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3a PTS - PM - ZTF > Public Health > Flashcards

Public Health Flashcards

1
Q

3 domains of public health

A

PIS

Health protection (control infectious diseases / environmental hazards)

Health improvement (social interventions aimed at preventing disease / promoting health / reducing inequality)

Health services (organisation and delivery of safe, high quality services)

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2
Q

Inverse care law

A

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

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3
Q

Determinants of health

A

PROGRESS:

Place of residence
Race/ethnicity
Occupation
Gender
Religion
Education
Socio-economic status
Social capital/resources

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4
Q

Horizontal vs vertical equity

A

Horizontal = equal treatment for equal need e.g. two identical twins with same level of asthma get same treatment

Vertical = unequal treatment for unequal need e.g. one person with life threatening asthma vs one person with mild asthma get different treatment, or the UK tax system

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5
Q

Health needs assessment definition

A

A systemic approach for reviewing health issues which leads to agreed priorities and resource allocation to improve health and decrease inequalities (takes into account need, demand, supply)

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6
Q

Epidemiological health needs assessment definition

A

Disease incidence & prevalence
Morbidity & mortality
Life expectancy
Services available (location, cost, utilisation, effectiveness)

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7
Q

Limitations of a epidemiological health needs assessment

A

Data availability may be poor
May be inadequate evidence base / quality of evidence
Reinforces a biomedical model of care / doesn’t consider felt need

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8
Q

Comparative health needs assessment definiton

A

Compares services received by one population to another
Spatial (e.g. different towns) or social (e.g. age, social class)
Evaluates variation in performance/costs of services

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9
Q

Comparative health needs assessment limitations

A

Data available may vary in quality
May be hard to find comparable population
Comparison may not be perfect

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10
Q

Corporate health needs assessment definition

A

Takes into account views of any groups that may have an interest e.g. patients, health professionals, media, politicians

Example of data collection = focus groups

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11
Q

Corporate health needs assessment limitations

A

May be hard to distinguish need from demand
Groups have vested interest - leads to bias
Dominant individuals may have undue influence

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12
Q

Types of need in health needs assessment (4) / Bradshaw taxonomy of social need

A

FENC

Felt need
Expressed need
Normative need
Comparative need

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13
Q

‘Felt need’ definition

A

Individual perceptions of deviations from normal health

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14
Q

‘Expressed need’ definition

A

Seeking help to overcome variation in normal health

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15
Q

‘Normative need’ definition

A

Professional expert defines intervention for expressed need e.g. vaccination

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16
Q

‘Comparative need’ definition

A

Comparison between severity, range of interventions and cost

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17
Q

Maslow’s hierarchy of needs

A

Physiological
Safety
Love/belonging
Esteem
Self-actualisation

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18
Q

Egalitarian resource allocation + pro/con

A

Provide all care that is necessary and required to everyone

+ equal for everyone
- economically restricted

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19
Q

Maximising resource allocation + pros/cons

A

Based solely on consequence

+ resources allocated to those likely to receive most benefit
- those with ‘less need’ will receive nothing

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20
Q

Libertarian resource allocation + pros/cons

A

Each individual responsible for own health

+ onus on patient, therefore may be more engaged
- not all diseases are self-inflicted

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21
Q

Maxwell’s 6 dimensions of quality

A

3 A’s, 3 E’s

Appropriateness / Effectiveness
Acceptability / Efficiency
Accessibility / Equity

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22
Q

Donabedian’s 3 step approach to quality

A

Structure
Process
Outcome

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23
Q

Examples of ‘structure’ in Donabedian’s 3 step approach to quality

A

Buildings e.g. wards
Facilities e.g. beds
Staff e.g. ratios to patients
Equipment e.g. new investment
Technology e.g. electronic notes

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24
Q

Examples of ‘process’ in Donabedian’s 3 step approach to quality

A

Guidelines + Protocols + Pathways of care = followed
Number of patients treated
User satisfaction surveys
Waiting times
Frequency of follow-up

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25
Q

Examples of ‘outcome’ in Donabedian’s 3 step approach to quality

A

Recovery
Morbidity rates
Mortality rates
Trends in preventable disease
Reduction in incidence in a population

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26
Q

Health behaviour aim

A

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

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27
Q

Illness behaviour aim

A

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

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28
Q

Sick role behaviour aim

A

Behaviour aimed at getting well e.g. taking antibitiotics

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29
Q

6 models of behaviour change

A

Theory of planned behaviours
Nudge theory
Health belief model
Motivational interviewing
Transtheoretical model
Financial incentives

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30
Q

Theory of planned behaviours model

A

intention is the greatest predictor of health behaviours

  1. Attitudes
  2. Subjective norms
  3. Perceived behaviour control
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31
Q

Advantages of theory of planned behaviours model

A

Can be applied to wide variety of health behaviours
Useful for predicting intention
Takes into account importance of social pressures

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32
Q

Disadvantages of theory of planned behaviours model

A

No temporal element, direction or causality
Doesn’t consider the complexity of human emotions
Assumes attitudes can be measured

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33
Q

Health belief model key 5 factors

A

Perceived susceptibility
Perceived severity
Health motivation
Perceived benefits
Perceived barriers

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34
Q

Other variables that could influence the health belief model

A

Demographic variables including age, gender and SE status
Psychological characteristics including personality, peer pressure

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35
Q

Advantages of the health belief model

A

Can be applied to wide variety of health behaviours
Cues to action are unique component
Longest standing model

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36
Q

Disadvantages of the health belief model

A

Other factors may influence the outcome
Doesn’t consider emotions
Doesn’t differentiate between first time and repeated behaviours

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37
Q

4 questions to consider when assessing medical negligence

A

Was there duty of care?
Was there a breach in that duty?
Was the patient harmed?
Was the harm due to the breach in care?

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38
Q

Twin pillars of medical negligence

A

Bolam rule (would a reasonable doctor do the same?)
Bolitho rule (would that be reasonable?)

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39
Q

Error definition

A

‘never events’

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

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40
Q

Types of error (7)

A

Lack of skill
Over attachment (conducting tests to confirm what we expect to see)
Failure to consider the alternative
Mistriage
Ignorance
Inheriting thinking
Bravado

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41
Q

Variables of ‘self’ in the 3 bucket model of error

A

Level of knowledge
Level of skill
Level of expertise
Current capacity to do task

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42
Q

Variables of ‘context’ in the 3 bucket model of error

A

Equipment + devices
Physical environment
Workspace
Team + support
Organisation + managment

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43
Q

Variables of ‘task’ in the 3 bucket model of error

A

Errors
Task complexity
Novel task
Process

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44
Q

4 screening tests in UK

A

E.g:
Newborn (heel prick)
Breast cancer (mammography)
Cervical cancer (smear)
Bowel cancer (stool in the post)

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45
Q

Screening criteria: disease factors

A

Important
Pre-clinical phase
Natural history known
Early treatment better than late / effective treatment available

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46
Q

Screening criteria: test

A

Fit for purpose (sensitive, specific, cost-calculated)
Acceptable to the population
Facilities available
Simple, safe, precise and validated

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47
Q

Screening criteria: outcomes

A

Ongoing feasibility
Treatment available
Cost-benefit analysis

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48
Q

True positive

A

Test +ve
Dx +ve

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49
Q

False +ve

A

Test +ve
Dx -ve

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50
Q

False -ve

A

Test -ve
Dx +ve

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51
Q

True -ve

A

Test -ve
Dx -ve

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52
Q

Cross-sectional study definition

A

Snapshot data of those with and without disease to find associations at a single point in time

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53
Q

Cross-sectional study positives (2)

A

Quick and cheap
Few ethical issues
Large sample size

54
Q

Cross-sectional study negatives (2)

A

Risk of recall bias and non-response
Cannot measure incidence
Risk of reverse causality

55
Q

Case-control study definition

A

Retrospective observational study which looks at a certain exposure and compares similar participants with and without the disease

56
Q

Case-control study advantages

A

Good for rare diseases e.g. cancer
Quicker than cohort or intervention as the outcome has already happened

57
Q

Case-control study negatives

A

Can only show association (not causation)
Unreliable due to recall bias

58
Q

Cohort study description

A

Longitudinal prospective study which takes a population of people recording their exposures and conditions they develop

59
Q

Cohort study advantages

A

Can follow-up a group with a rare exposure e.g. natural disaster
Less risk of selection and recall bias
Good for common outcomes

60
Q

Cohort study negatives

A

Takes a long time
Large amount lost to follow up (people dropping out)
Large sample size needed
Expensive

61
Q

RCT description

A

Similar participants randomly controlled to intervention or control groups to study the effect of the intervention

GOLD STANDARD

62
Q

RCT study positives

A

Can infer causality
Less risk of bias/confounders

63
Q

RCT study negatives

A

Time consuming and expensive
Ethical issues can interfere

64
Q

Bradford Hill criteria for causality (4)

A

Specificity (relationship specific to outcome of interest)
Strength of association
Dose response relationship
Temporality

65
Q

Confounding factor definiton

A

Risk factor independently associated with the exposure and the outcome

66
Q

Bias definition

A

A systematic error that results in a deviation from the true effect of an exposure of an outcome

67
Q

Types of bias (SIP)

A

Selection
Information
Publication

68
Q

4 types of information bias

A

Measurement bias (different equipment used to measure the outcome in the different groups)
Observer bias (not double blind)
Recall bias (past events incorrectly remembered)
Reporting bias (responder doesn’t tell the truth)

69
Q

Sensitivity equation

A

it is able to pick it (true positives) up but it might not pick it all up (false negatives left behind)

70
Q

Specificity equation

A

True negatives / True negatives + False positives

71
Q

2 ethical frameworks that can be used to assess an ethical dilemma

A

Seedhouses’s ethical grid
Four quadrants approach

72
Q

Four quadrants approach to an ethical dilemma

A

Medical indications (beneficence and non-mal)
Contextual features (justice)
Patient preferences (autonomy)
Quality of life (beneficence and non-mal)

Analogy: GP appointment - PC/PMH (medical indications), social history (contextual features), ICE (patient preferences), Management (QOL)

73
Q

Seedhouse’s ethical grid 4 layers

A

Core rational
Deontological layer (beneficence and non-mal)
Consequential layer (increase of good)
External considerations

74
Q

Who can provide consent for a child who lacks capacity

A

Consent from one parent is sufficient to administer treatment as long as it is in the best interest of the child

75
Q

Public health definition

A

The science and art of preventing disease, prolonging life and improving health through organised efforts of society

76
Q

3 perspectives of a health needs assessment

A
  1. Epidemiological
  2. Comparative
  3. Corporate
77
Q

3 systems of resource allocation

A
  1. Egalitarian
  2. Maximising
  3. Libertarian
78
Q

Primary prevention

A

Preventing disease from occurring in the first place e.g. vaccine

79
Q

Secondary prevention

A

Early identification/Screening e.g. cancer screening

80
Q

Tertiary prevention

A

Limit consequences/Treatment e.g. stroke rehab

81
Q

Population approach to prevention

A

Shift the risk factor distribution curve e.g. dietary salt reduction through legislation to reduce blood pressure

82
Q

High risk approach to prevention

A

Identify high risk individuals and treat them e.g. screening for BP and treating with anti-hypertensives

83
Q

Prevention paradox

A

Benefit to the population often offers little impact to each participating individual e.g. most people don’t ever need a seatbelt but wearing a seatbelt saves thousands of lives

84
Q

Pros of screening

A

Reproductive choice
Informed decision
Reassurance
More effective treatment

85
Q

Cons of screening

A

Exposure of well individuals to distressing or harmful diagnostic tests e.g. colonoscopies
Detection and treatment of sub-clinical disease that would never have caused any problems
Over treatment
Difficult decisions
Anxiety or false reassurance

86
Q

UK screening programmes (11)

A

3 in pregnancy (sickle cell and thalassaemia, infectious disease (HIV, Hep B and syphilis), and Down’s, Edward’s and Patau’s)
3 in newborn baby (NIPE, hearing, heel prick)
5 in young people and adults - BBC (bowel 60-74, breast 50-70, cervical 25-64), Diabetic eye screening (from age 12), Abdominal aortic aneurysm (over 65 men)

87
Q

Wilson and Jungner Criteria for a screening test

A
  1. The condition: knowledge of the disease (important, understood, recognisable stages)
  2. The screening programme (ongoing, cost balance)
  3. The test (suitable test, accepted by public)
  4. The treatment (accepted treatment, enough facilities, agreed policies on who to treat)
88
Q

Sensitivity definition

A

The ability of a test to correctly identify patients with a disease

89
Q

Specificity definition

A

The ability of a test to correctly identify people without the disease

90
Q

Positive predictive value definition

A

Out of the total positive screening test results, who was actually positive?

91
Q

Negative predictive value definition

A

Out of the total negative screening test results, who was actually negative?

92
Q

Analysing screening test (2 types of bias)

A

Length time bias
Lead time bias

93
Q

Top of the hierarchy of evidence

A

Systematic reviews & meta analysis

94
Q

Bottom of the hierarchy of evidence

A

Editorial reviews

95
Q

Odds equation

A

Probability event occurs / probability event does not occur

96
Q

Causes of association

A

Bias
Confounding factors
Chance
Reverse causality
True association

97
Q

Epidemiology

A

Branch of medicine that deals with incidence, distribution and possible control of diseases

98
Q

Incidence

A

Number of new cases over a certain time period

99
Q

Prevalence

A

number at set point in time

100
Q

Person-time definition

A

Measure of the actual ‘time at risk’ that all patients contributed to a study

101
Q

Risk definition

A

The probability that an event will occur

102
Q

Relative risk

A

Percentage of outcomes in one group/percentage of outcomes in another group

e.g. 1/3 women getting breast cancer vs 1/833 men
RR = 0.33/0.001 = 330 (women are 330 x more likely to get breast cancer than men)

103
Q

Number needed to treat definition

A

The number you need to treat to prevent one bad outcome from happening

104
Q

Factors that influence perceptions of risk (4)

A

Lack of personal experience with problem
Belief that it is preventable by personal action
Belief that if it has not happened by now, its not likely to
Belief that the problem is infrequent

105
Q

Transition points (6)

A

Leaving school
Entering the workforce
Becoming a parent
Becoming unemployed
Retirement
Bereavement

106
Q

Transtheoretical model stages of change

A
107
Q

Principles of treating drug use

A

Reduce harm to user, friends and family
Improve health
Stabilise life
Reduce crime

108
Q

Level of alcohol dependency factors (3)

A

Withdrawal symptoms
Tolerance
Narrowing of repertoire

109
Q

Barriers to refugee health

A

Reluctance of GPs to register them
Illiteracy
Communication
Lack of permanent site
Mistrust of professionals

110
Q

Malnutrition 2 groups

A

Under nutrition
Overweight, obesity

Triple = coexistence of undernutrition (stunting and wasting), micronutrient deficiencies (often termed hidden hunger), and overnutrition (overweight and obesity)

111
Q

4 dimensions of food insecurity

A

Availability (affordability) of food
Access - economic
Utilisation
Stability

112
Q

Need definition

A

The ability to benefit from an intervention

113
Q

Need supply demand Venn diagram

A
114
Q

Benefits of comparative health needs assessment

A

Quick
Inexpensive

115
Q

Evaluation of health needs assessment (2 +, 2 -)

A

+ improved patient care
+ better use of resources
- data access
- conflicts of interest

116
Q

Health equity audit

A

Helps services reduce health inequalities by using evidence to inform service planning and investment decisions

117
Q

Health impact assessment

A

Systematically assesses the potential health impacts of programmes and policies to improve decision making and help to predict future positive and negative health impacts of other projects

118
Q

Quaternary prevention

A

Prevent complications from over medicalising or over treatment of a condition

119
Q

Primordial prevention

A

Prevents risk from developing

120
Q

Public health interventions at population vs individual vs community level examples

A

Population: clean air act to reduce air pollution e.g. smoking ban

Individual: childhood immunisation schedule

Community: creating community spaces e.g. playgrounds

121
Q

Prevalence of no disease

A

Everyone who does not have the disease out of the whole population tested i.e. are we testing for a disease that is actually rare? Is it worth testing for?

122
Q

Length time bias example

A

Less aggressive cancers are diagnosed more on screening tests because a patient will survive longer to participate in screening

123
Q

Lead time bias

A

A patient can appear to have survived longer from a disease because their disease was identified earlier

124
Q

Absolute risk

A

Risk of developing a disease over a time period e.g. 1 in 3 women will develop breast cancer during their lifetime

125
Q

Reverse causation

A

People believe X causes Y, but actually Y causes X

126
Q

Odds ratio

A

How strongly an event is associated with exposure, commonly reported for case control studies

Odds of event in exposed group / odds of event in non-exposed group

127
Q

Advantage of the epidemiological approach health needs assessment

A

Uses existing data e.g. from GPs
Provides data on disease incidence, mortality etc.
Can calculate services by trends over time

128
Q

Selection bias

A

Systematic error in selection of study participants
1. Non-response
2. Loss to follow up
3. Differences in intervention group to control

129
Q

Corporate health needs advantages

A

Based on the felt and expressed needs of the population in question
Recognises the detailed knowledge of those working with the population e.g. teachers, social workers

130
Q

Comparative health needs assessment advantages

A

Quick and cheap if data is available
Indicates whether health or services provision is better or worse than comparable areas

3a PTS - PM - ZTF (8 decks)

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