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public health Flashcards

1
Q

3 domains of public health

A

Health protection, health promotion and improving and organising health services

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2
Q

Health

A

A state of complete physical, mental and social well-being and not merely absence of disease or infirmity

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3
Q

Incidence

A

The number of new cases per unit time

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4
Q

Prevalence

A

The number of existing cases at a particular point in time

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5
Q

Relative risk

A

Exposed/unexposed

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6
Q

Attributable risk/absolute risk reduction/risk difference

A

exposed/100 - unexposed/100 = x/100

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7
Q

Number needed to treat

A

1/attributable risk

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8
Q

Determinants of health

A

PROGRESS|Place of residence|Race/ethnicity|Occupation|Gender|Religion|Education|Socio-economic status|Social capital/resources

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9
Q

Equality

A

Equal shares/treatment for everyone no matter their need

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10
Q

Equity (horizontal and vertical)

A

Equity is what is fair and just|Horizontal - equal treatment for equal need|Vertical - unequal treatment for unequal need

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11
Q

3 types of bias

A

Selection, information, publication

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12
Q

Selection bias

A

Sample chosen is not representative of the population you want to generalise to

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13
Q

Information bias

A

Bias from measurement of either the exposure or outcome

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14
Q

Publication bias

A

Studies with negative results are less likely to be published

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15
Q

Confounding

A

A factor associated with exposure and the outcome, which is not on the causal pathway

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16
Q

Bradford-Hill criteria for causality

A

TDSRC|Temporality|Dose-response|Strength|Reversibility|Consistency

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17
Q

Cross-sectional study

A

Outcome and exposure measured at same time, looking at prevalence. E.g. survey of a population to see if they have both prev asbestos exposure and asbestosis

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18
Q

Cohort

A

Take a group of people, follow them up until they reach outcome or study engs. E.g. occupational cohort of people exposed to asbestos, followed up until they get asbestosis

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19
Q

Case-control

A

Retrospective observational study which looks at a certain exposure and compares similar participants with and without the disease.

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20
Q

RCT

A

Similar participants randomly assigned to intervention or control groups to study the effect of the intervention

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21
Q

Cross-sectional advantages

A

Quick and cheap|Few ethical issues

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22
Q

Cross-sectional disadvantages

A

Prone to bias|No time reference

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23
Q

Case-control advantages

A

Good for rare diseases|Inexpensive

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24
Q

Case-control disadvantages

A

Can only show association (not causation)|Unreliable due to recall bias

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25
Q

Cohort advantages

A

Can show causation|Less chance of bias

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26
Q

Cohort disadvantages

A

Large amount lost to follow up|Expensive

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27
Q

RCT advantages

A

Can infer causality|Less risk of bias/confounders

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28
Q

RCT disadvantages

A

Time consuming and expensive|Ethical issues can interfere

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29
Q

Health needs assessment

A

A systematic approach for reviewing the health issues affecting a population. Leads to agreed priorities and resource allocation that will improve health and decrease inequalities

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30
Q

Health needs assessment planning cycle

A

Needs assessment|Planning|Implementation|Evaluation

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31
Q

Epidemiological HNA

A

Defines problems and size of problem|Looks at current services|Recommends improvements

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32
Q

Epidemiological HNA limitations

A

Data available may be poor|May be inadequate evidence base|Doesn’t consider felt need

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33
Q

Comparative HNA

A

Compares services received by one population to another

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34
Q

Comparative HNA limitations

A

Data available may vary in quality|May be hard to find comparable population|Comparison may not be perfect

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35
Q

Corporate HNA

A

Takes into account views of any groups that may have an interest e.g. patients, health professionals, media, politicians

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36
Q

Corporate HNA limitations

A

May be hard to distinguish need from demand|Groups have vested interest - leads to bias|Dominant individuals may have undue influence

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37
Q

Need

A

The ability to benefit from an intervention. Bradshaw types of need = FENC

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38
Q

Felt need

A

Individual perceptions of deviations from normal health

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39
Q

Expressed need

A

Seeking help to overcome variation in normal health

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40
Q

Normative need

A

Professional defines intervention for expressed need

41
Q

Comparative need

A

Comparison between severity, range of interventions and cost

42
Q

Health behaviour

A

Aimed at preventing disease e.g. going for a run

43
Q

Illness behaviour

A

Seeking remedy e.g. going to GP for a symptom

44
Q

Sick role behaviour

A

Activity aimed at getting well e.g. taking antibiotics

45
Q

Transtheoretical/stages of change model

A

Pre-contemplation|Contemplation|Preparation|Action|Maintenance|At all stages relapse

46
Q

Theory of planned behaviour

A

Attitudes, subjective norms, perceived behavioural control all feed into intention and behaviour.

47
Q

TPB - bridging the gap between intention and behaviour

A

P PAIR|Preparatory actions|Perceived control|Anticipated regret|Implementation intentions|Relevance to self

48
Q

Health belief model

A

Perceived susceptibility, perceived severity, health motivation, perceived benefits, perceived barriers

49
Q

Tests of medical negligence

A
  1. Was there duty of care?|2. Was there a breach of that duty?|3. Did the patient come to harm?|4. Was the harm due to the breach in care?
50
Q

Bolam rule

A

Would a group of reasonable doctors do the same?

51
Q

Bolitho rule

A

Would it be reasonable of that group to do so?

52
Q

Swiss cheese model

A

Organizational influences|Unsafe supervision|Preconditions for unsafe acts|Active failures

53
Q

Never event

A

A serious, largely preventable patient safety incident that should not occur if the available preventative measures have been implemented

54
Q

Never event examples

A

Medical: wrong route chemo|Surgical: wrong site or retained object|Mental health: escape of transfer patient

55
Q

Maxwell’s dimesions for assessing service quality

A

3As, 3Es|Access|Appropriate|Acceptability|Equity|Efficient|Effective

56
Q

Donabedian approach to assessing service quality

A

Structure, process, output, outcome

57
Q

Structure

A

Buildings, staff, equipment. Number of ICU beds, location where screening provided

58
Q

Process

A

All that is done to the patients. Number of patients seen in A&E, number of operations performed

59
Q

Outputs

A

Immediate result of medical intervention. Number of cancers identified on screening

60
Q

Outcome

A

Gains in health status. 5Ds - death, disease, disability, discomfort, dissatisfaction

61
Q

Qualitative methods of evaluation

A

Observation|Interviews|Focus groups|Review of documents

62
Q

Quantitative methods of evaluation

A

Routinely collected data|Review of records|Surveys

63
Q

Duties of a doctor

A

Care of your patients is your first concern|Keep professional knowledge and skills up to date|Treat patients politely and considerately|Respect patients’ right to confidentiality|Act with integrity and honesty|Promote health

64
Q

Types of errors

A

Sloth|Fixation/loss of perspective|Communication breakdown|Playing the odds|Bravado|Ignorance|Mis-triage|Lack of skill|System error

65
Q

Egalitarian

A

Based on idea that NHS was founded on the requirement to provide all necessary care to everyone. BUT finite resources

66
Q

Utilitarian

A

Maximize public utility - act is evaluated solely in terms of its consequences - will it be beneficial? Give resources to those most likely to benefit BUT who decides this?

67
Q

Libertarian

A

Each person is responsible for their own health

68
Q

Primary prevention

A

Preventing disease becoming established. Reduce/eliminate exposures known to increase an individual’s risk of developing a disease. Individual or population

69
Q

Secondary prevention

A

Aims to detect early disease and slow down/halt the process of disease (screening)

70
Q

Tertiary prevention

A

Once the disease is established, detectable and symptomatic, tertiary prevention aims to reduce the complications or severity of disease by offering appropriate treatments or interventions

71
Q

Wilson screening criteria

A

Condition must be important|Facilities for diagnosis/treatment should be available|Natural history of the disease should be known|There should be a recognised early/latent stage|There should be an acceptable treatment|There should be a suitable test|The test should be acceptable to the population|There should be an agreed policy on whom to treat as patients|Cost must be balanced relative to possible expenditure|Case finding must be a continuous process

72
Q

Screening

A

A public health service in which members of a defined population are asked a question or offered at test to identify which individuals are more likely to be helped than harmed by further investigations

73
Q

True positive

A

Patient given positive test result is found to have the disease after a more specific diagnostic test

74
Q

False positive

A

Patient given positive test result is found to not have the disease after a more specific diagnostic test

75
Q

False negative

A

Patient given negative screening result is found to have the disease later

76
Q

True negative

A

Patient given negative screening result and subsequently did not develop the disease

77
Q

Sensitivity

A

Ability of the test to pick up those who DO have the disease

78
Q

Specificity

A

Ability of test to pick up those who DO NOT have the disease

79
Q

Positive predictive value

A

Proportion of people with a positive test result who do have the disease

80
Q

Negative predictive value

A

Proportion of people with a negative test result who do not have the disease

81
Q

Examples of antenatal and newborn screening problems

A

Quad test for Down syndrome|Foetal anomaly USS|Antenatal sickle cell|Newborn physical exam|Guthrie test|Newborn hearing screening

82
Q

Examples of young person and adult screening programmes

A

AAA screening|Breast Ca|Bowel Ca|Cervical Ca

83
Q

Arguments for screening

A

Prevent suffering rather than treating symptoms|Early identification leads to better outcomes|Lower costs involved with earlier treatment

84
Q

Arguments against screening

A

Damage caused by false positives and negatives|Adverse effects of screening on healthy people|Perception that personal choice compromised - “nanny state”

85
Q

Lead time bias

A

Time between diagnosis from screening and clinical diagnosis appears to improve length of survival but disease course (and length of time alive) has not changed

86
Q

Length time bias

A

More aggressive diseases that are asymptomatic for a shorter period are less likely to be picked up by screening than slowly progressive diseases - so screening may falsely appear to improve survival

87
Q

The sick role

A

A sick person is exempt from normal social roles|Not responsible for their condition|Should try to get well|Should seek help from and co-operate with the medical profession

88
Q

Nudge theory

A

Make the healthy option the easiest one - fruit near checkouts at supermarkets

89
Q

Human rights act 1998 important articles - 2, 3, 8, 12, 14

A

2 - right to life|3 - right to freedom from inhumane and degrading treatment|8 - right to respect for privacy and family life|12 - right to marry and found a family|14 - right to freedom from discrimination

90
Q

Domestic abuse

A

Any incident or pattern of incidents of controlling, coercive, threatening behaviour, violence or abuse between those ages 16 or over who are, or have been, intimate partners of family members. Can be psychological, physical, sexual, financial, emotional

91
Q

3 ways domestic abuse impacts on health

A

Traumatic injuries following assault.|Somatic problems or chronic illness consequent on living with abuse e.g. headaches, GI disorders, chronic pain, low birth weight, prem delivery.|Psychological/psychosocial issues secondary to abuse

92
Q

Person-time

A

A measure of time at risk - i.e. time from entry to a study to disease onset, loss to follow-up or end of study. Used to calculate incidence rate which uses person-time as the denominator

93
Q

Health behaviour transition points

A

Leaving school, entering the workforce, becoming a parent, becoming unemployed, retirement and bereavement

94
Q

PROMs

A

Patient reported outcome measures - Oxford Hip Score

95
Q

Direct spread of infectious diseases

A

Person to person - cough/sneeze, skin contact, exchange of body fluids (sex or bite/needlestick). Animal to person. Mother to unborn child

96
Q

Indirect spread of infectious diseases

A

Inanimate objects, insect bites, contaminated food or water

97
Q

What makes a communicable disease of public health importance?

A

High mortality (rabies), high morbidity (meningococcal disease, legionnaires, E Coli O157 gastroenteritis), highly contagious (influenza, measles), expensive to treat (HIV), effective interventions available (Hep B - vaccine available)

98
Q

Notifiable diseases

A

Acute encephalitis, acute meningitis, acute poliomyelitis, anthrax, botulism, cholera, diptheria, food poisoning, infectious bloody diarrhoea, scarlet fever, Legionnaire’s, leprosy, malaria, measles, meningococcal septicaemia, mumps, rabies, rubella, SARS, smallpox, tetanus, TB, typhus, VHF, whooping cough, yellow fever

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