3A Public Health Flashcards
Define equality, equity, horizontal equity and vertical equity
Equality = equal shares
Equity is fair and just.
Horizontal = equal treatment for equal need
Vertical = unequal treatment for unequal need
Give 6 variables you can measure for equity
- Supply
- Allocation
- Access
- Utilisation
- Outcomes
- Health status
Define Health Needs Assessment
A systematic method of reviewing a populations’ need, supply and demand
Name and define 3 approaches to Health Needs Assessment
Epidemiological - defines issue and size of issue, services available, effectiveness and unmet needs
Comparative - looks at two populations
Corporate - stakeholder views
Describe the person model of error
Error as a result of wayward mental processes. Anticipation of blame promotes coverup
Describe the system model of error
Errors are inevitable due to latent conditions and active failure. Latent conditions can be pro-actively modified by hard and soft engineering
Define medical negligence
Breach in a duty of care causing harm, as judged by court
Name 3 learning theories
Behaviourism
Cognitivism
Constructivism
Define behaviourism
New behaviours acquired through stimuli-response link
Define cognitivism
Learning occurs through internal processing of info
Define constructivism
Knowledge based on worldy experiences
How do you calculate attributable risk?
amount of disease caused by exposure
1-natural rate
Describe a cohort study
People without the disease are followed over time. Exposure and disease development noted and compared. Prospective
Describe a case control study
Retrospective study taking people with a disease and matched controls then studying historical exposure
Describe a cross sectional study
Looks at current disease prevalence and exposure
Describe an ecological study
Association between prevalence and exposure either geographically or over time
Define lead time bias
Screening results in earlier diagnosis so survival increases even if death is not delayed
Define length time bias
Screening picks up more mild disease. Aggressive disease presents and kills between screens. This makes it look like LE is longer than it really is
Define health improvement and give examples
Intervention aimed at preventing disease and reducing health inequalities
Education, housing, food supply, benefits
Define health protection and give examples
Intervention aimed at controlling infectious diseases and environmental hazards
Pollution control, disaster response
Define improving services and give examples
Delivery of safe and quality care
Audit, evaluation, clinical governance
How do you evaluate services?
SPO
S - structure e.g. # of beds
P - process e.g. # of pts
O - outcome e.g. death, disease, discomfort, dissatisfaction, disability
What are the 6 domains of clinical governance?
- educational training
- clinical audit
- clinical effectiveness
- research involvement
- open and honest
- risk management
Name Maxwell’s 6 dimensions of quality
Access Appropriateness Acceptability Effectiveness Equity Efficacy
Define health behaviour and give an example
Behaviour aimed at preventing disease e.g. healthy eating
Define illness behaviour and give an example
Behaviour aimed at seeking remedy e.g. going to the GP
Define sick role behaviour and give and example
Behaviour aimed at getting well e.g. taking medication
Give the 4 key points of unrealistic optimism
- lack of personal experience
- believes disease is preventable by personal action
- believes if its not happened yet, it won’t
- believes the disease is infrequent
Define felt need
Individual perception of variation from normal health.
Define expressed need
Saying your need out loud
Define normative need
Professional defines appropriate intervention for expressed need
Name the 4 key points of the health belief model
- believes they are susceptible
- believes there are serious consequences
- believes taking action reduces risk
- believes benefits outweigh the cost
Describe the theory of planned behaviour
Intention predicts behaviour
Intention is influenced by
- attitude
- social norm
- perceived behavioural control
Describe the structure of a motivational interview
F - feedback R - responsibility A - advice M - menu E - empathy S - self efficacy
Name 3 food and behaviour theories
Externality theorum - fat people respond to external cues
Goal conflict - tastes nice but is bad for you
Restraint theory - cognitive boundary wildy exceeded
Describe the MUST score
- BMI >20=0; 18.5-20=1; <18.5=2
- Unintentional wt loss in last 6 months <5%=0; 5-10%=1; >10%=2
- Acute illness/likely to not eat for 5 days = 2
Scoring
0 = low = do nothing
1 = mod = food diary
2 = high = dietician
When do you use the MCA and MHA?
MCA - lacking capacity
MHA - diagnosed disorder
Breast cancer screening ages
50-70yo, every 3 years
>70yo , on request
<50yo, if high risk, using MRI
Bowel cancer screening ages
55yo, flexible sigmoidoscopy
60-74yo, home testing kit every 2 years
>74yo, home testing kit on request
Cervical cancer screening ages
25-49yo, every 3 years
50-64yo, every 5 years
>65yo, if one of the previous 3 was abnormal
AAA screening
men aged 65+, one off USS
Describe the FEVERPAIN score and interpret its results
F - fever P - pus A - attend within 3 days I - inflamed tonsils N - no cough
Score 0 or 1 = no abx
Score 2 or 3 = delayed abx
Score 4 or 5 = immediate phenoxymethlypenicililin
Describe the Centor score and interpret its results
Pus
Lymphadenopathy
Fever
No cough
Score 0, 1 or 2 = no abx
Score 3 or 4 = immediate abx
Define health inequality
preventable, unfair and unjust differents in heath status that arise from unequal distribution of social, environmental and economic conditions within society, which determine the risk of people getting ill, their ability to prevent sickness, to take action and to access treatment
Describe Section 2
Diagnosis and plan Up to 28 days Can treat against will Can appeal in first 14 days Right to IMHA
Describe Section 3
Treatment Up to 6 months Can treat against will Can appeal once in the 6 month Right to IMHA Can renew
Describe Section 5(2)
Doctor’s holding power
Up to 72 hours
Inpatients only (not A&E)
Describe Section 135
Warrant needed
Private place
Police can enter with AMHP and HCP
For 24+12 hours
Describe Section 136
No warrant
Public place
For 24+12 hours
Compare anxiolytics and hyponotics
Anxiolytics - induce sleep at night. Used in anxiety. Benzodiazepines, propranolol, buspirone
Hypnotics - sedate when given in the day. Used in ST insomnia and phobias. Benzodiazepines, zopiclone, antihistamines, melatonin
Describe the triple swab
- Endocervical chlamydia swab
- Endocervical charcoal gonorrhoea swab
- HVS - BV, candida, trichmoniasis, GBS
Name APGAR
Appearance Pulse Grimace Activity Respiration
8 week jabs
6 in 1
Men B
rotavirus
12 week jabs
6 in 1
pneumococcal
rotavirus
16 week jabs
6 in 1
Men B
1 year jabs
MMR pneumococcal Men B Men C Hib
3 year 4 month jabs
MMR
4 in 1
Define culture
socially transmitted pattern of shared responsibility by which people communicate and develop their knowledge and life attitude
Define cross cultural education
acquiring cultural knowledge in order to better serve diverse groups
Define cultural expertise model
training providing info on different groups who share on characteristic
Define cultural competency
different cultural groups can be approached in different ways to reduce health inequality
Name 3 theories of resource allocation
egalitarian
maximising
libertarian
Describe egalitarian resource allocaiton
everyone gets the care the need and require
ignores resource limitation
‘ideal scenario’
describe maximising resource allocation
the people with the most ability to benefit will receive resources. those with mild needs, or conversely very high needs, who may benefit less, are ignored and receive nothing
describe libertarian resource allocation
people have individual responsibility for their own health. more engaged patients will receive more resources.
describe Bolam’s rule
would a reasonable doctor do the same?
describe Bolitho’s rule?
would that be reasonable tho?
name the 3 buckets of error
self
context
task
describe the contents of the ‘self’ bucket
level of knowledge
level of skills
level of expertise
current capacity e.g. illness, fatigue
describe the ‘context’ bucket
equipment physical env e.g. lighting workspace team support organisation management
describe the ‘task’ bucket
errors
complexity
novel task
process