PUBLIC HEALTH Flashcards
What did The Black Report show?
Confirmed social class health inequalities in overall mortality and that health inequalities were widening
What were the recommendations from The Black Report?
Material - environmental causes
Artefact - product of how inequality is measured
Cultural/Behavioural - poor people to unhealthy things, own responsibility
Selection - ill sink in society
What did the Acheson Report (1988) show?
Mortality decreased but health inequalities remained and sometimes widened
What did the Acheson Report recommend?
Evaluate all policies like to affect health inequalities
give high priority to health of families with children
Reduce income inequalities and improve living conditions I poor households
How can doctors close the gap in health inequalities?
- Changing perspectives
- Changing systems
- Changing education
Why is women life expectancy longer than mens?
80% environmental - men take more risks, have more dangerous jobs and are less likely to visit the doctor
20% biological - oestrogen protects against CHD
Describe the association between social class and lie expectancy
The higher the socio-economic classification the higher the life expectancy at birth
Describe the association between social class and smoking
A greater percentage of people who smoke are in the lower socio-economic classes
Describe the association between mortality and unemployment
Mortality is greater in the unemployed
Define patient compliance
The extent to which the patient’s behaviour coincides with medical or health advice
Give 3 disadvantages of patient compliance
- It is passive, the patient MUST follow the doctor’s orders
- It is professionally focused and assumes the doctor knows best
- It ignores problems patients have in managing their health
Define patient adherence
The extent to which he pateint’s action match agreed recommendations - it is more patient centred
What is the difference between patient compliance and adherence?
Patient adherence is more patient centred, it empowers patients and considers them as equals in care. Patient compliance is often viewed as uncaring, condescending and passive
What are the key principles of adherence?
- Improve communication
- Increase patient involvement
- Understand the patient’s perspective
- Provide and discuss information
- Assess adherence
- Review medicines
Describe the necessity-concerns framework
Looks at what influences adherence
Adherence increases when necessity beliefs are high and concerns are low
Give 2 factors that patient centres care encourages
- Focus on the patient as a whole person - holistic
2. Shared control of the consultation, decisions are made by the patient and doctor together
What is concordance?
Expectation that patients will take part in treatment decisions and have a say in the consultation - negotiation between equals
Give 5 barriers to concordance
- The patient may not want to engage in discussions with their doctor
- It may lead to worry
- Patients may just want the doctor to tell them what to do
- Time, resources and organisational constraints
- Challenging, patient choice may differ significantly from medical advice
Give 4 advantages of doctor-patient communication
- Better health outcomes
- Higher compliance to therapeutic regimens
- Higher patient and clinician satisfaction
- Decrease in malpractice risk
What are the 5 main duties of a doctor?
- Work in partnership with patients, treat as individuals and respect their dignity
- Work with colleagues in a way that best serve patients’ interests
- Protect and promote health
- Recognise and work within the limits of your competence
- Provide a good standard of care
What is the difference between infection and colonisation?
Infection results in harm to the individual whereas there is no harm in colonisation
What did the Health Act 2006 state?
Infection control is every health care workers responsibility
What are the principles of Infection Prevention and Control?
- Identification of risks
- Routes and modes of transmission
- Virulence of organisms - ease of spread likelihood of causing infections and consequences
- Remediable factors
How can the environment be changed to prevent transmission of infection?
- Design - hospital beds further apart
- Ensuring a clean environment
- Infectious individuals can be isolated
What can staff do to prevent the transmission of infection?
- Barrier precautions - gloves and aprons
- Isolation
- Good hand hygiene
What can norovirus cause?
Gastroenteritis
Diarrhoea and Vomiting
Why does norovirus have a high attack rate amongst close contacts?
Low infecting dose
Uncontaminated D+V
Will norovirus be killed by alcohol hand gel?
NO - resistant to conventional cleaning, only killed by soap and water
What are endogenous infections?
Infection of a patient by their own flora
How can endogenous infections be prevented?
- Good nutrition and hydration
- Antisepsis/skin prep
- Control underlying disease
- Remove lines and catheters as soon as clinically possible
- Reduce antibiotic pressure as much as clinically possible
What are the UNAIDS goals to be achieved by 2020
90/90/90
90% of people living with HIV are diagnosed
90% diagnosed are on ART (antiretroviral therapy)
90% viral suppression for those on ART
Name 3 HIV transmission routes
- Blood
- Sexual
- Vertical (mother to baby)
Give 6 ways in which HIV can be prevented
- Circumcision- Reduces HIV penetration due to keratinization of remaining foreskin
- Post exposure prophylaxis
- Pre-exposure prophylaxis
- STI control
- HAART
- Early diagnosis
- Behavioural - Sex education
- Condom use
- Needle exchange
Name the 5 most risk groups of individuals to HIV
Men who have sex with men Heterosexual women Injecting drug users Commercial Sex Workers Heterosexual men
Name the 3 stages to the HIV epidemic
- Nascent - prevalence <5%
- Concentrated - prevalence >5% in one or more subpopulation
- Generalised - >5% everywhere, not just confined to subpopulations
Name the 3 main ways of mitigating the impact of HIV
- Behavioural change - education
- Knowing your status
- Specific interventions
Name 4 problems with the delivery of antiretroviral to those in developed countries
- Awareness
- Clinical services are understaffed
- Cost
- Procurement/delivery
- Adherence
Name 3 goals of HIV testing services
- Provide high quality service for identifying HIV
- Link individuals to HIV - treatment, care and support
- Prevent transmission
What can diabetes result in?
Blindness
Renal failure
Amputation
Name 6 risk factors of Type 2 Diabetes
- Sedentary job, lack of exercise
- Obesity
- Family history
- History of gestational diabetes
- Hypertension
- Impaired glucose tolerance or impaired fasting glucose
What is the 4 step process to intervention of Diabetes
Step 0 = identifying those at risk Step 1 (primary) = Preventing diabetes Step 2 (secondary) = Diagnosing diabetes earlier Step 3 (tertiary) = Management of Diabetes
What is an obesogenic environment?
An environment that encourages people to eat unhealthily and not do enough exercise
Give 3 physical characteristics of an obesogenic environment
- TV remote controls
- Car culture
- Lifts
Give an economic characteristic of an obesogenic environment
Expensive fruit and vegetables
Cheap unhealthy food
Give a socio-cultural characteristic of an obesogenic environment
Family eating patterns
Give 3 mechanisms that lead to people being unable to lose weight
- Physical: more weight = more difficult to exercise
- Psychological: low self esteem = comfort eating
- Socioeconomic: reduced opportunities and employment
What is the primary prevention for Diabetes?
Focus on communities most at risk - increase exercise, improve diet, weight loss
Healthier you: The NHS Diabetes Prevention Programme
What is the secondary prevention for Diabetes?
Raise awareness of DM and symptoms in the community and within health care professionals
Use records to identify those at risk
Screening
Preventing Pre-daibetes –> Diabetes
What is the tertiary prevention for Diabetes?
Self-monitoring Diet Exercise Education Peer support Drugs
Define overweight/obese
Abnormal or excessive fat accumulation that presents a risk to health
How is BMI worked out?
Weight (kg)/height2 (m)
Where are higher levels of obesity seen?
In areas of greater deprivation
What can poor nutrition in children cause?
- Emotional and behavioural impacts - stigma, bullying, self-esteem
- Educational impacts
- Physical health impacts
Describe the association between obesity and shift work
Obesity is more prevalent in people who do shift work
Sleeping out of phase affects the metabolic circadian rhythm
Give 5 potential consequences of obesity in adults
- Less likely to be employed
- Discrimination and stigma
- Risk of hospitalisation
- Reduced life expectancy
- Depression and psychiatric problems
Describe individual level interventions for managing obesity
- Behaviour change: stimulus control, goal setting, slow rate of eating, relapse prevention, social support, hypnotherapy
- Community based programmes can provide on going advice and support
Describe wider level interventions for managing obesity
- Food supply: reduce energy dense ingredients and improve access to healthy foods
- Media campaigns e.g. change4life, 5-a-day
- Environment: improve cycle lanes etc
- Sugar tax and subsidise healthy eating
- Restrict the sale of certain foods and drinks in schools
What can doctor’s do to help manage obesity?
- Educate patients - make every contact count
- Signpost to weight management programmes
- Prescribe exercise
- Refer for surgery
Give 5 indications for the surgical treatment of obesity
- BMI > 40
- BMI > 35 and co-morbid
- Minimum 5 year’s obesity
- Failure of conservative treatment
- No alcoholism or psychiatric illness
- > 18 y/o
Give an example of a restrictive surgical treatment for obesity
Gastric banding
Give an example of a malabsorptive surgical treatment for obesity
Jejuno-ileal bypass
Give the 4 tiers to the obesity care pathway
Tier 1 = universal prevention
Tier 2 = Lifestyle intervention
Tier 3 = Specialist services
Tier 4 = Surgery
What are the 4 principles of medical ethics?
- Autonomy - respect the patient’s choices
- Beneficence - do good
- Non-maleficence - do no harm
- Justice
What is deontology?
duty to follow natural laws and rights;
rightness or wrongness from the character of the act itself
rather than the outcomes, features of the act themselves
determine worthiness
What are the challenges of deontology?
- Consequences aren’t taken into account
2. Duties can conflict
What are virtue ethics?
Focus on character of the person acting
Combines reason and emotion
An act is only virtuous if the person has the right mind set
Virtues are acquired
What are the 5 focal virtues?
- Discernment
- Conscientiousness
- Trustworthiness
- Integrity
- Compassion
Define discernment
The ability to judge well
Define conscientiousness
Being thorough, carful and vigilant
Define trustworthiness
The ability to be relied on and trusted
Define integrity
Being honest and having good moral principles
Define compassion
Showing concern for others
What are the challenges of virtue ethics?
- Culture specific and too broad for practical application
2. No clear guidance for moral dilemmas
What are utilitarian ethics (consequentialism)?
An act is evaluated solely in terms of its consequences
Maximise good, minimise harm
What are the challenges of utilitarian ethics (consequentialism)?
Treats minorities unfairly to promote the happiness of a majority
What tool can be used to assess type A behaviour?
Minnesota Multi-phasic Personality Index (MMPI)
Give 3 psychosocial factors that could increase someone’s risk of MI
- Depression/anxiety
- High demand and low control at work, working more than 11 hours a day
- Loneliness and social isolation
What can doctors do to help combat psychosocial factors that can increase the risk of patient mortality?
- Identify signs fo depression/anxiety
- Ask patients about their occupation
- Ask patients about their support networks
- Liaise with relevant services - social care, occupational health
Define clinical truth
Contextual, circumstantial and personal
Name the 5 ethics in practice
- Candour
- Consent
- Capacity
- Confidentiality
- Communication
Name 4 problems with teamwork
- Lack of teamwork
- Lack of leadership
- Lack of effort
- Lack of communication
- Lack of challenge
What are the 6 components of teamwork
- Communication/SBARR
- Leadership and followership
- Authority gradient
- Situational awareness
- Declaring emergency
- Training together
What is SBARR?
Used to facilitate communication Situation = what is the situation? Background = which is the clinical background Assessment = what is the problem? Request = what do I request to be done? Recommendation = what do I recommend?
How does someone go about challenging authority?
- Express concern
- Enquire or offer a solution
- Seek explanation
- Direct challenge
What is the populations attributed fraction?
The proportion of the incidence of a disease in the exposed and non-exposed population that is due to the exposure e
Exposure eliminated = disease incidence eliminated
Why has the CHD mortality declines in England and Wales?
Improvement of risk factors = reduction in smoking, population BP fall
Treatments = hypertension therapies, secondary prevention
Give the 2 explanations of why social inequalities occur
- Absolutist = it’s about poverty
2. Relativist = inequality in society, greater = bad
Define the number needed to treat
Measurement of the impact of a medicine or therapy by estimating the number of patients needed to treat over a given time period in order to have an impact on 1 person
1/ARR (absolute risk reduction)
Define substance use
Ingestion of a substance affecting the CNS which leads to behavioural and psychological changes
How do new psychoactive substances act?
Mimic the effects of other substances but less predictably
E.g. Synthetic cannabinoids, stimulant-type drugs
What is the prevention theory?
Prevent substance abuse by reducing risk factors and increasing protective factors throughout life
Give 4 risk factors for substance misuse
- Family history of substance misuse
- Family management problems e.g. poor parenting
- Family conflict e.g. domestic abuse
- Low academic attainment at school
- Availability of drugs in the community
- Peer pressure
- Experience of trauma e.g. abuse, loss, poor parenting
Give 3 ways to prevent substance misuse
- Good family attachment
- Academic achievement
- Opportunities to develop self confidence, self worth and resilience
Name the 2 categories of dependence
- Physical
2. Psychological
What is physical dependence?
Body adapts to presence of substance
Needs more and more for the same effect
What is the psychological dependence?
Feeling that life is impossible without the drug
Emotional effect = pain, fear, loneliness
Name the 3 diagnostic codes
0 = acute intoxication 1 = harmful use 2 = Dependence
What is the diagnostic code of acute intoxication mean?
Disturbances in level of consciousness, cognition, perception, affect to behaviour