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Public Health Flashcards

1
Q

Definition of Health

A

A state of physical, mental and social wellbeing. Not just the absence of the disease.

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2
Q

Definition of Patient Compliance

A

‘The extent to which the patient’s behaviours coincides with medical or health advice given’

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3
Q

5 factors affecting patient compliance

A
  1. Socioeconomic - long distance from treatment setting
  2. Health System - supply of medication
  3. Patient - denial/disbelief of dx
  4. Therapy - complex tx
  5. Condition - memory impairment
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4
Q

2 reasons for non-adherence (patient compliance)

A
  1. Unintentional - practical barriers

2. Intentional - motivational barriers

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5
Q

Ethical considerations to consider when making a decision (patient compliance)

A
  1. When the patient is a child - Gillick Competence
  2. Mental capacity
  3. Potential threat to others
  4. Decisions detrimental to the patient’s wellbeing
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6
Q

Definition of occupational disease

A

‘An occupational disease’ is where work is considered the main cause of the disease’

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7
Q

Examples of occupational diseases

A 
Asbestosis
Silicosis
Occupational dermatitis
Coalminers' pneumoconiosis
Tenosynovitis - repetitive movements
Mesothelioma
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8
Q

Work related ill health

A

‘Work-related diseases’ have multiple causes, where work is one of several components contributing to the disease

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9
Q

6 examples of work related ill-health

A
  1. Occupational stress
  2. Work-related MSK disorders
  3. Occupational lung cancer
  4. Occupational cancer
  5. Noise-inducing hearing loss
  6. Hand-arm vibration
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10
Q

Positive and negative effects of work

A

Employment - good mental health

Unemployment - bad mental health

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11
Q

Hazard definition

A

A hazard is something that could potentially cause harm

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12
Q

Risk definition

A

Probability of the hazard causing someone harm

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13
Q

Examples of work hazards

A

Mechanical - machinery
Physical - lifting
Biological - work in a hospital
Psychological - stress, long hours

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14
Q

Marmot 10 key components for good work

A
  1. Precariousness- stable, safe
  2. Individual control- part of decision making
  3. Work demands- quality and quantity
  4. Fair employment
  5. Opportunities
  6. Prevents- social isolation, discrimination and violence
  7. Share information
  8. Work/life balance
  9. Reintegrates sick or disabled wherever possible
  10. Promotes health and wellbeing
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15
Q

Questions to ask when occupational health screening

A
  1. What type of work do you do?
  2. Do you think your health problems might be related to your work?
  3. Are your symptoms different at work than at home?
  4. Are you currently exposed to chemicals, dusts, radiation, noise or repetitive work? Or in the past?
  5. Are any of your co-workers experiencing similar symptoms?
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16
Q

Influenza types

A

Influenza A
Subdivided by 2 key surface antigens:
Haemagglutinin - 15 subtypes
Neuraminidase: 9 subtypes

Can infect pigs, cats, horses, birds and sea mammals. The cause of severe outbreaks and pandemics.

Influenza B
Similar to influenza A (prone to mutation) but tends to cause sporadic outbreaks (schools, care homes, garrisons) that are less severe. More often in childeren

Influenza C
Minor disease: mild symptoms/asymptomatic

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17
Q

Epidemic definition

A

An epidemic refers to an illness that spreads to many people in one specific geographical region

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18
Q

Pandemic definition

A

An epidemic which occurs in several countries or continents (crosses border)

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19
Q

3 public health interventions for reducing spread of flu

A
  1. Hand washing
  2. Respiratory Hygiene - ‘catch it, bin it, kill it’
  3. Reduce social contact - not attending large gatherings
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20
Q

6 wider interventions for reducing spread of flu

A
  1. Travel restrictions
  2. Restrictions of mass public gatherings
  3. School closures
  4. Voluntary home isolation of cases
  5. Voluntary quarantine of contacts of known cases
  6. Screening of people entering UK ports
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21
Q

What is palliative care?

A

Palliative care improves the quality of life of terminal patients and their families who face life-threatening illnesses, by providing pain and symptom relief, spiritual and psychosocial support from diagnosis to the end of life and bereavement

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22
Q

5 aims of palliative care

A
  1. Treatment to remove pain
  2. Control symptoms
  3. Improve quality of life
  4. Supports families
  5. Designated health care professionals
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23
Q

Preventing spread of diarrhoea - C.difficile, SIGHT

A 
SIGHT
S - suspect C diff
I - isolate patient
G - gloves and apron
H - hand washing with soap and water
T - test stool for toxin (can also culture to identify strain)
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24
Q

Antibiotics that cause C. difficile

A

Ciprofloxacin
Cephalosporins
Carythromycin
Co-amoxiclav

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25
Q

Treatment for C. difficile

A

Vancomycin and Metronidazole

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26
Q

5 WHO prevention tactics for diarrhoea

A
  1. Rotavirus and measles vaccinations
  2. Promote early and exclusive breastfeeding and vitamin A supplementation
  3. Promote handwashing with soap
  4. Improved water supply and quantity and quality, including tx and safe storage of household water
  5. Community-wide sanitation promotion
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27
Q

WHO treatment package for diarrhoea

A
  1. Fluid replacement to prevent dehydration

2. Zinc treatment

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28
Q

Groups at risk of diarrhoea

A
  1. Poor personal hygiene/unsatisfactory facilities at home, work or school
  2. Children who attend nursery and pre-school
  3. Preparing or serving unwrapped/uncooked food
  4. HCW/social care staff working with vulnerable people
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29
Q

8 control measures for diarrhoea

A
  1. Handwashing with soap
  2. Ensure availability of safe drinking water
  3. Safe disposal of human waste
  4. Breastfeeding of infants and young children
  5. Safe handling and processing of food
  6. Control of flies/vectors
  7. Case management including exclusion
  8. Vaccination
30
Q

Coronary Heart Disease - 6 psychosocial factors that increase risk

A
  1. Type A personality (hostile, competitive, inpatient)
  2. Depression/anxiety
  3. Psychosocial work characteristics
  4. Long work hours (more than 11 hours/day)
  5. High demand, low control
  6. Lack of social support
31
Q

What 5 things can doctors do regarding CHD?

A
  1. Identify depression/anxiety
  2. Ask about occupation
  3. Liaise with social support services
  4. Vascular screening
  5. Risk reduction through promoting healthier lifestyles
32
Q

4 alcohol screening tools

A
  1. Clinical interview
  2. FAST - Fast Alcohol Screening Test
  3. AUDIT - Alcohol Use Disorders Identification
  4. CAGE questions
33
Q

What are the CAGE questions?

A
  1. Have you ever felt you should CUT down on your drinking?
  2. Have people ANNOYED you by criticising your drinking?
  3. Have you ever felt bad or GUILTY about your drinking?
  4. Have you ever taken a drink first thing in the morning (EYE-OPENER) to steady your nerves or get rid of a hangover?

2 or more positive responses indicate a likely problem

34
Q

What is one unit of alcohol equivalent to?

A

8g/10ml of pure alcohol
Half a pint of beer
Small glass of wine

35
Q

What is the alcohol units strength equation?

A

Units = Strength of drink (%ABV) x amount of liquid (ml)/1000

36
Q

Primary prevention of alcohol consumption

A
  1. Know your limits’ binge drinking campaign, targets 18-24 year olds
  2. Drinkaware - alcohol labelling
  3. ‘THINK!’ - drink driving campaign developed by the Department of Transport
  4. Restriction on alcohol advertising by OFCOM - strengthened rules around appeal to young people, sexual consent and irresponsible or antisocial behaviour
  5. TV AD campaign
  6. Minimum pricing - ScHARR research estimates 50p per unit would give benefits
37
Q

Secondary prevention of alcohol consumption

A
  1. Ask about it routinely
  2. Ask about it using screening questions/tools
  3. Think of it as an explanation for presenting symptom
  4. Think of it in relation to lifestyle change (violence, unemployment, depression or anxiety)
  5. Detect problem drinking (Liver Function Tests - look at liver enzymes)
  6. Feedback whether drinking is a problem
38
Q

What is foetal alcohol syndrome?

A 
Name for all the various problems that can affect children if their mother drinks alcohol during pregnancy. The abnormalities include:
Thin nose
Low nasal bridge
Small forehead
Minor ear abnormalities
Small jaw
39
Q

5 psychosocial effects of alcohol

A 
Interpersonal relationships
Problems at work
Criminality
Social disintegration (poverty)
Driving incidents/offences
40
Q

5 alcohol withdrawal after-effects

A
  1. Tremulousness - ‘the shakes’
  2. Activation syndrome - tremulousness, agitation, rapid HR, hypertension
  3. Seizures
  4. Hallucinations
  5. Delirium tremens - can be severe/fatal - tremors, agitation, confusion, disorientation, hallucinations, sensitivity to light and sound, seizures - medical emergency
41
Q

Drugs, substance misuse definition

A

‘Substance misuse: Ingestion of a substance affecting the CNS, which leads to behavioural and psychological changes, implicitly non-therapeutic use’

42
Q

Addiction equation

A

Addiction = physical + psychological dependence

43
Q

Local prevision of drugs

A
  1. GPs
  2. Harm reduction services e.g. needle exchange
  3. Open access service
  4. Structured psychological interventions - advice and structured counselling
  5. Prescribing services - substitution tx to help patient come off drugs gradually or long-term replacement for heroin (methadone)
  6. Detox - out/inpatient, over a period of a few weeks, a patient gradually reduces the drug dose
  7. Access to residential rehab - treatment for those who wish to attain/maintain abstinence after detox, duration 3-12 months
  8. Recovery support/mutual aid
44
Q

Why do people smoke?

A
  1. Fear of weight gain on cessation
  2. Coping with stress
  3. Socialising
  4. Nicotine addiction
  5. Habit/behavioural
45
Q

How can doctors help patients stop smoking?

A

Nicotine replacement therapy
ASK - are you a smoker
ADVISE - smoking is bad
ASSIST - refer to NHS Stop Smoking Service

46
Q

Transtheoretical model of change (smoking)

A

Precontemplation – smoker, not thinking about quitting
Contemplation – smoker, thinking about quitting but not ready yet (“ready”)
Preparation – smoker, thinking about quitting and taking steps to prepare for quitting (“steady”)
Action – ex-smoker, quit for <6 months (“stop”)
Maintenance – non-smoker, quit for >6 months
Relapse - quit smoking then had a lapse (1 cigarette) that led to smoking being resumed

47
Q

STIs - primary prevention

A

Primary prevention - reduce risk of acquiring
STI awareness campaigns - aim to reduce personal risk behaviour
One to one risk reduction discussion - 15-20 minutes, based on behaviour change theory
Vaccination - Hep B, HPV
Pre and post exposure prophylaxis - anti-retro viral for HIV (PEP and PrEP)
Free condoms

48
Q

STIs - secondary prevention

A

Secondary prevention - identify those who have it to stop spread
Easy access to STI/HIV tests/tx-free, confidential, self referral, short waiting lists
Partner notification
Targeted screening - antenatal screening for HIV and syphillis, national chlamydia programme, HIV home testing ‘it starts with me’

49
Q

STIs - tertiary prevention

A

Tertiary prevention - reduce complications once they have it
Antiretrovirals for HIV
Acyclovir for suppression of genital herpes

50
Q

Malnutrition definition

A

‘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’

51
Q

5 consequences of malnutrition

A
  1. Loss of muscle tissue and strength - respiratory muscles (chest infection), cardiac function (heart failure), mobility
  2. Reduced immune response/increased infections
  3. Poor wound healing
  4. Loss of mucosal integrity (malabsorption/bacterial translocation)
  5. Psychological decline - depression, apathy
52
Q

7 steps to end malnutrition in hospitals

A
  1. Hospital staff must listen to older people, relatives, and their carers, and act on what they say
  2. All ward staff must become ‘food aware’
  3. Hospital staff must follow their own professional codes and guidance from other bodies
  4. Older people must be assessed for the signs or danger of malnourishment on admission and at regular intervals during their stay
  5. Introduce ‘protected mealtimes’
  6. Implement a ‘red tray’ system and ensure it works in practice
  7. Use volunteers where appropriate
53
Q

What 4 questions should you ask patients to screen for malnutrition?

A
  1. Have you unintentionally lost weight recently?
  2. Have you been eating less than normal
  3. What is your normal weight?
  4. How tall are you?

All patients should be weighed and have their height measured

54
Q

Determinants of health

A
  1. Individual lifestyle factors
  2. Social and community influences
  3. Living and working conditions
  4. General socioeconomic, cultural and environmental factors
55
Q

Inverse care law

A

Those who need health most, do not seek/get it, and those who need it the least, get it the most

56
Q

Black report 1980

A

Black Report 1980 states that health inequalities are widening due to:

Material - environmental causes
Artefact - an apparent product of how the inequality is measured
Cultural/behavioural (poorer people behave in more unhealthy ways)
Selection - sick people sink socially and economically

57
Q

When are you allowed to breach confidentiality?

A

Required by law - notifiable disease, ordered by a judge or the police
Patient consent
Public interest

58
Q

Criteria for confidentiality

A
  1. Anonymous
  2. Patients consent
  3. Kept to a necessary minimum
  4. Meets current law
  5. After death confidentiality continues
59
Q

Health Belief Model 1974

A
  1. Individuals must believe they are susceptible to the condition
  2. Individuals must believe it has serious consequences
  3. Individuals must believe that taking action reduce their risks
  4. Individuals must believe that the benefits of taking action outweigh the costs
60
Q

8 duties of a doctor

A
  1. Make the care of your patient your first concern
  2. Keep your professional knowledge and skills up to date
  3. Treat your patient politely and considerately
  4. Respect your patient’s right to confidentiality
  5. Listen to patients and respond to their concerns and preferences
  6. Never discriminate unfairly against patients or colleagues
  7. Work with colleagues in the ways that best serve patients’ interests
  8. Treat patients as individuals and respect their interest
61
Q

4 principles of ethics

A

Autonomy - respect the decision of the patient, the decision must be intentional, done with understanding and there are no major controlling influences over the decision
Benevolence - do good
Non-maleficence - do no harm
Justice - need vs benefit, QALYs, fairness

62
Q

5 challenges faced with an ageing population

A
  1. Strains on pension and social security systems - pensions will have higher pay outs
  2. Increasing demand for healthcare
  3. Bigger need for trained health workforce
  4. Increasing demand for long term care
  5. Ageing population
63
Q

Primary, secondary and tertiary intervention for type II diabetes

A

Primary - lose weight, better diet, exercise
Secondary - population screening, diabetic eye screening
Tertiary - medication such as metformin, bariatric surgery

64
Q

Prevalence definition

A

The proportion of a population found to have the disease

65
Q

Incidence definition

A

The number of new cases within a specified time-period

66
Q

NHS screening programmes

A 
New-born hearing screening
Breast screening
Bowel cancer screening
Cervical screening
Sickle cell and thalassaemia
67
Q

10 criterions for screening

A
  1. Condition should be an important problem
  2. There should be an acceptable treatment
  3. There should be a recognised early stage
  4. Facilities for diagnosis/treatment are available
  5. There should be a suitable test
  6. The test should be acceptable to the population
  7. The natural history of the disease should be known
  8. Case finding should be a continuous process
  9. Early treatment should make a difference to prognosis
  10. Cost of case finding should be economical
68
Q

Human error of commission definition

A

A mistake that consists of doing something (action) wrong

69
Q

Errors of omission definition

A

Required action is delayed or not taken

70
Q

Errors of negligence definition

A

The actions or omissions do not meet the standard

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