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Block 13 Flashcards

1
Q

What percentage of deaths are caused by CVD in UK for men and women?

A

28% - men

26% - women

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2
Q

Globally most common cause of disease:

A

Cardiovascular disease

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3
Q

Globally where are rates of CVD highest?

A

Eastern Europe, North Africa + Middle East

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4
Q

Globally where are CVD rates lowest

A

Western Europe, Canada + Australia

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5
Q

What percentage of Coronary Heart disease causes death in men? (2019)

A

13%

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6
Q

What percentage of Coronary Heart disease causes death in women? (2019)

A

8%

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7
Q

Where are CHD rates lowest in UK?

A

Southeast

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8
Q

Where are CHD rates highest in UK?

A

North of England and Wales

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9
Q

Since 1970s how have CHD death rates changed

A

significant decrease in mortality rates from CHD deaths in men and women

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10
Q

How does general deprivation affect CHD death rates?

A

Where there is more general deprivation CHD rates are higher

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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

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12
Q

How does place of birth effect CHD mortality?

A

South Asian: India, Pakistan, Bangladesh => higher CHD death rates

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13
Q

List drugs that are risk factors for cardiovascular disease

A

Contraceptives

Nucleoside analogues

COX-2 inhibitors

Rosiglitazone

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14
Q

Non-modifiable risk factors for CHD

A
  • Age
  • Male sex
  • Positive FHx
  • Deletion polymorphism in ACE enzyme
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15
Q

Risk

A

probability of an event in a given time period

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16
Q

Risk difference is also known as

A

Attributable risk

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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

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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

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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

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20
Q

Prevention paradox

A

preventive measure that offers large benefit to the community but little benefit to each participating individual

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21
Q

2 main strategies for Primary prevention

A

Population approach

High risk strategy - subgroup of population targeted

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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

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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

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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
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25
Q

Which gender has a declining incidence of lung cancer?

A

Men

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26
Q

Leading most common cause of cancer deaths

A

Lung cancer

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27
Q

Peak incidence of lung cancer is between ages:

A

65-75

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28
Q

Risk factors for lung cancer

A
  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
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29
Q

How has global incidence of TB changed overtime?

A

1800s - TB caused more than 30% of all deaths in Europe

1940s - antibiotics introduce, TB incidence declined

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30
Q

Globally, where are most new cases of TB?

A

Southeast Asia - 45`%

Africa - 25%

Western Pacific (17%) - China, Japan, Phillipines + Australia etc.

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31
Q

Factors associated with recent increases in the prevalence of TB?

A

Urban homelessness

AIDs

living in group facilities e.g. prisons, shelters

32
Q

Give some examples of occupational lung diseases

A 
 Occupational asthma
 COPD
 Pneumoconiosis
 Toxic pneumonitis
 Hypersensitivity pneumonitis
 Benign pleural disease
 Infections including TB
 Malignancy of lung and pleura
33
Q

Define occupational asthma

A

asthma caused by something in workplace environment

34
Q

Which occupations might cause occupational asthma

A

Bakers, welders, paint sprayers, laboratory workers

35
Q

How has occupational health risks improved over time?

A

Better environment + health and safety control

Improved diagnosis of occupational lung diseases

36
Q

Occupational causes of COPD

A

Coal mining

agriculture

construction

dock workers

brick making

37
Q

What is pneumoconiosis?

A

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
Q

What is silicosis?

A

 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
Q

What is siderosis?

A

iron deposition in tissue

40
Q

What is acute pneumonitis

A

 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
Q

What is hypersensitive pneumonitis?

A

 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
Q

Potential causes of hypersensitive pneumonitis

A

 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
Q

What is mesothelioma?

A

cancer of mesothelium mainly caused by asbestos exposure

44
Q

Where are claims submitted for compensation for occupational illness in the UK?

A

Disability Benefits Centre of Benefits Agency (DSS)

45
Q

What are the two types of asbestos fibres?

A

 Serpentine - Curly, white asbestos (relatively harmless), cleared with mucociliary escalator

 Amphiboles - Short, sharp, blue/brown asbestos (have malignant potential)

46
Q

Utility

A

desirability or value attached to a decision outcome

47
Q

What is decision analysis?

A

Systematic and quantitative way of making healthcare decisions e.g. when presented with two options

48
Q

Assumptions of decision analysis

A

 Decision process is logical and rational

 A rational decision maker will choose the option to maximise utility

49
Q

Stages in decision analysis

A
  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
Q

What do circles and squares mean on decision trees?

A

Squares - decision nodes, represent choices between actions

Circles - chance nodes, represent uncertainty + potential outcomes of each decision

51
Q

What is sensitivity analysis?

A

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
Q

Pros of decision analysis

A
  • 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
Q

Preference sensitivity decision

A

how an individual feels about having side effects of a particular therapy

54
Q

Probability sensitive decision

A

a decision that is sensitive to changes in the chance of different outcomes occurring

55
Q

Benefits of using decision analysis to make a decision

A

 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
Q

Cons of using decision analysis

A

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
Q

What is the ICF model of disability?

A

functioning and disability are multidimensional concepts related to:
- body structures + functioning

  • activities
  • participation of ppl in life
  • environmental factors
58
Q

What is palliative care?

A

active holistic care of pts. w advanced, progressive illness

59
Q

main goal of palliative care

A

achieve best quality of life for pts. and their families

60
Q

What does general palliative care include?

A

holistic needs assessment + provision of basic symptom control

referral to specialist palliative care if appropriate

61
Q

Benefits of palliative care

A
  • 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
Q

Who is specialist palliative care provided for?

A

pts. + carers w:
- unresolved symptoms
- complex psychological issues
- complex end of life + bereavement issues

63
Q

What are the 2 types of palliative care services?

A

general OR specialist

64
Q

Give an example of a community specialist palliative care service

A

Macmillan nurses

65
Q

Why might it be inappropriate or unfair to resuscitate?

A

when the pt. is likely to die from the condition they have regardless =» ethically inappropriate to offer futile treatment

66
Q

What is “total pain”?

A

clinical idea or approach

recognises pain as being physical, psychological, social and spiritual

67
Q

What is end of life care?

A

Branch of palliative care - Caring for people who are nearing the end of the life

68
Q

4 different types of nurses involved in palliative care?

A

district nurse

practice nurse

macmillan nurse

marie curie nurse

69
Q

What is DNACPR?

A

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
Q

What are Bowlby’s 4 stages of grief?

A

 Numbness

 Yearning/pining and anger

 Disorganisation and despair

 Reorganisation

71
Q

What is Worden’s task of mourning?

A
  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
Q

Factors affecting severity of grief

A

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
Q

What is pathological grief?

A

extended grief reactions - getting stuck in one of the phases

mummification + denial

major depressive disorder >2months aft. loss

74
Q

Psychological impact of a close death

A

loss of a person’s presence

forced to confront own mortality

crisis of world view

75
Q

How can religious beliefs impact on bereavement?

A
  • 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
Q

How can religious beliefs impact on bereavement?

A
  • 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
Q

Myth of the neutral therapist

A

 Idea that psychotherapists will ‘leak’ their personal views regardless of their intention

 This will come across in their questioning/direction of questioning

Health and society (7 decks)

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