Public Health Flashcards
Define public health
The art and science of preventing disease, prolonging life and promoting health through the organized efforts of society.
Define health
A state of complete physica, mental and social well-being and not merely the absence of disease or infirmity.
Define epidemiology
The study and analysis of the distribution, patterns and determinants of health and disease in defined populations.
Define prevalence
The number of cases in a population at a given time
Define incidence
The number of new cases that develop in a given period of time.
What is the prevention paradox?
Where the majority of cases of a disease come from the population at low/moderate risk, and only a minority come from the high risk population.
What is the inverse care law?
The availability of care tends to vary inversely with the need of the population
Define sensitivity
The probability of a positive test among those with the disease. [TP/total number with the disease]
Define specificity
The probability of a negative test among those without the disease. [TN/total number without the disease]
What is the doctrine of dual effect?
If something morally good has a morally bad side-effect that was not intended, this is acceptable.
Define the following types of variable: Nominal Binary Discrete Continuous Ordinal
Nominal: categories e.g. colours.
Binary: One of two values e.g. dead or alive.
Discrete: Finite number values/integers.
Continuous: Any number value
Ordinal: Order matters e.g. socio-economic status or educational level.
What are the four ethical principles
Autonomy
Beneficence
Non-maleficence
Justice
What are the five virtues of a doctor?
Compassion Discernment Trustworthiness Integrity Conscientiousness
[‘Can doctors trust in colleagues?’]
Give two duties of a doctor according to the GMC
Protect & promote the health of patients and the public
Provide a good standard of practice and care
Recognise and work within the limits of your competence
Work with colleagues in the ways that serve patient’s interests
Treat patients as individuals and respect their dignity
What is the Gini coefficient?
A statistical representation of ineuality in a nation’s income distribution.
High = more unequality Low = more equal
What are the six stages of the Transtheoretical model?
Pre-contemplation Contemplation Preparation Action Maintenance Relapse
Give a problem with the transtheoretical model (stages of change model)
No time specified for each stage
Assumes people act rationally
Ignores social factors e.g. economic status or income.
What are the stages of the Health Belief Model?
Susceptibility - preceived risk of getting X
Severity - how bad is X
Benefits - How effective are the methods of stopping X
Barriers - What is stopping them
Cue to action - Trgger for change e.g. chest pain
Self-efficacy - Confidence in their ability to change
Give a problem with the Health Belief Model
Assumes people act rationally
Ignores social pressures
Ignores addictive nature of behaviours e.g. smoking.
What are the stages of the theory of planned behaviour?
Attitude - for and against change in behaviour
Behavioural intent - what is motivating them
Subjective norms - social pressures
Perceived power - what is stopping them
Perceived control - how much control do they have
What is a problem with the theory of planned behaviour?
Assumes people act rationally
Ignores economic status as a pressure
Assumes linear process
Screening is what kind of prevention?
Secondary (aims to identify cases early).
What is the difference between primary, secondary and tertiary prevention? Give an example for each
Primary: Prevent disease from happening e.g. exercise
Secondary: Early detection e.g. screening or education programmes.
Tertiary: Slow the progression of the disease e.g. rehabilitation programmes or support groups.
Give two criteria for a screening programme
Serious health problem Understood aetiology Detectable early stage Accepted treatment Facilities for dx. & tx. Test acceptable to patients Agreed policy on who to treat Benefits outweigh cost
What is the difference between PPV and NPV?
PPV = The proportion of people with a positive test who have the disease. [% of positive tests that are true]
NPV = Proportion of those without the disease who test negative. [% of negative tests that are true].
What are the three categores of health behaviour? Give an example of each
Health behaviour: Aimed at preventing illness e.g. exercise and good diet.
Illness behaviour: Aimed at getting diagnosed when unwell e.g. going to the doctor.
Sick-role behaviour: Aimed at getting well again e.g. taking medications as prescribed.
What is a near miss?
An event which has the potential to cause harm but fails to develop.
What are the three types of human error?
Errors of Omission: required action is not done.
Errors of Commussion: Wrong action is done.
Errors of Negligence: When errors of omussion/commission fail to meet the standard of an ordinary, skilled professional.
What is the difference between distress and eustress?
Distress is negative and harmful.
Eustress is motivating and beneficial.
What are the five categories of response to stress? Give an example of each
Biochemical e.g. cortisol, adrenaline released.
Physiological e.g. increased stomach acid or blood pressure.
Behavioural e.g. overeating or smoking.
Cognitive e.g. poor concentration or negative thoughts.
Emotional e.g. mood swings or irritability.
What is the difference between cost-effectiveness, cost-utility and cost-benefit?
Cost-effectiveness: Outcomes measured in natural units e.g. life years gained.
Cost-utility: Outcomes measures in standardised units [QALYs]
Cost-benefit: Outcomes measured in money [B for Bills!]
What is Gillick competency?
Children under 16 years can consent to medical procedures if they are judged mentally competent by a medical professional.
What are Fraser guidelines?
A child under 16 years can consent to contraceptive/sexual health advice or treatment.
1) Understand the info
2) Wont inform parents
3) Will likely still have sex
4) Will likely suffer as a result
5) In patient’s best interests
What is the difference between equity and equality?
Equity: Fair provision which relates proportionately to need.
Equality: Sameness/equivalence of provision.
What is the difference between horizontal and vertical equity?
Horizontal: same provision based on same need.
Vertical: Difference provision based on different need.
Name two kinds of observational study design
Case-control
Cross sectional
Ecological
Define the following kinds of study design:
- Meta Analysis
- Systematic Review
- Randomised Control Trial
- Cohort
- Case-control
- Cross-sectional
- Ecological
Meta Analysis: quantatitive synthesis of multiple studies
Systematic Review: Evaluative/descriptive synthesis of multiple studies
RCT: Intervention vs a control.
Cohort: Follows groups over time (one intervention, one control).
Case control: Identify cases and retrospectively look at causes.
Cross sectional: Single point in time looking at associated contributing factors.
Ecological: Observes population level trends.
What is a health needs assessment?
A systematic method of identifying unmet health/healthcare needs of a population and making changes to meet those needs.
What are the four types of need?
Normative: Professional judgement e.g. what doctors believe is required.
Felt: Individual perception.
Expressed: What an individual asks for.
Comparative: Differences identified between groups.
What is a demand?
The expression of a felt need
In relation to health needs assessments, what are the three methods of assessment?
Epidemiological: the landscape e.g. number of staff, facilities etc.
Comparative: Comparing different groups or systems.
Corporate: Talking to key stakeholders e.g. staff, patients, council members etc.
What are the six stags of the audit cycle?
Identify issues Define standards Collect data Compare performance with standards Implement change Re-audit
What is a lead time bias?
The difference in survival time between screened patients and typically presenting patients. Early detection from screening creates the illusion of longer survival times.
What is a length time bias?
The identification of milder/slower progressing cases of a disease picked up by screening result in the illusion of longer survival times.
What are the Bradford Hill Criteria? Give two of them
Criteria for determining causation vs correlation.
1) TEMPORALITY: Does the cause precede the effect?
2) PLAUSIBILITY: Is the association consistent with other known facts?
3) CONSISTENCY: Have similar results been demonstrated by others?
4) STRENGTH: Is there a strong association between cause and effect?
5) DOSE/RESPONSE: Does increased exposure increase the effect?
6) REVERSIBILITY: Does removing the cause decrease the effect?
7) STUDY DESIGN: Is the evidence based on a robust study design?
8) EVIDENCE: Are there multiple lines of evidence?
