Public Health Flashcards
What is primary prevention?
Preventing a disease form occuring in the first place-eliminates RF contriburting?
List 3 examples of primary prevention?
Vaccines
change4life
5 a day
What is secondary prevention?
detecting a disease in its early or pre-clinical phase to alter its course
List 2 examples of secondary prevention?
all screening programmes (breast, Bowel, cervical cancer)
Heel prick
What is tertiary prevention?
attempting to slow down disease progression + prevent complications of a disease, helping people manage their illness effectively.
List an example of tertiary prevention?
diabetic foot care, attending rehab after a stroke to prevent immobility.
What is the purpose of screening?
identifies seemingly well individuals who may be at risk of a disease, in the hope of catching the disease at its early stage
what is sensitivity?
the proportion of people with the disease who are correctly identified by the screening test.
(True Positive) / (True Positive + False Negative)
What is specificity?
the proportion of people without the disease who are correctly excluded by the screening test.
(True Negative) / (True Negative+ False Positive)
What is PPV (Positive predictive value)?
the proportion with a positive test result
who actually have the disease. Dependent on underlying prevalence.
(True Positive) / (True Positive + False Positive)
What is NPV (Negative predictive value)?
the proportion with a negative test result
who do not have the disease. This is lower if the prevalence is higher.
(True Negative) / (True Negative+ False Negative)
List 2 disadvantages of screening?
Exposing well individuals to distressful or harmful diagnostic tests
Overtreatment of disease that may have never caused any problems
Preventative interventions may cause harm to the inividual or population
Reassurance to false negatives patients
What criteria is used fro screening?
Wilson and Junger
List 3 requirements for successful screening according to the wilson jungner criteria?
IATROGENIC
I- Important problem
A- Available diagnosis and treatment facility
T- Treatable
R- Recognisable latent stage
O- Obvious diagnostic test
G- General public accepted
E- Economically viable
N- Natural history understood
I- Issued agreed policy on who to treat
C- Continuously done
What is lead time bias?
Screening identifies diseases earlier and so gives the impression that survival is prolonged but in reality survival time is unchanged
What is length time bias?
Diseases with a longer period of presentation are more likely to be detected by screening than ones with a shorter time of presentation.
Describe the prevention paradox.
A preventative measure that brings much benefit to the population often offers little to each participating individual.
Give 4 different types of screening.
Population based.
Opportunistic.
Screening for communicable diseases.
Pre-employment and occupational.
What is the population approach to prevention? Give an example.
Preventative measures delivered on a population wide basis e.g. dietary salt reduction.
What is the high risk approach to prevention? Give an example.
Identifying individuals above a chosen cut-off and treating them. E.g. treating those with high cholesterol to avoid heart disease.
What is a RCT?
Where a population is randomised to either an interventional or a control group. Often these are blind or double-blind trials.
Which type of study follows a population over time to see if they’re exposed to the agent in question and if they develop the disease?
A cohort or incidence study. These are prospective.
Which type of study compares people with a disease to those without a disease for age, sex, habits, class etc?
A case-control study. These are retrospective.
Which type of study looks at the population at a point in time?
A cross-sectional or prevalence study.
Which type of observational study uses routinely collected population level data to show trends and to generate hypotheses?
An ecological study.
What are the 4 main determinants of health?
Lifestyle.
Access to healthcare.
Genes.
Environment.
Define the following
A) Equity
B) Equality
Equity-Giving people what they need to achieve equal outcomes (what is fair and just)
Equality- Giving everyone the same rights, opportunities, and resources (equal shares)
Define horizontal equity.
Equal treatment for equal need.
Define vertical equity.
Unequal treatment for unequal need e.g. someone with a common cold would need a different treatment to someone with pneumonia.
Give 2 factors that can affect equity.
- Spatial factors - geographical.
- Social factors - age, gender, class, ethnicity.
What are the 3 domains of public health?
- Health promotion.
- Health protection.
- Improving health services.
Domains of public health: give examples of health promotion.
Health promotion looks at interventions e.g. immunizations, smoking cessation, screening.
Domains of public health: give examples of health protection.
Putting measures in place to control infectious diseases.
Domains of public health: what are the aims of health service improvements?
To ensure that there is delivery of organised, safe and high quality services.
Give 3 types of health behaviour.
- Health Behaviour
- Illness Behaviour
- Sick role behaviour
Define health behaviour.
Health behaviour is aimed at preventing disease e.g. eating healthily.
Define illness behaviour.
Illness behaviour is aimed at seeking remedy e.g. going to the Dr’s.
Define sick role behaviour.
Sick role behaviour is activity aimed at getting better e.g. taking medications.
What are health damaging behaviours?
Health damaging behaviours are often related to mortality e.g. smoking, alcohol, high risk sexual behaviours.
What are health promoting behaviours?
Behaviours that seek and maintain health e.g. exercise, eating healthily, having vaccines.
What is a meta-analysis?
Multiple studies measuring the same thing, compared to each other to assess overall trends and conclusions.
More accurate answer to the hypothesis and give you more reliable answer to any individual study
Define compliance.
The extent to which a patients behavior coincides with medical advice. It is professionally focused and assumes that the doctor knows best.
Give 3 factors that can effect compliance.
- Side effects of medications.
- Patient perception of risk.
- If the patient is asymptomatic.
- Socioeconomic status.
What is the single greatest cause of illness and premature death in the UK?
smoking
What 3 diseases are smoking related deaths normally due to?
Cancers.
COPD.
CHD.
When does smoking prevalence peak?
In the mid 20s.
Smoking cessation: give 3 symptoms of withdrawal
Difficulty concentrating.
Increased appetite.
Irritability.
Cravings
Anxiety
Insomnia
What are the 5 levels of Maslow’s hierarchy of needs?
- Physiological need
- Safety and security
- Love and belonging
- Self-esteem
- Self-actualisation
Define domestic abuse.
Incidents of controlling, coercive, threatening behaviour, violence or abuse between those aged 16+ who are, or have been, intimate partners or family members regardless of gender or sexuality.
Give 3 examples of domestic abuse.
Emotional abuse.
Physical abuse.
Financial abuse.
Sexual abuse.
Psychological abuse.
How can domestic abuse impact on health?
- Traumatic injuries following assault e.g. fractures, miscarriage.
- Somatic problems or chronic illness e.g. chronic pain, headaches.
- Psychological problems e.g. PTSD, depression, anxiety.
Give 3 potential indications of domestic abuse.
Unwitnessed by anyone else.
Repeat attendances to GP or A+E.
Delay in seeking help.
Multiple minor injuries.
What assessment tool can be used to determine someones risk of domestic abuse?
The DASH assessment
Domestic Abuse Stalking and Honour Based Violence
What action would you take if someone was at high risk of domestic abuse?
Refer to MARAC (Multi-agency risk-assessment conference) or IDVA (Independant Domestic Violence Advisor)
Define incidence.
The rate at which new diseases occur in a population in a certain time period.
Define prevalence.
The proportion of a population found to have a disease at a point in time.
What is NNT?
Number needed to treat is the number of patients that need to be treated in order to have an impact on one person.
How can you calculate NNT?
1 / absoloute risk reduction.
Define bias.
A systematic deviations from the true estimation of the association between exposure and outcome.
What is selection bias?
The people who choose to participate in screening programmes may be different from those who don’t. Proper randomisation is not achieved.
What is information bias?
Information or measurement bias is a systematic error in the measurement or classification of exposure or outcome. It can be due to observer, participant or instrument error.
Define confounding.
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.
Confounders may affect the validity of a study.
What is the Bradford Hill criteria for causation?
Used to assess causation: DRS CBT CASS
1. Dose response.
2. Reversibility.
3. Strength of association.
4. Consistency.
5. Biological plausibility.
6. Temporality - cause before disease.
7. Coherence
8. Analogy
9. Strength
10. Specificity
What is Public Health?
The science and art of preventing disease, prolonging life and promoting health through organised efforts and informed choices of society, organisations, public and private communities and individuals.
Define epidemiology.
The study of the frequency, distribution and determinants of diseases and health-related states in populations in order to prevent and control disease.
What is allostasis?
The process of achieving stability, or homeostasis, through physiological or behavioural change.
What is allostatic load?
The wear and tear on the body that accumulates as an individual is exposed to repeated or chronic stress. The price we pay for allostasis.
Definition of an asylum seeker?
a person who has made an application for refugee satus
Definition of refugee?
a person grnated asylum + refugee satutus (usually means leave to remian for 5 years and then reapply)
What are the entiletments for asylum seekers?
o Housing but with no choice of where.
o Cash support amounting £37pp in the household (or £35 if refused).
o Full access to NHS (free prescriptions, eyesight tests, dental care).
o Education for children 5-17.
What health problems to asylum seekers usaully present with?
o Common illness + illnesses specific to country of origin.
o Injuries from war + travelling.
o No previous health surveillance/neonatal screening/immunisations.
o Malnutrition, torture + sexual abuse (including female genital mutilation).
o Communicable + blood borne diseases.
o PTSD, depression, psychosis, self-harm, sleep disturbance.
List 3 causes for homelessness?
Realtionship breakdown
Mental illness, domestic abuse
Disputes with parents
Drugs, alcohol
No money or job
Which populations vulnerable to homelessness
o LGBTQ+.
o Ex-service men + women.
o Substance misusers.
o Failed asylum seekers
List 5 health problems are faced by the homeless?
Infectious diseases such as TB + hepatitis.
Poor condition of feet + teeth.
Respiratory problems.
Injuries following violence, rape.
Sexual health issues.
Serious mental illnesses (schizophrenia, depression + personality disorders).
Poor nutrition.
Addictions/substance misuse.
List 3 barriers to healthcare for travellers?
Reluctance of GPs to register travellers + to visit traveller sites.
Poor reading + writing skills (many are illiterate).
Communication difficulties.
Too few permanent sites.
Mistrust of professionals.
What is the inverse care law?
the availability of medical care tends to vary inversely with the need of the population served (those who need it most, don’t access it, vice versa).
What is the main theory why pateints undertake health damaging behaviours?
Unrealistic optimism** = individuals continue practicing health damaging
behaviours due to inaccurate perceptions of risk + susceptibility.
What perceptions influence unrealistic optimism?
Lack of personal experiences with the problem.
Belief that it’s preventable by personal action.
Belief that it’s not happened by now so it’s not likely to.
Belief that the problem is infrequent.
List the stages in the health belief model?
Percieved susceptibility
Percieved severity
Percieved benefits
Percieved barriers
What are the 6 stages of change/trnastheoritical model
Precontemplation
Contemplation
Preparation
Action
Relapse
Maintenance
What is nudge theory?
Changing the environment to make the best/healthiest option the easiest
What does the helath needs assessment planning cycle include?
needs assessment –>vplanning –> implementation –> evaluation –>
What is felt need?
individual perceptions of variation from normal health.
What is expressed need?
When an individual seeks help to overcome variation in normal health.
What is normative need?
When a professional defines interventions that are appropriate for expressed need.
What is comparative need?
Comparison between severity, range of interventions and cost
Name 3 different types of health needs assessment.
- Epidemiological
- Comparitive
- Corporate
Briefly describe a comparative health needs assessment.
Compares services received by one population with other populations.
Give 3 negative points for comparative health needs assessments.
Required data may not be available.
Variable data quality.
It is hard to find comparable populations.
Who might be involved with corporate health needs assessment?
Politicians.
Press.
Providers.
Professionals.
Patients.
Give 3 negative points for corporate health needs assessments.
Difficult to distinguish need from demand.
Groups may have vested interests.
May be influenced by political agendas.
Give one health related example of something that you consider is demanded but not needed or supplied.
Cosmetic surgery
List 5 transition points and what are they?
Transition points- points at which interventions are thought to be more effective
1) Leaving school
2. Entering the workforce
3) Becoming a parent
4) Beocming unemployed
5) Retirement and bereavement
What are the 4 dimensions of food insecurity
Availability (affordability) of food
Access – economic and physical
Utilisation – opportunity to prepare food
Stability of the three dimensions over time
What is relative risk ?
Ratio of risk of disease in the exposed to the risk in the unexposed
(a/a+b)/(c/c+d)
What is attributable risk
The rate of disease in the exposed that may be attributed to the exposure
– i.e. incidence in exposed minus incidence in unexposed.
(a/a+b)-(c/c+d)
What are the 2 ways in which healthcare can be assessed?
Maxwells dimension
Donebedian approach
What is maxwells dimensions?
3As and 3Es
Accesibility
Acceptibility
Appropriateness
Equity
Efficiency
Effectiveness
How many screening programmes are their in the UK and list them?
11
3 In pregnancy
-HIV/Syphylis/HepB
-Thallassemia and Sickle cell
-Foetal anomaly scan
3 in Newborn
- Hearing test
- NIPE
- Heel prick test
5 in adults
- AAA screening (Men >65)
- Bowel cancer (FIT test 60-74, every 2 years)
- Breast cancer (Women 50-70 every 3 years)
- Cervcial cancer (women, 25-49 every 3 years, 50-64 every 5 years)
- Diabetic eye
Define:
need
demand
supply
need- ability to benefit from an intervention
demand- what people ask for
supply- what is provided
What are the 5 key principles of the mental capacity act?
- Person assumed to have capacity unless proven otherwise.
- Steps taken to help person have capacity
- Unwise decision doesn’t mean person lacks capacity
- Any decision made under MCA must be in person’s best interest
- Any decisions may should be the least restrictive to person’s rights and freedoms
What type of error is a false negative test result for a disease?
Type 2 Error
What type of error is a false positive test result for a disease?
Type 1 Error
What are the positives and negatives of a ecological study?
Pro’s - Readily available data and Shows correlation
Con’s - Can’t show causation, Affected by Bias and other co-founders
What are the positives and negatives for a cross-sectional study?
Pro’s - Large samples
Con’s - Reverse causality, Length-time bias, Not suitable for rare diseases
What is a case-control study?
A retrospective observational study for investigating the causes and risk factors of a particular disease
What are the Pro’s and Con’s of a case control study?
Pro’s - Rapid and Good with rare diseases
Con’s - Reverse causality, Bias prone
What type of study is a cohort study?
Prospective longitudinal
What are the Pro’s and Con’s of a cohort study?
Pro’s - Show’s causation, Useful in common diseases
Con’s - Loss to Follow-up, Changed conditions over time
What are the Pro’s and Con’s of a RCT study?
Pro’s - Gold standard for causation
Con’s - Loss to follow-up, ethical issues, changed conditions over time
Define person-years
Unit of measurements which represents the number of years a person contributes to a study
What are the Pro’s and Con’s of a meta-analysis study?
Pro’s - Combines studies therefore more effective data, Increased statistical power
Con’s - Ignores differences between studies, Bias prone
What is publication bias?
Selective publication of research studies based on their results
What are the main points of the Health Belief Model by Becker 1974
Individuals will change if they believe they’re: - susceptible
- acknowledge consequences
- believe action will decrease their susceptibility
- Action outweighs Consequences
What are the Pro’s and Con’s of the Becker Health Belief Model 1974?
PRO’S
- Longstanding
- Many situational applications
CON’S
- No emotional/social cues
- No temporality
- Doesn’t differentiate 1st time vs Repeat behaviour
Describe the transtheoretical model of behaviour change?
- Pre-contemplation
- Contemplation
- Preparation
- Action
- Maintenance
- Relapse
What are the Pro’s and Con’s of the Transtheoretical model of behavioural change?
PRO’S
- Temporality
- Considers relapse
CON’S
- People may not go through all stages
- May go back and forth
- Doesn’t consider social cues or habits
Describe the theory of planned behaviour?
Positive attitude towards behaviour + Social norms + Perceived behavioural control
Affect Intention which Affect Action
What are the Pro’s and Con’s of the theory of planned behaviour?
PRO’S
- Accounts for emotional and social cues
- Applicable to many scenario’s
CON’S
- Lack of temporality
- Report bias
- Doesn’t consider habits
What is motivational interviewing?
Counselling method which asks questions to provoke change
What is nudge theory?
Changing environment to make healthy option easiest
e.g. Only keeping healthy foods at home
What is MINDSPACE in models of behavioural change?
Highlights the nine important factors which drive all behaviour
Messenger
Incentives
Norm
Default
Salience
Priming
Affect
Commitment
Ego
What is Bradshaw’s Health needs?
Felt needs - Individual perceptions
Expressed needs - Needs they put into action e.g. going doctors
Normative needs - Needs determined by professionals and experts
Comparative needs - Need compared between groups in access to services and resources
Describe the Health Needs Assessment Cycle?
Cycle of
Assessment, Planning, Implement, Evaluate
What are the benefits and drawbacks of an Epidemiological assessment approaches?
Benefits
- Biomedical data
- Uses existing data
Drawbacks
- No felt or expressed needs
- Variable data quality
- Data collected isn’t necessarily data required
