Public Health Flashcards
Advantages and disadvantages of case-control studies
Advantages: good for rare outcomes, quicker than cohort or intervention studies, can investigate multiple exposures
Disadvantages: difficulties finding controls to match with cases
Describe a case control study
A retrospective observational study which looks at a certain exposure and compares similar participants with and without the disease
What are the 3 domains of public health?
Health protection
Health improvement
Improving services
List the determinants of health
PROGRESS:
Place of residence
Race/ethnicity
Occupation
Gender
Religion
Education
Socio-economic status
Social capital/resources
What is the inverse care law?
The availability of medical & social care tends to vary inversely with the need of the population served
Define equality vs equity
Equality: concerned with equal shares
Equity: what is fair and just
Define health needs assessment
A systematic approach for reviewing the health issues affecting a population which leads to agreed priorities and resource allocation that will improve health and decrease inequalities
Describe the different types of resource allocation eg egalitarian etc
Egalitarian: provides all care that is necessary and required to everyone. Equal for everyone but economically restricted
Maximising: based solely on consequence. Resources are allocated to those likely to receive most benefit but those with less need receive nothing.
Libertarian: each individual responsible for own health. The onus is on the patient so leads to patients being more engaged but not all diseases are self inflicted
Advantages and disadvantages of the theory of planned behviours
Advantages: can be applied to wide variety of health behaviours, useful for predicting intention, takes into account importance of social pressures
Disadvantages: no temporal element, direction or causality, doesn’t consider emotions, assumes attitudes can be measured
What is the theory of planned behaviour?
A cognitive theory that proposes that an individual’s decision to engage in a specific behaviour, such as gambling or stopping gambling can be predicted by their intention to engage in that behaviour
Advantages and disadvantages of the the Health Belief Model
Advantages: can be applied to a wide variety of health behaviours, cues to actions are a unique component
Disadvantages: other factors may influence the outcome, doesn’t consider emotions, doesn’t differentiate between first time and repeated behaviours
Name the types of error involved in medical negligence and give examples
Fixation/loss of perspective: early focus on one diagnosis
Sloth: inadequate documentation/not checking results for accuracy
System error: environmental, technological or equipment failure
Lack of skills: not having appropriate training, skills, practice etc
Mistriage: over or underestimating severity of a situation
Ignorance: lack of knowledge or not knowing what you don’t know
Communication breakdown: unclear instructions/plans or not listening to others
Poor teamwork: poor direction & independent working
Playing the odds: choosing the common & dismissing the rare
Bravado/timidity: working beyond competence & showing confidence to hide underlying deficiences
What are never events? (in relation to errors)
Serious, largely preventable patient safety incident that should not occur if available, preventative measures have been implemented
Define screening
identifying apparently well individuals who have/are at risk of a particular disease
What is the key criteria for a screening test?
Disease: important, natural history known, early treatment better than late
Test: acceptable to the population, facilities available, simple & safe
Outcomes: ongoing feasibility, treatment available, cost-benefit analysis
What is a cross sectional study?
Snapshot data of those with and without a disease to find associations at a single point in time
Advantages and disadvantages of cross sectional studies?
Advantages: quick, cheap, few ethical issues, provide data on prevalence at a single point in time, large sample size, good for surveillance & public health planning
Disadvantages: risk of reverse causality (don’t know whether outcome or exposure came first), cannot measure incidence, risks recall bias & non-response
What is a cohort study?
Longitudinal prospective study which takes a population of people recording their exposures and conditions they develop
Advantages and disadvantages of a cohort study
Advantages: can show causation, less chance of bias
Disadvantages: large amount lost to follow up, expensive
What is a randomised control trial?
Similar participants randomly controlled to intervention or control groups to study the effect of the intervention (gold standard)
Advantages and disadvantages of a RCT?
Advantages: can infer causality, less risk of bias/confounders
Disadvantages: time consuming, expensive, specific inclusion/exclusion criteria may mean the study population is different from typical patients
What are the reasons for an association and an outcome?
Chance
Bias
Confounding
Reverse causality
A true causal association
What is a confounder?
A risk factor, other than those being studies that can influence the outcome, either affecting the exposure or the outcome itself
What is selection bias?
Systematic error in:
- selection of study participants
- allocation of participants to different study groups
Give examples of information bias
Measurement: eg different equipment used to measure outcome in the different groups
Observer: the researcher knows which participants are cases and which are controls and so subconsciously reports/measures the exposure or outcome differently
Recall: evens are not remembered or reported accurately
Reporting: respondents report inaccurate information bc they feel embarrassed or feel judged
What is publication bias?
Not all trial results are published eg drug trials with unfavourable results are less likely to be published
What is reverse causality?
Refers to the situation when an association between an exposure and an outcome could be due to the outcome causing the exposure rather than the other way round
Describe the Bradford-Hill criteria
Difficult to prove that an exposure causes an outcome, but this criteria increases the likelihood of this being the case →
strength: stronger association between the exposure & the outcome
consistency: same result observed from various studies & in geographical settings
Dose-response: increased risk of outcome with increased exposure
temporality: exposure occurs prior to outcome → not easy in case control/cross sectional studies as exposure and outcome measured simultaneously
Disadvantages of screening?
Exposure of well individuals to harmful or distressing procedures
Detection and treatment of disease that would never have caused the patient harm
Preventative measures that may cause harm to the patient or population
What is lead time bias?
When screening identifies an outcome earlier than it would have otherwise been identified, leading to an apparent increase in survival time even if it has no actual affect on the disease course itself.
e.g. someone being diagnosed with cancer 2 years before their symptoms started, but this would not affect the disease course and would have the same life span as someone who came into the doctor 2 years later with memory problems.
What is length time bias?
Type of bias resulting from differences in the length of time for a disease to progress to severe effects
Describe the epidemiological approach to a health needs assessment
Disease incidence and prevalence
Mortality and morbidity
Life expectancy
Services available- location, cost, effectiveness etc
Sources of data: GP registration, hospital admissions, disease registry, mortality data etc
Advantages of an epidemiological approach to a health needs assessment
Uses existing data, provides data on disease incidence & mortality etc, can evaluate service trends over time
Disadvantages of an epidemiological approach to a health needs assessment
Quality of data may be variable
Data collected may not be the data needed
Does not consider the needs or opinions of people affected
Describe the corporate approach to a health needs assessment
Ask the local population what their health needs are
Use focus groups, meetings, interviews etc
Wide variety of stakeholders eg teachers, doctors, business men, social workers, charity workers, council workers, politicians
Disadvantages of a corporate approach to a health needs assessment
Difficult to distinguish need and demand
Groups may have different priorities or interests
May be influenced by political agenda
Advantages of a corporate approach to a 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 a wide range of views
Describe a comparative approach to a health needs assessment
Compare the health and healthcare provision of one population to another
Spatial eg different towns or social eg different social classes
Can compare health, service provision, health outcomes
Means of evaluating variation in performance/costs of service
Advantages of a comparative approach to a health needs assessment
Quick and cheap if data available
Indicates whether health or services provision is better/worse than comparable areas
Disadvantages of a comparative approach to a health needs assessment
May be difficult to find a comparable population
Data may not be available/high quality
May not yield what the most appropriate level of provision should be F
What is horizontal equity?
Equal treatment for equal need eg giving everyone with pneumonia the same treatment
What is vertical equity?
Unequal treatment for unequal need eg treating a cold and pneumonia differently
What are the three domains of public health practice?
Health improvement
Health protection
Health care
