FPC3 Tutorial 3 Childrens' Health & Health Promotion

Question 1

what is health promotion?

Answer 1

Any planned activity designed to enhance health or prevent disease

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 2

what is health affected by?

Answer 2

Genetics,

Access,

Environment and

Lifestyle

Question 3

what areas can be changed by health promotion?:

Genetics,

Access,

Environment and

Lifestyle

Answer 3

the last 3

Question 4

What are Theories of Health Promotion Action?

Answer 4

Educational - Provides knowledge and education to enable necessary understanding to make informed choices re health – may be one –to-one or group workshop. Provision of leaflets or websites.​ ​e.g. smoking, diet, diabetes reviews with the practice nurse

Socioeconomic - ‘Makes healthy choice the easy choice’ National policies e.g. taxation of commodities to move people to make the healthier choice, town centres becoming pedestrian only, incentives to cycle to work / use public transport and walk rather than drive.

Psychological - Health related decisions arise from a 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 5

what is the definition of health promotion?

Answer 5

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

Question 6

what is the definition of health educaiton?

Answer 6

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 7

what is the definition of health protection?

Answer 7

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 8

what are some challenges to successful health promotion?

Answer 8

Many doctors are cynical about planned health promotion and question if the resources allocated to it are money well spent

It is worth noting that the majority of health activities in secondary and primary care have never been adequately evaluated

In response the UK government has set up the National Institute for Health and Clinical Excellence (NICE) to review evidence and develop appropriate guidelines to practice

Question 9

what is empowerment?

Answer 9

Empowerment refers to the generation of power in those individuals and groups which previously considered themselves to be unable to control situations or act on the basis of their choices

Question 10

Empowerment results in a number of benefits, what are they?

Answer 10

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 11

what is the cycle of change?

Answer 11

Question 12

Exercise : Examples of Health Promotion

Think of examples of health promotion in:

Primary Care : Planned or Opportunistic

Government : Legislation, Economic, Education

Answer 12

Primary care:

Planned – Posters, Chronic disease clinics, vaccinations, QOF (much of the QOF work is ongoing despite this no longer being necessary for the GP contract as it 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.

Government:

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 13

what is Primary Prevention?

Answer 13

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 14

what is secondary prevention?

Answer 14

“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 15

what is Wilson’s criteria for screening?

Answer 15

Illness – important, natural history understood, pre-symptomatic stage

Test – easy, acceptable, cost effective, sensitive and specific

Treatment – acceptable, cost effective, outcome better if treated early

●Knowledge of disease:

○The condition should be important public health concern.

○There must be a recognisable 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 recognised disease.

○Facilities for diagnosis and treatment available.

○Agreed policy concerning whom to treat as patients.

○Treatment results in improved outcome for the patient

●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 16

what do we screen for in scotland?

Answer 16

Cancers – Breast, Bowel, Cervical

AAA (abdominal aortic aneurysm)

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 17

Why not screen for everything?

Answer 17

E.g. whole body scans – would result in100’s of measurements. Remember distribution of normal (5% of normal people outwith normal range) so very little chance of having no “abnormalities”

Question 18

what is Tertiary Prevention?

Answer 18

“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 (motor neurone disease) or the provision of care support.

Question 19

do quiz on slide 21

Question 20

Presentation of children in primary care:

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

What are the important aspects of these consultations?

Answer 20

Feeding problems (new babies especially) pyrexia, URTI, coughs/colds, rashes, otalgia, sore throat, vomiting +/- diarrhoea, abdominal pains, behavioural problems.

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. Ethnic issues, language issues, referring if necessary, reporting if necessary [child protection issues]

Question 21

Presentation of children in primary care:

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

1. Why do you think parents present their children like this?

Answer 21

1. 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 22

Presentation of children in primary care:

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

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

Answer 22

2. 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 23

Presentation of children in primary care:

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

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

Answer 23

3. 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. Empathising and showing your understanding of how difficult it is to assess your own child and indeed how difficult parenting is.

Question 24

Social issues:

There are other determinants of Health in Children other than the Health Choices that are actively made. The nature of the family unit has changed considerably over the years. One example of this is the increase in single parent families. The UK has the highest number in Europe, about 2 million.

Answer 24

Why do you think this is?

What, if anything can Government do?

What difficulties can you envisage a single parent will have?

Are they unfairly stigmatised?

Question 25

what is important to think about in regards ot child protection?

Answer 25

• This is an important and complex topic and will be covered in detail in the year 3 Paediatrics and Child Health block.
• Important to understand that a child’s health is affected by their environment and a presentation with illness may be the first sign of a child protection concern. The following is taken from the Child Health block handbook:

“A+E doctors, surgeons and general practitioners may see the initial presentation of a health care problem that has resulted from abuse or neglect. Any doctor may be informed of issues that potentially affect a child. This may be though their care of adult relatives, contact with other professionals or dealings with the public. Failure to act when a child is at risk can have serious consequences for the child and their family.”

Question 26

what is important to think about in regards to screen time?

Answer 26

Lets focus on another social change.

Though television and cinema have been a part of our lives for some time, the concept of having a personal screen is a very modern phenomenon.

This has led to many cultural shifts, and changes in the way that we interact with the world, and each other.

Perhaps one of the largest social experiments we have ever undertaken is underway, with the almost universal deployment of ‘small screen personal devices’ to children.

We are now maybe starting to see the consequences of this cultural change.

Global organisations are starting to realise their corporate responsibility to help parents manage this cultural shift

Question 27

What to do?

Remember the cycle of change.

No-one, perhaps especially a teenager, changes until they are ready for action and have come to terms themselves that change is needed!

What style of questioning would be better when enabling change?

Answer 27

How does ‘ You should get some more sleep and go to bed earlier’ sound compared to ‘How does it feel to be tired every morning and at school all day?’

Or ‘Video games cause health issues’ compared to ‘Do you get to spend as much time doing fun family things as you would like’ ‘ What stops you doing that’.

A change of phrasing can be very helpful when speaking to a patient or a child.

Question 28

what is important to think about in regards to a childs health in primary care

Answer 28

Primary Care is the first point of contact and most consultations happen in Primary Care without further referral.

There are many factors to take into account including personal, social, developmental, parental, physical and psychological.

Inappropriate medical interventions can sometimes be as harmful as not intervening with children.

Primary care physicians must sift out what is normal from abnormal, be aware of the multitude of factors involved in the presentation of a child and communicate well with both parent and child.