I+P Flashcards
what is the WHO definition of health
a state of complete physical, psychological + social well-being, not simply the absence of disease or infirmity
what is the difference between a necessary cause and a sufficient cause of a disease?
necessary cause:
- MUST be present
- eg you need to be exposed to a virus to get a disease
sufficient cause:
- will cause outcome
- could contribute to disease, but need other stuff as well
necessary cause + sufficient cause = 100% correlation of cause and disease
list these 8 types of studies from most scientifically valid to least:
- anecdotes
- case control studies
- case reports
- cohort studies
- controlled trials
- cross-sectional surveys/incidence register
- ecological studies
- randomised controlled trials
1) randomised controlled trials (RCT)
2) controlled trials
3) cohort studies
4) case control studies
5) ecological studies
6) cross-sectional surveys/incidence register
7) case reports
8) anecdotes
what’s the difference between prevelence and incidence?
what is each best for?
prevelence:
- no. of people at a specific time who have the disease
- tends to just be used for chronic diseases
incidence:
- no. of people who contracted the disease over a given period (eg a year) compared to how many people at risk in the population
- can be used for chronic or acute diseases
what’s the difference between accuracy and precision?
accuracy = a lack of systematic error
precision = a lack of random error
what does validity mean?
how well a scientific test or piece of research actually measures what it sets out to, or how well it reflects the reality it claims to represent.
what is a confounding factor?
aka a confounding variable
a variable in a quantitative research study that explains some, or all, of the correlation between the dependent variable and an independent variable
what are the main differences between quantitative research and qualitative research?
quantitative:
- what? how many? how often?
- variables are concieved before research begins (cause + effect)
- research Q/hypothesis comes first
- statistical analysis, once taught, anyone can do it
- findings = generalisable
qualitative:
- why? how? when? who?
- no preconcieved assumptions (exploratory)
- patterns emerge from the collected data
- individual interpretation (take a lot of practise to do it well + needs knowledge in breadth + depth of research topic)
- findings = unique, insightful
give some examples of qualitative research methods?
- content analysis
- grounded theory
- framework analysis
- interpretive phenomenological analysis (IPA)
- protocol analysis
- discourse analysis
- conversation analysis
- ethonography
- phenomenology
“so basically if it has the word analysis in the description then likely to be qualitative”
describe the difference between a case-control study and a cohort study
which is best for rare diseases and which is best for rare exposures?
case-control study:
- patients witha disease (case) are compared to people without the disease (controls) and compared for an exposure (potential cause
- this is retrospective so recall bias
- best for rare diseases
cohort study:
- get a cohort of people and follow them up over a period of time and constantly ask them about potential exposures then see who gets the disease + who doesn’t (can also do for multiple diseases)
- very costly to continue surveying, lots of dropouts
- best for rare exposures
what’s the difference between a single-blind RCT and a double-blind RCT?
single-blind
- patient doesn’t know whether getting placebo or real
double-blind
- patient AND clinician/scientist doesn’t know whether getting placebo or real
what is the definition of need?
an individual’s, or population’s ability to benefit from health care/interventions in terms of potential prevention as well as curative services
what is a health needs assessment? incl purpose and desired outcome
a tool to describe + evaluate patterns of disease in a population + do something about it
- learn more about needs + priorities of people
- highlight areas of unmet need
- provide a clear set of objectives
- enable sound decisions about how to allocate resources
- influence policy, partnership working and collaboration
define lifestyle
a way of living based on identifiable patterns of behaviours. harachteristics, social interactions + socioeconomic + environmental living conditions
define health behaviour and risky behaviour?
health behaviour:
- any activity undertaken by an individual, to promote or maintain health, regardless whether or not such behaviour is objectively towards that end
risky behaviour:
- specific forms of behaviour which are proven to be asdsociated with increase susceptibility to a specific disease or ill-health
what are the four biggest causes of preventable deaths in the developedc world?
- smoking
- alcohol
- poor diet
- inactivity
what is a synergistic risk?
total risk is several times greater than sum of seperate risks
eg laryngeaal cancer for smoker-drinkers
what are the ‘five As’ for modifying health behaviours?
- assess
- advise
- agree
- assist
- arrange
which of these drugs are class A, B + C?
- amphetamines
- amphetamines prepared for injection
- anabolic steroids
- barbituates
- cannabis
- cocaine
- codeine
- crack cocaine
- ecstasy/MDMA
- GHB (date rape)
- heroin
- ketamine
- LSD
- magic mushrooms
- methamphetamine
- ritalin
- temazepam
- valium
- amphetamines = B
- amphetamines prepared for injection = A
- anabolic steroids = C
- barbituates = B
- cannabis = C
- cocaine = A
- codeine = B
- crack cocaine = A
- ecstasy/MDMA = A
- GHB (date rape) = C
- heroin = A
- ketamine = C
- LSD = A
- magic mushrooms = A
- methamphetamine = B
- ritalin = C
- temazepam = C
- valium = C
what are the prison sentences for possession and supply of class A, B + C drugs?
class A
- posession = 7 years
- supply = life
class B
- posession = 5 years
- supply = 14 years
class C
- posession = 2 years
- supply = 14 years
what is the difference between primary, secondary and tertiary prevention?
primary:
- aims to prevent disease/injury before it ever occurs
- eg banning of asbestos, vaccination, health education
secondary:
- aims to reduce the impact of a disease or injury that have already occured by detecting and treating disease or injury asap or halt its progress
- eg mammogram screening, diet/exercise to prevent further MIs/strokes
tertiary:
- aims to soften the impact of an ongoing illness or injury that has lasting effects
- eg cardiac or stroke rehabilitation programmes, depression support groups
what is the prevention paradox?
immunisation against MMR, benefits the population as a whole but, from an individual point of view, chance of benefit outweighed by certainty of pain and possible reaction
overcome this by building healthy public policy, creating supportive environments, strengthening community action, developing personal skills, re-orientating health services
give definitions of sensitivity and specificity
and how to calculate them
sensitivity:
- the proportion of people with the disease who are idntified as having it by a positive test result
- true positive / (true positive + false negative)
specificity:
- the proportion of people without the disease who are corfrectly re-assured by a negative test result
- true negative / (false positive + true negative)
what is the definition of positive and negative predictive values?
incl how to calculate
positive predictive value:
- the probability that a person with a positive test result actually has the disease
- true positive / (true positive + false positive)
negative predictive value:
- the probability that a person with a negative test result does not actually have the disease
- true negative / (true negative + false negative)
what does ESOL stand for?
english for speakers of other languages
what is the definition of health literacy?
cognitive and social skills which determine the motivation and ability of individuals to gain access to, understand and use information in ways which promote and maintain good health
eg to be able to apply literacy skills to health related materials such as prescriptions, appointment cards, medicine labels + directions for home health care
people with a low health literacy have poorer health outcomes
what % of prescriptions are taken incorrectly?
50%
what are the three different stages of health literacy?
describe them
what is this model called?
functional = lowest interactive = mid critical = highest
nutbeam model of health literacy
functional
- ability to understand and comply with simple info
interactive
- patients can evaluate a health message so as to interact appropriately with others in the environment. Patients will show improved motivation and self confidence. They may, for example, negotiate treatment with their doctor based on knowledge of their condition gained through reading self-help materials or express their understanding to peers in an online support group.
critical:
- can do all of above, plus has analysis skills that allow individual and group empowerment that supports social action participation in health-related issues. In general, these people are able to facilitate community development. At this top level of health literacy, individuals are able to evaluate health issues, determine the challenges and advantages of each issue, recognize who benefits and who loses by adopting a given health-promotion strategy, argue for or against adoption, and offer advice to community leaders.
what is the name of a major study which measured risk factors for cognitive decline?
what 7 protective factors against cognitive decline did it find?
Lothian birth cohort study (1921) - successful aging in scotland
- no CVD or chronic disease
- favourable environment, high social class
- complex + intellectually stimulating environment
- flexible personality style at midlife
- parter with high cognitive ability
- fast processing speed of brain
- satisfied with life in middle age
define these periods of an infection:
- incubation period?
- latent period?
- infectious period?
incubation period:
- time from infection until symptoms develop
latent period:
- time from infection until person becomes able to transmit infection to others
infectious period:
- time when person is able to transmit infection to others
what is the first case in an outbreak called?
index case
what is the definition of an OUTBREAK of an infectious disease?
2 or more linked cases of a disease (time/place) or a single case of a rare disease
name the ‘scary/developing world’ notifiable diseases. 13
- anthrax
- plague
- leprosy
- rabies
- smallpox
- typhus
- cholera
- dysentery
- typhoid fever
- paratyphoid fever
- malaria
- yellow fever
- viral haemorrhagic fever (eg ebola)
name the ‘nasty’ notifiable diseases. 9
- legionnaires disease
- SARS
- invasive group A strep
- scarlet fever
- relapsing fever
- brucellosis
- ACUTE infectious hepatitis (A, B, C, E etc)
- botulism
- acute infectious hepatitis
name the ‘vaccine preventable’ notifiable diseases. 8
- measles
- mumps
- rubella
- meningitis + meningococcal septicaemia
- tetanus
- whooping cough (pertussis)
- diphtheria
- acute poliomyelitis (polio)
name the ‘controllable’ notifiable diseases.
- food poisoning
- infectious bloody diarrhoea
- haemolytic-uremic syndrome
- TB
what are the two types of influenza?
which tends to be worse?
- which shows more antigenic drift?
which is classified by H + N antigens?
Influenza A + B
Influenza A tends to be worse, shows more antigenic drift and is classified by H+N antigens (eg H1N1 = swine flu)
nb antigenic DRIFT is slow changes in antigens (thus need ever changing vaccines)
- antigenic SHIFT is much more sudden change, likely to lead to epidemic/pandemic
how many millenium development goals were there?
- what are they?
when were they meant to be done by?
8
- eradicate extreme poverty + hunger
- achieve universal primary education
- promote gender equality + empower women
- reduce child mortality
- improve maternal health
- combat HIV/AIDS, malaria + other diseases
- ensure environmental sustainability
- develop a global partnership for development
2015
nb some were acieved fully, others only partially
what are the follow-on goals from the ‘millenium development goals’ called?
how many are there?
how do they differ from the MDGs?
when are they meant to be achieved by?
sustainable development goals
17
they cover broader + more topics
2030
which is the preferred concept: international health or global health?
what’s the difference?
international health
- focus on specific conditions in particular countries
- one-way flow of ideas/development
- seen as neo-colonialism
global health
- PREFERRED
- focused on partnerships and more broad etc
what is the definition of a communicable disease?
any condition which is transmitted directly (or indirectly) from an infected person (or animal) through the agency of an intermediate animal, host or vector, or through the inanimate environment
what are the 5 primary methods of funding health care systems?
- direct or out-of-pocket
- general taxation
- social health insurance
- voluntary/private health insurance
- donations or community health insurance
nb most countries have a combination of these
if a non-infectious disease could suddenly be cured, incidence would….
prevalence would….
stay the same
not preventing people getting the disease, just curing them when they do, so prevalence would decrease
what is the definition of sampling bias?
a bias in which a sample is collected/chosen in such a way that some members of the intended population are less likely to be included than others
study participants should be chosen completely randomly within the criteria of the study
what is the definition of an ecological study?
a type of 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 used to measure prevalence and incidence of disease, particularly when disease is rare
nb our RESS projects this year were technically ecological studies
they measure assosiation but NOT causation
they are relatively cheap
what is the definition of an error?
a measureof the estimated difference between the observed or calculated value of a quantity and its true value
what is the definition of a bias?
any systematic error in an epidemiological study that results in an incorrect estimate of the true effect of an exposure on the outcome of interest
what is the definition of information bias?
2 examples of types of information bias?
results from systemic differences in the way data on exposure or outcome are obtained from the various study groups. This may lead that results for individuals are not reported accurately and so data will not reflect the true outcomes of the experiment
eg:
- observer bias (double blind to eliminate)
- recall bias (in case control studies)
what is a confounding variable?
any other variable that has an effect on your outcome (other than the exposure which you are studying)
what does ‘intention to treat’ mean, in the context of clinical trials?
intention to treat (ITT) analysis means all patients who were enrolled and randomly allocated to treatment (ie not placebo/control) are included in the analysis and are analysed as a part of the group into which they were randomised
so it ignores noncompliance, protocol deviations, withdrawal and anything else that happens after randomisation
what does prospective mean?
give an example of a type of prospective study?
a prospective study watches for outcomes, such as the development of a disease, during the study period and relates this to other factors, such as suspected risks or protective exposures
ie a cohort study
- take a cohort of subjects and watch them over a long period
nb a case-control study would be an example of a RETROspective study
what is the life course approach to health?
the long term effects on later health or disease risk of physical or social exposures during gestation, childhood, adolescense, young adulthood + later adult life
summarise the Marmot Review
the marmot review into health inequalities (2010) proposes an evidence based strategy to address the SOCIAL DETERMINANTS OF HEALTH, the conditions in which peopple are born, grow, live, work + age and which can all lead to health inequalities.
It draws a lot of attention to the fact that most people in england aren’t living as long as the best off in society and spend longer in ill-health
premature illness and death affect the lower socioeconomic classes disproportionately
what is the intervention ladder?
what are the 8 rungs of it?
a step wise approach to changing people’s behaviours via public health interventions
1) do nothing
2) provide information
3) enable choice
4) guide choice by changing the default option
5) guide choice by incentives
6) guide choice by disincentives
7) restrict choice
8) eliminate choice
what is multimorbidity?
the presence of two or more chronic medical conditions in an individual
what is the Ottawa Charter?
ottawa charter for health promotion
an international agreement signed at the first international conference on health promotion (organised by the WHO) in 1986
it launched a series of actions among international organisations, national governments + local communities to achieve the goal of ‘health for all’ by 2000 and beyond
5 main areas identified:
- building healthy public policy
- creating supportive environemtns
- strengthening community action
- developing personal skills
- re-orientating health care services towards prevention of illness and promotion of health
what does counterfactual mean?
relating to or expressing what has not happened or is not the case
thinking about what did not happen but could have happened
eg if I had done the half marathon, I would have got a medal
what is health protection?
a term used to encompass a set of activities within the public health function
involving:
- ensuring the safety + quality of food, water, air + the general environment
- preventing the transmission of communicable diseases
what are social norms?
the rules of behaviour that are considered acceptable in a group or society
people who do not follow these norms may be shunned or suffer some kind of consequence
norms change according to the environment or situation + may change or be modified over time
describe the stages of a classic commissioning cycle, as used in the UK
- assess need (health needs asessment
- review current service provision
- decide priorities
- design service
- shape structure of supply
- manage demand + ensure appropriate access to care
- clinical decision making
- managing performance (quality, performance, outcomes)
basically:
- plan well
- carry out services
- review effect
