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PY3111 Exam Prep - Coggle Diagram

- - - - Benign tumours
        
        No spreading
      - Malignant tumours
        
        Show metastasis
        = process of breaking off from tumour and migration through blood/lymph everywhere; formation of new neoplasms
  - - - Lung cancer
        
        Blockage of bronchus
        
        Cough/pneumonia
      - Oesophageal cancer
        
        Narrowing/blockages in bowel, resulting in changes in bowel habits
      - Breast/testicles may be easily felt
    - - Fever
      - Unintentional weight loss
      - Being excessively tired
      - Changes to skin
  - - - Cancers of skin and organ linings
        (include developing in breast, prostate, lung, pancreas, colon)
    - - Cancers of connective tissue bine, cartilage, fat, nerve
    - - Cancers of lymphatic system
    - - Cancers of blood
        (30% of children's cancer)
  - - - Basal cell and squamous cell carcinomas is majority
        
        Possible cure with early detection
  - - - Increase risk with age starting from middle age
      - Incident rate x4 from 40 yrs to 80 yrs
      - Effect in relation to nature and location of cancer
    - - All Cancer
        
        Double rates
        
        Except low income countries, Men higher rate
        
        Upper middle income
        
        M 4x higher
      - Lung Cancer
        
        More than double
      - Breast Cancer
        
        More than 3x rate
      - Cervical Cancer
        
        Lower incidence rates than low/middle income countries
      - Colorectal Cancer
        
        Nearly 5x higher
      - Liver Cancer
        
        Low and lower middle income countries had the highest rates
      - Prostate Cancer
    - - M 2x higher
    - - Genetic basis
        
        Familiarity (colon/breast) means predisposition (+lifestyles)
    - - Ethnically linked
      - Culturally liked through lifestyle
      - SES
    - - M less cancers if married
        (except gender specific cancer)
  - - - Contribute to cancer death
        
        Tobacco (25 - 30%)
        
        Cause 90% of lung cancer
        
        Diet & Obesity (30 - 35%)
        
        Diet that are very low in whole grains, high in processed/red meats
        
        Overnutrition
        
        Infections (15 - 20%)
        
        Bacteria and parasites may also hv an effect
        
        Virus that cause cancer: oncovirus
        
        Radiation
        (Both ionising and non-ionizing, up to 10%)
        
        Ionising radiation
        
        From medical imaging and radon gas its molecules within cells randomly, damaging chromosome
        
        Damage -> cell dying but smaller damage may leave a stable, partly functional cell that may be capable of proliferating and developing into cancer
        
        Non-ionizing ultraviolet radiation
        
        From sun
        
        Prolonged exposure can lead to melanoma and other skin malignancies
        
        Medium wave UVB cause most non-melanoma skin cancers
        (most common forms of cancer in the world)
        
        Stress
        
        Lack of physical activity
        
        Effect on body weight
        
        Negative effects on immune system and endocrine system
        
        Environmental pollutants
    - - Failure of regulation of tissue growth
        
        Genes regulate cell growth and differentiation altered transforming normal cell into cancer cell
      - Cancer pathogenesis is due to DNA mutations that impact cell growth and metastasis
      - Carcinogens are mutagens that cause cancers: substances that cause DNA mutations
        
        Many mutagens are also carcinogens but some carcinogens are not mutagens
      - Mutation inactivates tumor suppressor gene
        
        Cells proliferate
        
        Mutation inactivates DNA repair gene
        
        Mutation of protocol-oncogene creates an oncogene
        
        Mutation inactivates several more tumour suppressor genes
        
        Cancer
      - Hormones
        
        Important agents in sex-related cancers
        
        Cancer of the breast, endometrium, prostate, ovary and testis
        
        Individual's hormone levels are mostly determined genetically
        
        Explains presence of cancers that run in families
        (w/o cancer-causing genes)
        
        Obese people have higher levels of some hormones associated with cancer and a higher rate of those cancer
  - - - Smoking
      - Cancer protective vitamins (A, C, E)
        
        Contrasting results
        
        Preventive measure
      - Sexual behaviour (7%)
      - Alcohol (3%)
    - - Positive association between depression and cancer
        
        Intermittent and LT depression
      - Relationship between cancer development and
        
        Use of denial/repressive coping
        
        Perceived control over stress
        
        Low hardiness profile
        
        Type C personality: ripon to stressors with appeasing, compliant and unexpressive behaviours
    - - Link between uncontrollable stress and cancer
      - Link between family with cancer victim and stressful life events: divorce, moving house, deterioration of health
      - Lack/loss of social support may affect onset/course of cancer
        
        Social isolation in woman can elevate risk of dying from cancer
    - - Psych stress affects ability of NK cells to destroy tumors
        
        NK cell activity is imps in survival rates for certain cancer
      - Alternation in biological stress regulatory pathways
        
        May affect course of cancer
    - - Improve immunologic responses to cancer
      - Married patients have btw survival rates
      - Young children might show fear/distress
      - Older children have new responsibilities
      - Marital and sexual r/s
        
        Strong marital r/s is impt
        
        sexual functioning is particularly vulnerable
      - Self representation of cancer patients
        
        Vocational disruption and job discrimination
  - - - Blood and urine tests
        
        Reveal signs in hormones/enzymes
      - Radiological imaging
        
        Allow doctors to examine internal organs and see if tumour exists
      - Biopsy
        
        Involves removing and examining tissue to look for malignant cells
    - - Singly/combi
        
        Choice depends on size, site, presence of metastasis and treatments effects on the patient's quality of life
      - Surgery
        
        Can be effective with localised cancer
        
        If metastasised, removal of large cluster and surrounding tissue; lumpectomy ve mastectomy
      - Radiation
        
        May involve destruction/not reproduction
        
        External beam therapy
        
        Directly on malignant tissue
        
        Internal radiation therapy
        
        Placing with surgery/injection radioactive agent at tumour location
      - Chemotherapy
        
        Uses drugs which kill rapid diving cells; some cancer are more responsive to the drugs
        
        Anticipatory nausea and learned food aversion and phobias
      - Invalidating side effects due to death of normal cells too
        
        Adverse that some opt to stop treatment
      - Compliance cld be problem for adolescence and minority gaps; mix finding
  - - - Substantial pain
        (action on nerves, normal tissue, flow of fluids)
      - 40% intermediate stages
        70/90% with advanced cancer
      - Death from cancer may come directly from invasion of vital organs or indirectly by weakening person
        (treatment and disease decrease immune function and appetite)
    - - Variaions in lvl of risk factors and environmental conditions
        
        Diff in prevalence of particular cancers in countries
  - - - Nausea and vomiting
      - Impaired libido and sexual function
      - Poor general health and disability
    - - Seperation Anxiety
      - Communication problems - strained r/s
      - Intimacy may be compromised
    - - Depression and anxiety
    - - Confrontation with Mortality
    - - Lack of info
      - Use of medical jargon
    - - CBT
        
        Widest evidence base for its effectiveness
        
        Typically in group format
        
        Major component
        
        Psycho education
        
        Cognitive procedures
        
        Behavioural procedures
      - Mindfulness
        = moment to moment and non-judgemental attention/awareness
      - Clinical hypnosis
      - Self help
        (print and internet based)
      - Relaxation and imagery
        
        Effective from 1st session
        
        Prevent nausea, systematic desnsitisation may be used to treat anticipatory nausea
      - Families may need family therapy and support groups
        
        Support group patients show lower depression and anxiety, less sexual problems, more leisure
      - Interventions may enhance survival
        
        Discussion meetings relative to concerns
        
        Health promo activities
        
        Positive coping, stress management
        
        Btw immune function
        
        Coping
        
        More vigour
        
        Less depression
        
        6 yr follow up less mortality
        
        Analysed effects of meetings
        
        Self hypnosis for pain led by therapists in remission phase
        
        18 mths increased life, over 10yr
    - - Contribution of psychology at all stages of illness
        
        Mitigates against developing cancer
        
        Lifestyles can trigger cancer cells
        
        Role in individuals progression
        
        Promoting longevity following cancer
      - Emotional response
        
        Grief, lack of control, anger, anxiety personality changes
        (see any presence of ss - intimate r/s
        
        Fighting spirit
      - Psy Strategies
        (Taylor's theory of cognitive adaptation)
        
        Search of meaning on how they developed
        
        Develop sense of mastery over illness
        
        Control
        
        Process of self enhancement
        
        Social comparison with others in their lives to analyse their condition
      - Dealing with symptoms
        
        Pain management
        
        SS
        
        Treatment of nausea and vomiting
        
        Bosy image counselling
        
        Cognitive adaptation strategies
        
        Holistic treatment
- - - - Health Belief Model
      - Theory of Reasoned Action
      - Theory of Planned Behaviour
      - Transtheoretical Model
  - - - Vigourous processes
    - - Role of expectancies in determining behaviour
        
        Person is motivated to engage in behaviour whose outcome is valued
        
        Action outcome expectancies
        
        Belief that a specific action will lead to a particular outcome
        
        Self-efficacy expectancies
        
        They feel capable of performing
      - Vicarious Learning
        
        Learning through observing others, role modelling, vicarious reinforcement)
      - Factors
        
        Behavioural Factors
        
        Outcome Expectations
        
        Environmental Factors
        
        Personal Factors/Cognitive Factors
        
        Knowledge
        
        Goal
        
        Self-efficacy
        
        Performance accomplishment
        
        Vicarious experience
        
        Verbal persuasion
        
        Physiological states
        
        Social Support/Barriers
  - - - Behaviour that is self-motivated and influenced by needs of autonomy, competence and psychological relatedness
    - - Behaviour that is motivated by external rewards
    - - Autonomy
      - Competence
      - Relatedness
    - - Need Supportive Exercise Settings and Interactions
      - Exercise Causality Orientaitons
        
        Excercise related Need Satisfaction
        
        Autonomy
        
        Competence
        
        Relatedness
        
        Autonomous vs Controlled Exercise
        Motivation/Regiulations
        
        Exercise Behaviour
        (Adoption and Maintenance)
      - Exercise Goals/Participation Motives
  - - - Stage 1: Interpretation
        
        Symptom perception
        
        Social messages -> deviation from norm
      - Stage 2: Coping
        
        Approach coping
        
        Avoidance coping
      - Stage 3: Appraisal
        
        Was my coping strategy effective?
      - Emotional response to Health Threat:
        
        Fear
        
        Anxiety
        
        Depression
  - - - Individual forms an intention to either adopt a precaution measure/change risk behaviours in favour of other behaviours
      - Self efficacy and outcome expectationcies are seen as major predictors of intentions
    - - Describe how hard individuals try and how long they persist
        
        Cognitive
        
        Behavioural
        
        Leading to action plans and control
        
        Situational aspects
  - - - Precede-Proceed Model
      - Action Areas
        
        Build healthy public policy
        
        Creative supportive environments
        
        Strengthen community action
        
        Develop personal skills
        
        Re-orient health services
      - Strategies
        
        Health communication
        
        Health education
        
        Self-help
        
        Origanizational change
        
        Community development and mobalization
        
        Advocacy and Policy development
        
        Community based vs Community Development Strategies
        
        Community Based
        
        Link programs to communities
        
        Health risk identified by agency
        
        Community Development
        
        Health issue defined by community
        
        Planning process involves community
        
        Development of community capacity
    - - Tends to be disease focused
      - Emphasise empowerment and engagement
      - Can be very effective if part of larger program
      - Programs
        
        Understanding key community characteristics
        
        Cross cultural communication
        
        Engaging communication
        
        Evidence based planning process
        
        Adapt community needs
        
        Components
        
        Capacity building, autonomy, ownership
        
        Information exchange
        
        Clear evalution
        
        Replicabilitty
    - - Healthy Places and Spaces
    - - Involves complex interaction and are collaborative
      - Should take into acc culture of the community?
      - Empowerment
        (Essential for LT sustainable impact)
      - Enahncve s community capacity
      - Community interventions are located within and affected by historical relations of inequality
      - Importance of participatory research
    - - Uses an issue based/locality based approach
      - Focuses on people as members of a community
      - Communities deliver policy, create solutions and are context within which health problems are understood
  - - - Focus groups
      - Needs assessment?
      - Capacity Analysis
      - Asset Analysis
  - - - Outcome Evaluation
      - Impact Evaluation
      - Process Evaluation
    - - 6 interconnected steps
        
        Engage stakeholders
        
        Describe program
        
        Focus evaluation design
        
        Gather credible evidence
        
        Justify conclusions
        
        Ensure use and share lessons learned
  - - - Enacted through:
        
        legislation
        
        rules & regulations
        
        Enables:
        
        provision of services and programs
        
        access to services and programs
- - - - Aggressive treatment regimens used to suppress HIV viral replication and slow its progression
      - Combines 3 or more diff drugs
    - - Common ones related to metabolism
        
        Nausea, vomiting, diarrhea
        
        Lipodystrophy: gain/loss/redistricbution of fat cells
        
        Dyslipidemia/Lipid abnormalities
        
        Peripheral neuropathy
        
        Insulin resistance
        
        Blood sugar prob
      - Build up lactic acids in blood
      - Sone disease
      - Abnormal heartbeat
      - Shortness of breath
      - Skin rash
  - - - Rectal
      - Genital
      - Oral
      - Increase risk
        
        Sexual transmitted infections and genital ulcers
        
        Rough sex
        
        Sexual assault
  - - - Homosexual men
      - IV drug users
    - - Chaotic and unstable living
        (drug/abuse)
      - Getting food and shelter for families salient than HIV status (low income)
      - Depression from stress
      - Suicide Attempt
  - - - Higher with less SS/avoidant coping/severe symptoms
    - - Instrumental
        
        reflection of fear and apprehension associated with any deadly and transmissible illness
      - Symbolic
        
        Expresses attitudes towards social gap/lifestyles perceived to be associated to disease
      - Courtesy
        
        Stigmatisation of people connected to issue of HIV?AIDs or HIV+ people
    - - Reduce depression
      - Stress management
      - Excercise
      - Cognitive therapy
  - - - Negative expectation -> factor course
      - Correlated with decline in TH/CD4 cells and onset of AIDs in HIV+
    - - Adverse effect on immune system
  - - - Men with new partner
        
        Gay more informed
        
        Adolescents less informed
    - - Provide knowledge to target populations
      - Magical thinking
        
        Over react to HIV+ contacts (individuals)
        
        Under react to their health risk behaviours (no condom)
        
        Germs of loved ones less dangerous
    - - Motivation training
        
        Inducing readiness to change for at risk groups their risk-related behaviours
      - Stress management techniques
      - Sexual negotiation skills
        
        Improving ability to negotiate condom use with partners
      - Targeting adherence
      - Targeting IV drug use
      - HIV prevention programs
      - Writing on emotional topic (and disclosure): more CD4/TH
      - Health beliefs and AIDs risk related behaviour
        
        Perceptions of self efficacy are critical
      - Theory of planned behaviour
        
        Effective for info (social norms)
      - Targeting sexual activity
        
        Interventions have focused on communication
        
        Beliefs + behaviours related to sex are hard to change also for those informed on risks
        (esp if spontaneous sexuality is viewed inherent to identity)
- - - - Parents/Siblings/Friends smoke
      - Belong to lower class
      - Social Pressure
      - Major family Stressor
  - - - Social learning
      - Nicotine regulates performance
      - Rewarding experience
      - Harder to stop than heroin addiction/alcoholism
      - Exact mechanisms not fully known
    - - Social acceptance
      - Pleasure
      - Addiction/Habitual needs
    - - Teen insecurity
    - - Social identity VS personal self concept
      - Based on saliency of personal/group norms
    - - Observational learning and modelling
      - Smoking perceived favourably within close environment
    - - Rebellious
      - Risk taker
      - hopelessness
      - External locus of control
      - Low self esteem
  - - - Absorbed in lungs, transmitted to blood and carried to brain; activate CNS and SNS -> arouses body -> increase alertness, HR, BP
      - Half life in 2hrs
    - - Keep smoking to regulate amt of nicotine in body and avoid withdrawal
    - - Nicotine regulates cognitive and emotional states
        
        Immediate/temporary desirable reinforcing effects
        
        Nicotine triggers release of Act and NE
        (Increase alertness and concentration and decrease withdrawal and anxiety)
        
        Hard to quit
        (Rely on nicotine as coping process)
  - - - Tar likely carcinogen
      - Tobacco -> lung cancer
      - Cilia along surface of lining of bronchial tubes stop functioning and disappear -> lining be exposed to carcinogenic (not removed by mucus)
      - Cause cancers of
        
        Oral cavity, nasal cavity, pharynx, oesophagus
        
        Pancreas, stomach, liver, bowel, bladder/kidney (via urine), cevix, ovary
    - - Decrease airflow on exhalation
      - Chronic bronchitis and emphysema
      - Acute respiratory infection more frequent: Pneumonia, cold virus
    - - 1/3 related to smoking
      - Nicotine increases on systolic and diastolic BP, HR, cardiac output
      - CO reduces O2 avail to heart (coronary blood flow) causing damage and atherosclerosis
      - Changes properties of blood vessels and blood cells, allowing cholesterol and other fatty substances to build up
      - Doubles risk of ischemic stroke (reduced blood flow to brain)
    - - decreases fertility in women
      - combines with oral contraceptive to increase risk of heart attacks and stroke -> poor health outcomes for foetus and newborns
      - Placenta disorders
      - Premature birth
      - Spontaneous abortion
      - Miscarriage
      - Premature repture of membrane
      - Foetal tobacco syndrome
        
        Neonatology: malformation complex affecting infants born to mothers smoking 1 or more packs of cigarettes per day during pregnancy
        
        Stunted gestational development
        
        FTS neonates 200g lighter
        
        Perinatal mortality/stillbirth, SIDS
        
        Children with FTS impaired cognitive and emotional development
        
        Show respiratory infections (bronchitis, pneumonia) and irritation (cough, wheezes phlegm); asthma exacerbation; impaired lung function and development
    - - Major component: side stream smoke
        
        Contain higher concentrations of carcinogens than mainstream smoke
        
        Cause immediate harm to CV and respiratory systems
        
        LT exposure can cause CHD and lung cancer in adults
        
        Expectant mothers, foetuses and infants are at particularly high risk of adverse health consequences
        
        Sudden Infant Death Syndrome (SIDS)
        
        Low birth weight babies
        
        Respiratory infections (cough, wheeze, phlegm, breathlessness)
        
        Behavioural and learning problems
  - - - Taxation
      - Restriction of access
      - Liability litigation
      - FDA regulation of tobacco
    - - Social influence approaches train individuals to resist social pressure to smoke
      - Info abt negative effects of smoking
        (appealing to adolescents)
      - Image of nonsmoker is presented as independent and self-reliant
      - Peer group is used to facilitate non smoking rather than smoking
    - - Rationale: if adolescents are trained in self esteem enhancement, then they will not feel need to bolster self-image by smoking
      - Behavioural inoculation: expose adolescents to a weak version of persuasive message so they can resist message in its stronger form
    - - Nicotine containing gums: disliked because nicotine is absorbed very slowly
      - Trans-dermal nicotine patches release nicotine in steady doses: reduce withdrawal and enhance waiting
      - Doubles quit rates
    - - Shown to alter mood transmitters in brain that are linked to addiction
      - must be prescribed by physician and may not be appropriate for everyone
    - - Scheduled reduction
      - Nicotine fading
      - Self monitoring
      - Contingency contracting
    - - strong image of oneself as "nonsmoker" helps treatment effectiveness
      - SS may prevent relapse by buffering from stress and offering encouragement
    - - Abstinence-violation effect
        = an episode of backsliding undermines confidence in remaining abstinent, reduces perceptions of self efficacy
        
        If self-efficacy wanes, vulnerability to relapse is high
      - Strong image of oneself as a "nonsmoker" helps treatment effectiveness
    - - Pre-contemplation to Contemplation
        
        Focus is on attitudes
        
        Emphasis on adverse health consequences
      - Contemplation to Action
        
        Smoker develops a timetable to quit and a program of how to go about it
      - Action Phrase
        
        Cognitive-behavioural techniques will be used
- - - - Closed System
      - Blood Vessels
        
        Veins
        
        Arteris/Aeterioles
        
        Capillaries
      - Transports Materials
        
        Removes wastes
        
        Supplies substances
    - - Muscle pump of fist size
        Avg beats: 100,000 times per day
        Myocardium - covering
      - 4 chambers
        
        Left/Right Atria/Atrium
        
        Left/Right Ventricles - Strongest pumping
        
        Valves help maintain direction
        
        Blood enters right atrium laden with waste/CO2 from our cells passes to right ventricle (valve) for O2 [pulmonary circulation] to left atrium to left ventricles into systemic circulation through aorta
        (Cycle: one minutes at rest - 70km/h)
    - - Cleanse blood and pass wastes to urine
    - - Blood from systemic circulation and intestinal tract
      - Cleanses from harmful elements (bacteria) and removes nutrients (sugar/amino acids) for storage
  - - - Expressed in mm Hg
      - When at rest; blood gets inside
        
        Diastolic pressure
        (90 mm Hg)
      - When pumps; max force in arteries
        
        Systolic ppressure
        (130 mm Hg)
    - - Fluid Dynamics
        
        Cardiac Output
        = blood volume pumped per minutes
        
        output, > BP
        
        Blood Volume
        
        volume, > BP to push blood
        
        Peripheral Resistance
        
        Difficulty to pass through various diameters of vessels
        
        Elasticity
        
        Ease in expanding and contracting
        
        < elasticity, > BP
        
        Viscosity
        
        Thickness of Blood
        
        thickness, > BP
      - Individual Factors
        affecting Fluid Dynamic
        
        Temperature
        
        Activity
        (exercise/position)
        
        Emotional experience
        
        SNS activation is a mediator
  - - - 4/6 litres; M +20%
    - - Red blood cells
      - Leukocytes/WBC
      - Platelets
    - - Plasma protein
      - Hormones
      - Enzymes
      - Nutrients
      - Waste products
  - - - and/or hypertension
        
        Consistent high BP = strains heart/arteries
        
        BP at/above 160/95
        
        Over 200: risk of rupture (stroke)
        
        High diastolic BP: strain to arteries also at rest condition
        
        2 types
        
        Primary (essential); unknown medical cause
        
        90% - 95%
        
        Secondary caused by conditions that affect arteries, heart or endocrine system, kidney (failure of kidneys to regulate BP)
        
        5% - 10%
        
        Can lead to myocardial infarction, heart failure, stroke, kidney failure, aneurysm of arteries
        
        Risk Factors
        
        Complex interaction of genetic and environmental factors
        
        Body weight positively correlated with BP; easy-middle adulthood (larger mass/blood volume)
        
        Age (> in west society)
        
        Gender/Ethnicity/Family History (link to genetics/diet)
        
        Genetic Factors
        
        Genes identified; mechanism pools understood
        
        R/s with stress
        
        Emotional factors
        
        Depression
        
        Hostility
        
        Anger
        
        Anger + Potential hostility = higher BP under conditions of stress/harassment
        
        Both expressed and suppressed anger associated to HBP
        
        Cynical Disrupt
        
        Intense Arousal
        
        Role of positive emotions as protection
        
        Emotional excitability in childhood: gain weight -> CVD predictor
        
        High demand + low control
        
        Chronic social conflict
        
        Job strain
        
        Associated with
        
        Crowded, noisy locales
        
        Migration from rural to urban areas
        
        Women: extensive family responsibilities
        
        Treatment
        
        Medication
        
        Diuretics; Statins: inhibitors of the cholesterol synthesis
        
        Beta blockers: on beta receptor of epinephrine in SNS weakens effects of stress hormones
        
        Angiotensin-converting enzymes (ACE) inhibitors; Angiotensin II receptor blockers (ARBs) (to prevent vasoconstriction)
        
        Diet
        
        Low-sodium diet
        
        DASH (Dietary Approaches to Stop Hypertension) diet
        
        Reduction of alcohol
        
        Weight-reduction in overweight patients
        
        Caffine restriction
        
        Exercise
        
        Stress Management
        
        CBT (Best combined with drugs)
        
        Relaxation training
        
        Anger management
      - Atherosclerosis
        = build up of fatty plaques on artery walls; plaques harden
        
        Arteriosclerosis
        < diameters; < elasticity
        
        Increase BP
        in elderly
        process starts early
    - - Ischemic heart disease
      - Coronary artery disease
      - Coronary artery atherosclerosis principal cause of coronary artery/heart disease (CAD/CHD)
      - Narrowing = condition in which plaques build up
      - Occlusion
        aka blockage = clot of blood platelets grows in artery
        
        Incomplete blockage = Angina Pectoris
        
        Aevere chest pain/left arm and jaw
        
        Cased by chemicals in myocardium due to O2 deprivation to its cells
        
        Complete blockage = Myocardial Infarction
        
        Myocardial cells die within minutes of O2 deprivation
        
        Pain/pressure/squeezing/fullness in chest, sweating, loss of consciousness, fainting, shortness of breath/nausea
      - Prognosis
        = extent of arterial damage after infarction
        
        Condition of left ventricle: if it functions well/10 yrs time
    - - Endocarditis (edocardium-valves)
      - Myocarditis (myocardium)
    - - Haemorrhage/Thrombosis
    - - Age, gender and socio cultural risk factors
        
        Risks higher for Men before old age
        
        Women more likely to die from CHD
        
        Prevalence rate increases over 45 yrs old
        
        Loss elasticity in vascular walls
        
        Low SES
      - Lifestyle and biological risk factors
        (account for age/gender/sociocultural difference)
        
        Hypertension
        
        Family history of heart disease
        
        Cigarette smoking
        
        High LDL and total cholesterol levels
        (trans fatty acids)
        
        Physical inactivity
        
        Diabetes
        
        Obesity
        
        Stress
        (link to Type A and hypertension; chronic stress, anger/hostility contribute to high BP)
      - Type A behaviour
        
        Hostility; Competitiveness; Impatience
        
        Under stress, shows reactivity
        
        Increased BP, catecholamines and corticosteroids production
        
        Reactivity (and hostility) possible risk factor for heart disease
        
        Adrenalin increases formation of platelet clots
        
        Infarctions occur mostly on Monday (working population), between 6am - 11am
        
        Passage from cream to wake might increase BP and catecholamine = clotting
        
        Characteristic of Personality
        
        Depression:
        elevated C reactive protein which is marker of inflammation
        
        Pessimism/rumination: increase BP
        
        Anxiety: less vagal control of HR
        
        Attempt to dominate social interactions - communication
      - Psychosocial Impact
        
        Going back to work is a sign of recovery
        
        Depends on severity (avg 3 mths)
        
        Contributes to long term wellbeing
        
        Less stressful/productivity/hrs job
        
        Illness may affect ability to work and r/s with co-workers
        
        Family Relationship
        
        Problem may both precede and become exaggerated more social support faster recovery and longer survival
        
        ILLness adds stress to all member & intimacy may be stressful
        
        Families may promote cardiac invalidism
        
        Person who suffered from heart attack becomes increasingly helpless and dependent
        
        Belief on spouse physical abilities aid/retard rehabilitation
      - Emotional Impact
        
        Emotional Reactions
        
        First weeks/mths anxiety and depression
        
        In 1 or 2 yrs distress declines
        
        Better emotional coping with social support
        
        If emotional distress persists
        
        Sign of poor adaptation
        
        Tied with less compliance and decreased physical condition
        
        Severe anxiety and depression
        
        Possible further H condition such as arrhythmia
        
        Higher risk to die in following mths
    - - Medical Treatment for CHD
        
        Initial medical treatment for heart attack to prevent/limit damage to myocardium
        
        Clot dissolving medication frees the blocked arteries
        
        Coronary care unit to monitor: high risk of another infarction within few days
        
        Balloon angioplasty:
        a small balloon is inflated in an artery to open the blood vessel
        
        Angioplasty with Stent
        
        Bypass Surgery:
        a diseased vessel is replaced with a healthy one from another part of the person's body
        
        High anxiety occurs in first few days of coronary care
        
        Cope with crisis with denial:
        Useful to control anxiety
        
        After few days level of anxiety decreases for all patients (with/without denial) yet still higher than normal
        
        Level of anxiety linked to previous deistess/social problems, not to severity
        
        Excessive anxiety, depression, denial impair recovery
        
        Anticipation of psychosocial problems
        
        Want to leave ward too early
      - Psychosocial Interventions:
        aimed to enhance recovery and LT adaptation
        
        Self help and support groups that may provide advice (on stressors to face) and information
        
        Technological devices that may benefit adjustment (ECG system for telephone checks; less depression)
        
        Increase compliance to cardiac regimens but only severe cases
        
        Stress management techniques that may promote better adjustment
        
        Reduce number of angina attacks by 40%
        
        Relaxation training/deep breathing/transcendental meditation
        
        Speech Style intervention
        
        Modify Type A behaviour
        
        Counselling for fear and anxiety
        
        Multicomponent Intervention Program
        
        Diet, exercise and stress management approach
        
        Vegetarian diet
        
        No caffine
        
        Limit alcohol consumption
        
        Quit smoking
        
        Regular excercise
        
        Regular support group
        
        Stress management technique (relaxation and meditation)
        
        Decrease: atherosclerosis, reported chest pain, hospitalisations
        
        Difficult ro mark which component is key for results
        
        Demonstrate life changes are beneficial for post infarction recovery
      - Rehabilitation of Cardiac Patients:
        Promote recovery and reduce risk for another infarction
        
        Information provided on symptoms (persisting angina pectoris), medications and risk factors (lifestyle changes)
        
        Recurrence can be prevented
        
        Health changes in lifestyle and attitudes can ensure life expectancy similar to no infarction people; difficult to change B.
        
        Quit smoking
        
        Lose weight
        
        Dietary intervention (fat/cholesterol):
        impact on family life
        
        Reduce alcohol consumption
        
        Exercise is introduced, tailored then becomes more vigorous
        
        Benefits: lower resting HR, lower diastolic and systolic BP, lower risk of dying from another infarction
        
        Exercise adherence is related to psychosocial adjustment self-concept/leisure/sexual activity
        
        50% discontinue in six moths; smoking/blue collars/high weight/less CV function/sedentary/more anxiety and depression
        
        Risk factors are behaviours acquired via known processes possible to be modified through strategies
        
        Stress management lowers mortality
        
        Modify hostility (and anger to reduce also hypertension)
        
        Patients may resent the restrictions due to rehabilitation
        
        Low self efficacy and social support = less adherence and slower recovery
  - - - Hypertension
        
        Sustained hypertension permanently changes the architecture of the blood vessels making them
        
        Narrow, stiff, deformed, uneven and more vulnerable to fluctuations in BP
      - Atherosclerosis
        
        Damages blood vessel lining, endothelium, exposing the underlying collagen where platelets aggregate to initiate a repairing process which is not always complete and perfect
    - - Old age
      - History of diabetes, smoking or ischemic heart disease
    - - Fall in BP during slp
        
        marked reduction in blood flow in narrowed blood vessels causing ischemic stroke in the morning
      - Sudden rise in BP due to excitation during daytime
        
        Can cause tear of blood vessels resulting in intracranial hemorrhage
      - Result in rapid loss of brain function (s) due to death of brain tissue
      - Causes
        
        Infarction
        = cerebral artery partially/totally blocked by a thrombus/embolus=ischemic stroke (majority)
        
        Haemorrhage
      - Risk Factors
        
        Age
        
        Increase sharply after age 55 and doubles each following decade
        
        Gender
        
        M 30% > W
        
        Sociocultural
        
        Indigenious
        
        Los SES
        
        Lifestyle and Biological
        
        HD
        
        Hypertension, atherosclerosis
        
        Smoking
        
        Heart disease, diabetes and relative
        
        High cholesterol
        
        Obssity
        
        Physical inactivity
        
        High alcohol consumption
        
        Drug use
        
        Family history
        
        High RBD count (thinker blood, easier to form clot)
        
        Negative emotions/physchological distress
      - Signs
        
        Characteristic signs
        
        Sudden weakness/numbness of face muscles
        
        Arm drift
        
        Abnormal speech
        (Loss/trouble talking/understanding speech)
        
        Sudden dimness/loss of vision
        
        Sudden unexplained, severe headache
        
        Unexplained dizziness, unsteadiness/sudden fall
      - Effect
        
        Depends on amount and location of brain damage
        
        Possible early intervention
        
        Clot dissolving drugs
        
        More effective for
        
        Young people
        
        Haemorrhagic strokes
        (recovery after blood has been reabsorbed)
        
        Motor impairment (common)
        (Contralateral paralysis)
        
        Cognitive impairment
        
        Disorganised thinking, confusion, memory/learning deficits and aphasia (left hemisphere)
        
        Visual disorders/patterns/limited visual field (right hemisphere)
        
        Emotional effect
        
        Left H damaged: depression
        
        Right H damaged: interpretation and expression of emotions
      - Psychosocial aspects
        
        Denial
        (common at first)
        
        Overly optimistic
        
        Depression
        
        From cognitive/physical deficits
        
        Emotional re-adjustment difficult because of this deficits
        
        Hoplessness and helplessness
        
        Loss of work
        
        Emotionally and financially stressful
        
        R/s prob
        
        Effects of family may be marked when patient is paralysed/aphasic
        
        Social interactions and leisure activities impaired
      - Rehabilitation
        
        Types of rehabilitative interventions
        
        Cognitive-remedial training
        
        Movement therapies for paralysis: biofeedback & physiotherapy
        
        Visual therapy
        
        Use of structured,, stimulating environments to challenge capabilities
        
        Family therapy and support groups to help adaptation
        
        Psychotherapy to deal with emotional problems
    - - Develop where blood vessels branches
        
        Structurally more vulnerable
      - May result from
        
        High BP
        
        Congenital defects
        
        Head trauma
      - Warning signs of ruptured brain aneurysm (subarachnoid hemorrhage)
        
        Severe headache
        
        Nausea/vomiting
        
        Stiff neck
        
        Blurred/double vision
        
        Sensitivity to light
        (photophobia)
        
        Loss of sensation
      - All age group
        
        Incident increase steadily for age 25 and older
        
        Ameuryem rupture: most prevalent 50-60 yrs old
- - - - Exercise
      - abstaining from smoking
      - Diet changes = avoiding vegetable oils and non-hydrogenated fat/ eating food with a low glycemic index and low saturated fat
      - abstaining from alcohol
- - - - Ghrelin = Hunger stimulating hormone produced by cells lining the stomach / Regulates satiety (what make us feel full)
      - Leptin = Protein hormone that regulates energy intake and energy expenditure
      - Set Point Theory = the body maintains a certain body weight through hypothalamic functions / dependent on no. of fat cells and the size of it
    - - Restraint Theory = If an indv starves for several days, should they eat again, eating becomes unhinged/ open the floodgates
      - Sensitivity to food related cues = indvs who are overweight are more sensitive to external food related cues / indv may stop at shihlin chicken more at mrt stations otw home
  - - - Biological Effects
        
        Increased risk of fractures
        
        Hypertension
        
        Early markers of CVDs (cardiovascular diseases)
        
        Insulin resistance** (marker for type II diabetes )
        
        high chance of childhood obesity being carried over into adulthood
        
        Risk of disability and premature DEATH
      - Social/Psychological Consequences
        
        Stereotyping
        
        Indvs seen as slow, sloppy, lazy, less sincere, less friendly, meaner and obnoxious
        
        Discrimination = Tend to be victims of ridicule and job discrimination
        
        Negative social attitudes
        
        Body Image Issues
        
        Consequences infuenced by
        
        Individual’s aspire ideal appearance
        
        Importance of physical appearance to that individual
        
        Body Dissatisfaction
        
        Low
        
        Self efficacy
        
        Motivation to lose weight
        
        Motivation to lose weight
        
        High
        
        Discrimination, stigma, social isolation, r/s difficulties, poor physical/mental health
        
        Negative thoughts regarding self and other perception inhibiting change
        
        Disturbance linked to body change related attitudes and behaviours
        
        Drive for thinness/muscularity
        
        Steroid use, supplements for diuretic purposes
        
        Severe restriction of food intake
        
        Obligatory excercise/cosmetic surgery
    - - Biological Consequences
        
        Hypertension
        
        Coronary heart disease
        
        Diabetes
        
        Musculoskeletal disorders
        
        Some cancers (endometrial, breast, colon)
  - - - Parenting
        
        Controlling food intake
        
        Model appropriate eating and exercise bhvs
      - Physical Activity
        
        Increases endorphin productions
        
        Reduces the risk of:
        
        Cancer
        
        Diabetes
        
        Coronary Heart Diseases
        
        Improves mood / make you feel kai xin kai xin
        
        Reduces depression/ big sad
        
        Reduces stress and anxiety
        
        Improves work performance
        
        Enhances and indv's self concept
    - - Behaviour Therapy
        
        Components
        
        Stimulus control
        
        Self-monitoring
        
        Problem solving and goal setting
        
        Cogntive restructuring
        
        Nutrition and excercise counselling
        
        Adult
        
        Difficult to modify
        
        Need to control environmental conditions
        
        Maintain eating habits
        
        Low drop rates
        
        Children
        
        Impressive success
        
        Family based behavioural programs
        
        Reinforce excercise
        
        Reduce TV watching
        
        Multimodal approach
        
        Screening, self monitoring, control over eating, excercise
        
        Controlling self talk, social support, relapes prevention
      - Motivational interview: enhance people’s intrinsic motivation to excercise and resolving feelings of ambivalence
        
        Increase motivation to change
        
        Expression of empathy
        
        Develop discrepancy btw what they re doing and what they will do
        
        Rolling with resistance
        
        supporting self efficacy
      - Acceptance and mindfulness-based approaches: reduce avoidant behaviour and increase psychological flexibility
        
        Experiential avoidance
        
        Associated with weight loss maintenance
        
        Cognitive flexibility
        
        Associated with weight loss maintenance
        
        Improve
        
        Body weight
        
        Obesity stigma
        
        Quality of life
        
        Psychological distress
        
        Distress tolerance, acceptance
        
        Coping and psychological flexibility
  - - - Larger and more numerous fat cells
    - - With family
      - Health and PE in school
    - - Sensible meal planning
      - Help children develop healthy eating habits
- - - - Alcohol Brain Syndrome = general term for the disorders associated to alc on the brain like withdrawal syndrome, intoxication and delirium tremens etc
      - Alcoholic Dementia = higher cortical functions impaired due to alc such as memory, language , learning capacity etc
      - Alcohol induced amnesic syndrome = recent and remote memory impaired due to alcohol (or drugs)
      - Alcohol Induced Psychotic Disorder = cognition, affect, personality and bhv is affected by alcohol / persists beyond how long it is usually expected
      - Alcoholic Cirrhosis = Severe liver disease resulting from alcohol intoxication / Liver failure or the architecture of the liver is distorted
      - Alcohol Induced Fatty Liver = accumulation of fat in the liver due to alcohol intake
      - Foetal Alcohol Syndrome = Dysfunctional development in newborn babies as a result of alcohol consumption during a mother's pregnancy
    - - Self management = includes self-monitoring, contingency contracting, stimulus control and motivational enhancement
      - Aversion therapy
        
        medications
        
        alcohol sensitising drugs like emetine and apomorphine
        
        naltrexone
        
        disulfiram / antabuse
        
        acamprosate
        
        giving shocks in association with an alcoholic drink with visual suggestions of drinking
        
        covert sensitisation = where the entire aversion procedure is carried out in the imagination
  - - - Substance related cues = specific internal and env stimuli associated with drinking
      - expectancies = ideas about the outcomes of a bhv
      - Reinforcement = positive reinforcement that increase the chance of an indv using the substance again/ the removal of aversive stimuli when using the substance also increase the likelihood of using the substance again
      - genetics = supported by twin studies
    - - Physical dependency model = repeated exposure to substances result in withdrawal symptoms if an indv tried to quit/ constitutes negative reinforcement
      - Positive reinforcement model = drugs have reinforcing properties
      - Disease model = ppl with an addiction was now seen as something more "acceptable"/ ppl were initially seen as criminals and sinners until they were seen as indvs who needed treatment
      - Reinforcement systems = from a biological perspective, drugs taken activate the reinforcement system in the brain (increased dopamine release in the nucleus accumbens)
- - - - Age = usually occurs between 40 to 60 but it can occur at any age
      - Prior family history
      - Gender = tends to be more common in women than men
      - Smoking = increased risk in some ppl/ quitting smoking can reduce the risk
    - - Pain = which can result in a limitation of activities an indv can do and may increase their dependence on others
      - Heart problem = the lining of the heart can get affected, the risk of hardened and blocked arteries increases
      - Lung disease = increased risk of inflammation and scarring of the lung tissues, resulting in shortness of breath
      - Carpal Tunnel Syndrome = if arthritis affects the wrists, inflammations may compress the nerves that serves the hands and fingers, resulting in sharp pain
      - Osteoporosis = when combined together with rheumatoid arthritis, it can make an indv's bones more prone to fracture
    - - enhancement of perceived self-efficacy
      - self help programs
      - rest and supervised exercise/ ensuring that indvs do not engage in heavy strenuous exercise
      - cbt
      - Aspirin and steroids
  - - - medication = analgesic acetaminophen used as the first line of treatment/ NSAIDS are also used but for more severe symptoms
      - Glucocorticoid injections used for short term pain relief
      - lifestyle modification = encouraging overweight indvs to lose weight as it exerts less weight on their weight bearing joints that has arthritis
      - cognitive pain coping
      - Relaxation techniques
      - Problem solving skills
      - Biofeedback