Public Health Flashcards
what are asylum seekers entitled too
-Weekly allowance
-Housing
-Free NHS care
NOT allowed to work or any other benefits
what does it mean when an asylum claim has been apporved
-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
What can be done after 5 years of refugee status ?
-Apply for indefinite leave to remain and after a year of ILR, can apply for british citizenship
what are the 3 core principles of the NHS
-Meets the needs of everyone
-Free at the point of delivery
-Based on clinical need, not ability to pay
Define the inverse care law
-The availability of good medical or social care tends to vary inversely with the need of the population served
What is Maslows Hierachy of needs
Physiological : air, water, food
Safety : security of body and resources
Love/belonging : friendship, family, intimac
Esteem : confidence
Self-actualisation
what are 3 barriers to healthcare access for homeless people
-Difficulties with access to healthcare
-Lack of integration with other agencies
-Other priorities
Define comorbidity
More than one illness or disease occurring in one person at the same time
Define multi-morbidity
More than two illnesses or diseases occurring in the same person at the same time
Define polypharmacy
Concurrent use of multiple medications in an individual (e.g. 5)
what is apporopriate polypharmacy
-Medicines have been optimised and where the medicines are prescribed according to best evidence
what is problematic polypharmacy
Prescribing of multiple medications inappropriately or where the intended benefit is not realised
Give 4 categories of the determinants of health
Genes
Environment : physical, social and economic
Lifestyle
Health care
Define equity
what is fair and just
define equality
equal shares
what is horizontal equity
Equal treatment for equal need
what is vertical equity
Unequal treatment for unequal need
E.G Individuals with common cold vs pneumonia need unequal treatment
What are the dimensions of health equity
Spatial (ie. geographical)
Social : age, gender, socioeconomic class, ethnicity)
what are the 3 domains of public health practice
-Health improvement : inequalities, education, housing etc
-Health protection : control infectious diseases etc
-Health care
What are the 3 levels of intervention when improving public health
-Individual : immunisation (delivered to each child)
-Community : E.g. playground for local community
-Ecological (population) level : smoking ban in public places
what is the approach to improving health of a population or population subgroup
Needs assessment -> planning -> implementation -> evaluation
Define need, demand and supply
Need : ability to benefit from intervention
Demand : what people ask for
Supply : what is provided
define a health needs assessment
-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
what 3 categories can a health needs assessment be carried out for
Population or sub-group
Condition
Intervention
Explain the 4 different definitions of need from a sociological perspective
-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
What are the 3 public health approaches to a health needs assessment
Epidemiological
Comparative
Corporate
what is the epidemiological approach to health needs assessment
-Informs health need based on : size of problem, services available, care of the patients and looking at evidence bases for effectiveness of services
Give 3 issues with the epidemiological approach to health needs assessment
- Doesn’t consider felt needs
- Required data may not be available
- Variable quality of the data.
what is the comparative approach to health needs assessment
-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
Give 2 + and 2 - of the comparative approach to health needs assessment
- Relies data availability
- Populations may be uncomparable
What is the corporate approach to health needs assessment
-Asks the local population what their heath needs are
-Uses focus groups, interviews, public meetings
Give 1 + and 2 - with the corporate approach to health needs assessment
-Difficult to distinguish ‘need’ from ‘demand’
-Groups mat have vested interests
What is Donabedian’s framework for a health service evaluation
Structure
Process
Outcome
What is the structure of a health service
what is there : buildings, staff, equipment etc
what is the process of a health service
- What is done : examples ->
- No. of pts seen
- The process pts go through
- No. of operations performed
How can the outcome of a health service be classified ?
- Mortality, morbidity, quality of life / PROMs, patient satisfaction
- Five Ds : death, disease, disability, discomfort, dissatisfaction
what is the issue with using health outcomes to evaluation a service?
-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
what is maxwell’s dimensions of quality for assessing quality of health care in evaluation
3 A’s =, 3 E’s
-Acceptability
-Accessibility
-Appropriateness
-Effectiveness
-Efficiency : is the output maximised for given input
-Equity
what is the qualitative method for evaluating a health service
-Observation
-Interviews
-Focus groups
-Reviews of documents
what are quantitive methods for evaluating a health service
-Routinely collected date
-Review of records
-Surveys
-Other special studies
Define primary prevention
Preventing a disease from occurring by reducing exposure or risk factor levels
Define secondary prevention
-Detecting disease early in order to alter the course of disease
OR
-Prevention of disease from recurring
Define tertiary prevention
Minimising disability or other negative effects of disease and precent complications
what is the population approach to prevention
Preventative measure delivered on a population wide basis and seeks to shift the RF distribution curve
what is the high risk approach to prevention
Identify individuals above a chosen cut off and treat them
What is the prevention paradox
A preventative measure which brings much benefit to the population often offers little to each participating individual
Define screening
Process which sorts out apparently well people who probably have disease (or precursors or susceptibility to a disease) from those who probably do not.
Define sensitivity
-Probability of a person with the disease obtaining a + test
Define specificity
-Probability that a person without the disease will test negative
How is sensitivity calculated
True positive / true positive + false negative
True positive over total no. of people with the disease who are screened
How is specificity calculated ?
True negative / True negative + false positive
Define positive predictive value
The proportion of people with a positive test result who actually have the disease
How is positive predictive value calculated ?
True positive / True positive + false positive
what is the negative predictive value
Proportion of people with a negative test result who do not have the disease
How is negative predictive value calculated
True negative / True negative + false negative
what is lead time bias ?
a patient can appear to have survived longer because the disease was diagnosed earlier, even if earlier detection made no difference to survival
what are the 3 categories of health behaviour
- 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)
what is the health belief model of behaviour change
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
What is a negative of the HMB of behaviour change
Doesn’t consider emotion
what is the theory of planned behaviour as a behaviour change model
-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
Give one + and one - of the theory of planned behaviour
- No emotions considered
- Doesn’t consider how the 3 interact
- Relies on self reported behaviour
- Assumes the 3 can be measured
What is the trans-theoretical model / stages of change model for behavioural change
- 5 stages of behaviour change
-Pre contemplation, contemplation, preparation, action, maintence
Give 3 negatives to the trans-theoretical model
- 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
Give 8 determinants of health (PROGRESS)
P : place of residence
R : race
O : occupation
G : gender
R : religion
E : education
S : socio-economic
S : social capital
What is the Wilson Jungner criteria for screening (INASEP)
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
What is length-time bias ?
-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)
what are the 5 domains of exclusion in older people
- Material resources
- Civic activities
- Basic services
- Neighbourhood
- Social relationships
what 3 principles guide resource allocation
-> 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
Give 2 descriptive observational studies
-> Ecological study : prevalence of disease over time
-> Case study : study individuals
give a descriptive and analytical observational study
Cross sectional : collects data from a population and a specific point in time
Give 2 analytical observational studies
-Cohort
-Case control
what is a cohort study
-Longitudinal study in similar groups but with different RF/treatments
-Follow them up, measure who gets disease
What is a case control study
Observational study looking at cause of a disease
what is an experimental study desgin
randomised control trial
How is odds calculated
odds = probability / 1 - probability
what is the bradford hill criteria for causality : STD R CRAP
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
Define incidence
- No. of new cases per unit time
- Increased by increasing screening
- Decreased by decreasing RF
define prevalence
- 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
define person time
time of entry to a study until (i) disease onset, (ii) loss to follow-up or (iii) end of study
How is incidence rate calculated
new cases in a time period / total person time at risk in time period
How is relative risk caclulated ?
- Ratio of risk of disease in the exposed to the risk in the unexposed
-Incidence in exposed / incidence in unexposed
R = Ratio
How is relative risk reduction calculated
1 - relative risk
How is attributable risk calculated
(DISEASE = EXPOSURE TO DISEASE IS BAD = EXPOSURE IS HIGHER)
Incidence in exposed - incidence in unexposed
what is a standard unit of alcohol
10ml/8g
What is the unit of alcohol calculation
% alcohol by volume x amount of liquid in ml / 100
Define compliance
- Extent to which a patient’s behaviour coincides with medical or health advice
- Professionally focused, doctor knows best
Define adherence
- Acknowledges patients beliefs, regards health professional as expert conveying their knowledge which results in enhanced patient knowledge, satisfaction and adherence to medical regime
define concordance
Sees patients as equals in care
They will take part in treatment decisions
Consultation is a negotiation between equals
define utilitarianism
an act is evaluated solely in terms of its consequences, it acts to maximise good
define deontology
the theory that the features of an act themselves determines worthiness
define validity
how close to the truth something is
define reliability
how consistent the results are, if the experiment was repeated would the results be the same/similar
what is used in the transition from opiate use (heroin) to abstinence
methadone
what can be used as an alternative to methadone?
buprenophine (safer)
what is used to prevent heroin relapse?
Naltrexone : opioid antagonist
(prevents the pleasure)
Relieves opioid withdrawal
Lofexidine
Opioid overdose treatment
Naloxone
How is attributable risk % calculated
Attributable risk / incidence in exposed X 100
How is absolute risk reduction calculated
(DRUG = GOOD = EXPOSURE = GOOD)
incidence in unexposed - incidence in exposed
How is number needed to treat calculated
1/absolute risk reduction
What 2 medications are used in smoking cessation
-> reduce craVVing = Varenicline
-> reduces PPleasure = Bupropion
What can be used for smoking cessation in pregnancy
Nicotine replacement -> patches, gum etc
