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
what are the 5 laws for law and smoking?
- 1908 - Children Act - sale of tobacco under 16s prohibited
- 1965 - Parliament bans cigarette advertising on TV
- 2007 - Smoking in public banned + legal min. raised to 18 in the UK
- 2015 - October (?) - Smoking in car with children banned in the UK
what are the treatments for smoking cessation?
- NRT (Nicotine Replacement Therapy)
- patches, gums, nasal spray, microtab, inhalator
- Non-nicotine pharmacotherapy (reduce cravings)
- Varenicline (Champix)
- Bupropion (Zyban)
what is the 3A patient approach to encourage smoking cessation?
- ASK - your patient about smoking
- ADVISE - your patient on cessation methods available
- ASSIST - your patient and refer to local NHS Stop Smoking Service
what were the 8 millennium development goals?
- Eradicate Extreme Poverty & Hunger
- Achieve Universal Primary Education
- Promote Gender Equality & Empower Women
- Reduce Child Mortality
- Improve Maternal Health
- Combat HIV/AIDS, Malaria and Other Diseases
- Ensure Environmental Sustainability
- Develop a Global Partnership for Development
what are the 3 leading causes of death in children in the developing world?
- Pneumonia
- Diarrhoea
- Malaria
who are the key actors in global health?
- the UN agencies:
i UNICEF / UNAIDS / WHO - Foundations:
i The Rockefeller Foundation
ii The Bill & Melinda Gates Foundation - NGOs:
i Doctors Without Borders (MSF)
ii Save the Children - Multilateral Development Banks
i The World Bank
ii Asian Development Bank
iii Inter-American Development Bank - Bilateral Agencies
i USAID, CIDA, DFID
name some global environmental changes
- CFCs and stratospheric ozone depletion
- Loss of biodiversity within ecosystems
- Freshwater decline and land degradation
- Loss of natural fisheries
- Increasing desertification
what are examples of migrants?
- asylum seekers, refugees, trafficked people
- migrant workers, family workers
- family joiners, international students
what defines a migrant?
- Country of birth
- Country of nationality
- Duration of stay
what are some common countries of origin for asylum seeker?
Pakistan, Iran, Sri Lanka, Syria
what are some common countries of origin for economic migrants?
Romania, Poland, Spain, Italy, Bulgaria
what are some vulnerability cases for migration?
- Persecution, war, political and social unrest
- Exploitation, torture, rape, bereavement
- Burden of disease and socio-economic status
what is Lampedusa?
- an Italian island (one of the Pelagie Islands)
- a primary transit point for immigrants from Africa
- a European territory closest to the shores of Libya
- from Jan-Apr 2015 about 1600 on the route from Libya to Lampedusa -> the deadliest migrant route in the world
what are the NHS goals regarding migration?
- Equity of access
- Reducing gap in health inequalities
- Providing services for the vulnerable
- Ensuring the services are appropriate and accessible
what is sustainability?
Being able to meet the needs of today without compromising the ability of future generations to meet the needs of tomorrow.
what are the current screening programmes in the UK
cervical
breast
bowel
AAA
diabetic eye (from age of 12 with DM, yearly)
When is cervical screening given?
in women ages 25-65
from 24-49 its every 3 years
from 50-65 its every 5 years
when is Bowel cancer screening given?
both male and female from ages 60-74
every 2 years given a home test kit
when is breast screening offered?
women over 50 to 71
every 3 years
when is screening for AAA offered?
one off ultrasound for men aged 65
what is the Bradford hill criteria for causation?
- strength
- consistency
- specificity
- temporality
- biological gradient
- coherence
- analogy
what is the Bradford hill criteria?
a group of minimal conditions necessary to provide adequate evidence of a causal relationship
what are possible consequences of global warming?
i heatwaves (bacteria happier, desertification, more diarrhoea)
ii sea level rise
iii new diseases
iv scarcity of resources -> migration -> war (?)
what are some solutions for the consequences of global warming?
i Control world population
ii Reduce energy consumption
iii Get our energy from renewable resources
what is the Wilson and Jungner criteria for offering a screening test?
- condition must be important, well understood and have a detectable early stage
- treatment must be available and accepted, facilities available to offer the treatment and enough provision for the extra workload
- test out be suitable, acceptable and have pre-determind time intervals
- cost considerations so cost balances against benefits and risks less than the benefits. agreed policy on who to treat
what is screening?
A process which sorts out apparently well people who probably have a disease from those who probably do not
- main purpose is prevention
What is primary prevention?
to prevent a disease from occurring
what is secondary prevention?
detection of early disease in order to alter the course of the disease and maximize the chances of a complete recovery
what is tertiary prevention?
trying to slow down the progression of the disease
What is sensitivity?
the proportion of people with the disease who are correctly identified by the screening test
sensitivity= TP/(TP+FN)
what is specificity?
the proportion of people without the disease who are correctly excluded by the screening test
specificity= TN/(TN+FP)
What is the positive predicted value?
the proportion of people with a positive test result who actually have the disease
PPV=TP/(TP+FP)
what is the negative predicted value?
the proportion of people with a negative test result who do not have the disease
NPV=TN/(TN+FN)
what is prevalence?
the proportion of a population found to have the disease
what is incidence?
the number of new cases within a specified time period divided by the size of the population initially at risk
what is selection bias?
people who choose to participate in screening programmes may be different from those who do not
what is lead time bias?
screening merely identifies the disease earlier than before and thus gives the impression that survival is prolonged (but survival time unchanged!)
what is length time bias?
diseases with longer period of presentation are more likely to be detected by screening than the ones with shorter time of presentation.
what is error?
any preventable event that may cause or lead to patient harm
errors can lead to one of two things, what are they?
adverse event
near miss
what is an adverse event?
an incident which results in harm to a patient
what is a near miss?
miss: an event which has the potential to cause harm but fails to develop further, thereby avoiding harm
what are the types of human error?
- ERRORS OF OMISSION (required action delayed/not taken)
- ERRORS OF COMMISSION (wrong action is taken)
- ERRORS OF NEGLIGENCE (the actions or omissions do not meet the standard of an ordinary, skilled person professing)
what are skill based errors?
- when performing a routine task that is well learnt (automatic)
- little attention given, thus if distracted - slips of action / memory lapses
what are knowledge based errors?
- an incorrect plan or course of action is chosen (no experience)
- mistakes more likely when the tasks are more complex
what are violations?
deliberate deviations from practices, procedures and standards or rules
what are the types of violations?
i routine (cutting the corners)
ii necessary (to get the job done - sometimes unavoidable)
iii optimising (personal gain, selfish)
what are information processing limitations?
- automaticity
- cognitive interference
- selective attention
- cognitive bias
- transferring our expectations from familiar situations to similar new ones
what are some approaches to managing errors?
- The person approach - individual - errors are the products of wayward mental processes of individual people in the system
- The system approach - organisational - adverse events are product of many causal factors (Swiss-cheese theory) - the whole system is to blame
what is needed for an effective team?
- optimal team size
- good team dynamic
- a common purpose
- an identified team leader
- shared knowledge and experiences
what are the benefits of team working?
- improving the service delivery
- improving the decision-making
- reducing the error
what is the WHO definition of mental health?
Mental health is a state of well-being in which the individual realises his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully and
is able to make a contribution to his or her community.
name some common mental health problems
- Depression
- Generalised Anxiety Disorder
- Panic disorder
- Phobias
- Social Anxiety Disorder
- Obsessive-compulsive disorder (OCD)
- Post-traumatic stress disorder (PTSD)
how many people have depression worldwide?
350 million
how many people have schizophrenia worldwide?
24 million
how many people commit suicide?
1 million
why are the common mental health problems (CMHP) dangerous?
- They have a negative impact on quality of life (employment, ADLs, family)
- They increase the risk of physical illness (chronic conditions)
- They increase mortality from physical illness (e.g. heart disease)
- Depression is a major risk factor for suicide
- There is a correlation between household income and the incidence of CMHPs - better-off men are three times less likely to suffer from CMHP. common mental health problems
what are some general interventions for mental health?
- Community level
- Service organization level
- Individual level
- IAPT service model (Improving Access to Psychological Therapies)
-high intensity care - low intensity care
what is the psychological definition of stress?
Stress occurs when the demands made upon an individual are greater than their ability to cope. (Atkinson, 1999)
what are the types of stress?
- DISTRESS - a negative stress which is damaging and harmful
- EUSTRESS - a positive stress which is beneficial and motivating
what are the 2 causes of stress?
- acute: noise, danger, infections, injuries, hunger etc
- chronic: health, home, finances, family, friends
what are internal stressors?
physical (inflammation, infection)
psychological (attitudes, believes, personal expectations, worries)
what are external stressors?
environment, work, social & cultural pressures
what is the flight or fight model?
an automatic response to external acute stressors:
* elicits a physiological response
- hypothalamus: sympathetic system + andrenocorticosteroid system
- both adrenal medulla (Ad, NA) and adrenal cortex (cortisol) activated
- activation of various organs and inhibition of the others: ForF response
What are the body responses to stress?
- LUNGS - take in more oxygen (rapid breathing)
- BLOOD FLOW - increasing up to 400%
- SKELETAL MUSCLES - tense
- SPLEEN - more RBCs discharged
- SKIN - blood flow directed away to support skeletal muscles and heart
- MOUTH - drier as saliva and mucus dry up
- IMMUNE SYSTEM - WBCs redistributed
what is the general adaptation syndrome?
- ALARM - when threat /stressor identified
- ADAPTATION/RESISTANCE - defensive countermeasures engaged
- EXHAUSTION - the body begins to run out of defences
what are the 5 signs of stress?
- BIOCHEMICAL - endorphin and cortisol levels altered
- PHYSIOLOGICAL - shallow breathing, raised BP, more HCL produced
- BEHAVIOURAL - over-eating, anorexia, insomnia, more alcohol or smoking
- COGNITIVE - negative thoughts, no concentration, worse memory, tension headaches
- EMOTIONAL - mood swings, irritability, aggression, boredom, apathy, tearfulness
what is the stress-illness model?
“An individuals susceptibility to disease or illness is increased
because an individual is exposed to stressors which cause strain upon the individual, leading to
psychological and physiological changes.”
what is the PTSD diagnostic criteria?
both must be present:
- The person experienced an event that involved actual or threatened death or serious injury or a threat to physical integrity
- The person’s response involved intense fear, helplessness, or horror.
what are the symptoms of PTSD?
- The event is persistently re-experienced in recollections and dreams
- Persistent avoidance of stimuli associated with the event
- Persistent symptoms of increase arousal (insomnia, irritability etc.)
name some examples of traumatic events
- Childhood physical/emotional/sexual abuse
- Violent attacks
- Natural catastrophes
- Rape, war or combat exposure (shell-shock)
name some physical illnesses that stress that contribute to
- Cancer
- Coronary Heart disease
- Chronic Fatigue Syndrome
- Infertility/Miscarriage
- Peptic Ulcers (H pylori bacteria)
- Irritable Bowel Syndrome & Inflammatory Bowel Disease
- Karoshi (a death from overwork - commonly a heart attack or stroke)
name some ways to manage stress
- Exercise
- Meditation
- Yoga, Tái Chi
- Cognitive Behavioural Therapy
what are the 2 key purposes of the NHS press releases?
- Reactive – defending the NHS reputation (reporting achievements, improvements, justifications)
- Proactive – improving and protecting population health-(Five a day, Act FAST)
what are some diseases that are linked to obesity?
- Type II diabetes
- Hypertension
- Cancer deaths amongst non-smokers (10% of which attributed to obesity)
- Coronary heart disease and stroke (obesity is a contributing factor)
- Reproductive function (6% of primary infertility in women due to obesity)
- Respiratory effects (obstructive sleep apnoea, pulmonary hypertension)
- Osteoarthritis
- Angina pectoris, congestive heart failure
- Hyperinsulinaemia, insulin resistance, glucose intolerance
- High blood cholesterol, dyslipidemia
- Bladder control problems, uric acid nephrolithiasis
- Psychological disorders (depression, eating disorders, low self esteem)
how has epidemiology surrounding obesity changed from the past?
- In the past: obesity affected the rich first
- Nowadays: obesity is a condition associated with poverty
- Social gradient:
- 18% professionals/managers are obese
- 28% unskilled/manual workers are obese
what are some causes of obesity?
- The causes are complex, multi-factorial, rooted in social, economic and cultural factors:
1. “Americanization” of diet and society
2. Increasing dominance of car culture, less walking
3. Numerous technical advances minimising physical work
4. More commuting
5. Longer working hours
6. Greater availability of energy dense food, cheaper, better promoted
7. Replacing water by sugary drinks
what is the WHO definition of obesity?
Abnormal or excessive fat accumulation resulting from chronic imbalance between energy intake and energy expenditure that presents a risk to health. It is a state of positive energy balance.
what do the BMI ranges signify?
- <18.4 Under weight
- 18.5 - 24.9 Normal range
- 25.0 - 29.9 Over-weight
- 30.0 – 34.9 Obese Class I
- 35.0 – 39.9 Obese Class II
- > 40.0 Obese Class III
what are the seven key domains of energy balance?
- Food environment (energy intake – population level)
- Food consumption (energy intake – individual level)
- Individual activity (energy expenditure)
- Activity of the environment (ee – population level)
- Societal influences (both intake and expenditure)
- Individual psychology (both intake and expenditure)
- Individual biology (both intake and expenditure)
what is the aetiology of obesity?
- Multifaceted and complex
- Causes are an interaction between biology and behaviour
what is Prader Willi Syndrome (PWS)?
i Short statue, almond shaped eyes, small hands and feet
ii Intelectual impairment, hyperphagia (over-eating)
iii Chromosome 15 deletion (paternal)
what is congenital leptin deficiency
i Extreme adiposity and uncontrollable appetite
ii Monogenic obesity is very rare!
what is the obesogenic environment?
The Pima Indians – showing a dramatic increase in obesity when exposed to western environment (the majority of Arizonian Pima are now severely obese, 95% have diabetes)
what aspects of behaviour are associated with weight gain?
- EMPLOYMENT (Shift work, lack of sleep, upset circadian rhythm, Reduced physical activity, Cortisol, leptin, ghrelin)
- DIETARY PATTERNS
- LEISURE AND ACTIVITIES
what are the links between developmental factors and obesity?
- Rapid infant weight gain (in the first 2yrs of life = increased risk)
- Breast feeding (associated with protective mechanisms from obesity)
- Early introduction of solid foods (<4months increases the risk of obesity)
- Childhood obesity (a big predictor of adult obesity)
what are the direct and indirect controls of meal size?
- Direct: all the factors relating to the direct contact of the food with the GI mucosal receptors
- Indirect: metabolic, endocrine, cognitive individual differences -> indirect controls can override the direct controls
what is satiation?
what brings an eating episode to an end
what is satiety?
inter-meal period
(feeling full)
what is the satiety cascade? and how does fat effect it?
- Sensory -> Cognitive -> Post-ingestive -> Post-absorptive
- Fat has a relatively weak effect on satiation and satiety
- High-fat foods often improve the sensory properties
how many macronutrients do protein, carbohydrates fat and alcohol have?
- Protein 4.7 kCal/g
- Carbohydrate 3.6 kCal/g
- Fat 9.5 kCal/g
- Alcohol 7.0 kCal/g
what satiates you most?
most to least:
- protein
- CHO
- fat
- alcohol
What is the order or utilisation by the body of the macronutrients?
most to least:
- alcohol
- protein + CHO
- fat
what are ways of reducing density?
i Incorporation of water or air
ii Fruits and vegetables
iii Reducing fat (industry)
iv Method of cooking (no frying)
what is energy compensation?
- The adjustment of energy intake following the ingestion of a particular food
- Energy compensation is lower with liquids than solids (except of soup!)
what is the role of alcohol in over-eating
- Stimulates intake, gives almost no satiety
- Efficiently oxidised
- Adds to the total daily energy intake
what environment factors lead to over-eating?
- Variety (greater variety stimulates over-eating)
- Portion size (has increased significantly over the last century)
- Distraction (promoting increased food intake)
i Watching TV
ii Social facilitation – eating with the others
what are psychological factors that contribute to over-eating
- Dietary restrain (disinhibited eating behaviour)
- Stress (individual, but often promotes eating)
- Sleep (short sleep linked to over-eating)
- Reward sensitivity (neural responses)
what are the 4 main STIs?
- Chlamydia
- Gonorrhoea (drug resistance!)
- Syphilis
- Trichomoniasis
what is key about education around sexual and reproductive health include?
- Involve young people as they are key decision-makers
- Provide comprehensive, accurate information
- Address barriers to accessing health services
- Empower adolescents to make life choices that are best for them
What are the 5 main complementary and alternative medicine (CAM)?
- Acupuncture
- Chiropractic therapy
- Homeopathy
- Herbal medicine
- Osteopathy
who uses CAMs?
- <35-60> age group, mainly women
- higher income, higher education levels
- poor health status, 60% have a chronic disease
- geographical variation in the UK (mostly in the South & Southwest of England)
- autism spectrum disorders
what are ‘push’ factors for new people using CAMs?
- Lack of effective conventional treatment for problem
- Concern about unpleasant side-effects
- Experience of poor communication with doctors, rejection of science
- Disease is not serious enough (e.g. life threatening)
- Gullibility and naivety
- High patient satisfaction rates (60-80%)
what are ‘push’ factors for new people using CAMs?
- Lack of effective conventional treatment for problem
- Concern about unpleasant side-effects
- Experience of poor communication with doctors, rejection of science
- Disease is not serious enough (e.g. life threatening)
- Gullibility and naivety
- High patient satisfaction rates (60-80%)
what are the major concerns with CAMs?
- Unrealistic expectations
- Delayed conventional care
- General safety (unregulated practitioners and treatments, drug interactions)
what are the basic economic problems?
- The resources are finite (scarcity)
- The desire for good and services is infinite (insatiable)
- No country treats all treatable ill health (no capacity to do so)
- Choice cannot be avoided (decision making)
what is opportunity cost?
The opportunity cost of an activity is the sacrifice in terms of the benefits forgone from not allocating resources to next best activity
what is efficiency in regards to health economics?
Economic efficiency is achieved when resources are allocated between activities in such a ways as to maximise benefit
what is economic evaluation?
- The method used to assess whether benefit is maximised – the assessment of efficiency
- Costs and effects are analysed in terms of their differences (increments)
- Asking: Are the incremental benefits of a new treatment worth the incremental costs?
what are the types of economic evaluation?
- Cost-effectiveness analysis (outcomes measured in natural units: incremental cost per life year gained)
- Cost-utility analysis (outcomes measured in quality adjusted life years: incremental cost per QALY gained)
- Cost-benefit analysis (outcomes are measured in monetary units: net monetary benefit)
what is equity?
Equity is concerned with the fairness or justice of the distribution of costs and benefits
There are opposing views about what is “fair” – difficult to quantify and very subjective
what is the difference between equity and equality?
equity is fair distribution of good and services based on individual needs
equality is fair distribution of good and services
