Semester 2.2, theme 9
Checklist week 33, Lifestyle
At the end of this week, the students will:
Know about determinants of healthy behaviour in children and behaviour that poses health risks
Personal: biological and psychological (attitude towards healthy behaviour, personal norm, perception)
Environmental: social influences, culture, SES…
Know about the model of determinants of
healthy behaviour (the Health Field Model)
Lalonde:
Know about terminology and definitions
regarding prevention
Primary prevention: prevent new cases, so take
away the causes.
Secondary prevention: detect as early as possible
Tertiary prevention: prevent consequences after diagnoses
≡> By means of Health Protection, Health Promotion and Disease Prevention (=combi of other 2)
Know about a systematic approach to prevention
Systemic approach to implement primary prevention:
1) Analysis + 2) development + 3) evaluation Of preventive measurement implementation
Know about the municipal policy cycle
Municipality health policy development cycle:
1) broad consultation (physical/social environment
2) prioritize
3) develop a coherent public health programme
4) implement
5) evaluate
Know examples of health promotion methods
Health protection: banning smoking from public places, place high taxes on alcohol and cigarettes,
clean H2O, environmental factors!
Health promotion: education to change behaviour: sex education, smoking campaigns, hygiene.
Know about tailoring information about healthy behaviour to individual parental health skills
It is important not to smoke around children and not during the pregnancy. Inform about the risks.
Know about Lifestyle Medicine
Lifestyle management is very important in preventive medicine. If the lifestyle is changed, a lot of diseases can be
prevented. A good example is coronary heart disease.
Know examples of dilemmas in primary prevention
,Compulsion or pressure? How far can you go with demanding things or not permitting things
Freedom of choice and informed choice patients can decide treatment, but they can be informed
by doctors, how much should doctors interfere?
Also: 40% of doctors think that if people are not willing to change their lifestyle, that they (as doctors) should be able
to refuse to give those patients treatment.
Know about environmental analysis focussing on the physical environment in which children grow up
Most easy i.c.o. identical twins who grow up in a different environment.
Know about “Bias and confounding”
Bias:
- selection bias: the participating group doesn’t reflect the population
maybe midwives only select uncomplicated pregnancies or only motivated pregnant women respond to
the study
- attrition bias: if people move, or drop out of the study, than other results
- Bergson’s bias: where is the study taken, in hospital (more complicated pregnancies) or outpatient
clinic (uncomplicated pregnancies)?
Hawthorne effect: i.e.: mothers try to smoke less because they are in the study
Confounders: associated with exposure and outcome. if smoking mothers have smaller babies, maybe this is due to
other causes than the smoking: alcohol, low socioeconomic status……
if confounder is equal in both situations, you know the effect was not due to this confounder
Know about “Validity, reliability and generalizability”
Generalizability: is the epidemiology applicable to my patient? Is the study internally/content wise
valid and if the patient is kind op the same as the study participants.
Know about “Interaction, standardization and stratification”
Interaction: Maybe there is a factor that also contributes, that is only associated with the outcome
Stratification: stratified analysis is used to see if there are confounding or interacting factors contribute: 2 groups are
compared.
- confounders only have an effect when differently present in groups
, Know about “Linear regression” and “Logistic regression”
G2020 2.2, Theme 9, week 34 (“Undersized child”)
Students know
Pediatric hip conditions: hipdysplasia (DDH),
Perthes Disease, epifysiolysis, transient synovitis
Hip dysplasia (DDH, developmental dysplasia hip)
Femoral head has abnormal relationship to the acetabulum
(=hip bone socket)
- dysplasia form of socket is abnormal, oft too steep in
acetabulum
- subluxation head is more out of the socket
- dislocation head is out of the socket
Risk factors: Breech position, fam history, delivery problems,
female sex, first born
At birth:
- rapid detection and treatment required
otherwise deformity, stiffness, dislocation,
osteoarthritis, and higher need of surgery
preferably first two weeks of life
Diagnosis: Barlow test + Ortolani’s test
Treatment: braces (95% resolves)
the later diagnosed, the worse the prognosis
If diagnosed later: surgery
Complications of surgery: avascular necrosis, residual
anteversion of the femur, infection, further episodes of
dislocation.
Perthes Disease (Legg-calve-Perthes’ disease)
= idiopathic osteonecrosis of the proximal femoral epiphysis
affects patient between 3-10 y/o, male : female = 4:1, 10-20% = bilateral
Risks: hypothyroidism, skeletal dysplasia’s, social deprivation, malnutrition
Signs: limp, hip/knee pain
Treatment:
- if mild: avoid high-impact activity
- surgical re-alignment of the proximal femur and occasionally an acetabular procedure
Checklist week 33, Lifestyle
At the end of this week, the students will:
Know about determinants of healthy behaviour in children and behaviour that poses health risks
Personal: biological and psychological (attitude towards healthy behaviour, personal norm, perception)
Environmental: social influences, culture, SES…
Know about the model of determinants of
healthy behaviour (the Health Field Model)
Lalonde:
Know about terminology and definitions
regarding prevention
Primary prevention: prevent new cases, so take
away the causes.
Secondary prevention: detect as early as possible
Tertiary prevention: prevent consequences after diagnoses
≡> By means of Health Protection, Health Promotion and Disease Prevention (=combi of other 2)
Know about a systematic approach to prevention
Systemic approach to implement primary prevention:
1) Analysis + 2) development + 3) evaluation Of preventive measurement implementation
Know about the municipal policy cycle
Municipality health policy development cycle:
1) broad consultation (physical/social environment
2) prioritize
3) develop a coherent public health programme
4) implement
5) evaluate
Know examples of health promotion methods
Health protection: banning smoking from public places, place high taxes on alcohol and cigarettes,
clean H2O, environmental factors!
Health promotion: education to change behaviour: sex education, smoking campaigns, hygiene.
Know about tailoring information about healthy behaviour to individual parental health skills
It is important not to smoke around children and not during the pregnancy. Inform about the risks.
Know about Lifestyle Medicine
Lifestyle management is very important in preventive medicine. If the lifestyle is changed, a lot of diseases can be
prevented. A good example is coronary heart disease.
Know examples of dilemmas in primary prevention
,Compulsion or pressure? How far can you go with demanding things or not permitting things
Freedom of choice and informed choice patients can decide treatment, but they can be informed
by doctors, how much should doctors interfere?
Also: 40% of doctors think that if people are not willing to change their lifestyle, that they (as doctors) should be able
to refuse to give those patients treatment.
Know about environmental analysis focussing on the physical environment in which children grow up
Most easy i.c.o. identical twins who grow up in a different environment.
Know about “Bias and confounding”
Bias:
- selection bias: the participating group doesn’t reflect the population
maybe midwives only select uncomplicated pregnancies or only motivated pregnant women respond to
the study
- attrition bias: if people move, or drop out of the study, than other results
- Bergson’s bias: where is the study taken, in hospital (more complicated pregnancies) or outpatient
clinic (uncomplicated pregnancies)?
Hawthorne effect: i.e.: mothers try to smoke less because they are in the study
Confounders: associated with exposure and outcome. if smoking mothers have smaller babies, maybe this is due to
other causes than the smoking: alcohol, low socioeconomic status……
if confounder is equal in both situations, you know the effect was not due to this confounder
Know about “Validity, reliability and generalizability”
Generalizability: is the epidemiology applicable to my patient? Is the study internally/content wise
valid and if the patient is kind op the same as the study participants.
Know about “Interaction, standardization and stratification”
Interaction: Maybe there is a factor that also contributes, that is only associated with the outcome
Stratification: stratified analysis is used to see if there are confounding or interacting factors contribute: 2 groups are
compared.
- confounders only have an effect when differently present in groups
, Know about “Linear regression” and “Logistic regression”
G2020 2.2, Theme 9, week 34 (“Undersized child”)
Students know
Pediatric hip conditions: hipdysplasia (DDH),
Perthes Disease, epifysiolysis, transient synovitis
Hip dysplasia (DDH, developmental dysplasia hip)
Femoral head has abnormal relationship to the acetabulum
(=hip bone socket)
- dysplasia form of socket is abnormal, oft too steep in
acetabulum
- subluxation head is more out of the socket
- dislocation head is out of the socket
Risk factors: Breech position, fam history, delivery problems,
female sex, first born
At birth:
- rapid detection and treatment required
otherwise deformity, stiffness, dislocation,
osteoarthritis, and higher need of surgery
preferably first two weeks of life
Diagnosis: Barlow test + Ortolani’s test
Treatment: braces (95% resolves)
the later diagnosed, the worse the prognosis
If diagnosed later: surgery
Complications of surgery: avascular necrosis, residual
anteversion of the femur, infection, further episodes of
dislocation.
Perthes Disease (Legg-calve-Perthes’ disease)
= idiopathic osteonecrosis of the proximal femoral epiphysis
affects patient between 3-10 y/o, male : female = 4:1, 10-20% = bilateral
Risks: hypothyroidism, skeletal dysplasia’s, social deprivation, malnutrition
Signs: limp, hip/knee pain
Treatment:
- if mild: avoid high-impact activity
- surgical re-alignment of the proximal femur and occasionally an acetabular procedure
