Public health Flashcards
Consent must be 3 things
Voluntary
Informed
Made by someone with mental capacity
4 things that need to be told to patient about their treatment
What it involves
Risk
Benefits
Alternative options (and their risks/benefits)
Mental capacity act 2005
Used to empower and protect individuals over 16 who lack mental capacity to make decisions about their care and treatment
E.g. people with dementia, stroke, disabilities
Before deciding completely whether the individual does have proper mental capacity, the following things need to be considered
Have they been given all the info they need
Have different ways of communication been explored (non verbal)
Could anyone else help communicate with them (family/relatives)
Does capacity fluctuate with time/environment
Can decision be delayed until person is able to make one
What happens when it is found that individual lacks mental capacity to make a decision
Decision must be made in their best interests - weight up advantages/disadvantages
Advance statement/ADRT (Advanced Decision to Refuse Treatment) - Made by someone before they become incapable of making a decision
LPA (Lasting Power of Attorney) - Can grant another person authority to make decisions about your healthcare, and even property and finance affairs
What is used for individuals under 16
Gillicks competency/Fraser guidelines
The laws are mostly specific to contraceptive advice
Substance misuse
Ingestion of a substance that affects the CNS, leading to behavioural and physiological changes, for a non-therapeutic reason
Substances used for misuse
Opiates for pain relief and euphoria (heroin, morphine)
Depressants for sedation and relaxation (valium)
Stimulants for improved mood and activity (caffeine, cocaine, nicotine)
Hallucinogens for altered sensory perception and thinking patterns (ketamine, magic mushrooms)
Addiction - Causes
Illness
Genetics
Bad habit
Social problems
Addiction - Risk factors
Family history of misuse, conflict, poor familial management/parenting
Community - low academic commitment, substance availability
Individual/peer - risk taking behaviour/rebelliousness, anti-social behaviour, substance abusing peers, experience of trauma (bereavement, abuse)
Addiction - Management
National drug strategy 2010 - reducing demand, restricting supply, suport services through local councils
GP support
Needle exchange programs
Rehab/detox programmes
Compliance
Patient’s behaviour coincides with medical advice
Adherence
Patient involvement and autonomy throughout course of treatment
Concordance
Patient is equal to doctor in care-giving, involving them in decision making
Reasons for non-adherence
Financial barriers
Forgetfulness (dementia)
Language barriers
Patient’s beliefs
Necessity-concerns framework
Key beliefs influencing patients put into 2 categories - Necessity and concerns (perceived need for treatment and adverse consequences)
Adherence requires more necessity and less concern beliefs
Coronary heart disease - Risk factors
Smoking Diabetes Hypertension Obesity High cholesterol
Population attributable risk
The disease incidence in the population that would be eliminated if the exposure (smoking) were eliminated
Type A personalities
Competitive
Hostile
Agression
Occupational health - Respiratory
Inhaling fumes, dust, gas, aerosols
Acute irritant asthma, pulmonary oedema, infection, allergy, chronic inflammation (COPD), destruction of lung tissue (fibrosis of lungs/pleura), carcinogenesis
Lung disease - Causes
Smoking
Occupational hazards
Geographical variation is due to socioeconomic differences, historic industry (mining, shipping, building)
Pandemic influenza - 3 Types
A, B, C (A/B more common)
Pandemic influenza - Symptoms
Upper/lower respiratory tract symptoms Fever Headache Malaise Weakness
Pandemic influenza - Epidemics and pandemics
Seasonal epidemics caused by micro-antigenic variation
Pandemics caused by major-antigenic variation
Pandemic influenza - Treatment
Oxygen
Hydration
Antivirals to prevent infection spread
Symptomatic relief
Palliative care
Comfort and high quality of life Meet patient and family needs Pain management and symptomatic relief Psychological, spiritual and practical support Bereavement support for family
Alcohol misuse - Psychosocial effects
Violence
Criminality
Work problems
Driving offences
Alcohol misuse - Acute and chronic health effects
Acute - Injuries, pneumonia, gastritis, pancreatitis, oesophagitis, cardiac arrhythmias, cerebrovascular accidents, foetal alcohol syndrome during pregnancy
Chronic - Dementia, cerebellar degeneration, fatty liver and cirrhosis, liver cancer, hypertension, peripheral neuropathy, osteoporosis, CHD
Alcohol misuse - Management
Primary prevention - Know your limits campaign, drinkaware labelling, minimum pricing, Think! campaign
Secondary prevention - Screening
Management - Therapy, social support and medication (Disulfiram), MoCAM 2006 (Model of Care for Alcohol Misusers)
Anorexia nervosa
Restriction of energy intake, low body weight, fear of weight gain
Bulimia nervosa
Recurrent episodes of binge eating (large amounts of food consumption with lack of control)
Diarrhoea - Transmission
Spread from person to person through exit and entry points
Direct transmission - STIs, viral gastroenteritis (faeco-oral)
Indirect transmission - Vector borne (malaria), HepB
Airborne - TB
Diarrhoeal diseases
Dysentery
Cholera
Typhoid
Hepatitis
Diarrhoea - Microorganisms
Rotaviruses Shigella E. Coli Salmonella Vibrio cholerae Norovirus (flu like) Clostridium difficile (associated with antibiotic use)
Diarrhoea - Prevention
Hygeine - Hand washing, vaccinations, sterilisation/sanitation in care giving and food preparation settings
Diarrhoea - Management
Fluid and electrolyte resus
Zinc
Back pain
Lumbosacral region and spreads to leg, feet/toes
Often numbness/parasthesia associated
Work related MSK disorders
Carpal tunnel syndrome - repetitive wrist flexion Hand-arm vibration syndrome - blanching of fingers, tingling, numbness Tendonitis/tears Epicondylitis - tennis elbow RSI Rotator cuff problems Osteoarthritis Mechanical back pain
Bradford Hill criteria
Guidelines to help provide evidence of work related disorders being due to work
Backed by evidence-based research
Legal impacts - Affected people are protected by The Equality Act 2010, and so employer must make appropriate adjustments
Chlamydia - presentation
Most common STI
Chlamydia trachomatis
Infects urethra, endocervical canal, rectum, pharynx, conjunctiva
In males - Dysuria and urethral discharge
In females - Discharge, menstrual irregularity, dysuria
Chlamydia - Diagnosis
Swabs
First void urine
Chlamydia - Management
Antibiotics - Doxycycline
Partner screening and notification
Test for other STIs (especially gonorrhoea)
Chlamydia - Complications
Pelvic inflammatory disease and subsequently infertility
Ectopic pregnancy
Chronic pelvic pain
Neonatal transmission
Syphillis - Presentation
Ulcers around genital skin, nipple, mouth
Skin rash
Can cause still births/late miscariages in neonates
Syphillis - Diagnosis
Blood serology
Syphillis - Management
Penicillin
Partner notification
Public health interventions to control STIs
R=BCD (R-Reproductive rate, B-Infectivity rate, C-Partners over time, D-Duration of infection)
Primary prevention - STI awareness, vaccination
Secondary prevention - Screening, partner notification, treatment access
Diabetes - Risk factors
Sedentary job
High calorie diet
Low fruit/veg intake
Obesity
Diabetes - Social factors
Culture of car usage, TV watching, cheap fast food
Factors maintaining obesity
More weight makes it harder to exercise, low self-esteem and comfort eating, reduced employment opportunities
Diabetes - Prevention
Primary - Weight loss, healthy diet, exercise
Secondary - Awareness, screening
Tertiary - Lifestyle changes, medication ,education, complications management
Obesity - Complications
High cholesterol Hypertension Prediabetes Bone/joint problems Respiratory problems Increased risk of CV event (MI, stroke)
Obesity - Media campaigns
Change4Life
5ADAY
Obesity - barriers to weight loss
Unhealthy food is cheap
Industry profits from unhealthy food
Lack of motivation/energy
Passive vs active immunisation
Passive - Transfer preformed antibodies (natural or artificial)
Active - Challenging immune system with weakened/live attenuated or dead form of pathogen
Factors contributing to unsafe practice
Communication Training Patient assessment Clinical complexity Staffing levels and competency Human error
Error types
Latent - resource allocation
Organisational - management failures
Technical failure - facilities
Active - direct patient contact
Reducing errors - SBAR method of management
Situation Background Assessment Recommendation Maintain situational awareness, eliminate distractions, open minded diagnoses - not anchoring on ideas early on
