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Medicine Finals > Public Health > Flashcards

Public Health Flashcards

1
Q

What is the altruism approach to medical ethics?

A

The moral value of an individual’s actions depends solely on the impact on other individuals

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2
Q

What is the egoism approach to medical ethics?

A

The self-interest of an action is the foundation of the morality of that action

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3
Q

What is the utilitarian approach to medical ethics?

A

Actions that maximise happens and wellbeing for the majority of the population are the best actions
The interests of all beings are equal

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4
Q

What is the deontological approach to medical ethics?

A

The morality of an action should be based on whether the action itself is right or wrong under a series of rules

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5
Q

What is the consequentialist approach to medical ethics?

A

The consequences of one’s conduct are the ultimate basis of any judgement about whether it is morally right

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6
Q

What is the virtue ethics approach to medical ethics?

A

Emphasises the virtue of mind, character and sense of honesty.

Focuses on character traits

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7
Q

What is the libertarianism approach to medical ethics?

A

Maximising freedom, autonomy and individual judgement

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8
Q

What are egalitarian principles?

A

All people are equal and deserve equal rights

Not treating all the same but what is appropriate for each person

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9
Q

What are the three domains of public health?

A

Health improvement - societal interventions to prevent disease and promote health

Health protection - control of infectious diseases and environmental hazards

Improving services - organisation and delivery of safe services

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10
Q

What are determinants of health?

A 
Genes
Environment - physical, social
Lifestyle - diet, smoking
Health seeking behaviour
Socioeconomic status
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11
Q

What is the difference between equality and equity?

A

Equality is everyone having exactly equal whereas equity is having what is fair and just

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12
Q

What is the difference between horizontal equity and vertical equity?

A

Horizontal equity = equal treatment for equal need e.g. all those with pneumonia treated the same

Vertical equity = unequal treatment for unequal need e.g. those with a cold need diff treatment to pneumonia, areas with poorer health may need more expenditure

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13
Q

What are the different levels of health intervention?

A

Individual level - patient centred approach - aimed at those with existing risky behaviour eg medication, smoking cessation

Community level - e.g. support groups

Population levels - policies or programmes aimed to shift distribution of health risk e.g. screening programmes, water fluoridation, immunisation programmes

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14
Q

What are the three different classifications of disease prevention?

A

Primary prevention = No disease. To prevent onset of illness before disease process begins (e.g. statin, exercise, immunisation)

Secondary prevention = Pre-clinical disease. To promote early diagnosis

Tertiary prevention = Clinical disease. Following significant illness.

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15
Q

What are the two different approaches to prevention?

A

Population approach = e.g. legislation on dietary salt

High-risk approach = screening for people at high risk, medication for people within a cut off

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16
Q

What is the Wilson and Jungner screening criteria?

A

The condition must =

  1. Be an important health problem
  2. Have a latent/pre-clinical phase
  3. Natural history must be known

The screening test must be=

  1. Suitable (sensitive, specific, inexpensive)
  2. Acceptable

The treatment must=

  1. Be effective
  2. Have an agreed policy on who to treat

The organisation and cost

  1. Facilities must be available
  2. Costs and benefits measured
  3. It be an ongoing process
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17
Q

What is false positive?

A

Those without the condition incorrectly identified as having the condition

Number of people who had a positive result who didn’t actually have it

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18
Q

What is false negative?

A

Those with the condition incorrectly identified as not having the condition

Number of people who have had a negative result who actually had it

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19
Q

What is true positive?

A

Those with the condition correctly identified as having it

Number of people who had a positive result who did have it

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20
Q

What is true negative?

A

Those without the condition correctly identified as not having it

Number of people who had a negative result who didn’t have it

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21
Q

How to calculate sensitivity?

A

Proportion of those with the disease who were correctly identified

True positives / True positives + false negatives

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22
Q

How to calculate specificity?

A

Proportion of those without the disease who were correctly identified as not having it

True negatives / True negatives + false positives

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23
Q

How to calculate PPV?

A

Proportion of all those with a positive test result who did actually have the disease

True positives / true positives + false positives

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24
Q

How to calculate NPV?

A

Proportion of those with a negative result who did not have the disease

True negative / true negative + false negatives

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25
Q

What is lead time bias?

A

Screening causes an apparent addition of time between detection of the disease up to survival

However not necessarily survived any longer, just diagnosed earlier

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26
Q

What is length time bias?

A

Overestimation of survival duration due to detection of cases which are asymptomatically slowly progressing

Fast progressing cases are more likely to be detected symptomatically

Makes it seem that those who are detected on screening do better but may not be the case

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27
Q

What is a cohort study?

A

Prospective study to identify causation - Start with a population without a disease, study them over time to see the effect of an exposure on their outcome

Can compare to a control group which is not exposed to this exposure (need the control to establish causation)

Prospective means it can show causation

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28
Q

What are advantages and disadvantages of a cohort study?

A

Advantages:
Can follow up groups with rare exposures e.g. radiation or dangerous exposures e.g. smoking - which you wouldn’t be able to control experimentally
Less risk of selection and recall bias

Disadvantages:
Takes a long time
May be loss to follow up (people drop out)
Need a large sample size

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29
Q

What is a case control study?

A

A retrospective study to identify risk factors

Take people with a disease, match them to people without the disease (sex/age etc)

Study their previous exposure

30
Q

What are advantages and disadvantages of a case control study?

A

Advantages:
Good for rare outcomes
Quicker than cohort study as outcome has already happened
Inexpensive

Disadvantages:
Can be difficult to match cases
Prone to selection and information bias
Data may not be reliable to memories

31
Q

What is a cross-sectional study?

A

Divides a population into those with and without a disease

Collects data on them at a defined point of time to find associations

32
Q

What are advantages and disadvantages of a case control study?

A 
Advantages:
Quick and cheap
Provides data on prevalence 
Large sample size possible
Good for surveillance

Disadvantages:
Risk of reverse causality as there is no time
Cannot measure incidence
Recall bias

33
Q

What is a randomised control trial?

A

Prospective study

Patients are randomised into groups, one group receives an intervention and the other receives a control

Outcome is measured

34
Q

What are advantages and disadvantages of a randomised control trial?

A

Advantages:
Low risk of bias and confounding
Can infer causality

Disadvantages:
Time consuming
Expensive
Ethical issues
Can't test dangerous exposures
35
Q

What is the independent and dependent variable?

A

Independent variable = variable which is altered in the study

Dependent variable = variable that you are measuring

36
Q

What is odds?

A

The ratio of the probability of an occurrence, compared to the probability of non-occurrence

Probability / (1-probability)

37
Q

What is odds ratio?

A

The ratio of odds of event for the exposed group, compared to the odds of the event for the non exposed group

OR = Odds of exposed group / Odds of non exposed group

38
Q

What is incidence?

A

Number of new cases over a period of time

39
Q

What is prevalence?

A

Number of existing cases at a specific point in time

40
Q

What is relative risk?

A

Ratio of risk of disease in the exposed to the risk in the unexposed

As a ratio, no units.

Risk in intervention / Risk in control

41
Q

What is absolute risk?

A

Has units, gives a feel for actual numbers involved

e..g. 50 deaths per 1000 population

42
Q

What is absolute risk reduction?

A

Absolute difference in the rates of events between two groups.

E.g.

If incidence on new treatment = 6 in 1000 people = 0.006
and incidence on placebo = 10 in 1000 people = 0.01

Absolute risk reduction = 4 in 1000 people = 0.004

43
Q

What is relative risk reduction?

A

Reduction in rate of outcome in intervention group, relative to control group

If relative risk in intervention group = 0.6
Then relative risk reduction is 40%

Risk of control group - Risk of intervention group
Divided by
Risk of control group

44
Q

What is number needed to treat?

A

Number of patients we need to treat to prevent one bad outcome

1 / ARR

45
Q

What is bias?

A

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

46
Q

What are confounding factors?

A

A situation in which the estimated association between an exposure and an outcome is distorted because of the association of the exposure with another factor (confounder) that is also independently associated with the outcome

47
Q

What is reverse causality?

A

When an association between an exposure and an outcome could be due to the outcome

48
Q

What is selection bias?

A

Systematic error in the selection of study participants or allocation to groups

49
Q

What is information bias?

A

Systematic error in the measurement or classification of exposure or outcome

Can either be observer bias, participant bias (recall or reporting bias) or instrument bias

50
Q

What is publication bias?

A

Positive results are more likely to be published than negative results

51
Q

What are the 3 different approaches to a health needs assessment?

A

Epidemiological approach
Comparative approach
Corporate approach

52
Q

What is a health needs assessment?

A

A systematic method for reviewing th e health issues facing a population, leading to agreed priorities and resource allocation that will improve health and reduce inequalities

53
Q

What is need, supply and demand?

A 
Need = ability to benefit from an intervention
Demand = what people ask for
Supply = what is provided
54
Q

What are the four different types of need?

A

Felt Need - Individual perceptions of variation from normal health
Expressed Need - Individual seeks health to overcome variation in normal health
Normative Need - Professional defines intervention appropriate for the expressed need
Comparative Need - Comparison between severity, range of interventions and cost

55
Q

What is the epidemiological approach to a health needs assessment - what are advantages and disadvantages?

A

Problem is defined in terms of epidemiological values - size of problem/services available/evidence base/existing services

Advantages=
Uses existing epidemiological data, provides data on disease incidence/mortality/morbidity

Disadvantages=
Quality of data is variable
Does not consider felt needs

56
Q

What is the comparative approach to a health needs assessment - what are advantages and disadvantages?

A

Compares the services received by a population with others
May examine health status/service provisions/service utilisation

Advantages=
Quick and cheap if data is already available
Indicates whether a certain service is better or worse than a comparative are

Disadvantages=
Can be difficult to find a comparative population
May not yield information about what the most appropriate methods are

57
Q

What is the corporate approach to a health needs assessment - what are advantages and disadvantages?

A

Asks the local population what they think their health needs are
Uses focus groups, interviews, meetings

Advantages=
Based on felt needs and expressed needs
Takes into account wide range of views

Disadvantages=
Difficult to distinguish need from demand
May be influenced by political agenda
Dominant voices may have undue influence

58
Q

What is the Donabedian Framework of health service evaluation?

A

SPO - Structure, process, outcome

Structure = What is there (buildings, staff, equipment)

Process = What is done (e.g. number of patient seen, number of procedures)

Outcome = Mortality, morbidity, QOL, patient satisfaction

59
Q

What are Maxwell’s 6 dimensions of quality?

A 
3 E's and 3 As
Effectiveness
Efficiency
Equity
Acceptability
Accessibility
Appropriateness
60
Q

What is health behaviour?

A

A behaviour aimed at preventing disease e.g. eating healthy

61
Q

What is illness behaviour?

A

A behaviour aimed at seeking remedy e.g. going to the GP

62
Q

What is sick role behaviour?

A

A behaviour aimed at getting better e.g. resting, taking medication

63
Q

Why do people engage with risky behaviour?

A

HIPP

Lack of Personal experience with the problem
Belief that it is Preventable
Belief that it hasn’t Happened so it won’t
Belief that the roblem is Infrequent

64
Q

What is the health belief model? What is a critique of the health belief model?

A

Individuals will change if they:

1) Believe they are susceptible to the condition
2) Believe that it has serious consequences
3) Believe that taking action reduces susceptibility
4) Believe that the benefits of taking action outweigh the costs

Alternative factors are not considered - self-efficancy
Does not consider influence of emotions
Does not differentiate between first time and repeat behaviour

65
Q

What is the theory of planned behaviour? ASP

How can this be critiqued?

A

Proposes that the best predictor of behaviour is intention
E.g. “I intend to stop smoking”

Intention is determined by:

  1. Attitude to the behaviour “I do not think smoking is good”
  2. Subjective norms “People want me to stop smoking”
  3. Perceived behavioural control “I believe I have the ability to stop”

CRITIQUE:
Lacks direction ofr causality
Does not take into account emotions
Useful to predict intentions but not actual behaviour

66
Q

What are the Bradford Hill Criteria for causation?

A

xx

67
Q

What is the difference between lead time and length time bias?

A

Lead time bias= Early identification doesn’t alter outcome but appears to increase survival
e.g. patient knows they have the disease for longer

Length time bias= Disease that progress more slowly is more likely to be picked up by screening (i.e. symptom free and around for longer), which makes it appear that screening prolongs life.

68
Q

What is the transtheoretical model of health behaviour? PC PAM!!

A

PCPAM!!!

Precontemplation - not ready yet
Contemplation - starting to consider
Preparation - getting ready
Action - doing it
Maintenance - sticking with it 
Relapse
69
Q

How can the transtheoretical model of health behaviour be critiqued?

A

Not all people move through all stages

Doesn’t take into account values, habits, culture, social, economic factors

70
Q

What are types of error?

A

Sloth =

Bravado =

Lack of skill =

Communication breakdown =

Lack of team working =

Mis-triage =

Ignorance =

Fixation =

Medicine Finals (32 decks)

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