Public Health Flashcards
What were the findings in the 1980 black report
Social inequalities lead to mortality and the inequalities are widening. Answer in political intervention.
What are the four mechanisms outlined in the black report
Artifact, social selection, behaviour and material circumstance
What is the artifact mechanism in the 1980 black report
The findings are just a response of statistical anomalies
What is the social selection mechanism in the 1980 black report
People are in the lower social class because of their ill health, not the other way around
What is the behaviour mechanism in the 1980 black report
The poorer you are the harder it is to control your behaviour and choose healthy behaviour
What is the material circumstance mechanism in the 1980 black report
No control over the resources available to them to improve health
What was the whitehall study
Looked at civil servants and linked employment differences to health inequalities
What was the archeson report of 1988
It found that although mortality reduced, inequality increased and made recommendations
What were the recommendations of the archeson report
Evaluate policies, prioritise families and children, reduce income inequality and improve the housing of the poor
What are the three theories of causation of health inequalities
Neomaterialist, psychosocial and lifecourse
What is the lifecourse theory
Poorer people have fewer resources (physical and mental) to overcome the stressors which accumulate. Critical periods, accumulation, interactions + pathways
What is the psychosocial theory
Low social status, lack of friends and stress in early life
What is the neomaterialist theory
Poverty exposes to health hazards, lack of resources and systematic underinvestment across society
Why do women live longer than men
Hormones, fewer hazards and more likely to see doctor
Three ways to reduce the health inequalities
Change perspectives, change systems and change education
What are the two parts of the medical licensing assessment
Test of applied knowledge and test of clinical/proffesional skills
What are the three outcomes states in the 2017 GMC outcomes for graduates
Professional values and behaviours, professional skills and professional knowledge
Define patient compliance
The extent to which the patient’s behaviour (in terms of medications, following diets or other lifestyle changes) coincides with medical or health advice
What % of chronic prescribed medications arent taken
30-50%
Examples of non adherence
Not taking meds, wrong dose, wrong frequency, stopping meds, modifying treatment for activities, continuing behaviours against advice
What are unintentional (practical) reasons for non adherence
Capacity and Resource. Can’t understand, use, pay or remember
What are intentional (motivational) reasons for non adherence
Perceptual. Due to beliefs about disease or treatment and preferences of treatment
What is the necessity concerns framework
Adherence is improved when necessity increases and concerns are reduced
Define necessity beliefs
Perceptions of personal need for treatment
Define concern beliefs
Concerns about a range of potential side effects
What is the patient centredness change
Shift in focus from treatment to process of care
How does patient centredness change the consultation
Holistic view of the patient in a social context and a shared control of the consultation
What are the four consequences of good patient-doctor communications
1-better health outcomes 2-increased compliance 3-increased patient and clinician satisfaction 4-decrease in malpractise risk
What are the principles of concordance rather than adherence
Recognises it is a negotiation between equals and a respect for the patient’s agenda
What are the steps in shared decision making
1-define problem 2-Dr opinions differ 3-options 4-information 5-Understood? 6-concerns and expectations 7-accept? 8-involve patient 9-review 10-review
How are staff made aware of infection control
Policy development, education and audit
What is infection
Affect with disease causing organism which does harm to the individual
What does the virulence of an organism depend on
Ease of spread, likelihood of causing infection and consequence of infection if it occurs
What are the infection controls at an environmental level
Design, clearing and isolation
What are the infection controls at a patient level
Isolation and antimicrobial stewardship
What are the infection controls at a staff level
Barrier precautions, isolation and handwashing and PPE
What are the stages in identifying an infected patient
Risk factors, screening, clinical diagnosis and lab diagnosis
What are the most common cause of UTI and intraabdominal infection
CPEs (Carbapenemase producing enterobacteriaceae) aka coliforms
Where do CPEs colonise
Large bowel, skin below the waist and moist sites
Name examples of CPEs
E.coli, klebsiella, enterobacter
What are carbapenams
Broadest spectrum beta lactam
What are class A carbapenamases
serine beta-lactamases
What are class B carbapenamases
metallo beta-lactamases
What are class D carbapenamases
OXA variants
What is the MIC of an antibiotic
Minimum inhibitory concentration. How much antibiotic is needed to prevent the growth of an organism
What factors increase norovirus’ deadliness
No envelope so easy spread of RNA, low infecting dose, short lived immunity, persists in environment and resists cleaning.
When should you do handwashing
Before and after handling patients or food or carrying out an aseptic procedure. After handling soiled item, using toilet or removing protective equipment
When should you use alcohol gel
When hands are visibly clean or after hand washing for invasive procedures or when barrier nursing
What are endogenous infections
Infection of a patient by their own flora
Which material is used as an antiinfective, such as for door handles
Copper
What is used for killing spores
Hydrogen peroxide vaping machines
What is the single most effective way of preventing cross infection
Hand hygeine
Which bugs arent eliminated by alcohol gel
C dificile and norovirus
What counts as a low risk encounter
No barrier nursing or fluid exposure - alcohol gel fine
How does the C dificile mechanism work
Spores germinate into bascilli normally following antibiotic therapy. This restricts the flora of bowel and allows C dificile to grow
What is the UNAIDS 2020 90/90/90 target
90% diagnosed, of those 90% on antiretrovirals, of those 90% viral suppression
Which age group has highest prevelance of HIV
35-49
Why are rates increasing in the 50-64 category
People stop using condoms, high divorce rate and poor sex education
What is classed as a late diagnosis
CD4 count below 350
How recent can HIV be picked up
4 weeks
Define palliative care
Palliative care improves the quality of life of patients and families who face life threatening illness, by providing pain and symptom relief, spiritual and psychosocial support from diagnosis to end of life and bereavement
What are the four philosophies of palliative care
Holistic, individualised, multidisciplinary and patients etc are clients
What are the inequalities seen with increasing age (in life)
Greater impairment (from diseases+treatments), increased psychological distress, increased social isolation, poverty and poorer living conditions
What are the inequalities seen with increasing age (in death
Less likely to go to hospice, die where they want, be involved in discussions or have plans. More likely to have repeated hospital admissions
Key issues in living with COPD
Unpredictable illness trajectory, unsure prognosis, poor patient understanding and limited access to specialist palliative care
How do COPD and lung cancer patients compare
COPD patients have more depression, worse activities of daily living, less certainty and less support than lung cancer patients
Define epidemiology
The study of how often diseases occur in different groups of people and why
Define incidence
The rate at which new cases occur in a population during a specified time period
Define prevalence
Proportion of the population which have the disease at a given time
How are prevalence and incidence linked in an equation
Prevalence=incidence x average duration
What is mortality
Incidence of death from a disease
What are reasons for geographical variations in COPD
Socioeconomic differences and deprivations, historic industry, developing world (indoor cooking and smoking), passive smoking
What are the bradford-hill criteria
For relationship. Strength, Consistency, specificity, reverse causation, dose response, experimental evidence, biological plausibility, coherence and analogy
What are components of good work
Safe, reliable, fair, social, individual control and good work/life balance
What are sources of data for occupational disease
Labour force survey, death certificate, disablement benefit and surveilance schemes (SWORD and EPIDERM etc)
Define hazard
Something that is potentially harmful
Define risk
The probability of harm
