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Public Health Flashcards

1
Q

Describe the three main categories of health behavior

A

Health Behaviour
Illness Behaviour
Sick Role Behaviour

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2
Q

Define Health Behaviour

A

A behaviour aimed to prevent disease (e.g. eating well)

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3
Q

Define Illness Behaviour

A

A behaviour aimed to seek remedy (e.g. going to the doctors)

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4
Q

Define Sick Role Behaviour

A

Any activity aimed at getting well (e.g. resting, medications)

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5
Q

Name two types of attitudes towards health

A 
Damaging health (smoking, alcohol)
Health Promoting (excersise)
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6
Q

Name some modifiable risk factors

A

Diet
Weight
Physical Activity
Sleep

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7
Q

Name some non-modifiable risk factors

A

Age
Sex
Genetics

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8
Q

Two ways we can PREVENT disease

A

Preventative services via NHS

Primary, secondary and tertiary prevention

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9
Q

What are preventative services

A

Screening

Child health protection

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10
Q

What does the MORGEN study show us

A

That sufficient sleep duration contributes to lower CV disease risk in addition to 4 traditional lifestyle factors

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11
Q

How long was the MORGEN study followed up for

A

10-14 years

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12
Q

Name five lifestyle factors

A 
Smoking
Being overweight
Little physical activity
Excessive alcohol
Poor Diet
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13
Q

Leading cause of death in Sheffield?

A

Cancer

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14
Q

What follows cancer as the leading cause of death in Sheffield

A

CV disease

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15
Q

Why do we need interventions

A

Could have a significant impact on mortality and morbidity

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16
Q

Define Morbidity

A

State of being diseased or ill health in a population

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17
Q

What can morbidity lead to

A

Mental health problems

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18
Q

Define Mortality

A

The number of people who died in a population

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19
Q

Three disadvantages of intervention

A

Genetic Predisposition
Expensive
Side-effects

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20
Q

Example of intervention at the population level

A

Health promotion

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21
Q

Describe health promotion

A

Process of enabling people to exert control over the determinants of health, improving health

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22
Q

Example of intervention at an individual level

A

Patient-centred approach

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23
Q

What are two examples of health promotions

A

Campaigns to promote ‘good’ health:

  • Change 4 Life
  • Movember

Promoting screening + immunisations:
MMR

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24
Q

What three factors should we consider to reduce alcohol consumption

A 
Individual Behaviour (how much they drink)
Local community (A&E and local sales of alcohol)
Population level (demographic patterns of liver cirrhosis)
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25
Four factors that can affect the perception of risk
- Lack of personal experience with the problem -Belief only personal action will help Belief that if it hasn't happened now it will never happen Belief that the problem is uncommon
26
What is the health belief model
Individuals will change if they: Believe that they are susceptible to disease in question Believe it has serious consequences Believe that action reduces susceptibility Believe that benefits of taking action outweigh the cost
27
What is the theory of planned behaviour
Proposes that predictor of behaviour can be best assessed by intent: - Person's attitude to behaviour - Subjective Norm - Percieved behavioural control
28
Define the transtheoretical model
Pre-contemplation (not ready yet) Contemplation ( Beginning to consider but not for any time in the future) Preparation (Getting ready to quit in the near future) Action (doing it) Maintenance (steady quitter) Relapse
29
Nice guidance on behaviour change
1. Planning interventions 2. Assessing the social context 3. Education and learning 4. Individual-level interventions 5. Community-level interventions 6. Population-level interventions 7. Evaluating effectiveness 8. Assessing cost-effectiveness
30
What three factors can allow you to break confidentiality
1. Required by law 2. Public Interest 3. Patient consent (implied or explicit) All have to be done in patient's knowledge
31
What are the four duties of a doctor as defined by the GMC
- Knowledge skills + Performance - Safety + Quality - Communication, partnership and teamwork - Maintain Trust
32
Criteria for disclosure
- Anonymous - Patient has not objected - Consent - Keep to minimum - Meets current guidelines and laws - Act promptly
33
What interactions with the law allow us to disclose information
Notifiable disease Regulatory body demands it (CQC, GMC) Ordered by a judge (Can be refused if needed) Police, solicitor (Only if consent is given)
34
Examples of public health which allow disclosure of information
- Serious communicable disease - Crime - Research - Education
35
Define long-term condition
A condition that cannot be, at present, cured but can be controlled by medication + other therapies
36
Define multi-morbidity
The co-occurrence of two or more chronic medical conditions in one person
37
Define Polypharmacy
Use of 4 or more medications by a patient
38
Define Medical Compliance
Describes the degree to which a patient correctly follows medical advice Usually if they've been taking their prescribed medication
39
How does an aging population affect age median
Increases it
40
How does the proportion of older people change and why
Increased proportion due to increased life expectancy and decreased birth rate Also due to improved health care, sanitation, living conditions and education
41
Four challenges of an ageing population
- Increased people with disabilities so more money needed to fund care for these people - Health Gap: The number of years someone can live without a disability after 65 can vary by 12 years - Increased multimorbidity - Increased pressure on the NHS (more hospital admissions)
42
What did Ignacz Semmelweis campaign for?
Hand washing after discovering a correlation between puerperal fever and dissection
43
Define Gini coefficient
A statistical representation of nation's income distribution
44
What was the Black Report (1980)
Document reporting on health inequality causes
45
What were the five causes of health inequality according to the black report (1980)
Material (environmental causes mediated by behaviour) Artefact (An apparent product of how inequality is measured) Cultural/Behavioural (poorer people live more unhealthy lifestyles) Selection (sick people sink socially and economically)
46
What two conclusions did the Acheson Report (1998) come to?
Income inequality should be reduced | Give high priority to health of families with children
47
What are three aspects of proportionate universalism
- Focusing on the disadvantage only will not help reduce inequality - Action must be universal but with a scale and intensity proportional to the disadvantage - Fair distribution of wealth is important
48
What are the three theories of causation?
Psychosocial Neo-material Life-Course
49
What is the theory behind psychosocial causation
- Stress results in inability to respond efficiently to the body's demands - Impact on blood pressure, cortisol levels and on inflammatory and neuroendocrine responses
50
What is the theory behind net-material causation
- The more hierarchal societies are less willing to invest into the provision of public goods - Poorer people have less material goods of which the quality is lower
51
What is the theory behind Life-Course theory of causation
- A combination of both psychosocial and net-material explanations - Critical periods: Possess greater impact at certain points in the life course (childhood) - Accumulation: Hazards and their impacts add up -> hard work leads to injuries resulting in disabilities that may lead to more injuries - Interactions and pathways (sexual abuse leads to poor partner choice in adulthood)
52
What are the four domains of public health
- Health protection (infectious disease, equity, service planning) - Improving services (efficiency and equity) - Health improvement - Addressing the wider detriments of health
53
What is meta-ethics
Exploring fundamental questions
54
What are the five types of ethics
- Virtue - Categorical - Imperative - Utilitarianism - Four principles
55
What is applied ethics
A recent emergence of ethical investigations in specific areas
56
What are four ethical arguments
- Deductive (one general ethical theory can apply to all medical problems) - Inductive (settled medical cases used to generate theory or guides to medical practice) - Considering what we believe in (feelings) - Ethical analogies (scenarios)
57
Define the 'ad hominem' ethical fallacy
Responding to arguments by attacking the person's character than the content of their argument
58
What is an 'authority claim' fallacy of ethics?
Saying a claim is correct because the authority has said so
59
What is the 'petition principii' fallacy of ethics
Assuming the initial point of the argument - 'beg the question'
60
What is the 'dissenters' fallacy of ethics
Identifying those who disagree does not prove the claim is not valid
61
What is the 'motherhoods' fallacy of ethics?
Inserting a soft statement to disguise the disputable one e.g. All humans are equal (so we shouldn't stop PVS patient treatment)
62
What is the 'no true scotsman' fallacy of ethics?
Modifying the argument
63
What are fine structural determinants of illness
- Social Class - Material Deprivation / Poverty - Unemployment - Discrimination - Gender and Health
64
What is the biomedical model of health
- Mind and body are treated separately - Body, like a machine, can be repaired - This privileges the use of technological interventions - It neglects social and psychological dimensions of disease
65
What are three main notifiable diseases that MUST be reported to the WHO + requires disclosure of private information
- Cholera - Yellow Fever - Plague
66
Define primary prevention of CVD
Preventing CVD before it occurs
67
Define secondary prevention of CVD
Preventing additional attacks of CVD after the first attack has occurred
68
What can we do as primary prevention of CVD
Blood thinning drugs (aspirin)
69
What can we do as secondary prevention of CVD
Surgical Procedures | Aspirin
70
What are three non-modifiable risk factors for CVD
Age Ethnicity Family history of heart disease
71
What are modifiable factors affecting CVD?
``` BP Physical Inactivity Being overweight High Blood Cholesterol Smoking ```
72
Changes to diet to prevent CVD
LDL - Bad cholesterol HDL - Good cholesterol Veg Fruits Whole-grains Low fat dairy products (fish)
73
What other ways can I reduce chances of CVD other than diet
Smoking - Quit Lower BP (reduce Na intake) Exercise (3-4 times a week at 40 mins sessions)
74
How would I assess for cardiac chest pain
1. Check whether they still have chest pain or if it happened in the last 12 hours 2. History of chest pain 3. Presence of CVD risk factors 4. History of ischaemic heart disease 5. Previous investigations for chest pain 6. Prescribe GTN spray 7. Take resting 12-lead ECG ASAP
75
What is GTN
A spray used for pain relief (short-term only)
76
How long do the effects of GTN last for
20-30 minutes
77
What symptom may indicate Acute Coronary syndrome
Pain lasting longer than 15 minutes
78
What is morality
Concern with the distinction between good and evil or right and wrong
79
Define ethics
A system of moral principles and a branch of philosophy which defines what is good for individuals and society
80
What is a teleological argument
Argument for the existence of god
81
What is a deontological ethics
Judges morality of an action based on rules
82
What type of argument is utilitarianism/ consequentialism
Teleological
83
What is the concept of utilitarianism / consequentialism
An act is evaluated solely in terms of its consequences Maximising good and minimising harm
84
What are a few criticisms of utilitarianism
It is impossible to apply - happiness can't be quantified or measured Difficult to apply as we can't calculate all the effects for an individual
85
What type of argument is kantianism
Deontological
86
What is kantianism
Features of the act themselves determine worthiness of the act Following natural laws and rights Gives us imperatives: do not kill, do not lie etc. 'A person is an end itself, never means to an end'
87
What are criticisms of kantianism
For an action to be permissible, it must be possible to apply it to all people without a contradiction occurring.
88
What type of argument is virtue ethics
Deontological
89
Define virtue ethics
Focus is on the kind of person who is acting, de-emphasises rules Is the person in action expressing good character or not? We become virtuous only by practicing virtuous actions
90
What are the five focal virtues that make up virtue ethics
``` Compassion Discernment Trustworthiness Integrity Conscientiousness ``` Cook Dick To Interest Callum
91
What is the criticism of virtue ethics
Virtue ethics is 'culturally relative' Since different people, cultures and societies often have different opinions on what constitutes a virtue.
92
What are the four principles of ethics
Autonomy (obligation to respect decision of our parents) Benevolence (balancing benefits with risks) Non-Maleficence (do no harm, reduce or prevent harm) Justice (need vs benefit)
93
5 GMC duties of a doctor
- Protect and promote health of patients and public - Provide good standard of practice and care - Recognise and work within limits of your own competence - Treat patients as individuals and respect their dignity Protect Provide Recognise Rspect
94
What does the Katz ADL consist of
Daily Life limitations for old people: - Bathing - Dressing - Toilet use - Transferring in/out of bed - Urine and Bowel continence - Eating Betty’s Dad Telephones Tim’s Uni Exterminator
95
Describe IADL
``` Telephone Travelling (by car or using public transport) Food or clothes shopping Meal Preparation Housework Medication use Management of money ``` Tim’s Teacher Fought Many Hamsters Mid March
96
Describe Barthel ADL Index
- Feeding - Moving from wheelchair to bed - Grooming - Transferring to and from a toilet - Bathing - Walking on level surface - Going up and down the stairs - Dressing - Continence of bowels - Continence of bladder Feelings Moved Gary To the Bar With Greg Dressed in Casual Costumes
97
What three aspects are being tested on old people in the Mini Mental State Examination
- Orientation, immediate memory - Short term memory - Language Functioning
98
Define acute illness
A disease of short duration that starts quickly and has severe symptoms
99
Define chronic illness
A persistent or recurring condition which may or may not be severe, often starting with gradually slow change
100
Define Polypharmacy
The use of multiple medications or administration of more medications than are clinically indicated
101
What are 5 challenges of aging population
1. Strains on pension and social security systems 2. Increasing demand on health care 3. Bigger need for trained health services 4. Increased demand for long term care 5. Pervasive ageism (denying old people rights and opportunities available for other adults) ``` Strains Demand Need Demand Ageism ```
102
What are five causes of waging population
1. Improvements in sanitation, housing and medical interventions 2. Life expectancy is rising around globe 3. Substantial fall sin fertility 4. Decline in premature mortality 5. More people reaching older age while fewer children are born
103
Facts on UK ageing population
Population of 65+ is the same as population of under 15 By 2025, there will be more people over 65 than under 20
104
Define intrinsic ageing
Natural, universal, inevitable
105
Define extrinsic ageing
Dependant on external factors (UV ray exposure smoking etc)
106
What are five examples of physical changes during ageing
1. Loss of skin elasticity + hair colour 2. Decrease in size and weight 3. Loss of joint flexibility 4. Increased susceptibility to illness 5. Decline in learning ability + less efficient memory
107
Three impacts of ageing on vision
1. Need 3 times more light 2. Depth/colour perception 3. Narrowing of visual field
108
Two impacts of ageing on hearing
1. High frequency loss | 2. Speech comprehension 20%
109
How does ageing affect taste and smell
We lose 50% of our taste buds.
110
Economic costs of smoking
5.5% of healthcare costs - smoking Loss of productivity from smoking breaks Increased Absents (£2.5 billion) Cleaning up butts
111
Health problems in the UK due to smoking
Single greatest cause of illness and premature death in the UK 100,000 die a year in UK COPD
112
Name four medications to stop smoking
Nicotine replacement therapy Varenicline Antidepressants Clonidine
113
How do nicotine replacement therapy work
Stimulates nicotinic receptors and stimulates release of dopamine
114
What three ways can GP manage smokers
Cost Health damages -> outline health risks Helplines
115
What are readings on a spirometer trace compared to
BMI and age
116
What will diagnosis using an X-ray for COPD tell us
Whether another condition is causing symptoms
117
What is a blood test for COPD aiming for
Checks if symptoms are due to anaemia
118
What does the peak flow test for COPD aim to show us
It it is asthma
119
What should we do to patients who remain breathless despite having bronchodilators
Maintenance therapy
120
What should we give to patients with an FEV1 > 50%
LABA (agonist) or LAMA (antagonist) or Pulmonary rehab
121
What does COPD stand for
Chronic Obstructive Pulmonary Disease
122
Symptoms of COPD
Tight chest Wheezing Short breath
123
What antibiotic can I use to treat exacerbation of COPD
Azithromycin
124
What does it mean to be 'institutionalising death'
60% of people die in hospital but 70% want to die at home
125
What is medicalisation of death
Death as a natural part of our life is challenged by trying to prolong life at any cost
126
What is the Glaser + Strauss (1965) study
Observational study of interactions between dying people, relatives and staff in USA hospitals
127
What were the four awareness contexts discovered in the Glaser + Strauss report
Closed Awareness - Patients not aware of their own impending death Suspicion - Awareness Mutual Pretence Open Awareness
128
What is closed awareness
Patients not aware of their own impending death
129
What is suspected Awareness
pt suspects others know and attempts to confirm/invalidate his/her suspicions
130
What is mutual Pretence
all sides know but pretend the others do not
131
What is Open Awareness
Everyone knows and openly admits it
132
What is the ratio of women:men in old age populations
2:1
133
Why do women live longer than males
20% biological - premenopausal women are protected from heart disease by hormones 80% environmental - Men take more lifestyle risks than women)
134
What is the consequence of life expectancy on pensions
Have higher pay outs than those currently planned
135
What is the consequence of a higher life expectancy on health
- Chronic conditions will prevail | - Rising inequalities as more affluent groups use health services for longer
136
What is the most common type of dementia
Alzheimer's - 62% Vascular Lewy Body Fronto-temporal
137
Define a social death
When people die in social and interpersonal terms before their actual biological death (lonely death)
138
Define a good death
Palliative care became a speciality, aiming to demedicalise death - more personal
139
What are four features of death in a hospice way
1. Open awareness, compassion + honesty 2. MDT 3. Family Approach (relationships) 4. Holistic Care One Member Farted Holistically
140
What two actions did Kate Granger take to raise awareness of importance of a good death
1. The Other Side (novel) | 2. Hellomynameis campaign
141
What makes a susceptible host to disease
Low immunity, low white cell count, imbalance in normal flora and invasive procedures
142
How can number of microorganisms increase in health care services
Resistant pathenogenic strains
143
What is a reservoir?
``` Where potential spread originates: Visitors Patients Staff Fomites ```
144
What are three portals of entry/exit
Resp tract GI Tract Broken Skin Genito-urinary tract
145
What two ways can infections spread
Exogenous - Direct/Indirect Contact, vector spread, airborne Endogenous - Self spread
146
Why do we do hand decontamination
Remove transient hand flora (Viruses, Staphylococcus aureus) Reduce number of resident flora
147
How do we do hand decontamination
Hand washed Take of wrists jewellery and long sleeves as we can't wash hands affectively Nails need to be short and clean
148
When do we wash our hands?
``` Before and after any patient contact Before and after carrying out any procedures After going toilet Before food eating Before entering a clinical area ```
149
What are the three levels of hand washing
Level 1 = Routine Handwash Level 2 = Hygienic hand antisepsis Level 3 = Surgical Handscrub
150
What is Level 1 hand washing purpose and method used to do it
Removes soil/dirt and transient microbes Method: Soap for at least 10-15 secs
151
What is level 2 hand washing + method
Removes and destroys transient microbes Method: Antimicrobial soap or alcohol-based hand rub for 10 to 15 secs
152
What is Level 3 hand washing + method
Removes or destroys transient microbes + reduce number of flora Method: Alcohol based rub or antimicrobial soap/detergent with a brush to achieve friction for 120 secs
153
What is alcohol gel effective and ineffective against
Destroys MRSA but not Norovirus or clostridium difficile
154
What is antimicrobial liquid soap and water effective against
ALL transient microbes
155
Two examples of campaigns to encourage hand washing
Clean your hands campaign Bare below the elbow policy (recommendation by department of health)
156
Name the two types of water
Household Clinical - All clinical waste must be identifiable and traceable back to the source it originated from
157
What is a sharp
A sharp is described as any item that can potentially cute or penetrate the skin
158
What should we never do during disposal of sharps
Re-sheathing needles Emptying sharp bin contents Overfill a sharps bin Carry bin with sliding doors OPEN
159
What should doctors wear when interacting with patients
Gloves/aprons in contact with body fluids or blood Dressings to cover wounds Body fluids or blood spillage on skin should be cleaned with chlorine granules
160
What are three psychological effects of nicotine
- Activation of nicotinic ACh receptors on the brain - Causing dopamine release in the nucleus accumbens - Stimulation (withdrawal)
161
What are four impacts of smoking
Premature death (main cause) 100,000 deaths due to smoking COPD and cancers A great economic impact of smoking
162
What are 7 problems connected to smoking
``` CV problems (heart attacks) Cancers of other organs Stomach ulcers Impotence Diabetes Oral Health Cataracts ```
163
What happened in 1908 in regards to smoking
Children's act - sale of tobacco to under 16s prohibited
164
What was published by Richard Doll and Austin Bradford Hill in 1950
A report on smoking and its link to lung carcinoma
165
What three laws have been passed to reduce smoking
1965 - Parliament ban of smoking adverts 2007 - Smoking in public places banned + min legal age raised to 18 2015 - Smoking in car with children banned in UK
166
What two ways can patients undergo smoking cessation
NRT (patches, inhaler, nasal spray) Non-nicotinic pharmacotherapy i. Varenicline ii. Bupropion
167
What are the three As used to approach smoking patients
ASK - your patients about their smoking habits ADVISE - your patients on cessation methods available ASSIST - your patient and refer to local NHS stop smoking service
168
Define 'digit divide'
Difference in access to information
169
What are the 8 millennium development goals
1. Eradicate extreme poverty and hunger 2. Achieve Universal Primary Education 3. Promote gender equality and empower women 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 Early Achievers Promote Independent Caring of Educational Development
170
What are the three leading causes of death in children in the developing world
1. Pneumonia 2. Diarrhoea 3. Malaria
171
Who are the five key actors in global health?
1. UN agencies (UNICEF/WHO) 2. Foundations (Rockefeller Foundation) 3. NGOs (Les MSF + Save the children) 4. Multilateral Development Banks (World bank, Asian development bank and inter-american development bank) 5. Bilateral Agencies (USAID, CIDA, DFID)
172
What five major environmental changes are happening at the moment
``` CFCs + Ozone depletion Loss of biodiversity within ecosystem freshwater decline + Land degradation Loss of natural fisheries Increasing desertification ```
173
What are 6 global health issues
``` Common Health problems Health problems that cross borders International migration Political crisis International agreements Global environmental change ```
174
Name some examples of migrants
``` Asylum Seekers Refugees Migrant workers Family workers Family Joiners International Students ```
175
What three factors define a migrant
Country of birth Nationality Duration of stay
176
What types of migrants do we usually see (2)
- Asylum seekers | - Economic migrants
177
What is lampedusa
An italian island
178
What is the issue with immigration in lampedusa
A primary transit point for immigrants from Africa
179
Where is lampedusa located
A european territory closest to the shores of Libya
180
What is the issue with the migrant route from Libya to Lampedusa
Most deadliest migrant route in the world
181
What are the four goals of the NHS when it comes to global health
1. Equity of access 2. Reducing gap in health inequalities 3. Providing services for the vulnerable 4. Ensuring the services are appropriate and accessible
182
Define Sustainability
Being able to meet the needs of today without compromising the ability of future generations to meet the needs of tommorow
183
What is the Bradford Hill Criteria
A group for minimal conditions necessary to provide adequate evidence of a causal relationship
184
List the Bradford Hill Criteria
``` Strength Consistency Specificity Temporality Biological Gradient Coherence Analogy ```
185
What are possible consequences of climate change
Heatwaves Sea Level Rise New Diseases Scarcity of resources -> war
186
How can we solve the issue with climate change
Control world population Reduce energy consumption Get our energy from renewable resources
187
Define screening
A process which sorts out apparently well people who probably do have the disease from those who probably do not
188
Why do we screen people
For PREVENTION
189
What is primary prevention
To prevent a disease from occurring
190
What is secondary prevention
Detection of early disease in order to alter the course of the disease and maximise chances of a complete recovery
191
What is tertiary prevention
Trying to slow down the progression of the disease
192
How do I calculate sensitivity
True positive/ True positive + False negative
193
What is sensitivity
The proportion of people with the disease who are correctly identified by the screening test
194
Formula for specificity
True negatives / True negatives + False positive
195
Define specificity
The proportion of people without the disease who are correctly excluded by the screening test
196
PPV Formula
True positive / True positive + False positive
197
Define PPV
The proportion of people with a positive test result who actually have the disease
198
DefineNPV
The proportion of people with a negative test result who do not have the disease
199
Calculate NPV
True negative/ True negative + False negative
200
Define prevalence
The proportion of a population found to have the disease
201
Define incidence
The number of new cases within a specified time period divided by the size of the population initially at risk
202
What are the four topics in the Wilson and Junglier criteria for screening
The condition The treatment The test Benefits
203
Outline the condition of the criteria
It should be a serious health problem The aetiology should be well understood There should be a detectable early stage
204
Outline the treatment of the criteria
There should be an accepted treatment of the disease Facilities for diagnosis and treatment should be available There can't be an unmanageable extra clinical workload
205
Outline the test of the criteria
A suitable test should be divided for the early stage The test should be acceptable for patients Intervals for repeating the test should be determined
206
Outline the benefits to consider for this criteria
There should be an agreed policy on who to treat | The cost should be balanced against the benefits
207
Define selection bias
People who choose to participate in screening programmes that may be different to those who do not
208
Define lead time bias
Screening merely identifies the disease earlier than before and thus gives the impression that survival is prolonged
209
Define length-time bias
Diseases with longer period of presentation are more likely to be detected by screening than ones with shorter time of presentation
210
What is a human error
Any preventable event that may cause or lead to patient harm
211
What is an adverse event
An incident which results in harm to a patient
212
What is a near miss
An event which has the potential to cause harm but fails to develop further, thereby avoiding harm
213
What are the three types of human error
Errors of omission (Required action delayed) Error of commission (wrong action taken) Error of negligence (actions do not meet standard of ordinary, skilled person professing
214
What are skill-based errors
Performing a routine task that is well learnt we give little attention and could have memory lapses if distracted
215
What are rule/knowledge based errors
An incorrect plan or course of action is chosen
216
When are rules/knowledge based errors more likely
When tasks are more complex
217
What are violations
Deliberate deviations from practices, procedures and standards or rules
218
Name the three types of violations
Routine (cutting corners) Necessary (to get the job done) Optimising (Personal gain, selfish)
219
What are five limitations to information processing
``` Automaticity Cognitive interference Selective Attention Cognitive Bias Transferring our expectations from familiar situations to similar new ones ```
220
What are the two approaches to managing errors
Individual - errors are the products of wayward mental processes of individual people in the system Organisational - Adverse events are product of many causal factors so the whole system is to blame
221
What are five components of an effective team
``` Optimal Size Good dynamic A common purpose Identified team leader Shared knowledge and experiences ```
222
What are three benefits of team working
1. Improving service delivery 2. Improving decision-making 3. Reducing the error
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What are four obstacles in team working
1. Different offices/shifts/rotation posts (organisational) 2. Location (ward based/visiting) 3. Management (Different employers/Sub-teams) 4. Other commitments of the team members
224
When do I use the SBAR checklist
When reporting a case
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What is the SBAR checklist
S - Situation B - Background A - Assessment R - Recommendation
226
Define Mental Health
Mental health is a state of well-being in which an individual realises his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully and is able to make a contribution to his or her community
227
What interventions can we introduce to people with CMHPs
- Community Level - Service organisational level - Individual Level - IAPT service model
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What is the IAPT service model
Improving access to psychological therapies i. High intensity care ii. Low intensity care
229
Define stress
Stress occurs when the demand made upon an individual are greater than their ability to cope
230
What is distress
A negative stress which is damaging and harmful
231
What is eustress
A positive stress which is beneficial and motivating
232
What can cause acute stress
noise, danger infections, injuries, hunger
233
What can cause chronic stress
Health, home, finances, work, family, friends
234
What are internal stressors
Physical (inflammation or infection) | Psychological (attitudes, beliefs, personal expectations, worries)
235
What are external stressors
Environment, work and social pressure
236
What is the main response to stress
Fight or Flight response
237
What type of stressor is the fight or flight model a response to
External acute stressors
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What is activated during the fight or flight model
Hypothalamus | Adrenal medulla and cortex
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What happens at the lungs during fight or flight
Take in more oxygen
240
What happens to the spleen during the fight or flight response
More RBCs discharged
241
What happens at the mouth during fight or flight response
mucous and saliva dry up
242
What happens to blood flow in the fight or flight response
Increases by up to 400%
243
When are we alarmed
When threat is identified
244
What are two aspects of the general adaptation syndrome to stress
Defensive countermeasures engaged - Resistance The body begins to run out of defences - Exhaustion
245
What are five signs of stress
Biochemical - Endorphin and cortisol levels altered Physiological - Shallow breathing, raised BP and more HCL produced Behavioural - Over-eating, anorexia, insomnia, more alcohol or smoking Cognitive - Negative thoughts, no concentration, worse memory, tension, headaches Emotional - Mood swings, irritability, aggression, boredom, apathy and tearfulness
246
Define the stress-illness model
An individual susceptibility to disease or illness is increased because an individual is exposed to stressors which cause strain upon the individual, leading to psychological and physiological changes
247
PTSD Diagnostic criteria
1. The person experienced an event tat involved actual or threatened death or serious injury or a threat to physical integrity 2. The person's response involved intense fear, helplessness or horror
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What are three symptoms associated with PTSD
1. The event is persistently re-experienced in recollections and dreams 2. Persistent avoidance of stimuli associated with the event 3. Persistent symptoms of increased arousal (irritability)
249
What are three examples of traumatic events
``` Childhood physical/emotional abuse Violent attacks Rape War Natural catastrophe ```
250
Name some physical illnesses which can bring upon stress
- Cancer - Coronary Heart Disease - Chronic Fatigue Syndrome - Infertility/Miscarriage Peptic Ulcers - Irritable Bowel Syndrome - Karoshi
251
What is Karoshi
A death from overwork usually resulting in a stroke
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How can we manage stress
Exercise Meditation Yoga Cognitive Behavioural Therapy
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What are two purposes of NHS press releases
Reactive - Defending the NHS reputation Proactive - Improving and protecting population health
254
Name some social marketing messages
Five-a-day | Change for life
255
Name some early recognition campaigns
act FAST
256
What diseases are linked to obesity
``` Type II diabetes hypertension Osteoarthritis Bladder control problems Psychological Disorders ```
257
What people did obesity originally affect
The rich
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What group of people does obesity affect now
Poor
259
What percentage of professionals are obese
18%
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What percentage of unskilled/manual workers are obese
28%
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What are some causes of obesity
``` Americanisation of diet and society Increasing dominance of car culture - less walking More commuting Replacing water by sugary drinks Longer working hours ```
262
Definition of obesity
Abnormal or excessive fat accumulation resulting from chronic imbalance between energy intake and energy expenditure that presents a risk to health. It is a state of positive energy balance
263
What two factors affect the aetiology of obesity
Environment and Genetics and Behaviour
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How do we try and monitor weight gain in an individual
1. MRI 2. Dual-energy X-ray Absorptiometry 3. Waist circumference 4. WHR (waist to hip ratio) 5. Skinfold thickness 6. BMI
265
What is BMI is counted as being underweight
Anything below 18.4
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What BMI is normal
18.5 - 24.9
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What BMI is classed as overweight
25.0 - 29.9
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What BMI is classed as obese class I
30.0 - 34.9
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What BMI is classed as Obese class II
35.0 - 39.9
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What BMI is classed as obese class III
Over 40.0
271
What are the seven key domains of energy balance
``` Food Environment Food Consumption Individual Activity Activity of the environment Social Influences Individual psychology Individual Biology ```
272
What is Prader Willi Syndrome
``` Short stature Almond shaped eyes Small hands Small feet Chromosome 15 deletion ``` A genetic cause of obesity
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What other genetic problems can result in obesity
Mutations of leptin and melanocortin receptors Congenital leptin deficiency Polygenic obesity
274
Name two studies used to investigate the role of leptin on obesity
Animal Studies: Agouti mice: Produced excess agouti which decreased melanocortin system's response to leptin Ob-gene mice: Produced no leptin
275
What was the relationship seen between pima indians and obesity
The Pima Indians showed dramatic increase in obesity when exposed to western environment - 9%% of population now have diabetes
276
How can employment affect weight gain
a) Shift work, lack of sleep and upset circadian rhythm b) reduced physical activity c) Cortisol, leptin, ghrelin
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What two behaviours can be associated with weight gain
Dietary patterns Leisure and activities
278
What advantage does breast feeding give in regards to obesity
It is associated with protective mechanisms from obesity
279
How does early introduction of solid food to a toddler affect obesity chances
Increases risk if introduced from under 4 months age
280
What is the biggest predictor of obesity
Childhood obesity
281
What is considered a 'direct control' of meal size
All factors relating to direct contact of the food with the GI mucosal receptors
282
What is considered an 'indirect control' of meal size
Metabolic, endocrine, cognitive individual differences NOTE: Indirect controls can override direct controls
283
Define satiation
What brings an eating episode to end
284
Define satiety
Inter-meal period
285
What is the satiety cascade
Sensory -> cognitive -> post-ingestive -> post-absorptive
286
How does fat affect satiation and satiety
Fat has a really weak impact NOTE: High-Fat foods improve the sensory properties
287
What food brings about the most efficient satiety
Proteins
288
What food brings about the least efficient satiety
Alcohol
289
How are STIs mainly transmitted
Sexual contact
290
What are the four main types of STIs
1. Chlamydia 2. Gonorrheas 3. Syphilis 4. Trichomoniasis
291
Which STI is currently drug resistant
Gonnorhea
292
What are the ABCs to prevent HIV
``` A = Abstain B = Be Faithful C = Condom use ```
293
What are the four aspects of sexual health education
1. Involve young people as they are key decision makers 2. Provide comprehensive, accurate information 3. Address barriers to a accessing health services 4. Empower adolescents to make life choices that are best for them
294
Define CAM
- A broad domain of healing resources that encompasses all health systems, modalities and practices and their accompanying theories and beliefs - It is those healing resources other than those intrinsic to the politically dominant health system of a particular society or culture in a given historical period
295
How can we reduce energy density in diets to reduce calorie intake
Incorporation of water Fruits or vegetables Reducing fat Method of cooking (frying or grilling)
296
In What state does food have a lower energy density
Liquid (except soup)
297
How does alcohol cause over-eating
``` Stimulates intake (no satiety) Efficiently oxidised Adds to total daily energy intake ```
298
How does food environment affect obesity
Variety (greater variety causes over-eating) Portion size - increased over the years Distraction (e.g. watching TV)
299
What psychological factors contribute to over-eating
1. Dietary restrain 2. Stress 3. Sleep (shorter sleep = more eating) 4. Reward sensitivity
300
What are three characteristics that encourage over-eating
Macronutrient composition Energy Density Liquid vs Solids
301
Example of primary care of CHD
SNAP 1. Smoking (taxing, no public places, health warnings and tobacco control) 2. Nutrition (5 a day) 3. Alcohol (Know your limits, taxation, alcohol pricing) 4. Physical Activity (At least 5 times a week)
302
What are the four phases of cardiac rehabilitation
Phase 1 - In hospital Phase II - Early post discharge Phase (III-IV) - 16 weeks Phase IV - SNAP (long-term maintenance of lifestyle change)
303
What are some ways we can do secondary prevention in people wit CHD
Primary care CHD registers Medical management: Aspirin, B-blockers, ACE inhibitors Phase IV cardiac rehabilitation
304
Define Social Class
A measure of occupation, stratification, social position and access to power and resources.
305
What model can quantify social class
NS-SEC model
306
Define the inverse care law
The availability of good medical care tends to vary inversely with the need for it within a population
307
What is the 'sick role' in society
People inhabit social roles and illness allows legitimate deviance from social obligation: 1. Exempt from normal social roles 2. Is not responsible for their role condition 3. Should try to get well
308
Define Iatrogenesis
The unintended adverse effects of therapeutic intervention
309
Name some examples of CAM medicine
``` Acupuncture Osteopathy Herbal medicine Chiropractic Hypnotherapy Aromatherapy Shiatsu ```
310
What are the four classifications based on therapeutic similarity
Manual therapies: Chiropractic, massage, osteopathy Ethnic medical systems: Acupuncture, herbal medicine Mind-body/energy medicine: Healing and hypnotherapy Non-allopathic system: Homeopathy, naturopathy
311
What is the house of lords classification for CAM
Group 1: Some scientific evidence of efficacy (acupuncture, chiropractic, herbal med) Group 2: Modalities working in a supportive capacity alongside conventional medicine but not on its own (massage, hypnotherapy) Group 3: Traditional systems of medicine backed only by historic practice (no evidence they actually work)
312
What sex mainly uses CAM
Females
313
What age group do CAM users lie in
35-60
314
What type of household do most CAM users come from
Rich
315
What three things do people expect to get from CAM
1. Reduction of symptoms + disability 2. Avoidance of medication 3. Gaining control and improving coping skills
316
What is appealing about CAM to potential users
1. Side-effects from conventional treatment 2. Disease is not serious enough to cure 3. Naivety 4. High patient satisfaction rate 5. Poor communication with doctors
317
What are three major concerns for CAM
- Unrealistic expectations 2. Delayed conventional care 3. General safety
318
What are the big 5 CAM based treatments for the NHS
1. Acupuncture 2. Chiropractice 3. Homeopathy 4. Herbal Medicine 5. Osteopathy
319
What are four basic health economic problems
1. Finite resources 2. Desire for good and services is infinite 3. No country treats all treatable ill health
320
Define opportunity cost
Sacrifice in terms of benefits foregone from not allocating resources to the next best activity
321
Define economic efficiency
When resources are allocated between activities to maximise benefit
322
What are three types of economic evaluation
1. Cost-effectiveness analysis 2. Cost-utility analysis 3. Cost-benefit analysis
323
Define cost-effectiveness analysis
Outcomes measured in natural units: incremental cost per life year gained
324
Define cost-utility analysis
Outcomes measured in quality adjusted life years: incremental cost per QALY gained
325
Define cost-benefit analysis
Outcomes are measured in monetary nuts: net monetary benefit
326
Define equity
Concerned with fairness or justice of the distribution of costs and benefits

Phase 1 (30 decks)

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