Adult Health Flashcards
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?
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
As the registrar, is there anything you would want to be aware of for your own health in this case?
x
How does Mr. X compare with Alex who you met in 1a- specifically thinking about lifestyle and social factors that will be impacting health?
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.
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?
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,
What stats show there is men’s heath inequality in healthcare?
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
How do nature and nurture impact men’s health?
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
Sex VS gender?
Sex = male or female, biological, assigned at birth
Gender = man or woman, social construct, personal identity
How many years on average do men die earlier than women?
What are the common causes?
5 years
IHD (ischaemic heart disease), road injury, lung cancer, COPD, stroke
Why do men die of CVD and resp diseases more than women?
Oestrogen thought to be CVD protecting
Men = greater tobacco use and poorer diet
Why do men die from injuries more than women?
They take more risks
Work in more ‘dangerous’ jobs - agriculture, industries
What are health seeking behaviours?
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
Why do men have worse mental health?
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
Suicide rate differences between men and women?
Women = more likely to attempt
Men = more likely to complete a suicide attempt
Men = more violent suicide attempts
How can suicide rates be lowered?
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
What is self-care?
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
What are the 7 pillars of self-care?
- Knowledge and Health Literacy
- Mental wellbeing
- Physical activity
- Healthy eating - high fibre with nutrients, not overeating
- Risk avoidance
- Good hygiene practices - oral, digital, sleep
- Rational use of products and services - responsible use of medications
What is the self-care continuum?
- Healthy behaviours ———————> acute conditions and trauma
- Daily choices –> lifestyle –> self-managed ailments –> minor ailments –> long-term conditions –> acute conditions –> compulsory psychiatric care –> major trauma
Why is self-care effective?
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
How can self-care be integrated into daily behaviours?
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
What technologies influence self-care behaviours?
eHealth and mHealth Diagnostics Fitness trackers Nudges (notifications) Internet pharmacies AIs BP monitors Sleep apnoea monitors Glucometer Heart rate monitors
Health apps/wearables
etc.
What is the paradigm shift?
Self-care not accessible to all
Poor self care –> government interventions –> Good self care
What can affect self-care?
Inequalities Homelessness Alcohol / substance dependency Suicide Social isolation / loneliness
How can we influence good self-care behaviours?
From a young age - to make self-care behaviours a habit
Starting with workplace interventions
How common is substance misuse?
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
Why may people misuse drugs?
Family influence / childhood
Parties / clubs
Pain
How does substance misuse affect the users?
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.
What is the support / treatment available for substance used?
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
What is the support for misuse of prescription drugs?
Discuss with GP - try other medications
Try non-medication approaches - exercise and psychological therapies
What drug is prescribes to reduce withdrawal symptoms and cravings for opioids such as heroin?
Methadone
What is alcohol misuse?
>14 units / week OR Binge drinking: Men >8 units /session Women >6 units /session
Are men or women more likely to misuse alcohol?
Men - 2x as likely to drink more than 14 units /week
Men and women both peak in excessive drinking between 55-64 y/o
What is the relationship between socioeconomic status and alcohol misuse
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
Why do less affluent groups experience greater harm from alcohol?
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
What is the relationship between alcohol use and mental health?
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
What are the wide social impacts of alcohol misuse?
Relationship breakdown
Child abuse
Domestic violence
Road traffic accidents
What are alcohol screening tools?
Audit and audit C
How can alcohol misusers be helped by healthcare professionals?
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
How is the support given to alcohol dependent misusers different?
Require more intensive support
What are the symptoms of alcohol withdrawal?
V. dangerous, can result in death Symptoms include: Hypertension Tachycardia Sweating Tremor Agitation
Severe cases = delirium tremens: confusion, seizures, hallucinations, hyperthermia
What do you do if alcohol withdrawal is suspected?
Admit patient to hospital immediately
What is Wernicke’s encephalopathy?
What is it caused by and how does it present?
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
What is the treatment for Wernicke’s encephalopathy?
Patients require IV thiamine (Vitamin B1)
How should alcohol misusers approach withdrawal?
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
Can supervised alcohol withdrawal be done in primary care?
Only if:
The patient is at reduced risk of adverse outcomes
Under the supervision of a GP with a special interest in substance misuse
Where else can alcohol withdrawal take place?
In specialist care
How are alcohol misuse patients treated?
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
Why is after care after supervised withdrawal important?
High chance of relapse
Therefore after care can involve: 1 to 1 support, group support or residential rehabilitation
What are the treatment options for smoking cessation?
Combination of medical treatments and behavioural support
Bupropion
NRT = nicotine replacement therapy
Varenicline
What is bupropion?
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
What are the side effects of bupropion?
Common = sleep disturbance
Dry mouth
Heachaches
Nausea
What can be used to check whether a person has smoked and to monitor smoking cessation?
Breath carbon monoxide (CO) monitor
Smokers tend to have around 20ppm of CO
Normal non-smokers have - 2-3 ppm
What questions do they normally ask at smoking cessation help centres?
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?
How can NRTs be delivered?
Patches, inhalator, sprays, gum, lozenges
How are NRTs used?
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
How quickly does CO go down after smoking?
Almost as soon as you stop smoking
What is the ‘not a puff’ rule?
Not a single smoke puff after quit date as even having one cigarette and cause a relapse
What is Varenicline?
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
What are the symptoms for Varenicline?
Nausea = most common, usually passes with time and can be helped by taking the tablets with food
Headaches
Sore throat
Sleep disturbance
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?
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?
When compared to females, the increased mortality associated with being male is driven predominantly by:
- . Exposure to occupational and environmental risks
- . Health seeking behaviours
What are the implications of late presentation for a health system/
- 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
2 myths about suicide
- . 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)
Suicide stats
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.
complications of drugs injected
- 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.
Which drug is methadone prescribed as a safer substitute for?
- 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.’
What is the definition of binge drinking in women?
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%).
What is the definition of binge drinking in men?
binge drinking is more than 8 units in a single session.
What class of medication is generally used in planned withdrawal of alcohol to allow dependent drinkers to stop drinking safely?
Benzodiazepine
- long-acting benzodiazepine, such as chlordiazepoxide, is used to reduce withdrawal symptoms when someone is undergoing planned withdrawal of alcohol.
best way to stop smoking
best way to stop smoking is through a combination of treatment and behavioural support
best smoking cessation treatment
Whichever treatment combination suits the patients life is best and that a combination of NRT options is more effective than one alone.
what is the FITT Principle
- 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.
Describe inequalities in relation to men’s health and potential initiatives to tackle them
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
Risk factors of drug misuse
ACEs
Struggling with mental health
Apart from these, very diverse
Impacts of drug misuse
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
Support + treatments for drug misuse
- GP, secondary care, psychiatry services, specialist services
- Methadone - heroin substitute
- Non-medication pain management
what is alcohol misuse defined as
Alcohol misuse = >14 units per week or binge drinking
Risk factors for
Alcohol misuse
- Men + middle aged
- Less deprived (although more harm to more deprived – alcohol harm paradox)
- Mental illness
- Abuse during childhood
Impacts of alcohol misuse
Relationship breakdown, domestic abuse, crime, road traffic accidents
support and treatments for alcohol misuse
- Brief advice + self-help + follow up (If unsuccessful – extended brief intervention/CBT)
- Planned withdrawal (primary care/specialist)
- –>Reducing doses of chlordiazepoxide then acamprosate
acute withdrawal symptoms of alcohol misuse and action
- Admit to hospital!
Hypertension, tachycardia, sweating, tremor, agitation
Delirium tremens: confusion, seizures, hallucinations, hyperthermia
What is alcohol misuse a risk factor for
Wernicke’s Encephalopathy (thiamine deficiency)
key points
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.
