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Biomedical subjects

A A Alonzo

Publications and source records attributed to A A Alonzo.

At least 19 recordsLinked to original sources
PubMed2000

The experience of chronic illness and post-traumatic stress disorder: the consequences of cumulative adversity.

In this paper the experiences of the chronically ill are examined to explore the impact of post-traumatic stress disorder (PTSD), accumulated burden of adversity and trauma spectrum disorder on subsequent illness and coping behaviors. Individuals experiencing chronic diseases have been studied with regard to depression, anxiety and a variety of coping maladaptions, but negligible attention has been given to the PTSD potential of chronic disease over the life course. Yet, growing evidence suggests that the traumatogenic potential of chronic diseases, some sudden and unexpected onsets, and the traumatogenic changes in life circumstance, may produce maladaptive illness coping over the life course. More importantly, attention needs to focus on the additive effect of co-morbid life events and the traumatic potential of invasive medical therapies. Consideration of PTSD and a continuum of cumulative adversity provide a more complex and fully drawn understanding of the circumstances surrounding chronic illness coping and reasons for maladaptive coping following invasive therapies and changes in the disease trajectory. The pathophysiology that produces a chronic diseases does not begin at symptom onset, and the psychosocial strategies to cope with a chronic illness, whether efficacious or maladaptive, also do not begin at symptom onset, but develops over the life course.

Adaptation, Psychological↗
PubMed1999

Acute myocardial infarction and posttraumatic stress disorder: the consequences of cumulative adversity.

This article examines the experiences of acute myocardial infarction (AMI) patients who are at high risk for reinfarction or sudden death to determine the impact of posttraumatic stress disorder (PTSD), accumulated burden of adversity, and trauma spectrum disorder on subsequent AMI care-seeking. Individuals experiencing an AMI have been studied with regard to depression and anxiety disorders, but negligible attention has been given to the PTSD potential of the total cardiovascular disease experience. Yet, growing evidence suggests the traumatogenic potential of AMI, with its sudden and unexpected onset, dramatic changes in life circumstance, and the additive effect of comorbid life events, is significant in producing impaired and extended coping during subsequent ischemic events. Consideration of PTSD and a continuum of cumulative adversity provides a more complex and fully drawn understanding of the circumstances surrounding AMI coping and reasons for delayed access to thrombolysis.

Adaptation, Psychological↗
PubMed1998

HIV informal caregiving: emergent conflict and growth.

Findings are reported from a prospective study of 20 persons on the experience of providing informal care to partners or family members with HIV syndrome. In-depth, focused interviews were completed. Data were initially coded using an inductive technique and thematically analyzed. The informal care providers were found to engage in a variety of interacting, and often conflicting, psychosocial and instrumental processes that occurred over three emergent phases: (a) transitions to care, (b) living the burden, and (c) facing the void. Although the care providers struggled with various sources of uncertainty and distress, when periods of equanimity were realized, they experienced a heightened sense of coherence and personal growth.

Adaptation, Psychological↗
PubMed1998

The structure of emotions during acute myocardial infarction: a model of coping.

The present state of medical care for heart attacks, or acute myocardial infarction (AMI), clearly indicates that rapidly and expeditiously seeking definitive medical care will reduce morbidity and prevent mortality. Despite the clearly established advantages of rapid AMI treatment, the time from the onset of acute symptoms of AMI to definitive medical care is often prolonged and individuals with a prior history of AMI and/or coronary artery disease (CAD) extend care-seeking. Behaviors and actions surrounding acute care-seeking are often fraught with complex social, psychological and emotional processes. The purpose of the present paper is to bring together a theoretical and an applied understanding of the interval of time from acute symptom onset to definitive medical care during AMI; and to understand the role of emotions in the care-seeking process. This task is especially important among individuals with a prior history of AMI and/or CHD. These individuals can be seen as experiencing a "spectrum of posttraumatic disturbances", ranging from anxiety to posttraumatic stress disorder and alexithymia. These disturbances contribute to extended care-seeking thereby placing the individuals at greater risk for AMI and sudden cardiac death. Effective intervention requires three elements. First, knowledge is necessary so that individual and lay others can correctly label symptoms and signs of an AMI. Second, it is necessary to provide feasible behaviors that individuals and lay others can use to access definitive medical care. Third, and perhaps most importantly, it is necessary to provide understanding of and skills to cope with the emotional arousal surrounding both the primary traumatic experience of symptoms and signs, potential secondary traumatic consequences of AMI care-seeking and tertiary trauma from the long-term consequences of CHD.

Adaptation, Psychological↗
PubMed1997

The physician's role in minimizing prehospital delay in patients at high risk for acute myocardial infarction: recommendations from the National Heart Attack Alert Program. Working Group on Educational Strategies To Prevent Prehospital Delay in Patients at High Risk for Acute Myocardial Infarction.

Physicians and other health care professionals play an important role in reducing the delay to treatment in patients who have an evolving acute myocardial infarction. A multidisciplinary working group has been convened by the National Heart Attack Alert Program (which is coordinated by the National Heart, Lung, and Blood Institute of the National Institutes of Health) to address this concern. The working group's recommendations target specific groups of patients: those who are known to have coronary heart disease, atherosclerotic disease of the aorta or peripheral arteries, or cerebrovascular disease. The risk for acute myocardial infarction or death in such patients is five to seven times greater than that in the general population. The working group recommends that these high-risk patients be clearly informed about symptoms that they might have during a coronary occlusion, steps that they should take, the importance of contacting emergency medical services, the need to report to an appropriate facility quickly, treatment options that are available if they present early, and rewards of early treatment in terms of improved quality of life. These instructions should be reviewed frequently and reinforced with appropriate written material, and patients should be encouraged to have a plan and to rehearse it periodically. Because of the important role of the bystander in increasing or decreasing delay to treatment, family members and significant others should be included in all instruction. Finally, physicians' offices and clinics should devise systems to quickly assess patients who telephone or present with symptoms of a possible acute myocardial infarction.

Algorithms↗
PubMed1995

Causes of delay in seeking treatment for heart attack symptoms.

With the advent of thrombolytic therapy and other coronary reperfusion strategies, rapid identification and treatment of acute myocardial infarction greatly reduces mortality. Unfortunately, many patients delay seeking medical care and miss the benefits afforded by recent advances in treatment. Studies have shown that the median time from onset of symptoms to seeking care ranges from 2 to 61/2 hours, while optimal benefit is derived during the first hour from symptom onset. The phenomenon of delay by AMI patients and those around them needs to be understood prior to the design of education and counseling strategies to reduce delay. In this article the literature is reviewed and variables that increase patient delay are identified. A theoretical model based on the health belief model, a self regulation model of illness cognition, and interactionist role theory is proposed to explain the response of an individual to the signs and symptoms of acute myocardial infarction. Finally, recommendations are made for future research.

Attitude to Health↗
PubMed1995

Stigma, HIV and AIDS: an exploration and elaboration of a stigma trajectory.

Stigma is a social construction which dramatically affects the life experiences of the individuals infected with the human immunodeficiency virus (HIV) and their partners, family and friends. While it has been generally recognized that the nature of stigma varies across illnesses, it has usually not been considered as changing and emerging over the course of a single illness. In this paper, HIV/AIDS is analyzed in terms of a stigma trajectory. The primary purpose is to conceptualize how individuals with HIV/AIDS experience stigma and to demonstrate how these experiences are affected by changes in the biophysical dimensions of HIV/AIDS. Four phases of the HIV/AIDS stigma trajectory are depicted: (1) at risk: pre-stigma and the worried well; (2) diagnosis: confronting an altered identity; (3) latent: living between illness and health; and (4) manifest: passage to social and physical death. The essential processes through which individuals personalize the illness, dilemmas encountered in interpersonal relations, strategies that are used to avoid or minimize HIV-related stigma, and subcultural networks and ideologies that are drawn upon to construct, avow, and adapt to an HIV identity are considered across the stigma trajectory.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Health behavior: issues, contradictions and dilemmas.

American medicine faces many contradictions and dilemmas. This is especially the case with regard to preventive health behavior. This paper explores the effects of several issues, contradictions and dilemmas on the American experience with primary preventive health behavior. These issues include: individualism, victim blaming, therapeutic nihilism, the over abundance of health information, America as a culture of risk takers, and the dilemma of the jungle vs the zoo. Four types of health behavior are defined. The first type of health behavior is the primary prevention of disease, defect, injury or disability. The second type is detection of asymptomatic disease, injury and defect. Third, is the promotion of enhanced levels of health, wellness and quality of life. And the fourth, at a more societal level, protective behaviors to make environmental transactions safe from disease, injury, defect and disability. These four types of health behavior are each explored in relation to societal values, technology and economics to determine which of these facilitate or impede health behavior at both the individual and societal levels.

Choice Behavior↗
PubMed1986

The impact of the family and lay others on care-seeking during life-threatening episodes of suspected coronary artery disease.

To understand the impact of the family on care-seeking during a suspected episode of acute coronary artery disease (CAD) interviews were conducted with 1102 individuals hospitalized for a suspected myocardial infarction. Analyzing the care-seeking behavior of these individuals within life threatening illness behavior and situational perspectives, bivariate and multivariate analyses revealed that family members, especially a spouse, had both positive and negative influences on the duration of time between acute symptom onset and arrival at a hospital emergency room. To reduce both the morbid and mortal consequences of acute CAD it is recommended that we direct our intervention efforts toward warning the public of situational circumstances which contribute to extended self treatment and evaluation during acute episodes of CAD.

Acute Disease↗
PubMed1985

An analytic typology of disclaimers, excuses and justifications surrounding illness: a situational approach to health and illness.

An analytic typology of disclaimers, excuses and justifications is developed to demonstrate how illness is possible within our everyday social situations. Beginning with the concepts of the 'disclaimer' from Hewitt and Stokes, and the 'excuse' and 'justification' from Scott and Lyman, these concepts are extended and reconceptualized to apply to circumstances where signs and symptoms of illness compromise and disrupt role performance and situational participation. Using a situational perspective on health and illness, the presentation of a disclaimer, excuse or justification is seen as a means of allowing the symptomatic individual to 'drift' in and out of illness while protecting his and others' social identity, the integrity of the social situation and the individual's health status.

Attitude to Health↗
PubMed1985

Health as situational adaption: a social psychological perspective.

A model to encompass the complex relationship between the individual and his social, physical and cultural environments and to provide strategies for intervention has not yet been developed. While professionals acknowledge the importance of an ecological and holistic conception of man-environment interaction, various biases and ideologies prevent them from adequately taking this interaction into account. To overcome this inadequacy this paper explores a relational conception of health, the central importance of the socially defined situation for health and adaption, the limits of medicine and holism in intervening in problems of adaption and suggests a situational approach to the study of health and adaption. By stressing the socially defined situation and the social psychological actor it may be possible to sensitize the actor to socially situated man-environment transactions, to preserve the actor's confidence in his own health, to encourage individual responsibility for maintaining health and to promote an awareness of signs and symptoms that require medical attention. Within a larger framework, however, it is not effective to intervene in the individual's social situations if we do not also attempt to alter the macro economic, political, cultural and structural elements in society which encourage, produce and support unhealthy environmental conditions.

Adaptation, Psychological↗
PubMed1984

An illness behavior paradigm: a conceptual exploration of a situational-adaptation perspective.

A situational-adaption perspective is developed as a basis of an analytic illness behavior paradigm. The situational-adaption perspective is derived from the ideas of Dubos wherein health is viewed as adaption and the interactionist conception of the defined social situation. The situational-adaption perspective is then applied to symptomatic episodes where signs and symptoms are contained in everyday situations without direct medical consultation, everyday illness behavior; to illness experiences where coping necessitates medical consultation, acute illness behavior; to chronic diseases where adjustment and long-term care are necessary, chronic illness behavior; and to emergent life threatening illness episodes which require definitive medical care, life threatening illness behavior. For each of these illness behavior types a primary process, role behavior and patient-practitioner relations are specified.

Acute Disease↗
PubMed1980

The mobile coronary care unit and the decision to seek medical care during acute episodes of coronary artery disease.

The mobile coronary care unit (MCCU) as a means of reducing coronary artery disease (CAD) morbidity and mortality cannot be realized unless patients, lay others, and medical personnel use it. The initial medical care decision of 1,102 patients who experienced acute cardiac symptomatology was studied to determine factors contributing to expedient care-seeking and the decision to use emergency medical services (EMS), direct emergency room services, or physician consultation. An expedient decision to utilize the EMS, the only means of obtaining the MCCU, occurred when symptoms began suddenly and were incapacitating, lay others advised the EMS, and patients relinquished and lay others usurped control of care-seeking process. To increase MCCU utilization and effectiveness, it is suggested that public education about CAD be refined and the teaching of cardiopulmonary resuscitation expanded, physicians be encouraged to educate patients realistically as to CAD prognosis, and a cardiac crisis center be instituted that incorporates a registery for patients at high risk of myocardial infarction or sudden cardiac death.

Adult↗
PubMed1977

The impact of physician consultation on care-seeking during acute episodes of coronary heart disease.

The care-seeking behavior of 262 patients who experienced acute episodes of coronary heart disease (CHD) was analyzed to determine: the incidence and duration of physician consultation; the proportion of total time from acute symptom onset to hospital arrival consumed by medical evaluation; and the impact of medical evaluation on mode and duration of travel to the hospital and the duration of medical evaluation and administrative procedures in the hospital emergency room. The results of this analysis suggest that physicians and ancillary medical personnel and the patient and lay others are about equally responsible for "delay" in obtaining definitive medical care. Extended medical evaluation was likely to occur when a patient's physician was an internist-cardiologist and the patient was young or without CHD, and a patient had numerous pre-existent chronic diseases. If effective techniques to bring patients under definitive medical care during the first critical hour of acute coronary episodes are to be developed, both lay and medical behavior should receive research attention.

Acute Disease↗
PubMed1975

Prodromata of myocardial infarction and sudden death.

A sample of 160 hospitalized, acute myocardial infarction patients and 138 individuals who died prior to hospitalization from acute coronary heart disease were studied to determine the incidence and duration of prodromal symptoms and action taken to cope with the symptoms. Seventy percent of the in-hospital subsample (IHS) and 64% of the out-hospital subsample (OHS) reported prodromata. The OHS reported a significantly longer median duration of symptoms than the IHS (29 versus 10.5 days). Sixty-seven percent of the IHS reported new or accelerated anginal symptoms as the most frequently occurring symptom, in contrast to 35% for the OHS. Twenty-seven percent of the IHS and 36% of the OHS consulted a physician about symptoms. Individuals in both subgroups, especially chronically diseased patients, considered their symptoms manageable. Likewise, when contacted, their physicians may have viewed these symptoms as manageable. Patients with a high risk of myocardial infarction and sudden death were significantly more likely to have consulted physicians during the prodromal phase than low-risk patients. A clearly delineated prodromal syndrome is needed so that both lay and medical communities can effectively respond to and intervene during the prodromal phase of acute myocardial infarction and sudden cardiac death.

Acute Disease↗