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PHASE 3a PH > Public health > Flashcards

Public health Flashcards

1
Q

Epigenetics

A

how the environment effects genes

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2
Q

Allostasis

A

how our systems have adapted to react rapidly to environmental stressors to maintain homeostasis

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3
Q

Allostatic load

A

Overtaxation of our systems leads to impaired health

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4
Q

Salutogenesis

A

physiological changes from experiences that promote health

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5
Q

Purpose of primary care

A

Manage illness and clinical relationships over time, promote health, shared decision making, preventing illness

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6
Q

Health needs assessment

A

A systematic method for reviewing the health issues facing a population - allocation of resources that reduces health inequalities

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7
Q

What are the 4 types of need

A 
Felt need (individual perceptions), 
Expressed need (seek to overcome variation in normal health), normative need (professional defines intervention for expressed need), 
Comparative need (comparing interventions)
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8
Q

Define primary, secondary and tertiary prevention

A

Primary (preventing disease before it happens),
Secondary (catching disease at early phase),
Tertiary (preventing complications)

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9
Q

Criteria for screening programme

A

Important condition, history of condition known, condition has a latent stage, the screening test is suitable and acceptable, the treatment is effective, agreed population to treat, cost of screening economical

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10
Q

Define sensitivity

A

the proportion of people with the disease who are correctly identified by the screening test

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11
Q

Define specificity

A

the proportion of people without the disease who are correctly excluded by the screening test

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12
Q

Positive predictive value

A

the proportion of people with a positive result who actually have the disease

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13
Q

Negative predictive value

A

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

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14
Q

Define incidence

A

New cases over time

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15
Q

Prevalence

A

existing cases in a point of time

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16
Q

Attributable risk

A

incidence in exposed minus incidence in unexposed

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17
Q

Relative risk

A

incidence in exposed divided by the incidence in unexposed

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18
Q

Number needed to treat

A

the number of patients we need to treat to prevent one bad outcome

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19
Q

What is confounding?

A

When there is another IV acting on the DV

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20
Q

Reverse causality

A

outcome causes the exposure rather than the exposure causing the outcome

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21
Q

Sources of information bias

A

Observer, Participant, Instrument

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22
Q

4 factors of the health belief model

A

1) perceived benefits/perceived barriers 2) perceived threat 3) self-efficacy 4) cues to action

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23
Q

6 stages of change

A

Precontemplation, contemplation, preparation, action, maintenance, relapse

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24
Q

Maslows hierarchy of needs from bottom to top

A

physiological, safety, belonging, esteem, self-actualisation

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25
Q

Biggest cause of homelessness

A

relationship breakdown

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26
Q

What types of error can be made?

A

Skill based errors (action is made that is not intended), Rule based errors (incorrect application of a rule), Knowledge-based errors

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27
Q

What are the different perspective on error?

A

Person approach (individuals fault) System approach (many causal factors, need more safety nets)

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28
Q

What is a never event?

A

Serious, largely preventable patient safety incidents that should not occur if preventative measures are in place

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29
Q

How to reduce harm

A

Simplification and standardisation, checklists, IT, team training, risk management programmes, implementing evidence based findings

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30
Q

Why do things go wrong?

A

System failure, Human factors, Judgement failure, Neglect, Poor performance, Misconduct

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31
Q

Types of learner

A

Theorist (questions ideas likes challenges), Activist (likes experiences), Pragmatist (likes feedback), Reflector (watches others)

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32
Q

Kolb’s learning cycle

A

Experience (activist) -> Reflect (reflector) -> Conclusions (theorist) -> Plan for next time (pragmatist)

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33
Q

Ethnocentrism

A

The tendency to evaluate other groups according to the values and standards of one’s own cultural group with the conviction that ones own cultural group is superior to other groups

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34
Q

4 pillars of ethics

A

autonomy, beneficence, non-maleficence, justice

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35
Q

3 types of resource allocation

A

Eqalitarian - provide all care that is necessary to everyone
Maximising - based solely on consequence
Libertarian - each individual responsible for their own health

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36
Q

What is Jonsens rule of rescue

A

We have an obligation to help others regardless of the expense

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37
Q

Define utilitarianism

A

Best option to maximise happiness for the greatest number of people

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38
Q

Deontology

A

the food of the action themselves rather than the consequences

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39
Q

Virtue Ethics

A

Character based ethics

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40
Q

What is the bolam rule

A

would a group of reasonable doctors do the same?

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41
Q

Wat is the bolitho rule?

A

would that be reasonable for them to do so?

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42
Q

3 domains of public health

A

Health improvement, health protection, improving services

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43
Q

What is the nudge theory?

A

nudge the environment for positive change - fruit near checkouts

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44
Q

What is selection bias?

A

selection of study population

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45
Q

What is information bias?

A

measurement bias, observers expectations influence reporting

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46
Q

What is publication bias?

A

trials with negative results less likely to be published

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47
Q

What is article 8 of the human rights act

A

right to respect for privacy and family life

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48
Q

What is article 3 of the human rights act

A

right to freedom from inhuman degrading treatment

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49
Q

What is article 2 of the human rights act

A

right to life

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50
Q

What is article 14 of the human rights act

A

right to freedom from discrimination

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51
Q

what is article 12 of the human rights act

A

right to marry and found a family

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52
Q

What is included in the newborn screening

A

Sickle cells, congenital hypothyroidism, CF, PKU, MCADD, MSUD

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53
Q

Name 5 features of high risk assessment of a child

A

Pale/mottled/ashen/blue skin, no response to social cues, does not wake, weak/high-pitched/continuous cry, RR>60, grunting, chest undraping, reduced skin turgor, bulging fontanelle

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54
Q

Signs of dehydration

A

prolonged cap refill, abnormal respiratory pattern, abnormal skin turgor, weak pulse, cool extremities

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55
Q

What are the 3 types of emergency contraceptions and the hours within they can be used

A

POP (72 hours), Ulipristal acetate pill (120 hours), ICUD (120 hours)

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56
Q

Name 5 pros and 5 cons to the OCP

A

Pros (reduce endometrial cancer risk, reduce heavy, irregular and painful bleeding, reduce iron deficiency anaemia, reduce pain due to endometriosis, stop acne, reduce chance of ectopic pregnancy) Cons (blood clots, increase LDL, migraines, cervical)

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57
Q

Name a anticholinesterase inhibitor

A

Donepezil, Galatamin, Rivastigmine

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58
Q

Name a NMDA receptor blocker

A

Memantine

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59
Q

What is the mental capacity COP3

A

An expert opinion of a mental capacity assessment for an application to make decisions for them

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60
Q

What is DOLS

A

procedure prescribed in law when it is necessary to deprive someone of their liberty who lacks capacity to keep them safe

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61
Q

What is an IMCA

A

Independent mental capacity advocacy - the right to receive independent support and representation

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62
Q

Name 5 differentials of low mood

A

Dementia, anxiety, depression, OCD, hypothyroidism, MS, adjustment disorder, bit b12 deficiency

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63
Q

Risk factors for depression

A

Isolation, lack of employment, no family support, substance abuse, chronic illness, PD, traumatic event

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64
Q

Risk factors for suicide

A

Previous attempts, plan, history of depression, substance abuse, physical illness

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65
Q

Treatment of TB

A

R- rifampicin, I - isoniazid, P - pyrazinamide, E - ethambutol

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66
Q

How long can a managing authority deprive someone of their liberty in an emergency?

A

7 days for urgent authorisation

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67
Q

What is common law?

A

The framework that govern the emergency management of patients who refuse treatment

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68
Q

what is the health needs made up of?

A

need - ability to benefit from an intervention
demand - what people ask for
supply - what we provide

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69
Q

factors that affect need

A

current research agenda

cultural and ethical determinants

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70
Q

factors that affect demand

A

media
medical influences
social/educational influences

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71
Q

factors that affect supply

A

public and political pressure

historical patterns

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72
Q

what are the 4 types of need

A

felt need - individual perception
expressed need - demand
normative need - professional defines the intervention appropriate for the demand
comparative need - comparison between severity, range of interventions and cost

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73
Q

what is the health needs assessment

A

establish what population needs what service

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74
Q

cycle of health needs assessment

A

plan
implement
evaluate
assess

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75
Q

what is the epidemiological approach to health needs assessment

A

its the biomedical model

looks at the problem and addresses them based on the extent of the issue

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76
Q

advantages of epidemiological health needs assessment

A

addresses a clear problem

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77
Q

disadvantages of the epidemiological approach

A

expensive

data collection and analysis

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78
Q

What is the corporate approach to health needs assessment

A

stakeholders ask what is needed

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79
Q

advantages to corporate approach

A

based upon the wishes and needs of the relevant parties

80
Q

disadvantages to corporate approach

A

demands and needs blur

may fit the agenda of the stakeholder – bias

81
Q

What is the comparative approach to health needs assessment

A

compares the health needs and supplies of one population with that of a similar population

82
Q

advantages to comparative approach

A

can see evidence of success in population

fairly quick and inexpensive

83
Q

disadvantages to comparative approach

A

hard to find similar population

84
Q

What are the 3 evaluation frameworks

A

Donabedian (inputs –> outcomes)
Black (efficacy –> humanity)
Maxwell (efficacy –> acceptability)

85
Q

What is an ecological study

A

carried out at population level rather than individual level

86
Q

what is a cross sectional study

A

measures prevalence

data collected at a single point in time ‘snapshot’

87
Q

what is a case control study (reverse of cohort)

A

identifies those with and without the outcomes and determines the previous exposure to potential risk factors
outcome –>exposure

88
Q

what is a cohort study

A

measures the exposures of interest and follows up participants to measure incidence of the outcome of interest
exposure –> outcome
no exposure –> outcome

89
Q

what is an intervention study

A

participants are actively allocated an intervention by the investigators

90
Q

what is a randomised control trial

A

random allocation to intervention or control

91
Q

what is prevalence

A

the number of existing cases in a defined population at a defined point in time divided by the total number of pepole in the population at that time

92
Q

Types of surveillance

A

passive
sentinel
active
enhanced

93
Q

notifiable diseases

A

S - scarlet fever
T - TB

M - MMR
A - acute meningitis
D - diphtheria
A - acute encephalitis
M - meningococcal septicaemia
M - malaria
W - whooping cough
94
Q

what is incidence

A

number of new cases in a specified time period divided by the population at risk during this time period

95
Q

what is odds

A

number of new cases in a specified time period divided by the number of people who did not become a case in that time period

96
Q

what is risk

A

number of new cases among contact in a specified time period over the total number of contacts of a primary case in that time period

97
Q

what is primary prevention

A

prevent the disease before it ever occurs

education/immunisation

98
Q

what is secondary prevention

A

reduce the impact of the disease by detecting it early

screening

99
Q

what is tertiary prevention

A

improve quality of life/prevent complications

treatment

100
Q

what is the prevention paradox

A

if something brings about a lot of benefit to the population then it provides little benefit to each individual

101
Q

Wilsons and Jungners screening criteria

A 
the condition should be important
the natural history of the disease should be well known
detectable at an early stage
suitable test at early sage
acceptable test
test is repeatable
accepted treatment
facilities available
adequate health provision
agreed policy on who to treat
cost effetive
risks < benefits
102
Q

New born screening all of them

A 
sickle cell
CF congenital hypothyroidism
MSD
MCADD
PKU
GAT1
Isovaleric acidaemia
homocysteine uria
103
Q

what is selection bias with regards to screening

A

people who choose to participate in screening may differ from the general population
those at higher risk may go due to a FH
those at lower risk may go because they are more educated

104
Q

Length time bias with regards to screening

A

screening happens at regular intervals
what if the disease is missed during the interval
shorter aggressive disease is usually missed

105
Q

lead time bias with regards to screening

A

difference between knowing about the disease and making a difference

106
Q

what is sensitivity

A

correctly identified by the screening test a/a+c

107
Q

what is specificity

A

correctly excluded by the screening test d/b+d

108
Q

what is positive predictive value

A

proportion of people with a positive test who have the disease a/a+b

109
Q

what is negative predictive value

A

proportion of people with a negative result who do not have the disease d/c+d

110
Q

types of errors

A 
sloth
fixation
ignorance
communication breakdown
playing the odds
bravado
miss-triage
lack of skill
system errors
111
Q

Why do errors happen

A 
human error
misconduct
judgement failure
neglect
poor performance
112
Q

what is a never event

A

adverse events that should never happen

113
Q

what do the components of the swiss cheese model represent

A

cheese slices - barriers to error propagation

holes - failures in the barriers

114
Q

negligence has occurred if..

A

there was a duty of care
that was breeched
and a patient came to harm
and that harm was due to the breech in the duty of care

115
Q

What is bolams test

A

would another doctor do the same

116
Q

what is bolithos test

A

would it be reasonable for them to do so

117
Q

stages of change

A

transtheoretical
health belief
theory of planned behaviour

118
Q

what is the inverse care law

A

those with the greatest need for health care access healthcare the least
due to: no transport, lack of understanding, missed days of work, no childcare

119
Q

Bradfords causation

A 
B - biologically plausible
R - reverse causality
A - association 
D - definite
F - faithful (do our results match others)
O - obscure (any confounders)
R - reversible
D - dose-response
120
Q

Relative risk

A

the risk of getting the disease taking the drug relative to the risk of getting the disease not taking the drug
drugAR/placeboAR

121
Q

Absolute risk

A

the number of cases who got the disease divided by the population

122
Q

NNT

A

100/(drugAR - placeboAR)

123
Q

Absolute risk reduction

A

people with disease in control group - proportion of disease in exposed group

124
Q

Attributable risk

A

proportion of disease in exposed group - proportion of disease in unexposed group

125
Q

5 stages of grief

A 
denial
anger
bargaining
sadness
acceptance
126
Q

4 essentials to grieving

A

accept the reality of loss
experience grief
adjust to life without the person
withdraw emotional energy

127
Q

What is horizontal equity

A

equal treatment for equal need

128
Q

What is vertical equity

A

unequal treatment for unequal need

129
Q

how many grams of alcohol in 1 unit

A

8g

130
Q

3 domains of public health

A

health improvement
health protection
improving services

131
Q

in the AUDIT alcohol screening questionnaire what score is counted as hazardous and what is counted as dependence

A

> 8 hazardous
13 (women) dependence
15 (men) dependence

132
Q

Signs of alcohol dependence syndrome

A 
> 12 months 
tolerance
physiological withdrawal
difficulty controlling quantity
neglect of social life
133
Q

Wernickes triad

A

1) mental confusion
2) opthalmoplegia
3) ataxia

134
Q

What drug reverses opiate overdose

A

naloxone

135
Q

what drugs are used for alcohol detoxification

A

lofexidine, buprenorphine

136
Q

What drugs are used for maintenance in alcohol dependence

A

methadone

137
Q

What drug is used for relapse prevention in alcoholics

A

naltrexone

138
Q

What is the theory of planned behaviour

A

involves attitude, subjective norm, perceived behavioural control and behavioural intention

139
Q

What does the transtheoretical model involve

A 
precontemplation
contemplation
preparation
action
maintenance
140
Q

what is the nudge theory

A

modifying the environment to make the best option easiest

141
Q

Maxwells 6 dimensions of quality

A 
effectiveness
efficiency
equity
accessibility
acceptability
appropriateness
142
Q

What is the centor criteria

A

fever
tonsillar exudates
absent cough
lymphadenopathy

143
Q

What is the main cause of homelessness

A

relationship breakdown

144
Q

What is passive surveillance?

A

routine reporting
eg notifiable diseases
adv - low cost
disadv - under reporting

145
Q

What is active surveillance?

A

health data actively sort out

eg outbreaks, health surveys

146
Q

What is sentinel surveillance?

A

selective institutions survey data eg GP
look at trends at their practice
disadv - not good for uncommon disease

147
Q

What is enhanced surveillance?

A

active surveillance in a particular area

148
Q

What is length time bias

A

missing the disease as screening is at regular intervals

disease may be more aggressive or short lived

149
Q

what is lead time bias

A

the time between knowing about the disease and making a dfiference

150
Q

Reasons for association (why the results may be what they are)

A 
Bias
Confounding
Chance
Reverse causality
True association
151
Q

Methods of prevention

A 
vaccines
education
prophylaxis
contact tracing
surveillance
treatment
152
Q

Define endemic

A

persistent level of disease occurence

153
Q

Define hyper-endemic

A

persistently high levels of disease occurence

154
Q

Define sporadic

A

irregular pattern of occurence

155
Q

Define epidemic

A

occurrence within an area in excess of expected for given time

156
Q

Define pandemic

A

epidemic widespread over several countries

157
Q

Define passive surveillance

A

notifiable disease reporting

158
Q

Define sentinel surveillance

A

GP survey their info from patients

159
Q

Define active surveillance

A

surveys
positive and negative reporting
good for rarer stuff

160
Q

Define enhanced surveillance

A

form of active surveillance but in one area - checking out the effect of a new vaccine

161
Q

WHat are the strengths of a RCT

A

minimise bias and confounders
multiple outcomes can be studied
incidence can be measured
look at causal relationships

162
Q

What are the weaknesses of a RCT

A 
expensive
big study teams needed
ethical concerns
complex to manage
large drop outs 
conflicting evidence
163
Q

What is the Bradford-Hill Criteria

A

look at how good the findings are
A - analogy - effect of similar factors
C - consistency - are findings reproducible
C - coherence - are the coherent with existing findings
E - experimental evidence
S - strength - effect size
S - specificity - more specific an association the stronger the relationship

164
Q

what is a p value

A

the probability of an event occurring given that the null hypothesis is true

165
Q

what is type 1 error

A

accidentally reject the null

false positive

166
Q

what is type 2 error

A

accidentally accepting the null

false negative

167
Q

what is bradshaws taxonomy need

A

felt need - individual perception
expressed need - demand
normative need - professional defines need
comparative need - comparison of needs

168
Q

needs led planning cycle

A

needs assessment
planning
implementation
evaluation

169
Q

what is wanted and needed by not supplied

A

cure for cnacer

170
Q

what is needed and supplied by not demanded

A

smoking cessation

171
Q

what is wanted and supplied but not needed

A

antibiotics

172
Q

what is needed, wanted and supplied

A

free contraception

173
Q

advantage of epidemiological assessment

A

addresses clear problem

174
Q

disadvantage of epidemological

A

can be expensive

175
Q

advantage of corporate apprach

A

recognises people important in the services success

176
Q

disadvantage of the corporate approach

A

bias

177
Q

advantage of comparative approach

A

see benefit in the population

quick and inexpensive

178
Q

disadvantage of comparative approach

A

hard to find a similar population

179
Q

what is the donabedian evaluation framework

A

eg evaluating a programe

inputs
process
outputs
outcomes

180
Q

what is the black evaluation framework

A

eg priority setting

efficacy
efficency
equity
humanity

181
Q

what is the maxwell evaluation framework

A

eg screening programme

efficacy
efficiency
equity
access
acceptability
182
Q

maslows hierarchy of need

A 
physiological needs
safety needs
belongingness and love needs
esteem needs
self-actualisation
183
Q

Services for drug users

A

S-sexual health screening
EX - needle exchange
C - contraception

S - signposting
H - health check
I - immunisations
T - treatment

184
Q

what drug detoxification drug is associated with rapid withdrawal symptoms

A

lofexidine

full agonist so associated with rapid and severe withdrawal symptoms

185
Q

opiate withdrawal symptoms

A 
low energy
irritability
anxiety
insomnia
aches and pains
abdominal cramping
186
Q

transtheoretical model

A 
stages of change
precontemplation
contemplation
preparation
action
maintenance
relapse
187
Q

health belief model

A

perceived benefits vs perceived barriers
perceived threat
self-efficacy
cues to action

188
Q

theory of planned behaviour

A

(attitute) behavioural beliefs - what do i think will happen
(subjective norm) normative beliefs - what do others think
(perceived behavioural control) control beliefs - do i think i can realistically do it

189
Q

What is DoLS

A

procedure prescribed in law when it is necessary to deprive of their liberty a resident or patient who lacks capacity to consent to their care and treatment in order to keep them safe from harm.

190
Q

5 principled of MCA

A

1) presume capacity 2) support decisions
3) unwise decision does not mean they lack capacity
4) if no capacity act in best interests
5) least restrictive intervention

191
Q

what is the acid test of DoLS

A
  • does the person lack capacity to consent to the arrangements
  • is the person subject to continuous supervision
  • is the person free to leave
192
Q

what are the 3 types of resource allocation

A

Egalitatianism - care accessible to everyone
Maximising - based on consequence (the ones that are most in need)
Libertarianism - each individual responsible for their own health

193
Q

Define deontology

A

looks at the good of the action itself rather than the consequences

194
Q

Virtue ethics

A

Looks at the moral character of the person rather than the action

195
Q

Name 5 types of error

A 
Sloth
Fixation
Communication breakdown
Poor team work
Playing the odds
Ignorance
Mis-triage
Lack of skill
System error

PHASE 3a PH (1 decks)

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