Public health Flashcards
What are the 4 types of prevention of disease?
- Primary
- Secondary
- Tertiary
- Quaternary?
What is primary prevention?
Preventing disease onset e.g. 5-a-day; vaccinations
What is secondary prevention?
Early detection/ optimise prognosis/ prevent recurrence e.g. screening
What is tertiary prevention?
Effective symptom management e.g. medications
What is quaternary prevention?
Prevent overmedicating patient??
What are two approaches to disease prevention?
- Population - for all
- High risk - for high risk groups
What is the prevention paradox?
Measures to improve public health will have little effect on MOST people
What is sensitivity?
True positive/ (true positive + false negative)
% diseased population testing +ve
What is specificity?
true negative/ (true negative + false positive)
% without disease who test negative
What is positive predictive value?
TP/(TP+FP)
% who test positive who are actually positive
What is negative predictive value?
TN/(TN+FN)
% who test negative who are actually negative
What are the different types of screening (3)?
- Population
- Opportunistic
- Occupational
What are some cons of screening (5)?
- Subclinical diagnosis?
- Fase reasurance
- Invasive/ uncessarsarry Tx/ Ix
- Expensive
- Anxiety/ worry
What is the name of the criteria to screen successfully?
Wilson junger criteria
What are the 10 Wilson junger criteria?
- Important health condition
- Available treatments and diagnostic facilities
- Treatable disease
- Recognisable latent period
- Obvious diagnostic test
- Generally accepted (the test to screen)
- Economically viable
- Natural history of untreated disease is known
- Issued agreed policy (on who to treat)
- Continuously done (not abruptly stopped)
What are two biases of screening that might make it appear to work?
- Lead time - cases picked up earlier so gives illusion of people living longer
- Length time - slower progressing disease more likely to be picked up on screening than faster progressing disease
What are the types of study design (6)?
- Ecological - observational across whole population (using census data)
- Cross sectional - looks at 1 point in time, assesses prevalence of disease and RFs at that point in time
- Case control - compares a group with a disease and a group without a disease and assesses their past exposure to RFs
- Cohort - follows a group with AND without a RF overtimes and assesses their development of a disease
- RCT - randomly assign an action to a group and compare their likelihood of disease with that of a control group
- Systematic review - combine currently existing studies into larger review
What is incidence?
Number of new cases in given time
What is prevalence?
Total number of cases at one point in time
What is relative risk?
The increased likelihood of an event occurring given exposure
What are odds?
Ratio of event happening/not happening
What are odds ratio?
Odds in exposed group/ odds in control group
this results in an amplification of the increase in likelihood
What are some types of bias (6)?
- Selection bias - includes if people drop out of study
- Recall bias (problem in how participants recall information)
- Reporter + observational bias
- Publication bias (results not published/ included in meta analysis)
- Measurement
- Observer - actions of participants change when they know they are in study
What criteria are used to assess causation?
Bradford hill criteria
What are the Bradford hill criteria?
- Dose - response
- Reversibility
- Consistency
- Biological plausibility
- Temporality (effect occurs after cause)
- Coherence (between lab and people)
- Analogy
- Strength
- Specificity
What are the 3 domains of public health?
- Improving health promotion
- Protection of health
- Service improvement
What is equality?
Everyone treated the same
What is equity?
People treated according to need
What is vertical vs horizontal equity?
- Horizontal = equal treatment for equal need
- Vertical = unequal treatment for unequal need
What are the 3 levels interventions can be delivered at?
- Individual
- Community
- Population
What are the two types of health behaviour?
- Health promoting
- Health damaging
What are the 3 types of health promoting behaviours?
- Health behaviour (e.g. exercise)
- Illness behaviour (e.g. seek remedy)
- Sick role (e.g. resting)
What are some reasons for damaging health behaviours (3)?
- Cultural
- Unrealistic optimism (e.g. infrequent so unlikely to do harm)
- Stress
What are the 3 models of behaviour?
- Becker (health belief model)
- Transtheoretical
- Theory of planned behaviour
What is the Becker model (health belief model) of behaviour (4)?
Individual will change if they believe they are:
* Susceptible
* Acknowledge consequences
* Believe action decreases susceptibility
* Action consequences outweigh continuing
What are the steps in the transtheoretical model of behaviour (6)?
Precontemplation –> contemplation –> preparation –> action –> maintenance –> relapse
What is the theory of planned behaviour (3)?
- Attitude + Subjective norm (others attitudes towards behaviour) + perceived behaviour control
- Intention
- Action
What is the nudge theory?
Changing environment can influence an individuals chance of choosing an action e.g. putting fruit near checkout makes people more likely to buy fruit
What is motivational interviewing?
Counselling approach to encourage patients to change their behaviour through exploring conflicting emotions
What is a model to describe health needs?
Bradshaw model
What is Bradshaw model (4)?
- Felt need - feeling short of breath
- Expressed need - attending GP
- Normative need - need determined by expert
- Comparative needs - comparing services received by one group of people with that of another
What is the health needs assessment cycle (4)?
- Assess
- Plan
- Implement
- Evaluate
How can health needs be assessed (assessment approach) (3)?
- Epidemiological - uses data on prevalence and incidence to evaluate needs
- Comparative - compare 2 demographically different services e.g. geographically
- Corporate - based on professionals POV/ organisational goals
What are some examples of services supplied +/- demand +/- need (3)?
- Supplied, not needed or demanded = ??75+ health checks??
- Supplied, needed, not demanded = heal prick newborn test
- Supplied, needed and demanded = surgery
How are health needs evaluated (evaluation approach) (2 methods)?
- Donabedian approach
- Maxwell dimensions
What is the donabedian approach to evaluating health needs (3)?
- Structure - what’s there
- Process - what’s done
- Outcome
What are the Maxwell dimensions to evaluate health needs (6)?
- Accessible
- Acceptable
- Appropriate
- Effective
- Efficacy
- Equity
How many grams + ml is 1 unit of alcohol?
- 8 grams
- 10 ml
How much alcohol is recommended to not drink over each week?
14 units
What is considered binge drinking?
Drinking more than 6 units at once
What is an error?
A preventable unwanted outcome due to human factor
What 2 models are used to explain errors?
- Swiss cheese model
- 3 bucket model
What is the Swiss cheese model?
All holes line up to allow for an error to occur
What are the 3 aspects of the 3 bucket model?
- Self
- Context
- Task
e.g. tired nurse, on a busy ward, fails an ECG
What is a never event?
A largely preventable outcome that shouldn’t have happened, provided adequate measures were put in place
Who should a never event be reported to?
Care quality commission
What is the consequence of some never events?
Fitness to practice
How can errors be minimised (2)?
- Regular training opportunities
- SBAR communication tool
What are two outcomes of errors in medicine?
- Near miss
- Adverse event occurs
What should the doctor do if an error leads to an adverse event?
Apologise + inform patient by duty of CANDOUR
What are the 2 types of abuse in domestic violence?
- Physical
- Psychological/ emotional
Which gender most commonly is the perpetrator of domestic violence?
Male
What are some risk factors for domestic violence (2)?
- 20-25 year old female (young female)
- Pregnancy
What are some features of domestic abuse that a GP may notice (4)?
- Only attend with partner
- Delayed presentation
- Multiple bruises at different stages of healing
- Recurrent GP appointments
How should domestic abuse be investigated (2)?
- Speak to patient alone
- Fill out DASH form (domestic abuse and sexual harassment)
What should you ask a patient you suspect is suffering domestic abuse about (3)?
- Directly ask about abuse
- Condemn and tell patient it is not ok
- DO NOT tell patient what to do
How should mild/ moderate domestic abuse (according to the DASH form) be managed?
Signpost to domestic abuse support services
How should severe domestic abuse according to the DASH form be managed?
Fill out MARAC (multi agency risk assessment conference) form
What are the 3 core NHS principles (3)?
- Free
- Universal
- Accessible
What is the inverse care law?
Those with best healthcare access need it least + vice versa
What theory shows the needs of a person and their importance?
Maslows hierarchy of needs
What are the 3 basic levels of maslows hierarchy of needs?
- Self actualisation (developed)
- Esteem; love + belonging (psychological)
- Food, shelter and safety (physiological)
What are some causes of homelessness (4)?
- Eviction
- Lost job
- Can’t afford rent
- Separation
What are some health complications of being homeless (4)?
- Reduced life expectancy (around 40)
- IVDU
- STI
- Poor mental health + suicide
What 4 things affect food security?
- Affordability
- Accessibility
- Utilisation
- Stability
What things early on in life may influence diet (3)?
- Maternal diet
- Breastfeeding
- Age of solid food
What is restraint theory on eating habits?
When dieting restraint theory predicts that the person will eat more due to imbalances in ghrelin and leptin
What are 3 forms of dieting?
- Decrease calorie intake
- Decrease window food is eaten within
- Decrease the number of types of food eaten
What age is sex considered to always be rape in the uk?
Under 13
as children under 13 are considered to not be able to consent
How should sex under 16 (but over 13) be managed?
Assess child’s gilick-fraser competence
What does Fraser guidance relate to and how should a doctor manage it?
Contraception specific guidance - give contraception if in child’s best interest + they are competent
What are the aspects to gilick competence (3)?
- Cannot be persuaded to tell parents
- Will likely have UPSI
- Mental health will suffer if not given
How should capacity be assessed in children (4)?
Understands –> retains –> weighs up –> communicates information
What are the parts of the human rights act that are relevant to healthcare (5)?
Article:
* 2 = right to life
* 3 = free from inhumane treatment
* 8 = respect family/ private life
* 12 = to marry/ conceive
* 14 = not to be discriminated against
What is an absolute vs qualitative right?
- Absolute = NEVER limited
- Qualitative = MAY be limited (e.g. article 8)
What are exceptionality criteria of the human rights act?
When human rights cannot be fulfilled due to certain exceptions e.g. withholding treatment due to lack of funding
What is rationing in healthcare?
Restricting resources due to reduced availability/ funding
What are 3 theories that explain how resources can be delivered?
- Egalitarianism
- Utilitarianism
- Libertarianism
What is egalitarianism?
Everyone is equal and should be given equal amounts of resources
What is utilitarianism?
Utilising resources to get the most overall benefit
What is libertarianism?
Patient responsible for own health and getting/ requesting resources
unfair for some e.g. genetic disorders
What is the harm principle?
The actions of an individual should only ever be limited to prevent harm to another individual
What is jonsens rule of rescue?
The obligation people feel to save lives wherever possible
What is negligence?
Breach of care which results in damage
What are the 4 questions that should be fulfilled for there to be negligence (4)?
- Was there duty of care?
- Was there breach of duty?
- Did harm occur?
- Was harm due to breach?
What are two tests to judge whether there has been negligence?
- Bolam = would other doctors act the same way
- Bolitho = was what happened a reasonable course of action
What is the type of compensation given if a doctor has been found to be negligent and what 3 factors should be fulfilled?
Financial compensation if:
* Duty of care
* Breech
* Irrepairable damage as a result
What is the amount of financial compensation given for negligence based upon (3)?
- Loss of income
- Cost of care
- Pain/ suffering
What are the 4 ethical pillars?
- Autonomy
- Non-maleficence (do no harm
- Beneficence (best interest)
- Justice (greater good)
What are 5 different ethical frameworks?
- Deontology
- Utilitarianism
- Consequentialism
- Virtue ethics
- Egoism
What is deontology?
Morality of action based on whether that action itself is right or wrong
What is utilitarianism (in terms of ethics)?
Greatest good for the greatest number
type of consequentialism
What is consequentialism?
Morality should be judged by evaluating the consequences it will have on others
What is virtue ethics?
The action is good if it is what a virtuous person would do
What is egoism?
We by nature act selfishly
How can you adapt communication style if a patient has a visual problem (4)?
- Bigger writing/ diagrams
- Textured
- Brighter
- Use audio instead
How can you adapt communication style if a patient has a hearing problem (4)?
- Sign language
- Lip reading
- Slow speech
- Interpreter
What is a 4 step process that is effective for learning?
- Demo
- Demo + explained
- Demo + student explains
- Student demo + explains
What are 5 types of leadership?
- Authoritarian
- Participation (democratic)
- Delegative
- Transactional - offers incentives
- Transformational - influence + inspire
What are 3 core duties of a doctor?
- Maintain knowledge, skills and performance
- Safety + quality
- Maintain trust
What are determinants of health (6)?
- Residence
- Race
- Occupation
- Gender
- Socioeconomic background
- Education
What are some of the conditions screened for in pregnancy (4)?
- Infections (e.g. HIV, syphilis, HepB)
- Sickle cell
- Thalassaemia
- Foetal abnormalities
What are 3 screening tests for a newborn?
- NIPE < 72 hours
- Blood spot test (5 days)
- Ottoacoustic emission test
What are 5 screening tests done on adult population?
- Cervicle
- Breast
- AAA (men 65 invited for USS)
- Diabetic eye
- Bowel cancer (50-74, FIT test every 2 years)
