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Pop Health 111 > Module 3 > Flashcards

Module 3 Flashcards

1
Q

Temporality

Bradford Hill Criteria 1995

A
  • First the cause then the disease

- Establish a causal relationship

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2
Q

Strength of Association

Bradford Hill Criteria 1995

A
  • Statistically significant
  • Stronger the association, more likely to be causal in absence of known biases (selection, information, and confounding)
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3
Q

Consistency of Association

Bradford Hill Criteria 1995

A
  • Replication of findings by different investigations, at different places, at different times, with different methods
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4
Q

Biological Gradients

Bradford Hill Criteria 1995

A
  • Dose-response
  • Incremental change in disease rates in conjunction with corresponding changes in exposure
  • As exposure increases, death rates also increase
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5
Q

Biological Plausibility of Association

Bradford Hill Criteria 1995

A
  • Does the association make sense biologically?
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6
Q

Specificity of Association

Bradford Hill Criteria 1995

A
  • A cause leads to a single effect, however a single cause often leads to multiple effects
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7
Q

Reversibility

Bradford Hill Criteria 1995

A
  • Under controlled conditions changing the exposure causes a change in the outcome
  • Multiple causes for a disease outcome - 1:1 relationship between causes and outcomes
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8
Q

Sufficient cause

A

A factor that will inevitable produce the specific disease

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9
Q

Necessary cause

A

A factor that must be present if a specific disease is to occur

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10
Q

Component cause

A

A factor that contributes towards disease causation but is not sufficient to cause the disease on its own

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11
Q

Population based Health Action

A

Focuses on the whole population but reducing the health risk or improve the outcome of all individuals

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12
Q

Advantages of a Population bases Health Action

A
  • Addresses underlying causes - Radical
  • Large potential benefit of the whole population
  • Shifts social norms
  • Behaviourally appropriate
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13
Q

Disadvantages of a Population bases Health Action

A
  • Small benefit to individuals - Prevention Paradox
  • Poor motivation of individuals who’s population is exposed to the downside of the strategy (benefit to risk less favourable)
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14
Q

High Risk Health Action

A
  • Focuses on individuals perceived to be of high risk and has targeted interventions for them to move them to the norm of the population
  • a large number of people at a small risk may give rise to more cases of disease than the small number who are at a high risk
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15
Q

Advantages of a High Risk Health Action

A
  • Individual motivation
  • Cost effective use of resources
  • Favourable benefit to risk ratio
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16
Q

Disadvantages of a High Risk Health Action

A
  • Cost of screening
  • Need to identify at risk individuals
  • Temporary effect/ongoing process
  • Behaviourally inappropriate - not changing social norms
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17
Q

Prerequisites for health

A
  • Peace and safety from violence
  • Shelter
  • Education
  • Food
  • Income and economic support
  • Stable ecosystem and sustainable resources
  • Social justice
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18
Q

3 Basic Strategies

Ottawa Charter

A
  1. Enable
  2. Advocate
  3. Mediate
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19
Q

Enable

Ottawa Charter

A

Provide opportunities for all individuals to make healthy choices through access to information, life skills, and supportive environments
Individual level

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20
Q

Advocate

Ottawa Charter

A

Create favourable political, economic, social, cultural and physical environments buy promoting/advocating for health
Systems level

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21
Q

Mediate

Ottawa Charter

A

Facilitate/bring together individuals, groups, and parties with opposing interest to work together/come to a compromise for the promotion of health
Systems and individual levels

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22
Q

5 Priority Action Areas

Ottawa Charter

A
  1. Develop personal skills
  2. Strengthen community action
  3. Create supportive environments
  4. reorient health services toward primary health care
  5. Build healthy public policy
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23
Q

Primary Disease Prevention

A

Limiting incidence of disease by controlling specific causes and risk factors
e.g. immunisation

24
Q

Secondary Disease Prevention

A

Reduce the more serious consequences of the disease

e.g. screening for cancers

25
Q

Tertiary Disease Prevention

A

Reduces the progress of complications of established diseases
e.g. rehabilitation

26
Q

Health Promotion

A
  • Determinants of health
  • Empowers people to increase control over and improve their health
  • Involves whole populations in everyday contexts
27
Q

Primary Care

A

Patients regular source of health care

28
Q

Secondary Care

A

Specialist care

29
Q

Tertiary Care

A

Hospital based, rehabilitation

30
Q

Health Protection

A
  • Monitoring
  • Risk communication
  • Occupational Health
31
Q

Determinants of Inequities in Health

A
  1. Differential access to heath determinants or exposures leading to differences in disease incidence
  2. Differential access to healthcare
  3. Differences in quality of care received
32
Q

Te Pae Mahutonga

A

Bases o the southern cross and is a fundamental component of health promotion from a Maori point of view
- Also applies to other New Zealanders

33
Q

4 Key Tasks of Te Pae Mahutonga

A
  1. Mauriora
  2. Waiora
  3. Toiora
  4. Te Oranga
34
Q

Cultural Identity

Key Task of Te Pae Mahutonga

A

Mauriora

  • Te Ao Maori - The Maori World
  • Make sure strategies align with Maori culture and values
  • Regain language and culture through health promotion
  • No need to fit to western standards
35
Q

Environmental Protection

Key Task of Te Pae Mahutonga

A

Waiora

- healthy physical, social, cultural, political environment

36
Q

Healthy Lifestyle

Key Task of Te Pae Mahutonga

A

Toiora

- Ensuring accessing a healthy lifestyle is possible

37
Q

Participation in Society

Key Task of Te Pae Mahutonga

A

Te Oranga

  • Education, employment, income
  • Being an active member in society
  • Socioeconomic determinants of health
38
Q

2 Prerequisites of Te Pae Mahutonga

A
  1. Nga Manukura

2. Te Mana Whakahaere

39
Q

Leadership

Prerequisite of Te Pae Mahutonga

A

Nga Manukura

  • Health professional and community leadership
  • Respect that communities have their own solutions to health problems
40
Q

Autonomy

Prerequisite of Te Pae Mahutonga

A

Te Mana Whakahaere

  • Capacity for self governance
  • Community control and enabling political environment
41
Q

Screening in health

A
  • Involves identifying risk factors for disease or unrecognised disease by applying test on a large scale to a population
42
Q

Criteria for Screening

A
  1. Suitable disease
  2. Suitable test
  3. Suitable treatment
  4. Suitable screening programme
  5. Improve health outcomes
43
Q

Suitable disease

A
  • Important health problem
  • Knowledge of relationship of risk factors to condition
  • Increased duration of pre clinical phase (b/w symptoms and diagnosis)
44
Q

Suitable test

A
  • Reliable
  • Safe, simple, cheap
  • Accurate (Sensitivity/Specificity)
45
Q

Suitable treatment

A
  • Evidence of early treatment leading to better outcomes
  • Effective, acceptable, accessable
  • Evidence based on who should be offered treatment
46
Q

Suitable screening programme

A
  • Benefits must outweigh the harm
  • RCT evidence that screening results in reduced mortality/increased survival time
  • Cost effective
  • Health system can support all elements
  • Reach groups most likely to be effected by disease
47
Q

Sensitivity

A

The likelihood of a positive test in those with the disease
= (TRUE POSITIVES/ALL WITH THE DISEASE) x 100
= a/(a+c)
- The sensitivity of a screening test is high if the proportion of true positives is high
- Fixed characteristic of the test

48
Q

Specificity

A

The likelihood of a negative test in those without the disease
(TRUE NEGATIVES/ALL WITHOUT THE DISEASE) x 100
= d/(b+d)
- The specificity is high if the proportions of true negatives is high
- Fixed characteristic of the test

49
Q

Positive Predictive Value (PPV)

A
  • The probability of having the disease if the test is positive
    = (TRUE POSITIVES/ALL WHO TEST POSITIVE) x 100
    = a/(a+b)
50
Q

Negative Predictive Value (NPV)

A
  • The probability of not having the disease if the test in negative
    = (TRUE NEGATIVES/ALL WHO TEST NEGATIVE) x 100
    = d/(c+d)
51
Q

Lead Time Bias

A

Apparent increase in survival time when you measure survival after diagnosis compared to survival after screening

52
Q

Length Time Bias

A

Calculating mean survival from screened patients can give wrong impression of longer than average survival time if there are different progressions of the disease (e.g. slow and fast)

53
Q

TB Control

A
  1. Anti TB educational campaigns
  2. TB prevention coordinated with community partners
  3. Improving living conditions
  4. Creating an environment supporting TB testing
  5. Pre-migration TB screening and notification of proven/suspected TB cases
54
Q

Decision Criteria

Dimension 3 Haddon Matrix

A
  1. Effectiveness
  2. Cost
  3. Freedom
  4. Equity
  5. Stigmatisation
  6. Preferences
  7. Feasibility
55
Q

Factors

Dimension 1 Haddon Matrix

A
  1. Host
  2. Agent
  3. Physical environment
  4. Social environment
56
Q

Population Attributable Risk (PAR)

A

Amount of extra disease attributable to a particular risk factor in a particular population
= PGO-CGO
(PGO = (a+b)/Population)

57
Q

Attributable Risk (AR)

A

Risk Difference (RD)
- Amount of extra disease attributable to a particular risk factor in the exposure group
= EGO - CGO

Pop Health 111 (4 decks)

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