(written by Ella Kulman) Public Health Flashcards
What are the 4 four broad categories that can influence an individual’s health?
- Biological factors e.g. gender, ethnicity.
- Personal lifestyle e.g. exercise, diet.
- The physical and social environment e.g. air pollution.
- Health services.
What did the Black Report 1980 confirm?
The Black Report confirmed that health inequalities were widening.
What is the Whitehall study of British civil servants?
Information was collected on risk factors from civil servants; inequalities were seen between different employment grades. Nearly an institution would show this same pattern.
What did the Acheson report 1988 suggest doing in order to reduce health inequalities?
- Give high priority to the health of families with children.
- Reduce income inequalities and improve living conditions.
Why do women tend to suffer more illness than men?
- Biological, women’s role in reproduction can cause ill health.
- Ageing, women live longer and so are more prone to old age associated ill health.
- Material, women are still seen as ‘carers’, these commitments have implications for paid employment.
What are the 4 main reasons for why men have higher mortality rates than women?
- Employment, men are more likely to have a high risk occupation.
- Risk taking behaviour.
- Men tend to smoke more than women.
- Men drink significantly more alcohol than women.
What is the disengagement theory?
The process by which older people disengage themselves from roles they previously occupied in wider society.
What is the theory of the third age?
The theory of the third age describes an era after retirement with health, vigour and a positive attitude.
Describe the association between social class and life expectancy.
The higher the socio-economic classification the higher the life expectancy at birth.
Describe the association between social class and smoking.
A greater percentage of people smoke in the lower socio-economic classes.
Describe the association between mortality and unemployment.
Mortality is greater in the unemployed.
What are the difficulties with the conceptualisation of ethnicity in health research?
- It is influenced by historical, social and political context.
- Notions of ethnicity can become fixed and lead to erroneous stereotyping.
- Experience of racism is strongly associated with poor health.
Define patient compliance.
The extent to which the patient’s behaviour coincides with medical or health advice.
Give 3 disadvantages of patient compliance?
- It is passive, the patient MUST follow the doctor’s orders.
- It is professionally focused and assumes the doctor knows best.
- It ignores problems patients have in managing their health.
Define patient adherence.
The extent to which the patient’s actions match agreed recommendations. It is more patient centred.
What is the difference between patient compliance and adherence?
Patient adherence is more patient centred, it empowers patients and considers them as equals in care. Patient compliance is often viewed as uncaring, condescending and passive.
What are the key principles of adherence?
- Improve communication.
- Increase patient involvement.
- Understand the patient’s perspective.
- Provide and discuss information.
- Assess adherence.
- Review medicines.
Describe the necessity-concerns framework.
The necessity-concerns framework looks at what influences adherence. Adherence increases when necessity beliefs are high and concerns are low.
Give 2 factors that patient centred care encourages?
- Focus on the patient as a whole person; holistic.
2. Shared control of the consultation, decisions are made by the patient and doctor together.
What is concordance?
Concordance is the expectation that patients will take part in treatment decisions and have a say in the consultation; it is a negotiation between equals.
Give 5 barriers to concordance.
- The patient may not want to engage in discussions with their doctor.
- It may lead to worry.
- Patients may just want the doctor to tell them what to do.
- Time, resources and organisational constraints.
- Challenging, patient choice may differ significantly from medical advice.
Give 4 advantages of doctor-patient communication.
- Better health outcomes.
- Higher compliance to therapeutic regimens.
- Higher patient and clinician satisfaction.
- Decrease in malpractice risk.
What are the 5 main duties of a doctor?
- Work in partnership with patients, treat as individuals and respect their dignity.
- Work with colleagues in a way that best serve patients’ interests.
- Protect and promote health.
- Recognise and work within the limits of your competence.
- Provide a good standard of care.
Define mental capacity.
The patient’s ability to make a decision about their care.
What 4 questions can be asked to assess mental capacity?
- Does the patient understand?
- Can the patient retain the information?
- Can they use the information to weigh up options and make a decision?
- Can they communicate their decision?
What is Gillick/Fraser competence?
If a child is under 16 they can be assessed as being Gillick/Fraser competent; this means they can make decisions about their care without parental involvement.
What is the main difference between infection and colonisation?
Infection results in harm to the individual whereas there is no harm in colonisation.
How can the environment be altered to aid infection control?
- Design: hospital beds spaced further apart.
- Ensuring a clean environment.
- Infectious individuals can be isolated.
What can staff do to prevent the transmission of infection?
- Barrier precautions; gloves and aprons.
- Isolation.
- Good hand hygiene!
What does MRSA stand for?
Methicillin resistant staphylococcus aureus.
Where might norovirus outbreaks be likely?
Schools, cruise ships, restaurants, hospitals.
What can norovirus cause?
Gastroenteritis; diarrhoea and vomiting.
Will norovirus be killed by alcohol hand gel?
No! Norovirus is resistant to conventional cleaning and is only killed by soap and water.
Why is c.difficile hard to destroy?
It is acquired in spore form and so is hard to eradicate.
Will c.diff be killed by alcohol hand gel?
No! C.diff is resistant to conventional cleaning and is only killed by soap and water.
Name 2 microorganisms that are not killed by alcohol hand gel?
Norovirus and C.diff.
What are endogenous infections?
Infection of a patient by their own flora. It is important to be aware of this when treating hospitalised patients.
How can endogenous infections be prevented?
- Good nutrition and hydration.
- Antisepsis.
- Control the underlying disease.
- Remove lines and catheters.
- Reduce antibiotic pressure e.g. short courses.
Define epidemiology.
The study of how often diseases occur in different groups of people and why.
What is epidemiological data used for?
Seeing trends in diseases and planning future preventative strategies.
Define incidence.
The rate at which new cases occur in a population during a specified time period.
Work out the incidence of new lung cancer cases:
- UK population: 61.4 million.
- New lung cancer cases per year: 39,000.
(39,000/61,400,000) X 100,000 = 63.5 per 100,000 per year.
Define prevalence.
The proportion of a population that have the disease at a point in time. (Normally given as a percentage).
What kind of diseases can prevalence be found for?
Prevalence can only be found for stable conditions, it is unsuitable for acute disorders.
Write an equation that links incidence and prevalence.
Prevalence = incidence X average duration.
Define mortality.
The incidence of death from a disease.
Work out the mortality from lung cancer cases:
- UK population: 61.4 million.
- Lung cancer deaths in 2009: 34,509.
(34,509/61,400,000) X 100,000 = 56.6 per 100,000 per year.
Do epidemiological studies look for cause?
No! They look for relationship not cause.
What types of study are most useful for epidemiology?
Ecological and cross-sectional.
Describe an ecological study.
Ecological studies use population level data e.g. mortality rates.
Give an advantage and a disadvantage of an ecological study.
- Cheap and easy to perform as it uses readily available data.
- Bias is possible due to variation in diagnostic criteria.
Give an advantage and a disadvantage of a cross-sectional study.
- Quick and cheap. Rapid insight into current events in a community.
- Prone to bias, no time reference, could be reporting medical oddities.
Describe a cross-sectional study.
Looks at the population at a point in time - prevalence study!
Describe a case-control study.
Looks at people with a disease (case) and compares with a control (matched). Retrospective.
Give an advantage and a disadvantage of a case-control study.
- Results can be obtained quickly due to being retrospective - cheap.
- Unreliable if individuals have bad memories. Cannot calculate incidence.
Describe a cohort study.
Follows a group of people over time; prospective. Incidence study.
Give an advantage and a disadvantage of a cohort study.
- Incidence can be determined, reduced chance of bias.
- Expensive, takes a long time and uses large populations. Difficulty with follow up.
Describe a RCT.
An intervention is given and compared to a control group.
Give an advantage and a disadvantage of a RCT.
- Confounders are equally balanced, less bias.
- Expensive, volunteer bias, ethical difficulties in withholding treatment from controls.
What type of study might also be known as a prevalence study?
Cross-sectional study; looks at the population at a point in time.
What type of study might also be known as an incidence study?
Cohort study; follows a group of people over time, prospective.
What type of study is retrospective?
Case control.
What type of study is prospective?
Cohort study.
Why is it difficult to determine the prevalence of COPD?
There are a lot of undiagnosed cases.
What can cause COPD?
Smoking is the main cause! Occupation, genetics and environmental factors can also lead to COPD.
Give 3 reasons why there is geographical variation for the risk of developing COPD.
- Socio-economic differences: housing and nutrition.
- Historic industry e.g. steel work and coal mining.
- Developing world e.g. more pollution.
What are the 4 key problems in managing COPD.
- Unpredictable illness trajectory.
- Prognosis is hard to determine due to the unpredictable illness trajectory and is often poor if it is determined.
- Bad patient understanding leads to anxiety and confusion.
- Limited access to specialist palliative care.
What is the WHO definition of palliative care?
Palliative care improves the quality of life of patients and families who face life threatening illness. It provides pain and symptom relief and spiritual and psychological support from diagnosis to the end of life and bereavement.
Define specialist palliative care.
Palliative care provided by health professionals who specialise in palliative care and work within a multi-disciplinary specialist care team.
Who can provide specialist palliative care.
- Consultants in palliative medicine.
- Clinical nurse specialists e.g. Macmillan nurses.
- Social workers.
- Chaplains.
- Physiotherapists.
- Dieticians.
Define generalist palliative care.
Health professionals who have not received accredited levels of training in palliative care and so are not deemed ‘specialists’, but who routinely provide health care for patients at the end of their lives.
Who can provide generalist palliative care.
- GP’s.
- Hospital doctors.
- Nurses and district nurses.
- Nursing home staff.
What are the 4 building blocks of palliative care?
- Holistic.
- Individualised.
- Patient and family centred.
- Multidisciplinary approach.
What does palliative care aim to do?
- Promote quality of life.
- Promote dignity and autonomy.
- Control disease symptoms.
What might multiple co-morbidities result in?
- A greater need for care.
- Increased psychological distress.
- Increased social isolation.
Palliative care for COPD patients is notoriously bad. Why is this?
- Lack of funding.
- Most palliative care teams are cancer focused.
- Differing patient need: COPD v cancer.
- Unpredictable illness trajectory in COPD.
- Lack of patient understanding.
Ethics: what are the 4 principles?
- Autonomy - respect the patient’s choices.
- Beneficence - do good.
- Non-maleficence - do no harm.
- Justice.
Ethics: what is deontology?
Features of the act determines worthiness. Deontology teaches that acts are right or wrong, people have a duty to act accordingly. Do unto others as you would be done by.
Ethics: categorical imperatives are a type of deontology. What are categorical imperatives?
A rule that is true in all circumstances. You should act in such a way that you would be willing for it to become universal law that everyone follows in the same situations.
What are the challenges of deontology?
- Consequences aren’t looked at.
2. Duties can conflict.
What are virtue ethics?
Virtue ethics focus on the character of the person acting, are they integrating reason and emotion? An act is only virtuous if the person has the right mind set. Virtues are acquired.
What are the five focal virtues?
- Discernment.
- Conscientiousness.
- Trustworthiness.
- Integrity.
- Compassion.
(TICCD)
Focal virtues: define discernent.
The ability to judge well.
Focal virtues: define conscientiousness.
Being thorough, careful and vigilant.
Focal virtues: define trustworthiness.
The ability to be relied on and trusted.
Focal virtues: define integrity.
Being honest and having good moral principles.
Focal virtues: define compassion.
Showing concern for others.
What are the challenges of virtue ethics?
Virtue ethics don’t focus on consequences. They are culture specific and too broad for practical application. It’s not always clear how to solve a moral dilemma using virtue ethics.
What are utilitarian ethics (consequentialism)?
An act is evaluated solely in terms of its consequences. Maximise good and minimise harm.
What are the challenges of utilitarian ethics (consequentialism)?
Treats minorities unfairly to promote the happiness of a majority.
Name 2 approaches to ethical analysis.
- Seedhouse’s ethical grid.
2. The four quadrants approach.
Seedhouse’s ethical grid: describe the inner layer.
The inner layer asks the question of whether the intervention is going to create autonomy, respect autonomy and treat all equally?
Seedhouse’s ethical grid: describe the second layer.
Duties and motives. Is the intervention consistent with moral duties; keeping promises, telling the truth, minimising harm and maximising benefit?
Seedhouse’s ethical grid: describe the third layer.
Consequentialist layer. Is the intervention going to provide the greatest benefit for the greatest number? Who will benefit, society, individuals, a group?
Seedhouse’s ethical grid: describe the outer layer.
Is the intervention likely to be affected by external considerations e.g. risks, law, use of resources.
What are the advantages of Seedhouse’s ethical grid?
It provides structure and function for analysing ethical problems. It is based on moral theory.
What are the headings which make up the four quadrants approach to clinical ethical analysis?
- Medical indications.
- Patient preferences: respect for autonomy.
- Quality of life.
- Contextual features.
Ethical analysis: define connectivity and interdependence.
The behaviour of one individual may affect others.
Ethical analysis: define co-evolution.
Adaptation of one organism alters other organisms; the doctor and patient co-evolve.
Ethical analysis: define the far from equilibrium.
Being pushed away from equilibrium is essential for survival and flourishing. Pushing yourself away from your comfort zone.
Ethical analysis: define conscientious objections.
Moral claims that are based on an individual’s core ethical beliefs e.g. when a doctor refuses to provide certain treatments because they believe it would violate their personal beliefs. It is important to balance conscientious objections with professional obligations - respect patient autonomy.
Until what week of pregnancy can an abortion be carried out?
Abortions can generally only be carried out up to 24 weeks of pregnancy. In exceptional circumstances an abortion can take place after 24 weeks e.g. if there’s a risk to life or there are problems with the baby’s development.
Could any pregnant lady request an abortion?
No. You need a medical reason to request a termination e.g. physical or mental risk to the mother.
What is the WHO definition of mental health.
A state of mental wellbeing in which a person realises their own abilities, can cope with normal life stressors, can work productively and fruitfully and are able to contribute to their community.
What can affect mental health?
Mental health can depend upon life experiences and life context. Gender, race, religion, social class etc. can all influence mental health.
Name 5 mental health conditions.
- Stress.
- Depression.
- OCD, PTSD.
- Schizophrenia.
- Eating disorders e.g. anorexia, bulimia.
- Substance misuse e.g. alcohol, illegal drugs.
Give 5 reasons why students are so vulnerable to mental health issues?
- Academic stress.
- Financial concerns.
- Alcohol, drugs.
- Peer pressure.
- Unrealistic expectations.
Name 3 things that doctors suffer from more than the general population.
- Increased suicide rates.
- Increased marital dysfunction and divorce.
- Increased drug and alcohol problems.
Give 5 factors that can contribute to work related stress.
- Insufficient resources.
- Excessive workloads.
- Poor management.
- Complaints and litigations.
- Dealing with patient suffering.
Give 4 symptoms of burnout.
- Diminished personal contact.
- Work avoidance.
- Increased minor illness.
- Feelings of failure.
What personality traits are susceptible to psychological illness?
- Perfectionism.
- High self criticism.
- Low flexibility.
- High discipline.
- High empathy.
Describe Malan’s ‘helping profession syndrome’.
People in helping professions compulsively give to others what they would like to have for themselves. They have an unconscious identification with the patient role, unmet emotional needs.
Give 5 trigger factors for conflict and assault in the workplace.
- Waiting times.
- Well being/state of mind.
- Medication, side effects.
- Frustration.
- Drug/alcohol abuse/withdrawal.
What is the best way to prevent conflict?
Good communication and good body language.
Give 3 barriers to good communication.
- Language barriers.
- Deafness/blindness.
- Medical jargon.
Describe the ‘LOVERS’ communication model.
L - listen, learn what the problem is.
O - observe, look at their body language.
V - verify, check you understand.
E - empathise.
R - reassure, tell them you want to help.
S - seek an agreeable compromise.
Define population attributable fraction (PAF).
The proportional reduction in population disease that would occur if exposure to a risk factor was reduced.
What is the principal factor behind social inequality?
Smoking!
What is the obesogenic environment?
An environment that encourages people to eat unhealthily and not do enough exercise.
Give 3 physical characteristics of the obesogenic environment.
- Increased car culture.
- Lifts/escalators.
- TV remote controls.
Give an economic characteristic of the obesogenic environment.
Healthy options tend to be more expensive.
Give a socio-cultural characteristic of the obesogenic environment.
Eating out and indulging has become a very social thing to do.
Define NNT.
The number of patients that need to be treated in order to have an impact on one person.
What did Friedman and Rosenman (1959) describe?
Coronary prone behaviour; competitive, hostile, impatient, type A behaviour.
What tool can be used to assess type A behaviour?
MMPI.
Give three psychosocial factors that could increase someone’s risk of MI.
- Depression/anxiety.
- High demand and low control at work, working more than 11 hours a day.
- Loneliness and social isolation.
What can doctors do to help combat psychosocial factors that can increase the risk of patient mortality?
- Identify signs of depression/anxiety.
- Ask patients about their occupation.
- Ask patients about support networks.
- Liaise with relevant services e.g. social care and occupational health.