Public Health Flashcards
Define risk
Probability of harm
Define hazard
Something potentially harmful
Define absolute risk
Risk of developing a disease over a time period
Define relative risk
Risk of getting a disease in an exposed group compared to an unexposed group
Attributable risk
Rate of a disease in an exposed group that may be attributable to exposure
Ecological studies
Uses population level data
Cheap and easy, info already there
Studies relationships not causes and subject to bias
Cross sectional studies
Prevalence study
Chick, cheap, rapid feedback
No time difference, could be medical oddity, prone to bias
Case control
Case with disease, control without disease
Look at cases and see if they were exposed to agent
Cheap data collected quickly
Retrospective so can’t be causal, prone to its and hard to chose controls
Cohort
Incidence study, followup over time, see if exposed to agent and whether disease develops
Can do causation, can calculate risk and can study more than one outcome in same exposure
Expensive, long time, follow up problem
Intervention study
RCT, do something, compare to non-intervention
Less likely to be bias and confounding variable
Expensive, volunteer bias, ethical issues
Define patient compliance
The extend to which the patient’s behaviour coincides with medical/ health advice
Give 5 factors affecting compliance
Socioeconomic, health system, condition, therapy related, Pt related
How can factors affecting compliance be categorised?
Unintentional (practical barriers) and intentional (motivational barriers)
Give 4 examples of ethical considerations with patient compliance
Mental capacity
Decisions detrimental to patient’s wellbeing
Potential threat to the health of others
Patient is a child
Define occupational health
The branch of medicine concerned with the interaction between work and health
Which study is best for calculating attributable risk and why?
Cohort studies (looks at incidence)
How might work hazards be classified?
Mechanical, physical, psychosocial, chemical, biological
Give 3 positive effects of occupation on health
Unemployment to reemployment, school leavers finding a 1st job, work to retirement if voluntary
Give the Marmot 10 key components for good work
Precariousness, individual control, work demands, fair employment, opportunities, prevent social isolation, discrimination and violence, share information, work-life balance, reintegrates sick/ disabled where possible, promotes health and wellbeing
Define endemic
Disease which is permanently present within a population within a geographical area
Define outbreak
2 or more linked cases
Define epidemic
Increase in the prevalence of disease above the number usually observed in a particular area
Define pandemic
Epidemic across several countries or continents
Give the 2 influenza A antigens
Haemaggluttinin
Neuraminidase
Describe influenza B
Tend to cause sporadic outbreaks i.e. schools
Describe what happens in pandemic flu
Antigenic shift (birds to humans)
How is the UK prepared for a flu pandemic?
30 million courses of antiviral drugs: tamiflu (within 24-48hrs contact) + relenza
Roughly how long after a pandemic outbreak would a vaccine become available?
4-6 months
Define 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
Give the 4 points of philosophy of palliative care
Holistic/ humanistic
Individualised
Pt carer/ family are clients
Multidisciplinary approach
Compare the % of COPD and lung cancer patients with depression and compare their palliative care
92% of COPD have depression (0% PC) 52% lung cancer have depression (30% palliative care)
Give 4 key issues with providing palliative care for a patient with COPD
Unpredictable trajectory
Difficulties with illness prognostication
Poor pt understanding
Limited access to speciality care
Give a study supporting the link between smoking and mortality
Doll and Bradford Hill study (1951-2001) found smokers die 10 years earlier in a dose-response manner
Also found an increase in COPD mortality in smokers
Give 5 reasons for geographical variations of COPD
Socioeconomic differences Socioeconomic deprivation Historic industry Developing world- biomass for cooking fuel Passive smoking
What is the ratio of male to female lung cancer cases?
7:5
Describe a study that investigated coronary prone behaviour pattern
Friedman and Rosenman (1959)- competitive, hostile and impatient behaviour is more likely to result in CHD
Give the questionnaire used to assess type A behaviour
Minnesota multiphase personality index
What evidence is there to support the link between psychosocial work characteristics and CHD?
Whitehall studies: British civil service- men in lower grade had higher CHD
Working >11 hours days makes you 67% more likely to have a heart attack than those working 7-8 hour days
Describe the association between social support and CHD
Attachment and social integration is lower in men with CHD
Define psychosocial factors
Factors influencing psychological responses to the social environment and pathophysiological changes
How common is diarrhoea as a cause of death in children under 5
2nd leading cause of death (from significant fluid loss and electrolyte imbalance)
Give the 5 factors of the WHO prevention package (diarrhoea)
Rotavirus and measles vaccination
Promote early and exclusive breast feeding (+ vitA supplementation)
Promote hand washing with soap
Improve water supply and tx/ safe storage of household water
Community wide sanitation
Describe the WHO treatment package (diarrhoea)
Fluid replacement
Zinc
How would you manage a c.diff infection? (SIGHT)
Suspect Isolate Gloves and aprons Hand wash with soap Test too for toxin
Give 4 ‘at risk’ groups of infective diarrhoea
Persons of doubtful personal hygiene
Children attending nursery
People who work with unwrapped/ uncooked food
Health care workers/ social care staff working with vulnerable people
Give the proportion of binge eating cases and anorexia cases that are male
1/4 binge
1/10 anorexia
Define anorexia nervosa
Restriction of energy intake relative to the requirements, leading to a significantly low body weight in the context of age, sex, developmental trajectory and physical health
Give 3 key features of anorexia nervosa
Intense fear of gaining weight
Disturbance in way in which ones body weight is experienced
Denial of seriousness of low body weight
Define bulimia nervosa
Recurrent episodes of binge eating characterised by both of the following:
Eat in a discrete amount of time large amounts of food
During the episode you have a sense of lack of control
+ includes recurrent compensatory procedure to prevent weight gain
Define binge eating disorder
(Same as bulimia) but no purging \+ 3/5: Eating more rapidly Eating until uncomfortably full Eating large amounts of food when not physically hungry Eating along due to embarrassment Feeling disgusted, depressed/ guilty
What is OSFED and what percentage of eating disorders does it make up?
Other specified feeding and eating disorders
40-50% do not meet full criteria for diagnosis
Describe the factors contributing to the onset of an eating disorder and the motivation to maintain it
CORE model (Slade): Perfectionism, need for control, low self-esteem Maintenance: Initial positive reinforcement then becomes terror at losing control
Give the key motivations for change with eating disorders
BN, binge- CBT
AN- family therapy
What is the weekly recommended units of alcohol?
14
Define one unit of alcohol
10ml of pure alcohol/ 8g
How are units calculated?
Strength of drink (%) x liquid in ml / 1000
How is binge drinking defined for men and women?
Men >8 units
Women >6 units in one sitting
Describe the alcohol harm paradox
Lower socioeconomic groups drink less alcohol but experience more harm because they drink at more extreme levels
Give 5 effects of drinking >35 units per week
HTN Stroke Pancreatitis CHD Liver disease
Describe foetal alcohol syndrome
Pre and post-natal slow growth development, crania-facial abnormalities, CNS abnormalities, congenital defects
Give 10 effects of alcohol consumption
Blackouts, delusions, headaches, peptic ulcers, inflammation of intestines, fatty liver/ cirrhosis, early DM, bone degeneration, pins and needles in hand, weakened heart muscle, degeneration of skeletal muscles
Describe the effects of alcohol withdrawal
Tremulousness Seizures Hallucinations Activation syndrome Delirium tremens
Give examples of primary prevention
THINK Drink aware (labels) Binge drinking campaign 18-24 know your limits Restriction on alcohol advertising Minimum pricing
Give examples of secondary prevention
Explore alcohol consumption with patients
Use screenings Qs
Explanation to lifestyle change
Detect problem e.g. liver test, feedback to patient if problem
Give 3 examples of screening tools for alcohol consumption
FAST (fast alcohol screening tes)
AUDIT (alcohol use disorder identification test)
CAGE
How would you treat alcohol dependence?
Community based/ inpatient assisted withdrawal
Benzodiazepines (depressant): CHLORDIAZEPOXIDE (4 weeks max)
Define substance use
Ingestion of a substance affecting the CNS which leads to behavioural and psychological changes
Give examples of opioids
Morphine, diamorphine/ heroin
Give examples of depressants
Alcohol, benzos (slow down thinking, relaxation and sedation)
Give examples of stimulants
Nicotine, cocaine, caffeine
Give examples of hallucinogens
LSD, ecstasy, ketamine, magic mushrooms
How can drug abuse be viewed?
Disease model (view as a chronic recurrent illness/ genetic disorder), behavioural model (bad habit), volitional (failure of will), sociocultural (social problems)
How might you prevent substance misuse?
Reducing RF and increasing protective factors (family attachment, academic achievement, opportunities, developing self-confidence, worth and resilience)
Describe physical dependence
The body adapts to the presence of a substance and overtime needs more for the safe effect, stopping leads to withdrawal
Describe psychological dependence
Feeling life is impossible/ you can’t face the challenges without the drug
Describe dependent syndrome
Experience at least 3/6 in 12 months:
Strong desire/ compulsion to use drugs
Difficulties controlling substance taking behaviour
Tolerance
Progressive neglect of pleasures/ interests
Persistent use despite harmful consequences
Compare the epidemiology of Chlamydia and Gonorrhoea
Chlamydia more common, more common in females
Gonorrhoea more common in men
What type of bacteria causes Chlamydia and gonorrhoea?
Chlamydia trachomatis ad Neisseria Gonorrhoea
Gram -ve
How can Chlamydia/ gonorrhoea cause damage?
Pelvic inflammatory disease, travels up fallopian tubes and cause tubule factor infertility, ectopic pregnancies, chronic pelvic pain
In men- reactive arthritis
How would you diagnose chlamydia?
Vaginal swab and first void
Nucleic acid amplifications test (using PCR)
How would you treat chlamydia?
Partner management, azithromyocin (once EVER), doxycycline (twice a day for a week), erythromycin (twice a day for 2 weeks)
How would you diagnose gonorrhoea?
NAAT/ near patient test- microscopy gram stain smears of secretions: look for diplocci- culture on selective medium
How would you treat gonorrhoea?
Partner notified, tx other STIs, ceftriaxone with azithromyocin)
What is the bacteria that causes syphilis?
Treponema pallidum
Gram -ve
What is the biggest risk group for syphilis transmission?
Male to male
How might early infections of syphilis present?
Painless ulcer, skin rash, small red circles on hands, soles, stomach
How might latent syphilis present?
Can involve CNS/ CVD
Describe the transmission of syphilis
40-60% partners infected, but very high vertical transmission (90%)
50% neonates die
How would you diagnose syphilis?
Early moist lesions sample, motile spirochetes under microscopy
How would you treat syphilis?
Penicillin injection
Reproductive rate of STIs
R= BCD R= reproductive rate B= infectivity rate (chance of infection passing on per exposure) C= partners over time D= duration of infection
Give examples of primary prevention for STI control
STI awareness campaign
1-1 risk reduction discussion
Variations against HepB and HPV
Pre/ post exposure prophylaxis for HIV
Give examples of secondary prevention for STI control
Identifying and stopping spread, easy access to kits- free, confidential
Short waiting lists
Targeted screening e.g. CHLAM, It starts with me HIV
Give examples of tertiary prevention for STI control
Reduce complications- HAART, prophylactic abx, acyclovir for suppression of genital herpes
Describe the epidemiology of migraines, MS and epilepsy
Migraines- F>M, peak 35-40
MS- common in 20-35, prevalence directly proportional to distance from equator
Epilepsy- rapidly increase at 60y/o
Describe Creutzfeldt- Jakob disease
Neuro-degenerative, rapidly progressive dementia, 55-75 (avg onset)
Abnormal ECG
Varient CJD- same strain as mad cow disease (BSE)
Describe passive immunisation
The administration of pre-formed ‘immunity’ from one person/ animal to another
Limitations: short lived, possible transfer of pathogens
Adv.: Immediate protection and effective in immunocomprimised
Describe active attenuated immunisation
Live organism replicate within host and induce immune response (polio and small pox)
Risk that may not be attenuated in immunocompromised hosts)
Describe active non-living immunisation
Whole killed- not cause infection but Ag induce immune response (diphtheria)
Toxoids- inactivated toxins (tetanus)
Describe 5 examines of alternative means of immunisation
Recombinant proteins Synthetic peptides Live attenuated vectors DNA vaccines Polysaccharide protein conjugates
