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Public Health and GP Flashcards

1
Q

Define incidence

A

The number of new cases in a given time period

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2
Q

Define prevalence

A

The number of existing cases at a given point in time

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3
Q

How is incidence rate calculated?

A

Incidence/Total person-time at risk during that period

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4
Q

What is the ratio of risk of disease in the exposed, to the risk of disease in the unexposed?

A

Relative risk

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5
Q

How is relative risk calculated?

A

Incidence in exposed/incidence in unexposed

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6
Q

What is attributable risk?

A

Rate of disease in the exposed that may be attributed to the exposure

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7
Q

How is attributable risk calculated?

A

Incidence in the exposed minus incidence in the unexposed

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8
Q

What is bias?

A

A systematic error that leads to the distortion of the true underlying association

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9
Q

What are the two types of bias?

A

Selection

Measurement

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10
Q

Give an example of selection bias

A

Systematic error in the allocation of participants to different study groups

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11
Q

Give an example of measurement bias

A

A systematic error in the measurement of the outcome e.g. wrongly calibrated instrument

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12
Q

What is confounding?

A

A factor is associated with the exposure of interest and independently influences the outcome, but does not lie on the causal pathway

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13
Q

Give three of the Bradford Hill criteria required for causality

A

Dose-response
Biological plausibility
Consistency

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14
Q

What is an evaluation of health services?

A

The assessment of whether a service achieves its objectives

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15
Q

What is the Donabedian framework for health service evaluation?

A

Structure, process, outcome

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16
Q

What are Maxwell’s dimensions of quality in assessing healthcare?

A 
Effectiveness
Efficiency
Equity
Acceptability
Accessibility
Appropriateness
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17
Q

Give three factors that promote excessive energy intake

A

Shift work
Early developmental factors
Characteristics of food (energy density, portion size etc)

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18
Q

What is malnutrition?

A

Deficiencies, excesses, or imbalances in a person’s intake of energy and/or nutrients

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19
Q

What are the four types of undernutrition?

A

Stunting (low height for age)
Wasting (low weight for height)
Underweight (low weight for age)
Micronutrient deficiencies

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20
Q

Name some chronic medical conditions that require nutritional support

A

Cystic fibrosis
Eating disorders
Cancer

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21
Q

Give two early influences of feeding behaviour

A

Antenatal maternal diet

Maternal diet if breastfeeding

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22
Q

Give three benefits of breastfeeding

A

Gut protection
Antibodies
Anti infective - bifidus factor

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23
Q

How should parents cope with refusal of food?

A 
Model healthful eating behaviours
Provide a variety of foods
Avoid pressure to eat
Not using food as a reward
Responsive feeding
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24
Q

What is responsive feeding?

A

Recognizing hunger and fullness cues

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25
Define eating disorder
Clinically meaningful behavioural or psychological pattern having to do with earing or weight that is associated with distress, disability, or a significantly increased risk of morbidity or mortality
26
Give three types of disordered eating
Strict dieting Emotional eating Binge eating
27
Give three problems of dieting
Slows metabolic rate Weight cycling accelerates weight gain Risk factor for development of ED
28
What is restrained eating?
The deliberate attempt to inhibit food intake in order to maintain or to lose weight
29
Give three determinants of health
Genes Lifestyle Employment Education
30
What is the difference between horizontal and vertical equity?
Horizontal - equal treatment for equal need | Vertical - unequal treatment for unequal need
31
What are the domains of public health practice?
Health improvement Health protection Improving services
32
Give three risk factors for homelessness
``` Relationship breakdown Unemployment Mental health problems Domestic violence Substance abuse ```
33
What is the inverse care law?
The people that need healthcare the most have the least access to it
34
What is a health needs assessment?
A systematic method for reviewing the health issues facing a population, leading to agreed priorities and resource allocation that will improve health and reduce inequalities
35
What is a health need?
The ability to benefit from an intervention
36
What are the types of health need?
``` Felt need Expressed need Normative need Comparative need Health care need ```
37
What are the three approaches to a health needs assessment
Epidemiological Comparative Corporate
38
What are the sections to Maslow's Hierachy of Needs (bottom upwards)?
``` Physiological Safety Love/belonging Esteem Self-actualization ```
39
What are epigenetics?
The expression of the genome depends on the environment
40
What is allostasis?
The process of achieving stability through physiological or behavioural change
41
How is allostasis carried out?
Altering that HPA axis hormones | Autonomic nervous system
42
Epigenetics + allostatic load + environment =
Multimorbidity
43
What is salutogenesis?
Favourable physiological changes secondary to experiences which promote healing and health
44
Give five models of behaviour change
``` Health belief Theory of planned behaviour Stages of change Motivational interviewing Nudging ```
45
What are the characteristics of the health belief model?
The individual will change if they believe they are susceptible to the condition, that it has serious consequences, that taking action reduces susceptibility, the benefits of taking action outweigh the costs
46
What is the unique component of the health belief model?
Cues to action
47
What are the three components of theory of planned behaviour?
Attitude to behaviour Subjective norm Perceived behavioural control
48
What are the 5 stages of change?
``` Pre-contemplation Contemplation Decision Action Maintenance ```
49
What is primary prevention?
Prevention of disease when there is no disease present
50
What is secondary prevention?
Prevention of disease when there is subclinical disease present
51
What are the two approaches to prevention?
Population | High-risk
52
What is screening?
A process that sorts apparently well people who probably have a disease, do those who probably do not
53
What is the criteria for screening tests?
Wilson and Jugner
54
Outline the Wilson and Jugner criteria
Condition is important, has a preclinical phase Test is suitable Effective treatment Cost-effective
55
What is a false positive?
Disease is absent but screening test says it is present
56
What is a false negative?
Disease is present but screening test says it is absent
57
Define specificity
The proportion of people without the disease who are correctly excluded by the test
58
Define sensitivity
The proportion of people with the disease who are correctly identified by the test
59
What is the PPV?
The proportion of people with a positive test result who actually have the disease
60
What is the NPV?
The proportion of people with a negative test result who do not have the disease
61
What are the types of health behaviours?
``` Health behaviour Illness behaviour Sick role behaviour Health damaging behaviour Health promoting behaviour ```
62
What are three characteristics of addiction?
Craving Tolerance Compulsive drug seeking behaviour Physiological withdrawal state
63
What are the aims of treating substance misuse?
Reduce harm Improve health Stabilise lifestyle Reduce crime
64
What medications are used for maintenance of an opioid user?
Methadone or buprenorphine
65
What is the biopsychosocial approach to health and disease?
Integrated approach | Involves biological, psychological, and social factors
66
What is the difference between demand and supply?
Demand - what people ask for | Supply - what we actually provide
67
What is expressed need the same as?
Demand
68
What is a felt need?
Individual perceptions of variation from normal health
69
What is the name of the taxonomy of need?
Bradshaw's
70
Finish the sentence: if there is no need, there should be...
No intervention
71
What does a corporate health needs assessment involve?
Stakeholders e.g. doctors, patients, funding bodies | -Asking what is needed
72
What does a comparative health needs assessment involve?
Compares health needs with similar populations/situations
73
What does an epidemiological approach to a health needs assessment involve?
Looks at problems, addresses them based on the extent of the issue
74
What is the difference between the Donabedian and Maxwell evaluation frameworks?
Donabedian - structure>process>outcomes | Maxwell - Efficacy, efficiency, equity, access, acceptability, appropriateness
75
What is the black evaluation framework?
Efficacy, efficiency, equity, humanity
76
What are the three types of evaluation frameworks?
Donabedian Black Maxwell
77
What is an ecological study?
Study carried out at population level rather than individual level
78
What is a cross-sectional study?
Examines distribution and determinants Data is collected on each participant at a single point in time - snapshot Measures prevalence
79
What is a case control study?
Identifies those with and without the outcome and determines previous exposure to risk factors
80
What is a cohort study?
Observational - group of individuals who share a common characteristic, measures incidence Prospective or retrospective
81
What is the criteria for a randomised controlled trial?
Random allocation to intervention or control | Predefined rules for eligibility, endpoints, follow up, analysis plans
82
What are the pros and cons of RCTs?
Pro - minimises bias and confounders | Cons - expensive, large drop outs
83
What is the PICO framework that is used for studies and literature searches?
Population Intervention/exposure Comparison/control Outcome
84
What are the four types of surveillance of prevalence of diseases?
Passive - routine Sentinel Active - requires negative reporting Enhanced
85
What is risk?
Total number of new cases in a defined population at risk over a specified time period
86
What is the prevention paradox?
If something brings about a lot of benefit to the population, then it provides little benefit to each individual
87
From what age is breast cancer screening an option and what are the details?
50-70 years Mammography every 3 years Triple assessment if positive
88
What is the triple assessment in breast cancer screening?
Imaging (USS<40, mammography+USS>40) Clinical assessment Biopsy
89
What are the disease screened for in the newborn heel-prick test?
``` Sickle cell CF Congenital hypothyroidism Maple-syrup disease PKU Homocystinuria ```
90
What is length-time bias in screening?
Shorter, more aggressive disease is usually missed as screening happens at regular intervals and is more likely to identify diseases with a prolonged pre-clinical stage
91
Why do negligence and never events happen?
``` Human error Misconduct Judgement failure Neglect Poor performance ```
92
What is a never event?
An adverse event that should never happen
93
When does negligence occur?
There was a duty of care This was breached The patient came to harm The harm was due to the breach in the duty of care
94
What are the four principles of ethics?
Autonomy Beneficience Non-maleficience Justice
95
What are some transition points in stages of change?
``` Leaving school Relationship breakdown Having children Losing/getting a job Bereavement ```
96
What is the difference between equity and equality?
Equity - what is fair and just | Equality - equal shares for all
97
What is stage 1 and stage 2 hypertension?
Stage 1 - Clinic BP >=140/90 or home BP >= 135/85 | Stage 2 - Clinic BP >=160/1-- or home/ambulatory BP>=150/95
98
When is hypertension severe?
Clinic systolic >=180mmHg OR | Clinic diastolic >=110mmHg
99
When do you treat Stage 1 hypertension?
Less than 80 years Target organ damage Established renal/CV disease/diabetes/Q-risk over 20%
100
When do you treat Stage 2 hypertension?
Drug treatment regardless
101
How much salt should be restricted in hypertensive patients?
Less than 6g/day, ideally less than 3g/day
102
What are three other lifestyle changes in hypertension?
Reduce caffeine | General - stop smoking, drink less alcohol, exercise etc
103
What is the first line treatment for hypertension in a) a patient less than 55 years, and b) a patient older than 55 years/Afro-Caribbean origin?
a) ACE inhibitor | b) Calcium channel blocker
104
What is the second line treatment for hypertension?
Combine ACEI and CCB
105
What is an alternative treatment if a patient does not tolerate an ACEI?
Angiotensin-receptor blocker
106
What is the third line treatment in hypertension?
Add a thiazide diuretic (chlorthalidone or indapamide)
107
What is the fourth step in treating hypertension?
Further diuretics: K<4.5mmol/l add spironolactone | K>4.5mmol/l add higher dose thiazide
108
What investigations would you do for "feeling tired all the time?"
``` FBC, ESR/CRP, WCC, LFT, UE IgA and TTG Thyroid function Random or fasting glucose/HbA1c PHQ-9 ```
109
What are the differentials for "feeling tired all the time?"
``` Diabetes Hypothyroidism Coeliac disease Lyme disease Infectious mononucleosis Vitamin D deficiency Chronic hepatitis Depression ```
110
What are three dietary advices for type 2 diabetes?
High fibre, low glycaemic index source of carbohydrates Oily fish Control saturated fats
111
How often is HbA1c checked?
6 monthly once stable
112
What is the HbA1c required for a diagnosis of diabetes, and non-diabetic hyperglycaemia?
DM: =>48mmol/mol Hyperglycaemic: 42-47mmol/mol
113
What is the fasting blood glucose level required to diagnose diabetes, and non-diabetic hyperglycaemia?
DM: >=7mmol/l Hyperglycaemia: >= 6.1-6.9
114
What is non-diabetic hyperglycaemia another phrase for?
Impaired glucose tolerance
115
Give three complications of uncontrolled type 2 diabetes?
``` Peripheral arterial disease Neuropathy Retinopathy Ketoacidosis Nephropathy ```
116
When should you arrange emergency admission to hospital in a man with chest pain?
Chest pain <3 days: emergency | Chest pain >3 days: History, ECG, troponin, then decide
117
What is the prophylactic treatment for angina?
Aspirin Statin Sublingual glycerol trinitrate BB/CCB
118
What type of calcium channel blockers can be used in angina?
Monotherapy - rate limiting one such as verapamil or diltiazem Combo with BB - long acting dihydropyridine e.g. nifedipine
119
What drug should beta-blockers not be prescribed with and why?
Verapamil | Risk of complete heart block
120
What medications are second line in the treatment of angina?
Ivabradine | Nicorandil
121
In treatment of Atrial Fibrillation, what factors favour rate control?
Older than 65 | History of ischaemic heart disease
122
In treatment of Atrial Fibrillation, what factors favour rhythm control?
Younger than 65 Symptomatic First presentation Congestive heart failure
123
Name three rate-control agents used in AF
Beta-blocker Calcium channel blocker Digoxin if heart failure
124
Name three rhythm control agents used in AF
Sotalol Amiodarone Flecainide
125
What is the CHADSVASC score?
Calculates risk of stroke in atrial fibrillation
126
What post-bronchodilator spirometry findings are likely in COPD?
FEV1/FVC<70
127
What are the X-Ray findings in COPD?
Hyperinflation Bullae Flat hemidiaphragm
128
What are the symptoms of COPD?
Productive chronic cough Dyspnoea Wheeze Afebrile
129
What are pink puffers?
Typically emphysema-predominant | Older and thing, not cyanosed, severe dyspnoea, quiet chest
130
What is emphysema?
Permanent enlargement and destruction of airspaces distal to the terminal bronchiole
131
What are blue bloaters?
Typically chronic bronchitis patients Overweight and cyanotic Cough and wheeze, peripheral oedema
132
What is the treatment of an acute exacerbation of COPD?
Increase frequency of bronchodilator use, consider giving via a nebuliser Prednisolone 7-14d
133
What should oral antibiotics be given in COPD?
Purulent sputum | Clinical signs of pneumonia
134
What is the most common case of an infective exacerbation of COPD?
Haemophilus influenzae
135
Which drugs should you be careful of in AKI/CKD?
``` Diuretics ACEI ARBs Metformin NSAIDs ```
136
What are the causes of anaemia in renal failure?
Reduced EPO Reduced iron absorption Reduced red cell survival Reduces erythropoiesis due to toxic effects of uraemia on bone marrow
137
What are three causes of acute heart failure?
Acute coronary syndrome Hypertensive crisis Acute arrhythmia Valvular disease
138
When is BNP raised?
>100mg/litre
139
What causes BNP to rise?
Heart failure Any cause of left ventricular dysfunction Reduced excretion in CKD
140
What is the name of the classification system for heart failure?
New York Heart Association
141
What test would you do for someone wanting to stop drugs?
Urine drugs screen
142
What blood test would you do in alcoholics?
MCV | Gamma GT
143
What are the symptoms of hypothyroidism?
``` Fatigue Feeling cold Poor memory and concentration Constipation Weight gain and poor appetite Shortness of breath Hoarse voice Poor hearing Carpal tunnel ```
144
What are the signs of hypothyroidism?
``` Dry skin Cool peripheries Hair loss Bradycardia Delayed relaxation of tendon reflexes Oedema Pleural effusion/ascites ```
145
What are the components of the health transaction?
Persons health needs and demands Providers services that are supplied How is it paid for
146
What is the main differentiation between different types of healthcare system?
How it is paid for
147
Name five barriers to accessing healthcare.
``` Costs Geography Risk perception Physical barriers Awareness/education ```
148
What are the components of health economics?
Opportunity cost Economic efficiency Equity Economic evaluation
149
What is meant by opportunity cost?
Sacrifice e.g. benefits lost from not allocating resources to the next best activity
150
What is meant by economic efficiency?
Resources allocated to maximise benefit
151
What is an economic evaluation?
Comparative study of the costs and benefits of healthcare interventions
152
What is a QALY?
Quality adjusted life year Measures disease burden - quality and quantity of life gained after an intervention 1 QALY = 1 year of perfect health
153
What is incremental analysis in cost-effectiveness?
Analysing by comparison
154
What is the incremental cost analysis ratio?
Cost intervention A-Cost intervention B / Benefit intervention A-Benefit intervention B

Phase 3a (18 decks)

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