Biopsych + Public Health 2 (Up To Jan) PDF

DOCTOR PATIENT RELATIONSHIP Mutualistic Consumerist relationship Patient and doctor control = high Patient control...

DOCTOR PATIENT RELATIONSHIP Mutualistic Consumerist relationship Patient and doctor control = high Patient control = high Doctor control = low Involves mutual respect where patient plays a more active role Greater levels of patient choice Patients becoming more active and demanding Doctor acknowledges the patient’s e.g. internet beliefs, knowledge and experiences as important Patients as consumers of health and health care Paternalistic model The consultation is more patient-centred Increased choice, participation in decision-making policy, design Patient is expected to be the passive and provision of services recipient of care Shared decision-making: both parties Nationally and internationally e.g. health tourism May be appropriate in certain clinical involved in decision-making contexts e.g. A&E and for some patients (differences between Conflict relationship Default relationship patients) Relationship characterised by conflict Patient control = low Overlooks the patient’s own Disagreement and difference in perspectives knowledge and experiences Doctor control = low ‘Clash of perspectives’ (Freidson,1970) Can result in low patient satisfaction Lack of engagement on both sides e.g. doctor’s attempts to involve the patient in the consultation are Doctors and patients come from different social worlds and complaints unsuccessful want more information than the doctor is willing to give May impact on adherence, disclosing of key information, understanding Shared decision making Different expectations about the behaviour of each agent e.g. and therapeutic relationship ‘The conversation that happens between a patient and their healthcare treatment, access professional to reach a health care choice together’ (NHS Shared May lead to conflict if patient tries to decision making 2012). take more control It involves sharing information, including uncertainties, about options, and outcomes, and using this with the knowledge, views and experiences of the patient to make decisions. Why do we eat what we eat? Developmental model- exposure, social learning, INGESTIVE BEHAVIORS association Weight concern model – meaning of food, meaning of weight, body dissatisfaction, dieting Weight concern model Cognitive models- cognition models, distraction Meaning of food + weight – symbolic significance, emotional Developmental model conflict - focus on development of food preferences Body dissatisfaction + dysmorphia – distorted body size - role of exposure, social learning + association estimation, can occur in both sexes, can be feature of clinically - exposure depends on cultural + economic factors defined eating disorder - associative learning (skinner), reinforcement, food as a reward, control Stunkard scale – measure body dissatisfaction - social learning (bandura), modelling + context - which body is closest to yours -> All suggest aqusition + maintenece of eating habits is - which is your ideal body shape learned -> Greater discrepancy can be indicative of eating disorders - barker hypothesis- intrauterine growth restriction, low Dieting + restrained eating birth weight -> may predispose children to obesity + Over + under eating -> weight fluctuation rather than weight loss metabolic syndrome – develop phenotype to survive Cognitive shift – breakdown in self control -> motivational collapse, give in nutrient poor environment – mismatch between intra + Role of denial – paradoxical effect, supress thoughts + become more silent extra uterine environment – neonate may be maladapted Mood modification – eating elevates low mood and higher risk of obesity + metabolic conditions Over eating as a relapse Restrained eating associated with: Body dissatisfaction Body dissatisfaction, cravings, food Cognitive model preoccupations, guilt about food/ eating, low Social factors - predict + explain eating behavior - role of media + social media self esteem, anxiety + depression, - theory of planned behavior - ethnicity + social class- related to beliefs overestimation of body size - behavioral attitudes, subjective norms + perceived control - - family – mothers communicate own dissatisfaction to daughters Obestity- product of complex set of factors > intention -> eating behavior - food myths, beliefs values + Psychological factors Biological eg. Genetic attitudes - beliefs- parents + personal Social eg. Food industry, family - trauma + childhood sexual abuse Behavioral eg. Under exercise, diet higher in fats Homeostatic eating – driven by the needs of the body - intergenerational- mother daughter relationship Hedonic eating – driven by what you want to eat, highly Gender Microbiome, drugs palatable foods due to the pleasure it brings - different concerns - media + pressure for males – bulking Violence = intentional use of physical force or power, threatened or actual, against oneself, Domestic violence + substance misuse another person or against a group or community – IPV- any incident or pattern of incidents of result in or has a high likelihood of resulting in controlling, coercive, threatening behavior, injury, death psychological harm, maldevelopment violence or abuse between those age 16 or or deprivation over who are, or have been intimate partners Three types of violence: or family members regardless of gender or Self directed violence sexuality Collective violence Pregnancy- gets worse during pregnancy or Interpersonal violence soon after the birth of the child Typology of violence Male- male vitcims are less likely to tell Instigating factors- circumstances or situations that Family + intimate partner violence- inside the anyone about the abuse normatively trigger an individual to behave aggressively Sexuality- LGBTQ+ more likely than Imnpelling factors- psycholgocially prepare an individual to home experience a strong urge to aggress when encountering Community violence- unrelated, may not know heterosexual relationships instigation eachother, taking place outside the home Disability/ illness- more likely + may be less Inhibiting factors- counteract instigating and impelling factors inclined to get help due to reliancy to mitigate the urge to act Social agenda- hate commited by organised groups, terrorist acts, mob violence Safeguarding Substance misuse- not causative or Political violence- war related violent conflicts, - person centred deterministic, strong association between the 2, state violence - assess capacity reduce inhibitions, use substances with partner Economic violence- larger groups motivated by - consider further action as a form of bonding economic gain Domestic abuse can include: Alcohol misuse and children/ Coercive control families – children affected by Psycholgical and/ or emotional abuse alcohol misuse are more likely to Physical abuse report physical, behavioral and Sexual abuse psycological problems Financial abuse Harrassment and stalking, online or digital abuse What does the quality of life include? Physical – functional ability/ disability, pain, fatigue, nausea Psychological – feelings/ mood, self esteem QUALITY OF LIFE Social – relationships, roles “An individual's perceptions of their position in life WHO 7 domains of QoL in the context of the culture and value systems in Physical health which they live and in relation to their goals, Psychological health standards and concerns” (WHO) Level of independence People vary regarding what they deem important Social relationships for a quality life. Environment Eg. one person may feel a strong network of Personal values + beliefs close relationships is necessary. In contrast, another person may forego What is health related quality of life? relationships for personally meaningful Multidimensional concept that includes domains related activities or accomplishments. to physical, mental, emotional + social functioning Beyond direct measures of population health Unidimetional measures Single overall score Comparing treatment outcomes: General health questionnaire Objective measures Beck depression inventory Key indicators of health: mortality rates, morbidity rates Barthel index Subjective measures- QoL Multidimensional Mortality rates Separate subscale scores Advantages: able to compare number of deaths from Short form 36 health survey treatment to treatment, Physical functioning/ social functioning, role Disadvantages: unreliable, doesn’t indicate morbidity limitations due to: physical problems, role limitations due tot emotions, pain, mental health, Morbidity rates energy/vitality, general health perception Can be measured in terms of: sickness absence rates, case loads, prevalence rates of certain problems – room for subjectivity? 5 types of discrimination against people: (Dis)ableism - discrimination and prejudice against people with DISABILITY + SOCIETY disabilities. Social model of disability Social/economic – education and employment Key Idea: Disability results from social barriers, not impairments themselves Physical – access to built environment (housing, transport) Examples: Inaccessible environments, lack of support, or discrimination. Cultural – language used/images of disability Origins: Emerged through disability rights activism (1960s-80s). Behavioural – Hate Crime, abuse and violence, staring, lack of Redefines Disability: Viewed as social oppression, rather than a medical condition. friendship and intimacy Focus: How society restricts opportunities for participation, e.g., in economic or social WHO classifications life. impairment - any loss of abnormality of psychological, Dependency: Created by exclusion, not by impairment. physiological or anatomical structure or function Political Impact: disability - any restriction or lack (resulting from an impairment) of Shifts debate to rights and citizenship, away from individual “suffering.” ability to perform an activity in the manner or within the range Challenges how society values people with impairments. considered normal for a human being Staples & Mehrotra (2016): “Bodily states don't always define individuals as ill or suffering but can be valued in their own right.” Medical/Individual Model: Disability equated with being defective, inferior, or Strengths + limitations of the medical model of disability Strengths + limitations of the social model of disability less than. Strengths Strengths:Promotes equality, dignity, and Focuses on biological/psychological anomalies and Provides a clear framework for diagnosing, treating, or empowerment for disabled individuals. deficits. managing certain impairments. Focuses on changing society to be more inclusive and Negative terminology often used. Advances in medicine can alleviate symptoms or improve accessible. Goal: Provide advice or prescriptions to the patient. quality of life. Helps to tackle stigma and discrimination. People are seen as passive recipients of care. Useful for conditions where medical interventions (e.g., Advocates for universal design and accessibility in public surgery, therapy) are effective. spaces, workplaces, and services. Social Model Focus on objective measures (e.g., diagnostic tools) offers Empowers disabled people to define their own Disability equated with being different, not less than. standardization. experiences and needs. Key shared experience: social stigma rather than Limitations: Limitations:Sometimes underestimates the role of inherent deficits. Ignores the social and environmental factors contributing to impairments (e.g., chronic pain, degenerative conditions) Uses positive/neutral terminology. disability. in an individual's daily life. Discussions focus on personal strengths and Focus on "curing" disability can stigmatize individuals who Doesn't always account for the complex weaknesses. can't or don't want to be "fixed." interaction between medical needs and social barriers. Goal: Empower individuals to take an active role in self- Leads to a paternalistic approach where disabled individuals Can be less effective for impairments requiring significant actualization. have less agency. medical or personal care. People are seen as active agents. Encourages discrimination by framing disabled people as Overemphasis on societal change can be slow and feel "broken" or "defective." impractical for individuals needing immediate solutions. Minimizes focus on creating inclusive environments. Medical model assumptions 9 protected characteristics Disability is viewed as a deficiency or abnormality within the age individual.It assumes that the problem lies in the person's body disability or mind.Focus is on diagnosis, treatment, and cure.The aim is gender reassignment to make the individual as "normal" or "functional" as marriage + civil partnership possible.Disability is a biological or medical issue requiring pregnancy + maternity professional intervention.Individuals are often seen as passive race recipients of help. religion + belief sex Social model assumptions sexual orientation Disability is not caused by an individual’s impairment but by societal barriers (e.g., lack of accessibility, prejudice).Society disables people by creating physical, attitudinal, and systemic barriers.The focus is on removing barriers to participation rather than "fixing" the individual.Disability is seen as a form of social oppression, not an inherent flaw.Individuals are considered active agents in addressing and overcoming barriers.  COMPLIMENTARY + ALTERNATIVE MEDICINE Inner self vs social self model alternative medical systems - map on the tongue, foot mind body interventions- meditation, yoga. proven benefits in stress reduction, anxiety management, chronic pain biologically based therapies- herbal remidies, dietary supplements. overlap w conventional medicines use of supplements, concerns: potential drug interactions, lack of standardisation, variable efficiacy manipulative + body based practices- chiropractor, osteopathy, massage. musculoskeletal issues energy therapies- reiki, accupuncture. aim to balance energy fields, accupuncture supported by evidence in pain management Pull factors towards CAM Push factors away from conventional medicine Safety concerns hollistic approach- treating the whole person, mind dissatisfcation- perception of insufficient time, - evaluate for potential harm body spirit empathy or personalisation, lack of effective - always consider contraindications percieved naturalness- use natural products or treatments for chronic or incurable conditions + patient specific factors approaches rather than synthetic medications side effects- avoid or minimise side effects of patient empowerment- more active role in their pharmaceuticals or invasive treatments ethical considerations health, fostering a sense of control and involvement cost- more affordable or accessible - respect patient autonomy + cultural and traditional beliefs - long standing cultural limited access to conventional care- geographic beliefs practices resonate w patients identities and values or economic barriers to accessing healthcare - provide informed advice based on success stories and testimonies - anecdotal evidence systems evidence from friends, family or public figures cultural or religious mismatch- conventional - avoid dismissiveness while focus on prevention + wellness- emphasises lifestyle medicine does not align with their cultural, ensuring patients make safe and prevention-> can appeal to health conscious spiritual or religious beliefs choices