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Phase 3a🩺 > Public Health🥱 > Flashcards

Public Health🥱 Flashcards

1
Q

What is a case-control study?

A

A retrospective and observational study used to determine if there is an association between an exposure and a specific health outcome

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2
Q

What are the advantages of case-control studies? (2)

A

Good for rare outcomes
Quicker than cohort or intervention studies
Can investigate multiple exposures

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3
Q

What are the disadvantages of case-control studies? (3)

A

Difficulties finding controls to match with cases
Prone to selection and information bias
Cannot determine causality
Not good for rare exposures

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4
Q

What is a cohort study?

A

An epidemiological study where a group of individuals with a particular characteristic are followed up over time

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5
Q

What are the advantages of a cohort study? (2)

A

Can follow up a group with a rare exposure Good for common outcomes Can investigate multiple outcomes Less risk of selection and recall bias

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6
Q

What are the disadvantages of a cohort study? (2)

A

Takes a long time
Loss to follow up
Need a large sample size

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7
Q

What is a cross-sectional study?

A

An observational study that analyses data from a specific population at one point in time (snapshot)

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8
Q

What are the advantages of a cross-sectional study? (3)

A

Relatively cheap and quick
Provide data on prevalence at a single point in time
Large sample size
Good for surveillance and public health planning

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9
Q

What are the disadvantages of a cross-sectional study? (3)

A

Risk of reverse causality (did the exposure or outcome come first?)
Cannot measure incidence
Risk recall bias and non-response

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10
Q

What is a randomised controlled trial?

A

Subjects are randomly assigned to one of two groups - one receiving the intervention that is being tested, and one receiving an alternative (conventional) intervention

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11
Q

What are the advantages of a RCT? (2)

A

Low risk of bias and confounding
Can infer causality

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12
Q

What are the disadvantages of a RCT? (3)

A

Time consuming
Expensive
Specific inclusion/exclusion criteria may mean the study population is different from typical patients
Drop outs

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13
Q

What is selection bias?

A

A systematic error in the selection of study participants and allocation of participants to different study groups

E.g. Health studies that recruit participants directly from clinics miss all the cases who don’t attend those clinics or seek care during the study

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14
Q

Why does selection bias occur? (2)

A

Non-response
Loss to follow up
Those in an intervention group might be different in some way to those in the control group

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15
Q

What types of information bias are there?

A

Measurement bias
Observer bias
Recall bias
Reporting bias

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16
Q

What is measurement bias?

A

Different equipment used to measure the outcome in the different groups

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17
Q

What is observer bias?

A

Observers expectations influence reporting

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18
Q

What is recall bias?

A

Past events not recalled correctly

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19
Q

What is reporting bias?

A

Respondants report inaccurate information because they are embarassed or feel judged

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20
Q

What is confounding?

A

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

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21
Q

What is reverse causality?

A

A situation when an association between an exposure and an outcome could be due to the outcome causing the exposure

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22
Q

What factors increase the likelihood of causality? (3)

A

Strength of association
Consistency of results
Dose-response association
Plausibility
Reversibility
Coherence with other information

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23
Q

What is the purpose of screening?

A

Identifying apparently well individuals who have a particular disease in order to reduce adverse outcomes

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24
Q

What are the disadvantages of screening? (2)

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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25
Q

What is sensitivity?

A

The proportion of those with the disease who are correctly identified by the screening programme

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26
Q

What is specificity?

A

The proportion of people without the disease who are correctly excluded by the screening programme

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27
Q

What is the positive predictive value?

A

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

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28
Q

What is the negative predictive value?

A

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

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29
Q

What criteria emphasises the important features of screen programmes?

A

The Wilson and Jungner criteria

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30
Q

What are the 4 domains of the Wilson and Jungner criteria?

A

Knowledge of disease
The screening test
Treatment
Organisation and cost

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31
Q

List 5 points detailed in the Wilson and Jungner criteria.

A

In Exam Season NAP

I- important disease
E- effective treatment available
S- simple, safe and precise test
N- natural hx of disease known
A- acceptable to population (not too invasive)
P- policy on who to tx agreed

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32
Q

What are the 3 approaches to health needs assessment?

A

Epidemiological approach
Corporate approach
Comparative approach

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33
Q

What is an epidemiological approach to health needs assessment?

A

An approach to health needs assessment based on:
- size of population (incidence and prevalence)
- services available (prevention/treatment/care)
- evidence base (effectiveness/cost effectiveness)

Sources: disease registry, admissions, gp databases

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34
Q

What are the advanatages of an epidemiological approach? (2)

A

Uses existing data
Provides data on disease incidence/mortality and morbidity
Can evaluate services by trends over time

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35
Q

What are the disadvantages of an epidemiological approach? (2)

A

Quality of data variable
Data collected may not be the data required
Does not consider the felt needs or opinions/experiences of the people affected

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36
Q

What is a corporate approach to health needs assessment?

A

An approach to health needs assessment that asks the local population and a wide range of stakeholders what their health needs are - through focus groups, interviews and public meeting

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37
Q

What are the advantages of a corporate approach? (2)

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 a wide range of views

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38
Q

What are the disadvantages of a corporate approach? (2)

A

Difficult to distinguish need from demand
Groups may have vested interests
May be influenced by political agendas

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39
Q

What is a comparative approach to health needs assessment?

A

An approach to health needs assessment that compares the health or healthcare provision of one population to another

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40
Q

What are the advantages of a comparative approach?

A

Quick and cheap if data is available
Indicates whether health or services provision is better/worse than comparable areas

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41
Q

What are the disadvantages of a comparative approach? (2)

A

May be difficult to find a comparable population
Data may not be high quality
May not yield what the most appropriate level of provision should be

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42
Q

What is equity?

A

Giving people what they need to achieve equal outcomes

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43
Q

What are the Dahlgren and whitehead determinants of health? (3)

A

Constitutional factors: age and sex
Individual lifestyle factors
Social and community networks
Living and working conditions
General socio-economic, cultural and environmental conditions

44
Q

What is equality?

A

Equality is giving everyone the same rights, opportunities and resources.

45
Q

What is horizontal equity?

A

Equal treatment for equal need

E.g. same treatment used for pneumonia of the same severity in different patients

46
Q

What is vertical equity?

A

Unequal treatment for unequal need

E.g. different treatments used in less severe vs more severe pneumonias

47
Q

How can health equity be examined? (3)

A

Supply of healthcareAccess to healthcare Utilisation of healthcare Healthcare outcomes Health status Resource allocation Education and housing Wider determinants of health

48
Q

What are the three domains of public health practice?

A

Health improvement
Health protection
Health care

49
Q

What are the approaches/levels to improving public health?

A

Ecological level
Community level
Individual level

50
Q

What are the three main health behaviours?

A

Health behaviour
Illness behaviour
Sick role behaviour

51
Q

What is health behaviour?

A

A behaviour aimed to prevent disease

E.g. regular exercise

52
Q

What is illness behaviour?

A

A behaviour aimed to seek remedy

E.g. going to the doctor

53
Q

What is sick role behaviour?

A

Any activity aimed at getting well

E.g. taking medication

54
Q

What is unrealistic optimism?

A

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

55
Q

What are perceptions of risk influenced by? (3)

A

Lack of personal experience with the problem
Belief that it is preventable by personal action
Belief that if it has not happened by now, it is not likely to
Belief that the problem is infrequent

56
Q

What is the health belief model?

A

Individuals will change if they:- Believe they are susceptible to the condition - Believe that is has serious consequences - Believe that taking action reduces susceptibility - Believe that the benefits of taking action outweight the costs

Alcohol example

57
Q

What is the theory of planned behaviour?

A

Proposes that the best predictor of behaviour is intention

58
Q

What is intention determined by according to the theory of planned behaviour?

A

A persons attitude to the behaviour
The preceived social pressure to undertake the behaviour (subjective norm)
A persons appraisal of their ability to perform the behaviour (perceived behavioural control)

59
Q

What are the stages of the transtheoretical model/stages of change?

A

Precontemplation Contemplation Preparation Action Maintenance

60
Q

What are the advantages of the transtheoretical model? (2)

A

Acknowledges individual stages of readiness
Accounts for relapse

61
Q

What are the critiques of the transtheoretical model? (2)

A

Not all people move through every stage
Change might operate on a continuum rather than in discrete stages
Doesn’t take into account values, habits, culture, social and economic factors

62
Q

What types of transition points are interventions more likely to be effective in behaviour change? (3)

A

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

63
Q

What is malnutrition?

A

Deficiencies, excesses or imbalances in a perons’s intake of energy and or nutrients - covers undernutrition and being overweight/obese

64
Q

What are the early influences on feeding/eating behaviour? (3)

A

Maternal diet and taste preference development
Breastfeeding
Parenting practices
Ages of introduction of solid food
Types of food exposed to during weaning

65
Q

What is food poverty?

A

Experiencing one or more of the following:- Having smaller meals than usual or skipping meals - Being hungry but not eating - Not eating for a whole day Due to being unable to afford or access food

66
Q

What are the four dimensions of food insecurity?

A

Availability (affordability) of foodAccess - economic and physicalUtilisation - opportunity to prepare food Stability of the three dimensions over time

67
Q

What is the inverse care law?

A

Good healthcare varies inversely with the need for healthcare

68
Q

What is health needs assessment?

A

A systematic approach to understanding the needs of a population, to improve health and reduce inequalities

69
Q

What are the three areas of health needs assessment?

A

Need Demand Supply

70
Q

What are the types of need?

A

Felt need
Expressed need
Normative need
Comparative need

71
Q

What is egalitarian resource allocation?

A

Providing all care that is necessary and required for everyone

72
Q

What is maximising resource allocation?

A

Act is evaluated solely in terms of its consequences

73
Q

What is libertarian resource allocation?

A

Each is responsible for their own health

74
Q

What is primary prevention?

A

Preventing a disease from occuring in the first place

75
Q

What is secondary prevention?

A

Early identification and intervention of the disease to alter disease course

76
Q

What is tertiary prevention?

A

Limiting the consequences of an established disease

77
Q

What is a population approach to prevention?

A

The prevention approach is delivered to everyone to shift the risk factor distribution curve

78
Q

What is a high risk approach to prevention?

A

Identify individuals above a chosen cut off and treat them

79
Q

What is prevention paradox?

A

A preventative measure which brings much benefit to the population often offers little impact to each participating individual

80
Q

What are the harms of screening? (3)

A

Over treatment
Treatment risks - invasive treatment
Difficult decisions
Anxiety or false reassurance
Incorrect results
Incidental findings that would not have been of harm

81
Q

What are the benefits of screening? (3)

A

Early detection of disease
Better future health
More effective treatment
Reassurance
Informed decision

82
Q

What screening programmes exist in the UK?

A

Pregnancy - Sickle cell and thalassaemia - Infectious disease- Fetal anomaly screening Newborns - NIPE - Hearing screening programme - Blood spot screening AAA Breast cancer Cervical cancer Bowel cancer Diabetic eye

83
Q

What is length time bias?

A

Occurs when screening is more likely to detect slow growing disease that has a long phase without symptoms. There will appear to be a survival benefit to screening even when early detection doesn’t improve outcome

84
Q

What is lead time bias?

A

Occurs when patients diagnosed earlier appear to live longer because they know they have the disease for longer

85
Q

What is odds?

A

Probability of the event occurring divided by the probability that the event does not occur

86
Q

What is an odds ratio?

A

Odds of an event, divided by the odds of another event

87
Q

What does an odds ratio 1 mean?

A

No association between condition and event occurrence

88
Q

What does an odds ratio of more than 1 mean?

A

The event’s odds are high for the group/condition - risk factor for event

89
Q

What does an odds ratio of less than 1 mean?

A

The proability of the outcome occurring is lower for the group/condition - protective factor for outcome

90
Q

What are the bradford-hill criteria? (5)

A

A group of 9 principals that can be useful in establishing epidemiological evidence of a causal relationship between a presumed cause and an observed effect.

Strength
Consistency
Dose response
Temporality
Plausibility
Reversibility
Coherence
Analogy
Specificity

91
Q

What are some causes of association? (3)

A

Bias
Confounding factors
Chance
Reverse causality
True association

92
Q

What is incidence?

A

The number of new cases in population in a given amount of time

93
Q

What is prevalence?

A

The current percentage of people with the condition in the population

94
Q

What is relative risk?

A

Risk among exposed group divided by the risk in the unexposed group

95
Q

What is attributable risk?

A

Works out how much of the event occurs because of the exposure (subtract the risk of the control group from the exposed group)

96
Q

What is the number needed to treat?

A

The number of patients you need to treat for one to benefit (1 divided by absolute risk)

97
Q

What is a transition point?

A

A point at which interventions are thought to be more effective

98
Q

What are the models of behaviour change?

A

Health belief model
Theory of planned behaviour
Stages of change/transtheoretical model

99
Q

What is the advantage of the theory of planned behaviour?

A

It takes into account social influences on behaviour

100
Q

What can you offer to a newly presenting drug user? (3)

A

Screening for blood bourne viruses
Health check
Sexual health advice
Immunisations

101
Q

What are errors in practice? (5)

A

Sloth error - being lazy
Lack of skill
Communication breakdown
System failure
Human factors
Judgement failure
Neglect
Poor performance
Misconduct

102
Q

How is an error classified?

A

Intention
Action - what task was supposed to be done
Outcome - near miss? death?
Context

103
Q

What is negligence?

A

4 parts:
- - Proven duty of care?
- - Breach in duty of care?
- - Was the patient harmed?
- - Was the harm because of the breach?

104
Q

What is bolam and bolitho?

A

Bolam - would a group of reasonable doctors do the same?
Bolitho - would that be reasonable?

105
Q

What is a never event?

A

A serious largely preventable patient safety incident - should not occur if the available preventative measures have been implemented

106
Q

What is a person approach to error?

A

Holds one person accountable

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