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3A Revision > 3a public health > Flashcards

3a public health Flashcards

1
Q

what vaccinations do you receive at age 2 months

A
  • 6 in 1
  • PCV (pneumococcal conjugate vaccine)
  • Rotavirus (oral drops)
  • Meningitis B
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2
Q

what vaccinations do you receive at age 3 months

A

6 in 1 second dose

rotavirus drops

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3
Q

what 6 vaccinations are included in the 6-in-1

A

diptheria polio pertussis tetanus hepititis B and h.influenzae type B

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4
Q

what vaccinations do you receive at 4 months old

A

6 in 1 third dose
PCV second dose
meningitis B second dose

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5
Q

what vaccines do you get between 12-13 months

A
  • Hib (h.influenzae B) (fourth dose) and meningitis C (combined vaccine)
  • MMR
  • PCV 3rd dose
  • meningitis B 3rd dose
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6
Q

what vaccinations do you get aged 2-3 years

A

nasal spray annually for flu

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7
Q

what vaccine do you get aged 3 years and 4 months old

A

4-in-1 injection (booster of tetanus, diptheria and pertussis, and polio)

2nd dose of MMR

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8
Q

what vaccine do you get aged 12-13

A

HPV

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9
Q

what vaccine do you get aged 14

A

tetanus, diptheria and polio booster (3-in-1)

meningitis A, C, Y and W

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10
Q

at what ages do you get your combined (e.g 6 in 1, 4 in 1 and 3 in 1) vaccinations

A
  • 6 in 1 = 2 month, 3 month and 4 month
  • 4 in 1 = 3 years and 4 months (preschool booster)
  • 3 in 1 = 14 years (high school booster)
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11
Q

at what ages do you get the MMR vaccine

A

12-13 months and preschool (3yrs and 4 months)

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12
Q

at what ages do you get the pneumococcal conjugate vaccine

A

2 months, 4 months and 1 year

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13
Q

at what ages do you get the meningitis B vaccine

A

2 months, 4 months and 1 year

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14
Q

at what age do you get the men A C Y W vaccine

A

14 years

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15
Q

at what age do you get the HPV vaccine

A

12-13 years

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16
Q

what is the bradford hill criteria

A

a group of criteria that is necessary to provide adequate evidence of CAUSATION

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17
Q

what are the 8 sections of the bradford hill criteria

A
  1. plausibility
  2. temporality
  3. consistency
  4. strength of association
  5. response
  6. reversibility
  7. study design
  8. evidence
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18
Q

what is temporality in the bradford hill criteria

A

does the cause precede the effect

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19
Q

what is plausibility mean in the bradford hill criteria

A

is the association consistent with existing knowledge

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20
Q

what is consistency in the bradfordhill criteria

A

do the results match other studies

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21
Q

what is strength in the bradford hill criteria

A

is the strength of association between the cause and the affect strong

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22
Q

what is response in the bradford hill criteria

A

does increased exposure cause increased affect

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23
Q

what is reversibility in the bradford hill criteria

A

when the removal of the cause decreases your risk of getting the affect

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24
Q

what is study design in the bradford hill criteria

A

is the evidence based on a robust study design

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25
Q

what is evidence in the bradford hill criteria

A

how many lines of evidence lead to the same outcome

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26
Q

what is primary prevention

A

aims to prevent a disease from occuring

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27
Q

what is secondary prevention

A

aims to detect a disease early to alter the course of the disease to produce better outcomes

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28
Q

what is tertiary prevention

A

when you already have the disease but you are trying to slow down the progression e.g medication

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29
Q

what is sensitivity

A

the proportion of people with the disease who are correctly identified by the screening test

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30
Q

what is specificity

A

the proportion of people without the disease who are correctly excluded by the screening test

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31
Q

what is positive predictive value

A

the proportion of people with a positive test result who actually have the disease

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32
Q

what is negative predictive value

A

the proportion of people with a negative test result who dont have the disease

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33
Q

what is prevalence

A

the proportion of a population who have a disease

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34
Q

what is incidence

A

the number of new cases of a disease within a specified time period divided by the size of the population

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35
Q

what is the wilson and jugner criteria for screening (11 criteria split into 4 parts)

A

the condition..

  • should be a serious health issue
  • aetiology should be well understood
  • should be a detectable early stage

the treatment..

  • should be an accepted treatment for disease
  • should be available facilities for diagnosis and treatment of disease
  • should be manageable workload
  • early treatment should be more of a benefit than treating at a later stage

the test..

  • suitable test should be available
  • should be acceptable for the patients
  • intervals for repeating the test should be determined

benefits. .
- risks should be less than the benefits
- costs should be balanced against the benefits

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36
Q

what is selection bias

A

people who choose to participate in a study may have different characteristics to those who do not participate

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37
Q

what is lead time bias

A

screening identifies the disease at an earlier stage giving the impression that it prolongs survival time when actually the time is probably unchanged

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38
Q

what is length time bias

A

diseases with longer periods of presentation are more likely to be detected by screening than the ones with shorter time of presentation

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39
Q

what is information bias

A

systematic differences in the way that data is obtained from study groups either on exposure or on outcome.

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40
Q

what is observer bias

A

where the investigator has a prior knowledge of the hypothesis or the individuals disease status etc so may influence the way that data is collected, measured and interperated

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41
Q

what is interviewer bias

A

where the interviewer asks leading questions to influence response from the interviewees

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42
Q

what is recall bias

A

when information depends on a participants ability to recall past exposures.

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43
Q

what is social desirability bias

A

when participants respond in a manner they perceive as desirable to others

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44
Q

what is reporting bias

A

where participants selectively suppress or reveal information

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45
Q

what is performance bias

A

where a participant acts how they think they are supposed to act when allocated to a particular study group and modify their normal behaviour

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46
Q

what is sampling bias

A

when some people in a target population are more likely to be selected for participation in the study than others

e.g if people are asked to volunteer, the people that volunteer are unlikely to be similar to those that didnt in the target population

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47
Q

what is allocation bias

A

occurs in controlled trials when there is a systematic difference between study groups except for the characteristic that is being studied

  • can be avoided by randomisation
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48
Q

what is loss to follow up bias

A

occurs in cohort studies. When the people who drop out of the study are likely to differ in exposures and outcomes to those who remain in the study

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49
Q

what is confounding

A

when an alternative explanation is found for the association between X and Y, e.g identifying another risk factor that could be causing the outcome

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50
Q

what are the 3 types of human errors

A

errors of omission
errors of commission
errors of negligence

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51
Q

what is an error of omission

A

when the required action is delayed or not taken

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52
Q

what is an error of commission

A

when the wrong action is taken

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53
Q

what is an error of negligence

A

when the actions or omissions taken do not meet the standard of an ordinary skilled practitioner

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54
Q

what are the two approaches to managing error

A

the person approach (individual)

The system approach (organisational)

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55
Q

what is the person (individual) approach to managing/explaining error

A

errors are the products of wayward mental processes of individual people in the system

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56
Q

what is the system (organisational approach) to managing/explaining error

A

adverse events are a product of many causal factors (the swiss cheese model) meaning the whole system is to blame

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57
Q

what is the swiss cheese model

A

adverse events are a product of many causal factors

used to explain human error (system errors)

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58
Q

what is the definition of stress

A

when the demands made upon an individual are greater than their ability to cope

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59
Q

what are the 2 types of stress

A

distress

eustress

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60
Q

what is distress

A

a negative stress which is dangerous and harmful

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61
Q

what is eustress

A

a positive stress that is beneficial and motivating

62
Q

what is the general adaptation syndrome (in relation to stress)

A

ALARM - when stressor is identified
ADAPTATION/RESISTANCE - defensive countermeasures
EXHAUSTION - body begins to run out of defences

63
Q

describe the stress-illness model

A

an individuals susceptibility to disease is increased because an individual is exposed to stressors that cause strain upon the individual which leads to psychological and physiological changes

64
Q

what is a cost effectiveness analysis

A

looks at the cost per life year gained

65
Q

what is cost-utility effectiveness analysis

A

looks at the cost per quality of life year gained

66
Q

describe a cohort study

A

an incidence study that looks at a group of people (target population) over time who dont have a disease. Looks at their exposure to a certain factor and sees whether or not they get the disease.

because its prospective it can show causation

67
Q

describe an ecological study

A

looks at the whole population data to look at relationships between certain factors and disease

68
Q

describe a cross sectional study

A

a prevalence study.
Looks at a whole population of people at a single point in time.

Allows you to look at multiple variables at once e.g age, gender, ethnicity
but doesn’t establish a causal relationship. Only looks at correlations

69
Q

describe a case-control study

A

looks at a group of people with a particular disease (case) and compares them to a control group (no disease) that is usually matched.
A retrospective study that looks at people that already have the outcomes and looks back to see if the exposure is related to the outcome

establishes the likelihood of you getting a disease if you are exposed to a certain exposure

70
Q

describe an intervention study

A

where you give a drug for example in one group and in one group you dont give one

often a randomised control trial

71
Q

what is the reproductive rate

A

the rate at which an organism reproduces itself

72
Q

what is infectivity rate

A

the chance of the infection passing per exposure

73
Q

what is health behaviour

A

behaviours aimed at preventing disease e.g eating healthily

74
Q

what is illness behaviour

A

behaviours aimed at seeking remedy from illness e.g going to see the doctor

75
Q

what is sick role behaviour

A

any behaviours aimed at getting better e.g taking medications or resting

76
Q

define health promotion

A

(population level) the process of enabling people to take control of the determinants of health therefore improving overall health

77
Q

define patient centred approach

A

(individual level) is care that is responsive to individual need

78
Q

give 5 reasons that patients engage in health damaging behaviour

A 
unrealistic optimism
health beliefs
situational rationality
culture variability
socioecoomic factors
stress 
age
79
Q

what is unrealistic optimism in relation to undertaking health damaging behaviour

A

when an individual continues to engage in health damaging behaviour due to inaccurate perceptions of risk and susceptibility

80
Q

name 4 factors that influence a patients perception of risk

A
  1. a lack of personal experience with the problem
  2. belief that it is preventable by personal action
  3. belief that if it hasnt already happened it is unlikely to
  4. belief that the problem is uncommon/infrequent
81
Q

what are the 4 beliefs outlined in beckers Health Belief Model

A
  1. believe they are susceptible to the disease
  2. believe the condition has serious consequences
  3. believe that taking action reduces susceptibility
  4. believe that benefits of taking the action outweigh the costs.
82
Q

In the adapted health belief model, what two factors can influence perceived severity, perceived susceptibility, perceived barriers, perceived control and health motivation?

A

psychological factors eg personality, peer group pressure

sociodemographic factors
e.g age, ethnicity, location, culture, gender

83
Q

name 3 critiques/downfalls of the health belief model

A
  • doesnt account for the effect of emotion on health behaviour
  • doesnt account for the effect of other factors such as self-efficacy on health behaviour

-

84
Q

what is the theory of planned behaviour

A

a theory that proposes the best predictor of behaviour change is intention e.g i intend to give up smoking

85
Q

describe the 3 determinants outlined in the theory of planned behaviour

A
  • persons attitude to the behaviour
  • subjective norm (perceived social pressure of undertaking the action)
  • perceived behavioural control (a persons perceived ability to perform the behaviour)

these all affect a persons INTENTION to change behaviour eg stop smoking

86
Q

what 5 factors influence a persons ability to act on behaviour change (eg they have the intention to change behaviours but these factors may stop them from actually doing the behaviours)

A
  • anticipatory regret
  • relevance to self
  • perceived control
  • engaging in preparatory actions
  • implementation intentions
87
Q

name 4 downfalls of the theory of planned behaviour

A
  • has a lack of direction or causality
  • model doesnt explain the interaction between attitudes, intentions and perceived behavioural control
  • doesnt take into account emotions which may affect ability to make rational decisions
  • relies on self reported behaviour
88
Q

what are the 5 stages of the transtheoretical model/stages of change model

A 
pre contemplation
contemplation
preparation 
action
maintenance
89
Q

name 2 advantages of the transtheoretical/stages of change model

A

acknowledges individual readiness

accounts for relapse

temporal element

90
Q

name 3 disadvantages of the stages of change model

A
  1. not everyone moves through every stage, some people jump stages or never make it to the end
  2. change might operate on continuum rather than in stages
  3. doesnt account for personal values, culture, socioeconomic factors
91
Q

what does the stages of change model look at

A

looks at the process of changing behaviour rather than the factor that contribute to behaviour change

92
Q

what is motivational interviewing

A

a counselling technique for initiating behavioural change by resolving ambivalence

93
Q

what is the nudge theory

A

‘nudging’ the environment to make the best option the easiest option

e.g opt-out schemes, placing fruit next to check outs

94
Q

In regards to behavioural change interventions, identify 4 ‘transition periods’ whereby interventions to change behaviour are likely to be more affective

A 
leaving school
entering a workforce
becoming a parent
becoming unemployed
retirement and bereavement
95
Q

define malnutrition

A

deficiencies, excesses or imbalances in a persons intake of energy and/or nutrients

96
Q

what are the 3 types of undernutrition

A
  1. wasting (low weight for height)
  2. stunting (low height for age)
  3. underweight (under weight for age)
97
Q

5 principles of the mental CAPACITY act

A
  • assume person has capacity unless proved otherwise
  • give pt help to assess and communicate capacity
  • making an unwise decision doesnt mean they lack capacity
  • decision must be done in best interests
  • least restrictive option of basic human rights
98
Q

what 4 things do you need for capacity

A
  1. understand
  2. retain info
  3. weigh up info
  4. communicate info
99
Q

what is DOLS

A

person not allowed to leave hospital or make decisions due to a lack of capacity.
for their best interests.
person must be provided with a representitive, they have the right to challenge the dols through the court of protection and the dols must be reviewed and monitored regularly.

100
Q

what is gillick competency and fraser guidelines

A

girls under 16 will understand advice
cannot persuade them to tell parents
likely to continue intercourse with or without treatment
if she doesnt recieve contraception her physical or mental health will suffer
best interests requires contraception without parental consent

101
Q

when would you refer a child coming to GP for contraception to child protection services

A
  • if they are under 13 it is always a criminal offence

- if they have an older boyfriend think sexual exploitation

102
Q

describe the purpose of screening

A
  1. pick up all people with disease (sensitivity)
  2. exclude people w.o the disease (specificity)
  3. exclude only those with disease (high positive predictive value)
  4. exclude only those without disease (high negitive predictive value);.
103
Q

wilson junger criteria for screening (10)

A
  1. important disease
  2. acceptable treatment
  3. recognisable at early stage of symptoms
  4. treatment and diagnostic facilities available
  5. agreed on who to treat
  6. guarenteed safety e.g low radiation
  7. examination deemed acceptable by the patient
  8. natural history of the disease is known
  9. test must be inexpensive
  10. continuous screening
104
Q

who is invited to breast cancer screening and how often

A

over 50’s

two view mammography ever 3 years

105
Q

what are the 3 domains of public health

A

health protection
improving health
improving services

106
Q

what is the inverse care law

A

the availability of health or social care varies inversely with the need for care in the population

107
Q

what is equality

A

everything is shared equally

108
Q

what is equity

A

those in need receive more = more fair and just

109
Q

what is horizontal equity

A

= equal treatment for equal need

remember because equal sign is horizontal

110
Q

what is vertical equity

A

unequal treatment for unequal need

111
Q

what does a health needs assessment involve

A

looking at the needs of a population, planning and implementing a solution to improve health and decrease inequality

112
Q

describe the epidemiological approach to assessing health needs

A

looks at a problem and the size of a problem in an area, looks at current services and provides recommendations to improve

113
Q

describe the corporate approach to assessing health needs

A

takes into account the views of people who have interests eg patients, media, doctors, politicians
on how to improve health

114
Q

describe the comparative approach to assessing health needs

A

compares the services one group is receiving compared to what another group is receiving

115
Q

what is felt need

A

individuals perceptions of deviations from normal health

116
Q

what is expressed need

A

seeking help to overcome a variation in normal health

117
Q

what is normative need

A

where a professional defines the intervention for the expressed need

118
Q

describe maslows hierarchy of need

A 
top to bottom =
self actualisation
esteem
love/belonging
safety
physiological need
119
Q

what are the 3 approaches to resource allocation

A
  1. eglatarian
  2. maximising
  3. libetarian
120
Q

describe the eglatarian approach to resource allocation

A

providing resources to all of those in need

pro = equal for everyone
con = economically restricted
121
Q

describe the maximising approach to resource allocation

A

based on consequences only
so resources would be allocated to those who are likely to receive the most benefit but those who are unlikely to benefit from the care wont receive it

122
Q

describe the libertarian approach to resource allocation

A

people are responsible for their own health and resources

means patients are more actively engaged in improving their own health

123
Q

what are the 5 domains of the health belief model

A 
perceived barriers
perceived benefits
perceived susceptibility
perceived severity of illness/consequences
health motivation
124
Q

what does the health belief model describe

A

the characteristics that are likely to make a person go into action to change their behaviour =

to change behaviour must have
low perceived barriers
high perceived benefits
high perceived susceptibility
high perceived severity of illness
high health motivation
125
Q

what are the 2 rules to consider in medical negligence

A

bolam rule: would a reasonable doctor have done the same?

bolitho rule: would that be reasonable?

126
Q

what are the 10 causes of error

A 
sloth
lack of skill
ignorance
mistriage
system error
playing the odds
timidity
poor team working
breakdown of comunication
127
Q

describe an error of sloth

A

not checking results properly
not documenting properly
due to laziness

128
Q

describe a system error

A

equipment failure

technical failure

129
Q

describe a lack of skill error

A

error made due to lack of skill or training

130
Q

describe an error of mistriage

A

over estimating the severity of a situation eg over treating

or under estimating the severity of a situation eg pt doesn’t receive right care

131
Q

describe an error of ignorance

A

errors are made due to not being aware that youve made a mistake or not knowing what youve done wrong
= unconscious error

132
Q

describe an error of timidity

A

working out of your competence e.g due to feeling pressure from colleagues and doing things you aren’t qualified to do

133
Q

describe an error of playing the odds

A

e.g choosing to treat for the common disease and deciding that symptoms are unlikely to be due to a rare disease

134
Q

describe an error of poor team working

A

where a team is uncertain of their role, some members doing too much, some members doing too little, a lot of uncertainty and unorganised

135
Q

describe an error of communication breakdown

A

errors made due to lack of communication eg not listening to others opinions or not being told the full story about a pt

136
Q

describe the 3 bucket model of error

A

errors occur due to failures in

  1. self - eg lack of knowledge or skill to do a task
  2. context - eg lack of medical supplies, wrong environment, poor team work
  3. task - eg making wrong calculations due to task complexity, errors of ommission, commission etc
137
Q

what is reverse causation

A

eg if a studies results state that people who drink coffee have a reduced risk of heart disease compared to those who dont, you could argue that reverse causation can explain this
eg the people who dont drink coffee already head heart disease before the study

138
Q

what is the prevention paradox

A

when an intervention benefits the population as a whole but brings little benefit to the individual

139
Q

what is “the number needed to treat”

A

the number of people needed to treat to prevent ONE person from getting the disease

140
Q

what is the population approach to disease prevention

A

delivering the intervention to an entire population in order to shift the risk factor distribution curve

141
Q

what is the high risk approach to disease prevention

A

only delivering the intervention to identified high risk individuals

142
Q

name types of screening programmes

A 
opportunistic screening
high risk approach
population approach
pre-employment/occupational health screening
screening for communicable disease
143
Q

how do you calculate odds ratio

A

odds of exposure in cases divided by odds of exposure in controls

144
Q

what is absolute risk

A

actual numbers of how many people get a disease eg 200 in 1000 people

145
Q

what is relative risk

A

risk that a person who smokes will get lung cancer compared to someone who doesnt smoke

146
Q

what is attributable risk

A

risk that the rate of disease in the exposed is actually attributable to the exposure

147
Q

what is bias

A

a deviation from the true estimation of association between the exposure and the outcome

148
Q

at what age do you..

  1. lift your head
  2. sit unsupported
  3. crawl
  4. grab furniture to walk
  5. walk unsteady
  6. walk steady
A
  1. life head at 6-8 weeks
  2. 6-8 months= sits unsupported
  3. 8-9 months = crawls
  4. 10 months = grabs furniture to get up
  5. 12 months = walks with an unsteady gait
  6. 15 months = walks steady
149
Q

at what age do you refer when they dont walk

A

18 months

150
Q 
for fine vision and motor...
at what age do they...
1. follow you with eyes
2. reach out to touch
3. grasp things
4. transfer between hands
5. pincer grip
6. scribble with a pen
7. stack things
8. draw lines on paper
A
  1. follow eyes = 6 weeks
  2. reach out = 4 months
  3. grasp at 6 months
  4. transfer at 7 months
  5. pincer grip at 10 months
  6. scribble at 16-18 months
  7. stack at 18 months
  8. draws proper lines at 2-5 years
151
Q 
speech hearing and language..
at what age do they...
1. coo and laugh
2. turn to sound
3. mama dada
4. 2-3 words
5. 6-10 words
6. joins 2 words together
7. talks in 3-4 word sentences
A 
coo and laugh to themselves= 3-4 months
turns to sound at 7 months
7-10 month = mama dada
12 month = knows 2-3 words
18 month = 6-10 words
20-24 month = joins 2 words together 
2-5 years = talks in 3-4 word sentences.

3A Revision (5 decks)

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