Public Health Flashcards
What is health?
A complete state of physical, mental and social well being - not just the absence of disease
When are you allowed to breach confidentiality?
- Required by law (e.g. notifiable disease, ordered by police/judge)
- Patient’s consent given
- It is in the best interest of the public
How can doctors help smokers?
AAA
A - ask (are you a smoker?)
A - advise (smoking is bad)
A -assist, i.e. refer to NHS Smoking Cessation Service (nicotine patches/gums etc.)
Describe the stages of the transtheoretical model of change, giving examples of a smoker
- Precontemplation = smoker, not thinking about quitting
- Contemplation = smoker, thinking about quitting but not ready yet
- Preparation = smoker, thinking about quitting and taking steps to prepare for quitting
- Action = ex-smoker, quit for < 6 months
- Maintenance = ex-smoker, quit for > 6 months
- Relapse?? = quit smoking, then had a lapse that led to smoking being resumed
Give an example of an alcohol screening tool
CAGE questionnaire:
- have you ever felt you should CUT down on your drinking?
- have you ever felt ANNOYED because someone criticised your drinking habits?
- have you ever felt GUILTY about drinking?
- have you ever taken a drink first thing in the morning (as an EYE-OPENER)?
How do you calculate a unit of alcohol?
Units = strength of drink (%ABV) x volume of liquid (mLs) / 1000
How many units of alcohol are you allowed per week?
You shouldn’t exceed 14 units of alcohol per week
Give some examples of public health campaigns to prevent alcohol abuse
- Know your limits (binge drinking campaign targeting 18-24 year olds)
- Drinkaware labelling
- ‘THINK!’ (drink driving campaign)
What is patient compliance?
The extent to which a patient’s behaviours coincide with medical or health advice given
Give some factors which can affect patient compliance
- Access to resources/facilities, e.g. distance from treatment setting
- Condition, e.g. memory impairment
- Complex treatment regimes
- Disbelief/denial of diagnosis
What is an occupational disease?
A disease where work is considered to be the main cause
Give some examples of occupational diseases…
Lungs:
- Asbestosis
- Mesothelioma
- Silicosis
- Coal worker’s pneumoconiosis
Skin:
- Occupational dermatitis
MSK:
- Tenosynovitis
Give some examples of criteria for ‘good work’ from the Marmot review
- Precariousness (stable and safe)
- Work/life balance
- Prevents social isolation, discrimination and violence
- Promotes health and well being
- Reintegrates sick and disabled where possible
What are the public health interventions for reducing the spread of flu?
- Hand washing
- Encouraging respiratory hygiene… ‘catch it, bin it, kill it’
- Reducing social contact, e.g. not attending large gatherings
What are the aims of palliative care?
- Improve quality of life for patients and their families
- Provide pain and symptom relief
- Provide spiritual and psycho-social support
- Provide care from diagnosis through to end-of-life and bereavement
Describe the interventions to help prevent the spread of C. difficile
SIGHT
S - suspect C. difficile
I - isolate patient
G - gloves and apron
H - hand washing with soap and water (alcohol gel won’t kill)
T - test stool for toxin or perform stool culture to identify the strain
Give some examples of antibiotics which cause C. difficile
Ciprofloxacin
Cephalosporins
Co-amoxiclav
Describe the pharmacological management of C. difficile
Vancomycin and Metronidazole
Describe the WHO prevention and treatment package for diarrhoea
Prevention:
- Vaccination: rotavirus and measles
- Promote early and exclusive breastfeeding and vitamin A supplementation
- Promote hand washing with soap and water
- Safe treatment and storage of drinking water
- Community-wide sanitation promotion
Treatment:
- Fluid replacement to prevent dehydration
- Zinc treatment
Give some examples of groups most at risk of diarrhoea
- Poor personal hygiene
- Young (e.g. nursery) and elderly (e.g. nursing home)
Give some psycho-social factors which increase risk of CHD
- Type A personality (hostile, competitive, impatient)
- Depression/anxiety
- Work characteristics: high demand, low control; long hours
- Lack of social support
Describe some psycho-social impacts of alcohol abuse
- Relationship problems (violence, rape, depression/anxiety)
- Work problems
- More likely to engage in criminal behaviour
- Driving offences
Describe the symptoms of alcohol withdrawal
- Tremulousness (‘the shakes’)
- Agitation
- Hallucinations
- Seizures
Give the definition of substance misuse
Ingestion of a substance affecting the CNS which leads to behavioural and psychological changes (non-therapeutic use)
What is Gillick competence?
The ability of a child (person under the age of 16 years) to consent to their own medical treatment, without the need for parental knowledge or permission
What is sensitivity?
The proportion of people WITH a disease who get a POSITIVE result in a screening test
What is specificity?
The proportion of people WITHOUT the disease who get a NEGATIVE result in a screening test
What are the 4 mental capacity requirements?
- Ability to understand information
- Ability to retain information
- Ability to evaluate information
- Ability to communicate decision (verbal or non-verbal)
What is incidence?
Number of new cases of a disease in a population per unit time
What is prevalence?
Number of existing cases of a disease in a population at a given point in time
What is primary prevention?
- Aims to prevent onset of disease
- Involves interventions that are applied before any stages of disease are present
- E.g. public health campaigns
What is secondary prevention?
- Aims to detect disease in its earliest stages before symptoms are present
- Involves interventions that stop, slow or reverse disease progression
- E.g. Screening programmes
What is tertiary prevention?
Interventions which aim to stop the progression of established disease and minimise its negative consequences
Give some examples of screening programmes
- Bowel cancer
- Breast cancer
- Cervical cancer
- AAA
- Newborn heel prick test
- Diabetic eye screening
What is the name of the screening principles criteria?
Give some examples of criteria
Wilson and Junger criteria:
- Important condition
- Population for screening identified, e.g. women aged 25-50
- Cost effective
- Natural history of the disease is known
- Suitable test identified
- Acceptable and effective treatment
- Case-finding is a continuous process
What is positive predictive value?
Probability that the disease is present when the test result is positive
What is the negative predictive value?
Probability that the disease is not present when the test result is negative
What are the limitations of screening?
- False positives = unnecessary stress
- Negative results = people feel like they have a licence to take risks
- Over detection of sub-clinical ‘harmless’ cases
- ‘Harm’ from screening, e.g. radiation exposure form mammography
What is one pack year?
Twenty cigarettes smoked every day for one year
