public health Flashcards
name 3 models of behaviour change (3):
- health belief model
- theory of planned behaviour
- stages of change/transtheoretical model
- nudging
- financial incentives
list the 4 things perceived in the health belief model:
perceives: 1. susceptible to ill health 2. severity of ill health 3. benefits of behaviour change 4. barriers of taking action (cues to action)
in the health belief model - if the individual believes all 4 things (perceptions) then what is thought to happen:
increased chance of engagement in health-promoting behaviour
in the theory of planned behaviour model, what 3 things impact intention to change behaviour? (3):
attitudes
social/subjective norms
perceived behavioural control
what are the 5 stages of behaviour change listed in the stages of change / transtheoretical model?
pre-contemplation contemplation preparation action maintenance
what can happen at any stage of the transtheoretical model?
relapse
disadvantages of health belief model?
lacks temporality
doesn’t take social norms into account
doesn’t consider the implication of emotions on behaviour
doesn’t differentiate between repeat and first-time behaviour
cues to action missing
a) What are the components of Donabedian Framework?
- Structure
- Process
- Outcome
- Output
what is the Donabedian framework used for?
to assess whether a specific service meets it’s objective
advantage of cohort study?
- Can assess multiple risk factors in one study
- Temporality – identify bias
disadvantage of cohort study?
- Sample size may be too small
- Lost follow ups
- £££££
define: incidence?
number of new cases per specific population per specific time period
what is cumulative incidence?
risk of getting disease in a set time period in a set population if don’t already have the disease
what is incidence rate relative to?
person years
c) Rates of severe asthma are 1/100 in Fulwood and 4/100 in central Sheffield. Calculate the relative risk reduction of living in Fulwood.
3/4
Interpreting association: what can association be due to?
bias chance confounding reverse causality true association
which criteria assesses true association?
Bradford Hill criteria
what does the Bradford Hill criteria include?
- temporality - exposure before disease
- dose-response - more dose>more response
- strength - p-values tiny
- reversibility - minus exposure, -disease
- consistency - geog., demographics
what are the two types of screening bias?
lead time - screening picks up sooner-increased survival time
length time - if screen at spec time pt, might miss candidates
criteria for screening test:
Wilson and Jungner
name 4 wilson and jungner screening criteria:
- condition should be an important health problem
- should be an accepted treatment for disease
- facilities for dx and tx should be available
- should be recognised latent/early disease stage
- suitable test/examination
- test should be acceptable to population
- understanding of natural history of disease
- agreed policy on which patients to treat
- cost benefit to medical care system
- continuing case finding process
define: specificity?
proportion of those without the disease correctly excluded by screening
define: positive predicted value?
The proportion of those who have tested positive who actually have the disease
in domestic abuse: what 3 components make up the toxic triangle?
domestic abuse itself
Mental Health effects/impact
Substance abuse
in a serious domestic abuse incident, in absence of the victim, who can advocate for them in an MDT?
MARAC - multiple agency risk assessment conference (independent)
3 drugs to assist recovering alcoholics stay abstinent?
- Disulfiram
- Acomprosate
- Naltrexone
what is the alcohol harm paradox?
- People with lower income who drinks less have higher risks of hospitalisations/conditions caused by alcohol
- may be due to higher stress levels, limited social support, poor diet/exercise
which 4 components make up the planning cycle for the health service?
**health needs assessment
planning
implementation
**evaluation
3 approaches to the health needs assessment:
- epidemiological
- comparative
- corporate
2 disadvantages of the corporate approach to a HNA?
blurs need and demand
political agenda could influence
loudest voice not majority voice heard
eg of something demanded but not needed or supplied?
certain plastic surgery on NHS
eg of something needed but not demanded or supplied?
ovarian cancer screening
treatment of child abusers
palliative care services
contraceptive services
eg of something supplied but not needed or demanded?
vaccinations
eg of needed and supplied but not demanded?
health promotion, some screening
GU contact tracing
MMR for some pts
collaborating assessment and management of suicidality
eg of needed and demanded but not supplied?
cure for cancer,
waiting lists
TOP in certain parts of world
eg of supplied and demanded but not needed?
Abx for viral URTI
2 short term cx of heroin use?
overdose, RDS, DVT, abscess
2 long term cx of heroin use
BBV, addiction, socioeconomic, violence
what are the 4 tests of whether medical negligence has occured?
- was there a duty of care?
- was there a breach of the duty of care?
- did the patient come to harm?
- did the breach cause the harm?
what are the guidelines that determine if there was a breach in the duty of care?
Bolum & Beletho
group of reasonable peers would do the same based on reasonable analysis
3 types of leadership?
transactional
transformational
behavioural
great man - born
WHO definition of health?
Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.
which human right is right to life?
2
which human right is right to not have inhumane treatment?
3
what is human right 8
right to have a private family life
what is human right 12? Is this absolute?
right to marry and have a family
Limited
what is human right 14>
right not to suffer discrimination
define a never event:
A serious, intolerable and inexcusable patient safety incident that largely preventable and should not have occurred if adequate preventative measures have been implemented.
who needs to be informed when a never event occurs?
National Reporting and Learning System
CQC
examples of never event (2):
PPH death wrong implant wrong site nerve block retained foreign objects suicide wrong site surgery
which ethical principle considers the impact a decision will have on greater society/healthcare system?
utilitarianism
which ethical principle focuses on the decision and the duty of a doctor?
deontology
which ethical principle focuses on compassion and understanding others views?
virtue
3 domains of health?
health improvement
health protection
improving services
what are the dimensions of health inequality?
geographical location variation in health outcomes and provisions different groups within society socioeconomic race religion trans travelers
what are the two types of health equity?
horizontal
vertical
what is vertical equity?
equal treatment for equal needs
eg all those who have a CAP get the same tx
what is horizontal equity?
unequal treatment for unequal need
eg pneumonia tx different to cold tx
What type of study is a cohort study?
longditudinal
f/u - prospective
different risk factors/tx
what is a cohort study?
- pick people
- split into exposed and unexposed
- see if groups get disease or not
- measures relative risk
what is a case controlled study?
- retrospective, observational
- pick people
- split into disease or not disease
- go back and see if each group exposed or not
- uses odds ratio
what is a RCT?
randomised control trial
- pick people
- randomise control and treatment group
what is a cross sectional study?
pick people at one point at time to find out prevalence
what is an ecological study (population)?
- compares between populations
- longditudinal - compares over time
Odds ratio?
OR represents the odds that an outcome will occur given a particular exposure, compared to the odds of the outcome occurring in the absence of that exposure
primary prevention?
intervention to prevent onset of disease
secondary prevention?
intervention to pick up asymptomatic individuals with disease and treat
tertiary prevention?
intervention to reduce negative effects of established disease from symptomatic individuals
define: prevalence:
overall cases in specific population at a time point
what is relative risk?
compares 2 incidences or 2 prevalences
attributable risk:
Rate of disease that can be attributed to exposure
incidence in exposed - unexposed
NNT/NNH:
1/Attributable risk (always round up)
sensitivity: define
% of those with the disease correctly identified
Define: negative predicted value:
if test negative, likelihood of actually not having the disease
Bradshaw “needs”:
- felt (pt feelings)
- expressed (health seeking behaviours)
- normative (what healthcare staff think)
- comparative (comparing needs of 2 diff CCGs)
disadvantages of an epidemiological approach?
not enough data available
paternalism
doesn’t consider felt need
Maxwell’s dimensions of Quality?
Effectiveness Efficiency Equity Acceptable Accessible Approproate
Qualitative methods: examples
observation, interviews, focus groups, survey, review of documents
Quantitative methods: examples
routinely collected data, review of records, PHQ9 questionnaires, specialist studies
what makes a communicable disease a public health concern?
high morbidity high mortality highly contagious expensive to treat effective treatment available
who notify in communicable disease control?
proper officer - is usually the consultant communicable disease control within 3 days by writing, or if urgent telephone
when are communicable diseases reported?
when they are suspected, not after - any case of clinical suspicion
can breach confidentiality if need to
cluster: define:
aggregation of cases which may or may not be linked
suspected outbreak definition:
- Occurrence of more cases of disease than normally expected within a specific place or group of people over a given period of time
- 2 or more cases who are linked through common exposure, personal characteristics, time or location
- A single case of a rare or serious disease such as diphtheria, rabies, viral haemorrhagic fever or polio
confirmed outbreak definition:
link confirmed with investigation
epidemic definition:
disease affects a greater number people than is usual for the locality or one that spreads to areas not usually associated with the disease
pandemic definition:
epidemic of world-wide proportions.
endemic definition:
disease or condition) regularly found among particular people or in a certain area
hyperendemic defintion:
exhibiting a high and continued incidence —used chiefly of human diseases hyperendemic malaria.
asapects of causality:
temporality (RCT)
dose-response
Malnutrition definition:
deficiencies, excesses or imbalances in
a person’s intake of energy and/or nutrients
disordered eating features:
restraint; strict dieting; disinhibition;
emotional eating; binge-eating; night eating; weight & shape
concerns; inappropriate compensatory behaviours that do not
warrant a clinical diagnosis
which of the behaviour change models has temporal element?
transtheoretical only
which of Maxwell’s dimensions of Quality ensures that patients receive the correct tx in a timely manner
appropriateness
how should the MCA impact human rights?
least restrictive way possible
what type of ethics is ‘pt died in pain but Dr tells family they died peacefully to reduce distress’?
consequentialism
free prescription criteria:
> 60
community care of children?
midwife <9 days
health visitor >10 days
domestic abuse definition:
any incident/pattern of incidents of controlling/coercive, threatening behaviour, violence or abuse >16yos intimate partners or family members regardless of gender or sexuality
examples of abuse:
psychological physical sexual financial emotional
risk assessment tool for domestic abuse?
DASH
high risk of domestic abuse?
identifiable indicators of imminent risk of serious harm
dynamic, could happen at any time, impact would be serious
break confidentiality if need to
eg public health interventions for individuals?
vaccinations
eg public health interventions population level?
laws to make it harder to access alcohol/smoking
eg public health interventions community level?
education in schools
what is a health needs assessment?
systematic method for reviewing the health issues facing a population, leading to agreed priorities and resource allocation that will improve health and reduce inequalities
supplied and needed and demanded egs?
operations for cateracts, free contraception
3 theories for resource allocation>
egalitarian
maximising utility
libertarian
what is the rule of rescue (Jonsen)
ethical imperative to save individual lives even when the money might be more efficiently spent to prevent deaths in the larger population
3 principles of substance and drug misuse management:
basic harm reduction: - advice to prevent death - advice to prevent BBV - referral brief intervention referral
alcohol units per week men and women:
14
drink drive limit:
<80mg alcohol/100ml blood
why women are drinking more:
more socially acceptable,
more disposable income
more drinks marketed at women
more drinking places aimed at female customers
risk factors for drinking:
drinking within family childhood behavioural problems early use of alcohol/nicotine/drugs poor coping responses depression
what is the prevention paradox?
intervention that brings large benefits to the community confers little benefit to each individual
public health strategy: tobacco control plan for england?
aims to stop promotion of tobacco make products less desirable regulate products help quitting reduce exposure to 2nd hand effective communications
2 stage capacity assessment:
- does pt have impairment of mind/brain
2. does impairment lead to lack of ability to make a specific decision
DOLs 6 assessments:
MHA MCA Age no refusals eligibility best interests
Frailty definition:
State of:
Having poor functional reserves
Failure to integrate responses in face of stress
Vulnerable to decompensation during illness, metabolic disturbances and drug side effects
geriatric giants:
immobility
instability
intellectual impairment
incontinence
pharmacokinetics:
time course of drug absorption, distribution, metabolism, and excretion.
pharmacodynamics:
effects of drugs and the mechanism of their action.
refeeding syndrome:
Metabolic derangement characterised by a group of symptoms that occur upon reintroduction of nutrition in severely malnourished/starved individuals
Kyphosis:
anteroposterior bending of spine
risk of # score in osteoporosis?
FRAX
intuitive decision making definition:
ability to understand something instantly without conscious reasoning
problems with intuitive decision making:
biases prone - over-attachment
inherited thinking
failure to consider alternative
error in prevalence perception/estimation
hw to minimise risks of intuitive decisions?
reduce distractions
personal deibiasing techniques - acknowledge bias, slowing and stopping techs
dual process theory
what is dual process theory?
combines intuitive and analytical thinking
negligence: burden of proof lies with?
pt
>50% probability = proven
how do things go wrong (4):
human error (swiss cheese model)
neglect
poor performance
misconduct
swiss cheese model:
organisational practices unsafe supervision preconditions for unsafe acts unsafe acts accident and injury
3 bucket model of error occuring?
self
context
task
sexual aversion disorder:
persistent or recurrent extreme aversion to and avoidance of all genital sexual contact with a partner
male hypoactive sexual desire disorder:
persistent or recurrent deficiency of sex fantasies and desire for sex
female sexual interest/arousal disorder:
failure of genital response
lack of or significantly reduced sex interest or arousal
erectile dysfunction:
difficulty in developing or maintaining an erection suitable for satisfying intercourse
inhibited/delayed ejaculation:
marked delay or absence of ejaculation occurring almost or all occasions without the individual desiring the delay
rapid ejaculation:
inability to control ejaculation sufficiently for both partners to enjoy sexual interaction
<1 min (roughly) from penetration + before he wishes it
retrograde ejaculation:
occurs when semen which would normally be ejaculated via the urethra is redirected into the bladder
dyspareunia:
pain during sex for either men or women
vaginismus:
spasm of pelvic floor muscles that surround the vagina, causing occlusion of the vaginal opening
penile entry is either impossible or painful
vulvodynia:
persistent unexplained pain in the vulva
Peyronie’s disease:
fibrous plaque formation in the tunica albuginea of the penis associated with pain, ED, anatomical malformations which negatively affect the QOL of affected men
azoospermia:
absence of sperm in ejaculate
hypospadias:
abnormally placed urinary meatus (opening)
anejaculation:
pathological inability to ejaculate in males with or without orgasms
sexual problems (broadly) 5:
drive desire/libido excitation organism resolution
sex response cycle:
desire
arousal
orgasm
resolution
sexual assessment:
full Hx phys ex fasting glucose, lipid ratio - CVD T, sex hormones binding globulin, albumin, free androgen index prolactin TSH oestrogen FBC
menopause and sexual dysfunction:
vaginal dryness
vaginal and pelvic pain
vaginal atrophy
change in self, image, mood, memory, cognition,
changes in desire
relationship, psychosoial, health factors
physical discomfort - sleep, night sweats
organis: causes of premature ejaculation:
genetics penile hypersensitivity hyperthyroidism prostatitis co-morbid sexual problems infrequent ejaculations
psychological causes of premature ejaculation:
performance anxiety early learned experiences lack of experience psych and environmental factors relationship issues
pathology: premature ejaculation:
primary - lifelong experience of problem since puberty
secondary - problem only occurring only in later life
treatment of premature ejaculation:
topical LA - stud 100 spray, special condoms
dapoxetine SSRI - PRN 3 hours before sex (short 1/2life)
couple psychosexual therapy - education, permission giving, normalising, partner expectations. sansate.
behavioural therapy - stop/start squeeze technique, kegel exercises
organic causes of vaginismus:
vulvovaginitis, FGM, congenital abnormalities, dyspareunia
psychological causes of vaginismus:
misinformation/mistaken beliefs, religious/cultural issues, fear of pregnancy, previous abuse, relationship issues
treatment of vaginismus:
personal sexual growth program,
behavioural interventions - mindfulness, self exploration, examination, kegel exercises
integrated CBT - everything integrated
public health definition:
science and art of preventing disease, prolonging life and promoting health through organised efforts of society
define bias:
deviation from true estimation of the association between exposure and outcome
2 types of bias:
selection information (measurement)
confounding:
situation where a factor is associated with the exposure of interest and independently influences the outcome (but does not lie on the causal pathway)
population vs high risk approach to prevention:
population - screen everyone
high risk - screen high risk only
health economics: basic economic health problem:?
scarcity - finite resources for infinite needs
opportunity cost -
benefits forgone from not allocating the resources to the next best activity
economic efficiency:
resources are allocated such that it achieves maximum benefit
types of economic evaluation: BUME
Cost benefit analysis (monetary units)
cost utility analysis (per QALY gained: NHS
evaluation of health needs:
Evaluation is a process that attempts to determine as systematically and objectively as possible the relevance of needs - Bradshaws needs
