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Public Health > Public health > Flashcards

Public health Flashcards

1
Q

What is the biopsychosocial model?

A

An integrated approach to health and disease where:

  • Biological - genetic, biochemical etc.
  • Psychological - mood, behaviours, personality etc.
  • Social - familial, education, cultural, socio-economic, medical etc.
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2
Q

What is the definition of need with regards to health needs?

A

Need is the ability to benefit from an intervention

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3
Q

What is the definition of demand with regards to health needs?

A

Demand (want) is what people ask for

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4
Q

What is the definition of supply with regards to health needs?

A

Supply is what we actually provide

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5
Q

What is Bradshaw’s Taxonomy of need?

A

Felt: individual perceptions of variation of normal health
Expressed: individual seeks help to overcome the variation in normal health (demand)
Normative: Professional defines intervention appropriate for the expressed need
Comparative: comparison between severity, range of interventions and cost

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6
Q

What is the capacity to benefit?

A

An individual’s ability to benefit from an intervention

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7
Q

What are examples of interventions that are wanted and supplied? (not needed)

A
  • Antibiotics fr viral illness

- PSA for prostate cancer - not always clinically appropriate

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8
Q

What are examples of wanted and needed? (not supplied)

A
  • Cure for cancer
  • Cures for chronic disease
  • Better mental health services
    (ideally nothing should be in this section)
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9
Q

What are examples of needed and supplied? (not wanted)

A
  • Smoking cessation (not wanted by all)
  • Alcohol cessation (not wanted by all)
  • Colorectal cancer screening (certain people don’t engage)
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10
Q

What are examples of interventions that are wanted, needed and supplied?

A
  • Free contraception
  • Breast cancer screening
  • smoking cessation
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11
Q

What may influence need/supply/demand?

A
  • Media
  • Cultural and ethical determinants
  • Current research agenda
  • Public and political pressure
  • Historical patterns, inertia, momentum
  • Social and educational influences
  • Medical influences
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12
Q

What is the health needs cycle?

A

1) Needs assessment (e.g. PICO - establish what population needs and what service)
2) design
3) launch
4) implementation
5) evaluation
REPEAT
1)…

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13
Q

What approaches may be taken to health needs assessment?

A
  • Epidemiological (biomedical model)
  • Corporate (involves stakeholders - asking what is needed)
  • comparative (compares health needs with similar populations)
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14
Q

What are the advantages of an epidemiological approach to health needs assessment?

A

Addresses a clear problem

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15
Q

What are the disadvantages to an epidemiological approach to health needs assessment?

A
  • Can be expensive
  • involves analysis of existing data and data collection
    reinforces biomedical model
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16
Q

What are the advantages of corporate approach to health needs assessment?

A
  • recognises people important in the services success

- based upon wishes and needs of relevant parties

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17
Q

What are the disadvantages of a corporate approach to health needs assessment?

A
  • may be blurring of demands and needs
  • may fit an agenda of a particular stakeholder
  • can involve political agendas
  • BIAS
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18
Q

What are the advantages of comparative method for health needs assessment?

A
  • Can see evidence of benefit/success in population

- fairly quick and inexpensive

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19
Q

What are the disadvantages of comparative method for health needs assessment?

A
  • hard to find a similar population
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20
Q

What are the evaluation frameworks for interventions?

A
  • Donabedian (evaluates programmes looking at the structure/inputs -> process -> output -> outcome)
  • Black (e.g. priority setting - looks at effectiveness -> efficiency -> equity -> humanity)
  • Maxwell (e.g. looking at screening programme- effectiveness -> efficiency -> equity -> access -> acceptability -> appropriateness)
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21
Q

What are ecological studies?

A

A study carried out at a population level rather than an individual one (is descriptive)

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22
Q

What is a multi-group ecological study?

A

Compares different groups at one point in time

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23
Q

What do Cross-sectional studies do?

A

Measure the frequency (prevalence), examine distribution and determinants, data is collected at a single point in time (a snapshot).
Can be DESCRIPTIVE or ANALYTICAL

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24
Q

What are the observational studies?

A

Case-control study

Cohort study

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25
Q

What are case-control studies?

A

(the reverse of cohort)

  • identify those with and without the outcome
  • determines previous exposure to potential risk factors
  • must have a prior hypothesis
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26
Q

What are cohort studies?

A

Measure exposures of interest and follow up study participants over time to measure incidence of outcome and interest

  • observational study
  • measures incidence
  • defined on the basis of absence or exposure to suspected risk factor
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27
Q

What are intervention studies?

A

-RCTs

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28
Q

What is a randomised controlled trial?

A

An experimental study where participants are randomly allocated to intervention or control with predefined rules for eligibility, endpoints, follow-ups, analysis plans and stopping rules
- the gold-standard of study designs

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29
Q

Why are stopping rules necessary in RCTs?

A
  • if becomes clear that harm or benefit is being shown - rules say that it should stop
  • predefined stopping rules should be in place to ensure:no undue risk to participants, control group aren’t being deprived of an effective intervention, no continuing an ineffective intervention
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30
Q

What are the strengths of RCTs?

A
  • Minimise bias and confounders
  • multiple outcomes can be studied
  • ‘incidence’ of outcome can be measured
  • strong evidence of casual relationships between intervention and outcome can be provided
31
Q

What are weaknesses of RCTs?

A
  • expensive
  • requires big study teams
  • multi-centre studies
  • ethical concerns
  • complex to manage
  • large participant drop out rates
  • conflicting evidence from trials can effect meta-analysis
32
Q

What does PICO stand for?

A

P- population/patient/problem
I- intervention/exposure
C - Comparison/control
O- Outcome

33
Q

What is the prevalence equation?

A

Prevalence = number of existing cases at one time point / total number of individuals in the defined population at the same time point

  • is a proportion that can never be greater than 1
34
Q

How can prevalence be monitored?

A

Actively - seek out people with the disease to establish prevalence
Passively - taken from data at ‘sentinel’ GP practices or anonymous information that is given e.g. STI screening tests at sexual health clinics - can establish prevalence from results

35
Q

What are methods of surveillance?

A
  • passive (most common)
  • Sentinel (sample surveillance- good for common diseases)
  • active
  • Enhanced
36
Q

What are the public health notifiable diseases?

A
  • acute encephalitis
  • acute infectious hepatitis
  • acute meningitis
  • acute poliomyelitis
  • anthrax
  • botulism
  • brucellosis
  • cholera
  • diphtheria
  • enteric fever
  • food poisoning
  • haemolytic uraemia syndrome (HUS)
  • infectious bloody diarrhoea
  • invasive group A streptococcal disease
  • Legionnaire’s disease
  • Leprosy
    ● Malaria
    ● Measles
    ● Meningococcal septicaemia
    ● Mumps
    ● Plague
    ● Rabies
    ● Rubella
    ● Severe Acute Respiratory Syndrome (SARS) ● Scarlet fever
    ● Smallpox
    ● Tetanus
    ● Tuberculosis
    ● Typhus
    ● Viral haemorrhagic fever (VHF)
    ● Whooping cough
    ● Yellow fever
37
Q

What is the odds equations?

A

number of new cases in a specified time period / number who did not become a case during that time period

38
Q

What are the three types of incidence:

A

Odds
Rate
Risk

(from ecological or cohort studies)

39
Q

What is the risk equation?

A

Number of new cases among contact in a specific time-period/total number of individuals at risk in the population at the start of the time period

40
Q

What is the incidence rate equation?

A

number of new cases in a specified time period / total person-time at risk during that time period

41
Q

What is primary prevention?

A

aims to prevent a disease before it ever occurs:

  • education
  • immunisation
42
Q

What is secondary prevention?

A

aims to reduce the impact of a disease - halt or slow progression

  • screening
  • regular check ups
43
Q

What is tertiary prevention?

A

Reduce the impacts of a disease - improve QoL or function

  • treatment
  • rehab
44
Q

What is an example of primary prevention?

A
  • change4life - lifestyle changes
  • childhood immunisations
  • fluoridation of water
45
Q

What is an example of secondary prevention?

A
  • breast cancer screening

- aspirin treatment to prevent further MIs

46
Q

What is an example of tertiary prevention?

A
  • rehab post stroke
47
Q

What is the prevention paradox?

A

If something brings about a lot of benefit to the population, then it provides little benefit to the individual

48
Q

Screening can be primary or secondary, what does it screen for in each and why?

A

Primary - risk factors to reduce them

Secondary - to detect early disease so can alter disease course

49
Q

What are the two screening criteria?

A

Wilson and Jungner

WHO screening criteria

50
Q

How are the screening criteria broken down?

A

The condition, the treatment, the test, the risks and benefits

51
Q

Examples of screening?

A
  • breast cancer screening
  • colorectal screening
  • STI screening
  • Diabetic retinopathy screening
  • Newborn screening programme
  • cervical screening programme
  • NHS health checks
  • these have age restrictions and can be condition dependant
52
Q

What is meant by selection bias?

A

Those who choose to participate in screening may differ from the general population e.g. those who are at higher risk - FHx of breast cancer may be more likely to attend or those at lower risk e.g. high socioeconomic group may be more likely to attend

53
Q

What is length-time bias?

A

people may be missed out due to the timing of the screening

- shorter, more aggressive disease is more likely to be missed whereas if is long-lived is ore likely to be identified

54
Q

What is lead-time bias?

A

the difference between knowing about disease and making a difference e.g one patient identified at screening at 2 years earlier than another that has the disease but they die at the same time

55
Q

What are false positives??

A

some people will be screened and the process will show them to be diseased / at risk – on further testing they have no disease.

56
Q

What are false negatives?

A

some people will be screened and they will be deemed as having no disease but later on in life will develop the disease.

57
Q

What is sensitivity?

A

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

58
Q

What is specificity?

A

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

59
Q

What is the positive predictive value?

A

The proportion of people who have a positive screening result who, following tests, have the disease

60
Q

What is the negative predictive value?

A

Proportion of people who do not have the disease following testing

61
Q

What types of errors can occur in healthcare?

A 
Sloth
fixation
communication breakdown
playing odds
bravado
ignorance
miss-triage
lack of skill
system error
62
Q

Why do mistakes happen?

A

Human error
Misconduct
neglect
poor performance

63
Q

What are the never events?

A 
○  Wrong site surgery
○  Wrong implants
○  Wrong route of administration
○  Wrong prescribing of potassium containing solution
○  Overdose of insulin
○  Overdose methotrexate (non-cancer treatment)
○  Mental health - failure to install collapsible shower rails / door hooks, etc.
○  Falls from windows
○  Entrapment in bedrails
○  Incompatible transfusions
○  Scalding patients
○  Incorrect oro/gastric tube feeding
64
Q

What is the Swiss cheese model of adverse events?

A

Each slice of cheese is a barrier to error propagation, errors happen when the holes line up

65
Q

What is the Bolam standard?

A

Rules in favour of the general medical opinions around acceptability
not negligent if acting in a way that is in accordance with accepted practice and other practitioners mostly agree

66
Q

The 4 steps that show negligence has occurred?

A

1) There was duty of care
2) The duty of care was breached
3) A patient came to harm
4) the harm was duet the breach in duty of care

67
Q

What is the Bolitho caveat?

A

Is a modified 1957 Bolam test

basically, a judge can disagree with a panel of edits if they think the act is unacceptable

68
Q

What are the four ethical principles and what they mean?

A

1) Autonomy - right to choose what happens to yourself
2) Beneficence - doing good
3) non-maleficence - doing no harm
4) Justice - being fair to all involved

69
Q

What are the three main models of stages of change?

A

1) Transtheoretical
2) Health belief
3) Theory of planned behaviour

70
Q

What are transition points in life that may indicate stages of change?

A 
leaving school
relationship breakdown
having children
significant health event
bereavement
losing/gettinga. job
retirement
71
Q

What is the inverse care law?

A

Those with the greatest need for healthcare, access healthcare the least

72
Q

What are the social determinants of health

A

1) age, sex, hereditary factors
2) individual lifestyle factors
3) social and community influences
4) living and working conditions
5) general socioeconomic, cultural and environmental conditions

73
Q

what is included in the Bradford hill criteria? (with regards to research)

A

1) strength (effect size)
2) consistency (reproducibility)
3) specificity
4) temporality
5) biological gradient
6) plausibility
7) coherence
8) Experiment
9) Analogy

Public Health (3 decks)

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