Adolescent Health (1)

Question 1

Why is sexual health important?

Answer 1

Improves physical and mental health outcomes

Positively influences social and emotional wellbeing

Question 2

What is the definition of good sexual health by the WHO?

Answer 2

A state of physical, mental and social well-being in relation to sexuality. It requires a respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence

Question 3

What are the consequences of poor sexual health?

Answer 3

Unplanned pregnancies and abortions - 1 in 6 pregnancies are unplanned

Psychological consequences - from sexual coercion and abuse

Poor educational, social and economic opportunities for teenage mothers, young fathers and their children

HIV transmission

Cervical and other genital cancers
Hepatitis, chronic liver disease, liver cancer
Recurrent genital herpes / warts
Pelvic inflammatory disease (subsequent ectopic pregnancies and infertility)
Adverse pregnancy outcomes (maternal and neonatal)

Question 4

How can poor sexual health be prevented?

Answer 4

Contraception
HPV immunisation
HIV prevention
Education / health literacy - changing public’s attitude to sexual health

Question 5

Why is barrier protection important?

Answer 5

Only type of protection that can prevent all STIs

Question 6

What are teenage pregnancies?

What are the consequences of teenage pregnancies?

Answer 6

Under 18 pregnancy

Most unplanned, 50% undergo abortions

Huge psychological and physical impacts

More likely to have poor antenatal health
Lower birth rate babies and higher infant mortality rates

Teen mothers less likely to finish education and find employment = children brought up in poverty
3x more likely to to experience post-natal depression

Question 7

Risk factors to teen pregnancies and coercion / abusive relationships:

Answer 7

In or leaving care
Homeless
Involved in crime 
Low educational attainment
Social deprivation

Question 8

What has already been implemented to improve poor sexual health?

Answer 8

Compulsory relationships and sex teachings in secondary schools

NHS HPV immunisation programme - 12-13 y/o of all girls and boys

PrEP (pre-exposure prophylaxis) and PEP (post exposure prophylaxis) medication to reduce transmission of HIV - needs to be seeked out

Testing, diagnosis and treatment of STIs

Question 9

What are the most common STI diagnosis?

Answer 9

49% - chlamydia
15% - gonorrhoea
11% - first episode of genital warts
7% - first episode of genital herpes

Highest i heterosexual 15-24 y/os

Question 10

What can increase sexual dysfunction?

Answer 10

Smoking
Prolonged drug or alcohol use
Stress
Poor mental health

Question 11

What must doctors do with their patients?

Answer 11

Take an opportunistic approach
Be non-judgmental and empathetic
Holistic
Inform patients and facilitate decisions
Provide them access to support /  services

Question 12

What is pre-natal care such an important time?

Answer 12

Impacts positively on future health outcomes for mother and baby

Amenable time for woman to make positive changes in their behaviour

Behaviour changes more likely to be long-lasting

Question 13

Why is maternal nutrition important?

Answer 13

Plays a crucial role in maintaining the health of the developing foetus

e.g. link has been found between maternal and childhood excess weight

Question 14

Which 2 micronutrients are supplemented during pregnancy?

Answer 14

Folic acid - recommended prior to conception and up to 12 weeks of pregnancy to reduce the risk of neural tube defects e.g. spinal bifida

Vitamin D supplements - throughout pregnancy and breast-feeding to promote bone health in foetus and reduce risk of ricketts

Question 15

What should a pre-natal diet consist of?

Answer 15

Folate-rich foods - green leafy vegetables, peas, kidney beans, chickpeas

Don’t overeat ‘for two’
Plant based diet is very good

Question 16

What are the benefits of physical activity during pregnancy?

Answer 16

Decreased risk of:
Hypertension in pregnancy
Pre-eclampsia 
Gestational diabetes
Severity of depressive symptoms during and after pregnancy

Question 17

Why is maternal mental health important?

Answer 17

Poor mental health in the mother can impact their ability to bond with the baby and respond to baby’s needs

Question 18

Why is attachment type important in baby?

Answer 18

Insecure attachment can affect child’s emotional and social development

Question 19

How does drinking alcohol during pregnancy affect the foetus?

Answer 19

Early miscarriage
Premature birth
Restricted growth
Still birth
Cognitive delay
Foetal alcohol spectrum disorders - irreversible and avoidable
Foetal alcohol syndrome - characterised by small stature, distinct facial features, abnormal palmar creases, cardiac defects, joint contractures, cognitive deficits

Question 20

How does smoking during pregnancy affect the foetus?

Answer 20

Increases risk of low birth rate
Increases risk of respiratory conditions, T2DM and obesity
Increase in miscarriages, premature births and perinatal deaths

Question 21

What is the microbiome?

Answer 21

Genetic material of all the microbes that live on or within the body - mostly found in the gut

Consists of bacteria, fungi, parasites and viruses including their genes found co-existing throughout the human body

Interacts with the nervous system (NS) and immune system

Plays an important role in health and disease

Question 22

What factors influence diversity and health or the microbiome?

Answer 22

Genes
Age
Environment
Stress
Diet
Physical activity 

Healthy lifestyle = healthy microbiome

Question 23

How does maternal microbiome impact on future health of the child?

Answer 23

In the uterus, foetus is exposed to maternal microbial DNA and maternal microbes

During birth - baby is exposed to vaginal and / or skin microbes

This rapidly colonises and imfluences diversity of baby’s microbiome

Breastfed babies have significantly different diversity of microbiomes than formula milk fed babies due to muicrobiome passed from mother to child via breast milk and skin when baby suckles

Question 24

What environmental factors can influence maternal and foetal health?

Answer 24

2 main man-made chemicals found on the umbilical cord during birth:

1. PFOS (perfluoro-octance sulfonate) - found on electronics, textiles and non-stick cookware
2. PFOA (perfluorooctanoate) - found on carpets, textiles, leather, household and industrial cleaning products

Unknown the long term effects of this on the foetus

Question 25

What is the role of the gut microbiome in secondary metabolite production?

Answer 25

Breaks down luminal compounds sto more useful metabolites Detoxify ingested toxins Synthesises antimicrobial peptides Break down of dietary fibre and resistant starches Fermentation by Firmicutes releases short chain fatty acids (SCFAs) = energy source and lowers the pH pH of colon dictates what micro-organisms can survive there, and interacts with the immune and nervous systems SCFAs = maintain local (gut) and systemic immune homeostasis and gut-brain axis

Question 26

What is the role of the gut microbiome in vitamin production?

Answer 26

Vitamin K synthesis and several components of vitamin B is undertaken by the gut microbiome

Question 27

What is the role of the microbiome in the immune system?

Answer 27

Homeostasis of immune system between tolerating beneficial micro-organisms and preventing pathogen overgrowth Toxin enters bloodstream --> dendritic cell detects this --> acute proinflammatory immine response --> toxin removed Dendritic cells constantly monitor gut environment and produce appropriate immune responses - either pro or anti inflammatory - through cytokine release and regulatory T cell production

Question 28

How can the balance between the microbiome and gut go wrong?

Answer 28

Constant exposure to lower level harms e.g. poor diet or unhealthy microbiome exposure = chronic low level inflammatory state = chronic disease Unhealthy diet makes intestinal membranes more permeable = 'leaky' gut = allows LPSs through

Question 29

What are LPSs and why are they harmful?

Answer 29

LPS = lipopolysaccharides can be harmful They form the outer coat of certain types of microbiota, and can cross into the bloodstream due to a 'leaky' gut - causes stress and inflammatory response

Question 30

How does the microbiome interact with the entertic and central nervous systems? (ENS and CNS)

Answer 30

Gut-brain axis pathway = two way communication system via ENS, CNS (vagus nerve) and cytokines in the blood Brain can induce stress mediated changes in the GI tract e.g. motility change GI tract can send stress mediated responses to the CNS via metabolites, neural afferent circuits etc. Microbiome involved in the metabolism of tryptohan, which is involved in the production of serotonin - gut motility can be impacted by serotonin

Question 31

What is the structure to implement lifestyle medicine in a consultation?

Answer 31

Ask permission to discuss x, y, z Find out what she already knows Discuss benefits specific to their situation Find out about risks / barriers for the patient to carrying out x, y, z Explore patient's motivations Identifying fears and barriers for patient Screening for x, y, z Positive reinforcement of current health behaviour and future plans Using a positive and empowering approach Signposting to further resources

Question 32

Sex VS Gender:

Answer 32

Sex - biological, assigned at birth | Gender - social construct, personal perception + identity

Question 33

What is healthy life expectancy and what is the trend in women?

Answer 33

No. of years lived in fairly good health Declining for women since 2010

Question 34

Women are more likely to:

Answer 34

More likely to move into residential care More likely to provide informal, unpaid care to relatives and children More likely to be obese More likely to develop cancer More likely to develop dementia

Question 35

Why does obesity increase the chances of developing cancer?

Answer 35

Fat tissues are: Inflammatory Produce sex hormones (oestrogen) Produce growth hormones (e.g. insulin, growth factor) = promote rapid cell division = increased risk of cancer

Question 36

Why are females less physically active than males?

Answer 36

Societal factors: Fear of judgement Lacking confidence Lacking time

Question 37

What is clinician bias?

Answer 37

Stereotyped attitude or belief about a patient e.g. women are more likely to receive an initial misdiagnosis following an MI so women face a 70% increased risk of death after 30 days

Question 38

What is the data published in medicine biased?

Answer 38

After thalidomide scandal - new law in 1977 banned women of childbearing age to be part of clinical trials = medications only tested and so suitable for men Not until 1993 this law was overturned - all minority groups must be represented in clinical trials

Question 39

Women are more likely to: | [finance]

Answer 39

Gender pay gap amongst all employees 17.4% in 2019, 15.5% in 2020 Women are over-represented in lower paid, lower skilled jobs More likely to be financially insecure Health workforce = 70% women But on represented 25% in leadership positions

Question 40

What is driving the pay gap between men and women?

Answer 40

Women and men do different jobs Jobs done by women are underrated Men hold more the most senior roles Women pay a 'motherhood penalty'

Question 41

During the pandemic, mothers were more likely to:

Answer 41

Quit / lost their job Be furloughed Contribute to childcare Contribute to household responsibilities

Question 42

Women and girls more likely to experience:

Answer 42

Sexual abuse Physical abuse Neglect Domestic abuse All causes of premature death All negatively affect physical, mental, reproductive and sexual health

Question 43

What is oxytocin? When is it produced?

Answer 43

Hormone - produced in the hypothalamus and released from posterior pituitary gland Produced during social connections, sex, labour and childbirth

Question 44

What does oxytocin promote? Why is it released?

Answer 44

Promotes social bonding, prosocial behaviour, empathy, elevated mood and stress reduction

Question 45

Why is good quality social connection important?

Answer 45

Live longer and have healthier lifestyle behaviours Suffer less from mental health issues and have better recoveries from mental and physical stressors Have better cardiovascular health and a stronger immune system Experience a lower severity of perceived physical pain

Question 46

What is meant by: Intimate connections Relational connections Collective connections

Answer 46

Intimate connections - people who personally love and support you e.g.family, friends and partners Relational connections - people who you see on a regular basis and may share an interest with e.g. work colleagues or a local barista who makes your coffee Collective - people who share a common affiliation or group membership with you e.g. people from your faith group

Question 47

How do men and women experience relationships differently?

Answer 47

Women are more likely to have broader and more intimate friendships than men. They are more likely to discuss personal matters and feel more supported during times of stress. Negative aspects of close relationships are more likely to affect women and people with a lower socioeconomic status. Women report higher psychological distress and negative interactions, despite having broader and more intimate relationships.

Question 48

What are the consequences of domestic abuse during pregnancy?

Answer 48

Miscarriage Infection Premature birth Injury or death of the baby following birth

Question 49

How can healthcare professionals support women experiencing domestic abuse?

Answer 49

Elicit information in a sensitive and empathetic manner Signpost to appropriate sources for guidance and safety Plan follow-up care with flexible appointments as needed, and refer to appropriate professionals, such as a domestic abuse support worker Address their fear of involvement of social or child protection services and reassure confidentiality where appropriate] Allow the patient to have autonomy over their decisions, without feeling pressured Respect their decisions and remain non-judgemental] Remind them that they are not alone in their experience and that there is always help available.