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POPLHLTH 111 > Module 2 (Lectures 12-18) > Flashcards

Module 2 (Lectures 12-18) Flashcards

1
Q

Step of Public Health Framework

A

Define Problem, Identify Risk / Protective Factors, Develop / Test Prevention Strategies, Assure Widespread Adoption

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2
Q

Determinants in Individuals

A

an events that causes a change in health in an individual

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3
Q

Determinants in Populations

A

includes characteristics of the popl itself

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4
Q

Downstream Interventions

A

at micro level, treatment systems and disease management

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5
Q

Upstream Interventions

A

at macro level, govn policies and international trade agreements

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6
Q

Proximal Determinants

A

‘near’, closely / directly associated with change in health status (eg lifestyle and behavioral factors related to exposure

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7
Q

Distal Determinants

A

distant in time / place from the change in health status (eg national, political, legal, cultural factors that indirectly influence health by acting on proximal factors)

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8
Q

Dahlgren and Whitehead Level 1 (includes 4 factors)

A

The Individual, age sex, constitutional factors, individual lifestyle factors

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9
Q

Dahlgren and Whitehead Level 2

A

Community, social / community networks and living / working conditions

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10
Q

Dahlgren and Whitehead Level 3

A

Environment, general socioeconomic, cultural and environmental conditions

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11
Q

Structure

A

social and physical environmental conditions and patterns (social determinants) that influence choices and opportunities

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12
Q

Agency

A

capacity of individual to act independently and make free choices

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13
Q

Aim of Epidemiology

A

find cause of disease, by looking at relationship between exposure and outcome (then judge against framework to see if causal)

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14
Q

Bradford Hill Framework Step 1

A

Temporality

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15
Q

Temporality

A

first cause then disease

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16
Q

Bradford Hill Framework Step 2

A

Strength of Association

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17
Q

Strength of Association

A

stronger association = more likely to be causal in absence of known biases

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18
Q

Bradford Hill Framework Step 3

A

Consistency of Association

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19
Q

Consistency of Association

A

replication of findings by different investigators, times, places, methods

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20
Q

Bradford Hill Framework Step 4

A

Biological Gradient

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21
Q

Biological Gradient

A

incremental change in disease rates in conjunction with corresponding changes in exposure

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22
Q

Bradford Hill Framework Step 5

A

Biological Plausibility of Association

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23
Q

Biological Plausibility of Association

A

does association make sense biologically?

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24
Q

Bradford Hill Framework Step 6

A

Specificity of Association

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25
Q

Specificity of Association

A

a cause leads to a single effect or an effect has a single cause. However health issues have multiple interacting causes and many outcomes share causes

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26
Q

Bradford Hill Framework Step 7

A

Reversibility

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27
Q

Reversibility

A

demonstration that under controlled conditions, changing exposure causes change in outcome

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28
Q

Bradford Hill Framework Step 8

A

Judgement

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29
Q

Cause of a Disease

A

an event, condition, characteristic (or combination) which plays an essential role in producing the disease

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30
Q

Sufficient Cause

A

‘the whole pie’, sum of all conditions needed for disease to occur

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31
Q

Component Cause

A

‘each slice’, an individual factor that contributes to a disease, but cannot cause it on its own

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32
Q

Necessary Cause

A

factor that must be present for disease to occur

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33
Q

Te Pae Mahutonga - 4 key tasks

A

Mauriora, Waiora, Toiora, Te Oranga

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34
Q

Te Pae Mahutonga - 2 prerequisites

A

Ngā Manukura, Te Mana Whakahaere

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35
Q

Mauriora

A

access to Te Ao Māori (the Māori world)

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36
Q

Waiora

A

environmental protection

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37
Q

Toiora

A

healthy lifestyles

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38
Q

Te Oranga

A

participation in society

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39
Q

Ngā Manukura

A

leadership (health and community)

40
Q

Te Mana Whakahaere

A

autonomy (capacity for self governance and community control / enabling political environment)

41
Q

Importance of preventing disease

A

limitations of curing disease, increasing cost

42
Q

Population Health Actions

A

Health Promotion, Disease Prevention, Health Protection

43
Q

Population Health Actions - 2 strategies

A

Population (mass) or high risk (individual)

44
Q

Population Based (mass) Strategy - focus, aims, useful for, example

A

whole popl, reduce health risk / improve outcome for all indiv. in popl, common disease / widespread cause, immunisation programs

45
Q

High Risk (individual) Strategy - focus, advantage, example

A

individuals perceived as high risk, well tailored to individuals, targeting obese adults

46
Q

Population Based (mass) Strategy - 3 advantages

A

addresses underlying causes, large potential benefit, behaviourally appropriate

47
Q

Population Based (mass) Strategy - 3 disadvantages

A

small benefit to individuals, little motivation for individuals, whole popl exposed to downsides (less favourable benefit to risk ratio)

48
Q

High Risk (individual) Strategy - 4 advantages

A

benefit to individuals, motivation for individuals, cost effective use of resources, good benefit to risk ratio

49
Q

High Risk (individual) Strategy - 4 disadvantages

A

cost of screening (need to identify individuals), temporary effect, limited potential, behaviourally inappropriate

50
Q

Health Promotion

A

acts on determinants of wellbeing

51
Q

Alma Act 1978

A

advocated a health promotion approach to primary care

52
Q

Ottawa Charter - 3 Basic Strategies

A

enable, advocate, mediate

53
Q

Ottawa Charter - 5 Action Areas

A

Strengthen community action, develop personal skills, create supportive environments, reorient health services, building healthy public policy

54
Q

Enable

A

(individual level strategy) provide opportunity for individuals to make healthy choices

55
Q

Advocate

A

(systems level strategy) favourable political, economic, social, cultural, physical enviro by promoting health, focusing on achieving equity

56
Q

Mediate

A

(joins indiv / groups / systems) opposing interests to compromise for promotion of health

57
Q

Strengthen community action

A

getting community to work together to promote health eg soup kitchens

58
Q

Develop Personal Skills

A

education (what is healthy) and cooking skills etc

59
Q

Create Supportive Enviro

A

physical social enviro, help indiv make healthy choices

60
Q

Reorient Health Services

A

focus on supporting needs for healthy lives, help reduce risk factor and enhance protective factors

61
Q

Building Healthy Public Policy

A

providing the opportunity for indiv to make healthy choices often through regulations

62
Q

Disease Prevention

A

look at particular disease and ways of preventing it eg incidence, prevalence, risk factors, impacts

63
Q

Primary Disease Prevention

A

limit occurrence of disease by controlling risk factors

64
Q

Secondary Disease Prevention

A

reduce the more serious consequences of a disease, slow the progression

65
Q

Tertiary Disease Prevention

A

reduce progress of complications of established disease

66
Q

Health Protection focus

A

on environmental hazards (risk assessment, occupational health, risk communication)

67
Q

Primary Screening

A

for a risk factor

68
Q

Secondary Screening

A

for more serious complications

69
Q

Tertiary Screening

A

for complications after clinical diagnosis

70
Q

Screening Criteria

A

Suitable disease, test, treatment, screening program

71
Q

Suitable Disease

A

common or uncommon but early detection leads to better outcome; knowledge of natural history of disease

72
Q

Suitable Test

A

reliable, safe, simple, affordable, acceptable, accurate

73
Q

Sensitivity

A

ability to correctly identify those who do have the disease from all indiv with the disease (true positives ÷ all with disease x 100)

74
Q

Specificity

A

ability to identify correctly those who do not have the disease from all indiv without the disease (true negatives ÷ all without disease x 100)

75
Q

Positive Predictive Value (PPV)

A

probability of having the disease if test positive (true positives ÷ all who test positive x 100)

76
Q

Negative Predictive Value (NPV)

A

probability of not having the disease if test negative (true negatives ÷ all who test negative x 100)

77
Q

Sensitivity and specificity fixed?

A

yes, fixed characteristic of the test

78
Q

PPV and NPV fixed?

A

no, reflect both the test accuracy and prevalence of the disease

79
Q

if prevalence is moderate / low ____

A

higher false positive test results

80
Q

if prevalence is high ____

A

higher false negative test results

81
Q

Suitable Treatment

A

effective, acceptable and accessible

82
Q

Suitable Screening Program

A

benefits must outweigh harm, result in reduced mortality or increased survival time

83
Q

Lead Time Bias

A

if screening program evaluated in terms of survival time -> false impression. Does it increase survival after point when they would have had clinical diagnosis

84
Q

Length Time Bias

A

screening more likely to catch slow progressing disease than fast progressing disease, so will look like survival time is longer than it actually is

85
Q

Why do we need to prioritize?

A

not enough money to fund everything

86
Q

Establishing Population Health Priorities

A

Evidence based measures (descriptive, explanatory, evaluative), community expectations and values, human rights and social justice

87
Q

Descriptive Evidence

A

who is most / least affected? where are we now, come from, going?

88
Q

Explanatory

A

what are the determinants / risks?

89
Q

YLL

A

years of potential life lost to death

90
Q

YLD

A

years lived with a disability

91
Q

PAR

A

population attributable risk

92
Q

Attributable Risk =

A

Risk Difference (EGO - CGO), amount of ‘extra’ disease attributable to a particular risk factor in EG

93
Q

Population Attributable Risk (definition)

A

amount of ‘extra’ disease attributable to a particular risk factor in a particular population

94
Q

Population Attributable Risk (formula)

A

occurrence in total popl (PGO) - occurrence in unexposed popl (CGO)
(all positive outcomes ÷ total popl) - (positive outcome for CG ÷ CG)

95
Q

Evaluative Evidence

A

is the intervention improving health outcomes? how well can problem be solved? economic feasibility

96
Q

Community Expectations / Values and Human rights / Social Justice

A

will it be accepted? what do communities want?

POPLHLTH 111 (2 decks)

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