3a Public Health Flashcards
1
Q
DETERMINANTS, EQUITY AND INTERVENTIONS
Define Horizontal Equity
A
Equal treatment for equal need
2
Q
DETERMINANTS, EQUITY AND INTERVENTIONS
Define Vertical Equity
A
Unequal treatment for unequal need
3
Q
DETERMINANTS, EQUITY AND INTERVENTIONS
What are the 3 domains of public health?
A
- Health improvement
- Health protection
- Health care
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
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
6
Q
HEALTH NEEDS ASSESSMENT
Define ‘need’
A
The ability to benefit from an intervention
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
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
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)
10
Q
EVALUATION OF HEALTH SERVICES
Define ‘evaluation’
A
The assessment of whether a service achieves its objectives
11
Q
EVALUATION OF HEALTH SERVICES
What is a ‘health economic evaluation’?
A
Incorporates a systematic review, economic evaluation and mathematical modelling
12
Q
EVALUATION OF HEALTH SERVICES
What is Donebedian’s (2005) framework?
A
- STRUCTURE
- PROCESS
- (output)
- OUTCOME
13
Q
EVALUATION OF HEALTH SERVICES
What is the ‘ 5 D’s’ tool?
A
Death Disease Disability Discomfort Dissatisfaction
14
Q
EVALUATION OF HEALTH SERVICES
What does PROM stand for?
A
Patient Reported Outcome Measure
15
Q
EVALUATION OF HEALTH SERVICES
What does CART stand for?
A
- Completeness
- Accuracy
- Relevance
- Timeliness
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)
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
18
Q
EPIDEMIOLOGY RECAP
Define incidence
A
new cases
19
Q
EPIDEMIOLOGY RECAP
Define prevalence
A
existing cases
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
21
Q
EPIDEMIOLOGY RECAP
Define absolute risk
A
Gives a feel for actual numbers e.g has units
22
Q
EPIDEMIOLOGY RECAP
Define relative risk
A
Risk in one category relative to another - no units
23
Q
EPIDEMIOLOGY RECAP
Define attributable risk
A
Rate of disease in exposed which may be attributed to exposure
24
Q
EPIDEMIOLOGY RECAP
Define bias
A
Systematic deviation from the TRUE ESTIMATION of the association between exposure and outcome
25
EPIDEMIOLOGY RECAP
Define confounding
Situation where a factor is associated with the exposure of interest and independently influences the outcome
(but does not lie on causal pathway)
26
EPIDEMIOLOGY RECAP
What are the 9 Bradford-Hill criteria for causality?
- STRENGTH of association
- DOSE-RESPONSE
- CONSISTENCY
- TEMPORALITY
- REVERSIBILITY
- Biological PLAUSABILITY
- COHERANCE
- ANALOGY
- SPECIFICITY
27
EPIDEMIOLOGY RECAP
If an association is not causal, what 4 things could it be due to?
- chance
- bias
- confounding
- reverse causality
28
EPIDEMIOLOGY RECAP
What is a cohort study?
- 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!
29
EPIDEMIOLOGY RECAP
What is a case-control study?
- Cases = people WITH disease
- Control = people WITHOUT disease
- LOOK BACK for both groups and see who was exposed
(by definition RETROSPECTIVE)
30
EPIDEMIOLOGY RECAP
What 2 forms can ecological studies take on?
- Geographical (and prevalence of disease)
| - Looking at time-trends (and prevalence of disease)
31
EPIDEMIOLOGY RECAP
How do you calculate an odds ratio?
Odds of exposure in cases / odds of exposure in controls
32
SCREENING & PREVENTION RECAP
What is the prevention paradox (Rose, 1981) ?
A preventative measure which brings much benefit to the population often offers little to each participating individual
33
SCREENING & PREVENTION RECAP
Define screening
A process which sorts out apparently well people who probably have a disease (or precursors/ susceptibility) from those who probably do not
34
SCREENING & PREVENTION RECAP
What are the Wilson and Junger screening criteria?
- 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)
35
SCREENING & PREVENTION RECAP
Define sensitivity
Proportion with the disease correctly identified by screening test
36
SCREENING & PREVENTION RECAP
Define specificity
Proportion without disease correctly excluded by the test
37
SCREENING & PREVENTION RECAP
Define PPV
Proportion with positive test result who actually have the disease
(are dependent on underlying prevalence)
38
SCREENING & PREVENTION RECAP
Define NPV
Proportion with negative test result who do not have the disease
39
SCREENING & PREVENTION RECAP
Define lead-time bias
Survival time appears longer due to earlier diagnosis
40
SCREENING & PREVENTION RECAP
Define length-time bias
Overestimation of survival duration due to relative excess of detected asymptomatic slow progressing cases
(e.g comparing less aggressive with more aggressive cancers)
41
SCREENING & PREVENTION RECAP
Give 5 examples of Health Promotion Campaigns
- 'Healthier You' diabetes prevention
- "Change 4 Life' 5 a day
- Every Mind Matters
- Stoptober
(- Promoting screening and vaccination)
42
HEALTH PSYCHOLOGY
Give the 3 health behaviours with an example of each
- 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
HEALTH PSYCHOLOGY
What is 'Unrealistic Optimism' (Weinstein, 1983) ?
Individuals continue to practice health damaging behaviour due to inaccurate perceptions of risk and susceptibility
44
HEALTH PSYCHOLOGY
What factors influence unrealistic assessment of risks?
- 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
HEALTH PSYCHOLOGY
(SMOKING CESSATION)
Is treating tobacco dependency part of a Drs job?
Yes
46
HEALTH PSYCHOLOGY
(SMOKING CESSATION)
Is smoking simply 'a patient's personal choice'?
No - tobacco dependency is seen as a medical condition that can be treated
47
HEALTH PSYCHOLOGY
(SMOKING CESSATION)
What is the general HCP stance on vaping?
'If you cant stop - swap'
48
HEALTH PSYCHOLOGY
(SMOKING CESSATION)
Demographically who is most likely to smoke?
Young men living in poverty
| smoking identified as single biggest cause of inequality in death rates between rich and poor in UK
49
BEHAVIOUR CHANGE
| Give the 4 stages of the Health Belief Model
Becker, 1974
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
BEHAVIOUR CHANGE
Give 4 critiques of the Health Belief Model (Becker, 1974)
- 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
BEHAVIOUR CHANGE
Give the 3 factors in the Theory of Planned Behaviour (Ajzen, 1988)
INTENTION determined by:
- Individual ATTITUDE to the behaviour
- SUBJECTIVE NORM
- PERCEIVED BEHAVIOURAL CONTROL!!!!!!!
52
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?
People tend to fail to act on their intentions
- Perceived control
- Anticipated regret
- Preparatory actions
- Implementation intentions
- Relevance to self
53
BEHAVIOUR CHANGE
Give 6 general critiques of the Theory of Planned Behaviour (Ajzen, 1988)
- 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
BEHAVIOUR CHANGE
Give the 5 stages of the Transtheoretical Model (Prochaska & DiClemente, 1984)
- Pre-contemplation
- Contemplation
- Preparation
- Action (relapse)
- Maintenance
(results inconclusive re whether this model actually works)
55
BEHAVIOUR CHANGE
What are some good things about the Transtheoretical Model (Prochaska & DiClemente, 1984) ?
- acknowledges individual stages
- accounts for relapse
- temporal element
56
BEHAVIOUR CHANGE
What are some bad things about (critiques of) the Transtheoretical Model (Prochaska & DiClemente, 1984) ?
- 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
BEHAVIOUR CHANGE
Apart from the 'big 3' give 2 more examples of behaviour change techniques
- 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
BEHAVIOUR CHANGE
What are some more general factors to consider when formulating a behaviour change model?
- personality traits
- risk perception
- past behaviours/ habits
- automatic influences
- predictors of maintenance
- social environment
59
BEHAVIOUR CHANGE
NICE state that interventions should 'work in partnership with individuals, communities, organisations and populations' - give the 5 typical transition points in life
- leaving school
- entering the workforce
- becoming a parent
- becoming unemployed
- retirement and bereavement
60
FOOD AND BEHAVIOUR (RECAP)
Give some factors contributing to the promotion of excessive energy intake
- 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
FOOD AND BEHAVIOUR
Define malnutrition
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
FOOD AND BEHAVIOUR
Many chronic medical conditions require nutritional support. Explain what 'diabulimia' and 'sarcopenic obesity' are
- 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
FOOD AND BEHAVIOUR
How is early flavour exposure experienced in utero and in infancy?
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
FOOD AND BEHAVIOUR
What demographic group is least likely to breast feed?
Very young, SE disadvantaged mothers (2010 Infant Feeding Survey)
65
FOOD AND BEHAVIOUR
What different components make up breast milk?
- Colostrum, foremilk, hindmilk
- Enzymes, transfer factors, gut protection, anti-infective, everyday health
- Composition/ taste varies throughout day
66
FOOD AND BEHAVIOUR
What 3 positive impacts can breastfeeding have on the child's future diet and dietary behaviours?
- acceptance of novel foods during weaning
- less picky eaters in childhood
- have diet richer in fruit and vegetables if BF > 3m
67
FOOD AND BEHAVIOUR
Does coercion and persuasion regarding children and trying new foods help?
No - it usually increases liking for reward food and reduces liking novel food
68
FOOD AND BEHAVIOUR
What 7 things can parents do to help with developing healthy eating behaviours?
- 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
FOOD AND BEHAVIOUR
In what aged children do NOFDs usually occur and what approaches have the parents usually tried?
Non organic feeding disorders = CHILDREN UNDER 6, aversion, fussy, failure to advance to age appropriate foods, parents often use MALADAPTIVE FEEDING PRACTICES
70
FOOD AND BEHAVIOUR
What are the 4 eating disorders laid out in the DSM-V?
- anorexia nervosa
- bulimia nervosa
- binge eating disorders
- OSOED (other specified or eating disorder)
71
FOOD AND BEHAVIOUR
Define eating disorder
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
FOOD AND BEHAVIOUR
Define disordered eating
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
FOOD AND BEHAVIOUR
Give the 3 ways in which dieting is usually associated with restriction of food intake
- restrict total amount of food eaten
- restrict certain types of food in diet
- restriction of time in day/ week allowed eating
74
FOOD AND BEHAVIOUR
How prevalent is dieting in the UK? And how much is the diet industry worth?
2/3rds of population in UK
Industry is worth £2 billion per year
75
FOOD AND BEHAVIOUR
Give 4 things that are wrong with dieting/ ways in which dieting can cause problems
- 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
FOOD AND BEHAVIOUR
What can happen when patients susceptible to obesity try to diet?
- Unresponsive to internal cues that signal satiety and hunger
- Vulnerable to external cues that signal availability and palatability of food
77
FOOD AND BEHAVIOUR
What is the 'Portion Size Effect' ?
Consumption of large portion sizes of energy dense food facilitates over consumption
78
FOOD AND BEHAVIOUR
In the ABSENCE OF COMPENSATORY EFFECTS what is happening re the portion size effect?
Large portions of energy dense foods are contributing to increased prevalence of overweight and obesity
79
FOOD AND BEHAVIOUR
In what ages does the Portion Size Effect operate?
Young children (from 2 y/o) to adults
80
FOOD AND BEHAVIOUR
What is one of the main barriers to overcome regarding decreasing portion sizes?
Many do not know what an appropriate portion size is!
| Also increasing evidence that individual and socioeconomic factors influence
81
ERROR
What is an error?
An unintended outcome
82
ERROR
Give the 5 types of error
- 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
ERROR
What is the Bolam test? And what is the Bolitho test?
Bolam = Would a group of reasonable doctors have done the same?
Bolitho = Would it have been reasonable of them to do so?
84
ERROR
What 4 questions you must ask when there has been an error?
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
LEADERSHIP
Give the 4 leadership styles
- Inspirational Leader
- Transactional Leader (reward and punishment)
- Laisse Faire Leader (delegates, hands off approach)
- Transformational Leader (distribute leadership throughout levels)
86
STUDY DESIGN
Give 3 ways to reduce confounders
- Randomisation
- Restriction
- Matching
87
STUDY DESIGN
What is ecological fallacy?
Drawing conclusions about individuals from ecological/ population based studies
