next level Flashcards

1
Q

What does NfKB do?

A

NFkB activates telomerase, cytokines, adhesion molecules, VEGF and TNF. Also results in macrophage recruitment.

The Very Angry Tabby Cat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

4 positive epigenetic influences:

A
Positives: 
Polyphenols and B vits 
Exercise 
Low stress 
Maternal and paternal diet
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

TOFU and it’s nutrition… incomplete so far

A

TOFU
High in -
Less high in - magnesium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q
AUD - the numbers:
How many in US?
% of adults exceeding NIH daily limits at least once a year?
% at-risk or mild?
%mod
%severe
A
17 million
30%
26%
3%
1%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Alcohol use effects:
% of cancers
% of intentinoal injuries
% of deaths - and top three

A

10%
20%
7% - RTA, cancer, suicide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

AUD and health

number of attributable deaths a year?
years of life lost?

A

88000

(8 servings exceeds the 7/week for women, 8+8 would exceed the male serving too)

  1. 5million per year among US adults
    (2. 5 is a serving of 8 proof spirits)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

AUD

Regions most at risk - 4 areas

What are they most likely to do?

Region least likely?

A

upper midwest, northeast, alaska, hawaii - most likely to binge drink at least once a year

South US are least likely

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

AUD highest risk groups:

8 RFs

A
Age 18-34
Higher income
White
Men 23% vs Women 11%
Smokers
Psych
Trauma
Family history
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

AUD and PCP - what proportion received proper mx?

A

10% only

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

AUD:

What two treatments are equivalent?

What is chronic care management?

A

ARM + medical management is as effective as addiction counselling for mild-moderate

CCM is effective for AUD and alcohol related serious medical illness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Heavy alcohol use (book definition)

A

Binge drinking on more than 5 days in the past month

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

At risk drinking (book definition)

A

Exceeding levels for any day or week, binge drinking at least once a month, or drinking that increases the risk of future problems

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

AUD - what % continue despite external consequence?

What most severe % are over-represented in rehabs, jails and hospitals?

A

10% - includes jail, marital, job etc.

10%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

DSM 5 12 month prevalence of AUD:

Men and women, mild or mod-severe:

A

Mild - 10/5%
Mod-severe 6/2%

From other numbers 26%/3%/1%
Mod - 3% and severe 1% - = 4% 6-4-2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

AUDIT scores:

How many items, rated 0-what?
Severity groups and importance?

A

10 items, 0-4

5-10 - 20% have AUD
11-15 - 40%
16+ - 90%+

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

AUDIT C postivie

A

4+ in men
3+ in women

‘more than 5 - in the book’

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Symptoms of impaired control include: 4 things

A

going over limits
desire to cut down
use despite internal consequences
tolerance

Lets Tolerate Cutting Insects
Limits, tolerance, Down down, Internal consequences

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

In severe AUD, 4 reasons to consider ARMs:

A
  • impairment may mean lifestyle intervention is difficult
  • medications are comparable to AA and counseling
  • medications are as good as SSRIs for depression
  • ARMs improve proportion of long-term recovery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

AUD - tracking outcomes

3 data sources
1 lab test

A

Number of heavy drinking days (5+) in past month
AUDIT/AUDIT-C

yGT - if initially elevated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

ARMS:

Name - MODA - effects (stats)

2 first line - 3 others

ALWAYS NALTREXONE

A

Naltrexone - 50mg prior to drinking - u opioid - reduces heavy drinking by 83%, all drinking by 4%

Acamprosate - moderates glutamate transmission - abstinence increased by 11 days, all drinking RR 0.86/NNT 9, no effect on heavy drinking

Disulfuram - aldehyde dehydrogenase inhibitor, leads to acetaldehyde build up - poor tolerance - no more effective than placebo
Gabapenting - addictive/street value - abstinence higher in 900mg a day 11%, 1800mg 17%, than placebo (4%) over 12 weeks
Topiramate - off-label - decreased percentage of heavy drinking days vs placebo (43.8% vs 51.8%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Effect of a Lowfat vs Low-Carbohydrate Diet on 12-month weight loss in overweight adults and the association with genotype pattern or insulin secretion: the diet fits RCT:

n=

Intervention=

A

609 adults without DM, BMI 28-40

Either low-fat or low-carb diet, with 500-600 calorie deficit on average (not specifically instructed)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Effect of a Lowfat vs Low-Carbohydrate Diet on 12-month weight loss in overweight adults and the association with genotype pattern or insulin secretion: the diet fits RCT:

Key findings:
Macro-nutrient distribution
Weight change
Diet interactions
Adverse events
A

48% vs 30% for carbs, 29% vs 45% for fats, 21% vs 23% for protein

Remember45/30/20 for each

-5.3kg and -6.0kg

No genotype or INS-30 interaction

18 adverse events, equal distribution

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Exercise and depression - how does it compare to other treatments?

Does it work with other treatments?

What about old and young?

A

Exercise slightly better than no or control treatment, not better than psycho or pharmacotherapy

Slightly synergistic with pharma

Effective treatment in elderly, protective if done as children

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Mood and nutrients:

Higher mood disorders if these nutrients are low:

A

Folate, B12, calcium ,iron, selenium, zinc, omega-3 FAs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Do fish oils/omega-3 fatty acids help mood?

A

Some studies say yes, others say no.

Better evidence in depression or bipolar - longer bipolar remission with FA treatment.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Mood scores and diet - what happened after how long with omnivores became vegetarians?

A

2 weeks, mood scores improved

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What nutrients may improve mood?

A

Can Some White Flowers Prevent Tears

Carb rich evening meals, Saffron, Walnuts, Flax, Probiotics, Turmeric

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Health promotion and positive emotions:

Direct and indirect impacts?

A

Direct - body physiology, well-being, disease prevention or treatment
Indirect - maintenance of behaviours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Eudaimonia protects against?

A

strokes, alz/CI, heart attacks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Eudamonia and epigenetic?

A

Associatied with down regulated pro-inflammatory genes, and unregulated antibody synthesis.

The opposite for hedonic.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Eudaimonia and brain activation?

A

less activation of amygdala
more higher cortical function when confronted by negative stimuli
sustained reward circuit with positive stiuli
greater insular cortex volume

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

The boston and harvard study showed?

What physiological effects do social connections cause?

A

happiness and longevity - from social connections

social connections increased PNS activation, lower heart rate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Highest quartile of social media AOR of depression is…

A

2.47

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

5 protective effects of WFPB on B cells:

A
Stabilises immune system
Avoids hypreglycaemia
Anti-inflammatory
Lipids normalise
Leptin/adiponectin pathway normalised
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

ACCORD trial

Aim:

Outcomes:

A

Tight control of DM2 in patients with CVD/CVD RFs

  • weight gain
  • hypoglycaemia requiring assistance
  • increased mortality (1.2), even with decreased HbA1c (0.9)
36
Q

Diabets:
Prevalence of DM and pre-DM? (percentages)
Approx prevalence in millenials
Costs of medical care on DM

A

9.3% and 33%

33% males, 39% females, 50% in Black/Hispanic

Medical costs - 2.3x higher, 16750/yr, 9600 attributed to DM

37
Q

Diabets…

NIDDM global rates 1980 to 2014

increase by 2025?

India - how many and cost implications?

A

5% to 8.3%

55% extra

100million, 25% family income

38
Q

Sleep in numbers:
Workes on night shifts, %?

% young adults sleeping less than 7 hours? And snince when to when has this double?

How many have difficulty sleeping?
Costs and those seeking help?

A

20% on nihgt shifts

37%, doubled 1960-2002

60million difficiuty, 10% seek help, costs 60billion

39
Q

Sleep as a normal activity…

How much?
How much of life?

A

7-8 hours a night, 1/3rd of lfie

no objective test for how much needed

40
Q

What is the SCN?
What entrains the SCN?
What other important connections?
What else is it important for?

A

the portion of the hypothalamus that controls melatonin secretions
Neurones from retina entrain the centril oscillators
Pineal gland, and splanchnic nerves to adrenal glands
Also responsible for awakening cortisol spike

41
Q

3 outputs of the circadian rhythm?

A

1) functional performance - alertness, motor skills, kinetic activity, strength and stamina
2) Sleep
3) Food-seeking behaviour

42
Q

4 things throughout sleep

A

1) DNA remodelling
2) leptin secretion
3) increasing cortisol
4) fatty acid metabolism

43
Q
Lux of lighting:
Bright sunlight
Floudy day
OVercast day
Kitchen
Home
A
100K
25K
2K-5K
200-500
50-200
44
Q

Blue light is what wavelength and what kelvin?

A

420-480 - 6500

Blue light is that which melanopsin is most sensitive to, the molevule in RGCs that entrains the SCN

45
Q

Sleep deficiency does what to cortisol@?

A

increased cortisol at night, which decreases cortisol mineralocorticoid action exacerbating low fluid effets

46
Q

Lower retinal illuminace…
45 year olds?
65 year olds?

A

45 year old have 50% that of a 10 year old`
65 year old 50% that of a 45 year old

affects blue light the most

47
Q

BIISS prevalence?
OSA prevalence and undiagnosed %?

Restless leg prevalence?

In RLS what percentage also have periodic movements of sleep?

A

7.3-20%
26% - 80% undiagnosed

5-15%

80% also have periodic movements of sleep

48
Q

OSA - 5 associated conditions:

A
metabolic syndrome
HTN
obesity
neck circumference
loud snoring
49
Q

Healthy sleep does 3 things for metabolic conditions:

A

Lower cortisol and BM
Greater insulin sensitivity
Higher leptin in the day

(poor sleep gives you higher cortisol during the night)

50
Q

Short sleep correlates with what 4 conditions?

A

Refractory/no-reduction of BP in early morning hours
Increased heart attacks
Increased CV deaths
Vasospastic disorders

51
Q

Short sleep duration correlates with what mental helath conditions?

A
MD, BD
SAD
PMS
PTSD - worst if sleep dep 2 weeks prior
TBI - worse wit hsleep dep pre or post

3 affective disorders, 2 from the army and 1 PMS

52
Q

Sleep and cancer:

Sleep helps with

Short sleep leads to 4 things

Correlates with 5 cancers

A

DNA repair, histrone remodeline, apoptotis and anti-cancer cytokines (IL1,2, TNFa)

Melatonin and immune suppression, increased cancer cytokines (IL10), cell/gene transcription dysfunction, aberrant DNA methylation

Brest, endometrial, prostate cancer, colorectal cnacer, AML

53
Q

Melatonin and west-ward - whats the special thing?

A

SR may be better, but also may cause morning drowsiness

54
Q

Sleep assessment - the steps (7)

A
Weekend
Weekday hours
Quality
Any red flags? - <7 >9 irregular, poor quality, 1+ hours difference
Daytime fatigue
Type of sleep disturbance and frequency
Attitude towards sleep
55
Q

Sleep red flags

A
5:
- less than 7 hours
more than 9 hours
poor quality despite 7 hours or more
irregular timings
one or more hours difference between weekend and weekday
56
Q
Sleep prescriptions - the numbers:
alcohol
Caffeine
Waking too early - when eat/caffeine?
Jetlag going west - when eat breakfast?
Blue light
Work/stimulating activity
Active relaxation
A
3 hours ETOH
limit daytme caffeine, no night time caffeine
30-60minutes after ideal wakeup
30-45minutes after ideal wakeup
1 hour pre sleep
90 minutes pre sleep
1 hour pre sleep
57
Q

Epigenetics - 4 components

A

DNA methylation
microRNA
histone acetylation
‘growing number of other components’

58
Q

Agouti mice - what did they show? (3)

A

genetic expression of DM, heart disease, obesity affected by lifestyle in genetically identical mice

59
Q

Physician health:
How many GPs are obese? (USA)
How many Candian 4th year med students don’t meet PA guidelines?

A

53%

36%

60
Q

Meta-analysis of health providers’ PA habits showed what?

A

19/24 high correlation between PA habits and PA counselling - Odds of counselling 1.4 to 5.7

61
Q

Female physician research showed what about behaviours and counselling?

A

Ate less fat –> cholesterol
5 fruit and veg –> nutrition
Vegetarian –> weight loss and nutrition

62
Q

Male internists - what associations in behaviour and counselling?

Female internists - same Q?

A

Male - smoking, seat belt ad PA associated with counselling, ETOH does not

Female - PA associated with counselling about exercise and alcohol use

63
Q

Examples of advocacy: (3)

A

Dean Ornish - Lifestyle heart medicine

Blue zones project - characteristics of the 5 healthies/longest living areas - collaboration amongst community and leaders to transform health community systems

RWJF - Creating a culture for health - community showcase of healthy ideas

64
Q

WHO recommends measuring waist at:

A

midpoint between the lowest rib and iliac crest

65
Q

Normal body fat charts - men and women

A
2-4%
6-13%
14-7%
18-25%
26%+
(notice 2-3-4-5-6 and 4/6/4/8)
10-12%
14-20%
21-24%
25-31%
32%+

(notice 1/1, 1/2, 2/2, 2/3 and 2/4/4/2)

66
Q

What is the Edmonton staging of obesity?

A

Stages 0-4 depending on function or morbidity

67
Q

Weight loss calorie reduction and goal calories:
Men
Women

A

750 reduction 1500-1800 a day

500 reduction 1200-1500 a day

68
Q

Energy expenditure: % and categories

A

5-10% TE of food
60% REE (resting)
30-40% Non-resting EE

69
Q

Bariatric surgery referral criteria

A

BMI 40+
BMI 35+ and co-morbidities

Must have tried and failed to lose weight other ways

ACLM - interprets failure as 6 months ILI

Must be motivated for weight loss

70
Q

Weight loss goals and outcomes at those goals

What is the minimum for clinically meaningful change?

A

3-5% - HbA1c, Trigs, reducing DM progression, glucose (biochemistry and DM)

5% - hypertension, dyslipidaemia, medication reduction (remember statins and amlodipine)

71
Q

Average weight loss from ILI in first 6 months?

A

around 8kg 17lbs

72
Q

Plateau phenomenon in obesity and weight loss…

A

Losing 10% of weight NREE decreases by 30%
Indiviudals must eat 10-15% less than expected
Persists for months+

Structural changes in the hypothalamus and brain must re-adapt for sustained body weight control

73
Q

Occupational factors and health - two stress related studies:

A

Finnish study showed 3-4 hours overtime a day at 7.5 years FU increased CVD risk

15 year study, work stressors doubled DM risk ,mildly attenuated by obesity and healthy behaviours associated with diabetes

74
Q

Dr Cohen’s perceived stress questionnaire:

A

10 items, 0-4
0-13 low
13-26 moderate
27-40 high stress

75
Q

PHQ-2:
What is positive?
What is sensitivity and specificity?

A

3 or higher is positive
Sensitivity 80-90%
70-85%

76
Q

GAD DSM symptoms

A

Must have GAD2 symptoms (anxiety and worry, difficulty controlling it)
also must have 3 other symptoms
impairement, no other condition or substance abuse

77
Q

PHQ-4 : the Qs and the scoring…

A

ask the GAD2 and the PHQ2 scores

Add them together:
0-2 - normal
3-5 mild
6-8 moderate
9-12 severe

This is a screening tool for anxiety and depression
Higher scores associated with impairment, disability days an dhealth care use
3+ is positive and should lead to suicidal ideation screening and further assessment

78
Q

Resiliency tipping point - what’s the ratio?

What is resiliency?

A

3:1

Resilience determines if someone will be able to overcome and obstacle - it is measurable

Use positivityratio.com a 2 minutes test

79
Q

Positive resonance is what?

What physiological parameter does it improve?

A

positive social connections

micro-connections improve HR

80
Q

For obesity - what are the most effective ILI?

A

intense (14 or more sessions in 6 months) with trained interventionists or nutritionists

include caloric restriction, PA, and behavioural strategies to facilitate change

81
Q

When do you use pharma + ILI for obesity?

A

BMI >27 with co-morbs, or over 30

82
Q

Confidence/importance and stages of changes…

A
1-3 - precontemplation
4-6 - contemplation
7 - planning
8-9 - action
10 maintainance
83
Q

The long chart for PA and mortality shows what exactly?

A

mod or vig PA - risk of premature death

84
Q

neuromotor/balance recommendations?

A

Healthy adults 18-64 years of age
• 20 – 30 minute per session of motor skill and proprioceptive skill training for cumulative 60 minutes/week
• This is a level we know is effective, but optimal duration and repetitions are not known.
• Older adults ≥65 years of age
• ≥ two-three days/week of motor skill and proprioceptive skill training
Motor skill = balance, gait, agility, and coordination
• Proprioceptive skill = awareness of body in space, examples include tai chi and yoga

85
Q

What is prescription for health?

A

“Prescription for Health”
• Successful primary care and office-based models for lifestyle modification for 4 health risk behaviors • Tobacco use, risky alcohol use, unhealthy diet, lack of physical activity
• Lessons learned
• PCP offices are capable and had interest in health behavior change if funding and support were available
• Health Care Delivery Model (PCMH)
• Electronic Preventative Services Selector (ePSS)