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3a > Public Health > Flashcards

Public Health Flashcards

1
Q

what are asylum seekers entitled too

A

-Weekly allowance
-Housing
-Free NHS care

NOT allowed to work or any other benefits

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2
Q

what does it mean when an asylum claim has been apporved

A

-5 years leave to remain in the UK
-Right to work and claim benefits
-Access to mainstream housing
-Can apply for family reunion
-Can apply for travel document

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3
Q

What can be done after 5 years of refugee status ?

A

-Apply for indefinite leave to remain and after a year of ILR, can apply for british citizenship

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4
Q

what are the 3 core principles of the NHS

A

-Meets the needs of everyone
-Free at the point of delivery
-Based on clinical need, not ability to pay

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5
Q

Define the inverse care law

A

-The availability of good medical or social care tends to vary inversely with the need of the population served

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6
Q

What is Maslows Hierachy of needs

A

Physiological : air, water, food
Safety : security of body and resources
Love/belonging : friendship, family, intimac
Esteem : confidence
Self-actualisation

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7
Q

what are 3 barriers to healthcare access for homeless people

A

-Difficulties with access to healthcare
-Lack of integration with other agencies
-Other priorities

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8
Q

Define comorbidity

A

More than one illness or disease occurring in one person at the same time

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9
Q

Define multi-morbidity

A

More than two illnesses or diseases occurring in the same person at the same time

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10
Q

Define polypharmacy

A

Concurrent use of multiple medications in an individual (e.g. 5)

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11
Q

what is apporopriate polypharmacy

A

-Medicines have been optimised and where the medicines are prescribed according to best evidence

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12
Q

what is problematic polypharmacy

A

Prescribing of multiple medications inappropriately or where the intended benefit is not realised

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13
Q

Give 4 categories of the determinants of health

A

Genes
Environment : physical, social and economic
Lifestyle
Health care

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14
Q

Define equity

A

what is fair and just

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15
Q

define equality

A

equal shares

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16
Q

what is horizontal equity

A

Equal treatment for equal need

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17
Q

what is vertical equity

A

Unequal treatment for unequal need
E.G Individuals with common cold vs pneumonia need unequal treatment

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18
Q

What are the dimensions of health equity

A

Spatial (ie. geographical)
Social : age, gender, socioeconomic class, ethnicity)

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19
Q

what are the 3 domains of public health practice

A

-Health improvement : inequalities, education, housing etc
-Health protection : control infectious diseases etc
-Health care

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20
Q

What are the 3 levels of intervention when improving public health

A

-Individual : immunisation (delivered to each child)
-Community : E.g. playground for local community
-Ecological (population) level : smoking ban in public places

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21
Q

what is the approach to improving health of a population or population subgroup

A

Needs assessment -> planning -> implementation -> evaluation

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22
Q

Define need, demand and supply

A

Need : ability to benefit from intervention
Demand : what people ask for
Supply : what is provided

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23
Q

define a health needs assessment

A

-Systematic method for reviewing the health issues facing a population, leading to agreed priorities and resource allocation that will improve health and reduce inequalities
-Done before designing an intervention

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24
Q

what 3 categories can a health needs assessment be carried out for

A

Population or sub-group
Condition
Intervention

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25
Q

Explain the 4 different definitions of need from a sociological perspective

A

-Felt : individual perceptions of variation from normal health
-Expressed : individual seeks help to overcome variation in normal health
-Normative : professional defines intervention appropriate for the expressed need
-Comparative : comparison between severity, range of interventions and cost

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26
Q

What are the 3 public health approaches to a health needs assessment

A

Epidemiological
Comparative
Corporate

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27
Q

what is the epidemiological approach to health needs assessment

A

-Informs health need based on : size of problem, services available, care of the patients and looking at evidence bases for effectiveness of services

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28
Q

Give 3 issues with the epidemiological approach to health needs assessment

A
  • Doesn’t consider felt needs
  • Required data may not be available
  • Variable quality of the data.
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29
Q

what is the comparative approach to health needs assessment

A

-Compares the services received by a population with the same service received by another : spatial, social (age, gender, class, ethnicity).
- E.g. breast services in one city compared to another

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30
Q

Give 2 + and 2 - of the comparative approach to health needs assessment

A
  • Relies data availability
  • Populations may be uncomparable
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31
Q

What is the corporate approach to health needs assessment

A

-Asks the local population what their heath needs are
-Uses focus groups, interviews, public meetings

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32
Q

Give 1 + and 2 - with the corporate approach to health needs assessment

A

-Difficult to distinguish ‘need’ from ‘demand’
-Groups mat have vested interests

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33
Q

What is Donabedian’s framework for a health service evaluation

A

Structure
Process
Outcome

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34
Q

What is the structure of a health service

A

what is there : buildings, staff, equipment etc

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35
Q

what is the process of a health service

A
  • What is done : examples ->
    • No. of pts seen
    • The process pts go through
    • No. of operations performed
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36
Q

How can the outcome of a health service be classified ?

A
  1. Mortality, morbidity, quality of life / PROMs, patient satisfaction
  2. Five Ds : death, disease, disability, discomfort, dissatisfaction
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37
Q

what is the issue with using health outcomes to evaluation a service?

A

-Causal link between service and outcome is hard to establish
-Long time lag between service provided and outcome
-Large sample sizes are needed
-Data may not be available
-Issues with data quality

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38
Q

what is maxwell’s dimensions of quality for assessing quality of health care in evaluation

A

3 A’s =, 3 E’s

-Acceptability
-Accessibility
-Appropriateness
-Effectiveness
-Efficiency : is the output maximised for given input
-Equity

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39
Q

what is the qualitative method for evaluating a health service

A

-Observation
-Interviews
-Focus groups
-Reviews of documents

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40
Q

what are quantitive methods for evaluating a health service

A

-Routinely collected date
-Review of records
-Surveys
-Other special studies

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41
Q

Define primary prevention

A

Preventing a disease from occurring by reducing exposure or risk factor levels

42
Q

Define secondary prevention

A

-Detecting disease early in order to alter the course of disease

OR

-Prevention of disease from recurring

43
Q

Define tertiary prevention

A

Minimising disability or other negative effects of disease and precent complications

44
Q

what is the population approach to prevention

A

Preventative measure delivered on a population wide basis and seeks to shift the RF distribution curve

45
Q

what is the high risk approach to prevention

A

Identify individuals above a chosen cut off and treat them

46
Q

What is the prevention paradox

A

A preventative measure which brings much benefit to the population often offers little to each participating individual

47
Q

Define screening

A

Process which sorts out apparently well people who probably have disease (or precursors or susceptibility to a disease) from those who probably do not.

48
Q

Define sensitivity

A

-Probability of a person with the disease obtaining a + test

49
Q

Define specificity

A

-Probability that a person without the disease will test negative

50
Q

How is sensitivity calculated

A

True positive / true positive + false negative

True positive over total no. of people with the disease who are screened

51
Q

How is specificity calculated ?

A

True negative / True negative + false positive

52
Q

Define positive predictive value

A

The proportion of people with a positive test result who actually have the disease

53
Q

How is positive predictive value calculated ?

A

True positive / True positive + false positive

54
Q

what is the negative predictive value

A

Proportion of people with a negative test result who do not have the disease

55
Q

How is negative predictive value calculated

A

True negative / True negative + false negative

56
Q

what is lead time bias ?

A

a patient can appear to have survived longer because the disease was diagnosed earlier, even if earlier detection made no difference to survival

57
Q

what are the 3 categories of health behaviour

A
  • Health behaviour : behaviour aimed to prevent disease (e.g healthy eating)
  • Illness behaviour : behaviour aimed to seek remedy (e.g. going to the doctor)
  • Sick role behaviour : any activity aimed at getting well (e.g. taking medications)
58
Q

what is the health belief model of behaviour change

A

Individuals will change if they :

-Believe that they are susceptible to the condition in question
-Believe that it has serious consequences
-Believe that taking action reduces susceptibility
-Believe that the benefits of taking action outweigh the costs

59
Q

What is a negative of the HMB of behaviour change

A

Doesn’t consider emotion

60
Q

what is the theory of planned behaviour as a behaviour change model

A

-Best predictor of behaviour is intention
-Intention is determined by :
- persons attitude to the behaviour
- the social pressure and societal norms
- perceived ability to perform the behaviour

61
Q

Give one + and one - of the theory of planned behaviour

A
  • No emotions considered
  • Doesn’t consider how the 3 interact
  • Relies on self reported behaviour
  • Assumes the 3 can be measured
62
Q

What is the trans-theoretical model / stages of change model for behavioural change

A
  • 5 stages of behaviour change
    -Pre contemplation, contemplation, preparation, action, maintence
63
Q

Give 3 negatives to the trans-theoretical model

A
  • Not all people move through every stage
  • Change might operate on continuum rather than discrete stages
  • Doesn’t take into account values, habits, culture, social and economic factors
64
Q

Give 8 determinants of health (PROGRESS)

A

P : place of residence
R : race
O : occupation
G : gender
R : religion
E : education
S : socio-economic
S : social capital

65
Q

What is the Wilson Jungner criteria for screening (INASEP)

A

I : important disease
N : natural Hx of disease understood
A : acceptable to population
S : simple, safe precise test
E : effective treatment
P : policy agreed on who to treat

66
Q

What is length-time bias ?

A

-Slowly progressing diseases more likely to be caught in screening, making it appear that screening prolongs life when it is only catching the slow growing types (e.g. cancer)

67
Q

what are the 5 domains of exclusion in older people

A
  1. Material resources
  2. Civic activities
  3. Basic services
  4. Neighbourhood
  5. Social relationships
68
Q

what 3 principles guide resource allocation

A

-> Egalitarian : provide all care that is necessary and required for everyone
-> Maximising : act is evaluated soley in terms of consequences
-> Libertarian : each is responsible for their own health

69
Q

Give 2 descriptive observational studies

A

-> Ecological study : prevalence of disease over time
-> Case study : study individuals

70
Q

give a descriptive and analytical observational study

A

Cross sectional : collects data from a population and a specific point in time

71
Q

Give 2 analytical observational studies

A

-Cohort
-Case control

72
Q

what is a cohort study

A

-Longitudinal study in similar groups but with different RF/treatments
-Follow them up, measure who gets disease

73
Q

What is a case control study

A

Observational study looking at cause of a disease

74
Q

what is an experimental study desgin

A

randomised control trial

75
Q

How is odds calculated

A

odds = probability / 1 - probability

76
Q

what is the bradford hill criteria for causality : STD R CRAP

A

S : strength of association
T : temporality : does exposure precede the outcome in time
D : dose response : the higher the dose of exposure reduces risk of disease
R : reversibility
C : consistency

77
Q

Define incidence

A
  • No. of new cases per unit time
  • Increased by increasing screening
  • Decreased by decreasing RF
78
Q

define prevalence

A
  • Number of people with a disease at a certain point in time
  • no. of cases of disease at a point in time / total no. of population at a certain point in time
79
Q

define person time

A

time of entry to a study until (i) disease onset, (ii) loss to follow-up or (iii) end of study

80
Q

How is incidence rate calculated

A

new cases in a time period / total person time at risk in time period

81
Q

How is relative risk caclulated ?

A
  • Ratio of risk of disease in the exposed to the risk in the unexposed
    -Incidence in exposed / incidence in unexposed
    R = Ratio
82
Q

How is relative risk reduction calculated

A

1 - relative risk

83
Q

How is attributable risk calculated

(DISEASE = EXPOSURE TO DISEASE IS BAD = EXPOSURE IS HIGHER)

A

Incidence in exposed - incidence in unexposed

84
Q

what is a standard unit of alcohol

A

10ml/8g

85
Q

What is the unit of alcohol calculation

A

% alcohol by volume x amount of liquid in ml / 100

86
Q

Define compliance

A
  • Extent to which a patient’s behaviour coincides with medical or health advice
  • Professionally focused, doctor knows best
87
Q

Define adherence

A
  • Acknowledges patients beliefs, regards health professional as expert conveying their knowledge which results in enhanced patient knowledge, satisfaction and adherence to medical regime
88
Q

define concordance

A

Sees patients as equals in care
They will take part in treatment decisions
Consultation is a negotiation between equals

89
Q

define utilitarianism

A

an act is evaluated solely in terms of its consequences, it acts to maximise good

90
Q

define deontology

A

the theory that the features of an act themselves determines worthiness

91
Q

define validity

A

how close to the truth something is

92
Q

define reliability

A

how consistent the results are, if the experiment was repeated would the results be the same/similar

93
Q

what is used in the transition from opiate use (heroin) to abstinence

A

methadone

94
Q

what can be used as an alternative to methadone?

A

buprenophine (safer)

95
Q

what is used to prevent heroin relapse?

A

Naltrexone : opioid antagonist

(prevents the pleasure)

96
Q

Relieves opioid withdrawal

A

Lofexidine

97
Q

Opioid overdose treatment

A

Naloxone

98
Q

How is attributable risk % calculated

A

Attributable risk / incidence in exposed X 100

99
Q

How is absolute risk reduction calculated

(DRUG = GOOD = EXPOSURE = GOOD)

A

incidence in unexposed - incidence in exposed

100
Q

How is number needed to treat calculated

A

1/absolute risk reduction

101
Q

What 2 medications are used in smoking cessation

A

-> reduce craVVing = Varenicline
-> reduces PPleasure = Bupropion

102
Q

What can be used for smoking cessation in pregnancy

A

Nicotine replacement -> patches, gum etc

3a (45 decks)

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