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Finals > Public Health > Flashcards

Public Health Flashcards

1
Q

What are the 3 principles that the NHS was founded on?

A
  1. It meets the needs of everyone
  2. It’s free at point of delivery
  3. It’s based on clinical need and not ability to pay
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2
Q

What does the marmot report 10 years on highlight?

A

people can expect to spend more of their lives in poor health
improvements to life expectancy have stalled, and declined for the poorest 10% of women
the health gap has grown between wealthy and deprived areas
place matters – living in a deprived area of the North East is worse for your health than living in a similarly deprived area in London, to the extent that life expectancy is nearly five years less.

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3
Q

Name 8 groups considered more vulnerable to health inequalities

A 
Homeless
Traveller community
Asylum seekers
LGBTQ+
Ex prisoners
Care leavers
Those with learning difficulties
Those with mental health problems
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4
Q

How many tiers are there in Maslow’s hierarchy of needs

A

5

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5
Q

What are the tiers of Maslow’s hierarchy of needs

A
  1. Self actualization, mortality, creativity, lack of prejudice
  2. Esteem - self-esteem, confidence, achievement, respect for and by others
  3. Love/belonging - friendship, family, intimacy
  4. Safety - security of body, employment, health
  5. Physiological - breathing, water, sleep
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6
Q

What are the two main perquisites for homelessness

A
  1. Eviction by private landlords

2. Relative/friends no longer offering accommodation

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7
Q

What are the two domains which impact the likelihood of becoming homeless

A
  1. Individual circumstances

2. Wider forces

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8
Q

What are some individual circumstances that may lead to homelessness

A

Poor physical health, drug and alcohol abuse, poor mental health, bereavement, crime

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9
Q

What are some of the wider forces which may lead to homelessness

A

Poverty, inequality, housing supply and affordability, unemployment, welfare, income policies

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10
Q

What are some barriers for homeless people accessing healthcare

A

Difficulties registering with a GP, appointment procedures, perceived or actual discrimination, lack of health priority

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11
Q

What is the life expectancy of travellers compared to the general population

A

10 years less for men

12 years less for women

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12
Q

What is the rate of child death/miscarriage in the traveller community

A

1 in 5 will lose a child compared to 1 in 100 in general population

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13
Q

What are the rates of traveller suicide compared to the general population

A

Irish travellers are three times more likely to commit suicide than the general population

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14
Q

What is the prevalence of anxiety and depression in the traveller community compared to the general population

A

Three times higher anxiety rates, twice as like to have depression

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15
Q

Which diseases are 1.5-4x more prevalent in the traveller community

A

Chronic bronchitis, asthma, angina, pregnancy complications, smoking

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16
Q

What inequalities are faced by the LGBTQ+ community

A

Social isolation, homelessness, workplace discrimination, relationship problems, crime and violence

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17
Q

What are the health inequalities for gay and bisexual men

A

Twice as likely to have anal cancer, higher rates of eating disorders, 21% higher rates of depression and anxiety. 4x lifetime risk of suicide attempt

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18
Q

What are the health inequalities for lesbian and bisexual women

A

Only half attend cervical screening as thought don’t need to, higher rate of PCOS, higher risk of obesity, poorer mental health, 1.8x suicide risk

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19
Q

What are the health inequalities for trans people

A

Higher rates of HIV and other STIs, higher rates of substance misuse, globally poorer health and little research

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20
Q

What is an asylum seeker

A

A person who has made an application for refugee status

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21
Q

What is a refugee

A

A person granted asylum and refugee status. Have leave to remain for 5 years then reapply

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22
Q

What is indefinite leave to remain

A

A person granted full refugee status and given permanent residence

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23
Q

What are asylum seekers entitled to

A 
£37.75 a week
Housing - no choice
Free NHS care
NOT allowed to work
NOT allowed to claim benefits
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24
Q

When can asylum seekers apply for British citizenship

A

After five years of refugee status can apply for indefinite leave to remain. After a year of indefinite remain can apply for British citizenship

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25
Q

What are the types of human trafficking

A

Sexual exploitation, domestic servitude, forced labour, forced criminality, organ harvesting

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26
Q

What are the demographics of slavery

A

41% forced labour, 34% sexual exploitation, 11% domestic servitude. 2/3 children, mostly from Vietnam and Slovakia

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27
Q

What are some red flags to look for when suspecting human trafficking

A

Timid, not registered with GP/school, accompanied by controlling person, foreign language, frequent location change, inconsistent history, no control of passport/bank, injuries untreated

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28
Q

What should you do if you suspect human trafficking

A

Try to talk to them alone, address health needs, ask what they want.
Immediate threat - 999
Under 18 - NSPCC child trafficking advice centre.
If >18 and consent to help inform safeguarding, if not then give leaflet

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29
Q

Name 4 models of behaviour change

A

Health belief model
Theory of planned behaviour
transtheoretical model
Social norms theory

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30
Q

What are the 4 criteria of the health belief model

A
  1. Believe they are susceptible to the disease
  2. Believe the disease has serious consequences
  3. Believe taking action reduces susceptibility
  4. Believe the benefits of taking action outweigh the costs
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31
Q

What are some health motivation/cues to action in the health belief model

A

Internal cues e.g. heart attack or external cues e.g, advice by GP

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32
Q

Define meta-analysis

A

Examination of data from a number of independent studies on the same subject, in order to determine overall trends

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33
Q

What are four critiques of the health belief model

A
  1. Alternative factors may predict health behaviour, such as outcome expectancy
  2. It does not consider the influence of emotions on behaviour
  3. Does not differentiate between first time and repeat behaviours
  4. Cues of action cannot always be determined in studies
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34
Q

Key points of the health belief model

A

Longest standing model of behavioural change.
Successful range of health behaviours
Perceived barriers have been shown to be the most important factor for addressing behaviour change

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35
Q

What are the three components of the theory of planned behaviour

A

Attitudes
Subjective norms/Social norms
Perceived behaviour control

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36
Q

What are attitudes

A

The degree to which a person has a favourable or unfavourable opinion on the behaviour of interest. e.g. do they like running

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37
Q

What is behavioural intention

A

The motivational factors that influence a given behaviour where the stronger the intention to perform the behaviour, the more likely it will be performed. e.g. the behavioural intention behind running is that its good for my health

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38
Q

What are subjective norms

A

The belief about whether most people approve or disapprove of the behaviour. If people important to you will approve of the behaviour

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39
Q

What are social norms

A

The codes of behaviour acceptable in a group of people or a larger cultural context.

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40
Q

What is perceived power

A

The perceived presence of factors that will facilitate or impede performance of a behaviour. The factors which contribute to perceived behavioural control

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41
Q

What is perceived behavioural control

A

The persons perception of the ease or difficulty of performing the behaviour. Are they able to do it?

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42
Q

Limitations of the theory of planned behaviour

A

Lacks time scale (how long from intent to action), doesn’t consider emotions, doesn’t consider habit/routine, assumes that attitudes/subjective/social norms can be measured, relies on self-reported behaviour, doesn’t consider economic or environmental factors

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43
Q

Key concepts of the theory of planned behaviour

A

Rational choice model
Attitudes, subjective norms and perceived behavioural control are the major determinants of intentions
can predict intentions for a wide range of health behaviours
Takes into account social pressures and perceived control
Useful for predicting intentions but not actual behaviours

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44
Q

What is the stages of change model/transtheoretical model

A

Descrete, ordered stages with each stage denoting a greater inclination than the last

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45
Q

What are the five stages of transtheoretical model

A 
Precontemplation
Contemplation
Preparation
Action
Maintenance
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46
Q

What stage would buying nicotine patches be in the transtheoretical model

A

Preparation

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47
Q

What stage would being a steady non-smoker be in the transtheoretical model be

A

Maintenance

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48
Q

What stage would thinking about giving up smoking be in the transtheoretical model

A

Contemplation

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49
Q

What stage would stopping smoking be in the transtheoretical model be

A

Action

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50
Q

What stage would no intention of giving up smoking be in the transtheoretical model be

A

Precontemplation

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51
Q

What are the advantages of the transtheoretical model

A

Acknowledges individual stages of readiness
accounts for relapse
temporal (time) element

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52
Q

What are the disadvantages of the transtheoretical model

A

Not everyone progresses in a linear fashion - may skip a step or go back
Change can operate on a continuum and does not always have an end
Doesn’t consider values, habits, culture, social and economic factors

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53
Q

Key concepts of the transtheoretical model

A

Precontemplation, contemplation, preparation, action, maintenance
Examines process of change rather than factors determining behaviour
Allows for interventions to be tailored for individuals

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54
Q

What are the ideas surrounding social norms theory

A

Scare tactics don’t work

Humans are group orientated so common beliefs and attitudes are the most influential factors influencing behaviours

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55
Q

What is a critique of social norms theory

A

Perceived social norms may be different from actual norms but still influence behaviour.
Social norms aims to find real norms via statistics.
Information does not equal behaviour change.
Population data may not reflect an individual’s social environment

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56
Q

Name three behaviours to health

A

Sick role
Illness
Health behaviours

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57
Q

What is the sick role

A

Behaviour aimed at getting well. Rules and obligations such as they are not responsible for their condition, and they should receive help/medical treatment. (engaging in treatment)

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58
Q

What is illness behaviour

A

Behaviour aimed at seeking a remedy. (finding treatment)

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59
Q

What is health behaviour

A

An activity undertaken by an individual who believes themself to be healthy, for the purpose of preventing illness.

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60
Q

What are some physical consequences of loneliness

A

Early death, more risks, smoking

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61
Q

What are some signs of loneliness

A

Talkative, clinging, denial, boredom, living alone, males >50, bereavement, poor mobility, sensory impairment.

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62
Q

What are the five domains of social exclusion

A 
Material resources
Civic activities
Basic services
Neighbourhood
Social relationships
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63
Q

Define relative risk

A

One intervention’s risk of an event occurring compared to another’s

64
Q

Give an example of relative risk

A

Relative risk of smoking on developing lung cancer is 3. You are 3x more likely to get lung cancer if you smoke than if you don’t

65
Q

Define hazard ratio

A

The risk of an event occurring over a set amount of time

66
Q

Give an example of hazard ratio

A

Hazard ratio of smoking and lung cancer over 10 years is 2. Over a 10-year period, twice as many people who smoked developed lung cancer than those who didn’t

67
Q

Give an example of reverse causation

A

People who are already ill don’t drink coffee. Coffee does not make you healthy!

68
Q

What is the aim of a population approach to prevention

A

Delivered on a population wide basis and seeks to shift the risk factor distribution curse. e.g. salt restrictions in the food industry.

69
Q

Define high risk approach to prevention

A

Identifies individuals above a chosen cut-off and treats them e.g. high blood pressure

70
Q

What is the prevention paradox

A

A preventative measure which brings much benefit to the population, often offers little to each participating individual. e.g. statins for CVD prevention

71
Q

What is relative risk reduction

A

How much the risk of an event is reduced in an experiment compared to a CONTROL group

72
Q

What is absolute risk

A

The odds of an event happening over a stated time period. e.g. women have an absolute risk of 12% of developing breast cancer in her life. Out of every 100 women, 12 will develop breast cancer in their life.

73
Q

What is number needed to treat

A

Number of people needed to treat for event to be prevented in 1 person

74
Q

How to calculate NNT

A

Ratio between number treated and number successful. e.g. give 10 million people statins and prevent 250,000 CVD, NNT = 40

75
Q

Define bias

A

A systematic deviation from the true estimation of the association between exposure and outcome

76
Q

What are the two main types of bias

A 
Selection bias (selection of participants or allocation into groups)
Information (error in measurement - observer, participant or instrument)
77
Q

What are some criteria for causality

A 
Strength of association
Dose-response
Consistency
Temporality
Reversibility
Biological plausability
78
Q

What study is this: Investigators find a high level of correlation between levels of socioeconomic
deprivation and cardiovascular mortality across electoral wards in the UK

A

Ecological study

79
Q

What study is this: Researchers set out to examine the association between alcohol consumption
and stroke. They identify all new patients admitted with stroke and compare
their alcohol consumption with patients admitted for elective surgery.

A

Case-control study

80
Q

What study is this: General practitioners set up a study to estimate the prevalence of depression
within their registered population. They decide to start with a random sample
of adults aged 45-74 years.

A

Cross-sectional study

81
Q

What is Person-years

A

the number of people in the study and the amount of time each person spends in the study. For example, a study that followed 1000 people for 1 year would contain 1000 person years of data.

82
Q

What best describes the measure being used: For patients with meningococcal meningitis, the risk of dying has been
estimated to vary from 5-10%.

A

Case-fatality rate

83
Q

What best describes the measure being used: In a case-control study of recent alcohol consumption and road traffic
accidents, the measure of association was substantially greater than 1 and
indicates that there is a positive association between exposure and outcome.

A

Odds ratio

84
Q

What best describes the issue best: Researchers set out to examine the hypothesis that stress causes
hypertension using hypertensive and normotensive individuals in a casecontrol study. The study design is however criticised because of concerns
regarding the temporal sequence of events.

A

Reverse causality

85
Q

What describes the issue best: A study reports an association between coffee consumption and cancer.
However, subsequent studies find that there is a clear association between
smoking and coffee consumption.

A

Confounding

86
Q

What describes the issue best: An association between postmenopausal oestrogen use and endometrial
cancer was reported in some studies. However, it was subsequently argued
that this might be due to increased diagnostic attention received by women
with uterine bleeding after oestrogen exposure.

A

Bias

87
Q

Define randomised control trial

A

Participants are allocated to intervention and control groups using random sorting.

88
Q

Give some advantages of RCT

A

Unbiased distribution of confounders
blinding more likely
randomisation facilitates statistical analysis

89
Q

Give some disadvantages of RCT

A

Expensive
Volnteer bias
takes time
ethical to not treat?

90
Q

What is a cohort study

A

Can be prospective or retrospective. When retrospective the outcomes have already occurred. USUALLY prospective - follows a cohort

91
Q

What is a case control study

A

Always retrospective, two groups one who has disease, one who doesn’t. Look at rates of exposure of a defined risk factor.

92
Q

Advantages of case control study

A

Cheap
Easy
Assess multiple exposure

93
Q

Disadvantages of case control

A

Prone to bias (recall)
only assess one outcome
cannot establish risk

94
Q

Cohort study advantages

A

Usually prospective
Can establish risk
Can assess multiple outcomes

95
Q

Cohort studies disadvantages

A

More expensive

Longer

96
Q

What is an ecological study

A

Observes rates of disease in populations. Mostly geographical, can compare ecological studies to each other to look for trends. Can also use prevalence over time.

97
Q

What is a cross sectional study

A

Examines relationship between disease and risk in defined population at a single point or over a short period of time.

98
Q

What are the advantages of a cross sectional study

A

May be used to show prevalence.
Quick and easy
Multiple outcomes and exposures studied.

99
Q

What are the three domains of public health practice

A

Health improvement
Health protection
Health care

100
Q

What is health improvement

A

Concerned with societal interventions aimed at preventing disease, promoting health, and reducing inequalities

101
Q

What is health protection

A

Concerned with measures to control infectious disease risks and environmental hazards

102
Q

What is health care

A

The organisation and delivery of safe, high quality services for prevention, treatment, and care

103
Q

What is horizontal equity

A

Equal treatment for equal need. e.g. those with pneumonia should be treated equally

104
Q

What is vertical equity

A

Unequal treatment for unequal need. e.g. those with cold vs pneumonia need unequal treatment. Areas with poorer health need higher expenditure

105
Q

What is a health needs assessment

A

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

106
Q

What are three approaches to the health needs assessment

A

Epidemiological
Comparative
Corporate

107
Q

What is the epidemiological approach to health needs assessment

A

Define problem and size of problem. Consider services available, look at evidence, cost-effectiveness, review existing services (are they needed) and make recommendations.

108
Q

What is the comparative approach to health needs assessment

A

Compares the services received by one group to another. May examine: health status, service use, patient satisfaction

109
Q

What is the corporate approach to health needs assessment

A

Obtains views from stakeholders to make adjustments e.g. politicians, press, patients, comissioners

110
Q

What is Donabedian’s framework for health service evaluation

A

Structure e.g. staff
Process e.g. no. of patients seen
Outcome e.g. 30 day mortality rate

111
Q

What are Maxwell’s dimensions of quality (health needs assessment)

A 
3Es and 3As
Effectiveness
Efficiency
Equity
Acceptability
Accessibility
Appropriateness
112
Q

What are some examples of the Wilson and Junger criteria for screening

A 
Important health problem
Latent/preclinical phase
Natural history known
Screening test is suitable (sensitive, specific)
Screening test is acceptable
Effective treatment is available
Facilities are available
Cost-effective
113
Q

What is sensitivity

A

The proportion of people with the disease who are identified by the screening test

114
Q

What is specificity

A

The proportion of people without the disease who are correctly excluded by the screening test

115
Q

What is positive predictive value

A

The proportion of people with a positive test result who actually have the disease

116
Q

What is negative predictive value

A

The proportion of people with a negative test result who do not have the disease

117
Q

What is lead time bias

A

Phenomenon where early diagnosis/detection of a disease makes it look like people are surviving longer

118
Q

What is length-time bias

A

Fast progression diseases have a smaller time period for which they can be detected. This means that screening picks up more cases of the slow progressing disease than the aggressive ones.

119
Q

What are the Bradford-hill criteria for causality

A

Strength - stronger the association
Consistency - various studies get same result
Dose-response - Increased risk of outcome with increased exposure
Temporality - Exposure prior to outcome
Plausibility - reasonable biological mechanism
Reversibility - removal of risk decreased outcome
Coherence - logical consistency with other information
Analogy - similar to other cause-effect relationships
Specificity - Relationship specific to outcome of interest

120
Q

Name some types of error

A 
System error - equipment
Lack of skill
Ignorance - not knowing what you don't know
Poor team working
Bravado - working beyond competence
Sloth
error of inherent thinking
121
Q

What are the four components of medical negligence

A
  1. Was there duty of care
  2. Was there a breach in that duty
  3. Was the patient harmed
  4. Was the harm due to the breach in care
122
Q

What is a never event

A

A serious, largely preventable patient safety incident that should not occur. If available preventative measures should have been implemented

123
Q

What is opportunity cost

A

To spend resources on one activity e.g. a heart transplant, means sacrificing an opportunity elsewhere e.g. hip replacements

124
Q

What is economic efficiency

A

Achieved when resources are allocated between activities in a way that maximises benefit

125
Q

What is meant by an equity-efficiency trade-off?

A

Improving equity often leads to loss in efficiency. e.g. funding treatment of rare disease with expensive drugs

126
Q

How can health benefits be measured

A

Natural units (blood pressure/pain score/number of cases)
Quality adjusted life years
Monetary value

127
Q

What is horizontal equity

A

equal treatment for equal need

128
Q

What is vertical equity

A

unequal treatment for unequal need

129
Q

what are the Bradford Hill criteria for causation

A 
temporality
dose-response
strength of association
reversibility
consistency
biological plausibility
130
Q

what can association be due to

A 
bias
confounding factors
chance
reverse causality
true association
131
Q

give an example of publication bias

A

trials with negative results are less likely to be published

132
Q

lead-time bias

A

ealry identification doesnt alter outcome but appears to increase survival

133
Q

Length-time bias

A

disease that progresses more slowly is more likely to be picked up by screening

134
Q

pros of corss sectional study

A

larger sample size
rapid
repeated studies show changes over time

135
Q

cons of cross sectional study

A

risk of reverse causality
disease length bias so wont include those who recover quickly
sample size too small for rarer disease

136
Q

pros of case control study

A

good for rare outcomes

rapid

137
Q

cons of case control study

A

prone to selection bias and information bias

resource consuming

138
Q

pros of cohort study

A

can establish disease risk factors - no reverse causality
can follow rare exposure
data on confounders can be collected

139
Q

cons of cohort study

A

difficult to assess rare disease
drop outs
large sample size required

140
Q

pros of randomised control trial

A

two groups compared accurately

risok of bias and confoudners low

141
Q

cons of RCT

A

ethical issues
drop outs
expensive and time consuming

142
Q

basics of ecological study

A

population based data rather than indicidual date

geographical or time comparisons

143
Q

what are Bradshaw’s needs

A

felt need
expressed need
normative need
comparative need

144
Q

what is felt need

A

indicidual perceptions of variation from normal health

145
Q

what is expressed need

A

individual seeks help to overcome variation in normal health

146
Q

what is normative need

A

professional defines intervention appropriate for the expressed need

147
Q

what is comparative need

A

comparison between severity range of interventions and cost

e.g we need this because they have it

148
Q

two main types of health needs assessment evaluation

A

Donabedian approach

Maxwell’s dimensions

149
Q

What is the Donabedian approach to health needs assessment

A

structure - what there is
process - what is done
outcome - mortalilty etc

150
Q

what are Maxwells dimensions

A 
effectiveness
equity
efficiency
acceptability
appropriateness
accessibility
151
Q

how to calculate ABSOLUTE RISK REDUCTION (attributable risk)

A

take the risk of two interventions and subtract one from the other

152
Q

how to calculate NNT

A

1/absolute risk reduction (as a decimal not its percentage (how ARR is usually expressed))

153
Q

what is the recommended alcohol a week for women and men

A

BOTH 14 units per week

154
Q

what would count as a binge drinking episode for women and men

A

men 8 units

women 6

155
Q

how to calculate units of alcohol

A

%ABV*volume(ml)/1000

156
Q

two screening questionnaires for alcohol

A

CAGE

AUDIT

Finals (15 decks)

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