Block 1 Flashcards
How can normality be defined?
- Statistical (Gaussian distribution - 95% of population should fall within +/- 2.5 standard deviations from the mean)
- Social (what is considered acceptable or desirable -subjective)
- Optimal (what is required for optimal health)
Define illness
A subjective experience of ill health (can be ill in the absence of disease)
Define sickness
A social role taken on by, or given to, someone perceived to be ill
Define disease
Objective diagnosis using specific signs and symptoms
Deviation from the biological norm
What is the medical model of health?
Health is the absence of disease
Role of HCP is to cure, treat or lessen symptoms of disease
What are the criticisms of the medical model of health?
Focus on the medical professional not the patient
Does not consider social influence on health
Does not account for chronic disease for which there is no cure
What is the social model of health?
Health is a social construct determined by a range of external factors (social, cultural and socioeconomic influence)
Takes into account lay knowledges and beliefs
Recognises that a person can have a disease or impairment but still consider themselves to be healthy
What is the biopsychosocial model of health?
Emphasises the importance of recognising psychological and social aspects of health and illness, not just biomedical aspects
Useful in clinical practice
How does WHO define health?
A state of complete physical, social and mental wellbeing and not merely the absence of disease or infirmary
What is a census and what is it used for?
Simultaneous recording of demographic data by the government at a given time pertaining to all the persons living in a particular territory
Uses: service requirements, birth and death rates, to identify and target inequalities
How often is a census carried out in the UK?
Every 10 years
What is the process for registering a birth?
1) Birth notification completed (e.g. by midwife) – information to local health authority
2) Birth registration by parents within 42 days – information to local registrar for births, deaths and marriages and to the ONS
How is crude birth rate determined?
No. of live births/ 1000 people in population
How is general fertility rate determined?
No. of live births/ 1000 women between age 15-44
How is total fertility rate determined?
No. of live births should every woman live to menopause and give birth in accordance with the current, age specific fertility rate
What is the process for registering a death?
1) Medical certificate issued by doctor (incl. cause of death)
2) Death registration by family within 5 days – information to local registrar for births, deaths and marriages and to the ONS
How is underlying cause of death defined?
Disease or injury which initiated the train of morbid events leading directly to death OR the circumstances of the accident or violence which produced the fatal injury
What are the strengths and weaknesses of how mortality data is collected?
Strengths:
• Complete coverage in UK
• Important information on health of population
Weaknesses:
• Inaccuracies (diagnostic uncertainty, coding issues, variable quality)
• Ethnicity not collected
• Derivation of social status (post-humous inflammation of status)
How are population estimates calculated?
Census baseline + births – deaths +/- migration
What are the strengths and weaknesses of population estimates?
Strengths: up to date; more accurate than population projections
Weaknesses: less reliable the further away from the census; poor migration information; cannot use for predictions
What are population projections?
Forecast about the future based on assumptions about mortality, fertility and migration.
What are the strengths and weaknesses of population projections?
Strengths: used for long term planning
Weaknesses: less accurate the further ahead you are projecting; unforeseen changes
What is the ageing population phenomena?
Population projection between 2016 and 2041 shows that there will be a larger older population by 2041 as life expectancy increases and the ‘baby boomer’ generation reach their 70s – impact on health service due to increased cost of care for elderly, need for chronic disease management and increased mental health issues (e.g. dementia)
What is the purpose of population pyramids?
Allow for resource planning and comparison of different groups across time
What is the purpose of the Cancer Registration System?
Monitors cancer rates, evaluates screening and treatment efficacy and aiding research
What are the strengths and weaknesses of the Cancer Registration System?
Strengths: detailed, up-to-date, record linkage to cancer deaths (through ONS)
Weaknesses: confidentiality can cause access difficulties, expensive
What is the purpose of Hospital Episode Statistics?
Monitors admissions, outpatients and ED visits in England incl. personal, clinical, geographical and administrative data
Monitors trends in hospital activity, supports service planning and fair access to healthcare
Uses ICD-10 (for conditions treated or investigated) and OPCS-4 (for surgery) as clinical classification
What are the strengths and weaknesses of Hospital Episode Statistics?
Strengths: complete, accurate and representative
Weaknesses: accessibility
What is the purpose of the Quality Outcomes Framework?
Points awarded for clinical areas (e.g. management of chronic conditions), public health (e.g. prevention) and additional services (e.g. screening) with a higher income awarded to GPs with higher QoF scores
What are the strengths and weaknesses of Quality Outcomes Framework?
Strengths: completeness, improves record keeping, representative, updated annually
Weaknesses: unclear whether it actually improves clinical outcomes; no age/ sex breakdown
What is the purpose of notification of infectious diseases?
31 notifiable diseases with doctor responsible for notifying local health protection team when disease is suspected. Laboratories notify Public Health England when notifiable organism is identified. Used to prevent further infection, identify outbreaks and monitor trends.
What are the strengths and weaknesses of notifying for infectious diseases?
Strengths: timeliness (weekly reporting); representativeness
Weaknesses: variable completeness for some diseases (e.g. food poisoning can sometimes be treated at home); reporting of suspected cases means accuracy is questionable (e.g. suspected but never diagnosed)
What is the CARTA framework for assessing quality of health information?
Completeness Accuracy Representativeness Timeliness Accessibility
Define incidence
Rate at which new events occur in a population, over a given time period. Expressed as per n people per time period or per n person-years (person-years = no. of people x no. of years)
How do you calculate incidence rate?
[no. of new cases/ (no. of people x years observed)] x 1000 (or however many person years the question asks for)
Define prevalence
A measure of how common a disease is, expressed as a percentage or number per n people
How is prevalence calculated?
P = (no. of people with disease/ total no. of people) x 100 (for %)
What are the 3 types of prevalence?
Point prevalence = prevalence at a given point in time
Period prevalence = prevalence within a given time period
Lifetime prevalence
What are the 4 factors affecting prevalence?
Incidence
Recovery rate
Migration (transfer)
Morbidity (death rate)
How are confidence intervals calculated?
Upper bound = prevalence + (1.96 x SE)
Lower bound = prevalence – (1.96 x SE)
What are confidence intervals used for?
Can be used to determine statistical significance between 2 groups – if range crosses 1 then null hypothesis must be accepted
The larger the sample size, the narrower the confidence intervals = good!
What is the concept of person-centred care?
Concept of person-centred care is a whole person approach designed to put the person’s needs and preferences, as they define them, first.
What are the key principles of person-centred care?
Care is personalised, coordinated, enabling and that person is treated with dignity, compassion and respect
What is the importance of using person-centred care in practice?
Positive outcome for patients
Increased patient satisfaction
Less ED visits and more concordance to treatment
Social and political drivers
