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Phase 3a Public Health > Public Health > Flashcards

Public Health Flashcards

1
Q

What are the 3 domains of public health?

A

Health Improvement, health protection, improving services

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2
Q

What is the inverse care law?

A

The availability of medical care tends to vary inversely with the need of the population served

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3
Q

What is horizontal equity?

A

Equal treatment for equal need - e.g. all people with pneumonia deserve equal treatment

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4
Q

What is vertical equity?

A

Unequal treatment for unequal need - e.g. individuals with pneumonia deserve different treatment from those with a common cold

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5
Q

What are the 9 parts of the Bradford Hill Criteria for causation?

A

Dose-response, reversibility, biological plausibility, consistency, strength, temporality, coherence, analogy, specificity

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6
Q

What is bias?

A

Systematic differences between comparison groups which may misrepresent the association being investigated

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7
Q

What is a confounding factor?

A

Situation where a factor is associated with the exposure of interest and independently influences outcome

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8
Q

What is chance?

A

Possibility that there is a random error

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9
Q

What is selection bias?

A

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

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10
Q

What is information bias?

A

Systematic error in the measurement or classification of exposure or outcome e.g. observer, recall bias, instrument

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11
Q

What is lead time bias?

A

Early identification doesn’t alter outcomes but appears to increase survival (patients have disease for longer)

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12
Q

What is length time bias?

A

A disease that progresses more slowly is more likely to be picked up by screening which makes it appear that screening prolongs life

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13
Q

What is a cross-sectional study?

A

Observation study collecting data from a population at a specific point in time (snap shot)

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14
Q

What are some advantages and disadvantages of cross-sectional?

A

+ large sample size, rapid, repeated studies can show change over time

  • sample too small for rare outcomes/diseases, reverse causality, disease length bias (those who recover quickly won’t be included)
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15
Q

What is a case control study?

A

Retrospective study looking at population with disease and control population - looking for causes of the disease

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16
Q

What are the advantages and disadvantages of a case control study?

A

+ good for rare outcomes/diseases, rapid

  • prone to selection bias and information bias, resource consuming trying to find well matched controls
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17
Q

What is a cohort study?

A

Prospective study looking at separate cohorts with different treatments/exposures applied and wait to see if disease occurs

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18
Q

What are the advantages and disadvantages of a cohort?

A

+ can establish disease risk factors (no chance for reverse causality as disease hasn’t occurred yet), can follow rare exposures, data on confounders can be collected prospectively

  • difficult to assess rare disease (may not develop), loss to follow up, large samples size required
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19
Q

What are the advantages and disadvantages of a RCT?

A

+ two groups can be compared accurately, risk of bias and confounding minimised by it being prospective and randomised

  • Ethical issues, drop outs, expensive and time consuming
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20
Q

What is an ecological study?

A

Population based data rather than individual data - compares two areas/two years

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21
Q

What is 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

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22
Q

What is a felt need?

A

Individual perceptions of variation from normal health e.g. cannot walk as far

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23
Q

What is an expressed need?

A

Individual seeks help to overcome variation in normal health e.g. seeks help from doctor

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24
Q

What is a normative need?

A

Professional defines intervention appropriate for the expressed need e.g. go to cardiopulmonary rehab

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25
Q

What is a comparative need?

A

Comparison between severity, range of intervention and cost e.g. patient improves and then service is oversubscribed, there are worse patient than them so in comparison they are no longer a priority

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26
Q

What are the 4 stages of the planning cycle?

A

Needs assessment, planning, implementation, evaluation

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27
Q

What are the problems with an epidemiology approach to health needs assessment?

A

Does not consider felt needs of people it is catering for, reinforces purely biomedical approach, requires existing data to compare off to be of high quality

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28
Q

What are the problems with a comparative approach to health needs assessment?

A

Difficulty in finding comparable groups, may be comparing 2 poor quality services, requires existing data to be of high quality

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29
Q

What are the problems with a corporate approach to a health needs assessment?

A

May be difficulty to distinguish need from demand, certain groups may have vested interests or be influenced by political agendas, dominant personality may have undue influences

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30
Q

What is the Donabedian approach to evaluation?

A

Death, disease, disability, discomfort, dissatisfaction

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31
Q

What are the Maxwell’s dimensions?

A

Effectiveness, efficiency, equity, acceptability, accessibility, appropriateness

32
Q

What is the Wright’s matrix?

A

Brings together Maxwell’s dimensions and Donabedian approach

33
Q

What is incidence?

A

Number of new cases in time period / size of population

34
Q

What is prevalence?

A

The number of existing cases in a population at a specific point in time

35
Q

What is relative risk?

A

Compares disease in exposed versus the unexposed
(a/a+b) / (c/c+d)

36
Q

What is the attributable risk/absolute risk reduction?

A

The difference in the disease rates in exposed and unexposed individuals
(a/a+b) - (c/c+d)

37
Q

What is the number needed to treat?

A

The number of patients who need a specific treatment to prevent 1 bad outcome

NNT = 1/attributable risk

38
Q

What is screening?

A

A process which sorts out apparently well people who probably have a disease from those who do not

39
Q

What is primary prevention?

A

Preventing a disease from occurring in the first place

40
Q

What is secondary prevention?

A

Detection of early disease in order to alter the course of the disease and maximise the chances of a complete recovery

41
Q

What is tertiary prevention?

A

Trying to slow down the progression of disease and stop complications

42
Q

What is sensitivity?

A

The proportion of people with the disease who are correctly identified by the screening test

a/a+c

43
Q

What is specificity?

A

The proportion of people without the disease who are correctly excluded by the screening test

d/b+d

44
Q

What is the PPV?

A

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

a/a+b

45
Q

What is the NPV?

A

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

d/c+d

46
Q

What are the parts of the Wilson and Junger criteria?

A

Condition - serious health problem, causes should be well understood, should be a detectable early stage

Treatment - should be an accepted treatment for the disease, facilities for diagnosis and treatment should be available, cannot be an unmanageable extra clinical workload

Test - suitable test should be devised for the early stage, test should be acceptable for patients, intervals for repeating test should be determined

Benefits - should be an agreed policy on whom to treat, cost should be balanced against benefits

47
Q

What is health behaviour?

A

Behaviour aimed at preventing disease e.g. going for a run

48
Q

What is illness behaviour?

A

Behaviour aimed at seeking remedy e.g. going to GP for a symptom

49
Q

What is sick role behaviour?

A

Behaviour aimed at getting well e.g. taking antibiotics

50
Q

What is an example of individual level health intervention?

A

Reducing level of alcohol consumption

51
Q

What is an example of a community level health intervention?

A

Improved alcoholic referrals/support in A+E

52
Q

What is a population level health intervention?

A

Nationally increased tax on alcohol sales

53
Q

What is the health belief model?

A

Individuals will change their behaviour if: they believe they are susceptible, they believe in serious consequences, they believe taking action reduces susceptibility, benefits outweigh costs

54
Q

What are the advantages and disadvantages of health belief model?

A

+ can be applied to wide variety of health behaviours, cues to action are unique component

  • other factors may influence outcome, doesn’t consider emotion, doesn’t differentiate between first time and repeated behaviours
55
Q

What are the 5 stages of the transtheoretical model of change?

A

Pre-contemplation, contemplation, preparation, action, maintenance

56
Q

What is a system error?

A

Inadequate built in safeguards, lack of surgical equipment due to failure to stock check

57
Q

What is a fixation error?

A

Focus on one diagnosis only e.g. decide its meningitis when it SAH

58
Q

What is a bravado error?

A

Working beyond competency e.g. deciding to treat complex patient alone without requesting senior opinion

59
Q

What is a playing the odds error?

A

Deciding it is a common disease and then it turns out to be a rare one

60
Q

What is a sloth based error?

A

Laziness leading to error

61
Q

What is an error of inherited thinking?

A

When a working diagnosis is passed over and it is assumed to be correct

62
Q

What are the components of the three bucket model?

A

Self, context, task (situations that lead to error)

63
Q

What are the outcomes of errors?

A

Adverse events and near misses

64
Q

What is a never event?

A

A serious largely preventable patient safety incident that should not occur if available preventative measures have been implemented

65
Q

What are the 4 parts of PDSA model of quality improvement?

A

Plan, do, study, act

66
Q

What is an error of omission?

A

A mistake that consists of not doing something you should have done

67
Q

What is an error of comission?

A

Quality problems such as excessive doses of medications, giving wrong medication or contraindicated medications

68
Q

What is negligence?

A

A breach of duty of care which results in damage
1. Is there a duty of care?
2. Was there a breach in that duty?
3. Did the patient come to any harm?
4. Did the breach cause the harm?

69
Q

What is a duty of candour?

A

Duty of a doctor to be open, honest and transparent - disclose errors

70
Q

What is ethnocentrisim?

A

Evaluate other groups according to the values and standards of one’s own culture group especially with the conviction that ones own culture group is superior to that of others

71
Q

What is unrealistic optimism?

A

Health damaging behaviour because people do not understand consequences e.g. not wearing suncream because do not get sunburnt

72
Q

What is a transactional leader?

A

Promotes compliance with reward and punishment

73
Q

What is a Laissez faire leader?

A

Delegates, hands off approach, allows team members to make decision for themselves

74
Q

What is a transformational leader?

A

Inclusive leadership distributes throughout all levels of organisation

75
Q

What is the prevention paradox?

A

A preventative measure that brings much benefit to the population but very little effect to the participating individual e.g. seatbelts

76
Q

How do you calculate alcohol units?

A

Units = (strength x volume) / 1000

Phase 3a Public Health (1 decks)

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