Transcript Health and disease

HEALTH AND DISEASE
Prof. J. Hanacek, M.D., Ph.D.,
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 is way of measuring health in a negative
sense. It is measured by the "5 ds" - death, disease,
discomfort, disability, and dissatisfaction. If there is
absence of 5 d‚s we can say that person is healthy
● In health there is freedom. Health is the first of
all liberties!
● Holistic view to a health recognizes 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 can be distinguished:
1) Subjective – it is formed by sensations and feelings
of a person, e.g. high working capacity, ability to
overcome problems, optimistic thinking, happiness,
satisfaction...
2) Objective – its basis is formed by objective
parameters obtained by measurement of
strutures and functions of a person
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
Classik phylosophy:
Diseased person  doctor  diagnosis  therapy
Modern phylosophy
healthy person
health promotion
health protection
prevention of disease
onset and development
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 of the body
● health is defined also by set of subjective
parameters expressed by healthy person
 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
(hight, body mass, heartrate, respiration rate, blood pressure,
body temperature, etc.)
Norm  Health; Health =Norm
Health – it is more qualitative term
Norm – it is more quantitative 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 – mainly genetic
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
Health is a friedom, disease is a prison
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
Pathologic 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 in 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 passed 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
First non-specific symptoms and signs of disease arise
3rd stage: manifestation of disease
There are specific symptoms and signs characteristic for
specific disease
4th stage: disease outcomes
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 – onset during few seconds or minutes
b) Acute – onset during hours and days, duration up to
3 weeks
a) Subacute – duration up to 6 weeks
b) Chronic – duration more than 6 weeks
Exacerbation of disease – usually sudden increse intensity
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!!!
Relation: disease - punishment
 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