HW Week 3 - Kevin Selby

HW Week 3 - Kevin Selby

by Kevin -

1. State your health outcome of interest. (It could be the one you used for week #2 or another one.) Pick two key behaviors that are important factors leading to your health outcome. Explain the importance of these behaviors either for etiology, prevention, or intervention. (If none of the behaviors in the readings are important for your health outcome, suggest another behavior that is.)
I am interested in hypertension control. In other words, if you have hypertension, was your blood pressure below goal at your most recent measurement. Key behaviors leading to my health outcome are diet and medication adherence.

Diet is important through several mechanisms; a high-sodium / low potassium diet can increase blood pressure, thus worsening HTN control. Poor diet can lead to obesity and worsening HTN control. Interventions to improve diet have been shown to improve BP.

Medications can lower BP and decrease complication rates. However, as BP meds are long-term, not usually linked to symptoms, and often times have side effects, adherence can be a problem. Poor adherence leads to worsening HTN control.

  1. 2.      Describe how you would study the role of one of the behaviors described for question #1 and your health outcome of interest. Incorporate a social factor (e.g. race/ethnicity, social exclusion, stress) in the study approach.

Several social factors can have an impact on medication adherence via multiple mechanisms, several of those are associated with social exclusion. Life instability and stress can make taking meds a lower priority. Economic hardship can make it difficult to afford meds. Those without a social network may be less motivated to make short term sacrifices in order to improve long-term outcomes.

  1. If key health behaviors (e.g. smoking, exercise, nutritious diet) are strongly influenced by neighborhood, income, and/or education, do we need to continue to study how these behaviors influence health outcomes? Why or why not?

    Yes, it is important that we continue to study these factors in order to prioritize areas for intervention. If the effects of low SES are largely reversible, than interventions at multiple levels will be beneficial and we should simply shoes what is most cost effective. However, if there is an imprinting of SES on someone’s health status at an early age that then causes persistent problems, we should focus on early child hood. Hertzmann describes SES is a problem that entails “involving repeated, self-amplifying exposures over time”. This would suggest that early childhood interventions, to avoid the self-amplification of problems, should be the most important. As an adult, the damage has already been done.

Re: HW Week 3 - Kevin Selby

by Kevin -

Hello,

Here is the correct homework:

1. Weaver et al: Yes, I definitely think that there are similar examples in human development. One would be the need for stimulation during infancy on the development of neural pathways. There is considerable ‘pruning’ of certain neural connections to focus on those pathways that will become important later on. Without direct stimulation that involves human-human contact and the development of motor skills, appropriate pathways will not be strengthened. Another example is the development of identity and self during adolescence. When this process is blocked during this critical period, significant psychologic problems can develop.

2.  Provide a brief proposal for a study: An example could be the study of identical twins. Even though most twins have very similar early childhood exposures, they diverge as they grow older. Large numbers of twins can give us insight into genetics and epigenetics through life. Presumably phenotypic differences in twins are from epigenetic changes (or chance, depending on how much you believe in randomness). You could use populations of identical twins to compare psychiatric diseases that develop in early adulthood, like schizophrenia and bipolar disease, to see the influence of environment.

3. Gruenewald: I think that Gruenewald’s findings are an extension of Weaver’s theories. The differences seen between upwardly and downwardly mobile individuals suggest that the critical childhood years are important, but that lifetime exposure also plays a role.

 4. Hertzmann and Boyce: The critical line, for me in this reading is “Experience affects individuals differently”, which echoes strongly with all of our personal experience. It is very difficult to understand the vast complexity of genetic, lifetime accumulated exposures, and current situations that make up how people present with common diseases in primary care (my specialty) like back pain. Genetics, past activities and professions, past experiences with pain, and current circumstances are all important.

Re: HW Week 3 - Kevin Selby

by Irene Yen -

Hi Kevin. Thanks for doing this twice. Sorry about the confusion. Medication adherence, as you know, involves many factors. You listed some of them. With hypertension, people don't feel sick, so don't necessarily notice the difference when they are on the medications. Also, some of the medications have unpleasant side effects. People with less insurance coverage have to get whichever pills are covered by the plan. The pills might change over time and the appearance can change, which is confusing.