year 1 Flashcards
What did Ignacz Semmelweis (1847) do?
campaigned for hand washing after he had
discovered a correlation between puerperal fever and dissection
what is the main
determinant of population health.
the extent of income division
what is the Gini coefficient?
a statistical representation of nation’s income distribution
amongst its residents - the lower the coefficient, the greater the equality amongst people.
true or false: UK has a rather high inequality coefficient compared to
Scandinavian countries (Denmark etc)
true
what is the most powerful predictor of health
experience
socio-economic model of health
What did the black report of 1980 find about responses to health inequalities?
- Material (environmental causes, might be mediated by behaviour)
- Artefact (an apparent product of how the inequality is measured)
- Cultural/behavioural (poorer people behave in unhealthy ways)
- Selection (sick people sink socially and economically)
what did the The Acheson Report (1998) find/say?
- income inequality should be reduced
- give high priority to the health of families with children
what are the principles of Proportionate Universalism?
- Focusing on the disadvantaged only will not help to reduce the inequality
- Action must be universal but with a scale and intensity proportional to the disadvantage
- Fair distribution of wealth is important
What is the psychosocial theory of causation?
-stress results in inability to respond efficiently to body’s demands
- impact on blood pressure, cortisol levels and on inflammatory and neuro-endocrine responses
What is the Neo-material theory of causation?
- more hierarchal societies are less willing to invest into the provision of public goods
- poorer people have less material goods, quality of which is generally lower
What is the life-course theory of causation?
- a combination of both Psychosocial and Neo-material explanations
- critical periods - possess greater impact at certain points in the life course (childhood)
- accumulation - hazards and their impacts add up -> hard work leads to injuries resulting in disabilities that may lead to more injuries
- interactions and pathways - sexual abuse in childhood leads to poor partner choice in adulthood
DOMAINS OF PUBLIC HEALTH: Health protection
infectious diseases, chemicals and poisons, pollution, radiation, emergency response
DOMAINS OF PUBLIC HEALTH: Improving services- what could be improved?
clinical effectiveness, efficiency, service planning, equity
DOMAINS OF PUBLIC HEALTH: Health improvement
lifestyles, family & community, education, employment,
housing, surveillance and monitoring
DOMAINS OF PUBLIC HEALTH: Addressing the wider determinants of health
seeing the big picture - making sense
of data
what are Meta-ethics?
exploring fundamental questions: right/wrong/defining the good life
what are examples of Ethical Theory?
virtue
categorical
imperative
utilitarianism
4 principles- Autonomy, Benevolence, Non maleficence, justice
What are Applied Ethics?
a recent emergence of ethical investigation in specific areas
(environmental, medical, public health)
what is a Deductive
what is Ad hominem?
responding to arguments by attacking person’s character rather than the content of their argument
what is Authority claims?
saying a claim is correct because authority has said so
what is Begging the question?
assuming the initial point of the argument
what is Dissenters?
identifying those who disagree does not itself prove the claim is not valid
what is Motherhoods? (ethical fallacies)
- inserting a soft statement to disguise the disputable one
what is No true Scotsman?
modifying the argument
When can confidential information be disclosed?
- required by law
- public at risk
- patient vulnerable to exploitation
- patient consent
what is the criteria for disclosure of information?
- anonymous if practicable
- patient’s consent (overrule?)
- kept to a necessary minimum
- meets current law (data protection)
Does confidentiality continue after a person has died?
yes
name 3 notifiable diseases that must be reported to WHO
- cholera
- yellow fever
- plague
What are the Structural determinants of illness?
social class
poverty
unemployment
discrimination
gender and health
what is the Biomedical model of health medicine?
Mind and body are treated separately
Body, like a machine, can be repaired
This privileges use of technological interventions
It neglects social and psychological dimensions of disease
What is health behaviour?
actions taken by individual to prevent disease
what is illness behaviour?
how an individual acts when they are unwell e.g going to the doctor
what is Sick role behaviour?
aimed at getting well, e.g compliance and resting
name 5 lifestyle factors that promote mortality
smoking
obesity
sedentary life
excess alcohol
poor diet
What is Becker 1974’s health belief model for change?
individuals must believe:
- they are susceptible to the condition
- it has serious consequences
- that taking action reduces their risks
- the benefits of taking action outweigh the costs
what is the Transtheoretical model of change?
Pre-contemplation (no intention giving up smoking)
Contemplation (considering quitting)
iii Preparation (getting ready to quit in the near future)
Action (engaged in giving up smoking)
Maintenance (steady non-smoker)
Relapse
what is morality?
concern with the distinction between good and evil or right and wrong
what are ethics?
a system of moral principles and a branch of philosophy which defines what is good for individuals and society (may differ in different cultures)
what is UTILITARIAN/CONSEQUENTIALISM (Teleological)?
- An act is evaluated solely in term of its consequences
- Maximising good and minimizing harm
- Types: hedonistic, rule, act, preference
- The “greatest happiness principle” of John Stuart Mill
What is KANTIANISM (Deontological)?
- Features of the act themselves determine worthiness (goodness) of that act
- Following natural laws and rights
- Categorical imperatives - a set of universal moral premises from which the duties are derived (do not lie; do not kill; …)
- A person is an end itself, never a means to an end
- deon = duty (from the Greek)
what is virtue ethics (Deontological)?
And what are the five focal Virtues?
- Focus is on the kind of person who is acting, deemphasizes rules
- Is the person in action expressing good character or not?
- We become virtuous only by practicing virtuous actions
- Integration of reason and emotion
- The Five Focal Virtues:
i Compassion
ii Discernment
iii Trustworthiness
iv Integrity
v Conscientiousness
what are the five focal virtues?
i Compassion
ii Discernment
iii Trustworthiness
iv Integrity
v Conscientiousness
what are the four principles (Prima Facie)?
- Autonomy (self-rule, the obligation to respect the decisions of our patients)
- Benevolence (providing benefits, balancing the benefits against risks)
- Non-maleficence (do no harm, reduce or prevent harm)
- Justice (Utility/QUALY, need vs. benefit, fairness in the distribution of benefits and risks)
what are the GMC “duties of a doctor”?
- Protect and promote the health of patients and the public
- Provide good standard of practice and care
- Recognise and work within the limits of your competence
- Work with colleagues in the ways that best serve patients’ interests
- Treat patients as individuals and respect their dignity
for autonomy to be valid, what need to be true regarding the decision?
- The decision is intentional
- The decision is done with understanding
- There are no major controlling influences over the decision
what is the Katz ADL (Activities of Daily Life) Scale?
i bathing
ii dressing
iii toilet use
iv transferring (in/out of bed or chair)
v urine and bowel continence
vi eating
what is IADL (Instrumental Activities of Daily Living)?
i use of the telephone
ii travelling by car or using public transport
iii food or clothes shopping
iv meal preparation
v housework
vi medication use (preparing and taking correct dose)
vii management of money (paying bills)
what is the Barthel ADL index (10 items that measure daily functioning)?
i feeding
ii moving from wheelchair to bed
iii grooming
iv transferring to and from a toilet
v bathing
vi walking on level surface
vii going up and down stairs
viii dressing
ix continence of bowels
x continence of bladder
what does the MMSE: Mini Mental State Examination test?
i orientation, immediate memory
ii short-term memory
iii language functioning
what is acute illness
a disease of short duration that starts quickly and has severe symptoms
what is chronic illness
a persistent or recurring condition, which may or may not be severe, often starting gradually with slow changes
what is polypharmacy
the use of multiple medications or administration of more medications than are clinically indicated
what are the key challenges of an aging population?
- Strains on pension and social security systems
- Increasing demand for health care
- Bigger need for trained health workforce
- Increasing demand for long-term care
- Pervasive ageism (denying older people the rights and opportunities available for other adults)
what are causes of an aging population?
- Improvements in sanitation, housing, nutrition & medical interventions
- Life expectancy is rising around the globe
- Substantial falls in fertility (higher age of first pregnancy?)
- Decline in premature mortality
- More people reaching older age while fewer children are born
what is intrinsic aging?
natural, universal, inevitable
what is extrinsic aging?
dependent on external factors (UV ray exposure, smoking, air pollution)
why do women live longer than men?
- 20% biological – premenopausal women are protected from heart disease by hormones
- 80% environmental – men take more lifestyle risks than women
what are some consequences of higher life expectancy?
- Pensions will have higher pay outs than those currently planned
- Chronic and comorbid conditions will prevail
- Rising inequalities as more affluent groups will use health services for longer
what are the types of dementia?
- Alzheimer’s disease 62%
- Vascular dementia 17%
- Mixed Alzheimer and Vascular 10%
- Lewy bodies 6%
- Fronto-temporal 2%
- Other types 3%
what are some alternatives to hospital admissions for older people?
- Supporting discharge from inpatient hospital care
- Providing alternatives in acute care within the community
- Supporting chronic disease management within the community
what does Institutionalising death mean?
60% of people die in hospital (but 70% want to die at home)
what does Medicalisation of death mean?
death seen as failure, curative endeavour of biomedicine, prolonging life at any cost, death as natural part of our life challenged
what is the Glaser and Strauss awareness of dying?
Observational study of interactions between dying people, relatives and staff in USA Hospitals
> Identified 4 awareness contexts:
i Closed awareness
ii Suspicion awareness
iii Mutual Pretence
iv Open awareness
what is social death?
when people die in social and interpersonal terms before their actual biological death
- lonely, impersonal death
what is a good death?
palliative care became a specialty, aiming to de-medicalise death - a reaction against the impersonal medical city
what is ‘death the hospice way’?
open awareness, compassion, honesty
multi-disciplinary teams
emotion and relationships - modelled on a family approach
holistic care
what is the chain of infection ?
- Susceptible host - low immunity, low white cell count, imbalance in normal flora, invasive procedures
- Causative micro-organism - increase number in hospital, resistant strains
- Reservoir - patients, visitors, stuff, fomites -> where the spread originates
- Portal of entry/exit - respiratory tract, GI tract, GeUri tract, broken skin
- Mode of Transmission- exogenous/ endogenous
What are the two modes of transmission ?
- exogenous spread (direct/indirect contact, vector spread, airborne)
- endogenous spread (self spread)
how can you prevent the spread of infections?
hand decontamination
disposal of clinical waste
standard infection control precautions (gloves, apron, hand hygiene, correct sharps disposal, correct clinical waste and linen handling)
what are the psychological effects of nicotine?
- activation of nicotinic ACh receptors in the brain
- causing dopamine release in the NAcc (nucleus accumbens)
- stimulant, tolerance and withdrawal
what are the impacts of smoking?
- the greatest single cause of illness and premature death in the UK
- 100,000 deaths/year due to smoking
- cancers, COPD, CHD
- a great economic impact of smoking
what are some health problems connected to smoking?
- cardiovascular problems (strokes, heart attacks, DVTs)
- other cancers (stomach, kidney, pancreas, bladder, mouth, throat,…)
- stomach ulcers
- impotence
- diabetes
- oral health (gum disease)
- cataracts
what is the 1908 children act (smoking)?
sale of tobacco to under 16s prohibited