Public Health Flashcards
1
Q
What are the 3 principles that the NHS was founded on?
A
- It meets the needs of everyone
- It’s free at point of delivery
- It’s based on clinical need and not ability to pay
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.
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
4
Q
How many tiers are there in Maslow’s hierarchy of needs
A
5
5
Q
What are the tiers of Maslow’s hierarchy of needs
A
- Self actualization, mortality, creativity, lack of prejudice
- Esteem - self-esteem, confidence, achievement, respect for and by others
- Love/belonging - friendship, family, intimacy
- Safety - security of body, employment, health
- Physiological - breathing, water, sleep
6
Q
What are the two main perquisites for homelessness
A
- Eviction by private landlords
2. Relative/friends no longer offering accommodation
7
Q
What are the two domains which impact the likelihood of becoming homeless
A
- Individual circumstances
2. Wider forces
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
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
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
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
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
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
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
15
Q
Which diseases are 1.5-4x more prevalent in the traveller community
A
Chronic bronchitis, asthma, angina, pregnancy complications, smoking
16
Q
What inequalities are faced by the LGBTQ+ community
A
Social isolation, homelessness, workplace discrimination, relationship problems, crime and violence
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
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
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
20
Q
What is an asylum seeker
A
A person who has made an application for refugee status
21
Q
What is a refugee
A
A person granted asylum and refugee status. Have leave to remain for 5 years then reapply
22
Q
What is indefinite leave to remain
A
A person granted full refugee status and given permanent residence
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
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
25
What are the types of human trafficking
Sexual exploitation, domestic servitude, forced labour, forced criminality, organ harvesting
26
What are the demographics of slavery
41% forced labour, 34% sexual exploitation, 11% domestic servitude. 2/3 children, mostly from Vietnam and Slovakia
27
What are some red flags to look for when suspecting human trafficking
Timid, not registered with GP/school, accompanied by controlling person, foreign language, frequent location change, inconsistent history, no control of passport/bank, injuries untreated
28
What should you do if you suspect human trafficking
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
29
Name 4 models of behaviour change
Health belief model
Theory of planned behaviour
transtheoretical model
Social norms theory
30
What are the 4 criteria of the health belief model
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
31
What are some health motivation/cues to action in the health belief model
Internal cues e.g. heart attack or external cues e.g, advice by GP
32
Define meta-analysis
Examination of data from a number of independent studies on the same subject, in order to determine overall trends
33
What are four critiques of the health belief model
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
34
Key points of the health belief model
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
35
What are the three components of the theory of planned behaviour
Attitudes
Subjective norms/Social norms
Perceived behaviour control
36
What are attitudes
The degree to which a person has a favourable or unfavourable opinion on the behaviour of interest. e.g. do they like running
37
What is behavioural intention
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
38
What are subjective norms
The belief about whether most people approve or disapprove of the behaviour. If people important to you will approve of the behaviour
39
What are social norms
The codes of behaviour acceptable in a group of people or a larger cultural context.
40
What is perceived power
The perceived presence of factors that will facilitate or impede performance of a behaviour. The factors which contribute to perceived behavioural control
41
What is perceived behavioural control
The persons perception of the ease or difficulty of performing the behaviour. Are they able to do it?
42
Limitations of the theory of planned behaviour
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
43
Key concepts of the theory of planned behaviour
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
44
What is the stages of change model/transtheoretical model
Descrete, ordered stages with each stage denoting a greater inclination than the last
45
What are the five stages of transtheoretical model
```
Precontemplation
Contemplation
Preparation
Action
Maintenance
```
46
What stage would buying nicotine patches be in the transtheoretical model
Preparation
47
What stage would being a steady non-smoker be in the transtheoretical model be
Maintenance
48
What stage would thinking about giving up smoking be in the transtheoretical model
Contemplation
49
What stage would stopping smoking be in the transtheoretical model be
Action
50
What stage would no intention of giving up smoking be in the transtheoretical model be
Precontemplation
51
What are the advantages of the transtheoretical model
Acknowledges individual stages of readiness
accounts for relapse
temporal (time) element
52
What are the disadvantages of the transtheoretical model
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
53
Key concepts of the transtheoretical model
Precontemplation, contemplation, preparation, action, maintenance
Examines process of change rather than factors determining behaviour
Allows for interventions to be tailored for individuals
54
What are the ideas surrounding social norms theory
Scare tactics don't work
| Humans are group orientated so common beliefs and attitudes are the most influential factors influencing behaviours
55
What is a critique of social norms theory
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
56
Name three behaviours to health
Sick role
Illness
Health behaviours
57
What is the sick role
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)
58
What is illness behaviour
Behaviour aimed at seeking a remedy. (finding treatment)
59
What is health behaviour
An activity undertaken by an individual who believes themself to be healthy, for the purpose of preventing illness.
60
What are some physical consequences of loneliness
Early death, more risks, smoking
61
What are some signs of loneliness
Talkative, clinging, denial, boredom, living alone, males >50, bereavement, poor mobility, sensory impairment.
62
What are the five domains of social exclusion
```
Material resources
Civic activities
Basic services
Neighbourhood
Social relationships
```
63
Define relative risk
One intervention's risk of an event occurring compared to another's
64
Give an example of relative risk
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
Define hazard ratio
The risk of an event occurring over a set amount of time
66
Give an example of hazard ratio
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
Give an example of reverse causation
People who are already ill don't drink coffee. Coffee does not make you healthy!
68
What is the aim of a population approach to prevention
Delivered on a population wide basis and seeks to shift the risk factor distribution curse. e.g. salt restrictions in the food industry.
69
Define high risk approach to prevention
Identifies individuals above a chosen cut-off and treats them e.g. high blood pressure
70
What is the prevention paradox
A preventative measure which brings much benefit to the population, often offers little to each participating individual. e.g. statins for CVD prevention
71
What is relative risk reduction
How much the risk of an event is reduced in an experiment compared to a CONTROL group
72
What is absolute risk
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
What is number needed to treat
Number of people needed to treat for event to be prevented in 1 person
74
How to calculate NNT
Ratio between number treated and number successful. e.g. give 10 million people statins and prevent 250,000 CVD, NNT = 40
75
Define bias
A systematic deviation from the true estimation of the association between exposure and outcome
76
What are the two main types of bias
```
Selection bias (selection of participants or allocation into groups)
Information (error in measurement - observer, participant or instrument)
```
77
What are some criteria for causality
```
Strength of association
Dose-response
Consistency
Temporality
Reversibility
Biological plausability
```
78
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
Ecological study
79
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.
Case-control study
80
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.
Cross-sectional study
81
What is Person-years
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
What best describes the measure being used: For patients with meningococcal meningitis, the risk of dying has been
estimated to vary from 5-10%.
Case-fatality rate
83
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.
Odds ratio
84
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.
Reverse causality
85
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.
Confounding
86
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.
Bias
87
Define randomised control trial
Participants are allocated to intervention and control groups using random sorting.
88
Give some advantages of RCT
Unbiased distribution of confounders
blinding more likely
randomisation facilitates statistical analysis
89
Give some disadvantages of RCT
Expensive
Volnteer bias
takes time
ethical to not treat?
90
What is a cohort study
Can be prospective or retrospective. When retrospective the outcomes have already occurred. USUALLY prospective - follows a cohort
91
What is a case control study
Always retrospective, two groups one who has disease, one who doesn't. Look at rates of exposure of a defined risk factor.
92
Advantages of case control study
Cheap
Easy
Assess multiple exposure
93
Disadvantages of case control
Prone to bias (recall)
only assess one outcome
cannot establish risk
94
Cohort study advantages
Usually prospective
Can establish risk
Can assess multiple outcomes
95
Cohort studies disadvantages
More expensive
| Longer
96
What is an ecological study
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
What is a cross sectional study
Examines relationship between disease and risk in defined population at a single point or over a short period of time.
98
What are the advantages of a cross sectional study
May be used to show prevalence.
Quick and easy
Multiple outcomes and exposures studied.
99
What are the three domains of public health practice
Health improvement
Health protection
Health care
100
What is health improvement
Concerned with societal interventions aimed at preventing disease, promoting health, and reducing inequalities
101
What is health protection
Concerned with measures to control infectious disease risks and environmental hazards
102
What is health care
The organisation and delivery of safe, high quality services for prevention, treatment, and care
103
What is horizontal equity
Equal treatment for equal need. e.g. those with pneumonia should be treated equally
104
What is vertical equity
Unequal treatment for unequal need. e.g. those with cold vs pneumonia need unequal treatment. Areas with poorer health need higher expenditure
105
What is a health needs assessment
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
What are three approaches to the health needs assessment
Epidemiological
Comparative
Corporate
107
What is the epidemiological approach to health needs assessment
Define problem and size of problem. Consider services available, look at evidence, cost-effectiveness, review existing services (are they needed) and make recommendations.
108
What is the comparative approach to health needs assessment
Compares the services received by one group to another. May examine: health status, service use, patient satisfaction
109
What is the corporate approach to health needs assessment
Obtains views from stakeholders to make adjustments e.g. politicians, press, patients, comissioners
110
What is Donabedian's framework for health service evaluation
Structure e.g. staff
Process e.g. no. of patients seen
Outcome e.g. 30 day mortality rate
111
What are Maxwell's dimensions of quality (health needs assessment)
```
3Es and 3As
Effectiveness
Efficiency
Equity
Acceptability
Accessibility
Appropriateness
```
112
What are some examples of the Wilson and Junger criteria for screening
```
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
What is sensitivity
The proportion of people with the disease who are identified by the screening test
114
What is specificity
The proportion of people without the disease who are correctly excluded by the screening test
115
What is positive predictive value
The proportion of people with a positive test result who actually have the disease
116
What is negative predictive value
The proportion of people with a negative test result who do not have the disease
117
What is lead time bias
Phenomenon where early diagnosis/detection of a disease makes it look like people are surviving longer
118
What is length-time bias
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
What are the Bradford-hill criteria for causality
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
Name some types of error
```
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
What are the four components of medical negligence
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
What is a never event
A serious, largely preventable patient safety incident that should not occur. If available preventative measures should have been implemented
123
What is opportunity cost
To spend resources on one activity e.g. a heart transplant, means sacrificing an opportunity elsewhere e.g. hip replacements
124
What is economic efficiency
Achieved when resources are allocated between activities in a way that maximises benefit
125
What is meant by an equity-efficiency trade-off?
Improving equity often leads to loss in efficiency. e.g. funding treatment of rare disease with expensive drugs
126
How can health benefits be measured
Natural units (blood pressure/pain score/number of cases)
Quality adjusted life years
Monetary value
127
What is horizontal equity
equal treatment for equal need
128
What is vertical equity
unequal treatment for unequal need
129
what are the Bradford Hill criteria for causation
```
temporality
dose-response
strength of association
reversibility
consistency
biological plausibility
```
130
what can association be due to
```
bias
confounding factors
chance
reverse causality
true association
```
131
give an example of publication bias
trials with negative results are less likely to be published
132
lead-time bias
ealry identification doesnt alter outcome but appears to increase survival
133
Length-time bias
disease that progresses more slowly is more likely to be picked up by screening
134
pros of corss sectional study
larger sample size
rapid
repeated studies show changes over time
135
cons of cross sectional study
risk of reverse causality
disease length bias so wont include those who recover quickly
sample size too small for rarer disease
136
pros of case control study
good for rare outcomes
| rapid
137
cons of case control study
prone to selection bias and information bias
| resource consuming
138
pros of cohort study
can establish disease risk factors - no reverse causality
can follow rare exposure
data on confounders can be collected
139
cons of cohort study
difficult to assess rare disease
drop outs
large sample size required
140
pros of randomised control trial
two groups compared accurately
| risok of bias and confoudners low
141
cons of RCT
ethical issues
drop outs
expensive and time consuming
142
basics of ecological study
population based data rather than indicidual date
| geographical or time comparisons
143
what are Bradshaw's needs
felt need
expressed need
normative need
comparative need
144
what is felt need
indicidual perceptions of variation from normal health
145
what is expressed need
individual seeks help to overcome variation in normal health
146
what is normative need
professional defines intervention appropriate for the expressed need
147
what is comparative need
comparison between severity range of interventions and cost
| e.g we need this because they have it
148
two main types of health needs assessment evaluation
Donabedian approach
| Maxwell's dimensions
149
What is the Donabedian approach to health needs assessment
structure - what there is
process - what is done
outcome - mortalilty etc
150
what are Maxwells dimensions
```
effectiveness
equity
efficiency
acceptability
appropriateness
accessibility
```
151
how to calculate ABSOLUTE RISK REDUCTION (attributable risk)
take the risk of two interventions and subtract one from the other
152
how to calculate NNT
1/absolute risk reduction (as a decimal not its percentage (how ARR is usually expressed))
153
what is the recommended alcohol a week for women and men
BOTH 14 units per week
154
what would count as a binge drinking episode for women and men
men 8 units
| women 6
155
how to calculate units of alcohol
%ABV*volume(ml)/1000
156
two screening questionnaires for alcohol
CAGE
| AUDIT
