Public health Flashcards
What diagnoses can have social labels with potentially negative consequences?
Psychiatric
Sick notes
Legal claims
What results in stigma?
Negative response to a label
Presence of some deviation from normality and social reaction to the subsequent diagnosis
What are the political consequences of stigma?
Political phenomenon related to citizenship and the lack of entitlement
Applied more broadly to any condition, attribute, trait, or behaviour that marks the bearer as culturally unacceptable or inferior
Where can stigma reside?
In the person
In the audience/observer
What are the 3 distinct types of stigma?
Abominations of the body such as blemishes/deformities
Character defects such as mentally ill/criminal
Tribal stigma -> distinction between virtual social identity (normative expectations) and actual social identity (attributes individual possesses)
What is the difference between discreditable and discredited tribal stigma
Discreditable -> something that can be hidden eg mastectomy/ileostomy
Discredited -> something that is obvious eg amputation/wheelchair user
What is felt/enacted stigma? What is the impact of both?
Enacted = discrimination
Fear of stigmatisation is more disruptive than enacted discrimination
What is the effect of weight stigma on children?
Bullying and impacts socialising and academic performance
What is the effect of weight stigma on adults?
Affects employment and health
Negatively impact likelihood of engaging in pro-health behaviours
Name some drugs that can cause addiction
Benzodiazepines
Opiates
Name some drugs that can cause follow-on abuse
Alcohol
Illicit drugs
Name some drugs that can cause electrolyte imbalances
Laxatives
Name some drugs that can cause withdrawal symptoms
SSRI
Name some drugs that can cause convulsions/acidosis
Chlorphenamine
Antihistamines
What are the main s/e of ibuprofen?
GI - indigestion, bleeding, death
Hypokalaemia
Acidosis
What are the main s/e of paracetamol?
Hepatotoxicity
Death
Rebound headache
What is the difference between misuse and abuse?
Misuse = wrong dose or indication, unintentional
Abuse = deliberately exploiting side effects, experimentation
What support is there for those abusing drugs?
Formal addiction services
Self-help
Involvement of GP
On-line support
Narcotic anonymous
Private clinics
Name 3 prescription drugs that are associated with abuse and dependency
Opioids
Benzodiazepines
Z-drugs (zopiclone, zolpidem)
SSRIs
GABAergics (pregabalin, gabapentin)
Name 3 OTC drugs that are associated with abuse and dependency
Analgesic codeine with paracetamol/ibuprofen
Opiate cough medicines
Sedative antihistamines
Laxatives
Nicotine replacement therapy
Decongestant stimulants
Who is most likely to abuse OTC medicines?
Older women
Name 3 risk factors for opiate abuse
Genetic predisposition
Personal psychosocial profile
Personal/family history of addiction
Psychiatric disorders
Younger
High opioid doses
Use of short-acting opioids
High pain level
Multiple pain complaints
Self-reported craving
Concurrent use of tobacco, alcohol, benzodiazepines
How can we deal with addiction in healthcare?
Pharmacy -> hide product, refuse sale, record sales
Harm reduction intervention pilot
Pack warnings
Training for HCPs
Increased awareness of issue
Information for patients about risk
Prevention
Treatment
Internet support groups
What treatment is available for addiction?
Depends on the medicine
Opiates -> substitution treatment (methadone)
Benzos -> tapering dose
What strategies are in place to minimise risk in the NHS?
Patient safety alerts
Simplification and standardisation of clinical processes eg marking surgical sites, SBAR
Checklists and aide memoires eg NEWS2
Information technology
Tools to improve uptake of evidence based treatment
Supporting better team working
What is mental preparedness?
Good healthcare professionals not error-free, expect, detect, and compensate for errors
Watchfulness and foresight are means of preventing and recovering incidents
Foresight ability to identify, respond to, and recover from initial indications that patient safety incident could take place
What is the three bucket model?
Self, context, task
Fuller buckets are, more likely something will go wrong but buckets are never empty
Name 3 nutritional concerns in older adults
Change in body composition
Decreased energy requirements
Sarcopenia (loss of lean body mass)/obesity/ sarcopenic obesity
Bone loss
Chronic disease
Monotonous diet
Protein
B12, B6
Folic acid
Vit D
Calcium
How does iron requirements change with age?
Identical for older and younger adults but lower in older women as not longer menstruating?
What is malnutrition?
State of nutrition in which deficiency or excess of energy, protein, and other nutrients causes measurable adverse effects of tissue/body function and clinical outcome
Closely linked with mortality
What are the consequences of malnutrition?
Lengthened hospital stay, reduced QoL
Increased risk of developing disease
Loss of muscle tissue and strength -> respiratory muscle = chest infection, cardiac function = HF
Mobility
Reduced immune response/increased infections
Poor wound healing
Loss of mucosal integrity (malabsorption/bacterial translocation)
Psychological decline
Poor prognosis
What is sarcopenia?
Decrease in lean body mass associated with ageing
Name 3 causes of sarcopenia
Reduced physical activity
Change in body composition
Malnutrition
Increased cytokine production
Reduced sex hormones
Chronic disease
Name a social factor affecting nutrition intake
Isolation
Neglect
Name a psychological factor affecting nutrition
Bereavement
Depression
Dementia
Name an economic factor affecting nutrition
Cost
Access
What social support is available for those at risk of malnutriton?
Meals on wheels
Lunch clubs
Home delivery services
Name some physiological factors affecting nutritional intake and absorption
Visual impairment
Mobility
Dexterity
Dental health
Illness/polypharmacy
GI changes -> taste, hormonal, CCK, gut motility, atrophic gastritis
What is important to remember about geriatrics in hospital?
People > 80 twice as likely to become malnourished during a hospital stay than the under 50s
How can you assess nutritional status?
Anthropometric measures
- BMI
- Waist circumference
- Body fat
- Demispan
Bioelectrical impedance analysis
Physiological function
- Hand grip strength
- Timed up and go
- 30 seconds chair stand test
MUST
MNA
