Public Health Flashcards
Describe 3 coronial legislations
Coroners Act 1988:
- Allow coroner to order an autopsy where death is likely due to natural causes. No power for coroner to authorise further investigations.
- Allow coroner to order an autopsy where death is clearly unnatural. Can authorise special investigations
Amendment Rules 2005:
- Pathologist must tell coroner what materials have been retained.
- Family has choice to decide whether materials are returned or retained for research/disposed respectfully
- Coroner authorises retention and sets disposal date.
- Autopsy report must declare retention and disposal.
Coroners and Justice Act, 2009
- Coroner can now defer opening the inquest and instead launch an investigation.
- Inquests now have conclusions, not verdicts.
What is the Human Tissue Act 2004?
- Autopsies are only to be performed on licensed premises
- Consent from relatives for ANY use of tissue retained at autopsy if not subject to coronial legislation or retained for criminal justice purposes
- Public display requires consent from the diseased
Give 2 disadvantages of patient compliance?
- It is passive, the patient MUST follow the doctor’s orders.
- It is professionally focused and assumes the doctor knows best.
Define patient adherence.
The extent to which the patient’s actions match agreed recommendations. It is more patient centred.
What is the difference between patient compliance and adherence?
Patient adherence is more patient centred, it empowers patients and considers them as equals in care. Patient compliance is often viewed as uncaring, condescending and passive.
Give examples of non-adherence
- Not taking prescribed medication
- Taking bigger/smaller doses than prescribed
- Taking medication more/less often than prescribed
- Stopping the medicine without finishing the course
- Modifying treatment to accommodate other activities (work, social)
- Continuing with behaviours that go against medical advice (smoking, drinking)
Reasons for non adherence
Unintentional:
- difficulty understanding instructions
- poor dexterity
- inability to pay
- forgetting
Intentional:
- patient’s beliefs about their health/condition
- beliefs about treatments
- personal preferences
Describe the necessity-concerns framework.
The necessity-concerns framework looks at what influences adherence. Adherence increases when necessity beliefs are high and concerns are low.
Give 2 factors that patient centred care encourages?
- Focus on the patient as a whole person; holistic.
- Shared control of the consultation, decisions are made by the patient and doctor together.
Give 4 advantages of doctor-patient communication.
- Better health outcomes.
- Higher compliance to therapeutic regimens.
- Higher patient and clinician satisfaction.
- Decrease in malpractice risk.
What is concordance?
An extension of principles of Patient Centred Medicine. Concordance is the expectation that patients will take part in treatment decisions and have a say in the consultation; it is a negotiation between equals.
Barriers to patient centred communication.
For Patients:
- Patients might not want to engage in discussion with their doctor.
- Research indicated that in some cases it might increase worry.
- Patients may simply want the doctor to tell them what to do, where medical decisions were complex or based on complicated statistical risks
Health Professional:
- Relevant communication skills
- Time/resources/organisational constraints
- Challenging – patient choice V Evidence
Ethical considerations: in which patient groups may there be ethical considerations when taking a patient centred approach and shared decision making approach?
- Mental Capacity - Mental Capacity Act (2005) e.g. dementia, severe learning disability, brain injury, mental health condition
- Decision that may be detrimental to a patient’s wellbeing
- Potential threat to the health of others (e.g. infections diseases)
- When the patient is a child:
3rd party (parents/guardians)
- When can children take responsibility for their treatment?
- Should more weight be given to the parents’ wishes or the child’s?
- What if the parent, child, and doctor all disagree?
What is the Public Health Act?
The Public Health Act (Health Protection Regulations 2010) provides a legal basis to detain and isolate an infectious individual. It allows for persons who have category 4 or 5 infections diseases to be brought to a specified place for isolation if they pose a serious public health risk to others and if all other reasonable efforts to support treatment have failed.
What does Section 1 of the Children Act 1989 state?
- Where a child is of sufficient understanding, medical treatment (including examination) may only be given with the child’s consent.
- It is for the Doctor to decide whether the child can give consent. Where the child is not of sufficient understanding a parent, or person with parental responsibility, may consent.
- Children capable of providing consent cannot be examined if they refuse that consent.
- If there is a dispute the matter should be put before a Court.
A 50 year old patient found to be at increased risk of cardiovascular disease mentions at a routine GP check-up that they have not been taking the statin prescribed at their last visit. The patient comments that they are “not anti-medication” but “feel fine without it”.
What seems to be the most pertinent reason for this non adherence?
Necessity beliefs about medication
Mortality difference between sex.
In the UK women generally live longer than men.
What kind of implications does masculinity have in health?
- Different risk behaviours
- Reluctance to seek help when ill
- Employment conditions more likely to be dangerous
What kind of implications does femininity have in health?
- women’s social responsibility is for ‘care’ and includes maintaining the family’s health
- Social status and access to material resources
- Feminization of poverty
What should doctors do if there is a suspected case of meningitis?
ALL CASES OF SUSPECTED MENINGITIS ARE NOTIFIABLE AND MUST BE NOTIFIED WITHOUT DELAY
Notifiable disease (Public Health Act, 1984)
Notify your regional UKHSA health protection team of
Meningitis (any cause)
Meningococcal septicaemia
Notify on suspicion – don’t wait for laboratory confirmation as public health action needed ASAP to prevent further cases!
When seeing adverse drug reactions, how should you respond?
Report to MRHA using the yellow card system
Which of the following ADRs should be reported via the Yellow Card reporting scheme?
a) Mild leg swelling caused by amlodipine
b) Dry mouth with Anoro inhaler - Black triangle
c) Suicide attempt by patient newly started on sertraline
d) Haemorrhagic stroke in patient taking warfarin
e) Nausea with ferrous sulphate
b) Dry mouth with Anoro inhaler - Black triangle
c) Suicide attempt by patient newly started on sertraline
d) Haemorrhagic stroke in patient taking warfarin
What four pieces of information is needed to fill in a Yellow Card?
Suspected drug(s)
Suspected reaction(s)
Patient details (initials, Hosp/NHS number)
Reporter details
When there is a confirmed or probable case of meningitis what is the first thing we should identify?
Identify close contacts
* People living in the same household as the case
* Anyone who slept overnight in the same household as the case in previous 7 days
* Other household members if case stayed overnight elsewhere in previous 7 days
* Intimate kissing contacts in last 7 days
If meningitis is suspected what should be given to close contacts?
Chemoprophylaxis
Antibiotics given to eradicate throat carriage
Ciprofloxacin (recommended for all age groups and in pregnancy)
single dose
doesn’t interact with oral contraceptives
readily available
Rifampicin (alternative)
In the case of delayed reporting of meningitis, how long before you stop offering treatment to close contacts?
Offer prophylaxis to household contacts up to 4 weeks after case became ill
Offer appropriate vaccine to unvaccinated close contacts (within a week)
What further public health action should be given when there is a case of meningitis?
Contact school/nursery/university etc
Standard letter to warn and inform
Customised letter if unusual circumstances e.g. death
Offer leaflets e.g. Meningitis Trust
https://meningitis-trust.org.uk/
Offer information/support/helpline
Media handling
What is WHO’s strategy to resolve meningitis by 2030?
- Elimination of bacterial meningitis epidemics
- Reduction of cases of vaccine-preventable bacterial meningitis by 50% and deaths by 70%
- Reduction of disability and improvement of quality of life after meningitis due to any cause
WHO strategy is to mass vaccinate in the event of an epidemic
What are the three types of meningitis vaccines?
Polysaccharide vaccines
Conjugate vaccines
Meningitis B vaccine
What is the routine meningococcal vaccine schedule for UK children?
8 weeks - Primary
16 weeks - Primary
One year - Primary (MenC) & Booster (Hib)
14 years - Primary (MenAWY) & Booster (MenC)
What is primary and secondary vaccine failure?
Primary vaccine failure – person doesn’t develop immunity from vaccine.
Secondary vaccine failure – initially responds but protection wanes over time.
What diseases are not infectious but notifiable?
STIs
- HIV
- Hepatitis B
Why is diabetes a key health issue?
- Mortality
- Disability
- Co-morbidity
- Reduced quality of life
- Preventable but increasing in prevelance
List 4 things we can do to reduce the impact of type 2 diabetes?
- Identifying people at risk of diabetes
- Preventing diabetes (“Primary” prevention)
- Diagnosing diabetes earlier (“Secondary” prevention)
- Effective management and supporting self-management (“Tertiary” prevention)
Examples of the obesogenic Environment?
Physical environment: eg TV remote controls, lifts, “car culture”
Economic environment: eg cheap TV watching, expensive fruit and veg
Sociocultural environment: eg safety fears, family eating patterns
Mechanisms that maintain overweight
Physical/physiological - more weight = more difficult to exercise (arthritis, stress incontinence) and dieting -> metabolic response
Psychological - low self-esteem and guilt, comfort eating
Socioeconomic - reduced opportunities employment, relationships, social mobility
