Impact of the Environment on Lifelong Health

Question 1

What impacts on a fetus in utero can have a lasting impact?

Answer 1

• fetal infection
• maternal nutrition
• maternal illness
• maternal stress
• maternal medication
• environmental factors/exposures

Question 2

What are the possible biological (nature) influences on long term health?

Answer 2

• genetics

- epigenetics

Question 3

What are the possible social/environmental (nurture) influences on long term health?

Answer 3

• environment
• family/neighbourhood, school
• nutrition
• social (behaviours observed, substance use, care-giver behaviour)
• health provisions

Question 4

What are the conclusions of the Barker hypothesis?

Answer 4

• adults that had a coronary event had been small at birth and 2 yrs
• and thereafter gained weight rapidly
• the risk of coronary events was more strongly related to the rate of change of childhood BMI, rather than BMI at a specific time.

Question 5

What is the Barker hypothesis?

Answer 5

• undernutrition in utero and over nutrition as a child leads to an increased risk of ‘metabolic syndrome’ and therefore increased risk of CV events

Question 6

What is epigenetics?

Answer 6

heritable changes in the marks on the DNA that do not change the nucleotide sequence but influence gene expression.

Question 7

What is the mechanism of the developmental origin of health and disease?

Answer 7

• ‘programming’ in utero

- leads to epigenetic changes that influence development and physiology.

Question 8

What diseases are associated with early environmental exposures?

Answer 8

• CVD
• DMT2
• lung disease
• cancer risk
• allergic and autoimmune diseases
• neurological, special sense and intellectual development

Question 9

What is the aim of the NHS healthy child programme?

Answer 9

to prevent disease and promote good health

• universal
• reduce health inequalities

Question 10

What is involved in the NHS healthy child programme?

Answer 10

• health promotion (obesity prevention)
• supporting care giving and care givers
• screening
• immunisation
• identification of high risk individuals in need of additional support
• signposting (accident prevention, and dental hygiene)

Question 11

What makes a good screening test?

Answer 11

the disease being screened should be:

• able to be identified
• treatable
• prevent/reduce mortality
• acceptable/easy to administer
• cost effective
• reproducible and accurate results

Question 12

What are some good examples of early childhood screening?

Answer 12

• newborn check
• newborn hearing screen
• blood spot check

Question 13

What is the aim of Sure Start?

Answer 13

to help support families with under 5 year old children in low income households

Question 14

What does Sure Start do?

Answer 14

• high levels of investment in children’s community centres
• parent and child education
• health promotion

Question 15

What is an example of a test done pre-conception?

Answer 15

Diabetic eye screening for T1 and T2 mothers

Question 16

What is an example of a test done in the first trimester?

Answer 16

blood test for the mother

• sickle cell disease
• thalassemia
• syphilis
• Hep B
• HIV

Question 17

What is an example of a test done in the second/third trimester?

Answer 17

US for structural abnormalities

Question 18

What is an example of a test done in the newborn period?

Answer 18

Newborn spot screen 
Day 5
- sickle cell disease
- CF
- congenital hypothyroidism
- inherited metabolic diseases