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3A > Public health > Flashcards

Public health Flashcards

1
Q

what is epigenetics

A

the study of how genes interact with the environment
- changes in an organism due to changes in gene expression rather than alterations to the genetic code itself

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2
Q

what is allostasis

A

the stability through change, or homeostasis, of our physiological systems to adapt rapidly to changes in our environment

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3
Q

what is allostatic load

A

long term over taxation of our physiological systems leading to impaired health - the price of allostasis

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4
Q

What is public health

A

the science and art of preventing disease, prolonging life and promoting health through organised efforts of societyw

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5
Q

what are the key concerns of public health

A

inequalities in health
wider determinents of health
prevention

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6
Q

What are the 3 domains of public helath

A

health improvement
health protection
improving services

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7
Q

what is health improvement (give an example)

A

societal interventions aimed at preventing disease, promoting health and reducing inequality
e.g. vaccines, education, housing

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8
Q

what is improving services (give an example)

A

organisation and delivery of safe, high quality sevices for prevention treatment and care
e.g. clincial effectiveness, audits

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9
Q

What are the determinents of health

A

genes
environment
lifestyle
access to healthcare

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10
Q

what are some wider determinents of health

A

education
socioeconomic status
uneployment
housing
physical environment

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11
Q

what makes up Marlow’s hierarchy of needs from bottom to top

A

physiological needs (e.g food, water)
Safety needs (security, housing, job)
Belongingness and love needs (friendship, family)
Esteem needs (self-esteem, confidence)
Self-actualisation (morality, creativity

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12
Q

What are health interventions

A

tactics to improve public health (e.g. promoting screening, vaccination)

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13
Q

what three levels can health interventions be at

A

individual level (childhood vaccine)
community level (playground)
population level (public health campaign)

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14
Q

What is the difference between vertical and horizontal equity

A

horizontal- equal treatment for equal need (e.g. same treatment for the same disease)
vertical- unequal treatment for unequal need (e.g. increased funding in more deprived areas)

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15
Q

How can equity be examined

A

access to healthcare, healthcare outcomes, health status, resource allocation

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16
Q

what is health psychology

A

the role of psychological factors in the cause, progression and consequences of health and illness

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17
Q

what are health behaviours

A

a behaviour aimed at preventing disease (e.g. eating healthier)

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18
Q

what are illness behaviours

A

a behaviour aimed at seeking remedy (e.g. going to the doctor)

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19
Q

what are sick role behaviours

A

a behaviour aimed at getting well (e.g. resting, taking medication)

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20
Q

what two types of health behaviours are there?

A

health promoting and health damaging behaviours

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21
Q

what is the main theory of why people undertake health damaging behaviours

A

unrealistic optimism - individuals carry on with behaviour as they dont believe that the problem will effect them

Occurs due to
- lack of personal experience with the condition
- belief that its not preventable by the action
- belief that if its not happened by now it wont happen
- belief that the problem is infrequent

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22
Q

What are the components of the health belief model

A

Individuals will change if they:
- believe that they are susceptible to the condition (perceived susceptibility)
- believe that the condition has serious consequences (perceived seriousness)
- believe that taking action will reduce their susceptibility to the condition (perceived benefits)
- believe that the benefits of taking the action outweigh the costs (perceived barriers)

There may be internal or external cues

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23
Q

What are examples of internal and external cues to behaviour change

A

internal- pain
external - GP advice

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24
Q

What are some advantages of the health belief model?

A

it can be applied to a wide range of health behaviours
it included cues to action which is unique\
its a long standing model

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25
Q

what are some criticisms to the health belief model?

A

it does not differentiate between first time and repeat behaviours,
it does not consider the influence of emotions and behaviour
cues to action often arent present
alternative factors may also influence behavioural change

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26
Q

What is the theories of planned behaviour model

A

proposes the best predictor of a behaviour is intention to change the behaviour

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27
Q

What determines someones intention in the theories of planned behaviour model?

A

a persons attitude to the behaviour (e.g. I dont think smoking is good for me)
subjective norm (perceived social pressure to give up the behaviour)
percieved behavioural control (perceived ability to perform the behaviour)

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28
Q

What 5 things bridge the gap between intention and behavioural change in the theories of planned behaviour model?

A

perceived control- individual feels they are capable
anticipated regret- individual reflects on feelings once failed
Preparatory actions- dividing the task into small sub goals to improve self-efficacy and satisfaction
implementation intentions- most important. The if and then plans.
Relevence to self

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29
Q

advantages of the theory of planned behaviour model

A

can be applied to a wide range of behaviours
useful in predicting intention
takes into account the importance of social pressure

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30
Q

Criticisms of the theory of planned behaviour model

A

lack of a temporal element and direction or causality
no sense of how long the behaviour may take
rational choice model so does not take into account emotions
assumes attitudes, subjective norms and percieved control can be measures
relies on self-reported behaviours

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31
Q

what is the transtheoretical model of behaviour change

A

it is a model that suggests individuals are located at discrete ordered stages rather than on a continuum- each stage indicates an increased likelihood of changing behaviour

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32
Q

What are the stages of the transtheoretical model of behavioural change

A

precontemplation
contemplation
preparation
action
maintenance
relapse

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33
Q

What are advantages of the transtheoretical model of behavioural change?

A
  • acknowledges individual stages of readiness
  • accounts for relapse and allows backwards movement between the stages
  • gives a time frame
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34
Q

what are criticisms of the transtheoretical model of behavioural change

A
  • not all people move through every stage
  • change might operate on a continuum rather than discrete stages
  • does not take into account values, habits, culture, social or economic factors.
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35
Q

What is motivational interviewing

A

a councelling approach to initiate behaviour change by resolving ambivolence - helping someone to see smoking is bad

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36
Q

What is the social norms theory?

A

suggests that social norms (which are the behaviours and attitudes most common in groups) are one of the most important factors in influencing behaviour

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37
Q

What are some problems with the social norms theory

A

sometimes the perceived social norms of the group are not the actual social norms
does not work when the risk behaviour is the norm
people often overestimate risk taking behaviour and understimate protective behaviours

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38
Q

what is the nudge theory

A

the idea that changing the environment to make the best option easier can influence behaviour change- e.g. putting fruit by checkouts

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39
Q

How doe transition points influence behaviour

A

there are transition points in life which may make a person more or less likely to change their behaviours- e.g. getting a job, unemployment, having children

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40
Q

List some theories of behavioural change

A

health belief model
theory of planned behaviour
transtheoretical model of behavioural change
motivational interviewing
social norms theory
nudge theory

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41
Q

what is a health needs assessment?

A

a systematic method of reviewing the health issues faced by a population leading to agreed priorities and resource allocation that will improve health and reduce inequality

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42
Q

define need

A

the ability to benefit from an intervention

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43
Q

define demand

A

what people ask for

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44
Q

demand supply

A

what is provided

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45
Q

what is a health need

A

a need for health in general

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46
Q

what is a health care need

A

a need for health care

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47
Q

What are Bradshaws 4 types of social need

A

felt need
expressed need
normative need
comparative need

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48
Q

what is felt need-

A

an individuals perception of variations from normal health

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49
Q

what is expressed need

A

when an individual seeks help to overcome variation in normal health

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50
Q

what is normative need
Give an example

A

when a professional defines interventions appropriate for the expressed need

Vaccinations

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51
Q

what is comparative need, give an example

A

comparsion between severity, range of interventions and cost

A village may identify a need for a school if a neighbouring village has one

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52
Q

what are three types of health needs assessments?

A

epidemiological health needs assessment
comparative health needs assessment
corporate health needs assessment

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53
Q

what is an epidemiological health needs assessment

A

defines a problem, the size of a problem, the services available for a problem, models of care, cost effectiveness and recommendations

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54
Q

what sources may be used for an epidemiological health needs assessment

A

GP registry, hospital admissions, mortality data

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55
Q

advantages of an epidemiological health needs assessment

A

uses existing data
provides data on current incidence, mortality and morbidity
can evaluate services by trends in time

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56
Q

criticism of epidemiological health needs assessment

A

the required data may not be available or may vary in quality
evidence bases may be inadequate
does not consider felt needs

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57
Q

what is a comparative health needs assessment?

A

compares the services received by a population with others- may vary spatially or socially (by age, gendeR)

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58
Q

advantages of a comparative health needs assessment

A

quick and cheap
indicates whether health or service provision is better or worse than comparable areas (gives a relative indication of performance)

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59
Q

what are some limitations of a comparative health needs assessment?

A

data may not be available or may differ in quality
may be hard to find a comparable population
may not yield what the most appropriate level of provision should be

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60
Q

what is a corporate health needs assessment?

A

it asks what the local populations health needs are- uses focus groups, interviews.
Includes a wide range of stakeholders (e.g. teachers, HCP, support works)

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61
Q

advantages of coporative health needs assessments?

A

bases on felt and expressed needs of the popualtion
recognises the detailed knowledge and experience of those working within the population
takes into account a wide range of views

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62
Q

what are some disadvantages of a corporative health needs assessment

A

difficult to distinguish between need and demand
groups may have vested interests and may be influenced by political agents
dominant personalities may have undue influence

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63
Q

what is an example of something that is demanded but not needed?

A

cosmetic surgery

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64
Q

what is an example of something that is needed but not demanded

A

anti hypertensives

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65
Q

what is an example of something that is not needed or demanded

A

> 75 health checks with GP

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66
Q

what is an evaluation of a health service?

A

an assessment of whether a service achieves its objectives - it attempts to systematically and objectively determine the relevance, effectiveness and impact of activities in the light of their objectives

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67
Q

what are the three components of the Donebedian framework for evaluating services and give an example for each

A

structure- what is there (e.g. number of vascular surgeons per 1000 patients)
Process- what is done (number of operations performed, number of patients need in a and e)
Outcome- the 5D’s (death, disease, disability, discomfort, dissatisfaction)

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68
Q

what are the steps of the general framework of service evaluation

A
  • define what the service is
  • what are the objectives of the service - are they stated and appropriate
  • Framework (structure, process, outcome)
  • methodology of evaluation- qualitative or quantitative
  • results, conclusions and recommendations
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69
Q

What factors may promote excessive energy intake

A

employment- shift work
characteristics of food (energy density, portion size)
social aspect- going out for food
genetics
advertisements

70
Q

What is malnutrtion

A

deficiences, excesses and imbalances in a persons intake of energy and/or nutrients
Includes both undernutrtion (stunting, wasting, underweight, micronutrient deficiencies)
and overnutrtion

71
Q

What are some examples of medical conditions that require special nutritional support

A

coeliac, T2DM, eating disorders

72
Q

What factors can influence early eating behaviours

A
  • maternal diet during pregnancy
  • breast feeding
  • parenting practices (maladaptive or positive)
73
Q

How can breast feeding influence eating behaviours

A

breast fed infants are more likely to:
- be less picky eaters
- accept more novel foods during weaning
- have a diet full of fruit and veg by 3 months

74
Q

How can breast feeding affect bodyweight regulation

A

breast fed infants usually stop feeding when full whereas bottle fed are often encouraged to finish the bottle

75
Q

How can parenting practices influence early eating behaviours

A

maladaptive tactics like coercion and percuading is more likely to cause non-organic feeding disorders such as aversion)
positive practices include - no pressure, not using food as a reward, providing a wide range of choices

76
Q

what are some examples of factors associated with disordered eating

A

restraint
strict dieting
disinhibition
emotional eating
night eating
weight and shape concern
inappropriate compensatory behaviours

77
Q

what 3 factors may make up dieting

A

restricting the amount of food eaten
restricting the type of food eaten
restricting the time window of eating

78
Q

what are some problems with dieting

A

increased risk of eating disorder
loss of lean body mass not just fat
slows metabolic rate
disruption of normal appetite response and increases hunger
long term weight loss is challenging- often plateaus then regains

79
Q

what are the core priniciples of the NHS

A

it is universal (meets the need of everyone), comprehensive (based on clinical need not ability to pay) and free at the point of delivery

80
Q

what are health inequalities?

A

unjust and avoidable differences in people health across a population or subgroup of the population
- they go against the principle of social injustice as they are avoidable

81
Q

what is the inverse care law

A

the availability of medical care tends to vary inversely with the need of the population served- those who need it most dont access it

82
Q

what is social exclusion

A

the process of being shut out from a social, economic, political or cultural system which determine the social integration of a person in society

83
Q

causes of homelessness

A

relationship breakdowns
mental illness
domestic abuse
disputes with parents
bereavement
drugs and alcohol
no money or job

84
Q

populations who are vulnerable to homelessenss

A

LGBTQ+
ex service men and women
subtance misusers
asylum seekers

85
Q

health problems faced by the homeless

A

infectious diseases (TB, hepatitis)
poor feet and teeth
resp problems
injuries from violence and rape
serious mental illness
poor nutrtion
addictions and substance misuse

86
Q

barriers travellers may experience on accessing healthcare

A

reluctance of GP’s to register travellers or visit traveller sites
poor reading and writing skills
communication difficulties
too few permanent sites
mistrust of professionals

87
Q

barriers homeless might experience in accessing healthcare

A

difficulty accessing care (opening times, location)
perceived or actual discrimmination
lack of integration between primary care services and other agencies such as housing, social care, criminal justice)
other priorities
not knowing where to go or how to get there

88
Q

barriers migrants might experience when accessing health care

A

language, cultural and communication barriers
racism, prejudice, discrimmination and stigma
different perceptions of care
not understanding how the NHS works

89
Q

What is domestic abuse?

A

any incident or pattern of incidents of controlling, coercive, threatening behaviour, violence or abuse between those aged > 16 who are or have been intimate partners or family members, regardless of their gender and sexuality.

90
Q

What are types of domestic abuse?

A

physical
sexual
psychological
Financial
Emotional

91
Q

How might domestic abuse present?

A

injuries following assault (miscarriages, facial issues, bruises, haemorrhage, puncture wounds)
Somatic problems or chronic illness from living with abuse (headaches, GI issues, chronic pain)
psychological or psychosocial problems (PTSD, substance misuse, depression and anxiety)

92
Q

What indications are there that someone might be experiencing domestic abuse

A

repeat attendances to GP and A&E - often at antisocial times
delay in seeking help for minor injuries

93
Q

What assessment tool might be used for domestic abuse

A

the DASH- Domestic abuse and sexual harassment tool
works by encouraging you to gain information about everything going on - no one score indicates a high risk but instead it might make someone say something suggestive of high risk

94
Q

if someone is moderate risk of domestic abuse what should be done

A

it is their choice- give information about services and allow them to decide

95
Q

if someone is high risk for domestic abuse what should be done

A

referal to MARAC/IDVAS with or without their concent

96
Q

what is MARAC

A

the domestic abuse Multi-Agency Risk Assessment Conference

97
Q

What are IDVAS

A

independent domestic abuse advisors

98
Q

What is the role of IDVAS

A

adovcate for patients and give them advice surrounding domestic abuse
support them through court proceedings
signpost to specialist services
act as a voice at MARAC

99
Q

What is the role of doctors in domestic abuse

A

ask women about abuse - in a direct, non-judgemental way
display posters and contact cards
only report to police if safe to do sso
give information and refer to appropriate services
do not ask in front of family members or tell patient what to do

100
Q

How can domestic abuse effect children

A

physical and psychological health problems - self-esteem, education, relationships
can be linked with child abuse

101
Q

What is equity?

A

giving people what they need to achieve equal outcomes

102
Q

what is equality

A

giving everyone the same amount of rights opportunities and resources

103
Q

What is horizontal equity?
Give and example

A

equal treatment for people with equal healthcare needs

e.g. giving the same pneumonia treatment to people with the same severity of pneumonia

104
Q

What is vertical equity?
Give and example

A

unequal treatment for unequal health care needs

Giving different treatments for less severe and mores severe diseases

105
Q

What is the inverse care law?

A

the availability of health care tends to vary inversely with its need

106
Q

how can you remember the determinents of health ?

A

PROGRESS
P- place of residence
R- race
O- occupation
G- gender
R- religion
E- education
S- socioeconomic
S- social capital

107
Q

What two frameworks are there to assess the quality of health care?

A

Maxwell’s dimensions of the quality of health care

Structure, process, outcome measures

108
Q

What makes up Maxwells dimensions of the quality of healthcare

A

3A’s and 3E’s
Acceptability
Accessability
Appropriateness
Effectiveness
Efficiency
Equity

109
Q

Give three different approaches to resource allocation

A

Egalitarian
Maximising
Libertarian

110
Q

Explain egalitarian approach to resource allocation

A

provides all the care that is necessary and required for everyone

111
Q

What is primary prevention?

A

preventing the disease from occuring in the first place -e.g. vaccines

112
Q

what is secondary prevention?

A

early identification of the disease to alter disease course (e.g. screening)

113
Q

What is tertiary prevention?

A

limiting the consequences of the established disease- prevent worsening renal function in CKD

114
Q

What is the prevention paradox

A

a preventative measure which brings much benefit to the population often brings little impact to the individual participating

e.g. the covid vaccine

115
Q

What is the purpose of screening?

A

to identify patients who have or are at risk of a particular disease so that you can have a real impact on outcome

116
Q

disadvantages of screening (4 )

A

exposure of well individuals to distressing or harmful diagnostic tests

detection and treatment of subclinical disease that would never cause problems

prevention interventions that may cause harm to the individual

Difficult decisions- e.g. a mother finding out her foetus will likely have downs syndrome

117
Q

Advantages of screening

A
  • reproductive choices about risks
  • more effective treatment
  • reassurance
  • worthwhile use of resources
118
Q

What three screening programmes are there in pregnancy?

A

infectious disease pregnancy screening programme (HepB, syphilis, HIV)
sickle cell and thalassaemia screening
Fetal anomaly screening programme (Downs, edwards and pataus)

119
Q

what three screening programmes are there in newborns?

A

newborn and infant physical examination (heart, eyes, hips, testes)
newborn hearing screening programme
newborn blood spot screening programme

120
Q

what diseases for are included in the newborn blood spot test?

A

sickle cell
CF
congenital hypothyroidism
+ 6 inherited metabolic diseases

121
Q

what 5 screening programmes are done in adults?

A

AAA screening
bowel cancer screening
breast cancer screening
cervical cancer screening
diabetic eye screening

122
Q

What makes up the WIlson and Jungner criteria for a screening programme

A

remember as ‘In Exam Season NAP’ or INASEP
-Important disease
- Natural history of the disease is understood
- Acceptable: the screening test needs to be acceptable to the population
- Simple safe test
- Effective treatment needs to be available
-Policy agreed on who to treat

123
Q

Define sensitivity?

A

the proportion of those with a disease who are correctly identified

124
Q

Define specificity

A

the proportion of people without the disease who are correctly identified as non having the disease

125
Q

Define positive predictive value

A

the proportion of those with a positive test result who actually have the disease

126
Q

define negative predictive value

A

the proportion of those with a negative test result who do not have the disease

127
Q

What is length time bias?

A

occurs when screening is more likely to detect slow growing disease that has a long phase without symptoms

This may mean that evaluation suggests that those screened had a better prognosis

128
Q

What is lead time bias?

A

occurs when patients diagnosed earlier appear to live longer because they know they have the disease for longer

129
Q

Describe a case control study

A

a retrospective observational study that looks at the cause of a disease by comparing similar patients with a disease to controls without

Looks for exposures in both cases

130
Q

Advantages of care control studies (3)

A

good for rare outcomes
quicker than cohort or intervention studies (the outcome has already happened)
can assess multiple different exposures

131
Q

Disadvantages of case control studies (2)

A

difficulty finding control to match with a case
prone to selection bias and information bias

132
Q

Describe a cross-sectional study

A

a retrospective observational study that collects data from a population at a specific point in time- a snapshot
Examines the presence of risk factors and the disease itself

133
Q

advantages of cross-sectional studies (3)

A
  • relatively quick and cheap
    -provide data on prevalence at a single point in time
    -good for surveillance and public health planning
134
Q

Give some disadvantages of cross-sectional studies (3)

A

can cause reverse causality - dont know if the exposure or the outcome came first)
cannot measure incidence
recall and response bias may occur

135
Q

describe a cohort study

A

a prospective longitudinal study looking at separate cohorts with different treatments or exposures - waits to see if the disease occurs

136
Q

advantages of cohort studies (3)

A
  • can follow up a group with a rare exposure
  • good for common outcomes and multiple outcomes
  • less risk of selection and recall bias
137
Q

disadvantages of cohort studies (3)

A

takes a long time
people drop out
needs a large sample size- is expensive and time consuming

138
Q

Advantages of randomised control trials

A

low risk of bias and confounding
can infer causality

139
Q

disadvantages of randomised control trials (3)

A

time consuming and expensive
drop outs
inclusion criteria may exclude certain populations

140
Q

What is an ecological study

A

one that looks at the prevalence of a disease overt time- uses population data rather than individual data

141
Q

How do you work out odds?

A

divide the probability of an even happening by the probability of an event not happening

142
Q

How do you work out an odds ratio?

A

you divide the odds of an event happening by the odds of an event not happening

143
Q

how do you calculate the absolute risk of an event ?

A

the p( event happening in an exposed/ control)/ the total number of people in that group

144
Q

How do you work out absolute risk reduction

A

the absolute risk of the event happening in the control group- the absolute risk of the event in the treatment group

145
Q

how do you work out relative risk

A

absolute risk in treatment group/ absolute risk in control group

146
Q

how do you calculate relative risk reduction

A

1- relative risk (absolute risk in treatment/relative risk in control)

147
Q

How do you calculate number needed to treat?

A

1/ absolute risk reduction (ARR)

ARR= absolute risk in control group- absolute risk in treatment group

148
Q

What are 4 types of information bias

A

measurement bias
observer bias
recall bias
reporting bias

149
Q

describe measurement bias?

A

different measurement equipment may measure differently

150
Q

explain observer bias

A

observer expectations may influence reporting

151
Q

explain recall bias

A

past events may not be recalled correctly

152
Q

explain reporting bias

A

people may not tell the truth because of fear of judgement or shame

153
Q

explain selection bias

A

bias in the recruitment or allocation to a group within a study, some may also be loss to follow up

154
Q

explain publication bias

A

trials with negative results are less likely to be published

155
Q

What components make up the Bradford hill criteria for causality

A
  • strength
  • temporality : exposure is prior to outcome
  • coherence: logical consistency with other info
  • consistency : same result from various studies
  • plausability: reasonable biological mechanism
  • analgoy: similarity with other established cause - effect relationships
  • dose responsive: increased risk of outcome with increased exposre
  • reversibility: intervention to reduce outcome
  • specificity: specific to the outcome of interest
156
Q

Why might you get a result that suggests an exposure influences an outcome?

A
  • true association (proven by Bradford hill)
  • bias
  • confounding factors
  • chance
  • reverse causality (the outcome actually results in the exposure_
157
Q

what criteria is used to prove causality

A

bradford hill criteria

158
Q

define incidence

A

the number of new cases of a disease over a certain time frame

159
Q

define prevalence

A

the number of people with a disease at a certain point in time

160
Q

alcohol dependence symptoms

A

withdrawal symptoms
cravings
drinking despite negative consequences
tolerance
primacy
loss of control
narrowing of repertoire

161
Q

What two medications can be used to treat alcohol dependence

A

disulfram and acamprosate

162
Q

How does disulfram work?

A

it promotes abstinence by causing a severe reaction to occur when alcohol is taken - due to inhibition of acetaldehyde dehydrogenase

163
Q

Contraindications to disulfram

A

ischaemic heart disease and psychoiss

164
Q

how does acamprosate work?

A

reduces cravings to alcohol
thought to be due to it being a weak agonist of NMDA receptors

165
Q

What is an asylum seeker?

A

someone who is applying for refugee status

166
Q

What are the four dimensions of food insecurity

A

availability of food
access to food- economic and physical
utilisation- opportunity to prepare food
stability of the three dimensions over time

167
Q

what is egalitarian resource allocation

A

provide all care needed for everyone - everything is equal.

problem- not financiable possible

168
Q

what is libertarian resource allocation

A

everyone is responsible for their own health

problem- not ethical, some conditions hard to reach out for help

169
Q

what is maximizing resource allocations

A

thinking about the consequences, using resources ….

170
Q

what three features make up an epidemiological health needs assessment

A

descriptive epidemiology- identify the problems by analyzing patterns
analytical epidemiology- determining risk factors and causes of problems
evaluative epidemiology- assess the effectiveness of interventions

171
Q

what are the three key stages of a corporate health needs assessment

A

consultation - engage stakehlders to gather insights
collaboration- work together to align goals and resources
prioritization

172
Q
A

3A (42 decks)

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