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Phase 4 > Public Health > Flashcards

Public Health Flashcards

1
Q

what is health psychology?

A

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

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2
Q

What are health behaviours?

A

a behaviour aimed to prevent disease - eg eating healthy

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3
Q

What is illness behaviour?

A

a behaviour aimed to seek remedy - eg going to doctor

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4
Q

what is the sick roll and sick role behaviour?

A

the sick role allows legitimate deviance from social obligation however the sick person is obliged to try to get well and seek help and co-operate with medical professionals

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5
Q

what is unrealistic optimism?

A

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

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6
Q

What is 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

can be acarried out for populations, conditions or interventions

assesses need, supply and demand

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7
Q

what is felt need?

A

individual perceptions of variation from normal health

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8
Q

what is expressed need?

A

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

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9
Q

What is normative need?

A

professional defines intervention appropriate for the expressed need

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10
Q

what is comparative need?

A

Weighing up between severity, range of interventions and cost when assessing a patients need for an intervention and what intervention to give

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11
Q

what is the definition of need in a health needs assessment?

A

ability to benefit from an intervention

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12
Q

What are 4 categories of determinants of health?

A

Genes
Environment - physical or social and economical
lifestyle
healthcare

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13
Q

What is primary prevention?

A

prevention before it starts - eg vaccination

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14
Q

what is secondary prevention?

A

screening
rehabilitation/prevention of secondary disease events

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15
Q

what is tertiary prevention?

A

stopping the progression and complications of a disease

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16
Q

What is horizontal equity?

A

Equal treatment for equal need

Individuals with pneumonia (with all other things being equal) should be treated equally

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17
Q

what is vertical equity?

A

Unequal treatment for unequal need

e.g. Individuals with common cold vs pneumonia need unequal treatment

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18
Q

what is health improvement?

A

Concerned with societal interventions (not primarily delivered through health services) aimed at preventing disease, promoting health, and reducing inequalities

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19
Q

what is health protection?

A

Concerned with measures to control infectious disease risks and
environmental hazards

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20
Q

What is healthcare?

A

Concerned with the organisation and delivery of safe, high quality services for prevention, treatment, and care

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21
Q

What is the epidemiological approach to a health care needs assessment?

A

define problem
size of problem
services available
evidence base - effectiveness and cost
models of care
existing services
recommendations

looks at data to assess healthcare needs

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22
Q

What are the problems with the epidemiological approach to a health care needs assessment?

A

data might not be available
variable data quality
evidence base may be inadequate
does not condiser felt needs of people affected and what they want

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23
Q

What are the advantages with the epidemiological approach to a health care needs assessment?

A

uses existing data
provides data on disease
incidence/mortality/morbidity are considered
can evaluate service by trends over time

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24
Q

what is the comparative approach to health care needs assessment?

A

compare services received by different populations in different places or categories

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25
Q

disadvantages of the comparative approach to a health care needs assessment?

A

May be difficult to find comparable population
Data may not be available/high quality data
May not yield what the most appropriate level (e.g. of provision or utilisation) should be

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26
Q

what are the advantages of comparative approach to health care need assessment?

A

Quick and cheap if data available
Indicates whether health or services provision is better/worse than comparable areas (gives a measure of relative performance)

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27
Q

what is the corporate approach to health needs assessment?

A

the process of gathering information on a specific population from the population itself e.g employees or patients, in order to decide where to invest to improve health and wellbeing

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28
Q

what is the corporate approach to health needs assessment?

A

Ask local population what needs are
Use focus groups
Wide variety of stakeholders

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29
Q

what are the advantages of the corportate approach to health needs assessment?

A

Based on the felt and expressed needs of the population in question
Recognises the detailed knowledge and experience of those working with the population
Takes into account wide range of views

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30
Q

What are the disadvantages of the corporate approach to health care assessment?

A

Difficult to distinguish ‘need’ from ‘demand’
Groups may have vested interests - big pharma, politics, press
May be influenced by political agendas
dominant personalities may have excess influence

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31
Q

What is length time bias?

A

Type of bias resulting from differences in the length of time taken for a condition to progress to severe effects, that may affect the apparent efficacy of a screening method

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32
Q

what is the health belief model of behavioural change?

A

individuals will change if they believe they are
1. susceptible to a condition
2. believe it has serious consequences
3. believe taking action reduces risk
4. believe that benefits outweigh costs

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33
Q

what are the problems with the health belief model of behavioural change?

A

Doesnt consider influence of emotions
Doesnt differentiate between first time and repeat behaviour (relapse)
Cues to action often missing in research

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34
Q

what is the theory of planned behaviour model of behavioural change?

A

proposes best predictor of behaviour is intention

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35
Q

What is the transtheoretical (stages of change) model of behavioural change?

A

precontemplation
contemplation
preparation
action
maintenance
relapse

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36
Q

What is intention determined by in the theory of planned behaviour model of change?

A

a persons attitude
subjective norm - perceived social pressure
perceived behavioural control - a persons perceived ability to perform an action

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37
Q

what are some problems with the transtheoretical model of behavioural change?

A

not always linear in reality
doenst take habit, emotions or culture into account
intentions can change over a very short time

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38
Q

what is nudge theory of behavioural change?

A

the environment is changed to make the best option the easiest

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39
Q

which opiod is safe in renal failure?

A

fentanyl

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40
Q

What are health inequalitites?

A

preventable unfair and unjust differences in health status between groups due to inequal distribution of socioeconomic conditions in society

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41
Q

What is the inverse care law?

A

the principle that that availability of good medical or social care is inverse to the need of the populations served

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42
Q

What are Maxwell’s dimensions of quality?

3As and 3Es

A

Acceptability
Accessibility
Appropriateness (relevance)
Effectiveness
Efficiency
Equity

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43
Q

What is the donabedian framework for health service evaluation?

A

Structure
Process
Outcome

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44
Q

What is meant by structure in the donabedian framework for health services evaluation?

A

what is there? - buildings, staff, equipment

No. ICU beds per 1000 people
No. vasc surgons per 1000 people

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45
Q

What is meant by Process in the donabeidian framework for health services evaluation?

A

what is currently done

46
Q

What is outcome in the donabedian frame work for health services evaluation?

A

outcomes - mortality, morbidity, QOL, patient satisfaction - what can be measured to evaluate services

47
Q

what is incidence?

A

the number of NEW cases over a certain time period (rate of new cases)

48
Q

what is prevalence?

A

the number of existing cases at a particular point in time

49
Q

what is iatrogenesis?

A

the unintended adverse effects of therapeutic intervention

50
Q

what is sensitivity?

A

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

51
Q

what is the social norms theory of behaviour?

A

situations in which individuals incorrectly perceive the attitudes and/or behaviours of peers and other community members to be different from their own when in fact they are not

52
Q

what is prevention paradox?

A

the seemingly contradictory situation where the majority of cases of a disease come from a population at low or moderate risk of that disease, and only a minority of cases come from the high risk population
due to health interventions

That most people will not benefit from an intervention on an individual level but on a population level it will be beneficial

53
Q

what criteria is used for screening?

A

Wilson Jungner criteria

54
Q

what is the 9 wilsons-jugner criteria?

A

Knowledge of disease
- Important problem
- Disease understood
- Recognisable early stage
The Test
- Acceptable
- Suitable test available
Treatment
- Accepted treatment
- Enough facilities
- Agreed policies on who to treat
Organisation and cost
- Cost-effective
- Case-finding should be a continuous process

55
Q

how do you calculate specificity?

A

true negatives/total number of patients without disease (True negative + false positives)

56
Q

how do you calculate sensitivity?

A

true positives/total number of people with disease (True positives + False Negatives)

57
Q

what is the positive predictive value?

A

proportion of people with positive test result who actually have disease

58
Q

what is the negative predictive value?

A

the proportion of people without the disease who are correctly excluded

59
Q

what are 5 reasons people don’t stop smoking?

A

Nicotine addiction
Coping with stress
habit
socialisation
fear of weight gain

60
Q

How do you calculate units?

A

(% alcohol x amount of liquid mls)/1000

61
Q

what are the cage questions of alcohol?

A

ever thought about cutting down
ever been annoyed by people telling you to cut down
feel guilty about how much you drink
eye opener

62
Q

what is public health?

A

The science and art of preventing disease, prolonging life and improving health through the organised effort of society

63
Q

what is equity?

A

Giving people what they need to achieve equal outcomes

64
Q

what is equality?

A

Giving everyone the same rights opportunities and resources

65
Q

what are 2 frameworks that can be used to assess the quality of health care available?

A

Donbedian framework - structure, process, outcome
Maxwell’s dimensions of quality healthcare

66
Q

what are the 3 domains of public health?

A

Health improvement
Health protection
Improving services

67
Q

what is egalitarian resource allocation?

A

providing all care necessary for everyone

68
Q

what is maximising resource allocation?

A

Act is evaluated solely in terms of its consequences - utilitarian approach for the better of the people

69
Q

what is libertarian resource allocation?

A

everyone is solely responsible for their own health

70
Q

How do you calculate positive predictive value?

A

No. of people who are true positive/Total No. of people who screened positive

71
Q

How do you calculate negative predictive value?

A

No of people who are true negative/Total No. of people who screened negative

72
Q

what is sensitivity?

A

proportion of those with disease who are correctly identified as having the disease

73
Q

what is specificity?

A

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

74
Q

What is a case control study?

A

Retrospective, observational study looking at cause of disease.
Compares similar participant with disease to controls without.

75
Q

what are 3 advantages of case control studies?

A

Good for rare outcomes
quicker than other studies
can investigate multiple exposures

76
Q

what are 2 disadvantages of case control studies

A

Difficulties finding controls to match with case
Prone to selection and information biases

77
Q

what is a cross-sectional study?

A

Retrospective observational collects data from a population at a specific point in time ‘snapshot’.
Prevalence of risk factors and disease itself

78
Q

what are 3 advantages of cross-sectional studies?

A

Relatively quick and cheap
Provide data on prevalence at single point in time
Good for surveillance and PH planning

79
Q

what are 3 disadvantages of cross-sectional studies?

A

Risk of reverse causality (did outcome or exposure come first?)
Cannot measure incidence
Recall and response bias risk (may miss quick recoveries)

80
Q

what is a cohort study?

A

Prospective longitudinal study looking at separate cohorts with different treatments or exposures. Wait to see if disease occurs

81
Q

what are 3 advantages of cohort study?

A

Can follow-up group with a rare exposure
Good for common and multiple outcomes -> establish disease risk and confounders
Less risk of selection and recall bias

82
Q

what are 3 disadvantages of cohort study?

A

Long and expensive
drop outs
Need large sample size

83
Q

What is a RCT?

A

Prospective study, all participants randomly assigned exposure or control intervention

84
Q

what are 2 advantages or RCTs?

A

Low risk of bias and confounding
Can infer causality

85
Q

what are 3 disadvantages of RCTs?

A

Time consuming, expensive
Drop outs
Inclusion criteria may exclude some populations

86
Q

what is an ecological study?

A

Looks at the prevalence of the disease over time according to population data rather than individual. Can show prevalence and association but not causation

87
Q

How do you calculate odds?

A

probability of event occurring/Probability of event NOT occurring (1-probability of occurring)

88
Q

how do you calculate odds ratio?

A

Odds of Event A/Odds of event B
compares odds of outcome occurring between 2 groups (control and intervention)

89
Q

what does it mean if odds ratio =1?

A

odds of the two events are equal

90
Q

what does it mean if odds ratio is >1?

A

odds of event A > Event B

91
Q

what does it mean if odds ratio <1?

A

odds of event B > event A

92
Q

what is measurement bias?

A

Different equipment measuring differently

93
Q

what is observer bias?

A

Observers expectations influence reporting

94
Q

what is recall bias?

A

Past events not recalled correctly

95
Q

what is reporting bias?

A

People don’t tell the truth because of shame/ judgement

96
Q

what is selection bias?

A

Bias in recruiting for a study, and some may be lost to follow up

97
Q

what is publication bias?

A

Trials with negative results less likely to be published

98
Q

what are the 9 bradford-hill criteria for causality?

A

Strength of association between exposure and outcome
Consistency between studies
Dose response
Temporality - exposure came before outcome
Biological Plausibility
Reversibility - intervention can reduce outcome
Coherence with logic
Analogy - similar to other cause-effect relationships
Specificity - relationship specific to outcome of interest

99
Q

what is a cofounder

A

A situation in which the estimate between an exposure and an outcome is distorted because of the association of the exposure with another factor (confounder) that is also independently associated with the outcome.

100
Q

what is person time?

A

Measure of time at risk for all the patients in the study- therefore if 1,000 patients were studied for 2.5 years, the study would have looked at 2,500 person years

101
Q

what is risk?

A

Number of new cases / number of people at risk of the disease (within a given time frame)

102
Q

what is relative risk?

A

Risk among exposed group / risk in unexposed group

doesn’t take into account baseline risk

103
Q

How can relative risk reduction be calculated?

A

(Absolute risk reduction/ control group event rate) X 100

104
Q

what is absolute risk?

A

Subtract the risk of the control group from from the exposed group- gives you the excess risk caused by the exposure

Works out how much of the event (e.g. disease) occurs BECAUSE of the exposure

105
Q

what is the number needed to treat?

A

1 divided by absolute risk

The number of patients you need to treat for one to benefit.

106
Q

when are the health psychology transition points when people are more susceptible to health intervension?

A

leaving school
entering the workforce
becoming a parent
becoming unemployed
retirement
bereavement

107
Q

what is 1 advantage and 1 disadvantage of the planned behaviour of change model of behavioural change?

A

NAME?

108
Q

what scoring system cab be used for alcohol dependence?

A

AUDIT questionnaire

109
Q

what is tolerance?

A

needing to take larger quantities of a drug in order to get the same effect

110
Q

what is malnutrition?

A

deficiencies, excesses or imbalances in a person’s intake of energy and/ or nutrients. The term malnutrition covers undernutrition and obesity

111
Q

what are the 4 parts of negligence?

A
  1. Was there a duty of care?
  2. Was there a breach in that duty?
  3. Was the patient harmed?
  4. Was the harm due to the breach in care?
112
Q

what is the order of evidence?

A

1 - Systematic review
2 - RCT
3 - Cohort study
4 - Case control
5 - Case series/reports
6 - Expert opinion

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