Public health Flashcards
Three domains of public health?
Health improvement - education, housing, employment
Health protection - radiation, immunisation, emergency response, environment
Health care -clinical effectiveness, efficiency, audit, clinical governance
Health behaviour?
Behaviour aimed at preventing disease
Illness behaviour?
Behaviour aimed to seek remedy
Sick role behaviour?
Behaviour aimed at getting well
WHO medication adherence in developed countries?
Around 50%
Interventions at the population level?
Health promotion - process of enabling people to exert control over their health:
-Awareness campaigns
-Screening and immunisations
Interventions at the individual level?
Patient-centred approach - care responsive to individual needs
Unrealistic optimism?
Individuals continue to practice health damaging behaviours due to inaccurate perceptions of risk and susceptibility
What I perception of risk influenced by?
- Lack of personal experience with problem
- Belief that the problem is preventable by personal action
- Belief that if it’s not happened by yet, it isn’t likely to
- Belief that the problem is infrequent
Health belief model?
Theory of behaviour change where perceived barriers have been demonstrated to be the most important factor in addressing behaviour change in patients
Health belief model: when will individuals change?
- They believe they’re susceptible
- They believe it has serious consequences
- Believe that taking action reduces susceptibility
- Believe that the costs of taking action outweigh benefits
Health belief model critiques?
Doesn’t consider outcome expectancy or self efficacy
Doesn’t consider influence of emotions and behaviour
Doesn’t differentiate between first time and repeat behaviour
Theory of planned behaviour?
Proposes the best predictor of behaviour change is intention
Theory of planned behaviour: what is intention determined by?
Personal attitude to behaviour
Social pressure to change behaviour
Person’s perceived behavioural control
Critique of theory of planned behaviour?
Lack of direction and causality
Doesn’t take into account emotions, habits and routines
What is the transtheoretical model of change?
Precontemplation - contemplation - preparation - action - maintenance - relapse
Advantages and disadvantages for transtheoretical model?
Ad - accounts for relapse
Disadvantages:
Not all people move through stages linearly
Change might operate on a continuum rather than stages
Four factors for developing food behaviours?
Maternal diet
Breastfeeding
Parental practices
Age of introduction to solids and types of foods given
Non-organic feeding disorders?
High prevalence in under 6s
Feeding aversion, food refusal, negative mealtime interactions
What is malnutrition?
Refers to deficiencies, excesses or imbalances in a person’s intake of energy and/or nutrients
Types of malnutrition?
Undernutrition - stunting, wasting, underweight, micronutrient deficiencies
Overweight/obesity - diet-relate non communicable diseases
Four dimensions of food insecurity?
- Availability
- Access
- Utilisation
- Stability
What are the determinants of health?
Progress:
-Place of residence, race, occupation, gender religion, education, socio-economic, social capital
What is equity?
What is fair and just
Types of equity?
Horizontal - equal treatment for equal need
Vertical - unequal treatment for unequal need
What is equality?
Everyone having an equal share
Types of interventions in public health?
Individual
Community
Ecological
What is a 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
What are the healthcare needs and what do they mean?
Felt need - individuals perceptions of variation form normal health
Expressed need - individual seeks help to overcome variations in normal health
Normative need - professional defined intervention appropriate for expressed need
Comparative need - comparison between severity, range of interventions and cost
What are three resource allocation methods?
Egalitarian - provides all care that is necessary and required to everyone (equal but expensive)
Maximising - based solely on consequences, resources allocated to those likely to receive most benefit. Those with less needs receive nothing
Libertarian - each individual responsible for their ow health (bad as not all diseases are self inflicted)
What is Maslow’s hierarchy of needs?
Needs of humans - five stages:
- Physiological - breathing, food, water, sex, sleep, excretion
- Safety - security of body, employment, resources, family, health and property
- Love/belonging - friendship, family, sexual intimacy
- Esteem - self-esteem, confidence, achievement, respect of others and by others
- Self-actualisation - a person’s motivation to reach their own full potential
Three approaches to health needs assessments?
Epidemiological approach - looks at size of population, services available and evidence based
Comparative approach - compare the needs/provision of health in one population with another
Corporate approach - asking the local population what their health needs are (focus groups, interviews, meetings)
Evaluation of health services?
Assessment of whether a service achieves its objectives
What is Donabedian’s framework of health service evaluation?
Structure - what the service is
Process - how does the process work
Ourcome - 5 D’s (death, disease, disability, discomfort, dissatisfaction
Issues with health outcomes in Donebedian’s framework?
Link between health service and health outcome is difficult to confirm
Time lag may be long
Large sample size needed
What is Maxwell’s dimensions of quality of healthcare?
Three E’s and three A’s
Effectiveness, efficiency, equity
Acceptability, accessibility, appropriateness
What is epidemiology?
The study of the frequency, distribution and determinants of diseases and health-related states in population in order to prevent and control disease
Incidence?
Number of new cases in a population in a period of time
Prevalence?
Number of existing cases in a population at a point in time
Absolute risk?
Gives a feel for actual numbers involves and has units:
‘Reduced from 2 in 1000 to 1 in 1000’
Relative risk?
Risk in one category relative to another with no units
‘50% reduction’
Attributable risk?
Rate of disease in the exposed that may be attributed to exposure
What is bias?
Systemic deviation from the true estimation of the association between exposure and outcome
Selection bias?
Selection of study participants and allocation of participants to different study groups
Information bias?
Observer’s recall and reporting
Instrument wrongly calibrated
Allocation bias?
Allocation of participants in different groups
Publication bias?
Trials with negative results less likely to be published
Lead time bias?
Early identification doesn’t alter outcome but appears to improve survival time as the patient is identified with the disease earlier than normal
Length time bias?
Disease that progresses more slowly is more likely to be picked up by screening which makes it appear that screening lengthens life
Confounding?
Situation where a factor is associated with the exposure of interest and independently influences the outcome but doesn’t lie on the casual pathway
e.g. lack of exercise causes weight gain but there are many confounding variables that also affect weight gain
What are the Bradford Hill criteria for causality?
Strength
Dose-response
Consistency
Temporality
Reversibility
Biological plausibility
Coherence
Analogy
Specificity
Give an example of reverse causality.
Stress could have caused hypertension rather than hypertension causing stress
Primary prevention?
Trying to stop yourself from getting a disease
Secondary prevention?
Trying to detect a disease early and prevent it from getting worse
Tertiary prevention?
Trying to improve your quality of life and reduce the symptoms of a disease you already have
What is the prevention paradox?
A preventative measure which brings much benefit to the population but offers little to each participating individual
What is the purpose of screening?
To identify well individuals who have or are at risk of developing a particular disease so that you can have a real impact on the outcome
Three disadvantages to screening?
-Exposing well individuals to distressing or harmful diagnostic tests
-Detection and treatment of subclinical disease which may have never caused problems
-Preventative intervention that may cause harm
Give examples of screening programmes.
Five in young people and adults:
- AAA screening
- Bowel cancer screening
- Breast cancer screening
- Cervical cancer screening
- Diabetic eye screening
Three in pregnancy:
- Infectious disease (hepB, syphilis, HIV)
- Sickle cell and thalassaemia screeening
- Fetal anomaly screening (Down’s, Edward’s, Patau)
Three in newborn babies:
- NIPE
- Newborn hearing screening
- Newborn blood spot screening
Wilson and Junger criteria for screening?
In Exam Season NAP:
Important disease
Existing treatment
Simple and safe test
Natural history of disease known with early detectable stage
Acceptable
Policy on who to treat
Sensitivity?
Proportion of people with the disease who are correctly identified by screening test
Does the test pick up the disease?
Specificity?
Proportion of people without the disease who are correctly excluded by the screening test
Does the test identify those who don’t have the disease
Positive predictive value?
The proportion of people with a positive test result who actually have the disease
Negative predictive value?
Proportion of people with a negative result who actually don’t have the disease
