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active immunity and example protection produced by own immune system stimulated by a antibody and cell-mediated immunity

• provides long term protection
  2 ways to acquire active immunity 1. via infection and recovery, if rexposed, the memory B cells begin to replicate and produce antibodies to reestablish protection

1. get vaxxed, which contain antigens that trigger the immune system to act (immune response)
   what factors affect immune response? (4) maternal antibodies, nature & dose of antigen, route of administration, presence of adjuvant (additives to improve immunogenicity of vaccine)
   what are some host factors that affect the immune response? (4) age, nutrition, genetics, comorbidity
   What are live attenuated vaccines? They are weakened but still active organisms (viruses) - a milder version but doesn't cause disease

e.g. MMR, rotavirus, smallpox, chickenpox, yellow fever
Inactivated vaccines contains killed viruses/bacteria/pathogens that were cultured and killed to destroy their disease-causing capacity

e.g. pertussis, rabies, Hepatitis A, poliovirus
how does the immune system work ability of human body to tolerate the presence of foreign material (bacteria, viruses, fungi) and to eliminate them

• develops defence against antigens via the production of protein molecules by B cells (antibodies) which are immunoglobulins and production of T lymphocytes
  What do B cells produce? and for what? antibodies (immunoglobulins) as an immune response
  What is an example of a vaccination scheme? at 3 months, 5 months, 11 months, 14 months, until 14 years etc. children would get certain vaccines throughout their lives
  what is the purpose of a vaccination scheme? eradicate conditions, decrease mortality rates (child)
  What is herd immunity? a large community becomes immune to a disease
  what are key determinants of herd immunity? reproduction number (R0) - expected number of cases generated by one case in a population where everyone is susceptible for an infection
  what should the reproduction number be for the disease to be eradicated? smaller than 1
  what may affect the R0 number heterogenous population (diverse), which are more interconnected will increase transmission and thus requires a larger vaccination threshold
  what are freeloaders? people who don't participate in vaccination for herd immunity and depend on others to achieve herd immunity

they will be very vulnerable for a focal outbreak around them
how can social media influence vaccination decisions? by delivering info that changes perceived personal risk of vaccine preventable diseases or side effects
what would be a solution to have a better platform to provide information for vaccines - implement interactive, customized communication

• increase effectiveness of existing communicatoin
• when there is less knowledge, need for reliable info on benefits & risks
  What is Web 2.0? Describes blogs, social networks, and internet-based services that emphasize collaboration and sharing
  what are some web 2.0 challenges for PH communication, online info influences people and everyone reacts to it, which makes it difficult to communicate safely (misinformation, etc.)
  how do people get influenced easy on social media? confirmation bias - they search for info that fits their beliefs rather than info that opposes their beliefs
  how could the government have better communication? - natural frequencies (statistic representation)
• visual support (infographics, videos9
• focus on facts and alternative explanations for myths
  what are challenges in global immunization? (6) - vaccines are not available to the poorest (inequality in distribution)
• false claims for associations for autism and vaccinations
• vaccines take a long process, expensive and difficult to make
• as more vaccines are added to the immunisation schedule, there is a need for more immunological interference when given together (a lot of research)
• confirmation bias
• vaccine hesitancy - delay in acceptance or refusal of vaccines despite the availability of them
  what solutions are there for vaccine inequality? better ways to target vulnerable communities with interventions
  what are reasons for vaccine hesitancy (6) - language barrier
• social media influences with false info
• cultural, religious beliefs
• politics
• gender
• trust in government or health system
  what is TB? infectious disease caused by a TB bacteria and attacks the lungs mostly
  what is latent TB? bacteria stays in body and is inactive, only activates when getting older and immune system suppresses + if comorbidities (esp. HIV/AIDS coinfection)
  how is tb caused? bacteria (Mb.), can survive in dry environment, only grows in living organism
• part of a family of bacteria
  where can TB be detected as well? and how was the vaccine made (with what) in cattle

the vaccine was made with the weakened living Mb. Bovis that causes TB in cattle
how does tb transmit human to human, by coughing, sneezing etc. (airborne)

goes into alveoli in lungs
what is the primary infection of tb immune system is battling the antigen locally (not yet spread further)

• no symptoms
  what is the secondary infection of tb latent tb, when it stays inactive
  what is open tb? when inflammation ruptures and gets into the airways and spreads into lungs
  what is miliary tb when inflammation ruptures and gets into the bloodstream and spreads throughout the body
  what are symptoms of active tb active --> fever, night sweats, weight loss, fatigue

in lung --> prolonged coughing, sputum, cough blood, chest pain, shortness of breath
how do you diagnose tb? - case history (symptoms, traveling or born in prevalent country)

• physical exam (listening to abnormal sounds)
• lab & radiological investigation (interferon gamma test, skin test tuberculin, smear sputum, XpertMBT/RIF pcr test, x-ray)
  what is the interferon gamma test measures t cell response to the TB antigens and sees whether there is TB infection from BCG or actual infection
  what is the skin test tuberculin (latent or active tb?) for latent tb, inject tuberculin antigen (protein extract) into skin and if person develops a rash/swelling/redness after 2-3 days larger than 1cm, theyre positive for TB
• wont be positive in primary infection since the antibodies arent formed properly yet
  what are drawbacks to the tuberculin skin test? - if vaccinated, false positive would show since antibodies form vaccination formed (not infected with TB)
• if immune system is suppressed, (HIV/AIDS), false negative may come up (weak antibody production for anything)
  what is the smear sputum? (latent or active?) active, if antigen is high, red dots can be seen on a microscopic level
  what was the old and new golden standard for tb testing? (old) culture --> breeding/culturing the antigen in its ideal environment and testing what type it is and whether it is sensitive to treatments
• see what drugs work best, if sensitive it will not grow and drug can be used, however, very slow process

(new) pcr XpertMTB/RIF --> DNA is multipled and see if there is TB-bacterium DNA, detects resistance of rifampicin (most important drug for tb)

• very expensive but fast
  what is the x-ray for tb? (latent or active?) active, showing presence for active disease
  what is the prolonged multi-drug treatment for tb? combining drugs to prevent resistance too
  what are the treatments for tb and mtb - prolonged multi-drug
• chemoprophylaxis
• (MTB) antibiotics and chemotherapeutics (not related to chemo, just made in lab)
  what is chemoprophylaxis for tb? prevention of disease after exposure
• used in children after contact with contagious patient
  how to treat active tb 2 month long with 4 drugs Isoniazide (I), Rifampicin (R), Ethambutol (E), Pyrazinamide (P)

decrease bacteria and limit contagiousness

then 4 months with 2 drugs (I) and (R)
downsides of treating active TB lots of side effects --> hepatitis, nervous disorders, eye disorders

if comorbidity, alcohol or other drugs are used, need to be careful
what are the consequences if active TB treatment is not consistent? (6) - development of resistance against drugs

• reactivation of TB
• complex and long process
• size of tablets
• further issues with comorbidities, addiction and low SES
• not cheap
  what is a treatment for mtb? antibiotics (organic origin) and chemotherapeutics (not linked to chemotherapy, just made in lab)
  what are the risk factors for the activation of TB? (5) - immune-suppressing conditions (HIV/AIDS)
• immune-suppresive drugs
• alcoholism
• diabetes, undernutrition
• genetic susceptibility
  what are the risk factors for death from TB? (5) - comorbidity
• accessibility of treatment
• resistance to drugs
  What is MDR and XDR? mdr - multidrug resistant tb (2 drugs)

xdr - extensively drug-resistant (almost every drug (4 drugs))
why are people developing mtb or even xdr? - weak health systems

• inadequate treatment process (difficult to stay on track
• high transmission between communities
• unnecessary antibiotic provision for other infections
  what happened after the collapse of the USSR? (MDR) prevalence increased with weak health systems (fewer drugs, drugs are expensive)
  why are elderly prevalent in TB? because their immune system weakens once theyre old, and the latent infection that they had activates
  where is mtb frequent? Eastern Europe and Africa
  what is the aim of surveillance of TB? reduce burden of morbidity and mortality from TB via contact tracing (notifying when there are cases) and seeing trends & patterns
  What is the vaccine for TB? BCG vaccine
  how effective is the BCG vaccine not effective, but protection is reported in children and newborns
  what are types of control for TB? (4) surveillance

vaccination

screening

outbreak management
how would you usually screen for TB? x-ray of thorax when coming from a region with high TB prevalence

then treat and supervise the case
what are 2 issues with the BCG vaccine and positive test results in tuberculin skin test? 1- if a vaccination was made, the test will come back positive - making it difficult to distinct and infection from the vaccine

2- false negative if the individual has a immune suppressive condition, the results will be negative, not showing how the body fights back
outbreak management in TB (stone-in-the-pond principle) investigate contacts closest and longest contact with index-case (e.g. group, family) first

--> if then no. of infected is bigger than expected, expand to bigger circle via DNA fingerprinting to identify source of infection
What are EIDs/newly emerging infectious disease? emerging infectious diseases, newly appeared in a population
what causes the spread of infections (moving) - travelling for reasons such as work, tourism, leisure
what are zoonoses? and what factors cause it? (5) - infectious disease spread from animals to humans

• farming, keeping domestic pets, hunting, camping, deforestation/habitat destruction
  what are the 4 categories of EIDs? (ARND) accidentally emerging infectious diseases

re-emerging infectious diseases

newly emerging infectious diseases

deliberately emerging infectious diseases
what is newly emerging infectious disease

one example disease recognised in humans for the first time

e.g. COVID-19
what is accidentally emerging infectious disease

one example disease created by humans unintentionally

e.g. vaccine derived polioviruses (over time changed into a wild or naturally occuring virus)
what is re-emerging infectious disease

one example when a previously known disease has re-entered human population in new locations or in a resistant form

e.g. HIV/AIDS, TB
what is deliberately emerging infectious disease

one example disease associated with the intent to harm (e.g. bioterrorism)

e.g. engineered microorganisms such as inserting genetic virulence to worsen a disease
what factors influence these infections? (3 categories) host --> humans who are susceptible to those infections

agent --> susceptibility to an agent

environment
what are the environment factors for infections? (7) - animal exposures

• traveling, commerce, tourism
• environmental degradation (urbanisation, deforestation, economic development, land use)
• climate & weather events
• poverty (lack of PH infrastructure, availability & accessibility, lack of surveillance & monitoring for infections)
• lack of political will (countries focus on different things)
• deliberate use of terror and harm
  what are the objectives for surveillance? (4) time - how are these disease trends, do they coincide with interventions? (e.g. vaccines)

place - where is the disease, geographic variations & factors

person - who is affected, minority groups, gender, age, culture, SES, race, occupation

disease characteristics - clinical or lab characteristics, severity and outcome
why is covid and ebola so different? they are two pandemics tho.. covid spreads really fast to others and mostly passes with light symptoms

whereas ebola also spreads fast but symptoms are severe and cause death so transmission is slower (since ppl are dying, they cant spread to anyone much)
what is risk assessment? research and evaluation on effects of substances or practices --> gaining understanding of positive & negative effects
what is risk estimation scientific judgement on past events to predict size and likelihood of future events and estimates of uncertainty
what is risk evaluation relies on social & political judgement to determine importance of hazards and estimated risks
what is the process of risk communciation estimate risk
evaluate risk

define options

make decisions

take action

monitor outcome
what needs to be considered for risk communication? (4) - different stakeholders to get a broader perspective

• potential pitfalls
• consider target audience risk perceptions (including beliefs and cultural/religious contexts)
• be open and accept uncertainty (transparency)
• language of risk with clear and only useful info that everyone understands (building on existing info, verbal info is perceived better where numeric info is difficult)
  who did a good and bad job in SARS control ? Singapore restricted travel to contain

China did not restrict

Canada was slow in communication

British ministry denied risk of infection
what is a biased way of individuals thinking about risk estimation example when there are news on high rates of accidents, individuals would think that they themselves wont be in that rate because they drive carefully
how do you achieve herd immunity? only a part of the population needs to be immune to prevent huge outbreaks (when R is less than 1)
how do you achieve herd immunity with vaccination when infection rate is very high? larger vaccination rates the larger the infections rate
what is CVD? group of disorders of the heart and blood vessels
what is atherosclerosis happens in coronary heart disease, when plaque (cholesterol deposits) builds up in the walls of the coronary arteries, they narrow over time
how do you diagnose CVD? - ECG

• blood measures (cholesterol levels, blood pressure)
  what are the 2 types of CVD tereatments? pharmacological --> medication to control and reduce risk factors (statins, aspirin, surgery (bypass),

non-pharmacological --> lifestyle changes (smoking cessation, increase PA, limit alcohol, focus on healthy diet, stress, reduce obesity)
what are risk factors of CVD (12) smoking
hypertension

obesity

unehalthy diet

limited PA

excessive alcohol consumption

family history & genetics of strokes

diabetes & metabolic syndromes

age

sex

chronic kidney disease

prior CVD experience
which age and sex group experiences hypertension more? men 65 and older
how could primary and secondary prevention look like for CVD? primary --> lifestyle change for people who experience risk factors

secondary --> prevent from further progression of CVD via medication and lifestyle changes
in which age group and sex has a higher CVD mortality rate ? men have higher rate at 84 but for women it starts at 85-95 due to their longer life expectancy (the longer they live, the more CVD peaks) and menopause (estrogen decreases, risk of CVD increases)
what are risk prediction models? estimate populations risk to develop CVD and to be able to control it in time with prevention strategies

to predict fatal and non fatal CVD
how does the prevalence looks like in CVD? mortality and prevalence decrease lately
what do risk prediction models include? (7) age, smoking, blood pressure, cholesterol, sex, diabetes, systolic blood pressure
what are cons of risk prediction models? (3) most of them are not externally valid and are different in countries, some risk factors (e.g. diabetes) are missing
what are the 3 risk prediction models? SCORE model

Framingham model

Q-risk model (up to 10 years in future)
what is preconception carrier screening (PCCS)? investigating whether a genetic disorder is present in someone who is about to get pregnant (before pregnancy)
what is selective preconception care? screening on request of the patient
what is premarital screening? testing couples before getting married for genetic blood disorders and infectious diseases
what is universal preconception care screening offered to populations from healthcare professionals
what dilemma is there when offering universal preconception care? whether it should be only for high risk groups or the whole population
why would preconception care take place? because there are many genetic diseases with a high carrier frequency
what are challenges in preconception care and counselling? (4) - variability on national guidelines

• low health literacy among patients & professionals due to lack of guidelines
• expensive, difficult reimbursement scheme
• societal/cultural/religious beliefs
  what is the aim of the 12 recommendations for carrier screening by Henneman? reach discussion in professionals and public on carrier screening

being able to understand:

• the purpose of the screening
• evidence
• informed consent
• available information
• good quality of services
  What is preimplantation genetic testing (PGT)? also called embryo selection, identifies genetic defects in embryos created through IVF before conception to see whether the embryo carries the same gene
  who is PGT done for for high risk couples and if carrier, the severity of the disease
  What is IVF? embryo made in the lab with sperm and egg cells
  what is the pgt success rate? 20-25%
  what is the IVF procedure and the biopsy types? in IVF, the egg is removed from the woman's ovaries and fertilised with sperm in a lab, the embryo is then returned to the woman womb to grow and develop
  when is IVF and PGT done? At the same time or after each other? in the PGT procedure, there is is a pre-IVF interview, then the IVF procedure, then PGT testing and then transfer of healthy embryo
  what is the PGT prep? - blood tests from both parents and family members for genetic conditions
• prep gynaecological test capability of ovaries to produce enough eggs
• internal exam
• ultrasound of ovaries
• hormone test
  what is the PGT procedure? IVF interview about medication to take, hormone injections (for eggs to mature), check ups how eggs mature
• then IVF procedure
• then PGT analysis on the embryo, if healthy transferred back to womb for conception
  what is done is the eggs aren't matured enough? PGT and IVF is cancelled
  what is informed decision making (3) knowledge, understanding of condition, options, risks, benefits, uncertainties of options

deliberation, weighing up pros and cons to make decision

value-consistency, preferences and values should be clear and decision should be based on that
what factors influence PGT decision making process (4) physical - concerns about physical burden and risks of IVF, to avoid offspring suffering, to avoid termination (yk if the child is healthy)

psychological - feelings of guilt, feeling the need to accept PGD since it is available and feeling guilty after for not using it, low success rate

ethical - personal conflict "playing god", making the perfect child, devaluing the lives of ppl with the condition

financial - if its covered by insurance

time - takes time to get pregnant and interviews
what is preconception care and counselling? hows the process education and care that should be given to a woman around conception

• medical facts, how condition is inherited, options, prenatal testing, acceptance of risk and to care for baby, other options like gamete donation and adoption
  what issues should be addressed during a preimplantation genetic testing consultation? - reasons for requesting, family history
• review of diagnosis and understanding risk
• review of other reproductive options
• explanation of PGD treatment
• Discussion of the pros and cons related to PGD
  what is downs syndrome and when is a baby at risk to develop it chromosmal anomaly - Trisomy 21, 3 copies of the 21st chromosome, the older the women gets, the higher the risk (maternal age)
  can downs be inherited? no
  what are some physical appearances of down syndrome? short neck, small ears, short height, prominent tongue
  what are some comorbidities that accompany downs? Leukaemia, heart defects, weakened immune system, visual & hearing impairment, neurological system imparity (speak slower, intellectual disability, behavioural issues), premature ageing (risk of alzheimers)
  has survival for downs increased? yes due to better treatment of comorbidities and respiratory infections
  NIPT - Non-Invasive Prenatal Testing, what is it? new version of combination tests that screen for Downs, Patau and Edward

has better sensitivity so lower false positive and less invasive
how is Downs Syndrome diagnosed? (7) maternal age, genetic & obstretic history, ultrasound, maternal serum, MRI, chromosome analysis, free fetal DNA

• behavioural responses, appeareance (difficult in premature infants, older adults, unfamiliar ethnic groups)
  what are some invasive prenatal tests? - amniocentesis
• chorionic villus sampling (CVS)
• fetal blood and tissue sampling
  on which populations is prenatal diagnosis screened? low risk populations
  what are some non-invasive prenatal tests? free fetal DNA, ultrasound (nuchal translucency, markers in DNA), MRI
  into what phrase did preimplantation genetic diagnosis (PGD) change to? preimplantation genetic testing (PGT)
  what is the difference between prenatal diagnosis and preimplantation genetic testing? prenatal diagnosis is during pregnancy to test whether child is affected

PGT is before pregnancy, create IVF embryos and test embryos for genetic conditions
what are some screening types for prenatal diagnosis
what is advised to confirm a normal pregnancy after a preimplantation genetic testing (PGT)? to go through a prenatal diagnosis
what should screening tests have? high sensitivity (low false negatives), and high specificity (low false positives)
what are Pros and cons of prenatal diagnosis? Pros:
Helps parents to have child with disability → to know in advance, arranging things, the doctors are also prepared

Cons:

• Lots of general info → Lack of certainty
• Non-directive counselling → the individual makes a decision themselves
• Putting emphasis that these things are normal
• Future stigma and view on children with trisomy 21
  What are the consequences of prenatal screening? - if abnormal results, options of abortion or continuation of pregnancy (wanting to be prepared)
• amniocentensis & CVS are coslty and risk for miscarriage
• with technology advancing, tests will be better and be able to detect conditions even before showing symptoms of pregnancy & they might cost less and insurance would cover it making it more universal
• some professionals have been rude in providing information of downs saying that it is a huge burden (biased)
  What are different views on screening and abortion in different countries? (6) the preference depends on:
• accuracy of test
• time of test
• risk of miscarriage
• types of info (is it good counselling)
• religion/social/cultural contexts and healthcare policies (financial management)
• participants focus on test safety and good info where professionals focus on accuracy and early testing
  decisional stages in vaccine decisions predecisional phase - seeking for more information before deciding to vaccinate

decisional phase - evaluating the outcomes of either decision (yes or no), risk perception on being affected or not by a consequence,

post-decisional phase - getting feedback to their decision (costs pain, time and potential side effects
prostate cancer can it be treated? may be cured (only when localised), responds to treatment if widespread
what are the types of lung cancer? symptoms, diagnosis, treatment non small lung cancer - more common

small cell lung cancer

symptoms: cough blood, chest pain, difficulty breathing

diagnosis: chest xray, CT, MRI, bronchoscopy

treatment: both types chemotherapy, surgery, radiotherapy (non small cell is less sensitive to therapies)
how is the tumour growth with prostate cancer? and what does it help with? very slow, helps with prolonged survival rates even if it metastasised
where does colorectal cancer start? in the inner lining of the colon or rectum
prostate cancer symptoms, diagnosis, treatment symptoms: urinating difficult, pain, hesitancy, urgency, nocturia (waking up to piss)

diagnosis: (based on age and coexisting conditions) biopsy, rectal exam, PSA level (metastatic progression), ultrasound, bone scan for bone metastases

treatment: hormonal therapy, surgery, radiation therapy
colorectal cancer symptoms, diagnosis, treatment symptoms: blood in stool, bowel changes, weight loss

diagnosis: CT, MRI, colonoscopy

treatment: surgery, radiotherapy, chemotherapy, targeted therapy
lung cancer incidence decrease due to smoking cessation
colorectal cancer incidence low but increases with age
prostate cancer incidence increase due to better screening
why cancer mortality rates have decreased better screening technology and opportunities

the earlier the stage, the better the survival rate
what are the risk factors for lung cancer smoking, older age, exposure to second hand smoke, radiation, exposure to carcinogens, family history
what are the risk factors for colorectal cancer nutrition (low veggie, fruits), history, comobidity (IBD), diabetes, alcohol consumption, obesity, low PA
what are the risk factors for prostate cancer over 50 years, race, family history, alcohol, vitamin, nutrition (high fat)
development of cancer where it starts starts locally, grows into blood vessels, spreads to rest of body and finally death
what are some prevention opportunities for prostate, lung and colorectal cancer (primary or secondary) prostate - (secondary) early widespread screening with PSA level

lung - (primary) reduce exposure to smoke in public, raising costs, laws

colorectal - (secondary) early detection with screening
why screen for cancer? the earlier, the better survival rate
what is screening population based opportunity to diagnose something and early detect it for risk groups then to provide adequate treatment and improve QoL
what are downsides of screening - false positives, if many screenings are done, people may get misdiagnosed and treated for something they dont have

• false negatives, letting the disease progress without any intervention
• dilemma of whether it improves survival rates or increases mortality rates
• big costs
  What is the wilson and jungner criteria for? some examples gold standard or screening assessment, shows the reasons why screening should take place
• is it a PH issue
• costs & benefits
• suitable tests (invasive or not)
• available treatments
• target population
  What is Alzheimer's disease? syndrome that shows difficulties in memory, language, behaviour that makes it difficult for daily activities
  how is the incidence rate for AD and why, why is it different in low & middle & high income countries expected to increase drastically as well as the costs for care
• rising ageing population
• high income is due to higher age, middle & low is due to change in lifestyle factors (obesity, alcohol, changed eating behaviours)
  what is the cause for alzheimer biologically (2) tau protein - binds and stabilises cells but when abnormal, they stick to other tau molecules and forms tangling inside neurons

beta amyloid as plaques - accumulation of these plaques between nerve cells
what happens to the gray matter reduces the older we get
what is grey matter and how is it with AD? the part where the networks of nerve cells that process information from different senses

grey matter usually declines with AD
what are the risk factors for AD (2 types) modifiable, CVD factors (hypertension, obesity, high cholesterol, T2Diabetes), lifestyle factors (limited PA, smoking, alcohol, diet), psychosocial (loneliness, bad social network, depression), environmental (air pollution, low educational level)

non-modifiable, age, sex, genetics, family history, brain injury, down syndrome
how to diagnose AD interview - draw things, questions,

physical exam - visual or auditory abnormalities

psychiatric exam

neurological exam
treatment for AD no cure

• drugs to improve attention & memory
• reduce breakdown of neurotransmitter of acetylcholine
• non drug intervention like cognitive stimulation therapy to help delay cognitive deterioration and improve QoL
  what was the FINGER experiment for AD about? they thought the RCT would increase brain reserve but it did not show significant results
• intervention group got nutritional advice, PA, social activities, self management
  what types of Dementia are there and what is most common? - Alzheimer
• lewy body
• alcohol caused dementia
• Parkinsons and dementia
• vascular dementia
• frontotemporal dementia

most common is the combination of these (esp. vascular & Alzheimer)
what are some primary and secondary prevention for AD primary - early diagnosis of cognitive impairment, early treatment at high risk, make people more aware of modifiable factors

secondary - lifestyle changes, cognition triggers
pathological ageing in brain as we age, we lose nerve cells (brain reserve) and also forms new connections

• with normal ageing not all cognitive functions will decline and decline at the same time (happens in Dementia ppl)
  how is the brain reserve related to dementia risk? the higher the brain reserve, the lower the risk of dementia (high educated ppl)
  how about the wilson and jungner criteria for AD? high incidence

can tests correctly diagnose (difficult to distinguish, false negative (normally ageing), false positive)

you cant cure it

treatment (invasive) can be helpful in beginning (early diagnosis)
What is T2DM and how is it characterized by, when is the risk high chronic disease, by HbA1c, the glycated haemoglobin (glucose is tuck to the blood cells and builds up in blood

• when the hba1c levels are high
  what are long term complication of T2DM mouth

feet

kidney - nephropathy, kidneys have it hard to clear fluit and waste from body due to high blood sugar levels and hypertension (need dialysis)

nervous system - neuropathy, nerves have it harder to carry messages from brain to body (attacks movement, senses, numbness, etc.), lead to diabetic foot and thus amputations (rare)

heart - CVD risk factors overlaps with T2DM

eyes - retinopathy , damage to retina causes vision impairment
td2m risk factors and different factors for long term complications unmodifiable - age, race, sex, family history & genetics, previous gestational (pregnancy) diabetes,

modifiable - obesity, PA, hypertension, alcohol, smoking, race, cholesterol levels, environmental influence (neighbourhood, space for PA, healthy shops)

long term complications - overlap with CVD (hypertension, smoking)
what is self-management in t2dm and the 5 core processes day to day management of the condition

5:
1- problem solving
2- decision making + shared decision making
3- resource utilisation
4- partnerships with healthcare providers
5- taking actions
what is diabetes self management education and support overall to improve QoL

education - all about teaching the patient and providing them with ideas of how to manage, old education was providing info but now it is helping to put the info into practice

support - support provided to enable the skills and behaviours such as helplines and group events (incl. psychological support)
how do you prevent T2dm + example of secondary prevention and what are the 15 healthcare essentials both primary, secondary and tertiary

• mainly lifestyle changes to reduce or prevent complications of the condition
• secondary, prevent CVD risk factors
  what is cancer survivorship cancer is transformed from a deadly disease into a manageable condition
  what are the short and long term consequences of cancer and its treatment very different for individuals, subjective

long term -

• psychological (fear of future, depression, anxiety)
• restrictions in social functioning
• chronic pain, fatigue
• stoma

short term - e.g. pain from chemotherapy
are the colorectal survival rates increasing or decreasing? increasing, due to:

• early screening
• improved treatment
• ageing population (more and more survivors)
  what is a down side of survivorship of colorectal cancer? they still have health & mental issues
  what is the definition of QoL very subjective, how one perceives their own situation

perspective of an individuals level of functioning and health status which also depends on environmental and personal factors
what is functioning (5 domains) physical functioning - jhsbdsd

emotion functioning

cognitive functioning

social functioning

role functioning
health-related QoL QoL subjective perspective based on your health status
ICF Model International Classification of Functioning, Disability, and Health by WHO

• helps to classify functioning, disability and health from a biopsychosocial perspective
  icf and colorectal cancer survivorship helps to see the patients disability and functioning, how their QoL looks like
  what does a biopsychosocial model include + how was it in the past perspectives from biomedical and psychological and contextual aspects of functioning

only biomedical, now psychological is included
what are the QoL dimensions (6) physical health

psychological state

level of independence

social relationships

personal beliefs

personal environment
what is nonspecific low back pain and when is it chronic? unknown cause of the pain, pain for 12 weeks or longer
causes of back pain - weak muscles

• obesity
• lack of exercise
• poor posture
  risk factors of back pain (5) - age
• fitness level
• weight
• smoking
• genetics
• psychological
  what is the rate of low back pain common, mostly in occupational-related cases
  criteria for pain disorder (5) - pain in one or more sites
• severity
• psychological factors influence
• pain is not faked
• cant solely depend on a mental disorder
  when is a pain disorder chronic and what if less after 6 months, if less its acute
  how is chronic non-specific low back pain treated and prevented (secondary, tertiary) - (tertiary) medication and self management
• (tertiary) psycho education & CBT, physical therapy (restore self efficacy, teaching them how to manage and understand with pain diaries)
• (secondary) little research on secondary prevention, only researched in high income countries, but theres is general advice on exercising, education
  glasgow illness model? biopsychosocial model of pain and disability (esp. chronic)
• what factors influence the pain
• pain - medical condition, severity, duration
• attitudes & beliefs - influence on how you deal with pain
• psychological distress - MHD increase pain
• illness behaviour - how you deal with it
• social environment - how much support you get, what info u get
  fear avoidance model and what behaviour does it entail relates to psychological aspect
• can be a cycle where one doesnt want to experience pain anymore so they try anything to avoid it
• affects daily life and activities, mal adaptive coping where the avoidance leads to other harmful activities (binge eating, substance abuse)
  fear avoidance model and non specific low back pain to avoid pain, one doesnt move, but movement is essential to prevent non specific low back pain
  what is operant conditioning part of and what 4 factors does it have understanding the punishment and reinforcement by external factors (stimulus)
• helps to make one learn to have healthier behaviours
• positive punishment, adding a stimulus to discourage a behaviour
• positive reinforcement, adding a stimulus to encourage behaviour
• negative punishment, removing a stimulus to discourage a behaviour
• negative reinforcement, removing a stimulus to encourage a behaviour
  beta version question beta version answer

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