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Marikka Villafuerte-Solana, MD

San Beda College of Medicine
FCH1
Jan. 14, 2010
Definitions of Health

"Health is a state of
complete physical, mental,
and social well-being and
not merely the absence of
disease"
(WHO, 1947, p. 1)
GOOD HEALTH MEANS…

Preventing premature death
Preventing disability
Promoting an environment that
supports life
Cultivating community and
family support
GOOD HEALTH MEANS…

Enhancing individual’s ability to
respond and to take action
Assuring that all people achieve and
maintain a maximum level of
functioning
Definition of Wellness
 an active process by which an individual
progresses towards maximum potential
possible, regardless of current state of
health
 five dimensions of wellness:
 Physical
 Sociocultural/environmental
 Emotional
 Intellectual
 Spiritual
FAMILY WELLNESS

Family wellness is a bigger
picture than personal wellness.
And while it includes the same
individual wellness factors for
each member of your family, it
also includes the wellness factors
of the family as a group.
FAMILY WELLNESS
 Each family is, in many
ways, its own living,
breathing ecosystem –
with all parts
dependent on the well
being of the others.
 Family well being
depends on the quality
of the communication
and time shared
between everyone in
the family.
The “positiveness”
of health does not
lie in the state , but
in the struggle--
the effort to reach a
goal …
Gordon, I . 1958
TREATMENT MODEL WELLNESS MODEL
DISABILITY SYMPTOMS SIGNS AWARENESSEDUCATION GROWTH

NEUTRAL POINT
(No discernible illness or wellness)
•Cornerstone of health and wellness
•Taking control of one’s lifestyle and
health behaviors so that lifestyle is
the result of choice and not the result
of chance and ignorance
•Conscious, willful, internally directed
behavior that promotes health and
Ingredients of
self-regulation

Information and knowledge
Decision making
Commitment
Goals
Skill acquisition

GREEN & SHELLENBERGER, 1991
Physician recommendations
have been demonstrated to
significantly improve
patient’s efforts to change
behaviors.
Rippe J et al., Lifestyl;e Medicine,
1999
THE  WELLNESS  GUIDE 
TO 
PREVENTIVE  CARE
Screening tests for early
detection of disease
Education/Counseling about
healthy habits and injury
prevention
Immunizations
Chemoprophylaxis
THE  WELLNESS  GUIDE  TO 
PREVENTIVE  CARE
 Education/Counseling
about healthy habits
and injury prevention
 Screening tests for
early detection of
disease
 Immunizations
 Chemoprophylaxis
LIFESTYLE
 DIET (fat, fiber, salt, caffeine, water )
 PHYSICAL ACTIVITY
 TOBACCO (active, passive)
 ALCOHOL (# of drinks)
 Stress Coping and MENTAL HEALTH
 SLEEP
 SEXUAL ACTIVITIES
 PERSONAL HYGIENE
 SKIN CARE
HOW BEHAVIOR
INFLUENCE HEALTH…..
People’s lifestyle include many behaviors
that are risk factors for illness and injury
Health protective behavior
 Any behavior performed by a person , regardless of his/her
perceived health status in order to protect, promote or
maintain health whether or not such behavior is in fact
effective or not (Harris and Guten, 1979)
Health seeking behavior
 Any behavior by which the person utilizes the available health
resources
THEORETICAL
CONSTRUCTS
CONSUMER INFORMATION

SOCIAL LEARNING

HEALTH BELIEFS MODEL

TRANS - THEORETICAL MODEL
CONSUMER
INFORMATION
APPROPRIATE INFORMATION FOR
RATIONAL DECISION MAKING
HAS AN IMPORTANT INFLUENCE
ON HUMAN BEHAVIOR
SOCIAL LEARNING
THEORY
BEHAVIOR CAN BE LEARNED AND
THEREFORE UNLEARNED OR
ALTERED.
THIS MAY BE DONE THROUGH
ACHIEVEMENT OF SMALL GOALS,
MONITORING OF PROGRESS AND
SELF REWARD.
HEALTH BELIEFS
MODELS
ATTITUDES AND BELIEFS ARE BEHIND WHAT
MOTIVATES PATIENTS TO CHANGE

Perceived seriousness
Perceived susceptibility
Cues to action
TRANS-THEORETICAL
MODEL
CHANGE IS A DYNAMIC
CONCEPT.
CHANGING BEHAVIOR GOES
THROUGH STAGES
A MODEL OF
HEALTH BEHAVIOR
CHANGE
PROCHASKA & VELICER, 1997
PRE-CONTEMPLATION
CONTEMPLATION
PREPARATION
ACTION
MAINTENANCE
TERMINATION
PRE-CONTEMPLATION

NOT INTENDING TO TAKE
ACTION WITHIN THE NEXT
SIX MONTHS
CONTEMPLATION
INTENDING TO CHANGE IN THE
NEXT SIX MONTHS

AWARE OF THE PROS AND CONS
OF CHANGING
PREPARATION
INTENDING TO TAKE ACTION IN
THE IMMEDIATE FUTURE
[USUALLY MEASURED AS
THE NEXT MONTH ]

HAVE A CONCRETE PLAN ON HOW
TO CHANGE
ACTION
HAVE MADE SPECIFIC OVERT
MODIFICATIONS TO
BEHAVIOR WITHIN THE LAST
6 MONTHS
MAINTENANCE
WORKING TO PREVENT RELAPSE
INCREASING CONFIDENCE IN
CAPABILITY
LASTS 6 MONTHS TO 5 YEARS
TERMINATION
ZERO TEMPTATION TO RELAPSE
AND
100 % CONFIDENCE IN ABILITY TO
MAINTAIN NEW BEHAVIOR
3’

2NDARY

PRIMARY

SELF-CARE
Primary
prevention
Identification of risk factors
Prevention of onset of disease
Secondary prevention

Early detection of disease to prevent
progression
screening
Tertiary prevention
Prevention of complications
Adequate treatment of existing
disease
Return to function despite disability
Natural Course of Disease

Asymptomatic Cellular Signs and
Normal physiology damage symptoms

NEUTRAL BIOLOGIC CLINICAL
POINT ONSET ONSET
Lifestyle - Specific
Recommendations
stop smoking
switch to a low fat diet
avoid saturated fats
maintain desirable cholesterol and
blood pressure levels
lose weight if needed
exercise
American Academy of Family Physicians
LIFESTYLE

 DIET (fat, fiber, salt, caffeine, water )
 PHYSICAL ACTIVITY
 TOBACCO (active, passive)
 ALCOHOL (# of drinks)
 Stress Coping and MENTAL HEALTH
 SLEEP
 CAFFEINE INTAKE
 SEXUAL ACTIVITIES
 PERSONAL HYGIENE & SKIN CARE
Caffeine contained in two cups of
coffee may raise the BP by 5 mm
Hg in infrequent users. In
habitual users, caffeine has
minor effect on the blood
pressure.
Ruhl et al, 2000
Drinking more than five cups of coffee per
day was more common among patients
with subarachnoid aneurysmal hemorrhage
(85%) than controls (59%) (p = 0.004).
Isaksen, 2002
At least 8 hours of sleep per day
poor sleep with initiation
difficulties is an independent
risk factor for cardiac events
among men
reduced stage 3-4 sleep
predicted poorer overall health
Poorer quality of life was
predicted by reduced deep sleep
Edell-Gustafson, 2002
Promoting Sleep Hygiene
American Academy of Family
Physicians

 Go to bed and wake up at the same time
every day even if you didn't get enough
sleep. This will help train your body to
sleep at night.
 Develop a bedtime routine. Do the same
thing every night before going to sleep.
For example, take a warm bath and then
read for 10 minutes. Soon you'll connect
these things with sleeping, and doing them
will help make you sleepy.
Promoting Sleep Hygiene

Use the bedroom only for sleeping or
having sex. Don't eat, talk on the phone
or watch TV while you're in bed
Make sure the bedroom is quiet and dark.
If noise is a problem, use a fan to mask
the noise or use earplugs. If you must
sleep during the day, hang dark blinds
over the windows or wear an eye mask
Promoting Sleep Hygiene

If you're still awake after trying to
fall asleep for 30 minutes, get up and
go to another room. Sit quietly for
about 20 minutes before going back
to bed. Do this as many times as you
need to until you can fall asleep.
Avoid alcohol. Even if alcohol makes
you drowsy, it interrupts your body's
sleep rhythms and can cause sleep
disturbances
Promoting Sleep Hygiene

Avoid caffeine. Consuming anything
with caffeine less than six hours
before bedtime can interfere with a
good night's sleep
Avoid eating a big meal too close to
bedtime
Maintain a comfortable
room temperature
Keep worries at bay
THE  WELLNESS  GUIDE 
TO 
PREVENTIVE  CARE
 Screening tests for early
detection of disease
 Education/Counseling about
healthy habits and injury
prevention
 Immunizations
 Chemoprophylaxis
Men's Health Check-up
List
 Cholesterol checks: every 5 years, starting
at age 35. If smoking, have diabetes or if
heart disease runs in the family, start
having cholesterol check at age 20
 Blood Pressure: every 2 years. Some racial
and ethnic groups have a higher risk and
should discuss the issue with their HCP.
 Colorectal Cancer Tests: Begin regular
screening for colorectal cancer starting at
age 50. Yearly Fecalysis w/ occult
blood(>50), Colonoscopy (>60)
Men's Health Check-up
List
 Diabetes Tests: (+) high blood pressure or
high cholesterol
 Depression: feeling "down," sad, or
hopeless, and have little interest or
pleasure in doing things for 2 weeks
straight
 Sexually Transmitted Diseases
 Prostate Cancer Screening: Talk to a doctor
about the possible benefits and harms of
prostate cancer screening if you are
considering having a prostate-specific
antigen (PSA) test or digital rectal
examination (DRE)
Women's Health Check-up
List
 Mammograms: every 1 to 2 years starting at
age 40. optional 40-49, yearly 50-75
 Pap Smears: Have a Pap smear every 1 to 3
years if you have been sexually active or are
older than 21. Maximum interval every 3 yrs
after 3 consecutive normal exams, yearly
until 75, >75 optional
 Cholesterol checks: Have your cholesterol
checked at least every 5 years, starting at
age 35. If smoking, have diabetes, or if heart
disease runs in the family, start having
cholesterol check at age 20.
Women's Health Check-up
List
Blood Pressure: checked at least
every 2 years or more often. Some
racial and ethnic groups have a
higher risk and should discuss the
issue with their HCP
Colorectal Cancer Tests: Begin regular
screening for colorectal cancer
starting at age 50
Diabetes Tests: if (+)high blood
pressure or high cholesterol
Women's Health Check-up
List

 Depression: feeling "down," sad, or
hopeless, and have little interest or
pleasure in doing things for 2 weeks
straight
 Osteoporosis Tests: bone density test at
age 65 to screen for osteoporosis. If
between the ages of 60 and 64 and weigh
154 lbs. or less, talk to HCP
 Chlamydia Tests and Tests for Other
Sexually Transmitted Diseases
THE  WELLNESS  GUIDE 
TO 
PREVENTIVE  CARE
 Screening tests for
early detection of
disease
 Education/Counseling
about healthy habits
and injury prevention
 Immunizations
 Chemoprophylaxis
H. Influenza vaccine every year
starting at age 50
Tetanus-diphtheria, 3-dose-series
for previously unvaccinated,
booster dose every 10 years
Pneumococcal vaccine once at
age 65 (earlier if (+) for certain
health problems, such as lung
disease)
Hepatitis A & B shots
Varicella vaccine for all adults
without prior infection
BCG
DPT
OPV
Measles
MMR
Hepatitis B
Varicella
Tetanus-diphtheria
boosters(Td)-11-16 yrs
Rubella (females > 12 yrs)
THE  WELLNESS  GUIDE 
TO 
PREVENTIVE  CARE
 Screening tests for
early detection of
disease
 Education/Counseling
about healthy habits
and injury prevention
 Immunizations
 Chemoprophylaxis
 Aspirin
 older than 40 or younger than 40 who have high
blood pressure, high cholesterol, diabetes, or if
smoking
 Hormonal Replacement Therapy
 risks of taking the combined hormones
estrogen and progestin after menopause to
prevent long-term illnesses outweigh the
benefits
 Iron in pregnant women helps both the mother and
baby's blood carry oxygen
 Folic acid-women of child bearing age- 400
micrograms (or 0.4 mg) every day could prevent up
to 70 percent of neural tube defects
Calcium
Guidelines from the National Academy of Sciences says that
the Adequate Intakes (AIs), in milligrams (mg), each day for
calcium are:
 Infants 0-6 mo - 210 mg
7-12 mo - 270 mg
 Children 1-3 yrs - 500 mg
4-8 yrs - 800 mg
9-13 yrs - 1,300 mg
4-18 yrs - 1,300 mg
 Adults 19-50 yrs - 1,000 mg
Over 51 yrs - 1,200 mg
 During Pregnancy & Lactation
Under 18 yrs - 1,300 mg
19 yrs and older - 1,000 mg
Calcium and Vitamin D

A serving of milk or yogurt
contains around 300 mg calcium
Vitamin D is needed to help the
body absorb calcium correctly