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 ds" - 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 persons 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 persons 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 individuals 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 persons 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.