Block 13 Flashcards
1
Q
What percentage of deaths are caused by CVD in UK for men and women?
A
28% - men
26% - women
2
Q
Globally most common cause of disease:
A
Cardiovascular disease
3
Q
Globally where are rates of CVD highest?
A
Eastern Europe, North Africa + Middle East
4
Q
Globally where are CVD rates lowest
A
Western Europe, Canada + Australia
5
Q
What percentage of Coronary Heart disease causes death in men? (2019)
A
13%
6
Q
What percentage of Coronary Heart disease causes death in women? (2019)
A
8%
7
Q
Where are CHD rates lowest in UK?
A
Southeast
8
Q
Where are CHD rates highest in UK?
A
North of England and Wales
9
Q
Since 1970s how have CHD death rates changed
A
significant decrease in mortality rates from CHD deaths in men and women
10
Q
How does general deprivation affect CHD death rates?
A
Where there is more general deprivation CHD rates are higher
11
Q
How are CHD rates affected by social position?
A
As you move away from professional high-skilled jobs into more manual jobs that are generally lower paid, CHD rates increase
12
Q
How does place of birth effect CHD mortality?
A
South Asian: India, Pakistan, Bangladesh => higher CHD death rates
13
Q
List drugs that are risk factors for cardiovascular disease
A
Contraceptives
Nucleoside analogues
COX-2 inhibitors
Rosiglitazone
14
Q
Non-modifiable risk factors for CHD
A
- Age
- Male sex
- Positive FHx
- Deletion polymorphism in ACE enzyme
15
Q
Risk
A
probability of an event in a given time period
16
Q
Risk difference is also known as
A
Attributable risk
17
Q
Why might CHD death rates decrease as you move up social classes?
A
Because higher social classes are associated with better health behaviours
18
Q
Define population attributable risk
A
What proportion of disease in a population is attributable to a particular risk factor e.g. how much risk of CVD is down to smoking
19
Q
3 main risk factors for global burden of CVD
A
Smoking - > regular smoking of more than 10 cigarettes a day
Cholesterol - > 3.8mm/mol
Blood pressure - SBP greater than 115mmHg
20
Q
Prevention paradox
A
preventive measure that offers large benefit to the community but little benefit to each participating individual
21
Q
2 main strategies for Primary prevention
A
Population approach
High risk strategy - subgroup of population targeted
22
Q
Outline a population approach strategy to primary prevention
A
reducing burden of disease across entire pop by modifying pop behaviour or a specific parameter
23
Q
Outline a high risk strategy to primary prevention
A
target high risk sub group of population an aim to move them to lower risk level
24
Q
List the pros and cons of population approach to prevention
A
Pros
- large potential
Cons
- subjects poorly motivated
- low benefit:risk ratio
- sml individual benefit **prevention paradox
25
Which gender has a declining incidence of lung cancer?
Men
26
Leading most common cause of cancer deaths
Lung cancer
27
Peak incidence of lung cancer is between ages:
65-75
28
Risk factors for lung cancer
1. Smoking - passive and being a smoker
2. Radon - 2nd leading cause of cancer
3. Occupational carcinogen exposure - arsenic, chromium, nickel, beryllium, silica
4. Only using open fires for heating + cooking
5. Environmental air pollution
6. Previous radiation exposure
29
How has global incidence of TB changed overtime?
1800s - TB caused more than 30% of all deaths in Europe
1940s - antibiotics introduce, TB incidence declined
30
Globally, where are most new cases of TB?
Southeast Asia - 45`%
Africa - 25%
Western Pacific (17%) - China, Japan, Phillipines + Australia etc.
31
Factors associated with recent increases in the prevalence of TB?
Urban homelessness
AIDs
living in group facilities e.g. prisons, shelters
32
Give some examples of occupational lung diseases
```
Occupational asthma
COPD
Pneumoconiosis
Toxic pneumonitis
Hypersensitivity pneumonitis
Benign pleural disease
Infections including TB
Malignancy of lung and pleura
```
33
Define occupational asthma
asthma caused by something in workplace environment
34
Which occupations might cause occupational asthma
Bakers, welders, paint sprayers, laboratory workers
35
How has occupational health risks improved over time?
Better environment + health and safety control
Improved diagnosis of occupational lung diseases
36
Occupational causes of COPD
Coal mining
agriculture
construction
dock workers
brick making
37
What is pneumoconiosis?
Occupational restrictive lung disease caused by inhalation of dust (coal dust, silica, asbestos)
can cause lung fibrosis + scarring which can obstruct + restrict the lungs
38
What is silicosis?
Occupational lung disease caused by inhalation of crystalline silica dust, and is marked by inflammation and scarring in the form of nodular lesions in the upper lobes of the lung.
It is a type of pneumoconiosis.
39
What is siderosis?
iron deposition in tissue
40
What is acute pneumonitis
Acute inhalation of a substance that causes symptoms immediately
Can be caused by - Chlorine, ammonia, organic chemicals, metallic compounds
Form of acute respiratory distress syndrome
41
What is hypersensitive pneumonitis?
Type 3 hypersensitive reaction (immune complex deposition)
It is an inflammation of the alveoli within the lung caused by hypersensitivity to inhaled organic dust
42
Potential causes of hypersensitive pneumonitis
Bird fancier's lung - Due to feathers and bird droppings
Farmer's lung - Due to mouldy hay (moulds and bacteria)
Metalworking fluids HP - Due to mist from metalworking fluids (non-TB
mycobacterium)
43
What is mesothelioma?
cancer of mesothelium mainly caused by asbestos exposure
44
Where are claims submitted for compensation for occupational illness in the UK?
Disability Benefits Centre of Benefits Agency (DSS)
45
What are the two types of asbestos fibres?
Serpentine - Curly, white asbestos (relatively harmless), cleared with mucociliary escalator
Amphiboles - Short, sharp, blue/brown asbestos (have malignant potential)
46
Utility
desirability or value attached to a decision outcome
47
What is decision analysis?
Systematic and quantitative way of making healthcare decisions e.g. when presented with two options
48
Assumptions of decision analysis
Decision process is logical and rational
A rational decision maker will choose the option to maximise utility
49
Stages in decision analysis
1. Structure the problem as a decision tree - Identifying choice, information (what is and is not known) and preferences
2. Assess the probability (chance) of every choice branch
3. Assess (numerically) the utility of every outcome
4. Identify the option that maximises expected utility
5. (Possibly) Conduct a sensitivity analysis to explore effect of varying judgements
50
What do circles and squares mean on decision trees?
Squares - decision nodes, represent choices between actions
Circles - chance nodes, represent uncertainty + potential outcomes of each decision
51
What is sensitivity analysis?
explores what would happen if the probabilities or utility values were slightly different to the ones you are using - Calculate effect of uncertainty on decision
52
Pros of decision analysis
- structures problem into decision tree enabling utility + cost to be examined
- suggests the most appropriate decision option for that particular situation
- divides decision task into components
- assists in understanding of a decision task
53
Preference sensitivity decision
how an individual feels about having side effects of a particular therapy
54
Probability sensitive decision
a decision that is sensitive to changes in the chance of different outcomes occurring
55
Benefits of using decision analysis to make a decision
Makes all assumptions in a decision explicit
Allows examination of decision making process
Integrates research evidence into the decision process
Insight gained during process may be more important than the generated numbers
Can be used for individual decisions, population level decisions and for cost-effectiveness analysis
56
Cons of using decision analysis
Probability estimates
Required data sets to estimate probability may not exist
Subjective probability estimates are subject to bias
Utility measures:
Individual may be asked to rate a state of health they have not experienced
Different techniques will result in different numbers
Subject to presentation framing effects e.g. survival/death
The approach is reductionist
57
What is the ICF model of disability?
functioning and disability are multidimensional concepts related to:
- body structures + functioning
- activities
- participation of ppl in life
- environmental factors
58
What is palliative care?
active holistic care of pts. w advanced, progressive illness
59
main goal of palliative care
achieve best quality of life for pts. and their families
60
What does general palliative care include?
holistic needs assessment + provision of basic symptom control
referral to specialist palliative care if appropriate
61
Benefits of palliative care
- Improves quality of life
- Provides relief from pain and other distressing symptoms
- Supports life and regards death as a normal process
- Doesn't quicken or postpone death
- Combines psychological and spiritual aspects of care
- Offers a support system to help people live as actively as possible until death
- Offers a support system to help the family cope during a person's illness and in bereavement
- Uses an MDT approach to address the needs of the person who is ill and their families
62
Who is specialist palliative care provided for?
pts. + carers w:
- unresolved symptoms
- complex psychological issues
- complex end of life + bereavement issues
63
What are the 2 types of palliative care services?
general OR specialist
64
Give an example of a community specialist palliative care service
Macmillan nurses
65
Why might it be inappropriate or unfair to resuscitate?
when the pt. is likely to die from the condition they have regardless =>> ethically inappropriate to offer futile treatment
66
What is "total pain"?
clinical idea or approach
recognises pain as being physical, psychological, social and spiritual
67
What is end of life care?
Branch of palliative care - Caring for people who are nearing the end of the life
68
4 different types of nurses involved in palliative care?
district nurse
practice nurse
macmillan nurse
marie curie nurse
69
What is DNACPR?
Do not attempt CPR - Decision made and recorded in advance, applies to those present if a person subsequently suffers sudden cardiac arrest or dies
70
What are Bowlby's 4 stages of grief?
Numbness
Yearning/pining and anger
Disorganisation and despair
Reorganisation
71
What is Worden's task of mourning?
1. Accepting the reality of the loss e.g. come to terms with the person being 'gone'
2. Work through the pain of grief
3. Adjust to an environment in which the deceased is missing
4. Emotionally relocate the deceased and move on with life
72
Factors affecting severity of grief
OBVIOUS
Closeness of relationship
Meaningfulness of relationship
Nature of relationship prior to death
Expectedness and manner of death
Age and developmental stage of griever
Social support
NON OBVIOUS
- individual resilience
- attachment + dependency
- religious belief
- social support
73
What is pathological grief?
extended grief reactions - getting stuck in one of the phases
mummification + denial
major depressive disorder >2months aft. loss
74
Psychological impact of a close death
loss of a person's presence
forced to confront own mortality
crisis of world view
75
How can religious beliefs impact on bereavement?
- belief in afterlife - idea tht you will see deceased again
- Prayer as means of continuing connection with the deceased
- Religious funeral rituals that aid and progress the grief process
76
How can religious beliefs impact on bereavement?
- belief in afterlife - idea tht you will see deceased again
- Prayer as means of continuing connection with the deceased
- Religious funeral rituals that aid and progress the grief process
77
Myth of the neutral therapist
Idea that psychotherapists will 'leak' their personal views regardless of their intention
This will come across in their questioning/direction of questioning
