Public Health Flashcards
What are the 3 domains of public health?
Health Improvement, Health protection, Service improvement
What is the difference between equality and equity?
Equality: treating everyone the same, giving everyone equal shares
Equity: being fair, giving everyone what they need to be successful
What is horizontal vs vertical equity?
- horizontal: equal treatment for equal need
- vertical equity: unequal treatment for unequal need
(theyre all the same lying down)
What are the bradford hill criteria?
BC-ASPECTS:
- biological gradient
- coherence
- analogy
- strength
- plausibility
- experiment
- consistency
- temporality
- specific
What can cause association?
Bias, confounding factors, chance, reverse causality, true association
What is bias?
A systematic error that results in a deviation from the true effect of an exposure of an outcome
What are the three classifications of bias?
Selection bias, information bias, publication bias
What is selection bias?
Systematic error in the selection of study participants or the allocation of participants to different study groups
What is information bias?
Systematic error in the measurement or classification of exposure or outcome
What are sources of information bias?
Observer, participant, instrument
What is publication bias?
Trials with negative results less likely to be published
What is lead time bias?
Early identification doesn’t alter outcome but appears to increase survival (eg, patient knows they have disease for longer)
What is length time bias?
Disease that progress more slowly is more likely to be picked up by screening, which makes it appear that screening prolongs life
What is confounding?
When an apparent association between an exposure and an outcome is actually the result of another factor
What is a cross sectional study?
A retrospective observational study collecting data from a population at a specific point in time
What are the pros of cross sectional study design?
Large sample size, rapid, can repeat over time to identify changes
What are the cons of cross sectional study designs?
Risk of reverse causality, disease length bias (won’t include those who recovery quickly), can’t identify any temporal components, selection bias, largely reliant on self reported data, limited for rare outcomes or exposures
What is a case control study?
A retrospective observational study looking at population with disease and a control population. Looks at those who were exposed/non exposed
What are the pros of case control study design?
Good for rare outcomes, rapid
What are the cons of case control study design?
Prone to selection bias, resource consuming to find well matched controls, retrospective, hard to establish causality, may be difficult to get enough numbers for rare outcomes
What is a cohort study?
Prospective longitudinal study looking at separate cohorts with different treatments/exposure applied. Wait to see if disease occurs
What are the pros of cohort studies?
Can establish disease risk factors, can follow rare exposure, can collect data on confounders, can establish causality, can track multiple otucomes and exposures, can calculate incidence rates and relative risk
What are the possible cons of cohort studies?
Difficult to assess rare diseases (might not develop), drop outs, large sample size required
What is the difference between cohort studies and RCTs?
In RCT groups are randomised and double blinded, whereas they are picked in cohort
What are the pros of RCTs?
Two groups can be accurately compared, risk of bias and confounding is minimised
What are the cons of RCTs?
Ethical issues, drop outs, expensive
What is a ecological study?
Population based data rather than individual data
What is the difference between ecological study and cross sectional study?
Ecological is looking at two areas/two years, whereas cross sectional just looks at one area, one year
What are the definitions of need, demand and supply?
Need = ability to benefit from an intervention
Demand = what people ask for
Supply = what is provided
What is the definition of a health needs assessment?
A health needs assessment is a systematic method for reviewing the health issues facing a population, leading to agreed priorities and resource allocation that will improve health and reduce inequalities
What is Bradshaw’s needs?
Felt need, expressed need, normative need, comparative need
What is felt need?
Individual perceptions of variation from normal health (eg, patient can’t walk as far as they could before)
What is expressed need?
Individual seeks help to overcome variation in normal health (demand) (eg, seeking help from a doctor)
What is normative need?
Professional defines intervention appropriate for the expressed need (eg, doctor says go to physio services)
What is comparative need?
Needs identified by comparing the services received by one group of individuals with those received by another comparable group. Eg, one person may think they need a hip replacement if someone they know gets one
What are the stages of planning cycle for health needs?
Needs assessment, planning, implementation, evaluation
What is the approaches to health needs assessments?
Epidemiological, comparative, corporate
What is an epidemiological approach to health needs assessment?
Top down approach, looks at a whole area
What are the problems with an epidemiological approach to health needs assessment?
Does not consider the felt needs of people it is catering for, purely biomedical approach, requires pre-existing high quality data
What is corporate approach health needs assessment?
Takes into account views from patients, politicians, press, professionals, etc
What are the cons of health needs assessments, corporate approach?
May be hard to distinguish need from demand, certain groups may have vested interests and be influenced by political agendas
What is comparative health needs assessment approach?
Compares the services receieved by a sub-group with services recieved by another sub group (eg; MS patients physiotherapy in Yorkshire vs North West (spacial) or between under 30s vs over 30s (social)
What are the cons of comparative health needs assessment approach?
Difficulty in finding two comparable groups, may be comparing 2 bad services (lol, blind leading the blind!), may have 2 different sets of needs
What are the main 2 types of health needs assessment evaluation?
Donabedian approach, Maxwell’s dimensions
What is the Donabedian approach to health needs assessments?
- Structure 2. Process 3. Outcome (eg, PROMs, mortality, morbidity, patient satisfaction groups, 5D’s)
What is Maxwell’s dimensions of evaluation?
3Es+3As (effectiveness, efficiency, equity, acceptability, accessibility, appropriateness)
What ties together the two models used in health needs assessment evaluation?
Wright’s Matrix
What is incidence?
The number of new cases in a population during a specific time period (rate)
What is the definition of prevalence?
The number of existing cases at a specific point in time
What is relative risk?
The risk in one category relative to another
What does relative risk tell us?
The strength of association between a risk factor and a disease
What does a relative risk of >1 indicate?
That risks have increased due to a factor exposure
What is attributable risk?
The amount of disease that is specifically due to the exposure
What is number needed to treat?
The number of patients who need a specific treatment to prevent one bad outcome
How do you calculate attributable risk?
Risk incidence with expousre - risk of incidence no exposure
How do you calculate number needed to treat?
1/attributable risk
What Criteria is used for screening programmes?
Wilson Jugner criteria
What are the 4 categories of Wilson and Jugner criteria?
Knowledge of disease, knowledge of test, treatment for disease, cost considerations
What fits under ‘knowledge of disease’, Wilson Jugner criteria?
Important disease, must be a recognisable latent or early symptomatic stage (DCIS), understand natural course of condition
What fits under knowledge of test for Wilson and Jungner criteria?
Suitable test of examination (sensitivity, specific, inexpensive), test acceptable to population,
What fits under cost and organisation, in Jungner and Wilson criteria?
Must have costs and benefits, and available facilities
What fits under ‘treatment’ in Wilson and Jungner critera?
Acceptable treatment, facilities for dx and tx available, agreed policy concerning who to treat
What is sensitivity?
Does the test pick up the disease
What is specificity?
Does the test identify people who do not have the disease
What is positive predictive value?
Probability that subjects with a positive screening test have the disease
What is the negative predictive value?
Probability that subjects with a negative screening test do not have the disease
What is health behaviour and an example?
Aimed at preventing disease, for example going for a run
What is illness behaviour?
Seeking remedy, for example going to GP for symptom
What is sick role behaviour?
Activity aimed at getting well, for example taking antibiotics
What is the health belief model?
Individuals will change their health behaviour if:
1. they believe they are susceptible to the condition
2. believe in serious consequences
3. believe taking action reduces susceptibility
4. believe that benefits of action outweigh costs
What are critiques of the health belief model?
Ignores that people often don’t weigh up decisions like this, they are shaped by habitual behaviours, and may be influenced by social factors
What is the transtheoretical model?
Stages of change model!
Precontemplation, contemplation, pla/determination, action, maintenance/relapse (PC PAM)
What are the cons of stages of change model?
Not all people move forwards through all the stages/skip stages, doesn’t take into account social factors
What is the theory of planned behaviour?
There are 3 factors (attitudes, subjective norm, and perceived behaviour control) that lead to intention, and lead to behaviour
What are three examples of models of change?
Transtheoretical model (Stages of change), health belief model, theory of planned behaviour
How do you calculate the number of units in alcohol?
Units=ABV% x (volume (mls)/1000)
What is the recommended alcohol limit/week?
14 units
What is binge drinking for men and women?
Men = 8 units in a single session, women = 6 units in a single session
What is the CAGE questionnaire?
C: have you ever felt the need to cut down your drinking
A: have other people ever been annoyed by your drinking
G: do you ever feel guilty about your drinking
E: do you ever have an eye opening drink in the morning?
What is sloth error?
An error due to laziness, inadequate documentation
What is system error?
Inadequate built in safeguards, lack of surgical equipment due to failure for rota to check stock
What is the swiss cheese model?
When weaknesses at every level can lead to error
What is the three bucket model of error?
Buckets represent ‘self’, ‘context’, ‘task’. The more full those buckets are, the more likely error is.
What is primary prevention?
Preventing disease before it occurs, such as via vaccination, health promotion
What is secondary disease prevention?
Detecting a disease process before it causes symptoms (eg, via screening) or reduce the impact of what has already occurred
What is tertiary prevention?
Treating a disease to prevent progression/complications
What is meant by ‘error’?
Unintended outcome
What are the 4 ways that error could be classified?
Context, Outcome, Intention, Action
COIA: ‘Come On It’s Accidental’
Rausmussen’s 3 levels of performance
How can error be classified based on intention?
Failure of planned actions to achieve desired outcome. Skill based errors, rule based mistake, knowledge based mistakes
What are the 2 different persepctives on error?
The person approach (focus on individual), system approach (focus on working conditions)
What are the 10 basic types of error?
Sloth, fixation and loss of perspective, communication breakdown, poor team playing, playing the odds, ignorance, mis-triage, lack of skill, system error
What criteria is used for prescribing abx to someone with a sore throat?
CENTOR score or FEVERPain Score
What is the CENTOR criteria?
Tonsillar exudate, absence of cough, fever or large lymphadenopathy, fever
What 3 levels can health interventions be applied?
Individual level, community level, population level
What are 2 general approaches to prevention?
Population approach and high risk approach
What is the prevention paradox?
A preventative measure which brings much benefit to the population often offers little to each participating individual
What is an independent variable?
A variable which can be altered in a study
What is a dependent variable?
A variable that is dependent on the independent variables/cannot be altered
What is meant by ‘odds’ of an event?
Odds = probability/ (1-probability)
What is meant by epidemiology?
Epidemiology is the study and analysis of the distribution (who, when, and where), patterns and determinants of health and disease conditions in a defined population.
What are the 5 factors that could be responsible a study finds an association between an exposure and an outcome?
Bias, chance, confounding factors, reverse causality, a true causal association
What is the definition of addiction?
Craving, tolerance, compulsive drug/substance seeking behaviour, physiological withdrawal state
How often must heroin be used in people with heroin dependency to avoid withdrawal?
8 hourly
What are the effects of heroin?
Euphoria, intense relaxation, miosis, drowsiness
What are the adverse effects of heroin?
Dependence, withdrawal symptoms, nausea, itching, sweating, constipation, overdose
What is the mode of action of crack/cocaine?
Blocks reuptake of serotonin and dopamine at synapse, leading to intense pleasurable sensation
What does the theory of planning behaviour suggest the best predictor of behaviour is?
Intention
What is the nudge theory?
Changing the environment to make the best/healthiest option the easiest (eg, not having sweets at supermarket checkouts)
What factor of the health beliefs models has been shown to be most important?
Percieved barriers
Why do patients continue high risk behaviours despite knowing the risk?
Fun, justifies behaviour with other things, doesn’t have willpower to stop, unrealistic optimism
What is unrealistic optimism?
The only theory for why patients engage in risky behaviours. They might be aware of risks but don’t think it could happen to them
What is the difference between an infectious disease and a communicable disease?
Infectious disease = any disease caused by an infection, communicable disease = disease that can spread from one person to another
Define cluster (in communicable disease)
Aggregation of cases, may or may not be linked
Define suspected outbreak?
Occurence of more cases of a disease than normally expected within a specific place or group of people over a given time period
What are the levels of Maslow’s hierarchy of needs?
(from bottom) physiological, safety, love/belonging, esteem, self actualisation
What is the definition of a never event?
Serious, largely preventable patient safety incidents that should not occur if the available preventative measures have been implemented
What is the definition of negligence?
A breach of duty of care which results in damage
What are the 2 tests that can be used to decide whether there was a breach in a duty of care?
Bolam test (would a group of responsible doctors do the same) and Bolitho test (would it be reasonable of them to do so)
What is the definition of ethnocentrism?
The tendency to evaluate other groups according to the values and standards of own’s own culture group
What are the 3 allocation theories?
Egalitarian principles, maximising principles (utilitarian), libertarian principles
What tool can be used to assess domestic abuse?
DASH tool
What sort of things would be evaluated for structure in health needs assessment evaluation?
Buildings, staff, equipment
What sort of things would be evaluated for process in health needs assessment evaluation?
What is done: eg, number of patients seen in A+E, number of procedures performed
How much alcohol is in a unit?
8 grams
What is deprivation of liberty?
When a person cannot consent to care or treatment
What is in the 6 in 1 vaccine?
Polio, whooping cough, influenzae (HiB), tetanus, hepB, diphtheria
When is the 6 in 1 given?
2,3,4 months
What vaccines given in the immunisation programme are live attenuated (and therefore C/I in immunocompromised)?
MMR, Flu, BCG, Rotavirus
When is BCG given?
At birth if indicated (high risk area, parent from high risk area, family member with known TB/prev infection)
What is given at month 2 of immunisation?
6 in 1, oral rotavirus, men B
What is given at month 3 of immunisation?
6 in 1, oral rotavirus, PCV
What is given at month 4 of immunisation?
6 in 1, Men B
What immunisation is given at 12/13 months?
Hib/MenC + MMR + PCV + MenB
What immunisation is given at 3/4 years?
4 in 1 (Polio, whooping cough, tetanus, diphtheria) + MMR
When is the HPV vaccine given?
12/13 years
What is given at 13 years and 18 years?
3 in 1 (Polio, tetanus, diphtheria) and Men ACWY
When is the flu vaccine given? (children)
annually between 2 and 8 years
What is the definition of equity?
Giving people what they need to achieve equal outcomes
What are sources for epidemiological health serviceassessment?
Disease registry, admission, GP databases
What are two possible approaches for prevention?
Population approach (delivered to everyone, but won’t impact everyone that much: Breast Screening), and high risk approach (identify individuals above a chosen cut off and treat them; eg, high blood pressure)
What is the staging for CKD?
1: >90
2: 60-90
3a: 45-59
3b: 30-44
2: 15-29
4: less than 15
What is the staging for AKI?
1: increased creatinine x 1.5 -1.9 baseline, urine less than 0.5 ml/kg/hr for 6 hours
2: increased creatinine x2-2.9 baseline, urine less than 0.5/ml/kg/hr for 12 hours
3: increase in creatinine x3 baseline, urine less than 0.3 ml/kg/hr for 24 hours, or no urine for 12 hours
What are the categories of developmental milestones?
Gross motor, fine motor, language, social
What are the red flags of gross motor skills?
Not sitting without support at 12 months, not walking supported at 18 months
When should a child be able to sit without support?
7-8 months
When should a child be able to crawl?
9 months
When should a child be able to walk unsupported?
12 months, unsupported at 13-15 months
When should a child be able to run?
2 years
When can a child ride a tricycle?
3 years
When can a child hop on one leg?
4 years
When can a child hold something in palmar grasp?
6 months (and swap hands)
When can a child point with their finger?
9 months
When does a child have a pincer grip?
12 months
When can a child stack 3 bricks?
18 months
When is hand preference abnormal and should be referred?
12 months
When can a child copy a vertical line?
2 years
When can a child copy a circle?
3 years
When can a child copy a cross?
4 years
When should a child that can’t say 2-6 words be referred?
18 months
When does a child turn towards sound?
3 months
When can a child say double syllables?
6 months
When can a child say mama and dada?
9 months
When does a child know and respond to name?
1 year
When should a child know 2-6 words?
12-15 months
When can a child combine 2 words?
2 years
When does a child smile, and when should this be referred?
6 weeks, refer at 10 weeks
When does a child laugh?
3 months
When can a child play peek a boo?
9 months
When does a child wave bye bye?
12 months
When does a child play alone?
18 months
When does a child play near others but not with them?
2 years
When does a child play with other children?
4 years
