HEALTH AND DISEASE

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					       HEALTH AND DISEASE

        Prof. J. Hanacek, M.D., Ph.D.,




Technical co - operation : Lila Surinová, Ing. M. Vrabec
Health and disease – two essential categories
                      of medicine
Definition of health

 Health is defined as a state of optimal physical,
 mental, and social well-being and not merely
 the absence of disease and infirmity
 (according to W.H.O.)
 Health can be defined as a „state“ of the person
  who is able to meet the demands placed on
  his/her body and to adapt to these demands or
  changes of the external environment so as to
  maintain reasonable constancy of the internal
  environment
 There are ways of measuring health in a negative
  sense. They measure the "5 ds" - death, disease,
  discomfort, disability, and dissatisfaction.

● In health there is freedom. Health is the first of
  all liberties


● Holistic view to a health recognises the inter
 relatedness of the physical, psychological, emotional,
 social, spiritual, and environmental factors that
 contribute to the overall quality of a persons life.
Two aspects of health:

1) Subjective – it is formed by sensations and feelings
                of a person suffering from some disease

2) Objective – its basis is formed by objective
               parameters obtaned by measurement of
                strutures and functions of a person during
                disease
Subjective and objective aspects of a health can differ
e.g.   – Man with  systemic BP can feel healthy
Oposite – Man can feel ill despite no measurable changes of
         structure and/or functions can be find
Positive cosequence of WHO definition of health:
– change of health care phylosophy

Previous phylosophy:
Diseased person  doctor  diagnosis  therapy

New phylosophy:


                  health promotion    prevention of disease
healthy person                        onset and development
                  health protection
Two dimensions of health according Nordenfeld (1986)

Scientistic = atomistic-biological dimension of health
             - quantitative dimension of life


Non-scientistic = holistic-humanistic view on health
- rather qualitative dimension of life
- seeing health as the totality of a persons existence

Summary: ● health is defined by set of objective,
          measurable parameters of structure and
          functions
           ● health is defined also by set of subjective
             parameters
 Positive wellness involves:


1. being free from symptoms of disease and pain
   as much as possible;


2. being able to be active - able to do what you want
   and what you have to do at the appropriate time;


3. being in good spirits most of the time
           Concept of normalcy
Norm (normal, within the norm) = parameters or
values ranging from - to of bodily or mental
functions or quantitative measurements of biological
indexes derived statistically from "healthy persons"
of the specific group (length, height, body mass, heart
frequency, respiration, blood, body temperature, blood
pressure etc.)

Norm  Health; Health = Norm
Health – it is more qualitative term
Norm – it is more kvantitative term

Normal parameter – parameter presents most
                  frequently in healthy population
Interindividual variability:

   – each person has its own profile of structures and
     functions, and almost each person is extreme in some of
     sign, and in different one

   – in population is created by influence of many factors:
     a) internal – e.g. genetik
     b) external – physical, chemical, biological, social...

   – can be one explanation for different level of health in
     different people, and different proneness to disease
            Definitions of disease

 Disease can be defined as a biosocial phenomenon
  characterized by interactions of pathological
 processes, defensive and adaptation processes
  resulting in damage of the organism as a whole, in
  limitation of the organism ability to adapt to
 living condition.

 Disease can be defined as a changes in individuals
  that cause their health parameters to fall outside
  the range of normal

 The term disease means a deviation from or an
  absence of the normal state
    The essential aspects of disease


1. disease is a new quality of life


2. disease is the result of one or more causes
  (noxas) and suitable conditions


3. disease is the unity of damaging, adaptive,
   defensive and compensation mechanisms
A picture of diseaase is created by:

 – pathologic reactions
 – pathologic processes
 – pathologic states

Paathologic reaction
- It is the most simple, mainly short-lasting,
  quantitativly and/or qualitativly non-adequate
  response of organisms to some noxa

Examples: syncopa, short-lasting increase of BP,
          tachycardia, bradycardia vomiting,
          diarhoe, hyperventilation ...
Pathologic process
It is the complex of pathologic and defensive-
- adaptive reactions induced by influence of noxa
on organism

Examples: inflammation, fever, hypoxia, growth
           of tumor, edema, acidosis, alkalosis...


Pathologic state
Pathological change which is stabile or it changes
very slowly and very small range during time period

Examples: congenital valvular heart disease, deafness,
          blindness, colour blindness...
  Dynamics of disease
  Disease is a definite morbid process haveing
  a characteristic train of symptoms and signs
Dynamics of disease is characterized by
stages of disease:

1st stage: latent – incubation (in infections diseases)
           Its duration is measured by time present between
           beginning of noxa influence of body and beginning
           of first non-specific symptoms and signs of disease
There are no manifestations of disease during this stage
2nd stage: prodromal
           Arising first non-specific symptoms and signs of
           disease
3rd stage: manifestation of disease
           There are specific symptoms and signs of
           specific disease

4th stage: disease conclusion
            a) healing and convalescence
            b) chronic disease
            c) death

Forms of healing:
- restitutio, or sanatio ad integrum
- sanatio per compensationem
Time course of disease

a) Peracute
b) Acute
c) Subacute
d) Chronic

Exacerbation of disease – usually sudden increse
                           of symptoms and signs of
                           chronic disease
Recidivation of disese – returning of previosly healed
                         disease
Remision of disease: decrese intensity of simptoms
                     and signs of disease
            ILLNESS AND DISEASE

 It is more important to know what sort of patient
 has a disease, than what sort of disease a
 patient has.

 A person may "feel ill" without a disease being evident or
  diagnosed; likewise, a person may have a disease without
  experiencing any illness or suffering.

 Illness tends to be used to refer to what is wrong with
  the patient, disease to what is wrong with his body.

● Illness is what the patient suffers from, what troubles
  him, what be complains of, and what prompts him to
  seek medical attention.
● When we say "a person is ill " we mean he feels
uncomfortable, he is suffering from certain
symptoms such as nausea, headache, abdominal
cramps, or just fatigue that can´t be explained on
the basis of exertion

● Disease refers to various structural disorders of the
individuals tissues and organs that give rise to the
signs of ill - health.
 The principal factors accounting for nearly all
  diseases are:


1. heredity - inherited (genetic) diseases,

2. infectious organisms - infectious diseases,
                          nosocomial disease

3. lifestyle and personal habits - lifestyle diseases

4. accidents

5. physical, chemical noxas (poisons and toxins)
 Most standard medical textbooks attribute anywhere
  from 50 to 80% of all disease to psychosomatic or
 stress-related origins.

 Examples of psychosomatic diseases:

 - peptic ulcer, essential hypertension, bronchial asthma,
   hyperreactive thyroid, rheumatoid arthritis, ulcerative
   colitis.....

 Partially or wholly psychosomatic disorders:
  hay fever, acne, diarrhea, impotency, warts, eczema,
  tinnitus, bruxism (grinding of teeth), nail biting,
  tension headaches, back pain, insomnia.....
 Psychosomatic illness are caused by negative mental
 states and attitudes that harmfully change
  the physiology.
 Psychosomatic illness are real - as real as
  appendicitis or pneumonia.
 Placebo effect = the healing that results from a
  persons belief in substances or treatments that have no
  medical value in themselves.
 The power of healing does not reside so much
  in the healer as in the belief of the patient.
  The cures that results from placebo effects sometimes
  seem miraculous but actually are caused by physiological
  changes brought about by peoples beliefs and mental
  states. The mind is healer!!!
 In nature there are neither rewards nor
 punishments - only consequences.


 All manifestations of human disease are the
 consequence of the interplay between body,
 mind, and environment.