HYMS health and society year 4

How has the climate and ecological crisis worsened over the years leading to implications on public health? (2)

- Volatility and frequency of climatic events

- biodiversity loss

(both acute and chronic)

What are some examples of climatic events severe enough to implicate public health? (4)

- flooding

- heatwaves

- draught

- storms

How does the current climate and ecological crisis influence political and economical relaities? (2)

- economic volatility and rising inequity

- failure of political systems to address grand social challenges with respect to climate impacts and the day to day experiences of inequity and injustices

What consequences of the current climate and ecological crisis pose risks to children's health? (4)

- Food scarcity

- Forced migration

- Pollution/Sites of natural resource extraction

- Economic and political instability

How does food scarcity impact on children's health? (2)

- poor growth and development

- neurological/immune system under-development

How does forced migration impact on children's health?

mental health and wellbeing impacts of displacement

How does pollution/Sites of natural resource extraction impact on children's health?

insults to lung development

How does economic and political instability impact on children's health?

less economic stability for families and households- downstream impact on children (poverty and destitution, and little to no political agency)

What are protective factors for children's health?

- Food - healthy food availability, affordability, accessibility and acceptability

- Adaptation and mitigation to reduce forced migration whilst enabling climate refugees safe and dignified possibilities for safety and wellbeing

- Reducing and ending use of harmful extractive processes and products and working towards safe alternatives

- Economic justice - economic stability and prosperity for families, households and communities

What is the impact on household economic stability for children?

downstream (positive) impact on children (resources to thrive as they grow up and have a political voice in shaping decisions around their wellbeing)

How can you give relevant guidance to parents regarding caring for their newborn? (2)

- Direct them to NHS Inform e.g., advice on the care of a newborn

- Ensure they’re in touch with their named community midwife for follow up

How can you advise parents who are concerned about air pollution near their children's school?

- Offer them a leaflet on an upcoming community group meeting setting out families' demands to the local council for clean air zones near schools

As a healthcare professional if a mother mentions her worries about smog coming from the nearby power plant, what should you do? (2)

- Write them a letter to the local council

- Reach out to other health workers in the area who might have experienced a similar consultation

What are examples of children living in disadvantaged circumstances? (4)

- deprived areas,

- poor-quality housing

- overcrowded housing

- households with addiction e.g., smoking, alcohol

Children living in disadvantaged circumstances increase the likelihood of developing persistent asthma by how much? (%)

How much of this proportion is attributable to early life exposures (before children reach 3 years old)?

- 70%

- almost two-thirds, 59%

What is the impact of childhood asthma on primary care?

struggling to manage the demand for services

- poorly controlled asthma is increasingly becoming a concern for child health workers

What is important to remember about childhood asthma mortality?

almost entirely preventable

Where in the UK has the largest share of deprived neighborhoods?

Middlesborough

Where in the UK has the most deprived neighborhood?

Jaywick in Tendring (Essex)

Between 2020 and 2022, what percentage did UK billionaire wealth increase by?

20% - almost £150bn

What are inequities in political power regarding public health?

differential agency and capacity to participate in decisions about their health and the circumstances of their health

What are inequities in economic power regarding public health?

differential distribution of the material conditions needed for a healthy life

What are inequalities in social power regarding public health?

a society that advantages/disadvantages and opportunities for health along the axis of race, gender, class, disability etc

How is medicine and the healthcare system involved in healthcare inequalities?

medicine and the health system are being used to ‘address’ unjust social and economic policies and the inequitable political system that underpins them

How has childhood vaccination coverage changed over time?

UK childhood immunisation rates are in decline

- There has been a decline uptake in 13 out of the 14 routine vaccination measures for children in 2021-22

How many UK childhood vaccinations met the 95% target set by the World Health Organization (WHO)?

0

Regional uptake of routine vaccinations (MMR, Polio) was at its lowest where?

London

What are the burdens that young people will be left with in the future as a result of political institutions failing to address the general concerns of families and communities across the UK and beyond? (8)

concerns surrounding:

- the social contract

- sense of community

- trust in government and the public

- quality of life

- living standards

- inequality

- disinformation

- political and economic instability

How are healthcare professional's voices powerful when it comes to safeguarding children? (4)

- Health workers are witnesses to the injustice - people will listen if we shout for help and have tools to amplify the voice and alert authorities

- Health workers have high public trust - should not be taken for granted

- Health workers can interfere with some elements of the system - e.g., engaging decision-makers, supporting cases, Freedom of Information (FOI) requests etc

- Health workers mostly have some level of privilege that enables us to engage with these issues - We each have different levels of privilege that requires acknowledging and acting on

What is the role of healthcare professionals for advocating a healthy lifestyle in children and young people for the protection of their rights? (5)

- Bearing witness to their conditions and listening to their testimony

- Supporting tenants and members of the community, uplifting their voices to hold truth to power by building community power through facilitating a ‘Healthy Homes Hearing’ with impacted residents

- Collaborating with legal experts to mount a class action lawsuit against an unaccountable corporate landlord

- Participating in protests and securing local journalists and Channel 4 media to cover the issue adding pressure on the situation to be resolved

- Undertaking research on the impact of housing related moral distress on health workers to push for political and policy change

After healthcare professionals have bared witness to the publics conditions of living and listened to their testimonies, what else can they do? (3)

- write letters to the local authority PRS enforcement officers

- attend the LA public health board meeting to raise the concerns of renters

- provide comments in local and national journalism to apply further pressure on authorities

If a child discloses abuse, what are the steps that should be taken regarding safe-guarding?

1. statutory obligation to tell an appropriate agency, often discuss with senior/child protection doctor

2. then inform social services, police, or NSPCC = child at risk will have case conference

3 inform school, relevant doctors (paediatrician or GP) and family members

4. MDT to share concerns and identify risk and what to do to protect the child - draw up Child Protection Plan

What are the possible child protection agencies that can be informed when a child discloses abuse? (3)

- police

- social services

- NSPCC = national society for the prevention of cruelty to children

Which act ensures child safeguarding and promotion of their welfare?

How do they do this?

- Children's Act 1989

- Allocates duties to local authorities, courts, parents and other agencies in the UK

How was the Children's Act 2004 amended from the 1989 version in terms of child safeguarding?

- to state there is an obligation to share information and to co-operate to safeguard and promote the welfare of children

What does the Children's Act 2004 state about concerns over sharing information with others regarding safeguarding? (3)

- If there are concerns HCPs should obtain advice from designated professionals for safeguarding children

- This should be undertaken as soon as possible to ensure little delay to the safety of the young person

- If concerns are based on information given by a child, HCPs should explain to the child why they are unable to maintain confidentiality (reassure them they’ll be kept in the loop)

What is inflammatory arthritis?

includes a group of arthritis accompanied by joint pain, swelling, warmth, and tenderness in the joints, and morning stiffness that lasts for an hour

What typically causes septic arthritis? (2)

- trauma

- intravenous drug abuse

What are the sub types of crystalline arthritis? (3)

- gout

- pseudogout

- basic calcium phosphate disease

What are the subtypes of autoimmune inflammatory arthritis? (15)

- Rheumatoid arthritis - seropositive or seronegative

- Juvenile idiopathic arthritis

- Seronegative spondyloarthritis

- SAPHO syndrome

-Systemic lupus erythematosus

- Drug-induced lupus

- Sjogren syndrome

- Mixed connective tissue disease

- Systemic sclerosis

- Inflammatory myopathies

- Behcet's disease

- Vasculitis

- Sarcoidosis

- Relapsing polychondritis

- Palmar fasciitis and polyarthritis (PFPA) syndrome

What is the annual incidence of early inflammatory arthritis per 100,000 in adults?

115 to 271 per 100,000

What is the most common inflammatory arthritis?

gout

What is the most common autoimmune inflammatory arthritis?

rheumatoid

Overall which gender is more likely to develop inflammatory arthritis?

females

Which gender is more likely to develop systemic lupus erythematosus, Sjogren syndrome, gout and seronegative spondyloarthritis?

males

What are the 3 main steps in assessment of inflammatory arthritis?

- bloods

- synovial fluid analysis

- imaging

What bloods are investigated for inflammatory arthritis? (3)

- inflammatory markers (raised)

- FBC (Leukocytosis and Leukopenia)

- U&Es (Renal function)

What can be used to predict the trajectory of inflammatory arthritis i.e., SLE? (3)

- Short Form-36 physical (PCS)

- mental component summaries (MCS)

- adjusted mean SLEDAI-2000 (AMS)

What conclusions were made about the trajectory of SLE and quality of life? (3)

- High disease activity did not necessarily associate with low quality of life

- More patients with worse HRQoL trajectories had fibromyalgia

- Older age at diagnosis increased the probability of belonging to a class with low HRQoL trajectories

What is the non-reversible and reversible element of inflammatory arthritis?

- inflammation = reversible

- joint destruction = non-reversible

What does early treatment of inflammatory arthritis help prevent? (4)

- Disease persistence

- Disease progression

- Joint damage

- Disability

What can delay in treatment or misdiagnosis can lead to in inflammatory arthritis? (2)

- erosions

- permanent joint damage (aggressive, especially in septic arthritis)

For the best outcomes in patients with inflammatory arthritis, what is required?

MDT approach

What is medical pluralism?

- Coexistence of both conventional and complementary and alternative medicine (CAM) for health and illness

Who is involved in the MDT for inflammatory arthritis? (12)

- Internal medicine

- Orthopaedics

- Rheumatology

- Infectious diseases

- General Practice

- Pharmacists

- Physiotherapists

- Nursing team

- Occupational therapists

- Surgical team

- Podiatrist

- Psychologists

What are the 6 categories for patient support needs in inflammatory arthritis?

- Disease impact and the pharmacological treatment

- The importance of non-pharmacological treatment

- Support needs related to work issues

- Care continuity and relations with healthcare professionals

- The need for support from family and friends

- Contextual preferences for self-management support

What can enhance patient's self-management skills in inflammatory arthritis?

patients understanding the pros and cons of the anti-rheumatic treatment, long-term side effects, their treatment options and principles of treatment

What information is needed for patients to better understand the disease impact of inflammatory arthritis? (3)

- Support to manage the direct consequences of their arthritis such as disease activity, pain, flares, and comorbidities

- Information and support focusing on the long-term disease impact on everyday life and prognosis

- Guidance on decisions on pregnancy, children and sex life

How do you ensure care continuity and relations with healthcare professionals are maintained in inflammatory arthritis? (7)

- Knowing who to contact and when, in case of flares

- Building a trusting relationship

- Essential that healthcare professionals are easy to talk to, compassionate and showed empathy

- Support to manage the direct consequences of their arthritis such as disease activity, pain, flares, and comorbidities

- The importance of shared decision making

- A focus on individual support needs

- Appropriate and timely referral

Early in the disease course of inflammatory arthritis, what can its physical, psychological and social impact affect in patients?

self-identity and perception

In inflammatory arthritis for men, what did they feel was often overlooked in their treatment?

psychosocial support

What is the need for family/friend support in inflammatory arthritis?

patients relied on relatives' technical skills, practical assistance and emotional support, to enhance self-management

How does inflammatory arthritis affect family life?

affected patients relationships, including partnership, parenthood, and friendship, and might lead to emotional states, such as thankfulness or guilt

What are the support needs related to work issues in inflammatory arthritis? (4)

- How to manage fatigue at work

- Disclosure of the diagnosis and arthritis-related information to employers to improve understanding

- Newly diagnosed patients also had a need for support in occupational choices

- Maintaining work was crucial throughout the disease course in terms of one's identity, social relationships and everyday normality

What are the contextual preferences for self-management support in inflammatory arthritis? (4)

- Arthritis information and self-management advice should be easy to access at any time

- Online services should include different ways to support knowledge sharing

- The need for appropriate expectations

- The need for time to reflect on the information provided or educational interventions

How can online services for inflammatory arthritis support knowledge sharing? (3)

- one-to-one discussions with various HCPs

- Talks by researchers or lifestyle experts

- Educational sessions

What percentage of the adult population will have back pain at some point in their lives?

60%

What percentage accounts for non-specific lower back pain presenting in primary care?

90-95%

How many over 80 year olds report lower back pain?

1 in 4

What age range is lower back pain most common in?

40-80 years old

What gender is lower back pain most common in?

females

Globally, what is lower back pain the leading cause of?

years lived with disability

Which condition accounts for the greatest healthcare expenditures?

lower back pain

How is back pain classified?

What are the 3 main subtypes?

- according to duration

- acute

- sub acute

- chronic

Why is the duration based classification of back pain useful? (2)

- because the trajectory for improvement differs depending on symptom duration

- some therapies may differ in effectiveness depending on when they are administered

What is acute back pain?

What typically causes it?

- Sudden onset, lasting less that 4weeks

- caused by trauma or strain

What is subacute backpain?

- Occurs suddenly or over time, lasting between 4 and 12 weeks

- Considered a transition period between acute and chronic back pain

What is chronic back pain?

- Occurs suddenly or over time, lasting longer than 12 weeks and occurs daily

- People with chronic back pain often have little alleviation of their symptoms

What are people with chronic back pain at risk of? (2)

- long-term pain

- functional disability

What red flags of back pain suggest cancer of the spine or surround structure? (3)

- Known past or current cancer diagnosis

- failure to improve after 4weeks

- no relief with bed rest

What red flags of back pain suggest ankylosing spondylitis? (2)

- Pain lasting more than 3 months

- not relieved when the patient is supine

What red flags of back pain suggest compression fractures?

Corticosteroid use which may denote metabolic bone disease

What red flags of back pain suggest spinal abscess? (2)

- Recent history of intravenous drug use

- recent infection

What are the mechanical/structural problems related to back pain? (9)

- Sprain

- Strain

- Degenerative disc disease

- Herniated or ruptured discs

- Spondylolisthesis

- Spinal stenosis

- Fractured vertebrae

- Scoliosis

- Myofascial pain

What are the subgroups of physical/biological factors influencing back pain? (3)

- mechanical/structural problems

- inflammatory conditions

- other medical conditions

What are the inflammatory conditions related to back pain? (2)

- Ankylosing spondylitis

- Inflammatory arthritis of the spine

What are other medical conditions related to back pain? (8)

- Osteoporosis

- Fibromyalgia

- Kidney stones

- Endometriosis

- Infections of the bones of the spine and discs

- Pregnancy

- Rare tumours growing between the spine

- Metabolic bone disease

What is the definition of yellow flags in back pain?

Psychosocial factors associated with development of persistent disabling pain

What are the yellow flags of back pain? (8)

- Anxiety and/or depression

- Stressful life events including previous or current physical or emotional trauma

- Perceived risk of persistent pain

- Previous or current substance misuse

- Pain coping characterised by excessively negative thoughts about pain and the future ('catastrophizing')

- Maladaptive coping strategies and 'fear avoidance'

- Fatigue

- Sleep disturbance

What is 'fear avoidance' in back pain?

avoidance of work, movement, or other activities due to fear of exacerbating pain or damaging the back

What are the NICE guidelines on the biopsychosocial management of back pain?

Offer advice on exercise programmes, manual therapy, and/or psychological support, if a person has risk factors for a prolonged or complicated recovery following risk stratification

What is the risk stratification used for Biopsychosocial management of back pain?

University of Keele's clinician STarT Back resources

What is included in the University of Keele's clinician STarT Back resources? (4)

- patient questionnaire

- online calculator for use during a consultation

- a case study

- other training resources

What does a score of 3 or less suggest in Keele's clinician STarT Back resource?

low risk of chronicity

What does a score of 4 or more AND a subscore of 3 or less suggest in Keele's clinician STarT Back resource?

medium risk of chronicity

What does a score of 4 or more AND a subscore of 4 or more suggest in Keele's clinician STarT Back resource?

high risk of chronicity

What are the benefits of the STarT Back tool for back pain? (2)

- significant improvements in patients clinical outcomes (disability, work loss, pain)

- substantial cost-savings to the NHS

- 30% fewer sick certificates issued due to back pain

- 50% fewer days off work for patients due to back pain

What referral does NICE recommend for back pain?

Consider offering referral or self-referral to physiotherapy for manual therapy (spinal manipulation, mobilisation, or massage) as part of a treatment package including exercise

What referral does NICE recommend for back pain in patients with significant psychosocial barriers to recovery or where other treatments are ineffective?

Consider offering referral or self-referral for cognitive behavioural therapy (CBT) as part of a treatment package including exercise, with or without manual therapy

What is the evidence for osteopathic manipulative treatment (OMT) for patients with non specific lower back pain (LBP),and pregnant/postpartum women with LBP? (2)

- OMT had a significant clinically relevant effect on pain relief

- OMT had a significant effect on functional status