Public health Flashcards
Define social class
A measure of occupation, stratification, social position, access to power and resources. Models = NS-SEC ot Registrar General’s
Define incidence
The no. of new cases per unit time
How can incidence be increased?
Screening
Increasing risk factors
How can prevalence be increased?
Screening
Increasing risk factors
Increasing life expectancy
How can incidence be decreased?
Decreased risk factors (primary prevention)
How can prevalence be decreased?
Cures
Decreased risk factors
How may someone enter the prevalence pool?
Diagnosis
How may someone leave the prevalence pool?
Cure
Death
Define sociology
It is the study of social relations and social processes
It is a measure of social INTERdependecies
What is the role of a sick person in society?
They are exempt from normal social responsibilities
They should focus on getting better
They should seek help from medical professionals
Define global health
Issues, concerns, ideas regarding health that transcend national boundaries
State the 3 millennium goals that relate to health
Reduce child mortality of under 5’s by 2/3rds
Improve maternal health
Combat AIDS/HIV
Define prevalence
The no. of existing cases of a disease at a point in time
Define sensitivity
The probability of a person with the disease testing positive
a/a+c
Define positive predictive value
The proportion of people with a positive result that actually have the disease
a/a+b
Define specificity
The probability of a person without the disease testing negative
b/b+d
Define negative predictive value
The proportion of people with a negative result correctly excluded by screening
d/c+d
What effect does screening of a common disease have on PPV and NPV?
Increased PPV
Decreases NPV
What effect does screening of a rare disease have on PPV and NPV?
Decreases PPV
Increases NPV
State the principles of screening
1) Important condition
2) Treatment available
3) Suitable test
4) Recognised latent and early phase of disease
5) Cost of screening balanced with that saved by early diagnosis
6) Known history of disease
7) Policy regarding who to treat
8) Facilities for test available
State the reasons for screening
Early diagnosis - better outcome
Early diagnosis - cheaper treatment
Prevention of suffering
Patient satisfaction
State the reasons against screening
Screening may have adverse effects on healthy individuals
Damaging effects of wrong diagnosis (hopes up/ fear or later diagnosis)
Personal choice comprimised
State the changing health behaviour models that exist
1) Health belief model
2) Stages of change model
3) Nudge theory
4) Financial incentives
5) Motivational interviewing
6) Social marketing
7) Mindspace
Describe health belief model
Perceived susceptibility
Perceived barriers
Perceived benefits
Self-efficacy
Describe the stages of change model
Pre-contemplation Contemplation Preparing Action Maintenance Stable changed lifestyle/replace
Describe the nudge theory model
Changing the environment to make the healthiest option the easiest one
Define primary prevention
Actions that aim to reduce the risk of a disease becoming ESTABLISHED
e.g. behaviour change/vacinations
Define secondary prevention
Action that aim to slow/halt the progression of a disease identified in its early stage
Define tertiary prevention
Actions that aim to reduce the complication or severity of a an established, detectable and symptomatic disease using treatments/interventions
What is the prevention paradox?
Whether to target many low risk individuals(population approach) or few high risk individuals
What sort of people does the high risk prevention approach target and why?
Affluent/well educated individuals These people are more like to: -engage with health services -comply with treatments -have means to change their lifestyle
What is the advantages of using the population approach to prevention?
Reduces social inequalities
State the primary prevention for CHD
Smoking cessation
Nutrition improved
Alcohol consumption decreased
Physical activity increased
Give 3 unmodifiable risk factors of CHD
Age
Sex
Ethnicity
Give 5 modifiable risk factors of CHD
Diet - cholesterol - type 2 diabetes Blood pressure Physical activity Smoking Alcohol
Give a psychological risk factor of CHD
Depression
Which personality type is more at risk of developing CHD
Type A personality - competitiveness, hostility, impatient
Under assessed using questionnaires/self report
How does work impact risk of CHD
High demand/low control job = stress = increased risk of MI/CHD
How does social support influence health
Increased social support = decreased morbidity/mortality
What is the link between smoking and men and women?
Men smoke more
But gap is closing
What is the link between smoking and social economic status?
People of LES tend to smoke more
What is the age limit for smoking?
18
When was smoking banned in public placed in the UK?
2007
What are the reasons for smoking
Nicotine addition Coping with stress Habit Socialising Fear of weight gain
What is the daily alcohol limit for a man?
3-4 units a day
What is the daily alcohol limit for a women?
2-3 units
What is standard unit of alcohol?
10ml/8g ethanol
How many units are there roughly in a bottle of wine?
10
What percentage of A&E admissions relate to alcohol?
55%
What are the social implications related to alcohol consumption
Disease
Danger - rape, accidents, violence
Driving offences
Depression
What are the withdrawal symptoms of alcohol
Tremor
Hallucinations
High BP/HR
What does CAGE stand for?
Have you ever thought about CUTTING down
Have you ever felt ANNOYED by people telling you to cut down
Do you feel GUILTY about how much you drink?
EYE OPENER: ever had a drink first thing in the morning
Define ethics
The attempt to arrive at an understanding of the nature of human values, of how we ought to live and what constitutes right conduct
State the rivals to ethics
Law
Religion/cultural beliefs
Personal conscience
What is meant by a bottom up inductive ethical argument?
Using past medical problems to create new guides for practice
What is meant by a top down deductive ethical argument?
Applying one specific ethical principle to all problems
What are the 4 ethical principles
Autonomy
Beneficence
Non-maleficence
Justice
What is meant by autonomy?
Allowing the patient to make a rational and informed decision
Define beneficence
Doing good
Define non-maleficence
Preventing harm/reducing harm/doing no harm
Define justice
Being fair e.g. distribution of health resources
What is utilitarianism
Act evaluated solely in terms of its consequences
Maximising good
Define deontology
Doing what you believe is morally right
It is the act itself that determines worthiness
Define virtue ethics
Focuses on the character of the person, integrating reason and emotion (person in their right state of mind intending to do the right thing)
State the 5 focal virtues
Compassion Trustworthiness Conscientiousness Integrity Discernment
Which strain of influneza caused pandemics?
A
What is the criteria for pandemic spread?
Novel virus Capable of infecting humans Capable of causing human illness Large pool of susceptible people Ready and sustainable transmission from person to person
What are the different phases of a pandemic?
1-3 animals mostly
4 human to human transmission sustained
5-6 widespread human infection
Post peak - possibility of recurrent events
Post pandemic - disease returns to seasonal levels
State the changes affecting the risk of pandemics
International travel Larger population Crowding ------ Improved population health Interdependency between countries Changes in animal husbandry
Define patient-centred medicine
Medicine involving shift in focus from treatment to care
Define compliance
The extent to which a patient’s behaviour coincides with medical/health advice. Professionally rather than patient focused ‘doctor knows best’
Give an example on unintentional non-compliance
Forgetting
Give a reason for intentional non-compliance
Religion/beliefs/personal preferences
Define adherence
Similar to compliance
Acknowledges a patient’s beliefs
Health professional = expert, convey their knowledge, results in increased patient satisfaction, knowledge and adherence
Define concordance
Patients as equals in care
Expected patients will take part in treatment decisions
What are the ethical considerations of concordance?
Mental capacity
Decision’s detrimental to patients health
Potential threat to the health of others
Children: sufficient understanding, can give consent
Give some examples of public health interventions (regarding influenza/pandemics)
Hand washing Respiratory hygiene Travel restrictions, Screening those entering UK Reducing social contact Restricting mass gatherings School closures
State the types of transmission of diarrhoeal diseases
Direct
Indirect
Airborne
Give 2 examples of bacteria that cause diarrhoea
E.coli
Rotavirus
What measures can be taken to reduce the risk of diarrhoea?
Hand washing with soap Safe drinking water Safe disposal of waste Breastfeeding infants Safe handling of food Control of flies/vectors Vaccination
Which groups are most at risk of developing diarrhoea?
Those with poor hygiene/sanitation
Children at pre-school
Health care and social workers
Those preparing unwrapped/uncooked foods
State the way in which disability can be divided
Cognitive V Physical
What subtypes of cognitive/physical disability exist?
Congenital Developmental Addicents Diseased of early/mid life Functional limitation of older people
Why is disability increasing?
Healthy life expectancy not increasing as much as life expectancy
Give an example of how disability can be assesed (elderly)
Activities of Daily Life scale
MMSE
Define palliative care
Care aiming to improve the quality of life of patients and families who face life-threatening illness by providing pain/symptom relief, spiritural, and psychosocial support from diagnosis to end of life and bereavement
What types of palliative care exist?
Specialist and generalist
Define specialist palliative care
Involves health professionals who specialise in palliative care within a MDT. Delivered in hospitals/care home etc
Define generalist palliative care
GPs, hospital doctors, district nurses social workers
Describe the relationship between age and comorbidities
Increase in age increase in comorbidity
Describe the relationship between chronic disability and SES
Lower SES, increased chronic disability
Describe the relationship between poverty/living conditions and age
Increase age, increase in poverty/poorer living conditions
Why do elderly people require more specialist care need?
More comorbidities, more impairment Greater risk of impairment from treatment complications Increased social isolation Increased psychosocial distress Increased economic hardship
Define gerontology
The study of changes in the body and mind with age
Define geriatrics
Diagnosis and treatment of disorders that occur with old age
Describe the difference in palliative care between COPD and lung cancer sufferers
Lung cancer patients receive more palliative care
COPD patients have a low QOL
What does evidence based medicine involve?
Asking a focused question Finding evidence Critical appraisal Making a decision Evaluating performance
What are the 4 components of asking a focused question in EBM?
Population
Intervention
Comparator
Outcome
Define the gold standing in EBM
Systematic reviews/meta analysis of multiple RCTs
Describe the hierarchy of evidence
1a - Systematic reviews/Meta analysis of multiple RCT GOLD STANDARD
1b - at least one RCT
2a - at least one controlled trial without randomisation
2b - at least one type of quasi-experimental study
What components should be assessed in critical analysis? And what other factors can affect these?
Validity Reliability Applicability --------- Stats Chance Bias Confounding factors
Define validity
How close to the truth something is
Define reliability
How consistent results are; same every time experiment repeated
Define applicability
How relevant a study is to clinal medicine
What makes a good study?
Randomisation - allocation of intervention
Have outcome measures for at least 80% of the population
Show causation rather than association
State the main two categories of study
Observational
Experimental/interventional
What are the subtypes of observational studies?
Descriptive
Descriptive/analytical
Analytical
What are the 2 types of descriptive observational studies?
Case report
Ecological
State the advantages of ecological studies
Quick/cheap
Help generate hypotheses
Few ethical issues
State the disadvantages of ecological studies
Can’t show causation
Diagnostic criteria bias
Give an example of a descriptive/analytical study
Cross-sectional
State the advantages of cross sectional studies
Quick cheap
Generate hyp
Few ethical issues
State the disadvantages of cross sectional studies
Prone to bias e.g. sampling
State the types of analytical observational studies
Case control
Cohort
Give an advantage of a case control trial
Quick, inexpensive (don’t have to wait for disease to develop)
Give a disadvantage of case control trial
Retrospective therefore relies on people’s memories
Can only show association not causation
Give an advantage of cohort study
Can distinguish causes from associated factors
Can measure more than one outcome for a single exposure
Give a disadvantage of cohort study?
Long - expensive, drop out rate high
Advances in diagnosis influence results
Describe the criteria for an association to be causal
Strength of association Consistency Coherence with existing theories Temporal relationship Dose-response relationship Specificity
What are the 3 types of causes?
1) X necessary for disease
2) Exposure of X is sufficient to cause disease
3) X contributes to the disease
Define a systematic review
A review of a clearly formulated question that uses symptomatic and explicit methods to identify, select and critically appraise relevant research, and to analyse the data from studies included in the review
Define meta-analysis
Review/analysis of results using STATISTICAL METHODS
Why is routine health data collected?
1) Monitor changes in health
2) Generate hypotheses of ill health
3) Improve planning of health services
4) Evaluate performance of policies/services
What information in collected in routine health data collection?
1) Morbidity
2) Mortality
3) Use/quality of health care
4) Individual lifestyle
5) Quality of life
6) Socioeconomical/cultural and environmental conditions
Define Ethnograph, and state what type of research it is involved in?
Emersing yourself in someone else lifestyle
Qualitative
What other types of qualitative research is there?
Interviews
Documentary analysis
What are the associated problems with qualitative research?
Subjective - open to personal interpretation
Not truly understanding what someone means
What are the disadvantages of quantitive research?
Requires a large population
Expensive
Quantitive data can be divided into what two categories?
Continuous
Discrete
What type of graphs can continuous data be show by
Histogram
Stem and leaf
Box and whisker
What types of graphs can discrete data be shown by?
Pie chart
Bar chart
Define normal distribution
The AVERAGE DISTANCE of observations from the MEAN value
How is a an outlier determined by a box and whisker plot?
Outliers more than 1.5 X IQR from the upper/lower ends of the box
Describe normal distribution curve
Bell shaped
66% data within 1 SD
95% data within in 2 SD
Describe the relation ship between the median and mean in normal distribution
They are the same
If the data is symmetrical what should be used to summarise the data
Mean and SD
If the data is skew what should be used to summarise the data?
Median and IQR
Describe the relationship between mean, median and mode in a positive skew
Mode is less than Median which is less than Mean
Define reference range
The limits in which you would expect the majority of your data to fall
What is the difference between population and sample
Pop = all the people we are interested in Sample = group within the pop which we will study
What is standard error?
The SD of all the sample means
SD/ square root of n
Standard error quantifies how good a sample result is likely to be
Estimate of precision
What are the different types of random sampling?
1) Simple
2) Stratified - divided into groups - sampled w/i groups
3) Cluster - groups of individuals sampled
Describe the relationship between sample size and confidence intervals
Sq sample size
Half CI
What is the role of the confidence intervals?
Assesses the sample mean against the population mean
Give the stages of hypothesis testing
Set null hypothesis H0 Carry out experiment H1 Carry out significance test Obtain test statistic Compare to critical value Obtain P value Make a decision e.g. reject null hypothesis if P value less than 0.05
Define (absolute risk)
Incidence/ population
What is absolute risk difference?
Absolute additional risk following exposure
Risk in exposed group - risk in unexposed group
What is meant in terms of absolute risk value when the confidence intervals include 0
No difference
Define no. needed to treat
The ADDITIONAL no of people you would have to treat to cure one extra person compared to the old treatment
Define no. needed to harm
The ADDITIONAL no of people who need exposure to the risk in order to have one extra person DEVELOP the disease
State the eq for NNT
1/absolute risk REDUCTION
State the eq for NNH
1/absolute risk DIFFERENCE
Define odds and give eq
The ratio of the probability of an occurrecne compared to the prob of a non-occurrence
Odds=prob/(1-prob)
Define odds RATIO
Ratio of odds for the exposed group and unexposed groups
Give an example of a study that OR is used
Case control study (relative risk can’t be used here)
Why might OR be used in a cohort study / crossectional study? (where relative risk can be used)
Not clear which is IV and DV
What is the result of a medical error?
Adverse effect or near miss
Define adverse effect
harm caused to patient that is not a direct result to their illness or due to chance
Define error
Failure of a planned action to completed as intended, preventable event
State the different types of error
Error of omission
Error of commission
Define error of omission
Delayed / not taken action
Define error of comission
Wrong action taken
What are the types of errors of omission/comission?
1) Professional negligence - skills not up to standard
2) Skill based error - routine task but distracted
3) Rule base - wrong plan
Define violation
Deliberate deviations from the practicals and rules
Disadvantage of personal error model?
Anticipation of blame encourages cover up (could make situation worse)
Dependant on trust
Advantages of systematic error model
Proactive rather than reactive
Early event stopped than could have late damaging effects
Define team
A group of of people working together to achieve a common goal
Define stress
A state of mental, physical or emotional strain causing great worry
Demands > ability to cope
Give examples of acute stress
Danger
Hunger
Noise
Short term inf
Give examples of chronic stressors
Relationships
Financial
Work
Lack of friends
How can work causes stress?
High demand, low control
Bullying/violence
Give example of internal stressors
Phys - inflammation
Psych - personal expectations/beliefs
What are the 5 types of stress
Biochemical Physiological Behavioural Cognitive Emotional
State the signs of biochemical stress
Increased cortisol
State the signs of physiological stress
Shallow breathing
Increased HR
Increased acid in stomach
State the signs of behavioural stress
No sleeping
Not eating well (increased/decreased)
Increased alcohol consumption
Increased smoking
State the signs of emotional stress
Tearfulness Mood swings Aggression Bored Apathy (lack of emotion)
State the signs of cognitive stress
Headaches
Negative thoughts
Loss of concentration
What are the 3 ways in which one can respond to stress?
1) Fight/flight
2) General adaptation system
3) Interaction model (impact of stressor influenced by coping methods adopted/past experiences with stressors)
What are the mediating factors of stress
Social support Beliefs/attitudes Perception Personality Coping strategies Lifesyle Gender
3 stress management methods
1) CBT
2) Exercise
3) Self-help/support
Why is public health v imp in neurology?
Lack of curative treatment
Need for prevention! And rehabilitation
Describe type A personality
Impatient Competitive Confident Achievement orientated Angry > risk CHD
Define frailty
Weak physical and psychological states, low vigour, low resilience, and vulnerability
What are the 2 types of aging
Intrinsic - natural
Extrinsic - due to external factors - UV/smoking
What are the effects of decreasing hospital stay?
- Pts return home w/ higher dependancy
- Increased pressure on commutity services
- Increase re-admission rate
How can we reduce hospital re-admissions for elderly people?
Increased support to discharged patients
Managing chronic disease in the community
Why is back pain increasing? What can doctors do to reduce it?
Reduced phy activity Inc obesity Ageing pop Education Advise exercise
State factors affecting sexual repro health
Decrease age of puberty
Increasing age of first marriage
Media
State problems with sexual health education
In schools - poor attendance, teachers lack training
Not youth friendly (should involve youth in design)
Fear of judgement
State the 1 prevention for STIs
Education/awareness
Vaccination
State the 2 prevention of STIs
Screening
Partner notification
State the 3 prevention of STIs
Treatment
State causes of obesity
(Imbalance of energy intake and energy expenditure) Car use/ decreased activity Work - long hours/shift/sedentary Grazing Consumption increased Food - high in fat, sugar, low in fibre (calorie dense) Sugary drinks Obesogenic lifestyle - watch TV/game
3 Diseases associated with obesity
Type II diabetes
CVR
Hypertension
Eq for BMI (N.B. doesn’t measure adiposity)
Kg/m2
Normal BMI range
18.5-25
What are the public health implications of obesity?
Disease
Increase pressure on health services
Give the risk factors of diabetes type II
Age Gender Ethnicity BMI Waist circumference Hypertension Impaired glucose tolerance
1 prevention for diabetes
Education - promotion exercise, change diet/weight loss
2 prevention for diabetes
Screening/routine bloods
3 prevention for diabetes
Management
Treating symptoms
Why is it more difficult for someone who it already overweight to lose weight?
More difficult to exercise
Low-self esteem/embarrassed/scared
Employment/relationships
Describe the run away weight gain train model
Obesogenic environment
Ineffective breaks - physiological, prejudice, knowledge
Accelerators - ineffective dieting, low SES, self-esteem
Risk factors of CKD
Alcohol/drugs
Hypertension
Diabetes
What does small birth body size indicate in terms of health in later life?
CVR disease Type II diabetes Osteoporosis Schizoprenia Depression
What does large birth body size indicate in terms of health in later life?
Cancer
What are the 4 key concepts of health economics
1) Opportunity cost - sacrifice in terms of benefits forgone by not allocating all the resources to the next best activity
2) Economic efficiency - Quality Adjusted Life Years/max benefit
3) Increments and margins - new vs old
4) Equity - fairness
What makes a good team
Communication Clearly identified common goal Identified team leader Feeling valued/team dynamic Appropriate size
Benefits/importance of working in a team
Efficient
Improves decision making
Reduces medical error
Disadvantages of working in a team
Difficult to monitor due to involvement of different health professions(different managers)/environmental problems - diff offices/shifts
Feeling of lack of responsibility when problem shared
State the 7 steps to pt safety
1) Safe culture
2) Lead/support staff
3) Integrate risk management activity
4) Promote reporting
5) Communicate w/ patients/public
6) Learn and share safety lessons
7) Implement solutions to prevent harm
What is the SBAR checklist
For asking advice from senior e.g. over phone Situation Background Assessment Recommendation
What are the types of violation
Routine - cut corners
Necessary
Optimising - personal gain
Give an example of a hard defence
Engineered safety features
Give an example of a soft defence
Law, rules, regulations, checklists, handovers
Why is safety in healthcare compromised so often
Complex environment
Shared responsibilities
Resource intensive
System, patient and practitioner interaction
What is heterogeneity
Variability of results
Homogeneity?
Similarity of results
Define substance abuse
Ingestion of substance affecting the CNS which leaves to behavioural and psychological changes. Implicitly not for therapeutic use
RFs for substance abuse
FHx Family conflict Low SES Friends (peer pressure) Academic failure
Define addition
Physical and psychological dependance on a substance
Physical - w/o = withdrawal symptoms
Psychological - feel like you can’t live w/o, fear, pain, guilt
Define an autonomous action
An intentional action, done with understanding and w/o controlling influences
Define malnutrition
A state nutrition in which the excess or deficiency of energy, protein and other nutrients causes measurable adverse effects on the body and clinical outcome
Describe the MUST tool
BMI
Unexplained weight loss/gain in last 3-6 months
Assess acute disease (e.g. NBM more than 5 days)
Define alcohol abuse
1 or more in the last 12 months of: Role failure Relationship problems Risk of bodily harm Problems with the law
Define alcohol dependance
3 or more in the last 12 month of: Withdrawal sym Tolerance Can't stay w/i limit Keep drinking despite problems
