Public health Flashcards
1
Q
Define mental health
A
A state of well being in which every individual realises their own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to their community
2
Q
What is the inverse care law?
A
The availability of good medical care tends to vary inversely with the need for it in the population served
3
Q
Give 4 categories of health influences
A
- ) Biological
- ) Personal lifestyle
- ) Health services
- ) Physical and social environment
4
Q
What 2 things did the Black report 1980 confirm?
A
- ) Social class health inequalities in overall mortality
- ) Health inequalities are widening
5
Q
Give 4 mechanisms to explain the Black report 1980
A
- ) Artefact
- ) Social selection
- ) Behaviour
- ) Material circumstances
6
Q
What did the Acheson report 1988 find?
A
Mortality has decreased in the last 50 years but inequalities remained or widened
7
Q
Give the 3 recommendations from the Acheson report 1988
A
- ) Evaluate all policies likely to affect health in terms of the impact on inequality
- ) Prioritise health of families with children
- ) Government should reduce income inequalities and improve living conditions in poor households
8
Q
Give the 3 domains of the theories of causation
A
- ) Lifecourse
- ) Psychosocial
- ) Materialist
9
Q
Describe the life course theory of causation
A
Critical periods have a greater impact in the life course (e.g. measles in pregnancy), hazards and their impacts accumulate (e.g. hard blue-collar work) - interactions and pathways
10
Q
Describe the psychosocial theory of causation
A
Social inequality may affect how people feel, which in turn can affect body chemistry - focuses on individual
11
Q
Describe the materialist theory of causation
A
Poverty exposes people to more health hazards, disadvantaged people are more likely to live in areas exposed to harm (e.g. damp and pollution)
12
Q
Give 2 ways in which doctors can help minimise health inequality
A
- ) Change perspectives
- ) Change systems
- ) Education
13
Q
Give 3 things consent must be
A
- ) Voluntary
- ) Informed
- ) Made by someone with capacity
14
Q
What must you tell someone to get consent?
A
What, how, risks, benefits, alternatives
15
Q
What 4 things may a patient not be able to do that leads to a decision not being made?
A
- ) Understand relavent information
- ) Retain it
- ) Use information to make a decision
- ) Communicate decision
16
Q
What 4 things must we take into account when acting in the best interests of a patient?
A
- ) Whether patient may soon regain capacity
- ) Patient’s past and present wishes
- ) Patient’s beliefs and values
- ) Consultation with anyone available
17
Q
Give 4 types of risk factor for CHD, and an example of each
A
- ) Unmodifiable (age, sex, ethnicity, genetics)
- ) Lifestyle (smoking, diet, physical inactivity)
- ) Clinical (HTN, lipids, DM)
- ) Psychosocial (behavioural trait, depression/anxiety, work, social support)
18
Q
What gives a 67% higher chance of an MI?
A
> 11hr work days
19
Q
Who did the Whitehall study 1 look at?
A
Male British civil servants over a 10 year period
20
Q
What did the Whitehall study 1 find?
A
Men in the lowest grade had higher mortality than men in the highest grade, 3x mortality rate from all causes
21
Q
Who did the Whitehall study 2 look at?
A
10,000 civil servents
22
Q
What did the Whitehall study 2 find?
A
Employment grade was strongly associated with work control and demands
23
Q
Give 3 things doctors can do to reduce psychosocial influences on CHD
A
- ) Observe/explore behaviour patterns
- ) Identify signs of depression/anxiety
- ) Ask questions from assessment tools
- ) Ask patients about job/occupation
- ) Ask about available support
- ) Liase with relevant services
24
Q
What is an absolutist explanation?
A
It’s about poverty, absolute measures of socioeconomic deprivation
25
What is a relativist explanation?
It's about relative differences, larger relative difference means poorer outcomes for the worse off
26
Give 4 ways we verify death
- ) No heart sounds/carotid pulse for 1 minute
- ) No breath sounds/respiratory effort for 1 minute
- ) No response to painful stimuli
- ) Pupils fixed and dilated
27
What % of people die in hospital?
60%
28
What is the maximum number of units you should drink in a week?
14
29
Give 2 ways to make drinking 14 units a week better
- ) Spread them evenly over 3+ days
| - ) Have several alcohol free days each week
30
What is substance misuse? (3)
- ) Results in failure to fulfil role obligations (school, work, home)
- ) May be physical hazardous (driving, machinery)
- ) Continued misuse despite persistent or recurrent social or interpersonal problems
31
How do we calculate the number of units in a drink?
(%ABV x volume in ml)/1000
32
What is dependence?
A state in which an organism functional normally only in the presence of a drug, manifests as a physical disturbance when the drug is withdrawn
33
What is tolerance?
A state in which an organism no longer responds to a drug, and a higher dose is required to achieve the same effect
34
What are the 2 actions of alcohol in the body?
- ) Potentiates GABA (inhibitor NT)
| - ) Inhibitis glutamate (excitatory NT)
35
Where is alcohol well absorbed in the body?
Small intestine
36
What is the half life of alcohol?
6-30 hours
37
Give 2 properties of alcohol in the body
- ) Highly lipophilic
| - ) Highly protein bound
38
What metabolises alcohol?
Liver
39
Can alcohol cross the BBB?
Yes
40
How is alcohol eliminated?
Excreted in urine mainly in form of its metabolites, as conjugates (glucuronide/sulphate)
41
What is Wernicke's encephalopathy?
Caused by a severe deficiency of thiamine, common in severely dependent drinkers
42
How do we treat Wernicke's encephalopathy?
Pabrinex, VB, thiamine
43
How do we treat alcohol withdrawal?
Benzodiazepines
44
What is the STI/HIV transmission equation?
```
R = BCD
R - reproductive rate
B - infectivity rate
C - partners over time
D - duration of infection
```
45
What is the infectivity rate of STI/HIV altered by?
Condom use, type of sex, microbe characteristics of organism
46
What is the duration of infection of STI/HIV altered by?
Reduced by easy access to services
47
What is primary prevention?
Reducing risk, prevention
48
What is secondary prevention?
Detecting, treating
49
What is tertiary prevention?
Reducing morbidity/mortality
50
Give 2 primary preventions for STIs
Awareness campaigns, vaccinations, key cash condom poster, pre/post exposure prophylaxis
51
Give 2 secondary preventions for STIs
Easy access to tests/treatment, partner notification, targeted screening
52
Give 2 tertiary preventions for STIs
Antiretrovirals for HIV, prophylactic ABX for PCP, acyclovir for genital herpes
53
Give 3 things partner tracing does
- ) Breaks the chain of transmission
- ) Prevents re-infection of index patient
- ) Prevents complications of untreated infection
54
Why do people carry out FGM?
- ) Seen as being 'pure'
| - ) Unable to marry without it
55
Give 2 complications of FGM
- ) Bleeding
- ) Infection
- ) Pain
- ) Death
- ) LUTS
- ) Period problems
- ) Anxiety
- ) PTSD
- ) Withdrawal
56
Give 3 infectious conditions that new migrants may present to their GP with
- ) Hepatitis
- ) TB
- ) Malaria
- ) HIV
- ) Parasitic infections
57
Give 2 mental health problems that war refugees may suffer from after immigration
- ) PTSD
- ) Depression
- ) Suicidal thoughts
- ) Anxiety
- ) Chronic pain, fatigue, dizziness, headache
58
Give 2 reasons we should be careful using family members as interpreters
- ) Agenda/bias
- ) Not confidential
- ) Poor English
- ) May limit translation
59
What is the typical history of occupational asthma?
Asthma improves on weekends/holidays
60
How can we diagnose occupational asthma?
Peak flow diary
61
Give 2 bits of advice for hand dermatitis prevention
- ) Avoid allergen/irritants
- ) Gloves
- ) Skincare 0 cream and soaps
62
What studies are best suited to calculating attributable risk?
Cohort
63
Give 3 teamwork problems
- ) Lack of teamwork
- ) Lack of leadership
- ) Lack of effort
- ) Lack of communication
- ) Lack of challenge
64
What is SBARR communication?
```
Situation
Background
Assessment
Recommendation
Response/review
```
65
What are the most commonly misused drugs?
Cannabis, ecstasy, new psychoactive substances
66
Give 4 types of substance, an example, and their effects
- ) Opiates - heroin, morphine - pain relief, euphoria
- ) Depressants - alcohol - sedation, relaxation
- ) Stimulants - caffeine, nicotine, cocaine - increased alertness, activity, mood
- ) Hallucinogens - ecstasy, ket, mushrooms - alter sensory perception and thinking
67
Give 3 risk factors in drug abuse
- ) Quantity and frequency of use
- ) Knowledge of what they're using
- ) Poly drug use
- ) Propensity for risky behaviour
- ) Co-existing problems
68
Give 2 risks of NPAs
- ) Overdose and temporary psychotic states
- ) Unpredictable behaviour
- ) Sudden pyrexia, tachycardia, coma
- ) Hallucination and vomiting
- ) Aggression and violence
- ) Intense comedown
69
Give 4 models of thinking for substance misuse
- ) Disease - addiction is a chronic recurring/genetic illness
- ) Behavioural - bad habit, would be punishment and rewards for non-using
- ) Volitional - failure of will, act to increase self-efficacy self -esteem, education on consequences
- ) Socio-cultural - target poverty, social exclusion, housing and mental health problems
70
Give 3 family risk factors for substance misuse
- ) FHx
- ) Family management problems
- ) Family conflict/abuse
- ) Being in care
71
Give 3 school/community risk factors for substance misuse
- ) Low academic attainment and commitment
- ) Availability of drugs
- ) Community norms
- ) Community disorganisation
- ) Transitions/mobility
- ) Low neighbourhood attachment
72
Give 3 individual risk factors for substance misuse
- ) Risk taking
- ) Rebelliousness
- ) Friends who use
- ) Experience of trauma
73
What is physical dependence?
Body adapts to presence of substance over time and needs more for the same effect (tolerance), stopping leads to withdrawal symptoms
74
Give an alcohol withdrawal symptom
- ) Tremors
- ) Stomach cramps
- ) Tachycardia
- ) HTN
- ) Hallucinations
- ) Seizures
- ) Delirium
75
What is psychological dependence?
Feeling that life is impossible/challenges cannot be face without drug, emotional effects
76
Give 4 points of the national drug strategy 2017
- ) Reduce demand
- ) Restrict supply
- ) Building recovery in communities
- ) Family/community involvement
- ) Payment by results
- ) Abstinece focused with emphasis on recovery and peer support
77
Give 3 local previsions for drug control
- ) GPs
- ) Harm reduction services
- ) Open access service
- ) Structured psychosocial interventions
- ) Prescribing services
- ) Detox
- ) Access to rehab
- ) Recovery support
78
What is one unit of alcohol defined as?
10ml pure alcohol (one shot, half pint, small glass of wine)
79
What is the alcohol harm paradox?
Low socioeconomic groups drink less alcohol than high socioeconomic groups, but experience more alcohol related harm
80
What does foetal alcohol syndrome cause?
- ) Pre and post-natal growth retardation
- ) CNS abnormalities
- ) Craniofacial abnormalities
- ) Defects of eyes, ears, mouth, CVS, GUT, skeleton
81
Give 2 chronic effects of alcohol excess
- ) Dementia
- ) Cerebellar degeneration
- ) Fatty liver
- ) Cirrhosis
- ) Liver cancer
- ) HTN, CHD
82
Give 3 psychosocial effects of excessive alcohol consumption
- ) Violence, rape, depression, anxiety
- ) Problems at work
- ) Criminality
- ) Social disintegration/povery
- ) Driving incidents/offences
83
Give a primary prevention for alcohol excess
- ) Known your limits campaign
- ) Drinkaware labelling
- ) THINK! drunk driving campaign
- ) Restriction on alcohol advertising
- ) TV ads
- ) Minimum pricing
84
Give a secondary prevention for alcohol excess
- ) Routinely asking, screening questions
| - ) FAST, AUDIT, CAGE
85
Give 3 examples of notifiable diseases
- ) Acute meningitis
- ) Acute infectious hepatitis
- ) Anthrax
- ) Acute encephalitits
- ) Cholera
- ) Legionnaires
- ) Malaria
- ) Measles
- ) SARS
- ) Smallpox
- ) TB
86
Why do we notify about diseases?
Outbreak detection, early warning, forecasting
87
What are the 2 types of vaccine failure?
Primary - no immunity developed from vaccine
| Secondary - initially responds but protection wanes over time
88
Give 2 reasons DM is a public health issue
- ) Mortality
- ) Disability
- ) Co-morbidity
- ) Reduced QOL
89
Give 3 risk factors for DM
- ) Sedentary job
- ) Obesogenic environment (physical, economic and sociocultural)
- ) Diet high in calories, low in veg
90
Give 2 factors that maintain obesity
- ) Physical - more weight, more difficult to exercise
- ) Psychological - low self-esteem, comfort eating
- ) Socioeconomic - reduced opportunities
91
Give a primary prevention of DM
- ) Sustained increase in physical activity
- ) Sustained change in diet
- ) Sustained weight loss
92
How do we achieve early DM diagnoses?
- ) Raising awareness in community and health professionals
| - ) Identify those at risk
93
Give 3 factors affecting patient compliance
- ) Socioeconomic (distance)
- ) Health system (medication)
- ) Condition (memory)
- ) Therapy (complex)
- ) Patient (denial)
94
What is an endemic?
Disease permanently present within a population in a geographic area
95
What is an epidemic?
An increase in the prevalence of a disease above the number usually observed in the population in a particular area
96
What is a pandemic?
Endemic in several countries
97
What does antigenic drift cause?
Seasonal epidemics
98
What does antigenic shift cause?
Pandemics
99
Give 3 conditions when confidentiality can be broken
- ) Risk to public
- ) Have given consent
- ) Required by law
100
What is anorexia nervosa?
Restriction of energy intake relative to requirements leading to a significantly low body weight in the context of age, developmental trajectory and physical health
101
What is bulimia nervosa?
Recurrent episodes of binge eating characterised by eating in a discrete amount of time large amounts of food, and a sense of lack of control over eating during an episode, with recurrent inappropriate compensatory behaviour to prevent weight gain
102
How do we distinguish binge eating disorder from bulimia nervosa?
No purging or compensatory behaviours
103
What does OSFED stand for?
Other specified feeding and eating disorders
104
Give 3 diseases of OSFED
- ) Atypical anorexia nervosa
- ) Bulimia nervosa/binge eating disorder of low freqeuncy/limited duration
- ) Purging disorder
- ) Night eating syndrome
105
Give 2 risk factors for developing eating disorders
- ) Genes
- ) Temperament
- ) Family interaction
- ) Social pressure
- ) Trauma
106
Give the maintaining factors of an eating disorder
- ) Positive reinforcement for weight loss initially
| - ) Then terror at losing control
107
How do we treat eating disorders?
CBT, family therapy, specialist support
108
What is the 2nd leading cause of death amongst children under 5 globally?
Diarrhoea
109
What does SIGHT mean with C. diff?
- ) Suspect C. diff as a cause of diarrhoea
- ) Isolate cause
- ) Gloves and apron
- ) Hand washing
- ) Test stool for toxin
110
Give 2 emotional side effects of obesity
- ) Stigma
- ) Bullying
- ) Low self esteem
- ) School absence
- ) Unemployment
111
Give 3 physical effects of obesity
- ) High cholesterol and BP
- ) Pre-diabetes
- ) Bone and joint problems
- ) Breathing problems
- ) Risk of premature mortality
- ) RF for heart disease, stroke, cancer, liver disease, infertility, depression, sleep apnoea, asthma, DM
112
Give 2 interventions for obesity
- ) Wider level - change4life, 5 a day
- ) Environment - more cycle paths, less car parking
- ) Public policy - sugar tax, minimum alcohol pricing
113
What are the 2 groups of beliefs influencing patients evaluation of prescribed drugs?
- ) Necessity
| - ) Concerns
114
What is human error?
A failure of a planned action or a sequence of mental or physical actions to be completed as intended, the use of a wrong plan to achieve an outcome
115
What is the swiss cheese model of patient safety?
Each slice is a level of defence, the holes are latent conditions/poor design/poor management conditions - if many holes line up, it gives a patient safety incident
116
Give an example of a patient safety defence
- ) Pre-op checklist
- ) Checking drugs before adminstration
- ) Marking surgical site before operation
