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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
4 reasons why diabetes is a key health issue
Mortality Disability Co-morbidity Reduced quality of life
26
Primary diabetes prevention
Screening of IGT/IFT if risk factors Health promotion - sustained changes in diet, weight loss, and physical activity
27
Secondary diabetes prevention
Early diagnosis!!! Raise awareness Screening every 5 years 40-75 as part of NHS health check
28
Tertiary diabetes prevention
3-6 months blood sugar tests Annual foot, BP, cholesterol, kidneys and weight checks 1-2 year eye tests
29
5 types of CHD risk factors
Clinical (diabetes) Lifestyle (activity) Environmental (air pollution) Demographic (age, sex) Psychosocial (mental health)
30
What is coronary prone behaviour pattern?
type A behaviour Competitive Hostile Impatient
31
How is BMI calculated and what does it mean?
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
32
4 causes of obesity
Genetic Health Environmental Behavioural
33
NOVA classification
UPFs Groups 1-4 where group 1 is unprocessed, group 4 is UPFs
34
Government policy examples for obesity
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
35
Obesity prevention examples
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)
36
Obesity pharmaceuticals
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
37
1 unit of alcohol
8g/10ml
38
How to calculate units
Strength of drink (%ABV) x Amount (L) = units e.g. 1 bottle wine 13.5%ABV x 0.75L = 10 units
39
Low risk drinking
No more than 14 units per week over 3 days or more (1% lifetime risk of death)
40
5 alcohol withdrawal syndromes
Tremulousness Activation syndrome Seizures Hallucinations Delirium tremens
41
How does alcohol work?
Alcohol is a depressant → potentiates GABA and inhibits glutamate
42
3 alcohol use disorders screening tools
FAST (fast alcohol screening test) AUDIT (alcohol use disorders identification test) (8+ harmful) CAGE Cut down? Annoyed by criticisms? Guilty feelings? Eye opener?
43
3 examples of PH alcohol harm prevention
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
What drugs are used for alcohol withdrawal?
Benzodiazepines (short term) e.g. diazepam
45
What drugs are used for alcohol dependence?
Acamprosate calcium -> reduces cravings Naltrexone -> stops effects of alcohol Disulfiram -> makes relapses worse Nalmefene -> reduces cravings
46
Define odds
Odds = ratio of probability of an event occurring to probability of it not occurring
47
Define odds ratio
Odds ratio = odds in group of interest over odds in comparator
48
Define linear regression
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
When is logistic regression used?
Linear regression used for continuous variables, logistic regression for binary/categorical as values are limited to within a range
50
What is the logistic function for regression?
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
What is PICO?
PICO - population, intervention, comparator, outcome
52
Name 5 types of variable
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
When is a CI statistically insignificant?
contains 1 in the range for HRs and ORs
54
What is survival analysis?
Used to model time taken for an event to occur based on many variable
55
Why is survival analysis used?
Time-to-event data tend to be skewed Censoring (patients lost to follow up, study may end before event)
56
Give examples of censoring
Patients lost to follow up Study ends before event takes place
57
Define survival probability
Probability an individual survives from the time origin to a specified future time e.g. survival probability in the next 5 years
58
Define hazard
The hazard is the probability an individual under observation at a specified time has an event at that time
59
What does the HR mean?
*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
What is a Kaplan-Meier plot?
Probability survival (stepwise) vs years A steeper slope indicates a higher event rate (death rate) and therefore a worse survival prognosis.
61
What is a hazard ratio?
Hazard ratio - compare ratio of observed to expected relapses in radio+chemo vs radiotherapy only group
62
What is a logrank test?
Provides strength of evidence agains H0: HR=1 in survival analysis (in p value)
63
What is the Cox proportional hazards model?
Use of logistic regression with hazard ratios for survival to create a survival model Compare hazards between groups allowing a multivariable model
64
How is the hazard ratio obtained in a Cox proportional hazards model or the odds ratio in logistic regression?
Exponentiate
65
Define substance misuse
Harmful use of any substance for non-medical purposes or effect
66
Outline drug classes
A - cocaine, heroin, MDMA, LSD, morphine B - cannabis, codeine, ketamine, oral amphetamines C - benzodiazepines, gabapentin, anabolic steroids
67
5 theoretical models of substance use
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
4 types of substances
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
Define diarrhoea
3+ loose/liquid stools in a day May be infective or non infective
70
Define dysentery
Bloody infective diarrhoea
71
Outline the chain of infection
Infectious agent → reservoir → portal of exit → mode of transmission → portal of entry → susceptible host →
72
Profuse watery diarrhoea, found in water, certain countries
Vibrio cholerae
73
Contact with infected animals faeces
Escherichia coli
74
Winter vomiting, some diarrhoea, 1-3 days
Norovirus
75
Low volume bloody stools, faeces contaminated food (takeaways, restaurants)
Shigella
76
C difficile causes
Commensal Healthcare settings Can be caused by treatment with antibiotics (broad spectrum) Clindamycin. Cephalosporins. Penicillins. Fluoroquinolones.
77
SIGHT (C difficile)
Suspect C diff as cause Isolate case Gloves and aprons Hand washing with soap and water Test stool for toxin
78
Why handwash for C difficile?
Spored resistant to alcohol rub
79
C difficile treatment
Metronidazole or vancomycin
80
At risk diarrhoea groups
A Doubtful personal hygiene/facilities B Pre-school/nursery C Preparing/serving food D HCW
81
3 groups of MSK conditions
Inflammatory conditions e.g. rheumatoid arthritis Conditions of pain e.g. osteoarthritis Osteoporosis and fragility fractures
82
Prevention of MSK conditions
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
Race
differentiates groups of people biologically on the basis of supposed differences in genetic make-up
84
Ethnicity
real collectivities with common and distinctive forms of thinking and behaviour, of language, custom, religion and so on
85
Culture
shared beliefs and values
86
Racism
conduct or words or practices that disadvantage or advantage people because of their colour, culture or ethnic origin
87
Stereotypes
generalised assumptions about a social group (generally inaccurate)
88
Consent must be:
Voluntary Informed Made by someone with capacity
89
Criteria for capacity
Understand Retain Weigh Communicate decision
90
If in doubt in an emergency
GIVE TREATMENT
91
If going in patients best interests (perhaps they cannot give consent) what must be in place in order to deprive their liberties?
Deprivation of Liberty safeguards - some restraint and restrictions in best interests - must be lawful, necessary and proportionate
92
Gillick competence
Under 16 years - Gillick competence - when child has sufficient intelligence to understand what is proposed can chose when treatment terminates
93
Define error
Any preventable event that may cause a patient harm
94
2 outcomes error
Near miss, adverse event
95
Swiss cheese model
Swiss cheese model - Reason’s model → More layers of defences, fewer accidents (fewer holes line up)
96
Three types of errors
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
Transfer effects
Positive - previous experience applies to new situation Negative - previous experience does not apply to new situation
98
Never events
serious largely preventable patient safety incidents Intolerable and inexcusable
99
3 benefits of teamwork
Reduce error Improve decision making Improve service delivery
100
SBAR checklist
SBAR checklist when reporting a case (maybe error?) (standardised formula) Situation Background Assessment Recommendation
101
Epidemiology of neurological disease 4 steps
Case definition Incidence, prevalence, trends Risk factors Scope for prevention?
102
Common neurological disorders of PH importance
Migraine Stroke Dementia Epilepsy Parkinson’s MS Cerebral palsy

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