Ethics and public health Flashcards
Name some causes of skin disease
- irritants
- allergens
- internal disease
- drugs
- genetics
- sun exposure
- temperature / humidity
- infections
- psychological factors
What type of skin tumours are mainly seen in fairer patients?
Malignant and premalignant
Skin disease is the 10th most frequent cause for GP consultations true or false?
False
It is the 4th most frequent
Name some common skin diseases
- eczema / dermatitis
- infections - viral, fungal, bacterial
- acne
- skin tumours
- psoriasis
Define prevalence
The total number of cases (of a disease) within the population at any one time
Define incidence
The number of new cases of a disease defined as the % of the population who develop the disease over a fixed period of time
Name some conditions that are becoming more common in the UK
- skin cancers (including melanoma)
- venous leg ulceration
- atopic dermatitis
Describe illness behaviour
The ways in which given symptoms may be differentially perceived, evaluated, acted upon (or not acted upon) by different kinds of person
Define disease
- a pathological condition of the body
- objective and demonstrable
- fits with the body as a machine model
- can be measured and quantified
Define illness
- the experience of discomfort and suffering
- subjective
- depends on the individual concerned, their psychological and social situation, culture and belief
- hard to measure and quantify
Describe the ‘social animal’ principle
- we are social animals, our social worlds are both external and internal, symbolic representations in our minds
- we are story telling animals
- we seek and construct meaning in our lives
- role; bundles of social expectations attaching to a position within a social structure
Describe sensation
Refers to the ‘raw data’ that impacts on the sense organs
Describe perception
Provides meaning for the raw data of sensation
Describe impression formation
- relevant both to the doctor-patient consultation, and to the patients social interactions with others
- importance of first impressions
- inferential processes are necessary, guidelines for action, order of chaos
Describe gestalt psychology
- Asch (1946) classic experiment in social psychology
- the human eye sees objects in their entirety before perceiving their individual parts
- the whole is greater than the sum of its parts
Describe stereotypes
- overgeneralisations
- in the absence of other information it may constitute a rational guess
- attribution of one trait leads to inference of other traits
- labelling; initial label tends to stick and become self validating
Describe affect
- the term affect is sometime used for momentary feeling states
- the ethologists ekman and friesen propose 6 primary affects
- happiness, surprise, fear, sadness, disgust and interest
- they suggest that the ‘disgust affect display’ develops from movements of the mouth and node involved in rejecting a bad taste or smell
Name the five essential elements of study design
- what are the reasons for undertaking the study
- who is the target group
- recruitment process and strategy
- consent
- confidentiality and data protection
Name examples of unethical research in the past
- edward jenner - smallpox experiments
- tuskegee syphilis experiment - US health service studied syphillis in rural black men who thought they were receiving free health care
- experiments on jewish prisoners in concentration camps
Name the two most important international declaration on ethics of research
- nuremberg code 1948 - the voluntary consent of the human subject is absolutely essential
- declaration of helsinki 1964 - research reviewed by independent committees
Describe respect for patient autonomy
- enabling a patient to make their own choices
- honest communication between doctor and patient
- aims to give the patient full information about proposed research including risks and benefits
Name the three major requirements for valid consent
- free will, no coercion
- patient must have the capacity to understand
- full information was given
Name the five main ethical issues
- recruitment and consent
- vulnerable patients
- confidentiality and data protection
- risks, harm and safety
- financial incentives
Name some risks of unethically conducted research
- harm to patients
- abuse of power
- mistrust of doctors
- mistrust of healthcare professions and institutions
- mistrust of useful research
- harm to researchers
Food allergy describes what?
When symptoms are caused by an immune reaction, usually IgE mediated but sometimes not (thought to be cell mediated but not well understood)
Food intolerance describes what?
A non-immune reaction, eg. lactose intolerance where there is lactase enzyme deficiency leading to poor breakdown of lactose in the GI tract and the excess unabsorbed lactose results in symptoms
Name some direct skin manifestations of obesity
- acanthosis nigricans
- skin tags
- hirsutism
- acne
- hidradenitis suppurative
- androgenic alopecia
- stretch marks
What is acanthosis nigricans?
A velvety thickening and pigmentation of the skin folds, usually axillae
What are skin tags (acrochordons)?
Frequently found around axillae and neck areas
What is hirsutism?
Increased hair in females in male distribution eg beard area
What is hidradenitis suppurativa?
A chronic inflammatory disease where boils and abscesses form and scar in apocrine gland areas (especially axillae, groin)
What is androgenentic alopecia?
Male pattern balding in men and women
What are stretch marks (striae distensae)?
Type of scarring associated with dermal connective tissue injury in response to local stretching forces eg rapid weight gain in pregnancy and obesity
Name some skin diseases aggravated by obesity
- lymphoedema
- chronic venous insufficiency
- skin infections
- intertigo
- psoriasis
Describe skin infections in relation to obesity
- increased tendency to bacterial, fungal and yeast infections, especially in skin folds and areas where circulation is affected eg legs
Describe intertigo in relation to obesity
- macerated red plaques which develop in skin folds due to high moisture levels, friction, increased pH and reduced barrier function and are prone to secondary infection
Describe psoriasis in relation to obesity
- the link is not clear
- psoriasis morbidity is higher in obesity and weight control plays a role in management
- flexural psoriasis is particularly aggravated
Name the two forms of protein energy malnutrition (PEM)
- marasmus
- kwashikor
Describe the marasmus form of PEM
- global nutrient deficiency causing weight loss by fat breakdown
- the child is very thin from muscle wasting
- there is no oedema
- the skin is dry, wrinkled and loose from subcutaneous fat and muscle loss
- hair is thin, brittle and falls out easily causing alopecia
Describe the kwashikor form of PEM
- thought to be caused by very low protein intake with reasonable carbohydrate intake
- there is oedema and children often developed an enlarged pot belly
- skin shows irregular or patchy discolouration caused by pigmentary change
- dark, dry skin may split when stretched, revealing pale areas between the cracks (crazy paving dermatosis)
What is the role of vitamin a?
- fat soluble vitamin
- vital for epithelial proliferation, keratinisation and development
What is the role of vitamin K?
- fat soluble vitamin
- essential for several blood coagulation factors
What is the role of vitamin B2 (riboflavin)?
- water soluble vitamin
- essential co-factor in numerous metabolic reactions
What is the role of vitamin B3 (niacin)?
- water soluble vitamin
- essential co-factor in numerous metabolic reactions
What is the role of vitamin B6?
- water soluble vitamin
- co-enzyme for many processes
What is the role of folate and vitamin B12?
- water soluble vitamin
- both critical co-enzymes in many processes with similar deficiency states
What is the role of biotin?
- water soluble vitamin
- essential co-factor for carboxylase enzymes
What is the role of vitamin C (abscorbic acid)
- water soluble vitamin
- essential co-factor in collagen formation eg hair and for bone and teeth health
What is the role of zinc?
- mineral
- required for many metabolic pathways
- required for structure and function of skin and so vital for wound healing
