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Community and Public Health - Quick > Community and Public Health - Quick > Flashcards

Community and Public Health - Quick Flashcards

1
Q

(Public Health)

What is public health?

A

The science and art of preventing disease, prolonging life and promoting health through organized efforts of society.

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2
Q

(Public Health)

What are the key concerns of public health?

A
  • Inequalities in health
  • Wider determinants of health
  • Prevention
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3
Q

(Three Domains of Public Health)

What are the three domains of public health?

A

Health IMPROVEMENT

Health PROTECTION

Improving SERVICES

(SIP)

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4
Q

(Three Domains of Public Health)

What is the Health Improvement Domain of Public Health Concerned with?

A

Health Improvement - Concerned with societal interventions (not primarily delivered through health services) aimed at preventing disease, promoting healt and reducing inequalities.

  • Inequalities
  • Education
  • Housing
  • Employment
  • Lifestyles
  • Family/ Community
  • Surveillance and Monitoring of specific diseases and risk factors.
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5
Q

(Three Domains of Public Health)

What is the health protection domain of public health concerned with?

A

Concerned with measures to control infectious disease risks and environmental hazards.

  • Infectious diseases
  • Chemicals and poisons
  • Radiation
  • Emergency response
  • Environmental health hazards
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6
Q

(Three Domains of Public Health)

What is the improving services demain of public health concerned with?

A

Concerned with the organization and delivery of safe, high quality services for prevention, treatment, and care.

  • Clinical effectiveness
  • Efficiency
  • Service planninng
  • Audit and evaluation
  • Clinical governance
  • Equity
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7
Q

(Health Inequalities) What influences health inequalities?

A

Dimensions such as socio-economic deprivation, smoking status, education. Fixed factors such as age, and sex.

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8
Q

(Health Inequalities) What is equity?

A

Giving everyone what they need.

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9
Q

(Health Inequalities) What is equality?

A

Treating everyone the same

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10
Q

(Health Inequalities) What is horizontal equity?

A

Equal treatment for equal need

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11
Q

(Health Inequalities) What is vertical equity?

A

Unequal treatment for unequal need

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12
Q

(Study Design and Interpretation) What is a cohort study?

A

Longitudinal study in similar groups but with different risk factors/treatments. Follows up over time.

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13
Q

(Study Design and Interpretation) What are the advantages of a cohort study?

A

Can follow up rare exposure Allows identification of risk factors Data on confounders collected prospectively

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14
Q

(Study Design and Interpretation) What are the disadvantages of a cohort study?

A

Large sample size required Impractical for rare disease (above) Expensive People drop out

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15
Q

(Study Design and Interpretation) What is a case control study?

A

Observational study looking at cause of a disease Compares similar participants with disease and controls without Looks retrospectively for exposure/cause

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16
Q

(Study Design and Interpretation) Advantages of case control?

A

Quick Good for rare outcomes

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17
Q

(Study Design and Interpretation) Disadvantages of case control?

A

Difficult finding appropriately matched controls Prone to selection and information bias

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18
Q

(Study Design and Interpretation) What is a cross sectional study?

A

Observational study collecting data from a population and a specific point in time A snapshot of a group

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19
Q

(Study Design and Interpretation) Advantages of cross sectional study?

A

Large sample size Provides data on prevalence of risk factors and disease Quick to carry out Repeated studies show changes over time

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20
Q

(Study Design and Interpretation) Disadvantages of cross sectional studies?

A

Risk of reverse causality - which came first? Less likely to include those who recover quickly or sort recovery. Not useful for rare outcomes

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21
Q

(Study Design and Interpretation) What is a randomised controlled trial?

A

Similar participants are randomly assigned to an intervention control group to study effect of intervention

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22
Q

(Study Design and Interpretation) What are the advantages of RCT?

A

Low risk of bias and confounding Comparative

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23
Q

(Study Design and Interpretation) What are the disadvantages of RCT?

A

High drop out rate Ethical issues Time consuming and expensive

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24
Q

(Incidence/Prevalence and Calculations) What is incidence? What is prevalence?

A

Incidence is the rate of new cases of a disease within a period of time. Prevalence is the proportion of cases in the population at a given time. Thus, incidence conveys information about the risk of contracting the disease, whereas prevalence indicates how widespread the disease is

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25
Q

(Incidence/Prevalence and Calculations) How is incidence calculated?

A

New cases/Population E.g. 50 cases in population of 1000 in 10 years = 50/1000 = 5%

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26
Q

(Incidence/Prevalence and Calculations) How is relative risk (ratio) calculated?

A

Relative Risk (Ratio) % Incidence in Risk Group/ % Incidence in Non-Risk Group. Example (pop. 1000). 300 Smokers, 45 cancer. 700 Non-smokers, 5 cancer. 45/300 = 15% 5/700 = 0.7% 15/0.7 = 21.4 So 21.4 times more likely to develop lung cancer if a smoker

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27
Q

(Incidence/Prevalence and Calculations) How is attributable risk calculated (risk difference)?

A

Risk of lung cancer in smokers (incidence) = 15% Risk of lung cancer in non-smokers (incidence) = 0.7% Attributable risk (15/100)-(0.7/100)=14.3/100 = 0.143.

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28
Q

(Incidence/Prevalence and Calculations) How is the number needed to treat calculated?

A

How many people stop to prevent one death? NNT = 1/attributable risk 1/0.143 = 6.99

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29
Q

(Incidence/Prevalence and Calculations) What is sensitivity? What is specificity? What is the positive predictive value? What is the negative predictive value?

A

% with disease correctly identified as having the disease TP/(TP+FN) Identified with/ all with. % without the disease correctly identified as not having the disease TN/(FP+TN) Identified without/ all without The probability that subjects with a positibe

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30
Q

(Incidence/Prevalence and Calculations)

What is are predictive values dependant on?

A

On the prevalence

PPV is higher if prevalence higher

NPV is higher if prevalence lower.

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31
Q

(Incidence/Prevalence and Calculations)

What is sensitivity?

What is specificity?

What is the positive predictive value?

What is the negative predictive value?

A

% with disease correctly identified as having the disease TP/(TP+FN) Identified with/ all with. % without the disease correctly identified as not having the disease TN/(FP+TN) Identified without/ all without The probability that subjects with a positive screening test truly have the disease. TP/(TP+FP) Correct ident/All ident The probability that subjects with a negative screening test truly don’t have the disease. TN/(TN+FN) Corrent ident no/ All indent no.

32
Q

(Screening)

What is screening?

A

A process which sorts out apparently well people who probably have a disease (or precursors or susceptibility to a disease) from those who probably do not. NOT diagnostic.

33
Q

(Screening)

Types of screening?

A
  • Population-based screening programmes
  • Opportunistic screening
  • Screening for communicable disease
  • Pre-employment and occupational medicals
  • Commercially provided screening.
34
Q

(Screening)

What are the disadvantages of screening?

A
  • Exposure of well individuals to distressing of harmful diagnostic tests
  • Detection and treatment of sub-clinical disease that would never have caused problems
  • Preventative interventions that may cause harm to the individual or population.
35
Q

(Screening)

What are the essential screening criteria (Wilson and Junger)? (10)

A

The condition

  • Important disease/ health problem
  • Latent/pre-clinical phase
  • Natural history of the disease understood

The screening test

  • Suitable (sensible, specific, inexpensive)
  • Acceptable to the population

The treatment

  • Effective treatment from early detection with better outcomes than late detection
  • Policy of who should receive treatment

The organisation and costs

  • Facilities available
  • Costs of screening should be economically balanced.
  • Should be ongoing process.
36
Q

(Screening)

What is lead-time bias?

A

When screening identifies an outcome earlier than it would otherwise be identified and this results in an apparent increase in survival time, even if screening has no effect on outcome.

37
Q

(Screening)

What is length-time bias?

A

Type of bias resulting from differences in the length of time taken for a condition to progress to severe effects, that may affect the efficacy of a screening method.

Length time bias an overestimation of survival duration due to the relative excess of cases detected that are asymptomatically slowly progressing, while fast-progressing cases are detected after giving symptoms.

38
Q

What can association be due to?

A

Bias Chance Confounding Reverse Causality True Association

39
Q

What is bias?

A

A systematic error that results in a deviation from the true effect of an exposure on an outcome

40
Q

What are the types of bias? (3)

A

Selection bias - None response of certain groups, allocation bias Information bias - Measurement bias, Observation bias, Recall Bias, Reporting bias. Publication Bias - Trials with negative results less likely to be published.

41
Q

What is confounding?

A

When there is a factors, which is not the factors under investigation, which has an effect on the outcome.

42
Q

What are the Bradford Hill Criteria for causation? (5) DRS TC

A

Dose-response Reversibility Strength Temporality Consistency

43
Q

How do we define ‘health’?

A

Bio-medical - Absence of disease Psychological - Stress and Function Lay views - Felt and expressed needs

44
Q

(Health Needs Assessment)

What is a health needs assessment?

A

A systematic method for reviewing the health issues facing a population, leading to agreed priorities and resource allocation that will improve health and reduce inequalities.

45
Q

(Health Needs Assessment)

What are the stages of the ‘planning cycle’ for health services?

A

Needs assessment

Planning

Implementation

Evaluation

46
Q

(Health Needs Assessment)

What is an intervention?

A

Delivered at an individual, community or population level. May be health/non-health interventions which have an impact on public health.

First, a HNA is required.

47
Q

(Health Needs Assessment)

Definitions:

Need

Demand

Supply

A
  • Need - ability to benefit from an intervention
  • Demand - what is asked for
  • Supply - what is provided
48
Q

(Health Needs Assessment)

Definitions:

Health need

Health care need.

A

Health need - need for health eg. measured using mortality, morbidity and socio-demographic measures.

Health care need - need for health care and ability to benefit from health care. Depends on the potential of prevention, treatment and care services to remedy health problems.

49
Q

(Health Needs Assessment)

What are Bradshaw’s Needs? (Societal Perspective)

A

Felt need - individual perceptions of variation from normal health. Felt needs are changes deemed necessary by people to correct the deficiencies they perceive in their com- munity.

Expressed need - individual seeks help to overcome variation in normal health (demand)

Normative need - professional defines intervention appropriate for the expressed need

Comparative need - comparison between severity, range of interventions and cost.

50
Q

(Health Needs Assessment)

What are the three approaches to a health needs assessment?

A

Epidemiological approach

Comparative approach

Corporate approach

51
Q

(Health Needs Assessment)

Explain the Epidemiological approach to HNA and the advantages and disadvantages of this?

A

Looks at the problem epidemiologically, uses data to define the size of the problem, services available, models of care, etc. Makes recommendations.

Sources of data: disease registry, hospital admissions, GP databases, etc.

Advantages: Uses existing data. Provides data on disease incidence/mortality/morbidity. Can evaluate services by trends over time.

Disadvantages: Quality of data variable. Data collected may not be required. Doesn’t consider felt needs.

52
Q

(Health Needs Assessment)

Explain the Comparative approach to HNA and the advantages and disadvantages of this?

A

Compares the services received by a population (or subgroup) with others - Spacial, Social (age, gender, class, ethnicity)

May examine - health status, service provision, and utilization.

Health outcomes - mortality, morbidity, quality of life, patient satisfaction.

Advantages - Quick and cheap if data available. Indicates whether health or services provision is better or worse than comparable areas (gives a measure of relative performance)

Disadvantages - May be difficult to find comparison population. Data may not be available or low qulaity. My no yield what the appropriate level (of provision or utilisation) should be.

53
Q

(Health Needs Assessment)

Explain the Corporate approach to HNA and the advantages and disadvantages of this?

A

Asks the local population what their health needs are.

Uses focus groups, interviews, public meetings ect.

Wide variety of stakeholders e.g. teachers, healthcare professionals, social workers, charity workers, business, politicians.

Advantages - Based on felt and expressed needs of the population in question. Recognizes the detailed knowledge and experience of hose working with the population. It takes into account a wide range of views.

Disadvantages - Difficult to distinguish ‘need’ from demand. Groups may have vested interests. May be influenced by political agendas.

54
Q

What are the models of behaviour change? (8)

A

Health Belief Model Theory of Planned Behaviour Stages of Change/Trans-theoretical Model Social norms theory Motivational interviewing Social marketing Nudging Financial incentives

55
Q

What are the factors of the Health Belief Model?

A

Perceived susceptibility to ill health Perceived severity of ill health Perceived benefits of behaviour change Perceived barriers to taking action All impact the

56
Q

What are the factors of the Health Belief Model?

A

Perceived susceptibility to ill health Perceived severity of ill health Perceived benefits of behaviour change Perceived barriers to taking action All impact the change of engaging in health-promoting behaviour

57
Q

What are the stages of the ‘Stages of the change/trans-theoretical model’

A

Pre-contemplation Contemplation Preparation Action Maintenance (Relapse)

58
Q

What are the stages of the ‘theory of planned behaviour’ model?

A

Attitudes, subjective norm and perceived behavioural change. Impact –> Intention Impacts –> Behaviour

59
Q

(Communicable Disease Control) What are the features of a communicable disease that would make it a public health concern?

A

High mortality High morbidity Highly contagious Expensive to treat Effective interventions

60
Q

(Communicable Disease Control) Who should notify? When? What data? How?

A

Registered medical professionals, Labs. Any case of notifiable disease - on suspicion not confirmation. Any risk to health. Case details e.g. NHS no. DOB, contact. Disease and contamination. Contact local health protection authority/ PHE Written notification or telephone.

61
Q

What are some of the notifiable disease?

A

Acute encephalitis Acute infectious hepatitis Acute meningitis Acute poliomyelitis Anthrax Botulism Brucellosis Cholera Diphtheria Enteric fever (typhoid or paratyphoid fever) Food poisoning Haemolytic uraemic syndrome (HUS) Infectious bloody diarrhoea Invasive group A streptococcal disease Legionnaires’ disease Leprosy Malaria Measles Meningococcal septicaemia Mumps Plague Rabies Rubella Severe Acute Respiratory Syndrome (SARS) Scarlet fever Smallpox Tetanus Tuberculosis Typhus Viral haemorrhagic fever (VHF) Whooping cough Yellow fever

62
Q

Definition: Epidemic?

A

A widespread occurrence of an infectious disease in a community at a particular time.

63
Q

Definition Pandemic?

A

A pandemic is the worldwide spread of a new disease.

64
Q

Definition Endemic?

A

(of a disease or condition) regularly found among particular people or in a certain area.

65
Q

Definition Hyperendemic?

A

Hyperendemic refers to persistent, high levels of disease occurrence.

66
Q

Definition of epigenetics?

A

The expression of the genome depends on the action of the environment on the genetics.

67
Q

Definition Allostasis?

A

Stability through change, our physiological systems have adapted to react rapidly to environmental stressors.

68
Q

Definition Allostatic Load?

A

Long term over-taxation of our physiological systems leads o impaired health (stress).

69
Q

Definition Salutogenesis?

A

Favorable physiological changes secondary to experiences which promote healing and health.

70
Q

Definition: Emotional Intelligence?

A

The ability to identify and manage one’s own emotions, as well as those of others.

71
Q

(Primary Care)

What is primary care for?

A
  • Managing illness and clinical relationships over time
  • Finding the best available solutions to clinical problems
  • Preventing illness
  • Promoting health
  • Managing clinical uncertainty
  • Getting the best outcomes with available resources
  • Working in a Primary Health Care Team
  • Shared Decision Making with Patients
72
Q

(Antibiotics)

What are the dangers of overprescribing antibiotics?

A
  • Unnecessary side effects
  • Medicalise self-limiting conditions
  • Antibiotic resistance
73
Q

(Antibiotics)

When should antibiotics be prescribed?

A
  • Bilateral otitis media <2 years old
  • Acute otitis media with otorrhoea
  • Acute sore throat with 3 or more centror criteria: exudate, fever, tender cervical lymphadenopathy, absence of cough.
  • Systemically very unwell
  • High risk e.g. comorbidities, immunosuppression, ex premature baby
  • Age >65 and 2 of the following and >80 and 1 of the following: hospital admission within 1 year, T1DM or T2DM, congestive cardiac failure, glucocorticoid use.
  • Complications: pneumonia, mastoiditis, peritonsillar abscess/cellulitis.
74
Q

(Antibiotics)

Amoxicillin?

Penecillin?

Trimethoprim or Nitrofuratoin?

A

Otitis media, Sinusitis, LRTI.

Tonsillitis

UTI

75
Q

(Prevention)

Definitions:

Primary prevention?

Secondary Prevention?

Tertiary Prevention?

A

Primary Prevention - Preventing disease before it has happened - Immunization, education, exercise.

Secondary prevention - Catching disease in the pre-clinical or early phase - Smears, Mammography.

Tertiary Prevention - Preventing complications of disease - Thrombolytic therapy in stroke, Speech therapy following stroke.

76
Q

(Prevention)

What are the approaches to prevention?

A

Population approach - preventative measure e.g. dietary salt reduction through legislation. (All)

High-risk approach - Identify individuals above a chosen cut off and treat - e.g. screening for high bp and treating. (Risk factor)

77
Q

(Prevention)

What is the prevention paradox?

A

A preventative measure which brings many benefits to the population often offers little to each participating individual.

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