Theme 2,3,4: Global heath, migrant and refugee health, culture and drug prescribing Flashcards
what are the leading causes of death worldwide?
cardiovascular disease cancers respiratory diseases lower respiratory diseases dementia
what are the differences in leading causes of mortality in developing and developed countries?
in developed countries non-communicable diseases are by far the leading cause of death
in developing countries non-communicable diseases (CVD) are still leading causes but they are closely followed by infectious diseases like TB, diarrhoeal disease, HIV/AIDS, malaria
what are the major determinants in the difference in mortality and morbidity in different parts of the world?
social determinants- poorest people suffer most from ill health and women suffer more than men
lower educational level, income or employment have all been lined to higher mortality and morbidity rates
life expectancy is significantly linked to how wealthy a country is
investment in healthcare, infrastructure, sanitation, education and nutrition all benefit a nations health
what improvements have impacted the progress in improving global health status?
overall economic development, improvements in public hygiene, access to clean water, sanitation, improved education and better nutritional status
what are the key governmental and non- governmental organisations seeking to improve global health?
the UN has branches such as the WHO, UNICEF (United Nations children fund), and UNAIDS to tackle health related issues. Medecins sans frontiers provides medical assistance to those affected by conflict, epidemics, disasters and exclusion from healthcare.
the international Red Cross is similar
what is the role of the WHO in monitoring, preventing and planing for infectious disease?
the WHO has a responsibility for monitoring public health risks that threaten the international community. WHO member states have the responsibility to share information with the WHO within 24hrs about potential disease outbreaks if they: are likely to have a serious PH impact, are unusual or unexpected, represent a risk of national spread or may require international travel/trade restrictions.
based on this information the WHO may declare a public heath emergency of international concern (PHEIC)
the WHO will have the task of preparing countries for poteintial spread, issuing guidance on health protection and disease management and co-oridnate research and management
how is COVID-19 diagnosed?
nasopharyngeal swabs- tested with reverse transcriptase polymerase chain reaction method (RT-PCR)
what is the pathogenesis of COVID-19?
SARS-CoV-2 has spike proteins which bind to ACE2 receptors (highly expressed on lung alveolar cells). the virus fuses with the host allowing RNA to enter the cell and highjack cellular machinery to produce new viral particles. when the virus enters the cell it triggers reactive oxygen species to be released leading to cell death. this causes inflammatory protein release which stimulate the release of cytokines. overactivation of the immune system leads to a cytokine storm which can lead to fluid accumulation in the lungs and lead to acute respiratory distress syndrome which can lead to respiratory failure. secondary bacterial infections can cause multi-organ dysfunction
how is severe COVID-19 treated?
oxygen, ventilatory support and circulation support
antibiotics- secondary bacterial infection
prone ventilation- lie patient on front
remdesivir- antiviral, could reduce duration of illness
dexamethasone- steroid, improves survival in severe COVID19, most likely decreases cytokine storm
convalescent plasma- ongoing studies
what are the psychological, social and economic impacts of pandemic infections?
physiological- morbidity, mortality, disruption of services, screening suspended, fear of infection- hospital avoidance, border closures- drug supply chains
psychological and social- loneliness and social isolation- depression, stigma (‘Chinese virus’), increased domestic violence
economic- workers becoming unwell/ having to isolate, reduced economic activity- restaurants, businesses closed, job losses, increased hinger and poverty
what is the impact of globalisation on infectious disease threat?
increased pace of urbanisation- poorly managed urban growth leading to overcrowding, poor housing, inadequate sanitation. urbanisation is also associated with increased mixing between groups and risk taking behaviour.
travel- allows groups with different susceptibilities to mix driving the evolution of pathogens
climate change- expands the geographic distribution of vector- borne diseases, extreme weather events - break down basic public health measures
deforestation- increased contact with animals- promotes zoonoses
what is the public health advice for travel in relation to communicable disease?
vaccinations/antimalarials/ mosquito bite prevention
be mindful of risky activities- outdoor at night, exposure to contaminated water, animal exposure
risky bahviour- tattoos, drug use, sexual activity
ensure accommodation with good hygiene, sanitation, access to clean water/food
travel insurance
what impact does the environment have on health?
air quality- pollutants can cause adverse health affects relating to the cardiorespiratory system, can also affect animals and crops
water quality- inadequate water can increase water associated infectious diseases
extreme weather events- direct harm (trauma, drowning, heatstroke), harm to infrastructure (homes, transport food/medical supplies, emergency service), event specific events (stagnant flood waters- vector reservoirs), worsen chronic health conditions, loss of habitable land, population displacement
what is the cultural iceberg model?
identifies that culture has both visible parts (surface culture) and invisible parts (deep culture)
surface culture- external behaviour- race, language, dress, etc.
deep culture- values and patterns of thought- ideas of gender, age, class, religion, relationships, marriage etc.
how can culture influence a patients perception of health and disease?
beliefs about what causes disease, perceptions of death, stigmatisation of certain conditions, engagement with health promotion, experience of illness/pain, perceptions of rehabilitation
