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aBaSLM > Everything again > Flashcards

Everything again Flashcards

1
Q

USPSTF obesity

A

If BMI >30 then refer to multicomponent intensive behavioural intervention

if BMI >25 and BM/lipids/HTN then the same

If not, individualise

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2
Q

Fasting mimicking diet … Cheng 2003

In MICE:

In Humans:

A

MICE:
4 day fast, 1 day re-feed
sox 17 –> pdx1 –> ngn3 –> B cell region

Acronym (Sox on, Pack for the day, Now go!)

In Humans
mTOR/PKA normally reduce ngn3 and sox2 activity.
Fasting reduces mTOR/PKA inhibition, thus increasing insulin.

Exogenous IGF1 prevents this, whilst inhibiting mTOR/PKA recapitulates

(Acronym - Park you Motor, Now you’ve Stopped)

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3
Q

Diabetes remission numbers across the studies:

LookAHEAD at 1 and 4 years?

DiRECT per weight category? (also how many practices, pts per arm?)

How about the ADA diet?

A

LookAHEAD - 2000 in each arm - lower intensity - 11% at 1 year remission or partial, 7.5% at 4 years

ADA 2%

DiRECT - 49 practices, 200 each arm - 46% at 1 year BUT dependent on weight loss

DiRECT per weight category:
0 - 0%
<5 - 7%
5-10 - 34%
10-15 - 57%
>15 - 86%

(notice 345786 for the last weight categories.. just the 6 is out of order)

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4
Q

DiRECT study:

Weight loss overall

How many lost the target weight?

Per weight category?

Whats the acronym to remember?

A

DiRECT - 49 practices, 200 each arm - 46% at 1 year BUT dependent on weight loss

24% lost the target weight

DiRECT per weight category:
0 - 0%
<5 - 7%
5-10 - 34%
10-15 - 57%
>15 - 86%

(notice 345786 for the last weight categories.. just the 6 is out of order)

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5
Q

Social media and depression:

What is the evidence mentioned?
Age-group?
Affected proportion?

A

1700 19-32 year olds

Top quartile had highest rates of depression

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6
Q

How does a plant based diet affect the different genders moods?

A

MAWS

Plant based diet reduces anxiety in men, and stress in women

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7
Q

ACC and AHA key nutrition guidelines:

For cholesterol - three grade ? guidelines:

For BP - 2 grade ? and 1 grade ?:

A

Cholesterol, GRADE A:
Saturated fat 5-6% of caloreis
Plant based and varied diet, low fat dairy, whole grains
Remove transfats

Blood pressure, GRADE A:
PB varied diet as above
Lower sodium in your diet

GRADE B: <2400mg sodium target, <1500mg better and <1000mg best

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8
Q

US dietary pattern - % processed and unprocessed?

A

Processed 63%, unprocessed animal 25%, plant based 12% (6% of which unprocessed)

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9
Q

Knowlers trial

Rates of diabetes per 100 years for placebo, metformin and lifestyle

RR %

and NNT

A

11/7.8.4.8

31% and 58%

13.9 and 6.9

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10
Q

Diabetes diagnosis

HbA1c
Fasting BM
2hr OGTT

A
  1. 6%-6.5%
  2. 6/100 - 7.0/126
  3. 8/140 - 11.1/200
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11
Q

When should you screen for diabetes?

A

If over 45 years - 3 yearly

If overweight and 1 or more risk factor

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12
Q

4 benefits of physical activity

A

Less disabling conditions
Less chronic conditions
Weight maintenance
Fitness

CDEF
Conditions, Disabling, oEbesity, Fitness

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13
Q

Deconditioning: Definition and comparative prevelance?

A

State from being consistently PI, resulting in FUNCTIONAL LOSS>

More common than HTN or DM

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14
Q 
PA and health stats:
Premature deaths
Worldwide PI decreased by 25%
Burden of 4 diseases?
Attributable % of all cause moraltiy
A

1:10
1.3million
CHD 6%, DM2 7%, breast/colon ca 10%
16% men (cancer + CHD), 17% women (cancer + DM2)

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15
Q

Non-vigorous PA and morality benefit:

% reduction at 2.5 hours and 7 hours

A

19% and 24%

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16
Q

Sitting - attributable fraction of all cause mortality?

A

6.9%

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17
Q

exerciseismedicine.org - what do they offer?

A

a health campaign to make PA and exercise a standard part of disease prevention
PAVS

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18
Q

Kaiser Permanente and PAVS

A

86% of 1.8million people had it documented as a vital sign

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19
Q

ACSM increasing exercise:
How long are the different phases?
At what % HRR should you start?

A

1-6 weeks and 4-8 months

40-60% moderate intensity

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20
Q

Initiating resistance training:
what intesnsity?
What reps?

A

5-6/10

8-12 reps

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21
Q

3 stages of balance training?

A

Hand hold
No support
Unstable surface

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22
Q

Standing for 2 hours - what mortality reduction?

A

10%

same as 1:10 premature deaths caused by physical inactivity

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23
Q

CV disease - low vs inactive groups
RR all-cause mortality
LE gain?

A

0.82

3 years

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24
Q

Weekend warrior - 150minutes in 1-2 days, whats the RR of mortality?

A

0.85

150 minutes 15% decrease

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25
Q

What is MHR % for moderate

A

64-76%

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26
Q

HRR recommended intensity range?

A

40-85%

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27
Q

What is the VT1?

How do you test?

A

Where blood lactate levels have risen enough that the lungs must blow off more C2 to buffer - approximately highest intensity that can be maintained for 2 hours.

Monitor on telemetry, HR increase by 5BPM per stage of exercise, end point when breathing rate changes and 5-10 words challenging. Lasts 8-16minutes.

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28
Q

Sit and reach test:
Consistent?
Hamstring flex?
Low back flex?

What type of flexibility does it assess?
4 benefits of this (believed not well evidence based)

A
  • highly consistent - 0.96-0.99
  • moderately accurate for hamstring flexibility r=0.64
  • poor accuracy for LB flex r=0.28
  • not accurate for low back pain

Assesses ham and low back blexilbity -

  • acute and chronic MSK injuries
  • risk of falls
  • postural issues
  • low back problems
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29
Q

How much body fat is subcutaneous?

A

1/3rd

Like 3x obesity in young adults now

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30
Q

What are normal of body fat for optimal health?

Men and women…

A

10-22% and 20-32%

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31
Q

USPSTF and PA

A

Recommends LM for patients with known risk factors - no specific mentions of PA

32
Q

Meta analyses of PCP PA counselling - what the NNT?

Whats the NNT from Grandes?

A

12

26

33
Q

Prevalence of PA and nutrition counselling at DM visits?

Predictors for adherence?

A

18% and 36% (double for nutrition)

Young, private insurance

34
Q

Sustainable behaviour change in PA - 6 resources…

A

1) Self-monitoring
2) Relapse prevention
3) CBT/problem solving
4) External resources - worksite wellness, tech
5) MDT - PT, coaches, exercise physiologist
6) giving resources such as health promotion clinics

35
Q

Motorola worksite wellness:
Duration of study and n=?
Savings vs median savings
Participants cost rise vs non-participants

A

3 years. 56000

  1. 93 vs 3.14
  2. 5% vs 18%
36
Q

Strong evidence that PA benefit 5 things:

A

All cause mortality
CHD
DM2
Cancer - breast and colon

37
Q 
Pregnancy and obesity:
How many are overweight?
how much weight gain?
Why is this important?
Interventions to prevent weight gain - how effective? and what's most effective?
A

1/3rd are overweight
twice the likely to gain excess weight
poor maternal and neonatal outcomes
interventions gained 2lbs/0.9kg less, and supervised were most effective

38
Q

PA and reduced DM2 risk: % accounting and not accounting for BMI?

A

31% and 17% reduced risk

39
Q

DM2 - meta-analysis of structured exercise training regimes and HbA1c:

  • does brief advice work?
  • do structure exercise programmes work? What makes them more effective?
A

1) BA on PA only worked if combined with nutrition advice

2) structure aerobic, resistance and combination decreased HbA1c, more so if >150 per week

40
Q

Who needs physical activity experts to give them advice?

A

Physical or mental disablities

41
Q

What associates with physical disability in terms of mobility?
Why is it important?

A

Medical mobility impairements

MMIs associate with mortality

42
Q

If PA is used as a weight loss intervention, what benefits occur?

What about weight does PA predict?

How much can NEAT burn?

A
  • diastolic pressure, trigs, fasting glucose, CVD risk
  • predictive of weight maintenance
  • 350cal a day
43
Q

ITLC - intensive therapeutic lifestyle change

Typical durations/intensities?

A

1-3 60 minute visits a week, for 8-18 weeks.

Also residential lasting 7-21 days, and also shorter immersion programs 3-10 days.

44
Q

What percentage of PC appointments are ‘primarily lifestyle?

What 8 conditions?

A

78%

Arthritis
Diabetes
Metabolic syndrome
Cardiovascular disease
Hypertensino
Obesity
Osteoporosis
Hyperlipidaemia
45
Q

How much premature deaths are attributable to what 3 behaviours?

A

80%

Smoking, diet and physical activity

46
Q

Health behaviours - 4 key behaviours:
What % of people do healthy amounts of all?
What percentage do healthy amounts of each behaviour?

A 
3%
Physical activity - 22% 4:5 poor PA
Five F&amp;V - 23% 3:4 low F&amp;V
BMI<25 - 40%
Non-smoking - 76% 1:7 still smoke
47
Q

Health behaviours after medical problems?
How many follow SF guidelines in DM2?
How many smoke in heart disease?

A

11% and 8%

48
Q

Nation strategy for Quality improvement in health care: 3 strategy priorities

A

1) Engage patients in their healthcare
2) Use communities to promote wide use
3) Promote best preventative strategies starting with CV disease

49
Q

Nation prevention strategy - american’s plan for better health and wellness - 2011

4 LM services

A

1) PA screening and counseling
2) Obesity screening and counselling
3) Alcohol screening an counseling
4) smoking cessation

50
Q

Cancer research: what’s percentage and number of cancers avoidable
Through what 4 factors?

A

33% and 340000 (US data)

smoking/alcohol, physical activity, diet, obesity

51
Q

Health behaviour decay:
At what time point were bheaviours most imporved?
A study demonstrated what level of sustained improvements at what timepoints?
What behaviours? (6)

A

Most improved at 6 weeks, 50% better than baseline at 18months
PA, calorie intake, F&V, SF, sweets, fiber

52
Q

Interheart and psychosocial - what are psychological factors comparable to?
What population attributable % risk?

A

To abdo obesity and high BP - 33% pop attributable risk

53
Q

Chicago heart association detection project in Industy

What did it show about RFs and CVD?
- benefits of being low risk in middle age?

what about costs? (men and women)

A

Risk factors determine risk of heart disease, lower risk in middle age have better quality of life and lower costs later.

Men had <2/3rd total charges (1615 dollars less than control) and women had <1/2 (1885) if low risk

54
Q

6 changes to decrease heart disease risk:

- individual percentage reductions too please

A

50% decrease in total cholesterol - 50%
Stop smoking - 50% risk of sudden MI

Ideal weight and waist - 35-55%
150PA - 35-55%

6mmHg decrease in diastolic BP - 16% (42% decreased CVA)
5 F&V - 25%

2 50%, 2 35-55%, 2 25% (16-42 middle is 25%)

55
Q 
Adventist study 2 - HR of total vegetarian diet vs non-vegetarian for:
All-cause mortality
IHD
CVD
Cancer
OThers

Also showed BMI values of x and y

And showed OR of diseases
Diabetes
HTN
MetS

A
  1. 85
  2. 90
  3. 91
  4. 92
  5. 74

Remember the ascending order - all-cause, IHD, CVD, cancer - others as an outlier.

23.6 vs 28.8

  1. 51
  2. 37
  3. 44
56
Q

How often do PCPs see chronic condition patients…

What proportion once a year? Most are seen how many times?

A

3 in 4 at least once a year, most seen 2-3 times

57
Q

Prescriptions for lifestyle change - whats best, whats next, whats least evidenced?

A

smoking is solidly evidence based, there is some evidence for exercise and least for nutrition…

58
Q

Stress vital sign -
How many items and what scores?
Are there thresholds?

A

10 items, 1-5

higher means more stress

59
Q

Alcohol vital sign - when do you screen?

A

At every visit if regularly drinking, otherwise once a year

60
Q

Reynold’s risk score - what is it? what does it include?

A

CV risk score for women - uses family history and hsCRP

61
Q

Hypertension prevalence and screening:
What % of >60s have HTN
How often should you screen?

A

50%

each periodic visit 6-12 monthly

62
Q

Improvements in BP of 2/3/5 systolic give what improvements in mortality?

A

Total 3/4/7
CHD 4/5/9
Stroke 6/8/14

63
Q

What do Trigs associate with?

A

Low HDL and increased abdo girth

64
Q

How is LDL calculated?

A

LDL = total chol - HDL - trigs/5

65
Q

What about cholesterol particles is important to kow?

A

particle size stratifies risk, desnity alone does not completely describe the role and function of cholesterol fractions

66
Q

HOMA-IR

A

is a homeostatic model assessment for insulin resistance - estimate of IS and beta cell function from fasting glucose and insulin/c-peptide

67
Q

Which 5 integrative practitioners usually include some aspects of lifestyle medicine?

A 
Acupuncture and oriental medicine
Chiropracters
Midwifes
MAssage therapy
Natuopathic medicine
68
Q 
Group appointments:
Provider benefits (6)
A 
Time efficient
Enahved quality
Fun
Reduces reptition
Documentation by other staff
Effective way of managing psychologically needy patients
69
Q

Group appointemtns: PAtient benefits (12)

A 
Adherence
Low hospitalisation
Higher trust
Imrpoved access
Improved satisfaction
Patient education
Peer support
Access to skills of nurse/psychologist
Choice
Costs &amp; Billable under medicare
Incrased physician productivity
Monitoring of elderly and complex
70
Q

Evidence that IDT is better:

Weight loss:

A

Doctor alon 1.2kg, 2.6lbs, dietician 5.6, both 6.0

71
Q

Lay health educators do what in lifestyle interventions?

A

they associate with improved implementation and have been successful in rural centres

72
Q

Ornish spectrum programme uses how many IDT memebers?

A

RN, exercise physiologist, health coach, stress, dietician, chef, group support, admin, MD and phsyician

73
Q

Whats the medical fitness collaboration?

A

A safe way for patients to transition from structured lcinical treatment to home/community based exercise

74
Q

Collaborative care manager model?
Whose model?
Explain it…

A

AHRQ

Patient at the centre, with nurse or Pa, doctor/expert and resident, +MDT around the patient who assumes their own self-care, sets goals and develops skills

75
Q

PDSA cycle the stages:

A

Plan - what is the desired improvement, what data needs collecting, what outcomes

Do - process map, then small scal pilot and evaluation

Study - review the data from previous level and determine if any modification to the process is needed

Act - large scale study

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