Public Health Flashcards
What is health?
A state of complete physical, mental and social well-being and not merely the absence of disease
3 areas of public health and 1 example of each
Health protection - environmental disasters
Health improvement - lifestyle e.g. change for life
Improving services - audit and evaluation
What is primary disease prevention? give 1 example
Aims to prevent a disease before it ever happens. Changes peoples exposure to a risk
Immunisation, fluoridation of water
What is secondary disease prevention? give 1 example
Aims to detect disease early to alter the course/slow progression
Screening, aspirin after an MI
What is tertiary disease prevention? give 1 example
Aims to reduce disability and minimise complications
stroke rehab
What is the prevention paradox?
If something brings a lot of benefit to a population it likely provides little benefit to the individual
10 screening criteria
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
What 3 things form the triple assessment for breast cancer screening?
Imaging - USS & mammography
Clinical assessment
Biopsy
When does breast cancer screening take place?
Every 3 years between the ages of 50 and 70
When does cervical cancer screening take place?
ages 25-50 every 3 years
ages 50-64 every 5 years
9 things on the newborn heel prick test
MCADD, sickle cell, CF, congenital hypothyroid, maple syrup disease, PKU, Glutamic acidaemia, isovaleric acidaemia, homocysteine uria
What are the 2 ways of monitoring prevalence?
Active and passive
Describe the difference between active and passive prevalence monitoring
Active - seeking out people with the disease
Passive - data taken from sentinel GP practices
Define sensitivity
The proportion of people with the disease who are correctly identified by the screening
Define specificity
The proportion of people who do not have the disease who are correctly excluded by the screening
Define PPV
Proportion of people who have a positive screening result who actually have the disease
Define NPV
Proportion of people who have a negative screening result who do not have the disease
3 biases associated with screening
Selection bias
Length time bias
Lead time bias
Define length time bias
Screening is more likely to pick up long lived slow growing tumours than short lived aggressive ones due to the timings
Define lead time bias
Overestimation of survival duration due to earlier detection by screening than clinical presentation
What is epidemiology?
Study of frequency, distribution and determinants of disease in populations in order to prevent and control disease
Define prevalence
Number of existing cases in a defined population at a defined point in time divided by the number of people in a population
Prevalence ratio
Prevalence in exposed divided by prevalence in unexposed
5 reasons for association between 2 variables
True association, reverse causality, chance, bias, confounding
8 elements of communicable disease control
Surveillance, epidemiology, incubation periods, outbreak management , diseases, immunisations, healthcare associated infections and emerging disease
Define communicable disease
A disease which can be transferred from one person to another
6 methods of preventing disease transmission
Vaccination, education, prophylaxis, contact tracing, monitoring, treatment
What is the chain of infection
Reservoir - portal of exit - agent - mode of transmission - portal of entry - host - person to person spread
3 types of transmission and an example for each
Direct - STIs
Indirect - malaria
Airborne - TB
Define endemic
Persistent level of disease occurrence
Define hyper-endemic
Persistently high levels of disease occurence
Define sporadic
Irregular pattern of disease occurrence
Define epidemic
Occurrence within an area in excess of expected for given time
Define pandemic
Epidemic widespread over several countries
Define cluster
Aggregation of cases which may or may not be linked
3 reasons for surveillance
Establish baseline rate, allow identification of outbreaks, monitor efficacy or immunisation programmes
Define outbreak
2 or more cases that are linked or occurrence of a disease in an area that isn’t expected
Define common source outbreak
A group of people exposed to a common source of infectious agent
4 methods of surveillance
Passive, sentinel, active, enhanced
What is gillick competence?
A child under 16 is able to give consent for medical treatment without the need for parental permission and knowledge
5 Fraser guidelines
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
Descrive a case control study
Population split into cases and controls and looks at exposures in both groups, usually retrospective
Describe a cohort study
An observational study where the population split into exposed and unexposed and looks at who gets the disease in both groups - usually prospective
What is an ecological study
A study carried out at population rather than individual level
What is a cross sectional study
Measures frequency and examines distribution and determinants, can be descriptive or analytical
Pros and cons of a cohort study
+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
Pros and cons of a case control study
+ves - good for rare outcomes, relatively inexpensive, small numbers and quick to complete
-ves - prone to selection bias, prone to recall bias
Pros and cons of a RCT
+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
9 Bradford Hill criteria
- criteria to provide evidence of a causal relationship
Temporality Strength Consistency Specificity Biological gradient Plausibility Coherence Experiment Analogy
Define bias
A systematic deviation from the true estimation of association between exposure and outcome
2 groups of bias
Selection and information
Define confounding
A factor that is independently associated with the exposure and outcome but does not lie on the causal pathway
Define need
The ability to benefit from an intervention
Define felt need
Individual perception of variation from normal health
Defined expressed need
Individual seeks help to overcome variation in normal health - demand
Define normative need
Professional defines intervention appropriate for expressed need - supply
Define comparative need
Comparison between severity, range of interventions and costs
What is a health needs assessment
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
What is the planning cycle
Needs assessment, planning, implementation, evaluation, REPEAT
3 approaches for a health needs assessment
Epidemiological, corporate, comparative
What is the epidemiological approach for a HNA? +ves and -ves
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
What is the corporate approach for a HNS? +ves and -ves
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
What is the comparative approach for a HNA? +ves and -ves
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
3 evaluation frameworks
Maxwell, Black, Donabedian
Outline the Donabedian evaluation framework
Structure, process, outcome
Outline Maxwells dimensions of quality
Appropriateness Accessibility Acceptability Efficiency Equity Effectiveness
Maslow hierarchy of need
Physiological, safety, belonging, esteem, self actualisation
What is health behaviour
Aims to prevent illness - eating healthy
What is illness behaviour
Aims to seek remedy - going to dr
What is sick role behaviour
Aims to get well, can lead to neglect of one’s usual duties - taking prescribed medications
3 models of behaviour change
Health belief model, Theory of planned behaviour, stages of change (transtheoretical)
Health belief model - what is it, pros and cons
Perceived severity, perceived susceptibility, perceived barriers and perceived benefits.
+ves - longest standing model
-ves - doesn’t consider emotions or repeat behaviour
Theory of planned behaviour - what is it, pros and cons
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
Cues to action in the health belief model
Media, advice from others, reminders from health services, illness of family
Services for drug users
Sexual health screening, needle exchange, contraception, signposting, health check, immunisations, treatment
5 drug treatment principles
Reduce illicit drug use, stabilise lifestyle, reduce crime, improve overall health, reduce harm to user, family and society
What is the transtheoretical model of behaviour change, pros and cons
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
8 barriers to accessing healthcare
Reluctance of professional to make visits, illiterate, language barriers, moving frequently, mistrust of professionals, cultural beliefs, lack of address, no form of contacting
5 migrant health problems
mental health, normal illness, infectious diseases, congenital abnormalities not routinely treated, injuries
4 questions to assess negligence?
was there a duty of care?
was it breached?
was the pt harmed?
was harm due to breach?
What is an error?
unintended outcome
6 causes of error
human factors system failure judgment failure neglect poor performance misconduct
Bolam and bolitho tests
Bolam - would a reasonable doctor do the same
Bolitho - would that be reasonable
FRAMES model of motivational interviewing
Feedback, responsibility, advice, menu, empathy, self efficacy
3 approaches of resource allocation
Egalitarian - equal for everyone
Maximising - maximise benefits - who needs it most
Libertarian - everyone responsible for their own health
What is a never event?
Serious, largely preventable, patient safety incidents that should not occur if the available preventative measures have been implemented
5 principles of the MCA?
Presumed to have capacity, steps taken to enable decision, unwise decisions allowed, decisions in best interests, least restrictive option
2 assumptions of MCA
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
What is dos? what is the acid test?
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
3 reasons to break confidentiality
Patient consented, required by law, justified in public interest
Define tolerance
reduced reaction to a drug following its repeated use
Define withdrawal
physical problems and emotions experienced i you are dependent on a substance then suddenly stop or drastically reduce dose
Define misuse
consequences of using substance involve social, psychological or physical harm
Define domestic abuse
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
8 signs of dependence
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
10 types of medical error
fixation, sloth, playing the odds, mistriage, bad teamwork, breakdown of communication, bravado, ignorance, lack of skill, system error
Define economic efficiency
Economic efficiency is achieved when resources are allocated between activities in such a way to maximise benefit
What is the equity efficiency trade off?
Improving equity often leads to a loss in efficiency
What is economic evaluation?
The study of efficiency - comparative study of costs and benefits of health interventions
What is incremental analysis
Everything is relative - compares to previous drug/treatment
What is the incremental cost effectiveness ratio? (ICER)
difference in costs / difference in benefits
4 types of economic evaluation
Cost-effectiveness (natural units)
Cost-utility (QALY)
Cost-benefit (monetary)
Cost-minimisation
3 ways of measuring health benefit
Monetary, natural units, QALYs
Define impairment
Any loss or abnormality of psychological, physiological or anatomical structure or function
Define disability
Any restriction or lack (due to impairment) of ability to perform an activity in the manner or range of what is considered normal
Define handicap
A disadvantage for a given individual that limits or prevents the fulfilment of a role
5 key ethical issues in palliative care
best interests, decision making, truth telling, sanctity of life, killing and letting die
What is opportunity cost?
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
Pros and cons of a private healthcare system
+ves - incentive to work if fee per service, ?more efficient
-ves - inequitable, no gatekeeping, inappropriate use of specialists
Pros and cons of a public health system
+ves - tighter control over expenditure, fair and equitable
-ves - efficient hospital receive cuts, often underfunded, rationing - waiting lists, queues, gatekeeping
Pros and cons of a social healthcare system
+ves - fair access, compulsory, user satisfaction is high
-ves - user driven demand, bias towards use of tech and decreased disease prevention
3 ways of classifying errors?
Skill based, rule based, knowledge based
5 tools for risk identification
Incident reporting Complaints and claims Audit and evaluation External accreditation Active measurement and compliance
6 strategies to reduce errors and harm
Simplification and standardisation of tasks
Checklists/aide memoirs
Information technology
Team training
Risk management
Mechanisms to improve uptake of evidence based treatments
Define culture
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
Define Ethnocentrism
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
Define stereotyping
Generalisations about the ‘typical’ characteristics of members of a group
Define predjudice
Attitudes towards another person based solely on their membership of a group
Define discrimination
Actual positive or negative actions towards the
GMCs 6 duties of a dr
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
