impact of environment on life-long health

Question 1

What are challenges a fetus can face in utero that can impact health?

Answer 1

Fetal infection in utero, maternal nutrition (high fat diet/low protein diet around conception), maternal illness, maternal stress, maternal medication, environmental factors/exposures

Question 2

What are biological influences and what are social/environmental influences affecting a child?

Answer 2

• Biological: genetics, epigenetics (how these genes are switched on and at what time).
• Environmental/social: family, school, nutrition, social, health provisions

Question 3

What is the barker hypothesis?

Answer 3

Adults who had coronary event had been small at birth and after age 2 put weight on rapidly.
-Risk of CV event more strongly related to rate of change of childhood BMI rather than BMI at any particular age of childhood

Question 4

What is the DOHad hypothesis?

Answer 4

Origins of lifestyle related diseases formed at time of embryonic/fetal/neonatal stages by interactions between genes and the environment

Question 5

How does the DOHaD hypothesis explain the barker hypothesis?

Answer 5

• Undernutrition in utero + overnutrition as child leads to increased risk of metabolic syndrome increasing risk of CV disease.
• These influences result in differences in gene expression that may alter metabolism/endocrinology/immunity.
• Environmental stimuli when born amplify these.

Question 6

What are the mechanisms of DOHaD? What could it affect?

Answer 6

• Influences in fetal stage and neonatal stage result in differences in gene expression affecting metabolism/immunity.
• Could affect CV , T2D, cancer, neurological development, allergies, autoimmunity

Question 7

What is the aim of the NHS healthy child programme? What does it involve?

Answer 7

• Prevent disease and promote good health and reduce health inequalities.
• Involves health promotion, support care givers, screening, immunisation, identifying high risk families, signposting

Question 8

What are the criteria for screening tests?

Answer 8

• Identify early, treatable, prevent morbidity/morality, cost-effective, acceptable/easy to administer, reproducible, accurate

Question 9

What is Sure start’s aims?

Answer 9

Aims to support families with under 5 age children in low income households with parent/child education & health promotion

Question 10

One screening test done pre-conception?

Answer 10

Annual diabetic eye screening for women with T1 or T2 diabetes

Question 11

One screening test done in 1st trimester?

Answer 11

• Blood for sickle cell & thalassaemia to see if mother is carrier.
• Screening for infectious diseases (hepatits B, HIV, syphilis)

Question 12

One screening test done in 2nd or 3rd trimester?

Answer 12

• Ultrasound at 20wks to screen for 11 rare conditions like spina bifida (for fetus)
• Further Diabetic eye screen for women with T1/2D

Question 13

One screening test done in newborn period?

Answer 13

Newborn blood spot screens & newborn hearing screen (for child)