Public health Flashcards
Define mental health
A state of well being in which every individual realises their own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to their community
What is the inverse care law?
The availability of good medical care tends to vary inversely with the need for it in the population served
Give 4 categories of health influences
- ) Biological
- ) Personal lifestyle
- ) Health services
- ) Physical and social environment
What 2 things did the Black report 1980 confirm?
- ) Social class health inequalities in overall mortality
- ) Health inequalities are widening
Give 4 mechanisms to explain the Black report 1980
- ) Artefact
- ) Social selection
- ) Behaviour
- ) Material circumstances
What did the Acheson report 1988 find?
Mortality has decreased in the last 50 years but inequalities remained or widened
Give the 3 recommendations from the Acheson report 1988
- ) Evaluate all policies likely to affect health in terms of the impact on inequality
- ) Prioritise health of families with children
- ) Government should reduce income inequalities and improve living conditions in poor households
Give the 3 domains of the theories of causation
- ) Lifecourse
- ) Psychosocial
- ) Materialist
Describe the life course theory of causation
Critical periods have a greater impact in the life course (e.g. measles in pregnancy), hazards and their impacts accumulate (e.g. hard blue-collar work) - interactions and pathways
Describe the psychosocial theory of causation
Social inequality may affect how people feel, which in turn can affect body chemistry - focuses on individual
Describe the materialist theory of causation
Poverty exposes people to more health hazards, disadvantaged people are more likely to live in areas exposed to harm (e.g. damp and pollution)
Give 2 ways in which doctors can help minimise health inequality
- ) Change perspectives
- ) Change systems
- ) Education
Give 3 things consent must be
- ) Voluntary
- ) Informed
- ) Made by someone with capacity
What must you tell someone to get consent?
What, how, risks, benefits, alternatives
What 4 things may a patient not be able to do that leads to a decision not being made?
- ) Understand relavent information
- ) Retain it
- ) Use information to make a decision
- ) Communicate decision
What 4 things must we take into account when acting in the best interests of a patient?
- ) Whether patient may soon regain capacity
- ) Patient’s past and present wishes
- ) Patient’s beliefs and values
- ) Consultation with anyone available
Give 4 types of risk factor for CHD, and an example of each
- ) Unmodifiable (age, sex, ethnicity, genetics)
- ) Lifestyle (smoking, diet, physical inactivity)
- ) Clinical (HTN, lipids, DM)
- ) Psychosocial (behavioural trait, depression/anxiety, work, social support)
What gives a 67% higher chance of an MI?
> 11hr work days
Who did the Whitehall study 1 look at?
Male British civil servants over a 10 year period
What did the Whitehall study 1 find?
Men in the lowest grade had higher mortality than men in the highest grade, 3x mortality rate from all causes
Who did the Whitehall study 2 look at?
10,000 civil servents
What did the Whitehall study 2 find?
Employment grade was strongly associated with work control and demands
Give 3 things doctors can do to reduce psychosocial influences on CHD
- ) Observe/explore behaviour patterns
- ) Identify signs of depression/anxiety
- ) Ask questions from assessment tools
- ) Ask patients about job/occupation
- ) Ask about available support
- ) Liase with relevant services
What is an absolutist explanation?
It’s about poverty, absolute measures of socioeconomic deprivation
What is a relativist explanation?
It’s about relative differences, larger relative difference means poorer outcomes for the worse off
Give 4 ways we verify death
- ) No heart sounds/carotid pulse for 1 minute
- ) No breath sounds/respiratory effort for 1 minute
- ) No response to painful stimuli
- ) Pupils fixed and dilated
What % of people die in hospital?
60%
What is the maximum number of units you should drink in a week?
14
Give 2 ways to make drinking 14 units a week better
- ) Spread them evenly over 3+ days
- ) Have several alcohol free days each week
What is substance misuse? (3)
- ) Results in failure to fulfil role obligations (school, work, home)
- ) May be physical hazardous (driving, machinery)
- ) Continued misuse despite persistent or recurrent social or interpersonal problems
How do we calculate the number of units in a drink?
(%ABV x volume in ml)/1000
What is dependence?
A state in which an organism functional normally only in the presence of a drug, manifests as a physical disturbance when the drug is withdrawn
What is tolerance?
A state in which an organism no longer responds to a drug, and a higher dose is required to achieve the same effect
What are the 2 actions of alcohol in the body?
- ) Potentiates GABA (inhibitor NT)
- ) Inhibitis glutamate (excitatory NT)
Where is alcohol well absorbed in the body?
Small intestine
What is the half life of alcohol?
6-30 hours
Give 2 properties of alcohol in the body
- ) Highly lipophilic
- ) Highly protein bound
What metabolises alcohol?
Liver
Can alcohol cross the BBB?
Yes
How is alcohol eliminated?
Excreted in urine mainly in form of its metabolites, as conjugates (glucuronide/sulphate)
What is Wernicke’s encephalopathy?
Caused by a severe deficiency of thiamine, common in severely dependent drinkers
How do we treat Wernicke’s encephalopathy?
Pabrinex, VB, thiamine
How do we treat alcohol withdrawal?
Benzodiazepines
What is the STI/HIV transmission equation?
R = BCD R - reproductive rate B - infectivity rate C - partners over time D - duration of infection
What is the infectivity rate of STI/HIV altered by?
Condom use, type of sex, microbe characteristics of organism
What is the duration of infection of STI/HIV altered by?
Reduced by easy access to services
What is primary prevention?
Reducing risk, prevention
What is secondary prevention?
Detecting, treating
What is tertiary prevention?
Reducing morbidity/mortality
Give 2 primary preventions for STIs
Awareness campaigns, vaccinations, key cash condom poster, pre/post exposure prophylaxis
Give 2 secondary preventions for STIs
Easy access to tests/treatment, partner notification, targeted screening
Give 2 tertiary preventions for STIs
Antiretrovirals for HIV, prophylactic ABX for PCP, acyclovir for genital herpes
Give 3 things partner tracing does
- ) Breaks the chain of transmission
- ) Prevents re-infection of index patient
- ) Prevents complications of untreated infection
Why do people carry out FGM?
- ) Seen as being ‘pure’
- ) Unable to marry without it
Give 2 complications of FGM
- ) Bleeding
- ) Infection
- ) Pain
- ) Death
- ) LUTS
- ) Period problems
- ) Anxiety
- ) PTSD
- ) Withdrawal
Give 3 infectious conditions that new migrants may present to their GP with
- ) Hepatitis
- ) TB
- ) Malaria
- ) HIV
- ) Parasitic infections
Give 2 mental health problems that war refugees may suffer from after immigration
- ) PTSD
- ) Depression
- ) Suicidal thoughts
- ) Anxiety
- ) Chronic pain, fatigue, dizziness, headache
Give 2 reasons we should be careful using family members as interpreters
- ) Agenda/bias
- ) Not confidential
- ) Poor English
- ) May limit translation
What is the typical history of occupational asthma?
Asthma improves on weekends/holidays
How can we diagnose occupational asthma?
Peak flow diary
Give 2 bits of advice for hand dermatitis prevention
- ) Avoid allergen/irritants
- ) Gloves
- ) Skincare 0 cream and soaps
What studies are best suited to calculating attributable risk?
Cohort
Give 3 teamwork problems
- ) Lack of teamwork
- ) Lack of leadership
- ) Lack of effort
- ) Lack of communication
- ) Lack of challenge
What is SBARR communication?
Situation Background Assessment Recommendation Response/review
What are the most commonly misused drugs?
Cannabis, ecstasy, new psychoactive substances
Give 4 types of substance, an example, and their effects
- ) Opiates - heroin, morphine - pain relief, euphoria
- ) Depressants - alcohol - sedation, relaxation
- ) Stimulants - caffeine, nicotine, cocaine - increased alertness, activity, mood
- ) Hallucinogens - ecstasy, ket, mushrooms - alter sensory perception and thinking
Give 3 risk factors in drug abuse
- ) Quantity and frequency of use
- ) Knowledge of what they’re using
- ) Poly drug use
- ) Propensity for risky behaviour
- ) Co-existing problems
Give 2 risks of NPAs
- ) Overdose and temporary psychotic states
- ) Unpredictable behaviour
- ) Sudden pyrexia, tachycardia, coma
- ) Hallucination and vomiting
- ) Aggression and violence
- ) Intense comedown
Give 4 models of thinking for substance misuse
- ) Disease - addiction is a chronic recurring/genetic illness
- ) Behavioural - bad habit, would be punishment and rewards for non-using
- ) Volitional - failure of will, act to increase self-efficacy self -esteem, education on consequences
- ) Socio-cultural - target poverty, social exclusion, housing and mental health problems
Give 3 family risk factors for substance misuse
- ) FHx
- ) Family management problems
- ) Family conflict/abuse
- ) Being in care
Give 3 school/community risk factors for substance misuse
- ) Low academic attainment and commitment
- ) Availability of drugs
- ) Community norms
- ) Community disorganisation
- ) Transitions/mobility
- ) Low neighbourhood attachment
Give 3 individual risk factors for substance misuse
- ) Risk taking
- ) Rebelliousness
- ) Friends who use
- ) Experience of trauma
What is physical dependence?
Body adapts to presence of substance over time and needs more for the same effect (tolerance), stopping leads to withdrawal symptoms
Give an alcohol withdrawal symptom
- ) Tremors
- ) Stomach cramps
- ) Tachycardia
- ) HTN
- ) Hallucinations
- ) Seizures
- ) Delirium
What is psychological dependence?
Feeling that life is impossible/challenges cannot be face without drug, emotional effects
Give 4 points of the national drug strategy 2017
- ) Reduce demand
- ) Restrict supply
- ) Building recovery in communities
- ) Family/community involvement
- ) Payment by results
- ) Abstinece focused with emphasis on recovery and peer support
Give 3 local previsions for drug control
- ) GPs
- ) Harm reduction services
- ) Open access service
- ) Structured psychosocial interventions
- ) Prescribing services
- ) Detox
- ) Access to rehab
- ) Recovery support
What is one unit of alcohol defined as?
10ml pure alcohol (one shot, half pint, small glass of wine)
What is the alcohol harm paradox?
Low socioeconomic groups drink less alcohol than high socioeconomic groups, but experience more alcohol related harm
What does foetal alcohol syndrome cause?
- ) Pre and post-natal growth retardation
- ) CNS abnormalities
- ) Craniofacial abnormalities
- ) Defects of eyes, ears, mouth, CVS, GUT, skeleton
Give 2 chronic effects of alcohol excess
- ) Dementia
- ) Cerebellar degeneration
- ) Fatty liver
- ) Cirrhosis
- ) Liver cancer
- ) HTN, CHD
Give 3 psychosocial effects of excessive alcohol consumption
- ) Violence, rape, depression, anxiety
- ) Problems at work
- ) Criminality
- ) Social disintegration/povery
- ) Driving incidents/offences
Give a primary prevention for alcohol excess
- ) Known your limits campaign
- ) Drinkaware labelling
- ) THINK! drunk driving campaign
- ) Restriction on alcohol advertising
- ) TV ads
- ) Minimum pricing
Give a secondary prevention for alcohol excess
- ) Routinely asking, screening questions
- ) FAST, AUDIT, CAGE
Give 3 examples of notifiable diseases
- ) Acute meningitis
- ) Acute infectious hepatitis
- ) Anthrax
- ) Acute encephalitits
- ) Cholera
- ) Legionnaires
- ) Malaria
- ) Measles
- ) SARS
- ) Smallpox
- ) TB
Why do we notify about diseases?
Outbreak detection, early warning, forecasting
What are the 2 types of vaccine failure?
Primary - no immunity developed from vaccine
Secondary - initially responds but protection wanes over time
Give 2 reasons DM is a public health issue
- ) Mortality
- ) Disability
- ) Co-morbidity
- ) Reduced QOL
Give 3 risk factors for DM
- ) Sedentary job
- ) Obesogenic environment (physical, economic and sociocultural)
- ) Diet high in calories, low in veg
Give 2 factors that maintain obesity
- ) Physical - more weight, more difficult to exercise
- ) Psychological - low self-esteem, comfort eating
- ) Socioeconomic - reduced opportunities
Give a primary prevention of DM
- ) Sustained increase in physical activity
- ) Sustained change in diet
- ) Sustained weight loss
How do we achieve early DM diagnoses?
- ) Raising awareness in community and health professionals
- ) Identify those at risk
Give 3 factors affecting patient compliance
- ) Socioeconomic (distance)
- ) Health system (medication)
- ) Condition (memory)
- ) Therapy (complex)
- ) Patient (denial)
What is an endemic?
Disease permanently present within a population in a geographic area
What is an epidemic?
An increase in the prevalence of a disease above the number usually observed in the population in a particular area
What is a pandemic?
Endemic in several countries
What does antigenic drift cause?
Seasonal epidemics
What does antigenic shift cause?
Pandemics
Give 3 conditions when confidentiality can be broken
- ) Risk to public
- ) Have given consent
- ) Required by law
What is anorexia nervosa?
Restriction of energy intake relative to requirements leading to a significantly low body weight in the context of age, developmental trajectory and physical health
What is bulimia nervosa?
Recurrent episodes of binge eating characterised by eating in a discrete amount of time large amounts of food, and a sense of lack of control over eating during an episode, with recurrent inappropriate compensatory behaviour to prevent weight gain
How do we distinguish binge eating disorder from bulimia nervosa?
No purging or compensatory behaviours
What does OSFED stand for?
Other specified feeding and eating disorders
Give 3 diseases of OSFED
- ) Atypical anorexia nervosa
- ) Bulimia nervosa/binge eating disorder of low freqeuncy/limited duration
- ) Purging disorder
- ) Night eating syndrome
Give 2 risk factors for developing eating disorders
- ) Genes
- ) Temperament
- ) Family interaction
- ) Social pressure
- ) Trauma
Give the maintaining factors of an eating disorder
- ) Positive reinforcement for weight loss initially
- ) Then terror at losing control
How do we treat eating disorders?
CBT, family therapy, specialist support
What is the 2nd leading cause of death amongst children under 5 globally?
Diarrhoea
What does SIGHT mean with C. diff?
- ) Suspect C. diff as a cause of diarrhoea
- ) Isolate cause
- ) Gloves and apron
- ) Hand washing
- ) Test stool for toxin
Give 2 emotional side effects of obesity
- ) Stigma
- ) Bullying
- ) Low self esteem
- ) School absence
- ) Unemployment
Give 3 physical effects of obesity
- ) High cholesterol and BP
- ) Pre-diabetes
- ) Bone and joint problems
- ) Breathing problems
- ) Risk of premature mortality
- ) RF for heart disease, stroke, cancer, liver disease, infertility, depression, sleep apnoea, asthma, DM
Give 2 interventions for obesity
- ) Wider level - change4life, 5 a day
- ) Environment - more cycle paths, less car parking
- ) Public policy - sugar tax, minimum alcohol pricing
What are the 2 groups of beliefs influencing patients evaluation of prescribed drugs?
- ) Necessity
- ) Concerns
What is human error?
A failure of a planned action or a sequence of mental or physical actions to be completed as intended, the use of a wrong plan to achieve an outcome
What is the swiss cheese model of patient safety?
Each slice is a level of defence, the holes are latent conditions/poor design/poor management conditions - if many holes line up, it gives a patient safety incident
Give an example of a patient safety defence
- ) Pre-op checklist
- ) Checking drugs before adminstration
- ) Marking surgical site before operation
