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3a > public health > Flashcards

public health Flashcards

1
Q

name 3 models of behaviour change (3):

A
  • health belief model
  • theory of planned behaviour
  • stages of change/transtheoretical model
  • nudging
  • financial incentives
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2
Q

list the 4 things perceived in the health belief model:

A 
perceives:
1. susceptible to ill health
2. severity of ill health 
3. benefits of behaviour change 
4. barriers of taking action
(cues to action)
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3
Q

in the health belief model - if the individual believes all 4 things (perceptions) then what is thought to happen:

A

increased chance of engagement in health-promoting behaviour

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4
Q

in the theory of planned behaviour model, what 3 things impact intention to change behaviour? (3):

A

attitudes
social/subjective norms
perceived behavioural control

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5
Q

what are the 5 stages of behaviour change listed in the stages of change / transtheoretical model?

A 
pre-contemplation
contemplation
preparation
action
maintenance
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6
Q

what can happen at any stage of the transtheoretical model?

A

relapse

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7
Q

disadvantages of health belief model?

A

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

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8
Q

a) What are the components of Donabedian Framework?

A
  • Structure
  • Process
  • Outcome
  • Output
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9
Q

what is the Donabedian framework used for?

A

to assess whether a specific service meets it’s objective

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10
Q

advantage of cohort study?

A
  • Can assess multiple risk factors in one study

- Temporality – identify bias

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11
Q

disadvantage of cohort study?

A
  • Sample size may be too small
  • Lost follow ups
  • £££££
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12
Q

define: incidence?

A

number of new cases per specific population per specific time period

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13
Q

what is cumulative incidence?

A

risk of getting disease in a set time period in a set population if don’t already have the disease

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14
Q

what is incidence rate relative to?

A

person years

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15
Q

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.

A

3/4

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16
Q

Interpreting association: what can association be due to?

A 
bias
chance
confounding
reverse causality
true association
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17
Q

which criteria assesses true association?

A

Bradford Hill criteria

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18
Q

what does the Bradford Hill criteria include?

A
  1. temporality - exposure before disease
  2. dose-response - more dose>more response
  3. strength - p-values tiny
  4. reversibility - minus exposure, -disease
  5. consistency - geog., demographics
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19
Q

what are the two types of screening bias?

A

lead time - screening picks up sooner-increased survival time

length time - if screen at spec time pt, might miss candidates

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20
Q

criteria for screening test:

A

Wilson and Jungner

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21
Q

name 4 wilson and jungner screening criteria:

A
  • 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
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22
Q

define: specificity?

A

proportion of those without the disease correctly excluded by screening

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23
Q

define: positive predicted value?

A

The proportion of those who have tested positive who actually have the disease

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24
Q

in domestic abuse: what 3 components make up the toxic triangle?

A

domestic abuse itself
Mental Health effects/impact
Substance abuse

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25
Q

in a serious domestic abuse incident, in absence of the victim, who can advocate for them in an MDT?

A

MARAC - multiple agency risk assessment conference (independent)

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26
Q

3 drugs to assist recovering alcoholics stay abstinent?

A
  • Disulfiram
  • Acomprosate
  • Naltrexone
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27
Q

what is the alcohol harm paradox?

A
  • 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
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28
Q

which 4 components make up the planning cycle for the health service?

A

**health needs assessment
planning
implementation
**evaluation

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29
Q

3 approaches to the health needs assessment:

A
  • epidemiological
  • comparative
  • corporate
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30
Q

2 disadvantages of the corporate approach to a HNA?

A

blurs need and demand
political agenda could influence
loudest voice not majority voice heard

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31
Q

eg of something demanded but not needed or supplied?

A

certain plastic surgery on NHS

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32
Q

eg of something needed but not demanded or supplied?

A

ovarian cancer screening
treatment of child abusers
palliative care services
contraceptive services

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33
Q

eg of something supplied but not needed or demanded?

A

vaccinations

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34
Q

eg of needed and supplied but not demanded?

A

health promotion, some screening
GU contact tracing
MMR for some pts
collaborating assessment and management of suicidality

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35
Q

eg of needed and demanded but not supplied?

A

cure for cancer,
waiting lists
TOP in certain parts of world

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36
Q

eg of supplied and demanded but not needed?

A

Abx for viral URTI

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37
Q

2 short term cx of heroin use?

A

overdose, RDS, DVT, abscess

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38
Q

2 long term cx of heroin use

A

BBV, addiction, socioeconomic, violence

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39
Q

what are the 4 tests of whether medical negligence has occured?

A
  1. was there a duty of care?
  2. was there a breach of the duty of care?
  3. did the patient come to harm?
  4. did the breach cause the harm?
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40
Q

what are the guidelines that determine if there was a breach in the duty of care?

A

Bolum & Beletho

group of reasonable peers would do the same based on reasonable analysis

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41
Q

3 types of leadership?

A

transactional
transformational
behavioural
great man - born

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42
Q

WHO definition of health?

A

Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.

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43
Q

which human right is right to life?

A

2

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44
Q

which human right is right to not have inhumane treatment?

A

3

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45
Q

what is human right 8

A

right to have a private family life

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46
Q

what is human right 12? Is this absolute?

A

right to marry and have a family

Limited

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47
Q

what is human right 14>

A

right not to suffer discrimination

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48
Q

define a never event:

A

A serious, intolerable and inexcusable patient safety incident that largely preventable and should not have occurred if adequate preventative measures have been implemented.

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49
Q

who needs to be informed when a never event occurs?

A

National Reporting and Learning System

CQC

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50
Q

examples of never event (2):

A 
PPH death
wrong implant
wrong site nerve block 
retained foreign objects
suicide
wrong site surgery
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51
Q

which ethical principle considers the impact a decision will have on greater society/healthcare system?

A

utilitarianism

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52
Q

which ethical principle focuses on the decision and the duty of a doctor?

A

deontology

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53
Q

which ethical principle focuses on compassion and understanding others views?

A

virtue

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54
Q

3 domains of health?

A

health improvement
health protection
improving services

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55
Q

what are the dimensions of health inequality?

A 
geographical location variation in health outcomes and provisions
different groups within society
socioeconomic
race
religion
trans
travelers
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56
Q

what are the two types of health equity?

A

horizontal

vertical

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57
Q

what is vertical equity?

A

equal treatment for equal needs

eg all those who have a CAP get the same tx

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58
Q

what is horizontal equity?

A

unequal treatment for unequal need

eg pneumonia tx different to cold tx

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59
Q

What type of study is a cohort study?

A

longditudinal
f/u - prospective
different risk factors/tx

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60
Q

what is a cohort study?

A
  • pick people
  • split into exposed and unexposed
  • see if groups get disease or not
  • measures relative risk
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61
Q

what is a case controlled study?

A
  • retrospective, observational
  • pick people
  • split into disease or not disease
  • go back and see if each group exposed or not
  • uses odds ratio
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62
Q

what is a RCT?

A

randomised control trial

  • pick people
  • randomise control and treatment group
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63
Q

what is a cross sectional study?

A

pick people at one point at time to find out prevalence

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64
Q

what is an ecological study (population)?

A
  • compares between populations

- longditudinal - compares over time

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65
Q

Odds ratio?

A

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

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66
Q

primary prevention?

A

intervention to prevent onset of disease

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67
Q

secondary prevention?

A

intervention to pick up asymptomatic individuals with disease and treat

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68
Q

tertiary prevention?

A

intervention to reduce negative effects of established disease from symptomatic individuals

69
Q

define: prevalence:

A

overall cases in specific population at a time point

70
Q

what is relative risk?

A

compares 2 incidences or 2 prevalences

71
Q

attributable risk:

A

Rate of disease that can be attributed to exposure

incidence in exposed - unexposed

72
Q

NNT/NNH:

A

1/Attributable risk (always round up)

73
Q

sensitivity: define

A

% of those with the disease correctly identified

74
Q

Define: negative predicted value:

A

if test negative, likelihood of actually not having the disease

75
Q

Bradshaw “needs”:

A
  • felt (pt feelings)
  • expressed (health seeking behaviours)
  • normative (what healthcare staff think)
  • comparative (comparing needs of 2 diff CCGs)
76
Q

disadvantages of an epidemiological approach?

A

not enough data available
paternalism
doesn’t consider felt need

77
Q

Maxwell’s dimensions of Quality?

A 
Effectiveness
Efficiency
Equity
Acceptable
Accessible 
Approproate
78
Q

Qualitative methods: examples

A

observation, interviews, focus groups, survey, review of documents

79
Q

Quantitative methods: examples

A

routinely collected data, review of records, PHQ9 questionnaires, specialist studies

80
Q

what makes a communicable disease a public health concern?

A 
high morbidity
high mortality
highly contagious 
expensive to treat
effective treatment available
81
Q

who notify in communicable disease control?

A

proper officer - is usually the consultant communicable disease control within 3 days by writing, or if urgent telephone

82
Q

when are communicable diseases reported?

A

when they are suspected, not after - any case of clinical suspicion
can breach confidentiality if need to

83
Q

cluster: define:

A

aggregation of cases which may or may not be linked

84
Q

suspected outbreak definition:

A
  • 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
85
Q

confirmed outbreak definition:

A

link confirmed with investigation

86
Q

epidemic definition:

A

disease affects a greater number people than is usual for the locality or one that spreads to areas not usually associated with the disease

87
Q

pandemic definition:

A

epidemic of world-wide proportions.

88
Q

endemic definition:

A

disease or condition) regularly found among particular people or in a certain area

89
Q

hyperendemic defintion:

A

exhibiting a high and continued incidence —used chiefly of human diseases hyperendemic malaria.

90
Q

asapects of causality:

A

temporality (RCT)

dose-response

91
Q

Malnutrition definition:

A

deficiencies, excesses or imbalances in

a person’s intake of energy and/or nutrients

92
Q

disordered eating features:

A

restraint; strict dieting; disinhibition;
emotional eating; binge-eating; night eating; weight & shape
concerns; inappropriate compensatory behaviours that do not
warrant a clinical diagnosis

93
Q

which of the behaviour change models has temporal element?

A

transtheoretical only

94
Q

which of Maxwell’s dimensions of Quality ensures that patients receive the correct tx in a timely manner

A

appropriateness

95
Q

how should the MCA impact human rights?

A

least restrictive way possible

96
Q

what type of ethics is ‘pt died in pain but Dr tells family they died peacefully to reduce distress’?

A

consequentialism

97
Q

free prescription criteria:

A

> 60

98
Q

community care of children?

A

midwife <9 days

health visitor >10 days

99
Q

domestic abuse definition:

A

any incident/pattern of incidents of controlling/coercive, threatening behaviour, violence or abuse >16yos intimate partners or family members regardless of gender or sexuality

100
Q

examples of abuse:

A 
psychological 
physical 
sexual 
financial 
emotional
101
Q

risk assessment tool for domestic abuse?

A

DASH

102
Q

high risk of domestic abuse?

A

identifiable indicators of imminent risk of serious harm
dynamic, could happen at any time, impact would be serious
break confidentiality if need to

103
Q

eg public health interventions for individuals?

A

vaccinations

104
Q

eg public health interventions population level?

A

laws to make it harder to access alcohol/smoking

105
Q

eg public health interventions community level?

A

education in schools

106
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

107
Q

supplied and needed and demanded egs?

A

operations for cateracts, free contraception

108
Q

3 theories for resource allocation>

A

egalitarian
maximising utility
libertarian

109
Q

what is the rule of rescue (Jonsen)

A

ethical imperative to save individual lives even when the money might be more efficiently spent to prevent deaths in the larger population

110
Q

3 principles of substance and drug misuse management:

A 
basic harm reduction:
- advice to prevent death
- advice to prevent BBV
- referral
brief intervention
referral
111
Q

alcohol units per week men and women:

A

14

112
Q

drink drive limit:

A

<80mg alcohol/100ml blood

113
Q

why women are drinking more:

A

more socially acceptable,
more disposable income
more drinks marketed at women
more drinking places aimed at female customers

114
Q

risk factors for drinking:

A 
drinking within family
childhood behavioural problems
early use of alcohol/nicotine/drugs
poor coping responses
depression
115
Q

what is the prevention paradox?

A

intervention that brings large benefits to the community confers little benefit to each individual

116
Q

public health strategy: tobacco control plan for england?

A 
aims to stop promotion of tobacco
make products less desirable
regulate products
help quitting
reduce exposure to 2nd hand
effective communications
117
Q

2 stage capacity assessment:

A
  1. does pt have impairment of mind/brain

2. does impairment lead to lack of ability to make a specific decision

118
Q

DOLs 6 assessments:

A 
MHA
MCA
Age 
no refusals 
eligibility
best interests
119
Q

Frailty definition:

A

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

120
Q

geriatric giants:

A

immobility
instability
intellectual impairment
incontinence

121
Q

pharmacokinetics:

A

time course of drug absorption, distribution, metabolism, and excretion.

122
Q

pharmacodynamics:

A

effects of drugs and the mechanism of their action.

123
Q

refeeding syndrome:

A

Metabolic derangement characterised by a group of symptoms that occur upon reintroduction of nutrition in severely malnourished/starved individuals

124
Q

Kyphosis:

A

anteroposterior bending of spine

125
Q

risk of # score in osteoporosis?

A

FRAX

126
Q

intuitive decision making definition:

A

ability to understand something instantly without conscious reasoning

127
Q

problems with intuitive decision making:

A

biases prone - over-attachment
inherited thinking
failure to consider alternative
error in prevalence perception/estimation

128
Q

hw to minimise risks of intuitive decisions?

A

reduce distractions
personal deibiasing techniques - acknowledge bias, slowing and stopping techs
dual process theory

129
Q

what is dual process theory?

A

combines intuitive and analytical thinking

130
Q

negligence: burden of proof lies with?

A

pt

>50% probability = proven

131
Q

how do things go wrong (4):

A

human error (swiss cheese model)
neglect
poor performance
misconduct

132
Q

swiss cheese model:

A 
organisational practices
unsafe supervision
preconditions for unsafe acts
unsafe acts
accident and injury
133
Q

3 bucket model of error occuring?

A

self
context
task

134
Q

sexual aversion disorder:

A

persistent or recurrent extreme aversion to and avoidance of all genital sexual contact with a partner

135
Q

male hypoactive sexual desire disorder:

A

persistent or recurrent deficiency of sex fantasies and desire for sex

136
Q

female sexual interest/arousal disorder:

A

failure of genital response

lack of or significantly reduced sex interest or arousal

137
Q

erectile dysfunction:

A

difficulty in developing or maintaining an erection suitable for satisfying intercourse

138
Q

inhibited/delayed ejaculation:

A

marked delay or absence of ejaculation occurring almost or all occasions without the individual desiring the delay

139
Q

rapid ejaculation:

A

inability to control ejaculation sufficiently for both partners to enjoy sexual interaction
<1 min (roughly) from penetration + before he wishes it

140
Q

retrograde ejaculation:

A

occurs when semen which would normally be ejaculated via the urethra is redirected into the bladder

141
Q

dyspareunia:

A

pain during sex for either men or women

142
Q

vaginismus:

A

spasm of pelvic floor muscles that surround the vagina, causing occlusion of the vaginal opening
penile entry is either impossible or painful

143
Q

vulvodynia:

A

persistent unexplained pain in the vulva

144
Q

Peyronie’s disease:

A

fibrous plaque formation in the tunica albuginea of the penis associated with pain, ED, anatomical malformations which negatively affect the QOL of affected men

145
Q

azoospermia:

A

absence of sperm in ejaculate

146
Q

hypospadias:

A

abnormally placed urinary meatus (opening)

147
Q

anejaculation:

A

pathological inability to ejaculate in males with or without orgasms

148
Q

sexual problems (broadly) 5:

A 
drive
desire/libido
excitation
organism 
resolution
149
Q

sex response cycle:

A

desire
arousal
orgasm
resolution

150
Q

sexual assessment:

A 
full Hx
phys ex
fasting glucose, lipid ratio - CVD
T, sex hormones binding globulin, albumin, free androgen index
prolactin
TSH
oestrogen
FBC
151
Q

menopause and sexual dysfunction:

A

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

152
Q

organis: causes of premature ejaculation:

A 
genetics
penile hypersensitivity 
hyperthyroidism 
prostatitis 
co-morbid sexual problems
infrequent ejaculations
153
Q

psychological causes of premature ejaculation:

A 
performance anxiety
early learned experiences 
lack of experience
psych and environmental factors 
relationship issues
154
Q

pathology: premature ejaculation:

A

primary - lifelong experience of problem since puberty

secondary - problem only occurring only in later life

155
Q

treatment of premature ejaculation:

A

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

156
Q

organic causes of vaginismus:

A

vulvovaginitis, FGM, congenital abnormalities, dyspareunia

157
Q

psychological causes of vaginismus:

A

misinformation/mistaken beliefs, religious/cultural issues, fear of pregnancy, previous abuse, relationship issues

158
Q

treatment of vaginismus:

A

personal sexual growth program,
behavioural interventions - mindfulness, self exploration, examination, kegel exercises
integrated CBT - everything integrated

159
Q

public health definition:

A

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

160
Q

define bias:

A

deviation from true estimation of the association between exposure and outcome

161
Q

2 types of bias:

A 
selection
information (measurement)
162
Q

confounding:

A

situation where a factor is associated with the exposure of interest and independently influences the outcome (but does not lie on the causal pathway)

163
Q

population vs high risk approach to prevention:

A

population - screen everyone

high risk - screen high risk only

164
Q

health economics: basic economic health problem:?

A

scarcity - finite resources for infinite needs

165
Q

opportunity cost -

A

benefits forgone from not allocating the resources to the next best activity

166
Q

economic efficiency:

A

resources are allocated such that it achieves maximum benefit

167
Q

types of economic evaluation: BUME

A

Cost benefit analysis (monetary units)

cost utility analysis (per QALY gained: NHS

168
Q

evaluation of health needs:

A

Evaluation is a process that attempts to determine as systematically and objectively as possible the relevance of needs - Bradshaws needs

3a (7 decks)

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