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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

b/b+d

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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

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

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25
Q

Relative risk calculation?

A

Incidence in exposed / incidence in unexposed

26
Q

Attributable/Absolute risk?

A

Rate of disease in the exposed which may be attributed to the exposure

27
Q

Attributable/Absolute risk calculation?

A

Incidence in exposed - incidence in unexposed

28
Q

What is number needed to treat?

A

Number needed to treat for 1 person to benefit

29
Q

NNT calculation?

A

1 / absolute risk

30
Q

Risk calculation?

A

Number of cases / total population size per year

31
Q

Odds calculation?

A

Number of cases / number of non cases per year

32
Q

Rate calculation?

A

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

33
Q

What is person time?

A

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

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?

34
Q

What are the tests for negligence?

A

Bolam and Bolitho test

35
Q

What is the Bolam test?

A

Would a group of reasonable doctors do the same?

36
Q

What is the Bolitho test?

A

Was it a logical/reasonable way to act?

37
Q

Examples of types of bias?

A

Selection bias, measurement bias, attrition bias

38
Q

What is selection bias?

A

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

39
Q

What are examples of measurement bias?

A

Observer = knowledge of the hypothesis influences observations and measurements

Recall bias

Social desirability bias

40
Q

What is attrition bias?

A

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

41
Q

What are Maxwell’s dimensions used for?

A

Assessing quality of healthcare

42
Q

What are Maxwell’s 6 dimensions?

A

Effectiveness
Acceptability
Efficiency
Access
Equity
Relevance

43
Q

What is the Bradford Hill criteria?

A

9 principles/criteria for causation - for establishing evidence of a causal relationship

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

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

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

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.

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

49
Q

Stages of health needs assessment?

A

Needs assessment
Planning
Implementation
Evaluation

50
Q

Needs vs. supply vs. demand?

A

Need = ability to benefit from an intervention
Supply = what is provided
Demand = what people ask for

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

Fefines 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

3a follow up (7 decks)

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