public health Flashcards
what are the two types of stress? define them.
distress = stress that is harmful. eustress = stress that is beneficial and motivating.
give examples of internal and external stressors.
internal = physical or psychological. external = work, environment, social and cultural.
how do we respond to stress?
fight and flight. tense muscles, increase breathing rate, increase heart rate, sweating.
what are the 3 steps of adaptation syndrome?
alarm = adrenaline release, adaptation = cortisol. and exhaustion.
what is the interaction model?
stress = interaction between person and the environment.
what are the 5 signs of stress?
biochemical = endorphin levels raised, cortisol raised. physiological = BP raised, breathing rate increased, increased stomach acid production. behavioural = eating pattern change, sleep change, increase in smoking/drinking. cognitive = negative thought, loss of concentration. emotional = tearful, mood swings, aggressive.
how does one manage stress?
social support, exercise
what is the definition of health?
a state of complete physical, mental and social wellbeing
what is incidence?
the number of new cases per unit time.
what is prevalence?
the number of existing cases at a point in time.
what are true positive and true negative results?
tested postitive and is positive. tested positive and is not positive.
what is sensitivity?
the number of true positives/all positives. tells you how well the test is picking up disease.
what is specificity?
the number of true negatives/total negatives. how well the test is picking up those without the disease.
what are the 4 reasons for screening?
prevent suffering, earlier treatment, earlier treatment is cheaper, top patient satisfaction
what are the 3 reasons against screening?
no personal choice, can cause people unnecessary stress is they get false positive
what is primary prevention?
preventing disease from happening, immunisation
what is secondary prevention?
slowing the progress of disease by detecting it early, e.g. screening
what is tertiary prevention?
limiting the adverse affects of disease
what is the prevention paradox?
the decision to target a smaller group more at risk or a larger group less at risk.
what are the 4 lifestyle changes to protect against CHD?
SNAP. smoking, nutrition, alcohol, physical activity.
what condition have improvements in social conditions had the biggest impact on?
TB
what determines health in a society?
the extent of income division between social classes, not the average income.
what is social class?
a measure of occupation, stratification, social position and access to power and resources.
what is the inverse care law?
the availability of good medical care tends to vary inversely with the need for it within a population
when does an individual leave the prevalence pool?
either die or cured.
what are the reasons for smoking?
nicotine addiction, coping with stress, fear of weight gain, social habitat
what are the stages of quitting smoking?
precontemplation, contemplation, preparing to change, action (v6 months), maintenance (^6 months)
what does iatrogenesis mean?
an unintended adverse affect from a therapeutic intervention.
what is the nudge theory?
changing the environment to make the healthy option the easiest option.
what are the stages of changing health behaviour?
pre-contemplation, contemplation, preparing to change, action, maintainance
what is public health concerned with?
health promotion, protection and improving and organising health sciences.
how much of the worlds population is it developing countries? how much global health spending do they account for?
84%, 11%
what are the world 8 development aims by 2015?
3 are health related.
what is the positive predictive value?
proportion of people with a positive test result whom actually have the disease
what is the negative predictive value?
the proportion of people without the disease who are correctly excluded by the screening test.
what happens to the predictive values if a disease becomes more prevalent?
the positive predictive value goes up because there are less false positives. the negative predictive value therefore decreases.
give some examples of screening tests
Guthrie test - sickle cell disease, cystic fibrosis. green tie disease
what are the screening principles?
the condition should be serious. there should be a suitable test. there should be effective treatment available. there should be diagnosis and treatment facilities available. there should be recognition of a condition at latent or early stage. the costs should be balanced. cause findings should be a continuous process. there should be an agreed policy on who to screen. the test should be acceptable to the population. natural history of the disease should be known.
what are the two approaches of the prevention paradox?
high risk - those at higher risk. population approach - target all individuals to lower the risk for everyone.
who does high risk benefit more?
affluent and better educated people because they are more likely to go to the health services and comply with treatment.
why is the population approach beneficial?
usually reduces social inequalities
what medications are used to treat CHD?
anti-hypertensives, statins, metformin/insulins.
what are the phases of cardiac rehabilitation?
phase 1 - in hospital, phase 2 - early post-discharge. phase 3 - 4-16 weeks. phase 4 - long term maintenance of SNAP.
what is involved in secondary prevention of CHD?
primary care CHD registers, medicing: Asprin, B-blockers, ACE inhibitors, statins. phase 4 cardiac rehabilitation.
unmodifiable risk factors for CHD.
sex, age, fam history, ethnicity, early life circumstances.
modifiable?
physiological/clinical: high cholesterol, hypertension, Diabetes type 2. other: smoking, physical activity, poor nutrition, alcohol, overweight
What does evidence based practice involve?
Asking focused questions, finding evidence, critical appraisal, making a decision, evaluating performance.
Asking focused questions: PICO?
Population, intervention, comparison, outcome
What is the hierarchy of evidence?
1a = systematic review. 1b = randomised control trial. 2a = control trial without randomisation. 2b = other type of quasi-experimental study. Continues to level 4 but others are shit
What is the purpose of critical appraisal?
Consider validity, reliability and applicability
What is reliability? what is validity? what is applicability?
How consistent results are. how close to the truth results are. How relevant a study is to clinical medicine.
what should a good study show?
randomly allocate participants to interventions, have outcome measures for over 80% of participants. show causation rather than association.
how can you categorise a study?
observational or experimental.
how can you categorise observational studies?
descriptive, analytical or both
give an example of a descriptive study.
ecological studies. case reports follow individuals. results are association not causation.
give an example of a descriptive and analytical study.
cross sectional study/survey.
what is a cross sectional study/survey?
divides population into those with and without the disease. used to generate hypotheses but can be biased.
give an example of an analytical study?
case control study. cohort study.
what is a cross case control study?
retrospective method. match someone with the disease to someone without the disease that is similar in age, sex, class etc. and look at what they were exposed to. only shows association and can be problems with patients remembering stuff.
what is a cohort study?
start with a population without the disease and study them over a period of time to see if they are exposed to the agent in question and if they consequently do get the disease or not. lower chance of bias. establishes causation.
give examples of experimental trials.
randomised control trial. non randomised control trial.
what are randomised control trials?
large expensive study involving patients being split into two groups. one receives intervention and one receives a control. bias is minimal. shows causation.
what are non randomised control trials?
subject to bias.
what is an independent/dependent variable?
one that can be altered in a study. depends on independent variable and cannot be altered.
what is the criteria for evaluation of wether an association is causative?
consistancy, biological plausability, association strength, consistent with previous theories, dose-response relationship
what are the three types of causes?
IV necessary for DV, IV sufficient to cause DV, IV contributes towards DV
what is a systematic review?
review of a clearly formulated question that uses explicit methods to collect info from previous studies.
what is meta-analysis?
statistical analysis used to summarise study results. e.g. in a forest plot.
why is routine health data collected? what type of info is studied?
monitor health of population, generate hypotheses on causes of ill health. mortality, morbidity, use and quality of health care, lifestyle.
what is qualitative research? what are the types? what are the problems?
tells us the type of things that exist in society rather than how many. interviews, documentaries, ethnography - putting ones self in a particular society. not understanding truly what someone is thinking, reflexivity - personal interpretations of data. methods - interview, reading.
what are the 2 types of data?
quantitative and qualitative
which graphs show continuous data and which show discrete?
continuous = histogram. discrete = bar chart, pie chart
what is a reference range?
range in which we can expect the majority of data to fall. 2 standard deviations above and below the mean.
what is the need for samples?
be be an estimate of a population.
what are the types of random sampling?
cluster - groups are sampled. stratified - divided into groups then randomly sampled within groups. simple - anyone in population can be sampled.
what is standard error?
standard deviation of all the sample means. standard deviation divided by square rot of all the people in the sample.
what is the confidence interval?
found between two standard errors of the mean, one above and one below.
what is a null hypothesis?
A hypothesis that you are looking to disprove. opposite to the study hypothesis.
what is a P value?
it is the probability of rejecting the null hypothesis when it is actually true. if P
what are the steps of testing a null hypothesis?
obtain a null hypothesis and a study hypothesis. carry out a significant test. obtain results, compare results. obtain P value. make a decision.
what is the power of the study?
possibility of rejecting a null hypothesis when it is actually false.
what is clinical significance?
wether a test is clinically worth while. sample size must be big enough to obtain a significant result.
what is absolute risk? what is relative risk? what is absolute risk difference?
incidence/population. risk of an event in an exposed group/risk in unexposed group. risk in exposed group - risk in unexposed group.
what is the number needed to treat?
1/absolute risk reduction
what is the number needed to harm?
1/absolute risk difference
what are the 5 signs of stress? give examples.
behavioural = smoking, drugs. cognitive = negative thoughts and loss of concentration. emotional = crying, anger. physiological = raised bP, shallow breathing. biochemical = increased cortisol and endorphins.
what is the stress illness model?
an individual is more susceptible to disease because they have been exposed to stressors.
give an example of PTSD and its consequences.
child abuse. insomnia, irritability.
give some examples of physical illnesses associated with stress.
cancer, heart disease, ME, infertility.
what does burden of disease mean?
how it affects your life.
what are some vaccine preventable neurological illnesses?
tetanus, measles.
what is epidemiology?
the study of the distribution and determinants of health-related states.
what is a migraine?
unilateral pain disturbance, blurred vision, vomiting.
list some risk factors for stroke.
age, sex, smoking, hypertension.
what are the key challenges of an ageing population?
increased demand for long-term care, increased load placed upon trained workers, need for more beds.
causes of an ageing population?
increased life expectancy, falls in fertility, decline in premature mortality
what are the two types of ageing?
intrinsic (natural, inevitable) and extrinsic (air pollution, UV)
what are some of the physical changes of ageing?
hair loss, skin spots, wrinkles, decrease in height
what are the alternatives to recurrent hospital admissions for old people?
support in the community, supporting chronic disease management.
what are the roles of a GP?
giving someone a good death not just a good life. prevent unnecessary loss of function
what are the red flags of back pain?
> 55 and
how to MSD affect us? and society?
loss of independence. physical pain. economic burden.
why is back pain increasing?
obesity, ageing.
why is affecting sexual health across the world?
MEDIA, marriage age increasing, puberty age decreasing.
what are the problems with sexual health across the world?
poor attendance in schools so education is lacking. poor resources. lack of youth friendly services.
what makes a youth friendly service?
non-judgemental practice. accurate informative information.
what is primary, secondary and tertiary prevention of sexual disease?
primary - raising awareness of STIs. secondary - easy access to tests. terry - available treatment.
what is the STI transition model?
reproduction, infectivity, partners, duration. R=BCD
why would you trace pack previous sexual partners?
break the line of transmission.
what are the causes of obesity?
americanisation of food, grazing rather than meal times, over consumption of food, longer hours, dependance on cars.
what are the complications of obesity?
diabetes type 2, CHD, cancer.
what is BMI?
body mass index. does not measure adiposity.
why is diabetes a public health issue?
mortality. disability = eyesight, renal failure, amutation. increased prevalence. reduce QuaL scores.
who is at risk of diabetes?
those with a low fruit intake, those with office jobs.
what does small/large baby body size indicate?
small = CVD, type 2 diabetes, depression. large = cancer.
what is global health?
health problems and issues that transcend national boundaries.
what are the important factors leading to disease in poorer countries?
underweight, low iron, high cholesterol, tobacco, high bp, unsafe sex and water
what are the important factors leading to disease in richer countries?
high BMI, unsafe sex, high cholesterol, smoking, alcohol
what are the development goals?
decrease child mortality, improve maternal health, empower women, combat HIV/AIDS.
what is economic efficacy?
resources being used to maximise benefit
what is satiety?
fair distribution of costs and benefits.
what is opportunity cost?
resources being used elsewhere to sacrifice them being used where they are currently
what makes an effective team?
tem sizes, common purpose, team dynamic
how can you prevent a pandemic?
school closures, travel restrictions, washing hands.
which type of influenza is seasonal? which is pandemic?
B, A.
what are the criterial for pandemic?
a novel virus, capable of infecting humans, capable of causing human illness, large pool, transmission from person to person.
what are the phases of a pandemic?
1-3 = animal infections. 4 = human to human. 5-6 = widespread human infection. post-peak = possibility of recurrent events. post-pandemic = seasonal disease.
what creates risk of pandemics?
crowded population, large population, international travel,
what are the types of transmission?
direct = STIs fecal oral route. indirect = vector-borne e.g. malaria. vehichle borne e.g. hep B. airborne = resp route.
how do you prevent against diarrhoea?
vaccinations, hand washing, safe water.
who is at risk of diarrhoea?
poor hygiene, health and social care.
CAGE?
have you every felt like CUTTING down? what you been ANGRY at someone asking you to cut down? do you ever feel guilty? Eye opener: ever had a drink in the evening?
what are the ethical considerations when making decisions on patients behalves?
age, mental health, if others are at risk.
what does discernment mean?
good judgement.
what is conscientiousness?
being aware of details about patients e.g. social situations and beliefs.
what is compassion?
sympathy and empathy and caring about the patient.
what is integrity?
acting morally.
what is interquartile range?
data is divided into quarters and it is the difference between the middle two quartiles. e.g. the middle 50% of the data.
what is a box and whisker diagram? what do the lines show/box?
box shows the interquartile range. median is a line across the box. lines extend to the highest value and lowest results excluding the outliers. outliers are dots.
what is the normal distribution?
the bell shaped curve where 2/3 of the data lies within 1 standard deviation of the mean. and 95% lies within 2 standard deviations away from the mean. the mean and median will be the same!
what is a Skew?
if the data is not skewed the mean and standard deviation should be used to summarise data. if skewed, median and interquartile range should be used.
what is positive skew?
mode is less than the median which is less than the mean. e.g. household income.
what is negative skew?
mode > median > mean. e.g. age of death.
what is a reference range?
limits within we would expect data to fall. standard deviations above and below the mean.
what are the types of random sampling?
simple, cluster, stratified.
what is standard error?
standard deviation of all the sample means. standard deviation/square root of number of people in the sample. measure of how far from the truth info is.
what is confidence interval?
95% confidence interval is found between 2 standard errors above and below the mean (1.96 standard errors)
what is the test statistic?
observed value-hypothesised value/standard error.
what is the risk
incidence/population.
what is relative risk?
risk in exposed group/risk in unexposed group.
what is the absolute risk?
risk in exposed group - risk in unexposed group.
what is odds?
probability/1-probability.
what is odds ratio?
comparing the odds of exposed group to the odds of unexposed group.
when do you have to use odds ratio?
case-control.
what is human error? 2 types?
adverse event or near miss.
duties of a doctor?
care of the patient. standard of the treatment. promotion of the patients health and treating with dignity,
what is opportunity cost?
is the benefit that would have come from allocating recourses into the next best treatment.
