Define postnatal depression. Describe and explain its causes, the symptoms, the impact on the infant and how it can be treated. How do these make postnatal depression a public health issue and what can be done about it?
Postnatal depression is depression which occurs in parents up to one year after having a child. There are both biological and psychosocial causes of postnatal depression and interactions occur between these. Biological causes of postnatal depression include having a genetic risk, previous family history and having suffered depression before childbirth. There has also been a strong link to hormonal changes which may affect some women more than others, leading to depression. There are also strong psychosocial causes of postnatal depression. The most strongly linked of these is a lack of support for the new mother, leaving her feeling isolated and alone. There is also the problem of society's views of mental health, with it often being stigmatized and mothers are told they are unfit parents or are harming their child. This then leads to further feelings of isolation. The symptoms of postnatal depression are wide, but can only be described as depression if they last for more than 2 weeks. The symptoms include low mood, difficulty sleeping, loss of appetite, disinterest in previously enjoyable activities and difficulty in bonding with the baby. As well as affecting the parents, postnatal depression also has an impact on the infant. This is often seen in bonding and attachment; interactions between parent and baby are less positive and there are fewer facial expressions. A lack of attachment between infants and parents has been shown to have future problems, such as anxiety and behavioral issues. Infants with depressed parents also do not sleep as well as other babies, show poorer feeding behaviors and have more minor health problems. Many treatments are available for postnatal depression. Doctors will initially suggest 'self-help' which involves parents opening up to their partners and other family members and friends to gain the support they need to overcome the depression. If this does not work, psychological treatment may be provided, such as cognitive behavioral therapy. Antidepressants can also be prescribed if needed but these come with side effects, stigma and issues for breastfeeding. These impacts on the parent and child and how common the issue is indicates that this is a serious public health issue which may not be given enough time and attention to tackle. Postnatal depression can have severe, long term health affects for parents and children which can be reduced or prevented with the correct support and treatment. Unfortunately, many parents do not seek this help due to the stigma of postnatal depression and the fears of being labelled a bad parent. To help reduce levels of postnatal depression, this stigma must be eliminated to allow practitioners to provide support for parents.
Name and explain in detail the two types of thrombosis, including the key differences between both, how they are caused and how they can be treated.
The two forms of thrombosis are arterial thrombosis and venous thrombosis. Arterial thrombosis is caused by inappropriate platelet activation in the blood which leads to a clot obstructing blood flow. This is the key difference between arterial and venous thrombosis as venous thrombosis is caused by inappropriate coagulation of the blood. Arterial thrombosis is most often caused by atheroschlerosis of the arteries. This is when lipids are deposited within the artery wall which grow in size until they eventually block the artery. As well as blocking the arteries themselves, atheroschlerotic lesions also damage the artery wall which triggers activation of platelets, leading to arterial thrombosis. Most commonly affected are the coronary arteries, causing a myocardial infarction, or the carotid arteries, causing an ischaemic stroke. Both myocardial infarction and ischaemic stroke can be treated with thrombolytic therapy and anti-platelet therapy. There are also possible surgical treatments. Myocardial infarction's can be surgically treated with PCTA which is a process which uses a small balloon to widen the blocked artery and CABG which is used to bypass the blocked vessel. Venous thrombosis is caused by inappropriate coagulation of platelets which leads to clots forming in the legs, called deep vein thrombosis. This is caused by Virchaw's triad of hyperstasis, hypercoagulation and vessel wall injury. These three factors together create a high risk of deep vein thrombosis. This clot which forms in the leg can then dislodge and travel to the lungs, causing a pulmonary embolism which is extremely dangerous. This higher risk of deep vein thrombosis can be caused by genetic factors, often due to inheriting a deficiency in coagulation inhibitors, or can be environmental, such as age or malignant cancer. Anticoagulants are used to treat venous thrombosis to prevent clots becoming bigger and also helps to stop them dislodging. The most common anticoagulant is heparin which stops the clot getting bigger immediately. Warfarin can then be prescribed which stops further clots from forming.
Describe and explain how a single, healthy human cell becomes cancerous.
There are 4 stages which allow a healthy cell to transform into a cancer cell. The first two stages are combined into a process named carcinogenesis. The first stage of carcinogenesis is called initiation. During initiation, the previously healthy cell is subject to genetic mutations which affect the genes controlling its growth and proliferation. This allows the cell to divide without any controls. These mutations can be caused by a variety of factors. For example, they can be inherited, such as those seen in some breast cancers, or they can be due to environmental factors, such as radiation. After initiation, the second stage of carcinogenesis occurs. This stage is called promotion and involves the cell continuing to divide due to the mutations to its growth control genes. The third stage of transformation into a cancerous cell is called progression. This involves the cell developing different phenotypes during the continual division, caused by further mutations. This then creates a polyclonal tumour containing cells which are different to each other but which originated from one cell. The final stage is metastasis. This is when cells from the polyclonal tumour are able to enter the blood stream and invade distant tissues. These cells then form tumours in these distance sites. This is when a patient is described as having cancer.