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
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)
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
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
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
6
Q
what can happen at any stage of the transtheoretical model?
A
relapse
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
8
Q
a) What are the components of Donabedian Framework?
A
- Structure
- Process
- Outcome
- Output
9
Q
what is the Donabedian framework used for?
A
to assess whether a specific service meets it’s objective
10
Q
advantage of cohort study?
A
- Can assess multiple risk factors in one study
- Temporality – identify bias
11
Q
disadvantage of cohort study?
A
- Sample size may be too small
- Lost follow ups
- £££££
12
Q
define: incidence?
A
number of new cases per specific population per specific time period
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
14
Q
what is incidence rate relative to?
A
person years
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
16
Q
Interpreting association: what can association be due to?
A
bias chance confounding reverse causality true association
17
Q
which criteria assesses true association?
A
Bradford Hill criteria
18
Q
what does the Bradford Hill criteria include?
A
- temporality - exposure before disease
- dose-response - more dose>more response
- strength - p-values tiny
- reversibility - minus exposure, -disease
- consistency - geog., demographics
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
20
Q
criteria for screening test:
A
Wilson and Jungner
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
22
Q
define: specificity?
A
proportion of those without the disease correctly excluded by screening
23
Q
define: positive predicted value?
A
The proportion of those who have tested positive who actually have the disease
24
Q
in domestic abuse: what 3 components make up the toxic triangle?
A
domestic abuse itself
Mental Health effects/impact
Substance abuse
25
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)
26
3 drugs to assist recovering alcoholics stay abstinent?
- Disulfiram
- Acomprosate
- Naltrexone
27
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
28
which 4 components make up the planning cycle for the health service?
**health needs assessment
planning
implementation
**evaluation
29
3 approaches to the health needs assessment:
- epidemiological
- comparative
- corporate
30
2 disadvantages of the corporate approach to a HNA?
blurs need and demand
political agenda could influence
loudest voice not majority voice heard
31
eg of something demanded but not needed or supplied?
certain plastic surgery on NHS
32
eg of something needed but not demanded or supplied?
ovarian cancer screening
treatment of child abusers
palliative care services
contraceptive services
33
eg of something supplied but not needed or demanded?
vaccinations
34
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
35
eg of needed and demanded but not supplied?
cure for cancer,
waiting lists
TOP in certain parts of world
36
eg of supplied and demanded but not needed?
Abx for viral URTI
37
2 short term cx of heroin use?
overdose, RDS, DVT, abscess
38
2 long term cx of heroin use
BBV, addiction, socioeconomic, violence
39
what are the 4 tests of whether medical negligence has occured?
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?
40
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
41
3 types of leadership?
transactional
transformational
behavioural
great man - born
42
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.
43
which human right is right to life?
2
44
which human right is right to not have inhumane treatment?
3
45
what is human right 8
right to have a private family life
46
what is human right 12? Is this absolute?
right to marry and have a family
| Limited
47
what is human right 14>
right not to suffer discrimination
48
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.
49
who needs to be informed when a never event occurs?
National Reporting and Learning System
| CQC
50
examples of never event (2):
```
PPH death
wrong implant
wrong site nerve block
retained foreign objects
suicide
wrong site surgery
```
51
which ethical principle considers the impact a decision will have on greater society/healthcare system?
utilitarianism
52
which ethical principle focuses on the decision and the duty of a doctor?
deontology
53
which ethical principle focuses on compassion and understanding others views?
virtue
54
3 domains of health?
health improvement
health protection
improving services
55
what are the dimensions of health inequality?
```
geographical location variation in health outcomes and provisions
different groups within society
socioeconomic
race
religion
trans
travelers
```
56
what are the two types of health equity?
horizontal
| vertical
57
what is vertical equity?
equal treatment for equal needs
| eg all those who have a CAP get the same tx
58
what is horizontal equity?
unequal treatment for unequal need
| eg pneumonia tx different to cold tx
59
What type of study is a cohort study?
longditudinal
f/u - prospective
different risk factors/tx
60
what is a cohort study?
- pick people
- split into exposed and unexposed
- see if groups get disease or not
- measures relative risk
61
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
62
what is a RCT?
randomised control trial
- pick people
- randomise control and treatment group
63
what is a cross sectional study?
pick people at one point at time to find out prevalence
64
what is an ecological study (population)?
- compares between populations
| - longditudinal - compares over time
65
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
66
primary prevention?
intervention to prevent onset of disease
67
secondary prevention?
intervention to pick up asymptomatic individuals with disease and treat
68
tertiary prevention?
intervention to reduce negative effects of established disease from symptomatic individuals
69
define: prevalence:
overall cases in specific population at a time point
70
what is relative risk?
compares 2 incidences or 2 prevalences
71
attributable risk:
Rate of disease that can be attributed to exposure
| incidence in exposed - unexposed
72
NNT/NNH:
1/Attributable risk (always round up)
73
sensitivity: define
% of those with the disease correctly identified
74
Define: negative predicted value:
if test negative, likelihood of actually not having the disease
75
Bradshaw "needs":
- felt (pt feelings)
- expressed (health seeking behaviours)
- normative (what healthcare staff think)
- comparative (comparing needs of 2 diff CCGs)
76
disadvantages of an epidemiological approach?
not enough data available
paternalism
doesn't consider felt need
77
Maxwell's dimensions of Quality?
```
Effectiveness
Efficiency
Equity
Acceptable
Accessible
Approproate
```
78
Qualitative methods: examples
observation, interviews, focus groups, survey, review of documents
79
Quantitative methods: examples
routinely collected data, review of records, PHQ9 questionnaires, specialist studies
80
what makes a communicable disease a public health concern?
```
high morbidity
high mortality
highly contagious
expensive to treat
effective treatment available
```
81
who notify in communicable disease control?
proper officer - is usually the consultant communicable disease control within 3 days by writing, or if urgent telephone
82
when are communicable diseases reported?
when they are suspected, not after - any case of clinical suspicion
can breach confidentiality if need to
83
cluster: define:
aggregation of cases which may or may not be linked
84
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
85
confirmed outbreak definition:
link confirmed with investigation
86
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
87
pandemic definition:
epidemic of world-wide proportions.
88
endemic definition:
disease or condition) regularly found among particular people or in a certain area
89
hyperendemic defintion:
exhibiting a high and continued incidence —used chiefly of human diseases hyperendemic malaria.
90
asapects of causality:
temporality (RCT)
| dose-response
91
Malnutrition definition:
deficiencies, excesses or imbalances in
| a person’s intake of energy and/or nutrients
92
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
93
which of the behaviour change models has temporal element?
transtheoretical only
94
which of Maxwell's dimensions of Quality ensures that patients receive the correct tx in a timely manner
appropriateness
95
how should the MCA impact human rights?
least restrictive way possible
96
what type of ethics is 'pt died in pain but Dr tells family they died peacefully to reduce distress'?
consequentialism
97
free prescription criteria:
>60
98
community care of children?
midwife <9 days
| health visitor >10 days
99
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
100
examples of abuse:
```
psychological
physical
sexual
financial
emotional
```
101
risk assessment tool for domestic abuse?
DASH
102
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
103
eg public health interventions for individuals?
vaccinations
104
eg public health interventions population level?
laws to make it harder to access alcohol/smoking
105
eg public health interventions community level?
education in schools
106
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
107
supplied and needed and demanded egs?
operations for cateracts, free contraception
108
3 theories for resource allocation>
egalitarian
maximising utility
libertarian
109
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
110
3 principles of substance and drug misuse management:
```
basic harm reduction:
- advice to prevent death
- advice to prevent BBV
- referral
brief intervention
referral
```
111
alcohol units per week men and women:
14
112
drink drive limit:
<80mg alcohol/100ml blood
113
why women are drinking more:
more socially acceptable,
more disposable income
more drinks marketed at women
more drinking places aimed at female customers
114
risk factors for drinking:
```
drinking within family
childhood behavioural problems
early use of alcohol/nicotine/drugs
poor coping responses
depression
```
115
what is the prevention paradox?
intervention that brings large benefits to the community confers little benefit to each individual
116
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
```
117
2 stage capacity assessment:
1. does pt have impairment of mind/brain
| 2. does impairment lead to lack of ability to make a specific decision
118
DOLs 6 assessments:
```
MHA
MCA
Age
no refusals
eligibility
best interests
```
119
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
120
geriatric giants:
immobility
instability
intellectual impairment
incontinence
121
pharmacokinetics:
time course of drug absorption, distribution, metabolism, and excretion.
122
pharmacodynamics:
effects of drugs and the mechanism of their action.
123
refeeding syndrome:
Metabolic derangement characterised by a group of symptoms that occur upon reintroduction of nutrition in severely malnourished/starved individuals
124
Kyphosis:
anteroposterior bending of spine
125
risk of # score in osteoporosis?
FRAX
126
intuitive decision making definition:
ability to understand something instantly without conscious reasoning
127
problems with intuitive decision making:
biases prone - over-attachment
inherited thinking
failure to consider alternative
error in prevalence perception/estimation
128
hw to minimise risks of intuitive decisions?
reduce distractions
personal deibiasing techniques - acknowledge bias, slowing and stopping techs
dual process theory
129
what is dual process theory?
combines intuitive and analytical thinking
130
negligence: burden of proof lies with?
pt
| >50% probability = proven
131
how do things go wrong (4):
human error (swiss cheese model)
neglect
poor performance
misconduct
132
swiss cheese model:
```
organisational practices
unsafe supervision
preconditions for unsafe acts
unsafe acts
accident and injury
```
133
3 bucket model of error occuring?
self
context
task
134
sexual aversion disorder:
persistent or recurrent extreme aversion to and avoidance of all genital sexual contact with a partner
135
male hypoactive sexual desire disorder:
persistent or recurrent deficiency of sex fantasies and desire for sex
136
female sexual interest/arousal disorder:
failure of genital response
| lack of or significantly reduced sex interest or arousal
137
erectile dysfunction:
difficulty in developing or maintaining an erection suitable for satisfying intercourse
138
inhibited/delayed ejaculation:
marked delay or absence of ejaculation occurring almost or all occasions without the individual desiring the delay
139
rapid ejaculation:
inability to control ejaculation sufficiently for both partners to enjoy sexual interaction
<1 min (roughly) from penetration + before he wishes it
140
retrograde ejaculation:
occurs when semen which would normally be ejaculated via the urethra is redirected into the bladder
141
dyspareunia:
pain during sex for either men or women
142
vaginismus:
spasm of pelvic floor muscles that surround the vagina, causing occlusion of the vaginal opening
penile entry is either impossible or painful
143
vulvodynia:
persistent unexplained pain in the vulva
144
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
145
azoospermia:
absence of sperm in ejaculate
146
hypospadias:
abnormally placed urinary meatus (opening)
147
anejaculation:
pathological inability to ejaculate in males with or without orgasms
148
sexual problems (broadly) 5:
```
drive
desire/libido
excitation
organism
resolution
```
149
sex response cycle:
desire
arousal
orgasm
resolution
150
sexual assessment:
```
full Hx
phys ex
fasting glucose, lipid ratio - CVD
T, sex hormones binding globulin, albumin, free androgen index
prolactin
TSH
oestrogen
FBC
```
151
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
152
organis: causes of premature ejaculation:
```
genetics
penile hypersensitivity
hyperthyroidism
prostatitis
co-morbid sexual problems
infrequent ejaculations
```
153
psychological causes of premature ejaculation:
```
performance anxiety
early learned experiences
lack of experience
psych and environmental factors
relationship issues
```
154
pathology: premature ejaculation:
primary - lifelong experience of problem since puberty
| secondary - problem only occurring only in later life
155
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
156
organic causes of vaginismus:
vulvovaginitis, FGM, congenital abnormalities, dyspareunia
157
psychological causes of vaginismus:
misinformation/mistaken beliefs, religious/cultural issues, fear of pregnancy, previous abuse, relationship issues
158
treatment of vaginismus:
personal sexual growth program,
behavioural interventions - mindfulness, self exploration, examination, kegel exercises
integrated CBT - everything integrated
159
public health definition:
science and art of preventing disease, prolonging life and promoting health through organised efforts of society
160
define bias:
deviation from true estimation of the association between exposure and outcome
161
2 types of bias:
```
selection
information (measurement)
```
162
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)
163
population vs high risk approach to prevention:
population - screen everyone
| high risk - screen high risk only
164
health economics: basic economic health problem:?
scarcity - finite resources for infinite needs
165
opportunity cost -
benefits forgone from not allocating the resources to the next best activity
166
economic efficiency:
resources are allocated such that it achieves maximum benefit
167
types of economic evaluation: BUME
Cost benefit analysis (monetary units)
| cost utility analysis (per QALY gained: NHS
168
evaluation of health needs:
Evaluation is a process that attempts to determine as systematically and objectively as possible the relevance of needs - Bradshaws needs
