PUBLIC HEALTH Flashcards
Causes of child death worldwide
- Pneumonia, acute respiratory infection
2. Diarrhoea (malnutrition is major component)
Prevention measures for diarrhoea
Access to safe drinking water
Sanitation/ access to toilets
Hand hygiene
Most common causes of diarrhoeal illness
1. Viruses (90% in adults; 70% in children) Rotavirus Norovirus Adenovirus Astrovirus
Leading cause of diarrhoea in children worldwide
Rotavirus
What is the difference in rotavirus transmission between developed and developing countries
Developing - all year around transmission
Developed - seasonal transmission
How is the rotavirus vaccine delivered to children and at what are in UK. What effect does the vaccine have on transmission.
Oral vaccine given at 8 and 12 weeks.
70% reduction in transmission.
What are the commonest work related diseases in UK
- Work related stress
- Work related MSK problems
- Work related lung disease
- Work related cancer
- Noise induced hearing loss
- Hand arm vibration
What is the difference between case control and cohort studies
Cohort studies the line of enquiry is always forward, even if its retrospective. You dont have the disease outcome, its looking at exposure to outcome, rather than outcome to exposure (this is case control)
Case control its backwards - in this situation you have your disease state already and you are looking backwards at what the risk factors were
What study design is best suited to
calculating attributable risk?
Attributable risk is mostly calculated in cohort
studies, where individuals are assembled based
on exposure status and followed over a period
of time.
What are the different patterns of occupational disease presentation
Acute Cumulative Progressive (disease progression after exposure ceases) Diseases with latencies.
Define hazard and risk
Hazard = potentially harmful Risk = probability of harm
List some common work hazards
Mechanical Physical Chemical Biological Psychosocial
What factors make work “good for you”
Precariousness – stable, risk of loss, safe
• Individual control – part of decision making
• Work demands – quality and quantity
• Fair employment – earnings and security from employer
• Opportunities – training, promotion, health, “growth”
• Prevents social isolation, discrimination & violence
• Share information, participate in decision making collective bargaining, justice
if conflicts
• Work/life balance
• Reintegrates sick or disabled wherever possible
• Promotes health and wellbeing – psychological needs self efficacy, self
esteem, belonging and meaningfulness
How can you identify an occupational work disorder
An illness that fails to respond to standard treatment, does not fit the typical demographic profile or is of unknown cause should raise suspicion of an occupational etiology
Flags for occupational work disorder
Illness doesnt fit normal demographic - eg. back pain in young person
Doesn’t respond to treatment
Unknown cause
Gets better away from work/ holidays
List some good screening questions for occupational work disorders
- What type of work do you do?
- Do you think your health problems might be related to your work?
- Are your symptoms different at work and at home?
- Are you currently exposed to chemicals, dusts, metals, radiation, noise or repetitive work? Have you been exposed to chemicals, dusts, metals, radiation, noise or repetitive work in the past?
- Are any of your co-workers experiencing similar symptoms?
If the answers to one or more of these questions suggest that a patient’s symptoms are job related or that the patient has been exposed to hazardous material, a comprehensive occupational history should be obtained.
Outline an occupational health history
-Current job, employer, duration • Tasks as well as job title • Past employers and jobs • A brief exposure can be enough • External and internal exposure • Hobbies? (DIY, pets, gardening, chemicals) • If you’re suspicious don’t give up !
What are the risks of being out of work on health
Greater risk than many “killer diseases” • Greater risk than most dangerous jobs (e.g. construction, fishing, etc) • 2 to 3 times risk of mental illness • 2 to 3 times risk of poor health • Loss of fitness and well-being • Social exclusion and poverty • Trapped on benefits to retirement
Define disability as per the Equality act 2010
A physical or mental impairment, which has a
substantial long-term adverse effect on a
person’s ability to carry out normal activities
Type of impairment is broadly defined
Substantial adverse effect
Long-term
Normal activities
What should employers do for those with disability, as per the Equality 2010 act
• altering the person’s working hours
• allowing absences during working hours for medical
treatment
• giving additional training
• getting special equipment or modifying existing equipment
• changing instructions or reference manuals
• changing an open plan working policy to accommodate
someone with an anxiety condition or autism
• providing additional supervision or support
• making adjustments to premises
What public health (population based) approaches can be used to help prevent occupational diseases
Levels of prevention
‒ Primary (e.g. monitor risk, controlling hazards, promotion)
‒ Secondary (e.g. screening, early detection, task modification)
‒ Tertiary (e.g. rehabilitation, support)
• Musculoskeletal - https://www.sheffieldachesandpains.com/
• Mental health - https://www.england.nhs.uk/mentalhealth/adults/iapt/
• Occupational asthma - http://www.hse.gov.uk/asthma/
What is length time bias
This is when a random interval is selected for analysis, that favours slow growing tumours for inclusion in analysis. This is because slow growing tumours have a longer asymptomatic period so these pts will be eligible for screening, where as those with fast growing will be symptomatic faster and not included. This distorts survival time from screening.
SELECTION BIAS
What is lead time bias
This is when disease survival looks better after screening but the actual length of the disease is unchanged, survival time is only increased because the disease what identified at an earlier time point, survival is the same.
What are the risks & benefits of PSA screening
Benefits
Early diagnosis of localised disease (cure)
Early treatment of advanced disease (effective palliation)
Risk
Overdiagnosis of insignificant disease
Harm caused by investigation/ treatment
What are the risks of opportunistic screening for prostate cancer
Conflicting opinion – increased anxiety Poor QA of procedures Iniquitous access Variable intervals of testing Costs ?
What is the prognosis for prostate cancer
Depends on what grade and stage you have
Localised prostate cancer - natural disease course unknown
Loalised advanced
Advanced metastatic = 2.5 years
Overall, around 8 years survival.
Only approx 1/4 die of prostate cancer, most men with prostate cancer die of another illness
Describe a typical patient with prostate cancer
Male, over 50
Presenting with symptoms - probably in 70s
Presenting without symptoms - 50-60s
How does prostate cancer metastasise
Through capsule - Lymph nodes - Bone
What is the grading system used for prostate cancer
Gleasons
1-5
What is the staging system used for prostate cancer
TNM
T = can stage by DRE
T1 - non palpable mass
T2 - palpable mass - localised to prostate
T3 - palpable mass - extended beyond prostate
N = can stage by MRI/ CT to look at noded M = can stage by bone scan to look at mets
HIV transmission routes
Blood, Vertical, Sex
What is the infective rate of HIV
Really low!
0.04 - 3% - highest with anal sex
Compare to syphilis, 40-60% - actually quite low
What is the May & Anderson 1987 model, what is it used for
It is a model that is used to describe STI transmission R = BCD R = reproductive rate B = infective rate C = no of partners D = Duration of infection
What is the diagnostic criteria for substance dependence as per ICD-10
3/6 of the following within the past 12 months
- Tolerance
- Drug withdrawal
- Compulsion or increased desire to take drugs
- Loss of control over drug use, (onset, level, termination, i.e. increasing binges etc)
- Prioritising drug seeking or taking over other interests
- Continued drug use and seeking despite negative consequences (personal, professional, social etc)
Outline theories on the causes of addiction/ approaches to intervention
1.Disease model - intervention is based around substitute drugs to stabilise physiology before terminating drug use. Vaccinations for high risk groups.
2.Behavioural model - interventions based around deincentivising drugs, eg punishments for drug use
3.Volitional model - interventions based around improving behavioural control
4.Socio-cultural - Target poverty, social exclusion, housing and mental health
problems etc
What are the impacts of substance misuse
Acute
Individual harms - medical - overdose, adverse drug reaction
Aggression/ violence - social
A&E attendance - costs
Chronic Dependence Family breakdown Relationship and peer breakdown Unemployment Isolation and mental health problems Behavioural problems Many illnesses - pancreatitis, liver disease, CNS disease, peripheral neuropathy etc Crime and violence More costs to NHS
What are the risk factors for dependence
Family - disorganised, chaotic, FHx of drug use, conflict, poor parenting, domestic abuse, being in care
School/ community - poor attainment in school, low social mobility in community, disorganised community, availability in community, community norms
Individual & peer group - peer recognition, risk taking/ sensation seeking, positive attitude towards antisocial behaviour, rebelliousness, alienation, experience of trauma
