SociologyofMedicineandHealthCareExam2 - 1 Textbook:chapters5,8,9,10,12,13 Class10(Feb25, Class11(February29, Class15ism

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Unformatted text preview: 1 Textbook: chapters 5,8,9,10,12,13 Class 10 (Feb 25, 2015 Stressful Life Events ­ Chapter 5) Class 11 (February 29, 2016 ­ More Stressful Life Events) Class 12 Thursday March 3rd. ↓Can somebody please finish these?↓ Class 13 Thursday March 10th​ Can someone please add their notes for this Class 15 is missing Class 16 is missing too Class 17 (3/28) Chapter 5: Social Stress and Health Outline I highlighted text that doesn’t have any additional notes. If you have notes from class in addition to what’s on the powerpoint, please add them! :) Can someone please add Chapter 12 + 13 notes? These are the pdf notes of the book chapters. (good short, summaries with the main points) Chapter 5: Chapter 8: Chapter 9: Chapter 10: *** Chapter 12 Chapter 12: *** Chapter 10 Chapter 13: *** This is the reading for Chapter 13? (I think the editions are different.) <­yes Notes (extra) for anyone who has studyblue. Class 10 (​Feb 25, 2015 Stressful Life Events ­ Chapter 5) I. Psychosomatic ­ psychological stress causes physical illness (mind affects physical health) A. Voodoo death 1. Voodoo death. Voodoo is a cult/religion. People worship a queen who sometimes casts spells on people. For true believers, if you believe a spell has been cast on you, it can affect your health & wellbeing. If a death curse has been put on you, there are documented cases where people who believe they have been cursed with a death curse, die. This is an intense psychosomatic connection. ​What happens is that people who believe they are going to die lose their appetite for eating and drinking​. They thus get ​severely dehydrated II. III. 2. if a death curse has been placed on you, people die (5 documented cases) 3. how does it work? people believe it, lose appetite for eating and 4. drinking, heart is overstressed pumping thicker blood through their dehydrated bodies. 5. Usually dehydration results in a heart attack. Somatopsychic ­ physical illness causes psychological illness (OPPOSITE of psychosomatic) You don’t feel good→ emotions go negative→ emotionally bothered A. Coronary artery bypass graft (CABG) psychosis 1. unanticipated consequence: temporary insanity/psychosis→ like a paranoid schizophrenic, stop cooperating with rehabilitation (try to rip off IVs, etc.) a) probably because it was so invasive b) now they give medication before operation to prevent Long tradition of psychosomatic research A. 1st stage ­ stimulus based definitions of stress 1. Case studies focused on situations assumed to stress everyone 2. Problem: not everybody in these situations experiences bad outcomes or illness a) war survivors, natural disasters, spouse death ​← are these examples of stimuli, or examples of people who don’t respond with bad outcomes? b) ^I have down that they are stimuli 3. E​xamples: a) Certain occupations are more stressful than others. Air traffic b) c) d) e) f) g) h) i) j) controllers. Those behindthe radar screens who help the plane land. ​The problem with air traffic controllers is that their work is repetitive but it is absolutely consequential for the safety of people. A ground controller who was controlling the plane left out a single word ​à​ death of 10 people on the plane. Since then, he has been under psychiatric care. His life was destroyed due of the stress of the job 2/3rds of people have ulcers by age 40. Usually coffee gulping insomniacs. Queasy stomach. ​High blood pressure is more common. Stress similar to PTSD​. Controllers called it ​collisionitis. (they are so afraid of crashing.) ​Overwork. Lots of smoking and drinking. Another stressful occupation is ​tax accountants​. Until April 15, they are under a lot of stress. Overworked & overstressed. Tax cycle stress starts January/February – April 15. Unemployment is also very stressful. In modern life, we are the first human culture where you have to compete to have a job. To be employed, you have to compete. In ancient cultures, everyone did what they could do in the village or tribe to help the tribe. ​Unemployment is a new human invention​. People take it personally when they lose their job. They lose their sense of self. They feel guilty for not providing for their families. 1% increase in unemployment ​­­>​ 4% increase in suicides. 6% increase in homicides. (some people take their stress out on others.) Peace work. They have a quota. They don’t have time. If you start delaying, they will hang you up. If they do not maintain their quota, it affects their salary. ​Can someone please explain this? Assembly line work. You have to do everything that goes past you. B. 2nd stage ­ response based definitions of stress 1. "You are stressed because your blood pressure increased“ 2. General adaptation syndrome (GAS) ­ Hans Selye Alarm Resistance Exhaustion (Hans Selye — rat researcher) immersed rats in frozen water beaker, (nothing for rat to hold on to); swim for life, or sink; rats connected to electronic monitoring, and found the following responses: a) Alarm (1) blood flow to muscles (2) Adrenaline increased (3) Rodents started swimming faster. b) Resistance (1) body using more energy than can afford; can’t maintain expenditure over time (2) keeps blood flow to essential organs, shuts it down to arms and legs (3) can’t swim as well; swimming slows down c) Exhaustion (1) Appendages blood supply shut down (2) sink and drown (3) People go through the same 3 stages when faced with extreme cold water/physical stress (4) GAS theory works for extreme situations NOT routine 3. Many different responses to stress a) Physiological (1) More salt in your sweat, the more conductivity in your skin — if you lie, your skin conductivity changes — GSR (2) lie detector test — BOGUS! doesn’t scan for lying.. scans skin conductivity! can’t be 100% b) Behavioral (1) ­They can be learned. (2) ­E­Z Pass: new behavior has been created with E­Z Pass. Some people are speedy and slam the accelerator and go past the E­Z Pass so it won’t notice that they did not pay. Some people are pointers so others will look and they won’t notice that they did not pay for E­Z pass. ^ can someone also explain the E­Z pass info? Like the response to stress part (3) ­Night club/theatre settings fires. There is only one exit. Everyone is clogged to get out of exit. The people in the back would burn to death. They would start breaking and try to get to the door. If there is a traffic jam, a lot of people die. (4) ­Miners trapped in a mine. If there is no chance of everyone escaping, they cooperate. If some people can be rescued, intense competition comes out. c) Cognitive (1) Lazarus’ Experiment: ​described as delayed return of spontaneous circulation (ROSC) after cessation of cardiopulmonary resuscitation (CPR) (2) Subincision Right: Right that primitive tribes have young males go through to become men; right of passage (3) Kid on log, and cut end of penis into two parts with a rock; bifurcated penis (4) showed video to undergraduates at UCLA; students watch movie and respond; disgust, fear, anger, guys=pain (5) “uncomfortable and disgusted” (6) Anthropologist lectured on this topic before watching video (7) There was an experimental group in which there was a presentation before the movie who described the process. These people were a bit more accepting than the control group with no presenter. d) Emotional (1) Swallowing tube for gastro­exam purposes — anxiety; fear of asphyxiation (2) if you prepare someone (even a two minute lecture on the emotion/physical responses they will experience) they do much better; easier time swallowing tube (3) PROBLEM: these responses to stress don’t correlate high e) Problem: these responses to stress don't correlate highly C. 3rd stage ­ complex model that separates stimuli and responses 1. Objective stress in physical or social environment 2. Perceived stress a) interpretation of objective stress 3. Coping behavior a) reduce/eliminate through coping behaviors b) studying= coping mechanism to exam stress c) Can be learned 4. Distress responses: physical, cognitive, emotional, behavioral 5. Personality a) Affects all of the things above. Type A behaviors expose themselves more to objective stress. They put themselves into competitive situations on purpose! 6. Example: stress of college application a) Experiment 1 (1) Educational Testing Service SAT test (2) •​went to ETC center where SAT is taken. Took the blood pressure of students just before they took the SAT. As you would expect, students who were just about to apply to college had the biggest increase in blood pressure. There were social factors that influenced the blood pressure. ​The people who had been in the school more years had a greater increase in blood pressure. Students who spent less years had a less increase in blood pressure. Students who were in the school longer had to represent the school & felt more pressured. D. •​Parents are always asked to support the school more. They measured on the parents’ involvement in school life. The students had to write down how involved their parents were in school life​. Higher involvement in parents was correlated with higher increase in blood pressure before the SAT. Those students felt more pressure to do well on the SATs and get into a good college. 3 a) Experiment 2 (1) Cold pressor test­ ​took bp of students first and then immersed their hand into a beaker of cold water. Saw rise in bp (2) Stress stimulus tape ­​ played tape recording of a student talking about the stress of going through the college application process. Students who were listening who had not gone through the process yet such as the juniors had higher bp. Seniors showed less stressful response because they had already went through the process and most likely got accepted to college already. (3) •​Freshmen did not have such a high increase. Same thing with seniors who already knew where they were going to college. ​Juniors had the highest increase in blood pressure. Social factors again. Students who had been in the school for more years & parents whose had been involved more in the school had the highest increase in blood pressure ● ­​This does not take into account people’s responses. It is only important that they experienced the objective stress. Class 11 ​(February 29, 2016 ­ More Stressful Life Events) I. Methods of stress research A. Big topic of research since 1967 B. Two major traditions that are very different 1. Checklist Approach 2. Contextual Approach II. Basics of checklist approach A. Stimulus­based approach to defining stress B. Counted “objective” stressful life experiences (objective experiences that disrupt or threaten to disrupt people's’ normal activities) 1. Natural life cycle changes 2. Unusual, unpredictable events C. Total events predicted illness well ● You count objective stress. Stressful events that disrupt or threaten to disrupt individual’s normal activities. (something that everyone can see and agree on) ● stressful events that occur in people’s lives. ● ­­Ex. Car crashes. Disrupt life a lot. OR the threat of a car crash. ● researchers do is count objective stressful events that have happened in the past 6 months. The events are age­graded. ● ­There are unpredictable events. Terrorism, car accidents, war. ● ­​Total events: If you sum up the events a person has in 6 months, that predicts their illness pretty well. ● ­There are numerous hypotheses but nothing completely sure of how it works. III. Details of checklist approach A. Holmes and Rahe Social Readjustment Rating Scale ​what is this? ​Holmes and Rahe were scientists in the navy. they conducted a study amongst navy personnel. created a rating scale to measure stress eg) experiencing death of spouse 100 points; getting married 50 points. People who had highest scores had greater chances of getting sick 1. marriage 2. loss of a spouse/child, etc IV. Checklist Findings A. Consistent findings with different age and sex groups B. More life events associated with increased psychological and physical illness V. Checklist Problems A. Event sampling bias ​can someone explain this? ​­ means that not all stressful events are listed, such as: coming out as gay, abortions, infidelity, chronic stress B. Intra­event variability: ex. divorce...high conflict parents...adolescents found it better when parents divorced...less conflict C. Negative vs. positive events a. Christmas vacations/holidays ​­­>​ stressful. You might not like it as much. Maybe you hate staying with your family. Other families have blissful holidays. Nonetheless, the holidays for most people are very stressful. The family dynamic (rivals and old aggressions resurface)​ gets extremely stressful. What they find is that people with very serious illnesses st somehow delay death till after the holiday is over. Then, January 1​ there are lots of people dying. They were able to delay their deaths till after the holidays but then they die. b. ­Bottom line: ​It is mainly negative events that cause stress. Positive events are not as stressful as bad negative events. D. Interrelationships among events: divorce, drop in income, change in family activities, residential move, etc. (stressful events:list of 43) a. If you get divorced as a women, you have to move, change in family activities, and drop in income. Sounds really bad. All these events are correlated with people who get divorced. Should they be included as 1 event or separate events? E. Contaminated Events: items that are measures of stress are all possible measures of illness...ex. overeating, troubles with having sex ­> why is this a problem?? Some items measuring stress measure illness outcomes​. Change in eating habits, change in sleeping habits, etc. They are all measures of illness. ­Illness may be confounded with stressful events. ­​There are a lot of events in the list of 43 in which the measure of stress has an aspect of illness imbedded in it. F. Controllable vs. uncontrollable events: controllable less stressful than uncontrollable G. Expected vs. unexpected: expected less stressful than unexpected H. Major vs. minor event: minor less stressful than major events a. Most of things we talk about are major life events. There is a lot of stress in our lives like hassles. Daily stress. Milk is rancid and you can’t put that in your coffee ​­­>​ stressed out. ​If enough minor hassles accumulate, that can result in negative consequences and physical illness. However, the major stressful events are the most consequential for illness. VI. Basics of contextual approach A. Based on complex theory of stress B. Fix problems of intra­event variability and event sampling bias C. tries to understand meaning of event to individual VII. Details of contextual approach A. life event interview a. ­​Subject of the study sits down for several hours with a researcher who b. c. d. e. asks them about the stress in their lives. ­Use a calendar to figure out when the stress happened. (go back in time and ask subject) ­​They stimulate people’s memories of the stressful events that actually happened to them. ­You are asking the person what happened to them, what led to the event, etc. ­​People’s responses were not measured. Just what happened in the event. ­You get the factual information f. B. group ratings of “contextual threat” of event a. ­They videotaped or audio taped the interviews. ​They took the recordings to a group of trained people who would rate the stress of those people (who could make judgments). b. ­The people made a stress score in terms of stress in context of that person’s life. C. Advantages a. ­The advantage: the trained raters are good at judging stress levels in terms of the context of people’s lives. b. ­​You can also access the meaning of stressful events & you can investigate unique stressors that happen to specific people. VIII. Contextual findings A. Contextual threat ratings predict illness ​better​ than checklist B. Reveals more information about the stress process for specific individuals C. Specific kinds of events linked to specific illnesses 1. Loss events increase depression a. Loss events – you experience a psychological or physical loss (loss of a friend, death of a family, financial loss, loss an arm, loss a limb). ​Anything that can be interpreted as a loss increases the chance of psychological interpretation. It is not the kind of loss. It is the meaning of the loss to the people. a. fresh start events decrease depression (ex. a new relationship) i. It gives you a sense of hope that drags you out of the valley of depression. You feel good about yourself and the world. ii. Decrease pressure and increase hope. 2. Danger events increase anxiety ● Any kind of event where the meaning puts you in a situation where you cannot win. A good example is a parent walks into the bedroom of their child and finds a bag of drugs. It puts them in an impossible situation. You can confront kids with the marijuana. That is the last thing that they can say to you. You’re in a dangerous event. Any possible outcome is BAD. Something bad will happen. ● Danger situations increase anxiety. Make us worry. Something bad will happen even if we do nothing. 3. intrusive events increase schizophrenia ● something getting in your space. ​They come too close or start telling you what to do. Parents are guilty of intrusive behavior when it comes to their children. They increase schizophrenia. People have cognitive distortions. ​It prevents people from working and having normal family lives. Their illness intrudes in living their lives to being close to people.​They have paranoid delusions. Distortions of reality. They hear things that are not there. ● They can’t have jobs. ● If people who are intrusive get into their space, these people with schizophrenia have more problems. They tend to have symptoms more often. It may trigger the expression of a schizophrenic episode. It increases the probability of schizophrenia. It triggers schizophrenic symptoms. 4. Goal frustration events increase GI disorders and heart attacks ● You wanted to say win the lottery and you never went. ● It increases GI diseases (ulcers) ● T​hese are things we want and we don’t get. 5. Challenge events increase menstrual disruptions ● People look to you for guidance and how to do it. Some women have menstrual disruptions from challenge events. IX. Contextual problems A. Expensive and labor intensive B. Difficult to define “average person” 1. Easier in homogenous population 2. More difficult in heterogeneous (diverse) population 3. Do you need raters who are similar to subjects of study? ● There are problems with contextual methods. ● ­​It is very expensive in labor and financial cost. It’s a one on one interview. ● ● ­It is also hard to define the average person. ­The group are rating stress in the context of a person’s life. They have to understand the person. ● ­The point is do you have to be similar to the person you are rating. ● ­Say they are poor minority person is a drug user in a very poor neighborhood. Maybe you need raters that have the same characteristics. You probably won’t see drug addict raters rate other drug addicts. ● ­It’s hard to rate people who are very different from you Class 12 Social Support Thursday March 3rd. ↓Can somebody please finish these?↓ I. Commonsense definition of social support A. Resources provided by other people B. Protects individuals from undue stress C. Provides things that people need to cope A. B. C. D. II. `` Social support is the support we get from other people. (resources provided by other people.) The support is believed to protect individuals and can have a curative role. If social support resources help cope with stress, then stress can be reduced. There is vagueness in this definition though. Problems with commonsense definition A. Vague, oversimplified B. No theory of etiology (set of causes for problem) C. No theory of treatment A. B. If people are asked if they are married or not. Married people usually have more...
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