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Flashcards in Public Health Deck (326):
1

Describe the three main categories of health behavior

Health Behaviour
Illness Behaviour
Sick Role Behaviour

2

Define Health Behaviour

A behaviour aimed to prevent disease (e.g. eating well)

3

Define Illness Behaviour

A behaviour aimed to seek remedy (e.g. going to the doctors)

4

Define Sick Role Behaviour

Any activity aimed at getting well (e.g. resting, medications)

5

Name two types of attitudes towards health

Damaging health (smoking, alcohol)
Health Promoting (excersise)

6

Name some modifiable risk factors

Diet
Weight
Physical Activity
Sleep

7

Name some non-modifiable risk factors

Age
Sex
Genetics

8

Two ways we can PREVENT disease

Preventative services via NHS
Primary, secondary and tertiary prevention

9

What are preventative services

Screening
Child health protection

10

What does the MORGEN study show us

That sufficient sleep duration contributes to lower CV disease risk in addition to 4 traditional lifestyle factors

11

How long was the MORGEN study followed up for

10-14 years

12

Name five lifestyle factors

Smoking
Being overweight
Little physical activity
Excessive alcohol
Poor Diet

13

Leading cause of death in Sheffield?

Cancer

14

What follows cancer as the leading cause of death in Sheffield

CV disease

15

Why do we need interventions

Could have a significant impact on mortality and morbidity

16

Define Morbidity

State of being diseased or ill health in a population

17

What can morbidity lead to

Mental health problems

18

Define Mortality

The number of people who died in a population

19

Three disadvantages of intervention

Genetic Predisposition
Expensive
Side-effects

20

Example of intervention at the population level

Health promotion

21

Describe health promotion

Process of enabling people to exert control over the determinants of health, improving health

22

Example of intervention at an individual level

Patient-centred approach

23

What are two examples of health promotions

Campaigns to promote 'good' health:
- Change 4 Life
-Movember

Promoting screening + immunisations:
MMR

24

What three factors should we consider to reduce alcohol consumption

Individual Behaviour (how much they drink)
Local community (A&E and local sales of alcohol)
Population level (demographic patterns of liver cirrhosis)

25

Four factors that can affect the perception of risk

- Lack of personal experience with the problem
-Belief only personal action will help
Belief that if it hasn't happened now it will never happen
Belief that the problem is uncommon

26

What is the health belief model

Individuals will change if they:
Believe that they are susceptible to disease in question
Believe it has serious consequences
Believe that action reduces susceptibility
Believe that benefits of taking action outweigh the cost

27

What is the theory of planned behaviour

Proposes that predictor of behaviour can be best assessed by intent:
- Person's attitude to behaviour
- Subjective Norm
- Percieved behavioural control

28

Define the transtheoretical model

Pre-contemplation (not ready yet)
Contemplation ( Beginning to consider but not for any time in the future)
Preparation (Getting ready to quit in the near future)
Action (doing it)
Maintenance (steady quitter)

Relapse

29

Nice guidance on behaviour change

1. Planning interventions
2. Assessing the social context
3. Education and learning
4. Individual-level interventions
5. Community-level interventions
6. Population-level interventions
7. Evaluating effectiveness
8. Assessing cost-effectiveness

30

What three factors can allow you to break confidentiality

1. Required by law
2. Public Interest
3. Patient consent (implied or explicit)

All have to be done in patient's knowledge

31

What are the four duties of a doctor as defined by the GMC

- Knowledge skills + Performance
- Safety + Quality
- Communication, partnership and teamwork
- Maintain Trust

32

Criteria for disclosure

- Anonymous
- Patient has not objected
- Consent
- Keep to minimum
- Meets current guidelines and laws
- Act promptly

33

What interactions with the law allow us to disclose information

Notifiable disease
Regulatory body demands it (CQC, GMC)
Ordered by a judge (Can be refused if needed)
Police, solicitor (Only if consent is given)

34

Examples of public health which allow disclosure of information

- Serious communicable disease
- Crime
-Research
- Education

35

Define long-term condition

A condition that cannot be, at present, cured but can be controlled by medication + other therapies

36

Define multi-morbidity

The co-occurrence of two or more chronic medical conditions in one person

37

Define Polypharmacy

Use of 4 or more medications by a patient

38

Define Medical Compliance

Describes the degree to which a patient correctly follows medical advice

Usually if they've been taking their prescribed medication

39

How does an aging population affect age median

Increases it

40

How does the proportion of older people change and why

Increased proportion due to increased life expectancy and decreased birth rate

Also due to improved health care, sanitation, living conditions and education

41

Four challenges of an ageing population

- Increased people with disabilities so more money needed to fund care for these people
- Health Gap: The number of years someone can live without a disability after 65 can vary by 12 years
- Increased multimorbidity
-Increased pressure on the NHS (more hospital admissions)

42

What did Ignacz Semmelweis campaign for?

Hand washing after discovering a correlation between puerperal fever and dissection

43

Define Gini coefficient

A statistical representation of nation's income distribution

44

What was the Black Report (1980)

Document reporting on health inequality causes

45

What were the five causes of health inequality according to the black report (1980)

Material (environmental causes mediated by behaviour)
Artefact (An apparent product of how inequality is measured)
Cultural/Behavioural (poorer people live more unhealthy lifestyles)
Selection (sick people sink socially and economically)

46

What two conclusions did the Acheson Report (1998) come to?

Income inequality should be reduced
Give high priority to health of families with children

47

What are three aspects of proportionate universalism

- Focusing on the disadvantage only will not help reduce inequality
- Action must be universal but with a scale and intensity proportional to the disadvantage
- Fair distribution of wealth is important

48

What are the three theories of causation?

Psychosocial
Neo-material
Life-Course

49

What is the theory behind psychosocial causation

- Stress results in inability to respond efficiently to the body's demands
- Impact on blood pressure, cortisol levels and on inflammatory and neuroendocrine responses

50

What is the theory behind net-material causation

- The more hierarchal societies are less willing to invest into the provision of public goods
- Poorer people have less material goods of which the quality is lower

51

What is the theory behind Life-Course theory of causation

- A combination of both psychosocial and net-material explanations
- Critical periods: Possess greater impact at certain points in the life course (childhood)
- Accumulation: Hazards and their impacts add up -> hard work leads to injuries resulting in disabilities that may lead to more injuries
- Interactions and pathways (sexual abuse leads to poor partner choice in adulthood)

52

What are the four domains of public health

- Health protection (infectious disease, equity, service planning)
- Improving services (efficiency and equity)
- Health improvement
- Addressing the wider detriments of health

53

What is meta-ethics

Exploring fundamental questions

54

What are the five types of ethics

- Virtue
- Categorical
-Imperative
- Utilitarianism
- Four principles

55

What is applied ethics

A recent emergence of ethical investigations in specific areas

56

What are four ethical arguments

- Deductive (one general ethical theory can apply to all medical problems)
- Inductive (settled medical cases used to generate theory or guides to medical practice)
- Considering what we believe in (feelings)
- Ethical analogies (scenarios)

57

Define the 'ad hominem' ethical fallacy

Responding to arguments by attacking the person's character than the content of their argument

58

What is an 'authority claim' fallacy of ethics?

Saying a claim is correct because the authority has said so

59

What is the 'petition principii' fallacy of ethics

Assuming the initial point of the argument - 'beg the question'

60

What is the 'dissenters' fallacy of ethics

Identifying those who disagree does not prove the claim is not valid

61

What is the 'motherhoods' fallacy of ethics?

Inserting a soft statement to disguise the disputable one

e.g. All humans are equal (so we shouldn't stop PVS patient treatment)

62

What is the 'no true scotsman' fallacy of ethics?

Modifying the argument

63

What are fine structural determinants of illness

- Social Class
- Material Deprivation / Poverty
- Unemployment
- Discrimination
- Gender and Health

64

What is the biomedical model of health

- Mind and body are treated separately
- Body, like a machine, can be repaired
- This privileges the use of technological interventions
- It neglects social and psychological dimensions of disease

65

What are three main notifiable diseases that MUST be reported to the WHO + requires disclosure of private information

- Cholera
- Yellow Fever
- Plague

66

Define primary prevention of CVD

Preventing CVD before it occurs

67

Define secondary prevention of CVD

Preventing additional attacks of CVD after the first attack has occurred

68

What can we do as primary prevention of CVD

Blood thinning drugs (aspirin)

69

What can we do as secondary prevention of CVD

Surgical Procedures
Aspirin

70

What are three non-modifiable risk factors for CVD

Age
Ethnicity
Family history of heart disease

71

What are modifiable factors affecting CVD?

BP
Physical Inactivity
Being overweight
High Blood Cholesterol
Smoking

72

Changes to diet to prevent CVD

LDL - Bad cholesterol
HDL - Good cholesterol

Veg
Fruits
Whole-grains
Low fat dairy products (fish)

73

What other ways can I reduce chances of CVD other than diet

Smoking - Quit
Lower BP (reduce Na intake)
Exercise (3-4 times a week at 40 mins sessions)

74

How would I assess for cardiac chest pain

1. Check whether they still have chest pain or if it happened in the last 12 hours
2. History of chest pain
3. Presence of CVD risk factors
4. History of ischaemic heart disease
5. Previous investigations for chest pain
6. Prescribe GTN spray
7. Take resting 12-lead ECG ASAP

75

What is GTN

A spray used for pain relief (short-term only)

76

How long do the effects of GTN last for

20-30 minutes

77

What symptom may indicate Acute Coronary syndrome

Pain lasting longer than 15 minutes

78

What is morality

Concern with the distinction between good and evil or right and wrong

79

Define ethics

A system of moral principles and a branch of philosophy which defines what is good for individuals and society

80

What is a teleological argument

Argument for the existence of god

81

What is a deontological ethics

Judges morality of an action based on rules

82

What type of argument is utilitarianism/ consequentialism

Teleological

83

What is the concept of utilitarianism / consequentialism

An act is evaluated solely in terms of its consequences

Maximising good and minimising harm

84

What are a few criticisms of utilitarianism

It is impossible to apply - happiness can't be quantified or measured

Difficult to apply as we can't calculate all the effects for an individual

85

What type of argument is kantianism

Deontological

86

What is kantianism

Features of the act themselves determine worthiness of the act

Following natural laws and rights

Gives us imperatives: do not kill, do not lie etc.

'A person is an end itself, never means to an end'

87

What are criticisms of kantianism

For an action to be permissible, it must be possible to apply it to all people without a contradiction occurring.


88

What type of argument is virtue ethics

Deontological

89

Define virtue ethics

Focus is on the kind of person who is acting, de-emphasises rules

Is the person in action expressing good character or not?

We become virtuous only by practicing virtuous actions

90

What are the five focal virtues that make up virtue ethics

Compassion
Discernment
Trustworthiness
Integrity
Conscientiousness

Cook Dick To Interest Callum

91

What is the criticism of virtue ethics

Virtue ethics is 'culturally relative'

Since different people, cultures and societies often have different opinions on what constitutes a virtue.

92

What are the four principles of ethics

Autonomy (obligation to respect decision of our parents)

Benevolence (balancing benefits with risks)

Non-Maleficence (do no harm, reduce or prevent harm)

Justice (need vs benefit)

93

5 GMC duties of a doctor

- Protect and promote health of patients and public
- Provide good standard of practice and care
- Recognise and work within limits of your own competence
- Treat patients as individuals and respect their dignity

Protect

Provide

Recognise

Rspect

94

What does the Katz ADL consist of

Daily Life limitations for old people:

- Bathing
- Dressing
- Toilet use
- Transferring in/out of bed
- Urine and Bowel continence
- Eating


Betty’s Dad Telephones Tim’s Uni Exterminator

95

Describe IADL

Telephone
Travelling (by car or using public transport)
Food or clothes shopping
Meal Preparation
Housework
Medication use
Management of money

Tim’s Teacher Fought Many Hamsters Mid March

96

Describe Barthel ADL Index

- Feeding
- Moving from wheelchair to bed
- Grooming
- Transferring to and from a toilet
- Bathing
- Walking on level surface
- Going up and down the stairs
- Dressing
-Continence of bowels
- Continence of bladder

Feelings Moved Gary To the Bar With Greg Dressed in Casual Costumes

97

What three aspects are being tested on old people in the Mini Mental State Examination

- Orientation, immediate memory
- Short term memory
- Language Functioning

98

Define acute illness

A disease of short duration that starts quickly and has severe symptoms

99

Define chronic illness

A persistent or recurring condition which may or may not be severe, often starting with gradually slow change

100

Define Polypharmacy

The use of multiple medications or administration of more medications than are clinically indicated

101

What are 5 challenges of aging population

1. Strains on pension and social security systems
2. Increasing demand on health care
3. Bigger need for trained health services
4. Increased demand for long term care
5. Pervasive ageism (denying old people rights and opportunities available for other adults)

Strains
Demand
Need
Demand
Ageism

102

What are five causes of waging population

1. Improvements in sanitation, housing and medical interventions
2. Life expectancy is rising around globe
3. Substantial fall sin fertility
4. Decline in premature mortality
5. More people reaching older age while fewer children are born

103

Facts on UK ageing population

Population of 65+ is the same as population of under 15

By 2025, there will be more people over 65 than under 20

104

Define intrinsic ageing

Natural, universal, inevitable

105

Define extrinsic ageing

Dependant on external factors (UV ray exposure smoking etc)

106

What are five examples of physical changes during ageing

1. Loss of skin elasticity + hair colour
2. Decrease in size and weight
3. Loss of joint flexibility
4. Increased susceptibility to illness
5. Decline in learning ability + less efficient memory

107

Three impacts of ageing on vision

1. Need 3 times more light
2. Depth/colour perception
3. Narrowing of visual field

108

Two impacts of ageing on hearing

1. High frequency loss
2. Speech comprehension 20%

109

How does ageing affect taste and smell

We lose 50% of our taste buds.

110

Economic costs of smoking

5.5% of healthcare costs - smoking
Loss of productivity from smoking breaks
Increased Absents (£2.5 billion)
Cleaning up butts

111

Health problems in the UK due to smoking

Single greatest cause of illness and premature death in the UK

100,000 die a year in UK

COPD

112

Name four medications to stop smoking

Nicotine replacement therapy
Varenicline
Antidepressants
Clonidine

113

How do nicotine replacement therapy work

Stimulates nicotinic receptors and stimulates release of dopamine

114

What three ways can GP manage smokers

Cost
Health damages -> outline health risks
Helplines

115

What are readings on a spirometer trace compared to

BMI and age

116

What will diagnosis using an X-ray for COPD tell us

Whether another condition is causing symptoms

117

What is a blood test for COPD aiming for

Checks if symptoms are due to anaemia

118

What does the peak flow test for COPD aim to show us

It it is asthma

119

What should we do to patients who remain breathless despite having bronchodilators

Maintenance therapy

120

What should we give to patients with an FEV1 > 50%

LABA (agonist) or LAMA (antagonist)

or Pulmonary rehab

121

What does COPD stand for

Chronic Obstructive Pulmonary Disease

122

Symptoms of COPD

Tight chest
Wheezing
Short breath

123

What antibiotic can I use to treat exacerbation of COPD

Azithromycin

124

What does it mean to be 'institutionalising death'

60% of people die in hospital but 70% want to die at home

125

What is medicalisation of death

Death as a natural part of our life is challenged by trying to prolong life at any cost

126

What is the Glaser + Strauss (1965) study

Observational study of interactions between dying people, relatives and staff in USA hospitals

127

What were the four awareness contexts discovered in the Glaser + Strauss report

Closed Awareness - Patients not aware of their own impending death
Suspicion - Awareness
Mutual Pretence
Open Awareness

128

What is closed awareness

Patients not aware of their own impending death

129

What is suspected Awareness

pt suspects others know and attempts to confirm/invalidate his/her suspicions

130

What is mutual Pretence

all sides know but pretend the others do not

131

What is Open Awareness

Everyone knows and openly admits it

132

What is the ratio of women:men in old age populations

2:1

133

Why do women live longer than males

20% biological - premenopausal women are protected from heart disease by hormones

80% environmental - Men take more lifestyle risks than women)

134

What is the consequence of life expectancy on pensions

Have higher pay outs than those currently planned

135

What is the consequence of a higher life expectancy on health

- Chronic conditions will prevail

- Rising inequalities as more affluent groups use health services for longer

136

What is the most common type of dementia

Alzheimer's - 62%
Vascular
Lewy Body
Fronto-temporal

137

Define a social death

When people die in social and interpersonal terms before their actual biological death (lonely death)

138

Define a good death

Palliative care became a speciality, aiming to demedicalise death - more personal

139

What are four features of death in a hospice way

1. Open awareness, compassion + honesty
2. MDT
3. Family Approach (relationships)
4. Holistic Care

One Member Farted Holistically

140

What two actions did Kate Granger take to raise awareness of importance of a good death

1. The Other Side (novel)
2. Hellomynameis campaign

141

What makes a susceptible host to disease

Low immunity, low white cell count, imbalance in normal flora and invasive procedures

142

How can number of microorganisms increase in health care services

Resistant pathenogenic strains

143

What is a reservoir?

Where potential spread originates:
Visitors
Patients
Staff
Fomites

144

What are three portals of entry/exit

Resp tract
GI Tract
Broken Skin
Genito-urinary tract

145

What two ways can infections spread

Exogenous - Direct/Indirect Contact, vector spread, airborne

Endogenous - Self spread

146

Why do we do hand decontamination

Remove transient hand flora (Viruses, Staphylococcus aureus)

Reduce number of resident flora

147

How do we do hand decontamination

Hand washed
Take of wrists jewellery and long sleeves as we can't wash hands affectively

Nails need to be short and clean

148

When do we wash our hands?

Before and after any patient contact
Before and after carrying out any procedures
After going toilet
Before food eating
Before entering a clinical area

149

What are the three levels of hand washing

Level 1 = Routine Handwash
Level 2 = Hygienic hand antisepsis
Level 3 = Surgical Handscrub

150

What is Level 1 hand washing purpose and method used to do it

Removes soil/dirt and transient microbes

Method: Soap for at least 10-15 secs

151

What is level 2 hand washing + method

Removes and destroys transient microbes

Method: Antimicrobial soap or alcohol-based hand rub for 10 to 15 secs

152

What is Level 3 hand washing + method

Removes or destroys transient microbes + reduce number of flora

Method: Alcohol based rub or antimicrobial soap/detergent with a brush to achieve friction for 120 secs

153

What is alcohol gel effective and ineffective against

Destroys MRSA but not Norovirus or clostridium difficile

154

What is antimicrobial liquid soap and water effective against

ALL transient microbes

155

Two examples of campaigns to encourage hand washing

Clean your hands campaign

Bare below the elbow policy (recommendation by department of health)

156

Name the two types of water

Household

Clinical - All clinical waste must be identifiable and traceable back to the source it originated from

157

What is a sharp

A sharp is described as any item that can potentially cute or penetrate the skin

158

What should we never do during disposal of sharps

Re-sheathing needles
Emptying sharp bin contents
Overfill a sharps bin
Carry bin with sliding doors OPEN

159

What should doctors wear when interacting with patients

Gloves/aprons in contact with body fluids or blood

Dressings to cover wounds

Body fluids or blood spillage on skin should be cleaned with chlorine granules

160

What are three psychological effects of nicotine

- Activation of nicotinic ACh receptors on the brain
- Causing dopamine release in the nucleus accumbens
- Stimulation (withdrawal)

161

What are four impacts of smoking

Premature death (main cause)
100,000 deaths due to smoking
COPD and cancers
A great economic impact of smoking

162

What are 7 problems connected to smoking

CV problems (heart attacks)
Cancers of other organs
Stomach ulcers
Impotence
Diabetes
Oral Health
Cataracts

163

What happened in 1908 in regards to smoking

Children's act - sale of tobacco to under 16s prohibited

164

What was published by Richard Doll and Austin Bradford Hill in 1950

A report on smoking and its link to lung carcinoma

165

What three laws have been passed to reduce smoking

1965 - Parliament ban of smoking adverts
2007 - Smoking in public places banned + min legal age raised to 18
2015 - Smoking in car with children banned in UK

166

What two ways can patients undergo smoking cessation

NRT (patches, inhaler, nasal spray)

Non-nicotinic pharmacotherapy
i. Varenicline
ii. Bupropion

167

What are the three As used to approach smoking patients

ASK - your patients about their smoking habits
ADVISE - your patients on cessation methods available
ASSIST - your patient and refer to local NHS stop smoking service

168

Define 'digit divide'

Difference in access to information

169

What are the 8 millennium development goals

1. Eradicate extreme poverty and hunger
2. Achieve Universal Primary Education
3. Promote gender equality and empower women
4. Reduce child mortality
5. Improve maternal Health
6. Combat HIV/AIDS, Malaria and other diseases
7. Ensure environmental sustainability
8. Develop a global partnership for development

Early Achievers Promote Independent Caring of Educational Development

170

What are the three leading causes of death in children in the developing world

1. Pneumonia
2. Diarrhoea
3. Malaria

171

Who are the five key actors in global health?

1. UN agencies (UNICEF/WHO)
2. Foundations (Rockefeller Foundation)
3. NGOs (Les MSF + Save the children)
4. Multilateral Development Banks (World bank, Asian development bank and inter-american development bank)
5. Bilateral Agencies (USAID, CIDA, DFID)

172

What five major environmental changes are happening at the moment

CFCs + Ozone depletion
Loss of biodiversity within ecosystem
freshwater decline + Land degradation
Loss of natural fisheries
Increasing desertification

173

What are 6 global health issues

Common Health problems
Health problems that cross borders
International migration
Political crisis
International agreements
Global environmental change

174

Name some examples of migrants

Asylum Seekers
Refugees
Migrant workers
Family workers
Family Joiners
International Students

175

What three factors define a migrant

Country of birth
Nationality
Duration of stay

176

What types of migrants do we usually see (2)

- Asylum seekers
- Economic migrants

177

What is lampedusa

An italian island

178

What is the issue with immigration in lampedusa

A primary transit point for immigrants from Africa

179

Where is lampedusa located

A european territory closest to the shores of Libya

180

What is the issue with the migrant route from Libya to Lampedusa

Most deadliest migrant route in the world

181

What are the four goals of the NHS when it comes to global health

1. Equity of access
2. Reducing gap in health inequalities
3. Providing services for the vulnerable
4. Ensuring the services are appropriate and accessible

182

Define Sustainability

Being able to meet the needs of today without compromising the ability of future generations to meet the needs of tommorow

183

What is the Bradford Hill Criteria

A group for minimal conditions necessary to provide adequate evidence of a causal relationship

184

List the Bradford Hill Criteria

Strength
Consistency
Specificity
Temporality
Biological Gradient
Coherence
Analogy

185

What are possible consequences of climate change

Heatwaves
Sea Level Rise
New Diseases
Scarcity of resources -> war

186

How can we solve the issue with climate change

Control world population
Reduce energy consumption
Get our energy from renewable resources

187

Define screening

A process which sorts out apparently well people who probably do have the disease from those who probably do not

188

Why do we screen people

For PREVENTION

189

What is primary prevention

To prevent a disease from occurring

190

What is secondary prevention

Detection of early disease in order to alter the course of the disease and maximise chances of a complete recovery

191

What is tertiary prevention

Trying to slow down the progression of the disease

192

How do I calculate sensitivity

True positive/ True positive + False negative

193

What is sensitivity

The proportion of people with the disease who are correctly identified by the screening test

194

Formula for specificity

True negatives / True negatives + False positive

195

Define specificity

The proportion of people without the disease who are correctly excluded by the screening test

196

PPV Formula

True positive / True positive + False positive

197

Define PPV

The proportion of people with a positive test result who actually have the disease

198

DefineNPV

The proportion of people with a negative test result who do not have the disease

199

Calculate NPV

True negative/ True negative + False negative

200

Define prevalence

The proportion of a population found to have the disease

201

Define incidence

The number of new cases within a specified time period divided by the size of the population initially at risk

202

What are the four topics in the Wilson and Junglier criteria for screening

The condition
The treatment
The test
Benefits

203

Outline the condition of the criteria

It should be a serious health problem
The aetiology should be well understood
There should be a detectable early stage

204

Outline the treatment of the criteria

There should be an accepted treatment of the disease
Facilities for diagnosis and treatment should be available
There can't be an unmanageable extra clinical workload

205

Outline the test of the criteria

A suitable test should be divided for the early stage
The test should be acceptable for patients
Intervals for repeating the test should be determined

206

Outline the benefits to consider for this criteria

There should be an agreed policy on who to treat
The cost should be balanced against the benefits

207

Define selection bias

People who choose to participate in screening programmes that may be different to those who do not

208

Define lead time bias

Screening merely identifies the disease earlier than before and thus gives the impression that survival is prolonged

209

Define length-time bias

Diseases with longer period of presentation are more likely to be detected by screening than ones with shorter time of presentation

210

What is a human error

Any preventable event that may cause or lead to patient harm

211

What is an adverse event

An incident which results in harm to a patient

212

What is a near miss

An event which has the potential to cause harm but fails to develop further, thereby avoiding harm

213

What are the three types of human error

Errors of omission (Required action delayed)
Error of commission (wrong action taken)
Error of negligence (actions do not meet standard of ordinary, skilled person professing

214

What are skill-based errors

Performing a routine task that is well learnt we give little attention and could have memory lapses if distracted

215

What are rule/knowledge based errors

An incorrect plan or course of action is chosen

216

When are rules/knowledge based errors more likely

When tasks are more complex

217

What are violations

Deliberate deviations from practices, procedures and standards or rules

218

Name the three types of violations

Routine (cutting corners)
Necessary (to get the job done)
Optimising (Personal gain, selfish)

219

What are five limitations to information processing

Automaticity
Cognitive interference
Selective Attention
Cognitive Bias
Transferring our expectations from familiar situations to similar new ones

220

What are the two approaches to managing errors

Individual - errors are the products of wayward mental processes of individual people in the system

Organisational - Adverse events are product of many causal factors so the whole system is to blame

221

What are five components of an effective team

Optimal Size
Good dynamic
A common purpose
Identified team leader
Shared knowledge and experiences

222

What are three benefits of team working

1. Improving service delivery
2. Improving decision-making
3. Reducing the error

223

What are four obstacles in team working

1. Different offices/shifts/rotation posts (organisational)
2. Location (ward based/visiting)
3. Management (Different employers/Sub-teams)
4. Other commitments of the team members

224

When do I use the SBAR checklist

When reporting a case

225

What is the SBAR checklist

S - Situation
B - Background
A - Assessment
R - Recommendation

226

Define Mental Health

Mental health is a state of well-being in which an 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

227

What interventions can we introduce to people with CMHPs

- Community Level
- Service organisational level
- Individual Level
- IAPT service model

228

What is the IAPT service model

Improving access to psychological therapies
i. High intensity care
ii. Low intensity care

229

Define stress

Stress occurs when the demand made upon an individual are greater than their ability to cope

230

What is distress

A negative stress which is damaging and harmful

231

What is eustress

A positive stress which is beneficial and motivating

232

What can cause acute stress

noise, danger infections, injuries, hunger

233

What can cause chronic stress

Health, home, finances, work, family, friends

234

What are internal stressors

Physical (inflammation or infection)
Psychological (attitudes, beliefs, personal expectations, worries)

235

What are external stressors

Environment, work and social pressure

236

What is the main response to stress

Fight or Flight response

237

What type of stressor is the fight or flight model a response to

External acute stressors

238

What is activated during the fight or flight model

Hypothalamus
Adrenal medulla and cortex

239

What happens at the lungs during fight or flight

Take in more oxygen

240

What happens to the spleen during the fight or flight response

More RBCs discharged

241

What happens at the mouth during fight or flight response

mucous and saliva dry up

242

What happens to blood flow in the fight or flight response

Increases by up to 400%

243

When are we alarmed

When threat is identified

244

What are two aspects of the general adaptation syndrome to stress

Defensive countermeasures engaged - Resistance

The body begins to run out of defences - Exhaustion

245

What are five signs of stress

Biochemical - Endorphin and cortisol levels altered
Physiological - Shallow breathing, raised BP and more HCL produced
Behavioural - Over-eating, anorexia, insomnia, more alcohol or smoking
Cognitive - Negative thoughts, no concentration, worse memory, tension, headaches
Emotional - Mood swings, irritability, aggression, boredom, apathy and tearfulness

246

Define the stress-illness model

An individual susceptibility to disease or illness is increased because an individual is exposed to stressors which cause strain upon the individual, leading to psychological and physiological changes

247

PTSD Diagnostic criteria

1. The person experienced an event tat involved actual or threatened death or serious injury or a threat to physical integrity
2. The person's response involved intense fear, helplessness or horror

248

What are three symptoms associated with PTSD

1. The event is persistently re-experienced in recollections and dreams
2. Persistent avoidance of stimuli associated with the event
3. Persistent symptoms of increased arousal (irritability)

249

What are three examples of traumatic events

Childhood physical/emotional abuse
Violent attacks
Rape
War
Natural catastrophe

250

Name some physical illnesses which can bring upon stress

- Cancer
- Coronary Heart Disease
- Chronic Fatigue Syndrome
- Infertility/Miscarriage
Peptic Ulcers
- Irritable Bowel Syndrome
- Karoshi

251

What is Karoshi

A death from overwork usually resulting in a stroke

252

How can we manage stress

Exercise
Meditation
Yoga
Cognitive Behavioural Therapy

253

What are two purposes of NHS press releases

Reactive - Defending the NHS reputation

Proactive - Improving and protecting population health

254

Name some social marketing messages

Five-a-day
Change for life

255

Name some early recognition campaigns

act FAST

256

What diseases are linked to obesity

Type II diabetes
hypertension
Osteoarthritis
Bladder control problems
Psychological Disorders

257

What people did obesity originally affect

The rich

258

What group of people does obesity affect now

Poor

259

What percentage of professionals are obese

18%

260

What percentage of unskilled/manual workers are obese

28%

261

What are some causes of obesity

Americanisation of diet and society
Increasing dominance of car culture - less walking
More commuting
Replacing water by sugary drinks
Longer working hours

262

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

263

What two factors affect the aetiology of obesity

Environment and Genetics and Behaviour

264

How do we try and monitor weight gain in an individual

1. MRI
2. Dual-energy X-ray Absorptiometry
3. Waist circumference
4. WHR (waist to hip ratio)
5. Skinfold thickness
6. BMI

265

What is BMI is counted as being underweight

Anything below 18.4

266

What BMI is normal

18.5 - 24.9

267

What BMI is classed as overweight

25.0 - 29.9

268

What BMI is classed as obese class I

30.0 - 34.9

269

What BMI is classed as Obese class II

35.0 - 39.9

270

What BMI is classed as obese class III

Over 40.0

271

What are the seven key domains of energy balance

Food Environment
Food Consumption
Individual Activity
Activity of the environment
Social Influences
Individual psychology
Individual Biology

272

What is Prader Willi Syndrome

Short stature
Almond shaped eyes
Small hands
Small feet
Chromosome 15 deletion

A genetic cause of obesity

273

What other genetic problems can result in obesity

Mutations of leptin and melanocortin receptors

Congenital leptin deficiency

Polygenic obesity

274

Name two studies used to investigate the role of leptin on obesity

Animal Studies:
Agouti mice: Produced excess agouti which decreased melanocortin system's response to leptin

Ob-gene mice: Produced no leptin

275

What was the relationship seen between pima indians and obesity

The Pima Indians showed dramatic increase in obesity when exposed to western environment - 9%% of population now have diabetes

276

How can employment affect weight gain

a) Shift work, lack of sleep and upset circadian rhythm
b) reduced physical activity
c) Cortisol, leptin, ghrelin

277

What two behaviours can be associated with weight gain

Dietary patterns

Leisure and activities

278

What advantage does breast feeding give in regards to obesity

It is associated with protective mechanisms from obesity

279

How does early introduction of solid food to a toddler affect obesity chances

Increases risk if introduced from under 4 months age

280

What is the biggest predictor of obesity

Childhood obesity

281

What is considered a 'direct control' of meal size

All factors relating to direct contact of the food with the GI mucosal receptors

282

What is considered an 'indirect control' of meal size

Metabolic, endocrine, cognitive individual differences

NOTE: Indirect controls can override direct controls

283

Define satiation

What brings an eating episode to end

284

Define satiety

Inter-meal period

285

What is the satiety cascade

Sensory -> cognitive -> post-ingestive -> post-absorptive

286

How does fat affect satiation and satiety

Fat has a really weak impact

NOTE: High-Fat foods improve the sensory properties

287

What food brings about the most efficient satiety

Proteins

288

What food brings about the least efficient satiety

Alcohol

289

How are STIs mainly transmitted

Sexual contact

290

What are the four main types of STIs

1. Chlamydia
2. Gonorrheas
3. Syphilis
4. Trichomoniasis

291

Which STI is currently drug resistant

Gonnorhea

292

What are the ABCs to prevent HIV

A = Abstain
B = Be Faithful
C = Condom use

293

What are the four aspects of sexual health education

1. Involve young people as they are key decision makers

2. Provide comprehensive, accurate information

3. Address barriers to a accessing health services

4. Empower adolescents to make life choices that are best for them

294

Define CAM

- A broad domain of healing resources that encompasses all health systems, modalities and practices and their accompanying theories and beliefs

- It is those healing resources other than those intrinsic to the politically dominant health system of a particular society or culture in a given historical period

295

How can we reduce energy density in diets to reduce calorie intake

Incorporation of water
Fruits or vegetables
Reducing fat
Method of cooking (frying or grilling)

296

In What state does food have a lower energy density

Liquid (except soup)

297

How does alcohol cause over-eating

Stimulates intake (no satiety)
Efficiently oxidised
Adds to total daily energy intake

298

How does food environment affect obesity

Variety (greater variety causes over-eating)

Portion size - increased over the years

Distraction (e.g. watching TV)

299

What psychological factors contribute to over-eating

1. Dietary restrain
2. Stress
3. Sleep (shorter sleep = more eating)
4. Reward sensitivity

300

What are three characteristics that encourage over-eating

Macronutrient composition

Energy Density

Liquid vs Solids

301

Example of primary care of CHD

SNAP
1. Smoking (taxing, no public places, health warnings and tobacco control)
2. Nutrition (5 a day)
3. Alcohol (Know your limits, taxation, alcohol pricing)
4. Physical Activity (At least 5 times a week)

302

What are the four phases of cardiac rehabilitation

Phase 1 - In hospital

Phase II - Early post discharge

Phase (III-IV) - 16 weeks

Phase IV - SNAP (long-term maintenance of lifestyle change)

303

What are some ways we can do secondary prevention in people wit CHD

Primary care CHD registers

Medical management: Aspirin, B-blockers, ACE inhibitors

Phase IV cardiac rehabilitation

304

Define Social Class

A measure of occupation, stratification, social position and access to power and resources.

305

What model can quantify social class

NS-SEC model

306

Define the inverse care law

The availability of good medical care tends to vary inversely with the need for it within a population

307

What is the 'sick role' in society

People inhabit social roles and illness allows legitimate deviance from social obligation:

1. Exempt from normal social roles

2. Is not responsible for their role condition

3. Should try to get well

308

Define Iatrogenesis

The unintended adverse effects of therapeutic intervention

309

Name some examples of CAM medicine

Acupuncture
Osteopathy
Herbal medicine
Chiropractic
Hypnotherapy
Aromatherapy
Shiatsu

310

What are the four classifications based on therapeutic similarity

Manual therapies: Chiropractic, massage, osteopathy

Ethnic medical systems: Acupuncture, herbal medicine

Mind-body/energy medicine: Healing and hypnotherapy

Non-allopathic system: Homeopathy, naturopathy

311

What is the house of lords classification for CAM

Group 1: Some scientific evidence of efficacy (acupuncture, chiropractic, herbal med)

Group 2: Modalities working in a supportive capacity alongside conventional medicine but not on its own (massage, hypnotherapy)

Group 3: Traditional systems of medicine backed only by historic practice (no evidence they actually work)

312

What sex mainly uses CAM

Females

313

What age group do CAM users lie in

35-60

314

What type of household do most CAM users come from

Rich

315

What three things do people expect to get from CAM

1. Reduction of symptoms + disability
2. Avoidance of medication
3. Gaining control and improving coping skills

316

What is appealing about CAM to potential users

1. Side-effects from conventional treatment
2. Disease is not serious enough to cure
3. Naivety
4. High patient satisfaction rate
5. Poor communication with doctors

317

What are three major concerns for CAM

- Unrealistic expectations
2. Delayed conventional care
3. General safety

318

What are the big 5 CAM based treatments for the NHS

1. Acupuncture
2. Chiropractice
3. Homeopathy
4. Herbal Medicine
5. Osteopathy

319

What are four basic health economic problems

1. Finite resources
2. Desire for good and services is infinite
3. No country treats all treatable ill health

320

Define opportunity cost

Sacrifice in terms of benefits foregone from not allocating resources to the next best activity

321

Define economic efficiency

When resources are allocated between activities to maximise benefit

322

What are three types of economic evaluation

1. Cost-effectiveness analysis
2. Cost-utility analysis
3. Cost-benefit analysis

323

Define cost-effectiveness analysis

Outcomes measured in natural units: incremental cost per life year gained

324

Define cost-utility analysis

Outcomes measured in quality adjusted life years: incremental cost per QALY gained

325

Define cost-benefit analysis

Outcomes are measured in monetary nuts: net monetary benefit

326

Define equity

Concerned with fairness or justice of the distribution of costs and benefits