PUBLIC HEALTH 3A Flashcards
What is equality?
Giving everyone the same rights, opportunities and resources
What is equity?
Giving people what they need to achieve equal outcomes
What is horizontal equity?
Equal treatment for people with equal health care needs
What is vertical equity?
Unequal treatment for people with unequal healthcare needs
What is the inverse care law?
That the availability of health care tends to vary inversely with its need (e.g. developing countries)
What are the determinants of health?
- Age, sex and race
- Individual lifestyle factors
- Social and community networks
- Living and working conditions
- General socio-economic, cultural and environmental conditions
What does PROGRESS stand for in terms of the determinants of health?
Place of residence
Race
Occupation
Gender
Religion
Education
Socio-economin
Social capital
What are the 3 domains of public health practice?
Health improvement
Health protection
Improving services
What are the two methods of assessing quality of healthcare?
Maxwell’s dimensions
Structure, process, outcome
What are Maxwell’s dimensions of the quality of healthcare?
3 A’s:
Acceptability
Accessibility
Appropriateness
3 E’s:
Effectiveness
Efficiency
Equity
What does the structure, process, outcome assessment criteria look at?
Structure: what is there (e.g. no. hospitals)
Process: What happens? (e.g how many people seen)
Outcome: e.g. number of deaths
What is a health needs assessment?
A systematic approach for reviewing health issues affecting a population in order to enable agreed priorities and resource allocation to improve health and reduce inequalities
What does a health needs assessment look at?
The need for an intervention
The demand
The current supply
Give an example of a health needs assessment for antibiotics for routine vaccinations?
Needed and supplied but not demanded
What are the 4 types of need?
Felt need
Normative need
Expressed need
Comparative need
What is felt need?
An individual’s perception of variation from normal health.
What is expressed need?
Felt need turned into action- help seeking
What is normative need?
Need defined by experts (e.g. vaccinations)
What is comparative need?
Needs identified by comparing the services received by one group with another
What are the 3 perspectives when looking at a health needs assessment?
Epidemiological
Comparative
Corporate
What does the epidemiological perspective look at when doing a health needs assessment?
The size of the population
The services available
The evidence base
What does the comparative perspective look at when doing a health needs assessment?
Compares services/ outcomes received by a population with others
looks at health status, service provision and outcomes
What does the corporate perspective look at when doing a health needs assessment?
Asks local population what their health needs are.
What are the 3 different resource allocation models?
Egalitarian
Maximising
Libertarian
What is the egalitarian model of resource allocation?
Provide all care that is necessary and required for everyone
What is the maximising model of resource allocation?
Resources allocated to those most likely to benefit
What is the libertarian model of resource allocation?
Each individual is responsible for their own health
What is primary prevention?
Preventing the disease from happening in the first place
What is an example of primary prevention?
Vaccine
What is secondary prevention?
Early identification of the disease to alter disease course
What is an example of secondary prevention?
Screening
What is tertiary prevention?
Limiting the effects of development of established disease
What is an example of tertiary prevention?
Stroke rehabilitation programme
What is the population approach to prevention?
Prevention approach delivered to everyone to shift the risk factor distribution curve
What is an example of a population approach to prevention?
Sugar tax
What is the high risk approach to prevention?
Identifying individuals above a chosen cut off and treating them
What is an example of a high risk approach to prevention?
Screening people for high blood pressure and treating them
What is the prevention paradox?
A preventative measure which brings much benefit to the population but offers little impact to each individual
What are the benefits of screening tests?
Good use of resources
Informed decision
Reassurance
Better future health
What are the downsides of screening test?
May cause harm or distress
Over treatment
Difficult decisions
Incorrect results
What are the 3 screening tests in pregnancy?
Infectious disease
Sickle cell & thalassaemia
Fetal anomoly screen
What does the fetal anomoly test screen for?
Downs, Edwards, Patau’s
What are the 3 screening tests in newborns?
NIPE
Hearing screen
Blood spot
What are the 5 screening tests in adults and young people?
AAA (men at 65)
Bowel cancer
Breast cancer
Cervical screen
Diabetic eye
What is the Wilson and Jugner criteria for a screening test?
Important disease
Effective treatment available
Simple and safe
Natural history of disease known
Acceptable test
Policy on who to treat
What is sensitivity?
The proportion of those with the disease who got a positive test
What is specificity?
The proportion without the disease who got a negative test
What is the positive predictive value?
The proportion of people with a positive test who have the disease
What is negative predictive value?
Proportion of people with a negative test who don’t have the disease
What is the formula for sensitivity?
TP/ (TP+FN)
What is the formula for specificity?
TN/(TN +FP)
What is the formula for PPV?
TP/ (TP+FP)
What is the formula for NPV?
TN/(TN+ FN)
What is the length time bias?
When screening is more likely to detect slow growing disease that has a long asymptomatic phase, making it appear as though there is a survival benefit to screening
What is lead time bias?
When a patient diagnosed earlier falsely appears to live longer
What is the best research method in the heirarchy of evidence?
Systematic review/ Meta analysis
What is a case-control study?
Retrospective, observational study looking at the cause of a disease that compares similar participants with the disease and without.
What is a cross-sectional study?
Retrospective observational study that collects data from a population at a specific point in time
What is a cohort study?
Prospective longitudinal study looking at seperate cohorts with different treatments of exposures to see if the disease occurs
What are RTC’s?
Prospective study where all participants are randomly assigned an exposure or control intervention
What is an ecological study?
Looks at the prevalence of the disease over time using population data
How to you work out the odds of an event occuring?
Probability event occurs (p)/ Probability event does not occur (1-p)
What is the odds ratio?
Comparing the odds of an outcome occuring between two groups (e.g. exposure and control group)
What is the formula for the odds ratio?
Odds of event A/ Odds of event B
What does an Odds ratio of 1 indicate?
The odds of the event occurring in one condition equal the odds of it happening in the other condition. (No association between event and condition)
What does it mean if the odds ratio is >1?
The events odds are higher for the group in the numerator (making it a risk factor)
What does it mean if the odds ratio is <1?
The probability of the outcome occurring is lower for the group/condition in the numerator. (Protective factor or a treatment provided)
What is measurement bias?
When different equipment may measure things differently
What is observer bias?
When observers expectations influence reporting
What is recall bias?
When past events are not recalled correctly
What is reporting bias?
When people don’t tell the truth because of shame/ judgement
What is selection bias?
Bias in recruiting for a study, or participants being lost to follow up
What is publication bias?
Trials with negative results less likely to be published
What does the Bradford-Hill criteria for causality include?
Strength of association
Consistency from different studies
Dose response
Termporarility
Plausibility
Reversibility
Coherence
Analogy (similar to others)
Specificity
What are confounders?
Variable that influences both the dependent variable and independent variable, causing a spurious association
What factors can cause a false association with exposure and outcome?
Bias
Confounding factors
Chance
What is incidence?
Number of new case over a certain time period
What is prevelance?
Total of number of people with a disease at a certain point in time
What is person time?
The measure of time at risk for all patients in the study (e.g. 1,000 people studied for 2 years = 2000 person years)
What is the relative risk?
Risk among exposed group/ Risk in unexposed group
What is the absolute risk?
Works out how much of the disease occurs because of the exposure
What is the formula for absolute risk?
Risk from exposed group - Risk from control group
What is the number needed to treat?
The number of patients you need to treat for one person to benefit
How do you calculate number needed to treat?
1/ Absolute risk
What does it mean if the relative risk is above 1?
The risk has increased due to exposure
What is a health behaviour?
A behaviour done to prevent disease
What is an illness behaviour?
A behaviour done to seek remedy (e.g. doing to the doctor)
What is sick roll behaviour?
Behavior done to get well (e.g. taking medicine)
What are perceptions of risk influenced by?
- Personal experience with problem
- Belief that it is preventable by personal action
- Belief that if it hasn’t happened by now, it won’t
- Belief that the problem is infrequent
At what points are interventions thought to be more effective?
Transition points:
Leaving school
Entering workforce
Becoming a parent
Becoming unemployed
Retirement
Bereavement
What are some examples of models of behaviour change?
Health belief model
Theory of planned behaviour
Stages of change
Social norms theory
Motivational interviewing
Nudging
What are the factors involved in the health belief model?
Patients will change their behaviour if they believe:
1. They are susceptible to the condition
2. There are serious consequences
3. That taking action reduces susceptibility
4. That benefits of action outweigh cost
What three factors are thought to determine an individuals health behaviour in the theory of planned behaviour?
Attitude
Subjective norm (societal pressure)
Perceived behavioural control
What are the 6 steps in the stages of change model?
- Precontemplation
2.Contemplation - Preparation
- Action
- Maintenance
- Relapse
What drug is used to help opiate detoxification?
Methadone (or naltrexone)
What drug is used in opiode overdose?
Naloxone
What is the formula to work out units of alcohol?
Volume (ml) X % alcohol)/ 1000
What are the key things that indicate alcohol dependence?
Withdrawal syptoms
Cravings
Tolerance
Primacy (putting it before other activities)
Loss of control
Narrowing of repertoire
What may be taken to help alcohol abstinence?
Disulfrem
Acomprosate
What are the four dimension of food insecurity?
Availability of food
Access
Utilisation
Stability
What are the different types of error?
Sloth error
Lack of skill
Communication
System failure
Human factors
Judgement failure
Neglect
Poor performance
Misconduct
What is the Bolam rule?
Would a reasonable doctor do the same?
What is the Bolitho rule?
Would that be reasonable
What are the 4 components of medical negligence?
Doctors have a duty of care which was breached and the patient came to harm as a result of this breech.
What is the swiss cheese model of error?
Latent failures build up to allow an error to happen (Organisational influence–> Unsafe supervision–> Preconditions–> Unsafe act)
What is the bucket model of error?
SELF (poor knowledge/skill, fatigue, unwell)
CONTEXT (Distraction, poor handover, lack of support)
TASK (Errors, complexity)
(Fuller the bucket, more likely an error will occur)
