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3a follow up > Public Health > Flashcards

Public Health Flashcards

1
Q

What is primary prevention and examples?

A

Preventing a disease from developing by modification of risk factors.
e.g. immunisations, smoking cessation

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2
Q

What is secondary prevention and examples?

A

Early detection of disease to slow progression/reduce impact of already diagnosed disease
e.g. Screening, statins post MI

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3
Q

What is tertiary prevention and examples?

A

Reducing complications or severity once a disease in established and symptomatic
e.g. Chronic disease management programmes

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4
Q

Examples of study design?

A

Cohort study
Cross-sectional study
Case control study
Randomised control trial
Ecological

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5
Q

What is a cohort study?

A

Look at a group with a certain exposure and look for outcomes

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6
Q

What is a cross-sectional study?

A

Assess a cross section of people with a certain exposure or outcome at fixed point in time

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7
Q

What is case control study?

A

Select cases with particular outcome already, and look back for exposure/factors in common

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8
Q

What is a randomised control trial?

A

2 groups, one exposed and one unexposed (control), look at response over time

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9
Q

What is an ecological study?

A

Use routinely collected population level data to show trends and generate hypotheses

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10
Q

What is sensitivity?

A

Proportion of people with the disease correctly identified by screening test

a/a+c

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11
Q

What is specificity?

A

Number of people without the disease correctly excluded by the screening test

d/d+b

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12
Q

What is positive predictive value?

A

Proportion with positive test who actually have the disease

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13
Q

What is negative predictive value?

A

Proportion with negative test who do not have the disease

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14
Q

What is screening?

A

Identifying people at risk of developing a particular disease

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15
Q

Why do we do screening?

A

So interventions can be implemented earlier

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16
Q

Cons of screening?

A

Test may be distressing or harmful to healthy ppl with no benefit
Preventative measures may carry greater risk for gen pop

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17
Q

What is lead time bias?

A

Earlier detection gives impression of longer survival but does not alter prognosis

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18
Q

What is length time bias?

A

Screening more likely to pick up slow growing illness with better prognosis

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19
Q

Name of criteria for screening programmes?

A

Wilson and Junger

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20
Q

Wilson and Junger key principles?

A

Knowledge of the disease
Knowledge of the test
Treatment for the disease
Cost considerations

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21
Q

4 different types of screening?

A

Population based e.g. breast
Opportunistic e.g. BMI at appt
Screening for communicable disease e.g. in pregnancy
Pre-employment/occupational

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22
Q

What is incidence?

A

Number of new cases in population during specific time period

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23
Q

What is prevalence?

A

Number of existing cases in population during specific time period

PREvalence = PRE-existing

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24
Q

What is relative risk?

A

How much more likely an individual is to get the disease with A compared to B

Risk in one category relative to another (strength of association between RF and disease)

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25
Q

Relative risk calculation?

A

Risk in exposed / risk in unexposed

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26
Q

Absolute risk?

A

Probability of event occurring in a group

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27
Q

Absolute risk calculation?

A

Number of events / absolute population

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28
Q

What is number needed to treat?

A

Number needed to treat for 1 person to benefit

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29
Q

NNT calculation?

A

1 / absolute risk

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30
Q

Risk calculation?

A

Number of cases / total population size per year

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31
Q

Odds calculation?

A

Number of cases / number of non cases per year

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32
Q

Rate calculation?

A

Number of cases / person-time at risk of developing disease

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33
Q

What is person time?

A

The amount of time each person is at risk of developing the disease

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34
Q

4 main questions in negligence?

A

Was there a duty of care?
Was there a breach in duty of care?
Was the patient harmed?
Was the patient harmed due to breach in care?

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34
Q

What are the tests for negligence?

A

Bolam and Bolitho test

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35
Q

What is the Bolam test?

A

Would a group of reasonable doctors do the same?

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36
Q

What is the Bolitho test?

A

Was it a logical/reasonable way to act?

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37
Q

Examples of types of bias?

A

Selection bias, measurement bias, attrition bias

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38
Q

What is selection bias?

A

Sample chosen is not representative of the population e.g. healthy user bias, volunteer bias

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39
Q

What are examples of measurement bias?

A

Observer = knowledge of the hypothesis influences observations and measurements

Recall bias

Social desirability bias

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40
Q

What is attrition bias?

A

Differences between those who finish trial vs. those who do not

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41
Q

What are Maxwell’s dimensions used for?

A

Assessing quality of healthcare

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42
Q

What are Maxwell’s 6 dimensions?

A

Effectiveness
Acceptability
Efficiency
Access
Equity
Relevance

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43
Q

What is the Bradford Hill criteria?

A

9 principles for establishing evidence of a causal relationship

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44
Q

What are the 9 Bradford Hill criteria?

A

Strength - strong association between the 2
Consistency - observed multiple times/studies
Specificity - Exposure associated with specific outcome and vise versa
Temporality - exposure must precede outcome
Biological gradient - dose-repsonse relationship
Plausibility - association in plausable
Coherence - cosistent with other knowledge
Experiment - confirmed by experimental studies
Analogy - similar to other know causal relationships

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45
Q

What is the prevention paradox?

A

A preventative measure that brings a lot benefits to population, often offers little to each participating individual
e.g. for each 100 people screened, only 1 suffers from the disease

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46
Q

What are the 4 main domains of determinants of health?

A

Genetic - age, gender, ethnicity
Environment - housing, education
Lifestyle - smoking, employment
Healthcare - access and quality

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47
Q

What is Maslow’s hierarchy of needs?

A

Physiological - food, water, sleep
Safety - employment, home
Love/belonging - friendship, intimacy
Esteem - confidence, respect of others
Self-actualisation - morality, creativity etc.

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48
Q

What is health needs assessment?

A

Systematic process to identify health and healthcare needs of a population

= agreed priorities and resource allocation, improve health and decrease inequalities

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49
Q

Stages of health needs assessment?

A

Needs assessment
Planning
Implementation
Evaluation

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50
Q

Needs vs. supply vs. demand?

A

Need = health issues requiring intervention
Supply = what is provided
Demand = what people ask for

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51
Q

What is felt need?

A

Individuals/communities perceptions about health needs

52
Q

What is expressed need?

A

Demands for services explicitly stated or observed

53
Q

What is normative need?

A

Need defined by proffesionals

54
Q

What is comparative need?

A

Need defined by comparing health status of one population to another

55
Q

Three different approaches to health needs assessment?

A

Epidemiological
Comparative
Corporate

56
Q

Epidemiological approach to HNA?

A

Defines burden and size by looking at current data (e.g. incidence, prevalence, mortality)
Looks at current services and recommends improvements

57
Q

Cons of epidemiological approach?

A

Database may be poor/inadequate
Doesn’t consider felt need

58
Q

Comparative approach to HNA?

A

Compares services received by one population to another

59
Q

Cons of comparative approach?

A

Data may vary in quality
May be hard to find comparable populations

60
Q

Corporate approach to HNA?

A

Takes into account views of anyone with an interest e.g. patients, professionals, media, politicians

61
Q

Cons of corporate approach?

A

Hard to distinguish needs for demand
Groups have vested interest
Dominant individuals may have undue influence

62
Q

Name three theories for behaviour change

A

Health belief model
Theory of planned behaviour
Trans-theoretical model

63
Q

Stages of trans-theoretical model?

A

Pre-contemplation - not considering change
Contemplation - aware of problem
Planning - ready to change, plans/steps
Action - taking necessary steps
Maintenance/Relapse - continue/revert

64
Q

Pros and cons of trans-theoretical model?

A

Pros:
Flexibility - allows for setbacks/relapse
Recognise ppl change at difference paces
Covers entire process from unaware to maintenance

Cons:
Subjectivity in determining current stage
Potential for stagnation
Doesn’t account for emotional influences

65
Q

What does the health belief model rely on?

A

Person believes:
They are susceptible to the condition
Personal action can reduce susceptibility
That there are serious consequences to the condition
The benefits of action outweigh the cons

66
Q

Pros and cons of health belief model?

A

Pros:
Can be applied to wide variety of behaviours
Cues to action are a unique component
Longest standing model

Cons:
Doesn’t consider emotional influence
Doesn’t consider habitual behaviour
Other factors may influence outcome

67
Q

What is the theory of planned behaviour?

A

Human behaviour is a result of behaviour, normative, and control beliefs

68
Q

What are the predictors in the theory of planned behaviour?

A

Intention is predictor of behaviour:
Personal attitude about behaviour (perceived consequences)
Perceived social pressure/norms
Perceived behaviour control (have skills/resources)

69
Q

Pros and cons of theory of planned behaviour?

A

Pros:
Can be applied to wide variety of behaviours
Useful for predicting intention
Takes into account importance of social pressures

Cons:
No temporal element, direction, or causality
Doesn’t consider emotional influence
Doesn’t account for hobbies/habits
Assumes attitudes can be measured

70
Q

What are some other models of change that could be mentioned?

A

Social norms theory = behaviour is influenced by misperceptions of how our peers think and act

Motivational interview = counselling approach for initiation of behavioural changes

Nudging = more effective to encourage positive choices rather than restricting unwanted behaviour with sanctions

71
Q

What is an error?

A

Any preventable event which may cause/lead to patient harm

72
Q

What is neglect?

A

Falling below an acceptable standard of care

73
Q

4 main domains of error?

A

Error of omission = action delayed/not taken
Error of commission = wrong action
Error of negligence = not meeting standard
Skill based errors = slips/lapses

74
Q

Medical error types?

A

Sloth
Poor team working
Fixation/loss of perspective
Communication breakdown
System error
Lack of skill
Ignorance
Bravado
Playing the odds

75
Q

What is the Swiss cheese model?

A

Incidents occur due to accumulations of multiple failures in defence = align, creating hazard trajectory

76
Q

What are latent errors (Swiss cheese model)?

A

Weakness in the system which are hidden/dormant. Existed for a long time without training

77
Q

What are active errors (Swiss cheese model)?

A

Unsafe acts/mistakes made by individuals

78
Q

What is the three bucket model?

A

Error due to interaction between personal, environmental, and physical (task) factors

79
Q

Examples for the three bucket models?

A

Personal: poor knowledge, fatigue, little experience
Environmental: distraction, poor handover, equipment failure
Physical: unfamiliar equipment, variation from ‘normal’

80
Q

What are never events?

A

Serious, largely preventable events resulting in harm or death to patients which should not occur (preventable measures in place)

81
Q

Examples of never events?

A

Med - wrong chemo route
Surg - wrong site/retained object
MH - escape of transfer patient

82
Q

What are confounders?

A

Risk factors, other than those being studied, that influence the outcome

83
Q

Who should notifiable diseases be reported to?

A

Local health protection officer

84
Q

What is a disease outbreak?

A

Number of cases exceeds that of what would be expected

85
Q

Epidemic defintion?

A

Cases occurring in the same geographical region

86
Q

Pandemic definition?

A

Disease has spread over countries/continents affecting large numbers of people

87
Q

Definition of an asylum seeker and NHS access?

A

A person who has made an application for refugee status

Free access to GP and secondary care if they have an active application

88
Q

Definition of a refugee?

A

A person granted asylum and refugee status

89
Q

Definition of indefinite leave to remain and access to NHS?

A

A person is given full refugee status and permanent residence in the UK

Free full access to NHS

90
Q

Definition of an unaccompanied child and NHS access?

A

Someone that has crossed international borders in seek of refuge <18 years old

Free full NHS access

91
Q

What is equity?

A

Providing resources and opportunities based on individual need

Horizontal = equal treatment for equal need

Vertical = unequal treatment for unequal need

92
Q

What is equality?

A

Everyone treated the same

93
Q

What is inverse care law?

A

The availability of medical or social care tends to vary inversely with the need of the population served

94
Q

3 resource allocation principles?

A

Libertarian approach
Egalitarian approach
Maximalism approach

95
Q

Libertarian approach to resource allocation?

A

Taking responsibility for own health
+ Onus on pt, may be more engage
- Not all diseases are self-inflicted

96
Q

Types of observational studies?

A

Case control
Cohort
Cross-sectional

97
Q

Maximalism approach to resource allocation?

A

Concentrating resources on those who stand to gain the most
+ Resources allocated to those likely to receive most benefit
- Those with ‘less need’ receive nothing

98
Q

What is odds?

A

The ratio of the probability of an event occurring to the probability of it not occuring

99
Q

What is odds ratio?

A

Measure of an association between exposure and outcome

100
Q

Odds ratio calculation?

A

Incidence in exposed / incidence in unexposed

101
Q

Egalitarian approach to resource allocation?

A

Provide all care that is needed and required to everyone
+ Equal for everyone
- Economically restricted

102
Q

What NHS access do refused asylum seekers have?

A

Free GP access

103
Q

Can refused asylum seekers access secondary care?

A

NI, Scotland, Wales - yes
England - depends if care is immediately necessary/urgent or non-urgent + other exemptions

104
Q

When can confidential information be disclosed?

A

Required by law - notifiable disease, ordered by judge
With patient consent
Public interest - serious crime, communicable disease

105
Q

GMC Duties of a doctor?

A

Protect and promote health
Provide good standard of care
Recognise + work within limits on competence
Work with colleagues to best serve patient interests
Treat patients as individuals and respect their diginity

106
Q

What is domestic abuse?

A

Any incident or pattern of behaviour showing controlling, threatening, violent or abusive actions between >16 years olds and their partners/family members

107
Q
A
108
Q

Types of domestic abuse?

A

Psychological
Physical
Sexual
Emotional
Financial

109
Q

Who to report domestic violence to if imminent risk of serious harm?

A

MARAC/IDVAS

MARAC - Multiagency risk assessment conference
IDVAS - Independent domestic violence advice services

110
Q

Examples of motivations for unhealthy behaviour?

A

Short term benefits > long term risks
Challenge of affluence to self control
Social networks
Backwards looking vs forward looking

111
Q

What are some of the early influences of feeding behaviours?

A

Parental preferences/practices
Breast feeding
Maternal diet and taste preference

112
Q

Examples of ‘dieting’?

A

Restricting amount of food
Not eating certain types of food
Avoiding eating foods for long periods of time

113
Q

What is the external theory of obesity?

A

Suggests obese individuals are more responsive to external food cues and less sensitive to internal hunger and satiety signals compared to lean individuals e.g. the sight or smell of food

Less responsive to internal signals of hunger/satiety

114
Q

What is the restraint theory?

A

Suggests deliberate attempts to restrict food intake can paradoxically lead to increased eating and weight gain

Restrained eaters = cognitive strategies to control intake
Cognitive controls broken = overeating
Common triggers = stress, emotions, exposure to tempting foods

115
Q

List some examples of social determinants of health which can influence substance misuse?

A

Physical/mental health
Trauma
Access to substances
Access to peer support
Fhx of substance abuse
Harm reduction programmes
Access to healthcare services
Attitude/opinion towards substance

116
Q

Barriers homeless people face when accessing healthcare?

A

Unable to coordinate - no watch/clock
Transport issues
Unable to afford indirect costs (meds, transport)
Judgement/maltreatment from HCPs
Concurrent mental illness

117
Q

Which report investigated inequalities in health?

A

The Black report 1980

118
Q

What were the main findings of the Black report?

A

Health inequalities due to social and economic factors, including:
Income inequality
Education
Employment
Working conditions
Housing
Diet

WIDENING HEALTH GAP

119
Q

Recommendations from the black report?

A

Reduce income inequality
Improve education
Create more jobs
Improve working conditions
Improve housing
Promoting healthy lifestyles

120
Q

What is deontologism?

A

Concerned with moral duty
Patient-centred

121
Q

What is utalitarianism?

A

Advocates actions that promote happiness or pleasure and oppose actions that cause unhappiness or harm

Society-centred

122
Q

What is consequentialism?

A

Ends justify the means

123
Q

What is an advance decision?

A

Legally binding document specifying a refusal of treatment in the future

124
Q

What is an advance statement?

A

Not legally binding - express preference for care/treatment and broader range of topics

125
Q

What is beneficence?

A

Duty to act in patients best interest and promote good

126
Q

What is non-maleficence?

A

Duty to avoid causing harm to others - do no harm

127
Q

What is autonomy

A

Right of the patient to make their own decisions and act under self-chosen plan

128
Q

What is justice?

A

Treating all people fairly and equitably

3a follow up (7 decks)

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