Phase 1 Public Health Flashcards
Inverse Care Law
those most in need of health care are least able to access it // those who need health care the least are most able to access it
- what barriers can you think of?
Incidence
Number of new cases in a certain unit of time
Prevalence
Number of existing cases at a certain point in time
The sick role
being ill exempts you from social obligation
- not responsible for their condition
- should try and get well
- should seek help from medical professionals
Changing Health Behaviours
perceived susceptibility, perceived barriers, benefits and self efficacy are all
influences on changing behaviours
Stages of behaviour change
not thinking (pre contemplation) → thinking about changing (contemplation) → preparing to change → action → maintenance → stable changed lifestyle/relapse
Sensitivity
The probability that a person with the disease tests positive (true positives/ total positives)
Specificity
the probability that a person without the disease tests negative (True negative/ total negatives)
Positive Predictive Value
the proportion of people with a positive test result who actually have the disease
Negative Predictive Value
proportion of people without the disease who are correctly excluded by the screening test
Effect of prevalence on PPV
Increase in prevalence = increase in PPV, incidence of false positives falls
Principles of Screening
- The condition should be an important problem
- There should be an acceptable treatment
- Facilities for diagnosis and treatment should be available
- There should be a recognised latent or early stage
- The natural history of the disease should be known
- There should be a suitable test
- The test should be acceptable to the population
- There should be an agreed policy on whom to treat as patients
- The cost of case finding should be economically balanced in relation to the possible expenditure
as a whole - Case findings should be a continuous process- not once and for all
Types of prevention
Primary, Secondary, Tertiary
What is primary Prevention
Stops an illness from happening in the first place
e.g. Change4life, vaccination progammes
What is Secondary Prevention
detecting a disease early in its progress to reduce its impact- makes treatment more effective, limits impact of disease.
e.g. Breast cancer/ Bowel cancer screening
Also stops a disease getting worse
e.g. blood pressure monitoring/ blood thinners after MI to prevent another event.
What is tertiary prevention
disease is established, symptomatic, reduces complications/ severity of disease.
e.g. physio/rehab after a stroke
Prevention paradox
Large group of people with a small risk will result in more cases of disease than a small group at higher risk
Unmodifiable risk factors
Age, Gender, Ethnicity, Family History, early life circumstances
Modifiable risk factors
Diet, exercise, HNT, T2DM, Smoking status, alcohol
Alcohol unit limits
14 units/ week
what is a unit of alcohol?
(% alcohol by volume x amount of liquid in millimeters)/ 1000
1 unit = 10ml/g of ethanol
Features of Foetal Alcohol Syndrome
Growth Retardation, CNS abnormalities, cranio-facial abnormalities, , congenital defects, increased risk of birth marks/ hernias.
Features of Alcohol Withdrawal
Tremors, Activation Syndrome (high BP, tachycardia, agitation, shakes)
CAGE questions
Cutting Down?
Annoyed by people telling you to cut down?
Guilty about how much you drink?
Eye-opener - have you ever had a drink first thing in the morning?
what is compliance?
professionally focused- how well is a patient doing what you’ve told them to do?
what is adherence
takes into account a patient’s beliefs. Dr is an expert giving their advice, but it accepts that patients make their own decisions.
What is concordance?
Partnership between Dr and patient. Make decisions about health care together.
Ethical Theories
Autonomy
Beneficence
Non-maleficence
Justice
Autonomy
Patients are allowed to make their own decisions
Beneficence
doing the right thing, benefits others
Non-maleficence
preventing/reducing harm ‘Do no harm’
Justice
being fair
Utilitarianism
act is measured in its consequences. Kill one to save many.
Deonotology
The act itself- what you do and how you do it is important
Virtue Ethics
what you meant to do- i.e. trying to do the right thing is what is important.
5 focal virtues
Compassion Discernment Trustworthiness Integrity Conciensciousness
Validity
How close to the truth - e.g. skewed by bias makes something less valid.
Reliable
How consistent something is. E.g. A broken BP machine might give everyone the same reading - its reliable but not valid.
