Public Health Flashcards
7 duties of a doctor?
Patients = 1st concern Knowledge = up to date Dignity Polite Confidential Promote health Within competence
4 psychosocial CHD
Type A
Depression
Work (hours, demand)
Social support
Helping those with increased CVD risk?
Depression Occupation Social services Vascular screening QRISK 2 Lifestyle
Benefits alcohol?
Euphoria
Social
Low dose = cardioprotective
Excess alcohol problems?
Relationships (violence, depression, anxiety) Criminal (violence) Unemployment Poverty Driving offences
Alcohol withdrawal sx?
Tremulouness Agitation >hr >bp Hallucinations Delirum Tremens (shaking, confusion...)
1 unit alcohol (in g/ml, eg drink, equation)
8g/10ml pure alcohol 1/2 pint beer Small glass wine Single measure spirits Strength (%ABV) x Amount (L)
Fetal alcohol syndrome?
Peri/post-natal growth retardation
CNS (mental retardation, irritability, hyper-reactivity)
>birthmarks./hernias
Primary prevention alcoholism?
Drinkaware (alc labelling)
THINK (driving)
‘Know your limits’ campaign
Secondary prevention alcoholism
Ask routinely (screening Q) Detect problem drinking (inc lab tests)
What can doctors do for alcoholics?
Screen: CAGE & AUDIT (ALcohol Use Disorders Interviews Test)
Brief Interventions: FRAMES (motivational interviewing)
Ref. specialists
Set goals, agree on plans, educational material
CAGE?
Cut down?
Annoyed by criticism
Guilt
Eye-opener
Alcohol abuse = ?
Role failure
Relationship problem
Run in with law
Risk of bodily harm
Alcohol dependence?
Withdrawal sx Tolerance Drinking despite problems Can't keep to limits Lots of time drinking/recovering Less time of imp. things
FRAMES?
Feedback (risks) Responsibility Advice Menu of alternatives Empathy Self-efficacy (patient feel able to cope w/goals)
Mx alcoholism?
Naltrexone (opioid antag) Disulfiram (>sensitivity to alc) Acaprosate (stabilises chem balance) Behavioral therapy Social support (AA)
Why do people smoke?
Fear >kg Stress Social Nicotine addiction Habit
Signs stress?
Beharioral (alc, sleep, absenteeism) Cognitive (concentration, -ve thoughts) Physiological (headache) Emotional (swings, tearful, irritable) Biochem (endorphins)
NHS Screening (breast)?
Mammo
50-60
3yr
NHS Screening (bowel)
Faecal-occult
60-74
2yr
NHS Screening (cervical)
Cervical smear liquid based cytology
25 3yr
50-64 5yr
NHS Screening (3 eg other than breast/bowel/cervical)
AAA>65, newborn hearing, sickle cell & thalassaemia screen
Screening Principles?
Wilson-Jugner: Important problem Recognisable early stage Facilities for dx and tx Suitable test Acceptable test Natural hx Continuous Dx improves prog Cost-effective
Occupational screening (5)?
What Health re/work? Sx home v work Exposure (chemicals, polutants, dust, metals, noise, repetetive) - current and past Co-workers similar
Def substance misuse?
Non-therapeutic ingestion substace affecting CNS, causing behavioural/psychological change
3 dx substance misuse
Acute intox, harmful use, dependance
4 tiers UK drug treatment
1 non-specialist (substitution)
2 open-access
3 specialist community based
4 inpatient (naltrexone, rehab)
Def malnutrition
Deficiency/excess energy/protein/other nutrients -> adverse effect tissue/body/clinical outcome
4 consequences malnutrition?
Loss muscle (resp, heart, mobility)
Immunity
Poor wound healing
Psychosocial (depression/apathy)
Malnutrition assement?
1) BMI
2) Unexplained
4 Q for patient re malnutrition?
Lost weight?
Eating normally?
Normal weight?
Height?
4 functional assessments older people?
ADL = 6
Instrumental (ADL) = 7
Barthal ADL = 10
Mini Mental State Exam (orientation, registration, short-term memory, language)
Disability paradox
Profound disability -> high QoL reported
expectation?
Influenza; R number?
Reproduction no.
Primary case -> x secondary cases?
Level intervention to control epidem?
Influenza; pub health intervention
Hand washing
Resp hygeine “catch, bin, kill”
X attend large gatherings
Influenza; wide intervation
Travel restriction Reduce large gatherings Schools closure Voluntary home isolation Volutary isolation Screening at ports
3 phases mx infection threat
Identification
Containment (reduce spread: hand washing, isolation etc)
Management (spreading freely: protect vulnerable, vaccinate)
C Diff (SIGHT, reduce, mx)
Suspect (diarrhoea) Isolate Gloves & apron Hand washing (soap!) Test (stool for Toxin)
Control abx
Vancomycin
5 types of study?
Ecological (pop based) Cross-sectional (incidence) Case-control Cohort (follow over time) Interventional
