PPS Flashcards
What is meant by the ‘clinical iceberg’ of morbidity
- Usually more unkown disease than known
- Unkown tends to be milder, severe morbidities known
- Because of this:
- Amount of disease underestimated
- Overall severity overestimated
To assess the total amount of disease, need a survey of the wider population, not just those seeking care
What is epidemiology?
The study of the distribution and determinants of health and disease in human populations.
What is public health?
The science and art of:
- prolonging life
- preventing disease
- promoting health
In the population, by the organised efforts of society.
How do epidemiology & clinical practice come together?
Clinical epidemiology.
The application of epidemiological methods in clinical practice informs understanding of:
- Diagnosis
- Causes
- Consequences
- Treatment
What is a prevalence rate?
The presence of disease new and old
- Has no time component. Epidemiologists dont view this as a true rate. Incidence & mortality rates are more informative as has time component.
What is an incidence rate?
Occurence of new cases of disease
No. new cases/at risk population (in specified time period)
What is the difference between disease rate & disease risk?
- A disease rate expresses events/population
- A disease risk is a statement of probabilty (a simple proportion)
What have migration studies shown, with respect to blood pressure? (origin = non western, adoption country = western)
Blood pressure patterns increase to match those of adopted population.
Evidence for mainly adult environmental influence on population BP
What does a cohort study show us?
Evidence of association between risk factors and outcomes. Allows us to look at relative & absolute disease risks by looking at a population over a long period of time
What is the healthy entrant effect?
Reduction in rates of morbidity and mortality in the initial stages of a longitudinal study in comparison with the general population because only healthy people were recruited to the study
What are some disadvantages of cohort studies?
- Unkown risk factors (confounders)
- Inference of association - not causation (participants are not randomised)
- Bias from loss to follow up
- Timely & expensive
- Changes in participant behaviour & epidemiology of disease
- Not suitable if disease is rare
What is meant by patient concordance?
(NICE 2007) - ‘the consultation process in which doctor and patient agree therapeutic decisions that incorporate their respective views, but now includes patient support in medicine taking as well as prescribing communication’
What are the two main sociological models of lay health beliefs? Briefly describe both
1) Health as functional capacity
- Idea of health as the ability to cope with everyday activities
- Working class conception of health
- Health is defined in the negative, includes notion of health as idea of ‘health despite disease’
2) Disease candidacy model
- Lay beliefs are constructed from appearance of a person, or the circumstances surrounding an event
What is the definition of a psychological theory of health?
What makes a good theory?
Definition - coherent account of phenomenon through influence & thought. Is empirically testable
Good theories:
- Explain related set of observations, not contradicted by observations.
- Testable hypothesis
- No more elements needed
- Comprehensible & coherent
What is the biopsychosocial model?
Holistic model that considers
- Presence of chronic illness
- Mental state
- Socioeconomic model
Contrasts the biomedical model
What are some pros & cons of quantitative vs qualitative data collection? (psychology)
Quantitative: objective, large cohorts.
+: quick, easy to compare data, cheaper
-: no depth, may be affected by bias
Qualitative: Subjective, smaller cohorts.
+: In-depth, generates lots of information about behaviour
-: Hard to standardise, time consuming, difficult to find participants
What is the COM-B model of behaviour change? (psychology)
Pros & cons?
Capability, motivation & opportunity all contribute to behaviour change.
Pros:
- Designs behaviour interventions
- Identifies components to be changed to meet targets
Cons:
- Doesn’t explain statistical behavioural variance
- Biased assumption that people are rational
What is the theory of planned behaviour?
Pros & cons?
Attitudes, subjective norms & percieved behavioural control feed into intention, which feeds into behaviour
Pros:
- Highlights social norms
- Intentions shown to predict some behaviour change (only 28%)
Cons:
- Past behaviour best predictor
- Environmental influences not considered
- Social support or habit not considered
What is the health belief model of behaviour change?
Pros & cons?
Expectancy-threat based model - weighing bad outcomes of behaviour against ability to act against it.
Modifying factors (age, gender, ethnicity, socioeconomics etc) lead into individual beliefs (perceived susceptibility, severity, benefits & barriers), which affect behaviour
Pros:
- Compares different influences on health behaviour
- Gives barriers
Cons:
- Threat doesn’t always predict behaviour change
- No emotions/habit/social norm modifications
- People underestimate liklihood of accidents
- No definition of how to test relationship between elements
What is the transtheoretical model of health behaviour change?
Pros & cons?
5-6 stages: precontemplation, preparation, action, maintenance, relapse.
Behaviour feeds into all of these.
Pros:
- Popular in practice
- Predicts some behaviour change
- Identifies broad processes leading to change
Cons:
- Stages vary between people
- Assumes change is planned
- No readiness to change
- Continuum of desire - no discreet changes in reality (oversimplification)
