Public Health Flashcards
Define adolescent
People between 10-19 years of age
Physical changes of puberty
Growth spurt of 10-12cm per year in boys and 8-10cm in girls per year
Change in jaw and forehead (boys)
Proportion of fat increases by 25% for girls and decreases by 15% for boys
What is self compassion
Taking an understanding, non-judgemental attitude towards ones inadequacies and failures and recognising that ones experience is part of the common human experience
What is prioritisation
To arrange in order of relative importance
What is importance
The state or fact of being of great significance and value
What is explicit rationing
In full view of the public
For example NICE guidelines are explicit about when an intervention or medication should be available and to whom
What is implicit rationing
At the bedside of behind the scenes
Eg GP acting as a gatekeeper to secondary care, delaying healthcare access through waiting lists, or reducing length of stay through early discharge
What are the different forms of rationing
Denial: care which is deemed unsuitable or not urgent enough eg commissioner doesn’t fund comsemctic procedure
Selection: those most likely to benefit from treatment are selected eg commissioner specifies eligibility criteria for GP to refer to specialist
Deflection: patients encouraged or turned towards another service eg private, non A &E services etc - implicit, may be used in communications eg using 111
Deterrence: barriers (lack of information) or costs put in place - implicit or explicit
Delay: needs not met immediately eg wait for appointments or waiting lists - implicit although there may be explicit policies to counter this eg 18 week wait or 2 week cancer wait
Dilution: services given to all but amount given reduced eg reducing GP / consultant time - implicit as it isn’t specified as a rationing method
Termination: system no longer treats certain patients eg cessation of cancer screening at primary level - explicit, specified in a policy
Types of comparative analysis of interventions in terms of costs and benefits
Cost minimisation analysis (CMA)
Cost effectiveness analysis (CEA)
Cost utility analysis (CUA)
Cost benefit analysis (CBA) N
What is a health system
The sum total of all the organisations, institutions and resources whose primary purpose is to improve health
What is commissioning
Assessing needs
Deciding priorities
Buying services from providers such as hospitals and clinics
How does the money flow
From parliament to department of health to public health England to local authorities (social care , public health)
Also from parliament to department of health and then nhs England and then to CCGs and to departments such as mental health, community services, hospital, ambulance, primary care
What is presenteeism
Working when unwell (and underproductive)
Twice as costly for employers as sickness absence
May not help recovery
What are the benefits of good work
Provides people with a sense of purpose and fulfilment
Good for physical and mental health
Provides financial benefits
Benefits patients, employers and national prosperity
What is leaveism
People taking annual leave (holiday entitlement) to recover from illness
What is karoshi
Death due to overwork
Acute cardiovascular events
Very long working hours; not taking holidays
What is malingering
Illness deception for material gain eg avoiding work or gaining sickness / insurance benefits
What is factitious disorder
Obtaining attention or sympathy
- psychiatric disorder
- identification and management of illness deception in the workplace is a ‘potential minefield’
What is illness deception
Deliberate distortion of health related information in order to deceive others
Define communicable disease
A disease capable of being directly or indirectly transmitted from an infected person to another from animal to human, from animal to animal or from the environment to humans
What is the epidemiological triad
A model for disease causation made up of agent, host and environment
What are the 3 phases of an infectious disease
Incubation period: time interval between invasion by an infectious agent and the appearance of the first sign of symptom of the disease
Duration may be determines by the infecting dose
Latent period: the period between exposure and the onset of infectiousness (this may be shorter than the incubation period)
Infectious period: length of time a person can transmit a disease (sheds the infectious agent)
What is global health
Improving health and achieving equity in health for all people worldwide
Health issues whose causes or solutions lie outside the capability of one nation state
Interdisciplinary
What happens as societies develop
Infectious diseases and malnutrition decline but non communicable diseases increase
What is globalisation
Increasing interaction between nations
Increasing formal structures / agencies between nations
Pros of globalisation for health
Dissemination of knowledge and strategies to address problems
International trade - economic growth - investment in health
Cons of globalisation for health
International travel - spread of communicable disease
Multinational companies promoting smoking, sugary drinks, fast food
Effects of conflict on health
Injuries Mental health impacts Destruction of healthcare Infrastructure Health professionals leaving
Determinants of global health: migration
272 million international migrants in 2019
In high income countries, migrants more likely to bolster health services than burden them
85% refugees go to low and middle income countries
Deaths in transit (1422 deaths in Mediterranean Sea in 2020)
Interruption of care for non communicable diseases
Overcrowding and poor sanitation in refugee camps -> communicable diseases
Effects of poverty on global health
People cant afford to pay for medication
Poor living conditions
Lack of health workforce
Weak health systems
Define screening
Process of identifying apparently healthy people who may have an increased chance of a disease or condition enabling earlier treatment or informed decisions
State the different types of screening criteria
Wilson - junger
UK national screening committee
Outline the Wilson junger criteria
1) the condition should be an important health problem
2) there should be treatment for the condition
3) facilities for diagnosis and treatment should be available
4) there should be a latent stage of the disease
5) there should be a test or examination for the condition
6) the test should be acceptable to the population
7) the natural history of the disease should be adequately understood
8) there should be an agreed policy on whom to treat
9) the total cost of finding a case should be economically balanced in relation to medical expenditure as a whole
10) case finding should be a continuous process, not just a once and for all project
Outline the UK national screening committee criteria
Condition:
- important health problem
- well understood natural history with either latent period or early symptomatic stage
Test:
- simple, safe, precise, acceptable validated test
- agreed policy on investigation of screen +ves
Treatment
- evidence of benefit for screening identified cases over symptomatic cases through effective treatment
- management of disease before screening should be optimised
Programme
- RCT
- acceptable to public
- value for money
- agree plan for monitoring, management and quality assurance
- adequately staffing and facilities
- appropriate patient information available
Benefits of screening
- produces earlier diagnoses
- early diagnosis may improve prognosis for those who develop disease
- cases may be prevented
- treating early may save money
Cons of screening
Cost Anxiety to patient Test can be harmful - not 100% accurate - health inequalities - subject to bias
What is length time bias
Screening more likely to diagnose slower growing, less aggressive disease with poor prognosis
What is lead time bias
Apparent improvement in survival due to earlier detection
Define sensitivity of a test
Proportion of those with a disease which it correctly identifies
Define specificity of a test
Proportion of those without the disease which it correctly identifies
Define +ve predictive value
Probability that subject has disease given that have a +ve result
Define -ve predictive value
Probability that subject does not have disease given that they have a -ve result
State the purpose of screening tests
Assess risk of disease in asymptomatic person to determine the need for further confirmatory diagnostic testing
State the purpose of diagnostic tests
Confirm or exclude the presence of a disease
State the purpose of prognostic tests
Assess risk of future disease and need for preventative measures
State the purpose of monitoring tests
Monitor progress in response to treatment
Define case finding
Systematic or opportunistic process that identifies individuals from a larger population for a specific purpose
Define risk stratification
Systematic process that can be used to divide a population into different strata of risk for a specified outcome
