1. HKMU HKMU BEHAVIORAL SCIENCES AND ETHICS DEPARTMENT SUBJECT: BEHAVIORAL SCIENCES CODE: BSC 300 TOPIC: BEHAVIORAL MEDICINE DATE:11 th March 2015

2. PRESENTERS 1. BESTINA MTAO 2. FADYA MOHAMMED 3. GIVENAL PATRICK 4. INNOCENT PETER 5. JOSHUA MBILINYI FACILITATOR: PROF. MASALAKULANGWA

3. TABLE OF CONTENTS INTRODUCTION OBJECTIVES DEFINITION OF TERMS GENERAL DISCUSSION SUMMARY CONCLUSIONS RECOMMENDATIONS REFERENCES

4. INTRODUCTION This is a presentation about behavioral medicine as one of the most important intervention in the world today. Our presentation as will be presented is intended to create awareness for medical personnel on latest and newest development discovered in the 21 st century, following efforts from previous centuries.

5. INTRO … All of us will benefit from the presentation, and we request you to listen carefully, and possibly after the presentation, we will pick some questions and comments from the floor at large.

6. Objectives At the end of the presentation, all students will be able to: I. Answer the Question: why do we need behavioral medicine II. Define behavioral medicine III. Know and explain events involved in the creation of behavioral medicine IV. Explain how is behavioral medicine relevant V. Highlight the history of Western Medical Knowledge which leads up to current medicine VI. Behavioral related illnesses

7. DEFINITION OF TERMS USED Acute infectious diseases (STIs, STDs)- Sexually Transmitted Infections and Sexually transmitted Diseases (STIs & STDs) are those infections or diseases acquired by sexual contact. An acute infection is the one that does not stay for a long time in the body. Behavioral medicine: Behavioral medicine is an interdisciplinary field of research and practice that focuses on how people’s thoughts and behavior affect their health. Chronic illness -Chronic illness is a long lasting disease that can be controlled but not cured. Chronic stress- Chronic stress is a state of prolonged tension from internal or external stressors, which may cause various physical manifestations example asthma, back pain, arrhythmias,hypertension and suppress the immune system. Infertility is the inability of a person, animal or plant to reproduce by natural means. In humans, infertility may describe a woman who is unable to conceive as well as being unable to carry a pregnancy to full term.full term

8. MAIN DISCUSSION 1. WHY DO WE NEED BEHAVIORAL MEDICINE? A.Behavioral medicine is a response to changes in healthcare. 1.Acute infectious diseases are no longer the major killer or cripplers. 2.The profile of today’s illness is marked by chronic stress related multifactorial diseases.

11. Why do we need Behavioral Medicine? Health Today Mortality rates indicate people are living longer Morbidity rates indicate fewer people suffer from infectious disease

12. I.Why Behavioral Medicine 3.These are diseases of “choice” not chance because of life style and unhealthy behaviors. a)With the chronicity of disease, behavioral and psychological factors become more crucial to prognosis and to effective therapy (i.e. consider passive patients that become active as they are given a diagnosis).

13. Why Behavioral Medicine Health: Yesterday and Today 1800 ’ s Health = absence of illness. Common illnesses: bubonic plague, pneumonic plague, tuberculosis Poor health often associated with poor hygiene Late 1800 ’ s and 1900 ’ s Suspicion of the environment as a cause of illness.

14. I.Why Behavioral Medicine World Health Organization 1947 conference on global health “ Health is the state of complete physical, mental, and social well-being, not just the absence of disease or infirmity. ” The first time health meant more than an absence of illness

15. I.Why Behavioral Medicine B.As such, Interdisciplinary communication begins. 1.Consequently, a school of medical thought is challenged – mind- body dualism (Descartes) 2.Simultaneously, another school of medical thought is challenged and reinforced – reductionistic vs integrative

16. I.Why Behavioral Medicine C.A unique conference held at Yale University in 1997 defines 1.Behavioral Medicine is defined 2.At this conference different disciplines open communication between researchers and clinicians.

17. II.Definition A.Behavioral Medicine is an interdisciplinary effort involving research and clinical practice. B.It studies the interactions of the physical, psychological, social environment, cognition, behavior and biology in health and illness.

18. II Definition C.It then, focuses on the applications of these findings or techniques based on the knowledge of these interactions in the promotion of health and rehabilitation as well as providing prevention, diagnosis, and treatment of illness

19. III.Events involved in the creation of Behavioral Medicine A.Success of behavior modification/behavioral analysis B.Success of biofeedback C.Emergence of Chronic illness as the major issue in healthcare

20. III.Events involved in the creation of Behavioral Medicine D.Escalation of healthcare costs ( due to the above)

22. III.Events involved in the creation of Behavioral Medicine E.Failure of psychosomatic medicine CHANGES IN MODELS OF HEALTH Biomedical Biopsychosocial Acceptance of the Biopsychosocial by lay public Currently, Biopsychosocialspiritual

24. 1960s definition of health included: Physical Social Mental Elements of life Environmental Spiritual Emotional Intellectual dimensions

25. The 6 Dimensions of the Health and Wellness Continuum Physical Includes body functioning, physical fitness, Activities of Daily Living (ADL) Intellectual “ brain power ” Ability to think clearly, reason objectively Social Ability to have satisfying relationships

26. The 6 Dimensions of the Health and Wellness Continuum Physical Includes body functioning, physical fitness, Activities of Daily Living (ADL) Intellectual “ brain power ” Ability to think clearly, reason objectively Social Ability to have satisfying relationships

27. .

29. IV.How is it relevant? A.It is an interdisciplinary effort to open communication and collaboration. B.It demonstrates that a common language can be created in which different discipline can benefit each other.

30. C.It Challenges us and our field to demonstrate effectiveness 1.Sometimes require common language 2.Similar to acculturation (dominant vs minority culture)

31. V.History of Western Medical Knowledge which leads up to current A.First epoch-between 15 th and 12 th centuries BC Hygeia (Greek Goddess of Health) 1.Patients are entitled to health if they via moderation in order to not elicit illnesses. 2.Toward of the end of Era, first Western Greek physician conceptualizes illness as organic and treats them with herbs.

32. V.History of Western Medical B.Second Epoch 12 th - 5 th centuries BC 1.The first disease specialist evolves. 2.Illness treated with surgery and medication but also with music and massage.

33. V.History of Western Medical C.Third Epoch –5 th BC – Dark Ages - Hippocrates’s era 1.Promotes the use of more of a scientific approach and systematic methods. 2.Aristotle also contributes to this era and creates the foundation for the future birth of psychology.

34. V.History of Western Medical D.Fourth Epoch- Dark Ages – the Catholic church becomes a powerful political and social force 1.The mind-body question becomes a religious one. 2.The church creates an institutionalized view of a separation of the body and behavior/mind. 3.The church allows for scientist to dissect bodies if they agree to limit their studies to the body.

35. V.History of Western Medical E.17 th Century – Rene Descartes formalizes the dualistic views of the church into the reductionistic approach. F.Industrial Revolution leads to a return to the Hippocratic approach in order to address environmental health problems

36. V.History of Western Medical G.19 th -20 th Centuries – scientific research experience gains in fighting acute illnesses

37. VI. BEHAVIORAL RELATED ILLNESSES Substance abuse -also known as drug abuse is a patterned use of a substance (drug) in which the user consumes the substance in amount or methods which are harmful to themselves or others.

40. Obesity Is a medical condition in which excess body fat has accumulated to the extent that it may have a negative effect on health, leading to reduce life expectancy and or increased health problems. Obesity increases the likelihood of various diseases particularly heart disease, type 2 diabetes, obstructive sleep apnoea certain type of cancer and osteoarthritis. Obesity is most commonly caused by a combination of excessive food energy intake, lack of physical activity and genetic susceptibility..

43. Hypertension Hypertension or high blood pressure sometimes called arterial hypertension is a chronic medical condition in which the blood pressure in the arteries is elevated. From a behavioral medicine point, hypertension is lifestyle disorder, aggravated by unhealthy diet, adiposity, excessive alcohol intake and stress. Insomnia Insomnia or sleeplessness is a sleep disorder in which there is inability to fall asleep or to stay asleep as long as desired

44. Stroke prevalence in Tanzania The Tanzania Stroke Incidence Project (TSIP) recorded stroke incidence in two well defined demographic surveillance sites (DSS) over a 3-year period from June, 2003. The Hai DSS (population 159,814) is rural and the Dar-es-Salaam DSS (population 56,517) is urban. Patients who died from stroke before recruitment into the TSIP were identified via verbal autopsy, which was done on all those who died within the study areas.

45. Findings Crude yearly stroke incidence rates were 94.5 per 100,000 (95% CI 76.0-115.0) in Hai and 107.9 per 100,000 (88.1-129.8) in Dar-es- Salaam. When age-standardised to the WHO world population, yearly stroke incidence rates were 108.6 per 100 000 (95% CI 89.0-130.9) in Hai and 315.9 per 100,000 (281.6-352.3) in Dar-es-Salaam

46. HIV PREVALENCE IN TANZANIA Results for all those tested. The survey tested 9,756 women and 7,989 men in the 15 to 49 age group from every administrative region of Tanzania for HIV infection.administrative region Stratified by gender, 6.2 percent of women were HIV positive, which was significantly higher than the 3.8 percentage rate for men.

47. SUMMARY Behavioral Medicine is an interdisciplinary effort involving research and clinical practice. Behavioral medicine studies the interactions of the physical, psychological, social environment, cognition, behavior and biology in health and illness. Behavioral medicine focuses on the applications these findings or techniques based on the knowledge of these interactions in the promotion of health and rehabilitation as well as providing prevention, diagnosis, and treatment of illness.

48. CONCLUSIONS In Tanzania today the leading killer diseases are HIV/AIDS, Heart Diseases, Diabetes, Malaria, Accidents Behavioral medicine undertaking is very important in the prevention, control or treatment of the many of the health related problems.

49. CONCLUSIONS … At international level, Africa is suffering from infection as one of the leading cause of death among women and men, and also one of the leading cause of primary and secondary infertility.

50. RECOMMENDATIONS The subject on behavioral medicine is highly recommended to all medical personnel, to all patients, and also to all people as it is helpful in understanding and explaining health problems and medical conditions. The topic is relevant to medical professionals, i.e doctors and nurses and allied health professionals. The topic is very useful to the modern medical practice, and for all centuries.

51. REFERENCES Tanzania HIV/AIDS and Malaria Indicator Survey 2011-12, authorized by the Tanzania Commission for AIDS (TACAIDS) and the Zanzibar Commission for AIDS; implemented by the Tanzania National Bureau of Statistics in collaboration with the Office of the Chief Government Statistician (Zanzibar); funded by the United States Agency for International Development, TACAIDS, and the Ministry of Health and Social Welfare, with support provided by ICF International; data collected 16 December 2011 to 24 May 2012; report published in Dar es Salaam in March 20Carlson, Neil (2013). Physiology of Behavior. Pearson. pp. 602–606. ISBN 9780205239399.Tanzania HIV/AIDS and Malaria Indicator Survey 2011-12, authorized by theTanzania Commission for AIDSTanzania National Bureau of StatisticsUnited States Agency for International DevelopmentMinistry of Health and Social WelfareICF InternationalISBN9780205239399.Sapolsky RM.Sapolsky RM. (1998). Why Zebras Don't Get Ulcers: An Updated Guide To Stress, Stress Related Diseases, and Coping. 2nd Rev Ed, W. H. Freeman ISBN 978-0-7167-3210-5Why Zebras Don't Get UlcersISBN 978-0-7167-3210-5 McEwen BS (2007). "Physiology and neurobiology of stress and adaptation: central role of the brain". Physiol Rev 87 (3): 873–904. doi:10.1152/physrev.00041.2006. PMID 17615391."Physiology and neurobiology of stress and adaptation: central role of the brain"doi10.1152/physrev.00041.2006 PMID17615391 Ending global poverty by Stephen.S.Smith [2005]. Pathologies of power by Paul Farmer[2005]