Public Health Flashcards
Acute effects of excess alcohol
Accidents and injury
Coma and death from respiratory depression
Aspiration pneumonia
Oesophagitis/ gastritis
Mallory-Weiss syndrome (gastric tears)
Pancreatitis
Cardiac arrhythmias
Cerebrovascular accidents
Neurapraxia due to compression
Myopathy/rhabdomyolysis
Hypoglycaemia
Chronic effects of excess alcohol
PancriatitisCNS toxicity:dementiaWernicke-Korsakoff syndrome cerebellar degenerationMarchiafava-Bignami syndrome central pontine myelinolysisLiver damage: fatty changehepatitisCirrhosisHepatic carcinomaCancers:BreastBowelMouthThroat (oesophagus, larynx, pharynx)LiverHypertension Peripheral neuropathy Oesophagitis Cardiomyopathy Gastritis Cerebrovascular accidents OsteoporosisMalabsorptionCoronary heart disease Skin disorders
Psychosocial effects of excessive alcohol consumption
Interpersonal Relationships ViolenceRapeDepression or anxietyProblems at Work Criminality Social Disintegration PovertyDriving incidents/offences
Alcohol trends over time
Decreasing levels of harmful levels of alcohol consumptionHospital admissions still increasingIncreased alcohol deaths in past few yearsLess medical intervention required to stop drinking harmfullyHighest rates in 50s/60s y/oYouth consumtion decreasingMore deprived - less likely to drink harmfully, BUT experiencing highest alcohol related death rates
NICE recommendation for policy to reduce alcohol disorders
- Price - Make alcohol less affordable2. Availability - licensing & import allowances3. Marketing - limit exposure, esp.to children and young people
NICE recommendation for Practice to reduce alcohol disorders
4: Licensing 5, 7-11: Screening & brief interventions6: Supporting children & young people aged 10-15 yrs (personal or alcohol at home/in environment) 12: Referral - consider referral for specialist treatment
Measure to prevent alcohol harm
Restrict choice:- Minimum unit pricing- Restriction on ads (not allowed: appeal to young people, sexual content & irresponsible or antisocial behaviour)Enable choice e.g. via Dry JanuaryProvide info (not much effect individually but helps set context for other policies)- Alcohol labelling (industry self-regulation)- Drinking guidelines- Media campaigns
How does Minimum unit pricing work
Set baseline of 50p per unit to restrict how cheap alcohol can beAffects heavy drinkers most (if they are drinking a lot tend to go for cheaper stuff - also affects lower income ppl who get more harm per drink) - moderate drinkers tend to drink more expensive stuff anywaysUnfortunately dependant drinkers are not very rational so may sacrifice other things like heating/food to get drinks - This is only like 4% of ppl tho so most ppl will likely reduce drinking/respond to MUPAlready used in Scot and Wales. North Irland planning to use it. Evidence shows there is DECREASED ALCOHOL PUCHASING However evidence shows there is:- Little impact on crime - No impact on hospital admissions
Health improvements after 1 month abstinence among weekly drinkers
IMPROVED:- Insulin resistance- Blood pressure- Cancer-related growth factors
Outcomes of temporary abstinance initiatives
Reduced drinking at 6 months follow-upIncreased ability to refuse drinksImproved self-rated health and wellbeing
lab tests results that can suggest problem drinking
Abnormal liver enzymesMacrocytosisHigh carb-deficient transferrin
Clinical indications for alcohol screening
As part of routine examination Before prescribing medicationIn the emergency departmentIn patients who are…- Pregnant or trying to conceive- Likely to drink heavily (e.g. smokers, middle-aged adults)- Having health problems that might be alcohol induced- Experiencing chronic illness not responding to treatment
Primary prevention of stroke
- Smoking/alcohol cessation- Improved diet + physical activity
Secondary prevention of stroke
- Screening for RFx - Attributable risk of HTN = 75%
Tertiary prevention
- stroke units + rehabilitation - 84% of patients return home but few return to work
