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public health > Public Health > Flashcards

Public Health Flashcards

1
Q

What are domains of public health

A

Health Improvement
Health Protection
Improving Services

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2
Q

What is Health Improvement and give an example

A

Social interventions aimed at preventing disease, improving health and reducing inequality

eg
Tackling inequalities
Education
Housing
Employment

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3
Q

What is Health Protection and give an example

A

Controlling infectious diseases and environmental hazards

eg
Chemicals
Notifiable diseases
Radiation
Emergency response

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4
Q

What is improving services and give an example

A

organising and delivering safe, high quality services

eg
Service planning
Audits
Clinical governance

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5
Q

What are determinants of health

A
  • P- place of residence
  • R- race
  • O- occupation
  • G- gender
  • R- religion
  • E- education
  • S- socio-economic
  • S- social capital
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6
Q

what is inverse care law

A

the availability of medical or social care tends to vary inversely with the need of the population served

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7
Q

what is the most powerful predictor of health experience

A

Socio-economic model of health

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8
Q

what is primary prevention and give example

A

Preventing the disease from occurring

eg vaccinations

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9
Q

what is secondary prevention and give example

A

Early detection of disease in high-risk groups

eg screening programmes

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10
Q

what is tertiary prevention and give example

A

Preventing complications of disease

eg
Cardiac rehabilitation
Diabetic control

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11
Q

what is the prevention paradox

A

A preventative measure that brings a lot benefits to population, often offers little to each participating individual (e.g. for each 100 people screened, only 1 suffers from the disease)

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12
Q

what is equity

A

What is fair and just

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13
Q

what is Horizontal equity

A

equal treatment for equal need

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14
Q

what is vertical equity

A

unequal treatment for unequal need

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15
Q

what is felt need

A

Individual perceptions of deviations from normal health

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16
Q

what is expressed need

A

Seeking help to overcome variation in normal health

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17
Q

what is normative need

A

Professional defines intervention/ approach for expressed need

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18
Q

what is comparative need

A

Needs identified by comparing services received by one group vs another

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19
Q

what is health needs assessment

A

assess
planning
implement
evaluate

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20
Q

what are types of health needs assessment

A

epidemiological
comparative
corporate

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21
Q

what is epidemiological health need assessment

A

Defines problem and size of problem
Looks at current services
Recommends improvements

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22
Q

what is comparative health need assessment

A

Compares services received by one population to another

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23
Q

what is corporate health need assessment

A

Takes into account views of any groups that may have an interest eg patients, health professionals, media, politicians

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24
Q

what is Maslows hierarchy of need

A
  1. Self Actualization
  2. Esteem
  3. Love/Belonging
  4. Safety
  5. Physiological
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25
Q

What is Libertarian approach to resource allocation

A

Taking responsibility for own health, wellbeing and fulfilment of life plan + autonomy

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26
Q

What is maximising principle approach to resource allocation

A

Concentrating resources on those who stand to gain the most

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27
Q

What is egalitarian principle approach to resource allocation

A

Equal access, equality and justice in healthcare

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28
Q

What is the quality of a service evaluated

A

3As and 3Es

  • Accessible – will patients actually be able to use it?
  • Acceptable – will the service be acceptable?
  • Appropriate – is this the right thing to do?
  • Equity – Is this fair and just?
  • Efficiency – this is concerned with maximizing output e.g., must do X amount of procedures/day for it to be viable
  • Effectiveness – Does it do what it’s intended to do?
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29
Q

what is the Donabedian framework of evaluating a health service

A
  • Structure - what is there? E.g. number of hospitals
  • Process - what goes on? E.g. how many patients seen
  • Outcome - e.g. number of deaths
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30
Q

what are 5 lifestyle factors promoting mortality

A

smoking
obesity
sedentary life
excess alcohol
poor diet

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31
Q

what is health behaviour

A

behaviour aimed at preventing disease

E.g., going for a run
Health damaging – Smoking
Health promoting - eating healthy

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32
Q

what is health promotion

A

the process of enabling people to take control of determinants of health, therefore improving their own health

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33
Q

what is illness behaviour

A

behaviour aimed at seeking remedy

E.g., going to GP for a symptom

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34
Q

what is sick role behaviour

A

any behaviour aimed at getting well

E.g., taking antibiotics

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35
Q

what are 3 models of change in behaviour

A

Health Belief Model
Theory of planned behaviour
Trans-theoretical model

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36
Q

what is trans-theoretical model

A

Pre-contemplation
Contemplation
Planning
Action
Maintenance/relapse

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37
Q

what are pros of trans-theoretical model

A

Acknowledges stages
Accounts for relapse
Time element

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38
Q

what are cons of trans-theoretical model

A

Not everyone moves through each stage
Change may be continuous, not discrete
Doesn’t account for habits
Doesn’t account for emotional influences
Doesn’t consider values e.g., cultural and social factors

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39
Q

what is health belief model

A

Individuals will change if:
They believe that they are susceptible to the condition
They believe that personal action can reduce susceptibility
They believe that there are serious consequences
They believe that benefits outweigh the costs

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40
Q

what are strengths of health belief model

A

Widely applicable
Cues to action are unique component
Longest standing model

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41
Q

what are cons of health belief model

A

Doesn’t consider emotional influences
Doesn’t consider repeated (habitual) behaviour
Other factors may influence the outcome

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42
Q

what is theory of planned behaviour

A

Intention is predictor of behaviour
Personal attitude about behaviour
Social norms/pressure
Perceived behavioural control

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43
Q

what are strengths of theory of planned behaviour

A

Can be applied to wide variety of health behaviours
Useful for predicting intention
Takes into account importance of social pressures

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44
Q

what are cons theory of planned behaviour

A

Doesn’t account for emotional influences
Doesn’t account for hobbies/habits
No temporal element, direction or causality
Assumes attitudes can be measured

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45
Q

what is medical negligence

A

A legal entity - Outcome of a court case

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46
Q

what are 4 criteria for medical negligence

A

Was there a duty of care?
Was there a breach in the duty of care?
Did the patient come to harm?
Did the breach cause the harm?

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47
Q

what bolam rule

A

Would a reasonable doctor do the same?

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48
Q

what is bolitho rule

A

Would that be reasonable?

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49
Q

what information is allowed to be disclosed

A
  • Required by law (notifiable disease, regulatory bodies, ordered by a judge or police)
  • Patient consent
  • Public interest (serious communicable disease, serious crime, research, education)
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50
Q

what is criteria for disclosure

A

Anonymous if practicable
Patient’s consent (overrule?)
Kept to a necessary minimum
Meets current law (data protection)

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51
Q

what is an error

A

An unintended outcome

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52
Q

what is neglect

A

Falling below the acceptable standard of care

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53
Q

what is error of omisson

A

Required action delayed/not taken

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54
Q

what is error of commission

A

Wrong action is taken

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55
Q

what is error of negligence

A

The actions or omissions do not meet the standard of an ordinary, skilled person professing

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56
Q

what is skill based error

A

Slips and lapses – when the action made is not what was intended

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57
Q

what is knowledge based error

A

An incorrect plan or course of action is chosen

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58
Q

what is organisational error

A

Adverse events are product of many causal factors (Swiss-cheese Model) - the whole system is to blame

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59
Q

what is swiss cheese model

A

Incidents of patient harm occur as a result of accumulations of multiple failures which align, creating a hazard trajectory

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60
Q

what is 3 bucket

A

identify potential for something to go wrong.

based on ‘buckets’ of self, context, and task factors

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61
Q

what is a never event

A

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

eg
Medical: wrong route chemo
Surgical: wrong site or retained object
Mental health: escape of transfer patient

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62
Q

What are GMC duties of a doctor

A
  • Knowledge, skills and performance.
  • Safety and quality.
  • Communication, partnership and teamwork.
  • Maintaining trust.
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63
Q

what is screening

A

Identifying apparently well individuals who have or are at risk of having a particular disease

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64
Q

give 4 examples of screening

A

Newborn (heel prick)
Breast cancer (mammography)
Cervical cancer (smear)
Bowel cancer (poo in the post)

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65
Q

what are types of screening

A
  • Population-based screening programmes
  • Opportunistic screening
  • Screening for communicable diseases
  • Pre-employment and occupational medicals
  • Commercially provided screening
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66
Q

what is Antenatal and newborn screening (6 tests)

A

foetal anomaly
infectious diseases in pregnancy
newborn and infant physical examination
newborn blood spot
newborn hearing
sickle cell and thalassaemia

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67
Q

what is diabetic eye screening

A

offered annually to people with diabetes aged 12 or over

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68
Q

what is cervical screening

A
  • offered to women from 25 to 49 every 3 years
  • and to women aged 50-64 every 5 years
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69
Q

what is breast screening

A
  • offered to women aged 50 to 70 every 3 years
  • women older than 70 can self-refer
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70
Q

what is bowel cancer screening

A
  • offered to men and women aged 60 to 69 every 2 years
  • people aged 70 or older can request screening
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71
Q

what is abdominal aneurysm screening

A

offered to all men aged 65 years, over this age self-refer

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72
Q

negatives to screening programs

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
  • Preventive interventions that may cause harm to the individual or population
73
Q

what is citerai for wilson and jugner screening criteria

A

I - important problem
A - available Dx/ Facility
T - Treatable
R -Recognisable latent stage
O - Obvious Dx test
G - Gen public accepted
E - Economically viable
N - Natural History of the untreated disease known
I - Issue agreed policy
C - Continuously done

74
Q

what is a cross-sectional study

A

Snapshot data of those with and without disease to find associations at a single point in time

75
Q

what are cons to a cross-sectional study

A

Established associated at most, not causality
Prone to bias:
Recall bias, Social desirability bias, Researchers bias
No time reference
Group sizes may be unequal

76
Q

what is a case control study

A

Retrospective observational study which looks at a certain exposure and compares similar participants with and without the disease

77
Q

what are pros to case control study

A

Good for rare diseases
quick
multiple exposures

78
Q

what are cons to case control study

A

Can only show association (not causation)
Reliance on recall or records to determine exposure
Confounders
Selection of control groups is difficult
Potential bias: recall, selection

79
Q

what is a cohort study

A

Longitudinal prospective study which takes a population of people recording their exposures and conditions they develop

80
Q

what are pros of cohort study

A

Can show causation: Establishing timing and directionality of events
Less chance of bias
Ethically safe
Participants can be matched
Eligibility criteria and outcomes can be standardised

81
Q

what are cons of cohort study

A

Large amount lost to follow up

Expensive
Controls may be difficult to identify
Exposure may be linked to hidden confounder
For rare disease, larger sample size or longer follow up is needed

82
Q

What is a RCT

A

Similar participants randomly controlled to intervention or control groups to study the effect of the intervention
Gold standard

83
Q

what are pros of RCT

A

Can infer causality
Less risk of bias/ confounders
Unbiased distribution of confounders
Randomisation facilitates statistical analysis

84
Q

what are cons of RCT

A

Expensive: time and money
Volunteer bias
Ethically problematic

85
Q

bradford hills criteria defintion

A

Criteria used to support causation

86
Q

what criteria is used to support causation

A

DR CBT CASS

Dose-Response
Reversibility

Consistency
Biological Plausibility
Temporality

Coherence
Analogy
Strength
Specificity

87
Q

what are confounders

A

Risk factors, other than those being studied, that influence the outcome

88
Q

what is bias

A

Systematic error that results in a deviation from the true effect of an exposure on an outcome

89
Q

what is selection bias

A

discrepancy of who is involved

90
Q

what are examples of information bias

A
  • Measurement bias: different equipment
  • Observer bias
  • Recall bias: past events incorrectly remembered
  • Reporting bias: responder doesn’t tell the truth
91
Q

whats is publication bias

A

some trials are more likely to be published than others

92
Q

what is lead time bias

A

screening merely identifies the disease earlier than before and thus gives the impression that survival is prolonged (but survival time unchanged!)

93
Q

what is length time bias

A

diseases with longer period of presentation are more likely to be detected by screening than the ones with shorter time of presentation

94
Q

what is an outbreak

A

a number of cases that exceeds what would be expected

95
Q

what is an epidemic

A

Cases occurring in the same geographical location

96
Q

what is a pandemic

A

disease that has spread over countries or continents affecting large numbers of people

97
Q

what are examples of notifiable diseases

A

Acute Encephalitis
Acute infectious hepatitis
Acute meningitis
Acute poliomyelitis
Anthrax
Botulism
Cholera
Diptheria
HUS
Leprosy
Malaria
Measles
Meningococcal septicaemia
Mumps
Rabies
Rubella
Scarlet fever
Smallpox
Tetanus
Tuberculosis
Whooping cough
Yellow Fever

98
Q

what are vulnerable groups

A

Homeless people
Gypsies and travellers
LGBTQ+
Asylum seekers and refugees

99
Q

what are asylum seekers

A

A person who has made an application for refugee status - Access to GP and A&E

100
Q

what is a refugee

A

A person granted asylum and refugee status

101
Q

what is indefinite leave to remain

A

A person is given full refugee status and permanent residence in the UK with Full access to NHS

102
Q

what is an unaccompanied child

A

Someone that has crossed international borders in seek of refuge <18 years old

103
Q

what article concerns human rights

A

article 14

The right to not be discriminated against on the groups of sex, race, colour, language, religion, political or other opinion, national origin, property, birth or other status.

104
Q

what is domestic abuse

A

Any incident or pattern of behaviour showing controlling, threatening, violent or abusive actions between >16 year olds and their partners/family member

105
Q

what are types of domestic abuse

A

Psychological
Financial
Sexual
Physical
Emotional

106
Q

what is standard risk domestic abuse

A

Does not suggest imminent serious harm – signpost

107
Q

what is moderate risk domestic abuse

A

Potential for serious harm but unlikely unless there is a change in circumstances – signpost

108
Q

what is high risk domestic abuse

A

Imminent risk of serious harm –
MARAC/IDVAS

MARAC: Multiagency risk assessment conference
IDVAS: Independent domestic violence advice services

109
Q

what is adherence

A

the extent to which patient actions match AGREED recommendations

Still recognises the doctor as the expert but acknowledges importance of patient beliefs

110
Q

what is compliance

A

the extent to which the patient’s behavior coincides with medical or health ADVICE, a paternalistic relationship

Paternalism means the patient must follow the doctor’s orders, not taking into account their views

111
Q

what are reasons for non adherence

A

Disagree with doctor
Cost
Side-effects
Forgetful (psych/neuro/chronic diseases)
Lack of understanding of importance
Barriers to healthcare

112
Q

what is unrealistic optimism

A

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

113
Q

what is sustainability

A

Meeting the needs of the present without compromising the needs of future generations

114
Q

what is morality

A

concern with the distinction between good and evil, or right and wrong

115
Q

what is ethics

A

A system of moral principles and a branch of philosophy which defines what is good for individuals and society

116
Q

what is utilitarianism

A

An act is evaluated solely in terms of its consequences

Maximizes good and minimizes harm

117
Q

what is criticism of utilitarianism

A

Assumes consequences can be predicted
Ignores rights of minorities
Happiness can’t be quantified

118
Q

what is Kantianism (deontology)

A

Features of the act determine the worthiness of the act

actions are good or bad according to a clear set of rules

119
Q

what is criticism Kantianism

A

Doesn’t consider consequences
Conflicting duties
Only considers absolutes, doesn’t allow for ‘grey areas’
Conflicting moral duties, rules might not be best for everyone, lack of emotion when applying ethics

120
Q

what is virtue ethics

A

Focus is on the individual doing the action

Is the person in action expressing good character or not?

121
Q

what are 5 focal virtues

A

Compassion
Discernment
Trustworthiness
Integrity
Conscientiousness

122
Q

what are the four principles

A

Autonomy
benevolence
Non-maleficence
Justice

123
Q

what is opportunity cost

A

health benefits for patients that will be foregone if a new treatment is funded

124
Q

what is QALY

A

Quality adjusted life year
Used as an outcome measurement, allowing for comparisons

125
Q

what is incremental cost

A

effectiveness ratio
Used to guide NHS on whether they should purchase a treatment

126
Q

what is economic evaluation

A

Comparative evaluation of cost and benefit, used to allocate finite resources

127
Q

what factors are needed for economic evaluation

A
  • Patient population: condition and severity, review of previous treatments
  • Intervention: drug (dose, frequency) and who can deliver the intervention
  • Currently used treatments
  • Outcomes
128
Q

what is cost effectiveness analysis

A

Measured in natural units
E.g., Cost per life year gained

New treatment adds 10 years to life. Cost of treatment is £10,000
£10,000 / 10 = £1000 per life year gained

129
Q

what is Cost-utility analysis

A

outcome measured in QALYs

130
Q

what is cost benefit analysis

A

outcomes measured in monetary units

131
Q

what is cost minimisation analysis

A

outcome is the same in both treatments, aim to minimise cost

132
Q

how is QALY calculated

A

QALY = length of life (years to life after a treatment) x Quality of life (0-1)

0 = dead
(eg can be 0.8)
1 = alive

133
Q

what is incidence

A

The number of individuals newly diagnosed with a condition over a set period of time

134
Q

what is prevalence

A

Number of individuals with a condition at one point in time

135
Q

what is absolute risk

A

An absolute measure of association between exposure and risk

136
Q

what is relative risk

A

How much more likely an individual is to get the disease with A compared to B

137
Q

what is odds

A

the probability that one thing is so or will happen rather than anothe

p = probability of disease = number of cases / total population

odds = p / 1-p

138
Q

what is odds ratio

A

a/c : b/d

139
Q

what does odds ratio >1 mean

A

Greater odds of associated with exposure and outcome

140
Q

what does odds ratio of 1 mean

A

No association

141
Q

what does odds ratio <1 mean

A

lower odds of association between exposure and outcome

Odds ratio of 0.8 = 20% decrease in odds

142
Q

what is the difference between odds ratio and relative ratio

A

OR- very simple, does not need incidence, binary outcome, Usually used in retrospective studies. Disadvantage- can overestimate risk in rare disease

RR- need incidence, good for prospective and RCTs, able to examine and model a variable over time

143
Q

what is prevalence proportion

A

number of cases at the time / total population at the time

144
Q

what are pros of prevalence proportion

A
  • Useful in causation research where follow-up data is not attainable and onset is hard to define
  • Useful for measuring disease burden
145
Q

what are cons of prevalence proportion

A
  • Hard to make meaningful comparisons of risk
  • Length-time bias: disease with longer duration is more likely to be captures in prevalence
146
Q

what is incidence proportion

A

number of new cases in time period / size of population at start of time period

by cohort study

147
Q

what are pros of incidence proportion

A

Used in range of circumstances
Attack rate in outbreaks
Case fatality rate
Risk of death from acute disease

148
Q

what are cons of incidence proportion

A

Required fixed and complete follow up
In long risk periods there are competing risks (e.g., death by other cause)

149
Q

what is incidence rate

A

number of diagnosed / time period x 100

150
Q

what is risk difference

A

Measure of association between exposure and disease occurrence

151
Q

what is absolute risk difference

A

the difference in the average risk of an event between two groups

Risk of A – Risk of B

152
Q

what is relative risk difference

A

(Risk of A – Risk of B) / Risk of B

153
Q

what does a risk difference >0 mean

A

positive association (risk factor)

154
Q

what does a risk difference <0 mean

A

negative association (protective factor)

155
Q

what is Attributable risk

A

The proportion of disease rate that is attributable to the exposure

incidence in exposed – incidence in unexposed

156
Q

what is risk ratio

A

A relative measure of association between exposure and disease occurrence

Risk ratio = risk of A / risk of B

157
Q

what is number needed to treat

A

A measure of the potential benefit of a clinical intervention

Number of people needed to be treated in order to prevent one outcome

NNT = 1 / Absolute risk difference

158
Q

what is confidence intervals a measure of

A

Estimate of range of plausible values for 95% of the population parameter

measure of certainty

159
Q

what is p value

A

p-value <0.05 – statistically significant

assess the credibility of a null hypothesis by calculating the p-value

160
Q

what are categorical/qualitative data

A

Nominal - mutually exclusive and unordered eg sex M/F
Ordinal - mutually exclusive and ordered eg pain 0-10

161
Q

what are numerical/quantitative numbers

A

discrete - whole numbers eg children in family
continuous - any value eg Height in cm

162
Q

what is sensitivity

A

correct ID disease

163
Q

what is specificity

A

correct excluding

164
Q

what is Positive predictive value

A

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

165
Q

what is Negative predictive value

A

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

166
Q

what is a T1 error

A

false positive

167
Q

what is a T2 error

A

false negative

168
Q

what is PICO

A

population
Intervention
Control
Outcome

169
Q

what are 3 levels for intervention

A

individual
community
population

170
Q

what are early food influences

A

maternal diet
breastfeeding
age of solid food

171
Q

what is restraint theory

A

paradoxical increased subjective hunger after dieting

unbalanced leptin and ghrelin levels

172
Q

what are 3 forms of dieting

A

decrease calories
decrease types of food
decrease window to eat

173
Q

what is sex <13 yrs

A

always rape, esclate

174
Q

what is sex 13-15yr

A

gillick-fraser guidence

175
Q

what is fraser

A

Contraception <16 specific guidance

give Contraception if

  • if understands/competent
  • likely to have UPSI anyway
  • Cannot be persuaded to tell parents
  • in best interest
  • mental/physical health will suffer
176
Q

what is Gillick

A

assess a child’s ability to consent to medical treatment w/o parental permission

competence; if capacity (understands retains, weighs up, communicates)

177
Q

what are Dr duties

A

knowledge
skills
performance
safety
quality
maintain trust

178
Q

name 4 leadership styles

A

authoritarian
participation
delegative
transformational
transactional

179
Q
A

public health (1 decks)

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