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phase 3b > Public Health > Flashcards

Public Health Flashcards

1
Q

What is health?

A

A state of complete physical, mental and social well-being and not merely the absence of disease

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2
Q

3 areas of public health and 1 example of each

A

Health protection - environmental disasters
Health improvement - lifestyle e.g. change for life
Improving services - audit and evaluation

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3
Q

What is primary disease prevention? give 1 example

A

Aims to prevent a disease before it ever happens. Changes peoples exposure to a risk
Immunisation, fluoridation of water

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4
Q

What is secondary disease prevention? give 1 example

A

Aims to detect disease early to alter the course/slow progression
Screening, aspirin after an MI

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5
Q

What is tertiary disease prevention? give 1 example

A

Aims to reduce disability and minimise complications

stroke rehab

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6
Q

What is the prevention paradox?

A

If something brings a lot of benefit to a population it likely provides little benefit to the individual

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7
Q

10 screening criteria

A

Important problem, recognised early stage, natural history known, suitable test, acceptable to population, continuous process, facility to diagnose and treat, agreed policy on who to treat, acceptable treatment, cost effective

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8
Q

What 3 things form the triple assessment for breast cancer screening?

A

Imaging - USS & mammography
Clinical assessment
Biopsy

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9
Q

When does breast cancer screening take place?

A

Every 3 years between the ages of 50 and 70

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10
Q

When does cervical cancer screening take place?

A

ages 25-50 every 3 years

ages 50-64 every 5 years

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11
Q

9 things on the newborn heel prick test

A

MCADD, sickle cell, CF, congenital hypothyroid, maple syrup disease, PKU, Glutamic acidaemia, isovaleric acidaemia, homocysteine uria

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12
Q

What are the 2 ways of monitoring prevalence?

A

Active and passive

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13
Q

Describe the difference between active and passive prevalence monitoring

A

Active - seeking out people with the disease

Passive - data taken from sentinel GP practices

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14
Q

Define sensitivity

A

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

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15
Q

Define specificity

A

The proportion of people who do not have the disease who are correctly excluded by the screening

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16
Q

Define PPV

A

Proportion of people who have a positive screening result who actually have the disease

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17
Q

Define NPV

A

Proportion of people who have a negative screening result who do not have the disease

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18
Q

3 biases associated with screening

A

Selection bias
Length time bias
Lead time bias

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19
Q

Define length time bias

A

Screening is more likely to pick up long lived slow growing tumours than short lived aggressive ones due to the timings

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20
Q

Define lead time bias

A

Overestimation of survival duration due to earlier detection by screening than clinical presentation

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21
Q

What is epidemiology?

A

Study of frequency, distribution and determinants of disease in populations in order to prevent and control disease

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22
Q

Define prevalence

A

Number of existing cases in a defined population at a defined point in time divided by the number of people in a population

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23
Q

Prevalence ratio

A

Prevalence in exposed divided by prevalence in unexposed

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24
Q

5 reasons for association between 2 variables

A

True association, reverse causality, chance, bias, confounding

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25
Q

8 elements of communicable disease control

A

Surveillance, epidemiology, incubation periods, outbreak management , diseases, immunisations, healthcare associated infections and emerging disease

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26
Q

Define communicable disease

A

A disease which can be transferred from one person to another

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27
Q

6 methods of preventing disease transmission

A

Vaccination, education, prophylaxis, contact tracing, monitoring, treatment

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28
Q

What is the chain of infection

A

Reservoir - portal of exit - agent - mode of transmission - portal of entry - host - person to person spread

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29
Q

3 types of transmission and an example for each

A

Direct - STIs
Indirect - malaria
Airborne - TB

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30
Q

Define endemic

A

Persistent level of disease occurrence

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31
Q

Define hyper-endemic

A

Persistently high levels of disease occurence

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32
Q

Define sporadic

A

Irregular pattern of disease occurrence

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33
Q

Define epidemic

A

Occurrence within an area in excess of expected for given time

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34
Q

Define pandemic

A

Epidemic widespread over several countries

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35
Q

Define cluster

A

Aggregation of cases which may or may not be linked

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36
Q

3 reasons for surveillance

A

Establish baseline rate, allow identification of outbreaks, monitor efficacy or immunisation programmes

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37
Q

Define outbreak

A

2 or more cases that are linked or occurrence of a disease in an area that isn’t expected

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38
Q

Define common source outbreak

A

A group of people exposed to a common source of infectious agent

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39
Q

4 methods of surveillance

A

Passive, sentinel, active, enhanced

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40
Q

What is gillick competence?

A

A child under 16 is able to give consent for medical treatment without the need for parental permission and knowledge

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41
Q

5 Fraser guidelines

A

Girl will understand advice, can’t be persuaded to tell parents, likely to carry on having sex anyway, physical/mental health likely to suffer, best interests

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42
Q

Descrive a case control study

A

Population split into cases and controls and looks at exposures in both groups, usually retrospective

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43
Q

Describe a cohort study

A

An observational study where the population split into exposed and unexposed and looks at who gets the disease in both groups - usually prospective

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44
Q

What is an ecological study

A

A study carried out at population rather than individual level

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45
Q

What is a cross sectional study

A

Measures frequency and examines distribution and determinants, can be descriptive or analytical

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46
Q

Pros and cons of a cohort study

A

+ves - best for common outcomes, yields true incidence and relative risks
-ves expensive, requires large numbers, prone to bias in change of methods over time

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47
Q

Pros and cons of a case control study

A

+ves - good for rare outcomes, relatively inexpensive, small numbers and quick to complete
-ves - prone to selection bias, prone to recall bias

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48
Q

Pros and cons of a RCT

A

+ves - minimises bias and confounders, multiple outcomes can be studied, strong evidence of causal relationships can be provided
-ves - expensive, ethical concerns, large drop outs, conflicting evidence from trials occurs

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49
Q

9 Bradford Hill criteria

- criteria to provide evidence of a causal relationship

A 
Temporality
Strength 
Consistency 
Specificity
Biological gradient
Plausibility 
Coherence
Experiment
Analogy
50
Q

Define bias

A

A systematic deviation from the true estimation of association between exposure and outcome

51
Q

2 groups of bias

A

Selection and information

52
Q

Define confounding

A

A factor that is independently associated with the exposure and outcome but does not lie on the causal pathway

53
Q

Define need

A

The ability to benefit from an intervention

54
Q

Define felt need

A

Individual perception of variation from normal health

55
Q

Defined expressed need

A

Individual seeks help to overcome variation in normal health - demand

56
Q

Define normative need

A

Professional defines intervention appropriate for expressed need - supply

57
Q

Define comparative need

A

Comparison between severity, range of interventions and costs

58
Q

What is a health needs assessment

A

A systematic method for reviewing the health issues facing a defined population leading to agreed priorities and resource allocation that will improve health and reduce inequalities

59
Q

What is the planning cycle

A

Needs assessment, planning, implementation, evaluation, REPEAT

60
Q

3 approaches for a health needs assessment

A

Epidemiological, corporate, comparative

61
Q

What is the epidemiological approach for a HNA? +ves and -ves

A

Looks at person place and time, defines the problem and size of problem.
+ves - cheap, quick, info about incidence and prevalence, shows utilisation of services
-ves - variable data quality, doesn’t consider felt need

62
Q

What is the corporate approach for a HNS? +ves and -ves

A

Engages with stakeholders as well as service users.
+ves - felt need, relevant people involved
-ves - difficult to distinguish need from demand, groups may have vested interest, time, influenced by political agendas

63
Q

What is the comparative approach for a HNA? +ves and -ves

A

Compares the needs and supplies of one population with another.
+ves - quick, cheap, existing data
-ves - hard to find similar population, may not yield what the ‘right’ outcome is

64
Q

3 evaluation frameworks

A

Maxwell, Black, Donabedian

65
Q

Outline the Donabedian evaluation framework

A

Structure, process, outcome

66
Q

Outline Maxwells dimensions of quality

A 
Appropriateness
Accessibility
Acceptability
Efficiency
Equity
Effectiveness
67
Q

Maslow hierarchy of need

A

Physiological, safety, belonging, esteem, self actualisation

68
Q

What is health behaviour

A

Aims to prevent illness - eating healthy

69
Q

What is illness behaviour

A

Aims to seek remedy - going to dr

70
Q

What is sick role behaviour

A

Aims to get well, can lead to neglect of one’s usual duties - taking prescribed medications

71
Q

3 models of behaviour change

A

Health belief model, Theory of planned behaviour, stages of change (transtheoretical)

72
Q

Health belief model - what is it, pros and cons

A

Perceived severity, perceived susceptibility, perceived barriers and perceived benefits.
+ves - longest standing model
-ves - doesn’t consider emotions or repeat behaviour

73
Q

Theory of planned behaviour - what is it, pros and cons

A

Proposes the best predictor of behaviour is intent which is determined by attitudes, social norms and perceived behavioural control.
+ves useful for predicting intention
-ves assumes attitude social normal and PBC can be measured

74
Q

Cues to action in the health belief model

A

Media, advice from others, reminders from health services, illness of family

75
Q

Services for drug users

A

Sexual health screening, needle exchange, contraception, signposting, health check, immunisations, treatment

76
Q

5 drug treatment principles

A

Reduce illicit drug use, stabilise lifestyle, reduce crime, improve overall health, reduce harm to user, family and society

77
Q

What is the transtheoretical model of behaviour change, pros and cons

A

Pre-contemplation, contemplation, preparation, action, maintenance, relapse
+ves - account for relapse
-ves - not necessarily discrete stages, doesn’t take into account habits, values and culture

78
Q

8 barriers to accessing healthcare

A

Reluctance of professional to make visits, illiterate, language barriers, moving frequently, mistrust of professionals, cultural beliefs, lack of address, no form of contacting

79
Q

5 migrant health problems

A

mental health, normal illness, infectious diseases, congenital abnormalities not routinely treated, injuries

80
Q

4 questions to assess negligence?

A

was there a duty of care?
was it breached?
was the pt harmed?
was harm due to breach?

81
Q

What is an error?

A

unintended outcome

82
Q

6 causes of error

A 
human factors
system failure
judgment failure
neglect
poor performance
misconduct
83
Q

Bolam and bolitho tests

A

Bolam - would a reasonable doctor do the same

Bolitho - would that be reasonable

84
Q

FRAMES model of motivational interviewing

A

Feedback, responsibility, advice, menu, empathy, self efficacy

85
Q

3 approaches of resource allocation

A

Egalitarian - equal for everyone
Maximising - maximise benefits - who needs it most
Libertarian - everyone responsible for their own health

86
Q

What is a never event?

A

Serious, largely preventable, patient safety incidents that should not occur if the available preventative measures have been implemented

87
Q

5 principles of the MCA?

A

Presumed to have capacity, steps taken to enable decision, unwise decisions allowed, decisions in best interests, least restrictive option

88
Q

2 assumptions of MCA

A

any impairment or disturbance in functioning of mind or brain?
unable to make a decision based on 4 key aspects - understand, weigh up, retain and communicate

89
Q

What is dos? what is the acid test?

A

Provides protection for vulnerable people who lack capacity to consent for their care and treatment
acid test - person under continuous supervision, person is not free to leave, person can’t consent

90
Q

3 reasons to break confidentiality

A

Patient consented, required by law, justified in public interest

91
Q

Define tolerance

A

reduced reaction to a drug following its repeated use

92
Q

Define withdrawal

A

physical problems and emotions experienced i you are dependent on a substance then suddenly stop or drastically reduce dose

93
Q

Define misuse

A

consequences of using substance involve social, psychological or physical harm

94
Q

Define domestic abuse

A

Any incident or pattern of incidents or controlling, coercive, threatening behaviour or violence between those who are, or have been, partners, family members. can encompass but not limited to - sexual, emotional, physical, financial, psychological

95
Q

8 signs of dependence

A

Primacy - tolerance - withdrawal - drug taking to avoid withdrawal - continued use despite negative effects on physical, mental and social health - loss of control - rapid reinstatement - narrowing of repertoire

96
Q

10 types of medical error

A

fixation, sloth, playing the odds, mistriage, bad teamwork, breakdown of communication, bravado, ignorance, lack of skill, system error

97
Q

Define economic efficiency

A

Economic efficiency is achieved when resources are allocated between activities in such a way to maximise benefit

98
Q

What is the equity efficiency trade off?

A

Improving equity often leads to a loss in efficiency

99
Q

What is economic evaluation?

A

The study of efficiency - comparative study of costs and benefits of health interventions

100
Q

What is incremental analysis

A

Everything is relative - compares to previous drug/treatment

101
Q

What is the incremental cost effectiveness ratio? (ICER)

A

difference in costs / difference in benefits

102
Q

4 types of economic evaluation

A

Cost-effectiveness (natural units)
Cost-utility (QALY)
Cost-benefit (monetary)
Cost-minimisation

103
Q

3 ways of measuring health benefit

A

Monetary, natural units, QALYs

104
Q

Define impairment

A

Any loss or abnormality of psychological, physiological or anatomical structure or function

105
Q

Define disability

A

Any restriction or lack (due to impairment) of ability to perform an activity in the manner or range of what is considered normal

106
Q

Define handicap

A

A disadvantage for a given individual that limits or prevents the fulfilment of a role

107
Q

5 key ethical issues in palliative care

A

best interests, decision making, truth telling, sanctity of life, killing and letting die

108
Q

What is opportunity cost?

A

Opportunity cost of an intervention is what is foregone in terms of the benefits from not allocating resources to the next bets activity - i.e to spend resources on one activity means a sacrifice in terms of a lost opportunity cost elsewhere

109
Q

Pros and cons of a private healthcare system

A

+ves - incentive to work if fee per service, ?more efficient

-ves - inequitable, no gatekeeping, inappropriate use of specialists

110
Q

Pros and cons of a public health system

A

+ves - tighter control over expenditure, fair and equitable

-ves - efficient hospital receive cuts, often underfunded, rationing - waiting lists, queues, gatekeeping

111
Q

Pros and cons of a social healthcare system

A

+ves - fair access, compulsory, user satisfaction is high

-ves - user driven demand, bias towards use of tech and decreased disease prevention

112
Q

3 ways of classifying errors?

A

Skill based, rule based, knowledge based

113
Q

5 tools for risk identification

A 
Incident reporting
Complaints and claims
Audit and evaluation
External accreditation
Active measurement and compliance
114
Q

6 strategies to reduce errors and harm

A

Simplification and standardisation of tasks
Checklists/aide memoirs
Information technology
Team training
Risk management
Mechanisms to improve uptake of evidence based treatments

115
Q

Define culture

A

Culture is a socially transmitted pattern of shared meanings by which people communicate, perpetuate and develop their knowledge and attitudes about life. An individuals culture may be based on heritage as well as circumstances and personal choice, and is a dynamic entity

116
Q

Define Ethnocentrism

A

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

117
Q

Define stereotyping

A

Generalisations about the ‘typical’ characteristics of members of a group

118
Q

Define predjudice

A

Attitudes towards another person based solely on their membership of a group

119
Q

Define discrimination

A

Actual positive or negative actions towards the

120
Q

GMCs 6 duties of a dr

A

Make care of pt first concern
Protect and promote health
Provide a good standard of care
Treat pts as individuals and respect dignity
Work in partnership with pts
Be honest and open and act with integrity

phase 3b (15 decks)

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