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Positive health of a person is defined as the ability to live long in good health without activity limitation.[1] This implies the availability of mechanism in the body to thwart the ailments and to minimize their adverse effect if they strike. The concept has evolved over time and has seen significant changes.

History

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The World Health Organization defines Health as a state of complete physical, mental and social well-being.[2] This is a utopian and unattainable ideal[3] as Moving the goalposts when an achievement is made. Possibly the first use of the term ‘positive health’ was in 1924 when it was considered a double positive as health itself is a positive term.[4] In the year 2000, it was described as the ability to cope with biological, Psychological, and social stress, and parameters such as pain-bearing capacity and Vital capacity were suggested as its indicators.[5] In 2008, positive health was explained as a combination of excellent status on biological, subjective, and functional measures,[6] including factors such as optimism, stable marriage, and lower blood pressure level.[7] In 2011, it was defined as the one's ability to adapt and self-manage in the face of social, physical, and emotional challenges, and it constituted psycho-social parameters.[8] In 2023, positive health was defined as the ability to live long in good health.[1] An effort has been made to identify major indicators that can objectively measure a person’s positive health in this sense.[9]

Domains and major indicators

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Indicators of positive health generally include Life style (sociology) parameters such as social interaction, diet, physical activity, water intake, sleep and relaxation, and yoga and meditation. But most of these defy direct measurement. Such lifestyle factors modulate medical parameters such as Immunity (medicine) level and hormonal balance,[10][11] and these parameters are objectively measurable. On the pattern of quality-of-life measurement, these parameters are divided into 5 domains, each comprising several parameters. The following domains and major parameters have been suggested to measure positive health.[9]

Domain Major parameters
Immunological markers IgG, IgM, lymphocytes, macrophages[12]
Nutritional elements Various vitamins, zinc, Omega-3, glutathione[13][14]
Endocrinological substances Thyroid, insulin, estrogen, melatonin-serotonin-oxytocin-dopamine, Endorphins[15][16][17][18][19]
Neurological parameters Montreal Cognitive Assessment Scale, P3 amplitude, gamma-aminobutyric acid (GABA)[20][21][22]
Physiological functions Respiratory – FEV1: FVC ratio, oxygen saturation[23][24]

Reproductive – M – semen quality and testosterone;[25][26] F – FSH, LH, estradiol[27][28]

Gastrointestinal – ALT, albumin, lipid profile[29][30][31]

Circulatory – BP, heart rate, Hb, HbA1c, platelets[32][33][34]

Musculoskeletal – Bone density handgrip, body mass index[35][36][37]

Urinary – Protein-creatinine ratio, GFR, pH[38][39][40]

Measurement

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All the major indicators mentioned in the table are numerically measurable in a laboratory or otherwise but, for many, high values are also injurious to health just as are low values. This affects the exact measurement of positive health. The optimal levels of most of these parameters are not known – thus a scale to exactly measure the level of positive health of a person is yet to be developed. However, there are parameters such as endorphins, semen quality in men, FEV1/FVC ratio, oxygen saturation, bone density, P3 amplitude, and handGrip strength whose increased value progressively indicates a better positive health.[9]

References

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  1. ^ Indrayan, Abhaya; Vishwakarma, Gayatri; Verma, Saumya; Sarmukaddam, Sanjeev; Tyagi, Asha (2023). "Quest for Biomarkers of Positive Health: A Review". Indian Journal of Community Medicine. 48 (3): 382–389. doi:10.4103/ijcm.ijcm_480_22. ISSN 0970-0218. PMC 10353687. PMID 37469906.
  2. ^ "Constitution of WHO" (PDF). World Health Organization. Retrieved 2024-08-04.
  3. ^ Misselbrook, David (2014-11-01). "W is for Wellbeing and the WHO definition of health". British Journal of General Practice. 64 (628): 582. doi:10.3399/bjgp14X682381. ISSN 0960-1643. PMC 4220217. PMID 25348979.
  4. ^ "Why "Positive Health"?". California State Journal of Medicine. 22 (1): 28. January 1924. ISSN 0093-402X. PMC 1517864. PMID 18739193.
  5. ^ Indrayan, A.; Sarmukaddam, S. B. (2000). Medical Biostatistics. Chapman & Hall/CRC.
  6. ^ Seligman, Martin E.P. (July 2008). "Positive Health". Applied Psychology. 57 (s1): 3–18. doi:10.1111/j.1464-0597.2008.00351.x. ISSN 0269-994X.
  7. ^ "Researching Strengths that Contribute to Good Health Against Illness". Positive Health. Retrieved 2023-03-14.
  8. ^ Huber, Machteld; Knottnerus, J. André; Green, Lawrence; Horst, Henriëtte van der; Jadad, Alejandro R.; Kromhout, Daan; Leonard, Brian; Lorig, Kate; Loureiro, Maria Isabel; Meer, Jos W. M. van der; Schnabel, Paul; Smith, Richard; Weel, Chris van; Smid, Henk (2011-07-26). "How should we define health?". BMJ. 343: d4163. doi:10.1136/bmj.d4163. hdl:1885/17067. ISSN 0959-8138. PMID 21791490.
  9. ^ a b c Indrayan, Abhaya; Vishwakarma, Gayatri; Sarmukaddam, Sanjeev; Verma, Saumya; Tyagi, Asha (2023-02-06). "A Review for Developing a Conceptual Framework for Objective Assessment of Positive Health for Personalized Medicine". SSRN.
  10. ^ Cruvinel, Wilson de Melo; Mesquita, Danilo; Araújo, Júlio Antônio Pereira; Catelan, Tânia Tieko Takao; de Souza, Alexandre Wagner Silva; da Silva, Neusa Pereira; Andrade, Luís Eduardo Coelho (2010). "Immune system - part I. Fundamentals of innate immunity with emphasis on molecular and cellular mechanisms of inflammatory response". Revista Brasileira de Reumatologia. 50 (4): 434–461. doi:10.1590/S0482-50042010000400008. ISSN 1809-4570. PMID 21125178.
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  13. ^ Calder, Philip C.; Carr, Anitra C.; Gombart, Adrian F.; Eggersdorfer, Manfred (April 2020). "Optimal Nutritional Status for a Well-Functioning Immune System Is an Important Factor to Protect against Viral Infections". Nutrients. 12 (4): 1181. doi:10.3390/nu12041181. ISSN 2072-6643. PMC 7230749. PMID 32340216.
  14. ^ Tardy, Anne-Laure; Pouteau, Etienne; Marquez, Daniel; Yilmaz, Cansu; Scholey, Andrew (January 2020). "Vitamins and Minerals for Energy, Fatigue and Cognition: A Narrative Review of the Biochemical and Clinical Evidence". Nutrients. 12 (1): 228. doi:10.3390/nu12010228. ISSN 2072-6643. PMC 7019700. PMID 31963141.
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  16. ^ Boelaert, K; Franklyn, J A (October 2005). "Thyroid hormone in health and disease". Journal of Endocrinology. 187 (1): 1–15. doi:10.1677/joe.1.06131. ISSN 0022-0795. PMID 16214936.
  17. ^ Sonksen, P.; Sonksen, J. (July 2000). "Insulin: understanding its action in health and disease". British Journal of Anaesthesia. 85 (1): 69–79. doi:10.1093/bja/85.1.69. PMID 10927996.
  18. ^ Simpkins, James W.; Perez, Evelyn; Wang, Xiaofei; Yang, Shaohua; Wen, Yi; Singh, Meharvan (January 2009). "The potential for estrogens in preventing Alzheimer's disease and vascular dementia". Therapeutic Advances in Neurological Disorders. 2 (1): 31–49. doi:10.1177/1756285608100427. ISSN 1756-2864. PMC 2771945. PMID 19890493.
  19. ^ Watson, Stephanie (2021-07-20). "Endorphins: The brain's natural pain reliever". Harvard Health. Retrieved 2024-08-04.
  20. ^ "Home". MoCA Cognition. Retrieved 2024-08-04.
  21. ^ Cohen, Marisa (2019-06-18). "How to Keep Your Brain Fit". WebMD. Retrieved 2024-08-04.
  22. ^ Walsh, P (2005-06-01). "The clinical role of evoked potentials". Journal of Neurology, Neurosurgery & Psychiatry. 76 (suppl_2): ii16–ii22. doi:10.1136/jnnp.2005.068130. ISSN 0022-3050. PMC 1765695. PMID 15961863.
  23. ^ Miller, Martin R.; Stanojevic, Sanja (2019-10-22). "FEV 1 :FVC Thresholds for Defining Chronic Obstructive Pulmonary Disease". JAMA. 322 (16): 1609–1610. doi:10.1001/jama.2019.13948. ISSN 0098-7484. PMID 31638669.
  24. ^ Hafen, Brant B.; Sharma, Sandeep (2024), "Oxygen Saturation", StatPearls, Treasure Island (FL): StatPearls Publishing, PMID 30247849, retrieved 2024-08-04
  25. ^ Omu, Alexander E. (December 2013). "Sperm Parameters: Paradigmatic Index of Good Health and Longevity". Medical Principles and Practice. 22 (Suppl 1): 30–42. doi:10.1159/000354208. ISSN 1011-7571. PMC 5586815. PMID 24051979.
  26. ^ Wein, Harrison (2013-09-23). "Understanding How Testosterone Affects Men". National Institutes of Health (NIH). Retrieved 2024-08-04.
  27. ^ Zaidi, Mone; Lizneva, Daria; Kim, Se-Min; Sun, Li; Iqbal, Jameel; New, Maria I; Rosen, Clifford J; Yuen, Tony (2018-07-31). "FSH, Bone Mass, Body Fat, and Biological Aging". Endocrinology. 159 (10): 3503–3514. doi:10.1210/en.2018-00601. ISSN 1945-7170. PMC 6134257. PMID 30085049.
  28. ^ Wise, Phyllis M.; Suzuki, Shotaro; Brown, Candice M. (2009-09-30). "Estradiol: a hormone with diverse and contradictory neuroprotective actions". Dialogues in Clinical Neuroscience. 11 (3): 297–303. doi:10.31887/DCNS.2009.11.3/pmwise. ISSN 1958-5969. PMC 3181927. PMID 19877497.
  29. ^ Kim, W. Ray; Flamm, Steven L.; Di Bisceglie, Adrian M.; Bodenheimer, Henry C. (2008-01-07). "Serum activity of alanine aminotransferase (ALT) as an indicator of health and disease". Hepatology. 47 (4): 1363–1370. doi:10.1002/hep.22109. PMID 18366115.
  30. ^ Belinskaia, Daria A.; Voronina, Polina A.; Shmurak, Vladimir I.; Jenkins, Richard O.; Goncharov, Nikolay V. (2021-09-25). "Serum Albumin in Health and Disease: Esterase, Antioxidant, Transporting and Signaling Properties". International Journal of Molecular Sciences. 22 (19): 10318. doi:10.3390/ijms221910318. ISSN 1422-0067. PMC 8508759. PMID 34638659.
  31. ^ "Lipids". Cleveland Clinic. 2022-11-03. Retrieved 2024-08-04.
  32. ^ Ettehad, Dena; Emdin, Connor A; Kiran, Amit; Anderson, Simon G; Callender, Thomas; Emberson, Jonathan; Chalmers, John; Rodgers, Anthony; Rahimi, Kazem (March 2016). "Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis". The Lancet. 387 (10022): 957–967. doi:10.1016/S0140-6736(15)01225-8. PMID 26724178.
  33. ^ Saxena, Arpit; Minton, Dawn; Lee, Duck-chul; Sui, Xuemei; Fayad, Raja; Lavie, Carl J.; Blair, Steven N. (December 2013). "Protective Role of Resting Heart Rate on All-Cause and Cardiovascular Disease Mortality". Mayo Clinic Proceedings. 88 (12): 1420–1426. doi:10.1016/j.mayocp.2013.09.011. PMC 3908776. PMID 24290115.
  34. ^ Johnson, Shirley A.; Van Horn, Diane L.; Pederson, Harlan J.; Marr, Jane (1966-01-02). "The Function of Platelets: A Review". Transfusion. 6 (1): 3–17. doi:10.1111/j.1537-2995.1966.tb04686.x. ISSN 0041-1132.
  35. ^ "Bone Density". Medline Plus. Retrieved 2024-08-04.
  36. ^ Rantanen, Taina (1999-02-10). "Midlife Hand Grip Strength as a Predictor of Old Age Disability". JAMA. 281 (6): 558–560. doi:10.1001/jama.281.6.558. ISSN 0098-7484. PMID 10022113.
  37. ^ Fontana, Luigi; Hu, Frank B. (June 2014). "Optimal body weight for health and longevity: bridging basic, clinical, and population research". Aging Cell. 13 (3): 391–400. doi:10.1111/acel.12207. ISSN 1474-9718. PMC 4032609. PMID 24628815.
  38. ^ Kamińska, Joanna; Dymicka-Piekarska, Violetta; Tomaszewska, Justyna; Matowicka-Karna, Joanna; Koper-Lenkiewicz, Olga Martyna (2020-07-03). "Diagnostic utility of protein to creatinine ratio (P/C ratio) in spot urine sample within routine clinical practice". Critical Reviews in Clinical Laboratory Sciences. 57 (5): 345–364. doi:10.1080/10408363.2020.1723487. ISSN 1040-8363. PMID 32058809.
  39. ^ Cimmino, Christopher J. (1998-08-01). "Benefits of direct glomerular filtration rate (GFR) determination versus creatinine-based tests for evaluating renal function". Journal of Osteopathic Medicine. 98 (8): 437–438. doi:10.1515/jom-1998-0080. ISSN 2702-3648. PMID 9747056.
  40. ^ Schwalfenberg, Gerry K. (2012). "The Alkaline Diet: Is There Evidence That an Alkaline pH Diet Benefits Health?". Journal of Environmental and Public Health. 2012: 727630. doi:10.1155/2012/727630. ISSN 1687-9805. PMC 3195546. PMID 22013455.
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