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3A > Public Health 1 > Flashcards

Public Health 1 Flashcards

1
Q

Epigenetic

A

Expression of genome

Depends on environment

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2
Q

Allostasis

A

Stability through change
Physiological systems adapt rapidly
In response to environmental stress

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3
Q

Allostatic load

A

Long-term overtaxation of our physiological systems

= Impaired health (stress)

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4
Q

Salutogenesis

A

Favourable physiological changes

In response to experiences promoting health and healing

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5
Q

Emotional intelligence

A

Ability to manage your own emotions

As well as the emotions of others

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6
Q

Purpose of primary care

A

Manage illness and clinical relationships
Manage clinical uncertainty

Find best available solutions to clinical problems
Achieve best outcomes with available resources

Prevent illness
Promote health

Work in a primary health care team
Shared decision making with patients

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7
Q

Dangers of overprescribing

A

Unnecessary side effects
Medicalising self-limiting conditions
Antibiotic resistance

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8
Q

Public health

A

Science and art
Preventing disease and promoting health
Organised efforts of society

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9
Q

3 domains of public health

A
  1. Improving health
  2. Protecting health
  3. Improving services
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10
Q

Key concerns of public health

A
  1. Preventing illness
  2. Reducing inequalities
  3. Understanding the wider determinants of health
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11
Q

What is health improvement

A

Societal interventions

Preventing disease
Promoting health
Reducing inequalities

Education
Housing
Employment

Surveillance and monitoring - Specific diseases and risk factors

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12
Q

What is health protection

A

Measures to control infectious disease risks and environmental hazards

Infectious diseases, chemicals and poisons, radiation, emergency response, environmental health hazards

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13
Q

What is improving services

A

Organisation and delivery of safe high quality services

  • Prevention
  • Treatment
  • Care
Clinical efficacy
Service planning
Audit and evaluation
Clinical governance
Equity
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14
Q

Health needs assessment

A

Systematic method
Reviewing the health issues facing a population

Leads to…

  • Agreed priorities
  • Resource allocation
  • Improve health
  • Reduce inequalities
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15
Q

Need
Demand
Supply

A

Need - Ability to benefit from intervention
Demand - What people ask for
Supply - What is provided

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16
Q

What is a health need

A

Need for health

  • Morbidity
  • Mortality
  • Sociodemographic measures
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17
Q

What is health CARE need

A

Ability to benefit from healthcare

Potential of…

  • Prevention
  • Treatment
  • Care services
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18
Q

Sociological needs

A

Felt - Individual perception of abnormal health

Expressed - Individual seeks help to overcome abnormal health

Normative - Professional defines appropriate intervention

Comparative - Comparison between…

  • Severity
  • Range of interventions
  • Cost
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19
Q

Different approaches for health needs assessment

A

Epidemiological
Comparative
Corporate

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20
Q

Epidemiological approach for health needs assessment

A

Define problem
Size of problem - Incidence/prevalence

Services available - Prevention, treatment and care
Evidence base - Efficacy vs cost-efficacy
Models of care - Quality and outcome measures

Recommendations

Sources of data - Disease registry, hospital admissions, GP databases, mortality data, primary data collection

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21
Q

Epidemiological approach

Advantages vs disadvantages

A

DATA DATA DATA

Advantages

  • Uses existing data
  • Provides data on disease incidence, mortality and morbidity
  • Evaluate service trends over time

Disadvantages

  • Quality of data is variable
  • Data collected may not be useful
  • Data does not consider felt needs or opinions of people
22
Q

Corporate approach for health needs assessment

A

Ask local population what their needs are

  • Focus groups
  • Interviews
  • Public meetings

Stakeholders

  • Teachers
  • Healthcare professionals
  • Social workers
  • Charity workers
  • Local business
  • Council workers
  • Politicians
23
Q

Comparative approach

Advantages vs disadvantages

A

Advantages

  • Quick and cheap if data is available
  • Gives a measure of relative performance - Health and services provision

Disadvantages

  • Difficult to find comparable population
  • Data may not be available
  • May not indicate what provision level should be
24
Q

Health needs assessment focus points

A

Population or sub-group
Condition
Intervention

25
Q

Comparative approach to health needs assessment

A

Compare SERVICES received by a population with others

Health status
Service provision
Service utilisation
Health outcomes

26
Q

Corporate approach to health needs assessment

Advantages vs disadvantages

A

Advantages

  • Based on felt and expressed needs
  • Recognises knowledge and experience of those working within the population
  • Considers a wide range of views

Disadvantages

  • Difficult to distinguish need from demand
  • Groups may have vested interests
  • May be influenced by political agendas
27
Q

Need assessment and planning cycle

A
  1. Needs assessment
  2. Planning
  3. Implementation
  4. Evaluation

………. Back to 1. Assessment

28
Q

Three types of prevention

A

Primary - Prevent disease before it occurs

Secondary - Catching disease in the early pre-clinical phase

Tertiary - Preventing complications

29
Q

Prevention approaches

A

Population approach
- E.g. Working with food industry to reduce salt

High-risk approach - Identify individuals
- Screen for high BP

30
Q

What is prevention paradox

A

Preventative measure which brings benefit to the population

BUT

Offers little to each participating individual

31
Q

Screening

A

Process

Sorts apparently well people who probably have disease
- Precursors or susceptibility

From those who probably do not

NOT DIAGNOSTIC!

32
Q

Different types of screening

A 
Population based 
Opportunistic 
Screening for communicable diseases
Pre-employment and occupational medicals 
Commercially approved
33
Q

Disadvantages of screening

A

Exposes well individuals to distressing or harmful tests
Detection and treatment of sub-clinical disease that would never have caused a problem
Preventative interventions may harm individual or population

34
Q

Screening programme criteria

A

Wilson and Junger model

  1. The condition - Important health problem, pre-clinical phase, known natural history
  2. The test - Sensitive, specific, inexpensive, acceptable
  3. Treatment - Effective, agreed policy on who to treat
  4. Organisation and cost - Facilities, costs of screening should be economically balanced in relation to healthcare spending, should be an ongoing process
35
Q

Sensitivity and specificity

A

Sensitivity - Proportion of people with disease who are correctly identified

Specificity - Proportion of people without disease who are correctly excluded

36
Q

Positive predictive value

Negative predictive value

A

PPV - Proportion of people with a positive result who actually have the disease

NPV - Proportion of people with negative result who do not have the disease

37
Q

Lead time bias

A

Screening identifies an outcome earlier than it would otherwise have been identified

Results in apparent increase in survival time

Even if screening does not affect outcome

38
Q

Observation study types

A

Descriptive - Case reports or ecological studies

Descriptive and analytical - Cross sectional study or survey

Analytical - Case-control studies or cohort studies

39
Q

Experimental or intervention studies

A

RCT

Non-RCT

40
Q

Ecological study

A

Uses routinely collected data
Shows trends in data

Useful for generating a hypothesis

Shows prevalence and association
DOES NOT show causation

41
Q

Cross-sectional study

A

Divides population into those with disease and those without

Collects data at a defined point in time

Shows associations at that point in time

42
Q

Cross-sectional study

Advantages vs disadvantages

A

Advantages

  • Relatively quick and cheap
  • Provides data on prevalence
  • Large sample size
  • Good for surveillance and public health planning

Disadvantages

  • Risk of reverse causality (chicken vs egg)
  • Cannot measure incidence
  • Recall bias
  • Non-response
43
Q

Case control study

A

Retrospective studies

People with a disease MATCHED to people without disease
(Sex, habitat, class, etc)

Study previous exposure to agent in question

44
Q

Case control study

Advantages vs disadvantages

A

Advantages

  • Relatively quick and cheap
  • Good for rare outcomes
  • Can investigate multiple exposures

Disadvantages

  • Retrospective - Only shows ASSOCIATION
  • Difficulty finding controls
  • Selection and information bias
  • Patients with memory problems?
45
Q

Cohort study

A

Population without disease
Study them over time
Are they exposed to the agent?
Do they develop disease?

46
Q

Cohort study

Advantages vs disadvantages

A

Advantages

  • Can show causation
  • Reduced selection and recall bias
  • Absolute, relative and attributable risks determined
  • Can follow-up rare exposure groups
  • Good for common and multiple outcomes

Disadvantages

  • Requires controls to establish causation
  • Takes a long time
  • Loss to follow-up
  • Requires large sample size
47
Q

Randomised control studies

A

Patients randomised into groups
One group given intervention
One group given control
Outcome measures

48
Q

Randomised control studies

Advantages vs disadvantages

A

Advantages

  • Randomisation - Confounding factors equally distributed
  • Minimises bias
  • Can show causation

Disadvantages

  • Large and expensive
  • Ethical issues - Is it ethical to withhold an effective treatment?
  • Time consuming
  • Inclusion/exclusion criteria - Low population validity
49
Q

Odds ratio

A

Exposed odds / Unexposed odds

Can be interpreted as RR

50
Q

Odds of an event mean

A

Probability of occurrence vs probability of non-occurrence

Odds = Probability / (1-probability)

3A (31 decks)

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