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Public Health 1 Flashcards

1
Q

When considering the patient in context, what factors should you be thinking about?

A
  • Individuals, Families, Communities
  • Age, Gender, Culture, Education, Employment
  • Origins
  • Well-being and health vs disease and illness
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2
Q

What is Maslow’s Hierarchy of needs?

A
  • A 5-tier model of human needs

- People are motivated to achieve certain needs; some needs take precedence over others.

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3
Q

What are the 5 factors that comprise Maslow’s hierarchy of human needs?

A
  1. Self-actualization: desire to become the most that one can be
  2. Esteem: respect, self-esteem, status, recognition, freedom
  3. Love + belonging: friendship, intimacy, family, sense of connection
  4. Safety needs: personal security, employment, resources, health, property
  5. Physiological needs: air, water, food, shelter, sleep, clothing, reproduction
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4
Q

What is ‘epigenetics’ in the context of public health?

A
  • The expression of the genome depends on the environment
  • No individual has the same experience as another
  • Genetic predisposition - not determination - is the key.
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5
Q

What is the concept of ‘biolography’?

A

Human organism is related to, and integrated with, its environment.

  • Lived experience affects human biology
  • Both interact + contribute substantially to health + disease
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6
Q

What is ‘allostasis’? Give an example

A

“Stability through change”

  • Our physiological systems have adapted to react rapidly to environmental stressors.
  • Turn on + off efficiently, but not too frequently.
  • The body can rise to a challenge.
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7
Q

What is the ‘allostatic load’?

A

Long term over-taxation of our physiological systems leads to impaired health.
> the pathophysiology of stress

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8
Q

Give examples of I) allostasis and ii) allostatic load with regards to the cardiovascular system.

A

Cardiovascular System:
i) Allostasis: works to maintain our erect posture + enable physical exertion

ii) Allostatic load: Over-activation leads to HTN, Stroke, MI.

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9
Q

Give examples of i) allostasis and ii) allostatic load with regards to the body’s metabolic systems.

A

Metabolic Systems:
i) Allostasis: activating + maintaining energy reserves, including energy supply to the brain

ii) Allostatic load: Obesity, Diabetes, Atherosclerosis

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10
Q

Give examples of i) Allostasis and ii) allostatic load with regards to the body’s immune systems.

A

Immune system:
i) Allostasis: Response to pathogens, Tumour surveillance

ii) Allostatic load: Inflammatory + autoimmune disorders

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11
Q

Give examples of i) Allostasis and ii) Allostatic load with regards to the Central Nervous System.

A

Central Nervous System:
i) Allostasis: Learning, Memory, Neuroendocrine + autonomic regulation

ii) Allostatic load: Neuronal atrophy, death of nerve cells, impairment of memory + executive function.

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12
Q

What is ‘salutogenesis’?

A

Favourable physiological changes secondary to health experiences which promote healing + health.

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13
Q

What does primary care do?

A
  • Manage illness + clinical relationships over time
  • Shared decision making
  • Illness prevention
  • Health promotion
  • Manage clinical uncertainty
  • Aims for best outcomes with available resources
  • Delivers care in the community via Primary Health Care Team
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14
Q

Give a definition for ‘Domestic Abuse’.

A

An 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.
The abuse can encompass, but is not limited to:
- psychological
- physical
- sexual
- financial
- emotional

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15
Q

Give 3 ways in which domestic abuse impacts on health.

A
  1. Traumatic injuries following an assault
    eg. fractures, miscarriages, facial injuries, puncture wounds, haemorrhages
  2. Somatic problems or chronic illness consequent of living with abuse
    eg. Chronic pain, low birthweight, premature delivery
  3. Psychological / psychosocial problems secondary to abuse
    eg. PTSD, attempted suicide, substance misuse, depression, anxiety, eating disorders
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16
Q

What are the ‘best’ indicators in identifying domestic abuse when taking a history in A+E?

A
  • Reported as ‘unwitnessed by anyone else’
  • Repeat attendance
  • Delay in seeking help
  • Multiple, minor injuries not requiring treatment
  • Always consider domestic abuse as a cause.
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17
Q

How might domestic abuse affect a child?

A
  • Affects physical + psychological health + well being

- Long term impact on self esteem, education, relationships, stress responses

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18
Q

What is the link between child abuse + domestic abuse?

A

Domestic abuse often starts / escalates during pregnancy.

* Always consider safeguarding responsibilities.

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19
Q

What is your role in the management of domestic abuse?

A
  • Display helpline posters
  • Focus on patient’s safety (+ child’s safety, if applicable)
  • Work with other agencies + professionals
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20
Q

What should you not do if someone discloses domestic abuse to you?

A
  • Assume someone else will take care of things
  • Ask about domestic abuse in front of family members (including kids!!!!!)
  • Tell them what to do -> aim to empower them to make safe + informed choices.
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21
Q

If a patient is considered to be at ‘standard’ risk with regards to Domestic Abuse, what does this mean?

A

Current evidence does not indicate likelihood of serious harm being caused.

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22
Q

If a patient is considered to be at ‘medium’ risk with regards to Domestic Abuse, what does this mean?

A
  • There are identifiable indicators of risk of serious harm

- offender has the potential to cause serious harm, but unlikely unless change in circumstances.

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23
Q

If a patient is considered to be at ‘high’ risk with regards to Domestic Abuse, what does this mean?

A
  • There are identifiable (risk factors) indicators of imminent risk of serious harm
  • Dynamic: harm could happen at any time + the impact would be serious.
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24
Q

Which risk assessment is used for Domestic Abuse?

A

DASH Tool:

Domestic Abuse, Stalking, Harassment + ‘Honour’ based violence

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25
Q

What is the risk assessment for domestic abuse designed to do?

A
  • Questionnaire used to identify + assess risk of DASH

- Such that measures can be put in place to protect the patient + any children who might be at risk.

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26
Q

If a person is considered to be ‘standard’ or ‘medium’ risk with regards to Domestic Abuse, what should you do?

A
  • Give contact details for domestic abuse services
  • National Helpline is 24hrs
  • Sheffield Helpline: Mon-Fri 9-5
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27
Q

If a patient is considered to be ‘high risk’ of domestic abuse, what action should you take?

A
  • Refer to MARAC (Multi-Agency Risk Assessment Conference) -> wherever possible, with consent
  • Refer to IDVA (Independent Domestic Violence Advisors)
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28
Q

True or False: for high risk cases, you can break confidentiality (to take to MARAC) if you cannot gain consent.

A

True.

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29
Q

What is ‘MARAC’ and what does it do?

A

Multi-Agency Risk Assessment Conference

  • links up-to-date information about victims’ needs + risks directly to the provision of appropriate services for all those involved
  • incl. victim, child(ren), perpetrator
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30
Q

What is ‘IDVA’ and what do they do?

A

Independent Domestic Violence Advisors:
Aim to increase patient’s safety by providing:
- advocacy + advice around domestic abuse
- safety planning
- support through court proceedings
- sign posting to specialist services

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31
Q

What specialist services might an IDVA sign post victims of domestic abuse to?

A
  • Housing services
  • Legal services
  • Refuge provision + home safety services
  • a voice in the MARAC
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32
Q

When would a Domestic Homicide Review be undertaken?

A

A review of the circumstances in which the death of a person aged 16 or over has, or appears to have, resulted from violence, abuse or neglect by:

a) a person to whom s/he was related or with whom s/he was or had been in an intimate personal relationship OR;
b) a member of the same household as himself

Held with a view to identifying lessons to be learned from the death.

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33
Q

Explain the ‘population perspective’.

A

Think in terms of groups, rather than individuals.

  • Gather information: data studies + surveys
  • Relates to demographics, sociology, epidemiology
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34
Q

When considering the ‘population perspective’, what should we be addressing?

A
  • Diagnosis + treatment
  • Causes of ill health
  • Policies + strategic plans
  • Commission (Buy) services
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35
Q

List 4 determinants of health

A
  1. Genes
  2. Environment
    - physical environment
    - social + economic environment
  3. Lifestyle
  4. Healthcare
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36
Q

What are the key concerns of Public Health?

A
  • Wider determinants of health
  • 1, 2 + 3 prevention
    Inequalities in health
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37
Q

What is ‘equity’?

A

What is fair and just

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38
Q

What is ‘equality’?

A

Concerned with equal shares

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39
Q

What are the two types of equity?

A

Horizontal equity: equal treatment for equal need

Vertical equity: unequal treatment for unequal need.

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40
Q

Define Horizontal Equity. Give an example of horizontal equity in practice.

A

Equal treatment for equal need.

eg. Individuals with pneumonia (with all other things equal) should be treated equally.

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41
Q

Define Vertical Equity. Give an example of vertical equity in practice.

A

Unequal treatment for unequal need.

eg. individuals with the common cold vs pneumonia need unequal treatment.
eg. Areas with poorer health may need higher expenditure on health services

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42
Q

What are the different forms of health equity?

A
  • Equal expenditure for equal need
  • Equal access for equal need
  • Equal utilisation for equal need
  • Equal healthcare outcome for equal need
  • Equal health
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43
Q

What are the 2 dimensions of health equity?

A
  1. Spatial -> geographical

2. Social -> age, gender, class, ethnicity

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44
Q

What factors should you consider when examining health equity?

A
  • Supply of healthcare
  • Access to healthcare
  • Utilisation of healthcare
  • Healthcare outcomes
  • Health status
  • Resource allocation - health services, housing services
  • Wider determinants of health.
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45
Q

List some examples of the wider determinants of health.

A
  • Diet
  • Smoking
  • Healthcare seeking behaviour
  • Socioeconomic + physical environment
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46
Q

How would you assess health equity?

A
  • Assess inequality, then decide if inequitable.
    > inequalities need to be explained BUT
    > equality (eg. equal utilisation) may not be equitable.
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47
Q

What are the 3 domains of Public Health practice?

A
  1. Health improvement
  2. Health protection
  3. Health care (improving services)
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48
Q

What comprises ‘Health Improvement’?

A

Societal interventions aimed at preventing disease, promoting health + reducing inequalities.

  • inequalities
  • housing
  • lifestyle
  • education
  • employment
  • family / community
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49
Q

What is ‘Health Protection’ concerned with? What does it comprise?

A

Concerned with measures to control infectious disease risks + environmental hazards

  • infectious diseases
  • radiation
  • Environmental health hazards
  • Chemicals + poisons
  • Emergency response
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50
Q

What is ‘Health Care’ or ‘Improving Services’ (as applied to public health) concern? What does it comprise?

A

Concerned with the organisation, and delivery of safe, high quality services for prevention, treatment + care

  • clinical effectiveness
  • audit + evaluation
  • clinical governance
  • efficiency
  • service planning
  • equity
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51
Q

At what levels might public health be delivered?

A
  • Individual level
  • Community level
  • Ecological (population) level
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52
Q

What is meant by ‘health psychology’ as applied to public health?

A

Emphasises the role of psychological factors in the cause, progression + consequences of health + illness.
> promote healthy behaviours + prevent illness

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53
Q

What are the 3 health behaviours?

A
  • Health behaviour
  • Illness behaviour
  • Sick role behaviour
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54
Q

What is meant by ‘Health behaviour’?

A

A behaviour aimed at preventing disease eg. eating healthily

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55
Q

What is meant by ‘Illness behaviour’?

A

A behaviour aimed at seeking a remedy. eg. going to a doctor.

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56
Q

What is meant by ‘Sick role behaviour’?

A

Any activity aimed at getting well eg. taking prescribed medications, resting

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57
Q

Give some examples of health damaging / impairing behaviours.

A
  • Smoking
  • Alcohol + substance abuse
  • Sun exposure
  • Risky sexual behaviour
  • Driving without a seat belt
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58
Q

Give some examples of health promoting behaviours.

A
  • Exercising
  • Healthy eating
  • Medicines compliance
  • Vaccinations
  • Attending health checks
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59
Q

Give an example of a disease that can be attributed to lifestyle.

A

OBESITY.

Costs the NHS lots of dollar :(

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60
Q

What percentage of patients with chronic illnesses are non-compliant with their medications?

A

50%:

50% of Patients with Diabetes, Hypertension + High cholesterol are non-compliant with their medication regimens.

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61
Q

Why is health behaviour an issue in the general population?

A
  • Health impairing behaviours + mortality are related
  • Quality of life
  • Working days lost to sickness
  • Morbidity is an issue -> Diabetes, CHD etc.
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62
Q

What is the aim of a population-level health promotion intervention? What does it comprise?

A

Health promotion at a population level:

- the process of enabling people to exert control over the determinants of health, thereby improving public health.

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63
Q

What is the aim of an individual-level health promotion intervention? What does it comprise?

A
  • Patient-centred approach

- Care responsive to individual needs

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64
Q

Give some examples of Health promotion / Awareness campaigns.

A
  • Change 4 life
  • 5 a day
  • Stoptober
  • Movember
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65
Q

Give some examples of Health promotion campaigns which promotes screening + immunisations.

A
  • Cervical smear screening

- MMR vaccine

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66
Q

How would a primary care intervention to reduce alcohol consumption affect an individual’s behaviour?

A
  • decrease level of alcohol consumption
  • improve individual health outcomes
  • decrease incidence of domestic violence
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67
Q

How would a primary care intervention to reduce alcohol consumption affect the local community?

A
  • Decreased local alcohol sales
  • Decreased alcohol-related crime
  • Fewer A+E events
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68
Q

How would a primary care intervention to reduce alcohol consumption affect the population level of alcohol usage?

A
  • National alcohol + sales consumption
  • National statistics on alcohol-related crime / A+E events
  • Demographic patters of liver cirrhosis.
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69
Q

Why do we engage in damaging health behaviours?

A
  • Unrealistic optimism
  • Health beliefs
  • Situational rationality
  • Cultural variability
  • Socioeconomic factors
  • Stress
  • Age
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70
Q

Explain the concept of ‘unrealistic optimism’ as applied to Health behaviours.

A

Individuals continue to practice health damaging behaviour due to inaccurate perceptions of risk + susceptibility.

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71
Q

The concept of ‘unrealistic optimism’ suggests that perception of risk can be influenced by several factors. List 4 factors.

A
  1. Lack of personal experience with the problem
  2. Belief that it’s preventable by personal action
  3. Belief that if it’s not happened by now, it’s not likely to.
  4. Belief that the problem is infrequent.
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72
Q

NICE has provided guidance on behaviour change. What factors are involved in this guidance?

A
  • Plan interventions
  • Assess social context
  • Education + training
  • Individual level interventions
  • Community level interventions
  • Population interventions
  • Evaluating effectiveness
  • Assessing cost-effectiveness
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73
Q

Why is behaviour change important?

A
  • Changing health behaviour can have an impact on mortality + morbidity
  • Interventions offer relatively simple solutions to disease reduction
    > by comparison, people’s behaviour may be easier to change.
74
Q

Interventions offer relatively simple solutions to disease reduction. What factors may be difficult to alter in order to reduce disease pre-disposition in some patients?

A
  • Genetic predisposition is difficult to alter
  • Socioeconomic circumstances associated with disease are difficult to change
  • interventions to treat / manage disease are often expensive.
75
Q

What is the current prevalence of smokers in the UK?

A

21% of men smoke

19% of women smoke

76
Q

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

A

SMOKING

77
Q

Approximately what percentage of smokers die from smoking-related diseases?

A

50%

78
Q

What is the economic impact of smoking?

A
  • 5.5% of the NHS’ total costs
  • Loss in productivity from smoking breaks
  • Cleaning up cigarette butts costs money
  • Cost of fires = £507m
79
Q

What is NCSCT? What’s it’s purpose?

A

National Centre of Smoking Cessation Training

  • delivers training + assessment programmes
  • provides support services for local + national providers
  • conducts research into behavioural support for smoking cessation
  • provides stop smoking services with a measure of quality assurance.
80
Q

What factors are involved in the ‘Planning Cycle’?

A
  • Needs assessment
  • Planning
  • Implementation
  • Evaluation
81
Q

What is ‘need’? (as applied to Public Health)

A

The ability to benefit from an intervention.

82
Q

What is ‘demand’? (as applied to Public Health)

A

What people ask for.

83
Q

What is ‘supply’? (as applied to Public Health)

A

What is provided

84
Q

What is a ‘Health Needs Assessment’?

A

“A systematic method for reviewing health issues facing a population, leading to agreed priorities and resource allocation that will improve health + reduce inequalities.”

A health needs assessment is usually used to cover both ‘Health Needs’ and ‘Healthcare Needs’ assessments.

85
Q

What is ‘Health Need’?

A
  • Need for health
  • Concerns ‘need’ in more general terms
  • Measured using mortality, morbidity, sociodemographic measures
86
Q

What is ‘Health Care Need’?

A
  • Need for healthcare
  • Much more specific than ‘health need’
  • Ability to benefit from healthcare
  • Depends on the potential of prevention, treatment + care services to remedy health problems
87
Q

Who / what might a health needs assessment be carried out for?

A
  • a population or subgroup eg. Manor Practice population
  • a condition eg. COPD
  • an intervention eg. Coronary Angioplasty
88
Q

Who defines ‘need’?

A
  • Individual
  • Family
  • Community
  • Society
  • Professionals
89
Q

What are the 2 ways in which a ‘Health Needs Assessment’ can be approached?

A
  1. Sociological perspective

2. Public Health perspective

90
Q

What 4 factors comprise the Sociological perspective in terms of the Health Needs Assessment?

A
  1. Felt need: individual perceptions of variation from normal health
  2. Expressed need: individual seeks help to overcome variation in normal health (demand).
  3. Normative need: professional defines intervention appropriate for the expressed need.
  4. Comparative need: comparison between severity, range of interventions + cost.
91
Q

Which 3 factors comprise the Public Health Approach to the Health Needs Assessment?

A
  1. Epidemiological
  2. Comparative
  3. Corporate
92
Q

Explain the Epidemiological Approach to Health Needs assessment.

A
  • Define problem
  • Size of problem: incidence / prevalence
  • Services available: prevention / treatment / care
  • Evidence base: effectiveness / cost-effectiveness
  • Models of care: incl. quality + outcome measures
  • Existing services: unmet need, services not needed
  • Recommendations
93
Q

List 4 problems with an Epidemiological approach to Health Needs Assessment.

A
  • Required data may not be available
  • Variable data quality
  • Evidence base may be inadequate
  • Does NOT consider ‘felt needs’ of people affected
94
Q

Explain the Comparative Approach to Health Needs Assessment.

A
  • Compares services received by a population (or subgroup) with others.
    > spatial
    > social

May examine:

  • Health status
  • Service provision
  • Service utilisation
  • Health outcomes: mortality, morbidity, QoL, Patient satisfaction
95
Q

List 4 problems with the Comparative approach to Health Needs Assessment.

A
  1. May not yield what the most appropriate level of provision or utilisation should be
  2. Data may not be available
  3. Data may be of variable quality
  4. May be difficult to find a comparable population.
96
Q

Explain the Corporate approach to Health Needs Assessment (who does it involve?).

A
  • Commissioners
  • Providers
  • Professionals
  • Opinion leaders
  • Politicians
  • Patients
  • Press
97
Q

List 4 problems with a corporate approach to health needs assessment.

A
  1. May be difficult to distinguish need from demand
  2. Groups may have vested interests
  3. May be influenced by political agendas
  4. Dominant personalities may have undue influence.
98
Q

Describe the demographics of homeless people in the UK.

A

25% are local authority care leavers
30-50% have enduring mental health issues
Alcohol + drug misuse affects 50% of rough sleepers

99
Q

What is the average life expectancy for a homeless man?

What is the national average life expectancy for a man?

A

Homeless: 43y

National average: 79y

100
Q

What is the life expectancy for a homeless woman?

What is the national average life expectancy for a woman?

A

Homeless: 47y

National average: 74y

101
Q

Give some reasons for homelessness.

A

Relationship breakdown caused by:

  • mental illness / breakdown
  • domestic abuse
  • disputes with parents
  • bereavement -> ‘no family ties’
102
Q

List some health problems faced by homeless adults

A
  • Infectious diseases eg. Hepatitis, TB
  • Poor condition of feet + teeth
  • Respiratory problems
  • Injuries following violence
  • Sexual health -> smears, contraception
  • Serious mental illness -> schizophrenia, depression
  • Poor nutrition
  • Addictions / substance misuse
103
Q

Describe the ‘needs of children’ with regards to social exclusion + health.

A
  • Stability + emotional security
  • Safety
  • Immunisations
  • School
  • Play, friends, toys
104
Q

Give 3 barriers to healthcare that might prevent the socially excluded from seeking medical attention.

A
  1. Access difficulties
    - Language barriers
    - Opening times
    - Perceived or actual discrimination
  2. Lack of integration between mainstream care services + other agencies eg. social services, criminal justice system.
  3. Other things on their mind
    - people do not prioritise health when there are more immediate survival issues.
105
Q

Gypsies and travellers experience poorer health than the general population. List some barriers to healthcare they may experience.

A
  • Reluctance of GPs to register gypsies + travellers and to visit sites
  • Poor reading + writing skills -> many are illiterate
  • Communication difficulties
  • Too few permanent + transient sites
  • Mistrust of professionals
  • Lack of choice
106
Q

Which members of the Multidisciplinary team comprise HASS (Homeless Assessment + Support Service)?

A
  • Mental health support workers
  • Community practice nurse
  • Specialist school nurse
  • Outreach family resource worker
  • Specialist midwife
  • Specialist community outreach nurses
  • Health visitor
107
Q

The ‘Travellers’ Team’ comprises a specialist health visitor, who liaises with GPs, hospitals + antenatal clinics to facilitate access. What is the main aim of this service?

A

Gradual acceptance of mainstream healthcare (for travellers)

Increased awareness from professionals

108
Q

Define ‘refugee’.

A

An adult or child who fits the 1951 Geneva Convention description that:
‘Owing to a well founded fear of being persecuted for reasons of race, religion, nationality etc. is unable ,or owing to such fear, unwilling to avail himself of the protection of that country.’

109
Q

Define ‘asylum seeker’.

A

Someone who has submitted an application to be recognised as a refugee + is waiting for their claim to be decided by the Home Office.

110
Q

Who has the right to apply for asylum in the UK?

A

Anyone has the right to apply for asylum in the UK + remain until a final decision on their application has been made.

111
Q

When a refugee is granted ‘indefinite leave to remain’, what does this mean?

A
  • When a person is granted full refugee status + given permanent residence in the UK.
  • they have all the rights of a UK citizen.
  • they are eligible for family reunion (one spouse, and any child of that marriage under the age of 18) .
112
Q

What are asylum seekers entitled to?

A
  • Entitled to Money: £35 / week
  • Entitled to housing: no choice dispersal
  • Entitled to NHS care
    > if under 18, are allocated a social services key worker + can go to school
  • Asylum seekers are not allowed to work; are not entitled to any other form of benefit.
  • failed asylum seekers are not entitled to any of the above.
113
Q

Why might asylum seekers find it difficult to access health care services?

A
  • Language / culture / communication barriers
  • Lack of knowledge re: where to get help
  • Health is not a priority.
114
Q

What state of physical health might an asylum seeker be in?

A
  • Injuries from war / torture / sexual abuse / travelling
  • Malnutrition
  • Illness specific to country of origin
115
Q

What state of psychological health might an asylum seeker be in?

A
  • Psychological distress = common

Note: psychological expression is culture-bound -> potential for misdiagnosis

116
Q

What mental health disorders might an asylum seeker have / be diagnosed with?

A
  • PTSD
  • Depression -> medication / counselling
  • Sleep disturbance
  • Psychosis
  • Self harm
117
Q

List some health needs of Asylum Seekers.

A
  • Rapid access
  • Screening
  • Catch up programmes / immunisations / child assessments
  • Education for asylum seekers + professionals
  • Mental health expertise
  • Supporting evidence for asylum hearings.
118
Q

Give short definitions for:

i) Asylum seeker
ii) Refugee
iii) Humanitarian protection

A

i) A person who has made an application for refugee status
ii) A person granted asylum + refugee status. Usually means leave to remain for 5 years, then reapply.
iii) Failed to demonstrate claim for asylum but face serious threat to life if returned. Usually 3 years, then reapply.

119
Q

Define ‘an unaccompanied asylum-seeking child’.

A
  • Someone who has crossed an international border in search of safety + refugee status
  • Is applying for asylum in his / her own right
  • Is under 18, or - in the absence of documentary evidence - appears to be under 18.
  • Is without family members or guardians to turn to in this country.
120
Q

What might a child’s experience of ‘torture’ have comprised?
What should we do as healthcare professionals?

A

Experience:

  • Direct experience of torture
  • Witnessing torture
  • Child soldiers
  • Different reactions
  • Secrets

HCPs should:

  • Develop trust / confidence / belonging
  • Promote the importance of school
  • Provide support for parents
121
Q

What are the physical consequences of loneliness?

A
  • Earlier death
  • Take more risks
  • Harder to self regulate
  • Physical changes which can bring on poor health.
  • Health risk (due to loneliness) is equivalent to 15 cigarettes / day.
122
Q

What signs might a patient exhibit if they are lonely?

A
  • Body language, appearance, talkative, clinging
  • Denial, ‘boredom’
  • Live alone
  • Male 50+
  • Bereavement / recent transition
  • Limited mobility
  • Sensory impairment
  • Quality, not quantity, of social contact
123
Q

Why are older men at risk of social isolation / loneliness?

A
  • Men have less social contact than women
  • 50% of 50+ men experience loneliness
  • Poor health, lower incomes, few qualifications, living in rented housing -> all are risk factors for loneliness.
  • Care plans lack a social dimension
124
Q

Define ‘Social exclusion’.

A

The dynamic process of being shut out, fully or partially, from any of the social, economic, political, or cultural systems which determine the social integration of a person in a society.’

125
Q

What are the 5 domains of social exclusion?

A
  • Material resources
  • Civic activities
  • Basic services
  • Neighbourhood
  • Social relationships
126
Q

Give some causes of social exclusion.

A
  • Poor health
  • Sensory impairment
  • Poverty / housing issues
  • Transport / problems on the roads
  • Discrimination -> sexuality, gender, ethnicity, belief
127
Q

Give 2 examples of national initiatives to tackle social exclusion / loneliness.

A
  • Age UK

- Dementia Friends

128
Q

Give 2 Sheffield examples of initiatives to tackle social exclusion / loneliness.

A
  • Age UK 50+ club / Active Sheffield

- Darnall Dementia Care

129
Q

Give some examples of housing initiatives that aim to tackle social isolation.

A
  • Intergenerational housing / activities
  • Co-housing
  • Flexible care
  • Planning for older people
130
Q

Give some examples of self help which are aimed at tackling loneliness / social isolation.

A
  • A compass for Old Age
  • Mindful Ageing
  • ‘Sod 70’
  • ‘Retirement with Attitude’.
131
Q

Give 4 Models of Behaviour Change

A
  1. Health Belief Model
  2. Theory of planned behaviour
  3. Transtheoretical Model
  4. Motivational interviewing
132
Q

Explain the theory behind the Health Belief Model (a theory of behaviour change).

A

Individuals will change if they believe:

  • they are susceptible to the condition
  • that the disease has serious consequences
  • that taking action reduces susceptibility
  • that the benefits of taking action outweigh the costs.
133
Q

Critique the Health Belief Model.

A
  • Alternative factors may predict health behaviour
  • HBM doesn’t consider the influence of emotions on behaviour
  • HBM doesn’t differentiate between 1st time and repeat behaviour
134
Q

Give a summary of the Health Belief Model.

A
  • Longest standing model of behaviour change
  • Successful for a range of health behaviours eg. breast self-examination, vaccinations, diabetes Mx etc.
    > perceived barriers have been demonstrated to be the most important factor for addressing behaviour change in patients.
135
Q

Explain the ‘Theory of Planned Behaviour’.

A
  • Proposes the best predictor of behaviour is ‘intention’
  • Intention is determined by:
    > a person’s attitude to the behaviour
    > the perceived social pressure to undertake the behaviour, or “subjective norm”
    > a person’s appraisal of their ability to perform the behaviour, or their perceived behavioural control.
136
Q

Critique the Theory of Planned Behaviour.

A
  • Lacks direction or causality
  • Doesn’t account for emotions eg. fear, threat, positive affect etc. which might disrupt ‘rational’ decision making.
  • Habits + routines bypass cognitive deliberation + undermine a key assumption of the model.
  • Relies on self-reported behaviour.
137
Q

Give a summary of the Theory of Planned Behaviour

A
  • Rational choice model
  • Attitudes, subjective norms, perceived behavioural control are the major determinants of intentions.
  • Takes into account the importance of social pressures + norms, as well as perceived control.
  • Useful for predicting people’s intentions; not as successful for predicting actual behaviours.
138
Q

Give a summary of the Theory of Planned Behaviour

A
  • Rational choice model
  • Attitudes, subjective norms, perceived behavioural control are the major determinants of intentions.
  • Takes into account the importance of social pressures + norms, as well as perceived control.
  • Useful for predicting people’s intentions; not as successful for predicting actual behaviours.
139
Q

Give 3 advantages of the transtheoretical model / ‘Stages of Change’ model

A
  • Acknowledges individual stages of readiness (tailored interventions)
  • Accounts for relapse
  • Temporal element (although arbitrary).
140
Q

Give 3 advantages of the transtheoretical model / ‘Stages of Change’ model

A
  • Acknowledges individual stages of readiness (tailored interventions)
  • Accounts for relapse
  • Temporal element (although arbitrary).
141
Q

Give 3 disadvantages of the transtheoretical model / stages of change model.

A
  • Not all people move through every stage. Some relapse. Some miss out stages completely.
  • Change might operator on a continuum, rather than in discrete stages
  • Doesn’t take into account values, habits, culture, social + economic factors
142
Q

Summarise the transtheoretical model / stages of change model.

A
  • Examines the process of change, rather than factors that determine behaviour.
  • Allows for interventions to be tailored to the individual according to what stage they are at.
143
Q

Summarise ‘Motivational Interviewing’ as a theory of behaviour change.

A
  • A counselling approach -> initiates behaviour change by resolving ambivalence.
  • Clinical impact has been shown in problem drinkers.
144
Q

Aside from the recognised models, what factors might influence a person’s ability to change their behaviour(s) eg. smoking cessation

A
  • Impact of personality traits on health behaviour
  • Assessment of risk perception
  • Impact of past behaviour / habit
  • Automatic influences on health behaviour
  • Predictors of maintenance of health behaviours
  • Social environments
145
Q

What does the NICE guidance say about behaviour change?

A
  • Interventions to change health related behaviour should work in partnership with individuals, communities, organisations + populations.
  • Typical transition points include:
    > leaving school
    > entering the workforce
    > becoming a parent
    > becoming unemployed
    > retirement + bereavement
146
Q

What does the NICE guidance say about behaviour change?

A
  • Interventions to change health related behaviour should work in partnership with individuals, communities, organisations + populations.
  • Typical transition points include:
    > leaving school
    > entering the workforce
    > becoming a parent
    > becoming unemployed
    > retirement + bereavement
147
Q

Define ‘evaluation’ of health services.

A

The assessment of whether a service achieves its objectives; assessment of a wide range of health-related activities.

148
Q

What 3 components make up the ‘Framework for Health Service Evaluation’?

A
  • Structure
  • Process (+ output)
  • Outcome
149
Q

What is ‘Process’ - part of the Framework for Health Service Evaluation - concerned with?

A
  • What is done?
    eg.
  • Number of patients seen in A+E
  • The process through which patients go in A+E.
150
Q

What is ‘Outcome’ - part of the Framework for Health Service Evaluation - concerned with?

A

Classification of health outcomes:

  • Mortality eg. 30 day mortality rate
  • Morbidity eg. Complication rates
  • Quality of life / PROMs (Patient Reported Outcome Measures)
  • Patient satisfaction
151
Q

List Maxwell’s Dimensions of Quality (as applied to Quality of Healthcare).

A
  • Effectiveness: does the intervention produce the desired effect?
  • Efficiency: is the output maximised for a given input?
  • Equity: are patients being treated fairly
  • Acceptability: how acceptable is the service offered to the people needing it?
  • Accessibility: is the service provided? Geographical access; costs for patients, information available, waiting times.
  • Appropriateness: is the right treatment being given to the right people at the right time? Overuse / Underuse / Misuse?
152
Q

Give examples of qualitative methods of evaluating healthcare services.

A
  • Consult relevant stakeholders eg. patients, staff, relatives
  • Qualitative methodology:
    > Observation
    > Interviews
    > Focus groups
    > Review of documents
153
Q

Give examples of quantitative methods of evaluating healthcare services.

A
  • Routinely collected data -> hospital admissions, mortality
  • Review of records -> e.g. medical, administrative
  • Surveys
  • Special studies eg. using epidemiological methods.
154
Q

Give examples of quantitative methods of evaluating healthcare services.

A
  • Routinely collected data -> hospital admissions, mortality
  • Review of records -> e.g. medical, administrative
  • Surveys
  • Special studies eg. using epidemiological methods.
155
Q

Give some general principles to consider when evaluating Health Services.

A
  • May be prospective OR retrospective
  • Define what the service is / what it includes
  • What are the aims / objectives of the service?
  • Framework, Structure, Process, Outcome
  • Methodology used -> qualitative / quantitative / mixed methods
  • Results, conclusions + recommendations
156
Q

List some factors which contribute to the promotion of excessive calorie intake.

A
  • Genetics
  • Employment (shift work)
  • Environmental cues
  • Decreased physical activity
  • Sleep
  • Psychological factors
157
Q

Define ‘malnutrition’.

A

Deficiencies, excesses, or imbalances in a person’s energy &/or nutrient intake.

158
Q

What are some of the consequences of undernutrition?

A
  • Stunting: low height for age
  • Wasting: low weight for height
  • Underweight: low weight for age
  • Micronutrient deficiencies / insufficiencies -> a lack of important vitamins + minerals.
159
Q

What are some of the consequences of being overweight?

A
  • Obesity

- Diet-related non-communicable diseases eg. Heart disease, stroke, diabetes, cancer

160
Q

Give examples of early influences on feeding behaviour.

A
  • Maternal diet + taste preference development
  • Breast feeding -> for taste preference + body weight regulation
  • Parenting practices
  • Age at introduction of solid food
161
Q

How does the maternal diet lead to early flavour exposure for the baby in utero?

A
  • Baby’s taste + olfactory systems can detect flavour information prior to birth
  • Amniotic fluid + human milk transmit volatiles from the maternal diet, providing early chemosensory experience.
162
Q

How might breast feeding be considered to be a public health issue?

A
  • Prevalence of breastfeeding is particularly low among very young mothers + disadvantages socio-economic groups, potentially widening existing health inequalities.
163
Q

What are the 3 components of breast milk?

A
  • Colostrum
  • Foremilk
  • Hindmilk
164
Q

Describe the composition of colostrum.

A
  • High protein
  • Low fat
  • Contains lots of antibodies
  • Delivers nutrients in a very concentrated, low volume form
  • Mild laxative effect -> encourages bowel movements.
165
Q

Give 4 properties of breast milk which are beneficial for the baby.

A
  1. Anti-infective: bifidus factor, white cells, oligosaccharides
  2. Efficient digestion: contains enzymes eg. lipase, lysozyme
  3. Gut protection:
    - epidermal growth factor
    - secretory IgA
    - anti-inflammatories
  4. Everyday health: Antibodies, viral fragment,s, lactoferrin (aids dental hygiene.
166
Q

How might parents influence positive feeding behaviours?

A
  • Modelling ‘healthful’ eating behaviours
  • Responsive feeding: recognizing hunger + fullness cues
  • Providing a variety of foods
  • Avoid pressure to eat
  • Not using food as a reward
  • Indulgent / neglectful feeding practices.
167
Q

What is ‘chemical continuity’ with regards to feeding behaviours?

A

Transmission of certain flavours from the maternal diet via amniotic fluid + then breast milk.

168
Q

What are the 3 distinct illnesses encompassed by ‘eating disorders’?

A
  • Anorexia nervosa
  • Bulimia nervosa
  • Binge eating disorder
169
Q

Define ‘eating disorder’.

A

Clinically meaningful behavioural or psychological pattern having to do with eating or weight that is associated with distress, disability, or with substantially increased risk of morbidity or mortality.

170
Q

Define ‘disordered eating’.

A

Restraint, strict dieting, disinhibition, emotional eating, binge eating, night eating, weigh + shape concerns, inappropriate compensatory behaviours that do not warrant a clinical diagnosis.

171
Q

What are the 3 basic forms of dieting?

A
  1. Restrict the total amount of food eaten
  2. Do not eat certain types of food
  3. Avoid eating for long periods of time
172
Q

What are the problems with dieting?

A
  1. Dieting is a risk factor for developing eating disorders
  2. Dieting results in a loss of lean body mass, not just fat mass.
  3. Dieting slows metabolic rate + energy expenditure
  4. Chronic dieting may disrupt ‘normal’ appetite responses + increase subjective sensations of hunger.
173
Q

Why is dieting so difficult for some patients?

A

Those susceptible to obesity (and who try to diet) appear particularly:
I) unresponsive to internal cue that signal satiety (when overconsuming) + hunger (when dieting)
ii) vulnerable to external cues that signal availability of palatable food.

174
Q

What is the ‘Externality Theory of Obesity’?

A
  • Normal weight individuals responsive to internal homeostatic cues.
  • Overweight individuals eat according to:
    > external cues
    > no compensation after preload
    > time of day
    > often lurid descriptions of desserts
    > sensory food cues.
    BUT the theory is too general
175
Q

What is ‘restrained eating’?

A

The deliberate attempt to inhibit food intake in order to maintain or to lose weight.
- effortful, cognitively demanding process: ignore feelings of hunger in order to adhere to self-imposed dietary rules.

Under certain circumstances, restrained eaters can be induced to overeat -> ‘disinhibition’
-> “what the hell” effect: inability to maintain cognitive control of food intake.

176
Q

Give a summary of the Restraint Theory (Boundary Model).

A
  • Unrestrained eaters are intuitive + regulate food intake without conscious effort.
  • Restrained eaters rely on consciously controlled processes to regulate food intake.
  • Break down of dietary restraint leads to ‘what the hell’ cognitions
177
Q

Give some examples of disinhibits which might lead someone to over eat (according to the Restraint theory / boundary model).

A
  • High energy preloads / merely the belief of high energy preloads
  • Large portion size, alcohol
  • Cognitive load -> stress
  • Strong emotion
178
Q

Give a critique of the Restraint Theory / Boundary Model.

A
  • Suggests a link between food restriction + over-eating
  • Dieters, bulimics, anorexics report episodes of over-eating.
  • Theory cannot explain restricting behaviour in anorexics
179
Q

Why are some dieters more successful?

A
  • Some people are more ‘flexible’ than ‘rigid’ in their dietary restraint -> results in decreased pre-occupation with food, decreased attentional bias to food cues -> longer term weight loss.
180
Q

What is the ‘Goal Conflict Theory’ as applied to dietary restraint?

A
  • Chronic dieters experience conflict between 2 incompatible goals: eating enjoyment vs weight control
  • Individuals are motivated to pursue a weight loss goal.
    HOWEVER, pervasive food cues in the environment prime the goal of food enjoyment (“external eating”).
181
Q

What is the ‘Portion Size Effect’?

A

Consumption of large portion sizes of energy dense (ED) food facilitates over consumption.
In the absence of compensatory effects, large portions of energy dense food may be contributing to the increased prevalence of overweight + obesity.

182
Q

What is the evidence behind the ‘Portion Size Effect’?

A
  • Associated with sustained increase in energy intake over several days without energy compensation.
  • Evidence for individual + socioeconomic influences
  • Most people don’t know what constitutes an appropriate portion size for many foods + beverages.

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