Adolescent, maternal and women's health Flashcards
Why is sexual health important?
- Improves physical health outcomes
- Improves mental health outcomes
- Positively influence social and emotional wellbeing
What is good sexual health?
‘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’
How can you prevent consequences of poor sexual health?
- Contraception
- HPV immunisation
- HIV prevention
- Education / Health literacy
What is the clinician’s role for contraception?
- Provide information around contraception options
- Educatie patients about risk and consequences of unprotected sex
- Facilitate prompt access to contraception and sexual health services
How common are unplanned pregnancies?
- 1 in 6 pregnancies in UK are unplanned
- More common in young single women
- Smoking, drug use and depression are more common in women who report unplanned pregnancies
What is the result of conception under the age of 18?
- Majority unplanned
- 50% result in abortion
- Huge physical and psychological impact
- Higher risk of poor antenatal health
- Lower birth weight babies
- Higher infant mortality rate
- Less likely to finish education
- Less likely to find employment
- More likely to live in poverty
- 3x more likely to suffer post0natal depression
When are you more vulnerable to conception under the age of 18?
- In or leaving care
- Teenagers that are homeless
- Involved in crime
- Lowe reducation attainment
- Social deprivation
- More vulnerable to coercive and exploitative sexual relationships
What does the HPV vaccine help?
protect against cancer caused by HPV including:
- Cervical cancer
- Some mouth and throat (head and neck) cancers
- Some cancers of the anal and genital areas
- It also helps protect against genital warts
What is PrEP?
course of HIV drugs taken by a HIV negative person to lower the chance of becoming infected with HIV in the future
What is PEP?
anti-HIV medication that is prescribed to a HIV negative person, after a postal exposure to HIV to protect them from being infected with HIV
Why is it important to have an opportunistic approach to STI prevention?
MAKING EVERY CONTACT COUNT - for STI who at most risk
- Initiate conversations about sexual health
- increase screening uptake
- Increasing subsequent diagnosis and treatment of STIs
When are STIs more common?
- Highest în heterosexual people aged 15-24 years old
- High rates in BAME and deprivation populations
- MSM high rates
How is their open access to sexual treatment?
digital services but not equally spread
What can lead to increased sexual dysfunction?
- smoking and prolonged alcohol misuse
- stress and poor mental health
How should you approach sexual health with patients?
- opportunistic approach
- Non judgmental
- Empathetic
- Holistic
- Informing patients and facilitating decisions / access to support and services
What is the first stage for intervention when taking a life course approach?
pre-conception
What is the most prevalent STI according to NATSAL?
HPV
Why is pregnancy a good time to discuss lifestyle?
- Pregnancy can be a time when mothers are amenable to change
- Long lasting behaviour change
- Impact positively on future health outcomes
What is drugs and alcohol use also associated with?
risky sexual behaviour, sexual assault and inter-partner sexual violence
What maternal supplements are reccomended?
- Folic acid 400mcg OD prior to conception and up to 12/40
2. Vitamin D 10mcg OD throughout pregnancy and during breastfeeding
What is folate rich foods?
- Green leafy vegetables
- Peas
- Kidney beans
- Chickpeas
What is physical acitivity during pregnancy associated with a decreased risk of?
- Hypertension in pregnancy
- Pre-eclampsia
- Gestational diabetes
- Reduced severity of depressive symptoms
What is drinking alcohol during pregnancy associated with?
- Early miscarriage
- Premature birth
- Restricted growth
- Still birth
- Cognitive delay
- Foetal alcohol spectrum disorders
- Foetal alcohol syndrome
What are foetal alcohol syndrome characteristics?
- Small stature
- Facial features (microcephaly, microphthalmia, short palpebral fissures, epicentral folds, a small or flat mid face, a flat elongated philtrum, a thin upper lip, and a small chin
- Abnormal palmar creases
- Cardiac defects
- Joint contractures
- Cognitive deficits
What does smoking in pregnancy cause?
- Up to 2,200 premature births
- 5,000 miscarriages
- 300 perinatal deaths every year in UK
- Low birth rate
- Respiratory conditions
- Problems of ENT
- Diabetes
- Obesity
What is the maternal microbiome?
- Majority of microbes found in gut
- Interacts with nervous system and immune system
- Plays an important role in health and disease
What factors influence diversity and health of the microbiome?
- Genes
- Age
- Environment
- Stress
- Diet
- Physical activity
What are the impacting factors on gut microbiome?
- Diet
- Stress
- Infant feeding method (breast fed vs formula)
- Birthing process (if through vagina different microbiome)
- Lifecycles stages
- Geography
- Pharmaceuticals
What has been found in umbilical?
PFOS and PFOA
Is it true that diet including whether a baby is breast milk or formula milk fed effects their microbiome?
true
Is it true that in utero the foetus is not exposed to the maternal microbiome?
false, in utero foetus is exposed to both microbial DNA and maternal microbes
Is it true that the microbiome is the bacteria, fungi, parisites and viruses found in GI tract?
- False
- The microbiome consists of bacteria, fungi, parasites and viruses including their genes found co-existing throughout the human body.
- This can also be found within and on all multicellular organisms, not just in the GI tract of humans.
- Microbiota is the term usually used for a group of micro-organisms found within a certain environment.
- For example, the ‘gut microbiome’ refers to all microbes and their genetic material found in the gut, whereas ‘gut microbiota’ refers to the micro-organisms in the gut only
Does the method of delivery of a baby influence its microbiome?
- Yes
1. Babies born vaginally are initially colonised by organisms from the maternal vagina to which they are exposed during delivery
2. Babies delivered via caesarean section are mostly colonised by maternal skin flora and tend to have significantly less diverse and fewer bacteria in their gut in early life compared with those delivered vaginally
Does the microbiome have immunomodulatory properties?
- Yes
- It is a complex and evolving field
- The microbiome curbs the growth of pathological microorganisms and has a role in balancing proinflammatory and anti-inflammatory signals
What is the microbiome?
trillions of bacteria, fungi, parasites and viruses and their own genetic material that co-exist on or inside our bodies
Is a person’s microbiome unique?
yes
What is the largest microbiome?
- GI tract microbiome is the largest
- The large intestine constitutes over 70% of the microbiome with Firmicutes and Bacteroidetes being the two main phyla present
What are the differences in distribution of species throughout the GI tract?
- temporal (oesophagus to colon)
- spatial (luminal versus mucosal)
Where does the GI tract microbiome derive its nutrition from?
- from host dietary intake
- shed epithelial cells
What physiological processes is the gut microbiome involved in?
- Metabolite and vitamin production
- Immune system
- Nervous system
What is one of the main roles of the gut microbiome?
producing secondary metabolites by breaking down luminal compounds to more useful metabolites
What can the reactions do?
- detoxify ingested toxins to make these less harmful
2. gut microbiome capable of synthesising antimicrobial peptides
What can dietary fibres and resistant starches only be broken down and fermented by?
enzymes from the gut microbiome in the colon
What does fermentation predominatelt by Firmicutes release?
short chain fatty acids (SCFAs) which
are a rich source of energy and lower the pH in the colon
What does pH of the colon dictate?
the
type of micro-organisms capable of surviving there and also interacts with both the immune
and nervous systems
What do SCFAs do?
- SCFAs (particularly butyrate) play a vital role in maintaining local (gut) and systemic immune homeostasis
- May also play a role in gut-brain axis
What vitamin production is undertaken by gut microbiome?
- Vitamin K synthesis
2. Several components of vitamin B
What must the GI tract mucosal immune system tolerate in homeostasis?
beneficial commensal micro-organisms whilst simultaneously preventing overgrowth of pathogens to keep us healthy
Why is this helpful and protective from an evolutionary perspective?
- If a ‘toxin’ such as pathological organism enters the gut, dendritic cells can detect this and help initiate an acute proinflammatory immune response to rid the body of the toxin
- However, if routinely exposed to lower level harms common in modern day life for example, a poor
diet or exposure to an unhealthy microbiome in the lumen, a low level, chronic
inflammatory state can occur which is detrimental to health and associated with chronic
disease
What are dendritic cells always doing?
constantly monitoring their environment and contents
within the gut (including the microbiota) and produce an appropriate immune response
What type of immune response can there be?
either be pro-inflammatory or anti-inflammatory responses through cytokine
release and regulatory T cell production depending on what they find
What else can an unhealthy diet damage?
- damage the integrity of the delicate and barrier between the
gut and rest of the body - making it permeable, sometimes referred to as a ‘leaky’ gut
What can this leaky gut lead to?
This can lead to harmful lipopolysaccharides (LPS’s) which form the outer coat of certain
types of microbiota crossing into the blood stream
What do the LPS do?
In the gut lumen, LPS’s don’t cause
any damage, but if they cross over into the blood stream, this causes a stress and
inflammatory response
What else does the gut microbiome do?
While the precise mechanisms are unclear it is speculated that through direct
and indirect pathways the gut microbiome can regulate innate and adaptive immune cells.
