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Public Health Flashcards

1
Q

What is primary prevention?

A

Preventing a disease form occuring in the first place-eliminates RF contriburting?

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2
Q

List 3 examples of primary prevention?

A

Vaccines
change4life
5 a day

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3
Q

What is secondary prevention?

A

detecting a disease inits early or pre-clinical phase to alter its course

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4
Q

List 2 examples of secondary prevention?

A

all screening programmes (breast, Bowel, cervical cancer)
Heel prick

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5
Q

What is tertiary prevention?

A

attempting to slow down disease progression + prevent complications of a disease, helping people manage their illness effectively.

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6
Q

List an example of tertiary prevention?

A

diabetic foot care, attending rehab after a stroke to prevent immobility.

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7
Q

What is the purpose of screening?

A

identifies seemingly well individuals who may be at risk of a disease, in the hope of catching the disease at its early stage

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8
Q

what is sensitivity?

A

the proportion of people with the disease who are correctly identified by the screening test.

a ÷ (a + c)

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9
Q

What is specificity?

A

the proportion of people without the disease who are correctly excluded by the screening test.

d ÷ (d + b)

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10
Q

What is PPV?

A

the proportion with a positive test result
who actually have the disease. Dependent on underlying prevalence.

a ÷ (a + b)

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11
Q

What is NPV?

A

the proportion with a negative test result
who do not have the disease. This is lower if the prevalence is higher.

d ÷ (c + d)

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12
Q

List 2 disadvantages of screening?

A

Exposing well individuals to distressful or harmful diagnostic tests

Overtreatment of disease that may have never caused any problems

Preventative interventions may cause harm to the inividual or population

Reassurance to false negatives patients

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13
Q

What criteria is used fro screening?

A

Wilson and Junger

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14
Q

List 3 requirements for screning according to the wilson junger criteria?

A
  1. condition should be an important health problem
  2. there should be an accepted tx for patients
  3. There should be facilities available for dx and tx
  4. There should be a recognisable latent and early symptomaic stage
  5. There should be a suitable test for examination
  6. Test should be acceptable for the population
  7. the natural hx of disease should be understood
  8. should be a policy on whom to treat as patients
  9. cost of screening should be economically balanced
  10. should be a continuous process, and not just a one off
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15
Q

What is lead time bias?

A

Screening identifies diseases earlier and so gives the impression that survival is prolonged but in reality survival time is unchanged

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16
Q

What is length time bias?

A

Diseases with a longer period of presentation are more likely to be detected by screening than ones with a shorter time of presentation.

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17
Q

Describe the prevention paradox.

A

A preventative measure that brings much benefit to the population often offers little to each participating individual.

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18
Q

Give 4 different types of screening.

A

Population based.
Opportunistic.
Screening for communicable diseases.
Pre-employment and occupational.

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19
Q

What is the population approach to prevention? Give an example.

A

Preventative measures delivered on a population wide basis e.g. dietary salt reduction.

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20
Q

What is the high risk approach to prevention? Give an example.

A

Identifying individuals above a chosen cut-off and treating them. E.g. treating those with high cholesterol to avoid heart disease.

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21
Q

What is a RCT?

A

Where a population is randomised to either an interventional or a control group. Often these are blind or double-blind trials.

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22
Q

Which type of study follows a population over time to see if they’re exposed to the agent in question and if they develop the disease?

A

A cohort or incidence study. These are prospective.

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23
Q

Which type of study compares people with a disease to those without a disease for age, sex, habits, class etc?

A

A case-control study. These are retrospective.

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24
Q

Which type of study looks at the population at a point in time?

A

A cross-sectional or prevalence study.

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25
Which type of study uses routinely collected population level date to show trends and to generate hypotheses?
An ecological study.
26
What are the 4 main determinants of health?
Lifestyle. Access to healthcare. Genes. Environment.
27
Define the following A) Equity B) Equality
Equity-Giving people wht they need to acheive equal outcomes (what is fair and just) Equality- Giving veryone the same rights, oppurtunities, adn resources (equal shares)
28
Define horizontal equity.
Equal treatment for equal need.
29
Define vertical equity.
Unequal treatment for unequal need e.g. someone with a common cold would need a different treatment to someone with pneumonia.
30
Give 2 factors that can affect equity.
1. Spatial factors - geographical. 2. Social factors - age, gender, class, ethnicity.
31
What are the 3 domains of public health?
1. Health promotion. 2. Health protection. 3. Improving health services.
32
Domains of public health: give examples of health promotion.
Health promotion looks at interventions e.g. immunizations, smoking cessation, screening.
33
Domains of public health: give examples of health protection.
Putting measures in place to control infectious diseases.
34
Domains of public health: what are the aims of health service improvements?
To ensure that there is delivery of organised, safe and high quality services.
35
Give 3 types of health behaviour.
1. Health Behaviour 2. Illness Behaviour 3. Sick role behaviour
36
Define health behaviour.
Health behaviour is aimed at preventing disease e.g. eating healthily.
37
Define illness behaviour.
Illness behaviour is aimed at seeking remedy e.g. going to the Dr’s.
38
Define sick role behaviour.
Sick role behaviour is activity aimed at getting better e.g. taking medications.
39
What are health damaging behaviours?
Health damaging behaviours are often related to mortality e.g. smoking, alcohol, high risk sexual behaviours.
40
What are health promoting behaviours?
Behaviours that seek and maintain health e.g. exercise, eating healthily, having vaccines.
41
What is a meta-analysis?
A statistical technique where you pool all the results of the available evidence and look at effect.
42
Define compliance.
The extent to which a patients behavior coincides with medical advice. It is professionally focused and assumes that the doctor knows best.
43
Give 3 factors that can effect compliance.
1. Side effects of medications. 2. Patient perception of risk. 3. If the patient is asymptomatic. 4. Socioeconomic status.
44
What is the single greatest cause of illness and premature death in the UK?
smoking
45
What 3 diseases are smoking related deaths normally due to?
Cancers. COPD. CHD.
46
When does smoking prevalence peak?
In the mid 20’s.
47
Smoking cessation: give 3 symptoms of withdrawal
Difficulty concentrating. Increased appetite. Irritability.
48
What are the 5 level’s of Maslow’s hierarchy of needs?
1. Physiological need 2. Safety need 3. Love and belonging 4. Esteem 5. Self-actualisation
49
Define domestic abuse.
Incidents of controlling, coercive, threatening behaviour, violence or abuse between those aged 16+ who are, or have been, intimate partners or family members regardless of gender or sexuality.
50
Give 3 examples of domestic abuse.
Emotional abuse. Physical abuse. Financial abuse. Sexual abuse. Psychological abuse.
51
How can domestic abuse impact on health?
1. Traumatic injuries following assault e.g. fractures, miscarriage. 2. Somatic problems or chronic illness e.g. chronic pain, headaches. 3. Psychological problems e.g. PTSD, depression, anxiety.
52
Give 3 potential indications of domestic abuse.
Unwitnessed by anyone else. Repeat attendances to GP or A+E. Delay in seeking help. Multiple minor injuries.
53
What assessment tool can be used to determine someones risk of domestic abuse?
The DASH assessment
54
What action would you take if someone was at high risk of domestic abuse?
Refer to MARAC or IDVAS
55
Define incidence.
The rate at which new diseases occur in a population in a certain time period.
56
Define prevalence.
The proportion of a population found to have a disease at a point in time.
57
What is NNT?
Number needed to treat is the number of patients that need to be treated in order to have an impact on one person.
58
How can you calculate NNT?
1 / absoloute risk reduction.
59
Define bias.
A systematic deviations from the true estimation of the association between exposure and outcome.
60
What is selection bias?
The people who choose to participate in screening programmes may be different from those who don’t. Proper randomisation is not achieved.
61
What is information bias?
Information or measurement bias can be due to observer, participant or instrument error.
62
Define confounding.
Confounders are associated with exposure and outcome but are not on the causal path from exposure to disease. Confounders may affect the validity of a study.
63
What is the Bradford Hill criteria for causation?
Used to assess causation: DRS CBT 1. Dose response. 2. Reversibility. 3. Strength of association. 4. Consistency. 5. Biological plausibility. 6. **Temporality** - cause before disease.
64
What is Public Health?
The science and art of preventing disease, prolonging life and promoting health through organised efforts of society.
65
Define epidemiology.
The study of the frequency, distribution and determinants of diseases and health-related states in populations in order to prevent and control disease.
66
What is allostasis?
The process of achieving stability, or homeostasis, through physiological or behavioural change.
67
What is allostatic load?
The wear and tear on the body that accumulates as an individual is exposed to repeated or chronic stress. The price we pay for allostasis.
68
Definition of an asylum seeker?
a person who has made an application for refugee satus
69
Definition of refugee?
a person grnated asylum + refugee satutus (usually means leave to remian for 5 years and then reapply)
70
What are the entiletments for asylum seekers?
o Housing but with no choice of where. o Cash support amounting £37pp in the household (or £35 if refused). o Full access to NHS (free prescriptions, eyesight tests, dental care). o Education for children 5–17.
71
What health problems to asylum seekers usaully present with?
o Common illness + illnesses specific to country of origin. o Injuries from war + travelling. o No previous health surveillance/neonatal screening/immunisations. o Malnutrition, torture + sexual abuse (including female genital mutilation). o Communicable + blood borne diseases. o PTSD, depression, psychosis, self-harm, sleep disturbance.
72
List 3 causes for homelessness?
Realtionship breakdown Mental illness, domestic abuse Disputes with parents Drugs, alcohol No money or job
73
Which populations vulnerable to homelessness
o LGBTQ+. o Ex-service men + women. o Substance misusers. o Failed asylum seekers
74
List 5 health problems are faced by the homeless?
Infectious diseases such as TB + hepatitis. Poor condition of feet + teeth. Respiratory problems. Injuries following violence, rape. Sexual health issues. Serious mental illnesses (schizophrenia, depression + personality disorders). Poor nutrition. Addictions/substance misuse.
75
List 3 barriers to healthcare for travellers?
Reluctance of GPs to register travellers + to visit traveller sites. Poor reading + writing skills (many are illiterate). Communication difficulties. Too few permanent sites. Mistrust of professionals.
76
What is the inverse care law?
the availability of medical care tends to vary inversely with the need of the population served (those who need it most, don’t access it, vice versa).
77
What is the main theory why pateints undertake health damaging behaviours?
Unrealistic optimism** = individuals continue practicing health damaging behaviours due to inaccurate perceptions of risk + susceptibility.
78
What perceptions influence unrealistic optimism?
Lack of personal experiences with the problem. Belief that it’s preventable by personal action. Belief that it’s not happened by now so it’s not likely to. Belief that the problem is infrequent.
79
List the stages in the health belief model?
Percieved susceptibility Percieved severity Percieved benefits Percieved barriers
80
What are the 5 stages of change/trnastheoritical model
Precontemplation Contemplation Preparation Action Maintenance
81
What is nudge theory?
Changing the environment to make the best/healthiest option the easiest
82
What does the helath needs assessment planning cycle include?
needs assessment -->vplanning --> implementation --> evaluation -->
83
What is felt need?
individual perceptions of variation from normal health.
84
What is expressed need?
When an individual seeks help to overcome variation in normal health.
85
What is normative need?
When a professional defines interventions that are appropriate for expressed need.
86
What is comparative need?
Comparison between severity, range of interventions and cost
87
Name 3 different types of health needs assessment.
1. Epidemiological 2. Comparitive 3. Corporate
88
Briefly describe a comparative health needs assessment.
Compares services received by one population with other populations.
89
Give 3 negative points for comparative health needs assessments.
Required data may not be available. Variable data quality. It is hard to find comparable populations.
90
Who might be involved with corporate health needs assessment?
Politicians. Press. Providers. Professionals. Patients.
91
Give 3 negative points for corporate health needs assessments.
Difficult to distinguish need from demand. Groups may have vested interests. May be influenced by political agendas.
92
Give one health related example of something that you consider is demanded but not needed or supplied.
Cosmetic surgery
93
List 5 transition points and what are they?
Transition points- points at which interventions are thought to be more effective 1) Leaving school 2. Entering the workforce 3) Becoming a parent 4) Beocming unemployed 5) Retirement and bereavement
94
What are the 4 dimensions of food insecurity
Availability (affordability) of food Access – economic and physical Utilisation – opportunity to prepare food Stability of the three dimensions over time
95
What is relative risk ?
how many times factor exposure would increase the incidence of an individual (a/a+b)/(c/c+d)
96
What is attributable risk
How many times a facotr exposure would increase the incidence rate of a group (a/a+b)-(c/c+d)
97
What are the 2 ways in which healthcare can be assessed?
Maxwells dimension Donebedian approach
98
What is maxwells dimensions?
3As and 3Es Accesibility Acceptibility Appropriateness Equity Efficiency Effectiveness
99
How many screening programmes are their in the UK and list them?
11 3 In pregnancy -HIV/Syphylis/HepB -Thallassemia and Sickle cell -Foetal anomaly scan 3 in Newborn - Hearing test - NIPE - Heel prick test 5 in adults - AAA screening (Men >65) - Bowel cancer (FIT test 60-74, every 2 years) - Breast cancer (Women 50-70 every 3 years) - Cervcial cancer (women, 25-49 every 3 years, 50-64 every 5 years) - Diabetic eye
100
Define: need demand supply
need- ability to benefit from an intervention demand- what people ask for supply- what is provided

Phase 3A (HV) (10 decks)

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