PH Flashcards
What are the 3 domains of public health?
1) Health improvement (societal interventions aimed at preventing disease, promoting health and reducing inequalities)
2) Health protection (Measures to control infectious diseases and environmental hazards)
3) Improving health services in health care (the organisation & delivery of safe and high quality services)
What is epigenetics?
Epigenetics = genetic predisposition but the fact that the environment contributes to the expression of the genome
Allostasis
allostasis = the process of achieving stability
Homeostasis
Allostatic load
Allostatic load = ‘wear and tear’ on the body which grows over time due to chronic stress on the body
Physiological consequences of chronic exposure to heightened neurological activity
Explain the difference between primary and secondary prevention
Primary prevention = no disease - preventions to stop the getting the disease (vaccinations)
Secondary prevention = pre-clinical Screening to catch the disease early & preventing the disease progressing (statins to stop CVD)
What are population and high risk approaches to prevention?
Population = preventative measures delivered on a population wide approach and it seeks to shift the risk factor distribution curve of disease to the left (e.g. reducing salt through registration to reduce BP)
High risk = identifies those at high risk and treats them - high BP give antihypertensives
What is the prevention paradox?
A preventative measures that has little benefit to the individual but overall reduces prevalence in the population - benefits the population more
What is screening?
A process that identifies people with a disease or who may have a susceptibility to a disease competed to those who don’t
Give examples of screening
Population based screening
Opportunistic screening
Screening for communicable disease
Define sensitivity
Sensitivity = proportion of the people who HAVE THE DISEASE who are correctly identifies as having the disease
Define specificity
Specificity = proportion of people WITHOUT the disease who are correctly identified
What is lead time bias?
Length of time between the detection of the disease and its usual clinical presentation and diagnosis
Time between early diagnosis due to screening and the time it would have been made without screening.
Length time bias?
A form of selection bias that occurs when screening over represents a slow progressive disease and appears to falsely improve survival
Detects less aggressive tumours due to longer asymptomatic periods - and improves to improve survival compared to more aggressive tumours when actually they are less dangerous in the first place.
Define Health Needs Assessment
A systematic method of identifying unmet health and healthcare needs of a population and making changes to meet those unmet needs. Provides information to improve health, for service planning, for priority setting and for policy dependant
What are the 3 parts of the framework for health service evaluation
Structure
Process
Outcome
Give the classification of health outcomes
Mortality
Morbidity
QOL/PROMS
Patient satisfaction
What is evaluation of health services?
Evaluation is the assessment of weather a service achieves its objectives
What are the 4 models of behaviour change?
1) Health belief model
2) Theory of planned behaviour
3) Transtheoretical model/stages of change model
4) S ocial norms
Give reasons why associations between and exposure and an outcome occur.
Bias Chance Confounding Reverse causality A true causal association
What is included in the bradford hill criteria for causation?
Temporal Dose-reponse Strength Reversibility Consistency Plausable Coherence Analogy Specific
What are the GMC duties of a dr?
- Care of the patient is the 1st priority
- Protect and promote the health of patients and the public
- Provide a good standard of care
- Treat patients as individuals and respect their confidentiality
- Work in partnerships with patients
- Be honest, open and act with integrity
Health economics:
What is the opportunity cost?
The opportunity cost of an activity is the sacrifice in terms of benefits forgone from not allocating the resources to the next best activity
How is economic efficiency achieved?
When resources are allocated between activities in such a way to maximise benefit
What is an economic evaluation?
It is a comparative study of the costs and benefits of health care interventions.
Costs and effects are analysed in terms of ‘increments’
How do we measure health benefit?
1) Quality adjusted life year QALY (combines length of life with quality of life)
2) Natural units (BP/pain score)
3) Monetary value
What is the Incremental cost effectiveness ratio (ICER)
Incremental cost effectiveness ratio (ICER):
A statistic used to summaries the cost effectiveness of a health care intervention
= Difference in cost / difference in benefit
Life time cost: Old £5,000 New £27,000 Utility: Old 0.8 New 0.9 Life expectancy: Old 9 New 10 What is the incremental cost of new treatment over the old treatment?
Incremental cost = difference in cost
27,000 - 5,000
= £22,000
Life time cost: Old £5,000 New £27,000 Utility: Old 0.8 New 0.9 Life expectancy: Old 9 New 10 Work out the QALYs for the new and old treatments
QALY = utility x length of life New = 0.9 x 10 = 9 Old = 0.8 x 9 = 7.2
Life time cost: Old £5,000 New £27,000 Utility: Old 0.8 New 0.9 Life expectancy: Old 9 New 10 Work out the incremental QALYs of new over old
Incremental QALYs = difference in QALYs
9 - 7.2 = 1.8
Life time cost: Old £5,000 New £27,000 Utility: Old 0.8 New 0.9 Life expectancy: Old 9 New 10 Work out the incremental cost-effectiveness rations ICERs
ICER = difference in cost/ difference in benefit
22,000/1.8 = £12,222
Give the 10 WHO screening Crieria
The disease: 1) Important 2) Recognisable early stage 3) Known NH of disease Test: 4) Suitable test 5) Acceptable test Rx: 6) Accepted treatment 7) Agreed policy of who to treat Facilities: 8) Facilities for dx and rx should be available 9) Cost benefits of screening and rx 10) Screening should be a continuous process
What are the Fraser Guidelines?
1) The girl understands the advice
2) They cannot be persuaded to tell their parents
3) They are likely to continue having intercourse if contraceptives are not given
4) Harm may come if they are not given (mental or physical)
5) It is in their best interests
What is Gillick Competence?
Weather a child under 16 can give consent for medical treatment without the need for parental permission or knowledge.
Can they: understand, retain, weigh up and communicate their decision?
Describe a Cohort study
Cohort
Is usually a longitudinal prospective study that takes a population and records exposures + the conditions they develop over time
It measures incidence
Give 3 advantages and disadvantages of cohort studies
Advantages:
Rare exposures, allows for identification of RF, and data on confounders Disadvantages:
Not good for rare diseases, expensive and large sample sizes are needed
Describe Case-Control
Case-control compares groups with and without disease and looks back for exposures/causes
Give some advantages and disadvantages of case control
Advantages = Quicker and good for rare outcomes Disadvantages = Can only show association, not causation. Unreliable due to recall bias. Difficulty finding controls
Describe a cross-sectional study
Takes a snapshot of the data of those with and without the disease at one point in time. It looks at prevalence of the disease.
Give some advantages and disadvantages of cross-sectional study
Advantages: Quick and cheap, few ethical considerations
Disadvantages: Prone to bias, no time reference, risk of reverse causality
What is bias?
Bias = systematic error that results in a deviation for the true effect
Give some of the Bradford hill criteria for causation (9 Principles that can be used to establish a causal relationship)
1) Temporal (exposure before outcome)
2) Strength (very high relative risk)
3) Reversibility (reducing exposure reduces outcome)
4) Dose response (increasing exposure increases outcome)
5) Specific
6) Consistent
7) Plausible
8) Analogy
9) Coherence
A study finds an association between an exposure and an outcome - what could this be due to?
Bias Chance, Confounding, Reverse causality A true causal association
Define the P value
The probability of an event occurring, given that the null hypothesis is true
Null hypothesis means there is no difference
What does a P value of <0.05 mean?
That it is statistically significant
- There is sufficient evidence to reject the null hypothesis and accept the alternative hypothesis
What is a utilitarian approach to resource allocation?
Greatest benefit to the greatest number of people
What is health behaviour?
Activity that is undertaken to prevent disease
E.g: exercising/healthy eating
What is Illness behaviour?
Activity taken by someone who feels ill in order to find a remedy
E.g: going to GP/pharmacist
What is sick role behaviour?
Activity taken by someone to make them selves feel better - aimed at no longer being sick (usually involves neglecting some usual duties)
E.g: taking abx from GP and taking time off work
Negligence has occurred if…
1) There was a duty of care
2) that duty of care was breeched
3) the patient came to harm
4) the harm was caused by the breech in the duty of care
What is the deprivation of liberty safeguards DOLS
DOLS = A procedure in law when it Is necessary to deprive a resident/patient of their liberty when they lack capacity to consent to their care/treatment - in order to keep them safe and from harm
What is the acid test in relation to DOLS?
It was made to clarify the definition or a deprivation of liberty
1) Do they lack capacity?
2) Is the person subject to continuous supervision and control?
3) is the person free to leave?
What are the 5 statutory principles of the mental capacity act?
1) Presumption of capacity
2) Every action taken to help them make a decision
3) They have the right to make an unwise decision
4) best interests
5) least restrictive intervention
What are some of the cons of a public health system?
- Often argued that it is underfunded through rationing
- Less incentives to improve efficiency/quality for staff and institutions (wont get paid more)
- Perverse insentives (Efficient hospitals get budget cuts)
What are some of the disadvantages of private health systems?
- Inequitable system (linked to ability to pay for service, not need)
- Adverse selection (individuals excluded on basis of ill health)
- No gatekeeping –> inappropriate use of specialists for general advice
- Inflation of health care expenditure (USA)
- Lack of restricitons on the demand side (pts may demand and over use services even when not needed)
