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Phase 3a > Community Health- Lectures + ILAs > Flashcards

Community Health- Lectures + ILAs Flashcards

1
Q

What is the definition of domestic abuse?

A

Any incident or pattern of incidents of controlling, coercive, threatening behaviour, violence, or abuse between those aged 16 or over who are, or have been, intimate partners or family members regardless of gender or sexuality

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2
Q

What are the different forms of domestic abuse?

A

Psychological, physical, sexual, financial, emotional

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3
Q

In what three ways does domestic abuse impact health?

A

1) Traumatic injuries following assault (e.g. fractures)
2) Somatic problems or chronic illness consequent on living with abuse (e.g. chronic pain)
3) Psychological/psychosocial problems secondary to the abuse (e.g. PTSD, depression)

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4
Q

What are the different risk levels involved in domestic abuse, and how are they acted upon?

A

Standard: current evidence does NOT indicate likelihood of causing serious harm.

Medium: there are identifiable indicators of serious harm. Offender has potential to cause serious harm but unlikely unless change in circumstances.

High: there are identifiable indicators of imminent risk of serious harm. Could happen at any time and impact would be serious.

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5
Q

What are some agencies involved in domestic abuse support?

A

MARAC (multi-agency risk assessment conference)

IDVA

DHR (domestic homicide review)

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6
Q

Describe cohort studies:

A

A longitudinal study of two groups, one is exposed to a factor and the other is a control group. Follow both groups and see who gets the disease.

E.g. two groups- smokers and non-smokers. Looking forward to see the incidence of lung cancer in each group.

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7
Q

Describe case-control studies:

A

Similar to cohort studies but works in opposite direction of enquiry

Look at two groups (group of people with a disease and a group without the disease)

Retrospective look to see how many were exposed to a specific factor that may have caused the disease

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8
Q

Describe intervention studies (RCT):

A

Take a group of people, exclude those who do not meet the inclusion criteria

Randomly place them into two groups, one receives the treatment and the other is given a placebo, and look at outcomes.

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9
Q

Describe ecological studies:

A

Studies of risk-modifying factors on health (or other outcomes) based on populations defined either geographically or temporally.

Can be geographical (looks at prevalence of a disease in a pop and compares to exposure level) or time trend (looks at prevalence of a disease over time)

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10
Q

Describe cross-sectional studies:

A

Observational research that analyses data of variables collected at one given time point across a sample population.

Used to assess burden of disease or health needs of a population

Can be descriptive (looking at prevalence of disease) or analytical

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11
Q

Describe the different types of prevention and give an example for each:

A

Primary: prevent someone from getting disease or injury before it occurs (e.g. immunisation)

Secondary: detection of a disease early and preventing it getting worse (e.g. cancer screening)

Tertiary: trying to improve QoL and reduce the symptoms of a disease that one already has (e.g. stroke rehab programs)

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12
Q

What is the difference between ‘population’ and ‘high-risk’ approaches to prevention? (give examples)

A

Population approach: preventative measure delivered on a population-wide basis and seeks to shift the risk factor distribution curve (e.g. dietary salt reduction through legislation)

High-risk approach: seeks to identify individuals above a chosen cut-off and treat them (e.g. screening for people with high blood pressure and treating them)

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13
Q

What is the prevention paradox?

A

A preventative measure which brings much benefit to the population often offers little to each participating individual (e.g. seatbelts)

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14
Q

What are the different types of screening?

A

1) Population-based screening programmes
2) Opportunistic screening
3) Screening for communicable diseases
4) Pre-employment and occupational medicals
5) Commercially provided screening

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15
Q

What are the Wilson/Jungner criteria for a screening programme?

A

1) important health problem
2) Latent/preclinical phase
3) Natural history known
4) Test must be suitable (sensitive, specific, inexpensive)
5) Test must be acceptable
6) Test must be effective
7) Must be an agreed policy on whom to treat
8) Must be facilities available
9) Cost v Benefit
10) Must be an ongoing process

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16
Q

Define sensitivity and specificity:

A

Sensitivity: the proportion of people with the disease that are correctly identified by the screening

Specificity: the proportion of people without the disease that are correctly excluded by the screening programme

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17
Q

What is meant by positive and negative predictive? value?

A

PPV: the proportion of people with a positive test result who actually have the disease

NPV: the proportion of people with a negative test result who do not have the disease

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18
Q

What is lead-time bias?

A

Lead time is the length of time between the detection of a disease and its usual clinical presentation and diagnosis

The bias is the appearance that early diagnosis of a disease prolongs survival with that disease

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19
Q

What is length-time bias?

A

Cancers may be slowly or rapidly progressive

Less aggressive cancers are more likely to be detected by screening rounds

A comparison of survival between screen detected/non-screen detected may be biased as there will be a tendency to compare less aggressive with more aggressive cancers.

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20
Q

What is the difference between incidence and prevalence?

A

Incidence: new cases over time (e.g. new cases of lung cancer per 1000 per year)

Prevalence: cases at a point in time (e.g. number of people with lung cancer

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21
Q

What is the difference between attributable and relative risk?

A

Attributable: the rate of disease in the exposed that may be attributed to the exposure (i.e. incidence in exposed minus incidence in unexposed). A type of absolute risk.

Relative: ratio of risk of disease in the exposed to the risk in the unexposed (i.e. incidence in exposed divided by incidence in unexposed

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22
Q

What are the two main types of bias?

A

Selection bias: systematic error in selection of study participants or allocation of them into different study groups.

Information (measurement) bias: a systematic error in the measurement or classification of exposure/outcome (can be from observers, participants, instruments)

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23
Q

What are the criteria for causality?

A

1) Strength of association
2) Dose-response
3) Consistency
4) Temporality
5) Reversibility
6) Biological plausibility

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24
Q

What are some determinants of health?

A

1) Age, sex, constitutional factors
2) Individual lifestyle factors
3) Social and community networks
4) Living and working conditions (education, work environment, housing, water and sanitation)
5) General socio-economic, cultural, and environmental conditions

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25
Q

What is the difference between equity and equality?

A

Equality is about having equal shares

Equity is about what is fair and just

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26
Q

What is the difference between horizontal and vertical equity?

A

Horizontal equity means equal treatment for equal need (e.g. treat all individuals with pneumonia equally)

Vertical equity means unequal treatment for unequal need (e.g. individuals with common cold usually require less treatment than those with pneumonia)

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27
Q

What are the three domains of public health practice?

A

1) Health improvement (concerned with interventions aimed at preventing disease, promoting health, and reducing inequalities
2) Health protection (concerned with measures to control infectious disease risks and environmental hazards)
3) Improving services (concerned with the organisation and delivery of safe, high quality services for prevention, treatment, and care

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28
Q

What is health psychology?

A

It emphasises the role of psychological factors in the cause, progression, and consequences of health and illness

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29
Q

What are the three main categories of health behaviours? (give an example for each)

A

1) Health behaviours: a behaviour aimed to prevent disease (e.g. eating healthily)
2) Illness behaviour: a behaviour aimed to seek remedy (e.g. going to the doctor)
3) Sick role behaviour: any activity aimed at getting well (e.g. taking prescribed medications)

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30
Q

What are the different levels of health interventions?

A

Individual interventions
Community interventions
Population interventions

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31
Q

Why might knowledge of risk factors not influence a patient’s behaviour?

A

Inaccurate perceptions of risk and susceptibility

Other reasons: health beliefs, situational rationality, culture variability, socioeconomic factors, stress, age.

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32
Q

What is the perception of risk influenced by?

A

1) Lack of personal experience with the problem
2) Belief that problem is preventable by personal action
3) Belief that if it’s not happened yet, it isn’t likely to
4) Belief that problem infrequent

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33
Q

What is need, demand, and supply regarding health needs assessment?

A

Need: ability to benefit from an intervention

Demand: what people ask for

Supply: what is provided

34
Q

What is the health needs assessment?

A

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

35
Q

What can a health needs assessment be carried out for?

A

A population or sub-group

A condition

An intervention (e.g. coronary angioplasty)

36
Q

What are the three different approaches to the health needs assessment?

A

Epidemiological
Comparative
Corporate

37
Q

What are the problems with the epidemiological approach to the health needs assessment?

A

1) Required data may not be available
2) Variable data quality
3) Evidence base may be inadequate
4) Does not consider felt needs of people affected

38
Q

What are the problems with the comparative approach to the health needs assessment?

A

1) May not yield what most appropriate level should be (e.g. of provision or utilisation)
2) Data may not be available
3) Data may be of variable quality
4) May be difficult to find a comparable population

39
Q

What are the problems with the corporate approach to the health needs assessment?

A

1) May be difficult to distinguish need from demand
2) Groups may have vested interests
3) May be influenced by political agendas
4) Dominant personalities may have undue influence

40
Q

What are the three core principles of the NHS?

A

1) That it meets the needs of everyone
2) That it be free at the point of delivery
3) That is be based on clinical, not ability to pay

41
Q

What are health inequalities?

A

Health inequalities are the preventable, unfair and unjust differences in health status between groups, populations, or individuals that arise from the unequal distribution of social, environmental, and economic conditions within societies, which determine the risk of people getting ill, their ability to prevent sickness, or opportunities to take action and access treatment when ill health occurs.

42
Q

What is the inverse care law?

A

The principle that the availability of good medical or social care tends to vary inversely with the need of the population served

43
Q

What are some vulnerable groups (regarding healthcare)

A

Homeless, gypsies + travellers, asylum seekers, LGBTQ, those with learning difficulties, those with mental health problems, ex-prisoners and care leavers

44
Q

What are some causes of homelessness?

A

Eviction by private landlords; relationship breakdown; domestic abuse; disputes with parents; unemployment or insecure employment

45
Q

What barriers prevent homeless people accessing healthcare?

A

Difficulties with access (e.g. opening times, appointment procedures, discrimination

Lack or integration between mainstream primary care services and other agencies

Other priorities (immediate survival over chronic problems)

46
Q

What barriers prevent Gypsies and travellers accessing healthcare?

A

Reluctance of GPs to register them and visit sites

Poor reading and writing skills

Communication difficulties

Frequent movement/transient sites

Mistrust of professionals

47
Q

What barriers prevent LGTBQ people from accessing healthcare?

A

Stigma/prejudice

Discomfort/fear of disclosing LGTBQ status due to real or perceived homophobia

Previous negative experiences

48
Q

What are the definitions of ‘asylum seeker’, ‘refugee’, and ‘indefinite leave to remain’?

A

Asylum seeker: a person who has made an application for refugee status

Refugee: a person granted asylum and refugee status (usually means leave to remain for 5 years then reapply)

Indefinite leave to remain: when a person is granted full refugee status and given permanent residence in the UK

49
Q

What barriers prevent asylum seekers/refugees people from accessing healthcare?

A

Lack of knowledge of where to get help

Lack of understanding how NHS works

Language/culture/communication

Frequent dispersal by home office

Not homogenous group

50
Q

Name some models/theories of behaviour change:

A
  • Health Belief Model (HBM)
  • Theory of Planned Behaviour (TPB)
  • Stages of Change/Transtheoretical Model
  • Social Norms Theory
  • Motivational Interviewing
  • Social Marketing
  • Nudging (choice architecture)
  • Financial Incentives
51
Q

What is the basis of the health belief model (Becker 1974)?

A

Individuals will change if:

1) They believe they are susceptible to the condition in question
2) They believe that it has serious consequences
3) They believe that taking action reduces susceptibility
4) They believe that the benefits of taking action outweigh the costs

52
Q

What are the limitations of the health belief model?

A

Alternative factors may predict health behaviour (outcome expectancy/self-efficacy)

Does not consider the influence of emotions on behaviour

Does not differentiate between first time and repeat behaviour

53
Q

What is the theory of planned behaviour?

A

Theory that intention to change behaviour is determined by:

1) Attitude: ‘I do not think smoking is a good thing’
2) Subjective norm: ‘Most people who are important to me want me to give up smoking
3) Perceived behavioural control: ‘I believe I have the ability to give up smoking’

54
Q

What are some criticisms of the theory of planned behaviour?

A

Lack of temporal element, and lack of direction or causality

Rational choice model- does not take into account emotions such as fear that might affect rational decision-making

Does not explain how attitudes, intentions, and perceived behavioural control interact

Habits and routines bypass cognitive deliberation and undermine a key assumption of the model

Assumes that attitudes, subjective norms, and PBC can be measured

Relies on self-reported behaviour

55
Q

What are the 5 stages of the Transtheoretical Model?

A

1) Precontemplation
2) Contemplation
3) Preparation
4) Action
5) Maintenance

56
Q

What are some advantages of the Transtheoretical Model?

A

Acknowledges individual stages of readiness

Accounts for relapse

Temporal element

57
Q

What are some disadvantages of the Transtheoretical Model?

A

Not all people move through every stage, some move backwards and forwards, or miss some stages completely

Change might operate on a continuum rather than in discrete stages

Doesn’t take into account values, habits, culture, social, and economic factors

58
Q

What is the concept of the Social Norms Model?

A

The idea that our behaviour is influenced by misperceptions of how our peers think and act. Overestimations of problem behavior in our peers will cause us to increase our own problem behaviors; underestimations of problem behavior in our peers will discourage us from engaging in the problematic behavior

59
Q

According to NICE, what are some typical transition points when people are more susceptible to change?

A 
Leaving school
Entering the workforce
Becoming a parent
Becoming unemployed
Retirement and bereavement
60
Q

What is involved in Donabedian’s framework for evaluating health services?

A

Structure: what is there (e.g. buildings, staff, equipment)

Processes: what is done (e.g. number of patients seen in A+E, number of operations performed per year)

Outcomes: classification of health outcomes (mortality, morbidity, QoL/PROMs, patient satisfaction)

61
Q

What are the limitations of using measures of health outcomes to evaluate health services?

A

Link between health service provided and health outcome may be difficult to establish and there may be other factors involved (e.g. case-mix, severity, confounding factors)

Time lag between service provided and outcome may be long

Large sample sizes may be needed to detect statistically significant effects

Data may not be available

There may be issues with data quality

62
Q

What are Maxwell’s six dimensions when assessing the quality of health services?

A

1) Effectiveness
2) Efficiency
3) Equity
4) Acceptability
5) Accessibility
6) Appropriateness (relevance)

63
Q

What is the general framework when evaluating health services?

A

1) Define what the service is
2) What are the aims and objectives of the service?
3) Framework (structure, process, outcome)
4) Methodology to be used (qualitative/quantitative/mixed)
5) Results, conclusions, and recommendations

64
Q

What are the different stages of managing hypertension?

A
  1. Under 55: ACE-I/ARB
  2. Over 55/Afro-Caribbean: CCB
  3. Combine the two above
  4. Add a thiazide-like diuretic
  5. Consider further diuretic or a/b- blocker, consider seeking expert advice
65
Q

What is involved in the management of HF with reduced ejection fraction?

A
  1. ACE-I and a B-blocker (start low, go slow.
  2. Offer a mineralocorticoid receptor agonist if they continue to have symptoms (spironolactone) along with above
  3. Specialist treatment (ivabradine, digoxin, sacubitril valsartan, hydralazine with nitrate
66
Q

What is involved in the management of heart failure?

A
  1. Diuretics for symptom relief (furosemide)
  2. ACE-I (LVSD)
  3. B-Blocker (carvedilol- reduced mortality)
  4. Mineralocorticoid receptor antagonist (spironolactone)
  5. Digoxin (LVSD- helps symptoms)
  6. Vasodilators (hydralazine with isosorbide dinitrate if intolerant of ACE-I/ARB)
67
Q

What is involved in the management of acute HF?

A
  1. High flow oxygen
  2. IV access, monitor ECG
  3. Diamorphine
  4. Furosemide
  5. GTN spray
  6. Consider nitrate infusion
68
Q

What are some issues related to polypharmacy when managing patients with chronic disease?

A

1) Increased healthcare costs of multiple medications
2) Adverse drug effects
3) Drug interactions
4) Medication non-adherence

69
Q

What is the prognosis of heart failure?

A

Poor with 25-50% of patients dying within 5 years of diagnosis

If admission needed, 5 year mortality is 75%

70
Q

Childhood Immunisation Schedule: What is given at 8 weeks? (4 things)

A

1) 6-in-1 Vaccine (polio, rubella, tetanus, Hib, pertussis, diphtheria)
2) Pneumococcal conjugate Vaccine (PCV- pneumococcal disease)
3) Rotavirus Vaccine
4) Men B Vaccine

71
Q

Childhood Immunisation Schedule: What is given at 12 weeks? (2 things)

A

1) 6-in-1 Vaccine (polio, tetanus, Hib, diphtheria, pertussis, rubella)
2) Rotavirus Vaccine

72
Q

Childhood Immunisation Schedule: What is given at 16 weeks? (3 things)

A

1) 6-in-1 Vaccine (polio, tetanus, rubella, diphtheria, Hib, pertussis)
2) PCV
3) Men B vaccine

73
Q

Childhood Immunisation Schedule: What is given at 12 months? (4 things)

A

1) MMR vaccine
2) PCV booster
3) Hib/Men C vaccine
4) Men B booster

74
Q

Childhood Immunisation Schedule: What is given at 3 years and 4 months? (2 things)

A

1) MMR vaccine

2) 4-in-1 pre-school booster (diphtheria, tetanus, pertussis, polio)

75
Q

Childhood Immunisation Schedule: What is given as a teenager? (3 things)

A

1) HPV vaccine
2) Teenage booster (tetanus, diphtheria, polio)
3) Men ACWY vaccine

76
Q

When you suspect a diagnosis of a notifiable disease who do you inform?

A

Public Health England (2010)

77
Q

If you suspect a notifiable disease how do you notify the appropriate authority?

A

Send the notification form within three days, or notify verbally within 24 hours if the case is urgent by phone, letter, encrypted email, or secure fax machine.

78
Q

List 10 notifiable diseases (loads)

A

1) Cholera
2) Measles
3) Mumps
4) Food poisoning
5) Anthrax
6) Acute meningitis
7) Acute encephalitis
8) Diphtheria
9) TB
10) Pertussis (whooping cough)

79
Q

When assessing a sore throat in an unwell child. What criteria do you use?

A

FeverPAIN

Fever (during previous 24 hours)
Purulence (pus on tonsils)
Attend rapidly (within 3 days after onset of symptoms)
Inflamed tonsils (severe)
No cough or coryza (inflammation of mucus membranes in the nose)

Score from 1 to 5, assesses likelihood of isolating streptococcus as cause

If score 0/1/2 do not offer antibiotic, consider backup prescription if 2/3, consider antibiotic if 4/5

80
Q

What advice would you give when safety netting?

A

1) Discuss the existence of uncertainty
2) What exactly to look out for
3) How exactly to seek further help
4) What to expect about the time course

81
Q

NICE Traffic Lights: what are some red lights in assessment of an unwell child?

A 
Pale/mottled/ashen/blue
No response to social cues
Appears ill to healthcare professional
Does not wake or if roused does not stay awake
Weak/high pitched/continuous cry
Grunting
RR>60 per minute
Moderate/severe chest indrawing
Reduced skin turgor
Temperature >38
Non-blanching rash
Bulging fontanelle
Neck stiffness
Status epilepticus
Focal neurological signs
Focal seizures
82
Q

NICE Traffic Lights: what are some amber lights in assessment of an unwell child?

A 
Pallor reported by carer
Not responding normally to social cues 
No smile
Wakes only with prolonged stimulation
Decreased activity
Nasal flaring
RR>50 (6-12 months)
RR>40 (>12 months)
Oxygen sats >95 in air
Crackles in chest
Dry mucous membranes
Tachycardia
CAP time >3 seconds
Temp raised
Fever >5 days
Rigors
Swelling of a limb/joint
Non-weight bearing limb/non using an extremity

Phase 3a (7 decks)

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