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Phase 1 mine > Public Health > Flashcards

Public Health Flashcards

1
Q

what is the main determinant of population health

A

extent of income division
measured with the Gini coefficient
lower coefficient = more equality

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2
Q

3 responses to health inequalities

A

the black report 1980
the acheson report 1998
proportionate universalism

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3
Q

3 theories of causation

A

psychosocial factors
neo-material factors
life-course factors

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4
Q

4 domains of public health

A

health protection
improving services
health improvement
addressing wider determinants

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5
Q

what is meta-ethics

A

exploring fundamental questions of what is right and wrong

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6
Q

what is applied ethics

A

ethical investigation in specific areas e.g. medical/environmental

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7
Q

a deductive ethical argument suggests

A

there is 1 general ethical theory for all medical problems

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8
Q

an inductive ethical argument suggests

A

settled cases of the past offer a guide/theory for medical practice

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9
Q

structural determinants of illness (5)

A 
social class
poverty
unemployment
discrimination
gender
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10
Q

negative of biomedical model

A

neglects social and psychological dimensions of disease

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11
Q

only disclose patient info if

A

required by law
patient has consented
for public interest

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12
Q

3 main notifiable diseases

A

yellow fever
cholera
plague

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13
Q

health behaviour definition

A

aimed to prevent disease

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14
Q

illness behaviour definition

A

aimed to seek remedy

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15
Q

sick role definition

A

aimed at getting well

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16
Q

5 lifestyle factors promoting mortality

A 
smoking
obesity
sedentary lifestyle
excess alcohol 
poor diet
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17
Q

4 principles of the health belief model

A

individuals must believe:

  1. they are susceptible
  2. it has serious consequences
  3. taking action reduces risk
  4. benefits of action outweigh costs
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18
Q

transtheoretical model

A
  1. pre-contemplation
  2. contemplation
  3. preparation
  4. action
  5. maintenance
  6. relapse
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19
Q

morality definition

A

concerned with good/evil right/wrong

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20
Q

ethics defintion

A

system of moral principles defines what is good for individual/society

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21
Q

what is utilitarianism/consequentialism

A

act evaluated solely on consequence

greatest good for greatest number

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22
Q

criticisms of utilitarianism

A

could cause harm to some
cant predict all consequences of actions
wrong actions can lead to right consequences

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23
Q

what is kantianism

A

features of the act determine goodness of that act
involves being motivated by duty
prescribes to categorical imperatives e.g. do not kill

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24
Q

criticisms of kantianism

A

not everybody has the same judgement of good and bad actions

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25
Q

what is virtue ethics

A

focus on the kind of person who is performing the act
good character or not?
we become virtuous by practicing virtuous actions

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26
Q

criticisms of virtue ethics

A

no clear decision model

cannot determine good actions only good character traits

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27
Q

what are the 4 principles of medicine

A

autonomy
benevolence
non-maleficence
justice

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28
Q

what does the mini mental state examination (MMSE) test

A
  1. orientation and immediate memory
  2. short term memory
  3. language functioning
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29
Q

define acute illness

A

disease of short duration that starts quickly and has severe symptoms (often can be cured)

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30
Q

define chronic illness

A

persistent or recurring condition, may or may not be severe, start gradually with slow changes (no cure but can be treated)

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31
Q

define polypharmacy

A

use of multiple medications/administration of more medication than are clinically indicated

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32
Q

what are the key challenges of an ageing population

A
  1. strains on pension/social security
  2. increase demand for healthcare
  3. bigger need for trained workforce
  4. increase demand for longterm care
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33
Q

what are the causes of an ageing population

A
  1. improvements in living conditions/nutrition/medicine
  2. life expectancy rising
  3. falls in fertility = higher age of birth
  4. decline in premature mortality
  5. more people reaching older/imbalance with children being born
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34
Q

key facts about ageing population in UK

A
  1. same number of over 65s than under 15s
  2. by 2025 more people 65+ than under 20
  3. by 2025 proportion of 85+ will increase by 60%
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35
Q

what is intrinsic ageing

A

natural/universal/inevitable

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36
Q

what is extrinsic ageing

A

dependent on external factors = UV/smoking/air pollution

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37
Q

visual decline in ageing

A

need 3x more light
depth/colour perception
narrowing of visual field

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38
Q

hearing decline in ageing

A

lose high frequency sound

lose speech comprehension 20%

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39
Q

taste and smell decline in ageing

A

50% loss of taste buds

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40
Q

gender bias in ageing

A

more old women than men
20% biological = premenopausal protected from heart disease by hormones
80% environmental = men more lifestyle risks

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41
Q

consequences of higher life expectancy

A
  1. lose pensions earlier than expected
  2. chronic conditions
  3. rising inequalities for less affluent people
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42
Q

3 most common types of dementia

A

alzheimers
vascular
mixed

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43
Q

alternatives to hospital admission for older people

A
  1. supporting discharge
  2. providing alternatives for acute care in the community
  3. supporting chronic disease management in the community
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44
Q

what percentage of people die in hospital

A

60%

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45
Q

what does the medicalisation of death mean

A

prolonging life at any cost - pharmaceutical/biomedical

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46
Q

4 awareness contexts for dying

A
  1. closed awareness
  2. suspicion awareness
  3. mutual pretence
  4. open awareness
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47
Q

what is social death

A

people die in social and interpersonal terms before their actual biological death - lonely/impersonal

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48
Q

what is a good death

A

palliative care as a specialty

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49
Q

what is death in a hospice way

A

open awareness
multi-disciplinary
emotion/relationships
holistic

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50
Q

a doctor as a dying person

A

the other side (novel)

hashtag hello my name is

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51
Q

what is the chain of infection

A 
susceptible host
causative micro-organism
reservoir
portal of entry/exit
mode of transmission
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52
Q

what makes a susceptible host

A

low immunity
low white cell count
imbalance in normal flora
invasive procedures

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53
Q

what is a reservoir

A

patients/visitors/stuff - where the spread originates

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54
Q

2 modes of transmission

A 
exogenous = direct/indirect contact, vector, airborne
endogenous = self spread
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55
Q

why wash your hands

A

remove transient hand flora

reduce number of resident flora

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56
Q

when do you wash your hands

A

before and after anything in hospital

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57
Q

types of handwashing

A

type 1 = routine
2 = hygienic hand antisepsis
3 = surgical scrub

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58
Q

alcohol handgel effectiveness

A

destroys most transient organisms (MRSA) but not norovirus/Clostridium difficile

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59
Q

antimicrobial liquid soap effectiveness

A

removes all transient organisms

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60
Q

what are the standard infection control precautions

A

gloves/apron/hand hygiene
correct sharps manipulation
correct clinical waste/linen handling

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61
Q

physiological effects of nicotine

A

activation of nicotinic ACh receptors in brain
cause of dopamine release
stimulant, tolerance, withdrawal

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62
Q

impact of smoking

A

greatest single cause of illness/premature death in UK
cancers/COPD
great economic impact

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63
Q

how many deaths per year due to smoking

A

100,000

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64
Q

name some health problems connected to smoking

A 
CVS problems
other cancers
stomach ulcers
impotence
diabetes 
oral health
cataracts
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65
Q

what happened in 1908

A

children act = banning sale of tobacco to under 16s

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66
Q

what happened in 1950

A

Doll and Hill = smoking a and lung carcinoma study

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67
Q

what happened in 1965

A

parliament band cigarette advertising

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68
Q

what happened in 2007

A

smoking in public banned + legal minimum age becomes 18

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69
Q

what happened in 2015

A

smoking with children in the car banned

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70
Q

forms of smoking cessation therapy

A

nicotine replacement therapy = patches/gum
non-nicotine pharmacotherapy = varenicline/buproprion
transtheoretical model = change in behaviour

71
Q

patient approach to smoking = 3As

A

ASK about smoking
ADVISE on cessation methods
ASSIST refer to local NHS stop smoking service

72
Q

4 main issues in global health

A
  1. great population growth
  2. low fertility in developed countries
  3. digital divide = difference in info access
  4. healthcare worker migration to richer countries
73
Q

millennium development goals (8)

A
  1. eradicate extreme poverty/hunger
  2. universal primary education
  3. promote gender equality/empower women
  4. reduce child mortality
  5. improve maternal health
  6. combat HIV/AIDS/malaria/other diseases
  7. environmental sustainability
  8. global partnership for development
74
Q

what are the 3 leading causes of death in children in the developing world

A
  1. pneumonia
  2. diarrhoea
  3. malaria
75
Q

UN agencies examples

A

UNICEF/UNAIDS/WHO

76
Q

global health foundations examples

A

rockefeller foundation

bill/melinda gates foundation

77
Q

example of NGOs

A

MSF/save the children

78
Q

multilateral development banks examples

A

world bank
asian development bank
inter-american development bank

79
Q

bilateral agencies for global health examples

A

USAID/CIDA/DFID

80
Q

key global environmental changes

A 
CFCs/stratosphere ozone depletion
loss of biodiversity
freshwater decline/land degradation
loss of natural fisheries
increasing desertification
81
Q

6 key global health issues

A
  1. common health problems
  2. cross border health issues
  3. international migration
  4. international political crises
  5. international agreements
  6. global environmental change
82
Q

examples of migrants

A

asylum seekers/refugees/trafficked
migrant workers/family workers
family joiners/international students

83
Q

defining a migrant

A

country of birth
country of nationality
duration of stay

84
Q

examples of asylum seeker countries

A

pakistan, iran, sri lanks, syria

85
Q

examples of economic migrants

A 
romania
poland
spain
italy
bulgaria
86
Q

reasons that people migrate

A

persecution/war/politcal unrest
exploitation/torture/rape
burden of disease/socio-economic status

87
Q

what is lampedusa

A

italian island = primary transit point for immigrants from africa = deadliest migrant route in world = Jan-Apr 2015 1600 on route

88
Q

NHS goals (4)

A
  1. equity of access
  2. reducing gap in health inequalities
  3. providing services for the vulnerable
  4. ensuring services = appropriate/accessible
89
Q

sustainability definition

A

being able to meet the needs of today without compromising the ability of the future generations to meet the needs of tomorrow

90
Q

how many years-worth of carbon locked away in burning fossil fuels over last 150 years

A

350million

91
Q

what is the bradford-hill criteria

A

group of minimal conditions necessary to provide adequate evidence of a causal relationship

92
Q

what is the criteria for causation

A 
strength
consistency
specificity
temporality
biological gradient
coherence 
analogy
93
Q

possible consequences for climate change

A

heatwaves
rising sea levels
new diseases
scarcity of resources = migration = war

94
Q

solutions to climate change

A

control world population
reduce energy consumption
renewable energy

95
Q

definition of screening

A

process which sorts out apparently well people who probably have a disease from those who probably do not

96
Q

what is primary prevention

A

prevent a disease from occuring

97
Q

what is secondary prevention

A

detection of early disease in order to alter the course of the disease and maximise chance of recovery

98
Q

what is tertiary prevention

A

trying to slow down progression of a disease

99
Q

what is sensitivity

A

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

100
Q

what is specificity

A

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

101
Q

what is the positive predictive value PPV

A

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

102
Q

what is the negative predictive value NPV

A

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

103
Q

what is the prevalence

A

proportion of population to have the disease

104
Q

what is the incidence

A

number of new cases within a specified time period divided by size of population initially at risk

105
Q

what are the Wilson and Jungner criteria for conditions of screening (3)

A
  1. should be serious health problem
  2. aetiology should be well understood
  3. should be a detectable early stage
106
Q

what are the Wilson and Jungner criteria for treatment of screening (3)

A
  1. accepted treatment should exist
  2. facilities for diagnosis/treatment should be available
  3. cant be unmanageable clinical workload
107
Q

what are the Wilson and Jungner criteria for the test for screening (3)

A
  1. suitable test should be devised for early stage
  2. test should be acceptable for patients
  3. intervals for repeating test should be determined
108
Q

what are the Wilson and Jungner criteria for the benefits of screening (2)

A
  1. should be agreed policy on whom to treat

2. cost should be balanced against benefits

109
Q

what is selection bias

A

people who choose to participate in screening may be different to those who do not

110
Q

what is lead time bias

A

screening only identifies disease earlier = impression that survival time increases but actually stays same

111
Q

what is length-time bias

A

diseases with longer periods of presentation more likely to be detected by screening than those with short presentation times

112
Q

what is an error

A

any preventable event that may cause or lead to patient harm

113
Q

what are the 2 possible outcomes of a medical error

A
  1. adverse event = harm

2. near miss = potential for harm but does not develop further

114
Q

name the 3 types of human error

A
  1. error of omission
  2. error of commission
  3. error of negligence
115
Q

what is an error of negligence

A

actions or omissions do not meet standard of ordinary skilled person

116
Q

what is a skill based error

A

performing routine task that is well learnt but little attention given = slip ups

117
Q

what is a rule/knowledge based error

A

incorrect plan of action is chosen because of lack of experience - more mistakes when more complex

118
Q

what is a violation and what are the 3 types

A

deliberate deviation from practice/procedures/standards/rules

  1. routine = cutting corners
  2. necessary = get job done/unavoidable
  3. optimising = personal gain
119
Q

name the 2 approaches to managing errors

A
  1. individual = can blame 1 person

2. system = mistakes are product of bad organisation set up, whole system to blame

120
Q

3 benefits of teamworking

A
  1. improve service delivery
  2. improve decision making
  3. reduce error
121
Q

what is the SBAR checklist when reporting a case

A 
S = situation
B = background
A = assessment
R = recommendation
122
Q

mental health WHO definition

A

state of well-being in which individual realises his/her own abilities, can cope with normal life stresses, work productively and fruitfully, able to make contribution to community

123
Q

name some common mental health problems

A 
depression
anxiety
panic disorders
phobias
OCD
PTSD
124
Q

how many people worldwide have depression at any one time

A

350 million

125
Q

how many people worldwide committed suicide in 2012

126
Q

what proportion of doctors have a mental disorder

127
Q

why are CMHPs dangerous - 4 reasons

A
  1. negative impact on quality of life
  2. increase risk physical illness
  3. increase mortality from physical illness
  4. depression = suicide risk factor
128
Q

name 4 types of interventions for mental health problems

A
  1. community level
  2. service organisation level
  3. individual level
  4. improving access to psychological therapies - high intensity/low intensity care
129
Q

psychological definition of stress

A

occurs when demands made on individual greater than ability to cope

130
Q

2 types of stress and what are they

A
  1. distress = negative, damaging

2. eustress = positive, beneficial

131
Q

what are the 2 types of causes of stress + examples

A

acute - noise/danger/infections

chronic - health/home/family

132
Q

name some internal and external stressors

A 
internal = physiological or . psychological - attitudes/beliefs
external = environment/work
133
Q

describe the body responses to stress

A 
lungs = more oxygen
blood flow = up to 400% increase
skeletal muscles = tense
mouth = dry
immune system = wbcs redistributed
134
Q

name the 3 steps of the general adaptation syndrome of stress

A
  1. alarm
  2. adaptation/resistance
  3. exhaustion
135
Q

what are the 5 signs/types of stress

A
  1. biochemical - endorphin/cortisol
  2. physiological - shallow breathing/raised bp
  3. behavioural - insomnia/eating habits
  4. cognitive - neg thoughts/memory probs
  5. emotional - mood swings/aggression
136
Q

what is the stress-ilness model

A

individuals susceptibility to disease/illness is increased because individual exposed to stressors = strain = psychological/physiological changes

137
Q

what is the ptsd diagnostic criteria

A

person experienced event involving actual or threat of death or serious injury AND persons response involved intense fear/helplessness/horror

138
Q

what are the symptoms of ptsd

A

event persistently reexperienced in dreams etc
persistant avoidance of event related stimuli
persistent symptoms of increased arousal - insomnia/irritability etc

139
Q

what are some physical illnesses related to stress

A 
stroke
heart attacks
cancer
chronic fatigue
infertility/miscarriage
peptic ulcers
140
Q

what is the reactive purpose of NHS press releases

A

defending reputation

141
Q

what is the proactive purpose of NHS press releases

A
  1. social marketing - 5 a day

2. early recognition/symptom awareness - FAST

142
Q

what is the social gradient of obesity

A

18% professionals/managers are obese

28% of unskilled/manual workers are obese

143
Q

what is the definition of obesity (WHO)

A

abnormal/excessive fat accumulation resulting from chronic imbalance between energy intake and energy expenditure = presents a risk to health

144
Q

what BMI is classed as overweight and obese

A 
25-29.9 = overweight
30+ = obese to different classes
145
Q

what are the 7 key domains of energy balance

A
  1. food environment
  2. food consumption
  3. individual activity
  4. activity of environment
  5. societal influences
  6. individual psychology
  7. individual biology
146
Q

what is the cause of obesity

A

interaction between biology and behaviour = multi-faceted

147
Q

what are some genetic diseases that lead to obesity

A

prader-willi syndrome

mutations of leptin/melanocortin receptors

148
Q

what apects of employments lead to obesity

A

shift work, lack of sleep, upset circadian rhythm, reduced phys activity, cortisol/leptin/ghrelin

149
Q

what developmental factors are linked to obesity

A

rapid infant weight gain = increase
breast feeding = protective
early intro to solid foods = increases
childhood obesity

150
Q

what are the direct and indirect controls of meal size

A 
direct = related to direct contact of food with GI mucosal receptors
indirect = metabolic/endocrine/cognitive = can override direct
151
Q

what is satiation

A

what brings an episode of eating to an end

152
Q

what is satiety

A

inter-meal period

153
Q

what is the satiety cascade

A

sensory to cognitive to post-ingestive to post absorptive

154
Q

what macronutrient has the greatest satiating efficiency

A

protein then carbs then fat then alcohol

155
Q

what macronutrient is used by the body first

A

alcohol then protein then carbs then fat

156
Q

how to reduce energy density of food

A

incorporate water/air
fruits/veg
reduce fat
method of cooking

157
Q

what factors of food environments lead to overeating

A

greater variety
greater portion size
distractions

158
Q

psychological factors that lead to overeating

A

dietary restrain
stress
sleep - low = overeating
reward sensitivity

159
Q

what are the 4 main STIs

A
  1. chlamydia
  2. gonorrhoea
  3. syphilis
  4. trichomoniasis
160
Q

what is complementary and alternative medicine

A

broad domain of healing resources that encompass all health systems/modalities and practices and accompanying theories/beliefs

161
Q

name some types of CAM

A 
acupuncture
osteopathy 
herbal medicine
chiropractic 
homeopathy
162
Q

what is the house of lords report classification for CAM

A

group 1 = some scientific evidence
group 2 = modalities work in a supportive capacity alongside medicine
group 3 = traditional, no science

163
Q

who uses CAM

A

35-60 mostly women chronic illnesses higher income/higher education

164
Q

why do people use CAM

A

gaps in treatment for common problems
concern of side effects
gullibility/naivety
disease is not life threatening

165
Q

what is the basic economic problem

A

finite resources
desire for goods/services is infinite
choices have to be made

166
Q

what is the opportunity cost

A

= sacrifice in terms of benefits forgone from not allocating resources to best activity

167
Q

what is economic evaluation

A

method used to asses whether benefit is maximised = costa and effect differences

168
Q

name 3 types of economic evaluation

A
  1. cost-effectiveness analysis = cost per life year gained
  2. cost-utility analysis = cost per QALY
  3. cost-benefit analysis = monetary units/net monetary benefit
169
Q

what is equity

A

fairness or justice of distribution of costs/benefits

equality = outcome of equity

170
Q

absolute risk

A

risk of developing a condition over a period of itime

171
Q

relative risk

A

risk in the exposed group divided by risk in the unexposed group

172
Q

attributable risk and calculation

A

rate of disease int he exposed group that may be attributed to the exposure
risk in exposed - risk in unexposed

173
Q

how many grams in 1 unit of alcohol

Phase 1 mine (12 decks)

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