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further more extras Flashcards

1
Q

How many have a smoking related disease?

A

16 million

whilst 17 million have AUD

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2
Q

Smoking causes how many deaths per year?

A

480,000

around 1/5th of deaths

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3
Q

The most effective smoking counselling includes 2 aspects:

A

practical - CBT/problem solving

social support

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4
Q

MODA of varencycline and bupropion

A

V is a nicotinic receptor partial agonist

B is a NA and DA re-uptake inhibitor

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5
Q

Smoking drug effectiveness:

Monotherapies

A

V 51% and 35% at 12w and 6m
B 40% at 8w
P45% at 8w
L 40% at 8w

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6
Q

Smoking drug combos effectiveness

A

V+B 71% and 58% at 12w and 6m
B + P + L 54% at 8W
B + L 50% at 8w

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7
Q

Smoking drugs in psychiatric disease or chronic disease

A

B + P + another NRT recommended

62% and 35% at 8w and 6m vs 37% and 19% with patch alone

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8
Q

Pregnancy and smoking
- what is best
what is what category?

A

counseling best

OTC no harm expected

B or V - category C

Rx NRT cat D - potential birth defects

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9
Q

Adolescents and NRT

A

it is safe, but little research on quitters

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10
Q

Alternative to 5As?

A

Ask
advise
Refer

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11
Q

Smoking stats

How many have AUD?
PErcentages?

A

17 million

30% - 26/3/1

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12
Q

Alcohol causes what harms (include %s) in the US?

How many attributable deaths and years of life lost?

A

10% of cancerns
20% intentional injuries
7% of deaths - include CTA, cancer, suicide

88000 attributable deaths, 2.5million years of life lost

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13
Q

4 things heavy drinking increases risk of

A

high BP, cancer, unintentional injuries, stroke

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14
Q

What % of AUD patients receive advice/tx?

A

10%

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15
Q

Heavy alcohol use definition?

A

5 binges in the last month

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16
Q

Common symptoms of AUD?

A 
Impairment or distress
Impaired control
Cravings
Cut down unsuccessful
Internal consequences

(ICICICIC)

10% develop serious external consequences and the most severe 10% are over-represented in rehabs, jails and hospitals

And only 10% get help

17 million have AUD

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17
Q

12 month prevalene of AUD

A

mild - 10/5 male female

mod-severe - 6/2

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18
Q

Audit - C - what is positive?

A

scores of more than 5 are positive

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19
Q

At-risk and mild drinkers

2 signs or symptoms

3 Primary risks
4 interventions

A

5+ drinks monthly, 0-3 DSM criteria

primary risks AUD/liver disease/marital problems

naltrexone
brief advice
follow up booster
behavioural intervention

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20
Q

mild to moderated AUD

4 symptoms of impaired control

What is it similar to?

3 treatments

A

going over limits
wanting to cut down
internal consequences
tolerance

simlar to functional depression

treat by PCP
Behavioural health intervention
use ARMs - same effectiveness as SSRIs

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21
Q

severe recurrent AUD

ARMS - 4 considerations

A

lifestyle intervention difficult
meds equivalent to AA and counseling
as good as SSRIs
improve propotion entering recovery

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22
Q

Drinkings - ARMS

A

Naltrexon - u-opiod - 25-50mg at time of drinking
83% reduction in heavy 4% in all

Acamprosate - glutamate alterer - 11 extra days abstinence, NNT 9 and RR 0.86 for any drinking

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23
Q

Normal waist circumfeerence

A

40/35 inches

24
Q

Reduction in BP and benefits

A

BP 2/3/5
Stroke (head is highest) 6/8/14
CV (heart in the middle) 4/5/9
Total (toes at the bottome) 3/4/7

25
Q

Framingham risk score

Age?
Factors included?
Outcome?

A

20+
HDL, total chol, BP meds, BP, smoking
10 year risk

26
Q

Reynold’s risk scoe

Patient?
Factors reuiqred?
Outcome?

A

Female

FHx and hsCRP

global risk score

27
Q

MESA

Patient
Factors required?
Outcome

A

Multi-ethnic

Coronary calcium score

10 year coronary risk

28
Q

ACC/AHA
patients
factors?
Outcome

A

black or non-hispanic caucasian, 40-79

determines if statin needed

29
Q

LDL =

A

TC - HDL - Trig/5
Or trig/2.17 for mmol/L outcome

Not valid if TRIGS >400/4.516mmol/L

30
Q

particle density, what else is important?

A

particle size

31
Q

Trigs associated with

A

Low HDL and biger abdo circ

32
Q

DM screening

A

every 3 years over 45

or

BMI 25 + a risk factor

33
Q

Group visits and costs - uncontrolled DM2

A

Gropu visits reduces total costs by 30%

34
Q

3 types of group consultation

A

DIGMA

shared and physical shared medical appoitments

35
Q

Flodgen showed what about IDT?

A

weight loss of 2.6, 12.3 adn 13.2lbs with dr/diet/both

36
Q

Healthy eating and lifestyle programmes - 3 outcomes

how long maintained?

A
  • wegiht reduction
  • improved BP
  • physical fitness
  • 5 months maintainence
37
Q

Chronic care model

A

ICCC - micro, meso, macro

AHRQ/Coll Care Man Model - patient sets goals, NP/PA manages visits, expert leads meetings and accountablity, Resident learns and helps provide care, IDT around them

MacColl, Ed Wagner - CCM -activated patient, proactive clinic, local health system

38
Q

Prescription for health - how many PCPs, how many behaviours, how many interventions trialled?

A

22
27 EB interventions
4 behaviours - tobaco, alcohol, diet, PA

39
Q

Years of life gained PA chart

A 
75mins - up to 3.75mets - 1.8
90-150mins - up to 7.5mets - 2.5
200 - 15 metS - 3
400 mins - up to 22.5 mets - 4
500 over 22.5 - 4.5
40
Q

3 models of health behaviour

A

Risk, Severity, Roadblocks, Benefits, Self-efficacy, Cues

SN, SN, Perceived behaviour control (ease of completing behaviour), Attitudes, Perceived power (over roadblocks and factors surrouding behaviour), Behaviour intention

Self-efficacy, Rec determinism, expectations, Observations, reinforcements, behavioural capability (knoweldge and skills)

41
Q

PHQ/GAD

A

0 to 3 - not at all, several days, more than half, nearly every day
3+ is positive

42
Q

PSQ

A

1-4 0/13/26/40 never to very often

43
Q

OR of yohgurt ruding inflammation?

A

0.34

44
Q

Sodium top 5

A 
Mixed dishes
Protein foods (also SF)
grains
veg
snacks and sweets (also SF)
45
Q

SF top 5

A 
burgers
snacks and sweets
protein foods
dairy
condiments
46
Q

TF top 5

What is highest?

What is moderately high?

A 
Grain based processed foods
animal products
MArgarine
French fries
Chips and popcorn

Highest is snack foods

Moderately is confections, diary, oils, PR/RM, reduced fat dairy and refined grains

47
Q

Calories top 5

A 
Feined grain-based desserts
Non whole grain breads
Chicken
Sweetened drinks
Pizza
48
Q

Vitamin A

A

liver, carrot, sweet potato (not potato), black EYED beans, spinach, cantaloupe

49
Q

Egg is a source of which two vitamins?

A

Vit D and A

50
Q

Vitamin K

A

OK Spicy PADS

OIls
Kiwi
Prunes
Avocado and asapargus
Dark green
Sprouts and snack foods
51
Q

BMI age cut offs?

A

20 and 65

52
Q

mini nutritional assessment of the elderly - age and outcomes?

A

65+, maln or at risk

53
Q

Essestyl - the initial one
review period
adherent and events
non-adherent and events

A

3.8 years
177 0.6%
21 - 13 had major events 62%

54
Q

Serum cholesterol can be improved with … what?

A

brazil nuts, cashews, almonds, pistachios, legumes, soy

55
Q

Nutrition and PA counseling in no risk factors - USPSTF

A

Grade C, based on readiness to change

56
Q

Grandes et al, the findings

Overall
Over 50s and prescription
Under 50s and prescription

A

Overall 18 mins, 3.9% increase in meeting PAGs NNT26

Over 50s - 131 and double minutes of activity

under 50 31.5

aBaSLM (10 decks)

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