PPS Year 1 Flashcards

Question

Describe the physical, psychological and social consequences of obesity

Answer 1

The risk of death is massively increased ``` 6x of hypertension 85% increased asthmatic risk 4x arthritis Risk of all cancers Colon cancer (93% increase) 6x depression ``` High BMI is more predictive of death from Cardiovascular disease (men) Socially - unattractive - employees are less willing to take obese people on - lower college attendance

Answer 2

Developmental Model of Eating Behaviour Exposure - People show neophobia but this reduces after exposure Social learning - Importance of modelling and observation - Parental feeding styles and practices are important! Association - Food as the reward - Food and control- overt & covert differ Cognitive Model Beleifs + Percived Behavioural Norm, Subjective Norm + Attitude - Intention - Behaviour Weight Concern and Body dissatisfaction - Food being contrived as attractiveness, control and success - Body dissatisfaction related to dieting too

Answer 3

Biopsychosocial Approach - recognises social patterns, psychological and social factors and a patient-centred approach to the individual. - the wider focus on healthcare

Answer 4

Micro - lived experence Macro - explanations for the social structuring of patterns of health and disease found in Population Health Health - more than the absence of illness Dahlgren and Whitehead's (1991) model of social determinants of health - differences in disease progress - effectiveness of treatment

Answer 5

Felt Stigma - when your disability makes you feel socially rejected, shame Enacted stigma - perceived act i.e job interviewer views you poorly Enacted Stigma The social stigma that results from the attaching of a disease label Societal reactions which may produce actual discriminatory experiences Felt Stigma Result in an imagined social reaction or internalised sense of blame regarding the health condition which can drastically change a person's self-identity

Answer 6

1. Sociological research on lay health perspectives focuses on the socio-cultural meanings that underpin how people comprehend their experience of health and illness. 2. This research has shown us that individuals do know what affects their health but are restricted by the material means through which they can act on this information. 3. The two key models of lay beliefs are the health as functional capacity and health as disease candidacy models.

Answer 7

The health as the functional capacity model is a conceptualisation of health as the ability to function ‘normally’ within society. Health is the absence of disease. This is indicated by: 1) being able to fulfil social and work roles; 2) not taking time off work as a result of disease, and 3) sustaining a positive mindset and being able to cope, despite physical illness.

Answer 8

1. The health as disease candidacy model reflects lay explanations of both the relative risk of disease and the relative efficacy of preventive health behaviours. 2. This model is indicated by: 1) a retrospective assessment of one’s a propensity for disease based on characteristics such as physical appearance and behaviours; 3. 2) the idea that the occurrence of the disease is attributed to a purpose, beyond conventional logic.

Answer 9

This in large reflects the willingness of Drs to engage with and not be dismissive of patients' own health beliefs about disease risk and causality The consultation process in Dr and patient agree therapeutic decisions that incorporate their respective views but now includes patient support in medicine taking as well as prescribing communication Sensitivity to cultural differences Culture relates to social class and generational differences

Answer 10

Perception of Symptoms Accommodation to Symptoms Breakdown of Accommodation 1. Inter-personal crisis 2. Perceived interference with work activities 3. Percied interference with social activities 4. Others (wife) 5. Symptoms persist past the time set by the patient The decision to seek help 1. Lay referral system 2. GP 3. Self-medication A person’s response to symptoms of illness depends on their cultural values and beliefs concerning health (what is ‘normal’) . The decision to seek professional medical help is either promoted or delayed by social factors- lay referral system 3. Access to information online has extended the lay referral system

Answer 11

Risk - bad outcome occurring in relation to some event or behaviour Risk - social construct, quite different perceptions of what is a health risk by the public and clinicians Assessments of risk is routinely practised , i.e fall risks, risk of disease. In health prevention - based on an aggregation of statistical probabilities of a set of actions linked to disease outcome

Answer 12

1. It is the perspective that the hazardous environmental costs of industrialisation (e.g., carbon emissions) now outweighs the benefits and that technological ‘advancement’ is leading the world to environmental disaster 2. Through this theory, the risk becomes a category of societal fear, forcing people to confront the possibility of an uncertain future, and a present in which the objects of risk are perceived to penetrate all aspects of modern society. 3. It is this fear and uncertainty that risk assessment and management strategies are responding to. 4. A consequence of the risk society theory is that perception of risk begin to become highly selective – e.g., peanut allergy 5. Secondly, the thesis is used as a diversion away from individual willingness to limit health-risk behaviours; that is, since there are much greater levels of risk embedded within society, changes at the individual level seem pointless.

Answer 13

1. The social construction of risk theory acknowledges risk as a social construct, subjective in nature, and influenced by sociocultural environments. 2. The premise of the social construction: we create this shared value system in which we attribute meaning to familiar phenomena, in the midst of a background of social anxieties and uncertainties. 3. In this way, we routinely engage in risky behaviours (e.g., drinking, smoking, unprotected sex) without consideration or calculation of the actual risks posed (e.g., liver disease, cancer). 4. This can be explained by sociological research, which has shown that lay people tend to translate epidemiological analyses of risk into all-or-nothing messages. 5. As a result, preventative healthcare strategies face a challenge, since these all-or-nothing interpretations do not represent culturally-meaning knowledge – hence, the persistence of risky behaviours in the face of such strategies. Latent risk= to potential risks that are present but not immediately apparent or recognized. Extra-rational risk= to risks that are driven by factors beyond rational decision-making or traditional risk assessment methods.

Answer 14

CAPBESP Food Consumption - Consumes large portion sizes Individual Activity - passive entertainment, parental worry (no going gout), less focus on exercise in school Food Preparation - longer working hours (less preparation time) Individual Biology - slow metabolism Activity Environment - greater urbanisation reduces the opportunity for physical activity Cultural.Social Factors - rising demand for convenience food - Processed food is cheaper - Media influences choice - Social acceptance of obesity Individual Psychology - eat until full Cultural Shift into having less money and inflation increasing Working-Class Mothers - cheaper food Middle-Class Mothers - veg and diversity in meal Socio-economic factors play the biggest role - Family meals vs light grazing of food

Answer 15

- characteristically older age - Decline in mortality after the 19th Centruy - Rising Life Expectancy after WW2 - Degenerative disorders have progressively increased as medicine improves. 26 million in the UK have 1 LTC 10 million have 2 LTC 8 million have 3+ LTCs EQ-5D (Quality of life, health measurement) QL of LTC is much lower than without but has a relation to social and financial factors.

Answer 16

Crisis Approach (Labelling Theory) Doctor Labels Impairment/Disability Focuses on the societal reaction to living with a chronic illness (how other people react to your changing status) The label is attached and you cannot remove the diagnosis of chronic illness that irreversibly changes the status of the person Illness is a deviation (primary deviance) from the norm of health. After labelling, there is a behaviour change in response to changing status (secondary deviance). MS carries social meanings and implications. Changes to conform to these social meanings occur this is the secondary deviance. The label changes the way the person thinks about themselves and how they act. Altering the person’s self-regard and hence the degree of social participation. Basically a self-fulfilling prophecy ``` Restriction of activities + social role Negative labelling (enacted stigma) -- NEGATIVE SOCIAL VIEWS INFLUENCE Low self Esteem (felt stigma) Isolation and Withdrawn Lack of confidence and skills ``` CYCLIC Biological Disruption - over time chronic illness cause one to lose their self-identity ina s struggle to maintain normality. - the uncertainty of the nature of pre-existing relationships within familiar environments such as home or work - relationships challenges as you are left to renegotiate the meaning they can place on certain relationships who offer care) This is known as coping but obviously differs for each person.

Answer 17

When anaphylaxis is involved it begins to muddle the cause of death: - cardio-respiratory arrest - intubation required ASAP But unknown factors could be related to asthma or COPD

Answer 18

Death (routine mortality stats - ONS) Inpatient (routine admissions stats - NHS) Primary Care (GP data, RCOGP) Prevalence of Symptoms (Public Health - national surveys) Asymptomatic (Census ONS)

Answer 19

Random Allocation - eliminates allocation bias, minimises confounding and facilitates blinding Placebo/Control groups - ensure blinding, minimises assessor and response bias, minimises dropouts Sampling minimised selection bias or sampling bias. Blinding - enables comparison and assessors to be non-bias (reduces response bias) and fishing Single Blinding of Assessors - Removes/minimises selection and assessor biases Blinding of Participants - Removes selection bias, response bias

Answer 20

Observational Studies (observing no interference) - Cross-sectional study - Case-control study - Control longitudinal study Experimental Studies (interference) - Clinical Trial Study - Randomized controlled trial

Answer 21

Pros: - reflects causal relationships OR random error BUT not due to bias - elimination of bias - facilitates blinding Cons: - expensive in large samples - loss of participants over time

Answer 22

Parallel Group - both groups undergo 1 interference thus parallel 1 Control group and 1 intervention group Crossover Groups - both groups undergo the control and 1 interference Pros: - fewer patients required - more comparisons derived Cons: - disease may to be stable - not useful for Long Term effects - could be more drop outs

Answer 23

Stress - situation the average person would approve as threatening and exceeding their ability to cope) Stressors - external events that may cause stress Stress Reponses - behavioural, emotional, cognitive, physiological response to stress Strain - effect of stress on a person ``` Acute = rat Chonric = less libdo ``` Traumatic Stress - real physical threat or injury or death Non - Tramatic Stress -threat to social self, self identity, confidence, bereavement

Answer 24

Response to stress 1. Alarm - flight/fight 2. Resistance - defence or adapt as body deals with stress 3. Exhaustion - physiological resources are low, disease and death are more likely Disadvantages: - assumes stress of equal magnitude - assumes automatic response to external stressor - respond similar to some stresors - cognitive knowledge of information (convict escaped, patient A hear B did not. A is more scared when loud noises)

Answer 25

Life Change Model - accumulation of life events is too much - Starts to impact health - events given numerical value and added up - if results are high then this predisposes them to conditions Strengths - quantitiave - all along the same gradient in weight - takes individual note of events rather - accounts for accumulation stress Weaknesses - all same magnitude - people respond the same to similar stressors - not all events are bad (divorce) - assumes no recall bias

Answer 26

Stress viewed a dynmaic series of transactions between individual and environment - stress is a perception of events - appraise stressor - adopt coping strategy - re-appraise enlight of strategy Primary Appraisal - assessment of the stressor itself and the demands it makes - how important is it? Cost? Benefits? (assessment of stressor) Secondary Appraisal - internal appraisal (perceived individual resources to cope) - individual assessment of perceived resources required to cope Re-appraisal - evaluate how well coping strategies work Strengths - Lay referral system is a massive part of medicine - Personalises healthcare - Doesn't maintain similar magnitude - Indivudal cases Weaknesses - doesn't account for sudden stressors - people response same wat - pre-exisitng factors don't influence appraisal - response not always dependent on appraisal

Answer 27

Probelm Focused - stressor itself Behavioural - attept to control - escape - info seeking - problem solving Cognitive - ositive reappraisal - over-generalising Emotional Focus - emotional reaction Behavioural - seeking support - alcohol, smoking - exercise - distraction Cognitive - emotional expression - repression - denial

Answer 28

Work Stress - objective, subjective factors in work relationships that generaqte stress reactions Job Strain - high job demands, low job control High Levels of Work Stress - associated with sick leave, Cardiovascular disease + Depression and Anxiety Job Decision Latitude - authority and skill in your position

Answer 29

Proposes that job stress occurs when: 1. High job demand 2. Low job control 3. Low social support (colleague, bosses) Pros: - quantitiative data (correlates psychological well-being and physical health) Cons: - social factors treated as e all end all (someone enjopys high demand) - no mention of perception, cognition or reflection

Answer 30

Intention to Treat - analysis on the basis of randomisation to preserve non-bias - likely to underestimate effect of intervention (as includes non-compliance) - treatment polic rather than specific effect Per Protocol - caries out the analysis on the basis of treatment being take (compliance) - less likely to underestimate effect of intervention - may be BIAs (no. and determinants of dropouts) - subsidory analysis

Answer 31

Relative RIsk - ratio of absoulte risk of exposed/unexposed Absolute Risk - a measure of the risk of a certain event occurring Number Needed to Treat - is the number of patients you need to treat to prevent one additional bad outcome ``` Risk Ratio (intervention) = Certain Event/TOTAL Risk Ratio (placebo) = Certian Event/TOTAL ``` ``` Risk Ratio (intervention) -------------------------------------- = Relative Risk Risk Ratio (placebo) ``` Risk Differences (Absolute) = Risk Ratio (intervention) - RIsk Ratio (placebo) = -/+ Ve Intervention reduces certain event by - (- Ve) Intervention increased certain event by (+Ve) Number Needed to Treat = 1/Absolute Risk = Patients

Answer 32

Epidemiology - the study o the distrubition and determinants of disease frequency in human populations and the application of this study to control health problems Objectives: 1. study the natural history 2. identify patterns 3. extent of disease 4. causes and prevention Public Health - the science and art of preventing disease, prolonging life and promoting health through organsied efforts of society Objectives 1. promoting health in population 2. focus on prevention tactics and strategies (reduces alcohol consumption)

Answer 33

Public Health: 1. Promotes healthier lifetsyle 2. Support local authorities 3. Collect, orangise, anaylse ad improve on data 4. Target and focus on inequalities present in out healthcare system and society

Answer 34

Health Outcomes (changes in health status of an individual or group) 1. Determines the impact of the process of care or intervention 2. must be valid and responsive (well detailed)

Answer 35

Risk Factor - aspect of personal lifestyle/genetics associated with a disease Attributable Risk - extra risk due to exposure Relative Risk - ratio of absolute rate of exposed/unexposed Confounding - associatedwith risk factor without being a consequence or associated with the disease indepently of risk factor Incidence Rate - total new occurrences during follow up at risk

Answer 36

Incidence - new cases of disease that develop in a certain time interval (Royal College of GP) Primary Care basis Prevelance - Current cases (NHS in hospital, general admission stats)

Answer 37

VTE - Venous Thrombembolsion (DVT and PE) (1 every 37s in West dies) Numerical - weight - BP S/D - Prothrombin time - Age - No. long distance flights - No. of cigarettes smoked Categorical - Smoker? - Cancer? - Anticoagulation medication? - Blood Group Type Nominal - no natural order (A, AB, B, O-) Ordinal - natural order (1, 2, 3), (thin to fat)

Answer 38

Histograms (present data that is direclty comparitable and relative) - large number of values to plot - general If data is not normally distribute use median and quartiles. If data is normally distribute use means and SD. If mean > median = Positive skewness If mean < median = Negative skewness Mean +/- SD = 68% Mean +/- 2SD = 95%

Answer 39

CHECK BOOK.(last page)

Answer 40

CHECK BOOK.(last page)

Answer 41

Hypothesis testing is an act in statistics whereby an analyst tests an assumption regarding a population parameter To write a null hypothesis, first start by asking a question. Rephrase that question in a form that assumes no relationship between the variables. In other words, assume a treatment has no effect. Write your hypothesis in a way that reflects this.

Answer 42

The smaller the p-value, the stronger the evidence that you should reject the null hypothesis. A p-value less than 0.05 (typically ≤ 0.05) is statistically significant. It indicates strong evidence against the null hypothesis, as there is less than a 5% probability the null is correct

Answer 43

● A confidence interval calculated for a measure of treatment effect shows the range within which the true treatment effect is likely to lie A p-value is calculated to assess whether trial results are likely to have occurred simply through chance Confidence intervals are preferable to p-values, as they tell us the range of possible effect sizes compatible with the data. ● p-values simply provide a cut-off beyond which we assert that the findings are ‘statistically significant’

Answer 44

Becomes smaller as sample size increases.

Answer 45

Does the interval contain the value that implies no change / no effect / no association? - If the confidence interval is for a ratio measure, look to see if the interval contains 1.0 - If the confidence interval is for a measure of absolute change/difference look to see whether that interval includes zero 2. Is the confidence interval wide or narrow? - If it is narrow then the results are precise - If its wide then the results are imprecise - What are the upper and lower limits? (This ties in with clinical implications of any potential effect)

Answer 46

Does the interval contain the value that implies no change / no effect / no association? - If the confidence interval is for a ratio measure, look to see if the interval contains 1.0 - If the confidence interval is for a measure of absolute change/difference look to see whether that interval includes zero 2. Is the confidence interval wide or narrow? - If it is narrow then the results are precise - If its wide then the results are imprecise - What are the upper and lower limits? (This ties in with clinical implications of any potential effect)

Answer 47

P—protection of the injured area R—resting the injured area I—ice or other cold compress to the injured area C—compression to the injured area, not tight E—elevation of the injured area.

Answer 48

Blood Pressure ◦ Higher BP strongly associated with increased risk of CVD ◦ Statistical phenomenon of regression to the mean and accommodation means that BP lowers with repeated measurements ◦ With complications of HTN, risk of CVD rises seven-fold ◦ Prevalence of HTN increases with age and is more common in men ◦ Risk Factors: ↑BMI, ↑alcohol, ↑salt, ↑diet, ↓potassium, physical inactivity ◦ Low BP Populations: Hunter-gathers, ↓fat, ↓salt, ↓alcohol, ↓BMI, physical activity ◦ Causes of Secondary HTN: Aortic coarctation, renal disease, renal vascular disease, adrenal disease, pregnancy, drugs

Answer 49

VTE ◦ Incidence of ~1/100 per year, strong association with age ◦ Prognosis – 28-day mortality in 10% DVT and 15-20% PE ◦ VTE association with flying may be causal ◦ Not explained by confounding, consistent in different study types, dose-response relationship, biologically plausible ◦ Relative risk of flying is constant (~4x) ◦ Factors influencing baseline VTE risk: Age, pre-existing illness, recent recovery from surgery/ trauma, pregnancy smoking, obesity, oral contraceptives/HRT, inherited thrombophilia

Answer 50

Coronary Heart Disease ◦ Major global health problem, ~9mil deaths/year worldwide ◦ Major causes: Smoking, HTN, hyperlipidaemia (↑risk with each) ◦ Prevention is mainly achieved by reducing exposure/ altering pathogenesis ◦ Secondary prevention: Smoking cessation, dietary changes, risk-reducing medication ◦ Statins, B-blockers, ACE-inhibitors, anti-platelets (Combo = 70% risk reduction) ◦ Strong evidence that anti-platelets reduce relative risk by ~25% ◦ Not used for low-risk as side effects outweigh benefits ◦ Challenges to control – Strengthen population based strategies, increasing risks of obesity and T2DM, understanding social/ethical differences, rising epidemic in low income countries

Answer 51

The climate crisis is a health crisis because the changing climate has numerous impacts on human health. For example: Air quality: As temperatures rise, air pollution worsens, leading to increased rates of respiratory illness such as asthma and bronchitis. Extreme weather events: Climate change is causing more frequent and severe weather events, such as hurricanes, floods, and wildfires, which can cause injuries, displacement, and loss of life. Food and water insecurity: Changes in rainfall patterns and rising temperatures can lead to crop failures, water scarcity, and malnutrition. Spread of disease: Climate change is increasing the range and activity of disease-carrying insects such as mosquitoes and ticks, leading to the spread of diseases such as Lyme disease, dengue fever, and malaria. Mental health: The stress and trauma caused by climate change-related disasters and displacement can lead to mental health issues such as depression and anxiety.

Answer 52

Reduce environmental impact: Sustainable healthcare seeks to reduce the environmental impact of healthcare activities, such as energy use, waste generation, and water consumption. This can be achieved through the use of renewable energy, waste reduction and recycling, and the use of environmentally friendly materials. Promote social equity: Sustainable healthcare aims to promote social equity by ensuring that all individuals have access to quality healthcare regardless of their socio-economic status. This can be achieved through policies that reduce healthcare disparities and improve access to healthcare services for marginalized populations. Enhance public health: Sustainable healthcare seeks to enhance public health by promoting prevention and healthy lifestyles, reducing exposure to environmental toxins, and improving healthcare quality. Promote economic viability: Sustainable healthcare aims to promote economic viability by reducing healthcare costs and improving the efficiency of healthcare delivery. Foster collaboration: Sustainable healthcare recognizes that addressing complex health and environmental challenges requires collaboration across sectors and disciplines. Therefore, it seeks to foster collaboration between healthcare providers, policymakers, researchers, and community stakeholders.

Answer 53

Energy efficiency: Healthcare facilities can reduce their energy use and carbon emissions by adopting energy-efficient practices such as using LED lighting, implementing HVAC systems that reduce energy consumption, and upgrading to energy-efficient medical equipment. Renewable energy: Healthcare facilities can transition to renewable energy sources such as solar, wind, and geothermal to reduce their reliance on fossil fuels and reduce their carbon footprint. Waste reduction: Healthcare facilities can reduce their waste by implementing recycling programs and composting food waste. Medical equipment and devices can be reused or recycled instead of being disposed of after a single use. Sustainable transportation: Healthcare providers can use public transportation, walk, or bike to work instead of driving to reduce their carbon footprint. Additionally, healthcare facilities can encourage their patients and visitors to use public transportation or carpool to reduce the number of cars on the road. Sustainable food practices: Healthcare facilities can promote sustainable food practices by serving locally sourced, organic, and plant-based food options, which have a lower carbon footprint compared to meat-based products. Green building design: Healthcare facilities can adopt green building practices such as green roofs, rainwater harvesting, and natural ventilation systems, which can reduce energy consumption and improve indoor air quality.

Answer 54

1900’s and before - infectious diseases or war were the main cause of death (acute conditions such as TB and pneumonia)  1960s - degenerative diseases main cause of death (chronic conditions)  1990s - new infectious disease main cause of premature death  Today : contageous diseases and infections contribute minimally to illness and death in the Western World most deaths are caused by heart disease, cancer and strokes, diseases which studies suggest are a by- product of lifestyle  WHO (2004) - 65% of the world's population live in countries where overweight and obesity kills more people than underweight

PPS Year 1 Flashcards

(78 cards)