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PaSS Sem 4 > 5.1 Revision > Flashcards

5.1 Revision Flashcards

1
Q

What are the 3 domains of public health?

A

Health protection - Ensuring that the risks to health from communicable diseases and/or environmental hazards are minimised.
Health improvement - Preventing ill health and promoting wellbeing by commissioning and providing services that fit with the needs of our population
Healthcare public health - Making sure we have the right health services in place for the population and that these are effective and accessible to all those who need them

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2
Q

Give some examples of health protection in maternal and child health

A

• Good infection control: sanitation and hygiene during delivery to prevent infections (in mothers and infants)
• Controlling communicable diseases: prevention of vertical
transmission of blood-borne diseases e.g. HIV
• Control of environmental hazards, such as ionising radiation,
heavy metals, which can be harmful in pregnancy…

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3
Q

Give some examples of health improvement in maternal and child health

A

• Family planning and contraception
• Screening for foetal abnormalities, e.g. ultrasound scans
• Folic acid for the prevention of neural tube defects
• Behaviour and lifestyle changes: e.g. stopping smoking,
alcohol and substance misuse, improving physical exercise
Some measures discussed in childhood:
• Weight management programmes
• Oral health promotion (brush4life)
• Free school meals

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4
Q

Give an example of healthcare public health in maternal and child health

A

Health needs assessment to improve access to mental health care in vulnerable young people at risk of offending

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5
Q

What are the 4 main categories of maternal health care?

A

Family planning
Pre-conception
Antenatal
Postnatal

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6
Q

What is the biggest maternal mortality cause in the UK?

A

Heart disease

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7
Q

What are the top 4 priorities concerning children’s health?

A

Exercise and hobbies
Food and drink
Healthy living
Emotional and mental health

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8
Q

Name some of the things that relate to childhood mental health illness?

A 
Lower-income household
Lack of support
adversity
parental mental illness
child physical illness
self-harm and suicide
risky behaviours
being bullied / bullying,
special educational needs
exclusion from education
crime (victim / perpetrator)
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9
Q

What associations are highlighted in the Health Needs Assessment’ in vulnerable population Youth Offenders?

A

Complex associations between offending, mental health and:
• education, employment, and training; substance misuse…
• interactions with justice system predicts later mental illness
• Need equitable and accessible services: those with greatest need not always referred to mental health services in a timely way

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10
Q

What are the 2 broad categories of epidemiological studies?

A

Observational studies

Experimental studies

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11
Q

What are examples of experimental studies?

A

Trials

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12
Q

What are the 4 main examples of observational studies?

A

Ecological studies
Cross-sectional studies
Case-control studies
Cohort studies

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13
Q

What is a cross sectional study?

A

A study thats just happening in the current time. Just a snapshot in the present time, no longitudinal aspect.
Recruit a sample of the population and see who has the exposure and see who has the outcome. Both are measured at the same time

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14
Q

What are the disadvantages of a cross-sectional study?

A

Prone to various biases (selection bias) and confounding

Hard to say if exposure preceded disease (problem of reverse causation)

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15
Q

What are the 2 broad categories of bias?

A

Information bias

Selection bias

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16
Q

What is information bias?

A

Bias that arises from systematic differences in collection, recall, recording or handling of information used in a study.

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17
Q

Give some examples of information biases?

A

Recall bias

Observer bias

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18
Q

What is selection bias?

A

Occurs when individuals or groups in a study differ systematically from the population of interest leading to a systematic error in an association or outcome

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19
Q

Give an example of selection biases

A 
Loss-to-follow bias
Attrition bias
Allocation bias
Non-response bias
Sampling bias
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20
Q

What is confounding?

A

The distortion of the effect of an exposure on an outcome because of the association of the exposure and outcome with another factor

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21
Q

What methods can be used to identify if there is confounding factors?

A
  1. Stratify by suspected compounding factor
  2. Multi variable methods estimate the association between an exposure and an outcome after adjusting for, or taking into account, the impact of one or more confounding factors
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22
Q

What is reverse causation?

A

When it is unclear which factor is the exposure and which is the outcome. Can happen during cross-sectional study (e.g. depression and lack of exercise)

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23
Q

What is a case-control study?

A

Recruit group of people with the outcome of interest to be the cases. Then separately go out and find people who are very similar to our cases in almost every way except for the fact that they do not have the certain outcome you looked for in the cases. Want the control group to be comparable to the case group.
Then look back in time and compare if they were previously exposed in the past. Can then calculate the association between disease and exposure

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24
Q

When are case-control studies really useful?

A

Good for rare diseases

Good for diseases that take a long time to develop

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25
What are the disadvantages of case-control studies?
Prone to recall bias Prone to selection bias Cannot estimate how common a disease is
26
What is a cohort study?
Recruit sample of interest from the population, based on exposure status Should all be disease free and comparable Classify people into exposed and unexposed groups After time, in the future record the number of people who have went on to develop the disease or had not. Can be prospective or retrospective
27
What is a prospective cohort study?
Recruit the random sample of people before we know whom has exposure. Then measure exposure
28
What is a retrospective cohort study?
Work in the present day. Recruit a population of people who had recorded exposure in the past and then see who went on to get the outcome over time
29
What are the advantages of cohort studies?
Allows for temporal sequencing - reverse causation is less of a problem as we can identify which of the outcome and exposure came first.
30
What are the disadvantages of cohort studies?
Less good for rare diseases than a case-control study as need larger sample sizes Confounding variables are a major problem in analysing cohort studies Selection into the stud and loss-to-follow-up are potential causes of bias
31
What is the difference between a case-control study and a retrospective cohort study?
Case control study selects the people based on the outcome status. Can compare cases and controls in terms of their exposure In retrospective cohort studies, select participants based on exposure status in the past and look at which participants went on to develop the disease
32
What is an ecological study?
Analyse populations/ groups not individuals
33
What is ecological fallacy?
Assuming that relationship at the group level applies to individuals.
34
What are the 5 routes of disease spread?
``` Aerosol Faecal-oral Direct contact Vector-borne Blood-borne ```
35
What are fomites?
Non-living object that transmits pathogens
36
What are the 3 components of the epidemiological triangle?
Host Environment Agent
37
What are the 3 models for understanding disease spread?
Epidemiological triangle Chain of infection Source-pathway-receptor
38
What is an outbreak?
2 or more cases with a proven link (time/place/person) Or cases rising above background rate not due to chance Or single case of infection that is unusual or high risk
39
What is a cluster?
An observed aggregation of cases grouped in a single item period or setting, suspected to be above the expected level
40
Compare a cluster to an outbreak
Cluster is not an unusual or high risk disease In a cluster the link is not proven but suspected, in outbreak it is proven In clusters the rise in cases may be due to chance, but is not due to chance in an outbreak
41
What is an endemic?
The constant presence and/or usual prevalence of a disease / agent in a population within a geographic area.
42
What is an epidemic?
Increase, often sudden, in cases of a disease above expected in a population in an area (similar definition to outbreak, but ‘outbreak’ often used for a more limited area.)
43
What is a pandemic?
An epidemic that has spread over several countries or continents, usually affecting a large number of people.
44
What are the 3 shapes of outbreak curves/
Propagated Point source Extended
45
What is R0?
The basic reproduction number - measures the transmission potential of an infection. It is the average number of secondary cases produced by a typical case of an infection, assuming everyone is susceptible
46
What is R(effective)?
The effective reproduction number - considers the reality that some people may be immune to the disease and that the average number of secondary cases is much lower than R0.
47
When is R0 = R(effective) ?
When the whole population is susceptible to the disease
48
R0 for a disease is 12 25% of the population is immune What is the effective reproduction number, R?
12 x 0.75 = 9 | A single case of the disease would produce an average of 9 new secondary cases
49
When is a doctor required to notify a disease?
Any notifiable disease Any infection which presents, could present or could have presented significant harm to human health Any contamination (e.g. chemical or radiological) which present, could present or could have presented significant harm to human health
50
How do doctors notify about notifiable diseases?
All URGENT cases should be reported, by PHONE, within 24 hours as there is often a CRITICAL WINDOW OF TIME within which effective public health control measures can be implemented. This should be followed up by a written notification within 3 days. ROUTINE cases should be notified in writing within 3 days.
51
What are the key steps when investigating and managing outbreaks?
``` Make a case definition Confirm increase in cases Find your cases Describe cases (time, place, person) Plot outbreak curves Generate and test hypothesis ```
52
What is used to calculate the risk ratio?
Risk of vaccine group / risk in unvaccinated group
53
What is the odds ratio?
Odds in vac group / odds in unvaccinated group
54
What is meant by health improvement asa domain of public health?
Preventing ill health and promoting wellbeing by commissioning and providing services that fit with the needs of our population Understanding the health needs of the population, identifying what works in relation to improving health, reducing inequalities and preventing disease, using your resources wisely and evaluating impact.
55
What are the different things considered in health improvement?
``` Population health Population health management Health promotion Health education Early intervention Prevention Social prescribing Lifestyle medicine ```
56
What is a population approach to health promotion?
Encourage everyone to change , shifting the entire distribution
57
What is a risk reduction approach to health improvement?
Move high risk individuals into normal range
58
What are the different models and theories of behaviour change??
``` Diffusion of innovation theory The virtuous cycle of public health Health beliefs model Knowledge-attitude-behaviour model Transtheoretical model COM-B model Social norm theory ```
59
What can we use to understand the population health needs?
Research Routine data Health needs assessment
60
What is a logic model?
An inforgraphic that represents a theory of how a proposed intervention actually produces its outcome
61
What are the different strategies for planning an implementation?
Logic models | The donabedian model
62
What are the 4 different strategies of disease prevention?
Primordial prevention Primary prevention Secondary prevention Tertiary prevention
63
What framework is used in the making every contact count initiative?
Ask, assist, act
64
What are the biases associated with screening programmes?
Length time bias Lead time bias Volunteer bias
65
What is the positive predictive value?
If the screening is positive, what is the probability you do have the disease
66
What is the negative predictive value?
If the screening test is negative, what is the probability you don’t have the disease
67
What is a system?
A system has components and interconnections. There is a defined whole (you can draw a line around the system) Systems can interact with other systems. Systems have a purpose (trying to achieve or not achieve something), which needs to be well-defined.
68
What are PDSA cycles?
Plan Do Study Act cycle
69
What are the 2 cycles in reinforcing loops?
Virtuous cycle | Vicious cycle
70
What are the 4 different models of healthcare provision?
``` Out-of-pocket model (individual liability) Bismarck model (multi-payer) Beveridge model (single-payer and provider) National health insurance model (single payer) ```

PaSS Sem 4 (4 decks)

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