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pain reflects high levels of stimulation through other senses
i. not as specific, but still focused on sensation
ii. does not allow for CNS modulationiii. pain is predictable result from pattern of senses
contracts muscles without shortening
contracts muscles and moves joints
Must use exertion to lift an object and return to starting position
requires special equipment
restores strength and endurance after injury
Requires short bursts of energy
does not require increased oxygen
improves speed and endurance
can be dangerous for people with CHD
-Valid evidence of association
-Other explanations ruled out
-Cause precedes effect-Plausible mechanism
Melzack extended the gate control theory- the neuromatrix emphasizes the role of brain in pain perception
Epilepsy is a syndrome in which brain seizure activity is a primary and chronic symptom.
A Seizure is the firing of groups of neurons in synchronous oscillation as opposed to the normal pattern of relatively independent electrical activity.
1% of the population.
There is a 3% increase in incidence by age 75,
Grand mal: "Big bad".
Tonic (stiffening)/clonic (jerking), + loss of consciousness.
Petit mal: "Little bad". No violent physical loss of control but does cause an altered state of consciousness.
Generalized seizures: Involve both cortical hemispheres at the onset.
Partial seizures: Are confined to a specific area at the onset, although they can spread out and cause a generalized seizure. There are 2 types:
1: Simple partial: Consciousness is preserved.
2: Complex partial: consciousness is impaired.
The Temporal lobe is particularly epileptogenic.
Aura, Seizure, Post-ictal.
Aura - smelling strange smells, or seeing blinking lights, or having a feeling of immense fear. Apparently auras only happen in partial seizures. Generalized seizures don't have auras.
What is the main pathway for vision called?
What is the tectopulvinar pathway and what is its course?
What are the optic chiasm, optic tract, LGN, optic radiation, V1?
What are the other names for V1 (3)?
What is the visual field? Explain the overlap between the visual fields of the R and L eyes.
Explain which fibers from the two halves of the retina go where before/after the optic chiasm. Which half is nasal and which is temporal?
From where in the visual field do the nasal/temporal halves of the retina get information?
What do “ipsilateral” and “contralateral” mean?
What are the striate, extrastriate, primary, secondary, tertiary visual cortices?
What are the dorsal & ventral visual stream?
What is the function of ventral & dorsal streams? Which one is ‘where/what for/vision for action’ and which one is ‘what’?
What is processed in MT (V5), and V4?
What does it mean that the representation in V1 (BA 17) is retinotopic?
- They are not productive, healthy cells
- Cancer that has spread
- can be slowed, but not stopped by medication
- other symptoms include agitation, irrationality, paranoia, sleep disorders, ect.
Psychological, behavioral, and social effects of having a chronic illness
Better psychological functioning predict quality of life
variety of coping strategies predictive of quality of life
therapy and support groups help. Invisible social support more effective
- Surrogates tend to interpret living will inaccurately...
- ...overestimate desire for treatment
designate a surrogate decision-maker in case of incapacitation
can be oral, written, informal, formal, general or specific
Prevalence of completion of living wills/advance directives in the U.S.
Principles in end-of-life decision-making
Definitions of common principles
3.Preserving cognition and functioning
5.Fear about inviting problems by planning for them
Principle given primacy in the U.S. medicolegal system
Rationale for studying health behaviors
-leading cause of preventable death
-prevent and lessen progress of illnesses
Most efficient way to prevent injuries
- Have much greater reach than other preventative methods.
- The impact of any intervention if the function of its efficacy relative to its reach...
- Interventions like laws have enormous reach so they have a major impact
Risk factors: intimate terrorism( high levels of control denigration, isolation from others)
Prevalence of: infants and older adults
Intervention: improve women's status, focus on victim, not batterer, shelters, community-based referral, support groups, protective orders
-second hand smoke effects non-smokers
-increased risk of lung cancer, cardiovascular disease, respiratory disease in children, leading preventable cause of death
Genes, social norms, optimistic bias, weight concern
cancer, cardiovascular disease
Direct drug and alcohol effects on health
- Increased wanting
- Conscious desire
Leptin: low fat signals & prompts eating
Insulin: regulates cell intake of glucose
Ghrelin: rises before, falls after- short term regulation
CCK: short term regulator signaling satiation rise before stop eating
- Acts on CNS to signal low fat levels & prompt eating
- Produced in Adipose tissue
- Regulates cell intake of glucose
*Model accommodates variability in weight
- little or no body movement
- i.e Plank, pull up hold
- Builds strength
- motion must move against resistance, then return to starting position
- i.e Lifting weights
- requires special equipment
- Restores strength & endurance after injury
- repeated movement
- constant muscle tension
- i.e Pushups
- Builds stamina
- Oxygen levels, HR, ect catch up w/ energy expenditure after exertion
- Requires short bursts of energy
- i.e 100m dash
- Improves speed & endurance
Cardiovascular fitness from increase energy expenditure
- i.e Walking
Increase good cholesterol
decrease bad cholesterol
increase bone strength and flexibility
increase cardiac efficiency
decrease cancer risk
Ways to prevents STIs
- ..affect quality of life more
- 25% of people complete this action
- Can be oral (vs. written), formal (vs. informal), generic (vs. specific)
- Treatment preferences & designation of a surrogate decision-maker in the event that a person can't make their own decisions.
- Surrogate judgments are often inaccurate & based on projection...
- They tend to overestimate desire for treatment
- Overestimate in a way that is based on their own desires
- More likely to escalate over time, but less likely to be mutual.
* Tobacco use declining over time
- The more you use the drug, the more you will want to use it.
- Everytime you use, more dopamine gets released.
- Frames addiction as a result of human weakness - a defect in character.
- Doesn't offer biological or genetic components of addiction & offers little sympathy for those who display addictive behaviors.
- Brain becomes increasingly sensitive to the same quantity of a drug
- "incentive salience"
- wanting, not liking or pleasure, is associated with drug cravings
- Addicts repeat the addictive behavior even though they know the health risks & want to stop.
- Preconscious neural wanting becomes conscious desire.
- A short-term regulator that signals satiation (fullness)
- Appetite increaser
- Rises before meals, falls after
- Produced in stomach
- May be role in short-term regulation of eating by acting on hypothalamus
Starvation: inactivity, apathy, self-neglect, aggression, obsession with food, negative mood
Overfeeding: weight gain rapid at first the maintained, food repulsive, family history of obesity had trouble returning to previous weight
Problem: genes don't change as rapidly as obesity has risen
- BMI, body fat distribution are heritable (twin vs. adoption studies)
- Heritability likely due to changes in set point
- Weight is regulated around a setpoint (a type of internal thermostat)
- Evidence from starvation, overeating studies
- Biological mechanisms: Leptin levels in hypothalamus
Problem: How does this model explain the rapid rise in obesity & variation in setpoints?
35% are obese
30% are overweight
- Body image preoccupation / dissatisfaction
- Distorted body image - below 85% of ideal body weight
*More common in women, young adults
*Associated with impulsivity, substance abuse
inflammatory lung disease
genetic, environment, insufficient exposure to dirt, obesity/sedentary lifestyle
accelerated forgetting, decline in daily living skills, agitation and irritability, sleep problems, delusions, hallucinations, inappropriate sexual behavior, incontinence, depression
adaptive: maintaining optimism, enhancing self-understanding
Maladaptive: denial, hopelessness, aggression
1.Patient completes living will
2. Patient expresses authentic wishes
3. Surrogate exposed to living will
4. Surrogate interprets living will
5. Surrogate able to honor wishes
6. Doctor willing to honor wishes
Accuracy of children's interpretations of their parent's wishes regarding the future medical care
overestimate want of aggressive care
bias own desires
Humans are resilient (don't grieve but push on), no evidence that people should experience in set pattern, people with chronic disease and terminal illness show range of negative reactions but may have positive response
19% Americans smoke
24% 18-24 year olds
More men than women
Less than 12 years of education
Used to be more prevalent
Rates are declining in high-income nations
Increasing in middle and lower-income nations
Direct: liver damage, increased blood pressure/heart damage, cancer, infertility, respiratory disease, miscarriage
Indirect: increased aggression impaired judgment, changes in attention, unintentional injuries, suicide, poor nutrition, STI's
increased good cholesterol, decreased clotting-related problems, possible reduce risk of type II diabetes, gallstones, reduction in Alzheimer's Disease
No health benefits
eating self-regulated through learning, not automatic, diverse motives for eating: personal pleasure, social context, biological factors
accommodates variability in weight
Effective: moderation, exercise, behavior modification programs, self-monitoring
Ineffective: fasting, diet pills, surgery, liposuction, hypnosis
type II diabetes
Diagnostic: refusal to maintain normal weight, fear of fat/food, body image preoccupation, distorted body image, below 85 ideal weight --restricting/purging
Treatment: re-feeding, medical stabilization, motivational enhancement, cognitive behavioral therapy
Diagnostic: normal weight or overweight, binges, loss of control over eating, impulsivity, substance abuse
Treatment: CBT, Prozac, exercise
Requires increased oxygen
benefits cardiorespiratory health
intensity and duration important
can build strength and endurance
flexibility and range of motion
oxygen concentration, blood pumped/heart beat, blood pressure increase, increased cardiac efficiency
Curable: syphilis, gonorrhea, chlamydia, pelvic inflammatory disease, tricomoniasis
Incurable: HIV/AIDS, Herpes, Hepatitis, HPV
Sexual assault: 1.9%
Abusive relationships: 15%
- Perceived Susceptibility: My mom has breast cancer, and there is a chance I can get it
- Likelihood of action: if my pt is likely to perceive action
i. Ex) If woman in my family had breas cancer, then there's a higher lieklihood of doing breast exam (enefit of doing BE, might find tumor)
attitude, subjective norm and perceived behavioral control lead to intention, which leads to behavior
relevant attitudes do predict intended and actual behavior
-Interactive Literacy: cognitive skills, social skills, extract& derive information, apply information to new situations
-Critical Literacy: analyze information, exert control over own health
Strategiesto address health literacy in health care
complements or alternatives to western biomedical medicine
-ex: acupuncture, herbal treatments, rituals, prayer
-pain in arthritis
-lower back pain
Magnitude of mind-body therapies on pain and mood
-beneficence (do good)
-nonmaleficence (do no harm)
1) Informed consent (compensation as well)- take responsibility and can stop anytime.
3) Protection from harm- physically and psychologically
4) Confidentiality- identity
-duty to prevent self-harm
-purpose of research
-rights to decline
-free to withdraw
Singer and Singer’s Information, Motivation, Behavior Model of AIDS Risk Reduction
Leventhal’s Common-Sense Self-Regulation Model
Status and critiques of our current models of health behavior
-some researched more than others
-poor predictive power
-results inconsistent across behaviors
-doesn't explain differences by gender, race/ethnicity
Relations between intentions and behavior
Best predictor of future behavior currently known
-Assess understanding: teach back, show me
-Invite patient participation
-Focus on patient concerns
-Central Route: critical evaluation of message, attention to logic, supporting facts, credibility of source
- Peripheral Route: affect-based, attention to feeling, tone, likability
Need for Cognition:
Monitoring vs. Blunting:
Age & Developmental Level:
-dose-response relationship between exposure to truth ads and decrease smoking prevalence
-When considering losses, people accept greater uncertainty (risk) to avoid the loss
-When considering gains, people opt for greater certainty in an effort to conserve gain
-Threat messages increase intention, not always action
-When paired with action plan better outcome
-Acceptance (attitude change)
-Action (behavior change)
-Purpose of treatment
-Length of treatment
-Nature of treatment
-educate, cultural competence
-urge behavioral strategies
-asses patient understanding
-incentives for adherence to guidelines
-electronic health records prompts
Model: Patient forms theory of symptoms, illness, treatment. Tests theory and revises
-3 phases: problem representation, coping, outcome appraisal
-training physicians to pay attention to patients' commonsense models
-social disadvantages in childhood
-viable placebos and double blind
Theory Of Reasoned Action: attitude toward behavior and subjective norm for behavior--intention--health related behavior
Theory of Planned Behavior: attitude toward behavior, subjective norm for behavior, perceived behavioral control--intention--health-related behavior
1.Unaware of hazard
4.Decide to take action or
5.Decide not to take action
Focuses on understanding the threat of HIV infection and behavior
-Label: know what the actions are risky
-Commitment: decision making stage
-Enactment: seek information and enact solutions
When symptomatic and undiagnosed
aims: discover health status, find suitable remedies
Perceived Behavioral Control
Self-Efficacy: extent or strengths of one's belief in one's own ability to complete tasks and reach goals
Perceived Behavioral Control: people's perceptions of their ability to perform a given behavior
Netherlands: biopsychosocial model, patient engagement, emotional rapport, more visits
US: longer visits, but less frequent
loss--accept greater uncertainty
gain--opt for greater certainty to conserve gain
Adherence: a person's ability and willingness to follow recommended health practices--cooperation between patient and provider
Compliance: implementation or fulfillment of a prescriber's prescribed course of treatment
-Provider: give accurate information, communicate clearly, follow up
-Patient: understand advice, apply it to life, practice it
-attitude toward risk
-trust in providers
-providers' cultural competency
Work w community to establish sustainable services for all participants
Have community providers offer services
Consult w people from population of interest (show respect, ensure informed consent)
Those who tend to monitor their emotions closely may be more influenced by emotional appeals than those who tend to blunt their emotions and are less attuned to their feelings.
Not just a single event of a form needed to be signed; an educational process that takes place from the researchers to the people involved.
Informs subjects of the general nature & purpose of study and their rights as research subjects.
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