Public Health Flashcards
When considering the patient in context, what factors should you be thinking about?
Individuals, Families, Communities
Age, Gender, Culture, Education, Employment
Origins
Well-being and health vs disease and illness
What is Maslow’s Hierarchy of needs?
A 5-tier model of human needs. People are motivated to achieve certain needs; some needs take precedence over others.
What are the 5 factors that comprise Maslow’s hierarchy of human needs?
1.Self-actualization: desire to become the most that one can be
2.Esteem: respect, self-esteem, status, recognition, freedom
3.Love + belonging: friendship, intimacy, family, sense of connection
4.Safety needs: personal security, employment, resources, health, property
5.Physiological needs: air, water, food, shelter, sleep, clothing, reproduction
Give a definition for ‘Domestic Abuse’.
An incident - or pattern of incidents - of controlling, coercive, threatening behaviour, violence or abuse between those aged 16 or over who are, or have been, intimate partners or family members regardless of gender or sexuality.
The abuse can encompass, but is not limited to:
- psychological
- physical
- sexual
- financial
- emotional
Give 3 ways in which domestic abuse impacts on health.
1.Traumatic injuries following an assault
eg. fractures, miscarriages, facial injuries, puncture wounds, haemorrhages
2.Somatic problems or chronic illness consequent of living with abuse
eg. Chronic pain, low birthweight, premature delivery
3.Psychological / psychosocial problems secondary to abuse
eg. PTSD, attempted suicide, substance misuse, depression, anxiety, eating disorders
What are the ‘best’ indicators in identifying domestic abuse when taking a history in A+E?
Reported as ‘unwitnessed by anyone else’
Repeat attendance
Delay in seeking help
Multiple, minor injuries not requiring treatment
Always consider domestic abuse as a cause.
How might domestic abuse affect a child?
Affects physical + psychological health + well being - a long term impact on self esteem, education, relationships and stress responses
What is the link between pregnancy + domestic abuse?
Domestic abuse often starts / escalates during pregnancy. Always consider your safeguarding responsibilities.
What is your role in the management of domestic abuse?
Display helpline posters
Focus on patient’s safety (+ child’s safety, if applicable)
Ask direct questions
Listen in a non-judgmental manner
Give information and refer where appropriate
Work with other agencies + professionals
Ensure the safety of any children in the household
What should you not do if someone discloses domestic abuse to you?
Assume someone else will take care of things
Ask about domestic abuse in front of family members (including kids!!!!!)
Tell them what to do -> aim to empower them to make safe + informed choices.
If a patient is considered to be at ‘medium’ risk with regards to Domestic Abuse, what does this mean?
There are identifiable indicators of risk of serious harm - offender has the potential to cause serious harm, but unlikely unless change in circumstances
If a patient is considered to be at ‘standard’ risk with regards to Domestic Abuse, what does this mean?
Current evidence does not indicate likelihood of serious harm being caused.
If a patient is considered to be at ‘high’ risk with regards to Domestic Abuse, what does this mean?
There are identifiable (risk factors) indicators of imminent risk of serious harm
Dynamic: harm could happen at any time + the impact would be serious.
Which risk assessment is used for Domestic Abuse?
DASH Tool: Domestic Abuse, Stalking, Harassment + ‘Honour’ based violence
What is the risk assessment for domestic abuse designed to do?
Questionnaire used to identify + assess risk of DASH, such that measures can be put in place to protect the patient and any children who may be at risk
If a person is considered to be ‘standard’ or ‘medium’ risk with regards to Domestic Abuse, what should you do?
Give contact details for domestic abuse services
National Helpline is 24hrs
Sheffield Helpline: Mon-Fri 9-5
Keep good records
Ensure follow up
If a patient is considered to be ‘high risk’ of domestic abuse, what action should you take?
Refer to MARAC (Multi-Agency Risk Assessment Conference) -> wherever possible, with consent
Refer to IDVA (Independent Domestic Violence Advisors)
True or False: for high risk cases, you can break confidentiality (to take to MARAC) if you cannot gain consent.
True
What is ‘MARAC’ and what does it do?
Multi-Agency Risk Assessment Conference
links up-to-date information about victims’ needs + risks directly to the provision of appropriate services for all those involved
incl. victim, child(ren), perpetrator
What is ‘IDVA’ and what do they do?
Independent Domestic Violence Advisors:
Works with DV victims at the highest level of risk. Aim to increase patient’s safety by providing:
- advocacy + advice around domestic abuse
- safety planning
- support through court proceedings
- sign posting to specialist services
What specialist services might an IDVA sign post victims of domestic abuse to?
Housing services
Legal services
Refuge provision + home safety services
a voice in the MARAC
When would a Domestic Homicide Review be undertaken?
A review of the circumstances in which the death of a person aged 16 or over has, or appears to have, resulted from violence, abuse or neglect by:
a) a person to whom s/he was related or with whom s/he was or had been in an intimate personal relationship OR;
b) a member of the same household as himself
Held with a view to identifying lessons to be learned from the death.
List 4 determinants of health according to the Lalonde Report?
Genes
Environment
- physical environment
- social + economic environment
Lifestyle
Healthcare
What is ‘equity’?
What is fair and just
What is equality?
Concerned with equal shares
What are the two types of equity?
Horizontal equity: equal treatment for equal need
Vertical equity: unequal treatment for unequal need.
Define Horizontal Equity. Give an example of horizontal equity in practice.
Equal treatment for equal need.
eg. Individuals with pneumonia (with all other things equal) should be treated equally.
Define Vertical Equity. Give an example of vertical equity in practice.
Unequal treatment for unequal need.
eg. individuals with the common cold vs pneumonia need unequal treatment.
eg. Areas with poorer health may need higher expenditure on health services
What is the idea underlying health equity?
Equal expenditure for equal need
Equal access for equal need
Equal utilisation for equal need
Equal healthcare outcome for equal need
This results in: equal health
What are the 2 dimensions of health equity?
- Spatial -> geographical
- Social -> age, gender, class, ethnicity
What are some outcomes that can be measured to determine health equity?
Supply of healthcare
Access to healthcare
Utilisation of healthcare
Healthcare outcomes
Health status
Resource allocation - health services, housing services
Wider determinants of health - prevalence of smoking, drinking etc
How would you assess health equity?
Assess inequality, then decide if inequitable.
What are the 3 domains of Public Health practice?
Health improvement - education, housing, employment
Health protection - radiation, immunisation, emergency response, environment
Health care - clinical effectiveness, efficiency, audit, clinical governance
What comprises ‘Health Improvement’?
Societal interventions aimed at preventing disease, promoting health + reducing inequalities.
housing
lifestyle
education
employment
family / community
What is ‘Health Protection’ concerned with? What does it comprise?
Concerned with measures to control infectious disease risks + environmental hazards
Infectious diseases
Radiation
Environmental health hazards
Chemicals + poisons
Emergency response
What is ‘Health Care’ in terms of the 3 concerns of public health? What does it comprise?
Concerned with the organisation, and delivery of safe, high quality services for prevention, treatment + care
clinical effectiveness
audit + evaluation
clinical governance
efficiency
service planning
equity
At what levels might public health be delivered?
Individual level
Community level
Ecological (population) level
What is meant by ‘health psychology’ as applied to public health?
Emphasises the role of psychological factors in the cause, progression + consequences of health + illness. Used to promote healthy behaviours + prevent illness
What are the 3 health behaviours?
Health behaviour
Illness behaviour
Sick role behaviour
What is meant by ‘Health behaviour’? (In the context of health, illness and sick role)
A behaviour aimed at preventing disease eg. eating healthily
What is meant by ‘Illness behaviour’?
A behaviour aimed at seeking a remedy. eg. going to a doctor.
What is meant by ‘Sick role behaviour’?
Any activity aimed at getting well eg. taking prescribed medications, resting
Give some examples of health damaging / impairing behaviours.
Smoking
Alcohol + substance abuse
Sun exposure
Risky sexual behaviour
Driving without a seat belt
Give some examples of health promoting behaviours.
Exercising
Healthy eating
Medicines compliance
Vaccinations
Attending health checks
Why is health behaviour an issue in the general population?
Reduction in quality of life
Working days lost to sickness
Morbidity is an issue –> Diabetes, CHD etc.
What is the aim of a population-level health promotion intervention? What does it comprise?
The process of enabling people to exert control over the determinants of health, thereby improving public health and reducing inequalities across the population. Includes awareness campains, screening and immunisations.
What is the aim of an individual-level health promotion intervention? What does it comprise?
Patient-centred approach - care responsive to individual needs
Give some examples of health promotion / awareness campaigns.
Change 4 life
5 a day
Stoptober
Movember
Dry January
Give some examples of health promotion campaigns which promotes screening + immunisations.
Smears, school vaccines, national vaccine program
How would a primary care intervention to reduce alcohol consumption affect an individual’s behaviour?
decrease level of alcohol consumption
could improve domestic violence if present
improve individual health outcomes
How would a primary care intervention to reduce alcohol consumption affect the local community?
Decreased local alcohol sales
Decreased alcohol-related crime
Fewer A+E events
How would a primary care intervention to reduce alcohol consumption affect the population level of alcohol usage?
National alcohol + sales consumption
National statistics on alcohol-related crime / A+E events
Demographic patters of liver cirrhosis.
Explain the concept of ‘unrealistic optimism’ as applied to health behaviours.
Individuals continue to practice health damaging behaviour due to inaccurate perceptions of risk + susceptibility.
What is the greatest single cause of illness + premature death in the UK?
Smoking
What is NCSCT? What’s it’s purpose?
National Centre of Smoking Cessation Training
delivers training + assessment programmes
provides support services for local + national providers
conducts research into behavioural support for smoking cessation
provides stop smoking services with a measure of quality assurance.
What factors are involved in the ‘Planning Cycle’?
Needs assessment
Planning
Implementation
Evaluation
What is ‘need’? (as applied to Public Health)
The ability to benefit from an intervention.
What is ‘demand’? (as applied to Public Health)
What people ask for.
What is ‘supply’? (as applied to Public Health)
What is provided.
What is a ‘Health Needs Assessment’?
“A systematic method for reviewing health issues facing a population, leading to agreed priorities and resource allocation that will improve health + reduce inequalities.”
A health needs assessment is usually used to cover both ‘Health Needs’ and ‘Healthcare Needs’ assessments.
What is ‘Health Need’?
Need for health
Concerns ‘need’ in more general terms
Measured using mortality, morbidity, sociodemographic measures
Incudes social environmental factors such as housing, diet, education, and employment. Does not necessarily include seeking medical interventions.
What is ‘Health Care Need’?
Need for healthcare
Much more specific than ‘health need’
Ability to benefit from healthcare
Depends on the potential of prevention, treatment + care services to remedy health problems
Health need is much broader - a broad category that encompasses environmental and social factors like housing, diet, education, and employment
Who / what might a health needs assessment be carried out for?
a population or subgroup eg. patients at a specific GP surgery
a condition eg. COPD
an intervention eg. Coronary Angioplasty
Who defines ‘need’?
Individual
Family
Community
Society
Professionals
What are the 2 ways in which a ‘Health Needs Assessment’ can be approached?
Sociological perspective (Bradshaw’s)
Public health perspective
What 4 factors comprise the Sociological Perspective for a Health Needs Assessment? (Bradshaw’s taxonomy of social need)
Felt need: individual perceptions of variation from normal health
Expressed need: individual seeks help to overcome variation in normal health (demand, use of health services).
Normative need: professional defines intervention appropriate for the expressed need. (these can either be met or unmet, based on supply)
Comparative need: comparison between severity, range of interventions + cost.
Name 3 public health approaches to Health Needs Assessments?
Epidemiological
Comparative
Corporate
Explain the Epidemiological Approach to Health Needs assessment.
The traditional method of conducting a health needs assessment - epidemiological methods can be used to describe health needs in terms of the distribution of specific diseases.
Statement of the problem: defines the person affected by the problem, the place of the problem, the time of the problem
Size of problem: incidence / prevalence
Impact of problem: morbidity and mortality, life expectancy
Data comes from: registry, hospital admissions, GP databases, mortality data, primary data collection
Services available for the problem: prevention / treatment / care
Evidence base: effectiveness / cost-effectiveness
Models of care: incl. quality + outcome measures
Existing services: unmet need, services not needed
List 4 problems with an Epidemiological approach to Health Needs Assessment.
Reinforces the biomedical model
Required data may not be available
Variable data quality
Evidence base may be inadequate
Requires staff to be trained in data analysis
Does NOT consider ‘felt needs’ of people affected
Explain the Comparative Approach to Health Needs Assessment.
Compares services received by a population (or subgroup) with other populations, to identify variation in performance, cost and service use
> can be spatial (different towns)
> can be social (two age groups in the same town)
May examine:
Service access
Service provision
Service utilisation
Health outcomes: mortality, morbidity, QoL, Patient satisfaction
List 4 problems with the Comparative approach to Health Needs Assessment.
May not yield what the most appropriate level of provision or utilisation should be
Data may not be available
Data may be of variable quality
May be difficult to find a comparable population.
Explain the Corporate approach to Health Needs Assessment (who does it involve?).
Asking the local population what their health needs are - structured collection of knowledge and views of the stakeholders
Use of focus groups, interviews and public meetings.
Wide variety of stakeholders, such as teachers, healthcare workers, social workers, charity workers, local businesses, council workers, politicians, patients, parents
Based on the demands, wishes and perspectives of the parties involved, and recognises the importance of their experiences.
List 4 problems with a corporate approach to health needs assessment
May be difficult to distinguish need from demand
Groups may have vested interests
May be influenced by political agendas
Dominant personalities may have undue influence.
Give some reasons for homelessness.
Relationship breakdown caused by:
Unemployment
Mental illness / breakdown
Fleeing domestic abuse
Disputes with parents
Bereavement -> ‘no family ties’
Loss of home - fire, natural disaster
Prison leavers, ex-forces, care leavers
List some health problems faced by homeless adults
Infectious diseases eg. Hepatitis, TB
Poor condition of feet + teeth
Respiratory problems
Injuries following violence
Sexual health -> smears, contraception
Serious mental illness -> schizophrenia, depression
Poor nutrition
Addictions / substance misuse
Describe the ‘needs of children’ with regards to social + health.
Stability + emotional security
Safety
Immunisations
School
Play, friends, toys
Give 3 barriers to healthcare that might prevent the socially excluded from seeking medical attention
Access difficulties
- Language barriers
- Opening times
- Being housebound/non-mobile
- Perceived or actual discrimination
- Not being able to use phone/website
- Not being able to afford taxi/bus to get there
Lack of integration between mainstream care services + other agencies eg. social services, criminal justice system.
Other things on their mind
- people do not prioritise health when there are more immediate survival issues.
Gypsies and travellers experience poorer health than the general population. List some barriers to healthcare they may experience.
Reluctance of GPs to register gypsies + travellers and to visit sites
Poor reading + writing skills -> many are illiterate
Communication difficulties
Too few permanent + transient sites
Mistrust of professionals
Lack of choice
What is HASS?
Homeless Assessment and Support Service
Who comprises the HASS?
Mental health support workers
Community practice nurse
Specialist school nurse
Outreach family resource worker
Specialist midwife
Specialist community outreach nurses
Health visitor
Define ‘refugee’.
An adult or child who fits the 1951 Geneva Convention description that:
‘Owing to a well founded fear of being persecuted for reasons of race, religion, nationality etc. is unable or unwilling to accept the protection of that country.’ Their asylum claim has been approved and they have indefinite leave to remain.
Define ‘asylum seeker’.
Someone who has submitted an application to be recognised as a refugee + is waiting for their claim to be decided by the Home Office.
Who has the right to apply for asylum in the UK?
Anyone has the right to apply for asylum in the UK + remain until a final decision on their application has been made.
When a refugee is granted ‘indefinite leave to remain’, what does this mean?
When a person is granted full refugee status + given permanent residence in the UK.
They have all the rights of a UK citizen.
they are eligible for family reunion (one spouse, and any child of that marriage under the age of 18).
What are asylum seekers entitled to?
Entitled to Money: £49.18 / week
Entitled to housing: no choice dispersal
Entitled to NHS care
> if under 18, are allocated a social services key worker + can go to school
Asylum seekers are not allowed to work; are not entitled to any other form of benefit.
Failed asylum seekers are not entitled to any of the above, apart from the NHS. They can still access emergency care and primary care, but free secondary care is only accessible under very specific circumstances. They can access maternity care if they had started it before their claim was denied.
Why might asylum seekers find it difficult to access health care services?
Language / culture / communication barriers
Lack of knowledge re: where to get help
Health is not a priority.
What state of physical health might an asylum seeker be in?
Injuries from war / torture / sexual abuse / travelling
Malnutrition
Illness specific to country of origin
What state of psychological health might an asylum seeker be in?
Psychological distress = common
Note: psychological expression is culture-bound -> potential for misdiagnosis
What mental health disorders might an asylum seeker have / be diagnosed with?
PTSD
Depression -> medication / counselling
Sleep disturbance
Psychosis
Self harm
List some health needs of Asylum Seekers
Rapid access
Screening
Catch up programmes / immunisations / child assessments
Education for asylum seekers + professionals
Mental health expertise
Supporting evidence for asylum hearings.
Give short definitions for:
i) Asylum seeker
ii) Refugee
iii) Humanitarian protection
i) A person who has made an application for refugee status
ii) A person granted asylum + refugee status. Usually means leave to remain for 5 years, then reapply.
iii) Failed to demonstrate claim for asylum (their situation doesn’t meet criteria set by the UN) but still face serious threat to life if returned. Usually 3 years, then reapply.
Define ‘an unaccompanied asylum-seeking child’.
Someone who has crossed an international border in search of safety + refugee status
Is applying for asylum in his / her own right
Is under 18, or - in the absence of documentary evidence - appears to be under 18.
Is without family members or guardians to turn to in this country.
What are the physical consequences of loneliness?
Earlier death
Take more risks
Harder to self regulate
Physical changes which can bring on poor health.
Health risk (due to loneliness) is equivalent to 15 cigarettes / day.
What signs might a patient exhibit if they are lonely?
Body language, appearance, talkative, clinging
Denial, ‘boredom’
Live alone
Male 50+
Bereavement / recent transition
Limited mobility
Sensory impairment
Quality, not quantity, of social contact
Why are older men at risk of social isolation / loneliness?
Men have less social contact than women.
Men are less likely to share their feelings or seek help for mental health issues.
Poor health, lower incomes, few qualifications, living in rented housing -> all are risk factors for loneliness.
Define ‘social exclusion’.
The dynamic process of being shut out, fully or partially, from any of the social, economic, political, or cultural systems which determine the social integration of a person in a society.’
What are the 5 domains of social exclusion?
Material resources
Civic activities
Basic services
Neighbourhood
Social relationships
Give some causes of social exclusion.
Poor health
Sensory impairment
Poverty / housing issues
Transport / problems on the roads
Discrimination -> sexuality, gender, ethnicity, belief
Give 2 examples of national initiatives to tackle social exclusion / loneliness.
Age UK
Dementia Friends
Give 2 Sheffield examples of initiatives to tackle social exclusion / loneliness.
Age UK 50+ club / Active Sheffield
Darnall Dementia Care
Give 4 Models of Behaviour Change
Health Belief Model
Theory of planned behaviour
Transtheoretical Model
Motivational interviewing
Social norms theory
Nudging (choice architecture, e.g. fruits and veg near the till)
Financial incentives
Explain the theory behind the Health Belief Model:
Individuals will change if they believe:
they are susceptible to the condition
that the disease has serious consequences
that taking action reduces susceptibility
that the benefits of taking action outweigh the costs.
Cues to action may also be present
Critique the Health Belief Model:
Alternative factors may predict health behaviour (outcome expectancy, aka whether someone feels their behaviour will make them healthier, and self efficacy)
HBM doesn’t consider the influence of emotions on behaviour
HBM doesn’t differentiate between 1st time and repeat behaviour
In the Health Belief Model, what has been demonstrated to be the most important factor in addressing behaviour change?
Perceived barriers have been demonstrated to be the most important factor for addressing behaviour change in patients.
Explain the ‘Theory of Planned Behaviour’.
Proposes the best predictor of behaviour is ‘intention’
Intention is determined by:
> a person’s attitude to the behaviour
> the perceived social pressure to undertake the behaviour, or “subjective norm”
> a person’s appraisal of their ability to perform the behaviour, or their perceived behavioural control.
Critique the Theory of Planned Behaviour.
Lacks direction or causality or temporal element
Doesn’t account for emotions eg. fear, threat, positive affect etc. which might disrupt ‘rational’ decision making.
Habits + routines bypass cognitive deliberation + undermine a key assumption of the model.
Relies on self-reported behaviour.
Doesn’t account for the intention-behaviour gap
In the theory of planned behaviour, what impacts people’s ability to act on their intentions?
Perceived control
Anticipated regret
Preparatory actions (dividing a task into subgoals improves behaviour)
Implementation intentions (i-then plans)
Relevance to self
Give 3 advantages of the transtheoretical model / ‘Stages of Change’ model:
Acknowledges individual stages of readiness (tailored interventions)
Accounts for relapse
Temporal element (although arbitrary)
Give 3 disadvantages of the transtheoretical model / stages of change model.
Not all people move through every stage.
Arbitrary lines are drawn between stages
- change might operator on a continuum, rather than in discrete stages
Doesn’t take into account values, habits, culture, social + economic factors
Summarise the transtheoretical model / stages of change model.
Examines the process of change, rather than factors that determine behaviour.
Allows for interventions to be tailored to the individual according to what stage they are at.
Summarise ‘Motivational Interviewing’ as a theory of behaviour change.
A counselling approach -> initiates behaviour change by resolving ambivalence.
Clinical impact has been shown in problem drinkers or substance abusers.
Aside from the recognised models, what factors might influence a person’s ability to change their behaviour(s)?
Impact of personality traits on health behaviour
Assessment of risk perception
Impact of past behaviour / habit
Automatic influences on health behaviour
Ability to maintain the behaviour
Social environments
What does the NICE guidance say about behaviour change and transition points?
Interventions to change health related behaviour should work in partnership with individuals, communities, organisations + populations.
Typical transition points include:
> leaving school
> entering the workforce
> becoming a parent
> becoming unemployed
> retirement + bereavement
Define ‘evaluation’ of health services.
The assessment of whether a service achieves its objectives; assessment of a wide range of health-related activities.
What 3 components make up Donabedian’s ‘Framework for Health Service Evaluation’?
Structure
Process (+ output)
Outcome
What is ‘Process’ - part of the Framework for Health Service Evaluation - concerned with?
“Process denotes the transactions between patients and providers throughout the delivery of healthcare”
What is done?
eg.
Number of patients seen in A+E
The process through which patients go in A+E.
What is ‘Outcome’ - part of the Framework for Health Service Evaluation - concerned with?
Classification of health outcomes: (the 5Ds: death, disease, disability, discomfort, dissatisfaction)
Mortality eg. 30 day mortality rate
Morbidity eg. Complication rates
Quality of life / PROMs (Patient Reported Outcome Measures)
Patient satisfaction
List Maxwell’s Dimensions of Quality (as applied to Quality of Healthcare). (3As and 3Es)
Effectiveness: does the intervention produce the desired effect?
Efficiency: is the output maximised for a given input?
Equity: are patients being treated fairly
Acceptability: how acceptable is the service offered to the people needing it?
Accessibility: is the service provided? Geographical access; costs for patients, information available, waiting times.
Appropriateness: is the right treatment being given to the right people at the right time? Overuse / Underuse / Misuse?
Give examples of qualitative methods of evaluating healthcare services.
Consult relevant stakeholders eg. patients, staff, relatives
Qualitative methodology:
> Observation
> Interviews
> Focus groups
> Review of documents
Give examples of quantitative methods of evaluating healthcare services.
Routinely collected data - hospital admissions, mortality
Review of records - e.g. medical, administrative
Surveys
Clinical audits
Special studies eg. using epidemiological methods.
Give some general principles to consider when evaluating Health Services.
May be prospective OR retrospective
Define what the service is / what it includes
What are the aims / objectives of the service?
Framework, Structure, Process, Outcome
Methodology used -> qualitative / quantitative / mixed methods
Results, conclusions + recommendations
Define ‘malnutrition’.
Deficiencies, excesses, or imbalances in a person’s energy &/or nutrient intake. Covers undernutrition, overweight and obesity. triple burden = micronutrient deficiencies (hidden hunger)
What are some of the consequences of undernutrition?
Stunting: low height for age
Wasting: low weight for height
Underweight: low weight for age
Micronutrient deficiencies / insufficiencies -> a lack of important vitamins + minerals.
What are some of the consequences of being overweight?
Obesity
- Diet-related non-communicable diseases eg. Heart disease, stroke, diabetes, cancer
Give examples of early influences on feeding behaviour.
Maternal diet + taste preference development - amniotic fluid is influenced by maternal diet, so in utero environment influences taste exposure
Breast feeding - for taste preference + body weight regulation
Parenting practices
How does the maternal diet lead to early flavour exposure for the baby in utero?
Baby’s taste + olfactory systems can detect flavour information prior to birth
Amniotic fluid + human milk transmit volatiles from the maternal diet, providing early chemosensory experience.
How might breast feeding be considered to be a public health issue?
Prevalence of breastfeeding is particularly low among very young mothers + disadvantages socio-economic groups, potentially widening existing health inequalities.
What are the 3 components of breast milk?
Colostrum
Foremilk
Hindmilk
Describe the composition of colostrum.
High protein
Low fat
Contains lots of antibodies
Delivers nutrients in a very concentrated, low volume form
Mild laxative effect -> encourages bowel movements.
Give 4 properties of breast milk which are beneficial for the baby.
Anti-infective: bifidus factor, white cells, oligosaccharides
Efficient digestion: contains enzymes eg. lipase, lysozyme
Gut protection: epidermal growth factor, secretory IgA, anti-inflammatories
Everyday health: antibodies, viral fragments, lactoferrin (aids dental hygiene)
How might parents influence positive feeding behaviours?
Modelling ‘healthful’ eating behaviours
Responsive feeding: recognizing hunger + fullness cues
Providing a variety of foods
Avoid pressure to eat
Not using food as a reward
Indulgent / neglectful feeding practices.
What is ‘chemical continuity’ with regards to feeding behaviours?
Transmission of certain flavours from the maternal diet via amniotic fluid + then breast milk.
What are the 3 distinct illnesses encompassed by ‘eating disorders’?
Anorexia nervosa
Bulimia nervosa
Binge eating disorder
Define ‘eating disorder’
Clinically meaningful behavioural or psychological pattern having to do with eating or weight that is associated with distress, disability, or with substantially increased risk of morbidity or mortality.
Define ‘disordered eating’.
Restraint, strict dieting, disinhibition, emotional eating, binge eating, night eating, weigh + shape concerns, inappropriate compensatory behaviours that do not warrant a clinical diagnosis.
What are the 3 basic forms of dieting?
Restrict the total amount of food eaten
Do not eat certain types of food
Avoid eating for long periods of time
What are the problems with dieting?
Dieting is a risk factor for developing eating disorders
Dieting results in a loss of lean body mass, not just fat mass.
ieting can be difficult to stick to - people often relapse back into unhealthy behaviours.
Dieting slows metabolic rate + energy expenditure
Chronic dieting may disrupt ‘normal’ appetite responses + increase subjective sensations of hunger.
Why is dieting so difficult for some patients? (cues)
Those susceptible to obesity (and who try to diet) appear particularly:
I) unresponsive to internal cue that signal satiety (when overconsuming) + hunger (when dieting)
ii) vulnerable to external cues that signal availability of palatable food.
What is the prevention paradox?
A preventative measure which brings much benefit to the population but offers little to
each participating individual” E.g. If all male British doctors wore their car seat belts on
every journey throughout their working lives, then for one life saved there would be 400 who never benefit from it.
What are the aims of treatment for drug users?
To reduce harm to user, family + society
To improve health
To stabilise lifestyle
Reduce crime
What are the modalities of treatment for drug users?
Harm reduction
Detoxification
Maintenance
Relapse prevention
Psychological interventions
Referral for allied problems (Hep C, STIs, etc.)b
What can you offer a newly presenting drug user?
Health check
Screening for blood borne viruses
Contraception, smear
Sexual Health Advice
Check general immunisation status
Sign post to additional help
Information on local drugs services, including needle exchange
What are the 3 levels of Basic Harm Reduction (as applied to drug users).
Action to prevent deaths
Action to prevent blood borne virus transmission
Referral where appropriate.
Who might be suitable for detoxification (as applied to drug use)?
Young user
Less time addicted
Often not injecting
Lower level of drug use
Following drug use, who might be suitable for stabilisation + maintenance? (as opposed to detox)
Opiate user
Longer time addicted, usually injecting
May be high levels of drug use
What is the aim of stabilisation + maintenance’ following drug use?
Harm minimisation - keep people alive until they are ready to become abstinent
What can you offer someone who is using crack cocaine?
Harm reduction is key as there are no substitute meds available
- advice on safe sex / contraception / blood borne viruses
Brief Intervention
- explanation of effects / risks
- setting limits
- cognitive based approaches
Team working
- Refer to Sexual Health / Infectious Diseases
- Referral for specialist advice, if appropriate
What are the recommended alcohol intake levels for men and women?
14 units a week
What is ‘hazardous drinking’?
Pattern of alcohol use which increases someone’s risk of physical, psychological or social harm
What is increasing risk drinking and higher risk drinking?
Men: increasing = 15-49, higher = 50+ units / week
Women: increasing = 15-34, higher = 35+ units / week
What is a ‘unit’ of alcohol?
A standard measurement of the alcohol content of a drink. Takes into account the strength (%ABV) and the volume.
Describe the aetiology of problem drinking.
Individual
> genes / personality
> physique
> occupation
Societal
> advertising
> availability
> peer group (peer pressure) / family pressure
> religion / tradition / culture / social norms
Why are women now drinking more than ever?
more socially acceptable
more disposable income
more drinks marketed at women
more drinking places aimed at women customers
Give 5 social + psychological risk factors for problem drinking
Drinking within the family / parental drinking
Childhood problem behaviour relating to impulse control
Early use of alcohol, nicotine + drugs
Poor coping responses to life events
Depression as a cause (not a result) of problem drinking
How might Alcohol + Deprivation be linked?
Adverse effects of alcohol exacerbated amongst lower SE groups - they are more likely to experience negative effects directly and indirectly, and are more likely to die as a result.
> lack of money means they are less likely to protect themselves against negative health + social consequences
What are the 4 most common causes of death due to alcohol?
Accidents + violence
Malignancies
Cerebrovascular disease
Coronary Heart Disease
What can be done to curb alcohol usage?
Increase price + decrease supply
Screening + brief interventions from healthcare workers
Develop a more ‘joined up’ approach from services
What Public Health measures might be used to reduce alcohol usage at a population level?
Minimum price per unit of alcohol
Change licensing laws in areas where cirrhosis is the biggest problem
What is the recommended management for people requesting help with an alcohol problem.
Perform physical + mental assessment
Offer appropriate investigation(s) + follow up
Offer referral / treatment as appropriate
What screening questionnaires can be conducted if a person is suspected of excessive alcohol consumption?
Who are these questionnaires recommended for?
CAGE
AUDIT
What does the AUDIT questionnaire (alcohol use) comprise?
10 point questionnaire; 5 mins to carry out
Hazardous drinking: Score 8 +
Alcohol dependence: Women = 13; Men = 15
What are the 4 questions which make up the CAGE questionnaire?
Have you ever thought you needed to cut down on your drinking?
Have you ever become angry / annoyed at people criticising your drinking?
Do you ever feel guilty about your drinking?
Have you ever had an eye-opener in the morning to ease your hangover?
What medications might be used to prevent an alcoholic person from relapsing?
Disulfiram -> sensitise against alcohol
Acamprosate -> GABA blocker
Naltrexone -> used in specialist centres
none of these agents are particularly effective
Define ‘disability’.
A disability is related to anyone who has a physical, sensory or mental impairment which seriously affects their daily activities.
Perception of risk is influenced by 4 factors. What are they?
- Lack of personal experience with the problem
- Belief that the problem is preventable by personal action
- Belief that if its not happened by not, its not likely to
- Belief that the problem is infrequent
What are non organic feeding disorders?
High prevalence in under 6s
Feeding aversion, food refusal, negative mealtime interactions
Often influenced by maladaptive feeding practices
Name 3 resource allocation methods:
Egalitarian
Maximising
Libertarian
Explain the egalitarian approach to resource allocation:
Provide all care that is necessary and required to everyone
Pros: equal for everyone
Cons: economically restricted
Explain the maximising approach to resource allocation:
Based solely on consequence, focusing on high productivity activities
Pros: resources allocated to those most likely to receive benefits
Cons: those with “less needs” receive nothing
Explain the libertarian approach to resource allocation:
Each individual is responsible for their own health.
Pros: onus is on the patient, and therefore may be more engaged
Cons: not all diseases are self inflicted
What is ‘Structure’ - part of the Framework for Health Service Evaluation - concerned with?
“Structure describes the context in which care is delivered, including hospital buildings, staff, financing, and equipment”
What actually is the service - the inputs and resources that go into a health service, such as the staff, equipment, and facilities
What are the issues with ‘Outcome’ part of the Framework for Health Service Evaluation?
- Link between health service and health outcome can be difficult to
confirm - Time lag between service and outcome may be long
- Large sample sizes may be needed
- Data may not be available or have a problem with it (CART =
completeness, accuracy, relevance, timeliness)
Define epidemiology:
Definition: The study of the frequency, distribution and determinants of diseases and health-related states in populations in order to prevent and control disease.
Define incidence:
Number of new cases in a population in period of time
Define prevalence:
Number of existing cases ina population at a point in time
Define absolute risk:
The likelihood of an event or outcome occurring, such as the chance of developing a disease.
Divide the number of people who experienced the event by the total number of people exposed to the risk of that event
Define relative risk:
The probability of an event occurring with an exposure versus the probability of the event occurring without the exposure.
RR = [a/(a+b)] / [c/(c+d)]
Define attributable risk:
A measure of the proportion of the disease occurrence that can be attributed to a certain exposure (aka risk in the exposure group - risk in the control group)
Define bias:
Bias = a systemic deviation from the true estimation of the associated between exposure and outcome (it is an example of a systematic error)
Define selection bias:
An error in the selection of study participants, or allocation of participants to different study groups, or loss of participants, such that they differ systematically from the population of interest (broad term that encompasses many other forms of bias)
Define information bias (also known as classification bias):
Bias that arises from systematic differences in the collection, recall, recording or handling of information used in a study. Includes inaccurate recording, lack of blinding (which might skew interpretation of results) etc. Includes measurement bias, observer bias, reporting bias, recall bias
Define allocation bias:
A type of selection bias. Different spread of participants in different groups (unequal spread), for example allocating sicker patients to the treatment. Occurs when blinding is not effective.
Define publication bias:
Trials with negative bias are less likely to be published
Define lead time bias:
Early identification doesn’t alter the outcome but appears to increase survival as the patient has the disease identified earlier than normal
Define length time bias:
Diseases that progress more slowly are more likely to be picked up by screening which makes it appear that the screening lengthens life
Define confounding factors:
Situation where a factor is associated with the exposure of interest and independent
influences the outcome but does not lie on the causal pathway e.g. lack of exercise
causes weight gain but there are many confounding variables that also effect weight gain
What are the Bradford Hill criteria for causality:
9 things - some days cat travel around beautiful cities and smile
Strength - The strength of the association
Dose-response – does a higher exposure produce higher incidence?
Consistency – similar results in different studies and populations
Temporality – does the exposure precede the outcome
Reversibility – removing exposure reduced risk of disease
Biological plausibility – does it make sense biologically
Coherence – logical consistency with lab information e.g. incidence of lung cancer
with increased smoking is consistent with lab evidence that tobacco is carcinogenic
Analogy – similarity with other established cause-effect relationships in the past e.g.
thalidomide in pregnancy, not other teratogenic drugs show similar effects
Specificity – Relationship is specific to the outcome of interest e.g. introducing
helmets reduced head injuries specifically, it wasn’t that there has been an overall
lower injury rate
What is reverse causality?
Stress causes HTN or HTN causes stress
What are the types of disease prevention:
Primary prevention: stopping people for getting disease
Secondary prevention: trying to detect a disease early to prevent it getting worse, and to reduce the impact of the early stages of a disease that has already occurred
Tertiary prevention: trying to improve quality of life and reduce the symptoms of an established disease that is already present
What are population approaches to prevention and screening?
A preventative measure delivered on a whole population wide basis
and seeks to shift the risk factor distribution curve.
What is the high risk approach to prevention and screening?
Seeks to identify individuals that are above a high risk chosen cut off and treat them.
What are the types of screening?
Population-based
Opportunistic
Screening for communicable diseases
Pre-employment and occupational medicals
Commercially provided screening
What is the name of the criteria for screening?
Wilson and Jungner
What are the Wilson and Jungner criteria?
The Condition
* Important condition
* Natural history, latent and declared staged, risk factors and disease markers understood.
* The disease should have a latent, detectable stage.
Screening Programme
* Screening should be ongoing and not just performed on a ‘one-off’ basis.
* Cost-effective
The Test
* There should be a simple, safe, precise and validated screening test.
* The distribution of test values in the target population should be known and a suitable cut-off
level defined and agreed.
* The test should be acceptable (willing to do it) to the population.
* There should be an agreed policy on the further diagnostic investigation of individuals with a
positive test result and on the choices available to those individuals.
The Treatment
* There should be an effective treatment or intervention for patients identified through early
detection, with evidence of early treatment leading to better outcomes than late treatment
* Agreed policy on who to treat
* Facilities should be available
Define sensitivity:
Proportion of people with the disease who are correctly idenitified by screening test - how well a test can detect a specific disease or condition in people who actually have the disease or condition (a/a+c)
Define specificity:
Proportion of people without the disease who are correctly excluded by the screening test
Define positive predictive value:
The proportion of people with a positive test who actually have the disease
Define negative predictive value:
The proportion of people with a negative result who actually do not have the disease
Define a cohort study:
Sample is taken from study population and split into two groups, one exposed and
one not. Incidence of the disease amongst the two groups is compared.
Prospective
Define a case control study:
Groups with and without a disease are selected and past exposures are identified
Retrospective
What are the advantages of a cohort study?
Follow up rare exposures
Identifies risk factors
Sequence of happenings can prove cause-effect
Multiple exposures and outcomes can be studies at once
What are the disadvantages of a cohort study?
Needs a large sample size
Impractical for rare disease
Expensive
High drop out rate with a long follow up
Impractical for diseases with long latent periods
What are the advantages of a case control study?
Quick
Good for looking at rare diseases with long latency periods
Multiple exposures can be studies
What are the disadvantages of a case control study?
Selection and information bias
Impractical for rare exposures
Hard to establish a sequence of events
Difficult to separate the effect of confounding factors
Define cross sectional studies?
A cross-sectional study is a type of research design in which researchers collect data from many individuals at a single point in time
What are the advantages of a cross sectional study?
Can assess a large sample size
Quick
Repeated studies can show changes over time
What are the disadvantages of a cross sectional study?
Risk of reverse causality
Not useful for rare diseases
Unclear timeline
Define an RCT:
Two groups are recruited, one control and one intervention, which allows for comparison in order to assess the effectiveness of the intervention
What are the advantages of an RCT?
Low risk of bias and confounding
Comparative
Good evidence for cause and effect
What are the disadvantages of an RCT:
High drop out rate
Ethical issues
Time consuming and expensive
Results cannot always be generalised because of strict entry criteria
Define an ecological study:
In ecological studies the unit of observation is the population or community. Disease rates and exposures are measured in each of a series of populations to find a certain correlation between two things e.g. there is a
high level of CHD in deprived areas.
Define a meta-analysis:
Meta-analysis is a quantitative method that uses and synthesizes data from multiple individual studies to arrive at one or more conclusions.
Define systematic review:
Review which endeavours to consider all published and unpublished evidence of a specific question. Combines the results of independent studies which are drawn from
the published literature, and synthesizing summaries and conclusions
What makes a disease notifiable?
High mortality, high morbidity, highly contagious, expensive to treat, effective interventions
Name some notifiable diseases:
Acute encephalitis, meningitis, covid, measles, mumps, rubella, scarlet fever, tetanus, TB, whooping cough
What is a cluster in terms of infectious disease?
A group of cases that might be linked e.g. scabies in a care home
What is an epidemic?
More than expected incidence in a country
What is a pandemic?
More than one country
What does endemic mean?
Persistent level of disease occurrence in a region
What are the 4 aspects of negligence?
Was there a duty of care?
Was there a breach of that duty?
Was the patient harmed?
Was the harm due to the breach of care?
NEGLIGENCE = LEGAL RULING
What is the Bolam rule?
The Bolam test is based on the idea that a medical professional’s actions should be in line with those of other medical professionals in the same field. The test is a peer review process that assesses whether the medical professional’s actions were reasonable and acceptable
What is the Bolitho rule?
The test states that a doctor is not negligent if it can be proven that they acted in accordance with a reasonable body of medical opinion. Unlike the Bolam test, which focuses primarily on whether the defendant’s actions align with accepted medical practice, the Bolitho test introduces a requirement for the court to assess the reasoning behind the defendant’s actions
Describe the swiss cheese model of error:
Falling through the holes because there is failed or absent defenses against error happening. These are called LATENT FAILURES.
Organisational influence → Unsafe supervision → preconditions for
unsafe acts → unsafe acts
Describe the bucket model of error:
The three buckets model is a useful tool that supports you to identify potential for something to go wrong, enabling you to enhance safe practice. The potential for a clinical situation to become ‘risky’ is influenced by what the model calls ‘the three buckets’ - self, context and task.
SELF = Poor knowledge, fatigue, little experience/skill, feeling unwell
CONTEXT = distraction, poor handover, lack of team support, equipment
TASK = errors, take complexity, new task, process
Describe some types of poor performance:
Sloth = inaccurate documenting/not checking results for accuracy
Fixation/loss of perspective = focus on one diagnosis – confirmation bias
Communication breakdown = unclear plan/not listening and explaining well
Poor team working = some individuals out of depth and others underutilised
Playing the odds = choosing the common and dismissing the rare
Bravado/timidity = working beyond competence/not having confidence to object
Ignorance = lack of knowledge (can be conscious or unconscious incompetence)
Mis-triage = over or under-estimating the severity of the situation
Lack of skill = not having appropriate skills/training/practice
What are never events?
A serious, largely preventable patient safety incident that should not occur if
available, preventative measures have been implemented
Examples: wrong site for surgery, wrong drug given, escape of psychiatry patient
Define duty of candour:
Every healthcare professional must be open and honest with patients when
something that goes wrong with their treatment causes, or has the potential to
cause, harm or distress.
What are odds ratios and how are they calculated?
Dividing the odds of an event in an exposure group by the odds of the event in a control group (odds of it happening in one group, vs the odds of it happening in another group)
What are odds and how are they calculated?
The ratio of the probability that the event will happen to the probability that the event will not happen.
To calculate odds, you can divide the number of times an event occurs by the number of times it doesn’t occur.
Define the inverse care law:
The availability of good medical care tends to vary inversely with the need for it in the population served
What are the benefits of Health Needs Assessments?
Strengthen community involvement in decision making (because they can express their needs)
Better use of resources
Improved patient care
Improved communication between agencies and services
What are the challenges of Health Needs Assessments?
Professional boundaries may prevent information sharing
Lack of shared languages between sectors
Lack of commitment from higher ups
Problems accessing data
Problems accessing the target populaiton
Give 3 examples of HNA frameworks?
Two stage HNA framework (Harvey and Taylor)
Five stage HNA (Cavanaugh and Chadwick)
Deveopmental approaches to HNA (Harvey and Taylor)
What is a screening tool used to identify people at risk of domestic violence?
HARK
Humiliation
Afraid
Rape
Kick
Define multimorbidity:
People with multiple health conditions
Define polypharmacy:
Concurrent use of 5+ medications in an individual
Define appropriate polypharmacy:
Prescribing for an individual in circumstances where medicines use has been optimised
Define problematic polypharmacy:
Prescribing multiple medications inappropriately, or where the intended benefit of the medicine is not recognised
What are some effects of appropriate polypharmacy?
Improved quality of life, longevity and harm reduction
What are some effects of problematic polypharmacy?
Interactions
Pill burden is unacceptable to the patient
Taking many pills harms adherence
Further medicines end up being prescribed to combat harmful side effects, when deprescribing may be more useful
Breast milk taste varies between women. Why is it beneficial for babies to have repeated exposures to different tastes?
Greater acceptance of foods during weaning
Less likely to be a picky eater
Have a diet richer in fruits and vegetables
What impact can coersion, persuasion and contingencies as a means to encourage children to consume new foods have?
This quite often has a paradoxical effect – using food as an
incentive to eat a novel food increases liking for the reward and reduces liking
for the novel food
How long is the sensitive period for developing flavour and food preferences?
2 years
What is food poverty?
Having smaller meals, skipping meals, being hungry but not eating, not eating for a day, being unable to access food
What is the process of claiming asylum?
Claim on arrival ⇒ screening interview ⇒ second screening interview (must correlate) ⇒ decision
Granted ⇒ granted refugee status, humanitarian protection, and discretionary leave
Declined ⇒ removal or voluntary return
People can appeal if declined but must provide new evidence
What are people not entitled to if their asylum claim is denied?
Nothing - no work, no housing. Still allowed NHS access. Have 28 days to leave/be deported/ detained in a removal centre
Define homelessness:
No accommodation to occupy, have accommodation but it is not reasonable for them to occupy it, have accommodation but cannot secure entry to it, have no legal right to their accommodation, or have a mobile home but no place to put it
What is CORE20PLUS5?
An NHS approach to inform action to reduce healthcare inequalities at a national and system level. The approach defines a target population – the ‘Core20PLUS’ – and identifies ‘5’ focus clinical areas requiring accelerated improvement (maternity, mental illness, chronic respiratory disease, early cancer diagnosis, hypertension)
What is human trafficking?
Movement of people by means of force, fraud, coersion, or deception, with the purpose of exploiting them
What are some forms of human trafficking?
- Sexual
- Criminal (forced to commit benefit fraud, beg, commit crimes etc)
- Domestic servitude
- Labour exploitation
- Forced marriage
- Organ harvesting
- County lines (criminals befriend children, either online of offline, and then manipulate them into drug dealing)
What are some red flags for human trafficking in a patient?
- Timid, terrified, tense
- Not registered with GP/school etc
- Accompanied by a controlling person
- Frequently moving location
- Inconsistent history
- No control of passport/bank
- Untreated injuries
- DNA future appointments
Name some models for the social determinants of health?
What are the social determinants of health?
Dahlgren and Whitehead Model
Bronfrenbrenner Model
Non-medical factors that can have a significant impact on health outcomes. These factors can include:
Healthcare
Economic stability
Education
Social and community life
Neighborhood
What are some methods of evaluating healthcare?
Audits, focus groups, patient interviews, surveys, questionnaires
As applied to the Framework for Health Service Evaluation, what is a denominator?
Structure - a thing, like a hospital or GP surgery
Process - an intervention eg blood test
Denominator - x per y eg bloods per 100 appointments
Which antibiotics inhibit cell wall synthesis?
Penicillins
Cephalosporins
Vancomycin
Which antibiotics inhibit DNA synthesis?
Quinolones
Rifampicin
Which antibiotics inhibit protein syntheisis?
Macrolides
Tetracyclines
AMinoglycosides
What are the stages of a two step HNA?
- Health profiling and identifying priorities
- In depth assessment of a health priority (as defined by stage one)
This is an epidemiological approach, looking at normative needs.
What are the stages of a five step HNA?
- Getting started: what population, what problem, what’s the justification? Who needs to be involved? What resources do you have? What is your aim?
- Identifying health priorities: informed by aim and objectives - population profiling, collection of data (both existing and generating new)
- Assessing health priority for action
- Action planning for change
- Project review
This can be an epidemiological, corporate or comparative approach, looking at any of Bradshaw’s social needs.
What is a developmental approach to a HNA?
A developmental approach to health needs assessment (HNA) can involve identifying evolving stages of psychological processes that trigger social behavior. This approach can help to identify the inner processes that lead to beliefs, attitudes, and cognitive skills. They increase community involvement in the process.
What is a health equity audit?
A health equity audit (HEA) is a process that examines how health determinants, access to relevant health services, and related outcomes are distributed across the population. Uses this evidence on inequalities to inform decisions on investment, service planning, commissioning and delivery and to review the impact of action on inequalities. This allows them to prioritise services relative to needs.
What is a health impact assessment?
Aims to systematically assess the potential health impacts, both positive and negative, intended and unintended, of projects, programmes and policies. Improves policy decisions by identifying the ones with the biggest positive outcomes.
Define recall bias:
When participants in a study do not accurately remember previous events, or subconsciously alter their memories.
Define confirmation bias:
When researchers consciously or unconsciously look for information or patterns in their data that confirm their existing ideas or opinions
Define attrition bias:
A type of selection bias. When participants withdraw from a study, or when outcome reporters omit certain participants from study outcome reports, such that it no longer represents the population of interest.
Define reporting bias:
Reporting bias refers to systematic differences between reported and unreported findings. Within a published report those analyses with statistically significant differences between intervention groups are more likely to be reported than non-significant differences.
Define sampling bias:
A type of selection bias. Sampling bias or ascertainment bias occurs when some members of the intended population are more likely to be included than others, aka non random sampling.
What happens to the patient if a doctor is found to be negligent?
Patient can get compensation for loss of earnings and additional costs such as having to get taxis to work instead of driving
What happens to the doctor if they are found to be negligent?
- Learning for the doctor
- Employer engagement - they must be confident in the doctors capability and can provide additional training if required
What are the differences between poor performance, negligence, misconduct, human error?
Poor performance: Individual with conduct below acceptable standard, such as not taking responsibility or lying
Negligence: Poor culture, accepting low standards, legal ruling
Misconduct: Deliberate harm is caused - theft, assault, alcohol, inappropriate relationships
Human err: Not deliberate, in the context of systemic errors, 4 types
What are the 4 types of human error?
- Mistake - incorrect judgement (believing you have done the right thing but you judged it wrong)
- Lapse - memory failures (forgetting to do something)
- Slip - attention failures (doing the wrong thing by accident)
- Violation - knowingly break the rules (misconduct)
Give an example of how felt needs can inform public health interventions?
Felt Needs: Conduct surveys or focus groups to understand community members’
perceptions of their health concerns, which can guide the design of culturally
appropriate interventions
Give an example of how expressed needs can inform public health interventions?
Expressed Needs: Assess healthcare utilization data to determine what services
community members are seeking and develop services that are easily accessible
Give an example of how comparative needs can inform public health interventions?
Comparative Needs: Analyze disparities in health outcomes between different
demographic groups to prioritize interventions for underserved populations. Indicates that needs arising in one location may be reflected in areas with similar socio-economic characteristics
Give an example of how normative needs can inform public health interventions?
Normative Needs: The team can identify health issues based on epidemiological
data (e.g., high rates of diabetes) and develop targeted screening programs (1).
What frameworks are used for assessing quality of healthcare?
Maxwell’s Dimensions of the Quality of Healthcare (3As 3Es)
Donabedian’s Framework for Health Service Evaluation
What are the benefits of screening?
Can identify people early, when the disease is treatable
Improves long term mortality
Saves NHS money in the long run
Can provide people with reassurance
What are the downsides of screening?
False positives can cause unnecessary expenditure, anxiety and investigations that may be invasive
False negatives can cause false hope
May result in overdiagnosis of low level cancers that may never become an issue
What screening happens in pregnancy?
Infectious diseases - HepB, herpes and syphilis
Sickle cell and thalassaemia
Fetal anomaly screening program
What screening happens to neonates?
NIPE
Hearing assessments
Bloodspot at 5 days old
What screening do adults receive?
AAA
Bowel
Breast
Cervix
Diabetic eye
Define confounders?
A situation in which the estimate between an exposure and an outcome is distorted because of the association of the outcome with another exposure that is also independently associated with the outcome
What might cause the association between an exposure and an outcome?
Bias
Confounding
Reverse causality
Chance
True association, as defined by the Bradford Hill criteria
How do you calculate incidence?
New cases / (population x time frame)
How do you calculate prevalence?
Total number with the disease / total number at risk of the disease
Define number needed to treat:
The number of patient you need to treat for one to benefit (1/absolute risk)
What are the 4 dimensions of food insecurity?
Availability - production and distribution
Access - affordability
Utilisation - the use that households make of the food they have, for example food storage, cooking and prep
Stability of the 3 dimensions over time
Describe the physiology of addiction:
Drugs stimulate the mesolimbic pathway int he brain (reward), of which dopamine is the main neurotransmitter, giving a sense of pleasure that reinforces the behaviour. Repeated exposure to the stimulus reduces the number and sensitivity of the dopamine receptors, requiring an increasingly strong stimulus to activate them for the same reward. At the same, the reward response to everyday activities also decreases. As a result, the person increasinly seeks out the substance to trigger their reward pathway. People, places or events can trigger cravings.
What are the stages of the MRC Muscle Power Scale?
0 - no contraction
1 - flicker / contraction but no movement
2 - movement with gravity eliminated
3 - movement against gravity
4 - movement against gravity and resistance
5 - full power
