Public Health Flashcards
Why is type 2 diabetes a public health issue?
- it is preventable
- it is increasing in prevalence
- lack of effective global, national or local policy
- major inequalities in prevalence and outcomes
What does prevalence depend on?
- Primary prevention: incidence of condition
- Secondary prevention: % of incident cases
- Tertiary prevention: survival from diagnosis
What are the ways in which we can reduce the impact of type 2 diabetes?
- identify people at risk of diabetes
- prevent diabetes
- diagnose diabetes earlier
- effective management and supporting self-management
What are the requirements of effective interventions to prevent diabetes?
- Sustained increase in physical activity
- Sustained change in diet
- Sustained weight loss
What are the 3 approaches for diagnosing diabetes earlier?
- Raising awareness of diabetes and possible symptoms in the community
- Raising awareness of diabetes and possible symptoms in health professionals
- Using clinical records to identify those at risk and/or using blood tests to screen before symptoms develop
What are the current screening practices in place for T2DM?
- screen as part of CHD prevention health check (every 5yrs from 40-74yrs)
- screening at review of hypertension management
- other risk groups may be screened
What is the NICE guidance in terms of preventing progression of T2DM from pre-diabetes?
- Focus on risk assessment followed by blood tests (HbA1c;FBG)
- Focus on cost-effective weight loss, diet and physical activity interventions
What are the ways to support self-care for diabetes?
- Self-monitoring
- Diet - support for changing eating patterns
- Exercise - support for increasing physical activity
- Drugs - support for taking medication
- Education
- Peer-support
What are the guidelines for safe weekly alcohol intake?
14> units per week (men + women)
Spread drinking over 3≤ days
What are the factors considered in alcohol-associated harm?
Who is harmed: self vs other
How much does alcohol attribute: fully (alcohol-specific) vs partially (alcohol attributable)
When does the harm take place: immediately (acute) vs over prolonged exposure (chronic)
What domain is harmed: health vs social
When does drinking become excessive?
When it causes or elevates the risk for alcohol-related problems
When it complicates the management of other health problems
What are the acute effects of excessive alcohol consumption?
Accidents and injury
Coma and death from respiratory depression
Aspiration pneumonia
Oesophagitis/ gastritis
Mallory-Weiss syndrome (gastric tears)
Pancreatitis
Cardiac arrhythmias
Cerebrovascular accidents
Neurapraxia due to compression
Myopathy/rhabdomyolysis
Hypoglycaemia
What are some of the chronic effects of excessive alcohol consumption?
Pancreatitis
CNS toxicity (dementia, Wernicke-Korsakoff syndrome, cerebellar degeneration, central pontine myelinolysis)
Liver damage (fatty change, hepatitis, cirrhosis, hepatic carcinoma)
Cancers (breast, bowel, mouth, throat, liver)
Hypertension
Peripheral neuropathy
What is the most common cause of alcohol-specific death?
Alcoholic liver disease
What are the clinical alcohol withdrawal syndromes?
Tremulousness - “the shakes”
Activation syndrome - characterized by tremulousness, agitation, rapid heartbeat and high blood pressure
Seizures - acute grand mal seizures can occur in alcohol withdrawal in patients who have no history of seizure or any structural brain disease
Hallucinations - usually visual or tactile in alcohol dependence
Delirium tremens - can be severe/fatalTremors, agitation, confusion, disorientation, hallucinations, sensitivity to light and sound, and seizures [medical emergency]
What are the presentations of foetal alcohol spectrum disorder (FASD)?
Pre and post-natal growth retardation
CNS abnormalities including learning disabilities, irritability, incoordination, hyperactivity
Craniofacial abnormalities
Associated abnormalities including congenital defects of eyes, ears, mouth, cardiovascular system, genitourinary tract and skeleton, and an increase in the incidence of birthmarks and hernias
What are the psychological effects of excessive alcohol consumption?
interpersonal relationships (violence, rape, depression/anxiety)
problems at work
criminality
social disintegration (poverty)
driving incidents/offences
What are the methods of alcohol harm prevention in the UK?
restrict choice (minimum unit pricing, restriction of alcohol advertising)
enable choice (dry January)
provide information (alcohol labelling, drinking guidelines, media campaigns)
What is the definition of ‘At risk drinking’?
A pattern of drinking which brings about the risk of physical or psychological harm
Define ‘harmful drinking’ (alcohol abuse)
A pattern of drinking which is likely to cause physical or psychological harm
Define ‘alcohol dependence’
Substance dependence is defined as a set of behavioural, cognitive and physiological responses that can develop after repeated substance use
What are the screening tools used for alcohol?
Clinical interview - single question about heavy drinking days
FAST - Fast Alcohol screening test
AUDIT - Alcohol Use Disorders Identification Test
CAGE questions
What are the treatments for alcohol dependence?
Psychosocial:
Therapy (cognitive + behavioural)
Social support (one to one or group e.g. AA)
Medical/Pharmacological
Acamprosate calcium
Disulfiram
Nalmefene
Naltrexone
What are the policy recommendations for preventing alcohol-use disorders?
Price - make alcohol less affordable
Availability - licensing + import allowances
Marketing - limit exposure, esp. to children + young people
