PPD/public health Flashcards
what is epigenetic?
expression of genome depends on the environment
what is allostasis?
stability through change, our physiological systems have adapted to react rapidly to environmental stressors
what is allostatic load?
long term overtaxation of our physiological systems leads to impaired health (stress)
what is salutogenesis?
favourable physiological changes secondary to experiences which promote healing and health
what is emotion intelligence?
the ability to identify and manage one’s own emotions, as well as those of others
what is the purpose of primary care?
- managing illness and clinical relationships over time
- finding the best available clinical solutions to clinical problems
- preventing illness
- promoting health
- managing clinical uncertainty
- getting the best outcomes with available resources
- working in a primary health care team
- shared decision making with patients
what are the dangers of overprescribing antibiotics?
unnecessary side effects
medicalise self-limiting conditions
antibiotic resistance
what antibiotics would you prescribe otitis media?
amoxicillin
what antibiotic would you prescribe sinusitis?
amoxicillin
what antibiotic would you prescribe for tonsillitis?
penicillin
what antibiotics would you treat LTRI?
amoxicillin
what antibiotic would you use for UTI?
trimethoprim
or
nitrofurantoin
what is public health?
The science and art of preventing disease, prolonging life and promoting health through organised efforts of society
what are the 3 domains of public health?
health improvement
health protection
improving services
what are the key concerns of public health?
inequalities in health
wider determinants of health
prevention
what is health improvement in public health?
Concerned with societal interventions (not primarily delivered through health services) aimed at preventing disease, promoting health, and reducing inequalities
Inequalities, education, housing, employment, lifestyles, family/community, surveillance and monitoring specific diseases and risk factors
what is health protection in public health?
Concerned with measures to control infectious disease risks and environmental hazards
- infectious diseases , chemicals and poisons, radiation, emergency response, environmental health hazards
what is improving services in terms of public health?
concerned with the organisation and delivery of safe, high quality services for prevention, treatment and care
- clinical effectiveness, efficacy, service planning, audit and evaluation, clinical governance, equity
what are interventions following health needs assessments?
delivered at individual, community or population level.
may be health/non-health intervention which have an impact on public health
before intervening - health need have to be assessed?
what is a health needs assessment?
Health needs assessment is 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.
what is need, supply and demand in terms of health needs assessment?
Need – ability to benefit from an intervention
Demand – what people ask for
Supply – what is provided
what is a health need?
need for health e.g. measured using mortality, morbidity, socio-demographic measures
what is health care need?
Health care need – need for health care, ability to benefit from health care. Depends on the potential of prevention, treatment and care services to remedy health problems.
what are the different types of need from a sociological perspective?
- Felt need- individual perceptions of variation from normal health
- Expressed need- individual seeks help to overcome variation in normal health (demand)
- Normative need- professional defines intervention appropriate for the expressed need
- Comparative need- comparison between severity, range of interventions and cost
what are the different approaches for health needs assessment?
epidemiological
comparative
corporate
what is the epidemiological approach for health needs assessment?
Define problem
Size of problem - incidence / prevalence
Services available - prevention / treatment / care
Evidence base - effectiveness and cost-effectiveness
Models of care - including quality and outcome measures
Existing services- unmet need; services not needed
Recommendations
Sources of data: disease registry, hospital admissions, GP databases, mortality data, primary data collection (e.g. postal/patient survey)
what are the advantages and disadvantages of the epidemiological approach for health needs assessment?
advantages - uses existing data, provides data on diseases incidence/mortality/morbidity, can evaluate service trends over time
Disadvantages - quality of data variable, data collected may not be the data required, data does not consider the felt needs or opinions/experiences of the people affected
what is the comparative approach for health needs assessment?
compare the services received by a population (or subgroup) with others - spatial or social (age, gender, class, ethnicity)
may examine health status, service provision, service utilisation, health outcomes (mortality, morbidity, quality of life, patient satisfaction)
what might a health needs assessment be carried out for?
a population or sub group
a condition
an intervention
what are the advantages and disadvantages of the comparative approach to health needs assessment?
advantages - quick and cheap if data is available, indicated whether health or services provision is better/worse than comparable areas - gives a measure of relative performance
disadvantages - may be difficult to find a comparable population, data may not be availbale/high quality, may not yield what the most appropriate level (e.g. of provision or utilisation) should be
what is the corporative approach to the health needs assessment?
ask the local population what their health needs are
use focus groups, interviews, public meeting etc..
wide variety of stakeholders, e.g. teachers, healthcare professionals, social workers, charity workers, local businesses, council workers, politicians
what are the advantages and disadvantages of the corporate approach to health needs assessment?
advantages - based on the felt and expressed needs of the population in question, recognises the detailed knowledge and experience of those working within the population, takes into account wide range of views
disadvantages - difficult to distinguish need from demand, groups may have vested interests, may be influenced by political agendas
what is the need assessment and planning cycle?
needs assessment –> planning –> implementation –> evaluation –> assessment
what are the three types of prevention ?
- primary prevention - preventing disease before it has happened
- secondary prevention - catching the disease in the pre-clinical or early phase
- tertiary prevention - preventing complication of disease
what are the different approaches to prevention?
population approach (work with food industry to reduce salt in foods to reduce BP) high risk approach - identify individuals (screen for people with high BP and treat them)
what is prevention paradox?
A preventive measure which brings much benefit to the population often offers little to each participating individual
what is screening?
a process which sorts out apparently well people who probably have a disease or precursors or susceptibility to a disease from those who probably do not
NOT DIAGNOSTIC
what are the different types of screening?
Population-based screening programmes Opportunistic screening Screening for communicable diseases Pre-employment and occupational medicals Commercially provided screening
what are the disadvantages of screening?
exposure of well individuals to distressing or harmful diagnostic tests
detection and treatment of sub-clinical disease that would have never cause any problems
preventative interventions may cause harm to the individual or the population
before implementing a screening programme, what criteria should be considered?
most criteria based on the Wilson and Junger model
The condition - important health problem, latent/preclinical phase, natural history known.
The screening test - suitable (sensitive, specific, inexpensive), acceptable
the treatment - effective, agreed policy on whom to treat
The organisation and costs - facilities, costs of screening should be economically balanced in relation to healthcare spending as a whole, should be an ongoing process
what is sensitivity and specificity?
Sensitivity –the proportion of people with the disease who are correctly identified by the screening test
Specificity –the proportion of people without the disease who are correctly excluded by the screening test
what is positive predictive value and negative predictive value?
Positive predictive value –the proportion of people with a positive test result who actually have the disease
Negative predictive value –the proportion of people with a negative test result who do not have the disease
what is lead time bias?
Lead time bias: When screening identifies an outcome earlier than it would otherwise have been identified this results in an apparent increase in survival time, even if screening has no effect on outcome.
what is length term bias?
Length time bias: Type of bias resulting from differences in the length of time taken for a condition to progress to severe effects, that may affect the apparent efficacy of a screening method
what are the different types of observation studies?
descriptive (case reports or ecological studies) descriptive and analytical (cross sectional study/survey) analytical studies (case-control studies, cohort studies)
what are the different types of experimental/intervention studies?
RCT
non RCT
what is an ecological study?
• Ecological studies use routinely collected data to show trends in data and thus is useful for generating hypotheses. Shows prevalence and association, cannot show causation.
what is a cross sectional study/survey?
what are the advantages and disadvantages of it?
divides population into those without the disease and those with the disease and collect data on them at a defined time to find associations at the point in time
advantages: relatively quick and cheap, provide data on prevalence at a single point in time, large sample size, good for surveillance and public health planning
Disadvantages - risk of reverse causality (don’t know whether the outcome or exposure came first), cannot measure incidence, risk recall bias and non-response
what are case control studies and what are their advantages and disadvantages?
these are retrospective studies that take people with a disease and match them to people without the disease for age/sex/habitat/class etc and study previous exposure to the agent in question. It is quick and inexpensive but the retrospective nature shows only an association and data may not be reliable due to problems with patients memories
advantages: good for rare outcome (e.g. cancer), quicker than cohort or intervention studies (as the outcome has already happened), can investigate multiple exposures
Disadvantages: difficulties finding controls to match with cases, prone to selection and information bias
what is a cohort study and what are the advantages and disadvantages of cohort stidues?
These studies start with a population without the disease in question and study them over time to see if they are exposed to the agent in question and if they develop the disease in question or not. The advantage is that it is possible to distinguish preceding causes from concurrent associated factors. There is a lower chance of bias and absolute, relative and attributable risks can be determined. Requires controls to establish causation. It is prospective which can show causation where retrospective studies cannot.
advantages: can follow-up a group with a rare exposure, good for common and multiple outcomes, less risk of selection and recall bias
Disadvantages - takes a long time, loss to follow up, needs a large sample size
what are randomised control studies and what are the pros and cons?
• Randomised control trial: patients are randomised into groups, one group is given an intervention, the other is given a control and the outcome is measured. Randomisation allows confounding features to be equally distributed. Confounding and biases are minimalized. They tend to be large and expensive and show volunteer bias. Ethical issues – is it ethical to withhold a treatment that is strongly suspected to be effective? Show causation.
advantages: low risk of bias and confounding, can infer causality
disadvantages: time consuming, expensive, specific inclusion/exclusion criteria may mean the study population is different from typical patients.
what is odd ratio?
the odds ratio is the ratio of odds for exposed group to the odds for the not exposed group
exposed odds/ unexposed odds
OR can be interpreted as a relative risk when the event is rare
what is the odds of an event mean?
is the ratio of the probability of an occurrence against the probability of a non-occurrence.
odds = probability / (1-probability)
helping people to act on their interventions - the theory of planned behaviour
- bridging the gap interventions
Perceived control Anticipated regret Preparatory actions Implementation intentions Relevance to self
test for tubal potency (O+G) in female infertility
laproscopy and dye and hysteroscopy
TVUS and ultrasound opaque liquid
HSG
effects of steroids on kids from mark scheme on 2016 paper
- weight gain
- increased infections
- osteoporosis
- bruising
- thinning of the skin
- puffy face
- increased risk of stomach ulcers
who to report a never event to
national reporting and learning system
strategic executive information systems
what influences health inequalities?
PROGRESS Place of Residence (rural, urban, etc.) Race or ethnicity Occupation Gender Religion Education Socioeconomic status Social capital or resources
