public Health Flashcards
How do you describe screening?
Like a sieve. Trying to find people at higher risk of a disease
How many screening programmes in NHS?
11
What nhs screening programmes are offered to female population uk?
1.Breast (50-71 3 yearly)
2.bowel (FIT test age 60-74 2 yearly, reducing to age 50 in future)
3.cervical (25-49 3 yr, 50-64 5yr)
What screening programmes are offered to male population uk?
1.AAA
2. Bowel
Who decides what screening is implemented in NHS?
Uk screening Committee make recommendations to each of 4 nations govt ministers who tell nhs what to implement-accounts for differences between nations
What do uk NSC use for evidence re screening benefit?
RCT ideally that compare outcomes in those undergoing screening with similar group usual care. Looks at full consequences of screening programme.
What is role of DHSC in England screening board?
National strategic oversight
Policy
Finances
Holding PHE/nhse to account
What is role of PHE in England screening board?
-Advise govt and NHS to ensure screening reflect best evidence and UK NSC advice
-pilot new programmes and demonstrate value
What is role of NHSE in England screening board?
Commission and deliver national programmes
Which ph services are delegated via govt to NHSE?
‘Section 7a services’
Immunisations
Screening
Child health information
Ph services for people in secure/detained settings
Sarcs
Pregnancy screening
10/40-disorders that affect bloods ability to carry oxygen
Sickle cell
Thalasemmia
8-12/40-infections
HIV
Hep B
Syphilis
10-14/40 Combined test-USS and bloods for down/edwards/patau
Quadruple test bloods up to 20/40 if can’t do combined-downs only
18-20+6/40 anomaly (11 conditions)
If diabetes-eye screening
Explain to pt why we screen for HIV in pregnancy?
HIV weakens immune system making it difficult to fight infections
If untreated can be passed to baby in pregnancy/birth/BF
Treatment reduces chance of passing on from 1:4 to <3:1000
need early specialist appointments to plan care
Explain why screen for syphillis?
can be passed to baby in pregnancy
if untreated can cause serious health problems, miscarriage or still birth
explain why screen for Hep B?
-pass from mother to baby
-affects liver and can cause chronic or acute ill health
-if infected and untreated 90% chance of lifelong infection affecting liver including cancer
-treated 10 % chance
explain why test for scd and thalassaemia?
-major serious inherited diseases affecting haemoglobin, part of blood that carries oxygen
-passed on by unusual genes
genes are code for body eg eye colour
-work in pairs, need 2 unusual to have scd or thal
-if mum tests positive ideally test father
-if father not available/two genes present offer diagnostic test
what are risks of diagnostic tests after pregnancy screening? when are they offered?
CVS and amnio- 1:200 will miscarry as a result of test
CVS 11-14 weeks
Amnio-15+weeks
will confirm diagnosis of
SCD
Thalassemia
Down T21
Patau T13
Edwards T18
What is NIPT?
Non- invasive prenatal testing
measures fetal dan in blood
A screening test (better than combined so offered if combined positive)
Detects if extra dna from chromosomes 13/18/21
If result indicates lower chance result diagnostic test not indicated.
Why do we offer cervical screening?
reduced deaths from cervical cancer saving 000’s of lives.
If everyone attended 83% deaths could be prevented
Who do we invite for cervical cancer screening?
From age 25, 3 yearly until 49.
From age 49 5 yearly until 64
regardless of HPV vacinne/sexual history
transmale not invited-gp to arrange
How does cervical screening work?
with a 1 min test, we look for high risk HPV and abnormal cervical cells that could lead to cervical cancer
if find HPV check for abnormal cells can remove before cancer develops
What are risks of cervical screening?
main risks are from removing abnormal cells at colp-
1.Infection
2.bleeding
3.may affect future pregnancy if more extensive tissue removed
What are 4 possible results of cervical screening?
- No HR HPV-return to routine screening
2.HR HPV no abnormal cells-recheck in 1 year for clearance/advise stop smoking
3.HR HPV abnormal cells-refer to colp
4.Inadequate sample-repeat in 3/12
What affects chances of cervical cancer?
-Persistence of high risk HPV
-Smoking
-HPV vaccination covers most but not all HR
-Condom use reduces infection
-FH does not affect risk.
SCREENING!
