3a public health Flashcards
what vaccinations do you receive at age 2 months
- 6 in 1
- PCV (pneumococcal conjugate vaccine)
- Rotavirus (oral drops)
- Meningitis B
what vaccinations do you receive at age 3 months
6 in 1 second dose
rotavirus drops
what 6 vaccinations are included in the 6-in-1
diptheria polio pertussis tetanus hepititis B and h.influenzae type B
what vaccinations do you receive at 4 months old
6 in 1 third dose
PCV second dose
meningitis B second dose
what vaccines do you get between 12-13 months
- Hib (h.influenzae B) (fourth dose) and meningitis C (combined vaccine)
- MMR
- PCV 3rd dose
- meningitis B 3rd dose
what vaccinations do you get aged 2-3 years
nasal spray annually for flu
what vaccine do you get aged 3 years and 4 months old
4-in-1 injection (booster of tetanus, diptheria and pertussis, and polio)
2nd dose of MMR
what vaccine do you get aged 12-13
HPV
what vaccine do you get aged 14
tetanus, diptheria and polio booster (3-in-1)
meningitis A, C, Y and W
at what ages do you get your combined (e.g 6 in 1, 4 in 1 and 3 in 1) vaccinations
- 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)
at what ages do you get the MMR vaccine
12-13 months and preschool (3yrs and 4 months)
at what ages do you get the pneumococcal conjugate vaccine
2 months, 4 months and 1 year
at what ages do you get the meningitis B vaccine
2 months, 4 months and 1 year
at what age do you get the men A C Y W vaccine
14 years
at what age do you get the HPV vaccine
12-13 years
what is the bradford hill criteria
a group of criteria that is necessary to provide adequate evidence of CAUSATION
what are the 8 sections of the bradford hill criteria
- plausibility
- temporality
- consistency
- strength of association
- response
- reversibility
- study design
- evidence
what is temporality in the bradford hill criteria
does the cause precede the effect
what is plausibility mean in the bradford hill criteria
is the association consistent with existing knowledge
what is consistency in the bradfordhill criteria
do the results match other studies
what is strength in the bradford hill criteria
is the strength of association between the cause and the affect strong
what is response in the bradford hill criteria
does increased exposure cause increased affect
what is reversibility in the bradford hill criteria
when the removal of the cause decreases your risk of getting the affect
what is study design in the bradford hill criteria
is the evidence based on a robust study design
what is evidence in the bradford hill criteria
how many lines of evidence lead to the same outcome
what is primary prevention
aims to prevent a disease from occuring
what is secondary prevention
aims to detect a disease early to alter the course of the disease to produce better outcomes
what is tertiary prevention
when you already have the disease but you are trying to slow down the progression e.g medication
what is sensitivity
the proportion of people with the disease who are correctly identified by the screening test
what is specificity
the proportion of people without the disease who are correctly excluded by the screening test
what is positive predictive value
the proportion of people with a positive test result who actually have the disease
what is negative predictive value
the proportion of people with a negative test result who dont have the disease
what is prevalence
the proportion of a population who have a disease
what is incidence
the number of new cases of a disease within a specified time period divided by the size of the population
what is the wilson and jugner criteria for screening (11 criteria split into 4 parts)
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
what is selection bias
people who choose to participate in a study may have different characteristics to those who do not participate
what is lead time bias
screening identifies the disease at an earlier stage giving the impression that it prolongs survival time when actually the time is probably unchanged
what is length time bias
diseases with longer periods of presentation are more likely to be detected by screening than the ones with shorter time of presentation
what is information bias
systematic differences in the way that data is obtained from study groups either on exposure or on outcome.
what is observer bias
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
what is interviewer bias
where the interviewer asks leading questions to influence response from the interviewees
what is recall bias
when information depends on a participants ability to recall past exposures.
what is social desirability bias
when participants respond in a manner they perceive as desirable to others
what is reporting bias
where participants selectively suppress or reveal information
what is performance bias
where a participant acts how they think they are supposed to act when allocated to a particular study group and modify their normal behaviour
what is sampling bias
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
what is allocation bias
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
what is loss to follow up bias
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
what is confounding
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
what are the 3 types of human errors
errors of omission
errors of commission
errors of negligence
what is an error of omission
when the required action is delayed or not taken
what is an error of commission
when the wrong action is taken
what is an error of negligence
when the actions or omissions taken do not meet the standard of an ordinary skilled practitioner
what are the two approaches to managing error
the person approach (individual)
The system approach (organisational)
what is the person (individual) approach to managing/explaining error
errors are the products of wayward mental processes of individual people in the system
what is the system (organisational approach) to managing/explaining error
adverse events are a product of many causal factors (the swiss cheese model) meaning the whole system is to blame
what is the swiss cheese model
adverse events are a product of many causal factors
used to explain human error (system errors)
what is the definition of stress
when the demands made upon an individual are greater than their ability to cope
what are the 2 types of stress
distress
eustress
what is distress
a negative stress which is dangerous and harmful
what is eustress
a positive stress that is beneficial and motivating
what is the general adaptation syndrome (in relation to stress)
ALARM - when stressor is identified
ADAPTATION/RESISTANCE - defensive countermeasures
EXHAUSTION - body begins to run out of defences
describe the stress-illness model
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
what is a cost effectiveness analysis
looks at the cost per life year gained
what is cost-utility effectiveness analysis
looks at the cost per quality of life year gained
describe a cohort study
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
describe an ecological study
looks at the whole population data to look at relationships between certain factors and disease
describe a cross sectional study
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
describe a case-control study
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
describe an intervention study
where you give a drug for example in one group and in one group you dont give one
often a randomised control trial
what is the reproductive rate
the rate at which an organism reproduces itself
what is infectivity rate
the chance of the infection passing per exposure
what is health behaviour
behaviours aimed at preventing disease e.g eating healthily
what is illness behaviour
behaviours aimed at seeking remedy from illness e.g going to see the doctor
what is sick role behaviour
any behaviours aimed at getting better e.g taking medications or resting
define health promotion
(population level) the process of enabling people to take control of the determinants of health therefore improving overall health
define patient centred approach
(individual level) is care that is responsive to individual need
give 5 reasons that patients engage in health damaging behaviour
unrealistic optimism health beliefs situational rationality culture variability socioecoomic factors stress age
what is unrealistic optimism in relation to undertaking health damaging behaviour
when an individual continues to engage in health damaging behaviour due to inaccurate perceptions of risk and susceptibility
name 4 factors that influence a patients perception of risk
- a lack of personal experience with the problem
- belief that it is preventable by personal action
- belief that if it hasnt already happened it is unlikely to
- belief that the problem is uncommon/infrequent
what are the 4 beliefs outlined in beckers Health Belief Model
- believe they are susceptible to the disease
- believe the condition has serious consequences
- believe that taking action reduces susceptibility
- believe that benefits of taking the action outweigh the costs.
In the adapted health belief model, what two factors can influence perceived severity, perceived susceptibility, perceived barriers, perceived control and health motivation?
psychological factors eg personality, peer group pressure
sociodemographic factors
e.g age, ethnicity, location, culture, gender
name 3 critiques/downfalls of the health belief model
- 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
-
what is the theory of planned behaviour
a theory that proposes the best predictor of behaviour change is intention e.g i intend to give up smoking
describe the 3 determinants outlined in the theory of planned behaviour
- 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
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)
- anticipatory regret
- relevance to self
- perceived control
- engaging in preparatory actions
- implementation intentions
name 4 downfalls of the theory of planned behaviour
- 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
what are the 5 stages of the transtheoretical model/stages of change model
pre contemplation contemplation preparation action maintenance
name 2 advantages of the transtheoretical/stages of change model
acknowledges individual readiness
accounts for relapse
temporal element
name 3 disadvantages of the stages of change model
- not everyone moves through every stage, some people jump stages or never make it to the end
- change might operate on continuum rather than in stages
- doesnt account for personal values, culture, socioeconomic factors
what does the stages of change model look at
looks at the process of changing behaviour rather than the factor that contribute to behaviour change
what is motivational interviewing
a counselling technique for initiating behavioural change by resolving ambivalence
what is the nudge theory
‘nudging’ the environment to make the best option the easiest option
e.g opt-out schemes, placing fruit next to check outs
In regards to behavioural change interventions, identify 4 ‘transition periods’ whereby interventions to change behaviour are likely to be more affective
leaving school entering a workforce becoming a parent becoming unemployed retirement and bereavement
define malnutrition
deficiencies, excesses or imbalances in a persons intake of energy and/or nutrients
what are the 3 types of undernutrition
- wasting (low weight for height)
- stunting (low height for age)
- underweight (under weight for age)
5 principles of the mental CAPACITY act
- 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
what 4 things do you need for capacity
- understand
- retain info
- weigh up info
- communicate info
what is DOLS
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.
what is gillick competency and fraser guidelines
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
when would you refer a child coming to GP for contraception to child protection services
- if they are under 13 it is always a criminal offence
- if they have an older boyfriend think sexual exploitation
describe the purpose of screening
- pick up all people with disease (sensitivity)
- exclude people w.o the disease (specificity)
- exclude only those with disease (high positive predictive value)
- exclude only those without disease (high negitive predictive value);.
wilson junger criteria for screening (10)
- important disease
- acceptable treatment
- recognisable at early stage of symptoms
- treatment and diagnostic facilities available
- agreed on who to treat
- guarenteed safety e.g low radiation
- examination deemed acceptable by the patient
- natural history of the disease is known
- test must be inexpensive
- continuous screening
who is invited to breast cancer screening and how often
over 50’s
two view mammography ever 3 years
what are the 3 domains of public health
health protection
improving health
improving services
what is the inverse care law
the availability of health or social care varies inversely with the need for care in the population
what is equality
everything is shared equally
what is equity
those in need receive more = more fair and just
what is horizontal equity
= equal treatment for equal need
remember because equal sign is horizontal
what is vertical equity
unequal treatment for unequal need
what does a health needs assessment involve
looking at the needs of a population, planning and implementing a solution to improve health and decrease inequality
describe the epidemiological approach to assessing health needs
looks at a problem and the size of a problem in an area, looks at current services and provides recommendations to improve
describe the corporate approach to assessing health needs
takes into account the views of people who have interests eg patients, media, doctors, politicians
on how to improve health
describe the comparative approach to assessing health needs
compares the services one group is receiving compared to what another group is receiving
what is felt need
individuals perceptions of deviations from normal health
what is expressed need
seeking help to overcome a variation in normal health
what is normative need
where a professional defines the intervention for the expressed need
describe maslows hierarchy of need
top to bottom = self actualisation esteem love/belonging safety physiological need
what are the 3 approaches to resource allocation
- eglatarian
- maximising
- libetarian
describe the eglatarian approach to resource allocation
providing resources to all of those in need
pro = equal for everyone con = economically restricted
describe the maximising approach to resource allocation
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
describe the libertarian approach to resource allocation
people are responsible for their own health and resources
means patients are more actively engaged in improving their own health
what are the 5 domains of the health belief model
perceived barriers perceived benefits perceived susceptibility perceived severity of illness/consequences health motivation
what does the health belief model describe
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
what are the 2 rules to consider in medical negligence
bolam rule: would a reasonable doctor have done the same?
bolitho rule: would that be reasonable?
what are the 10 causes of error
sloth lack of skill ignorance mistriage system error playing the odds timidity poor team working breakdown of comunication
describe an error of sloth
not checking results properly
not documenting properly
due to laziness
describe a system error
equipment failure
technical failure
describe a lack of skill error
error made due to lack of skill or training
describe an error of mistriage
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
describe an error of ignorance
errors are made due to not being aware that youve made a mistake or not knowing what youve done wrong
= unconscious error
describe an error of timidity
working out of your competence e.g due to feeling pressure from colleagues and doing things you aren’t qualified to do
describe an error of playing the odds
e.g choosing to treat for the common disease and deciding that symptoms are unlikely to be due to a rare disease
describe an error of poor team working
where a team is uncertain of their role, some members doing too much, some members doing too little, a lot of uncertainty and unorganised
describe an error of communication breakdown
errors made due to lack of communication eg not listening to others opinions or not being told the full story about a pt
describe the 3 bucket model of error
errors occur due to failures in
- self - eg lack of knowledge or skill to do a task
- context - eg lack of medical supplies, wrong environment, poor team work
- task - eg making wrong calculations due to task complexity, errors of ommission, commission etc
what is reverse causation
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
what is the prevention paradox
when an intervention benefits the population as a whole but brings little benefit to the individual
what is “the number needed to treat”
the number of people needed to treat to prevent ONE person from getting the disease
what is the population approach to disease prevention
delivering the intervention to an entire population in order to shift the risk factor distribution curve
what is the high risk approach to disease prevention
only delivering the intervention to identified high risk individuals
name types of screening programmes
opportunistic screening high risk approach population approach pre-employment/occupational health screening screening for communicable disease
how do you calculate odds ratio
odds of exposure in cases divided by odds of exposure in controls
what is absolute risk
actual numbers of how many people get a disease eg 200 in 1000 people
what is relative risk
risk that a person who smokes will get lung cancer compared to someone who doesnt smoke
what is attributable risk
risk that the rate of disease in the exposed is actually attributable to the exposure
what is bias
a deviation from the true estimation of association between the exposure and the outcome
at what age do you..
- lift your head
- sit unsupported
- crawl
- grab furniture to walk
- walk unsteady
- walk steady
- life head at 6-8 weeks
- 6-8 months= sits unsupported
- 8-9 months = crawls
- 10 months = grabs furniture to get up
- 12 months = walks with an unsteady gait
- 15 months = walks steady
at what age do you refer when they dont walk
18 months
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
- follow eyes = 6 weeks
- reach out = 4 months
- grasp at 6 months
- transfer at 7 months
- pincer grip at 10 months
- scribble at 16-18 months
- stack at 18 months
- draws proper lines at 2-5 years
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
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.
