Disease

"Human disease" redirects here. For the Slayer song, see Soundtrack to the Apocalypse.

"Flare-up" redirects here. For the Transformers character, see Flareup (Transformers).

"Medical condition" redirects here. For the descriptive terminology using words such as "good", "serious", "critical", etc., see Medical state.

For other uses, see Disease (disambiguation).

A disease is an abnormal condition affecting the body of an organism. It is often construed to be a medical condition associated with specific symptoms and signs.^[1] It may be caused by external factors, such as infectious disease, or it may be caused by internal dysfunctions, such as autoimmune diseases. In humans, "disease" is often used more broadly to refer to any condition that causes pain, dysfunction, distress, social problems, and/or death to the person afflicted, or similar problems for those in contact with the person. In this broader sense, it sometimes includes injuries, disabilities, disorders, syndromes, infections, isolated symptoms, deviant behaviors, and atypical variations of structure and function, while in other contexts and for other purposes these may be considered distinguishable categories. Diseases usually affect people not only physically, but also emotionally, as contracting and living with many diseases can alter one's perspective on life, and their personality.

Death due to disease is called death by natural causes. There are four main types of disease: pathogenic disease, deficiency disease, hereditary disease, and physiological disease.

Diseases can also be classified as communicable and non-communicable disease.

Terminology

In many cases, the terms disease, disorder, morbidity and illness are used interchangeably.^[2] In some situations, specific terms are considered preferable.

Disease

The term disease broadly refers to any condition that impairs normal function. Commonly, this term is used to refer specifically to infectious diseases, which are clinically evident diseases that result from the presence of pathogenic microbial agents, including viruses, bacteria, fungi, protozoa, multicellular organisms, and aberrant proteins known as prions. An infection that does not and will not produce clinically evident impairment of normal functioning, such as the presence of the normal bacteria and yeasts in the gut, is not considered a disease; by contrast, an infection that is asymptomatic during its incubation period, but expected to produce symptoms later, is usually considered a disease. Non-infectious diseases are all other diseases, including most forms of cancer, heart disease, and genetic disease.

Illness

Illness and sickness are generally used as synonyms for disease.^[3] However, this term is occasionally used to refer specifically to the patient's personal experience of their disease.^[4][5] In this model, it is possible for a person to be diseased without being ill (to have an objectively definable, but asymptomatic, medical condition), and to be ill without being diseased (such as when a person perceives a normal experience as a medical condition, or medicalizes a non-disease situation in his or her life). Illness is often not due to infection but a collection of evolved responses, sickness behavior, by the body which aids the clearing of infection. Such aspects of illness can include lethargy, depression, anorexia, sleepiness, hyperalgesia, and inability to concentrate.^[6][7][8]

Disorder

In medicine, a disorder is a functional abnormality or disturbance. Medical disorders can be categorized into mental disorders, physical disorders, genetic disorders, emotional and behavioral disorders, and functional disorders.

The term disorder is often considered more value-neutral and less stigmatizing than the terms disease or illness, and therefore is preferred terminology in some circumstances. In mental health, the term mental disorder is used as a way of acknowledging the complex interaction of biological, social, and psychological factors in psychiatric conditions. However, the term disorder is also used in many other areas of medicine, primarily to identify physical disorders that are not caused by infectious organisms, such as metabolic disorders.

Medical condition

A medical condition is a broad term that includes all diseases and disorders. While the term medical condition generally includes mental illnesses, in some contexts the term is used specifically to denote any illness, injury, or disease except for mental illnesses. The Diagnostic and Statistical Manual of Mental Disorders (DSM), the widely used psychiatric manual that defines all mental disorders, uses the term general medical condition to refer to all diseases, illnesses, and injuries except for mental disorders.^[9] This usage is also commonly seen in the psychiatric literature. Some health insurance policies also define a medical condition as any illness, injury, or disease except for psychiatric illnesses.^[10]

As it is more value-neutral than terms like disease, the term medical condition is sometimes preferred by people with health issues that they do not consider to be deleterious. On the other hand, by emphasizing the medical nature of the condition, this term is sometimes rejected, such as by proponents of the autism rights movement.

The term medical condition is used as a synonym for medical state, where it describes a patient's current state, as seen from a medical standpoint. This usage is seen in statements that describe a patient as being "in critical condition", for example.

Morbidity

Morbidity (from Latin morbidus, meaning "sick, unhealthy") is a diseased state, disability, or poor health due to any cause.^[11] The term may be used to refer to the existence of any form of disease, or to the degree that the health condition affects the patient. Among severely ill patients, the level of morbidity is often measured by ICU scoring systems.

Comorbidity is the simultaneous presence of two medical conditions, such as a person with schizophrenia and substance abuse.

In epidemiology and actuarial science, the term morbidity rate can refer to either the incidence rate, or the prevalence of a disease or medical condition. This measure of sickness is contrasted with the mortality rate of a condition, which is the proportion of people dying during a given time interval.

Stages

In an infectious disease, the incubation period is the time between infection and the appearance of symptoms. The latency period is the time between infection and the ability of the disease to spread to another person, which may precede, follow, or be simultaneous with the appearance of symptoms. Some viruses also exhibit a dormant phase, called viral latency, in which the virus hides in the body in an inactive state. For example, varicella zoster virus causes chickenpox in the acute phase; after recovery from chickenpox, the virus may remain dormant in nerve cells for many years, and later cause herpes zoster (shingles).

A cure is the end of a medical condition or a treatment that is very likely to end it, while remission refers to the disappearance, possibly temporarily, of symptoms. Complete remission is the best possible outcome for incurable diseases.

A flare-up can refer to either the recurrence of symptoms or an onset of more severe symptoms.

A refractory disease is a disease that resists treatment, especially an individual case that resists treatment more than is normal for the specific disease in question.

Progressive disease is a disease whose typical natural course is the worsening of the disease until death, serious debility, or organ failure occurs. Slowly progressive diseases are also chronic diseases; many are also degenerative diseases. The opposite of progressive disease is stable disease or static disease: a medical condition that exists, but does not get better or worse.

Scope

A localized disease is one that affects only one part of the body, such as athlete's foot or an eye infection.

A disseminated disease has spread to other parts; with cancer, this is usually called metastatic disease.

A systemic disease is a disease that affects the entire body, such as influenza or high blood pressure.

Causes and transmissibility

Main article: Transmission (medicine)

Only some diseases such as influenza are contagious and commonly believed to be infectious. The micro-organisms that cause these diseases are known as pathogens and include varieties of bacteria, viruses, protozoa and fungi. Infectious diseases can be transmitted, e.g. by hand-to-mouth contact with infectious material on surfaces, by bites of insects or other carriers of the disease, and from contaminated water or food (often via faecal contamination), etc. In addition, there are sexually transmitted diseases. In some cases, micro-organisms that are not readily spread from person to person play a role, while other diseases can be prevented or ameliorated with appropriate nutrition or other lifestyle changes.

Some diseases, such as most (but not all) forms of cancer, heart disease and mental disorders, are non-infectious diseases. Many non-infectious diseases have a partly or completely genetic basis (see genetic disorder) and may thus be transmitted from one generation to another.

Social determinants of health are the social conditions in which people live which determine their health. Illnesses are generally related to social, economic, political, and environmental circumstances. Social determinants of health have been recognized by several health organizations such as the Public Health Agency of Canada and the World Health Organization to greatly influence collective and personal well-being.

When the cause of a disease is poorly understood, societies tend to mythologize the disease or use it as a metaphor or symbol of whatever that culture considers to be evil. For example, until the bacterial cause of tuberculosis was discovered in 1882, experts variously ascribed the disease to heredity, a sedentary lifestyle, depressed mood, and overindulgence in sex, rich food, or alcohol—all the social ills of the time.^[12]

Burdens of disease

Disease burden is the impact of a health problem in an area measured by financial cost, mortality, morbidity, or other indicators.

There are several measures used to quantify the burden imposed by diseases on people. The years of potential life lost (YPLL) is a simple estimate of the number of years that a person's life was shortened due to a disease. For example, if a person dies at the age of 65 from a disease, and would probably have lived until age 80 without that disease, then that disease has caused a loss of 15 years of potential life. YPLL measurements do not account for how disabled a person is before dying, so the measurement treats a person who dies suddenly and a person who died at the same age after decades of illness as equivalent. In 2004, the World Health Organization calculated that 932 million years of potential life were lost to premature death.^[13]

The quality-adjusted life year (QALY) and disability-adjusted life year (DALY) metrics are similar, but take into account whether the person was healthy after diagnosis. In addition to the number of years lost due to premature death, these measurements add part of the years lost to being sick. Unlike YPYLL, these measurements show the burden imposed on people who are very sick, but who live a normal lifespan. A disease that has high morbidity, but low mortality, will have a high DALY and a low YPLL. In 2004, the World Health Organization calculated that 1.5 billion disability-adjusted life years were lost to disease and injury.^[13]

Disease category	Percent of all YPLLs lost, worldwide[13]	Percent of all DALYs lost, worldwide[13]	Percent of all YPLLs lost, Europe[13]	Percent of all DALYs lost, Europe[13]	Percent of all YPLLs lost, US and Canada[13]	Percent of all DALYs lost, US and Canada[13]
Infectious and parasitic diseases, especially lower respiratory tract infections, diarrhea, AIDS, tuberculosis, and malaria	37%	26%	9%	6%	5%	3%
Neuropsychiatric conditions, e.g. depression	2%	13%	3%	19%	5%	28%
Injuries, especially motor vehicle accidents	Cardiovascular diseases, principally heart attacks and stroke	18%	77%	39%	24%	29%	100%
Premature birth and other perinatal deaths	11%	8%	4%	2%	3%	2%
Cancer	8%	5%	19%	11%	25%	13%

Social significance of disease

Obesity was a status symbol in Renaissance culture: "The Tuscan General Alessandro del Borro", attributed to Andrea Sacchi, 1645.^[14] It is now generally regarded as a disease.

How society responds to disease is the subject of medical sociology.

A condition may be considered to be a disease in some cultures or eras but not in others. For example, obesity can represent wealth and abundance, and is a status symbol in famine-prone areas and some places hard-hit by HIV/AIDS.^[15] Epilepsy is considered a sign of spiritual gifts among the Hmong people.^[16]

Sickness confers the social legitimization of certain benefits, such as illness benefits, work avoidance, and being looked after by others. The person who is sick takes on a social role called the sick role. A person who responds to a dreaded disease, such as cancer, in a culturally acceptable fashion may be publicly and privately honored with higher social status.^[17] In return for these benefits, the sick person is obligated to seek treatment and work to become well once more. As a comparison, consider pregnancy, which is not usually interpreted as a disease or sickness, even if the mother and baby may both benefit from medical care.

Most religions grant exceptions from religious duties to people who are sick. For example, one whose life would be endangered by fasting on Yom Kippur or during Ramadan is exempted from the requirement, or even forbidden from participating. People who are sick are also exempted from social duties. For example, ill health is the only socially acceptable reason for an American to refuse an invitation to the White House.^[18]

The identification of a condition as a disease, rather than as simply a variation of human structure or function, can have significant social or economic implications. The controversial recognitions as diseases of post-traumatic stress disorder, also known as "Soldier's heart", "shell shock", and "combat fatigue;" repetitive motion injury or repetitive stress injury (RSI); and Gulf War syndrome has had a number of positive and negative effects on the financial and other responsibilities of governments, corporations and institutions towards individuals, as well as on the individuals themselves. The social implication of viewing aging as a disease could be profound, though this classification is not yet widespread. Lepers were a group of afflicted individuals who were historically shunned and the term "leper" still evokes social stigma. Fear of disease can still be a widespread social phenomenon, though not all diseases evoke extreme social stigma.

Social standing and economic status affect health. Diseases of poverty are diseases that are associated with poverty and low social status; diseases of affluence are diseases that are associated with high social and economic status. Which diseases are associated with which states varies according to time, place, and technology. Some diseases, such as diabetes mellitus, may be associated with both poverty (poor food choices) and affluence (long lifespans and sedentary lifestyles), through different mechanisms. The term diseases of civilization describes diseases that are more common among older people. For example, cancer is far more common in societies in which most members live until they reach the age of 80 than in societies in which most members die before they reach the age of 50.

Language of disease

An illness narrative is a way of organizing a medical experience into a coherent story that illustrates the experience.

People use metaphors to make sense of their experiences with disease. The metaphors move disease from an objective thing that exists to an affective experience. The most popular metaphors draw on military concepts: Disease is an enemy that must be feared, fought, battled, and routed. The patient or the physician is a warrior, rather than a passive victim or bystander. The agents of communicable diseases are invaders; non-communicable diseases constitute internal insurrection. Because the threat is urgent, perhaps a matter of life and death, unthinkably radical, even oppressive, measures are society's and the patient's moral duty as they courageously mobilize to struggle against destruction. The War on Cancer is an example.^[19]

Another class of metaphors describes the experience of illness as a journey: The person travels to or from a place of disease, and changes himself, discovers new information, or increases his experience along the way. He may travel "on the road to recovery" or make changes to "get on the right track".^[19] Some are explicitly immigration-themed: the patient has been exiled from the home territory of health to the land of the ill, changing identity and relationships in the process.^[20]

Some metaphors are disease-specific. Slavery is a common metaphor for addictions: The alcoholic is enslaved by drink, and the smoker is captive to nicotine. Some cancer patients treat the loss of their hair from chemotherapy as a metonymy or metaphor for all the losses caused by the disease.^[19]

Some diseases are used as metaphors for social ills: "Cancer" is a common description for anything that is endemic and destructive in society, such as poverty, injustice, or racism. AIDS was seen as a divine judgment for moral decadence, and only by purging itself from the "pollution" of the "invader" could society become healthy again.^[19] Authors in the 19th century commonly used tuberculosis as a symbol and a metaphor for transcendence. Victims of the disease were portrayed in literature as having risen above daily life to become ephemeral objects of spiritual or artistic achievement. In the 20th century, the same disease became the emblem of poverty, squalor, and other social problems.^[20]

Epidemiology

Main article: Epidemiology

Epidemiology is the study of the factors that cause or encourage diseases. Some diseases are more common in certain geographic areas, among people with certain genetic or socioeconomic characteristics, or at different times of the year.

Epidemiology is considered a cornerstone methodology of public health research, and is highly regarded in evidence-based medicine for identifying risk factors for disease. In the study of communicable and non-communicable diseases, the work of epidemiologists ranges from outbreak investigation to study design, data collection and analysis including the development of statistical models to test hypotheses and the documentation of results for submission to peer-reviewed journals. Epidemiologists also study the interaction of diseases in a population, a condition known as a syndemic. Epidemiologists rely on a number of other scientific disciplines such as biology (to better understand disease processes), biostatistics (the current raw information available), Geographic Information Science (to store data and map disease patterns) and social science disciplines (to better understand proximate and distal risk factors).

In studying diseases, epidemiology faces the challenge of defining them. Especially for poorly understood diseases, different groups might use significantly different definitions. Without an agreed-upon definition, different researchers will find very different numbers of cases and characteristics of the disease.^[21]

Prevention

Main article: Preventive medicine

Many diseases and disorders can be prevented through a variety of means. These include sanitation, proper nutrition, adequate exercise, vaccinations, and other self-care and public health measures.

Treatments

Main article: Therapy

Medical therapies or treatments are efforts to cure or improve a disease or other health problem. In the medical field, therapy is synonymous with the word "treatment". Among psychologists, the term may refer specifically to psychotherapy or "talk therapy". Common treatments include medications, surgery, medical devices, and self-care. Treatments may be provided by an organized health care system, or informally, by the patient or family members.

A prevention or preventive therapy is a way to avoid an injury, sickness, or disease in the first place. A treatment or cure is applied after a medical problem has already started. A treatment attempts to improve or remove a problem, but treatments may not produce permanent cures, especially in chronic diseases. Cures are a subset of treatments that reverse diseases completely or end medical problems permanently. Many diseases that cannot be completely cured are still treatable.Pain management (also called pain medicine) is that branch of medicine employing an interdisciplinary approach to the relief of pain and improvement in the quality of life of those living with pain^[22]

Treatment for medical emergencies must be provided promptly, often through an emergency department or, in less critical situations, through an urgent care facility.

See also

• List of acronyms on diseases and disorders
• List of cutaneous conditions
• Lists of diseases
• Rare disease
• Plant pathology
• Sociology of health and illness

References

1. ^ "Disease" at Dorland's Medical Dictionary
2. ^ "Mental Illness—Glossary". US National Institute of Mental Health. http://science.education.nih.gov/supplements/nih5/mental/other/glossary.htm. Retrieved 2010-04-18. 
3. ^ "Illness" at Dorland's Medical Dictionary
4. ^ Emson HE (April 1987). "Health, disease and illness: matters for definition". CMAJ 136 (8): 811–3. PMC 1492114. PMID 3567788. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=1492114. 
5. ^ McWhinney IR (April 1987). "Health and disease: problems of definition". CMAJ 136 (8): 815. PMC 1492121. PMID 3567791. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=1492121. 
6. ^ Hart BL (1988). "Biological basis of the behavior of sick animals". Neurosci Biobehav Rev 12 (2): 123–137. doi:10.1016/S0149-7634(88)80004-6. PMID 3050629. 
7. ^ Johnson R (2002). "The concept of sickness behavior: a brief chronological account of four key discoveries". Veterinary Immunology and Immunopathology 87 (3-4): 443–450. doi:10.1016/S0165-2427(02)00069-7. PMID 12072271. 
8. ^ Kelley KW, Bluthe RM, Dantzer R, Zhou JH, Shen WH, Johnson RW, Broussard SR (2003). "Cytokine-induced sickness behavior". Brain Behav Immun 17 (Suppl 1): S112–118. doi:10.1016/S0889-1591(02)00077-6. PMID 12615196. 
9. ^ American Psychiatric Association. Task Force on DSM-IV (2000). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: American Psychiatric Association. ISBN 9780890420256. 
10. ^ "Expat Insurance Glossary by The Insurance Page". http://www.theinsurancepage.co.uk/expat-insurance-glossary.html. Retrieved 2008-11-20. 
11. ^ Dorland's Medical Dictionary: morbidity, Dorland's Medical Dictionary, MerckSource
12. ^ Olson, James Stuart (2002). Bathsheba's breast: women, cancer & history. Baltimore: The Johns Hopkins University Press. pp. 168–170. ISBN 0-8018-6936-6. 
13. ^ ^{a b c d e f g h} :"Disease and injury regional estimates for 2004". World Health Organization. http://www.who.int/healthinfo/global_burden_disease/estimates_regional/en/index.html. 

    Standard DALYs (3% discounting, age weights).

    DALY spreadsheet

    YLL spreadsheet.

14. ^ Carol Gerten-Jackson. "The Tuscan General Alessandro del Borro". http://www.cab.u-szeged.hu/cgfa/m/m-12.htm. 
15. ^ Haslam DW, James WP (2005). "Obesity". Lancet 366 (9492): 1197–209. doi:10.1016/S0140-6736(05)67483-1. PMID 16198769. 
16. ^ Fadiman, Anne (1997). The spirit catches you and you fall down: a Hmong child, her American doctors, and the collision of two cultures. New York: Farrar, Straus, and Giroux. ISBN 0-374-52564-1. 
17. ^ Sulik, Gayle (2010). Pink Ribbon Blues: How Breast Cancer Culture Undermines Women's Health. New York: Oxford University Press. ISBN 0199740453. 
18. ^ Martin, Judith (2005). Miss Manners' Guide to Excruciatingly Correct Behavior. New York: W.W. Norton & Co. pp. 703. ISBN 9780393058741. OCLC 57549405. 
19. ^ ^{a b c d} Gwyn, Richard (1999). "10". In Cameron, Lynne; Low, Graham. Researching and applying metaphor. Cambridge, England: Cambridge University Press. ISBN 9780521649643. OCLC 40881885. 
20. ^ ^{a b} Diedrich, Lisa (2007). Treatments: language, politics, and the culture of illness. Minneapolis: University of Minnesota Press. pp. 8, 29. ISBN 9780816646975. OCLC 601862594. 
21. ^ Tuller, David (4 March 2011). "Defining an illness is fodder for debate". The New York Times. http://www.nytimes.com/2011/03/08/health/research/08fatigue.html. 
22. ^ Hardy, Paul A.; Hardy, Paul A. J. (1997). Chronic Pain Management: The Essentials. Cambridge University Press. p. 10. ISBN 9781900151856. OCLC 36881282. http://books.google.com/books?id=EtZ-4eb_aDUC&pg=PA10&lpg=PA10. 

External links

• Health Topics, MedlinePlus descriptions of most diseases, with access to current research articles.
• OMIM Comprehensive information on genes that cause disease at Online Mendelian Inheritance in Man
• CTD The Comparative Toxicogenomics Database is a scientific resource connecting chemicals, genes, and human diseases.
• NLM Comprehensive database from the US National Library of Medicine
• Health Topics A-Z, fact sheets about many common diseases at Center for Disease Control
• The Merck Manual containing detailed description of most diseases
• Report: The global burden of disease from World Health Organization (WHO), 2004
• Free online health-risk assessment by Your Disease Risk at Washington University in St Louis