Public Health Flashcards
What are the 7 duties of a doctor?
- Make the care of your patient your first concern
- Keep your professional knowledge and skills up to date
- Treat your patient politely and considerately
- Respect your patient’s right to confidentiality
- Protect and promote the health of patients and the public.
- Treat patients as individuals and respect their dignity.
- Recognise and work within `the limits of your competence.
What are 4 psychosocial factors that increase CHD risk?
- Type A personality (hostile, competitive, impatient)
- Depression/anxiety
- Psychosocial work characteristics -Long work hours (more than 11hrs/day) -High demand, low control
- Lack of social support
What can doctors do for those with CHD risk?
Identify depression/anxiety Ask about occupation Liaise with social support services Vascular screening Risk reduction through promoting healthier lifestyles QRISK2 score
What are the 8 Bradford Hill Criteria?
- Strength of association
- Consistency
- Specificity
- Temporality
- Dose response
- Removal
- Biological plausibility
- Experimental animals
What are the benefits of alcohol consumption?
- Mildly euphoriant for many
- Socialisation
- Cardioprotective in low doses
What are the psychosocial effects of excessive alcohol consumption?
- Interpersonal relationship problems
- Criminality/Violence
- Problems at work/ Unemployment
- Social disintegration (Poverty)
- Driving Offences
List 4 withdrawal symptoms
- Tremulousness
- Activation syndrome: Tremulousness, agitation, rapid heart beat, high bp
- Seizures
- Hallucination
- Delirium tremens
What is the UK alcohol limit?
14 Units per week (not more than 6 in one session)
How can you work out how many units a drink is?
Strength of drink (%ABV)x amount of liquid (ml)/1000
What are some symptoms of fetal alcohol syndrome?
Pre + post-natal growth retardation and CNS abnormalities: mental retardation
Irritability, incoordination, hyperactivity
Craniofacial abnormalities
Congenitial defects, increase in incidence of birthmarks and hernias
List some primary preventative methods for alcoholism?
Drinkaware – alcohol labelling THINK! – drink driving campaign ‘Know your limits’ binge drinking campaign Restriction on alcohol advertising Minimum pricing Legislation – e.g. age limit Opening hours Glass substitution
What can doctors do for alcoholics?
Screening: CAGE and Alcohol Use Disorders Identification Test (AUDIT)
Brief interventions: FRAMES
Motivational interviews
referral to specialist
Help set goals, agree on plan, provide educational materials
What are the four CAGE questions?
Have you ever felt you should Cut down on your drinking?
Have people Annoyed you by criticising your drinking?
Have you ever felt bad or Guilty about your drinking?
Have you ever taken a drink first thing in the morning? (Eye- opener)
What are the four risks for alcohol abuse?
Role failure
Relationship problems
Run-ins with law
Risk of bodily harm
What are the 6 features of alcohol dependence?
Withdrawal symptoms Tolerance Keep drinking despite problems Cannot keep within drinking limits Spend a lot of time drinking/recovering from drinking Spend less time on other impt matters
What are the 5 treatments for alcoholism?
Naltrexone: competitive antagonist for opioid receptors, rapid detox
Disulfiram: produces sensitivity to alcohol - worst hangover
Acamprosate: stabilises chemical balance
Behavioural therapy
Social support - Alcoholics Anonymous
Why do people smoke?
Fear of weight gain on cessation Coping with stress Socialising Nicotine addiction Habit/behavioural
What can doctors do for smokers?
Nicotine replacement therapy: patches, gum, nasal spray
Ask (are you a smoker)
Advise (smoking is bad)
Assist (refer to NHS Stop Smoking service)
What are the stages of change for stopping smoking?
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 <6months
Maintenance: non-smoker, quit for >6 months
Relapse
What are the 5 components of stress?
Behavioral=Alcohol, poor sleep Cognitive= Poor concentration Physiological= Headaches Emotional= Mood swings, irritable Biochemical= Endorphin levels altered
What are the Wilson-Junger criteria?
- Condition should be an important problem
- There should be an acceptable treatment
- There should be a recognised early stage
- Facilities for diagnosis/treatment are available
- There should be a suitable test
- The test should be acceptable to the population
- The natural history of the disease should be known
- Case finding should be a continuous process
- Early treatment should make a difference to prognosis
- Cost of case finding should be economical
What is sensitivity?
Measure of how well a test picks up those with the disease
What is specificity?
Measure of how well a test recognises those without the disease
What is prevalence?
A measure of how common a disease or condition is in a defined population at a particular point in time
What is screened for in pregnancy?
Sickle cell and thalassaemia, infectious diseases, Downs syndrome, patau’s syndrome, Edwards’ syndrome, physical conditions
What is screened for in newborns?
Newborn hearing
Physical examinations for eyes, hearts, hips and testes
Newborn blood spot for sickle cell etc
When does cervical screening start?
Age 25
When does breast screening start?
Age 50
What is addiction?
Physical and psychological dependence
What are the diagnostic criteria for addiction?
Acute intoxication, harmful use, dependence
What is the tier 1 UK drug treatment?
Non-specialist, generic-substitution treatment: wean patient off drug
What is tier 2 UK drug treatment?
Open-access services
What is tier 3 UK drug treatment?
Specialist community-based drug services
What is tier 4 UK drug treatment?
Specialist inpatient services- detoxification
What is malnutrition?
State of nutrition in which deficiency or excess of energy, protein and other nutrients causes measurable adverse effects on tissue/body function and clinical outcome
What are the consequences of malnutrition?
- Loss of muscle tissue and strength
- Reduced immune response/ increased infection
- Poor wound healing
- Loss of mucosal integrity
- Psychological decline
What are the seven steps to end malnutrition in hospitals?
- Hospital staff must listen to older people
- All ward staff must become food aware
- Hospital staff must follow their own proffesional codes
- Older people must be assessed on admission and at regular intervals
- Introduce protected mealtimes
- Implement a red tray system and ensure that it works
- Use volunteers where appropriate
List 5 methods to improve or maintain nutritional intake
- Oral nutrition support
- Enteral tube feeding
- Parenteral nutrition
- Nutritional screening to identify malnourished patients
- Nutritional assessment for malnourished patients
How do you calculate BMI?
Weight (kg)/ Height^2 (m)
What should patients be asked to measure malnutrition?
Have you unintentionally lost weight recently?
Have you been eating less than normal?
What is your normal weight?
How tall are you?
List 3 eating disorders
Anorexia nervosa, bulimia nervosa, binge-eating
What are some symptoms of anorexia nervosa?
Dread of fatness Self starvation Refusal to maintain or achieve 85% normal body weight Dietary restriction Excessive exercise Induced vomitting Appetite suppressants Social withdrawal BMI <17.5 Metabolic change
What are some symptoms of bulimia nervosa?
Repeated bouts of overeating Preoccupation with body weight Purging Fasting Excessive exercise
What are the 4 psychological principles of eating disorders?
- Judge self worth exclusively in terms of shape, weight and their control
- Control of eating and shape is socially reinforced
- Individual vulnerability plus challenges of adolescence can start the disorder
- Thinness= competence, attractiveness, control
What are the treatments of anorexia?
- Stabilisation of eating, self-monitoring, weekly weighting
- Initial focus on enhancing motivation
- Behavioral change
- Cognitive reconstruction
- Relapse prevention
What are the treatments of bulimia?
- Education
- Stabilise eating patterns
- Strategies to manage urges to binge or purge
- Systematic introduction of avoided foods
- Problem-solving
- Reduction of body-checking
- Modification of beliefs
Generally is anorexia or bulimia easier to treat?
Bulimia
What is the definition of health?
State of complete physical, mental and social well-being and not merely the absence of disease or infirmity
What are ethics?
A system of moral principles and branch of philosophy which defines what is good for individuals and society
Name 5 branches of ethics?
Consequentialism Utilitarian Deontology Virtue Ethics Morality
What is consequentialism?
Concerned with the outcomes or consequences of behaviour; form the basis for any valid moral judgement
What is utilitarian ethics?
An act is evaluated solely in terms of its consequences, produce the greatest possible balance of value over disvalue, maximising well-being and minimize suffering
What is deontology?
A duty to follow natural laws and rights; rightness or wrongness from the character of the act itself rather than the outcomes, features of the act themselves determine worthiness e
What is virtue ethics?
Focus in on the character of the agent, integrates reason and emotion; deemphasizes rules, consequences and particular acts -contrast with consequentialisation
What is morality?
Concern about the distinction between good and evil or right and wrong
What are the five focal virtues?
Compassion Discernment Trustworthiness Integrity Conscientiousness
What are the four principles?
- Autonomy
- Beneficence
- Non-maleficence
- Justice
What is distrubive justice?
Fair distribution of scarce resources
What is right based justice?
Respect for people’s rights
What is legal justice?
Respect for the law
What is an autonomous action?
- Intentional
- Done with understanding
- Done without controlling influences that determine an individual’s actions
Where are some areas where ethics conflict with law?
Euthanasia, suicide, abortion, assault etc
What are the millennium development goals?
- Eradicate Extreme Poverty & Hunger
- Achieve Universal Primary Education
- Promote Gender Equality & Empower Women
- Reduce Child Mortality
- Improve Maternal Health
- Combat HIV/AIDS, Malaria and Other Diseases
- Ensure Environmental Sustainability
- Develop a Global Partnership for Development
What are some recommendations to reduce inequality?
- Improve daily living conditions
- Tackle the inequitable distribution of power, money and resources
- Measure and understand the problem and assess the results of action
What are 4 ways of functionally assessing older people?
- ADL
- IADL
- Barthel ADL index
- MMSE
What is an R number?
The average number of secondary cases generated by a primary case
What is the disability paradox?
People with profound disability report a high quality of life as expectations adjust to current conditions
What public health interventions can prevent influenza?
- High washing
- Respiratory hygiene “Catch it, Bin it, Kill it”
- Reduce social contact
What wide interventions can prevent influenza?
- Travel restritions
- Restrictions of mass public gatherings
- Schools closure
- Voluntary home isolation of cases
- Voluntary quarantine of contacts of known cases
- Screening of people entering UK ports
What are the phases of managing infectious threat?
- Infection of new threat
- Containment phase- Reduce spread, isolate cases
- Management phase- manage cases, reduce severity, protect those most vulnerable
How is clostridium difficile identified?
S- Suspect C diff as a cause of diarrhoea I- Isolate the case G- Gloves and aprons must be worn H- Hand washing T- Test stool for toxin
How is clostridium difficile treated?
Metronidazole/ Vancomycin
How is diarrhoea controlled?
Handwashing with soap Ensure availability of safe drinking water Safe disposal of human waste Breastfeeding of infants & young children Safe handling and processing of food Control of flies/vectors Case management including exclusion Vaccination
What are the at risk groups for diarrhoea?
A- Persons of doubtful personal hygiene or with unsatisfactory hygiene facilities
B- Children who attend pre-school or nursery
C- People whos work involves preparing or serving unwrapped/uncooked food
D- HCW/ Social care staff working with vulnerable people
What is epidemiology prevalence?
The proportion of a population that have the disease at a point in time
How do you calculate prevalence?
Incidence x avg. duration
What is an ecological study?
Population based data rather than individual data
What is a case-control study?
Looks at people with a disease and compares with a control
What is a cohort study?
Incidence study, follow a group of people over a period in time
What is an intervention study?
Do something and compare to none intervention
What is confounding?
When the effect of an intervention is distorted because of the association with other factor that influences the outcome
What is bias?
Systemic disposition of certain trial designs to produce results consistently better or worse than other trial designs
Name some pandemics
Cholera, Spanish flu, SARS, Covid19
What is the RAAMbo method for critical appraisal?
R – Representative?
A – Allocated or Adjusted?
A – Accounted for?
Mbo –Measurement blind or objective?
Describe the chain of infection
Reservoir Portal of exit Mode of transmission Portal of entry Susceptible host Pathogen
Describe the increase in infection group
Sporadic Cluster Outbreak Epidemic Pandemic Endemic
Name some public health countermeasures in pandemics
Hygiene Social distancing Isolation PPE Treatment as prevention Chemoprophylaxis Vaccination
What are the three groups of causes for gender differences in health?
Biological, social roles, structural factors
List three reasons as to why men may have a lower life expectancy
- Risk behaviours
- Reluctance to seek help when ill
- More dangerous employment conditions
What is adherence?
The patient-centred approach to encourage patients to work with healthcare professionals to get the best possible outcome.
Give some examples of non adherence
- Not taking prescribed medication
- Taken more or less than prescribe
- Stopping taking medication before finishing the course
- Continuing with behaviours against medical advise
List some unintentional reasons for non adherence
Difficulty understanding instructions
Problems using treatment
Inability to pay
Forgetting
List some intentional reasons for non adherence
Patients belief about their health/ conditions
Beliefs about treatments
Personal preferences
What are necessity beliefs?
Perceptions of personal need for treatment
List some notifiable diseases
- Covid-19
- Measles, mumps, rubella
- Malaria
- Leprosy
- Food poisoning
- Meningitis
- Acute infectious hepatitis
What is is a notifiable disease
Diseases notifiable to local authority proper officers under the Health Protection
