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3a Public and Community Health > 3a Public Health > Flashcards

3a Public Health Flashcards

1
Q

DETERMINANTS, EQUITY AND INTERVENTIONS

Define Horizontal Equity

A

Equal treatment for equal need

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2
Q

DETERMINANTS, EQUITY AND INTERVENTIONS

Define Vertical Equity

A

Unequal treatment for unequal need

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3
Q

DETERMINANTS, EQUITY AND INTERVENTIONS

What are the 3 domains of public health?

A
  • Health improvement
  • Health protection
  • Health care
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4
Q

DETERMINANTS, EQUITY AND INTERVENTIONS

Give the 3 levels at which interventions can operate and an example of each

A
  • Individual level e.g childhood immunisation
  • Community level e.g park for local area
  • Ecological/ population level e.g clean air act (legislation) to prevent smoking in public places
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5
Q

DETERMINANTS, EQUITY AND INTERVENTIONS

Give the 3 types of prevention and an example of each

A
  • Primary prevention (preventing the disease before it occurs) e.g immunisations
  • Secondary prevention (reducing the impact of a disease, ‘pre-clinical’ disease) e.g SCREENING
  • Tertiary prevention (softening the impact of a disease, ‘clinical disease’) e.g stroke rehab
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6
Q

HEALTH NEEDS ASSESSMENT

Define ‘need’

A

The ability to benefit from an intervention

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7
Q

HEALTH NEEDS ASSESSMENT

Define ‘health needs assessment’

A

A SYSTEMATIC method for REVIEWING health issues facing a population ………….. leading to agreed PRIORITIES and RESOURCE ALLOCATION that will improve health and reduce inequalities

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8
Q

HEALTH NEEDS ASSESSMENT

The Sociological Perspective (Bradshaw) described 4 types of ‘need’ - define them

A

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 expressed need

COMPARATIVE NEED = comparison between severity, range of interventions and cost

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9
Q

HEALTH NEEDS ASSESSMENT

The Public Health Approach can take on 3 different forms, what are they?

A
  • Epidemiological
    (does not consider felt needs)
  • COMPARATIVE
    (may not yield what most appropriate level should be)
  • Corporate
    (not to do with corporations, about obtaining the views of a range of stakeholders)
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10
Q

EVALUATION OF HEALTH SERVICES

Define ‘evaluation’

A

The assessment of whether a service achieves its objectives

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11
Q

EVALUATION OF HEALTH SERVICES

What is a ‘health economic evaluation’?

A

Incorporates a systematic review, economic evaluation and mathematical modelling

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12
Q

EVALUATION OF HEALTH SERVICES

What is Donebedian’s (2005) framework?

A
  • STRUCTURE
  • PROCESS
  • (output)
  • OUTCOME
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13
Q

EVALUATION OF HEALTH SERVICES

What is the ‘ 5 D’s’ tool?

A 
Death 
Disease 
Disability 
Discomfort 
Dissatisfaction
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14
Q

EVALUATION OF HEALTH SERVICES

What does PROM stand for?

A

Patient Reported Outcome Measure

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15
Q

EVALUATION OF HEALTH SERVICES

What does CART stand for?

A
  • Completeness
  • Accuracy
  • Relevance
  • Timeliness
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16
Q

EVALUATION OF HEALTH SERVICES

What are ‘Maxwell’s Dimensions of Quality’?

(hint: 3Es, 3As)

A

3 E’s 3 A’s

  • effectiveness
  • efficiency
  • equity
  • acceptability
  • accessibility
  • appropriateness (relevance)
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17
Q

EPIDEMIOLOGY RECAP

Define epidemiology

A

The study of the frequency, distribution and determinants of diseases and health related states in populations, in order to prevent and control disease

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18
Q

EPIDEMIOLOGY RECAP

Define incidence

A

new cases

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19
Q

EPIDEMIOLOGY RECAP

Define prevalence

A

existing cases

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20
Q

EPIDEMIOLOGY RECAP

Define ‘person-time’

A

A measure of time at risk, used to calculate incidence:

number of persons becoming cases in a given time / total person-time at risk during this period

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21
Q

EPIDEMIOLOGY RECAP

Define absolute risk

A

Gives a feel for actual numbers e.g has units

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22
Q

EPIDEMIOLOGY RECAP

Define relative risk

A

Risk in one category relative to another - no units

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23
Q

EPIDEMIOLOGY RECAP

Define attributable risk

A

Rate of disease in exposed which may be attributed to exposure

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24
Q

EPIDEMIOLOGY RECAP

Define bias

A

Systematic deviation from the TRUE ESTIMATION of the association between exposure and outcome

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25
Q

EPIDEMIOLOGY RECAP

Define confounding

A

Situation where a factor is associated with the exposure of interest and independently influences the outcome

(but does not lie on causal pathway)

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26
Q

EPIDEMIOLOGY RECAP

What are the 9 Bradford-Hill criteria for causality?

A
  • STRENGTH of association
  • DOSE-RESPONSE
  • CONSISTENCY
  • TEMPORALITY
  • REVERSIBILITY
  • Biological PLAUSABILITY
  • COHERANCE
  • ANALOGY
  • SPECIFICITY
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27
Q

EPIDEMIOLOGY RECAP

If an association is not causal, what 4 things could it be due to?

A
  • chance
  • bias
  • confounding
  • reverse causality
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28
Q

EPIDEMIOLOGY RECAP

What is a cohort study?

A
  • Take people WITHOUT the disease
  • Who were and were not exposed (e.g natural disaster)
  • Assess whether they get the disease

USEFUL FOR RARE DISEASES!

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29
Q

EPIDEMIOLOGY RECAP

What is a case-control study?

A
  • Cases = people WITH disease
  • Control = people WITHOUT disease
  • LOOK BACK for both groups and see who was exposed

(by definition RETROSPECTIVE)

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30
Q

EPIDEMIOLOGY RECAP

What 2 forms can ecological studies take on?

A
  • Geographical (and prevalence of disease)

- Looking at time-trends (and prevalence of disease)

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31
Q

EPIDEMIOLOGY RECAP

How do you calculate an odds ratio?

A

Odds of exposure in cases / odds of exposure in controls

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32
Q

SCREENING & PREVENTION RECAP

What is the prevention paradox (Rose, 1981) ?

A

A preventative measure which brings much benefit to the population often offers little to each participating individual

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33
Q

SCREENING & PREVENTION RECAP

Define screening

A

A process which sorts out apparently well people who probably have a disease (or precursors/ susceptibility) from those who probably do not

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34
Q

SCREENING & PREVENTION RECAP

What are the Wilson and Junger screening criteria?

A
  • CONDITION (important, has pre-clinical phase, natural hx known)
  • TEST (sensible, specific, inexpensive, acceptable)
  • TREATMENT (effective, agreed policy on who to treat)
  • ORGANISATION & COSTS (facilities, cost vs benefit, ongoing process)
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35
Q

SCREENING & PREVENTION RECAP

Define sensitivity

A

Proportion with the disease correctly identified by screening test

36
Q

SCREENING & PREVENTION RECAP

Define specificity

A

Proportion without disease correctly excluded by the test

37
Q

SCREENING & PREVENTION RECAP

Define PPV

A

Proportion with positive test result who actually have the disease

(are dependent on underlying prevalence)

38
Q

SCREENING & PREVENTION RECAP

Define NPV

A

Proportion with negative test result who do not have the disease

39
Q

SCREENING & PREVENTION RECAP

Define lead-time bias

A

Survival time appears longer due to earlier diagnosis

40
Q

SCREENING & PREVENTION RECAP

Define length-time bias

A

Overestimation of survival duration due to relative excess of detected asymptomatic slow progressing cases

(e.g comparing less aggressive with more aggressive cancers)

41
Q

SCREENING & PREVENTION RECAP

Give 5 examples of Health Promotion Campaigns

A
  • ‘Healthier You’ diabetes prevention
  • “Change 4 Life’ 5 a day
  • Every Mind Matters
  • Stoptober

(- Promoting screening and vaccination)

42
Q

HEALTH PSYCHOLOGY

Give the 3 health behaviours with an example of each

A
  • Health Behaviour - aimed at preventing disease (e.g eating healthily)
  • Illness Behaviour - aimed at SEEKING REMEDY (e.g going to GP)
  • Sick Role Behaviour - actively aimed at GETTING WELL (e.g rest, taking mediation)
43
Q

HEALTH PSYCHOLOGY

What is ‘Unrealistic Optimism’ (Weinstein, 1983) ?

A

Individuals continue to practice health damaging behaviour due to inaccurate perceptions of risk and susceptibility

44
Q

HEALTH PSYCHOLOGY

What factors influence unrealistic assessment of risks?

A
  • lack personal EXPERIENCE with problem
  • belief preventable by PERSONAL action
  • belief that if its not happened BY NOW, its unlikely to
  • belief that the problem is INFREQUENT
45
Q

HEALTH PSYCHOLOGY
(SMOKING CESSATION)

Is treating tobacco dependency part of a Drs job?

A

Yes

46
Q

HEALTH PSYCHOLOGY
(SMOKING CESSATION)

Is smoking simply ‘a patient’s personal choice’?

A

No - tobacco dependency is seen as a medical condition that can be treated

47
Q

HEALTH PSYCHOLOGY
(SMOKING CESSATION)

What is the general HCP stance on vaping?

A

‘If you cant stop - swap’

48
Q

HEALTH PSYCHOLOGY
(SMOKING CESSATION)

Demographically who is most likely to smoke?

A

Young men living in poverty

smoking identified as single biggest cause of inequality in death rates between rich and poor in UK

49
Q

BEHAVIOUR CHANGE

Give the 4 stages of the Health Belief Model
Becker, 1974

A

Individuals will change if they:

  • believe it has SERIOUS CONSEQUENCES
  • believe they are SUSCEPTIBLE
  • believe TAKING ACTION reduces susceptibility
  • believe benefits of taking action OUTWEIGH costs

(perceived barriers most important factor)

50
Q

BEHAVIOUR CHANGE

Give 4 critiques of the Health Belief Model (Becker, 1974)

A
  • Alternative factors may predict health behaviour e.g outcome expectancy, self efficacy
  • Does not consider emotions
  • Does not differentiate first time vs repeat
  • CUES TO ACTION (internal or external) often missing
51
Q

BEHAVIOUR CHANGE

Give the 3 factors in the Theory of Planned Behaviour (Ajzen, 1988)

A

INTENTION determined by:

  • Individual ATTITUDE to the behaviour
  • SUBJECTIVE NORM
  • PERCEIVED BEHAVIOURAL CONTROL!!!!!!!
52
Q

BEHAVIOUR CHANGE

What is one of the main problems with the Theory of Planned Behaviour (Ajzen, 1988) and give 5 ways in which this be overcome?

A

People tend to fail to act on their intentions

  • Perceived control
  • Anticipated regret
  • Preparatory actions
  • Implementation intentions
  • Relevance to self
53
Q

BEHAVIOUR CHANGE

Give 6 general critiques of the Theory of Planned Behaviour (Ajzen, 1988)

A
  • No temporal element - lack of direction or causality
  • Does not consider emotions
  • Does not explain how factors in model interact
  • Habits and routines undermine the model
  • Assumes all aspects can be measured
  • Relies on self-reporting
54
Q

BEHAVIOUR CHANGE

Give the 5 stages of the Transtheoretical Model (Prochaska & DiClemente, 1984)

A
  • Pre-contemplation
  • Contemplation
  • Preparation
  • Action (relapse)
  • Maintenance

(results inconclusive re whether this model actually works)

55
Q

BEHAVIOUR CHANGE

What are some good things about the Transtheoretical Model (Prochaska & DiClemente, 1984) ?

A
  • acknowledges individual stages
  • accounts for relapse
  • temporal element
56
Q

BEHAVIOUR CHANGE

What are some bad things about (critiques of) the Transtheoretical Model (Prochaska & DiClemente, 1984) ?

A
  • Not all will move through the stages linearly (might be more of a continuum)
  • Does not account for values, habits, culture, social factors, economic factors
57
Q

BEHAVIOUR CHANGE

Apart from the ‘big 3’ give 2 more examples of behaviour change techniques

A
  • Motivational Interviewing (Miller, 1996) (counselling approach, initiating behaviour change by resolving ambivalence, clinical impact in problem drinkers)
  • Nudge theory (weak evidence can improve population health alone)
58
Q

BEHAVIOUR CHANGE

What are some more general factors to consider when formulating a behaviour change model?

A
  • personality traits
  • risk perception
  • past behaviours/ habits
  • automatic influences
  • predictors of maintenance
  • social environment
59
Q

BEHAVIOUR CHANGE

NICE state that interventions should ‘work in partnership with individuals, communities, organisations and populations’ - give the 5 typical transition points in life

A
  • leaving school
  • entering the workforce
  • becoming a parent
  • becoming unemployed
  • retirement and bereavement
60
Q

FOOD AND BEHAVIOUR (RECAP)

Give some factors contributing to the promotion of excessive energy intake

A
  • genetics
  • employment/ shift work
  • early developmental factors
  • TV (viewing and ads)
  • characteristics of food (energy density, macronutrient composition, satiety and satiation, portion sizes)
  • reduced physical activity
  • sleep
  • environmental cues
  • psychological factors
61
Q

FOOD AND BEHAVIOUR

Define malnutrition

A

Deficiencies, excesses or imbalances in a person’s intake of energy and/or nutrients. Covering 2 broad groups.

Undernutrition - stunting, wasting, underweight, micronutrient deficiencies

Overweight, obesity and diet related non-communicable disease

62
Q

FOOD AND BEHAVIOUR

Many chronic medical conditions require nutritional support. Explain what ‘diabulimia’ and ‘sarcopenic obesity’ are

A
  • diabulimia = when T1 DM patients stop taking their insulin in order to loose weight
  • sarcopenic obesity = age-related loss of muscle mass (often in older adults) often accompanied by increase in adipose tissue
63
Q

FOOD AND BEHAVIOUR

How is early flavour exposure experienced in utero and in infancy?

A

BREAST MILK AND AMNIOTIC FLUID:

  • taste and olfactory systems capable of detecting flavour information prior to birth
  • swallowing of sig amount amniotic fluid
  • amniotic fluid and milk transmit volatiles
  • garlic makes amniotic fluid smell stronger

(and infant will have a greater preference for these flavours)

64
Q

FOOD AND BEHAVIOUR

What demographic group is least likely to breast feed?

A

Very young, SE disadvantaged mothers (2010 Infant Feeding Survey)

65
Q

FOOD AND BEHAVIOUR

What different components make up breast milk?

A
  • Colostrum, foremilk, hindmilk
  • Enzymes, transfer factors, gut protection, anti-infective, everyday health
  • Composition/ taste varies throughout day
66
Q

FOOD AND BEHAVIOUR

What 3 positive impacts can breastfeeding have on the child’s future diet and dietary behaviours?

A
  • acceptance of novel foods during weaning
  • less picky eaters in childhood
  • have diet richer in fruit and vegetables if BF > 3m
67
Q

FOOD AND BEHAVIOUR

Does coercion and persuasion regarding children and trying new foods help?

A

No - it usually increases liking for reward food and reduces liking novel food

68
Q

FOOD AND BEHAVIOUR

What 7 things can parents do to help with developing healthy eating behaviours?

A
  • modelling ‘healthful’ eating behaviours
  • RESPONSIVE feeding
  • providing VARIETY
  • restriction and authoritative parenting
  • avoiding pressure to eat
  • not using food as a reward
  • avoid indulgent/ neglectful feeding practices
69
Q

FOOD AND BEHAVIOUR

In what aged children do NOFDs usually occur and what approaches have the parents usually tried?

A

Non organic feeding disorders = CHILDREN UNDER 6, aversion, fussy, failure to advance to age appropriate foods, parents often use MALADAPTIVE FEEDING PRACTICES

70
Q

FOOD AND BEHAVIOUR

What are the 4 eating disorders laid out in the DSM-V?

A
  • anorexia nervosa
  • bulimia nervosa
  • binge eating disorders
  • OSOED (other specified or eating disorder)
71
Q

FOOD AND BEHAVIOUR

Define eating disorder

A

Clinically meaningful behavioural or psychological pattern,

having to do with eating or weight,

that is associated with DISTRESS, DISABILITY

or with substantially increased risk of morbidity and mortality

72
Q

FOOD AND BEHAVIOUR

Define disordered eating

A

Restraint, strict dieting, disinhibition, emotional eating, binge eating, night-eating, weight and shape concerns, inappropriate compensatory behaviours, THAT DOES NOT WARRANT A CLINICAL DIAGNOSIS

73
Q

FOOD AND BEHAVIOUR

Give the 3 ways in which dieting is usually associated with restriction of food intake

A
  • restrict total amount of food eaten
  • restrict certain types of food in diet
  • restriction of time in day/ week allowed eating
74
Q

FOOD AND BEHAVIOUR

How prevalent is dieting in the UK? And how much is the diet industry worth?

A

2/3rds of population in UK

Industry is worth £2 billion per year

75
Q

FOOD AND BEHAVIOUR

Give 4 things that are wrong with dieting/ ways in which dieting can cause problems

A
  • risk of developing eating disorders
  • loss of lean body mass (as well as fat)
  • slowing of metabolic rate and energy expenditure
  • chronic dieting may disrupt normal appetite responses and increase subjective sensations of hunger
  • Interventions typically demonstrate weight loss, plateau, weight gain
  • Weight cycling may cause ‘overshoot’ and weight gain
  • non obese dieters are at increased risk fat overshooting compared to obese dieters
76
Q

FOOD AND BEHAVIOUR

What can happen when patients susceptible to obesity try to diet?

A
  • Unresponsive to internal cues that signal satiety and hunger
  • Vulnerable to external cues that signal availability and palatability of food
77
Q

FOOD AND BEHAVIOUR

What is the ‘Portion Size Effect’ ?

A

Consumption of large portion sizes of energy dense food facilitates over consumption

78
Q

FOOD AND BEHAVIOUR

In the ABSENCE OF COMPENSATORY EFFECTS what is happening re the portion size effect?

A

Large portions of energy dense foods are contributing to increased prevalence of overweight and obesity

79
Q

FOOD AND BEHAVIOUR

In what ages does the Portion Size Effect operate?

A

Young children (from 2 y/o) to adults

80
Q

FOOD AND BEHAVIOUR

What is one of the main barriers to overcome regarding decreasing portion sizes?

A

Many do not know what an appropriate portion size is!

Also increasing evidence that individual and socioeconomic factors influence

81
Q

ERROR

What is an error?

A

An unintended outcome

82
Q

ERROR

Give the 5 types of error

A
  • error of commission (actively doing something wrong)
  • skill-based error
  • fixation error (making diagnosis w/o investigation)
  • sloth based error (laziness)
  • error of omission (missing something/ not doing it)
83
Q

ERROR

What is the Bolam test? And what is the Bolitho test?

A

Bolam = Would a group of reasonable doctors have done the same?

Bolitho = Would it have been reasonable of them to do so?

84
Q

ERROR

What 4 questions you must ask when there has been an error?

A

Was there a duty of care?
Was there a BREACH of this duty?
Did the patient come to harm?
Did the breach cause the harm?

85
Q

LEADERSHIP

Give the 4 leadership styles

A
  • Inspirational Leader
  • Transactional Leader (reward and punishment)
  • Laisse Faire Leader (delegates, hands off approach)
  • Transformational Leader (distribute leadership throughout levels)
86
Q

STUDY DESIGN

Give 3 ways to reduce confounders

A
  • Randomisation
  • Restriction
  • Matching
87
Q

STUDY DESIGN

What is ecological fallacy?

A

Drawing conclusions about individuals from ecological/ population based studies

3a Public and Community Health (2 decks)

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