Public health and PPS Flashcards
Define good musculoskeletal health
Healthy/disease-free muscles, joints, and bones, with the ability to carry out a wide range of physical activities/functions both effectively and symptom free
What are the primary, secondary, and tertiary preventions in musculoskeletal health?
Primary prevention = reduce the prevalence of risk factors (physical activity, nutrition through life course)
Secondary prevention = screening (specific conditions e.g. congenital hip dislocation)
Tertiary prevention = management of conditions to reduce impact (e.g. back pain, joint pain, minor injuries)
What is the prevalence of MSK conditions in England?
30%
What are the modifiable risk factors of MSK conditions?
Vitamin D/calcium deficiency
Obesity
Physical activity
Injury prevention
How is physical activity used in MSK health?
Self-directed: needing accessible community facilities (e.g. parks, cycle paths, gyms, swimming pools)
Supervised physical activity: run by fitness professionals (e.g. walking clubs, aqua aerobics, dance clubs)
Structures community rehabilitation programmes: run by physiotherapist more condition specific (e.g. ESCAPE-pain)
Individualised support: covered by sports/exercise medicine and physiotherapy
Define frailty
Loss of individual resilience that affects the rate and extent of recovery following an injury, illness, or other physical, emotional, or psychological trauma
What things are required for consent?
Consent must be…
- voluntary
- informed
- mad by someone with capacity
You must tell people…
- what
- how
- risk
- benefits
- alternatives
Why is informed consent important?
Properly informed consent helps to prevent a negligence claim being brought
What things mean that a patient is unable to make a decision?
A patient is unable to make a decision if they cannot…
- understand the relevant information
- retain it
- use or weight it to make a decision
- communicate the decision
What should be done if the patient is not capable of making a decision for themselves?
Check whether there is someone who can make a decision on their behalf
Act in the patients best interests, taking into account…
- whether the patient may soon regain capacity
- patient’s past and present wishes
- patients’ beliefs and values
- consultation with anyone applicable
What is the recommended level of alcohol to keep the associated harm risks low?
> 14 units per week
Spread evenly over 3+ days
Have several alcohol-free days each week
How are the number of units in an alcoholic drink calculated?
(%ABV x volume in ml)/1000
What is substance misuse?
Continued misuse of a substances (e.g. alcohol, drugs) despite persistent or recurrent social or interpersonal problems
May be physically hazardous e.g. driving or operating machinery
Results in failure to fulfil role obligations e.g. work, school, home life
Define dependence
A state in which an organism functions normally only in the presence of a drug, manifesting as a physical (e.g. stomach cramps, muscle aches) or psychological (e.g. feelings of fear, pain, shame, guilt, loneliness) disturbances when the drug is withdrawn
Define tolerance
A state in which an organism no longer responds to a drug, and when a higher dose is required to achieve the same effect
What are withdrawal symptoms treated with?
Benzodiazepines (e.g. diazepam)
List the types of substances, some examples, and their effects
Opiates e.g. heroin, morphine: euphoria, pain relief
Depressants e.g. alcohol, benzodiazepines: sedation, relaxation, slow down thinking
Stimulants e.g. caffeine, nicotine, cocaine: increased alertness, activity and mood
Hallucinogens e.g. ecstasy, ketamine, mushrooms: alter sensory perception and thinking
What are the risk factors for developing substance misuse?
Family:
- family history of substance misuse
- management problems (e.g. poor parenting)
- family conflict/domestic abuse
- being in care
School/community:
- low academic attainment and commitment
- availability of drugs
- community norms favourable to drug use
- community disorganisation
Individual:
- risk taking/rebelliousness
- friends who use drugs
- experience of trauma e.g. abuse, loss, poor parenting
What are the local provisions for substance misuse?
GPs
Harm reduction services e.g. needle exchange, advice
Open access service
Structured psychosocial interventions
Prescribing services
Detox
Access to residential rehab
Recovery support
Describe the primary and secondary prevention of alcohol misuse
Primary prevention:
- ‘know your limits’ binge drinking campaign
- drinkaware alcohol labelling
- ‘THINK!’ drunk driving campaign
- restriction on alcohol advertising by Ofcom
- TV ad campaigns
- minimum pricing
Secondary prevention:
- exploring alcohol consumption with patients e.g. routinely asking, screening questions, detect problem drinking
- screening tools: FAST, ADUIT, CAGE
Describe the primary, secondary, and tertiary prevention of STIs
Primary: (reducing risk)
- awareness campaigns
- vaccination (e.g. HBV, HPV)
- pre/post exposure prophylaxis
Secondary: (find/treat undetected cases early)
- easy access to STI tests/treatments
- partner notification (contact tracing)
- targeted screening (e.g. antenatal screening for HIV and syphilis, national chlamydia screening programme)
Tertiary prevention: (reducing morbidity/mortality)
- antiretrovirals for HIV
- prophylactic antibiotics for PCP
- acyclovir for suppression of genital herpes
Describe the population approach to C. diff
SIGHT:
Suspect C. diff as a cause of diarrhoea
Isolate the cause
Gloves and apron
Hand washing
Test stool for toxin
List some interventions for obesity
Wider level e.g. change4life, 5-a-day
Environment e.g. more cycle paths, less car parking
Public policy e.g. sugar tax, minimum alcohol pricing
Define compliance
The extent to which the patient’s behaviour coincides with medical or health advice
What are some disadvantages to the theory of compliance?
It is passive: the patient MUST follow the doctor’s orders
It assumes the doctor knows best
It ignores problems patients have in managing their health
Define adherence
The extent to which the patient’s actions match agreed recommendations (more patient centred)
What are the key principles of how adherence is achieved?
Improve communication
Increase patient involvement
Understand the patient’s perspective
Provide and discuss information
Review medicines
Define concordance
Expectation that patients will take part in treatment decisions and have a say in the
consultation, it is a negotiation between equals
What are some barriers to good communication?
Language barriers
Deafness / blindness
Medical jargon
What factors may affect a patients compliance/adherence?
Socioeconomic e.g. long distance from treatment setting
Health system e.g. supply of medication
Condition e.g. memory impairment
Therapy e.g. complex treatment regimes
Patient e.g. disbelief / denial of diagnosis
In what circumstances can confidentiality be broken?
They are a risk to the public e.g. intend to commit a crime
If they have given consent
If it is required by law e.g. notifiable disease, ordered by a judge
What are the 9 protected characteristics listed in the equality act?
Age
Disability
Gender reassignment
Marriage and civil partnership
Pregnancy and maternity
Race (including colour, nationality, ethnic or national origin)
Religion or belief
Sex
Sexual orientation
