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Everything again Flashcards

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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
What is MHR % for moderate
64-76%
26
HRR recommended intensity range?
40-85%
27
What is the VT1? How do you test?
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.
28
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)
- 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
29
How much body fat is subcutaneous?
1/3rd Like 3x obesity in young adults now
30
What are normal of body fat for optimal health? | Men and women...
10-22% and 20-32%
31
USPSTF and PA
Recommends LM for patients with known risk factors - no specific mentions of PA
32
Meta analyses of PCP PA counselling - what the NNT? Whats the NNT from Grandes?
12 26
33
Prevalence of PA and nutrition counselling at DM visits? Predictors for adherence?
18% and 36% (double for nutrition) Young, private insurance
34
Sustainable behaviour change in PA - 6 resources...
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
Motorola worksite wellness: Duration of study and n=? Savings vs median savings Participants cost rise vs non-participants
3 years. 56000 3. 93 vs 3.14 2. 5% vs 18%
36
Strong evidence that PA benefit 5 things:
All cause mortality CHD DM2 Cancer - breast and colon
37
``` 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? ```
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
PA and reduced DM2 risk: % accounting and not accounting for BMI?
31% and 17% reduced risk
39
DM2 - meta-analysis of structured exercise training regimes and HbA1c: - does brief advice work? - do structure exercise programmes work? What makes them more effective?
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
Who needs physical activity experts to give them advice?
Physical or mental disablities
41
What associates with physical disability in terms of mobility? Why is it important?
Medical mobility impairements | MMIs associate with mortality
42
If PA is used as a weight loss intervention, what benefits occur? What about weight does PA predict? How much can NEAT burn?
- diastolic pressure, trigs, fasting glucose, CVD risk - predictive of weight maintenance - 350cal a day
43
ITLC - intensive therapeutic lifestyle change Typical durations/intensities?
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
What percentage of PC appointments are 'primarily lifestyle? What 8 conditions?
78% ``` Arthritis Diabetes Metabolic syndrome Cardiovascular disease Hypertensino Obesity Osteoporosis Hyperlipidaemia ```
45
How much premature deaths are attributable to what 3 behaviours?
80% Smoking, diet and physical activity
46
Health behaviours - 4 key behaviours: What % of people do healthy amounts of all? What percentage do healthy amounts of each behaviour?
``` 3% Physical activity - 22% 4:5 poor PA Five F&V - 23% 3:4 low F&V BMI<25 - 40% Non-smoking - 76% 1:7 still smoke ```
47
Health behaviours after medical problems? How many follow SF guidelines in DM2? How many smoke in heart disease?
11% and 8%
48
Nation strategy for Quality improvement in health care: 3 strategy priorities
1) Engage patients in their healthcare 2) Use communities to promote wide use 3) Promote best preventative strategies starting with CV disease
49
Nation prevention strategy - american's plan for better health and wellness - 2011 4 LM services
1) PA screening and counseling 2) Obesity screening and counselling 3) Alcohol screening an counseling 4) smoking cessation
50
Cancer research: what's percentage and number of cancers avoidable Through what 4 factors?
33% and 340000 (US data) | smoking/alcohol, physical activity, diet, obesity
51
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)
Most improved at 6 weeks, 50% better than baseline at 18months PA, calorie intake, F&V, SF, sweets, fiber
52
Interheart and psychosocial - what are psychological factors comparable to? What population attributable % risk?
To abdo obesity and high BP - 33% pop attributable risk
53
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)
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
6 changes to decrease heart disease risk: | - individual percentage reductions too please
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
``` 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
0. 85 0. 90 0. 91 0. 92 0. 74 Remember the ascending order - all-cause, IHD, CVD, cancer - others as an outlier. 23.6 vs 28.8 0. 51 0. 37 0. 44
56
How often do PCPs see chronic condition patients... | What proportion once a year? Most are seen how many times?
3 in 4 at least once a year, most seen 2-3 times
57
Prescriptions for lifestyle change - whats best, whats next, whats least evidenced?
smoking is solidly evidence based, there is some evidence for exercise and least for nutrition...
58
Stress vital sign - How many items and what scores? Are there thresholds?
10 items, 1-5 | higher means more stress
59
Alcohol vital sign - when do you screen?
At every visit if regularly drinking, otherwise once a year
60
Reynold's risk score - what is it? what does it include?
CV risk score for women - uses family history and hsCRP
61
Hypertension prevalence and screening: What % of >60s have HTN How often should you screen?
50% | each periodic visit 6-12 monthly
62
Improvements in BP of 2/3/5 systolic give what improvements in mortality?
Total 3/4/7 CHD 4/5/9 Stroke 6/8/14
63
What do Trigs associate with?
Low HDL and increased abdo girth
64
How is LDL calculated?
LDL = total chol - HDL - trigs/5
65
What about cholesterol particles is important to kow?
particle size stratifies risk, desnity alone does not completely describe the role and function of cholesterol fractions
66
HOMA-IR
is a homeostatic model assessment for insulin resistance - estimate of IS and beta cell function from fasting glucose and insulin/c-peptide
67
Which 5 integrative practitioners usually include some aspects of lifestyle medicine?
``` Acupuncture and oriental medicine Chiropracters Midwifes MAssage therapy Natuopathic medicine ```
68
``` Group appointments: Provider benefits (6) ```
``` Time efficient Enahved quality Fun Reduces reptition Documentation by other staff Effective way of managing psychologically needy patients ```
69
Group appointemtns: PAtient benefits (12)
``` Adherence Low hospitalisation Higher trust Imrpoved access Improved satisfaction Patient education Peer support Access to skills of nurse/psychologist Choice Costs & Billable under medicare Incrased physician productivity Monitoring of elderly and complex ```
70
Evidence that IDT is better: | Weight loss:
Doctor alon 1.2kg, 2.6lbs, dietician 5.6, both 6.0
71
Lay health educators do what in lifestyle interventions?
they associate with improved implementation and have been successful in rural centres
72
Ornish spectrum programme uses how many IDT memebers?
RN, exercise physiologist, health coach, stress, dietician, chef, group support, admin, MD and phsyician
73
Whats the medical fitness collaboration?
A safe way for patients to transition from structured lcinical treatment to home/community based exercise
74
Collaborative care manager model? Whose model? Explain it...
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
PDSA cycle the stages:
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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