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Public Health Flashcards

1
Q

what is health psychology?

A

emphasises the role of psychological factors in the cause, progression and consequences of health and illness

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2
Q

What are health behaviours?

A

a behaviour aimed to prevent disease - eg eating healthy

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3
Q

What is illness behaviour?

A

a behaviour aimed to seek remedy - eg going to doctor

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4
Q

what is the sick roll and sick role behaviour?

A

the sick role allows legitimate deviance from social obligation however the sick person is obliged to try to get well and seek help and co-operate with medical professionals

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5
Q

what is unrealistic optimism?

A

Individuals continue to practice health damaging behaviour
due to inaccurate perceptions of risk and susceptibility

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6
Q

What is health needs assessment?

A

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

can be acarried out for populations, conditions or interventions

assesses need, supply and demand

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7
Q

what is felt need?

A

individual perceptions of variation from normal health

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8
Q

what is expressed need?

A

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

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9
Q

What is normative need?

A

professional defines intervention appropriate for the expressed need

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10
Q

what is comparative need?

A

Weighing up between severity, range of interventions and cost when assessing a patients need for an intervention and what intervention to give

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11
Q

what is the definition of need in a health needs assessment?

A

ability to benefit from an intervention

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12
Q

What are 4 categories of determinants of health?

A

Genes
Environment - physical or social and economical
lifestyle
healthcare

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13
Q

What is primary prevention?

A

prevention before it starts - eg vaccination

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14
Q

what is secondary prevention?

A

screening
rehabilitation/prevention of secondary disease events

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15
Q

what is tertiary prevention?

A

stopping the progression and complications of a disease

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16
Q

What is horizontal equity?

A

Equal treatment for equal need

Individuals with pneumonia (with all other things being equal) should be treated equally

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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 is health improvement?

A

Concerned with societal interventions (not primarily delivered through health services) aimed at preventing disease, promoting health, and reducing inequalities

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19
Q

what is health protection?

A

Concerned with measures to control infectious disease risks and
environmental hazards

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20
Q

What is healthcare?

A

Concerned with the organisation and delivery of safe, high quality services for prevention, treatment, and care

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21
Q

What is the epidemiological approach to a health care needs assessment?

A

define problem
size of problem
services available
evidence base - effectiveness and cost
models of care
existing services
recommendations

looks at data to assess healthcare needs

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22
Q

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

A

data might not be available
variable data quality
evidence base may be inadequate
does not condiser felt needs of people affected and what they want

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23
Q

What are the advantages with the epidemiological approach to a health care needs assessment?

A

uses existing data
provides data on disease
incidence/mortality/morbidity are considered
can evaluate service by trends over time

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24
Q

what is the comparative approach to health care needs assessment?

A

compare services received by different populations in different places or categories

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25
disadvantages of the comparative approach to a health care needs assessment?
May be difficult to find comparable population Data may not be available/high quality data May not yield what the most appropriate level (e.g. of provision or utilisation) should be
26
what are the advantages of comparative approach to health care need assessment?
Quick and cheap if data available Indicates whether health or services provision is better/worse than comparable areas (gives a measure of relative performance)
27
what is the corporate approach to health needs assessment?
the process of gathering information on a specific population from the population itself e.g employees or patients, in order to decide where to invest to improve health and wellbeing
28
what is the corporate approach to health needs assessment?
Ask local population what needs are Use focus groups Wide variety of stakeholders
29
what are the advantages of the corportate approach to health needs assessment?
Based on the felt and expressed needs of the population in question Recognises the detailed knowledge and experience of those working with the population Takes into account wide range of views
30
What are the disadvantages of the corporate approach to health care assessment?
Difficult to distinguish ‘need’ from ‘demand’ Groups may have vested interests - big pharma, politics, press May be influenced by political agendas dominant personalities may have excess influence
31
What is length time bias?
Type of bias resulting from differences in the length of time taken for a condition to progress to severe effects, that may affect the apparent efficacy of a screening method
32
what is the health belief model of behavioural change?
individuals will change if they believe they are 1. susceptible to a condition 2. believe it has serious consequences 3. believe taking action reduces risk 4. believe that benefits outweigh costs
33
what are the problems with the health belief model of behavioural change?
Doesnt consider influence of emotions Doesnt differentiate between first time and repeat behaviour (relapse) Cues to action often missing in research
34
what is the theory of planned behaviour model of behavioural change?
proposes best predictor of behaviour is intention
35
What is the transtheoretical (stages of change) model of behavioural change?
precontemplation contemplation preparation action maintenance relapse
36
What is intention determined by in the theory of planned behaviour model of change?
a persons attitude subjective norm - perceived social pressure perceived behavioural control - a persons perceived ability to perform an action
37
what are some problems with the transtheoretical model of behavioural change?
not always linear in reality doenst take habit, emotions or culture into account intentions can change over a very short time
38
what is nudge theory of behavioural change?
the environment is changed to make the best option the easiest
39
which opiod is safe in renal failure?
fentanyl
40
What are health inequalitites?
preventable unfair and unjust differences in health status between groups due to inequal distribution of socioeconomic conditions in society
41
What is the inverse care law?
the principle that that availability of good medical or social care is inverse to the need of the populations served
42
What are Maxwell's dimensions of quality? | 3As and 3Es
Acceptability Accessibility Appropriateness (relevance) Effectiveness Efficiency Equity
43
What is the donabedian framework for health service evaluation?
Structure Process Outcome
44
What is meant by structure in the donabedian framework for health services evaluation?
what is there? - buildings, staff, equipment | No. ICU beds per 1000 people No. vasc surgons per 1000 people
45
What is meant by Process in the donabeidian framework for health services evaluation?
what is currently done
46
What is outcome in the donabedian frame work for health services evaluation?
outcomes - mortality, morbidity, QOL, patient satisfaction - what can be measured to evaluate services
47
what is incidence?
the number of NEW cases over a certain time period (rate of new cases)
48
what is prevalence?
the number of existing cases at a particular point in time
49
what is iatrogenesis?
the unintended adverse effects of therapeutic intervention
50
what is sensitivity?
the proportion of people with the disease who are correctly identified by the test
51
what is the social norms theory of behaviour?
situations in which individuals incorrectly perceive the attitudes and/or behaviours of peers and other community members to be different from their own when in fact they are not
52
what is prevention paradox?
the seemingly contradictory situation where the majority of cases of a disease come from a population at low or moderate risk of that disease, and only a minority of cases come from the high risk population due to health interventions That most people will not benefit from an intervention on an individual level but on a population level it will be beneficial
53
what criteria is used for screening?
Wilson Jungner criteria
54
what is the 9 wilsons-jugner criteria?
Knowledge of disease - Important problem - Disease understood - Recognisable early stage The Test - Acceptable - Suitable test available Treatment - Accepted treatment - Enough facilities - Agreed policies on who to treat Organisation and cost - Cost-effective - Case-finding should be a continuous process
55
how do you calculate specificity?
true negatives/total number of patients without disease (True negative + false positives)
56
how do you calculate sensitivity?
true positives/total number of people with disease (True positives + False Negatives)
57
what is the positive predictive value?
proportion of people with positive test result who actually have disease
58
what is the negative predictive value?
the proportion of people without the disease who are correctly excluded
59
what are 5 reasons people don't stop smoking?
Nicotine addiction Coping with stress habit socialisation fear of weight gain
60
How do you calculate units?
(% alcohol x amount of liquid mls)/1000
61
what are the cage questions of alcohol?
ever thought about cutting down ever been annoyed by people telling you to cut down feel guilty about how much you drink eye opener
62
what is public health?
The science and art of preventing disease, prolonging life and improving health through the organised effort of society
63
what is equity?
Giving people what they need to achieve equal outcomes
64
what is equality?
Giving everyone the same rights opportunities and resources
65
what are 2 frameworks that can be used to assess the quality of health care available?
Donbedian framework - structure, process, outcome Maxwell's dimensions of quality healthcare
66
what are the 3 domains of public health?
Health improvement Health protection Improving services
67
what is egalitarian resource allocation?
providing all care necessary for everyone
68
what is maximising resource allocation?
Act is evaluated solely in terms of its consequences - utilitarian approach for the better of the people
69
what is libertarian resource allocation?
everyone is solely responsible for their own health
70
How do you calculate positive predictive value?
No. of people who are true positive/Total No. of people who screened positive
71
How do you calculate negative predictive value?
No of people who are true negative/Total No. of people who screened negative
72
what is sensitivity?
proportion of those with disease who are correctly identified as having the disease
73
what is specificity?
proportion of people without disease who are correctly excluded by screening test
74
What is a case control study?
Retrospective, observational study looking at cause of disease. Compares similar participant with disease to controls without.
75
what are 3 advantages of case control studies?
Good for rare outcomes quicker than other studies can investigate multiple exposures
76
what are 2 disadvantages of case control studies
Difficulties finding controls to match with case Prone to selection and information biases
77
what is a cross-sectional study?
Retrospective observational collects data from a population at a specific point in time ‘snapshot’. Prevalence of risk factors and disease itself
78
what are 3 advantages of cross-sectional studies?
Relatively quick and cheap Provide data on prevalence at single point in time Good for surveillance and PH planning
79
what are 3 disadvantages of cross-sectional studies?
Risk of reverse causality (did outcome or exposure come first?) Cannot measure incidence Recall and response bias risk (may miss quick recoveries)
80
what is a cohort study?
Prospective longitudinal study looking at separate cohorts with different treatments or exposures. Wait to see if disease occurs
81
what are 3 advantages of cohort study?
Can follow-up group with a rare exposure Good for common and multiple outcomes -> establish disease risk and confounders Less risk of selection and recall bias
82
what are 3 disadvantages of cohort study?
Long and expensive drop outs Need large sample size
83
What is a RCT?
Prospective study, all participants randomly assigned exposure or control intervention
84
what are 2 advantages or RCTs?
Low risk of bias and confounding Can infer causality
85
what are 3 disadvantages of RCTs?
Time consuming, expensive Drop outs Inclusion criteria may exclude some populations
86
what is an ecological study?
Looks at the prevalence of the disease over time according to population data rather than individual. Can show prevalence and association but not causation
87
How do you calculate odds?
probability of event occurring/Probability of event NOT occurring (1-probability of occurring)
88
how do you calculate odds ratio?
Odds of Event A/Odds of event B compares odds of outcome occurring between 2 groups (control and intervention)
89
what does it mean if odds ratio =1?
odds of the two events are equal
90
what does it mean if odds ratio is >1?
odds of event A > Event B
91
what does it mean if odds ratio <1?
odds of event B > event A
92
what is measurement bias?
Different equipment measuring differently
93
what is observer bias?
Observers expectations influence reporting
94
what is recall bias?
Past events not recalled correctly
95
what is reporting bias?
People don’t tell the truth because of shame/ judgement
96
what is selection bias?
Bias in recruiting for a study, and some may be lost to follow up
97
what is publication bias?
Trials with negative results less likely to be published
98
what are the 9 bradford-hill criteria for causality?
Strength of association between exposure and outcome Consistency between studies Dose response Temporality - exposure came before outcome Biological Plausibility Reversibility - intervention can reduce outcome Coherence with logic Analogy - similar to other cause-effect relationships Specificity - relationship specific to outcome of interest
99
what is a cofounder
A situation in which the estimate between an exposure and an outcome is distorted because of the association of the exposure with another factor (confounder) that is also independently associated with the outcome.
100
what is person time?
Measure of time at risk for all the patients in the study- therefore if 1,000 patients were studied for 2.5 years, the study would have looked at 2,500 person years
101
what is risk?
Number of new cases / number of people at risk of the disease (within a given time frame)
102
what is relative risk?
Risk among exposed group / risk in unexposed group doesn’t take into account baseline risk
103
what is absolute risk?
Subtract the risk of the control group from from the exposed group- gives you the excess risk caused by the exposure Works out how much of the event (e.g. disease) occurs BECAUSE of the exposure
104
what is the number needed to treat?
1 divided by absolute risk The number of patients you need to treat for one to benefit.
105
when are the health psychology transition points when people are more susceptible to health intervension?
leaving school entering the workforce becoming a parent becoming unemployed retirement bereavement
106
what is 1 advantage and 1 disadvantage of the planned behaviour of change model of behavioural change?
+ takes into account societal pressure - intention does not always predict actual action
107
what scoring system cab be used for alcohol dependence?
AUDIT questionnaire
108
what is tolerance?
needing to take larger quantities of a drug in order to get the same effect
109
what is malnutrition?
deficiencies, excesses or imbalances in a person’s intake of energy and/ or nutrients. The term malnutrition covers undernutrition and obesity
110
what are the 4 parts of negligence?
1. Was there a duty of care? 2. Was there a breach in that duty? 3. Was the patient harmed? 4. Was the harm due to the breach in care?

Phase 3A (7 decks)

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