Brief public health Flashcards
Describe the Transtheoretical model of behavioural change.
- Pre-contemplation (no intention of giving up smoking).
- Contemplation (consider quitting).
- Preparation (get ready to quit in near future).
- Action (engaged in giving up).
- Maintenance (steady non-smoker).
- Relapse- a lapse leads back to resumption of smoking
What is the Gini coefficient?
A statistical representation of a nation’s income distributed among it’s residents. It is the most commonly used measure of equality.
Responses to health inequalities: what are the main principles of the Acheson Report (1998)?
- Reduce income inequality.
- Give high priority to the health of families with children.
Responses to health inequalities: what are the main principles of Proportionate Universalism?
- Focusing on the disadvantaged only will not help to reduce the inequality
- Action must be universal but with a scale and intensity proportional to the disadvantage
- A fair distribution of health (wealth?) is important
Responses to health inequalities: What are the main principles of the Black Report (1980)?
- Material (environmental causes, low income, poor education)
- Artefact (an apparent product of how inequality is measured)
- Cultural/behavioural (poorer people behave in unhealthy ways)
- Selection (sick people sink socially and economically)
Causes of health inequalities
1) Psychosocial (stress lower’s ability of body’s response to demands
2) Neo-material (poorer people have lower quality goods)
3) Life course (a combination of both psychosocial and neo-material explanations)
What are the 3 main notifiable diseases (that must be reported to Public Health England, potentially WHO)
Cholera, Meningitis, yellow fever and plague
Briefly describe the chain of infection
1) Infectious agent- microorganism that can cause harmful infections and make someone ill
2) Reservoir- Where the germ lives and grows
3) Portal of exit - Germ finds a way out of the infected person so it can spread
4) Mode of transmission - Once the germ is out, it can spread from one person to another (by hands, equipment, in the air)
5) Portal of entry - The germ finds a way into another person
6) Susceptible host - People at risk of infection (as they are unable to fight the infection)
Definition of stress
Stress occurs when the demands made upon an individual are greater than their ability to cope.
What is the stress illness model?
An individuals susceptibility to disease or illness is increased because an individual is exposed to stressors which cause strain upon the individual, leading to
psychological and physiological changes
What are the types of stress?
Distress - Negative stress which is harmful and damaging
Eustress- Positive stress which is beneficial and motivating
Name potential stressors
Acute stressors - Noise, danger, injuries, hunger
Chronic stressors- home, health, finances, work, family, friends
Internal stressors- Inflammation, infection, Psychological (attitudes, personal expectations)
External stressors- Environment, social and cultural pressures
Definition of specificity (in screening)
The proportion of people without the disease who are correctly excluded by the screening test. (how well a test detects those without a disease)
Definition of prevalence
The proportion of a population found to have the disease at a point in time
Definition of incidence
The number of new cases within a specified time period divided by the size of the population initially at risk.
Definition of positive predictive value
The proportion of people with a positive test result who actually have the disease
Define error (in patient care)
Any preventable event that can cause or lead to patient harm
3 types of human error
Errors of omission (required action is not taken/delayed)
Errors of commission (wrong action is taken)
Error of negligence (the actions or omissions do not meet the level of standard required)
What are the 2 outcomes of medical error?
Adverse event - an incident which results in harm to a patient
Near miss - An event which has the potential to cause harm but fails to develop further, thus avoiding harm
Definition of skill based errors
When performing a routine or a well learnt task, you may give little attention. If distracted or interrupted, it could result in slips of action or memory lapses.
Definition of rule/knowledge based error
When an incorrect plan or course of action is taken (can happen in emergencies or due to lack of experience)
- Mistakes are more likely when the task is complex (insufficient information, communication breakdown)
5 factors that can affect performance
Fatigue
Drugs or alcohol
Stress
Distraction
Illness
Define swiss cheese theory of errors
A model used to understand how multiple layers of defences can have weaknesses that when aligned, can lead to accidents or failures.
Health problems connected to smoking
Cardiovascular problems (strokes, heart attacks)
Stomach ulcers
Diabetes
Negative impact on oral health
Cancer - Pancreas, bladder, stomach, etc
4 domains of public health
Health protection
Improving services
Health improvement
Addressing the wider determinants of health
Name 5 ethical theories
Virtue
Categorical
Imperative
Utilitarianism
4 principles
Describe the Health Belief Model (Becker 1974) of behavioural change.
(Theoretical model that can be used to guide health promotion and disease prevention programs)
The individual needs to believe that there are consequences and that they are susceptible to disease. They need to believe that taking action reduces the risks and that the benefits outweigh any costs.
Primary prevention
Preventing a disease/condition from occurring in the first place.
Eliminate exposures/risk factors that contribute to the disease.
e.g. ban or control of use of hazardous products, health and safe habits (exercising regularly, eating a balanced diet, not smoking) - vaccination?
Secondary prevention
Detecting a disease as soon as possible in order to alter its course and to improve health outcomes.
E.g. Regular screenings, blood pressure monitoring, routine HIV testing
Tertiary prevention
Trying to slow down the progression of a disease and helping people to manage their illness effectively.
e.g. stroke/cardiac rehabilitation programmes, therapy
What is the ‘prevention paradox’?
A preventive measure which brings much benefit to the population, although it may offer little benefit to each participating individual e.g salt reduction (benefit population) versus treatment for high blood pressure (benefit individual)
What are the 2 levels of behaviour change?
Population level
- Health promotion campaigns (screening, 5 a day)
Individual level
- Patient centered approach - care in response to individual’s needs
Theory of planned behaviour Ajzen (1988)- What does it propose and what are the 3 principles?
It proposes that the best predictor of behaviour is intention
Intention is determined by
- ATTITUDES- Patient’s attitude towards something
- SUBJECTIVE NORM- Attitudes of significant others towards something (perceived social pressure to undertake the behaviour)
- PERCEIVED BEHAVIOURAL CONTROL- A belief that one can stop something e.g. stop smoking (an appraisal of your ability to perform the behaviour)
What does PICO stand for?
P - patient problem or population.
I - intervention.
C - comparison.
O - outcome.
What is a meta analysis?
When data from individual studies in systematic reviews are combined to address the research question
3 biological and cognitive features of depression
Biological - Loss of appetite, overeating, early morning wakening, poor memory, concentration loss, loss of libido, insomnia, constipation, diarrhoea, menstrual disturbance
Cognitive - feeling of being a failure, negative thoughts, reduced self-esteem, reduced confidence (poor memory, concentration loss – if not included in answer above) anhedonia
Treatment for depression (pharmacological and non pharmacological)
Selective serotonin Reuptake inhibitor
Fluoxetine, sertraline
Non pharmacological
- CBT
- Counselling
- Talking therapy
Alcohol harm paradox
Lower socioeconomic status groups consume less alcohol than higher SES groups, but experience greater alcohol related problems
2 types of dependence (Alcohol/Drug)
Physical dependence - Without the drug, they will experience withdrawal symptoms like stomach cramps, aches
Psychological dependance - the feeling that life is impossible without the drug OR feelings of fear/guilt without the drug
