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Core clinical problems > Public health > Flashcards

Public health Flashcards

1
Q

What are the 3 concerns of public health?

A

Inequalities in health
Wider determinants of health
Prevention

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2
Q

What are the 3 domains of public health

A

Health improvement
Health protection
Service improvement

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3
Q
A
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3
Q

How can health interventions be applied?

A

Delivered at an individual level (i.e. vaccinations to prevent an individual from getting ill)

Delivered at a community level (i.e. opening a new outdoor play area in a particular town)

Delivered at a population level (i.e. putting iodine in salt to prevent iodine deficiency)

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4
Q

What needs to be done/performed before a health intervention is made?

A

Health needs assessment

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5
Q

What is a health needs assessment?

A

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

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6
Q

What are the three approaoches of health needs assessment?

A
  1. Epidemiological (considers the burden of illness in terms of the incidence, prevalence, and mortality of a disease or health condition. This approach also draws on estimates of clinical and cost effectiveness from systematic reviews of well-designed studies)
  2. Comparative (Compares the services received by a population (or subgroup) with others)
  3. Corporate (the systematic collection of the knowledge and views of local health professionals and users of health services on health-care services and needs)
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7
Q

What is a health care need?

A

The ability to benefit from a health care intervention

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8
Q

What are the four sociological approaches to need?

A

Felt need – individual perceptions of variation from normal health

Expressed need – individual seeks help to overcome variation in normal health (demand)

Normative need – professional defines intervention appropriate for the expressed need

Comparative need - comparison between severity, range of interventions and cost

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9
Q

What is primary prevention? example?

A

Preventing a disease before it has happened eg DRINKAWARE, change4life

Vaccinations. Counseling to change high-risk behavior.

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10
Q

What is secondary prevention? example?

A

Catching a disease in its pre-clinical or early clinical phase eg screening

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11
Q

What is tertiary prevention? example?

A

preventing complications of a disease eg diabetic foot care, eye reviews in diabetes, attending physio after stroke

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12
Q

What is secondary prevention in myocardial infarction?

A

NICE produced guidelines on the management of patients following a myocardial infarction (MI) in 2013.

All patients should be offered the following drugs:
dual antiplatelet therapy (aspirin plus a second antiplatelet agent)
ACE inhibitor
beta-blocker
statin

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13
Q

What are the two approaches to prevention?

A

Population approach – preventative measures e.g. dietary salt reduction through legislation to reduce BP, adding iodine to salt to prevent iodine deficiency

High risk approach – identifying individuals above a chosen cut-off and treat e.g. screening for hypertension,

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14
Q

What is meant by the prevention paradox?

A

A preventative measure which brings much benefit to the population often offers little to each participating individual
i.e. it’s about screening a large number of people to help a small number of people

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15
Q

What are the different types of screening?

A

Population-based screening programmes (e.g. cervical cancer, breast cancer)

Opportunistic screening (e.g. performing BP measurements in GP)

Screening for communicable disease

Pre-employment and occupational medicals

Commercially provided screening (where you can pay to get your blood sent off and tested for all sorts of genetic problems)

Genetic counselling (i.e. genetic testing for people with FHx of genetic disease)

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16
Q

Disadvantages of screening?

A

Exposure of well individuals to distressing or harmful diagnostic tests

Detection and treatment of sub-clinical disease that would never have caused any problems

Preventative interventions that may cause harm to the individual or population

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17
Q

What is the sensitivity of a screening program and how do you calculate it?

A

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

True positive / (true positive + false negative)

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18
Q

What is the specificity of a screening program and how do you calculate it?

A

The proportion of people without the disease that are correctly excluded by the screening test
True negative / (true negative + false positive)

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19
Q

What is the positive predicted value and how is it calculated?

A

The proportion of people with a positive test result who actually have the disease

True positive / (true positive + false positive)

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20
Q

What is the negative predictive value and how is it calculated?

A

The proportion of people with a negative test result who do not have the disease

True negative / (true negative + false negative)
This is lower if the prevalence is higher

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21
Q

Antenatal child health surveillance

A

Ensure intrauterine growth
Check for maternal infections e.g. HIV
Ultrasound scan for fetal abnormalities
Blood tests for Neural Tube Defects

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22
Q

Newborn child health surveillance

A
  • Clinical examination of newborn
  • Newborn Hearing Screening Programme e.g. oto-acoustic emissions test
  • Give mother Personal Child Health Record
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23
Q

First month and following months child health surveillance

A
  • Heel-prick test day 5-9 - hypothyroidism, PKU, metabolic diseases, cystic fibrosis, medium-chain acyl Co-A dehydrogenase deficiency (MCADD)
  • Midwife visit up to 4 weeks
  • Health visitor input
  • GP examination at 6-8 weeks
  • Routine immunisations
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24
Q

Pre school child health surveillance

A

National orthoptist-led programme for pre-school vision screening to be introduced

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25
Q

What is a cross-sectional study?

A

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

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26
Q

What is a case control study?

A

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

selects absed on DISEASE

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27
Q

What is a cohort study?

A

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

can be prospective or retrospective

selects based on EXPOSURE

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28
Q

What is a randomised control trial?

A

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

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29
Q

What is prevalence

A

measuring existing cases

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30
Q

What is point prevalence?

A

number of cases of disease at a point in time / total number of people in the defined population at the same point in time

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31
Q

what is period prevalence?

A

Period prevalence is the number of individuals identified as cases during a specified period of time, divided by the total number of people in that population.

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32
Q

What can increase prevelence?

A

screening programmes identifying new cases

increasing risk factors

increased life-expectancy due to better treatments can increase prevalence

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33
Q

What is incidence?

A

The number of new cases per unit time (can be expressed as a percentage or per e.g. 100,000). e.g. 100,000 new cases per year

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34
Q

What is incidence rate?

A

Number of persons who have become cases in a given time period / total person-time at risk during that period eg 3/32 = 9.4 per 100 person years

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35
Q

What is absolute risk?

A

the incidence divided by the population.

Gives a feel for the actual numbers involved i.e. has units (e.g. 50 deaths/ 1000 population)

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36
Q

What is attributable risk?

A

The rate of disease in the exposed that may be attributed to the exposure

Attributable risk = incidence in exposed – incidence in unexposed

It’s about the size of the effect in absolute terms – gives a feel for the public health impact if causality is assumed

The attributable risk:
AR = (A/(A+B)) – (C/(C+D))

The attributable risk percentage of smoking can be calculated as:
AR % = AR / (A/(A+B)) x 100

This means 53.31% of incidence of cardiovascular disease among smokers is attributable to their smoking.

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37
Q

What is relative risk?

A

Ratio of risk of disease in the exposed to the risk in the unexposed

Relative risk = incidence in exposed / incidence in unexposed

Tells us about the strength of association between a risk factor and a disease

Relative risk of 1.74 = 74% more likely

An RR of 1.00 means that the risk of the event is identical in the exposed and control samples. An RR that is less than 1.00 means that the risk is lower in the exposed sample. An RR that is greater than 1.00 means that the risk is increased in the exposed sample.

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38
Q

What is relative risk reduction?

A

The reduction in rate of the outcome in the intervention group relative to the control group

1 minus RR

(incidence in non exposed – incidence in exposed) / incidence in non-exposed

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39
Q

What is absolute risk reduction?

A

The absolute difference in the rates of events between the 2 groups

Gives an indication of the baseline risk and the intervention effect

Incidence in nonexposed – incidence in exposed

i.e. assuming exposed means they have had a particular intervention (such as giving statins to people with hypercholesterolaemia and then a control group who do not have statins and seeing how many in each group have a heart attack to see if the intervention of statins is effective

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40
Q

What is number needed to treat?

A

the number of patients we need to treat to prevent one bad outcome

NNT = 1/(risk in non-exposed – risk in exposed)

Aka 1/absolute risk reduction

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41
Q

When is odds ratio used?

A

For case control studies it is not possible to calculate the relative risk and so the odds ratio is used.

For cross-sectional and cohort studies both can be derived but odds ratio is used if it is not clear which is the IV and which is the DV because it is symmetrical.

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42
Q

What is odds?

A

The odds of an event is the ratio of the probability of an occurrence compared to the probability of a non-occurrence.

Odds = probability/(1-probability)

eg probability = 0.75

Odds = 0.75/(1-0.75)
Odds = 3

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43
Q

Interpretation of odds ratio?

A

OR=1 Exposure does not affect odds of outcome

OR>1 Exposure associated with higher odds of outcome

OR<1 Exposure associated with lower odds of outcome

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44
Q

What is cumulative incidence/risk

A

number of new cases in a time period/ number of disease free people at the start of the time period.

Cohort study would do this

Denominator is disease-free people

It is a proportion.
Time period must be stated.
Closed population/cohort

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45
Q

What is incidence odds/odds of disease?

A

number of new cases of disease in time period/ number of people who were still disease free at the end of the time period so is probability of disease/probability of not getting disease.

Eg 25/75 if 25 out of 100 get disease. Odds of disease

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46
Q

Define epigenetics

A

The expression of a genome depends on the environment

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47
Q

Define allostasis and allostatic loads

A

The same as homeostasis, the stability through change of our physiological systems to adapt rapidly to change in environment

Allostatic load: Long-term overtaxation of our physiological systems leading to impaired health (stress)

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48
Q

Define salutogenesis

A

Favourable physiological changes secondary to experiences which promote healing and health

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49
Q

Define emotional intelligence

A

The ability to identify and manage one’s own emotions, as well as those of others

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50
Q

What is health psychology?

A

Emphasises the role of psychological factors in the cause, progression and consequences of health and illness

Aims to put theory into practice by promoting healthy behaviours and preventing illness

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51
Q

What are the three categories of behaviour in health psychology ?

A

Health behaviour is a behaviour aimed to prevent disease

Illness behaviour is aimed at seeking remedy eg going to doctor

Sick role behaviour is any activity aimed at getting well eg taking medication

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52
Q

What is health behaviour

A

a behaviour aimed to prevent disease

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53
Q

What is illness behaviour?

A

a behaviour aimed at seeking remedy eg going to doctor

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54
Q

What is sick role behaviour?

A

any activity aimed at getting well eg taking medication

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55
Q

What is the theory of unrealistic optimism

A

Individuals continue to practice health damaging behaviours due to inaccurate perceptions of risk and susceptibility

  1. Lack of personal experience
  2. Belief that preventable by personal action
  3. Belief that if it’s not happened by now, it’s not likely to
  4. Belief that the problem is infrequent
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56
Q

What is the health belief model of behaviour change?

A

Individuals will change if they think:
1. Perceived susceptibility
2. Perceived severity/consequences
3. Perceived benefits
4. Perceived barriers (cost<benefit)

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57
Q

What are cues to behaviour change?

A

Internal - getting older, MI, perception of health

External - loss of a family member, public health messaging, doctor opinion

it is part of the health belief model but isn’t always included - critique when not included

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58
Q

What is self-efficacy?

A

The belief in their ability to carry out a preventative behaviour

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59
Q

What is outcome expectancy?

A

Whether the person feels they will be healthier as a result of their action

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60
Q

What is the theory of planned behaviour?

A

Proposes that the best predictor of behaviour is ‘intention’ eg i intend to give up smoking.
Intention are determined by:

  1. Attitudes A person’s attitude to the behaviour
  2. Subjective norm The perceived social pressure to undertake the behaviour, or subjective norm (messages from significant others)
  3. Perceived behavioural control A person’s appraisal of their ability to perform the behaviour, or their perceived behavioural control (psychological and physical barriers can influence this)
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61
Q

What is the transtheoretical model or stages of change model

A
  1. Precontemplation
  2. Contemplation (thinking about it sometime in the future)
  3. Preparation (28 days)
  4. Action (6 months)
  5. Maintenance (6 months)
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62
Q

What is the theory of social norms?

A

Our health behaviours are guided by our perception of social norms. We are more likely to do what we think everyone else is doing even if this isn’t accurate.

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63
Q

NICE transition points where behaviour change may be effective

A

Leaving school
Entering the workforce
Becoming a parent
Becoming unemployed
Retirement and bereavement

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64
Q

Equation for working out units of alcohol

A

(% alcohol by volume x amount of liquid in millimetres) divided by
1,000

or litres x % alcohol

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65
Q

Equation for working out BMI?

A

weight (kg) divided by (height (m) squared)

66
Q

First line for smoking cessation

A
  1. have a target stop date
  2. prescribe NRT, varencline or bupropion
  3. prescription to last until just after stop date
  4. If unsuccessful, don’t offer repeat prescription within 6 months
67
Q

three pharma options for smoking cessation?

A

Nicotine replacement therapy

Varenicline

Bupropion

68
Q

Forms of NRT?

A

patches, gum, inhalator, lozenge or nasal spray

offer a combo if high dependencne/not worked in past

69
Q

adverse effects of NRT?

A

nausea & vomiting, headaches and flu-like symptoms

70
Q

What is varencicline?

A

a nicotinic receptor partial agonist

should be started 1 week before the patients target date to stop

the recommended course of treatment is 12 weeks (but patients should be monitored regularly and treatment only continued if not smoking)

varenicline should be used with caution in patients with a history of depression or self-harm. There are ongoing studies looking at the risk of suicidal behaviour in patients taking
varenicline
contraindicated in pregnancy and breast feeding

71
Q

Side effects varenicline?

A

nausea is the most common adverse effect. Other common problems include headache, insomnia, abnormal dreams

72
Q

What is bupropion

A

a norepinephrine and dopamine reuptake inhibitor, and nicotinic antagonist

should be started 1 to 2 weeks before the patients target date to stop

small risk of seizures (1 in 1,000)

contraindicated in epilepsy, pregnancy and breast feeding. Having an eating disorder is a relative contraindication

73
Q

Interventions for smoking cessasion in pregnancy?

A
  1. cognitive behaviour therapy, motivational interviewing or structured self-help and support from NHS Stop Smoking Services
  2. NRT if the above measures failure. There is no evidence that it affects the child’s birthweight. Pregnant women should remove the patches before going to bed
74
Q

What is in the 6 in 1 vaccine?

A
  • diptheria
  • tetanus
  • polio
  • pertussis
  • haemophilus influenzae type B (HiB)
  • Hepatitis B
75
Q

What is in the 4 in 1 vaccine?

A
  • diptheria
  • tetanus
  • polio
  • pertussis
76
Q

What is in the 3 in 1 vaccine?

A
  • diptheria
  • tetanus
  • polio
77
Q

8 week vaccinations?

A
  • 6 in 1 vaccine
  • Meningococcal type B
  • Rotavirus (oral vaccine)
78
Q

12 week vaccinations?

A
  • 6 in 1 vaccine (again)
  • Pneumococcal (13 different serotypes)
  • Rotavirus (again)
79
Q

16 week vaccinations?

A
  • 6 in 1 vaccine (again)
  • Meningococcal type B (again)
80
Q

1 year vaccinations?

A
  • 2 in 1 (haemophilus influenza type B and meningococcal type C)
  • Pneumococcal (again)
  • MMR vaccine (measles, mumps and rubella)
  • Meningococcal type B (again)
81
Q

Yearly vaccine from age 2 – 8

A

Influenza vaccine (nasal vaccine)

82
Q

3 years 4 months vaccine

A

4 in 1 (diphtheria, tetanus, pertussis and polio)
MMR vaccine (again)

83
Q

Vaccine 12-13 years

A

Human papillomavirus (HPV) vaccine (2 doses given 6 to 24 months apart)

84
Q

Vaccine 14 years?

A

3 in 1 (tetanus, diphtheria and polio)
Meningococcal groups A, C, W and Y

85
Q

Institute of medicine 6 aims of quality?

A

Safe
Effective
Patient-centred
Timely
Efficient
Equitable

86
Q

What are the 2 types of equity?

A

Horizontal equity – equal treatment for equal need (people with the same disease should be treated equally)

Vertical equity – unequal treatment for unequal need (e.g. areas with poorer health may need higher expenditure on health serviceS)

87
Q

How much alcohol is in a unit?

A

8g

88
Q

Maxwell classification for quality of health services

A

3 A’s and 3 E’s:

Acceptability – how acceptable is the service for people needing it
Accessibility – geographical access, costs for patients, waiting times
Appropriateness – right treatment given to the right people?

Effectiveness – does the intervention produce the desired effect?
Efficiency – is the output maximised for a given input?
Equity – are patients being treated fairly?

89
Q

What are the three things that make up the framework for health service evaluation?

A

Structure (buildings, staff, equipment)

Process (number of pts seen, number of operations perfomed)

Outcome (mortality, morbitity, PROMS, 5 Ds)

90
Q

What is a meta analysis?

A

Take lots of studies and combine the results (statistical procedure)

91
Q

What approaches can be used to help people act on their intentions?

A

Perceived control – ask them to reflect on how they felt when something went well (i.e. when they said no to a cigarette)

Anticipated regret – ask them to reflect on how they felt when they didn’t do something (i.e. when they weren’t able to say no to a cigarette)

Preparatory actions – remind people to prepare for their change of behaviour (i.e. throwing away cigarettes)

Implementation intentions – help them help themselves incorporate the behaviour change into their routine (i.e. putting tablets next to the kettle so they know to take it when they make a cup of tea)

92
Q

What strain of e.coli is most dangeorus

A

e.coli O157

93
Q

Levels of maslows hierarchy of needs

A

Physiological – breathing, food, water, sleep

Safety – security of employment, resource’s, family, health, property

Love/belonging - friendship, family, sexual intimacy

Esteem – self-esteem, confidence, achievement, respect of others

Self-actualisation - morality, creativity, spontaneity, problem solving, lack of prejudice, acceptance of facts

94
Q

define asylum seeker

A

A person who has made an application for refugee status

95
Q

Define refugee

A

A person granted asylum and refugee status, usually means leave to remain for 5 years and then re-apply

96
Q

What 4 questions need to be asked when negligence is suspected?

A

Is there a duty of care?

Was there a breach in that duty?

Did the patient come to any harm?

Did the breach cause the harm?

97
Q

What are 2 tests that can be used to decide whether there was a breach in a duty of care?

A

Bolam test = would a group of responsible doctors do the same?

Bolitho test = would it be reasonable of them to do so?

98
Q

What are the features of Kolb’s learning cycle?

A

Experience (activist)
Review, reflect on experience (reflection)
Conclusions from experience (theorist)
What can I do differently next time? (pragmatist)

99
Q

article 2 human rights

A

the right to life (limited)

100
Q

article 3 human rights

A

the right to be free from inhumane and degrading treatment (absolute)

101
Q

article 8 human rights

A

the right to respect for privacy and family life (qualified)

102
Q

article 12 human rights

A

right to marry and found a family

103
Q

What are the GMC duties of a doctor?

A

Make the care of your patient your first concern

Protect and promote the health of patients and the public

Provide a good standard of practice and care - keep professional skills up to date, recognise limits of competence, work with colleagues to serve patients best interests

Treat patients as individuals and respect their dignity and confidentiality

Work in partnership with patients

Be honest, open and act with integrity – act without delay if you believe a colleague is putting patients at risk

104
Q

What is meant by primary, secondary and tertiary intention with respect to wound healing?

A

Primary intention – little or no tissue loss, wound edges directly opposed (linear scarring)

Secondary intention – wound edges not oppose, would allowed to granulate, epithelialisation occurs from edge of hair follicle remnants in the base of the wound

Tertiary intention – wound is purposefully left open e.g. infection, foreign body, initially cleaned, debrided and observed. Surgically closed later

105
Q

4 stages of wound healing?

A

Vascular response

Inflammatory response

Proliferation

Maturation

106
Q

What is the definition of domestic abuse?

A

Controlling, coercive, threatening behaviour, violence of abuse between those aged 16 or over who are or have been intimate partners or family members

Includes – psychological, physical, sexual, financial and emotional abuse

107
Q

What tool can be used to assess domestic abuse?

A

DASH tool (Domestic abuse and Sexual Harassment tool)

108
Q

What do you do if you think someone is at medium/standard risk of domestic abuse?

A

in these cases it’s their CHOICE what they do

Give them contact details for domestic abuse services and let them decide what to do

109
Q

calculate attributable risk and attributable risk percentage :
disease no disease
smoked 25 140

non-smoked 52 683

A

The attributable risk of smoking can be calculated as:
AR = (A/(A+B)) – (C/(C+D))
AR = (25/(25+140)) – (52/(52+683))
AR = .08077

The attributable risk percentage of smoking can be calculated as:
AR % = AR / (A/(A+B)) * 100
AR % = .08077 / (25/(25+140)) * 100
AR % = 53.31%
This means 53.31% of incidence of cardiovascular disease among smokers is attributable to their smoking.

110
Q

What is odds ratio?

A

The odds ratio is the ratio of odds for exposed group to the odds for the not exposed groups.

Odds ratio = (AxD) / (BxC)

value > 1 is positive

111
Q

Physiological changes renal - pregnancy

A

Increased perfusion to kidneys (up 30%) → increased GFR (up 30-60%)

Urine : increased protein, increased urea, increased creatinine, trace glucose
Serum: decreased urea, decreased creatinine, reduced albumin

If trace glucose, may offer OGTT at 24 weeks

112
Q

Physiological changes respiratory - pregnancy

A

Increased oxygen demands, progesterone increases sensitivity of respiratory centre to CO2

Tidal volume increases
Respiratory rate increases

113
Q

Physiological changes hematology - pregnancy

A

There is increased red blood cell production in pregnancy, leading to higher iron, folate and B12 requirements. There is also an increase in calcium req but body absorbs better too so may be unchanged

Plasma volume increases > red blood cell volume, leading to a lower concentration of red blood cells. High plasma volume means the haemoglobin concentration and red cell concentration (haematocrit) fall in pregnancy, resulting in anaemia.
Lower Hb
Lower platelets

Clotting factors such as fibrinogen and factor VII, VIII and X increase in pregnancy, making women hyper-coagulable (ready for delivery). This increases the risk of venous thromboembolism (blood clots developing in the veins). Pregnant women are more likely to develop deep vein thrombosis and pulmonary embolism.

Placental secretion
High ALP (up to 4 times higher)

114
Q

Physiological changes skin and hair - pregnancy

A

Increased skin pigmentation due to increased melanocyte stimulating hormone, with linea nigra and melasma

Striae gravidarum (stretch marks on the expanding abdomen)

General itchiness (pruritus) can be normal, but can indicate obstetric cholestasis

Spider naevi (related to increased estrogen)

Palmar erythema

Postpartum hair loss is normal, and usually improves within six months.

115
Q

Physiological cardiovascualr changes pregnancy

A

Increased blood volume Increased cardiac output
Higher heart rate
Ejection systolic murmur
Third heart sound
Decreased pulmonary vascular resistance

Decreased diastolic blood pressure in early and middle pregnancy, returning to normal by term (blood being diverted to placenta)

Peripheral vasodilation → oedema (increased levels of estrogen and progesterone) could also be caused by an enlarged uterus impeding venous return

116
Q

Principles of parkinsons management

A

Motor symptoms affecting everyday life : levodopa
Motor symptoms not affecting everyday life: dopamine agonist, levodopa or MAO-B

Levodopa: better at treating motor symptoms, causes more motor SEs
Dopamine agonist
Examples: bromocriptine, cabergoline, apomorphine, ropinirole
Worse at treating motor, less motor SEs, more adverse events
Ergot-derived (bromo and carbo) can cause fibrosis
MAO-B
Example: selegiline
Worse at treating motor, less motor SEs, less adverse events

117
Q

what are ecological studies?

A

Ecological studies are carried out at the group or area level where exposure and
outcome is determined for groups (in this case the population living in each census
area) rather than for individuals.

118
Q

Error due to failure to consider alternatives

A

Is typically when one abnormality is
found that fits a particular diagnosis and so you stop searching for other potential clues that may change
your differential.

119
Q

Error of overattachment

A

Is conducting tests to confirm what we expect or want to see
and not ruling out other causes

120
Q

Error of bravado

A

Is typically working above competence in a show of
over confidence that is not safe. E

121
Q

Error of ignorance

A

Unconscious incompetence

122
Q

Seedhouse ethical grid

A

Core rationale (patient preference, autonomy)
Deontological layer (beneficience/non-malifecence)
Consequential layer (justice/utilitarianism)
External considerations (law, resources, guidelines)

123
Q

sloth based error

A

being lazy eg not checking results

124
Q

error of comission

A

doing something wrong eg prescribe the wrong drug

125
Q

error of omisson

A

doing something wrong because you didn’t do something

126
Q

Investigators find a high level of correlation between levels of socioeconomic
deprivation and cardiovascular mortality across electoral wards in the UK.

A

ecological study

127
Q

Researchers set out to examine the association between alcohol consumption
and stroke. They identify all new patients admitted with stroke and compare
their alcohol consumption with patients admitted for elective surgery.

A

case control study

128
Q

General practitioners set up a study to estimate the prevalence of depression
within their registered population. They decide to start with a random sample
of adults aged 45-74 years. .

A

cross-sectional

129
Q

AAA screening program

A

Men over 65 are invited

no enlargement - never tested again

small 3cm to 4.4cm- tested every year

medium 4.5cm to 5.4cm across.- test every 3 months

large 5.5cm or more across. - rf to surgeon within 2 weeks

130
Q

Bowel cancer screening

A

everyone 60-74, expanding to be 50+

FIT test every 2 years

131
Q

Breast cancer screening

A

women aged 50-71

mammogram every 3 years

132
Q

Diabetic eye screening

A

everyone older than 12 with diabetes

once per year

133
Q

Fetal Anomaly Screening Programme (FASP)

A

20 week scan checking for anomalies such as:
Edwards’ syndrome (T18)
Patau’s syndrome (T13)
anencephaly
spina bifida
cleft lip
congenital diaphragmatic hernia
gastroschisis
exomphalos
congenital heart disease
bilateral renal agenesis
lethal skeletal dysplasia

134
Q

Infectious diseases in pregnancy screening (IDPS)

A

booking appt

HIV
Hep b
Syphilis

135
Q

steps of satiety cascade

A

sensory
cognitive
pre-ingestion
post-absorptive

136
Q

what is lead time and length time bias

A

lead time - survival looks better beacuse screening picks things up earlier than they would clinically present

length time - survival looks better becuase screening picks up slowly progressing disease as well as rapidly progressing instead of just rapidly progressing presenting clinically

“the length of time to die would have been longer!”

137
Q

what is ecological fallacy

A

Drawing conclusions about individuals from data on groups

mismatch that arises from trying to draw conclusions about individual-level epidemiological associations from a group-level study

138
Q

wilson and junger criteria screening

A

Disease must be an important problem
Disease must have a known and detectable latent phase
Disease must have a known natural course and progression
There must be a test which is acceptable to the population
There must be a treatment for the disease
There must be an agreed at-risk population of which to screen
There must be an agreed policy on who to treat
The cost of the screening should be economically balanced

139
Q

what is the materialist model of health inequalities

A

Poverty exposes people to health hazards.

Disadvantaged people are more likely to live in areas where they are exposed to harm such as air-pollution and damp housing.

140
Q

what is the indirect selection model of health inequalities

A

The idea that an individual’s health can influence their social mobility and, hence, their position in the social hierarchy

141
Q

What is the cultural-behavioural model of health inequality?

A

culture determines or frames behavioural choices, including decisions affecting health, i.e., engaging in higher risk lifestyles that may include drinking, smoking, or an unhealthy diet

142
Q

Bradford-Hill criteria of study of causation

A

STD CRAP

Strength of Association – relative risk
Specificity – relationship specific to outcome of interest
Temporality – dose exposure precedes outcome
Dose-Response – higher exposure correlates to higher risk of
disease
Consistency – similar results from different researchers
Coherence – logical consistency with other information
Reversibility – removal of exposure reduces risk
Analogy – similarity with other established cause-effect relationships
Plausibility - Biological Plausibility – mechanism to explain the link

143
Q

what are the 12 human factors that contribute to error?

A

the dirty dozen

fatigue
stress
pressure
distraction
complacency
norms

lack of knowledge
lack of awareness
lack of teamwork
lack of assertiveness
lack of communication
lack of resources

144
Q

What is point prevalence?

A

number of cases of disease at a point in time / total number of people in the defined population at the same point in time

145
Q

what is period prevalence?

A

Period prevalence is the number of individuals identified as cases during a specified period of time, divided by the total number of people in that population.

146
Q

What can increase prevelence?

A

screening programmes identifying new cases

increasing risk factors

increased life-expectancy due to better treatments can increase prevalence

147
Q

What is incidence?

A

The number of new cases per unit time (can be expressed as a percentage or per e.g. 100,000). e.g. 100,000 new cases per year

148
Q

What is incidence rate?

A

Number of persons who have become cases in a given time period / total person-time at risk during that period eg 3/32 = 9.4 per 100 person years

149
Q

What is absolute risk?

A

the incidence divided by the population.

Gives a feel for the actual numbers involved i.e. has units (e.g. 50 deaths/ 1000 population)

150
Q

What is attributable risk?

A

The rate of disease in the exposed that may be attributed to the exposure

Attributable risk = incidence in exposed – incidence in unexposed

It’s about the size of the effect in absolute terms – gives a feel for the public health impact if causality is assumed

The attributable risk:
AR = (A/(A+B)) – (C/(C+D))

The attributable risk percentage of smoking can be calculated as:
AR % = AR / (A/(A+B)) x 100

This means 53.31% of incidence of cardiovascular disease among smokers is attributable to their smoking.

151
Q

What is relative risk?

A

Ratio of risk of disease in the exposed to the risk in the unexposed

Relative risk = incidence in exposed / incidence in unexposed

Tells us about the strength of association between a risk factor and a disease

Relative risk of 1.74 = 74% more likely

An RR of 1.00 means that the risk of the event is identical in the exposed and control samples. An RR that is less than 1.00 means that the risk is lower in the exposed sample. An RR that is greater than 1.00 means that the risk is increased in the exposed sample.

152
Q

What is relative risk reduction?

A

The reduction in rate of the outcome in the intervention group relative to the control group

1 minus RR

(incidence in non exposed – incidence in exposed) / incidence in non-exposed

153
Q

What is absolute risk reduction?

A

The absolute difference in the rates of events between the 2 groups

Gives an indication of the baseline risk and the intervention effect

Incidence in nonexposed – incidence in exposed

i.e. assuming exposed means they have had a particular intervention (such as giving statins to people with hypercholesterolaemia and then a control group who do not have statins and seeing how many in each group have a heart attack to see if the intervention of statins is effective

154
Q

What is number needed to treat?

A

the number of patients we need to treat to prevent one bad outcome

NNT = 1/(risk in non-exposed – risk in exposed)

Aka 1/absolute risk reduction

155
Q

When is odds ratio used?

A

For case control studies it is not possible to calculate the relative risk and so the odds ratio is used.

For cross-sectional and cohort studies both can be derived but odds ratio is used if it is not clear which is the IV and which is the DV because it is symmetrical.

156
Q

What is odds?

A

The odds of an event is the ratio of the probability of an occurrence compared to the probability of a non-occurrence.

Odds = probability/(1-probability)

eg probability = 0.75

Odds = 0.75/(1-0.75)
Odds = 3

157
Q

Interpretation of odds ratio?

A

OR=1 Exposure does not affect odds of outcome

OR>1 Exposure associated with higher odds of outcome

OR<1 Exposure associated with lower odds of outcome

158
Q

What is cumulative incidence/risk

A

number of new cases in a time period/ number of disease free people at the start of the time period.

Cohort study would do this

Denominator is disease-free people

It is a proportion.
Time period must be stated.
Closed population/cohort

159
Q

What is incidence odds/odds of disease?

A

number of new cases of disease in time period/ number of people who were still disease free at the end of the time period so is probability of disease/probability of not getting disease.

Eg 25/75 if 25 out of 100 get disease. Odds of disease

160
Q

calculate attributable risk and attributable risk percentage :
disease no disease
smoked 25 140

non-smoked 52 683

A

The attributable risk of smoking can be calculated as:
AR = (A/(A+B)) – (C/(C+D))
AR = (25/(25+140)) – (52/(52+683))
AR = .08077

The attributable risk percentage of smoking can be calculated as:
AR % = AR / (A/(A+B)) * 100
AR % = .08077 / (25/(25+140)) * 100
AR % = 53.31%
This means 53.31% of incidence of cardiovascular disease among smokers is attributable to their smoking.

161
Q

What is odds ratio?

A

The odds ratio is the ratio of odds for exposed group to the odds for the not exposed groups.

Odds ratio = (AxD) / (BxC)

value > 1 is positive

162
Q

define confidence interval

A

A range of values in which we are 95% certain that the true value lies

163
Q

define statistical power

A

Statistical power is the probability of detecting an effect if there is a difference present.

More simply it means that if there was a difference in a particular factor between two groups, how likely are we to find this difference?

Power can be increased by using a greater sample size, using more precise measuring instruments, and using a higher significance value.

Core clinical problems (94 decks)

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