Early Environmental & Biological Impacts on Lifelong Health

Question 1

What challenges could the fetus face in utero that might have lasting impact on its health (6)?

Answer 1

• Foetal infection in utero
• Maternal nutrition
• Maternal illness
• Maternal stress
• Maternal medication
• Environmental factors / exposures

Question 2

What are the influences on long term health and risk of disease divided into (2)?

Answer 2

• Biological influences (‘Nature’)
• Social and Environmental cues (‘Nurture’)

Question 3

What are the biological influences on long term health and risk of disease (2)?

Answer 3

• Genetics
• Epigenetics

Question 4

What are the social and environmental influences on long term health and risk of disease (5)?

Answer 4

• Environment (Neighbourhood, School)
• Family
• Nutrition (maternal and foetal / child)
• Social - behaviours seen – substance use, care giver behaviour
• Health Provisions

Question 5

What is the Barker Hypothesis: Developmental Origins of Health and Disease (DOHaD) Hypothesis?

Answer 5

• Idea of programming in utero
• Leads to epigenetic changes which influence development and physiology

Epigenetics: heritable changes in marks on the DNA that do not change the nucleotide sequence but influence how genes are expressed (where, when and how much a gene is switched on or off)

Question 6

Give an example of the Barker Hypothesis: Developmental Origins of Health and Disease (DOHaD) Hypothesis.

Answer 6

1. Undernutrition in utero
2. Overnutrition as a child
3. Increased risk of ‘Metabolic Syndrome’
4. Which in turn leads to increased risk of cardiovascular events

Question 7

Where can the Barker Hypothesis: Developmental Origins of Health and Disease (DOHaD) Hypothesis be used?

Answer 7

There is a link between early environmental exposures and major diseases such as:
* Cardio-vascular disease
* Type 2 diabetes
* Lung disease
* Cancer risk
* Neurological, special sense and intellectual development
* Allergic and auto-immune diseases

Question 8

What are the aims of NHS Healthy Child Programme?

Answer 8

Aims to prevent disease and promote good health
* Universal
* Reduce health inequalities

• Health Promotion (Obesity prevention is a key aspect)
• Supporting care giving and care givers
• Screening
• Immunisation
• Identification of high-risk families/ individuals for additional support
• Signposting
  
  • accident prevention
  • dental hygiene

Question 9

What makes up a good screening test (disease 3 / test 3)?

Answer 9

The disease it is screening for:
* Should be able to identified early / before critical point
* Treatable
* Prevent / reduce morbidity / mortality

The test should be:
* Acceptable / Easy to administer
* Cost effective
* Reproducible and accurate results

Question 10

Name one screening test undertaken pre-conception in the NHS Perinatal Screening Programme.
* What is being tested for?
* Who is being tested (mother or foetus / child)?

Answer 10

Diabetic eye (DE) screening (red box):
* Microvascular complications of T1DM / T2DM
* Offered to women with T1DM / T2DM annually

Question 11

Name one screening test undertaken in the first trimester in the NHS Perinatal Screening Programme.
* What is being tested for?
* Who is being tested (mother or foetus / child)?

Answer 11

Screening for inherited conditions (pink box):
* Sickle cell anaemia / thalassaemia
* The foetus

Question 12

Name one screening test undertaken in the second or third trimester in the NHS Perinatal Screening Programme.
* What is being tested for?
* Who is being tested (mother or foetus / child)?

Answer 12

Screening for foetal anomalies (green box):
* Down’s syndrome and foetal anomalies
* The foetus

Question 13

Name one screening test undertaken in the newborn period in the NHS Perinatal Screening Programme.
* What is being tested for?
* Who is being tested (mother or foetus / child)?

Answer 13

Screening for newborn hearing (blue box):
* Newborn hearing
* The newborn