Public Health Flashcards
What are the three domains of public health?
Health improvement, Illness behaviour, sick role behaviour
What is health behaviour
Behaviour aimed to prevent disease
What is illness behaviour
Behaviour aimed to seek a remedy
Sick role behaviour
Behaviour aimed at getting well
Intervention at population level vs individual
Population - health promotion - enable people to exert control over health
Individual - patient-centred approach - care responsive to individual needs
What is unrealistic optimism
Individuals continue to practice health damaging behaviours due to inaccurate perceptions of risk and susceptibility
What four factors influence the perception of risk
Lack of personal experince, belief that the problem is preventable with personal action, belief that if it has not happened yet it wont happen, belief that the problem is infrequent
Why will individuals change their behaviour according to the health belief model
Believe they are susceptible, believe it has serious consequences, believe that taking action reduces susceptibility, believes that the costs of taking action outweigh the benefits
Critique of health belief model
does not consider outcome expectancy or self-efficacy, does not consider influence of emotions and behaviour, does not differentiate between first time and repeat behaviour
What is the theory of planned behaviour
Proposes the best predictor of behaviour change is intention
What three things is intention determined by
Personal attitude to the behaviour, social pressure to change, persons perceived behavioural control
Critique of theory of planned behaviour
Lacks temporal element or lack of direction and causality, doesnt take into account emotions, doesnt explain how the three factors interact, doesnt take into account habits and routine
What are the five stages of change is the trans-theoretical model
Pre-contemplation, contemplation, preparation, action and maintenance
Critiques of the trans theroetical model
Not everyone moves through the stages linearly, change might be on a continuum rather than discrete stages, doesnt take into account habits, culture, social and economic factors
What are the advantages of the trans theoretical model
accounts for relapses and temporal element
State five other models of behaviour change
Social norms theory, motivational interviewing, social marketing, nudging, financial incentives
What are the four determinants of health
Genes, environment, lifestyle and healthcare
Horizontal vs vertical equity
Horizontal - equal treatment for equal need e.g. individuals with pneumonia should be treated equally
Vertical - unequal treatment for unequal need - patients with a cold vs pneumonia should be treated differently
What is a health needs assessment
Systematic method for reviewing the health issues facing a population, leading to agreed priorities and resource allocation that will improve health and reduce inequalities
What is felt need
individual perception of variations from normal health
what is expressed need
individual seeks help to overcome variation in normal health
What is normative need
Professional defines intervention appropriate for the expressed need
What is comparative need
Comparison between severity, range of intervention and cost
What is the epidemiological approach to health needs assessment
Disease incidence and prevalence, morbidity and mortality, life expectancy, data from health care databases
What is the corporate approach to health needs assessment
asking the population what their needs are, use of focus groups and interviewing, wide variety of stakeholders
What is the comparative approach to health needs assessment
Compare the needs of the healthcare in one populations to another, can be spatial or social
What is the egalitarian method of resource allocation
Provides all care that is necessary and required to everyone. it is equal but is economically restricted
What is the maximising method of resource allocation
Based solely on consequence, resources given to those most likely to receive benefit but those with less need receive nothing
What is the Libertarian method of resource allocation
Each individual responsible for own health, onus on patient however not all diseases are self inflicted
What are the three parts of Donabedians framework of health service evaluation
Structure, Process and Outcome
Explain the three parts of Donabedians framework of health service evaluation
Structure - what actually is the service
Process - how does the process work
Outcome - 5 D’s death, disease, disability, discomfort, dissatisfaction
What are the parts of Maxwells dimensions of quality of health care
Effectiveness, Efficiency, equity, acceptability, accessibility, appropriateness
What is incidence
Number of new cases in a population in a period of time
What is prevalence
Number of existing cases in a population at a point in time
Absolute risk
Gives a feel for the actual numbers involved and has units
Relative risk
Risk in one category relative to another with no units
Attributable risk
rate of disease in the exposed that may be attributed to exposure
What is Bias
A systemic division from the true estimation of the associated between exposure and outcome
What is selection bias
Selection of study participants, Allocation of participants to different study groups
What is information bias
Observers recall and reporting, participant, instrument wrongly calibrated
What is allocation bias
Different participants in different groups
What is publication bias
trials with negative results are less likely to be published
Lead time bias
Early identification of the disease doesnt alter the outcome but appears to as the disease is identified earlier than usual
Length time bias
Disease that progresses more slowly is more likely to be picked up by screening which makes it appear that screening lengthens life
What is confounding
Situation where a factor is associated with the exposure of interest and independent influences the outcome but does not lie on the causal pathway e.g. lack of exercise causes weight gain but there are confounding variables that also effect weight gain
What are the bradford hill criteria for causality?
Strength, temporality, does-response, consistency, reversibility, biological plausibility, coherence, analogy, specificity
What is dose response
Does a higher exposure produce higher incidence
What is consistency
Are similar results seen in different studies and populations
What is temporality
Does the exposure precede the outcome
What is reversibility
Removing the exposure reduced the risk of disease
What is biological plausibility
Does it make sense biologically
What is coherence
Logical consistency with lab information e.g. incidence of lung cancer with increased smoking is consistent with lab evidence that smoking is carcinogenic
What is analogy
Similarity with other cause-effect relationships in the past e.g. thalidomide in pregnancy, not other teratogenic drugs show the same effects
What is Specificity
Relationship is specific to the outcome of interest e.g. introducing helmets reduced head injuries specifically, it wasnt that there has been an overall decrease in injuries
What is reverse causality
Stress could have caused HTN rather than HTN causing stress
Explain Primary, secondary and tertiary prevention
Primary - Trying to stop yourself getting the disease
Secondary - Trying to detect the disease early and prevent it from getting worse
Tertiary - Trying to improve you QoL and reduce the sx of a disease you already have
What is the prevention paradox
A preventative measure that brings much benefit to the population but little to the participating individual
name five types of screening
Population based, Opportunistic, screening for communicable disease, Pre-employment and occupational medicals, Commercially provided
What are the four parts of the Wilson and Junger criteria for screening
The condition, screening programme, the test and the treatment
Explain the wilson and junger criteria
The condition - important, natual history, latent and declared stage, risk factors and disease markers must be understood, disease should have a latent and detectable stage
Screening programme - ongoing not one off, cost effective
the test - simple, safe, precise and validated screening test, define cut offs and distribute to population, test should be acceptable to the population, agreed policy for further investigations of +ve results
Treatment - effective treatment for the disease with evidence of early treatment leading to a better prognosis, agreed policy on who to treat, facilities available to treat
What is sensitivity
Proportion of people with the disease who are correctly identified
What is specificty
Proportion of people without the disease who are correct excluded
What is PPV
The proportion of people with a +ve result who actually have the disease
What is NPV
Proportion of people with a negative result who do not have the disease
What is a cohort study
Sample taken from the study population and split into two groups one exposed and one not. incidence is compared between the two groups. Its prospective
Adv vs disadv of cohort study
Adv - Follow up rare exposure, identify rf, sequence of events can prove cause and effect, multiple exposures and outcomes can be measure
Disadv - Needs a large sample size, impractical for rare diseases, expensive, high drop out rate with long term follow up, important for diseases with long latent stages
What is a case control study
Groups with and without a disease are selected and past exposures are identified, retrospective
Adv and Disadv of case control study
Adv: Quick, good for looking at rare disease and long latency periods, multiple exposures can be studied
Disadv: selection and information bias, impractical for rare, hard to establish sequence of events, difficult to tell apart confounding factors
What is a cross sectional stusy
Exposure and outcome are measured simultaneously in a population at one particular time ‘snapshot’
Adv and Disadv of cross sectional
Adv - can assess a large sample size, quick, repeated studies can show change over time
Disadv - Risk of reverse causality, not good for rare, unclear timeline
What is an RCT
Two groups - one control and one treatment which allows for comparison in order to assess the effectiveness of an intervention
Adv and Disadv of RCT
Adv - low risk of bias and confounding, comparitive, good evidence of cause and effect
Disadv - High drop out rate, ethical issues, time consuming and expensive, results cannot always be generalised because of strict entry criteria
What is an ecological study
Investigation finds a certain correlation between two things in a population
What are the fraser guidelines
Do they understand the advice, has the doctor encouraged them to tell their parents, will she have sex anyway, is mental/physical health at risk if you dont give the treatment, best interests
What is gillick competence
Does a child under 16 have capacity to make their own decisions, clinical judgement made by the doctor based on age, capacity, maturity
What features of a disease make it a public health concern and make them possibly notifiable
High mortality, high morbidity, highly contagious, expensive to treat, effective interventions
Name some notifiable diseases
Acute enceph, acute infectious hep, acute meningitis, acute poliomyelitis, anthrax, botulism, brucellosis, covid, cholera, diphtheria, enteric fever (typhoid), HUS, infectious bloody diarrhoea, invasive group a strep, legionnaires, leprosy, malaria, measles, mumps, plague, rabies, rubella, SARS, scarlet fever, smallpox, tetanus, TB, typhus, VWF, whooping cough, yellow fever
What is a cluster
group of cases that may be linked e.g. scabies outbreak in a care home
Define epidemic, pandemic, endemic and hyper-endemic
Epidemic - more than expected incidence in a country
Pandemic - more than one country
Endemic - persistent levels of disease occurence
Hyper-endemic - persistently high level of disease occurrence
What are the four aspects of negligence and error
Was there a duty of care? Was there a breach of that duty? Was the patient harmed? Was the harm due to a breach in duty of care?
What is the bolam rule
Would a reasonable doctor do the same
What is the bolitho rule
Would that be reasonable - was it logical and were pros and cons weighed
What is the swiss cheese model of error
Falling through holes because there is failed or absent safeguards against error occuring. called latent failures. Organisational influence > Unsafe supervision > preconditions for unsafe act > unsafe act
Name the 10 types of error
Sloth, Fixation/loss of perspective, communication breakdown, poor team working, playing the odds, bravado/timidity, ignorance, mistriage, lack of skill, system error
Explain the types of error
Sloth - inaccurate documentation
Fixation - focus on one diagnosis
Communication breakdown - unclear plan/not listening
Poor team working - some are out of their depth
Playing the odds - choosing the common and dismissing the rare
bravado/timid - not having confidence or working beyond competence
ignorance - lack of knowledge
mistriage - over or under estimate of severity
lack of skill - not properly trained
system error - environmental/tech/equipment failure
What is a never event
serious, largely preventable patient safety incident that should not occur if available preventative measures are in place. e.g. wrong site for surgery, wrong drug given, escape of psych patient
What is the duty of candour
Every prof must be open and honest with the patient when something has gone wrong with their treatment or has the potential to cause harm or distress
