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Phase 3A 2021 > Public Health and Psychology > Flashcards

Public Health and Psychology Flashcards

1
Q

Determinants of health as established by Lalonde report 1974?

A

Genes
Environment (physical, social and economic)
Lifestyle
Health care

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2
Q

Describe Dahlgren and whitehead 1991 determinants of health classification

A

Rainbow model. Individuals placed at centre with various layers of influences on health surrounding them

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3
Q

What are the layers in the Dahlgren-Whitehead model?

A 
Centre=age/sex/constitutional factors
Next=individual lifestyle factors
Next=social and community networks
Next=living and working conditions
Outer=general socio-economic, cultural and environmental conditions
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4
Q

Describe the 7 boxes in the living and working conditions element of the Dahlgren-Whitehead model

A 
Agriculture and food production
Education
Work environment
Unemployment 
Water and sanitation
Health care services
Housing
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5
Q

Equity vs equality

A

Equity=what is fair and just

Equality=equal shares

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6
Q

Describe horizontal equity with example

A

equal treatment for equal need

individuals with pneumonia with all other things being equal should be treated equally

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7
Q

Describe vertical equity with example

A

unequal treatment for unequal need

individuals with common cold vs pneumonia need unequal treatment

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8
Q

List 5 different forms of health equity

A 
Equal expenditure for equal need
Equal access for equal need
Equal utilisation for equal need
Equal healthcare outcome for equal need
Equal health
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9
Q

Classification of health equity?

A

Spatial ie geographical

and Social -age/gender/class/ethnicity

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10
Q

What are the three domains of public health practice?

A 
Health improvement (societal interventions aimed at preventing disease, promoting health and reducing inequalities)
Health protection (control infectious disease risks and environmental hazards)
Health care (organisation and delivery of services)
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11
Q

What levels can interventions to improve public health be delivered at? Give example for each

A

Individual level eg childhood immunisation
Community level eg playground for local community
Ecological (population) level eg clean air act

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12
Q

Primary prevention? example

A

Prevent disease or injury before it even occurs

eg eating well, exercise regularly

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13
Q

Secondary prevention? example

A

Reduce the impact of a disease or injury that has already occurred
eg screening for breast cancer, daily aspirin post MI

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14
Q

Tertiary prevention? example

A

Reduce the impact of an ongoing illness or injury that has lasting effects , reduce mortality
eg stroke rehab programs

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15
Q

Describe the different health behaviours with an example

A

Health behaviour=prevent disease eg eat well
Illness behaviour=seek remedy eg act of going to doctor
Sick role behaviour=actively aimed at getting well eg taking prescription

Health behaviours=health damaging or health promoting

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16
Q

Why do people engage in health damaging behaviours?

A 
Self-serving bias
Unrealistic optimism (inaccurate perceptions of risk and susceptibility)

Perceptions of risk influenced by lack of personal experience, belief preventable by personal action, belief not happened now not likely to, belief problem infrequent

Health beliefs, situational rationality (felt like a good idea at the time), culture variability, socioeconomic factors, stress, age

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17
Q

Describe the needs assessment cycle

A

Needs assessment-planning-implementation-evaluation

Weighing up need, demand and supply

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18
Q

What is meant by health need?

A

Need for health. Measured using mortality, morbidity, socio-demographics

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19
Q

What is meant by health care need?

A

Much more specific than health need. Ability to benefit from health care, depends on potential of prevention, treatment and care services to remedy health problems

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20
Q

Sociological perspective of need?

A 
Felt need (individual perceptions)
Expressed need (individual seeks help to overcome variation)
Normative need (professional defines intervention appropriate)
Comparative need (between severity, range of interventions and cost)
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21
Q

Public health approaches to needs?

A

Health needs assessment by either epidemiological , comparative, corporate

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22
Q

Describe epidemiological approach for health needs assessment

A

Define problem
Size of problem; incidence/prevalence
Services available; prevention, treatment, care
Evidence based; (cost) effectiveness
Models of care (quality and outcome measures)
Existing services (unmet need, services not needed)
Recommendations

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23
Q

Problems with epidemiological approach to health needs assessment

A

Required data may not be available, variable data quality, evidence base may be inadequate, does not consider felt needs of people affected

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24
Q

Describe comparative approach for health needs assessment

A

Compare services. May examine health status, service provision, service utilisation, health outcomes

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25
Q

Problems with comparative approach for health needs assessment?

A

May not yield most appropriate level of eg provision should be, data may not be available, data may be of variable quality, may be difficult to find comparable population

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26
Q

Describe corporate approach for health needs assessment

A

Obtaining views of a range of stakeholders eg opinion leaders, commissioners, providers, professionals, patients, press

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27
Q

Problems with health needs assessment corporate approach

A

Difficult to distinguish need from demand, groups may have vested interests, may be influenced by political agendas, dominant personalities may have undue influence

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28
Q

What form can be used for domestic violence? What levels of risk

A

DASH and MARAC (multiagency risk assessment conference) forms
Standard risk=serious harm not likely
Medium risk=potential to cause serious harm but unlikely unless a change in circumstances
High risk=high risk of serious harm

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29
Q

What question format can be used in asking about domestic violence in consultations?

A

HARK
H=humiliation eg does partner make you feel bad about yourself
A=afraid eg what does your partner do that makes you feel scared
R=rape=ever forced to do anything your not comfortable with
K=kick eg does your partner threaten to hurt you

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30
Q

Cut off between child abuse and domestic abuse

A

16 years=domestic abuse

31
Q

6 most common causes of visual impairment

A

cataracts, diabetic retinopathy, retinitis pigmentosa, glaucoma, age related macular degeneration, hemianopia

32
Q

3 types of cane for visually impaired people

A

Symbol cane; hold to notify of condition
Guide cane; find obstacles on the ground and help measure depth of steps
Long cane; avoid obstacles and navigate, ball on end, used in sweeping motion

33
Q

What is Charles Bonnet syndrome?

A

“Phantom visions” Brain tries to compensate for not seeing by creating visual hallucinations=side effect of sight loss. Affects up to 50% of people who lose their sight, especially in early stages.

34
Q

Describe the Donabedian model

A

Used for evaluation of health services
Structure, process, [output], outcome
NB/outputs frequently all come under process

35
Q

Donabedian framework: describe structure

A

What is there- buildings, staff, equipment

eg number of ICU beds per 1000 population

36
Q

Donebadian framework: describe process

A

What is done
eg number of patients seen in A&E-the process through which patients go in to A&E-where and when first seen, who triages, assessing priority etc

37
Q

Donebadian framework: describe outcome

A

Classification of health outcomes: mortality, morbidity, quality of life/PROMs (patient reported outcome measures) and patient satisfaction

Can also use 5Ds: death, disease, disability, discomfort, dissatisfaction

38
Q

Problems with measuring health outcomes

A

Cause and effect link may be difficult to establish as many other factors may be involved
Time lag between service provided and outcome may be long
Large sample sizes may be needed to demonstrate statistically significant effects
Data may not be available
May be issues with data quality (CART-completeness, accuracy, relevance, timeliness)

39
Q

Describe Maxwell’s dimensions of quality to be used in assessment in quality of health care

A

3Es and 3As
Effectiveness (desired effect?), efficiency (output maximised for given input?), equity (patients treated fairly)
Acceptability (acceptable to patients?), accessibility (geographical, costs, waiting times etc?), appropriateness (relevance?)

40
Q

What methods can be used in evaluation of health care

A

Qualitative-via observation, interviews, focus group, review of documents. Consult relevant stakeholders

Quantitative- via routinely collected data, review of records, surveys, special studies

Mixed

41
Q

Overview of evaluating health services: general framework?

A

Define what the service is
Aims/objectives of service-are they stated and are they appropriate
Framework: structure, process, outcome (+/- dimensions of quality)
Methodology to be used: quali/quanti/mixed
Results, conclusions and recommendations

42
Q

Name 4 models of behaviour change

A

Health belief model, theory of planned behaviour, stage models (transtheoretical/stages of change), motivational interviewing, social marketing, nudging (choice architecture, make best choice the easiest eg fruit at checkouts), financial incentives, social norms

43
Q

Describe the health belief model

A

Change if the individual believes they are susceptible to the condition, the condition has serious consequences, taking action will reduce their susceptibility, benefits of taking action outweighs the costs

Also contributed to by health motivations/self efficacy and cues to action

Longest standing model. Successful for range of health behaviours eg breast self exam. Perceived barriers are the most important factor for addressing behaviour change

44
Q

Critique of health belief model?

A

Alternative factors may predict health behaviour
Cognitive based model-doesn’t consider influence of emotions
No differential between 1st time and repeat behaviour
Cue to action often missing

45
Q

Describe the theory of planned behaviour

A

Proposes best predictor of behaviour is intention.
Rational choice model. Major determinants=attitudes, subjective norms, perceived behavioural control.
Can predict for wide range of behaviours eg smoking
Accounts for social pressures and norms

46
Q

Under the theory of planned behaviour, what determines intentions?

A

Person’s attitudes to the behaviour, subjective norms (perceived social pressure) and perceived behavioural control (appraisal of self’s ability to perform the behaviour)

47
Q

What techniques can be employed to help bridge the gap between intention and behaviour?

A

Perceived control, anticipated regret, preparatory actions, implementation intentions, relevance to self

48
Q

Critique of theory of planned behaviour?

A

Lack of temporal element and lack of direction or causality
Rational choice model
Habits and routines undermine model
Assumes attitudes, subjective norms and perceived behavioural control can be measured
Relies on self reported behaviour

49
Q

Describe the transtheoretical model/stages of change model of behaviour change?

A

Discrete stages and with each stage a greater inclination to change
5 stages=pre-contemplation, contemplation, preparation, action (6months), maintenance (6months)
Progress and relapse. Temporal element and acknowledges individual stages of readiness
Allows interventions to be tailored to each stage/each individual

50
Q

Critique of transtheoretical model?

A

not all people go through every stage
change may operate on a continuum rather than discrete stages
doesn’t account for values, habits, culture, social and economic factors

51
Q

Basis of the social norms model?

A

Misperceptions of how peers think and act, need to alter perceptions of these pseudonorms.

52
Q

NICE defined transition points for behaviour change?

A

Leaving school, entering workforce, becoming a parent, becoming unemployed, retirement, bereavement

53
Q

Define allodynia

A

Perception of pain to a non painful stimulus (chronic pain-sensitisation)

54
Q

Define hyperalgesia

A

Minimally painful stimulus produces disproportionate response (Chronic pain-sensitisation)

55
Q

3 opioid receptors? Where?

A

MOR, KOR, DOR (mu, kappa, delta)

CNS, less so PNS. Occupy sites in vas deferens, knee joint, GI tract, heart and immune system

56
Q

Describe 5 negative effects of opioids

A

GI system-constipation and nausea
Resp system-resp depression, sleep apnoea, CO2 retention
CNS- dizziness, sedation, hyperalgesia
MSK-fracture risk
Immune system-mu receptor on immune cells leads to apoptosis
Addiction and misuse, depression
Endocrine system-hypogonadism (opiate induced androgen deficiency), decreased fertility, ED

57
Q

Non pharm management of chronic pain?

A

Physical eg wt loss, smoking cessation, stretching, physio
Psychological eg CBT, counselling, meditation
Complementary eg massage and reflexology
Occupational eg work place based review

58
Q

Analgesic ladder?

A

Non-opioid eg NSAID, COX-2 inhibitors, paracetamol
Mild opioid eg codeine
Strong opioid eg morphine

Adjuvants=anti convulsants, anti depressants, lidocaine patches

59
Q

Name 5 factors that promote excessive energy intake

A

Genetics, employment (shift work), early developmental factors, TV viewing/advertisements, characteristics of food (energy density, macronutrient composition, satiety/satiation, portion size), decreased physical activity, sleep, environmental cues, psychological factors

60
Q

Define malnutrition

A

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

61
Q

What are three early influences on feeding behaviour?

A

Maternal diet during pregnancy and breast feeding.
Influence of parents to consume new food
Parental feeding practices and infant feeding patterns

62
Q

Briefly describe the impact of maternal diet on feeding behaviour

A

Taste and olfactory systems can detect flavour in utero
Foetus swallows amniotic fluid (by third trimester=1L a day)
Amniotic fluid and human milk transmit volatiles from maternal diet providing early chemosensory experience (esp garlic, chilli, anise)
Neonates orientate towards odour of own amniotic fluid and mother’s breast milk

63
Q

Regarding feeding behaviour influences, advantages of breast feeding?

A

Acceptance of novel foods during weaning, less picky eaters in childhood, have a diet richer in fruit and veg
Early experiences of breast milk/amniotic fluid shown to last after 10 years of age

64
Q

Describe paradoxical effect of parents using coercion when feeding

A

Coercion/persuasion/contingencies to encourage children to consume new food= using other food as an incentive to eat novel food increases liking for the reward not the novel food (reduces liking for novel food)

65
Q

Describe 3 features of “healthful” eating behaviours

A 
Responsive feeding-recognise hunger and fullness cues
Provide variety of food
Avoid pressure to eat
Authoritative parenting 
Not using food as a reward
66
Q

What are non-organinc feeding disorders (NOFEDs)?

A

Feeding aversion/refusal, food selectivity, fussy, failure t advance to age appropriate foods, negative mealtime interactions, high prevalence in under 6s
Parents have often used maladaptive feeding practices

67
Q

Name the eating disorders

A

3 distinct= anorexia nervosa, bulimia nervosa, binge eating disorder.
OSFED= other specified feeding or eating disorder

68
Q

Define eating disorder

A

Clinically meaningful behavioural or psychological pattern re eating or weight associated with distress/disability/substantially increased risk of morbidity or mortality

69
Q

Define disordered eating

A

Restraint, strict dieting, disinhibition, emotional eating, binge eating, night eating, weight and shape concerns.
Inappropriate compensatory behaviours that do not warrant a clinical diagnosis

70
Q

Name 5 challenges/disadvantages of diets

A

Risk factor for development of eating disorder
Loss of lean body mass not just fat mass
Slows metabolic rate and energy expenditure
Chronic dieting may disrupt normal appetite responses and increase subjective sensations of hunger
LT wt loss challenging-normal pattern is wt loss, plateau then wt gain
Non-obese dieters at increased risk of fat overshooting
Wt cycling (repeated diet relapse) may accelerate wt gain

71
Q

In epidemiology, what factors contribute to association rather than a causative link?

A

Bias-studies finding associations more likely to have been published resulting in publication bias
Chance
Confounding
Reverse causation eg people who are already unwell don’t drink coffee

72
Q

2 methods of approaching epidemiological intervention?

A

Population approach: preventative measure seeking to shift risk factor distribution curve eg dietary salt restriction through legislation
High risk approach: seeks to identify individuals above a chosen cut off and treat them eg screening for hypertension and subsequent treatment

73
Q

Describe the prevention paradox

A

Preventive measure which brings much benefit to population often offers little to each participating individual eg seat belt use

Phase 3A 2021 (7 decks)

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