Block 9 - part 2 Flashcards by Olivia Brownlee

Intervention strategies for HIV/AIDS

Blood donor screening, promotion/distribution of condoms, peer education for high risk groups, promotion of safe sex, diagnosis and treatment of STDs, HIV voluntary counselling and testing

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Determinants of effective outcomes of intervention

Economics, priorities, setting

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Current problems and issues surrounding HIV/AIDS intervention

Africa struggles against debt, trade restrictions and inadequate aid provisions,
global fund under-resourced,
US politics are retrogressive and harmful

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7 PH objectives of vaccination

Reduce mortality and morbidity from vaccine preventable infections,
Prevent outbreak/epidemics,
Contain infection in a populations,
Redue number of infections,
Interrupt transmission to humans,
generate herd immunity,
eradicate infectious agent

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9 factors influencing utility of vaccination for disease prevention

Disease burden
risk of exposure
age, health status, vacc Hx
special risk factors
reactions to previous vaccine
risk of infecting othrs
cost
other ways to control?
impact on public perception

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3 things required for disease to be eradicated using vaccination

No other reservoirs of infection exist in animals or environment,
consequences of infection are very high,
scientific and political prioritisation exist

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2 diseases which have been eradicated with vaccine

smallpox

polio

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Herd immunity

level of immunity in population which protects whole population

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what does herd immunity only apply to

Diseases which are passed from person to person

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what is R0

Basic reproduction rate

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Basic reproduction rate =

average number of individuals directly infected by infectious case during the infectious period, in a totally susceptibe population

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factors affecting R0

rate of contacts in host population, probability of infection being transmitted during contact, duration of infectiousness

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Effective reproduction rate (R)

estimates average number of secondary cases per infectious cases in a population made up of both susceptible and non susceptible hosts

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Equation for effective reproduction rate

R=R0x

x=fraction of host population which is susceptible (50% - x=0.5)

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R>1

Number of cases increases

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R<1

number of cases decreases, needs to be maintained for elimination

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R=1

Epidemic threshold

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Equation for herd immunity

H = (R0-1)/R0

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What is a susceptible population

Any person who is not immune to a particular pathogen

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reasons for person to be susceptible

never encountered infection or vaccine before, unable to mount an immune response, vaccination contraindicated for them

Role of WHO in vaccination

recommendations for countries on vaccination policy
supports less able countries wiht implementation strategy
Works through internation health regulations to ensure maximum security against international spread of disease

3 examples of international immunisation programmes

Expanded programme on immunisation (EPI)
Global polio eradication initiative (GPEI)
Global alliance for vaccines and immunisation (GACI)

Who/why of vaccination program implementation

Protect vulnerable, contain outbreak, eradicate disease

How of vaccination implementation

Pilots, phased introduction, global vaccination

When is vaccination implemented

greatest impact of disease burden

What is shared decision making?

Conversation between patient and their healthcare professional to reach a health care choice together

When is shared decision making important

more than one reasonable option, no option has the clear advantage, possible benefits/harms affect patient differently

8 pros of vaccination

``` Can save life ingredients safe in amounts used adverse reactions rare herd immunity save children and parents time and money protect future generations economic benefits for society ```

7 cons of vaccination

side effects harmful ingredients goverment intervention in people's choices contain ingredients people object to (chicken eggs) unnatural pharmaceutical companies aim to make profit some diseases vaccines target re relatively harmless (rotavirus)

6 factors which influence decision making

``` lifestyle perception of health beliefs about childhood diseases risk perception of the diseases perceptions about vaccines trust in institution ```

Popular vs individual debate individual argument

protections by 'herd immunity' may be safest option as avoids risk of vaccine

popular vs individual debate community argument

avoidance of vaccination leads to reduced coverage so diminishes herd immunity

2 websites useful for travel vaccine info

NHS fitfortravel | National travel health network and centre NaTHNeC

Which travel vaccines available

diptheria, polio, tetanus, typhoid, hep A, cholera

Which travel vaccines are private

Hep B, japanese encephalitis, meningitis, rabies, TB, yelow fever

Factors to consider when deciding to get travel vaccines

Country visiting, when travelling, where staying, how long for, age and health, what doing, working as aid worker, working in medical setting, in contact with animals

5 most common cancers (incidence) in UK in order

``` Breast/prostate Lung Bowel Melanoma Non-Hodgkin Lymphoma ```

5 most common causes of cancer mortality in the UK in order

Lung, bowel, prostate/breast, pancreas, oesophagus

Most common cancers in children

Leukaemias

Most common causes of cancer mortality in children

Brain, CNS, intracranial tumours

How do patterns of cancer in UK differ from that in developing country

Mortality higher in UK (29%)

Role and legal lifestyle changes in reducing incidence and mortality of cancer

Prevention, screening, diagnosis

Define bad/difficult news

Any news that drastically and negatively alters the patient's (or their relatives) view of his or her future

Factors which can affect the impact of news on a patient

``` Institutionalised beliefs personality types gender culture/race religion patients knowledge relatives ```

Anxieties of health care professionals about breaking bad news

uncertinaty about pt expectations, fear of destroying hope, fear of their own inadequacy in controlling disease, not feeling prepared to manage pt emotions, embarrassment at having previously painted too optimistic picture

ABCDE of breaking bad news

``` Advanced preparation Building relationship Communicate well Deal with patient reactions Encourage and validate emotions ```

SPIKES of breaking bad news

``` Setting up Perception Invitation Knowledge Emotions Strategy/summary ```

Emotions a patient may feel on receiving bad news

Grief, distress, denial, anger, agitated/restless

How can cancer change partner relationships

Change in roles, responsibilities, physical needs, emotional needs, sexuality and intimacy, future plans