impact of the environment on lifelong health Flashcards
what possible challenges could a foetus face in utero?
Fetal infection in utero
Maternal nutrition (eg. high fat or low fat diets can have impacts on the foetus)
Maternal illness
Maternal stress
Maternal medication
Environmental factors/exposures (eg. pesticides
what are the biological influences on long term health of a foetus (nature)?
genetics epigenetics (when are the genes switched on and off)
wha tare the social and biological cues that influence the long term health of a foetus (nurture)?
Environment Family, Neighbourhood, School Nutrition (maternal and fetal/child) Social - behaviours seen – substance use, care giver behaviour (see Still Face Experiment on Insendi) Health Provisions
what is the DOHaD hypothesis?
Developmental Origins of Health and Disease
what is the barker hypothesis?
On average, adults who had a coronary event had been small at birth and thin at two years of age
Thereafter put on weight rapidly.
The risk of coronary events was more strongly related to the rate of change of childhood BMI, rather than to the BMI attained at any particular age of childhood.
Undernutrition in utero Overnutrition as a child -> Increased risk of ‘Metabolic Syndrome’ Which in turn leads to increased risk of cardiovascular events
what is the mechanism of DOHaD?
Idea of PROGRAMMING in utero
Leads to epigenetic changes which influence development and physiology
Epigenetics: heritable changes in marks on the DNA that do not change the nucleotide sequence but influence how genes are expressed (where, when and how much a gene is switched on or off)
how do the mechanisms of DOHaD link to biology?
foetal gene expression may be modified by maternal health and environment, and malnutrition, endocrine milieu (eg. mums stress), placental vascular supply
this may alter the foetus': endocrinology metabolism bone, lean and fat mass blood flow/vascular loading immune responses
this may then be amplified in infancy, or undergo similar adult exposures
leading to cardio/metabolic/lung and immune mediated diseases or neurodevelopmental disorders
in which diseases are there associations with early developmental exposures?
Cardio-vascular disease Type 2 diabetes Lung disease Cancer risk Neurological, special sense and intellectual development Allergic and auto-immune diseases
what is the NHS healthy child programme?
Aims to prevent disease and promote good health
universal
reduce health inequalities
what are some aspects of the NHS healthy child programme?
Health Promotion (Obesity prevention is a key aspect)
Supporting care giving and care givers
Screening
Immunisation
Identification of high-risk families/ individuals for additional support
Signposting -accident prevention, dental hygiene
what are the fundamentals of a good screening test?
The Disease it is screening for should be: able to identified early/before critical point treatable prevent/reduce morbidity/mortality
Acceptable/easy to administer
Cost effective
Reproducible and accurate results
eg. for children in:
Newborn Check (developmental defects following birth)
Newborn Hearing Screen
Blood spot check (heel prick test)
what is sure start?
High level of investment in children’s community centres
Aims to help support families with under 5 year old children in low income households
Parent & child education
Health promotion
all you need would be in one place
what is an example of a screening test offered pre-conception?
people with type 1 or 2 diabetes are offered diabetic eye screening anually
what is an example of a screening test offered in the first trimester?
blood for sickle cell and thalassaemia
what is an example of a screening test offered in the second or third trimester?
downs syndrome
