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Health and society > Block 15 > Flashcards

Block 15 Flashcards

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Sociology 101 flashcards
1
Q

Bowel cancer is more common where?

A

The west: Western Europe, America

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2
Q

Oesophageal cancer is most common where?

A

Eastern Europe/Russia

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3
Q

Levels of what correlate well with colorectal cancer?

A

Fat consumption

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4
Q

What type of study can be used to explore environmental effects?

A

Migrant studies

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5
Q

Ex of a migrant study

A

Looking at Japanese men who migrated to Hawaii. Stepwise increase in lifetime CA risk from 1st to 2nd gen

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6
Q

What is confounding in a Japanese migrant study?

A

May not just be diet that changed - alcohol, smoking etc.

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7
Q

What % of cancer is caused by the diet?

A

30%

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8
Q

In the UK, what are the top 4 causes of cancer? in order

A

Smoking
Diet
Obesity
Alcohol

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9
Q

What type of study are best for looking at affect of diet?

A

Observational studies

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10
Q

Some problems with case control studies in diet and cancer:

A

Recall bias
Hard to measure diet
Early CA may influence diet

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11
Q

Problems with cohort studies in diet and cancer:

A

Measuring diet difficult

Takes a long time

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12
Q

General problems with observational studies:

A

Bias

Confounding

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13
Q

Ex of confounding in diet and cancer

A

Beta carotene. Thought to be protective for lung cancer, but seems to cause it. Confounders weren’t controlled properly (i.e. those who take in more beta carotene tend to smoke less/drink less)

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14
Q

Measures of diet:

A 
Food disapperance data
Household surveys
24 hr recall
Food frequency questionnaires
Diet diary
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15
Q

Pros of food frequency questionnaires:

A
  • Easy to code and complete

- Captures usual diet

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16
Q

Cons of food frequency questionnaires:

A
  • Doesn’t actually capture what people eat
  • No portion size/energy intake
  • People overestimate fruits/veg
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17
Q

Pros of diet diary

A
  • Captures actually what people eat
  • Portion size/energy intake
  • More flexible, can track a lot of food
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18
Q

Cons of diet diary:

A
  • Expensive and difficult to code
  • Take effort to do
  • Misrepresentation
  • People may change diet when completing diary to make it easier
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19
Q

Aflatoxin is a what found it what

A

Fungal toxin found in cereals and peanuts

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20
Q

Aflatoxin is linked to what cancer?

A

Hepatic

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21
Q

Colorectal cancer is caused by

A

red meat
processed mat
overweight
alcohol

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22
Q

beta carotene is causative of what and protective of what

A 
causative = lung cancer
protective = oesophageal
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23
Q

Why is it 5 a day?

A

Evidence shoes 400g/day of fruit and veg is protective of cancer. Average portion is 80g

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24
Q

Evidence shows less that what fruit and veg is associated with increased cancer?

A

<200g/day

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25
Q

Important health promotion messages for cancer:

A
  • Increase levels of physical exercise
  • Don’t put on weight in adulthood
  • Aim for BMI between 18-25
  • Maintain safe levels of alcohol intake
  • Increase intake of fruit and vegetables, at least 400g/day
  • Limit intake of preserved and red meat
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26
Q

CDSS =

A

Clinical decision support systems

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27
Q

CDSS’s are designed to =

A

Aid decision making by taking into account resources, patient preferences and doctor’s skill set

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28
Q

CDSS may be based on

A

Computer based

Paper based

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29
Q

Examples of CDSS

A

Reminder systems
Diagnostic systems
Prescription systems

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30
Q

Ex of a reminder system

A

Systemone

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31
Q

What do reminder systems do?

A

Flash up on screen and remind for: screening, vaccination, testing, allergies, prescriptions

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32
Q

What do diagnostic systems do?

A

Model signs and symptoms against what we know epidemiologically

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33
Q

Examples of 2 diagnostic systems:

A

Ottawa Ankle rules

Well’s score

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34
Q

Ottawa ankle rules:

A

15% of sprains are fractures but not all require x-ray…used to reduce need for x-rays. ‘Should only x-ray if there is pain in the malleolar area’ – Prevents 85% of X-rays showing no fracture – so reduces the number of unnecessary X-Rays

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35
Q

Well’s score is for diagnosis of

A

DVT

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36
Q

Prescribing systems can give:

A

Advice on drug
Advice of dosage
Contraindications

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37
Q

CDSS can improve practitioner performance in:

A

Diagnosis
Disease management
Prescribing
Rates of vaccination, screening, health promotion etc.

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38
Q

Aspects of CDSS that are successful:

A
  • Computer based
  • Normal work flow
  • Gives advice when and where decision is being made
  • Recommendations for management not just assessment
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39
Q

Barriers to CDSSs usefulness/uptake

A

Increases workload
Practitioner has bad experience with IT in past
Affects doctor-patient relationship
Obscures responsibilities - loss of clinical autonomy

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40
Q

Give an example of how CDSS can aid shared decision making

A

Patient decision aids

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41
Q

Trials show patient decision aids can

A

Increase knowledge of condition
Be more accurate with their perception of risk
Reduce uncertainty over decisions

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42
Q

Alcohol consumption in Western countries has

A

Decreased

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43
Q

Alcohol consumption in eastern countries has

A

Increased

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44
Q

What % of people are abstainent

A

17%

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45
Q

What % of people are non-risky drinkers

A

59.2%

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46
Q

What % of people are drinking at an increasing risk

A

20%

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47
Q

What % of people are higher risk drinkers

A

4%

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48
Q

What % of people are binge drinkers

A

17%

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49
Q

What % of people are dependent on drinking alcohol

A

1%

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50
Q

Highest risk age in women for alcohol consumption

A

16-24

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51
Q

Highest risk age in men for alcohol consumption

A

45-64

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52
Q

Which region has the highest alcohol consumption

A

North East England

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53
Q

What age cohort are higher risk drinking than others

A

middle age

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54
Q

Rates of abstinence in what population are increasing?

A

Younger males and females (16-24)

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55
Q

Why might abstinence be increasing in younger people?

A

Increasing health consciousness

Other substances

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56
Q

Household income correlated to increased drinking how

A

Positively

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57
Q

In the alcohol harm model, alcohol can be looked at in terms of:

A

Volume

Pattern

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58
Q

Societal vulnerability factors for alcohol harm

A

Development level
Culture
Drinking context
Alcohol production, distribution and legislation

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59
Q

Individual vulnerability factors for alcohol harm

A

Age
Sex
Socioeconomic status
Familial factors

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60
Q

Recommenced alcohol threshold for increased risk

A

14 units a week

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61
Q

How to work out alcohol units

A

(vol in ml x %) / 1000

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62
Q

Alcohol harm paradox

A

People in most deprived areas drink less than affluent but harm is higher

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63
Q

Possible explantations for the alcohol harm paradox:

A
  • Patterns of drinking
  • History of drinking
  • Confounding: diet, smoking, occupation etc.
  • Access to health care
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64
Q

Most effective alcohol policy is to

A

Reduce affordability

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65
Q

Policies for alcohol:

A

Reduce affordability
Market regulation - change drinking behaviours
- Reduce hrs which alcohol can be serves
- brief interventions for at risk

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66
Q

Little evidence supports the effectiveness of what on reducing alcohol

A

Education

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67
Q

Barriers to brief interventions in primary care:

A 
GPs don't want to go there
Time
Doc-patient relationship
Skills and training
Patient's reluctant to disclose/talk about
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68
Q

Over 85s account for what % of population and use how many beds?

A

2.2%

4x more

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69
Q

Levels of resource allocation

A

Macro

Micro

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70
Q

Macro level =

A

Strategic, societal

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71
Q

Micro level =

A

Clinical levels

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72
Q

Why should resources on a macrolevel be affected by age?

A
  • Health care for older people is costly

- Fair innings argument

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73
Q

Fair innings argument =

A

Older people have already had a long life, younger people have not. Fairer for resources to be diverted from older people to younger people

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74
Q

Validity of an argument relates to

A

If premises are true, does conclusion follow

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75
Q

Soundness of argument related to

A

Are premises true?

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76
Q

Why might the fair innings argument be unvalid?

A

Conclusion doesn’t follow. Just because its fairer doesn’t mean we should reallocate resources - other things may be important

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77
Q

Why might the fair innings argument be unsound?

A

Premises are wrong - fairness isn’t a measure of fullness of life

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78
Q

Why should age not be a factor in allocating resources at a macro levels?

A
  • Much of this burden doesn’t relate to age but costs of illness and incapacity in last years of life
  • Even if costly, price worth paying for a society that treats members equally, respectfylly and with compassion
  • Devalues the status of older people and caters to the values of a youth-orientated culture in which negative stereotyping based on age is prevalent
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79
Q

Health care providers make decisions on a microlevel based on:

A

Need/severity

Likelihood to benefit

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80
Q

Why should age be considered when allocating on a micro level?

A
  • Age is relevant because older people are less likely to be responsive to treatment
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81
Q

Why should age not be considered when allocating on a micro level

A
  • Chronological age isn’t a good predictor of responsiveness - biological age more important
  • Discrimination
82
Q

Name 2 laws/Regulators which prohibits age related discrimination in NHS

A 
Equality Act (2010)
GMC
83
Q

Equality at (2010) protects how many characteristics?

A

9

84
Q

Characteristics protected by equality act:

A 
Age
Sex
Race
Gender reassignment status
Diability
Religion or belief
Sexual oreintationn
Marriage or civil partnership status
Pregnancy
85
Q

Direct discrimination =

A

Direct difference in treatment based on characteristic

86
Q

Indirect discrimination =

A

Seemingly neutral provision has harmful repercussions on an individual/group

87
Q

Equation for QALY:

A

Utility x no of years in health state

88
Q

An efficient health activity in terms of QALYs

A

Low cost per QALY

89
Q

Beneficial health activity in terms of QALYS

A

Generates positive amount of QALYs

90
Q

Why are QALYs good?

A

Addresses primary purpose of healthcare (well being)
Patient identify them as important
Used by NICE

91
Q

Why might someone object to QALY assessments?

A

Difficulty measuring/bias
Unjust
Ageist

92
Q

Why might QALY assessments be unjust:

A
  • Double jepordy argument
  • End of life care
  • Number of lives over individual lives
93
Q

Double-jeapordy argument =

A

People with pre-exisitng conditions will be treated worse on a QALY assessment

94
Q

Why might QALY disadvantage end of life care

A

Based on number of years lives

95
Q

Why might a QALY be ageist?

A

Indirect discrimination

96
Q

Efficiency =

A

Obtaining the greatest output for a given set of resources

97
Q

2 main types of efficiency

A

Technical efficiency

Allocative efficiency

98
Q

How is the NHS funded?

A

General taxation
National insurance
Out of pocket charges

99
Q

Largest lump of money goes to:

A

Hospitals

100
Q

What is the principle of funding general practice?

A

Contractual arrangements between GPs and NHS

101
Q

How are GP funding allocated?

A

Capaitation - per head
QODs
Enhances services (e.g. vaccines)
Other - e.g. pharmacy

102
Q

How else can we fund a health service?

A

Out of pocket
Social insurance
Private insurance

103
Q

Social insurance models, costs fall mainly on

A

Employment sector

104
Q

2 main problems with private insurance models:

A

Adverse selection

Moral hazard

105
Q

Adverse selection =

A

Private insurance tends to be more expensive the more likely you are to need healthcare

106
Q

How to tackle adverse selection:

A

Universal insurance

Safety-nets

107
Q

Moral hazard =

A

Consumer - more risks

Provider - un-needed work

108
Q

Ways to help consumer moral hazard

A

Co-payments

109
Q

Ways to help provider moral hazard

A

Regulations/guidelines

110
Q

Efficacy =

A

Does an intervention work? (RCTs)

111
Q

Effectiveness =

A

Does an intervention work in practice?

112
Q

Technical efficiency =

A

Best way to use resources to best achieve an objective.

113
Q

Ex of technical efficiency

A

To pass my exams, should I go to lecture or go to library and watch later?

114
Q

Allocative efficiency =

A

Whether or how many resources should be allocated to objective

115
Q

Ex of allocative efficiency =

A

How much time should I dedicate to passing exams and how much should I dedicate to going out?

116
Q

Ex of some ‘costs’ in opportunity cost =

A

depression
pain
death

117
Q

Why are markets good?

A

Meeting points between suppliers and consumers. Can provide a good way to achieve best exchnage of scarce resources

118
Q

As price increases

A

Supply increases

Demand decreases

119
Q

As price decreases

A

Supply decreases

Demand increases

120
Q

When supply = demand

A

Both consumer and producer make best of their resources (efficiency)

121
Q

Why might a market fail?

A

Not efficient

Not provide fair allocations

122
Q

Why might a market not be efficient?

A
  • Asymmetry in information (supplier-induced demand)
  • Monopoly or cannot enter the market
  • Transaction costs
123
Q

Supplier induced demand

A

Demand increases/is there just becuase it is provided

124
Q

How to make a market more efficient:

A
  • Empower patients or regulate
  • Subsidise new entrants to market
  • Minimise complexity of transaction costs
125
Q

Economic evaluation is the

A

comparative analysis of courses of action in terms of both costs and consequences

126
Q

Function of NICE =

A

provides recommendations of the use of new and existing medicines and treatments within NHS based on clinical and economic evidence

127
Q

What is a partial economic evaluation?

A

Only considers costs
Only considers consequences
Only looks at 1 option

128
Q

A full economic evaluation must =

A

Look at costs and consequences

Look at 2 or more alternatives

129
Q

Methods of economic evaluation:

A

Cost-effectiveness analysis
Cost-utility analysis
Cost-benefit analysis

130
Q

Costs are measured as

A

£

131
Q

Outcomes measured in CEA

A

Single common variable/natural clinical unit

132
Q

Outcomes measured in CUA

A

All effects

133
Q

How are outcomes values in CUA

A

QALYs

134
Q

Outcomes measured in CBA

A

All effects

135
Q

How are outcomes valued in CBA

A

Monetary terms

136
Q

2 ways economic evaluations can be conducted?

A

Alongside RCTs

Rely on existing data/studies

137
Q

Example of evaluations which rely on existing data

A

Technology assessment reviews (NICE)

138
Q

Costs which may be considered in economic evaluation:

A

Costs to health sector
Costs to patients and family
Costs onto other sectors

139
Q

Costs to health sector

A
  • treatment
  • staff
  • time
  • facilities
  • other operational costs
140
Q

Costs to patient and family

A
  • worry/stress
  • loss of productivity
  • out of pocket expenses: transport
141
Q

Ex of costs to other sectors

A

Social services

142
Q

Consequences that can be measures:

A

Health state/QoL
Resources saved further down line
Productivity gain
Savings to patient and family

143
Q

NHS decision making may only consider what perspective?

A

Health service implications

144
Q

CMA =

A

Cost-minimisation analysis

145
Q

What does a cost minimisation analysis assume?

A

Health effects are equal

146
Q

Choice in a CMA is the treatment with

A

the lowest cost

147
Q

In a CEA effects are measured in terms of

A

the most appropriate uni-dimensional nautral unit

148
Q

is a CEA uni-dimensional or multi-dimensional?

A

Uni-dimensional

149
Q

Benefits of CEA

A

Straightforward to carry out

Easy to interpret

150
Q

Cons of CEA

A

One unit - may have a range of outcomes

Cannot compare alternatives which don’t have same unit

151
Q

ICER =

A

Incremental cost-effectiveness ratio

152
Q

Calculation for ICER

A

(c of intervention - c of control) / (mean effect of intervention - mean effect of control)

153
Q

ICER will give you

A

Cost per unit outcome

154
Q

Decision rules when using CEA

A
  • Reject any alternatives that are dominated by others

- If not dominated, chose lowest ICER if below ceiling ratio

155
Q

What does it mean when an alternative is ‘dominated’ by another?

A

Greater cost with no greater benefits.

Lower benefits at no smaller cost

156
Q

Ceiling ratio =

A

Level of ICER which any alternative must meet if it is regarded as cost effective

157
Q

NICE ceiling ratio =

A

20,000 per QALY saved

158
Q

In CUA effects are (unidimensional/multidimensional)

A

Multi dimensional

159
Q

CUA is a special care of what

A

CEA

160
Q

CUA allows comparison of interventions that

A

would be measured using different clinical outcomes

161
Q

CUA allows what to be allocated across clinical areas?

A

Global budget

162
Q

Disadvantages of QALY league table:

A

Assumations underlying ratios not considered
Equity: people at bottom of list won’t get anything?
Is QALY the end goal?

163
Q

The most comprehensive form of evaluation is the

A

Cost benefit analysis

164
Q

Why is CBA more comprehensive?

A

Takes a societal perspective.

All costs and outcomes included

165
Q

Why are CBAs controversial?

A

Monetary values to health outcomes - how do we do this?

166
Q

Preferred economic evaluation in the UK

A

Cost utility analysis

167
Q

Food posioning cases should be notified to

A

Public health England

168
Q

Bacterial causes of food posioning:

A

Campylobacter
Salmonella
E.coli

169
Q

Most common viral cause of food posioning:

A

Norovirus

170
Q

Ex of fungal cause of food poisioning

A

Aspergillus

171
Q

Ex of protozoal cause of food poisioning

A

Cryptosporidia

172
Q

Chemicals that can cause food poisioning:

A

Heavy metals
Pesticides
Hercicides

173
Q

Most common reported cause of food poisioning

A

Campylobacter

174
Q

Most common/underreported source of FP

A

Norovirus

175
Q

Salmonella is what type of bacteria

A

Gr -

176
Q

S.typhi and S.paratyphi cause

A

Enteric fever

177
Q

S.enteritidis causes

A

Enterocolitis

178
Q

If food poisioning comes on very quickly it is likely to be

A

S.aureus

179
Q

S.aureus food poisiong is due to a

A

Toxin

180
Q

Cryptosporidium is not killed by

A

Chlorine

181
Q

S.aureus is not killed by

A

Heating food

182
Q

EPEC

A

Enteropathogenic E.coli

183
Q

EPEC causes

A

Infantile diarrhoea

184
Q

EAEC

A

Enteroagregative E.coli

185
Q

EAEC causes

A

travellers diarrhoea

186
Q

ETEC

A

Enterotoxic e.coli

187
Q

EIEC

A

Enteroinvasive e.coli

188
Q

EHEC

A

Enterohaemorrhagic E.coli

189
Q

Ex of an EHEC

A

E.coli O157 H7

190
Q

E.coli O157 H7 can cause

A

Gastroenteritis
Hemolytic uremia
Haemorrhagic colitis

191
Q

Genome of Norovirus

A

RNA

192
Q

Outbreaks of norovirus are common in

A

Semi-closed envirnoments

193
Q

Incubation period of norovirus

A

24-48 hrs

194
Q

Name 2 campylobacter species:

A

C.coli

C.jejuni

195
Q

Why investigate food poisioning outbreaks?

A

Level of morbidity and mortality - Vulnerable groups (elderly and children), unpleasant, people do die  Potentially can get very big outbreaks  Common but changing problem  Public concern with political implications  We can do something about it  We all need to eat and shouldn’t have to worry about what we eat

196
Q

What act allows exclusions from work of people that pose an increased risk of GI infection spread?

A

Public health act

197
Q

Ex of people protected by public health act

A
  • Care workers
  • Food handlers
  • children in nurdery
198
Q

Offences under the food safety act (1990)

A
  • Sale of food that have been rendered injourous to health
  • Sale of food not of the nature or substance or qulaity demanded by the purchaser
  • Display of food for sale which falsely describes food
199
Q

HACCP

A

Hazard analysis critical control point

200
Q

GMP

A

Good manufacturing practice

201
Q

HACCP is cmpulsory within

A

Good manufacturing procress

Health and society (6 decks)

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