Public Health Flashcards
what are necessity beliefs
perceptions of personal need for treatment
what is patient compliance
extent to which patient behaviour coincides with medical health or advice
what is adherence
extent to which patients actions match agreed recommendations = acknowledges importance of patients beliefs
what does the health act 2006 say
infection control is every health workers responsibility
what is an endogenous infection
infection of patient by their own flora
what is a notifiable infectious disease
legal obligation to inform authority
why is a notifiable disease notifiable
very dangerous
vaccine preventable
disease that needs specific control measures
what are the steps of a notifiable disease
notification
contact tracing
prophylaxis = advice, antibiotics, immunisation
what is antigenic drift
minor antigenic variation causes seasonal epidemics
what is antigenic shift
major antigenic variation causes pandemics
what is obesity
abnormal/excessive fat accumulation resulting from chronic imbalance between energy intake and energy expenditure = presents a risk to health
what are the BMI values
25-29.9 = overweight 30-34.9 = obese class 1 35-39.9 = obese class 2 40-49.9 = morbidly obese class 3 50+ = super obese class 4
what is the obesogenic environment
physical = using cars, lifts = more weight harder to exercise economic = cheap food = low self-esteem = comfort eating sociocultural = family eating patterns = reduced opportunities
what aspects of employment increase risks of obesity
shift work
lack of sleep
upset circadian rhythm
reduced physical activity
what is my role in infection control (4)
follow policies/procedure
communicate with infection control team for questions
set good example
dont follow bad examples
how to reduce endogenous HAI (5)
- good nutrition/hydration
- asepsis/skin prep
- control of underlying disease
- remove lined/catheters as soon as
- reduce antibiotic use to remove selection pressures
how is patient to patient transmission prevented
identification of patient A = screening, diagnosis
isolation of infected patients
how is patient to staff transmission prevented
hand washing
barrier precautions
PPE
how is environmental transmission prevented
isolation
cleaning
ward design
what are carbapenemase producing enterobacteriacease CPEs
bacteria with carbapenemase resistance (broad spec beta lactams)
bacteria colonise large bowel/skin/moist sites
cause most UTIs and intra-abdominal infections
when is it ok to break confidentiality of HIV according to the GMC
can disclose to a known sexual partner identified at risk who is unaware of risk and patient cannot be persuaded to inform partner BUT must inform patient you will be doing this
what developmental aspects increase risk of obesity
rapid infant weight gain = increase
breast feeding = protective
early intro to solid foods = increases
childhood obesity
what features help identify those at risk of diabetes
sedentary job
high calorie diet
obesogenic environment
name risk factors of diabetes
unmodifiable = age/sex/ethnicity/genetics
modifiable = weight/BMI/waist circumference
hypertension
impaired glucose tolerance test/impaired fasting glucose
how can we diagnose diabetes earlier
raise awareness of symptoms
screening
diagnosing pre-diabetes
what groups are most at risk of communicable diseases
- poor hygiene groups
- children attending preschool/nursery
- workers involved in preparing or serving unwrapped/uncooked food
- HCW working with vulnerable people
what are the 4 main diorrhoeal diseases
dysentery
typhoid
hepatitis
cholera
what is the mental capacity act 2005
presumed to have capacity unless established dont
decision made for person without capacity must be in their best interest
when is someone said to not have capacity
if unable to:
- undertsand relevant info
- retain info
- use or weigh info to make decision
- communicate decision
who decides for children under 16
if child understands consequences of decision they decide
if child does not understand consequences = parents decide
consent must be (3)
voluntary
informed
made with capacity
what you need to inform about treatment
what it is
significant risks
benefits
alternatives - risk/benefit
what does SBARR stand for
situation background assessment request recommendation
what is candour
openness and honesty, disclosure of error
= correct error, offer apology, explain effects
what is deontology
belief that we owe duty of care to eachother
religious
immanuel kant
features of the act determine goodness of that act
involves being motivated by duty
what is consequentalism
the means are unimportant if the consequences are good
= utilitarianism = greatest good for greatest number
what is virtue ethics
the character of the person doing act is essential
we become virtuous by doing virtuous things - virtues are subjective in cultures
what is sensitivity
ability of test to correctly identify those WITH disease
what is specificity
ability of test to correctly identify those WITHOUT disease
what is PPV
proportion of positive results that are true positives
what is NPV
proportion o negative results that are true negatives
what is screening
process which identifies apparently well individuals who may be at increased risk of developing a condition in the early stage of a condition so that intervention can alter the course of disease = reduce mortality/morbidity
what is a disability according to the equality act 2010
physical or mental impairment which has substantial long-term adverse effect of a persons ability to carry out normal activities
what is the incidence
rate at which new cases occur in population during a specified time period
what is prevalence
proportion of population that have disease at point in time - incidence x average duration
what is mortality
incidence of death from a disease
what are the 3 goals of HIV testing services
- provide high quality service to identify
- link individuals to treatment, care, support
- prevent transmission (circumcision, prophylaxis)
what was made a criminal offence in November 2016
if patient knows have HIV and pass it on = criminally liable
name 9 ways to prevent HIV
- circumcision
- post exposure prophylaxis PEP
- preexposure prophylaxis PreP
- STI control
- HAART
- education
- condom use
- needle exchange
- early diagnosis
what are the principles of IPC (infection/prevention/control)
ID risks
routes/modes transmission
virulence of organisms
remedial factors
how is norovirus so effective
low infecting dose
able to persist in environments
relatively resistant to conventional cleaning
what did the black report 1980 say
4 mechanisms to explain widening health inequality:
material = enviro cause
artefact = product of how inequality measured
cultural = poor people do unhealthy things
selection = ill sink in society
what did the whitehall study of british civil servants show
inequalities and mortality between employment
risk factors only cover 1/3rd of the variation by employment grade
what did the acheson report 1988 show
mortality decreased but inequalities remain/widened
prioritise families with children
what proportion of adults in England are overweight or obese (2017)
64.3%
what proportion of year 6 children were overweight/obese (2017)
34%
name 5 focal virtues
trustworthiness compassion conscientiousness integrity discernment
what are the positives of virtue ethics
centres ethics on person
includes persons whole life
what are the negatives of virtue ethics
no clear guidance for moral dilemmas
no gen agreement on what virtues are
what are the 4 principles of medical ethics
autonomy
beneficence
non-maleficence
justice
what are the doctors obligations (4)
duty to patient
accountable to employer
responsible to eachother, professional, public health
moral obligations
what is hippocrates paternalism
medicine offers hope, bad news destroys hope so should conceal news in patients best interest
what is the 4 quadrants approach
- medical indications
- patient preferences
- quality of life
- contextual features
what is distributive justice
fair distrobution of scarce resources
what is right based justice
respect for peoples rights
what is legal justice
respect for the law
what is the doctrine of double effect
if doing something morally good has a morally bad side-effect it’s ethically OK to do it providing the bad side-effect wasn’t intended
what is the population attributed fraction
proportion of incidence of disease in exposed and non-exposed population that is due to exposure
exposure eliminated = disease incidence eliminated
what has driven the CHD mortality decline in england and wales
reduction in smoking
population blood pressure fall
hypertension therapies
secondary prevention measures
what is the significance of social inequality in smoking
accounts for 59% difference between male mortality between high and low socioeconomic groups
what is an absolutist explanation of social inequality
its about poverty
whats a relativist explanation of social inequality
inequality in society
greater = bad
what is the NNT
measurement of impact of medicine or therapy by estimating the number of patients needed to treat over given time in order to have an impact on 1 person
what is the NNT calculation
1/ARR
describe a coronary prone behaviour pattern
competitive
hostile
impatient
type A
what was the recurrent coronary prevention project
included cardiac counselling and type A behaviour modification
achieved fewer cardiac events
what is the association between depression and CHD
higher depression = higher CHD and associated mortality
what did the whitehall study conclude about CHD
men in lowest grade has higher CHD mortality rate than men in highest grade of work
how is depression/anxiety measured
beck depression inventory
general health questionnaire
spielberger’s state anxiety inventory
what work characteristics are risk factors for CHD
high demand low control
11+ hours = 67% more likely to have a heart attack
what is the doctors role in preventing CHD
- observe behaviour patterns
- identify signs of depression/anxiety
- ask about occupation
- ask about support available
name the cardiac disease risk calculator
QRISK2
what percentage of 16-24 year olds have used drugs in the past year
19%
what are the gender proportions of people in treatment for drug abuse
70% men
30% women
define substance abuse
ingestion of a substance affecting the central nervous system which leads to behavioural and psychological changes
what are new psychoactive substances
mimic the effects of other substances but less predictably
e.g. synthetic cannabinoids, stimulant-type drugs
what is prevention theory
prevent substance abuse by reducing the risk factors and increasing protective factors throughout life
what are the risk factors fro substance abuse
family
school/community
individual/peer
describe physical dependence
body adapts to presence of substance
removal of substance causes physical withdrawal symptoms
describe psychological dependence
feeling that life is impossible without the drug
emotional effect = pain, fear, loneliness
what are the diagnostic codes for substance abuse
0 = acute intoxication = disturbances in level of consciousness/cognition 1 = harmful use = pattern of use damaging to health 2 = dependence = strong desire to take drug, difficult controlling use
diagnostic model 1-3
- consuming more than originally planned
- worrying about stopping/consistently failed efforts to control use
- spending large amount of time using/obtaining substance
diagnostic model 4-7
- use results in failure to fulfil major role obligations
- craving
- continued use despite health problem caused/worsened
- continued use despite negative relationship effects
diagnostic model 8-11
- repeated use in a dangerous situation e.g. driving
- giving up or reducing activities
- building up a tolerance to the alcohol or drug = more for same effect
- withdrawal symptoms
what is the significance of the diagnostic model in the past 12 months
2-3 = mild 4-5 = moderate 6+ = severe
what are the 6 components of dependence syndrome
- desire to use
- difficulties controlling use
- physiological withdrawal state when reduced use
- tolerance
- increased time spent using
- use despite evidence of harmful consequences§
what is residential rehabilitation
3-12 months
address underlying issues and learn coping mechanism
solve social/financial issues
what are the guidelines for safe alcohol consumption
14 units per week over more than 3 days
how to calculate number of units in a drink
strength of the drink (%) x Volume (ml) / 100
what is the alcohol harm paradox
low socioeconomic groups consume less alcohol than higher socioeconomic groups
but experience greater alcohol related harm
what are the 5 most common alcohol related deaths
- alcoholic liver disease
- cirrhosis and fibrosis of lver
- mental / behavioural disorders
- accidental poisoning
- other
what are the consequences of foetal alcohol syndrome
growth retardation
CNS abnormalities - mental retardation
craniofacial abnormalities
describe alcohol withdrawal
occurs 6-24hrs after last drink
lasts up to 1 week
tremor, seizures, insomnia
what is delirium tremens
most severe form of alcohol poisoning occurs 24-72 hrs after stopping hyper-adrenergic state disorientation diaphoresis tremors impaired attention hallucinations
name 4 primary prevention health promotions for alcohol misuse
- know your limits
- drinkaware
- THINK - drink driving
- minimum pricing
describe some forms of secondary prevention for alcohol misuse
detect patients at risk screenign questions/tools: FAST = fats alcohol screening test AUDIT = alcohol use disorders identification test CAGE questions
what are the cage questions
- have you ever felt you should CUT down your drinking
- have people ANNOYED you by criticising your drinking
- have you ever felt GUILTY about your drinking
- have you ever taken a drink first thing in the morning to settle nerves/sort out hangover = EYE opener
2+ = problem!!
what treatment is there for alcohol misuse
= psychosocial
therapy - CBT
social support
what are the 4 tiers of alcohol intervention
- non substance misuse specific services
- open access drug/alc services
- specialist community based clinics
- specialist inpatient services
prevention schemes for alcohol abuse
price marketing availability school partnerships licensing
what is dependence
state in which an organism functions normally only in the presence of a drug
explain how alcohol dependency occurs
alcohol is a depressant
inhibits presynaptic Ca2+ entry and transmitter release
= causes increase in a Ca2+ channel
what is the severity of dependence questionnaire
SADQ
physical withdrawal symptoms
affective withdrawal symptoms
speed of onset of withdrawal symptoms
relief drinking
frequency of alcohol consumption
31+ = severe alcohol dependency
under 16 = mild physical dependency
what is tolerance
state in which an organism no longer responds to a drug
higher dose is required to achieve same effect
what interventions are available for alcohol dependency
community based assisted withdrawal
in-patient based assisted withdrawal
benzodiazepines
chlorodiazepines
what is wernicke’s encephalopathy WE
caused by thiamine deficiency
metabolism of alcohol depends on thiamine
common in dependent drinkers
poor diet/intake of vitamins
what are the symptoms of wernicke’s encephalopathy WE
ataxia = lack of voluntary coord
confusion
nystagmus = eyes make repetitive uncontrolled movement
how is wernicke’s encephalopathy treated
pabrinex
vitamin B/thiamine
what is korsakoff syndrome
85% untreated WE leads to kosakoff
memory impairment
chronic and irreversible
what drugs can be used to prevent relapse of alcohol dependency
- acamprostate (campral) = acts on neural pathways
- DISULFIRAM (antabuse) = disrupts oxidative alcohol metabolsim = build up of acetaldehyde = increase hangover length - nausea/vomiting/SOB
- NALMEFENE (selnicro) = opioid receptor antagonist
reduces feeling of reward/pleasure
what are the psychosocial effects of excessive alcohol
- interpersonal relationship problems
- criminality/violence
- problems at work/unemployment
- social disintegration = poverty
- driving offences
what does FRAMES stand for
= motivational interviewing feedback responsibility advice menu of options empathetic self-efficacy
what is malnutrition
state of nutrition in which deficiency or excess of energy/protein/other nutrients cause measurable adverse effects on tissues/body function and clinical outcome
what does telling the truth require
right amount
right person
right time
what is the role of environmental health officers
- inspect businesses for health and safety, food hygiene, food standards
- investigate outbreaks of food poisoning and infectious disease
- collect lab samples for testing
what can the infective causes of diorrhoea be divided into
non-bloody
bloody = dysentery
what are the non-infective causes of diorrhoea
1. neoplasm inflammatory irritable bowel anatomical 2. hormonal radiation chemical
name 7 causative organisms of diarrhoea
- rotavirus
- shigella
- salmonella typhi
- salmonella paratyphi
- ecoli 0157
- vibrio cholerae
- hep A+E
what are the 3 types of transmission
direct
indirect
airborne
name 5 methods of diarrhoea prevention in children
- rotoavirus and measles vaccinations
- promote early and exclusive breastfeeding + vit A supplementation
- promote handwashing with soap
- improve water supply quantity and quality
- community wide sanitation promotion
what is the treatment for diarrhoea in children
fluid replacement
zinc replacement
name the 4 at-risk groups for diarrhoea
- poor hygiene groups
- children at pre-school/nursery
- workers involved in preparing and serving unwrapped/uncooked food
- HCW working with vulnerable people
what are c.diff spores resistant to
heat
drying
chemicals
what is c.diff associated with
antibiotic use, especially broad spec
what does c.diff cause in hospitalised patients
antibiotic associated diarrhoea
antibiotic associated colitis
pseudomembranous colitis
36% of hospitalised patients = asymptomatic carriers
what causes 80% of antibiotic related diorrhoea
clostridium difficile
what does SIGHT stand for
S-suspect C diff as cause of diarrhoea I-isolate the case G-gloves and apron must be worn H-hand washing with soap and water T-test stool for toxin
what is used to treat c.diff
vancomycin
metranidazole
control Ab use
infection control
how is C.diff investigated
test stool samples
tissue samples
culture
no need to screen/treat asymptomatic carriers
what action is taken when a notifiable infectious disease is found
- investigate
- identify and protect vulnerable individuals
- remove from high risk settings
- health promotion
- coordinate multi-agency response
what are the types of immunisation
- active = cell mediated/Ab mediated
2. passive = placental/transfusion of Ig
what is active immunisation made from
inactivated attenuated live organisms secreted products constituents of cell walls recombinant components
what is passive immunisation made from
human normal immunoglobulin HNIG
= plasma from donors
= contains antibodies to infectious disease currently prevalent
what is primary vaccine failure
person doesnt develop immunity from vaccine
what is secondary vaccine failure
initially responds but protection reduces over time
describe a passive immunity vaccine
passive immmuntiy provided by injection of human immunoglobulin containing antibodies to target infection
temporarily increases antibody level for that specific infection
what specific immunoglobulins are available for passive immunisation
tetanus
rabies
hep B
varicella zoster (chicken pox)
what is a meningococcal infection
present as meningitis or septicaemia
caused by neisseria meningitidis
can cause very bad things in children (gangrene, brain abcess)
treated with cefotaxime or ceftriaxone
name the phases of managing infectious threat
- identification of new threat
- containment phase
- management phase
name 5 benefits of work
- lower mortality
- social relationships
- structure to life
- improved fitness and mental health
- reduced state benefits
when is an illness due to work
symptoms improve away from work
characteristics distribution of rash e.g. contact dermatitis
cluster of cases at workplace
exposure to hazard linked to disease
work related neck conditions
tension neck
thoracic outlet syndrome
cervical spondylosis
work related shoulder conditions
rotator cuff tendonitis
shoulder tendinitis
bicipital tendinitis
shoulder capsulitis
work related elbow conditions
lateral and medial epicodylitis
work related arm conditions
carpal tunnel syndrome
tenosynovitis of the wrist
De Quervain’s disease of the wrist
what are the red flags for serious spinal pathology
age of onset between 20 and 55 violent trauma systemically unwell persisting severe restriction of lumbar flexion widespread neurology
what are the top 3 causes of injury at work
- single excessive force
- static loading
- repetitive wear and tear
what is the rapid upper limb assessment
series of tasks performed and scored
provides information on the level of intervention required to reduce the risk of injury
what is the definition of good MSK health
healthy/disease free muscles bones and joints
ability to carry out wide range of physical activities/functions effectively and symptom free
what are 4 factors that are effective MSK risk managements
- vit D/calcium intake increase
- weight management
- physical activity to increase strength and mobility
- injury prevention in all areas of life
describe the screening of developmental dysplasia of the hip
screening at physical examination at 6-8 weeks old
early detection and diagnosis = reduce need for surgery
is there screening for osteoporosis
no
uncertainty about who would be included and effect on treatment
evidence has shown that screening all women does NOT reduce fractures
is there screening for vit D deficiency
not unless patient has symptoms or risk factors of deficiency
what conditions should you think of is there is discharge
gonorrhoea
chlamydia
how is the male presentation of chlamydia/gonorrhoea different from female
pain
puss in urine
longer incubation period
more asymptomatic
what are the complications for males with chlamydia or gonorrhoea
epididymo-orchitis
reactive arthritis
what are the complications for females with chlamydia/gonorrhoea
pelvic inflammatory disease = ectopic pregnancy
neonatal transmission during birth
fitz hugh curtis syndrome
what is the most common STI
chlamydia
what test is used to diagnose chlamydia
nucleic acid amplification test NAAT
what test is used to diagnose gonorrhoea
near patient test
= swab
what STI causes genital ulcers
syphilis
what is the STI transmission model
R = B x C x D R = reproductive rate (aim for lower than 1) B = infectivity rate C = partners over time D = duration of infection AIM to effect 1 of these variables
describe some primary prevention methods for STIs
= reduce risk of acquiring awareness campaign face to face reduction discussion vaccination = HepB/HPV Anti-retroviral = PEP, PrEP
describe some secondary prevention methods for STIs
= case finding
access to STI tests/treatment
partner notification
targeted screening - antenatal for HIV/syph, chlamydia, HIV home testing
describe tertiary prevention for STIs
anti-retrovirals for HIV
acyclovir to suppress genital herpes
what are the aims for partner notification
break chain of transmission
prevent re-infection
prevent complication of untreated infection
what are some contraindications for use of benzodiazepines to treat alcohol dependence
hypersensitivity severe pulmonary insufficiency sever hepatic insufficiency chronic psychosis pregnancy DONT USE AS STAND ALONE TREATMENT
what is the risk of using benzos to treat alcohol dependency
risk of dependency in increased doses especially over longer period of time
what are the withdrawal effects of benzodiazepines
headache muscular pain anxiety hallucinations seizures
what are some drug interactions of benzos
alcohol = enhanced sedatives
central NS acting drugs = enhanced depressive effects
compounds affecting P450 = reduce clearance
who can make decisions for someone without capacity
lasting power of attorney
make advanced decision
healthcare professional act on behalf (section 5 of mental capacity act)
what does best interest need to consider
- whether patient have capacity and if wont have in future
- patients past/present/future wishes
- patients beliefs and values
- other factors
- consult with anyone named as needing to be consulted
definition of mental health
state of well-being in which every individual
- realises their own potential
- can cope with normal stresses of life
- can work predominately and fruitfully
- is able to make a contribution to his/her community
ABC of self care
awareness
balance
connection
what are the 8 primary emotions
joy, anger, fear, sadness, disgust
anticipation
surprise
trust
what factors verify a death
no heart sound/carotid pulse for 1 minute
no breath sounds or respiratory effort for 1 minute
no response to painful stimuli
pupils fixed and dilated
