasitic diseases that are often spread by unsafe water. less likely to live in overcrowded conditions, which can spread diseases such as tuberculosis be able to immunize their children against vaccine-preventable diseases.

Important factors in adjusting to cancer treatment include

having access to information (Information presented in narrative form, as compared to nonnarrative (usually statistical) form, may be particularly effective. Another source of information that can affect how people cope with cancer is social comparison with other cancer patients), perceiving some degree of control over treatment, and being able to express emotions while feeling supported by others. systematic desensitization: a form of behavior therapy, commonly used for overcoming phobias, in which the person is exposed to a series of increasingly fearful situations while remaining deeply relaxed.

national health service

health care is provided and financed by the government through tax payments. characterized by universal coverage, tax-based financing, and government ownership. Also called a single-provider system, this type of health care is based on the ideas of William Beveridge, a daring social reformer who in 1948 designed the National Health Service in the United Kingdom after the country's health infrastructure was destroyed by war. (United Kingdom, Italy, Spain, New Zealand, Greece, Portugal, Norway, Sweden, Denmark, Finland, Ireland), General taxation, central government (United Kingdom) or local/regional government (Scandinavia), public ownership, private insurance single-payer system, A variant of the single-provider model follows the national health insurance model, except that private-sector health care providers are paid directly by a universal, government-run insurance program. Canada, South Korea, and Taiwan have single-payer health care systems.

Naturopaths follow six basic principles, which are in keeping with the major ideals of CAM:

help nature heal, do no harm, find the underlying cause, treat the whole person, encourage prevention, and act as a teacher.

Health psychologists, behavioral consultants, and other collaborative care providers increasingly use cognitive-behavioral therapy (CBT) to

help patients cope with anxiety and depression, as well as to help them prepare for surgery and other medical procedures. Aimed at improving cognitive control, CBT directs the patient's attention to the positive aspects of a procedure (such as improved health) rather than to feelings of discomfort. They also aim at improving patients' behavioral control by teaching techniques for controlling pain and speeding recovery during and after a medical procedure. cognitive control: interventions that direct the patient's attention to the positive aspects of a procedure (such as improved health) rather than to feelings of discomfort. behavioral control: interventions that teach techniques for controlling pain and speeding recovery during and after a medical procedure.

Affordable Care Act (ACA)

in 2010 brought about significant changes in how health care is paid for and provided in the United States. Supporters of ACA frequently cited a 2000 World Health Organization comparison of global health care delivery systems in which American health care ranked only thirty-seventh among 191 member countries in its overall performance. In 2016, the United States spent about twice as much as 10 other affluent countries on medical care, yet performed less well on many population health outcomes

the frequency of unprotected sex can be dramatically reduced with a few steps:

help people to improve their outlook on life, their feelings of self-efficacy, and their sense of personal control; encourage them to talk more openly about safe sex; and always take the following precautions: Stay sober. Alcohol and many other drugs lower inhibitions and increase the likelihood of high-risk behaviors. Be selective in choosing partners, and limit the number of partners in the sexual network. Avoid sexual contacts with people who are known to engage in high-risk sexual or drug-use behaviors. Use latex condoms during vaginal, anal, and oral sex. These barriers block nearly all sexually transmitted microorganisms, including HIV. Doctor-prescribed and -fitted vaginal diaphragms or cervical caps that block semen and spermicides that paralyze sperm (and lymphocytes) are also advisable. Never share hypodermic needles, razors, cuticle scissors, or other implements that may be contaminated with another person's blood or bodily fluids. Do not be lulled into a sense of complacency about STIs by media reports about treatment breakthroughs. There is still no cure for AIDS or many other STIs.

Although 25% of our pharmaceutical drugs are derived from herbs, many physicians believe that

herbs in general are ineffective and potentially dangerous. there is at least some evidence that plant-based medicines are effective in treating certain conditions.

illness representation

how a person views a particular illness, including its label and symptoms, perceived causes, timeline, consequences, and controllability. affect our health in at least two ways: by influencing our preventive health behaviors and by affecting how we react when symptoms appear.

personal background factors such as early life experiences, socioeconomic status, personality (e.g., negative affectivity), and neighborhood quality also influence

how people adjust to chronic disease

eHealth literacy

how well a person navigates, understands, and uses electronic health information. A critical factor in tailored interventions that are delivered via smartphones, tablets, and other digital devices

HIV/AIDS

human immunodeficiency virus (HIV): a virus that infects cells of the immune system, destroying or impairing their function. If untreated, develops into acquired immunodeficiency syndrome (AIDS): the most advanced stages of HIV infection, defined by a T cell count of less than 200 and the occurrence of opportunistic infections or HIV-related cancers that take advantage of a weakened immune system. victims usually struggle with infections that otherwise would be handled with relative ease if their immune systems were not compromised. In this way, AIDS increases its victims' vulnerability to opportunistic infections, such as pneumonia and certain cancers. HIV-positive individuals, HIV can enter the body through any tear in the skin or mucous membranes, including tears not visible to the human eye. HIV can be spread through any of these: Unprotected sex—primarily vaginal and anal intercourse Blood exchange—including by accidental needle sticks or by needle-sharing Mother-to-child transmission—during birth or through breast feeding unprotected vaginal sex is much riskier for HIV for women than for men, and unprotected anal sex is even riskier for women than unprotected vaginal sex Male-to-female transmission of HIV through vaginal intercourse is far more common than is female-to-male transmission In the early years of the AIDS epidemic, HIV spread rapidly through transfusions of infected blood to victims of hemophilia: A genetic disease in which the blood fails to clot quickly enough, causing uncontrollable bleeding from even the smallest cut. Without a supportive environment of blood, semen, or the cytoplasm of a host cell, the virus quickly dies, usually within 30 minutes

the most prevalent combinations of chronic conditions:

hypertension and diabetes, hypertension and heart disease, and hypertension and cancer.

4 of the most popular Mind-Body Therapies:

hypnosis relaxation and meditation biofeedback spirituality and prayer

Issues with the immunosuppression model

if the stress-immune response did indeed evolve, a healthy person should not be adversely affected when it is triggered because this would be maladaptive; natural selection would have selected against this over the course of evolution

How HIV Progresses:

infects mostly lymph tissues, where lymphocytes (immune cells that help prevent cancer and other chronic illnesses by controlling cell growth. They also guard against infection by producing antibodies) develop and are stored HIV invades and destroys a type of lymphocyte called the T cell, which is a crucial player in the immune response because it recognizes harmful microbes and triggers the production of antibodies. It also coordinates the release of natural killer (NK) cells. HIV is a retrovirus: a virus that copies its genetic information onto the DNA of a host cell. Progresses through 4 stages of infection: Stage 1: soon after the initial HIV infection, the immune system destroys most of the virus; symptoms are mild or nonexistent Stage 2: latency period, may last for months or years, the T cell concentration falls and HIV concentration rises, accompanied by symptoms such as swollen lymph nodes Stage 3: within 5 years, 30% of people move to this stage, as T cells are reduced further, immune function is impaired, and opportunistic infections occur. Among the most common are Kaposi's sarcoma, lymphoma; parasitic gastrointestinal infections; and pneumocystis carinii pneumonia (PCP), a bacterial disease that caused 60% of all AIDS deaths prior to the development of the effective treatments available today. Stage 4: Finally, almost all natural immunity is lost and full-blown AIDS occurs. T cells drop from healthy 1,000 to 200 cells or less per cubic milliliter of blood. Without treatment, death generally occurs within a year or two.

Genital human papillomavirus (HPV)

is a group of more than 100 different viruses that are passed on by an infected person through genital contact, most often during vaginal or anal sex but also through oral sex. highest prevalence rates found among women ages 20 to 24, anyone who is having (or has ever had) sex can get HPV. HPV is the most common; nearly all sexually active women and men become infected at some point in their lives. Most people never develop symptoms/health problems, but it can cause serious health problems, including genital warts and certain cancers.

HPV and cancer

main causes of cervical cancer, and they also contribute to some cancers of the mouth and throat

The health care system in the United States is unlike that of any other country, because it

maintains so many separate systems for different groups of people and is a combination of several approaches.

Treatment regimen variables

more likely to follow recommendations that they believe in and are capable of carrying out. the more complex a treatment regimen is, the less likely patients are to adhere to it completely. steps to improve adherence in their patients: Tailor the treatment to fit the patient's lifestyle. Adherence will increase in response to anything that makes a treatment regimen easier to follow. Simplify instructions with clear language to ensure that the patient understands the amount, timing, and duration of the treatment. Make sure that the patient understands enough of the treatment rationale to gain confidence in the treatment schedule. Involve family members, friends, and other patient supporters in the treatment and the explanation of its rationale. Provide feedback about progress.

Diseases that are strongly affected by lifestyle and environment are among those for which naturopathic treatment most

often is reported to be effective.

The cancers that have been most directly linked to foods are those that affect the cells that line bodily tissues, including those in the lungs, colon, bladder, stomach, rectum, and, to a lesser degree, the uterus, prostate, breasts, and kidneys. studies of human populations have not demonstrated that any particularly dietary component causes cancer or prevents cancer. Two food products that appear to cause cancer are charred meat and processed meat (which is a group 1 carcinogen). Nutrition therapy is used to help cancer patients get the nutrients they need to fight infection and keep up their strength. AICR's model plate for a cancer preventive diet: two thirds plant-based foods, and one third (or less) animal protein.The American Institute for Cancer Research (AICR) offers several dietary recommendations that people can follow to help reduce their risk of developing cancer:

reducing intake of foods and drinks that promote weight gain—namely, foods high in saturated fats and sugary drinks; eating mostly plant-based foods; limiting intake of red meat, and avoiding processed meat; limiting consumption of alcoholic beverages and salt; and reducing intake of oat-based, corn-based, wheat-based, and rice-based breakfast cereals—such as Cheerios, Cornflakes, Total, and Rice Krispies—which may contain ochratoxin—a potentially cancer-causing by-product of mold.

If we view our disease or condition as incurable, we may

skip appointments, neglect treatment, or even behave in self-destructive ways because we feel helpless and lack hope.

coping with cancer

some personality factors do predict how well a person copes with cancer. For instance, expression of both positive and negative emotions can be beneficial in adjusting to a diagnosis of cancer. emotion-focused coping and denial of the diagnosis may be positive traits for cancer victims. emotional regulation is critical to coping with traumatic events such as a diagnosis of cancer; emotional intelligence. Higher levels of aspects of masculinity, gender role conflict, and gender-linked personality characteristics are related to poorer outcomes in men with cancer. researchers have developed a questionnaire to measure cancer-related masculine threat (CMT) in prostate cancer patients. Despite these benefits, some research suggests that less than 10% of eligible American men opt for AS, in part because the perception of "doing nothing" is difficult for men to accept Other researchers have found that women of lower SES, as well as African American and Hispanic women, are more likely than European Americans to perceive benefits from a diagnosis of breast cancer, such as a renewed focus on relationships in their lives: minority women are more likely to have faced discrimination in their everyday lives before they developed cancer, and this adversity has prepared them to derive benefits from traumatic events. post-traumatic growth (PTG): positive psychological change experienced as the result of struggle with a highly challenging life circumstance. Also referred to as benefit finding, or thriving.

Social and Psychological factors that have direct and indirect impacts on relationships between patients and the health care system:

such factors strongly influence when and how people initially decide they are sick. the confidence that people have in their health care providers influences their satisfaction with treatment, as well as how they respond to it. the extent and quality of communication between patients and health care providers indirectly influence almost every aspect of health care, including how patients decide when they need medical attention, why people sometimes choose to ignore health-related symptoms, and why people carefully follow their provider's instructions at some times but not at other times.

Five stages in the decision-making process for seeking medical care: people will avoid seeking medical care because:

symptoms go unnoticed (appraisal delay), sickness seems unlikely (illness delay), patients who had previously experienced similar symptoms were more likely than those who experienced symptoms for the first time to delay seeking medical attention. patients who spent more time imagining the consequences of being sick were more likely to delay seeking medical attention. professional help is deemed unnecessary (behavioral delay), the individual procrastinates in making an appointment (scheduling delay), or the perceived costs of treatment outweigh the perceived benefits (treatment delay).

Effective interventions to prevent STIs are those that

target high-risk behaviors among at-risk individuals; teach specific skills to reduce risk (such as proper condom use and needle cleaning); promote interpersonal assertiveness and other communication skills necessary to initiate and maintain lower-risk sexual relationships; address social and cultural norms that surround sexual activity; focus on improving self-esteem and feelings of self-efficacy regarding how to practice safer sex; address faulty, even "magical," thinking regarding HIV transmission and personal vulnerability; and involve coordinated, community-level education.

Benign (noncancerous) tumors

tend to remain localized and usually do not pose a serious threat to health

antimicrobial resistance

the ability of bacteria, viruses, and other microbes to resist the effect of drugs as a result of mutation or the exchange of genetic material among different strains. The use of antibiotics is the single most important factor in the development of antimicrobial resistance

illness anxiety disorder

the condition of experiencing abnormal anxiety over one's health, often including imaginary symptoms. An underlying factor in many cases of illness anxiety disorder appears to be neuroticism, a state of emotional maladjustment that encompasses self-consciousness; the inability to inhibit cravings; vulnerability to stress; and the tendency to experience anxiety, depression, and other negative emotions. diagnostic criteria for illness anxiety disorder: an absence of somatic (physical) symptoms; chronic, worrisome preoccupation that one has a serious medical condition that has lasted six months or longer; high levels of health anxiety, with very low sickness thresholds; constantly checking for signs of illness; and the absence of symptoms of another disorder

Trends that led to the emergence of health psychology and also have fueled increasing interest in alternative forms of medicine; include increasing public concern about:

the costly and impersonal nature of modern medical care; the adverse effects of treatment; and the seemingly profit-driven nature of health care and medical research that ignores unpatentable (and unprofitable) treatment options, such as herbal medicines.

patient-centered health care:

the delivery of health care services that are respectful of and responsive to individual patient preferences, needs, and values.

dynamic tailoring:

the delivery of individualized and targeted health messages over multiple periods of time.

Why do placebos work?

the medical treatments that we receive over the course of our lives are like conditioning trials, and we still may experience a therapeutic benefit as a conditioned response to the same medical stimuli. placebos tap into the body's natural "inner pharmacy" of self-healing substances. Researchers also strongly suspect that at least part of placebo-based pain relief occurs because placebos stimulate the release of endorphins, morphine-like neurotransmitters produced by the brain. According to expectancy theory, the anticipated consequences of treatment play a crucial role in health outcomes because people tend to feel and act in ways that they think they should According to meaning response theory, every health care intervention, from taking a pill to undergoing surgery, is imbued with symbolism that conveys meaning and determines its efficacy

cancer treament: surgery

the oldest form of cancer treatment, and it generally offers the greatest chance of cure for most types of cancer Diagnostic surgery: used to obtain a tissue sample for laboratory testing to confirm a diagnosis and identify the specific cancer. A procedure to remove all or part of a tumor for diagnostic tests is called a biopsy. Preventive surgery is performed to remove a growth that is not presently malignant but is likely to become so if left untreated. Sometimes, preventive surgery is used to remove an organ when a person has an inherited condition that makes development of a cancer likely. Staging surgery is used to determine the extent of disease. In laparoscopy a tube is passed through a tiny incision in the abdomen to examine the abdomen's contents and remove tissue samples. Curative surgery involves the removal of a tumor when the tumor appears to be localized and there is hope of taking out all of the cancerous tissue. Restorative (or reconstructive) surgery is used to restore a person's appearance or the function of an organ or body part. Examples include breast reconstruction after mastectomy and the use of bone grafts or prosthetic (metal or plastic) bone or joint replacements after surgical treatment of bone cancer.

Factors in the Progression of AIDS

the strength of the initial immune response: HIV progresses much more slowly among patients whose immune systems mount strong lymphocyte activity in the acute stage of HIV sickness (stage 2) Genetic vulnerability also may affect the rate at which AIDS develops. 1% of people of Northern European descent inherit a gene from both parents that blocks this development, giving them apparent immunity to HIV infection. Another 20% inherit the protective gene from only one parent and, while not immune to HIV, display a much slower progression of symptoms access to treatment is a major factor in the progression of AIDs. Today's optimum HIV treatment regimen is combination antiretroviral therapy (cART), which involves several antiretroviral drugs that attack different parts of HIV or stop the virus from entering cells. Poor nutrition, drug use, repeated HIV exposure, and other viral infections all can accelerate the progression of the disease racial discrimination and social exclusion have been suggested as important contributing factors in health-risk behaviors and HIV infection:experiences of discrimination at ages 10 to 11 were associated with greater sexual risk-taking at ages 18 to 19, even after controlling for neighborhood risk, socioeconomic status (SES), gender, age, the absence of a father, and other variables. discrimination is often associated with heightened perceived norms for deviant behavior among peers, which in turn predict higher levels of substance use and risky sex behaviors Stress, negative emotions, and social isolation may influence the pace at which AIDS progresses, perhaps by altering hormonal and immune environments that affect the resistance of host cells to the invading virus. Several researchers have reported that low self-esteem, a pessimistic outlook, chronic depression, and other negative emotions may influence the production of proinflammatory cytokines Stress and social support

naturopathic medicine

the system that aims to provide holistic health care by drawing from several traditional healing systems, including homeopathy, herbal remedies, and traditional Chinese medicine.

delay behavior

the tendency to avoid seeking medical care because symptoms go unnoticed (appraisal delay), sickness seems unlikely (illness delay), professional help is deemed unnecessary (behavioral delay), the individual procrastinates in making an appointment (scheduling delay), or the perceived costs of treatment outweigh the perceived benefits (treatment delay).

complementary and alternative medicine (CAM)

the use and practice of therapies or diagnostic techniques that fall outside conventional biomedicine.

Weaknesses for CAM research:

the use of incomplete, biased, or invalidated treatment outcome measures. Many CAM studies rely on self-reporting. randomized clinical trials (RCTs) sometimes present problems for medical researchers, especially for CAM researchers because Many CAM trials include too few people in a group to allow researchers to determine whether results are statistically significant or are due to chance alone. CAM practitioners find it difficult/morally unacceptable to persuade volunteers to participate in a study in which they may be "randomized" into a no-treatment control group.

Spirituality and Prayer

through much of history, religion and medicine have been closely connected as healing traditions. The wall between them is starting to go down recently Evidence is mixed as to whether it can promote health. A number of studies have reported that devotees of various religions have lower illness and mortality rates than the general population. However, most of those studies were uncontrolled, making them vulnerable to mistaken interpretation and unable to pinpoint causation. What accounts for the correlation between strong religious practices and longevity? At least three intervening factors remain strong candidates: lifestyle, social support, and positive emotions.

The health belief model,

which is based on the idea that beliefs predict behavior, has achieved modest success with a variety of high-risk groups in predicting condom use, the number of sexual partners, and knowledge of partners' past sexual history. The theory of planned behavior, which links beliefs and behavior, has achieved greater success, probably due to the influence of social norms on the sexual activity of many at-risk populations, including teenagers. Researchers have consistently found that people with more favorable attitudes toward condoms, as well as those who believe their friends are supportive of condom use, are more likely to engage in protected sex. also found that individuals in high-risk groups, such as young men who have sex with men, often have overly optimistic beliefs about their risk, which does little to deter their risk behaviors