public Health Flashcards
What is Primary prevention?
Prevent disease onset by targeting risk factors
- Vaccination
- 5 a day
What is Secondary Prevention?
Early detection of disease and prevent recurrence
- Screening
What is Tertiary Prevention?
Effective Symptom Management
- Medications
- Surgery
What is Quarternary Prevention?
Prevent Overmedication
What are the two preventions approaches that can be taken
1) Population (All)
2) High Risk (Above a threshold)
What is the Prevention Paradox?
Improving public health measure will have little effect on most people
What is Sensitivity? (TP/TP+FN)
Correctly identifying the disease
What is Specificity? (TN/TN+FP)
Correctly excluding disease
What is the Predictive Positive Value? (TP/TP+FP)
All Positive patients who are positive for the disease
What is Negative Predictive Value? (TN/TN+FN)
All negative patients who test positive
What is a type 1 error?
FP - Patients who are wrongly rejected
What is a Type 2 error?
FN -Patients who are wrongfully accepted
What are three types of screening?
Population
Opportunistic
Occupational
What are the consequences of screening?
Subclinical Diagnosing
Expensive
Invasive
What is Wilson Jugner Criteria?
Criteria for a successful screen
What are the Wilson Jugner criteria for a successful screen?
I - Importance
A - Availability
T - Treatable
R - Recignisable Latent Stage
O - Obvious Diagnostic Test
G - General Public Accepts
E - Economically Viable
N - Natural History of disease known
I - Issued Agreed Policy
C - Continuously Done
What are the two types of biases for screening?
Lead Time
- Screening earlier gives apparent increase in life expectancy
Length Time
- Slow progressing diseases more likely picked up on screening than rapid progressing diseases
What are the 6 forms of study designs?
Ecological
- Observational census w/ Population data
Cross Sectional
- Retrospecitive Observational (Looks at risk factors, present time and disease development)
Case Control
- Retrospective (Establishing risk factors and disease relationship)
Cohort
- Prospective Longitudinal following positive and negative groups
Randomised Controlled
- Rigorous blind/ double blinded groups w/ Placebo and followed up over time
Systemic Review
- Meta Analysis
What is an Ecological Study?
Observational census w/ Population data
P = Readily available and shows correlation
N = Cant show causation and has bias
What is a Cross sectional study?
Retrospecitive Observational (Looks at risk factors, present time and disease development)
P = Large samples and shows change over time
N = Reverse Causality, Legth time bias and unuseful in rare disease
What is a case control study?
Retrospective (Establishing risk factors and disease relationship)
P = Rapid and good in rare disease
N = Reverse causality and bias
What is a cohort study?
Prospective Longitudinal following positive and negative groups
P = Can show causation and good for common disease
N = LTFU and chnage in behaviour of group
What is a randomised control study?
Rigorous blind/ double blinded groups w/ Placebo and followed up over time
P = Gold standard for causation
N = LTFU and change in behaviour of group
What is a sytemic review?
A meta Analysis
P = Combine studies w/ great statistical power
N = Ignoring differences between studies and prone to bias
What is Incidence?
No. of new cases in population in a given time
What is Prevalence?
Total cases in population in a given time
What is Person Years?
Measure of time of patients at risk in study
- (No. of patients x years = Person years)
What is attributable risk (AR)?
Risk difference between exposed and unexposed groups
- Exposed - Unexposed
What is Absolute Risk Difference? (ARD)
Measure the risk attributed to exposure
- Unexposed - Exposed
How do you calculate Number Needed to Treat?
1/ARD
What is relative risk?
Measuring the effect of treatment against non treatment
- Exposed/Unexposed
What is relative risk reduction?
How treatment can reduce the risk of an event compared to a control group
- 1- Relative Risk (E-C)
- (C - E)/C
What is Correlation?
Numerical relationship between 2 variables
What is a Confounder
Associating factor independanlty affecting outcome
What is PICO
Population
Intervention
Control
Outcome
What is bias?
Systematic error impairing outcomes
What are the types of bias?
Selection
Information
Publication
What criteria is used for Causation?
Bradford Hill criteria
What is Bradford Hill Criteria?
Criteria behind causation
What are the DR CBT CASS criteria in bradford Hill for causation?
Dose and Response
Consistency
Biological plausability
Temporality
Coherence
Analogy
Strength
Specificity
What are the factors for causation?
Chance
Confounder
Causation
Correlation
Bias
What are the domains for Public health (IPS)?
Improving health promotion
- Education, Employment and decreasing Inequality
Protecting health
- Hazard prevention
Service improvement
- Audits and Equity
What is Equity?
Fairness - Ability to have the chance for equal success
(Everyone sees over the fence)
What is Equality?
Everyone deserves the same thing/amount as each other
(Everyone stands on the same box)
What is horizontal equity?
Equal Treatment for equal needs
- Same income tax
What is vertical equity?
Unequal Treatment for Unequal Needs
- Managing a chronic vs acute disease
What three levels are involved in Interventions?
Individual
- Alcohol Abuse
Community
- Local crime rate data
Population
- Alcohol related antisocial behaviour
What are health promoting behaviours?
Health Behaviour
- Maintaining good health (Lifestyle)
Illness Behaviour
- Seeking support (GP)
Sick role
- Management in recovery (Rest and Adherance)
What are health damaging behaviours?
Unreal optimism
Cultural stigma
Stress
What are the models of behaviour change?
Becker
Transtheoretical
Theory of Planned Behaviour
Nudge Theory
Social Norms
Motivational Interview
What are the main three models for behavioural change?
Becker (1974)
- Individual exhibits change if they believe they are susceptible
Transtheoretcial Model
- The 5 stages from precontemplation to relapse
Theory of planned behaviour
- person’s likelihood of engaging in a behavior is related to the strength of their intention to do so
What is the Nudge Theory?
Positive reinforcement aids health seeking behaviours
Describe Becker HBM 1974
Individual will change based on…
- Susceptibility
- Acknowledge consequences
- Benefits of taking action
What are the stages of the Transtheoretical model?
Precontemplation
Contemplation
Preparation
Actions
Maintenance
Relapse
What is the Theory of planned behaviour?
Assumes that individuals act rationally, according to their attitudes, subjective norms, and perceived behavioral control
What are the components of Bradshaw’s health needs?
F - Felt
E - Expressed
N - Normative
C - Comparative
What are the components of a health needs assessment cycle?
1) Assessment
2) Planning
3) Implement
4) Evaluation
What are the Health Needs Assessment Approaches?
Epidemiological
- This approach considers the burden of illness by looking at the incidence, prevalence, and mortality of a disease or health condition
Comparative
- Compares the services a population receives in one area to those in other areas
Corporate
- Eliciting the views of stakeholders - which may include professionals, patients and service-users, the public and politicians - on what services are needed.
What is the Donbedian Evaluation Approach?
Structure (What is available)
Process (What is done)
Outcome (Death, Disease, Disability, Discomfort and Disatisfaction)
What are the outcomes of Donebedian’s Evaluation Approach
Death, Disease, Disability, Discomfort and Disatisfaction
What are Maxwell Dimensions?
Accessibility
Acceptance
Appropriate
Effective
Efficacy
Equity
How is Donebedian and Maxwell approach evaulated?
Wright’s Matrix
- X axis = Donebedian
- Y axis = Maxwell
How do you calculate units of alcohol?
1) ABV x Vol(ml)
2) Divide by 1000
How can you screen alchol abuse?
CAGE
AUDIT
How many units charecterise alcohol binge?
> 6 Units
What is the definition of a medical error?
Preventable unwanted outcome due to human factor
How can you classify medical error?
Intention
Action
Outcome
Context
What are the types of medical error?
Lack of skill
Sloth
Bravado
Playing the Odds
Fixation
System
What is the Swiss Cheese Model?
Weakness in each layer of defence.
Not an issue unless the holes (Weaknesses) line up
Result = Adverse event
What are the two types of adverse events that can occur in the Swiss cheese model?
Active = Direct event predisposing to negative outcomes
Latent = Systematic failure built up over time
What is the 3 Bucket model for medical error
Errors are as a result of an Individual in Context performing a Task
What is a Never Event?
Largely preventable outcome that should not happen if the adequate measures are in place
- Report to CQC, SEIS
- Consequences = Malpractice suits and fitness to practice
How can medical error be prevented?
Standardised Training
SBAR Tool (Communcating)
What are the two outcomes of a medical error?
Near Miss
- Error not directly leading to adverse outcome
Adverse Event
- Error leading to poor outcome
How should you address an adverse event?
Duty of Candour
- Apologise to the patient and inform them of the incident
What is Domestic Abuse?
Emotional, Physical or Psychological abused inflicted in a relationship
What presentations can make you suspicious of domestic violence?
- Delayed/ Recurrent GP Presentations
- Multiple bruising at different healing stage
- Injury mechanism does not match the injury
- Partner is always present at appointments
What are the investigations for Domestic Violence?
1) Isolate the individual
2) Communicate w/ Patient
3) File a DASH Form (Risk Assessment)
How can you manage cases of domestic violence?
Mild-Moderate
- Signpost to services
Severe
- Obtain consent and file MARAC form
What are the 3 core NHS principles?
Free
Universal
Accessible
What is the Inverse Care Law?
Those w/ best healthcare access may need it less
OR
Those w/ worse healthcare access may need it more
What is Maslow’s Pyramid of needs?
1) Self Actualisation
2) Esteem
3) Food and Shelter
Causes of Homelessness
- Eviction
- Low funds
- Separation
- Lost Job
Complications of Homelessness
Decreased Life Expectancy
IVDU
STI
Mental Health Disorder
Suicide
What are the 4 determinants of food secuirty?
Affordable
Accessible
Utilisation
Stability
What are examples of early food influences?
Maternal diet
Breastfeeding
Age of Solid Food
What is Restraint Theory?
Paradoxical increase of hunger after dieting due to imbalanaced leptin and ghreelin leves <1 year
What are the three forms of dieting?
Calorie restriction
Low Abundance of food types
Decreased window to eat
What is Considered as illegal underage sex?
Children <13 years
When is a child’s Gillick and Fraser competence measured?
Ages 13-15
What is Fraser guidance for underage sex?
Assess competence in the interest of providing contraception
What is Gillick Competence?
A child’s competence is assessed by the ability to understand, retain and compare pros and cons of any medical intervention w/o the need of parents
Which Human rights acts of 2005 are medically relevant?
2) Right to life
3) Free from inhuman treatment
8) Respect family/ Private life
12) To Marry/ Conceive
14) Protected vs Discrimination
What is the Exceptionality Criteria?
NHS and NICE may be excused in certain contexts
- Witholding treatment due to low funding
What is an Absolute Right?
Right is Never Limited
What is a Qualified Right?
May be limited but not disregarded
What is Rationing Resources?
Refusing resources due to affordability
What are the 3 Theories of Resources
Egalitarianism
- Equality to supply anything to anyone
Ultratarianism
- Maximising resources for the majority
Liberterianism
- Patient responsible for their own health
What is the positive and negative for Egalitarianism
P = Morally Just
N = Financially Unjust
What are the pros and cons of Ultratarianism?
P = Efficient
N = Immoral vs Minority
What are the pros and cons of Libertarianism?
P = Motivated
N = Unfair (Genetic Diseases….)
What is the Harm Principle?
Patient free from judgement to make decisions even if unwise
What is the Johnson’s Rule of Rescue?
Percieved duty to save lives wherever possible
What is Medical Negligence?
Breech of care resulting in damage
What are the 4 questions of Negligence?
Duty of Care?
Breach?
Harm?
Harm due to breach?
What are the two tests of Negligence?
Bolam
- Would other doctors act the same way
Bolitho
- Was the event a reasonable course of action
What factors can lead to a financial claim?
Duty of Care
Breach
Irreparable damage
What are the 4 pillars of Medical Ethics?
Autonomy (Self Governance)
Beneficance (Best Interests)
Non Malificence (Do No Harm)
Justice ( Protection in society)
What are the 3 Theories of Medical Ethics?
Deontology
- Treat others as you would wnat to be treated
Ultratarianism
- the right action is the one that produces the greatest balance of good over harm for everyone affected
Consequentialism
- Evaluating course of action based on the consequences
What is the Deontology Theory?
Judges the morality of an action based on whether it follows a set of rules or principles, rather than on the action’s consequences
What is Ultratarianism?
The right action is the one that produces the greatest balance of good over harm for everyone affected
What is Consequentialsim?
Rightness or wrongness of an action is based on the consequences of that action
How can communication be improved for managing visually impaired?
Bigger Writing
Textured/ Braille
Brighter
Audible
How can communication be improved for managing auditory impaired?
Sign Language
Lip Reading
Slow Speech
Interpretors
What is Peyton’s 4 step list?
1) Demo
2) Demo + Explain
3) Demo + Student Explains
4) Student Demo + Explains
