Public Health Flashcards
what is the Gini coefficient?
a statistical representation of the nation’s income distribution - the lower the coefficient, the greater the equality
The Acheson Report
1998: said that income inequality should be reduced and that priority should be given to families with children
Proportional Universalism
Focusing only on the disadvantaged will not help to reduce inequality. Action must be universal but with scale and intensity proportional to the disadvantage.
Theories of causation
i) Psychosocial
ii) Neo-material
iii) Life Course
Psychosocial causation
Stress results in inability to respond to body’s demands
There’s also impact on blood pressure and cortisol levels
Neo-material causation
Hierarchal societies are less willing to invest in public goods
Poor people also have fewer goods, the quality of which is generally lower
Life course as causation
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.
Domains of public health
Health protection
Improving services
Health improvement
Addressing the wider determinants of health
Ethical levels
Meta-ethics (fundamental questions e.g. right & wrong)
Ethical Theory - (5 levels)
Applied Ethics (e.g. specific areas)
Ethical theory
i) virtue
ii) categorical
iii) imperative
iv) utilitarianism
v) 4 principles
Structural determinants of illness
i) social class
ii) material deprivation/poverty
iii) unemployment
iv) discrimination/racism
v) gender and health
Confidentiality: when is disclosure allowed?
i) required by law
ii) patient consents
iii) there is a public interest xn
Confidentiality: criteria for disclosure
i) anonymous if practical
ii) patient’ consent if possible
iii) kept to a necessary minimum
iv) meets current law
Three notifiable diseases that must be reported to WHO
i) cholera
ii) plague
iii) yellow fever
Difference between health behaviour illness behaviour and sick role behaviour.
HB: to prevent disease (eat healthily)
IB: to seek remedy (go to dr)
SRB: to get well (complianc, resting)
5 lifestyle factors that promote morbidity
i) smoking
ii) obesity
iii) excess alcohol
iv) poor diet
v) sedentary lifestyle
Two theories of behavioural change
Health Belief Model and Transtheoretical model
Health belief model
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
Transtheoretical model
i) pre-contemplation
ii) contemplation
iii) preparation
iv) action
v) maintenance
vi) ReLaPSe?
Utilitarianism/consequentialism (Teleological)
i) an act is evaluated solely in terms of its consequences
ii) maximising good and minimising harm
Kantianism (Deontological)
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
Virtue ethics (Deontology)
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
Five focal virtues of virtue ethics
i) compassion
ii) discernment
iii) trustworthiness
iv) integrity
v) conscientiousness
The 4 Principles
i) autonomy
ii) benevolence
iii) non-malificence
iv) justice
GMC duties of a doctor
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
The Katz ADL Scale
activities of daily life
i) bathing
ii) dressing
iii) toilet use
iv) transfering from bed to chair
v) urine and bowel continence
vi) eating
IADL (Instrumental activities of daily life)
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
Acute illness
a disease of short duration that starts quickly and has severe symptoms
Chronic illness
a persistent or recurring conditon which may or may not be severe, often starting gradually with slow changes
Polypharmacy
the use of mulitiple medications or administration of more medications than are clinically indicated
key challenges of an ageing population
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
Intrinsic aging
natural, universal and inevitable
Extrinsic aging
dependant on external factors (smoking, air polution, UV rays)
why women live longer than men
20% biological (premenopausal women are protected from heart disease by hormones)
80% environmental (men take more lifestyle risks than women)
Types of dementia
i) alzheimers (62%)
ii) vascular dementia (17%)
iii) mixed alzheimers and vascular (10%)
iv) lewy bodies
v) fronto temporal (2%)
vi) other types (3%)
Institutionalising death
60% of people die in hospital but 70% want to die at home
Four contexts for awareness
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
social death
when people die in social and interpersonal terms before their actual biological death - lonely
Death the hospice way
i) open awareness, compassion and honesty
ii) multi-disciplinary teams
iii) emotion and relationships - modelled on a family approach
iv) holistic care
Health problems associated with smoking
i) cancers (all types)
ii) cardiovascular
iii) impotence
iv) diabetes
v) oral health
vi) cateracts
Smoking cessation
i) NRT - patches, gum, nasal spray
ii) non-nicotine pharmacotherapy - varenicline, bupropion
iii) transtheoretical model §
Transtheoretical model
i) precontemplation
ii) contemplation
iii) preparation
iv) action
v) maintenance
3 A’s to smoking cessation
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
The millenium development goals
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
3 leading causes of death in children in the developing world
i) pneumonia
ii) diarrhoea
iii) malaria
examples of migrants
asylum seekers, refugees, trafficked people, migrant workers, family workers, family joiners, international students
causes of vulnerability in migrants
persecution, war, political and social unrest, exploitation, torture, rape bereavement, burden of disease and socio-economic status
sustainability
meeting the needs of today without compromising the ability of future generations to meet the needs of tomorrow
definition of screening
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
primary, secondary and tertiary prevention
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
screening sensitivity
true positives / total with the disease
screening specificity
true negative / total without the disease
Positive predictive value
true positive / total with positive result
Negative predictive value
true negative / total with negative result
Prevalence and incidence
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
Wilson and Jugner criteria for screening
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
Types of bias in screening
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
Medical error leads to two outcomes
i) adverse effect
ii) near miss
Human error types
i) errors of omission
ii) errors of commission
iii) errors of negligence
skill based errors
when performing a task that is well learned and therefore automatic, lapses in concentration cause error
Rule/knowledge based error
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
Violations
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)
Approaches to managing errors
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
Defining an effective team
i) optimal size
ii) good team dynamic
iii) a common purpose
iv) an identified team leader
v) shared knowledge and experiences
obstacles of teamwork
Organisational - different offices, shifts and rotation posts
Location - based elsewhere
Management - different employers
Other commitments of the team members
SBAR checklist
for reporting a case
S - situation
B - background
A - assessment
R - recommendation
Mental health definition
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
CMHP - common mental health problems
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
Psychological definition of stress
stress occurs when the demands made upon an individual are greater than their ability to cope
Stressors
acute - noise, danger, infection
chronic - health, home, finances
internal stressors - physical, psychological
external stressors
PTSD daignostic criteria
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
PTSD Symptoms
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)
Stress and physical illness
i) peptic ulcers
ii) cancer
iii) obesity
iv) chronic fatigue syndrome
Causes of Obesity
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
Obesity definition
abnormal or excessive fat accumulation resulting from chronic imbalance of energy intake and energy expenditure
BMI Brackets
<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
7 key domains of energy balance
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
difference between satiation and satiety
satiation - what brings an eating episode to an end
satiety - the inter-meal period
the 4 main STIs
i) chlamydia
ii) gonorrhoea
iii) syphilis
iv) trichomoniasis
HIV safety ABC
i) abstain
ii) be faithful
iii) use a condom
CAM definition
complementary and alternative medicine - those healing resources other than those intrinsic to the politically dominant healthcare system
examples of CAM
manual therapies: osteopathy, chiropractic, reflexology
ethic medical systems: chinese medicine acupuncture, herbal medicine
mind-body/energy medicine: hypnotherapy, healing, reiki
Non-allopathic sysytems: homeopathy
House of Lords CAM classification
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
Who uses CAM
mainly older women with higher income and higher education level. 60% of users have a chronic illness
Major concerns
Unrealistic Expectations
Delays in conventional care
General safety
Basic Health Economic Problem
resources are finite
desire for goods and services is infinite
no country treats all treatable ill health
choice cannot be avoided
Economic evaluation
Assessing whether a benefit has been maximised
Costs and effects are analysed in terms of their differences
Types of economic evaluation
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
Equity
Fairness or justice of the distribution of costs and benefits
