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Soc Pop & VLE > Block 1 Soc Pop > Flashcards

Block 1 Soc Pop Flashcards

1
Q

What are the 3 different ways of viewing normality?

A
  1. Statistical basis
    - Normal as the usual or average
    - Derived from measurements of populations
    - Normal (Gaussian) distribution: 95% of population should be within
    ±2 Standard Deviations
  2. Optimal health
    - ‘Normal’ value is determined by what is required for optimal health
    - Examples: BMI, Glomerular filtration rate, Vitamin D
    - Statistical average is not necessarily healthy e.g. weight (in this obesity epidemic) and Vitamin D
    - The good doctor interprets the values, considering the condition of the patient, the disease process etc. and comes to a view about the “rightness” of the value
    - It is a change from the person’s normal values that is most reliable
  3. Social (normative) basis
    - We interpret what is ‘normal’ with reference to social ‘norms’
    - Normality is what society finds acceptable or desirable
    - It is influenced by cultural and time – ideas about normality vary widely across and within cultures
    - Beliefs, attitudes and behaviour considered acceptable in one culture
    may not be accepted in others eg gender, sexuality, dress and behaviour codes
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2
Q

Define illness

A
  1. A subjective experience or ‘feelings’
  2. Something personal
  3. Symptoms are defined and responded to in different ways by
    different people
  4. May be experienced in the absence of pathology
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3
Q

Define sickness

A

a social role adopted or assigned to people perceived to be ill

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4
Q

Define disease

A
  1. A pathological process confirmed by signs and investigations – objective
  2. Deviation from the biological norm
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5
Q

Compare the medical model of health with the social model of health

A

M - Health is the absence of disease
S - Can have a disease or an impairment but still consider oneself healthy

M - Disease is caused by biological/pathological changes
S - Accepts that ill health and disease is also caused by social and psychological factors
Social determinants: income, gender, ethnicity etc
Psychological determinants: Beliefs, cognition, resilience

M - Causes of ill health can be identified by signs and symptoms and the process of ‘diagnosis’’

M - Medicine is important for health: role is ‘cure’ or ‘treat’ to lessen effects or make some comfortable
S - Takes into account lay knowledge and beliefs – people have own ideas about what causes ill-health

M - Focuses on the individual: patient is target of interventions
S - Intervention is at population level

M - Power with the medical profession
S - Places people at the centre and recognises their autonomy and rights

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6
Q

What are the limitations of medical model of health?

A
  1. Based on mono-causal model : A –> B
    a. Need a multi-causal model that takes account of the factors
    that lead to A – many of these are social factors
  2. Shift to chronic/degenerative conditions: often not associated with a
    simple biological cause or amenable to medical cure
    a. mono-causal where A leads to B; It’s a reductionist approach.
    b. e.g. Atheroma - degeneration of the walls of the arteries
    caused by accumulated fatty deposits and scar tissue, and leading to restriction of the circulation and a risk of thrombosis.

c. Medical model starts with the atheroma. But how does the atheroma appear; e.g. lifestyle, genetic predisposition, place in society, income. Doesn’t’ look at wider determinants of health.
3. Power is located in the hands of the medical profession not patients

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7
Q

What is the WHO definition of health?

A

A state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity

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8
Q

What are the 4 factors of health?

A
  1. The absence of disease,
  2. functional ability,
  3. wellbeing/equilibrium
  4. physical fitness
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9
Q

Outline the 4 key principles of person-centred care

A

1) Care is personalised
2) Care is coordinated
3) Care is enabling (shared decision-making, supporting the person to self-manage)
4) Patient is treated with dignity, compassion and respect

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10
Q

Why is person-centred care important?

A
  1. Evidence of positive outcomes for patients
  2. Social and political drivers
  3. Concurs with ethical principles underpinning duties of a doctor
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11
Q

What are the ethical principles and values underpinning person-centred care?

A
  1. Respect - Recognising the moral value of a person as an autonomous being.
  2. autonomy of patient - underpins the legal and professional framework that governs the patient doctor relationship
  3. Dignity
  4. Care – beneficence, best interests
  5. Consequence – better outcomes, increases trust, less complaints etc.
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12
Q

What are the social and political drivers towards policy and practice developments around person-centred care

A
  1. Societal expectations
  2. Patient dissatisfaction with NHS
  3. Spiraling economic cost of NHS - fewer consultations
  4. Reports on appalling care standards
    a. Mid Staffordshire Hospital NHS Trust (Francis Report in 2013) - poor hygiene, feeding, patients ignored
    b. Serious care review of Winterbourne View Hospital (2012) – patients physically and verbally abused by staff
    c. Southern Healthcare Inquiry – many unexpected deaths of those with learning difficulties/mental health problems, failure to investigate them
  5. Increase in health policy focus on:
    a. Delivering safe, dignified and compassionate care
    b. Putting the person at the centre of their own care
    c. Patient and public involvement in service planning
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13
Q

Outline the Calgary-Cambridge model of the consultation

A

Tasks

  1. Commencing the consultation
  2. Gathering information
  3. Physical examination
  4. Explanation and planning
  5. Closing the consultation

Functions

  1. Building the relationship
  2. Providing structure
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14
Q

Define prevalence

A

a percentage/proportion of all individuals affected by a disease at a particular time

number of cases in a defined population at a point in time/number of persons in defined population at that point in time

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15
Q

What are the 3 types of prevalence?

A
  1. Point prevalence: the proportion of individuals with the condition at a specified point in time
  2. Period prevalence: the proportion of individuals with the condition at any time during a specified time interval
  3. Lifetime prevalence: the proportion of individuals with the condition at any point in their lives
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16
Q

What is the purpose of knowing the prevalence of a disease?

A

To gauge the burden of disease

NOTE: can be affected by disease duration e.g. in point/period prevalencechronic and acute

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17
Q

Define incidence (rate)

A

The rate at which new events occur in a population, over a defined period of time

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18
Q

What is the purpose of knowing the incidence rate of a disease?

A
  1. Estimate risk of disease development

2. Taking action to control disease

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19
Q

What is the difference between incidence and prevalence?

A
  1. Prevalence – proportion/percentage of current sufferers of the disease
  2. Incidence – the rate at which new cases appear (number of new cases per person per year), also the mortality rate
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20
Q

What are the 4 factors affecting prevalence?

A
  1. Incidence rate
  2. Recovery (cure) rate
  3. Death rate
  4. Transfer (migration) rate
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21
Q

How do you calculate incidence rate?

A

new cases observed / (people observed x years observed)

22
Q

Define 95% confidence interval

A

95% confidence interval is the range in which we expect 95% of the results to lie; 95% certain that the true value with lie within that range.

23
Q

What is the importance of the 95% confidence interval?

A

Important because it adds power and weighting to results; allows understanding of how significant the results are

24
Q

How do you calculate a 95% confidence interval?

A

A 95% confidence interval includes all values within 1.96 standard errors of the point estimate
• Lower bound = point estimate – (1.96 × S.E.)
• Upper bound = point estimate + (1.96 × S.E.)

S.E. = standard error (do not need to know the formula to calculate this)

25
Q

How do you interpret a 95% confidence interval?

A
  1. The width of a confidence interval gives an indication of how precise our estimate is
  2. A wide confidence interval means you cannot be precise about the truth
  3. Larger sample sizes result in narrower confidence Intervals
  4. A narrow confidence interval is more reassuring!

Comparing CIs

  • CIs can be used to see if there is a real (statistically significant) difference between two groups
  • If confidence intervals overlap, cannot say that there is a statistical difference between the two
26
Q

Outline the history/process of census taking

A

Office for National Statistics (ONS) in England and Wales.

Legal requirement every 10 years since 1841.

Complete source of population info - 98%.

Low enumeration groups (students, elderly, homeless, travelling).

Accuracy: Census Coverage Survey & Census Quality Survey (interviews).

Online completion or post back

27
Q

What is included in the UK census?

A
  1. Demographic data - age / sex
  2. Cultural Characteristics - ethnicity / religion
  3. Material deprivation - employment / home ownership /overcrowding / car access / lone parents / lone pensioners
  4. Health – General, long-term illness, unpaid care
  5. Workplace & Journey to work
28
Q

How is the UK census data used by healthcare workers?

A
  1. Population size & structure: young, old, ethnic minorities –> service
    needs
  2. Base population (denominator) –> rates
  3. Measures of material deprivation –> identify & target inequalities
29
Q

What is used to assess quality of health information?

A 
CARTA
Completeness
Accuracy
Representativeness/relevance
Timeliness
Accessibility
30
Q

What are the strengths and weaknesses of UK census (using CARTA)?

A

Completeness
+ 98% complete
- Low enumeration of some groups

Accuracy
+ Check of forms, coverage and quality surveys
- Self reported religion ‘Jedi’

Representative/relevance
+ Data available for different levels (200 people to country)
- Low enumeration of some groups

Timeliness
- 10 years, takes time for release

Access
+ www.ons.gov.uk/ , local councils
- Individual returns confidential 100yrs

31
Q

Outline the process of birth and death registration in the UK

A

Look at slide 14 and slide 17

32
Q

What are the strengths and weaknesses of births and deaths registration (using CAR)

A

Completeness
+ Complete coverage of UK
- Ethnicity not collected

Accuracy
- Not reliable eg. underlying cause of death subject to diagnostic uncertainty, coding issues and variable quality

Representative/relevance
+ Important information on health of population
- Derivation of socioeconomic status - posthumous inflation of status

33
Q

What are the 3 measures of fertility?

A

1) Crude birth rate
live births/1,000 population

2) General fertility rate
live births/1,000 women aged 15-44 yrs (child bearing lifespan)

3) Total fertility rate
Number of children that would be born to a woman if she were to live to the end of her childbearing years and bear children in accordance with current age-specific fertility rates (number of children born per woman)

34
Q

Describe how population estimates are calculated

A

Estimate of population size & structure between census

Applies what is known on births/deaths/migration to present

Census baseline + births – deaths +/- migration

35
Q

What are the strengths and weaknesses of population estimates (using ART)?

A

Accuracy
+ More accurate than projections
- Less reliable with time from census

Representative/Relevance

  • Poor information on migration
  • Says nothing about future

Timeliness
+ More up to date than the census

36
Q

Describe how population projections are calculated

A
  1. Forecast future population size and structure
  2. Based on assumptions about:
    - mortality
    - fertility
    - migration
37
Q

What are the strengths and weaknesses of population projections (using ART)?

A

Accuracy
- Less accurate about future - only predict

Representative/relevance
- Unforeseen changes of past trends invalidate projections

Timeliness
+ Can be used for longer term planning

38
Q

What are the uses of population estimates and projections?

A
  1. Used for planning services
  2. resource allocation
    • In the past: to understand what has been happening to the population
    • The present: to make sense of present activity
    • In the future: to predict what is going to change
39
Q

What are the main sources of information on morbidity in the UK?

A
  1. National cancer registry
  2. NHS data - Hospital Episode Statistics (HES) and Quality and
    Outcomes Framework (QOF)
  3. Notifications of infectious diseases
40
Q

What are the uses of the National Cancer Registry?

A
  1. evaluation of screening programmes
  2. clinical (treatment) & epidemiological (causes) research
  3. planning services for prevention and care
41
Q

What are the strengths and weaknesses of the National Cancer Registry (using ARA)?

A

Accuracy
+ Detailed information updated over time

Representative/relevance
+ Record linkage to cancer (ONS)

Accessibility

  • Access is difficult due to confidentiality
  • Expensive
42
Q

What information is collected in the Hospital Episode Statistics (HES)?

A
  1. all admissions, out-patient and A&E visits to NHS hospitals in England
  2. Information on:
    i. personal information (e.g. age, gender)
    ii. clinical information - diagnoses and operations
    iii. administrative data (e.g. date of admission, discharge)
    iv. geographical information - where treated & lives
43
Q

Who uses the Hospital Episode Statistics (HES)?

A
  1. Commissioning organisations
  2. Provider organisations
  3. Researchers
44
Q

What are Hospital Episode Statistics (HES) used for?

A
  1. Trends in NHS hospital activity
  2. Supports local service planning
  3. Health trends over time
  4. Fair access to healthcare
45
Q

What are the strengths and weaknesses of Hospital Episode Statistics (HES) (using CARA)?

A

Completeness
+ Good, covers all hospital activity

Accuracy
+ Standard codes used
- Differences between individuals/hospitals in diagnostic coding

Representative/relevance
+ Routine national data

Accessibility
- To individual data

46
Q

What are the uses of Quality and Outcomes Framework (QOF)?

A
  1. Linked to GP payments, voluntary, ‘rewarding good practice’ to improve care.
  2. Primary care practices are scored on the 75 indicators for the 2 domains.
  3. The higher score they achieve, the higher their income, adjusted for caseload and casemix.
  4. Significant expenditure, significant incentive
  5. Points (max 559) awarded to Practices in 2 domains:
    – Clinical (19 areas) – managing common chronic diseases
    e.g. diabetes, epilepsy, CKD, asthma.
    – Public Health – Cardiovascular disease (primary prevention);
    BP; obesity; smoking; cervical screening; contraception
  6. Unclear to what extent it improves clinical outcomes. Initial improvements, fell back to pre-existing trends. Poorest performing practices have improved the most.
47
Q

What are the strengths and weaknesses of Quality and Outcomes Framework (QOF) (using CARTA)?

A

Completeness
+ Almost 100% response
-Excludes practices who don’t participate

Accuracy
- Uncertain how accurate or complete the disease registers are for individual practices

Representative/relevance
+ Representative of all population: data at surgery, CCG, national levels
- Only aggregated data for each practice, no breakdown eg. age, sex

Timeliness
+ Updated annually

Accessibility
+ Online
- Aggregated data only

48
Q

Describe how Notifications of Infectious Disease works

A

Look at slide 50

49
Q

What are the uses of Notifications of Infectious Disease?

A

Surveillance:

  1. Action to prevent further infection
  2. Identify outbreaks
  3. Monitor trends
50
Q

What are the strengths and weaknesses of Notifications of Infectious Disease (using CART)?

A

Completeness
- Poor or variable completeness of some diseases eg. not all food poisoning notified, some treated at home

Accuracy
+ Linked to other data = increase in accuracy eg. lab reports
- Accuracy questioned due to diagnostic uncertainty

Representative/relevance
+ Routine national data

Timeliness
+ Returned weekly to HPA

51
Q

What is the classification system used in the NHS for diseases?

A

ICD-10
1. International Classification of Diseases, 10th Revision, WHO
2. Describes conditions treated or investigated, e.g. myocardial
infarction, fractured skull.
3. Also used for coding Mortality statistics
4. Has 21 chapters
5. Division:
Chapter > blocks i.e. broad disease areas > specific types of disease > complications

52
Q

What is the classification system used in the NHS for procedures and interventions?

A

OPCS-4
1. OPCS - Classification of Surgical Operations and Procedures, 4th
Revision
2. Records details of operations e.g. hip replacement

Soc Pop & VLE (12 decks)

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