Childrens' Health & Health Promotion

Question 1

What is health promotion? (simply)

Answer 1

Any planned activity designed to enhance health or prevent disease.

Question 2

What is health affected by?

From these what is affected by health promotion?

Answer 2

Genetics,
Access,
Environment and
Lifestyle.

The last 3 areas

Question 3

To be an appropriate use of resource what does health promotion need to be?

Answer 3

Evidence based

Question 4

What is health promotion?

Answer 4

It promotes health through a combination of legislation, the provision of preventative services such as immunisation and the development of activities to promote and maintain change to a healthier lifestyle.

Question 5

What are the theories of health promotion action?

Answer 5

Educational
Socioeconomic
Psychological

Question 6

What is the educational theory?

Answer 6

Provides knowledge and education to enable necessary skills to rate informed choices re health – may be one –to-one or group workshop
e.g. smoking, diet, diabetes

Question 7

What is the socioeconomic (radical) theory?

Answer 7

‘Makes healthy choice the easy choice’
National policies e.g. re unemployment, redistribute income, taxation of commodities to move people to make the healthier choice

Question 8

What is the psychological theory?

Answer 8

Complex relationship between behaviour, knowledge, attitudes and beliefs. Activities start from an individual attitude to health and readiness to change. Emphasis on whether individual is ready to change. (e.g. smoking, alcohol).

Question 9

What is the definition of health promotion?

Answer 9

An overarching principle/activity which enhances health and includes disease prevention, health education and health protection. It may be planned or opportunistic.

Question 10

What is the definition of health education?

Answer 10

An activity involving communication with individuals or groups aimed at changing knowledge, beliefs, attitudes and behaviour in a direction which is conducive to improvements in health.

Question 11

What is health protection?

Answer 11

Involves collective activities directed at factors which are beyond the control of the individual. Health protection activities tend to be regulations or policies, or voluntary codes of practice aimed at the prevention of ill health or the positive enhancement of well-being.

Question 12

Why is healthcare promotion relevant?

Answer 12

Consider poor lifestyles, exercise, diet etc and the cause / burden of chronic disease and the effect of the aging population on the NHS.

Question 13

Why is Health Promotion an essential tool for modern healthcare provision?

Answer 13

Growing healthcare costs managing disease and its complications.
Benefits of prevention of disease rather than treating established disease.

Question 14

What advantages do we have in the UK to enable effective health promotion?

Answer 14

Consider the organised primary care system, health visitors, chronic disease clinics, network of pharmacies – all able to deliver health promotion. Also use of media and ability to organize and advertise national programmes

Question 15

Are there any disadvantages to a Health Promotion program?

Answer 15

May include medicalising healthy individuals, possible increased worry, may not effectively target the most at risk groups e.g. those in more deprived areas less likely to respond unless health promotion meaningful / accessible for them – this can widen the care gap.
It may not deliver the required benefits leading to further increased cost. Difficult to assess impact.

Question 16

What is empowerment?

Answer 16

Empowerment refers to the generation of power in those individuals and groups which previously considered themselves to be unable to control situations nor act on the basis of their choices.

Question 17

What are the number of benefits that empowerment results in?

Answer 17

An ability to resist social pressure.
An ability to utilise effective coping strategies when faced by an unhealthy environment.
A heightened consciousness of action.

Question 18

What is the Cycle of Change?

Answer 18

See diagram.

Question 19

What are examples of health promotion in primary care?

Answer 19

Planned – Posters, Chronic disease clinics, vaccinations, QOF (much of the QOF work is ongoing despite this no longer being necessary as seen as good clinical care). Also would include things like travel clinic and then disease prevention measures such as smears, bowel screening.
Opportunistic – Advice within consultation e.g. re smoking, diet, taking BP, Alcohol brief intervention. Delivered by the GP but also increasingly by the practice nursing team.

Question 20

What are examples of health promotion by the government?

Answer 20

Legislation – Legal age limits, Smoking ban, Health and safety, Clean air act, Highway code
Economic – Tax on cigarettes and alcohol
Education – HEBS (ask students to recall adverts they’ve seen)

Question 21

What is Primary Prevention?

Answer 21

Measures taken to prevent onset of illness or injury
Reduces probability and/or severity of illness or injury
e.g. Smoking cessation or immunisation

Question 22

What is Secondary Prevention?

Answer 22

“Detection of a disease at an early (preclinical) stage in order to cure, prevent, or lessen symptomatology”

Earliest opportunity is when a disease becomes evident or detectable. Ends when disease becomes symptomatic.

Question 23

What are the requirements for screening?

Answer 23

Illness – important, natural history understood, pre-symptomatic stage
Test – easy, acceptable, cost effective, sensitive and specific
Treatment – acceptable, cost effective, better if early

Question 24

What is the Wilson and Jugner criteria for screening?

Answer 24

Knowledge of disease:
- The condition should be important public health concern.
- There must be a recognizable latent or early symptomatic stage.
- The natural course of the condition, including development from latent to declared disease, should be adequately understood.
Knowledge of test:
- Suitable test or examination.
- Test acceptable to population.
- Case finding should be continuous (not just a ‘once and for all’ project).
- Test sensitive (definitely) and specific
Treatment for disease:
- Accepted treatment for patients with recognized disease.
- Facilities for diagnosis and treatment available.
- Agreed policy concerning whom to treat as patients.
Cost considerations:
- Costs of case finding (including diagnosis and treatment of patients diagnosed) economically balanced in relation to possible expenditures on medical care as a whole.

Question 25

What do we screen for in Scotland?

Answer 25

Cancers – Breast, Bowel, Cervical
AAA
Diabetic retinopathy
Pregnancy screening
- Pre-eclampsia and diabetes
- Anaemia and blood group. Blood disorders e.g. thalassaemia and sickle cell
- Viral infections e.g. HIV, Hep B, Syphilis, Rubella
- Down’s syndrome and other chromosomal conditions
- Baby and placental position
New born screening including hearing, cataracts, congenital heart disease, hip dysplasia and undescended testes
- Guthrie test – PKU, Hypothyroidism, sickle cell, CF

Question 26

What is Tertiary Prevention?

Answer 26

“measures to limit distress or disability caused by disease”
Any intervention after the disease onset that limits the effect of the disease
e.g. secondary prevention for stroke / MI, analgesia and physiotherapy for OA, OT input for patients with MND or the provision of care support.

Question 27

What early effects impact on lifelong health?

Answer 27

Establishment of a healthy lifestyle
- Growth and development fuelled by food
- Scotland has the highest incidence of premature death due to heart disease
- High saturated fats and low fruit and veg are important factors in this
Role of parenting
- Habits and lifestyles established in adolescence
- Smoking is more than twice as likely if your parents smoke
- Neglect and abuse recur

Question 28

What are the common reasons for a young child seeing their GP/Health Visitor?

Answer 28

Feeding problems (new babies especially) pyrexia, URTI, coughs/colds, rashes, otalgia, sore throat, vomiting +/- diarrhoea, abdominal pains, behavioral problems (older infants and will depend on area / parent(s) situation).

Question 29

What are the important aspects of paediatric consultations?

Answer 29

Listening, watching, observing, examining properly, putting child at ease as well as parent / guardian, being seen to take it seriously, parental understanding, explain in clear language what your thinking is and plans are.
[So introducing the Cambridge-Calgary model]
Ethnic issues, language issues, referring if necessary, reporting if necessary
[child protection issues]

Question 30

Parents will bring their child to the surgery stating that they are unwell.
Often the child is not clinically unwell.

Why do you think parents present their children like this?

Answer 30

They might well be correct, someone else urging them to act, anxiety re a normal illness, inexperience, single parent with no support, parenting difficulty manifesting as child illness, parent depression / anxiety, social issues, child presenting to them with difficult symptoms to interpret, child abuse by a partner

Question 31

What measures can the GP take to be sure of what is happening?

Answer 31

Listen, observe, read the notes of child and parent(s), examine properly, explain clearly what you are thinking / doing, discuss with other Health Professionals, review, ‘open door’ policy, reassure appropriately, investigate appropriately, refer appropriately, care re over- investigating, no dogmatic statements

Question 32

How do you think a GP might manage apparently over anxious parent / guardian?

Answer 32

Striking a balance between what needs to be done and what does not. Again, listening, examining, considering ICE, rapport, explaining properly, consensus, allowing questions, offering second opinion, no dogma, facilitating a return visit.

Question 33

How can you provide information on diet to children?

Answer 33

It’s easy to access good dietary advice for adolescents - NHS Choices for example.

Question 34

How often do families eat together?

Answer 34

Often children arrive home at different times to their parents, and only 58% of families eat together on weekdays, rising to 61% at weekends.

Question 35

How much exercise should children do?

Answer 35

NHS Guidelines for teens suggest at least 60 minutes of moderate to vigorous exercise daily for teenagers.

Question 36

How much sleep do children require?

Answer 36

The need for sleep changes as children get older.

Average daily sleep duration ranges from 10-17 hours at 6 months to 8-11 hours at aged 11.

Question 37

What is the right amount for any particular child determined by?

Answer 37

Whether they are developing mentally and physically well, and whether they are suffering any of the consequences of not enough sleep.

Question 38

What are the potential complications of poor sleep?

Answer 38

behavioural problems, obesity, accidental injury (higher rates of drowsy driving accident), depression

Question 39

How much sleep should adolescents get?

Answer 39

Teens need about 8 to 10 hours of sleep each night to function best. Most teens do not get enough sleep — one study found that only 15% reported sleeping 8 1/2 hours on school nights.