Health and Society (Block 1-3) Flashcards
1
Q
Define age standardisation
A
Allows populations to be compared when the age profiles of the populations are different
2
Q
What is Giemsa banding?
How does it arrange chromosomes?
A
Pattern for each chromosome
Arranges chromosomes based on their p+q arms, shape and centromere
3
Q
3 examples of meiosis errors
A
Unequal segregation
Chromosome non-disjunction/division
4
Q
5 examples of chromosome abnormalities
A
Deletions, duplications, inversions, translocations and isochromosomes
5
Q
Define polymorphism
A
2 or more phenotypes in the population of a species occupying the same habitat at the same time
6
Q
Which diagram is used to study inheritance?
A
Pedigree diagrams
7
Q
What are the 2 types of gene mutations
A
Somatic
Germline
8
Q
What does it mean if a circle is coloured in on a pedigree diagram?
A
That person is affected
9
Q
4 changes to proteins that can occur due to a mutation
A
Shorter
Wrong amino acid
Wrong structure
No binding/active site
10
Q
Define missense mutation
A
One DNA base pair is changed resulting in a different amino acid
11
Q
Define nonsense mutation
A
1 DNA base pair is changed which signals the cell to stop building the protein
12
Q
Define reading frame
A
3 bases that code for an amino acid
13
Q
Define trinucleotide
A
3 base pair repeats
14
Q
What do you need for cancer to be inherited?
A
Many mutations
15
Q
Define genetics
A
Bio-medical differences between individuals which you can control and manipulate
They are linked to biology and social factors
16
Q
What happens to medical decisions over time?
A
They change as society changes
17
Q
Define positive eugenics
A
Intervention to humans to improve the genetic inheritance of a child/community
18
Q
Define negative eugenics
A
If you are of a lower socio-economic status then you have worse inheritance
19
Q
What did Francis Galton believe?
A
That fitter people should breed together to produce the ‘perfect species’
20
Q
What was the eugenics society in the UK?
When was it created?
A
Explained social status by biology
1907
21
Q
When was DNA discovered?
A
1953
22
Q
When was recombinant DNA discovered?
A
1973
23
Q
When did the Human Genome Project start?
A
1990
24
Q
What does polygenic mean?
A
Many genes have multi-factorial causes
25
What type of medicine is becoming more popular?
Personalised medicine
26
Define evidence
An observation, fact or organised body of information that helps to decrease uncertainty
27
Define decision making
A choice or action made to achieve goals
28
What are the 3 types of uncertainties that doctors face?
Technical
Personal
Conceptual
29
Give an example of a technical uncertainty
Wrong diagnosis
30
Give an example of a personal uncertainty
Not know what the patient wants
31
Give an example of a conceptual uncertainty
Unable to apply the knowledge to the patient
32
What is the purpose of a 'cumulative meta-analysis'
Combines the research together so that time and money is not wasted if the information is already there
33
2 ways in which evidence improves clinical care
Increases efficiency
| Standardising treatments
34
Define evidence-based decision making
The use of the current best evidence to make decisions about the care and value of patients so that uncertainty is reduced
35
What 4 things does evidence-based practise rely upon?
Research, resources, patient preferences, expertise
36
What are the CQC
Care and quality commission
37
Define economics
How people choose to allocate scarce resources
38
Define opportunity cost
The value of what you give up when you have to make a decision
39
2 examples of sellers in the NHS market
GP's
| Hospitals
40
Explain the flat curve of medicine
NHS first established: Little we could do but effective
| NHS now: A lot we can do but not as effective
41
Describe the NHS in one word
Inefficient
42
Define epidemiology
Distribution and determinants of a populations health
| Applying this to control the health of the population
43
Define descriptive epidemiology
How things are distributed in patterns across society
44
Define analytical epidemiology
Exploits the distributions to ask and answer questions
45
Define experimental epidemiology
Change the distributions to see the effect
46
Define incidence
New diagnosis and immigration of the ill
47
Define prevalence
Number of individuals who have the disease
48
What is the equation for incidence?
Number of new cases in a period / Number initially free of disease
49
What is the equation for prevalence?
Number with the disease at a specific time/ Total population
50
3 ways to express the answer to incidence/prevalence
Percentage
Decimal
Number affected per number sampled
51
What word describes cumulative incidence?
Rate
52
What is the difference in the trend between the whole population and smaller populations?
They differ
53
What is another word for incidence rates?
Person-time incidence rates
54
What do symptoms not always lead to?
Help seeking behaviour
55
Do lay people have medical knowledge.
Yes
56
What are the 5 levels in the symptom iceberg?
Controlled - Diagnosed - Un/mis-diagnosed - Risk factors - Free of risk factors
57
Define medical pluralism
Conventional and traditional medicine
58
What is the lay-referral system?
Patients seek help from 3 sources before the doctor
59
Define industrial
| Which world did it happen in?
Encourage people to seek help
| Happened in the 'old world'
60
Define information
| Which world did it happen in?
Encourage people to self-care to save time and money
| Happens in the new world as patients have the same information as doctors and don't want to waste their time
61
What is the inverse case law?
Increased deprivation in an area decreases the number of services which are available
62
What were the classes in the 1900's?
Gentry and professional
Farmers and tradesmen
Artisans and labourers
63
What were the new classes?
```
Professional
Managerial and technical
Skilled
Partly-skilled
Unskilled
```
64
Who made and commissioned the black report?
Made: Labour
Commissioned: Conservative
65
What are the 4 parts of the black report?
Statistical artefact
Culture
Health related social mobility
Materialist
66
What does statistical artefact mean in the back report?
Inequalities are artificial due to inadequate data
67
What does statistical culture mean in the back report?
Ill health is caused by lifestyle but behaviour is still shaped by circumstance
68
What does health related social mobility mean in the back report?
Health determines social class
69
What does materialist mean in the back report?
Health is determined by social structure and circumstances
| These influence material conditions
70
What are the two reports which followed the black report?
```
Acheson report (1998)
Marmot review (2010)
```
71
What is a guarantee against ill health?
Employment
72
What 3 things can eliminate health inequalities?
Social accumulation, mobility and protection
73
What is the difference between behaviour and physiological status?
Behaviour: Current social context
| Physiological status: Past and present
74
What 3 things contribute towards your health?
Position in society, material conditions and behaviour
75
How many methods do you use to measure health inequalities at once?
Why?
More than one
| Increases the accuracy
76
What are the layers in the model of health inequalities?
- Constitutional factors
- Individual lifestyle factors
- Social and community networks
- Living and working conditions
- General socio-economic, cultural and environmental factors
77
What does the multiple index measure? (7)
| How many areas in England are there?
Crime, education, employment, environment, health, housing and income
32,844
78
Give 5 measures of current income
```
Area of residence
Education
Employment
Housing tenure
Social class
```
79
How do you measure housing?
By the three-fold classification
| -Owner, rental or council tenant
80
What is area deprivation an example of?
An example of a way to measure health inequalities
81
Where are most resources in healthcare directed?
| Where should they be directed?
Treatment
| Prevention
82
What is the 'epidemiological transition'
A decrease in infectious disease
| An increase in chronic and non-infectious disease
83
6 determinants of health outcomes
```
Biological
Social and economic
Environment
Lifestyle
Health services
Material deprivation and poverty
```
84
What did the Whitehall study determine?
That the social class gradient leads to disease
85
Define health promotion
People improve their own health through a range of social interactions
86
Define health education
A voluntary change in behaviour through improvement of knowledge
87
Define health protection
Legislation to protect public health
88
What are the WHO's 5 aspects of health promotion?
1. Healthy public policy
2. Supportive environments
3. Community action
4. Personal skills
5. Re-orientating health services (downstream --> upstream)
89
What are the differences between primary, secondary and tertiary prevention
Examples
Primary: Prevents onset (e.g. vaccination, health promotion)
Secondary: Detecting at early stages (e.g. screening)
Tertiary: Overlaps with treatment to decrease the impact
90
Define authoritative intervention
Medical professionals or governments inform people
91
Define negotiated intervention
Experience and knowledge
92
Define health persuasion
| Example
Professionals tell people
| 5-a-day
93
Define personal counselling
Advice to patients
94
Define community development
Community work for local needs
95
Define prevention paradox
Benefits to the population rarely benefit the individual person
96
4 problems with the idea of health promotion
Lack of balance between freedom of individual and societal control
Limited resources
No clear evidence
Who is responsible?
97
Define diagnosis
Determining the nature of the disorder by looking at the patient's signs, symptoms, background and tests
98
What 2 things is the prognosis based upon?
Knowledge of past patients
| Type of patient
99
What are the 3 theories of decision making?
| Define them
Normative: Social and professional norms
Prescriptive: Improvement
Descriptive: What YOU are doing
100
What 3 things are decisions influenced by?
Bias
Individual variation
Experience
101
What are the 5 stages of the Hypothetic-Deductive model?
1. Cue acquisition
2. Hypothesis formation
3. Cue interpretation
4. Hypothesis evaluation
5. You then accept the hypothesis or make a new one
102
What does the Hypothetic-Deductive mode aim to do?
| When is it used?
Seeks evidence to disprove
| When the clinician is less experienced
103
How are decisions made?
By looking at theories
104
What are the two phases of making a decision?
Phase 1: Framing and editing (preliminary analysis)
| Phase 2: Evaluation (framed prospects evaluated)
105
Define evidence
A factor that influences clinical decisions
| Based on the results of clinical trials and studies
106
Rank these in order of the hierarchy of evidence:
Case series - Randomised controlled double blind - Case control studies - Opinions - Case reports - Systemic reviews - In vitro - Animal - Cohort studies
In vitro - Animal - Opinions - Case reports - Case series - Case control studies - Cohort studies - Randomised controlled double blind - Systemic reviews
107
What are the 5S levels of organisation of evidence?
Studies - Syntheses - Synopses - Summaries - Systems
108
What is the purpose of the 5S levels of organisation of evidence?
To deal with the volume of evidence
109
4 examples of research which can be used in a clinical setting?
Statistics, knowledge, experience and research
110
What are the two acts surrounding drugs?
Human regulation act of 2012
| Medicines act of 1968
111
What agency gathers the yellow cards?
Medicines and Healthcare Products Regulatory Agency
112
What can herbal medication affect in the body aside from other drug interactions
Certain enzymes in the liver and other bodily functions
113
What is the role of the MHRA?
To give drugs a 'market authorisation'
114
What is the EMC and what does it have?
Electronic Medicines Compendium
| A summary of the product characteristcs
115
4 characteristics to be re-classified from a POM to P?
No danger to health
Used correctly
Not an injection
Not have products which need investigating
116
2 characteristics to be re-classified from a P to a GSL?
Sold/supplied safely with no pharmacist
| May need age limits
117
What is the scale of community pharmacy schemes?
Local or national
118
What are the 4 main roles of a community pharmacy?
Minor ailments
Emergency contraception/sexual health
Health education and promotion
Medicine reviews if another drug has been prescribed
119
What are the 2 types of outcome variables?
Quantitative and Qualitative
120
Define dichotomous
Only 2 categories
121
What are the 3 types of data?
Interval
Ordinal
Nominal
122
3 words to describe interval data
| Example
Quantitative, discrete and continuous
| E.g. Number of admissions
123
2 words to describe ordinal data
| Example
Qualitative, more than 2 categories with some order
| E.g. Excellent, Good, Bad, Poor
124
3 words to describe nominal data
| Example
Qualitative, multinominal, more than 2 categories with no order
E.g. divorced/married
125
What are the three approaches to statistical analysis?
| Define them
Descriptive: Organise, summarise and describe data
Correlational: Relationships
Inferential : Stats
126
What makes statistics valid?
If they follow the normal distribution
127
3 words to describe a normal distribution
Continuous, symmetrical and unimodal
128
What happens to the mode, median and mean in a normal distribution?
They are the SAME
129
What is negative skew?
| Is the mode or mean left of the median?
Skewed to + values
| Mean is left of median
130
What is positive skew?
| Is the mode or mean left of the median?
Skewed to - values
| Mode is left of median
131
Where do the observations lie in a normal distribution?
68% of observations lie within 1 SD from the mean
| 95% of observations lie within 1.98 SD from the mean
132
What are the 3 measures of location?
Mean, mode and median
133
What are the 3 measures of dispersion?
Standard deviation
Inter-quartile range
Range
134
What is the statistically significant P value?
0.05
135
What is the difference between a type 1 and type 2 error?
Type 1: Reject null hypothesis by mistake
| Type 2: Accept null hypothesis by mistake
