Public Health Extra Flashcards
What does the health belief model and Theory of Planned Behaviour say the most important factor in addressing behaviour change is?
Health Belief: Perceived Barriers
Theory of Planned Behaviour: Intention
What are the key determinants of health?
- Genes
- Environment
- Lifestyle
- Health care
What are some developing food behaviours?
- Maternal Diet
- Breastfeeding
- Parenting Practices
- Age of introduction to solids and types of food given
What is a health need assessment for?
Systematic method for reviewing the health issues facing a population
Therefore to determine resource allocation
What aspects of public health are involved in Health Needs Assessments and resource allocation?
- Maslow’s Heirarchy of Needs
- Types of health care need: Felt, Expressed, Normative, Comparative
- Health needs assessment (Resource allocation)
- Approach to Health Needs Assessments: Epidemiological, Comparative, Corporate
- Resource allocation Methods: Libertarian, Maximising, Egalitarian
What aspects of Public Health are involved with evaluation of health services and assessing the quality of health care?
- Evaluation: Assessment of whether a service achieves its objectives
- Donabedian Framework: Structure, Process, Outcome
- Maxwell’s Dimensions of Quality of Health Care: 3A’s and 3E’s
What is bias?
A systemic deviation from the true estimation of the association between exposure and outcome
What are some types of bias?
Selection bias: selection of participants
Information Bias: observers recall and reporting, instruments wrong
Allocation bias: Different participants in different groups
Publication Bias: Trials with negative results are les likely to be published
Lead time bias: Earlier screening does change survival outcome
Length time bias: diseases with slower progression more likely to be identified by screening
Explain what these features mean on the Bradford Hills Criteria:
- Strength
- Dose response
- Consistency
- Temporality
- Reversibility
- Biological Plausibility
- Coherence
- Analogy
- Specificity
- Strength - The strength of the association
- Dose-response – does a higher exposure produce higher incidence?
- Consistency – similar results in different studies and populations
- Temporality – does the exposure precede the outcome
- Reversibility – removing exposure reduced risk of disease
- Biological plausibility – does it make sense biologically
- Coherence – logical consistency with lab information e.g. incidence of lung cancer
with increased smoking is consistent with lab evidence that tobacco is carcinogenic - Analogy – similarity with other established cause-effect relationships in the past e.g.
thalidomide in pregnancy, not other teratogenic drugs show similar effects - Specificity – Relationship is specific to the outcome of interest e.g. introducing
helmets reduced head injuries specifically, it wasn’t that there has been an overall
lower injury rate
Should you ever inform parents about a childs actions?
No but encourage them to inform
What should you do if an Under 13 year old presents saying they have had sex?
Refer to social services
What are the Fraser Guidelines?
- Does she understand the advice?
- Has the doctor encouraged her telling the parents?
- Will she have sex anyway?
- Is the mental/physical health going to be effected if you don’t give it
- Best interests
What is Gillick’s Competency?
Does a child under 16 have capacity to make own medical decisions?
Clinical judgement made by the doctor; age, capacity, maturity
What are some different types of error and what do they mean?
- Sloth = inaccurate documenting/not checking results for accuracy
- Fixation/loss of perspective = focus on one diagnosis – confirmation bias
- Communication breakdown = unclear plan/not listening and explaining well - - - - - -
- Poor team working = some individuals out of depth and others underutilised
- Playing the odds = choosing the common and dismissing the rare
- Bravado/timidity = working beyond competence/not having confidence to object
- Ignorance = lack of knowledge (can be conscious or unconscious incompetence)
- Mistriage = over or under-estimating the severity of the situation
- Lack of skill = not having appropriate skills/training/practice
- System error = environmental/technological/equipment failure\
What is a Never Event?
Serious largely preventable patient safety incidents that should not occur
Define Public Health
The science and art of preventing disease, prolonging life and improving health through organised efforts of society
What should be considered in a health needs assessment?
Need: ability to benefit from an intervention
Demand: What people ask for
Supply: What is provided
What does the epidemiological perspective look at?
Size of population
Services available
Evidence base
What are the different approaches for disease prevention?
Primary Secondary and Tertiary Prevention
- Population approach: Prevention approach delivered to everyone to shift risk factor distribution curve
- High Risk Approach: Identify individuals above a cut off and treat them
- Prevention Paradox: Preventative measures which benefits the population has little impact to individual participants
How many UK Screening programs are there?
11 total:
3 in Pregnancy:
- Pregnancy infectious disease (HIV, Syphilis, Hep B)
- Thalassaemia and Sickle Cell
- Fetal Anomaly Screening (Downs, Edwards, Pataus)
3 In Newborns:
- NIPE
- Newborn Hearing screening program
- Heelprick blood spot
5 in Adults
- Cervical Cancer
- Breast Cancer
- Bowel Cancer
- AAA screening
- Diabetic Retinopathy
What are the 4 dimensions of Food insecurity?
- Availability of food
- Access - Economic and physical
- Utilisation: Opportunity to prepare food
- Stability of 3 dimensions over time
What is malnutrition in public health?
Deficiency’s, Excess or imbalances in a persons intake of energy and/or nutrients
Includes: Undernutrition, Overweight/obesity and Triple burden
Define Undernutrition and what it includes:
Define Overweight and obesity?
Undernutrition:
- Stunting: Low height for age
- Wasting: Low weight for height
- Underweight: Low weight for age
- Micronutrient Deficiencies: Lack of important vitamins and minerals
Overweight Excess diet
What is an Asylum Seeker?
Someone who is applying for refugee status
What is a refugee?
Someone who has been granted asylum status for 5 years
What healthcare can an asylum seeker access if their claim is refused?
Emergency NHS Services
Get charged for anything after that
What are common health problems for refugees?
- Injury and illness from war and travelling
- Communicable disease
- Lack of health screening and immunisations
- Malnutrition
- Untreated chronic disease
- Untreated Mental Illness
What are some barriers against Refugees/Asylum seekers?
- Reluctance of GPs to register them
- Illiteracy
- Communication barriers
- Lack of permanent site
- Mistrust of Professionals
What support do Asylum Seekers Receive?
- Vouchers to live off (may or may not be restricted)
- NASS support package
- Access to Emergency NHS services
- Not allowed to work initially and no control over location
What are some levels of Alcohol Dependency?
- Withdrawal Symptoms
- Cravings - strong desire to drink
- Drinking despite negative consequences
- Tolerance - drinking larger amounts to achieve the same effect
- Primacy - Neglecting basic physical needs such as food and water
- Loss of control
- Narrowing of repertoire - Start to drink only one type of drink in one place
What is the purpose of Disulfiram?
Promotes abstinence - Alcohol intake causes severe nausea and vomiting reaction due to inhibition of acetaldehyde dehydrogenase
What is the purpose of Acomprosate?
Reduces craving by acting as a weak NMDA antagonist - improves abstinence in placebo controlled trials
What components make up drug addiction?
Craving, tolerance, compulsive drug seeking behaviour and withdrawal
What can you offer a newly presenting drug user?
- Screening for blood borne viruses
- Health check
- Sexual health and contraception advice
- Check immunisation Hx
- Signpost to drug services
What is positive and negative conditioning in relation to drug use?
Positive Conditioning: Addiction increases desire to use drug
Negative Conditioning: People don’t quit due to unpleasant symptoms
What can an association between an exposure and outcome be due to?
- Chance
- Bias
- Confounding
- Reverse Causality
- True Causal Association
What are some types of information bias?
- Measurement
- Observer
- Recall
- Reporting
What is reverse causality?
When an association between an exposure and outcome are due to the outcome causing the exposure
