Public Health Flashcards
Define health behaviour
Behaviour aimed at preventing disease
Define illness behaviour
Behaviour aimed at seeking remedy
Define sick role behaviour
Behaviour aimed at getting well
Three models of behaviour change
Transtheoretical model
Theory of planned behaviour
Health belief model
Stages of transtheoretical model
Precontemplation Contemplation Preparation Action Maintenace Relapse
Stages of theory of planned behaviour
ASP -attitudes -subjective norms -perceived behaviour control Affect -intention Which affects -behaviour
What factors affect the intention to behaviour
P PAIR
- prepatory actions
- percieved control
- anticipated regret
- implementation actions
- relevance to self
Stages of health belief model
No stages just factors. Percieved -susceptibility to ill health -severity of ill health -benefits of behaviour change -barriers to taking action
Three domains of public health
Health protection
Health improvement
Improving services
Define health protection
Measures to control infectious diseases and environmental hazards
Define health improvement
Social interventions aimed at preventing disease, promoting health and reducing inequality
Define improving services
Organisation and delivery of a safe high quality service
Three approaches to resource allocation
Egalitarian
Maximising
Libertarian
Define egalitarian approach to resource allocation
Provide all care that is necessary and required to everyone
Define maximising approach to resource allocation
Resources allocated to those most likely to benefit
Define libertarian approach to resource allocation
Each individual is responsible for their own health
Define need
The ability to benefit from an intervention
Define felt need
Individual perceptions of deviations from normal health
Define expressed need
Seeking help to overcome variation in normal health
Define normative need
Professional defines intervention for expressed need
Define comparative need
Comparison between severity, interventions and cost
Define supply
What is provided
Define demand
What people ask for
What are the steps of maslows pyramid
Physiological Safety Love and belonging Esteem Self actualisation
3As and 3Es of maxwells dimensions for assessing the quality of a service
Accessible
Appropriate
Acceptible
Equity
Efficient
Effective
Define health
A state of complete physical, mental and social wellbeing and not merely the absence of disease
PROGRESS wider determinants of health
Place of residence Race Occupation Gender Religion Education Socioeconomic status Service availability
Define inverse care law
The availability of health and social care tends to vary inversely with the need of the population served
Define equality
Concerned with equal shares
Define equity
What is fair and just
Define horizontal equity
Equal share for equal need
Define vertical equity
Unequal share for unequal need
Define health needs assessment
A systematic approach for reviewing the health issues affecting a population which leads to agreed priorities and resource allocation that will impprove health and reduce inequality
4 steps of a health needs assessment
Needs assessment
Planning
Implementation
Evaluation
State three approached to health needs assessment
Epidemiological
Comparative
Corporate
Describe epidemiological approach to health needs assessment
Defines problem and size of the problem, looks at current service provision and suggests improvements
Describe comparative approach to health needs assessment
Compares services received by one population with those received by another
Describe corporate approach to health needs assessment
Considers the views of all key stakeholders e.g. staff, politicians
Define domestic abuse
Any incident or pattern of incidents of controlling, coercive or threatening behaviour, violence or abuse between two adults over the age of sixteen who are or have been close family members or intimate partners, irrespective of age, gender or sexual orientation
Define standard risk of domestic abuse
Does not indicate risk of serious harm
Define medium risk of domestic abuse
Indicators of risk of serious harm
Define high risk of domestic abuse
Imminent risk of serious harm
Which tool is used for assessment of domestic abuse risk
DASH
4 Questions for medical negligence
Was there a duty of care?
Was there a breach in that duty of care?
Was the patient harmed?
Was the harm due to the breach in duty of care?
What is the bolam rule of medical negligence
Would a reasonable doctor do the same?
What is the boltiho rule of medical negligence
Would that be reasonable
Define never events
Serious, largely preventable patient safety incidents that should not occur if available preventative measures have bene implemented
Examples of error
Fixation and loss of perspective Communication breakdown Poor team working Playing the odds Bravado/timidity Ignorance Mistriage Lack of skill System error Sloth
Name three error models
Swiss cheese model
Three buckets approach
Systems approach
Define screening
Identifying apparently well individuals who have (or are at risk of having) a particular disease
State the wilson and junger screening criteria
Disease
- important
- known natural history
- early treatment better than late
Test
- acceptable to the public
- facilities available
- simple, safe and precise
Outcome
- ongoing feasability
- treatment available
- cost benefit analysis
Heirachy of study design
Case report Case series Cross sectional Case control Cohort RCT Systematic review
Bradford Hill factors to assess causality
Biological plausability Temporal relationship Dose response Reversibility In keeping with existing literature Strength of association Specificty Consistency
Define bias
A systematic error that results in deviation from the true effect of an exposure on an outcome
Define confounders
Risk factors other than those being studied which influence the outcome
Define selection bias
Discrepancy of who is involved
What are three examples of information bias
Measurement bias
Recall bias
Reporter bias
Define publication bias
Some trials are more likely to be published than others
Define diversity
Diversity means appreciating the differences between people and treating peoples values, beliefs, cultures and lifestyles with respect
Define aristotle virtues
Courage and integrity
Skill
Knowledge
Judgement
Define intuitive thinking
Able to understand instantly without conscious reasoning
Define analytical thinking
Measured and calculated, basis of evidence based medicine
4 leadership styles
Inspirational
Transformational
Transactional
Laissez Faire
P<0.05
Statistically significant result so the null hypothesis can be rejected
The confidence interval does not cross 1
So the outcome is unlikely to be due to chance
Define economic efficiency
Resources allocated in a way to maximise benefit
Three approaches to economic evaluation
Cost effectiveness analysis
Cost utility analysis
Cost benefit analysis
Unit of measure for cost effectiveness analysis
BP readings improving
Units of measure for cost utility analysis
QALYs
Units of measure for cost benefit analysis
Measured in monetary cost
Benefits=money
Define incidence
New cases in an allotted period of time
Define prevalence
Existing cases at a set point in time
Define relative risk
Ratio of risk of disease in the exposed to the risk of the disease in the unexposed
Define attributable risk
The rate of disease in the exposed that may be attributed to the exposure
Define relative risk reduction
Reduction in the rate of the outcome in the intervention group relative to the control group
Define number needed to treat
Number of patients needed to treat to prevent one bad outcome
How to calculate number needed to treat
1/Absolute risk reduction
Define sensitivty
Percentage correctly identified with the disease
Define specificity
Percentage correctly excluded as disease free
Define positive predictive value
Percentage of those with a positive test that actually have the disease
Define negative predictive value
Percentage of those with a negative test who are actually disease free
Primary prevention
Prevent disease before it ever occurs
Secondary prevention
Treat a disease early and stop it getting worse/ recurring
Tertiary prevention
Trying to improve quality of life and improve symptoms of a disease you already have
Utilitarianism
Act is evaluated solely in terms of its consequences
Virtue ethics
The morality of an action is based on the character of the person doing it
Deontology
The morality of an action based on the actions adherence to rules
Define autonomy
Capacity of a rational individual to make an informed decision
Define non maleficence
Do no harm
Define beneficence
Action that is done for the benefit of others
Define justice
Fairness
Ethical arguements
Top down deductive
Bottom up inductive
Doctrine of dual effect
Normally, if you carry out an action knowing that X is a likely consequence of that act then the law regards you as intending to cause X.
5 focal virtues
Compassion Discernment Trustworthiness Integrity Conscientiousness
Two approaches to ethical analysis
Seedhouse ethical grid
Four quadrants approach
Four quadrants approach to ethical analysis
- medical indications
- patient preferences
- contextual features
- quality of life
