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Medicine year 2 semester 1 > Case 18- SAP > Flashcards

Case 18- SAP Flashcards

1
Q

How does the environment and health interact (global level)

A
  • Air quality- pollutants causing cardiorespiratory diseases e.g. from forest fires, sulfur from factories
  • Temperature extremes- heat stroke, dehydration, burns, asthma exacerbation, water shortages (lack of crops) cold exacerbates COPD/asthma/influenza
  • Housing inadequacy
  • Natural disasters- trauma/drowning/burns, disruption to homes, shelters, food. loss of habitable land resulting in over-crowding, drying out of water reserves/floodwaters act as reservoirs for vectors
  • Noise pollution
  • Food and drink availability and quality
  • Waste management
  • Vector-borne diseases
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2
Q

What is the impact of climate change on global health

A
  • WHO predicts 250,000 additional deaths per year between 2030-2050 due to climate change
  • Increased heat - cancer, food shortages
  • More insect-borne disease - new habitats created
  • Decreased air quality - more pollution due to industry/transport
  • Less safe drinking water - floods, reservoirs for vectors, water-borne diseases
  • Food insecurity - malnutrition, heat, crop failure, less importation
  • Extreme weather events - implications for work, natural disasters, infrastructure damage
  • Mental health - fewer green spaces, climate anxiety
  • Rising sea levels - more flooding, homelessness
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3
Q

Sustainable healthcare

A

Delivering healthcare whilst working within environmental, social and economic limits. Done by looking at resources used and the consequences of the healthcare delivered

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4
Q

International action on climate change

A

1) IPCC (International Panel on Climate Change) collates all scientific data on climate change and turns it in to reports. Encouraged cooperation between nations and progression towards scientific targets.
2) Paris Climate Agreement 2016 is an international agreement to keep global average temperature change to less than 2 degrees, countries have their own individual targets.
3) NHS Greener NHS campaign aims to be net-zero by 2040 in regards to the NHS carbon footprint.

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5
Q

Air pollution

A

Substances in the air which are harmful to human health. Can be gases, solid particles or lipid droplets. Air pollution can damage animals, food crops and the environment. Air pollution affects the cardiorespiratory system causing stroke, heart disease, COPD, lung cancer and acute respiratory infections.

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6
Q

Primary and Secondary pollutants

A

1) Primary pollutants can be from natural origins or from human activities.
2) Secondary pollutants form in the air when primary pollutants interacts.

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7
Q

Haze

A

Caused by slash and burn, Affects Malaysia, Singapore and Thailand. Causes cardiorespiratory diseases, mortality, skin and eye irritation. Leads to school closures and flight cancellations.

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8
Q

Effects of extreme weather events

A
  • Direct harm to human health: trauma, drowning, hypothermia, heatstroke, burns, smoke inhalation, emotional and psychological disturbance
  • Harm to infrastructure: homes, transport, shelters, food supplies, medical supplies
  • Event-specific effects: stagnant floodwaters create good reservoirs for water-borne diseases and other vectors, and contaminate food resources. Heatwaves may dry out water reserves. Fires may cause wide-ranging smoke.
  • Chronic health conditions may be worsened by the event itself (e.g. respiratory conditions) and in the aftermath by lack of access to healthcare.
  • Loss of habitable land can cause overcrowding
  • Population displacement, both temporary and long-term
  • Economic disruption
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9
Q

Weather and illness

A

Heat and illness
• Heat related diseases- heat stroke, heat cramps, dehydration, sunburn
• Worse in the elderly and very young
• Knock on effects- water shortage, forest fires, snow melt can cause increased rock and ice falls, agriculture shortage, challenges to transport due to melted road surfaces
Cold weather can cause- respiratory illness, COPD and asthma exacerbations and increased admissions for influenza.

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10
Q

Climate change- water quality

A

Increased floods can contaminate supplies of fresh water, stagnant floodwaters are a good reservoir for water-borne diseases. Stagnant floodwaters are a good breeding ground for some vectors i.e. mosquitos. Effects- poor sanitation, water borne infectious diseases in unsafe water (diarrhoeal, trachoma), dehydration, drought.

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11
Q

Climate change- Food availability

A

Can cause crop failure, shortage of arable land, reduction in diversity of food produced. Food production may increase in some areas. Large scale changes can lead to food instability with associated biopsyosocial stresses. Effect- hunger, starvation, malnutrition and changes to food price and availability.

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12
Q

Climate change- infectious disease

A

Changes to temperature can create habitats which are favourable for the vectors. Increasing geographic range and transmission seasons of the disease. As animals loose their habitat they are more likely to come into contact with humans. Spread of water borne diseases due to extreme weather.

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13
Q

Climate change- displaced people

A

Political instability and conflict leads to people displacement. Displacement generates new health concerns i.e. infectious diseases, malnutrition and physical and mental trauma. Population displacement can cause conflict.

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14
Q

Climate change- poverty

A

The health impacts of climate change will affect the disadvantaged and vulnerable the most through rising food and water insecurity, increasing food prices, insecure jobs and poor access to regular medication.

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15
Q

How tackling climate change improves healthcare

A
  • Many greenhouse gas emissions also contribute to air pollution so be reducing greenhouse gases you can improve health outcomes related to air pollution
  • Increased use of public transportation reduces air pollution, heat in urban areas and urban noise
  • Walking to work or school also gives the health benefits of physical activity
  • Improved house insulation- reduces heat in urban areas, reduces damp and humidity in homes and reduces urban noise
  • Consuming less meat leads to less cardiovascular disease and lower rates of cancer and obesity
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16
Q

When do member states have to report diseases to the WHO

A

Member states have a responsibility to share information within 24 hours about potential disease outbreaks, if they

  • Represent risk of spread
  • Unexpected or unexplained
  • Likely to have serious impact
  • May require international trade or travel restrictions
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17
Q

PHEIC

A

May declare public health emergency of international concern (PHEIC) - restrict trade and travel to help minimise spread. A PHEIC is declared if a public health event:
- Constitutes a public health risk to other countries through the international spread of disease and to potentially require a coordinated international response

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18
Q

What the WHO can do in a pandemic

A

Train healthcare workers, produce technical advice and share epidemiological data

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19
Q

Health emergencies programme

A

Created by the WHO. Helps countries prepare for outbreaks and disasters and deploys a response quickly, establishing a line of leadership and setting responsibilities

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20
Q

The role of the WHO in monitoring and preventing infectious disease

A
  • Issue guidance on health protection and disease management
  • Educate community on signs and symptoms
  • Stress the importance of seeking medical care
  • Emphasising benefit of early diagnosis and treatment
  • Get information about where the disease is occurring
  • Manage fear and panic
  • Promote public health education through risk communication and community engagement (RCCE)
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21
Q

Endemic, Epidemic, Pandemic

A
  • Endemic-constant occurrence of a disease, disorder or infection in a particular area or group of people
  • Epidemic- occurrence of a group of cases of an infection in excess of normally expected levels in a geographic area or population
  • Pandemic- epidemic of infectious disease over a wide area, crossing international borders and affecting a large number of people
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22
Q

Globalisation

A

Growing integration of the world economies, more connected through travel, trade and cultural exchange.

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23
Q

Challenges linked to health education

A
  • Lack of basic health infrastructure - limits vaccine distribution and delivery
  • Effects of war and internal strife
  • Perception of health workers as hostile
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24
Q

How can you use education to delay the spread of infection

A
  • Education about signs and symptoms as well as modes of transmission
  • Stressing the importance of seeking medical care and reporting suspected cases
  • Emphasising the benefit of early diagnosis and treatment
  • Understanding alleviating concerns
  • Consulting cultural leaders
  • Fact checking social media
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25
Q

When do people act on health warnings

A
  • If they feel they are personally susceptible to the condition
  • If they perceive the condition as severe
  • Perceive preventative action as effective
  • Believe they can perform the preventative action
26
Q

Phsychiological effect of infectious diseases

A
  • mortality and morbidity
  • disruption to services for other medical conditions
  • hospital avoidance due to fear
  • impact on medical supplies, borders closing
27
Q

Social and psychological effect of illness

A
  • stigma
  • social isolation
  • increased domestic violence
  • disrupted education
  • mental health issues
28
Q

Economic effect of illness

A
  • workers becoming unwell and taking time off, self isolating
  • job losses
  • increased world hunger and poverty
  • increases economic disparity
29
Q

Environmental effects of illness

A

Reduced pollution due to travel and industrial disruptions

30
Q

Effects of illness on human rights

A
  • loss of mandating behaviours
  • compulsory face mask wearing
  • prevent gatherings
  • restrict movement and activity
31
Q

What does global health include

A
  • Measurement of health and disease
  • Determinants of health and inequality
  • Culture and health
  • Demographic and epidemiological transitions
  • Key risk factors for health conditions
  • Health systems
32
Q

Global health

A

An area for study, research and practise that places a priority on improving health and achieving equity in health for all people worldwide. Looks at determinants of health and inequality, epidemiology, risk factors for health conditions etc.

33
Q

What measurements can be used to assess global health

A
  • Births and deaths
  • Diseases
  • Quantity of life (life expectancy)
  • Quality of life (DALY)- disability adjusted life year, 1 DALY is year of healthy life lost
34
Q

Global burden of disease

A

A way to describe the worlds health. Combines losses from premature death and losses from disability. Represents DALY’s, falls heaviest on poorest people/countries.

35
Q

Causes of disease= Non-communicable/ Communicable and Injury relates

A 
73% = non communicable
19% = communicable
8% = injury related
36
Q

How does globalisation link with infectious diseases

A
  • Travel and refugees - spread between countries and refugees often live-in crowded places with poor sanitation
  • Urbanisation - creation of large towns and cities so more motility and mixing
  • Climate change - expands geographical distribution of vector borne diseases, increase in shipping and globalisation have increased greenhouse gas’s release
  • Water systems – irrigation systems increase risk of water borne diseases
  • Deforestation - humans in closer contact with animal species promoting transmission of zoonotic diseases. Loss of biodiversity affects drug development
  • Trade - increased availability of drugs with limited regulation
37
Q

Public health advice for travel- infectious disease

A
  • Get available vaccinations
  • Prevent mosquito bites - repellent, nets, clothing
  • Reduce evening outdoor activities
  • Anti-malarial medication
  • Reduce exposure to animals and contaminated water
  • Refrain from risky behaviours - tattoos, sexual activity
  • Travel insurance
  • Adequate food, water and accommodation
38
Q

Questions to ask in a travel history

A
  • Where they visited
  • Accommodation
  • Activities they took part in
  • Drank tap water/ice in drinks?
  • Bitten by mosquitos
  • Malaria prophylaxis
  • Routine and travel vaccinations
  • Animal contacts
  • Tattoos/piercings
  • Drug use
  • Sexual activity
39
Q

Difference between Migrant, Refugee, Internally displaced person and Asylum seeker

A

Migrant- traveller who comes from one region or country and moves to another
Refugee- someone who has fled their home and crossed an international border due to being at risk of or having been a victim of persecution or in a crisis. They then come under the protection of the united nations.
Asylum seeker- make a formal application for the right to remain in another country and keeps that status till their application is approved
Internally displaced person- someone who has fled their home but remained in their own country

40
Q

Health problems migrants and refugees experience

A
  • Poorly controlled non-communicable diseases
  • Communicable diseases
  • Poor nutrition
  • Injuries, chronic pain, disability
  • Mental health problems
  • Dental and eye problems
  • Pregnancy, female genital mutilation
41
Q

Psychological problems migrants and refugees experience

A

1) Traumatic experience, PTSD
2) Stress, depression
3) Discrimination

42
Q

Social problems migrants and refugees experience

A

1) Poverty
2) Overcrowding
3) Language barrier
4) Unsafe working conditions
5) Cultural differences

43
Q

Factors which influence health of migrants pre-movement

A

Trauma, conflict, human rights violations, climate change and economic disadvantage

44
Q

Factors which influence the health of migrants during movement

A

Duration, mode and conditions of travel, single or mass movements, violence and exploitation

45
Q

Factors which influence the health of migrants on arrival and during integration

A

Legal status, social exclusion, discrimination, language barrier, culture and separation from social network.

46
Q

Which groups are vulnerable

A
  • Pregnant women
  • LGBT people
  • Long term unemployed or precarious work
  • Prisoners
  • Drug or alcohol dependency
  • Non English speakers
  • Homeless people
  • Children
  • BAME ethnicity
  • Disabled people
  • Migrants, refugees, asylum seekers
  • Chronic physical/mental illness
  • Malnourished
  • Elderly people
  • Sex workers
47
Q

Why are BAME people more likely to suffer from health inequalities

A
  • socioeconomic deprivation
  • racism and discrimination
  • reduced access to health services
48
Q

Structural racism in healthcare

A

1) Lots of pictures in medical textbooks are of white skin
2) Black doctors are more likely to be reported to the GMC
3) Less likely to be given sufficient information about their health
4) Less likely to be involved in shared decision making, services are not always available

49
Q

Culture

A

The set of distinctive spiritual, material, intellectual and emotional features of a society or social group which encompasses in addition to art and literature, lifestyles, ways of living together, value systems, traditions and beliefs.

50
Q

How does culture affect health and interactions with patients

A
  • Mandala of health shows how certain factors are all part of culture and influence health
  • Culture affects work, community, lifestyle, physical environment, personal behaviour etc
51
Q

How culture affects perceptions of health and disease

A
  • How health and illness are defined
  • Beliefs about what causes diseases
  • Perceptions of death
  • What conditions are stigmatised and why
  • Engagement with health promotion
  • Experience and expression of illness and pain
  • Perceptions of rehabilitation
52
Q

How does culture affect diet

A
  • Mediterranean diet
  • Perceptions of obesity
  • Gelatin based drugs - vegetarians
  • Fasting - type 1 diabetic during Ramadan
53
Q

How does culture affect clinical care

A
  • Modesty and examination exposure
  • Interactions between men and women, young and old
  • Treatment concordance
  • Experience with healthcare providers
  • Doctors as representatives of the state - anxiety if undocumented or experienced persecution
54
Q

Supernatural causation of disease

A
  • The will of God
  • Malicious magic
  • Retribution- i.e. for violating a taboo
  • Soul loss
  • Contagion - e.g. contact with menstruating women
  • Malevolent spirit
  • Fate- predestined, luck
  • Ominous sensations - dreams, sights, sounds
55
Q

Cultural competence

A

Congruent behaviours, attitudes and policies that enable working effectively in cross-cultural situations.

56
Q

How to practise in a culturally competent way

A
  • Develop awareness of impact of the socio-cultural factors on health beliefs, behaviours and decisions
  • Develop knowledge about culture
  • Be aware how own cultural values could impact interactions
  • Adapt your style to meet the needs of individuals
  • Work with people from diverse populations in a respectful manner
  • Work towards increasing access to healthcare
  • Equity- i.e. if someone is unable to read make sure they have access to the same information as someone who can
  • Ask - understanding cultural values/beliefs is critical
  • Pay close attention to signals that your patient is anxious or conflicted
57
Q

Four C’s in a cross-cultural consultatio

A
  • What do you CALL the problem?
  • What do you think has CAUSED it?
  • How do you COPE with the problem?
  • What are your CONCERNS?
58
Q

Tips for using an interpretor

A
  • Speak directly to patient, not interpreter
  • Avoid interrupting
  • Avoid speaking privately to interpreter during the session
  • Use active listening, eye contact and follow up questions
  • Consider use of specialist terminology - sometimes doesn’t translate well
  • Don’t work on autopilot - give interpreter time to translate before starting an examination or procedure
  • Don’t ask for interpreters personal opinions or advice
  • Everything said should be translated
  • Speak slower than usual
59
Q

Problems with using family members at interpreters

A
  • Lack of understanding
  • Confidentiality - patient may not disclose information
  • Conflict of interest and roles
  • Technical language proficiency
60
Q

Why using a child is inappropriate for interpretors

A
  • sensitive information
  • age-inappropriate information
  • bad news
  • disturb parent-child relationship
  • potential for error
61
Q

What aspects of culture are visible to others

A
  • race, ethnicity, accent
  • dress, profession, food, festivals
  • appearance and external behaviour
62
Q

What aspects of culture lie below the surface

A
  • facial expression, eye contact, tone of voice
  • good vs bad, right vs wrong, desirable vs undesirable
  • attitudes to people, authority, decision making
  • religion, relationships, raising children
  • ideas of sex/gender/class
  • courtesy, manners, leadership
  • values and patterns of thought

Medicine year 2 semester 1 (53 decks)

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