Public health Flashcards
What are the three domains of public health?
Health protection, health improvement, improving services
What is the inverse care law?
the availability of medical or social care tends to vary inversely with the need of the population served
What is equity?
equity - to do with what is fair and just. equal treatment for equal need, unequal treatment for unequal need
What is a 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 disease inequalities
What are the three areas/types of health needs assessment?
Epidemiological
comparative
corporate
What are the four types of need?
FENC
Felt need
Expressed need
Normative need
Comparative need
What is the felt need?
Individual perceptions of deviations from normal health
What is expressed need?
seeking help to overcome variation in normal health
What is normative need?
Professional defines intervention for expressed need
What is comparative need?
Comparison between severity, range of interventions and cost
What are the five areas in maslow’s hierachy of needs? (bottom to top)
Physiological - food, water, sex, sleep, breathing
Safety - security of body, home, resources, employment
Love/belonging - friendship, sexual intimacy
Esteem - confidence, achievement
Self-actualisation - morality, creativity, problem solving
What is the egalitarian approach to resource allocation?
Provide all care that is necessary and required to everyone (+ equal for everyone, - economically restricted)
What is the maximising approach to resource allocation?
Based solely on consequence (+ resources allocated to those most likely to benefit, - those with less need receive nothing)
What is the libertarian approach to resource allocation?
Each individual is responsible for own health (+ onus on patient, so more likely to engage, - not all illnesses are self-inflicted)
What are maxwell’s 6 dimensions to assessing the quality of a service?
Access, equity, appropriate - relevant to need, acceptability, efficient, effective
What is health behaviour?
behaviour aimed to preventing disease (e.g. going for a run)
What is illness behaviour?
behaviour aimed at seeking remedy (e.g. going to a GP for a symptom)
What is sick role behaviour?
Activity aimed at getting well (e.g. taking antibiotics)
What is the transtheoretical model of behaviour change?
(PC PAM) Precontemplation - contemplation - preparation - action - maintenance
(- some individuals skip stages, change may be continues not in discrete stages)
What is the theory of planned behaviours model of behaviour change?
ASP
Attitudes, subjective norms, perceived behaviour control
All goes into intention, which then leads to behaviour
(P PAIR - preparatory actions, perceived control, anticipated regret, implementation intentions, relevance to self)
What are the advantages and disadvantages of the theory of planned behaviours model?
+ applied to lots of health behaviours
+ takes into account social pressures
- no temporal element
- doesn’t consider emotions
What is the health belief model of behaviour change?
- Takes into account demographics, personality and peer groups
- perceived susceptibility
- perceived severity
- health motivation
- perceived benefits
- perceived barriers
Uses these to assess likelihood of action as well as uses cues to action
What are the questions that you ask in medical negligence?
Was there duty of care?
Was there a breach in that duty?
Was the patient harmed?
Was the harm due to a breach in care?
Bolam rule: would a reasonable doctor do the same
Bolitho rule: would that be reasonable?
What types of error can occur?
Sloth (inadequate documentation), fixation (fixing on one diagnosis, loss of perspective), communication breakdown, poor teamworking, playing the odds (choosing the common dismissing the rare), bravado/timidity, ignorance, mitriage, lack of skill, system error
What is the three bucket model of error?
A model that shows that error is due to a combination of personal, environmental and physical factors
What is a never event?
A serious, largely preventable patient safety incident that should not occur if available, preventative measures have been implemented
What are the criteria for screening to take place?
Disease: important, natural history known, early treatment better than late
Test: acceptable to the public, facilities available, simple, safe, precise
Outcomes: ongoing feasibility, treatment available, cost-benefit analysis
What is a false positive test?
When the test is positive but they do not have the disease
What is a false negative?
When the test is negative but they do have the disease
What are the most accepted studies and data (top to bottom)?
meta-analysis, RCT, cohort, case-control, cross-sectional, case series, case report
What is a cross sectional study?
A snapshot of data of those with and without a disease to find associations at a single point in time
What are the advantages of disadvantages of a cross-sectional study?
Quick and cheap, few ethical issues
Prone to bias, no time reference
What is a retrospective/case control study?
An observational study which looks at a certain exposure and compares similar participants with and without the disease
What are the advantages and disadvantages of a retrospective/case control study?
Good for rare diseases
Inexpensive
Can only show association not causation
unreliable due to recall bias
What is a cohort study?
A longitudinal prospective study which takes a population of people recording their exposures and conditions they develop
What are the advantages and disadvantages of a cohort study?
Can show causation
Less chance of bias
Large amount lost to follow up
expensive
What are the advantages and disadvantages of an RCT?
Can infer causality
less risk of bias/confounders
time consuming and expensive
ethical issues can interfere
What are confounders?
Risk factors other than those being studies that influence the outcome
What is bias?
A systematic error that results in a deviation from the true effect of an exposure on an outcome
What are the three main types of bias in science?
selection bias, information bias, publication bias
How do you work out sensitivity?
true +VE / true +ve + false negative
How do you work out specificity?
true -ve / true -ve + false +ve
