young adults Flashcards
list some behavioural risk factors in death
alcohol and drug use
dietary risks
tobacco smoke
low physical activity
list some metabolic risk factors in death
High BMI
High systolic blood pressure
High total cholesterol
High fasting plasma glucose
List some environmental risk factors
air pollution
occupational risks
WHAT IS THE ROLE OF PRIMARY CARE WORKERS WITH RESPECT TO EMPLOYMENT?
Prevention Occupational health Vaccinations Risk factor reduction Promoting baseline health Specific advice e.g. Covid-19, driving or infection
Fit notes and certification Suggesting amendments What position should GPs take when people request sick notes? Is there a conflict of interest? What if the doctor and patient disagree?
Treatment
Could work be a cause of ill health
presenting to them?
How is health impacting on work?
FIT NOTES AND SICKNESS CERTIFICATION
Doctor certification Opportunity for treatment Opportunity for prevention Opportunity for ‘reach in’ to working conditions Is the worker fit for work? Can they work full time and do all tasks? Would amended duties be suitable? Would reduced hours be suitable?
what are some inequalities in health caused by?
Genes Parental health Birth Childhood Educational opportunities Income Work Environment Individual behaviours Social behaviours – community Structural inequalities: race, disability, sexuality, gender, faith etc Access to health care
what are some reasons that umemployment occurs?
- Never worked – ill health, no skills or no jobs
- Macro Economic failure: redundancy
- Incompetence: employment terminated
- Ill-health unrelated to work
- Ill-health related to work
- Retirement
what are some health consequences of unemployment
- Depression
- Low self esteem
- Increased damaging health behaviours
- Increased cardiovascular risk
- Less likely to successfully engage with health promotion strategies
Increases with time of unemployment
FISCAL BENEFITS FOR PEOPLE ECONOMICALLY INACTIVE
Universal credit (previously JSA/ESA/HB/IS/WTC Personal independence payment (long term disability) Carer’s Allowance Attendance allowance (only one not means tested)
IMPACT ON INEQUALITIES & HEALTH:THE WORKPLACE
Race Disability Gender reassignment Sex Sexual orientation Faith Marriage and civil partnership Age
What are the positive impacts of work on physical health
Immediate – Mental health / Physical activity
Delayed – Income/Access to health care/ Physical Health/ Income / Mental health
What are the negative impacts of work on physical health
Immediate harm – injury, toxins, environmental exposures e.g. Covid19 assault.
Delayed harm – sedentary jobs, shift working, diet, mental health, injury, toxins.
Reduced access to health care
when was the health and safety at work act established?
1974
IMPACT OF HEALTH CARE ENVIRONMENT ON HEALTH WORKERS
Hazardous environment
Radiation
Infection
Chemical hazards
Physical risks Manual handling Confused patients/assault Lifting/slips Shifts
Interpersonal stressors
Moral distress
Income
Occupational health
what is the NHS Practioner health programme
free and confidential NHS Service for doctors and dentists with issues relating to a mental or physical health concern or addiction problem, in parrticular where these might affect their work.
depression - improving access to talking therapies.
steps
step 1 - Gp, practice nurse, recognises and assesses level of depression.
reffers to primary care team/primary care mental health worker. mild depression = watchful waiiting, guided self-help, brief psychologicsl interventions
moderate/severe = medication, psychological interventions, social support.
later steps for more severe / atypical psychotic depression referred to mental health specialists, including crisis team. treatment involves medication, complex psychological interventions, combined treatments.
mental health services in primary care?
Managing distress due to SMI Diagnose Signpost to services & wellbeing Treat Monitor Refer when needed Manage physical health & comorbidities Emergencies Chronic care
mental health services in secondary care?
Managing distress due to SMI Diagnose Treat Care co-ordination Decision making re use of Mental health law Refer back to primary care Living well network
SMI: EFFECTIVE SECONDARY CARE TREATMENTS
Admission (voluntary and compulsory) Medication/treatments Complex talking therapies Crisis management Case management incl. social support Early intervention
ADVANTAGES OF SMI MANAGEMENT IN PRIMARY CARE
De-stigmatizing Respect Maintaining dignity Longitudinal relationship Communication skills Integrated physical and psychological care Holistic approach Prescribing Managing physical consequences of SMI and treatment
what is SMR and how to calculate?
STANDARDISED MORTALITY RATIO = SMR
Observed death in a population
___________________
Expected deaths in a population
PHYSICAL HEALTH: CHALLENGES
Smoking: 30-50% of people with SMI smoke c/w ~ 20% general population
Recreational drug and alcohol use: 44% of people with SMI
Metabolic consequences of anti-psychotic medication: diabetes,
hypercholesterolaemia, obesity, hypertension.
Physical activity
Poor self care of chronic health conditions, and reduced uptake of health care
PHYSICAL HEALTH IN SMI
Current service:
Reduced use of preventive services e.g. bowel screening for people with SMI
Non-attendance
Increased rates of hospitalisation (especially emergency) for physical health problems
Challenge:
Lack of evidence base for preventive work in people with SMI e.g. smoking cessation
Motivating attendance for physical checks
Managing mental health conditions alongside physical health
PRIMARY CARE: ANNUAL PHYSICAL HEALTH CHECKS
CHECKS Mental health review: mental state, care, crisis management, carers Employment/Housing/Finances Efficacy and side effects medication Screening e.g. cervical or bowel Blood pressure Weight ECG Smoking status Bloods (Diabetes, cholesterol, kidney function, liver function, Vitamin D, full blood count) Physical activity
