Public Health Flashcards
Define Error of inheriting thinking?
when a working diagnosis is handed over and accepted without pause for consideration and determining whether it has been substantially proven or whether it matches the overall clinical picture
Define Error due to failure to consider alternatives?
when one abnormality is found that fits a particular diagnosis and so you stop searching for other potential clues that may change your differential
Define Error of overattachment?
conducting tests to confirm what we expect or want to see and not ruling out other causes
Define Error of bravado?
typically working above competence in a show of over confidence that is not safe
Define Error of ignorance?
Unconsiouss incompetence
Define horizontal and vertical equity?
Horizontal = equal treatment for equal need Verticle = unequal treatment for unequal need
Define an epidemiological health needs assessment?
Defines a problem and size of the problem. Looks at current services and recommends improvements.
Uses existing data!
Define a comparative health needs assessment?
Compares the services recieved by one population to another.
May examine health status, service provision and service utilisation
Define a corporate health needs assessment?
Asks the local population what their health needs are, uses focus groups, interviews etc.
Also takes into account views of health care proffessionals, busniessess, social workers and politicians etc.
Define felt need?
Individual perceptions of deviations from normal health
Define expressed need?
Seeking help to overcome variation in normal health
Define normative need?
Professional defines intervention for an expressed need
Define comparative need assessment?
Comparisons between severity, range of interventions and cost
What are the 3 methods of resource allocation?
Egalitarian (provide all care that is necessary and appropriate to everyone)
Maximising (based soley on consequence and need)
Libertarian (each individual is responsibe for their own health)
Define health behaviour, illness behaviour and sick role behaviour?
Health behaviour = aimed at preventing disease (e.g. going for a run)
Illness behaviour = seeking remedy (e.g. going to the gp for a symptom)
Sick role behaviour = activity aimed at getting well (e.g. taking antibiotics)
What are the stages of the transtheoretical model (for change)
Precontemplation, Contemplation, Preparation, Action, Maintenance (relapse can occur at any time)
In the theory of planned behaviours how can we bridge the gap between intention and behaviour?
Preparatory actions, Percieved control, Anticipated regret, Implementation of intentions, Relevance to self
Name the elements of the health belief model?
Perceived susceptibility, prercieved severity, health motivation, percieved benefits, percieved barriers
What is a Never Event?
A serious, largely preventable patient saftey incident that should not occur if available, preventative measures have been implemented.
What is a cross-sectional study?
A snapshot of data of those with and without disease to find associations at a single point in time.
Used to generate hypotheses but are prone to bias
What is a case-control study?
A retrospective study which looks at certain exposures and compares similar participants with and without the disease. Can only show association (not causation) and relies on people having good memory
What is a cohort study?
A prospectivee study which takes a population without a disease and records their exposures and conditions which they develop. Can show causation
What is a Randomised Control Trial?
A group of similar participants randomly sorted into intervention or control groups to study the effect of the intervention.
GOLD STANDARD but there are ethical issues around withholding Tx
What is a confounder?
A risk factor other than those being studied which influence the outcome
Define bias?
A systematic error that results in a deviation from the true effect of an exposure on an outcome
Define selection and publication bias?
Selection bias = discrepancy of who is involved in a study or who is allocated to which study group
Publication bias = some trials are more likely to be published than others
Define the types of information bias?
Measurement bias = different equipment used or instruments are wrongly calibrated
Observer bias = the reporter is incorrect when observing or recording data
Recall bias = past events are remembered incorrectly
Reporting bias = responder doesn’t tell the truth
Define epigenetics?
Expression of a genome depends on the environment
Define allostasis?
Stability through change, our physiological systems have adatpted to react rapidly to environmental stressors
Define allostatic load?
Long term overtaxaion of our physiological systems leads to impaired health (stress)
Define salutogenesis?
Favourable physiological changes secondary to experiences which promote healing and health
Define emotional intelligence?
The ability to identify and manage ones own emotions as well as those of others
Under which circumstances should you always prescribe antibiotics (pt.1)
Bilateral otitis media in <2 years.
Acute otitis media with otorrhoea.
Acute sore throat with 3 or more of: exudate, fever, tender cervical lymphadenopathy, absence of cough.
Systemically very unwell.
Under which circumstances should you always prescribe antibiotics (pt.2)
High risk.
Age >65 and 2 of the following or >80 and 1 of the following: hospital admission within the last 12 months, type 1 or type 2 diabetes, congestive HF, glucocorticoid use.
Complications: pneumonia, mastoiditis, peritonsilar abscess and cellulitis
Which Abx is most appropriate in otitis media?
Amoxicillin 5 days
Which Abx is most appropriate in sinusitis?
Amoxicillin 5 days or Doxycycline 5 days
Which Abx is most appropriate in tonsillitis?
Penicillin 10 days
Which Abx is most appropriate in LRTI?
Amoxicillin 5 days
Which Abx is most appropriate in UTI?
Trimethoprim 3 days or Nitrofurantoin 3 days
What are the 3 domains of public health?
Health improvement - social interventions
Health protection - measures to control infectious disease, risks and environmental hazzards
Improving services - organisation and delivery of safe and high quality services
What is a health needs assesment?
A systematic method for reviewing the health issues facing a population
What is a health needs assement based on?
Need = ability to benefit from an intervention Demand = what people ask for Supply = what is provided
Define primary, secondary and tertiary prevention?
Primary = preventing a disease before it has happened Secondary = catching diseases in the pre-clinical or early phase Tertiary = preventing complications of disease
What is the prevention paradox?
A preventative measure which brings much benefit to the population often offeres little to each participating individual
Define screening?
A process which sorts out apparently well people who probably have a disease (or precursors/susceptibility to a disease) from those who probably do not. NOT diagnostic!
What is the Wilson and Junger criteria for screening?
The condition = an important health problem, latent/preclinical phase, natural history known
The test = suitable and acceptable
The treatment = effective and agreed policy on who to treat
The organisation and cost = facilities available, costs of screening is balanced in relation to healthcare spending as a whole
Define sensitivity?
The proportion of people with the disease who are correctly identified by the screening programme
TP/(TP + FN)
Define specificity?
The proportion of people without the disease who are correctly excluded by the screening test
TN/(TN+FP)
Define positive predicitve value? How does preverlance affect this?
The proportion of people with a positive test result who actually have the disease.
Higher if prevelance is higher
TP/(TP+FP)
Define negative predicitve value? How is this affected by prevelance
The proportion of people with a negative test who do not have the disease
Lower if prevelance is higher
TN/(FN+TN)
What is an ecological study?
Uses routinley collected data to show trends in data and is useful in generating a hypothesis. It shows preverlance and association but can not show causation.
Define epidemiology?
The study of the frquency, distribution and determinants of dieases and health related states in populations in order to prevent and control disease
Define incidence?
New cases of a disease in a population over a specified period of time
Define prevelance?
The proportion of persons in a population who have a particular disease at a specified point in time
Define relative risk?
How many times more likely it is that a health event will occur in the one group compared to another (intervention group compared to the control)
Define number needed to treat?
The number of patients who we need to treat to prevent one bad outcome
What are the symptoms of drug addiciton?
Craving, tolerance, compulsive drug-seeking behaviour, priortising drugs, psychological withdrawal state
What is the first-line drug used in detoxification of heroin? Who is this likely to work on?
Buprenorphine
Younger users, less time addicted, often not injecting, lower level of drug use
Which medications can be used in maintenance of heroin abstinence?
Methadone, buprenorphine
Naltrexone - prevent relapse
What drug treatments can be offered to aid smoking cessation? Which is the most affective
NRT, Varenicline or Bupropion Combined NRT (a patch plus a short acting preparation) or Vareniciline
When should you start taking the different nicotine replacement therapies?
NRT = on the day of quitting Varenicline = 7-14 days before quitting Bupropion = 7-14 days before quitting
How long can NRT patches be used for?
16 hours (and taken off over night) or 24 hours
What drug treatments can be offered to aid smoking cessation in pregnant or breastfeeding women?
NRT - this can only be precribed if she has previously failed to quit without NRT!
How quickly must you provide information to the Health Protection Agency if requested?
In writing within 3 days
Define an outbreak?
2 or more related cases of a communicable disease
What are the health problems commonly found amoungst homeless people?
Infectious disease (TB and hepatitis). Poor condition of feet and teeth. Respiratory issues. Injuries following violence and rape. Sexual health issues. Serious mental illness. Poor nutrition. Addictions
What are the types of leadership?
Inspirational, transactional, laissez-faire, transformational
Define Bolam test (in relation to negligence)?
Would a group of reasonable doctors do the same?
Define Bolitho test (in relation to negligence)?
Would it be reasonable of them to do so?
What are the types of learner?
Theorist, Activist, Pragmatist, Reflector
Define Ethnocentrism?
The tendency to evaluate other groups according to the values and standards of ones own cultural group with the conviciton that ones own cultural group is superior
Define Stereotype?
Involves generalisations about the ‘typical’ charcteristics of members of a group
Define prejudice?
Attitudes towards anotehr person based soley on their membership of a group
Define discrimination?
Actual positive or negative actions towards the objects of prejudice
Define rationing?
A resource is refused because of lack of affordability rathter than clinical ineffectivness
What are the GMC duties of a doctor?
Make the care of your patient your first concern.
Protect and promote the health of patients and the public.
Provide a good standard of practice and care.
Treat patients as individuals and respect their dignity.
Work in partnership with patients.
Be honest and open and act with integrity
What are the stages of wound healing?
Vascular response, inflammatory response, proliferation and maturation
What are the elements of the 4 quadrant approach to ethics?
Medcial indications (beneficence and non-maleficence) Patient preference (respect autonomy) Quality of life (beneficence and non-maleficence) Contextual features (loyalty and fairness)
What is invovled in the seed house ethical gird?
Transparency and honesty, respect and care, consious freedom, experiential and tacit awareness, reflexive practice
What are the core features of the seed house ethical grid?
Core rationale, deontological layer, consequential layer and external considerations
Transition points are a thing in life which may influence someone to be more or less likely to change their behaviours. Give 4 examples?
Becoming a parent, becoming unemployed, bereavement and leaving school
Which score is used to assess pressure ulers?
Waterlow score
What are the elements of maxwells dimensions of quality?
Effectivness, acceptability, efficiency, access, equity and relevance
What is in the Bradford-Hill criteria?
Strength (effect size), consistency (reproductibility), specificity, temporality, dose-dependant relationship (biological gradient), plausability, coherence, experiment and analogy
What are the 4 componenets of negligence?
Duty of care, breach in this, harm, harm because of breach
