Public health Flashcards
1
Q
Define health need
A
The ability to benefit from a intervention
2
Q
Define demand
A
What people ask for
3
Q
Define supply
A
What is provided
4
Q
What makes up Bradshaw’s Taxonomy of Need
A
- Felt need - individual perceptions of variation from normal health
- Expressed need - individual seeks help to overcome variation in normal health
- Normative need - professional defines intervention appropriate for the expressed need
- Comparative need - comparison between severity, range of interventions and cost
5
Q
Define health needs assessment
A
A systematic method of reviewing the health issue facing a population, leading to agreed priorities and resource allocation that will improve health
6
Q
What approach to health needs assessment has been used in the following case?
A public health consultant is asked by a local politician what the major health issues are in a small town within their constituency.
She cannot find an existing health needs assessment so she conducts one herself. She does this by arranging focus groups with local healthcare professionals, teachers, social workers, business leaders and charities.
She also invites local residents to attend public meetings and sends emails to them to identify issues that they feel are important.
A
Corporate approach
7
Q
What are the advantages of a corporate approach to health needs assessment
A
- Based on the felt and expressed needs of the population in question
- Recognises the detailed knowledge and experience of those working with the population
- Takes into account wide range of views
8
Q
What are the limitations of a corporate approach to health needs assessment
A
- Difficult to distinguish ‘need’ from ‘demand’
- Groups may have vested interests
- May be influenced by political agendas
9
Q
What approach to health needs assessment has been used in the following case?
The health status of South Hill is compared with a nearby town ‘North Hill’, which is a similar size and affluence. You find that South Hill has a higher prevalence of cardiovascular disease and COPD than North Hill. However, it has a lower rate of injuries and death from road traffic accidents
A
Comparative approach
10
Q
What are the advantages of a comparative approach to health needs assessment
A
- Quick and cheap if data available
- Indicates whether health or services provision is better/worse than comparable areas (gives a measure of relative performance)
11
Q
What are the limitations of a comparative approach to health needs assessment
A
- May be difficult to find comparable population
- Data may not be available/high quality
- May not yield what the most appropriate level (e.g. of provision or utilisation) should be
12
Q
Describe the epidemiological approach to health needs assessment
A
Uses a source of data i.e. disease registry, hospital admissions, GP databases, mortality data, primary data collection (e.g. postal/patient survey) to look at:
a. Disease incidence & prevalence
b. Morbidity & mortality
c. Life expectancy
d. Services available (location, cost, utilisation, effectiveness etc)
13
Q
What are the advantages of a epidemiological approach to health needs assessment
A
- Uses existing data
- Provides data on disease incidence/mortality/morbidity etc
- Can evaluate services by trends over time
14
Q
What are the limitations of a epidemiological approach to health needs assessment
A
- Quality of data variable
- Data collected may not be the data required
- Does not consider the felt needs or opinions/experiences of the people affected
15
Q
What are the three approaches to health needs assessment and briefly describe them
A
- Epidemiological: Uses existing data to look at:
a. Disease incidence & prevalence
b. Morbidity & mortality
c. Life expectancy
d. Services available (location, cost, utilisation, effectiveness etc) - Comparative: compares the health or healthcare provision (i.e. health, service provision/utilisation, health outcomes) of one population to another - spatial (e.g. different towns) / social (e.g. age, social class)
- Corporate: Ask the local population what their health needs are and uses focus groups, interviews, public meetings. Wide variety of stake holders: teachers, healthcare professionals, social workers, charity workers, local businesses, council workers, politicians
16
Q
Give one health related example of something that
you consider is demanded but not needed or
supplied & explain the reasoning behind this
example
A
?
17
Q
Give one health related example of something that
you consider is wanted and needed but poorly
supplied & explain the reasoning behind this
example
A
Mental health services i.e. counselling & psychological therapy demanded & needed however services are facing budget cuts and are struggling to supply this.
IVF: needed and demanded for patients with infertility however not widely available on the NHS and there can be long waiting lists
Yellow fever vaccine: only available privately, but demanded and needed if travelling to an endemic area to prevent infection
18
Q
Give one health related example of something that
you consider is wanted and supplied but not needed explain the reasoning behind this
example
A
Antibiotics for an uncomplicated viral upper respiratory tract infection. This can be demanded by the patients parents and supplied in severe cases however antibiotics do not treat viral infections therefore is not needed.
19
Q
Give one health related example of something that
you consider is needed and supplied but not always wanted/demanded explain the reasoning behind this
example
A
Smoking cessation services is supplied and needed for health promotion however not everyone will demand for this service.
20
Q
Give one health related example of something that
you consider is needed, wanted and supplied explain the reasoning behind this
example
A
Childhood vaccinations
Free contraception
Ambulance services
21
Q
Define primary prevention
A
Interventions that aims to remove or reduce a risk factor or introduce a protective factor to prevent a disease before it has developed
22
Q
Define secondary prevention
A
2 definitions:
- Trying to catch a disease at an pre-clinical/ early stage to alter the course of disease
- Interventions that prevent recurrence of disease
23
Q
Define tertiary prevention
A
Interventions that aim to minimise disability and
prevent complications one disease is diagnosed
24
Q
What type of prevention is this?: GP practice sets up a diabetes clinic to try to improve the glucose control of its diabetic patients. Patients are provided with education and support, along with lifestyle advice and regular screening of their eyes, kidneys and feet.
A
Tertiary
25
What type of prevention is this?:
Referral to smoking cessation for patients with COPD.
Tertiary
26
What type of prevention is this?:
Mammography screening to detect early breast cancer
Secondary
27
What type of prevention is this?:
Advising pregnant mothers to take folic acid
Primary
28
What is the population approach to prevention
A preventative measure delivered on a population wide basis and seeks to shift the risk factor distribution curve i.e. dietary salt reduction through legislation to reduce BP distribution curve
29
What is the high risk approach to prevention
Identifies individuals above a chosen cut-off and treat them i.e. screening for high BP and treating
30
What is the prevention paradox
A preventive measure which brings much
benefit to the population often offers little to
each participating individual
31
What is screening
A process which sorts out apparently well
people who probably have a disease (or
precursors or susceptibility to a disease)
from those who probably do not. NOT diagnostic.
32
List the 5 types of screening
1. Population-based screening programmes
2. Opportunistic screening
3. Screening for communicable diseases
4. Pre-employment and occupational medicals
5. Commercially provided screening
33
Based on the Wilson and Jungner criteria of screening what criteria comes under "the condition"
1. Natural history well understood
2. Has a detectable early/pre-clinical phase
3. Considered as an important health problem
34
Based on the Wilson and Jungner criteria of screening what criteria comes under "the test"
1. Suitable (sensitive, specific, inexpensive)
2. Acceptable to population
3. Should be repeated and not on a one off basis
35
Based on the Wilson and Jungner criteria of screening what criteria comes under "the treatment"
1. Facilities for diagnosis and treating available
2. Acceptable and effective
3. Adequate health service provision should
exist for people found positive on screening
36
Based on the Wilson and Jungner criteria of screening what criteria comes under "risk and benefits"
```
1. Should be an agreed policy on whom to
treat
2. Costs should be balanced against
benefits
3. Risks ( psychological and physical, should)
be less than the benefits
```
37
Describe selection bias associated with screening
People who choose to participate in screening may differ from general population:
1. May be at higher risk (family history of breast cancer, more likely to attend)
2. May be at lower risk (higher socioeconomic group – may be more likely to attend)
38
Describe led-time bias associated with screening
By detecting the presence of disease earlier, screening can appear to increase length of survival even if it has no impact on the course of the disease
39
Describe length-time bias associated with screening
Disease detected through screening is less aggressive than disease detected because it causes symptoms. Screening can suggest that those who are screened have a better prognosis due to the screening, rather than because they have a less aggressive form of the disease.
40
Give 3 disadvantages of screening and an example for each
1. Exposure of well individuals to distressing or harmful diagnostic tests i.e. colonoscopies for those with positive faecal occult blood tests
2. Detection and treatment of sub-clinical disease that would never have caused any problems i.e. non-aggressive prostate cancer in elderly men
3. Preventive interventions that may cause harm to the individual or population i.e. the potential for increased antibiotic resistance if all mothers were screened for group B streptococcus in pregnancy
41
The UK National Screening Committee is evaluating the breast cancer screening programme.
One member of the committee highlights some research that found women with cancers detected through screening had a lower mortality than those detected after they became symptomatic.
Other members of the committee suggest that bias could have contributed to this apparent difference.
Which type of bias from the following list are they referring to?
Length time bias
42
Define sensitivity
The proportion of people who have the disease who are correctly identified
43
Define specificity
The proportion of people without the disease who are correctly excluded
44
Define positive predictive value
The proportion of people with a positive test who have the disease
45
Define negative predictive value
The proportion of people with a negative test who don't have the disease
46
An elderly man asks his GP why all men do not get screened for prostate cancer using PSA tests. The GP replies that few patients with high PSA turn out to have prostate cancer. What does this suggest about PSA as a screening test for prostate cancer?
Positive predictive value is low
47
What type of bias is this describing:
A comparison of survival in screen detected patients with non-screen detected patients may be biased as there will be a tendency to compare less aggressive with more aggressive cancers
Length time bias
48
Give 4 examples of an observational epidemiological study
1. Descriptive:
a. Ecological
2. Descriptive and analytical:
a. Cross-sectional
3. Analytical:
a. Case-control
b. Cohort studies
49
Give an example of an experimental/interventional study
Randomised controlled trial
50
What is a cross-sectional study?
AKA Prevalence study
Divides population into those with & without disease and collects data on them at a single point in time.
Finds associations between disease prevalence and exposure.
51
What are the advantages of a cross sectional study?
1. Relatively quick and cheap
2. Provide data on prevalence at a single point in time
3. Large sample size
4. Good for surveillance and public health planning
52
What are the disadvantages of a cross sectional study?
1. Risk of reverse causality (don’t know whether outcome or exposure came first)
2. Cannot measure incidence
3. Risk recall bias and non-response
53
What is a case-control study?
Retrospective study.
Identifies those with the outcome/disease and match then to people without the outcome/ disease for age/sex/class.
Study previous exposure to potential risk in hypothesis.
54
What are the advantages of a case-control study
1. Good for rare outcomes (e.g. cancer)
2. Quicker than cohort or intervention studies (as the outcome has already happened)
3. Can investigate multiple exposures
55
What are the disadvantages of a case-control study
1. Difficulties finding controls to match with cases
2. Most prone to recall bias when people are required to remember and record information from events that happened in the past
3. Also prone to selection bias
56
What is an ecological study?
Uses routinely collected data to show trends in the data :
a. Ecological trends: prevalence of disease in different population groups (i.e. different areas)
b. Time trends: prevalence of disease over time
57
What are the disadvantages of an ecological study
Does not show causation
58
What is a cohort study?
Starts with a population without the disease in question and follow up study participants over time to see if they are exposed to the agent in question and if they develop the disease in question or not.
59
What are the advantages of a cohort study
1. Can follow-up a group with a rare exposure (e.g. a natural disaster)
2. Good for common and multiple outcomes
3. Less risk of selection and recall bias
60
What are the disadvantages of a cohort study
1. Takes a long time
2. Loss to follow up (people drop out)
3. Need a large sample size
61
What is a randomised controlled trial?
Randomised: Random allocation to intervention or control
Controlled: Predefined rules for eligibility, endpoints, follow up, analysis plans and stopping rules
Trial: An experimental study to measure outcome between intervention and control groups
62
What are the advantages of a randomised controlled trial
1. Low risk of bias and confounding
| 2. Can infer causality (gold standard)
63
What are the disadvantages of a randomised controlled trial
1. Time consuming
2. Expensive
3. Specific inclusion/exclusion criteria may mean the study population is different from typical patients (e.g. excluding very elderly people)
64
If a study find an association between and exposure and an outcome what 5 things can this be due to?
1. Confounding
2. Chance
3. Bias
4. Reverse causality
5. True association
65
An academic core trainee in rheumatology wants to investigate whether there is any association between the use of antihypertensive drugs and gout. What would be the most appropriate study design, given that she has relatively little time in which to conduct the research?
Retrospective case-control study
66
Define confounding
A situation in which the estimate between an exposure and an outcome is distorted because of the association of the exposure with another factor (confounder) that is also independently associated with the outcome.
67
Define reverse causality
A situation when an association between an exposure and an outcome could be due to the outcome causing the exposure rather than the exposure causing the outcome
68
According to the the Bradford Hill criteria supporting causality define strength
A small association does not mean that there is not a causal effect, though the larger the association, the more likely that it is causal
69
According to the the Bradford Hill criteria supporting causality define consistency
Same result observed from various studies and in different geographical settings
70
According to the the Bradford Hill criteria supporting causality define dose-response
Increased risk of outcome with increased exposure
71
According to the the Bradford Hill criteria supporting causality define temporality
The effect has to occur after the cause (and if there is an expected delay between the cause and expected effect, then the effect must occur after that delay).
72
According to the the Bradford Hill criteria supporting causality define plausibility
Reasonable biological mechanism to explain the link
73
According to the the Bradford Hill criteria supporting causality define reversibility
Intervention to reduce/remove exposure eliminates/reduces outcome
74
According to the the Bradford Hill criteria supporting causality define coherence
Coherence between epidemiological and laboratory findings increases the
likelihood of an effect.
75
According to the the Bradford Hill criteria supporting causality define analogy
Similarity with other established cause-effect relationships
76
According to the the Bradford Hill criteria supporting causality define specificity
Relationship specific to outcome of interest
77
Randomised intervention trials of vitamin D supplementation in the elderly found it improves muscle strength and function, supporting evidence that vitamin D deficiency can cause muscle weakness
This is an example of which of the BradfordHill
criteria supporting causality?
Reversibility
78
The association between cigarette smoking and cardiovascular disease has been observed in many cohort and case-control studies over 30 years in different populations.
This is an example of which of the BradfordHill
criteria supporting causality?
Consistency
79
Heavy smoking is associated with an increased risk of lung cancer compared to moderate smoking (which is in turn associated with greater risk than light smoking)
This is an example of which of the BradfordHill
criteria supporting causality?
Dose response
80
A recently published paper found that increased exposure to background noise in populations living near
Heathrow airport were associated with increased risk of cardiovascular disease. To support these results,
the authors highlight previous research suggesting that acute exposure to noise may increase blood
pressure and stress hormones.
This is an example of which of the BradfordHill
criteria supporting causality?
Plausibility
81
Define incidence
Number of new cases at a certain time
82
Define prevalence
Number of existing case at a point in time
83
What type of study is this?
Investigators find a high level of correlation between levels of socioeconomic deprivation and cardiovascular mortality across electoral wards in the UK.
Ecological study
84
What type of study is this?
Researchers set out to examine the association between alcohol consumption and stroke. They identify all new patients admitted with stroke and compare their alcohol consumption with patients admitted for elective surgery.
Case-control study
85
What type of study is this?
General practitioners set up a study to estimate the prevalence of depression within their registered population. They decide to start with a random sample of adults aged 45-74 years.
Cross-sectional study
86
What issue is being describe in relation to causation:
A study reports an association between coffee consumption and cancer.
However, subsequent studies find that there is a clear association between smoking and coffee consumption.
Confounding
87
Define attributable risk & how it is calculated
The rate of disease in the exposed that may be attributed to the exposure, it is a type of absolute risk (absolute excess risk). Gives a feel of actual numbers and uses units i.e. per 1000 person-years
Incidence in exposed minus incidence in unexposed.
88
Define relative risk & how it is calculated
How many times more likely it is that an event will occur in the exposed/intervention group relative to unexposed/control group. Has no units.
RR = 1 means no different
RR > 1 means increased risk
RR<1 mean decreased risk
Incidence in exposed divided by incidence in unexposed.
89
Calculate attributable & relative risk:
Incidence of Disease A in smokers, 1/1000 person-years
Incidence of Disease A in non-smokers, 0.05/1000 person-years
Attributable risk = 0.95/1000 person-years (i.e. difference)
Relative risk = 20 (i.e. ratio, no units)
90
Calculate attributable & relative risk:
Incidence of Disease B in smokers, 8/1000 person-years
Incidence of Disease B in non-smokers, 4/1000 person-years
Attributable risk = 4/1000 person-years
Relative risk = 2
91
How is number needed to treat calculated?
1/ absolute risk reduction
92
5 year RCT follow-up:
Cumulative incidence of Disease X in people given a new treatment is 6/1000
Cumulative incidence of Disease X in people on placebo is 10/1000
Calculate:
1. Absolute risk reduction
2. Relative risk
3. Number needed to treat
1. Absolute risk reduction = 4/1000 (over 5 years)
2. Relative risk = 0.6
3. Number needed to treat (to avoid one case of disease X) = 1/ (4/1000) = 250
93
What is bias?
A systematic deviation from the true estimation of the association between exposure and outcome
94
What are the 2 types of bias?
1. Selection Bias
| 2. Measurement Bias
95
What is selection bias?
A systematic error in:
the selection of study participants
the allocation of participants to different study groups
96
What is measurement bias?
A systematic error in the measurement or classification of: exposure/ outcome
97
Give 3 sources of information bias
1. Observer (e.g. observer bias)
2. Participant (e.g. recall bias)
3. Instrument (e.g. wrongly calibrated instrument)
98
How is odds ratio calculated & in what type of study is it used?
Odds of exposure in cases / odds of exposure in controls
Used in case control studies as it is not possible to calculated relative risk
99
Calculate the odds ratio in the following case control study:
cases controls
Fluoride high 75 80
exposure low 25 20
Odds ratio of exposure in cases = 73/25
Odds ratio of exposure in controls = 80/20
OR = (73/25) / (80/20) = 0.75
100
If the P value to <0.05 is this statistically significant or not significant?
Yes
101
If the confidence interval of an OR or RR crosses 1 is this significant?
No
102
Define health behaviour
A behaviour aimed to prevent disease i.e. healthy eating
103
Define illness behaviour
A behaviour aimed to seek remedy i.e. going to the dr
104
Define sick role behaviour
Any activity aimed at getting well i.e. taking prescription medicines
105
According to Weinstein's study in 1983 outline the 4 reasons (related to perception of risk) why people continue to practice health damaging behaviour?
1. Lack of personal experience with the problem
2. Belief that preventable by personal action
3. Belief that if it has not happened now it is unlikely to
4. Belief that the problem is infrequent
106
According to Becker's health belief model (1974) outline the 4 reasons that prompt people to change their health impairing behaviours?
1. Believe they are susceptible to the condition in question (e.g. heart disease)
2. Believe that it has serious consequences
4. Believe that taking action reduces susceptibility
5. Believe that the benefits of taking action outweigh the costs
107
What does the theory of planned behaviour (1988) propose?
The best predictor of behaviour is intention, this is determine by:
1. A persons attitude to the behaviour i.e. I don't think smoking is good
2. Subjective norm (the perceived social pressure to undertake the behaviour) i.e. my family want me to stop smoking
3. Their perceived behavioural control i.e. I believe I have the ability to stop smoking
108
What are the 5 stages of change according to the transtheoretical model?
Pre contemplation - contemplation - Preparation - Action - Maintenance ( + Relapse )
109
A student has decided to increase the amount of exercise they do in an effort to improve their overall
health. After discussing their intended exercise plan with a fitness adviser, they joined the local gym and
purchased some new running trainers. They have decided to have their gym induction next week. Which
stage of the stages model of health behaviour is the student at currently?
Preparation
110
Define malnutrition
State of nutrition in which deficiency or excess of energy, protein and other nutrients causes measurable adverse effects on tissue/body function and clinical outcome
111
Give 4 early influences on feeding behaviour
1. Maternal diet
2. Breastfeeding
3. Parenting practices
4. Age of introduction of solid foods
112
Give 4 characteristics of non-organic feeding disorders
1. Negative mealtime interactions
2. Food refusal
3. Feedin aversion
4. Food selectivity/ fussy eating
113
What are the 5 determinants of health
1. Genes, age, sex
2. Individual lifestyle
3. Social and community network
4. Work and living conditions i.e. health care employment, education
5. General socioeconomic, cultural & environmental conditions
114
Define horizontal equity
Equal access & treatment for equal need
115
Define vertical equity
Unequal treatment for unequal need
e.g. Individuals with common cold vs pneumonia need
unequal treatment
116
Define health equality
Giving people the same despite unequal needs
117
What are the 3 domains of public health?
1. Health improvement
2. Health protection
3. Improving services
118
What does health improvement address?
Societal interventions (not primarily delivered
through health services) aimed at preventing disease, promoting health, and reducing inequalities:
1. Education
2. Housing
3. Employment
119
What does health protection address?
Measures to control infectious disease risks and
| environmental hazards such as chemical and poisons, radiation, emergency response
120
What does improving services look at?
The organisation and delivery of safe, high quality health care services for prevention, treatment, and care.
Looks at:
1. Clinical effectiveness
2. Efficiency
3. Equity
4. Audit and evaluation
121
Ecological interventions can be delivered in 3 different levels, what are they?
1. Individual
2. Community
3. Population
122
What do individual level interventions focus on? Give an example
Aims to change the individual person. Characteristics of the individual i.e. knowledge, attitude, beliefs ect. that influence health behaviour.
Smoking cessation as an intervention for an individual give them skills and strategies to stop smoking.
123
What do community level interventions focus on? Give an example
Aims to change the social environment. Focuses on community norms, values, attitudes and power structures that influence health behaviour.
Media campaigns in the community, cessation-focused and general anti-smoking messages in the media.
124
What do population level interventions focus on? Give an example
Aims to change local and national laws and policies. Focuses on government regulations, procedures or laws on health protection.
Increase in tobacco price and tax.
125
Define health evaluation
The assessment of whether a service achieves
| its objectives
126
What framework is used for health evaluation
1. Structure
2. Process (output)
3. Health outcome
127
When evaluating health services what does "structure" assess?
What there is i.e. no. of beds, no. of staff, amount of equipment available
128
When evaluating health services what does "process" assess?
What is done i.e. number of patients seen in A&E,
| the process through which patients go in A&E, no. of operations performed
129
When evaluating health services how is "health outcomes" classified? (4 things)
1. Mortality
2. Mobility (complications)
3. Quality of life
4. Patient satisfaction
130
Give 4 limitations when evaluating health outcome
1. Time lag between service provided and outcome may be long
2. Large sample sizes may be needed to detect statistically significant effects
3. Data may not be available
4. Link (cause and effect) between health service provided and health outcome may be difficult to establish as many other factors may be involved
131
What are the 3Es and 3As in Maxwell’s Dimensions of Quality
Effectiveness - does it produce desired effect
Efficiency - is the output maximised for a given input
Equity - are all patients treated fairly
Acceptability
Accessibility
Appropriateness - right treatment for right people at the right time?
132
What are the 3 methods used in health service evaluation?
1. Qualitative
2. Quantitative
3. Mixed
133
Describe qualitative methodology used in health service evaluation
Consult relevant stakeholders i.e. policy makers, staff & patients through interviews, focus groups, observation
134
Describe quantitative methodology used in health service evaluation
Looks at:
1. Routinely collected data i.e. hospital admissions; mortality
2. Review of records: medical; administrative
3. Surveys
4. Other special studies e.g. using epidemiological methods
135
5 key principles of the mental capacity act
1. Presume capacity
2. Supported individuals to make their own decisions
3. People have the right to make unwise decisions
4. Anything done must be in the patients best interest
5. Must consider the least restrictive option
136
What is Maslow's heirarchy of need?
1. Basic physiological need: food, water, sleep, breathing
2. Safety: security of body, employment, property
3. Love and belonging: friendships, relationships, sexual intimacy
4. Esteem: feeling of accomplishment
5. Self actualisation: achieving ones full potential, creativity, problem solving
137
What is the main cause of homelessness
Relationship breakdown caused by:
1. Mental illness/breakdown,
2. Domestic abuse
3. Disputes with parents
4. Bereavement- more than half say they have ‘no family ties’
138
Give 5 health problems faced by homeless people
1. Infection: TB and hepatitis
2. Malnutrition
3. Psychological illnesses: depression, Scz
4. Violence and rape
5. Poor dental hygiene
6. Addiction and substance misuse
139
Give 4 barriers to healthcare for homeless people
1. Difficulty to access
2. Lack of integration between mainstream primary care services and other agencies i.e. social services
3. Other priorities when there are more immediate survival issues
4. May not know where to find help
140
Give 5 barriers to health for travellers/ gypsies
1. Reluctance of GPs to register gypsies and travellers
2. Poor reading and literally skills
3. Communication difficulties
4. Mistrust of professionals
141
Defines asylum seeker
A person who has made an application for refugee status
142
Define refugee
A person granted asylum and refugee status. Usually means leave to remain for 5 years then reapply
143
What is humanitarian protection
Failed to demonstrate claim for asylum but face serious threat to life if returned. Usually 3years then reapply
144
What are asylum seekers entitled to?
1. £35 pounds per week
2. Housing: no choice dispersal
3. NHS care
4. < 18s, have the services of a social services key worker and can go to school
145
Give 5 barriers to health for asylum seekers/refugees
1. Lack of knowledge of where to get help
2. Lack of understanding how NHS works
3. Language / Culture / Communication
4. Hyper-mobility
5. Health not priority
146
Give 5 physical health issues faced by asylum seekers/refugees
1. Injuries from war/travelling
2. Torture and sexual abuse
3. Malnutrition
4. Untreated congenital/ chronic disease
5. Infectious diseases
147
Give 5 mental health issues an asylum seeker/refugee may suffer from
1. PTSD
2. Depression
3. Anxiety
4. Sleep deprivation
5. Self harm
148
Give 5 examples of domestic abuse
1. Physical
2. Psychological
3. Sexual
4. Financial
5. Emotional
149
Give 3 ways in which domestic abuse can impact health
1. Physical injury
2. Somatic problems/ chronic illness
3. Psychological and psychosocial
150
If you suspect a case of measles who do you notify and when?
"Proper officer" in local council or local health protection team. Verbally.as soon as possible, in writing within 3 days
