GP lectures Flashcards
Dangers of overprescribing antibiotics
Unecessary side effects
Medicalise self limiting conditions
Antibiotic resistance
Purposes of primary care
Managing illness and clinical illness over time
Finding the best available clinical solutions to clinical problems
Preventing illness
Promoting health
Epigenetics
Expression of the genome depends on the environment
Allostasis
Stability through change
What is allostatic load
Long term overtaxation of our physiological systems leads to impaired health (the pathophysiology of stress)
Salutogenesis
Favourable physiological changes secondary to experiences which promote healing and health
Define domestic abuse
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 of gender or sexuality
Give some types of domestic abuse
Pscyhological Physical Sexual Financial Emotional
How does domestic abuse affect health
Traumatic injuries following assault
Somatic problems or chronic illness
Psychological or psychosocial problems
Standard domestic abuse risk
Current evidence does not indicate likelihood of causing serious harm
Medium domestic abuse risk
Idenitifiable indicators of risk of serious harm
High domestic abuse risk
Identifiable indicators of imminent risk of serious harm
How to deal with domestic and sexual abuse as a GP
Display posters Focus on safety Ask direct questions Be clear that behaviour is not ok Give info Be part of the process
Practical advice to domestic abuse patients
Phone a helpline
Domestic abuse MARAC
Single meeting about the abuse
IDVA
Service that works with high risk women
DHR
Review of circumstances surrounding domestic abuse deaths
Determinants of health
Genes
Environment
Lifestyle
Health Care
Horizontal equity
Equal treatment for equal need
Vertical equity
Unequal treatment for unequal need
Examining health equity
Supply of healthcare Access to health care Utilisation of health care Health care outcomes Health status Resource allocation Wider determinants of health
Three domains of public health
Health improvement
Health protection
Improving services
Health needs assessment definition
Systematic method for reviewing the health issues facing a population, leading to agreed priorities and resource allocation that will improve health and reduce inequalities
Define felt need
Individual perceptions of variation from normal health
Define expressed need
Individual seeks help to overcome variation in normal health
Define normative need
Professional defines intervention appropriate for the expressed need
Define comparative need
Comparison between severity, range of interventions and cost
Public health approach to health needs assessment
Epidemiological
Comparative
Corporate
Epidemiological approach to health needs assessment
Define problem Size of problem Services available Evidence base Models of care Existing services Reccomendations
Comparative approach to health needs assessment
Compares the services received by a population with others
Corporate approach to health needs assessment
Takes everyones views into account
Commisioners Providers Professionals Politicians Press Patients Opinion leaders
What is health psychology
Emphasises the role of psychological factors in the cause, profession and consequences of health and illness
3 main categories of health behaviours
Health Behaviour
Illness Behaviour
Sick role Behaviour
Define health behvaiour
A behaviour aimed to prevent disease
Define illness behaviour
A behaviour aimed to seek remedy
Define sick role behaviour
Any activity aimed at getting well
What is unrealistic optimism
Individuals continue to practice health damaging behaviour due to inaccurate perceptions of risk and susceptibility
What influences perceptions of risk
Lack of personal experience with problem
Belief that preventable by personal action
Belief that if not happened by now, its not likely to
Define need
Ability to benefit from intervention
8 NICE guidance steps on behaviour change
Planning interventions Assessing the social context Education and training Individual level interventions Community level interventions Population level interventions Evaluating effectiveness Assessing cost effectiveness
3 core principles of the NHS
meets needs of everyone
Free at point of delivery
based on clinical need not ability to pay
Health inequality definition
Preventable unfair and unjust differences in health status between people of different backgrounds
Inverse care law
Good medical or social care tends to vary inversely with the need of the population served
Vulnerable groups in NHS
Homeless Refugees Asylum seekers Elderly LGBTQ Travellers Ex prisoners Care leavers
Reasons why people may find it difficult to access care
Language
Cultural
No address
Fear
Maslows heirachy of needs
Physiological Safety Love/ Belonging Esteem Self actualisation
Define homeless
People without a home or safe living space of their own
Causes of homelessness
Breakdown of relationships Addiction Mental health Poverty Domestic abuse Unemployment "eviction from private landlords"
Where are homeless people on maslows heirachy
The bottom “physiological”
Health problems in homeless people
Malnutrition Mental Illness Substance misuse Alcohol misuse Infectious diseases STI Poor feet and teeth DVT and leg ulcers
Life expectancy for homeless people
42 for women
44 for men
Life expectancy for population
81 for women
76 for men
Barriers to health for homeless
Lack of address
Lack of phone
Prioritising food etc
Drugs
Services available for homeless people
Charities
Traveller definition
People who are committed to a nomadic or travelling lifestyle and see travelling as an important part of their ethnic or cultural identity
Traveller health prolems
Anxiety Pregnancy complications Chronic bronchitis Asthma Smoking Angina Fewer vaccinations
Traveller barriers to healthcare
Language
Cultural
Fear
Education
Services for travellers
Health worker and hub
Infections likely if unvaccinated
Haemophilus influenza b, dipertheria
Cause of epiglotitis
Hib
LGBTQ health problems
Mental health
Substance abuse
LGBTQ problems in accessing healthcare
Stigmatised
Discomfort/ fear of LGBTQ status
Previous negative experiences
Reasons for homelessness in LGBTQ
Social isolation
Discrimation
Relationship problems
Victims of crime
Problems for trans people in healthcare
Screening
Reference ranges
Effect of hormones on normal values
Define asylum seeker
A person who has made an application for refugee status
Refugee definition
A person granted asylum and refugee status. Usually means leave to remain for 5 years then reaaply
Define indefinite leave to remain
When a person is granted full refugee status and given permenet residence in the UK
Define unaccompanied child
Someone under 18 who has entered without parent or guardian
What do asylum seekers have access to
Financial support
Temporary housing
NHS care
Education
What are asylum seekers not entitled to
Employment
Benefits
What are failed asylum seekers entitled to
Money, housing NHS care (only emergency)
Asylum seekers health problems
PTSD Depression Sleep disturbance Psychosis Slef harm Presenting as physical symptoms
Asylum seekers problems in accessing health problems
Language barrier
Health not a priority
Education
Types of exploitation
Sexual Domestic servitude Forced labour Forced crime Organ harversting
Gender split of trafficked people
51% female. 2/3 children.
Impact of trafficking on health
PTSD
Contact dermatitis
Work with no equipment
Pregnancy
Red flags for trafficking
Timid
Terrified
Accompanied by controlling person
Do you need to deal with immigration status
Just focus on patient you arent an immigration officer
Name some models and theories of behaviour change
Health belief model
Theory of planned behaviour
Stages of theoretical model
What is the Health Belief Model
Individuals will change if they believe that
- theyre susceptible
- theres consequences
- action reduces susceptibility
- benefits outweigh risks
What is theory of planned behaviour
Intention determine by
- attitude to behaviour
- social norm
- able to, percieved behaviour control
Stage models of health behaviour
Stage theories see individuals located at discrete ordered stages rather than on a continuum
Stages of trranstheoretical model
Pre contemplation Contemplation Preparation Action Maintenance
Define evaluation in the context of health services
Evaluation is the assessment of whether a service achieves its objectives
Methods of classification of health outcomes
Mortality
Morbidity
Quality of life
Patient satisfaction
Maxwells dimensions of quality (3Es, 3As)
Effectiveness Efficiency Equity -Acceptability -Accessibility -Appropriateness
Define malnutrition
Malnutrition refers to deficiencies, excesses or imbalances in a persons intake of energy and or nutrients
Early influences on feeding behaviour
Maternal diet (early flavour exposure) and taste preference Role of breastfeeding Parenting practises Influences Food exposures
What is colostrum
Fat, protein protective factors; for 3 days after birth
What is foremilk
Beginning of a feed- watery
What is hindmik
End of a feed- energy dense
Advantages of breast milk
Enzyme digestion
Gut protection
Anti infective
Everyday health
Why should doctors know about nutrition
Enough knowledge to educate and advise patients effectively
Diabulimia
Underdose on insulin to cause weight loss
Sarcopenic obesity
Loss of muscle, gain weight
When do children start tasting and smelling
Before birth
Food neophobia
Fear of new foods, aged 2 to 6
How does breast milk affect later diet
Formula fed babies are less accepting of new foods
3 basic forms of dieting
Restrict total amount fo food eaten
Don’t eat certain types of food
Avoid eating for long periods
Define restrained eating
Deliberate attempt to inhibit food intake in order to maintain or lose weight
Why can dieting be unsuccesful
Consisdered individual differences
Explored portion sizes
4 features of addiction
Craving
Tolerance
Compulsive drug seeking behaviour
Physiological withdrawal state
Acute physical effects of dependent drug use
Complications of injecting (DVT, abscesses, SBE)
Overdose (respiratory depression)
Poor pregnancy
Side effects (contipation, low salivery flow)
Chronic physical effects of dependent drug use
Blood borne virus transmission
Effects of poverty
Side effects of cocaine (vasoconstriction, local anaesthesia)
Social effects of dependent drug use
Effects on families
Drive to criminality
Imprisonment
Social exclusion
Psychological effects of dependent drug use
Fear of withdrawal
Craving
Guilt
Aims of addiction treatment
Reduce harm to user, family and society
Improve health
Stabilise lifestyle and reduce use
Reduce crime
Modalities of addiction treatment
Harm reduction Detoxification Maintenance Relapse prevention Psychological interventions Alternative therapies
Which drugs are sued for detoxification for opioids
Lofexidine, buprenorphine
Which drugs are used for maintenance on opioids
Methadone, buprenorphine
Which drugs are used for relapse prevention on opioids
Naltrexone
Key questions for initial addiction assessment
Which drug Route How long addicted Pt goal ?Referral
When is quick detoxification more successful
Young user
Less time addicted
Not injecting
Lower level of drug use
Drug used for quick detoxification
Buprenorphine
Do you get seizures in opiate or alcohol withdrawal
Alcohol
Heroin effects
Euphoria, relaxation, miosis, drowsiness
Heroin adverse effects
Dependence and withdrawal
Alcohol addiction drug
Chlordiazepoxide
Drug which makes alcohol taste bad
Disulfiram
Facial features of fetal alcohol syndrome
Low nasal bridge Epicanthal folds Minor eat abnormalities Short nose Thin upper lip Indistinct philtrum
