More of everything

Question 1

Insulin resistance (/failure to produce enough insulin)

Answer 1

Adipocytes undergo hyperplasia and hypertrophy

This results in:

1) Overproduction and release of - leptin, retinol binding protein (prevents activation of glucose carrying proteins), EDGF (causes IR), inflammatory cytokines (e.g. TNFa, IL1/2), decreased adiponectin (that normal protects the endothelium), activation of the JNK and NFkB pathways
2) Muscle and hepatic fat deposition/TAG
3) Macrophages are recruited
4) Increased FFA in the blood stream - cause inflammation

Question 2

Standard drinks

• what is one standard drink?
• how many drinks in standard bottles?

Answer 2

Standard drinks include:
12 oz beer, 5oz wine, 1.5oz 80 proof spirits

Bottles of:
750ml wine (5 drinks)
1L spirits (24 drinks)
750ml spirits (18 drinks)

Question 3

Sleep hormones at different stages:
Onset of sleep
First half of sleep
Second half of sleep
Awakening

Answer 3

At onset - melatonin rises
First half - melatonin continues to rise, leptin produced throughout sleep
Second half - melatonin gradually falls
Awakening - cortisol spike shortly after, cortisol gradually rises through sleep too

Question 4

Stages of sleep

How many are there? And what are they?

Answer 4

4 stages:
Stages 1-3 of non-REM sleep
REM sleep

Stage 1 - several minutes, going from awake to asleep - high amplitude theta waves, very slow
Stage 2 - deeper sleep, slow brain waves with some brief bursts ‘sleep spindles’
Stage 3 - deepest sleep, slow waves, makes you feel refreshed ‘delta sleep’ (previously stages 3 and 4)

Question 5

Benefits of MBSR programmes?

Whats the ACRONYM?

Answer 5

MBSR really (h)RELPS

1) Physical symptoms and psych symptoms
2) Loneliness in the elderly
3) Empathy and compassion
4) Resilience/ability to cope with stressors
5) Self-esteem

Question 6

Nurses health study - how much physical activity is found to reduce all-cause mortality? By how much?

And how much doesn’t give any significant benefit?

Answer 6

1-1.9 hours a week gave all-cause mortality of 0.82

Whilst >7 a week didn’t give significant improvements

Question 7

Smoking quitting benefits?
Immediate
1 year
2-5 years
10 years

Answer 7

Immediate - 50% risk of acute MI
1 year - 50% of heart disease
2-5 years - stroke at baseline levels
10 years - cancer at 50% (lung)

Question 8

Physical activity:

What benefits of RR of all-cause morality at what hours of exercise (The simple chart and the longer chart…)

And for MeTs and years of life gained?

At what level of MeTs is ‘most benefit’ achieved?

Another random stat - 150 minutes reduces mortality how much? 7 hours how much?

Answer 8

All-cause mortality and hours of exercise a week:

0. 8 = 1.5 hours
1. 7 = 3 hours
2. 6 = 6 hours

Longer chart:

1. 0 = 30mins
2. 8 = 90mins (1.5 hours, same as above)
3. 73 = 180 mins (3 hours)
4. 64 = 330 mins (5.5 hours)
5. 615 = 420 mins (7 hours)

In terms of MeTs and years of life
0-3.75/week = 75 mins = 1.8
3.75-7.5 = 90-150 = 2.5
7.5-15 = 200 = 3
15-22.5 = 400 = 4
\+22.5 = 500 = 4.5

10-20Met hours!

19% and 24%

Question 9

Assessing fitness in the different domains:

Functional assessment?

Cardiorespirtatory (3 tests)?

Answer 9

Function - 6 minute walk test, compare pre and post intervention

CR fitness:

1) the step test - 3 minutes of stepping to metronome, rest for a minute, then measure heart rate, compare to charts
2) the rockport test - run/walk a mile, measure heart rate and time
3) sub ventilatory threshold test - easiest on treadmill, increase exercise going up by 5% heart rate until breathing rate changes, can’t say 5-10 word sentences

Question 10

Physical activity intensities…

What different tests are there?
What are their different thresholds?

What thresholds correspond to what MeTs?

Answer 10

For each: very light/light, moderate, vigorous

Talk test: can sing/can talk/can’t talk

Maximum heart rate %: 63% or less, 64-76%, 77% or more

Heart rate reserve %: <40%, 40-60%, >60%

MeTs: <3, 3-6, >6

Borg scale of perceived exertion

Question 11

USPSTF and alcohol

Answer 11

Grade B recommendation to assess and give brief advice

Question 12

Epidemiology of sleep…

What is the average amount of sleep?
How many young adults get less than what duration of sleep?
What percentage gets less than 6 hours?

How many people have difficulty sleeping?
What percentage seek help?
What is the cost?

Answer 12

Average sleep is 6 hours 57

37% get less than 7 hours
20% get less than 6 hours

60 million
10% (6million)
60 billion dollars

ALL THOSE NUMBERS ARE LINKED

Question 13

Results of low daylight?

On melatonin suppression?
On other aspects of life?

Answer 13

• false blue light sensitivity

- decreased affect, mood, alertness and peak body temperature

Question 14

The ACSM suggests how much exercise for obese patients?

Answer 14

250 minutes a week, with 60-90 minutes a day

Resistance twice a week

Question 15

What is heavy drinking?

Answer 15

• NIAAA defines heavy alcohol use as more than 4 drinks on any day for men or more than 3 drinks for women.
• SAMHSA defines heavy alcohol use as binge drinking on 5 or more days in the past month.

I think the best for the course is exceeding 4/3 drinks in the past 30 days

Binge drinking and heavy alcohol use can increase an individual’s risk of alcohol use disorder.

Question 16

Alcohol and the manual:

At what level do symptoms of impaired control develop?

What are the DSM thresholds for mild/mod/severe?

AUDIT thresholds and sensitivity?

Answer 16

• Mild-mod is characterised by impaired control
• 2-3, 4-5, 6+
• 5-10 20%, 10-15 40%, 16+ 90%

Question 17

AGEs - two things that make it more likely that I always forget…

conditions associated?

Answer 17

more trace minerals, more acidic or alkaline pH

Atherosclerosis, renal disease, poor wound healing, DM1 and 2

Question 18

Poor sleep and mental health.

What factor is decreased?

What does poor sleep do in different diseases? (5)

Answer 18

BDNF is lower

Poor sleep associated with worsened depression, SAD, anxiety, PTSD (worse if sleep deprived) and TBI (worse if sleep deprived pre or post)

Question 19

Treating diabetes mellitus…

Bypass - what remission at what time periods?

Answer 19

18-24 months - 39-83% remission (with weight losS)

5 years and 15 years - 30%

Question 20

Physical activity and cancers…

Which cancers have evidence?
What threshold of exercise duration?
What % risk reduction?

Answer 20

(note that physical activity also reduces CAD by 20-30% in primary prevention)
Colorectal - 3-4 hours a week, 17-30%
Breast - 3-4 hours a week, 20-30%, also prevents recurrence and benefits treatment/side effects/mortality
Prostate - physical activity during and post treatment improves quality of life, symptoms, survival and cardiorespiratory fitness

Question 21

Nutrition and cancer links…

Answer 21

Breast
Fruit and veg, soy
Obesity, red and processed meat

Colorectal
Fruit and veg, fibre, calcium
Red and processed meat

Prostate
Selenium, lycopene, whole food plant based

Gastric
Fruit and veg, antioxidants
Processed meat

Question 22

The nurses health study showed what percentage of diabetes type 2 was attributable to what behaviours?

It also showed what about:
Meat consumption
Egg consumption

Answer 22

91% due to PI, smoking, obesity, poor diet, alcohol intake
(similar to the finings on 5 healthy behaviours and coronary artery disease risk)

Have regular meat or 5 eggs a week increased diabetes risk

Question 23

Diabetes and physical activity - how much physical acitivity is sufficient to decrease risk?

What % decrease occurs? what about accounting for BMI?

Meta-analysis of brief advice vs structured exercise and HbA1c - what did it show?

Answer 23

150 minutes a week

31% and 17%

BA only works if diet advice also given, however structured exercise programmes had some HbA1c benefit

Question 24

The nurses health study and health professional follow up study - diet/substitutions of saturated fat and heart disease…

1) Study by Joshipura showed what about fruit and veg intake?
2) Study by Li Y showed what about quintiles, and what about dietary substitutions?

Answer 24

1) Each serving gave a 4% decreased risk
2) The top quintile of intake, vs the bottom quintile for PUFA had 20% decreased risk, WG had 10% decreased risk, sugar and refined grains had 10% increased risk

Substituing 5% of daily intake of calories of saturated fat with PUFA gave 25% decreased risk, MUFA gave 15% decrease, whole grain gave 9%, whilst refined grains and sugar didn’‘t change anything

Question 25

The nurses health study and health professional follow up study - substitution analysis of red and processed meats by Pan 2012 1) Diabetes - what did it show about meat? What about substitutions of meat? 2) Mortality substitutions?

Answer 25

1) HR for 1 serving of red meant is 1.12, processed is 1.32, total is 1.14, whilst 100g red meat gave HR 1.19, and 50g processed meat 1.51 Substituting with nuts/LF diary, wholegrain decreased this by 16-35% 2) Substriting nuts for processed meats gave HR 0.78, and red meat 0.83, and similar findings for other substitutions

Question 26

Lyon heart study - follow up duration? What outcomes? What diets?

Answer 26

4 years follow up Coronary event recurrence following MI (i.e. secondary prevention) med diet protective vs AHA step 1 diet

Question 27

Root causes analysis steps - beyond 3-5 why's, so what and fishbone...

Answer 27

1) Analyse and discuss - what causes of main cause? 2) Research and interview IDT/patients, do process maps 3) Decide to address a few causes with PDSA cycles

Question 28

Prescription for health What is it? Who did it? Main findings or outcomes?

Answer 28

- Study with 49 practices, looked at 4 behaviours (PI, tobacco, smoking, diet) - RWJF, AHRQ 4 findings: 1) Primary care is willing and able 2) Substantial practice redevelopment - patient-centred medical home 3) toolkit for health (defunct) and now ePSS 4) lots of studies

Question 29

Chronic care models: How many? Name them... Key principles

Answer 29

4 models The chronic care model - MacColl institute and Ed Wagner - focusses on an activated patient and a proactive medical team, working with the community The Innovative Care for Chronic Conditions - WHO - considers macro, meso and micro level care Value based care Chronic care manager model - AHRQ - patient centred care surrounded by IDT

Question 30

Ed Wagners model... Name it: Key aspects?

Answer 30

The Chronic Care Model - MacColl institute and Ed Wagner Community resources - co-ordinated and linked Self-management - informed and activated patient IT - decision support, integrated guidelines, reminder Working under local and wider healthcare system All together - productive relationships and better care

Question 31

Group visits What outcomes are improved?

Answer 31

1) Patient adherence 2) Peer support 3) Accessibility 4) Patient and provider satisfaction 5) Lower hospitalisation

Question 32

What should the aims of an IDT be? 8

Answer 32

1) Advocate for LM 2) Utilise eMR and tech 3) Support self-efficacy 4) Optimise patient time/support/counselling 5) Utilise group visits 6) Utilise patient registries 7) Attain adherence 8) Implement good office workflows

Question 33

Diseases of sleep

Answer 33

BIISS Narcolepsy Insomnia 3+, 6 months Restless legs

Question 34

Obstrutive sleep apnoea: Prevalence, how many not diagnosed? What is a positive STOP screening score? Diagnostic test and cut off values?

Answer 34

Prevalence 26% Undiagnosed 80% STOP 2+ is high risk Diagnosis based on sleep polysomnography - AHI/apnoea hypopnea index - <5 none, 5-15 mild, 15-30 mod, 30+ severe

Question 35

NHANES III - 10000 people with BP What did it show about counselling?

Answer 35

33% counselled on physical activity | 71% followed the advice

Question 36

Intensive sleep therapies - Which are evidence based?

Answer 36

Sleep restriction - EB and RCT support Stimulus control - partially EB, RCT support Relaxation training - not EB, RCT support Sleep hygiene - no EB and no RCT

Question 37

Uses of melatonin - there are 2... What causes an acute altering affect?

Answer 37

Jet lag Circadian rhythm disorders With B6 supplements (pyridoxine)

Question 38

Beta cell death: How many factors kill them? What are they?

Answer 38

5 factors in the book - LLONG (lipids, leptin, oxidative, glucotoxicity, NFkB) 1) Dyslipidaemia - V/LDL are pro-apoptotic 2) Glucotoxicity - IL1beta causese inflammation 3) Leptin - activates cytokine pathways 4) NFkB and JNK pathways 5) Oxidative stress - FFA, BM, NFkB, JNK (note - others are mentioned at other times - e.g. macrophages, TAG - but this is the list they produce under the title of Beta cell death)

Question 39

B12 sources? Folate sources?

Answer 39

B12 source is bacteria -- found in animal products only - also supplements, fortified products Folate - green leafy veg, peas, cruciferous veg

Question 40

Depression and CAD What kind of RF is depression for what kind of CAD? What does treating depression do? What does having depression do? (3 different stats!)

Answer 40

It is a primary risk factor for developing CAD, and a secondary risk factor prognosis. Treating increased quality of life, benefits symptoms, but no clear affect on survival Our different stats: 1) twice risk of events - controlling for number of blocked arteries 2) Increased risk by 15-20% in CAD 3) OR of 2.5 for death/resus/arrest/MI in CAD

Question 41

How does depression compare to smoking in its relationship with mortality?

Answer 41

They are both equal and independent risk factors!

Question 42

Smoking and medicare - what can they get?

Answer 42

Prescribed and not over the counter NRT They can try to quit twice a year, receiving 4 counselling sessions per attempt

Question 43

Intensity of counselling in medicare smoking cessation:

Answer 43

3-10minutes is intermediate | 10 minutes or more is intense

Question 44

Alcohol use disorder and 12 month prevalence - split by gender For mild AUD? For mod-severe?

Answer 44

Mild - 10% male, 5% female Mod-severe - 6% male, 2% female (female about half both times)

Question 45

Anti relapse medication for alcohol use disorder: What are the licensed and useful meds? (2 meds, 2 effects each) What benefits do they provide? What are the other 3 meds?

Answer 45

1) Naltrexone - reduces heavy drinking by 83%, overall drinking by 4% 2) Acamprosate - RR of any drinking 0.86, increases abstinence by 11 days, no effect on heavy drinking Other meds: (DONT use) Disulfuram - not tolerated/used Gabapentin - abuse potential Topirimate

Question 46

AUD interventions in Mild/at risk patients 3 interventions:

Answer 46

At risk/mild - brief advice, naltrexone, follow up booster sessions

Question 47

AUD interventions in mild-moderate groups 3 intervention points: What is the comparison of medication and counselling? What characterises this group of patients?

Answer 47

Mod: Can be primary care led ARM = counselling (=SSRI in depression) Behaviour modification Characteristic is features of impaired control of use developing - normally it is a 3-4 year episode and isolated.

Question 48

AUD interventions in severe: 3 interventions? When do you refer? What are risk factors for developing severe AUD?

Answer 48

Counselling, ARMs and manage withdrawal Refer if impairment, failure or relapse RFs include: family history, early onset, psychiatric disease, adverse childhood events

Question 49

Physical activity and obesity... How many years of life lost comparing: 1) those who are overweight and sufficiently physically active with normal weight and sufficiently physically active? 2) Those who are obese and sufficiently physically active with normal weight and inactive? 3) Specific years of life lost for active obese II vs inactive normal weight?

Answer 49

1) they are the same 2) they are the same! 3) 4.7 and 4.5

Question 50

Sedentary behaviour How does it compare to common other conditions? Mortality contribution, what study follow up period? Hazard ratio of TV watching? Breaking it up helps how?

Answer 50

1) Prevalence at least twice HTN, smoking, hyperlipidaemia 2) 6.9% in a 2.8 year follow up of 222 thousand patients 3) 4 hour of TV a day - 1.5 (same as not being physically active) 4) 2 min walk in overweight 45-65 years olds every 20 minutes, lowered BM and insulin

Question 51

Physical inactivity is the 4th leading worldwide risk factor for premature death... What % of premature death does it account for? How about for different conditions (4)? Reducing physical inactivity by how much would save how many worldwide deaths?

Answer 51

Reduce physical inactivity by 25% - save 1.3million deaths a year 10% of premature deaths 6% CHD, 7% DM2, 10% breast and colorectal cancer

Question 52

Sleep prescription - going EAST Easier or harder than WEST? Treating jet lag requires advancing or delaying your body clock? What would you prescribe?

Answer 52

Travelling East is HARDER - when you arrive it feels EARLIER than the local time - and the body clock needs to be ADVANCED Dim light at sleep time (which is easy because it's naturally dim - e.g. you'll think it's 5pm but it's actually 10pm) Avoid bright light until ideal wake up time. Then get bright light. Breakfast 30-45 minutes after ideal wake up time. Melatonin 1 hour before sleep.

Question 53

Sleep prescription - going WEST Easier or harder than EAST? Treating jet lag requires advancing or delaying your body clock? What would you prescribe?

Answer 53

It feels LATER than the actual local time. EASIER than going east. You need to DELAY your body clock. Get bright early evening light. Dim light only 1 hour before sleep (which is hard, because you'll be tired having had a long day) Complex carbs dinner 2-3 hours before sleep. Breakfast 30-45 minutes after ideal wake up. Melatonin 30-60mintues before sleep. Bright light on waking

Question 54

Ornish - effects of lifestyle on telomeres... Study length? Patient group and number? Key findings?

Answer 54

1 and 5 year follow up Men with low risk prostate cancer 10 intervention, and 25 control Findings: 1) Telomere length increased in Ix group by 0.06, and decreased in control by 0.03 2) Telomerase activity decreased in Ix by 0.25 and in controls by 1.08 3) Combined data showed adherence is related to telomere length

Question 55

Advanced phase body clock

Answer 55

Fall asleep early, wake up early. | Body clock is less than 24 hours.

Question 56

Delayed phase body clock

Answer 56

Most people have this, 24 hours and 8 minutes Stay up late, wake up late

Question 57

Epidemiology of smoking: Costs? Total proportion of US deaths? Disease burden: CVD COPD Lung cancer Kills what proportion of users?

Answer 57

Cost - 150 direct, 130 indirection (bn dollars) 1/5th of US deaths (twice that of physical inactivity) CVD - 32% COPD - 80% Lung cancer 87% Kills 50% of users

Question 58

From the US 2018 physical activity guidelines what are the key benefits mentioned from the following... A single episode of exercise? Within days-to-weeks? What specifics does physical activity benefit...

Answer 58

1) A single episode improves - ABCDS - anxiety, blood pressure, cognition, insulin sensitivity (diabetes), sleep 2) Within days to weeks - lower disease risks, better function 3) Conditions benefitted (ABCDDDEF) arthritis, blood pressure, cancer, dementia, depression, diabetes, everything (Quality of life), fat (weight maintenance)

Question 59

Balance training - what is suggested? For adults? For older adults?

Answer 59

20-30minutes a day for adults. | 60 minutes 3 times a week for older adults.

Question 60

Physical activity: How much does it cost to transform someone from inactive to sufficiently active? Being inactive costs how much extra a year? An extra day of physical activity saves how much in health costs?

Answer 60

1) $500-5000 2) $1543 a year 3) 4.7% (essentially 5%) the RULE OF 5s!

Question 61

Benefits of resistance exercise? 9 in total, split into 3 groups

Answer 61

3 musculoskeletal - Injury prevention - Bone mineral density and QoL in early post-menopause - Arthritis pain 4 weight and metabolic - Increased basal metabolic rate - Body fat and weight maintainance - NAFLD, independent of weight loss - Improved BM and cholesterol 2 others - Sleep and fatigue - Heart muscle function

Question 62

Benefits of balance exercise in a systematic review: 4 groups...

Answer 62

Reductions in the following: Falls resulting in injury - 37% Falls resulting in medical care - 30% Falls resulting in severe injury - 43% Falls resulting in fracture - 61%?

Question 63

Benefits of flexibility... In OAPs? In diabetes?

Answer 63

in OAP - hip flexor stretch improves gait in diabetes type 2 gives a small improvement in BM (post prandial and fasting) and HbA1c

Question 64

The Israeli Health study showed what? How many Drs and how many patients?

Answer 64

A 13.7% (max) relative improvement in patients if doctors complied with screening and vaccination practices (8 practices looked at) 429 and 1621 respectively.

Question 65

When considering the minimum amount of exercise... Does standing help? What did the Shanghai Women Health study show? The nurses health study showed what about RR and moderate physical activity? In cardiovascular disease what was the relative risk and life expectancy gain of low active vs inactive patients?

Answer 65

2 hours standing a day - 10% decreased all cause mortality SWHS - 4 hours NEAT (HR 0.6), 1 hour walk (HR 0.65) - both 40% reduction NHS showed RR 0.82 for 1-1.9hours a week, minimal significant improvement over 7 hours Low active (15mins/day, 90/week) had RR 0.86 and 3 years increased life expectancy

Question 66

What is the FRIEND database?

Answer 66

A national VO2 max database

Question 67

Sleep: When do you stop working? When do you wind down? What intensive therapies are there?

Answer 67

Stop working 90 minutes before bed Wind down 60 minutes before bed CBTI - CBT for insomnia - first line over medication for insomnia Also sleep restriction, and stimulus control

Question 68

Sleep fragmentation:

Answer 68

Dark room, allow to cool, water by bedside Red light if necessary when getting up Increase late afternoon hydration, avoid after dinner

Question 69

Waking up too early

Answer 69

Use blue spectra until one hour pre bed Don't have caffeine until 30-60minutes after wake up Carbs at dinner

Question 70

Grandes et al study Patient population and how many? Main findings? What % are meeting the guidelines? OVerall and with prescription by age?

Answer 70

29 and 27 practices, 2248 and 2069 physically inactive patients. 6 month follow up, 7 day PA recall. Brief intervention, 30% with prescription Vs current care Overal: 18.1 minutes increased PA more than controls, 3.9% more meeting guidelines (NNT 26) With prescription: +131mins (actually 67) for >50s, +31.5 for <50s, 11% and 7% meeting guidelines 3.9, 7, 11

Question 71

Grandes study: Just tell me the %s that met guidelines

Answer 71

3.9%, 7% and 11%!

Question 72

Primary care physical activity counselling, Orrow, meta analysis (published BMJ): OR for effectiveness at how many months? NNT for sedentary to meet guidelines at how many months?

Answer 72

In 13 trials presenting self reported physical activity: Positive intervention effects at 12 months (odds ratio 1.42). NNT = 12 at 12 months

Question 73

Health promotion clinics - the study what did they do? main conclusion?

Answer 73

66 primary care practices bs control group Given resources and pedometers 31% increased recall of patients being given advice Therefore advice and resources possible in PCP

Question 74

Exercise versus medication... 4 conditions and medication comparisons. Study by Naci and Ioannadis - how did they do the study?

Answer 74

Exercise better treating post stroke Equivalent post MI and in pre-diabetes Worse than medication in heart failure (though meds + lifestyle probably best) 305 RCT meta-analysis, n=339000

Question 75

Physical activity and ischaemic heart disease prevention - what are the key stats on: What percentage primary prevention? Number of calories? Active commuting? What vascular conditions are affected?

Answer 75

20-30% primary prevention - the same as breast and colorectal (17-30%) 550cals a week, dramatic redcution HR of active commute 0.892 IHD, PVD, CVA, HF - complications and mortality decreased

Question 76

Wellbeing self-management - 5 techniques

Answer 76

PATCH! ``` Problem solving Assertiveness Time-management CBT techniques Humour (sense of humour development) ```

Question 77

Nutrition specifics in depression: 1) How do specific fats relate to depressive symptoms 2) In ___ women ____ is lower... 3) Do omega 3s help? In which populations (2)? 4) Some evidence the folate and fish oil may benefit...

Answer 77

1) Transfats associated with higher depression, poly/mono-unsaturated fats are associated with decreased depression (weakly) 2) Child-bearing age - various nutrients deficiencies increased risk of depression 3) Some evidence that omega 3s work in patients with bipolar for managing depressive periods. Additionally, if they are low in pregnancy then depression is more likely.

Question 78

How to escape suffering?

Answer 78

COATEd - Connect not disconnect - live in ORDER - Attention not inattention - be aware of THOUGHT PATTERNS - Ease not dis-ease

Question 79

In intensive lifestyle interventions, what 3 scores/aspects of mental health have been shown to improve? In what studies?

Answer 79

Beck depressive index, social function and mental health In Thiezen looking at CHIP, and in Kelly using a multi-centre study

Question 80

Making an emotional action plan: 4 stages - it has a 4 letter acronym

Answer 80

PATS 1) What emotional problem? 2) What action? 3) What timeline/follow up? 4) What support?

Question 81

The stages of changed - stage matched interventions: Pre Cont Plan Act Main

Answer 81

P - discuss general risks of specific behaviours C - specific to patient, benefits/risks/impact P - work on confidence/readiness, collaborative action plan, modify environment A - CBT/problem solve, refine action plan, improve confidence, identify support M - revise goals/motivation, revisit values

Question 82

10 causes of death in the US One ridiculous acronym

Answer 82

Having Cancer Can Affect Some Armadillos During Itchy Nose International ``` Heart disease Cancer COPD/chronic resp diseases Accidents Stroke Alzheimers Diabetes Influenza and pneumonia Nephritic and other renal issues Intentional injuries/suicide ```

Question 83

2 key determinants of behaviour - relating to doctor/patient/community relationships

Answer 83

Good provider-patient trust | Support system including IDT, social, and community

Question 84

The longer PA mortality chart...

Answer 84

Longer chart: 1. 0 = 30mins 0. 8 = 90mins (1.5 hours, same as above) 0. 73 = 180 mins (3 hours) 0. 64 = 330 mins (5.5 hours) 0. 615 = 420 mins (7 hours)

Question 85

ACSM guidance on increasing physical activity: Name the phases... And detail the phases...

Answer 85

Initiation (2-8 weeks)- intervals, 15-30 minutes, 2-3 per week, 40-60% HRR Improvement 4-8 months : Increase HRR by 5% every 6 sessions Increase duration by 20% a week Maintenance: When 50th centile

Question 86

USPSTF guidelines on depression USPSTF on anxiety

Answer 86

Grade B - you must screen if you have resources to help No recommendations on anxiety

Question 87

Whats the other model like the transtheoretical model?

Answer 87

Precaution model - 7 stages - linear