Health and Disease in Adolescents/Adults Flashcards
What is the average age of first sexual intercourse in Scotland? How many pregnancies are unplanned, and how many end in abortion?
16 years
1 in 3 pregnancies are unplanned, and 1 in 3 end in abortion
What people are more prone to negative outcomes in relation to sexual health?
Prisoners
People in deprived areas, learning disabilities, in commercial sexual exploitation
Looked after and accommodated children and young people
Lesbian, gay, bisexual, transgender and intersex people
What are serious health needs in relation to sexual health clinic appointments?
Pregnancy risk/need for emergency contraception STI risk Ongoing contraception Alcohol consumption Consent issues
What are the types of emergency contraception and which is most effection?
Copper IUD- most effective
EllaOne- oral, delays ovulation, effective up to 5 days post-coitus
Levonelle- Same as EllaOne but only effective up to 72 hours post-coitus with reduced efficacy over this time
What are the modes of action of contraceptives in females, and which is most effective?
Preventing ovulation via stopping LH surge- most effective
Preventing fertilisation
Preventing implantation
Thickening cervical mucus helping to block sperm
How do combined pills, mini-pills, patch, or vaginal ring prevent pregnancy?
Mode of Action: Varies, ingestion or insertion
Mechanism: prevents ovulation, back-up alters cervical mucus
Efficacy with perfect use: 0.3%
Typical failure use: 9%
How does the copper IUD prevent pregnancy?
Mode of Action: Prevents fertilization as copper is toxic to sperm, prevents implantation
Mechanism: Insert into uterus, lasts 5-10 years
Efficacy with perfect use: 0.6%
Typical failure use: 0.8%
How do barrier methods prevent pregnancy?
Mode of Action: Prevent fertilization and reduce STI transmission
Mechanism: condom, female condom,
Efficacy with perfect use: 2%
Typical use failures: 18%
How do subdermal implants prevent pregnancy?
Mode of Action: Prevent ovulation and alters cervical mucus
Mechanism: Insertion into upper arm, lasts 3 years
Efficacy with perfect use: 0.05%
Typical use failure: 0.05%
How does saya press injections prevent pregnancy?
Mode of Action: Progesterone based. Prevents ovulation and alters cervical mucus
Mechanism: Subcutaneous injection, lasts 14 weeks
Efficacy with perfect use: 0.3%
Typical user failure: 6%
How does sterilization prevent pregnancy?
Mode of Action: Prevents fertilization Mechanism: severing vas deferens to prevent successful sperm ejaculating, sever the fallopian tubes to prevent movement of egg and entry of sperm Typical use failure: Vasectomy 0.15% Female sterilization 0.5%
How does the hormonal IUS prevent pregnancy?
Mode of Action: Prevents implantation, alters cervical mucus, prevents ovulation in some (progesterone)
Mechanism: implantation into uterus, lasts 5 years
Typical use failure: 0.2%
Perfect use: 0.2%
If a women came to a sexual health clinic to discuss her sexual health and intercourse, and she was 15, what questions would you need to consider when treating her?
Does she have capacity? Was she able to consent? Age of partner? How did they meet? How long having sex? Alcohol/drugs involved? Who buys them? Are they gifts? Vulnerability markers- accommodation, school attendance, lives with gran/friends, social work involvement, learning disabilities Evidence of grooming?
What are the ages for the Sexual Offences (Scotland) Act?
Under 13- offence: rape of a young child
13-15 years- offence: intercourse with an older child
What is the definition of rape?
Penile penetration of any orifice
What are genital warts?
Most common STI
Painless genital lumps, some itching
Caused by HPV
Typically cleared over time but can use creams, cryotherapy, lasers, heat, surgery
What is herpes simplex?
A sexually transmitted virus that can cause painful genital lumps/blisters or sores, flu-like symptoms, no symptoms, itches
Caused by herpes simplex virus
Anti-viral medication, and suppressant therapy for those with lots of break-outs
What is syphilis?
Produces a chancre which is painful lesion that appears for 8 weeks, then disappears
Blisters or sores, flu-like symptoms, lumps, no symptoms, rashes, itches
Caused by bacteria Treponema pallidum.
Treated with antibiotic injections (penicillin most common)
What is chlamydia?
Often are asymptomatic, bleeding after sex, bleeding between periods, discharge, pain
Caused by bacteria Chlamydia trachomatis.
Treated with antibiotics
What is gonorrhoea?
Discharge more common, bleeding between periods, no symptoms, pain
Caused by Neisseria gonorrhoeae.
Treated with antibiotics, although growing Ab-resistance.
No treatment can lead to pelvic-inflammatory disease, testes infection, sexually acquired reactive arthritis.
What is trichomonas?
Less common in Caucasians
Can cause smelly discharge in females and urethral discomfort in men, painful urination, itchy genitals
Caused by Trichomonas vaginalis (TV).
Treated with antibiotics typically
What routine testing is done for common STIs?
Men: Urine- chlamydia and gonorrhoea Blood- HIV and syphilis Women: Self-take vaginal swab- chlamydia and gonorrhoea Blood- HIV and syphilis
How many deaths is tobacco responsible for?
1 in 10
How does tobacco use vary in developing/developed countries?
Dropping in developed but rising by 3.4% each year in developing countries.
How does tobacco use vary in deprived/thriving communties?
Much higher in deprived regions.
Glasgow’s most deprived areas have prevalence of 39%, whereas average prevalence is 20%
“Those in lower socio-economic groups are more likely to smoke, more likely to smoke more heavily, more likely to smoke in pregnancy, more likely to be exposed to second-hand smoke, less likely to make a quit attempt and less likely to quit successfully.”
What are the 3 themes associated with smoking, as well as some examples?
Individual-attitude, beliefs, gender, knowledge, self-esteem, values
Personal Environment- Friends, school, resources, family, social support
Social and Cultural Environment- ethnicity, tobacco promotion, price, social disadvantage,
When was tobacco display banned in scotland?
2013, and 2015 in smaller stores
How many carcinogens, chemicals are found in cigarettes, and what are the most commonly known ones?
4000 chemicals, 60 carcinogens
Nicotine (vasoconstrictor, ^bp, highly addictive- not actually a carcinogen)
Carbon monoxide (outcompetes O2 for haemoglobin, reducing oxygen levels, linked to CVD)
Arsenic, cyanide, ammonia, acetone, benzene, formaldehyde, cadmium and hydrogen cyanide.
How is nicotine addictive? Explain what it does, and what aspects form the addiction.
Stimulates adrenal glands to release adrenaline.
Fast effect it has on the brain, hitting the brain within 7-10 seconds of inhalation (helped with release by ammonium added to cigarettes), binding acetylcholine receptors (up-regulates the receptors and becomes preferred ligand) causing dopamine release, stimulating reward pathway.
Emotional, habit, and neurochemical addiction.
Explain the physiological effects and changes associated with nicotine.
Stimulates adrenal glands to release adrenaline
Adrenaline causes increased HR, BP, RR, causes release of glucose and suppression of insulin.
Nicotine also binds AChR in brain, upregulating receptors and causing receptor preference for nicotine, called alpha-4 beta-2 nicotinic acetyl choline receptors (which contribute to withdrawal). Stimulation results in dopamine production by nucleus accumbens in frontal lobe (reward pathway).
What are common withdrawal symptoms?
urges to smoke, irritability, anxiety, low mood, restlessness, poor concentration, increased appetite and productive cough
What conditions in children are associated with exposure to second-hand smoke?
Sudden Infant Death Syndrome (SIDS), Asthma, Lower respiratory tract infections, pneumonia and bronchitis, glue ear and bacterial meningitis
What are the stages within the “cycle of change / stages of change / transtheoretical model of change” model developed by Prochaska & DiClemente (1983)?
Pre-contemplation - not thinking about changing
Contemplation – thinking about changing behaviour
Preparation – deciding & preparing to change, but not yet performing the new behaviour.
Action – Overt behaviour change
Maintenance – six months regular practice of a behaviour
Relapse – normal occurrence in the stage of change model
On average, how many people die a week due to alcohol related causes in 2015? How many deaths in Scotland are attributable to alcohol?
22 a week
1 in 15 deaths a year (cancer is 1 in 4)
How do alcohol and deprivation relate?
Rate of alcohol-related hospital stays was almost 9 times higher in those living in the 10% most deprived areas of Scotland.
Alcohol related mortality is 9 times higher in these areas as well.
Chronic Liver Disease is 6 times higher
What are examples of some medical treatments used to treat alcohol addiction?
Naltrexone- reduced dopamine-induced rewarding feeling from alcohol consumption
Disulfiram- works in liver to block aldehyde dehydrogenase (acid aldehyde builds up leading to sickness)
Acamprosate- Helps avoid up-taking of drinking once stopped by modulating NMDA signalling
Nalmafene
What is significant when looking at results from combined behavioural intervention, medical management (9 session treatment), and drug prescriptions of naltrexone?
Patients taking naltrexone and receiving behavioural intervention or taking naltrexone and both CBI and behavioural intervention, had the same levels of improvement.
This means those without access to a therapist can receive same degree of efficacious help. Also allows for more patient choice in treatment
What are the top 4 drugs used in England and wales?
Cannabis, powder cocaine, ecstasy, amphetamines
What are the top reasons for treatment in terms of drug misuse, moving from most prevalent to least?
Opiate, alcohol only, non-opiate and alcohol, non-opiate
What biological predisposition may put a person at an increased risk of addiction, and why?
Fewer D2 receptors may predispose someone to higher rates of addiction
Dopamine receptor prevalence is downregulated by the body when there is too much dopamine (a result of drug abuse), so someone with low levels of receptors would need to take more of the drug to feel the same degree of satisfaction. This principle can be applied to everything else in their lives as well.
What comorbidities are linked to substance abuse and why?
ADHD- Tend to be impulsive, which is risk factor for addiction
Anxiety and depression- thought it could be self-prescribing
What psychological factors may contribute to increased risk of addiction?
Impulsivity
Sensation seeking
Risk sensitivity (not thinking about risk)
Neuroticism (minimize stress reaction via self-medication)
Aggressive behaviour
What environmental issues may contribute to increased risk of addiction?
Presence of stress Lack of stability Abuse Parent with drinking/drug use Lack of family involvement Lack of bonds within family Friends surrounding person Peer pressure Community (low SES and poverty have increased substance abuse, but not increased substance use) Availability of drugs
Are somatic mutations inherited?
No, germ line mutations are passed down in generations.
What does disposable soma theory of ageing state?
Evolutionary pressure ensures the body heavily invests a lot of energy into DNA repair activity within the germline, but less into the somatic line, thus mutations in soma are higher
How is cancer related to genetics?
It is an acquired genetic disease.
Mutations (>10) in genes controlling cell division and growth. Tumours are associated with mutator phenotype.
You can inherit germ line mutations which predispose them to cancer, or a mutation in somatic line may occur resulting in cancer.
What is the DNA mismatch repair pathway? Explain its role and how it completes it.
Hetero-tetramer that follows DNA polymerase, and will halt it if polymerase makes an error.
It then recruits DNA Exonuclease which will digest nucleic acids on the ends of the daughter strands being built, to remove errors.
DNA mismatch repair complex then dissociates and DNA polymerase can re-bind and contribute DNA replication.
What can mutations in DNA mismatch repair complex cause?
Hereditary non-polyposis colon cancer (lymph syndrome)
Inherited mutation in DNA mismatch repair complex genes
Second-hit eliminates the one working DNA mismatch repair complex gene from one parent, resulting in two mutated copies, and less ability to correct DNA polymerase replication errors.
Typically causes colon cancer due to high crypt cell replication in colon (need to renew epithelial due to constant ‘scraping away’ of colon wall).
What are types of acquired DNA damage?
Base Loss (26,000) Base Modification (13,350) Single-strand breaks (100,000) Double-strand break (50,000)
What endogenous and exogenous mutations can cause damage?
Endogenous: free radicals from mitochondria glycolysis
Exogenous: environmental (pollution), diet (pickling, burned food), chemical exposure, smoking, radiation (x-rays cause double strand breaks, UV light causes covalent thymidine dimerization leading to skin cancer)
What is a single stranded break? How is it corrected?
A break in the backbone of DNA
DNA ligase can easily repair this via ligation
What is nucleotide excision repair and when does it typically happen?
Typically for base modifications mutations
NER Multi-Enzyme Complex tracks along the DNA duplex and can identify lesions, then recruit DNA endonucleases (within the molecule) which can cut damage on either side of lesion, leaving gap of DNA, allowing for polymerase to bind and replicate gap. DNA ligase can then perform ligation
What are two examples of problems with abilities to undergo nucleotide excision repair?
Xeroderma pigmentosa (UV light sensitivity induced skin lesions/cancer, accelerated ageing, dwarfism, neurological abnormalities) Cockayne Syndrome (predisposed to light induced skin lesions/cancer, (less so than XP) dwarfism, accelerated ageing, neurological abnormalities) Autosomal recessive, with unaffected parents, very rare
How are double-strand mutations repaired?
In both, break is processed by exonuclease to create single overhang.
Homology-dependent repair:
Other homologous strand is found (can be on sister chromatid or homologous chromosome), no information is lost, but is expensive in terms of energy. Usually used in germ line cells
Non-homology end-joining: Chromosomes are compared, and when small sections are found to match (even in non-homologous chromosomes), hydrogen bonds are formed, endonuclease will trim off non-matching DNA, DNA polymerase will fill gaps, and Ligase will ligate. Typically used in somatic mutations. This results in changes that are non-conservative, and can result in mutations. Can result in chromosomal translocation (chronic myeloid leukaemia)
What is Nijmegen Breakage Syndrome?
Rare autosomal recessive condition
Defective in homology dependent repair, making them sensitive to radiation, and immunodeficient
Adaptive immune response relies of rearranging of genes within immunoglobulin to generate Abs. Breaks occur as programmed, but cell cant process the break to form new antibodies, thus leaving them with more mutations, and lowered Ab response
How is breast cancer related to germ line mutations? Explain how the cancer can develop.
BRCA1/2 gene mutations.
Important in repair of double-stranded breaks.
Good copy of gene has second-hit, meaning no ability to function as tumour suppressor and repair breaks, resulting in predisposition to chromosomal rearrangements, and becoming cancerous
