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Health after work

Health after work . Dr M Feldman Petersfield Screening. Who am I ?. Senior partner general practice Trainer in general practice Petersfield Screening Occupational health. Life and Death. Genetics. Infection. Decline and death NOW. Trauma. IDEAL. Cancer. Autoimmune. Endocrine.

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Health after work

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  1. Health after work Dr M Feldman Petersfield Screening

  2. Who am I ? • Senior partner general practice • Trainer in general practice • Petersfield Screening • Occupational health

  3. Life and Death Genetics Infection Decline and death NOW Trauma IDEAL Cancer Autoimmune Endocrine Vascular Drugs

  4. Henri Frederic Amiel • To know how to grow old is the masterwork of wisdom, and one of the most difficult chapters in the great art of living • Journal 21Sept 1874

  5. What is Health? • A healthy person is one who has been inadequately investigated

  6. What is Health? • WHO definition a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity

  7. The Four Cornerstones • Psychological • Social • Spiritual • Physical

  8. Psychological Health • Mood and Mind • Use it or lose it • Studies show that active minds less likely to have dementia – Bridge helps the brain. • High IQ protects against Alzheimer's • What you think is what you feel • Value of positive thinking

  9. Stress • Negative aspects of too much or too little pressure

  10. Pressure or stress

  11. Pressure or stress two types of people

  12. Different Perspectives of stress Stimulus based • Noxious environment - heat, cold, lack of sleep • Social ridicule / failure / bad relationships

  13. Different Perspectives of stress Response based General adaptation syndrome • 1}Alarm reaction - defence mobilisation - lowering of resistance • 2}Stage of resistance - coping mechanisms resistance restored • 3}Stage of exhaustion - Adaptation declines

  14. Different Perspectives of stress Interactional models. • Outcome dependent on interaction between person and environment • Cooper - Stress due to misfit between perceived demand and perceived abilities • Cox - Stressor - perception of stress -> appraisal of ability to cope -> stress reaction

  15. Stress and careers • Early career - understanding the system, establish oneself - REALITY SHOCK • Mid career - reflecting on achievements, achieving a balance, ‘locked in’ - THE MID-LIFE CRISIS • Late career - reduced capability, anticipating the future - END GAMES

  16. Effects of Stress in retirement • Self Definition from role • Lack of ‘Power’ • Depression • Beravement • Status • Money • Social contacts

  17. Effects of Stress in retirement Short Term • Fight or flight Long Term • Physical - Many different body systems affected • Social - Work and home - Stress Spiral • Psyche - Anxiety / Depression

  18. Cardiovascular Gastrointestinal Respiratory Skin Reproductive Neurological Immune Long Term Physical

  19. Long Term Psychological • Addiction • Insomnia • Depression / anxiety

  20. Social • Marital Problems • Relationship Problems • Stress Spirals

  21. Social Health • Everard 1999 • Activities which help to connect socially more benefit than isolated hobbies to ‘pass the time’ • Enhanced well being • Improved mental and physical health • Keeping busy is not the key • Do the things you enjoy – in company!!

  22. Social Health • Study at Centre for aged Mass • Extreme elderly who were socially engaged • More likely to survive for 2 years irrespective of other illnesses.

  23. Spiritual Health • No values conflict • Behaving as you believe is right • Values conflict  stress • Belonging • Faith

  24. Physical Health

  25. Best Chiltern 78.4 East Dorset 77.9 Ryedale 77.9 Wokingham 77.8 Fareham 77.6 South Norfolk 77.6 South Oxford 77.5 Worst Glasgow 68.4 Inverclyde 69.2 W Dunbarton 69.1 Manchester 70.1 Eilean Siar 70.9 Merthyr Tydfil 71.1 Liverpool 71.2 Life Expectancy UK Men

  26. UK Heart attacks 234 Stroke 124 Cancer lung 46 Pneumonia 34 Chronic Bronc 28 Cancer colon 25 Cancer stom 21 Abroad 87 71 --- 95 46 --- --- Deaths per 100,000 UK and Developing countries

  27. UK RTA 19 Suicide 17 Diabetes 15 Diarrhoea -- Perinatal -- TB -- Measles -- Malaria -- Abroad 19 --- --- 71 57 47 26 21 Deaths per 100,000 UK and Developing countries

  28. Leading causes death UK • Circulatory disease • IHD • CVA • Cancer • Colon / Stomach • Lung • Breast • Prostate

  29. Causes of Disease • Circulatory • Family History • Hypertension • High Cholesterol • Diabetes • Smoking

  30. Hypertension • Incidence about 25% • Predisposes to • Stroke • Heart attack • Heart failure

  31. Hypertension • Management • Weight Loss • Low salt diet • Exercise

  32. Hypertension • Reduce alcohol if excessive • Medication – if >=160, and/or>=100 or 30% risk of heart attack at 10 yrs • Diurectics • B Blockers • Calcium antagonist • ACE / Angiotensin II inhibitors

  33. Raised Cholesterol • May be hereditary • Related to Genes / Weight / Diet • Predisposes to • Heart disease • Strokes • Furring up of arteries

  34. Raised Cholesterol • Average British Cholesterol = 6.2 mM/L • Desirable Cholesterol = < 5.2 mM/L • Good and bad types • Good should be > 0.9 HDL • Bad should be < 3 LDL • Ratio of total to good should be less than 4

  35. Diabetes Mellitus • Insulin dependent • In young people • Presents with • Thirst • Weight Loss • Tiredness • Relatively rare about 2-3 per 1000 people

  36. Diabetes Mellitus • Non insulin dependant diabetes • Familial • Related to weight • Incidence 2% of total population 10% over 70 yrs • Reduces life expectancy by 10 years

  37. Diabetes Mellitus • Affects • Increase heart attacks • Increase strokes • Kidney damage • Eye damage • Nerve damage – neuropathy • Numbness, weakness, impotence • Blood vessels damage • Poor peripheral circulation – intermittent claudication and gangrene

  38. Diabetes Mellitus • Treatment • Weight loss • Low fat diet • Oral medication • Insulin

  39. Osteoarthritis • Disease of articular cartilage • Possible link to heart disease OA hands • Wear and tear disease • Some inflammation also • May be hereditary • Hands affected ends of fingers • Mainly weight bearing joints • Spine • Hip • Knees • Ankles

  40. Osteoarthritis • Prevent by • Avoiding excessive weight • Not overstraining joints • Symptoms • Pain • Reduced movement

  41. Osteoarthritis

  42. Osteoporosis • low bone mass – Bones thin and spongy • 1/3 of all women>60 • 1/12 of all men > 60 Serious as fracture neck of femur common terminal event cf in elderly women 24% of women die in the year following a hip fracture

  43. Osteoporosis • Osteoporosis – spongy bones • Can effect – back, hip and wrist • Back • Wedging is seen

  44. Osteoporosis

  45. Osteoporosis • Osteoporosis symptoms • Height loss • Protruding abdomen • Dowagers hump • Reduced Lung capacity • Oesophageal reflux

  46. Osteoporosis • Causes • Premature menopause • Alcohol • Steroids – ( prednisolone > 7.5 mg per day) • Thin – BMI < 19 • Family history • Low calcium intake • Smoking

  47. Osteoporosis • Diagnosis • Dual energy X-ray absorptiometry – DEXA • Gold standard • Ultrasound – also tests structure • T score - = SD compared with young adult • Z score - = SD compared with age matched control • -2.5 SD= osteoporosis

  48. Osteoporosis Prevention • Exercise in youth – builds bone mass • Calcium Supplements – if :- • Deficient in diet • On steroids • Postmenopausal > 5 yrs and thin • Vitamin D – Aids calcium absorption assimilation • 800iu per day – or from fish oil/milk/egg etc • HRT

  49. Osteoporosis Treatment • Calcium – Vitamin D – ok • HRT – stops the rot • Biphosphonates – a cure

  50. HRT • Recently linked to increase of • PE x2.17 • DVT x2.07 • MI x1.29 • Cancer Breast x1.26 • But reduces • Hip fracture • Cancer Bowel • XS deaths about 1:500

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