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Public Health Flashcards

1
Q

What is epigenetics

A

Genetic expression depends on the environment - everyone has different experiences -> environment alters genes

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2
Q

What is salutogenesis

A

Favourable physiological changes secondary to experiences which promote healing and health

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3
Q

What is public health

A

Science and art of preventing disease, prolonging life and promoting health through the organised efforts of society

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4
Q

What’s the difference between equality and equity

A

Equality - equal shares (eg access to healthcare)

Equity - What is fair and just

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5
Q

Vertical and horizontal equity ?

A

H- equal treatments for equal needs (everyone with pneumonia treated the same)
V - unequal treatments for equal needs (areas with poorer health need higher expenditure on health services)

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6
Q

Dimensions of health equity

A

Spacial

Social - age, gender, SES, ethic

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7
Q

What does health equity study ? What things does it look at to do that

A

The differences and causes of quality of healthcare across the population
Supply of healthcare
Access
Utilisation
Health care outcomes
Resource allocation
Wider determinants of health - diet / smoking…

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8
Q

Would you normally assess equality or equity first ?

A

Equality

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9
Q

Does equality always mean equitability

A

No - equal utilisation of health care services does not result in equity

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10
Q

What are the 3 main domains of public health

A

Health improvement - social interventions aimed at preventing disease, promoting health and reducing inequalities
Health protection - measures to control infectious disease risks and environmental hazards
Improvement of health services - organisation and delivery of safe, quality services for the prevention and treatment of disease

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11
Q

Egs of health improvement areas

A 
Inequalities 
Education 
Housing
Employment 
Lifestyle 
Family / community
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12
Q

Egs of health protection

A 
Infectious diseases 
Chemicals / poisons 
Radiation 
Emergency response 
Environmental health
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13
Q

Egs of health service improvement

A 
Clinical effectiveness 
Efficiency 
Service planning 
Audits / evaluations 
Clinical governance 
Equity
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14
Q

Levels and Eg of public health interventions

A

Individual - behavioural change
Community - clean the local community
Population - recommend exercise 4 x 30 min a week

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15
Q

3 levels of prevention and eg

A

1 - prevent disease before it starts - immunise / diet
2 - detect early - screening, regular examinations, daily aspirin to prevent further CVD
3 - reduce impact of a disease that has lasting effects - stroke rehab, diabetes management

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16
Q

How do you calculate incident rate

A

Number of persons who become cases over time period / total person-time at risk during that period

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17
Q

What is the denominator of cumulative incidence

A

Number of disease free people

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18
Q

What is absolute risk

A

Risk of developing a disease

It has units Eg 50/1000 population

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19
Q

What is relative risk

A

Risk in one category compared to another - between 2 groups

Doesn’t have units

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20
Q

How do you calculate relative risk

A

Incidence in exposed / incidence in unexposed

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21
Q

What does relative risk tell us

A

The strength of association between a risk factor and disease

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22
Q

What is attributable risk? How do you calculate it?

A

Rate of disease that can be attributed to the exposure

AR = Incidence in exposed - incidence in unexposed

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23
Q

What does attributable risk tell us

A

The size and effect of the disease IF causality is assumed

The public health impact

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24
Q

Which disease is more common?

AR of A<b>B</b>

A

B is much more common

Higher attributable risk = much more common

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25
What does the SD form ?
The true estimation of the association between exposure and outcome
26
What does a systematic error lead to?
A distortion of the true underlying association
27
What is selection bias
Systematic error in the selection of participants or the allocation of participants into different groups
28
What is information bias? Other name? What causes it
Systematic error in the measurement or classification of exposure / outcome Measurement bias Observer / participant / instrument
29
What is confounding ?
A factor associated with the exposure independently influences the outcome but doesn't lie on the Causal pathway Eg coffee ->smoking -> lung cancer
30
What are the criteria for causality ?
Strength of association - magnitude of relative risk Dose - higher exposure = higher risk Consistency - similar results from other research Temporality - does exposure precede outcome Reversibility - removal of exposure prevents disease Biological plausibility - can be explained
31
If a result is not causal what can explain it ?
Bias, chance, confounding, reverse causality
32
Basics of cohort
Longitudinal Follows patients Split into exposure vs not exposed
33
Basics of case control
Look at existing cases Compare with control Look at HX to see if exposed
34
Rare disease, case control or cohort?
Case control
35
What is a cross sectional
Data at a specific point in time
36
2 types of ecological study
Geographical - prevalence of disease in certain areas | Time trends - prevalence of disease over time
37
How do you calculate odd ratio? What is it?
Odds of exposure in cases / odds of exposure in controls Measure of association between exposure and outcome
38
Formula for odds ratio
(A/c) / (b/d)
39
3 parts of health needs assessment
Need - ability to benefit from an intervention Demand - what people ask for Supply - what is provided
40
What is a health needs assessment?
A systematic method for reviewing health issues facing a population, leading to agreed priorities and resource allocation that will improve health and reduce inequalities
41
What is health need? Healthcare need?
HN - the need for health - measured in mortality / morbidity HCN - the need for health care - more specific, the ability to benefit - depends on the potential of prevention and treatment
42
What are the sociological types of need?
Felt need - individual perceptions of variation from normal health Expressed need - seeking to overcome variation Normative need - professional defines an appropriate intervention Comparative need - comparison between severity, range of interventions and cost
43
What is the corporate approach to HNA ?
Lead by politicians, press, commissioners, patients... | The problems are political agenda
44
What might indicate domestic abuse was occurring in A&E?
Injury witnessed by no one else Repeated attendance for injuries Delay in seeking health
45
Why is important to to keep health records in DA
They used as evidence
46
What things can GPs d for DA?
Display - posters/ leaflets -> creates an environment where it can be talked about Direct - questions, make sure they are non judgemental and reassuring Information - refer if needed, be clear behaviour is not acceptable Process - be ready to be part of the process of escaping the abuse by working with other agencies
47
3 levels of DA
Standard - current evidence does not indicate risk of harm Medium - identifiable indicators of risk / harm --> but unlikely without change in circumstances High - imminent risk of harm that could happen at any time
48
When do you give contact details for domestic abuse services?
Medium / high risk
49
Who do you refer to in high risk ? What can you do without consent ?
MARAC / IDVAS | Break confidentiality
50
What is MARAC ? What do they do?
Multi agency risk assessment conference | One meeting to determine plan for all those involved
51
What do IDVAS do?
Work with women of high risk | Provide advice and support through court proceedings, housing options, legal services
52
What do the domestic homicide review do?
Independent review when the death of someone over 16 appears to be due to violence / neglect by - a person they were related to - member of the same household
53
What are the emotional needs in old age?
``` Security - life can get too regimented to try and protect Attention - need to make more effort Autonomy and control Intimacy Privacy Part of a community Status Competence Purpose ```
54
Services for older people
Silverline - telephone service Dementia friends Men in sheds Housing - inter generational housing, co-housing Self help - mindfulness
55
Top 2 causes for homelessness?
Eviction - due to private landlords | Relationship breakdown
56
Egs of some contributory factors associated with homelessness
Unemployment, addiction (drug / gambling/ alcohol...), domestic violence
57
3 groups who are over represented in homelessness?
Care leavers, ex prison, veterans
58
What is the inverse care law
The availability of good medical / social care tends to vary inversely with the health need of a population
59
Barriers to accessing healthcare by vulnerable groups
Perception - no address -> think they cant visit GP Not prioritising illness Disability Language / cultural
60
Common health problems in vulnerable groups
Diseases of neglect / poverty | 0 malnutrition, infectious disease (resp/sexual), intoxication, dental health, injection site infections / vascular
61
Three factors that impact heavily on traveller populations
Lack of education -> literacy Smoking Antenatal care
62
What is an asylum seeker? Common places they are from?
Someone requesting refugee status | Anywhere with war
63
What 3 things are asylum seekers entitled to? What are they not? Common diseases?
Healthcare, housing, small benefit (£35/week), <18-get education Look for a job / work Mental health / PTSD, diseases of poverty and neglect

GP (6 decks)

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