Intro to Lifestyle Medicine Midterm 1

Six Pillars of Lifestyle Medicine

1) Abuse 2) Activity 3) Nutrition 4) Sleep 5) Social 6) Stress

Scientific Evidence Hierarchy

1) Systematic reviews and meta-analyses 2) RCT 3) Observational research 4) Animal and cell studies 5) Expert opinions and anecdotes

Cohort

A group of study subjects; a RCT has at least two cohorts, or groups of subjects getting the same intervention

In a 2014 article by Kivela et al The effects of health coaching on adult patients with chronic diseases, in Patient Education and Counseling, the authors: A) Performed a systematic review and concluded that health coaching did have a significant effect on management of chronic disease. B) Performed a randomized controlled trial and concluded that health coaching has a significant effect on management of chronic disease. in the United StatesPerformed a cross-sectional study and concluded that heart disease is the leading cause of mortality in the United States. C) Performed a cohort study and concluded that alcohol consumption is the leading cause of mortality in the United States

A) Performed a systematic review and concluded that health coaching did have a significant effect on management of chronic disease.

The more a drug is marketed to physicians, the more it is: A) Prescribed B) Overdosed C) Found D) Avoided

A) Prescribed

Non-profit organizations who provide objective reviews and evaluation of research, like the Cochrane Group, are useful because: A) They counteract the conflict of interest that exists when for-profit organizations conduct research on their own product. B) They preferentially publish the studies that show a benefit of helpful procedures and medications. C) They accept money from cutting edge pharmaceutical companies to get useful products to patients, faster. D) They employ a Board of Directors made up of CEO's of pharmaceutical companies.

A) They counteract the conflict of interest that exists when for-profit organizations conduct research on their own product.

In the article Hierarchies of evidence applied to lifestyle Medicine (HEALM), the authors: A) challenges with cost and adherence make it difficult to conduct long-term health behavior studies. B) argued that randomized controlled trials are well-suited to assessing long-term effects of lifestyle behaviors. C) performed a randomized controlled trials to determine if lifestyle medicine works. D) noted that blinding of the treatment group is easy when modifying health behaviors.

A) challenges with cost and adherence make it difficult to conduct long-term health behavior studies.

Clinical Trial Study

Any study where an intervention is being tested; a specific intervention is "tried" on a group of people

Cross-Sectional Study

Assesses the prevalence of an outcome in a broad population at one point in time Data is collected only once (survey)

In the Current Healthcare Model A) gets better patient outcomes with use of multiple medications. B) uses many doctors, each taking care of one small area of the patient's issues (subspecialists). C) encourages, supports and coaches the patient to make major behavior changes. C) money, time and resources are invested in preventing illness from ever happening.

B) uses many doctors, each taking care of one small area of the patient's issues (subspecialists).

In the article Compendium of Health and Wellness Coaching Literature the authors say that one reason for the previous lack of a comprehensive summary of the coaching literature stems from: A) Lack of previous studies that were published in English B) Too many articles have been published to perform a review C) Lack of agreement on the definition of health and wellness coaching D) No previous studies about health and wellness coaching have been published

C) Lack of agreement on the definition of health and wellness coaching

A plethora of technological advances have changed societal norms over the past century. Some of these advances and their effects include: A) Transportation advances (cars), have resulted in better health through more exercise and gym attendance. B) Online digital meetings are correlated with more oxytocin (the human-touch or "cuddle hormone") release than face-to-face meetings. C) Television sitting is correlated with weight gain and disease. D) The increase in computer-driven exercise machines is correlated with the national decrease in obesity.

C) Television sitting is correlated with weight gain and disease.

Wellness is... A) A person's risk of having heart disease or cancer. B) The use of current science to treat disease. C) The state of being in good health based on emotional, physical, mental, spiritual and social health. D) The use of supplements and high-intensity interval training.

C) The state of being in good health based on emotional, physical, mental, spiritual and social health

To determine what lifestyle factors might lead to high blood pressure, researchers recruited two groups of subjects, half with high blood pressure and half without. They asked each patient many questions about their past diet and exercise habits. This is a :

Case-controls study

Researchers observed a large group of subjects for many years, tracked how many of them died, and what they died of. Many of the subjects smoked. This showed that smoking caused a lot of deaths. This was a:

Cohort Study

Case-Control Study

Compares histories of a group of people with a condition to a group of people without

A random sample of medical students was given a single survey to determine how many hours of sleep they averaged at night. This is a:

Cross-sectional study

A snapshot of the American healthcare scene presents a mixed message. Some medical conditions have improved, while some have regressed. For example: A) Obesity has decreased since the year 2000 due to increased fitness centers. B) The number of people with diabetes is predicted to decrease by 2050 due to an increased number of sugar-free treats. C) Heart disease is no longer a problem in the US, due to technological advances. D) Many life-threatening infections are no longer deadly due to the invention of antibiotics.

D) Many life-threatening infections are no longer deadly due to the invention of antibiotics.

In a 2004 article by Mokdad et al, Actual Causes of Death in the United States, 2000, in the Journal of the American Medical Association, the authors: A) Performed a cohort study and concluded that alcohol consumption is the leading cause of mortality in the United States B) Performed a cross-sectional study and concluded that heart disease is the leading cause of mortality in the United States. C) Performed a randomized controlled trial and concluded that heart disease is the leading cause of mortality in the United States. D) Performed a review and meta-analysis and concluded that smoking remains the leading cause of mortality in the United States.

D) Performed a review and meta-analysis and concluded that smoking remains the leading cause of mortality in the United States.

Scientific studies and articles frequently report their findings of risk or benefit in percentages as "relative" effects rather than absolute. This can be a problem because: A) Readers cannot understand absolute effects. B) Presenting risks and benefits as "relative" is more accurate than presenting findings as "absolute". C) The findings only pertain to people the subjects are related to, or their "relatives." D) Presenting risks and benefits as relative can make effects seem bigger than they actually are.

D) Presenting risks and benefits as relative can make effects seem bigger than they actually are.

In the Lifestyle Medicine approach to health care: A) the responsibility for improvement is on the clinician. B) the provider treats individual risk factors with medications. C) the treatment is often short term. D) emphasis is on patient motivation and compliance. E) the patient is a passive recipient of care.

D) emphasis is on patient motivation and compliance.

Researchers gave daily fish oil tablets to school children for one year, to see if their academic performance would improve due to the fish oil. At the end of the year, many of the children who got fish oil did improve their academic performance on a test, but no other group was tested. This is an example of a scientific error called:

Failing to have a control group

Cohort Study

Follows a group of people to track risk factors and outcomes over time Exposed vs. Non-Exposed

A study showed that in premature infants with severe colon infections, giving probiotic tablets by mouth helped their colon heal and slowed diarrhea. A blogger is advertising his probiotics and using this study as a reference, claiming that the pills heal damaged colons in adults. This is an example of a common scientific error called:

Generalizing to a different population than was studied

Qualitative Studies

Helps us understand, for instance, what it is like for people to live with a certain disease. Unlike other kinds of research, qualitative research does not rely on numbers and data.

Blinding

Methods of preventing individuals, healthcare providers, and those assessing outcome in a study from knowing whether the participant is in the experimental or control group

A study finds a correlation between men in Greece who smoke and also consume a large number of olives daily, who later develop lung cancer. The media published a headline stating that "olives cause lung cancer." This is an example of of a scientific error called:

Mistaking correlation for causation

Tertiary Prevention

Patient has already suffered an event or already has received a diagnosis, and they are trying to prevent any consequences of the disease or even reverse it

Secondary Prevention

Patient has risk factors for a disease and wants to avoid receiving a diagnosis

Primary Prevention

Patient is healthy and wants to stay that way

In the 2009 article by Ford et al, Healthy Living is the Best Revenge, in the Archives of Internal Medicine, the authors: A) Performed a meta-analysis and concluded that adhering to healthy lifestyle factors can prevent chronic disease. B) Performed data analysis on participants in a multicenter prospective cohort study called EPIC and concluded that four lifestyle factors prevented disease. C) Performed a review and meta-analysis and concluded that adhering to healthy lifestyle factors can prevent chronic disease. D) Performed a randomized controlled trial and concluded that adhering to healthy lifestyle factors can prevent chronic disease.

Performed data analysis on participants in a multicenter prospective cohort study called EPIC and concluded that four lifestyle factors prevented disease.

Jan Smith is 28 years old. She has no known medical problems and takes no medications. She makes an appointment with you to talk about her health. Together you set goals to help her to remain healthy. This is:

Primary Prevention

Dr. Singh wanted to understand the problems that cancer survivors face. She administered a questionnaire and conducted interviews with 20 cancer survivors asking them to describe their problems. This is a:

Qualitative study

Randomized-Controlled Trial

Randomly selects a group of patients to receive a treatment and another to receive a placebo

In nutritional research, study subjects are often asked to complete a food questionnaire, describing what they ate over several days, weeks or years. This introduces a potential scientific error called:

Response bias with inaccurate self-reported data

Joe Walters is 52 years old. He is obese, smokes cigarettes, and has high blood pressure and high cholesterol. He makes an appointment with you to talk about his health. Together you set goals to help him reduce his risk factors for heart disease. This is:

Secondary Prevention

___ is responsible for 1 in 5 deaths in the United States.

Smoking

SMART

Specific, Measurable, Attainable, Realistic, Timely

Mildred Baker is 78 years old. She had a stroke last year, and has heart disease. She makes an appointment with you to talk about her health. Together you set goals to help her maximize her health and prevent further negative outcomes due to her conditions. This is:

Tertiary Prevention

Confounder

a known or unknown factor, that could explain an association between a study factor and an outcome

Observational Studies

cohort and case control

Bias

something that distorts the real effect in a study, so that researchers get the wrong answer

Systematic Review

summarize the results of all the studies on a medical treatment and assess the quality of the studies

Meta-Analysis

the results of all of the studies found and included in a systematic review can be summarized and expressed as an overall result