Health Psych Final Exam - Chapters 12-15

Talk about Health Promotion

-Americans have made substantial gains in altering their poor health habits. Many have stopped smoking & many have reduced their consumption of high-cholesterol & high-fat foods. Exercise has increased. -Despite these advances, alcohol consumption patterns remain largely unchanged. Overweight & obesity are currently prevalent and will shortly supplant smoking as the major avoidable contributor to mortality.

Describe AIDS and give stats

-Appears to have begun in central Africa perhaps in the early 1970s. From Africa the disease made its way to Europe & Haiti and from Haiti into the U.S. Currently estimated (CDC) that approx. -1.2 million U.S. residents are living with HIV. About 13% of whom are unaware of their infection. Researchers estimated 65 million deaths from AIDS by 2020. Currently, AIDS is the 6th leading cause of death worldwide. HIV attacks helper T cells and macrophages of the immune system, severely compromising the immune system. -Produces a vulnerability to opportunistic infections including pneumocystis carinii, Kaposi's Sarcoma and non-Hodgkin's lymphoma

Death is old age

-the elderly (over age 65) are generally more prepared to face death than are the young. Typically, the elderly die of degenerative diseases (cancer, stroke, heart failure) or from general physical decline that predisposes them to infectious disease or organ failure. The terminal phase is generally shorter for them because there is often more than one biological competitor for death. a. On average, women live 5 years longer than men in the U.S. Factors that contribute: women appear to be biologically more fit than men, men engage in more risky behaviors, men engage in less preventive healthcare, & social support may be more protective for women. the patient feel comfortable).

Risk factors for Hypertension

-Gender - prior to age 45, males are at greater risk than females. From age 55 to 64, men and women in the U.S. face a similar chance of developing hypertension. After age 65, a higher percentage of women have hypertension than men. d. Genetic factors - if one parent has high blood pressure, offspring have a 45% chance to develop. If two parents have high blood pressure, the offspring have a 95% chance. The genetic factor in hypertension (as in CHD) may be reactivity (a predisposition toward elevated sympathetic nervous system activity especially in response to stressful events). e.Emotional factors - depression (even in childhood), hostility, & frequent experiences of intense arousal predict increases in blood pressure over time. Stress has been suspected as a contributor to hypertension for many years.

When did CHD become an issue?

It was not a major cause of death until the 20th century. Prior to that time, most people did not live long enough to develop heart disease (most died of infectious diseases). CHD is a disease of modernization, due at least in part to the changes in diet & reduced activity level. Sudden death from heart attack is most likely to occur at home.

Give stats about Type II Diabetes

a. 7th most common chronic illness in this country b. leading cause of kidney failure in adults c. over 9% of the U.S. population has diabetes d. of the 29 million individuals who have it, 8 million cases remain undiagnosed e. in the past 34 years in the U.S. incidence of diabetes has tripled f. diabetes contributed to 234,051 deaths in 2010 alone g. about 68% of deaths among people with diabetes due to heart disease & stroke h. the incidence of cases of Type II diabetes is increasing so rapidly that it is considered a pandemic.

From HIV+ to AIDS

strongly related to socioeconomic factors. Low-income blacks & Hispanics develop AIDS faster than whites

Antiretroviral Therapy

the most promising development in the treatment of AIDS. ART is a combination of antiretroviral medications (protease inhibitors). People on protease inhibitors must take these drugs faithfully, often several times a day or the drug fails to work

Describe the immune system

the surveillance system of the body. Implicated in infection, allergies, cancer, autoimmune diseases, and other disorders. Primary function of the immune system is to distinguish between what is "self" and what is foreign and then to attack & rid the body of foreign invaders.

How do children understand death?

1. Up to age 5 most children think of death as sleep. A dead person is still around but in an altered state. 2. Between ages 5-9 the idea that death is final develops although most children do not have a biological understanding of death 3. Age 9-10 the idea that death is universal & inevitable.

Describe Type II Diabetes

A metabolic disorder characterized by high blood glucose in the content of insulin resistance occurs with risk for heart disease

Evaluation of Theory

As a description of the reactions of dying patients her work was invaluable. She has chronicled nearly the full array of reactions to death. Limitations: patients do not typically go through five stages in a predetermined order but rather may experience these stages in a various intermittent order. The theory also does not fully acknowledge the importance of anxiety which next to depression, is one of the most common responses.

Describe Hypertension (High blood pressure)

Excessively high blood pressure that occurs when the supply of blood through the blood vessels is excessive, putting pressure on the vessel walls. Risk factor for a variety of medical problems (including coronary heart disease). Can occur when cardiac output is too high which puts pressure on the arterial walls as blood flow increases. Also occurs in response to peripheral resistance (the resistance to blood flow in the small arteries of the body.)

Define Psychoneuroimmunology

The interactions among behavioral, neuroendocrine, & immunological processes of adaption

Describe Rheumatoid Arthritis

(RA) = most crippling form of arthritis. Affects 1.5 million Americans, mostly women. Strikes primarily the 40-60 age group (middle age - elderly). Usually affects the small joints (hands, feet, wrists, ankles, neck).

Death in Adolescence and Young Adulthood (20-40)

-death rate in adolescence is low (~1 in 1,000). a. Causes of death: 1. Major cause is unintentional injury, mainly involving automobiles 2. Homicide is the 2nd leading cause of death (leading cause of death for young black men) 3. Suicide (largely through firearms) is the 3rd leading cause of death 4. Cancer - is the 4th leading cause of death 5. Heart disease & AIDS - account for most of the remaining deaths in this age group.

What is the most common emotion experienced by cancer patients?

The most common emotion experienced by those with cancer is depression. Implicated in the progression of cancer and has been tied by itself, and in conjunction with other factors.

Stats, Cause & Treatment of Stroke

a. 5th leading cause of death in the U.S. Caused approx. 1 of every 20 deaths in U.S. (2013). Estimated that every 4 minutes someone dies of stroke. b. In the U.S. approx. 800,000 individuals experience a stroke every year c. Stroke compromises mobility in half of elderly survivors d. Some strokes occur when blood flow to localized areas of the brain is interrupted which can result from arteriosclerosis or hypertension. When arteriosclerotic plaques damage the cerebral blood vessels, the damaged area may trap blood clots (thrombi) or produce circulating blood clots (emboli) that block the flow of blood e. Stroke can also be caused by cerebral hemorrhage (bleeding caused by the rupture of a blood vessel in the brain). When blood leaks into the brain, large areas of nervous tissue may be compressed against the skull, producing widespread or fatal damage.

Talk about Health Disparities

a. Although the U.S. spends more on health care than any other country in the world, we have neither the longest life expectancy nor the lowest infant mortality rate b. Some of this disadvantage is due to low SES and some of the differences are due to the stress of discrimination. More than 13% of the population has no health insurance and this gap affects the poor & the ethnic minorities. c. Another significant gap in health care and research concerns gender 1c. Women live, on average, 6.5 years longer than men. 2c. Women are sick more than men. 3c. Their advantage in mortality has been decreasing in recent years. 4c. Women are less likely than men to have health insurance. 5c. In the future, we can expect models for minorities & women.

Causes of death 1-15 years old

1. Accidents - after the first year, the main cause of death among children under age 15. 40% of all deaths in this group. Early childhood accidents are frequently due to accidental poisoning, injuries, or falls in the home. In later years, automobile accidents take over as the leading cause of accidental death. 2. Cancer (especially leukemia) - 2nd leading cause of death in youngsters age 1-15. Its incidence is rising. Leukemia is a form of cancer that strikes the bone marrow producing an excessive number of white blood cells, leading to severe anemia & other complications. Because of advances in treatment (chemotherapy & bone marrow transplants) over 80% of those treated for cancer survive the disease for 5 years or more. These procedures can be painful and have unpleasant side effects.

Who gets cancer?

1. Many cancers run in families - many things run in families (genes, diet, lifestyle). Overall, cancer is more closely tied to lifestyle than to genes. 2. Infectious agents (human papillomavirus HPV is the main cause of cervical cancers) 3. Ethnically linked (Anglo men in U.S. have a bladder cancer rate twice that of other groups) 4. Socioeconomic Status - Most cancers are related to SES, with low-SES individuals more at risk 5. Married people (especially married men) develop fewer cancers than single people.

What can greatly reduce the risk of stroke?

Aspirin can greatly reduce the risk. Aspirin also has immediate benefits for stroke patients by preventing coagulation. Statins also appear to help.

Describe Cancer

Cancer is a set of more than 100 diseases that have several factors in common: All cancers result from a dysfunction in DNA. That part of the cellular programming that controls cell growth & reproduction. Instead of ensuring the regular, slow production of new cells, this malfunctioning DNA causes excessively rapid cell growth & proliferation. Unlike other cells, cancerous cells provide no benefit to the body (they merely sap it of resources).

What are some symptoms of Type I Diabetes?

Early symptoms: frequent urination, unusual thirst, excessive fluid consumption, weight loss, fatigue, weakness, irritability, nausea, uncontrollable craving for food (sweets), fainting. These symptoms are due to the body's attempt to find sources of energy, which prompts it to feed off its own fats & proteins. If the condition in untreated, a coma can result.

Coronary Heart Disease (CHD) Stats

Number 1 killer in the U.S. 1 out of every 4 deaths. Approx. 525,000 new cases annually. 33% of these deaths are considered premature (occur before age 78.5) CHD is a major chronic disease.

100 years ago, what did people primarily die from? What are some examples? Are they around today?

People died primarily from infectious diseases (tuberculosis, influenza, or pneumonia). Those diseases now are much less widespread because of substantial advances in public health & preventive medical technologies that were developed in the 20th century. On average, people in the U.S. can currently expect to live about 78.8 years. When death does come, it will probably stem from a chronic illness (heart disease or cancer) rather than from an acute disease

Where does cancer rank in causes of death?

Second (only to heart disease) in causes of death in the U.S. and most developing countries. More than 577,190 deaths each year in U.S. Many hundreds of thousands more people live long lives after having has cancer

Talk about changes in technology

Technology is changing the face of medical practice Interventions currently range from sending people electronic reminders to take medications at the appropriate time, to individually tailoring health interventions to help people control weight gain, exercise routines, calorie counts for meals, and texts and online visits with physicians

Talk about the aging of the population

The aging of the population means that within the next 10 years, we will have the largest cohort of older adults ever seen in this and many other countries. It is expected there will be an increase in chronic disorders. Interventions should focus on enabling older adults to achieve the highest level of functioning possible through programs that emphasize diet, exercise, control of alcohol consumption, & other habits.

Death in Middle Age (40-60)

a. Death begins to assume more realistic and fearful proportions (in some cases) because it is more common and because people develop chronic health problems that my ultimately kill them. Midlife Crisis - the abrupt life changes that are sometimes made in middle age (divorce, remarriage to a younger person, job change) may be viewed partly as an effort to postpone death. b. Premature Death - death that occurs before the projected age of 79. Main cause is sudden death due to heart attack or stroke. Although sudden death has the disadvantage of not allowing people to prepare their exit, in some ways it facilities a more graceful departure.

Talk about refocusing Health Promotion Effects

a. In the past we have stressed the mortality more than morbidity, although the reduction of mortality is a priority, there will always be 10 major causes of death. Refocusing our efforts toward morbidity is important for several reasons: 1. Cost - chronic disorders are expensive to treat (particularly when those diseases persist for years, even decades) 2. Maximizing the number of good years during which a person is free from the burdens of chronic illness produces a higher quality of life (increase quality of life for longer periods of time. Decreases morbidity period of time.)

Stages of Adjustment to Dying

a. Kubler-Ross a pioneer in the study of death & dying developed the stages of dying: a1. Denial - defense mechanism by which people avoid the implications of an illness. They may act as if the illness were not severe, it will shortly go away. Denial early on in adjustment is normal & useful because it can protect the patient from the full realization of impending death. a2. Anger - "Why me?" May show resentment toward anyone who is healthy. One of the harder responses for family & friends to deal with. The patient is not really angry with them but at fate. a3. Bargaining - trading good behavior for good health. May take the form of a pact with God in which the patient agrees to engage in good works for better health. a4. Depression - coming to terms with lack of control. Patient acknowledges that little can now be done to stay the course of illness. "Anticipatory grief" patients mourn the prospect of their own deaths. a5. Acceptance - a tired, peaceful, though not necessarily pleasant calm may descend.

Describe Lupus

chronic, inflammatory form of arthritis. Red rash may appear on the face. It leads to chronic inflammation producing pain, heat, redness, and swelling. Can be life-threating when it attacks the connective tissue of the body's internal organs.

Causes of death 0-1 year old

congenital abnormalities, sudden infant death syndrome (SIDS). SIDS appears to be a gentle death for the child but not for the parents. The parents show poor adjustment due to the confusion, self-blame & suspicion from others.

Describe Osteoarthritis

develops when the smooth lining of a joint begins to crack or wear away because of overuse, injury, or other causes. The disease tends to affect the weight-bearing joints (hips, knees, spine). Affects many elderly & some athletes.

Treatment of Hypertension

a. Prehypertension Stage: weight loss, lowering salt intake b. Once it is diagnosed the most common treatment are drugs and patients are put on a low-sodium diet

What is the most common drug treatment for reducing heart attack, stroke, & death?

The Statins

List the four major forms of arthritis

Rheumatoid, Osteoarthritis, Gout, Lupus

Is there a right to die?

-Many states have now enacted laws enabling people with terminal disease to be able to express their wishes. 1. Living Will - a will prepared by a person with a terminal illness, requesting that extraordinary life-sustaining procedures not be used in the event that the person's ability to make this decision is lost. 2. Advance Directives - provide instructions & legal protection for the physician, so that life-prolonging interventions (ie. use of respirators) will not be indefinitely undertaken in a vain effort to keep the patient alive. This document helps to ensure that the patient's wishes (rather than someone else's) are respected. 3. Research suggests that many physicians ignore the wishes of their dying patients and needlessly prolong pain & suffering. 4. Patients may begin a process of social withdrawal whereby they gradually restrict visits to only a few family members. As the prognosis worsens & treatment becomes more drastic communication may break down. Each person involved may believe that others do not want to talk about the death (death itself is still a taboo topic in our society). 5. Nontraditional Treatment - As health & communication deteriorate, some terminally ill patients turn away from traditional medical care. When the patient is well informed and feels cared for by others, and is satisfied with interpersonal aspects of their medical care, he/she is less likely to look for alternative remedies.

Terminal Patients

-Many terminal patients will receive palliative care (care designed to make the patient feel comfortable), rather than curative care (care designed to cure the patient). a. Working with terminally ill children is perhaps the most stressful of all terminal care. As a result, family members, friends, even medical staff may be reluctant to talk openly with a dying child about their situation. However, terminally ill children often know more about their situation than they are given credit for. Children use cues from their treatments and from the people around them to infer what their condition must be.

Consequences of Stroke

-Stroke affects all aspects of one's life. Personal, social, vocational, & physical. Impairments occur on the side opposite to the stroke side. a. Motor Problems - Immediately after a stroke, motor difficulties are common. Usually difficult or impossible for the patient to move the arm & leg on the affected side. Stroke almost inevitably leads to increased dependence on others. With physical therapy some of these problems are diminished. b. Cognitive Problems - depend on which side of the brain was damaged. b1. Left-brain damage: communication disorders such as aphasia (difficulty in understanding others & expressing oneself). Problems with short-term memory. b2. Right-brain damage: May be unable to process or make use of certain kinds of visual feedback (ie. only shave one side of the face, put makeup on only one side of the face), may have difficulty perceiving distances correctly (may bump into objects or walls), may think they are hearing voices if a speaker is on the impaired side c. Emotional Problems - Patients with left-brain damage often react to their disorder with anxiety and depression. Patients with right-brain damage more commonly seem indifferent to their situation.

Survivors

-The death of a family member may be the most upsetting and dreaded event in a person's life. For many people the death of a loved one is a more terrifying prospect than their own death or illness. After the patient dies there are activities related to the death and settling the estate. Abruptly the activities cease, visitors return home, the patient has been buried or cremated...the survivor is left alone. a. Grief - a response to bereavement involving a feeling of hollowness & sometimes marked by preoccupation with the dead person, expressions of hostility toward others, and guilt over the death. May also experience yearning for their loved one and anger or depression especially during the first 6 months. Health problems are common also. b. Many widows & widowers are still deeply troubled by their spouse's death several years later. The grief response may be more aggravated in men, in caregivers, and in those whose loss was sudden and unexpected.

Eutanasia

-ending the life of a person who is suffering from a painful terminal illness. -In 1994 Oregon became the first state to pass a law permitting physician-assisted dying. -Several states since have also approved physician-assisted dying. -A 1997 Supreme Court ruling did not find physician-assisted dying to be a constitutional right, however, the Court left legislation to individual states.

Risk Factors for CHD

-high cholesterol, high blood pressure, elevated levels of inflammation, diabetes, smoking, obesity, little exercise, stress, and the metabolic syndrome: when a person has 3 or more of the following: obesity centered around the waist, high blood pressure, low levels of HDL (good cholesterol), difficulty metabolizing blood sugar, high levels of triglycerides. -Other Risk factors: 1. Hostility - hostile people have more interpersonal conflict in their lives & less social support. Their reactivity to stress seems especially engaged during these episodes of interpersonal conflict. They have larger and longer-lasting blood pressure responses to anger-arousing situations. 2. Depression - affects the development, progression, and mortality from CHD. Depression is also linked to risk factors for: coronary heart disease, metabolic syndrome, inflammation, likelihood of a heart attack, heart failure, mortality, suicide

Risk factors for Stroke

-overlap those for heart disease. Includes high blood pressure, heart disease, cigarette smoking, a high red blood count. a. Transient ischemic attacks (TIAs) - little strokes that produce temporary weakness, clumsiness, or loss of feeling in one side or limb, a temporary dimness or loss of vision or a temporary dimness of vision, or a temporary loss of speech or difficulty understanding speech. b. likelihood of a stroke increases with age c. occurs more often in men d. a prior stroke or a family history of stroke also increases the likeliness e. stress f. depression & anxiety

Give Health Implications of Type II Diabetes

-thickening of the arteries, blindness, kidney failure, nervous system damage, Alzheimer's disease. Consequence of all these complications is shorten life expectancy. -Adherence to lifestyle changes is problematic: Type II diabetics are often unaware of the health risks they face. Many fail to recognize that they have a chronic health condition that requires sustained commitment to medications and behavior change

Cardiac Invalidism

a psychological state that can result after a myocardial infraction or after a diagnosis of coronary heart disease, consisting of the perception that a patient's abilities & capacities are lower than they really are. Patients & their spouses are vulnerable to these misperceptions.

Rehabilitative Interventions for Stroke

5 approaches: medication, psychotherapy including treatment for depression, cognitive remedial training to restore intellectual functioning, movement therapies, the use of structured stimulating environments to challenge their capabilities, stem cell transplantation shows promise.

What is the US's infant mortality rate? Who are more likely to die during the first year of life?

5.97 per 1,000 (higher than most Western European nations). African Americans & Hispanic infants are still more than twice as likely to die during the first year as White infants are. The countries that have a lower infant mortality rate than the U.S. all have national medical programs that provide free (or low cost) maternal care during pregnancy. This may be a factor in the high infant mortality in the U.S.

Describe Stroke

A condition that results from a disturbance in blood flow to the brain, often marked by resulting physical or cognitive impairments and in the extreme, death.

Describe Type I Diabetes

Autoimmune disorder characterized by the abrupt onset of symptoms which result from lack of insulin production by the beta cells of the pancreas. More serious of the two types of diabetes. The immune system falsely identifies cells in the pancreas as invaders and destroys these cells, compromising or eliminating their ability to produce insulin. The disorder may appear following viral infection and probably has a genetic contribution. Stress may precipitate Type I diabetes in those with a genetic risk.

Describe CHD

CHD is a general term that refers to illnesses caused by atherosclerosis (narrowing of the coronary arteries, the vessels that supply the heart with blood). Temporary shortages of oxygen and nourishment frequently cause pain called angina pectoris. When severe deprivation occurs, a heart attack (myocardial infarction) can result

Describe Arthritis and give stats

a. Arthritis is the most prevalent of the autoimmune diseases (autoimmune diseases - the body falsely identifies its own tissue as foreign matter & attacks it) b. Stats: one of the most common causes of disabilities. About 53 million people in the U.S. are afflicted with arthritis severe enough require medical care. Projected to rise to 67 million by 2030 due to the aging of the population. Rarely fatal. Ranks 2nd to heart disease as the most widespread chronic disease in the U.S. today.

What are chronically stressful events linked too?

They are linked to adverse effects on almost all functional measures of the immune system. Chronic low-level inflammation which can occur in response to chronically stressful conditions contributes to a broad range of disorders including heart disease & declines in cognitive performance. b. Children & adults under stress show increased vulnerability to infectious disease including colds, flus, herpes virus infections (such as cold sores or genital lesions), chicken pox, mononucleosis, Epstein-Barr virus. c. Depression is associated with several alterations in cellular immunity & with inflammation. The more depressed a person is, the more cellular immunity is likely to be compromised

At what age is Type II Diabetes most prevalent?

Until recently, Type II (non-insulin-dependent) diabetes was typically a disorder of middle & old age. As obesity has become rampant & the consumption of sugary foods & drinks has increased, Type II has become more prevalent at earlier ages. Children & adolescents are now at risk for Type II diabetes.

When does Type I Diabetes develop?

Usually develops relatively early in life (earlier in girls than boys). Two common time periods when the disorder arises: between the ages of 5 & 6 OR between 10 & 13.

Women and CHD

Women and CHD - leading killer of women in the U.S. & most other developed countries. Heart disease typically occurs later for women, but it is more dangerous. Women have a 50% chance of dying from a first heart attack (compared to 30% for men). Of those who survive their heart attack, 38% will die within a year (compared to 25% of men). Women may be protected against early onset coronary disease by factors related to estrogen (estrogen diminishes sympathetic nervous system arousal). Women's risk of coronary heart disease goes up substantially after menopause. May explain this rising risk: weight gain, increases in blood pressure, elevated cholesterol & triglycerides, and heightened cardiovascular reactivity. (Estrogen replacement my increase these risks)

Talk about health Services

a. Our health care is marked by at least three basic problems: health care costs too much, the system is grossly inequitable & health care consumers use health care services inappropriately. Also, trends within medical care suggest that the problem of patient-provider communication may get worse (not better). b. The most significant change in American health care that has implications for health psychology - increasingly patients are receiving their medical care through pre-paid, colleague-centered services (rather than through private, fee-for-service, client-centered practices.) These changes can improve the quality of medical care, but they may sacrifice the quality of communication. Although the well-to-do can pay for emotionally satisfying care, the poor cannot. c. Changes in society, technology, and microorganisms themselves are leading to the emergence of new diseases, the reemergence of diseases that were once controlled, and problems with drug-resistant strains of once-controlled disorders. d. A trend within medicine that affects health psychology is the movement toward comprehensive intervention models = models that pool and coordinate the medical & psychological expertise in a well-defined area of medicine practice so as to make all available technology & expertise available to a patient. 1. Examples: pain management (all available treatments for pain are brought together so that individual regimens can be developed for each patient) hospice (palliative management technologies & psychotherapeutic technologies are available to the dying patient) Coronary heart disease (coordinated residential and outpatient rehabilitation programs in which health habits are dealt with simultaneously)

Stats for Hypertension

a. Serious medical problem. b. recent estimates: over 29% of U.S. adults have high blood pressure. Because there are no symptoms, nearly 1/3 of these people do not know they have it. c. About 47% of adults in the U.S. may be at risk for hypertension d. it is a risk factor for other disorders (heart disease, kidney failure). e. untreated hypertension can affect cognitive functioning. a2.Approx. 5& of hypertension is caused by failure of the kidneys to regulate blood pressure b2.Almost 90% of all hypertension is essential (unknown origin)

Give symptoms of Type II Diabetes

frequent urination, fatigue, dryness of the mouth, impotence, irregular menstruation, loss of sensation, frequent infection of the skin, gums, or urinary system, pain or cramps in legs, feet, or fingers, slow healing of cuts & bruises, intense itching & drowsiness

Describe Gout

inability to excrete uric acid in the urine. Uric acid forms crystals which may become lodged in the joints. Results from a buildup of uric acid in the body. About 1 million Americans (mostly men) are affected. Exact cause not known but it appears to be triggered by stress & certain foods.