Public Health Flashcards
1
Q
What are the duties of a doctor?
A
- care of patient is first priority
- keep knowledge and skills up to date
- treat patient as individual and respect their dignity
- respect patients rights to confidentiality
- treat patient politely and considerately
- recognise and work within limits of your competence
2
Q
How can premature death be quantified?
A
death under 75yrs
3
Q
What psychosocial factors increase CHD risk?
A
- type A personality
- depression or anxiety
- psychosocial work aspects: long hours (<11hrs), high demand, low control
- lack of social support
4
Q
What can doctors do for those with CVD risks?
A
- identify depression/anxiety
- ask about occupation
- promote better healthier lifestyles
- QRISK 2 score
- vascular screening
- liase with support services
5
Q
How to remember Bradford Hill Criteria?
A
Strong, consistent, specifically I love you, temper is good, more you see the more you like him, doesn’t expect you to swallow, can give you children, discovery channel
6
Q
What is the Bradford Hill Criteria used for?
A
To establish a causal relationship (used in CVD risk factors)
7
Q
What are the 8 Bradford Hill Criteria?
A
Strong Consistency Specificity Temporality Dose Removal Biological plausibility Experimental animals
8
Q
What are the benefits of alcohol consumption?
A
- mild euphoria
- socialisation
- cardiopreventative in low doses
9
Q
Psychosocial effects of excessive alcohol consumption?
A
- relationship problems
- violence/criminality
- problems at work/unemployment
- social disintegration (poverty)
- driving offences
10
Q
Give some examples of withdrawal symptoms…
A
shakes 'activation syndrome': tremulousness, agitation, rapid HR, high BP seizures hallucinations deliruim tremens (severe and fatal)
11
Q
What are the recommended weekly alcohol limits?
A
men and women 14 units per week
12
Q
How do you calculate the units in an alcoholic drink?
A
strength of drink (%ABV) x amount of liquid (ml) / 1000
13
Q
How much is one unit of alcohol?
A
8g/10ml of pure alcohol
14
Q
What is foetal alcohol syndrome?
A
Woman drinks alcohol during pregnancy and can cause damage to foetus:
- growth retardation
- CNS abnormalities: mental retardation, incoordination and hyperactivity
- craniofacial abnormalities: congenital defects (eyes, mouth, ears)
- increased incidence of birthmarks and hernias
15
Q
Give some primary prevention strategies of alcoholism
A
Drinkaware- alcohol labelling THINK! - drink driving campaign 'know your limits' - binge drinking campaign + restriction on alcohol advertising Minimum pricing age limit on alcohol
16
Q
Give some secondary prevention strategies for alcoholism
A
Screening and intervention:
- ask about it routinely using screening questions or tools (FAST AUDIT)
- detect problem drinking (through lab tests)
17
Q
What can doctors do for alcoholics?
A
Screening: CAGE and AUDIT
Brief interventions: FRAMES- motivational interviews
Referral to specialist
Help set goals, agree on plan, provide educational materials
18
Q
What is AUDIT?
A
Alcohol Use Disorders Identification Test- ask patients 10 questions then score them on scale of 0-4
A score of 8 or more is considered to indicate hazardous or harmful alcohol use
Questions include: how often, how many, how often more than 6, injured someone else due to drinking + CAGE questions
19
Q
What is the severity of dependence questionnaire?
A
Used to assess dependence on alcohol: 20q
score = >30 severe; 16-30 mod, <16 mild
20
Q
What is the CAGE questionnaire?
A
Screening test for drinking problems
C= anyone asked you to cut down?
A= ever been annoyed by someone asking you to cut down?
G = ever felt guilty about your drinking
E = ever needed an ‘eye opener’ the next day to steady nerves/get rid of hangover?
21
Q
Give the 4x R’s of alcohol abuse…
A
Role failure
Run ins with the law
Relationship problems
Risk of bodily harm
22
Q
How can you define alcohol dependence?
A
3 or more of the following in last 12 months:
- withdrawn symptoms
- increased tolerance
- keep drinking despite problems
- cannot keep within drinking limits
- spend lot of time drinking/recovering
- spend less time on other important matters
23
Q
What is FRAMES?
A
Motivational interviewing- Brief Intervention for risky or harmful alcohol consumption
- Feedback- risk of personal harm/impairment
- Responsibility- stress personal responsibility for change
- Advice- cut down/stop drinking
- Menu- provide alternative strategies for change
- Empathetic- use empathetic interviewing style
- Self-efficacy- leaves patient feeling they can cope with goals agreed
24
Q
What are the pharmacological treatments for alcoholism?
A
DAN
- Disulfiram- produces a sensitivity to alcohol»_space; worst hangover
- Acamprosoate- stabilises chemical balance BUT GI Sx
- Naltrexone- competitive antagonist for opioid receptors»_space; reduces pleasure/reward associated with alcohol
25
What treatments are there for alcoholism?
1. pharmacological: Disulfiram, Acamprosoate, Nalmefine
2. behavioural therapy
3. social support
4. detoxification: chlordizapoxide
26
Give one complication of alcoholism...
Vit B1 (thiamine) def >> Wernickes encephalopathy >> Wernickes-Korsakoffs syndrome
27
Give 5 reasons why people smoke?
```
fear of weight gain on cessation
coping with stress
socialising
nicotine addition
habit/behavioural
```
28
What can doctors do for smokers?
All the A's
Ask (are you a smoker)
Advise (smoking is bad)
Assess willingness to quit
Assist (therapy)
Arrange to follow-up (refer to NHS Stop Smoking services)
+ nicotine replacement therapy: patches, gum, nasal spray
29
What is the Stages of Change/Transtheoretical model applied to smoking cessation?
1. Pre-contemplation- not thinking of quitting
2. Contemplation: thinking about quitting but not ready
3. Preparation: takes steps to prepare for quitting
4. Action- ex-smoker, less than 6 months
5. Maintenance- non-smoker, quit for >6months
6. Relapse = quit but had a lapse that led to smoking being resumed
30
What is Eustress?
Good stress that is motivating and provides an incentive to get the job done
31
What is distress?
When good stress becomes too much to bear or cope with and leads to poor decision making
32
Give 6 signs of stress...
Biochemical- increased cortisol
Physiological- increase HR
Emotional- tearful, mood swings, irritable
Behavioural- take up smoking or drinking
Cognitive- -ve thoughts, poor concentration
Sleep disturbances- insomnia
33
What is the stress-illness model?
an individuals susceptibility to illness is increased because an individual is exposed to stressors which cause strain on the individual leading to psychological and physiological change
34
Which physical illnesses are associated with stress?
IBS, IBS, Heart disease, ME, infertility, peptic ulcers
35
Name some NHS screening programmes...
1. Breast screening: 50-70 every 3 years
2. Bowel cancer- 60-74 every 2 years
3. Cervical screening 25+, 3 years and 50-64 every 5 yrs
4. AAA- 65+
5. Newborn hearing screening
6. Sickle cell and thalassaema screening
36
What are the Wilson and Junger screening principles?
IATROGENIC
Important – the condition should be an important one
Acceptable treatment for the disease
Treatment and diagnostic facilities should be available
Recognisable at an early stage of symptoms
Opinions on who to treat as patients must be agreed
Guaranteed safety e.g. low radiation exposure
Examination must be acceptable by the patient
Natural history of the disease must be known
Inexpensive test
Continuous screening i.e. not a one-off
37
What is sensitivity?
measure of how well a test picks up those with the disease
38
What is specificity?
Measure of how well a test recognises those without the disease
39
What is prevalence?
measurement of all individuals affected by the disease at a particular time
40
What is incidence?
the number of new individuals who contract a disease during a particular period of time
41
How would you carry out occupational screening?
Ask the following questions:
1. What type of work do you do?
2. Do you think your health problems might be related to work?
3. Are your symptoms different at work and at home?
4. Exposed to chemicals, dusts, metals, radiation, noise or repetitive work? In the past?
5. Are any of your co-workers experiencing similar symptoms?
42
The Marmot review suggested what recommendations to tackle health inequalities in the workplace? OCCUPATIONAL GOOD WORK
1. work/life balance
2. opportunities- training, promotion, health, growth
3. promotes health and wellbeing (psych needs)
4. fair employment- earnings and security from employer
5. prevents social isolation, discrimination and violence
6. reintegrates sick or disabled wherever possible
43
Define an occupational cause of illness?
an illness that fails to respond to standard treatment, doesn't fit the typical demographic model or is of unknown causes should raise the suspicion of occupational aetiology
44
What did Waddell and Burton find in 2006?
That work has positive effect on health >> good mental health, physical, choice of voluntary retirement and wellbeing
45
Give a population approach to OH?
Prevention:
1. primary- control hazards, monitor
2. secondary- screening
3. tertiary- rehabilitation, support
46
How can a GP tackle OH?
"fit note"
| Phased returns to work after illness
47
What are the principles of first aid treatment?
1. Look for danger- make area safe
2. make area safe
3. assess casualties + attend to unconscious
4. send for help
5. check response "Are you okay"
6. Shout for help (call 999)
7. open airway
8. check for normal breathing
9. no breathing 30-2 + repeat
48
What is ABC?
Airways
Breathing
CPR- rate 100-120per min
49
Define sustainable healthcare?
"being able to meet the needs of today without compromising the ability of future generations to meet the needs of tomorrow"
50
Define substance misuse?
ingestion of a substance affecting the CNS which causes behavioural and psychological changes, non therapeutic use
Addiction = physical and psychological dependence
51
Give some types of drugs...
Opiates, depressants, stimulants, hallucinogens
52
What are New Psychoactive Substances (NPS)?
"legal highs" much less predictable and v.harmful: OD, psychosis, pyrexia, vomiting, hallucinations, confusion
53
What are the risk factors for drug use?
```
bad parenting
familial drug use
poor schooling.lack of education
community norms
low neighbourhood attachment
being in care
peer pressure
trauma
```
54
What is the UK drug treatment?
Tier 1: non-specialist, generic, wean patient off drug
Tier 2: open-access services
Tier 3: specialised community-based drug services
Tier 4: specialist inpatient services
- detoxification: naltrexone (opioid antagonist)
- residential rehabilitation (3-12months)
55
Define malnutrition...
State of nutrition in which deficiency or excess of energy, and other nutrients causes adverse effects of tissues or body function
56
What are the consequences of malnutrition?
1. loss of muscle tissue and strength
2. reduced immune response/increased infections
3. poor wound healing
4. malabsorption
5. psychological decline- depression, apathy
57
Seven steps to end malnutrition in hospital...
1. hospital staff must listen to elderly, their relatives and carers and act on what they say
2. all ward staff must become 'food aware'
3. host staff must follow own professional codes and guidance from other bodies
4. older people assessed for signs of malnutrition on admission ad regular intervals during their stay
5. introduce 'protected mealtimes'
6. implement 'red tray' system and ensure it works in practice
7. use volunteers where appropriate
58
Define nutritional screening and nutritional assessment in malnutrition?
National screening- to identify malnourished patients by medical and nursing staff
Nutritional assessment: to fully assess, monitor and support patients by dieticians and nutrition nurses
59
What methods can be used to improve or maintain nutritional intake?
1. oral nutrition support- food, fortified sip feeds
2. enteral tube feeding- delivery of a nutritional complete feed directly into the gut via a tube
3. parenteral nutrition- delivery of a complete nutrition IV
60
How do you calculate BMI?
BMI = Weight (kg) / height (M)2
61
In malnutrition what should patients be asked?
1. have you unintentionally lost weight recently?
2. have you been eating less than normal?
3. what is your normal weight?
4. how tall are you?
All patients should be weighed and have their height measured
62
What is anorexia nervosa?
fear of fatness, self starvation, refusal to maintain or achieve 85% of normal body weight
dietary restriction, excessive exercise, induced vomiting, laxatives
'starvation syndrome'
BMI <17.5
secondary endocrine and metabolic change (amenorrhoea)
63
What is bulimia nervosa?
repeated bouts of overeating (bingeing) for a set period of time followed by purging, fasting or excessive exercise
- pre-occupation with body weight
Need, once weekly for 3m = Dx
64
What are the 4 psychological principles of eating disorders?
1. judge self-worth exclusively in terms of shape, weight and their control
2. Control of eating and shape is socially reinforced and apparently more controllable than other aspects of life
3. individual vulnerability plus challenges of adolescence can start the disorder
4. Thinness = competence, attractiveness, control and independence
65
Name some 'other' eating disorders.....
- atypical anorexia nervosa )extreme weight loss but normal weight)
- binge eating disorder (low freq)
- bulimia nervosa (low freq or duration)
- purging disorder
- night eating syndrome
66
What is the treatment approach for anorexia nervosa?
1. stabilise eating, self-monitoring and weekly weighing (not self-weighing)
2. focus on enhancing motivation
3. change behaviour: weight gain = essential
4: cognitive restructuring
5. relapse prevention
6. food diaries
7. psychological- CBT, MANTRA, family therapy
67
What is the treatment approach for bulimia nervosa?
1. education
2. stabilise eating patterns
3. strategies to manage urges ot binge/purge
4. systematic intro of avoided foods
5. problem-solving
6. reduction of body-checking
7. modification of beliefs
68
What is the difficulty in treating anorexia when compared with bulimia?
anorexia harder to treat than bulimia
- people with anorexia less likely to want treatment and unlikely to persevere with efforts to change
- higher mortality rate in anorexia
69
Define health...
a state of complete physical, mental and social wellbeing and not merely the absence of disease
70
Define ethics...
system of moral principles and branch of philosophy which defines what is good for individuals and society
71
What is consequentialism?
concerned with the outcomes or consequences of behaviour; form the basis for any valid moral judgement; means are unimportant
72
What is utilitarian?
Act evaluated solely in terms of its consequences, produce the greatest possible balance of value over disvalue
- maximise wellbeing and minimise suffering
73
What is deontology?
duty to follow natural laws and rights
- rightness or wrongness from the character of the act itself rather than the outcomes
- features of the act themselves determine worthiness e.e.g doctors ought to respect every human being, both oneself and every other person, even if this leads to unfortunate consequences
74
What is virtue ethics?
focus is on the character of the agent
- integrates reason and emotion
- deemphasises rules, consequences and particular acts
- contrasts with consequentialism
75
What is morality?
concerna bout the distinction between good and evil or right and wrong
76
Describe truth telling...
Sensitive to cultures
| Right amount, right person, right time
77
What is whistleblowing and why should you do it?
'raising concerns about a person, practice or organisation'
1) duty as a doctor
2) bristol cardiac surgery
3) mid Staffordshire
4) patient and their care is primary concern
78
What are the five focal virtues?
1. compassion
2. discernment- understand why as well as how
3. trustworthiness
4. integrity
5. conscientiousness
79
What is compassion?
An active regard for another's welfare combined with an imaginative awareness and emotional response of deep sympathy, tenderness and discomfort at another's misfortune
80
What are the limitations of virtue ethics?
- assessment of virtue is cultural- non specific
- notion of virtue is too broad to allow for practical application
- an emphasis on moral character of individuals ignores social and communal dimensions
- conflicting virtues : honesty vs. kindness
81
What are The Four Principles?
1. Autonomy
2. Beneficience
3. Non-malificence
4. Justice
82
What is autonomy?
self-rule or self-governance; obligation to respect the decision-making capacities of autonomous person
subsumes informed consent before treatment, confidentiality, honesty and good communication
Emmanuel Kant: treat others as ends in themselves and not merely as a means to an ent
- contrast with paternalism
83
What is beneficence?
Doing the right thing for patients; provide benefits to others, better off than before
Also incorporates empowerment; helping the patient to make appropriate decisions for themselves
84
What is non-maleficence?
DO NO HARM intentionally or inadvertently wherever possible
| - means evidence based practice and keeping up to date
85
What is justice?
A MORAL OBLIGATION to act on the basis of fair adjudication between competing claims
need vs. benefit
86
What is an autonomous action?
1. intentional
2. done with understanding
3. done without controlling influences that determine an individuals actions
87
Give an example of conflict between principles in medicine?
1. It is morally prohibited to risk death for a patient whose life threatening condition can be medically managed by suitable medical techniques
2. It is morally prohibited to disrespect a first party refusal of treatment
88
What is the doctrine of dual effect?
1. nature of the act itself is good
2. agent intends the good effect and not the bad, either as a means to the good or as an end itself
3. good effect outweighs the bad to justify causing the bad effect and the agent exercises due diligence to minimise the harm
The principle is used to justify the case where a doctor gives drugs to a patient to relieve distressing symptoms even though he knows doing this may shorten the patient's life.
This is because the doctor is not aiming directly at killing the patient - the bad result of the patient's death is a side-effect of the good result of reducing the patient's pain.
Many doctors use this doctrine to justify the use of high doses of drugs such as morphine for the purpose of relieving suffering in terminally-ill patients even though they know the drugs are likely to cause the patient to die sooner.
89
Define consent...
Voluntary
Informed
Made by someone with capacity
90
Conflict with the law....
1. euthanasia
2. manslaughter
3. suicide
4. abortion
If a patient is unable to give consent, you can only give the treatment necessary to preserve life and limb in an emergency
91
Name 4 of the millennium developmental goals...
1. eradicate extreme poverty and hunger
2. universal primary education
3. promote gender equality
4. reduce child mortality
5. improve maternal health
6. combat HIV/AIDS, malaria and other diseases
7. ensure environmental sustainability
8. develop a global partnership for development
92
Black Report (1980)- theoretical explanations of the relationship between health and inequality might be roughly divided into what 4 categories?
Material: environmental causes, maybe influenced by behaviour
Artefact: apparent product of how it is measured
Cultural: poorer people behave in unhealthy ways
Selection: sick people sink both socially and economically
93
Give some recommendations to reduce inequality...
1. improve daily living conditions
2. tackle unequal distribution of power, money and resources
3. measure and understand the problem and assess the results of action: need high quality surveillance systems
94
Give 4 different methods of function assessment in older people...
1. KATZ: activities of daily living scale: 6 capabilities graded on level of independence
2. Instrumental Activities of Daily Living scale: 8 capabilities graded on level of independence
3. Barthel ADL index: based on 10 items that measure a persons daily functioning
4. Mini Mental State Examination (MMS): measures orientation, registration, short-term memory and language functioning
95
What is the disability paradox?
People with a profound disability report a higher QoL: they adjust their expectations to their condition and lower expectations >> higher satisfaction
96
What is influenza reproduction number?
R is defined as the average number of secondary cases generated by a primary case
97
Name 3 public health interventions for influenza...
1. hand washing
2. respiratory hygiene 'catch it, bin it, kill it'
3. reduce social contact: not attending large gatherings
98
Name some influenza wide interventions...
1. travel restrictions
2. restrictions of mass public gatherings
3. schools closure
4. voluntary home isolation of cases
5. voluntary quarantine of contacts of known cases
6. screening of people entering UK ports
99
What are the phases of managing infectious threats?
IDENTIFICATION: of new threat
CONTAINMENT: reduce spread whilst learning about disease and developing treatments/vaccines. Handwashing, antivirals, controlling ports etc.
MANAGEMENT: manage cases, reduce severity, protect vulnerable. Vaccinate/isolate
100
What is done in the management of Clostridium difficile?
```
Suspect the cause of diarrhoea is C.difficile
Isolate the case
Gloves and apron must be worn
Hand washing with soap and water
Test stool for toxin
```
101
How is C.diff treated?
Metronidazole or vancomycin
102
What is on the diarrhoea control measures checklist?
1. hand washing with soap
2. sure availability of safe drinking water
3. safe disposal of human waste
4. breastfeeding of infants and young children
5. safe handling and processing of food
6. control of flies/vectors
7. case management including exclusion
8. vaccination
103
What are the diarrhoea at risk groups?
A- people with poor hygiene
B- children at nursery or pre-school
C- people who prepare or serve unwrapped/uncooked food
D- HCW/social care staff
104
What is the treatment for diarrhoea?
```
1 = prevent
2 = treat: fluids or zinc
```
105
Describe cause of death reporting...
1(a) disease or condition leading directly to death
(b) other disease or condition, if any, leading to 1(a)
(c) other disease or condition, if any, leading to 1(b)
II = other significant conditions contributing to death but not related to the disease or condition causing it
106
What is the Iceberg concept of disease?
"iceberg of disease” is a metaphor emphasising that for virtually every health problem the number of cases of disease ascertained (those visible) is outweighed by those not discovered (those invisible).
The floating tip of the iceberg represents what the physician sees in the community. The tips represents those persons who have showed symptoms of the disease and are recognized as cases (diseased persons).
The vast submerged portion of the iceberg represents the hidden mass of the disease that is latent/ inapparant/ pre-symptomatic/ undiagnosed cases and carriers in the community.
Blocks 1 and 2 correspond to the iceberg above the sea-level and 3 to 5 below sea level
107
What is reflection?
- a process of exploration and discovery
- it is deliberate, intended and directed towards a goal
- it is total response to a situation or event
- it includes thoughts, feelings and behaviours
- it occurs at the time of an event or after it
108
Define prevalence
Proportion of a population that have a given disease at a given point in time
109
How is prevalence calculated?
prevalence = incidence x average duration
110
Define mortality
incidence of death from a disease
111
Name the 3 types of error...
Ommission- delay in action or not taken
Professional negligence
Commission ( wrong action taken)
112
Define human error...
failure of planned action or sequence of mental/physical actions to be completed as intended
113
Define never events...
serious, preventable patient safety incidents that should not occur if available preventative measures have been implemented.
These are INTOLERABLE and INEXCUSABLE
114
Define latent failure...
removed from practitioner and involving decision that affect organisational policies, procedures and allocation of resources
115
Define active failure...
involved direct contact with patient
116
What is the duty of candour?
professional duty to be open, transparent and honest if a patient under your care has been subjected to your mistake. Tell the truth, inform of short and long term SE and how situation will be remedied.
117
What are the rights of prescribing?
right drug, right patient, right dose, tight time, right paperwork, right reason, right route
118
Define NNT..
number of patients receiving treatment that it takes to benefit 1 person
119
Define PPV (positive predicted value)
proportion with +ve result who have disease (high = good)
120
Define NPV (negative predicted value)
proportion with -ve result who don't have the disease
121
Define Odds Ratio...
measure of association between an exposure and an outcome and it represents the odds that an outcome will occur given a particular exposure
122
Define population attributable fraction (PAF)
disease incidence in the population that would be eliminated if the exposure were eliminated
123
What in the inverse care law?
that the availability of healthcare in a population varies inversely with the need for it in a population (those that need it the most don't receive it)
124
What is the alcohol harm paradox?
Lower SES drink less than higher SES, BUT come to more harm as a result (likely due to more acute binges vs. higher SES)
125
What is the prevention paradox?
a large number of people exposed to a small risk can create many more cases of disease that the small number of people exposed to greater risk factors
126
What is the Bolam test?
It states that if a doctor has acted according to proper and accepted practice, he is not guilty of medical negligence.
It also states that the standards should be judged by one’s own peers — not the longest-serving doctor or the senior consultant, but those who work in the same field and are peers of the doctor in question.
127
What is the Bolitho test?
"The court should not accept a defence argument as being ‘reasonable’, ‘respectable’ or ‘responsible’ without first assessing whether such opinion is susceptible to logical analysis”
128
Why is diabetes a public health issue?
increasing prevalence
affecting younger people
many associated comorbidities
129
Types of glucose screening
- random capillary blood glucose
- random venous blood glucose
- fasting venous blood glucose
- oral glucose tolerance test
- HbA1c
130
What problems are there with doctors health?
- high suicide rates
- MH problems
- martial problems
- alcohol and drug abuse
131
Why are health problems so bad amongst doctors?
- excessive workloads
- poor Mx
- insufficient resources
- patient suffering
- mistakes and litigation
- complaints
- pressure
132
When can confidentiality be broken?
1. patients consent
2. required by law (criminal, notifiable disease)
3. publics best interests (terrorism)
133
How would you describe burnout in a doctor?
diminished personal contact, work avoidance, habitual lateness, acting out of sorts, increasing minor illness, feelings of failure/guilt/blame
134
How do you prevent burnout?
- prioritise
- take time off work
- delegate
- set boundaries
- progressive muscular relaxation: treatment strategy for mental health by suppressing SNS and activating PNS
135
What are the priorities in end of life care?
1) possibility recognised and communicated
2) sensitive communication
3) decision making is shared
4) families needs met
5) individual plan of care
136
How is death verified?
1. no heart sounds or carotid pulse for 1 min
2. no rest effect or breath for 1 min
3. fixed and dilated pupils
4. no response to pain stimuli
137
What matters to patients in end of life care?
pain, SOB, fear, anger, regrets, sadness, family disputes, depression, dry mouth, respiratory secretions (death rattle)
138
Define capacity...
ability to make decisions about ones life- determined at that point in time
139
How is mental capacity assessed?
```
Need ALL 4 for capacity:
Understand information
Retain it
Balance/weight it up
Communicate back
```
140
What is the 2 stage capacity test?
1) is there an impairment or disturbance in functioning of a persons brain or mind?
2) if so, has it made the person unable to make a particular decision
141
What happens if a patient has no capacity?
Lasting power of attorney: appoint someone you trust to make decisions on your behalf
Advanced decision: make an Advance Decision to Refuse Treatment
142
Who might lack capacity?
```
dementia
a mental health problem
a brain injury
a learning disability
had a stroke
been given end-of-life sedation
```
143
What is Gillicks competency?
used in medical law to decide whether a child (under 16 years of age) is able to consent to his or her own medical treatment, without the need for parental permission or knowledge
144
What are Fraser Guidelines?
Guidelines that need to be met for contraceptive or sexual health advice under 16 w/o parent consent:
1) girl understands advice
2) can't persuade to inform parents via doctor or herself
3) likely to cont having sexual intercourse (with or without contraceptives)
4) mental and physical health will suffer if not provided sexual health
5) best interests
145
When are fraser/gillick guidelines disregarded and case reported?
children under 13 as they cannot consent to any sexual activity
146
What is the abortion cut off?
24 weeks
147
When can mothers have an abortion after the 24 weeks?
1. risk to mums life too high
2. permanent injury to mum
3. greater risk to patient continuing pregnancy vs. risk associated with termination
4. existing kids and family at risk
5. risk to child of being handicapped
148
What does a GP need to do to allow abortion after 24 weeks?
fills out a HSA1 form with patient:
- 2 doctors signatures
- 1 of 5 reasons to be satisfied
149
What did the House of Lords ruling in 1980's state about treatment in children
children that understand issues and consequences surrounding treatment can be considered legally competent, EVEN AGED 13
BUT can be over ridden by courts if NOT in child's best interests
150
Name the types of behaviour associated with health...
Health behaviour: behaviour aimed at preventing disease (healthier eating)
Illness behaviour: behaviour aimed to seek a remedy (going to the doctors)
Sick-role behaviour: any activity aimed at getting well (taking medication)
151
What does the Marmot Report reveal about health inequalities?
Social determinants determine health inequalities:
- people in most deprived area die 7yrs earlier
- people in most deprived areas suffer more disability and chronic conditions
- gap between rich and poor = 17yrs
- inequalities will result in monumental cost
152
What are the 4 main aims set out by the Marmot report?
1. sustainable local communities
2. active transport
3. sustainable food production
4. zero carbon houses
153
What is the theory of planned behaviour?
Links beliefs and behaviours
| Attitude, subjective norms, perceived behavioural control all contribute to behaviour intention >> behaviour
154
What is Maslows hierarchy of needs?
Maslow (1943, 1954) stated that people are motivated to achieve certain needs and that some needs take precedence over others. Our most basic need is for physical survival, and this will be the first thing that motivates our behavior. Once that level is fulfilled the next level up is what motivates us, and so on.
```
Level 1 = physiological
Level 2 = safety
Level 3 = love/belonging
Level 4 = esteem
Level 5 = self-actualization
```
155
What is norovirus and how would you control it?
winter vomiting bug, high attack rate >50% in closed settings
resistant to standard cleaning and persists in environment therefore ISOLATE
156
What is endogenous infection?
Patients own flora infects them, typical in hospitalised patients
157
How can you prevent endogenous infection?
1) hydrate and good nutrition
2) aseptic procedures
3) control underlying condition
4) remove catheters asap
5) reduce Abx pressure
158
How can you prevent HIV?
1) circumcision
2) PEP/PrEP
3) STI control
4) screen blood products (transfusion)
5) vaccinations
6) needle exchange programmes
7) education and behavioural change: condoms, reduce partner changes, reduce traumatic sex
8) HIV Dx and partner notification
159
HIV testing and insurance...
DONT need to tell insurers if tested and -ve
| insurers WILL ask if +ve test
160
HIV risk factors...
```
multiple sexual partners
HIV +ve mum to baby
Sex with high prevalence groups
Rape in high prevalence localities
IVDU
```
161
What are the trends in HIV?
-associated with migrant workers, truck drivers, sex workers
162
What are the HIV UNIAIDS targets by 2050?
90/90/90
90% patients with HIV Dx
90% diagnosed on ART
90% on ART have 90% suppression
163
Define viral suppression in HIV?
undetectable HIV in blood and increased CD4 count
164
Describe HIV criminalisation...
"Offences against the person act 1861: S20 = reckless transmission of HIV"
165
What is the U=U campaign?
Undetectable viral load = Untransmittable HIV
Campaign influencing public opinion, causing more people with HIV (and their friends and families) to comprehend that they can live long, healthy lives, have children, and never have to worry about passing on their infection to others.
166
What happens if a patient refuses to disclose their HIV to their partner?
GP can disclose to partner
| So confidentiality can be broken as required by law >> notifiable disease
167
What are the stages of an epidemic in HIV?
Nascent- less than 5% in one risk group
Concentrated- >5% in more than one risk group
Generalised- more than >5% in general population
168
How can you define black minority ethnic groups (BME)
"people of non white descent, umbrella term for social groups that share common experiences of discrimination, culture, religion and inequality as a consequence of their ethnicity"
169
How does the health differ of BME groups?
- poorer health
- health problems: different culture so value health differently
- different language so hard to diagnose Sx
170
Why do people engage in FGM?
1. control women sexuality
2. cultural identify
3. gender based factors
4. religion
5. hygeine
171
What suspicions of FGM would you have as a teacher?
1. child returns from holiday late
| 2. spends more time in the toilet and withdrawn
172
Name some teamwork problems...
lack of: leader, teamwork, effort, communication, challenge
173
What are Belbin team roles?
Belbin suggests that, by understanding your role within a particular team, you can develop your strengths and manage your weaknesses as a team member, and so improve how you contribute to the team.
Different roles = coordinator, shaper, teamwork, implementer, specialist, completer
174
What is the Doll and Bradford-Hill study?
found causal association between smoking and lung disease
- stopping smoking at 30 avoided ALL risks
- stopping smoking at any age increased life expectancy
- COPD causes: smoking, occupational, genetics, prematurely (only 20-25% of smokers go on to get COPD)
- Lung cancer causes: smoking, environmental and occupational
175
What is the epidemiology of lung cancer?
M>F (7:5)
disease of elderly
most common cause of cancer death
176
What factors lead to a geographical variation in lung disease?
SES, socioeconomic deprivation, historic industry, developing world, passive smoking
177
How can you prevent STIs: primary, secondary and tertiary prevention?
Primary: promotion of safe sex
Secondary: screening, PN, contact tracing, accessible services
Tertiary: ART in HIV, PCP prophylaxis in HIV, acyclovir for genital herpes suppression (shingles)
178
What is May and Anderson (1987) HIV/STI transmission model?
Mathematical models for the transmission parameters and viewed STD epidemiology from an ecologic perspective
R = reproduction rate: rate organism reproduces
B = infectivity rate: chance of infection per potential exposure
C = partners overtime: no. of opportunities for transmission
D = duration of infection
179
What is the importance of partner notification?
1. prevents further transmission
2. prevent re-infection of index patient
3. prevents complication of untreated infection
180
How can you assess work related upper limb disorders?
Rapid Upper Limb Assessment (RULA)
181
Name the types of upper limb MSK disorders...
1. mechanical tension neck
2. frozen shoulder
3. rotator cuff damage
4. thoracic outlet syndrome
5. bicipital tendonitis
6. epicondylitis
7. hand arm vibration syndrome
8. carpal tunnel syndrome
9. tenosynovitis
10. repetitive strain disorder
182
Name some lower-limb wok related disorders...
1. osteoarthritis: hip and knee
2. plantar fasciitis
3. housemaids knee
183
What is the importance of prescribed diseases and name some....
Diseases that allow for industrial injury disability benefit
- need to have been in the job for at least 10yrs
RSD
hand arm vibration syndrome (construction)
carpal tunnel syndrome (typists)
tenosynovitis (manual labourer)
osteoarthritis (kneeling or heavy lifting)
184
Name some notifiable diseases?
TB, acute meningitis, malaria, mumps, yellow fever, diphtheria, cholera, leprosy, measles
185
Why do you need to notify PHE of certain diseases?
prevent outbreaks
control possible epidemics
surveillance
186
How can you notify PHE of notifiable diseases?
1) registered practitioner informs 'proper officer' within 3 days of Dx, 24hr if urgent- fill out notifiable form
2) proper officer then informs PHE within 3 days or 24 hours if urgent
187
Patient safety- adverse event
incident that results in patient harm that isn't a direct result of their illness
188
Give some primary prevent strategies for smoking?
- increase legal age
- tax
- smoking ban
- no cig adverts
- hidden in shops
189
What is a near miss?
an event that arises during care with the potential to cause harm but fails to develop (harm is avoided)
190
What is the HSE (health and safety executive)?
public body responsible for the regulation, encouragement and enforcement of workplace health, safety and welfare
191
What is RIDDOR?
Reporting of Injuries, Diseases and Dangerous Occurrences Regulations
192
Why is there health inequality between men and women?
- women live longer than men but suffer more illness during life
193
What are the physical changes of ageing?
- loss of skin elasticity
- loss of hair and colour change
- decrease size and weight
- loss of joint flexibility
- susceptible to illness
194
Describe QALY
Quality adjusted life years = combines length and QoL
- 1 QALY = 1 yr perfect health
- QALY = years increased x utility time
195
Define occupational health
branch of medicine concerned with interaction between work and health
196
What are the limitations of screening?
- not all diseases can be screened
- cost to society
- false +ves = psychological
- funds diverted away from treatments
197
How does materialism affect health? (past exam Q)
- poor access to green space in poverty >> dec exercise and Inc obesity
- exposure to pollution
- overcrowding
198
How to decrease inequality?
- improve daily living conditions
- ensure equal distribution of power, money and resources
- measure and understand problem: surveillance
199
Red flags for back pain....
```
Under 20 and over 55
thoracic pain
persistent night pain (chronic >3 months)
night sweats
unexp weight loss
trauma
sphincter problems
PMHx
```
200
2 strategies that focus on behavioural change (past exam Q)
- junk food tax
- smoking ban
- cigarettes hidden in shops
- increased age for cigarettes and alcohol
- min alcohol pricing
- change 4 life campaign
201
4 reasons for increased mortality in men...
1. higher risk jobs
2. risk taking behaviour e.g. RTIs
3. smoke more
4. drink more alcohol
202
4 examples of inequality from Marmotts/Black's report... (past exam Q)
- women live longer: more illness in life
- men: more dangerous jobs, risk taking bet, smoking/alcohol
- women reproduce >> decreased health risk
203
Define compliance....
the extent to which the patients behaviour coincides with medical or health advice
204
Give some examples of non-adherence....
not taking medication
taking wrong dose
stopping meds before course finished
continuing to smoke against advice
205
What is concordance?
- treating patients as equals in care
| - respect for patient agenda
206
What are randomised controlled trials?
- patients randomised into groups
- one group intervention, one group placebo and outcome measured
- confounding factors and bias minimised
207
What is a systematic review?
- review of a clearly formed Q that uses systematic and explicit methods
- identify, select and critically praise relevant research
- collect and analyse studies included in the review
208
What is a meta-analysis?
statistical review of multiple studies used to analyse and summarise the results of the included studies
209
What is a cohort study?
Obtains evidence to try and refute the existence of a suspected association between cause and effect
e.g. does smoking cause lung cancer
210
Name some factors affecting global health
- worlds population increasing
- population is ageing
- world fertility decreasing
- population increasing in weight
- immigration increasing
211
How do you prevent CHD?
```
SNAP
S- smoking
N- nutrition
A- alcohol
P- physical activity
```
212
Name some psychosocial health aspects associated with social inequality...
social inequality may affect how people fell and therefore affect body chemistry
- social support
- control and autonomy at work
- balance between home and work
213
Give 3 social influences on an individuals health...
1. Biological influences- gender, ethnicity
2. Personal lifestyle- alcohol, diet, occupation, ex
3. The physical and social environment- pollution, asbestos exposure
4. health services
214
What did the Black Report 1980 identify?
health inequalities were widening
215
Give 3 theories associated with old age...
1. Disengagement theory- process by which older people disengage themselves from the roles they occupied in society
2. Theory of third age- an era after retirement with health, visor and a positive attitude
3. Structure dependence theory- dependency fo older people is structured by society
216
Give 4 advantages of good Dr-patient communication
- improved patient and clinical satisfaction
- decrease in malpractice risk
- improved compliance
- better health outcomes
217
What leads to an increase in adherence?
When necessity beliefs are high and concerns are low
- Necessity beliefs = perceptions of personal need for treatment
- concerns= concerns about potential adverse effects of treatment
218
Define epidemiology
the study of how often disease occur in different groups of people and why.
- good for seeing new trends in a disease
219
Calculate incidence using the following data:
UK pop = 61.4 million
New lung cancer cases per year = 39,000
(39,000/61,400,000) x 100,000 = 63.5 per 100,000 per year
220
What type of study is known as a prevalence study?
| - give one advantage and one disadvantage of a prevalence study...
Cross sectional study- looks at proportion of a population with a disease at a point in time
- adv: quick, cheap, rapid insight into current events in a community
- disadvantage: no time reference, bias
221
What type of study is retrospective?
| - give one advantage and one disadvantage of a retrospective study...
Case control- matches people with a disease and compares to a control
- adv: quick and cheap
- disadvantage: unreliable if individuals have bad memories
222
What type of study is known as an incidence study?
| - give one advantage and one disadvantage of a incidence study...
Cohort study- follows a group over time- prospective
adv: reduced chance of bias, incidence can be determined
disadvantage: expensive, takes a long time, difficulty with follow up
223
A RCT gives an intervention and compares the results to a control group. Give 2 advantages and two disadvantages of a RCT....
Adv: confounders are equally balanced, reduced bias
Disadv: expensive, volunteer bias, ethical problems in withholding treatment from control groups
224
Define palliative care...
improves the QoL of patients and families who face life threatening illnesses
- provides pain and symptoms relief, spiritual and psychosocial support from diagnosis to end of life and bereavement
225
What are the 4 aspects fo good palliative care?
holistic, individualised, patient centred, MDT approach
226
What are the 3 aims of palliative care?
improve QoL, promotes dignity and autonomy, symptoms control
227
Give 3 signs of Wernickes encephalopathy...
ataxia, confusion, ophthalmoplegia
