Case 6 SAP Flashcards
Define evidence-based public health
conscientious, explicit, and judicious use of current best evidence in making decisions about the care of communities and populations in the domain of health protection, disease prevention, health maintenance and improvement
Examples of health promotion interventions
Policies of governments and non-government organisations, laws and regulations, organisational, community and individual education, service development and delivery, resources (discounts, rewards etc.)
Define health promotion
the process of enabling people to increase control over, and to improve, their health
Tannahill’s model of health promotion
health education, prevention, and health protection
Primary prevention
concerned with preventing the onset of disease. It aims to reduce the incidence of disease. Involves interventions that are applied before there is any evidence of disease or injury.
Secondary prevention
concerned with detecting a disease in its earliest stages, before symptoms appear, and intervening to slow or stop its progression (catch it early)
Tertiary prevention
interventions designed to arrest the progress of an established disease and to control its negative consequences
21st century public health challenges
child mortality, mental health, new diseases, chronic disease epidemic (from ageing population and globalisation of risk factors)
Public health intervention outcome
quantification of the effects, beneficial or otherwise, of an intervention
Public health intervention process
qualitative or quantitative assessment of how and why effects were observed and the meaning and experience of the intervention for those involved
Public health intervention challenges
What counts as evidence
Evaluation - method and timing
Several interacting components
Several (often challenging) behaviours need to be changed
Involve many groups
Number of desired outcomes
What is evaluated in a public health intervention?
need, effectiveness, safety, efficiency, cost-effectiveness, equity, feasibility, acceptability
Describe health education
communication activity aimed at enhancing positive health and preventing or diminishing ill-health in individuals and groups through influencing the beliefs, attitudes, and behaviour of those with power and of the community at large
Health education examples
change 4 life, mental health awareness week, smokefree
Describe health protection
legal or fiscal controls, other regulations and policies, and voluntary codes of practice, aimed at the enhancement of positive health and the prevention of ill health
Health protection examples
Legal controls are laws, fiscal controls include the sugar tax and green homes grant (i.e. it is cheaper to live better and more expensive to live more unhealthily), and voluntary codes include challenge 25 and putting nutritional information on food packaging
Define public health
the science and art of preventing disease, prolonging life, and promoting health. maximum benefit for the largest number of people
How do public health interventions increase inequalities?
if they rely on voluntary change, are financially regressive, have an educational component, or are one-size-fits all
How do public health interventions decrease inequalities?
compulsory, opt out rather than opt in, tailored to individual, or are financially progressive.
FEV1
forced expiratory volume, volume of air blown out in 1 second
FVC
forced vital capacity, total volume of air blown out in one breath until the lungs are empty (usually as hard and fast as possible)
Steps in spirometry test
Take age, height, weight, ethnicity, and sex of the patient as these all have an impact on the values. Explain the risk of presyncope and coughing. Put nose clip on the patient. Take largest inhalation possible, form a seal around the mouthpiece, then exhale as hard and long as possible until can’t expire anymore. Repeat 3 times for reliability. Best two measures are within 5% of each other
FER
forced expiratory ratio, ratio of FEV1/FVC
Peak flow
maximum speed of expiration
How to measure peak flow?
Should be stood up straight, take a maximal inspiration, form a seal around the meter with the mouth, then exhale as hard and fast as possible
What changes peak flow measurements?
Increase: height and initial increasing age
Decrease: loss of muscle mass
Tidal volume
Standard resting volume
IRV
inspiratory reserve volume, max forcibly inspired
ERV
expiratory reserve volume, max forcibly expired
Vital capacity
slow and gentle expiration volume after max inhale, TV + IRV + ERV
Residual volume
volume left after max inhale
FRC
functional residual capacity, volume left after normal exhale
total lung capacity
VC + RV
How does haemothorax affect ventilation?
Lung capacity decreased - fluid takes up volume so the lung cannot expand as much. less air exchanged per breath so blood pO2 decreased but V/Q ratio unchanged
How does pneumothorax affect ventilation?
lung capacity decreased and blood pO2 decreased. affected lung collapses as the pressure outside of the lung becomes greater than the pressure inside the lung
Symptoms of lung carcinoma
persistent cough, haemoptysis, persistent breathlessness, unexplained tiredness and weight loss, ache or pain when breathing or coughing. pain only in advanced diseases as only parietal pleura has pain receptors
How do lung tumors affect ventilation?
most compress the alveoli and reduce gas exchange capacity
Cavitary pneumonia
process in which the alveoli are destroyed and produce a cavity
Which types of lung carcinoma are associated with smoking?
small cell and squamous cell
Risk factors for lung carcinoma
smoking, increasing age, exposure to substances (nickel, chromium, radon, asbestos), and areas of high pollution
Cardinal symptoms of respiratory disease
cough, sputum, wheeze, chest pain, breathlessness, haemoptysis
Normal FVC
around 5L
How does FVC change in obstructive and restrictive lung diseases?
decrease in both
How does FEV1 change in obstructive and restrictive lung diseases?
decreases in both
How does FER change in obstructive and restrictive lung diseases?
Obstructive = decreases
Restrictive = no change or increase
How is COPD categorised?
Based on FEV1:
mild = >80% predicted
moderate = 50-79% predicted
severe = 30-49% predicted
very severe = <30% predicted
FER and FEV1 indicative of obstructive lung diseases
FER >0.7 with impaired FEV1
FER and FEV1 indicative of restrictive lung diseases?
FER <0.7 with impaired FEV1
