Public Health Flashcards
Health definition
Persons capacity to function in relation to age and need while having feelings such as enjoyment from everyday life
determinants of health
range of factors that combine together to affect or influence the health of individuals
conditions in which people are born, grow, live, work and age
causes of ill-health
cancers communicable diseases (can be spread) mental disorders liver disorders CV disease congenital malformation (birth defects) respiratory disease dental caries disability HIV/AIDS
Health inequalities
systematic differences in health status between different socio-economic groups
health literacy
people having the skills (language, literacy and numeracy), knowledge, understanding and confidence to access, understand, evaluate, use and navigate health and social care information and services
two types of health behaviour models
- explanatory theory/ social cognition models
2. change theory
public health
the health of a population as a whole, especially as the subject of government regulation and support
understanding causes of ill-health, seeking to explain and or predict health-related behaviour, helping clients, groups or communities redirect their own activities towards health and wellbeing
health education
combination of learning experiences to help individuals and communities improve their health by increasing their knowledge or influencing their attitudes
part of health promotion
what is explanatory theory
used to explore reasons behind a particular health behaviour by focusing on the individual
examples of explanatory theories
health belief model theory of reasoned action/planned behaviour transtheoretical (stages of change) model social cognitive (learning) theory
What is change theory
Theory to guide change following explanation of change needed to improve health
health belief model (HBM)
desire to avoid negative health consequences
used to try and predict health behaviours
examples of health belief models
condoms, seat belts, medical compliance, health screening
6 concepts protective/health promoting actions depend on in the Health Belief Model
- perceived susceptibility
- perceived severity
- perceived benefits
- perceived barriers
- cues to action
- self-efficacy
what is perceived susceptibility
belief of chances of getting a condition
what is perceived severity
belief of how serious condition and consequences
what is perceived benefits
belief in the efficacy of the advised action to reduce risk or seriousness of impact
what is perceived barriers
belief in the tangible and psychological costs of the advised behaviour
what are cues to action
strategies to activate ‘readiness’
what is self-efficacy
confidence in ones ability to take action
3 challenges in applying the HBM
- avoiding blame (HBM stresses personal responsibility)
- solutions often more complex or caused by factors over which individuals have less personal control
- challenge of providing meaningful cues to action
theories of reasoned action and planned behaviour
centres on individuals attitudes and beliefs
seeks to explain behaviours under voluntary control
Stages of change (transtheoretical) model
identifies 5 stages of change in behaviour representing ‘levels of readiness’
5 stages of stages of change model
- pre-contemplation
- contemplation
- preparation
- action
- maintenance
- potentially relapse as 6th stage
social cognitive theory (SCT)
takes into account determinants of health and individual behaviours
links personal factors, behaviour and environmental influences
diffusion of innovations
identifies factors that influence how quickly an idea or behaviour is adopted
highlights uncertainties associated with new behaviours
according to diffusion of innovations, what 4 factors does the adoption of a new idea depend on
- characteristics of the innovation
- communication channels
- time
- social system
behavioural change wheel
developed from 19 frameworks of behaviour change and consists of 3 layers
3 layers of behaviour change wheel
- 6 source of behaviour (2 in each domain)
- domains of: opportunity, capability and motivation
- 9 intervention functions
6 sources of behaviour in behaviour change wheel
Capability domain 1. physical 2. psychological Opportunity domain 3. social 4. physical Motivation domain 5. reflective 6. automatic
what is the purpose of screening
to reduce risk of certain groups in the population by identifying those more susceptible to diseases, reducing associated risks of complications
what is screening
process of identifying healthy people who may be at increased risk of disease or condition, enabling earlier treatment and better informed decisions
11 UK national population screening programmes
abdominal aortic aneurysm (AAA) bowel cancer screening (BCSP) breast screening (BSP) cervical screening (CPS) diabetic eye screening (DES) fetal anomaly screening (FASP) infectious diseases in pregnancy screening (IDPS) newborn and infant physical examination (NIPE) newborn blood spot (NBS) newborn hearing screening (NHSP) sickle cell and thalassaemia (SCT)
screening parameters
- eligible group (decided by risk and benefit; balancing both with affordability)
- test (sieve or screen)
- sorting for positives (
- intervention for cases
- avoidable outcomes
false positive
wrongly reported as having the condition
false negative
wrongly reported as not having the condition
harm caused by false negative/positive
unnecessary treatment
physical and emotional stress
cost to NHS
deter people from trusting results in future
what is obesity
accumulation of body fat when energy intake from eating is greater than energy expended over time
BMI
kg/(m^2)
healthy = 18.5 - 24.9 overweight = BMI >25 obesity = BMI >30
risk factors of obesity/ excess weight
CV disease T2D hypertension cancer MSK pain and impair mobility from stress on joints and spine poorer mental health and wellbeing
approach to tackling obesity
whole system approach
- diet
- physical activity
- sitting less
- alcohol consumption
UK advice on diet
- 5 (80g servings) fruit and veg per day
- no more than 35% of food energy should be from fat
- maximum salt intake = 6g/day
- at least one 140g portion of oily fish per week
- dietary fibre 30g/day
choose smaller portions
health issues from alcohol harm
heart disease stroke high blood pressure liver cirrhosis/ cancer reduced fertility depression and anxiety breast cancer cancer of mouth, throat, oesophagus or larynx pancreatitis harm to unborn babies
7 priorities for action to improve national health
- tackle obesity, particularly among children
- reduce smoking and stop children starting
- reduce harmful drinking and alcohol related hospital admissions
- ensure every child has best start in life
- reduce risk of dementia, incidence and prevalence in 65-75y/o
- tackle growth in antimicrobial resistance
- achieving a year-on-year decline in the incidence of Tb
UK guidance for alcohol consumption
14 units spread over 3 days or more
1 unit of alcohol equivalent to…
half a pint of beer
half a small glass of wine
one single shot of spirit
low risk of drinking behaviour
both men and women not drinking regularly more than 14 units per week spread over 3 or more days
increasing risk of drinking behaviour
men - regularly drinking 15-49 units/week
women - regularly drinking 15-34 units/week
higher risk of drinking behaviour
men - regularly more than 8 units/day or 50+ units/week
women - regularly more than 6 units/day or 35+ units/week
binge drinking - risk of drinking behaviour
men - more than 8 units on heaviest drinking day in previous week
women - more than 6 units on heaviest drinking day in previous week
brief alcohol interventions
short, time-limited interaction/ conversation (no more than 5 mins)
guided nature of conversation, delivered in a motivational style, distinguishes it from basic information giving
addressing smoking (3 A’s)
ASK - all patients if they smoke
ADVISE - the best way to stop (for them)
ACT - by offering referral to local stop smoking services
4 quitting methods for smoking
- local stop smoking services offer best chance of success
- using a prescribed medicine
- using OTC nicotine replacement (patches, gum or e-cig)
- using will power alone - least effective method
Nicotine Replacement Therapy products (NRT) formulations
- transdermal patch
- gum (chewed slowly)
- inhalation cartridges
- sublingual tablets/ lozenge
- nasal spray/ mouth spray
prescription only smoking cessation therapy
bupropion
varenicline
benefits of smoking cessation
slows decline in lung function
gives extra years of life
duration of potential withdrawal symptoms
less than 4 weeks: - irritability/ aggression - depression - restlessness less than 2 weeks: - poor concentration more than 10 weeks: - increased appetite less than 48 hours: - light-headedness less than 1 week: - night-time awakeness urges to smoke: years
advise for smoking cessation pregnancy and breastfeeding
try to stop without NRT but can be used as far less risk to baby than continuing to smoke
for breastfeeding: if using NRT = should use intermittently (not patches)
factors that can lead to relapse
low self-efficacy negative emotions and poor coping high craving expectation of reinforcement low motivation interpersonal issues
3 interventions to promote smoking cessation
- clinical interventions
- motivational support (friend/family support)
- public health (workplace/government interventions etc)
normal waist circumference
men - less than 94cm
women - less than 80cm
high and very high risk waist circumference
high:
men - 94-102
women - 80-88
very high:
men - over 102
women - over 88
advice for low waist circumference and overweight
general advice on healthy weight and lifestyle
advice for low waist circumference and obesity I or high waist circumference and overweight
diet and physical activity
advice for high waist circumference and obesity I or very high waist circumference and overweight
diet and physical activity; consider drugs
advice for very high waist circumference and obesity I
diet and physical activity
consider drugs
consider surgery
activity recommendations for adults
- at least 30 minutes
- moderate or greater physical activity
- 5 or more days a week
- either in one session or several sessions lasting 10 minutes or more
activity recommendation for children
at least 60 minutes of moderate or greater intensity physical activity
dietary advice for losing weight in adults
- 600kcal/day deficit
- reduce calories by lowering the fat content
- in combination with expert support and intensive follow-up
dietary advice for losing weight in children
dietary approach alone not recommended
should be part of multicomponent intervention
pharmacological interventions for weight loss (2)
should only be recommended after lifestyle changes have been made and evaluated
orlistat - lipase inhibitor
liraglutide - glucagon-like peptide-1 receptor agonist
not recommended for children 12 and under
Orlistat - mechanism of action
reduces absorption of dietary fat by inhibition of GI lipases which stops breakdown of triglycerides to absorbable free fatty acids and monoglycerides
BMI that is orlistat used
BMI 30 or more
OR
BMI 28 or more PLUS other risk factors (T2D, HTN etc)
administration of orlistat
120mg up to 3 times a day
taken immediately before, during or up to 1 hour after a meal
if meal contains no fat - skip dose
review at 12 weeks
additional meds when taking orlistat
use additional contraceptive to prevent failure of oral contraception from severe diarrhoea
orlistat may impair absorption of vit A,D,E and K - consider multivitamins taken at least 2 hours after orlistat, or at bedtime
conditions for buying orlistat OTC
- over 18 years
- BMI 28 or above
- have a mildly hypocaloric, lower fat diet
- treatment should not exceed 6 months
- dose = 60mg TDS
- capsule should be taken with water
orlistat contraindications
- hypersensitivity to orlistat
- taking ciclosporin or warfarin (and other anticoagulants)
- chronic malabsorption syndrome
- cholestasis
- pregnant/ breastfeeding
- signs of eating disorder
what is an opioid
natural derivative of opium or synthetic substance with agonist, partial agonist or mixed agonist and antagonist activity at opioid receptors
what is an opioid antagonist
drug that blocks the activity of a drug with agonist activity
what is an opiate
a natural derivative or semi-synthetic constituent of opium
what is dependence
strong desire or sense of compulsion to take the substance
difficulty in controlling use
goal of maintenance therapy
harm reduction and stabilisation of lifestyle
goal of detoxification
to come off opioids altogether
what is needle exchange service
safe disposal of needles
encourages testing for BBV and other diseases spread through needles
what is the antidote for opioid overdose
naloxone (POM) = opioid antagonist
definition of pain
unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage
influences on pain perception
co-morbidities - psychological - substance misuse - previous trauma lifestyle factors - exercise - smoking - alcohol intake - stress social isolation - elderly - disabled patients
Qs in pain assessment
intensity, location, quality, duration, aggravating/relieving factors, associated symptoms, impact on activities of daily living, patients pain beliefs, cause of the pain, expectations, acceptable pain levels, coping mechanisms, emotional response and spiritual beliefs
descriptions of neuropathic pain
shooting tingling numbness like an electric shock burning
descriptions of somatic pain
achy
throbbing
dull
well localised
descriptions of visceral pain
cramping
pressure
distention
deep
