Public health Flashcards

Question

What is secondary prevention?

Answer 1

Aim – detect early disease in order to alter the course of the disease e.g. screening by mammography for breast cancer in order to treat it early

Answer 2

Aim - prevent a disease from occurring screening to identify people with risk factors and reduce risk factor levels

Answer 3

Reduce the risk of developing disease Provide treatment Provide information E.g. pre-natal screening for genetic disorders

Answer 4

Sensitivity – the proportion of people with the disease who are correctly identified by the screening test a / a+c

Answer 5

Specificity – the proportion of people without the disease who are correctly excluded by the screening test d / b+d

Answer 6

Positive predictive value – the proportion of people with a positive test result who actually have the disease a / a+b

Answer 7

Negative predictive value – the proportion of people with a negative test result who do not have the disease d / c+d

Answer 8

Predictive values are dependent on underlying prevalence (Sensitivity and specificity are not)

Answer 9

The condition The condition sought should be an important health problem The natural history of the condition should be well understood There should be a detectable early stage

Answer 10

There should be an accepted treatment for patients with recognized disease. Facilities for diagnosis and treatment should be available Adequate health service provision should be made for the extra clinical workload resulting from screening

Answer 11

A suitable test should be devised for the early stage The test should be acceptable Intervals for repeating the test should be determined (not a one off)

Answer 12

Risks and benefits There should be an agreed policy on whom to treat The costs should be balanced against the benefits Additionally The risks, both physical and psychological, should be less than the benefits

Answer 13

Ideally by RCT individual cluster Could use other methods but potential for bias Well recognised biases Selection bias Lead-time bias Length-time (or length) bias

Answer 14

People who choose to participate in screening programmes may be different from those who do not May be at higher risk e.g. women with family history of breast cancer more likely to attend May be at lower risk e.g. women in higher socioeconomic groups (lower risk of cervical cancer) more likely to attend

Answer 15

Population-based screening programmes (“mass” screening) -Thailand, national diabetes and hypertension screening Opportunistic screening -Prevention and control of substance abuse Screening for communicable diseases -Heaf test? Pre-employment and occupational medicals -Vision test for commercial drivers? Commercially provided screening -Screening is more than a test, it is a programme

Answer 16

It is the loss or limitation of opportunities to take part in society on an equal level with others due to social and environmental barriers. * A disabled person is a person with an impairment who experiences disability. * Disability is the result of negative interactions that take place between a person with an impairment and her or his social environment. * Impairment is thus part of a negative interaction, but it is not the cause of, nor does it justify, disability.

Answer 17

* negative cultural representations; * inflexible organisational policies, procedures and practices; * segregated social provision; * inaccessible information formats; * inaccessible built environment and product design.

Answer 18

Images and assumptions that medicalise, patronise, criminalize, and dehumanise people with impairments.

Answer 19

* Many deaf people or those with a hearing impairment were forced to make contact with their GP using a method that was not the best for them * 90% of GP surgeries in Wales did not offer suitable alternatives for making appointments.

Answer 20

* Significant impairment of general cognitive functioning acquired in childhood that is lifelong. * Leads to difficulty with everyday activities, e.g. household tasks, socialising or managing money. * People with a learning disability tend to take longer to learn and may need support to develop new skills, understand complicated information and interact with other people.

Answer 21

About 4% of population- in 2011 1.2 million ppl in the UK 2.5% of children Boys more likely than girls More common in poorer/ less educated households

Answer 22

-genetic factors – maternal use of alcohol, drugs and tobacco during pregnancy – complications during pregnancy – and environmental toxins, such as cadmium and lead

Answer 23

Higher prevalence of many disorders such as CHD, respiratory disease, visual impairment, msk impairments and constipation Lower prevalence of death from cancer

Answer 24

One of the commonest causes of LD * ~ 40,000 persons with DS in England and Wales (prevalence of ~6 per 10,000) * More than two thirds are adults. Average life expectancy for babies with DS born in 2011 was now 51 years (median of 58 years).

Answer 25

– dementia, – thyroid problems, – visual/hearing impairment – and other associated long term medical conditions.

Answer 26

* more likely to be economically disadvantaged – Less than 7% in some form of employment in 2010/11 * have communication, numeracy , literacy and memory difficulties * have personal health risks and behaviours; * experience deficiencies in access to and the quality of healthcare provision. * have increased risk associated with specific genetic and biological causes of learning disabilities

Answer 27

-Failure to provide adjustments -Discriminatory attitudes -Failure to provide accessible info -Diagnostic overshadowing -Can't make appointments alone -Problems with reading appt letters or info leaflets -Might not trust doctors bc of past trauma

Answer 28

* Low uptake of health promotion or screening activities among * Access to health promotion considerably poorer for people with more severe LD

Answer 29

Adults with LD should have annual health checks but the offer and uptake is poor. * Health checks are effective in identifying previously unrecognised health needs, including life threatening conditions * UK studies report that 88% of persons with LD had specific health needs identified through a health screening process. * Annual health checks in primary care for these adults may not alter overall emergency admissions, but may reduce preventable emergency admissions by ~18%

Answer 30

Premature mortality- due to a failure to diagnose and treat illnesses Inappropriate use of DNAR orders Poorer mental health- over prescription of antibiotics

Answer 31

– Registration with a GP is important in accessing screening programmes – Primary care mandated in GP contract to offer people with learning disabilities an annual holistic health check. – Easy read formats for patient information leaflets – Patient champions – Be aware and mindful of their needs!

Answer 32

Individual and population health influenced by Housing Sanitation Food safety Water quality Environment quality Often the poorest groups are most exposed and vulnerable to environmental hazards

Answer 33

Water, sanitation and drainage Garbage collection and waste disposal Housing structure e.. ventilation, infestations Air pollution Nutrition House sites hazards e.g. accidents, floods, illegal occupation Health services access

Answer 34

Breeding of vectors of disease e.g. Mosquitoes Transmit diseases such as malaria, dengue fever, Japanese Encephalitis B, yellow fever, Chikunguya Flies Transmit foodborne disease such as Typhoid fever, dysentery and cholera Rats

Answer 35

Move from traditional hazards to modern hazards

Answer 36

Related to poverty & insufficient development: - Lack of safe drinking water, Inadequate sanitation, Indoor air pollution, Inadequate waste disposal

Answer 37

Related to development that lacks health & environmental safeguards, & to unsustainable consumption of natural resources: - Environmental contamination Urban air pollution Climate change

Answer 38

Microbiologically contaminated drinking water can transmit diseases such as diarrhoea, cholera, dysentery, typhoid, hepatitis A, and polio Causes ~505,000 diarrhoeal deaths each year. Also risks from chemical pollutants in drinking water e.g. arsenic

Answer 39

Intracellular parasite Commonest non-viral cause of diarrhoea worldwide Prevalence ~ 1% - 4.5% of population in North America/Europe. (3% - 20% in developing countries) 80% of the population has had cryptosporidiosis. Peak age of incidence 1-5 years, marked reduction over 35 years.

Answer 40

Faeco-oral transmission Person-to-person spread Nurseries Food handlers Animal contact MSM

Answer 41

Occupational risk groups Vets Animal handlers Farm workers

Answer 42

Transmitted in surface run-off water contaminated by calf faeces. Incidence seasonal and related to rainfall. Manure fertilizers Waterborne Oocysts are resistant to standard chlorination or many disinfectants. Unboiled tap water Swimming pools

Answer 43

Self-limiting in most healthy individuals Low infectious dose Symptoms: watery diarrhoea lasting 2-4 days, abdominal cramps, fever, vomiting, anorexia. Likelihood of recurrence in cases (auto-infection). Can lead to malnutrition from malabsorption, gall bladder infection Can get chronic cryptosporidiosis in patients who are immunodeficient (e.g. AIDS) Difficult to treat.

Answer 44

In general, good hygiene & handwashing is essential, especially after handling animals. Avoid ingesting water if swimming in lakes, rivers or swimming pools. You should not swim in a swimming pool for 14 days after your symptoms have cleared. This is because cryptosporidium can still be present in your stools during this time. Food handlers should stay away from work until 48 hours after the last episode of diarrhoea or vomiting. Water companies routinely test for it Drink only treated water Immunocompromised persons should drink boiled water.

Answer 45

naturally present at high levels in the groundwater of a number of countries, e.g. Argentina, Bangladesh, Cambodia, Chile, China, India, Mexico, Pakistan, USA. industrial processes: e.g. as an alloying agent, processing of glass, pigments, textiles, paper, metal adhesives, wood preservatives, hide tanning, pesticides, and pharmaceuticals. tobacco

Answer 46

Long-term exposure to arsenic can cause Skin lesions Cancers of the bladder, lungs and skin, Arsenic-induced myocardial infarction Diabetes Adverse outcomes in pregnancy Also affects cognitive development

Answer 47

Exposure to lead can affect multiple body systems and is distributed to the brain, liver, kidney and bones. No level of exposure to lead that is known to be without harmful effects. Young children are very vulnerable and can suffer profound and permanent adverse health impacts, particularly on brain and central nervous system, and can lead to acute encephalopathy, coma, convulsions and even death. Causes long-term harm in adults, including increased risk of high blood pressure, cardiovascular problems and kidney damage. Exposure of pregnant women can cause miscarriage, stillbirth, premature birth and low birth weight.

Answer 48

People can become exposed to lead through occupational and environmental sources: inhaling lead particles generated by burning materials containing lead (e.g. during smelting, recycling, stripping leaded paint and plastic cables containing lead) and leaded fuel ingesting lead-contaminated dust, water (from leaded pipes) and food (from lead containers) and from hand-to-mouth behaviour (e.g. pica) due to lead paint.

Answer 49

Key management action is to removing the source of exposure! Some patients may require chelation therapy Prevention: phasing out of lead-containing fuel, lead in paint

Answer 50

Diseases like hypertension, diabetes, intentional and unintentional injuries, tuberculosis, rheumatic heart disease, leptospirosis and HIV infection exist in slums Late complications of these diseases seen Issues of poverty and disadvantage, that affect access to healthcare and good health Also limited access to key services e.g. clean water, sanitation etc…

Answer 51

Almost 1 in 10 people in the world fall ill after eating contaminated food and 420,000 die every year. Foodborne illnesses usually infectious or toxic in nature and caused by ingestion of food contaminated with bacteria, viruses, parasites or chemical substances. Food hygiene refers to the practices used to minimize the risks of foodborne illnesses caused by bacterial contamination. Involves proper food handling, transport, storage, processing/preparation of food

Answer 52

Emmanuel Kant’s Categorical Imperative, that you should treat others as ends in themselves and not merely as a means to an end. * Subsumes informed consent before treatment, confidentiality, honesty (lack of deceit) and good communication

Answer 53

Doing the right thing for patients * A Subset of respect for autonomy in many ways * Also incorporates empowerment; helping the patient to make appropriate decisions for themselves

Answer 54

Not doing the wrong thing to patients * Not harming patients intentionally or inadvertently where ever possible. * Means evidence based practice * And keeping up to date * Again, it is a subset of respect for autonomy

Answer 55

The moral obligation to act on the basis of fair adjudication between competing claims * Distributive justice - Fair distribution of scarce resources * Rights based justice - Respect for people's rights. * Legal Justice - Respect for the Law

Answer 56

Sleep Smoking Eating Exercise

Answer 57

Health damaging/impairing Health promoting

Answer 58

Smoking, alcohol and substance abuse, risky sexual behaviours, sun exposure, driving without a seatbelt

Answer 59

Exercise, healthy eating, attending health checks, medication compliance, vaccinations

Answer 60

(things we can potentially change) Diet/ Excessive weight, Smoking, Alcohol, Physical activity, Sleep, Stress

Answer 61

(things that we cannot change) Sex, Age, Genetics/ Family history

Answer 62

➢Important from both an individual and population perspective ➢ Overwhelming evidence that changing people’s health behaviour can have an impact on some of the largest causes of mortality and morbidity

Answer 63

➢Health promotion *The process of enabling people to exert control over the determinants of health, thereby improving health

Answer 64

➢Patient centred approach *Care responsive to individual needs

Answer 65

*Individual's behaviour (level of alcohol consumption, individual health outcomes, or incidence of domestic violence) *Local community (local alcohol sales, alcohol-related crime or accident and emergency [A&E] events) *Population level (for example, national alcohol sales and consumption, national statistics on alcohol-related crime and A&E events, or demographic patterns of liver cirrhosis)

Answer 66

Individuals continue to practice health damaging behaviour due to inaccurate perceptions of risk and susceptibility

Answer 67

1. Lack of personal experience with problem 2. Belief that preventable by personal action 3. Belief that if not happened by now, it's not likely to 4. Belief that problem infrequent

Answer 68

1. Health belief model (HBM) 2. Theory of Planned Behaviour 3. Stages of change (transtheoretical) model

Answer 69

Individuals will change if they: ➢ Believe they are susceptible to the condition in question (e.g. heart disease) ➢ Believe that it has serious consequences ➢ Believe that taking action reduces susceptibility ➢ Believe that the benefits of taking action outweigh the costs

Answer 70

The HBM predicts that an individual will attend the screening programme if: They perceive themselves at high risk or susceptible to breast cancer, that breast cancer is a serious threat to their health/ life, that the benefits of screening are high, and that the costs of such actions are low.

Answer 71

Proposes the best predictor of behaviour is ‘intention’ e.g. I intend to give up smoking Intention determined by: * A persons attitude to the behaviour * The perceived social pressure to undertake the behaviour, or subjective norm * A persons appraisal of their ability to perform the behaviour, or their perceived behavioural control

Answer 72

Someone's belief that they can change their behaviours

Answer 73

Attitude – I do not think smoking is a good thing Subjective Norm – most people who are important to me want me to give up smoking Perceived Behavioural Control – I believe I have the ability to give up smoking Behavioural Intention – I intend to give up smoking

Answer 74

Stage theories see individuals located at discrete ordered stages, rather than on a continuum Each stage denotes a greater inclination to change behaviour Transtheoretical model, or Stages of change model Proposes 5 stages of change: precontemplation, contemplation, preparation, action, maintenance

Answer 75

Precontemplation – no intention of giving up smoking Contemplation – beginning to consider giving up, probably at some illdefined time in the future Preparation – getting ready to quit in the near future Action – engaged in giving up smoking now Maintenance – steady non-smoker, i.e. state of change reached

Answer 76

Regularly collected Data to describe the population health status, health care and factors influencing it

Answer 77

- Monitor population health - Generate hypothesis of causes of ill health - Inform planning of services and policy - Evaluate and assess performance -Generate research statistics

Answer 78

- Mortality - diseases - Use and quality of health care - Health status/ quality of life - Individual lifestyle ( health relates behaviour) - Wider determinants ( socio-economic, cultural and environmental conditions) - Population (demographics)

Answer 79

1. Dr completes certificate of cause of death 2. Informant takes certificate to local registrar and registers death 3. Copy of reg sent to ONS when cause of death are coded 4. Causes of death are analysed

Answer 80

Disease of injury that initiated the train of events leading to the death The

Answer 81

1. mitigation of harm 2. restoration of depleted capacities 3. building new capacities 4. microbial diversity

Answer 82

* Reduce Air pollution * Noise reduction * Temperature regulation

Answer 83

* reduction of stress - Improved relaxation and restoration * increases in positive emotions * facilitation of recovery from attentional fatigue

Answer 84

* Community and Social cohesion * physical exercise

Answer 85

Health improvement Health services Health protection

Answer 86

Epidemiology The who, what, when and where of disease Statistics Making sense of big numbers Health economics Ethical rationing Costs vs benefits

Answer 87

Changing the status quo requires: Influence Leadership Relationships Authenticity Partnership working / collaboration Patient and public engagement

Answer 88

Intersectionality is a concept for understanding how aspects of a person's identities combine to create different and multiple discrimination and privilege.

Answer 89

Health inequalities are unfair and avoidable differences in health across the population, and between different groups within society. Health inequalities arise because of the conditions in which we are born, grow, live, work and age. These conditions influence our opportunities for good health, and how we think, feel and act, and this shapes our mental health, physical health and wellbeing.”

Answer 90

Socioeconomic factors- Education, employment, income, family and social support, community safety- 40% Physical environment- Housing, access to green spaces, air quality - 10% Lifestyle factors- Diet and physical activity, tobacco use, alcohol use- 30% Healthcare- Access to good quality health care services, experience of care and patient satisfaction- 20%

Answer 91

Male Family history Past medical history of CVD Hypertension Raised lipids Smoking

Answer 92

Smoking Obesity Sedentary lifestyle Physical inactivity Excess alcohol Stress Poor diet

Answer 93

Loneliness Unemployment Poor housing Fear of crime No access to green space Food poverty Pollution Social inequality

Answer 94

Non-clinical factors that impact physical and mental health

Answer 95

Poverty- can cause or be caused by mental health problems Childhood adversity- esp abuse and sexual abuse Social capital- how ppl can draw on their social networks and value ascribed to them Education- school a place for social support Healthy aging Inequalities- greater inequality is linked with higher mental health

Answer 96

Body mass index (BMI)– weight divided by the square of height (kg/m2) Overweight: BMI 25-30 Obese: BMI 30 or higher Morbid obesity: BMI over 40 Excess weight umbrella term for BMI over 25 BMI is not a perfect measure, not appropriate for all groups and other measures are used – waist circumference, waist-hip-ratio

Answer 97

Deprived areas have up to five times as many fast-food outlets – influences food choice (Brandkvist et al. 2019) Food restriction limiting availability: * Foods deserts – areas of poor access to healthy food options, poverty premium * Food swamps – areas of greater provisions of unhealthy, nutrient poor, caloricdense food and drinks Commercial determinants of health: negative impact of commercial activities * Increased exposure to advertisements (Ziaudden et al. 2018, Penney et al. 2018) * Promotions in supermarkets, portion sizes, front of pack labelling, SSB taxes People living in deprived areas more likely to experience food insecurity.

Answer 98

What is it? A major public health challenge How is food insecurity defined? Experiencing one or more of the following: 1. Having smaller meals than usual or skipping meals due to being unable to afford or get access to food. 2. Being hungry but not eating due to being unable to afford or get access to food. 3. Not eating for a whole day due to being unable to afford or get access to food

Answer 99

How diverse aspects of the host, agent and environment are implicated in multifactorial aetiology of disease Situates all behaviours in the social context Prevention is not just about public health interventions in the health care system but about the wider determinants of health that can only be changed through more widespread social action

Answer 100

Diarrhoeal disease Acute Respiratory Infections Malnutrition Vaccine Preventable Diseases e.g. Measles, pertussis, etc. Neonatal causes

Answer 101

Haemorrhage Obstructed labour Puerperal sepsis Eclampsia

Answer 102

Too young Too soon … after the last child Too late … to access healthcare Too many

Answer 103

1. CVR disorders 2. Cancer 3. Resp disorders 4. Nervous system disorders 5. Digestive disorders

Answer 104

1. Lower resp infections 2. HIV/AIDS 3. Diarrhoeal diseases 4. Stroke 5. Ischaemic heart disease 6. Malaria 7. Preterm birth complications 8. TB

Answer 105

- Close contact - Overcrowding - Smoking - Indoor air pollution - Delayed health seeking - No access to care

Answer 106

- Ease of access to care - Affordability of care - Reliability of care - Stigma/taboo - Lack awareness & understanding - Mental wellbeing - Gender - Socio-economic deprivation - Migrant status

Answer 107

“health problems, issues, and concerns that transcend national boundaries, may be influenced by circumstances or experiences in other countries, and are best addressed by cooperative actions and solutions."

Answer 108

Massive disease burden in the world‘s poorest nations poses a huge threat to global wealth and security. Millions around the world die of preventable and treatable infectious diseases because they lack access to basic medical care and sanitation. Potential to save millions of lives each year, but only if wealthy nations provide the poorer ones with the requisite services and support.

Answer 109

Previously, medical schools had little on global health in their curricula but that is changing Health is a growing global problem, with chronic diseases being the main killer worldwide By learning about global health, medical students will be better equipped to face future challenges

Answer 110

Previously, medical schools had little on global health in their curricula but that is changing Health is a growing global problem, with chronic diseases being the main killer worldwide By learning about global health, medical students will be better equipped to face future challenges

Answer 111

have a biscuit!

Answer 112

1.3 billion people live on less than $1 a day, more than half the world lives on less than $2 a day 20% of the world population have no access to modern health services. 6 billion people have no access to improved sanitation facilities in 2006 In low-income countries, 65% of the population face health risks because of inadequate sanitation Source: WHO World Health Statistics 2008

Answer 113

Sexual (& reproductive) health: * is about well-being, not merely the absence of disease. * involves respect, safety and freedom from discrimination and violence. * is relevant throughout the individual’s lifespan, not only to those in the reproductive years. * is expressed through diverse sexualities and forms of sexual expression. * is critically influenced by gender norms, roles, expectations and power dynamics

Answer 114

Sexual (& reproductive) health: * is about well-being, not merely the absence of disease. * involves respect, safety and freedom from discrimination and violence. * is relevant throughout the individual’s lifespan, not only to those in the reproductive years. * is expressed through diverse sexualities and forms of sexual expression. * is critically influenced by gender norms, roles, expectations and power dynamics

Answer 115

Estimated to account for 20% of global burden of ill-health among women and 14% among men Even more significant among the poor; some countries 5/10 leading causes of lost DALYs relate to SRH Determinants closely linked to socio-cultural, economic and political aspects of society. Increasingly portrayed as a human rights issue Social and economic impacts huge. Priority public health area in the UK and globally

Answer 116

High mortality developing subregion- 3 Low mortality developed subregions- 9

Answer 117

-Changing patterns of mortality and morbidity -Technological and medical advances -Wider socioeconomic and cultural changes in society -Shifting social norms, values and attitudes -Inter-play between these elements

Answer 118

Rising gap between sexual debut, cohabitation and childbearing Fall in teenage pregnancy rates Older age childbearing Change in significance of HIV/AIDS Reduction in prejudice based on sexual orientation Increasing expectations of sexual fulfilment at older ages Increased treatment for infertility ‘Normal birth’; choice Visibility of sexual violence and exploitation Diversifying population; growing inequalities and vulnerable groups

Answer 119

- Fall in unwanted pregnancies, esp. those resulting in terminations - More HIV testing in high-risk groups; reduced late stage diagnosis - Access to free condoms; knowledge to prevent STIs - Protecting children from sexual abuse and exploitation - Continue to eradicate prejudice based on sexual orientation - Build confidence and ability to say ‘no’ as well as ‘yes’ - Build knowledge and resilience in young people - Women-centred maternity services; social models of care; choice; continuity - Improve service access; tackle inequalities; vulnerable groups

Answer 120

STIs including HIV/AIDS Maternal mortality and morbidity Female genital mutilation

Answer 121

- Caused by more than 30 different bacteria, viruses and parasites - Spread predominantly by sexual contact, including vaginal, anal and oral sex >1 million people acquire STI every day - Majority are asymptomatic - Some STIs increase risk of HIV infection 3-4x - Consequences include infertility, mother-to-child transmission and chronic diseases - Nearly 1 million pregnant women infected with syphilis in 2016 resulting in >200,000 stillbirths and newborn deaths - Drug resistance, especially for gonorrhoea

Answer 122

Chlamydia Gonorrhoea Syphilis Trichomonas Vaginalis(TV) Chancroid Donovanosis Herpes Simplex Virus (HSV) - “Cold sore virus” Human Papilloma Virus (HPV) – “Wart virus” Hepatitis A, B & C Human Immunodeficiency Virus (HIV)

Answer 123

- Poverty/social deprivation - Migration - Rapid urbanisation - Economic & political instability / war - Absence of diagnostic and treatment services for STIs - Early sexual debut - Multiple partners - Absence of visible symptoms - Unprotected sex - Substance misuse - Lack of public awareness - Lack of training of health workers - Stigma - Sex tourism

Answer 124

More likely to have multiple sexual partners (sequential or concurrent) rather than long-term sexual relationships May have difficulty using barrier methods that would offer protection from STIs May be more likely to have higher-risk partners May have less access to STI care because of different factors: Lack of awareness Non disclosure of sexual activity Fear of being found out by parents/carers Restrictive policies of clinics Lack of money to pay for care – not an issue in the UK but relevant in other parts of the world where you pay for health care

Answer 125

- Up to 70% of women & 50% of men with Chlamydia have no symptoms - Helps drive the epidemic

Answer 126

Several partners Frequent partner change Unprotected sex

Answer 127

Serious implications for both individuals and society  poor reproductive and maternal health STIs are the main preventable cause of infertility especially in women. Post infection tubal damage responsible for 30-40% of female infertility 10-40% of untreated women with genital Chlamydia develop Pelvic Inflammatory Disease (PID) 40-50% of ectopic pregnancies can be attributed to previous PID

Answer 128

Could also lead to poor newborn health: Eye infections in the newborn Chlamydia, Gonorrhoea Could lead to blindness Congenital syphilis

Answer 129

Some strains of HPV can lead to cancer of the cervix, anus, vulva, penis

Answer 130

The presence of untreated STIs increases the risk of acquiring and transmitting HIV by up to 10 times

Answer 131

Diagnoses of STIs on the increase Highest among young people, some minority ethnic groups and men who have sex with men Recent rise also among those >45 yrs. Sexual ill health disproportionately affects vulnerable groups e.g. young people minority ethnic groups those affected by poverty and social exclusion

Answer 132

HIV continues to be a major global public health issue, having claimed 36.3 million lives so far. There is no cure for HIV infection. Increasing access to effective HIV prevention, diagnosis, treatment and care, including for opportunistic infections, has made HIV infection a manageable chronic health condition ~37.7 million people living with HIV at the end of 2020, over 2/3 of whom are in the WHO African Region. In 2020, 680,000 people died from HIV-related causes and 1.5 million people acquired HIV.

Answer 133

Individuals can reduce the risk of HIV infection by limiting exposure to risk factors. Key approaches for HIV prevention, which are often used in combination, include: male and female condom use testing and counselling for HIV and STIs testing and counselling for linkages to tuberculosis (TB) care voluntary medical male circumcision (VMMC) use of antiretroviral drugs (ARVs) for prevention harm reduction for people who inject and use drugs elimination of mother-to-child transmission (MTCT) of HIV treatment as prevention But only 73% of people living with HIV were receiving ART in 2021!

Answer 134

Most commonly diagnosed STI in the UK Prevalence of infection is highest in young sexually active women (15 to 24 year olds), and is approximately twice the prevalence in 16 to 44 year olds (3.1% compared to 1.5% in women) May have long-term implications including infertility. Of those women with untreated chlamydia 10 to 17% will develop PID. 35% of PID in women aged 16 to 24 attributable to chlamydia National chlamydia screening programme, targeting especially young women under 25 yrs

Answer 135

Goal is to inhibit the development of disease before it occurs - Counselling and behavioural interventions - Interventions targeted at key populations - Immunisation e.g. Hepatitis A & B, HPV

Answer 136

E.g., comprehensive sex education, safer sex/risk-reduction counselling, condom promotion - when used correctly & consistently, condoms are one of the most effective methods of protection against STIs Counselling can improve people’s ability to recognize symptoms of STIs and increase likelihood they will seek care or encourage a sexual partner to do so

Answer 137

In UK, initially only in girls aged 12-18. Now also in men who have sex with men

Answer 138

Goal is to identify and detect disease in its earliest stages, before noticeable STI screening HIV testing – e.g. universal testing at GU clinics, antenatal clinics, etc Especially useful for the diagnosis of asymptomatic infections Hinges heavily on accurate diagnostic tests which may not be readily available in resource poor settings Rapid/point of care tests very useful A good way of achieving this is by integrating STI services into existing health services e.g. reproductive health services

Answer 139

Involves actual treatment of the disease Prompt & effective treatment is given To cure the disease To prevent and limit complications/sequelae To prevent transmission Single dose regimens if possible to aid treatment compliance Prevent re-infection: abstinence till completion of treatment, identification and treatment of contacts

Answer 140

Surveillance is an integral part of any STI control program To obtain information on the burden of STIs in the population To determine the demographic and geographical distribution of STIs and trends

Answer 141

Confidentiality & non-judgemental attitude to encourage attendance Open access Accurate diagnosis & effective treatment (preferably on the day of presentation) Screen for concomitant infections – often asymptomatic Free treatment – single dose & oral preferred Contact tracing

Answer 142

Cervical cancer is the 4th most common cancer among women globally ~604 000 new cases and 342 000 deaths in 2020. ~90% of new cases and deaths worldwide in 2020 occurred in LMICs Two HPV types (16 & 18) responsible for nearly 50% of high grade cervical pre-cancers HPV mainly transmitted through sexual contact Most people are infected with HPV shortly after the onset of sexual activity. Women with HIV 6 times more likely to develop cervical cancer than women without HIV HPV vaccination and screening and treatment is cost-effective to prevent cervical cancer. Cervical cancer can be cured if diagnosed at an early stage and treated promptly. Comprehensive cervical cancer control includes primary prevention (vaccination against HPV), secondary prevention (screening and treatment of pre-cancerous lesions), tertiary prevention (diagnosis and treatment of invasive cervical cancer)

Answer 143

99% of all maternal deaths occur in developing countries Lifetime risk of dying as a result of pregnancy or childbirth 1 in 6 in the poorest parts of the world vs 1 in 30,000 in Northern Europe Common causes: Post-partum bleeding Unsafe abortion Pregnancy-induced hypertension Postpartum infection Obstructed labour Can lead to long-term morbidities and disabilities Significant inequalities in maternal mortality and morbidity in the UK

Answer 144

Confidential Enquiries into maternal deaths (CEMACH/CMACE) 5x higher risk of maternal death in Black African compared to White women Likelihood of severe maternal morbidity significantly associated with non-White ethnicity Black African and Black Caribbean highest risk (Linquist et al. 2013; Knight et al. 2008) Also, poorer birth outcomes (prematurity, low birth weight, infant mortality) and lower satisfaction among minority ethnic groups Sub-standard care contributes to these inequalities

Answer 145

Family planning allows people to have desired no. of children and to determine the spacing of their pregnancies. Prevention of unintended pregnancies lowers maternal ill health and pregnancy-related deaths. Health benefits of delaying pregnancies in young girls who are at increased risk of health problems from early childbearing, and among older women who also face increased risks. By reducing unintended pregnancies, also reduces need for unsafe abortion. Also benefits education, employment, etc In 2017, 214 million women of reproductive age in developing regions have an unmet need for contraception due to limited access to contraception limited choice of methods a fear or experience of side-effects cultural or religious opposition poor quality of available services gender-based barriers.

Answer 146

Sometimes referred to as female circumcision Procedures that intentionally alter or cause injury to the female genital organs for non-medical reasons Some communities believe it is a necessary custom to ensure that a girl is accepted within the community and eligible for marriage Perceived health benefits, preservation of the girl’s virginity, cleanliness, rite of passage, status in the community, protection of family honour, perceived religious justifications. It is illegal to perform or arrange for FGM to be carried out on a girl in the UK or to take a girl abroad (FGM Act 2003; Serious Crime Act 2015) Has a negative impact on a person’s dignity, physical, psychosocial and moral integrity and development, participation, health, education and economic and social status.

Answer 147

* Mother has undergone FGM * Mother has requested re-infibulation following childbirth * Has older sibling or cousin who has undergone FGM * Parents/elder relatives consider FGM integral to cultural/religious identity * Girl/family has limited level of integration within UK community * Girl withdrawn from PSHE/SRE * Girl makes references to FGM in conversation, or confides she is to have a “special procedure” or attend a special occasion to “become a woman” * Parents state the child will be taken out of country for a prolonged period and are evasive about why * Girl is to be taken out to a country with high prevalence of FGM (especially during the summer holidays which is known as the cutting season)

Answer 148

At least 200 million girls and women alive today living in 30 countries have undergone FGM (UNICEF) Africa (almost universal in Somalia, Guinea, Djibouti) Middle East (e.g. Iraq, Yemen, Oman, UAE, Saudi Arabia) Asia (e.g. Indonesia, Malaysia, India) UK areas with communities of first generation immigrants, refugees and asylum seekers: London, Cardiff, Manchester, Sheffield, Northampton, Birmingham, Crawley, Reading, Milton Keynes, Slough, Oxford

Answer 149

Deep seated hierarchies and inequalities difficult to address; e.g. gender and poverty Closely linked to religious and moral understandings: - opposition from churches and other religious leaders - personal views of healthcare providers, teachers etc. powerful - policy decisions influenced by public opinion Stigma, discrimination, confidentiality concerns, compounded by legality issues Wide range of providers; disjointed: general practice, community services, acute hospitals, pharmacies and the voluntary, charitable and independent sector, schools Data gaps and inadequate evidence on what works for different groups and in different settings

Answer 150

* Homeostatic mechanisms to protect against excessive food deprivation * Gene-environment interaction * Habitual, social, stress/ emotional eating behaviours – “passive” overconsumption * Hedonic mechanisms (pleasure and reward)

Answer 151

All factors relating to the direct contact of food to the gastrointestinal mucosal receptors.

Answer 152

All factors relating to the direct contact of food to the gastrointestinal mucosal receptors. Become clear that indirect controls have the capacity to override direct controls

Answer 153

What brings an eating episode to an end

Answer 154

Inter-meal period

Answer 155

Satiety cascade showing the relationship between satiation and satiety and some mediating psychological and physiological processes. Increase of hunger-> eat -> increase of fullness until satiation then fullness for a while satiety

Answer 156

* Energy density (ED; Kcal/g) * Liquids versus solids

Answer 157

* Energy density (kcal/g) * People tend to keep volume constant when consuming food (Rolls et al. 2002, 2004) * Large portions of energy dense food facilitate overconsumption * Reductions in ED are associated with reduced energy intake (Bell et al. 1998, Stubbs et al. 1998, Rolls et al. 1999) * Altering ED allows individuals to keep portions constant but consume fewer kcal whilst maintaining satiety.

Answer 158

* Incorporating water - Fruits and vegetables * Air (industry) * Reducing fat/ sugar (individual/ industry) * Method of cooking

Answer 159

Energy compensation is the adjustment of energy intake following the ingestion of a particular food Energy compensation is lower with liquids than solids Exception of soup! ➢Textural properties e.g. short oral residency time, speed of consumption, water content also cognitive aspects e.g. drinks related to thirst not hunger

Answer 160

* Consumed in liquid form * Least satiating macronutrient * Efficiently oxidised at the expense of fat * Additive to total daily energy intake – passive overconsumption * Stimulates intake – active overconsumption * Associated with poorer food choices – interaction with type of beverage consumed * Pattern of consumption is important

Answer 161

* Variety * Portion size * Distraction

Answer 162

* Variety often improves dietary quality – incorporated in the NHS eat well guidelines. * Variety can promote energy intake. Exposure to a variety of foods undermines development of meal satiation. Following the consumption of a food, there is a reported decrease in the pleasantness of the appearance, smell, taste, & texture of that food, whilst other foods remain pleasant. * Named “Sensory-specific satiety” (Rolls, 1986) or satiation (SSS) * Sensory = taste, smell, sight, texture

Answer 163

Evidence consistently demonstrates that consumption of large portion sizes of energy dense (ED) food facilitates over consumption – Portion size effect (PSE) In the absence of compensatory effects, large portion sizes of ED food may be contributing to the increased prevalence of overweight and obesity Synergistic effect between portion size and ED. Portion size effect persists over days/ weeks in children and adults.

Answer 164

* Mathias (2012): serving larger portion sizes of F&V to pre-school children increased intake but did not affect intake from the rest of the meal * Savage et al. (2012): reducing the portion sizes of children’s meals promoted intake of fruit and vegetables * Rolls et al. (2010): serving more vegetable at a meal reduced energy intake in adults

Answer 165

Watching TV: * Hetherington et al. (2006) reported a 14% increase in intake when participants watched TV whilst eating versus eating alone. Eating with others: Social facilitation * Food intake can increase between 40 – 70% (De Castro 1990, 1991, 1994) * Increased perceived pleasantness (Bellise & Dalix 2011) * Ruddock et al. (2019) eating with others increases food intake relative to eating alone. Effect is moderated by the familiarity of co-eaters.

Answer 166

- Dietary restraint - Stress - Sleep - Reward sensitivity - Weight stigma

Answer 167

Disinhibited eating behaviour (opportunistic eating) is not only associated with weight gain and obesity, less healthful food choices

Answer 168

Stress and eating behaviours in children and adolescents; systematic review and meta-analysis. * Impact of stress on eating behaviours occurs around ages 8-9 yrs

Answer 169

Insufficient sleep duration and quality associated with increased risk of obesity, insulin resistance and T2DM * Sleep restriction led to changes in appetite regulating hormones and increased hunger. * Sleep restriction led to increased insulin resistance and elevated diabetes risk, through multiple mechanistic pathways. * Behavioural sleep extension and sleep quality improvement may help reduce obesity and diabetes risk.

Answer 170

* Beaver et al. (2006): Correlation between sensitivity to reward traits and neural responses to palatable food images * Burger et al. (2011): Increased body weight associated with enhanced responsiveness to visual images of food

Answer 171

In 2003 the parliament in Sweden adopted a new public health policy “to create the social conditions for good health, on equal terms, for the entire population” Instead of using treating diseases as paradigm they use determinants as starting point Determinants are factors in both the structure of society and people’s living conditions and lifestyles that are either good or bad for health.

Answer 172

Presence of two or more chronic conditions >50% of those aged over 65 have multimorbidity 10M have multimorbidity Multimorbidity is the leading cause of service use £7 in every £10 of the total health and social care expenditure are on chronic conditions

Answer 173

Accumulation of deficits across organ systems Impaired ability to respond to an adverse event 25-50% of the over 80s 1.7M in UK are clinically frail, due to double by 2045 A patient with frailty costs 2x GP in appointments. 4x hospital admissions 10X in social care

Answer 174

A new discipline to meet the challenge of an ageing population Studies ageing

Answer 175

Accumulation of damage to cells and tissues leading to progressive loss of function

Answer 176

The concept behind systems medicine is that there are common genes and pathways among diseases and diseases appear in clusters, Each cluster is underpinned by a common mechanistic origin. These clusters radically change what we call a disease. The underlying causal molecular mechanism becomes the disease definition Drugs are developed targeting the molecular mechanism for specific clusters of diseases.

Answer 177

Size of problem Effectiveness of intervention Whether there are alternatives Whose “fault” is the disease? Is this a health problem? Is the NHS responsible for this problem? Special population - e.g. preterm babies Is there a large payback from treatment? Is this disease population particularly “deserving”?

Answer 178

The NHS provides a comprehensive service, available to all Access to NHS services is based on clinical need, not an individual’s ability to pay The NHS is committed to providing best value for taxpayers’ money

Answer 179

The basic economic problem is scarcity: Resources are limited The desire for goods and services exceeds current resources Choices cannot be avoided, therefore decisions have to made No country treats all treatable ill health – all countries ration health care

Answer 180

The opportunity cost of a choice is the lost benefit of the best alternative - i.e. the sacrifice in terms of the benefits forgone from not allocating resources to next best activity. A health example might be: spending spare budget on hip replacements means it can’t be spent on mental health services. The opportunity cost is the lost benefit of the mental health services.

Answer 181

Economic efficiency is achieved when resources are allocated between activities in such a way as to maximise benefit. In healthcare this means aiming to get the maximum health benefit from our fixed budget.

Answer 182

Economic evaluation is the assessment of economic efficiency - Economic evaluation is a comparative study (between two or more interventions) of the costs and benefits of health care interventions for some given disease - Costs and benefits are analysed in terms of their ‘increments’ or differences between the interventions - We are usually comparing something new with something we are currently doing - We ask: are the incremental benefits of a new treatment (compared with the existing treatment) worth the incremental costs?

Answer 183

Change in something measured in “natural units” blood pressure pain score number of cases detected walking distance blood cholesterol Comparison between diseases is difficult

Answer 184

The Quality Adjusted Life Year (QALY) - Combines length of life with quality of life - How do we measure quality? - We use the idea of “utility” as a measure of quality - Someone’s “utility” for a health state is how strongly they value that health state - Full health is defined to have a utility of 1 - Being dead is defined to have a utility of 0 - States worse than death have negative utility values

Answer 185

Length (years) x quality (“utility”) weighting (0 to 1 scale) 1 year perfect health (i.e. utility of 1) = 1 QALY 2 years with utility of 0.5 = 1 QALY 8 years in utility of 0.75 = 6 QALYs

Answer 186

Health is measured in monetary terms - This draws on the idea of “willingness to pay” - How much is someone prepared to pay for some health benefit? - Difficult to determine in a healthcare system that is free at the point of use - Has various problems: richer people might be willing to pay more than poorer people. Does this mean their health is more valuable? Is this fair?

Answer 187

Monetary units (£ in the UK) - All relevant costs should be measured, e.g. - Drug treatment - Hospital stay - Outpatient appointments - We are usually interested in the costs to the NHS (and not any costs to the patient)

Answer 188

Cost effective analysis Cost utility analysis Cost benefit analysis Cost minimisation analysis

Answer 189

Outcomes measured in natural units Costs in monetary units

Answer 190

Outcomes measured in QALYs Costs in monetary units

Answer 191

Outcomes measured in monetary units Costs in monetary units

Answer 192

Outcomes, measured in any units, are equal in both treatments. Therefore, just minimise cost.

Answer 193

The ICER is the incremental cost of one treatment versus another, divided by the incremental benefit of one treatment versus another.

Answer 194

Cost New - Cost Old . Benefit New - Benefit Old

Answer 195

Once an economic evaluation has been completed it is up to the National Institute of Health and Care Excellence (NICE) to decide if a new treatment should be available on the NHS (in England and Wales)

Answer 196

When we fund a new more expensive treatment, we need to stop funding another treatment, somewhere else in the NHS to pay for it – the overall NHS budget is fixed NICE thinks that any services that are closed down to fund new services probably generate benefits at a cost of about £20,000 per QALY gained Taking £20,000 from somewhere else in the NHS to fund a more expensive drug therefore loses 1 QALY So, it only makes sense to fund new things if we get at least 1 QALY per £20,000 Equivalent to requiring the cost to be less than £20,000 per QALY gained for something to be cost-effective £20,000 is called the “NICE threshold”

Answer 197

Society is concerned with more than just efficiency Equity is concerned with the fairness or justice of the distribution of costs and benefits Economists are clear in principle about the definition of efficiency. There are, however, opposing views about what is ‘fair’ Such considerations are very difficult to quantify and so tend to enter the decision making process much more subjectively Equity is just as important as efficiency There is usually a trade-off between equity and efficiency

Answer 198

A fixed budget means that we cannot afford everything We must make choices If we fund treatments that cost more than the threshold, overall health goes down – we lose more than we gain We therefore choose not to fund some treatments This gets called “rationing” It is seen as very very bad, even though we do it to maximise overall health

Answer 199

- A fixed budget means that we cannot afford everything - We must make choices - If we fund treatments that cost more than the threshold, overall health goes down – we lose more than we gain - We therefore choose not to fund some treatments - This gets called “rationing” - It is seen as very very bad, even though we do it to maximise overall health

Answer 200

“activity requiring physical effort, carried out to sustain or improve health and fitness” ▫ a subcategory of physical activity that is planned, structured, repetitive, and aims to improve or maintain one or more components of physical fitness.

Answer 201

▫ “any bodily movement produced by skeletal muscles that requires energy expenditure” ▫ includes exercise as well as other activities which involve bodily movement and are done as part of playing, working, dancing, active transportation, house chores, recreational activities etc.

Answer 202

MET- metabolic equivalent 1 met- metaboilic rate at rest

Answer 203

* Self report (e.g. IPAQ, WSQ) * Direct observation * Heart rate monitoring * Accelerometry * Inclinometry * Portable indirect calorimetry * Doubly labelled water

Answer 204

Cardio Pulmonary Exercise Testing ▫ (CPET/CPEx)- gold standard

Answer 205

* Sarcopenia + bone loss → frailty ▫ Hip fracture: average 83.5years ▫ 30% mortality at 1 year * Inverse association b/t weight bearing exercise + hip/spine fracture * strength & balance-fall prevention

Answer 206

* 30,000 deaths/year * 10 year reduction lifespan * £4.7 billion/year (inactivity 8.2 billion) * Mortality increases by 30% every 5kg/m2 ▫ 57 observational studies (900,000 people) ▫ vascular disease ▫ renal ▫ diabetes ▫ respiratory ▫ cancer

Answer 207

* True for over weight & obese individuals * Partially, being ‘ideal weight’ & fit is still the aim * Being fit & obese is healthier than slim & unfit * Improvements in fitness (in the overweight/obese) do improve health (mortality)

Answer 208

* Mostly cross-sectional data, but prospective studies are emerging * Sedentary behaviour appears independently associated with: - higher all-cause mortality - higher CVD mortality - increased risk of: obesity, type 2 diabetes, cancer

Answer 209

Frequency Intensity Type Time

Answer 210

strains on pension and social security systems; increasing demand for health care; bigger need for trained-health workforce; increasing demand for long-term care; pervasive ageism that denies older people the rights and opportunities available for other adults.

Public health Flashcards

(244 cards)