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
2
Q
3 responses to health inequalities
A
the black report 1980
the acheson report 1998
proportionate universalism
3
Q
3 theories of causation
A
psychosocial factors
neo-material factors
life-course factors
4
Q
4 domains of public health
A
health protection
improving services
health improvement
addressing wider determinants
5
Q
what is meta-ethics
A
exploring fundamental questions of what is right and wrong
6
Q
what is applied ethics
A
ethical investigation in specific areas e.g. medical/environmental
7
Q
a deductive ethical argument suggests
A
there is 1 general ethical theory for all medical problems
8
Q
an inductive ethical argument suggests
A
settled cases of the past offer a guide/theory for medical practice
9
Q
structural determinants of illness (5)
A
social class poverty unemployment discrimination gender
10
Q
negative of biomedical model
A
neglects social and psychological dimensions of disease
11
Q
only disclose patient info if
A
required by law
patient has consented
for public interest
12
Q
3 main notifiable diseases
A
yellow fever
cholera
plague
13
Q
health behaviour definition
A
aimed to prevent disease
14
Q
illness behaviour definition
A
aimed to seek remedy
15
Q
sick role definition
A
aimed at getting well
16
Q
5 lifestyle factors promoting mortality
A
smoking obesity sedentary lifestyle excess alcohol poor diet
17
Q
4 principles of the health belief model
A
individuals must believe:
- they are susceptible
- it has serious consequences
- taking action reduces risk
- benefits of action outweigh costs
18
Q
transtheoretical model
A
- pre-contemplation
- contemplation
- preparation
- action
- maintenance
- relapse
19
Q
morality definition
A
concerned with good/evil right/wrong
20
Q
ethics defintion
A
system of moral principles defines what is good for individual/society
21
Q
what is utilitarianism/consequentialism
A
act evaluated solely on consequence
greatest good for greatest number
22
Q
criticisms of utilitarianism
A
could cause harm to some
cant predict all consequences of actions
wrong actions can lead to right consequences
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
24
Q
criticisms of kantianism
A
not everybody has the same judgement of good and bad actions
25
what is virtue ethics
focus on the kind of person who is performing the act
good character or not?
we become virtuous by practicing virtuous actions
26
criticisms of virtue ethics
no clear decision model
| cannot determine good actions only good character traits
27
what are the 4 principles of medicine
autonomy
benevolence
non-maleficence
justice
28
what does the mini mental state examination (MMSE) test
1. orientation and immediate memory
2. short term memory
3. language functioning
29
define acute illness
disease of short duration that starts quickly and has severe symptoms (often can be cured)
30
define chronic illness
persistent or recurring condition, may or may not be severe, start gradually with slow changes (no cure but can be treated)
31
define polypharmacy
use of multiple medications/administration of more medication than are clinically indicated
32
what are the key challenges of an ageing population
1. strains on pension/social security
2. increase demand for healthcare
3. bigger need for trained workforce
4. increase demand for longterm care
33
what are the causes of an ageing population
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
34
key facts about ageing population in UK
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%
35
what is intrinsic ageing
natural/universal/inevitable
36
what is extrinsic ageing
dependent on external factors = UV/smoking/air pollution
37
visual decline in ageing
need 3x more light
depth/colour perception
narrowing of visual field
38
hearing decline in ageing
lose high frequency sound
| lose speech comprehension 20%
39
taste and smell decline in ageing
50% loss of taste buds
40
gender bias in ageing
more old women than men
20% biological = premenopausal protected from heart disease by hormones
80% environmental = men more lifestyle risks
41
consequences of higher life expectancy
1. lose pensions earlier than expected
2. chronic conditions
3. rising inequalities for less affluent people
42
3 most common types of dementia
alzheimers
vascular
mixed
43
alternatives to hospital admission for older people
1. supporting discharge
2. providing alternatives for acute care in the community
3. supporting chronic disease management in the community
44
what percentage of people die in hospital
60%
45
what does the medicalisation of death mean
prolonging life at any cost - pharmaceutical/biomedical
46
4 awareness contexts for dying
1. closed awareness
2. suspicion awareness
3. mutual pretence
4. open awareness
47
what is social death
people die in social and interpersonal terms before their actual biological death - lonely/impersonal
48
what is a good death
palliative care as a specialty
49
what is death in a hospice way
open awareness
multi-disciplinary
emotion/relationships
holistic
50
a doctor as a dying person
the other side (novel)
| hashtag hello my name is
51
what is the chain of infection
```
susceptible host
causative micro-organism
reservoir
portal of entry/exit
mode of transmission
```
52
what makes a susceptible host
low immunity
low white cell count
imbalance in normal flora
invasive procedures
53
what is a reservoir
patients/visitors/stuff - where the spread originates
54
2 modes of transmission
```
exogenous = direct/indirect contact, vector, airborne
endogenous = self spread
```
55
why wash your hands
remove transient hand flora
| reduce number of resident flora
56
when do you wash your hands
before and after anything in hospital
57
types of handwashing
type 1 = routine
2 = hygienic hand antisepsis
3 = surgical scrub
58
alcohol handgel effectiveness
destroys most transient organisms (MRSA) but not norovirus/Clostridium difficile
59
antimicrobial liquid soap effectiveness
removes all transient organisms
60
what are the standard infection control precautions
gloves/apron/hand hygiene
correct sharps manipulation
correct clinical waste/linen handling
61
physiological effects of nicotine
activation of nicotinic ACh receptors in brain
cause of dopamine release
stimulant, tolerance, withdrawal
62
impact of smoking
greatest single cause of illness/premature death in UK
cancers/COPD
great economic impact
63
how many deaths per year due to smoking
100,000
64
name some health problems connected to smoking
```
CVS problems
other cancers
stomach ulcers
impotence
diabetes
oral health
cataracts
```
65
what happened in 1908
children act = banning sale of tobacco to under 16s
66
what happened in 1950
Doll and Hill = smoking a and lung carcinoma study
67
what happened in 1965
parliament band cigarette advertising
68
what happened in 2007
smoking in public banned + legal minimum age becomes 18
69
what happened in 2015
smoking with children in the car banned
70
forms of smoking cessation therapy
nicotine replacement therapy = patches/gum
non-nicotine pharmacotherapy = varenicline/buproprion
transtheoretical model = change in behaviour
71
patient approach to smoking = 3As
ASK about smoking
ADVISE on cessation methods
ASSIST refer to local NHS stop smoking service
72
4 main issues in global health
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
millennium development goals (8)
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
what are the 3 leading causes of death in children in the developing world
1. pneumonia
2. diarrhoea
3. malaria
75
UN agencies examples
UNICEF/UNAIDS/WHO
76
global health foundations examples
rockefeller foundation
| bill/melinda gates foundation
77
example of NGOs
MSF/save the children
78
multilateral development banks examples
world bank
asian development bank
inter-american development bank
79
bilateral agencies for global health examples
USAID/CIDA/DFID
80
key global environmental changes
```
CFCs/stratosphere ozone depletion
loss of biodiversity
freshwater decline/land degradation
loss of natural fisheries
increasing desertification
```
81
6 key global health issues
1. common health problems
2. cross border health issues
3. international migration
4. international political crises
5. international agreements
6. global environmental change
82
examples of migrants
asylum seekers/refugees/trafficked
migrant workers/family workers
family joiners/international students
83
defining a migrant
country of birth
country of nationality
duration of stay
84
examples of asylum seeker countries
pakistan, iran, sri lanks, syria
85
examples of economic migrants
```
romania
poland
spain
italy
bulgaria
```
86
reasons that people migrate
persecution/war/politcal unrest
exploitation/torture/rape
burden of disease/socio-economic status
87
what is lampedusa
italian island = primary transit point for immigrants from africa = deadliest migrant route in world = Jan-Apr 2015 1600 on route
88
NHS goals (4)
1. equity of access
2. reducing gap in health inequalities
3. providing services for the vulnerable
4. ensuring services = appropriate/accessible
89
sustainability definition
being able to meet the needs of today without compromising the ability of the future generations to meet the needs of tomorrow
90
how many years-worth of carbon locked away in burning fossil fuels over last 150 years
350million
91
what is the bradford-hill criteria
group of minimal conditions necessary to provide adequate evidence of a causal relationship
92
what is the criteria for causation
```
strength
consistency
specificity
temporality
biological gradient
coherence
analogy
```
93
possible consequences for climate change
heatwaves
rising sea levels
new diseases
scarcity of resources = migration = war
94
solutions to climate change
control world population
reduce energy consumption
renewable energy
95
definition of screening
process which sorts out apparently well people who probably have a disease from those who probably do not
96
what is primary prevention
prevent a disease from occuring
97
what is secondary prevention
detection of early disease in order to alter the course of the disease and maximise chance of recovery
98
what is tertiary prevention
trying to slow down progression of a disease
99
what is sensitivity
the proportion of people with the disease who are correctly identified by the screening test
100
what is specificity
proportion of people without the disease who are correctly excluded by the screening test
101
what is the positive predictive value PPV
proportion of people with a positive test result who actually have the disease
102
what is the negative predictive value NPV
proportion of people with a negative test result who do not have the disease
103
what is the prevalence
proportion of population to have the disease
104
what is the incidence
number of new cases within a specified time period divided by size of population initially at risk
105
what are the Wilson and Jungner criteria for conditions of screening (3)
1. should be serious health problem
2. aetiology should be well understood
3. should be a detectable early stage
106
what are the Wilson and Jungner criteria for treatment of screening (3)
1. accepted treatment should exist
2. facilities for diagnosis/treatment should be available
3. cant be unmanageable clinical workload
107
what are the Wilson and Jungner criteria for the test for screening (3)
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
what are the Wilson and Jungner criteria for the benefits of screening (2)
1. should be agreed policy on whom to treat
| 2. cost should be balanced against benefits
109
what is selection bias
people who choose to participate in screening may be different to those who do not
110
what is lead time bias
screening only identifies disease earlier = impression that survival time increases but actually stays same
111
what is length-time bias
diseases with longer periods of presentation more likely to be detected by screening than those with short presentation times
112
what is an error
any preventable event that may cause or lead to patient harm
113
what are the 2 possible outcomes of a medical error
1. adverse event = harm
| 2. near miss = potential for harm but does not develop further
114
name the 3 types of human error
1. error of omission
2. error of commission
3. error of negligence
115
what is an error of negligence
actions or omissions do not meet standard of ordinary skilled person
116
what is a skill based error
performing routine task that is well learnt but little attention given = slip ups
117
what is a rule/knowledge based error
incorrect plan of action is chosen because of lack of experience - more mistakes when more complex
118
what is a violation and what are the 3 types
deliberate deviation from practice/procedures/standards/rules
1. routine = cutting corners
2. necessary = get job done/unavoidable
3. optimising = personal gain
119
name the 2 approaches to managing errors
1. individual = can blame 1 person
| 2. system = mistakes are product of bad organisation set up, whole system to blame
120
3 benefits of teamworking
1. improve service delivery
2. improve decision making
3. reduce error
121
what is the SBAR checklist when reporting a case
```
S = situation
B = background
A = assessment
R = recommendation
```
122
mental health WHO definition
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
name some common mental health problems
```
depression
anxiety
panic disorders
phobias
OCD
PTSD
```
124
how many people worldwide have depression at any one time
350 million
125
how many people worldwide committed suicide in 2012
1 million
126
what proportion of doctors have a mental disorder
1/3rd
127
why are CMHPs dangerous - 4 reasons
1. negative impact on quality of life
2. increase risk physical illness
3. increase mortality from physical illness
4. depression = suicide risk factor
128
name 4 types of interventions for mental health problems
1. community level
2. service organisation level
3. individual level
4. improving access to psychological therapies - high intensity/low intensity care
129
psychological definition of stress
occurs when demands made on individual greater than ability to cope
130
2 types of stress and what are they
1. distress = negative, damaging
| 2. eustress = positive, beneficial
131
what are the 2 types of causes of stress + examples
acute - noise/danger/infections
| chronic - health/home/family
132
name some internal and external stressors
```
internal = physiological or . psychological - attitudes/beliefs
external = environment/work
```
133
describe the body responses to stress
```
lungs = more oxygen
blood flow = up to 400% increase
skeletal muscles = tense
mouth = dry
immune system = wbcs redistributed
```
134
name the 3 steps of the general adaptation syndrome of stress
1. alarm
2. adaptation/resistance
3. exhaustion
135
what are the 5 signs/types of stress
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
what is the stress-ilness model
individuals susceptibility to disease/illness is increased because individual exposed to stressors = strain = psychological/physiological changes
137
what is the ptsd diagnostic criteria
person experienced event involving actual or threat of death or serious injury AND persons response involved intense fear/helplessness/horror
138
what are the symptoms of ptsd
event persistently reexperienced in dreams etc
persistant avoidance of event related stimuli
persistent symptoms of increased arousal - insomnia/irritability etc
139
what are some physical illnesses related to stress
```
stroke
heart attacks
cancer
chronic fatigue
infertility/miscarriage
peptic ulcers
```
140
what is the reactive purpose of NHS press releases
defending reputation
141
what is the proactive purpose of NHS press releases
1. social marketing - 5 a day
| 2. early recognition/symptom awareness - FAST
142
what is the social gradient of obesity
18% professionals/managers are obese
| 28% of unskilled/manual workers are obese
143
what is the definition of obesity (WHO)
abnormal/excessive fat accumulation resulting from chronic imbalance between energy intake and energy expenditure = presents a risk to health
144
what BMI is classed as overweight and obese
```
25-29.9 = overweight
30+ = obese to different classes
```
145
what are the 7 key domains of energy balance
1. food environment
2. food consumption
3. individual activity
4. activity of environment
5. societal influences
6. individual psychology
7. individual biology
146
what is the cause of obesity
interaction between biology and behaviour = multi-faceted
147
what are some genetic diseases that lead to obesity
prader-willi syndrome
| mutations of leptin/melanocortin receptors
148
what apects of employments lead to obesity
shift work, lack of sleep, upset circadian rhythm, reduced phys activity, cortisol/leptin/ghrelin
149
what developmental factors are linked to obesity
rapid infant weight gain = increase
breast feeding = protective
early intro to solid foods = increases
childhood obesity
150
what are the direct and indirect controls of meal size
```
direct = related to direct contact of food with GI mucosal receptors
indirect = metabolic/endocrine/cognitive = can override direct
```
151
what is satiation
what brings an episode of eating to an end
152
what is satiety
inter-meal period
153
what is the satiety cascade
sensory to cognitive to post-ingestive to post absorptive
154
what macronutrient has the greatest satiating efficiency
protein then carbs then fat then alcohol
155
what macronutrient is used by the body first
alcohol then protein then carbs then fat
156
how to reduce energy density of food
incorporate water/air
fruits/veg
reduce fat
method of cooking
157
what factors of food environments lead to overeating
greater variety
greater portion size
distractions
158
psychological factors that lead to overeating
dietary restrain
stress
sleep - low = overeating
reward sensitivity
159
what are the 4 main STIs
1. chlamydia
2. gonorrhoea
3. syphilis
4. trichomoniasis
160
what is complementary and alternative medicine
broad domain of healing resources that encompass all health systems/modalities and practices and accompanying theories/beliefs
161
name some types of CAM
```
acupuncture
osteopathy
herbal medicine
chiropractic
homeopathy
```
162
what is the house of lords report classification for CAM
group 1 = some scientific evidence
group 2 = modalities work in a supportive capacity alongside medicine
group 3 = traditional, no science
163
who uses CAM
35-60 mostly women chronic illnesses higher income/higher education
164
why do people use CAM
gaps in treatment for common problems
concern of side effects
gullibility/naivety
disease is not life threatening
165
what is the basic economic problem
finite resources
desire for goods/services is infinite
choices have to be made
166
what is the opportunity cost
= sacrifice in terms of benefits forgone from not allocating resources to best activity
167
what is economic evaluation
method used to asses whether benefit is maximised = costa and effect differences
168
name 3 types of economic evaluation
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
what is equity
fairness or justice of distribution of costs/benefits
| equality = outcome of equity
170
absolute risk
risk of developing a condition over a period of itime
171
relative risk
risk in the exposed group divided by risk in the unexposed group
172
attributable risk and calculation
rate of disease int he exposed group that may be attributed to the exposure
risk in exposed - risk in unexposed
173
how many grams in 1 unit of alcohol
8g
