public health Flashcards
1
Q
3 domains of public health
A
Health protection, health promotion and improving and organising health services
2
Q
Health
A
A state of complete physical, mental and social well-being and not merely absence of disease or infirmity
3
Q
Incidence
A
The number of new cases per unit time
4
Q
Prevalence
A
The number of existing cases at a particular point in time
5
Q
Relative risk
A
Exposed/unexposed
6
Q
Attributable risk/absolute risk reduction/risk difference
A
exposed/100 - unexposed/100 = x/100
7
Q
Number needed to treat
A
1/attributable risk
8
Q
Determinants of health
A
PROGRESS|Place of residence|Race/ethnicity|Occupation|Gender|Religion|Education|Socio-economic status|Social capital/resources
9
Q
Equality
A
Equal shares/treatment for everyone no matter their need
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
11
Q
3 types of bias
A
Selection, information, publication
12
Q
Selection bias
A
Sample chosen is not representative of the population you want to generalise to
13
Q
Information bias
A
Bias from measurement of either the exposure or outcome
14
Q
Publication bias
A
Studies with negative results are less likely to be published
15
Q
Confounding
A
A factor associated with exposure and the outcome, which is not on the causal pathway
16
Q
Bradford-Hill criteria for causality
A
TDSRC|Temporality|Dose-response|Strength|Reversibility|Consistency
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
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
19
Q
Case-control
A
Retrospective observational study which looks at a certain exposure and compares similar participants with and without the disease.
20
Q
RCT
A
Similar participants randomly assigned to intervention or control groups to study the effect of the intervention
21
Q
Cross-sectional advantages
A
Quick and cheap|Few ethical issues
22
Q
Cross-sectional disadvantages
A
Prone to bias|No time reference
23
Q
Case-control advantages
A
Good for rare diseases|Inexpensive
24
Q
Case-control disadvantages
A
Can only show association (not causation)|Unreliable due to recall bias
25
Cohort advantages
Can show causation|Less chance of bias
26
Cohort disadvantages
Large amount lost to follow up|Expensive
27
RCT advantages
Can infer causality|Less risk of bias/confounders
28
RCT disadvantages
Time consuming and expensive|Ethical issues can interfere
29
Health needs assessment
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
30
Health needs assessment planning cycle
Needs assessment|Planning|Implementation|Evaluation
31
Epidemiological HNA
Defines problems and size of problem|Looks at current services|Recommends improvements
32
Epidemiological HNA limitations
Data available may be poor|May be inadequate evidence base|Doesn't consider felt need
33
Comparative HNA
Compares services received by one population to another
34
Comparative HNA limitations
Data available may vary in quality|May be hard to find comparable population|Comparison may not be perfect
35
Corporate HNA
Takes into account views of any groups that may have an interest e.g. patients, health professionals, media, politicians
36
Corporate HNA limitations
May be hard to distinguish need from demand|Groups have vested interest - leads to bias|Dominant individuals may have undue influence
37
Need
The ability to benefit from an intervention. Bradshaw types of need = FENC
38
Felt need
Individual perceptions of deviations from normal health
39
Expressed need
Seeking help to overcome variation in normal health
40
Normative need
Professional defines intervention for expressed need
41
Comparative need
Comparison between severity, range of interventions and cost
42
Health behaviour
Aimed at preventing disease e.g. going for a run
43
Illness behaviour
Seeking remedy e.g. going to GP for a symptom
44
Sick role behaviour
Activity aimed at getting well e.g. taking antibiotics
45
Transtheoretical/stages of change model
Pre-contemplation|Contemplation|Preparation|Action|Maintenance|At all stages relapse
46
Theory of planned behaviour
Attitudes, subjective norms, perceived behavioural control all feed into intention and behaviour.
47
TPB - bridging the gap between intention and behaviour
P PAIR|Preparatory actions|Perceived control|Anticipated regret|Implementation intentions|Relevance to self
48
Health belief model
Perceived susceptibility, perceived severity, health motivation, perceived benefits, perceived barriers
49
Tests of medical negligence
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
Bolam rule
Would a group of reasonable doctors do the same?
51
Bolitho rule
Would it be reasonable of that group to do so?
52
Swiss cheese model
Organizational influences|Unsafe supervision|Preconditions for unsafe acts|Active failures
53
Never event
A serious, largely preventable patient safety incident that should not occur if the available preventative measures have been implemented
54
Never event examples
Medical: wrong route chemo|Surgical: wrong site or retained object|Mental health: escape of transfer patient
55
Maxwell's dimesions for assessing service quality
3As, 3Es|Access|Appropriate|Acceptability|Equity|Efficient|Effective
56
Donabedian approach to assessing service quality
Structure, process, output, outcome
57
Structure
Buildings, staff, equipment. Number of ICU beds, location where screening provided
58
Process
All that is done to the patients. Number of patients seen in A&E, number of operations performed
59
Outputs
Immediate result of medical intervention. Number of cancers identified on screening
60
Outcome
Gains in health status. 5Ds - death, disease, disability, discomfort, dissatisfaction
61
Qualitative methods of evaluation
Observation|Interviews|Focus groups|Review of documents
62
Quantitative methods of evaluation
Routinely collected data|Review of records|Surveys
63
Duties of a doctor
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
Types of errors
Sloth|Fixation/loss of perspective|Communication breakdown|Playing the odds|Bravado|Ignorance|Mis-triage|Lack of skill|System error
65
Egalitarian
Based on idea that NHS was founded on the requirement to provide all necessary care to everyone. BUT finite resources
66
Utilitarian
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
Libertarian
Each person is responsible for their own health
68
Primary prevention
Preventing disease becoming established. Reduce/eliminate exposures known to increase an individual's risk of developing a disease. Individual or population
69
Secondary prevention
Aims to detect early disease and slow down/halt the process of disease (screening)
70
Tertiary prevention
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
Wilson screening criteria
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
Screening
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
True positive
Patient given positive test result is found to have the disease after a more specific diagnostic test
74
False positive
Patient given positive test result is found to not have the disease after a more specific diagnostic test
75
False negative
Patient given negative screening result is found to have the disease later
76
True negative
Patient given negative screening result and subsequently did not develop the disease
77
Sensitivity
Ability of the test to pick up those who DO have the disease
78
Specificity
Ability of test to pick up those who DO NOT have the disease
79
Positive predictive value
Proportion of people with a positive test result who do have the disease
80
Negative predictive value
Proportion of people with a negative test result who do not have the disease
81
Examples of antenatal and newborn screening problems
Quad test for Down syndrome|Foetal anomaly USS|Antenatal sickle cell|Newborn physical exam|Guthrie test|Newborn hearing screening
82
Examples of young person and adult screening programmes
AAA screening|Breast Ca|Bowel Ca|Cervical Ca
83
Arguments for screening
Prevent suffering rather than treating symptoms|Early identification leads to better outcomes|Lower costs involved with earlier treatment
84
Arguments against screening
Damage caused by false positives and negatives|Adverse effects of screening on healthy people|Perception that personal choice compromised - "nanny state"
85
Lead time bias
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
Length time bias
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
The sick role
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
Nudge theory
Make the healthy option the easiest one - fruit near checkouts at supermarkets
89
Human rights act 1998 important articles - 2, 3, 8, 12, 14
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
Domestic abuse
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
3 ways domestic abuse impacts on health
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
Person-time
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
Health behaviour transition points
Leaving school, entering the workforce, becoming a parent, becoming unemployed, retirement and bereavement
94
PROMs
Patient reported outcome measures - Oxford Hip Score
95
Direct spread of infectious diseases
Person to person - cough/sneeze, skin contact, exchange of body fluids (sex or bite/needlestick). Animal to person. Mother to unborn child
96
Indirect spread of infectious diseases
Inanimate objects, insect bites, contaminated food or water
97
What makes a communicable disease of public health importance?
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
Notifiable diseases
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
