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I+P Flashcards

1
Q

What are the 8 steps of the intervention ladder?

A
  1. Do nothing.
  2. Provide information.
  3. Enable choice.
  4. Guide choice through changing default policy.
  5. Guide choice through incentives.
  6. Guide choice through disincentives.
  7. Restrict choice.
  8. Eliminate choice.
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2
Q

When are intrusive public health efforts justified? (7).

A 
When is it evidenced.
Publicly supported.
Proportionate.
Pros > cons.
Those impacted will benefit.
There are no alternatives.
It is specifically focused.
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3
Q

Differentiate between birth rate and fertility rate.

A

Birth rate: births per whole population (M+W)

Fertility rate: births per women of childbearing age.

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4
Q

Why has life expectancy increased in developed countries?

A

Decreased mortality rate due to increased sanitation.

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5
Q

Differentiate between period and cohort life expectancy.

A

Period: using age-specific mortality rates for that time period throughout their life.
Cohort: using known/projected mortality rates as the years change (more appropriate).

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6
Q

What do rapid, slow and a decrease in growth look like on a population pyramid?

A

Rapid: mohican
Slow: empire state building
Decrease: narrowing base

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7
Q

In the US population pyramid what does the narrowing at 25-39 show? 5-24yrs?

A

25-39: low birth rate during great depression

5-24: baby boom after war

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8
Q

What is the rate of natural increase?

A

Difference between the birth rate and the death rate.

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9
Q

What are the four stages of classical demographic transition?

A
  1. high birth and death rate.
  2. decreased death rate (growth).
  3. decreased birth rate (slower growth).
  4. population stabilises.
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10
Q

What is the normal sex ratio at birth?

A

106 males to 100 females

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11
Q

Differentiate between a necessary and sufficient cause

A

Necessary: presence required for occurrence.
Sufficient: presence leads to effect (both exposures may induce same outcome).

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12
Q

How much of the health variance can be explained by individuals?

A

25%

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13
Q

What are the layers of Maslow’s hierarchy of need? (5).

A 
Physiological.
Safety.
Love/belonging.
Esteem.
Self-actualisation.
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14
Q

What are the four different types of need as explained by Bradshaw?

A

Normative - seat by norm
Comparative - compared to others
Felt - from people who have it
Expressed - need they say they have

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15
Q

Which three factors are considered in a health needs assessment?

A

Need - research, culture, genes, lifestyle
Supply - public/ political pressure, inertia, momentum
Demand - media, medical/ social/ cultural/ educational influences

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16
Q

What is a health needs assessment?

A

Systematic method for reviewing the health issues facing a population, leading to agreed priorities and resource allocation that will improve and reduce inequalities, including an assessment of effectiveness and priority setting.

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17
Q

Pros and cons of anecdote and case series.

A

Pros: quick, easy, unobserved conditions, new potential risk factors
Cons: can’t test a hypothesis, observer bias, no causal inferences

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18
Q

What can a cross sectional survery provide?

A

Prevalence.

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19
Q

Pros and cons of cross-sectional surveys.

A

Pros: quick, good prevalence estimate
Cons: one point in time, no incidence, sampling frame bias

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20
Q

Pros and cons of ecological studies.

A

Pros: inexpensive, less participation bias, routinely collected data, provides new hypotheses and risk factors
Cons: ecological fallacy (pop->ind?), assumes average risk and incidence applies to everyone, data collection varies

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21
Q

Pros and cons of case control studies.

A

Pros: quick, good for rare occurrences
Cons: selection, participation and recall bias; finding control groups

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22
Q

What is the best type of observational study?

A

A cohort study.

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23
Q

Pros and cons of cohort studies.

A

Pros: good for rarities, multiple outcomes, reduces info/survivor bias, direct incidence measurement
Cons: bad for rarities, expensive, slow, loss to follow-up

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24
Q

Pros and cons of a randomised controlled trial.

A

Pros: strongest causal evidence, selection and confounding bias removed, less observer bias
Cons: not real life, high cost, unethical and inappropriate

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25
Q

Define error:

A

The difference between an estimated/measured value and the true value.

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26
Q

Define bias:

A

Systematic, non-random deviation of results and inferences from the truth, or processes leading to such deviation.

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27
Q

What is diagnostic bias?

A

When diagnosis is made based upon the exposure.

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28
Q

Name three types of information bias:

A

Recall bias.
Interviewer bias.
Surrogate bias.

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29
Q

Differentiate between primary, secondary and tertiary prevention.

A
  1. preventing onset of disease
  2. halting progression once started
  3. limiting disability and complication in established disease
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30
Q

Differentiate between a high risk and a population approach.

A

High risk: identify and treat the top end of the population.

Population: shift the mean of the entire population to the left.

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31
Q

What is social capital?

A

Networks together with shared norms, understandings and values that facilitate co-operation within or among groups.

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32
Q

Define sensitivity.

A

The proportion of people with the disease who get a positive test result.

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33
Q

Define specificity.

A

The proportion of people without the disease who get a negative test result.

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34
Q

Define positive predictive value.

A

The probability that a person with a positive test result actually has the disease.

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35
Q

Define negative predictive value.

A

The probability that a person with a negative test result does not actually have the disease.

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36
Q

When is a test with high sensitivity desirable? (2).

A

Adverse consequences of a missed diagnosis for the individual or society.
Diagnosis is quickly confirmed by other tests (or before treatment is started

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37
Q

When is a test high specificity desirable?

A

Diagnosis is associated with anxiety/stigma. Further investigations are time-consuming, painful or expensive. Cases will be detected anyway later. Treatment is offered without further investigation.

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38
Q

What is lead time bias?

A

Early diagnosis falsely appears to prolong diagnosis.

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39
Q

What is length time bias?

A

Screening over-represents less aggressive disease.

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40
Q

What are the wilson and jungner criteria for screening programs? (9).

A 
Condition should be important. 
Acceptable treatment. 
Facilities for diagnosis and treatment.
Latent stage. 
Natural history understood. 
A suitable test which is acceptable.
Agreed policy on whom to treat. 
Cost-effective. 
Case finding should be continuous.
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41
Q

Define health promotion.

A

The process of enabling people to increase control over, and to improve their health.

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42
Q

What are the core themes of the ottawa charter for health promotion? (4).

A

Strengthen community action.
Develop personal skills.
Create supportive environments.
Reorient health services.

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43
Q

What are the five approaches to health promotion?

A 
Medical or preventative.
Behaviour change.
Educational.
Empowerment.
Social change.
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44
Q

Disadvantages of the medical approach to health promotion: (3)

A

Paternalistic approach led by experts.
Based on medical definition of health (absence of disease or infirmity).
Ignores social determinants of health.

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45
Q

Disadvantages of the behavioural approach to health promotion:

A

Success dependant on individual.

Ignores social determinants of health.

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46
Q

Disadvantages of the educational approach to health promotion: (2)

A

Relies on individuals to make right choice.

Little on the social determinants of health.

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47
Q

What is the empowerment approach to health promotion?

A

Enhancing the capacity of individuals/populations to identify and address their concerns.

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48
Q

What is the social change approach to health promotion?

A

Change the physical and social environment, leading to healthier choices. Needs public and political support. E.g. smoking band, school food standards.

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49
Q

Name 5 health promotion intervention planning models:

A 
Precede proceed.
Strategic rational PM.
SMART.
CD Cynergy.
MATCH.
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50
Q

What are the precede evaluation takes in the precede proceed model? (4).

A

Social assessment.
Epidemiological assessment.
Educational and ecological assessment.
Administrative and policy assessment and intervention alignment.

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51
Q

What are the proceed asks in the precede proceed model? (4).

A

Implementation.
Process evaluation.
Impact evaluation.
Outcome evaluation.

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52
Q

Differentiate between marketing, social marketing and the social norms approach:

A

Marketing: aims to increase sales.
Social marketing: used to address lack of knowledge.
Social norms: address misperceptions of the norm.

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53
Q

What are the steps involved in the social norms approach? (4)

A

Understand the norm.
Understand what people believe is the norm.
Evidence of misperception.
Challenge misperception.

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54
Q

How do social norms work?

A

False social norm beliefs encourage the perceived behaviour.

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55
Q

What are the characteristics of the social norms approach? (3)

A

Doesn’t use health terrorism.
A participatory process.
Not moralistic in tone.

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56
Q

Give some examples of the social norms approach being used.

A

Unitcheck - Leeds alcohol.
Pinterfields - 99% smoke free entrances.
Smoke free homes across yorkshire.

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57
Q

What are the challenges of the social norms approach? (2)

A

Differentiating pure social norms approach interventions from complex interventions.
Successful integration with more complex interventions.

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58
Q

Why is qualitative data collection used?

A

Gain an understanding of the target population’s behaviours/ attitudes/ experiences - the why and how.

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59
Q

How is the data qualitative research produces different from quantitative research?

A

It is unique and non-generalisable.

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60
Q

What is a ‘theme’ in qualitative research?

A

Recurrent and distinctive features that characterise particular perception/experiences and are relevant to the research.

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61
Q

How are themes identified in qualitative research?

A

Immersing in the data. Coding transcripts until data saturation. Organising codes into meaningful groups. Generating themes.

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62
Q

When are qualitative methods useful?

A

Topic is concerned with interaction, is complex, non quantifiable or sensitive.
Objective is to understand how/why, to explore understudied areas.

63
Q

What is commissioning?

A

Ensuring services provided meet the need of the population by assessing, prioritising, procuring and managing.

64
Q

Differentiate between purchasing, contracting and procurement.

A

Purchasing: buying services.
Contracting: selecting provider, negotiating terms, management.
Procurement: identifying supplier, and stimulating market.

65
Q 
From 1991-7 commissioning was via GP fundholdings.
Size?
Budget?
Scope?
Clinical governance?
Status?
A 
10,000.
Real and negotiated.
Elective care.
None.
Independant.
66
Q 
From 1994-7 commissioning was via Total Purchasing Pilot.
Size?
Budget?
Scope?
Clinical governance?
Status?
A 
30,000.
Indicative and negotiated.
Selective  hospital +community.
None.
Subcommittee of health authority.
67
Q 
From 2005 until 2013 commissioning was Practice-Based commissioning.
Size?
Budget?
Scope?
Clinical governance?
Status?
A 
63,000.
Indicative, delegated + negotiated.
Selective hospital + community.
Sometimes.
Voluntary.
68
Q 
From 2013 on commissioning was via GPs.
Size?
Budget?
Scope?
Clinical governance?
Status?
A 
250,000.
Real.
All hospital and community except NCB + maternity.
Yes.
Statutory organisation.
69
Q

What are the stages of planning in the strategic commissioning cycle? (4)

A

Health needs assessment.
Reviewing current provision.
Identifying gaps + priorities.
Capacity planning.

70
Q

What are the stages of procurement in the strategic commissioning cycle? (4)

A

Service design/redesign.
Defining contracts.
Procuring appropriate services.
Managing demand.

71
Q

What are the stages of monitoring in the strategic commissioning cycle? (4)

A

Monitoring activity + quality.
Invoicing and payment.
User and LA views.
Feedback.

72
Q

What is the main aim on NICE?

A

Provide advice to health and social care in a resource constrained system.

73
Q

What guidance does NICE produce aimed at the NHS?

A

Technology appraisals (pharmaceuticals).
Guidance on devices.
Medical technology guidance - cost saving.
Interventional procedures: safety +efficacy.
Clinical guidlines.

74
Q

What are clinical guidelines?

A

Guidelines on appropriate treatment and care for people with specific conditions.
Based on clinical + cost effectiveness.

75
Q

What advice does NICE give regarding interventional procedures?

A

Wether they are safe enough + work well enough for use.

Don’t use, may use, may used with special arrangements.

76
Q

What are quality standards?

A

Concise + measurable statements designed to drive quality improvement.

77
Q

What does colloquial evidence include?

A

Values.
Practical considerations.
Interests of specific groups.

78
Q

What are the 7 principles of NICE guidance making?

A 
Comprehensive evidence base.
Expert input.
Patient and public involvement.
Independent advisory committees.
Consultation with all stakeholders.
Regular review.
Open and transparent process – meetings held in public.
79
Q

Who are the citizens council and what is their role?

A

30 people who reflect social make up of population.

Consider societal and ethical issues.

80
Q

What does NICE consider an interventional procedure? (3).

A

Making hole to gain access to internal body.
Gaining access to body cavity without hole.
Using EM radiation.

81
Q

What are the three types of economic evaluation?

A

Cost effective, utility, benefit.

82
Q

How are health gains measured by:
Cost effectiveness?
Cost utility?
Cost benefit?

A

Single health indicator.
QALYs.
Monetary value.

83
Q

What are patient access schemes?

A

Mechanisms to share cost of new drug between a company and the NHS.

84
Q

What are the criteria for entry into the cancer drugs fund? (3).

A

Insufficient evidence for routine commissioning.
Plausible potential for satisfying criteria.
Company agrees to fund data collection for less tan 24 months, with a commercial access arrangement that makes it affordable.

85
Q

When is departure from NICE guidance justified?

A

Full explanation is given to patient.
Patient gives informed consent.
Clear documentation with reasons.
Acting in good faith.

86
Q

What are the two types of community action?

A

Community of geography.

Community of interest.

87
Q

What is a statutory organisation?

A

Directly funded out of tax + other revenues from central government.
Publicly accountable.

88
Q

What does health protection include? (3).

A

Preventing + controlling infectious diseases.
Reducing adverse effects of chemical, micro + radio hazards.
Preparing for potential threats.

89
Q

Why are certain infectious diseases remerging? (6).

A 
Societal events.
Human behaviour.
Health care.
Environmental change.
Public health infrastructure.
Microbiological adaptation.
90
Q

How is scabies transmitted?

A

Direct contact.

91
Q

What are the three organism factors controlling susceptibility?

A

Dose.
Virulence.
Length of exposure time.

92
Q

When must medical professionals notify PHE? (3).

A

Someone has:
A notifiable disease.
An infection that does or could present significant harm to human health.
Is contaminated with could/does present ….
Has died with anything that could/does…

93
Q

What is the chain of infection? (7)

A

Reservoir, portal of exit.
Agent, mode of transmission, portal of entry.
Host, person to person spread.

94
Q

Define incubation period:

A

Time from acquiring infection to being symptomatic.

95
Q

Define latent period:

A

Time from acquiring infection to being infectious.

96
Q

Differentiate between an epidemic and a pandemic:

A

Epidemic: single community/population/region.
Pandemic: spreads around world, affecting 100,000s in many countries.

97
Q

What are the three types of notifiable diseases? (4)

A

Very serious diseases.
Diseases that spread v easily.
Vaccine preventable diseases.
Controllable infectious diseases.

98
Q

Differentiate between influenza B and C:

A

B: sporadic outbreaks, prone to mutation.
C: mild symptoms, stable.

99
Q

Describe influenza A:

A

Infects pigs, cats, horses, birds, sea mammals.
No proof reading - mutation prone.
Antigenic drift and shift.

100
Q

What is antigenic shift?

A

Gene swapping during co-infection by two different strains.

101
Q

What does haemagglutinin control?
Subtypes?
Immunity efficacy?

A

Virus binding and cell entry.
15.
Protection to specific sub type.

102
Q

What does neuraminidase control?
Subtypes?
Immunity efficacy?

A

Release of formed virus.
9.
Reduces amount of virus released from cells - less severe disease.

103
Q

How many H and N subtypes are there?

A

15 H.

9 N.

104
Q

Which influenza strains have caused pandemics and when?

A

1918: H1N1 (Spanish flu).
1957: H2N2 (Asian flu).
1968: H3N2 (Hon Kong Flu).

105
Q

Describe Avian Flu:

A 
H5N1.
Mild disease in birds.
60% human mortality.
First case: Hong Kong 1997.
Strict avian pathogen. Able to pass to humans, but not between them.
106
Q

How is Avian flu controlled? (5).

A 
Culling.
Biosecurity + quarantine.
Control poultry movement.
Vaccinate workers.
PPE.
107
Q

How are early stages of an epidemic managed? (4).

A

Containment phase:

Identification of cases.
Treat cases.
Contact tracing.
Large scale prophylaxis.

108
Q

How are the later stages of an epidemic managed?

A

Treat cases only.

109
Q

Differentiate between global health and international health:

A

Global: determinants circumvent territorial boundaries, focus’ on whole planet.
International: relates to practices, policies + systems of other countries. Stresses differences.

110
Q

What is a demographic transition?

A

Urbanisation, industrialisation, rising incomes, more education, improved health technology -> decrease in infectious disease mortality -> decreased fertility.

111
Q

What is the epidemiologic transition?

A

Population ages -> emergence of chronic + non-communicable diseases.

112
Q

How are demographic, edpidemiologic, and health transitions related?

A

Demographic leads to epidemiologic.

Both together are health transition.

113
Q

What are the three objectives of health systems?

A

Improving population health.
Responding to expectations.
Providing financial protection against cost of ill-health.

114
Q

What is the minimum spend per person by a health system to deliver reasonable + minimal services?

A

60 USD per person.

115
Q

What are the five methods of funding health care systems?

A 
Direct payment.
General taxation.
Social health insurance.
Voluntary/private heath insurance.
Donations/community insurance.
116
Q

What are the eight millennium development goals?

A 
End poverty + hunger.
Universal education.
Gender equality.
Child health.
Maternal health.
Combat HIV/AIDS.
Environmental sustainability.
Global partnership.
117
Q

What are the five transformative shifts of the universal agenda?

A

Leave no one behind.
Sustainable development.
Transform economies for jobs + inclusive growth.
Build peace + effective, open and accountable institutions.
Forge a new global partnership.

118
Q

What is confounding bias?

A

Relationship between two variables is confounded by a third variable.

119
Q

What is the hierarchy of studies?

A 
Anecdote
Cross-sectional study
Register/ecological studies
Case-controlstudy
Cohort
Randomised controlled trial
120
Q

What is the counterfactual?

A

Hypothetical world, in which your hypothetical causation is removed. Would the disease still exist?

121
Q

Why is intention to treat analysis used?

A

It most closely resembles what might be observed in real practise.

122
Q

What are the key messages of the marmot review?

A

Lower social position=lower health.

Productivity losses, reduced tax revenue, higher welfare payments, increased Rx cost.

123
Q

What are the key inequalities mentioned in the marmot review?

A 
Child development + education
Employment
Working conditions
Housing + neighbourhood conditions
Standard of living
Freedom to participate equally in benefits of society
124
Q

How are health needs addressed on a population level?

A

Comparative needs assessment (define pop + analyse data)
Corporate “ (agree priorities by involving others)
Epidemiological “ (measure problem size + effect of current services)

125
Q

What is the epidemiological triad?

A

Time, place, person

126
Q

What is validity?

A

How closely it resembles the truth

127
Q

What is reliability?

A

Ability to give consistent results

128
Q

What is the preventative paradox?

A

Measures that bring large benefit to the community offer little to each participating individual.

129
Q

What are the characteristics of effective health promotion? (6)

A 
Planned
Informed by theory + evidence
Public + political awareness
Size, sophistication + duration
Resources available
Use varied methods
130
Q

What is the theory of ‘programming’ as an epidemiological paradigm?

A

Stimulus/insult at critical period in foetal/early life has permanent effect on physiology/metabolism, predisposing individuals to chronic disease in later life.

131
Q

What does the adult risk factor approach (as an epidemiological paradigm) fail to explain?

A

Geographical + social differences in chronic disease risk.

Ignores broader determinants of health.

132
Q

In the life course approach to epidemiology, differentiate between uncorrelated and correlated exposures.

A

Uncorrelated: exposure effect independent and irrespective of later exposures.
Correlated: accumulation of exposures related to each other. Chain of risk.

133
Q

In the life course approach to epidemiology, differentiate between additive and trigger effects.

A

Both part of a chain of risk (each exposure leads to the next).
Additive: exposures increase risk in cumulative manner.
Trigger: only final exposure has marked effect.

134
Q

What are the limitations of the life course approach to epidemiology?

A

Requires detailed cohort data covering the whole of the life course.

135
Q

How does alcohol behaviour change over the population?

A

Frequency of drinking increases with age.
Heavy drinking % decreases with age.
Employed drink more than unemployed.
More smokers than non smokers are heavy drinkers.

136
Q

How does smoking behaviour change over the population?

A

Unemployed smoke more than employed.
Deprivation level increase, making increase.
Increased above M62 corridor + in North East.

137
Q

How is greater physical activity clustered with drinking and smoking on a population level.

A

Greater physical activity - greater smoking and drinking. (Not a typo).

138
Q

How does clustering of risk vary across SEC?

A

Increased clustering in lower SEC’s.

Inequality in clustering increased in recent years.

139
Q

Differentiate between co-morbidity and multi-morbidity.

A

Co: one or more additional disorders co-occuring with a primary disease/disorder.
Multi: two or more medical conditions existing simultaneously regardless of causal relationship.

140
Q

Does two conditions being co-moribities tell you anything about their causal status?

A

No.

141
Q

What is the theory of the obesogenic environment?

A

Urban sprawl and land use mix is associated with obesity status.

142
Q

What are the ten King’s fund commissioning priorities?

A

Active self support.
1o prevention.
2o prevention.
Managing ambulatory care sensitive conditions.
Improving physical + mental management.
Integrated health and social care teams.
Improving 1o management of end of life care.
Effective medicines management.
Managing elective activity-referral quality.
Managing emergency/urgent care.

143
Q

How does King’s fund suggest integrating health and social care teams?

A 
Community based.
Wide range of professionals.
Focus on intermediate care.
Personalised programmes.
Named coordinator.
Shared clinical records.
144
Q

How does King’s fund propose to effective medicines management?

A

Medication reviews.
Pharmacist led.
IT decision support tools.
Improved data transportation.

145
Q

What are the 4 overarching themes of the KIng’s fund?

A

Systematic + proactive management of chronic disease.
Patient empowerment.
Population based approach to commissioning.
Integrated models of care.

146
Q

What are the four bits to psychological well being?

A

Individual vitality.
Activities that are meaningful + engaging which make them feel competent + autonomous.
Stock of inner resources to help them cope.
Sense of relatedness to other people.

147
Q

What are the three domains of psychological well being?

A

Personal
Social
Work

148
Q

What is an ‘asset’ in the asset approach to public health?

A

Asset: Any factor/resource that enhances ability to maintain + sustain health/wellbeing.

149
Q

What is the asset approach to public health?

A 
Start with assets.
Identify opportunities + strengths.
Invest in people.
Emphasis on role of civil society.
Focus on communities.
Sees people as citizens.
Help people take control.
Answer = people.
150
Q

What is the deficit approach to public health?

A 
Focus on deficiencies.
Respond to problems.
Provides services.
Emphasises agencies.
Individual focused, people = clients.
People treated as passive.
Answer = programme implementation.
151
Q

How will climate change impact upon global health?

A 
Decreased air quality.
Lengthened pollen season.
Change in distribution + behaviour of vectors/rodents.
Hot working environments.
UV radiation.
Hot + cold waves.
Freak weather events increase.
152
Q

How is climate change a ‘regressive problem’?

A

Those who contributed least are being affected the most.

153
Q

How can healthcare become more sustainable?

A

Prevention focus.
Patient partnership.
Leaner care pathways.
Low carbon Rx alternatives.

I+P (1 decks)

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