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SPINE > Public Health > Flashcards

Public Health Flashcards

1
Q

What is population screening?

A

• Population screening, also known as universal or mass screening, is applied to an entire population or a broad segment of it, typically based on demographic factors like age or gender.
• The primary goal of population screening is to identify individuals with a particular condition or risk factor within a general population, even if they don’t show symptoms. It aims to reduce the burden of disease and prevent its spread.

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2
Q

What is targeted screening?

A

• Population screening, also known as universal or mass screening, is applied to an entire population or a broad segment of it, typically based on demographic factors like age or gender.
• The primary goal of population screening is to identify individuals with a particular condition or risk factor within a general population, even if they don’t show symptoms. It aims to reduce the burden of disease and prevent its spread.

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3
Q

What are the current UK population screening programmes?

A

• NHS abdominal aortic aneurysm (AAA) programme
• NHS bowel cancer screening (BCSP) programme
• NHS breast screening (BSP) programme
• NHS cervical screening (CSP) programme
• NHS diabetic eye screening (DES) programme
• NHS fetal anomaly screening programme (FASP)
• NHS infectious diseases in pregnancy screening (IDPS) programme
• NHS newborn and infant physical examination (NIPE) screening programme
• NHS newborn blood spot (NBS) screening programme
• NHS newborn hearing screening programme (NHSP)
• NHS sickle cell and thalassaemia (SCT) screening
programme

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4
Q

Pros and cons of public health screening

A

Benefits
• Better future health
• More effective treatment
• Reassurance
• Informed decision
• Worthwhile use of resources
• Reproductive choice in antenatal screening

Downsides
• Incorrect results (anxiety or false reassurance)
• Physical harm
• Psychological harm
• Financial harm
• Overdiagnosis

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5
Q

What are the barriers to screening?

A
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6
Q

What is sensitivity?

A

• Definition: Sensitivity, also known as the true positive rate or recall, measures the ability
of a test to correctly identify individuals who have the condition or disease (true positives).
• Formula: Sensitivity = True Positives / (True Positives + False Negatives)
• Interpretation: A high sensitivity indicates that the test is good at ruling out the condition when it is absent. In other words, a highly sensitive test rarely misses individuals who truly have the condition. It has a low false negative rate.
• Example: In the context of a cancer screening test, high sensitivity means the test is effective at detecting people with the disease, reducing the chances of missing actual cases

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7
Q

What is specificity?

A

• Definition: Sensitivity, also known as the true positive rate or recall, measures the ability of a test to correctly identify individuals who have the condition or disease (true positives).
• Formula: Sensitivity = True Positives / (True Positives + False Negatives)
• Interpretation: A high sensitivity indicates that the test is good at ruling out the condition when it is absent. In other words, a highly sensitive test rarely misses individuals who truly have the condition. It has a low false negative rate.
• Example: In the context of a cancer screening test, high sensitivity means the test is effective at detecting people with the disease, reducing the chances of missing actual cases

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8
Q

What is the disease and test table?

A
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9
Q

What is qualitative research?

A

• Approaches that aim to understand social reality of individuals, groups and cultures.
• Meaning, not frequency
• Beliefs, values, experiences of the social world and contextual circumstances: ‘interpretive’.
• Aims to provide an in-depth, holistic context-specific understanding
•Researchers immerse themselves in the setting of the people whose experiences they wish to explore.
•Understanding is the aim in itself (rather than predicting).
•Richly descriptive
•The researcher is the primary instrument for data collection and analysis.
•Data to build concepts, understanding and theories rather than to test hypothesis

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10
Q

What is the sampling and aims of qualitative research?

A

• Smaller but focused inquiry instead of large random samples.
• NOT ‘representative’ of the population under study in a statistical sense.
• Uses ‘purposive’ sampling (people, documents,
institutions, etc.)—related to the research questions.
• Aims to produce transferable (rather than generalisable) and credible/trustworthy (rather than internally or externally valid) findings

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11
Q

What are the methods of collecting and analysing qualitative data?

A

Data collection
•Interviews
•Focus groups
•Life grids
•Diaries
•Photographs
•Objects
•Scrap books

Data analysis
•Content and Thematic analysis
•Phenomenological analysis
•Narrative analysis
•Grounded theory approach
•Affective textual analysis

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12
Q

What is content and thematic analysis?

A

Summarises and categorises themes in the data

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13
Q

What is narrative analysis?

A

Explores lived experiences and social stories,
connecting personal identity to culture and history

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14
Q

What is Interpretative Phenomenological Analysis (IPA)?

A

Focuses on participants’ experiences and how they assign meaning in their interactions

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15
Q

What is discursive/discourse analysis?

A

Examines how language constructs social
reality and reveals participants’ subjective worlds

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16
Q

What is the PAR approach?

A
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17
Q

What is a health needs assessment (HNA)?

A

A Health Needs Assessment (HNA) is a systematic assessment of the health issues facing a population leading to agreed priorities and resource allocation that will improve health and reduce inequalities

•Equity, effectiveness and efficiency:
•Identifies unmet need
•Identifies ineffective activity (stop or change)
•Identifies opportunities to improve efficiency

•HNA is a recommended public health tool to provide evidence about a population on which to plan services and address health inequalities
•HNA provides an opportunity to engage with specific populations and enable them to contribute to targeted service planning and resource allocation
•HNA provides an opportunity for cross-sectoral partnership working and developing creative and effective interventions

•is objective, valid and takes a systematic approach
•involves a number of professionals and the general public
•involves using different sources and methods of collecting and analysing information (including epidemiological, qualitative and comparative methods)
•seeks to identify needs and recommends changes to optimise the delivery of health service

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18
Q

What is the triangle of health needs assessment?

A
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19
Q

What are the elements of need assessment?

A

•Epidemiological- Measurements by time, place, person
•Comparative- “here vs there” or “Population 1vs 2”
•Corporate- People, providers, purchasers

20
Q

What is assessed in HNA?

A

•Problems- Determinants, risk factors, diseases etc.
•Services (not necessarily health services)- Prevention, social, care, treatment etc.
•Community or social experience- Community, crime, engagement

21
Q

What are the 5 objectives of a healthcare needs assessment?

A
  1. Planning
  2. Intelligence
  3. Equity
  4. Target efficiency
  5. Involvement of stakeholders
22
Q

What are the 5 steps to a health needs assessment?

A

1.Defining the population and setting objectives
2.Identifying health priorities by collecting and analysing data.
3.Assessing and Agreeing a health priority
4.Planning for change
5.Evaluate

23
Q

What is economic analysis and what are the types?

A

•A comparative analysis of alternative courses of action in terms of both costs and consequences
Types:
•Cost-effectiveness (consequences in natural units, e.g. cost per stroke prevented)
•Cost-utility (consequences measured in QALYs)
•Cost-benefit (costs and consequences measured in monetary units)

24
Q

What are the key principles of trauma-informed care?

A

• Safety (physical environment, clear communication)
• Trustworthiness and transparency (building trust)
• Peer support
• Collaboration (shared decision-making)
• Empowerment
• Cultural, history and gender sensitivity

25
Q

What is cultural competency?

A

Cultural competence describes a set of aligned and transparent skills, attitudes and principles that acknowledge, respect and work together as a system
towards optimal interactions between individuals and the various cultural and ethnic groups within a community.

How to build:
- self-awareness
- knowledge
- communication skills
- attitudes

26
Q

What are the common modes of transmission?

A
  1. Airborne route via respiratory secretions/droplets e.g. pulmonary tuberculosis
  2. Direct contact by hand e.g. MRSA
  3. Enteric secretions - direct contact e.g. Salmonella
  4. Blood or body fluids via sharps injury or exposure of wounds or mucous membranes or conjunctivae e.g. Hepatitis B
27
Q

What is standard isolation?

A

Single room preferably with own toilet and hand-wash basin

•Hands should be washed with liquid soap or alcohol gel (depending upon infectious agent) when:
–Following all procedures.
–After removing protective clothing.
–Before leaving the room.

•PPE – gloves and aprons should be donned prior to entering the room and removed whilst in the room

28
Q

What is respiratory isolation?

A

Single room preferably with own toilet and hand-wash basin

•Hands should be washed with liquid soap or alcohol gel (depending upon infectious agent) when:
–Following all procedures.
–After removing protective clothing.
–Before leaving the room.

•PPE – gloves and aprons should be donned prior to entering the room and removed whilst in the room

For:
- resp illnesses
- measles
- mumps
- chickenpox

29
Q

What is strict isolation?

A

Single room with an ante-room
•Extract ventilation
•Staff entering the room must be kept to a minimum

For:
- smallpox
- ebola

30
Q

What is protective isolation?

A

•Single room preferably with own toilet
•Handwashing should take place:
•On entering the room and prior to contact with the patient.
•Following all procedures.
•Before leaving the room.
•After removing protective clothing (outside the room)
•Aprons should be worn on entering the room
•Drinking water should be boiled

31
Q

What is the hierachy of isolation?

A
32
Q

What is point prevalence and how is it measured?

A
33
Q

What is prevalence in terms of disease frequency?

A

• Proportion
• Not a rate – no time component in the calculation
• Measures proportion of existing disease in the population at a given time
• “Snapshot”
• Dimensionless, positive number (0 to 1)

34
Q

What is period prevalence and how is it measured?

A
35
Q

What is incidence in terms of disease frequency?

A

• Measures only the occurrence of new cases in a population at risk at a specific time
• Tells us how quickly people are developing a disease
• Can be expressed as number of new cases, as a proportion of people who are newly
infected, or a rate at which new infection has occurred
• The most fundamental epidemiologic indicator
• Measures force of morbidity (as a rate)
• Measures conversion of health status (proportion /rate)

36
Q

What is incidence proportion and how is it measured?

A
37
Q

What is incidence rate and how is it measured?

A

• Measures the speed that new cases develop during specified time period
• Cases per person-time
• Synonyms: incidence, incidence density, rate
• Follow-up may be incomplete
• Risk period not the same for all subjects

38
Q

What is person-time and how is it measured?

A
39
Q

What is absolute risk vs relative risk?

A

• Absolute Risk (AR) = the number of events (good or bad) in a treated (exposed) or control
(non-exposed) group, divided by the number of people in that group.
• Relative Risk (RR) = Risk of outcome among exposed/risk of outcome among non-
exposed
• Attributable risk difference (risk difference, excess risk) = Risk of outcome among exposed-
risk of outcome among non-exposed

40
Q

What is count and ratio in terms of disease frequency?

A

• Count- number of cases
• Ratio- obtained by dividing one value by another
• Proportion- type of ratio where the numerator is part of the denominator
• Rate- type of ratio where the denominator involves a measure of time

41
Q

Experimental vs observational studies

A
42
Q

Strengths and limitations of case control studies

A

Examples:
• Smoking and risk of lung cancer
• Low fertility and age at menopause as risk factors for breast cancer
• Use of antibiotics and penicillin and risk of multiple sclerosis
• Solvent exposure and risk of Alzheimer’s
• Genome-wide association studies of diseases
• Mobile phone use and risk of glioma

43
Q

What is an odds ratio?

A

• The measure of association between an exposure and an outcome
• Used to compare the relative odds of the occurrence of the outcome of interest (e.g. Stroke), given exposure to the variable of interest (e.g. smoking).
• Can be used to determine whether a variable of interest is a risk factor for the outcome of interest
• Most commonly used in case-control studies but can also be used in cross-sectional and cohort study designs with some modifications

44
Q

What is the population attributable fraction (PAF)?

A

• The contribution of a risk factor to a disease or a death is quantified using the population attributable fraction (PAF).
• The estimated PAF represents the proportional reduction in population disease or mortality that would occur if exposure to a risk factor were reduced to an alternative ideal exposure scenario (e.g. no tobacco use).
• Many diseases are caused by multiple risk factors, and individual risk factors may interact in their impact on overall risk of disease. As a result, PAFs for individual risk factors often overlap and add up to more than 100 percent

Apply the general formula:
• PAF = Proportion of cases who were exposed to the risk factor x (1 - 1/adjusted odds ratio)

Example
20% of population have psychosocial stress. Adjusted OR for the association between
psychosocial stress and stroke is 1.30.
PAR = 0.20 x (1 – 1/1.3) = 4.6%

45
Q

What is the table for rates and risks?

A

SPINE (6 decks)

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