Adolescent Health (1) Flashcards
Why is sexual health important?
Improves physical and mental health outcomes
Positively influences social and emotional wellbeing
What is the definition of good sexual health by the WHO?
A state of physical, mental and social well-being in relation to sexuality. It requires a respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence
What are the consequences of poor sexual health?
Unplanned pregnancies and abortions - 1 in 6 pregnancies are unplanned
Psychological consequences - from sexual coercion and abuse
Poor educational, social and economic opportunities for teenage mothers, young fathers and their children
HIV transmission
Cervical and other genital cancers
Hepatitis, chronic liver disease, liver cancer
Recurrent genital herpes / warts
Pelvic inflammatory disease (subsequent ectopic pregnancies and infertility)
Adverse pregnancy outcomes (maternal and neonatal)
How can poor sexual health be prevented?
Contraception
HPV immunisation
HIV prevention
Education / health literacy - changing public’s attitude to sexual health
Why is barrier protection important?
Only type of protection that can prevent all STIs
What are teenage pregnancies?
What are the consequences of teenage pregnancies?
Under 18 pregnancy
Most unplanned, 50% undergo abortions
Huge psychological and physical impacts
More likely to have poor antenatal health
Lower birth rate babies and higher infant mortality rates
Teen mothers less likely to finish education and find employment = children brought up in poverty
3x more likely to to experience post-natal depression
Risk factors to teen pregnancies and coercion / abusive relationships:
In or leaving care Homeless Involved in crime Low educational attainment Social deprivation
What has already been implemented to improve poor sexual health?
Compulsory relationships and sex teachings in secondary schools
NHS HPV immunisation programme - 12-13 y/o of all girls and boys
PrEP (pre-exposure prophylaxis) and PEP (post exposure prophylaxis) medication to reduce transmission of HIV - needs to be seeked out
Testing, diagnosis and treatment of STIs
What are the most common STI diagnosis?
49% - chlamydia
15% - gonorrhoea
11% - first episode of genital warts
7% - first episode of genital herpes
Highest i heterosexual 15-24 y/os
What can increase sexual dysfunction?
Smoking
Prolonged drug or alcohol use
Stress
Poor mental health
What must doctors do with their patients?
Take an opportunistic approach Be non-judgmental and empathetic Holistic Inform patients and facilitate decisions Provide them access to support / services
What is pre-natal care such an important time?
Impacts positively on future health outcomes for mother and baby
Amenable time for woman to make positive changes in their behaviour
Behaviour changes more likely to be long-lasting
Why is maternal nutrition important?
Plays a crucial role in maintaining the health of the developing foetus
e.g. link has been found between maternal and childhood excess weight
Which 2 micronutrients are supplemented during pregnancy?
Folic acid - recommended prior to conception and up to 12 weeks of pregnancy to reduce the risk of neural tube defects e.g. spinal bifida
Vitamin D supplements - throughout pregnancy and breast-feeding to promote bone health in foetus and reduce risk of ricketts
What should a pre-natal diet consist of?
Folate-rich foods - green leafy vegetables, peas, kidney beans, chickpeas
Don’t overeat ‘for two’
Plant based diet is very good
What are the benefits of physical activity during pregnancy?
Decreased risk of: Hypertension in pregnancy Pre-eclampsia Gestational diabetes Severity of depressive symptoms during and after pregnancy
Why is maternal mental health important?
Poor mental health in the mother can impact their ability to bond with the baby and respond to baby’s needs
Why is attachment type important in baby?
Insecure attachment can affect child’s emotional and social development
How does drinking alcohol during pregnancy affect the foetus?
Early miscarriage
Premature birth
Restricted growth
Still birth
Cognitive delay
Foetal alcohol spectrum disorders - irreversible and avoidable
Foetal alcohol syndrome - characterised by small stature, distinct facial features, abnormal palmar creases, cardiac defects, joint contractures, cognitive deficits
How does smoking during pregnancy affect the foetus?
Increases risk of low birth rate
Increases risk of respiratory conditions, T2DM and obesity
Increase in miscarriages, premature births and perinatal deaths
What is the microbiome?
Genetic material of all the microbes that live on or within the body - mostly found in the gut
Consists of bacteria, fungi, parasites and viruses including their genes found co-existing throughout the human body
Interacts with the nervous system (NS) and immune system
Plays an important role in health and disease
What factors influence diversity and health or the microbiome?
Genes Age Environment Stress Diet Physical activity
Healthy lifestyle = healthy microbiome
How does maternal microbiome impact on future health of the child?
In the uterus, foetus is exposed to maternal microbial DNA and maternal microbes
During birth - baby is exposed to vaginal and / or skin microbes
This rapidly colonises and imfluences diversity of baby’s microbiome
Breastfed babies have significantly different diversity of microbiomes than formula milk fed babies due to muicrobiome passed from mother to child via breast milk and skin when baby suckles
What environmental factors can influence maternal and foetal health?
2 main man-made chemicals found on the umbilical cord during birth:
- PFOS (perfluoro-octance sulfonate) - found on electronics, textiles and non-stick cookware
- PFOA (perfluorooctanoate) - found on carpets, textiles, leather, household and industrial cleaning products
Unknown the long term effects of this on the foetus
What is the role of the gut microbiome in secondary metabolite production?
Breaks down luminal compounds sto more useful metabolites
Detoxify ingested toxins
Synthesises antimicrobial peptides
Break down of dietary fibre and resistant starches
Fermentation by Firmicutes releases short chain fatty acids (SCFAs) = energy source and lowers the pH
pH of colon dictates what micro-organisms can survive there, and interacts with the immune and nervous systems
SCFAs = maintain local (gut) and systemic immune homeostasis and gut-brain axis
What is the role of the gut microbiome in vitamin production?
Vitamin K synthesis and several components of vitamin B is undertaken by the gut microbiome
What is the role of the microbiome in the immune system?
Homeostasis of immune system between tolerating beneficial micro-organisms and preventing pathogen overgrowth
Toxin enters bloodstream –> dendritic cell detects this –> acute proinflammatory immine response –> toxin removed
Dendritic cells constantly monitor gut environment and produce appropriate immune responses - either pro or anti inflammatory - through cytokine release and regulatory T cell production
How can the balance between the microbiome and gut go wrong?
Constant exposure to lower level harms e.g. poor diet or unhealthy microbiome exposure = chronic low level inflammatory state = chronic disease
Unhealthy diet makes intestinal membranes more permeable = ‘leaky’ gut = allows LPSs through
What are LPSs and why are they harmful?
LPS = lipopolysaccharides can be harmful
They form the outer coat of certain types of microbiota, and can cross into the bloodstream due to a ‘leaky’ gut - causes stress and inflammatory response
How does the microbiome interact with the entertic and central nervous systems? (ENS and CNS)
Gut-brain axis pathway = two way communication system via ENS, CNS (vagus nerve) and cytokines in the blood
Brain can induce stress mediated changes in the GI tract e.g. motility change
GI tract can send stress mediated responses to the CNS via metabolites, neural afferent circuits etc.
Microbiome involved in the metabolism of tryptohan, which is involved in the production of serotonin - gut motility can be impacted by serotonin
What is the structure to implement lifestyle medicine in a consultation?
Ask permission to discuss x, y, z
Find out what she already knows
Discuss benefits specific to their situation
Find out about risks / barriers for the patient to carrying out x, y, z
Explore patient’s motivations
Identifying fears and barriers for patient
Screening for x, y, z
Positive reinforcement of current health behaviour and future plans
Using a positive and empowering approach
Signposting to further resources
Sex VS Gender:
Sex - biological, assigned at birth
Gender - social construct, personal perception + identity
What is healthy life expectancy and what is the trend in women?
No. of years lived in fairly good health
Declining for women since 2010
Women are more likely to:
More likely to move into residential care
More likely to provide informal, unpaid care to relatives and children
More likely to be obese
More likely to develop cancer
More likely to develop dementia
Why does obesity increase the chances of developing cancer?
Fat tissues are:
Inflammatory
Produce sex hormones (oestrogen)
Produce growth hormones (e.g. insulin, growth factor)
= promote rapid cell division
= increased risk of cancer
Why are females less physically active than males?
Societal factors:
Fear of judgement
Lacking confidence
Lacking time
What is clinician bias?
Stereotyped attitude or belief about a patient
e.g. women are more likely to receive an initial misdiagnosis following an MI
so women face a 70% increased risk of death after 30 days
What is the data published in medicine biased?
After thalidomide scandal - new law in 1977 banned women of childbearing age to be part of clinical trials = medications only tested and so suitable for men
Not until 1993 this law was overturned - all minority groups must be represented in clinical trials
Women are more likely to:
[finance]
Gender pay gap amongst all employees 17.4% in 2019, 15.5% in 2020
Women are over-represented in lower paid, lower skilled jobs
More likely to be financially insecure
Health workforce = 70% women
But on represented 25% in leadership positions
What is driving the pay gap between men and women?
Women and men do different jobs
Jobs done by women are underrated
Men hold more the most senior roles
Women pay a ‘motherhood penalty’
During the pandemic, mothers were more likely to:
Quit / lost their job
Be furloughed
Contribute to childcare
Contribute to household responsibilities
Women and girls more likely to experience:
Sexual abuse
Physical abuse
Neglect
Domestic abuse
All causes of premature death
All negatively affect physical, mental, reproductive and sexual health
What is oxytocin?
When is it produced?
Hormone - produced in the hypothalamus and released from posterior pituitary gland
Produced during social connections, sex, labour and childbirth
What does oxytocin promote? Why is it released?
Promotes social bonding, prosocial behaviour, empathy, elevated mood and stress reduction
Why is good quality social connection important?
Live longer and have healthier lifestyle behaviours
Suffer less from mental health issues and have better recoveries from mental and physical stressors
Have better cardiovascular health and a stronger immune system
Experience a lower severity of perceived physical pain
What is meant by:
Intimate connections
Relational connections
Collective connections
Intimate connections - people who personally love and support you e.g.family, friends and partners
Relational connections - people who you see on a regular basis and may share an interest with e.g. work colleagues or a local barista who makes your coffee
Collective - people who share a common affiliation or group membership with you e.g. people from your faith group
How do men and women experience relationships differently?
Women are more likely to have broader and more intimate friendships than men. They are more likely to discuss personal matters and feel more supported during times of stress.
Negative aspects of close relationships are more likely to affect women and people with a lower socioeconomic status. Women report higher psychological distress and negative interactions, despite having broader and more intimate relationships.
What are the consequences of domestic abuse during pregnancy?
Miscarriage
Infection
Premature birth
Injury or death of the baby following birth
How can healthcare professionals support women experiencing domestic abuse?
Elicit information in a sensitive and empathetic manner
Signpost to appropriate sources for guidance and safety
Plan follow-up care with flexible appointments as needed, and refer to appropriate professionals, such as a domestic abuse support worker
Address their fear of involvement of social or child protection services and reassure confidentiality where appropriate]
Allow the patient to have autonomy over their decisions, without feeling pressured
Respect their decisions and remain non-judgemental]
Remind them that they are not alone in their experience and that there is always help available.
