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Public health Flashcards

1
Q

Define public health

A

The science and art of preventing disease, prolonging life and improving health through organised efforts of society

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2
Q

Define equity

A

Giving people what they need to achieve equal OUTCOMES

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3
Q

Define equality

A

Giving everyone the same rights, OPPORTUNITIES and resources

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4
Q

Define horizontal equity

A

Equal treatment for people with equal health care needs

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5
Q

Define vertical equity

A

Unequal treatment for unequal healthcare needs

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6
Q

Inverse care law?

A

Availability of health care tends to vary inversely with its need

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7
Q

Mnemonic to remember determinants of health

A

PROGRESS
Place of residence
Race
Occupation
Gender
Religion
Education
Socio-economic

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8
Q

What are the 3 domains of public health?

A

Health improvement - preventing disease, promoting health and reducing inequalities

Health protection - measures to control infectious diseases and environmental hazards

Improving services

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9
Q

3 As and 3 Es of Maxwell’s dimensions of assessing quality of healthcare

A

Acceptability
Accessibility
Appropriateness
Effectiveness
Efficiency
Equity

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10
Q

Give an example of need, demand and supply

A

Antibiotics for a mild infection - supplied, demanded but not needed

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11
Q

Give 4 types of need

A

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

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12
Q

Perspectives of health needs assessment - describe epidemiological approach, give positives and negatives

A

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

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13
Q

Perspectives of health needs assessment - describe comparative approach, give positives and negatives

A

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

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14
Q

Perspectives of health needs assessment - describe corporate approach, give positives and negatives

A

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

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15
Q

Describe egalitarian approach to resource allocation - give positive and negative

A

Provide all care that is necessary and required by everyone

Good - equal
Bad - expensive

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16
Q

Describe maximising approach to resource allocation - give positive and negative

A

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

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17
Q

Describe libertarian approach to resource allocation - give positive and negative

A

Each is responsible for their own health

Good - promotes engagement
Bad - most diseases are not self inflicted

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18
Q

Define primary prevention and give example

A

Preventing disease form occurring in the first place e.g vaccine

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19
Q

Define secondary prevention and give example

A

Early identification of disease to alter disease course e.g screening

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20
Q

Define tertiary prevention

A

Limit consequences of an established disease e.g preventing worsening renal function in CKD

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21
Q

Describe the population approach to disease prevention and give example

A

Deliver approach to everyone to shift risk factor distribution curve

e.g dietary salt reduction through legislation

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22
Q

Describe the high risk approach to disease prevention and give example

A

Identify individuals above chosen cut off and treat them e.g screening for high blood pressure and treating

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23
Q

Describe the prevention paradox

A

A preventative measure which brings benefit to the population offers little impact to the individual

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24
Q

What is the purpose of screening?

A

To identify apparently well individuals who have/are at risk of a particular disease so that you can impact the outcome

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25
Give 5 benefits of screening
Reproductive choice Worthwhile use of resources > more cost effective Informed decision Reassurance More effective treatment > better prognosis
26
Give 6 negatives of screening
Harm from tests Over treatment Treatment risks Difficult decisions Anxiety/false reassurance Incorrect results
27
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
28
Give 3 screening programmes in neonates
NIPE Newborn hearing screening programme Blood spot screening programme - CF, sickle cell, congenital hypothyroidism
29
Give 5 screening programmes in young people and adults
AAA Bowel cancer Breast cancer Cervical cancer Diabetic eye
30
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
31
Define sensitivity
Proportion of those with the disease who are correctly identified
32
Define specificity
Proportion of people without the disease who are correctly excluded
33
Define positive predictive value
Proportion of people with a positive test result who have the disease
34
Define negative predictive value
Proportion of people with a negative test result who don't have the disease
35
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
36
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
37
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
38
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
39
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
40
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
41
Describe ecological study
Looks at prevalence of disease over time Cannot show causation
42
How to calculate odds
Divide probability of an event occurring by the probability of an event no occurring
43
How to calculate odds ratio
Compares the odds of an outcome between 2 groups Usually group with exposure divided by control groups
44
Define measurement bias
Different equipment measuring differently
45
Define observer bias
Observers expectations influence reporting
46
Define recall bias
Past events not recalled correctly
47
Define reporting bias
People don't tell the truth because of shame/judgement
48
Define selection bias
Bias in recruiting study and some may be lost to follow up
49
Publication bias
Trials with negative results less likely to be published
50
List 4 types of information bias
Measurement Observer Recall Reporting
51
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
52
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
53
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
54
Define epidemiology
The study of frequency, determinants and distribution of disease in populations in order to prevent and control disease
55
Define incidence
Number of new cases over a certain period of time
56
Define prevalence
The number of people with a disease at a certain point in time
57
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
58
Define risk
Number of new cases/number of people at risk of disease within a given time frame
59
Define relative risk
Risk among exposed group divided by risk in an unexposed group
60
Define absolute risk
Subtract risk of control group from exposed group - gives you excess risk causes by exposure
61
Define number needed to treat
1 divided by absolute risk
62
Define health behaviour and give example
Aimed at preventing disease e.g regular exercise
63
Define illness behaviour and give example
Aimed at seeking remedy e.g going to doctor
64
Define sick role behaviour and give example
Aimed at getting well e.g taking medication
65
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
66
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
67
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
68
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
69
Models of behaviour change describe the transtheoretical model (stages of change)
1) Pre-contemplation 2) Contemplation 3) Preparation 4) Action 5) Maintenance 6) Relapse
70
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
71
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
72
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
73
What are 4 principles of treating drug use?
Reduce harm to user, friends and family Improve health Stabilise life Reduce crime
74
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
75
Define positive and negative conditioning in drug use
Positive - addiction increases desire to use drug Negative - people don't quit due to unpleasant symptoms
76
Heroin - mechanism of action
Acts on opiate receptors
77
Describe opiate detox
Methadone helps transition Naltrexone and buprenorphine also used
78
Cocaine/crack - mechanism of action, symptoms
Blocks reuptake of serotonin > intense pleasure Depletion at neurons > anxiety, panic, paranoia adrenaline secretion (wired). Leads to depression
79
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
80
Describe the difference between an asylum seeker and refugee
Asylum seeker - applying for refugee status Refugee - been granted asylum status, usually lasts 5 years
81
What healthcare barriers do refugees experience?
Reluctance of GPs to register them Communication Lack of permanent home Mistrust of professionals
82
What healthcare can people with refused asylum seekers claim receive?
Emergency Will be charged after
83
What do asylum seekers receive?
Vouchers to life off NASS support package Access to NHS Not allowed to work initially
84
Define malnutriton
Deficiencies, excesses or imbalances in intake of energy/nutrients
85
Define 2 domains of malnutrition
Undernutrition - includes stunting, wasting, underweight, micronutrient deficiencies Overweight
86
Define triple burden of malnutrition
Undernutrition, overnutrition and micronutrient deficiencies co-existing in the same population
87
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
88
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
89
Give 3 strategies to reduce risk of errors
1) Team training 2) Checklists 3) Simplification and standardisation of clinical practice
90
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?
91
Bolam and Bolitho questions of negligence
Bolam - would a group of reasonable doctors do the same? Bolitho - would that be reasonable?
92
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
93
Gives 2 approaches to error
Person - holds one person accountable System - identifies latent errors in the system
94
Give 4 professionals involved in health needs assessment
Community nurses GP Public health officials Mental health practitioners
95
Give 2 barriers homeless people face when accessing healthcare
Indirect costs e.g transport Judgement/maltreatment from HCPs
96
Give 3 practical strategies to reduce risks associated with IV drug use
Avoid sharing needles Avoid mixing drugs Rotate injection site
97
How to calculate relative risk reduction
1 - relative risk
98

Public health (1 decks)

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