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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? (2)

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? (4)

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
What is sensitivity?
The proportion of those with the disease who are correctly identified by the screening programme
26
What is specificity?
The proportion of people without the disease who are correctly excluded by the screening programme
27
What is the positive predictive value?
Proportion of people with a positive test result who actually have the disease
28
What is the negative predictive value?
Proportion of people with a negative test result who do not have the disease
29
What criteria emphasises the important features of screen programmes?
The Wilson and Jungner criteria
30
What are the 4 domains of the Wilson and Jungner criteria?
Knowledge of disease The screening test Treatment Organisation and cost
31
List 5 points detailed in the Wilson and Jungner criteria.
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
32
What are the 3 approaches to health needs assessment?
Epidemiological approach Corporate approach Comparative approach
33
What is an epidemiological approach to health needs assessment?
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
34
What are the advanatages of an epidemiological approach? (2)
Uses existing data Provides data on disease incidence/mortality and morbidity Can evaluate services by trends over time
35
What are the disadvantages of an epidemiological approach? (2)
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
36
What is a corporate approach to health needs assessment?
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
37
What are the advantages of a corporate approach? (2)
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
38
What are the disadvantages of a corporate approach? (2)
Difficult to distinguish need from demand Groups may have vested interests May be influenced by political agendas
39
What is a comparative approach to health needs assessment?
An approach to health needs assessment that compares the health or healthcare provision of one population to another
40
What are the advantages of a comparative approach? (2)
Quick and cheap if data is available Indicates whether health or services provision is better/worse than comparable areas
41
What are the disadvantages of a comparative approach? (2)
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
42
What is equity?
Giving people what they need to achieve equal outcomes
43
What are the Dahlgren and whitehead determinants of health? (3)
Constitutional factors: age and sex Individual lifestyle factors Social and community networks Living and working conditions General socio-economic, cultural and environmental conditions
44
What is equality?
Equality is giving everyone the same rights, opportunities and resources.
45
What is horizontal equity?
Equal treatment for equal need E.g. same treatment used for pneumonia of the same severity in different patients
46
What is vertical equity?
Unequal treatment for unequal need E.g. different treatments used in less severe vs more severe pneumonias
47
How can health equity be examined? (3)
Supply of healthcareAccess to healthcare Utilisation of healthcare Healthcare outcomes Health status Resource allocation Education and housing Wider determinants of health
48
What are the three domains of public health practice?
Health improvement Health protection Health care
49
What are the approaches/levels to improving public health?
Ecological level Community level Individual level
50
What are the three main health behaviours?
Health behaviour Illness behaviour Sick role behaviour
51
What is health behaviour?
A behaviour aimed to prevent disease E.g. regular exercise
52
What is illness behaviour?
A behaviour aimed to seek remedy E.g. going to the doctor
53
What is sick role behaviour?
Any activity aimed at getting well E.g. taking medication
54
What is unrealistic optimism?
Individuals continue to practice health damaging behaviour due to inaccurate perceptions of risk and susceptibility
55
What are perceptions of risk influenced by? (3)
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
What is the health belief model? (4)
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
What is the theory of planned behaviour?
Proposes that the best predictor of behaviour is intention
58
What is intention determined by according to the theory of planned behaviour? (3)
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
What are the stages of the transtheoretical model/stages of change?
Precontemplation Contemplation Preparation Action Maintenance
60
What are the advantages of the transtheoretical model? (2)
Acknowledges individual stages of readiness Accounts for relapse
61
What are the critiques of the transtheoretical model? (2)
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
What types of transition points are interventions more likely to be effective in behaviour change? (3)
Leaving school Entering the workforce Becoming a parent Becoming unemployed Retirement and bereavement
63
What is malnutrition?
Deficiencies, excesses or imbalances in a perons's intake of energy and or nutrients - covers undernutrition and being overweight/obese
64
What are the early influences on feeding/eating behaviour? (3)
Maternal diet and taste preference development Breastfeeding Parenting practices Ages of introduction of solid food Types of food exposed to during weaning
65
What is food poverty? (3)
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
What are the four dimensions of food insecurity?
Availability (affordability) of foodAccess - economic and physicalUtilisation - opportunity to prepare food Stability of the three dimensions over time
67
What is the inverse care law?
Good healthcare varies inversely with the need for healthcare
68
What is health needs assessment?
A systematic approach to understanding the needs of a population, to improve health and reduce inequalities
69
What are the three areas of health needs assessment?
Need Demand Supply
70
What are the types of need? (4)
Felt need Expressed need Normative need Comparative need
71
What is egalitarian resource allocation?
Providing all care that is necessary and required for everyone
72
What is maximising resource allocation?
Act is evaluated solely in terms of its consequences
73
What is libertarian resource allocation?
Each is responsible for their own health
74
What is primary prevention?
Preventing a disease from occuring in the first place
75
What is secondary prevention?
Early identification and intervention of the disease to alter disease course
76
What is tertiary prevention?
Limiting the consequences of an established disease
77
What is a population approach to prevention?
The prevention approach is delivered to everyone to shift the risk factor distribution curve
78
What is a high risk approach to prevention?
Identify individuals above a chosen cut off and treat them
79
What is prevention paradox?
A preventative measure which brings much benefit to the population often offers little impact to each participating individual
80
What are the harms of screening? (3)
Over treatment Treatment risks - invasive treatment Difficult decisions Anxiety or false reassurance Incorrect results Incidental findings that would not have been of harm
81
What are the benefits of screening? (3)
Early detection of disease Better future health More effective treatment Reassurance Informed decision
82
What screening programmes exist in the UK? (5)
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
What is length time bias?
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
What is lead time bias?
Occurs when patients diagnosed earlier appear to live longer because they know they have the disease for longer
85
What is odds?
Probability of the event occurring divided by the probability that the event does not occur
86
What is an odds ratio?
Odds of an event, divided by the odds of another event
87
What does an odds ratio 1 mean?
No association between condition and event occurrence
88
What does an odds ratio of more than 1 mean?
The event's odds are high for the group/condition - risk factor for event
89
What does an odds ratio of less than 1 mean?
The proability of the outcome occurring is lower for the group/condition - protective factor for outcome
90
What are the bradford-hill criteria? (5)
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
What are some causes of association? (3)
Bias Confounding factors Chance Reverse causality True association
92
What is incidence?
The number of new cases in population in a given amount of time
93
What is prevalence?
The current percentage of people with the condition in the population
94
What is relative risk?
Risk among exposed group divided by the risk in the unexposed group
95
What is attributable risk?
Works out how much of the event occurs because of the exposure (subtract the risk of the control group from the exposed group)
96
What is the number needed to treat?
The number of patients you need to treat for one to benefit (1 divided by absolute risk)
97
What is a transition point?
A point at which interventions are thought to be more effective
98
What are the models of behaviour change?
Health belief model Theory of planned behaviour Stages of change/transtheoretical model
99
What is the advantage of the theory of planned behaviour?
It takes into account social influences on behaviour
100
What can you offer to a newly presenting drug user? (3)
Screening for blood bourne viruses Health check Sexual health advice Immunisations
101
What are errors in practice? (5)
Sloth error - being lazy Lack of skill Communication breakdown System failure Human factors Judgement failure Neglect Poor performance Misconduct
102
How is an error classified?
Intention Action - what task was supposed to be done Outcome - near miss? death? Context
103
What is negligence?
4 parts: - - Proven duty of care? - - Breach in duty of care? - - Was the patient harmed? - - Was the harm because of the breach?
104
What is bolam and bolitho?
Bolam - would a group of reasonable doctors do the same? Bolitho - would that be reasonable?
105
What is a never event?
A serious largely preventable patient safety incident - should not occur if the available preventative measures have been implemented
106
What is a person approach to error?
Holds one person accountable

Phase 3a🩺 (12 decks)

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