Definitions/Waffly shit Flashcards
What is Epigenetics?
expression of genome depending on the environment
What is Allostasis?
stability through change, our physiological systems have adapted to react rapidly to environmental stressors
What is Allostatic load?
long term overtaxation of our physiological systems leads to impaired health (stress)
What is Salutogenesis?
favourable physiological changes secondary to experiences which promote healing and health.
What is Emotional Intelligence?
the ability to identify and manage one’s own emotions, as well as those of others
What is primary care for?
managing illness
preventing illness
promoting health
shared decision making with patients
managing clinical uncertainty
What are the 3 domains of public health?
Health improvement
Health protection
Improving services
What is health improvement?
Social interventions aimed at :
a) preventing disease
b) promoting health
c) reducing inequalities
What are some aspects of health improvement?
Education
Housing
Employment
Lifestyles
Community
Surveillance and monitoring of specific diseases and risk factors
What is health protection?
Measures to control infectious disease risks and environmental hazards
What are some aspects of health protection?
infectious diseases
chemicals and poisons
radiation
emergency response
environment health hazards
What is improving services?
The organization and delivery of safe, high quality services for prevention, treatment and care
What are some aspects of improving services?
clinical effectiveness
efficiency
service planning
audit and evaluation
clinical governance
equity
What is a health needs assessment?
Systemic method for reviewing the health issues facing a population, leading to :
i) agreed priorities ii) resource allocation
that will
i) improve health ii) reduce inequalities
What are the different approaches to a health care assessment?
Epidemiological
Comparative
Corporate
What are the adv and disadv to a epidemiological approach to health care assessment?
Adv - uses existing data, can evaluate services by trends over time
disadv - quality of data variable, data collected mat not be data required, doesn’t take into account opinions of people involved
What are the adv and disadv to a comparative health care assessment?
quick and cheap
gives a measure of relative performance
may be difficult to find comparable population
data may not be available/quality
What are the adv and disadv to a corporate health care assessment?
based on opinions of population in question
takes into account knowledge and experience of those in popln
takes into account wide range of views
difficult to distinguid need from demand
may be influenced by poilitcal agendas
What is Primary, Seconday and Tertiary prevention?
Primary prevention - preventing disease before it has happened
Secondary prevention – catching disease in the pre-clinical or early phase
Tertiary prevention – preventing complications of disease
What are the 2 approaches to prevention?
Population approach - preventative measure eg. dietary salt reduction through legislation to reduce bp
High risk approach – identify individuals above a chosen cut off and treat – eg. screening for high bp
What are the different kinds of screening?
- Population-based screening programmes
- Opportunistic screening
- Screening for communicable diseases
- Pre-employment and occupational medicals
- Commercially provided screening
What are the disadvantages to screening?
- Exposure of well individuals to distressing or harmful diagnostic tests
- Detection and treatment of sub-clinical disease that would never have caused any problems
- Preventive interventions that may cause harm to the individual or population
What is the Wilson and Junger criteria?
The condition being screened for should be an important health problem
The natural history of the condition should be well understood
There should be a detectable early stage
Treatment at an early stage should be of more benefit than at a later stage
A suitable test should be devised for the early stage
The test should be acceptable
Intervals for repeating the test should be determined
Adequate health service provision should be made for the extra clinical workload resulting from screening
The risks, both physical and psychological, should be less than the benefits
The costs should be balanced against the benefits
What is lead time bias?
When screening identifies an outcome earlier than it would otherwise have been identified this results in an apparent increase in survival time, even if screening has no effect on outcome.
What is length time bias?
Type of bias resulting from differences in the length of time taken for a condition to progress to severe effects, that may affect the apparent efficacy of a screening method
What are the advantages and disadvantages of a cross sectional study/survey?
Relatively quick and cheap
Provide data on prevalence at a single point in time
Large sample size
Good for surveillance and public health planning
Risk of reverse causality (don’t know whether outcome or exposure came first)
Cannot measure incidence
Risk recall bias and non-response
What are the advantages and disadvantages of a case-control study?
Good for rare outcomes (e.g. cancer)
Quicker than cohort or intervention studies (as the outcome has already happened)
Can investigate multiple exposures
Difficulties finding controls to match with cases
Prone to selection and information bias
What are the advantages and disadvantages of a cohort study?
Can follow-up a group with a rare exposure (e.g. a natural disaster)
Good for common and multiple outcomes
Less risk of selection and recall bias
Takes a long time
Loss to follow up (people drop out)
Need a large sample size
What are the advantages and disadvantages of a randomised control trial?
Low risk of bias and confounding
Can infer causality (gold standard)
Time consuming
Expensive
Specific inclusion/exclusion criteria may mean the study population is different from typical patients (e.g. excluding very elderly people
What is the odds of an event?
the ratio of the probability of an occurrence compared to the probability of a non-occurrence.
Odds = probability/(1-probability)
What is the odds ratio?
The odds ratio is the ratio of odds for exposed group to the odds for the not exposed groups.
OR = {Pexposed/ (1 – Pexposed)}
{Punexposed/ (1 – Punexposed)}
What is incidence?
new cases, denominator, time
What is prevalence?
existing cases, denominator, point in time
What is incidence rate?
= (No.of persons who have become cases in a given time period)/(Total person-time at risk during that period)
What is a never event?
serious, largely preventable patient safety incidents that should not occur if the available preventative measures have been implemented
surgery - wrong site/implant
medication - wrong preparation/route
mental health - suicide
misidentification
What is sensitivity?
the proportion of people with the disease who are correctly identified by the screening test
What is specificity?
the proportion of people without the disease who are correctly excluded by the screening test
What is positive predictive value?
the proportion of people with a positive test result who actually have the disease
What is negative predictive value?
the proportion of people with a negative test result who do not have the disease
What are predictive values dependent on?
underlying prevalence
What is person time?
measure of time at risk, i.e. time from entry to a study to (i) disease onset, (ii) loss to follow-up or (iii) end of study. Used to calculate incidence rate which uses person time as the denominator.
Association between exposure and outcome can be attributed to?
Bias
Chance
Confounding
Reverse causality
a true causal association
What types of bias are there?
selection bias - a systematic error in selection of participants, allocation of participants to different study groups
information/measurement bias : systematic error in the measurement of classification of exposure/outcome e.g. observer bias, recall bias, reporting bias, instrument
publication bias -
What is bias?
a systemic deviation from the true estimation of the association between exposure and outcome
What is confounding?
situation in which the estimate between an exposure and an outcome is distorted because of the association of the exposure with another factor (confounder) that is also independently associated with the outcome
What is reverse causality?
this refers to the situation when an association between an exposure and an outcome could be due to the outcome causing the exposure rather than the exposure causing the outcome
What is the criteria for causality?
Bradford-hill criteria