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Phase 3a Jemima > Public health > Flashcards

Public health Flashcards

1
Q

what is primary disease prevention

A

prevention of disease onset - target risk factors

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2
Q

what is secondary disease prevention

A

early detection and optimise progression such as screening

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3
Q

what is tertiary disease prevention

A

effective symptom management and slowing of progression with things such as medication and surgery

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4
Q

what is quintenary disease prevention

A

prevention of overmedicating the patient

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5
Q

what is the prevention paradox

A

measures to improve public health will have little effect on most people

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6
Q

what is a tests sensitivity

A

it is the correct identification of a disease

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7
Q

how do you work out the sensitivity

A

true positive / (true positive + false negative)

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8
Q

what is a tests specificity

A

how well it correctly excludes negative results

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9
Q

how do you work out a tests specificity

A

True negative/ (true negative + false positive)

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10
Q

what is the positive predive value

A

it is all those who are positive who tested positive

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11
Q

how do you work out the positive predicted value

A

True positive/ (true positive + false positive)

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12
Q

what is the negative predictive value

A

it is all those who are negative who test negative

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13
Q

how do you work out the negative predictive value

A

True negative/(true negative + false negative)

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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)

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15
Q

what is lead time bias

A

this is that screening earlier gives an apparent increase in life expectancy

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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

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17
Q

what are the types of study design

A

ecological
cross section
case control
cohort
randomized control trial
systematic review

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18
Q

what is an ecological study

A

it is an observational study - censes, population data

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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

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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

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21
Q

what are positives and negatives of a cross sectional study

A

positives: large samples and shows change over time
negatives: reverse causality can occur, there can be length time bias, cant use for rare diseases

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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

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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

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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

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25
Q

what are positives and negatives of a cohort study

A

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

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26
Q

what is a randomised control trial

A

it is the most rigorous - blinded or double blinded groups with a placebo, looking at exposure and then followed up over time

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27
Q

what are positives and negatives of a RCT

A

positives: gold standard for causation, can balance the arms
negatives: change in behaviour of cohorts, ethical issues, loss to follow up

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28
Q

what are positives and negatives of a systematic review

A

positives: combines studies therefore more effective data and higher statistical power
negatives: ignoring differences between studies, bias prone, depends on other data

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29
Q

what is the incidence of a disease

A

the number of new cases a population in a given time

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30
Q

what is the prevalence of a disease

A

it is the total number of cases in the population at a given time

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31
Q

what is the meaning of person years

A

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

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32
Q

what is a confounder

A

it is an associated factor which independently affects the outcome

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33
Q

what are the types of biases

A

selection bias
information bias
publication bias
and lead and length time bias

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34
Q

how do you determine causation

A

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

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35
Q

what are factors for causation

A

change
confounder
causation
correlation
and bias, reverse causation

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36
Q

what are the public health domains

A
  1. Improving health promotion: reducing inequality through education, employment
  2. Protection of health (environmental and occupational hazards identified)
  3. Service improvement (audits, equity)
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37
Q

what is equality

A

part of deontology - everyone deserves the same thing

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38
Q

what is equity

A

this is fairness: everyone deserves enough for success

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39
Q

what is horizontal equity

A

equal treatment for equal needs for example the same income tax

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40
Q

what is vertical equity

A

unequal treatment for unequal need i.e managing severe T2DM vs newly diagnosed

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41
Q

what are the three levels involved in interventions for equity

A

individual
community
population

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42
Q

what are promoting health behaviours

A

health behaviour - maintenance of good health
illness behavours - seeking remedy
sick role - aimed at recovery

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43
Q

what are reasons for damaging health behavours

A

reasons: cultural, unrealalistic optimism ( problem is infrequent, unlikely, lack of experience with problem, preventable), stress

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44
Q

what is the Becker model of behaviour

A

Health Belief model 1974
- individual will change if they believe they are susceptible, acknowledge the consequences, and believe action will reduce susceptibility, and action consequences outweigh continuing

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45
Q

what are positives and negatives of Becker model of behaviour

A

Positives: long standing use, applicable in lots of situations
Negatives: no emotional or social cues, no temporality, no differential diagnosis list vs repeat illnesses

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46
Q

what is the transtheoretical model of behaviour

A

precontemplation
contemplation
reparation
action
maintenance
(+relapse)

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47
Q

what are the positives and negatives of the transtheoretical model of behaviour

A

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

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48
Q

what is the theory of planned behaviour

A

a positive attitude, subjective norms and perceived behavioural control all act together to give someone intention to change which then becomes action

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49
Q

what are positives and negatives of the theory of planned behaviour

A

positives: accounts for emotional cues, lots of scenarios
negatives: lack of temporality, report bias

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50
Q

what is the nudge theory of behavioural change

A

fruit next to the checkout rather than sweets

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51
Q

what are Bradshaws health needs

A

Felt
Expressed
Normative
Comparative

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52
Q

what is the health needs assessment cycle

A

assessment - planning - implement - evaluate - assessment etc

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53
Q

what are different assessment approaches to health needs assessment

A

epidemiological
comparative
corporate

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54
Q

what is the epidemiological assessment approach

A

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

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55
Q

what is the comparative assessment approach

A

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

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56
Q

what is the corporate assessment approach

A

looking at other professionals point of view - what do other people think
- can introduce biases

57
Q

what are the three things that services can be

A

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
Q

What is the Donabedian evaluation approach

A

Structure - whats there
Process - whats done
Outcome - death, disease, disability, discomfort, dissatisfaction which is determined through interviews and observation

59
Q

what is the Maxwell dimensions evaluation approach

A
  • Accessible? Acceptable? Approachable?
  • Effective? Efficacy? Equality?
60
Q

what is the Wrights matrix

A

it is when Donabedian and Maxwell dimensions evaluation approaches are brought together

61
Q

how do you work out alcohol units

A

(ABV% X VoL/mL)/1000

62
Q

how many mL and grams are in 1 unit of alcohol

A

8g or 10 mL

63
Q

what is the maximum weekly alcohol units for men and women

A

14 units

64
Q

what is an error in medicine

A

a preventable, unwanted outcome due to human factor

65
Q

how do you classify error in medicine

A

through intension, action, outcome and context looking at the person and systemic approach

66
Q

what are the reasons for error in medicine

A

lack of skill
sloth
bravado
playing the odds
fixation
systemic issue

67
Q

what is the swiss cheese mode l

A

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
Q

what are the two kinds of swiss cheese model

A

active = direct event which predisposes a negative outcome: holes line up
latent = systemic failure built up over time: dont line up

69
Q

what is the 3 bucket model of error

A

that errors are a result of self, context and task factors
i.e tired nurse + a busy ward + fails an ABG

70
Q

what is a never event

A

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
Q

who should never events be reported to

A

CQC - care quality commission
StEIS - Strategic Executive Information System

72
Q

what are consequences of never events

A

fitness to practice
Never event claims if duty of care is breached and there are irreparable consequences

73
Q

how can we reduce error

A

maintain standards through training
SBAR communication tool to improve communication

74
Q

what is a near miss

A

it is an error which doesnt lead to an adverse outcome

75
Q

what is an adverse event

A

it is an error which leads to a negative/poor outcome:
apologise and inform patient by duty of candour

76
Q

what are the different types of domestic violence

A

physical
emotional
psychological
sexual

77
Q

what are risk factors for domestic violence

A

20-25 years old
female
pregnant

78
Q

when might you suspect domestic violence

A

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
Q

how might you determine if someone is being domestically abused

A

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
Q

what would the outcomes of a DASH form mean for managing suspected abuse

A

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
Q

what are the 3 NHS core principals

A

that it is free, universal and accessible

82
Q

what is the inverse care law

A

that those with the best healthcare access need it the least and visa versa

83
Q

What are Maslows needs

A
  1. self actualisation (top of triangle)
  2. Esteem, love and belonging (middle of triangle)
  3. food and shelter, safety (bottom of triangle)
84
Q

what are causes of homelessness

A

eviction
cant afford rent
separation
lost job

85
Q

what are complications of homelessness

A

reduced life expectancy (about 40 yrs)
intravenous drug use
STI
mental health issues and suicide

86
Q

what is needed for food security

A

affordability
accessibility
utilisation
stability

87
Q

what is allostasis

A

this is the physiological process that helps organisms maintain stability through change by anticipating and adjusting energy use in response to environmental demands

88
Q

what is salutogenesis

A

it is a concept which focuses on the factors responsible for well-being rather than disease pathogenesis
- focuses on the direction towards health

89
Q

what is the allostatic load

A

it is the toll on the body of long term physiological allostasis
- cumulative affects that chronic stress has on mental and physical health

90
Q

what are early food influences

A

the maternal diet
breastfeeding
age of solid food

91
Q

what is the restraint theory of food behaviour

A

it is paradoxical - there is increased subjective hunger after dieting (due to imbalanced leptin and ghrelin levels) leading to excessive food intake

92
Q

what are the three forms of dieting

A

reduced calories
reduced types of foods eaten
reducing the window to eat

93
Q

when is underaged sex considered rape

A

if someone has sex under 13 then it is always rape, you need to escalate it !

94
Q

when would you apply Gillick-Fraser guidance apply to underage sex

A

between the ages of 13-15 years old

95
Q

what is fraser competence

A

this is contraception specific guidance - when giving contraception in best interests and if competent

96
Q

what is Gillick competence

A

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
Q

what are the healthcare relevant human rights determined in the human rights act 2005

A

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
Q

what is an absolute right

A

it is a right that is never limited

99
Q

what are qualified rights

A

those requiring a balance between the rights of the individual and the needs of another or of the wider community

100
Q

when might there be exceptionality criteria to the human rights act 2005

A

the NHS + NICE may be excused in certain contexts such as withholding treatment due to ack of funding

101
Q

what is rationing of recourses

A

this is when resources are refused due to decreased affordability

102
Q

What are the three theories for distribution of resources

A
  1. egalitarianism
  2. utilitarianism
  3. libertarianism
103
Q

what is egalitarianism

A

it is equality, supply everything to everyone
- morally just
- negative financially

104
Q

what is utilitarianism

A

it is maximising resources for the majority
- it is efficient
- it can be immoral against minority

105
Q

what is libertarianism

A

it is that people are responsible for their own health
- patient motivated
- unfair for e.g in genetic disease

106
Q

what is the Harm principle

A

patient is free from judgment to make decisions even if it is unwise unless those actions can cause harm to someone else

107
Q

what is the Jonsen rule of rescue

A

it is the imperative that people feel to rescue identifiable individuals facing avoidable death
- perceived duty to save a life wherever possible

108
Q

what is negligence

A

it is breach of care which results in damage!

109
Q

what are reasons for negligence

A

the main reason is error
neglect
reduced performance
misconduct

110
Q

what are the four test parts to negligence

A

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
Q

what are the two tests which can determine negligence or not

A

Bolam = would other doctors act in the same way
Bolitho = was what happened a reasonable cause of action

112
Q

when are financial claims of negligence made

A

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
Q

what are the ethical pillars

A

autonomy
beneficence
non maleficence
justice

114
Q

what is deontology (ethical theory)

A

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
Q

what is utilitarianism

A

it is a moral theory that suggests that actions should be chosen to maximise happiness and well being for the most people

116
Q

what is consequentialism

A

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
Q

in communication difficulties, how might you help improve communication with someone who it blind

A

make things textured, brighter, audible, brail

118
Q

in communication difficulties how might you help improve communication with someone who is deaf

A

sign language
lip reading
slow speech
interpreters

119
Q

what is the Peyton 4 step list to learning

A
  1. demonstrate
  2. demonstrate and explain
  3. demonstrate and student explains
  4. student demonstrates and explains
120
Q

what is the KOLB learning cycle

A

Activist (experiences) - pragmatist (feedback) - reflector - theorist - activist etc

121
Q

what are the different types of leadership

A

authoritarian - dictator
participation - democratic
delegative - independent roles
transactional - incentives
transformational - inspirational

122
Q

what are the positives and negatives of a authoritarian leadership

A

positive: quick and efficient
negative: only one option

123
Q

what is the positives and negatives of a participation leadership

A

positives: lots of opinions
Negative: less efficient

124
Q

what are the positives and negatives of a delegative leadership

A

positive: more responsibility
negative: no leadership role

125
Q

what are the positives and negatives or a transactional leadership

A

positives: motivation to work
negatives: no transformation - passive

126
Q

what are the positives and negatives of transformational leadership

A

positives: inspires
negatives: lots of monitoring

127
Q

what are the duties of a doctor

A

knowledge, skills, performance
safety and quality
maintain trust

128
Q

what are the determinants of health

A

residence
race
occupation
gender
social background
religion
education

129
Q

What is the management of cervical cancer

A

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
Q

What is the staging for cervical cancer

A

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
Q

What is the 5 year survival of cervical cancer

A

The 5-year survival drops significantly with more advanced cervical cancer, from around 98% with stage 1A to around 15% with stage 4.

132
Q

What is pelvic exenteration

A

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
Q

What is bevacizumab

A

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
Q

When is the HPV vaccination given

A

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
Q

What is the most common type of endometrial cancer

A

Around 80% of cases are adenocarcinoma. It is an oestrogen-dependent cancer

136
Q

What is endometrial hyperplasia

A

precancerous condition involving thickening of the endometrium. The risk factors, presentation and investigations of endometrial hyperplasia are similar to endometrial cancer.

137
Q

What are they two kinds of endometrial hyperplasia

A

Hyperplasia without atypia
Atypical hyperplasia

138
Q

What is the treatment for endometrial hyperplasia

A

treated by a specialist using progestogens, with either:
Intrauterine system (e.g. Mirena coil)
Continuous oral progestogens (e.g. medroxyprogesterone or levonorgestrel)

139
Q

What are risk factors for getting endometrial cancer

A

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

Phase 3a Jemima (16 decks)

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