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next level Flashcards

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1
Q

What does NfKB do?

A

NFkB activates telomerase, cytokines, adhesion molecules, VEGF and TNF. Also results in macrophage recruitment.

The Very Angry Tabby Cat

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2
Q

4 positive epigenetic influences:

A 
Positives: 
Polyphenols and B vits 
Exercise 
Low stress 
Maternal and paternal diet
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3
Q

TOFU and it’s nutrition… incomplete so far

A

TOFU
High in -
Less high in - magnesium

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4
Q 
AUD - the numbers:
How many in US?
% of adults exceeding NIH daily limits at least once a year?
% at-risk or mild?
%mod
%severe
A 
17 million
30%
26%
3%
1%
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5
Q

Alcohol use effects:
% of cancers
% of intentinoal injuries
% of deaths - and top three

A

10%
20%
7% - RTA, cancer, suicide

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6
Q

AUD and health

number of attributable deaths a year?
years of life lost?

A

88000

(8 servings exceeds the 7/week for women, 8+8 would exceed the male serving too)

  1. 5million per year among US adults
    (2. 5 is a serving of 8 proof spirits)
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7
Q

AUD

Regions most at risk - 4 areas

What are they most likely to do?

Region least likely?

A

upper midwest, northeast, alaska, hawaii - most likely to binge drink at least once a year

South US are least likely

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8
Q

AUD highest risk groups:

8 RFs

A 
Age 18-34
Higher income
White
Men 23% vs Women 11%
Smokers
Psych
Trauma
Family history
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9
Q

AUD and PCP - what proportion received proper mx?

A

10% only

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10
Q

AUD:

What two treatments are equivalent?

What is chronic care management?

A

ARM + medical management is as effective as addiction counselling for mild-moderate

CCM is effective for AUD and alcohol related serious medical illness

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11
Q

Heavy alcohol use (book definition)

A

Binge drinking on more than 5 days in the past month

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12
Q

At risk drinking (book definition)

A

Exceeding levels for any day or week, binge drinking at least once a month, or drinking that increases the risk of future problems

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13
Q

AUD - what % continue despite external consequence?

What most severe % are over-represented in rehabs, jails and hospitals?

A

10% - includes jail, marital, job etc.

10%

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14
Q

DSM 5 12 month prevalence of AUD:

Men and women, mild or mod-severe:

A

Mild - 10/5%
Mod-severe 6/2%

From other numbers 26%/3%/1%
Mod - 3% and severe 1% - = 4% 6-4-2

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15
Q

AUDIT scores:

How many items, rated 0-what?
Severity groups and importance?

A

10 items, 0-4

5-10 - 20% have AUD
11-15 - 40%
16+ - 90%+

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16
Q

AUDIT C postivie

A

4+ in men
3+ in women

‘more than 5 - in the book’

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17
Q

Symptoms of impaired control include: 4 things

A

going over limits
desire to cut down
use despite internal consequences
tolerance

Lets Tolerate Cutting Insects
Limits, tolerance, Down down, Internal consequences

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18
Q

In severe AUD, 4 reasons to consider ARMs:

A
  • impairment may mean lifestyle intervention is difficult
  • medications are comparable to AA and counseling
  • medications are as good as SSRIs for depression
  • ARMs improve proportion of long-term recovery
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19
Q

AUD - tracking outcomes

3 data sources
1 lab test

A

Number of heavy drinking days (5+) in past month
AUDIT/AUDIT-C

yGT - if initially elevated

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20
Q

ARMS:

Name - MODA - effects (stats)

2 first line - 3 others

ALWAYS NALTREXONE

A

Naltrexone - 50mg prior to drinking - u opioid - reduces heavy drinking by 83%, all drinking by 4%

Acamprosate - moderates glutamate transmission - abstinence increased by 11 days, all drinking RR 0.86/NNT 9, no effect on heavy drinking

Disulfuram - aldehyde dehydrogenase inhibitor, leads to acetaldehyde build up - poor tolerance - no more effective than placebo
Gabapenting - addictive/street value - abstinence higher in 900mg a day 11%, 1800mg 17%, than placebo (4%) over 12 weeks
Topiramate - off-label - decreased percentage of heavy drinking days vs placebo (43.8% vs 51.8%)

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21
Q

Effect of a Lowfat vs Low-Carbohydrate Diet on 12-month weight loss in overweight adults and the association with genotype pattern or insulin secretion: the diet fits RCT:

n=

Intervention=

A

609 adults without DM, BMI 28-40

Either low-fat or low-carb diet, with 500-600 calorie deficit on average (not specifically instructed)

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22
Q

Effect of a Lowfat vs Low-Carbohydrate Diet on 12-month weight loss in overweight adults and the association with genotype pattern or insulin secretion: the diet fits RCT:

Key findings:
Macro-nutrient distribution
Weight change
Diet interactions
Adverse events
A

48% vs 30% for carbs, 29% vs 45% for fats, 21% vs 23% for protein

Remember45/30/20 for each

-5.3kg and -6.0kg

No genotype or INS-30 interaction

18 adverse events, equal distribution

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23
Q

Exercise and depression - how does it compare to other treatments?

Does it work with other treatments?

What about old and young?

A

Exercise slightly better than no or control treatment, not better than psycho or pharmacotherapy

Slightly synergistic with pharma

Effective treatment in elderly, protective if done as children

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24
Q

Mood and nutrients:

Higher mood disorders if these nutrients are low:

A

Folate, B12, calcium ,iron, selenium, zinc, omega-3 FAs

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25
Do fish oils/omega-3 fatty acids help mood?
Some studies say yes, others say no. Better evidence in depression or bipolar - longer bipolar remission with FA treatment.
26
Mood scores and diet - what happened after how long with omnivores became vegetarians?
2 weeks, mood scores improved
27
What nutrients may improve mood?
Can Some White Flowers Prevent Tears Carb rich evening meals, Saffron, Walnuts, Flax, Probiotics, Turmeric
28
Health promotion and positive emotions: | Direct and indirect impacts?
Direct - body physiology, well-being, disease prevention or treatment Indirect - maintenance of behaviours
29
Eudaimonia protects against?
strokes, alz/CI, heart attacks
30
Eudamonia and epigenetic?
Associatied with down regulated pro-inflammatory genes, and unregulated antibody synthesis. The opposite for hedonic.
31
Eudaimonia and brain activation?
less activation of amygdala more higher cortical function when confronted by negative stimuli sustained reward circuit with positive stiuli greater insular cortex volume
32
The boston and harvard study showed? What physiological effects do social connections cause?
happiness and longevity - from social connections social connections increased PNS activation, lower heart rate
33
Highest quartile of social media AOR of depression is...
2.47
34
5 protective effects of WFPB on B cells:
``` Stabilises immune system Avoids hypreglycaemia Anti-inflammatory Lipids normalise Leptin/adiponectin pathway normalised ```
35
ACCORD trial Aim: Outcomes:
Tight control of DM2 in patients with CVD/CVD RFs - weight gain - hypoglycaemia requiring assistance - increased mortality (1.2), even with decreased HbA1c (0.9)
36
Diabets: Prevalence of DM and pre-DM? (percentages) Approx prevalence in millenials Costs of medical care on DM
9.3% and 33% 33% males, 39% females, 50% in Black/Hispanic Medical costs - 2.3x higher, 16750/yr, 9600 attributed to DM
37
Diabets... NIDDM global rates 1980 to 2014 increase by 2025? India - how many and cost implications?
5% to 8.3% 55% extra 100million, 25% family income
38
Sleep in numbers: Workes on night shifts, %? % young adults sleeping less than 7 hours? And snince when to when has this double? How many have difficulty sleeping? Costs and those seeking help?
20% on nihgt shifts 37%, doubled 1960-2002 60million difficiuty, 10% seek help, costs 60billion
39
Sleep as a normal activity... How much? How much of life?
7-8 hours a night, 1/3rd of lfie | no objective test for how much needed
40
What is the SCN? What entrains the SCN? What other important connections? What else is it important for?
the portion of the hypothalamus that controls melatonin secretions Neurones from retina entrain the centril oscillators Pineal gland, and splanchnic nerves to adrenal glands Also responsible for awakening cortisol spike
41
3 outputs of the circadian rhythm?
1) functional performance - alertness, motor skills, kinetic activity, strength and stamina 2) Sleep 3) Food-seeking behaviour
42
4 things throughout sleep
1) DNA remodelling 2) leptin secretion 3) increasing cortisol 4) fatty acid metabolism
43
``` Lux of lighting: Bright sunlight Floudy day OVercast day Kitchen Home ```
``` 100K 25K 2K-5K 200-500 50-200 ```
44
Blue light is what wavelength and what kelvin?
420-480 - 6500 Blue light is that which melanopsin is most sensitive to, the molevule in RGCs that entrains the SCN
45
Sleep deficiency does what to cortisol@?
increased cortisol at night, which decreases cortisol mineralocorticoid action exacerbating low fluid effets
46
Lower retinal illuminace… 45 year olds? 65 year olds?
45 year old have 50% that of a 10 year old` 65 year old 50% that of a 45 year old affects blue light the most
47
BIISS prevalence? OSA prevalence and undiagnosed %? Restless leg prevalence? In RLS what percentage also have periodic movements of sleep?
7.3-20% 26% - 80% undiagnosed 5-15% 80% also have periodic movements of sleep
48
OSA - 5 associated conditions:
``` metabolic syndrome HTN obesity neck circumference loud snoring ```
49
Healthy sleep does 3 things for metabolic conditions:
Lower cortisol and BM Greater insulin sensitivity Higher leptin in the day (poor sleep gives you higher cortisol during the night)
50
Short sleep correlates with what 4 conditions?
Refractory/no-reduction of BP in early morning hours Increased heart attacks Increased CV deaths Vasospastic disorders
51
Short sleep duration correlates with what mental helath conditions?
``` MD, BD SAD PMS PTSD - worst if sleep dep 2 weeks prior TBI - worse wit hsleep dep pre or post ``` 3 affective disorders, 2 from the army and 1 PMS
52
Sleep and cancer: Sleep helps with Short sleep leads to 4 things Correlates with 5 cancers
DNA repair, histrone remodeline, apoptotis and anti-cancer cytokines (IL1,2, TNFa) Melatonin and immune suppression, increased cancer cytokines (IL10), cell/gene transcription dysfunction, aberrant DNA methylation Brest, endometrial, prostate cancer, colorectal cnacer, AML
53
Melatonin and west-ward - whats the special thing?
SR may be better, but also may cause morning drowsiness
54
Sleep assessment - the steps (7)
``` Weekend Weekday hours Quality Any red flags? - <7 >9 irregular, poor quality, 1+ hours difference Daytime fatigue Type of sleep disturbance and frequency Attitude towards sleep ```
55
Sleep red flags
``` 5: - less than 7 hours more than 9 hours poor quality despite 7 hours or more irregular timings one or more hours difference between weekend and weekday ```
56
``` Sleep prescriptions - the numbers: alcohol Caffeine Waking too early - when eat/caffeine? Jetlag going west - when eat breakfast? Blue light Work/stimulating activity Active relaxation ```
``` 3 hours ETOH limit daytme caffeine, no night time caffeine 30-60minutes after ideal wakeup 30-45minutes after ideal wakeup 1 hour pre sleep 90 minutes pre sleep 1 hour pre sleep ```
57
Epigenetics - 4 components
DNA methylation microRNA histone acetylation 'growing number of other components'
58
Agouti mice - what did they show? (3)
genetic expression of DM, heart disease, obesity affected by lifestyle in genetically identical mice
59
Physician health: How many GPs are obese? (USA) How many Candian 4th year med students don't meet PA guidelines?
53% | 36%
60
Meta-analysis of health providers' PA habits showed what?
19/24 high correlation between PA habits and PA counselling - Odds of counselling 1.4 to 5.7
61
Female physician research showed what about behaviours and counselling?
Ate less fat --> cholesterol 5 fruit and veg --> nutrition Vegetarian --> weight loss and nutrition
62
Male internists - what associations in behaviour and counselling? Female internists - same Q?
Male - smoking, seat belt ad PA associated with counselling, ETOH does not Female - PA associated with counselling about exercise and alcohol use
63
Examples of advocacy: (3)
Dean Ornish - Lifestyle heart medicine Blue zones project - characteristics of the 5 healthies/longest living areas - collaboration amongst community and leaders to transform health community systems RWJF - Creating a culture for health - community showcase of healthy ideas
64
WHO recommends measuring waist at:
midpoint between the lowest rib and iliac crest
65
Normal body fat charts - men and women
``` 2-4% 6-13% 14-7% 18-25% 26%+ (notice 2-3-4-5-6 and 4/6/4/8) ``` ``` 10-12% 14-20% 21-24% 25-31% 32%+ ``` (notice 1/1, 1/2, 2/2, 2/3 and 2/4/4/2)
66
What is the Edmonton staging of obesity?
Stages 0-4 depending on function or morbidity
67
Weight loss calorie reduction and goal calories: Men Women
750 reduction 1500-1800 a day | 500 reduction 1200-1500 a day
68
Energy expenditure: % and categories
5-10% TE of food 60% REE (resting) 30-40% Non-resting EE
69
Bariatric surgery referral criteria
BMI 40+ BMI 35+ and co-morbidities Must have tried and failed to lose weight other ways ACLM - interprets failure as 6 months ILI Must be motivated for weight loss
70
Weight loss goals and outcomes at those goals | What is the minimum for clinically meaningful change?
3-5% - HbA1c, Trigs, reducing DM progression, glucose (biochemistry and DM) 5% - hypertension, dyslipidaemia, medication reduction (remember statins and amlodipine)
71
Average weight loss from ILI in first 6 months?
around 8kg 17lbs
72
Plateau phenomenon in obesity and weight loss...
Losing 10% of weight NREE decreases by 30% Indiviudals must eat 10-15% less than expected Persists for months+ Structural changes in the hypothalamus and brain must re-adapt for sustained body weight control
73
Occupational factors and health - two stress related studies:
Finnish study showed 3-4 hours overtime a day at 7.5 years FU increased CVD risk 15 year study, work stressors doubled DM risk ,mildly attenuated by obesity and healthy behaviours associated with diabetes
74
Dr Cohen's perceived stress questionnaire:
10 items, 0-4 0-13 low 13-26 moderate 27-40 high stress
75
PHQ-2: What is positive? What is sensitivity and specificity?
3 or higher is positive Sensitivity 80-90% 70-85%
76
GAD DSM symptoms
Must have GAD2 symptoms (anxiety and worry, difficulty controlling it) also must have 3 other symptoms impairement, no other condition or substance abuse
77
PHQ-4 : the Qs and the scoring...
ask the GAD2 and the PHQ2 scores ``` Add them together: 0-2 - normal 3-5 mild 6-8 moderate 9-12 severe ``` This is a screening tool for anxiety and depression Higher scores associated with impairment, disability days an dhealth care use 3+ is positive and should lead to suicidal ideation screening and further assessment
78
Resiliency tipping point - what's the ratio? What is resiliency?
3:1 Resilience determines if someone will be able to overcome and obstacle - it is measurable Use positivityratio.com a 2 minutes test
79
Positive resonance is what? What physiological parameter does it improve?
positive social connections micro-connections improve HR
80
For obesity - what are the most effective ILI?
intense (14 or more sessions in 6 months) with trained interventionists or nutritionists include caloric restriction, PA, and behavioural strategies to facilitate change
81
When do you use pharma + ILI for obesity?
BMI >27 with co-morbs, or over 30
82
Confidence/importance and stages of changes...
``` 1-3 - precontemplation 4-6 - contemplation 7 - planning 8-9 - action 10 maintainance ```
83
The long chart for PA and mortality shows what exactly?
mod or vig PA - risk of premature death
84
neuromotor/balance recommendations?
Healthy adults 18-64 years of age • 20 – 30 minute per session of motor skill and proprioceptive skill training for cumulative 60 minutes/week • This is a level we know is effective, but optimal duration and repetitions are not known. • Older adults ≥65 years of age • ≥ two-three days/week of motor skill and proprioceptive skill training Motor skill = balance, gait, agility, and coordination • Proprioceptive skill = awareness of body in space, examples include tai chi and yoga
85
What is prescription for health?
“Prescription for Health” • Successful primary care and office-based models for lifestyle modification for 4 health risk behaviors • Tobacco use, risky alcohol use, unhealthy diet, lack of physical activity • Lessons learned • PCP offices are capable and had interest in health behavior change if funding and support were available • Health Care Delivery Model (PCMH) • Electronic Preventative Services Selector (ePSS)

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