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Med 3 > Public Health > Flashcards

Public Health Flashcards

1
Q

Define adolescent

A

People between 10-19 years of age

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2
Q

Physical changes of puberty

A

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

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3
Q

What is self compassion

A

Taking an understanding, non-judgemental attitude towards ones inadequacies and failures and recognising that ones experience is part of the common human experience

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4
Q

What is prioritisation

A

To arrange in order of relative importance

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5
Q

What is importance

A

The state or fact of being of great significance and value

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6
Q

What is explicit rationing

A

In full view of the public

For example NICE guidelines are explicit about when an intervention or medication should be available and to whom

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7
Q

What is implicit rationing

A

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

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8
Q

What are the different forms of rationing

A

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

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9
Q

Types of comparative analysis of interventions in terms of costs and benefits

A

Cost minimisation analysis (CMA)
Cost effectiveness analysis (CEA)
Cost utility analysis (CUA)
Cost benefit analysis (CBA) N

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10
Q

What is a health system

A

The sum total of all the organisations, institutions and resources whose primary purpose is to improve health

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11
Q

What is commissioning

A

Assessing needs
Deciding priorities
Buying services from providers such as hospitals and clinics

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12
Q

How does the money flow

A

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

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13
Q

What is presenteeism

A

Working when unwell (and underproductive)
Twice as costly for employers as sickness absence
May not help recovery

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14
Q

What are the benefits of good work

A

Provides people with a sense of purpose and fulfilment

Good for physical and mental health

Provides financial benefits

Benefits patients, employers and national prosperity

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15
Q

What is leaveism

A

People taking annual leave (holiday entitlement) to recover from illness

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16
Q

What is karoshi

A

Death due to overwork
Acute cardiovascular events
Very long working hours; not taking holidays

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17
Q

What is malingering

A

Illness deception for material gain eg avoiding work or gaining sickness / insurance benefits

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18
Q

What is factitious disorder

A

Obtaining attention or sympathy

  • psychiatric disorder
  • identification and management of illness deception in the workplace is a ‘potential minefield’
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19
Q

What is illness deception

A

Deliberate distortion of health related information in order to deceive others

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20
Q

Define communicable disease

A

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

21
Q

What is the epidemiological triad

A

A model for disease causation made up of agent, host and environment

22
Q

What are the 3 phases of an infectious disease

A

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)

23
Q

What is global health

A

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

24
Q

What happens as societies develop

A

Infectious diseases and malnutrition decline but non communicable diseases increase

25
Q

What is globalisation

A

Increasing interaction between nations

Increasing formal structures / agencies between nations

26
Q

Pros of globalisation for health

A

Dissemination of knowledge and strategies to address problems

International trade - economic growth - investment in health

27
Q

Cons of globalisation for health

A

International travel - spread of communicable disease

Multinational companies promoting smoking, sugary drinks, fast food

28
Q

Effects of conflict on health

A 
Injuries 
Mental health impacts 
Destruction of healthcare 
Infrastructure 
Health professionals leaving
29
Q

Determinants of global health: migration

A

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

30
Q

Effects of poverty on global health

A

People cant afford to pay for medication
Poor living conditions
Lack of health workforce
Weak health systems

31
Q

Define screening

A

Process of identifying apparently healthy people who may have an increased chance of a disease or condition enabling earlier treatment or informed decisions

32
Q

State the different types of screening criteria

A

Wilson - junger

UK national screening committee

33
Q

Outline the Wilson junger criteria

A

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

34
Q

Outline the UK national screening committee criteria

A

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
35
Q

Benefits of screening

A
  • produces earlier diagnoses
  • early diagnosis may improve prognosis for those who develop disease
  • cases may be prevented
  • treating early may save money
36
Q

Cons of screening

A 
Cost 
Anxiety to patient 
Test can be harmful 
- not 100% accurate 
- health inequalities 
- subject to bias
37
Q

What is length time bias

A

Screening more likely to diagnose slower growing, less aggressive disease with poor prognosis

38
Q

What is lead time bias

A

Apparent improvement in survival due to earlier detection

39
Q

Define sensitivity of a test

A

Proportion of those with a disease which it correctly identifies

40
Q

Define specificity of a test

A

Proportion of those without the disease which it correctly identifies

41
Q

Define +ve predictive value

A

Probability that subject has disease given that have a +ve result

42
Q

Define -ve predictive value

A

Probability that subject does not have disease given that they have a -ve result

43
Q

State the purpose of screening tests

A

Assess risk of disease in asymptomatic person to determine the need for further confirmatory diagnostic testing

44
Q

State the purpose of diagnostic tests

A

Confirm or exclude the presence of a disease

45
Q

State the purpose of prognostic tests

A

Assess risk of future disease and need for preventative measures

46
Q

State the purpose of monitoring tests

A

Monitor progress in response to treatment

47
Q

Define case finding

A

Systematic or opportunistic process that identifies individuals from a larger population for a specific purpose

48
Q

Define risk stratification

A

Systematic process that can be used to divide a population into different strata of risk for a specified outcome

Med 3 (10 decks)

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