Public Health Flashcards
(264 cards)
1
Q
What did The Black Report show?
A
Confirmed social class health inequalities in overall mortality and that health inequalities were widening
2
Q
When was The Black Report?
A
1980
3
Q
What were the recommendations from The Black Report?
A
Material - environmental causes
Artefact - product of how inequality is measured
Cultural/Behavioural - poor people to unhealthy things, own responsibility
Selection - ill sink in society
4
Q
Explain the Whitehall study of British Civil Servants cohort
A
Inequalities in health and mortality between employment
Risk factors only explain 1/3 of observed variation in health by employment grade
5
Q
What did the Acheson Report (1988) show?
A
Mortality decreased but health inequalities remained and sometimes widened
6
Q
What did the Acheson Report recommend?
A
Evaluate all policies like to affect health inequalities
give high priority to health of families with children
Reduce income inequalities and improve living conditions I poor households
7
Q
Name 3 theories of casuation
A
Psychosocial
Neo-material
Life-course
8
Q
What is the psychosocial theory of causation?
A
Effect of poverty on us psychosocially
Stressors are mainly social
Stress –> BP, cortisol levels
9
Q
What is the neo-material theory of causation?
A
Poverty exposes people to health hazards
Hierarchy to public good
Money = goods
10
Q
Explain the life-course theory of causation
A
Critical periods – greater impact at certain points in life course primarily childhoods (e.g. measles in pregnancy)
Accumulation – hazards and their impacts add up (e.g. hard blue collar work –> injuries –> reduced work opportunities)
Interactions and pathways – (e.g. sexual abuse in childhood –> poorer partner choices, increases exposure to violence etc.)
11
Q
How can doctors close the gap in health inequalities?
A
- Changing perspectives
- Changing systems
- Changing education
12
Q
Why is women life expectancy longer than mens?
A
80% environmental - men take more risks, have more dangerous jobs and are less likely to visit the doctor
20% biological - oestrogen protects against CHD
13
Q
Describe the association between social class and lie expectancy
A
The higher the socio-economic classification the higher the life expectancy at birth
14
Q
Describe the association between social class and smoking
A
A greater percentage of people who smoke are in the lower socio-economic classes
15
Q
Describe the association between mortality and unemployment
A
Mortality is greater in the unemployed
16
Q
Define patient compliance
A
The extent to which the patient’s behaviour coincides with medical or health advice
17
Q
Give 3 disadvantages of patient compliance
A
- It is passive, the patient MUST follow the doctor’s orders
- It is professionally focused and assumes the doctor knows best
- It ignores problems patients have in managing their health
18
Q
Define patient adherence
A
The extent to which he pateint’s action match agreed recommendations - it is more patient centred
19
Q
What is the difference between patient compliance and adherence?
A
Patient adherence is more patient centred, it empowers patients and considers them as equals in care. Patient compliance is often viewed as uncaring, condescending and passive
20
Q
What are the key principles of adherence?
A
- Improve communication
- Increase patient involvement
- Understand the patient’s perspective
- Provide and discuss information
- Assess adherence
- Review medicines
21
Q
Describe the necessity-concerns framework
A
Looks at what influences adherence
Adherence increases when necessity beliefs are high and concerns are low
22
Q
Give 2 factors that patient centres care encourages
A
- Focus on the patient as a whole person - holistic
2. Shared control of the consultation, decisions are made by the patient and doctor together
23
Q
What is concordance?
A
Expectation that patients will take part in treatment decisions and have a say in the consultation - negotiation between equals
24
Q
Give 5 barriers to concordance
A
- The patient may not want to engage in discussions with their doctor
- It may lead to worry
- Patients may just want the doctor to tell them what to do
- Time, resources and organisational constraints
- Challenging, patient choice may differ significantly from medical advice
25
Give 4 advantages of doctor-patient communication
1. Better health outcomes
2. Higher compliance to therapeutic regimens
3. Higher patient and clinician satisfaction
4. Decrease in malpractice risk
26
What are the 5 main duties of a doctor?
1. Work in partnership with patients, treat as individuals and respect their dignity
2. Work with colleagues in a way that best serve patients' interests
3. Protect and promote health
4. Recognise and work within the limits of your competence
5. Provide a good standard of care
27
What is the difference between infection and colonisation?
Infection results in harm to the individual whereas there is no harm in colonisation
28
What did the Health Act 2006 state?
Infection control is every health care workers responsibility
29
What are the principles of Infection Prevention and Control?
1. Identification of risks
2. Routes and modes of transmission
3. Virulence of organisms - ease of spread likelihood of causing infections and consequences
4. Remediable factors
30
How can the environment be changed to prevent transmission of infection?
1. Design - hospital beds further apart
2. Ensuring a clean environment
3. Infectious individuals can be isolated
31
What can staff do to prevent the transmission of infection?
1. Barrier precautions - gloves and aprons
2. Isolation
3. Good hand hygiene
32
What can norovirus cause?
Gastroenteritis
| Diarrhoea and Vomiting
33
Why does norovirus have a high attack rate amongst close contacts?
Low infecting dose
| Uncontaminated D+V
34
Will norovirus be killed by alcohol hand gel?
NO - resistant to conventional cleaning, only killed by soap and water
35
What are endogenous infections?
Infection of a patient by their own flora
36
How can endogenous infections be prevented?
1. Good nutrition and hydration
2. Antisepsis/skin prep
3. Control underlying disease
4. Remove lines and catheters as soon as clinically possible
5. Reduce antibiotic pressure as much as clinically possible
37
What are the UNAIDS goals to be achieved by 2020
90/90/90
90% of people living with HIV are diagnosed
90% diagnosed are on ART (antiretroviral therapy)
90% viral suppression for those on ART
38
Name 3 HIV transmission routes
1. Blood
2. Sexual
3. Vertical (mother to baby)
39
Give 6 ways in which HIV can be prevented
1. Circumcision- Reduces HIV penetration due to keratinization of remaining foreskin
2. Post exposure prophylaxis
3. Pre-exposure prophylaxis
4. STI control
5. HAART
6. Early diagnosis
7. Behavioural - Sex education
8. Condom use
9. Needle exchange
40
Name the 5 most risk groups of individuals to HIV
```
Men who have sex with men
Heterosexual women
Injecting drug users
Commercial Sex Workers
Heterosexual men
```
41
Name the 3 stages to the HIV epidemic
1. Nascent - prevalence <5%
2. Concentrated - prevalence >5% in one or more subpopulation
3. Generalised - >5% everywhere, not just confined to subpopulations
42
Name the 3 main ways of mitigating the impact of HIV
1. Behavioural change - education
2. Knowing your status
3. Specific interventions
43
Name 4 problems with the delivery of antiretroviral to those in developed countries
1. Awareness
2. Clinical services are understaffed
3. Cost
4. Procurement/delivery
5. Adherence
44
Name 3 goals of HIV testing services
1. Provide high quality service for identifying HIV
2. Link individuals to HIV - treatment, care and support
3. Prevent transmission
45
What can diabetes result in?
Blindness
Renal failure
Amputation
46
Name 6 risk factors of Type 2 Diabetes
1. Sedentary job, lack of exercise
2. Obesity
3. Family history
4. History of gestational diabetes
5. Hypertension
6. Impaired glucose tolerance or impaired fasting glucose
47
What is the 4 step process to intervention of Diabetes
```
Step 0 = identifying those at risk
Step 1 (primary) = Preventing diabetes
Step 2 (secondary) = Diagnosing diabetes earlier
Step 3 (tertiary) = Management of Diabetes
```
48
What is an obesogenic environment?
An environment that encourages people to eat unhealthily and not do enough exercise
49
Give 3 physical characteristics of an obesogenic environment
1. TV remote controls
2. Car culture
3. Lifts
50
Give an economic characteristic of an obesogenic environment
Expensive fruit and vegetables
| Cheap unhealthy food
51
Give a socio-cultural characteristic of an obesogenic environment
Family eating patterns
52
Give 3 mechanisms that lead to people being unable to lose weight
1. Physical: more weight = more difficult to exercise
2. Psychological: low self esteem = comfort eating
3. Socioeconomic: reduced opportunities and employment
53
What is the primary prevention for Diabetes?
Focus on communities most at risk - increase exercise, improve diet, weight loss
Healthier you: The NHS Diabetes Prevention Programme
54
What is the secondary prevention for Diabetes?
Raise awareness of DM and symptoms in the community and within health care professionals
Use records to identify those at risk
Screening
Preventing Pre-daibetes --> Diabetes
55
What is the tertiary prevention for Diabetes?
```
Self-monitoring
Diet
Exercise
Education
Peer support
Drugs
```
56
Define overweight/obese
Abnormal or excessive fat accumulation that presents a risk to health
57
How is BMI worked out?
Weight (kg)/height2 (m)
58
Where are higher levels of obesity seen?
In areas of greater deprivation
59
What can poor nutrition in children cause?
1. Emotional and behavioural impacts - stigma, bullying, self-esteem
2. Educational impacts
3. Physical health impacts
60
Describe the association between obesity and shift work
Obesity is more prevalent in people who do shift work
| Sleeping out of phase affects the metabolic circadian rhythm
61
Give 5 potential consequences of obesity in adults
1. Less likely to be employed
2. Discrimination and stigma
3. Risk of hospitalisation
4. Reduced life expectancy
5. Depression and psychiatric problems
62
Describe individual level interventions for managing obesity
1. Behaviour change: stimulus control, goal setting, slow rate of eating, relapse prevention, social support, hypnotherapy
2. Community based programmes can provide on going advice and support
63
Describe wider level interventions for managing obesity
1. Food supply: reduce energy dense ingredients and improve access to healthy foods
2. Media campaigns e.g. change4life, 5-a-day
3. Environment: improve cycle lanes etc
4. Sugar tax and subsidise healthy eating
5. Restrict the sale of certain foods and drinks in schools
64
What can doctor's do to help manage obesity?
1. Educate patients - make every contact count
2. Signpost to weight management programmes
3. Prescribe exercise
4. Refer for surgery
65
Give 5 indications for the surgical treatment of obesity
1. BMI > 40
2. BMI > 35 and co-morbid
3. Minimum 5 year's obesity
4. Failure of conservative treatment
5. No alcoholism or psychiatric illness
6. > 18 y/o
66
Give an example of a restrictive surgical treatment for obesity
Gastric banding
67
Give an example of a malabsorptive surgical treatment for obesity
Jejuno-ileal bypass
68
Give the 4 tiers to the obesity care pathway
Tier 1 = universal prevention
Tier 2 = Lifestyle intervention
Tier 3 = Specialist services
Tier 4 = Surgery
69
What are the 4 principles of medical ethics?
1. Autonomy - respect the patient's choices
2. Beneficence - do good
3. Non-maleficence - do no harm
4. Justice
70
What is deontology?
Features of the act determines worthiness
Teaches that acts are right to wrong, people have a duty to act accordingly
Do unto others as you would be done by
71
What are the challenges of deontology?
1. Consequences aren't taken into account
| 2. Duties can conflict
72
What are virtue ethics?
Focus on character of the person acting
Combines reason and emotion
An act is only virtuous if the person has the right mind set
Virtues are acquired
73
What are the 5 focal virtues?
1. Discernment
2. Conscientiousness
3. Trustworthiness
4. Integrity
5. Compassion
74
Define discernment
The ability to judge well
75
Define conscientiousness
Being thorough, carful and vigilant
76
Define trustworthiness
The ability to be relied on and trusted
77
Define integrity
Being honest and having good moral principles
78
Define compassion
Showing concern for others
79
What are the challenges of virtue ethics?
1. Culture specific and too broad for practical application
| 2. No clear guidance for moral dilemmas
80
What are utilitarian ethics (consequentialism)?
An act is evaluated solely in terms of its consequences
| Maximise good, minimise harm
81
What are the challenges of utilitarian ethics (consequentialism)?
Treats minorities unfairly to promote the happiness of a majority
82
Name 2 approaches to ethical analysis
1. Seedhouse's ethical grid
| 2. The four quadrant approach
83
Describe the inner layer of Seedhouse's ethical grid
Asks the question of whether the intervention is going to create autonomy, respect autonomy and treat all equally
84
Describe the second layer of Seedhouse's ethical grid
Duties and motives
Is the intervention consistent with moral duties - keeping promises, telling the truth, minimising harm and maximising benefit
85
Describe the third layer of Seedhouse's ethical grid
Consequentialist layer
Is the intervention going to provide the greatest benefit for the greatest number?
Who will benefit, society, individuals, a group?
86
Describe the outer layer of Seedhouse's ethical grid
Is the intervention likely to be affected by external considerations e.g. risk, law, use of resources?
87
What are the advantages of Seedhouse's ethical grid?
It provides structure and function for analysing ethical problems
Based on moral theory
88
What are the heading which make up the four quadrants approach?
1. Medical indications - beneficence and non-maleficence
2. Patient preferences - respect for autonomy
3. Quality of life - beneficence and non-maleficence
4. Contextual features - loyalty and fairness
89
Define connectivity and interdependence
The behaviour of one individual may affect others
90
Define co-evolution
Adaptation of one organism alters other organism
| The doctor and patient co-evolve
91
Define the far from equilibrium
Being pushed away from equilibrium is essential for survival and flourishing
pushing yourself away from your comfort zone
92
Define conscientious objections
Moral claims that are based on an individual core ethical beliefs
It is important to balance conscientious injections with professional obligations
93
What did Friedman and Rosenman (1959) describe?
Coronary prone behaviour --> competitive, hostile, impatient, type A behaviour
94
What tool can be used to assess type A behaviour?
Minnesota Multi-phasic Personality Index (MMPI)
95
Give 3 psychosocial factors that could increase someone's risk of MI
1. Depression/anxiety
2. High demand and low control at work, working more than 11 hours a day
3. Loneliness and social isolation
96
What can doctors do to help combat psychosocial factors that can increase the risk of patient mortality?
1. Identify signs fo depression/anxiety
2. Ask patients about their occupation
3. Ask patients about their support networks
4. Liaise with relevant services - social care, occupational health
97
Define clinical truth
Contextual, circumstantial and personal
98
Name the 5 ethics in practice
1. Candour
2. Consent
3. Capacity
4. Confidentiality
5. Communication
99
Name 4 problems with teamwork
1. Lack of teamwork
2. Lack of leadership
3. Lack of effort
4. Lack of communication
5. Lack of challenge
100
What are the 6 components of teamwork
1. Communication/SBARR
2. Leadership and followership
3. Authority gradient
4. Situational awareness
5. Declaring emergency
6. Training together
101
What is SBARR?
```
Used to facilitate communication
Situation = what is the situation?
Background = which is the clinical background
Assessment = what is the problem?
Request = what do I request to be done?
Recommendation = what do I recommend?
```
102
How does someone go about challenging authority?
1. Express concern
2. Enquire or offer a solution
3. Seek explanation
4. Direct challenge
103
What is the populations attributed fraction?
The proportion of the incidence of a disease in the exposed and non-exposed population that is due to the exposure e
Exposure eliminated = disease incidence eliminated
104
Why has the CHD mortality declines in England and Wales?
Improvement of risk factors = reduction in smoking, population BP fall
Treatments = hypertension therapies, secondary prevention
105
Give the 2 explanations of why social inequalities occur
1. Absolutist = it's about poverty
| 2. Relativist = inequality in society, greater = bad
106
Define the number needed to treat
Measurement of the impact of a medicine or therapy by estimating the number of patients needed to treat over a given time period in order to have an impact on 1 person
1/ARR (absolute risk reduction)
107
Define substance use
Ingestion of a substance affecting the CNS which leads to behavioural and psychological changes
108
How do new psychoactive substances act?
Mimic the effects of other substances but less predictably
| E.g. Synthetic cannabinoids, stimulant-type drugs
109
What is the prevention theory?
Prevent substance abuse by reducing risk factors and increasing protective factors throughout life
110
Give 4 risk factors for substance misuse
1. Family history of substance misuse
2. Family management problems e.g. poor parenting
3. Family conflict e.g. domestic abuse
4. Low academic attainment at school
5. Availability of drugs in the community
6. Peer pressure
7. Experience of trauma e.g. abuse, loss, poor parenting
111
Give 3 ways to prevent substance misuse
1. Good family attachment
2. Academic achievement
3. Opportunities to develop self confidence, self worth and resilience
112
Name the 2 categories of dependence
1. Physical
| 2. Psychological
113
What is physical dependence?
Body adapts to presence of substance
| Needs more and more for the same effect
114
What is the psychological dependence?
Feeling that life is impossible without the drug
| Emotional effect = pain, fear, loneliness
115
Name the 3 diagnostic codes
```
0 = acute intoxication
1 = harmful use
2 = Dependence
```
116
What is the diagnostic code of acute intoxication mean?
Disturbances in level of consciousness, cognition, perception, affect to behaviour
117
What is the diagnostic code of harmful mean?
Pattern of use causing damage to health
118
What is the diagnostic code of dependence mean?
Strong desire to take drug, difficulty controlling use
119
What are the 11 factors that contribute to the diagnostic model?
1. Consuming more than originally planned
2. Worrying about stopping/consistently failed efforts to control use
3. Spending a large amount of time using/obtaining substance
4. Use results in failure to fulfil major role obligations
5. Craving
6. Continued use despite health problems caused or worsened by it
7. Continued use despite negative relationship effects
8. Repeated use in a dangerous situation e.g. driving
9. Giving up or reducing activities
10. Building up a tolerance to the alcohol or drug (more for same effect)
11. Withdrawal symptoms
120
How is the diagnostic model used?
In the past 12 months:
2-3 = mild depended
4-5 = moderate dependence
6+ = severe dependence
121
What factors define dependence syndrome?
1. Desire to use
2. Difficulties controlling use
3. Physiological withdrawal state when reduce use
4. Tolerance
5. Increased time spent using
6. Use despite evidence of harmful consequences
122
Name 2 opiates and describe their effects
Heroin and morphine
| They create a sense of euphoria, and provide pain relief and are depressants
123
What are the effects of alcohol?
Alcohol is a depressant, its effects are sedation, relaxation and slowing down thinking/acting
124
Name 3 stimulants and describe their effects
Caffeine, nicotine, cocaine
| Increases alertness and activity and elevate mood
125
Name 2 hallucinogens and describe the effects
Ecstasy and ketamine
| Alter sensory perception and thinking patterns, and loss of sense of reality
126
Give 5 different societal opinions to substance abuse
1. Addiction is a disease
2. Genetics influence addictive tendencies
3. Punishments should be greater for those who use drugs
4. Addiction is due to up bringing and a lack of moral values
5. Poverty, social exclusion and mental health should be targeted to help deal with addiction
127
What are the 3 main features of the national drug strategy?
1. Reduce demand
2. Restrict supply
3. Build recovery in communities
128
What are local provisions that are provided for people with substance misuse?
1. GPs
2. Harm reduction service
3. Open access service
4. Structure psychosocial intervention
5. Prescribing services
6. Detoxification
7. Access to residential rehab
8. Recovery support/mutual aid
129
What is residential rehab?
3-12 months
Address underlying issues and learn coping mechanisms
Solve social, financial etc issues
130
What is the maximum units of alcohol that men and women can consume within a week?
14 units
| Spread over >3 days
131
Write an equation that can be used to work out the number of units in a drink
Strength of the drink (%abv) X amount of drink (ml) / 1000
132
How would you define binge drinking?
Drinking >6 units of alcohol in one go
133
Describe the alcohol harm paradox
Those in lower socioeconomic groups consume less alcohol than the in higher socio-economic groups but they experience greater alcohol-related harm
134
Give the main causes of alcohol related death
1. Alcoholic liver disease
2. Fibrosis and cirrhosis of liver
3. Mental and behavioural disorders
4. Accidental poisoning
135
Give 3 acute effects of excessive alcohol
1. Accidents and injury
2. Pancreatitis
3. Cardiac arrhythmias
4. Coma and death from respiratory depression
5. Gastritis
136
Give 3 chronic effects of excessive alcohol
1. Liver disease
2. CNS toxicity (e.g. dementia)
3. Hypertension
4. CHD
137
Give 4 psychosocial effects of excessive alcohol consumption
1. Interpersonal relationships affects (e.g. violence, rape)
2. Problems at work
3. Criminality
4. Driving offences
138
Give 4 signs of foetal alcohol syndrome
1. Pre and post natal growth retardation
2. Mental retardation
3. Craniofacial abnormalities
4. congenital defects (e.g. eyes, ear, mouth)
139
Give 4 symptoms of alcohol withdrawal
1. Tremor
2. Seizures
3. Insomnia
4. Hallucinations
5. Activation syndrome
140
How long does alcohol withdrawal last?
Occurs 6-24 hours after last drink and can last up to a week
141
What is delirium tremens?
Most sever form of Algol withdrawal
Occurs 24-72 hours after stopping
Hyper-adrenergic state, disorientation, tremors, diaphoresis, impaired attention, hallucinations
142
Name 3 public health campaigns associate with reducing alcohol intake
1. 'Know your limits' - binge drinking
2. Drinkaware - alcohol labelling
3. THINK! - drink drive campaign
143
Give 3 methods of screening for alcohol consumption
1. FAST - fast alcohol screening test
2. CAGE questions
3. AUDIT tool
144
What are the 4 questions that make up CAGE?
1. Have you ever felt that you should cut down?
2. Have you ever felt annoyed by people telling you to cut down?
3. Do you feel guilty about how much you drink?
4. Eye opener - ever had a drink first thing in the morning?
145
What are the 3 questions that make up AUDIT?
1. How often do you have a drink containing alcohol?
2. How many units of alcohol do you drink on a typical day?
3. How often did you have >6 units on a single occasion in the past year?
146
Define at risk drinking
A pattern of drinking which brings about the risk of harm
147
Define alcohol abuse
A pattern of drinking which is likely to cause harm
148
Define alcohol dependence
A set of behavioural, cognitive and physiological responses the can develop after repeated substance abuse
149
Define tolerance
State in which an organism no longer responds to a drug
| A higher dose is required to achieve that same effect
150
Describe the four tiers alcohol intervention
Non substance misuse specific services
Open access drug/alcohol services
Specialist community-based clinics
Specialist in-patient services
151
What questions might you ask to determine whether someone has alcohol dependence?
In the past 12 months have you:
1. Shown tolerance?
2. Shown signs of withdrawal?
3. Not been able to stick to drinking limits?
4. Spent a lot of time drinking?
5. Kept drinking despite known problems?
152
What kinds of questions are asked in the severity of alcohol dependence questionnaire?
1. Asks about withdrawal symptoms
2. Relief drinking?
3. Frequency of alcohol consumption
4. Speed of onset of withdrawal symptoms
153
What inhibitory neurotransmitter does alcohol potentiate?
GABA
| Inhibits presynaptic Ca2+ entry and transmitter release so increase in Ca2+ channels
154
What is the preferred drug used in alcohol detoxification?
Chlordiazepoxide
155
Name 2 drugs that can prevent alcohol replace?
1. Acamprosate - acts on neural pathways
2. Disulfiram - disrupts oxidative metabolism of alcohol
3. Nalmefine - opioid receptor antagonist so reduces felling of reward/pleasure
156
Give 3 side effects of disulfiram
Dilsulfiram leads to increased acetaldehyde levels
| Side effects include flushing of skin, SOB, nausea, vomiting, tachycardia
157
Deficiency of what vitamin can lead to Wernike's encephalopathy?
Vitamin B1 - thiamine
| Metabolism of alcohol depends on thiamine so common in dependent drinkers
158
What are the symptoms of Wernike's encephalopathy?
Ataxia
Confusion
Nystagmus
159
What is the treatment for Wernike's encephalopathy?
Pabrinex
| Vitamin B/thiamine
160
What can Wernike's encephalopathy lead to?
Korsakoff syndrome
Memory impairment
Chronic and irreversible
161
What do environmental health officers do?
Inspect businesses for health and safety, food hygiene and food standard
Investigate outbreaks of food poisoning and infectious disease
Collect samples for lab testing
162
Name 3 causes of non-infective diarrhoea
1. Neoplasm
2. Inflammatory
3. Corhn's disease
4. UC
5. IBS
6. Hormonal
7. Radiation and chemical
163
Name 4 causative organism of diarrhoea
1. Rotavirus
2. Shigella
3. E.coli
4. Salmonella
5. Hepatits
164
Describe the chain of infection
Reservoir --> portal of exit --> agent --> mode of transmission --> portal of entry --> host --> person to person spread --> reservoir
165
Name 3 types of transmission of infection
1. Direct
- direct
- face-oral
2. Indirect
- vector borne
- vehicle borne
3. Airbourne
- respiratory route
166
Give 3 symptoms of norovirus
1. Vomiting
2. Diarrhoea
3. Nausea
4. Cramps
5. Headache
167
What is the spread of C. diff associated with?
Antibiotics
168
What prevention techniques are used to prevent diarrhoea?
1. Rotavirus and measles vaccinations
2. Promote early & exclusive breastfeeding + vitamin A supplementation
3. Promote hand washing with soap
4. Improve water supply quantity & quality
5. Community-wide sanitation promotion
169
What is the treatment for diarrhoeal disease?
1. Fluid replacement
| 2. Zinc treatment
170
Give 4 control measure to prevent diarrhoea
1. Hand-washing with soap
2. Ensure availability of safe drinking water
3. Safe disposal of human waste
4. Breastfeeding of infants & young children
5. Safe handling and processing of food
6. Control of flies/vectors
7. Case management including exclusion
8. Vaccination
171
Name 4 at risk groups for diarrhoea
1. Poor hygiene groups
2. Children attending pre school/nursery
3. Workers involved in preparing and serving unwrapped/uncooked food
4. HCW working with vulnerable people
172
What has to happen if you come across a notifible infectious disease?
Legal obligation to inform authority
173
Why are certain diseases notifiable?
Very dangerous
Vaccine preventable
Disease that need specific control measures
174
Name 4 notifiable infectious disease
1. Malaria
2. MMR
3. Meningitis
4. Cholera
5. Anthrax
6. TB
175
Why do we report infectious diseases?
```
Detection of any changes in disease
- Outbreak detection
- Early warning
- Forecasting
Track changes in disease
- Extent and severity of disease
- Risk factors
Allows development of interventions targeted at vulnerable groups
```
176
What actions are taken when a notifiable infectious disease is reported?
```
Investigate case
Identify + protect vulnerable individuals
Remove from high risk settings
Health promotion
Coordinate multi-agency responses
```
177
What are the steps in reporting a notifiable infectious disease?
1. Notification
- All suspected cases without delay
2. Contact tracing
- Any person with close contact in the past 7days
3. Prophylaxis
- Advice
- Antibiotic chemoprophylaxis
- Doesn’t stop disease if already incubating
- Immunisation
178
Name the 2 types of immunisation
1. Active = cell mediated and antibody mediated immunity
| 2. Passive = temporary protective from transfer of antibodies from immune individuals
179
How does active immunity work?
Vaccination stimulates immune response and memory to a specific antigen/infection
180
Name 3 things of which active immunisations can be made from?
```
Inactivated
Attenuated live organism
Secreted products
Constituents of cell walls
Recombinant components
```
181
How does passive immunisation work?
Human normal immunoglobulin (HNIG) from plasma of donor
| Contains antibodies to infectious disease in the short term
182
How can vaccines fail?
Primary failure = person doesn't develop immunity from vaccine
Secondary failure = initially responds but protection reduces over time
183
Name 5 serogroups of Meningitis
B, C, A, Y, W135
184
How is meningitis prevented?
Notification of any suspected cases
Contract tracing
Prophylaxis - advice, antibiotic chemoprophylaxis, immunisation
185
What routine meningitis vaccines are provided?
Childhood = Men C, Men B and quadrivalent (ACYWY pre-university)
Travel vaccines
186
What classifies as good musculoskeletal health?
Healthy/disease free muscle, joints and bones
| Ability to carry out a wide range of physical activities.functions both effectively and symptom free
187
Name 4 types of effective and cost-effective MSK risk management strategy
1. Vitamin D/calcium - adequate dietary intake +/- supplements
2. Weight management - calorie intake and calorie expenditure
3. Physical activity - balance + strength + mobility (+/- fitness)
4. Injury presentation - home, workplace, recreational, travel related
188
What are the Wilson and juggler screening criteria?
1. The condition being screened for should be an important health problem
2. The natural history of the condition should be well understood
3. There should be a detectable early stage
4. Treatment at an early stage should be of more benefit than at a later stage
5. A suitable test should be devised for the early stage
6. The test should be acceptable
7. Intervals for repeating the test should be determined
8. Adequate health service provision should be made for the extra clinical workload resulting from screening
9. The risks, both physical and psychological, should be less than the benefits
10. The costs should be balanced against the benefits
189
When is an illness due to work?
Symptoms improve away from work
Characteristic distribution of rash - e.g. contact dermatitis
Cluster of cases at workplace
Exposure to hazard linked to disease
190
What is the Bradford Hill criteria?
A group of minimal conditions necessary to provide adequate evidence of a causal relationship
191
Give 6 of the Bradford Hill criteria that provide evidence for causation
```
Strength of association
Consistency in association
Exposure- response relationship
Specificity
Temporal relationship
Coherence of evidence
Biologically plausible
```
192
Give 3 examples of work related MSK disorders
1. Carpal tunnel syndrome
2. Tenosynovitis
3. Rotator cuff problems
193
Who might be at risk of carpal tunnel syndrome?
A painter/decorator due to the forceful and repetitive nature of their work with abnormal wrist postures
194
Who might be at risk of rotator cuff problems?
People in jobs that involve lifting above the shoulder
195
What is anorexia nervosa?
A restriction of energy intake relative to requirement leading to low body weight
Person has an intense fear of gaining weight
196
What BMI indicates that someone might be suffering from anorexia nervosa?
BMI < 17.5
197
Name 2 sub types of anorexia nervosa
1. Restricting
| 2. Binge-eating and purging
198
Give the 2 characteristic features of bulimia nervosa
1. Recurrent episodes of eating large amount in discrete periods of time
2. Inappropriate compensatory behaviour to prevent weight gain - purging
199
What is binge eating?
Eating large amounts of food in discrete periods of time and having a lack of control of eating
There is no purging or compensatory behaviour
200
Give 5 characteristics of binge eating episodes
1. Rapid eating
2. Eating until uncomfortably full
3. Eating large amounts of food when not hungry
4. Eating alone due to embarrassment
5. Feeling depressed or guilty afterwards
201
Name 3 Other Specified Feeding and Eating Disorders (OSFED)
1. Atypical anorexia nervosa
2. Purging
3. Night eating syndrome
202
Describe the Core model (Slade, 1982)
Describes the factors that contribute to the onset of eating disorders
It says onset is due to a combination f Lowe self esteem and perfectionism lead to a need for control
This is a trigger for using food as a means of self control
203
What is important to look out for when assessing someone who you suspect has an eating disorder?
```
Severe resection of food/fluid
Electrolyte imbalance - particularly K+
Bone deterioration
Physical damage (blood in vomit)
Alcohol/drug intake
```
204
What are the urgent signs when assessing someone who may have an eating disorder?
```
Muscular weakness
Breathing problems
Cardiac signs
Rapid weight loss
Risk behaviours
```
205
What do the NICE guidelines say is the first line treatment for anorexia nervosa?
Family therapy for adolescent cases
| CBT
206
What do the NICE guidelines say is the first line treatment for bulimia nervosa and binge eating?
CBT
207
What is the STI transmission model?
```
R = B x C x D
R = reproductive rate (aim <1)
B = Infectivity rate
C = Partners overtime
D = Duration of infection
```
208
What is the primary prevention of controlling STIs?
```
= reduce risk of acquiring STI
Awarenesses campaign
Face to face reduction discussion
Vaccination - Hep B, HPV
Anti-retroviral
- Post-exposure prophylaxis
- Pre-exposure prophylaxis
- Treatment as prevention (HIV reduce viral load so low = no spread)
```
209
What is the secondary prevention of controlling STIs?
```
= Case finding
Access to STI tests/treatment
Partner notification
Targeted screening
- Antenatal screening for HIV/syphilis
- National chlamydia screening programme
- HIV home-testing
```
210
What is the tertiary prevention of controlling STIs?
= reduce mobility/mortality
Anti-retrovirals for HIV
Acyclovir to suppress genital herpes
Prophylactic antibiotics for PCP
211
Give 3 benefits of partner notification
1. Prevents re-infection
2. Prevents complications of untreated infection
3. Breaks the chain of transmission
212
Give 3 things that consent must be
1. Voluntary
2. informed
3. Made by someone with capacity
213
What must you tell someone about their treatment in order for them to make an informed decision?
1. What is the treatment
2. How you're going to do it
3. Risks
4. Benefits
5. Alternative options and their risks/benefits
214
What is section 2 of the mental capacity act?
A patient is unable to make a decision for themselves in relation to the matter because of an impairment or disturbance in the functioning of the mind or brain
215
Section 2 of the mental capacity act: what can cause an impairment or disturbance in the functioning of the mind or brain?
Schizophrenia
| Needle phobia
216
What is section 3 of the mental health act?
A person is unable to make a decision for themselves if they cannot:
1. Understand the relevant information
2. Retain the information
3. Weight up the information
4. Communicate their decision
217
What 4 questions can be asked to determine whether a patient has capacity?
1. Does the patient understand the relevant information
2. Can they retain the information?
3. Can they weigh up the information?
4. Can they communicate their decision?
218
What are the 2 main option for treatment a patient deemed incompetent?
1. Can someone make the decisions on their behalf? (e.g. lasting power of attorneys)
2. A healthcare professional can make the decision if it's in the patients best interests
219
What 4 things need to be considered when deciding what's in the patients best interests?
1. Will the patient have capacity in the future? if so, when?
2. Consider the patient's past and present wishes/feelings
3. Consider the patient's beliefs and values that would influence a decision
4. Consult with anyone who need to be consulted (e.g. lasting power of attorney, carers etc.)
220
What is Gillick competence?
It can be used to determine whether children <16 have competence to make decision about their care
Does the child understand the consequences of their decision?
221
Name 4 vaccine preventable neurological infections
1. Polio
2. Tetanus
3. Measles
4. H. influenza
5. TB
6. Meningococcus
222
Define burden of disease
Time lost of work due to a disease
223
Name 4 common neurological disorders of public health importance
1. Migraine
2. Stroke
3. Dementia
4. Epilepsy
5. Parkinsons
6. Multiple sclerosis
7. Cerebral palsy
224
What is Creutzfeldt-Jakob disease?
Rapidly progressive dementia
| Average age of onset = 55-75 years
225
What is Variant Creutzfeldt-Jakob disease?
Neurodegenerative disease simulator to CJD
| Peak incidence = 27 years
226
What is the WHO definition of health?
State of complete physical, mental and social well-being and not merely the absence of disease or infirmary
227
What is the WHO definition of mental health?
A state of well-being in which every individual realises their own potential, can cope with the normal stressors of life, can work predominantly and fruitfully and is able to make a contribution to their community
228
What can affect mental health?
```
Can depend upon life experiences and life context
Gender, race, religion, social class etc. can all influence mental health
```
229
Name 5 mental health conditions
1. Stress
2. Depression
3. OCD, PTSD
4. Schizophrenia
5. Eating disorders
6. Substance misuse
230
Give 5 reasons why students are so vulnerable to mental health issues
1. Academic stress
2. Financial concerns
3. Alcohol, drugs
4. Peer pressure
5. Unrealistic expectations
231
Name 3 things that doctors suffer more from than the general population
1. Increased suicide rates
2. Increased marital dysfunction and divorce
3. Increased drug and alcohol problems
232
Give 5 factors that can contribute to work related stress
1. Insufficient resources
2. Excessive workloads
3. Poor management
4. Complaints and litigations
5. Dealing with patient suffering
233
Give 4 symptoms of burnout
1. Diminished personal contact
2. Work avoidance
3. Increased minor illness
4. Feelings of failure
234
What personality traits are susceptible to psychological illness?
1. Perfectionism
2. Self-criticism
3. Low flexibility
4. High discipline
5. High empathy
235
Describer Malan's 'helping profession syndrome'
People in helping professions compulsively give to others what they would like to have for themselves
They have an unconscious identification with the patient role, unmet emotional needs
236
What are the 5 sections to Maslow's hierarchy of needs?
```
Physiological (most essential)
Safety
Love/belonging
Esteem
Self-actualisation
```
237
What does Robert Plutchik's wheel of emotion represent?
If emotions are left unchecked they can intensify in a negative way
238
What is the WHO definition of palliative care?
Improves the QOL of patient and families who face life-threatening illness, by providing pain and symptomatic relief, spiritual and psychosocial support form diagnosis to the end of life treatment and bereavement
239
Define specialist palliative care
Palliative care provided by health care professionals who specialise in palliative care
240
Who can provide specialist palliative care?
```
Consultant in palliative medicine
Clinical nurse specialist - Macmillian nurses
Social workers
Chaplains
Physiotherapists
Dieticians
```
241
Define generalist palliative care
Health professions who have not received accredited levels of training in palliative care
Not deemed specialise but routinely provide health care for patients at the end of their lives
242
Who can provide generalist palliative care?
GPs
Hospital doctor
Nurses and district nurses
Nursing home staff
243
What are the main 4 philosophies of palliative care?
1. Holistic approach
2. Individualised
3. Patient and family centred
4. Multidisciplinary approach
244
What does palliative care aim to do?
1. Promote quality of life
2. Promote dignity and autonomy
3. Control disease symptoms
245
What might multiple co-morbidities result in?
1. Great need for care
2. Increased psychological distress
3. Increased social isolation
246
What is the link between chronic illness an inequalities?
1. Lower socio-economic status = higher incidence of chronic illness
2. Poverty + poor living condition increase with age
3. Most severe deprivation experienced by pensioners living alone
247
Palliative care for COPD patients is notoriously bad, why is this?
1. Lack of funding
2. Most palliative care teams are cancer focused
3. Differing patient need: COPD vs cancer
4. Unpredictable illness trajectory in COP
5. Lack of patient understanding
248
Name 3 occupational diseases
1. Asbestosis
2. Silicosis
3. Coalminers pneumoconiosis
4. Mesothelioma
249
What are the most common work related ill health disorders?
1. Occupational stress
2. work related MSK disorders
3. Occupational lung disease
4. Occupational cancer
250
How are work hazards classified?
1. Mechanical
2. physical
3. Chemical
4. Biological
5. Psychosocial
251
Define hazard
Hazard has the potential to cause harm
252
Define risk
Risk is the probability of something to cause harm
253
Give 3 ways of telling if an illness is due to work
1. Symptoms improve when way from work
2. Characteristic rash distribution - contact dermatitis
3. Cluster of cases in a workplace
254
What is the effect of moving from work to unemployment on someone's health?
Negative impact on mental and physical health
255
What is the effect of moving from unemployment to re-emplyment on someone's health?
Positive impact on mental health and well-being
256
What is the effect of moving from school leavers to first job on someone's health?
Positive impact on mental and physical health
| Negative - unsatisfactory employment
257
What is the effect of moving from work to retirement on someone's health?
Positive impact if voluntary
| Negative impact if forced
258
What are Marmot's 10 key components of 'good work'?
1. Precariousness - stable, risk of loss, safe
2. Individual control - part of decision making
3. Work demands - quality and quantity
4. Fair employment - earnings and security
5. Opportunities - training, promotion, 'growth'
6. Prevents social isolation, discrimination and violence
7. Share information
8. Work-life balance
9. Reintegrates sick or disabled wherever possible
10. Promotes health and wellbeing
259
What is a GPs role in occupational health?
- Sickness certificate
| - Will the patient benefit from a phased return or altered hours
260
What are the impacts of long term unemployment?
Increased mental health, poor health and social exclusion and poverty
Loss of fitness and well-being
Trapped on benefits until retirement
261
Define disability
A physical or mental impairment, which has a substantial long-term adverse effect on a person's ability to carry out normal activities
262
What is the primary prevention population approaches to occupational health?
Monitor risk
Control hazards
Promotion
263
What is the secondary prevention population approaches to occupational health?
Screening
Early detection
Tast modification
264
What is the tertiary prevention population approaches to occupational health?
Rehabilitation
| Support
