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Shohaib's DFPH > 2 diseases > Flashcards

2 diseases Flashcards

1
Q

types of epidemiological paradigms for disease causation (x3)

A
  1. Programming:
    - critical periods of growth: exposure here leads to outcome

eg barker hypothesis: IU malnutrition leads to CVD as adult

  1. Adult Risk factor:
    - risk factors of LIFESTYLE AND BEHAVIOUR as adult leads to outcome

eg: exercise –> outcome

  1. Life Course:
    - programming and adult risk factor together
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2
Q

top causes of death High income and low income

A

From WHO: Global health estimates 2021

top cause of death globally is IHD

High income:
- Driver: Aging population
- conditions: IHD, covid, stroke, Alzheimer’s, lung cancer, COPD, colon ca, LRTI, Kidney, HTN

Low income:
Driver: high rates of communicable disease (8/10 communicable)
conditions: LRTI, stroke, IHD, malaria, Preterm birth, covid, diarrhoeal, TB, birth, HIV

HIV deaths decreasing

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3
Q

Global burden of disease

A

Lancet study published in 2024 for 2021 data
- Looks at DALYs

2010 -2021

KEY TAKE AWAYS
- non communicable largest burden: make up 16/25
- decrease communicable ( caveat COVID new entry at TOP )
- CMNN remain high (communicable, maternal, neonatal, nutrition)

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4
Q

Depression

A

Clinical: low mood >2 weeks, with functional disability. Physical and mental

Aetiology: genetic, biological, environmental

Public Health relevance:
World: Commonest mental health disorder no. 12 on GBD

UK: (fingertips)
13% prevalence

Time: increasing

Person:
- ethnic minority
- W>M
- increases with age
- unemployed

Place:
- South Yorkshire and North east

Prevention:
- secondary

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5
Q

Suicide

A

Clinical: intentionally causing own death. coroner’s verdict.

Aetiology: genetic, biological, environmental

Public Health: leading cause of death for young adults. Early intervention prevents suicide

UK: (ONS)
10 per 100,000 deaths per year

Time:
-decrease since 1982
- increase 08-10 (financial crash)

Person:
- Men >women
-highest >45
- Low SEC
- other MH

Place:
- North East HIGHEST
- London lowest

Prevention:
- 1: strengthen protective factors
- 2: detect those at risk, intervention

England suicide prevention strategy 2023-28

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6
Q

Dementia

A

Clinical: neurodegenerative, memory loss, confusion, speech, understanding

Aetiology: Alzheimer’s 60% (beta-amyloid, tau) + Vascular (infarcts)

PH relevance:
- aging population, cost, undiagnosed, no cure

UK:
- 12% deaths due to dementia
4.3% prevalence in England

Time:
- increasing (1.6mil by 2040)

Person:
- increase with age
- W > M

place:
- IMD high
- North West, south east, north east, East England,

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7
Q

Schizophrenia

A

Clinical: psychosis. Positive, negative, cognitive

Aetiology: unknown

PH relevance:
- high disease burden
- high physical health burden
- stigmatised and hard to reach group

UK:
- 1% prevalence

Time:
- ?falling (poor data)

Person:
- male, 25-40, black
- low SEC
- ?cannabis use

Place:
- Urban >rural

Prevention:
- Early intervention for first presentation psychosis

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8
Q

Parkinsons

A

Clinical: progressive neurological disorder that primarily affects movement. Motor + non-motor symptoms

Aetiology: loss of dopamine producing neurons in SN + lewy body

PH relevance:
- increasing with aging population
- falls, fractures and hospital admission
- social care

UK
200 per 100,000

Time:
Time: prevalence stable (Okunoye et al 2022 cohort study), but will increase as population gets older

Person: increase with age (doubles between 50-69), Male, sporadic

place: n/a

Prevention:
no routine screening

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9
Q

Coronary heart disease

A

Clinical: inadequate blood supply to heart. Angina, MI, cardiac arrest

Aetiology: atherosclerosis

PH relevance:
- one of the top causes of death in the UK

UK:
Time: fallen since 80s

Person:
- M, increasing age,
age, lifestyle, disease, family, other

Place:
North, Scotland, wales

Prevention:
1: exercise, diet
2: treatment

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10
Q

Stroke

A

Clinical: form of CVD: ischaemic or haemorrhagic
TIA

Aetiology: CVD, HTN

PH relevance:
- leading cause of death and disability
- preventable

UK
100K strokes a year

Time:
- increasing due to age (age adjusted decreasing)

Person:
male, old, low SEC

Place: n/a

Prevention:
1: lifestyle, HTN, cholestrol
2: FAST

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11
Q

Breast Cancer

A

Relevance: major cancer in women

Incidence: 173 per 100,000 (females)
5 year survival :85%

Time: survival increasing

Person: female, older, deprivation, white higher ethnic lower (start family early), genetic

breast cancer screening in place (50-71 every 3 years)

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12
Q

Lung Cancer

A

Relevance: high case fatality rate + preventable

Incidence: 66 per 100 000
5 year survival: 20%

Time: improving ( reducing smoking, stage shift)

Person: men, over 50

targeted lung cancer screening started (55-74)

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13
Q

Colorectal cancer

A

PH Relevance:
- 4th most common cancer in the UK
- known RF
- Screening

Incidence: 56.6 pr 100 000

5 year survival: 60%

Time: survival improving,

Person: older Age, diet, smoking, gastro conditions
(increasing in younger age but 90% still >50)

Screening: 50-74: Home FIT kit (then colonoscopy)

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14
Q

Prostate cancer

A

2nd most common cause of cancer in the UK

Incidence: 88 per 100,000

5 year survival: 87% 5 year survival

Time: improving

Person: Men, old, African,

Screening: ?(prostate then MRI screening: NEJM

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15
Q

Cervical cancer

A

Common cancer in women

Incidence:
5 per 100,000
highest in females aged 30 to 34
decreasing

5 year survival: 70%
Improving

Person: gender, younger age, lower deprivation

Prevention:
Primary:
HPV vaccine (1 HPV vaccine 12/13: coverage 83% F, 65% M)

Secondary: screening
screen (25-64) uptake 72-76&
HPV first

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16
Q

Asthma

A

Clincal: chronic, inflam condition, shortness of breath

PH relevance:
Commonest chronic condition in childhood

UK:
Prevalence: 12%

Time

Person:
Boys, childhood, viral,

Place:
air pollution,

Prevention:
I: air quality
2: annual review, personalised asthma plan, medication

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17
Q

COPD

A

Clinical: Chronic bronchitis and emphysema

Public health:
- preventable (smoking)
- high mortality and morbidity

UK
- 3 million in the UK
- Common reason for ED admission and hospital readmission

Time:
- increasing

Person:
Men = women,
older age,
lower SEC,
smoking

place:

prevention:
1: stop smoking, occupational exposure

2: vaccination

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18
Q

sickle cell

A

Clinical: red blood cell disease, sickling, obstruct blood

aetiology:
Autosomal recessive (Ch 11)

Public health prevalence:
- Health inequality
- screening

UK:
Prevalence: Afro-Caribbean: 1 in 10-40 have trait 1 in 60-200 have disease
UK Prevalence: 20 per 100,000

  • Screening:
    1. blood test for mothers and fathers who mother is a carrier
  • in high prevalence areas to all women
  1. family origin questionnaire
    - in low prevalence areas then blood test
  2. Heel prick test
    - all new-borns

1 +2 then diagnostic test (CVS and amnio)

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19
Q

diabetes

A

Clinical: multisystem characterised by hyperglycaemia

aetiology:
T1DM: autoimmune
T2DM: insulin resistance and relative insulin deficiency

Public health relevance:
- Increasing mortality and morbidity
- increasing prev.

UK:
- 4 million in the UK
- large undiagnosed

Time: increase

Person:
- deprived, LMIC, more common England

20
Q

Alcohol use disorder

A

clinical: drink >14 units in a week, harmful drinking + dependence

Aetiology: addiction cycle

Public health:
- short and long term effects
- prevention

UK
21% of adults

time:
- overall decrease since 2000 with decrease in binge drinking in young adults

place: all 4 nations. worse scotland

person:
mortality: 39.5 per 100,00

prevention:
SAFER

Strengthen restriction

Advance drink driving counter measures

Facilitate screen and treatment

Enforce bans on advertising
promotion, sponsorship

Raise price

21
Q

Air pollution

A

overview:
- household, particulate, ozone

causes:
- transport, industry, farming, energy consumption, heating

public health importance:
- increase CVD, resp infections and diseases, maternal, neonatal, cancers

UK:
28K deaths a year due to air pollution

time:
- increasing worldwide
- decrease UK

person:
- high risk groups

place:
- cities, location to road/ polluter

22
Q

drug misuse

A

clinical: dependence leading to harm

Public health:
- preventable
- inequality
- cross-sector

UK:
- 2% drug use disorder

time:
- opioid USA, increasing UK

place:
- deprivation, Scotland

Person:
men, young

23
Q

Smoking

A

leading cause of cancer, COPD

Why PH:
- cause of cancer
- preventable
- inequality

UK:
- 13% adults smoke
- declining
- 1 in 4 cancer deaths

cost:
- England £17 billion
- productivity
- direct (healthcare costs) and indirect

Vaping:
- increasing around 13% of youth
reasons: social, and mental health

control:
tobacco and vapes bill 2024

MPOWER
Monitor tobacco use and prevention policies

Protect people from tobacco smoke

Offer help to quit tobacco use

Warn about the dangers of tobacco

Enforce bans on tobacco advertising, promotion and sponsorship

Raise taxes on tobacco

24
Q

Oral health

A

conditions: tooth decay, periodontal disease, oral cancers

Public health:
- cost £3.6billion per year
- tooth decay most common hospital admission for 5-9 year olds

UK:
- 1/4 of <5 experience tooth decay
- deprivation

time:
- better

person:
- young, elderly, LD
- homeless, prison

place:
- North West
- deprivation

prevention:
1: fluoride brush and varnish, breastfeeding, less sugar, fluoridation of drinking water

25
Q

Obesity

A

definition: >30 BMI

public health:
1 in 8 obese WW
increase risk of multiple conditions (DN, cancer, HD)

UK:
26% adults

primary

secondary

treatment: ?ozempic

26
Q

Road traffic injuries

A

TBC

27
Q

screening

A

the process of identifying apparently healthy people who may have an increased chance of a disease or condition.

Individuals can then be offered more information, further tests or treatment as appropriate.

28
Q

3 approached to screening

A

1 population:
- offered to a group of people identified form the whole population, and defined eg by sex or age

eg. bowel, breast, cervical

  1. targeted
    - offer screening to a more specific group with a higher risk of a condition

eg targeted lung cancer screening to smokers

  1. stratified:
    - happens in both above
    - offer testing which varies in frequency and modality based on individual risk

eg. HPV +ve follow different CC screening pathway, FHx of breast cancer invited more frequently.

29
Q

Wilson and Junger

A

Disease – importance, preclinical course, natural history, latent period

test – valid, safe, effective, acceptable, reliable, cheap

Diagnosis and treatment – evidence-based, acceptable, cost-effective, safe, facilities adequate

Overall programme – evidence-based, ethical (Beauchamp and Childress, informed decision and popularity paradox), legal (4 aspects), economic (opportunity cost), social (factors affecting participation)

30
Q

Overview of national screening programmes

A
  1. Pregnancy
    - infectious disease
    - Foetal anomaly scan
    - sickle and thalassemia
  2. New born
    - Heal prick
    - new born and infant physical exam
    - new born hearing
  3. Adult
    - Cervical cancer: 25- 64 (25-49: 3Y, 50-64: 5Y)
    - Bowel cancer (50-74 M and F: FIT kit)
    - Breast Cancer: (50-71 F. AgeX trial to x2 one off at 47-49, 71-73)
    - AAA ( M year turn 65)
    - Diabetic eye check (>12 diabetes, every year, if x2 -ve every 2 years)

others:
- NHS health checks
- Chlamydia (targeted F)
- prostate
- TB

31
Q

Cervical screening

A

WHY:
- common cancer in women (14)
- highest in females aged 30 to 34
- pre-clinical stage: dysplasia: CIN (1-3)->cancer
- strategy to eliminate by 2040

High risk HPV testing, cytology, colposcopy.

Impact:
- estimate save 4500 lives every year
- cervical rates have halved

Uptake:
- 30% eligible never screened
- lowest in ethnic minority and young age groups, deprived

  • letter language, accessible appointments, discomfort

HPV vaccine
- 1 dose for M and F in Y8
- 9 types of HPV

32
Q

Bowel cancer screening

A

WHY:
- 42K cases a year
- 17K deaths
- 80% >60 years
- -early treatment Increases survival: duke (90%) Vs metastatic (10% 5ys)

Works?
- risk of dying of bowel cancer by 16%

What is it:
- 54- 74 every 2 years (increased to 50-74)
- FIT home test (blood) then colonoscopy

33
Q

screening bias

A

Lead time: know ill earlier (longer lead in)

length time bias: slower developing illness

healthy screene effect

34
Q

threshold

parallel and serial testing

A

threshold: need to set cut off

ROC: AUROC

parallel: both tests together (downs: USS + blood test),

serial: one after another (cervical)

35
Q

Screening Vs Diagnostic test

Vs case finding

A

case finding:
strategy for targeting resources at individuals or groups who are suspected to be at risk for a particular disease. It involves actively searching systematically for at risk people, rather than waiting for them to present with symptoms or signs of active disease similar to screening

  • communicable disease control
  • health systems
36
Q

legal aspects of screening

A
  1. confidentiality
  2. accreditation and qual
  3. right to NOT screen
  4. consent
37
Q

informed choice for screening

A

GMC:
- purpose of screening

  • likelihood of +ve and -ve result
  • risks associated with screening
  • implications for particular condition (medical, social, financial)
  • follow up
38
Q

Genetic screening

A

involve testing members of a population (or sub-population) for a defect or condition, no prior evidence of its presence

OR limited to a sub-population that is at particular risk of a genetic condition.

Issues:
1. ethical:
- 4 principles,
- autonomy
- reproductive choice

  1. legal
    - consent
    - confidentiality
    - right to not be screened
  2. social
    - stigma
    - counselling
    - disclosure to family
    - insurer/ employer
39
Q

genotype vs phenotype

A

The set of alleles a person has is known as their genotype.

This genotype then codes a set of observable characteristics which are then expressed, known as the phenotype.

40
Q

karotype

A

species-specific characteristic set of chromosomes.

41
Q

how to make a protein

A
  1. transcription
    - in nucelus. RNA polymerase
    - mRNA from single strand DNA
  2. splicing
    - introns removed from mRNA
  3. exporting
    - leaves nucleus
  4. translation
    - ribosome
    - mRNA adds tRNA which carries amino acis

5.protein modification

  1. translocation
42
Q

patterns of inheritence

A
  1. monogenic
    AD: huntingtins
    AR: sickle cell
    x- linked: Rett syndrome
  2. polygenic
    - many genes
    - alzheimers
  3. chromosomal
    - numerical: trisomy (downs 21) loss monosomy (turners)
    - structural: Charcot - MTD
  4. mitochondrial: Leigh disease
    - threshold effect
43
Q

penetrance

A

proportion of people with a given genotype express phenotype

44
Q

genetic testing

A
  1. individual if there is an indication
    - medically
    - fhx

can work out familial relative risk: risk in family/ riskin gen population

done:
1. molecular tests
- FISH

  1. karotyping
  2. non invasive prenatal: cfDNA

population screening
1. Heelprick for 9 rare conditions

  1. pregnant: downs, edwards, patua, SC and thalasemmia
45
Q

nutrition

A

study of the the influence on food intake on health and wellbeing.

Macro and micronutrients

Surveillance:
- routine collection and collation of data

-food supply: FAO data
- ONS Living cost and food survey (2023)
- infant feeding survey

46
Q

Nutritional status

A
  1. anthropmentry
    - height, weigh, BMI
    NHS child measurement programme
  2. indices
    - MUST
  3. biochemical
  4. bioelectrical impedance
  5. imaging
  6. food surveys
47
Q

Dietary nutritional values

A

EAR (estimated average requir): Average amount needed by a group of people (i.e. 50% of the
group’s requirements are met)

Reference Nutritional Intake: Amount that is enough to meet the dietary needs of about 97.5%
of a group of people (i.e. the majority need less)

Lower Reference NI: Amount that is enough for a small number (2.5%) of people in a
group with the smallest needs (most people will need more than this)

Safe intake:

Shohaib's DFPH (8 decks)

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