Professional Documents
Culture Documents
Introduction
Health: A state of complete physical, mental and social well-being and not merely the absence of
disease or infirmity
Public Health: The science and art of preventing disease, prolonging life and promoting health
through the organized efforts of society, organizations, public and private, communities and individuals.
Biostatistics
Environmental health physical, chemical and biological agents; social economic and
cultural factors
Increasing trend for both male and female in HK [Female>Male because male has more
alcohol consumption and smoking behavior]
Preston Curve Increase in National Income per head, increase in life expectancy
Aging population
Health Behavior Indicators:
1.
Smoking Pattern
Decreasing trend in HK
Health Ethics: A set of moral principles that guide us in making medical care to solve conflicts on the
right action
Ethical Theories:
1.
Utilitarianism
A person ought to act so as to maximize utility to product the greatest balance of good over evil,
everyone considered
Maximize benefits and happiness, reduce sufferings greatest good for the greatest
number
Evaluate different paths of action and foresees the consequences of each action weigh
the good against the bad, considering the impact of the action on everyone whom it is likely to
affect
One may break the moral rule (e.g. do not kill) if it will produce greater balance of good
over evil
Problems:
Does NOT allow consideration of special relationship during decision making (e.g. parent
to child)
Conflicts of Duties
Prima Facie Duties: the more stringent duty in conflict-of-duty situation can be regarded as
the actual duty because there are no absolute or unconditional duties
Health care professionals respect patients autonomy and are uncomfortable with
paternalism
Paternalism is justified when:
Benefit provided or harm prevented outweighs the loss of independence and any other
benefits the patient seeks in taking the risks in question
Patients Rights: Right of information (understanding of sickness and treatment; chargers and drugs
usage etc.), refusal, confidentiality, complaints and medical reports
Informed Consent:
Agreement with the physicians recommendations after considering the risk associated
with plan of care
Mutual decision after taking initiative to discuss with patients about 1) nature of
treatment, 2) benefits, risks (Benefit-Risk Ratio) and consequences of intervention, 3)
alternative treatments
Respect patients autonomy; enhance patients well-being; fulfill legal requirements
Benefits
Problems
Engage patient in his own health
Do not understand medical information
Enhance patient-doctor relationship
Might not want to make decision individually
Thorough review on treatment options
Cannot anticipate reactions to future conditions
Reduce discontent and litigation during
Might make decisions that contradict their best
complications
interest
Standards of Competence: Abilities to comprehend and process information and to reason about the
consequences of ones actions
Understand treatment procedures, major risks and benefits, and make a decision in light of this
deliberation
Grey area exists in rival standards of incompetence
Surrogate Decision Marker: A person who will make crucial clinical decisions on behalf of the patient
when he is very sick or unable to communicate his desire about care
Durable power of attorney: assign another person authority to perform specified actions
on behalf of himself
Benefits
Drawbacks
Protect patient against harmful outcomes
Lack of explicit instructions
Reduce stress for families and health
Restricted to terminally ill case
professionals
Prior decision may not be best in current situation
Professional Obligation
Nonmaleficence: not to inflict evil or harm others (e.g. do not kill, cause pain, incapacitate, cause
offense)
Beneficence: prevent and remove harm/evil; do or promote good
Nonmaleficence is more stringent than beneficence when there is a conflict of duties
Distributive Justice: Fair, equitable and appropriate allocation of health care resources
Problems arise when scarcity and competition takes place to obtain goods or avoid
burdens
Theories of Justice:
A. Libertarian
Protect rights of property and liberty, allowing persons to improve their circumstances and protect
their own health on their own initiative
B. Communitarian
Emphasize the responsibility of the community to the individual and vice versa; services will be
provided to fulfill community-endorsed social goals
C. Egalitarian
Persons should receive an equal distribution of health care but not require equal sharing of all
possible social benefits fair equality of opportunity
Loss of privacy: Others obtain information about a person that he/she wants to keep inaccessible;
enters zones of secrecy, anonymity, seclusion, or solitude to be observed, touched, or intruded
upon against his/her wishes
Confidentiality: Limits on the dissemination of information disclosed by a person
Data shall be used for original stated or directly related purpose unless
prior consent given to subject
Data users should comply with above mentioned request within time limit
Handling of Confidential Information, Records and Property
Under no circumstances shall we use such information or records for personal gains
Exceptions to Confidentiality
Protect Patients
Child abuse
Elder abuse
Domestic violence
Unprofessional behaviours
Physical health
Mental health
Patient Safety: The absence of preventable harm to a patient during the process of health care
Every point in the process of care-giving contains a certain degree of inherent unsafety
Adverse events may result from problems in practice, products, procedures or system
5 Principles
Information
Choice & empowerment
Respect
Access and support
Involvement in healthcare
policy
Patient-Centred Healthcare
Patient Engagement
Involvement in healthcare policy
Expression of opinions (ask and be asked)
Patients complaints handling
Patients acquiring of information
Rainfall
Sea level
Extreme weather
events
Environmental refugee
Mental health conflict and war
Human insecurity
Injuries and death
*** Does NOT directly lead to earthquake or tsunami etc.
Help-seeking
Ozone (O3), particular matter, carbon monoxide (CO), nitrogen oxides (NO x), sulphur
dioxide (SO2), lead
Causes of air pollution: i) Natural sources (e.g. volcanic eruption, forest fires, dust storm),
ii) Human activities
Coal: one of the dirtiest fuels produces large amount of ash, CO2, SO2, NOx, sulphuric acid and arsenie
Historical events that raised social awareness on air pollution:
Warm and sunny climate helps form ozone and air pollutant
Major Air Pollutant
Sulphur
Dioxide
Formation
Source
Properties / Effects
Ships, especially
in container
(SO2)
terminals
Nitrogen
Oxides
(NOx)
Combination of nitrogen
and oxygen in varying
proportions at high
temperature
Motor vehicles
(buses and
trucks in
roadside), power
generation and
gas cooking
Ozone (O3)
Complex reactions
involving sunlight,
hydrocarbon and NO2
Air
Particulate
Matter
(PM)
[PMx, where
x = diameter
or less in
m]
Motor vehicles
Oxidation of H2SO3 to
H2SO4 further form sulphates SO42-,
found in PM
Irritates mucus
membranes in mouth, nose and throat
Elderly
Air pollution leads to deaths, illnesses of cardiovascular and respiratory system, poor
lung function and health problems in infants
Monitoring Air Quality
HK: EPD uses air quality monitoring stations routinely to monitor concentrations of air pollutants (SO 2,
NO2, O3 and PM10) based on Air Quality Objectives [Established in 1987 under Air Pollution Control
Ordinance]
Many countries have developed ambient air quality standards for the most harmful air
pollutants (SO2, SO42-, NO2, O3, CO, PM10, PM2.5 and H2S)
Air Quality Standards: Legal limits that identify the (i) maximum concentration level and (ii) time an
air pollutant can be present in air before it begins to cause health problems
Air Quality Guidelines: Produced by WHO in 2005
Solution
Inter-disciplinary efforts are required through utilizing expertise in urban planning, technology, policies,
public health, environmental health, and political will and public awareness
Antibiotics kill bacteria causing the illness, as well as good bacteria protecting the body
from infection
Drug-resistant bacteria (possibly mutated) are now allowed to grow and take over
[survival of fittest]
Some bacteria give their drug-resistance to other bacteria, causing more problems
Antibiotics must be used correctly (right drug, dose and time)
Impact of Resistance:
Longer duration of infectiousness, greater cost of treatment, pass on resistance genes to other
vulnerable hosts
Infectious Disease: Exposure Infection Disease
Epidemiologic Triad: (i) Agent (pathogen), (ii) Host, (iii) Environment [possible vector in between]
Single case may be reportable and 2 cases are sufficient to define an epidemic; deviation
from expected threshold
4. Outbreak Investigation
Establish a case definition Active surveillance Define population at risk Formulate hypothesis for
Useful for developing case definition and incubation times for illness
Types of outbreaks: (i) Point source, (ii) Continuous common source (iii) Propagated person to person
Case Control Study
A group with disease compared to a group without disease
Rarely cured completely; may have fluctuations in disease course; may need add-on
therapy with time; lifestyle factors usually play a major role
High prevalence: many leading causes of death in the world are NCDs [2/3 deaths]
Physical inactivity, harmful use of alcohol, tobacco use, unhealthy diet lead to NCD
Aging population
Westernization and urbanization - westernization of Asian Eating Practice, increased
inflammatory bowel disease
Depression
people at higher risk of chronic disease are less likely to undergo health check
Strategies to control NCDs
Upstream Parable: repair the bridge before it actually falls down prevention more important than
cure
Definition
Example
Primary
Prevent altogether the development
- Health education (smoking
Prevention
of a disease process by reducing the
cessation campaign)
risk factors
- Prophylaxis (vaccination &
immunization)
- Sanitation
Secondary
Early diagnosis of disease at a pre- Screening (population-based
Prevention
symptomatic stage followed by
cervical cancer screening
prompt and effective treatment
programme)
- Periodic assessment of BMI
Tertiary
Minimize harmful effects after
More meticulous monitoring of
Prevention
detecting disease
hypertension to reduce the risk of endorgan damage
Telomere: non-gene DNA at the ends of DNA strands in chromosomes, which are shortened during
DNA replication, cell division and DNA damage
Entire loss in telomere would cause the cell to stop replicating or cell death
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Hospital Authority (HA) established in 1990 to facilitate management and distribution of hospital
beds
Hong Kong Academy of Medicine (HKAM) established in 1993 to foster development of
postgraduate professional training and set standards
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