public health COPY Flashcards
1
Q
what are the 7 main duties of a doctor?
A
- 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.
2
Q
what are the psychosocial factors that increase CHD risk?
A
- 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
3
Q
what can doctors do for those with CHD risk?
A
Identify depression/anxiety Ask about occupation Liaise with social support services Vascular screening Risk reduction through promoting healthier lifestyles QRISK2 score
4
Q
what is the Bradford Hill criteria?
A
A group of minimal conditions necessary to provide adequate evidence of a causal relationship
5
Q
Give 6 of the Bradford Hill criteria that provide evidence for causation
A
Strength of association Consistency in association Exposure- response relationship Specificity Temporal relationship Coherence of evidence Biologically plausible
6
Q
what are the benefits of alcohol consumption?
A
- Mildly euphoriant for many
- Socialization
- Cardioprotective in low doses
7
Q
what are the psychosocial effects of excessive alcohol consumption?
A
1. Interpersonal relationship problems (violence, rape, depression or anxiety) 2. Criminality/violence 3. Problems at work/unemployment 4. Social disintegration (poverty) 5. Driving offences
8
Q
what are the symptoms of alcohol withdrawal?
A
- Tremulouness: ‘the shakes’
- Activation syndrome: tremulouness, agitation, rapid
heart beat, high bp - Seizures
- Hallucinations
- Delirium tremens
9
Q
What is the maximum units of alcohol that men and women can consume within a week?
A
14 units
Spread over >3 days
10
Q
Write an equation that can be used to work out the number of units in a drink
A
Strength of the drink (%abv) X amount of drink (ml) / 1000
11
Q
How would you define binge drinking?
A
Drinking >6 units of alcohol in one go
12
Q
Give 4 signs of foetal alcohol syndrome
A
- Pre and post natal growth retardation
- Mental retardation
- Craniofacial abnormalities
- congenital defects (e.g. eyes, ear, mouth)
13
Q
How long does alcohol withdrawal last?
A
Occurs 6-24 hours after last drink and can last up to a week
14
Q
What is delirium tremens?
A
Most sever form of alcohol withdrawal
Occurs 24-72 hours after stopping
Hyper-adrenergic state, disorientation, tremors, diaphoresis, impaired attention, hallucinations
15
Q
Name 3 public health campaigns associate with reducing alcohol intake
A
- ‘Know your limits’ - binge drinking
- Drinkaware - alcohol labelling
- THINK! - drink drive campaign
16
Q
what are the secondary preventions of alcoholism?
A
Ask about it routinely using screening questions/tools
Detect problem drinking (including laboratory tests)
17
Q
what can doctors do for alcoholics?
A
-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
18
Q
What are the 4 questions that make up CAGE?
A
- Have you ever felt that you should cut down?
- Have you ever felt annoyed by people telling you to cut down?
- Do you feel guilty about how much you drink?
- Eye opener - ever had a drink first thing in the morning?
19
Q
What questions might you ask to determine whether someone has alcohol dependence?
A
3 or more in the last 12 months
- 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
20
Q
what are the signs of alcohol abuse?
A
- Role failure
- Relationship problems
- Run-ins with law
- Risk of bodily harm
21
Q
how could the FRAMES motivational interviewing be used with alcoholism?
A
- Feedback - risk of personal harm or impairment
- Stress personal Responsibility for making change
- Advice - cut down/ stop drinking
- Provide a Menu of alternative strategies for changing
drinking patterns - Empathetic interviewing style
- Self-efficacy: leaves patient enhanced in feeling able to
cope with goals they have agreed
22
Q
Define at risk drinking
A
A pattern of drinking which brings about the risk of harm
23
Q
Define alcohol abuse
A
A pattern of drinking which is likely to cause harm
24
Q
Define alcohol dependence
A
A set of behavioural, cognitive and physiological responses the can develop after repeated substance abuse
25
what are the treatments for alcoholism?
1. Naltrexone: competitive antagonist for opioid receptors,
rapid detox
2. Disulfiram: produces sensitivity to alcohol - worst
hangover
3. Acamprosate: stabilises chemical balance
4. Behavioural therapy
5. Social support - Alcoholics Anonymous
26
why do people smoke?
```
Fear of weight gain on cessation
Coping with stress
Socialising
Nicotine addiction
Habit/behavioural
```
27
what are the stages of stopping smoking?
1. Ready: mentally prep yourself, understand process
2. Steady: throw away ashtray, lighter, set quit date
3. Stop: reward yourself for not smoking, avoid triggers
28
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)
```
29
what are the stages of change model for smoking?
1. Precontemplation: smoker, not thinking about quitting
2. Contemplation: smoker, thinking about quitting but not
ready yet
3. Preparation: smoker, thinking about quitting and taking
steps to prepare for quitting
4. Action: ex-smoker, quit for <6months
5. Maintenance: non-smoker, quit for > 6 months
6. Relapse: quit smoking then had a lapse (1cig) that led to
smoking being resumed
30
what are the different types of stress?
Eustress (good) vs. distress (bad)
Behavioural – increased alcohol, poor sleep, absenteeism
(not going to lectures)
Cognitive – poor concentration, negative thoughts
Physiological – headaches
Emotional – mood swings, feeling tearful, irritable
Biochemical – endorphin levels altered
31
give 4 examples of NHS screening programmes
Breast screening - 50-70 every 3 years, mammo
Bowel cancer screening - 60-74 every 2 years, faecal
occult blood
Cervical screening - 25’s< 3 years, 50-64 every 5 years,
cervical smear liquid based cytology
AAA - 65
32
What are the Wilson and juggler screening criteria?
1. important problem
2. acceptable treatment
3. recognised early stage
4. diagnosis/treatment are available
5. suitable test
6. acceptable to the population
7. natural history known
8. Case finding should be a continuous process
9. Early treatment should make a difference to prognosis
10. low cost
33
what is sensitivity?
measure of how well a test picks up those with the disease
34
what is specificity?
measure of how well a test recognises those without the disease
35
what is prevalence?
measure of how common a disease or condition is in a defined population at a particular point in
time
36
what questions are used for occupational screening?
1. What type of work do you do?
2. Do you think your health problems might be related to
your work?
3. Are your symptoms different at work and at home?
4. Exposed to chemicals, dusts, mentals, radiation, noise or
repetitive work? In the past?
5. Are any of your co-workers experiencing similar
symptoms?
37
What are Marmot's 10 key components of 'good work'?
1. Precariousness – stable, risk of loss, safe
2. Individual control – part of decision making
3. Work demands – quality and quantity
4. Fair employment – earnings and security from employer
5. Opportunities – training, promotion, health, growth
6. Prevents social isolation, discrimination & violence
7. Share information – participate in decision-making
8. Work/life balance
9. Reintegrates sick or disabled whenever possible
10. Promotes health and wellbeing – psychological needs
38
What is the primary prevention population approaches to occupational health?
Monitor risk
Control hazards
Promotion
39
What is the secondary prevention population approaches to occupational health?
Screening
Early detection
Tast modification
40
What is the tertiary prevention population approaches to occupational health?
Rehabilitation
| Support
41
What is a GPs role in occupational health?
- Sickness certificate
| - Will the patient benefit from a phased return or altered hours
42
Name 3 occupational diseases
1. Asbestosis
2. Silicosis
3. Coalminers pneumoconiosis
4. Mesothelioma
43
What are the most common work related ill health disorders?
1. Occupational stress
2. work related MSK disorders
3. Occupational lung disease
4. Occupational cancer
44
Define substance use
Ingestion of a substance affecting the CNS which leads to behavioural and psychological changes
45
How do new psychoactive substances act?
Mimic the effects of other substances but less predictably
| E.g. Synthetic cannabinoids, stimulant-type drugs
46
What is the prevention theory?
Prevent substance abuse by reducing risk factors and increasing protective factors throughout life
47
Give 3 ways to prevent substance misuse
1. Good family attachment
2. Academic achievement
3. Opportunities to develop self confidence, self worth and resilience
48
Give 4 risk factors for substance misuse
1. Family history of substance misuse
2. Family management problems e.g. poor parenting
3. Family conflict e.g. domestic abuse
4. Low academic attainment at school
5. Availability of drugs in the community
6. Peer pressure
7. Experience of trauma e.g. abuse, loss, poor parenting
49
what is addiction?
Physical + Psychological dependence
50
what is the diagnostic criteria for substanc emisuse?
Acute intoxication, harmful use, dependence
51
what are the different tiers for UK drug treatment?
Tier 1: non-specialist, generic
-substitution treatment: wean patient off drug
Tier 2: open-access services
Tier 3: specialist community-based drug services
Tier 4: specialist inpatient services
-detoxification -> Naltrexone (opioid antagonist)
-residential rehabilitation
52
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
53
what are the consequences of malnutrition?
1. Loss of muscle tissue & strength
-respiratory muscles (chest infection)
-cardiac function (heart failure)
-mobility
2. Reduced immune response/increased infections
3. Poor wound healing
4. Loss of mucosal integrity (malabsorption/bacterial
translocation)
5. Psychological decline – depression, apathy
54
what are the 7 steps to end malnutrition in hospitals?
1. Hospital staff must listen to older people, their relatives and carers and act on what they say
2. All ward staff must become ‘food aware’
3. Hospital staff must follow their own professional code + guidance from other bodies
4. Older people must be assessed for signs or danger of malnourishment on admission + at regular intervals during their stay
5. Introduce ‘protected mealtimes’
6. Implement a ‘red tray’ system + ensure that it works in practice
7. Use volunteers where appropriate
55
what methods can be used to improve or maintain nutritional intake?
1. Oral nutrition support – food, fortified, sip feeds
2. Enteral tube feeding – delivery of a nutritionally
complete feed directly into the gut via a tube
3. Parenteral nutrition – delivery of complete nutrition IV
56
what is the purpose of nutritional screening?
To identify malnourished patients by medical & nursing staff.
57
what is the purpose of nutritional assessments?
To fully assess, monitor & support malnourished patients by dieticians + nutrition nurses
58
what is the equation for BMI?
BMI = Weight (kg) / Height2 (m)
59
what is the normal BMI?
18.5-24.9
60
what BMI is classed as overweight?
25-29.9
61
what BMI is classed as obese?
```
30-34.9 = obese class I
35-39.9 = obese class II
40-49.9 = morbidly obese class III
>50 = super obese class IV
```
62
what is the malnutrition universal assessment tool?
```
1. Body Mass Index (BMI)
>20 = 0 / 18.5 – 20 = 1 / <18.5 = 2
2. Unexplained Weight Loss in past 3-6months
<5% = 0 / 5-10% = 1 / >10% = 2
3. Assess acute disease & score
If patient is acutely ill + there has been or is likely to be no
nutritional intake for >5days = 2
4. Add scores together
```
63
what do the malnutrition universal assessment tool scores mean?
```
0 = Low risk = routine clinical care (repeat screening)
1 = Medium risk = observe (document diet intake)
>2 = High risk = treat (refer to dietician)
```
64
what questions should you ask patients about malnutrition?
1. Have you unintentionally lost weight recently?
2. Have you been eating less than normal?
3. What is your normal weight?
4. How tall are you?
All patients should be weighed and have their height measured
65
What is anorexia nervosa?
A restriction of energy intake relative to requirement leading to low body weight
Person has an intense fear of gaining weight
66
What BMI indicates that someone might be suffering from anorexia nervosa?
BMI < 17.5
67
Name 2 sub types of anorexia nervosa
1. Restricting
| 2. Binge-eating and purging
68
Give the 2 characteristic features of bulimia nervosa
1. Recurrent episodes of eating large amount in discrete periods of time
2. Inappropriate compensatory behaviour to prevent weight gain - purging
69
What is binge eating?
1. Rapid eating
2. Eating until uncomfortably full
3. Eating large amounts of food when not hungry
4. Eating alone due to embarrassment
5. Feeling depressed or guilty afterwards
70
What is important to look out for when assessing someone who you suspect has an eating disorder?
```
Severe resection of food/fluid
Electrolyte imbalance - particularly K+
Bone deterioration
Physical damage (blood in vomit)
Alcohol/drug intake
```
71
What are the urgent signs when assessing someone who may have an eating disorder?
```
Muscular weakness
Breathing problems
Cardiac signs
Rapid weight loss
Risk behaviours
```
72
What do the NICE guidelines say is the first line treatment for anorexia nervosa?
Family therapy for adolescent cases
| CBT
73
What do the NICE guidelines say is the first line treatment for bulimia nervosa and binge eating?
CBT
74
what are eating disorders?
- set of beliefs about importance of weight & size as index of personal worth
- lead to stereotyped behaviours to manipulate food intake & energy expenditure
- disrupt normal physiology; predictable & profound effects on health & functioning
- problems maintaining positive self-image, perfectionism, seeking control & ‘ideal’ body, difficulties to early attachment, once established, powerfully addictive
75
what are the psychological principles of eating disorders?
1. Judge self-worth exclusively in terms of shape, weight and their control
2. Control of eating and shape is socially re-inforced and apparently more controllable than other aspects of life
3. Individual vulnerability plus challenges of
adolescence can start the disorder
4. Thinness= competence, attractiveness, control,
independence
76
what is the treatment approach for anorexia nervosa?
1. Stabilisation of eating, self-monitoring, weekly
weighting (not self weighting)
2. Initial focus on enhancing motivation
3. Behaviour change: weight re-gain is essential
4. Cognitive restructuring: testing dysfunctional attitudes on weight pain, loss of control, etc
5. Relapse prevention
77
what is the treatment approach for bulimia nervosa?
1. Education
2. Stabilise eating patterns
3. Strategies to manage urges to binge or purge
4. Systematic introduction of avoided foods
5. Problem-solving
6. Reduction of body checking
7. Modification of beliefs
78
what is the difficulty in treating eating disorders, particularly anorexia?
- People with anorexia are less likely to want treatment and are unlikely to persevere with efforts to change
- Higher mortality rate
79
What is the WHO definition of health?
State of complete physical, mental and social well-being and not merely the absence of disease or infirmary
80
what is the definition of ethics?
system of moral principles and branch of philosophy which defines what is good for individuals and
society
81
What are the 4 principles of medical ethics?
1. Autonomy - respect the patient's choices
2. Beneficence - do good
3. Non-maleficence - do no harm
4. Justice
82
What is deontology?
Features of the act determines worthiness
Teaches that acts are right to wrong, people have a duty to act accordingly
Do unto others as you would be done by
83
What are the challenges of deontology?
1. Consequences aren't taken into account
| 2. Duties can conflict
84
What are virtue ethics?
Focus on character of the person acting
Combines reason and emotion
An act is only virtuous if the person has the right mind set
Virtues are acquired
85
What are the 5 focal virtues?
1. Discernment - the ability to judge well
2. Conscientiousness - Being thorough, carful and vigilant
3. Trustworthiness - be relied on and trusted
4. Integrity - honest and having good moral principles
5. Compassion - Showing concern for others
86
What are the challenges of virtue ethics?
1. Culture specific and too broad for practical application
| 2. No clear guidance for moral dilemmas
87
What are utilitarian ethics?
An act is evaluated solely in terms of its consequences
| Maximise good, minimise harm
88
What are the challenges of utilitarian ethics?
Treats minorities unfairly to promote the happiness of a majority
89
what is consequentialism?
concerned with the outcomes or consequences of behaviour; form the basis for any valid moral judgement
90
what is the definition of morality?
concern about the distinction between good and evil or right and wrong
91
what is autonomy?
self rule or self governance; obligation to respect the decision making capacities of autonomous person, subsumes informed consent before treatment,
confidentiality, honesty (lack of deceit) and good
communication
92
what is beneficence?
doing the right thing for patients; provide benefit to others, better off than before, also incorporates empowerment; helping the patient to make appropriate
decisions for themselves
93
what is non-maleficence?
do no harm intentionally or
| inadvertently where ever possible; means evidence based practice and keeping up to date
94
what is justice?
moral obligation to act on the basis of fair adjudication between competing claims; utility, need vs benefit
95
what is distributive justice?
fair distribution of scarce resources
96
what is right-based justice?
respect for people’s rights
97
what is legal justice?
respect for the law
98
what is an autonomous action?
1. Intentional
2. Done with understanding
3. Done without controlling influences that determine an individual’s actions.
99
what is the doctrine of dual effect?
1. nature of the act is itself good
2. agent intends the good effect and not the bad either as a means to the good or as an end itself
3. good effect outweighs the bad to justify causing the bad effect and the agent exercises due diligence to minimize the harm
100
when does medical ethics conflict with law?
1. Euthanasia Homicide
2. Gross Negligence Manslaughter
3. Suicide (pact, assisted)
4. Abortion (follow Act 1978 to the letter)
5. Assault
6. Theft
101
what is the principle of necessity?
If a patient is unable to give consent, you can only give the treatment necessary to preserve life and limb in an emergency
102
what are the 8 millennium development goals?
Goal 1: Eradicate Extreme Poverty & Hunger
Goal 2: Achieve Universal Primary Education
Goal 3: Promote Gender Equality & Empower Women
Goal 4: Reduce Child Mortality
Goal 5: Improve Maternal Health
Goal 6: Combat HIV/AIDS, Malaria and Other Diseases
Goal 7: Ensure Environmental Sustainability
Goal 8: Develop a Global Partnership for Development
103
what were the findings of the Black report into health inequalities?
1. Material: environmental causes, possibly mediated by behaviour
2. Artefact: apparent product of how it is measured
3. Cultural/behavioural: poorer people behave in unhealthy ways
4. Selection: sick people sink socially and economically
104
what were the recommendations of the black report to reduce inequality?
1. Improve daily living conditions
2. Tackle the inequitable distribution of power, money and resources: strong public sector needed
3. Measure and understand the problem and assess the results of action: need to high quality surveillance systems
105
what are the different functional assessments for older people?
1. Activities of Daily Living scale
- 6 capabilities graded on level of dependence
2. Instrumental Activities of Daily Living scale
- 7 capabilities graded on level of independence
3. The Barthel ADL index
- Based on 10 items that measure a person’s daily functioning
4. Mini Mental State Examination
- measures orientation, registration, short-term memory and language functioning
106
what is the disability paradox?
People with profound disability report a high QOL:
1. expectations adjust to current condition – there is a
response shift, challenged health status leads to re-
evaluation of what is important to life quality, lowered
expectations translates to higher satisfaction
107
what is the R number in epidemics?
reproduction number
R, defined as the average number of secondary cases
generated by a primary case -> identify the intensity of
interventions required to control an epidemic
108
what public health interventions can prevent the spread to influenza?
1. Hand washing
2. Respiratory hygiene: ‘Catch it, Bin it, Kill it’
3. Reduce social contact: not attending large gatherings
109
what wide interventions can help prevent the spread of influenza (and COVID)?
1. Travel restrictions
2. Restrictions of mass public gatherings
3. Schools closure
4. Voluntary home isolation of cases
5. Voluntary quarantine of contacts of known cases
5. Screening of people entering UK ports
110
what are the phases of managing infectious threats?
1. Identification of new threat
2. Containment Phase –few cases
-handwashing, isolation of cases, antivirals for reducing
spread, controlling ports, stopping groups etc
3. Management Phase: many cases, spreading freely in the
community
-vaccinate, ensure system able to provide best treatment possible given
111
what is the aim of the containment phase of managing infectious threats?
-aim: reduce spread while learning about disease and
| developing treatments/vaccine
112
what is the aim of the management phase of managing infectious threats?
manage cases, reduce severity and protect those most vulnerable to the infection
113
what is the process for suspecting c.diff infection?
```
S – Suspect C diff as a cause of diarrhoea
I – Isolate the case
G – Gloves and aprons must be worn
H – Hand washing with soap and water
T – Test stool for toxin
-Control antibiotic usage
-Treat: metronidazole/vancomycin
```
114
how is c.diff treated?
- Control antibiotic usage
| - Treat: metronidazole/vancomycin
115
What prevention techniques are used to prevent diarrhoea?
1. Rotavirus and measles vaccinations
2. Promote early & exclusive breastfeeding + vitamin A supplementation
3. Promote hand washing with soap
4. Improve water supply quantity & quality
5. Community-wide sanitation promotion
116
What is the treatment for diarrhoeal disease?
1. Fluid replacement
| 2. Zinc treatment
117
Give 4 control measure to prevent diarrhoea
1. Hand-washing with soap
2. Ensure availability of safe drinking water
3. Safe disposal of human waste
4. Breastfeeding of infants & young children
5. Safe handling and processing of food
6. Control of flies/vectors
7. Case management including exclusion
8. Vaccination
118
Name 4 at risk groups for diarrhoea
1. Poor hygiene groups
2. Children attending pre school/nursery
3. Workers involved in preparing and serving unwrapped/uncooked food
4. HCW working with vulnerable people
119
Name 4 notifiable infectious disease
1. Malaria
2. MMR
3. Meningitis
4. Cholera
5. Anthrax
6. TB
120
Name 3 types of transmission of infection
1. Direct
- direct
- face-oral
2. Indirect
- vector borne
- vehicle borne
3. Airbourne
- respiratory route
121
Describe the chain of infection
Reservoir --> portal of exit --> agent --> mode of transmission --> portal of entry --> host --> person to person spread --> reservoir
122
what is reflection?
It is a process of exploration & discovery
It is deliberate, intended & directed to a goal
It is total response to a situation or event
It includes thoughts, feelings & behaviours
It occurs at the time of an event or after it
123
what is prevalence?
proportion of a population that have the
disease at a point in time
= incidence x avg. duration
124
what is mortality?
incidence of death from a disease
125
what are ecological studies?
population based data rather than individual data
126
what are cross sectional studies?
prevalence study
127
what is a case-control study?
looks at people with a disease and
| compares with a control
128
what is a cohort study?
incidence study, follow a group of people over a
| period of time
129
what is an intervention study?
do something and compare to none intervention
130
what are the different types of randomisation in RCTs
simple, block, stratified
131
what is blinding?
participants, investigators and/or assesssors
| unaware of group allocation
132
what is confounding?
when the effect of an intervention is distorted
| because of the association with other factor that influences the outcome
133
what is bias?
systemic disposition of certain trial designs to
| produce results consistently better or worse than other trial designs
134
what are the problems with RCTs?
ethical issues, cost, attrition.
135
what is the CASP checklist for RCTs?
1. Did the study ask a clearly focussed question?
2. Was it an RCT, and appropriately so?
3. Were participants appropriately allocated to control
and intervention groups?
4. Were all persons blind to participants study group?
5. Were all participants accounted for?
6. Was there consistency between groups?
7. Did the study have enough participants?
8. How well are results presented, what is main result?
9. How precise are the results?
10. Were all important outcomes considered?
