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Phase 2A > Public Health > Flashcards

Public Health Flashcards

1
Q

Why is type 2 diabetes a public health issue?

A
  • it is preventable
  • it is increasing in prevalence
  • lack of effective global, national or local policy
  • major inequalities in prevalence and outcomes
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2
Q

What does prevalence depend on?

A
  • Primary prevention: incidence of condition
  • Secondary prevention: % of incident cases
  • Tertiary prevention: survival from diagnosis
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3
Q

What are the ways in which we can reduce the impact of type 2 diabetes?

A
  • identify people at risk of diabetes
  • prevent diabetes
  • diagnose diabetes earlier
  • effective management and supporting self-management
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4
Q

What are the requirements of effective interventions to prevent diabetes?

A
  1. Sustained increase in physical activity
  2. Sustained change in diet
  3. Sustained weight loss
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5
Q

What are the 3 approaches for diagnosing diabetes earlier?

A
  1. Raising awareness of diabetes and possible symptoms in the community
  2. Raising awareness of diabetes and possible symptoms in health professionals
  3. Using clinical records to identify those at risk and/or using blood tests to screen before symptoms develop
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6
Q

What are the current screening practices in place for T2DM?

A
  • screen as part of CHD prevention health check (every 5yrs from 40-74yrs)
  • screening at review of hypertension management
  • other risk groups may be screened
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7
Q

What is the NICE guidance in terms of preventing progression of T2DM from pre-diabetes?

A
  • Focus on risk assessment followed by blood tests (HbA1c;FBG)
  • Focus on cost-effective weight loss, diet and physical activity interventions
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8
Q

What are the ways to support self-care for diabetes?

A
  • Self-monitoring
  • Diet - support for changing eating patterns
  • Exercise - support for increasing physical activity
  • Drugs - support for taking medication
  • Education
  • Peer-support
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9
Q

What are the guidelines for safe weekly alcohol intake?

A

14> units per week (men + women)
Spread drinking over 3≤ days

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10
Q

What are the factors considered in alcohol-associated harm?

A

Who is harmed: self vs other
How much does alcohol attribute: fully (alcohol-specific) vs partially (alcohol attributable)
When does the harm take place: immediately (acute) vs over prolonged exposure (chronic)
What domain is harmed: health vs social

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11
Q

When does drinking become excessive?

A

When it causes or elevates the risk for alcohol-related problems
When it complicates the management of other health problems

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12
Q

What are the acute effects of excessive alcohol consumption?

A

Accidents and injury
Coma and death from respiratory depression
Aspiration pneumonia
Oesophagitis/ gastritis
Mallory-Weiss syndrome (gastric tears)
Pancreatitis
Cardiac arrhythmias
Cerebrovascular accidents
Neurapraxia due to compression
Myopathy/rhabdomyolysis
Hypoglycaemia

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13
Q

What are some of the chronic effects of excessive alcohol consumption?

A

Pancreatitis
CNS toxicity (dementia, Wernicke-Korsakoff syndrome, cerebellar degeneration, central pontine myelinolysis)
Liver damage (fatty change, hepatitis, cirrhosis, hepatic carcinoma)
Cancers (breast, bowel, mouth, throat, liver)
Hypertension
Peripheral neuropathy

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14
Q

What is the most common cause of alcohol-specific death?

A

Alcoholic liver disease

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15
Q

What are the clinical alcohol withdrawal syndromes?

A

Tremulousness - “the shakes”
Activation syndrome - characterized by tremulousness, agitation, rapid heartbeat and high blood pressure
Seizures - acute grand mal seizures can occur in alcohol withdrawal in patients who have no history of seizure or any structural brain disease
Hallucinations - usually visual or tactile in alcohol dependence
Delirium tremens - can be severe/fatalTremors, agitation, confusion, disorientation, hallucinations, sensitivity to light and sound, and seizures [medical emergency]

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16
Q

What are the presentations of foetal alcohol spectrum disorder (FASD)?

A

Pre and post-natal growth retardation
CNS abnormalities including learning disabilities, irritability, incoordination, hyperactivity
Craniofacial abnormalities
Associated abnormalities including congenital defects of eyes, ears, mouth, cardiovascular system, genitourinary tract and skeleton, and an increase in the incidence of birthmarks and hernias

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17
Q

What are the psychological effects of excessive alcohol consumption?

A

interpersonal relationships (violence, rape, depression/anxiety)
problems at work
criminality
social disintegration (poverty)
driving incidents/offences

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18
Q

What are the methods of alcohol harm prevention in the UK?

A

restrict choice (minimum unit pricing, restriction of alcohol advertising)
enable choice (dry January)
provide information (alcohol labelling, drinking guidelines, media campaigns)

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19
Q

What is the definition of ‘At risk drinking’?

A

A pattern of drinking which brings about the risk of physical or psychological harm

20
Q

Define ‘harmful drinking’ (alcohol abuse)

A

A pattern of drinking which is likely to cause physical or psychological harm

21
Q

Define ‘alcohol dependence’

A

Substance dependence is defined as a set of behavioural, cognitive and physiological responses that can develop after repeated substance use

22
Q

What are the screening tools used for alcohol?

A

Clinical interview - single question about heavy drinking days
FAST - Fast Alcohol screening test
AUDIT - Alcohol Use Disorders Identification Test
CAGE questions

23
Q

What are the treatments for alcohol dependence?

A

Psychosocial:
Therapy (cognitive + behavioural)
Social support (one to one or group e.g. AA)

Medical/Pharmacological
Acamprosate calcium
Disulfiram
Nalmefene
Naltrexone

24
Q

What are the policy recommendations for preventing alcohol-use disorders?

A

Price - make alcohol less affordable
Availability - licensing + import allowances
Marketing - limit exposure, esp. to children + young people

25
Q

What are the recommendations for practice for preventing alcohol-use disorders?

A

Licensing
Screening & brief interventions
Supporting children & young people aged 10-15 yrs
Referral - consider referral for specialist treatment

26
Q

What is substance misuse?

A

The harmful use of any substance for non-medical purposes or effect.
Typically psychoactive substances that produce CNS effects; poly-drug use common
Associated with both illicit and legal substances
Cannabis = most commonly used globally

27
Q

What are some examples of opiates and their effects?

A

Heroin (A), codeine (B), tramadol (B)
Euphoria, analgesia

28
Q

What are examples of depressants and their effects?

A

Alcohol, benzodiazepines (c), gabapentinoids (C)
Sedation, anxiolytic

29
Q

What are examples of stimulants and their effects?

A

Amphetamines (B), Khat (C), cocaine (A), crack (A), caffein, ecstasy/MDMA (A)
Increase alertness, alter mood

30
Q

What is the effect of cannabis (B)?

A

Relaxation, mild euphoria

31
Q

What are examples of hallucinogens and their effects?

A

LSD (A), magic mushrooms (A)
Altered sensory perceptions, thinking

32
Q

What are examples of anaesthetics and their effects?

A

Ketamine (B), GHB (C), Nitrous oxide
Anaesthesia, sedative

33
Q

What are NPSs?

A

New Psychoactive substances previously termed legal highs and designed to mimic other substances of abuse but less predictable effects
Examples:
Depressant/downer - Etizolam Pyrazolam
Stimulant - Mephadrone, BZP
Cannabinoids - Spice, Clockwork Orange, Black Mamba
Hallucinogens - Bromo-Dragonfly Methoxetamine
Synthetic opioids - Brorphine, Metonitazene

34
Q

What are the effects associated with drug misuse?

A

Mortality
Morbidity (physical and psychological impact on quality of life)
Social (criminal justice involvement, crime, violence, acceptability)
Economic (productivity, tax)
Personal (identity, stigma, relationships)

35
Q

What are the main theoretical models used to explain drug misuse and how it can be combatted?

A

Disease model - chronic recurrent illness - use substitution medicines
Moral model - failure of morality - parenting classes, religious education
Socio-cultural model - symptoms of social problems - target health inequality
Behavioural model - bad habit - law/criminal justice to deter through fines/prison
Volitional model - failure of will - raise self-efficacy
Disease model - genetic disorder - explore gene therapies

36
Q

Define addiction

A

Severe substance disorder involving compulsive use of a substance despite harmful consequences. often involves structural and biochemical changes to parts of the brain linked to reward, self-control and stress.

37
Q

What are risk factors for substance misuse?

A

Aggressive childhood behaviour
Lack of parental support, family conflict, family history of substance abuse
Community deprivation/poverty, low neighbourhood attachment
Drug experimentation
Poor social skills
Availability of drugs at schools
Academic failure, low school commitment

38
Q

What are protective factors for substance misuse?

A

Often the reverse of risk e.g. family attachment, academic achievement
Opportunities / recognition / reward for positive involvement
Opportunities to develop self-confidence, feelings of self-worth, resilience

39
Q

What are the non-infective causes of diarrhoea?

A

Neoplasm
Hormonal
Inflammatory
Radiation
Irritable bowel
Chemical
Anatomical

40
Q

What are 4 examples of diarrhoeal diseases?

A

Dysentery, typhoid, hepatitis, cholera

41
Q

What are some examples of causative organisms for diarrhoeal disease?

A

Rotavirus
Shigella
E.Coli 0157
Salmonella Typhi
Salmonella Paratyphi
Hepatitis A
Hepatitis E
Vibrio cholerae

42
Q

Which bacteria cause low volume, bloody stools?

A
  • shigella
  • salmonella
  • campylobacter
43
Q

What the characteristics of clostridium difficile infection?

A

Associated with antibiotic use
Cause antibiotic associated diarrhoea and colitis in hospitalised patients
High mortality especially in elderly, vulnerable patients

44
Q

What is the SIGHT protocol for C. difficile?

A

S- suspect C. diff as a cause of diarrhoea
I - isolate the cause
G - gloves + aprons must be worn
H - Hand washing with soap and water
T - test stool for toxin

45
Q

What are the prevention measures for diarrhoea?

A
  1. Rotavirus and measles vaccinations
  2. Promote early & exclusive breastfeeding
    + Vitamin A supplementation
  3. Promote hand washing with soap
  4. Improved water supply quantity & quality, including treatment & safe storage of household water
  5. Community-wide sanitation promotion.
46
Q

What are the control measures for diarrhoeal illness?

A

Hand-washing with soap
Ensure availability of safe drinking water
Safe disposal of human waste
Breastfeeding of infants & young children
Safe handling and processing of food
Control of flies/vectors
Case management including exclusion
Vaccination

Phase 2A (18 decks)

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