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EM: > Public Health > Flashcards

Public Health Flashcards

1
Q

what is the Gini coefficient?

A

a statistical representation of the nation’s income distribution - the lower the coefficient, the greater the equality

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2
Q

The Acheson Report

A

1998: said that income inequality should be reduced and that priority should be given to families with children

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3
Q

Proportional Universalism

A

Focusing only on the disadvantaged will not help to reduce inequality. Action must be universal but with scale and intensity proportional to the disadvantage.

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4
Q

Theories of causation

A

i) Psychosocial
ii) Neo-material
iii) Life Course

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5
Q

Psychosocial causation

A

Stress results in inability to respond to body’s demands

There’s also impact on blood pressure and cortisol levels

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6
Q

Neo-material causation

A

Hierarchal societies are less willing to invest in public goods
Poor people also have fewer goods, the quality of which is generally lower

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7
Q

Life course as causation

A

Critical periods - events have greatest impact at certain times in people’s lives. Hazards and their impacts also build up over time. Injuries and disabilities may be self propagating. Childhood abuse leads to mental health issues in later years.

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8
Q

Domains of public health

A

Health protection
Improving services
Health improvement
Addressing the wider determinants of health

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9
Q

Ethical levels

A

Meta-ethics (fundamental questions e.g. right & wrong)
Ethical Theory - (5 levels)
Applied Ethics (e.g. specific areas)

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10
Q

Ethical theory

A

i) virtue
ii) categorical
iii) imperative
iv) utilitarianism
v) 4 principles

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11
Q

Structural determinants of illness

A

i) social class
ii) material deprivation/poverty
iii) unemployment
iv) discrimination/racism
v) gender and health

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12
Q

Confidentiality: when is disclosure allowed?

A

i) required by law
ii) patient consents
iii) there is a public interest xn

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13
Q

Confidentiality: criteria for disclosure

A

i) anonymous if practical
ii) patient’ consent if possible
iii) kept to a necessary minimum
iv) meets current law

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14
Q

Three notifiable diseases that must be reported to WHO

A

i) cholera
ii) plague
iii) yellow fever

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15
Q

Difference between health behaviour illness behaviour and sick role behaviour.

A

HB: to prevent disease (eat healthily)
IB: to seek remedy (go to dr)
SRB: to get well (complianc, resting)

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16
Q

5 lifestyle factors that promote morbidity

A

i) smoking
ii) obesity
iii) excess alcohol
iv) poor diet
v) sedentary lifestyle

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17
Q

Two theories of behavioural change

A

Health Belief Model and Transtheoretical model

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18
Q

Health belief model

A

i) individuals must believe they are susceptible to the condition
ii) individuals must believe it has serious consequences
iii) individuals must believe that taking action reduces their skills
iv) individuals must believe that the benefits of taking action outweigh the costs

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19
Q

Transtheoretical model

A

i) pre-contemplation
ii) contemplation
iii) preparation
iv) action
v) maintenance
vi) ReLaPSe?

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20
Q

Utilitarianism/consequentialism (Teleological)

A

i) an act is evaluated solely in terms of its consequences

ii) maximising good and minimising harm

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21
Q

Kantianism (Deontological)

A

i) features of the act themselves determine the worthiness of the act
ii) follow categorical imperatives (do not lie; do not kill etc)
iii) people are ends not means to an end

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22
Q

Virtue ethics (Deontology)

A

i) focus is on the kind of person who is acting
ii) deemphasises rules
iii) is the person expressing good character or not
iv) five focal virtues

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23
Q

Five focal virtues of virtue ethics

A

i) compassion
ii) discernment
iii) trustworthiness
iv) integrity
v) conscientiousness

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24
Q

The 4 Principles

A

i) autonomy
ii) benevolence
iii) non-malificence
iv) justice

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25
Q

GMC duties of a doctor

A

i) Protect and promote the health of patients and the public
ii) provide good standard of practice and care
iii) recognise and work within the limits of your competencies
iv) work with colleagues in the ways that best serve patients interests
v) treat patients as individuals and respect their dignity

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26
Q

The Katz ADL Scale

activities of daily life

A

i) bathing
ii) dressing
iii) toilet use
iv) transfering from bed to chair
v) urine and bowel continence
vi) eating

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27
Q

IADL (Instrumental activities of daily life)

A

i) use of the telephone
ii) travelling by car or using public transport
iii) food or clothes shopping
iv) meal preparation
v) housework
vi) medication use
vii) management of money

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28
Q

Acute illness

A

a disease of short duration that starts quickly and has severe symptoms

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29
Q

Chronic illness

A

a persistent or recurring conditon which may or may not be severe, often starting gradually with slow changes

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30
Q

Polypharmacy

A

the use of mulitiple medications or administration of more medications than are clinically indicated

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31
Q

key challenges of an ageing population

A

i) strains on pension and social security systems
ii) increasing demand for health care
iii) bigger need for trained health workforce
iv) increasing demand for a long-term care
v) pervasive ageism (denying older people the rights and opportunities available to young people)
vi) inequality as more affluent groups will be able to afford better care for longer

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32
Q

Intrinsic aging

A

natural, universal and inevitable

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33
Q

Extrinsic aging

A

dependant on external factors (smoking, air polution, UV rays)

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34
Q

why women live longer than men

A

20% biological (premenopausal women are protected from heart disease by hormones)
80% environmental (men take more lifestyle risks than women)

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35
Q

Types of dementia

A

i) alzheimers (62%)
ii) vascular dementia (17%)
iii) mixed alzheimers and vascular (10%)
iv) lewy bodies
v) fronto temporal (2%)
vi) other types (3%)

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36
Q

Institutionalising death

A

60% of people die in hospital but 70% want to die at home

37
Q

Four contexts for awareness

A

i) closed awareness - staff know by the patient doesn’t
ii) suspected awareness - the patient suspects but is uncertain that they’re dying
iii) mutual pretence - everyone knows but it isn’t discussed openly
iv) state of awareness - everyone knows and openly admits that death is approaching

38
Q

social death

A

when people die in social and interpersonal terms before their actual biological death - lonely

39
Q

Death the hospice way

A

i) open awareness, compassion and honesty
ii) multi-disciplinary teams
iii) emotion and relationships - modelled on a family approach
iv) holistic care

40
Q

Health problems associated with smoking

A

i) cancers (all types)
ii) cardiovascular
iii) impotence
iv) diabetes
v) oral health
vi) cateracts

41
Q

Smoking cessation

A

i) NRT - patches, gum, nasal spray
ii) non-nicotine pharmacotherapy - varenicline, bupropion
iii) transtheoretical model §

42
Q

Transtheoretical model

A

i) precontemplation
ii) contemplation
iii) preparation
iv) action
v) maintenance

43
Q

3 A’s to smoking cessation

A

i) Ask - your patient’s smoking
ii) Advise - your patient on cessation methods available
iii) Assist - your patient and refer to local NHS stop smoking services

44
Q

The millenium development goals

A

i) eradicate extreme poverty and hunger
ii) achieve universal primary education
iii) reduce child mortality
iv) improve maternal health
vi) combat HIV/AIDS, malaria and other diseases

45
Q

3 leading causes of death in children in the developing world

A

i) pneumonia
ii) diarrhoea
iii) malaria

46
Q

examples of migrants

A

asylum seekers, refugees, trafficked people, migrant workers, family workers, family joiners, international students

47
Q

causes of vulnerability in migrants

A

persecution, war, political and social unrest, exploitation, torture, rape bereavement, burden of disease and socio-economic status

48
Q

sustainability

A

meeting the needs of today without compromising the ability of future generations to meet the needs of tomorrow

49
Q

definition of screening

A

a process that sorts a cohort of symptomless people into a group that are likely to have a disease and a group that are unlikely to have a disease

50
Q

primary, secondary and tertiary prevention

A

primary - to prevent the disease from occuring
secondary - detection of early disease and action to alter the course of disease in order to maximise chances of recovery
tertiary prevention - trying to slow down the progression of a disease

51
Q

screening sensitivity

A

true positives / total with the disease

52
Q

screening specificity

A

true negative / total without the disease

53
Q

Positive predictive value

A

true positive / total with positive result

54
Q

Negative predictive value

A

true negative / total with negative result

55
Q

Prevalence and incidence

A

prevalence - the proportion of a population with a characteristic
incidence - the number of new cases within a specified time period divided by the size of the population initially at risk

56
Q

Wilson and Jugner criteria for screening

A

THE CONDITION
i) it should be a serious health problem
ii) the aetiology should be well understood
iii) there should be a detectable early stage
THE TREATMENT
i) there should be an accepted treatment for the disease
ii) facilities for diagnosis and treatment should be available
iii) there can’t be an unmanageable extra clinical workload
THE TEST
i) a suitable test should be devised for the early stage
ii) the test should be acceptable for the patients
iii) intervals for repeating the test should be determined
THE BENEFITS
i) there should be an agreed policy on whom to treat
ii) the cost should be balanced against the benefits

57
Q

Types of bias in screening

A

selection bias
lead time bias - identified earlier but survival is not longer
length time bias - diseases with longer period of presentation are more likely to be detected by screening

58
Q

Medical error leads to two outcomes

A

i) adverse effect

ii) near miss

59
Q

Human error types

A

i) errors of omission
ii) errors of commission
iii) errors of negligence

60
Q

skill based errors

A

when performing a task that is well learned and therefore automatic, lapses in concentration cause error

61
Q

Rule/knowledge based error

A

incorrect plan or course of action is chosen - these mistakes are more likely when the task is more complex or the person has less experience

62
Q

Violations

A

deliberate deviations from practices, procedures and standards or rules

i) routine (cutting corners)
ii) necessary (to get the job done)
iii) optimising (personal gain, selfish)

63
Q

Approaches to managing errors

A

individual - errors are the products of the wayward mental processes of individual

organisational - adverse events are the effect of wayward causal factors - the whole system is to blame

64
Q

Defining an effective team

A

i) optimal size
ii) good team dynamic
iii) a common purpose
iv) an identified team leader
v) shared knowledge and experiences

65
Q

obstacles of teamwork

A

Organisational - different offices, shifts and rotation posts

Location - based elsewhere

Management - different employers

Other commitments of the team members

66
Q

SBAR checklist

for reporting a case

A

S - situation
B - background
A - assessment
R - recommendation

67
Q

Mental health definition

A

a state of wellbeing in which the individual realises his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully and is able to contribute to the community

68
Q

CMHP - common mental health problems

A

i) depression
ii) generalised mental health disorder
iii) panic disorders
iv) phobias
v) social anxiety disorder
vi) obsessive compulsive disorder
vii) post traumatic stress disorder

69
Q

Psychological definition of stress

A

stress occurs when the demands made upon an individual are greater than their ability to cope

70
Q

Stressors

A

acute - noise, danger, infection

chronic - health, home, finances

internal stressors - physical, psychological

external stressors

71
Q

PTSD daignostic criteria

A

both must be present:

i) the person experienced an event that involved actual or threatened death or serious injury or a threat to physical integrity
ii) the person’s response involved intense fear, helplessness and horror

72
Q

PTSD Symptoms

A

i) event persistently re-experienced in recollections and dreams
ii) persistent avoidance of stimuli associated with the event
iii) persistent symptoms of increased arousal (insomnia, irritability)

73
Q

Stress and physical illness

A

i) peptic ulcers
ii) cancer
iii) obesity
iv) chronic fatigue syndrome

74
Q

Causes of Obesity

A

i) Americanization of diet and society
ii) increasing dominance of car culture
iii) numerous technical advances minimising physical work
iv) more commuting
v) longer working hours

75
Q

Obesity definition

A

abnormal or excessive fat accumulation resulting from chronic imbalance of energy intake and energy expenditure

76
Q

BMI Brackets

A 
<18.4 --> underweight 
18.5 - 24.9 --> normal
25 - 29.9 --> overweight
30 - 34.9 --> obese class I
35 - 39.9 --> obese class II
>40 --> obese class III
77
Q

7 key domains of energy balance

A

i) food environment (population level energy intake)
ii) food consumptions (energy intake on individual level)
iii) individual activity
iv) activity of the environment (population level)
v) societal influences
vi) individual psychology
vii) individual biology

78
Q

difference between satiation and satiety

A

satiation - what brings an eating episode to an end

satiety - the inter-meal period

79
Q

the 4 main STIs

A

i) chlamydia
ii) gonorrhoea
iii) syphilis
iv) trichomoniasis

80
Q

HIV safety ABC

A

i) abstain
ii) be faithful
iii) use a condom

81
Q

CAM definition

A

complementary and alternative medicine - those healing resources other than those intrinsic to the politically dominant healthcare system

82
Q

examples of CAM

A

manual therapies: osteopathy, chiropractic, reflexology

ethic medical systems: chinese medicine acupuncture, herbal medicine

mind-body/energy medicine: hypnotherapy, healing, reiki

Non-allopathic sysytems: homeopathy

83
Q

House of Lords CAM classification

A

Group 1: some scientific evidence of efficacy - herbal, chiropractic, osteopathy

Group 2: modalities working in a supportive capacity alongside conventional medicine, not offering independent diagnosis - massage, aromatherapy

Group 3: traditional systems of medicine backed by historical practice only - chinese medicine

84
Q

Who uses CAM

A

mainly older women with higher income and higher education level. 60% of users have a chronic illness

85
Q

Major concerns

A

Unrealistic Expectations

Delays in conventional care

General safety

86
Q

Basic Health Economic Problem

A

resources are finite
desire for goods and services is infinite
no country treats all treatable ill health
choice cannot be avoided

87
Q

Economic evaluation

A

Assessing whether a benefit has been maximised

Costs and effects are analysed in terms of their differences

88
Q

Types of economic evaluation

A

Cost-effectiveness analysis: cost per life year gained

Cost-utility analysis: cost per QALY gained

Cost benefit analysis: outcomes measured in monetary units so net gain

89
Q

Equity

A

Fairness or justice of the distribution of costs and benefits

EM: (14 decks)

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