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Phase 4 > God i hate public health > Flashcards

God i hate public health Flashcards

1
Q
  1. What is the definition of public health ?
A
  • Public health is the science and art of preventing disease, prolonging life, and promoting health through organized efforts of society, organizations, public and private sectors, communities, and individuals.
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2
Q
  1. What are the main objectives of public health ?
A
  • Preventing disease, promoting health, prolonging life, and improving quality of life through the organized efforts of society.
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3
Q
  1. What is primary prevention ?
A
  • Preventing disease before it occurs
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4
Q
  1. What is secondary prevention ?
A
  • Detecting disease early to prevent progression
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5
Q
  1. What is tertiary prevention ?
A
  • Reducing the impact of an established disease
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6
Q
  1. What are the 3 key determinants of health ?
A
  • Social factors
  • Physical factors
  • Health services
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7
Q
  1. What is epidemiology and how is it used in public health ?
A
  • Epidemiology is the study of the distribution and determinants of health-related events in populations.
  • It is used to identify risk factors, track health trends, inform public health interventions, and evaluate the effectiveness of health programs.
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8
Q
  1. What are the various types of studies ?
A
  • Experimental studies e.g. RCT
  • Observational studies e.g. Cohort, Case control, cross sectional and prospective
  • Systematic review and meta-analyses
  • Qualitative research
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9
Q
  1. What is a randomised controlled trial ?
A
  • A study where participants are randomly assigned to either an experimental group receiving the treatment or a control group receiving a placebo or standard treatment.
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10
Q
  1. What is a cohort study ?
A
  • Differs from an RCT as it observes groups based on exposure status over time without randomisation
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11
Q
  1. What is a case-control study ?
A
  • Compares individuals with a disease (cases) to those without
    (controls) to identify risk factors.
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12
Q
  1. What is a cross-sectional study ?
A
  • Collects data at a single point in time and is used for prevalence studies.
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13
Q
  1. What is a systematic review ?
A
  • Synthesizes existing studies on a topic, while a meta-analysis statistically combines data from multiple studies.
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14
Q
  1. What types of bias are there ?
A
  • Selection bias – when participant selection is non-random
  • Information bias – arises from measurement errors
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15
Q
  1. What does a relative risk of 2.0 mean ?
A
  • There is x2 the likelihood of an outcome
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16
Q
  1. What does an odds ratio of 1.5 mean ?
A
  • 50% higher odds
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17
Q
  1. What does a hazard ratio of 0.75 mean ?
A
  • Indicates a 25% risk reduction
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18
Q
  1. What are the 6 steps of a clinical audit ?
A
  • Identify an area of concern
  • Set standards
  • Collect data
  • Compare results with standards
  • Implement changes
  • Re-audit to measure improvement
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19
Q
  1. What national organisations are involved in quality improvement ?
A
  • Care quality commission
  • National institute for health care and excellence
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20
Q
  1. What are the 4 main principles of medical ethics ?
A
  • Autonomy
  • Beneficence
  • Non-maleficence
  • Justice
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21
Q
  1. What is an advance decision ?
A
  • A legally binding decision under UK law that allows a patient to refuse treatment in advance
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22
Q
  1. What is lasting power of attorney ?
A
  • Enables a designated individual to make healthcare decisions on behalf of the patient who lacks capacity
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23
Q
  1. What is a case control study
A
  • Looks at 2 sets of participants. One group has the condition you are interested in (the cases) and one group does not have it (the controls).
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24
Q
  1. What are the advantages of a case-control study ?
A
  • Good for rare outcomes e.g. cancer
  • Quicker than cohort or intervention studies as outcome has already happened
  • Can investigate multiple exposures
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25
Q
  1. What are the disadvantages of a case-control study ?
A
  • Difficulties finding controls to match cases
  • Prone to selection bias
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26
Q
  1. What is a cohort study ?
A
  • Participants who do not have the outcome at baseline are followed over time to estimate the incidence of the outcome.
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27
Q
  1. What are the advantages of a cohort study ?
A
  • Can follow-up a group with a rare exposure e.g. natural disaster
  • Good for common or multiple outcomes
  • Less risk of selection and recall bias
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28
Q
  1. What are the disadvantages of a cohort study ?
A
  • Take a long time
  • Loss to follow up
  • Need a large sample size
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29
Q
  1. Cross-Sectional Studies
A
  • Observational studies that analyze data from a population at a single point in time
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30
Q
  1. What are the advantages of a cross sectional study ?
A
  • Relatively quick and cheap
  • Provide data on prevalence at a single point in time
  • Large sample size
  • Good for surveillance and public health planning
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31
Q
  1. What are the disadvantages of a cross sectional study ?
A
  • Risk of reverse causality
  • Cannot measure incidence
  • Risk recall bias and non-response
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32
Q
  1. What is a randomised control trial ?
A
  • Gold standard trial
  • A trial in which subjects are randomly assigned to one of two groups: one (the experimental group) receiving the intervention that is being tested, and the other (the comparison group or control) receiving an alternative (conventional) treatment (fig 1).
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33
Q
  1. What are the advantages of a randomised control trial ?
A
  • Low risk of bias and confounding
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34
Q
  1. What are the disadvantages of a randomised control trial ?
A
  • Time consuming and expensive
  • Specific inclusion/exclusions criteria may mean the study is different from typical patients e.g. excludes elderly
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35
Q
  1. How can an association between 2 things be explained ?
A
  • Chance
  • Bias
  • Confounding
  • Reverse causality
  • A true causal association
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36
Q
  1. Selection bias can result from
A
  • Selection of study participants
  • Allocation of participants to different study groups
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37
Q
  1. How can the selection of study participants and there allocation to different study groups impact selection bias ?
A
  • Non response e.g. are those who don’t respond likely to be from a specific group e.g. elderly
  • Loss to follow up e.g. are those who drop out more likely to be better or worse ?
  • Are those in the intervention group (or the cases) in some way from the controls other than the exposure in question
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38
Q
  1. What types of information bias are there ?
A
  • Measurement
  • Observer
  • Recall Reporting
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39
Q
  1. What types of Bias are there ?
A
  • Information
  • Selection
  • Publication
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40
Q
  1. What is publication bias ?
A
  • Not all trial results are published
  • Papers with less positive results are less likely to be published
41
Q
  1. What is confounding ?
A
  • A situation in which estimates between an exposure and outcome is distorted because of the association of the exposure with another factor (confounder) that is also independently associated with the outcome
  • E.g. More shark attacks while there are more ice cream sales
42
Q
  1. Reverse causality
A
  • 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
43
Q
  1. What is the Bradford-Hill Criteria for Causality
A
  • List of things required to say that one thing causes another
44
Q
  1. Features of the Bradford Hill Criteria
A
  • Strength
  • Consistency
  • Dose-response
  • Temporality
  • Plausibility
  • Reversibility
  • Coherence
  • Analogy
  • Specificity
45
Q
  1. Explain Strength from the Bradford Hill Criteria
A
  • Stronger the association between exposure and outcome
46
Q
  1. Explain Consistency from the Bradford Hill Criteria
A
  • Same results observed from various studies in different geographical settings
47
Q
  1. Explain Temporality from the Bradford Hill Criteria
A
  • Exposure occurs prior to outcome
48
Q
  1. Explain Plausibility from the Bradford Hill Criteria
A
  • Reasonable biological mechanism
49
Q
  1. Explain Reversibility from the Bradford Hill Criteria
A
  • Intervention to reduce/remove the exposure eliminated/reduces outcome
50
Q
  1. Explain Coherence from the Bradford Hill Criteria
A
  • Logical consistency with other information
51
Q
  1. Explain Analogy from the Bradford Hill Criteria
A
  • Similarity with other established cause-effect relationships
52
Q
  1. Explain Specificity from the Bradford Hill Criteria
A
  • Relationship specific to outcome of interest
53
Q
  1. What is the purpose of screening ?
A
  • To identify apparently well individuals who have or are risk of developing a particular disease so that you can have a real impact on the outcome
54
Q
  1. What does cervical screening detect ?
A
  • Pre-cancerous dyskaryosis and treats it to prevent it developing into carcinoma of the cervix
55
Q
  1. Disadvantages of screening
A
  • Exposure of well individuals to distressing or harmful diagnostic tests e.g. colonoscopies to those with positive faecal occult
  • Detection and treatment of subclinical disease that would have never cause any problems e.g. non-aggressive prostate cancers in elderly men
  • Prevention interventions that may cause harm to the individual or population
56
Q
  1. What is sensitivity
A
  • The proportion of those with the disease who are correctly identified by the screening test
57
Q
  1. What is specificity ?
A
  • The proportion of people without the disease who are correctly excluded by the screening test
58
Q
  1. Positive predictive value
A
  • Proportion of people with a positive test result who actually have the disease
59
Q
  1. Negative predictive value
A
  • Proportion of people who have a negative test result who do not have the disease
60
Q
  1. What is the NHS criteria for a condition to screen for
A
  • Should be an important health condition e.g. 1/8 women will develop breast cancer
  • Epidemiology and natural history must be adequately understood
  • There should be detectable RF, disease markers, latent period and early symptomatic stage
61
Q
  1. What is the NHS criteria for a test used in screening ?
A
  • Simple, safe and valid
  • Distribution of test values in the target population should be known and a suitable cut-off level defined and agreed
  • The test should be acceptable to the population
62
Q
  1. What is the NHS criteria for a screening program ?
A
  • Screening should be ongoing
  • The cost of screening should be economically balanced to healthcare spending as a whole
63
Q
  1. What is the NHS criteria for a treatment secondary to a screening program ?
A
  • Effective intervention or treatment for patients with evidence that early treatment leads to better outcomes than late treatment
  • Agreed evidence based policies determining who should be offered the appropriate treatment
  • Clinical management of the condition and the patient outcomes should be optimized in all health care providers prior to participation in the programme
64
Q
  1. What is lead time bias
A
  • When a screening identifies an outcome earlier than it otherwise would have been identified resulting in an apparent increase in survival even if screening has no effect on the outcome
65
Q
  1. What is length lead bias
A
  • 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
66
Q
  1. What are different approaches to a Health Needs Assessment
A
  • Epidemiological
  • Corporate
  • Comparative
67
Q
  1. What is a health behaviour ?
A
  • A behaviour aimed at reventing disease or illness e.g. eating healthily
68
Q
  1. What is an illness behaviour ?
A
  • A behaviour aimed at seeking remedy e.g. going to the GP
69
Q
  1. What is a sickness behaviour ?
A
  • An activity aimed at getting well e.g. taking prescribed medications or resting
70
Q
  1. What are the 5 models of behaviour change ?
A
  • Theory of planned behaviour
  • Nudge theory
  • Stages of change model
  • Health belief model
  • Motivational interviewing
71
Q
  1. List the study designs that are retrospective ?
A
  • Case report
  • Case series
  • Cross-sectional
  • Case control
  • Cohort
  • Randomised control trial
72
Q
  1. Which study designs are prospective ?
A
  • Cohort
  • Randomised control trial
  • Systematic review
73
Q
  1. What are the areas of health determinants ?
A
  • Lifestyle
  • Genetic
  • Environmental
  • Health
74
Q
  1. What impacts Lifestyle as a determinant of health ?
A
  • Smoking status
  • Wealth
  • Employment
75
Q
  1. How does genetics impact determinants of health ?
A
  • Age
  • Gender
  • Ethnicity
76
Q
  1. How does environment impact determinants of health ?
A
  • Housing
  • Socioeconomic status
  • Access to education
77
Q
  1. How does healthcare impact determinants of health ?
A
  • Economic factors
  • Access
  • Quality
78
Q
  1. Pneumonic for remembering influences on health inequalities ?
A
  • PROGRESS
  • Place of residence
  • Race or ethnicity
  • Occupation
  • Gender
  • Religion
  • Education
  • Socioeconomic status
  • Social capital/resources
79
Q
  1. What is the inverse care law ?
A
  • Availability of medical and social care tends to vary inversely with the need of the population served
80
Q
  1. What does equality mean ?
A
  • Treating everyone the same and giving everyone equal shares e.g. giving £100 to the rich and £100 to the poor
81
Q
  1. What does equity mean ?
A
  • About being fair and just e.g. giving everyone what they need to be successful e.g. giving £500 to the poor and nothing to the rich
82
Q
  1. What does Horizontal mean in the context of health inequalities ?
A
  • Equal treatment for equal need e.g. all people with pneumonia deserve equal treatment
83
Q
  1. What are the types of error ?
A
  • Sloth
  • System error
  • Lacking skill
  • Fixation
  • Bravado
  • Playing the odds
  • Poor team working
  • Mis-triage
  • Error of inherited thinking
84
Q
  1. What is an adverse event ?
A
  • An event where a patient comes to harm
85
Q
  1. What is a Near Miss ?
A
  • An event which has the potential to cause harm but fails to develop further: avoids harm
86
Q
  1. What is the bucket model of error ?
A
  • Error evolves due to interaction between personal environmental and physical factors as well as organizational
  • Systems approach is the recognition that we need to look at our systems rather than individual people
  • 3 bucket model  looks at situations leading to error
87
Q
  1. What are the 3 buckets of error ?
A
  • Self – poor knowledge, fatigue, little experience and currently capacity to do task
  • Context – equipment failure, physical environment, inadequate handover, team, support leadership
  • Task – task complexity, novel task, overlapping tasks, multitasking
88
Q
  1. What are Never Events ?
A
  • A serious preventable patient safety incident that should not occur if available preventable measures have been implemented
  • E.g. Wrong chemo route, wrong surgical site or escape of sectioned patient
  • Results in reputation loss, care quality commission investigation and financial penalty
89
Q
  1. What are the 3 types of Public Health Interventions ?
A
  • Primary – preventing the disease
  • Secondary – catching a disease in its early/preclinical stage e.g. cervical screening
  • Tertiary – preventing complications of disease e.g. diabetic foot care
90
Q
  1. What are the 2 general approaches to public health interventions ?
A
  • Population = preventative measures e.g. legislation of dietary salt reduction
  • High risk = identifying individuals above a chosen cut off and treating e.g. screening for HTN
91
Q
  1. What is the prevention paradox ?
A
  • Preventative measures which bring much benefit to the population often offers little to each individual
  • E.g. screening a large number of people only helps a small number
92
Q
  1. What is a false positive ?
A
  • Disease is identified by a screen in a person who has not disease
93
Q
  1. What is a true positive ?
A
  • Disease identified correctly by a test or screen in someone who has the disease
94
Q
  1. What is a false negative ?
A
  • When a test or screen fails to identify someone with disease
95
Q
  1. What is a true negative ?
A
  • When a disease is not present and a test or screen identifies it correctly
96
Q
  1. What is sensitivity ?
A
  • The proportion of people with the disease who are correctly identified by screening test
97
Q
  1. What is specificity ?
A
  • The proportion of people without the disease who are correctly excluded by the screening test
98
Q
  1. What is the positive predictive valve ?
A
  • The proportion of people with a positive test result who have the disease
99
Q
  1. What is the negative predictive valve ?
A
  • Proportion of people with a negative test result who don’t have the disease

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