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Finals > Public Health > Flashcards

Public Health Flashcards

1
Q

What is epigenetics?

A

Expression of a gene depends on the environment

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2
Q

What is allostasis?

A

Stability through change

Physiology adapts rapidly to environmental stress

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3
Q

What is allostatic load?

A

long term overtaxing of physiology leads to impaired health

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4
Q

What is salutogenesis?

A

favourable physiological changes secondary to experiences promoting healing and health

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5
Q

What is primary care for?

A 
Managing illness
Finding clinical solutions
Prevent illness
Promote health
Manage clinical uncertainty
Best outcomes with available resources
Working in health care team
Shared decision making with pt
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6
Q

Dangers of overprescribing abx?

A

Side effects
Medicalise self-limiting conditions
Antibiotic resistance

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7
Q

When to definitely prescribe abx?

A 
B/l otitis media <2yo
Acute otitis media + otorrhoea
Acute sore throat + >2 centor criteria
High risk (co-morbs, immunosuppressed)
Complications
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8
Q

Abx in otitis media?

A

amoxicillin 500mg TDS 5d

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9
Q

Abx in sinusitis?

A

amoxicillin 500mg TDS 5d

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10
Q

Abx in tonsilitis?

A

Penicillin V 10d

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11
Q

Abx in LRTI?

A

Amoxicillin 5d

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12
Q

Abx in UTI?

A

Trimethoprim 200mg BD 3d
OR
Nitrofurantoin 50mg QDS 3d

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13
Q

Define public health?

A

The science and art of preventing disease, prolonging life and promoting health through organised efforts of society

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14
Q

3 domains of public health?

A

Health improvement
Health protection
Improving services

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15
Q

Define health improvement?

A

Concerned with SOCIETAL interventions aimed at preventing disease, promoting health and reducing inequalities

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16
Q

Define health protection?

A

Concerned with measures to control infectious disease risks and environmental hazards

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17
Q

Egs of health improvement

A 
education
housing
employment
family
surveillance of diseases + RFs
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18
Q

Egs of health protection

A

Infectious diseases
chemicals
radiation
emergency response

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19
Q

Define improving services?

A

Concerned with the ORGANISATION and delivery of safe, high quality services for prevention, treatment and care

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20
Q

Egs of improving services?

A 
Clinical effectiveness
Efficiency 
Service planning
Audit + evaluation
Equity
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21
Q

Key concerns in public health? (3)

A

Inequalities
Wider determinants of health
Prevention

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22
Q

What is a health needs assessment?

A

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

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23
Q

Define ‘need’

A

Ability to benefit from an intervention

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24
Q

Define ‘demand’

A

what people ask for

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25
Q

Define ‘supply’

A

what is provided

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26
Q

How is ‘health need’ measured?

A

need for health eg measured using mortality, morbidity, socio-demographic measures

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27
Q

How is ‘health care need’ measured

A

the ability to benefit from health care

Depends on potential of prevention, treatment and care services to remedy health problems

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28
Q

Define ‘felt need’

A

Individual perceptions of variation from normal health

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29
Q

Define ‘expressed need’

A

individual seeks help to overcome variation in normal health

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30
Q

Define ‘normative need’

A

professional defines intervention appropriate for the expressed need

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31
Q

Define ‘comparative need’

A

Comparison between severity - range of interventions and cost

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32
Q

Advantages of epidemiological approach to a health needs assessment?

A

Uses existing data
Provides data on disease incidence/mortality/morbidity etc
Can evaluate services by trends over time

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33
Q

Disadvantages of epidemiological approach to a health needs assessment?

A

Relies on quality of data available
Data collected may not be the data required
Does not consider the felt needs/opinions of population

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34
Q

How to do epidemiological approach to health needs assessment?

A 
Define problem
Size of problem
See what services are available
Evidence base for intervention (effective?cost-effective?)
Models of care
Existing services
Recommendations
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35
Q

How to do comparative health needs assessment?

A

Compares services in one population with others (can be spatial, or social)

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36
Q

Advantages of a comparative health needs assessment?

A

Quick and cheap if data is available

Relative performance indicator

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37
Q

Disadvantages of a comparative health needs assessment?

A

May be hard to find a comparable population
Data may not be available/good quality
May not yield what the best intervention should be

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38
Q

Types of health needs assessment?

A

epidemiological
comparative
corporate

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39
Q

How to do corporate health needs assessment

A

Ask local population what their health needs are
Use focus groups/interviews/meeting
Wide variety of stakeholders..

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40
Q

Advantages of a corporate health needs assessment?

A

Based on felt and expressed need of the population
Recognises the experience of those individuals
Takes into account a wide range of views

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41
Q

Disadvantages of a corporate health needs assessment?

A

Difficult to distinguish need from demand
Groups may have vested interests
May be influenced by agenda

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42
Q

Primary prevention?

A

preventing disease before it occurs

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43
Q

Secondary prevention?

A

Catching disease in early phase

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44
Q

Tertiary prevention?

A

preventing sequelae of disease

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45
Q

Approaches to prevention?

A

Population

High-risk

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46
Q

Population approach?

Eg?

A

preventative measures eg dietary salt reduction through legislation to reduce BP of a population

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47
Q

High risk approach?

Eg?

A

identify individuals above a chosen cut off and treat

eg screening for high BP

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48
Q

Prevention paradox?

A

A preventive measure which brings much benefit to the population offers little to each participating individual

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49
Q

Screening?

A

Process which sorts apparently well people who probably have a disease from those who probably do not.
NOT DIAGNOSTIC

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50
Q

Types of screening?

A 
Population based programmes
Opportunistic screening
Screening for communicable diseases
Occupational medicals
Commercial
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51
Q

Disadvantages of screening?

A

Exposes well individuals to harmful diagnostic tests
Detection and treatment of sub-clinical disease that would never have cause harm
Interventions may cause harm

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52
Q

Wilson+Junger criteria for screening?

A

The condition
 [Important health problem, Latent / preclinical phase, Natural history known]

The screening test [Suitable (sensitive, specific, inexpensive), Acceptable]

The treatment [Effective, Agreed policy on whom to treat]

The organisation and costs [Facilities, Costs of screening should be economically balanced in relation to healthcare spending as a whole, Should be an ongoing process]

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53
Q

Sensitivity of a screening test?

A

The proportion of people with the disease correctly identified by the screening test

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54
Q

Specificity of a screening test?

A

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

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55
Q

PPV?

A

Proportion of people with a positive test result who actually have the disease

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56
Q

NPV?

A

Proportion of people with a negative test who do not have the disease

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57
Q

Define ‘lead time bias’

A

Screening identifies an outcome earlier that it would otherwise have been identified resulting in an apparent increase in survival time, even if screening has no effect on outcome

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58
Q

Define ‘length time bias’

A

Difference in lengths of time taken for a condition to progress to severe effects may affect the apparent efficacy of a screening method

Eg less severe diseases is more likely to be found by screening

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59
Q

Egs of observational studies?

A

Descriptive [case reports, ecological studies]

Analytical [cross sectional]

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60
Q

Advantages of observational studies?

A

quick and cheap
provide prevalence data
large sample size
good for surveillance

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61
Q

Disadvantages of observational studies?

A

Risk of reverse causality
Cannot measure incidence
Risk recall bias/non-response

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62
Q

Egs of analytical studies?

how do they work?

A

Case control studies (RETROSPECTIVE - people with disease + a matched control without)

Cohort studies (study a population without disease over time)

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63
Q

Advantages of analytical studies?

A

Good for rare outcomes
Quicker than cohort/intervention
Investigate multiple exposures

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64
Q

Disadvantages of analytical studies?

A

Difficulty finding control to match with case

Prone to selection and information bias

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65
Q

Egs of experimental/intervention studies?

A

RCT

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66
Q

Advantages of experimental study

A

Can follow up a group with rare exposures
Can follow multiple outcomes
Low risk of bias and confounding
Can infer causality

67
Q

Disadvantages of experimental study

A

Takes a long time
Lose people to follow up
Needs large sample

68
Q

Independent variable?

A

Variable that is altered in a study

69
Q

Dependent variable?

A

Depends on the independent variable

70
Q

Odds?

A

Ratio of probability of an occurrence compared to the probability of a non-occurrence

Odds= Probability / (1-probability)

71
Q

Odds ratio?

A

Ratio of odds for exposed group to the odds for non-exposed group

OR = {Pexposed/(1-Pexposed)} / {Punexposed/(1-Punexposed)}

72
Q

When to use OR?

A

OR can be interpreted as RR when an event is rare

Case control studies -> cannot calculate relative risk so OR is used

Cohort studies/cross-sectional studies when it is unclear which variable is IV / DV

73
Q

Define ‘epidemiology’

A

The study of the frequency, distribution and determinants of diseases and health related states in populations in order to prevent and control disease

74
Q

Incidence?

A

New cases over a period of time

75
Q

Prevalence?

A

Existing cases at a point in time

76
Q

Person time?

A

Measure of time at risk

i.e. time from entry to a study to outcome (disease onset; loss to follow up; or end of study)

77
Q

Incidence rate?

A

incidence / total person-time during the period

78
Q

Absolute risk?

A

Has a denominator!

Gives feel for actual numbers i.e. 50 deaths / 1000 population

79
Q

Attributable risk?

A

The rate of disease in the exposed that may be attributed to the exposure
i.e. incidence in exposed minus the incidence in unexposed

80
Q

Relative risk?

A

Ratio of risk in disease in the exposed to the risk in the unexposed
Tells us about strength of assosciation

EER/CER

81
Q

How to describe epidemiology of a disease?

A

TIme
Place
Person [age, gender, class, ethnicity]

82
Q

Relative Risk Reduction?

A

RRR=(CER-EER)/CER

83
Q

Absolute risk reduction?

A

ARR = CER-EER

84
Q

Number needed to treat?

A

NNT = 1 / ARR

85
Q

What can association between exposure and outcome be due to?

A 
Bias
Chance
Confounding
Reverse Causiality
True causal assos
86
Q

Bias?

A

Systematic deviation from the true estimation of association between exposure and outcome

87
Q

Types of bias?

A

Selection
Information (measurement)
Publication

88
Q

Selection bias?

A

Systematic error in: selection of study participants / allocation of participants to study groups

89
Q

Information bias?

A

Systematic error in measurement

90
Q

Sources of info bias?

A

Observer
Participant (recall / reporting)
Instrument (badly calibrated)

91
Q

Publication bias?

A

More likely to publish positive studies

92
Q

Confounding?

A

A situation when estimate between exposure and outcome is distorted because the association of exposure with another CONFOUNDING factor that is independently associated with the outcome

93
Q

Reverse causality?

A

Outcome causes exposure not the other way round

94
Q

Bradford-Hill criteria for causality

A 
Strength of assos
Dose-response
Consistency
Temporality
Reversibility
Biological plausibility
Coherence
Analogy
Specificity
95
Q

Features of drug-addiction

A

Craving
Tolerance
Compulsive drug-seeking behaviour
Physiological withdrawal

96
Q

Effects of dependent drug use?

A

Physical - injection complications, OD, SEs, BBVs, poverty

Social - criminality, imprisonment, exclusion

Psychological - fear of withdrawal, craving, guilt

97
Q

Principles of treating drug-addiction?

A

Harm reduction
Detoxification
Maintenance

98
Q

Detoxification of heroin?

A

Buprenorphine

99
Q

Maintenance of heroin abstinence?

A

Methadone

Buprenorphine

100
Q

What to offer newly presenting drug user?

A 
Health check
Screening for BBVs
Contraception
Sexual health advice
Immunisations
Signposting
Local drug services info
101
Q

Health behaviour?

A

Behaviour to prevent disease

102
Q

Illness behaviour?

A

Behaviour to seek remedy

103
Q

Sick role behaviour?

A

Aimed at getting well

104
Q

Theory of planned behaviour?

A

Best predictor of behaviour is ‘INTENTION’

105
Q

What is intention determined by? [in TPB]

A

Attitude
Subjective norms (social pressure)
Perceived control

106
Q

Criticisms of TPB?

A

lack of temporal element

lack of direction/causality

107
Q

5 stage model of health behaviour?

A 
Pre-contemplation
Contemplation
Preparation
Action
Maintenance
108
Q

Motivational interviewing?

A

Counselling to resolve ambivalence and initiate behaviour change

109
Q

Nudge theory?

eg?

A

‘nudge’ the environment to make the best option the easiest

eg opt-out schemes
fruit next to checkout

110
Q

Factors in health psychology/behaviour change?

A

Personality traits
Perception of risk
Past behaviours/habit
Social norms

111
Q

Transition points for behavioural change

A 
leaving school
starting work
becoming a parent
unemployment
retirement
bereavement
112
Q

What is NCSCT?

A

National Centre of Smoking Cessation + Training

social enterprise supporting tobacco control programmes and smoking cessation interventions

113
Q

Actions of NCSCT?

A

deliver training and assessment programmes
provides support services
conducts research

114
Q

Why notify PHE of communicable disease?

A

So PHE can take urgent control measures

You may be the only one who can tell PHE

115
Q

Duties in communicable disease control?

A

Duty to notify suspected disease, infection or contamination in patients and dead people

Duty to notify causative agents found in human samples (orally ASAP; in writing in 7d)

116
Q

Notifiable diseases

A 
encephalitis
meningitis
poliomyelitis
hepatitis
anthrax
botulism
brucellosis
cholera
diphtheria
enteric fever
HUS
infectious bloody disarrhoea
group A strep
Legionnaires'
leprosy
malaria
measles
meningococcal septicaemia
mumps
plague
rabies
rubella
SARS
smallpox 
tetanus
TB
typhus
VHF
whooping cough
yellow fever
117
Q

Role of consultant in communicable disease control?

A

Surveillance

Prevention

118
Q

Managing outbreaks?

A 
Clarify problem
Decide if it is an outbreak (>2 of a communicable disease)
Get help!
Call outbreak meeting
Identify cause
Initiate control measures
119
Q

Modes of transmission?

A 
Foodborne
Faecal-oral
Resp
Physical contact
Zoonoses
120
Q

Maslow’s hierachy of needs

A 
Self-actualisation
Esteem
Love/belonging
Safety
Physiological
121
Q

Causes of homelessness?

A 
RELATIONSHIP BREAKDOWN
mental illness
DA
disputes
bereavement 'no family ties'
122
Q

Health problems for homeless?

A 
Infectious diseases (TB, hepatitis)
Feet, teeth
Resp
Violence
Sexual health
Mental illness
Poor nutrition 
Substance misuse
123
Q

Barriers to healthcare for travellers?

A 
Reluctance of GPs
Poor reading/writing
Communication difficult
Too few permanent sites
Mistrust of professionals
124
Q

Barriers to healthcare for homeless?

A

Access
Lack of integration
Don’t prioritise health
May not know where to find hlep

125
Q

Asylum seeker?

A

Person who has made an application for refugee status

126
Q

Refugee?

A

A person granted asylum and refugee status

Can stay for 5y then must reapply

127
Q

Humanitarian protection?

A

Failed to demonstrate claim for asylum but face serious threat to life if returned
Stay for 3y then must reapply

128
Q

Rights of asylum seekers?

A 
no choice dispersal
vouchers/70% of income support sum
NASS support package
NHS access
Not allowed to work
129
Q

Health problems of asylum seekers?

A

Physical - common illness, injuries, no previous screening/vaccines, malnutrition, infestations, communicable disease, chronic/congenital problems

Mental - PTSD, depression, psychosis, DSH

130
Q

Define error?

A

an unintended outcome

131
Q

Why is safety compromised so often in healthcare?

A 
Complex
High risk environment
Resource intensive
Shared responsibility
Unknowing risk taking
132
Q

Common issues in healthcare resulting in error?

A

Wrong diagnosis -> wrong plan
Medication reconciliation
High conc medication solutions

133
Q

Error classification based on….?

A

Intention [skill- ; rule- ; knowledge- based mistakes]

Action [generic, task specific]

Outcome [near miss, death, litigation]

Context [

134
Q

Perspectives on error?

A

Person approach -> blame the individual

System approach -> focus on working conditions

135
Q

Strategies to reduce error

A 
Simplify and standardise clinical processes
Checklists - SBAR
Information technology
Team training 
Risk management 
Mechanisms
136
Q

Never event?

A

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

137
Q

Egs of never event?

A

Surgery - wrong site, retained item

Medication - wrong preparation/route

Mental health - suicide

138
Q

Leadership styles?

A

Inspirational
Transactional
Laissez-faire
Transformational

139
Q

Why do things go wrong in health care?

A 
System failure
Human factors 
Judgement failure
Neglect
Poor performance
Misconduct
140
Q

Qs to ask when possible negligence?

A
  1. Is there a duty of care?
  2. Was there a breach in that duty?
  3. Did patient come to harm?
  4. Did the breach cause the harm?
141
Q

Bolam test

A

Would a group of reasonable doctors do the same

142
Q

Bolitho test

A

Would it be reasonable for them to do so?

them being the group of reasonable doctors in the Bolam test

143
Q

Approaches to learning?

A

Tripartite model

  • Surface (fear of failure)
  • Strategic (desire for success)
  • Deep approach (intrinsic desire for understanding)

Kolb’s learning cycle

144
Q

Types of learner

A

Theorist

Activist

Pragmatist

Reflector

145
Q

Key responsibilities of small group tutors

A

Manage the group, activities and learning

146
Q

How to facilitate learning?

A

Lead discussions
Open-ended Qs
Guide process
Enable active participation

147
Q

Why teach diversity?

A

Better health outcomes for patients

More satisfying doctor-patient encounters

148
Q

Define ‘culture’

what is it based on?

A

socially transmitted pattern of shared meanings.

Based on heritage as well as individual circumstances and personal choice.

149
Q

Define ‘ethnocentrism’

A

the tendency to evaluate other groups according to the values and standards of one’s own cultural group.

Conviction that one’s own cultural group is superior

150
Q

Define ‘stereotype’

A

generalisations about ‘typical’ characteristics of members of a group

151
Q

Define ‘prejudice’

A

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

152
Q

Define ‘discrimination’

A

positive/negative actions towards the objects of prejudice

153
Q

Why has the need for rationing resources increased?

A

Shift from acute illness to chronic long term

Normal physiological events medicalised

Increase in choice and cost of drugs

154
Q

Define ‘rationing’

A

resource is refused due to lack of affordability

155
Q

Theories of resource allocation?

A

Egalitarian - provide all care that is necessary and appropriate to everyone.
Maximising - criteria maximising public utility
Libertarian - each is responsible for their own health

156
Q

Rights in health care?

A

Right to life
Right to be free from inhuman and degrading treatment
Right to respect for privacy
Right to marry and found a family

157
Q

Benefits of social media

A

Wide and diverse social/professional networks
Engage in debates
Facilitates public access to health information
Improve patient access to services

158
Q

Risks of social media

A

Loss of privacy
Confidentiality breach
Online behaviour seen a unprofessional
Risk of being reported

159
Q

GMC duties of a doctor

A

Care of patient is 1st concern
Protect + promote health of patients and public
Provide a good standard of practice and care
Treat patients as individuals + respect their dignity
Work in partnership with patients
Be honest, open and act with integrity

160
Q

3 features of health economic evaluation?

A

Cost of service(s)
Benefit of service(s)
Comparison of cost and benefit of the service and any alternate service

161
Q

2 features compromising a QALY?

A

Number of years

Quality of life - i.e. utility

162
Q

What system do health economists use to evaluate disability?

A

DALYS - disability adjusted life years

163
Q

Define health care economic ‘efficiency’

A

Getting the maximum cost/health benefit outcomes from a service

164
Q

What is the term when treatment is given elsewhere and benefit foregone other patients?

A

Opportunity cost - i.e. money is spent elsewhere because it gives better benefit on another opportunity

Finals (20 decks)

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