public health Flashcards
alcohol effect on CNS
potentiate GABA (inhibitory neurotransmitter) inhibits glutamate (excitatory neurotransmitter)
goverement alcohol strategy
- when
- what
2012
prevention- based
minimum pricing licensing law marketing availability lower risk limits (14 units/ week)
AUDIT
- stands for
- short version
- long version
alcohol use disorder identification test
short version - indicates high risk drinking
- how often alc
- how many units/day
- how often 6/8 units +
long version- indicates dependance
- unable to stop drinking
- failed to do what was expected
- needed morning drink
- guilt/remorse
- unable to remember
- someone worried about it
- injury because of it
unit calculation
% x ml /1000
SADQ
severity of dependance questionaire
- withdrawal symptoms, frequency of alc, withdrawal onset speed,
relief drinking
name 2 treatments for alcohol withdrawal
benzodiazepines eg chlordiazepoxide
lorazepam (better for hepatic insufficiency)
name 3 medicines for alcohol relapse prevention
acomprosate - alleviates cravings
disulfiram - makes you v ill (anaphylactic-like) every time you drink alcohol
nalmefene - effect of alc still present but reduced feeling of pleasure/reward
law of tort sections
negligence
battery
breach of confidence
negligence
what are the 3 requirements
1 Duty of care exists
- Obligation to take care to prevent harm being suffered by another
- -Doctors have duty of care for patients
2 Duty of care is breached
– Have they breached the standard of care?
(doctors agree if they would have done the same (Standard of care) – judge decides whether they think this standard of care is fit – or if the practice needs to change
3 Harm results
do doctors have a duty of care to someone outside the hospital
legally, no
unless they stop to help
gmc thinks you do have a duty
battery =
lack of consent
can consent be implied
for some things yes - eg vaccination : arm held out
mental illness and consent
Mental illness- can admit without their consent but cannot treat for other medical conditions without their consent (mental health act)
if patient is not able to give consent eg unconscious, can family/ friends speak for them?
relatives/ friends do NOT make decision on behalf of those unable to give consent unless specifically empowered to do so by the mental capacity act (eg advance decision) (or minor)
what is bolams test
asks if doctors actions meet standard of care by asking medical body (doctors) to assess the actions (eg they would do the same)
how to deem if someone has capacity
1 Understand and retain information about treatment
2 Believes it
3 Weighs it to arrive at an informed choice
when can doctor disclose information without breaching consent
- Patient gives consent (you can tell me wife ..)
- Others involved with patient’s care
- Required by a judge in court
- Police (not always: )
- — Terrorism act
- — Road traffic act
- To coroner
- Statutory duty
- — To public health england, notifiable infectious diseases
- — Register births (inc under infertility treatment) and deaths (inc abortion)
do patients have right to see own health records?
yes
Unless will cause serious harm to mental/ physical health of patient/ physician/ another person
Or if the information is about or provided by another individual
necessity belief
perceptions of personal need for treatment
adherence/compliance
adherence = joint decision
(better term)
compliance = doctors orders
when to wash hands
before and after patients after handling soiled item after toilet before and after aseptic procedure after removing protective clothing inc gloves
seedhouses framework
ethical framework
like sqaures inside each other with X over it
inner grid = autonomy (yours and patients)
truth telling
best interests of patient and family
outer tier = risks, resources available, law, effectiveness
four quadrants framework
this is just like four things- going top left to right to bottom left to right:
medical indications (beneficence, non-maleficence)
patient preferences
quality of life
contextual factors (unintended consequences for other people eg patient family)
legally how do you prioritise two sick people where one is your patient
patient first
deontology
in regards to truth telling
duty of care
people are ends, not means to end
tell truth always, ignores consequences
consequentialism (Mill)
in regards to truth telling
consequences matter most
(this is hard to tell sometimes)
truth telling depends
virtue ethics
in regards to truth telling
based on virtues (charachteristics)
compassion and truth – these may clash… and there is on ranking of virtues
autonomy
in regards to truth telling
whole truth always
beneficence /non -maleficence
in regards to truth telling
depends on situation
what ever is judged to do most good / least harm
GMC
in regards to truth telling
important in whistle blowing
essential to inform patient about treatment options, side effects etc, doctor trust
when were drugs classed
misuse of drug act 1971
a/b/c system
substance use and misuse epidemiology
age
gender
employment status
race
younger
males
unemployed
black
esp! black male
effects of substance use /misuse
health (mortality/morbidity - physical, psychological and cost to NHS)
social (crime, violence)
economic (productivity, tax, NHS cost)
personal (identity, stigma, relationships)
weekly alcohol limit
14 units/ week
men and women
spread over 3 days if 14
35ish is hazardous but depends lots
are people good at estimating alcohol intake
no. un/conciously underestimate
alcohol harmful drinking trends
youth drinking trend
alcohol related deaths trend
alcohol gender and age (typically)
decrease
decrease (inc increase in non drinkers)
increase
men, middle ages (60s)
what is the paradox related to alcohol misuse
more affluent people drink more alcohol
more deprived people experience more alcohol-related harm
is HIV a notifiable disease
no
nor bird flu
types of vaccine failure
primary – immunity does not develop
secondary – immunity wanes over time
eating disorder association with:
prevalence age gender underweight ethnic socioeconomic
common (incidence less useful as unclear start)
not age related
f>m
majority not underweight
similar across ethnic/ socio-economic groups
anorexia nervosa
restriction of energy intake relative to requirements
restrictive or purge and bigne
bulimia nervosa
recurrent episodes of binge eating (lack of control, large amounts of food) + compensatory behaviour to prevent weight gain (diuretics, vomiting, exercise)
check K (goes low, needs rehydration)
do patients with bulimia nervosa feel better about their body when they are purging compared to binging
no. unrelated overestimation of body weight and shape / size distorted
binge eating disorder
recurrent episodes of binge eating (episodes of rapid, uncontrolled eating when not hungry until uncomfortably full, eating alone and feeling disgusted after)
no purging/compensatory behaviours
which people with eating disorders are often failed by lack of (correct ) diagnoses
those who are not white
those who are not underweight
purging disorder
restrictive behaviours to prevent weight gain + absence of binge eating
night eating syndrome
when asleep
so not aware
eat little in day
what is the psychology of eating disorders
triggers for loss of control
need control, like it (perfectionist, good at something), loss of control, regain on control (their weight is under their control)
then viscous circle : fear of loss of control increases the need for control
puberty
negative comment
got sick, lost weight, positive
new social circle
what to look out for in eating disorders
- severe food/fluid restriction
- electrolyte imbalance (K)
- drug/alc
- muscular weakness
- breathing problems
- physical damage - haematemesis / oesophageal tears (vom)
- deterioration of consciousness
- cardiac signs
- rapid weight loss (speed rather than actual figure)
- risky behaviours (driving drunk, suiicidal)
eating disorder management
food
diary keeping
talking therapies, CBT, family
only short term medications are evidence based
STI/HIV transmission model
reproductive rate (R<1 = will decline; R>1 = can cause infection
infectivity rate
partners over time
duration of infection
examples oF STI prevention
primary = reduce risk of acquiring
- campaigns
- vaccination
- Prep/pep (HIV)
secondary = undetected case finding
- partner notification
- screening eg antenatal
- service access
tertiary = reduce morbidity/ mortalirt
- ARV (HIV)
- prophylactic antibiotics for PCP (HIV)
polypharmacy=
5+ medicines
obesogenic enviroment
TV culture, lifts/escalators, cars, expensive fruit, fast food, family eating patterns
Steep slope - ‘runaway train’ – if overweight:… harder to exercise, low self esteem eating, reduced social mobility, decline in opportunities and relationships… so weight is maintained/increases
diet for healthy weight, low CV risk and diabetes
good is nuts, fruit/veg, grains, beans.
Bad is starch, sugar, processed meat, high Na
