- Alejandra Medinilla
The aim of this work is to cover the whole process of disease diagnoses. In medicine, exist different ways to classify diseases as well as different test and procedures to diagnose them. The world health organization (WHO) plays a very important role here; since they created normalized classifications of diseases and disabilities, with specific codes to describe each of them with the purpose of simplify and standardize the process of diagnose 1.2. We are going to review the two most important models of health, used in medicine to explain illness. They help to predict and identify risks and consequences, make decisions and reduce the possibility of occurrence of an illness.
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Diseases can be classified in different ways, depending on the criteria taken into account; duration, distribution, pathology and aetiology are some examples. They are important in the compilation of statistics on causes of illness (morbidity) and causes of death (mortality).
The most used classifications divided illnesses depending on the organs affected, nature and causes of the disease, risk of contagious and communicable and the occurrence and frequency of it. According to the British encyclopedia these classifications are: 1) topographic, (2) anatomic (3) physiological, (4) pathological (5) etiologic (6) juristic, (7) epidemiological and (8) statistical. (Stanley L. Robbins, Jonathan H. Robbins, Dante G. Scarpelli. 2013. Classifications of diseases [online]. Available at: http://www.britannica.com/EBchecked/topic/275628/human-disease/63272/Classifications-of-diseases)
The WHO has a very important role in classifying disease. They develop the WHO Family of International Classifications (WHO-FIC), with the ICD and ICF as core classifications.
They are call the Normalized Classifications and are based on professional and scientific criteria.
The International Classification of Diseases (ICD) is a classification that uses different codes to differentiate symptoms, signs and illnesses. This classification allowed a global standardization making easier the diagnostic process. Each illness is classifying trough a code of 5 characters.
The last version is the 10th, ICD-10, created in 1992. The 11th revision is running until 2015.
The other classification created by the WHO is the ICF, which complements the ICD. This classification has two parts. One refers to functionality and disability and the other to conceptual factors.
Both classify of the different states of illness/health within a standardize framework, with specific codes.
On the other hand, more generally speaking, in 1997 was created the “triangle of health”. It classifies health, into social, mental or physical making emphasis on the importance of the three states together.
We can define as Physical Health, to the body health; it refers to optimal weigh, vision, a healthy skin, and bones, tissues and organs, a good dental condition and a good neuro-muscular coordination. A person with physical health must able to do all his routine workwithout any difficulty. To evaluate the physical health of a person we can focus in different areas like life style (drug abuse, alcohol and tabaco habits, regular exercise, medical checkups), human biology (genetic and body chemistry), environment (the air we breathe and where we live) and medical services ( to prevent, detect and treat diseases).
Mental Health – refers to the state of mind. It is the capability that a person has to manage stress and tension of daily life and keep a good attitude. Personal relationships with family and friends are a key aspect when trying to evaluate a person’s mental health. Mental health is essential requirement to make judgments, to possess discretion and to face and overcome the problems.
The World Health Organization describes Mental Health as the “state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community”. (WHO. December 2013. Mental health: a state of well-being [online]. Available at: http://www.who.int/features/factfiles/mental_health/en/)
And last, Social Health – which is the ability to function in society. It is in the ability to build positive and constructive relationships with peers. The social network of a person is a crucial indicator. Having no friends could lead to depression being more prone to manifest physical problems. In contrast, a person with strong relationships will feel more supported and accompanied.
As a resume, a person could have a very good physical health, making exercises every day, eating healthy food and doing regular checkups with the doctor, but, if the person moves away from friends and social events to maintain this condition, this means luck of social health and could lead him to mental health problems in the future.
In the process of diagnoses and establishing health and disease it is important to have knowledge and understanding of the Health research methods.
Health research has been defined as “the process for obtaining systematic knowledge and technology which can be used for the improvement of the health of individual groups.” (Davies 1991, cited in A. Bowling 2002, p.3)
Health research methods are used to obtain the necessary information to develop new tools and procedures that help to protect people from diseases or recover from them.
Classifications of research methods are based on different criteria. Dankhe classification (1989) proposed 4 types of research studies: exploratory, descriptive, correlational and explanatory.
In general depending on the role of the researcher we can have observational or experimental methods; according to the time when the data is collected or measured, prospective or retrospective; according to the number of occasions on which the variable is measured in the study, transversal or longitudinal and according to the number of variables under study, descriptive or analytic.
Experimental studies are prospective studies; they evaluate the effect of one or more interventions. Frequently used in the assessment of therapeutic drugs and therapeutic interventions, being really careful with the ethic limits. They can be applied to the investigation of preventive measures of the disease, seeking to reduce individual risk. An example is the study that evaluates the effectiveness of a vaccine. On the other hand observational studies are those in which the patient is not assigned to an specific treatment or intervention, the evaluation is carried out according to a standard clinical practice, being therefore the researcher an observer of what is happening or has happened.
Research involves a combination between the different types of research. Research methods are used in conjunction.
As the WHO suggest “another way of classifying health research… is to describe it under three operational interlinked categories of biomedical, health services and behavioral research, the so-called health research triangle” (WHO. 2001. Health research methodology. Chapter 1, p. 3)
Multi-dimensional approaches are available for evaluating outcomes research. In evaluating research outcomes it is important to measure effectiveness, acceptability and humanity, equity and accessibility and efficiency.
The evaluation of the data is made using the scientific method, and the collection of research data. Evaluation can be divided into two types: formative and summative.
Formative evaluation is carried out during the investigation process. It aims to improve the methodology concentrating on the strengths and weaknesses.
On the other hand, Summative evaluation takes place at the end of the process. It determines achievement and other outcomes, to evaluate the continuity or not of the process or program.
There are different ways to disseminate the results of a research. As a general rule it is better to plan at the beginning of the research which is going to be the dissemination strategies. It should be consider the goals and objectives of the dissemination, as well as the impact, the Audience, the Medium to best reach each the audience and the execution process.
Ones we have the results of an investigation we need to concentrate in how they are going to be disclosed. The options are diverse, depending on the public we want to focus on.
The most common and generally used is the publication of texts, could as scientific papers, in specialize magazines, newspapers or posters, leaflets and advertising for a more general public.
In the field of health exist different Principles of Health modeling. Models are a simplification of reality. They help to predict, identify risks and consequences, make decisions and reduce the burden of illness.
We can mention 2 important models, the Biomedical and the Biopsychosocial models. Both are theories that explain illness from different perspectives.
The biomedical model assumes that disease is a deviation from normal biological functioning and biological mechanisms are sufficient to explain disease, excluding psychological and social processes. It is a reductionist and single-factor model; it reduces illness to low-level processes, such as disordered cells and chemical imbalances, and explains illness in terms of a biological malfunction.
We can say that the Body was treated as a machine; Physical disease is measured by the absence of health. It is the one used to develop the classification of diseases.
On the other hand, the Holistic or biopsychosocial model includes biological, psychological, and social factors as important determinants of health and illness.
It maintains that health and illness are caused by multiple factors and produce multiple effects. So it is a multicausal model. Mind and body cannot be distinguished in matters of health and illness because both influence the state of health.
The perception of wellbeing is influence by different factors. There are psychological and social factors that influence the development of illness, and these are ignored by the biomedical model since it take into account just the physical aspects of the problem.
It is important to mention the difference between Diseases and Illnesses. A disease is a pathological condition of the body in response to disruption of homeostasis. It is a result of pathogens, trauma, physical and chemical agents, genetics (inheritance), metabolic or nutritional disorders, while an Illness is the condition of a person experiencing disease.
In order to establish people’s health we need to follow different procedures and make various tests to be able to give diagnoses. Before we can proceed with a specific test or group of tests we need to look the Signs and symptoms the patient presents.
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Signs can be define as any indication of a medical condition that can be objectively observed and normally they have no meaning to the patient or they not even notice them. Signs can be detected during a physical examination. Elevated blood pressure is an example. 2.2
Symptoms on the other hand are recognized, experienced and referred by the patients. The patient feels something anomalous in his body. Examples of symptoms can be, feeling tired, low mood and energy, anxiety, nausea, dizziness, and drowsiness. Symptoms become key elements when any health professional want to make a diagnosis to a patient and give him treatment.
As examples to clarify we can mention three examples. In the case of a headache, the patient is the only one capable to notice it so, it is a symptom; if we talk about blood pressure, this could only be a signs, since it needs to be measured by a doctor in a laboratory; and the one that could be both, a sign and a symptom is a rush.
Ones we have observe and checked the signs and symptoms we are able to proceed with the correspondent diagnostic process.
The diagnostic process includes all types of measurements and tests that are used to evaluate a patient’s condition, such as physiological measurements, laboratory tests and pathology tests, imaging tests and endoscopies. 2.1
Each form of diagnosis involves specific procedures and tests that we can summarize as:
Laboratory tests: blood test, urine, and/or other body fluids. They are used to evaluate what is going on in the body and also in specific cases like cancer treatment, to evaluate the side effects like anaemia and neutropenia (low white blood cell count), which can increase the risk of infection. 2.1
Endoscopic tests: is a procedure performed with an endoscope (a flexible and very thin tube with a camera) to examine the inside of the body. The endoscope model varies depending on the part of the body that is going to be examined.
Biopsy: is the removal of tissue, a very small amount to be examined under a microscope. There are different types of biopsies: Fine needle aspiration biopsy, Core needle biopsy, Vacuum-assisted biopsy, Image-guided biopsy and surgical biopsy. 2.1
In practice, Multiple Tests are used. Choices depend on cost, invasiveness, volume of test, presence and capability of lab infrastructure, urgency, etc.
As an example, to diagnose cancer the most common types of tests used are biopsy, imaging tests, endoscopic tests and laboratory tests.
It is important to know that a disease could be developed in a normal or an abnormal way. That is the field of etiology, which in medicine refers to the factors coming together to cause a disease.
As mention previously, a disease can have a normal or an abnormal aetiology. To clarify this concept we can observe the development of Diabetes. In general it could be describe as a chronic disease that occurs when the body loses the ability to produce enough insulin or use it effectively.
We can divide this disease in 2 main groups. The first one includes the types of diabetes with normal aetiology and the second one with abnormal aetiology.
In the 1st group (normal aetiology), the common forms of diabetes are Type 1 diabetes (T1D, known as insulin-dependent diabetes or IDDM) and Type 2 diabetes.
In Type 1, the pancreatic cells produce little or no insulin. Its causes are not precisely known but are believed to be an autoimmune reaction. It can occur at any age, but usually occurs before the age of 30.
Type 2 diabetes (T2D), known as non-insulin-dependent diabetes (NIDDM) usually develops slowly over time. Most people with this disease are overweight at the time of diagnosis. The increment of body fat makes it difficult for the body to use insulin the right way. It can also occur in thin people and are more common in the elderly. It is the most common form of diabetes. 2.3
The 2nd group involves the types of diabetes with abnormal aetiology. In general these types present a gene mutation and some grade of inheritance. We can mention MODY (Maturity onset diabetes of the young) and GDM (Gestational diabetes).
(MODY) is a rare form of diabetes that runs strongly in families. It is caused by an inherited genetic defect, an autosomal inheritance (3 generations of the same family affected) of the insulin-producing cells. After the Type 1 diabetes it is the most frequency type within infants.
GDM is first developed during pregnancy, usually appears in mid-pregnancy. The body cannot produce or use enough insulin. It is of very high risk for the pregnancy, so it needs to be controlled. Gestational diabetes can be controlled with a healthy diet and regular exercise, but sometimes the mother will also need insulin. Normally it disappears after delivery, but the mother has more risks of developing diabetes type 2 in the future.
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