Health Psychology Final Study Guide
Health Psychology Final Study Guide Psyc 3128
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This 27 page Study Guide was uploaded by Maya Blair on Thursday April 28, 2016. The Study Guide belongs to Psyc 3128 at George Washington University taught by Thomas Nassif in Winter 2016. Since its upload, it has received 113 views. For similar materials see Health Psychology in Psychlogy at George Washington University.
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Chapter 7—Stress and Coping 1.) Distinguish between chronic and acute stressors (202) Chronic stressors ● Situations that present multiple daily stressors that continue for months without foreseeable endpoint Acute stressors ● Acute timelimited stressors ● Stress during manipulated or staged events such as public speaking or mental math ● Activities of short duration, ranging in time from approximately five to 100 minutes 2.) Be familiar with Cannon’s Fight or Flight theory ● Focuses specifically on the body’s physiological response to stressinducing stimuli ● Cannon proposed that stress is best understood as the body’s biological activation in response to stressproducing stimuli ● Sympathetic and endocrine systems activate “fightorflight” response to potential dangers 3.) Know the divisions and functions of each part of the nervous system (p.204; figure 7.1) ● The Nervous System the body’s network of cells that communicate information about itself and its environment. Two major parts: 1.entral Nervous System ➢ Responsible for receiving and responding to information obtained through our sensory receptor site (eyes, ears, nose, and fingers) ➢ Coordinates the communication between the receptor sites, the spinal cord, and the brain, the processing center for our sensory experiences 2.Peripheral Nervous System ➢ Contains two substructures: the autonomic nervous system and the somatic nervous system ANS ○ Most relevant when describing the body’s response to stress ○ Controls the automatic and involuntary functions that are essential for living (ex. Heart rate, digestion, and perspiration) ○ Also contains two substructures which play a role in our body’s response to stress: the sympathetic nervous system and the parasympathetic nervous system Sympathetic Nervous System Parasympathetic Nervous System Activates the body’s response to Takes control once the threat danger, emergencies, or foreign has abated microorganisms that invade the Responsible for returning body the body to its normal or When activated, the SNS puts in baseline stateallostasis) motion a series of physiological Allostasis = ability to changes that may signal danger maintain a steady and a need to either defend (fight) physiological state (ex. or flee (flight) Blood pressure, heart, and respiration rates) 1 4.) Be familiar with the physiological changes elicited by the parasympathetic vs. sympathetic nervous system. 5.) Know the hormones released by the adrenal medulla (catecholamine: epinephrine, norepinephrine) and adrenal cortex (glucocorticoids: cortisol). ● Endocrine System a second system critical to the body’s response to stress. A communication system that sends messages using ductless glands that releasehormones directly into the body’s bloodstream. ● Hormones chemical messengers that facilitate the body’s communication process ● Two glands release hormones in response to stress: the pituitary glands and the adrenal glands . The adrenal glands consist of the adrenal medulla and the adrenal cortex ADRENAL GLANDS Adrenal Medulla ➢ Found in the inner layer of the adrenal glands ➢ When stimulated by sympathetic nervous system, the adrenal medulla produces catecholamine , a class of chemicals that contains epinephrine (adrenaline), norepinephrine. Adrenal Cortex ➢ The outer layer of the adrenal glands ➢ When stimulated by ACTH, the adrenal cortex releases glucocorticoids , which includes and cortisol (the major stress hormone) 2 6.) Be familiar with the effects of glucocorticoids on inflammation, allostasis, and the immune system (both shortterm and longterm) (207) Glucocorticoids ● Are antiinflammatory agents that play a role in response to stress ● Protects the body from shortterm effects of stress ● Activate the immune system and immune defenses when the body is exposed to stress ● Play a role in returning the body llostasis ○ By returning to allostasis, glucocorticoids can play a role in preserving health of some organs ● When experiencing prolonged or chronic stress, levels may remain high. ○ High levels could suppress the body’s immune system and expose the body to illnesses such as infections, depression, clogging of arteries ○ Prolonged production of glucocorticoids may make body susceptible to illness/disease ● So while glucocorticoids protect the body fromshortterm effects of stresprolonged production of this agent may make the body susceptible to illness 7.) What is the name of the system responsible for restoring the body to allostasis, and what brain area/glands are involved? (206) Sympathetic via Adrenal Glands ?? Adrenal Cortex??? Glucocorticoids??? Parasympathetic Nervous System Takes control once the threat has abated Responsible for returning the body to its normal or baseline state allostasi) Allostasis = ability to maintain a steady physiological state (ex. Blood pressure, heart, and respiration rates) 8.) What are the benefits of oxytocin for stress and cardiovascular health? (207 and see video ● Triggers the “tend and befriend” response ● Same hormone that stimulates the maternal behavior and milk production needed to sire an offspring (tend) and the desire to seek social affiliations (befriending) ● “The Hug Hormone” released when you hug someone ● A STRESS hormone Benefits ➢ Mild sedation ➢ Lowered blood pressure ➢ Lowered pain sensitivity ➢ Decreased glucocorticoid secretion 3 From Video ➢ Makes you crave physical contact ➢ Enhances empathy and makes you more willing to help and support the people you care about ➢ Motivates you to seek support, nudges you to tell someone how you feel ➢ When life is difficult your stress response wants you to be surrounded by people who care about you ➢ Protects cardiovascular system from the effects of stress! A natural antiinflammatory. Helps blood vessels stay relaxed during stress. ➢ Helps heart cells regenerate and heal from any stress induced damage. This “stress” hormone strengthens your heart. ➢ ALL of these physical benefits of oxytocin are enhanced by social contact/support. SO when you reach out to others under stress, either to seek support or to help someone else, you release more of this hormone, your stress response becomes healthier, and you recover faster from stress ➢ Caring creates resilience. How you think/act can transform your experience of stress. https://www.youtube.com/watch?v=RcGyVTAoXEU 9.) Be familiar with the results of the study on the effects of music on postoperative coronary artery bypass patients (227) ● Shows a clear link between postoperative music intervention and psychological and physiological wellbeing ● Results showed that patients on the bed rest with music intervention had higher oxytocin levels and higher subjective relaxation levels than those in the bed restonly condition ● Not only did these patients report being more relaxed, their physiological response as determined by their oxytocin levels also confirmed their subjective assessment ● Music = beneficial for BOTH the psychological and physiologica health of the study participants 10.) Know and briefly describe the 3 steps of the General Adaptation Syndrome and 3 criticisms of this theory (208209) ● Reveals the important association between stress and illness 3 Steps ➢ Alarm stage ○ The organism first experiences shock at the initial and immediate impact of the stressinduced agent ○ Initial response might include lowering of the body’s blood pressure or body temperature ○ Body proceeds to the countershock phase, in which the organism prepares to respond defensively to the stressproducing agent. In this phase we see the fightorflight reaction ○ Body starts to release higher levels of adrenaline and increase respiration and blood pressure rates. Activates the sweat glands as the body prepares to respond ➢ Resistance ○ If the stressor persists, the body maintains it’s increased and sustained resistance to the stress agent ○ Sustained resistance to one stressor decreases the body’s ability to withstand or defend against other agents ○ While fighting one agent intensely, the body is vulnerable to attack by other stress agents ➢ Exhaustion ○ Prolonged exposure to stressors (chronic stress) can cause symptoms similar to those that appear during the alarm stage 4 ○ Stresses have exhausted our body’s defense system and illnesses may form ○ Illnesses may include hypertension or gastrointestinal ulcers (sometimes even allergies) 3 Criticisms ➢ Inability to explain the role of psychosocial factors on illness ➢ Lack of distinction between shortterm versus longterm stress on the immune system ➢ The attenuated link between stress and illness (too quick to link a stressor to an illness) 11.) Understand the diathesisstress model of disease, and how it can be used to explain depression and chronic pain (215). ● States that an individual’s biochemical or organ imbalances can predetermine their reaction to environmental stressors, which can result in physical symptoms of illness ● In other words, a biological predisposition and an environmental precipitating factor are necessary determinants to cause the onset of a stressrelated illness ● Diathesis triggered by astresso has been proposed as a possible explanation for psychopathology such as schizophrenia, depression, and physiological illness such as chronic pain ○ Diathesis: biological or psychological predisposition to an illness ○ Stressor an environmental precipitating factor ■ Premis: a biological predisposition and an environmental precipitating factor are necessary determinants for onset of a stressrelated illness ● If depression is a preexisting condition in someone who developed a chronic pain, then the person’s preexisting psychological state may increase the likelihood of developing major depressive symptoms in response to the ongoing pain. In this instance, depression is the psychological diathesis, and chronic pain represents the stressor 12.) Which personality type and characteristics are associated with Coronary artery disease? ➢ Type A (unhealthy ELEMENTS: anger,hostilit and ggression contribute to illness. NOT the personality type itself highly competitive, need for achievement, impatient) Heartrelated health problems? (216) ➢ Type D ( stres, nxiety ostilit anddepression) 5 13.) What does the social readjustment rating scale measure? How does the daily life hassles scale differ, and why do some believe it is a more accurate assessment of the effects of stress on wellbeing? (219221) Social Readjustment Rating Scale ● Measures the impact of stressful psychosocial stimuli on health outcomes ● 43item scale including a list of life events, rank ordered from most to least stressful ● Each life event is associated with a life change unit score: a measure of the perceived stressfulness of the event on a scale from 100 to 0 ○ Ex. Death of a spouse = 100, highly stressful event. Outstanding personal achievement = 28, lease stressful Daily Life Hassles & Stress ● Frequently occurring daily hassles of life are more likely to cause negative health outcomes than a major event ● Major infrequently occurring events cannot explain frequent incidences of stress individuals claim to experience ● Daily hassles can lead to adverse health outcomes over time if not managed successfully ● Hassles Scale assesses frequency and level of aggravation associated with daily and usual issues (ex. owing money or being lonely) 14.) Distinguish between problem vs. emotionfocused and engagement vs. disengagement coping ProblemFocused Coping Strategy EmotionFocused Coping Strategy Seek information and generate solutions to Seeking solace or emotional support from address the issue others but may also receive help/guidance Most effective coping strategy Engagement Disengagement Hybrid of problem solving and Withdrawal from the problem or denial of its emotionalfocused coping existence Goal is to obtain helpful information but also May include attempts to address problem empathetic connection without help or reliance on substances to withdraw Least effective strategy 15.) Know the beneficial effects of laughter on the body and release of hormones (see video https://www.youtube.com/watch?v=J5sSgdJIU5g and 228) ● Physical act of laughing causes changes in the body’s physiology, including reduction of muscle tension, increased oxygenation of the blood, and release of endorphins ● Used as an adjunct therapy for persons with cardiovascular disease. Report that patients who received combined therapy had incidences of arrhythmia, fewer incidences of heart attack, and lower blood pressures than did patients who received only standard therapy ● Changes a person's emotional state → makes you feel better ● Humor → positive mood → moderates pain perception ● Humor can moderate stress Video ● Breathing and laughing will improve your health (even if you have to fake it) ● Decreases stress hormones, improves immune system, boosts endorphins 6 ● Even the anticipation of laughter produces some of the same beneficial results ● Positive outlook (optimists) = less likely to get the flu 16.) What is the effect of stress on food consumption? ● Stress influences amount and type of food consumed ○ Causes increase in consumptions of sweet or salty foods ● Tendency is most prevalent in restrained eaters (people who frequently monitor food consumption) How do women and men differ? (232233) ➢ Women are more likely to increase food intake in response to stress 7 Chapter 8—HIV and AIDS 17.) Define psychoneuroimmunology, and understand how it relates to HIV (240 and 272273) ● Psychoneuroimmunology a field that examines mental health (psychology) as a cofactor in the progression of diseases involving the central nervous system (neurology), and the immune system (immunology) ● Research suggests that the progression of HIV, its speed, and its impact on daily functioning may affect a person’s mental, psychological, and physiological state 18.) Know the 2 criteria for diagnosis of AIDS (241242) ● A person is diagnosed with AIDS when two things occur 1. Individual’immune system is suppressed, making it difficult to resist infections 2. His or hehite blood cell count falls below 2cells per microliter of blood Know how this contributes to opportunistic infections. ➢ Diminished white blood cell count suppresses the immune system and allows for opportunistic infections Know the 2 types of opportunistic infections most often associated with AIDS ➢ Pneumonia ➢ Kaposi Sarcoma 19.) Distinguish between innate vs. adaptive immunity, and provide examples of each (242243) ● Innate (natural) Immunity ○ Protects our bodies from foreign substances. Readily visible. Body’s first line of defense. ○ Ex. Skin, saliva, mucus, urinary tract ○ Ex. SKIN ■ First layer of the skin (epidermis) thin outer layer. Waterproof. Work to repel germs and other foreign matter from the body’s surface and prevents germs from penetrating the skin. Second layer of the skin (dermis) thicker than the epidermis. Contains blood vessels, hair follicles, and glands that secrete oil. Oils maintain pH balance and inhibit the growth of microorganisms (germs) ● Adaptive (acquired) immunity ○ If a microorganism evades the body’s natural immunity ○ Ex. B and cells that reside in blood and other body fluids ○ Ex. Bmemory and B antibody; TC H S 20.) Be familiar with the 2 types of B lymphocytes. ● B lymphocytes form in the bone marrow until mature 1. Bmemory “remembers” prior invading microorganisms. Able to detect, identify, and eliminate it more quickly 2. Bantibody forms specific antigens to attack invading microorganisms Know the role of T helper cells in the immune system (i.e. cytokines, antibodies, Bmemory cells, CD4) ● T helper cells produccytokines (agents that produce antibodies*) ● T helper cell help activate Bmemory cells ● T helper cells displaCD4* glycoproteins on the surface of the cell 8 *Antibodies fight invading viruseCD4 cells are an important measure of the strength of the immune system What CD4 cell count tells us about the health of an individual (i.e. healthy, asymptomatic, seroconversion to AIDS) CD4 Cell Counts In Individuals (cells per microliter of blood) ➢ Healthy 500 1500 ➢ Asymptomatic 500 + ➢ Seroconversion 200 499 ➢ AIDS below 200 *CD4 cells are an important measure of the strength of the immune system, CD4 cells tell us how many T helper cells are in the system* 21.) Distinguish between DNA vs. RNA viruses, and understand why HIV is so difficult to target by the body’s immune system (246) ● DNA Virus (DNA → RNA) ○ DNA virus contains one strand of DNA ○ When a DNA virus enters the body, it copies its genetic code ontviral RNA, the agent that helps the virus reproduce ○ Viral RNA easily identified and destroyed by the immune system ● RNA Virus (RNA → DNA) ○ HIV is aretrovirus which means it stores its information in the form of RNA ○ The virus converts its genetic RNA into viral DNA ○ As recoded DNA, HIV inserts itself into cell nucleus ○ Hides undetected until time to reproduce ● HIV targets and attacks the immune system. The repeated exposure to infections and viruses further weakens the immune system and eventually renders the body unable to destroy even minor viral infections 22.) Know and briefly describe the 3 methods of HIV transmission (248). HumantoHuman Transmission 1. Sexual intercourse ➢ Majority of HIV cases ➢ HIV carried in semen, vaginal fluids, and blood ➢ Salava not a good conduit of HIV virus 2. Parenteral (bloodborn) transmission ➢ Includes blood transfusions, infected needles, and intravenous drug use 3. Perinatal (mothertochild) transmission (MTCT) ➢ During birth 23.) What 3 groups were believed to have the highest rates of HIV in the 1980’s? ● Homosexual men ● Intravenous drug users ● Haitians 9 Was simply belonging to one of these highrisk groups enough to increase the risk of someone getting HIV? Or was there another factor that increases susceptibility to HIV? Explain (253) ➢ The increased risk came from their behaviors, not their status ➢ For instance, gay men are are more likely to contract HIV BECAUSE they engage in high risk sexual practices that led to high probabilities of open anal sores and multiple sex partners.IVDU were at high risk BECAUSE of their tendency to share needles. Haitians were a mistake. Overestimated risk based on a very small sample. ➢ We now know that highrisk behaviors, not highrisk populations, increase susceptibility to HIV 24.) What are two explanations for why rates of HIV have increased among women? (254) ● Incidence rates increasing faster than other groups ● Two explanations 1. Due to the highrisk behaviors of women and men 2. Risk factor for sex workers 25.) Why does the author contend that individuals 1524 years of age are the largest newly infected group of HIVpositive individuals? ● Because when they compare prevalence rates across age groups, they find that the highest HIV prevalence occurs among 25 44 years of age. Remembering the 8 to 10 year dormant period for the virus, they conclude that individuals who are currently 25 44 years of age and are newly diagnosed as HIV positive contracted HIV when they were between 15 and 34 years of age Approximately what percent of newly infected adolescents are represented by different ethnicities? (254). ➢ 57% African American ➢ 19% Hispanic ➢ 19% White What are 2 possible reasons for this disparity in HIV rates, and what could be done to address it? (bottom of 257) 1. Education African American adolescents initiate sexual behavior early than other groups but are less likely to receive information about safer sexual practices HOW TO ADDRESS Realize the problem and address the barriers to implementation of the health policy 2. Peer Influence Influenced by behavior of peers Misperceive the extent of their friends’ involvement in highrisk behaviors or inflate the number of friends involved Adolescents’ beliefs about friends’ behavior constitute one individual determinant of health that contributes to the risk of contracting HIV HOW TO ADDRESS Correct their misperceptions 10 26.) What is an epicenter, and what two cities reported the highest rates of HIV worldwide? (p. 255) ● Epicenter geophysical foci of the disease ○ New York City ○ San Francisco 27.) Provide 2 reasons why many HIVpositive individuals have a lack of access to healthenhancing medicines (i.e. health care systems, pharmaceutical companies), and a solution that other governments have proposed (261). Access to health care ● Access to health care influenced by SES ● Inverse relationship between SES and HIV prevalence (lower SEC = higher HIV prevalence) ● If finding is replicated in other cities and countries, it may explain the increasing global relationship between racial disparities in HIV prevalence and socioeconomic class Reasons for Lack of Access to Medicine Comes down to cost 1. Decision by health care systems not to subsidize the cost of HIV medication 2. Pharmaceutical companies that manufacture HIV medications determine the market price of their product. To recoup their expenses and make a profit, they establish a high price. Thus, the price of medications set by the manufacturer may also limit access to care Solutions ➢ Gay Men’s Health Crisis: implemented successful social marketing campaign that informed their audience (gay men) about the virus and effective means of prevention. Also directed them to agencies to obtain testing, counseling, and health care services ➢ Ugandan HIV Prevention Program : Ugandan government campaigned to halt the spread of HIV among the most vulnerable population, adolescents and young adults 15 to 24 years of age. Included a large scale social marketing campaign similar to that developed by GMHC. Goal: raise awareness, delay onset of sexual behavior, increase testing, and increase condom use. Campaign halted the spread of HIV in Uganda and served as a blueprint for intervention programs that work in Africa as well as Europe and Asia. Lowered HIV rate 28.) Know the 3 statistics of the region of the world most affected by HIV (262) ● SubSaharan Africa 1. 10% of the world population 2. 70% of the world’s HIVpositive adults 3. 80% of the world’s HIVpositive children 29.) Is risky sexual behavior responsible for the high rates of HIV in this region of the world, or is there another explanation? Briefly discuss (p. 264) ● High rates of risky sexual behavior are unlikely to be responsible for the high rates of HIV in this region because sexually risky behavior is inconsistent with the values of the people of Southern Africa. ● One possible explanation is that HIV and malaria are linked. ● Dual Infection Theory malaria increases the risk of HIV and vise versa. Individuals with a suppressed immune system are more likely to be infected. Reasoning is that malaria and HIV occur in similar geographic areas and also we see spikes in HIV and malaria rates after rainy seasons. Further, lab studies suggest that malaria appears to induce replication of the virus. 11 30.) What is the waiting period of the ELISA test vs. Rapid HIV test? Which test is preferable and why? (266). ELISA ➢ Results take 2 weeks ➢ At least 25% of individuals do not return for their results Rapid HIV Test ➢ No delayed results (20 minutes) Preferred because... ✓ They lessen stress and anxiety on the individual ✓ Reduces the 25% attrition rate of individuals who refuse to return ✓ Allows for immediate counseling and other psychological services if needed ✓ Can be done in pointofcare facilities (communitybased testing! Improves access to care! Reduces travel time AND repeated costs associated with multiple visits) 31.) How are antiretroviral drugs used to treat HIV? (You do not need to know the names of the 3 drugs.) ● Medications that slow the progression of HIV and allows for the immune system to recover ● 21 different antiretroviral drugs approved by FDA but a combination of three drugs (“drug cocktail”) has proven to be the most effective What is HAART, and how does it work? (268) ➢ Highly Active Antiretroviral Therapy ➢ Triple drug combination therapy dramatically improves health outcomes ➢ Drugs slows the virus’s ability to replicate itself (thus slowing the reproduction of HIV) ➢ Prolongs life: 11.3 year gain in South African community ➢ Decreases transmission rates : 38% 12 Chapter 9—Cardiovascular Disease 32.) Know the structures of the heart (figure 9.1) and the direction of oxygenated vs. deoxygenated blood flow through the different chambers, valves, and blood vessels (278279) ● 2 sides; 4 chambers (2 per side) ● Chambers: Right and leftatria andventricles 1. Deoxygenated blood from organs → right atrium → right ventricl → pulmonary arteries → lungs 2. Lungs reoxygenate blood (resupply blood with new oxygen) → left pulmonary veins → left atrium → left ventricl → aorta → oxygenrich blood goes on to the organs ***Arterie: vessels carrying blood to other organVeins blood vessels that carry blood from the capillaries towards the heart;Capillarie: small blood vessels with very thin walls that connect the arteries 33.) Some behaviors increase the risk of cardiovascular disease. What are 4 examples? 1. Poor diet 2. Lack of exercise 3. Smoking 4. Alcohol consumption What do we call these behaviors and why? (281) ➢ Modifiable risk factors implies that individuals can modify their risk of having a cardiovascular disease by changing behaviors 34.) Distinguish between the 4 types of cardiovascular disease (specifically what goes wrong in each health condition and the cause) : CAD, cardiac arrest, stroke, hypertension (280283). CAD ➢ Most common type of cardiovascular diseaseleading cause of heart attacks ➢ What goes wrong: arteries that pump blood to and from the heart become partially or completely obstructed. Less blood flowing through the arteries = less blood for the heart and other organs. ➢ Cause: atherosclerosis (lining of plaque on the arteries of our circulatory system). Can reduce the risk by changing lifestyle. 13 Cardiac Arrest ➢ What goes wrong: heart fails to pump blood to other organs. Cardiac arrest renders a person unconscious and is fatal unless the heart is jolted back into its normal rhythm with 10 minutes (7 minutes there will be brain damage) ➢ Cause: ventricular fibrillati an abnormal heart rhythm, is precipitatinactor. Coronary artery disease is redisposingfactor Stroke ➢ AKA cerebrovascular disease ➢ Strokes affect the vessels that carry blood and oxygen to the brain, due to plaque buildup ➢ Two kinds: ischemic strok (interruption of blood flow to the brahemorrhagic stroke (rupture of blood vessels in the brain) ➢ Cause: hypertensio the excessive force of blood pumping through the blood vessels can prompt a hemorrhagic stroke Hypertension ➢ AKA high blood pressure ➢ Characterizes the effect of the illness on the heart ➢ Systolic pressure anddiastol pressure are higher than normal ➢ Hypertensive person will show signs of an enlarged heart. When the muscle is enlarged, it has reached its threshold of efficiency and cannot push blood through the chambers as efficiently as before. ➢ Known as the silent ki(easy to escape detection) ➢ Cause ○ Essential/primary hypertension no known or identifiable causes. Contributing factors may be genetics and stress. ○ Secondary hypertension caused by healthinhibiting behaviors such as highfat/calorie diets, lack of exercise, and smoking. 35.) What is cardiovascular reactivity, and how is racism and stress thought to affect the heart? (286) ● Cardiovascular Reactivity ○ The body’s return to a baseline blood pressure and heart rate at the conclusion of a stressful event ○ More reliably measures impact of perceived racism on physiological health ● Stress and racism can elevate diastolic blood pressure rates and lead to early onset and longterm hypertension, especially in African Americans 36.) Are all carbohydrates and fats unhealthy? Explain why some are less healthy than others (290) ● Includes starches and sugars ● Found in breads, pastas, potatoes, and cereals ● The main component of a carb is a sugar molecule; when consumed in excess, carbs are taken in as sugar and turned into fat, an ingredient that is needed only in small quantities ● But NOT ALL CARBS ARE BAD. Foods such as whole grains, beans, cereals, breads, and brown rice are GOOD sources of carbs ○ Low levels of good carbs helpful for more effective, longterm weight loss than no carbs ○ Additionally, low levels of good carbs in combination with other healthy elements, can protect our heart health 14 37.) Explain 2 reasons why heart disease was less recognized among women, as compared to men (i.e. age of onset, symptoms) A first men were overrepresented in research studies based on the belief that women didn’t experience as much job stress as men. Age of Onset ➢ Heart disease for women appears at a later point in life than men ➢ Men report the first signs of cardiovascular health problems in their late 40s. Women in their 50s. Symptoms ➢ Men generally report tightness in the chest, shortness of breath, and possibly pain in the left arm ➢ We now know the classic warning signs of heart disease in women are pain in the neck and shoulder, lower back pain, and possibly shortness of breath ➢ Implication: medical providers trained to look for the indications more common among men will miss or misinterpret the symptoms reported most often by women! 38.) Be familiar with the results from the study comparing an Amish population in a rural setting against an urban/suburban population in Minnesota (298). ● Highlights the role of risk factors in heart disease ● Amish high levels of physical activity associated with farming and less reliance on technology ● Minnesota Population urban lifestyle meant less physically demanding work. ● Both groups white What risk factors were believed to lead to higher rates of artery calcification? ➢ Results were that the AMISH had higher levels of coronary artery calcification ➢ Due to diets which contained significantly higher levels of calories, fats, and proteins ➢ Interestingly, ⅓ of the Rochester group used medication to lower cholesterol or blood levels. Therefore, although the Amish diet lead to higher rates of artery calcification, it was not, apparently, high enough to require medication. This study supports the notion that physical exercise in combination with lowfat, lowcholesterol diets, could improve heart health and lower rates of heart disease 15 Chapter 10—Chronic Pain and Arthritis 39.) Why do many health organizations believe that chronic pain should be considered a disease in its own right? (307) Because protracted pain often defies health providers’ best efforts to locate and diagnose the problem. Thus it is not surprising that the chronic pain that can accompany a medical problem may go untreated or undertreated even after the principal problem is resolved. 40.) Distinguish between nociceptive pain vs. neuropathic pain (308) Nociceptive Pain Neuropathic Pain Caused by disease or damage to tissue Malfunction of our nervous system Receptors called nociceptors located Due to damage or lesions of somatosensory throughout body and send nerve projections to system (receptors that transmit information spinal cord. Projections trigger two actions from body and environment → central A spinal reflex sends commands to nervous system) muscles The second reflex sends information about the discomfort to the brain Examples Spontaneous shooting or burning sensations, Forms of Nociceptive Pain greater discomfort than normal in response to Visceral Somatic normally painful stimulus, and sensations of aching, throbbing, or soreness when Nonlocalized and Localized and usually encountering nonpainful stimuli episodic pain time limited Involving major organs Involving bone, joint, Diabetes, some cancers, and alcoholism can May be referred to muscle, skin, or trigger neuropathic pain because of the distant site connective tissue Pain in hollow organ Aching, throbbing damage they can cause to the nervous system (intermittent cramping) Exception: arthritic pain is somatic nociceptive pain but not time limited Nociceptive AND Neuropathic Pain = combination. Common example: migraine headaches 41.) Be familiar with the Gate Control Theory (308309) ● Pain is multidimensional and subjective experience ● Gate mechanism located in the dorsal horn of the spinal cord permits or inhibits pain signal to brain ● Dorsal Horn ○ Sensory nuclei in spinal cord ○ Receive and process all incoming sensory information ○ Receive information from the brain about the psychological and emotional state of the person experiencing the discomfort/pain ○ This psychological information can regulate the transmission of pain signals, influencing a person’s perception ○ This psychological process may help explain individual differences in response to the same painful stimuli 16 42.) Research on experimentally induced pain found that persistent pain resulted in selective release of ENDOGENOUS OPIOIDS in specific brain regions (309) 43.) Understand the relationship between emotional reactivity, pain perception, and the amygdala (p. 310) ● The amygdala is the site for individual differences in the regulation of emotion ● In one study, participants were able to successfully regulate their response to negative pictures. They were also able to successfully regulate pain over two years ● These researchers demonstrated that these emotion and painregulation skills are shared and are located in the amygdala, thus suggesting a relationship among painful sensations, emotional reactivity, and the brain (i.e. emotion and pain regulation skills are shared and located in amygdala) 44.) What is the most likely explanation for the difference in pain tolerance between African Americans and nonHispanic whites? (i.e. pain perception vs. functional disability) (311312) ● Current studies suggests that differences in pain perception is due (at least in part) to a difference in the treatment or management of pain across ethnic groups ○ African Americans report more functional and jobrelated disability due to pain ○ Studies have found unequal treatment or mismanagement of pain for minority groups 45.) Define degeneration, inflammation, and progressive disease (315) ● The three characteristics that define arthritis. Arthritis is a physiologically based disease caused by either degeneration or by inflammation. It is also a progressive disease. Degeneration ➢ Gradual wearing away or erosion of the bones near the joints Inflammation ➢ A swelling of the tissue surrounding the bones and joints Progressive Disease ➢ Arthritis is a progressive disease, meaning that the degeneration or inflammation worsens over time 17 46.) Distinguish between the 4 types of arthritis (specifically what goes wrong in each health condition and the causes): rheumatoid arthritis, ankylosing spondylitis, osteoarthritis, gout (315319) Rheumatoid Arthritis (RA) ➢ Swelling of the joints and of the synovium , a thin layer of tissue that covers the joints ➢ Autoimmune disease because it appears to be triggered by the body’s immune system. Unfortunately it triggers inflammation in the absence of infection or injury ➢ Unnecessary inflammation, possible damage to tissues, blood vessels, and other organs as well as pain, stiffness, and swelling of the inflamed joints ➢ CAUSE: immune system malfunction Ankylosing Spondylitis (AS) ➢ A specific type of RA that affects the spinal joints (a genetic version or RA) ➢ Rigid or stiff spine ➢ Disease causes the spinal column to fuse, limiting an individual’s ability to pivot or turn his/her back or neck ➢ CAUSE: largely genetic in origin. H LAB27 gene appears to be a marker that predisposes an individual to AS Osteoarthritis (OA) ➢ Associated with wear and tear on the body ➢ More specifically, the cartilage (the part of the joint that cushions the end of the bones and enables easy movement of the joints) is worn away. As a result, bone spurs may form. These spurs rub against each other, causing pain and further deterioration of both the cartilage and bones ➢ The erosion process is one reason OA is considered a degenerative joint disease (permanent deterioration of cartilage) ➢ CAUSE: degeneration is not well understood but research suggests several factors that may play a role in the development and progression of OA. These include genetic abnormalities, developmental defects,trauma that alerts or disrupts the body’s normal biomechanics, and obesity Gout ➢ Crystal deposits in joints and tissues ➢ CAUSE: proximal: behavior, specifically diet. Distal: genetics that may predispose you to an overproduction of uric acid* *Uric acid is a byproduct of food and can become lodged in joints → inflammation, redness, soreness. This is the reason diet can be a cause 47.) Why is pain considered to be “an elusive health problem”? (320) ● Because it is influenced by an individual’s subjective perception of discomfort, by their accurate or inaccurate recall of the pain and its location, and by a provider’s assessment of the physiological symptoms. Add to these points the fact that pain is a private and internal sensation that cannot be observed direction and that may include changing symptoms 18 48.) The experience of pain is an interaction of what 3 factors? (320) 1. The interaction of a painful stimulus (biological or environmental) experienced by the body 2. The characteristics of the individual experiencing pain, such as his or her age, gender, and coping strategies 3. The social and environmental circumstances, such as cultural upbringing, that may proscribe an individual’s perception of or response to pain 49.) Most research and intervention practices for pain (related to illness or injury) emphasize pain management or pain elimination? Briefly explain why (322) ● Emphasize p ain management ● This is because there is no treatment that offers total relief from the pain associated with chronic illnesses ● Injuryrelated pain also focuses on pain management because often such injuryrelated discomforts linger well beyond the point of treatment. 50.) What are the limitations of nonaspirin NSAIDs? (324) ● Considered inadequate pain relievers because they do not totally relieve pain and stiffness ● In fact, individuals who use NSAIDs report relief from 80% of the pain at best ● Further, NSAIDs do not appear to slow the or reverse the progression of the disease ● Therefore, they are only moderate pain relievers that manage symptoms and minimize pain but do not address the underlying disease How do opioids analgesics compare in terms of effectiveness and what is one reason for their limited use? (324) ➢ Opioids are more effective in alleviating pain ➢ CON1: highly addictive which prohibits its use as a longterm treatment option ➢ CON2: In many countries, physicians must report any patients who is proscribed an opioid for medical purposes. This may discourage physicians from prescribing the substance 51.) What are the benefits of exercise therapy for arthritis? (326) ● Helps to minimize pain and improve functionality ● Physical therapists, athletic directors, and group programs help maximize movement and flexibility ● Customized program can address specific pain and limitations of the individual ● Stretching and weight bearing exercises improve both mobility and strength ● Longterm adherence to exercise reduces pain, stiffness, and inflammation due to arthritis 52. Briefly mention a major barrier to participation in exercise programs and a solution to overcome this barrier. ● Movement is painful ● Challenging to convince people to endure pain in order to get relief from pain ● Even though participants experienced improvements from yoga, 60% attended less than half of exercise sessions ● SOLUTION: Health psychologists can match individuals with exercises that appeal to their interests. For example, people who usually enjoy recreational or competitive swimming may be more likely to participate in water aerobic programs. By doing this, participants can enjoy what they are doing while also taking advantage of the therapeutic benefits of exercise. If health psychologists did this, individuals would be more likely to return. ○ The goal of exercise programs is to connect people with arthritis or other forms of chronic pain to a program that is beneficial and enjoyable. 19 Chapter 11—Cancer 53.) Distinguish between benign vs. malignant tumors (339) Benign tumor ➢ A large mass of overgrown cells ➢ They are not usually life threatening ➢ Grow in size but do not reproduce, nor do they spread to other parts of the body ➢ Can usually be removed safely and without damage to other body tissues or organs Malignant tumor ➢ Cancerous, life threatening large mass of cells ➢ Grows and multiplies uncontrollably and interfere with other body organs and functions ➢ Undetected, they can metastasize, or spread to other parts of the body, making it impossible to locate and remove all of them ➢ If a cancer metastasizes, it is hard to contain and effectively treat, so the outcome is usually fatal 54.) Distinguish between the categories of cancer (specifically what goes wrong in each health condition and the causes): carcinomas, sarcomas, leukemia, lymphomas (339341) Carcinomas ➢ Cancers derived from epithelial cells ➢ Basal cell carcinoma = skin cancer ○ Occurs more frequently in people over 40 but can occur in anyone who has repeated, prolonged, and unprotected exposure to the harmful ultraviolet rays of the sun ○ Most frequently occurring but least deadly form of cancer in the US (illustrates that frequently occurring form of the disease is not necessarily the deadliest) ➢ Other forms of carcinomas include breast,liver,bladder, andprostate Sarcomas ➢ Softtissue cancers ➢ Can occur in a number of sites in the body, including fat, muscle, nerves, tendons, and other tissue that support organs ➢ Often spread to other parts of the body (malignant) ➢ CAUSE: ○ Genetic disease ○ Exposure to chemicals like herbicides or arsenic ○ Some infectious viruses ○ Other causes that have not yet been identified Leukemia ➢ Uncontrolled growth of white blood cells ➢ Leukemia produces an abundance of abnormal white blood cells that are unable to perform the protective function of the body’s more mature white blood cells. Because of a smaller amount of mature white blood cells, the body’s immune systems weakens → leaves the body vulnerable to infections ➢ Several factors are linked to childhood leukemia includinggenetic predisposition,nutrition, drug use,infections, andenvironmental factors (living near nuclear power plants) ➢ Infrequent, but deadly form of cancer 20 Lymphomas ➢ Malignant tumors that form in the lymphatic system ➢ Form because of abnormal lymphocytes ○ Lymphocytes = the white blood cells in the lymph glands that defend against infection ○ When abnormal they cannot destroy invading viruses and other infections. They also cannot prevent infections from spreading to other parts of the body ○ Leaves the body vulnerable to infections or other illnesses! ➢ 2 Types ○ NonHodgkin’s Lymphoma fatal form because tumors are usually maligna
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