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LMAP > Adult Health > Flashcards

Adult Health Flashcards

1
Q

Case Study:

Mr X = presented to A&E with metacarpal fractures a few weeks ago, here for a check up

Smoking history, VBA about smoking cessation worked
Suffered from mild depression in 2001 - treated with SSRIs for 6 months

Served in the military, but currently unemployed
Two children

Mentions he is ‘stressed’ - cannot find a new job, misses the military and his friends

What are the key social determinants and lifestyle behaviours identified in this case that would be important in taking a holistic approach to this man’s health?

A

Stress from lack of job

Odd sleep schedule - going back to bed in the mornings for an hour or two

Parent of two children

Used to smoke, but has now quit - hopefully does not relapse from stress

Missing his friends

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2
Q

As the registrar, is there anything you would want to be aware of for your own health in this case?

A

x

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3
Q

How does Mr. X compare with Alex who you met in 1a- specifically thinking about lifestyle and social factors that will be impacting health?

A

stress - Not all stress is negative, but ongoing chronic stress can be toxic

Both Alex and Mr. X are dealing with financial stressors. This will be taking up a lot of their cognitive bandwidth, making other aspects of life more stressful. In both cases there are negative lifestyle behaviours which may be related to faulty coping mechanisms- binge drinking, smoking, gambling.

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4
Q

What else might be affecting Mr.X?

Besides health behaviours and the financial worries inherent in unemployment how else might leaving the military be impacting Mr. X?

A

No longer has a regime/ timetable so can feel derailed

Loss of friends

unemployed = feel detached from his support networks,

Social connection and social support are key components for mental health, and for bolstering your perceived ability to work though stress.

  • protective impact that positive social relationships have within the context of ACEs.
  • men in this study are more likely to report a lack of meaningful social connection. This is a common finding, and may relate to reasons for men also not seeking help for mental health.
  • Belonging to a social group:
  • is important for health.
  • can help form our sense of identity and purpose in society
  • history of depression. = risk for Post Traumatic Stress Disorder,
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5
Q

What stats show there is men’s heath inequality in healthcare?

A

Males live shorter lives than females
Suffer life-limiting diseases soon

And gap between male and female life expectancy is greater in higher income countries

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6
Q

How do nature and nurture impact men’s health?

A

Initially thought to be mostly biological differences that led to men leading shorter lives

Now, also thought to be partially due to social constructs about gender and identity

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7
Q

Sex VS gender?

A

Sex = male or female, biological, assigned at birth

Gender = man or woman, social construct, personal identity

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8
Q

How many years on average do men die earlier than women?

What are the common causes?

A

5 years

IHD (ischaemic heart disease), road injury, lung cancer, COPD, stroke

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9
Q

Why do men die of CVD and resp diseases more than women?

A

Oestrogen thought to be CVD protecting

Men = greater tobacco use and poorer diet

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10
Q

Why do men die from injuries more than women?

A

They take more risks

Work in more ‘dangerous’ jobs - agriculture, industries

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11
Q

What are health seeking behaviours?

A

Men are 2x as likely to have inadequate health literacy than women

Men are less likely to seek help when they need it

Tend to attribute health concerns to ‘getting old’

Present to doctors with more progressed health issues = harder to treat

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12
Q

Why do men have worse mental health?

A

Do not seek help

Find mental health to be ‘stigmatising’ - do not talk to friends or GP

Less socially connected as they get older

More likely to substance abuse, alcohol abuse and be homeless

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13
Q

Suicide rate differences between men and women?

A

Women = more likely to attempt

Men = more likely to complete a suicide attempt

Men = more violent suicide attempts

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14
Q

How can suicide rates be lowered?

A

Generational change in culture

Work place health initiatives - can influence better health behaviours: better work hours, more efficiency, provide mental health first aid courses, suicide prevention, promote mental health discussions

Social prescribing - ‘Men in sheds’ = men connect shoulder to shoulder = shared connection

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15
Q

What is self-care?

A

WHO = what people do for themselves to establish and maintain health, and to prevent and deal with illness

  • Can modify personal + intermediate risk factors for NCDs
  • Help with communicable disease via risk avoidance, good hygiene, health literacy
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16
Q

What are the 7 pillars of self-care?

A
  1. Knowledge and Health Literacy
  2. Mental wellbeing
  3. Physical activity
  4. Healthy eating - high fibre with nutrients, not overeating
  5. Risk avoidance
  6. Good hygiene practices - oral, digital, sleep
  7. Rational use of products and services - responsible use of medications
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17
Q

What is the self-care continuum?

A
  • Healthy behaviours ———————> acute conditions and trauma
  • Daily choices –> lifestyle –> self-managed ailments –> minor ailments –> long-term conditions –> acute conditions –> compulsory psychiatric care –> major trauma
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18
Q

Why is self-care effective?

A

Lack of self care e.g. unhealthy diet, physical inactivity, tobacco use, excess alcohol

= Raised BP (hypertension), obesity, raised BGL

= Chronic disease = heart disease, stroke, cancer, diabetes, lung diseases

= Higher mortality rates

Also reduces spread of communicable diseases - risk avoidance, good hygiene, awareness and literacy

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19
Q

How can self-care be integrated into daily behaviours?

A

Activation, incentivisation, nudges, gamification, personalisation

Can be achieved by lifestyle medicine, lifestyle modifications > drugs, person-centred medicine, doctors as coaches, democratisation of self-care, and Health is All Policy (HiAP) approach

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20
Q

What technologies influence self-care behaviours?

A 
eHealth and mHealth
Diagnostics
Fitness trackers
Nudges (notifications)
Internet pharmacies
AIs 
BP monitors
Sleep apnoea monitors
Glucometer
Heart rate monitors

Health apps/wearables

etc.

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21
Q

What is the paradigm shift?

A

Self-care not accessible to all

Poor self care –> government interventions –> Good self care

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22
Q

What can affect self-care?

A 
Inequalities
Homelessness
Alcohol / substance dependency 
Suicide
Social isolation / loneliness
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23
Q

How can we influence good self-care behaviours?

A

From a young age - to make self-care behaviours a habit

Starting with workplace interventions

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24
Q

How common is substance misuse?

A

1 in 9 adults between 16-59 have used an illegal drug in the past year

Often substance misuse is greatest between teens - tapers off as they get older

Diverse group of people use drugs - both illegal and prescribed

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25
Q

Why may people misuse drugs?

A

Family influence / childhood
Parties / clubs
Pain

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26
Q

How does substance misuse affect the users?

A

Physical health affected by how drug is used - inhaled = lung issues; injections = infections and blood clots

Social health affected e.g. maintaining formal work, normally go for informal work e.g. sex work, drug dealing etc.

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27
Q

What is the support / treatment available for substance used?

A

Support from GPs and secondary care (psychiatric services)

Specialist drug services provided by third sector organisations

Local drug and alcohol services

Outreach workers

Psychological therapies to work through childhood issues

Drug testing organisations - find what is in the drugs and promote safer use of them

Specialist club drug clinics

Lifestyle changes - better relationships

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28
Q

What is the support for misuse of prescription drugs?

A

Discuss with GP - try other medications

Try non-medication approaches - exercise and psychological therapies

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29
Q

What drug is prescribes to reduce withdrawal symptoms and cravings for opioids such as heroin?

A

Methadone

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30
Q

What is alcohol misuse?

A 
>14 units /  week
OR
Binge drinking: 
Men >8 units /session
Women >6 units /session
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31
Q

Are men or women more likely to misuse alcohol?

A

Men - 2x as likely to drink more than 14 units /week

Men and women both peak in excessive drinking between 55-64 y/o

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32
Q

What is the relationship between socioeconomic status and alcohol misuse

A

Inverse relationship between socioeconomic status and alcohol misuse

More deprived = lesser alcohol abuse

BUT
More deprived populations experience greater harm from alcohol than more affluent ones

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33
Q

Why do less affluent groups experience greater harm from alcohol?

A

Multiplier effects - other factors in their life worsening the harms of alcohol misuse
e.g. lack of financial security
OR
They may binge drink - drink excessive amounts more rarely = more harmful than drinking a bit regularly

34
Q

What is the relationship between alcohol use and mental health?

A

Poor mental health –> maladaptive coping strategy –> increased alcohol consumption –> depressant effects of alcohol –> poorer mental health (cycle)

Poor mental health can often stem from poor / abusive childhoods

35
Q

What are the wide social impacts of alcohol misuse?

A

Relationship breakdown
Child abuse
Domestic violence
Road traffic accidents

36
Q

What are alcohol screening tools?

A

Audit and audit C

37
Q

How can alcohol misusers be helped by healthcare professionals?

A

VBA - very brief advice
Self help resources
Follow up appointment

And if all above unsuccessful, then: extended brief intervention and/or psychological therapy e.g. CBT

38
Q

How is the support given to alcohol dependent misusers different?

A

Require more intensive support

39
Q

What are the symptoms of alcohol withdrawal?

A 
V. dangerous, can result in death
Symptoms include: 
Hypertension
Tachycardia
Sweating
Tremor
Agitation

Severe cases = delirium tremens: confusion, seizures, hallucinations, hyperthermia

40
Q

What do you do if alcohol withdrawal is suspected?

A

Admit patient to hospital immediately

41
Q

What is Wernicke’s encephalopathy?

What is it caused by and how does it present?

A

Those who consume large amounts of alcohol are at risk of this

Caused by Vit B1 (thiamine) deficiency

Symptoms include:
Gait and balance disturbance
Altered consciousness
Eye movement abnormalities

42
Q

What is the treatment for Wernicke’s encephalopathy?

A

Patients require IV thiamine (Vitamin B1)

43
Q

How should alcohol misusers approach withdrawal?

A

Planned withdrawal - not stop drinking suddenly (Can lead to severe alcohol withdrawal symptoms)

Inform DVLA of their alcohol dependence and stop driving

Patient should be assessed for alcohol related co-morbidities requiring specialist care e.g. mental illness, liver disease, pancreatitis

Patients should be given oral thiamine tablets - reduce risk of Wernicke’s encephalopathy

44
Q

Can supervised alcohol withdrawal be done in primary care?

A

Only if:
The patient is at reduced risk of adverse outcomes

Under the supervision of a GP with a special interest in substance misuse

45
Q

Where else can alcohol withdrawal take place?

A

In specialist care

46
Q

How are alcohol misuse patients treated?

A

Treated with reducing amounts of chlordiazepoxide (a benzodiazepine) allow the patient to stop drinking safely

Protects against withdrawal symptoms

Planned withdrawal normally takes 1-2 weeks

After this, course of acamprosate = influences levels of gama aminobutyric acid (GABA) = reduces urge to drink

Best effects = taken alongside psychological therapies

47
Q

Why is after care after supervised withdrawal important?

A

High chance of relapse

Therefore after care can involve: 1 to 1 support, group support or residential rehabilitation

48
Q

What are the treatment options for smoking cessation?

A

Combination of medical treatments and behavioural support

Bupropion

NRT = nicotine replacement therapy

Varenicline

49
Q

What is bupropion?

A

Tablet - start 1-2 weeks before quit date

Usually take them for about 9 weeks
Helps reduce craving and withdrawal symptoms

No need to cut down smoking before quit date

50
Q

What are the side effects of bupropion?

A

Common = sleep disturbance
Dry mouth
Heachaches
Nausea

51
Q

What can be used to check whether a person has smoked and to monitor smoking cessation?

A

Breath carbon monoxide (CO) monitor

Smokers tend to have around 20ppm of CO

Normal non-smokers have - 2-3 ppm

52
Q

What questions do they normally ask at smoking cessation help centres?

A

Why are you here / how can I help you?
What made you want to stop?
How many cigarettes do you smoke a day?
When do you have your first cigarette each day?
Any thoughts about what you’d like to try to help you stop?
Have you tried smoking cessation before?
Why didn’t it work before?
Have you ever used medication to help stop smoking?
Is there anything stopping you from not being able to stop smoking?

53
Q

How can NRTs be delivered?

A

Patches, inhalator, sprays, gum, lozenges

54
Q

How are NRTs used?

A

Need to use NRTs the day / the day before quit date

Patch placed onto dry, hairless skin
Remove after 24 hrs, place another patch on a different area of skin

Inhalator = pull apart mouth piece, insert cartridge, put mouth piece together
Change cartridge when taste changes

Must use NRTs for around 2-3 months

55
Q

How quickly does CO go down after smoking?

A

Almost as soon as you stop smoking

56
Q

What is the ‘not a puff’ rule?

A

Not a single smoke puff after quit date as even having one cigarette and cause a relapse

57
Q

What is Varenicline?

A

Start tablets 1-2 weeks before quit date

Prevent nicotine hit from cigarette and reduce withdrawal symptoms after quit date

Taken for 12 weeks, can be longer

Slowly build up dose over 1-2 weeks

No need to cut down smoking before quit date

58
Q

What are the symptoms for Varenicline?

A

Nausea = most common, usually passes with time and can be helped by taking the tablets with food
Headaches
Sore throat
Sleep disturbance

59
Q

A typical Mr X day:

His children wake him at 6:30am, walks 20 mins to drop them off

Returns home for breakfast (toast), gets back into bed for an hour - feels stressed / anxious during this time about finances and previous military job

Job search online til quick lunch, collects kids from school, and looks after them the evening

Sleeps at midnight, struggles to fall asleep thinking about job opportunities

Once a week goes to pub with friends

Weekends = chill with partner and kids

What advice could be given to Mr X?

A

Fix sleep schedule - go to bed earlier, try not to get back into bed after dropping off kids to school

Set a specific time to go job hunting

See buddies outside of the context of a pub, maybe more than once a week - perhaps exercise with them

Try to meal prep more - cook with the family?

60
Q

When compared to females, the increased mortality associated with being male is driven predominantly by:

A
  • . Exposure to occupational and environmental risks

- . Health seeking behaviours

61
Q

What are the implications of late presentation for a health system/

A
  • Additional pressure on urgent and emergency care services
  • Increased system cost as the disease will be more progressed and may need more aggressive therapeutic response
  • Poorer outcomes as more advanced disease is more likely to lead to longer-term morbidity and / or mortality
62
Q

2 myths about suicide

A
  • . Most suicides happen suddenly without warning (most people cry for help discreetly)
  • Talking about suicide will encourage someone to have suicidal ideas. (important approach to talk about it, preventing it and tackling stigma associated)
63
Q

Suicide stats

A

b. Suicide is preventable
d. Suicide is about four times more common among men than women.
People with a history of mental health problems (including self-harm), experience in the criminal justice system, those who are unemployed, as well as specific occupational groups (including doctors, nurses, veterinarians and agricultural workers) are more likely to attempt suicide than other groups.

64
Q

complications of drugs injected

A
  • infectious disease
  • blood clot

harm reduction initiatives, such as needle exchanges where users can obtain clean needles, are a key part of reducing the damage drugs can do to health.

65
Q

Which drug is methadone prescribed as a safer substitute for?

A
  • an opioid medication
  • prescribed to reduce withdrawal symptoms and cravings for other opioids (e.g. heroin).
  • generally preferable to heroin because the dosage can be tightly controlled, reducing the risk of overdose compared to using illicitly obtained heroin of unknown strength.
  • methadone is taken orally, usually as a liquid, which is generally safer than injecting.
  • heroin can be used legally with a prescription, it means that the person does not have to try to obtain heroin illegally, which sometimes leads to participation in criminal activity to obtain funds.
  • Instead, they can use their time productively such as in education, parenting or employment.
  • Methadone is on the World Health Organisation’s Model List of Essential Medicines, meaning that it is one of the ‘most efficacious, safe and cost–effective medicines for priority conditions.’
66
Q

What is the definition of binge drinking in women?

A

Binge drinking in women is defined as drinking more than 6 units in a single session. This is roughly equivalent to three standard glasses of wine (175ml, ABV 12%).

67
Q

What is the definition of binge drinking in men?

A

binge drinking is more than 8 units in a single session.

68
Q

What class of medication is generally used in planned withdrawal of alcohol to allow dependent drinkers to stop drinking safely?

A

Benzodiazepine

  • long-acting benzodiazepine, such as chlordiazepoxide, is used to reduce withdrawal symptoms when someone is undergoing planned withdrawal of alcohol.
69
Q

best way to stop smoking

A

best way to stop smoking is through a combination of treatment and behavioural support

70
Q

best smoking cessation treatment

A

Whichever treatment combination suits the patients life is best and that a combination of NRT options is more effective than one alone.

71
Q

what is the FITT Principle

A
  • can be used in lifestyle prescription as part of “move” pillar

The FITT principles are an exercise prescription to help participants understand how long and how hard they should exercise.

FITT is acronym that stands for Frequency, Intensity, Time, and Type. FITT can be applied to exercise in general or specific components of exercise. For example, below are some general FITT guidelines for weekly exercise.

Frequency: Daily moderate exercise is ideal, but try to exercise a minimum of 3-5 days per week.

Intensity: Moderate to vigorous intensity exercise is recommended for adults.

Time: 30-60 minutes per day.

Type: To maintain a well-balanced fitness level, perform a variety of exercises included cardio, strength, and flexibility training.

72
Q

Describe inequalities in relation to men’s health and potential initiatives to tackle them

A

Shorter life expectancy (avg. 5 years less)
Gap between life expectancies is greater in higher income countries
Suffer life-limiting disease sooner
Higher mortality rate
More accidental injury + interpersonal violence
Less likely to show health seeking behaviours
Put more stigma on mental health + less socially connected
More prone to substance misuse, alcohol dependence, and homelessness
Suicide and Mental health
3 in 4 suicides are men (women more likely to attempt)
Method of suicide is more likely to be violent
Presents signs of depression differently (more irritable)
Interventions
Workplace health initiatives
Social prescribing intiatives

73
Q

Risk factors of drug misuse

A

ACEs
Struggling with mental health
Apart from these, very diverse

74
Q

Impacts of drug misuse

A

Impacts
Smoked – lung issues
Injected – blood clots, bacterial skin infections, viral infections (HIV, Hep C)
Struggle with formal work
-Less able to look after others
-Violence and abuse associated with drug trade

75
Q

Support + treatments for drug misuse

A
  • GP, secondary care, psychiatry services, specialist services
  • Methadone - heroin substitute
  • Non-medication pain management
76
Q

what is alcohol misuse defined as

A

Alcohol misuse = >14 units per week or binge drinking

77
Q

Risk factors for

Alcohol misuse

A
  • Men + middle aged
  • Less deprived (although more harm to more deprived – alcohol harm paradox)
  • Mental illness
  • Abuse during childhood
78
Q

Impacts of alcohol misuse

A

Relationship breakdown, domestic abuse, crime, road traffic accidents

79
Q

support and treatments for alcohol misuse

A
  • Brief advice + self-help + follow up (If unsuccessful – extended brief intervention/CBT)
  • Planned withdrawal (primary care/specialist)
  • –>Reducing doses of chlordiazepoxide then acamprosate
80
Q

acute withdrawal symptoms of alcohol misuse and action

A
  • Admit to hospital!

Hypertension, tachycardia, sweating, tremor, agitation

Delirium tremens: confusion, seizures, hallucinations, hyperthermia

81
Q

What is alcohol misuse a risk factor for

A

Wernicke’s Encephalopathy (thiamine deficiency)

82
Q

key points

A

Key points
a. Men’s health and especially mental health continues to face considerable stigma and
requires focused initiatives to address their specific barriers to seeking help.
b. Although stress is a normal physiological response, chronic stress can have damaging
effects on health across the life course.
c. Self-care can vastly improve several clinical outcomes, especially in relation to noncommunicable
disease by mitigating risk factors through lifestyle modification.
d. Substance misuse (drug use, alcohol and/or smoking) is a complex issue requiring
assessment and management on an individual basis, in a non-judgemental manner.
e. The FIIT principle is a useful took to construct the Move pillar within a lifestyle medicine
prescription.

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