Phase 4 Public Health Flashcards
Utilitarian
Maximise benefit and consider all beings equal
Deontology
Action is right or wrong
Consequentialist
Consequences are right are wrong e.g. white lies
Virtue
Character traits - mind, character, honesty
Libertarianism
Maximise freedom, autonomy and choice
Which allocation theory is the NHS founded on
egalitarian
3 allocation theories and their definitions
Egalitarian - equal access, equity
Maximising
Libertarian - autonomy and responsibility
rule of rescue
duty to save a life even if that money could prevent more deaths elsewhere
public health
the science and art of preventing disease, prolonging life and promoting health through the organised efforts of society
3 domains of public health and examples
health improvement - education, housing
health protection - ID, environmental hazards and emergency response
improving services - clinical governance, service planning
Lalonde determinants of health
E - environment (physical, social, economic)
F - lifestyle
G - genes
H - health care
6 measurements of equity
supply access utilisation outcomes health status allocation
dimensions of equity
spatial - geographic
social - age, gender, class, socioeconomic, ethinicity
levels of health interventions
individual
community
population
levels of health preventions
high risk - cut off the curve
population - shift the curve
prevention paradox
prevention measure bringing great benefit to the population offers little to each participating individual
2 major types of screening
population based e.g. smear
opportunistic e.g. chlamydia
10 Wilson and Jugner criteria
important problem history understood latent phase effective treatment policy on who to treat facilities acceptable test suitable test economic ongoing process
first in S/S
disease
first in NPV/PPV
test
impact of prevalence on S/S/NPV/PPV
no impact on S/S
impact on NPV/PPV
lead time bias
survival looks longer because it was noticed sooner
length time bias
aggressive disease is missed
3 descriptive studies
case reports
ecological studies
cross sectional
3 analytical studies
cohort
case control
cross sectional
retrospective study
case control - shows RF
why is prospective important
can show causation
study for rare exposures
cohort
study for rare diseases
case control
odds formula
with exposure/#without exposure
odds ratio formula
(#controls exposed/#controls unexposed)
when must an odds ratio be used
case control
when may an odds ratio be used
cross sectional
cohort
(where IV/DV is unclear)
how to state odds ratio
individuals with [DISEASE] are x5 more likely to be exposed to [EXPOSURE]
when is incidence rate useful
when Ps are followed up for varying lengths of time (denominator is person-time)
what does relative risk show
strength of association
reasons for association
BRACC bias chance confounders reverse causal
bias
systematic deviation form the true estimation of the association
3 types of bias
selection
information - observer, P, instrument
publication
Bradford Hill criteria for causal link
strenght of assocaition dose response consistency temporality reversibility biological plausibility coherence analogy specificity
health needs assessment
a systematic method for reviewing the health issues facing a population, leading to agreed priorities and resource allocation that will improve health and reduce inequalities
4 parts of health needs assessment
needs assessment
planning
implementation
evaluation
define need
ability to benefit
health need vs healthcare need
health - wider social and environmental determinants of health e.g. housing and education
healthcare - ability to benefit from healthcare e.g. health education, diagnosis, rehab
an intervention must be directed at
a population and a condition
3 health needs assessment approaches
epidemiological
comparative
corporate
advantages and disadvantages of epidemiological approach
+: uses existing data, provides data, evaulate over time
-: variable data quality, data collected may not be data required, ignores felt needs
describe epidemiological approach
SMEAR
S - size of problem - incidence, prevelance
M - models of care
E - evidence base
A - available services - unmet and overmet need
R - recommendations
advantages and disadvantages of comparative approach
+: quick and cheap. shows relative performance
-:incomparable population, low quality data, doesn’t show whats right
advantages and disadvantages of corporate approach
+: felt and expressed needs, range of views
-: difficult to distinguish need from demand, vested interests, politics, dominant voices
define evaluation
assessment of whether a service achieves its objectives with regard to relevance, effectiveness and impact
Framework for service evaluation
Structure
Process
Outcome
6 dimensions of quality
effective efficient equity acceptable accessible appropriate
3 qualitative approaches of health outcome measures
observation
interview
focus group
health, illness and sick role behaviours
health - prevent disease
illness - seek remedy
sick role - getting well
unrealistic optimism components
HIPPy
H - hasn’t happened yet
I - infrequent
P - preventable by personal action
P -personal experience lacking
health belief model components
4 beliefs - susceptible, serious consequences, taking action reduces risk, benefits outweigh costs
cues to action
perceived barrier (most important)
critique of health belief model
ignored impact of emotions on behaviour
doesn’t differentiate first and repeat behaviours
no temporal element
critique of theory of planned behaviour
ignores impact of emotions
no temporal element
bridging the gap
stages of change
precontemplation contemplation preparation action maintenance
Theory of planned behaviour. 50% of intenders fail to change behaviour. Give 5 bridging methods.
perceived control anticipated regret preparatory actions divided into chunks If-then plans (implementation intention) relevence to self
aim of motivational interveiwing
resolve ambivalence
4 types of undernutrition
stunting (height for age)
wasting (weight for height)
underweight (weight for age)
insufficiency
3 early influences on eating behaviour
maternal diet
breastfeeding
parenting practices
4 tips for parents on healthy eating
responsive feeding
provide variety
avoid pressure to eat
don’t usee food as a reward
3 main components of restraint theory
dieters rely on conscious control to regulate intake
dieters have greater hunger-satiety gap
what the hell effect if cognitive boundary is broken
3 eating behaviour models
Restraint theory
Externality
Goal conflict
6 services for newly presenting IVDU
BB virus screen Immunisations Smear and STI screen Drug service signposting General Health check Needle exchange
5 domains of social exlcusion
material civic activities basic services neighbourhood social relationships
what is an asylum seeker and what rules must they live by
application for refugee status in progress
Not allowed to work £35 a week, housing, 70% income support Full NHS access Full education and social care access if <18yo NASS support package
NHS care for rejected asylum seekers
primary care A&E communicable diseases and STI family planning treatment of trauma problems
rights of ILR
all UK citizen rights
family reunion
maslows hierarchy
so everyone loves stupid pyramids
self actualisation esteem love and belonging safety physiological
epigenetics
the expression of a gene is dependent on its environement
allostasis and allostatic loas
allostasis is stability through time and allostatic load is the physiolocial burden of acheiving this
how does major life change affect us
radical change of working model
percent of female injuries caused by domestic abuse
25%
domestic abuse tool and levels
DASH
standard - serious harm unlikely
medium - potential to cause serious harm is circumstances change
high - potential to cause serious harm imminently
2 referrals for high risk domestic abuse
MARAC - multi agency risk assessment conference
IDVA - independent domestic abuse advocate
Process after murder by domestic abuse
domestic homicide review
1,2,3 wound healing
1 = apposed edges e.g. sutures 2 = unopposed edges, allow granulation and epithelialisation 3 = open, close later
5 local factors influencing wound healing
site infection oedema vascular insufficiency previous RT
hydrogel
rehydrate dry wounds
alginate
highly exudative wounds
hydrocolloid
sloughy, moderately exudative wounds
non adherent
low exudate, delicate wounds
slips
attentional error causing observable action
e.g. pushing the patient buzzer instead of emergency alarm
lapse
internal event, memory, action based
e.g. forgetting to flush a cannula
mistake
action is carried out according to plan but the plan is wrong
two types of mistake and describe
rule based - wrong rule or bad rule, e.g. treating an MI as pneumonia
knowledge based - novel and cognitively effortful situation, e.g. suturing using random stitches because you don’t know how to do it
3 types of violations
routine - cutting corners
necessary - no other option
optimising - personal gain
individual factors of error
IM SAFE
Illness medication stress alcohol fatigue emotion
situation factors of error
SIT REP
S - situation misunderstood I - inadequate checking T - time pressures R - regular teams missing (unfamiliar) E - experience lacking P - poor procedures e.g. staffing and training
ways to learn from error
incident reporting - identify error traps and culture
root cause analysis
learning theories and describe
behaviourism - learning through reinforcement e.g. clinical skills, lectures
cognitivism - learning through processing e.g mindmaps, discussions, flipped lectures
constructivism - learning through safe experience e.g placement
features of effective small group session
clarify roles and purpose
active, specific and reflective
safe environment promotes discussion
safe questioning identify edge of knowledge
Problems: silent group, alpha student, tangents, lack of prep
leadership vs management
leader - influence and engage, create a vision and culture, work in the future
manager - specific technical skills and expertise, follow a vision and culture, work in the present
standard of proof for medical negligence
balance of probabilities (>50%), not beyond reasonable doubt
