public health Flashcards
what are the dimensions of quality Maxwell designed
acceptability
accessability
appropriateness
effectiveness
efficiency
equity
what is attributable risk
rate of disease in the exposed that may be attributed to the exposure
(incidence in exposed - incidence in unexposed)
what is relative risk
ratio of rate of disease in exposed to unexposed
(exposed/unexposed)
what is the basis of the Health Belief Model
that individuals will change if:
- they believe they’re susceptible to the disease
- it has serious consequences
- that taking action reduces susceptibility
- benefits of taking action outweigh the costs
what is the theory of planned behaviour
best predictor of behaviour is intention, determined by:
- attitudes
- subjective norm
- perceived behavioural control
in the theory of planned behaviour, what helps bridge the gap between intention and behaviour
perceived control
anticipatory regret
preparatory actions
implementery intentions
relevance to self
what is the transtheoretical model
individuals located at discrete ordered stages rather than on a continuum
- precontemplation
- contemplation
- preparation
- action
- maintenance
what are the 3 main categories of health behaviour
health - aimed to prevent disease
illness - aimed to seek remedy
sick role - aimed at getting well
what are the different types of need (Bradshaw)
felt - individuals perceptions of deviation from normal health
expressed - seeking help to overcome variation in normal health
normative - professional defines intervention for expressed need
comparative - between severity, cost and range of interventions
categories in Maslow’s hierarchy of needs
self-actualisation
esteem
love and belonging
safety needs
physiological needs
what are the components of a health needs assessment
epidemiological - defines problem and size, looks at current services, recommends improvement
comparative - compares services received from other populations
corporate - takes into account views of interested groups
what are the 3 types of resource allocation
egalitarian
maximising
libertarian
what is egalitarian resource allocation and give 1 advantage and 1 disadvantage for it
provide all care that is necessary and required to everyone
ADV - equal
DADV - economically restricted
what is maximising resource allocation and give 1 advantage and 1 disadvantage for it
based solely on consequence
ADV - resources allocated to those likely to receive the most benefit
DADV - those with less need receive nothing
what is libertarian resource allocation and give 1 advantage and 1 disadvantage for it
each individual is responsible for their own health
ADV - onus on patient therefore may be more engaged
DADV - not all diseases are self-inflicted
advantages of a case control study
good for rare outcomes
quick as outcome already happened
can investigate multiple exposures
advantages of a cohort study
can follow up a group with a rare exposure
good for common and multiple outcomes
less risk of selection or recall bias
disadvantages of a cohort study
takes a long time
loss to follow ups
needs large sample size
advantages of a cross-sectional study
relatively quick and cheap
provide data on prevalence at a single point in time
large sample size
good for surveillance and public health planning
disadvantages of a cross sectional study
risk of reverse causality
cannot measure incidence
risk of recall bias and non-response
advantages of an RCT
low risk of bias and confounding factors
can infer causality
disadvantages of an RCT
time consuming
expensive
needs specific inclusions/exclusion criteria
what 5 things can association be due to
chance
bias
confounding
reverse causality
true causal association
what is sensitivity in regards to screening
proportion of those with the disease correctly identified by the test
a/a+c
what is specificity in regards to screening
proportion of those without the disease who are correctly excluded by the test
b/b+d
what is positive predictive value in regards to screening
proportion of those with a positive test who actually have the disease
a/a+b
what is negative predictive value in regards to screening
proportion of those with a negative test who do not have the disease
d/c+d
Wilson and jugner screening criteria
disease must be:
- important
- known and detectable latent phase
- known natural course of progression
there must be:
- acceptable test
- treatment
- agreed at risk group to screen
- agreed policy on who to treat
- cost is economically balanced
what is prevention paradox
preventative measure which benefits population may offer little to each participating individual
what is lead time bias
early detection and diagnosis makes it look like people are surviving longer so there is an overestimation of survival duration
what is length time bias
less aggressive disease more likely to be picked up so there will be an overestimation of survival duration due to excess of cases detected that are slowly progressing
what is ethnocentrism
tendency to evaluate other groups according to the values and standards of ones own culture
what is rationing
refusing resources based on a. lack of affordability rather than clinical ineffectiveness
problems with an epidemiological HNA
required data might not be available
variable quality in the data
does not consider felt needs
problems with a comparative HNA
populations have different needs
relies on availability of data
shows you a comparison but not neccesarily if one population is doing better/worse
problems with a corporate HNA
conflict of interest
difficult to distinguish need from demand
dominant personalities may influence
what is a transactional leader
promotes compliance with rewards and punishments
what is a Laissez faire leader
delegates, hands off approach, allows team members to make decision for themselves
what is a transformational leader
inclusive leaderships distributes throughout all levels of organisation
what is prevalence
number of cases of disease at one time/total number of people in defined population at same time
what is incidence
number of new cases of disease
factors in the Bradford hill causality method
strength
temporality
dose response
specificity
reversibility
consistency
coherence
analogy
plausability
