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3a GP and public health > Public health > Flashcards

Public health Flashcards

1
Q

Define public health

A

the science and art of preventing disease, prolonging life and promoting health through organised efforts of society

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2
Q

Define epigenetic

A

environment and personal experiences dictates the expression of your genome

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3
Q

Define allostasis

A

stability through behavioural and physiological change

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4
Q

Define allostatic load

A

long term overtaxation of the body leading to impaired health and stress (= price we pay for allostasis)

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5
Q

Define salutogenesis

A

favourable physiological changes secondary to experiences which promote healing and health

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6
Q

Define emotional intelligence

A

the ability to identify and manages ones own emotions, as well as those of others

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7
Q

what are the 3 domains of public health practice?

A
  1. health improvement
    = concerned with societal interventions to prevent disease, promote health and reduce inequalities
  2. health protection
    = measures to control infectious disease risks and environmental hazards
  3. improving services
    = organisation and delivery of safe, high quality services for prevention, treatment and care
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8
Q

What are public healths key concerns?

A

wider determinants of health
prevention
inequalities in health

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9
Q

What is the difference between equity and equality?

A

equity = fair and just

equality= equal shares

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10
Q

Define horizontal and vertical equity

A

horizontal equity = equal treatments for equal need
e.g. patients with pneumonia treated equally

vertical equity = unequal treatment for unequal need
e.g. individuals with common cold or pneumonia need different treatments

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11
Q

How is health equity examined?

A 
supply of health care 
access to health care 
utilisation of health care 
health care outcomes
health status
resource allocation 
wider determinants of health
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12
Q

Define health needs assessment

A

a systematic method of reviewing the health issues facing a population, leading to agreed priorities and resource allocation that will improve health and reduce inequalities

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13
Q

What is included in the “needs assessment”

A
  1. need = ability to benefit from an intervention
  2. demand= what people ask for
  3. supply= what is provided
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14
Q

Describe the planning cycle

A

needs assessment -> planning -> implementation -> evaluation -> needs assessment …

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15
Q

What is the difference between health need and health care need?

A

health need = need for health, concerns needs more general (measure using mortality, morbidity)

health care need= need for healthcare, more specific and ability to benefit from health care (prevention, treatment, care services)

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16
Q

Who defines need?

A 
individuals
family
community
professionals
services
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17
Q

What must a “health needs assessment” be carried out for?

A
  1. a condition e.g. COPD
  2. a population e.g. manor top practice
  3. an intervention e.g. coronary angioplasty
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18
Q

Outline the social perspective of who defines need

A
  1. felt need= individual perceptions of variation from normal health
  2. expressed need= individual seeks help to overcome variation in normal health
  3. normative need= professional defines interventions appropriate for expressed need
  4. comparative need= comparisons between severity, range of interventions and cost
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19
Q

List the 3 approaches the health needs assessment

A
  1. epidemiological
  2. comparative
  3. corporate
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20
Q

Describe the epidemiological approach to health needs assessment

A
  1. define the problem and size of problem
  2. which services are available
  3. evidence based
  4. models of care
  5. existing services
  6. recommendations
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21
Q

What are the advantages of the epidemiological approach?

A

uses existing data

provides data on disease incidence/ mortality/ morbidity

can evaluate services by trends over time

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22
Q

What are the issues with the epidemiological approach?

A

required data may not be available

variable data quality

does not consider felt needs of people affected

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23
Q

Describe the comparative approach to health needs assessment

A

compares the services received by a population/ subgroup with others

can examine health status, service provision, service utilisation, health outcomes

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24
Q

What are the advantages of the comparative approach?

A

quick and cheap if data available

indicates whether service provision is better/ worse than comparable areas

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25
Q

What are the disadvantages of the comparative approach?

A

may not yield what the most appropriate level is

data might not be available

data of variable quality

difficult to find comparative population

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26
Q

Describe the corporate approach to health needs assessment

A

elicits the views of the people to decide which services are needed e.g. commissioners, professionals, patients, press, politicians

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27
Q

What are the advantages of the corporate approach?

A

based on felt and expressed needs of population

wide range of views

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28
Q

what are the disadvantages of the corporate approach?

A

difficult to distinguish need from demand

groups may have vested interests

influenced by political agenda

dominant personalities have undue influence

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29
Q

How is prevention classified?

A
  1. primary = preventing the disease before it has happened
  2. secondary = catching the disease in the early phase and preventing progression
  3. tertiary = preventing complications of the disease
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30
Q

What are the 2 approaches to prevention?

A
  1. population approach = a preventative measure delivered on a population wide basis and seeks to shift the risk factor distribution curve
  2. high risk approach = seeks to identify individuals above a chosen cut off and treat them
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31
Q

Define prevention paradox

A

a preventative measure which brings much benefit to the population, often offers little to each participating individual

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32
Q

Define screening

A

a process of sorting out apparently well people who probably have a disease from this who probably do not

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33
Q

List the types of screening

A
  1. population based screening programmes
  2. opportunistic screening
  3. screening for communicable diseases
  4. pre-employment and occupational medicals
  5. commercially provided screening
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34
Q

Outline the criteria (wilson and junger) needed for a screening programme

A

THE CONDITION
important health problem
latent/ pre clinical phase
natural history known

THE SCREENING PROCESS
suitable
acceptable

THE TREATMENT
effective
agreed policy on who to treat

THE ORGANISATION
costs and benefits
facilities
ongoing process

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35
Q

What are the disadvantages of screening?

A

exposure of well individuals to distressing or harmful diagnostic tests

detection and treatment of sub clinical disease that would never have caused any problems

preventative interventions that may cause harm to individual or population

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36
Q

Define sensitivity

A

the proportion of people who are correctly identified by the screening test

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37
Q

Define specificity

A

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

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38
Q

Define positive predictive value

A

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

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39
Q

Define negative predictive value

A

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

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40
Q

Define length time bias?

A

relates to screen detected vs intervals cancer

cancers may be slow or rapid progressive and less aggressive cancers are more likely to be detected on screening rounds

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41
Q

List the types of observational study designs

A
  1. descriptive
    case reports, ecological studies
  2. descriptive and analytical
    cross sectional study
  3. analytical
    case control studies, cohort studies
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42
Q

Describe ecological studies

A

(type of descriptive study design)

use routinely collected data to show trends in data and useful for generating hypothesis

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43
Q

Describe cross sectional studies

A

divides population into those without the disease and those with the disease
collects data on them once at a defined time to find associations at that point in time

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44
Q

What are the advantages of cross sectional studies?

A

quick and cheap

provide data on prevalence at a single point in time

large sample size

good surveillance for public health planning

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45
Q

What are the disadvantages of cross sectional studies?

A

prone to bias

no time reference

cannot measure incidence

risk of reverse causality

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46
Q

Describe case control studies

A

retrospective studies that take people with a disease and match them to similar people (of age/sex/class) without the disease and study previous exposure

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47
Q

What are the advantages of case control studies?

A

quick
inexpensive
good for rare outcomes
can investigate multiple exposures

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48
Q

What are the disadvantages of case control studies?

A

difficulties finding controls to match with cases

prone to selection and information bias

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49
Q

Describe cohort studies

A

start with a population without the disease and study them over time to see if they are exposed to agent in question and see if they develop the disease or not

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50
Q

What are the advantages of cohort studies?

A

can follow group with rare exposure

good for common and multiple outcomes

less risk of selection and recall bias

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51
Q

What are the disadvantages of cohort studies?

A

long time

people drop out of study

need large sample size

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52
Q

List the types of experimental/ intervention studies

A
  1. randomised control trials

2. non randomised control trials

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53
Q

Describe randomised control trials

A

patients randomised into groups, one group given interventions and other given control and outcome measured

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54
Q

What are the advantages of randomised control trials?

A

low risk of bias and confounding

can infer causality

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55
Q

What are the disadvantages of randomised control trials?

A

time consuming
expensive
volunteer bias
ethical issues - is it ethical to withhold a treatment if could be effective?

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56
Q

define independent variable

A

variable that can be altered in the study

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57
Q

Define dependent variable

A

variable that is dependent on the independent variables - one that cannot be altered

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58
Q

Define odds

A

ratio of probability of occurrence compared to probability of non occurrence

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59
Q

Define epidemiology

A

the study of the frequency, distribution and determinants of diseases and health related states in populations in order to prevent and control disease

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60
Q

Define prevalence

A

existing cases of a condition

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61
Q

Define incidence

A

number of new cases of a condition

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62
Q

define incidence rate

A

the number of people who have become cases in a given time period / total person time at risk during that period

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63
Q

Define person time

A

measure of time at risk

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64
Q

Define absolute risk

A

actual numbers involved e.g. has UNITs

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65
Q

Define relative risk

A

risk in one category relative to another e.g. no units

how many times more likely it is that an event will occur in the intervention group relevant to the control group

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66
Q

How is relative risk calculated?

A

incidence in exposed / incidence in unexposed

67
Q

Define attributable risk

A

the rate of disease in the exposed that may be attributed to the exposure (type of absolute risk)

68
Q

How are relative risk values interrupted?

A

RR=1 : no difference between the 2 groups

RR<1 : intervention group decreased the risk of the outcome

RR>1 : intervention group increased the risk of the outcome

69
Q

Define relative risk reduction

A

the reduction in rate of the outcome in the intervention group relative to the control group

70
Q

Define absolute risk reduction

A

the absolute difference in the rates of events between the two groups and gives an indication of the baseline risk and intervention effect

71
Q

Define number needed to treat

A

tells us the number of patients we need to treat to prevent one bad outcome

72
Q

Define bias

A

a systematic deviation from the true estimation of the association between exposure and outcome

73
Q

What are the 3 types of bias?

A
  1. SELECTION BIAS
    = error in the selection of study participants or the allocation of participants to different study groups
  2. INFORMATION/MEASUREMENT BIAS
    = error in measurement of exposure or outcome (observer bias, recall bias, wrongly calibrated instrument)
  3. PUBLICATION BIAS
74
Q

Define confounding

A

a situation where the estimate between an exposure and an outcome is distorted because of the association of the exposure with another factor (confounder) that is also associated with the outcome

75
Q

Define reverse causality

A

refers to the situation when an association between an exposure and an outcome could be due to the outcome causing the exposure rather than exposure causing the outcome

76
Q

List the bradford criteria for causality

A 
strength of association 
dose response
consistency 
temporality 
reversibility
biological plausibility 
coherence 
analogy 
specificity
77
Q

Define health psychology

A

emphasises the role of psychological factors in the cause, progression and consequences of health and illness

78
Q

What are the 3 health behaviours?

A
  1. health behaviour
    = a behaviour aimed to prevent disease
    e.g. eating healthily, exercise
  2. illness behaviour
    = behaviour aimed to seek remedy
    e.g. visiting the GP
  3. sick role behaviour
    = behaviour aimed at getting well
    e.g. taking medication, resting
79
Q

List health damaging behaviours

A 
alcohol 
smoking 
substance abuse 
sun exposure
driving without a seatbelt
80
Q

List health promoting behaviours

A 
exercise
healthy eating
wearing sun cream protection 
attending health checks/screening
vaccinations
medication compliance
81
Q

Why do people not comply with taking medications?

A 
bad, intolerable side effects 
don't understand consequences of not taking medication
complex regimes
polypharmacy 
forget 
don't understand why taking medication
82
Q

How can we improve compliance of medication?

A
  1. explain side effects
  2. explain what the medication is for and why they need to take it
  3. reduce number of tablets they are taking
  4. simplify regime
83
Q

Define meta analysis

A

statistical outcome from combining data from multiple studies on a topic

84
Q

Define systematic review

A

literature review that collects secondary data, critically appraise research studies and provide a summary of current evidence relevant to a research question

85
Q

Define regression analysis

A

statistical process for estimating relationships/ risk factors among variables

86
Q

List possible interventions at a population level and individual level to improve health behaviours

A

pOPULATION LEVEL:

  1. health promotion/ awareness campaigns
    e. g. stoptober, change 4 life campaign, 5 fruit/veg a day
  2. promoting screening and immunisations

INDIVIDUAL LEVEL:

  1. patient centred approach
  2. care responsive to individual needs
87
Q

why do we engage in damaging health behaviours? / what is the theory of damaging health behaviour?

A

UNREALISTIC OPTIMISM *

= individuals continue to practice health damaging behaviour due to inaccurate perceptions of risk and susceptibility

88
Q

What are perceptions of risk influenced by?

A
  1. lack of personal experience with problem
  2. belief that preventable by personal action
  3. belief that if not happened by now, it is not likely to
  4. belief that problem infrequent
89
Q

Outline the NICE guidelines on behaviour change

A
  1. planning interventions
  2. assessing the social context
  3. education and training
  4. individual level interventions
  5. community level interventions
  6. population level interventions
  7. evaluating effectiveness
  8. assessing cost effectiveness
90
Q

How as doctors can we help individuals change their health behaviours?

A
  1. work with patients priorities
  2. aim for easy change over time
  3. set and record goals
  4. plan explicit coping strategies
  5. review progress regularly
91
Q

What is the national centre of smoking cessation and training?

A

a social enterprise to support the delivery of effective evidence based tobacco control programmes and smoking cessation interventions provided by local stop smoking services

92
Q

What can the NCSCT provide?

A
  1. deliver training and assessment programmes
  2. provide support services for local and national providers
  3. conducts research into behavioural support for smoking cessation
  4. intereventions e.g. behavioural support, group support, text messages, medication, internet support, self help groups
93
Q

Define health behaviour

A

any activity undertaken for the purpose of preventing or detecting disease or for improving health and wellbeing

94
Q

outline the theory of the health belief model

A

individuals will change fi they…

  1. believe they are susceptible the condition in question
  2. believe that it has a serious consequence
  3. believe that taking action reduces susceptibility
  4. believe that the benefits of taking action outweigh the cost
95
Q

What are “cues to action” in the health belief model?

A

cues to change make the action more likely

can be:

  1. internal= internally think about health behaviour
  2. external = being told advice
96
Q

What are the disadvantages of the health behaviour model?

A

other factors can predict health e.g. outcome expectancy, self efficacy

does not consider influence of emotions on behaviour

does not differentiate between first time and repeat behaviour

97
Q

Describe the theory of planned behaviour

A

proposes the best predictor of behaviour is INTENTION

Attitude + social norm + perceived behavioural control -> intention -> behavioural change

98
Q

What is intention determined by?

A

(theory of planned behaviour)

  1. ATTITUDE = persons attitude to the behaviour
  2. SOCIAL NORM= perceived social pressure to undertake the behaviour
  3. PERCEIVED BEHAVIOURAL CONTROL= a persons appraisal of the ability to perform the behaviour
99
Q

Use smoking as an example to explain the theory of planned behaviour

A

attitude = i do not think smoking is a good thing

social norm= most people who are important to me want me to give up smoking

perceived behavioural control = i believe i have the ability to give up smoking

behavioural intention = i intend to give up smoking

100
Q

How can you help people to act on their intentions by bridging the intention behaviour gap?

A
  1. PERCEIVED CONTROL
    = recalled success predicted success in the task
  2. ANTICIPATED REGRET
    = increased anticipated regret was related to sustained intention
  3. PREPAPARTORY ACTIONS
    = dividing a task into subgoals increases self efficacy and satisfaction at the point of completion
  4. IMPLEMENTATION INTENTIONS
    = “if then” plans facilities the translation of intention in to action
  5. RELEVANCE TO SELF
    = how is health behaviour relevant to them
101
Q

What are the disadvantages of the theory of planned behaviour model?

A

lack of temporal elect of lack of direction
doesn’t take into account emotions
does not explain how attitudes, intentions and perceived behaviours control interact
relies on self reported behaviour

102
Q

What is the stages of change model also called?

A

transtheoretical model (TTM)

103
Q

Describe the stages of change model

A

stage theories see individuals located at discrete ordered stages and each stage denotes a greater inclination to change their behaviour than the previous one

104
Q

What are the 5 proposed stages of change?

A
  1. pre contemplation
    = no intention to give up behaviour
  2. contemplation
    = considering changing behaviour
  3. preparation
    = getting ready to change
  4. action
    = engaged in health behaviour and change
  5. maintenance
    = maintaining that health behaviour and sticking with the change for >6 months
105
Q

What are the advantages of the stages of change model?

A

acknowledge individual stages of readiness
accounts for relapse
temporal element

106
Q

What are the disadvantages of the stages of change model?

A

not all people move through each stage, can move backwards/forwards/skip stages

change could operate on a continuum rather than discrete stages

doesn’t take into account values, habits, social and economic factors

107
Q

Describe motivational interviewing as a model for behaviour change

A

a counselling approach for initiating behaviour change by resolving ambivalence

108
Q

Describe the “nudging” theory of behaviour change

A

“nudge” the environment to make the best option the easiest

e.g. fruit next to checkouts

109
Q

List some behaviour change models

A
  1. health belief model
  2. theory of planned behaviour
  3. stages of change
  4. motivational interviewing
  5. nudging
  6. social norms theory
  7. social marketing
  8. financial incentives
110
Q

Identify the typical transition points whereby interventions are likely to be more effective? (NICE behaviour change guidelines)

A 
leaving school
entering workforce
becoming a parent
unemployment/ losing a job
retirement
bereavement
111
Q

What can doctors offer a newly presenting drug user?

A 
health check
screening 
contraception
sexual health advice
check general immunisation status
signpost to additional help e.g. counselling, benefits, housing
information for local drug services
112
Q

What are the aims of treatment for drug users?

A

reduce harm to user, family and society
improve health
stabilise lifestyle and reduce amount of illicit drug use
reduce crime

113
Q

Define domestic abuse

A

any incident or pattern of incidents of controlling, coercive, threatening behaviour, violence or abuse between those >16 y/o and who are/have been intimate partners or family members

114
Q

What type of abuse can domestic abuse involved?

A 
physical
emotional
financial 
sexual
psychological
115
Q

How can domestic abuse impact on health?

A
  1. physical injuries as a result of assault
    e. g. fractures, miscarriages, bruises, haemorrhages
  2. chronic illness/ somatic problems as a result of living with abuse
    e. g. headache, chronic pain, premature delivery, low birth weight
  3. psychological problems secondary to abuse
    e. g. PTSD, suicide, substance misuse, depression, anxiety
116
Q

how can domestic abuse affect children?

A
  • long term impact of self esteem, education, relationship and stress responses
  • link between domestic and child abuse
  • affect physical and psychological health
117
Q

What is our role as doctors in responding to domestic/sexual abuse?

A
  1. display helpline posters and contact cards
  2. focus on patients safety
  3. ask direct, non judgemental questions
  4. acknowledge and be clear that the behaviour is not ok
  5. refer when appropriate
  6. work with other agencies and professionals
118
Q

Outline the risk levels of domestic abuse

A
  1. standard - current evidence does not indicate likelihood of causing serious harm
  2. medium - there are identifiable indicators of risk of serious harm
  3. high - imminent risk of serious harm and dynamic (could happen at any time)
119
Q

Whys should we notify communicable diseases?

A
  1. so HPA can take urgent control measures
  2. may be the only one who can tell HPA
  3. duty of registered medical practitioners
120
Q

Who should be notified for a communicable disease?

A

the proper officer of the local authority

121
Q

List some of the notifiable diseases

A 
acute encephalitis
acute meningitis
acute infectious hepatitis
cholera
diphtheria
food poisoning 
haemolytic uraemic syndrome 
legionnaires disease
malaria
measles
meningococcal septicaemia
mumps
plague
rabies 
rubella
tetanus 
tuberculosis
whooping cough
yellow fever
122
Q

what are the modes of transmission for notifiable diseases/

A 
food borne
faecal oral route 
respiratory route
direct physical contact
acquired from animals
123
Q

Define inverse care law

A

those who need medical treatment are least likely to receiver it

124
Q

Describe maslows hierarchy

A

gives an idea about the patients priority and needs

if patient not bothered about things at the bottom of the triangle e.g. food, water, sleep then they won’t care about things at the top and won’t progress

125
Q

What are the stages of maslows hierarchy?

A
  1. physiological (bottom of triangle)
    breathing, food, water, sleep, sex, excretion
  2. safety
    security of body, of employment, of family and of health
  3. love/belonging
    friendship, family, sexual partner
  4. esteem
    self confidence, achievement, respect of/by others
  5. self actualisation
    morality, creativity, problem solving, acceptance of facts
126
Q

What are the main causes of homelessness?

A 
eviction **
relationship breakdown *
mental illness
domestic abuse
bereavement
127
Q

List some of the health problems faced by homeless adults

A

infectious diseases e.g. TB, HIV, hepatitis
poor conditions of teeth, feet
respiratory problems
sexual health
mental health e.g. depression, schizophrenia
poor nutrition
addictions/substance abuse

128
Q

List the barriers to healthcare with homeless adults

A
  1. difficulties with access to health care e.g. not registered at GP, opening times, lack of transport
  2. lack of integration between primary care services and other agencies
  3. other things on their mind e.g. other priorities
  4. may not know where to find help
129
Q

List the barriers to healthcare with travellers

A 
reluctance of GPs to register travellers
poor reading and writing skills
communication difficulties
mistrust of professionals
lack of choice
130
Q

Define refugee

A

a person granted asylum and refugee status - leave to remain for 5 years and then reapply

131
Q

Define humanitarian protection

A

failed to demonstrate claim for asylum but face serious threat to life if returned - 3 years then reapply

132
Q

Describe what is meant by a refugee status

A

indefinite leave to remain (permanent residence in UK)
all the rights of a UK citizen
they are eligible for family reunion

133
Q

Define asylum seeker

A

someone who has made an application for refugee status and is waiting for their claim to be decided by the home office

134
Q

Describe what is meant by an asylum seeker status

A

entitled to money (£35 a week)
entitled to housing but no choice dispersal
entitled to NHS care
if under 18, have a social services key worker and attend school

BUT not allowed to work or any other form of benefit

135
Q

List the barriers to healthcare for asylum seekers

A 
lack of knowledge where to get help
lack of understanding how the NHS works
language barrier
health not priority
cultural/ religious differences
136
Q

Outline common physical health problems in asylum seekers

A 
injuries from war/ travelling
no previous health checks/ immunisations
malnutrition
torture and sexual abuse 
infestations and debilitation
blood borne diseases
untreated chronic diseases
137
Q

What are the physical consequences of loneliness

A

earlier death
take more risks
harder to self regulate / neglect
physical changes which bring on poor health

138
Q

List some factors which indicate loneliness

A 
body language
denial "boredom"
lives alone
male >50 y/o
bereavement
mobility
sensory impairment
close family nearby?
139
Q

Define social exclusion

A

the dynamic process of being shut out fully or partially from any of the social, economic, political or cultural systems which determine the social integration of a person in society

140
Q

Define evaluation of health services

A

evaluation is a process that attempts to determine as systematically and objectively as possible the relevance, effectiveness and impact of activities in the light of their objectives

141
Q

Describe the framework for health service evaluation by Donabedian

A
  1. Structure - buildings, staff, equipment
  2. Process- number of patients seen, operations performed…
    (3. output)
  3. outcome - mortality, morbidity, quality of life, patient satisfaction
142
Q

What are the issues with health outcomes?

A

cause and effect difficult to establish as other factors involved

time lag between service provided and outcome may be long

large sample size may be needed to detect statistically significant effect

data may not be available

issues with data quality

143
Q

Describes Maxwells dimensions of quality of healthcare

A

3 E’s and 3 A’S
1. Effectiveness= does the service produce the desired effect

  1. Efficiency= is the output maximised for a given input
  2. Equity= are patents treated fairly?
  3. Acceptability= how acceptable is the service offered to the people needing it
  4. Accessibility = geographical access, costs to patients, info available
  5. Appropriateness = is the right treatment given to the right people at the right time?
144
Q

Describe the 2 methods of evaluation

A
  1. qualitative methods - observe, interviews, focus groups, review of documents
  2. quantitative methods - routinely collected data, review of records, surveys
145
Q

Define opportunity cost

A

to spend resources on ONE activity means a sacrifice in terms of lost opportunity cost elsewhere

146
Q

Define economic efficiency

A

achieved when resources are allocated between activities in such a way as to maximise benefit

147
Q

How do we measure benefit?

A
  1. natural units e.g. BP, pain score
  2. Quality of Life Y
  3. monetary value
148
Q

Factors that could contribute to promotion of excessive energy intake (over-eating)?

A 
genetics
employment e.g. shift work
TV adverts
reduced physical activity 
sleep
conditions e.g. CF, trader willi
characteristics of food e.g. energy density, portion size
149
Q

Define malnutrition

A

deficiencies, excess or imbalances in a persons intake of energy +/- nutrients

150
Q

Name the 2 conditions malnutrition includes

A
  1. undernutrition = includes stunting and micronutrient deficiencies
  2. overweight= obesity and diet related non communicable diseases
151
Q

Why should doctors understand the psychology of behaviours associated with eating?

A

understand normal psychological processes related to eating

be able to understand and adequately respond to/advise patients

chronic mental conditions requiring nutritional support e.g. cancer, CF, coeliac disease, IBS, diabetes, failure to thrive, obesity, eating disorders

152
Q

List the early influences on feeding behaviour

A
  1. maternal diet and taste preference development
  2. role of breastfeeding for taste preference and body weight regulation
  3. parenting practices
  4. age of introduction of solid food
  5. types of food exposed to during the weaning period
153
Q

describe how maternal diet and taste development influences feeding behaviour

A

foetus swallow a significant amount of amniotic fluid during gestation

amniotic fluid transmits volatiles from the maternal diet end provide early chemosensory experience

taste and olfactory systems developed prior to birth

154
Q

Describe the advantages of breastfeeding

A
  1. acceptance of novel foods during weaning
  2. less picky eaters in childhood
  3. have a richer diet in fruit and veg
  4. can protect against childhood obesity
  5. encourages better appetite regulation
155
Q

How is breastfeeding a public health issue?

A

prevalence of breast feeding is particularly low among young mothers and disadvantaged socio economic groups

widens existing health inequalities

156
Q

What does breast milk contain?

A
  1. efficient digestion- enzymes (lipase, lysozyme), transfer factors (lactoferrin)
  2. gut protection- epidermal growth factor, secretory IgA, anti inflammatories
  3. anti infective- bifidus factor, white cells
  4. every day health - antibodies, viral fragments, lactoferrin
157
Q

How can parental practices influence feeding behaviour?

A

caregivers use tactics such as coercion, percussion and contingencies as a means of encouraging children to try new foods

caregivers need to: model healthy behaviours, recognise hunger and fullness, avoid pressure to eating, not use food as a reward, authoritative parenting

158
Q

What are non organic feeding disorders?

A

characterised by:

  1. feeding aversion
  2. food refusal
  3. food selectivity, fussy eaters
  4. failure to advance to age appropriate food
  5. negative mealtime interactions
159
Q

Define eating disorders

A

clinically meaningful behavioural or psychological pattern to do with eating or weight that is associated with distress, disability or with substantially increased risk of morbidity or mortality

160
Q

Define disordered eating

A

inappropriate compensatory behaviours that do not warrant a clinical diagnosis e.g. strict dieting, emotional eating, binge eating, nigh eating

161
Q

List the 3 basic forms of dieting associated with restriction

A
  1. restrict total amount of food eaten
  2. do not eat certain types of food
  3. avoid eating for long periods of time
162
Q

What are the problems with dieting?

A

risk factors for developing eating disorders
dieting results in loss of lean body mass
dieting slows metabolic rate
chronic dieting may disrupt normal appetite responses
weight cycling leads to overheat and accelerates weight gain

163
Q

What are the 3 theories of dieting?

A
  1. externality theory of obesity
  2. restraint theory / boundary model
  3. goal conflict theory

3a GP and public health (3 decks)

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