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Public Health > Key Diseases In Public Health > Flashcards

Key Diseases In Public Health Flashcards

1
Q

What percentage of deaths in the UK does cardiovascular disease account for

A

40%

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2
Q

How many men have CHD

A

1 in 5

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3
Q

How many women have CHD

A

1 in 8

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4
Q

Number of phases of cardiac rehabilitation

A

4

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5
Q

Phase 1 of cardiac rehabilitation

A

In hospital

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6
Q

Phase 2 of cardiac rehabilitation

A

Early post-discharge

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7
Q

Phase 3 of cardiac rehabilitation

A

4-16 weeks

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8
Q

Phase 4 of cardiac rehabilitation

A

Long term maintenance of lifestyle change

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9
Q

What is the NHS plan to tackle CHD

A

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

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10
Q

Primary prevention of CHD - SNAP and management of related conditions

A

Smoking
Nutrition
Alcohol
Physical activity

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11
Q

Primary prevention of CHD- smoking

A

Taxation
No public places
Cessation services
Health warnings
Tobacco control

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12
Q

Primary prevention of CHD- nutrition

A

Recommendations eg 5 a day
Food standards
Regulations
Labelling
Food in schools

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13
Q

Primary prevention of CHD- alcohol

A

Know your limits
Taxation
Alcohol pricing
Refulation

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14
Q

Primary prevention of CHD- physical activity

A

5 times a week
PE in school

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15
Q

Who does secondary prevention for CHD include

A

Patients after recovery from ACS or with stable angina

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16
Q

What does secondary prevention for CHD include

A

Primary care CHD registers
Medical management-medications
Phase 4 cardiac rehabilitation- SNAP

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17
Q

3 groups of ~CHD causes

A

Medical history
Lifestyle factors
Cause of the causes

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18
Q

CHD causes: medical history

A

Male gender
Family history
Past medical history of cardiovascular disease
Hypertension
Raised lipids
Smoking

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19
Q

CHD causes: lifestyle factors

A

Smoking
Obesity
Sedentary lifestyle
Excess alcohol

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20
Q

CHD causes: causes of the causes

A

Loneliness
Unemployment
Poor housing
Fear of crime
No access to green space
Food poverty
Pollution
Social inequality

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21
Q

4 groups of CHD risk factors

A

Unmodifiable
Physiological/clinical
Psychological
Lifestyle

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22
Q

CHD risk factors: unmodifiable

A

Sex
Age
Ethnicity
Family history
Early-life circumstances

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23
Q

CHD risk factors: physiological/clinical

A

High blood cholesterol
Hypertension
Type 2 disbetes

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24
Q

CHD risk factors: psychological

A

Personality (type A/B)
Depression
Anxiety
Work

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25
Q

CHD risk factors: lifestyle

A

Smoking
Physical inactivity
Overweight
Poor nutrition
Alcohol intwke

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26
Q

What is the single biggest risk factor for coronary heart disease

A

Smoking

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27
Q

How does musculoskeletal disease affect individuals

A

Physical pain
Psychological burden - loss of independence, chronic pain
Economic implication- loss of income , cost of treatment or care

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28
Q

How does musculoskeletal disease affect society

A

Economic burden - of treatment , loss of work
Workplace productivity- secondary to cost to individuals

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29
Q

Back pain red flags

A

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

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30
Q

Predictive factors of lower back pain

A

Psychosocial factors
Pain intensity
Episode duration
Previous history

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31
Q

Chronic lower back pain

A

Continuous pain for 3+ months

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32
Q

Epidemiology of lower back pain

A

Women get more than men in UK
Generally increases with age
Social class

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33
Q

Increasing prevalence of lower back pain

A

Ageing population
More obesity
Work burdens
Less active society

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34
Q

What can doctors do for lower back pain

A

Education
Prescribe exercise

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35
Q

What should doctors know about musculoskeletal disease

A

Common
Expensive for society
Only ever measure a fraction of total cost
Treat with exercise
Remember red flags

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36
Q

Stroke definition

A

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

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37
Q

Classification of stroke

A

Thrombosis
Embolism
Haemorrhage

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38
Q

Risk factors for stroke

A

Age and sex
Hypertension
Smoking
Alcohol consumption
CVD
Diabetes

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39
Q

Symptoms of Parkinson’s disease

A

Tremor
Rigidity
Akinesia

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40
Q

Incidence of smoking

A

Incidence increases with age
Less common in smokers

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41
Q

Parkinsonism

A

Drug induced movement disorder
Non-progressive

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42
Q

Why does smoking lower the risk of Parkinson’s

A

Elevated dopamine levels due to nicotine effect
60% lower risk

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43
Q

Multiple sclerosis definition

A

Multiple areas of demyelination and spinal cords

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44
Q

Prevalence of multiple sclerosis

A

Directly proportional to distance from equator
Uncommon in fishing communities

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45
Q

How is multiple sclerosis diagnosed

A

MRI

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46
Q

Cerebral palsy definition

A

Non-progressive brain damage before or during neo-natal period
Wide spectrum of physical/mental impairment

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47
Q

Risk factors of cerebral palsy

A

Anoxia
Low birth weight

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48
Q

Aetiology of dementia

A

Genetic
Cardiovascular
Multi factorial

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49
Q

Types of dementia

A

Alzheimer’s
Vascular
Mixed
Lewy body dementia
Fronto-temporal dementia
Other

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50
Q

Prevalence of Alzheimer’s

A

62%

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51
Q

Prevalence of vascular

A

17%

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52
Q

Prevalence of mixed dementia

A

10%

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53
Q

Prevalence of Lewy body dementia

A

6%

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54
Q

Prevalence of fronto-temporal dementia

A

2%

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55
Q

Epilepsy

A

Characterised by recurrent epileptic seizures
Unprovoked by any identifiable cuases

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56
Q

Aetiology of epilepsy

A

Genetic factors
Febrile seizures
Head injuries
Bacterial and parasitic infections

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57
Q

Symptoms of influenza

A

Musculoskeletal aching
Headache
Fever
Respiratory symptoms

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58
Q

Transmission of influenza

A

Spreads via coughing, sneezing and touch

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59
Q

Incubation period of influenza

A

1-3 days

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60
Q

When is someone infectious with influenza

A

From onset of symptoms to 4-5 days lster

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61
Q

Viral family of influenza

A

Orthomyxoviridae

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62
Q

2 types of influenza that affects humans

A

A - transmission from other organisms leading to pandemics
B

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63
Q

Surface antigens of influenza

A

Hemagglutinin
Neuraminidase

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64
Q

How do new strains of influenza arise

A

Antigenic shift
Antigenic drift

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65
Q

Antigenic shift

A

Horizontal transmission of genes between different strains of virus

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66
Q

Antigenic drift

A

De novo mufations

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67
Q

H5N1

A

Avian flu
60% mortality but not sustained transmission

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68
Q

H1N1

A

Spanish flu -1918
Swine flu - 2009

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69
Q

Criteria for pandemic spread

A

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

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70
Q

Phases of a pandemic

A

Phases 1-3
Phase 4
Phases 5-6
Post-peak
Post-pandemic

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71
Q

Phase 1-3 of a pandemic

A

Mostly animal infections with few human infections

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72
Q

Phase 4 of a pandemic

A

Sustained human to human transmission

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73
Q

Phases 5-6 of a pandemic

A

Widespread human infection

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74
Q

Post-peak phase of a pandemic

A

Possibility of recurrent events

75
Q

Post-pandemic phase of a pandemic

A

Disease returns to seasonal levels

76
Q

Factors Altering the risk of pandemics

A

International travel
Large populations
Crowding
Population health has improved
Animal husbandry has changed
Interdependence between countries

77
Q

Public health pandemic interventions

A

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

78
Q

Containment phase

A

Early phase using anti-virals as prophylaxis (problematic side effects)

79
Q

WHO definition of mental health

A

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

80
Q

Common mental health problems

A

Depression
Generalised anxiety disorder
Panic disorder
Phobias
Social anxiety disorder
Obsessive-compulsive disorder
Post-traumatic stress disorder

81
Q

Effects of mental health disorders

A

Negative effect on quality of life
Increase risk of physical illness
Increased mortality from physical illness
Depression is a major risk for suicide

82
Q

Correlation between household income and mental health disorders

A

More affluent are 3 times less likely to suffer

83
Q

Number of people who suffer with depression worldwide at any one time

A

350 million

84
Q

Number of people who have a severe mental illness

A

24 million

85
Q

Number of people who commit suicide

A

1 milliom

86
Q

Percentage of children who have a mental disorder

A

10-20%

87
Q

Percentage of doctors who have a mental disorder

A

1/3

88
Q

Percentage of doctors who are depressed at some point and have a higher suicide risk

A

20%

89
Q

Percentage of people who have work-related fatigue

A

42%

90
Q

Percentage of people who have depression

A

29%

91
Q

Percentage of people who have anxiety

A

26%

92
Q

Percentage of people who have PTSD

A

15%
Especially females

93
Q

Percentage of people who have burn out syndrome

A

6%

94
Q

Chronic kidney disease

A

Blanket term referring to evidence of long term kidney damage leading to a reduced estimated GFR of below 60ml/min/1.73m^-2

95
Q

How is chronic kidney disease classified

A

5 stages
Stage 5 = dialysis

96
Q

GFR of stage 1 chronic kidney disease

A

> 90

97
Q

GFR of stage 2 chronic kidney disease

A

60-90

98
Q

GFR of stage 3a chronic kidney disease

A

45-60

99
Q

GFR of stage 3b chronic kidney disease

A

30-45

100
Q

GFR of stage 4 chronic kidney disease

A

15-30

101
Q

GFR of stage 5 chronic kidney disease

A

<15

102
Q

Risk factors of chronic kidney disease

A

Obesity
Diabetes
CVD
Ageing population
High prevalence in immigrant populations

103
Q

Causes of chronic kidney disease

A

Diabetes
Hypertension
Atherosclerosis
Glomerulonephritis
Chronic pyelonephritis/reflux/obstruction
Polycystic kidney disease
Drug toxicity

104
Q

Chronic kidney disease in the developing world

A

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

105
Q

Why is chronic kidney disease controversial

A

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

106
Q

Prevalence of smoking

A

Men smoke more than women- gap closing
Overall decrease
Lower socioeconomic groups smoke more than those from higher

107
Q

Physiological effects of smoking

A

Activation of nicotinic ACh receptors in brain
Dopamine release in nucleus accumbens
Stimulant, tolerant, withdrawal

108
Q

Number of deaths per year from smoking

A

100000

109
Q

Associated health problems with smoking

A

Cancer
COPD
CHD
stomach ulcers
Impotence
Oral health
Cataracts

110
Q

What is the single greatest cause of illness and premature death in the UK

A

Smoking

111
Q

Reasons people smoke

A

Addiction
Coping with stress
Habit
Socialising
Fear of weight gain after cessation
Pleasure
Choice
Advertising
Peer group/family
Signifier of cultural status

112
Q

What law prohibits the sale of cigarettes to U16s

A

1908- children act

113
Q

Richard Doll and Austin Bradford Hill - 1950

A

Smoking associated with lung carcinomas

114
Q

When did parliament bans cigarette advertising on TV

A

1965

115
Q

When was smoking in public places banned and the legal minimum raised to 18

A

2007

116
Q

When was smoking in the car with children banned

A

2015

117
Q

When was standardised plain packaging required for cigarettes

A

2016

118
Q

Smoking cessation tools

A

Nicotine replacement therapy- patches, gum, nasal spray, microtab, lozengers, inhalators
Varenicline
Bupropion

119
Q

How is smoking cessation modelled

A

Transtheoretical model
Planned behaviour theory (attitude, subjective norm, perceived behaviour control, behavioural intention)

120
Q

The 3 As

A

Ask- patient about smoking
Advise- smoking cessation methods
Assist - refer to NHS services

121
Q

Reluctance to change: type A behaviour

A

Hostility
Competitiveness
Impatience

122
Q

Reluctance to change: uncle norman behaviour

A

Smoked/drank and was obese all his life and died when he was 90 so I can do the same

123
Q

Reluctance to change: last person behaviour

A

Well he was fit and well and died suddenly, what benefit is this to me if he died

124
Q

Reluctance to change: unrealistic optimism

A

Tendency to perceive oneself of being at less risk of disease than other people of same age/sex

125
Q

Cost of alcohol to NHS

A

55% of A&E costs
£3.5 billion per year from alcohol related harm

126
Q

Fetal alcohol syndrome

A

Growth retardation
CNS abnormalities
Craniofacial abnormalities
Congenital defects
Increased risk of birth marks and hernias

127
Q

Symptoms of alcohol withdrawal

A

Tremors
Seizures
Hallucinations
Delirium tremens
Activation syndrome (agitation, shakes, rapid heart rate, high bp)

128
Q

Social implications of alcohol

A

Violence
Rape
Depression/anxiety
Driving offences

129
Q

What is a standard unit of alcohol

A

10 ml/8g ethanol

130
Q

How many units in a bottle of wine

A

10

131
Q

How to calculate units in alcohol

A

(%alcohol by volume x amount of liquid in ml) / 1000

132
Q

Guidelines for amount of alcohol per week

A

14 units/week for men and women

133
Q

Old recommendation of alcohol consumption for men

A

3-4 units a day
28 units per week

134
Q

Old recommendation of alcohol consumption for women

A

2-3 units a day
21 units per week

135
Q

What is 14 units of alcohol equivalent to

A

6 pints of beer
6 glasses of wine
14 shot of a spirit

136
Q

How to question a patient about alcohol dependency

A

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

137
Q

Alcoholism

A

Primary chronic disease with genetic , psychosocial and environmental influences
Progressive and fatal
Impaired control over-drinking

138
Q

WHO definition of obesity

A

Abnormal/excessive fat accumulation
Resulting from chronic imbalance between energy intake and expenditure which presents a risk to health
State of positive energy balance

139
Q

Aetiology of obesity

A

Complex balance between multiple factors
Biology = environment = behavioru

140
Q

7 domains of energy balance

A

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

141
Q

Diagnostic measures of obesity

A

MRI
dual-energy x-ray absorptiometry
Waist circumference
Waist to hip ratio
Skinfold thickness
BMI

142
Q

BMI value for underweight

A

<18.4

143
Q

BMI value for normal

A

18.5-24.9

144
Q

BMI value for overweight

A

25-29.9

145
Q

BMI value for obese class I

A

30-34.9

146
Q

BMI value for obese class II

A

35- 39.9

147
Q

BMI value for obese class III

A

> 40

148
Q

Treatment of obesity

A

Diet and exercise

149
Q

Associated diseases with obesity

A

T2DM
Hypertension
Cancer
Cardiovascular disease

150
Q

Current prevalence of obesity

A

2/3 adults
1/3 11-15 yrs
1/4 2-10 yrs

151
Q

Causes of obesity

A

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

152
Q

Mechanisms that maintain obesity

A

Physical/physiological - more weight means it’s harder to exercise and diet
Psychological- low self esteem and guilt
Socioeconomic- employment and relationships

153
Q

Costs of obesity

A

Between £2.6 and 15.8 billion per year from direct and indirect costs

154
Q

Social gradient and obesity

A

18% professionals/managers are obese
28% of unskilled/manual workers are obese

155
Q

Runaway weight gain train

A

Steep slope- obesogenic environment
Ineffective brakes - knowledge, prejudice, physiology
Accelerators - vicious cycles of mechanical dysfunction, ineffective dieting, psychological impact, low socioeconomic status

156
Q

Prader Willi syndrome

A

Short stature, almond-shaped eyes, small hands and feet
Intellectual impairment
Hyperphagia (over eating)
Chromosome 15 deletion- paternal

157
Q

Congenital leptin deficiency

A

Extreme adiposity and uncontrollable appetite
Monogenic obesity-very rare

158
Q

Obesogenic environment

A

The Pima Indians showed a dramatic increase in obesity when exposed to the western diet
Majority are now severely obese and 95% have diabetes

159
Q

Obesity and genetics

A

Prader Willi syndrome
Mutations of the leptin and melanocortin receptors
Congenital leptin deficiency
Polygenic obesity

160
Q

Behaviour associated with weight gain-

A

Employment
Developmental factors
Overeating
Satiety
Energy density of foods
Energy compensation
Alcohol
Food environment characteristics
Psychological factors

161
Q

Behaviour associated with weight gain- employment

A

Shift work, lack of sleep , upset circadian rhythm
Reduced physical activity
Influence on release of cortisol, leptin, ghrelin
Dietary patterns
Leisure and activities

162
Q

Behaviour associated with weight gain- developmental factors

A

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

163
Q

Behaviour associated with weight gain- factors promoting overeating

A

Direct- all factors relating to direct contact of the food with the GI mucosal receptors
Indirect- metabolic, endocrine, cognitive differences

164
Q

Behaviour associated with weight gain- satiety

A

Cascade: sensory - cognitive - post-ingestive - post-absorptive
Fat has a relatively weak effect on satiation and satiety
High fat foods improve sensory properties

165
Q

Satiety efficiency

A

Proteins > carbs > fats > alcohol

166
Q

Utilisation of food by body

A

Alcohol > protein + carbs > fat

167
Q

Behaviour associated with weight gain- energy compensation

A

Adjustment of energy intake following ingestion of a particular food
Lower effect with liquids than solids

168
Q

Behaviour associated with weight gain- alcohol

A

Stimulates intake
Almost no satiety
Efficiently oxidised
Adds to total daily energy intake

169
Q

Behaviour associated with weight gain- food environment

A

Variety - greater variety stimulates over-eating
Portion size - significantly increased over the last century
Distraction - promotes increased food intake

170
Q

Behaviour associated with weight gain- energy density of foods

A

Volume of meals constant
By reducing energy density/richness, fewer calories consumed but keep satiety

171
Q

How to reduce energy density of food

A

Incorporation of water and air
Fruits and vegetables
Reducing fat
Method of cooking - no frying

172
Q

Behaviour associated with weight gain- psychological factors

A

Dietary restrain
Stress
Sleep
Reward sensitivity

173
Q

Macronutrient energy density of protein

A

4.7 kcal/g

174
Q

Macronutrient energy density of carbohydrates

A

3.6 kcal/g

175
Q

Macronutrient energy density of fat

A

9.5 kcal/g

176
Q

Macronutrient energy density of alcohol

A

7 kcal/g

177
Q

Why do people develop T2DM

A

Genotype
Age
Insulin resistant
Lifestyle factors : poor diet, overweight, lack of physical activity

178
Q

Diabetes as a public health issue

A

Mortality
Disability
Co-morbidity
Reduced QOL
Increasing prevalence
Inequalities

179
Q

Disabilities caused by diabetes

A

Diabetic retinopathy
Renal failure
Amputation (peripheral neuropathies and vascular disease)

180
Q

Reducing the impact of T2DM

A

Identifying individuals at risk
Sedentary jobs
Obesogenic environment

181
Q

Primary prevention of T2DM

A

Increase physical activity
Changes in diet
Weight loss
Focus on ethnic minorities and socioeconomically deprived communities
Culturally appropriate interventions

182
Q

Secondary prevention of T2DM

A

Raising awareness of possible symptoms
Use of clinical records to identify those at risk
Blood tests
Data collection
Diagnostic tests

183
Q

Tertiary prevention of T2DM

A

Self-monitoring
Diet
Exercise
Drugs- metformin, sulfonylureas
Eduction
Peer support

Public Health (7 decks)

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