everything Flashcards
(102 cards)
1
Q
What types of food are carcinogens?
What cancers?
A
Processed meat - group 1
red meat - 2A
Causes pancreatic, stomach, colorectal, prostate
2
Q
Ileal digestibility of proteins
Downsides of animal
A
Animal 95%
Soy/Wheat 90%
Cereals/Peas 80-90%
Intact cell walls 50-80%
More sulphur containing acidic – calcium buffering - osteoporosis
3
Q
Beneficial non-nutrients
A
Polyphenols Carotenoids Phytochemicals Antioxidants Glucosi... Phytostanols
4
Q
Anti-oxidant foods
A
CSI Doesn’t PretEnd Any Old Original Characters Go Mad
+ Vit C, E and selenium!
Cruciferous - sulforophane, indole-3-carbinols
Dark berries and fruit - polyphenols, ellagic acid,
Alium - organosulfurs
Orange/yellwo/DG F&V - carotenoids
Dark green leafy - Metals - K/Ca/Mg
Elsewhere lycopene - tomatoes
5
Q
Root cause analysis steps (3)
A
Ask 3-5 why’s
Ask so what
Draw fishbone diagram
6
Q
Benefits of quitting smoking
- timeline
- years of life gained
A
Immediate - 50% risk 'heart attack' (1-9 months - less cough, better lung function) 1 year - 50% risk of heart disease 2-5 years - Stroke risk of non-smoker 10 years - 50% risk of lung ca
Quit at 30 - gain 10 years
40 - 9
50 - 6
60 - 3
7
Q
Smoking stats:
Costs
Deaths
A
$150 billion direct/130 indirect
480000 deaths (0.5 million
1:5 deaths
Kills 50% of users
(RULE OF 5s)
83% of lung cancers
32% of cardiac disease (check)
8
Q
Quitting cold turkey
Relapse at 14 days?
Relapse at 30 days?
Quitting with medical help
Relapse at 3 months
A
14 days 50%
(2 weeks, 1 in 2)
30 days 75%
(30 days THREE quarters)
With doctors - 40-50% at 3 months, double success rate
9
Q
USPHS - 10 guidelines for smoking cessation servics
A
2 background
6 treatment
1 MI
1 cost
1 - Dependence is a chronic disease 2 - Assess and document it 3 - Treatment works in lots of groups 4 - Brief intervention works 5 - Telephone/group/individual counselling all works, best with social support and problem solving, dose-dependent 6 - Meds effective 7 - Tele quitline works 8 - Best is counselling and meds 9 - If not ready, motivational interviewing to help for next time 10 - Treatment is cost effective
10
Q
Smoking treatment success stats
8 week study
12 week and 6 month study
In chronic disease and mental health (12week and 6 month)
A
8 week data Placebo 30% Bupropion 40% Patch 45% Lozenge 40% Bupropion and lozenge 50% Bupropion, patch and lozenge 54%
12 week and 6 month data
Placebo 21%/17%
Varencycline 51%/35% (most effective mono therapy)
Varencycline and bupropion 71%/58%
Bupropion and patch and 2nd NRT 62%/35%
Patch 37%/17%
11
Q
Smoking cessation and special groups
A
Bipolar and schizophrenia - use only patch
Psych - generally need meds and longer duration
12
Q
Smoking cessation off-label
A
Clonidine and nor-trip
13
Q
Behavioural insufficient sleep syndrome
Prevalence
Risk factors
A
7.5-20%
RFs: Age 30-40, work hours over 40, white, rich, alcohol, stress and depression
14
Q
Insomnia
Diagnosis days/duration
A
3 days a week, 3 months
+ daytime consequences
15
Q
Restless legs - prevalence
Periodic limb movements - how often
BISS prevalence
A
5-15%
Every 30 seconds, over 50 years age
7.5% - 20%
16
Q
Sleep and diseases
What disease?
For each, what process/mechanism?
CVD
Metabolic
Mood
Cancer
A
CVD - poor sleep, higher BP especially at night, sympathetic activation, less peripheral perfusion
Metabolic - raised cortisol, raised BMs, increased food seeking behaviour (study shows 5 days of 4 hours sleep, approx 300 extra calories and more sat fat)
Mood/brain - poor sleep, less REM and fear extinguishing, less memory formation, less deep sleep (restorative)
Cancer - poor sleep, less DNA repair, more cell cycle dysfunction, increased IL10 - cancer forming cytokines
- good sleep - increased Il1/2, TNFa (anticancer)
17
Q
Melatonin suppression and affective disorders
Specific percentages vs control
A
Control 15%
Major depressive 20%
SAD 40%
Bipolar 45%
18
Q
At risk drinkers are, 3 things
A
1) Drinking not causing harm but might in the future
2) Binge drinking 1 or more a month
3) Exceeding NIH limits
19
Q
Screening for alcohol - how does the book advise?
A
1) How many times in the past year have you had 4 or more drinks in a day
If 1 or more then complete AUDIT-C
20
Q
AUDIT-C positive scores
A
4 in men
3 in women
0-12 in total
21
Q
5 Rs of motivational interviewing
A
Relevance Risks Rewards Roadblocks Repitition
22
Q
Smoking cessation considerations
Weight gain - how much?
What is a light smoker?
What meds are cat C/D in pregnancy?
A
Weight - 10lbs or 4.5kg
Light smokers are <10 a day, NRT no evidence it helps
Pregnancy:
Bupropion and varencycline - category C - animal studies show harm, but use in people MAY be beneficial
Prescribed NRT - category D - Evidence of foetal changes in humans, but MAY be beneficial overall
OTC NRT - no harm proven, limited studies
23
Q
Nutrition prescription for hypertension
Reduce…
Increase…
Other LM considerations?
Key paper?
A
Reduce: Saturated fats, trans fats Salt (50% of people respond) ETOH - J shaped curve Caffeine Smoking
Increase:
Potassium, calcium and magnesium
Garlic (possible reductions of 5.1/2.5mmHg)
Also manage stress and physical activity
DASH - NHLBI
- Lots of fruit and veg, whole grain, fat free dairy, fish, poultry, limit sat fat and palm oils, limit sugar
The book also mentions water fasting causing dramatic effects in under 2 weeks - this is obvious and also an absolutely pointless statement
24
Q
The DASH DIET
Year/Study group
Patients Intervention Control Outcome Time
A
1997, NIH, NEJM
P:
459 with SBP <160 and DBP 80-95mmHg
I:
3 weeks of control diet - low in F&V, low in dairy, fat typical of US
Then randomly put into one of 3 groups for 8 weeks:
1) Control diet continued
2) High fruit and beg
3) Combination diet - fruit and beg, low-fat dairy, reduced sat and total fat
(sodium and body weight maintained constant)
Outcome:
Combo diet - 5.5/3 reduction overall, in those with HTN then 11.4/5.5 reduction
F&V diet - 2.8/1.1
25
LookAHEAD trial
Remission of diabetes on a relatively minor intervention.
1200-1800 calories a day, 175minutes physical activity
VS
Diabetes support and education
Overall 11% had total or partial remission at 1 year, 7% at 2 years vs around 2%
This was sustained for 2/3/4 years in 9/6.5/3.5% respectively
26
LookAHEAD
DM2 remission at:
1 year
4 years
Sustained for:
2 years
3 years
4 years
1 year - 11%
4 years - 7.3%
2/3/4 - 9%,6.5%,3.5%
27
Shortfall nutrients
What are they?
Vitamins: A,C,D,E,K
Minerals:
Ca2+, K+, Mg2+
Folate and Folate
28
Sugar targets:
WHO
AHA
US average
WHO:
10% cals ok, 5% better, 0% best
AHA:
Men - 36g, 150cals, 9tsp
Women/children - 24g, 100cals, 6tsp
US av:
13tsp, 52g, 13% of calories
29
Blue zone project - an example of health advocacy
9 factors these places have in common
5 places with longevity used as examples of healthy communities
1) Family first
2) Right tribe to do life with
3) Stop when 80% full
4) Whole food/plant based
5) Live as part of something greater
6) Have a sense of purpose
7) Physically active
8) Down shift
9) Relax
30
3 examples of health advocacy
1) Dean Ornish - advocated for medicare/medicaid for lifestyle medicine for CVD
2) Robert Wood Johnson Foundation - 'Creating a culture for health' - Chicago community zones project
3) Blue zones project - transforming cities through healthy community systems, based on 5 places with longevity
31
What is 'Creating a Culture for Helath'
It is a Robert Wood Johnson foundation health advocacy program.
Communities showcase their healthy lifestyle interventions
32
What is 'Prescription for Health'?
Who's programme is it?
What did it look at?
What are the outcomes?
6 year study by Robert Wood Johnson Foundation (also did 'creating a culture for health') and AHRQ
```
Looked at:
Physical inactivity
Smoking
Alcohol
Diet
```
22 primary care practices trialled different methods of addressing these behaviours.
4 outcomes:
1) Primary care is able to address these behaviours
2) Significant redesign is required, creating a 'patient centred medical home'
3) A 'Toolkit' was produced, but is no longer in use
4) Now the ePSS is available from the AHRQ
33
Prescription for health - which 4 behaviours?
Physical activity
ETOH
Smoking
Diet
34
The interdisciplinary team:
Weight loss evidence?
What broad outcomes are better?
Weight loss is greater with doctor and dietician, vs dietician or doctor
IDT improves:
1) Compliance/Adherence
2) Health Outcomes
3) chronic disease self-Management
4) Patient Engagement
and weight loss as above (12lbs vs 3 lbs)
CHOMPED weight loss
Or AHEM (adherence, health outcomes, engagement, self-Management)
35
What makes a good IDT?
10 factors
1) Leadership
2) Clear vision
3) Good resources
4) Skill mix
5) Personal development and rewards
6) Characters that like team working
7) Communication
8) Supportive
9) Good quality of care
10) Respect and understanding of each other's roles
36
Examples of IDT programmes
Ornish spectrum
Medical fitness collaboration
37
Poor sleep leads to what cardiovascular outcomes?
More MIs, mortality and vasospastic disorders
38
A requiem for palliative cardiology
A broad overview...?
24 patients
WFPB, very low fat, no oil, LF dairy
18 adherent, 6 not adherent
No evidence of any progression, and no events at 12 years for adherent (who had 49 events in 8 years before trial).
Non-adherent had 13 events
39
Esselstyn at 3.7 years
Very low fat, no oil, WFPB, low fat dairy
177 adherent - 0.6% cardiac event rate
Nonadherent 21 - 62% rate
40
PCI vs exercise in stable CAD
Hambrecht (you use your hamstrings and breaks in cycling)
Men with stable CAD, cycled 20+ minutes
At 12 months:
1) 88% vs 70% event free survival
2) Higher VO2 max - 16% increase (relative) from 22.6 to 26.2 (notice the 6s)
3) To gain one canadian CV class costs $3429 vs 6956
41
Hambrecht
88% vs 70% event free survival
16% relative and 4% absolute increase in VO2
3.5k vs 6.5k to raise CV class by 1
42
```
LDL level by diet:
Omnivore
Lacto-ovo
Lacto
Vegan
```
123/101/87/69
43
Effects of stress management and diet - CVD evidence
Who did the study?
2 key findings?
Ornish
91% fewer angina episodes
49% increased exercise tolerance
44
Name some antioxidants...
```
CSI
DP
AO
OC
GM
vit C/E and selenium
```
45
Fiber...
RDA and average
What percentage of people meet the minimum amounts?
Soluble sources acronym?
Insoluble acronym?
25g female
38g male
18g average - 3% meet minimum amounts
FLOwS - fruit legumes oats soluble
VSwIB - Veg Seeds Insoluble Bran
46
Activity Counselling Trial
Date?
Practices?
Patients?
Findings (5)
1998
54 practices
874 patients
99% pts received advice
86% took 5-6 minutes or less
46% took 3-4 minutes (the suggested amount)
63% little to no increase in clinic time
83% giving advice was an asset to the clinic
47
BMI, waist and increased risks
What are the risk categories for BMI?
For waist <40/35 and BMI?
For waist >35/40 and BMI?
Low, normal, increased, high, severe, very severe
Increased, high, very high, extremely high
High, very high, very high, extremely high
48
Reducing BP and reductions in mortality
BP reductions - 2/3/5
CVA mortality - 6/8/14
CVD mortality - 4/5/9
Total mortality - 3/4/7
2:3-4-5
3:4-5-8
Then for the last column just add up the numbers
49
Fat sources:
Omega 3
Omega 6
MUFA
Omega 3s - flax/hemp/fish
Omega 6 -poultry, eggs, nuts, most vegetable oils
MUFA - saff, olive, canola, peanut oils/butters, avocado, cashew, pecan
CAMPOS - canola, avocado, MUFA, peanut, olive, safflower,
50
Diabetes diagnosis - normal/diabetic values
HbA1c
Fasting BM
2hr OGTT BM
5. 6%/6.5% (it reverses)
5. 6/7.0 (same normal as HbA1c) ALSO 100/126
7. 8/11.1 ALSO 140/200
51
CVD risk score calculators (4)
FARM
Framingham - 10 year risk, 20 years plus, smoking, HDL and total cholesterol, BP (no CVD or DM)
- - - - - 2008 framinham used other factors like CVD and DM
ACC/AHA - 10 years and lifestime, 40-79, African or non-hipsanic caucasian
Reynold's risk score for women
MESA (multi-ethnic) - needs coronary calcium score
52
Motivational interviewing principles
REDS
- Roll with resistance
- Empathy
- Develop discrepancy
- Support Self-efficacy
53
Vital signs and their Qs
BMI - BMI calculator
PhysAct - validated 2 Q screening
Alcohol - AUDIT-C
Smoking - pack year history
Stress - 10-item perceived stress score (0-13 loq, 14-26 mod, 27+ high stress)
Wellbeing - 2 item Q (is your life ideal, are you satisfied with your life)
Sleep - weekday, weekend hours, and quality
Diet - recall
54
Adventist health study 2:
shows stepwise drop in what things 3 things?
Specific percentages for lipids and hypertension?
Veg diet associated with lower incidence of what?
Regular meat did what to DM risk?
Stepwise reduction in BMI, diabetes, and hypertension.
- Hyperlipidaemia 15% vs <5%
- Hypertension 23% vs 7%
```
BMI
DM
Metabolic syndrome
Hypertension
Mortality
Cancer
```
Regular meat - 2x risk of DM
55
Reversal of diabetes type 2 and triacylglycerol
Author
Date
Process
Patient group and controls
Key findings
Author - Lim et al, 2011, Diabetologica
Patient group - 11 patients with type 2 diabetes, blood tests at baseline, 1/4/8 weeks, vs controls at baseline only
Process - 8 weeks, 600 calorie diet
Key findings
1) Supra-normal insulin sensitivity by 8 weeks
2) At one week - BM and insulin suppression of hepatic glucose iproved
2) Decrease in TAG in liver and pancreas
56
Geminal study
Author
Date
Process
Patient group and controls
Key findings
Additional findings??
Ornish, 2008
30 men with low risk prostate cancer, biopsies done at baseline and 30 days, 30% had prostate cancer in the biopsy
48 genes upregulated, and 453 downregulated
Weight, abdominal circumference, blood pressure, lipids - all also improved
57
Comparison of Atkins, Ornish spectrum, Zone and Weight watchers diet
Patient group and acceptance criteria
Follow up length
Key findings on weight?
Findings on other bloods/anthopometrics?
Dansinger - dancing between different diets
160 patients, 40 each group
Overweight and dyslipidaemia or IFG or Hypertension
1 year follow up
Average weight loss around 10lbs/5kg in each group
Weight loss consistent with adherence more than diet type
No change in hypertension and diabetes
Weight loss related to total cholesterol and HDL, CRP, and insulin use
58
Prostate and low fat diet, Ornish
Follow up at 1 years - what happened to PSA and cell growth
Follow up at 2 years - broadly what happened?
Followed Ornish low fat, plant based diet. 93 experimental patients.
Treatment group PSA 6.3 to 6.0, cell growth 70% decreased
Control PSA 6.3 to 6.7, cell growth 9% depressed
At 2 years, more control needed extra treatment:
- 13 of 49 (27%) control patients and 2 of 43 (5%) experimental patients had undergone conventional prostate cancer treatment
- PSA not changed...
59
Framingham heart study
Lifestime risk of atherosclerotic HD in who?
What risk factors?
Key findings?
Optimal status gives? (LE and % reductions in CV mortality and total)
Patients age 50, disease free
RFs were - BMI, DM, smoking, cholesterol, BP
Compared 0 RFs with 2 or more RFs
Men - 5%, 69%
Women - 8%, 50%
6-10 years of life expectancy if optimal RF status, 80% lower CVD mortality, 40-60% lower overall mortality
60
Interheart
9 risk factors account for 90% IHD
5 account for 80%
1) Smoking
2) Lipids
3) Diabetes
4) Blood pressure
5) Obesity (Stroke - cardiac causes)
6) Diet
7) Physical activity
8) Alcohol
9) Psychosocial factors (Stroke - stress and depression)
61
Interstroke
10 risk factors account for 90% of stroke
1) Smoking (current)
2) Lipids
3) Blood pressure
4) Diabetes
5) Cardiac causes (MI - obesity)
6) Diet
7) Physical activity
8) Alcohol
9) Depression (MI - psychosocial)
10) Stress
62
Hambrecht study, 2004
Patient group?
Study design?
Main findings?
Men with stable CAD, 101
1 year - 20+ minutes of cycling a day + group session a week vs PIC/stent
Findings:
1) 88% vs 70% event free survival (RR 26%) (NNT 5.5)
2) Improved VO2 max
3) Cost 3.5k vs 6.9k to gain a canadian class
63
A portfolio diet - Jenkins
Study design
Results
4 weeks on F&V diet very low sat fat + placebo
4 weeks F&V diet and statin (20mg)
4 weeks on Portfolio diet
Results
1) LDL-C 28.6% and 30.8% better vs 8%
2) CRP also lower (very similar %)
3) dose-response
64
Examples of the effectiveness of lifestyle medicine to lower costs...
2 key examples
CHIP programme shown to return on investment for diabetics - healthcare costs substantially reduced for participants vs non-participant group
DPP outcomes study - cost of LM offset by reductions in non-intervention
65
4 biological processes affected by a health lifestyle...
I I A E
1) reduced inflammation
2) reduced insulin resistance
3) antioxidants
4) epigenetic changes
66
Preventable US cancers:
proportion?
number?
4 main lifestyle factors?
33%
340,000 (33% of a million)
Smoking and alcohol
Physical activity
Diet
Obesity
(Same as NHS 5 RFs for CAD)
67
Not overweight - 4 causes of morbidity and mortality from poor diet...
Cancer
Vascular - CVA/CVD
Osteoporosis
Type 2 diabetes
68
Qualitative review into changing diet...
- what aspects of diet were best changes?
- who changed the most?
- 2 promising intervention methods?
1) 77% showed F&V increase (0.6 servings a day), and 7% reduction in calories from fat
2) Those at risk of or with disease
3) Small groups and goal setting
69
The CHIP program - 18 month study
How well were behaviours maintained over time?
Which 3 behaviours had the best improvements at 18 months?
1) Improvements better at 6 than 18 months
2) At 18 months, improvements 50% above baseline in 3 aspects:
- lower calories and lower sat fat
- greater F&V and fiber
- great physical activity
These findings overlap with qualitative study into diet changes showing that 77% increase F&V (0.6 servings) and 7% reduce calories/SF.
70
MRFIT cohort study showed what? - total mortality %, CV mortality %, LE change
(findings the same as what study?)
3 related cohort studies showed..? (cholesterol and rate of CV death)
Followed you men from 30-37 years, for 16-34 years in total
Low risk factor status had 80% lower CV mortality, 50% lower total mortality, 6-10 years greater LE (SAME AS FRAMINGHAM - which showed optimal risk factor status showed the same LE and mortality drops)
3 related studies in young men showed chol>240 had 3.5 rate of CV death than cholesterols 200
71
Chicago heart association detection project in industry
1) Four factors with 50% decreased heart disease risk (each)
2) Two factors with 20% decrease heart disease risk
Four factors:
1) Stop smoking - 50% immediate risk in MI
2) 150 minutes of physical activity - 35-55%
3) Ideal body weight and waist - 25-55%
4) 50% decrease in total cholesterol
Two factors:
1) 6mmHg decrease in diastolic BP
2) 5 or more F&V a day
```
From another card:
BP reductions - 2/3/5
CVA mortality - 6/8/14
CVD mortality - 4/5/9
Total mortality - 3/4/7
```
72
Nurses health study and coronary artery disease:
(84000 nurses, 14 year follow up)
What were the 5 risk factors identified?
What was their benefit on RR?
Risk factors were: (same as preventable cancers in US)
1) Non-smoking
2) PA 30 minutes a day
3) Health diet score
4) BMI <25
5) Moderate EtOH
RR depended on number of factors:
3 (diet, smoking, exercise) - 54%
4 (+ BMI) - 62%
5 (+EtOH) - 75%
73
Stimulus control is...
the ability to have improved control over choices despite your environment
74
Improving self-confidence?
```
Leverage your Strengths (S)
Positive Emotions (E)
Support system (S)
Education (E)
Self-efficacy (SE)
```
75
Self-confidence VS self-efficacy -- what's the difference?
SC - confidence in abilities/reasoning
SE - confidence in successfully performing a behaviour
76
What is self-efficacy?
What affects it?
SE - confidence in performing a behaviour
Affected by:
- behavioural capability
- environmental facilitators and inhibitors
77
Topics to couple obese patients about - except diet -
The 3 Ss
Stress
Smoking cessation (can gain weight)
Sleep
78
Overweight and obese - four levels of psychosocial needs:
Macro (public policy)
Community/institution
Interpersonal - support systems/community support
Intrapersonal - coping, MI, CBT
79
Worksite wellness programmes
1) 3 benefits
2) Median return on investment
3) Best programmes for return on investment, and worst?
4) Motorola example - how long, how many employees, ROI, and annual increase in healthcare costs for participants vs non
1) Save money, increased health, increased productivity
2) $1 = $3.14
3) Best are disease management, worst are educational/disease prevention
4) 3 years, 56000, ROI=3.92, 2.5% vs 18%
80
Obese patients and function - what's the best way to improve?
Lose weight + exercise better than either alone
81
Muscle quality - what is it?
Why is it important (2 things)
Low intramuscular fat
More important than muscle mass in:
- maintaining mobility
- preventing early death
82
Obesity in pregnancy:
How many women overweight + at the beginning of pregnancy?
What are the likely outcomes?
How can we reduce weight in pregnancy?
What are the best interventions?
1/3rd overweight - they also gain more weight, and have worse maternal/foetal outcomes
Physical activity gives less weight gain than control group - most effective are supervised PA and diet
83
How much exercise reduces primary CAD 'dramatically'?
| How about just 'PA' vs 'PI' people?
550cal per week
| Physical activity reduces risk by 20-30%
84
Active commuting HR for CAD
0.89
85
Physical activity and DM prevention:
Whats the threshold dose?
How much does BMI contribute to the decrease in risk?
PA advice, structured programmes, resistance training and dose of PA...?
150 minutes is the threshold.
BMI is half the risk reduction - 31% vs 17%
Advice only works with diet advice, structured aerobic, resistance and combo regimens gave decreased HbA1c, greater regression if PA >150min/week
86
DM type 2 a diet
Eggs and meat regularly - how much?
Adventist and prevalence?
NIH study on PB vs ADA - effects of HbA1c, weight, LDL
5 meat per week
5 eggs per week
1 egg per day x 2 week
Adventist - regular meat gives 40% increased prevalence in women and 80% in men, with 93% increased risk, and 97% respectively
NIH study - plant based diet vs ADA - HbA1c dropped 1.23/0.38, LDL 21.2/9.3, Wt 6.5kg/3kg
87
Adherence of dietary restriction vs calorie restriction - adherence? at how many years?
71% adherence to Ornish diet at 3 years, 3% for calorie restrictiion
88
Key studies in nutrition:
LDL cholesterol in different diets?
Lifestyle heart trial - key numbers at 5 years?
Stress management and diet did what to angina and exercise tolerance?
Multicentre trial using 10% low fat diet, 3 hours PA showed what in angina at 12 weeks?
Essestyle at 12 years... what did it show?
1) 123/101/87/70
2) Ix group - 7.9% decrease (3.1% absolute), control - 27.7% increase (11.1% absolute), no statin control 46.7% increase
3) Angina decreased 91%, ex tolerance 44% better
4) 74% had no angina, 9% had decreased an angina threshold, findings similar to PCI/CABG results
5) Adherent to diet showed no progression or events
89
Lifestyle competencies: the 5 domains?
```
Leadership
Knowledge
Clinical skills
Management
Office/IDT/Community
```
90
Lifestyle competencies: the full 15
2/2/3/4/4
Leadership:
Promote a healthy environment at home/work/community
Practice good personal lifestyle behaviours and advocacy for LM as foundational
Knowledge (engagement and interventions)
Be aware of/understand how lifestyle interventions can change outcomes/prevent certain conditions
Physician and patient engagement - Be aware of how motivational interviewing/CBT techniques can benefit patients
Clinical Skills (3 - Bio, history, stage of change)
Be able to perform a full biopsychosocial assessment of a patient
Have the skills to take a history, examination, and appropriate investigations
Assess readiness and willingness to change (i.e. place them in the transtheoretical model)
Management (Rapport, collaborate, sustainable, guidance)
Manage in line with guidance
For good relationships witth patients
Create collaborative action plans
Support sustained change, including referral/support
```
Office and community (4 'i's)
IT
Quality improvement
IDT
refer to community resources using Induction phase/intense lifestyle changes
```
91
Lifestyle competencies - office and community
The four Is
IDT
IT
Improvement
Induction programmes
92
Lifestyle competencies - Management
Form a rapport
Collaborate in making an action plan
Support the sustainability of this, referrals/community
Do so within GUIDANCE
93
Lifestyle competencies - Assessment
Biopsychosocial
History through to labs
Stage of change
94
Models of behaviour change:
Name them
Give an example of each
Things in common?
Health belief model - breast cancer screening
Transtheoretical model - behaviour change counselling
Social or cognitive model - acts of kindness
Theory of planned behaviour - going to the gym
Commonalities:
The patients beliefs about condition severity/importance/risk
External cues
Self-efficacy
95
Health belief model:
| 6 constructs
1) Perceived susceptibility
2) Perceived severity
3) Benefits
4) Roadblocks
5) Cues to action
6) Self-efficacy
96
Theory of planned behaviour:
| 6 constructs
1) Attitudes surrounding the behaviour and outcome
2) Behavioural intention (motivation)
3) Perception of normality of behaviour
4) Social norms
5) Perceived power over circumstances/roadblocks
6) Self-efficacy
97
Social/cognitive model
| Constructs
1) Reciprical determinism
2) Social/observational learning
3) Behavioural capability
4) Reinforcements of behaviour (internal and external)
5) Expectations of outcome (driven by experience)
6) Self efficacy
98
Data from the HPFUS shows:
what's the HR of 1) CAD 2) DM2 in plant based diets that are: a) total/unselected b) healthy and c) unhealthy?
CAD: 0.92 overall, 0.75 healthy, 1.32 unhealthy
DM2: 0.67 healthy, 1.16 unhealthy
99
The National prevention strategy 2011 - a part of the affordable care act
- Which behaviours does it target?
- What about these behaviours is targeted?
BMI, smoking, physical activity, alcohol
Assessment/screening and management
100
Determinants of health - name them!
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Genetics - 10%
Epigenetic - 70-80%
Environment
Adverse child events
Education/socio-economic status
Health literacy
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101
Which 3 behaviours account for what percentage of premature deaths?
What percentage of people have healthy levels of what 4 behaviours? And what ratios achieve the individual behaviours?
In heart disease - how many still smoke?
In diabetes - how many follow saturated fat guidelines?
Physical activity, BMI, smoking - 80%
3% achieve all of: 5 servings of fruit and veg (3:4), smoking (1:7), BMI, sufficiently physically active (4:5)
HD - 8% smoke
Diabetes - 11% follow SF guidelines
102
USPSTF - what is the advice on nutrition and physical activity advice for the general population?
Grade C recommendation to base advice given on stage of change
If overweight with risk factors for cardiac disease, or obese, then grade B to offer an intensive lifestyle change intervention.
