I and P Flashcards
1
Q
What is public health?
A
the science and art of the following:
- preventing disease
- prolonging life
- promoting health
This is through organised efforts and informed choices of society, organisations, public and private, communities and individuals.
2
Q
What is health improvement?
A
promoting the health of populations by influencing:
- lifestyle
- socio-economic determinants of health
- physical environment
- cultural factors
3
Q
What is the Nuffield council of bioethics?
A
Independent body that examines and reports on ethical issues in biology and medicine.
They then provide information
e.g. campaign for 5 a day
4
Q
What is the Marmot review?
A
proposes an evidence based strategy to address the following:
- social determinants of health,
- the conditions in which people are born,
- grow,
- live,
- work
- age
which can lead to health inequalities.
The conclusion is that premature death and illness effects everyone below the top.
5
Q
What does the Marmot review call for?
A
Proptional universalism
For universal action - not just focussing on the bottom 10%.
6
Q
What are the 6 policy objectives for proportional universalism which is part of Marmots review?
A
- giving every child the best start in life
- enabling all children, young people and adults to maximise their capabilities and have control over their lives
- creating fair employment and good work for all
- ensuring a healthy standard of living for all
- creating and developing sustainable places and communities
- strengthening the role and impact of ill-health prevention
7
Q
What does the commission say about the social determinants of health?
A
it is important to close the gap in generation by:
- improving the conditions of daily life - the circumstances people are born, grown, live, work and age in
- tackle the inequitable distribution of power, money and resources - the structural drivers of those conditions of daily life (globally, nationally and locally)
- measure the problem, evaluate action, expand knowledge base, develop workforce that is trained in the social determinants of health and raise public awareness about social determinants of health.
8
Q
What is income inequality inversely proportional to?
A
health and social problems of a country
9
Q
What is society?
A
the aggregate of people living together in a more or less ordered community
10
Q
As part of society what does it mean by biological?
A
who we are
- sex
- age
- disability
- genealogy
- ph/genotype
11
Q
As part of society what does it mean by cultural?
A
language, diet, customs and beliefs
12
Q
As part of society what does it mean by structural?
A
status
occupation
wealth
education
13
Q
What 5 types of inequalities does Ferdinand Mount talk about?
A
- polictical
- life outcomes - equal quality of health
- opportunity - equal access to health care
- treatment and responsibility
- participation - equal consideration in healthcare decisions
14
Q
Where is health information available from?
A
- statutory surveys
- statutory notifications
- health service records
- health services research
15
Q
What is the index of multiple deprivation? (IMD)
A
Based on the idea of distinct dimensions of deprivation which can be recognised and measured separately.
These are then combined into a single overall measure for each small area.
the index is made up of 7 distinct dimensions of deprivation called domain indices.
16
Q
What are 7 domain indices which is part of the index of multiple deprivation (IMD)?
A
- income
- employment
- health and disability
- education, skills and training
- barriers to housing and services
- living environment
- crime
17
Q
What does it mean if the area is ranked 1 by the ImD 2004?
A
it is the most deprived
each patients is assigned to an area and iMD rank by postcode
18
Q
What are the main causes of child mortality?
A
- pneumonia
- preterm complications
- diarrhoeal
- intrapartum related complications
- malaria
19
Q
What are the social determinants of health also known as?
A
upstream factors
20
Q
What is the integrated management of childhood illness (IMCI) designed to do?
A
to reduce childhood mortality, morbidity and disability in developing countries.
to contribute to improved growth and development of children under 5 years.
21
Q
What is the community integrated management of childhood illness? (IMCI) - what components are involved?
A
Component 1
- improving case management skills of health providers through training using locally adapted materials
Component 2
- improving the health system by strengthening district health planning and management,
- making available essential drugs and supplies required for effective case management,
- providing quality support and supervision at health facilities,
- improving referral and heath information systems and organising work efficiently at the health centre.
Component 3
- improving family and community practices by promoting those practices with the greatest potential for improving child survival, growth and development.
22
Q
What studies can be used for evidence for disease prevention?
A
descriptive studies:
- Anecdote and case series
- Cross-sectional survey
- measuring of incidence
- ecological studies
- case control studies
- cohort studies
23
Q
What are descriptive studies?
A
- describe cases - those with the disease
- describe population - persons in whom cases arise
Purpose
- to know how much disease a region or group has
- to formulate worthy hypotheses
24
Q
What are the pros and cons of anecdote and case series?
A
Pros
- quick
- easy to perform in a clinic
- provides new previulsy unobserved conditions
- provides new potential risk factors
Cons
- not scientific hence not able to test a hypothesis
- seriously affected by observer bias
- difficult to make inference about disease cause
25
What is cross-sectional survey and what are the pros and cons?
is a type of observational study that involves the analysis of data collected from a population, or a representative subset, at one specific point in time—that is, cross-sectional data.
Pros
1. quick
2. good at estimating prevalence or burden
Cons
1. only represents that point in time
2. cannot estimate incidence
3. sampling frame may lead to bias
26
What is an ecological study and what are the pros and cons?
is an observational study defined by the level at which data are analysed, namely at the population or group level, rather than individual level. Ecological studies are often used to measure prevalence and incidence of disease, particularly when disease is rare.
Pros
1. less expensive
2. less prone to bias due to participation
3. easy to perform using routinely collected data
4. provides news hypotheses about the causes of a disease or condition
5. provides new potential risk factors
Cons
1. ecological fallacy
2. assumption of average value
3. assumption of average incidence
4. data collections may vary
27
What are case control studies and what are the pros and cons?
A study that compares patients who have a disease or outcome of interest (cases) with patients who do not have the disease or outcome (controls).
Often used to identify factors that may contribute to a medical condition by comparing subjects who have that condition/ disease with patients who don't.
Pros
1. good for rare diseases and/or rare exposures
2. fairly quick - no need to follow up
Cons
1. prone to selection bias
2. prone to participation bias
3. finding a suitable control can be difficult
4. difference in recall can lead to bias
28
What is cohort study and what are the pros and cons?
Cohort studies are a type of medical research used to investigate the causes of disease, establishing links between risk factors and health outcomes. Cohort studies are usually forward-looking - that is, they are "prospective" studies, or planned in advance and carried out over a future period of time.
Cohort - people who share a common experience or condition
Followed through time for the outcome
Pros
1. good for rare exposures
2. can look at multiple outcomes
3. reduce information bias, survivor bias
4. direct measurement of incidence
Cons
1. inefficient for rare diseases
2. expensive
3. retrospective is quicker
4, loss of follow up
29
What is health promotion?
the process of enabling people to increase control over and to improve their health
30
What 3 basic strategies does the Ottawa Charter identify?
1. advocating for health
2. enabling people to achieve their full health potential
3. mediating between the different interests in society in pursuit of health
31
Obesity
individual choice or subject to our environment
32
What are the 4 health promotion disciplines?
1. fiscal
- tax or subsidy
e. g. making healthy things cheaper and non-healthy things more expensive
2. Legislate
- making particpation in some unhealthy or risky activities illegal
3. Service provsion
- how the routine activities of services can modify risk exposure
4. Education
- increasing consciousness, awareness and knowledge
33
What is libertarian paternalism?
Guiding choice by architecture rather than by coercion (by tax, law or other)
34
What is micro/individually focussed changes?
lifestyles at individual/ GP level
such as diabetes prevention trials
35
What are macro changes?
subsidies/ taxes to effect behaviour change
- not likely to be popular
36
What makes difference to population health?
Randomised controlled trials
37
What are the pros and cons of randomised controlled trials?
Pros
1. strongest evidence for causality if randomised selection bias and confounding is removed.
2. If blinded less observer bias
Cons
1. Not real life
2. costly
3. can inappropriate or unethical for many question
38
What are randomised controlled trials (RCT)?
A study in which people are allocated at random (by chance alone) to receive one of several clinical interventions. One of these interventions is the standard of comparison or control. The control may be a standard practice, a placebo ("sugar pill"), or no intervention at all.
39
What is error?
the difference between estimated/ measured value and true value
40
What is bias?
systematic, non-random deviation of results and inferences from the the truth or processes leading to such deviations.
41
What is diagnostic bias?
when a diagnosis is made based on exposure
e.g. mesothelioma in asbestos workers
42
Self-selection bias
Participants contact study
- through adverts or word of mouth
- more likely to participate in it runs in family history
- HEALTHY WORKER EFFECT - workers self-selecting are more likely to be healthier
43
What are the types of information bias (3)?
1. recall bias
2. interview bias
3. surrogate bias
44
What do the types of information bias lead to?
misclassification bias.
When data is placed into categories (discrete variables) the ignored should be sampled.
45
What are the main measures of childhood obesity?
1. BMI
2. Skinfold thickness
3. Waist circumference
4. Bio-impedence - a form of body composition analysis
46
What does the national child measurement programme measure?
height and weight measurements go over 1 million kids aged 4-5 yrs and 10-11 yrs each year.
47
What is the national obesity observatory?
a single point of contact for wide-ranging authoritative information on data, evaluation and evidence related to weight status and it's determinants.
Centiles
less than 2nd = underweight
48
What did the foresight report in 2007 state influences obesity?
1. obseogenic envrioment
2. obesity as normal response to an abnormal environment
3. locked into lifestyles
4. passive obesity
49
What is the most consistent risk factor for childhood obesity?
Parental obesity
50
What is important in psychological well-being (PWB)?
feeling
1. a sense of individual vitality
2. to undertake activities which are meaningful, engaging and makes them feel competent and autonomous
3. stock of inner resources to help them cope when things go wrong and be resilient to changes beyond their immediate control
4. feeling of relatedness to people
51
What are measures of well-being?
1. short warwick edinburgh mental wellbeing scale (SWEMWBS) - extensively validated
2. ONS measures of subjective well-being - some validation
3. social trust question - would you say most people can be trusted?
52
What is GDP and what does it measure?
Gross domestic product (GDP) is the monetary value of all the finished goods and services produced within a country's borders in a specific time period. Though GDP is usually calculated on an annual basis, it can be calculated on a quarterly basis as well.
It measures everything in short except that which makes life worthwhile (wellbeing).
53
What is herd immunity?
all members of a population (herd) are protected (immunity) by the proportion already immune.
It provides indirect protection of unvaccinated/ susceptible as well as vaccinated individuals.
1. the infection won't be able to invade the pop
2. reduction in epidemic
3. infection may be eradicated - smallpox
54
What does uptake of vaccine depend on?
Public consent - acceptibility
55
What are the factors that reduce vaccine uptake?
1. the paradox of parental concern
| 2. health services
56
is vaccination compulsory in the UK?
No
It is reliant on public consent
57
What is qualitative research?
collection and nalysis of non-numerical information via formal research methods which allows the researcher to gain an understanding of the target pop.
- behaviour
- attitudes
- experiences
Why? and How?
58
What does qualitative research enable and reach? Which research topics is this relevant for?
1. enables understanding of patient choices
2. enables exploration of factors affecting patients choices
3. reaches the part of a subject matter that other methods cannot reach
Research projects
1. concerned with interaction or process
2. complex
3. not quatifiable
4. sensitive
59
What is prenatal testing?
screening tests - non-invasive
diagnostic tests - invasive
Help identify high risk patients
60
At what stage in pregnancy is biochemical/ ultrasound scanning offered?
1st and 2nd trimester
61
What is the risk of invasive diagnostic tests?
risk of miscarriage
62
What is ANSWER?
antenatal screening web resource
63
What is cultural competence in health care?
the ability of a system to provide care to patients with diverse values, beliefs and behaviours.
This includes - tailoring delivery to meet patients' social, cultural and linguistic needs.
64
What is institutional racism?
the collective failure of an organisation to provide a proper service to people because of their colour, culture and ethnic origin.
this is due to unwitting pressure, ignorance, thoughtlessness and stereotyping
65
What are the causes of ethnic health inequalities? (5)
1. long term impact of migration
2. differences in culture and lifestyles
3. biological susceptibility
4. poor delivery and take up of health care
5. racism and discrimination
66
What is a stereotype?
an ending point
assumptions about group behaviour
have negative impact
67
What is a generalisation?
is a bezinning point
requires further information from the individual.
positive impact
68
What does NICE do?
standardise quality of care across the NHS
69
What does NICE prevent and how does it do this?
prevents the postcode lottery of patient care.
By making guidance based on evidence based medicine:
1. Reviews of RCTs
2. RCTs
3. Cohort studies
4. Case control studies
5. Case series
6. Expert opinion
70
What is a citizen council?
30 people who reflect the social make up of the population in England and Wales.
71
What does the citizen council consider?
1. societal and ethical issues
such as taking age problems and prices
72
What do citizen councils take into account?
cost
73
How is central funding distributed?
1. treasury - public expenditure survey (health, education and transport)
2. geographic allocation - principle of equal allocation for equal need
3. caption allocation - adjusted for additional health need and unavoidable variation in costs of providing health care
74
What is economic evaluation?
the comparative analysis of alternative courses of action in terms of both their costs and consequences.
1. cost-effectiveness
2. cost-utility
3. cost-benefit
75
What is the QALY concept?
Quality adjusted life years
76
What is a patient access scheme?
a mechanism to share the cost of new drug between the NhS and the company.
NICE has no role for negotiation
77
What are the categories for health prevention and what does each entail?
1. primary
- preventing the onset of disease
- behaviour and environment
2. secondary
- halt progression once started
- early diagnosis
- screening NB healthy people thus different
3. tertiary
- limit disability and complications in established disease
- rehabilitation
78
What are the different approaches to health prevention? example = Hypertension
1. high risk
- idnetify and treat the top end of the population distribution
- case finding/ screening in gp
2. population approach
- shift the mean of the entire distribution to the left
- increase exercise, reduce salt and reduce obesity
79
What is an example of a prevention paradox?
describes the seemingly contradictory situation where the majority of cases of a disease come from a population at low or moderate risk of that disease, and only a minority of cases come from the high risk population (of the same disease).
e.g. immunisation against MMR
80
Are the causes of population incidence and individual cases the same?
no
81
What may a large number of people at small risk give rise to?
more cases of disease than small number of people at high risk
82
What is an example of secondary prevention?
screening
83
What is sensitivity?
the proportion of people with the disease who are identified as having it by a positive test result.
84
What is specificity?
the proportion of people who don't have the disease with the correct negative result.
85
What is a positive predictive value?
the probability that a person with a positive test result actually has the disease
86
What is a negative predictive value?
the probability that person with a negative test result doesn't have the disease
87
What does it mean if a test has high sensitivity?
1. maximise identification of diseased people in the screened population
2. few false negatives
3. unnecessary investigations or treatments for others
4. lots of false positives
88
What does it mean if a test has high specificity?
1. tend to detect only people with the disease
2. few false positives
3. miss people who have the disease
89
What is lead time bias?
early diagnosis falsely appears to prolong survival
90
What is length-time bias?
screening over-represents less aggressive disease
91
What are examples of Class A drugs, what are the consequences of possession and supply?
Examples
1. Heroin
2. LSD
3. Ecstasy
4. Amphetamines
5. cocaine
6. Crack cocaine
7. Magic mushrooms
Possession
up to 7 years in prison, unlimited fine or both
Supply
life in prison , unlimited fine or both
92
What are examples of Class B drugs, what are the consequences of possession and supply?
Examples
1. Amphetamines
2. methamphetamine
3. barbiturates
4. Codeine
Possession
up to 5 years in prison, unlimited fine or both
Supply
14 years in prison
93
What are examples of Class C drugs, what are the consequences of possession and supply?
Examples
1. Temazepam
2. anabolic steroids
3. valium
4. ketamine
5. Ritalin
6. GHB
Possession
2 years
Supply
14 years
94
What is an off measure?
how we underestimate the amount we drink
95
What does the health protection include?
1. preventing and controlling infectious diseases
2. reducing the adverse effects of chemical, microbiological and radiological hazards
3. preparing for potential or emerging threats
96
Risk management plans (RMPs) must notify when they have reasonable grounds the patient has what and who is this legal obligation created by?
by Pubilic Health England
1. notifiable disease
2. siginificant harm to human health
3. Contaiminated
4. died with a notifiable disease
97
What is an example of a sexual health screening program?
National chyamydia screening programme
15-24 years
GUM clinics
98
What antibiotic resistance is a worry?
Gonococcal
99
In whom is poor sexual health common in?
- young heterosexual adults
| - homosexuals
100
Which areas have the highest prevalence of STIs?
urban areas
101
What is an epidemic?
a serious outbreak in a single community, population or region
102
What is a pandemic?
epidemic spreading around the world
103
What is equity?
an ethical concept in health - with fixed resources this may lead to taking from the haves and giving to the have nots.
104
What is a sample?
a set of data collected and/or selected from a statistical population by a defined procedure.
105
What is a population?
a summation of all the organisms of the same group or species, which live in a particular geographical area, and have the capability of interbreeding.
106
What is a case?
an instance of a disease, injury, or problem.
107
Control
a person or thing used as a standard of comparison for checking the results of a survey or experiment.
108
Randomised
make random in order or arrangement; employ random selection or sampling in (an experiment or procedure).
109
Ecological study
an epidemiological study in which the unit of analysis is a population rather than an individual
110
Counterfactual
relating to or expressing what has not happened or is not the case.
111
Sampling bias
in which a sample is collected in such a way that some members of the intended population are less likely to be included than others.
112
Information bias
bias arising from measurement error.
113
Confounding
occurs when the experimental controls do not allow the experimenter to reasonably eliminate plausible alternative explanations for an observed relationship between independent and dependent variables.
114
Blinding
an experiment in which information about the test is masked (kept) from the participant, to reduce or eliminate bias, until after a trial outcome is known. It is understood that bias may be intentional or unconscious, thus no dishonesty is implied by blinding.
115
What is intention to treat (ITT)?
analysis of the results of an experiment is based on the initial treatment assignment and not on the treatment eventually received.
116
Placebo
doesn't contain the drug
117
What is casualty?
relationship between an event (the cause) and a second event (the effect) where the second event is understood as a consequence of the first.
118
experimental
based on untested ideas or techniques and not yet established or finalized.
119
Observational
a judgment on or inference from what one has observed; broadly : remark, statement.
120
Retrospective
exposure, latent period, and subsequent outcome (ex. development of disease) have already occurred in the past. We merely collect the data now, and establish the risk of developing a disease if exposed to a particular risk factor.
121
Prospective
a longitudinal cohort study that follows over time a group of similar individuals (cohorts) who differ with respect to certain factors under study, to determine how these factors affect rates of a certain outcome
122
Epidemiology
the branch of medicine which deals with the incidence, distribution, and possible control of diseases and other factors relating to health.
