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AC1 > Week 4 > Flashcards

Week 4 Flashcards

1
Q

Define migrant

A

Any person who is moving or has moved across an international border or within a State away from his/her habitual place of residence, regardless of:

1) the person’s legal status
2) whether the movement is voluntary or involuntary
3) What the causes for the movement are
4) What the length of stay is

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2
Q

What is a refugee?

A

Refugees are persons who are outside their country of origin for reasons of feared persecution, conflict, generalised violence, or other circumstances that have seriously disturbed public order and, as a result, require international protection.

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3
Q

What is an asylum seeker?

A

An individual who is seeking international protection. In countries with individualised procedures, an asylum-seeker is someone whose claim has not yet been finally decided on by the country in which they have submitted it.

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4
Q

Define migrant worker

A

A person who is to be engaged, is engaged or has been engaged in a remunerated activity in a state of which they are not a citizen.

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5
Q

Define international students

A

Students who have crossed a national or territorial border for the purpose of education and are now enrolled outside their country of origin.

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6
Q

Define undocumented migrants

A

Someone who does not have legal papers to support their presence in another country eg. students or tourists with overstayed visa, victims of trafficking, women who entered on a spouse visa.

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7
Q

Why does definition of a migrant matter in the NHS?

A
  1. Everyone in England is entitled to free primary care, regardless of immigration status
  2. Asylum seekers and refugees are entitled to free secondary care, others are charged
  3. Understanding these terms can help healthcare workers advocate for their patients
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8
Q

Give examples of models that are used in migration in health

A
  • The migration cycle

- The Dalghren and Whitehead model (rainbow model)

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9
Q

What can be some burdens of disease and migration?

A

Perinatal health – worse outcomes for maternal mortality, maternal mental health, preterm birth and congenital abnormalities. [ 19 systematic reviews]

Child health – generally adapt well but disruption to immunisation schedules, early childhood development and access to schooling.

Adolescent health- puberty = brain maturation leading to increased sensitivity to differences related to migration. Stigma, social exclusion, bullying can contribute to anxiety, depression, self-harm and suicide.

Mental health – prevalence varies widely. In first generation international migrants have higher rate of depression, anxiety and PTSD.

Communicable disease –public health burden remains high in many settings.

Non-communicable diseases – people are moving with established NCDs. Interruption of care – prevents effective management of chronic health conditions. One study found 2.5x incidence of diabetes compared to host population.

Tobacco and alcohol use – depended on prevalence in country of origin + in host country.

Occupational health – rates of fatal and non-fatal injuries are higher in labour migrant populations. Type of employment – construction, fishing, metal-working. Can include: injuries, exposure to weather or pesticides, respiratory conditions, depression + anxiety, infectious diseases.

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10
Q

What should you take into account when assessing new patients from overseas?

A
  • Social circumstances
  • Integration
  • Risk of infectious disease
  • Immunisations
  • Dental health
  • Nutritional or metabolic disorders
  • Vision and hearing
  • Ethnicity risk factors
  • Lifestyle
  • Sexual health
  • Travel plans
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11
Q

What does good access to healthcare mean?

A

Adequate and appropriate supply of health care so that people who need it can access it

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12
Q

What is the difference between equal access and equitable access?

A

Equal access refers to providing the same level or kind of service to everyone, regardless of need

Equitable access is providing services according to need

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13
Q

What is horizontal inequity?

A

When people with the same needs do not have access to the same resources.
Unequal treatment of equals.

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14
Q

What is vertical inequity?

A

When people with greater needs are not provided with greater resources to meet those needs

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15
Q

What is the key indicator of health inequity?

A

Maternal mortality

Tuberculosis is also a disease of poverty

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16
Q

Why address inequities in health care?

A
  • Justice and fairness
  • Growing evidence base that equitable access to medical and health care can contribute towards reductions in health inequities
  • Not addressing inequity in access to health care may widen health inequalities
  • Duty under Equality Act 2010: public sector duty
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17
Q

What are some barriers to equitable access?

A

Supply side:

  • Lack of funding
  • Services at wrong time/place
  • Costs attached
  • Culturally inappropriate
  • Variable quality
  • Clinician biases

Demand side:

  • Health literacy
  • Can’t use services due to geographical or physical barriers
  • Community and cultural attitudes and norms
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18
Q

Define rough sleepers

A
  • People sleeping, about to bed down or actually bedded down in the open air
  • People in buildings or other places not designed for habitation
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19
Q

What is hidden homelessness?

A
  • This includes people who become homeless but find a temporary solution by staying with family members or friends (sofa surfing), living in squats orother insecure accommodation, cars and night shelters.
  • Research by the charity Crisis indicates that about 62% of single homeless people are hidden and may not show up in official figures.
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20
Q

What are some causes of homelessness?

A

Structural:

  • Poverty
  • Inequality
  • Housing supply and affordability
  • No employment/insecure employment
  • Access to social security

Individual:

  • Poor physical health
  • Mental health problems
  • Childhood trauma
  • Experience of violence, abuse, neglect, harassment, hate crime
  • Substance abuse
  • Bereavement
  • Relationship breakdown
  • Time in care or prison
  • Refugees
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21
Q

What is the role of health professionals in homelessness?

A
  • Identify the risk of homelessness among people who have poor health, and prevent this
  • Minimise the impact of homelessness on health among people who are already homeless
  • Enable improved health outcomes for people experiencing homelessness so that their poor health is not a barrier to moving on to a home of their own.
22
Q

What is the Homeless Reduction Act (2017)

A

TheHomelessness Reduction Act 2017puts a legal duty on councils to offer more support to a wider range of people who are homeless or threatened with homelessness within 56 days.

Some public authorities in England have a duty to notify Local Housing Authorities of service users they think may be homeless or at risk of homelessness

Known as Duty to Refer

This came into place on 1st October 2018

23
Q

Which public services are included in the duty to refer?

A
  • youth offender institutions
  • secure training centres
  • secure colleges
  • youth offending teams
  • probation services (including - community rehabilitation companies)
  • Jobcentre Plus
  • social service authorities
  • emergency departments
  • urgent treatment centres
  • hospitals in their function of providing inpatient care.
24
Q

Define bronchitis

A

LRTI affecting the bronchi, may be acute or chronic

25
Q

Define pneumonia

A

LRTI affecting the alveoli, may be lobar or multifocal

26
Q

What are the different types of pneumonia?

A

Community acquired pneumonia (CAP) = usually due to organisms that are rare and resistant to first-line antibiotics

Hospital acquired pneumonia (HAP) = possibly due to organisms that are rare and resistant to first-line antibiotics

Atypical pneumonia = due to uncommon organisms (eg. pertussis)

Secondary pneumonia = bacterial pneumonia following viral LRTI

Aspiration pneumonia = due to aspirating drinks, secretions etc.

27
Q

What is an opportunistic LRTI

A

Due to immunodeficiency or immunosuppression

28
Q

What are host risk factors for LRTIs?

A

Extremes of age: younger children and older adults

Stress and starvation: known to be a specific risk factor

Immunocompromised host: LRTIs more common with HIV

Compromised barriers to infection:

  • Smoking increases mucus production, but reduces ciliary action
  • Smoking related damage to respiratory tissues (bronchitis)
  • Viral LRTIs damage respiratory tissues (bronchitis)
  • Viral LRTIs damage respiratory tissues –> bacterial (bronchitis)
  • Depletion of commensal organisms by anti-microbial treatment
  • Malformations (rare) and obstructions (eg. tumours)
  • Iatrogenic (eg. tracheostomy, bronchoscopy)
29
Q

What investigations would you do for LRTI?

A

Peak expiratory flow rate: for possible airway constriction

Pulse oximetry: measures oxygen saturation

Full blood count: possible leukocytosis (increased WCC)

U&Es: possible AKI therefore sepsis

CRP: Increased in bacterial infection

Lactate: Increased in severe sepsis

ABGs: hypoxia +/- hypercapnia

CXR: shadowing consistent with pneumonia, possible pleural effusion or empyema

Nose & throat swabs: for viral investigations (PCR tests)

Sputum: for bacterial investigations (microscopy, culture & sensitivities)

N.B. Tuberculosis needs specialist microscopy, culture & sensitivity

30
Q

What is CURB-65?

A

Confusion
Urea >7mmol/L
Resp rate >30/minute
Blood Pressure <90mmHg systolic or <60mmHg diastolic

age >65 yo

If score >1 –> admit
If score >2 IV treatment

31
Q

What causes Tuberculosis?

A
  • Mycobacterium tuberculosis (& related species in the same complex)
  • Gram stain -ve, but more like Gram +ve bacteria in structure
  • They have a unique cell wall, which is “waxy” and impermeable
  • They can infect various different body tissues
  • They divide very slowly and can become latent
  • Transmission is usually from aerosolised droplets or fomites
32
Q

Where does containment of tuberculosis usually happen?

A

Containment usually within a Ghon focus and hilar lymph nodes

33
Q

What investigations would you do for tuberculosis?

A 
FBC: possible leukocytosis (increased WCC)
U&Es: usually normal
LFTs: possibly raised
CRP: mild-moderate rise only
Lactate: usually normal (no sepsis)

CXR:

  • upper lobe cavitating pneumonia
  • miliary shadowing
  • hilar lymphadenopathy
  • pleural effusion
  • pericardial effusion

CT/MRI scans: thorax/abdomen/spine/bones/head

Laparoscopy/thoracoscopy: direct visualisation & biopsy

Other biopsies: lymph nodes/ bones/ cold abscesses

34
Q

What stains could you use for the sputum to investigate TB?

A

Ziehl-Neelsen stain –> Acid-Fast Bacilli (AFBs) = pink

Auramine-Phenol stain –> AFBs = fluorescent

35
Q

How do you treat TB?

A

Very rarely presents with sepsis

Multi-drug treatment required to prevent resistance

  • Rifampicin for 6 months
  • Isoniazid for 6 months
  • Pyrazinamide for 2 months
  • Ethambutol for 2 months

(TB in the CNS requires 12 months of treatment)

Pyridoxine to prevent neuropathy from isoniazid

Steroids if CNS or pericardial infection

Vitamin D if deficient

36
Q

Treatment for acute bronchitis?

A

Oseltamivir

37
Q

Treatment for chronic bronchitis?

A

Co-amoxiclav

38
Q

Treatment for community-acquired pneumonia?

A

Amoxicillin & clarithromycin

39
Q

Treatment for hospital-acquired pneumonia?

A

Piperacillin-tazobactam

40
Q

How do you prevent primary infection?

A

For active TB cases:

  • Respiratory isolation
  • Prompt diagnosis & treatment
  • Contact tracing & testing

Vaccination with BCG

41
Q

How do you prevent secondary (re-activation) TB?

A

Screening for latent TB infection and treatment:

  • Tuberculin skin tests (TST)
  • TB interferon-gamma release assays (IGRA)

Treatment for latent TB:
Rifampicin and isoniazid for 3 months

42
Q

What is surveillance?

A

Surveillance is the ongoing systematic collection, collation, analysis and interpretation of data, and the dissemintation of information (to those who need to know) in order that action may be taken

43
Q

What are some surveillance systems?

A
  • Notifications of Infectious Disease
  • Laboratory notifications
  • Other disease specific systems
  • Primary care surveillance systems (remote health advice, GP in hours and GP out of hours, RCGP, COVER
  • Secondary care surveillance systems (Emergency department syndromic surveillance)
44
Q

What is infection or colonisation?

A

the entry and development or multiplication of an infectious agent in/on the body of man or animals (not synonymous with disease).

45
Q

What is communicable or infectious disease?

A

disease which occurs following direct or indirect transmission of an infectious agent or its toxic products.

46
Q

What does contagious mean?

A

Describes an infection transmitted by direct contact

47
Q

What are some direct modes of transmission?

A
  • Touching (eg. scabies), kissing (oral infections), sexual intercourse (chlamydia, gonorrhoea, syphilis, HIV, Hep B)
  • Droplet spread (eg. measles, mumps, flu, meningococcal disease)
  • Vertical transmission - transplacental/during childbirth (toxoplasmosis, rubella, CMV, herpes simplex, and blood-borne viruses HIV and Hep B, Hep C, other infections)
  • Faeco-oral (eg. campylobacter, salmonella, E Coli 0157, Hep A)
48
Q

What are some indirect modes of transmission?

A
  • Vehicle borne (eg. flu) - inanimate objects, food/water, biological products eg. blood, tissues
  • Vector borne (eg. malaria) - an insect or living carrier which carries disease from an infected individual to a susceptible individual
  • Airborne (aerosols eg. TB and dust eg. fungi and respiratory viruses)
49
Q

What are some different ways to describe the occurrence of a disease?

A

Occurrence = frequency of disease (does not distinguish between incidence and prevalence)

  • Sporadic: irregular pattern of disease, occasional cases at irregular intervals
  • Endemic: Persistent, low or moderate level of disease
  • Hyper endemic: A higher persistent level of disease
  • Cluster: Occurrence exceeds the expected level for a given population and/or in a given geographical area and/or in a given time period (cases have a possible but unconfirmed link)
  • Epidemic/Outbreak: Occurrence exceeds the expected level for a given population and/or in a given geographical area and/or in a given time period (cases have a highly probable or confirmed link).
    An outbreak is a localised epidemic, and is also practically defined as two or more linked cases, or a single case of a rare or serious disease e.g. rabies, diphtheria, botulism, polio
  • Pandemic: Epidemic occurring worldwide or over a very wide area, crossing international boundaries, and usually affecting a large number of people
50
Q

How can you break the chain of transmission?

A
  • Control the source
  • Interrupt transmission
  • Protect susceptible population by immunisation or chemoprophylaxis
51
Q

How can you manage outbreaks?

A
  • Confirm (verify diagnosis)
  • Immediate control
  • Convene an Outbreak Control Team
  • Review epidemiological (time, place and person) and microbiological information
  • Case finding
  • Definitive control measures
  • Descriptive Epidemiology (epidemic curves)
  • Analytical study (case control or cohort)
  • Declare outbreak over – lessons learnt, prevention measures in place, ongoing monitoring
  • Communication (throughout)

AC1 (9 decks)

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