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Public health and PPD > Public health and PPD > Flashcards

Public health and PPD Flashcards

1
Q

What are health determinants, and according to the Lalonde report. How are they organised?

A

Health determinants are causes of ill health in the population
1. Genes
2. Environment- housing (eg water/sanitation, damp, cramped), social &
economic (employment, education)
3. Lifestyle
4. Health care- access and quality

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2
Q

What is the definition of equality and equity?

What is the definition of equity in healthcare

A

Equality is equal shares
Equity is concerned with what is fair and just

In healthcare equity is defined as equal access for equal need

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3
Q

What is the difference between horizontal and vertical equity in relation to healthcare?

A
  • Horizontal equity is equal treatment for equal need eg when all other factors equal pneumonia pts get equal treatment
  • vertical equity- unequal treatment for unequal need eg pneumonia vs common cold will receive different treatments
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4
Q

What are the two dimensions of health equity?

A

Spatial (geographical)

Social (age, gender, class, ethnicity)

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5
Q

How is healthy equity examined?

A 
Supply of healthcare 
Access to healthcare 
Utilisation to healthcare
Health care outcomes
Health status
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6
Q

What are 3 domains of public health practice, give examples

A
  1. Health improvement (preventing disease, promoting health and reducing inequalities)
    - education, inequalities, housing, employment, lifestyle
  2. Health protection
    - infectious disease, environmental hazards
  3. Health care (improving services)
    - clinical effectiveness, clinical governance, audits, equity
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7
Q

What are some examples of models and theories of behaviour change?

A
  1. Health belief model
  2. Theory of planned behaviour
  3. Stage models of behaviour/transtheoretical model
  4. Motivational interviewing
  5. Nudge theory
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8
Q

What is the health belief model?

What are its limitations

A

Health belief model-cognitive. Patient will change if:
1. Believe they are susceptible
2. Believe condition has serious consequences eg death
3. Believe that by taking action it reduced susceptibility
4. Believe benefits of taking action outweighs costs
Perceived barriers are the most important for dictating change

Limitation

  • cognitive doesn’t take into account emotions or behaviour
  • doesn’t differentiate between first time and repeated behaviour
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9
Q

What is the theory of planned behaviour?

A

Believes that intention is most important factor in behavioural change

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10
Q

Which factors comprise intention in the theory of planned behaviour?

A
  • Attitudes
  • Subjective norms
  • Perceived behavioural norms
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11
Q

Limitations of theory of planned behaviour?

A
  • Relies on self reported behaviour
  • Assumes that attitudes, subjective norms and perceived behavioural control can be measured
  • doesn’t take into account cognitive element of behavioural change
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12
Q

What are the stage models of behaviour/transtheoretical model?

A
  1. Precontemplation
  2. Contemplation
  3. Preparation
  4. Action
  5. Maintenance
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13
Q

Advantages and disadvantages stage models of behaviour

A

Advavatges- takes into account relapse behaviour
Disadvantages- doesn’t take into account values, culture, habits, socioeconomic factors
- not everyone moves through all the stages

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14
Q

What is the purpose of motivational interviewing and who does it work for?

A

removes ambivalence about change

works in problem drinkers

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15
Q

What is the nudge theory?

A

Changes in the environment to make the best option the easiest

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16
Q

What is are the 5 components for Maslow’s heirachy of needs?

A
  1. Physiological
  2. Safety
  3. Love/belongng
  4. Esteem
  5. Self actualization

Bottom 4 are deficiency needs, and top tier self actualization is being needs

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17
Q

What are the definitions of:

Epigenetics
Allostasis
Allostatic load
Salutogenesis

A

Epigenetics- expression of genome depends on the environment
Allostasis- stability through change (ie physiological systems have adapted to react to environmental stressors)
Allostastic load: price we pay for allostasis. Overtaxation of physiological systems leads to impaired health
Salutogenesis- favourable psychological changes secondary to experiences which promote health and healing

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18
Q

What are the dangers of over prescribing antibiotics?

A
  1. Medicalizing self limiting illnesses
  2. Side effects
  3. Antibiotic resistance
19
Q

When should antibiotics be prescribed?

A
  1. If systemically unwell
  2. High risk of comorbidities (ie immunosuppression, pre-term)
  3. Aged 65 and over with two features or aged >80 with 1 feature:
    - hopsital admission in past 12 months, diabetes, CCF, glucorticoid use
20
Q

Which antibiotics and when you can prescribe for:

  • otitis media
  • Sore throat/pharyngitis/tonsillitis
  • Rhinosinusitis
  • LRTI
  • UTI
A
  • Otitis media: amoxicillin 500mg 5 days if bilateral, <2 years, acute otitis media with ottorhoea
  • Sore/throat/pharyngitis/tonsillitis- Penicillin v 10 days. If 3 or more features: fever, exudate, cervical lymphoadenoapthy, abscence of cough
  • Rhinosinusitis- self limiting but not better in two and half weeks then Amoxicillin 5 days

LRTI- Amoxicillin 5 days if they fulfill criteria for antibiotic prescribing
UTI- Trimethoprim 3 days

21
Q

Definition of domestic abuse?

A

Incidents or patterns of incidents with coercive, threatning, violent or abusive behaviour between individuals aged 16 years or over who have been intimate partners or family members

22
Q

When is domestic abuse most likely?

A

During pregnancy, may be due to financial constraints

23
Q

What is the Duluth wheel?

A

Demonstrates how power and control may be asserted in different ways

24
Q

What are three ways in which domestic abuse impacts health in?

A
  1. Physical trauma injuries
  2. Somatic illness
  3. Pyschosocial problems
25
Q

In women, where are domestic abuse injuries most likely? Normally and in pregnancy?

A
  • Neck and trunk

- Pregnancy: breast and abdomen

26
Q

How is risk assessed for domestic abuse, and how is it stratified?

A
  • Use the DASH assessment tool

Standard- no evidence of likely serious harm
Medium- identifiable indicators of serious harm
High- imminent danger of serious harm

27
Q

What is the name of the single meeting, where domestic abuse cases are discussed?

What is the IVDA service?

A

Domestic abuse MARAC (multiagency risk assessment conference)

IVDA service works with those at highest risk of domestic abuse to increase their level of safety

28
Q

Define need, demand and supply?

A
  • Need is the ability to benefit from an intervention
  • Demand: what people ask for
  • Supply: what is provided
29
Q

Define health need, and health care need

A

Health need- the need for health

Health care need- the need for health care and the ability to benefit from health care

30
Q 
What are the definitions of the sociological definitions of need (Bradshaw) 
Felt need 
Expressed need 
Normative need 
Comparitive need
A

Felt need- the individuals perception of variation from normal health
Expressed need- individuals seeks help to overcome variation in normal health
Normative need- professional defined most appropriate intervention for expressed
Comparative need- comparison between severity, range, intervention and cost

31
Q

What is the definition of a health needs assessment?

A
  • Is a systematic approach at looking at the health issues facing a population
  • to reduce inequalities in health
  • inform decision making and action planning
32
Q

What are the three approaches in which health needs assessment may be carried out?

A

Epidemiological
Comparative
Corporate

33
Q

What is the epidemiological approach to health needs assessment. Give advantages and disadvantages?

A

Epidemiological, defines problems, assesses the size of problem (incidence, prevalence), services available (prevention, treatment, care), evidence base, models of care, existing services, recommendation

Advantages- uses existing data
Limitations- required data may not be available, variable data quality, evidence base inadequate, doesn’t consider expressed or felt need

34
Q

What is the comparative approach to health needs assessment. Give advantages and disadvantages?

A

Compares the services received by a population to another group. Comparison may be spatial, or social

Advantages- quick and cheap if existing data already exists
Limitation- may be difficult to find a comparable population, data may not be available, may not yield what the most appropriate level of utilisation or provision should be

35
Q

What is the corporate approach to health needs assessment. Give advantages and disadvantages?

A

Asks local population what their health needs are using focus groups, interviews, public meetings
Advantages- takes into account felt and expressed need
Disadvantages- May be difficult to distinguish between need and demand, may be influenced by political agendas, groups may have vested interests

36
Q

Give examples of the following:
1. Something which is needed and supplied but not wanted

  1. Needed, but not supplied or demanded
  2. Needed and demanded but not supplied
  3. Supplied and demanded but not needed
A
  1. MMR vaccine for some, GU tracing
  2. Palliative care series, contraceptive series in some countries
  3. Patient waiting lists
  4. Antibiotics for sore throats or other self limiting illnesses, cosmetic surgery
37
Q

Define evaluation of health services?

A

Assessment of whether health services are achieving their objectives

38
Q

What is the general framework for evaluating health services?

A
  1. Define what the service is?
  2. What the aims and objectives are of the service
  3. Framework (Structure etc) and dimensions of quality
  4. Methodology to be used (qualitative, and quantitative)
  5. Results, conclusions, recommendations
39
Q

What is the Donobedian framework used in the evaluation of health care services?

A

Structure- buildings, staff, working equipment
Process, (includes output)- eg number of pts seen, process, number of operations performed, time from referral
Outcome

40
Q

What are the measures of outcome in evaluating health care services?

A

Mortality- ie 30 day
Morbidity- ie time taken off from work, time spent at physiotherapy, 30 readmission to hospital
Quality of life/ patient reported outcomes
Patient satisfaction

41
Q

What are Maxwell’s 6 dimensions of quality when evaluating health care services?

A

3 E’s: Effectiveness, Efficiency, Equity

3 A’s: Acceptability, Accessibility, Appropriateness

42
Q

What is government recommended intake of alcohol in women and males

A

Now no more than 14 units in men and women
Prior females: 14
Males: 21

43
Q

What is the definition of hazardous drinking?

A

A pattern of alcohol use which increases someones risk of harm

44
Q

Which two tools can you used to assess someones drinking?

A

Audit questionarre

CAGE questionarre

Public health and PPD (1 decks)

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