Public Health Flashcards

Question

Disadvantages of the corporate approach to health needs assessment

Answer 1

* May be difficult to distinguish need from demand * Groups may have vested interests (eg pharma companies, politicians, press) * May be influenced by political agendas * Dominant personalities may have undue influence

Answer 2

Emphasises the role of psychological factors in the cause, progression and consequences of health and illness

Answer 3

* Promoting healthy behaviours * Preventing illness

Answer 4

- Health behaviour; a behaviour aimed to prevent disease eg eating healthy - Illness behaviour; behaviour asimed to seek remedy eg going to the doctor - Sick role behaviour; any activity aimed at getting well eg taking prescribed medications, resting

Answer 5

Health Damaging/Impairing - eg smoking, alcohol abuse, sun exposure Health Promoting - eg taking exercise, healthy eating, medication complicance

Answer 6

Any 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 *Definition of family members includes people you have lived with but are not related to eg step family members

Answer 7

Duluth Model - Power and Control

Answer 8

*Injury is reported as unwitnessed by anyone else *Repeat attendance *Delay in seeking help *Multiple minor injuries not requiring treatment *Presenting between 7pm and 7am *Majority present with assault injuries

Answer 9

HARK - Humiliation; "In the last year, have you been humiliated or emotionally abused in other ways by your partner?" "Does your partner make you feel bad about yourself?" "Do you feel you can do nothing right?" - Afraid; "In the last year have you been afraid of your partner or ex-partner?" "What does your partner do that scares you?" - Rape; "In the last year have you been raped by your partner or forced to have any kind of sexual activity?" "Do you ever feel you have to have sex when you don't want to?" "Are you ever forced to do anything you are not comfortable with?" - Kick; "In the last year have you been physically hurt by your partner?" "Does your partner threaten to hurt you?"

Answer 10

Multi-Agency Risk Assessment Conference (MARAC) - In a single meeting, links up to date information about victims’ needs & risks directly to the provision of appropriate services & responses for all those involved: victim, children, perpetrator.

Answer 11

Independent Domestic Violence Advisor Service (IDVAS) - works primarily with victims who are at the highest levels of risk from domestic abuse in Sheffield, and helps them to increase their safety by providing: advocacy and advice around domestic abuse, safety planning, support through court proceedings, signposting to specialist services: housing, legal services, refuge provision and home safety services, a voice in the MARAC process.

Answer 12

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 the lessons to be learnt from the death. Age 16-17: SCR takes precedence; criteria include suicides.

Answer 13

Standard/Medium Risk - Give contact details for Domestic Abuse services, keep good records, ensure follow up as needed. High Risk - Refer to MARAC/IDVAS (local authority meeting - police, social care, GP, housing, probation etc, IDVAS is the independent advocate) in addition to the above, wherever possible with consent, can be done via helpline as well *However, for HIGH risk cases, you can break confidentiality to do so if you cannot get consent.

Answer 14

Strangling/Choking/Drowning - less likely to admit to these compared to other forms of harm like hitting Access to weapons - eg abuser works in police, w/ pesticides, soldier Suicidal intent in perpetrator - doesn't care about consequences when abusing as isn't planning to be around

Answer 15

When told about domestic abuse by patient - always acknowledge that that behaviour is wrong; doing nothing is perceived to be tacet acceptance Never tell them what to do (behaviourally) - they are treading a fine line and stepping outside of that may trigger a response from abuser, empower them instead to make safe and informed choices

Answer 16

Fentanyl - mainly metabolised by the liver so won't accumulate in the blood during renal failure (Buprenorphine will accumulate but to a lesser extent than the other opioids)

Answer 17

Naturally Occurring Compounds * Morphine * Codeine * Thebaine * Papaverine Semi-Synthetic Compounds * Diamorphine (heroin) * Dihydromorphone * Buprenorphine * Oxycodone Synthetic Compounds * Pethidine * Fntanyl * Methadone * Alfentanil * Remifentanil * Tapentadol

Answer 18

Amitriptyline - NNT = 5 Pregabalin - NNT = 7

Answer 19

No evidence that opioids help for chronic non-malignant pain beyond 3 months So review after 3 months and if no effect, stop it

Answer 20

Manage expectations when prescribing - say this will work for a short period of time but isn't a long term fix

Answer 21

* Constipation * Addiction * N+V * Endocrine (dampening down) - anterior pituitary hormone suppression * Immune suppression (dampening down not suppression) * Drowsiness * Respiratory depression + sleep disordered breathing - especially in combination with benzos, pregabalin etc, risk increased with obesity (OSA) and alcohol use ○ Patient may likely say that they are tired all the time (think anti-cholinergic burden) *Itch

Answer 22

Stimulant laxatives like senna and bisacodyl

Answer 23

* Sweating * Anxiety * Vomiting * Hallucinations * Jittering *Sneezing *Insomnia

Answer 24

* Use of pain medications other than for pain treatment * Impaired control (of self or of medication use) * Compulsive use of medication * Continued use of medication despite harm (or lack of benefit) * Craving or escalation of medication use * Selling or altering prescriptions * Stealing or diverting medications * Calls for early refills / losing prescriptions *Reluctance to try nonpharmacologic interventions.

Answer 25

* Age: High in younger and then decreases with age increases. * Marital Status: Highest in those cohabiting but not married. * Employment: Highest dependency in the unemployed. * Ethnicity: Highest rates in non white population. * General Health : Very bad health has a strong association. * Smoking : Association with smokers compared to non-smokers * Internet Pharmacy: High association between buying on the internet and dependency *No statistically significant association with opioid dependency and gender, education and alcohol use

Answer 26

* Physical Component ○ Eg injury ○ Brain tries to manage it itself * Psychological Component ○ Depression from being in pain all the time ○ Because it hurt yesterday it will hurt again today thought pattern * Environmental Component ○ Stress factors - eg anti-social environment (Shit life syndrome)

Answer 27

Allodynia - pain due to a stimulus that does not normally provoke pain Hyperalgesia - an increased sensitivity to feeling pain and an extreme response to pain

Answer 28

* There are three opioid receptors, MOR (µ), KOR(κ) and DOR(δ) * Opioid receptors are distributed throughout the central nervous system, to a lesser extent in the periphery, and also occupying sites within the vas deferens, knee joint, gastrointestinal tract, heart and immune system *The presynaptic action of opioids inhibiting neurotransmitter release is considered to be their major effect in the nervous system.

Answer 29

Analgesia for short term pain relief eg post operative pain

Answer 30

* It is crucial that the potential benefits and potential risks are discussed with the patient. * Side effects resulting from continuing use of opioids may include tolerance, withdrawal, weight gain, reduced fertility and irregular periods, erectile dysfunction, hyperalgesia, depression, dependence, addiction, reduced immunity, osteoporosis and constipation. *There is a variety of evidence regarding misuse of these medicines and this should be considered particularly when prescribing to at risk patients. Consider non pharmacological measures: *Physical - eg weight loss, smoking cessation, exercise/physio *Psychological - counselling, CBT, meditation etc *CT - massage reflexology *Occupational - work place based review Consider pharmacological interventions: * Non-opioid analgesics - NSAIDs, COX-2 inhibitors, paracetamol * Opioid analgesics - intermittent usage/slow and low * Adjuvant analgesics - anti-convulsants, antidepressants, lidocaine patches

Answer 31

Duloxetine

Answer 32

Health Belief Model (HBM) Theory of Planned Behaviour (TPB) Stages of Change/Transtheoretical Model (TTM) Social Norms Theory Motivational Interviewing Nudging (Choice Architecture)

Answer 33

Despite growing interest in their use, mixed patterns of results reported Single unifying theory has yet to be developed Other factors need to be considered eg impact of past behaviour/habit, automatic influences on health behaviour

Answer 34

* Believe they are susceptible to the condition in question (e.g. heart disease) * Believe that it has serious consequences * Believe that taking action reduces susceptibility * Believe that the benefits of taking action outweigh the costs

Answer 35

Unique to HBM Can be internal or external cues Not always necessary for behaviour change

Answer 36

* Alternative factors may predict health behaviour, such as: ○ Outcome expectancy (whether the person feels they will be healthier as a result of their behaviour) ○ Self-efficacy (the person’s belief in their ability to carry out preventative behaviour) * As a cognitively based model, HBM does not consider the influence of emotions on behaviour * HBM does not differentiate between first time and repeat behaviour * Cues to action are often missing in HBM research

Answer 37

Proposes the best predictor of behaviour is ‘intention’ e.g. I intend to give up smoking Intention determined by: ○ A persons attitude to the behaviour ○ The perceived social pressure to undertake the behaviour, or subjective norm *A persons appraisal of their ability to perceived behavioural control Rational choice model - attitude, subjective norms, percieved behavioural control

Answer 38

* Perceived control – Fisher & Johnson (1996) patients with chronic back pain took part in a lifting task. Recalled success predicted success in the task * Anticipated regret – Abraham & Sheeran (2003) increased anticipated regret was related to sustained intentions * Preparatory actions – Stock & Cervone (1990) dividing a task in to sub-goals increases self-efficacy and satisfaction at the point of completion * Implementation intentions – Gollwitzer (1999) “if-then” plans facilitates the translation of intention in to action (specify a time and a context) * Relevance to self

Answer 39

* Criticisms include the lack of a temporal element, and the lack of direction or causality (Schwarzer, 1982) * TPB is a “rational choice model”. Doesn’t take in to account emotions such as fear, threat, positive affect, all of which might disrupt “rational” decision making * Model does not explain how attitudes, intentions and perceived behavioural control interact * Habits and routines - which Simon (1957) referred to as “procedural rationality” - bypass cognitive deliberation and undermine a key assumption of the model * Assumes that attitudes, subjective norms and PBC can be measured * Relies on self-reported behaviour

Answer 40

* Stage theories see individuals located at discrete ordered stages, rather than on a continuum * Each stage denotes a greater inclination to change outcome, typically behaviour, than the previous one * 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 Transtheoretical model, or stages of change model (Prochaska & DiClemente, 1984)

Answer 41

Proposes 5 stages of change (with smoking cessation example): 1) Precontemplation - No intention of giving up smoking 2) Contemplation - Beginning to consider giving up, probably at some ill-defined time in the future 3) Preparation - Getting ready to quit in the near future 4) Action - Engaged in giving up smoking now 5) Maintenance - Steady non-smoker, i.e. state of change reached *Progress = travelling up from 1 onwards **Relapse = travelling down

Answer 42

Advantages * Acknowledges individual stages of readiness (tailored interventions) * Accounts for relapse * Temporal element (although arbitrary) Critiques * Not all people move thorough every stage, some people move backwards and forwards or miss some stages out completely * Change might operate on a continuum rather than in discrete stages * Doesn’t take in to account values, habits, emotions, culture, social and economic factors * People often change their behaviour in the absence of planning/ intentions can change over a very short time period

Answer 43

A counselling approach for initiating behaviour change by resolving ambivalence (having mixed feelings/contradictory ideas about something) A meta-analysis did not support efficacy for smoking or HIV-risk behaviour, however clinical impact shown in problem drinkers

Answer 44

* ‘Nudge’ the environment to make the best option the easiest –e.g. opt-out schemes such as pensions, placing fruit next to checkouts * To date, few nudging interventions have been evaluated for their effectiveness in changing behaviour in general populations and none has been evaluated for its ability to achieve sustained behaviour change. * At present, the evidence to support the view that nudging alone can improve population health is weak (Marteau, 2011)

Answer 45

Perceptions of norms ○ Is the perception of peer norms the same as the actual peer norms - people misperceive the norms among their peers ○ Norm is positive protective behaviours ○ We typically overestimate the risk behaviour activity and underestimate the protective factors *Eg university students thinking that the majority of students use cocaine when in reality its 5% (exact figures not relevant) * "If I think everyone else is doing it, even if I think it is wrong, I will do it to be like everyone else" * Let people know and promote what the majority are doing and that it is a healthy behaviour that is the social norm

Answer 46

* That it meets the needs of everyone * That it is free at the point of delivery * That it is based on clinical need, not ability to pay

Answer 47

* The preventable, unfair and unjust differences in health status between groups, populations or individuals * Arise from the unequal distribution of social, environmental and economic conditions within societies * Determine the risk of people getting ill, their ability to prevent sickness, or opportunities to take action and access treatment when ill health occurs.

Answer 48

The principle that the availability of good medical or social care tends to vary inversely with the need of the population served (Julian Tudor Hart 1971)

Answer 49

* Homeless * Gypsies and Travellers * Asylum Seekers * LGBTQ * Ex prisoners * Care leavers * Those with learning disabilities * Those with mental health problems

Answer 50

Asylum Seeker - A person who has made an application for refugee status Refugee - A person granted asylum and refugee status. Usually means leave to remain for 5 years then reapply Indefinite Leave to Remain (ILR) - When a person is granted full refugee status and Given permanent residence in the UK

Answer 51

* Is someone who has crossed an international border in search of safety and refugee status * Is applying for asylum in his/her own right * Is under the age of 18, or in the absence of documentary evidence appears to be under that age * Is without adult family members or guardians in this country

Answer 52

Entitled to: ○ Money- currently £37.75 per week ○ Housing- no choice dispersal ○ Free NHS care If under 18, have the services of a social services key worker and can go to school ○ NOT allowed to work *NOT entitled to any other form of benefit

Answer 53

* Have five years leave to remain in the UK * Have the right to work and claim benefits * Access to mainstream housing * Can apply for family reunion * Can apply for a travel document After five years of refugee status: * Can apply for Indefinite Leave to Remain (ILR), and after a year of ILR can apply for British citizenship

Answer 54

* NOT entitled to any money * NOT housed * NOT entitled to full NHS care (only emergency care) * Reliant on charities * Maybe able to appeal the decision * Maybe detained in an immigration removal centre

Answer 55

The movement of people, by means such as force, fraud, coercion or deception, with the aim of exploiting them * It is modern day slavery

Answer 56

* Sexual exploitation - prostitution * Domestic servitude - cleaning, cooking, looking after children * Forced labour - agriculture, construction, kitchens, car wash, nail bars, factories * Forced criminality - forced begging, illegal drugs, benefit frauds

Answer 57

TRAFFICKING * Timid/terrified/tense * (not) Registered with GP/nursery/school * Accompanied by a controlling person * Foreign language * Frequently moving location * Inconsistent history * (No) Control of passport/bank account * Keep alert! * Evidence of injuries left untreated * DNA future appointments

Answer 58

National Referral Mechanism