Public Health 2

Question 1

Unmodifiable RF for CHD

Answer 1

Age
Sex
Ethnicity
Genetics

Question 2

Lifestyle RF for CHD

Answer 2

Smoking
Diet
Physical inactivity

Question 3

Clinical RF for CHD

Answer 3

HTN
Lipids
DM

Question 4

Psychosocial RF for CHD

Answer 4

Behaviour traits
Depression/anxiety
Work
Social support

Question 5

Describe some coronary prone behaviours

Answer 5

Competitive, hostile, impatient
Type A behaviour

Question 6

Who described coronary prone behaviours?

Answer 6

Friedman and Rosenman 1959

Question 7

How do you assess Type A behaviour?

Answer 7

MMPI-2

Question 8

How does >11 hour work days affect the risk of MI?

Answer 8

67% higher chance of MI

Question 9

What psychosocial work characteristics affect chance of MI?

Answer 9

High demand
Low control

Question 10

Describe the Whitehall I study

Answer 10

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

Question 11

Describe the Whitehall II study

Answer 11

10, 000 civil servants
Employment grade was strongly associated with work control and demands

Question 12

What type of Questionnaires are used for research purposes to explore how Type A influences risk of CHD?

Answer 12

Minnesota Multiphasic Personality Index (MMPI-2)
Jenkins Activity Survery
Bortner Rating Scale
Self-report = poorer predictors

Question 13

What did the Western Collaborative Group Study find?

Answer 13

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

Question 14

What were the findings of the Framingham Heart Study?

Answer 14

1674 men & women
Questionnaire - JAS

Question 15

What are the types of questionnaires used to research the psychosocial influences on CHD?

Answer 15

Minnesota Multiphasic Personality Index (MMPI-2)
Jenkins Activity survery
Bortner rating scale

Question 16

How does self-report questionnaires impact the prediction of CHD?

Answer 16

Poorer predictors

Question 17

What were the groups in the recurrent coronary prevention project?

Answer 17

4.5 years
RCT

Group 1 - Cardiology counselling
Group 2 - Type A behaviour modification
Group 3 - No intervention

Question 18

What are some examples of Type A behavioural modification?

Answer 18

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

Question 19

What were the findings & conclusion from the recurrent coronary prevention project?

Answer 19

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

Question 20

What key risk factor within Type A behaviour has been more significantly related to CHD?

Answer 20

Hostility
Anger, annoyance and resentment
Verbal/physical aggression

Question 21

What measurement instruments are used to explore the relationship between depression/anxiety and CHD?

Answer 21

MMPI
Beck depression inventory
General health questionnaire
Spielberger’s state anxiety intervention

Question 22

Quick! Summarise Anda, Williamson et al study (depression and CHD)

Answer 22

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

Question 23

What does the Orth-Gomer (1993) study show about social support and CHD?

Answer 23

‘Attachment’ and ‘social integration’ lower in men who developed CHD
& greater incidence of MI and death from CHD

Question 25

What can doctors do to reduce psychosocial influences on CHD?

Answer 25

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)