PPGH Flashcards
what is the definition of public health?
the science and art of promoting and protecting health and wellbeing, preventing ill health and prolonging life through the organised efforts of
society
what is epidemiology?
the study of distribution and the determinants of disease in a population
what is qualitative data?
observed not measured
what is quantitative data?
observed and measured
what is point prevalence?
the number of new and old cases at one point of time in a population
what is an endemic?
this is a permanent disease in a region or population
what is an epidemic?
this is an outbreak of disease that affects a higher number of individuals and
spreads more than it should for a given time and place
what is a pandemic?
disease that spreads worldwide
what does DALYs stand for?
disability adjusted life years:
what does DALYs measure?
measures disease burden and is often used in measuring chronic diseases
what is the equation for DALYs?
years of potential life lost due to premature mortality + years lived in disability or disease (YLL + YLD)
what does QALYs stand for?
quality adjusted life years
what does QALYs measure?
measure of the state of health of a person/ group in which the benefits or burdens are adjusted to reflect the quality of life
what is incidence rate?
the number of new cases in a population
what is the prevalence rate?
the number of new and old cases in a population at a given time
what is the equation to work out prevalence?
number of cases at a given time/ number in population at that time
what is classed as an outbreak?
2 or more cases where the onset of illness is closely linked in time (weeks rather than months) and in space, where there is suspicion of, or evidence of, a
common source of infection, with or without microbiological support
what is a cluster?
2 or more cases that initially appear to be linked by space (eg residence/ work) and which have sufficient proximity in dates of onset of illness-eg 6 months to warrant further investigation
what is an impairment?
this is any abnormality of psychological, physiological or anatomical structure or loss in function
what is an example of an impairment?
-losing a leg in an accident
what is a disability?
a restriction or lack of ability to perform an activity in ways that are considered normal for a human being
what is an example of a disability?
being unable to walk
what is a handicap?
these are limitations or preventions that put one at a disadvantage from performing their normal roles
what is an example of a handicap?
losing your jobs as a driving instructor
what is health improvement?
enhancing health of an entire population (local/ regional/ national)
what is health promotion?
enabling people to increase control over their health and its determinants and thereby improving health
describe the Tannahill model.
- a concept that describes health promotion as three overlapping activities
- —>Health protection- legal and fiscal policies to protect health e.g. ‘no smoking’ ads
- —–>Disease prevention (vaccination)
- —->Health education (educating people to make healthier choices; changing beliefs, attitudes & behaviours)
what is primary disease prevention?
actions taken to prevent disease from happening in the first place
what are examples of primary disease prevention?
- immunisation
- reducing salt in foods
- stopping smoking
what is secondary disease prevention?
actions taken to catch a disease early and prevent progression
what are examples of secondary disease prevention?
- screening
- early detection of STIs
what is tertiary disease prevention?
measures taken to minimise suffering and improve quality of life/ reducing disability
what is an example of tertiary disease prevention?
medication
outline the rose principle.
large number of people exposed to small risk generates more cases than small number of people exposed to large risk
describe the meaning of the clinical iceberg model
- > the apparent disease hides the bigger problem
- > a large % of a problem is subclinical, unreported or otherwise hidden from view->only the tip of the iceberg is apparent
what are the 4 types of Bradshaw’s taxonomy of health care needs?
1-felt-individual perception of variations from normal health
2-expressed-vocalisation of need and how people demand for services
3-normative-based on professional judgement
4-comparative-based on professional judgements as to relative needs of different groups in population
what are the 5 stages of Maslow’s hierarchy of needs?
1-physical 2-security 3-social 4-ego 5-self-actualisation
how do you progress to the next stage in Maslow’s hierarchy of needs?
you must first satisfy the lower level
what are health needs?
deficiencies in health that require health care from promotion to palliation
what is a health needs assessment?
systematic method for reviewing the health issues facing a population, identifying un-met needs leading to agreed priorities and resource allocation that will improve health and reduce inequalities
what does GFR stand for?
general fertility rate
what is GFR?
the ratio of live births to the number of women in childbearing years
what is birth rate?
number of live births per thousand population per unit of time
what is the still birth rate?
- number of stillbirths per thousand births
- number of stillbirths/ number of live births +stillbirths
what is the total period fertility rate?
average number of children per women that would be born to a group of women if they experienced the current years age specific fertility rates for each year of their childbearing years
what is maternal death?
death of a women whilst pregnant or within 42 days of the pregnancy
what is neonatal mortality rate?
->number of neonatal deaths per thousand births (deaths within 28 days)
how do you work out neonatal mortality rate?
number of neonatal deaths/ live births
what are direct deaths (maternal)?
from obstetric complications of the pregnant state
what are indirect deaths (maternal)?
from previous existing disease or disease that developed that was not the direct result of pregnancy but was aggravated by pregnancy
what are late deaths (maternal)?
maternal death 42 days to a year
what is perinatal mortality rate?
deaths by seven days post birth
how do you work out perinatal mortality rate?
still births + neonatal deaths/ number of live births + still births
what is post neonatal mortality rate?
number of deaths after 28 days and up to a year
how do you work out post neonatal mortality rate?
number of post neonatal deaths/ number of live births
what is infant mortality rate?
number of infant deaths per thousand births
how do you work out infant mortality rate?
number of infant deaths (up to 1 year of age) / number of live
what is risk?
probability that an event will occur
what is absolute risk?
probability of an event under the study
what is relative risk/ risk ratio?
ratio of the risk of a disease among the exposed to the risk among the unexposed
what is a case fatality rate?
number of deaths from a disease
how do you calculate case fatality rate?
number of deaths from a specified disease over a defined period of time/ number of individuals diagnosed with the disease during that time
what is statistical significance?
probability that an effect is not due to chance alone
what is the null hypothesis?
- > the hypothesis that suggests the opposite to what you are testing
- > there is no significant difference between two variables
- > this is the outcome you try to disprove
what is the p value?
- > a measure of statistical significance
- > evaluates how compatible the data is with the null hypothesis
- > is the probability of obtaining the observed difference in the outcome measure, or a larger one, given that no difference exists between treatments the population
what does a low p value mean?
- > your data is unlikely to be a true null (this is good)
- > p>0.05—>reject null hypothesis-> results are not just due to chance
what does a high p value mean?
- > indicates that your data is likely a true null
- > p>0.05
- > accept null hypothesis
- > results are likely due to chance
what is a type 1 error?
the null hypothesis was true but you are confident in your data and you reject it
what is a type 2 error?
the null hypothesis was false but you are not confident in your data so you accept the null hypothesis
what is a communicable disease?
an infectious disease that can be transmitted from one individual to another
what is a transmissible disease?
a disease that can only be transmitted between individuals by unnatural routes
what is surveillance?
a systematic collection, collation and analysis of data with dissemination of the results so that appropriate control measures can be take
outline the types of surveillance
- active
- passive
- sentinel
- syndromic
- enhanced
what is passive surveillence?
data are collected from routine sources eg lab reports
what is sentinel surveillence?
data from a sample of health care providers
what is syndromic surveillence?
from telephones/ GP consultations
what is enhanced surveillence?
collects more detailed information than routine
what determines if a test is suitable?
- > sensitivity
- > specificity
- > positive predictive values
what is PPV (positive predicable values)?
this is the proportion of people who test positive who are actually positive
how do you calculate PPV?
true positive/ true positive + false positive
what is NPV (negative predictive values)?
the proportion of people who test negative who are actually negative
how do you calculate NPV?
true negative/ true negative + false positive
what is a true positive?
testing identifies as having a disease after further testing this is confirmed
what is a false positive?
testing identifies as having a disease but further tests say they do not actually have the disease
what is a true negative?
testing says you do not have a disease and further tests confirm this
what is a false negative?
testing says you don’t have the disease but further testing says you do
how do you work out sensitivity?
TP/TP + FN
how do you work out specificity?
TN/FP + TN
what is sensitivity?
how many people with the disease screening detects (should be 100% but never is)
what is specificity?
how many people without the disease the screening doesn’t detect (should be 100%)
what are Dahlgren and whiteheads 5 social determinants of health?
1-socioeconomic, cultural and environmental conditions
2-living and working
conditions
3-social and community networks
4-individual lifestyle
5-age, sex and constitutional factors
what are Maxwell’s 6 dimensions of health quality?
EEEAAA 1-effectiveness 2-efficiency 3-equity 4-acceptability 5-appropriateness 6-accessibility
what is the population case series?
collection of subjects with common characteristics used to describe some clinical pathophysiological or operational aspect of a disease, treatment, exposure or diagnostic procedure
how often is the UK census?
every 10 years
what is the limiting long term illness?
when your day-to-day activities are limited because of a health problem or disability
what is the NNT?
- > number needed to treat
- > number of people who are needed to be treated in order to prevent more events
- > it is 1/ absolute risk reduction
how many days do you have to register your baby?
42 days from birth
what are paradigms?
this is a world view underlying the theories and methodology of a particular scientific subject
what is the McKeown hypothesis?
- > the population changed due to increased child survival
- > the deaths mainly due to infectious diseases with nutrition and other environmental issue as major determinants
- > environmental, political and social measures caused drop in number of deaths, not therapy
what are the 5 parts making up the structure of the NHS?
1-parliament (secretary of state for health and social care)-Matt Hancock
2-department of health
3-NHS England-Simon Stevens
4-CCGs or clinical commissioning groups-purchase hospital and GP services for their local area.
-deal with secondary care services too e.g. rehab
5-Public Health England
what are social inequalities of health?
systematic differences in health status between different socioeconomic groups-they are unfair
what is equity in health?
implies that ideally everyone could attain their full potential and that no one should be disadvantaged from achieving this potential because of their social position or other socially determined circumstances
what are the 3 area-based measures of socioeconomic status?
- index of multiple deprivation
- townsend score
- carstairs index
(prone to ecological fallacy)
what are the individual measures of socioeconomic status?
- educational attainment
- occupation
- income
what are health inequalities?
systematic, preventable, unfair and unjust differences in health across population groups
what is case definition?
this is a set of uniform criteria used to define a disease for public health surveillance, they enable public health to classify and count cases consistently across reporting jurisdictions
what is hypothesis testing?
statistical method that uses sample data to evaluate a hypothesis about population parameter, helps researchers to differentiate between real and random patterns in data
what is interference?
using a random sample to learn something about a larger population
what is a hypothesis?
an assumption about the population parameter
what is a confidence interval?
interval between 2 numbers where there is specified level of confidence that a population parameter lies
what is the calculation for confidence interval?
population estimate +/- 1.96 x standard deviation
what is a confounder?
a known risk factor to the outcome associated with the exposure under study but is not on the casual pathway between exposure and outcome
what is bias?
a systematic error in design or conduct of a study that results in an incorrect estimation of the association between exposure and health-related event
what is lead time bias?
the length of time between the detection of a disease and its unusual clinical presentation and diagnosis
what is selection bias?
this occurs when there is a systematic difference between either those who participate in the study and those who do not or those in the treatment arm of a study and those in the control group
what is information bias?
results from systematic differences in the way data on exposure or outcome are obtained from various study groups
what is risk?
the probability that an event will occur
what is absolute risk?
this is the probability of an event under the study
what is relative risk (risk ratio)?
the ratio of the risk of a disease among the exposed to the risk among the unexposed
what is case fatality rate?
the number of deaths from a disease
what is prevention paradox?
a preventative measure that brings large benefits to the community but may offer little to most participating persons
what is ecological fallacy?
bias that may occur because of an association observed between variable on an aggregate level doesn’t represent the association that exists on an individual level
what are the 3 health care evaluation elements?
1-efficacy
2-effectiveness
3-efficacy
describe the 9 Bradford Hill criteria
1-Does the cause come before the effect- Temporality
2-If the cause is removed does the effect go away? - Reversibility
3-Does greater exposure lead to greater incidence of the effect? And vice versa? Dose response relationship/biological gradient
4-How strong is the association between the cause and the effect? Strength
5-There should be a plausible mechanism between the cause and effect? Plausibility
6-If the study were replicated in a different time and place would the same association be observed? Consistency
7-Does the evidence come from a strong robust study? Study design
8-A single cause produces a single effect. Specificity (weakest criterion)
9-Applying accepted evidence from another area of study- analogy
what is the Bradford Hill criteria used to establish?
a casual relationship rather than just a correlation
what is the Wilson-Junger criteria used for?
to be applied before implementing a potential population screening programe
what does the Wilson-Junger criteria involve?
1-The condition should be an important health problem
2-The history of the condition should be understood
3-There should be a recognizable latent or early symptomatic stage.
4-There needs to be a suitable test for it
5-Is the treatment accepted
6-Is the treatment more effective when started early?
7-There needs to be a policy on who should be treated
8-Is diagnosis and treatment cost effective
9-Case finding should be a continuous process
what is Donabedian’s framework?
1-structure->context in which care is delivered
2-process->sum of all actions that makeup health care
3-outcome->the effect of healthcare on patients and populations
what are the 8 principles of the NHS?
1-free at point of delivery 2-for the needs of everyone 3-based on need not wallet 4-based on excellence and professionalism 5-based on integrated working across organisational boundaries 6-best value and sustainable 7-accountable to the public 8-patient centred
what are the core values of the NHS?
1-working together 2-respect and dignity 3-commitment to quality care 4-compassion 5-improving lives 6-everyone counts
