All SocPop Flashcards
What is person-centred care?
A patient should be treated how they wish to be treated, with tailored care and shared-decision making
Person-centered care should be whatnm?
1) Personalised = treat the patient as a whole and put their needs first
2) Enabling = care is continued across episodes
3) Coordinated = patient feels empowered and involved in decision-making process
What is the importance of person-centred care?
1) Less emergency room visits
2) Positive outcomes for patients
What are the drivers of person-centred care?
1) Spiraling costs of the NHS
2) Patient dissatisfaction with the NHS
What is infant mortality rate?
Number of deaths under 1 year old per 1000 live births in a population, per time period
What is life expectancy at birth?
Number of years a person can be expected to live in a state of generally good health, if mortality rates remain constant in the future
What is disability-free life years?
Number of years a person can be expected to live without a limiting chronic illness or disability
What are the main causes of death in the UK
1) Cancer
2) Ischaemic Heart Disease
3) Lung disease
What is health inequality?
Systemic differences in health and illness between different socioeconomic groups
What is the social gradient?
A clear stepwise gradient in health, evident across many indicators including general health and mortality measures
What is the behavioural model of inequality?
Proposes that health inequalities are a result of variations in health behaviours e.g. smoking, poor diet, etc.
What is the materialistic model of inequality?
Proposes that health inequalities are the direct effects of poverty and material deprivation
What is the psychosocial model of inequality?
- Health inequality is directly linked to how people’s environment makes them feel
- Psychological stress from social inequality leads to worse health outcomes
Why is it important to tackle health inequalities?
All systemic differences in health between social groups is unfair (WHO)
What is the aim of tackling health inequalities?
Aim of reducing health inequalities is to yield a more even distribution of health across different population groups
What is progressive universalism?
Population-wide approach aimed at achieving a more equal distribution of health resources according to proportionate to needs of different social groups
What is the upstream approach in tackling social disadvantage?
Tackle wider influences and public policies e.g. water fluoridation
What is the downstream approach in tackling social disadvantage?
Tackle health behaviours such as smoking, diet, exercise, etc.
Which interventions have reduced health inequalities?
1) Improved housing/workplace environment
2) Increased tobacco prices
3) Water fluoridation
Describe the paternalistic doctor-patient relationship
- Doctor makes the decision and the patient takes a passive approach
- information flow is largely one way from doctor to patient
+ves: appropriate in some emergency situations
-ves: may hinder autonomy and patient may feel unable to express themselves
Describe the shared doctor-patient relationship
- Advocated model in which both doctor and patient are equally involved in decision-making
- considers importance of patient ideas, concerns and expectations
+ves: promotes patient autonomy
-ves: risk of coercion
Describe the informed doctor-patient relationship
- Doctor provides all the relevant information and treatment options
- Patient is active and the sole decision maker
+ves: promotes autonomy and good for the expert patient
-ves: information overload can hinder autonomy
What is disease prevention?
Actions aimed at eradicating or eliminating the impact of disease and disability
What is primary disease prevention?
Actions aimed at preventing the spread of the disease in the first place e.g. immunisation, health education
What is secondary disease prevention?
Actions aimed at early detection of disease via screening programmes e.g. cancer screening
What is tertiary disease prevention?
Actions aimed at treating asymptomatic disease that can’t be cure e.g. palliative care
What is health promotion?
Actions aimed at increasing the control people have over their health to improve health
What is the medical approach to health promotion?
Relies on medical view of health
What is the behavioural approach to health promotion?
Retains role for health professionals and utilises behaviour change models
What is the education approach to health promotion?
Aim is to provide information to enable people to make informed health choices e.g. cigarette warnings
What is the societal change approach to health promotion?
Focus on creating healthier environment locally and nationally e.g. smoking ban, sugar tax
Define sex
Biologically-determined characteristic differences between males and females
Define gender
Socially constructed concept of what is expected of males and females
Outline gender differences for health
- Women have a higher life expectancy at birth than men
- Women report more disease
- Women are more likely to suffer mental illness than men
- Men are more likely to commit suicide
- Men are more likely to die an accidental death
Differences in patterns of health behaviour between men and women
- Men smoke and binge drink more
- Women have lower smoking rates but more difficulty quitting
Differences in health between ethnicities
A higher proportion of ethnic minority groups are deprived, which raises the morbidity and mortality
Explain the Health Belief Model of behaviour change
Proposes that someone’s health behaviours depend on perceived threat of an illness and their perceived efficacy of change
Perceived threat = perceived susceptibility + perceived severity
Perceived efficacy = perceived benefits + perceived barriers
Explain the Theory of Planned Behaviour model of change
Behavioural intentions are determined by:
1) Behavioural attitudes = behavioural beliefs + outcome evaluation
2) Subject norms = normative beliefs + motivation to comply
3) Perceived behavoiural control = control beliefs + self-efficacy
Explain the Transtheoretical Model of behaviour change
Proposes that an individual moves through 5 stages during the process of behaviour change
1) Pre-contemplation
2) Contemplation
3) Preparation
4) Action
5) Maintenance
Explain the COM-B model
Behaviour change wheel made of 3 elements:
1) Capability = knowledge, skills, resources to make change
2) Opportunity = time availability
3) Motivation = desire to succeed, affected by beliefs
What are lay beliefs?
Beliefs of the general public based on assumption about the world and things they believe to be true
They are rooted in the socio-cultural contexts in which we live, influenced by religion, culture, etc.
What is the importance of lay beliefs to doctors?
- Allows insight into the needs of the patient
- Allows doctors to understand health-seeking behaviours
What drives individuals to seek help?
- Perception of symptoms
- Evaluation of symptoms
What social triggers make individuals seek help?
- Interference with relationships and job/activities
- Interpersonal crisis
- Sanctioning by others
What are health behaviours?
Behaviours related to the health status of an individual
Explain the BioPsychoSocial model of health behaviours
- Implies that behaviours, thoughts and feelings may influence a physical state
- Broadens scope with which health and illness can be examined clinically
- Patient is seen as a person with and individual lifestyle
What are the determinants of health behaviours?
1) Background factors = characteristics that define the context in which people live their lives
2) Stable factors = individual differences in psychological activity
3) Social factors = social connections in the immediate environment
4) Situation factors = appraisal of personal relevance that shape responses in a specific situation
Explain individual differences in health
1) Emotional dispositions = psychological processes involved in experience and expression of emotions
2) Generalised expectancies = processes involved in formulating expectations in relations to future outcomes
3) Explanatory styles = psychological processes involved in explaining causes of negative events
What is prevalence?
Number of people with a disease in a defined population at a particular time
What is incidence?
Number of new cases of a disease arising in a defined population in a defined period of time
Define mortality rate
Number of people dying in a defined population in a defined period of time
What is bias?
Any trend in the collection, analysis, interpretation or publication of data which allows conclusions to be drawn that are systematically different from the truth
What is selection bias?
Bias in choosing study participants
What is information bias?
Bias arising from measurement errors
What is confounding bias?
An additional, unmeasured variable that is connected to both the dependent and independent variables
What is publication bias?
Rejection of unfavoured outcomes
What is recall bias?
Differences in accuracy and completeness of recollections obtained from study participants
What is the deterministic concept of causality?
Variation of hypothesis by systematic observations to predict with certainty of future events
What is the stochastic concept of causality?
Assessment of hypothesis by systematic observation to give risk of future events
What are the Bradford-Hill criteria?
Bradford-Hill criteria is used to determine causality vs causation
1) Specificity of the association
2) Strength of the association
3) Consistency of the association
4) Dose response to exposure
What is the hierarchy of evidence?
1) Systematic reviews
2) Experimental studies (e.g. RCTs)
3) Observational studies (e.g. cohort studies & case control studies)
4) Descriptive studies (e,g, cross-sectional studies)
What are observational studies?
Studies that measure variable of interest in subjects as opposed to actively giving treatments/interventions
1) Descriptive observational studies are able to examine distributions
2) Analytic observational studies are able to examine determinants
What are case control studies?
Cheap, retrospective studies that are good for researching rare diseases
Prone to selection bias
What are cross-sectional studies?
Prospective studies that are quick, cheap, simple and good for prevalence, but not incidence
+ve: good for hypothesis generation
-ve: prone to sample bias and response bias
What are cohort studies?
Prospective studies that are good for rare exposure, but poor for rare disease
What are randomised controlled trials?
A scientific way of evaluating safety and efficacy of new treatments, allocated by chance mechanism
Random allocation done electronically gives equal chances of receiving each treatment and reduces bias
+ves: eliminates selection bias & ensures validity of statistical tests
What are controlled clinical trials?
They are prospective studies that compare the effects and value of an intervention against a control in
What is the “intention to treat approach” in pragmatic trials?
Takes everybody into account, disregarding problems associated with non-compliance
More relevant in clinical practice
Smaller size effects
What is the “as-treated approach” in explanatory trials?
Generally, measures efficacy of treatment
Realises issues with compliance
Larger effect sizes
Explain the ethical dilemma in randomised controlled trials
- Clinicians should provide best treatment for each individual patient
- Scientific integrity requires treatment chosen radnomly
Define chronic illness
The experience of living with a long-term condition for which there is no cure, which may be managed with drugs and other treatments
What are the main areas affected by chronic illness?
1) Activities of daily living
2) Sense of self
3) Social identity
4) Social relationships
What are the common coping strategies with chronic illness?
1) Denial = ignore reality of having the illness
2) Normalisation
3) Resignation = embrace illness
4) Accommodation = deal with the illness
What is the expert patient programme?
- Peer-led self-management programme, designed to improve self-managment
- Suitable for any long-term health condition
- Covers healthy eating, exercise, pain management and problem solving
How is odds ratio calculated?
OR = ad/bc
E.g. OR = (1262x1174)/(1488x1147) = 0.87
What is the 95% CI?
A 95% confidence interval is A range of values that you can be 95% certain contains the true mean of the population
How is 95% CI calculated?
E.f. = exp (1.96 x √(1/a) + (1/b) + (1/c) + (1/d)
E.g. E.f. = exp(1.96 x √(1/1262) + (1/1488) + (1/1147) + (1/1174) = 1.12
95% CI = OR/e.f ., OR x e.f.
0.87/1.12., 0.87 X 1.12
= 0.78, 0.97
Interpretation = odds are less than 1, therefore a protective effect is implied
How do you interpret odds ration?
- State odds with and without the exposure
- State what the null hypothesis
- State boundaries of the 95% CI
- Does the CI exclude the null hypothesis (i.e. 1)?
* If CI <1 then the exposure has protective effect
* If CI >1 then exposure has detrimental effect
* If CI crosses 1, there is not a statistical significance
Define impairment
Bodily/mental/intellectual limitation or condition
What is disability?
Loss or limitation of opportunities to participate in society on an equal basis
Explain the Medical model of disability
- Disability is intrinsic to the individual
- Restrictions are due to individual’s physical or cognitive impairment
- Intentions should focus on treatment
- ves
1) Individualises issue of disability
2) Sees disability as a personal tragedy
Explain the Social model of disability
- Disability is extrinsic to the individual
- Restrictions are due to the way society is set up
-ve: fails to recognised the significance of impairments to the individual
+ve: emphasise need to remove physical & social barriers
Explain the Integrated/Interactional model of disability
- Favoured by the WHO
- Realises disability is a complex interaction of impairments, environment, cultural and social factors
- Role of policies is to enable disabled people to lead ordinary lives as non-disable people
What is the legislation regarding disability in the UK?
UK Equalities Act (2010)
Why is the human rights approach to disability important?
- Disable people should have the same rights as everybody else
- Establishes a benchmark of treatment which can be applied
- It is a human rights violation if standards and a disabled person’s experiences drop below this benchmark
What are the inequalities faced by people with disability?
- People with disabilities experience lower levels of participation in all aspects of life
- They are significantly less likely to be in employment
- More likely to experience poverty
- More likely to experience poor health outcomes
What are systemic reviews?
A reliable way of identifying which forms of healthcare work, which do not, and which are even harmful
Limitations
1) May oversimplify important distinctions between studies
2) May be difficult for practitioners to apply in clinical practice
What is a PICO search?
Population
Intervention
Comparison
Outcome
What are forest plots?
Looks at and collates different study results
What are funnel plots?
Way of assessing if the results are affected by publication bias
Publication bias is less likely if the plot is symmetric (inverted V)
What are meta-analyses?
Combination of the results of individual studies to produce an overall statistic
- Subjected to any biases that arise from the study selection process
- May produce mathematically precise, but clinically misleading, result
What are biases involved in systemic reviews/meta-analysis?
1) Selection bias = systematic bias in the way included studies
2) Attrition bias = systematic bias between comparison groups in loss of subjects from study
3) Performance bias = systematic differences in care provided to participants in comparison groups
4) Detection bias = systematic differences between comparison groups in outcome assessment
What are common causes of occupational disease?
1) Occupation asthma
2) Exposure to chemicals, dies, etc
What is a fit note?
Medical certificate required for over 7 days of absence from work
Provides certification for statutory sick pay
What are the factors that facilitate return to work?
1) Medical treatment
2) Changing work factors that may affect health
What is the access to work scheme?
1) Provision of special aids and equipment
2) Adaptations to equipment
3) Provides travel arrangements to work
4) Mental health support service
What are the major screening programmes in the UK?
Antenatal and newborn
1) Down’s Syndrome
2) Sickle cell
3) Newborn hearing screen
4) Newborn blood spot
Adults
1) AAA
2) Breast cancer
3) Diabetic retinopathy
4) Bowel cancer
What is sensitivity?
Likelihood that if you have the disease, the test will pick up that you have it and give you a positive result
Sensitivity = TP/(TP+FN)
What is specificity?
Likelihood that if you do not have the disease, the test will identify you as free from the disease
Specificity = TN/(TN+FP)
What is the positive predictive value?
Proportion of people tested as positive that are true positive
PPV = TP/(TP+FP)
What is the negative predictive value?
Proportion of people tested as negative that are true negatives
NPV = TN/(TN+FN)
What are the common biases in screening?
1) Healthy screenee bias = people who take up offer of screening are more likely to be healthier
2) Length time bias = screening simply detects disease that develops slowly but does not actually increase lifespan
3) Lead time bias = illusion of increased survival time simply by detecting the disease earlier
4) Over-diagnosis = diagnosis and treatment of a disease that is left, would never be symptomatic
