3a Public Health Flashcards
Give 2 ways health psychology aims to put theory into practice
By promoting healthy behaviours and preventing illness
What are the 3 main behaviours classifies in health psychology?
- Health behaviour
- Illness behaviour
- Sick role behaviour
What is health behaviour? Give an example
A behaviour aimed to prevent disease e.g. eating healthy
What is illness behaviour? Given a example
A behaviour aimed to seek remedy e.g. going to see the doctor
What is sick role behaviour? Give an example
Any activity aimed at getting well e.g. taking prescribed medications
Systematic review vs meta-analysis
A systematic review is a way of collecting, analysing and synthesising evidence to answer a specific question. A meta-analysis is a statistical procedure for combining numerical data from multiple studies - normally carried out as part of a systematic review
Give examples of health damaging behaviours
- Smoking
- Alcohol and substance abuse
- Risky sexual behaviour
- Sun exposure
- Driving without a seatbelt
Give examples of health promoting behaviours
- Exercise
- Healthy eating
- Vaccinations
- Medication compliance
Give examples of health interventions at a population level
Clean Air Act, health promotion/awareness campaigns
Give examples of health interventions at an individual level
Cervical smear screening, childhood immunisations
What is the leading cause of preventable death in England?
Smoking
What is the NCSCT?
National centre of smoking cessation and training
What’s the most successful intervention for smoking cessation?
Group behavioural support plus medication
How much to South Yorkshire and Bassetlaw CCG currently spend on smoking related admissions?
Over £26m
How does the Lalonde Report (1974) classify the determinants of health?
- Genes
- Environment (physical/social/economic)
- Lifestyle
- Health care
Describe equity
Equity is about what is fair and just
Describe equality
Equality is concerned with equal shares
What is horizontal equity?
Equal treatment for equal need
What is vertical equity?
Unequal treatment for unequal need
How can the dimensions of health equity be classified?
Spatial and social:
- Spatial - geographical
- Social - age, gender, class (socioeconomic), ethnicity
How can health equity be examined?
Supply of health care, access to health care, resource allocation (health services/education/housing), health care outcomes
How is health equity assessed?
- First assess inequality, then judge if inequitable
- Note - equal utilisation may not be equitable
What are the 3 domains of public health practice?
- Health improvement
- Health protection
- Health care
An intervention is anything done to improve public health. What are non-health interventions?
Interventions that improve the economy and social conditions - have an impact on public health
Give an example of a health intervention at a community level
Playground set up for the local community
Explain the difference between public health interventions delivered at the ecological and individual levels, using one example for each
Childhood immunisation is an example of an individual level intervention - the injection is delivered to each individual child so the intervention solely affects their health
Building a playground for a local community is an example of a community level intervention - the playground would provide a place for children within the community to exercise and socialise, benefiting the health of individual in a particular area
Give an example of horizontal and vertical equity
Horizontal - individuals with pneumonia should be treated equally
Vertical - individuals with pneumonia and a common cold should receive unequal treatment
What is primary prevention? Provide an example
Preventing diseases before they happen e.g vaccinations, bike helmets
What is secondary prevention? Provide an example
Identifying disease before problems become serious e.g. newborn screening/mammography/regular blood pressure testing
what is tertiary prevention? Provide an example
Managing disease post diagnosis to slow or stop disease progression e.g. post stroke rehabilitation/screening for complications/chemotherapy
Incidence vs prevalence
New cases vs existing cases
What is attributable risk? (+ formula)
The rate of disease in the exposed that may be attributed to the exposure (incidence in exposed minus incidence in unexposed)
What is relative risk? (+ formula)
Ratio of risk of disease in the exposed to the risk in the unexposed (incidence in exposed divided by incidence in unexposed)
The incidence of disease B in smokers is 8/1000 person-years. The incidence of disease B in non-smokers is 4/1000 person-years. Calculate 1) the attributable risk and 2) the relative risk
1) 4/1000 person-years
2) 2
What does the relative risk tell us?
The strength of association between a risk factor and a disease
What are the 2 main groups of bias?
- Selection bias
- Information (measurement bias)
Give 3 sources of information bias
- Observer
- Participant
- Instrument
In a RCT the time at risk was determined from entry to the study to various end points. What measure is being used here?
Person-years
For patients with meningitis, the risk of dying has been estimated to vary 5-10%. What measure is being used here?
Case-fatality rate
If a meta-analysis showed the relative risk of CHD in smokers was A) 1.74 and B) 2.27 - how much higher is the relative risk of CHD in non-smokers vs smokers (in percentages)
a) 74%
b) 124%
What is the prevention paradox (Rose 1981)?
‘A preventative measure which brings much benefit to the population offers little to each participating individual’
What is the number needed to treat?
The number of people we need to treat in order to prevent one person from developing the outcome
Give 5 types of domestic abuse
- Psychological
- Physical
- Sexual
- Financial
- Emotional
Give 4 models/theories of behaviour change
- Health belief model
- Theory of planned behaviour
- Stages of change/transtheoretical model
- Social norms theory
What four components are crucial for behaviour change according the the Health belief model?
- Perceived susceptibility
- Perceived severity
- Perceived benefits
- Perceived barriers
What are criticisms of the Health belief model?
- Alternative factors may predict health behaviour e.g. outcome expectancy
- The model does not consider the influence of emotions on behaviour
- The model does not differentiate between first time and repeat behaviour
What is the longest standing model of behaviour change?
Health belief model
Give 3 examples of where the Health belief model can be applied
- Breast self-examination
- Vaccinations
- Diabetes management
According to the Theory of planned behaviour, what is the best predictor of behaviour change?
Intention
According to the Theory of planned behaviour, what is intention determined by?
- Attitude
- Subjective norm (the perceived social pressure to undertake the behaviour)
- Perceived behavioural control
What are criticisms of the Theory of planned behaviour?
- Its useful for predicting people’s intention but not as successful for actual behaviours
- It is a ‘rational choice model’, it doesn’t take into account how emotions could disrupt ‘rational’ decision making
Give 3 examples of where the Theory of planned behaviour can be applied
- Smoking
- Abortion
- Diet
What does the transtheoretical model propose the five stages of change are?
- Pre-contemplation
- Contemplation
- Preparation
- Action
- Maintenance
What are criticisms of the Transtheoretical model?
- Change might not operate in discrete stages
- People often change their behaviour in the absence of planning
What are advantages of the Transtheoretical model?
- It acknowledges individual stages of readiness
- It accounts for relapse
According to the transtheoretical model, what does moving back through the five stages of change indicate?
Relapse
What is the third stage of the Transtheoretical model?
Preparation
What is breast milk composed of?
- Colostrum
- Foremilk
- Hindmilk
What are the 3 distinct eating disorders in order of prevalence?
- Binge eating disorder
- Bulimia nervosa
- Anorexia nervosa
What % of the population is overweight/obese?
> 50%
Give 3 dietary approaches to weight loss
- Restricting the amount of food eaten
- Avoiding certain types of food
- Avoiding eating for long periods of time
What are the 2 main causes of homelessness?
- Eviction by private landlords
- Relatives/friends no longer able to offer accommodation
Define refugee
A person granted asylum and refugee status. Usually means leave to remain for 5 yrs then reapply
Define indefinite leave to remain
When a person is granted full refugee status and given permanent residence in the UK
Give 3 things asylum seekers are entitled to and 2 things they are not
- Entitled to money
- Entitled to housing
- Entitles to free NHS care
- Not allowed to work
- Not entitled to any other form of benefit
How much money as asylum seekers currently entitled to per week?
£37.75
Define polypharmacy
The concurrent use of multiple medications in an individual
What 3 public health approaches are there to health needs assessment?
- Epidemiological
- Comparative
- Corporate
What is the comparative approach to health needs assessment? Give 2 issues with it.
Compares the services received by one population with others.
1. May be difficult to find a comparable population
2. Data may be of variable quality
What is the corporate approach to health needs assessment? Give 1 issue with it.
It is about obtaining the views of a range of stakeholders e.g. politicians, press, pharmaceutical companies
1. Groups may have vested interests
Give 3 issues with the epidemiological approach to health needs assessment.
- Required data may not be available
- Variable data quality
- Does not consider felt needs of people affected
Give one health related example of something that you consider is needed and supplied but not demanded
Health promotion
Give one health related example of something that you consider is demanded but not needed or supplied
Cosmetic surgery
What are the 3 opiod receptors?
MOR, KOR, DOR
What framework, prosed by Donabedian, is widely used to evaluate health services?
- Structure
- Process
- Outcome
Explain what is meant by ‘structure’ according to Donabedian’s framework for evaluating health services
What is there e.g. buildings, staff, equipment
Explain what is meant by ‘process’ according to Donabedian’s framework for evaluating health services
What is done e.g. number of patients seen in a&e
Explain what is meant by ‘outcome’ according to Donabedian’s framework for evaluating health services
Looking at health outcomes e.g. mortality, morbidity, QoL, patient satisfaction
When assessing the quality of health services, Maxwell’s classification lists six dimensions. List the six dimensions
- Acceptability
- Accessibility
- Appropriateness
- Effectiveness
- Efficiency
- Equity
Although using measures of health outcomes is desirable in evaluation of health services, there are potential limitations. Give a reason (+example) why it may be difficult to attribute a health outcome to the service provided
Time lag between service provided and outcome may be too long e.g. between healthy eating intervention in childhood and incidence of T2DM in middle age
What is error of fixation/loss of perspective?
Unshakeable focus on one diagnosis
What is error of bravado?
Working beyond competence
What is error of ignorance?
Unconscious incompetence
What is ‘playing the odds’ error?
Choosing the common and dismissing the rare
What is ‘sloth’ error?
Inadequate documentation, not checking results for accuracy
What is error of commission?
Doing something wrong e.g. giving the wrong antibiotic
What is error of ommission?
Failing to do the right thing e.g not bothering to order a head CT
What is negligence?
A breech in duty of care which results in damage
When assessing if negligence occurred what two tests can you use?
- Bolam test - would a group of reasonable doctors do the same?
- Bolitho test - would it have been reasonable of them to do so?
What 4 questions do you need to ask when negligence is suspected?
- Was there duty of care?
- Was this duty breeched?
- Was patient harmed?
- Was harm due to breach of care?
Give 3 examples of allocation theories
- Egalitarian
- Maximising principles (utilitarian)
- Libertarian principles
What are 4 types of need?
FENC
- Felt need - what individuals state their need to be
- Expressed need - what services people use
- Normative need - expert opinion regarding appropriate standards
- Comparative need
Give the 5 stages of Maslow’s Hierarchy of Needs
- Physiological
- Safety
- Love/belonging
- Esteem
- Self-actualisation
Which is better at ruling in a disease - specific tests or sensitive test
Highly specific tests
Which is better for ruling out disease - specific tests or sensitive tests?
Highly sensitive tests
Describe lead time bias in relation to screening?
Early detection makes it look like people are surviving longer
Describe length time bias in relation to screening?
Less aggressive conditions with slow progression are likely to be picked up by screening -> screening appears to improve survival
What does NICE define as transition points in life that can influence behaviour change?
- Leaving school
- Entering the workforce
- Becoming a parent
- Becoming unemployed
- Retirement
- Bereavement
What’s included in Edwards and Gross criteria for alcohol dependance?
- Narrowing of repertoire
- Salience of drink seeking behaviour
- Increased tolerance
- Repeated withdrawal symptoms
- Relief/avoidance of ^^^ by drinking
- Subjective awareness of compulsion to drink
- Reinstatement after abstinence
Which between the Fraser guidelines and Gillick guidelines are specific to contraception?
FRASER GUIDELINES!
