Public Health Flashcards
Definition
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
Health Needs Assessment
What might a health needs assessment be carried out for?
A population or a sub-group, a condition or an intervention
Definiton
What is a felt need?
Individual perceptions of variation from normal health
Definition
What is an expressed need?
When an individual seeks help to overcome variation in normal health (demand)
Definition
What is a normative need?
When a professional defines intervention appropriate for the expressed need
Definiton
What is a comparative need?
The comparison between severity, range of interventions and cost
Health Needs Assessment
What are the three types of a Health Needs Assessment?
Epidemiological, comparative and corporate
Health Needs Assessment
What does the epidemiological approach do?
It defines and evaluates:
- a problem and the size of the problem (incidence, prevalence)
- the services available for the problem (prevention, treatment and care)
- the evidence base for the problem (effectiveness and cost-effectivess)
- the models of care for the problem (quality and outcome measures)
- the existing services for the problem (unmet need, services not needed)
- future recommendations
Health Needs Assessment
What does the comparative approach do?
It compares the services received by a population (or a sub-group) with others. It may be spacial or social (age, gender, class, ethinicity).
It may examine health status, service provision, service utilisation and health outcomes.
Health Needs Assessment
What does the corporate approach do?
It obtains the views from a range of stakeholders including:
- comissioners
- providers
- opinion leaders
- voluntary organisations
- relatives and carers
- patients
- professionals
- politicians, press and pharmaceutical companies
Health Needs Assessment
What are the limitations of a comparative approach?
May not yield what the most appropriate level of provision/utilisation should be
Required data may not be available
Variable data quality
May be difficult to find a comparable population
Health Needs Assessment
What are the limitations of a corporate approach?
May be difficult to distingush need from demand
Groups may have vested interests
May be influenced by political agendas
Dominant personalities may have undue influence
Health Needs Assessment
What are the limitations of an epidemiological approach?
Required data may not be available
Variable data quality
Evidence base may be inadequate
Does not consider felt needs of people affected
Definition
What is evaluation of health services?
Assessment of whether a service achieves its objectives.
A process that attempts to determine as systematically and objectively as possible the relevance, effectivess and impact of activities in the light of their objectives.
Health service evaluation
What does the framework used for health service evaluation include?
Structure, process and outcome.
Output may be named but is usually classified under process.
Heakth service evaluation
What does the structure evaluate?
What is there i.e., buildings, staff, equipment
Health service evaluation
What does the process evaluate?
What is done in the health service
E.g., the number of patients seen in A&E, number of operations performed
Health service evaluation
How are health outcomes classified?
- Mortality
- Morbidity
- Quality of Life/PROMs
- Patient satisfaction
Or using the 5 Ds: death, disease, disability, discomfort, dissatisfaction
Health service evaluation
What are the limitations of evaluating health outcomes?
- Link (cause and effect) between health service and health outcome may be difficult to establish due to other factors.
- Time lag between service provided and outcome may be long.
- Large sample sizes may be needed to detect statistically significant effects
- Data may not be available
- There may be issues with data quality
Health service evaluation
What are Maxwell’s 6 Dimensions of Quality?
Acceptability
Accessibility
Appropriateness
Effectiveness
Efficiency
Equity
Health service evalution
How are qualitative methods performed?
Consult relevant stakeholders as appropriate.
Methodology:
1. Observation (participant and non-participant)
2. Interviews
3. Focus groups
4. Review of documents
Health service evalution
How are quantitative methods performed?
- Routinely collected data (hospital admissions, mortality etc)
- Review of records
- Surveys
- Other special studies (e.g., using epidemiological methods)
Health service evaluation
What is the general framework for evaluating health services?
- Define what the service is
- Define the aims and objectives of the service
- Structure, Process, Outcome +/- Dimensions of quality
- Methodology to be used (qualitative, quantitative, mixed)
- Results, Conclusions and Recommendations
Prevention
How is prevention classified?
Primary, secondary and tertiary
Definition
What is primary prevention?
It aims to prevent a disease from occuring by reducing exposure to risk factor levels.
Definition
What is secondary prevention?
Aims to detect early disease in order to alter the course of the disease
OR
Prevention of a disease from recurring
Definition
What is tertiary prevention?
Aims to minimise disability and other negative effects of disease and prevent complications.
Definition
What is a population approach to prevention?
A preventative measure delivered on a population-wide basis and seeks to shift the risk factor distribution curve
Definition
What is a high risk approach to prevention?
It seeks to identify individuals above a chosen cut-off and treat them
Definition
What is a prevention paradox?
A preventative measure which brings much benefit to the population but often offers little to each participating individual
Definition
What is screening?
A process which sorts out apparently well people who probably have a disease (or precursors/susceptibility to a disease) from those who probably do not.
NOT diagnostic.
Screening
What types of screening are there?
- population-based screening programmes
- opportunistic screening
- screening for communicable diseases
- pre-employment and occupational medicals
- commercially provided screening
Screening
What are the criteria for the test in a screening programme?
The test has to be:
* simple, safe, precise and validated
* suitable cut-off level should be defined and agreed
* acceptable to the target population
* there has to be an agreed policy on further investigation of individuals with a positive result
Screening
What are the criteria for the condition in a screening programme?
The condition has to be:
* an important health problem
* in the latent/preclinical phase
* all the cost effective primary prevention interventions should have been implemented as far as practicable
* its natural history must be known
Screening
What are the criteria for the intervention/treatment in a screening programme?
- it should be effective
- there should be an agreed policy on whom to treat
Screening
What are the criteria for the implementation in a screening programme?
- clinical management of the condition should be optimised
- all other options for managing the condition should have been considered to ensure that no more cost-effective intervention could be used
- there should be a plan for managing and monitoring the programme
- adequate staffing and facilities should be available
Definition
What is sensitivity and how is it calculated?
The proportion of people with the disease who are correctly identified by the screening test
Sensitivity = (true positive) / (true positive + false negative)
i.e., a/a+c
Definition
What is specificity and how is it calculated?
The proportion of people withou the disease who are correctly excluded by the screening test
Specificity = (true negative) / (false positive + true negative)
Definition
What is positive predictive value and how is it calculated?
The proportion of people with a positive test result who actually have the disease
PPV = (true positive) / (true positive + false positive)
Definition
What is negative predictive value and how is it calculated?
The proportion of people with a negative test result who do not have the disease
NPV = (true negative) / (false negative + true negative)
Definition
What is lead time bias?
When a patient appears to have survived longer because the disease was diagnosed earlier, even though earlier detection made no difference to survival
Definiton
What is length-time bias?
Length time bias is an overestimation of survival duration due to the relative excess of cases detected that are asymptomatically slowly progressing, while fast progressing cases are detected after giving symptoms.
I.e., patients with slowly progressing diseases are more likely to be detected through screening
Determinants of health
What are the four main determinants of health?
Genes, environment (physical, social and economic), lifestyle and healthcare
Equity
What is the difference between equity and equality?
Equity is about what is fair and just whereas equality is concerned with equal shares
Definition
What is horizontal equity?
Equal treatment for equal need
E.g., individuals with pneumonia should be treated equally
Definition
What is vertical equity?
Unequal treatment for unequal need
E.g., individuals with common cold vs pneumonia need unequal treatment
Equity
What are the different forms of health equity?
- equal expenditure for equal need
- equal access for equal need
- equal utilisation for equal need
- equal health care outcome for equal need
- equal health
Equity
How are dimensions of health equity classified?
Spatial (geographical) and social (age, gender, class, ethnicity)
Equity
How can health equity be examined?
i.e, what can be examined to assess it
It can be examined in terms of:
* supply of healthcare
* access to healthcare
* utilisation of healthcare
* healthcare outcomes
* health status
* resource allocation (health and other services)
* wider determinants of health (diet, smoking, healthcare seeking behaviour, socioeconomic and physical environment)
Interventions
What are the three domains of public health practice?
Health improvement, health protection, health care
Interventions
What are the three levels of interventions?
Individual, community and ecological (population)
Health behaviours
What are the 3 types of health behaviours?
Health behaviour
Illness behaviour
Sick role behaviour
Health behaviours
What is a health behaviour?
A behaviour aimed to prevent disease
Health behaviours
What is an illness behaviour?
Behaviour aimed to seek remedy
Health behaviours
What is a sick role behaviour?
Any activity aimed at getting well
Health behaviours
What influences perceptions of risk?
Lack of personal experience with a problem
Belief that the problem is preventable by personal action
Belief that is it hasn’t happened by now, it’s unlikely to
Belief that the problem is infrequent
Smoking
What age group is most likely to smoke?
25-34
Behaviour change
What is the health belief model?
Becker 1974
Individuals will change if they:
* believe they are susceptible to the condition in question
* believe that it has serious consequences
* believe that taking action reduced susceptibility
* believe that the benefits of taking action outweigh the costs
Behaviour change
What is the HBM model of behaviour change?
Demographic variables and psychological characteristics influence:
* health motivation
* perceived susceptibility and severity
* perceived benefits and barriers
This influences the likelihood of action, which is also influenced by cues to action
Behaviour change
What is the theory of planned behaviour?
Proposes that the best predictor of behaviour is intention
Attitudes, subjective norm and perceived behavioural control influences the intentions, which influences the behaviour
Behaviour change
What is the transtheoretical model of behaviour change?
Pre-contemplation –> Contemplation –> Preparation –> Action –> Maintenance
PC PAM
can go backwards, forwards or skip steps
Food and behaviour
What are the 3 types of breast milk?
Colostrum: less fat, more protein and protective factors, 3 days after birth
Foremilk: beginning of a feed
Hindmilk: end of a feed (energy dense)
Food and behaviour
How is the composition of breast milk beneficial to baby?
Efficient digestion: enzymes (lipase, lysozyme), transfer factors (lactoferrin)
Anti-infective: bifidus factor, white cells, oligosaccarides
Gut protection: epidermal growth factor, secretory IgA, anti-inflammatories
Others: antibodies, entero/broncho-mammary pathways, viral fragments, lactoferrin helps dental hygiene
Food and behaviour
What is a non-organic feeding disorder?
High prevalence in children <6 years
Feeding aversion, food refusal, food selectivity, fussy eaters, failure to advance to age-appropriate foods, negative mealtime interactions
Parents often use maladaptive parental feeding practises
Food and behaviour
Why is dieting challenging for some patients susceptible to obesity?
Unresponsive to internal cues that signal satienty and hunger
Dietary restraint
Vulnerable to external cues that signal availability of palatable food
Food and behaviour
What are the 4 main points about why dieting may be a problem?
- Risk factor for the development of eating disorders in some individuals
- Results in a loss of lean body mass, not just fat mass
- Slows metabolic rate and energy expenditure
- Chronic dieting may disrupt normal appetite responses and increase subjective sensations of hunger
Food and behaviours
What is malnutrition?
Deficiencies, excesses or imbalances in a person’s intake of energy and/or nutrients.
May be undernutrition or overweight.
Smoking
What are the most common times of the year to stop smoking?
January, March and October
Smoking
What are the main causes of death attributable to smoking?
Cancer
Cardiovascular disease
Lung disease
Smoking
What does secondhand smoke increase the risk of?
Respiratory disease, lung cancer and coronary heart disease
Smoking
What does smoking reduce the risk of?
Pre-eclampsia, morning sickness during pregnancy, ulcerative colitis, Parkinson’s disease
Smoking
What does nicotine do?
In terms of neurotransmitters
Mimics acetylcholine, causes dopamine release
Smoking
What are the symptoms of nicotine withdrawal?
- Depressed mood
- Irritability
- Restlessness
- Difficulty concentrating
- Increased appetite
- Cough
- Constipation
- Weight gain
- Mouth ulcers
Smoking
What nicotine replacement therapy products are available?
Transdermal patch
Oral (chewing gum, lozenges, microtabs etc)
Nasal spray
