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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
Comparative approach to health needs assessment
Compare SERVICES received by a population with others Health status Service provision Service utilisation Health outcomes
26
Corporate approach to health needs assessment Advantages vs disadvantages
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
Need assessment and planning cycle
1. Needs assessment 2. Planning 3. Implementation 4. Evaluation .......... Back to 1. Assessment
28
Three types of prevention
Primary - Prevent disease before it occurs Secondary - Catching disease in the early pre-clinical phase Tertiary - Preventing complications
29
Prevention approaches
Population approach - E.g. Working with food industry to reduce salt High-risk approach - Identify individuals - Screen for high BP
30
What is prevention paradox
Preventative measure which brings benefit to the population BUT Offers little to each participating individual
31
Screening
Process Sorts apparently well people who probably have disease - Precursors or susceptibility From those who probably do not NOT DIAGNOSTIC!
32
Different types of screening
``` Population based Opportunistic Screening for communicable diseases Pre-employment and occupational medicals Commercially approved ```
33
Disadvantages of screening
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
Screening programme criteria
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
Sensitivity and specificity
Sensitivity - Proportion of people with disease who are correctly identified Specificity - Proportion of people without disease who are correctly excluded
36
Positive predictive value | Negative predictive value
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
Lead time bias
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
Observation study types
Descriptive - Case reports or ecological studies Descriptive and analytical - Cross sectional study or survey Analytical - Case-control studies or cohort studies
39
Experimental or intervention studies
RCT | Non-RCT
40
Ecological study
Uses routinely collected data Shows trends in data Useful for generating a hypothesis Shows prevalence and association DOES NOT show causation
41
Cross-sectional study
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
Cross-sectional study Advantages vs disadvantages
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
Case control study
Retrospective studies People with a disease MATCHED to people without disease (Sex, habitat, class, etc) Study previous exposure to agent in question
44
Case control study Advantages vs disadvantages
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
Cohort study
Population without disease Study them over time Are they exposed to the agent? Do they develop disease?
46
Cohort study | Advantages vs disadvantages
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
Randomised control studies
Patients randomised into groups One group given intervention One group given control Outcome measures
48
Randomised control studies Advantages vs disadvantages
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
Odds ratio
Exposed odds / Unexposed odds Can be interpreted as RR
50
Odds of an event mean
Probability of occurrence vs probability of non-occurrence Odds = Probability / (1-probability)

3A (31 decks)

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