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Phase 3A Revision > Public Health > Flashcards

Public Health Flashcards

1
Q

Definition of health

A

A state of complete physical, mental and social wellbeing
Not merely the absence of disease

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2
Q

Three domains of public health

A

Health protection
Health improvement
Improving services

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3
Q

What is Health protection in public health

A

Measures to control infectious disease risk and environmental hazards
e.g. notifiable diseases, contact tracing for STIs, immunisations

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4
Q

Health improvement in public health

A

Social interventions aimed at preventing disease, promoting health + reducing inequality
e.g. 5-a-day, screening

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5
Q

Improving services in public health

A

Organisation and delivery of safe, high quality services
e.g. auditing and implementing recommendations

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6
Q

Domains of determinants of health

A

Genetic
Environmental
Lifestyle
Healthcare

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7
Q

PROGRESS in determinants of health

A

Place of residence
Race/ethnicity
Occupation
Gender
Religion
Education
Socioeconomic status
Social capital/resources

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8
Q

Inverse care law

A

Availability of medical or social care tends to vary inversely with the needs of the population served

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9
Q

Equality

A

Equal shares
Equality does not always mean equitable

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10
Q

Equity

A

What is fair and just

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11
Q

Horizontal equity

A

Equal treatment for equal need e.g. individuals with pneumonia should be treated equally

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12
Q

Vertical equity

A

Unequal treatment for unequal need e.g. individuals with pneumonia require more care than those with common cold

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13
Q

Forms of health equity

A

Equal expenditure for equal need
Equal access for equal need
Equal utilisation for equal need
Equal healthcare outcome for equal need
Equal health

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14
Q

Dimensions of health equity

A

Spatial e.g. geographical
Social:
- Age
- Gender
- Socioeconomic status
- Ethnicity

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15
Q

How can health equity be examined

A

Supply of healthcare
Access to healthcare
Utilisation of healthcare
Healthcare outcomes
Health status

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16
Q

Levels for improving public health

A

Individual e.g. childhood immunisation
Community e.g. playground set up for local community
Ecological/population level e.g. banning smoking in public places

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17
Q

Difference between secondary + tertiary prevention

A

Secondary: detecting disease early and preventing it worsening e.g. screening
Tertiary: once disease already well-established, improving quality of life + reducing symptoms

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18
Q

Cycle of health needs assessment

A

Needs Assessment –> Planning –> Implementation –> Evaluation –> Assessment etc.

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19
Q

What is health needs assessment

A

A systematic approach for reviewing health issues affecting a population which leads to agreed priorities and resource allocation, to improve health and decrease inequalities

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20
Q

Elements to consider in health needs assessment

A

Need - ability to benefit from an intervention
Demand - what is asked for
Supply - what is provided

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21
Q

Felt need

A

Individual perceptions of variation from normal health

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22
Q

Expressed need

A

Individual seeks help to overcome variation in normal health (demand)

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23
Q

Normative need

A

Professional defines intervention appropriate for the expressed need

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24
Q

Comparative need

A

Comparison between severity, range of interventions and cost

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25
Q

Sociological (Bradshaw) perspective on health needs elements

A

Felt need
Expressed need
Normative need
Comparative need

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26
Q

Epidemiological approach to health needs

A

Defines problem and size of problem
Looks at current services
Recommends improvements

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27
Q

Limitations of epidemiological approach to health needs

A

Data available may be poor
May be inadequate evidence base
Doesn’t consider felt need

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28
Q

Comparative approach to health needs

A

Compares services received by one population to another

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29
Q

Limitations of comparative approach to health needs

A

Data available may vary in quality
May be hard to find comparable population
Comparison may not be perfect

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30
Q

Coroporate approach to health needs

A

Takes into account views of any groups that may have an interest e.g. patients, health professionals, media, politicians

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31
Q

Limitations of corporate approach to health needs

A

May be hard to distinguish need from demand
Groups have vested interest –> bias
Dominant individuals may have undue influence

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32
Q

Egalitarian resource allocation

A

Provide all care that is necessary and required to everyone
Equal for everyone
Economically restricted

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33
Q

Maximising resource allocation

A

Based solely on consequence
Resources allocated to those likely to receive most benefit
Those with ‘less need’ receive nothing

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34
Q

Libertarian resource allocation

A

Each individual responsible for own health
Onus on patient so may be more engaged
However, not all diseases are self-inflicted

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35
Q

Donabedian framework for health service evaluation

A

Structure - what is there e.g. number of hospitals
Process (+ output) - what goes on?
Outcome - e.g. number of deaths

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36
Q

Maxwell’s dimensions of assessing quality of health service

A

3As and 3Es
Access
Appropriateness (relevant to need)
Acceptability
Equity
Efficient
Effective

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37
Q

Limitations of using health outcomes for assessment of health services

A

Link between health service provided + health outcome difficult to establish as other factors involved
Delay between service + outcome may be long
Large sample sizes required
Data may not available/may be poor

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38
Q

What is health psychology

A

Emphasises the role of psychological factors in the cause, progression and consequences of health and illness
Aims to promote healthy behaviours + prevent illness

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39
Q

Three behaviours related to health

A

Health behaviour
Illness behaviour
Sick role behaviour

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40
Q

Health behaviour

A

A behaviour aimed to prevent disease e.g. eating healthily

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41
Q

Illness behaviour

A

A behaviour aimed to seek remedy e.g. going to the doctor

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42
Q

Sick role behaviour

A

Any activity aimed at getting well e.g. taking prescribed medication, resting

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43
Q

Examples of health damaging/impairing behaviours

A

Smoking
Alcohol + substance abuse
Risky sexual behaviour
Sun exposure
Driving without a seatbelt

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44
Q

Examples of health promoting behaviours

A

Exercising
Healthy eating
Attending health checks
Medication compliance
Vaccinations

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45
Q

Stages in transtheoretical model of behaviour change

A

Precontemplation
Contemplation
Preparation
Action
Maintenance
<– relapse

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46
Q

Advantages of transtheoretical model of behaviour change

A

Acknowledges individual stages of readiness
Accounts for relapse
Temporal element

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47
Q

Disadvantages of transtheoretical model of behaviour change

A

Some individuals skip stages
Change may be continuous, not discrete
Doesn’t consider values e.g. cultural + social factors

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48
Q

Examples of models and theories of behaviour change

A

Health belief model
Theory of planned behaviour
Stages of change/transtheoretical model
Social norms theory
Motivational interviewing
Social marketing
Nudging
Financial incentives

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49
Q

Health belief model (Becker, 1974)

A

Individuals will change if they:
- Believe they are susceptible to the condition (perceived susceptibility)
- Believe that it has serious consequences (perceived severity)
- Believe taking action reduces susceptibility (perceived benefit)
- Believe benefits of taking action outweigh costs (health motivation)
Takes into account demographics + psychological characteristics + cues to action (internal or external), as well as perceived barriers

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50
Q

Advantages of health belief model

A

Can be applied to wide variety of health behaviours
Cues to action are unique
Longest standing model

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51
Q

Disadvantages of health belief model

A

Other factors may influence outcome
Doesn’t consider emotions
Doesn’t differentiate between first time and repeated behaviours

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52
Q

Elements of health belief model

A

Demoographic variables + psychological characteristics
–>
Perceived susceptibility
Perceived severity
Health motivation
Perceived benefits
Perceived barriers
–>
Likelihood of action
+ cues to action
–> Action

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53
Q

Theory of planned behaviour (Ajzen, 1988)

A

Proposes best predictor of behaviour is intention, determined by:
- Attitude to behaviour
- Perceived social pressure to undertake behaviour (subjective norm)
- Perceived behavioural control
–> Intention
–> Behaviour

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54
Q

Bridging the gap between intention and behaviour in theory of planned behaviours

A

P PAIR
Prepatory actions
Perceived control
Anticipated regret
Implementation intentions
Relevance to self

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55
Q

Advantages of theory of planned behaviours

A

Can be applied to wide variety of health behaviours
Useful for predicting intention
Takes into account importance of social pressures

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56
Q

Disadvantages of theory of planned behaviours

A

No temporal element, direction or causality
Doesn’t consider emotions
Assumes attitudes can be measured

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57
Q

Transitional points where health behaviour interventions are likely to be more effective

A

Leaving school
Entering workforce
Becoming a parent
Becoming unemployed
Retirement
Bereavement

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58
Q

Static risk factors

A

Features of a patient’s history that someone cannot deliberately intervene in and change e.g. race, childhood trauma

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59
Q

Dynamic risk factors

A

Potentially changeable risk factors that may fluctuate over time and that have the possibility of intervention e.g. substance misuse, financial problems

60
Q

Error of inherting thinking

A

Working diagnosis handed over and accepted with consideration and determination of whether this has been substantially proven/whether it matches the overall clinical picture

61
Q

Error due to failure to consider alternatives

A

Typically when one abnormality is found that fits a particular diagnosis and no further searching is done for other clues that may change the differential

62
Q

Error of overatachment

A

Conducting tests to confirm what we expect or want to see, instead of ruling out other causes
Confirmation bias
Premature closure

63
Q

Error of bravado

A

Typically working above competence in a show of over-confidence that is not safe

64
Q

Error of ignorance

A

Unconscious incompetence

65
Q

Examples of ethical frameworks

A

Four quadrants approach
Seedhouse’s ethical grid

66
Q

Factors in four quadrants approach to ethical dilemmaa

A

Medical indications (beneficence + non-maleficence): encounters include a review of diagnosis + treatment options
Quality of life (beneficence + non-maleficence): aim of encounters is to improve, or at least address, quality of life for a patient
Patient preferences (respect for autonomy): encounters occur as patient presents –> patients values are integral
Contextual features (loyalty + fairness): encounters occur in wider context beyond patient + physician e.g. family, law, policy, insurance etc.

67
Q

Layer 1 in Seedhouse’s ethical grid

A

Core rationale
Is the intervention going to create autonomy, respect autonomy, treat all persons equally and serve needs first?

68
Q

Layer 2 in Seedhouse’s ethical grid

A

Deontological layer
Is the intervention consistent with moral duties - keeping promises, telling the truth, minimising harm and generating benefit?

69
Q

Layer 3 in Seedhouse’s ethical grid

A

Consequentialism layer
Is the intervention going to provide the greatest benefit for the greatest number? Furthermore, who will be the benefactors: society, an individual, a group or onself

70
Q

Layer 4 in Seedhouse’s ethical grid

A

External considerations
Is the intervention likely to be affected by resources, the law, risks, disputed evidence or facts and degree of certainty of the evidence on which the action is taken?

71
Q

Toxic triangle for child abuse

A

Parents mental health issues
Alcohol + drug abuse
Domestic abuse

72
Q

Domestic abuse

A

Any incident or pattern of incidents of controlling, coercive, threatening behaviour, violence or abuse between current or former partners or family members in a person over 16

73
Q

Role of doctor in dealing with domestic abuse

A

Display helpline posters, give contact cards
Ensure records are kept
Vocally acknowledge it is not acceptable, be non-judgemental
Refer when appropriate
Break confidentiality if health is in danger
Don’t speak about abuse when family members are present

74
Q

DASH risk asessment

A

Low = serious harm unlikely
Medium = serious harm likely without change in circumstances –> give domestic abuse helpline contact details
High = risk of imminent harm
- Refer for multi-agency risk assessment conference (Marac) or independent domestic violence advocacy service (IDVAS)

75
Q

Wilson Jungner criteria for screening

A

INASEP
Important disease
Natural history of disease understood e.g. known disease marker
Acceptable to population e.g. not too invasive
Simple, safe, precise test
Effective treatment (early detection –> better outcomes)
Policy agreed on who to treat + screen

Cost should be economically balanced
Continuous process
Facilities for diagnosis + treatment available

76
Q

Screening disadvantages

A

Over-detection of subclinical disease
Harmful/distressing diagnostic tests e.g. colonoscopy after faecal occult blood test
Preventive interventions may be harmful e.g. side effects of medication

77
Q

Sensitivity =

A

Ability to detect people with disease
Number of true positive results/total disease population

78
Q

Specificity =

A

Ability to correctly exclude those without disease
Number of true negatives/total population without disease
Low specificity –> high number of false positives requiring follow-up

79
Q

Positive predictive value =

A

Proportion of people who test positive who actually have the diseae
True positive/total positive

80
Q

Negative predictive value =

A

Proportion of people who test negatively who do not have the disease
True negative/total negatives

81
Q

Lead-time bias

A

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

82
Q

Length-time bias

A

Slowly progressive diseases are more likey to be caught in screening, so screening appears to prolong life (whereas it is only catching slow growing disease)

83
Q

Ecological studies

A

Descriptive
Observational
Looks at prevalence of disease over time
Population data, not individual
Can show prevalence and association, but not causation

84
Q

Cross-sectional studies

A

Descriptive + analytical
Observational
Collects data from a population at a specific point in time e.g. census or patient survey

85
Q

Advantages and disadvantages of cross-sectional studies

A

+ve:
- Large sample size
- provides data on prevalence
-ve:
- No time reference –> risk of reverse causality i.e. outcome may have caused exposure

86
Q

Cohort studies

A

Analytical
Observational
Longitudinal study in similar groups, but with different risk factors/interventions
Follow-up over time to measure disease incidence
+ve:
- Can follow up rare exposure
- Can follow up naturally occuring-exposure that means RCT would not be ethical
- Allows identification of risk factors
-ve:
- Takes long time
- Expensive
- Drop out

87
Q

Case-control study

A

Analytical
Observational
Looks at cause of disease by comparing similar participants with disease, and controls without
Retrospective assessment of exposure/cause
+ve:
- Quick
- Good for looking at exposures of rare outcomes
-ve:
- Difficutly finding similarly matched control participants
- Prone to selection + information bias

88
Q

Advantages + disadvantages of RCTs

A

+ve
- Low risk of bias or confounding
- Can infer causality
-ve
- Time-consuming
- Expensive
- Can still be unrealiable if population sample not representative e.g. volunteer bias
- Not ethical in many scenarios

89
Q

Odds

A

Probability/1-probability

90
Q

Odds ratio

A

Odds that an outcome will occur given a particular exposure, compared to odds of outcome occurring in absence of the exposure
Odds of exposure in cases/odds of exposure in controls
Can be interpreted as relative risk when event is rare

91
Q

Selection bias

A

Bias in selection of study participants
e.g. loss to follow up, difference between intervention + control group

Systematic difference between characteristics of individuals sampled and the population from which the sample is taken, OR
A systematic difference between the comparison groups within the study

Most important in case-control studies

92
Q

Information bias

A

Systematic error in measurement or classification of exposure or outcome
Occurs when there is a systematic difference between comparison groups in the way that the data was collected

93
Q

Sources of information bias

A

MORRP
Measurement bias e.g. different equipment
Observer bias i.e. observer’s expectations influencing reporting
Recall bias - past events not remembered or recalled correctly
Reporting bias - respondent doesn’t report truth as they feel ashamed/judged
Publication bias - trials with negative results less likely to be published

94
Q

Bradford Hill criteria for causality

A

STD R Crap
Strength of association - magnitude of RR
Temporality - does exposure precede outcome
Dose response - higher risk of exposure –> higher risk of disease
Reversibility - removal of exposure reduces risk of disease
Consistency - similar results from different researchers using various study designs

Biological plausability

95
Q

Epidemiology

A

Study of frequency, determinants + distribution of diseases and health realted states in populations
In order to prevent and control diease

96
Q

Absolute risk vs relative risk

A

Absolute = actual numbers involved, has UNITS
Relative = ratio of risk of disease in exposed to risk in unexposed ie.g. incidence in exposed/incidence in non-exposed, NO units

97
Q

Absolute risk reduction

A

Absolute difference in the rate of events between the 2 groups
Gives an indication of baseline risk + intervention effect
Incidence in non-exposed - incidence in exposed

98
Q

Attributable risk, number needed to save:

A

Attributable = incidence in exposed - incidence in unexposed
Number needed to save = 1/attributable risk of exposure

99
Q

Number needed to treat

A

1/absolute risk reduction (as decimal)

100
Q

Addiction

A

Craving
Tolerance
Compulsive drug-seeking behaviour
Physiological withdrawal state

101
Q

Positive conditioning in addiction

A

Addiction increases desire to use drug

102
Q

Positive conditioning in addiction

A

Addiction increases desire to use drug

103
Q

Positive conditioning in addiction

A

Addiction increases desire to use drug

104
Q

Negative conditioning in addiction

A

People do not quit due to unpleasant withdrawal e.g. nausea

105
Q

Negative conditioning in addiction

A

People do not quit due to unpleasant withdrawal e.g. nausea

106
Q

Motivational interviewing

A

Attempts initiating behaviour change by resolving ambivalence

107
Q

Motivational interviewing

A

Attempts initiating behaviour change by resolving ambivalence

108
Q

Nudge theory in behaviour change

A

‘Nudge’ the environment to make the best option the easiest e.g. placing fruit next to checkouts

109
Q

Unrealistic optimism theory

A

People engage in health-risky behaviours due to inaccurate perception of risk and susceptibility

110
Q

Reasons for unrealistic optimism

A

Lack of personal experience
Hasn’t happened now –> isn’t going to happen
Believes problem is infrequent

Cultural variability
Socioeconomic factors
More common in younger age
Health belief e.g. believes healthy in other ways

111
Q

Social exclusion

A

Dynamic process of being shut out fully/partially from social, economic, cultural or political systems

112
Q

Social exclusion

A

Dynamic process of being shut out fully/partially from social, economic, cultural or political systems

113
Q

5 domains of exclusion in older people

A

Material resources
Civic activities
Basic services
Neighbourhood
Social relationships

114
Q

What does the NCSCT do?

A
  • Delivers training + assessment programmes
  • Provides support services for local + national providers
  • Conducts research into behavioural support for smokign cessation
    Overall: delivers tobacco control and smoking cessation interventions
115
Q

Why notify about communicable diseases

A

So health protection agency can take urgent control measures
May be the only one who can tell Health protection agency
Duty of registered medical practitioners

116
Q

What is included in Maslow’s hierarchy of needs

A
  • Self-fulfillment needs –>
    Self-actualisation: desire to become the most that one can be, including creativity
  • Psychological needs –>
    Esteem: respect, self-esteem etc
    Love + belonging: friendship, intimacy, family, connection
  • Basic needs –>
    Safety needs: personal security, employment, resources, health, property
    Physiological needs: air, water, food, shelter, sleep, clothing, reproduction
117
Q

Common causes of homelessness

A

Relationship breakdown
Domestic abuse
Fight with parents
Bereavement

118
Q

Common causes of homelessness

A

Relationship breakdown
Domestic abuse
Fight with parents
Bereavement

119
Q

Health problems faced by homeless

A

Mental illness
Infectious disease
Nutrition
Drug addiction
Dental + feet hygiene
Violence

120
Q

Barriers to healthcare for homeless

A

Location
Discrimination
Don’t prioritise health
May not know where to find help

121
Q

Rules about asylum seekers

A

Someone applying for refugee status
They recieve:
- Vouchers to live off
- NASS support package
- Access to NHS
Not allowed to work, and have no choice where they go

122
Q

Rules about asylum seekers

A

Someone applying for refugee status
They recieve:
- Vouchers to live off
- NASS support package
- Access to NHS
Not allowed to work, and have no choice where they go

123
Q

Refugee

A

Someone who has been granted asylum status
Usually lasts 5 years

124
Q

Humanitarian protection

A

Failed to get asylum, but serious threat of returning means they can stay for 3 years

125
Q

Health problems for refugees

A

Injury/illness from war or travelling
Communicable disease
Lack of health screening + immunisation
Malnutrition
Untreated chronic disease
Mental illness: PTSD, depression, anxiety, post-migratory stress

126
Q

Barriers to healthcare for travellers/migrants

A

Reluctance of GPs to register them
Illiteracy
Communication difficulties
Lack of permanent site
Mistrust of professionals

127
Q

Article 2 of Human Rights Act 1998

A

Right to life

128
Q

Article 2 of Human Rights Act 1998

A

Right to life

129
Q

Article 3 of Human Rights Act 1998

A

Right to freedom from inhuman + degrading treatment

130
Q

Article 8 of Human Rights Act 1998

A

Right to respect for privacy and family life

131
Q

Article 8 of Human Rights Act 1998

A

Right to respect for privacy and family life

132
Q

Article 12 of Human Rights Act 1998

A

Right to marry + find a family

133
Q

Article 12 of Human Rights Act 1998

A

Right to marry + find a family

134
Q

Article 14 of Human Rights Act 1998

A

Right to freedom from discrimination

135
Q

4 elements of negligence

A
  1. Was there a duty of care?
  2. Was there are a breach in that duty?
  3. Was the patient harmed?
  4. Was the harm due to the breach in care?
136
Q

Never events

A

Serious, largely preventable patient safety incidents that should not occur if the available preventative measures have been implemented

137
Q

GMC duties of a doctor

A

Make the care of your patient your first concern
Protect + promote the health of the public
Provide a good standard of practice + care
Treat patients as individuals and respect their dignity
Work in partnership with patients

138
Q

Intuitive thinking

A

Ability to understand something instantly without concious reasoning, recognition primed + heuristic (cognitive shortcuts), pattern recognition
+ve: fast + frugal
-ve: prone to biases

139
Q

Intuitive thinking

A

Ability to understand something instantly without concious reasoning, recognition primed + heuristic (cognitive shortcuts), pattern recognition
+ve: fast + frugal
-ve: prone to biases

140
Q

Analytical thinking

A

Not good at estimating odds or values, but very good at measuring + calculatig them
Premise of medical research + evidence-based medicine
+ve: accurate + reliable
-ve: slow, resource intensive + expensive, cognitively demanding

141
Q

Analytical thinking

A

Not good at estimating odds or values, but very good at measuring + calculatig them
Premise of medical research + evidence-based medicine
+ve: accurate + reliable
-ve: slow, resource intensive + expensive, cognitively demanding

142
Q

Dual process theory

A

Intuitive thinking with its irresistible combination of heuristics + biases AND analytical thinking –>
Not always just either/or –> BOTH in unison

143
Q

Bias

A

A systematic errior which leads to an incorrect measure of association

144
Q

Confounding

A

Occurs when an apparent association between an exposure and an outcome is actually the result of another outcome

145
Q

Methods for reducing confounders

A

Randomisation - assumes confounders are then distributed equally
Restriction - limit study to people who are similar in relation to the confounders
Matching - select two comparative groups with the same distribution of the potential confounder (case-control)

146
Q

Ecological fallacy

A

Mismatch that arises when making assumptions about an individual on the basis of a group study e.g. assuming everyone in the class has a high IQ, just because the average IQ is high

147
Q

Prevention paradox

A

SEATBELTS
Intervention that brings benefit on a population level, but little to no benefit on the individual

Phase 3A Revision (12 decks)

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