Public Health Flashcards
Hospital autopsy
- Less than 10% in the UK - Requires medical certificate of cause of death (MCCD) - Used for audit, teaching, research and governance
Medico-legal autopsy
- > 90% in the UK - Coronial autopsy - death is not due to unlawful action - Forensic autopsy - unlawful (eg: murder)
What percentage of deaths are referred to the coroner?
- About 40% - But they only choose to investigate about 10%
Deaths referred to coroner
Presumed natural - Presumed iatrogenic - Presumed unnatural
Presumed natural death
- Not seen by a doctor in the last 14 days - Unknown cause
Presumed iatrogenic death
Peri/postoperative deaths - Anaesthetic deaths - Abortions - Complications of therapy
Presumed unnatural death
Accidents - Industrial death - Suicide - Unlawful killing - Neglect - Custody deaths
Who carries out an autopsy?
A doctor (pathologist)
Who can refer to autopsy
Doctors - Registrar of BDM (statuatory duty to refer) - Relatives - Police - Anatomical pathology technicians
What 4 questions do coronial autopsies aim to answer?
Who was the deceased? - When did they die? - Where did they die? - How did they come About their death?
Steps of autopsy
External examination - Evisceration - Internal examination
Autopsy external examination
Identification: formal identifiers, gender, age, body habitus, jewellery, body modifications, clothing - Disease and treatment - Injuries
Autopsy evisceration
Y-shaped incision - Open all body cavities - Examine all organs in situ - Remove thoracic and abdominal organs - Remove brain
Autopsy internal examination
Heart and great vessels - Lungs trachea, bronchi - Liver, gallbladder, pancreas - Spleen, thymus and lymph nodes - Genitourinaty tract - Endocrine organs - CNS
How many healthcare associated infections are in England every year? And how many deaths are due to healthcare associated infections
- About 300,000 (9% of patients) - 20,000 deaths
The Health Act 2006 on infection control
Infection control is every health care workers responsibility - the possibility of health care related infections should be considered in all aspects of patient management
What percentage of healthcare workers are estimated to get infected at work?
75%
Bacteria to consider in infection control
MRSA - C.difficile - Multi-drug resistant gram negatives - Glycopeptide resistant enterococci - Group a strep - Mycobacterium tuberculosis
Viruses to consider in infection control
- Influenza - Norovirus - SARS-CoV-2 - HIV - Hep B + C - Varicella Zoster Virus - Viral haemorrhagic fevers
Other things to consider in infection control
Candida auris (a fungus) - Creutzfeldt-Jakob Disease
How do we prevent and control infections?
- Identify risks (both patients/staff and the environment) - Ensure staff are aware of the risks and what to do - Develop strategies to reduce risks - Policy development - Audit
Ways to identify risk of infectous disease
Look at risk factors (eg: going abroad to a particular country) - Screening - Clinical diagnosis - Lab diagnosis
Why is diabetes a public health issue?
Mortality - Disability - Co-morbidity - Reduced quality of life - Preventable but increasing in prevelance
How can we reduce the impact of T2DM?
Identify those at risk - Prevention - Diagnose earlier - Effective management and supporting self-management
Lifestyle and environmental factors that increase risk of diabetes?
Sedentary job and leisure activities - Diet high in calories, low in fruits, vegetables, pulses and wholegrains - Obesogenic environment
Obesogenic environment
Physical: TV remotes, lifts, car culture - Economic: Cheap TV, expensive fruit and veg - Sociocultural environment: Safety fears, family eating patterns
Mechanisms that maintain being overweight
- Physical/physiological - more weight = more difficult to exercise (arthritis, stress incontinence) and dieting -> metabolic response - Psychological - low self-esteem and guilt, comfort eating - Socioeconomic - reduced opportunities employment, relationships, social mobility
What do effective interventions for prevention of diabetes require?
Sustained increase in Physical activity - Sustained change in Diet - Sustained weight loss
NICE guidance for prevention of T2DM
Prioritise interventions for pre-diabetics - Use metformin if BMI>35 + HbA1c increasing - Focus on ethnic minorities and socioeconomically deprived communities at increased risk
How to diagnose diabetes earlier
Raise awareness of the Disease and possible symptoms in the community and amongst healthcare professionals - Use Clinical records to Identify those at risk and/or Use blood tests to screen before symptoms develop
Aspects to consider when supporting self-care for diabetes
self-monitoring - Diet - exercise - Drugs - Education - Peer support
BMI thresholds
<18.5 underweight 18.5 - 24.9 normal 25.0 - 29.9 overweight 30.0 - 39.9 obese >40 morbidly obese
What can obesity lead to?
T2DM - Hypertension - Coronary artery Disease - Stroke - Osteoarthritis - Obstructive sleep apnoea - Carcinoma: breast, endometrium, prostate, colon Especially abdominal (visceral) rather than subcutaneous fat
Hypothalamus role in appetite regulation
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Top 5 obesity interventions in terms of cost effectiveness for years of life saved
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What is medicines optimisation?
Looks at the value which medicines deliver to make sure they are clinically-Effective and cost-Effective - Ensures people get the right choice of medicines at the right time and are engaged in the process by their Clinical team
Goal of medicines optimisation for patients
Improve outcomes - Take meds correctly - Avoid taking unnecessary medicines - Improve medicines Safety - Reduce wastage of medicines
Examples of non-adherance
Not taking meds - taking bigger/smaller doses than prescribed - taking meds more/Less often than prescribed - Stopping meds without finishing the course - Modifying treatment to accommodate other activties (work, social) - Continuing with behaviours against medical advice
Unintentional reasons for non-adherance
Practical barriers - Difficulty understanding instructions - Problem using treatment - Inability to pay - Forgetting
Intentional reasons for non-adherance
Intentional barriers - Patients’ beliefs about their health/condition - Beliefs about treatment - Personal preferences
Necessity-concerns framework
Necessity beliefs - Perceptions of personal need for treatment (increase for adherence) Concerns - about a range of potential adverse consequences (decrease for adherence)
Impacts of good doctor patient communication
Better health outcomes - Higher adherance to therapeutic regimens - Higher patient and clinician satisfaction - Decrease in malpractice risk
2 key things a doctor is required to do
Certification of death - Notification of infectuous diseases
What is a reproduction number in the context of infections?
If one person is infected, how many people they will infect
What is the only bacteria that alcohol handgel can’t kill?
C.difficile
What is a UK unit of alcohol?
8g/10ml of pure alcohol To work out: Strength of drink (%ABV) x amount of liquid (L)
UK drinking guidelines
- No more than 14 units per week (men and women) - Spread drinking over 3+ days
Low risk drinking to dependency
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Alcohol specific deaths
- mc: alcoholic liver disease (78%) - Mental and behavioural disorders due to alcohol use - External causes + other
Fetal acohol spectrum disorder (FASD)
pre and post-natal growth retardation - CNS abnormalities including learning disabilities, irritability, incoordination, hyperactivity - Craniofacial abnormalities
Psychosocial effects of excessive alcohol consumption
Interpersonal relationships - Problems at work - Criminality - social disintegration and poverty - Driving incidents/offences
NICE recommendations for alcohol policy
Price - make alcohol Less affordable - Availability - licensing and import allowances - Marketing
NICE recommendations for alcohol in medical practice
licensing - Screening and brief interventions - supporting children and young people - Referral
Who to screen for alcohol
Routine examination - before prescribing meds - Emergency department - Pregnant or trying to conceive - Likely to drink heavily (smokers, middle aged adults) - Have health Problems that might be alcohol induced - Chronic illness Not responding to treatment
Alcohol screening tools
Clinical interview - just ask - FAST - FAST alcohol Screening test - AUDIT - alcohol Use disorders Identification test - CAGE questions
Psychosocial treatments for alcohol dependence
CBT - social support, one to one or Group, eg: alcoholics anonymous
Opiates - examples, classes and effects
Examples - Heroin (A) - Codeine (B) - Tramadol (B) Effects - Euphoria - Analgesia
Depressants - examples, classes and effects
Examples - Alcohol - Benzodiazepines (C) - Gabapentinoids? (C) Effects - Sedation - Anxiolytic
Stimulants - examples, classes and effects
Examples - Amphetamines (B) - Khat (C) - Cocaine (A) - Crack (A) - Caffeine - Ecstasy/MDMA (A) Effects - Increase alertness - Alter mood
Cannabinoids - examples, classes and effects
Cannabis - most commonly used worldwide Effects: Relaxation, mild euphoria
Hallucinogens - examples, classes and effects
Examples - LSD (A) - Magic mushrooms (A) Effects - Altered sensory perceptions and thinking
Anaesthetics - examples, classes and effects
Examples - Ketamine (B) - GHB (C) - Nitrous oxide Effects - Anaesthesia - Sedative
Effects of drug misuse
Mortality - morbidity - social - Economic - Personal
Preventative risk factors of drug misuse
self control - Parental monitoring and support - Positive relationships - Neighbourhood resources - Academic achievement - School anti-drug policies
Risk factors for drug misuse
Aggressive childhood behaviour - Lack of Parental support - community deprivation/poverty - drug experimentation - Poor social skills - Availability of Drugs at School
Definition of good musculoskeletal health
Healthy/Disease free muscles, joints and bones - Abilitiy to carry out Physical activities/functionsboth effectively and symptom free
Physical activity advice in clinical consultations
Recognised as important but often Not prioritised over medical management elements - Multiple common barriers for implementation of behaviour change interventions - Evidence from randomised trials that brief interventions may be Effective and cost-Effective at least in short term
