ISM DHC Flashcards
Outline the direct and indirect impacts of natural disasters on population health
Direct injuries as result of the disaster
Communicable diseases
Acute illness (e.g. earthquakes can release soil containing spores that cause illness)
Direct system effects (healthcare facilities and workers are subject to the same destructive forces)
Damage to physical infrastructure
Outline activities countries should undertake to ensure preparedness for disaster
Free education (educate public on natural disaster plans and what to do for better survival rate)
Technology (implement early warning systems)
Discourage settlement on high risk lands
Ensure reconstruction efforts are geared towards improving infrastructure
Describe the harm minimisation principle of prevention
Harm minimisation approach considers the actual harms associated with the use of.a drug rather than just the drug itself, and how these harms can be reduced.
Harm reduction: reducing the harm from drugs for both individuals and communities and not necessarily stopping drug use (e.g. needle syringe services)
Supply reduction: aimed at reducing the production and supply of illicit drugs (e.g. increasing cost through actions like crop eradication)
Demand reduction aimed at preventing the uptake of harmful drug habits (e.g. community education at schools)
List population subgroups with highest risk of suicide
Men midlife and older
People in justice and child welfare settings
People with medical conditions or disabilities
People with mental or substance use disorders
People who are LGBT
Members of military and veterans
What is the risk factor model of causation of disease?
The model generally states that as the number of risk factors a person has for a particular condition increases, so does the risk for developing the disease.
People at greatest risk can be identified and may be of the most benefit of early intervention.
Explain primary, secondary and tertiary prevention.
Primary: promotion of health and prevention of illness (e.g. immunisations and making physical environments safe)
Secondary: early detection and prompt intervention to correct departures from good health (e.g. cervical screening, BP monitoring)
Tertiary: reducing impairments and disabilities, minimising suffering caused by existing departures from good health (e.g. management of diabetes, physiotherapy)
Explain the difference between population wide public health interventions and interventions aimed at high risk populations.
Interventions targeting whole population generally have higher effectiveness ratings and are less costly to implement and maintain than those targeting at risk groups. Population wide interventions are used when there is a high prevalence of the risk. But it may expose more people to a potential adverse effect and side effects (e.g. too much fluoride in water), autonomy considerations (can’t opt out), equity considerations (those who are already healthy are more likely to take up opportunity than at risk groups).
High risk interventions have a greater benefit:risk ratio for each individual than applying population wide. Problem is high-risk people may not want to become involved or be labelled by going to support centres.
List the risk factors for hypertension
Age Smoking Diet Alcohol Hyperlipidemia Diabetes Ethnicity Family History Obesity Inactivity Recreational drugs
List the social determinants of health
Socioeconomic position - higher income allows for greater access to goods and services that provide health benefits
Education - leads to stable employment, secure income, understanding of healthy choices
Social exclusion - unemployment or discrimination
Residential Environment - neighbourhoods that ensure access to basic goods and services are essential for health equity
List conditions for which adequate physical activity is a preventative factor
Cardiovascular disease Type 2 diabetes Osteoporosis Hypetension Hyperlipidaemia Stroke
List lifestyle measures that can be used to treat hypertension
Improving diet Increase physical activity Quit smoking Reduce alcohol intake better control of diabetes
Explain the purpose behind the legislative requirements to notify some conditions to state government departments of health
To direct response as necessary (e.g. contact tracing, infection control, management)
Identify causes that need immediate response
Identify outbreaks and assist in management
Provide information to help develop public health policy and strategies
Assess disease impact and help prioritise prevention and control activities
Study the value of preventative measures
Understand and outline methods of public health control of communicable diseases
Contact Tracing Education of staff Vaccination Isolation Surveillance Screening and treatment Quarantine Post-exposure prophylaxis Pre-exposure prophylaxis
List the risk factors for skin cancers
Overexposure to UV radiation Skin type Many moles/freckles Immune suppression Age Smoking
List the main global health issues
Globalisation Population growth Displacement Non-communicable diseases Infectious diseases (antibiotic resistance) Rise in rates of obesity Environmental degradation Wars
Discuss the impact of childhood experiences on health throughout life
Negative childhood experiences are associated with:
Increased psychiatric disorders
Increased stress (impairs development of brain and nervous system)
Increased alcoholism, drug abuse, overweight, heavy smoking
Relationship problems with friends and partners
List the risks of alcohol, smoking and recreational drugs on pregnancy
Smoking:
Foetus exposed to chemicals. Nicotine causes the blood vessels to narrow leading to less oxygen dn fewer nutrients to the foetus. This damages the foetus lungs and brains and results in lower birth weight. Increased risk of sudden infant death syndrome.
Alcohol:
Interferes with normal growth of a foetus and causes birth defects. Foetus can develop life-long physical, intellectual, behavioural and learning disabilities. Foetal Alcohol Syndrome (FAS).
Drugs:
Increased risk of long-term medical and behavioural problems. Increases the risk of still birth. Opioids can lead to placental abruption (where the placenta begins to separate from inner wall of uterus before baby is born). Can also lead to preterm birth.
Define relative risk, odds ratio, attributable risk and number needed to treat.
Risk ratio: incidence in the exposed divided by incidence in the non-exposed.
Odds Ratio: odds that a disease outcome will occur given a particular exposure. odds of disease in exposed/odds of disease in non-exposed
Attributable risk: incidence in exposed - incidence in the non-exposed. Describes the excess risk of disease given exposure.
Number needed to treat is a measure of effect. Describes the number of patients needed to be treated to prevent therapeutic effort needed to prevent one additional adverse event. The lower the number, the more beneficial the treatment.
Understand how to identify and reduce the major sources of error in population health epidemiological research.
Type 1 error:
Probability of rejecting the null hypothesis when the hypothesis is actually true. (i.e. saying two groups are different when they are not). Minimised by picking a smaller level of significance before doing a test (i.e. require a smaller p value to reject null hypothesis)
Type 2 error:
When the null hypothesis is not rejected when it is false (i.e. saying there is no significant difference when in reality there is). Increase sample size to minimise this error.
Chance:
Association observed in a sample due to luck of the draw. This decreases with bigger study population.
Bias:
Volunteer Bias: people who volunteer tend to be healthier than those who don’t
Follow up bias: intervention group may lose contact if you have a long period of time between follow ups
Control bias: need the controls to be a similar population to the case group
Healthy worker effect: people who are employed are generally healthier than the target group
Recall bias
Responder bias: placebo effect
Observer bias: surveyor can ask questions that influence the answers of test groups
Minimise bias through: repeat measurements, standardised training, random selection and randomisation, ease of follow up
Confounding:
association between an exposure and outcome due to a 3rd variable
Minimise by restricting the group selection, stratification, and standardisation
Effect modification: if an effect is real but the magnitude of the effect is different for different groups of individuals
explain what internal and external validity means
Internal Validity = Study Validity. The degree to which the observed findings lead to correct inferences about phenomena taking place in the study sample.
External validity = generalisability. The degree to which the inferences drawn from a study can be generalised to a broader population beyond the study population.
Describe the elements of pre-pregnancy counselling
Medical History: assessment of any medical problems and how they may affect pregnancy
Reproductive carrier screening: counselling should be offered to high-risk populations to determine risk of an affected child and provide information about options
Vaccinations:
Vaccination history for MMR, chickenpox, tetanus, pertussis should be checked and maintained
Lifestyle recommendations:
Healthy BMI, supplementation, substance use, travel and environmental risks, healthy environment
Define inter-rater/inter-observer reliability and know how it is measured.
Interobserver reliability looks at the reliability when 2 people do the test at the same time and shows the extent that a test will change the results depending on the person performing it.
Interrater reliability looks at a test being done by the same person at different time points.
Define passive and active surveillance and give examples of when they are used.
Active Surveillance: a system employing staff members to regularly contact health care providers of the population to seek information about health conditions. Provides the most accurate and timely information but is expensive.
Passive surveillance: a system by which a health jurisdiction receives reports submitted from hospitals, and other sources. It relatively inexpensive strategy to cover large areas however it depends on people in different institutions to provide data, data quality and timeliness which are difficult to control.
How do you achieve appropriate sample size for a study?
Saturation - when adding more participants to the study does not result in additional perspectives or information.
What is Primary Health Care?
Primary health care is a socially appropriate, universally accessible, scientifically sound first level care provided by health services and systems. Gives priority to those most in need and addresses:
Health Inequalities
Maximises community and individual self-reliance
Participation and control
Involves Collaboration and partnership with other sectors
Types of services include: Health Promotion Prevention and screening Early Intervention Treatment and Management
Benefits of community agencies and support
Members usually share their personal experiences and offer one another emotional comfort and moral support. May also offer practical advice and tips
Feeling less lonely, isolated or judged
Gaining a sense of empowerment
Talking openly and honestly about feelings
Improving coping skills and sense of adjustment
Developing a clearer understanding of what to expect in regards to the condition
Comparing notes about resources
