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public Health Flashcards

1
Q

What is Primary prevention?

A

Prevent disease onset by targeting risk factors
- Vaccination
- 5 a day

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2
Q

What is Secondary Prevention?

A

Early detection of disease and prevent recurrence
- Screening

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3
Q

What is Tertiary Prevention?

A

Effective Symptom Management
- Medications
- Surgery

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4
Q

What is Quarternary Prevention?

A

Prevent Overmedication

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5
Q

What are the two preventions approaches that can be taken

A

1) Population (All)
2) High Risk (Above a threshold)

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6
Q

What is the Prevention Paradox?

A

Improving public health measure will have little effect on most people

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7
Q

What is Sensitivity? (TP/TP+FN)

A

Correctly identifying the disease

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8
Q

What is Specificity? (TN/TN+FP)

A

Correctly excluding disease

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9
Q

What is the Predictive Positive Value? (TP/TP+FP)

A

All Positive patients who are positive for the disease

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10
Q

What is Negative Predictive Value? (TN/TN+FN)

A

All negative patients who test positive

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11
Q

What is a type 1 error?

A

FP - Patients who are wrongly rejected

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12
Q

What is a Type 2 error?

A

FN -Patients who are wrongfully accepted

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13
Q

What are three types of screening?

A

Population
Opportunistic
Occupational

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14
Q

What are the consequences of screening?

A

Subclinical Diagnosing
Expensive
Invasive

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15
Q

What is Wilson Jugner Criteria?

A

Criteria for a successful screen

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16
Q

What are the Wilson Jugner criteria for a successful screen?

A

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

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17
Q

What are the two types of biases for screening?

A

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

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18
Q

What are the 6 forms of study designs?

A

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

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19
Q

What is an Ecological Study?

A

Observational census w/ Population data
P = Readily available and shows correlation
N = Cant show causation and has bias

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20
Q

What is a Cross sectional study?

A

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

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21
Q

What is a case control study?

A

Retrospective (Establishing risk factors and disease relationship)
P = Rapid and good in rare disease
N = Reverse causality and bias

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22
Q

What is a cohort study?

A

Prospective Longitudinal following positive and negative groups
P = Can show causation and good for common disease
N = LTFU and chnage in behaviour of group

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23
Q

What is a randomised control study?

A

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

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24
Q

What is a sytemic review?

A

A meta Analysis
P = Combine studies w/ great statistical power
N = Ignoring differences between studies and prone to bias

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25
What is Incidence?
No. of new cases in population in a given time
26
What is Prevalence?
Total cases in population in a given time
27
What is Person Years?
Measure of time of patients at risk in study - (No. of patients x years = Person years)
28
What is attributable risk (AR)?
Risk difference between exposed and unexposed groups - Exposed - Unexposed
29
What is Absolute Risk Difference? (ARD)
Measure the risk attributed to exposure - Unexposed - Exposed
30
How do you calculate Number Needed to Treat?
1/ARD
31
What is relative risk?
Measuring the effect of treatment against non treatment - Exposed/Unexposed
32
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
33
What is Correlation?
Numerical relationship between 2 variables
34
What is a Confounder
Associating factor independanlty affecting outcome
35
What is PICO
Population Intervention Control Outcome
36
What is bias?
Systematic error impairing outcomes
37
What are the types of bias?
Selection Information Publication
38
What criteria is used for Causation?
Bradford Hill criteria
39
What is Bradford Hill Criteria?
Criteria behind causation
40
What are the DR CBT CASS criteria in bradford Hill for causation?
Dose and Response Consistency Biological plausability Temporality Coherence Analogy Strength Specificity
41
What are the factors for causation?
Chance Confounder Causation Correlation Bias
42
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
43
What is Equity?
Fairness - Ability to have the chance for equal success (Everyone sees over the fence)
44
What is Equality?
Everyone deserves the same thing/amount as each other (Everyone stands on the same box)
45
What is horizontal equity?
Equal Treatment for equal needs - Same income tax
46
What is vertical equity?
Unequal Treatment for Unequal Needs - Managing a chronic vs acute disease
47
What three levels are involved in Interventions?
Individual - Alcohol Abuse Community - Local crime rate data Population - Alcohol related antisocial behaviour
48
What are health promoting behaviours?
Health Behaviour - Maintaining good health (Lifestyle) Illness Behaviour - Seeking support (GP) Sick role - Management in recovery (Rest and Adherance)
49
What are health damaging behaviours?
Unreal optimism Cultural stigma Stress
50
What are the models of behaviour change?
Becker Transtheoretical Theory of Planned Behaviour Nudge Theory Social Norms Motivational Interview
51
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
52
What is the Nudge Theory?
Positive reinforcement aids health seeking behaviours
53
Describe Becker HBM 1974
Individual will change based on... - Susceptibility - Acknowledge consequences - Benefits of taking action
54
What are the stages of the Transtheoretical model?
Precontemplation Contemplation Preparation Actions Maintenance Relapse
55
What is the Theory of planned behaviour?
Assumes that individuals act rationally, according to **their attitudes, subjective norms, and perceived behavioral control**
56
What are the components of Bradshaw's health needs?
F - Felt E - Expressed N - Normative C - Comparative
57
What are the components of a health needs assessment cycle?
1) Assessment 2) Planning 3) Implement 4) Evaluation
58
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.
59
What is the Donbedian Evaluation Approach?
Structure (What is available) Process (What is done) Outcome (Death, Disease, Disability, Discomfort and Disatisfaction)
60
What are the outcomes of Donebedian's Evaluation Approach
Death, Disease, Disability, Discomfort and Disatisfaction
61
What are Maxwell Dimensions?
Accessibility Acceptance Appropriate Effective Efficacy Equity
62
How is Donebedian and Maxwell approach evaulated?
Wright's Matrix - X axis = Donebedian - Y axis = Maxwell
63
How do you calculate units of alcohol?
1) ABV x Vol(ml) 2) Divide by 1000
64
How can you screen alchol abuse?
CAGE AUDIT
65
How many units charecterise alcohol binge?
>6 Units
66
What is the definition of a medical error?
Preventable unwanted outcome due to human factor
67
How can you classify medical error?
Intention Action Outcome Context
68
What are the types of medical error?
Lack of skill Sloth Bravado Playing the Odds Fixation System
69
What is the Swiss Cheese Model?
Weakness in each layer of defence. Not an issue unless the holes (Weaknesses) line up Result = Adverse event
70
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
71
What is the 3 Bucket model for medical error
Errors are as a result of an **Individual** in **Context** performing a **Task**
72
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
73
How can medical error be prevented?
Standardised Training SBAR Tool (Communcating)
74
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
75
How should you address an adverse event?
Duty of Candour - Apologise to the patient and inform them of the incident
76
What is Domestic Abuse?
Emotional, Physical or Psychological abused inflicted in a relationship
77
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
78
What are the investigations for Domestic Violence?
1) Isolate the individual 2) Communicate w/ Patient 3) File a DASH Form (Risk Assessment)
79
How can you manage cases of domestic violence?
Mild-Moderate - Signpost to services Severe - Obtain consent and file MARAC form
80
What are the 3 core NHS principles?
Free Universal Accessible
81
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
82
What is Maslow's Pyramid of needs?
1) Self Actualisation 2) Esteem 3) Food and Shelter
83
Causes of Homelessness
- Eviction - Low funds - Separation - Lost Job
84
Complications of Homelessness
Decreased Life Expectancy IVDU STI Mental Health Disorder Suicide
85
What are the 4 determinants of food secuirty?
Affordable Accessible Utilisation Stability
86
What are examples of early food influences?
Maternal diet Breastfeeding Age of Solid Food
87
What is Restraint Theory?
Paradoxical increase of hunger after dieting due to imbalanaced leptin and ghreelin leves <1 year
88
What are the three forms of dieting?
Calorie restriction Low Abundance of food types Decreased window to eat
89
What is Considered as illegal underage sex?
Children <13 years
90
When is a child's Gillick and Fraser competence measured?
Ages 13-15
91
What is Fraser guidance for underage sex?
Assess competence in the interest of providing contraception
92
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
93
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
94
What is the Exceptionality Criteria?
NHS and NICE may be excused in certain contexts - Witholding treatment due to low funding
95
What is an Absolute Right?
Right is Never Limited
96
What is a Qualified Right?
May be limited but not disregarded
97
What is Rationing Resources?
Refusing resources due to affordability
98
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
99
What is the positive and negative for Egalitarianism
P = Morally Just N = Financially Unjust
100
What are the pros and cons of Ultratarianism?
P = Efficient N = Immoral vs Minority
101
What are the pros and cons of Libertarianism?
P = Motivated N = Unfair (Genetic Diseases....)
102
What is the Harm Principle?
Patient free from judgement to make decisions even if unwise
103
What is the Johnson's Rule of Rescue?
Percieved duty to save lives wherever possible
104
What is Medical Negligence?
Breech of care resulting in damage
105
What are the 4 questions of Negligence?
Duty of Care? Breach? Harm? Harm due to breach?
106
What are the two tests of Negligence?
Bolam - Would other doctors act the same way Bolitho - Was the event a reasonable course of action
107
What factors can lead to a financial claim?
Duty of Care Breach Irreparable damage
108
What are the 4 pillars of Medical Ethics?
Autonomy (Self Governance) Beneficance (Best Interests) Non Malificence (Do No Harm) Justice ( Protection in society)
109
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
110
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
111
What is Ultratarianism?
The right action is the one that produces the greatest balance of good over harm for everyone affected
112
What is Consequentialsim?
Rightness or wrongness of an action is based on the consequences of that action
113
How can communication be improved for managing visually impaired?
Bigger Writing Textured/ Braille Brighter Audible
114
How can communication be improved for managing auditory impaired?
Sign Language Lip Reading Slow Speech Interpretors
115
What is Peyton's 4 step list?
1) Demo 2) Demo + Explain 3) Demo + Student Explains 4) Student Demo + Explains

3a mehdi (6 decks)

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