Public health Flashcards
what are some definitions of health?
WHO 1948 definition:
– “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”
WHO 1984 definition:
– “The extent to which an individual or a group is able to realise aspirations and satisfy needs, and to change or cope with the environment. Health is a resource for everyday life, not the objective of living; it is a positive concept emphasising social and personal resources as well as physical capabilities”
What is public health
The science and art of promoting and protecting health and prolonging life through the organised efforts in society.
What levels of intervention are there in public health?(least to most invasive)
Do nothing or monitor situation, Provide information, Enable choice, Guide choice by changing default, guide choice through incentives, guide choice through disincentives, restrict choice, eliminate choice.
Why is prevention important?
it is better than a cure
What is Primary prevention?
Preventing the onset of disease
What is Secondary prevention?
Preventing the progression of a disease from a pre-clinical stage.
What is tertiary prevention?
Preventing morbidity or mortality through treatment of clinical disease
What needs to be taken into account when launching a public health campaign.
Which type of prevention. What age people? Which services are needed? What budget will you require? What are the political considerations?
What are the unmodifiable determinants of health?
Age, sex, ethnicity, sexuality genetics.
What are some determinants for health?
Income, environment, occupation, culture, societal status and access to education
What are the three domains of public health?
Health improvement, Health protection and Healthcare
What does health improvement involve?
Inequalities Education Housing Employment Family / community Lifestyles Surveillance / Monitoring
What does healthcare public health involve?
Clinical Effectiveness Efficiency Service planning Audit and evaluation Clinical governance Equity
What does health protection public health involve?
Infections diseases Chemicals / poisons Radiation Emergency Response Environ. health
What could be the reason someone smokes?
Parental or peer pressure, educational attainment, quit rates and deprivation.
What are important in publc health and diet (AAAA)?
Access, Availability, affordability and awareness.
what are cultural norms?
Activities or behaviours that are expected or seen as normal.
What are some norms in our society?
can breastfeed in public, smoking is bad, too much alcohol is antisocial but also everyone drinks.
What must you consider when trying to change someone’s behaviour?
• Do people know how to make a change?
• Do people have the skills to implement that
knowledge?
• Do people understand the benefits of change?
• And the risks or costs associated with change?
• Are their any social barriers to change?
• Or any physical barriers?
• Or psychological barriers?
Why is ethics important?
new issues arise all the time like assisted death, fertility problems, transplants
What is ethics?
The attempt to arrive at an understanding of the nature of human values, of how we ought to live, and of what constitutes right conduct. Not certain, it involves value claims. can involve two different perspective
What is meta-ethics?
Explored fundamental questions (can things be right or wrong)
What is ethical theory?
Philosophical attempts to create ethical theories (virtue, categorical imperative, utilitarianism, 4 principles)
What is applied eithics?
Recent emergens of ethical investigation in specific areas.
What is a fact?
Something that is happening
What is the is/ought issue?
you can’t get an ought from an is. just because something is like that it shouldn’t be that way.
What can ethics be based on?
Laws, codes of ethics, religious and/or cultural beliefs, personal conscience
What types of law are important in medicine?
negligence, assault, confidentiality, data protection, mental capacity, homicide.
What is the link between law and ethics?
Laws can set ethics in stone but they often have gaps or lag behind development.
Why can ethics and religion be slightly incompatible?
Religion lacks logic to some of the beliefs.
What are the problems with codes of eithics?
They are not often followed, they are too specific and don’t allow thinking. The codes could be reasoned from poor logic. They might not apply to all situations
What is top down logic?
Deductive logic goes from a general theory to a medical problem.
What is bottom up logic?
Inductive logic takes a settled case and creates a theory or guide to medical practice.
What is the ad Hominem fallacy?
shifting claim to an irrelevant aspect of person making the argument.
What is the authority claim fallacy?
Arguig a claim is correct simply because someone is in authority has said it
What is the Dissenters fallacy?
Identifying people who disagree with an argument does not in itself show that it is wrong.
What process shoudl you use if you come across an eithical dilemma?
Recognise the situation, identify the key problems, identify the legal and professional guidance, if no solution found apply critical ethical analysis and then justify your reasoning.
Which act sets out rules for infection prevention?
The 2010 health and social care Act
Who’s responsibility is infection control?
Everyone’s responsibility
What are the reasons to reduce care related infections?
Costs money, causes harm, increases length of stay, allows antibiotic resistance to increase
What make someone a susceptible host?
Low immunity, elderly neonatal or malnourished, on antibiotics, invasive procedures, those who have IV or catheters inadequate levels of hygiene/cleaning
What is the problems with microbes in hospital?
Increased number in healthcare setting. Antibiotic treatments develop resistant strains.
What are resivours or sources?
Patients and visitors, Staff, Fomites inanimate objects like door handles
What are portals of entry or exit?
Respiratory tract, GI tract, Genito-urinary tract, broken skin
What are the modes of transmission?
Direct transmission- direct contact, bodily fluids, vertical transmission
Indirect- fomites
Vector spread
Airborne spread these are exogenous spread Cross-infections
there are also cases of self spread where moving of bacteria around the body can cause infection.
What is the main infection prevention measure?
washing hands with correct technique less than 50% compliance
What infection control measures are there?
Bare below the elbow to allow effective washing.
When should you wash your hands?
before entering and leaving a clinical area, before and after any patient contact, before and after a procedure, before removing aprons and gloves, after going to the toilet, before food preparation and eating.
What are the types of handwashing?
Level 1- social or routine hadnwash
Level 2- aseptic for on ward
Level 3- Surgical hand scrub
What can you use to wash your hands?
Alcohol gel wont get rid of C diffficile or norovirus and should only be used when hands are visibly clean.
Antimicrobial liquid soap and water
Why is it important to use the hand barrier cream or moisturiser?
dry skin cracks and skin integrity is comprimised.
What types of waste are there on the ward?
Household waste
Clinical waste- Infectious waste for incineration, bloody swabs body parts, orange infectious waste offensice/hygien waste can be general waste. black bags general household waste.
What is a sharp?
Any item that could cut or penetrate the skin.
Why is it important to look after sharps?
To protect staff from injuries and prevents blood borne viruses.
What are the golden rules for sharps?
Disposed in appropriate way, never on the floor, put in sharps bin straight away don’t re sheath a sharp, don’t retrieve it, close it off if its full.
What are standard infection control precaution?
Gloves and aprons when contamination is at risk from bodily fluid. Broken skin, protective eye wear, cuts,
What are barrier precautions?
To protect others from people with a known infection
What is the problem with text books?
They catch up to developments very slowly
Where can you get advice on treatment from?
Guidelines either locally or internationally
How to keep up with developments?
Look for focused studies, only read important clinically relevant articles,
What is the best evidence down?
Systems with computerised support systems, evidence based guidlines or systematic reviews then at the bottom is the actual studies only get to this if other levels don’t get you there
What are good solutions to information overload?
Critically appraising research, reading critically appraised summaries and looking at synopses
What is NNT?
Number to treat to prevent one problem
What is NNH
number needed to harm
What is ARR?
absolute risk reductions
How do you get NNT?
1/ARR
What are some quality markers in diagnostics?
Spectrum of participants, get both tests, interpret separately and blind.
What can you use to look at study quicky?
PECOT population, exposure, comparison, outcome, time.
RAAMbo. representitive adjusted or allocated accounted for measurement and blind of objective.
What is Trip database?
Lookup index of appraised evidence
How is it best to cope with uncertainty?
be aware of it acknowledgement and discuss it to find support
What is Occam’s razor?
The simplest explanation is usually true
What is hickam’s dictum?
Patients can have as many diseases as they want and the sipleset explanation may be multiple diseases.
What is crabtree’s bludgeon?
sometimes there is not a single answer for something complex.
What is pretest probability?
Knowing whether it is worth testing for a certain thing. start with the obvious and the common explanation is often true. it is very likely that that will happen.
What is sensitivity?
The proportion of true positives correctly identified
What is specificity?
Proportion of true negatives that are correctly identified.
What is the biomedical model of medicine?
Western medicine, the mind and body are separate and can be treated separately, solutions are often technological, it is reductionist that there is a cause for diseases, knowledge is presumed to be objective.
What is the social model of health?
Medical knowledge is a social construct, it embraces a mind body dualism, health is affected by the wider socioeconomic context, medical knowledge is not objective
What is the Health as an ideal state theory?
Health is the goal of perfect well being in every respect must be free from disease illness and forms of handicap. who definition used to be based on it. criticisms we can’t be perfect
What is Health as a daily state of functioning?
That its a means towards the end of social functioning, can have chronic disease but be healthy this is linked to biophychosoical model. criticisms, its narrow often much more than absence of disease, sometimes refusing to function is healthy.
What is health as a personal strength or ability?
it is humanist and focus on how people resond to the challenges, its about responding well to things, is trying to be holistic. criticisms- too vague unclear on what, hard to know how to intervene with this definition.
What are the objections to defining health?
things change over time, the medical definition is new and older understanding can be more meaningful as they open up more routes to improving health, narrow definition of health you have to consider wider causes of disease.
How can you define disease?
Disease is an aggregate of conditions judged to be painful or disabling an deviating from the norm social or statistical. Culver and Gert but it mixes disease and illness you can be ill but not feel it.
Disease is a state of the organism tat is fiting a losing battle.
A disturbance of the structor of function of the body.
often lead to circular arguements
What is the biomedical model of health?
More diseas and pain = worse health
The problems they have can be treated. health is something that can be provided by treatment. it was used to inspire governments to invest in health services.
What is Health as a commodity?
Commodities can improve help. but there can be mysticism with this definition, we feel that we can regain something that we lost because of some sort of failing, the commodities provided to us by medical practitioners will somehow help us to regain our lost state of health. can be delusional.
Why is the definition of illness important?
Disease isn’t homogeneous and social problems can end up being labelled as medical ones.
Why are definitions of health important?
Definition of disease affect how we treat it and what services we provide and how we view disease and illness.
What is the sick role?
The privileges and obligations that accompany illness
What are doctors roles in the sick role?
Illness is a state of social deviance and is an unnatural state. Doctors are actors of social control, moral guardians and distinguishing between normality and deviance.
What do you get as part of adopting the sick role?
Legitimate withdrawal from social obligations, not blamed for their condition, must want to et well as soon as possible and take up their social responsibilites, and seek medical help
What does the professional have to do in the sick role?
Objectibve and non judgemental, must not act out of self interest, must obey a code of practive, be professionally competent, has the right to examine a patient.
What is the role of the doctor in the sickrole?
Only a doctor can allow entry gives official guidance that they are not malingering. the medical profession is neutral in its fulfilment of community intersts rather than its own self interest.
What are some problems with the sickrole?
Disabilities aren’t suited, chronic condition, medically unexpained symptomes, not all conditions involved, some are caused by the person, people aren’t criticized for not fulfilling their duties.
what are the strengths of the sickrole?
people get care sympathy financial allowances and time off work which helps them
What is the theory of consequentialism?
Looking at the morality of an action by its consequences.
What is utilitarianism?
maximising good well being and welfare for the most number of people
What are the types of consequentialism?
Act and rule based.
What is Act vs Omission?
Is harm by omission wors than harm than by action.
What is the doctrine of double effect?
You do something because the act you do is with good intentions but there is a secondary harm that is a consequence eg morphine palliative care.
What are challenges of utilitarianism?
what is useful, it discriminates minorities
What is deontology?
To do with the innate worth of the action. either kantiamism or virtue ethics
What is Kantianism?
Imperatives are categorical set rules like don’t lie or hypothetical do something to get an outcome.
What are the problems with deontology?
The key concernt is duties and rights not about consequences of actions but have a worthiness the duties can conflict
What is virtue ethic?
Focuses on the character of an agent integrates reason and emotion.
What are the limitation of virtue ethics?
Is it culture-specific? its too broad to have practical application, emphasiss of character can ignore the effects
What are the four principals?
Benificeience, Autonomy, Non-maleficence, justice
What is Autonomy?
Self determination, need Agency (cognitve ability to make decisions)Liberty( not be pressured)
What is Justice?
Like case like and unlike cases differently, need vs benefit, utility
What is medicalisation?
It is explaining problems in medical terms, in can be conceptual in the terms used to define a problem, institutionally when organasiation adopt a medical approach to a problem. Doctor-patient interations where a problem is defined as medical.
What is the process of medicalisation?
Behaviour defined as deviant, mecial conception of such behavior in a journal, claims from groups to help, legitimation of claim and it is designated a disease.
Is medicalsiation reversible?
Medicalisation is reversible eg homosexuality.
What are causes of medicalsiation?
It’s medical profession using its power to define and control, broader social processes and doctors facilitate, bureauccratization with industrialisation, pharma companies want in.
What are causes of iatrogenesis in medicalisation?
Clinical unintended side effects of treatments, Social leads to sick role, Cultural health professionals have an even deeper heath denying impact that removes peoples ability to deal with their weakness and vulnerability.
What are the benefits of medicalisation?
Alleviate symptoms, legitimates and reduces stigma, counteracts blame
What are the criticisms of medicalisation?
Over simplistic, underestimates the degree to which modern medicine has been successful in eradicating disease, the addition of patients to modern medicine is considerably over.
What is genetic counselling?
Process that patiente or relatives at risk of a disorder than mat be hereditary are advised of the consequences and risks.
What are two concepts for counselling?
Non-directive and Non-judgemental
Why would you want directive counselling?
Family dosen’t understand full counselling. family may expect to be directed, doctors know best? reduce disease frequency?
Why should counselling be non- directive?
Family might have personal experience, decisions on reproduction are personal, can be counter productive, aim of it is to help them
What is a diagnostic test?
Confirmed whether a condition is present or not
What is Screening test
Screening is identifying people at a higher risk.
What invasive screening test are available?
Amniocientesis, Chorionic villus sampling
What is NIPT?
Non- invasive pre-natal testing taking maternal blood test instead of baby 1in150
What is the moral status of the embryo?
Embryo has full moral status at conception, It has partial or limited moral status as pregnancy progresses to 24. termination up to 24 weeks.
What is the problem with screening?
It could be lead to eugenics.
What can you split disabilities into?
Cognitive and physical disabilities. and whether they are congenital, developmental or diseases early in life and accidents or older people who have functional limitations
How can you define disability?
It is not based on origin, it is about how it affects the person’s life.
What is disability paradox?
when you lower expectations to what is possible and are happier as a result
Name some functional limitation assessment criteria
Activities of daily living scale essential looking after activities, Instrumental activities of daily living scale mainly on social, The Barthel ADL index, Mini mental state examination they are simplistic and are not diagnostic
what is mortality?
death rate
What is morbidity?
The state of being diseased
How can you deal with disability?
Primary prevention, ask what they want,
What is a cronic disease?
A persistent or recurring condition, the disease which can be sever or minor often starts gradually and changes will be slow
What is a chronic disease?
A persistent or recurring condition, the disease which can be sever or minor often starts gradually and changes will be slow
What is the meaning of acute of chronic illness for patients?
Acute is life threatening, chronic have to learn to live with the condition
What are common defects in management of chronic conditions?
Different conditions treated separately, failings in communication between specialists and general practitioners, hard to manage frequent changes in presentation and severity of symptoms, poly pharmacy.
What is an intermediate care scheme?
A scheme that integrates hospital to community care
What is evidence based medicine?
Conscientious use of best evidence and paractical evidence integrating clinical knowledge and using patients wishes
How do you do EBM?
Chose a question find evidence decide if its good enough or applicable see if its useful and apply it to patients.
What are the 5 steps of EBM?
Asking focused questions, Finding the evicence, Critical appraisal, Making a decision and evaluating performance
What is the hierachy of evidence?
Best is systematic review of RCTs,RCT then Cohort, Case-control, Crossectional survey
What is PICO?
Patient/population, intervention/exposure, comparison control group, outcome
How to critically appraise?
Validity Reliability and applicability.
CASP NICE guidlines manual checklist
How do you make a decision on patient care using evidence?
Is it internally valid is it good enough in the study, external validity is whether it applies to the patient, what is the right decision about this evidence for my patient, shared decision making
How can you evaluate performance?
Is evidence still valid, am i actually doing what the evidence tells me the best thing like an audit. As I become confident in the evidence are decisions shared still
What is health psychology?
The role pf psychological factors in the cause, progression and consequences of health and illness,
What are the 3 behaviours related to health?
Health behaviours, illness behaviours and sick role behaviours
What are health behaviour?
A behaviour aimed to prevent disease
What is an illness behaviour?
Seeking out a remedy
What is a sick role behaviour?
any activity aimed at getting well
How can you split health behaviours?
Health damaging and impairing and health promoting
What are exmples of health promoting activities?
Taking exercise, healthy eating, attending heath checks, medication comliance, vaccination
What are modifiable risk factors?
Diet/exercise, smoking, alcohol, physical activity, sleep stress
What are some none modifiable risk factors?
Sex Age, Genetics/family history
How much does the NHS spend on alcohol?
3.5Million
What are the costs to society of diseases?
Individual’s life, social disruption, time off work, cost to economy
Why is health behaviour important?
Large factor in many diseases and understanding our behaviour can help to change this
What are population level ways to change health behaviour?
Health promotion by enabling people to make decisions about their health. campaigns like cange for life stoptober movember propotion of screening and immunisation
What is unrealistic optimism?
When you continue a damaging behaviour due to an inaccurate perceptions of risk and susceptibility
What cahnges people’s perceptions of risk?
Lack of personal experience with the problem. Belief that preventable by personal action, belief that if its not happened yet it wont in the future or that it is an infrequent problem.
What are other reasons for health damaging behaviours?
Health beliefs, situational rationality, culutrevariability, socoeconomic factors, stress and age
What are the three important models and theories of behaviour change?
Health belief model, theory of planned behaviour, stages of change transtheoretical model
What are the ideas of health belief model?
Individuals will change if they:
Believe that they are susceptible, it has serious consequences, believe taking action makes a difference, the benefits will outweigh the costs
What type of theory of health belief model?
Cognitive
What is the theory of planned behaviour?
The best predictor of change is intention. This is determined by a person’s attitude to the behaviour, the perceived social pressure and subjective norm and a person’s appraisal of their ability to perform the behaviour or their perceived behavioural control.
What is the stage model of health behaviour?
They put individuals on the stage change model, thre are 5 stages of change. Not yet ready to change, thinking about changing, getting ready to change, doing the change and sticking to the change?
What happens to patients on the model?
They can progress and relapse
How long does preparation usually take?
30 days
How long is the doing it stage?
3-6 months
How long is sticking to it?
> 6 months but can still relapse
What is international health usually involved with?
The diseases, conditions of middle and low incom contries and usually had ideas going from developed to less developed
What is global health?
Probmels that transcend national border and is influenced by many factors
Why is global heath good for medical students?
Health is a global problem and it will help medical students to face different problems in the future.
Which health factors are more of a problem in poorest countries?
Underweight, unsafe sex, unsafe water and sanitation, indoor smoke from fires, sinc deficiency, iron deficiency vitamin A deiciency, high blood pressure tobacco high cholesterol
What are the risk factors for developed countries?
Toacco high blood pressure, alohol, high cholesterol, high BMI, low fruit and veg, physcical inactivity, illicit drugs, unsafe sex, iron deficiency
Why is the media important to doctors?
They cause patient’s anxiety, they cause patients to change their behaviour, they result in demands for treatments.
What types of stroy are usually in the news?
Clinical and epidemiological study findidngs, pateint safety stories, finance in the NHS, variable access to health services, health protection incidents, organisation changes in the health services
What are the common problems with stories?
They need to be news-worthy, they can be from press releases, discuss implications of research with out crituque, the relative and absolute risk problem
How does the NHS make press releases?
Reactive to defend the NHS or its staff, They also do proative messages like health protectio and prevention campaigns
What can the effects of stories be?
Harmful or just confusing
Why do people start smoking?
Experimenting at the start in teens and usually does to psychosocial, siblinga and family background, after the initial aversion most people smoke a lot
What is the main reason for addiction?
Nicotine is addictive, this is widely variable though, also social economic and political influences and it becomes a habit
How does nicotine work?
Pervasive effects on the brain. crosses the blood brain barrier very quickly, activates nicotinic acetylcholine receptors, in the brain and causes dopamine release in the nucleus accumbans, this leads to tolerance and withdrawl
What is prevalence of smoking like?
used to be nerly 50% now it is around 15% married are less likely and younger people are worst
What is linked to smoking status?
Poverty, high stress jobs, and unemployment
What is the impact of smoking?
Causes cancers, COPD and heart diseases and half of smokers will die of a smoking related disease.
What is the problem with smoking evidence?
People cant use RCT as it’s unethical
what are the best studies?
Cohort studies with a large number of confounders take into account
How can causality be demonstrated?
That stopping smoking will reduce the risk compared to others that continue
What are the other health problems with smoking?
Cardiovascular problems, cancers, stomach ulcers, cateracts, diabetes, gum disesase, impotence
What are some of the measures we have stopped smoking?
Banning TV adverts/ restricting them, putting warnings on the box, making it illegal to sell to under 16, banning smoking in underground and trains then public places, and raised to 18, banning visibility in shops, smoking in cars,
How can smoking be stopped?
Stop smoking services can get nicotine replacement therapy. one to one or groups work checkups, uses stages of change theory.
What are some medicines available?
patches gum spray inhalator, and some are there to make you dislike smoking.
How can you have an effect?
Opportunistic advice in practice. Ask do you smoke? Advise the best way to uit is with support and medications we offer the referral and ask if they want. Assist make a refferal.
What privileges do medical professionals get in the law?
Right to recover fees, rights in respect of possession and prescription of certain drugs, Right to sign ertain certificates, right to be appointed as a medical practitioner in NHS, armed forces and restricted titles. Can do things to people that would usually be illegal to help them
Where are the duties listed?
The GMC guidlines of good medical practice.
Who is your friend?
The defence organisation will be
What are the main principals to pay attention to patients?
Autonomy, Benificence non-maleficence and justice
What does autonomy include?
Need informed consent before treatment, confidentiality, honesty and good communication
What does beneficence include?
Doing the right thing for patients, helping patients make the right decision empowerment
What does non-maleficence include?
Not doing the wrong thing to patients, not harming patients and following means evidence based practice keeping up to date
What does Justice include?
The moral obligation to act on the basis of fair adjudication between competing claims, distributive, rights and legal justice
What are good ways of avoiding patient confidentiality?
Don’t talk about patients in the lift don’t talk about patients on social media
What are the ways you can get inplicatied with a legal proceding?
Homicide- muder and manslaughter, Abortion, Drug related offences, Fraud, Theft, Assault
What is the duty of candour and self inctrimination?
Dont write self-incriminatory reflectie notes, doctors hace the right to not self incriminate over candour but not in civil litigation.
How can assault be taken in?
If you do something without consent that are not savig their life.
How to avoid getting sued?
Keep meticulous contemporaneous rectords dated and signed. keep up to date, don’t do things you aren’t qualified to do, be nice to people
What is epistemology?
knowledge claims the things we can measure and talk about there are two parts, positivism and interpretative
What is methodology?
is the study of methods and refers to the strategy or approach to research
What is positivism?
underpins research i natural and physical science, things are true if we ca measure them. Objective truth and the removal of bias.
What is interpretivism?
not a single philosophical approach but linked to several hermeneutics- interpreting inique human activity. phenomenology how individuals experience the world. it says social reality can be understood hrough social constrctios.
What is quantitative methodology?
Emphasising words rather than numbers generate theories based on interpretivism
What is method?
The method is a specific technique for data collection.
What are some of the qualities of qualitative research?
Small purposive samples dont have to be representative, less structured instruments, results as words and concepts, dont infer to a population, reflexivity and attention to individual participants
What can qualitative data?
interview transcripts, focus groups transcripts, field notes, documents, film photographs diary entries take longer to do
What is the frequency of screening in the UK?
Low
What is screening?
A process which sorts out apparently well people who probably have a disease from those who probably do not. its a process not a test
Which type of prevention is screening?
Any stage can be done. no disease cholesterol of Blood pressure, no symptoms breast screening, clinical disease diabetic eye screening
Why do we screen?
To reduce the risk of development to provide treatment and provide information
How is the effectiveness of a screening test measured?
Specificity and sensitivity. positive predict value negative predict values
What is sensitivity?
The proportion of people with the disease who are correctly identified by the screening test. true positives over all positives
What is specificity?
the proportion of people without the disease who are correctly excluded. the true negaives over all those who don’t have it
What is positive predict value?
The proportion of people with a positive test result who actually have the disease. the true positives over false positives
What is the negative predict value?
The proportion of people with a negative test result who do not have the disease. true negatives over total negatives
What happens to high prevalence screening tests?
the screening test is quite good we have high positive predicts and it is a good idea
What happens to low prevalence screening tests?
Positive predict values will decrease, negative predict goes up
Why dont specificity and sensitiveity not change?
They are intrinsic to the test
What are the Wilson and Jungner criteria?
the disesase should be Important condition, know the causes, should be able to detect early treatment should be available, facilities for the treatment and should be able to provide for it. the test should be suitable and acceptable and intervals needed
Risk benegits should be agreed on who gets treated costs should be balanced
How do you evaluate screening?
RCT use others due to politicians. lots of selection bias lead-time bias, length-time bias
What is lead time bias?
how long the disease is present before it is recognised it affects the length of time of survival after
What is length time bias?
to do with agressive disease being less likely to be detected at screening but slower is easier to catch so will record slow progressing disease and they last longer
What are selection biases in screening?
High socioeconomic background or people with family history
What screening is available in the NHS?
Lots in baby heel prick etc, diabetic eye screening, cervical screening, breast screening, bowl cancer, AAA.
What are the types of screening?
Population or mass screenings, opportunistic, communical diseases, pre employment and occupational medicals, commercially provided screening
What is imparement?
loss or anormality of psychological and physiological or anatomical structure or function
What is a handicap?
A disadvantage for an indicidual that limits or prevents the fulfilment of a role that is normal
What is a disability?
Any restriction or lack of ability to perform an activity in the manner or within the range considered normal for a human being
What is the legal definition of disability?
having a physcial or mental imparment which has a substantial and long-term adverse effect on her or is ability to carry out normal day to day activities
What is a social definition of a disability?
Loss or limitation of opportunities to take part in society on an equal level with others due to social and environmental barriers
What are the barriers for disabled people?
Negative cultural representations, inflexible policies procedures and practices, segregation, inaccesssible formats of information, inaccessible build environment and design
What is a learning disability?
impairment in cognitive function. leads to difficulties in everyday activities. take longer to learn and need support
How to help with learning disabilities understand you?
Short sentences, speak slowly be clear, simplify language
Why is it important to know how to help people with disabilities?
They die earlier and have more disease . they need more help than most!
What are down syndrome more susceptible to?
dementia thryroid problems visual problems hearing impairment.
Why can people with learning difficulties be more likely to get problems?
they have few resilience factors like freinds and dont like school. they have poor health behaviours like low exercise more likely to be obese. they are bullied live in damp housing often impovrished
How does the NHS discriminate?
Don’t identify them, staff discriminate, don’t make reasonable adjustments to information or systems, diagnostic overshadowing where syotoms of illness are mistaken for bad behaviour
Low screening uptakes, annual health checks,
What parts of equality act are important?
make reasonable adjustments to avoid putting disabled person as disadvantage. eg identify communication needs flag them share with other organisations
What does the equality act mean for docors?
Reasonable adjustments to services, be aware of varying levels of support, some only need small things, can make a big difference by doing small changes,
What are asylum seekers?
person who has a departed their country of origin ad applied for refugee status
What is a refugee?
A person who for reasons of being persecuted for someting is unable to stay n their own country
Who are undocumented migrants?
Foreign born nationals who do not have the right to remain in the UK
What are the steps to gain refugee status?
Application for asylum detention or processing in the community, screening questionnaires asylum interview and either granted to sent away
what is the problems for asylum seekers?
Long complex legal immigration process, detention, culture shock, delayed access to education, no community support racism and discrimination
What are the rights of asylum seekers?
Right to health and with children and adults, human rights acts and international covenant on economic social and cultrual
What are hostile environment polices?
limiting right of migrants in terms of health and other public services.
What causes their extra need for health care?
Live in poverty, exploited, can’t work can’t get benefits.lots of times for people to fall through the gaps
what are child rights in education?
All children should be given places at school, ask for documents, often dont have foreign national teaching ability, Foreign office can track down migrants
Why is education important for migrant children?
Learn English, social stability, encourage resilience, develp abilities, facilitate integration.
what should you do as a doctor for migrants?
treat patients as it s human right there are public health problems. learn how to use interpreters. be clear on who is entitled to what. use migrant checkup resources
How to fight back/ be advocate?
Challenge ID checks, Check people meet exemptions, if its urgent or lifesaving, inform patients, signpost support, communicate patietns not passports
Why does leadership matter?
Requirements and working in teams running a hospital
What is SBAR?
Situation background assesment reccommendation
What is the edward jenner program?
A leadership programme
Why do we collect routine health data?
Monitor health of poulation, generate hyothesise (research) inform policies and service planning and evaluate performace
What can we collect data on?
Deaths, diseases, usage of healthcare services, individual lifestyle wider deperminants and population
What is included in mortality statistics?
Doctor completes cause of death certificate, informant takes to registrar and registers death, copy sent to ONS and code deaths and the compile and publish
What is on a death certificate?
Name date place, time, cause of death disease directly leading to death, secondary cause for first and finally others that could causethat and finally other conditions that could cause it
What is the cause of death definition?
Disease or injury that initiates the train of events that directly lead to the death, circumstances of an accident that produced the fatal injury
what should you be careful with in mortality statistics?
life expectancy changes in policy on reporting death etc
What are important things to consider when it comes to Data quality?
Completness accuracy, relevance, Timeliness
What is incidence?
Number or new cases in a certain time
What is prevalance?
How many cases are aroud right now
What is HES
Health episode statistics
What is Candour?
Responsibility to declare mistakes and apologise to patients
What is good practice for students?
Social media and patients, probity confidentiality, Teaching and training engagement.
What happens in a fitness to practice case?
Investigation action plan, warnings undertaken, referral to occupational health or faculty FTP panel
What areas can public health need people from?
Epidemiology, statistics, Health economics, influencing people, leadership partnerships and working
What are the benefits of urban green spaces?
Relaxation restoration, social capital, immune function, air pollutions, pysical activiy, improved sleep, sunlight exposure
How can green spaces be restorative?
Helps escape problems feelings of relaxing and freedom. being away and allow soft fascination
What is social capital in green space?
A place to socialise with people.
How is immune system improved by green space?
Stress relief is linked to immune system
What is anthropogenic noise and how can green help?
Noise that is stressful. green space reduced noise covers noise with outher noise, disguises visual noise making things
What can green space do for air pollution?
It can capture some of the particulate matter in the air
How can health care professionals help with green space?
Look too get change in hospital, signpost people to connect with nature, lobby in changed for planning of environments
Why is teamwork needed in a healthcare setting?
Efficient or effective service delivery, may improbe decision-making, may reduced medical error, essential in complex conditions and complex treatment
How can teams be made to work better?
Medics need to be more involved with the team
What are the environmental barriers for teamworking in the NHS?
Management structure, working patterns, location, management, contact frequecy
What are the 6 characteristics of a good healthcare team?
clear roles and understanding of each team members role
Knowledge sharing helps team members to co-ordinate
effective communication
Shared goals
Mutual respect
Positive attitude
How can low socioeconomic status lead to obesity?
Cheap foods are worse of health, high calorie, less time for activity and free time, increased stress, less green space near the home, crime higherq
What is the cost of medical errors?
wasted medications to death and huge litigation costs
What is a skill based error?
When you are performing a task and get mixed up part way through or forget to do a certain step, even if you do the job a lot. can be things being given late and decimal place errors
What is a knowledge or rule based error?
Incorrect course of action from knowledge or bad protocols often in complex tasks, wrong adjustments or not doing guidlines
What are the information processing limitations?
Automaticity, Cognitice interference, Selective attention, cognitice biases.
What is automaticity?
can do what we want so makes us prone to not planned activities involuntary is see what you expect
What is cognitive inference?
more complex task make greater processing demands
What is selective attention?
You only notice what you are focused on
What is cognitive bias?
A long term memory containing heuristics rather than facts leave us liable to confirmation bias
What can affect performance?
Fatigue illness drugs alcohol stress reliance on memory, distractions, handovers complexity
What is a watchful sharpender?
Looking at things twice as you are doing them
How can you improve mental preparedness for spotting errors?
Set up catchin processes, identify where you are likely to make mistakes, reherse procedures,
