Public health Flashcards
What are causes of causes of obesity?
isolation lack o social support, poor social networks, poor self-esteem, low perceived power
What are the main policies for alcohol prevention of harm?
MMake alcohol less affordable, reduce availability, marketing limiting exposure especially to younger people
licensing events, resources for age checks, screening in young groups, brief interventions traiining, screening adults extended brief interventions motivational interviewing
What is primary prevention in the UK?
know your limits binge drinking campaign, awareness of risks drinkaware labelling, changes to advertising
What is minimum unit pricing?
Making it a specific cost for each unit to limit affordability. Supposed to help target the most heavy drinkers
What secondary prevention is recomended?
Ask about it routinely, especially in routine examinations, in ED in prescribing medications heavy drinking backgroun when they are having potentially alcohol induced health problems
What is at risk drinking?
Hazardous drinking cn be bringing physical or psychological harm
What is alcohol abuse drinking?
Likely to case physical or psychological harm
What is alcohol dependence?
when experience side effects it gets in the way of doing your daily activities.
What is FAST screening?
Heavy drinking days adverse consequences from drinking. unable to remember wat hapenned, others talked about cutting down
What are alcohol dependence treatments?
CBT, social support groups, drugs that make you feel hungover as soon as you drink
Why are linear regressions useful?
Model for risk prediction of a clinical outcome, estimate the risk of future outcomes, in individuals based on diferent combinations of clinical and non-clinical characteristics. classify indiciduals as likely to experience an outcome or not and develop prediction rules to direct further diagnostic evaluations
Why are regresssions performed?
To isolate a clinical outcome from other confounding factors
Why might linear regression not be suitable?
some outcoms are binary
What is used in logistic regression?
Odds ratios but have to Ln them to get a linear scale
How are Odds ratio coefficients calculated?
not in a linear fashion like risk ratio
What shows that it is significant in logistic regression?
If it doesn’t include 1
When is survival analysis used?
The time it takes for death and when not all individuals in the study die
What is censoring in survival analysis?
It happens when the data doesnt continue for that person
Why might a person be censored in a study?
They might not die before the end of the study, they might leave the area and lost to follow up, die from other cause, or reuse to be observed or even die before study starts
What is a Kaplan-Meier graphs?
Shows comparable survival ratio over time
What is on a Kaplan-Meier graph?
Time on X survival probablility Y axis, survival curves for two or more groups, start at 1, vertical lines when censoring happens Numbers underneath showing who is left in the study and median survival line shades area showing CI of that point of data
What is the p value for in Kaplan-Meier graph?
testing the difference between the two survival curves, it is a log-rank test
What is Cox regression?
It is regression for survival analysis, it handles the confounders in the study better than log-Rank test
What are other regression for survival analysis?
Weibull and Exponential they make assumptions about pattern of risk
What is Hazard?
Similar to risk
What is the the assumption made in Cox regression?
that the Hazard risk is the same throughout the study
What is relationship between hazard ratio and factors?
Multiplicative
What are ANCA?
Anti neutrophilic cytoplasm antibodies IgG. They are against the monocytes and neutrophils.
What are ANCA associated?
small vessel Vasculidities IBD Goodpastures syndrome
What is the pathophysiology of ANCA?
When monocytes and neutrophils are activated they allow the ANCA antibodies which activate the neutrophils releasing reactive oxygen species so they cause vessel damage
What is c-ANCA vs p-ANCA?
c-ANCA detects granulomatosis with polyangiitis others are for different ones
What is rheumatoid factor?
It is an antibody in the serum that is against an antibody. Auto-antibody usually IgM against Fc portion of IgG forming a complex causing inflammation
How sensitive and specific is RF?
80% sensitive vs 75% specific so it is good for ruling out RA
What oher diseases can RF beraised?
SLE, SJorgren, Interstitial pulomary fibrosis, Hep B, Infectious mononucleosis, TB Haematological malliganancies. Infective endocarditis
What is seronegative arthritis?
Inflammatory arthrisis that has negative RF, this inclused Psoriatic arthritis, Ankylosing Spondylitis, IBDassociated arthritisandreactive arthritis
What typeof hypersensitivityreaction is inflammation caused by rheumatoid factor?
Type 3
Where does synovial fluid come from?
The plasma,
What is the consistency of synovial fluid in RA?
Lower than more swelling so more dilute fluid
What usually causes monoarthritis?
Gout osteoarthritis septic arthritis lyme’s disease and trauma
What can usually cuae oligoarthritis?
Psoriatic arthritis enteropathicarthritisand reactive arthritis
What can often cause polyarthrits?
RA and SLE
Which arthritises can affect the DIP?
OA and Psoriatic arthrits
Which canaffect the metacarpal phallangeal joints?
RA, SLE, CPPD pseudogout
Which can affect the 1st metatarsal joint?
OA and Gout
Which types are arthrits can be acute?
Sponduloarthrits, crystaline arthritis, septic arthrits, acute rheumatic fever,
Which arthridities are symetric?
RA, SLE, Psoriatic arthrits, scleroderma MCTD and viral
Which arthridities are symetric?
RA, SLE, Psoriatic arthrits, scleroderma MCTD and viral
What can be seen on arthritis X-ray?
Jointspace narrowing , bone erosions, hypertrophic changes, periostitis and chondrocalcinocis
Whatare the signs of OA?
No signs of inflammation, no constitutional symptoms, joint pain worsens with use asymmetric, no elevated CRP ESR,
Which jonts are affected very often in OA?
weight bearing joints like hip and knees
What can increase risk of OA?
Trauma, obesity chronic insidious disease, manual labour
What are main symptoms of rheumatoid arthritis?
inflammation of joints, fever weight loss night sweats, joint pain improves with use, symetrical involvment elevated ESR and or CRP
What is Baker cyst?
At the back the nee can rupture and looks like DVT as obstructs the veins
What does DMARD mean?
Disease modifying anti rheumatic drugs
Which risks should be mentioned?
The most common and life threataing
What information is needed for informed consent?
Details risks benefits and alternatives and risks of refusing
What are steps for assesing capacity?
Understand, retain weigh and communicate their decision about the decision
What is in the mental capacity act?
Presume capacity unless it is established otherwise. if no capacity all decisions are made with best interest
What can reduce capacity for consent?
Learning disiblit, dementia mental illness and impaired capacity
What happens when they dont have capacity?
Lasting power of attorney or advanced directive, a healthcare professional can act in their best interests, always involve the pateint as much as is possible
What is important in urgent patient without capacity?
do lifesaving treatment usually unless some orders
What is an independent mental capacity advocate?
They act as a friend or relative of a patient to help them make a decision
When is court or Judge involved in consent?
If very serious or complex decision or conflict between healthcare team and patient views/relatives eg sterilisation, withdrawal of nutrition and hydration from a person in a vegitative state
What shoule you do when acting in best interest of the patient?
Would the patient regain capacity?, past and present wishes and feelings, what are the pateint’s beliefs and values that would be likely to influence the decision other factors they might consider, consultation with people interested in their welfare
What is Gillick competence?
When a child can make a decision themyself and have capacity they can make their own decision on their treatment
What can parents allowed to consent for with children?
They can give treatment but cannot refuse it if it is in their best interests
Where do respiratory viruses affect?
some upper only some sinuses some lower tract
What virus causes common cold?
Rhinoviruses and coronoviruses
What cause sore throats?
Adenovirus(can be GI), Epstein-Barr virus
What is laryngo-tracheobronchitis?
Croup parainfluenza viruses
what is RSV?
respiratory syncitial virus
What are most pneumonias caused like?
2/3rds are viral
What are Haemagglutinin and neuraminidase?
They are proteins on the cell that help them into the cell they are used to type influenza A viruses H and N
Where are flue viruses from?
Mainly birds and some in mamals like pigs and horses
What is antigenic drift?
the viral mutation slightly allowing it to evade the immune system
How is influenza spread?
Droplets some aerosol,
What would flu pandemic look like?
short incubation infection from symptoms some before hand could be 2-4 weeks frm firstcase could have first waves, could affect different ages,
What is the use of medications in flu?
Reduce risk of transmission to others? reduce severity and duration of symptoms?
Which neurological disease cause problems in the older age group?
Strokes and dementia
What affects migraines (risk factors)?
age female sex hormones family history education, income and socio-economic status
What can you do to prevent stroke?
TertiaryMDT stroke rehab units. Secondary prevention screening for risk factors mostly from hypertension 75% Primary prevention smoking alcohol diet and physical activity
What are causing dementia?
genetic, multi infarct or multifactorial Alzheimer’s
How is Parkinson’s diagnosed?
Tremor, rigidity, akinesia
What neurological disease is protected from smoking?
Parkinsons incidence is reduced in it
How is MS diagnosed?
MS lesions on the scan, but can also be on symptoms
What is cerebral palsy?
Brain damage in utero that causes non-progressive brain damage before or during neo-natal period
What is variant Creutzfeild Jacob disease?
different to dementia causing creutzfeild Jacob disease
