Health is “the state of complete physical, economic, cultural, psychosocial and spiritual wellbeing, not simply the absence

of illness”
nervous system, endocrine system, immune system

Maslow’s hierarchy of needs 1943 states that a person is healthy is all of these FIVE needs are satisfied
1 Physiological 2 Safety 3 Belonging 4 Esteem 5 Self-actualisation
Homeostasis = the state of balance: temperature, PH, hydration / Allostasis = the combination of stressor-responses which maintain this balance LIKE

Homeostasis = 10mg/100ml
blood calcium high, thyroid gland produces the calcitonin, which acts to decrease blood calcium levels via urine
blood calcium low, thyroid gland produces the parathyroid hormone, which acts to increase blood calcium levels
Homeostasis = 300mOsmols/L
water concentration high, adrenal cortex releases aldosterone, kidneys increase sodium concentration which retains more water in blood
water concentration low, pituitary gland releases anti-diuretic hormone, kidneys retain more water by constriction of arterioles
Homestasis = 90mg/100ml
blood glucose high, beta cells in pancreas make insulin, liver coverts glucose into glycogen
blood glucose low, alpha cells in pancreas makes glucagon, liver converts glycogen into glucose

These are examples of Negative feedback loops… a problem in feedback system = Type 1 Diabetes. Immune cells destroy beta cells in pancreas so that it
cannot produce insulin, leaving more glucose in blood. An example of Positive feedback loop: is childbirth. Head of baby pushes against cervix, nerve
impulses from cervix sent to brain, pituitary gland is stimulated and releases hormone oxytocin, which is carried in bloodstream to uterus, oxytocin
stimulates uterine contractions and pushes head further against cervix

Allostasis was coined by Sterling and Eyer in 1988 who argued that healthy functioning requires continual adjustments of internal environment to
maintain or reestablish homeostasis. Most efficient regulation is anticipatory, relying on understanding or memory I.E. prediction for efficiency. Allostatic
load refers to ‘wear and tear’ on body reflecting the cumulative effect of experiences like poor sleep, lack of exercise, unhealthy diet etc It explains why an
inherently adaptive process can lead to disease if there is excessive stress

There are 2 main types of cell in brain = neurones and glial cells
Glial cells provide support and nutrition, maintain local homeostasis, produce myelin and participate in signal transmission. Microglial cells are highly
plastic and behave as macrophages (big eaters) the nervous system main immune defence. Lieff in 2013 explained this constant surveillance protects the
brain against any microbial invaders. Glial cells provides the physical and chemical support to neurones and maintain their environment. Sometimes called
the “glue”. Glia are more numerous than our nerve cells.

Neuromodulators do not propagate nerve impulses, but instead affect the synthesis, breakdown or reabsorption of neurotransmitters. Neuromodulation
occurs when a neurone uses a chemical to regulate diverse populations of neurones, instead of simply into the synaptic gap. Immune systems:

Innate: first line of defence, comprised of barriers which keep harmful germs from entering the body. For example - skin, nails, cough / gag reflex,
stomach acid, mucous membranes. If germs pass through still, a second line of defence is specialised cells that alert the body of danger.
Adaptive: our third line of defence includes the spleen, tonsils. thymus , bone marrow and lymphatic system. These different body parts work together in
order to produce, store and transport specific immune responses that combat health threats

Neurotransmitters = dopamine, serotonin, glycine, norepinephrine, adenosine, acetylcholine, histamine, cortisol, melatonin, GABA, glutamate
Dead cells on Skin, low ph, chemical disruptors, normal flora, provides protection, inflammation, immune response

b lymphocytes made in bone marrow responsible for humoral response and produces naive antibodies that sense the shape of antigens then reproduces
memory b cells for immunity. t lymphocytes made in thymus responsible for cell-mediated response and produces killer t cells, which destroy cells that
are infected or cancerous already… macrophages eat antigens, once inside them, enzymes are released to digest the antigen, but keep one piece, the MHC2
will take it out to surface where a helper T cells docks with the macrophage and senses the shape of antigen for specific immune response. antibodies are
y-shaped proteins that dock to antigens, marking the virus so that macrophages can locate them easily… gland > hormone > cells (water or lipid soluble)
Endocrine system consists of ductless glands. Hormone are messenger carried in bloodstream to different cells around the body, which interpret them

Pineal Gland > Melatonin > Circadian Rhythm

Anterior Pituitary > HGH > Cell Growth
Posterior Pituitary > Antidiuretic > Water Balance
Thymus > Thymosin > T Cells for immunity
Thyroid > T3 + T4 > Metabolism AND Calcitonin > Lowers Blood Calcium
Parathyroid > PTH > Raises Blood Calcium
Pancreas > Insulin > Lowers Blood Sugar AND Glucagon > Raises Blood Sugar
Adrenal Cortex > Glucocorticoids > Anti-inflammatory
Adrenal Medulla > Epinephrine > Flight or Flight
Testes > Testosterone > Male Characteristics
Ovaries > Estrogen > Female Characteristics

action potential > dendrite > the soma > hillock > axon > myelin > schwann cells > node of ranvier > terminals > dendrons > Ca voltage gated channels >
vesicles > synaptic cleft > receptors / NT transporter (unipolar, bipolar, multipolar) Salty banana = sodium outside potassium inside − 70 mV A neurone at
rest is negatively charged, below is undershoot. Negative 55 mV is threshold, overshoot is above 0. Peaks at + 40 mV [Membrane Voltage]

Inflammatory responses take precedence over normal body metabolism with the objective of restoring normality was quickly as possible. Disorder can
result in autoimmune disease. Immunodeficiency: when the Immune system is less active than normal so recurring and life threatening infections can
occur. Immunodeficiency can result from genetic or acquired conditions. Autoimmunity: results from a hyperactive immune system attacking normal
tissues as if they were foreign organisms. Examples are rheumatoid arthritis and diabetes mellitus type 1

Nervous system organisation

Central nervous system: brain and spinal cord, integration and deciding a response to stimulus
Peripheral nervous system: cranial and spinal nerves, communicates incoming and outgoing info
Motor (Efferent) division: information goes out to effectors like muscles or glands, through motor nerve fibres
Sensory (Afferent) division: information comes into CNS from the body, through somatic or visceral nerve fibres
Autonomic nervous system: responds to internal environment by regulating involuntary processes
Somatic nervous system: responds to external environment by coordinating voluntary movement
Sympathetic division: mobilises the body for action, fight or flight, releases energy (norepinephrine)
Parasympathetic division: responsible for housekeeping, rest and digest, conserves energy (acetylcholine)
Natural selection relies on mainly four things: 1) There are differences between individuals within a species = traits 2) Traits are passed onto the offspring
3) Some traits are ‘fitter’ than others 4) There’s an excess of individuals. If these 4 things are true, fit traits must spread between generations and species
will become fitter overtime. Evolution requires a mechanism of inheritance. A theory was developed in 1900 by W. Bateson where the unit of inheritance =
“gene”, and different versions of a gene = “alleles”. How a trait is expressed depends on what specific alleles that you carry. Twas originally assumed that
we only had monogenic traits = a single gene determines one specific trait. Psychological traits are predominantly the most polygenic of all = the product
of many many many genes, each one having a smaller effect. 55% of genes are expressed within the brain. No single gene “accounts” for >1-2% of every
trait. Unit of inheritance = gene. Genes are made of DNA – universal heritable material. DNA has a four-letter code (ATGC) standing for adenine,
cytosine, thymine, guanine – and comes in double strands or helixes. As pair up with Ts, Gs pair up with Cs. This is how our DNA is copied. DNA codes
for proteins: which are responsible for everything inside our body. Proteins control development and function. In all eukaryotes, DNA is split over a
number of chromosomes. We have 46 chromosomes, which come in pairs - one from each of your biological parents. 22 pairs are except the 23rd pair is
different – these are the sex chromosomes. Proteins are made up from 20 kinds of amino acids. From two consecutive letters – you have 4x4 or 16 amino
acids. It takes 3 DNA letters to specify all amino acids = Codon. A mutation will change one letter in DNA and so change an amino acid within the protein.
The 1900s definition of genes was “a unit of inheritance” ... Discoveries in 1950/60s changed that definition into “A gene, being the sequence of DNA that
codes for a protein”. Reading a full DNA sequence (genome) began in 1990 with the Human Genome Project, completed in 2003. We have 20,000 genes,
making 20,000 proteins. Different alleles have different DNA sequences and code for different types of proteins. Proteins called “Histones” form into a
ball – where DNA wraps around it, chromatin. Afterwards the balls form a tightly bound fibre. This forms into loops and these into bigger loops that are
eventually packed together into a chromosome. Both genes and environment can influence a trait. Heritability measures the influence of genes over a
trait... the proportion of total variation of traits within a population that is due to variation in genes. 0% heritability = no genes, all environment. 100%
heritability = all genes, no environment I.E. nature/nurture. Low variability in genes, then heritability will be low as well, even if genes have tight control
over the trait. Heritability isn’t fixed, even though your genes are. Heritability started being measured in 1980 with twin studies. As monozygotic
(identical) twins develop from a single egg fertilised by a single sperm, they are expected to share all of their genes, whereas dizygotic (fraternal) twins
share only about 50% of them. Heritability of psychological traits is high at 50 to 60%: Intelligence, some aspects of personality and mental health
problems. Traits under the strongest pressure of selection – pull in genes to improve fitness. When something is necessary for survival lots of genes will
enhance it = the “watershed model” — Their analogy uses the metaphor of a river being the downstream effect of many smaller upstream contributions
(Cannon & Keller, 2005) ... Any psychological trait depends on hundreds of different processes and thousands of different genes. Inheritance systems =
genetics/epigenetics. Hard inheritance, gene transmission vs soft inheritance, gene expression. Histones are proteins around which DNA winds for
compaction and (through loosening/tightening) gene regulation. A chromosome is DNA tightly wrapped around these spool-like proteins. DNA
Methylation: Methyl groups which are found in particular foods can tag DNA on cytosine, to activate or repress genes (express or silence) Histone
Modification: The binding of epigenetic factors to histone ”tails” alters the extent to which DNA is wrapped around histones and consequently the
availability of genes within the DNA that get activated. DNA inaccessible, gene inactive. Acetyl group loosens the wrapping. Good stress (adaptation)
Tolerable Stress (negative but reparable) Toxic Stress (allostatic load complications) Exposome: The exposome captures the essence of nurture; the
summation and integration of external forces acting upon our genome throughout our lifespan.” (Miller and Jones; 2014) Environmental factors
comprising the exposome include: diet, air quality, lifestyle... Epigenetic modification cannot be reversed. Recovery from traumatic, gene-altering
experiences is possible by redirecting gene expression to compensate. This is known as plasticity. Autonomic, Immune, metabolic and endocrine systems
communicate & affect each other. Allostasis involves turning on physiological responses when needed and turning it off when the stressor is over.
Telomeres are simply a protective end, casing each strand of DNA. Each time a cell divides, it loses a bit of telomere. An enzyme called telomerase can
replenish it, but chronic stress and cortisol exposure decrease your supply. Whence, they shorten. Developmental plasticity means the ability of genes to
express differently in response to environmental factors for adaptation. Epigenetics = gene expression. Concentration of molecules activates or deactivates
certain genes which are read and transcribed by RNA, which is done by ribosomes. Turned into proteins which determine a cell’s function

Allele = a version of same gene like eye colour. Traits are passed down in different patterns. Dominant overrules the other, appears every generation.
Recessive is overruled, can disappear some generations. Requires both parents to have one (homozygous). Meiosis produces cells genetically unique from
parents, whereas mitosis produces cells genetically identical to parents. Genome = complete set of DNA. Genotype determines potential characteristics,
Phenotype is observable characteristics resulting from interaction of genotype with environment. In humans, every cell normally contains 23 pairs of
chromosomes for a total of 46. 22 of them, called autosomes are identical for males and females. sex chromosomes = XX females, XY male. X is bigger
than Y. Chromosomes always come in pairs. One from mum, one from dad. However the 23rd pair is different – these are the sex chromosomes. SRY gene
expressed by the Y chromosome makes you male, and leads to production of testosterone which shapes your morphology and personality.

Sleep = A naturally recurring state of suspended activity partial or total unconsciousness. Karolinska subjective questionnaire sleepiness scale 1-10.
Polysomnography (gold standard) EEG Brain activity, EOG Eye Movement, EMG Electromyography…

N1 Transitional Sleep (rolling eye movement) N2 Light Sleep (Sleep Spindle, K-complex) N3 Deep Slow (slow waves) N4 REM (rapid eye movement)
Examples of pathologies are insomnia, hypersomnia, parasomnia, narcolepsy, sleep paralysis, hypnagogic / hypnopompic hallucinations and REM sleeps
behaviour disorder like fragmentation. Sleep is critical for memory consolidation. There are 2 branches of thought. Theory 1: Active system
consolidation in sleep, newly encoded information from hippocampus is replayed to strengthen memory traces in neocortex. Hippocampus is encoded
short-term. Neocortex is where its stored long-term. Encoding = temporary store (fast learning) to consolidation = long-term store (slow learning) via
reactivation. Memory reactivation is process that results from reexposure to salient training-related information whereby a memory is brought from an
inactive to active state. Theory 2: Synaptic homeostasis / downscaling Waking - synaptic potentiation. Sleep - synaptic downscaling. Encoding (during
wakefulness) potentiates synapses which are then downscaled during subsequent sleep. This eliminates weak but protects strong connections like pruning.
Emotional memories are composed of core memory + affective tone. Core memories are described as emotional memories that resurface when that
emotion becomes dominant.Wundt referred to simple feelings as having the “affective tone of a sensation” (1987) Wundt described momentary affective
states as having three independent qualities—pleasantness/unpleasantness (hedonic valence), arousing/subduing (arousal), and strain/relaxation (intensity)
Affective tone is describes as being our emotional blanket. REM sleep reduces affective tone until an emotional memory remains. Psychotherapy can
update pre-existing memories by reconsolidating labile memory traces. Based on Smith suggested that in humans, REM sleep is associated with the
processing of procedural memory, not in forming declarative memories. Declarative memory is facts, data, and events. Procedural memory is how to

Suprachiasmatic nucleus. in hypothalamus. Your master clock for circadian rhythm. Circadian clocks are in most cells. Main zeitgeber (time giver) is
usually sun. Blue light inhibit the production of melatonin. Circadian rhythms that regulate our inner sleep clock interact with sleep pressures and
stressors. Social clock = work/friends. Social jetlag describes having 2 separate and distinct sleep patterns. Workdays / weekdays very common. Increases
general / cancer-specific mortality. Sleep is essential for proper immune function. Bidirectional relationship > uptake of antigens are encoded, consolidated
with memory b cells and retrieves by informed T cells (like memories) Every one night of low-sleep reduces immune function level of antibodies present
until 4 weeks afterwards. Sleep enhances cytokine production, cell migration / proliferation. Increases growth hormone and prolactin, decreasing levels of
cortisol. Cytokine storm happens when the immune system produces an excess of inflammatory signals. Can lead to organ failure and death. Beta-amyloid
is called a peptide (protein) Normal function still unknown but accumulates in brain with a lack of sleep and linked to cell-death by plaques, found in
tissue between the nerve-cells in clumps with degenerating bits of neurones. Neurofibrillary tangles are abnormal accumulations of a protein called tau that
collect inside neurones. Healthy neurones are supported internally by structures called microtubules, which help guide nutrients and molecules from the
cell body to axons. Neurofibrillary tangles are abnormal accumulations of a protein called tau that collect here
‘Intergenerational transmission’ occurs when enduring epigenetic changes in parental biological systems in response to maternal exposure are
transmitted over to offspring. Teratogens are environmental agents that may cause deviations in foetal development like diet, pollution, meds. Teratogens
effects may include abnormalities, mental social and physical impairments. Symptoms of Foetal Alcohol Syndrome: small eyes, thin upper lip, short and
upturned nose, smooth skin surface between the nose and upper lip + problems with growth Maternal smoking & alcohol during pregnancy – Avon
Longitudinal Study of Parents and Children (ALSPAC): Changes to DNA methylation in blood cord of infants at birth. These epigenetic changes are
critical intermediary between prenatal environment and subsequent substance abuse risk in adolescence (Cecil et al., 2016) Increased DNA methylation of
a gene that encodes for an enzyme that inactivates stress hormones. This may lead to heightened exposure of foetus to cortisol. A common result of
prenatal stress is preterm birth (disruption to in utero environment) One theory of epigenetic processes suggested by (Klengel and Binder, 2015) is that
stress, and in particular early life adversities can activate the stress hormone system which may epigenetically program the system toward a hormonal
maladaptation to stressors - lifelong. Maternal smoking during pregnancy: Increased hyperactivity (Melchior, 2015) Conduct disorder (Talati, 2017)
Asthma (Hu, 1997) Changes to DNA methylation in placenta and foetal cord. Pulmonary function impaired (Shorey-Kendrick, 2017)

Maltreated children who are/were exposed to six additional risks face a 90-100% likelihood of having a delay in their developmental stages (Barth, 2008).
Adults who recall 7 or 8 serious adverse experiences in childhood are 3 times more likely to have cardiovascular disease as an adult (Dong, 2004)

Three main stages of Addiction:

1 Binge
2 Withdrawal
3 Craving

1 Positive reinforcement by substance reward mediated by dopamine associative learning of context

2 poor emotional state decrease in endogenous opioids negative reinforcement with abstinence
3 vulnerability to relapse from preoccupation with the substance and disrupted PFC function

Hierarchy of substance use disorders: 1 Non-user 2 Low risk 3 Hazardous use 4 harmful substance abuse 5 Dependence. Physical and psychological
addition is distinct … Dopamine seems to code for expectation and reflect what you believed would happen

4 Areas involved with dopamine reward pathway

Ventral tegmental area - Risk Reward regulation
Nucleus Accumbens - Reward Action Interface
Amygdala in Temporal Lobe - Emotional Control
Prefrontal Lobe/cortex - Higher Order Thinking

Substances change neurotransmitter activity: Glutamatergic means excitatory, Gaba-ergic means inhibitory
Acute effects - no tolerance was immediately developed to substance, which isn’t the same for biological motivational stimuli
Chronic Effects - receptors become habituated to levels of substance and release less neurotransmitters which are endogenous

ICD-10 International Classification of Disease: Maladaptive pattern of substance use, leading to significant distress or impairment (Three or more)
Tolerance is developed to original effect so more is required, Strong compulsion to retake the substance, difficulties in controlling onset, termination or
levels, neglect of alternative hobbies and responsibilities, and persistent use despite full awareness of harm its doing
DSM-5 Diagnostic and statistical manual of disorders: A problematic pattern of substance use, leading to significant distress or impairment (Two or more)
Impaired control like using more of substance or longer than intended, social impairment like giving up activities or failure to attend, risky use like
ignoring health complications, Pharmacological criteria like tolerance and withdrawal

Opponent process theory of motivation: Two opposing mechanisms of action — Process A Tolerance (positive) Process B: Withdrawal (Negative)
Repeat use changes because of allostatic state and regulation (there is shift in homeostatic point)

Incentive-sensitisation model: Wanting does not equal liking. Liking is enjoying the pleasurable effect. Wanting is process of changing your perception by
increasing the attractiveness of substances, while ignoring the negative aspects (this is called ‘incentive salience’)

Delay Discounting: systematic decrease in subjective value of reinforcer if there is delay to delivery I.E. greater preference for smaller-immediate rewards
over larger-delayed rewards,. Biased decision making or impulsive choices are typical in substance use disorder. Higher discounting rate is preference for
immediacy of reward. Basically a problem with the mechanism delayed gratification

Probabilistic reward task: chronic alcohol usage impairs gold-directed behaviour… Each trial, 2 choices/options are presented to learner, one advantageous
(more likely to ensue a reward), one disadvantageous (more likely to ensue a punishment) Goal-directed control is deliberate self regulation of behaviour

Attentional bias is susceptibility to prioritise the processing of certain types of stimuli. The dot-probe task is considered gold standard for assessing the
intrinsic attentive selection of visual cues, measured by response time. Slow reaction times in smokers, their attention is drawn to addiction-related stimuli

Implicit action tendencies can be measured with the Approach-Avoidance Task (AAT). Avoidance = push. Approach = Pull. Measures people's behavioural
tendencies either to approach or avoid particular stimuli. Alcoholics have stronger approach tendencies for alcohol cues. This correlates with craving

Aversive memories can be updated during sleep-time. This can be used to change peoples’ association with smoking. Olfactory aversive conditioning has
unpleasant odours like ammonium sulphide or rotten fish combined with cigarette odour vs clean air during sleep. Reduction in number of smoked
cigarettes post sessions, dramatically from 1-3 days but progress not maintained

Puberty and Stress Sensitivity: Changes in grey and white matter. Grey matter changes include synaptogenesis and synaptic pruning. Formation and
disappearance of synapse. Myelination increase: increases quality and speed of neurone to neurone communication 1. Grey matter throughout brain
shrinks in adolescence because it’s becoming more specialised 2. Nerve cells in cortex get wrapped with myelin, an insulating substance that helps protect
and speed up signals 3. Communication links between different regions, called white matter tracts, start to solidify into adult like structures 4. Cortical
thinning where grey matter reduction and increased white matter organisation leads to increased connectivity between important circuitry and pruning
unnecessary synapses. What is PTSD? A specific stress response in persons exposed to extreme stressors (disasters, war, abuse) the specific term ‘PTSD’
emerged after US soldiers returned from the Vietnam War. Symptoms include: Distress, insomnia, nightmares, flashbacks, problems with memory and
concentration etc.Risk of developing PTSD… 10–30% of persons exposed to traumatic stress develop PTSD. This depends on the type of stressor:
Children who witness parental homicide (100%) Children exposed to school shooting (77%) Urban youths exposed to community violence (35%). What is
PTG? Post traumatic growth is when one experiences a positive change from an intense life crisis. Also called anti fragility. Associated with Increased
appreciation for life, meaningful interpersonal relationships, Increased sense of personal strength. But most of all - A change of priorities. Richer
existential and spiritual life (Tedeschi & Calhoun, 2004) The process of PTG is two-step. Major life crises challenge a person’s understanding of
themselves and/or world. Growth phase – cognitive rebuilding takes into account the changed sense of reality and self, post-trauma
When is measurement taken? Cross-sectional = at one time point. Longitudinal = at more than one time point Both can be experimental or observational /
Quasi-experimental. You can’t determine causation from cross-sectional data; only associations! Also can’t from longitudinal data, unless you have a
control group. Data coding is known as iterative - A circular process of noticing, collecting, and thinking (Seidel, 1998) Experiential semantic coding =
Take data at face value - Participants’ experiences are prioritised, accepted and focused on. Critical latent coding = Read between the lines - Participants’
word choices, expressions, pauses scrutinised to seek hidden assumptions. Ontology = the nature of reality. Reality = the social world in which you want to
conduct work. Epistemology = Beliefs about what counts as knowledge. Positivism = Truth is waiting to just be discovered by correct method of enquiry.
Constructionist: Truth is not independent of researcher; but produced through enquiry. Contextualism = Knowledge emerges from context and reflects the
researcher’s position Still believes in a single realty or truth, so not consistent with constructionism, which rejects this notion. Realism = There is a single
objective reality observable through science if you have the correct tools. Truth exists, independent of people’s beliefs. Critical Realism = There is a single
objective reality only ever known imperfectly. Truth exists, but our understanding of it can only ever be partial and biased. Relativism = There are multiple
subjective realities, each of which is socially constructed by and between individuals; all then are equally true.

Healthism (Crawford, 1980, 2006) Health is a moral good. Individuals have an obligation to maximise their own health. Individuals are responsible for
doing so (and not doing is irresponsible) Illness is seen as fault of individual. Neoliberal policies re taxation, benefits etc. A practical definition of stigma
in operation (Link & Phelan, 2001) Labelling, Stereotyping, Separation, Status loss, Discrimination, Use of power. Stigma entirely dependent on political,
social and economic power. Powerful groups in society cannot be stigmatised Effect on health: Availability of resources, Social isolation, Psychological
and behavioural responses to stigma, chronic or acute Stress, Allostatic load. Types of stress: Biological – illness, pollution, etc Economic – opportunity,
hardship etc Social – structural, interpersonal etc. Class I misdiagnosis: a missed major diagnosis that caused death and whose identification and treatment
would have prolonged life or cured. More likely to occur in ‘obese’ patient. Weight not protected category. Microaggressions: “Brief and commonplace
verbal, behavioural, or environmental indignities, whether intentional or unintentional that communicate hostile, derogatory, or negative insults and target
a person/group”. Multiple risk factors; throughout life course, direct and indirect effects.

Lower standard of care. Case Study: Irmtraud Eichler — 60 year old woman, Rapid weight gain, Trouble breathing, Doc: diabetes + lack of activity,
Prescription: anti-obesity pills… But a second opinion (when she could not stand up even) 7-hour op, Removed ovaries, uterus, thyroid. 28 kg tumour

Shared decision-making (SDT): Patients are involved with decisions about their own care and treatment. Key elements (Charles, 1999): 1) Physician and
patient engage in decision-making and information exchange 2) Both express treatment preferences 3) Together, agree on treatment decision. E-health
Digital technology for health promotion. M-health is Mobile and wireless applications. For example, flash glucose monitors are sensors (small white discs)
worn on arm to monitor continuous glucose levels. Adherence to chronic disease management - sms = 40% Which frame is more persuasive? Loss-frame:
Illness-detecting (screening) behaviours. Sunscreen, Risk seeking or Behaviours that involve a level of uncertainty. Gain-frame: Health affirming
(prevention) behaviours. Mouthwash, Risk averse (avoidant) or Behaviours that are relatively certain. Detection behaviours can reveal health problems
which is risky. Prevention behaviours prevent future health problems which is safe.

prevention behaviour
perceived as effective, action low risk, gain frame
perceived as ineffective, action high risk, loss frame
detection behaviour
low perceived susceptibility, action low risk, gain frame
high perceived susceptibility, action high risk, loss frame

Stimulus-based (‘stressful life’) Response-based (‘feeling stressed’) Interactional (‘coping with stress’) … Stimulus-based perspective — Social
readjustment rating scale (Holmes & Rahe, 1967) Life events are scored and ranked according to amount of stress they induce. The nature of event dictates
the magnitude of response. Uncontrollable events do require more readjustment and cause greater stress. The contamination hypothesis is that some life
events may actually be stress-related outcomes. Hassles and uplifts scale (Kanner et al., 1981) Focus on relatively minor events. Hassles: Confusing,
frustrating, demanding. Uplifts: Positive experiences. Hassles and uplifts better predict neurological symptoms than life-events scores. In SRRC (Holmes
& Rahe, 1967), any change, regardless of valence and coping ability, is potentially damaging to health. However, positive emotional experiences can
buffer against stress disorders (Lazarus, 1980) Breathers: Breaks from regulate stressful encounters. Sustainers: Sustain coping activity. Restores:
Replenish depleted resources. General adaptation syndrome (Hans Selye) Alarm reaction – body’s defences are mobilised. Resistance stage – body adapts
to stressor. Exhaustion stage – body’s capacity for resistance is depleted. Disease adaptation – abnormal physiology resulting from long-term resistance.
Response-based perspective … Psychosomatic medicine (Franz Alexander) Fight or flight – temporary and biologic adaptive changes. Chronic stress –
over activation of the sympathetic branch of the autonomic nervous system. Chronic Stress, HPA Axis activation, higher cortisol levels, Hypercortisolism
leads to Greater intra-abdominal fat, Larger waist circumference and Type 2 diabetes. Interactional models (Lazarus & Folkman, 1984) Primary appraisal –
evaluation of stressor (threat or no threat?) Secondary appraisal – identify coping options and resources. Interactional perspective like Flowchart for model
of stress (Cox, 1978) suggested that stress is due to transaction between the individual and environment. Significant is really the individual's cognitive
assessment of whatever perceived demands are made on him or her. Conservation of resources theory (COR; Hobfoll, 1989) proposes that stress occurs
when people (a) are threatened with resource loss, (b) actually lose resources, or (c) fail to gain resources following resource investment. Deepwater
Horizon drilling rig explosion The explosion occurred in 2010, Gulf of Mexico. Largest marine oil spill in world. Relatively untested chemical dispersants
were released. Subsequent reports of depression, anxiety, and post-traumatic stress symptoms among residents of communities on coastline.