Public Health Flashcards
What is the definition of allostatic load?
Longterm overtaxation of our physiological systems leading to impaired health
What is the definition of salutogenesis?
Favourable physiological changes secondary to experiences that promote healing and health
What are the four stages of health needs assessment?
Needs assessment
Planning
Implementation
Evaluation
Name and describe 4 different types of need
Felt need - individual’s perception of variation from normal health
Expressed need - individual seeks help (same as demand)
Normative need - Professional defined intervention appropriate for expressed need
Comparative need - severity versus range of interventions versus cost
What are the pros of the epidemiological approach to health needs assessment? (2)
It uses existing data
It can evaluate trends over time
What are the cons of the epidemiological approach to health needs assessment? (3)
Data quality is variable or data is not available
The data collected already may not be the data required
It does not consider felt need
What are the pros of the comparative approach to health needs assessment? (2)
Quick and cheap
Gives a measure of relative performance and health inequalities
What are the cons of the comparative approach to health needs assessment? (2)
Can be difficult to find a suitable comparison population
May not determine the appropriate service needed
What are the pros of the corporate approach to health needs assessment? (2)
Based on felt and expressed need
Recognises local knowledge and experience
What are the cons of the corporate approach to health needs assessment? (2)
Hard to distinguish need from demand
Can be influenced by political agendas
What are the three components of Donabedian Framework for health needs assessment?
Structure - what is there
Process/Output - what is done
Outcome - 5 Ds
What are the 5 Ds of outcome in Donabedian framework of health needs assessment?
Death, disease, disability, discomfort, dissatisfaction
What are Maxwell’s Dimensions of Quality? (6)
Effectiveness Efficiency Equity Acceptability Accessibility Appropriateness
What 10 criteria must be met for a screening programme to be valid? (10)
The condition
1) It must be an important health problem
2) Have a latent/preclinical phase
3) Have a known natural history
The test
4) Must be suitable (sensitive, specific, cost effective)
5) Acceptable (level of invasiveness, risk etc.)
The treatment
6) Must be effective
7) Agreed policy on who to treat
The organisation and costs
8) Facilities must be available
9) Costs must be acceptable
10) Ongoing process in place
Define sensitivity
The proportion of people with the disease that are identified
Define specificity
Proportion of people without the disease that are correctly excluded
Define positive predictive value
Proportion of people with a positive test result that have the disease
Define lead time bias
When screening identifies an outcome earlier than it would have, it can cause an apparent increase in survival time even if screening had no effect on outcome
Define length time bias
Variation in length of time taken for a condition to progress to severe effects can effect the apparent efficacy of screening
More likely to identify slower, less aggressive tumours
More likely to miss the faster growing, more aggressive tumours
What is the Bradford-Hill criteria for causality? (9)
Strength of association Dose-response Consistency Temporality Reversibility Biological plausibility Coherence Analogy Specificity
Define incidence
the number of new cases over a specified time (e.g) 200 per year)
Define prevalence
The proportion of a population affected at a point in time
How is relative risk calculated?
Risk for exposed group/ Risk for unexposed group
How are odds calculated?
Probability / (1 - probability)
In models of health behaviour change, in the health belief model, what 4 criteria must be met for change to occur?
What is the biggest obstacle for behaviour change?
Belief that they are susceptible to the condition
Belief that it has serious consequences
Belief that taking action will reduce susceptibility
Belief that benefits will outweigh the costs
Perceived barriers
What are the stages of the transtheoretical/stage model of health behaviour change? (5)
Pre-contemplation Contemplation Preparation Action Maintenance
What can be prescribed to aid smoking cessation, how do they work? (4)
Bupropion - decreases nicotine cravings and withdrawal symptoms
Varenicline (Champix) - decreases cravings and pleasurable effects
In the theory of planned behaviour what are the three things that determine intention?
The person’s attitude to the health behaviour
Perceived social pressure
Self efficacy/perceived behavioural control
What are the five levels of Maslow’s Hierarchy of Needs?
Physiological Safety Love/Belonging Esteem Self actualisation
What must be fulfilled to satisfy Fraser Guidelines? (5)
1) They must have sufficient maturity and intelligence
2) The cannot be persuaded to tell their parents
3) They are likely to continue to have sexual intercourse regardless
4) Their mental health is likely to suffer if they do not receive advice +/- treatment
5) The advice/treatment is in the young person’s best interest
What three medications other than metformin can be used to manage type 2 diabetes before insulin therapy is considered?
DPP4 inhibitor (‘gliptin’ e.g.) Saxagliptin)
Pioglitazone
Sulfonylurea
What is the Bolam test?
It determines if a group of their professional peers would have acted the same
What is the Bolitho test?
Would it be reasonable and logical for a group of doctors to act in a certain way
What is a lapse error (type of human error)?
The action plan put in place is correct but one or more of the planned actions was skipped
What is a slip error (type of human error)?
The action plan put in place was correct but one or more of the planned actions was performed incorrectly
What is a rule-based mistake?
When an action plan is incorrect due to choice of the wrong rule after misinterpreting a situation
What is a knowledge based mistake?
When an action plan is incorrect due to lack of knowledge or incorrect application
What type of study is this:
Follows a group of people to track risk factors and outcomes over time
Cohort study
Describe a case control study
Compares the histories of people with a condition to people without a condition
Describe a cross-sectional survey (1)
Assesses the prevalence of an outcome in a broad population and one point in time
What is the WHO definition of health? (1)
A state of complete physical, mental, and social well-being and not merely the absence of disease of infirmity
What is PICO? (4)
Patient/Population/Problem
Intervention/Exposure
Comparison/Control
Outcome
What is Utilitarianism? (1)
Utilitarianism holds that the most ethical choice is the one that will produce the greatest good for the greatest number.
QALYs are based on utilitarianism principles.
What is the acid test? (4)
Determines if a person requires DoLS
1) Does the person lack capacity to consent to the arrangements?
2) Is the person subject to continuous supervision and control?
3) Is the person free to leave?
