Public Health 2 Flashcards
Unmodifiable RF for CHD
Age
Sex
Ethnicity
Genetics
Lifestyle RF for CHD
Smoking
Diet
Physical inactivity
Clinical RF for CHD
HTN
Lipids
DM
Psychosocial RF for CHD
Behaviour traits
Depression/anxiety
Work
Social support
Describe some coronary prone behaviours
Competitive, hostile, impatient
Type A behaviour
Who described coronary prone behaviours?
Friedman and Rosenman 1959
How do you assess Type A behaviour?
MMPI-2
How does >11 hour work days affect the risk of MI?
67% higher chance of MI
What psychosocial work characteristics affect chance of MI?
High demand
Low control
Describe the Whitehall I study
Male british civil servants over 10 year period
Men in lowest grade had higher mortality than men in the highest grade
3x mortality rate from all causes
Describe the Whitehall II study
10, 000 civil servants
Employment grade was strongly associated with work control and demands
What type of Questionnaires are used for research purposes to explore how Type A influences risk of CHD?
Minnesota Multiphasic Personality Index (MMPI-2)
Jenkins Activity Survery
Bortner Rating Scale
Self-report = poorer predictors
What did the Western Collaborative Group Study find?
3, 154 men - Free from CHD & other health problems
8.5 year follow up - 257 CHD & 50 deaths
Behaviour pattern - structured interview
Type A:Type B = 2:1
What were the findings of the Framingham Heart Study?
1674 men & women
Questionnaire - JAS
What are the types of questionnaires used to research the psychosocial influences on CHD?
Minnesota Multiphasic Personality Index (MMPI-2)
Jenkins Activity survery
Bortner rating scale
How does self-report questionnaires impact the prediction of CHD?
Poorer predictors
What were the groups in the recurrent coronary prevention project?
4.5 years
RCT
Group 1 - Cardiology counselling
Group 2 - Type A behaviour modification
Group 3 - No intervention
What are some examples of Type A behavioural modification?
Cognitive - Reconstruct thoughts, i.e. NOT “I must always arrive first at work!! >:(“ but instead “As long as I arrive by 9am, i will be productive :) <3 <3”
Behavioural - Relaxation, walk more relaxed, reduce work demands
Emotional - Learning relaxation techniques in response to early signs of anger
What were the findings & conclusion from the recurrent coronary prevention project?
Group 2 (Type A behaviour modification) -
↓ Type A behaviour vs Group 1
Signif few fatal & non-fatal cardiac events
Group 3 (no intervention) had most cardiac events
Conclusion : Reduction in Type A behaviours reduces morbidity and mortality in post-infarction patients
What key risk factor within Type A behaviour has been more significantly related to CHD?
Hostility
Anger, annoyance and resentment
Verbal/physical aggression
What measurement instruments are used to explore the relationship between depression/anxiety and CHD?
MMPI
Beck depression inventory
General health questionnaire
Spielberger’s state anxiety intervention
Quick! Summarise Anda, Williamson et al study (depression and CHD)
Higher depression ratings at baseline = higher CHD and associated mortality
If participants had/were developing CHD in first 2 years, they were excluded
Followed up over 12 years
Controlled for known risk factors
What does the Orth-Gomer (1993) study show about social support and CHD?
‘Attachment’ and ‘social integration’ lower in men who developed CHD
& greater incidence of MI and death from CHD
What can doctors do to reduce psychosocial influences on CHD?
Observe/explore behaviour patterns
Identify signs of depression/anxiety
Ask Qs from assessment tools
Ask patients about occupation& available support
Liase w appropriate services (Social care etc)
