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Summary theme 9

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Summary of 19 pages for the course Theme 9 at RuG (Checklist theme 9)

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  • 24. januar 2021
  • 19
  • 2020/2021
  • Zusammenfassung
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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

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