Block 14 H + S Flashcards

Question

What are concerns with food?

Answer 1

``` -Food borne illness - Nutritional adequacy - Environmental contaminants - Pesticides - Naturally occurring contaminants - Food additives ```

Answer 2

Allows exclusions from work of people that pose increased risk of GI infection spread - Children in nursery/pre-school, people who work with food, health and social care staff, people with doubtful personal hygiene

Answer 3

- The sale of food that has been rendered injurious to health, is unfit for human consumption or is so contaminated that it would not be reasonable to expect it to be used for human consumption -  The sale of any food which is not of the nature or substance or quality demanded by the purchaser -  The display of food for sale with a label which falsely describes the food, or is likely to mislead as to the nature or substance or quality of the food

Answer 4

-Analysis of the potential food hazards in a food business (e.g. microbiological, chemical & foreign matter contamination). - Identification of the points in the operations where such hazards could occur. - Deciding which of the identified points are critical to food safety (critical points). - Identifying and implementing effective control and monitoring procedures at the critical points. - Reviewing the hazards and critical points at periodic intervals and particularly when any change occurs to the operation

Answer 5

Incident in which two or more people, thought to have a common exposure, experience a similar illness or proven infection

Answer 6

-Reduce the number of primary and secondary cases - Reduce the harm consequent on the episode - Prevent further outbreaks

Answer 7

- Preliminary phase - Is there an outbreak? Confirming the diagnosis. What is the nature and extent of the outbreak? -  Immediate steps - Who is ill? How many? Case finding. What is the cause? Is proper care being arranged? What immediate action can be taken?

Answer 8

- Outliers are cases at the very beginning and end that may not appear to be related - First check to make certain they are not due to a coding or data entry error.

Answer 9

-Baseline level of illness - Outbreak source - A case exposed earlier than the others - An unrelated case - A case exposed later than the others - A case with a longer incubation period

Answer 10

- Compare food history of ill and well persons -  Point source outbreak - Cohort study -  Common source of outbreak - Case-control study

Answer 11

-Oesophageal - Middle east and china - Gastric - Russia - Colon - Western world e.g. US, UK

Answer 12

- Evidence from observational epidemiology that average fruit/veg intake of less than 200g associated with increased risk of cancer, but possibly little additional benefit beyond 400g/day -  Very little evidence that 5 a day have impact on cancer

Answer 13

-Beta carotene found in fruit/vegetables - Cohort studies indicated protective relationship against cancer - However RCT showed beta carotene increased risk of cancer  -Cohort groups had reduced risk due to confounding factors e.g. increased exercise, reduced smoking etc

Answer 14

-Random error - Diet varies and difficulties in measurement, people don't eat the same things everyday and out individual consumptions vary significantly - Homogeneity of exposure - If you only do your studies in the same types of populations they are likely to have similar environments and hence diets, so you are not able to apply results to the population - Bias - Confounding

Answer 15

-Food disappearance data - Household survery - What do you buy and who eats what? - Individual survery - 24 hour recall, food frequency (very open to bias), diet diary, biomarkers (very rarely have this)

Answer 16

-Pros - Captures usual diet and less work to code/complete - Cons - Doesn't record actual diet as eaten, overestimates fruit and vegetables, poor measure of energy intake, less flexible

Answer 17

-Pros - Records diet as eaten (over limited period), better estimate of energy and absolute intake, more flexible - Cons - Required effort to complete and expensive to code

Answer 18

-Oesophageal - Alcohol, obesity - Stomach - Possible salted preserved foods - Pancreas - Overweight, obesity - Hepatic - Aflatoxin contamination - Colorectal - Preserved and red meat, alcohol, body fat - Breast - Alcohol, overweight - Urologic - high calcium

Answer 19

- Per capita consumption in the UK is lower than many European countries - However people in the UK start earlier and tend to drink more on single occasions ('binge drinking') -  Peak of consumption was 2008 - This is linked with affordability

Answer 20

-38% of men and 16% of women (16-64) have an alcohol use disorder (approx 8 million people) - 21% of men and 9% of women are binge drinkers - Double the recommended daily intake - 3.6% of the total population are alcohol dependent (1.1 million people)

Answer 21

Delivered in a range of settings - Primary and secondary care but also community settings (pharmacies, community health-oriented events).

Answer 22

-CBT common - Behavioural approaches - Behavioural couples therapy, behavioural self-control for moderation goal  -Motivational interviewing - Social behaviour and network therapy (SBNT)

Answer 23

``` -Alcoholic liver disease - Alcoholic neuropathy  -Chronic pancreatitis  -Alcoholic cardiomyopathy - Alcoholic gastritis - Alcohol related accidents - Risk factor for - Colon cancer, mouth and oesophageal cancer etc ```

Answer 24

-Death - Declining since 2008 - Crime and disorder - Domestic violence - Involved in 73% of cases - Poor productivity at work  -Absences/sick leave from work - Family effects - 5 million families deal with problem drinker, arguments, violence, debt, relationship problems

Answer 25

More effective policies: - Price increases - Taxation, minimum price - Restricting availability - Opening times, reducing outlet density, age restrictions Moderately effective policies: - Restricting exposures of young people to adverts - Treatment - Identification and brief advice Less effective policies: - Drug and alcohol education - Mass media campaigns

Answer 26

- Home office (focus on public order) | -  Department of health (focus of public health)

Answer 27

-Minimum unit price policy dropped, multi-buy promotion offers were not banned as suggested - Local health bodies able to instigate review of licenses - Double fine for selling alcohol to underage people - 'Enforced sobriety' - 1 year pilots based on US models - Overview alcohol consumption guidelines for adults - Alcohol included in NHS health check for adults 40-75

Answer 28

- Target resources to those activities that give the greatest health gain for the money spent as this will maximise population health gain -  Informing these choices required estimation of value of what is given up when a patient is treated (opportunity cost) and the value of what is gained in terms of improvements in the health of patients

Answer 29

Investing in health care interventions that are worthwhile

Answer 30

Investing in health care interventions which make the best use of scarce resources

Answer 31

-Geographic allocation of funding by weighted capitation | - Resourcing determined by population weighted by need

Answer 32

Evidence of social class equality in the use of primary care and social class inequality in the use of secondary care

Answer 33

The incremental change in resources (inputs and their cost) committed to an activity that produces an incremental change in effects (improved patient outcomes)

Answer 34

-Incremental investments in an activity may be associated with diminishing returns - I.e. successive increase in activity (inputs) yield declining benefits to the patient, or the more you do, the less they benefit

Answer 35

-Values both inputs (opportunity costs) and outputs (health outcomes) of any intervention - Assess if changes in resource allocation are efficient - Important because increasing healthcare expenditure needs best outcome for the money e.g NICE

Answer 36

- Cost to NHS - NICE perspective, cost of drug, cost of delivery - Cost to patient, carers, and society - Lost working days

Answer 37

Health gain = Increase in length + QoL

Answer 38

Chooses cheapest option between treatments that have identical outcomes

Answer 39

-Costs and outcomes are combined into a single measure e.g reduction in blood pressure - Allows comparison between treatments in the same therapeutic area only

Answer 40

-Combines multiples outcomes into a single measure (QALY) using QoL instruments e.g EQ5D - Allows comparisons between alternatives in different therapeutic categories e.g CV and cancer

Answer 41

Puts cost and benefit into monetary/numerical terms, e.g. how much is the 3 months gained worth to the patient?

Answer 42

- If the outcome measures are just clinical - If other more generic outcome measures are used use cost utility analysis to get QALY (NICE use it)

Answer 43

-Macro (societal) level - Regarding health funding v education or funding of certain drugs - Micro (clinical) level - Individual decisions regarding care of individual patients

Answer 44

-For - Treatment and care of elderly people is very costly so ‘cost-effective’ argument might require resources elsewhere - Against - Most of the elderly burden relates to cost of illness and incapacity rather than age, young person with chronic/serious disease could also cost the same amount

Answer 45

-Older people have had a long life already, therefor fairer to divert resources to younger people - Elderly also have a disproportionate share of the available resources allocated to them

Answer 46

-Treating on the basis of need might mean older people don’t receive lower priority - Years of life saved shouldn’t matter, the quality of life is more important e.g QALYs - Fairness is not the only thing that matters, other things do too e.g equal treatment

Answer 47

- For - Age should be relevant because older people are less likely to respond to treatment and have a poorer prognosis in general due to increased complication risk -  Against - Age alone is not a good predictor of prognosis/complications hence need case-by-case decisions, decisions based on age may be hidden form of discrimination

Answer 48

Unjustifiable difference in treatment based solely on age

Answer 49

-Direct - Direct difference in treatment based on age, cannot be justified - Indirect - Neutral provision or practice that has harmful repercussions on a person based on their age

Answer 50

- GMC - must not unfairly discriminate against patients or let views about patient affect decisions -  Law - equality act 2010, protects age, race, sex, gender, disability, religion etc

Answer 51

-Assign a utility value (0-1) to a state of health and then multiply by the number of years expected to live in this state - 0.5 QALY points x 5 yrs = 2.5 QALYs - 0.8 QALY points x 5 years= 4.0 QALYs

Answer 52

QALYs focus on overall likely outcomes of resource allocations

Answer 53

- Low - High priority, efficient health care | -  High - Low priority

Answer 54

-Maximises healthcare based on quality and quantity of life - Considers individual patient level when informing decisions about whether or not to proceed with an invasive procedure based on QALys they are likely to gain

Answer 55

-Difficulties in mesuring - How do you measure quality or value or life? Who makes the decisions? Introduces bias - Can seem unjust - Can favour life years over individual lives

Answer 56

-The older you are the fewer QALYs you will gain due to lower life expectancy + co- morbidities - Doesn’t aim for ageism but it is still discriminatory (indirect)