1 Flashcards
3 domains of public health
- health promotion - eg. inequality/housing
- health protection - eg. infectious disease prevention
- improving services - eg. audits/evaluation/efficiency
sociological perspectives on needs (Bradshaw’s needs)
- Felt need - individual perceptions of variation from normal health
- Expressed need - individual seeks help to overcome variation in normal health (demand)
- Normative need - professional defines intervention appropriate for the expressed need
- Comparative need - comparison between severity, range of interventions and cost
advantages of epidemiological approach to health needs assessment
- uses existing data
- provides data on disease incidence/mortality/morbidity
- can judge services on results over time
disadvantages of epidemiological approach to health needs assessment
- variable quality of data
- data collected may not be appropriate
- does not consider felt needs/experiences of those affected
cohort study
- Longitudinal study in similar groups but with different risk factors/treatments.
- Follows up over time
advantages of cohort study
- follow up
- identify risk factors
- confounders identified prospectively
disadvantages of cohort study
- large sample size required
- people drop out
- impractical for rare conditions
- expensive
case control study
- Observational study looking at cause of a disease
- Compares similar participants with disease and controls without
- Looks retrospectively for exposure/cause
advantages of case control study
- fast
- good for rare outcomes
disadvantages of case control study
- hard to find well-matched controls
- prone to selection bias
- prone to information bias
cross sectional study
- Observational study collecting data from a population and a specific point in time
- A snapshot of a group
advantages of cross sectional study
- Large sample size
- Provides data on prevalence of risk factors and disease
- Fast
- Repeated studies show changes over time
disadvantages of cross sectional study
- Risk of reverse causality – which came first?
- Less likely to include those who recover quickly or short recovery
- Not useful for rare outcomes
randomised controlled trial
similar participants randomly allocated to intervention or control group to study effect of intervention
disadvantages of RCTs
- High group drop out rate
- Ethical issues
- Time consuming and expensive
number needed to treat
1/attributable risk(aka risk difference)
what can association be due to?
- Bias
- Chance
- Confounding
- Reverse Causality
- True association
definition of bias
A systematic error that results in a deviation from the true effect of an exposure on an outcome
Bradford Hill causality criteria
1) temporality = exposure occurs before outcome
2) dose response = more exposure = inc risk of outcome
3) strength = stronger association (relative risk) = less chance due to something else
4) reversibility = take away exposure = reduces risk of outcome
5) consistency = pattern seen in different study types and different backgrounds/communities (reproducible)
6) plausibility = existence of a mechanism to explain cause and effect
7) coherence = consistency with other info
8) analogy = similarity with other cause/effect relationships
9) specificity = relationship is specific to outcome of interest
stages of planning cycle for health services
1) needs assessment
2) planning
3) implementation
4) evaluation
define a need
- the ability to benefit from an intervention
advantages of comparative approach
- take 2 or more different areas and compare their different services and their provision, utilisation, success, users background, etc.
- fast and cheap to do
- with limited resources, can decide what to continue or change
disadvantages of comparative approach
- May not yield what the most appropriate level
e.g. of provision or utilisation should be - Data may not be available
- Data may be of variable quality
- May be difficult to find a comparable
population
advantage of corporate approach
- listen to opinions of everyone involved, see where most need is
- suggestions that may not have been considered
- compromises made
disadvantages of corporate approach
- May be difficult to distinguish need from demand - Groups may have vested interests - May be influenced by political agendas - Dominant personalities may have undue influence
determinants of health
- Genes
- Environment
>Physical environment
>Socioeconomic environment - Lifestyle
- Health care
examining health equity - take into account…
- supply of health care
- access to health care
- utilisation of health care
- health care outcomes
- health status
- resource allocation
- wider determinants of health
primary prevention definition
actions to reduce the incidence of disease and health problems within the population
either through:
- universal measures that reduce lifestyle risks and their causes
- targeting high-risk groups
secondary prevention definition
systematically detecting the early stages of disease and intervening before full symptoms develop
tertiary prevention definition
Softening the impact of an ongoing condition by helping people manage long-term, complex health problems (e.g. chronic diseases, permanent impairments) in order to improve as much as possible their quality of life and their life expectancy
domestic abuse definition
Any incident or pattern of incidents of controlling, coercive, threatening behaviour, violence or abuse between those aged 16 or over who are, or have been, intimate partners or family members.
domestic abuse agencies
MARAC - multi agency risk assessment conference
IDVA - independent domestic violence advisors
health behaviours
- Health behaviour = behaviour aimed to prevent disease (eg. healthy eating)
- Illness behaviour = behaviour aimed at seeking remedy (eg. go to doctor)
- Sick role behaviour = behaviour aimed at getting well (eg. taking meds/rest)
health belief model - factors
1) perceived susceptibility to ill health
2) perceived severity of ill health
3) perceived benefits of behaviour change
4) perceived barriers to taking action
approaches to prevention
- Population approach – preventative measure eg. dietary salt reduction through legislation to reduce bp
- High risk approach – identify individuals above a chosen cut off and treat – eg. screening for high bp
what is the prevention paradox?
A preventive measure which brings much benefit to the population often offers little to each participating individual
addiction
- craving
- tolerance
- compulsive drug-seeking behaviour
- physiological withdrawal state
modalities of treatment for drug abuse
- harm reduction
- detoxification (buprenorphine)
- maintenance (methadone/buprenorphine)
- relapse prevention (naltrexone)
- psychological interventions
benefits of methadone/buprenorphine as maintenance
- Significantly reduces mortality
- Reduces drug-related morbidity
- Reduces crime
- Reduces risk-taking behaviour and spread of blood-borne viruses
- Evidence that this can be done safely without increasing iatrogenic mortality
mechanism of action of cocaine
blocks reuptake of serotonin and dopamine at synapse = pleasurable sensation
unrealistic optimism
Individuals continue to practice health damaging behaviour due to inaccurate perceptions of risk and susceptibility
Maxwell’s dimensions of quality
- Effectiveness
- Efficiency
- Equity
- Acceptability
- Accessibility
- Appropriateness
donabedian approach
- Structure = buildings/staff/equipment
- Process = patients seen/number of procedures
- Outcome = mortality/QoL/satisfaction
models of behaviour change
- Health Belief Model
- Theory of Planned Behaviour
- Stages of Change/Transtheoretical Model
- Social norms theory
- Motivational Interviewing
- Social Marketing
- Nudging
- Financial Incentives
theory of planned behaviour
- A persons attitude to the behaviour
- The perceived social pressure to undertake the behaviour, or subjective norms
- A persons appraisal of their ability to perform the behaviour, or their perceived behavioural control
disadvantages of theory of planned behaviour
- lack of temporal element
- lack of direction or causality
motivational interviewing
- counselling approach for initiating behaviour change by resolving ambivalence
nudging
Nudge the environment to make the best option the easiest – eg. opt-out schemes such as pensions, placing fruit next to checkouts
typical transition points for behaviour change
– leaving school – entering the workforce – becoming a parent – becoming unemployed – retirement and bereavement
maslow’s hierarchy of needs
- self-actualisation
- esteem
- love/belonging
- safety
- physiological
how do asylum seekers live day to day?
- No choice dispersal
- Vouchers/70% of income support sum
- NASS support package
- Full access to NHS
- Not allowed to work
Humanitarian protection
failed to demonstrate claim for asylum but face serious threat to life if returned - lasts 3 years then reapply
classification of error
- intention
- action
- outcome
- context
methods to reduce error
- Simplification and standardisation of clinical processes
- Checklists and aide memoires - SBAR
- Information technology
- Team training
- Risk management programmes
- Mechanisms to improve uptake of evidence based Tx patterns
types of leader
- Inspirational = energising + motivating for change
- Transactional = reward + punishment
- Laissez-faire = people excel when left to their responsibilities
- Transformational = work with team to identify changes needed
examples of errors
- sloth
- fixation
- communication breakdown
- playing the odds
- mis-triage
- system error
- probability assessment
approach to learning - tripartite model
- superficial = fear of failure
- strategic = desire to be successful
- deep = intrinsic + finding links, full understanding
Kolb’s learning cycle/types of learner
- activist - experience
- reflector - review
- theorist - conclusions from experience
- pragmatist - improvements to make
ethnocentrism
tendency to evaluate other groups according to the values and standards of own cultural group, especially with the conviction that own cultural group is superior to the other groups
egalitarian - resource allocation
provide all care that is necessary and appropriate to everyone
maximising - resource allocation
criteria that maximize public utility
libertarian - resource allocation
each is responsible for their own health, well being and fulfillment of life plan
stages of wound healing
- vascular response
- inflammatory response
- proliferation
- maturation
Alginate
- highly exudative wound (use for ~4 days)
hydrogel
- rehydrates dry necrotic tissue
hydrocolloid
- low to moderate exudative
- sloughy/necrotic
PDSA cycle
- plan
- do
- study
- act
example of an absolute right
the right to be free from inhuman and degrading treatment (article 3)
example of a limited right
the right to life (article 2)
example of qualified right
the right to respect for privacy and family life (article 8)
