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Public Health 2 Flashcards

1
Q

Epidemiology

A

Study of…

  • Frequency
  • Distribution
  • Determinants

…of disease and health

…in populations

… in order to prevent and control disease

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2
Q

Incidence

A

New cases in a set time period

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3
Q

Prevalence

A

Existing cases at a given point in time

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4
Q

Person time

A

Measure of time at risk

From entry to study to…

  • Disease onset
  • Loss to follow-up
  • End of study

Used to calculate incidence rate
Person time is the denominator

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5
Q

Absolute risk

A

ACTUAL numbers

E.g. 50 deaths per 1000

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6
Q

Relative risk

A

Risk in one group relative to another

Ratio of risk of disease in exposed to risk of disease in unexposed

Incidence in exposed / incidence in unexposed

RR = 1 = No difference
RR > 1 = Intervention increases risk of outcome
RR < 1 = Intervention decreases risk of outcome

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7
Q

Attributable risk

A

Rate of disease in the exposed that can be attributed to the exposure

(Incidence in exposed - incidence in unexposed)

ABSOLUTE RISK

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8
Q

Relative risk reduction

A

RRR

Reduction in rate of outcome in the intervention group relative to control group

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9
Q

Absolute risk reduction

A

ARR

Absolute difference in the rates of events between the two groups

Gives an indication of baseline risk and intervention effect

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10
Q

Number needed to treat

A

NNT

Number of patients needed to treat to prevent ONE bad outcome

1 / absolute risk reduction

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11
Q

Reasons for association between exposure and outcome

A 
Bias 
Chance 
Confounding 
Reverse causality 
True causal association
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12
Q

Bias

A

Systematic deviation from the true estimation of association between exposure and outcome

Systematic error which leads to a distortion of the true underlying association

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13
Q

Main groups of bias

A

Selection bias

Information bias

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14
Q

Selection bias

A

Systematic error

Selection of study participants
Allocation of participants to different groups

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15
Q

Information bias

A

Systematic error

Measurement or classification of exposure or outcome

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16
Q

Sources of information bias

A

Observer bias
Recall bias
Instrument

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17
Q

Confounding

A

A factor that is associated with the exposure in question

Independently influences the outcome

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18
Q

Association and causation considerations

A

Bias
Chance
Confounding
Criteria for causality

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19
Q

Reverse causality

A

Association between exposure and outcome

Could be due to outcome causing exposure

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20
Q

Causality criteria

A

Bradford-Hill

  1. Strength of association - Magnitude of RR
  2. Dose-response - Higher exposure = Higher risk
  3. Consistency - Similar results from different researchers and various study designs
  4. Temporality - Does exposure precede outcome
  5. Reversibility - Removal of exposure reduces risk of disease
  6. Biological plausibility - Biological mechanisms explaining the link
  7. Coherence - Logical consistency with other information
  8. Analogy - Similarity with other established cause-effect relationships
  9. Specificity - Relationship specific to outcome of interest
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21
Q

Different types of health behaviours

A

Health behaviour - Behaviour aimed at preventing disease (eating healthy)

Illness behaviour - Behaviour aimed at seeking remedy (going to the doctor)

Sick role behaviour - Activity aimed at getting well (taking medications)

22
Q

Theory of planned behaviour

A

Best predictor of behaviour is intention

e.g. I intent to give up smoking

23
Q

Intention in the theory of planned behaviour

A

Persons attitude towards the behaviour

Perceived social pressure to undertake the behaviour

Persons appraisal of their ability to perform the behaviour

Perceived behavioural control

24
Q

Theory of planned behaviour

Criticisms

A

Lack of temporal element

Lack of direction or causality

25
Stage models of health behaviour
5 stages of change 1. Precontemplation 2. Contemplation 3. Preparation 4. Action 5. Maintenance
26
Motivational interviewing
Counselling approach Initiating behaviour change by resolving ambivalence
27
Nudge theory
Nudge the environment to make the best option the easiest E.g. opt-out schemes
28
Factors to consider in behavioural change
Impact of personality traits on health behaviour Impact of past behaviour Assessment of risk perception Social norms Automatic influences on health behaviour Predictors of maintenance of health
29
Transition points leading to behaviour change Positive or negative
``` Leaving school Entering the workforce Becoming a parent Becoming unemployed Retirement Bereavement ```
30
NCSCT
National Centre of Smoking Cessation and Training Social enterprise Support the delivery of effective evidence-based tobacco control programmes Smoking cessation interventions Provided by local stop smoking services
31
What does the NCSCT do
Delivers training and assessment programmes Provides support services for local and national providers Conducts research into behavioural support for smoking cessation
32
Why notify PHE about communicable disease
They notify health protection agency Health protection agency can take urgent control measures Duty of medical practitioners
33
When do medical practitioners have to notify
Notifiable diseases INFECTION which could present significant harm to human health CONTAMINATION which could present significant harm to human health
34
When do diagnostic laboratory operators have to notify
Causative agents found in human samples Must provide in writing within 7 days Duty to provide information to HPA HPA may require requesting clinician to provide supplementary information Must provide in writing within 3 days of HPA request
35
Local authority powers
Schools - Keep children away from school - Schools must provide list of attendees Requests for co-operation - Serve notice - Asking people to do (or not do) something - For prevention, protection, control or provision of public health response - Response to incidence, contamination, or spread of infection - Which presents or could present significant harm to health MAY OFFER COMPENSATION
36
Magistrate order requirements - People
Medical examination Disinfection or decontamination Removal and/or detention in isolation or quarantine Wear protective clothing Restrict movements Prohibition from working or trading Provide information Attend training sessions Monitor
37
Magistrate order requirements - Things
Seizure or retention Isolation or quarantine Disinfection or decontamination Destruction
38
Magistrate order requirements - Premises
Closure Detention of conveyances or movable structures Disinfection or decontamination Destruction
39
Role of consultant in communicable disease control
Surveillance - Monitor communicable disease Prevention - E.g. immunisation programmes Control - Procedure when routine cases and outbreaks occur
40
Managing outbreaks of communicable disease
1. Clarify the problem - Make the diagnosis 2. Decide if this is an outbreak (2 or more related cases of a communicable disease) 3. Get help - Microbiologists, health visitors, consultants, etc. 4. Call an outbreak meeting 5. Identify the cause 6. Initiate control measures
41
Models of transmission for communicable disease
1. Foodborne 2. Faeco-oral 3. Respiratory 4. Physical contact 5. Animals
42
Maslow's hierarchy of needs
1. Physiological 2. Safety 3. Love/belonging 4. Esteem 5. Self actualisation
43
Relationship breakdown leading to homelessness
Mental illness Domestic abuse Disputes with parents Bereavement
44
Problems facing the homeless
Infectious disease Sexual health - Contraception unavailable Poor nutrition Addiction and substance misuse Injuries following violence and rape Mental illness Feet and teeth problems Respiratory
45
Travellers and gypsies Barriers to healthcare
GPs won't visit sites Constantly moving Illiteracy Communication difficulties Mistrust of professionals
46
Homeless people Barriers to healthcare
Difficulties with access - Opening times and appointment procedure Perceived (actual) discrimination Lack of integration between primary care services and other agencies Unsure of where to find help
47
Asylum seeker
Has made an application for refugee status
48
Refugee
Person granted asylum and refugee status 5 years Then reapply
49
Humanitarian protection
Failed to demonstrate claim for asylum Face serious threat to life if returned 3 years Then reapply
50
Asylum seekers lives
No choice dispersal Not allowed to work Vouchers - 70% of income support sum NASS support package Full access to NHS
51
Asylum seekers - Physical health problems
Common illness No previous screening or immunisations Untreated chronic/congenital disease Illness specific to country of origin Injuries from war or travelling Communicable disease Malnutrition Sexual abuse/exploitation
52
Asylum seekers - Mental health problems
PTSD Sleep disturbance Depression Self-harm Psychosis

3A (31 decks)

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