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Phase 1 Public Health > Public Health > Flashcards

Public Health Flashcards

1
Q

What is the definition of Health

A

Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity

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2
Q

What effect does decreased social class have on life expectancy?

A

It decreases it

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3
Q

Once a country reaches a financial threshold at which diseases associated with poverty are replaced with degenerative diseases, does further income increase have an impact?

A

No

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4
Q

What is the definition of social class?

A

A measure of occupation, stratification, social position and access to power and resources

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5
Q

What is the inverse care law?

A

Where the availability of good medical care tends to vary inversely with the need for it within a population

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6
Q

What is incidence?

A

The number of new cases per unit of time (can be expressed as a percentage or per number e.g. 100,000)

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7
Q

How can incidence be increased?

A

1) by screening for new cases

2) by increasing risk factors

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8
Q

How can incidence be decreased?

A

By decreasing risk factors e.g. Using primary interventions

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9
Q

What is prevalence?

A

The number of existing cases at a particular point in time (can be expressed as a total, percentage or per number e.g. 100,000)

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10
Q

How can prevalence be increased?

A

1) Screening programmes identifying new cases
2) increasing risk factors
3) increased life expectancy due to better treatments

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11
Q

How could prevalence be decreased?

A

1) cures for the condition

2) decreasing risk factors

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12
Q

What is sociology?

A

The study of social relations (the bonds between people and groups of people) and social processes (where direct human actions are a result of collective human actions).

It is a measure of social interdependencies.

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13
Q

What is the sick role?

A

This is where being ill allows a person to deviate from their normal social roles.

A sick person is: 
Exempt from normal social roles
Is not responsible for their condition
Should try to get well
Should seek help and co-operate with medical professionals
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14
Q

What is the Medicalisation hypothesis?

A

This is where professionals tend to see problems in terms of their own profession, therefore doctors tend to see all problems medically.

This may not always be the case, they may be the result of social forces e.g. ADHD and depression

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15
Q

Iatrogenesis, what is it?

A

The unintended adverse effects of therapeutic intervention. It can be clinical, social or cultural

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16
Q

Changing health behaviours:

What is the health belief model?

A

Perceived susceptibility, perceived barriers, benefits and self efficacy are all influences on changing behaviours

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17
Q

Changing health behaviours:

What is the stages of change model?

A

Not thinking (pre-contemplation) - thinking about changing (contemplation) - preparing to change - action - maintenance - stable changed lifestyle/relapse

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18
Q

What ways can health behaviour be changed?

A

1) Motivational interviewing
2) social marketing
3) financial incentives

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19
Q

Changing health behaviours:

What is the nudge theory?

A

Changing the environment to make the healthiest option the easiest

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20
Q

What is public health?

A

Public health is concerned with health protection, promotion and improving and organising health sciences

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21
Q

Screening: what is sensitivity?

A

The probability of a person with a disease obtaining a positive test result - true positive.

This is the true positive results divided by the total number of people with the disease.

It measure how well the test picks up the disease.

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22
Q

Screening: what is specificity?

A

A test to look at the probability of a person without the disease testing negative - true negative

This is calculated by the true negatives divided by total number of people without the disease.

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23
Q

What is the positive predictive value?

A

The proportion of people with positive test result who actually have the disease

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24
Q

What is the what’ve predictive value?

A

The proportion of people without the disease who are correctly excluded by the the screening process

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25
Q

What are the affects of prevalence on positive predictive and negative predictive values?

A

If prevalence of a disease is high false positives fall - this means that the positive predictive value increases and the negative predictive value decreases

Reverse is true for rare diseases

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26
Q

What are the principles of whether screening should be carried out?

A

1) the condition should be a important problem
2) there should be an acceptable treatment
3) facilities for diagnosis and treatment should be available
4) there should be a recognised early stage
5) the natural history of the disease should be known
6) there should be a suitable test
7) there should be an agreed policy on whom to treat
8) the cost of case finding should be balanced in relation to cost as a whole

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27
Q

What are the points in support of screening?

A

1) prevent suffering
2) early identification beneficial
3) early treatment is cheaper
4) patient satisfaction tends to be high

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28
Q

What are the points against screening?

A

1) potential damage caused by false positives and negatives
2) potential adverse effects of screening on healthy people
3) personal choice may be compromised

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29
Q

What is primary prevention?

A

Aims to prevent a disease from occurring in the first place - reducing exposures

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30
Q

What is secondary prevention?

A

The aim is to detect disease early and slow down or halt its progression

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31
Q

What is tertiary prevention?

A

This aims to reduce the complications of an established disease by offering appropriate treatments or interventions

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32
Q

What is the prevention paradox?

A

This is where a larger number of people who have a small risk contribute to more cases of that disease than people at higher, individual risk

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33
Q

What is the high risk approach to reducing risk?

A

1) target all individuals
2) aim to reduce the risk below set limit
3) accepted by society - target those outside normal levels

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34
Q

What is the population approach to reducing disease risk?

A

1) target all individuals
2) aim to reduce risk to individuals
3) recognises that the low risk majority contribute to the majority of cases
4) has concerns over treating the well - “nanny state”

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35
Q

The high risk approach favours the affluent and educated, why?

A

1) they are more likely to engage with health services
2) they are more likely to comply with treatments
3) they are more likely to have the means to make the necessary means to change lifestyle

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36
Q

What are the phases of cardiac rehabilitation?

A

Phase 1 - in hospital
Phase 2 - early post discharge
Phase 3 - 16 weeks
Phase 4 - long term maintenance of lifestyle changes

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37
Q

What are common reasons cited for smoking?

A

1) nicotine addiction
2) coping with stress
3) habit
4) socialising
5) fear of weight gain

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38
Q

What are the two types of influenza?

A

Influenza A - the strain which causes pandemics

Influenza B - the strain which is seasonal

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39
Q

What are the criteria for a pandemic?

A

1) novel virus
2) capable of infecting humans
3) capable of causing human illness
4) large pool of people susceptible
5) ready and sustainable transmission from person to person

40
Q

What are public health interventions to reduce pandemics ?

A 
Hand washing 
Respiratory hygiene 
Reduced social contact 
Travel restrictions 
School closures 
Screening
41
Q

What is direct transmission?

A

This is where infection occurs through a direct route e.g. STI or faecal oral route

42
Q

What is indirect transmission?

A

Vector-Bourne e.g. Malaria

Vehicle-Bourne e.g. Viral gastroenteritis

43
Q

Other than direct and indirect transmission, how else can a disease be transmitted?

A

Airborne e.g. TB

44
Q

What is a unit of alcohol?

A

10ml/8g of ethanol

45
Q

What is foetal alcohol syndrome?

A

Where maternal alcohol consumption leads to:
Growth retardation
CNS abnormalities
Cranio-facial abnormalities
Congenital defects
Increased risk of birth marks and hernias

46
Q

What is withdrawal?

A

Where someone comes off alcohol or other addictive substances
It can involve:
Tremors, activation syndrome (agitation, shakes, rapid heart rate, Hugh blood pressure), seizures, hallucinations, delirium

47
Q

What are the cage questions for alcohol dependency?

A

1) have you ever felt that you should it down?
2) have you ever been annoyed about people telling youth cut down
3) have you ever felt guilty about how much you drink
4) have you ever had a drink first thing in the morning

48
Q

What is adherence?

A

Acknowledges the importance of the patients belief.

Medical experts convey information to enhance patient knowledge and satisfaction

49
Q

What is concordance?

A

This thinks of patients as equals in care, with them taking part in decisions. Consultation becomes negotiation.

50
Q

What is ethics?

A

An attempt to understand the nature of human values, of how we ought to live and what constitutes right conduct - Richard Norman

51
Q

What is the top down deductive method to ethics?

A

Where an ethical theory is consistently applied to all problems

52
Q

What is the bottom up inductive method to ethics?

A

Where past medical problems are used to create guidelines on practice

53
Q

What are the four principles of ethics?

A

Autonomy - allowing patients to make rational and informed decisions
Beneficence - doing the right thing to benefit another
Non-maleficence - preventing harm and doing no harm
Justice - being fair

54
Q

What is utilitarianism?

A

Where an act is evaluated in terms of its consequences. It acts to maximise good.

55
Q

What is deontology?

A

This is where the features of the act itself determine worthiness

56
Q

What is virtue ethics?

A

Where the focus is on the character of the person. An action an be virtuous only if performed by a person in the right state of mind e.g. Genuinely intending to do the right thing

57
Q

What are the five focal virtues?

A

1) Compassion
2) Discernment
3) Trustworthiness
4) Integrity
5) conscientiousness

58
Q

What is evidence based medicine?

A 
Asking focuses questions
Finding the evidence 
Critical appraisal 
Making a decision 
Evaluating performance
59
Q

What should you focus on when asking focuses questions?

A

PICO

Population
Intervention
Comparing
Outcome

60
Q

What is critical appraisal?

A

It’s purpose is to assess and consider validity, reliability and applicability. It should be done so that you can apply results to your own patients and provide the best possible evidence when communicating risk to remain professional

61
Q

What is validity?

A

How close to the truth something is

62
Q

What is reliability?

A

It is how consistent the results are. If the study was repeated again would the same/similar results be seen?

63
Q

What is applicability?

A

It is how relevant a study is to clinical medicine

64
Q

What are good markers for a good study?

A

Random allocation of participants to interventions (reduce bias/confounding variables)

Have outcome measures for at least 80% of participants

Show causation rather than association

65
Q

What does frailty mean?

A

A broad term for weak physiological and psychological states

66
Q

Whta is Rockwoods Frailty Scale?

A

It has four levels:

1) People who walk without helpm independently perform activities of daily living are continent and not cognitively impaired
2) Bladder incontinence only
3) One (or two if incontinent) of: Needing mobility assistance or with ADLs, has cog impairment or has bowel or bladder incontinence
4) Two (or three if incontinent) of: Total dependence for transfers or one or more ADLs, incontinent of bowel and bladder or diagnosis of dementia

67
Q

What are Activities of Daily Living (ADLs)?

A 
They include:
Eating
Dressing
Bathing
Bed transfers
68
Q

What is episodic memory?

A

Encoding, storage and retrieval of personally experienced events

69
Q

How is memory affected with age?

A

Long-term memory tends to be unaffected but working memory, short-term and processing, seem to decline

70
Q

What is generic memory?

A

Repository knowledge stored without any reference to context in which it was acquired

71
Q

What are the theorises of causation over life course?

A

Critical periods - Where things can have a greater impact at certain points in life e.g. measles in regancy

Accumulation - Hazards and their impacts add up e.g. hard labour leads to injuries which leads to reduced work which leads to reduced opportunities

Interactions and pathways - e.g. sexual abuse in childhood leads to poorer partner choices etc

72
Q

What three ways have been suggested that Doctors can close the gap in inequalities?

A

1) Changing perspectives
2) Changing systems
3) Changing education

73
Q

What are the levels of ethics?

A

Meta-ethics: Fundamental questions
Ethical Theory: Attempts to create theories
Applied ethics: Ethical investigations

74
Q

What is the ethical fallacy Ad hominem?

A

Shifting the blame to an irrelevant aspect of the person making the argument e.g. Jones is wrong, but he votes conservative

75
Q

What is the ethical fallacy authority claims?

A

Arguing a claim is correct just because someone in authority has said it

76
Q

What is the ethical phallacy question begging?

A

Where conclusions are included in premise

e.g. abortion is non-justified killing and that is murder, murder is illegal so abortion should be

77
Q

What is meant by the ethical fallacy dissenters?

A

Where finding people who disagree doesn’t mean an argument is invalid

78
Q

What is meant by motherhoods in terms of ethical fallacies?

A

Inserting a soft statement to disguise a contentious one

79
Q

What is the decision making model in ethics?

A

1) Recognise ethical situation
2) Break down dilemma
3) Seek information from patients and others
4) Identify legal and professional guidance
5) If no solution found apply critical ethical analysis
6) Break down dilemma
7) Justify decisions with sound arguements

80
Q

What are the outcomes set by Tomorrow’s Doctors (2009)?

A

1) The doctor as a scholar and a scientist
2) The doctor as a practitioner
3) The doctor as a professional

81
Q

What are the three main categories of behaviours related to health?

A

1) Health Behaviour
2) Illness behaviour
3) Sick role behaviour

82
Q

What is health behaviour?

A

A behaviour aimed at preventing a disease e.g. eating healthy

83
Q

What is illness behaviour?

A

A behaviour aimed at seeking remedy

84
Q

What is a sick role behaviour?

A

Any activity aimed at getting well e.g. taking perscribed medications

85
Q

What is urealistic optimisim?

A

it is where individuals continue to practi e health damaging behaviour due to inaccurate perceptions of risk and susceptibility
(Weinstein, 1983)

86
Q

What is the Health Belief Model?

A

The idea that individuals will change their behaviour if:

  • They believe they are susceptible
  • There are serious consequences
  • Taking action reduces susceptibility
  • Benefits of action outweigh cost
87
Q

What does the Theory of Planned Behaviour say about changing behaviour?

A

That intension is the biggest predictor

Intention determined by:

  • Attitude to behaviour
  • Perceived social pressures
  • Appraisal of ability to do behaviour
88
Q

What is confidentiality?

A

A set of rules or a promise that limits access or places restrictions on certain types of information

89
Q

What permits disclosure of confidential information?

A

1) Law
2) Consent
3) Public interest

90
Q

What classes as public interest in terms of releasing information?

A

1) Serious communicable diseases
2) Serous crime
3) Research
4) Education
5) Beneficial to society

91
Q

What are the objectives outlined by the General Medical Council in the Medical act in terms of fitness to practice (1983)?

A

a) To protect, promote and maintain the health, safety and well being of the public
b) To promote and maintain public confidence in the medical profession
c) To promote and maintain proper professional standards and conduct for members of that profession

92
Q

What are the four domains set out by the General Medical Council?

A

1) Knowledge, skills and performance
2) Safety and Quality
3) Communication, partnership and teamwork
4) Maintaining trust

93
Q

What does probity mean?

A

Being honest and trustworthy and acting with integrity

94
Q

What are the 6 capabilities of the Activities of Daily Living Scale?

A

1) Bathing or shower
2) Dressing
3) Toilet use
4) Transferring (bed or chair)
5) Urine and bowel continence
6) Eating

95
Q

How are ADL graded?

A

Performs independently = 1
Performs with assistance = 0.5
Unable to perform = 0

Phase 1 Public Health (1 decks)

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