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Dan's Copy > Public Health 2 > Flashcards

Public Health 2 Flashcards

1
Q

What is the ‘Prevention Paradox’?

A

A preventative measure which brings much benefit to the population offers little to each participating individual.

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2
Q

Give an example of an everyday activity to which the prevention paradox can be applied.

A
  • If everyone wears a seatbelt on every journey, for 1 life saved, there would be about 400 who would always take the preventative precaution of wearing a seatbelt.
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3
Q

The ICD-10 can be used to assess addiction. What behaviours might a person who is addicted to drugs / alcohol exhibit?

A
  • Craving
  • Tolerance
  • Compulsive drug-seeking behaviour
  • Physiological withdrawal state
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4
Q

List some acute physical effects of dependent drug use.

A
  • Complications of injecting -> DVT, Abscesses
  • Overdose -> respiratory depression
  • Poor pregnancy outcomes
  • Side effects of opiate: constipation, low salivary flow
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5
Q

List some chronic physical effects of dependent drug use.

A
  • Blood-borne virus transmission e.g. Hep C
  • Effects of poverty
  • SE of cocaine: vasoconstriction, local anaesthesia
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6
Q

List some social effects of dependent drug use.

A
  • Effects on families / relationships
  • Social exclusion
  • Driven to criminality
  • Imprisonment
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7
Q

List some psychological effects of dependent drug use.

A
  • Fear of withdrawal
  • Craving
  • Guilt
  • all are temporarily alleviated by drug use.
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8
Q

How does Heroin act?

How is it used?

A
  • Acts at opiate receptors; used 8 hourly
  • Routes of administration:
    > smoking / snorting
    > oral / rectal
    > sub cut / IV / IM
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9
Q

What are the effects of Heroin?

A
  • Euphoria
  • Intense relaxation
  • Miosis (excessive pupil constriction)
  • Drowsiness
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10
Q

What are the adverse effects of heroin?

A
  • dependance + withdrawal symptoms
  • physical complications -> nausea, itching, sweating, constipation
  • over dose :(
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11
Q

How does Cocaine / Crack act?

A
  • Blocks re-uptake of mood-enhancing neurotransmitters at the synapse (serotonin, dopamine)
  • Intense, pleasurable sensation
  • Reinforcement -> leads to further use
  • Depletion at sensory neurone
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12
Q

What are the effects of Cocaine / Crack?

A
  • Confidence, well-being, euphoria, impulsivity, increased energy, alertness
  • impaired judgement, decreased need for sleep
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13
Q

What are the ‘negative’ effects of Cocaine / Crack?

A
  • May produce anxiety, hypertension, arrhythmias
  • subsequent ‘crash’ -> dysphoria

Chronic effects:

  • depression, panic, paranoia, psychosis
  • damaged nasal septum
  • cerebrovascular accidents
  • respiratory problems
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14
Q

What are the aims of treatment for drug users?

A
  • To reduce harm to user, family + society
  • To improve health
  • To stabilise lifestyle, and decrease the amount of illicit drug use
  • Reduce crime
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15
Q

What are the modalities of treatment for drug users?

A
  • Harm reduction
  • Detoxification
  • Maintenance
  • > Methadone = full agonist
  • > buprenorphine = partial agonist
  • Relapse prevention -> Naltrexone
  • Psychological interventions
  • Referral for allied problems (Hep C, STIs, etc.)
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16
Q

What can I offer a newly presenting drug user?

A
  • Health check
  • Screening for blood borne viruses
  • Contraception, smear
  • Sexual Health Advice
  • Check general immunisation status
  • Sign post to additional help
  • Information on local drugs services, including needle exchange
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17
Q

You are an F1 + you need to do a quick assessment of a newly presenting drug user.
What 6 questions should you ask?

A

1, Which drug?

  1. Route of administration?
  2. How long have they been addicted?
  3. What is the patient’s goal
    - quick detox -> good outcomes in new users
    - slow reduction / maintenance
  4. Does the patient need a referral?
    - eg. pregnancy, severe psychiatric co-morbidity, Hep C positive
  5. Does the patient require interagency working / specialised support?
    - child protection issues
    - housing problems etc.
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18
Q

What are the 3 levels of Basic Harm Reduction (as applied to drug users).

A
  1. Action to prevent deaths
  2. Action to prevent blood borne virus transmission
  3. Referral where appropriate.
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19
Q

Who might be suitable for quick detoxification (as applied to drug use)?

A
  • Young user
  • Less time addicted
  • Often not injecting
  • Lower level of drug use
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20
Q

What medication(s) might you use for quick detoxification (of drug use)?

A
  • Buprenorphine is 1st line
    > Lofexidine in very young / very low level use
  • Other symptomatic medication
  • Support from other agencies + teams
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21
Q

Following drug use, who might be suitable for ‘Stabilisation + Maintenance’?

A
  • Opiate user
  • Longer time addicted, usually injecting
  • May be high levels of drug use
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22
Q

What is the aim of ‘Stabilisation + Maintenance’ following drug use?
How is the medication used?

A
  • Harm minimisation
  • Use methadone or buprenorphine
  • Titrate from a low starting dose to a maintenance dose.
  • Keep people alive until they are ready to become abstinent
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23
Q

What is the aim of treating a person who is using crack cocaine?

A
  1. Harm reduction is key -> no substitute meds are available
    - advice on safe sex / contraception / blood borne virus advice
  2. Brief Intervention
    - explanation of effects / risks
    - setting limits
    - cognitive based approaches
  3. Team working
    - Refer to Sexual Health / Infectious Diseases
    - Referral for specialist advice, if appropriate
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24
Q

What is involved in drug relapse prevention?

A
  • Naltrexone tablets are licensed
    > check LFTs, Urinalysis
    > warnings regarding concomitant heroin use
  • MDT approach = essential
  • Constantly relapsing patients may need stabilisation + maintenance to avoid ‘revolving door’
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25
Q

What considerations should you have when a drug user comes into hospital?

A
  • may be very ill
  • may be craving drugs, esp. opiates
  • may fear a negative response from staff
  • may already be prescribed maintenance medication (needs to be continued)
  • may be untreated and will need to start treatment if they are to stay in hospital
  • liaison between community + hospital prescribers on admission + discharge
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26
Q

What are the recommended alcohol intake levels for men and women?

A

14 units / week

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27
Q

What is the guidance for alcohol consumption during pregnancy?

A
  • Abstain for 1st trimester

- No more than 2 units / week in the 2nd and 3rd trimesters

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28
Q

What is ‘hazardous drinking’?

A
  • Pattern of alcohol use which increases someone’s risk of harm
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29
Q

What is ‘higher risk drinking’?

A

Men: 50+ units / week
Women: 35+ units / week

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30
Q

What is ‘increasing risk drinking’?

A

Men: 22-50 units / week

Women 15 - 35 units / week

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31
Q

What is a ‘unit’ of alcohol?

A

A standard measurement of the alcohol content of a drink. Takes into account the strength (%ABV) and the volume.

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32
Q

Give an equation used to calculate the number of units in a drink.

A

[ % ABV x volume (mls) ] / 1000 = units

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33
Q

Why do men metabolise alcohol faster?

A

Due to their %age body fat.

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34
Q

Describe the aetiology of problem drinking.

A
  • Individual
    > genes / personality / physique
    > occupation
    > advertising / availability / peer group
  • Family
    > Religion / tradition / culture
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35
Q

Why are women now drinking more than ever?

A
  • more socially acceptable
  • more disposable income
  • more drinks marketed at women
  • more drinking places aimed at women customers
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36
Q

Give 5 social + psychological risk factors for problem drinking

A
  • Drinking within the family
  • Childhood problem behaviour relating to impulse control
  • Early use of alcohol, nicotine + drugs
  • Poor coping responses to life events
  • Depression as a cause (not a result) of problem drinking
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37
Q

How might Alcohol + Deprivation be linked?

A

Adverse effects of alcohol exacerbated amongst lower SE groups

  • more likely to experience negative effects directly and indirectly
  • lack of money means they are less likely to protect themselves against negative health + social consequences
  • more likely to die of causes influenced by - or attributable to - alcohol
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38
Q

What are the 4 most common causes of death due to alcohol?

A
  • Accidents + violence
  • Malignancies
  • Cerebrovascular disease
  • Coronary Heart Disease
39
Q

Alcohol causes multi system disease, and has physical, psychological + social implications. What might be some of the physical manifestations of alcohol disease?

A
  • Liver disease
  • Birth defects -> fetal alcohol syndrome
  • Respiratory
  • Neurological
  • Haematological
  • Rheumatological
40
Q

Describe the possible progression of liver disease in an alcoholic.

A

Fatty liver -> Cirrhosis

  • No significant risk of liver damage at less than 30g alcohol / day
  • Fatty liver reversible on withdrawing alcohol
41
Q

Give some symptoms of mild - moderate alcoholic hepatitis.

A
  • Anorexia
  • Nausea
  • Abdominal pain
  • Weight loss
  • patients are more susceptible to infection
42
Q

What are the signs of severe alcoholic hepatitis?

A
  • Ascites
  • Bleeding
  • Encephalopathy
  • severe alcoholic hepatitis is a medical emergency
43
Q

What is the relationship between alcohol + heart disease?

A
  • Moderate alcohol intact can protect against interstitial heart disease
  • Heavy alcohol use increases risk -> hyperlipidaemia, hypertension
    > alcohol can precipitate arrhythmias eg. Atrial Fibrillation
44
Q

What is the relationship between alcohol + cancer?

A
  • 25-50% head and neck cancers due to alcohol

- Other alcohol-related cancers: breast, liver, stomach, colon, rectum, pancreatic

45
Q

What is the recommended alcohol intake during pregnancy?

A
  • None in the 1st trimester

- 2-3 units / week in 2nd + 3rd trimesters

46
Q

How does excess alcohol intake affect a pregnancy?

A
  • Increased rate of miscarriage

- Low birthweight babies

47
Q

What does persistent drinking throughout pregnancy lead to?

A

Foetal Alcohol Syndrome

  • small, underweight babies; slack muscle tone
  • mental retardation; behavioural + speech problems
  • characteristic facial appearance
  • cardiac, renal + ocular abnormalities
48
Q

What percentage of Child Protection cases involve parental alcohol use?

A

30 - 60%

49
Q

What can be done to curb alcohol usage?

A
  • Increase price + decrease supply
  • Screening + brief interventions from healthcare workers
  • Develop a more ‘joined up’ approach from services
50
Q

What Public Health measures might be used to reduce alcohol usage?

A
  • Minimum price per unit of alcohol
  • Change licensing laws in areas where cirrhosis is the biggest problem
  • Reduce ‘passive drinking’ effects
51
Q

What is the recommended management for people requesting help with an alcohol problem.

A
  • Perform physical + mental assessment
  • Offer appropriate investigation(s) + follow up
  • Offer referral / treatment as appropriate
52
Q

What should you consider under ‘general support + care’ for a person requesting help with an alcohol problem?

A
  • Address other health issues, as well
  • Consider vitamin supplementation
  • Assess interstitial heart disease risk
  • Consider osteoporosis risk
  • Tailor health assessment to an individual
53
Q

When should blood tests be used with regards to a person who is known to drink alcohol in excess?

A
  • Should NOT be used in screening

- use in established alcohol-related disorder to assess severity + progress in primary care / hospital

54
Q

What screening questionnaires can be conducted if a person is suspected of excessive alcohol consumption?
Who are these questionnaires recommended for?

A
  • AUDIT or CAGE

- Recommended for ‘at risk’ groups, including children

55
Q

When should you consider using the AUDIT or CAGE questionnaires?

A
  • Consider in all adults presenting with health problems commonly linked to alcohol problem drinking
  • not blood tests
56
Q

What does the AUDIT questionnaire (alcohol use) comprise?

A
  • 10 point questionnaire; 5 mins to carry out
  • Hazardous drinking: Score 8 +
  • Alcohol dependence: Women = 13; Men = 15
57
Q

What are the 4 questions which make up the CAGE questionnaire?

A
  • Have you ever thought you needed to cut down on your drinking?
  • Have you ever become angry / annoyed at people criticising your drinking?
  • Do you ever feel guilty about your drinking?
  • Have you ever had an eye-opener in the morning to ease your hangover?
58
Q

What is the sensitivity + specificity of the CAGE questionnaire for alcohol usage?

A 
Sensitivity = 87% 
Specificity = 65%
59
Q

Brief structured advice (Motivational interviewing) has been shown to reduce alcohol intake. What might this discussion cover?

A
  • Potential harm caused
  • Reasons for changing
    > health + wellbeing benefits
    > obstacles to change
    > strategies to combat
    > goals
60
Q

What medications might be used to prevent an alcoholic person from relapsing?

A
  • Disulfiram -> sensitise against alcohol
  • Acamprosate -> GABA blocker
  • Naltrexone -> used in specialist centres
  • none of these agents are particularly effective
61
Q

How is Alcohol Dependence Syndrome classified?

A

Cluster of 3 of the below symptoms in a 12 month period:

  • Tolerance: increasing the amount of alcohol to achieve the same effect
  • Characteristic physiological withdrawal
  • Difficulty controlling onset, amount + termination of use
  • Neglect of social + other areas of life
  • Spending more time obtaining + using alcohol
  • Continued use, despite negative physical and psychological effects
62
Q

What is Wernicke’s Encephalopathy?

A
  • Vitamin B1 deficiency, often occurring on withdrawal of alcohol.
  • Reversible.
  • Not treating can lead to Korsakoff’s.
63
Q

Wernicke’s Encephalopathy is characterised by a triad of symptoms. Name these symptoms.

A
  • Acute mental confusion
  • Ataxia
  • Ophthalmoplegia
64
Q

How should Wernicke’s Encephalopathy be treated?

A
  • Timely injections of Thiamine (Vitamin B1)
  • Poorly absorbed orally
  • Small risk of anaphylaxis when given IV.
65
Q

What is Korsakoff’s syndrome?

A
  • Amnestic disorder due to enduring B1 malnutrition
  • not reversible
  • short term memory loss
  • lose spontaneity, initiative
  • confabulation -> disturbance in memory, defined as the production of fabricated, distorted or misinterpreted memories about oneself or the world.
66
Q

How is diagnosis of Korsakoff’s syndrome made?

A

CT scan

67
Q

What is Delirium Tremens?

A
  • A short-lived (3-5 days) toxic confusional state which usually occurs as a result of reduced alcohol intake in alcohol dependent individuals with a long history of use.
68
Q

What symptoms might a person experiencing delirium tremens present with?

A
  • Clouding of consciousness / confusion / seizures
  • Hallucinations in any sensory modality
  • Marked tremor
69
Q

What is the treatment for Delirium Tremens?

A
  • Supportive:
    > Fluids
    > Benzodiazepines
  • Detoxification in acute situation -> use Benzodiazepines
  • Need support: effective in short term in hospitals
  • Don’t forget about Pabrinex!!! (Vitamin B1)
70
Q

BME communities are at greater risk of developing some of the leading causes of sight loss. Name the top 3.

A
  • Glaucoma
  • Cataracts
  • Diabetic eye disease
71
Q

Name the 6 most common eye conditions leading to sight loss.

A
  1. Cataracts
  2. AMD (Age-related macular degeneration)
  3. Glaucoma
  4. Retinitis pigments
  5. Hemianopia
  6. Retinopathy
72
Q

Describe the manifestation of cataracts.

A
  • Lens becomes less transparent as we age
  • If the lens turns misty / cloudy -> this is a cataract
    > cataract can get worse -> makes vision mistier
73
Q

What is ‘macular disease’?

A

A collective term for conditions which cause damage to the cells of the macula (the central part of the retina) + affects central vision.

74
Q

Describe the visual changes which occur in AMD (Age-related Macular Degeneration).

A
  • Peripheral vision is not affected
  • AMD causes blurred, distorted or dim vision
  • May progress very slowly
75
Q

Which group of people does AMD (Age-related Macular Degeneration) tend to affect?

A

Over 65s: AMD is the leading cause of sight loss in the over 65s.

76
Q

What is the cure for AMD? How can you decrease the risk of developing AMD?

A
  • No cure
  • Slow / halt the disease progression with medical treatment, drug therapy or laser treatment.
  • Decrease risk by having regular sight tests
77
Q

What is ‘glaucoma’?

A
  • Group of eye conditions which affect the optic nerve

- damage may be caused by raised eye pressure or a weakness in the optic nerve

78
Q

Describe the visual changes which occur in glaucoma.

A
  • No symptoms in early stages
  • Peripheral vision is affected; damage can’t be reversed
  • Leads to blindness without early diagnosis + treatment.
79
Q

What are the risk factors for glaucoma?

A
  • Increased age

- Family History of glaucoma

80
Q

What should you offer someone who is over 40 + who has a family history of glaucoma?

A
  • Free eye health checks

- Available to anyone over the age of 40yrs with a family history of glaucoma.

81
Q

What is ‘retinitis pigmentosa’?

A
  • Inherited conditions of the retina -> lead to a gradual, progressive reduction in vision.
82
Q

Describe the visual changes which occur with Retinitis Pigmentosa.

A
  • Initially: difficulties with night vision + peripheral vision
  • Then: reading, colour + central vision are affected
  • Visual deterioration occurs over years, not months.
  • Regular sight tests should pick up any changes in vision.
83
Q

Describe the visual changes which occur with ‘Hemianopia’?

A
  • Sufferers lose either the Left or Right half of the visual field in both eyes following a stroke
84
Q

What pathology might give rise to a person suffering from hemianopia?

A
  • Stroke

- Traumatic Brain Injuries

85
Q

How does Diabetic Retinopathy affect the eyes?

A
  • Affects blood vessels supplying the retina

- Blood vessels become weak + damaged -> serious if untreated

86
Q

What is the leading cause of blindness in the under 65s?

A

Diabetic Retinopathy

87
Q

What is the treatment for Diabetic Retinopathy?

A
  • Laser eye treatment

- Laser treatment can’t restore the sight already lost, but could stop the condition progressing further.

88
Q

What might visually impaired people need to ensure communication is easier for them?

A
  • Large print
  • Audio
  • Email (voice activated)
  • Mobile phones / text
  • Braille + Moon
  • Speech packages
89
Q

When might people need SRSB (Sheffield Royal Society for the Blind)?

A
  • From birth
  • Hereditary conditions
  • Following an accident
  • Emotional support
  • Degenerative conditions
  • Following an illness
  • Care in later life
90
Q

How might people access SRSB services?

Sheffield Royal Society for the Blind

A
  • Self referral
  • GP / Optician
  • Mobile Information Unit
  • Family / friend
  • Low vision clinic
  • Fire + Rescue service
  • Community Engagement Team
91
Q

Define ‘disability’.

A

A disability is related to anyone who has a physical, sensory or mental impairment which seriously affects their daily activities.

92
Q

Not all visually impaired people are visually impaired in the same way. What things might visually impaired people be able to see / not see?

A
  • Nothing
  • Differentiate between light + dark
  • No peripheral vision
  • No central vision
  • Patchwork of blanks + defined areas
  • Some may see enough to read text, although they may have difficulty crossing roads.
93
Q

What is Charles Bonnet Syndrome?

A
  • When visual loss occurs, the brain doesn’t receive pictures as previously occurred.
  • Sometimes, new fantasy pictures (or old pictures stored in the brain) are released + experienced as though they were seen.
94
Q

Who does Charles Bonnet Syndrome affect?

A
  • Condition affects people with serious sight loss
  • Generally affects those who’ve lost their sight later in life.
  • May also affect people who suffer from AMD or retinal disorders.

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