Table of contents :

  • health : a state of optimal physical, mental, and social well-being, and not merely the absence of disease and infirmity.
  • sanity : soundness, especially soundness of mind.
  • disease / illness / sickness / maladie : any deviation from or interruption of the normal structure or function of a part, organ, or system of the body as manifested by characteristic symptoms and signs; the etiology, pathology, and prognosis may be known or unknown.
  • affection : an affliction or disease
  • disorder : a derangement or abnormality of function; a morbid physical or mental state.
  • indisposition : the condition of being slightly ill; a slight illness.
  • handicap : any physical or mental defect or characteristic, congenital or acquired, preventing or restricting a person from participating in normal life or limiting his capacity to work
  • mutilation : the act of depriving an individual of a limb, member, or other important part; deprival of an organ; severe disfigurement
  • invalid : 1. not well and strong. 2. a person who is disabled by illness or infirmity.
  • activities of daily living (ADL) : activities routinely performed daily by the average person in a given society; rehabilitation following illness or injury often aims to help patients achieve independence in performing them.
  • Charlson comorbities index :
  • Guttman health scale for the agedref

  • Cultural and professional models of illness influence decisions on individual patients and delivery of health care. The biomedical model of illness, which has dominated health care for the past century, cannot fully explain many forms of illness. This failure stems partly from three assumptions: all illness has a single underlying cause, disease (pathology) is always the single cause, and removal or attenuation of the disease will result in a return to health. Evidence exists that all three assumptions are wrong. We describe the problems with current models and describe a new model, derived from the World Health Organization's international classification of functioning frameworkref, that provides a more comprehensive, less biologically dependent account of illness. The model of illness adopted by society can have important consequences. In the first world war, for example, soldiers complaining of symptoms after experiencing severe stresses were sometimes shot as malingerers, but today they are considered victims and eligible for financial settlements Social acceptance that a behaviour or reported symptom constitutes an illness bestows privileges on an individual and formal duties on society. Currently, most models of illness assume a causal relation between disease and illness—the perceived condition of poor health felt by an individual. Cultural health beliefs and models of illness help determine the perceived importance of symptoms and the subsequent use of medical resourcesref. The assumption that a specific disease underlies all illness has led to medicalisation of commonly experienced anomalous sensations and often disbelief of patients who present with illness without any demonstrable disease process. Despite their importance, models of illness are rarely explicitly discussed or defined. The often criticised but nevertheless dominant 20th century biomedical models originate from Virchow's conclusion that all disease results from cellular abnormalities. The biomedical model is clearly relevant for many disease based illnesses, has intuitive appeal, and is supported by a wealth of supporting biological findings. By embracing reductionism, however, biomedical models of illness combine several closely related sets of beliefs. These can be summarised as follows: Many different models of illness exist, originating in professionsref specialties, and elsewhereref. The social model primarily focuses on the causation of disability by society rather than the whole spectrum of illness. The biopsychosocial model is perhaps the most popularref1, ref2. Over 400 Medline titles include the word, and it is increasingly used in many areas of medicineref1, ref2, ref3. In contrast to the biomedical model, it recognises that psychological and social factors influence a patient's perceptions and actions and therefore the experience of what it feels like to be ill. People often experience anomalous sensationsref1, ref2. The model of illness adopted will influence whether a person or their health adviser interprets a change in their state as indicating diseaseref, when someone should enter and leave the sick role, and often the health care given. Only a small minority of potential symptoms lead to involvement with health care, but a small change in the rate of interpreting anomalous sensations as symptoms by any party will have a major influence on the use of healthcare systems. Being ill, and being allowed to enter the sick role, has social and personal advantages for the person. Sick people may be absolved from social responsibilities, they are not held responsible for their condition, and they will often be eligible for healthcare benefits for which they do not pay directly. The sick role is most effective when it is validated by a doctor, but increasingly other health and non-healthcare professionals contribute to validation; indeed, ill people can now classify themselves as sick—for example, through self completed incapacity benefit forms in the United Kingdom. Already many patients present with symptoms that are not attributable to any underlying pathology or diseaseref. Nevertheless, such patients are often given a medical diagnosis, implying an underlying structural cause and reflecting cultural expectations. Unfortunately, the use of diagnostic labels has implications for the patient, society, and ultimately for the credibility of medicine. Any illness provided with a (medically validated) diagnostic label is widely assumed to be secondary to defined pathology, to be capable of confirmation independently of the symptoms, and to have a specific treatment that health services should supply. The problems arising from illnesses without a definable cause have been well documented. They are most appropriately termed functional somatic syndromesref1, ref2, ref3, recognising that psychological and social factors strongly influence the presentation of somatic symptomsref1, ref2. However, suggesting that patients do not have a disease (pathology) to explain their illness may understandably upset themref and creates difficulty for healthcare bureaucracy which relies on the patient's specific disease label. Funding is determined by diagnosis (in health related groups or similar) and ignores the initial cost associated with diagnosis (patients present with problems, not diagnoses). It also fails to recognise that a major part of healthcare cost relates to disabilityref. Resources are primarily allocated for the diagnosis and specific treatment of disease. Little attention is paid to other interventions despite good evidence of their effectiveness. Examples include the provision of equipmentref the use of specialist multidisciplinary stroke rehabilitation units, and the altering of patients' beliefs. Most healthcare systems also assume that treatment after diagnosis is brief and acts quickly. Indeed, the medical model might more accurately be termed the surgical model, given the pre-eminence of surgery in popular culture and health organisation. Finally, most biomedical models also seem strongly linked to primitive forms of intuitive mind-body dualism. Health commissioners, budgetary systems, healthcare professionals, and the public all act as if there is some clear, inescapable separation between physical and mental health problems, ignoring evidence that a person's emotional state always affects their function and presentation of physical symptomsref1, ref2. For example, separate services exist for people with physical disability and for those with mental health problems. 2 main factors fostered our new model. Firstly, WHO's international classification of impairment, disability and handicap and its later development, the international classification of functioning, disability and health, both recognise that disease has consequences at different levels, often influenced by contextual factors. Secondly, the power of a systems analytical approach to illness has been recognisedref An earlier version of this model formed the basis of the UK national guidelines on stroke and multiple sclerosis. The main modifications to the international classification of functioning model are: This model suggests that illness is a dysfunction of the person in his (or her) physical and social environment. It is centred on the (ill) person, who does not necessarily have to consider himself ill (for example, if someone is deluded).

    The model suggests that people with illness should be considered as follows : This model has many implications (see table A on bmj.com). One characteristic of a systems model is that abnormalities in one system can occur without any of its components being faulty, and so the model explicitly predicts that illness will occur without discernable pathology. The mystery of non-organic or functionalref illness is no longer medically unexplainedref. This analysis does not deny the reality of the illness but rather provides the rationale and support for explanations and treatments that direct their focus to the non-medical reasons why people may feel ill. This model also predicts that the effects of an abnormality may depend crucially on the characteristics of other parts of the system. For example, hip arthritis may become apparent only after a stroke affects the other leg. Consequently, reduction of illness may require intervention at several points, and indeed may not necessarily include removal of the main abnormality; this may explain the success of specialised stroke rehabilitation. The model suggests that some resources should be focused on altering contextual factors. Evidence already supports this approach: teaching carers of stroke patients benefits both the patient and healthcare systemsref1, ref2; changing social contextref may be effective—for example, reducing time off work with back painref; altering personal context may help in some illnessesref—for example, using cognitive behaviour therapy; and improving the physical context reduces expenditure on health careref. The role of personal choice, absent in many biomedical models of illness is central to any progressive explanation of human behaviour: "People are rational, aware self creating agents of their own health... influenced by consciously chosen goals."ref Personal choice plays an important part in the genesis or maintenance of illness, particularly in and through the domain of activities. This model also illuminates some of the current stresses within health care and illness related benefits systems. Systems focused on pathology (that is, hospitals) work in short time scales and ignore all patient context. However, they have to manage patients with activity limitations, in whom the time scale is longer and context is important. A coherent approach to rehabilitation inevitably requires action from other agencies such as social, housing, or employment services. When the characteristics (speed of priorities, available interventions) across organisational boundaries do not match each other or the needs of the patient, stresses may arise (often referred to as bed blocking in hospital). The new model undoubtedly has several weaknesses but it strives to provide a fuller understanding of the factors involved in illness at the level of both the individual and healthcare systems. The model could also be applied outside the health arena—for example, to people in the criminal justice systemref. Healthcare systems are social organisations, and their continuing health depends on members of society using a congruent model of illness and system of values to decide the rights and responsibilities associated with illness and the sick role, and how these are to be policed where individuals choose to take advantage of the role. The use of this model might improve the delivery of better health more than any other change in healthcare organisation. It is time that the medical models underpinning health delivery were debated openly.

    The classification of diseases according to tissue(s)/organ(s) involved is mainly used by clinicians in order to evaluate the systemic consequences of a disease and the right therapy. Many diseases (if not all) involve more than one tissue/organ : this is why ...

    1) ... in genetic diseases, often the defective gene sequence or expression is required in more than one cell type
    2) ... in extrinsic aetiology, often ...

    Anyway, from a clinical point of view, diseases can be classified according to the following criteria : In the following classification, when a disease is recognized as having a monofactorial aetiology, then a link to the aetiological factor is provided

    According to localizations, diseases are classified as :

    According to duration, diseases are classified as :
  • organic disease : one associated with demonstrable change in a bodily organ or tissue.
  • complicating disease : one which occurs in the course of some other disease as a complication.
  • paleopathology : the study of disease in bodies preserved from ancient times, such as mummies.

  • forme fruste [Fr. “defaced”] : an atypical, especially a mild or incomplete, form, as of a disease or anomaly.
  • forme tardive [Fr. “late”] : a late-occurring form of a disease that usually makes its appearance at an earlier age



    Leading causes of death :

    Medicine was once divided into : Another classification is : Medical algorythm Web resources: Bibliography
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