Introduction to Aboriginal Health

I'm going to start this post with a disclaimer: I have absolutely no experience working with Aboriginal people. I will try to be as culturally-sensitive as I can in this post, but if I inadvertently say anything insensitive, please let me know so I can fix it up :)

From the sounds of things, Aboriginal health is going to be a common topic throughout our medical degree. So, why study Aboriginal health? Unfortunately, there are still a lot of disparities between the Aboriginal and non-Aboriginal populations, including a massive difference in life expectancy (Aboriginal people have a life expectancy roughly 10-15 years lower than non-Aboriginal people). Understanding the determinants of health in Aboriginal populations might help to reduce these disparities. Furthermore, studying Aboriginal health gives us an opportunity to reflect not only on Aboriginal culture, but on other cultures too.

Describe the cultural diversity within the Aboriginal population and the importance of cultural protocols when engaging with Aboriginal people.

Often, Aboriginal and Torres Straight Islander people are grouped together and talked about as if they are the same. They are not: Aboriginal and Torres Straight Islanders have quite different cultures, and even within the Aboriginal population, there are many distinct cultures. Here is a map showing many of the nation groups of Aboriginal Australians: https://aiatsis.gov.au/explore/articles/aiatsis-map-indigenous-australia

All of these distinct cultures have their own protocols and rules, so it would probably take a lifetime to learn all of the protocols and rules. However, it's important to keep an open mind, to listen, and to learn. We all want to be treated in a way that aligns with our cultural values, so in order to provide a comfortable experience for your patients, you will need to listen and find out what their values are first.

Another quick note is that spirituality is important to a lot of Aboriginal cultures, and some Aboriginal people see illness as stemming from a spiritual cause. This may be useful to keep in mind when talking to and explaining things to patients and their families.

Explain what the cultural determinants are and discuss how they influence health in Aboriginal people and communities. Understand that aspects of Aboriginal culture are a strength for Aboriginal peoples health.

There are a range of cultural determinants of health, including but not limited to peace, shelter, education, social relations, food, income, respect for human rights, and so on. Unfortunately, as I mentioned earlier, there are a range of disparities between Aboriginal and non-Aboriginal people, and these disparities include lower average incomes and education levels among Aboriginal people as compared to non-Aboriginal people. Clearly, the issues surrounding Aboriginal health and the large gap in life expectancy are part of a broader, systemic issue without an easy solution.

On the other hand, there are many aspects of Aboriginal culture that can impact positively on a person's health. For instance, many Aboriginal communities have a complex kinship system, often built on groups of families that may not necessarily be related by blood. Kinships are complex and diverse, and determine a lot of the rules and structures of society. They are based on respect and sharing and may assist in maintaining social and emotional wellbeing. Other aspects of Aboriginal culture that may have a positive effect on health and wellbeing include connection to the land, spirituality, traditional knowledge, and so on.

One last note...

In order to wrap up this post, I'd like to share this video. It's a satirical take on what Australia would be like if it was Aboriginal people taking over white land, rather than the other way around. This video has been around for over 30 years now, but is unfortunately still very relevant today. (When Tony Abbott became the Special Envoy for Indigenous Affairs, I was immediately reminded of the Aboriginal man in this video playing the role of "Minister for White Affairs"...)

Aetioogy and classification of disease

This lecture was basically an overview of what pathology is, so it's not too content-heavy.

Define pathology, aetiology and pathogenesis

• Pathology- The study of disease and its underlying causes.
• Aetiology- The cause or set of causes for a disease.
• Pathogenesis- The mechanism that leads to the development of a disease.

Note that while aetiology and pathogenesis seem quite similar, they aren't the same. Pathogenesis refers more to the steps that take place to cause someone to get sick. For instance, in a pulmonary embolus, a person gets a clot somewhere in the body (usually the leg), which then breaks off and lodges in the smaller blood vessels of the lung. This process is the pathogenesis of the pulmonary embolus. The aetiology, on the other hand, is the cause or set of causes that caused the clot to form in the first place. This could be a range of factors, such as inactivity or heart failure.

Understand how knowledge of pathology, pathogenesis and aetiology of disease can be utilised in patient care

Most importantly, if we know what made someone sick, we can help by (hopefully) treating the cause. Furthermore, knowing a cause might help inspire research into treating the cause, leading to the development of better treatments over time.

Understanding the pathogenesis can also help in telling patients the prognosis of their disease. If you know how the disease progresses, you can tell patients if they are likely to be well again soon, or if they will need long-term treatment.

Describe ways that disease can be classified

Diseases are defined using consistent and reproducible criteria. This is important as it helps doctors and scientists to use the same terminology in communicating with each other.

There are many ways to classify diseases. Often, diseases are classified by process, underlying cause, or time course. Note that the terms "acute" and "chronic" in medicine refer to the time course and onset of the disease, rather than the severity (as the term is often used in casual conversation): in medicine, "acute" refers to sudden and/or short-term illnesses, whereas "chronic" refers to longer-term illnesses.

The "pathological sieve" or the "surgical sieve" is a useful way to think about various causes of disease. It even comes with a nice little acronym: VITAMIN C:

• Vascular (problems with blood flow or blood vessels)
• Inflammatory/Infective (appropriate activation of the immune system, may be caused by an infectious microorganism)
• Trauma (caused by physical damage, like a broken bone)
• Autoimmune (due to the immune system being inappropriately activated)
• Metabolic (related to metabolism or biochemistry)
• Iatrogenic (don't know what caused it) or Idiopathic (caused by medical interventions)
• Neoplastic (new growth, i.e. tumours)
• Congenital (born with) or Genetic (due to a mutation, either inherited or acquired)

Aside from these causes, you also need to consider degenerative diseases (such as Alzheimer's), environmental conditions (such as asbestos-related mesothelioma), and psychological and neurological conditions (such as schizophrenia).

Embryology, Tissues and Organs Overviews

I've written about these topics before, so this is just going to be a post containing quick links to my previous posts.

Embryology

• Early Embryology: The First Four Weeks
• Embryology 2: Fate of the Ectoderm and Mesoderm
• Embryology and Evolution

We will need to learn about the development of specific systems later, but we won't learn about specific system development until we start learning about those specific systems. (Hope that sentence made sense :P)

Tissues

• Tissues

In that post, I mentioned that there were cells that support the neurons, but I didn't say what they were. Well, here's a quick rundown: oligodendrocytes form myelin sheets around axons in the central nervous system, Schwann cells do the same thing in the peripheral nervous system, astrocytes protect and form the blood-brain barrier, and microglia mediate the immune response and act as macrophages.

Organs

I've just realised that I actually don't have a previous general post about organs (at least not one that I could find with a quick search), as most of my posts tend to be about specific organs. However, given that I can't be bothered making a separate post, I'm going to give a tl;dr version of this lecture, right here, right now.

Define an organ

At least two types of tissues that work together to form a functional unit. For instance, muscle is an organ as it consists of two types of tissues (muscle tissue surrounded by connective tissue) and it works as a functional unit, causing contraction.

Know the principal organs of each system

Note that this is not an exhaustive list- I'm just writing random words from the lecture slides.

• Respiratory- nose, mouth, pharynx, larynx, trachea, lungs
• Digestive- mouth, tongue, teeth, pharynx, oesophagus, stomach, small intestine, pancreas, liver, gall bladder, colon
• Circulatory- heart, blood vessels
• Endocrine- hypothalamus, pituitary gland, pancreas, suprarenal/adrenal glands, gonads, thymus, thyroid gland, parathyroid gland
• Muscular- muscles
• Skeletal- bones, cartilage, joints
• Urinary- kidneys, ureters, bladder, urethra
• Nervous- brain, spinal cord, peripheral nerves, special sense organs (e.g. eyes and ears)
• Immune/Lymphatic- lymph nodes, thymus, bone marrow, tonsils, spleen, appendix
• Integumentary- skin, hair, nails
• Reproductive- gonads, vas deferens, seminal vesicles, prostate gland, bulbourethral gland, penis, ovarian tube, uterus, vagina

Recognise the relationship between the structure and function of an organ

This is one that we'll learn more about over the course of the year, or by casually perusing literally any material that has been written about any organ. For instance, organs involved in absorption (e.g. small intestine) tend to have structures that increase the surface area, such as folds and microvilli on the cells. Organs that need to squeeze a lot (heart, stomach, etc.) tend to have a lot of muscle. Similarly, pretty much every other organ has a structure that helps it carry out its function.

Cell Chemistry

Name the cellular macromolecules, and have an understanding of their structure and function.

See the end of this earlier post: Diffusion, osmosis, enzymes and organic compounds relevant to human bio

Define an atom, electron, neutron and proton.

See previous post: Atomic Structure and the Periodic Table

Have a general understanding of the different types of bonds and relative bond energies.

See previous post: Intermolecular Bonding

For this unit, you also need to know about hydrophobic interactions and coordinate links. These aren't really bonds per se, but they can be important. In hydrophobic interactions, hydrophobic parts of a molecule tend to cluster together and "hide" on the inside of a molecule. This often occurs as part of the formation of the tertiary protein structure, as mentioned here. Coordinate links form between metals and groups containing O and N.

Recognise the functional groups given.

See previous posts: Basics of Organic Chemistry and Organic Chemistry- Some New Functional Groups.

Other groups that we need to know are -SH (sulfhydryl), -CH3 (methyl), -S-S- (disulfide), -PO4 (phosphate) and -COCH3 (acetyl).

Have a basic understanding of types of organics.

See the end of this post that I referenced above: Diffusion, osmosis, enzymes and organic compounds relevant to human bio

Have an understanding of the importance of isomers.

Isomers are basically molecules that have the same atoms, but in different locations. The main types of isomers are structural isomers, in which the functional groups are in a different place, and stereoisomers, which are molecules that are mirror images of each other but aren't exactly the same. I've written more about stereoisomers in this earlier post: Carbohydrates- Structure, Chemistry and Biological Function. I have written about the importance of isomers in this post: Stereochemistry.

Define the properties of water.

See previous post: Water, Sodium, Potassium and Chlorine

Define mole, molarity, acid, bases, pH, buffers.

For mole and molarity, see this post for way too much information: Simple Calculations Involving Moles

For acids and bases, see this post: Acids and Bases Part 1

For pH, see here for an information overload: Amino Acids- Acid Base Chemistry

For buffers, see here: Peptides- Charge and Isoelectric Points, Buffering Capacity

Know the macromolecule types and their molecular building blocks.

Once again, see this post: Diffusion, osmosis, enzymes and organic compounds relevant to human bio

Cellular Physiology and Function

Describe the cellular level of organisation

It looks like, for this lecture at least, all you need to know about the organisation of cells is that they are surrounded by a membrane and contain many smaller structures called organelles. Each organelle carries out a specific function, and some of them are also surrounded by membranes.

List the main organelles and other major structures of a cell, describe their structure, and explain their functions

See previous posts: Cell Structure and Mitosis and Cell Biology- Introduction and Energy Production

Develop an understanding of membrane structure and function

There wasn't really a whole lot on membrane structure and function in this lecture. The Cell Structure and Mitosis post probably contains all you need to know for now. However, you can read a bit more information about cell membranes at these posts: Lipids- Membranes as Dynamic Molecular Barriers and Lipids- Membrane Biosynthesis and Asymmetry.

Introduction to Physiology and Homeostasis

The very first lecture for medical school was an introduction to physiology, which I majored in in undergrad. Hence a lot of these initial posts will likely consist mainly of links to previous posts that I've written about physiology.

Gain an understanding of the field of Physiology

Physiology is basically the study of how the body works. Physiology often views the body as being like a machine, mostly responding to the world around it to keep the internal environment constant (though there are feed-forward mechanisms as discussed here).

Describe the level of organisation in the body

As multicellular organisms, we are made up of a lot of cells. Many of our cells are specialised; that is, they have been built to perform a few tasks and to perform those tasks well. Cells can combine to form tissues, which combine to form organs, which combine to form organ systems, which then combine to form us.

Know the constituents of the intracellular and extracellular environment

This lecture didn't really go into the intracellular environment that much- it focused more on the extracellular environment. The extracellular fluid (ECF) "bathes" the cells. It contains a variety of constituents, such as glucose and various ions (sodium, potassium, calcium, chloride, etc.). The concentration of these constituents, as well as the temperature and pH, has to be kept fairly consistent in order to keep the cells happy.

Discuss the concept of homeostasis and homeostatic control systems

Homeostasis refers to the need to keep the internal environment relatively constant. As I mentioned just above, the extracellular fluid needs to be kept constant so that the cells that are bathing in it can stay healthy. In order to keep the internal environment consistent, there are control systems in place. You can read about them in more detail than you really need to know here and here. If you don't want the detailed review, the tl;dr version is this: you need some kind of sensor to detect the level of a variable (concentration of a constituent, temperature, pH, etc.), some kind of integrating centre to decide what to do with this information, and some way to make a change if it's necessary. for instance, with blood pressure, we have baroreceptors in our carotid sinus and aortic arch to monitor blood pressure and send signals to the medulla, which then makes necessary adjustments via the sympathetic and parasympathetic nervous systems.

Know that multicellular life involves specialisation of individual cells and communication between cells

As I mentioned earlier, many of our cells are specialised in that they can perform a few tasks and perform them well. For instance, cardiac muscle is pretty good at contracting and making the heart beat, but I wouldn't count on it to help me type up a blog post. Since we have many different types of cells located all over our body, it is important that they can all work together. Cardiac muscle cells would be pretty useless if they only beat randomly: you need a good strong contraction from a bunch of them in order to make the heart beat.

Describe and understand the forms of communication between cells

There are many different types of communication between cells. They mainly differ in terms of how direct they are (some target only very specific cells while others target basically anything within firing range) and how fast they are.

Juxtacrine

Juxtacrine signalling occurs between two cells that are physically in contact with each other. It occurs via a membrane-bound signalling molecule on one cell and a receptor on the other cell. This type of signalling is pretty rare, and pretty much only occurs in Notch signalling, which occurs in neural development.

Gap Junctions

Gap junctions, just like juxtacrine signalling, can be found between two cells that are directly in contact. In gap junctions, there are channels between the cells, made up of proteins called connexons. Due to these channels, the two cells basically get to share the same intracellular fluid, allowing for the free passage of ions and other molecules. Gap junctions are very handy during contraction of the heart and some smooth muscles, as the signal can propagate between cells and create a rhythmic, coordinated contraction.

Autocrine

In autocrine signalling, a cell releases a molecule into the extracellular fluid, and then this molecule binds to a receptor on the same cell. In essence, the cell is communicating with itself. Autocrine signalling is not very common, except for in the immune system. For instance, monocytes send interleukin-1 to themselves, and macrophages send TNF-α to themselves. Smooth muscle also uses autocrine signalling in the mediation of the stretch response.

Paracrine

Similar to autocrine signalling, paracrine signalling also involves the release of molecules into the ECF. However, the target here is not the same cell, but rather other cells that are a short distance away. An example of paracrine signalling is the effect of various metabolites on blood vessels: for instance, carbon dioxide can cause vasodilation, which is dilation of blood vessels (except in the respiratory system, where it causes vasoconstriction, which is constriction of blood vessels).

Endocrine

In endocrine communication, hormones are released into the blood and are transported through the blood to their target organs. Hormones will only have an effect on cells that have a receptor for them. Endocrine signalling can affect a lot of cells at once, but is slow as it takes time for the hormones to be transported by blood.

Neural

Neural signalling literally just uses neurons to send signals. I have briefly described how neurons work here. In contrast to endocrine signalling, neural signalling is faster and more specific.

Neuroendocrine

Neuroendocrine signalling is like a hybrid of neural and endocrine signalling. Essentially, neurons release neurotransmitters into the blood, rather than to other neurons or target cells. Examples of neuroendocrine signalling include the release of ADH and oxytocin from the posterior pituitary.

New year, new degree

As I mentioned in an earlier post, I have been accepted to medical school! In fact, orientation was two days ago and I had my first lectures yesterday.

I will try to continue posting on Year 11 Misadventures during medical school, but given that we have a large amount of content to cover, I likely won't be able to cover everything. Instead, I will probably just blog about the topics that I am having the most trouble understanding (because writing things out helps me learn), though I may cover more topics if I have the time. I'm going to try not to burn myself out though!