Medical Sociology Chapters 5-8

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Before making an assessment of an individual’s stress
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Nature of the threat Social environment of the individual Psychology stole and personality of the individual Definition of the threat Social influences acting upon the individual Duration of the threat
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Brenner’s studies
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Linked increased incidents of diseases to downturn in economies Few areas not affected by downturn of the economy Employment rates and mental health conditions
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Provokation hypothesis
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Stress from dislocation or inability to improve current lifestyle
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Uncovering hypothesis
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Downturn doesn’t promote mental health problems, only uncovers them
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Subjective interpretation of the situation
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Potentially changes the individual’s physiological make up
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Fight or flight
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Physiological perspective Can change physiological make up
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Leonard Pearlin
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Stress comes from life events or chronic strains
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Life events
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Important specific events or experiences that interrupt an individual’s usual activities and require some adjustments Can be positive, but still cause stress (marriage, baby)
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Chronic strains
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relatively enduring problems, conflicts and threats that many people face in their daily lives Role overload (being a parent and having a career) Conflicts in role sets Interrole conflict (too many roles) Role captivity Have stronger effects than life events
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David Mechanic
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Extent of physiological damage or change is dependent on various factors
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Factors affecting the extent of physiological damage or change
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Stimulus situation Individual’s capacity to handle the situation Individual’s preparation by society to meet with problems Influence of society’s approved modes of behavior
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Group membership
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Creates a subjective feeling of belongingness Makes coping with stress easier
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10 Year Study in Alameda, CA 6-7 qualities live longer than 3-4 or less
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7-8 hours of sleep eating breakfast seldom/never eating snacks weight control exercising moderate alcohol consumption never having smoked
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Low SES
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less likely for preventative care less likely to receive prenatal care less likely to received dental care
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Preventative care
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mostly seen in upper/middle class
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Healthiest states Unhealthiest states
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VT and UT OK and MS
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Health Behavior Model
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Determined by one’s belief about perceptible diseases
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HBM used to explain
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perceived susceptibility to a disease perceived benefits of preventive action perceived barriers to action (no insurance) cues to action
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Factors that influence HBM
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Culture Education level Past experience Skills
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Theory of reasoned action
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Intention/motivation to perform a behavior Precedes actual performance Beliefs/attitudes Wishes of significant others
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Being sick
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Not a deliberate and knowing choice Talcott Parsons Secondary gains
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Freund and McGuire
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Illness disrupts regular routine
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Acute Illness
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Sudden onset of pain, discomfort, or inflammation Disappears after a few days
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Chronic Illness
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Slow developing Long duration Typically incurable Usually not communicable Typically results in death
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Experiences of very sick
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Alienation Withdrawing A sense of self is more affected by diagnosis in younger patients
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Health Behavior
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Conceptualized as an activity undertaken by a person believing himself or herself to be healthy for the purpose of preventing health problems
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Dimensions of health behavior
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Prevention Detection Promotion Protection
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Social factors affecting medical care
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Greater for females than males Greater for elderly Social networks
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Social networks
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Women visit doctors more, are diagnosed earlier, Influence males visiting doctor (greater number of women in the family mean men are more likely to visit) African Americans visit less and have a more negative outlook (till 1970s), are still underserved
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Social class
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Poor did not visit doctors often Longer waits in waiting room Use fewer services to their needs Creation of medicare/medicaid–seen in free clinics Higher class see private practices and specialists Poor appear to have more illnesses but less doctors visits
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Dutton theories studied in Washington DC
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Financial coverage only played a small role Culture of poverty-attitudes and characteristics have some validity Systems barriers-hospital out-patient clinics, ER atmosphere, \”looked down upon\” strongest indicator
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Concept of health dimensions
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Physical functioning Mental health Social well-being Role functioning General health perceptions Symptoms
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Biomedical model’s assumptions
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The presence of disease, its diagnosis and its treatment are all completely objective phenomena Only medical professionals are capable of defining health and illness Health and illness should be solely in terms of physiological function Health is defined as merely the absence of disease
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Talcott Parsons
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Objecting to the biomedical definition, Talcott Parsons suggested that health be viewed as the ability to comply with social norms. He defined health as \”the state of optimum capacity of an individual for the effective performance of the roles and tasks for which he has been socialized.
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Sociological perspective of social stress, Emile Durkheim
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Helped identify individual behaviors that are tied to and shaped by larger social forces through his book Suicide. He focused on behaviors that seem individualistic, but are shaped by social forces.
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The nature to which individuals were integrated into a group
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When an individual identifies with a social group and is sufficiently integrated within a group.
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Sociological perspective of social stress, WI Thomas
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Recognized that individuals are affected by events only to the extent to which they are perceived. Life events nor chronic strains are not stressful, the situations or occurrences in which the likelihood of a stressful response is increased.
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Sociological perspective of social stress, Charles Horton Cooley
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Looking-glass self, showed that reality is socially constructed by describing the process by which each person develops a self-image. We see ourselves as we believe others see us.
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Coping
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Refers to personal responses people make to prevent, avoid, or control emotional distress and includes efforts to eliminate or modify the stressful situation so that it will not be a continuing problem. The three most common characteristics to help mediate stress include positive self-esteem, internal control, and hardiness
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Social support
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Resources people receive from their social relationships and social networks and their membership in groups
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Effects of gender of the stress process
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Women have higher rates than men of psychological distress and depression Women are exposed to more discrete, stressful life events than are men Women include more people in their social network, care more about these people and are more emotionally involved in the lives of people around them Are more likely than men to be both providers and recipients of support More vulnerable than men to stress due to their socialization to respond passively
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Ten factors that determine how individuals respond to symptoms identified by David Mechanic
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The visibility, recognizability, or perceptual salience of symptoms Perceived seriousness of symptoms Extent to which symptoms disrupt family, work and other social activities Frequency of the appearance of symptoms, their persistence, or frequency of recurrence Tolerance of threshold of those who are exposed to and evaluate the deviant signs and symptoms Available information, knowledge, and cultural assumptions and understandings of the evaluator Perceptual needs related to anxiety about and fear of the illness Needs competing with illness response Competing possible interpretations that can be assigned to the symptoms once they are recognized Availability of treatment resources, physical proximity, and psychological and monetary costs of taking action
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Palliative care
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treating the pain and suffering of seriously ill patients
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Four major obstacles to the use of pain relief medicine for more patients
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Few physicians have received training in pain management and are ill-informed about opioids, synthetic, versions of morphine, the most potent oral painkillers Insurance companies inadequately compensate physicians who can spend a very large amount of time with patients in pain The DEA has actively prosecuted physicians for a variety of offenses related to the prescription of narcotic pain relief medications Many patients are fearful that the narcotic drugs that may be used will be addictive or have significant, negative side effects
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Sick Role
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introduced by Talcott Parsons, emphasized that illness is not simply a biological or psychological condition, and it isn not simply an unstructured state free of social norms and regulation
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Macro factors criticism by Max Weber
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Criticized by several medical sociologists for the almost exclusive focus that policy makers and general public have given to personal choices and individual behaviors in considering health behaviors
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Macro level factors
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Have a direct impact on individual behaviors including the availability of protective or harmful consumer products, physical structures/characteristics of products, social structures and policies, and media and cultural messages
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Reasons little attention is devoted to macro level factors
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The use of social policy and the force of laws to regulate individuals behavior is viewed by some as contradicting the cultural value of individualism The value of individualism carries over into political economy The absence of attention to macro level factors enables society to forego dealing with the wealth of research that establishes a direct relationship between individuals’ social and physical environment and their health status
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Micro level theories
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Provides a paradigm for understanding why some individuals engage in health protective behaviors while others behave in knowingly unhealthy ways Health Belief Model
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Type of role strain that typically touches people most deeply
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Interpersonal problems within role sets
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Chronic strains
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A more powerful determinant than life events of stress-related disorders Chronic strains may lead to life events and vice versa
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Functionalists
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viewed sickness as a type of deviant behavior in that it is a violation of role expectations

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