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Public Health Flashcards

1
Q

What are the three domains of public health?

A

Health promotion/improvement
Health protection
Improving health services

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2
Q

Describe the public health response

A

Surveillance (epidemiology)

Risk factor identification

Intervention and evaluation

Implementation

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3
Q

What did Engels write?

A

Engels - The condition of the working class in England (1845)

Poverty produces ill health, ill health produces poverty

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4
Q

What did Chadwick write?

A

Chadwick - Report on the sanitary condition of the labouring population of Great Britain (1842)

Unsanitary living conditions produces poor health
Prevention should be PH focus

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5
Q

What is medicines optimisation?

A

Looks at the value which medicines deliver ensuring they are clinically effective and cost effective

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6
Q

What is polypharmacy?

A

Use of multiple medicines (arbitrarily 5+)

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7
Q

What is adherence?

A

Extent to which a patient’s actions match agreed recommendations

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8
Q

What is concordance?

A

An agreement reached after negotiation between a patient and healthcare professional that respects the beliefs and wishes of a patient in determining whether, when and how medicines are to be taken

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9
Q

7 reasons for non-adherence

A

Unintentional (practical barriers)

Difficult understanding instructions
Poor dexterity
Inability to pay
Forgetting

Intentional (motivational barriers)

Beliefs about health (e.g. I’m not symptomatic so I’m fine)
Beliefs about treatments (e.g. this drug will cause this to happen to me)
Personal preferences (Rather do holistic)

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10
Q

Necessity-concerns framework

A

↑ adherence when ↑ necessity beliefs and ↓ concerns

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11
Q

4 impacts of good Dr-Pt communication

A

(Theofilou 2011)

Better health outcomes
Higher adherence
Higher satisfaction
Reduced malpractice risk

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12
Q

Sex vs Gender

A

Sex is biological, gender is cultural

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13
Q

Gender

A

Practice organised in terms of or in relation to the reproductive division of people into male and female (Connell 1987)

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14
Q

Masculine vs Feminine health risks

A

Masculine -> more likely to be reluctant to seek help when ill, more likely to have risker employment

Feminine -> perceived social responsibility to care

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15
Q

Meningitis

A

Inflammation of meninges

Bacteria e.g. meningococcus, pneumococcus
Viruses e.g. coxsackievirus, herpes virus

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16
Q

Two types of invasive meningococcal disease

A

Neisseria meningitidis
Gram negative diplococci
12 serogroups

Meningitis - localised infection of meninges
Septicaemia - systemic infection

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17
Q

What meningitis cases are notifiable?

A

All cases (even possible/not confirmed) ARE NOTIFIABLE!!!

Confirmed - immediate PH action
Probable - immediate PH action
Possible - no immediate PH action

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18
Q

Public health meningococcal infection action steps

A
  1. Contact tracing
  2. Chemoprophylaxis
  3. Identify clusters
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19
Q

Close contact meningitis

A

Prolonged contact in a household setting during 7 days before onset

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20
Q

What is chemoprophylaxis in meningitis?

A

Offered to close contacts and transient close contacts with direct exposure to large respiratory droplets e.g. sneezed on

Single dose ciprofloxacin (or rifampicin)
Vaccine to contacts (if unvaccinated)

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21
Q

Clusters definition meningitis

A

Two probable or confirmed cases of same type within 28 days
Schools, household
Dissemination of information on signs/symptoms
Risk assessment of prophylaxis and vaccination

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22
Q

Two types of vaccine failure

A

Primary - person doesnt develop immunity
Secondary - initially responds but protection wanes (needs boosters)

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23
Q

6 vaccine preventable diseases

A

Diphtheria
Pertussis (whooping cough)
Tetanus
Polio
Haemophilus influenzae
Meningococcal disease

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24
Q

Name some notifiable diseases

A

Anthrax
Botulism
Cholera
COVID
Diphtheria
Typhoid/paratyphoid fever
Food poisoning
Group A strep
Legionnaires disease
Leprosy
Malaria
Measles
Meningococcal septicaemia
Mumps
Plague
Rabies
Rubella
SARS
Smallpox
Tetanus
TB
Typhus
Whooping cough
Yellow fever

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25
Q

4 reasons why diabetes is a key health issue

A

Mortality
Disability
Co-morbidity
Reduced quality of life

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26
Q

Primary diabetes prevention

A

Screening of IGT/IFT if risk factors
Health promotion - sustained changes in diet, weight loss, and physical activity

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27
Q

Secondary diabetes prevention

A

Early diagnosis!!!

Raise awareness

Screening every 5 years 40-75 as part of NHS health check

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28
Q

Tertiary diabetes prevention

A

3-6 months blood sugar tests

Annual foot, BP, cholesterol, kidneys and weight checks

1-2 year eye tests

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29
Q

5 types of CHD risk factors

A

Clinical (diabetes)
Lifestyle (activity)
Environmental (air pollution)
Demographic (age, sex)
Psychosocial (mental health)

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30
Q

What is coronary prone behaviour pattern?

A

type A behaviour
Competitive
Hostile
Impatient

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31
Q

How is BMI calculated and what does it mean?

A

Weight divided by height squared

Under 18.5 underweight 25-30 overweight 30+ obese 40+ morbidly obese

Class I: 30-34.9
Class II: 35-39.9
Class III: over 40

Approx ⅔ adult population overweight/obese

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32
Q

4 causes of obesity

A

Genetic
Health
Environmental
Behavioural

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33
Q

NOVA classification

A

UPFs
Groups 1-4 where group 1 is unprocessed, group 4 is UPFs

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34
Q

Government policy examples for obesity

A

Sugar drinks tax (2016 childhood obesity strategy, implemented 2018)

Tackling obesity strategy
Reduce promotion of high fat foods
Calorie labelling
Advertising restrictions on HFSS foods

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35
Q

Obesity prevention examples

A

Primary - early years, marketing, awareness

Secondary - diet intervention, weight loss support programmes

Tertiary - activity/diet, mental health support, surgery/pharmaceuticals (e.g. orlistat inhibits lipases)

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36
Q

Obesity pharmaceuticals

A

Orlistat - lipase inhibitor

Semaglutide - Semaglutide binds to, and activates, the GLP-1 (glucagon-like peptide-1) receptor to increase insulin secretion, suppress glucagon secretion, and slow gastric emptying

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37
Q

1 unit of alcohol

A

8g/10ml

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38
Q

How to calculate units

A

Strength of drink (%ABV) x Amount (L) = units
e.g. 1 bottle wine 13.5%ABV x 0.75L = 10 units

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39
Q

Low risk drinking

A

No more than 14 units per week over 3 days or more (1% lifetime risk of death)

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40
Q

5 alcohol withdrawal syndromes

A

Tremulousness
Activation syndrome
Seizures
Hallucinations
Delirium tremens

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41
Q

How does alcohol work?

A

Alcohol is a depressant → potentiates GABA and inhibits glutamate

42
Q

3 alcohol use disorders screening tools

A

FAST (fast alcohol screening test)

AUDIT (alcohol use disorders identification test) (8+ harmful)

CAGE
Cut down?
Annoyed by criticisms?
Guilty feelings?
Eye opener?

43
Q

3 examples of PH alcohol harm prevention

A

Restrict choice!
Minimum Unit Pricing (Wales and Scotland, decreased purchasing)
Restricted advertising

Enable choice!
Dry january (health improvements in temporary abstinence)
Alcohol free alternatives

Provide information!
Labelling on alcohol
Guidelines
Media campaigns

44
Q

What drugs are used for alcohol withdrawal?

A

Benzodiazepines (short term) e.g. diazepam

45
Q

What drugs are used for alcohol dependence?

A

Acamprosate calcium -> reduces cravings

Naltrexone -> stops effects of alcohol

Disulfiram -> makes relapses worse

Nalmefene -> reduces cravings

46
Q

Define odds

A

Odds = ratio of probability of an event occurring to probability of it not occurring

47
Q

Define odds ratio

A

Odds ratio = odds in group of interest over odds in comparator

48
Q

Define linear regression

A

y = a + bx

y is outcome variable (dependent)
x is predictor variable (independent)

a is constant
b is regression coefficient

Multiple regression e.g. FEV1 = a + b1height + b2age + b3sex + b3ethnicity…

49
Q

When is logistic regression used?

A

Linear regression used for continuous variables, logistic regression for binary/categorical as values are limited to within a range

50
Q

What is the logistic function for regression?

A

Log odds of y = a + bx
Logistic function:

P(Y) = e^((a+bx))/(1+ e^((a+bx)) )

Enables prediction of probability of an outcome based on multiple characteristics/risk factors

51
Q

What is PICO?

A

PICO - population, intervention, comparator, outcome

52
Q

Name 5 types of variable

A

Categorical:

Binary - two categories e.g. present/absent
Ordinal - categories with natural order e.g. stage of cancer
Nominal - categories with no natural order e.g. ethnicity

Numerical:

Discrete - observations can only take certain numerical values e.g. number of children
Continuous - observations can take any value within a range e.g. height

53
Q

When is a CI statistically insignificant?

A

contains 1 in the range for HRs and ORs

54
Q

What is survival analysis?

A

Used to model time taken for an event to occur based on many variable

55
Q

Why is survival analysis used?

A

Time-to-event data tend to be skewed
Censoring (patients lost to follow up, study may end before event)

56
Q

Give examples of censoring

A

Patients lost to follow up

Study ends before event takes place

57
Q

Define survival probability

A

Probability an individual survives from the time origin to a specified future time e.g. survival probability in the next 5 years

58
Q

Define hazard

A

The hazard is the probability an individual under observation at a specified time has an event at that time

59
Q

What does the HR mean?

A

*HR = 1 no difference in survival
*HR < 1 lower event hazard/increased survival in numerator
*HR > 1 higher event hazard/decreased survival in numerator

60
Q

What is a Kaplan-Meier plot?

A

Probability survival (stepwise) vs years

A steeper slope indicates a higher event rate (death rate) and therefore a worse survival prognosis.

61
Q

What is a hazard ratio?

A

Hazard ratio - compare ratio of observed to expected relapses in radio+chemo vs radiotherapy only group

62
Q

What is a logrank test?

A

Provides strength of evidence agains H0: HR=1 in survival analysis (in p value)

63
Q

What is the Cox proportional hazards model?

A

Use of logistic regression with hazard ratios for survival to create a survival model

Compare hazards between groups allowing a multivariable model

64
Q

How is the hazard ratio obtained in a Cox proportional hazards model or the odds ratio in logistic regression?

A

Exponentiate

65
Q

Define substance misuse

A

Harmful use of any substance for non-medical purposes or effect

66
Q

Outline drug classes

A

A - cocaine, heroin, MDMA, LSD, morphine

B - cannabis, codeine, ketamine, oral amphetamines

C - benzodiazepines, gabapentin, anabolic steroids

67
Q

5 theoretical models of substance use

A

Disease (addiction is a disease so give drugs/treatments, may be influenced by genetic factors)

Behavioural (punish behaviours)

Moral (high moral standards prevents drug use)

Volitional (lack of willpower to change)

Socio-cultural (social injustice causes it)

68
Q

4 types of substances

A

Opiates e.g. heroin, morphine: euphoria, pain relief

Depressants e.g. alcohol, benzodiazepines: sedation, relaxation, slow down thinking

Stimulants e.g. caffeine, nicotine, cocaine: increased alertness, activity and mood

Hallucinogens e.g. ecstasy, ket, mushrooms: alter sensory perception and thinking

69
Q

Define diarrhoea

A

3+ loose/liquid stools in a day
May be infective or non infective

70
Q

Define dysentery

A

Bloody infective diarrhoea

71
Q

Outline the chain of infection

A

Infectious agent → reservoir → portal of exit → mode of transmission → portal of entry → susceptible host →

72
Q

Profuse watery diarrhoea, found in water, certain countries

A

Vibrio cholerae

73
Q

Contact with infected animals faeces

A

Escherichia coli

74
Q

Winter vomiting, some diarrhoea, 1-3 days

A

Norovirus

75
Q

Low volume bloody stools, faeces contaminated food (takeaways, restaurants)

A

Shigella

76
Q

C difficile causes

A

Commensal
Healthcare settings
Can be caused by treatment with antibiotics (broad spectrum)
Clindamycin.
Cephalosporins.
Penicillins.
Fluoroquinolones.

77
Q

SIGHT (C difficile)

A

Suspect C diff as cause
Isolate case
Gloves and aprons
Hand washing with soap and water
Test stool for toxin

78
Q

Why handwash for C difficile?

A

Spored resistant to alcohol rub

79
Q

C difficile treatment

A

Metronidazole or vancomycin

80
Q

At risk diarrhoea groups

A

A Doubtful personal hygiene/facilities
B Pre-school/nursery
C Preparing/serving food
D HCW

81
Q

3 groups of MSK conditions

A

Inflammatory conditions e.g. rheumatoid arthritis
Conditions of pain e.g. osteoarthritis
Osteoporosis and fragility fractures

82
Q

Prevention of MSK conditions

A

Primary - reduce prevalence of risk factors
- Physical activity
- Nutrition (vitamin D)
- Injury prevention
- Healthy weight (obesity risk factor)
Secondary - screening e.g. congenital hip dislocation, osteoporosis
Tertiary - management of conditions to reduce impact

83
Q

Race

A

differentiates groups of people biologically on the basis of supposed differences in genetic make-up

84
Q

Ethnicity

A

real collectivities with common and distinctive forms of thinking and behaviour, of language, custom, religion and so on

85
Q

Culture

A

shared beliefs and values

86
Q

Racism

A

conduct or words or practices that disadvantage or advantage people because of their colour, culture or ethnic origin

87
Q

Stereotypes

A

generalised assumptions about a social group (generally inaccurate)

88
Q

Consent must be:

A

Voluntary
Informed
Made by someone with capacity

89
Q

Criteria for capacity

A

Understand
Retain
Weigh
Communicate decision

90
Q

If in doubt in an emergency

A

GIVE TREATMENT

91
Q

If going in patients best interests (perhaps they cannot give consent) what must be in place in order to deprive their liberties?

A

Deprivation of Liberty safeguards - some restraint and restrictions in best interests - must be lawful, necessary and proportionate

92
Q

Gillick competence

A

Under 16 years - Gillick competence - when child has sufficient intelligence to understand what is proposed can chose when treatment terminates

93
Q

Define error

A

Any preventable event that may cause a patient harm

94
Q

2 outcomes error

A

Near miss, adverse event

95
Q

Swiss cheese model

A

Swiss cheese model - Reason’s model
→ More layers of defences, fewer accidents (fewer holes line up)

96
Q

Three types of errors

A

Error of omission (action not taken)
Error of commision (wrong action taken)
Error of negligence (actions do not meet standard of ordinary, skilled person professing)

97
Q

Transfer effects

A

Positive - previous experience applies to new situation
Negative - previous experience does not apply to new situation

98
Q

Never events

A

serious largely preventable patient safety incidents
Intolerable and inexcusable

99
Q

3 benefits of teamwork

A

Reduce error
Improve decision making
Improve service delivery

100
Q

SBAR checklist

A

SBAR checklist when reporting a case (maybe error?) (standardised formula)
Situation
Background
Assessment
Recommendation

101
Q

Epidemiology of neurological disease 4 steps

A

Case definition
Incidence, prevalence, trends
Risk factors
Scope for prevention?

102
Q

Common neurological disorders of PH importance

A

Migraine
Stroke
Dementia
Epilepsy
Parkinson’s
MS
Cerebral palsy

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