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Medical School Finals > Public Health > Flashcards

Public Health Flashcards

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USMLE® Step 1 flashcards
1
Q

Define Health

A

Complete state of mental, physical and social well-being. Not just the absence of disease.

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2
Q

Define public health

A

The science and art of preventing disease, prolonging life and promoting health through organised efforts of society, organisations, public and private communities and individuals.

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3
Q

The key features of public health

A

1) Health promotion
2) Health protection
3) Service improvement

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4
Q

Health promotion ?

A
  • Lifestyle changes
  • Overcoming inequality
  • Education
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5
Q

Health protection ?

A
  • Infectious disease and natural disaster management

- Emergency responses

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6
Q

Service improvement?

A
  • Efficiency
  • Efficacy
  • Audit
  • Governance
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7
Q

Prevention; types?

A

Primary - prevent before it occurs
Secondary - Limits impact of disease
Tertiary - Manages disease complications.

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8
Q

Prevention paradox

A

If something brings benefit to a population it often has little benefit to the individual; wearing seatbelts.

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9
Q

6 in 1 immunisation; what is it and when is it given?

A
  1. diptheria
  2. tetanus
  3. Pertussis
  4. Polio
  5. HIB
  6. Hep B

8w, 12w, 16w

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10
Q

Screening; Types?

A
  • Primary - identifies those at risk and screens to prevent disease from occurring.
  • Secondary - aims to find the disease in it’s early stages.
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11
Q

Wilson and Junger criteria

A

1) Condition should be important
2) natural Hx should be understood
3) Recognisable latent phase
4) Rx should be acceptable
5) Facilities for Dx and Rx should be available
6) Adequate health service provision should exist for those found +’ve.
7) Suitable test for early stage
8) Acceptable test
9) Should be repeatable
10) Agreed policy on whom to treat
11) Costs should be balanced against benefits
12) Risks, psychological and physical should be less than risks

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12
Q

Screening programme examples;

A
  • Breast cancer
  • Colon cancer
  • STI
  • Diabetic retinopathy
  • Newborn screening
  • Cervical smear
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13
Q

Cervical screening

A
  • High risk HPV (16/18)
  • Screening 25-64 (25-50 every 3yrs)(50-64 every 5 yrs)
  • Gardasil protects against 6,11,16,18
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14
Q

Breast screening

A
  • 50-70yrs
  • every 3 yrs
  • Triple assessment if positive.
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15
Q

Antenatal screening

A
  • 1st trimester (combined - nuchal translucency, PAPP-A, bHCG) and maternal infections (Hep B, HIV, malaria)
  • 20 weeks anomaly scan
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16
Q

NIPE

A
  • Newborn hearing test
  • Newborn physical exam
  • Guthrie test - MCADD, Sickle cell, CF, congential hypothyroidism, maple syrup disease, PKU.
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17
Q

False positive

A

Some people will be screened and found to be positive when infact they are not.

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18
Q

False negative

A

Some people will be screened and shown to not have a disease when infact they do.

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19
Q

Sensitivity

A
  • The proportion of people who are screened positive who actually have the disease.

True +’ve/(True +’ve + False -‘ve)

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20
Q

Specificity

A

The proportion of people who are correctly excluded via screening

True negative/(False positive + True negative)

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21
Q

Positive predictive value

A
  • Proportion of people who have a positive screening test and have the disease.

True positive/ (true positive + false positive)

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22
Q

Negative predictive value

A
  • Proportion of people who have a negative result who do not have the disease

True negative/ (False negative + true negative)

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23
Q

Selection bias

A
  • Essentially those who partake in screening may be a certain subset of society (worried well) which may influence results.
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24
Q

Length time bias

A
  • Screening happens at regular intervals.

- Disease may develop in the intervening period

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25
Q

Lead time bias

A
  • Positive result may not actually influence survival the patient may just be aware of disease for longer which makes it appear like extended survival when without screening they would have been perfectly fine.
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26
Q

Epidemiology

A

Study of frequency, distribution and determinants of disease and health related states in the population.

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27
Q

Prevalence

A

All existing cases at a point in time

Number of cases at one point in time / total number of people in the defined population at the same time period.

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28
Q

Incidence

A

All new cases within a time period in a population.

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29
Q

Risk

A
  • Total number of cases in a defined population at risk over a time period.
  • Likelihood that someone will develop an outcome in a time period.

Number of new cases among contact group in a specified time period / total number of people at risk in the same time period.

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30
Q

Odds

A
  • Ratio
  • Ratio of risk that a person will develop the outcome during a time period

Number of new cases in a time period / number who did not become a case in the same time period.

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31
Q

Endemic

A

Persistent level of disease

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32
Q

Gillick competence

A
  • Medical treatment
  • Whether a child under the age of 16 can give consent w/o the need of parental knowledge or permission.
  • UNDERSTAND, REASON, RETAIN, RESPOND
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33
Q

Fraser Guidelines

A
  • Refer to contraception only.
  • The girl will understand the advice
  • Cannot be persuaded to inform parents
  • Will continue to have intercourse either way
  • Her physical or mental health may suffer if she doesn’t get the contraception.
  • This is in her best interests.
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34
Q

Observational studies

A
  • Cohort (analytical - looks at who was exposed and non-exposed and whether they have the disease or not)
  • Case control (analytical - looks at who was exposed or not from cases of a disease (retrospective))
  • Case report (descriptive)
  • Cross sectional (descriptive)
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35
Q

Ecological studies

A
  • Carried on a population level.
  • In their own environment
  • Looks for associations not causality
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36
Q

Cross sectional study

A
  • Prevalence
  • Examines distribution and determinants
  • Data is collected on each ppt at a single point in time.
37
Q

Cohort study

A
  • A group of people who share a common characteristic.
  • Presence or absence of a suspected risk factor.
  • Measures incidence.
  • Prospective or retrospective.
  • Tells us about causality
38
Q

Case control

A
  • Reverse of Cohort study.
  • Identifies those with and without an outcome and determine there previous exposures.
  • Retrospect.
39
Q

Bradford hill criteria of causality

A
  1. strength of association
  2. Consistency of findings
  3. Specificity
  4. temporality (effect occurs after cause)
  5. Biological gradient (greater exposure = greater effects)
  6. Plausibility
  7. Coherence
  8. Experiment
  9. Analogy to similar factors
40
Q

PICO

A

Patient
Intervention
Comparison
Outcome

41
Q

Bias

A

Systematic error in studies which lead to errors in results or skewed conclusions.

42
Q

Types of bias

A

Observer, measurement, lead-time, length-time, publishing.

43
Q

How to overcome Bias

A

Blinding and randomisation

44
Q

Confidence interval

A
  • 95% CI

- If the study was done 100times 95 are likely to contain the true value for the population but 5 would not.

45
Q

P value

A

The probability of an event occurring assuming the null hypothesis is true.

  • Low P value means we have sufficient evidence to reject the null hypothesis.
46
Q

Type 1 error

A
  • False positive

- Accidentally rejected the null hypothesis

47
Q

Type 2 error

A
  • False negatives

- Accidentally didn’t reject the null.

48
Q

Four quadrants approach

A

1) Medical indications
2) QOL
3) Patient preferences
4) Contextual features.

49
Q

Resource allocation

A

Human right to health care

- Article 2 of the human rights convention.

50
Q

Utilitarianism

A

Resources being allocated to less expensive treatments which will benefit more people
QALY

51
Q

Equity and distributive justice

A

Equals should be treated equally and unequally in proportion to the relevant inequalities.

52
Q

Health needs assessment

A 
Need = the ability to benefit 
Demand = what people want 
Supply = what we provide
53
Q

Types of need

A 
Felt = what people want 
Expressed = What people say they want 
Normative = what a professional defines as needed
Comparative = comparing severity and interventions and relevant costs. to another population.
54
Q

Needed and demanded

A

Cure for cancer
Cure for chronic disease
Better mental health services

55
Q

Needed and supplied

A

Smoking cessation
Alcohol cessation
Colorectal cancer screening

56
Q

Supplied and demanded

A

Antibiotics for viral illness

PSA

57
Q

Needed, supplied and demanded

A

Free contraception

Breast cancer screening

58
Q

Health needs assessment approaches

A
  1. Epidemiological = person/place/time
  2. Corporate = involves stakeholders (doctors, funding bodies, patients)
  3. Comparative = compares with similar areas etc.
59
Q

Advantages and disadvantages of epidemiological HNA

A

Addresses the problem directly

Can be expensive, involves analysis and data collection.

60
Q

Advantages and disadvantages of Corporate HNA

A

Recognises people who are involved and important to the process

Demands and needs can blur, open to political agenda, bias.

61
Q

Advantages and disadvantages to comparative HNA

A

Can see direct evidence in a population.
Quick and inexpensive

Hard to find the comparator population.

62
Q

Evaluation frameworks

A
  1. Donabedian
    Structure/input –> Process –> Outut –> Outcome
  2. Maxwell
    Efficacy, efficiency, equity, access, acceptability, appropriateness
63
Q

Maslow’s hierarchy of needs

A 
Level 1 = physiological 
Level 2 = safety
Level 3 = Love and safeguarding 
Level 4 = Esteem 
Level 5 = self-actualisation
64
Q

Alcohol screening

A
  1. CAGE

2. AUDIT

65
Q

Alcohol unit

A

Multiply the volume in ML by the alcohol by volume and divide by 1000.

66
Q

Alcohol withdrawal Sx

A
  1. in 8hrs –> Nausea, insomnia, anxiety, abdominal pain
  2. 1-3 days –> HTN, fevers
  3. > 3days –> hallucinations, fever, seizures and agitation
67
Q

Wernicke’s encephalopathy

A
  • Acute onset of a confusional state
  • Occular signs (nystagmus, opthalmoplgeia)
  • Ataxia
  • Peripheral neuropathy, tachycardia
68
Q

Korsakoff’s syndrome

A
  • Late stage after WE.
  • Thiamine deficiency
  • Amnesia, confabulation, apathy, lack of insight
69
Q

Alcohol cessation help

A
  • AA
  • 12 step
  • Disulfram - makes people sick when they consume
  • Naltrexone - stops pleasure derived from drinking
70
Q

Opioid helps

A
  • NA
  • Buprenoprhine
  • Methadone
71
Q

Services for drug users

A

SEX-C SHIT

Sexual health screening 
Needle exchange 
Contraception 
Signposting 
Health check 
Immunisations 
Treatment
72
Q

Health behaviours

A

Health behaviour - aimed at preventing disease

73
Q

Illness behaviour

A

Aims to define illness and seeks remedy

74
Q

Sick role

A

Aiming to no longer be sick

75
Q

Stages of change model

A
  1. Pre-contemplation
  2. Contemplation
  3. Preparation
  4. Action
  5. Maintenance
  6. Relapse
76
Q

Theory of planned behaviour

A
  1. Attitude
  2. Subjective norm
  3. Perceived behavioural control.
77
Q

Negligence

A
  1. Bolam test

2. Bolitho caveat (a judge can disagree with the panel of medics)

78
Q

Types of error

A
  1. Sloth
  2. Fixation
  3. Communication breakdown
  4. Playing odds
  5. Bravado
  6. Ignorance
  7. Mis-triage
  8. Lack of skill
  9. System error
79
Q

Why does error occur

A 
Human factors 
System failure 
Misconduct 
Mis-judgement 
Neglect
80
Q

Never events

A
  • wrong site surgery
  • wrong implants
  • wrong route admission
  • wrong potassium
  • wrong insulin
  • overdose MTX
  • falls from windows
  • Trapped in bedrails
  • Incompatible blood Tx
  • Scalding patients
  • Incorrect NG tube
81
Q

Health economics

A
  1. Opportunity cost
    - Spending resources on one activity prevents others
    - Sacrifice and utilitarianism.
  2. Economic efficiency
  3. Equity
  4. Economic evaluation
82
Q

QALY

A

Combines life years with QOL - Year (number) + QOL

Number of years x utility.

83
Q

Others ways of measuring health benefits

A
  1. Natural units (bp reduction)
  2. QALY
  3. Money
84
Q

Types of economic evaluation

A
  • Cost effectiveness (outcomes in natural units)
  • Cost utility (outcomes measures in QALY)
  • Cost benefit (outcomes in money)
85
Q

Horizonal Equity

A

all people pay the same tax.

All people in the same bracket pay the same tax.

86
Q

Vertical equity

A

Those who earn more pay more.

87
Q

DOLS

A
  • Deprivation of liberty in those who lack capacity to consent to care and Rx to keep them safe from harm.
  • Can be challenged
88
Q

Incremental cost effectiveness ratio for QALY

A

Difference in cost / difference in benefit

Drug 1 costs 10,000 per person and 5 QALY benefit.

Drug 2 costs 25,000 per person and 6 QALY benefit

ICER = (25,000 - 10,000) / (6-5)
= 15,000 / QALY gained.

89
Q

NHS aim for QALY on ICER

A

1 QALY for 20,000

Medical School Finals (24 decks)

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