B9 H+S Flashcards
What does EBDM involve? (4)
Patient preferences, resources, research evidence, clinical expertise
what is a cohort study used for?
prognosis, cause
case- control studies are used for?
cause
what makes a case in a case- control study?
those with the disease already, these are compared to those without the disease.
risk is another name for?
probability
risk ratio is calculated by?
risk of event in questionable group/ risk of event in the control group.
risk ratio can also be called?
relative risk
the odds of an event is?
the number of events/ number of non- events
odds ratio calculation?
odds of event in questionable group/ odds of event in the control group
Odds ratio vs risk ratio
Odds ratio: (a/b)/(c/d) whereas RR: (a/a+b)/(c/c+d)
when is a case- control study better than a cohort study?
when the population is large and ill- defined, and when the disease outcome is uncommon. (as look at those with disease and compare their exposures)
when is a cohort study better than a case- control study?
dealing with outbreaks in small- well defined source population. (As 2 groups will be more similar in size).
RCT’s are used in?
treatment intervention, benefits and harm, cost effectiveness.
1st step in smoking cessation
- Health education and general information to enhance motivation (light smokers) eg: TV ads
2nd step in smoking cessation
- brief advice from health professional (light smokers) Eg: stop smoking week at GP
3rd step in smoking cessation
advice, nictotine replacement, follow up by specialist (moderately motivated, medium dependency)
4th step in smoking cessation
specialised counselling rooms and agencies working with group sessions (high dependent smokers)
2 reasons for widespread use of antibiotics
increase in global availability
uncontrolled sale in low/ middle income countries
Some causes of antibiotic resistance?
use in livestock, releasing into environment, volume prescribed, missing doses, inappropriate prescribing
how antibiotic resistance can be prevented?
only when prescribed, complete full prescription, never share, only prescribe when needed, right antibiotic for illness
what is surveillance?
systematic collection, collation and analysis of date and dissemination of the results so appropriate control measures can be taken.
purpose of surveillance?
early warning sign for public health emergency, documents impact of intervention or goals, monitors and clarifies epidemiology.
3 infectious diseases becoming more common?
MRSA, STIs, mumps
Mandatory infectious surveillance in hospitals for what?
MRSA
what is the 90/10 gap and where was it mentioned?
commission on health research for development- 1990, less than 10% resources put towards 90% of all preventable deaths. `
WHO’s health definition of environment?
All physical, chemical, biological factors external to a person and all related behaviours. Preventing and controlling disease, injury, disability by interaction management.
what is an outbreak?
increase in occurrence where disease never experienced before
epidemic?
group of illness similar in nature from a common source
How to prevent an epidemic?
insure poor countries against threat of pandemic, funds where outbreaks occur, vaccines, planned response, monitor disease for future.
What does WHO do in public health?
provide leadership, shape research agenda, setting norms and promoting standards, provide technical support and monitor health situations and trends
some ways to intervene with HIV/AIDS
blood donor screening, condoms at affordable prices, peer education (high risk groups), safe sexual behaviour, treatment of STD’s, increased testing
3 determinants of effective outcomes of intervention
economics- most developing countries spend little money on healthcare
priorities- what is cost- effective?
setting- depending on political openness
2 most effective developments in population protection?
clean drinking water, vaccines
3 things required for a disease to be eradicated using vaccination?
Human= only resorvoir
consequence of infection is very high
scientific and political prioritisation.
2 main diseases eradicated
smallpox, polio
herd immunity facts (3)
protects whole population
only applies human-human
disease may be eradicated even if some susceptible.
what is R0?
basic reproduction rate
average number of individuals directly infected by 1 invective case in TOTALLY SUSCEPTIBLE POPULATION
factors affecting R0?
rate of contacts in host populations
probability of infection being transmitted
infective duration
what is effective reproduction rate (R)?
estimation of average number of secondary cases per infectious case in a population of both susceptible and non- susceptible.
how to calculate effective reproductive rate (R)?
R= R0x X (number susceptible to disease)
what does R value mean?
below 1, cases decreases (needs to be maintained)
1= epidemic threshold
more than 1, cases increasing
equation for herd immunity?
H= (R0-1)/R0
WHO’s role in vaccination?
makes recommendations on policy.
supports less able countries with strategy implementation
3 international immunization programs?
EPI- expanded programme on immunizisation
GPEI- global polio eradication initiative
GAVI- global alliance for vaccines and immunisation
what is the population vs individual interest debate? (vaccines)
individual- protection by herd immunity is safest option
population- avoidance of vaccine leads to diminishing herd immunity
2 websites for travel vaccine info?
NHS fit for travel
National travel and health network and centre
3 diseases for private vaccination?
Hep B, Japanese encephalitis, yellow fever, TB
5 most common cancers (incidence) in UK
1. Breast/ prostate 2, lung 3. bowel 4. melanoma 5. Non- hodgkin lymphoma
5 most common cancer mortalities in UK
- lung
- bowel
- prostate/ breast
- pancreas
- oesophagus
Most common cancer in children
leukaemias
cancer mortality UK compared to 3rd world
UK= 29%- higher than developing
ABCDE method of bad news?
Advanced preparation building relationships communicating well dealing with patient reactions encourage and validate emotions
SPIKES method of breaking bad news?
Setting up perceptions invitation knowledge emotions strategy and summary
2 conclusions and consequences of Eurocare II report?
cancer survival in 80s and 90s UK were one of worst in Europe
Expert advisory group formed generating the calman- Hine report
what were the conclusions of the Calman- Hine report?
examined cancer cervices and restructured services to achieve more equitable access
all patients have uniform high quality care
earlier symptom spotting and should be patient centred
The Calman- Hine solution?
3 levels of care-
primary
cancer units in district general (2), common cancers, diagnostic procedures
cancer centres (3) rare cancers, radio and chemo
what is a national service framework?
national standards and define service model. Put in programs to promote this and give timescales for change
Main aims of NHS cancer plan (2000)
save more lives, ensure right professional support, tackle health inequality, build for the future (research)
6 key areas for the cancer reform strategy
prevention- smoking, obesity etc diagnosis early ensure better treatment living with and beyond cancer reducing cancer inequalities delivering care in most appropriate setting (local)
3 cancers that can be screened for?
cervical, breast, bowel
4 main outcomes for improving outcomes: a strategy for cancer
prevention and early diagnosis
QoL and patient experience
better treatments
reducing inequality
Outcomes form the independent cancer taskforce?
spearhead radical upgrade in prevention
nation ambition for early diagnosis
what is a biographical distribution?
chronic illness leads to loss of confidence in the body
from this follows a loss of confidence in social interaction/ self identity
3 ethical theories?
consequentalism- correct moral response related to outcome
deontology- rules
virtue ethics- moral characters
why may an argument be invalid?
different premises may express different concepts
confusing necessary with sufficient
insensitive to the way in which claims are qulified
why may argument be unsound?
argument is invalid
valid argument but a premise is false (opinion/ claim)
does not mean unsound conclusion
What is straw man fallacy?
ignoring persons position and substituting it for a misinterpreted version
Ab hominenms meaning?
directed against a person rather then position maintaining
what is a deductive argument?
purely logic, “this means this, therefore this means this” (maths)
moral argument?
seek to support a moral claim, argument need not succeed but must provide supporting reasons (ethics)
what is an inductive argument
making argument based on observation, more probably conclusions (may not have seen everything however) (physics)
