SFSBM Review I Em

Question 1

Focusing exclusively on proximal causes of disease obscures the underlying determinants of health such as

Answer 1

natural selection, fetal and early childhood development, lifetime of environmental exposures and social interactions

Question 2

3 ways that inherited genomes contribute to the risk of disease

Answer 2

• aneuploidy
• single-gene mutations
• multigene interactions of single nucleotide polymorphisms, whose expression is heavily influenced by developmental placticity and environmental factors

Question 3

Natural selection has left us vulnerable to disease through a variety of mechanisms such as

Answer 3

• environmental mismatch
• selective pressure against post-reproductive maintenance/repair
• co-evolution with rapidly evolving pathogens
• heterozygote advantage
• design constraints

Question 4

The dramatic drop in mortality from infectious disease over the last century largely predates

Answer 4

the introduction of clinical interventions such as immunizations and abs

Question 5

Preventable premature morbidity and mortality throughout the world is most strongly linked to …

Answer 5

low socioeconomic status: poverty, illiteracy, poor living conditions, and social exclusion

Question 6

social-ecological model

Answer 6

accounts for the full web-like complexity of health determinants on multiple levels: 
individual 
interpersonal
organizational/institutional
community
policy

Question 7

By any measure (wealth, income, education, neighborhood, occupation), the __________ of a population is a strong predictor of its health, and the relationship is continuous across all __________ (no threshold effect)

Answer 7

By any measure (wealth, income, education, neighborhood, occupation), the SOCIOECONOMIC STATUS of a population is a strong predictor of its health, and the relationship is continuous across all SES STRATA(no threshold effect)

Question 8

intermediary factors between SES and health

Answer 8

Poor social capital, noxious environments, risky behaviors, and psychological stress (among other things)

Question 9

Within SES strata, the _________ (rather than its absolute amount) becomes relevant

Answer 9

Within SES strata, the DISTRIBUTION OF WEALTH (rather than its absolute amount) becomes relevant

Question 10

measures of inequities in income (e.g., ____ coefficient) are associated with a variety of social and health outcomes

Answer 10

measures of inequities in income (e.g., GINI coefficient) are associated with a variety of social and health outcomes

Question 11

Gini coefficient

Answer 11

represents the fraction of the aggregate income in a population that would need to be redistributed to obtain full equality (roughly 48% in 2016).

Question 12

stress response

Answer 12

the combined physiologic, cognitive, emotional and behavioral changes associated with a stressful exposure

Question 13

This occurs when the challenges imposed by the physical or social environment exceed an individual’s emotional adaptive capacity, increasing the risk of a maladaptive stress response

Answer 13

Psychological stress

Question 14

allostatic load

Answer 14

one model to explain how social determinants of health leave individuals more or less vulnerable to chronic disease over a lifetime

Question 15

The most common clinical strategy for addressing stress

Answer 15

wait and intervene once the damage has occurred. This is done by diagnosing and treating stress-related disorders (e.g., depression, acute coronary syndrome, asthma) when they become symptomatic or their pathology is otherwise recognized.

advantage: does not require addressing the stress itself, which is time consuming and so does not lend itself to fast-paced, acute care settings.

Question 16

___________ preventive interventions have the greatest impact on the health of societies, but ___________ interventions can be also be useful and have their advantages

Answer 16

POPULATION-BASED (LOW-RISK) preventative interventions have the greatest impact on the health of societies, but CLINICALLY-BASED (HIGH-RISK) interventions can be also be useful and have their advantages

Question 17

Primary prevention

Answer 17

aims to eliminate precipitating causes of disease or injury before they occur

Question 18

secondary prevention

Answer 18

targets existing pathology (or risks) that have yet to become symptomatic or cause harm

Question 19

medical tx of cancer would be classified of which type of prevention?

Answer 19

tertiary

focus is on the patient’s future risk of harm rather than their present condition

Question 20

Do most recipients of clinical preventive interventions personally benefit from them?

Answer 20

No.

this largely accounts for its relative inefficiency

Question 21

unlike immunizations, the benefits and harms (which can be substantial) of ________ must be balanced for individual patients

Answer 21

unlike immunizations, the benefits and harms (which can be substantial) of CHEMOPREVENTIVE AGENTS must be balanced for individual patients

Question 22

chemopreventative agents

Answer 22

pharmaceuticals or dietary supplements intended to protect against disease

many of these also used to treat previously diagnosed conditions, in which case they would not be considered chemopreventive (e.g. iron supplements to treat anemia, endocrine therapy to treat breast cancer)

Question 23

Patient education is necessary but insufficient for behavior change; success depends on …

Answer 23

longitudinal sessions of patient-centered, motivational training performed in the context of the social ecologic model

Question 24

Generally, __________ are associated with higher costs and potential harms compared to other preventive services

Answer 24

Generally, SCREENING PROGRAMS are associated with higher costs and potential harms compared to other preventive services

Question 25

According tp USPSTF guidelines, clinicians should strongly consider the use of interventions receiving grade ____ recommendations and should consider not using grade ___ interventions

Answer 25

According tp USPSTF guidelines, clinicians should strongly consider the use of interventions receiving grade A AND B recommendations and should consider not using grade D interventions

Question 26

Decision regarding grade C and I interventions must rely more heavily on factors other than research evidence, such as

Answer 26

scientific rationale, common sense, patient values, safety and cost

Question 27

When using USPSTF guidelines it is still important to

Answer 27

stratify patients according to risk

Question 28

modern biomedicine is based largely on the principle of

Answer 28

reductionism: the best (and some would say only) way to fully understand a complex system is to disaggregate it into its smaller component parts and study each individually

Question 29

Proponents of holism argue that reductionism is inherently flawed because…

Answer 29

it fails to give adequate attention to the interactions between components and to the influence of irreducible phenomena

Question 30

holism

Answer 30

alternative to reductionism

• what matters most is not the components themselves, but their relationship to one another
• holists may further argue that certain complex phenomena are irreducible, like the human mind

Question 31

the most common indication is for non-allopathic therapies is for …

Answer 31

the management of pain

Question 32

specific effects of therapies

Answer 32

presumed physiologic mechanism

Question 33

non-specific effects of therapies

Answer 33

chance variation
natural history
concurrent tx
psychobiologic response

Question 34

RCT’s are ill suited for the investigation of

Answer 34

most non-allopathic therapies (w/ exception of dietary supplements)

Question 35

placebo response

Answer 35

an improvement in a patient’s (or research subject’s) illness attributable to the meaning (or prior conditioning) of an intervention rather than a presumed physiologic property of that intervention

in many ways, clinical placebo are synonymous with the context of care

Question 36

The frequency and magnitude of effects routinely observed among controls in clinical trials are poorly predictive of _____ effects in clinical practice

Answer 36

The frequency and magnitude of effects routinely observed among controls in clinical trials are poorly predictive of PLACEBO effects in clinical practice

Question 37

mechanisms underlying the placebo effect appear to primarily involve expectancy and conditioning (learned response)

Answer 37

expectancy and conditioning (learned response)

Question 38

_______ is one of several TCM interventions based on pre-scientific concepts regarding the relationship between humanity and nature

Answer 38

acupuncture

Question 39

Despite its vitalistic origins, ________ is now largely based on biomechanical principles

Answer 39

chiropractic

most chiropractors focus on conditions anatomically related to the spine; its long-standing popularity has had more to do with its high levels of patient satisfaction than clear evidence of efficacy

Question 40

Implicit association research shows that _______ physicians commonly exhibit implicit bias against black patients

Answer 40

Implicit association research shows that NON-HISPANIC WHITE PHYSICIANS commonly exhibit implicit bias against black patients