Environmental factors/public health/tests Flashcards
what is the epidemiology of a disease
what causes it, where why and when it happens and to whom
what are the external causes of lung disease
smoking and exposure to agents
what are the internal causes of lung disease
genetics, uterine development
what are the social causes of lung disease
deprivation, cultural norms
what are the two types of occupational lung disease and give examples of each
hypersensitivity pneumonitis= extrinsic allergic alveolitis (e.g farmers lung, bird breeders lung, cheese workers lung)
pneumoconiosis (e.g. asbestosis, silicosis, coal workers lung, beryiliosis)
what is hypersensitivity pneumonitis
chronic inflammatory reaction in the lung due to exposure to specific antigens/ pathogens (lots from mould spores)
what does chronic hypersensitivity pneumonitis result in in the lung and how is it treated
extensive fibrosis with honeycombing and air trapping (scarring and inflammation). antigen avoidance
what type of lung disease is asbestosis and how is it caused
fibrotic lung disease, pneumoconiosis, caused by inhalation of asbestos fibres
why does mesothelioma take over 20 years (after exposure) to develop
as fibres stay in lungs causing damage until cancer develops
how much does asbestos increase risk of cancer from baseline risk of 1
x 5
how much does smoking increase risk of cancer from baseline risk of 1
x 10
how much does smoking and asbestos increase risk of cancer from baseline risk of 1
x 53
how much does smoking <1 pack a day and asbestos increase risk of cancer from baseline risk of 1
x 87
what is the synergistic effect of smoking and asbestos
work together to increase risk of cancer (particularly mesothelioma)
what were the main sources of exposure to asbestos
shipbuilding, mining (coal particles as well), heat insulation and building
what are the indoor environmental sources of lung disease
asbestos, mould, cooking smoke, passive smoking, nanoparticles
what are the outdoor environmental sources of lung disease
air/traffic pollution
what are the main effects of poor housing
mostly respiratory but also accidents and mental health
what are DALY
disability adjusted life years- a measure of the burden of a disease as the number of years lost to ill health
what is fuel poverty
amount of income spent on fuel
what helped to reduce passive smoking
the smoking ban
what in relation to population can attribute to lung disease
overcrowding
what is the primary and other components of smog
ozone (O3) primary, nitrogen oxide (NO), nitrogen dioxide (NO2), volatile organic compounds (VOCs)
what is smog caused by
poor consumption of fossil fuels in cars
what are the components of london smog
fly ash, sulphur dioxide, sodium chloride, calcium sulphate particles
what creates london smog
smoke based fog from burning of (high sulphur) coal fires
what are the most common chemical hazards of lung disease
sulphur dioxide, nitrogen oxide, particle matter, ozone and VOCs, persistent organic compounds (POCs), benzene, carbon monoxide, lead and heavy metals
what are the main effects of traffic fumes
reduced lung growth in adolescents, increased rates of COPD, asthma and respiratory symptoms (wheeze, cough and breathlessness)
what are some of the wider effects of inhaled substances outside the lungs
low birth weight, appendicitis, stroke, neurological/ neurobehavioural outcomes
what are dioxins a sub group of
persistent organic compounds
why are dioxins (found in food (meat) and airborne) so potent for us
as they bioaccumulate
what are dioxins associated with
reproductive and immunological problems
how does environmental injustice influence lung disease
wealth determines where you live and therefore your exposure as well as social norms- poor systemically disadvantaged
how does the increased tobacco outlet in poorer areas affect environmental injustice
makes poverty and smoking cyclic
how will water scarcity affect global health
growing population will put strain as water unevenly distributed
how will climate change affect global health
more frequent droughts, storms and flooding- destroys crops, contaminates water and damages water storage and transportation facilities
what is the only infectious agent causing environmental lung disease
legionella
what percentage of the population would be considered smoke free
5%
how do you reduce demand for smoking
reduce; availability, visibility, affordability and desirability
how is availability of cigarettes reduced
age limit, proxy purchase is an offence, banned vending machines, test purchasing, tobacco register (of shops)
how is affordability of cigarettes reduced
price in increase, duty escalator, increasing minimum size of pack/roll up pack available
how is visibility of cigarettes reduced
advertising bans, display bans, indoor smoking ban, smoke free environments, smoke free events, outdoor bans
how is desirability of cigarettes reduced
ban lipstick style packs aimed at women, plain packaging, ugly colour
what are possible NRT
vaping, NUS and champix
where are smoking rates highest in vulnerable populations
mental health, addiction, prisoners, homeless, LGBTQ+
why do people smoke
social, culture, self-medication, boredom
when in NRT most effective
when on prescription as engaged in partnership programme
what are some incentive scheme for quitting and who is eligible
Quit 4 U and Give it up for baby, 40% most deprived zones, 1 in 6 signing up. get asda credit
what is smoking role in pregnancy
largest preventable cause of disease and death in pregnancy
what happens to smoking in pregnancy rates with age
increases as age decreases
what is illicit tobacco
illegal, counterfeit, smuggled
what is epidemiology
branch of medicine which deals with the incidence, distribution, and possible control of diseases and other factors relating to health
what are the principles of epidemiology
what is it, where does it happen, why does it happen, why does it happen, when does it happen, who does it happen to
what is a positive predictive value
percentage of people who have a positive result who have the disease
what is prevalence
measure of how common disease is in the tested population
what happens to the positive predictive value as the prevalence falls
decreases
define test sensitivity
ability of the test to correctly identify those with the disease
define test
ability of test to correctly identify those without the disease
what are effort dependant pulmonary function tests
forced expiratory volumes/flow rates- spirometry
name some effort independent tests
relaxed vital capacity, exhaled breath nitric oxide
name three gas diffusion tests
CO transfer factor, ABG (resting), SaO2 during exercise
what are the dynamic lung volumes
forced expiratory volume; from TLC to RV (FEV1, FVC, FEV1/FVC, RVC (relaxed))
what diseases cause volume dependant expiratory airway closure
asthma, chronic bronchitis
what diseases cause pressure dependant expiratory airway closure
emphysema
what is PEFR
peak expiratory flow rate
how is PEFR affected in obstructive/restrictive disease
normal in restrictive, reduced in obstructive
how is FEV1 affected in obstructive and restrictive disease
decreased in both
how is FVC affected in obstructive and restrictive disease
obstructive;asthma=normal, COPD= reduced
restrictive; decreased
what is the FEV1 response to a B2-agonist in restrictive disease
no response
what is bronchial challenge testing done and what does it show
breathes in nebulised methacholine/histamine/mannitol, marker of airway hyper-responsiveness- diagnosis of occupational asthma via spirometry
how can exercise testing show asthma
reduced FEV1 and PEFR post exercise
how can exercise testing show ILD
reduced SaO2 during exercise
when would TLC be increased
hyperinflation, emphysema
what is TLCO
total lung transfer for CO
when is TLCO reduced
anaemia, emphysema, ILD, pulmonary oedema, PE, bronchiectasis
what is exhaled breath nitric oxide a measure of
marker of eosinophilic airway inflammation- high levels
what is the FEV1 response to a B2-agonist in asthma and COPD
> 15% in asthma
<15% in COPD
how is TLCO affected in emphysema, asthma and restrictive disease
reduced in emphyema and restrictive, normal in asthma
what is a buffy coat
white cells and platelets
what does a lower Hb level suggest
anaemia
what helps to determine the cause of anaemia
mean cell volume (red cell size)
what does microcytic mean and suggest in patients
smaller cells, iron deficiency (e.g chronic blood loss)
what does macrocytic mean and suggest in patients
larger cells, alcohol excess, liver disease, hypothyroidism, vitamin B12/folate deficiency
what does normocytic mean and suggest in patients
normal, acute blood loss, anaemia of chronic disease e.g. inflammation, infection
in what situation are neutrophils common
bacterial infection, steroid use
in what situation are lymphocytes common
viral infections
in what situation are monocytes common
atypical infections, cancers
in what situation are eosinophils common
parasitic infections, allergies
in what situation are basophils common
allergic reactions
what suffixes are used to describe high white cell agents
cytosis or philia
what can cause thrombocytosis (high plasma)
acute/chronic blood loss, inflammation, malignancies
what is low platelets called
thrombocytopenia
what is an epidemic
widespread occurrence of an infectious disease in a community at a particular time
what is a pandemic
disease that is prevalent over a whole country/the world
what is endemic
disease/condition that is regularly found among particular people/ in certain area
why is influenza likely to cause a pandemic
as caused by different strains so hard to gain immunity
how is influenza spread
droplets via cough, sneeze, touch or touching contaminated surface
how is influenza risks managed and contained
index clusters identified, routine control measures, anti-virals when necessary.
describe the WHO stages (8) of pandemic
1-3;predominantly animal infections 4;sustained human-human transmission 5-6;widespread human infection post peak;possibility of reccurence post pandemic;seasonal levels of disease
