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Phase 3a > Public Health > Flashcards

Public Health Flashcards

1
Q

What is health?

A

complete physical mental and social wellbeing, and not merely the absence of disease

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2
Q

What are the 3 domains of public health?

A

Health Improvement
Health Protection
Improving Services

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3
Q

What is equality and what is equity?

A

Equality: Everyone is given the same treatment
Equity: Everyone is given different treatment to ensure equal chance of success

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4
Q

What is horizontal equality and vertical equality?

A

Horizontal: Equal treatment for equal need
Vertical: Unequal treatment for unequal need

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5
Q

What is a health needs assessment?

A

A systematic approach to assess a populations needs for health care to inform decision making and planning for service provisions

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6
Q

What are the stages of the planning cycle?

A
  1. Health Needs Assessment
  2. Planning
  3. Implementing
  4. Evaluating
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7
Q

What are Bradshaw’s needs?

+ what is each?

A
  1. Felt need- what people feel they need
  2. Expressed need- what people say they need
  3. Normative need- what an external party (e.g. doctor) assesses the person needs based on what is expressed
  4. Comparative need- comparison of severity, range of interventions and cost
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8
Q

What are the 3 approaches to health needs assessment?

A
  1. Epidemiological
  2. Comparative
  3. Corporate
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9
Q

What is the Epidemiological approach?

+advantages/ disadvantages?

A

Top down; gathers data on a population and how they are effected by an issue. Based on this they evaluate potential interventions, and consider its efficacy.

Adv.: Can collect data, personalised to this population, can evalutate trends over time

Disadv.: Don’t consider felt or expressed needs, data may be of poor quality

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10
Q

What is the Comparative approach?

+advantages/ disadvantages?

A

You compare the health needs and interventions of the population in question to a similar population to evaluate what is needed, what interventions are working/ not working, and implement them accordingly.

Adv.: Quick and cheap, uses existing data, gives measure of relative performance

Disadv: Data might not be available, can’t find an identical population

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11
Q

What is the Corporate approach?

+advantages/ disadvantages?

A

Discuss with individuals in the population to determine what they think is necessary for their health needs and services.

Adv.: Utilise expertise within local population, based on felt and expressed needs, wide range of views

Disadv.: Difficult to distinguish between peoples’ needs and demands, open to biased influences

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12
Q

What are the approaches to ill health prevention?

+ what do they mean?

A
  1. Primary- Preventing a disease from happening
  2. Secondary- Managing a disease in the early stages
  3. Tertiary- Preventing a disease from recurring or causing complicationg
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13
Q

What are the types of screening?

A

Opportunistic
Commercial
Population based
Pre-employment/ occupational

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14
Q

What are the disadvantages of screening?

A
  • Causes distress to people unnecessarily
  • Not always cost effective
  • Method of screening could be dangerous (e.g. radiation)
  • Over-medicalising people and treating unnecessarily
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15
Q

What are the Wilson and Junger criteria for screening?

A

The condition:
- Must know it’s natural history
- Must be an important health problem
- Must have a subclinical phase
The screening tool:
- Must be acceptable
- Must be safe
- Must be able to accurately identify those with the disease, and exclude those without the disease
The treatment:
- Must have an effective treatment
- Must have a clear threshold for treatment
Facilities and logistics:
- Must be cost effective
- There must be the facilities to carry out the screening and the management for those identified with the disease
- Must be an ongoing process (i.e. can’t just screen for breast cancer once in 2013)

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16
Q

What is sensitivity?

A

The ability of a screening tool to identify people with the disease

All people with the disease

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17
Q

What is specificity?

A

The ability of a screening people to correctly exclude people without the disease

All the people without the disease

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18
Q

What positive predictive value?

A

The proportion of those people who the screening tool has identified as having a disease, who actually have the disease

All the people identified to have the disease by the screening tool

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19
Q

What is negative predictive value?

A

The proportion of those people who the screening tool has identified as not having a disease, who actually don’t have the disease

All the people identified to not have the disease by the screening tool

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20
Q

What is lead time bias?

A

Screening makes it seem like the process of screening has extended peoples’ prognosis/ life expectancy but they have just identified a disease earlier + have identified a number of diseases that never would have reached a clinical presentation

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21
Q

What is length time bias?

A

Screening makes it seem like the process of screening has extended peoples’ prognosis/ life expectancies, but they only identify the long term diseases and those with less aggressive forms of the disease.

Ie. the people with more aggressive forms would either already have been identified or perhaps already be dead.

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22
Q

What is a cross sectional study?

+ advantages
+ disadvantages

A

Take a sample of a population at a given time point and evaluate them for a disease and exposures

Advantages:

  • quick
  • cheap
  • large population
  • good for public health planning

Disadvantages:

  • no temporality (allows for ?reverse causality)
  • can’t measure incidence
  • recall bias
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23
Q

What is a cohort study?

+ advantages
+ disadvantages

A

Take a population who have had a particular exposure, and compare to a non-exposed control group and assess the incidences and prevalences of disease

Advantages:

  • good for rare exposures (e.g. famine)
  • can establish temporality
  • can identify a number of diseases (common and multiple outcomes)

Disadvantages:
- Loss to follow up

24
Q

What is a case control study?

+ advantages
+ disadvantages

A

Take a population with a disease and match them to people without the disease (controls) and compare exposures

Advantages:

  • good for rare diseases
  • can identify a number of exposures
  • quicker than cohort or RCT

Disadvantages:

  • recall bias
  • can be hard to find controls
25
Q

What is a randomised control trial?

+ advantages
+ disadvantages

A

Take a group of people and randomly assign them into 2 groups, and expose one of them to an intervention and evaluate outcomes

Advantages:

  • Can assess intervention safety, efficacy etc.
  • Direct causation/ temporality
  • Low risk of subject bias and confounding factors

Disadvantages:

  • Can be hard to get ethical approval
  • Can have researcher bias or often has a third party vested interest (for funding)
  • Very expensive and time consuming
26
Q

What is incidence?

A

The number of new cases of a disease in a time frame (e.g. a year) in a given population (e.g. /1000)

27
Q

What is prevalence?

A

The number of people in a population (/1000) with a particular disease at a particular point in time

28
Q

If a study finds an association between an exposure and an outcome, what could this be due to?

A
  • Bias
  • Confounding variables
  • Reverse causality
  • Genuine association
  • Chance
29
Q

How do you calculate the number needed to treat?

A

1/ Attributable risk (as a decimal)

30
Q

What is a confounding factor?

A

When an association which is found between an exposure and an outcome is in reality due to a third (confounding) factor which is associated independently with both the exposure and the outcome

31
Q

What is reverse causality?

A

When the outcome causes the exposure instead of the other way around

32
Q

What is a health behaviour?

A

Action that is aimed at preventing disease?

33
Q

What is an illness behaviour?

A

Behaviour seeking health improvement/ remedy

34
Q

What is a sick role behaviour?

A

Action aimed at getting well

35
Q

What are the 5 stages of behaviour change?

Trans-theoretical model

A 
Precontemplation 
Contemplation 
Planning 
Action 
Maintenance
36
Q

What is the health belief model?

A

The idea that in order to actually cause a behaviour change, a person needs to;

  • Believe that their current actions have negative results
  • Believe the negative results are severe enough to warrant change
  • Believe that a positive change will improve health
  • Believe that they are able to do it
37
Q

What is the theory of planned behaviour?

A

There are things that affect someone’s intention to change, once these are in place, the intention will lead to behaviour change.

These are;

  • Personal attitude towards the behaviour
  • Subjective norms (social pressure to change)
  • Perceived behaviour control (believe you can change behaviour)
38
Q

What causes a disease to become a public health concern?

A
  1. High mortality
  2. High morbidity
  3. Expensive to treat
  4. Able to prevent
  5. Highly contagious
39
Q

What is nudge theory?

A

Change the environment to make the best option the easiest e.g. fruit next to check outs/ opt outs of schemes

40
Q

Who has an obligation to report a communicable disease?

A

Medical practitioners

Labs

41
Q

When should you report a communicable disease?

A

On clinical suspicion

42
Q

When reporting a communicable disease, what information needs to be given?

A

Case details: patient information (DoB, NHS numbers, contact details)
Disease/ history details

43
Q

Who do you report a communicable disease to?

A

Public health England

Local health protection authority

44
Q

What are the 5 tiers in Baslow’s Hierarchy of Need? (bottom- up)

A

Physiological - eating, drinking, sleeping, sex, excretion, breathing

Safety- In self, environment, of body, financial, employment

Love + Belonging- Family, friendship, intimacy

Esteem- Success, achievement, respect from others

Self-actualisation- Creativity, morality, spontaneity

45
Q

What are the 4 elements of negligence?

A
  1. Duty
  2. Breach
  3. Harm
  4. Cause
46
Q

What are the 4 classifications of errors?

A
  1. Intention
  2. Action
  3. Outcome
  4. Context
47
Q

What is the deontological approach to healthcare?

A

We should always do the right thing and morally help others, regardless of the consequences of our action.
E.g. should always CPR or everyone should get the treatment they need despite the finite resources

48
Q

What is the libertarian approach to healthcare?

A

Patients should be in control of their own health-care, well-being and fulfilment of life goals.

49
Q

What is the utilitarian approach to healthcare?

A

Should do the actions that cause the most benefit over all

E.g. taking into consideration chances of an alcohol remaining sober after a liver transplant should effect whether or not you give him the liver transplant

50
Q

What are disadvantages in the theory of planned behaviour?

A

Does not factor in temporality
Does not allow reversal
No account for emotions or other barriers in action
relies on self reported behaviour

51
Q

What are maximising principles?

A

Criteria used to maximise public utility from resources

52
Q

What is the egalitarian principles of healthcare?

A

Should provide ALL care that is necessary and appropriate to EVERYONE

53
Q

Give examples of a never event.

A 
Administering drug through wrong route 
Surgery in the wrong site 
Retained foreign product in surgery 
Wrong implant or prosthesis 
Non-matched transplantation or transfusion 
Airflow to pt who require oxygen 
Falls from windows
Neck or chest stuck in railings
54
Q

What is and how do you calculate the relative risk?

A

Ratio of how many more times likely you are to develop a disease due to an exposure

risk with exposure/ risk without exposure
as a number

55
Q

What is and how to you calculate the attributable risk?

A

The amount of a disease that is due to the exposure

Risk with exposure - risk without exposure
as a %

56
Q

What is bias?

A

A systematic error that results in a deviation from the true effect of an exposure on an outcome

57
Q

What are the 3 types of bias?

A
  1. Selection Bias- problem with the group- non response from certain subgroups/ allocation bias (not randomised)
  2. Information Bias- problem with data- measurement bias, observation bias, recall bias
  3. Publication Bias- trials with negative results are less likely to be published

Phase 3a (9 decks)

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