CVB Health and Society Flashcards
How does polycystic ovary syndrome affect a woman’s risk of heart disease?
Polycystic ovary syndrome exposes women to many risk factors of coronary disease
- Increased testosterone
- Low HDL
- Decreased insulin sensitivity
- Possible hypertension
These women often present with fertility problems
When do the origins of heart disease begin?
In utero
Raising taxes on tobacco products by 10% decreases tobacco sales by ____%
Raising taxes on tobacco products by 10% decreases tobacco sales by 5 %
Give some examples of individual surface constructs of culture.
What are the limitations of these surface constructs?
- Race/ethnicity
- Immagrant status
- Years in the US
- General behaviors
- Food preferences
- Friend preferences
These surface constructs do not capture how culture might intersect with factors that lead to variability the way culture affects health (gender, religion, education, income, immigrant generation)
What is the systolic blood pressure threshold at which risk for stroke mortality increases?
Risk of stroke mortality increases in a log-linear fashion for blood pressures above 115
(May be even lower; in class they talked about how there is no threshold, increased blood pressure will always mean increased stroke mortality)
Rank the managed care plans from most affordable to least affordable
- HMO (Health maintenence organization = most affordable
- POS (Point of service)
- EPO (Exclusive provider organization)
- PPO (Preferred provider organization) = least affordable
In order for something to be considered a “fundamental cause,” it must…
- 4.
In order for something to be considered a “fundamental cause,” it must…
- Influence multiple disease outcomes
- Affect these disease outcomes through multiple risk factors
- Involve access to resources that can be used to avoid risks or minimize the consequences of disease
- Have an association that is reproduced over time via the replacement of intervening mechanisms
What was the objective of the SPRINT trial?
To compare the benefit of treatment of systolic blood pressure to a target of less than 120 mm Hg (intensive treatment) with treatment to a target of less than 140 mm Hg (standard treatment) in non-diabetic patients
What are the advantages of high-deductible insurance plans?
- High network availability
- Lower premiums
- Cheaper option for rare insurance users
- Avoid market rates
- HSA (health savings account) elligible
How is the WHO model list of essential medicines selected?
- Disease prevalence
- Public health relevance
- Evidence of clinical efficacy, safety, and relative cost-effectiveness
How were the participants of the HOPE-3 trial different from the participants in the SPRINT trial?
- HOPE-3
- Intermediate risk of CVD
- Risk of a major cardiac event <1% per year
- SBP < 160
- Intermediate risk of CVD
- SPRINT
- High risk of CVD or age 75+
- 10-year CVD risk ≥15%
- SBP 130-180
- High risk of CVD or age 75+
What was the objective of the HOPE-3 study?
To determine the effects of lowering blood pressure in intermediate risk individuals (SBP <160)
[Evaluate the role of therapy in persons at intermediate risk (defined as an annual risk of major cardiovascular events of approximately 1%) who do not have vascular disease and who have a systolic blood pressure of less than 160 mm Hg (who represent the majority of middle-aged and older persons)]
What are the requirements for a POS plan?
- PCP?
- Referall to see a specialist?
- In-network benefits?
- Non-emergency out-of-network benefits?
- Emergency coverage?
- PCP? Yes
- Referall to see a specialist? Sometimes
- In-network benefits? Yes
- Non-emergency out-of-network benefits? Yes
- Emergency coverage? Yes
List some biological reasons why it is difficult to quit smoking
- Genes
- Acute and chronic effects on the brain
- Nicotine is very addictive
Describe the MPOWER framework for toboacco control (What does each letter stand for?)
- Monitor tobacco use and prevention policies
- Protect people from tobacco smoke
- Offer help to quit
- Warn about the dangers of tobacco
- Enforce bans on tobacco advertising
- Raise taxes on tobacco
Why is enrollemnt in Illinois’ insurance marketplace declining?
- Strong economy => more people are insured through work
- Open enrollment is shorter than it was in 2016
- Cuts to federal funding that supported enrollment outreach
- Trump signed a tax reform bill that repealed the ACA’s individual mandate penalty (fee for not being insured)
What is the average age of smoking initiation in the US?
14 years old
(90% of smokers started before age 18;
98% started before age 26)
Plaque biology is different in women and men. What is the effect on the risk of infarction?
In women, plaques are more likely to erode
In men, plaques are more likely to rupture
Both can lead to infarction
What is the strongest predictor of a child’s cardiovascular health?
The parent’s cardiovascular health
Who were the participants of the HOPE-3 trial?
Intermediate risk participants, as defined by teh INTERHEART risk score
(Risk of a major cardiac event <1% per year)
The SAHELI study revealed that __________, __________, and __________ factors contributed most to the explanatory models of heart disease in the South-Asian immigrants who were interviewed.
The SAHELI study revealed that physchological**, **behavioral** , and **physical factors contributed most to the explanatory models of heart disease in the South-Asian immigrants who were interviewed.
- Psychological: worry and stress cause heart disease
- Behavioral: Heating unhealthy food causes heart disease
- Physical: Increased cholosterol causes heart disease
____ years after quitting smoking, a person’s risk of coronary artery disease is similar to that of a non-smoker
15 years after quitting smoking, a person’s risk of coronary artery disease is similar to that of a non-smoker
List some of the societal burdens of tobacco use
- $$$: lost productivity, healthcare costs
- Absenteeism
- Excessive utilization of healthcare services
- Secondhand smoke
- Social stigma
According to the results of the MESA study, Blacks living in more segregated neighborhoods were % more likely to develop atherosclerosis
According to the results of the MESA study, Blacks living in more segregated neighborhoods were 20% more likely to develop atherosclerosis
Who bears the risk in a fully-insured, individual (non-group) insurance plan?
How do these plans work?
The insurance company bears the risk
Indivduals buy health insurance directly from the insurer or on the health insurance marketplace
The individual is responsible for 100% of the premium
Coverage must follow the essential health benefits standard
What percentage of adults meet the “moderate to vigorous physical activity” requirements?
~50%
What are the early (childhood) risk factors for CV disease?
- Mild increases in, LDL-C, TG
- Mild decreases in HDL-C
- High carbohydrate diet
- Increases TG by enhancing hepatic VLDL synthesis
- High VLDL, TG (associated with low HDL-C)
South Asians with stronger traditional cultural beliefs had _____ physical activity levels
South Asians with stronger traditional cultural beliefs had lower physical activity levels than South Asians with less strong cultural beliefs
Why is the Trump adiministration encouraging states to redesign their medicaid programs
(What are the goals? Potential disadvantages?)
- Let states…
- Transition to premium support models
- Access looser regulatory requirements
- Impose work requirements to enrollees
- But democrats believe…
- These changes would weaken the ACA’s coverage expansions
What would allow a patint to enroll in a health insurance marketplace plan outside of open enrollment?
A qualifying event
- Birth of a child
- Marriage
- Employment change
How does sitting affect skeletal muscle LPL?
Prolonged sitting leads to suppression of skeletal muscle LPL
This results in reduced TG uptake, and reduced HDL cholesterol production
What is more beneficial:
accumulating physical activity in short bursts throughout the day,
or
condensing it all into one sustained bout?
Neither! Both are equally beneficial (2018 guidelines)
What are the 7 building blocks included in the WHO’s health-systems framework?
SWIM-FL (SWIM For your Life)
- Service Delivery
- Health Workforce
- Health Information Systems
- Access to Essential Medicines
- Financing
- Leadership/Governance
What was the South Asians Active Together (SAATH) intervention?
An Exercise Intervention for South Asian Mothers at Risk for Diabetes
- Excercise programs and opportunities designed specifically for South Asian women
Is this an example of structural or cultural competency?
Recognizing that a patient is eating fried foods because there aren’t any healthy food options in his neighborhood
Structural
What was the intervetion in the HOPE-3 trial?
Candesartan
One in ____ women die from heart disease
One in 3 women die from heart disease
Why was the SPRINT trial stopped early?
People in the intervention arm (target BP <120) were dying less than the standard care arm (target BP <140)
According to the 2017 Blood Pressure Guidelines, initiation of drug therapy is recommended when blood pressure is _______\_mmHg in the setting of >10% predicted 10-year ASCVD risk
According to the 2017 Blood Pressure Guidelines, initiation of drug therapy is recommended when blood pressure is >130/>80 in the setting of >10% predicted 10-year ASCVD risk
What are the requirements for a PPO plan?
- PCP?
- Referall to see a specialist?
- In-network benefits?
- Non-emergency out-of-network benefits?
- Emergency coverage?
- PCP? No
- Referall to see a specialist? No
- In-network benefits? Yes
- Non-emergency out-of-network benefits? Yes
- Emergency coverage? Yes
What is driving the rising number of global CVD deaths, despite declining rates of death due to CVD?
Population growth and aging
How does the tobacco industry try to undermine tobaco control efforts?
Many states make huge revenues on tobacco - there is not a lot of incentive to fund tobacco cessation programs
Tobacco companies make up their revenue in countries where advertising bans are less strict
What are the ACA’s Cost-Sharing Reduction Programs (CSRs)?
How have they changed under the Trump administration?
Cost Sharing Reduction Programs
- Allocated money to subsidize insurance for Americans with incomes 100-250% of the poverty level
- This money must be allocated every year, but Trump has not done so
In the Multi-Ethnic Study of Atherosclerosis (MESA), what did the Z score of a neighborhood represent?
Z-score >1.96 = high segregation
Z-score 0-1.96 = medium segregation
Z-score <0 = low segregation
What were the results of the London Transport Workers study (Morris et al., 1953)?
More active people (ex: ticket checkers) had less incidence of CV events and less death at follow up if they did have a CV event than less active people (ex: conductors, bus drivers)
What were the objectives of the CARDIA study?
- Study link between neighborhood environment (food environment) and development of subclinical atherosclerosis
- Measure food environment
- Measure Coronary Artery Calcification (CAC)
What is the United Nations Sustainable Development Goal that relates to cardiovascular disease?
Under Good Health and Well Being,
Reduce premature death from chronic diseases
(including CVD) by 1/3 by 2030
Why is the shape of this curve different from the PSC data and figure (that showed increasing risk of stroke as BP increased above 115 mmHg)?
Note: the figure pictured shows achieved SBP on medications
Patients may have underlying reasons (confounding factors) for blood pressure that low (ex: heart failure)
What is reverse causality?
When the true cause and effect relationship is reversed
Ex: looking at this graph and assuming that lower blood pressure causes an increased risk of CVD
(In reality, the patients with lower achieved blood pressure typically have heart failure, or another CVD that causes lower blood pressure)
