NUR 220 Chapter 4, 5, 6, 7 Quiz
Questions and Correct Answers
The determinants of health ✅The complex interactions between biological and social
elements, and their influence on health, are called
The Ecological Framework ✅Determinants of health
- Biological
- Social
- Cultural
- Environmental
Represent a departure from past nature-nurture dichotomies
Genes and environment are intricately linked
(none of these things is more important than the other)
The model can be visualized starting with the individual level in the center,
interpersonal/social level, the institutional environmental level, the community cultural
level, and finally the public policy level. These systems interact with and influence each
other.
Determinants of health ✅Biological- strikes against us because of our ancestors. But
good to have the knowledge and ability to prevent things from getting worse
Social
Cultural- if people have a certain belief, it can affect everyone else
Environmental- where do they live? In a food desert? Hard in rural communities
The Stress-Diathesis Model ✅- Examines how social circumstances and individual
responses to stressful events affect health at the:
--Cellular level
--Physiological level
-One's current health status reflects physiological responses to past experiences
-Diseases linked to stress include depression, ulcers, colitis, heart disease, and adult-
onset diabetes
Genetic Determinants of Health ✅- The search for genetic causes to health conditions
has moved beyond the traditional model of Mendelian patterns of inheritance
- Many common diseases that account for most of the morbidity and mortality in our
society do not fit Mendelian patterns of inheritance; they are caused by both hereditary
and nonhereditary factors
Gene Regulation and Mutations ✅- Gene regulation turns genes "on" or "off"—critical
to maintaining life
- Mutations can change gene regulation
,- Mutations can be harmless or can cause disease
Gene-Environment Interaction ✅- Development, including our health, is a co-action of
genes and the environment
- Gene-environment interaction can even be noted at the cellular level
- Can also be illustrated through risk behaviors such as smoking, unhealthy diets, and
physical inactivity
Epigenetics Mechanisms ✅"Epigenetics" refers to inheritance that is not explained by
changes in the DNA
Highly influenced by the internal and external cellular environment
Three main mechanisms:
- DNA methylation (when present, turns genes off. No present, turns genes on)
- Histone modification (remain fairly constant)
- Non-coding rnas (Transcriptions that cannot be translated into functional proteins are
called noncoding rnas. Noncoding rnas serve as epigenetic modifiers and regulate
genes)
(epigenetics: changes in organisms caused by modification of gene expression rather
than alteration of the genetic code itself)
Epigenetics Mechanisms (2nd slide) ✅- Response to stress is a highly focused area in
the field of epigenetics
- There is evidence of maternal "programming" of gene expression in their reared
offspring (The physiological and observable changes associated with the stress
response can even be passed down to the next generation without any mutations or
changes in gene patterns)
- Environmental influences change early development, determine a person's behavioral
phenotype, shape the risk of disease later in life, and create changes that can be
transmitted across generations
Pharmacogenomics ✅the study of how genetic inheritance affects the body's response
to drugs
- Pharmacogenomics is the study of inherited and genomic differences in drug
metabolism and response
- 20% to 95% of drug variability is a product of genetics
- A goal of pharmacogenomics is to use biomarkers to identify drugs that have the most
predictable and positive outcomes with the least adverse effects for a given individual
Ethical and Legal Considerations ✅- Impossible to de-identify genetic information
obtained from research specimens
, - Vital to protect patient privacy and spend sufficient time obtaining informed consent for
genetic and epigenetic research
- Vulnerable computerized and electronic health records contain genetic and epigenetic
data that cannot be de-identified and can be hacked
(De-identification is the process used to prevent someone's personal identity from being
revealed)
The Nurse's Role (in genetics) ✅- Nurses need to be educated about genetics and
understand genetic influences on disease in order to:
-- Convey genetic information and disease risks to patients
-- Effectively participate in disease management
-- Assess patients for familial patterns of disease
-- Ensure privacy of confidential information and obtain adequate informed consent
Social Determinants of Health ✅WHO definition:
- The circumstances in which people are born, grow up, live, work and age, as well as
the systems put in place to deal with illness
- These circumstances are in turn shaped by a wider set of forces: economics, social
policies, and politics
Health promotion strategies can result in meaningful interventions
The Social Gradient of Health ✅- Evidence has shown that mortality increases with
decreasing socioeconomic position
- Not just between low and high socioeconomic positions, but within those levels
- A suggested factor is difference in social status
- The assumption is that there is less stress as one goes up the social gradient
- Clinicians have argued that it is important to perform a social history screening and
follow up with referrals
Cultural Perspectives ✅- Understanding cultural diversity and the complex nature of
culture is the cornerstone of health promotion
- Culture is linked to perceptions about health
- Leininger's theory of culture care diversity and universality gives a framework to
understand cultural dimensions
Cultural and Social Gradient ✅In addition to cultural values of individuals and social
groups, the nurse needs to consider:
- Demographic factors such as income and education
- How these factors interact with other influences in the ecological environment to
contribute to the determinants of health
Questions and Correct Answers
The determinants of health ✅The complex interactions between biological and social
elements, and their influence on health, are called
The Ecological Framework ✅Determinants of health
- Biological
- Social
- Cultural
- Environmental
Represent a departure from past nature-nurture dichotomies
Genes and environment are intricately linked
(none of these things is more important than the other)
The model can be visualized starting with the individual level in the center,
interpersonal/social level, the institutional environmental level, the community cultural
level, and finally the public policy level. These systems interact with and influence each
other.
Determinants of health ✅Biological- strikes against us because of our ancestors. But
good to have the knowledge and ability to prevent things from getting worse
Social
Cultural- if people have a certain belief, it can affect everyone else
Environmental- where do they live? In a food desert? Hard in rural communities
The Stress-Diathesis Model ✅- Examines how social circumstances and individual
responses to stressful events affect health at the:
--Cellular level
--Physiological level
-One's current health status reflects physiological responses to past experiences
-Diseases linked to stress include depression, ulcers, colitis, heart disease, and adult-
onset diabetes
Genetic Determinants of Health ✅- The search for genetic causes to health conditions
has moved beyond the traditional model of Mendelian patterns of inheritance
- Many common diseases that account for most of the morbidity and mortality in our
society do not fit Mendelian patterns of inheritance; they are caused by both hereditary
and nonhereditary factors
Gene Regulation and Mutations ✅- Gene regulation turns genes "on" or "off"—critical
to maintaining life
- Mutations can change gene regulation
,- Mutations can be harmless or can cause disease
Gene-Environment Interaction ✅- Development, including our health, is a co-action of
genes and the environment
- Gene-environment interaction can even be noted at the cellular level
- Can also be illustrated through risk behaviors such as smoking, unhealthy diets, and
physical inactivity
Epigenetics Mechanisms ✅"Epigenetics" refers to inheritance that is not explained by
changes in the DNA
Highly influenced by the internal and external cellular environment
Three main mechanisms:
- DNA methylation (when present, turns genes off. No present, turns genes on)
- Histone modification (remain fairly constant)
- Non-coding rnas (Transcriptions that cannot be translated into functional proteins are
called noncoding rnas. Noncoding rnas serve as epigenetic modifiers and regulate
genes)
(epigenetics: changes in organisms caused by modification of gene expression rather
than alteration of the genetic code itself)
Epigenetics Mechanisms (2nd slide) ✅- Response to stress is a highly focused area in
the field of epigenetics
- There is evidence of maternal "programming" of gene expression in their reared
offspring (The physiological and observable changes associated with the stress
response can even be passed down to the next generation without any mutations or
changes in gene patterns)
- Environmental influences change early development, determine a person's behavioral
phenotype, shape the risk of disease later in life, and create changes that can be
transmitted across generations
Pharmacogenomics ✅the study of how genetic inheritance affects the body's response
to drugs
- Pharmacogenomics is the study of inherited and genomic differences in drug
metabolism and response
- 20% to 95% of drug variability is a product of genetics
- A goal of pharmacogenomics is to use biomarkers to identify drugs that have the most
predictable and positive outcomes with the least adverse effects for a given individual
Ethical and Legal Considerations ✅- Impossible to de-identify genetic information
obtained from research specimens
, - Vital to protect patient privacy and spend sufficient time obtaining informed consent for
genetic and epigenetic research
- Vulnerable computerized and electronic health records contain genetic and epigenetic
data that cannot be de-identified and can be hacked
(De-identification is the process used to prevent someone's personal identity from being
revealed)
The Nurse's Role (in genetics) ✅- Nurses need to be educated about genetics and
understand genetic influences on disease in order to:
-- Convey genetic information and disease risks to patients
-- Effectively participate in disease management
-- Assess patients for familial patterns of disease
-- Ensure privacy of confidential information and obtain adequate informed consent
Social Determinants of Health ✅WHO definition:
- The circumstances in which people are born, grow up, live, work and age, as well as
the systems put in place to deal with illness
- These circumstances are in turn shaped by a wider set of forces: economics, social
policies, and politics
Health promotion strategies can result in meaningful interventions
The Social Gradient of Health ✅- Evidence has shown that mortality increases with
decreasing socioeconomic position
- Not just between low and high socioeconomic positions, but within those levels
- A suggested factor is difference in social status
- The assumption is that there is less stress as one goes up the social gradient
- Clinicians have argued that it is important to perform a social history screening and
follow up with referrals
Cultural Perspectives ✅- Understanding cultural diversity and the complex nature of
culture is the cornerstone of health promotion
- Culture is linked to perceptions about health
- Leininger's theory of culture care diversity and universality gives a framework to
understand cultural dimensions
Cultural and Social Gradient ✅In addition to cultural values of individuals and social
groups, the nurse needs to consider:
- Demographic factors such as income and education
- How these factors interact with other influences in the ecological environment to
contribute to the determinants of health
