Cardiorespiratory Flashcards

Question

describe the population strategy of prevention?

Answer 1

lower the exposure of WHOLE population. •PROS: Large potential to prevent more deaths. •CONS: Small individual benefit, poor motivation (why should I make this change if I’m already @ risk?), low benefit:risk (must be safe to do!)

Answer 2

``` ApoB/ApoA-1 - 49% smoking. - 36% diabetes - 10% hypertension - 18% abdominal obesity - 20% psychosocial - 33% fruit and veg daily - 14% exercise - 12% alcohol - 7% ```

Answer 3

* These are based on DATA from the Framingham Study, a cohort study looking at RFs + outcomes. * 10,000 subjects analysed for BP, diabetic status, smoking status + outcomes measured. * Found numerous factors were associated with ↑ risk of CHD, CVA, HF and peripheral vascular disease.

Answer 4

* Illustrates visually to patient – RED = BAD * Informs the clinician as to who to treat * Emphasises what’s important in terms of modifiable risk factors (i.e. more important to stop smoking than to eat extra fruit + veg)

Answer 5

* Where are we now? Baseline data, how many people have the disease? How many at risk? WHO is affected? * Where do we want to go? We want less. How much? Is that realistic? Will we have balance ↓ across demographic/socioeconomic classes? Where we draw the line, between treating ‘well people’ for a disease they don’t have? * How to get there? -> Evidence base should inform us what’s effective – diet? Exercise? Medication? * How will we know if we’re there? Measures of…death? Cashed prescriptions? + NSFs

Answer 6

• Policies set by NHS to define care standards for major diseases (Cancer, CHD, COPD, DM etc.) or for specific patient groups (elderly, palliative care) • TWO main roles: 1) Set formal quality requirements, based on best evidence for/against treatments/services 2) Offer strategies/support to help organisations attain these

Answer 7

* Department of Health create the strategy, after IDing need for one * Strategic Health Authority implement + manage it * Consultation with patients, carers, public, charities, healthcare professionals and industry

Answer 8

* Look at risk factors and patient pathway (rapid referral, diagnostic testing) and ID areas for improvement. * ID what priorities should be • Evidence in support of proposed interventions * Should include clear (SMART) goals, which should be quantified and time-related * Outline what measures would be used to monitor this * Outline HOW this change can be implemented

Answer 9

* Incidence ↑ with age * M>F * FH * Social disadvantage * South Asia - ↑ mortality of IHD + stroke, c.f Europeans * African/Caribbean - ↓ risk of IHD mortality but ↑ stroke, c.f. Europeans

Answer 10

* Difference in access to healthcare, health-seeking behaviour – different ethnicities may hold firm health beliefs, which arise from their native culture, ↓ likely to seek doctor help. * Inaccessible due to language barrier * Genetic susceptibility * Discrimination – Inverse care law * ↑diabetes prevalence in S asians * Smoking prevalence↑, ↓ F+V consumption, ↓ exercise levels in Bangladeshi population

Answer 11

• Oestrogen may have protective effect – HRT  ↓ IHD | o May be selection bias as HRT users typically healthier in general, than non-HRT users.

Answer 12

* Larger populations of of those at ↑risk -> ↑Average population risk * Should be used to target intervention where it is needed most i.e. community education in areas with ↑population of those at risk. * Need to address other barriers – to focus on prevention i.e. provision of information, interpreter access

Answer 13

* UK incidence of IHD is falling, in line with most of developed world. * Eastern Europe has the reverse pattern!! * Continual flux of race/ethnicity in our population, carries with it changing risks for various diseases.

Answer 14

* HYPERTENSION * SMOKING (↑50%) * DIABETES * TOTAL CHOLESTEROL + HDL:LDL RATIO

Answer 15

* AGE * SEX * FAMILY HISTORY * ETHNICITY * SOCIO-ECONOMIC POSTION (?)

Answer 16

↓numbers but ↑teenage F smokers | Factor with one of highest population attributable risk

Answer 17

– thought to be responsible for 25-50% of CVS deaths per year o Prevalence↑ rapidly worldwide o Factor with one of highest population attributable risk

Answer 18

↑prevalence rapidly across the westernised world | o Also has high population attributable risk

Answer 19

All have ↓ recently – accounts for reduction from 70s

Answer 20

* Visual aids + demonstration of how altering lifestyle can ↓ risk * JBS2 or QRISK online aids * 2 mmHg ↑  7% ↑ in CVD and a 10%↑ in Cerebrovascular disease * Inform that diet and exercise are the MOST EFFECTIVE methods of ↓ CVD risk * If ↓ risk, less or no need to take medication (i.e. statins)

Answer 21

* BENEFICIAL – Advice from healthcare professionals re: ↓Na+/Cholesterol diet, antismoking interventions (NRT, Buproprion, Varenicline), exercise advice, * LIKELY TO HELP - counselling to ↑activity levels, self-help materials, telephone advice service on smoking cessation * INEFFECTIVE/HARMFUL – acupuncture in smoking cessation, anxiolytics in smoking cessation Studies of these influences are bound to be susceptible to confounding factors and also are very heterogeneous, making meaningful meta-analyses DIFFICULT to assess. However trials have showed benefit.