Community Health intro and seminars 1&2 Flashcards
Fraser Guidelines (x5)
- understand advice
- cannot persuade to inform parents
- likely to continue unprotected sex
- unless receives contraception, psychical and mental health likely to suffer
- best interests require contraception w/o parental consent
UPSSI (understanding, parents, sex, suffer, interest)
Safeguarding definition in ‘Working together to safe guard children 2013’ (x4)
- protect children from maltreatment
- preventing impairment of childs health and dev
- ensuring children grow up in circumstances consistent with the provision of safe and effective care
- taking action to enable all children to have best outcomes
Age on consent
16
<13 = statutory rape (criminal offence)
<18 can be exploited
5 stages of Marlows hierarchy
self-actualisation esteem love/belonging safety physiological
epigenetics
how environment affects expression of genome (twin studies)
allostasis
stability through change (we are programmed to respond to stress)
allostatic load
pathophysiology of stress - the result of chronic stress exposure
imaginative intelligence
difficult solutions never have one answer - MDT
salutogenesis
favourable physiological changes, secondary to experiences, which promote healing and health
domestic abuse definition
any incident or pattern of incidents of controlling, coercive, threatening behaviour, violence or abuse between those aged 16 or over who are or have been intimate partners or family members regardless or gender or sexuality
which model explains domestic violence
duluth model - women and children are more susceptible to DA due to their unequal social, economic and political status
using:
- economic abuse
- coercion and theft
- children
- intimidation
- male privileged
- emotional abuse
- minimizing, denying and blaming
- -> to get POWER and CONTROL
How does domestic abuse influence health (x3)
- traumatic injury
- somatic problems (chronic illness)
- psychological/ psychosocial
psycological = mental behaviour of individual, psychosocial = mental behaviour of society
what is the best indicator in a history of domestic abuse
‘unwitnessed’
how can doctor help with DA
- display Helpline posters/ contact cards
- ask direct questions
- focus on patients safety (and childrens)
- acknowledge and be clear the behaviour is not ok
- be part of pt.’s process in recognising and escaping abuse
RF for DA
pregnancy, alcohol, financial pressure, previous assault, criminal convictions
3 levels of risk for DA
STANDARD - current evidence does not indicate likely serious harm
MEDIUM - potential risk of serious harm
HIGH - imminent risk of serious harm
tool to assess risk of DA
DASH Risk Model/ tool
Domestic Abuse Stalking and Harassment
Mx medium/standard DA risk
give info for Domestic Abuse Services
Mx high DA risk
refer to MARAC/ IDVAS where possible w/ consent (can break consent)
MARAC - multi agency risk assessment conference
IDVAS - independent domestic violence advisers
Domestic Homicide Review
review of circumstances in which death of a person ages 16 or over has, or appears, to have resulted from violence/ neglect
public health definition
the science and art of preventing disease, prolonging life and promoting health through organised efforts of society
determinants of health
Lalonde Report
- genes
- environment
- lifestyle
- health care
equity
what is fair and just
horizontal equity
equal treatment for equal need
vertical equity
unequal treatment for unequal need
equality
equal shares
forms of health equity
- Equal expenditure for equal need
- Equal access for equal need
- Equal utilisation for equal need
- Equal health care outcome for equal need
- Equal health
dimension of health equity
spatial (geography) and social (age, gender, class, economic)
examining equity
expenditure, access, utilisation, outcomes, health status
wider determinants of health
smoking, health seeking behaviour, socioeconomic, physical environment
assessing inequity
- is it unequal
2. is it inequitable
three domains of public health practice
health improvement
health protection
improving services
e.g. health improvement
housing, education, employment, lifestyle, reduce inequality
e.g. health protection
infectious diseases, radiation, chemical/ poisonetc.
e.g. improving services
clinical effectiveness, efficiency, audit, equity, clinical governance
3 levels of public health intervention
individual (smoking cessation course)
community (local sales of cigarettes)
population/ecological (smoking ban in public) (stats on alcohol related crime/ A&E attendance)
primary prevention e.g.
smoking cessation, statins, weight loss
secondary prevention e.g.
anti plt. after MI, mamogram for breast ca
tertiary prevention e.g.
stroke/ CVD rehab, chronic disease management - diabetes eyes and foot checks
health psychology
role of psychological factors in the cause, progression and consequences of disease
3 main health behaviours
health - behaviour aimed at: prevent disease (eat health)
illness - seek remedy (got to dr)
sick role - getting well (take meds)
factors proved to impact mortality
smoking, being overweight, little physical activity, excess alcohol, poor diet
what do drs need to know about health behaviours
life style impacts health!
economics
which factors impact mortality
what are interventions at public level called
health promotion
health promotion definition
process of enabling people to exert control over the deterioration of health, thereby improving health
intervention at individual level =
patient centred - care responsive to individuals needs
why do people engage in risky behaviours (x4)
inaccurate perception of risk and susceptibility (weinstein)
- lack of personal experience with problem
- belief that preventable by personal action ??
- belief that if not happened now, wont happen
- belief that problem is infrequent
why is perception of risk important
medication adherence, keeping appointments
NICE guidance on behaviour change (x8)
planning intervention assess social context education and training individual level intervention community level population level evaluate effectiveness assess cost-effectiveness
everette et al
people underestimate risk perception
lower risk perception –> reduced attendance/ rehab
davidson et al
people have their own ideas about what causes disease
Health professionals roles in behaviour change
work with patients priorities easy changes over time set and record goals plan explicit coping strategies review progress
health belief model (x4 criteria)
an individual with change if they:
- believe they are susceptible
- believe it has serious consequences
- believe that taking action reduces susceptibility
- believe that the benefits of taking action outweigh the costs
types of health promotion (x2)
- awareness campaigns e.g. change4life
2. promoting screening e.g. cervical
three behaviour change models
- health belief model
- theory of planned behaviour
- stages of change/ trans theoretical model
unique component of HBM
cues to action - internal/ external
HBM critique
- alternative factors may predict health behaviour (e.g. outcome expectancy)
- does not consider influence of emotion
- doesn’t differentiate between first time and repeat behaviour
- cues to action missing in HBM research
most important factor for addressing behaviour change in pts in HBM
perceived barriers
what does theory of planned behaviour propose as best predictor of behaviour
intention
what is intention determined by (theory of planned behaviour)
- at persons attitude to behaviour
- perceived social pressure
- persons appraisal of their ability to perform behaviour
predicts peoples intention but NOT successful for actual behaviours
ToPB critique
- lack of temporal element
- doesnt take emotions into account
- doesnt explain how attitudes/ intentions and perceived behavioural control interact
- self-reported behaviour
stages of change/ transtheoretical (x)
pre-contemplation (not ready) contemplation preparation action maintenance
transtheoretical model +vs and -ves
+ves
- individual stages
- accounts for relapse
- temporal (time) element
- ves
- not everyone moves through all stages some people miss some
- change might be continuum not stages
- doesnt take into account values, habits, social, cultural factors
ToPB +ves
rational choice model
predict intentions
importance of social pressure included
how to help people act on their intentions
perceived control anticipated regret preparatory actions implement intentions relevance to self
other models of health change to be aware of
nudge theory - change environment to make best option easiest (weak evidence) motivational interviewing (works in problem drinking)
NICE guidance on behaviour change
health behaviour interventions should work in partnership w/ individuals/ communities/ populations/ organisation
NB: population interventions can have individual effect and visa versa
transition points in life (name 4)
leaving school entering workforce becoming a parent becoming unemployed bereavement/ retirement
impacts of smoking (x3 domains)
health - greatest single cause of illness
general lifestyle - poverty, health inequality
economic - personal and social (cleaning butts)
what is the single largest cause of health inequality
smoking
who provides evidence based tobacco control and smoking cessation courses
National Centre of Smoking Cessation and Training
which type/ combination of smoking therapy gives highest success rate
group behavioural support + medication
which type/ combination of smoking therapy gives SECOND highest success rate
individual behavioural support + medication
give examples of:
- specialist support
- non-specialist support
- non-NHS
- behavioural therapy
- medication
- internet/ books
specialist> non-spec> non-nhs
best individual medication to quit smoking
varenicline (champix)
best medication (a combination) to quite smoking
varaenicline + NRT
combination NRT better than 1 alone
how do you monitor smoking cessation progress
CO test
need definition
ability to benefit from an intervention
demand definition
what people ask for
supply definition
what is provided
steps in planning cycle
needs assessment –> planning –> evaluation –> needs assessment
example of needed and supplied but not demanded
GU contact tracing, health promotion
example of needed but not supplied or demanded
treatment of child abusers, some palliative care, contraception in some countries
example of needed and demanded but not supplied
waiting lists, evidence based gaps e.g. TB services
example of supplied and demanded but not needed
abs for sore throat, cosmetic surgery
example of needed and supplied and demanded
cataract surgery, free contraception
what is a health needs assessment
a systematic method for reviewing the health issues facing a population, leading to agreed priorities, and resource allocation that will improve health and reduce inequalities
- systematic approach to assessing needs
- reduce inequalities in health
- inform decision making and action planning
health need vs health care need
health need = general
health care need = more specific (service provision)
felt need
individual perceptions of variation from normal health
expressed need
individual seeks help to overcome variation in normal health (demand)
normative need
professional defines intervention appropriate for expressed need
comparative need
comparison between severity, range of interventions and cost
what are the three approaches to health needs assessment (HNA)
comparative
corporate
epidemiological
epidemiological approach to HNA
define problem
e.g. size of population, services available, models of care, evidence based
problems with epidemiological approach to HNA
- data may not be available
- doesn’t include felt need
- evidence base may be inadequate
- variable data quality
comparative approach to HNA
compares services received by a population (or subgroup) with others
- spatial, social
- may examine: health status, service provision, service utilisation, health outcomes
problems with comparative approach for HMA
- may not yield what is most appropriate level
- data may not be available
- data quality variable
- may be difficult to find comparable population
corporate approach to HNA
incorporate many groups views
- commissioners, providers, opinion leaders, politicians, third sector, patients, professionals
problems with corporate approach to HNA
- may be difficult to distinguish need from demand
- vested interests
- political agenda
- dominant personality
4 signs of addiction
craving
tolerance
physiological withdrawal state
compulsive drug seeking behavour
harm reduction philosophy
set of practical strategies and ideas aimed at reducing negative consequences associated with drug use
health economics
invest in treatments to stop other costs e.g. HIV, hep and criminal justice costs
give 2 examples of HNA frameworks
- Five step approach (NICE)
2. healthy equity audit (DoH)
physical effects of drug use
IDU - DVT, abscess overdose - resp depress poor pregnancy outcomes opiates --> constipation, low saliva chronic - hep c cocaine - vasoconstriction, local anaesthetic, (mydriasis)
socical effects of drug use
criminality
imprisonment
social exclusion
impact on family
psychological effects of drug use
fear of withdrawal
craving
guilt
effects of heroine
CNS DEPRESSANT miosis (constrict) - opposite to cocaine euphoria intense relaxation drowsy
used every 8hrs
effects of cocaine
STIMULANT (block mood enhancing neuroTs - serotonin and dopamine) - anxiety, panic, adrenaline
confident, impaired judgement, impulsive
mydriasis (dilated)
chronic: depression, panic, paranoia, psychosis, CVA etc.
detox heroine
o Lofexidine
o (Buprenorphine)
maintenance off heroine
methadone
buprenorphine
(psycho-soiall intervention)
drug to prevent heroine relapse
o Naltrexone
public health intervention for IVDU
needle exchange programme
how many unity of alcohol per week
14 (spread over 3 days a week)
how much alcohol in a unit
8g/10ml ethanol
what is %ABV (alcohol by volume)
number of units in L of a drink
give 5 factors affecting drinking problems
occupation religion availability peer group advertising
high risk groups for alcohol misuse
adolescents (female)
middle aged men
seamen
sex workers
are hangovers familial
yes
- bad hangovers run in families
- younger girls are when first get drunk = worse hangover
- boys hangover get worse with age girls get better
why are women drinking more
socially acceptable
more disposable income
drinks markets at women
more drinking places aimed at female customers
hazardous drinking definitions
drinking pattern of alcohol use which increases someone risk of harm
why should women drink less (x2)
- smaller body weight
- liver already metabolising oestrogen
higher risk drinking - how many units?
men 50+
women 35+
? out of date figures
increasing risk drinking - how many units?
22-50 units men
15-35 units women
? out of date figures
give 4 alcohol related diseases
accidents and violence malignancy (head, neck, GIT, breast) CVA CVD - moderate alcohol protective! NOT JUST LIVER!
how does social deprivation impact alcohol abuse
- lack of money means less likely to protect yourself against negative health and social consequences
- more likely to experience negative effects (direct and indirect)
- adverse effects of alcohol exaggerated in lower socioeconomic groups
social and psychological RF for alcohol abuse
- drinking within the family
- childhood problem behaviour relating to impulse control
- early use of alcohol, nicotine and drugs
- poor coping response to life events
- depression (as a cause not a result - become an alcoholic because your depressed not depressed because you’re an alcoholic’
how much alcohol causes liver damage?
> 30g/ day
symptoms of alcoholic hepatitis (x4)
anorexia, nausea, abdo pain, weight loss
is fatty liver reversible?
yes completely reversible!
consequences of severe hepatitis (x3)
ascities
bleeding
encephalopathy
CAGE Qs
- Have you ever felt you needed to Cut down on your drinking?
- Have people Annoyed you by criticizing your drinking?
- Have you ever felt Guilty about drinking?
- Have you ever felt you needed a drink first thing in the morning (Eye-opener) to steady your nerves or to get rid of a hangover?
give 2 screening tools for problems drinking
CAGE
AUDIT (Alcohol Use Disorders Identification Test)
(not blood test)
evidence based public health interventions for alcohol (x2)
- increasing price
- reducing supply
- screening and brief intervention
GP Mx of alcohol abuse
- vitamins
- assess IHD risk
- osteoporosis risk
- motivational interviewing (evidence based) - brief structured advice
what score on an AUDIT = hazardous drinking
8
what score on an AUDIT = alcohol dependence
women >13
men >15
features of fetal alcohol syndrome (x5)
thin upper lip short palpabral fissure smooth piltrum hypoplastic jaw microcephaly epicanthis folds
tx for alcohol dependence (x3 drugs)
disulfaram - sensitise against alcohol
acamprosate - GABA blocker
naltrexone - specialist centre
(baclofen unlicensed)
+ refer to councillor
define alcohol dependence syndrome
cluster of 3 of below symptoms in a 12 month period:
- tolerance increasing
- physiological withdrawal
- difficulty controlling onset, amount and withdrawal of use
- neglect of social and other areas of life
- spending more time obtaining and using alcohol
- continued use despite negative physical and psychological effects
what deficiency is wernikes ecepthalopathy?
B1
triad of symptoms for wernikes ecepthalopathy
acute mental confusion
ataxia
opthalmopelgia
treatment for wernikes ecepthalopathy
pabrinex (thiamine - B1)
what is koraskoff syndrome
amnesia due enduring B1 malnutrition - especially short term memory
(end result of wernikes ecepthalopathy)
is wernikes ecepthalopathy reversible
yes
is koraskoff syndrome reversible
no
symptoms of koraskoff syndrome
loss of short term memory
loss spontaneity, initiative, confabulation
what is delirium tremens
a short lived (3-5d) toxic confusional state which occurs as a result of reduced alcohol intake in alcohol dependent individuals with a long term hisotry of use
S&S of delirium tremens (x3)
clouding of consciousness/ confusion/ seizures
hallucination in any sensory modality
marked tremor
tx delirium tremens
fluids
benzos to prevent fitting
example of physiological (maslows)
Breathing, food, water, sex, sleep, homeostasis, excretion
example of security (maslows)
Security of body, employment, resources, morality, family, health, property
example of love/belonging (maslows)
Friendship, family, sexual intimacy
example of esteem (maslows)
Self-esteem, confidence, achievement, respect for other, respect by others
example of self-actualisation (maslows)
Morality, creativity, spontaneity, problem solving, lack of prejudice, acceptance of facts
what is maslows hierarchy of need
the pattern through which human motivations generally move
