Week 13 - healthy and unhealthy communities Flashcards
1
Q
Where is malaria prevalent? (LO1)
A
Tropical regions:
- Africa and Asia.
- Central and South America.
- Dominican Republic and Haiti.
- Parts of the Middle East.
- Some pacific islands.
- NOT found in the UK and you cannot catch it from another person.
2
Q
Describe the basic epidemiology of malaria. (LO1)
A
- NOT found in the UK and you cannot catch it from another person.
- In 2020, estimates 241 million cases worldwide.
- Estimated number of malaria deaths in 2020: 627,000.
- Death rate: 54% if no preventative or other measures are taken beforehand.
- 95% of malaria cases and 96% of malaria deaths were located in Africa in 2020.
- Childern under 5 account for around 80% of all malaria deaths in Africa.
3
Q
List the at-risk groups for malaria. (LO1)
A
- Pregnancy.
- Young children.
- > 65s.
- Compromised immune system.
- Absent spleen.
4
Q
Describe the general presentation of malaria. (LO1)
A
Malaria is rarely seen in clinical practice.
- History of travel to endemic area.
- High temperature, sweats and chills.
- Headaches and feeling confused.
- Feeling very tired and sleepy (especially in children).
- Nausea, vomiting, stomach pain and diarrhoea.
- Loss of appetite.
- Muscle pains.
- Yellow skin or white of the eyes.
- Sore throat, cough and difficulty breathing.
These symptoms usually appear between 7 and 18 days after being bitten by an infected mosquito. Sometimes, symptoms may not appear for months after travel.
5
Q
Explain what is meant by periodicity of fever in malaria. (LO1)
A
- Fever follows a rupture of erythrocytic scizonts, thus there is periodicity in fever and characteristic patterns of fever.
- 48 hours (tertian: day 1 and 3).
- 72 hours (quartan: day 1 and 4).
- 24 hours (quotidian: daily).
6
Q
How does splenomegaly come about in malaria? (LO1)
A
Occurs as erythrocytes burst due to osmotic fragility caused by parasitic infection.
7
Q
Do all species of malaria cause the same symptoms? (LO1)
A
NO. There are four species with varying degrees of severity:
- P. vivax.
- P. ovale.
- P. malariae.
- P. falciparum.
8
Q
Describe a P. vivax infection (malaria). (LO1)
A
- Develops into a chronic febrile illness with severe mortality.
- Causes severe malaria with pronounced anaemia and respiratory distress.
9
Q
Describe P. ovale and P. malariae infections. (LO1)
A
Usually self-limiting but can recur as they often form hypnozoites that can re-present with anaemia years after the original infection.
10
Q
Describe a P. falciparum infection (malaria). (LO1)
A
- Frequently fatal during first 2 weeks due to a variety of complications.
- In hyperendemic areas, complicated falciparum malaria is most common in children aged 6 months to 5 years and in pregnant (primigravid) women.
11
Q
List the main complications of a malaria infection. (LO1)
A
- Cerebral malaria.
- Severe anaemia.
- Acute renal failure.
- Hypoglycaemia and lactic acidosis.
12
Q
Describe cerebral malaria as a complication of malaria. (LO1)
A
- Most dangerous complication.
- Convulsions and diminished levels of consciousness progressing to a coma.
- If treated successfully, little or no impairment of cerebral function but neurological and psychiatric sequelae may occur in 5-10% of childhood cases.
- Treatment relies on the time when antimalarial medications have been given to the patient.
13
Q
List the causes of cerebral malaria as a complication of malaria. (LO1)
A
- Binding (sequestration) of parasitised red blood cells in cerebral capillaries.
- Endothelial dysfunction.
- Increased permeability of blood-brain barrier.
- Dysregulation of coagulation pathways.
- Excessive induction of pro-inflammatory cytokines.
14
Q
What are the causes of severe anaemia as a complication of malaria? (LO1)
A
- Partly due to red blood cell destruction.
- Partly due to dyserythropoiesis in bone marrow.
More common complication.
15
Q
What is the cause of acute renal failure as a complication of malaria? (LO1)
A
Due to acute tubular necrosis which is also an important complication.
16
Q
Describe the management of malaria. (LO1)
A
- Intravenous artesunate in combination with other antimalarials to avoid drug resistance for severe malaria.
- IV quinine if artesunate cannot be obtained without delay.
Uncomplicated falciparum malaria:
- Treated with oral artemisinin combination therapy.
- Complications of any other species should be treated as severe falciparum.
P. vivax, P. ovale, P. malariae:
- Treated with oral artemisinin combination therapy.
- Or oral chloroquine.
- Primaquine used to kill hypnozoites of P. vivax or P. ovale in the liver and prevents relapses of these.
17
Q
Describe the prognosis of malaria. (LO1)
A
If identified promptly, appropriate treatment is given and no organ dysfunction has occurred, most people make a rapid and complete recovery
If treated inappropriately or delayed, severe or fatal malaria can develop.
Untreated malaria is fatal in most cases.
18
Q
Describe how we can prevent malaria. (LO1)
A
- Travel clinic or GP before travelling.
- Take antimalarial medication as prescribed - start a few days or weeks before travelling and stop a few weeks after you return.
- Use insect repellent on skin - 50% DEET based.
- Mosquito nets treated with insecticide around beds.
- Long-sleeved clothing and trousers in the evening, when mosquitos are most active.
- Antimalarial medicine may be prescribed even if you are travelling to a low-risk area.
19
Q
Describe the investigations for malaria. (LO1)
A
- Lateral flow devices: detect antigen without need for a lab.
- Molecular assays: detect malarial DNA/RNA and are much more sensitive. Available in reference labs.
- Antibody testing - if persisting for several years.
- Thick and thin blood films: detects parasitised red blood cells.
NOTE: one single negative blood film doesn’t exclude any species of malaria. Further blood films need to be done 24 and 48 hours in continuum.
NOTE: P. falciparum schizont stage (late) may be sequestered in deep tissues, so parasites may be deceptively scarce in, or even absent from peripheral blood.
20
Q
List some hospital investigations for malaria. (LO1)
A
- Polymerase chain reaction (PCR) blood.
- FBC - may show thrombocytopaenia, anaemia, variable white cell count.
- Clotting profile.
- Serum LFTs - may show elevated bilirubin or elevated aminotransferases.
- U+Es - usually normal or mildly impaired, renal failure may be present in severe infection.
- Urinalysis - may show trace to moderate proteins, urobilinogen and conjugated bilirubin may be present.
- Arterial blood gas.
21
Q
List the types of arthropod infections. (LO2)
A
- Mosquito-borne parasitic infections.
- Mosquito-associated viral infections.
- Tick-borne infections.
22
Q
Give an example of a mosquito-borne parasitic infection. (LO2)
A
Malaria.
23
Q
List some examples of mosquito-associated viral infections. (LO2)
A
- Dengue - types 1, 2, 3, 4.
- Japanese encephalitis.
- Murray Valley encephalitis.
- St Louis encephalitis.
- West Nile virus.
- Zika virus.
- Yellow fever.
- Chikungunya virus.
24
Q
List some examples of tick-borne infections. (LO2)
A
- Encephalitis.
- Kyasanur Forest disease (Alkhumra).
- Loupill ill.
- Omsk haemorrhagic fever.
- Powasan.
- Crimean-Congo haemorrhagic fever.
25
List the prevention measures against arthropod associated travel infections. (LO2)
Arthropod avoidance:
- Repellent spray.
- Bed nets.
- Avoid monsoon season.
- Travel to colder, dryer areas.
- Stay inside at night.
Chemoprophylaxis:
- Malaria.
- Vaccines.
26
Describe the epidemiology of dengue fever. (LO2)
- ~400 million infections annually - 25% symptomatic.
- <10% mortality.
Prevalent in:
- South-east Asia.
- Africa.
- Australia.
- Pacific islands.
- South America.
27
Which micro-organism is responsible for dengue fever? How is it transmitted? (LO2)
- Micro-organism: Dengue virus (DENV) from the Flavivirus genus.
- Transmission: bite from an infected Aedes mosquito.
28
Describe the clinical presentation of dengue fever. (LO2)
- Fever - 2-7 days.
- Headache.
- Pain behind the eyes.
- Arthralgia.
- Myalgia.
- Bone pain.
- Mild bleeding: nose, gums.
- Rash.
Can lead to haemorrhage.
29
Describe the investigations for dengue fever. (LO2)
- Seroconversion of IgM or IgG.
- Isolation of the virus.
- Detection of RNA by PCR in the blood or CSF.
- ELISA kits - NS1 antigen.
30
Describe the management for dengue fever. (LO2)
- Paracetamol/NSAIDs.
- Fluids.
- Rest.
- No vaccine or specific treatment.
31
Describe the epidemiology of malaria. (LO2)
- 212 million cases worldwide (2015).
- 62% mortality.
- Fluctuates with seasonal shift.
Prevalent in:
- Africa.
- South Asia.
- South America.
32
Which micro-organism is responsible for malaria? How is it transmitted? (LO2)
- Micro-organism: Protozoa of the Plasmodium genus.
- 4 types can cause disease in humans: P falciparum, P vivax, P ovale and P malariae.
- Transmission: bite from an infected Anopheles mosquito.
33
Describe the clinical presentation of malaria. (LO2)
- Fever.
- Headache.
- Vomiting.
- Muscle pain.
- Diarrhoea.
Extreme:
- Cerebral malaria.
- Liver and kidney failure.
- Pulmonary oedema.
34
What are the risk factors for more severe malaria? (LO2)
- Pregnancy.
| - <5 years old.
35
Describe the diagnosis of malaria. (LO2)
- Thick and thin blood film.
| - Liver function tests (LFT).
36
What is the management for malaria? (LO2)
- Prophylaxis (tablets).
37
List some common viral haemorrhagic fevers (VHFs). (LO2)
- Dengue haemorrhagic fever.
- Crimean-Congo haemorrhagic fever.
- Ebola.
- Marburg.
- Rift Valley fever (RVF).
- Lassa fever.
- Yellow fever.
- All of these can lead to bleeding.
38
Describe the clinical presentation of dengue haemorrhagic fever. (LO2)
- Fever - 2-7 days.
- Fever declines - persisting vomiting, abdominal pain, dyspnoea.
- Haemorrhage = circulatory failure, shock and death.
39
Describe the investigations for dengue haemorrhagic fever. (LO2)
- Seroconversion of IgM or IgG.
- Isolation of the virus.
- Detection of RNA by PCR in blood or CSF.
- ELISA kits - NS1 antigen.
40
Describe the epidemiology of Crimean-Congo haemorrhagic fever. (LO2)
- Mortality 10-40%: 30%.
Prevalent in:
- Africa.
- Asia.
- Eastern Europe.
41
Which micro-organism is responsible for Crimean-Congo haemorrhagic fever? How is it transmitted? How long is the incubation time? (LO2)
- Micro-organism: Nairovirus.
- Transmission: bite from an infected Ixodes tick or inoculation with body fluids of an infected person.
- Incubation: 1-3 days.
42
List the clinical presentations of Crimean-Congo haemorrhagic fever. (LO2)
- Fever.
- Myalgia.
- Stiff neck.
- Backache.
- Headache.
- Photophobia.
- Nausea.
- Diarrhoea.
- Abdominal pain.
- Mood swings.
- Confusion.
- Bleeding into the skin mucosa and internal organs.
- Liver and kidney failure.
43
Describe the investigations for Crimean-Congo haemorrhagic fever. (LO2)
- Examination.
- Liver function tests (LFTs).
- Bloods.
- Throat swab.
- Urinalysis.
44
Describe the management for Crimean-Congo haemorrhagic fever. (LO2)
- Isolation.
- Fluids.
- Paracetamol/NSAIDs.
45
Describe the epidemiology of Ebola. (LO2)
- Prevalent in Central Africa.
| - Mortality is 25-90%.
46
Which micro-organism is responsible for Ebola? How is it transmitted? How long is the incubation time? (LO2)
- Micro-organism: Ebola virus.
- Transmission: Inoculation with bodily fluids from infected primates or people.
- Reservoir: Fruit bats.
- Incubation: 8-10 days.
47
List the clinical features of Ebola. (LO2)
- Fever.
- Malaise.
- Myalgia.
- Sore throat.
- Headache.
- Vomiting.
- Hiccups.
- Maculopapular rash (day 5-7).
- Haemorrhage.
- Diarrhoea.
- Kidney and liver failure.
48
Describe the investigations for Ebola. (LO2)
- Full blood count (FBC).
- Blood culture.
- Throat swab.
- Pleural fluid sample.
49
List the most common symptoms between most viral haemorrhagic fevers (VHFs). (LO2)
- Fever.
- Malaise.
- Body pains.
- Sore throat.
- Headache.
- Vomiting and diarrhoea.
- Abdominal pain.
- Haemorrhage.
- Shock.
50
List the most common clinical findings upon examination for viral haemorrhagic fevers (VHFs). (LO2)
- Conjunctivitis.
- Throat infection.
- Erythematous/petechial rash.
- Bleeding.
- Lymphadenopathy.
- Bradycardia.
51
List the most common investigations for viral haemorrhagic fevers (VHFs). (LO2)
- FBC.
- U+Es.
- Blood culture.
- Throat swab.
- Urinalysis.
- Pleural fluid sample.
- Serological tests.
52
What is the most common course of management for viral haemorrhagic fevers? (LO2)
- Isolation.
| - General supportive measures (oxygen, fluids, pain relief).
53
List some common traveller-associated infections. (LO2)
- Gastroenteritis.
- Hepatitis E.
- Hepatitis A.
- Rabies.
- Monkeypox.
Respiratory:
- Tuberculosis (TB).
- Middle East Respiratory Syndrome Coronavirus (MERS-CoV).
54
Describe the epidemiology of gastroenteritis. (LO2)
- 1.5 million children die of this annually.
- Viruses account for ~68% of gastroenteritis.
- Endemic areas.
55
Which micro-organism is responsible for gastroenteritis? How is it transmitted? (LO2)
- Viral micro-organism: rotavirus, norovirus, astrovirus.
- Bacterial micro-organism: Campylobacter jejuni, E. coli, salmonella, shigella, Vibrio cholerae.
- Transmission: through food and water.
56
Describe the clinical presentation of gastroenteritis. (LO2)
- Anorexia.
- Nausea.
- Vomiting.
- Diarrhoea.
- Abdominal pain.
57
Which investigations are done for gastroenteritis? (LO2)
Clinical evaluation stool testing.
58
Describe the management of gastroenteritis. (LO2)
- Oral/IV rehydration.
- Antibiotics (if bacterial).
- Usually self-limiting.
59
Describe the epidemiology of hepatitis E. (LO2)
Developing countries (destination important). Caused by:
- Crowding.
- Poor sanitation.
- Lack of clean water.
- Monsoon season.
60
Which micro-organism is responsible for hepatitis E? How is it transmitted? How long is the incubation period? (LO2)
- Micro-organism: Hepatitis E virus (HEV).
- Transmission: via food and water contaminated by faeces.
- Incubation: 3-7 weeks.
61
Which groups are high-risk with regards to hepatitis E? (LO2)
- Pregnancy.
| - Older age.
62
Describe the management and prevention methods against hepatitis E. (LO2)
- Vaccine available in China and Nepal only.
| - Avoid unpurified water, uncooked shellfish and raw vegetables.
63
Describe the epidemiology of hepatitis A. (LO2)
Developing countries (destination important). Caused by:
- Crowding.
- Poor sanitation.
- Lack of clean water.
- Monsoon season.
64
Who might be symptomatic for hepatitis A? (LO2)
Children.
65
Describe the management and prevention methods against hepatitis A. (LO2)
- Acute: self-limiting.
- Pre-exposure: vaccine.
- Post-exposure: vaccine (7 days) or Ig HNIG (14 days).
* HNIG = human normal immunoglobulin.
66
Describe the epidemiology of rabies. (LO2)
- Prevalent in more than 150 countries.
- 59,000 human deaths annually.
- 95% of cases occur in Africa and Asia.
67
Which micro-organism is responsible for rabies? How is it transmitted? (LO2)
- Micro-organism: Lyssavirus.
- Reservoir: dogs.
- Transmission: any other mammal can transmit.
68
Describe the management and prevention method against rabies. (LO2)
- Immediately wash with soap and water.
- Pre-exposure: vaccine.
- Post-exposure: vaccine and rabies immunoglobulin (RIG)
69
Describe the epidemiology of monkeypox. (LO2)
- Primarily prevalent in remote central and West Africa (near rainforests).
- 1-10% mortality.
70
Which micro-organism is responsible for monkeypox? How is it transmitted? (LO2)
- Micro-organism: Monkeypox virus - viral zoonotic disease.
- Reservoir: rodents and primates.
- Transmission: limited secondary spread through humans.
71
Which group is at higher risk with regards to monkeypox? (LO2)
Younger groups of people.
72
Describe the management and prevention methods against monkeypox. (LO2)
- No specific treatment.
| - Smallpox vaccine is highly effective in prevention.
73
Describe the epidemiology of tuberculosis. (LO2)
- 25% of the world's population is infected with mycobacteria.
- 10 million people were ill with TB in 2017.
74
Which micro-organism is responsible for tuberculosis? How is it transmitted? (LO2)
- Micro-organism: Various strains of mycobacteria (most commonly mycobacterium tuberculosis).
- Transmission: inhalation of airborne droplets.
75
Describe the clinical presentation of tuberculosis. (LO2)
- Coughing >3 weeks - presence of blood/mucus.
- Chest pain, or pain on breathing.
- Fatigue.
- Fever.
- Night sweats.
- Chills.
- Latent TB infection (LTBI) carriers are asymptomatic and non-infectious.
76
Describe the management and prevention methods against tuberculosis. (LO2)
Prevention:
- Bacillus Calmette-Guerin (BCG) vaccine gives partial protection.
Management: 6 month regimen:
- 4 first line drugs: Isoniazid, Rifampicin, Ethambutol, Pyrazinamide.
- Multi-drug resistant (MDR) and extensively drug-resistant (XDR) variants have higher mortality.
77
Describe the epidemiology of MERS-CoV. (LO2)
- 2260 confirmed cases and 803 deaths (2018).
- 35.5% mortality.
- 27 countries reported to have cases.
78
Which micro-organism is responsible for MERS-CoV? How is it transmitted? (LO2)
- Micro-organism: Covid virus.
| - Reservoir: Dromedary camels.
79
Describe the clinical presentation of MERS-CoV. (LO2)
- Fever.
- Cough.
- Shortness of breath (SOB).
- Pneumonia.
- GI symptoms - diarrhoea.
80
What are health inequalities? (LO3)
Health inequalities are unjust and avoidable differences in people's health across the population and between specific population groups.
81
Which model is used to explain health inequalities? (LO3)
The socio-ecological model.
82
Describe the various layers of the socio-ecological model when talking about health inequalities. (LO3)
A person's health can be influenced by uncontrollable factors such as age, sex and hereditary factors. It can also be influenced by:
1. Individual lifestyle.
2. Which could be influenced by social and community networks.
3. Which could be influenced by structural factors.
4. Which could be influenced by general socio-economic, cultural and environmental conditions such as climate and climate change.
83
What is meant by structural factors with regards to the socio-ecological model (health inequalities)? (LO3)
These are things that could influence a social/community network of a population.
- Housing.
- Healthcare services.
- Water and sanitation.
- Unemployment.
- Living and working conditions.
- Work environment.
- Education.
- Agriculture and food production.
84
How do health inequalities rise from this socio-ecological model? (LO3)
These determinants differ from population to population which is how we get the rise of health inequalities, leading to inequity in health. This uneven distribution may be unnecessary and avoidable.
85
Example 1: family income and school readiness. What were the findings from this study? (LO3)
A study analysed average scores for children's cognitive and socio-emotional development. The children were from three different income groups: low income, low-to-medium income (LMI) and higher income.
- LMI children 5 months behind on vocabulary development than higher income children.
- Lower income children 8 months behind on vocabulary development than LMI children.
- LMI children scored 1.2 points higher on behaviour problems scale than higher income children.
- Lower income children scored 1.7 points higher on the behaviour problems scale than LMI children.
(Higher the score on behaviour problems scale, the better behaved the children are).
86
Example 2: sex and mortality rates. What were the findings from this study? (LO3)
A study analysed avoidable mortality rates in each sex for differently affluent areas.
- Males experienced more avoidable deaths than females in the same decile. This was the trend for every decile.
- Most deprived areas of England had the highest avoidable mortality rates and vice versa.
- Largest gap seen between decile 1 (most deprived) and decile 2. This means, even in the least affluent areas, the smallest difference in deprivation made a big contrast in mortality rates.
87
Example 3: birth-place and mortality. What were the findings from this study? (LO3)
A report published by PHE:
- People living in England but born elsewhere in Great Britain have higher mortality rates at all ages.
- Additional disadvantage for people in these categories as they also experience more premature deaths under the age of 75 than people born in and living in England.
88
What are the three steps recommended by the Commission on Social Determinants of Health (CSDH) to help tackle health inequalities? (LO3)
This was published by WHO:
1. Improve daily living conditions.
2. Tackle the inequitable distribution of power, money and resources.
3. Measure and understand the problem and assess the impact of action.
89
Define environment. (LO4)
- The surroundings or conditions in which a person, animal, or plant lives or operates.
- The air, water, and land in or on which people, animals and plants live.
90
What is meant by built environment? (LO4)
Refers to areas that have been fundamentally transformed and influenced by human activity, such as cities, towns, infrastructure, and so on.
91
List the key environmental hazards. (LO4)
- Water and sanitation.
- Chemical safety.
- Housing.
- Occupation.
- Noise.
- Transport.
- Air quality.
- Extreme weather – earthquakes and flooding.
- Climate change.
92
What is the most common occupation hazard? (LO4)
Slips, trips and falls.
93
List the key occupational hazards. (LO4)
1. Slips, trips and falls.
2. Electrical.
3. Fire.
4. Confined spaces.
5. Physical hazards.
6. Ergonomic hazards.
7. Chemical hazards.
8. Biological hazards.
9. Asbestos.
10. Noise.
94
What are the public health approaches to address occupational hazards? (LO4)
- Signs to be put up.
- Mandatory safety equipment, e.g., hard hats, goggles.
- Manual handling training.
- In Denmark: provision of standing desks is law to reduce risk of musculoskeletal problems.
95
List some hazards we may come across as doctors (LO4)
- Sharps – needles.
- Chemicals – disinfectants, medications, anaesthetics.
- Biological hazards – blood, bodily fluids, bacteria, viruses.
- Electricals – beds, automated blood pressure cuffs, diagnostic instruments, scanning equipment.
- Physical – poor posture, repetitive motions, moving patients, prolonged periods of sitting or standing.
- Stress – long hours, rotating shifts, delivering bad news.
- Aggression and violence.
96
List the most common transport hazards. (LO4)
1. Speeding.
2. Vehicle collisions.
3. Vehicles hitting pedestrians and cyclists.
4. Carbon emissions.
5. Brake failures, burst tyres.
97
What are the public health approaches to address transport hazards? (LO4)
- Seatbelts.
- Drink driving laws.
- Safe crossings for pedestrians.
- Lower speed limits.
98
Define climate. (LO5)
The average weather in a place over many years.
99
Define climate change. (LO5)
A shift in the average weather of a place over many years.
100
How does climate change occur? What causes it? (LO5)
- We use fossil fuels to power our homes, factories and transport.
- Greenhouse gases are released when these fossil fuels are burnt.
- The greenhouse gases trap the sun's heat and cause the planet's temperature to rise.
101
List the potential environmental effects of further temperature increase of >1.5ºC. (LO5)
- More intense storms in Northern America.
- Extreme rainfall and flooding in Europe.
- Droughts and food shortage in Africa.
- Extreme heatwaves in the Middle East.
- Heat and drought in Australia.
- Islands disappearing under rising seas.
102
What are the public health approaches to address climate change? (LO5)
- Retrofitting buildings to make them more energy efficient.
- Adopting renewable energy sources such as solar and wind.
- Helping cities develop more sustainable transport such as rapid bus transit and electrical vehicles.
103
Describe the potential impact of climate change on health services, focusing on extreme weather such as flooding. (LO5)
1. Direct impact – drowning and stress from damaged houses, insurance claims, temporary relocation.
2. Power outages – ability to call emergency services.
3. As a result of power outage and increased called for help due to the flood – response times will be delayed.
4. Insufficient ambulances to deal with the victims.
5. Ambulances may not be able to reach the victims due to flooding.
6. Increased demands on healthcare – more demand for hospital beds, healthcare workers, existing workers working longer hours and feeling stressed and fatigued.
104
List the factors which contribute to health inequalities. (LO6)
- Gender.
- Ethnicity.
- Disability.
- Area of residence.
- Socioeconomic status.
- Deprivation.
- Other factors.
These differences often represent an unjust, especially if they are potentially avoidable. One of these is deprivation.
105
Deprivation is measured across a range of factors. List these. (LO6)
- Income factors.
- Employment factors.
- Education and skills within a population.
- Levels of chronic ill-health and disability.
- Crime.
- Barriers to housing and local services.
- The living environment.
106
What is meant by wider determinants of health? (LO6)
Broader social, economic, political and environmental circumstances that influence health outcomes throughout life.
107
List the mechanisms of health inequality (the 4 models). (LO6)
1. Behavioural.
2. Psychosocial.
3. Materialist.
4. Life-course.
108
Describe the cultural/behavioural explanation for health inequalities. (LO6)
- These show that individual, or lifestyle differences rooted in personal characteristics and levels of education have a large influence over behaviour.
- These behaviours are open to alteration through health education.
- This model suggests that lack of knowledge and lack of long-term goals give fewer possibilities of making maximum use of health and other services of taking preventative health measures.
109
Give some examples of the effects of cultural/behavioural factors on health inequalities. (LO6)
Among manual occupation classes:
- Higher rates of smoking which will contribute to ill health.
- Lower consumption of vitamin C, carotene, and fibre.
- Higher dietary sodium/potassium ratio.
- Lower rates of vegetable intake.
- Elevated rates of saturate fat intake.
- Lower rates of exercise.
110
List the factors that the psychosocial model for health inequality focuses on. (LO6)
Focuses on three factors:
1. The home.
2. The workplace.
3. The community.
111
Give some examples of the effects of psychosocial factors on health inequalities. (LO6)
- High workload combined with low control over work tasks may negatively affect the immune system.
- Poor social support within the family context leads to high levels of psychosocial stress and leads to impaired health.
112
Describe the materialist/structuralist explanation for health inequalities. (LO6)
- Emphasises the role of economic and associated socio-structural factors in the distribution of health and wellbeing.
- This explains how social structure is characterised by permanent social and economic inequality which exposes individuals to different probabilities of ill health and injury.
113
Give some examples of the effects of materialist/structuralist factors on health inequalities. (LO6)
- Poor quality and damp housing - associated with worse health, particularly higher rates of respiratory disease in children.
- Low socio-economic status, low pay, financial insecurity - inadequacies in diet and dietary values.
- All-cause mortality directly related to income with age adjusted. Poorest group of subjects at twice the risk then those of the richest group.
114
Describe the life-course explanation for health inequalities. (LO6)
- A recognition that adult health outcomes cannot be understood in isolation from earlier life antecedents.
- Occupational class structure is seen to act as a filter of human beings and one major basis of selection is health, i.e. physical strength, vigour or agility.
- In these hypotheses, health determines one's social class of destination.
- This means, people in better health have greater chances to ascend the social hierarchy.
- Those in poorer health may undergo downward social mobility.
115
Give some examples of the effects of life-course factors on health inequalities. (LO6)
- Low birth weight - predictor of socio-economic disadvantage through childhood and adolescence.
- Health problems in childhood and youth - can produce downward socio-economic drift.
- The highest health risks are found among those who both grow up and remain in disadvantaged material circumstances.
116
Define screening. (LO7)
Screening entails looking for a disease in people who do not have symptoms of that disease, in order to inform decisions and actions so as to reduce future health risks.
117
List some NHS national screening programmes. (LO7)
- Cervical cancer.
- Breast cancer.
- Bowel cancer.
- Abdominal aortic aneurysms.
- Antenatal and neonatal testing.
- Diabetic eye testing.
118
List the components of a screening programme. (LO7)
- Register eligible people.
- Systems of invitation and recall.
- Screening tests.
- Confirmation of diagnosis.
- Treatment of other interventions.
- Info and support for patients.
- Staff training.
- Standard and quality assurance.
119
List the harms that screening can cause. (LO7)
- Over-diagnosis.
- False positives.
- False negatives.
- Unnecessary treatment.
- Cost of screening, further testing and treatment.
120
Describe the screening process. (LO7)
1. The population eligible for screening identified - this is typically people at high risk of disease, although not all of them will develop the disease.
2. After screening, those positive go on to have a diagnostic test. If that is positive too, interventions such as treatment, advice or information provision are provided.
121
List the common biases in evaluations of effectiveness of screening. (LO7)
- Healthy screening effect.
- Length-time bias.
- Lead-time bias.
122
What is the healthy screening effect? (LO7)
People who take part tend to be healthier than those who don't.
123
What is the length-time bias? (LO7)
The disease is more likely to be detected in people with longer lasting and slowly progressive types of the disease who have better outcomes anyways.
124
What is the lead-time bias? (LO7)
Earlier detection makes the duration of survival after diagnosis longer even if treatment is ineffective.
125
Give an example of screening effectiveness. (LO7)
UEA's SCOOP trial of osteoporosis screening in older women showed that screening increased the diagnosis and treatment of osteoporosis, and thus reduced hospital admissions for hip fractures, compared to controls.
