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Public health Flashcards

1
Q

What are the 4As?

A

Access
Availiability
Affordability
Awareness

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2
Q

What is deviance?

A

An action that violates a cultural norm
May be necessary to change health behaviour

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3
Q

What is the WHO health definition 1948

A

A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.

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4
Q

What is the WHO health definition 1984

A

The extent to which an individual or group is able to realise aspirations and satisfy needs, and to change or cope with the environment. Health is a resource for everyday life, not the objective of living; it is a positive concept emphasising social and personal resources as well as physical capabilities.

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5
Q

What is public health?

A

The science and art of promoting and protecting health and wellbeing, preventing ill-health and prolonging life through the organised efforts of society.

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6
Q

Describe the Nuffield Ladder of intervention

A

At bottom do nothing, then guiding by incentives, then disincentives, then eliminating choice

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7
Q

What are the 3 types of prevention?

A

Primary prevention: Preventing the onset of disease
Secondary prevention: Preventing the progression of disease from a pre-clinical stage
Tertiary prevention: Preventing morbidity and mortality through treatment of clinical disease

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8
Q

Name 6 things that determine health outcomes

A

Income
Environment
Occupation
Culture
Societal Status
Access to Education

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9
Q

What are the 3 domains of public health?

A

Health Improvement:
This is about dealing with those six things that determine health outcomes.

Health Protection:
This relates to infectious diseases, radiation, chemicals/poisons, emergency response and environmental health.

Health services improvement:
This is about ensuring the NHS is fit for purpose and the money is being spent in the right place. Could include monitoring clinical effectiveness and efficiency, service planning, audits and evaluations and clinical governance.

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10
Q

What is ethics?

A

The philosophical study of right and wrong actions or ways of living

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11
Q

What are the 3 levels of ethics?

A
  1. Meta ethics - explores fundamental questions (such as is there a right and wrong?)
  2. Ethical theory - philosophical attempts to create ethical theory. e.g., utilitarianism
  3. Applied ethics - ethical investigation in specific areas.
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12
Q

Name 3 different forms of ethical reasoning

A

Top down - Deductive - take one ethical theory and apply it consistently to each issue.
Bottom up - Inductive - Use past settled medical cases to generate a theory/guide to practice.
Consider the theory that best fits own considered beliefs and then apply it.

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13
Q

What is evidence based medicine?

A

The conscientious, explicit, and judicious use of the best evidence in making decisions about the care of individual patients.
The practice of EBM means integrating individual clinical expertise with the best available external clinical evidence from systematic research.

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14
Q

Describe 5 key elements of EBM

A

Find the evidence.
Assess the evidence.
Synthesise the evidence (e.g., combine results of different studies narratively or perform meta-analysis)
Make a good decision (is the evidence good enough and does it apply to this patient)
Evaluating performance against the evidence (is the evidence I used before still relevant?)

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15
Q

What is PICO?

A

Patient or Population
Intervention
Control
Outcome
Used to make a good question or determine relevance of research

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16
Q

What is medical professionalism?

A

A set of values, behaviours and relationships that underpins the trust the public has in its doctors.

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17
Q

What is patient safety?

A

Coordinated efforts to prevent harm, caused by the process of healthcare itself, from occurring to patients.

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18
Q

Name 4 key ethical theories

A

Consequentialism - e.g. Utilitarianism
Deontology
Virtue
The 4 principles

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19
Q

What is normative ethics?

A

Focusses on acts - e.g. the person doing it, the act itself or the consequences of the act
3 types - virtue, deontology, consequentialism

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20
Q

What is consequentialism?

A

Morality judged solely by consequences

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21
Q

What is utilitarianism?

A

Most happiness for largest number of people
Type of consequentialism

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22
Q

Describe 3 problems with consequentialism.

A

Can we treat minorities unfairly to promote the happiness of a majority?
Should we carry out ethically questionable research to maximise the welfare of society?
How do we quantify good/better?

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23
Q

What is the doctrine of double effect?

A

If doing something morally good has a morally bad side effect it’s ethically ok to do so provided the bad side effect wasn’t intended, even if you knew the bad side effect would probably happen.
e.g. giving morphine reduces life expectancy but reduces agony

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24
Q

What is deontology?

A

Whether an act is right or wrong is determined by its inherent nature, based on a set of principles, regardless of its consequences

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25
Describe two types of imperatives
Hypothetical imperatives: e.g. eat well to stay healthy (dependent on outcome, not certain) Categorical imperatives: e.g. Do not lie (not dependent on the end.)
26
Describe 3 challenges of deontology
The key concern is with duties and rights (what makes something right?) Doesn’t matter what the consequences are Duties can conflict
27
What is virtue ethics?
The focus is on the character of the agent (person performing the action) - action only right of that of a virtuous person
28
Describe 3 problems with virtue ethics
Can be culture specific 'Virtue' is too broad and non-specific to be practically applied Emphasis on individuals ignores social dimensions
29
What are the four principles of medical ethics?
Autonomy Beneficence Non-maleficence Justice
30
What is a stereotype threat?
When a patient senses that they are being seen in terms of a stereotype, a stress response might occur. This can make it difficult to communicate or receive information.
31
What are the two modes of thinking?
Type 1 - fast, instinctive, emotional, prone to error. Type 2 - slower, deliberate, analytical, used for complex decisions and more reliable.
32
What are two models of health and disease?
Biomedical model Social model
33
Name 3 theories of health
1. Health as an ideal state (unattainable) 2. Health as a personal strength or ability (too vague) 3. Health as a state of functioning to perform social tasks (narrow as assumes health opposite to disease)
34
Illness vs disease
Illness: the social, lived experience of symptoms and suffering. Disease: a technical malfunction or deviation which is diagnosed.
35
What is the 90:10 paradox?
Most health activity occurs outside hospitals but health resources concentrated there
36
What is the inverse care law?
Those who need healthcare most are least likely to receive it
37
What is the sick role?
Term used to describe the rights and obligations of a person that is sick Postulates: - The person is not responsible for assuming the sick role. - The sick person is exempted from carrying out some or all of normal social duties (e.g. work, family). - The sick person must try and get well – the sick role is only a temporary phase. - In order to get well, the sick person needs to seek and submit to appropriate medical care.
38
What is medicalisation?
The process by which nonmedical problems become defined and treated as medical problems often requiring medical treatment Labels and treats deviant and non-conformist behaviour
39
What is iatrogenesis?
The side effects and risks associated with the medical intervention
40
What must be the case for consent to be valid?
Patient must be competent Patient must have sufficient information Consent must be freely given
41
What are 3 types of consent?
Implied, verbal, written
42
What is confidentiality?
A set of rules or a promise that limits access or places restrictions on certain types of information
43
Name the 3 leading causes of death in children in the developing world
Pneumonia Diarrhoea Malaria
44
Name 5 key dates in the UK to do with smoking
* 1908 - Children Act - sale of tobacco under 16s prohibited * 1950 - Richard Doll & Austin Bradford Hill - Smoking & Lung Carcinoma * 1965 - Parliament bans cigarette advertising on TV * 2007 - Smoking in public banned + legal min. raised to 18 in the UK * 2015 - October (?) - Smoking in car with children banned in the UK
45
What support is there for smoking cessation?
NRT - patches, gum etc. Non-nicotine pharmacotherapy e.g. varenicline (Champix) and bupropion (Zyban) NHS smoking cessation services
46
What is epistemology?
The theory of knowledge - do we know things? what can we know?
47
Describe 2 different positions in epistemology
Interpretivism (qualitative research is most valuable) Positivism (quantitative research is most valuable)
48
Method vs methodology
Method - how something is done. Methodology - study of methods, refers to strategy or approach to research.
49
Describe some differences between quantitative and qualitative research
Quantitative: deductive (test your hypothesis). large random samples. infer to population. results are numbers and stats. Qualitative: inductive (develop a theory as you go along) Small purposeful samples may or may not be representative. presented in words.
50
Define sensitivity
The proportion of people with the disease who are correctly identified by the screening test. True positive/true positive+false negative.
51
Define specificity
The proportion of people without the disease who are correctly excluded by the screening test. True negative/false positive + true negative.
52
Define PPV
The proportion of people with positive test result who actually have the disease
53
Define NPV
The proportion of people with negative test result who do not have the disease.
54
Outline the Wilson-Jugner criteria
The condition - Should be an important health problem - Should be well understood - There must be a detectable early stage The Treatment - There should be an accepted treatment for the disease - Facilities for diagnosis and treatment ought to be available - Health service provision should be made for the extra workload screening causes The Test - A suitable test for the early stage should be devised - The test must be acceptable - Intervals for repeating the test have to be determined - Risks and benefits - There should be an agreed policy on whom to treat the risks must be less than the benefits
55
Describe how selection bias could come into screening
People who show up may be higher risk - e.g. family history of the condition People who show up may be lower risk - e.g. high socioeconomic group
56
What is lead time bias?
Screening appears to increase survival time because disease is detected earlier. Once this is taken into account, screening test may not be effective (may not improve survival).
57
What is length time bias?
Overestimation of survival because long duration cases are more likely to be detected and treated than short duration cases.
58
Name 5 types of screening programmes
Population based screening programmes Opportunistic screening - e.g. asking everyone in GPs about their alcohol intake Screening for communicable diseases Pre-employment medical Commercial screening (23andme)
59
What are some barriers people with learning disabilities face in accessing healthcare?
Failure to identify people with LDs to make reasonable adjustments in advance Discriminatory attitudes from staff Failure to make reasonable adjustments Diagnostic overshadowing (physical problem seen as behavioural problem) Unable to read letters/make appointments unaided May not trust doctors May not understand advice leaflets
60
What is sustainable development?
Meeting the needs of the present generation without compromising the ability of future generations to meet their needs
61
Why is team working important?
- Efficient and effective service delivery - May improve decision making - May reduce medical error - Essential with the complexity of provision in modern healthcare
62
What is a hierarchical challenge?
Not everyone feels like they have a voice due to hierarchy e.g. nurses may find it difficult to challenge a doctor
63
What is a safety culture?
No blame, trust teammates
64
What is somatic stress?
Physical, emotional and subjective experiences associated with damage of body tissue and bodily threat such as pain and inflammation
65
What is psychological stress?
Emotional strain or tension resulting from adverse or demanding circumstances, often involving anticipation
66
Describe two types of stress
Eustress - beneficial, motivating, 'good' Distress - damaging, harmful, 'bad'
67
Acute vs chronic stress
Acute is necessary for survival and adaptive Chronic is due to continued exposed to threatening situations that cannot be controlled
68
What is allostasis/allostatic load?
Allostasis - how complex systems adapt in changing environments by changing set points Allostatic load - cumulative exposure to stressors and cost to the body of allostasis, which can lead to systems wearing out
69
5 elements of human stress response
biochemical physiological behavioural cognitive emotional
70
2 autonomic systems that mediate stress response
Sympathetic-adrenal-medullary system (SAM) Hypothalamic-pituitary-adrenal (HPA) axis
71
What framework can we use to determine data quality?
CART Completeness Accuracy Relevance Timeliness
72
Define a medical error
Any preventable event that may cause or lead to patient harm.
73
What two things could a medical error lead to?
Adverse event - incident resulting in patient harm Near miss - event which has the potential to cause harm but fails to develop further, thereby avoiding harm.
74
List 3 types of medical error
* ERRORS OF OMISSION (required action delayed/not taken) * ERRORS OF COMMISSION (wrong action is taken) * ERRORS OF NEGLIGENCE (the actions or omissions do not meet the standard of an ordinary, skilled person professing)
75
What are two types of medical errors?
* SKILL BASED ERRORS i when performing a routine task that is well learnt (involuntary automaticity) ii little attention given, thus if distracted - slips of action / memory lapses * RULE/KNOWLEDGE BASED ERRORS i an incorrect plan or course of action is chosen (no experience) ii mistakes more likely when the tasks are more complex
76
What are some organisational strategies to reduce error?
1. Simplification and standardisation of clinical processes 2. Checklists and aide memoires 3. Information technology 4. Team training 5. Risk management programmes 6. Mechanisms to improve uptake of evidence based treatment patterns
77
What are some personal strategies to reduce error?
1. Try to develop your internal alarm bells 2. Seek help when feeling overwhelmed 3. Use clinical guidelines where available 4. Always document your thought processes, actions, and plans 5. Checking results and all recorded information 6. Speaking up if an error is suspected.
78
Name two types of obesogenic food environments
Food deserts - areas of poor access to healthy options Food swamps - greater provision of unhealthy food
79
Define food insecurity
1 or more of the following: - smaller meals or skipping meals - being hungry but not eating - not eating for a whole day
80
What are the two types of control of meal size?
Direct - all factors relating to direct contact of food to GI mucosal receptors Indirect - everything else - social, environmental, endocrine, metabolic etc
81
List some CMHPs
* Depression * Generalised Anxiety Disorder * Panic disorder * Phobias * Social Anxiety Disorder * Obsessive-compulsive disorder (OCD) * Post-traumatic stress disorder (PTSD)
82
What characteristics of one's food environment could result in overeating?
Variety effect - exposure to variety undermines satiation Portion size - large portion sizes of ED food causes overconsumption Distraction - eat more when watching TV or with people
83
What are the 3 groups of CAM?
Group 1: there is some scientific evidence of efficacy (acupuncture, chiropractic, homeopathy, osteopathy, herbal medicine) * Group 2: modalities working in a supportive capacity alongside conventional medicine, not offering independent diagnosis (massage, aromatherapy, reflexology, hypnotherapy) * Group 3: Traditional systems of medicine backed by historical practice only/ with little evidence (traditional Chinese medicine, iridology, kinesiology)
84
What are the big 5 in CAM?
acupuncture herbal medicine homeopathy osteopathy chiropractic
85
How is weight often defined?
BMI - weight divided by height squared Under 18.5 underweight 25-30 overweight 30+ obese 40+ morbidly obese
86
What are two types of ageing?
intrinsic - natural, universal, inevitable. extrinsic - dependent on external factors, e.g. UV, smoking and air pollution
87
What is ageing?
Progressive physiological changes in an organism that lead to senescence, or a decline of biological functions and of the organisms ability to adapt to metabolic stress.
88
What are two types of ageing?
INTRINSIC AGEING: natural, universal, inevitable EXTRINSIC AGEING: dependent on external factors (UV ray exposure, smoking, air pollution, etc.)
89
Types of dementia
* Alzheimer’s disease 62% * Vascular dementia 17% * Mixed Alzheimer and Vascular 10% * Lewy bodies 6% * Fronto-temporal 2% * Other types 3%
90
4 important concepts in health economics
Opportunity cost Economic efficiency Economic evaluation Equity
91
What is opportunity cost?
The sacrifice in terms of the benefits forgone from not allocating resources to the next best activity e.g. spending money on heart transplants means sacrificing hip replacements
92
What is economic efficiency?
When resources are allocated between activities in such a way as to maximise benefit e.g. 2 people vs 1 saved for same cost
93
What is economic evaluation?
Comparative study of the costs and benefits of competing healthcare interventions for a given disease
94
What is equity?
Concerned with the fairness or justice of the distribution of costs and benefits
95
4 types of economic evaluation
*Cost-effectiveness analysis –Outcomes measured in natural units *Cost-utility analysis –Outcomes measured in QALYs *Cost-benefit analysis –Outcomes measured in monetary units *Cost-minimisation analysis –Outcomes, measured in any units, are the same in both treatments. Therefore, just minimise cost.
96
What is an ICER?
Incremental cost effectiveness ratio - difference in costs / difference in benefits
97
What is biological ageing?
Impact of the accumulation of molecular and cellular damage over time.
98
List some physical changes associated with ageing
loss of skin elasticity loss of hair and colouring decrease in size loss of joint flexibility less efficient memory less effective sight and hearing lose 50% of tastebuds
99
What are the 3 main categories of health behaviours?
1. health behaviour - aimed at preventing disease 2. illness behaviour - aimed at seeking remedy 3. sick role behaviour - aimed at getting well
100
What are the two levels of behaviour change?
Population level: health promotion ( or any example of a health promotion campaign, e.g. 5 a day, screening, etc.) Individual level: Patient centred approach, care in response to individual’s needs
101
Factors that effect perception of risk
1. Lack of personal experience with problem 2. Belief that preventable by personal action 3. Belief that if not happened by now, its not likely to 4. Belief that problem infrequent
102
Describe the health belief model (Becker 1974)
Individuals will change if they: * Believe they are susceptible to the condition in question (e.g. heart disease) * Believe that it has serious consequences * Believe that taking action reduces susceptibility * Believe that the benefits of taking action outweigh the costs
103
Describe the theory of planned behaviour (Ajzen, 1988)
Proposes the best predictor of behaviour is ‘intention’ e.g. I intend to give up smoking Intention determined by: * A person's attitude to the behaviour * The perceived social pressure to undertake the behaviour, or subjective norm * A persons appraisal of their ability to perform the behaviour, or their perceived behavioural control
104
Describe the transtheoretical model of behavioural change
* Precontemplation – no intention of giving up smoking * Contemplation – beginning to consider giving up, probably at some ill-defined time in the future * Preparation – getting ready to quit in the near future * Action – engaged in giving up smoking now * Maintenance – steady non-smoker, i.e. state of change reached

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