Public Health Flashcards
what is health psychology?
emphasises the role of psychological factors in the cause, progression and consequences of health and illness
What are health behaviours?
a behaviour aimed to prevent disease - eg eating healthy
What is illness behaviour?
a behaviour aimed to seek remedy - eg going to doctor
what is the sick roll and sick role behaviour?
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
what is unrealistic optimism?
Individuals continue to practice health damaging behaviour
due to inaccurate perceptions of risk and susceptibility
What is 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
can be acarried out for populations, conditions or interventions
assesses need, supply and demand
what is felt need?
individual perceptions of variation from normal health
what is expressed need?
individual seeks help to overcome variation in normal health (demand)
What is normative need?
professional defines intervention appropriate for the expressed need
what is comparative need?
Weighing up between severity, range of interventions and cost when assessing a patients need for an intervention and what intervention to give
what is the definition of need in a health needs assessment?
ability to benefit from an intervention
What are 4 categories of determinants of health?
Genes
Environment - physical or social and economical
lifestyle
healthcare
What is primary prevention?
prevention before it starts - eg vaccination
what is secondary prevention?
screening
rehabilitation/prevention of secondary disease events
what is tertiary prevention?
stopping the progression and complications of a disease
What is horizontal equity?
Equal treatment for equal need
Individuals with pneumonia (with all other things being equal) should be treated equally
what is vertical equity?
Unequal treatment for unequal need
e.g. Individuals with common cold vs pneumonia need unequal treatment
what is health improvement?
Concerned with societal interventions (not primarily delivered through health services) aimed at preventing disease, promoting health, and reducing inequalities
what is health protection?
Concerned with measures to control infectious disease risks and
environmental hazards
What is healthcare?
Concerned with the organisation and delivery of safe, high quality services for prevention, treatment, and care
What is the epidemiological approach to a health care needs assessment?
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
What are the problems with the epidemiological approach to a health care needs assessment?
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
What are the advantages with the epidemiological approach to a health care needs assessment?
uses existing data
provides data on disease
incidence/mortality/morbidity are considered
can evaluate service by trends over time
what is the comparative approach to health care needs assessment?
compare services received by different populations in different places or categories
disadvantages of the comparative approach to a health care needs assessment?
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
what are the advantages of comparative approach to health care need assessment?
Quick and cheap if data available
Indicates whether health or services provision is better/worse than comparable areas (gives a measure of relative performance)
what is the corporate approach to health needs assessment?
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
what is the corporate approach to health needs assessment?
Ask local population what needs are
Use focus groups
Wide variety of stakeholders
what are the advantages of the corportate approach to health needs assessment?
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
What are the disadvantages of the corporate approach to health care assessment?
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
What is length/lead time bias?
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
what is the health belief model of behavioural change?
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
what are the problems with the health belief model of behavioural change?
Doesnt consider influence of emotions
Doesnt differentiate between first time and repeat behaviour (relapse)
Cues to action often missing in research
what is the theory of planned behaviour model of behavioural change?
proposes best predictor of behaviour is intention
What is the transtheoretical (stages of change) model of behavioural change?
precontemplation
contemplation
preparation
action
maintenance
relapse
What is intention determined by in the theory of planned behaviour model of change?
a persons attitude
subjective norm - perceived social pressure
perceived behavioural control - a persons perceived ability to perform an action
what are some problems with the transtheoretical model of behavioural change?
not always linear in reality
doenst take habit, emotions or culture into account
intentions can change over a very short time
what is nudge theory of behavioural change?
the environment is changed to make the best option the easiest
which opiod is safe in renal failure?
fentanyl
What are health inequalitites?
preventable unfair and unjust differences in health status between groups due to inequal distribution of socioeconomic conditions in society
What is the inverse care law?
the principle that that availability of good medical or social care is inverse to the need of the populations served
What are Maxwell’s dimensions of quality?
3As and 3Es
Acceptability
Accessibility
Appropriateness (relevance)
Effectiveness
Efficiency
Equity
What is the donabedian framework for health service evaluation?
Structure
Process
Outcome
What is meant by structure in the donabedian framework for health services evaluation?
what is there? - buildings, staff, equipment
No. ICU beds per 1000 people
No. vasc surgons per 1000 people
What is meant by Process in the donabeidian framework for health services evaluation?
what is currently done
What is outcome in the donabedian frame work for health services evaluation?
outcomes - mortality, morbidity, QOL, patient satisfaction - what can be measured to evaluate services
what is incidence?
the number of NEW cases over a certain time period (rate of new cases)
what is prevalence?
the number of existing cases at a particular point in time/in a particular defined population
what is iatrogenesis?
the unintended adverse effects of therapeutic intervention
what is sensitivity?
the proportion of people with the disease who are correctly identified by the test
what is the social norms theory of behaviour?
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
what is prevention paradox?
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
what criteria is used for screening?
Wilson Jungner criteria
what is the 9 wilsons-jugner criteria?
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
how do you calculate specificity?
true negatives/total number of patients who do not have the disease (True negative + false positives)
how do you calculate sensitivity?
true positives/total number of people who have the disease (True positives + False Negatives)
what is the positive predictive value?
proportion of people with positive test result who actually have disease
what is the negative predictive value?
the proportion of people without the disease who are correctly excluded
what are 5 reasons people don’t stop smoking?
Nicotine addiction
Coping with stress
habit
socialisation
fear of weight gain
How do you calculate units?
(% alcohol x amount of liquid mls)/1000
what are the cage questions of alcohol?
ever thought about cutting down
ever been annoyed by people telling you to cut down
feel guilty about how much you drink
eye opener
what is public health?
The science and art of preventing disease, prolonging life and improving health through the organised effort of society
what is equity?
Giving people what they need to achieve equal outcomes
what is equality?
Giving everyone the same rights opportunities and resources
what are 2 frameworks that can be used to assess the quality of health care available?
Donbedian framework - structure, process, outcome
Maxwell’s dimensions of quality healthcare
what are the 3 domains of public health?
Health improvement
Health protection
Improving services
what is egalitarian resource allocation?
providing all care necessary for everyone
what is maximising resource allocation?
Act is evaluated solely in terms of its consequences - utilitarian approach for the better of the people
what is libertarian resource allocation?
everyone is solely responsible for their own health
How do you calculate positive predictive value?
No. of people who are true positive/Total No. of people who screened positive
How do you calculate negative predictive value?
No of people who are true negative/Total No. of people who screened negative
what is sensitivity?
proportion of those with disease who are correctly identified as having the disease
what is specificity?
proportion of people without disease who are correctly excluded by screening test
What is a case control study?
Retrospective, observational study looking at cause of disease.
Compares similar participant with disease to controls without.
what are 3 advantages of case control studies?
Good for rare outcomes
quicker than other studies
can investigate multiple exposures
what are 2 disadvantages of case control studies
Difficulties finding controls to match with case
Prone to selection and information biases
what is a cross-sectional study?
Retrospective observational collects data from a population at a specific point in time ‘snapshot’.
Prevalence of risk factors and disease itself
what are 3 advantages of cross-sectional studies?
Relatively quick and cheap
Provide data on prevalence at single point in time
Good for surveillance and PH planning
what are 3 disadvantages of cross-sectional studies?
Risk of reverse causality (did outcome or exposure come first?)
Cannot measure incidence
Recall and response bias risk (may miss quick recoveries)
what is a cohort study?
Prospective longitudinal study looking at separate cohorts with different treatments or exposures. Wait to see if disease occurs
what are 3 advantages of cohort study?
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
what are 3 disadvantages of cohort study?
Long and expensive
drop outs
Need large sample size
What is a RCT?
Prospective study, all participants randomly assigned exposure or control intervention
what are 2 advantages or RCTs?
Low risk of bias and confounding
Can infer causality
what are 3 disadvantages of RCTs?
Time consuming, expensive
Drop outs
Inclusion criteria may exclude some populations
what is an ecological study?
Looks at the prevalence of the disease over time according to population data rather than individual. Can show prevalence and association but not causation
How do you calculate odds?
probability of event occurring/Probability of event NOT occurring (1-probability of occurring)
how do you calculate odds ratio?
Odds of Event A/Odds of event B
compares odds of outcome occurring between 2 groups (control and intervention)
what does it mean if odds ratio =1?
odds of the two events are equal
what does it mean if odds ratio is >1?
odds of event A > Event B
what does it mean if odds ratio <1?
odds of event B > event A
what is measurement bias?
Different equipment measuring differently
what is observer bias?
Observers expectations influence reporting
what is recall bias?
Past events not recalled correctly
what is reporting bias?
People don’t tell the truth because of shame/ judgement
what is selection bias?
Bias in recruiting for a study and assigning to study groups
sampling bias - where subjects are not representative of population
volunteer bias and non-responder bias
what is publication bias?
Trials with negative results less likely to be published
what is expectation bias?
in non-blinded trials
observers may subconsciously measure or report data in a way that favours the expected study outcome
what is the hawthorne effect?
a group changing it’s behaviour due to the knowledge that it is being studied
what is late-look bias?
gathering information at an inappropriate time e.g. after participants are dead
what are the 9 bradford-hill criteria for causality?
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
what is a cofounder
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.
what is person time?
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
what is risk?
Number of new cases / number of people at risk of the disease (within a given time frame)
what is relative risk?
Risk among exposed group / risk in unexposed group
doesn’t take into account baseline risk
How can relative risk reduction be calculated?
(Absolute risk reduction/ control group event rate) X 100
what is absolute risk?
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
what is the number needed to treat?
1 divided by absolute risk reduction
The number of patients you need to treat for one to benefit.
when are the health psychology transition points when people are more susceptible to health intervension?
leaving school
entering the workforce
becoming a parent
becoming unemployed
retirement
bereavement
what is 1 advantage and 1 disadvantage of the planned behaviour of change model of behavioural change?
NAME?
what scoring system cab be used for alcohol dependence?
AUDIT questionnaire
what is tolerance?
needing to take larger quantities of a drug in order to get the same effect
what is malnutrition?
deficiencies, excesses or imbalances in a person’s intake of energy and/ or nutrients. The term malnutrition covers undernutrition and obesity
what are the 4 parts of negligence?
- Was there a duty of care?
- Was there a breach in that duty?
- Was the patient harmed?
- Was the harm due to the breach in care?
what is the hierarchy of evidence?
1 - Systematic review
2 - RCT
3 - Cohort study
4 - Case control
5 - Case series/reports
6 - Expert opinion
How quickly do urgent notifiable diseases have to be reported?
By phone within 24 hours to UK health security agency
what are urgent notifiable diseases?
Hep A/B/C
Meningitis
Poliomyelitis
Anthrax
Botulism
Cholera
Diphtheria
Enteric fever
Haemolytic uraemic syndrome
Infectious blood diarrhoea
invasive group A strep
Legionnaire’s
Measles
Menigococcal septicaemia
Mumps
Plague
Rabies
SARS
Small pox
Viral haemorrhagic fever
Whooping cough - if acute phase
how quickly should routine notifiable disease be reported?
within 3 days via online services
what are routine notifiable diseases?
Acute encephalitis
brucellosis
COVID
Food poisoning
Leprosy
Malaria
Mumps
Rubella
Scarlet fever
Tetanus
Typhus
Yellow fever - urgent if acquired in uk
what is the likelihood ratio for a positive test result?
sensitivity/ 1 - specificity
How much the odds of the disease increase when the test is positive
what is the likelihood ratio for a negative test result?
1-sensitivity /specificity
How much the odds of the disease decreases when the test is negative
what is phase 0 of clinical trials?
exploratory studies
small number of participants to assess how drug behaves in human body - assess phamacokinets and pharmacodynamics
what is phase 1 of a clinical trial?
safety assessment
Determines side effects prior to larger study - HEALTHY INDIVIDUALS
what is phase 2 of a clinical trial?
assess efficacy
small number of patient affected by disease
2a - optimal dosing
2b - efficacy
what is phase 3 of a clinical trial?
more patients part of RTC comparing new treatment vs established treatments
what is phase 4 of clinical trials?
postmarketing surveillance
monitoring for long-term effectiveness and side effects
How do you calculate the standard error mean?
Standard deviation / sample size
what is cofounding?
a variable which correlated with other variables within a study leading to false results
what does linear regression look at?
used to predict how much one variable changes when a second variable in changed
what does a box and whisker plot show?
graphical representation of sample minumum, lower quartile, median, upper quartile and sample maximum
what does a histogram show?
graphical display of continuous data where values have been categorised into a number of categories
what does a forest plot repristent?
in meta analysis, represent strength of evidence in constituent trials
what is hazard ration?
for analysing survival over time - similar to relative risk but for when risk is not constant
what is intention to treat analysis?
all patients are analysed together whether they complete or received the treatment
avoids effects of crossover and drop out
what are 4 features of normal distribution?
symmetrical
68.3% of values lie in 1SD of mean
95.4% of values lie in 2 SDs of mean
99.7% of values in 3SDs of mean
who has precedent - an advanced decision or lasting power of attorney?
lasting power of attorney
what is a clinical audit?
a quality improvement process that seeks to improve patient care and outcomes through systematic review of care against explicit criteria and the implementation of change
what is required to confirm death after unsuccessful CPR?
5 minutes of observation of signs of life
5 mins continuous asystole on cardiac monitoring
No heart sounds, central pulse or resp sounds for 5 mins
No pupillary reflex, corneal reflex or response to painful stimuli
what is consent form 1 used for?
adults able to consent for themselves
when is consent form 2 used?
adult consent on behalf of child where consciousness will be impaired
when is consent form 3 used?
adult consent on behalf of child where consciousness will NOT be impaired
when is consent form 4 used?
for adult who lack capacity to provide informed consent
what are the 4 criteria for capacity?
able to understand
weigh up
retain
communicate back
how are controlled drug prescriptions writted?
need name and address of patient as well as form of drug
Total quantity in words and figures or number of dosage units in words and figures
The dose
what are 3 things that influence the power of a study?
sample size
meaningful effects size - difference between 2 means that leads you to reject the null hypothesis
significance level
