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Lucy Knox - Year 1 > MHS > Flashcards

MHS Flashcards

1
Q

What is epidemiology?

A

Study of distribution and determinants of health - in specified populations, and application to control health problems

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2
Q

What is public health?

A

Preventing disease, prolonging life and promoting health - through organised efforts of society

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3
Q

What are the 2 approaches of public health?

A

Medical specialty

Population based - everyone involved

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4
Q

What are the three steps in prevention of a disease?

A

Primary - Stop the onset/remove the risks
Secondary - Stopping progression (early detection and treatment key)
Tertiary - minimising impact of established disease

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5
Q

What is a communicable disease?

A

one that is passed between people - infectious.

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6
Q

Describe the chain of infection

A

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

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7
Q

What are the different modes of transmission of an infectious agent?

A

Direct - ie. direct contact, direct projection (large droplet spread)
Indirect - Vehicle borne, vector borne, airborne

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8
Q

How does Sackett describe evidence based medicine?

A

As the integration of best research evidence with clinical expertise and patient values

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9
Q

What steps do you take in evidence based medicine (5 A’s)

A 
Asses the patient
Ask the question
Acquire the evidence
Appraise said evidence
Apply with the patient
Self evaluate
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10
Q

What is PICO? Why do you use it?

A 
To help you asses what to look for evidence about
P - person
I - intervention
C - comparison
O - Outcome
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11
Q

What study type is best when looking at diagnosis?

A

Prospective blind comparison

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12
Q

What study type is best when looking at therapy/

A

RCT

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13
Q

What study type is best when looking at prognosis?

A

Cohort study

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14
Q

What study type is best when looking at Harm/Etiology?

A

RCT

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15
Q

What study type is best when looking at prevention of a diesease?

A

RCT

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16
Q

What study type is best when looking at clinical exams?

A

Prospective blind comparison

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17
Q

What study type is best when looking at cost benefit?

A

Economic analysis

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18
Q

What is the hierarchy of study design types?

A

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

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19
Q

What are the 3 schools of thinking that analyse suicide, and what are their main thoughts?

A

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

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20
Q

There were 7 psychological theories of suicide outlined int he lectures, what were they?

A 
Freud - unconscious intentions
Beck - cognitive model
Wenzel+Beck 2008 - Cognitive behavioural
Sneidman + Leenaars - Multidimensional
Diathesis-stess hypothesis
Self-regulatory theroy
Beaumister 1990 - Escape theory
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21
Q

What is the basis of Freuds model of suicide?

A 
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
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22
Q

Describe Beck’s cognitive model of suicide

A

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

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23
Q

Describe Wenzel and Beck’s cognitive behavioural model of suicide

A

– 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

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24
Q

Describe Shneidman and Leenaars multidimensional model of depression

A

– 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

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25
Q

Describe the diathesis-stress hypothesis of suicide

A

It considers cognitive vulnerability as the key factor - lack of problem solving ability

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26
Q

What are the 4 types of suicide described by Durkheim?

A
  1. Egoistic – self-centred (under-integration)
  2. Altruistic – for the good of others (over-integration)
  3. Anomic – social isolation (under-regulation)
  4. Fatalistic – no choice (over-regulation)
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27
Q

What are the main anthropological thoughts on suicide?

A

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

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28
Q

What are the 5 catagories personality types are divided into?

A 
Neuroticism
Extraversion
Openness
Agreeableness
Conscientiousness
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29
Q

What is neuroticism?

A

A disposition to experience more negative feelings and low self esteem

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30
Q

If you are extraverted how will you be/

A

Outgoing, risk taking and cheerful

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31
Q

If you have an open personality type how will you be?

A

Curious, interested in novel and unconventional things

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32
Q

Someones locus of control can be internal or external, what does this mean?

A

Internal - guided by their personal decisions and efforts

External - guided by fate, luck, other people or external circumstances

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33
Q

Who has developed theories of development - what are their brief outlines?

A

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.

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34
Q

What is habituation?

A

Repeated stimulation = reduced response

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35
Q

If you give a different stimulus to someone who is habituated what happens?

A

The habituation is eliminated

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36
Q

What animal model to they use for models of learning?

A

Aplysia - sea slugs - gill and syphon reflex

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37
Q

What is sensitization?

A

An inceased response due to a painful stimuli given at the same time as a habituated stimuli

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38
Q

What is conditioning?

A

Associative learning - associations are made between one stimulus and another stimulus/outcome

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39
Q

What is instrumental conditioning?

A

Involved doing a voluntary action to evoke a response

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40
Q

What is operant conditioning?

A

When there are repeated operant responses with a schedule of responses

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41
Q

What is blocking of a stimuli?

A

When 2 stimuli are given at once, the response will only be linked to one of them.

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42
Q

What is overshaddowing of a stimulus?

A

When one stimulus is ignored due to a more salient stimulus

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43
Q

What is simple Mendelian genetics?

A

Complete correlation between genotype and phenotype - genes are sufficient and necessary for the disease to occur

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44
Q

What diseases follow simple medelian inheritance?

A

Huntington’s
Cystic fibrosis - autosomal recessive
Duchenne musc. dystropy
Familial hypercholesterolaemia (autosomal dominant)

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45
Q

What is oligogenic or polygenic inheritance?

A

Dysfunction fo the genes is sufficient but not necessary for the disease to occur

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46
Q

What is an example of a oligogenic inherited disease?

A

Alzhiemers

47
Q

What is complex or multifactorial inheritance?

A

Dysfunction in any one gene is neither necessary nor sufficient for a disease to occur

Other factors involved - environmental, many genes…

48
Q

How does your behaviour towards health impact on your health?

A

Generating a biological change (ie. liver disease with alcohol)
Changing exposure to health risks
Early detection and screening

49
Q

What is the principle behind social learning?

A

People conform to groups - copy actions, swayed by others answers, feel less vulnerable.

50
Q

What study was an example of the strengeth of social learning?

A

Milgram’s obedience study - giving electric shocks

51
Q

What is compliance?

A

The extent to which a persons behaviour (taking their medication) coincides with medical professionals advice

52
Q

What is adherence?

A

The extent to which a personals behaviour (taking medication) corresponds with medical professionals advice

53
Q

What is health inequality?

A

Difference in health status

54
Q

What is health inequity/

A

Unfair differences that are avoidable

55
Q

What is the inverse care law? Who coined it?

A

The availability of good medical care varies inversely with where it is most needed.
Julian Tudor heart

56
Q

What did the marmot review find?

A

Disadvantage starts before birth and accumulates through life
Action must start before birth

57
Q

What principles should be applied to any ethical question?

A

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
58
Q

What is body image?

A

A persons perceptions thoughts and feelings about their body

59
Q

What are the 3 different body types?

A

Endomorph - chubby
Mesomorph - Athletic
Ectomorph - skinny

60
Q

What is cognitive fusion?

A

When an individual is dominated by their thoughts and allow these thoughts to control behaviour

61
Q

What 5 recommendations have been made to reduce obesity and eating disorders in adolescents?

A

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

62
Q

What is the percentage of worldwide deaths from non-communicable diseases?

A

63% globally

80% in developing countries younger people

63
Q

What are the general risk factors for non communicable diseases?

A 
High BP
Tobacco use
Alcohol
Raised blood glucose
Decrease fruit and veg
Raised cholesterol
Obesity
Physical inactivity
64
Q

Describe epidemiological transition

A

Changing patterns in death and illness

65
Q

What are the 3 phases of transition ofdisease, who described them?

A

Omran
1 - age of pestilence and famine
2 - Age of pandemics
3- Age of degenerative diseases and man

66
Q

What is DALY?

A

Disability adjusted life year

67
Q

What do DALYs take into account?

A

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

68
Q

Who is affected during conflict?

A

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.

69
Q

What are high conception rates associated with?

A

deprivation and health inequalities

70
Q

What adverse outcomes can occur to babies born from unplanned, teenage pregnancies?

A

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

71
Q

What factors are related to high teen pregnancy rates?

A

Risky behaviors
Education related (low attainment, disengagement, leaving school)
Family/background (vulnerable groups, daughter of teenage mother, culture)

72
Q

How has medicine changed over its history? What are thr 3 stages it has gone through?

A

Bedside medicine
Hospital medicine
Laboratory medicine

73
Q

How has the concept of illness changed?

A

Total psuchomotor disterbance -> organic lesion -> biochemical process

74
Q

When was anaesthesia developed? Why did mortality rate increase after it for a while?

A

1840’s - liston used ether.
More complex operations were attempted
Time constraint removed from agony
Enabled penetrating below body surface - more infections and deaths.

75
Q

When were antiseptics introduced?

A

1865 - by Lister

76
Q

What is the null hypothesis?

A

H0 the statement being tested

77
Q

What is the alternative hypothesis?

A

H1 - What will be believed to be true if the null hypothesis is wrong

78
Q

What measure of association is used in Case control studies?

A

Odds Ratio = odds of cases being a smoker / odds of controls being a smoker

79
Q

What is the P value?

A

The probablity of getting the results you did given that the null hypothesis is true. if P value over 1 = significant

80
Q

What is the 95% confidence interval used for?

A

Calculated in stats software from odds ratio - if value range doesn;t include 1 = significant

81
Q

What is a case control study good at looking at?

A

Rare diseases

Typically retrospecitve

82
Q

What is the limitation of a case control study?

A

Prone to bias

Incidence cant be determined

83
Q

What is a cohort study good at looking at?

A

Rare exposures - multiple effects of one exposure
incidence can be exposed
typically prospective

84
Q

What is a type II error?

A

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

85
Q

What is a type I error?

A

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

86
Q

What are the 3 types of bias?

A

Selection bias
Exclusion bias
Reporting bias

87
Q

How do you control bias?

A

Randomization and blinding

88
Q

How do you control random error?

A

Sample size and significance level

89
Q

How do you control confounding error?

A

Study design

90
Q

What is the prevalence?

A

Proportion of the population with a disorder

91
Q

What 2 scoring methods are used for depression?

A

ICD-10 and DSM

92
Q

What 3 domains does the bio-psycho-social model suggest causes depression?

A

Predisposing factors
Precipitating factors
Maintaining factors

93
Q

what are the 3 models of stress?

A

Stimulus model
Response model
Transactional model

94
Q

Describe the stimulus model of stress

A

Focus on the environmental conditions that cause a stress response - Avoidance as a technique?

95
Q

Describe the response model of stress

A

Focus on the response produced by the environment. Stimulus less important. Minimise the impact of the response?

96
Q

Describe the transaction model of stress

A

Transactional model - A process between the organism and the environment. Techniques to help - coping mechanisms?

97
Q

What are the 3 stages of stress?

A

Alarm - resistance - exhaustion

98
Q

What 2 routes activate the sympathetic nervous system?

A

SAM - sympathoadrenaomedullary axis - adrenaline

HPA - Hypothalamic-pirtuitary-adrenal axis - corticosteroids`

99
Q

What is the incidence rate?

A

Thenumberofnewcasesofadiseaseoveraperiodoftime(usuallyayear)

100
Q

What is culmulative incidence?

A

Incidence measured over a period of time where the period of time is the same for each person under study

101
Q

what is Incidence density?

A

Incidence rate in a population where periods of observation are different for each person

102
Q

What is prevalence?

A

The number of people who have a disease in a population at a given time

103
Q

What is point prevalence?

A

The number of people with the disease at a specific point in time

104
Q

What is the absolute risk?

A

The risk that a person in the group will develop a disease
= incidence rate
In cohort studies

105
Q

What is the relative risk?

A

The ratio of incidence rate in an exposed group vs. an unexposed group

RR = AR exposed group / AR unexposed group

106
Q

What is standardisation?

A

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

107
Q

What is Selye’s theory of stress?

A

The stress response - general adaptation syndrome

The body’s resistance to stress can only last so long before exhaustion sets in.

108
Q

Where is stress detected in higher animals first?

A

Cerebral cortex - actives sympathetic NS - prepares for physical activity and exertion

109
Q

What 2 parts of the Pons are important in the sypathetic stress response?

A

Locus coeruleus - synthesises noradrenaline

Raphe nucleus - serotonin production

110
Q

What is Eustress?

A

Positive cognitive response to stress

111
Q

What is distress?

A

Negative stress - when your level of arousal is too high or too low and you body/mind responds negatively to stressors

112
Q

Describe Lazarus’s cognitive appraisal model

A

In order for a psycho-social situation to be stressful, it must be appraised as such - how you view a situation.

113
Q

What did Langer and Rodin discover about personal control and stress?

A

Those with more personal control had lower levels of stress - experiment with looking after a plant in a care home.

114
Q

When making decisions there are 3 main types of interpersonal conflict - what are they?

A

Approach-approach
Avoidance-avoidance
Approah-avoidance

Lucy Knox - Year 1 (36 decks)

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