PUBLIC HEALTH Flashcards
What is Mental Health as a Definition?
“a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community”.
What are some Specific mental health problems in doctors?
Increased suicide rates
Increased marital dysfunction and divorce
Increased drug and alcohol problems
What are the symptoms of burnout?
o Diminished personal contact
o Work avoidance
o Increased minor illness
o Feelings of fatigue
What categories can influence health?
o Biological
o Personal lifestyle
o Health services
o The Physical and Social Environment
What is the Black Report 1980?
o Confirmed that social class health inequalities had a big part in overall mortality
o Confirmed health inequalities are widening
o Mechanisms to explain why:
▪ Artefact, social selection, behaviour, material circumstance
What is the Acheson Report 1988?
o Mortality has decreased in the last 50 years but inequalities remained or widened
o Recommendations:
▪ Evaluate all policies likely to affect health in terms of the impact on inequality
▪ Prioritise health of families with children
▪ Government should reduce income inequalities and improve living
conditions in poor households
What is the prevention paradox
Outlines that large numbers of people must participate in a preventive strategy for direct benefit to relatively few.
eg everyone wears seatblets, but only gonaa actually beenfit the small number of people that get in car crashes
What are the 3 doman of publinc health
health improvement - (tackling inequalities)
Health protection (controlling infectious diseases)
Improving services (eg Audits)
What are the Theories of Causation?
Lifecourse
Psychosocial
Materialist
What are some Theories of Causation?
- Lifecourse:
▪ Critical periods have a greater impact in the life course e.g. measles in pregnancy
▪ Accumulation: hazards and their impacts add up e.g. hard blue-collar work
▪ Interactions and pathways - Psychosocial
▪ Social inequality may affect how people feel which in turn can affect body
chemistry, focuses on the individual - Materialist
▪ Poverty exposes people to more health hazards
▪ Disadvantaged people are more likely to live in areas exposed to harm e.g.
damp and pollution
What must consent be?
Consent must be:
o Voluntary
o Informed
o Made by someone with capacity
When is a patient unable to make a decision?
If the Px cannot:
o Understand the relevant information
o Retain it
o Use or weight it to make a decision
o Communicate the decision
What are some Risk factors for CHD?
o Unmodifiable = age, sex, ethnicity, genetics
o Lifestyle: smoking, diet, physical inactivity
o Clinical RF: hypertension, lipids, DM
o Psychosocial: behaviour trait, depression/anxiety, work, social support
What are Coronary Prone behaviours and who described them?
Friedman and Rosenman 1959:
o Competitive, hostile, impatient
o Type A behaviour
o Assess type A behaviour with MMPI
What do the Whitehall Studies show?
o Whitehall I:
▪ Male british civil servants over 10yr period
▪ Men in lowest grade had higher mortality than men in highest grade
▪ 3x mortality rate from all causes
o Whitehall II:
▪ 10,000 civil servants
▪ Employment grade was strongly associated with work control and demands
What is required to verify death?
o No heart sounds or carotid pulse for one minute
o No breath sounds or respiratory effort for one minute
o No response to painful stimuli
o Pupils are fixed and dilated
Define Palliative Care?
Improves QOL of patients and families who face life threatening
illness.
Provides pain and symptom relief and spiritual and psychological support from diagnosis to the end of life and bereavement
Who are some providers of Palliative Care?
o Consultants in palliative medicine
o Clinical nurse specialists e.g. Macmillan nurses
o Social workers
o Chaplains
o Physiotherapists
o Dieticians
What are the building blocks of Palliative Care?
o Holistic
o Individualised
o Patient and family centred
o Multidisciplinary approach
What are the aims of Palliative Care?
o Promote QOL
o Promote dignity and autonomy
o Control disease symptoms
How can you keep alcohol related harm risks low?
o Do not regularly drink >14 units / week
o If you do drink 14 units spread them evenly over 3+ days
o It’s a good idea to have several alcohol-free days each week
What are factors that suggest substance misuse?
o Results in failure to fulfil role obligations e.g. work, school, home life
o May be physically hazardous e.g. driving or operating machinery
o Continued misuse despite persistent or recurrent social or interpersonal problems
How do you calculate the number of alcoholic units in a drink?
- Number of units in a drink = (%ABV x volume in ml)/1000
8g of pure alcohol or 10ml
Define what 1 pack year is
How many straights is in a standard pack of cigarettes?
1 pack year =
1 pack, every day, for a year
its a way of gauging how much someone has smoked over their life
There are 20 cigarettes are in a standard pack of cigarrarettes
Define Dependence?
o a state in which an organism functions normally only in the presence of a drug
o Manifests as a physical disturbance when the drug is withdrawn
Define Tolerance?
o A state in which an organism no longer responds to a drug
o A higher dose is required to achieve the same effect
What are the effects of Alcohol on the CNS?
o Potentiates GABA (inhibitory neuroT in the CNS)
o Inhibits Glutamate (excitatory neuroT in the CNS)
Outline the Pharmacokinetics of Alcohol?
o Absorption:
▪ Well absorbed at small intestine.
▪ Highly lipophilic
▪ Absorption is age related and can be delayed in the elderly
▪ Half life 6 – 30 hrs.
▪ Highly protein bound
o Distribution and metabolism:
▪ Extensively metabolised by the liver.
▪ Crosses BBB
▪ Particularly active in CNS ‘grey matter’ (high blood flow)
o Elimination:
▪ Excreted in the urine mainly in the form of its metabolites.
▪ Excreted as conjugates (glucuronide or sulphate).
▪ Nil biliary excretion.
How is Wernicke’s Encephalopathy Treated?
Treated with Pabrinex, (and thiamine)
How is Alcohol Withdrawal Treated?
TREAT WITHDRAWAL WITH BENZODIAZEPINES
What is the Primary Prevention to control STIs in the community?
o Primary prevention = reducing the risk of acquiring STI
▪ Awareness campaigns e.g. “Sex. Worth talking about”
▪ Vaccination e.g. HBV, HPV
▪ One to one risk reduction discussions
▪ “keys cash condom” poster
▪ Pre and post exposure prophylaxis
What are some Secondary Control Strategies to control STIs in the community?
o Secondary prevention = find and treat undetected cases of infection
▪ Easy access to STI/HIV tests/treatment
▪ Partner notification (contact tracing)
▪ Targeted screening:
* Antenatal screening for HIV and syphilis
* National chlamydia screening programma
* HIV home testing kds
What are some Tertiary Preventions of STIs?
o Tertiary prevention = reducing morbidity / mortality
▪ Antiretrovirals for HIV
▪ Prophylactic ABX for PCP
▪ Acyclovir for suppression of genital herpes
What are some complications of STIs in Women?
o Pelvic inflammatory disease
o Ectopic pregnancy
o Infertility
o Neonatal transmission
Why do some populations/religions carry out Female Genital Mutilation (FGM)?
o Seen as being ‘pure’
o Unable to marry without it being performed
What are complications of FGM?
o Bleeding
o Wound infection incl. tetanus, HIV, HBV
o Pain, death
o LUTS, period problems
o Anxiety
o PTSD
o Withdrawal
What are some Infective conditions that Migrants may present to their GP with?
o Hepatitis viruses
o TB
o Malaria
o HIV
o Parasitic infections
What are some mental health problems that War Refugees may Suffer with following immigration?
o PTSD
o Depression
o Suicidal thoughts, anxiety
o Somatisation e.g. chronic pain, dizziness, chronic fatigue, headache
What are some signs for Occupational Asthma?
o Typical history = improve away from work / when on holiday
o Peak flow diary
o Look for a dip of >20% when at work
o Workplace challenge testing
What are some Problems with Teamwork?
o Lack of teamwork
o Lack of leadership
o Lack of effort
o Lack of communication
o Lack of challenge
What is SBARR Communication?
o Situation
o Background
o Assessment
o Recommendation
o Response / review
Outline the tradition hierarchy of evidence, form top to bottom - it ranks how reliable different types of study design are
Systematic reviews/metanalysis
Randomised control trail
Cohort studies
Case control studies
Case series/reports
What is a meta analysis?
examination of data from a number of independent studies of the same subject, in order to determine overall trends.
” a study of studies”
What Do Antigenic Drift and Shift Cause?
- Antigenic drift → seasonal epidemics
- Antigenic shift → pandemics
What is the difference between an outbreak, Epidemic and Pandemic?
- Outbreak = 2+ linked cases
- Epidemic = more cases in a region or country
- Pandemic = spans international boundaries
What is the characteristic presentation of Influenza?
Influenza characterised by upper and lower RT symptoms + fever, headache, myalgia, weakness
What are the risk factors for Drug Use and Misuse?
o Quantity and frequency of use
o Knowledge of what they’re using e.g. strengths, purity etc
o Poly drug use
o Propensity for risky behaviour
o Co – existing problems e.g. mental and physical health, housing, employment, family
What are some side effects of drug misuse?
o Overdose and temporary psychotic states, unpredictable behaviour
o Sudden pyrexia, tachyC, coma
o Hallucination and vomiting
o Aggression and violence
o Intense comedown
What are some family risk factors for Drug Abuse?
o FHx of substance misuse
o Family management problems e.g. poor parenting
o Family conflict / domestic abuse
o Being in care
What are some Social/Community Risk factors for Drug Abuse?
o Low academic attainment and commitment
o Availability of drugs
o Community norms favourable to drug use
o Community disorganisation
o Transitions / mobility
o Low neighbourhood attachment
What are some individual Risk factors for Drug Abuse?
o Risk taking
o Rebelliousness
o Friends who use drugs
o Experience of trauma e.g. abuse, loss, poor parenting
What is Physical Dependence?
o The body adapts to presence of the substance and over time needs more for the same effect (tolerance)
o Stopping leads to withdrawal symptoms e.g. stomach cramps, muscle aches
What is Psychological Dependence?
o Feeling that life is impossible / challenges cannot be faced without the drug
o Emotional effect: feelings of fear, pain, shame, guilt, loneliness if not on drug
What are the features of the National Drug Strategy 2017?
o Reduce demand
o Restrict supply
o Building recovery in communities
o Family / community involvement
o Payment by results
o Abstinence focused with emphasis on recovery and peer support
Types of screening - outline the Seedhouse ethical grid
The Seedhouse grid is an ethical tool used by healthcare professionals to consider possible. actions to take when faced with a difficult situation.
It helps one explore the dilemma and. competing interests
Consits of four layers, each look at 4 difference categories of issues
Outline the first 2 inner layers of the seedhouse ethical grid
1st - whether the intervention is going to create autonomy, respect autonomy and treat all equally?
2nd - Duties and motives. Is the intervention consistent with moral duties; keeping promises, telling the truth, minimising harm and maximising benefit?
Outline the second outer 2 layers of the seedhouse ethical grid
3rd - Consequentialist layer. Is the intervention going to provide the greatest benefit for the greatest number? Who will benefit, society, individuals, a group?
4th Is the intervention likely to be affected by external considerations e.g. risks, law, use of resources
AMCL
What are the headings which make up the four quadrants approach to clinical ethical analysis?
Medical indications.
Patient preferences: respect for autonomy.
Quality of life.
Contextual features.
MP QC
What is the chain of Transmission?
Host → person to person spread → reservoir (soil, water, people) → portal of exit (coughing faeces) → agent → mode of transmission → portal of entry → host
