Public Health Flashcards
(182 cards)
1
Q
What is the main determinant of public health?
A
NOT mean income but the extent of income division
2
Q
What is the Gini-coefficient
A
A statistical method of measuring wealth of a nation divided amongst its residents
low co-efficient = greater equality amongst people
High = UK
Low = Scandanavian countries
3
Q
Name 3 responses to health inequalities…
A
- The Black Report (1980’s)
- The Acheson Report (1998)
- Proportionate Universalism
4
Q
What is the Black Report?
A
Material (environmental causes influenced by behaviour)
Artifact (apparent product of how inequality is measured)
Cultural (poorer people = unhealthy behaviours)
Selection (sick people sink socially and economically)
5
Q
What is the Acheson Report?
A
Aim = decrease inequalities in wealth
Healthcare priority to those families with children
6
Q
What is proportionate universalism?
A
- just targeting disadvantaged will not reduce inequality
- needs to be a universal approach
- fair distribution of wealth is important
7
Q
Name 3 theories of causation of inequalities?
A
- Psychosocial
- Neo-material
- Life-course
8
Q
What are the 5 structural determinants of illness?
A
- social class
- poverty
- unemployment
- racism
- gender and health
9
Q
What is the psychosocial theory of causation of inequalities?
A
stress»_space; inability to respond efficiently to the bodies demands
- impact on BP, cortisol levels and inflammatory and endocrine responses
10
Q
What is the neo-material theory of causation of inequalities?
A
more hierarchical societies are less willing to invest into the provision of public goods
- poorer people has less material goods, quality of which is generally lower
11
Q
What is the life-course theory of causation of inequalities?
A
comb of both psychosocial and net-material explanations
critical periods: possess greater impact at certain points in the life course
accumulation- hazards and their impacts add up»_space; hard work leads to injuries»_space; resulting in disabilities that may lead to more injuries
12
Q
What is the biomedical model?
A
- mind and body = separate
- body, like a machine, can be repaired
- this privileges the use of technological interventions
- it neglects social and psychological dimensions of disease
13
Q
When are you allowed to break confidentiality?
A
- Patient consent
- Public interest e.g. rare disease, research, education
- You are required to do so by law e.g. notifiable disease, ordered by police)
14
Q
What is the criteria for patient information disclosure?
A
- anonymous
- patients consent
- kept to a necessary minimum
- data protection
15
Q
What happens to confidentiality after death?
A
Duty of confidentiality continues
16
Q
What are the 3 main notifiable diseases that must be reported to WHO?
A
cholera, yellow fever and the plague
17
Q
What is health behaviour?
A
aimed to prevent disease (e.g. healthy eating, exercising)
18
Q
What is illness behaviour?
A
aimed to seek remedy (going to the doctors)
19
Q
What is sick role behaviour?
A
aimed at getting well (compliance, resting)
20
Q
5 factors that promote mortality?
A
- poor diet
- sedentary lifestyle
- obesity
- smoking
- excess alcohol
21
Q
What are the 4 domains of public health?
A
Health protection
Health improvement
Improving services
Addressing the wider determinants of health
22
Q
What is meta-ethics?
A
Exploring fundamental questions: right/wrong/defining good or bad
23
Q
Name the 5 ethical theories…
A
Virtue Imperative Categorical Utilitarianism 4x principles
24
Q
What is applied ethics?
A
a recent emergence of ethical investigation into specific areas (e.g. medical, public health etc)
25
Name the ethical arguments
```
DICE
Deductive
Inducive
Considering what we believe in
Ethical analogies
```
26
What is a deductive ethical argument?
That one ethical theory can be applied to all medical problems
27
What is an inductive ethical argument?
That settles medical cases generate theory or guidelines for future practice)
28
What are ethical analogies?
removing limb of a healthy patient vs. plastic breast surgery
29
What is an ethical fallacy?
The idea that ethical considerations help to solve the problem of free will.
The assumption but some philosophers that free decisions must be restricted to moral decisions
30
What is Ad hominem?
a claim or argument is rejected on the basis of some irrelevant fact about the persons character rather than focusing on the content of their argument
31
What is petito principii?
assuming the initial point of the argument (a premise is assumed to be true without warrant)
32
What is an authority claim?
saying a claim is correct because the authority has said so
33
What is motherhood with regards to ethical fallacies?
The insertion of a soft statement to disguise the disputable one e.g. all humans are equal (so we shouldn't stop PVS patient treatment)
34
What is the Health Belief Model (Becker 1974)
- individuals must believe they are susceptible to the condition
- believe that it has serious consequences
- believe that taking action reduces their risks
- believe that the benefits of taking action outweigh the costs
35
What is the Transtheoretical model?
```
Pre-contemplation
Contemplation
Preparation
Action
Maintenance
Relapse?
```
36
What are the key purposes of the NHS press releases?
1. reactive- defend the NHS reputation (reporting achievements, improvements, justifications)
2. proactive- improving and protecting public health
- social marketing messages (Five-a-day, change4life)
- early recognition and symptom awareness (FAST)
37
What are the GMC duties of a doctor?
1. protect and promote the health of patients and the public
2. provide a good standard of practice and care
3. recognise and work within the limits of your competence
4. work with colleagues in the ways that best serve patients interests
5. treat all patients as individuals and respect their dignity
38
What is morality?
concerned with the distinction between good and bad or right and wrong
39
What is ethics?
the attempt to arrive at an understanding of the nature of human values, how we ought to live and what constitutes right conduct
40
What it consequentialism/utilitarianism?
- act is evaluated solely in terms of its consequences
- maximising good and minimising harm
- the greatest happiness for the greatest number of people
e. g. killing one innocent person to save the lives of 10 others
41
What are the different types of consequentialism?
1. hedonistic
2. rule
3. act
4. preference
42
What are the 5 virtues of virtue ethics?
1. compassion
2. discernment
3. trustworthiness
4. integrity
5. conscientiousness
43
What is the definition of hedonistic utilitarianism?
The theory that the right action is the one that produces the greatest net happiness for ALL concerned
44
What is the definition of preference utilitarianism?
promotes actions that fulfil the preferences of those involved
45
What is deontology?
the right/wrong of action themselves (the worthiness of an act)
46
What are the limitations of virtue ethics?
- assessment of virtue is culture specific
- notion of virtue = too broad and non-specific to allow practical application
- ignores social and communal dimensions
47
What are some challenges associated with utilitarianism?
- is it okay to treat minorities fairly to promote the happiness of the majority?
- is it okay to carry out ethically questionable research to maximise the welfare of society
48
What are some rivals of ethics?
- law
- personal conscience
- religious of cultural beliefs
49
What are the 4 principles of ethics?
1. Autonomy
2. Beneficience
3. Non-maleficence
4. Justice
50
With regards to ethical arguments what is the top down incentive?
That one specific ethical theory is consistently applied to each problem
51
With regards to ethical arguments what is the bottom-up incentive?
Past problems are used to create guides to future practice
52
What is the definition of autonomy?
respect the decision of the patient
- the decision is rational and informed
- there are no major controlling influences over the decision
53
What is non-maleficence?
Do no harm, reduce or prevent harm
54
What is beneficence?
doing something with the aim to benefit others (providing benefits, balancing the benefits against the risks)
55
What is justice?
needs vs. benefit, fairness in the distribution of benefit s and risks
56
What can be used to assess functional limitations amongst older people?
Katz ADL scale
IADL (instrumental Activities of Daily Living)
The Barthel ADL
MMSE
57
What activities does the Katz ADL assess?
Getting out of bed, bathing, dressing, toilet use, eating
58
What activities does the Barthel ADL Index assess?
feeding, getting out of bed, walking along the flat, going ups and down stairs
59
What activities does the IADL assess?
use of telephone, going shopping, cooking food, driving, housework, medication use
60
What does the MMSE assess?
- orientation, immediate memory
- short term memory
- language functioning
61
What is an acute illness?
A disease of short duration, that starts suddenly, has severe symptoms (can often be cured)
62
What is a chronic illness?
a persistent or recurring condition, may or may not be severe, often starts gradually with slow changes (cannot be cured but can be treated.
63
What is polypharmacy?
the use of 4 or more medications by a patient, generally adults over 65 years
64
Name 5 key challenges of an ageing population...
1. strain on pension and social security systems
2. increasing demand for long-term care
3. bigger need for trained health workforce
4. increasing demand for healthcare
5. pervasive ageism
65
What is pervasive ageism?
denying older people the rights and opportunities available for other adults
66
What are the causes of an ageing population?
1. improvement in sanitation, housing
2. decline in premature mortality
3. falls in fertility
4. life expectancy is increasing around the globe
5. more people reaching older age whilst fewer children are born
67
Name 2 key facts about ageing population...
1. In the UK there are as many people +65 as there are under 15
2. By 2025 there will be more people aged 65+ than <20
68
What are the two types of ageing?
Instrinsic: inevitable, natural
Extrinsic: dependent on external factors (air pollution, UV rays, smoking)
69
What are some examples of physical changes in later life?
- decrease in skin elasticity
- decrease in height >> stoop
- hair goes grey
- decreased in weight
- loss of joint flexibility
- increased susceptibility to illness
- decline in learning ability
- less efficient memory
70
What visual declines does ageing cause?
- need 3x more light
- depth/colour perception
- narrowing of visual field
71
What hearing declines does ageing cause?
- high frequency loss
| - speech comprehension 20%
72
What loss of taste and smell does ageing cause?
50% loss of taste buds
73
Why do women live longer than men?
20% biological- pre-menopausal women are protected from heart disease by hormones
80% environmental- men take more lifestyle risks than women)
74
What are the consequences of a higher life expectancy?
1. pensions will have higher payouts than those currently planned
2. chronic and comorbid conditions will prevail
3. rising inequalities as affluent groups will use health services for longer
75
What are the different types of dementia?
Alzheimers = 62%
Vascular = 17%
Mixed dementia = 10%
Lewy bodies= 6%
76
What are the alternatives to hospital admission for older people?
1. supporting discharge from inpatient hospital care
2. providing alternatives in acute care within the community
3. supporting chronic disease management within the community
77
What is institutionalising death?
60% of people die in hospital (but 70% want to die at home)
78
What is medicalisation of death?
Death is seen as a failure, prolonging life at any cost, death as natural part of our life challenged
79
What did Glaser and Strauss (1965) observe?
observational study of interactions between dying people, relatives and staff in USA hospitals
80
What 4 types of awareness contexts did Glaser and Strauss identify?
closed awareness
suspicion awareness
mutual pretence
open awareness
81
What is social death?
When people die in social and interpersonal terms before their actual biological death- lonely impersonal death
82
What is a good death?
palliative care became a speciality, aiming to demedicalise death- a reaction against the impersonal medical city
83
What is death the hospice way?
1. open awareness, compassion, honesty
2. MDT's
3. emotion and relationships- modelled on a family approach
4. holistic care
84
Who is Kate Granger and what has she introduced?
- A campaign by a terminally ill doctor .
- Introduced the #hellomyname is campaign to encourage healthcare staff to introduce themselves to patients - to improve the patient experience in a hospital
85
What is the chain of infection?
Susceptive host >> causative microorganism >> reservoir >> portal of entry/exit >> transmission
86
Name two modes of transmission
```
Exogenous spread (direct/indirect contact, vector, airborne)
Endogenous spread (self-spread)
```
87
Give some examples of susceptible hosts...
those with low immunity, low WBC count, imbalance in normal flora, invasive procedures
88
Give some examples of portal of exit/entry?
respiratory tract, GI tract, broken skin
89
What are the 3 different types of handwashing?
1. routine handwashing
2. surgical scrub
3. hygienic hand antisepsis
90
Name two types of resident flora?
1. anaerobic cocci
| 2. staphylococcus epidermis
91
How can you prevent infection?
By breaking the chain!!
92
Give some examples of how you can break the chain?
Handwashing, disposal of clinical waster, standard infection control precautions
93
Name some standard infection control precautions...
gloves and aprons, hand hygiene, correct sharps manipulation, correct clinical waste and linen handling
94
What are the physiological effects of nicotine?
- activation of nicotinic Ash receptors in the brain
- causing dopamine release in the NAcc (nucleus accumbent)
- stimulant, tolerance and withdrawal
95
What is the impact of smoking?
- greatest single cause of illness and premature death in the UK
- 100,000 deaths per year due to smoking
- cancers, COPD, CHD
a great economic impact of smoking
96
What are the health problems connected to smoking?
- cardiovascular problems (stokes, heart attacks, DVT's)
- cancers
- stomach ulcers
- impotence
- diabetes
- oral health (gum disease)
- cataracts
97
Methods for smoking cessation...
- nicotine replacement therapy (patches, gum, inhalator)
- non- nicotine pharmacotherapy (varenicline, bupropion)
- trans-theoretical model (change in behaviour)
98
What are the 3A's
The patient approach to smoking
ASK- your patient about smoking
ADVICE- your patient on cessation methods
ASSIST- your patient and refer to local NHS stop smoking service
99
The Law and smoking- key dates
1908- Children Act- sale of tobacco to under 16s prohibited
1965- parliament bans cigarette advertising on TV
2007- smoking in public banned + legal age raised to 18 in the UK
2015- smoking in car with children banned
100
What is the 'digital divide'?
difference in access to information
101
What are the millennium developmental goals?
1. eradicate extreme poverty and hunger
2. achieve universal primary education
3. promote gender equality
4. reduce child mortality
5. improve maternal health
6. combat HIV/AIDS and other diseases
7. ensure environmental sustainability
8. develop a global partnership for development
102
What are the 3 leading causes of death in children in the developing world?
Diarrhoea, pneumonia and malaria
103
Name the UN agencies involved in global health?
UNICEF
| WHO
104
Name the foundations involved in global health?
The Rockefeller Foundation
| The Bill and Melinda Gates Foundation
105
Name the NGO's involved in global health?
Doctors without borders (MSF)
| Save the children
106
Name the multilateral development banks involved in global health?
The World Bank
| Asian Developmental Bank
107
Name some current global environmental changes
```
CFC's and stratospheric ozone depletion
loss of biodiversity within ecosystems
freshwater decline and land degradation
loss of natural fisheries
increasing desertification
```
108
Give some examples of migrants...
international students, asylum seekers, refugees, trafficked people, migrant workers, family joiners
109
How do you define a migrant?
- country of birth
- country of nationality
- duration of stay
110
What is the origin of asylum seekers?
Iran, Pakistan,Sri Lanka, Syria
111
What is the origin of economic migrants?
Poland, Spain, Italy, Romania
112
Why are migrants vulnerable in their own countries?
- persecution, war, political and social unrest
- exploitation, torture, rape, bereavement
- burden of disease and socio-economic status
113
What is the significance of Lapedusa?
Island off the coast of italy
Primary transit point for immigrants from Africa
EU territory closest to the shores of Libya
THE DEADLIEST MIGRANT ROUTE IN THE WORLD
January to April 2015 about 1600 died
114
What are the NHS goals with regards to migrant health?
- equity of access
- reducing gap in health inequalities
- providing services for the vulnerable
- ensuring the services are appropriate and accessible
115
What is the definition of sustainability?
Being able to meet the needs of today without compromising the ability of future generations to meet the needs of tomorrow
116
What is climate change leading to?
the greenhouse effect >> irreversible heating of the planet
117
What are the Bradford Hill Criteria?
a group of minimal conditions necessary to provide adequate evidence of a causal relationship
118
Name the Bradford Hill criteria...
```
strength
consistency
specificity
coherence
temporality
analogy
```
119
What are the possible consequences of global warming?
heatwaves
sea levels rising
new diseases
scarcity of resources >> migration >> war?
120
What are the solutions to climate change?
- control world population
- reduce energy consumption
- get our energy from renewable resources
121
How do you define an effective team?
- optimal team size
- good team dynamic
- a common purpose
- an identified team leader
- shared knowledge and experiences
122
What are the benefits of team working?
- improving the service delivery
- improving decision-making
- reducing the error
123
What are the obstacles when it comes to team work?
- organisational (different offices, shifts, rotations)
- location (ward based/visiting/based elsewhere)
- management (different employers/sub-teams)
- other commitments of team members
124
When handing off a patient from one clinician to another what checklist is used?
```
SBAR checklist- to improve patient safety
S = situation
B = background
A = assessment
R = recommendation
```
125
What is the WHO definition of mental health?
a state of wellbeing in which the individual realises his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully and is able to make a contribution to his or her community.
126
What are the CMHP's (Common Mental Health Problems)
- depression
- general anxiety disorder
- panic disorder
- probes
- social anxiety disorder
- OCD
- PTSD
127
Why are CMHP's dangerous?
- have a -ve impact on QoL (employment, family, ADLs)
- increase risk of physical illness (chronic conditions)
- increase mortality from physical illness (e.g. heart disease)
- depression = major risk for suicide
128
Men are how many times more likely to suffer from CMHP?
men are 3x more likely
129
What are the interventions for public health?
- community level
- service organisation level
- individual level
- IAPT service (Improving Access to Psychological Therapies)
130
What does IAPT service model include?
- high intensity care
| - low intensity care
131
How many people worldwide have depression at any one time?
350 million people
132
How many people have a sever mental illness such as schizophrenia?
24 million people
133
How many people commit suicide
1 million
134
How many children have a mental disorder
10-20%
135
How many doctors have some kind of mental disorder ?
1/3
136
Do doctors or the general population have a higher suicide risk?
Doctors
137
What diseases are linked to obesity?
- type 2 diabetes
- hypertension
- cancer deaths amongst non-smokers
- CHD and stroke
- reproductive function
- osteoarthritis
- angina
- high cholesterol
- bladder control problems
- psychological disorders: depression, eating disorders, low self-esteem
138
What is the difference in epidemiological patterns in the the past and nowadays?
In the past obesity affected the rich first
| Nowadays obesity is a condition affected with poverty
139
What social gradient is reflective of obesity?
18% professionals/managers are obese
| 28% unskilled/manual workers are obese
140
What words describe the causes of obesity?
complex, multi-factorial, rooted in society, economic and cultural factors
141
What are the causes of obesity?
- 'Americanisation' of diet and society
- increasing dominance of car culture
- technological advances minimising physical work
- more commuting
- longer working hours
- greater availability of energy dense food, cheaper, better promoted
- replacing water with sugary drinks
142
What is the main question with regards to the causes of obesity?
Is the more about the increased energy intake or the reduced energy expenditure??
143
What is the WHO definition of obesity?
abnormal or excessive fat accumulation resulting from chronic imbalance between energy intake and energy expenditure that presents a risk to health. It is a state of positive energy balance.
144
What diagnostic measures can be used in obesity?
```
MRI
Waist circumference
WHR (waist to hip ratio)
Skinfold thickness
BMI
```
145
How do you calculate BMI?
Weight (kg) / height squared (m)
146
What are the BMI categories?
```
<18.4 = underweight
18.5-24.9 = normal range
25-29.9 = over-weight
30-34.9 = Obese Class I
35-39.9 = Obese Class II
> 40 = Obese Class III
```
147
What are the 7 key domains of energy balance?
1. food environment (energy intake - population level)
2. food consumption (energy intake - individual level)
3. individual activity (energy expenditure)
4. activity of the environment (EE-PL)
5. societal influences (I & E)
6. individual psychology (I & E)
7. individual biology (I & E)
148
What is the aetiology of obesity?
- multifaceted and complex
| - causes = interaction between biology and behaviour
149
What links does obesity have with genetics?
Prada-Willi Syndrome
Mutations of the leptin and melanocortin receptors
congenital leptin deficiency
polygenic obesity
150
What is Prada-Willi Syndrome (PWS)?
- short, stature, almond shape eyes, small hands and feet
- intellectual impairment
- hyperplasia (overeating)
- chromosome 15 partial deletion (paternal)
151
What does congenital leptin deficiency lead to?
extreme adiposity and uncontrollable apetite
152
What is leptin?
Leptin, the "satiety hormone", is a hormone made by adipose cells that helps to regulate energy balance by inhibiting hunger.
153
What obesity studies have been carried out on agouti mice?
agouti mice produce excess Agouti; a natural antagonist of melanocortin receptor, thus decreasing the melanocortin systems response to leptin (leptin insensitive)
154
What is melanocortin gene?
A gene responsible for appetite and satiety regulation. Appetite is the desire to eat while satiety refers to the sensation of fullness after eating.
155
What is melanocortin receptor?
MC4R codes for a protein called melanocortin 4 receptor, which is mainly found in the hypothalamus of the brain, an area responsible for controlling appetite and satiety.
156
What happened to the Pima Indians when they were exposed to the western environment ?
a dramatic increase in obesity
157
What aspects of behaviour are associated with weight gain?
- employment
- dietary patterns
- leisure and activities
158
Why is employment associated with weight gain?
- shift work, lack of sleep, upset circadian rhythm
- reduced physical activity
- cortisol, leptin, ghrelin
159
How are cortisol, leptin and ghrelin linked to obesity?
sleep loss has been shown to result in metabolic and endocrine alterations, including increased evening concentrations of cortisol, increased levels of ghrelin, decreased levels of leptin, and increased hunger and appetite.
160
What effect do cortisol, leptin and ghrelin have on the body?
Cortisol exhibits circadian rhythmicity
| Ghrelin and leptin promote and suppress food intake, respectively
161
What are the developmental factors associated with obesity?
- rapid infant weight gain (in first 2 years of life = increased risk)
- breast feeding (associated with protective mechanisms from obesity)
- early intro of solid foods (<4 months increases risk)
- childhood obesity (big predictor of adult obesity)
162
What are the direct and indirect controls of meal size?
```
direct = all the factors relating to the direct contact of the food with the GI mucosal receptors
indirect = metabolic, endocrine, cognitive individual differences >> indirect controls can override direct
```
163
What is satiation?
what brings an eating episode to an end
164
What is satiety?
inter-meal period
165
Describe the satiety cascade...
sensory >> cognitive >> post-ingestive >> post-absorptive
- fat has a relatively weak effect on satiation and satiety
- high fat foods often improve the sensory properties (palatable)
166
How many calories does protein contain?
5 kCal/g
167
How many calories does carbohydrate contain?
4 kCal/g
168
How many calories does fat contain?
9.5 kCal/g
169
How many calories does alcohol contain?
7 kCal/g
170
What is the satiating efficiency of macronutrients...
Protein > CHO > Fat > Alcohol
171
What is the macronutrient utilisation by the body?
Alcohol > Protein + CHO > Fat
172
How can we reduce the energy density of our foods?
1. incorporation of water or air
2. fruits and vegetables
3. reducing fat (industry)
4. methods of cooking (no frying)
173
By reducing the density of our foods what happens..
we consume fewer kCal and keep satiety
174
Energy consumption of which foods is lower than solids?
liquids with exception of soup
175
What is the role of alcohol in over-eating?
- stimulates intake, gives almost no satiety
- efficiently oxidised
- adds to the total daily energy intake
176
What food environment characteristics lead to obesity?
- variety of foods available
- portion size (increased over the last century)
- distraction e.g. watching TV and social facilitation- eating with others
177
What psychological factors are associated with under/over eating?
1. dietary restrain (disinhibited eating behaviour)
2. stress (often promotes eating)
3. sleep (short sleep linked to over eating)
4. reward sensitivity (neural response)
178
How are sexually transmitted diseases spread?
sexual contact
179
How are STI's caused?
by over 30 different bacteria, viruses and parasites
180
What are the 4 main STI's?
1. chlamydia
2. gonorrhoea (DRUG RESISTANT)
3. syphilis
4. trichomoniasis
181
What is the ABC list with regards to HIV safety?
A- abstain
B- be faithful
C- condom use
182
What are the 4 things that sexual and reproductive health education must do...
1. involve young people as they are key decision makers
2. provide comprehensive, accurate information
3. address barriers to accessing health services
4. empower adolescents to make life choices best for them
