- Adherence means following medical advice, which relies on patient understanding and satisfaction with their doctor. Non-adherence is failing to follow advice. Doctors can increase adherence by discussing treatment from the patient's perspective, simplifying instructions, and increasing recall through repetition. - Complimentary therapies are used alongside conventional medicine and include osteopathy, chiropractic, and herbal medicine. Alternative therapies substitute for conventional medicine. People choose complimentary therapies due to dissatisfaction with or risks of conventional options. - Illness is a subjective experience that differs between individuals and social groups. It can be viewed as a moral category. Disease is defined medically but changes over time, while health and illness are also social concepts

1. + Individuals, Groups and Society (IGS)
Adherence
• Adherence means following the advice of health care professionals
• Most medical interventions rely on patient adherence
• Patients can sometimes not follow advice. Some patients may intend to take some
recommended medication but forget to do so. Others may disagree with the diagnosis and
decide not to take on the advice
• There are a number of factors that influence adherence as it is most likely when patients
understand what they are asked to do and why
Non adherence
• Non adherence is defined as the failure to follow advice
How can adherence be increased?
• Patients are most likely to feel satisfied and understand advice when doctors find out what
they think is wrong and discuss
• Adherence is most likely when patients understand what they are being asked to do and
why
• Patients must also remember what they are told if they to act on it later
• Satisfaction with the doctor increases adherence
• The doctor should seek an agreement with the patient to find out what is wrong with them
and what should be done about it
• Instead of encouraging adherence doctors should seek to establish concordance in their
consultations
• If doctors can concord about treatment then patients are most likely to adhere.
• Doctors should ensure that the recommended treatment is clearly understood
• Adherence is more likely when patients understand advice, remember it and feel satisfied
with the consultation
• Doctors can increases satisfaction by being more friendly and considerate
• Adherence is more likely when doctors consider and discuss the patients perspective and
understanding
• Doctors can increase understanding by simplifying instructions and information and
discussing the patients health beliefs
• Doctors can increase patients recall by giving specific advice and repeating instructions
Complimentary Therapies
• Complimentary Medicine
o Used alongside conventional medicine (in most cases)
• Alternative Medicine
o Substitute for conventional medicine (considered inappropriate)
• Reasons why people choose complimentary medicine
o Dissatisfied with conventional medicine
o Risk associated with conventional medicine
 Little or no pain
 Side effects with CAM
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2. o Consultations tend to be longer so the person is able to convey symptoms and concerns
more effectively, lead to higher satisfaction rating
• Types of complimentary therapies:
o Group 1: Osteopathy, Chiropractic , Accupuncture, Herbal Medicine, Homeopathy
o Group 2: Therapies used to compliment conventional medicine and don’t claim to
diagnose. Aromatherapy, Reflexology
o Group 3: Claim to diagnose and treat, Chinese Medicine, Crystal Therapy
Illness
• Subjective experience
• Different definitions by different people
• It is a social concept defined differently by different social groups
• Illness can be thought as a moral category especially in a society that emphasizes personal
responsibility for health
• People initially provide public accounts of their experience and concepts of illness in contrast
to more private accounts as the doctor-patient relationship grows
• There are various public accounts of illness
• It is split up into three groups
o Normal illness
 For example childrens infectious disease
o Real illness
 For example major life threatening diseases
o Health problems that are not illness
 Conditions with ageing
• Reproduction
• It is important to distinguish between disease, health and illness
o Disease
 medical science plays a crucial role in defining disease but this definition changes
over time.
 Typically in western medicine disease are now thought to have signs and symptoms
 It is considered to be objective
 If the definition of normal relates to what is statistically normal is not always clear
cut when we get pathologically abnormal
 What is normal for one person isn’t always normal for another person
 Normality can be seen as socially rather than biologically defined
Stigma
• Associated with the works of Erving Goffman
• Severe social disapproval of personal characteristics or beliefs that are against cultural
norms
• Examples of social stigmas can be found in physical mental disabilities or disorders
• Erving Goffman defined stigma as “a process by which the reaction of others spoils normal
identity."
• Goffman was particularly interested in the public humiliations and social disgrace that may
happen to people where highly negative labels were applied
• He made the distinction between
o Discreditable stigma
 One that is not known about the world at large. Only the person with the
stigmatizing condition and a few close inmates will know about it. For example –
having a scar on your leg that is covered by a pair of trousers
o Discrediting Stigma
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3.  Stigma that cannot be hidden from other people because it is obvious and visible
 For example, having a physical disability such as Duchene Muscular Dystrophy – this
can be physically seen. Stigmatization can be seen as a form of discrimination. There
is a distinction between enacted stigma and felt stigma
• Enacted stigma
o Real experience of prejudice, discrimination and disadvantage as the
consequence of a particular condition
• Felt Stigma
o Scambler and Hopkins research has shown that in the case of epilepsy actual
stigma is rare. But the fear that discrimination might occur influences
patients to a large extent
Race
• The concept of race does not exist in any biologically meaningful way
• Dividing people into populations or groups on the basis of various sets of characteristics on
ancestry
• The most common human racial categories are based on visible traits such as skin colour,
facial features etc
Ethnicity
• Complex concept consisting of the interplay between culture, history and language and so
on
• Ethnic minorities are at an increased risk of poverty due to the effects of racism
• Population of human beings whose members identify with each other
• Ethnicity is also defined by others as a distinct group and by common linguistic, cultural,
behavioural, religious and biological traits
• Ethnicity is measured in the UK by asking people to assign themselves to a category, as in the
2001 census in England
Culture
• Set of shared beliefs, values and attitudes that guide behaviour
• People identify themselves as members of a group on cultural grounds, they may share
similar histories, think of themselves in relation to the colour of their skin, continent of
ancestry and cultural background
• Concepts of race, ethnicity and culture are related
• Art, literature and music can contribute to culture
Stereotype
• Generalization about groups and individual members of that particular group
• This may be positive, negative or prejudicial
• Most stereotypes make the person saying the phrase more superior to the group/person
being stereotyped
Discrimination
• Behaviour or action intended towards a group because of the fact that they are in that
particular group
• Unequal treatment to people in a particular group
• Three types
o Personal
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4.  Directed to a particular individual
 Refers to an act that leads to unequal treatment because of the individuals real
group membership
o Legal
 Unequal treatment on the grounds of group membership that is guided by law
o Institutional
 Unequal treatment that is entrenched in basic social institutions
 It results in advantaging one group over the other
 For example – the indian caste system
 For example: Discrimination of age, Gender, Sex, Sexuality, Race, Ethnicity
Prejudice
• Prejudging a particular person/group. Antipathy means negative feeling
• John Farley mentioned that there are two types of prejudice
o Cognitive prejudice
 Refers to what people believe to be true
o Affective prejudice
 What people like and dislike
 E.g. particular races, ethnicity
• Prejudice is having bias and opinions about groups such
o Racism, Heterosexism, Ageism, Feminism
Ageism
• Prejudice against old people simply because they are old
• Maybe because indictive fear of old age in contemporary society
• The fear is associated with the belief that chronological age results inevitably in mental and
physical decline
• Jerrome defined old age as
o “state of feeling and behaving rather than a chronological state”
Deviance
• Violation of social norms
• For example crime is the social deviance of law
• Staying in bed when others are working
• Deviance is not a characteristic of the behavior itself but it is the characteristic of its
interpretation
• The sick role is a response to deviance
Biographic disruption
• Rest of life has been changed due to illness
• Dreams and desires are harder to fulfil
• Plan of life has been altered due to the chronic illness
• Alteration in biography of the individual
Anxiety
Emotional state that is divided into three components
o Thoughts
 Often act as trigger for creating the state of anxiety e.g. what if foot slips off a ledge
and i slip
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5. o Physical symptoms
 These are numerous. Most commonly include an increased heart rate, blood
pressure and feelings of tension in muscles, sweating and nausea
o Behaviour
 Involved in reduction of anxiety e.g. refusing to go on rockface or avoiding
interviews or deep breathing
• Types of anxiety problem
o High anxiety interferes with everyday function is categorised as:
 Phobias
• Fear that is out of proportion to the potential threat posed by a particular object
or situation e.g. being afraid of a pit bull terrier wouldn’t be classed as a phobia
but being afraid of a moth would as there is a significant risk to safety in first but
not second
 Generalised anxiety
• Refers to the experience of all pervasive anxiety not apparently linked to any
specific situation or object. The person experiences a high state of arousal and a
general sense of dread. Likely to experience uncontrollable worry, a variety of
somatic complaints, tension and restlessness
 Panic attacks
• Sudden waves of acute anxiety that seem to come out of the blue. People may
be overwhelmed by feelings of loss and control and going mad and even dying.
Panic attacks in public places involve a feeling of being trapped are called
agrophobia
 OCD
• Treatment
o Methods of treatment depend on: Nature of anxiety, Impact on everyday life, Individual
preference
o Drugs; These can be worked to reduce physiological symptoms of anxiety
Stress
• Stress is generated when we think that we may not be able to meet perceived demands and
expect negative consequences to follow
• It arises out of the relationship between our perception of appraisal of environmental
demands and or own resources
• Our experience of stress doesn’t always correspond to others assessment of the demands
that we face
• Stress involves negative emotional response affecting physiological functioning
• Factors influencing Stress
o When we are familiar with an event we are less likely to feel stressed
o For example – when a doctor who has previous experience of preparing surgery is less
likely to feel stressed than a doctor who has no experience
o Feeling stressed also undermines our performance as we may feel distracted by our own
worries and seek to avoid the task than manage it well
o We are less likely to feel stressed when we know the demanding situation will be short
term
o Greater control results in less stress – when people are unclear about their role in work
it is most likely to cause stress
o Stress can also be caused by role conflict when the demands of one role prevent the
person fulfilling the demands of another role.
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6. • Measuring Stress
o Numerous self report measures of stress
o Holmes and Rahe in 1967 developed the first “life events” scale
o This approach involves asking people to list events in their recent past that might be
expected to be stressful and adding up the burden
o For example the death of a close family member warrants a high score (100) while
trouble with a boss attracts a lower score (23)
o The scale acknowledges that change in general can cause stress
o Stress affects the sympathetic nervous system and thus we can measure the
sympathetic nervous system activity as indicators of the arousal of stress
o These include: Respiration rate, Blood pressure, Heart rate, Skin conductance,
Corticosteroids, Catecholamines
• Stress and the Cardiovascular System – PERSONALITY
o Continued stress can damage the CV system over time
o Personality factors makes some people likely to experience stress more than others
o Two types of personality
 Type A
• People who are very ambitious in relation to the amount they try to get done in
a limited time and are more likely to be competitive and hostile towards others
• This may result in strong, frequent stress responses which result in considerable
wear and tear on the cv system
• Such stress responses may precipitate a myocardial infarction
 Type B
• Low on competitiveness
• Hostility appears to be a particularly dangerous personality trait with those
scoring highly on hostility having a greater chance of coronary heart disease
• Stress and Immune Response
o Stress is associated with weaker immune response and slower wound healing
o For example - medical students report that higher stress during exams show reduced
the T helper (CD4) cells
o Similar examination has shown that ongoing stress make us susceptible to infection,
slow wound healing and surveillance
• Stress and risk behaviour
o As well as affecting our CV and immune system stress an increase the likelihood of
illness indirectly by means of our behaviour
o People who feel stressed are less likely to take preventative measures
o They may take risks with their health through drug abuse and alcohol abuse and sleep
loss.
• Helping people deal with stress
o Social support and emotional support
o Encouraging people to change their appraisals
o Relaxation training and alternative medicine
Quality of Life
• WHO – “individuals perceptions of their position in life in the context of the culture and
value systems in which they live and in relation to their goals, standards and concerns”
• Calmsn (1984) “The extent to which hopes and ambitions are matched by experience”
• 6 areas
o Physical health
o Psychological state
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7. o Level of independence
o Social relationship
o Environmental features
o Spiritual concerns
• QOL is a multidimensional concept that included both positive and negative aspects of life
• QOL used to be seen as a objective assessment of the persons functioning, whereas the
current approach tries to measure QOL as an individuals perceived health status or well
being
• QOL is individual
• Different factors affect QOL for different people
• QOL is a dynamic construct and changes over time
• QALYs
o Quality of life adjusted years
o Measure derived from a combination of mortality, morbidity and function
o Improvement of the QOL will be the aim o the patient and the health professional
o QALYs quantify the capacity of the population to benefit from a health service
intervention
o The capacity to benefit is one way of defining need
Models and psychosocial theories
Biomedical Model
• Most commonly held in western society and focuses on the physical process of disease and
mechanisms of action
• Childbirth is pathological and since we cannot predict its risks we must admit women to the
safest environment
• Pregnancy and childbirth are only safe in retrospect
• Emphasis:
o Risk
o Risk reduction
o Illness
o Women = passive
Psycho-social Model
• General model that claims that biological, psychological, love and social factors play a
significant role in human functioning in the context of disease or illness
• It is a contrast to the biomedical model
• The treatment of a disease requires the health care team to look at psychological and
sociological factors as well
• Pregnancy and childbirth are normal events in most women’s life cycle
• 85% of all babies will be born without any complications
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8. • Many risks in childbirth can be predicted and thus pregnant women most at risk can be
selected for hospital delivery at a specialist obstetric hospital
• Childbirth is normal until the pathology occurs
• Emphasis:
o Normality
o Social Support
o Health
o Women = active
Sick role model
• Developed by Talcott Parsons in the 1950s
• It is a contrast to the biomedical model, which pictured illness as a mechanical malfunction
• Parsons defined the sick role as a temporary, medically sanctioned form of deviant
behaviour
• The sick role model outlined two rights and two obligations of the sick person
• Rights:
o The sick person is exempt from normal social rules
o The sick person is not responsible for their condition
• Obligation:
o The sick person should try and get well
o The sick person should seek technically competent help and cooperate with the medical
professional
Stress coping paradigm
• The stress coping paradigm was originally developed by Lazarus in the 1980s
• People have to cope and adapt to different things
• The degree to which this produces stress is determined by the extent to which these
external stimuli are perceived to exceed the ability of the person to deal with them, and so
endangering their well being
When confronted with a stimulus that is potentially stressful an individual engages in two processes
of appraisal
• Primary appraisal
o is the means whereby the person determines whether or not a stimulus is dangerous or
not
o If the stimulus is not dangerous then it isn’t relevant for them, If the stimulus is benign
and positive. If the stimulus is perceived benign/positive/irrelevant then it is not a
stressor. If the stimulus is regarded as stressful this is because it is perceived to
represent harm, loss or threat
• Secondary appraisal
o process is about mastering the condition of harm or threat
o Several forms of doing this: Seeking information, taking direct action, confronting the
stressor, doing nothing, attempting to ignore, worrying
The importance of this model is that it recognises that stimuli are not themselves stressful. Stress
arises as a consequence of the cognitive thinking process which people bring to bear on a particular
stimuli. When the patient cannot control things then stress arises.
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9. Stress and chronic illness
It has been argued that stress and failure to cope is responsible for the development of a particular
type of illness because certain biological responses in the individual lead to tissue damage
Strategies to coping with chronic illness
 Normalising
• Patient acknowledges the symptoms but redefines them as part of normal
existence
 Denial
• Patient denies the existence of illness altogether. his may have benefits
especially in the early stages of a threatening diagnosis. Denial may help the
patient draw back from the condition and resume their daily tasks in the short
term. However, in the long term denial prevent the patient from confronting the
illness
 Avoidance
• Don’t deny their problem. Set to avoid situations that might exacerbate their
symptoms e.g. – a reformed alcoholic avoids going to occasions with alcohol.
This poses threats as the person who is a reformed alcoholic might miss out on
other social opportunities provided to them
 Resignation
• Person has totally embraced themselves in the illness and it is the most
important thing to them. They resign themselves to the fate of the illness. In less
serious conditions resignation leads to invalidism
 Accomodation
• Patient acknowledges and deals with the problem that the illness produces. The
everyday handling of the disease is seen as part of normal living
Health Belief Model
• Psychological model that attempts to explain peoples health behaviours
• Focuses on peoples beliefs about the threat of ill health and the costs and benefits of health
behaviour
o Perceived susceptibility
 Ones opinion on the chances of getting a condition
 How likely am I to contract breathing difficulties or contract lung cancer if I smoke?
o Perceived severity
 The anticipated severity or consequences of an action
 How bad would it be if I suffered from breathing problems if i smoked
o Perceived Benefits
 Benefits of the health behaviour
 If I give up smoking what will i gain?
o Perceived Barriers
 Cost barriers associated with the behaviour
 How difficult would it be to give up smoking? What would i lose? How much money
will it cost?
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10. Transtheoretical Model
It is a model to show how people modify a problem behaviour or acquire a positive behaviour
It focuses on decision making of individuals and helps us understand behaviour change
Involves emotion, cognition, behaviour . Constructs change as a process involving progress through a
series of five stages
o Precontemplation
 Patient not taking action to modify behaviour for next six months
• Traditional health promotion programs are not designed for such people
• Patient may be aware of importance of change in behaviour
o Contemplation
 Intent to change in next six months
• Aware of pros and cons
o Cost and benefits may keep people in this stage for a long time (chronic
contemplation)
o Preparation
 Plan to take action in next month
• Taken some significant action in last year
o Has planned and ready to take advice
o Action
 Behaviour has changed
• Person made some change over last six months
o Vigilance against relapse important
o Mantainance
 Working to prevent relapse
• Becomes easier as people become confident

Relapse or regression occurs when people go back to an earlier stage from action or mantainance
Techniques are used to try and move people between stages
 E.g. motivation and sending them to health promotion and health education classes
Self Regulatory Model
• Useful model to understand how patients react to threatening stimuli
• A useful model for understanding how people react to threatening information is Self
regulation or parallel processing model
o Stimuli
 Getting told you have cancer
o Representation of Danger/fear
 You start to think about the consequences of cancer
o Coping procedure
 If people find the information threatening the abilities to cope will be poor
 They may focus on managing there emotion at the expense of managing the danger
o Appraisal
• If a pt perceives their illness or the information they have been given as very threatening or
their abilities to cope with it very poor, they may focus on managing their emotion at the
expense of managing the danger
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11. • Emotion focused coping strategies include avoiding thinking about the threat, distracting
oneself from it or denying that it exists
• However this may mean that pt delays seeking help/non-adherent to recommended
treatment – may prove detrimental to health
• As a result it is important to give threatening info in a way that prevents people from being
overwhelmed by emotion – allows them to develop coping strategies
• Problem focused coping strategies include problem solving, action planning, expressing
emotions and seeking social support
Disability coping Model
• Three different models or perspectives of disability
• Each contribute to a broader understanding and achieving better medical, social and
psychological outcomes for patients
o Medical Model
 Activity limitations can be seen as a direct consequence of an underlying disease or
disorder that causes impairment with a resulting disability
 Suggests that disability can only be reduced by treating the medical condition
o Social Model
 Emphasises that activity limitations result from social and environmental constraints
 The individual isn’t just limited by their medical conditions but by their behaviour of
others and environmental barriers towards them
o Psychological Model
 So the individual will be more motivated to engage in the activity because it will
result in them doing the things they like as they believe other people who are
important to them would want them to do it because they can.
Role of Carers
• 4 types of carers
• Carer as a resource
o Most common view
o Natural order of things for a family to be responsible for the care of its members
o Little concern from the carers as they are only doing there duty
• Carer as a Co-Worker
o Aims to mantain and increase informal care
o Carers are given some support – such as domestic help, holidays, education and advice
o Relatives become “semi-professionals”
• Carer as a Co-client
o Indirect client – legitimate focus for support and service
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12. o Client finds it easier to get support from services than NHS unless service seen to have
direct clinical outcome- all members of family are treated as clients
• Superseded Carers
o Looks at the future of the dependent person
o Tries to make them independent and less reliant on support
o Most appropriate for those dependent on parents
Burden of Carers
• The impact on family is usually referred to as a burden
• Two types:
o Objective
o Subjective
• Objective
• Compromises the things that are externally observable and objectively quantifiable
• Includes:
o Financial problems
 Loss or earning through loss of job
o Disruption to household
 Loss of freedom and privacy
 Carer loses outside contact as he is constantly involved in caring
o Effects on carer
 Physical injuries
• Back pain
 Social isolation
• Little support available
o The tasks the carer does depends on who is being cared for
o Elderly pts – focused on physical tasks as person maybe able to do little for themselves
o Psychiatric pts – more supervision and responsibility for finances/medication
• Subjective
o Difficult to measure
o How the carer feels about caring
o The carers main complaint is the lack of support available
o Carer m ay feel isolated and withdrawn from the sense of freedom
o Family life changed dramatically – person may resent new role e.g. from a wife to a carer
– loss of mutual support in relationship
o Caring for chronically ill has a greater psychological effect – inevitably become affected
themselves by illness of family members – loss in Q of L similar to those of pt
o Informal care is regulated by social, cultural and context specific system of rights, duties
and obligations – ‘moral minefield’
o Carers often need ‘professional skills of a nurse, remedial therapist, psychologist and
speech therapist’ as well as ‘unfailing optimism & patience’
o THERE ARE ALSO MANY POSITIVE ASPECTS OF CARING WHICH BRINGS MANY REWARDS
AND PLEASURES
Personalities
• One view is that people have a fixed personality that is deep inside but it is covered up like
layers of an onion- if only we could strip the layers we can uncover the real person lying
within – these layers give colour or characteristics to a person. This is the trait theory of
personality
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13. • Trait Theory
o Nomothetic theories
o Individuals are thought of having many traits
o These can be described by different sets of adjectives relating to behaviour
o There are three factors in trait theory:
 Introversion-extroversion
• People who score highly in extroversion are sociable, lively and assertive in
contrast to introverts who are more retiring and controlled
 Neuroticism – stability
• People who score highly on neuroticism show anxiety and guilt feelings
 Psychoticism –impulse control
• Aggressive
• Cold
• Lack of empathy
o Trait theories describe differences but we also want to know the reasons for being
different
• Psycho-dynamic theory
o Ideographic theory
o Assumption that behaviour is influenced by unconscious mind
o Using an iceberg analogy he described the part above the water as representing the
conscious experience and the part below the water as the unconscious experience
o 3 major systems:
 Ego
• The ego is conscious and is in touch with the real world
 Id
• Id is child like and demands that its needs need to be fulfilled
 Super Ego
• Individuals conscious and tends to be authoritarian
• People with different personalities are more susceptible to different diseases: e.g. type A
and type B personalities in ischaemic heart disease
Parent – Infant Attachment
• Secure
o Strongest type
o A child in this category feels he can depend on his parent or provider. He knows that
person will be there when he needs support. He knows what to expect.
 The secure child usually plays well with other children his age.
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14.  He may cry when his mother leaves. He will usually settle down if a friendly adult is
there to comfort him.
 When parents pick him up from childcare, he is usually very happy to see them.
o Avoidant
o Non secure
 This is one category of attachment that is not secure. Avoidant children have learned
that depending on parents won’t get them that secure feeling they want, so they
learn to take care of themselves.
 Children may seem too independent. They do not often ask for help, but they get
frustrated easily.
 They may have difficulty playing with other children their age. They may be
aggressive at times.
 Biting, hitting, pushing, and screaming are common for many children, but avoidant
children do those things
• Ambivalent
o Ambivalence (not being completely sure of something) is another way a child may be
insecurely attached to his parents. Children who are ambivalent have learned that
sometimes their needs are met, and sometimes they are not. They notice what behavior
got their parents’ attention in the past and use it over and over. They are always looking
for that feeling of security that they sometimes get.
o Ambivalent children are often very clingy.
o They tend to act younger than they really are and may seem over-emotional.
o Ambivalent children often cry, get frustrated easily, and love to be the center of
attention.
 They get upset if people aren’t paying attention to them and have a hard time doing
things on their own.
• Disorganised
o Disorganized children don’t know what to expect from their parents. Children with
relationships in the other categories have organized attachments. This means that they
have all learned ways to get what they need, even if it is not the best way. This happens
because a child learns to predict how his parent will react, whether it is positive or
negative. They also learn that doing certain things will make their parents do certain
things.
o Disorganized children will do things that seem to make no sense. Sometimes these
children will speak really fast and will be hard to understand.
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15. o There are two types of disorganized attachments:
1) Controlling-Disorganized, children who are controlling tend to be extremely bossy
with their friends.
2) Caregiving-Disorganized, children who are caregiving might treat other children in a
childish way, acting like a parent.
Social Class
• General measure obtained by combining occupational groups equal in skill and general
standing in the community to form occupational classes in the UK
• It can be seen as an indirect indicator of education, income, standards of living and working
conditions
• Death rates for UK can be calculated for occupational classes by combining data on birth and
death certificates with occupational data
• 5 social classes in UK
• Type I- Profession, Large employers
• Type II- Lesser Professions, Teachers, Trade
• Type III- Skilled/Non Manual, Clerk Workers, Skilled/Manual, Electricians/Lorry Drivers
• Type IV- Semi- skilled/Manual, Farm workers
• Type V- Unskilled Manual, Building Labourers
What are the key features of immunisations?
• Two types of immunization
• Passive immunisation:
o is the donation of host specific antibodies against a particular agent by the injection of
blood products derived from immune animals or humans. It is primarily used to give
temporary immunity to those who are not immune. Passive immunity to common
infections occur naturally through the transplacental transfer of antibodies from mother
to baby.
• Active Immunisation:
o active immunity to an infection is acquired naturally after recovery from infection with
the organism. Artificial active immunity can be induced by the administration of an
appropriate vaccine which stimulates the production of antibodies. This provides
complete or partial protection
• There are four main types of vaccines:
• Inactivated vaccines -are made from whole organisms which are killed during manufacture.
E.g. infected polio
• Live vaccines -are made from living organisms, which are either the organisms that cause the
disease or organisms whose virulence has been reduced by attenuation methods
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16. • Toxoids -are produced from bacterial toxins artificially rendered harmless e.g. diphtheria
• Component vaccines -contain one or more of the component antigens of the target
organism which are necessary to provoke an appropriate protective antibody response.
Health Risks of immunizations
• Critics claim that the public health benefits of vaccination are exaggerated. The mortality
rates of certain illnesses was reduced before vaccination was introduced
• Secondary long term effects for introducing immunogens and adjuvents are still unknown
• It is still unclear whether or not vaccinations can actually create immunity against certain
diseases as some people who have been vaccinated have still contracted the illness
• Religious objections
• Live or attenuated virus vaccination can actually produce the infection that the vaccine is
supposed to prevent. For example, live polio should never be administered to a child who
comes in contact with an HIV patient, for the attenuated virus can "leap" to the HIV patient
and produce polio. Reports exist of normal parents who have developed polio from the viral
vaccine given to their children.
• A second mechanism of damage comes from neurotoxic materials found sometimes in
vaccines. Thimerosol is the most widely discussed, since it contains mercury. The amount is
small. Each vaccine is equivalent to the amount of mercury found in a 6 oz. Can of tuna fish.
Nevertheless, some argue that even these levels may be important in a vulnerable child
• Allergic reactions and the development of an auto-immune response, stimulated by the
vaccine and its adjuvant. Vaccines always contain adjuvants, which are substances known to
amplify the body's response to the vaccine. These adjuvants are known to sometimes cause
allergic and auto-immune responses on their own.
Why do people self medicate?
• Easier than seeing the doctor
• Over the counter drugs are easily accessible
• Problems
o Wrong dosage taken
o Wrong diagnosis of illness
o Wrong medication taken
Tolerance
• Effectiveness of a drug dose in producing a physiological response
Dependence
• Series of complex homeostatic mechanisms to cause disturbances if the drug is stopped
being used
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17. Addiction
• Addiction is the “behavioural pattern characterised by compulsive use of a drug ”
• Two models:
o Life Process Model
 Addiction is not a disease
 But rather a habitual response and a source of gratification
o Disease Model
 Addiction is a lifelong disease involving biological and environmental source of origin
 Genetic tendency seems to be present.
 Addiction could be genetic
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