Public health Flashcards
1
Q
Explain the difference between primary, secondary and tertiary prevention?
A
Primary - prevent yourself from getting the disease in the first place e.g. Healthy eating, vaccination
Secondary - Detect disease and prevent it from getting worse e.g. Breast cancer screening
Tertiary - improve the quality of life and treat the symptoms of the disease you already have e.g. insulin therapy in T2DM, Bronchodilators in COPD
2
Q
Equity?
A
Distribution of healthcare resources dependent on the needs of the recipient
3
Q
Equality in healthcare?
A
Resources distributed the same regardless of the need of the recipient
4
Q
Horizontal equity?
A
Equal treatment for equal need e.g. all pneumonia patients treated the same
5
Q
Vertical equity?
A
Unequal treatment for unequal need e.g. treatment for common cold v pneumonia
6
Q
What are the different levels of intervention?
A
Individual
Community
Ecological
7
Q
Provide 1 example for each level of intervention?
A
Individual - smoking cessation, managing hypertension or diabetes
Community - building parks, community centres, taking down takeaways, healthy food markets
Ecological - Sugar tax, Smoking bans in specific places, Healthy eating promotions, Walk instead of drive promotions
8
Q
Explain the WHO determinants of health?
A
Structural
- Socioeconomic and political context e.g. governance, policy, values
- socioeconomic status - education, income, occupation, gender, class
Intermediary
- Material, Psychosocial factors, Behaviours, Health systems
9
Q
3 domains of public health?
A
Health improvement
Health protection
Health care
10
Q
Explain health improvement and provide an example?
A
Interventions aimed to improve disease, promote health and reduce inequalities
- Working with people and understanding why they make the choices they do
encouraging better behaviour and working with them - Influencing policies so people make better choices e.g. sugar tax
11
Q
Explain Health protection and provide examples?
A
Identifying risks factors that exist and finding means to protect people against them
- Sharing this information with other relevant bodies
e. g. vaccines, food processing regulations so food isn’t contaminated, walking instead of driving to decrease air pollution
12
Q
Explain Health care and provide examples?
A
Making sure the quality of care being delivered is at a high standard is maximising benefit for the recipient
- Facilitating health promotion
e. g. audits, reviews, Care pathways evaluate
13
Q
What is social cohesion/ Social capital?
A
The bridge structural determinant and intermediary determinants
- Willingness of people of different populations to make sacrifices/ co-ordinate with each other for the overall benefit of others or so society can better function
14
Q
Examples of WHO structural determinants?
A
Governance (how does the government make decisions) Policy Values (social and cultural values of communities) Education Gender Ethnicity Income Social Class
15
Q
Examples of WHO intermediary determinant?
A
Material circumstances
Psychosocial factors
Behavioural and biological factors
16
Q
What is the difference between need, demand and supply? provide an example for each?
A
Need - the ability to benefit from intervention e.g sugar tax, minimum unit pricing for alcohol
Demand - what people ask for e.g. cosmetic surgery
Supply - what is provided e.g. Tamiflu stockpiles for pandemic flu
17
Q
Provide health-related examples of intervention, with explanations for each example as to why they may or may not be classified as need, demand or supply
A
cosmetic surgery - demand - it isn’t necessarily an intervention that people will 100% benefit from and it isn’t just provided to people automatically
Flu jab - supply - what is provided and not always what people ask for and some don’t 100% benefit from it
minimum unit pricing for alcohol - need - 100% benefit from this form of intervention and it’s not what people asked for and it isn’t provided on all types of alcohol
18
Q
3 main approaches to health need assessment?
A
Epidemiological
Comparative
Corporate
19
Q
Explain the epidemiological, comparative and corporate approaches to the health need assessment and provide an illustration
A
Epidemiological - Define the problem, size of the problem, service availability, quality of service, evidence base, outcomes, existing services, recommendations
Comparative - compares the services received by a population/ subgroup with others - spatial + social e.g. outcomes, service provision, service utilisation
Corporate - obtaining views from a range of stakeholders/ people who can influence decision making and policy e.g. politicians, patients, press, professionals, commissioners
20
Q
Limitation of the epidemiological approach in health needs assessments?
A
- Data may be lost
- Variable data quality
- Doesn’t consider the felt needs of people affected
21
Q
Limitation of the comparative approach in health needs assessment?
A
- Data may not be available
- Variation in data quality
- Difficult to find a comparable population
22
Q
Limitation of the corporate approach in health needs assessment?
A
- Those with the loudest voices will always get their way
- Influence by political agenda
- Difficult to distinguish need from demand
23
Q
What is health psychology?
A
Understanding the psychological factors in the cause, progression and consequences of health and illness.
Tackling misconceptions or beliefs and coming up with practical solutions to improve health behaviours
24
Q
What is health behaviour?
A
Behavior aimed at preventing disease
25
What is illness behaviour?
Seeking remedy for illness
26
What is sick role behaviour?
Behavior aimed at actively getting well
27
Why do doctors need to know about health behaviours?
- Challenge media headlines read by patients
- Medicine adherence
- Cost of damaging health behaviours
- Lifestyle and morbidity relationship
28
Difference between self-serving bias and unrealistic optimism with regards to damaging health behaviour?
Self-serving bias - Engaging in health impairing behaviour that we perceive as not being as bad for us but bad for other people
Unrealistic optimism - Due to an inaccurate perception of risk and susceptibility, individuals continue to engage in health-damaging behaviours
29
Describe 4 factors that influence the perception of risk?
1. Lack of personal experience with the problem
2. If it's not happened now, it's not likely to
3. Belief that it is preventable through personal action
4. Belief that the problem is infrequent
30
What is the leading cause of preventable death in Sheffield?
Smoking
31
What are some ways that the national centre for smoking cessation and training try to improve the overall quality of smoking intervention?
Ensure evidence-based interventions are used
Committing practitioners to provide evidence of them using evidence-based approaches for smoking interventions as part of their CPD
Ensuring healthcare workers have the knowledge and skill to deliver the interventions
32
What is domestic abuse?
An incident of pattern of coercive, controlling, threatening, violence or abuse between those aged 16+ who have been/ are intimate partners, family members or members of the same household
33
What risk assessment tool is used to assess the severity of domestic abuse?
DASH risk assessment
34
Explain the difference between a standard, medium and high DASH risk assessment?
Standard - current evidence doesn't indicate the likelihood of causing harm
Medium - identifiable indicators of risk of serious harm. The offender has the potential to cause serious harm but unlikely unless a change in circumstances
High - Identifiable indicators of imminent risk of serious harm
35
In what situations can domestic abuse escalate?
During pregnancy
| When the victim tries to leave
36
What is the MARAC?
Multi agency Risk Assessment Conference - where different agencies come together for people in high risk situations and draw up action plans for such people
- Identify resources that can help such high risk individuals
37
HARK question?
What kind of direct questions that can be used to explore abuse during a consultation
Humiliation - ever embarrassed you? ever made you feel bad about yourself?
Afraid - what do they do that makes you feel afraid?
Rape - have they ever forced you to do something you didn't want to or were uncomfortable with?
Kick - Have you ever been physically hurt by your partner?
38
What is Charles bonnet syndrome?
Side effects of sight loss - phantom visions.
People who have recently lost their vision begin to experience visual hallucinations. The normal response of the brain to a sudden loss of vision
39
3 different type of canes used by visually impaired people?
Symbol cane
Guide cane
Long cane
40
Causes of sight loss?
```
Cataracts
Diabetic nephropathy
Macular degeneration
Glaucoma
Hemianopia following brain injury
Retinitis pigmentosa
```
41
How does smoking prevalence differ between gender?
Teenage girls > teenage boys
| Adult males > Adult females
42
3 main complications of smoking?
Cancer
CVD
COPD
43
What special populations should be looked out for with regards to smoking cessation?
Pregnant
Mental health problems
Drug/ alcohol dependence
44
MOA of nicotine?
Mimics acetylcholine which works on part of the brain that controls motivation - Ventral tegmental area
Increased release of dopamine in nucleus accumbens meaning people smoke more to get that same feeling
45
Withdrawal symptoms of smoking?
```
Depression
Irritability
Restlessness
Difficulty concentrating
Increased appetite
Cough
Constipation
Weight gain
Mouth ulcers
```
46
What is NRT?
Nicotine replacement therapy gives the patient a small amount of pure nicotine without the harmful constitutes found within cigarettes
47
Most effective timeframe to use NRT?
2 weeks before quit date and continue for 8 to 12 weeks on
48
What kind of people should NRT be used cautiously in?
```
Unstable cardiovascular disease
DM
Oesophagitis
Gastric or peptic ulcers
Renal or hepatic impairment
Phaeochromocytoma
Uncontrolled hyperthyroidism
```
49
MOA of Varenicline (champix)?
Reduces desire to smoke by acting on same nicotinic receptors but producing moderate amount of reward dopamine. Experience less satisfaction as nicotine acts on less receptors
50
SE of Varenicline?
Nausea
Headache
Insomnia
Abnormal dreams
51
MOA of Bupropion (Zyban)?
Atypical anti-depressant that aims to reduce withdrawal symptoms and desire to smoke. Improves rates of abstinence
52
SE of Bupropion?
Dry mouth
Insomnia
Lowers seizure threshold
Urticaria
53
What can be used to measure how much a person has smoked on the day of the smoking cessation appointment?
Expired carbon monoxide >10 parts per million
54
Aside from expired carbon monoxide, what can be measured to estimate if someone has smoked?
Saliva cotinine - a metabolite of nicotine that lasts several days >13ng/ml
55
What are some ways the national centre for smoking cessation and training try to improve the overall quality of smoking intervention?
- Ensure healthcare workers have knowledge and skill to deliver the sessions
- Ensure interventions are knowledge-based
- Commit practitioners to provide evidence of them using evidence-based smoking interventions as part of CPD
56
What are 3 influential factors to behaviour change as described by Ajzen's theory of planned behaviour?
Attitude e.g. smoking isn't good
Subjective norms e.g. people important to me want me to give up smoking
Perceived behaviour control e.g. I intend to give up smoking
57
What are the 5 stages of the transtheoretical model?
```
Precontemplationn
Contemplation
Preparation
Action
Maintenance
```
58
What are the 4 beliefs of the health belief model?
Individuals will change if they:
- Believe they are susceptible to the condition
- Belive condition has serious consequences
- Believe taking action will reduce susceptibility
- Believe the benefits of taking action outweigh the cost
59
2 critiques of the health belief model?
Alternative factors may predict behaviour e.g. outcome expectancy (if a person feels healthier as a result of their behaviour) or self-efficacy (Person's belief in their ability to carry out preventative behaviour)
Influence of emotion on behaviour
Cues to action often missing in research
Does not differentiate between first time and repeat behaviour
60
1 critique of the theory of planned behaviour model?
Doesn't take into account that emotions can disrupt rational thinking
Habits and routine bypass cognitive deliberation
Assumes attitudes, subjective norms and perceived behavioural control can be measured
61
2 advantages of the transtheoretical model?
Tailor intervention to the stage the patient is identified to be in
Accounts for relapse
62
2 disadvantages of the transtheoretical model?
Not all people move through each stage in the specified order
Change is a continuum rather than discrete
Doesn't take into account values, habits, cultures, social or economic factors
63
What is motivational interviewing?
Counselling approach for initiating behaviour change by resolving ambivalence (mixed feelings)
64
What is the nudge theory and give an example?
Nudge the environment to make the best option the easiest .e.g place fruit next to check outstand
65
What is the social norms theory to behaviour change?
- Behaviour is guided by perceived social norms. What people believe is the common behaviour causes them to also behave in a similar manner
- most people misperceive the norms - overestimate risk-taking behaviour and underestimate protective behaviours
66
What preventative work can be done based on the social norms theory of behaviour change?
- Identify norms
- Collect evidence to show true norms and get rid of misconceptions
- Avoid scare tactics and constantly address misconceptions
67
3 examples of malnutrition?
Stunting (low height for age)
Wasting (low weight for height)
Underweight (low weight for age)
68
What is malnutrition?
Deficiencies, excess or imbalances in a persons intake of energy and/ or nutrients
69
An example of parental feeding practice that can influence eating behaviour?
```
Responsive feeding - recognising hunger and fullness
Avoid pressure eating
Restriction
Neglectful feeding practice
Authoritarian parenting
```
70
3 examples of eating disorders?
Anorexia Nervosa, Bulimia Nervosa, Binge eating disorder
71
What is the difference between an eating disorder and disordered eating?
Eating disorder: clinically meaningful behaviour or psychological pattern having to do with eating or weight that is associated with distress, disability or increased risk of mortality
Disordered eating: restraint, strict dieting, emotional eating, weight and shape concerns, inappropriate compensatory behaviours that don't warrant a clinical diagnosis
72
Why is dieting a challenge for some patients?
Unresponsive to internal cues that signal satiety and hunger
Dietary restraint
Vulnerable to external cues that signal availability to palatable food
73
1. Donabedian’s “structure, process, outcome” is a useful framework to use when carrying out an evaluation of health services. Explain what is meant by “structure”
What is there e.g. buildings, staff, equipment
74
2. Donabedian’s “structure, process, outcome” is a useful framework to use when carrying out an evaluation of health services. Explain what is meant by “Process”
What is done e.g. number of patients seen, process patients go through, the number of operations performed
75
3. Donabedian’s “structure, process, outcome” is a useful framework to use when carrying out an evaluation of health services. Explain what is meant by the outcome and provide examples
Mortality, Morbidity, Quality of life, PROMS (listing condition-specific questions e.g. oxford hip score)
5Ds - Death, Disease, Disability, Discomfort, Dissatisfaction
76
When assessing the quality of health services, Maxwell’s classification lists six dimensions. List the six dimensions
3E's + 3A's
```
Effectiveness
Efficiency
Equity
Accessibility
Acceptability
Appropriateness
```
77
Although using measures of health outcomes is desirable in the evaluation of health services, there are potential limitations. Explain why it may be difficult to attribute a health outcome to the service provided.
- Time lag
- Confounding variables outside of the service provided
- Larger sample size may be needed to detect statistical significance
- Data may not be available
- Issues with the quality of data e.g. completeness, Accuracy, Relevance, Timeliness
78
What are the 4 points of the planning cycle?
Needs assessment
Planning
Implementation
Evaluation
79
Examples of quantitative data that can be collected to measure the outcome
- Routine collected data e.g hospital admission, mortality
- Review of records
- Surveys
80
Methods of collecting qualitative data
- Consult relevant stakeholders
- Observation
- Interview
- Focus groups
81
What is the absolute risk?
Odds of something happening over a stated period of time
82
What is the risk ratio?
The ratio of the probability of an outcome in an exposed group to the probability of an outcome in an unexposed group e.g. risk of developing cancer between smokers and non-smokers
83
What is the number needed to treat?
The number of people that need to be treated to prevent disease in 1 person
84
Explain the prevention paradox?
A preventative measure that brings much benefit to the population that often offers little to each participating individual
85
Provide an example of the prevention paradox?
Use of statins in preventing CVD
| Wearing seatbelts
86
What are the 2 main approaches to the prevention paradox?
Population approach
| High-risk approach
87
What is multimorbidity?
Having multiple diagnosed healthcare problems
88
What is polypharmacy?
What a patient takes multiple medications for different conditions they have been diagnosed with
89
2 impacts of multimorbidity?
- Reduced quality of life
- Unemployment
- Mental health problems
- Possible diagnostic overshadowing
- Reduction in compliance
90
2 impacts of polypharmacy?
- Risk of side effects
- More medication just to manage side effects
- Drug interactions
- Reduction in compliance
91
What tools can be used to assist in managing polypharmacy?
Nomad
| Healthcare assistant
92
What are the 3 pain receptors + MOA?
MOR
KOR
DOR
once stimulated they inhibit presynaptic neurotransmitter release
93
Negative effects of opioids?
- Constipation + Nausea
- Sleep disorders, Sleep apnoea, Resp depression
- Dizziness, Sedation,
- Hyperalgesia
- Fracture risk
- Decreased hormones of HPA axis e.g. GnRH
- Addiction and misuse
94
Examples of non-opioid analgesics?
NSAIDs
COX-2 inhibitors
Paracetamol
95
General advice around prescribing opioids?
Intermittent, Low and slow
96
Examples of adjuvants
Anti-convulsants
Anti-depressants
Lidocaine patches
97
What signs may indicate abuse or dependency on opioids?
- Early calls for refills
- Presence of side effects
- Developed tolerance
- Use pain medication for other reasons outside pain
- Selling or altering prescriptions
- Stealing medication
- Reluctance to try non-pharmacologic interventions
98
What are the 10 types of error?
Sloth
Fixation + loss of perspective
Communication breakdown
Poor team working
Playing the odds
Bravado (timidity)
Ignorance
Mis-triage
Lack of skill
System error
99
Error: Sloth?
Not bothering to check results/ information for accuracy
Incomplete evaluation
Inadequate documentation
100
Error: Fixation + loss of perspective?
Early unshakable focus on a diagnosis
Inability to see the bigger picture
Overlooking warning signs
101
Error: Communication breakdown?
Unclear instructions or plans
| Not listening to or considering others opinions
102
Error: Poor team working?
Team members working independently
103
Error: Playing the odds?
Choosing the common and dismissing the rare event
104
Error: Bravado (timidity)?
Working beyond your competence or without adequate supervision
Show of confidence to hide underlying deficiencies
105
Error: Ignorance?
Lack of knowledge
Unconscious incompetence
Not knowing what you don't know
106
Error: Mis-triage?
Over/ Underestimating the seriousness of a situation
107
Error: Lack of skill?
Lack of appropriate skill, teaching or practice
108
Error: System error?
Environmental, Technology, Equipment or Organisational features
Inadequate built in safeguards
109
What is the difference between health need and healthcare need?
Health need - identifying what are the health concerns using mortality, morbidity + sociodemographic measures
Healthcare need - Ability to benefit from healthcare
110
Felt need?
Individual perception of variation from normal health
111
Expressed need?
Individual seeks help to overcome variation in normal health
The need which they say they have
E.g. commercial weight groups
112
Normative need?
Set standard/ need which is identified according to the norm
e.g. attend annual check recommended by doc
113
Comparative need?
When 2 groups with similar characteristics don't receive similar service or products
Comparison between severity, range of intervention + cost
