Public health Flashcards
What are the 3 concerns of public health?
Inequalities in health
Wider determinants of health
Prevention
What are the 3 domains of public health
Health improvement
Health protection
Service improvement
How can health interventions be applied?
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)
What needs to be done/performed before a health intervention is made?
Health needs assessment
What is a health needs assessment?
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 are the three approaoches of health needs assessment?
- 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)
- Comparative (Compares the services received by a population (or subgroup) with others)
- Corporate (the systematic collection of the knowledge and views of local health professionals and users of health services on health-care services and needs)
What is a health care need?
The ability to benefit from a health care intervention
What are the four sociological approaches to need?
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
What is primary prevention? example?
Preventing a disease before it has happened eg DRINKAWARE, change4life
Vaccinations. Counseling to change high-risk behavior.
What is secondary prevention? example?
Catching a disease in its pre-clinical or early clinical phase eg screening
What is tertiary prevention? example?
preventing complications of a disease eg diabetic foot care, eye reviews in diabetes, attending physio after stroke
What is secondary prevention in myocardial infarction?
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
What are the two approaches to prevention?
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,
What is meant by the prevention paradox?
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
What are the different types of screening?
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)
Disadvantages of screening?
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
What is the sensitivity of a screening program and how do you calculate it?
The proportion of people with the disease who are correctly identified by the screening test
True positive / (true positive + false negative)
What is the specificity of a screening program and how do you calculate it?
The proportion of people without the disease that are correctly excluded by the screening test
True negative / (true negative + false positive)
What is the positive predicted value and how is it calculated?
The proportion of people with a positive test result who actually have the disease
True positive / (true positive + false positive)
What is the negative predictive value and how is it calculated?
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
Antenatal child health surveillance
Ensure intrauterine growth
Check for maternal infections e.g. HIV
Ultrasound scan for fetal abnormalities
Blood tests for Neural Tube Defects
Newborn child health surveillance
- Clinical examination of newborn
- Newborn Hearing Screening Programme e.g. oto-acoustic emissions test
- Give mother Personal Child Health Record
First month and following months child health surveillance
- 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