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Phase 3A > Public Health > Flashcards

Public Health Flashcards

1
Q

Define incidence

A

Number of new cases of a disease/condition in a population per unit time

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2
Q

Define prevalence

A

Number of existing cases of a disease/condition in a population at a given point in time

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3
Q

What are the 5 stages of change?

A 
Pre-contemplation
Contemplation
Preparation
Action
Maintenance
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4
Q

What is the aim of a primary intervention?

A

It aims to prevent the onset of a disease and involves interventions that are applied before any evidence of disease is present e.g. vaccines

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5
Q

What is the aim of a secondary intervention?

A

Detection of disease in earliest stages before symptoms are present and intervening to slow, stop or reverse disease progression e.g. breast cancer screening

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6
Q

What is the aim of a tertiary prevention?

A

Interventions designed to arrest the progress of established disease and minimise its negative consequences

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7
Q

What is screening?

A

A process which identifies apparently well individuals who may be at increased risk of developing a condition, in the early stages of a condition so that intervention can alter the disease course thereby reducing morbidity and mortality

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8
Q

What is selection bias?

A

A systematic error in selection/allocation of study participants

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9
Q

What is a true negative?

A

A result that is negative and the patient has not got the disease

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10
Q

What is a false positive?

A

A positive result but the patient does not have the disease

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11
Q

What is a false negative?

A

A negative result but the patient does have the disease

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12
Q

Define sensitivity

A

Ability of a test to correctly identify those with the disease
A/A+C

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13
Q

Define specificity

A

Ability of a test to correctly identify those without the disease
B/B+D

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14
Q

Define positive predicted value

A

The proportion of the positive results that are true positives
A/A+B

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15
Q

Define negative predicted value

A

The proportion of the negative results that are true negatives
D/D+C

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16
Q

What is absolute risk?

A

The risk of developing risk over a time period

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17
Q

What is relative risk?

A

Risk of getting a disease in an exposed group compared to an unexposed group. It’s a ratio so has no units

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18
Q

What’s attributable risk?

A

AKA absolute risk reduction
Rate of disease in exposed that may be attributed to exposure
Incidence in exposed - incidence in unexposed

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19
Q

Define number needed to treat

A

The number of people need to be treated for one person to benefit
NNT= 1/ARR

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20
Q

Define a never event

A

A serious, largely avoidable patient safety event which should not occur if the available preventative measures have been implemented

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21
Q

Give some examples of a never event

A 
Wrong patient 
Wrong site surgery 
Wrong drug dose
Foreign body retained
Mental health: escape of transfer patient 
ABO incompatibility
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22
Q

What is neglect?

A

Falling below the acceptable standard of care

A breach of the legal duty of care owed which results in harm to that patient

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23
Q

What is the Swiss cheese model?

A

Each layer represents processes which have been put in place to prevent errors happening. Holes are where processes fail. When the holes in the cheese line up an error can occur.

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24
Q

What are the two types of error?

A

Errors of commission - doing something

Errors of omission - not doing something

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25
Q

What are the two tests to determine negligence?

A

Bolam - would a group of reasonable doctors have done the same?
Bolitho - would it have reasonable for them to do so?

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26
Q

What are the 5 factors affecting patient compliance?

A 
Socioeconomic - long distance from treatment setting
Health system - supply of medication
Condition - memory impairment 
Therapy - complex treatment regimens
Patient - disbelief/denial of condition
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27
Q

What are the principles of treatment for substance misuse interventions?

A 
Minimise harm e.g. decrease risk of blood borne viruses
Substitute prescribing e.g. methadone 
Psychosocial interventions
Residential treatment 
Self-help groups
28
Q

What are the 3 times you can break confidentiality?

A

If they’re a risk to the public - intend to commit a crime
If they have given consent
If it is required by law - notifiable disease, a judge orders you to do so
You should always try to obtain consent

29
Q

Define epidemic

A

An increase in the prevalence of a disease above the number usually observed in the population in a particular area

30
Q

Define pandemic

A

An epidemic which occurs in several countries or continents

31
Q

What is information bias?

A

A systematic error in measurement/classification of exposure or outcome

32
Q

List 3 examples of screening programs.

A 
Bowel cancer - FOB
Breast cancer - mammograms
Cervical cancer - smear and HPV testing 
AAA
Foetal anomaly screening program
Diabetic eye screening
33
Q

What are the 3 domains of public health?

A

Health improvement
Health protection
Improving services (health care)

34
Q

What is health improvement concerned with?

A

Societal interventions (not primarily delivered through health services) aimed at preventing disease, promoting health and reducing inequalities

35
Q

What is health protection concerned with?

A

Measures to control infectious disease risks and environmental hazards

36
Q

What is horizontal equity?

A

Equal treatment for equal need e.g. individuals with pneumonia (with all other things being equal) should be treated equally

37
Q

What is vertical equity?

A

Unequal treatment for unequal need e.g. individuals with the common cold vs. pneumonia need unequal treatment

38
Q

What are the different forms of health equity?

A
  • Equal expenditure for equal need
  • Equal access for equal need
  • Equal utilisation for equal need
  • Equal health care outcome for equal need
  • Equal health
39
Q

How is health equity examined?

A 
•Supply of health care 
•Access to health care 
•Utilisation of health care
•Health care outcomes 
•Health status 
•Resource allocation
--Health services 
--Other services e.g. education, housing
•Wider determinants of health 
--Smoking 
--Diet 
--Healthcare seeking behaviour 
--Socioeconomic and physical environment
40
Q

What is a health needs assessment?

A

A systematic method for reviewing the health issues facing a population, leading to agreed priorities and resource allocation that will improve health and reduce inequalities. In practice, the term “health needs assessment” is usually used to cover both health needs assessment and health care needs assessment. A health needs assessment may be carried out for a population, a condition or an intervention.

41
Q

Define health need.

A

A need for health, concerns need in more general terms e.g. measured using mortality, morbidity, socio-demographic measures

42
Q

Define health care need

A

A need for health care and the ability to benefit from health care. It depends on the potential prevention, treatment and care services to remedy health problems

43
Q

What is a felt need?

A

An individual’s perception of variation from normal health

44
Q

What is an expressed need?

A

An individual seeks help to overcome the variation in normal health

45
Q

What is a normative need?

A

A professional defines the intervention appropriate for the expressed need

46
Q

What are some negatives of a corporate approach?

A
  • May be difficult to distinguish need from demand
  • Groups may have vested interests
  • May be influenced by political agendas
  • Dominant personalities may have undue influence
47
Q

What is health behaviour?

A

A behaviour aimed to prevent disease e.g. eating healthily

48
Q

What is illness behaviour?

A

A behaviour aimed to seek remedy e.g. going to the doctor

49
Q

What is sick-role behaviour?

A

Any activity aimed at getting well e.g. taking prescribed medications, resting

50
Q

What are some critiques of the health belief model?

A
  • Alternative factors may predict health behaviour such as outcome expectancy (whether the person feels they will be healthier as a result of their behaviour) and self-efficacy (the persons belief in their ability to carry out preventative behaviour)
  • As a cognitively based model, HBM does not consider the influence of emotions on behaviour
  • HBM does not differentiate between first time and repeat behaviour
  • Cues to action are often missing in HBM research
51
Q

What are some critiques of the theory of planned behaviour?

A
  • Criticisms include the lack of a temporal element and the lack of direction or causality
  • TPB is a “rational choice model”, it doesn’t take in to account emotions such as fear, threat, positive affect, all of which might disrupt “rational” decision making
  • Model does not explain how attitudes, intentions and perceived behavioural control interact
  • Habits and routines bypass cognitive deliberation and undermine a key assumption of the model
  • Assumes that attitudes, subjective normal and PBC can be measured
  • Relies on self-reported behaviour
52
Q

What are the advantages of the transtheoretical model (PC-PAM)?

A
  • Acknowledges individual stages of readiness (tailored interventions)
  • Accounts for relapse
  • Temporal element (although arbitrary)
53
Q

What are the critiques of the transtheoretical model (PC-PAM)?

A
  • Not all people move through every stage, some people move backwards and forwards or miss some stages out completely
  • Change might operate on a continuum rather than in discrete stages
  • Doesn’t take in to account values, habits, culture, social and economic factors
54
Q

What is nudge theory?

A

“Nudge” the environment to make the best option the easier e.g. opt out schemes such as pensions, placing fruit next to checkouts

55
Q

What makes up Maxwell’s dimensions of quality?

A 
Effectiveness 
Efficiency
Equity 
Acceptability 
Accessibility 
Appropriateness
56
Q

What are the advantages of a cohort study?

A

Follow up of a group with rare exposure is good for common and multiple outcomes decreases the risk of selection and recall bias

57
Q

What are the negatives of a cohort study?

A

Takes a long time

Loss to follow up so requires a large sample

58
Q

What are the advantages of a case control study?

A

Good for rare outcomes
Quick and inexpensive
Multiple exposures

59
Q

What are the negatives of a case control study?

A

Difficulty finding controls to match cases selection and information bias

60
Q

What are the advantages of a cross-sectional study?

A

Cheap, quick
Data on prevalence at a single point in time
Large sample size

61
Q

What are the negatives of a case-sectional study?

A

Risk of reverse causality

Cannot measure incidence

62
Q

What is association?

A

A relationship between two factors. It could be due to chance, bias, confounding (association of exposure with another factor also independently associated with outcome), reverse causality (outcome causing exposure or exposure causing outcome?) or true causal association.

63
Q

What is the Bradford-Hill criteria for?

A

To establish epidemiological evidence of a causal relationship between a presumed cause and an observed effect; to establish whether there is a true causal association.

64
Q

What is an epidemiological health needs assessment?

A

It studies and analyses the patterns, causes and effects of health needs within defined populations

65
Q

What is a comparative health needs assessment?

A

The services in the population under study are compared and contrasted with those provided at a different time, place or to a different population group.

66
Q

What is a corporate health needs assessment?

A

The use of mainly qualitative information to understand the views of stakeholders about current needs and priorities for future provision.

Phase 3A (9 decks)

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