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Phase 1 > Public Health > Flashcards

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
Q

Four factors that can affect the perception of risk

A
  • 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
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26
Q

What is the health belief model

A

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

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27
Q

What is the theory of planned behaviour

A

Proposes that predictor of behaviour can be best assessed by intent:

  • Person’s attitude to behaviour
  • Subjective Norm
  • Percieved behavioural control
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28
Q

Define the transtheoretical model

A

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

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29
Q

Nice guidance on behaviour change

A
  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
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30
Q

What three factors can allow you to break confidentiality

A
  1. Required by law
  2. Public Interest
  3. Patient consent (implied or explicit)

All have to be done in patient’s knowledge

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31
Q

What are the four duties of a doctor as defined by the GMC

A
  • Knowledge skills + Performance
  • Safety + Quality
  • Communication, partnership and teamwork
  • Maintain Trust
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32
Q

Criteria for disclosure

A
  • Anonymous
  • Patient has not objected
  • Consent
  • Keep to minimum
  • Meets current guidelines and laws
  • Act promptly
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33
Q

What interactions with the law allow us to disclose information

A

Notifiable disease
Regulatory body demands it (CQC, GMC)
Ordered by a judge (Can be refused if needed)
Police, solicitor (Only if consent is given)

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34
Q

Examples of public health which allow disclosure of information

A
  • Serious communicable disease
  • Crime
  • Research
  • Education
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35
Q

Define long-term condition

A

A condition that cannot be, at present, cured but can be controlled by medication + other therapies

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36
Q

Define multi-morbidity

A

The co-occurrence of two or more chronic medical conditions in one person

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37
Q

Define Polypharmacy

A

Use of 4 or more medications by a patient

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38
Q

Define Medical Compliance

A

Describes the degree to which a patient correctly follows medical advice

Usually if they’ve been taking their prescribed medication

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39
Q

How does an aging population affect age median

A

Increases it

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40
Q

How does the proportion of older people change and why

A

Increased proportion due to increased life expectancy and decreased birth rate

Also due to improved health care, sanitation, living conditions and education

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41
Q

Four challenges of an ageing population

A
  • 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)
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42
Q

What did Ignacz Semmelweis campaign for?

A

Hand washing after discovering a correlation between puerperal fever and dissection

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43
Q

Define Gini coefficient

A

A statistical representation of nation’s income distribution

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44
Q

What was the Black Report (1980)

A

Document reporting on health inequality causes

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45
Q

What were the five causes of health inequality according to the black report (1980)

A

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)

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46
Q

What two conclusions did the Acheson Report (1998) come to?

A

Income inequality should be reduced

Give high priority to health of families with children

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47
Q

What are three aspects of proportionate universalism

A
  • 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
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48
Q

What are the three theories of causation?

A

Psychosocial
Neo-material
Life-Course

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49
Q

What is the theory behind psychosocial causation

A
  • Stress results in inability to respond efficiently to the body’s demands
  • Impact on blood pressure, cortisol levels and on inflammatory and neuroendocrine responses
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50
Q

What is the theory behind net-material causation

A
  • 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
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51
Q

What is the theory behind Life-Course theory of causation

A
  • 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)
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52
Q

What are the four domains of public health

A
  • Health protection (infectious disease, equity, service planning)
  • Improving services (efficiency and equity)
  • Health improvement
  • Addressing the wider detriments of health
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53
Q

What is meta-ethics

A

Exploring fundamental questions

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54
Q

What are the five types of ethics

A
  • Virtue
  • Categorical
  • Imperative
  • Utilitarianism
  • Four principles
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55
Q

What is applied ethics

A

A recent emergence of ethical investigations in specific areas

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56
Q

What are four ethical arguments

A
  • 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)
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57
Q

Define the ‘ad hominem’ ethical fallacy

A

Responding to arguments by attacking the person’s character than the content of their argument

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58
Q

What is an ‘authority claim’ fallacy of ethics?

A

Saying a claim is correct because the authority has said so

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59
Q

What is the ‘petition principii’ fallacy of ethics

A

Assuming the initial point of the argument - ‘beg the question’

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60
Q

What is the ‘dissenters’ fallacy of ethics

A

Identifying those who disagree does not prove the claim is not valid

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61
Q

What is the ‘motherhoods’ fallacy of ethics?

A

Inserting a soft statement to disguise the disputable one

e.g. All humans are equal (so we shouldn’t stop PVS patient treatment)

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62
Q

What is the ‘no true scotsman’ fallacy of ethics?

A

Modifying the argument

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63
Q

What are fine structural determinants of illness

A
  • Social Class
  • Material Deprivation / Poverty
  • Unemployment
  • Discrimination
  • Gender and Health
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64
Q

What is the biomedical model of health

A
  • 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
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65
Q

What are three main notifiable diseases that MUST be reported to the WHO + requires disclosure of private information

A
  • Cholera
  • Yellow Fever
  • Plague
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66
Q

Define primary prevention of CVD

A

Preventing CVD before it occurs

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67
Q

Define secondary prevention of CVD

A

Preventing additional attacks of CVD after the first attack has occurred

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68
Q

What can we do as primary prevention of CVD

A

Blood thinning drugs (aspirin)

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69
Q

What can we do as secondary prevention of CVD

A

Surgical Procedures

Aspirin

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70
Q

What are three non-modifiable risk factors for CVD

A

Age
Ethnicity
Family history of heart disease

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71
Q

What are modifiable factors affecting CVD?

A 
BP
Physical Inactivity
Being overweight
High Blood Cholesterol
Smoking
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72
Q

Changes to diet to prevent CVD

A

LDL - Bad cholesterol
HDL - Good cholesterol

Veg
Fruits
Whole-grains
Low fat dairy products (fish)

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73
Q

What other ways can I reduce chances of CVD other than diet

A

Smoking - Quit
Lower BP (reduce Na intake)
Exercise (3-4 times a week at 40 mins sessions)

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74
Q

How would I assess for cardiac chest pain

A
  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
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75
Q

What is GTN

A

A spray used for pain relief (short-term only)

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76
Q

How long do the effects of GTN last for

A

20-30 minutes

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77
Q

What symptom may indicate Acute Coronary syndrome

A

Pain lasting longer than 15 minutes

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78
Q

What is morality

A

Concern with the distinction between good and evil or right and wrong

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79
Q

Define ethics

A

A system of moral principles and a branch of philosophy which defines what is good for individuals and society

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80
Q

What is a teleological argument

A

Argument for the existence of god

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81
Q

What is a deontological ethics

A

Judges morality of an action based on rules

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82
Q

What type of argument is utilitarianism/ consequentialism

A

Teleological

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83
Q

What is the concept of utilitarianism / consequentialism

A

An act is evaluated solely in terms of its consequences

Maximising good and minimising harm

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84
Q

What are a few criticisms of utilitarianism

A

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

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85
Q

What type of argument is kantianism

A

Deontological

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86
Q

What is kantianism

A

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’

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87
Q

What are criticisms of kantianism

A

For an action to be permissible, it must be possible to apply it to all people without a contradiction occurring.

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88
Q

What type of argument is virtue ethics

A

Deontological

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89
Q

Define virtue ethics

A

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

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90
Q

What are the five focal virtues that make up virtue ethics

A 
Compassion
Discernment
Trustworthiness
Integrity
Conscientiousness

Cook Dick To Interest Callum

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91
Q

What is the criticism of virtue ethics

A

Virtue ethics is ‘culturally relative’

Since different people, cultures and societies often have different opinions on what constitutes a virtue.

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92
Q

What are the four principles of ethics

A

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)

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93
Q

5 GMC duties of a doctor

A
  • 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

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94
Q

What does the Katz ADL consist of

A

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

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95
Q

Describe IADL

A 
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

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96
Q

Describe Barthel ADL Index

A
  • 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

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97
Q

What three aspects are being tested on old people in the Mini Mental State Examination

A
  • Orientation, immediate memory
  • Short term memory
  • Language Functioning
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98
Q

Define acute illness

A

A disease of short duration that starts quickly and has severe symptoms

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99
Q

Define chronic illness

A

A persistent or recurring condition which may or may not be severe, often starting with gradually slow change

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100
Q

Define Polypharmacy

A

The use of multiple medications or administration of more medications than are clinically indicated

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101
Q

What are 5 challenges of aging population

A
  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
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102
Q

What are five causes of waging population

A
  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
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103
Q

Facts on UK ageing population

A

Population of 65+ is the same as population of under 15

By 2025, there will be more people over 65 than under 20

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104
Q

Define intrinsic ageing

A

Natural, universal, inevitable

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105
Q

Define extrinsic ageing

A

Dependant on external factors (UV ray exposure smoking etc)

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106
Q

What are five examples of physical changes during ageing

A
  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
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107
Q

Three impacts of ageing on vision

A
  1. Need 3 times more light
  2. Depth/colour perception
  3. Narrowing of visual field
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108
Q

Two impacts of ageing on hearing

A
  1. High frequency loss

2. Speech comprehension 20%

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109
Q

How does ageing affect taste and smell

A

We lose 50% of our taste buds.

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110
Q

Economic costs of smoking

A

5.5% of healthcare costs - smoking
Loss of productivity from smoking breaks
Increased Absents (£2.5 billion)
Cleaning up butts

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111
Q

Health problems in the UK due to smoking

A

Single greatest cause of illness and premature death in the UK

100,000 die a year in UK

COPD

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112
Q

Name four medications to stop smoking

A

Nicotine replacement therapy
Varenicline
Antidepressants
Clonidine

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113
Q

How do nicotine replacement therapy work

A

Stimulates nicotinic receptors and stimulates release of dopamine

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114
Q

What three ways can GP manage smokers

A

Cost
Health damages -> outline health risks
Helplines

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115
Q

What are readings on a spirometer trace compared to

A

BMI and age

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116
Q

What will diagnosis using an X-ray for COPD tell us

A

Whether another condition is causing symptoms

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117
Q

What is a blood test for COPD aiming for

A

Checks if symptoms are due to anaemia

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118
Q

What does the peak flow test for COPD aim to show us

A

It it is asthma

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119
Q

What should we do to patients who remain breathless despite having bronchodilators

A

Maintenance therapy

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120
Q

What should we give to patients with an FEV1 > 50%

A

LABA (agonist) or LAMA (antagonist)

or Pulmonary rehab

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121
Q

What does COPD stand for

A

Chronic Obstructive Pulmonary Disease

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122
Q

Symptoms of COPD

A

Tight chest
Wheezing
Short breath

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123
Q

What antibiotic can I use to treat exacerbation of COPD

A

Azithromycin

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124
Q

What does it mean to be ‘institutionalising death’

A

60% of people die in hospital but 70% want to die at home

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125
Q

What is medicalisation of death

A

Death as a natural part of our life is challenged by trying to prolong life at any cost

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126
Q

What is the Glaser + Strauss (1965) study

A

Observational study of interactions between dying people, relatives and staff in USA hospitals

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127
Q

What were the four awareness contexts discovered in the Glaser + Strauss report

A

Closed Awareness - Patients not aware of their own impending death
Suspicion - Awareness
Mutual Pretence
Open Awareness

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128
Q

What is closed awareness

A

Patients not aware of their own impending death

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129
Q

What is suspected Awareness

A

pt suspects others know and attempts to confirm/invalidate his/her suspicions

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130
Q

What is mutual Pretence

A

all sides know but pretend the others do not

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131
Q

What is Open Awareness

A

Everyone knows and openly admits it

132
Q

What is the ratio of women:men in old age populations

A

2:1

133
Q

Why do women live longer than males

A

20% biological - premenopausal women are protected from heart disease by hormones

80% environmental - Men take more lifestyle risks than women)

134
Q

What is the consequence of life expectancy on pensions

A

Have higher pay outs than those currently planned

135
Q

What is the consequence of a higher life expectancy on health

A
  • Chronic conditions will prevail

- Rising inequalities as more affluent groups use health services for longer

136
Q

What is the most common type of dementia

A

Alzheimer’s - 62%
Vascular
Lewy Body
Fronto-temporal

137
Q

Define a social death

A

When people die in social and interpersonal terms before their actual biological death (lonely death)

138
Q

Define a good death

A

Palliative care became a speciality, aiming to demedicalise death - more personal

139
Q

What are four features of death in a hospice way

A
  1. Open awareness, compassion + honesty
  2. MDT
  3. Family Approach (relationships)
  4. Holistic Care

One Member Farted Holistically

140
Q

What two actions did Kate Granger take to raise awareness of importance of a good death

A
  1. The Other Side (novel)

2. Hellomynameis campaign

141
Q

What makes a susceptible host to disease

A

Low immunity, low white cell count, imbalance in normal flora and invasive procedures

142
Q

How can number of microorganisms increase in health care services

A

Resistant pathenogenic strains

143
Q

What is a reservoir?

A 
Where potential spread originates:
Visitors
Patients
Staff
Fomites
144
Q

What are three portals of entry/exit

A

Resp tract
GI Tract
Broken Skin
Genito-urinary tract

145
Q

What two ways can infections spread

A

Exogenous - Direct/Indirect Contact, vector spread, airborne

Endogenous - Self spread

146
Q

Why do we do hand decontamination

A

Remove transient hand flora (Viruses, Staphylococcus aureus)

Reduce number of resident flora

147
Q

How do we do hand decontamination

A

Hand washed
Take of wrists jewellery and long sleeves as we can’t wash hands affectively

Nails need to be short and clean

148
Q

When do we wash our hands?

A 
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
Q

What are the three levels of hand washing

A

Level 1 = Routine Handwash
Level 2 = Hygienic hand antisepsis
Level 3 = Surgical Handscrub

150
Q

What is Level 1 hand washing purpose and method used to do it

A

Removes soil/dirt and transient microbes

Method: Soap for at least 10-15 secs

151
Q

What is level 2 hand washing + method

A

Removes and destroys transient microbes

Method: Antimicrobial soap or alcohol-based hand rub for 10 to 15 secs

152
Q

What is Level 3 hand washing + method

A

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
Q

What is alcohol gel effective and ineffective against

A

Destroys MRSA but not Norovirus or clostridium difficile

154
Q

What is antimicrobial liquid soap and water effective against

A

ALL transient microbes

155
Q

Two examples of campaigns to encourage hand washing

A

Clean your hands campaign

Bare below the elbow policy (recommendation by department of health)

156
Q

Name the two types of water

A

Household

Clinical - All clinical waste must be identifiable and traceable back to the source it originated from

157
Q

What is a sharp

A

A sharp is described as any item that can potentially cute or penetrate the skin

158
Q

What should we never do during disposal of sharps

A

Re-sheathing needles
Emptying sharp bin contents
Overfill a sharps bin
Carry bin with sliding doors OPEN

159
Q

What should doctors wear when interacting with patients

A

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
Q

What are three psychological effects of nicotine

A
  • Activation of nicotinic ACh receptors on the brain
  • Causing dopamine release in the nucleus accumbens
  • Stimulation (withdrawal)
161
Q

What are four impacts of smoking

A

Premature death (main cause)
100,000 deaths due to smoking
COPD and cancers
A great economic impact of smoking

162
Q

What are 7 problems connected to smoking

A 
CV problems (heart attacks)
Cancers of other organs
Stomach ulcers
Impotence
Diabetes
Oral Health
Cataracts
163
Q

What happened in 1908 in regards to smoking

A

Children’s act - sale of tobacco to under 16s prohibited

164
Q

What was published by Richard Doll and Austin Bradford Hill in 1950

A

A report on smoking and its link to lung carcinoma

165
Q

What three laws have been passed to reduce smoking

A

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
Q

What two ways can patients undergo smoking cessation

A

NRT (patches, inhaler, nasal spray)

Non-nicotinic pharmacotherapy

i. Varenicline
ii. Bupropion

167
Q

What are the three As used to approach smoking patients

A

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
Q

Define ‘digit divide’

A

Difference in access to information

169
Q

What are the 8 millennium development goals

A
  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
Q

What are the three leading causes of death in children in the developing world

A
  1. Pneumonia
  2. Diarrhoea
  3. Malaria
171
Q

Who are the five key actors in global health?

A
  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
Q

What five major environmental changes are happening at the moment

A 
CFCs + Ozone depletion 
Loss of biodiversity within ecosystem
freshwater decline + Land degradation 
Loss of natural fisheries
Increasing desertification
173
Q

What are 6 global health issues

A 
Common Health problems
Health problems that cross borders
International migration
Political crisis
International agreements
Global environmental change
174
Q

Name some examples of migrants

A 
Asylum Seekers
Refugees
Migrant workers
Family workers
Family Joiners
International Students
175
Q

What three factors define a migrant

A

Country of birth
Nationality
Duration of stay

176
Q

What types of migrants do we usually see (2)

A
  • Asylum seekers

- Economic migrants

177
Q

What is lampedusa

A

An italian island

178
Q

What is the issue with immigration in lampedusa

A

A primary transit point for immigrants from Africa

179
Q

Where is lampedusa located

A

A european territory closest to the shores of Libya

180
Q

What is the issue with the migrant route from Libya to Lampedusa

A

Most deadliest migrant route in the world

181
Q

What are the four goals of the NHS when it comes to global health

A
  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
Q

Define Sustainability

A

Being able to meet the needs of today without compromising the ability of future generations to meet the needs of tommorow

183
Q

What is the Bradford Hill Criteria

A

A group for minimal conditions necessary to provide adequate evidence of a causal relationship

184
Q

List the Bradford Hill Criteria

A 
Strength
Consistency
Specificity
Temporality
Biological Gradient
Coherence
Analogy
185
Q

What are possible consequences of climate change

A

Heatwaves
Sea Level Rise
New Diseases
Scarcity of resources -> war

186
Q

How can we solve the issue with climate change

A

Control world population
Reduce energy consumption
Get our energy from renewable resources

187
Q

Define screening

A

A process which sorts out apparently well people who probably do have the disease from those who probably do not

188
Q

Why do we screen people

A

For PREVENTION

189
Q

What is primary prevention

A

To prevent a disease from occurring

190
Q

What is secondary prevention

A

Detection of early disease in order to alter the course of the disease and maximise chances of a complete recovery

191
Q

What is tertiary prevention

A

Trying to slow down the progression of the disease

192
Q

How do I calculate sensitivity

A

True positive/ True positive + False negative

193
Q

What is sensitivity

A

The proportion of people with the disease who are correctly identified by the screening test

194
Q

Formula for specificity

A

True negatives / True negatives + False positive

195
Q

Define specificity

A

The proportion of people without the disease who are correctly excluded by the screening test

196
Q

PPV Formula

A

True positive / True positive + False positive

197
Q

Define PPV

A

The proportion of people with a positive test result who actually have the disease

198
Q

DefineNPV

A

The proportion of people with a negative test result who do not have the disease

199
Q

Calculate NPV

A

True negative/ True negative + False negative

200
Q

Define prevalence

A

The proportion of a population found to have the disease

201
Q

Define incidence

A

The number of new cases within a specified time period divided by the size of the population initially at risk

202
Q

What are the four topics in the Wilson and Junglier criteria for screening

A

The condition
The treatment
The test
Benefits

203
Q

Outline the condition of the criteria

A

It should be a serious health problem
The aetiology should be well understood
There should be a detectable early stage

204
Q

Outline the treatment of the criteria

A

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
Q

Outline the test of the criteria

A

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
Q

Outline the benefits to consider for this criteria

A

There should be an agreed policy on who to treat

The cost should be balanced against the benefits

207
Q

Define selection bias

A

People who choose to participate in screening programmes that may be different to those who do not

208
Q

Define lead time bias

A

Screening merely identifies the disease earlier than before and thus gives the impression that survival is prolonged

209
Q

Define length-time bias

A

Diseases with longer period of presentation are more likely to be detected by screening than ones with shorter time of presentation

210
Q

What is a human error

A

Any preventable event that may cause or lead to patient harm

211
Q

What is an adverse event

A

An incident which results in harm to a patient

212
Q

What is a near miss

A

An event which has the potential to cause harm but fails to develop further, thereby avoiding harm

213
Q

What are the three types of human error

A

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
Q

What are skill-based errors

A

Performing a routine task that is well learnt we give little attention and could have memory lapses if distracted

215
Q

What are rule/knowledge based errors

A

An incorrect plan or course of action is chosen

216
Q

When are rules/knowledge based errors more likely

A

When tasks are more complex

217
Q

What are violations

A

Deliberate deviations from practices, procedures and standards or rules

218
Q

Name the three types of violations

A

Routine (cutting corners)
Necessary (to get the job done)
Optimising (Personal gain, selfish)

219
Q

What are five limitations to information processing

A 
Automaticity 
Cognitive interference
Selective Attention
Cognitive Bias
Transferring our expectations from familiar situations to similar new ones
220
Q

What are the two approaches to managing errors

A

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
Q

What are five components of an effective team

A 
Optimal Size
Good dynamic
A common purpose
Identified team leader
Shared knowledge and experiences
222
Q

What are three benefits of team working

A
  1. Improving service delivery
  2. Improving decision-making
  3. Reducing the error
223
Q

What are four obstacles in team working

A
  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
Q

When do I use the SBAR checklist

A

When reporting a case

225
Q

What is the SBAR checklist

A

S - Situation
B - Background
A - Assessment
R - Recommendation

226
Q

Define Mental Health

A

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
Q

What interventions can we introduce to people with CMHPs

A
  • Community Level
  • Service organisational level
  • Individual Level
  • IAPT service model
228
Q

What is the IAPT service model

A

Improving access to psychological therapies

i. High intensity care
ii. Low intensity care

229
Q

Define stress

A

Stress occurs when the demand made upon an individual are greater than their ability to cope

230
Q

What is distress

A

A negative stress which is damaging and harmful

231
Q

What is eustress

A

A positive stress which is beneficial and motivating

232
Q

What can cause acute stress

A

noise, danger infections, injuries, hunger

233
Q

What can cause chronic stress

A

Health, home, finances, work, family, friends

234
Q

What are internal stressors

A

Physical (inflammation or infection)

Psychological (attitudes, beliefs, personal expectations, worries)

235
Q

What are external stressors

A

Environment, work and social pressure

236
Q

What is the main response to stress

A

Fight or Flight response

237
Q

What type of stressor is the fight or flight model a response to

A

External acute stressors

238
Q

What is activated during the fight or flight model

A

Hypothalamus

Adrenal medulla and cortex

239
Q

What happens at the lungs during fight or flight

A

Take in more oxygen

240
Q

What happens to the spleen during the fight or flight response

A

More RBCs discharged

241
Q

What happens at the mouth during fight or flight response

A

mucous and saliva dry up

242
Q

What happens to blood flow in the fight or flight response

A

Increases by up to 400%

243
Q

When are we alarmed

A

When threat is identified

244
Q

What are two aspects of the general adaptation syndrome to stress

A

Defensive countermeasures engaged - Resistance

The body begins to run out of defences - Exhaustion

245
Q

What are five signs of stress

A

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
Q

Define the stress-illness model

A

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
Q

PTSD Diagnostic criteria

A
  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
248
Q

What are three symptoms associated with PTSD

A
  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
Q

What are three examples of traumatic events

A 
Childhood physical/emotional abuse
Violent attacks
Rape
War
Natural catastrophe
250
Q

Name some physical illnesses which can bring upon stress

A
  • Cancer
  • Coronary Heart Disease
  • Chronic Fatigue Syndrome
  • Infertility/Miscarriage
    Peptic Ulcers
  • Irritable Bowel Syndrome
  • Karoshi
251
Q

What is Karoshi

A

A death from overwork usually resulting in a stroke

252
Q

How can we manage stress

A

Exercise
Meditation
Yoga
Cognitive Behavioural Therapy

253
Q

What are two purposes of NHS press releases

A

Reactive - Defending the NHS reputation

Proactive - Improving and protecting population health

254
Q

Name some social marketing messages

A

Five-a-day

Change for life

255
Q

Name some early recognition campaigns

A

act FAST

256
Q

What diseases are linked to obesity

A 
Type II diabetes
hypertension
Osteoarthritis 
Bladder control problems 
Psychological Disorders
257
Q

What people did obesity originally affect

A

The rich

258
Q

What group of people does obesity affect now

A

Poor

259
Q

What percentage of professionals are obese

A

18%

260
Q

What percentage of unskilled/manual workers are obese

A

28%

261
Q

What are some causes of obesity

A 
Americanisation of diet and society 
Increasing dominance of car culture - less walking
More commuting
Replacing water by sugary drinks
Longer working hours
262
Q

Definition of obesity

A

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
Q

What two factors affect the aetiology of obesity

A

Environment and Genetics and Behaviour

264
Q

How do we try and monitor weight gain in an individual

A
  1. MRI
  2. Dual-energy X-ray Absorptiometry
  3. Waist circumference
  4. WHR (waist to hip ratio)
  5. Skinfold thickness
  6. BMI
265
Q

What is BMI is counted as being underweight

A

Anything below 18.4

266
Q

What BMI is normal

A

18.5 - 24.9

267
Q

What BMI is classed as overweight

A

25.0 - 29.9

268
Q

What BMI is classed as obese class I

A

30.0 - 34.9

269
Q

What BMI is classed as Obese class II

A

35.0 - 39.9

270
Q

What BMI is classed as obese class III

A

Over 40.0

271
Q

What are the seven key domains of energy balance

A 
Food Environment
Food Consumption 
Individual Activity
Activity of the environment 
Social Influences
Individual psychology 
Individual Biology
272
Q

What is Prader Willi Syndrome

A 
Short stature
Almond shaped eyes
Small hands
Small feet
Chromosome 15 deletion

A genetic cause of obesity

273
Q

What other genetic problems can result in obesity

A

Mutations of leptin and melanocortin receptors

Congenital leptin deficiency

Polygenic obesity

274
Q

Name two studies used to investigate the role of leptin on obesity

A

Animal Studies:
Agouti mice: Produced excess agouti which decreased melanocortin system’s response to leptin

Ob-gene mice: Produced no leptin

275
Q

What was the relationship seen between pima indians and obesity

A

The Pima Indians showed dramatic increase in obesity when exposed to western environment - 9%% of population now have diabetes

276
Q

How can employment affect weight gain

A

a) Shift work, lack of sleep and upset circadian rhythm
b) reduced physical activity
c) Cortisol, leptin, ghrelin

277
Q

What two behaviours can be associated with weight gain

A

Dietary patterns

Leisure and activities

278
Q

What advantage does breast feeding give in regards to obesity

A

It is associated with protective mechanisms from obesity

279
Q

How does early introduction of solid food to a toddler affect obesity chances

A

Increases risk if introduced from under 4 months age

280
Q

What is the biggest predictor of obesity

A

Childhood obesity

281
Q

What is considered a ‘direct control’ of meal size

A

All factors relating to direct contact of the food with the GI mucosal receptors

282
Q

What is considered an ‘indirect control’ of meal size

A

Metabolic, endocrine, cognitive individual differences

NOTE: Indirect controls can override direct controls

283
Q

Define satiation

A

What brings an eating episode to end

284
Q

Define satiety

A

Inter-meal period

285
Q

What is the satiety cascade

A

Sensory -> cognitive -> post-ingestive -> post-absorptive

286
Q

How does fat affect satiation and satiety

A

Fat has a really weak impact

NOTE: High-Fat foods improve the sensory properties

287
Q

What food brings about the most efficient satiety

A

Proteins

288
Q

What food brings about the least efficient satiety

A

Alcohol

289
Q

How are STIs mainly transmitted

A

Sexual contact

290
Q

What are the four main types of STIs

A
  1. Chlamydia
  2. Gonorrheas
  3. Syphilis
  4. Trichomoniasis
291
Q

Which STI is currently drug resistant

A

Gonnorhea

292
Q

What are the ABCs to prevent HIV

A 
A = Abstain 
B = Be Faithful 
C = Condom use
293
Q

What are the four aspects of sexual health education

A
  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
Q

Define CAM

A
  • 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
Q

How can we reduce energy density in diets to reduce calorie intake

A

Incorporation of water
Fruits or vegetables
Reducing fat
Method of cooking (frying or grilling)

296
Q

In What state does food have a lower energy density

A

Liquid (except soup)

297
Q

How does alcohol cause over-eating

A 
Stimulates intake (no satiety)
Efficiently oxidised 
Adds to total daily energy intake
298
Q

How does food environment affect obesity

A

Variety (greater variety causes over-eating)

Portion size - increased over the years

Distraction (e.g. watching TV)

299
Q

What psychological factors contribute to over-eating

A
  1. Dietary restrain
  2. Stress
  3. Sleep (shorter sleep = more eating)
  4. Reward sensitivity
300
Q

What are three characteristics that encourage over-eating

A

Macronutrient composition

Energy Density

Liquid vs Solids

301
Q

Example of primary care of CHD

A

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
Q

What are the four phases of cardiac rehabilitation

A

Phase 1 - In hospital

Phase II - Early post discharge

Phase (III-IV) - 16 weeks

Phase IV - SNAP (long-term maintenance of lifestyle change)

303
Q

What are some ways we can do secondary prevention in people wit CHD

A

Primary care CHD registers

Medical management: Aspirin, B-blockers, ACE inhibitors

Phase IV cardiac rehabilitation

304
Q

Define Social Class

A

A measure of occupation, stratification, social position and access to power and resources.

305
Q

What model can quantify social class

A

NS-SEC model

306
Q

Define the inverse care law

A

The availability of good medical care tends to vary inversely with the need for it within a population

307
Q

What is the ‘sick role’ in society

A

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
Q

Define Iatrogenesis

A

The unintended adverse effects of therapeutic intervention

309
Q

Name some examples of CAM medicine

A 
Acupuncture
Osteopathy 
Herbal medicine
Chiropractic
Hypnotherapy 
Aromatherapy
Shiatsu
310
Q

What are the four classifications based on therapeutic similarity

A

Manual therapies: Chiropractic, massage, osteopathy

Ethnic medical systems: Acupuncture, herbal medicine

Mind-body/energy medicine: Healing and hypnotherapy

Non-allopathic system: Homeopathy, naturopathy

311
Q

What is the house of lords classification for CAM

A

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
Q

What sex mainly uses CAM

A

Females

313
Q

What age group do CAM users lie in

A

35-60

314
Q

What type of household do most CAM users come from

A

Rich

315
Q

What three things do people expect to get from CAM

A
  1. Reduction of symptoms + disability
  2. Avoidance of medication
  3. Gaining control and improving coping skills
316
Q

What is appealing about CAM to potential users

A
  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
Q

What are three major concerns for CAM

A
  • Unrealistic expectations
    2. Delayed conventional care
    3. General safety
318
Q

What are the big 5 CAM based treatments for the NHS

A
  1. Acupuncture
  2. Chiropractice
  3. Homeopathy
  4. Herbal Medicine
  5. Osteopathy
319
Q

What are four basic health economic problems

A
  1. Finite resources
  2. Desire for good and services is infinite
  3. No country treats all treatable ill health
320
Q

Define opportunity cost

A

Sacrifice in terms of benefits foregone from not allocating resources to the next best activity

321
Q

Define economic efficiency

A

When resources are allocated between activities to maximise benefit

322
Q

What are three types of economic evaluation

A
  1. Cost-effectiveness analysis
  2. Cost-utility analysis
  3. Cost-benefit analysis
323
Q

Define cost-effectiveness analysis

A

Outcomes measured in natural units: incremental cost per life year gained

324
Q

Define cost-utility analysis

A

Outcomes measured in quality adjusted life years: incremental cost per QALY gained

325
Q

Define cost-benefit analysis

A

Outcomes are measured in monetary nuts: net monetary benefit

326
Q

Define equity

A

Concerned with fairness or justice of the distribution of costs and benefits

Phase 1 (30 decks)

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