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Rach SOCPOP > Block 3 > Flashcards

Block 3 Flashcards

1
Q

Define health behaviours

Behaviours that are related to the health status of an individual.

A

3 types:

1. Good health behaviours

Sleeping (7-8 hours), regular exercise, healthy eating

2. Health protective behaviours

Wearing seatbelt, health screening

3. Health imparing habits

Smoking, high fatty diets, alcohol abuse

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2
Q

What are the determinants of health?

A

Background factors

Factors that define the context in which people live their lives

Stable factors

Individual differences (personality) in psychological activity that are stable over time and context

Social factors

Social connections in the immediate enviroment

Situational factors

Appraisal of personal relevance that shape responses in a specific situation

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3
Q

What drives seeking medical help?

A

Explanation of symptoms:

How they make sense of it in the context of their lives.

Perception of symptoms:

Frequency, severity etc.

Evaluation of symptoms:

Costs and benefits of seeking help.

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4
Q

What social triggers make us seek help?

A

Interference with relationships

Sanctioning by others

Interference with job/activities

Interpersonal crisis

Temporising of symptoms.

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5
Q

What are health behaviours?

A

Behaviours that are related to the health status of an individual

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6
Q

Explain the dual pathway model

A

There are two main ways that psychology can influence health:

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7
Q

Give examples of emotional dispositions that are important in determining health behaviours

A

OCEAN!

Openness

Conscientiousness

Extroversion

Agreeableness

Neurotic-ism.

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8
Q

Define locus of control

(Generalised expectancies)

A

Expectations that future events will be determined by internal (self) factors or external control (others, God etc.)

People with an internal locus of control tend to have better outcomes, as they believe they are in control of their health.

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9
Q

Define self-efficacy

(Generalised expectancies)

A

Belief in one’s own ability to organise and execute a course of action

And the expectation that the action will result in, or lead to, a desired outcome

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10
Q

What are the 3 broad types of individual differences?

A

1. Emotional dispositions

(present - psychological processes involved in both the expereince and expression)

2. Generalised expectancies

(future – psychological processes involved in formulating expectations in relation to future outcomes)

3. Explanatory styles

(past – psychological processes involved in explaining the causes of negative events)

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11
Q

Define optimism (Explanatory style)

A

Expectation of a positive future outcome despite current negative event

Linked to better physical health, illness recovery and health behavours

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12
Q

Define Attributional style

(Explanatory style)

A

Causal explanations of negative events as internal, permanent and global

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13
Q

What factors need to be considered when designing studies/interpreting results?

A
  1. Chance
  2. Bias
  3. Confounding factors
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14
Q

Define bias

A

“Any trend in the collection, analysis, interpretation or publication of data which allows conclusions to be drawn that are systematically different from the truth.”

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15
Q

Define publication bias

A

Rejection of unflavoured outcomes.

Prefers studies that support favoured theories.

Ie. That a drug works

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16
Q

Define recall bias

A

Caused by differences in the accuracy/completeness of the recollections obtained from study participants.

This is a type of information bias, as it affects the information received as data.

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17
Q

Define selection bias

A

Bias in choosing who will take part in the study.

Ie. One might choose patients with less severe symptoms in order to prove that a drug works.

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18
Q

Define confounding factors

A

An additional, unmeasured variable that is connected to both the dependent and the independent variable.

Eg. Obesity and CHD, smoking may be a confounding factor.

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19
Q

When must bias be considered?

A

Bias must be considered when interpreting results from a study.

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20
Q

What is the Bradford Hill criterion for causality?

A

Group of minimal conditions necessary to provide adequate evidence of a causal relationship between an incidence and a consequence.

Critera includes:

  1. Strength of assciation
  2. Specificity of association
  3. Consistency of association
  4. Temporal sequence
  5. Dose response
  6. Reversibility
  7. Coherence of theory
  8. Biological plausibility
  9. Analogy
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21
Q

Describe the hierarchy of evidence

A
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22
Q

What are the types of bias?

A

1. Selection

Admission, prevalence/incidence, detection, volunteer, loss to follow up

Error in choosing the individuals or groups to take part in the study leads to the distortion of the analysis.

Needs to be taken into account when making conclusions about the study.

2. Information

Interviewer, questionnaire, recall, diagnostic suspicion and expose.

Bias that arises from measurement error.

3. Confounding

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23
Q

Define reverse causality

A

Like the chicken or the egg.

Which is the causality and which is the outcome?

Ie. Mental health problems can cause unemployment but unemployment can cause mental health problems.

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24
Q

Define ‘the number needed to treat’

A

The number of people that would have to receive the treatment in order to prevent one negative outcome.

NNT = 1/AR

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25
Q

What is the difference between observational studies and experimental studies?

A

Observational studies measure variables of interests in subjects as opposed to actively giving treatments/intervening in any way.

Experimental studies intervene, setting specific variables for differences between groups.

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26
Q

Define descriptive observational studies

A

Examines distributions.

Ie. what is the prevalence?

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27
Q

Define analytical observational studies

A

Examines determinants.

Ie. What exposures increase risk?

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28
Q

What are ecological studies?

A

Studies that compare an area or population with another.

Ie alcohol consumption of UK to France

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29
Q

What is the ‘ecological fallacy’

A

The ecological fallacy is thinking that relationships observed for populations hold for individuals:

ie. if populations with more protestants tend to have higher suicide rates, then protestants must be more likely to commit suicide.

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30
Q

What are the pros and cons of ecological studies?

A

Pros:

Easy to do as information available

Cheap

May raise hypothesis

Cons:

Work on whole population data so cannot be applied to individual persons

Cant establish cauasation only association

Ecological fallacy

Less reliable data collection (disadvantage related to cross-sectional studies)

Confounding

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31
Q

What are cross-sectional studies/surveys?

A

A study in which information is collected from each subject in the study population at one point in time.

eg. survey

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32
Q

What are the pros and cons of cross-sectional studies/surveys?

A

Pros:

Cheap and simple

Good for examining exposures that do not change over time (sex)

No exposure to harm or denial of beneficical therapy

May raise hypothesis

Cons:

Cannot establish causation only association

Cannot measure incidence

Confounding

Recall bias

Response rates (dependent on this factor)

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33
Q

Define Case-control studies

A

Involve comparing subjects with a condition (the cases) to subjects without the condition (the controls).

This involves comparing the exposure of both groups to certain factors.

If the prevalence of an exposure is higher in cases then in controls then it is thought that the exposure may be a risk factor.

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34
Q

What is the odds ratio (equation)?

A

Odds ratio is the odds in one category over the odds in another category.

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35
Q

Interpret an odds ratio with its 95% confidence interval

(4 point interpretation)

A
  1. Odds ratio estimate – best estimate of the odds of the outcome in the population
  2. 95% CL – 95% confident that the population odds ratio lies between these two limits
  3. Is the null hypothesis included in the 95% confidence interval
  4. Is it statistically non-/significant at the 5% level
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36
Q

How many controls per a case is optimum?

A

The precision of the OR is affected by the number of healthy people (b and d).

Hence is it worth increasing the number of controls; typically up to 4-6 times as many controls as there are cases.

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37
Q

What are the pros of Case-Control studies?

A

Shorter than cohort studies

Cheaper than cohort studies

Good for studying rare events (which are not studied best via cohort studies as they need a large sample size)

Multiple exposures can be examined

No loss to follow

Suitable when randomisation is unethical (alcohol and pregnancy outcome)

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38
Q

What are the cons of Case-Control studies?

A

Prone to biases i.e. recall

Problems sorting out sequence of events

Not suited for rare exposures

Cannot measure disease incidence

Multiple outcomes cannot be studied

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39
Q

Define nested case-control study

A

Nested case-control studies involve collection of data before disease has developed

(from pre-existing records or biological samples)

Whereas conventional case-control studies involve retrospective collection of data

(from recall).

40
Q

What are the advantages of a nested case control study over a case-control study?

A

Incidence rates can be calculated

Population for sampling of controls is already defined

Data obtained before disease has developed hence recall bias is eliminated

41
Q

What are the advantages of a nested case control study over a cohort study?

A

Can collect more detailed information for a minority of participants

(cost are dramatically reduced)

Cost-effective alternative to a full cohort analysis

42
Q

Define cohort studies

A

Study in which a group of people with a common factor are followed up over time

Two groups of people, one group exposed and another unexposed to a potential cause of disease are followed-up over time

The incidence of the disease in one group is compared with the incidence in the other group.

43
Q

How are cohort studies analysed?

A

Two ways depending on population used:

  1. Incidence rate ratio (IRR)
  2. Standardised mortality/morbidity ratio (SMR)
44
Q

What are the pros of cohort studies?

A

Monitor changes over time

Detect (casual) associations and time sequence

Establish population-based incidence

Examine rare exposures

Multiple outcomes can be studied

45
Q

What are the cons of cohort studies?

A

Lengthy and expensive

Require very large samples

Not suitable for rare diseases

Not suitable for diseases woth long latency

46
Q

What is the difference between a cohort study and case-control study?

A

Case-control study begins with people with the disease (the cases)

Compares them to people without the disease (the controls).

47
Q

What is the epidemiological transition?

A

Shift from acute to chronic and degenerative conditions

48
Q

What are the key features of the epidemiological transition?

A

Decline in mortality - concentrated on infectious diseases, increase in non-infectious ‘degenerative’ diseases

A shift in burden of illness from younger to older age group

A shift from acute, often fatal illness to chronic conditions

Disease of affluence (CVD, stroke, hypertension, obesity) becoming more common among poorer groups

49
Q

Table of summary of study designs

A
50
Q

How would you calculate the incidence rate ratio?

A

IRR is a ratio of the incidence of the outcome in the exposed group over the incidence of the outcome in the unexposed group.

51
Q

What is the standardised mortality ratio?

A

Used when you have to compare the population in your cohort study to an external population.

Ie. “If my cohort had the same composition (age, sex, ethnicity) as a reference population, would we expect more or less deaths then expected?”

52
Q

How would you calculate the standardised mortality ratio?

A
53
Q

Define attributable risk

A

The incidence of disease in the exposed that can be attributed to the exposure

Ie the risk difference:

AR = I exposed – I unexposed

54
Q

Define chronic illness

A

The experience of living with a long tem condition for which there is no other cure

Which may be managed with drugs and other treatment

1 in 3 live with chronic illness.

55
Q

Explore some illness narratives

A

Search for meaning – Why me?

Uncertainty/Unpredictability

Resilience and coping.

56
Q

What are the main biopsychosocial areas affected by chronic illness?

A

ADLs

Sense of self

Social relationships

Social identity (How others see you.)

57
Q

Outline some common coping strategies used by people affected by chronic illness

A

Denial

Ignoring

Normalisation

“Passing off” as normal

Resignation

Embrace illness

Accommodation

Deal with the illness

Becoming the expert patient.

58
Q

What is meant by ‘passing off’ in relation to chronic illness

A

To cover up the presence of symptoms and act as if everything is normal.

The cost of passing off normal can come at a cost

i.e. increase the risk of symptoms becoming evident

Usually the presentation of normal requires the support and co-operation of partners and other relatives

59
Q

What is meant by biographical disruption?

A

Biographical disruption with respect to chronic illness means that chronic illness may disturb the trajectory of people’s lives.

Everything changes for them and it gets hard!

60
Q

What is the expert patient programme?

A

Recognises the knowledge and expertise held by patients living with chronic illness

Encourages patients to become ‘key decision makers in their treatment process’

Provides training opportunities for people with chronic conditions to develop skills to ‘self-manage’ their condition more effectively

Is open to all people living and coping with a long-term health condition

Led by people with chronic health conditions

61
Q

What are the potential pros of the expert patient programme?

A

Patients will see their condition improve or stay stable

Patients will have more confidence in seeking the right health and social care services for them

Patients will contribute towards improving health services

Patients will need fewer visits to GPs and outpatient clinics thus saving NHS resources

Patients and health professionals will work together to find better solutions to care and treatment issues

62
Q

What are the potential cons of the expert patient programme?

A

How is the participation of all social groups to be achieved

May intensity the exclusion and marginalisation of the most disadvantaged groups

Extra pressure placed on patient organisations

No corresponding strategy to challenge professional attitudes

Thought just to be a method to save resources

63
Q

What are the impacts of chronic illness?

A

Biopsychosocial impact

It’s a shock and as a result there are huge changes in life – reduces quality of life

The patient needs to make many changes to deal with the chronic illness

Examples:

Adjust to symptoms and disability

Maintain an emotional balance

Preserve a self-image and sense of competence

Learn about symptoms, treatment and self-management

Maintain relationships with friends and family

Forming and maintaining relationships with health care professionals

Preparing for an uncertain future

64
Q

Explain pain management using psychological and social factors via the crisis theory

A

Crisis theory – tries to explain how people manage and cope with chronic illness

They need to find a social and psychological balance.

Certain challenges, setbacks and social influences can impact the coping responses of patients.

For example:

When in a crisis, patients are more likely to listen to those close to them (family).

65
Q

What are the features of a pain management programme?

A

Endorsed by NICE

Reinforces the message of gate control theory (a combination of psychological and physical factors can open and close the gate)

Involves clinicians, specialist nurses, physiotherapists, and psychologists

Can come in different formats

i.e. intense and residential or spread over a few weeks (6-8) and not residential

66
Q

What are the pros of the pain management programme?

A

Helps patients manage their pain rather than the pain managing/controlling them

Learn to change cognitive perceptions of pain, less catastrophizing, challenging unhelpful thoughts

Management of stress and anxiety as well as low mood and depression

Not feeling so isolated with the condition when in a group

67
Q

What are the cons of the pain management programme?

A

Managing group dynamics

Stages of change – are patients ready to change their behaviours?

Commitment

Managing fears

68
Q

What is the difference between social carers (paid carers) and unpaid carers?

A

Paid carer:

Include staff who work with people in residential care homes, in day centres and who provide care in someone’s home.

Unpaid carer:

Carers who provide unpaid care by looking after an ill, frail or disabled family member, friend or partner

69
Q

What are the main kinds of support that unpaid carers provide?

A

Practical help

(preparing meals, housework)

Personal care

(bathing, washing, dressing and toileting)

Physical help

(with getting in and out of bed, walking and getting up and down stairs)

Finances

Administering medication

70
Q

Why do some people not use the term ‘carer’?

A

May not consider themselves to be a ‘carer’

They may not describe or see themselves as carers:

Instead they continue to be husbands, wives, partners, parents, sons, daughters

Believe they are caring out of love for the other person

71
Q

Outline the pros and cons of using the term carer

A

Pros:

May identify need and open up the way to providing services

May give recognition of the demands made upon carers and the contribution they make

May offer some carers a sense of identity – more likely to attend support groups

Cons:

May lead to others to see that person only in terms of that definition and the responsibilities linked to it

May lock some people into a role they do not want

Some may dislike or reject carer tag preferring to define them in terms of their relationship to the patient

Person being cared for may feel undermined if someone close is defined as their carer

72
Q

Define caring

A

“Caring for somebody that is unable to look after themselves.”

73
Q

What are the main impacts of caring, on carers?

A

Financial

Social exclusion

Health

Work

Being a young carer (education)

74
Q

What are the main impacts of caring on carers regarding finances?

A

Carers usually on lower income as reduced ability to work

Usually have higher costs: additional laundry, higher bills

75
Q

What are the main impacts of caring on carers regarding social exclusion?

A

Hard to access holidays, leisure pursuits and other social activities

Most get few or no breaks from caring duties

Most look after people who do not get any regular visits from health or welfare professionals

Those people who care carer by relatives are less likely to receive help

Greatest lack of support in black and minority ethnic groups

76
Q

What are the main impacts of caring on carers regarding health?

A

Carers usually have poorer mental and physical health than non-carers

Injuries due to the manual handling responsibilities of the role

High prevalence of stress and depression among carers

Unable to find time for own health check-ups or do things to improve own health

Reluctant to accept certain treatments if it interferes with caring duties

May want to be discharged from hospital earlier

77
Q

Outline the potential impacts on a young carer

A

Lots of younger carers around who provide care for a parent, sibling or other relative

There can be a lack of awareness of their existence

Usually have double responsibilities which can impact them

  • Absence from education
  • Behavioural problems
  • Social exclusion/isolation
  • Emotional problems
  • Physical health problems
  • Traumatic life changes
  • Poverty
  • Lack of support and benefits
78
Q

What support is available for carers?

A

Financial support:

Carer’s allowance – if you care >35 hours a week for someone who qualifies for disability benefit and not earning more than £100 a week

Health services support:

Consideration of carer when planning care for patient · Consideration for carers health

Signposting carers services (carers assessment, carers allowance, other services)

Carer’s assessment:

Have right to assessment of their needs

Allows carer support even if who they care for does not want help from social services

Provides information about support available to carers

Young carers project

79
Q

What is the young carers project?

A

Aims to provide opportunities for young carers to take break from their caring duties and spend time with other young carers

Can provide guidance on other support available for them

80
Q

What are the key ways of improving health and wellbeing of carers?

A

Give information about rights and entitlements

Provision of equipment quickly can help

Doctors play important role in signposting support for carers

Regular health checks for carers

Should consider the impact of timing and nature of health decisions on the carer

Carers should be consulted about decisions where possible

81
Q

What is the difference between experimental and observational studies?

A

Experimental studies:

The effect of clinical intervention is assessed

The patients receive treatments in a designed experiment.

i.e. clinical trial

Observational studies:

Patients receive normal medical care

The outcomes are observed and the relationship to risk factors is assessed.

i.e. cohort study, case-control study

82
Q

Define clinical trial

A

Any form of planned experiment, which involves patients

Is designed to find to most appropriate method of treatment of future patients with a given medical condition.

83
Q

What is the purpose of a clinical trial?

A

To evaluate a new treatment:

Scientifically

Unbiased evaluation

Controlled comparison

Ethical considerations

84
Q

What are the features of randomised controlled trials?

A
  1. Concurrent controls
  2. Random allocation
  3. Process of randomisation (computer generates random numbers)
  4. Blinding
  5. Placebo effect
85
Q

Why is random allocation important in RCT’s?

A

Aims to have the groups differ only in treatment they receive

Random allocation allows:

Gives equal chance of receiving each treatment

Long run leads to groups that are likely to be similar in characteristics by chance

Reduces the selection bias

Used in other experimental settings

86
Q

Why is blinding important in RCT’s?

A

Two types of blinding:

Single blind

One of the patient, clinician or assessor does not know the treatment allocation

(usually patient)

Double blind

Two or more of patient, clinician or assessor does not know the treatment allocation

(usually patient +clinician/assessor)

Examples

Make treatments appear identical (taste, appearance, texture or dosage)

Compare active drug to placebo

Use a designated pharmacy to label identical containers with code numbers

87
Q

Why is concurrent controls important in RCT’s?

A

All patients undergo the two types of treatments at the same time

Prevents historical controls process and thus eliminates bias and makes the trial fairer

88
Q

Why is a placebo effect important in RCT’s?

A

Even if the therapy is irrelevant to the patient’s condition, the patient’s attitude to her or his illness and the illness itself can be improved by a feeling that something is being done about it

89
Q

What does non-compliance mean?

A

Not every patient remains in the trial due to several reasons.

  • The clinical condition may mean they have to be removed from the trial
  • They may choose to withdraw from the trial.

Not every participant complies with his or her allocated treatment.

  • They may have misunderstood the instructions
  • May not like taking their treatment
  • May think the treatment is not working
90
Q

What is the difference between ‘As-Treated’ and ‘Intention to treat’ analysis?

A

Explanatory trials – “As-treated approach.”

Realises issues with non-compliance.

Follows up only the subjects that took to treatment and complied with their treatment.

BUT loses some of the randomisation, as compliers are likely to be fundamentally different from non-compliers, selection bias and confounding.

Pragmatic Trials – “Intention to treat approach.”

Takes everybody into account, disregarding the problems associated with non-compliance.

91
Q

Is the ‘As treated approach’ or the ‘Intention to treat approach’ more relevant to clinical practice?

A

The intention to treat approach ( Pragmatic trails) is more relevant to clinical practice!

This is the approach used in clinical trials.

They give smaller effect sizes.

92
Q

What are the ethical issues involved in a clinical trial?

A
  • Doctors should provide best treatment for each individual patient*
  • Scientific integrity requires treatment chosen randomly*

Clinical equipoise

Reasonable uncertainty about which treatment is better

Randomisation does not deny any patient the best treatment

Informed consent

It should be explained that patient is invited into a trial, what the alternative treatments are, that the treatment is allocated at random, that the patient may withdraw at any time.

The information should be given verbally and in writing with some time to decide and by a knowledgeable informant

93
Q

Outline the ethical and governance research requirements

A

Ethical requirements:

The type of ethical review required depends on the type of study carried out

If the study type is an audit or service evaluation then the approving ethical requirements include:

  • Course director/Supervisor
  • Head of NHS department.

Governance Requirements:

Compliance with the principles of GCP

NHS Research Governance Framework 2005

94
Q

What are the guiding principles in research ethics (Declaration of Helsinki)?

A

Regarded as the cornerstone document of human research ethics but not legally binding

(4 key points):

  1. Respect for the individual
  2. Informed consent
  3. Risks and benefits
  4. Ethics review
95
Q

What are the 13 principles of good clinical practice?

A
  1. Clinical trials should be conducted in accordance with the ethical principles that have their origin in the Declaration of Helsinki, are consistent with GCP and applicable regulatory requirements
  2. Before trial, potential risks should be weighed against the anticipated benefit for the individual trial subject and society.
  3. The rights, safety and well-being of the trial subjects are the most important considerations and should prevail over interests of science and society
  4. The available non-clinical and clinical information on an investigational product should be adequate to support the proposed clinical trial
  5. Clinical trials should be scientifically sound and described in a clear, detailed protocol.
  6. A trial should be conducted in compliance with the protocol that has received prior institutional review board (IRB) / independent ethics committee (IEC) approval / favourable opinion
  7. The medical care given to, and medical decisions made on behalf of, subjects should always be the responsibility of a qualified physician
  8. Each individual involved in conducting a trial should be qualified by education, training and experience to perform his or her respective task(s).
  9. Freely given informed consent should be obtained from every subject prior to clinical trial participation.
  10. All clinical trial information should be recorded, handled and stored in a way that allows its accurate reporting, interpretation and verification
  11. The confidentiality of records that could identify subjects should be protected by privacy and confidentiality rules in accordance with the applicable regulatory requirement(s).
  12. Investigational products should be manufactured, handled and stored in accordance with applicable good manufacturing practice (GMP).
  13. Systems with procedures that assure the quality of every aspect of the trial should be implemented
96
Q

What is reflexivity and why is important in qualitative research?

A

Considers influences on data sources (social desirability) and analysis (preconceptions)

Rach SOCPOP (5 decks)

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