Public health Flashcards
1
Q
what is primary disease prevention
A
prevention of disease onset - target risk factors
2
Q
what is secondary disease prevention
A
early detection and optimise progression such as screening
3
Q
what is tertiary disease prevention
A
effective symptom management and slowing of progression with things such as medication and surgery
4
Q
what is quintenary disease prevention
A
prevention of overmedicating the patient
5
Q
what is the prevention paradox
A
measures to improve public health will have little effect on most people
6
Q
what is a tests sensitivity
A
it is the correct identification of a disease
7
Q
how do you work out the sensitivity
A
true positive / (true positive + false negative)
8
Q
what is a tests specificity
A
how well it correctly excludes negative results
9
Q
how do you work out a tests specificity
A
True negative/ (true negative + false positive)
10
Q
what is the positive predive value
A
it is all those who are positive who tested positive
11
Q
how do you work out the positive predicted value
A
True positive/ (true positive + false positive)
12
Q
what is the negative predictive value
A
it is all those who are negative who test negative
13
Q
how do you work out the negative predictive value
A
True negative/(true negative + false negative)
14
Q
what are the criteria for a successful screen
A
WILSON JUNGNER
Important problem
Available diagnosis and treatment facility
Treatable
recognisable latent stage
obvious diagnosis test
general public accepted
economically viable
natural history of untreated disease known
issued agreed policy (who to treat)
continuously done (not abruptly stopped)
15
Q
what is lead time bias
A
this is that screening earlier gives an apparent increase in life expectancy
16
Q
what is length time bias
A
this is slower progressing diseases are more likely to be picked up on screening than rapidly progressing ones
17
Q
what are the types of study design
A
ecological
cross section
case control
cohort
randomized control trial
systematic review
18
Q
what is an ecological study
A
it is an observational study - censes, population data
19
Q
what are positives and negatives of an ecological study
A
positives: readily available data, shows correlation
negatives: cant show causation, biases and other confounders
20
Q
what is a cross sectional study
A
it is a retrospective observational study, stops at a point in time and looks at risk factors and disease development at this time period
- identified prevalence
21
Q
what are positives and negatives of a cross sectional study
A
positives: large samples, Data on all variables are only collected at one time point, Multiple outcomes and exposures can be studied, quick and inexpensive
negatives: reverse causality can occur, there can be length time bias, cant use for rare diseases
22
Q
what is a case control study
A
this is a retrospective study which is establishing risk factors and disease relationship with a positive and negative group
- identifies predictors of outcomes: odds ratio often used
23
Q
what are positives and negatives of a case control trial
A
positives: rapid and are good for rare diseases
negatives: reverse causation and are bias prone
24
Q
what is a cohort study
A
it is a prospective longitudinal study: uses positive and negative groups which are followed up with exposure or nor not over time
25
what are positives and negatives of a cohort study
positives: can show causation
negatives: takes a long time to complete, can be expensive, there may be a change in behaviour in the cohort, loss to follow up
26
what is a randomised control trial
it is the most rigorous - blinded or double blinded groups with a placebo, looking at exposure and then followed up over time
27
what are positives and negatives of a RCT
positives: gold standard for causation, can balance the arms
negatives: change in behaviour of cohorts, ethical issues, loss to follow up
28
what are positives and negatives of a systematic review
positives: combines studies therefore more effective data and higher statistical power
negatives: ignoring differences between studies, bias prone, depends on other data
29
what is the incidence of a disease
the number of new cases a population in a given time
30
what is the prevalence of a disease
it is the total number of cases in the population at a given time
31
what is the meaning of person years
it is the unit of measurement that represents the number of ears that a person contributes data until they are lost to follow up, the disease develops or the study ends
32
what is a confounder
it is an associated factor which independently affects the outcome
33
what are the types of biases
selection bias
information bias
publication bias
and lead and length time bias
34
how do you determine causation
use the BRADFORD HILL CRITERIA
1. must be dose response
2. must be reversible
3. must be consistent
4. must have biological plausibility
5. temporality
6. coherence
7. analogy
8. strength
9. specificity
35
what are factors for causation
change
confounder
causation
correlation
and bias, reverse causation
36
what are the public health domains
1. Improving health promotion: reducing inequality through education, employment
2. Protection of health (environmental and occupational hazards identified)
3. Service improvement (audits, equity)
37
what is equality
part of deontology - everyone deserves the same thing
38
what is equity
this is fairness: everyone deserves enough for success
39
what is horizontal equity
equal treatment for equal needs for example the same income tax
40
what is vertical equity
unequal treatment for unequal need i.e managing severe T2DM vs newly diagnosed
41
what are the three levels involved in interventions for equity
individual
community
population
42
what are promoting health behaviours
health behaviour - maintenance of good health
illness behavours - seeking remedy
sick role - aimed at recovery
43
what are reasons for damaging health behavours
reasons: cultural, unrealalistic optimism ( problem is infrequent, unlikely, lack of experience with problem, preventable), stress
44
what is the Becker model of behaviour/ health belief model
Health Belief model 1974
pervieved barriers is the most important determinant of change
- believe they are susceptible
- believe it has serious consequences
- believe that taking action reduces susceptibility
- believes cost of taking action outweighs carrying on
45
what are positives and negatives of Becker model of behaviour
Positives: long standing use, applicable in lots of situations
Negatives: no emotional or social cues, no temporality, no differential diagnosis list vs repeat illnesses
46
what is the transtheoretical model of behaviour
precontemplation
contemplation
preparation
action
maintenance
(+relapse)
47
what are the positives and negatives of the transtheoretical model of behaviour
positive: temporality, and accounts for relapse
negatives: people may not go through all states, people can go forward and back, there are no social cues involved
48
what is the theory of planned behaviour
a positive attitude, subjective norms and perceived behavioural control all act together to give someone intention to change which then becomes action
49
what are positives and negatives of the theory of planned behaviour
positives: accounts for emotional cues, lots of scenarios
negatives: lack of temporality, report bias
50
what is the nudge theory of behavioural change
fruit next to the checkout rather than sweets
51
what are Bradshaws health needs
Felt
Expressed
Normative
Comparative
52
what is the health needs assessment cycle
assessment - planning - implement - evaluate - assessment etc
53
what are different assessment approaches to health needs assessment
epidemiological
comparative
corporate
54
what is the epidemiological assessment approach
Top down approach, defines size, issue and service (Biomedical data on the population, capacity to benefit and with what service)
- issue is there is no felt or expressed need taken into account
55
what is the comparative assessment approach
comparing two demographically different services - how does our service compare to others
- issue is they may compare two bad services or two good services so there is no baseline
56
what is the corporate assessment approach
looking at other professionals point of view - what do other people think
- can introduce biases
57
what are the three things that services can be
supplied, demanded or needed
- supplied, not demanded or needed = 75 year old and a health check
- supplied and needed but not demanded = heel prick test
- Not supplied but needed and demanded = surgery
58
What is the Donabedian evaluation approach
Structure - whats there
Process - whats done
Outcome - death, disease, disability, discomfort, dissatisfaction which is determined through interviews and observation
59
what is the Maxwell dimensions evaluation approach
- Accessible? Acceptable? Approachable?
- Effective? Efficacy? Equality?
60
what is the Wrights matrix
it is when Donabedian and Maxwell dimensions evaluation approaches are brought together
61
how do you work out alcohol units
(ABV% X VoL/mL)/1000
62
how many mL and grams are in 1 unit of alcohol
8g or 10 mL
63
what is the maximum weekly alcohol units for men and women
14 units
64
what is an error in medicine
a preventable, unwanted outcome due to human factor
65
how do you classify error in medicine
through intension, action, outcome and context looking at the person and systemic approach
66
what are the reasons for error in medicine
lack of skill
sloth
bravado
playing the odds
fixation
systemic issue
67
what is the swiss cheese mode l
it is when there are weaknesses (holes) in each layer of defense. If these holes line up then there risk of an adverse event
68
what are the two kinds of swiss cheese model
active = direct event which predisposes a negative outcome: holes line up
latent = systemic failure built up over time: dont line up
69
what is the 3 bucket model of error
that errors are a result of self, context and task factors
i.e tired nurse + a busy ward + fails an ABG
70
what is a never event
serious incidents that are wholly preventable because of guidance or safety recommendations that provide strong systemic protective barriers are available and should be implemented
71
who should never events be reported to
CQC - care quality commission
StEIS - Strategic Executive Information System
72
what are consequences of never events
fitness to practice
Never event claims if duty of care is breached and there are irreparable consequences
73
how can we reduce error
maintain standards through training
SBAR communication tool to improve communication
74
what is a near miss
it is an error which doesnt lead to an adverse outcome
75
what is an adverse event
it is an error which leads to a negative/poor outcome:
apologise and inform patient by duty of candour
76
what are the different types of domestic violence
physical
emotional
psychological
sexual
77
what are risk factors for domestic violence
20-25 years old
female
pregnant
78
when might you suspect domestic violence
delayed GP presentation for illness
bruises at different stages of healing
the mechanism of injury being told doesnt match the injury seen
recurrent GP appointments
only coming in with the partner
79
how might you determine if someone is being domestically abused
speak to the woman alone and directly ask about abuse - if told you condemn, tell the patient it isnt okay and be supportive of them
fill out DASH form (D.A and sex harassment) to assess the risk
80
what would the outcomes of a DASH form mean for managing suspected abuse
mild to moderate risk - signpost the patient to DA services
severe risk (10% top risk) - obtain consent and fill out MARAC (muti agency risk assessment conference)
consider an independent domestic violence advisor (IVDA) to hep patient navigate and give voice to them during MARAC
81
what are the 3 NHS core principals
that it is free, universal and accessible
82
what is the inverse care law
that those with the best healthcare access need it the least and visa versa
83
What are Maslows needs
1. self actualisation (top of triangle)
2. Esteem, love and belonging (middle of triangle)
3. food and shelter, safety (bottom of triangle)
84
what are causes of homelessness
eviction
cant afford rent
separation
lost job
85
what are complications of homelessness
reduced life expectancy (about 40 yrs)
intravenous drug use
STI
mental health issues and suicide
86
what is needed for food security
affordability
accessibility
utilisation
stability
87
what is allostasis
this is the physiological process that helps organisms maintain stability through change by anticipating and adjusting energy use in response to environmental demands
88
what is salutogenesis
it is a concept which focuses on the factors responsible for well-being rather than disease pathogenesis
- focuses on the direction towards health
89
what is the allostatic load
it is the toll on the body of long term physiological allostasis
- cumulative affects that chronic stress has on mental and physical health
90
what are early food influences
the maternal diet
breastfeeding
age of solid food
91
what is the restraint theory of food behaviour
it is paradoxical - there is increased subjective hunger after dieting (due to imbalanced leptin and ghrelin levels) leading to excessive food intake
92
what are the three forms of dieting
reduced calories
reduced types of foods eaten
reducing the window to eat
93
when is underaged sex considered rape
if someone has sex under 13 then it is always rape, you need to escalate it !
94
when would you apply Gillick-Fraser guidance apply to underage sex
between the ages of 13-15 years old
95
what is fraser competence
this is contraception specific guidance - when giving contraception in best interests and if competent
96
what is Gillick competence
this is used to determine if a child (under 18) has capacity to make a decision about their own health
- understands, retains, weighs up and communicates back, with mental health suffering if not given
97
what are the healthcare relevant human rights determined in the human rights act 2005
2 = right to life
3 = free from inhumane treatment
8 = respect family/private life
12 = right to marry and conceive
14 = protected vs discrimination
98
what is an absolute right
it is a right that is never limited
99
what are qualified rights
those requiring a balance between the rights of the individual and the needs of another or of the wider community
100
when might there be exceptionality criteria to the human rights act 2005
the NHS + NICE may be excused in certain contexts such as withholding treatment due to ack of funding
101
what is rationing of recourses
this is when resources are refused due to decreased affordability
102
What are the three theories for distribution of resources
1. egalitarianism
2. utilitarianism
3. libertarianism
103
what is egalitarianism
it is equality, supply everything to everyone
- morally just
- negative financially
104
what is utilitarianism
it is maximising resources for the majority
- it is efficient
- it can be immoral against minority
105
what is libertarianism
it is that people are responsible for their own health
- patient motivated
- unfair for e.g in genetic disease
106
what is the Harm principle
patient is free from judgment to make decisions even if it is unwise unless those actions can cause harm to someone else
107
what is the Jonsen rule of rescue
it is the imperative that people feel to rescue identifiable individuals facing avoidable death
- perceived duty to save a life wherever possible
108
what is negligence
it is breach of care which results in damage!
109
what are reasons for negligence
the main reason is error
neglect
reduced performance
misconduct
110
what are the four test parts to negligence
for liability in negligence to be founded, for key ingredients must be present:
duty of care
breach of that duty
damage
foreseeability of such damage
111
what are the two tests which can determine negligence or not
Bolam = would other doctors act in the same way
Bolitho = was what happened a reasonable cause of action
112
when are financial claims of negligence made
if there is a duty of care which has been breeched, and irreparable damage occurred as a result
- based on loss of income, cost of care and pain and suffering
113
what are the ethical pillars
autonomy
beneficence
non maleficence
justice
114
what is deontology (ethical theory)
it is that things are right or wrong based on a set of principles and rules that govern it rather than the consequences of the action
- treat others as you would want to be
- moral however no consequences are considered
115
what is utilitarianism
it is a moral theory that suggests that actions should be chosen to maximise happiness and well being for the most people
116
what is consequentialism
this is a moral theory that judges actions based on their consequences rather than the action itself: best action is the one that provides the best outcome
- safe however sometimes risks are needed
117
in communication difficulties, how might you help improve communication with someone who it blind
make things textured, brighter, audible, brail
118
in communication difficulties how might you help improve communication with someone who is deaf
sign language
lip reading
slow speech
interpreters
119
what is the Peyton 4 step list to learning
1. demonstrate
2. demonstrate and explain
3. demonstrate and student explains
4. student demonstrates and explains
120
what is the KOLB learning cycle
Activist (experiences) - pragmatist (feedback) - reflector - theorist - activist etc
121
what are the different types of leadership
authoritarian - dictator
participation - democratic
delegative - independent roles
transactional - incentives
transformational - inspirational
122
what are the positives and negatives of a authoritarian leadership
positive: quick and efficient
negative: only one option
123
what is the positives and negatives of a participation leadership
positives: lots of opinions
Negative: less efficient
124
what are the positives and negatives of a delegative leadership
positive: more responsibility
negative: no leadership role
125
what are the positives and negatives or a transactional leadership
positives: motivation to work
negatives: no transformation - passive
126
what are the positives and negatives of transformational leadership
positives: inspires
negatives: lots of monitoring
127
what are the duties of a doctor
knowledge, skills, performance
safety and quality
maintain trust
128
what are the determinants of health
residence
race
occupation
gender
social background
religion
education
129
What is the management of cervical cancer
Cervical intraepithelial neoplasia and early-stage 1A: LLETZ or cone biopsy
Stage 1B – 2A: Radical hysterectomy and removal of local lymph nodes with chemotherapy and radiotherapy
Stage 2B – 4A: Chemotherapy and radiotherapy
Stage 4B: Management may involve a combination of surgery, radiotherapy, chemotherapy and palliative care
130
What is the staging for cervical cancer
The International Federation of Gynaecology and Obstetrics (FIGO) staging system is used to stage cervical cancer:
Stage 1: Confined to the cervix
Stage 2: Invades the uterus or upper 2/3 of the vagina
Stage 3: Invades the pelvic wall or lower 1/3 of the vagina
Stage 4: Invades the bladder, rectum or beyond the pelvis
131
What is the 5 year survival of cervical cancer
The 5-year survival drops significantly with more advanced cervical cancer, from around 98% with stage 1A to around 15% with stage 4.
132
What is pelvic exenteration
Pelvic exenteration is an operation that may be used in advanced cervical cancer. It involves removing most or all of the pelvic organs, including the vagina, cervix, uterus, fallopian tubes, ovaries, bladder and rectum. It is a vast operation and has significant implications on quality of life.
133
What is bevacizumab
Bevacizumab (Avastin) is a monoclonal antibody that may be used in combination with other chemotherapies in the treatment of metastatic or recurrent cervical cancer. It is also used in several other types of cancer. It targets vascular endothelial growth factor A (VEGF-A), which is responsible for the development of new blood vessels. Therefore, it reduces the development of new blood vessels
134
When is the HPV vaccination given
The HPV vaccine is ideally given to girls and boys before they become sexually active. The intention is to prevent them contracting and spreading HPV once they become sexually active. The current NHS vaccine is Gardasil, which protects against strains 6, 11, 16 and 18:
Strains 6 and 11 cause genital warts
Strains 16 and 18 cause cervical cancer
135
What is the most common type of endometrial cancer
Around 80% of cases are adenocarcinoma. It is an oestrogen-dependent cancer
136
What is endometrial hyperplasia
precancerous condition involving thickening of the endometrium. The risk factors, presentation and investigations of endometrial hyperplasia are similar to endometrial cancer.
137
What are they two kinds of endometrial hyperplasia
Hyperplasia without atypia
Atypical hyperplasia
138
What is the treatment for endometrial hyperplasia
treated by a specialist using progestogens, with either:
Intrauterine system (e.g. Mirena coil)
Continuous oral progestogens (e.g. medroxyprogesterone or levonorgestrel)
139
What are risk factors for getting endometrial cancer
Exposure to unapposed oestrogen Increased age
Earlier onset of menstruation
Late menopause
Oestrogen only hormone replacement therapy
No or fewer pregnancies
Obesity
Polycystic ovarian syndrome
Tamoxifen
Type 2 diabetes
Hereditary nonpolyposis colorectal cancer (HNPCC) or Lynch syndrome
