Public health Flashcards
Define public health
The science and art of preventing disease, prolonging life and improving health through organised efforts of society
Define equity
Giving people what they need to achieve equal OUTCOMES
Define equality
Giving everyone the same rights, OPPORTUNITIES and resources
Define horizontal equity
Equal treatment for people with equal health care needs
Define vertical equity
Unequal treatment for unequal healthcare needs
Inverse care law?
Availability of health care tends to vary inversely with its need
Mnemonic to remember determinants of health
PROGRESS
Place of residence
Race
Occupation
Gender
Religion
Education
Socio-economic
What are the 3 domains of public health?
Health improvement - preventing disease, promoting health and reducing inequalities
Health protection - measures to control infectious diseases and environmental hazards
Improving services
3 As and 3 Es of Maxwell’s dimensions of assessing quality of healthcare
Acceptability
Accessibility
Appropriateness
Effectiveness
Efficiency
Equity
Give an example of need, demand and supply
Antibiotics for a mild infection - supplied, demanded but not needed
Give 4 types of need
Felt need - perception of variation from normal health
Expressed need - seeks help to overcome variation
Normative need - professional defines intervention for expressed need
Comparative need - comparison between severity, range of interventions and cost
Perspectives of health needs assessment - describe epidemiological approach, give positives and negatives
Looks at:
Size of population
Services available
Evidence base
Good:
Uses existing data
Provides data on incidence/mortality/morbidity
Bad:
Does not consider felt need of patients
Perspectives of health needs assessment - describe comparative approach, give positives and negatives
Compares services/outcomes received by populations
Good:
Quick and cheap if data is available
Shows if services are better or worse than compared group
Bad:
Can be difficult to find comparable population
Data may not be available/high quality
Perspectives of health needs assessment - describe corporate approach, give positives and negatives
Asks local population what their health needs are e.g focus groups, interviews, public meetings
Good:
Based on felt and expressed need of population
Recognised detailed knowledge and experience of those within population
Takes into account wide range of views
Bad:
Can be difficult to distinguish need from demand
Groups may have vested interests/political agendas
Describe egalitarian approach to resource allocation - give positive and negative
Provide all care that is necessary and required by everyone
Good - equal
Bad - expensive
Describe maximising approach to resource allocation - give positive and negative
Act is evaluated solely in terms of its consequences
Good - resources allocated to those most likely to benefit
Bad - those who do not make cut receive nothing
Describe libertarian approach to resource allocation - give positive and negative
Each is responsible for their own health
Good - promotes engagement
Bad - most diseases are not self inflicted
Define primary prevention and give example
Preventing disease form occurring in the first place e.g vaccine
Define secondary prevention and give example
Early identification of disease to alter disease course e.g screening
Define tertiary prevention
Limit consequences of an established disease e.g preventing worsening renal function in CKD
Describe the population approach to disease prevention and give example
Deliver approach to everyone to shift risk factor distribution curve
e.g dietary salt reduction through legislation
Describe the high risk approach to disease prevention and give example
Identify individuals above chosen cut off and treat them e.g screening for high blood pressure and treating
Describe the prevention paradox
A preventative measure which brings benefit to the population offers little impact to the individual
What is the purpose of screening?
To identify apparently well individuals who have/are at risk of a particular disease so that you can impact the outcome
Give 5 benefits of screening
Reproductive choice
Worthwhile use of resources > more cost effective
Informed decision
Reassurance
More effective treatment > better prognosis
Give 6 negatives of screening
Harm from tests
Over treatment
Treatment risks
Difficult decisions
Anxiety/false reassurance
Incorrect results
Give 3 screening programmes in pregnancy
Infectious disease in Pregnancy Screening Programme - hep B, syphilis, HIV
Sickle cell and Thalassaemia
Foetal anomaly screening - Down’s, Edward’s, Patau’s
Give 3 screening programmes in neonates
NIPE
Newborn hearing screening programme
Blood spot screening programme - CF, sickle cell, congenital hypothyroidism
Give 5 screening programmes in young people and adults
AAA
Bowel cancer
Breast cancer
Cervical cancer
Diabetic eye
Mnemonic to remember Wilson and Jungner screening criteria
In Exam Season NAP
Important disease
Effective treatment available
Simple and safe test
Natural history of disease known
Acceptable e.g not too invasive
Policy on who to treat agreed
Define sensitivity
Proportion of those with the disease who are correctly identified
Define specificity
Proportion of people without the disease who are correctly excluded
Define positive predictive value
Proportion of people with a positive test result who have the disease
Define negative predictive value
Proportion of people with a negative test result who don’t have the disease
Give 2 biases that can occur with screening
Length time bias - screening is more likely to detect slow-growing disease that has a long phase without symptoms
Lead time bias - patients diagnosed earlier appear to live longer because they know they have the disease for longer
List hierarchy of evidence
1) Systematic reviews and meta analysis
2) RCT
3) Cohort studies
4) Case-control/cross-sectional
5) Case series/case reports
6) Editorials/expert opinions
Case-control studies - describe and list positives and negatives
Compares exposure to a potential cause between participants with disease and controls
Good:
Good for rare outcomes
Quicker and cheap
Can investigate multiple exposures
Bad:
Difficult to find matching controls
Prone to confounders
Cross-sectional studies - describe and list positives and negatives
Collects data from a population at a specific point in time e.g prevalence of risk factors and disease itself
Good:
Quick and cheap
Provides data on prevalence at single time point
Bad:
Risk of reverse causality
Cannot measure incidence
Cohort studies - describe, list positives and negatives
Prospective study looking at outcomes of separate cohorts with different exposures or treatment
Good:
Can follow up group with rare disease
Good for common and multiple outcomes > establish disease risk of and confounders
Bad:
Long and expensive
People drop out
Needs large sample size
RCT - describe, list positives and negatives
Participants randomly assigned to exposure or control intervention
Good:
Low risk of bias and confounding factors
Can infer causality
Bad:
Time consuming
Expensive
Inclusion criteria can exclude populations
Describe ecological study
Looks at prevalence of disease over time
Cannot show causation
How to calculate odds
Divide probability of an event occurring by the probability of an event no occurring
How to calculate odds ratio
Compares the odds of an outcome between 2 groups
Usually group with exposure divided by control groups
Define measurement bias
Different equipment measuring differently
Define observer bias
Observers expectations influence reporting
Define recall bias
Past events not recalled correctly
Define reporting bias
People don’t tell the truth because of shame/judgement
Define selection bias
Bias in recruiting study and some may be lost to follow up
Publication bias
Trials with negative results less likely to be published
List 4 types of information bias
Measurement
Observer
Recall
Reporting
List the 9 Bradford-Hill criteria for causality
1) Strength - strong association between exposure and outcome
2) Temporality - exposure prior to outcome
3) Coherence - Logical consistency with other info
4) Consistency - same results from various studies
5) Plausibility - reasonable biological mechanism
6) Analogy - similar with other established cause-effect relationships
7) Dose response - increased risk of outcome with increased exposure
8) Reversibility - intervention to reduce outcome
9) Specificity - relationship specific to this outcome
Define confounders
The relationship between an exposure and an outcome is distorted because association of exposure with another factor is independently associated with the outcome
Give 5 reasons why results might suggest that exposure influences outcome
1) True association - confirm with Bradford-Hill criteria
2) Bias
3) Confounding factors
4) Chance
5) Reverse causality
Define epidemiology
The study of frequency, determinants and distribution of disease in populations in order to prevent and control disease
Define incidence
Number of new cases over a certain period of time
Define prevalence
The number of people with a disease at a certain point in time
Define person time
Measure of time at risk for all patients in a study e.g 1,000 patients studied for 2.5 years = 2,500 person years
Define risk
Number of new cases/number of people at risk of disease within a given time frame
Define relative risk
Risk among exposed group divided by risk in an unexposed group
Define absolute risk
Subtract risk of control group from exposed group - gives you excess risk causes by exposure
Define number needed to treat
1 divided by absolute risk
Define health behaviour and give example
Aimed at preventing disease e.g regular exercise
Define illness behaviour and give example
Aimed at seeking remedy e.g going to doctor
Define sick role behaviour and give example
Aimed at getting well e.g taking medication
Give 4 factors that influence perception of risk
Lack of personal experience of problem
Belief that it is preventable by personal action
Belief that if it has not happened by now it is not likely to
Belief that the problem is infrequent
What is a transition point, give 6 examples
Points at which interventions are thought to be most effective
Leaving school
Entering workforce
Becoming a parent
Becoming unemployed
Retirement
Bereavement
Models of behaviour change - describe the health belief model
Individuals change behaviour if they:
1) Believe they are susceptible to condition
2) Believe in serious consequences
3) Believe taking action reduces susceptibility
4) Believe that benefit of taking action outweighs cost
Models of behaviour change - describe the theory of planned behaviour model
Proposes best predictor of behaviour is intention
Intention is determined by attitude towards behaviour, subjective norm and perceived behaviour control
Models of behaviour change describe the transtheoretical model (stages of change)
1) Pre-contemplation
2) Contemplation
3) Preparation
4) Action
5) Maintenance
6) Relapse
Give a disadvantage of the health belief model of behaviour change
Doesn’t account for social cues, consider influence of emotion or differentiate between first time and repeat behaviour
Give an advantage of the theory of planned behaviour model of behaviour change
Takes into account social influence
Useful for predicting intention but not actual behaviours
What are the advantages and disadvantages of the transtheoretical model of behaviour change?
+
Acknowledges different stages of readiness
Allows relapse
-
People may skip stages
Doesn’t take cultural views into account
What are 4 principles of treating drug use?
Reduce harm to user, friends and family
Improve health
Stabilise life
Reduce crime
What can you offer a newly presenting drug user?
Screening for blood borne viruses
Health check
Sexual health advice/contraception
Check immunisation history
Signpost to drug services
Define positive and negative conditioning in drug use
Positive - addiction increases desire to use drug
Negative - people don’t quit due to unpleasant symptoms
Heroin - mechanism of action
Acts on opiate receptors
Describe opiate detox
Methadone helps transition
Naltrexone and buprenorphine also used
Cocaine/crack - mechanism of action, symptoms
Blocks reuptake of serotonin > intense pleasure
Depletion at neurons > anxiety, panic, paranoia adrenaline secretion (wired). Leads to depression
List Maslow’s hierarchy of needs
1) Self-actualisation - achieving full potential
2) Esteem needs - feeling of accomplishment
3) Belonging and love needs
4) Safety needs - security, safety
5) Physiological needs - food, water, rest, sex
Describe the difference between an asylum seeker and refugee
Asylum seeker - applying for refugee status
Refugee - been granted asylum status, usually lasts 5 years
What healthcare barriers do refugees experience?
Reluctance of GPs to register them
Communication
Lack of permanent home
Mistrust of professionals
What healthcare can people with refused asylum seekers claim receive?
Emergency
Will be charged after
What do asylum seekers receive?
Vouchers to life off
NASS support package
Access to NHS
Not allowed to work initially
Define malnutriton
Deficiencies, excesses or imbalances in intake of energy/nutrients
Define 2 domains of malnutrition
Undernutrition - includes stunting, wasting, underweight, micronutrient deficiencies
Overweight
Define triple burden of malnutrition
Undernutrition, overnutrition and micronutrient deficiencies co-existing in the same population
4 dimensions of food insecurity?
1) Availability (affordability) of food
2) Access - economic and physical
3) Utilisation - opportunity to prepare food
4) Stability of the above three over time
Give 7 types of error that can occur in practice
Sloth error - being lazy, not checking results for accuracy
Lack of skill
Communication breakdown - not listening to others
System failure - faulty equipment
Human factors - bravado, timidity
Neglect
Misconduct
Give 3 strategies to reduce risk of errors
1) Team training
2) Checklists
3) Simplification and standardisation of clinical practice
4 part of negligence?
1) Was there a duty of care?
2) Was there a breach in that duty?
3) Was the patient harmed?
4) Was the harm due to the breach of care?
Bolam and Bolitho questions of negligence
Bolam - would a group of reasonable doctors do the same?
Bolitho - would that be reasonable?
Define never event
Serious, largely preventable patient safety incidents that should not occur if available preventative measures are in place e.g cutting off wrong leg
Gives 2 approaches to error
Person - holds one person accountable
System - identifies latent errors in the system
Give 4 professionals involved in health needs assessment
Community nurses
GP
Public health officials
Mental health practitioners
Give 2 barriers homeless people face when accessing healthcare
Indirect costs e.g transport
Judgement/maltreatment from HCPs
Give 3 practical strategies to reduce risks associated with IV drug use
Avoid sharing needles
Avoid mixing drugs
Rotate injection site
How to calculate relative risk reduction
1 - relative risk
