HEALTH AND DISEASEHEALTH AND DISEASE

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

Health and disease Health and disease – – two essential categories two essential categories of medicineof medicine

Definition of healthDefinition of health

Health Health is is defined as a defined as a state of optimal physical, state of optimal physical, mental, and social well-beingmental, and social well-being and not merely and not merely the the absence of disease absence of disease and and infirmity infirmity (according to W.H.O.)(according to W.H.O.)

Health can be defined as a Health can be defined as a „„statestate““ of the of the personperson who is able to meet the demands placed on who is able to meet the demands placed on his/herhis/her body body and to and to adapt to these demands or adapt to these demands or changes of changes of the the external external environment environment so so as as to to maintain reasonable constancymaintain reasonable constancy of of the the internal internal environmentenvironment

There There isis way of way of measuring health in a negativemeasuring health in a negative sense. sense. It is It is measuremeasuredd by by thethe "5 d "5 ds" - death, disease,s" - death, disease, discomfort, disability, and dissatisfactiondiscomfort, disability, and dissatisfaction. . If there is If there is absence of 5 dabsence of 5 d‚‚s we can say that person is healthy s we can say that person is healthy

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

● ● HolisticHolistic view view to a health to a health recognirecognizzes the es the interinter relatedness of therelatedness of the physical, psychological, physical, psychological, emotional, emotional, social, spiritual,social, spiritual, and environmental factorsand environmental factors thatthat contribute to the overall quality of a personcontribute to the overall quality of a persons s lifelife

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 seeing health as the totality of a personof a persons existences 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:Positive wellness involves:

1. being free from symptoms of disease and 1. being free from symptoms of disease and pain pain

as much as possible;as much as possible;

2. being able to be active - able to do what you 2. being able to be active - able to do what you want want and what youand what you have to do have to do at the appropriate at the appropriate time;time; 3. being in good spirits most of the time3. being in good spirits most of the time

Concept of normalcyConcept of normalcy

NormNorm (normal,(normal, within the norm) = parameters or values within the norm) = parameters or values ranging ranging fromfrom -- toto of bodily or of bodily or mental mental functions or functions or quantitative measurquantitative measureements of biologicalments of biological indexes derived indexes derived statistically statistically from from "healthy "healthy persons" of the specific persons" of the specific ggrouproup ((highthight, body mass, heart, body mass, heartraterate, respiration, respiration rate rate,, bloodblood pressure pressure, , body temperature, etc.) body temperature, etc.)

Norm Norm HHealthealth; Health ; Health ==NormNormHealth – Health – it is more qualitative termit is more qualitative term Norm – Norm – it is more quantitative termit is more quantitative term

Normal parameter – parameter presents most Normal parameter – parameter presents most frequently in healthy populationfrequently 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

DefinitionDefinitionss of disease of disease DDisease isease can be defined can be defined as a as a biosocial phenomenonbiosocial phenomenon characterizedcharacterized byby interactions of pathological interactions of pathological processes,processes, defensive and adaptation processesdefensive and adaptation processes resulting in resulting in damage of the organismdamage of the organism as a wholeas a whole, , inin limitation of the organism ability to adapt to limitation of the organism ability to adapt to livingliving condition.condition.

Disease can be defined as a Disease can be defined as a changes in individuals changes in individuals that cause theirthat cause their health parameters to fall outsidehealth parameters to fall outside the range ofthe range of normalnormal

The term disease means a The term disease means a deviation from or an deviation from or an absenceabsence of the normal state of the normal state

The essential aspects of diseaseThe essential aspects of disease

1.1. disease is a disease is a new quality of lifenew quality of life Health is a friedom, disease is a prisonHealth is a friedom, disease is a prison

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

3. disease is the3. disease is the unity of damaging, unity of damaging, adaptive, adaptive, defensive and compensation defensive and compensation mechanismsmechanisms

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 diseaseDisease is a definite morbid process hDisease is a definite morbid process haavveeiningg a characteristic train of symptoms and signsa characteristic train of symptoms and signs

Dynamics of disease is characterized by stages of disease:

1st stage:1st stage: latent – incubationlatent – incubation (in infections (in infections

diseasesdiseases))

Its duration is measured by time passed between Its duration is measured by time passed between

beginning of noxa influence of body and beginning of noxa influence of body and

beginning beginning

of first non-specific symptoms and signs of of first non-specific symptoms and signs of

diseasedisease

There are no manifestations of disease during this stageThere are no manifestations of disease during this stage

2nd stage: 2nd stage: prodromalprodromal First non-specific symptoms and signs of First non-specific symptoms and signs of disease arisedisease 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 diseaseTime course of disease

a)a) Peracute – onset during few seconds or minutesPeracute – onset during few seconds or minutes

b)b) Acute – onset during hours and days, duration Acute – onset during hours and days, duration

up to up to 3 weeks3 weeks

a)a) SubacuteSubacute – – duration up toduration up to 6 weeks6 weeks

b)b) Chronic – duration more than 6 weeksChronic – duration more than 6 weeksExacerbation of disease – usually sudden increse intensity of symptoms and signs of chronic diseaseRecidivation of disese – returning of previosly healed diseaseRemision of disease: decrese intensity of simptoms and signs of disease

ILLNESS AND DISEASEILLNESS AND DISEASE

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

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

IllnessIllness tends to be used to refer to tends to be used to refer to what is wrong withwhat is wrong with the patient, disease to what is wrong with his bodythe patient, disease to what is wrong with his body

●● IllnessIllness is what the patient suffers from, what troubles is what the patient suffers from, what troubles him, what be complains of, and what prompts him to him, what be complains of, and what prompts him to seek medical attentionseek medical attention

●● When we say "a person is ill " we mean he feelsWhen we say "a person is ill " we mean he feels

uncomfortable, he is suffering from certain uncomfortable, he is suffering from certain

symptomssymptoms

such as nausea, headache, abdominal cramps, or such as nausea, headache, abdominal cramps, or

just just

fatigue that canfatigue that can''t be explained on thet be explained on the basis of basis of

exertionexertion●● Disease refers to various structural disorders of the Disease refers to various structural disorders of the individualindividuals tissues and organs that give rise to the s tissues and organs that give rise to the signssigns of ill - healthof ill - health

The principal factors accounting for nearly all The principal factors accounting for nearly all diseases are:diseases are:

1. heredity - inherited (genetic1. heredity - inherited (genetic)) diseases, diseases,

2. infectious organisms - infectious 2. infectious organisms - infectious diseases, diseases, nosocomial diseasenosocomial disease3. lifestyle and personal habits - lifestyle 3. lifestyle and personal habits - lifestyle diseasesdiseases4. accidents4. accidents

5. 5. physical, chemical noxas (physical, chemical noxas (poisons and poisons and toxitoxins)ns)

Most standard medical textbooks attribute anywhere Most standard medical textbooks attribute anywhere from 50 to 80% of all disease to from 50 to 80% of all disease to psychosomatic or psychosomatic or stress-related originsstress-related origins

Examples of psychosomatic diseases:Examples of psychosomatic diseases:

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

PPartially or wholly psychosomatic disorders:artially or wholly psychosomatic disorders: hay fever, acne, diarrhea, impotency, warts, eczema, hay fever, acne, diarrhea, impotency, warts, eczema, tinnitus, bruxism (grinding of teeth), nail biting, tinnitus, bruxism (grinding of teeth), nail biting, tension headaches, back pain, insomniatension headaches, back pain, insomnia..........

Psychosomatic illness are caused by Psychosomatic illness are caused by negative negative mental mental statesstates and attitudesand attitudes that harmfully change that harmfully change the the physiologyphysiology Psychosomatic illness are realPsychosomatic illness are real - as real as appendicitis - as real as appendicitis

or pneumoniaor pneumonia

Placebo effectPlacebo effect = the healing that results from a = the healing that results from a personpersonss belief in substances or treatments that have nobelief in substances or treatments that have no medicalmedical value in themselvesvalue in themselves The power of healing does not reside so much The power of healing does not reside so much

in the healer as in the belief of the patientin the healer as in the belief of the patient.. The cures that results from placebo effects sometimes The cures that results from placebo effects sometimes seem miraculous but actually are caused by physiological seem miraculous but actually are caused by physiological changes brought about by peopleschanges brought about by peoples beliefs and mental beliefs and mental states. states. The mind is healerThe mind is healer!!!!!!

In nature there are neither rewards nor In nature there are neither rewards nor punishments - only consequencespunishments - only consequences

All manifestations of human disease are theAll manifestations of human disease are the consequence of the interplay between body,consequence of the interplay between body, mind, and environmentmind, and environment

Relation: disease - punishment