Health Flashcards
WHO definition of health
State of complete physical, mental and social well-being
-not merely the absence of disease or infirmity
-positive concept emphasising social and personal resources as well as physical capabilities
Biomedical model of health
Physical and biological factors of disease- can be repaired
Only health professionals practice it
Mind/body dualism (suggests that they can be treated separately)
Knowledge is objective -neutral and distinct from social factors
Biomedical model of health focus
Diagnosis, cure and treatment of disease- solutions found in technologies
Social model of health
Gives thought to a wide range of factors
Wide range of people can practice it
Challenges mind/body dualism
Knowledge is not objective - we are taught how to see the body
Social model of health focus
Prevention
Health as an ideal state
Goal of perfect well being
Disease, illness and forms of handicap, along with social problems must be absent in order for health to be present
Problems with theory that health is an ideal state
Is anyone ever healthy
What is complete well-being
Can we ever attain this ideal state
Misleading
Health as a state of social functioning
Health is a means towards social functioning
All forms of disease and social handicap need to be removed
Can still be healthy (function socially) even when suffering with a chronic illness/disease
Problems with theory that health as a state of social functioning
Very narrow definition seeing health as the opposite of disease
Patients normal state may be unhealthy
Refusal of treatment might be seen as healthy
Health as a personal strength or ability
Approaches are typically humanist- focus in how people respond to challenges
Health is a means to a greater end- responding positively to problems
Attempts to recover holistic ideas about health
Problems with theory that health is a personal strength or ability
Vague
How can we intervene
Illness definition
The social, lived experience of symptoms and suffering
Disease definition
Technical malfunction or deviation from the normal which is scientifically diagnosed
Theories of illness/disease: Culver and gert
Aggregate of condition, judged by a culture, deemed painful or disabling, and which deviate from statistical norm or some idealised status
Theories of illness/disease: culver and gert
Problems
Mixes disease and illness- you can have pathology with feeling ill
Theories of illness/disease: William white
State of the organism, which is currently losing a battle with temperature, water, micro-organisms, disappointment etc (disruption of homeostasis)
Visualised as the reaction to an energy impact (addition or deprivation)
Theories of illness/disease: Peery and miller
Disturbance of the structure or function of the body
Imbalance between the individual and his environment
A lack of perfect health
Theories of illness/disease: the biomedical model
More disease= poorer health
Problems can be resolved by remedies- therefore health is something that exists outside of the person
Definition was used to inspire governments to invest in health services
Biomedical model problems
Risk of mysticism- regain something we’ve lost Asa result of person or social failing
Not all problems can be solved with a remedy
Suggests solution is either the medical practitioner not the individual
Structural determinants of health
Genetic
Constitutional (age/sex)
Culture
Lifestyle
Social/community network
Living and working conditions
Lifestyle factors promoting mortality
Obesity
Smoking
Sedentary lifestyle
Excessive alcohol
Poor diet
Health belief model
Influences on changing behaviours:
Perceived susceptibility
Perceived barriers
Benefits
Self-efficacy
Health behaviour
Aimed to prevent disease
Illness behaviour
Aimed to seek remedy
Sick role behaviour
Aimed to get well
4 components of the sick role
Patient exempt from normal social roles
Is not responsible for their condition
Should try to get well
Should seek help and cooperate with medical professionals
Criticisms of the sick role
Failure to account for conflict
Cannot account for social change- patients are not passive and more active in their care; patient-doctor relationship is not symmetrical
People with chronic conditions remains in a deviant state
Sociological models of health - sociology
Study of social relations and social processes (direct human actions result from collective human actions)
Social structures can include religion, family or medical professional
Sociological models of health - functionalism
Suggests that health is a state of optimum capacity if an individual for being effective at the tasks required by them for society
Illness can be a state of social deviance. - failure to conform to norms
Doctors distinguish between normality and deviance
Sociological models of health - Marxist
Economy is the base of society and this changes the pattern of health with society
Health is viewed at 2 levels:
Affected either directly or indirectly- industrial disease, or indirectly- commodity production
Income and wealth determine standard of living
Sociological models of health - social paradox
Diseases can be caused by social factors but treated with biological interventions
Sociological models of health - medicalisation hypothesis
Professionals see problems in terms of their own profession- doctors see everything medically
Problems that seem medical could be products of social forces
Sociological models of health - iatrogenesis
The unintended adverse effects of a therapeutic intervention
Can be clinical, social or cultural
Role of public health
Improve health protection and promotion
Preventing ill health and prolonging life through the organised efforts of society
Can be local regional national or international
3 domains of public heath
Health protection
Health improvement/promotion
Improving services
Health protection
Infectious diseases
Chemicals and poisons
Radiation
Emergency response
Environmental health hazards
Health improvement/promotion
Lifestyle
Inequality
Education
Housing
Employment
Family/community
Improving services
Clinical effectiveness
Efficiency
Service planning
Audit and evaluation
Clinical governance
Equity
Demography
Anatomy of a population
Sociology
Physiology of a population
Epidemiology
Pathology of a population
Policies and strategy plans
Diagnosis and treatment
Epidemiology
Study of distribution and determinants of health related states or events in specified populations
Application = to control health problems
Incidence
How many new cases in a year
Prevalence
Proportion of population affected, overall burden
affected by incidence and rate of cure/death
Burden of disease
How it affects your lofe
Person time
Years of study that each person gives
Useful for assessing power of a trial when people drop out
Incidence rate
Number of persons becoming cases divided by total person time risk
Social influences on health
Life expectancy
Income division
Income threshold
Gini coefficient
Social class
Inverse care law
Patient compliance
Illness vs disease
Life expectancy
Decreases as social class decreases
Within a nation, income influences health
Lower come = worse health
Uk- further north = lower life expectancy
What is social class a measure of
Occupation
Stratification (hierarchical rank)
Social position
Access to power and resources
Income division
Main determinant of population health
Increasing- more unequal societies
What is the main determinant of population health
Income division
When a country reaches a certain income threshold
Disease stops being due to poverty
Becomes degenerative disease
Income has no effect on health of a nation
Gini coefficient
Statistical representation of a nation’s income distribution
Lower the coefficient = greater the equality
UK has high inequality coefficient compared to Scandinavian countries
Inverse care law
Availability of good medical care tends to vary inversely with the need for it within a population
Disease
Objective medical definition of a deviation in normal functiom
Illness
Subjective perception of a deviation from normal experience
Public health in action
83 bus route
Chloera
Notifiable diseases
Notifiable diseases types
Scary
Nasty
Preventable
Other
Contact tracing
Notifiable diseases types - scary
Anthrax
Cholera
Dysentery
Malaria
Rabies
Yellow fever
Notifiable diseases types - nasty
Scarlet fever
Viral hepatitis (A,B,C)
Notifiable diseases types - preventable
Measles
Mumps
Rubella
Whooping cough
Notifiable diseases types - other
Food poisoning
TB
Chlamydia
Notifiable diseases types - contact tracing
Meningitis
83 bus route
Bus route through Sheffield
Starts south-west in most affluent area finishes in north-east in least affluent area
Change in life expectancy of around 9 years
Cholera
John snow
1854 Soho outbreak
Large number of people in localised area died from an unknown cause
Discovered that the spread was related to a water pump
Broad street water pump
Association between risk factor and outcome
Removal of pump handle led to stop of cholera
Became the founder of epidemiology and father of Public health
Primary prevention
An intervention implemented before there is evidence of a disease or injury
Intent of primary prevention
Reduce or eliminate causative risk factors- risk reduction
NAS Example of primary prevention
Prevent addiction from occurring
Prevent pregnancy
Secondary prevention
An intervention implemented after a disease has begun, but before it’s symptomatic
Intent of secondary prevention
Early identification through screening and treatment
NAS Example of secondary prevention
Screen pregnant women for substance use during prenatal visits and refer for treatment
Tertiary prevention
An intervention implemented after a disease or injury is established
Intent of tertiary prevention
Prevent sequelae (getting worse)
NAS Example of tertiary prevention
Treat addicted women
Treat babies with NAS
Prevention paradox
A larger number of people at small risk of disease may contribute to more cases of disease than a smaller number of people who are individually at greater risk
Examples of health promotion campaigns
Change 4 life
Stoptober
Promoting screening and immunisations
Cervical smear screening
MMR vaccine
Smoking ban- population approach to secondary prevention
High risk approach to prevention
Targeting of health promotion and disease prevention at groups based on information from epidemiological studies eg chlamydia screening for people age 15-24
Population approach to prevention
Aims to lower the level of risk in the population
- includes health promotion
Which prevention approach reduces social inequalities
Population approacj
Why does the high risk group approach to prevention favour more affluent/better educated groups
More likely to engage with health services
More likely to comply with treatments
More likely to have the necessary means to change their lifestyle
Absolute risk
Probability of an event within a stated time period
Relative risk
Probability of an event relative to exposure
Levels of intervention
Population level
Individual level
Population level intervention
Health promotion
Process of enabling people to exert control over determinants of health, thereby improving health
Individual level intervention
Patient centred approach
Care responsive to individual needs
Nuffield ladder of intervention
Do nothing- monitor
Provide information
Enable choice
Guide choice through changing default
Guide choice through incentives eg financial
Guide choice through disincentives
Restrict choice
Eliminate choice
Intervention methods
Motivational interviewing
Social marketing
Nudge theory
Mindspace
Financial incentive
Nudge theory
Changing the environment to make the healthy option easiest
Transtheoretical model
Pre-contemplation
Contemplation
Preparing to change
Action
Maintenance
Stable changed lifestyles/relapse
When and who created the health belief model
Becker
1974
Health belief model
Individuals must believe:
-they are susceptible to the condition
-it has serious consequences
-taking actions reduces their risk
-benefits of taking action outweighs the cost
When and who created theory of planned behaviour
Ajzen
1988
Theory of planned behaviour
Best predictor of behaviour is intention
Determined by:
-attitude towards the behaviour
-perceived social pressure/subjective norm
-persons appraisal of their ability to perform the behaviour/their perceived behavioural control
-barriers to action eg fear, time, cost , stigma
Reasons for resistance to change
Unrealistic optimism
Health beliefs
Situational rationality
Culture variability
Socioeconomic factors
Stress
Age
Unrealistic optimism
Individuals continue to practice health damaging behaviour due to inaccurate perceptions of risk and susceptibility
What can influence health perceptions and change
Lack of personal experience
Belief that preventable by personal action
Belief that if it hasn’t happened by now it is unlikely to
Belief that problem is infrequent
Types of transmission
Direct
Direct route eg STIs
Faecal oral route
Indirect
Vector-borne eg malaria
Vehicle-borne eg viral gastroenteritis
Airborne
Respiratory route eg TB
Number of health care associated infections in England per year
300000
Number of direct deaths attributable to infection control per year
5000
Number of deaths substantially attributable to infection control per year
15000
Cost of infection control
£1 billion per year
What percentage of blood stream infections are directly related to IV devices in situ
64%
Legal responsibility to prevent infection
Health and social care act 2006/2009
Prevention is better than cure
Why is infection control important
Prevention is better than cure
Increased length of stay for patients
Public perception/confidence in health care
A reservoir of infection develops
Antibiotics become ineffective
Chain of infection
Susceptible host
Causative microorganisms
Reservoir
Portal of entry/exit
Mode of transmission
Chain of infection: susceptible host
Low immunity
Elderly
Neonatal
Malnourished
Low white cell count
Imbalance in normal flora
Invasive procedures
Inadequate hygiene
Chain of infection: causative microorganisms
Increase number in hospitals
Resistant strains
Chain of infection: reservoir
Patients
Visitors
Staff
Fomites- where the spread originates
Chain of infection: portal of entry/exit
Respiratory tract
GI tract
GU tract
Broken skin
Chain of infection: mode of transmission
Exogenous - direct/indirect, vector spread, airborne
Endogenous- self spread
Types of hand washing
Level 1- routine handwashing
Level 2- hygienic hand antisepsis
Level 3-surgical hand scrub
Types of soaps
Alcohol gel
Antimicrobial liquid soap
Alcohol gel
Destroys most transient organisms eg MRSA
Doesn’t kill norovirus or C.diff
Antimicrobial liquid soap
Removes all transient organisms
Transient hand flora
Staphylococcus aureus
Streptococci
Viruses
Anaerobic cocci
Staphylococcus epidermis
3 types of ways to dispose of clinical waste
Household waste
Clinical waste- sharps, dressing, body fluids/tissue
Sharps bins
Associated diseases with diarrhoea
Dysentery
Typhoid
Hepatitis
Cholera
Causative organisms of diarrhoea
E.coli
Salmonella paratyphi
Norovirus
Clostridium difficile
Norovirus
Major cause of winter vomiting
Lasts 1-3 days
Common in winter- 600000-1 million cases per year
Clostridium difficile
Associated with broad spectrum antibiotics
High mortality
Carried asymptomatically in 36% of hospital patients
Spread by faecal-oral route and via spores
Clostridium difficile- SIGHT
SUSPECT c.diff as a cause of diarrhoea
ISOLATE the case
GLOVES and aprons must be worn
HAND washing with soap and water
TEST stool for toxin/ TREAT with metronidazole or vancomycin
Diarrhoea in children
Kills more than aids, malaria and measles combined
1 in 5 child deaths
Prevention with a oral rehydration therapy package from WHO-UNICEF
Control measures to prevent spread of causative agents of diarrhoea
Hand washing with soap
Safe drinking water
Safe disposal of human waste
Breastfeeding of infants and young children
Safe handling and processing of food
Control of flies/vectors
Vaccination
Challenges of an ageing population
Strains on pensions and social security
Causes of an aging population
Improvement in sanitation, housing, nutrition and medical interventions
Life expectancy is rising
Substantial falls in fertility
Cedline in premature mortality
How much will the proportion of the population +85 increase by 2025
60%
Age gender bias
Women live longer than men
In very old age the ratio is 2:1
Causes of age gender bias
Biological (20%)- premenopausal women are protected from heart disease by hormones
Environmental (80%)- men take more lifestyle risks
Types of ageing
Intrinsic
Extrinsic
Intrinsic aging
Natural
Universal
Inevitable
Extrinsic aging
Dependent on external factors
UV rays
Smoking
Air pollution
Physical changes of the ageing process
Loss of skin elasticity
Loss of hair and hair colouring
Decrease in size and weight
Loss of joint flexibility
Increased susceptibility to illness
Decline in learning ability
Less efficient memory
Affects hearing taste and smell
Age and sight
Need x3 more light
Narrowing visual field
Worse colour/depth perception
Age and hearing
High frequency loss
Poor speech comprehension
Taste and smell and age
50% loss of taste buds
Categorising disabilities
Physical or cognitive
Congenital or developmental
Chronic illness
Persistent or recurrent condition
May or may not be severe
Starts gradually with slow changes
Can’t be cured but can be treated
Age and chronic illness
Correlation with increasing co-morbid conditions
Poverty and poor living conditions increase with age
Katz ADL scale measures
Bathing
Dressing
Toilet use
Transferring- in/out of beds and chairs
Urine and bowel continence
Eating
Measuring limitations amongst the elderly
Katz ADL scale
IADL (instrumental activities of daily life)
MMSE (mini mental state examination)
Barthel ADL index
IADL
Use of the telephone
Travelling by car or using public transport
Foods/clothes shopping
Meal preparation
Housework
Medication use
Management of money
MMSE
Orientation
Immediate memory
Short term memory
Language functioning
MMSE
Orientation
Immediate memory
Short term memory
Language functioning
Number of items on the barthel ADL index
10
Barthel ADL index
Feeding
Moving from wheelchair to bed
Grooming
Transferring to and from toilet
Bathing
Walking on level surface
Stairs
Dressing
Continence of bowels
Continence of bladder
Institutionalising death
60% of people die in hospital
Most want to die at hoem
Medicalisation of death
Death as failure
Curative endeavour of biomedicine
Prolonging life at any cost
Death as a natural part of our life challenge
Glaser and srauss 1965
Awareness of dying
Observational study of interactions between dying people, relatives and staff
Identified 4 awareness contexts: closed awareness, suspicion awareness , mutual pretence, open awareness
4 awareness contexts identified by glaser and srauss
Closed awareness
Suspicion awareness
Mural pretence
Open awareness
4 awareness contexts identified by glaser and srauss
Closed awareness
Suspicion awareness
Mutual pretence
Open awareness
Social death
When people die in social and interpersonal terms before their biological death- lonely , impersonal death
Good death
Palliative care became a speciality
Aiming to de-medicalise death
Reaction against impersonal medical deaths
Death - the hospice way
Open awareness, compassion, honesty
Multi-disciplinary teams
Emotion and relationships- modelled on a family approach
Holistic care
Psychological definition of stress
Occurs when demands made upon an individual are greater than their ability to cope
2 types of stress
Distress
Eustress
Distress
Negative stress
Damaging and harmful
Eustress
Positive stress
Beneficial and motivating
Causes of stress
Acute
Chronic
Acute causes of stress
Noise
Danger
Infections
Injuries
Hunger
Chronic causes of stress
Health
Home
Finances
Work
Family
Friends
Internal stressor
Physical- inflammation/infection
Psychological- personal expectations/worry/belief in yourself
External stressors
Environmental factors
Work
Social and cultural pressures
Jobs with high stress levels
Health professionals
Teachers
Care personnel
Main reasons for work place stress
Pressure
Lack of managerial support
Work related violence and bullying
Percentage of junior doctors with a drinking problem
20%
Percentage of medical students found to be stressed and probably mentally unwell
31%
Fight or flight response
Automatic response to external acute stressors
Produces a physiological response
Effects of fight or flight response
Lungs- increase O2 uptake
Blood flow- increases to muscles by up to 400%
Skeletal muscles- tense
Spleen - more erythrocytes released
Skin- loses blood flow
Mouth- drier as saliva and mucus dry up
Immune cells - redistributed to where injury might occur
General adaptation syndrome
Alarm
Adaption/resistance
Exhaustion
Interaction model
Stress is an interaction between a person and the environment
Introduces the concept of appraisal
Impact of stressors influenced by coping mechanisms and past experience with stressors
Stress-illness model
Susceptibility to disease or illness is increased
Stressors cause strain to the individual
Leads to psychological and physiological changes
Biochemical signs of when stress becomes too much
Endorphin levels altered
Increase in cortisol
Physiological signs of when stress becomes too much
Shallow breathing
Raised BP
Increased acid production in stomach
Fight or flight response
Behavioural signs of when stress becomes too much
Increase in absenteeism
Smoking
Alcohol
Changes in eating patterns
Sleep disturbances
Cognitive signs of when stress becomes too much
Negative thoughts
Loss of concentration
Tension headaches
Emotional signs of when stress becomes too much
Tearful
Mood swings
Irritable
Aggressive
Bored
Apathetic
Managing stress
Mediating factors- social support, beliefs and attitudes, perception, personality, coping strategies, lifestyle and gender
Stress management - CBT, t’ai chi, yoga, exercise, self help and support
PTSD criteria
Person experienced or witnessed a traumatic event or a threat to physical integrity
Person responded with fear, helplessness or horror
PTSD symptoms
Traumatic event persistently experienced
Persistent avoidance of stimuli associated with trauma
Persistent symptoms of increased arousal, insomnia, irritability, difficulty concentrating
Example of causes of PTSD
Childhood physical/ emotional/ sexual abuse
Violent attacks
Nataural catastrophes
Rape, war, combat exposure
Multimorbidity
Presence of 2 or more chronic conditions
What percentage of over 65 have multimorbidity
> 50%
What is the leading cause of service use
Multimorbidity
How much of total health and social care expenditure is on chronic conditions
£7 in £10
Frailty
Accumulation of deficits across organ systems
Impaired ability to respond to adverse events
Number of people in uk who are clinically frail
1.7 million
Signs of frailty
Slow walking
Low energy
Low physical activity
Unintentional weight loss
Limitations in activity of daily living
Geroscience
A research paradigm based in addressing the biology of ageing and biology of age-related diseases together
What is biological ageing
Accumulation of damage to cells and tissues leading to progressive loss of tissue function
What causes damage to cells in ageing
Accumulation of toxic metabolites
DNA damage
Mitochondrial dysfunction
Leading to apoptosis or senescence
Senescence
the condition or process of deterioration with age
loss of a cell’s power of division and growth
What accelerates the rate of ageing
Lower socioeconomic status
Pollution
Poor housing and harsh working conditions
High stress levels
Lack of nutritious diet and exercise
Discrimination
What drives organ dysfunction
Senescence
Concept behind system medicine
there are common genes and pathways among diseases and diseases appear in clusters,
Each cluster is underpinned by a common mechanistic origin.
These clusters radically change what we call a disease.
The underlying causal molecular mechanism becomes the disease definition
Drugs are developed targeting the molecular mechanism for specific clusters of diseases.
What model of care does not work well for older people
Present single disease model
Number of adults not active enough
1 in 3
Percentage of adolescents insufficiently physically active
80%
Exercise definition
Activity required physical effort carried out to sustain or improve health and fitness
A subcategory of physical activity that is planned, structured, repetitive and aims to improve or maintain one or more components of physical fitness
Physical activity definition
Any bodily movement produced by skeletal muscles that requires energy expenditure
Ways of measuring physical activity
Self report eg IPAQ, WSQ
Direct observation
Heart rate monitoring
Accelerometry
Inclinometry
Portable indirect calorimetry
Doubly labelled water
How is physical activity measured
MET- metabolic equivalent
1 MET =metabolic rate at rest
Accelerometers
Small, lightweight , unobtrusive
Record the time, duration, frequency and intensity of walking or running movements
Aerobic exercise prescription - frequency
X5 weekly
Aerobic exercise prescription - intensity
Moderate/vigorous
Aerobic exercise prescription - type
All weight-bearing
Aerobic exercise prescription - time
30 mins+, minimise sedentary time
Resistance exercise prescription - frequency
X2 weekly
Resistance exercise prescription - intensity
Moderate
Resistance exercise prescription - type
Muscle-strengthening
Bone loading
Resistance exercise prescription - time
30 mins+
Gold standard for measuring fitness
Cardiopulmonary exercise test
model of iatrogenesis
Disease can be caused by the unintended adverse effects of therapeutic intervention which can be clinical, social or cultural
Ageing - biological level
impact of the accumulation of molecular and cellular damage over time.
Decrease in physical and mental capacity, growing risk of disease and death
WHO key challenges of an ageing population
•strains on pension and social security systems;
•increasing demand for health care;
•bigger need for trained-health workforce;
•increasing demand for long-term care;
•pervasive ageism that denies older people the rights and opportunities available for other adults.
Current number of people over 65 in the uk
11 million
Causes of ageing population
Improvements in sanitation, housing, nutrition, medical interventions.
•Life expectancy is rising around the world.
•Substantial falls in fertility.
•Decline in premature mortality.
•More people reaching older age while fewer children are born.
UN decade of healthy aging 2021-2030
Global collaboration for 10 years of ‘concerted, catalytic and collaborative’ action to foster longer and healthier lives
•Seeks to reduce health inequalities in 4 ways:-
◦changing how we think, feel and act towards age and ageism;
◦developing communities in ways that foster the abilities of older people;
◦delivering person-centred integrated care and primary health services responsive to older people;
◦and providing older people who need it with access to quality long-term care
Main causes of all deaths
Circulatory (CHD,stroke)
Cancers (lung, breast, bowel)
Respiratory (COPD, bronchitis, asthma)
Influenced on poor mental health in later life
Retirement
Bereavement
Medication
Loneliness
Depression
Poor physical health
What percentage of hospital admissions are for patients aged 65+
40%
How many times more is the health budget spending for patients aged 65+ than 16-64
4
Principles for good primary health care of older people
To help prevent unnecessary loss of function
◦To prevent and treat health problems which adversely affect quality of life in old age
◦To supplement the existing system of informal care and prevent its breakdown
◦To give older people a good death as well as a good life
Caregiver burden
◦Problems – disability & disturbance behaviours
•Incontinence; nocturnal disturbance; demands; apathy/disengagement
◦Physical disabilities less problematic than mental
•Distortion & loss of relationship
◦Mental & physical health problems as outcome
•Carer requires care
