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Y2 - LMAP > Adolescent Health (1) > Flashcards

Adolescent Health (1) Flashcards

1
Q

Why is sexual health important?

A

Improves physical and mental health outcomes

Positively influences social and emotional wellbeing

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2
Q

What is the definition of good sexual health by the WHO?

A

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

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3
Q

What are the consequences of poor sexual health?

A

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)

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4
Q

How can poor sexual health be prevented?

A

Contraception
HPV immunisation
HIV prevention
Education / health literacy - changing public’s attitude to sexual health

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5
Q

Why is barrier protection important?

A

Only type of protection that can prevent all STIs

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6
Q

What are teenage pregnancies?

What are the consequences of teenage pregnancies?

A

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

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7
Q

Risk factors to teen pregnancies and coercion / abusive relationships:

A 
In or leaving care
Homeless
Involved in crime 
Low educational attainment
Social deprivation
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8
Q

What has already been implemented to improve poor sexual health?

A

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

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9
Q

What are the most common STI diagnosis?

A

49% - chlamydia
15% - gonorrhoea
11% - first episode of genital warts
7% - first episode of genital herpes

Highest i heterosexual 15-24 y/os

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10
Q

What can increase sexual dysfunction?

A

Smoking
Prolonged drug or alcohol use
Stress
Poor mental health

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11
Q

What must doctors do with their patients?

A 
Take an opportunistic approach
Be non-judgmental and empathetic
Holistic
Inform patients and facilitate decisions
Provide them access to support /  services
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12
Q

What is pre-natal care such an important time?

A

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

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13
Q

Why is maternal nutrition important?

A

Plays a crucial role in maintaining the health of the developing foetus

e.g. link has been found between maternal and childhood excess weight

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14
Q

Which 2 micronutrients are supplemented during pregnancy?

A

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

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15
Q

What should a pre-natal diet consist of?

A

Folate-rich foods - green leafy vegetables, peas, kidney beans, chickpeas

Don’t overeat ‘for two’
Plant based diet is very good

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16
Q

What are the benefits of physical activity during pregnancy?

A 
Decreased risk of:
Hypertension in pregnancy
Pre-eclampsia 
Gestational diabetes
Severity of depressive symptoms during and after pregnancy
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17
Q

Why is maternal mental health important?

A

Poor mental health in the mother can impact their ability to bond with the baby and respond to baby’s needs

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18
Q

Why is attachment type important in baby?

A

Insecure attachment can affect child’s emotional and social development

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19
Q

How does drinking alcohol during pregnancy affect the foetus?

A

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

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20
Q

How does smoking during pregnancy affect the foetus?

A

Increases risk of low birth rate
Increases risk of respiratory conditions, T2DM and obesity
Increase in miscarriages, premature births and perinatal deaths

21
Q

What is the microbiome?

A

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

22
Q

What factors influence diversity and health or the microbiome?

A 
Genes
Age
Environment
Stress
Diet
Physical activity

Healthy lifestyle = healthy microbiome

23
Q

How does maternal microbiome impact on future health of the child?

A

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

24
Q

What environmental factors can influence maternal and foetal health?

A

2 main man-made chemicals found on the umbilical cord during birth:

  1. PFOS (perfluoro-octance sulfonate) - found on electronics, textiles and non-stick cookware
  2. PFOA (perfluorooctanoate) - found on carpets, textiles, leather, household and industrial cleaning products

Unknown the long term effects of this on the foetus

25
Q

What is the role of the gut microbiome in secondary metabolite production?

A

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

26
Q

What is the role of the gut microbiome in vitamin production?

A

Vitamin K synthesis and several components of vitamin B is undertaken by the gut microbiome

27
Q

What is the role of the microbiome in the immune system?

A

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

28
Q

How can the balance between the microbiome and gut go wrong?

A

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

29
Q

What are LPSs and why are they harmful?

A

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

30
Q

How does the microbiome interact with the entertic and central nervous systems? (ENS and CNS)

A

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

31
Q

What is the structure to implement lifestyle medicine in a consultation?

A

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

32
Q

Sex VS Gender:

A

Sex - biological, assigned at birth

Gender - social construct, personal perception + identity

33
Q

What is healthy life expectancy and what is the trend in women?

A

No. of years lived in fairly good health

Declining for women since 2010

34
Q

Women are more likely to:

A

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

35
Q

Why does obesity increase the chances of developing cancer?

A

Fat tissues are:
Inflammatory
Produce sex hormones (oestrogen)
Produce growth hormones (e.g. insulin, growth factor)

= promote rapid cell division
= increased risk of cancer

36
Q

Why are females less physically active than males?

A

Societal factors:
Fear of judgement
Lacking confidence
Lacking time

37
Q

What is clinician bias?

A

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

38
Q

What is the data published in medicine biased?

A

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

39
Q

Women are more likely to:

[finance]

A

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

40
Q

What is driving the pay gap between men and women?

A

Women and men do different jobs
Jobs done by women are underrated
Men hold more the most senior roles
Women pay a ‘motherhood penalty’

41
Q

During the pandemic, mothers were more likely to:

A

Quit / lost their job
Be furloughed
Contribute to childcare
Contribute to household responsibilities

42
Q

Women and girls more likely to experience:

A

Sexual abuse
Physical abuse
Neglect
Domestic abuse

All causes of premature death
All negatively affect physical, mental, reproductive and sexual health

43
Q

What is oxytocin?

When is it produced?

A

Hormone - produced in the hypothalamus and released from posterior pituitary gland

Produced during social connections, sex, labour and childbirth

44
Q

What does oxytocin promote? Why is it released?

A

Promotes social bonding, prosocial behaviour, empathy, elevated mood and stress reduction

45
Q

Why is good quality social connection important?

A

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

46
Q

What is meant by:

Intimate connections
Relational connections
Collective connections

A

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

47
Q

How do men and women experience relationships differently?

A

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.

48
Q

What are the consequences of domestic abuse during pregnancy?

A

Miscarriage
Infection
Premature birth
Injury or death of the baby following birth

49
Q

How can healthcare professionals support women experiencing domestic abuse?

A

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.

Y2 - LMAP (24 decks)

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