Public health Flashcards
1
Q
What is population perspective?
A
The population perspective is a preventive approach that targets the broad distribution of diseases and health determinants in a defined population.
2
Q
When considering the population perspective, what should be addressed?
A
- Diagnosis + treatment
-Causes of ill health
-Policies and strategic plans
-Commission services
3
Q
What are the 4 determinants of health?
A
- genes
- Environment (physical, social,economic)
- Lifestyle
4.Healthcare
4
Q
What is Equity?
A
What is fair and just
5
Q
What is equality?
A
Concerned with equal shares
6
Q
What is horizontal equity and give an example?
A
Equal treatment for equal need- individuals with pneumonia should be treated equally
7
Q
What is vertical equity and give an example?
A
Unequal treatment for unequal need - Areas with poorer health need higher expenditure on health services
- Individuals with common cold vs pneumonia need unequal treatment
8
Q
What are the different forms of health equity?
A
- Equal expenditure for equal need
- Equal access for equal need
3.Equal health
4.Equal utilisation for equal need - Equal healthcare outcome for equal need
9
Q
What are the dimensions of health equity?
A
Spatial - geographical
social- age, gender, ethnicity, class
10
Q
What factors should be considered when examining health equity?
A
- supply of healthcare
2.Access to healthcare
3.Utilisation of healthcare
4.Healthcare outcomes - Health status
6.Resource allocation - Wider determinants of health
11
Q
What are the wider determinants of health?
A
- diet
- smoking
- Healthcare seeking behaviour
4.Socioeconomic and physical environment
12
Q
How is health equity assessed?
A
Typically assess inequality then judge if unequitable BUT equality may not be equitable
13
Q
What are the 3 domains of public health?
A
- Health improvement
- Health protection
3.Healthcare
14
Q
What is health improvement?
A
Societal interventions aimed at preventing disease, promoting health and reducing inequalities.
- housing
-education
-lifestyle
-employment
-family/community
15
Q
What is health protection?
A
Concerned with the measure to control infectious disease risks and environmental hazards
- infectious disease
-radiation
-chemical/poisons
-emergency response
-environmental health hazard
16
Q
What is healthcare?
A
Concerned with the organisation, and delivery of safe high quality services for prevention, treatment and care
- clinical effectiveness
-audit and evaluation
-clinical governance
-efficiency
-service planning
-equity
17
Q
What are the levels of public health?
A
- individual
- community
- Ecological
18
Q
What is health psychology?
A
Health psychology emphasises the role of psychological factors in the cause, progression and consequences of health and illness
- promotes healthy behaviour and prevents illness
19
Q
What are the 3 health behaviours?
A
- health behaviour
- illness behaviour
- sick role behaviour
20
Q
What is health behaviour?
A
Behaviour that aims to prevent disease
21
Q
What is illness behaviour?
A
Behaviour that aims to seek remedy
22
Q
What is sick role behaviour?
A
Any activity aimed to get well
23
Q
What are two other behaviours that health behaviours are defined as?
A
- Health damaging/ impairing - smoking
- Health promoting - exercise
24
Q
What are the top two reasons for absence from work?
A
Musculoskeletal issues
Depressive disorders
25
What lifestyle factors increase the risk of mortality over 15 years?
- smoking
-physical activity
-Alcohol
-diet
26
What is intervention at a population level?
Health promotion - the process of enabling people to exert control over the determinants of health
27
What is the individual level of intervention?
-patient centered approach
-care responsive to individual needs
28
What are examples of health promotion ?
- promoting screening nd vacines
-5 a day campaign
-every mind matters
29
The concept of ‘unrealistic optimism’ suggests that perception of risk can be influenced by several factors. List 4 factors.
1. lack of personal experience with problem
2.Belief that preventable by personal action
3. Belief that if not happened by , it's not likely too
4. Belief that problem infrequent
30
Explain the concept of ‘unrealistic optimism’ as applied to Health behaviours.
Individuals continue to practice health damaging behaviour due to inaccurate perceptions of risk + susceptibility.
31
Why do we engage in damaging health behaviours?
Unrealistic optimism
Health beliefs
Situational rationality
Cultural variability
Socioeconomic factors
Stress
Age
32
NICE has provided guidance on behaviour change. What factors are involved in this guidance?
Plan interventions
Assess social context
Education + training
Individual level interventions
Community level interventions
Population interventions
Evaluating effectiveness
Assessing cost-effectiveness
33
What is the economic impact of smoking?
5.5% of the NHS’ total costs
Loss in productivity from smoking breaks
Cleaning up cigarette butts costs money
Cost of fires = £507m
34
What factors are involved in the planning circle?
-Needs assessment
-Planning
-Implementation
-Evaluation
35
What is Need (public health)?
The ability to benefit from an intervention
36
What is demand (public health)?
What people ask for
37
What is supply (public health)?
What is provided
38
What is a health needs assessment?
A systematic method for reviewing health issues facing a population, leading to agreed priorities and resource allocation that will improve health and reduce inequalities.
39
What is health need?
- Need for health
- concerns need in more general terms
- measured using mortality, morbidity, sociodemographic measures
40
What is healthcare need?
- Need for healthcare
-More specific than health need
-Ability to benefit from healthcare
-Depends on the potential of prevention, treatment and care services to remedy health problems.
41
What is a healthcare needs assessment carried out for?
- A population or subgroup
-A condition
- An intervention
42
Who defines need?
- individuals
-family
-community
-professionals
-society
43
What ways are the HCA approached?
1. sociological perspective
2.Public health perspective
44
What 4 factors comprise the Sociological perspective in terms of the Health Needs Assessment?
Felt need: individual perceptions of variation from normal health
Expressed need: individual seeks help to overcome variation in normal health (demand).
Normative need: professional defines intervention appropriate for the expressed need.
Comparative need: comparison between severity, range of interventions + cost.
45
Which 3 factors comprise the Public Health Approach to the Health Needs Assessment?
Epidemiological
Comparative
Corporate
46
What is the epidemiological approach?
- define problem
-size of problem - incidence/prevalence
-Services available - prevention/ treatment care
-Recommends improvements
47
What are the disadvantages of the epidemiological approach?
Data available may be poor
May be inadequate evidence base
Doesn’t consider felt need
48
What is the comparative approach?
Compares health performance/ services across one population to another
49
What are the disadvantages of comparative approach?
Data available may vary in quality
May be hard to find comparable population
Comparison may not be perfect
50
What is the corporative approach?
Takes into account views of any groups that may have an interest eg patients, health professionals, media, politicians
51
What are the disadvantages of the corporate approach?
- Difficult to distinguish need from demand
-Groups may have vested interest
- Dominant individuals may have undue influence
52
Who should do the HNA?
- primary care staff
-public health staff
-health visitors
-community workers
53
What are the benefits of a health needs assessment?
1. strengthening community involvement in decision making
2. improved public participation
3. improved team and partnership working
4. better use of resources
5. Development of skills
54
What are the challenges of health needs assessment?
1. lack of shared language between sectors
2. Difficulty assessing target population
3. Professional boundaries may prevent power and information sharing
55
What is the definition of domestic abuse?
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
56
Give 3 ways in which domestic abuse impacts on health.
Traumatic injuries following an assault
eg. fractures, miscarriages, facial injuries, puncture wounds, haemorrhages
Somatic problems or chronic illness consequent of living with abuse
eg. Chronic pain, low birthweight, premature delivery
Psychological / psychosocial problems secondary to abuse
eg. PTSD, attempted suicide, substance misuse, depression, anxiety, eating disorders
57
If a patient is considered to be at ‘standard’ risk with regards to Domestic Abuse, what does this mean?
Current evidence does not indicate likelihood of serious harm being caused.
58
If a patient is considered to be at ‘medium’ risk with regards to Domestic Abuse, what does this mean?
There are identifiable indicators of risk of serious harm
- offender has the potential to cause serious harm, but unlikely unless change in circumstances.
59
If a patient is considered to be at ‘high’ risk with regards to Domestic Abuse, what does this mean?
There are identifiable (risk factors) indicators of imminent risk of serious harm
Dynamic: harm could happen at any time + the impact would be serious.
60
Which risk assessment is used for Domestic Abuse?
DASH Tool:
Domestic Abuse, Stalking, Harassment + ‘Honour’ based violence
61
What is the risk assessment for domestic abuse designed to do?
Questionnaire used to identify + assess risk of DASH
- Such that measures can be put in place to protect the patient + any children who might be at risk.
62
If a person is considered to be ‘standard’ or ‘medium’ risk with regards to Domestic Abuse, what should you do?
Give contact details for domestic abuse services
National Helpline is 24hrs
Sheffield Helpline: Mon-Fri 9-5
63
If a patient is considered to be ‘high risk’ of domestic abuse, what action should you take?
Refer to MARAC (Multi-Agency Risk Assessment Conference) -> wherever possible, with consent
Refer to IDVA (Independent Domestic Violence Advisors)
64
How might domestic abuse affect a child?
Affects physical + psychological health + well being
- Long term impact on self esteem, education, relationships, stress responses
65
What is the link between child abuse + domestic abuse?
Domestic abuse often starts / escalates during pregnancy.
* Always consider safeguarding responsibilities.
66
What is your role in the management of domestic abuse?
Display helpline posters
Focus on patient’s safety (+ child’s safety, if applicable)
Work with other agencies + professionals
67
What are the ‘best’ indicators in identifying domestic abuse when taking a history in A+E?
Reported as ‘unwitnessed by anyone else’
Repeat attendance
Delay in seeking help
Multiple, minor injuries not requiring treatment
Always consider domestic abuse as a cause.
68
What should you not do if someone discloses domestic abuse to you?
Assume someone else will take care of things
Ask about domestic abuse in front of family members (including kids!!!!!)
Tell them what to do -> aim to empower them to make safe + informed choices.
69
What is ‘MARAC’ and what does it do?
Multi-Agency Risk Assessment Conference
links up-to-date information about victims’ needs + risks directly to the provision of appropriate services for all those involved
incl. victim, child(ren), perpetrator
70
What is ‘IDVA’ and what do they do?
Independent Domestic Violence Advisors:
Aim to increase patient’s safety by providing:
- advocacy + advice around domestic abuse
- safety planning
- support through court proceedings
- sign posting to specialist services
71
What specialist services might an IDVA sign post victims of domestic abuse to?
Housing services
Legal services
Refuge provision + home safety services
a voice in the MARAC
72
When would a Domestic Homicide Review be undertaken?
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 lessons to be learned from the death.
73
What are the HARK questions?
The four HARK questions were developed as a framework for helping identify people who have suffered domestic abuse, and found to be a sensitive tool.
- Humiliation
-Afraid
-Rape
-Kick
74
What percentage of injured women in the A&E department are caused by physical abuse from partners?
20-30%
75
Give 4 models of behaviour change
Health Belief Model
Theory of planned behaviour
Transtheoretical Model
Motivational interviewing
76
Explain the theory behind the Health Belief Model (a theory of behaviour change).
Individuals will change if they believe:
they are susceptible to the condition
that the disease has serious consequences
that taking action reduces susceptibility
that the benefits of taking action outweigh the costs.
77
Critique the Health Belief Model.
- Alternative factors may predict health behaviour
- HBM doesn’t consider the influence of emotions on behaviour
-HBM doesn’t differentiate between 1st time and repeat behaviour
78
Give a summary of the Health Belief Model.
Longest standing model of behaviour change
Successful for a range of health behaviours eg. breast self-examination, vaccinations, diabetes Mx etc.
> perceived barriers have been demonstrated to be the most important factor for addressing behaviour change in patients.
79
Explain the ‘Theory of Planned Behaviour’. (What is intention determined by)
Proposes the best predictor of behaviour is ‘intention’
Intention is determined by:
> a person’s attitude to the behaviour
> the perceived social pressure to undertake the behaviour, or “subjective norm”
> a person’s appraisal of their ability to perform the behaviour, or their perceived behavioural control.
80
What are the advantages of theory of planned behaviour?
-Can be applied to wide variety of health behaviours
-Useful for predicting intention
-Takes into account importance of social pressures
81
What are the disadvantages of theory of planned behaviours?
- No temporal element, direction or causality
-Doesn't consider emotions
-Assumes attitudes can be measured
82
Give 3 advantages of the transtheoretical model / ‘Stages of Change’ model
Acknowledges individual stages of readiness (tailored interventions)
Accounts for relapse
Temporal element (although arbitrary).
83
Give 3 disadvantages of the transtheoretical model / stages of change model.
Not all people move through every stage. Some relapse. Some miss out stages completely.
Change might operator on a continuum, rather than in discrete stages
Doesn’t take into account values, habits, culture, social + economic factors
84
Summarise the transtheoretical model / stages of change model.
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.
85
What is the pathophysiology of chronic pain?
- Physical component
- Psychological component
- environmental component
- sensation – allodynia/hyperalgesia
86
What are the naturally occurring compound opioids?
- morphine
-codeine
-Thebine
-papaverine
87
What is the mechanism of actions of opioids?
- 3 opioid receptors, MOR, KOR,DOR
- Opioid receptors are distributed throughout the CNS, to a lesser extent in the periphery, and occupies sites within the vas deferens, knee joint, GI tract, heart and immune system.
- The presynaptic action of opioids inhibiting neurotransmitter release is considered to be their major effect in the nervous system
88
What are the positive effects of opioids?
- can be administrated orally, transdermally, intrathecally
- clinical significant reduction in pain
89
What are the negative effects of opioids?
- Effects on the body
- addiction and misuse
-renal failure
-withdrawal symptoms
- respirator depression
90
What are the side effects of continuing use of opioids?
tolerance, withdrawal, weight gain, reduced fertility, irregular periods, ED, hyperplasia, depression, dependence, addiction, reduced immunity, osteoporosis, constipation
91
What are non pharmacological ways to treat chronic pain?
- weight loss, smoking cessation, physiotherapy, exercise
-counselling
-massage
92
What is the pharmacological ways to treat chronic pain?
Non Opioid Analgesics: NSAIDs, Cox- 2 inhibitors, paracetamol.
Opioid Analgesics: Intermittent usage / slow and low.
Adjuvant Analgesics: Anti-convulsants, antidepressants, lidocaine patches.
93
What are the sings of abuse and dependency?
*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 lack of benefit
*Craving or escalation of medication use
*Selling or altering prescriptions
94
What are the key associations with opioid dependency?
- Age: Higher in younger
- Highest dependency in unemployed
- Highest rates in non-white population
- Bad health
95
What is malnutrition?
Deficiencies, excesses, or imbalances in a person’s energy and or nutrient intake
96
Which chronic medical conditions require nutritional support?
* Cancer
* Cystic Fibrosis
* Coeliac disease
* Inflammatory bowel diseases
* Type 1 Diabetes Mellitus – “diabulimia”
* Type II Diabetes
* Faltering growth (Failure to thrive)
* Eating disorders
97
What are the consequences of undernutrition?
*Stunting: low height for age
*Wasting: low weight for height
*Underweight: low weight for age
*Micronutrient deficiencies / insufficiencies -> a lack of important vitamins + minerals.
98
What are the early influences on feeding behaviour?
*Maternal diet + taste preference development
*Breast feeding -> for taste preference + body weight regulation
*Parenting practices
*Age at introduction of solid food
99
How does a maternal diet lead to early flavour exposure for the baby in the uterus?
*Baby’s taste + olfactory systems can detect flavour information prior to birth
*Amniotic fluid + human milk transmits volatiles from the maternal diet, providing early chemosensory experience.
100
What are the components of breast milk?
colostrum/ foremilk/ hindmilk
101
What are the benefits of breast feeding?
1.Anti-infective: bifidus factor, white cells, oligosaccharides
2.Efficient digestion: contains enzymes eg. lipase, lysozyme
3.Gut protection:
- epidermal growth factor
- secretory IgA
- anti-inflammatories
4.Everyday health: Antibodies, viral fragments, lactoferrin (aids dental hygiene.
102
What is the parental influence on positive feeding behaviours?
*Modelling ‘healthful’ eating behaviours
*Responsive feeding: recognizing hunger + fullness cues
*Providing a variety of foods
*Avoid pressure to eat
*Not using food as a reward
*Indulgent / neglectful feeding practices.
103
What is chemical continuity?
Transmission of certain flavours from the maternal diet via amniotic fluid + then breast milk.
104
What is an eating disorder?
Clinically meaningful behavioural or psychological pattern having to do with eating or weight that is associated with distress, disability, or with substantially increased risk of morbidity or mortality.
105
What are the types of eating disorders?
* Anorexia nervosa
* Bulimia nervosa
* Binge eating disorder
106
What is disordered eating?
Restraint, strict dieting, disinhibition, emotional eating, binge eating, night eating, weigh + shape concerns, inappropriate compensatory behaviours that do not warrant a clinical diagnosis.
107
What are the types of dieting?
1.Restrict the total amount of food eaten
2.Do not eat certain types of food
3.Avoid eating for long periods of time
108
What are the problems with dieting?
1.Dieting is a risk factor for developing eating disorders
2.Dieting results in a loss of lean body mass, not just fat mass.
3.Dieting slows metabolic rate + energy expenditure
4.Chronic dieting may disrupt ‘normal’ appetite responses + increase subjective sensations of hunger.
109
What is the externality theory of obesity?
*Normal weight individuals responsive to internal homeostatic cues.
*Overweight individuals eat according to:
> external cues
> no compensation after preload
> time of day
> often lurid descriptions of desserts
> sensory food cues.
BUT the theory is too general
110
What is restrained eating?
The deliberate attempt to inhibit food intake in order to maintain or to lose weight.
- effortful, cognitively demanding process: ignore feelings of hunger in order to adhere to self-imposed dietary rules.
Under certain circumstances, restrained eaters can be induced to overeat -> ‘disinhibition’
-> “what the hell” effect: inability to maintain cognitive control of food intake
111
What is the restraint theory?
*Unrestrained eaters are intuitive + regulate food intake without conscious effort.
*Restrained eaters rely on consciously controlled processes to regulate food intake.
*Break down of dietary restraint leads to ‘what the hell’ cognitions
112
What are some critiques of restraint theory?
*Suggests a link between food restriction + over-eating
*Dieters, bulimics, anorexics report episodes of over-eating.
*Theory cannot explain restricting behaviour in anorexics
113
Why are some dieters more successful?
*Some people are more ‘flexible’ than ‘rigid’ in their dietary restraint -> results in decreased pre-occupation with food, decreased attentional bias to food cues -> longer term weight loss.
114
What is the goal conflict theory?
*Chronic dieters experience conflict between 2 incompatible goals: eating enjoyment vs weight control
*Individuals are motivated to pursue a weight loss goal.
HOWEVER, pervasive food cues in the environment prime the goal of food enjoyment (“external eating”).
115
What is the portion size effect?
Consumption of large portion sizes of energy dense (ED) food facilitates over consumption.
In the absence of compensatory effects, large portions of energy dense food may be contributing to the increased prevalence of overweight + obesity.
116
What is the evidence behind portion size effect?
*Associated with sustained increase in energy intake over several days without energy compensation.
*Evidence for individual + socioeconomic influences
*Most people don’t know what constitutes an appropriate portion size for many foods + beverages.
117
What are the dimensions of food security?
1. Availability of food
2. Access
3. Utilisation
4. Stability
118
Why is dieting so difficult for some patients?
Those susceptible to obesity (and who try to diet) appear particularly:
I) unresponsive to internal cue that signal satiety (when overconsuming) + hunger (when dieting)
ii) vulnerable to external cues that signal availability of palatable food.
119
What are the NHS core principles?
1. Meets the needs of everyone
2. Free at the point of delivery
3. Based on clinical need, not ability to pay
120
What is health inequality?
The preventable, unfair and unjust differences in health status between groups, populations or individuals that arise from unequal distribution of social, environmental and economic conditions within societies which determine the risk of people getting ill.
121
What is Inverse care law?
The principle that the availability of good medical or social care tends to vary inversely with the need of the population served
122
What are the vulnerable groups in the NHS?
- Homeless
- Gypsies/ travellers
- Asylum seekers
- LGBTQ+
- Prisoners
- Care leavers
- Learning disabilities
- Mental health problems
123
What is Maslow’s Hierarchy of needs?
A 5-tier model of human needs
- People are motivated to achieve certain needs; some needs take precedence over others.
124
What are the 5 factors that comprise Maslow’s hierarchy of human needs?
1. Self-actualization: desire to become the most that one can be
2. Esteem: respect, self-esteem, status, recognition, freedom
3. Love + belonging: friendship, intimacy, family, sense of connection
4. Safety needs: personal security, employment, resources, health, property
5. Physiological needs: air, water, food, shelter, sleep, clothing, reproduction
125
What is an asylum seeker?
A person who has made an application for refugee status
126
What is a refugee?
A person granted asylum and refugee status. Usually means leave to remain for 5 years then reapply.
127
What is indefinite leave to remain ?
When a person is granted full refugee status and given permanent residence in the UK
128
What is unaccompanied asylum seeking child?
- Someone who has crossed an international border in search of safety and refugee status
- Under the age of 18 and is without a guardian
129
What are asylum seekers entitled to?
- Money – currently £39.60 per week
- Housing
- Free NHS care
- Under 18 can go to school and have social services
130
What can asylums claim if the home office approve ?
-Have five years leave to remain in the UK
-Have the right to work and claim benefits
-Access to mainstream housing
-Can apply for a family reunion
131
How does a refugee become a British citizenship?
After 5 years of refugee status, they can apply for indefinite leave to remain and after a year of ILR can apply for British citizenship
132
What is the impact on refugees physical health?
-Common illness
-Injuries from war and travelling
-Torture and sexual abuse
-Infectious disease
-Malnutrition
-Mental health
133
What is the impact on refugees social situation ?
-Separation from family
-Racism
-Poverty
-Poor housing
-Unemployment
134
What are the barriers to accessing healthcare for refugees?
-Lack of knowledge of where to get help
-Lack of understanding how NHS works
-Language barriers
-Differences in culture
-Transport to appointments
-Difficulty meeting the costs
135
Who is counted as homelessness?
●staying with friends or family
●staying in a hostel, night shelter or B&B
●squatting (because you have no legal right to stay)
●at risk of violence or abuse in your home
●living in poor conditions that affect your health
●living apart from your family because you don't have a place to live together
136
What are the causes of homelessness?
- Eviction by private landlords
Relatives and friends no longer able to offer accommodation
137
What factors impact on the likelihood of becoming homeless?
Individual circumstances
- poor physical health
- drug and alcohol issues
- mental health problems
- Bereavement
Wider forces
- Poverty
- Inequality
- Housing supply
- Unemployment
138
What health problems are homeless people faced with?
- 78% have a physical health condition
- Serious mental illnesses
- Addictions
- Infectious disease
- STI
- Poor condition of feet
- Poor nutrition
Death = suicide, accidents, pneumonia
139
What are the barriers to access healthcare for homeless people?
-Difficulties with access to health care
-Lack of integration with other agencies (housing, social services, criminal justice)
-People that do not prioritise health
-Fear/ embarrassment
140
What health problems do travellers experience?
- Maternal health -- One in five gypsy traveller mothers will experience the loss of a child
-Higher rates of miscarriages, still births and neonatal deaths
- Mental Health
141
What are the barriers to accessing healthcare for travellers?
-Registering and accessing GP services
-Discrimination, no permanent address
-Reluctance to seek medical attention until their condition is serious
142
What are the social factors of travellers?
-Education – lowest attainment of all ethnic groups
-Income
-Accommodation
-Experience of discrimination
143
What health problems can LBBTQ+ community suffer from?
-Depression
-Suicide and self harm
-Drugs and addiction problems
-STI
144
What are associated health problems that LGBTQ+ community suffer from?
-Social isolation
-Homelessness
-Workplace discrimination
-Relationship problems
-Victims of crime and violence
145
What are the barriers to accessing healthcare for LGBTQ+?
-Stigma/prejudice
-Discomfort/fear of disclosing LGBTQ status due to real or perceived Homophobia
-Previous negative experiences
146
How do qualifies doctors improve the health of patients?
1. Treating the individual patients
2. Influencing the services available to patients
147
What is the definition of evaluation of health services?
Evaluation is the assessment of whether a service achieves its objectives
148
What is the framework fro health service evaluation by Donabedian?
Structure, process, outcome
149
What is structure in HSE?
Buildings, staff and equipment
150
What is process in HSE?
Tests, examination, counselling and prescribing
151
What is outcome in HSE?
Morbidity, mortality and satisfaction
152
What are the issues with health outcomes?
*Link between health service provided and health outcome may be difficult to establish as many other factors may be involved
*Time lag between service provided and outcome may be long
*Large sample sizes may be needed to detect statistically significant effects
*Data may not be available
153
What are the Maxwell's dimension of quality (3As and 3Es) ?
Acceptability
Accessibility
Appropriateness
Effectiveness
Equity
Efficiency.
154
What are the evaluation methods?
Qualitative- Observation, interviews, focus groups , review of documents
Quantitative - Routinely collected data, review of records, surveys , other special studies
155
What is multi morbidity?
Used to mean people with multiple heath conditions. These are often long-term health conditions which require complex and ongoing care.
156
What are the effects of multi morbidity?
People with multimorbidity are at higher risk of safety issues for many reasons:
- Polypharmacy which may lead to poor medication adherence.
- Complex management regimes
- More frequent and complex interactions with health care services
- Vulnerability to safety issues due to poor health, advanced age, cognitive impairment, limited health literacy
157
What is polypharmacy?
* Concurrent use of multiple medications in an individual
158
What is appropriate polypharmacy?
optimisation of medication regimes has the potential to improve quality of life, longevity and minimise the harm from medications.
159
What is problematic polypharmacy?
prescribing of multiple medications inappropriately or where the intended benefit of the medication is not realised
160
What are the effects of polypharamcy?
-The drug combination is hazardous because of interactions.
-Overall demand of medicine taking are unacceptable to the patient
-Medicines are being prescribed to treat the side effects of other medications where alternative solutions are available to reduce the number of medicines prescribed.
161
What are the recommended alcohol intake levels for men and women?
14 units
162
What is ‘higher risk drinking’?
Men: 50+ units / week
Women: 35+ units / week
163
What does persistent drinking throughout pregnancy lead to?
Foetal Alcohol Syndrome
small, underweight babies; slack muscle tone
mental retardation; behavioural + speech problems
characteristic facial appearance
cardiac, renal + ocular abnormalities
164
What is Wernicke’s Encephalopathy?
Vitamin B1 deficiency, often occurring on withdrawal of alcohol.
Reversible.
Not treating can lead to Korsakoff’s.
165
Wernicke’s Encephalopathy is characterised by a triad of symptoms. Name these symptoms.
Acute mental confusion
Ataxia
Ophthalmoplegia
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How should Wernicke’s Encephalopathy be treated?
Timely injections of Thiamine (Vitamin B1)
Poorly absorbed orally
Small risk of anaphylaxis when given IV.
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What is Korsakoff’s syndrome?
Amnestic disorder due to enduring B1 malnutrition
not reversible
short term memory loss
lose spontaneity, initiative
confabulation -> disturbance in memory, defined as the production of fabricated, distorted or misinterpreted memories about oneself or the world.
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What is Delirium Tremens?
A short-lived (3-5 days) toxic confusional state which usually occurs as a result of reduced alcohol intake in alcohol dependent individuals with a long history of use.
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What symptoms might a person experiencing delirium tremens present with?
Clouding of consciousness / confusion / seizures
Hallucinations in any sensory modality
Marked tremor
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What is the treatment for Delirium Tremens?
Supportive:
> Fluids
> Benzodiazepines
Detoxification in acute situation -> use Benzodiazepines
Need support: effective in short term in hospitals
Don’t forget about Pabrinex!!! (Vitamin B1)
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Name the 6 most common eye conditions leading to sight loss.
Cataracts
AMD (Age-related macular degeneration)
Glaucoma
Retinitis pigments
Hemianopia
Retinopathy
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Describe the manifestation of cataracts.
ens becomes less transparent as we age
If the lens turns misty / cloudy -> this is a cataract
> cataract can get worse -> makes vision mistier
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What is ‘macular disease’
A collective term for conditions which cause damage to the cells of the macula (the central part of the retina) + affects central vision.
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Describe the visual changes which occur in AMD (Age-related Macular Degeneration).
Peripheral vision is not affected
AMD causes blurred, distorted or dim vision
May progress very slowly
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Which group of people does AMD (Age-related Macular Degeneration) tend to affect?
Over 65s: AMD is the leading cause of sight loss in the over 65s.
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What is the cure for AMD? How can you decrease the risk of developing AMD?
No cure
Slow / halt the disease progression with medical treatment, drug therapy or laser treatment.
Decrease risk by having regular sight tests
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What is ‘glaucoma’?
Group of eye conditions which affect the optic nerve
- damage may be caused by raised eye pressure or a weakness in the optic nerve
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Describe the visual changes which occur in glaucoma.
- No symptoms in early stages
- Peripheral vision is affected; damage can’t be reversed
- Leads to blindness without early diagnosis + treatment.
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What are the risk factors for glaucoma?
Increased age
- Family History of glaucoma
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What should you offer someone who is over 40 + who has a family history of glaucoma
Free eye health checks
- Available to anyone over the age of 40yrs with a family history of glaucoma.
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What is ‘retinitis pigmentosa’?
Inherited conditions of the retina -> lead to a gradual, progressive reduction in vision.
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Describe the visual changes which occur with Retinitis Pigmentosa.
Initially: difficulties with night vision + peripheral vision
Then: reading, colour + central vision are affected
Visual deterioration occurs over years, not months.
Regular sight tests should pick up any changes in vision.
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Describe the visual changes which occur with ‘Hemianopia’?
Sufferers lose either the Left or Right half of the visual field in both eyes following a stroke
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What pathology might give rise to a person suffering from hemianopia?
Stroke
- Traumatic Brain Injuries
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How does Diabetic Retinopathy affect the eyes?
Affects blood vessels supplying the retina
- Blood vessels become weak + damaged -> serious if untreated
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What is the leading cause of blindness in the under 65s?
Diabetic Retinopathy
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What is the treatment for Diabetic Retinopathy?
Laser eye treatment
- Laser treatment can’t restore the sight already lost, but could stop the condition progressing further.
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What might visually impaired people need to ensure communication is easier for them?
Large print
Audio
Email (voice activated)
Mobile phones / text
Braille + Moon
Speech packages
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When might people need SRSB (Sheffield Royal Society for the Blind)?
From birth
Hereditary conditions
Following an accident
Emotional support
Degenerative conditions
Following an illness
Care in later life
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How might people access SRSB services?
Sheffield Royal Society for the Blind
Self referral
GP / Optician
Mobile Information Unit
Family / friend
Low vision clinic
Fire + Rescue service
Community Engagement Team
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Define ‘disability’
A disability is related to anyone who has a physical, sensory or mental impairment which seriously affects their daily activities.
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Not all visually impaired people are visually impaired in the same way. What things might visually impaired people be able to see / not see?
Nothing
Differentiate between light + dark
No peripheral vision
No central vision
Patchwork of blanks + defined areas
Some may see enough to read text, although they may have difficulty crossing roads.
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What is Charles Bonnet Syndrome?
When visual loss occurs, the brain doesn’t receive pictures as previously occurred.
Sometimes, new fantasy pictures (or old pictures stored in the brain) are released + experienced as though they were seen.
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Who does Charles Bonnet Syndrome affect?
Condition affects people with serious sight loss
Generally affects those who’ve lost their sight later in life.
May also affect people who suffer from AMD or retinal disorders.
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How can I help a visual impaired person?
* Try to identify whether a person is visually impaired.
* Are they blind or partially sighted?
* Do they need assistance with guiding?
* Be aware this could be an unfamiliar environment for the VIP
* Tell them if you are going to examine them.
* Explain about medication, other tests etc
* Make sure they understand.
* Inform VIP of what will happen next, ie referral to hospital or other agency.
* Alternative formats for information.
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What do you do when you meet a visual impaired person?
* Always behave and talk naturally.
* Introduce yourself.
* Talk to the person, not their companion.
* Use the VI person’s name if you know it.
* A light touch on the arm is acceptable.
* Never talk to the guide dog ignoring the owner.
* If there is more than one person with you, make sure you introduce that person as well.
* Refusing assistance is ok
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How do you recognise a visual impaired person?
* White walking stick
* White Symbol cane
* Guiding cane
* Reading Braille
* Peering closely at something
* Dark glasses
* Being guided
* Feeling their way
* Guide dog
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