Public Health Flashcards
What are the 3 types of prevention?
Primary - prevent it occuring
Secondary - detect in early phase
Tertiary - slow down disease progression
What is prevention paradox?
Preventative measure which brings benefit to population but little to each individual
What is sensitivity formula?
True positive / (true positive + false negatives)
What is specificity formula?
True negatives / (true negatives + false positives)
What is positive predictive value formula?
True positive / (true positive + false positives)
What is negative predictive value formula?
True negative / (True negative + false negatives)
What is ecological study?
Observational study of case reports of groups rather than individuals -> no causation
What is a cross-sectional study?
Study used to generate hypotheses by looking at population at ONE point in time -> cannot assess incidence + recall bias
What is a case control study?
Retrospective study which matches people with and without the disease to a factor -> cannot assess causation and recall bias
What is a cohort study?
Prospective study which can establish causation -> takes a long time
What is an RCT?
Randomising control and intervention groups and measuring outcomes -> time consuming and expensive
What is incidence?
Number of new cases of a disease in a population
What is prevalence?
Total number of people in a population at one point in time
What is relative risk?
Incidence in exposed / unexposed
What is attributable risk?
Incidence in exposed - incidence in unexposed
What is relative risk reduction?
(Incidence in unexposed - exposed) / incidence in unexposed
What is absolute risk reduction?
Incidence in unexposed - incidence in exposed
What is odds?
Probability / (1 - probability)
What is odds ratio?
(P exposed ÷ [1 – P exposed]) ÷ (P unexposed ÷ [1 – P unexposed])
What is number needed to treat?
1 / (incidence in unexposed - incidence in exposed)
What is epigenetics?
Study of how genes interact with environment
What are the 3 concerns of public health?
- Inequalities
- Wider determinants of health
- Prevention
What are the 3 domains of public health?
- Improvement
- Protection
- Improving services
What is equality vs equity?
Equality - concerned with equal shares
Equity - concerned with what is fair and just
What is horizontal vs vertical equity?
Horizontal - equal treatment for equal need
Vertical - unequal treatment for unequal need
What are the Fraser guidelines?
- Understand advice
- Cannot be persuaded to inform parents
- They will continue to have sex without contraception
- Physical/Mental health may suffer without contraception
- Best interest of patient
What are the 3 things needed for DOLS?
- Patient is under continuous supervision and control
- Person is not free to leave
- Person lacks capacity to consent to this
What are screening tests in pregnancy?
- Hep B
- HIV
- Syphilis
- Downs, Edwards, Patau
- Sickle cell and thalassaemia
What are newborn screening?
- NIPE
- Hearing
- Heel prick
What are the adult screening programmes?
- Diabetic eye
- Cervical
- Breast
- Bowel
- AAA
What is selection bias?
Error in assigning individuals to groups may lead to differences which influence outcomes
What is lead time bias?
When screening identifies outcomes earlier than they would have resulting in an apparent increase in survival time but it has no effect on outcomes
What are the phases of clinical trials?
1 - safety assessment on healthy volunteers
2 - Assess efficacy on those with disease
3 - Large scaled RCT to assess effectiveness
4 - Post marketing surveillance
What is confounding bias?
A factor which is associated with what you are looking at and independently influences outcome but is not considered in the study
What are examples of parametric (can be measured) tests?
- T-test
- Pearon’s product moment coefficient
What are non parametric (cannot be measured) tests?
- Mann-Whitney U test (compares
- Chi-squared test (compare proprtions/percentages)
- Spearman rank
What is a Bolam and Bolitho test?
Bolam: A test used to judge the expected standard for doctor
If they do not meet the standards then the Bolitho test is used
Bolitho: scrutinise actions to see if they are logical
What is important about DNACPR?
It is not legally binding -> a decision can overrule this if CPR is now in best interests
What is an advanced decision?
A legally binding document to refuse treatment they do not want to happen
What are the important criteria around advanced decisions?
- Had capacity
- Over 18
- Written down and witnessed
- Cannot include basic care like washing. pain relief etc
What is an advanced statement?
A statement of wishes, beliefs and values around their future care which is not legally binding but should be considered when making best interests decisions under Capacity Act
What is a doctrine of double effect?
Accept an action if the intention is good even if it may lead to harm
What are the key principles of the capacity act?
- Capacity is assumed
- Individuals should be enabled people to make their own decisions
- They can make unwise decisions
- Decisions must be made in their best interests
- Least restrictive option should be used
What do Box and Whisker plots show?
Box - median and 2 quartiles
Whiskers - 1st and last data value
What are type 1 and type 2 errors?
Type 1 - rejecting a null hypothesis when it is true
Type 2 - failing to reject a null hypothesis when it is false
What is validity?
How accurately a study measures what it is supposed to
What is reliability?
How consistent the results are
What is attrition bias?
Skew in data due to a systematic issue in study e.g. people dropping out
