MHS Flashcards
What is epidemiology?
Study of distribution and determinants of health - in specified populations, and application to control health problems
What is public health?
Preventing disease, prolonging life and promoting health - through organised efforts of society
What are the 2 approaches of public health?
Medical specialty
Population based - everyone involved
What are the three steps in prevention of a disease?
Primary - Stop the onset/remove the risks
Secondary - Stopping progression (early detection and treatment key)
Tertiary - minimising impact of established disease
What is a communicable disease?
one that is passed between people - infectious.
Describe the chain of infection
Infectious agent - lives in reservoir - has a portal of exit - has a mode of transmission - gets in via a portal of entry - to a susceptible host
What are the different modes of transmission of an infectious agent?
Direct - ie. direct contact, direct projection (large droplet spread)
Indirect - Vehicle borne, vector borne, airborne
How does Sackett describe evidence based medicine?
As the integration of best research evidence with clinical expertise and patient values
What steps do you take in evidence based medicine (5 A’s)
Asses the patient Ask the question Acquire the evidence Appraise said evidence Apply with the patient Self evaluate
What is PICO? Why do you use it?
To help you asses what to look for evidence about P - person I - intervention C - comparison O - Outcome
What study type is best when looking at diagnosis?
Prospective blind comparison
What study type is best when looking at therapy/
RCT
What study type is best when looking at prognosis?
Cohort study
What study type is best when looking at Harm/Etiology?
RCT
What study type is best when looking at prevention of a diesease?
RCT
What study type is best when looking at clinical exams?
Prospective blind comparison
What study type is best when looking at cost benefit?
Economic analysis
What is the hierarchy of study design types?
Meta analysis/ systematic review of RCT
RCT
Non randomised intervention/clinical studies
Observational studies
Analytically: (Cohort -> Case Control)
Descriptive ( self controlled Case series)
Ecological studies
Cross sectional studies
Case series and case reports
What are the 3 schools of thinking that analyse suicide, and what are their main thoughts?
Psychological - as an intentional act of an individual
Sociological - As a socially constrained act, or a meaningful act within a social group
Anthropological - As a culturally patterned act
There were 7 psychological theories of suicide outlined int he lectures, what were they?
Freud - unconscious intentions Beck - cognitive model Wenzel+Beck 2008 - Cognitive behavioural Sneidman + Leenaars - Multidimensional Diathesis-stess hypothesis Self-regulatory theroy Beaumister 1990 - Escape theory
What is the basis of Freuds model of suicide?
Motivated by unconscious intentions – Root cause is loss and rejection – A desire for self punishment – Has impaired organisation of experience – No coherent synthesis of experience
Describe Beck’s cognitive model of suicide
Cognitive structure : Polarised thinking: viewing the world in extreme ways with no intermediates
– Problem solving deficits : Inflexible, thinking in rigid categories
– Anticipation of the future:
• As suicidal ideation increases the future looks bleaker
• As suicidal ideation increases the future view is shortened with the person becoming absorbed in the present
Describe Wenzel and Beck’s cognitive behavioural model of suicide
– Associated with depression with the critical link being feelings of hopelessness
– Negative expectations
– Negative personal view
– Affective reaction is proportional to the labelling of an event/situation not to its true intensity
– Involuntary thoughts are treated as the only applicable thoughts (judgements become absolute)
– Only one possible solution (rigid thinking)
– Death is more desirable than life
Describe Shneidman and Leenaars multidimensional model of depression
– Unbearable psychological pain
– High degree of perturbation
– Associated with a traumatic situation
– Cognitive constriction (logic and perception)
– Focus is on escaping the pain using one ‘arbitrarily’ selected solution
– A desire to end conscious experience
Describe the diathesis-stress hypothesis of suicide
It considers cognitive vulnerability as the key factor - lack of problem solving ability
What are the 4 types of suicide described by Durkheim?
- Egoistic – self-centred (under-integration)
- Altruistic – for the good of others (over-integration)
- Anomic – social isolation (under-regulation)
- Fatalistic – no choice (over-regulation)
What are the main anthropological thoughts on suicide?
Recognises suicide as a social meaning which varies between cultures (in many cultures suicide isn’t seen as wrong).
It is a socially patterned act that conveys a cultural meaning
What are the 5 catagories personality types are divided into?
Neuroticism Extraversion Openness Agreeableness Conscientiousness
What is neuroticism?
A disposition to experience more negative feelings and low self esteem
If you are extraverted how will you be/
Outgoing, risk taking and cheerful
If you have an open personality type how will you be?
Curious, interested in novel and unconventional things
Someones locus of control can be internal or external, what does this mean?
Internal - guided by their personal decisions and efforts
External - guided by fate, luck, other people or external circumstances
Who has developed theories of development - what are their brief outlines?
Piaget : internal cognitive structure provides individuals with a script of how to proceed in different situations. You develop through assimilation and accommodation. STAGES
Vygotsky: Social cultural influence - Development of children is guided by adults. They need scaffolding, you learn in the ZPD: Zone of Proximal development.
Erikson Development of personality happens by crisis - cathartic moments within individuals lives. (BUT too simplistic).
Bates: Development is lifelong and Multidimensional & multidirectional. LIFE-SPAN.
What is habituation?
Repeated stimulation = reduced response
If you give a different stimulus to someone who is habituated what happens?
The habituation is eliminated
What animal model to they use for models of learning?
Aplysia - sea slugs - gill and syphon reflex
What is sensitization?
An inceased response due to a painful stimuli given at the same time as a habituated stimuli
What is conditioning?
Associative learning - associations are made between one stimulus and another stimulus/outcome
What is instrumental conditioning?
Involved doing a voluntary action to evoke a response
What is operant conditioning?
When there are repeated operant responses with a schedule of responses
What is blocking of a stimuli?
When 2 stimuli are given at once, the response will only be linked to one of them.
What is overshaddowing of a stimulus?
When one stimulus is ignored due to a more salient stimulus
What is simple Mendelian genetics?
Complete correlation between genotype and phenotype - genes are sufficient and necessary for the disease to occur
What diseases follow simple medelian inheritance?
Huntington’s
Cystic fibrosis - autosomal recessive
Duchenne musc. dystropy
Familial hypercholesterolaemia (autosomal dominant)
What is oligogenic or polygenic inheritance?
Dysfunction fo the genes is sufficient but not necessary for the disease to occur
What is an example of a oligogenic inherited disease?
Alzhiemers
What is complex or multifactorial inheritance?
Dysfunction in any one gene is neither necessary nor sufficient for a disease to occur
Other factors involved - environmental, many genes…
How does your behaviour towards health impact on your health?
Generating a biological change (ie. liver disease with alcohol)
Changing exposure to health risks
Early detection and screening
What is the principle behind social learning?
People conform to groups - copy actions, swayed by others answers, feel less vulnerable.
What study was an example of the strengeth of social learning?
Milgram’s obedience study - giving electric shocks
What is compliance?
The extent to which a persons behaviour (taking their medication) coincides with medical professionals advice
What is adherence?
The extent to which a personals behaviour (taking medication) corresponds with medical professionals advice
What is health inequality?
Difference in health status
What is health inequity/
Unfair differences that are avoidable
What is the inverse care law? Who coined it?
The availability of good medical care varies inversely with where it is most needed.
Julian Tudor heart
What did the marmot review find?
Disadvantage starts before birth and accumulates through life
Action must start before birth
What principles should be applied to any ethical question?
Principles to apply to an ethical question:
- The principle of respect for autonomy
- The principle of beneficence
- The principle of non-maleficence (nb the dictum primum non nocere)
- The principle of justice
What is body image?
A persons perceptions thoughts and feelings about their body
What are the 3 different body types?
Endomorph - chubby
Mesomorph - Athletic
Ectomorph - skinny
What is cognitive fusion?
When an individual is dominated by their thoughts and allow these thoughts to control behaviour
What 5 recommendations have been made to reduce obesity and eating disorders in adolescents?
1) Discourage unhealthy dieting
2) Promote a positive body image
3) Encourage more family meals
4) Talk less about weight
5) Address issues of stigmatisation
What is the percentage of worldwide deaths from non-communicable diseases?
63% globally
80% in developing countries younger people
What are the general risk factors for non communicable diseases?
High BP Tobacco use Alcohol Raised blood glucose Decrease fruit and veg Raised cholesterol Obesity Physical inactivity
Describe epidemiological transition
Changing patterns in death and illness
What are the 3 phases of transition ofdisease, who described them?
Omran
1 - age of pestilence and famine
2 - Age of pandemics
3- Age of degenerative diseases and man
What is DALY?
Disability adjusted life year
What do DALYs take into account?
Time based measure
Combines years lost due to premature mortality and years of life lost due to time lived in states of less than full health
Who is affected during conflict?
Children - disrupts education, shelter, vaccinations
Adults - Lose main wage earner, combat injuries, torture and rape
Elderly - Unable/unwilling to move, medical resources redirected
5% deaths due to fighting directly.
What are high conception rates associated with?
deprivation and health inequalities
What adverse outcomes can occur to babies born from unplanned, teenage pregnancies?
Pre-term, low birth weight, Small for gestational age
15% of teenage pregnancies are planned - so risk of smoking and drinking high in first trimester
Less likely to breastfeed
What factors are related to high teen pregnancy rates?
Risky behaviors
Education related (low attainment, disengagement, leaving school)
Family/background (vulnerable groups, daughter of teenage mother, culture)
How has medicine changed over its history? What are thr 3 stages it has gone through?
Bedside medicine
Hospital medicine
Laboratory medicine
How has the concept of illness changed?
Total psuchomotor disterbance -> organic lesion -> biochemical process
When was anaesthesia developed? Why did mortality rate increase after it for a while?
1840’s - liston used ether.
More complex operations were attempted
Time constraint removed from agony
Enabled penetrating below body surface - more infections and deaths.
When were antiseptics introduced?
1865 - by Lister
What is the null hypothesis?
H0 the statement being tested
What is the alternative hypothesis?
H1 - What will be believed to be true if the null hypothesis is wrong
What measure of association is used in Case control studies?
Odds Ratio = odds of cases being a smoker / odds of controls being a smoker
What is the P value?
The probablity of getting the results you did given that the null hypothesis is true. if P value over 1 = significant
What is the 95% confidence interval used for?
Calculated in stats software from odds ratio - if value range doesn;t include 1 = significant
What is a case control study good at looking at?
Rare diseases
Typically retrospecitve
What is the limitation of a case control study?
Prone to bias
Incidence cant be determined
What is a cohort study good at looking at?
Rare exposures - multiple effects of one exposure
incidence can be exposed
typically prospective
What is a type II error?
False negative. Beta error
Medicine: Study finds the condition is not present (negative result), but in reality it is (positive).
Type II error is failing to detect an effect that is present
What is a type I error?
False positive - alpha error
Medical: Study finds condition is present (positive) when in reality it isn’t (negative)
Type I error is detecting an effect that is not present
What are the 3 types of bias?
Selection bias
Exclusion bias
Reporting bias
How do you control bias?
Randomization and blinding
How do you control random error?
Sample size and significance level
How do you control confounding error?
Study design
What is the prevalence?
Proportion of the population with a disorder
What 2 scoring methods are used for depression?
ICD-10 and DSM
What 3 domains does the bio-psycho-social model suggest causes depression?
Predisposing factors
Precipitating factors
Maintaining factors
what are the 3 models of stress?
Stimulus model
Response model
Transactional model
Describe the stimulus model of stress
Focus on the environmental conditions that cause a stress response - Avoidance as a technique?
Describe the response model of stress
Focus on the response produced by the environment. Stimulus less important. Minimise the impact of the response?
Describe the transaction model of stress
Transactional model - A process between the organism and the environment. Techniques to help - coping mechanisms?
What are the 3 stages of stress?
Alarm - resistance - exhaustion
What 2 routes activate the sympathetic nervous system?
SAM - sympathoadrenaomedullary axis - adrenaline
HPA - Hypothalamic-pirtuitary-adrenal axis - corticosteroids`
What is the incidence rate?
Thenumberofnewcasesofadiseaseoveraperiodoftime(usuallyayear)
What is culmulative incidence?
Incidence measured over a period of time where the period of time is the same for each person under study
what is Incidence density?
Incidence rate in a population where periods of observation are different for each person
What is prevalence?
The number of people who have a disease in a population at a given time
What is point prevalence?
The number of people with the disease at a specific point in time
What is the absolute risk?
The risk that a person in the group will develop a disease
= incidence rate
In cohort studies
What is the relative risk?
The ratio of incidence rate in an exposed group vs. an unexposed group
RR = AR exposed group / AR unexposed group
What is standardisation?
A set of techniques used to remove as much as possible the effects of differences in confounders (eg. age, sex, ethnicity) when comparing 2 or more populations
What is Selye’s theory of stress?
The stress response - general adaptation syndrome
The body’s resistance to stress can only last so long before exhaustion sets in.
Where is stress detected in higher animals first?
Cerebral cortex - actives sympathetic NS - prepares for physical activity and exertion
What 2 parts of the Pons are important in the sypathetic stress response?
Locus coeruleus - synthesises noradrenaline
Raphe nucleus - serotonin production
What is Eustress?
Positive cognitive response to stress
What is distress?
Negative stress - when your level of arousal is too high or too low and you body/mind responds negatively to stressors
Describe Lazarus’s cognitive appraisal model
In order for a psycho-social situation to be stressful, it must be appraised as such - how you view a situation.
What did Langer and Rodin discover about personal control and stress?
Those with more personal control had lower levels of stress - experiment with looking after a plant in a care home.
When making decisions there are 3 main types of interpersonal conflict - what are they?
Approach-approach
Avoidance-avoidance
Approah-avoidance
