Key Diseases In Public Health Flashcards
What percentage of deaths in the UK does cardiovascular disease account for
40%
How many men have CHD
1 in 5
How many women have CHD
1 in 8
Number of phases of cardiac rehabilitation
4
Phase 1 of cardiac rehabilitation
In hospital
Phase 2 of cardiac rehabilitation
Early post-discharge
Phase 3 of cardiac rehabilitation
4-16 weeks
Phase 4 of cardiac rehabilitation
Long term maintenance of lifestyle change
What is the NHS plan to tackle CHD
Around ‘standards’
Standards 1 and 2 - aim to reduce heart disease across the entire population
Standards 3 and 4 - aim to prevent CHD in high risk patients
Primary prevention of CHD - SNAP and management of related conditions
Smoking
Nutrition
Alcohol
Physical activity
Primary prevention of CHD- smoking
Taxation
No public places
Cessation services
Health warnings
Tobacco control
Primary prevention of CHD- nutrition
Recommendations eg 5 a day
Food standards
Regulations
Labelling
Food in schools
Primary prevention of CHD- alcohol
Know your limits
Taxation
Alcohol pricing
Refulation
Primary prevention of CHD- physical activity
5 times a week
PE in school
Who does secondary prevention for CHD include
Patients after recovery from ACS or with stable angina
What does secondary prevention for CHD include
Primary care CHD registers
Medical management-medications
Phase 4 cardiac rehabilitation- SNAP
3 groups of ~CHD causes
Medical history
Lifestyle factors
Cause of the causes
CHD causes: medical history
Male gender
Family history
Past medical history of cardiovascular disease
Hypertension
Raised lipids
Smoking
CHD causes: lifestyle factors
Smoking
Obesity
Sedentary lifestyle
Excess alcohol
CHD causes: causes of the causes
Loneliness
Unemployment
Poor housing
Fear of crime
No access to green space
Food poverty
Pollution
Social inequality
4 groups of CHD risk factors
Unmodifiable
Physiological/clinical
Psychological
Lifestyle
CHD risk factors: unmodifiable
Sex
Age
Ethnicity
Family history
Early-life circumstances
CHD risk factors: physiological/clinical
High blood cholesterol
Hypertension
Type 2 disbetes
CHD risk factors: psychological
Personality (type A/B)
Depression
Anxiety
Work
CHD risk factors: lifestyle
Smoking
Physical inactivity
Overweight
Poor nutrition
Alcohol intwke
What is the single biggest risk factor for coronary heart disease
Smoking
How does musculoskeletal disease affect individuals
Physical pain
Psychological burden - loss of independence, chronic pain
Economic implication- loss of income , cost of treatment or care
How does musculoskeletal disease affect society
Economic burden - of treatment , loss of work
Workplace productivity- secondary to cost to individuals
Back pain red flags
Aged below 20 or above 55
Thoracic pain
Persistent night pain
Night sweats
Recent unexplained weight loss
Saddle anaesthesia/sphincter disturbance
Trauma
Significant past medical history
Predictive factors of lower back pain
Psychosocial factors
Pain intensity
Episode duration
Previous history
Chronic lower back pain
Continuous pain for 3+ months
Epidemiology of lower back pain
Women get more than men in UK
Generally increases with age
Social class
Increasing prevalence of lower back pain
Ageing population
More obesity
Work burdens
Less active society
What can doctors do for lower back pain
Education
Prescribe exercise
What should doctors know about musculoskeletal disease
Common
Expensive for society
Only ever measure a fraction of total cost
Treat with exercise
Remember red flags
Stroke definition
Rapidly developing clinical signs of focal disturbance and cerebral functions lasting more than 24 hours
Leads to death with no apparent causes other than vascular origin
Classification of stroke
Thrombosis
Embolism
Haemorrhage
Risk factors for stroke
Age and sex
Hypertension
Smoking
Alcohol consumption
CVD
Diabetes
Symptoms of Parkinson’s disease
Tremor
Rigidity
Akinesia
Incidence of smoking
Incidence increases with age
Less common in smokers
Parkinsonism
Drug induced movement disorder
Non-progressive
Why does smoking lower the risk of Parkinson’s
Elevated dopamine levels due to nicotine effect
60% lower risk
Multiple sclerosis definition
Multiple areas of demyelination and spinal cords
Prevalence of multiple sclerosis
Directly proportional to distance from equator
Uncommon in fishing communities
How is multiple sclerosis diagnosed
MRI
Cerebral palsy definition
Non-progressive brain damage before or during neo-natal period
Wide spectrum of physical/mental impairment
Risk factors of cerebral palsy
Anoxia
Low birth weight
Aetiology of dementia
Genetic
Cardiovascular
Multi factorial
Types of dementia
Alzheimer’s
Vascular
Mixed
Lewy body dementia
Fronto-temporal dementia
Other
Prevalence of Alzheimer’s
62%
Prevalence of vascular
17%
Prevalence of mixed dementia
10%
Prevalence of Lewy body dementia
6%
Prevalence of fronto-temporal dementia
2%
Epilepsy
Characterised by recurrent epileptic seizures
Unprovoked by any identifiable cuases
Aetiology of epilepsy
Genetic factors
Febrile seizures
Head injuries
Bacterial and parasitic infections
Symptoms of influenza
Musculoskeletal aching
Headache
Fever
Respiratory symptoms
Transmission of influenza
Spreads via coughing, sneezing and touch
Incubation period of influenza
1-3 days
When is someone infectious with influenza
From onset of symptoms to 4-5 days lster
Viral family of influenza
Orthomyxoviridae
2 types of influenza that affects humans
A - transmission from other organisms leading to pandemics
B
Surface antigens of influenza
Hemagglutinin
Neuraminidase
How do new strains of influenza arise
Antigenic shift
Antigenic drift
Antigenic shift
Horizontal transmission of genes between different strains of virus
Antigenic drift
De novo mufations
H5N1
Avian flu
60% mortality but not sustained transmission
H1N1
Spanish flu -1918
Swine flu - 2009
Criteria for pandemic spread
A novel virus
Capable of infecting humans
Capable of causing human illness
Large pool of susceptible people
Ready and sustainable transmission from person to person
Phases of a pandemic
Phases 1-3
Phase 4
Phases 5-6
Post-peak
Post-pandemic
Phase 1-3 of a pandemic
Mostly animal infections with few human infections
Phase 4 of a pandemic
Sustained human to human transmission
Phases 5-6 of a pandemic
Widespread human infection
Post-peak phase of a pandemic
Possibility of recurrent events
Post-pandemic phase of a pandemic
Disease returns to seasonal levels
Factors Altering the risk of pandemics
International travel
Large populations
Crowding
Population health has improved
Animal husbandry has changed
Interdependence between countries
Public health pandemic interventions
Hand washing
Respiratory hygiene
Reduce social contact
Travel restrictions
Restricting mass gatherings
School closures
Voluntary home isolation of cases
Screening people entering UK
Contain,ent phase
Containment phase
Early phase using anti-virals as prophylaxis (problematic side effects)
WHO definition of mental health
State of well-being in which the individual realises his/her own abilities can cope with the normal stresses of life
Can work productively and fruitfully and is able to make a contribution to his/her society
Common mental health problems
Depression
Generalised anxiety disorder
Panic disorder
Phobias
Social anxiety disorder
Obsessive-compulsive disorder
Post-traumatic stress disorder
Effects of mental health disorders
Negative effect on quality of life
Increase risk of physical illness
Increased mortality from physical illness
Depression is a major risk for suicide
Correlation between household income and mental health disorders
More affluent are 3 times less likely to suffer
Number of people who suffer with depression worldwide at any one time
350 million
Number of people who have a severe mental illness
24 million
Number of people who commit suicide
1 milliom
Percentage of children who have a mental disorder
10-20%
Percentage of doctors who have a mental disorder
1/3
Percentage of doctors who are depressed at some point and have a higher suicide risk
20%
Percentage of people who have work-related fatigue
42%
Percentage of people who have depression
29%
Percentage of people who have anxiety
26%
Percentage of people who have PTSD
15%
Especially females
Percentage of people who have burn out syndrome
6%
Chronic kidney disease
Blanket term referring to evidence of long term kidney damage leading to a reduced estimated GFR of below 60ml/min/1.73m^-2
How is chronic kidney disease classified
5 stages
Stage 5 = dialysis
GFR of stage 1 chronic kidney disease
> 90
GFR of stage 2 chronic kidney disease
60-90
GFR of stage 3a chronic kidney disease
45-60
GFR of stage 3b chronic kidney disease
30-45
GFR of stage 4 chronic kidney disease
15-30
GFR of stage 5 chronic kidney disease
<15
Risk factors of chronic kidney disease
Obesity
Diabetes
CVD
Ageing population
High prevalence in immigrant populations
Causes of chronic kidney disease
Diabetes
Hypertension
Atherosclerosis
Glomerulonephritis
Chronic pyelonephritis/reflux/obstruction
Polycystic kidney disease
Drug toxicity
Chronic kidney disease in the developing world
Ageing population
Rise in chronic diseases, especially obesity and diabetes
High incidence in some ethnic groups
Little/no infrastructure to treat end stage renal failure
Why is chronic kidney disease controversial
Arbitrary threshold in a continuously varying physiological parameter
Existing tests perform relatively poorly
Progression from CKD 3 to 5 is rare- especially in the elderly
No specific treatment
Prevalence of smoking
Men smoke more than women- gap closing
Overall decrease
Lower socioeconomic groups smoke more than those from higher
Physiological effects of smoking
Activation of nicotinic ACh receptors in brain
Dopamine release in nucleus accumbens
Stimulant, tolerant, withdrawal
Number of deaths per year from smoking
100000
Associated health problems with smoking
Cancer
COPD
CHD
stomach ulcers
Impotence
Oral health
Cataracts
What is the single greatest cause of illness and premature death in the UK
Smoking
Reasons people smoke
Addiction
Coping with stress
Habit
Socialising
Fear of weight gain after cessation
Pleasure
Choice
Advertising
Peer group/family
Signifier of cultural status
What law prohibits the sale of cigarettes to U16s
1908- children act
Richard Doll and Austin Bradford Hill - 1950
Smoking associated with lung carcinomas
When did parliament bans cigarette advertising on TV
1965
When was smoking in public places banned and the legal minimum raised to 18
2007
When was smoking in the car with children banned
2015
When was standardised plain packaging required for cigarettes
2016
Smoking cessation tools
Nicotine replacement therapy- patches, gum, nasal spray, microtab, lozengers, inhalators
Varenicline
Bupropion
How is smoking cessation modelled
Transtheoretical model
Planned behaviour theory (attitude, subjective norm, perceived behaviour control, behavioural intention)
The 3 As
Ask- patient about smoking
Advise- smoking cessation methods
Assist - refer to NHS services
Reluctance to change: type A behaviour
Hostility
Competitiveness
Impatience
Reluctance to change: uncle norman behaviour
Smoked/drank and was obese all his life and died when he was 90 so I can do the same
Reluctance to change: last person behaviour
Well he was fit and well and died suddenly, what benefit is this to me if he died
Reluctance to change: unrealistic optimism
Tendency to perceive oneself of being at less risk of disease than other people of same age/sex
Cost of alcohol to NHS
55% of A&E costs
£3.5 billion per year from alcohol related harm
Fetal alcohol syndrome
Growth retardation
CNS abnormalities
Craniofacial abnormalities
Congenital defects
Increased risk of birth marks and hernias
Symptoms of alcohol withdrawal
Tremors
Seizures
Hallucinations
Delirium tremens
Activation syndrome (agitation, shakes, rapid heart rate, high bp)
Social implications of alcohol
Violence
Rape
Depression/anxiety
Driving offences
What is a standard unit of alcohol
10 ml/8g ethanol
How many units in a bottle of wine
10
How to calculate units in alcohol
(%alcohol by volume x amount of liquid in ml) / 1000
Guidelines for amount of alcohol per week
14 units/week for men and women
Old recommendation of alcohol consumption for men
3-4 units a day
28 units per week
Old recommendation of alcohol consumption for women
2-3 units a day
21 units per week
What is 14 units of alcohol equivalent to
6 pints of beer
6 glasses of wine
14 shot of a spirit
How to question a patient about alcohol dependency
CAGE
- ever felt you should CUT DOWN
- been ANNOYED by people telling you to cut down
- do you ever feel GUILTY about how much you drink
- EYE OPENER: ever had a drink first thing in the morning
Alcoholism
Primary chronic disease with genetic , psychosocial and environmental influences
Progressive and fatal
Impaired control over-drinking
WHO definition of obesity
Abnormal/excessive fat accumulation
Resulting from chronic imbalance between energy intake and expenditure which presents a risk to health
State of positive energy balance
Aetiology of obesity
Complex balance between multiple factors
Biology = environment = behavioru
7 domains of energy balance
Food environment = energy intake - population level
Food consumption - energy intake - individual level
Individual activity = energy expenditure
Activity of the environment = energy expenditure- population level
Social influences = both intake and expenditure
Individual psychology = both intake and expenditure
Individual biology = both intake and expenditure
Diagnostic measures of obesity
MRI
dual-energy x-ray absorptiometry
Waist circumference
Waist to hip ratio
Skinfold thickness
BMI
BMI value for underweight
<18.4
BMI value for normal
18.5-24.9
BMI value for overweight
25-29.9
BMI value for obese class I
30-34.9
BMI value for obese class II
35- 39.9
BMI value for obese class III
> 40
Treatment of obesity
Diet and exercise
Associated diseases with obesity
T2DM
Hypertension
Cancer
Cardiovascular disease
Current prevalence of obesity
2/3 adults
1/3 11-15 yrs
1/4 2-10 yrs
Causes of obesity
Car culture and commuting- less walking
Longer working hours
Technical advances that minimise physical work
Over consumption and increasing portion sizes
Greater availability of energy dense foods
Grazing and snaking
Replacement of water by sugary drinks
Built an obesogenic environment- Americanisation of diet and society
Mechanisms that maintain obesity
Physical/physiological - more weight means it’s harder to exercise and diet
Psychological- low self esteem and guilt
Socioeconomic- employment and relationships
Costs of obesity
Between £2.6 and 15.8 billion per year from direct and indirect costs
Social gradient and obesity
18% professionals/managers are obese
28% of unskilled/manual workers are obese
Runaway weight gain train
Steep slope- obesogenic environment
Ineffective brakes - knowledge, prejudice, physiology
Accelerators - vicious cycles of mechanical dysfunction, ineffective dieting, psychological impact, low socioeconomic status
Prader Willi syndrome
Short stature, almond-shaped eyes, small hands and feet
Intellectual impairment
Hyperphagia (over eating)
Chromosome 15 deletion- paternal
Congenital leptin deficiency
Extreme adiposity and uncontrollable appetite
Monogenic obesity-very rare
Obesogenic environment
The Pima Indians showed a dramatic increase in obesity when exposed to the western diet
Majority are now severely obese and 95% have diabetes
Obesity and genetics
Prader Willi syndrome
Mutations of the leptin and melanocortin receptors
Congenital leptin deficiency
Polygenic obesity
Behaviour associated with weight gain-
Employment
Developmental factors
Overeating
Satiety
Energy density of foods
Energy compensation
Alcohol
Food environment characteristics
Psychological factors
Behaviour associated with weight gain- employment
Shift work, lack of sleep , upset circadian rhythm
Reduced physical activity
Influence on release of cortisol, leptin, ghrelin
Dietary patterns
Leisure and activities
Behaviour associated with weight gain- developmental factors
Rapid infant weight gain is damaging
Breast feeding is protective
Early introduction of solid food before 4 months is damaging
Childhood obesity and parental obesity are predictors of adult obesity
Behaviour associated with weight gain- factors promoting overeating
Direct- all factors relating to direct contact of the food with the GI mucosal receptors
Indirect- metabolic, endocrine, cognitive differences
Behaviour associated with weight gain- satiety
Cascade: sensory - cognitive - post-ingestive - post-absorptive
Fat has a relatively weak effect on satiation and satiety
High fat foods improve sensory properties
Satiety efficiency
Proteins > carbs > fats > alcohol
Utilisation of food by body
Alcohol > protein + carbs > fat
Behaviour associated with weight gain- energy compensation
Adjustment of energy intake following ingestion of a particular food
Lower effect with liquids than solids
Behaviour associated with weight gain- alcohol
Stimulates intake
Almost no satiety
Efficiently oxidised
Adds to total daily energy intake
Behaviour associated with weight gain- food environment
Variety - greater variety stimulates over-eating
Portion size - significantly increased over the last century
Distraction - promotes increased food intake
Behaviour associated with weight gain- energy density of foods
Volume of meals constant
By reducing energy density/richness, fewer calories consumed but keep satiety
How to reduce energy density of food
Incorporation of water and air
Fruits and vegetables
Reducing fat
Method of cooking - no frying
Behaviour associated with weight gain- psychological factors
Dietary restrain
Stress
Sleep
Reward sensitivity
Macronutrient energy density of protein
4.7 kcal/g
Macronutrient energy density of carbohydrates
3.6 kcal/g
Macronutrient energy density of fat
9.5 kcal/g
Macronutrient energy density of alcohol
7 kcal/g
Why do people develop T2DM
Genotype
Age
Insulin resistant
Lifestyle factors : poor diet, overweight, lack of physical activity
Diabetes as a public health issue
Mortality
Disability
Co-morbidity
Reduced QOL
Increasing prevalence
Inequalities
Disabilities caused by diabetes
Diabetic retinopathy
Renal failure
Amputation (peripheral neuropathies and vascular disease)
Reducing the impact of T2DM
Identifying individuals at risk
Sedentary jobs
Obesogenic environment
Primary prevention of T2DM
Increase physical activity
Changes in diet
Weight loss
Focus on ethnic minorities and socioeconomically deprived communities
Culturally appropriate interventions
Secondary prevention of T2DM
Raising awareness of possible symptoms
Use of clinical records to identify those at risk
Blood tests
Data collection
Diagnostic tests
Tertiary prevention of T2DM
Self-monitoring
Diet
Exercise
Drugs- metformin, sulfonylureas
Eduction
Peer support
