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3a > Public health > Flashcards

Public health Flashcards

1
Q

Three domains of public health?

A

Health improvement - education, housing, employment
Health protection - radiation, immunisation, emergency response, environment
Health care -clinical effectiveness, efficiency, audit, clinical governance

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2
Q

Health behaviour?

A

Behaviour aimed at preventing disease

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3
Q

Illness behaviour?

A

Behaviour aimed to seek remedy

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4
Q

Sick role behaviour?

A

Behaviour aimed at getting well

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5
Q

WHO medication adherence in developed countries?

A

Around 50%

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6
Q

Interventions at the population level?

A

Health promotion - process of enabling people to exert control over their health:
-Awareness campaigns
-Screening and immunisations

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7
Q

Interventions at the individual level?

A

Patient-centred approach - care responsive to individual needs

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8
Q

Unrealistic optimism?

A

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

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9
Q

What I perception of risk influenced by?

A
  1. Lack of personal experience with problem
  2. Belief that the problem is preventable by personal action
  3. Belief that if it’s not happened by yet, it isn’t likely to
  4. Belief that the problem is infrequent
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10
Q

Health belief model?

A

Theory of behaviour change where perceived barriers have been demonstrated to be the most important factor in addressing behaviour change in patients

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11
Q

Health belief model: when will individuals change?

A
  1. They believe they’re susceptible
  2. They believe it has serious consequences
  3. Believe that taking action reduces susceptibility
  4. Believe that the costs of taking action outweigh benefits
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12
Q

Health belief model critiques?

A

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

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13
Q

Theory of planned behaviour?

A

Proposes the best predictor of behaviour change is intention

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14
Q

Theory of planned behaviour: what is intention determined by?

A

Personal attitude to behaviour
Social pressure to change behaviour
Person’s perceived behavioural control

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15
Q

Critique of theory of planned behaviour?

A

Lack of direction and causality
Doesn’t take into account emotions, habits and routines

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16
Q

What is the transtheoretical model of change?

A

Precontemplation - contemplation - preparation - action - maintenance - relapse

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17
Q

Advantages and disadvantages for transtheoretical model?

A

Ad - accounts for relapse
Disadvantages:
Not all people move through stages linearly
Change might operate on a continuum rather than stages

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18
Q

Four factors for developing food behaviours?

A

Maternal diet
Breastfeeding
Parental practices
Age of introduction to solids and types of foods given

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19
Q

Non-organic feeding disorders?

A

High prevalence in under 6s
Feeding aversion, food refusal, negative mealtime interactions

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20
Q

What is malnutrition?

A

Refers to deficiencies, excesses or imbalances in a person’s intake of energy and/or nutrients

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21
Q

Types of malnutrition?

A

Undernutrition - stunting, wasting, underweight, micronutrient deficiencies

Overweight/obesity - diet-relate non communicable diseases

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22
Q

Four dimensions of food insecurity?

A
  1. Availability
  2. Access
  3. Utilisation
  4. Stability
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23
Q

What are the determinants of health?

A

Progress:
-Place of residence, race, occupation, gender religion, education, socio-economic, social capital

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24
Q

What is equity?

A

What is fair and just

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25
Q

Types of equity?

A

Horizontal - equal treatment for equal need

Vertical - unequal treatment for unequal need

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26
Q

What is equality?

A

Everyone having an equal share

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27
Q

Types of interventions in public health?

A

Individual
Community
Ecological

28
Q

What is a health needs assessment?

A

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

29
Q

What are the healthcare needs and what do they mean?

A

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

30
Q

What are three resource allocation methods?

A

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)

31
Q

What is Maslow’s hierarchy of needs?

A

Needs of humans - five stages:

  1. Physiological - breathing, food, water, sex, sleep, excretion
  2. Safety - security of body, employment, resources, family, health and property
  3. Love/belonging - friendship, family, sexual intimacy
  4. Esteem - self-esteem, confidence, achievement, respect of others and by others
  5. Self-actualisation - a person’s motivation to reach their own full potential
32
Q

Three approaches to health needs assessments?

A

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)

33
Q

Evaluation of health services?

A

Assessment of whether a service achieves its objectives

34
Q

What is Donabedian’s framework of health service evaluation?

A

Structure - what the service is
Process - how does the process work
Ourcome - 5 D’s (death, disease, disability, discomfort, dissatisfaction

35
Q

Issues with health outcomes in Donebedian’s framework?

A

Link between health service and health outcome is difficult to confirm
Time lag may be long
Large sample size needed

36
Q

What is Maxwell’s dimensions of quality of healthcare?

A

Three E’s and three A’s

Effectiveness, efficiency, equity
Acceptability, accessibility, appropriateness

37
Q

What is epidemiology?

A

The study of the frequency, distribution and determinants of diseases and health-related states in population in order to prevent and control disease

38
Q

Incidence?

A

Number of new cases in a population in a period of time

39
Q

Prevalence?

A

Number of existing cases in a population at a point in time

40
Q

Absolute risk?

A

Gives a feel for actual numbers involves and has units:

‘Reduced from 2 in 1000 to 1 in 1000’

41
Q

Relative risk?

A

Risk in one category relative to another with no units

‘50% reduction’

42
Q

Attributable risk?

A

Rate of disease in the exposed that may be attributed to exposure

43
Q

What is bias?

A

Systemic deviation from the true estimation of the association between exposure and outcome

44
Q

Selection bias?

A

Selection of study participants and allocation of participants to different study groups

45
Q

Information bias?

A

Observer’s recall and reporting
Instrument wrongly calibrated

46
Q

Allocation bias?

A

Allocation of participants in different groups

47
Q

Publication bias?

A

Trials with negative results less likely to be published

48
Q

Lead time bias?

A

Early identification doesn’t alter outcome but appears to improve survival time as the patient is identified with the disease earlier than normal

49
Q

Length time bias?

A

Disease that progresses more slowly is more likely to be picked up by screening which makes it appear that screening lengthens life

50
Q

Confounding?

A

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

51
Q

What are the Bradford Hill criteria for causality?

A

Strength
Dose-response
Consistency
Temporality
Reversibility
Biological plausibility
Coherence
Analogy
Specificity

52
Q

Give an example of reverse causality.

A

Stress could have caused hypertension rather than hypertension causing stress

53
Q

Primary prevention?

A

Trying to stop yourself from getting a disease

54
Q

Secondary prevention?

A

Trying to detect a disease early and prevent it from getting worse

55
Q

Tertiary prevention?

A

Trying to improve your quality of life and reduce the symptoms of a disease you already have

56
Q

What is the prevention paradox?

A

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

57
Q

What is the purpose of screening?

A

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

58
Q

Three disadvantages to screening?

A

-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

59
Q

Give examples of screening programmes.

A

Five in young people and adults:

  1. AAA screening
  2. Bowel cancer screening
  3. Breast cancer screening
  4. Cervical cancer screening
  5. Diabetic eye screening

Three in pregnancy:

  1. Infectious disease (hepB, syphilis, HIV)
  2. Sickle cell and thalassaemia screeening
  3. Fetal anomaly screening (Down’s, Edward’s, Patau)

Three in newborn babies:

  1. NIPE
  2. Newborn hearing screening
  3. Newborn blood spot screening
60
Q

Wilson and Junger criteria for screening?

A

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

61
Q

Sensitivity?

A

Proportion of people with the disease who are correctly identified by screening test

Does the test pick up the disease?

62
Q

Specificity?

A

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

63
Q

Positive predictive value?

A

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

64
Q

Negative predictive value?

A

Proportion of people with a negative result who actually don’t have the disease

65
Q
A

3a (8 decks)

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