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Public Health Flashcards

1
Q

What is the principle of GP management?

A

shared decision making

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2
Q

What is multimorbidity?

A

having multiple chronic diseases to manage at one time

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3
Q

What is appropriate vs problematic polypharmacy?

A

Appropriate polypharmacy: where drugs are helping pt function at their max capacity
Problematic polypharmacy: prescription inappropriate

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4
Q

What are the core principles of the NHS?

A

that it meets the needs of everyone
that it is free at the point of delivery
that it is based on clinical need, not ability to pay

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5
Q

What is the definition of health inequalities?

A

Health inequalities are the preventable, unfair and unjust differences in health status between groups, populations or individuals that arise from the unequal distribution of social, environmental and economic conditions within societies, which determine the risk of people getting ill, their ability to prevent sickness, or opportunities to take action and access treatment when ill health occurs.

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6
Q

What is the inverse care law?

A

The inverse care law is the principle that the availability of good medical or social care tends to vary inversely with the need of the population served.
This was shown by Julian Tudor Hart in 1971 and still is the case today

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7
Q

What are the findings from the marmot review?

A

The more deprived the area, the shorter the life expectancy. eg sheffield bus route
Mortality rates are increasing for men and women aged 45-49 – perhaps related to so-called ‘deaths of despair’ (suicide, drugs and alcohol abuse)
Child poverty has increased (22% compared to Europe’s lowest of 10% in Norway, Iceland and The Netherlands); children’s and youth centres have closed; funding for education is down.
There is a housing crisis and a rise in homelessness; people have insufficient money to lead a healthy life; and there are more ignored communities with poor conditions and little reason for hope.

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8
Q

What is the structure of Maslow’s hierarchy of needs?

A

physiological: food; housing; money; sex; sleep; homeostasis; excretion
→ safety: security of body; employment; resources; morality; safety family; safety healthy and body
—> love/belonging: friends/ family/ intamacy
—> esteem: self-esteem; confidence; achievement; respect -
–> self-actualisation: morality; creativity; problem of solving; lack of prejudice; acceptance of facts

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9
Q

What is the definition of domestic abuse?

A

DA is between those who are over 16 yrs by partners or family, with controlling, coercive, abusive, violent or threatening behaviour - can include financial, emotional, psychological, physical, sexual

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10
Q

What are the 3 domains of public health?

A

health protection, health improvement, improving services

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11
Q

What is a health needs assessment?

A

A systematic approach for reviewing the health issues affecting a population which leads to agreed priorities and resource allocation that will improve health and decrease inequalities
a needs = ability to benefit from an intervention

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12
Q

What is the difference between an epidemiological, comparitive and corporate health assessment?

A

epidemiology - Defines problem and size of problem, Looks at current services, Recommends improvements (may not get felt need across)

comparitive - compares services of one population to another (may not be able to find good comparitive)

corporate - Takes into account views of any groups that may have an interest eg patients, health professionals, media, politicians (ppl may have vested interests)

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13
Q

What is the difference between bradshaws needs - ?

A

think of FENC

felt: indiv. perception of deviations from normal health
expressed: seeking help to overcome variation in normal health
normative: professional defines intervention for expressed need
comparitive: compare severity, range of interventions and cost

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14
Q

what are maxwell’s 6 dimensions for assessing health service quality? (3As and sEs)

A

Equity - pts treated fairly
Effective- does the intervention have desired
Efficiency

Appropriate - is the right treatment being given to the right people at the right time? is it being under/mis/overused?
Acceptable - do the people find the services acceptable
efficient - output maximised for a given input?
Access - can ppl access it

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15
Q

What is a health behaviour?

A

prevent disease eg stay active

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16
Q

What is a illness behaviour?

A

seek remedy eg go to drs

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17
Q

What is a sick role behaviour?

A

aimed at getting well eg abx

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18
Q

Describe the transtheoretical model of change ( think of: PC PAM)

A 
Pre contemplation
Contemplation
preparation
action
maintainence
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19
Q

Describe the theory of planned behaviours

A

attitudes (to their behaviour), subjective norms (social pressures) and percieved behaviour control (do they believe they can control their behaviour) –> predicts intention

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20
Q

Describe the health belief model

A

Indiviudals with change depending on demographics and psychological characteristics –> percieved susceptibility to condition, percieved severity of conditions consequnces, believe taking action reduces susceptibility, benefits of taking action outweights the cost

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21
Q

Bolam vs Bolitho rule for medical negligence?

A

The Bolam Test had stipulated that no doctor can be found guilty of negligence if they are deemed to have acted “in accordance with a responsible body of medical opinion.”

The Bolitho Test helped to clarify what was meant by “a responsible body,” defining it as one whose opinion had a “logical basis.

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22
Q

What are the different types of medical error?

A

Errors of commission: doing something.
Errors of omission: not doing something

sloth
systems
lack of skill
mistriage 
ignorance
bravado/ timidity
playing the odds
poor team working
communication breakdown
fixation + loss of perspective
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23
Q

Describe the swiss cheese model

A

Latent failures are the first three layers, with active layer being the actual unsafe act:
organisational infleunces -> unsafe supervision -> preconditions for unsafe acts -> unsafe act

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24
Q

What are never events?

A

a serious, largely preventable patient safety incident that should not occur if available, preventative measures have been implemented.

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25
What is the three bucket model of error?
need to look at systems of error not individuals: self: poor knowledge, fatigue, little exp/ skill, feel unwell context: distraction , poor handover, lack of team support, equipment task: errors, task complexity, new task, process
26
Outline the wilson-jugner screening criteria
Condition: important, hx well understood, detectable early stage + treatment at early stage more beneficial than later Test: suitable for early stages, acceptable to public, intervals for repeating known, effective and safe, faciltiies available outcomes: risks
27
In what order are study designs from least to most trusted
case report -> case series -> cross sectional -> case control -> cohort -> RCT -> met-analysis
28
Describe cross-sectional studies
Snapshot data of those with and without disease to find associations at a single point in time
29
Describe case control studies
Retrospective observational study which looks at a certain exposure and compares similar participants with and without the disease
30
Describe a cohort study
Longitudinal prospective study which takes a population of people recording their exposures and conditions they develop
31
Describe a RCT
Similar participants randomly controlled to intervention or control groups to study the effect of the intervention Gold standard
32
What is bias in a study?
a systematic error that results in a deviation from the true effect of an exposure on an outcome
33
Name some different types of bias
Selection bias: discrepancy of who is involved/ non-response from certain groups allocation bias: different participants in different groups Information bias: Measurement bias (different equipment); Observer bias AND Recall bias: (past events incorrectly remembered) Publication bias: negative trials less likely to be published Lead time bias: early identification of disease appears to increase survival as pt has known about disease for longer Length time bias: disease progresses slowly so is more likely to be picked up on screening, making screening look like it prolongs life
34
How do you calculate screening specificity? How to do you calculate the associated predictive value?
specificity = how many people correctly indentified as NOT having the disease - they're been properly excluded true negatives / (true negatives + false positives i.e. the ppl actually without the disease) Negative predictive value = true negatives / ppl tested -ve Proportion of people with negative test who do not have the disease.
35
How do you calculate screening sensitivity?
true positives) / (true positives + false negatives) ie how many people correctly identified as have the disease POSITIVE predictive value: true positive/ ppl who all tested +ve
36
What is an ecological study?
Geographical (ecological correlation) of a population + prevalence trends over time
37
What is a prevention paradox?
“A preventive measure which brings much benefit to the population often offers little to each participating individual.” eg statins
38
What is the number needed to treat? How is it calculated?
NNT in order to prevent one person from developing disease - related to prevention paradox 1/ attributable risk - round up! because people are whole numbers
39
What is incidence vs prevalence?
prevalence is the proportion of cases in the population at a given time rather than rate of occurrence of new cases. Thus, incidence conveys information about the risk of contracting the disease, whereas prevalence indicates how widespread the disease is.
40
Difference between relative and absolute risk?
Absolute risk – gives a feel for actual numbers involved i.e. has units (e.g. if out of population of 1000, 300 people who smoke 45 get cancer aboslute risk = 45/300 = 15% people) Relative risk – risk in one category relative to another i.e. no units - how many more times likely are you to get this disease with this risk calculate: Absolute risk exposed group / absolute risk non exposed group so if use data from before and say 5 non-smokers get cancer then: 5/700 = 0.7% 15/0.7= 21.4RR
41
Difference between relative risk and attributable risk? How is attributable risk calculated?
Relative risk – tells us about the strength of association between a risk factor and a disease Attributable risk – amount of damage due to a specific RF eg impact of smoking on lung cancer calculat: absolute risk exposed group - absolute risk non-exposed group e. g. example above: 15-0.7 = 14.3
42
What is confounding?
When an apparent association between an exposure and an outcome is actually the result of another factor e.g. association of occupation with lung cancer could actually be because the cohort of that occupation are more likely to smoke and therefore get cancer
43
Researchers set out to examine the association between alcohol consumption and stroke. They identify all new patients admitted with stroke and compare their alcohol consumption with patients admitted for elective surgery. What kind of study is this?
Case-control study
44
General practitioners set up a study to estimate the prevalence of depression within their registered population. They decide to start with a random sample of adults aged 45-74 years. What kind of study is this?
Cross-sectional study
45
Investigators find a high level of correlation between levels of socioeconomic deprivation and cardiovascular mortality across electoral wards in the UK. What kind of study is this?
Ecological study
46
For patients with meningococcal meningitis, the risk of dying has been estimated to vary from 5-10%. What does this estimate describe?
Case-fatality rate
47
In a case-control study of recent alcohol consumption and road traffic accidents, the measure of association was substantially greater than 1 and indicates that there is a positive association between exposure and outcome. What does this describe?
Odds ratio
48
A study reports an association between coffee consumption and cancer. However, subsequent studies find that there is a clear association between smoking and coffee consumption What is this?
Confounding
49
An association between postmenopausal oestrogen use and endometrial cancer was reported in some studies. However, it was subsequently argued that this might be due to increased diagnostic attention received by women with uterine bleeding after oestrogen exposure. WHat is this?
Bias
50
WHat are the two different types of equity?
vertical (unequal treatment for unequal need) and horizontal (equal tx for equal need)
51
What is unrealistic optimism?
individuals continue to practice damaging health behaviours due to inaccurate perceptions of risk and suceptibility
52
What is chance?
The possibility of random error
53
What is reverse causality?
outcome results in exposure
54
What is the bradford hill criteria for causation?
Considerations for building up evidence of a causal relationship: temporarily (exposure comes before outcome eg ppl smoke before cancer); dose response (higher exposure = higher risk); strength (the stronger the association the less chance the relatioship is due to another factor); reversibility (if you take away the exposure, then risk goes away eg if stop smoking cancer risk decreases); consistency (repeatability); plausability; coherence; analogy; specificity
55
How do you calculate incidence?
cases/ population
56
What is the Donabedian approach to evaluating health needs assessment?
Look at structure, process and outcomes
57
how do you calculate alcoholic units
ABV x volume /1000 is 8g of alcohol, takes an hr average to metabolsie
58
List all the notifiable diseases
``` Acute encephalitis Acute infectious hepatitis Acute meningitis Acute poliomyelitis Anthrax Botulism Brucellosis Cholera COVID-19 Diphtheria Enteric fever (typhoid or paratyphoid fever) Food poisoning Haemolytic uraemic syndrome (HUS) Infectious bloody diarrhoea Invasive group A streptococcal disease Legionnaires’ disease Leprosy Malaria Measles Meningococcal septicaemia Mumps Plague Rabies Rubella Severe Acute Respiratory Syndrome (SARS) Scarlet fever Smallpox Tetanus Tuberculosis Typhus Viral haemorrhagic fever (VHF) Whooping cough Yellow fever ```
59
What criteria must be fulfilled to make someone negligent?
duty breached to patient which then leads to harm of patient that dr has duty of care over
60
Error vs negligence?
Error: an unintended outcome. Neglect: falling below the acceptable standard of care.

GP (9 decks)

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