Public Health JR Flashcards
1
Q
What are the GMC Duties of a Doctor?
A
Protect and promote health of patients and public
Provide good standard of practice and care
Recognise and work within limits of competence
Work with colleagues in way that best serves patient’s interests
Treat patients as individuals and respect dignity
2
Q
What are the 3 domains of Public health?
A
Health Improvement
Health Protection
Improving Services
3
Q
Annotate the social health determinants diagram
A
Age, sex and hereditary factors Individual lifestyle factors social and community influences living and working conditions general socioeconomic, cultural and environmental conditions
4
Q
What are the theories of behavioral change and what model does it use?
A
Health Belief Model (Becker 1974)
Individuals must believe they are susceptible to the condition
Must believe in serious consequences
must believe taking action reduces risk
must believe benefits of actions outweigh costs
5
Q
What is the transtheoretical change model of behavioral change?
A
Precontemplation contemplation preparation action maintenance
6
Q
What are the structural determinants of illness?
A
Social Class Material deprivation and poverty unemployment discrimination and racism gender and health
7
Q
What is the biological Model?
A
Mind and body are treated separately
The body is like a machine that can be repaired
This privileges the use of technological interventions
It neglects the social and psychological dimensions of disease
8
Q
Define Morality
A
Concern with the distinction between good and evil or right and wrong
9
Q
Define ethics
A
A system of moral principles and a branch of philosophy which defines what is good for individuals and society
10
Q
What is utalitarianism/consequentialism?
A
An act is evaluated solely in terms of its consequences
maximises good and minimises harm
11
Q
What is Kantianism/Deontology?
A
Features of the act determine the worthiness of the act
Following natural laws and rights
12
Q
What is virtue ethics?
A
Focus is on the individual doing the action.
An action is only virtuous if the person is genuinely intending to do the right thing
13
Q
What are the 5 focal virtues?
A
Compassion Discernment Trustworthiness Integrity Conscientiousness
14
Q
What are the 4 principles of ethics?
A
Autonomy - The right to make your own informed decisions.
Beneficence - Always do good
Non-maleficence - Do no harm
Justice - Concerns fair distribution of services
15
Q
What are used to assess the functional limitations in the elderly population?
A
Katz ADL (Activities of Daily Living)
IADL
Barthel’s ADL
MMSE
16
Q
What do the Katz and Barthel’s ADL indexes assess?
A
An individuals ability to carry out activities of daily living such as:
Dressing
Bathing
Going to the toilet - and urinary and bowl continence
Getting in and out of bed
17
Q
What does the IADL Index assess?
A
Instrumental activities of daily living: Use a telephone do laundry go shopping handle finances
18
Q
What does the MMSE assess?
A
Immediate and orientation memory
Short term memory
language
19
Q
What are some key challenges that are faced with an ageing population?
A
Strains on pension and social security - pensions will have a higher payout
Increased demand for health care
Increased demand for longer-term healthcare
Bigger need for trained health workforce
Ageing workforce
Perversive ageism
20
Q
What is an acute illness?
A
A disease of short duration that starts quickly
and has severe symptoms (often can be cured)
21
Q
What is a Chronic Illness?
A
A persistent or recurring condition, which
may or may not be severe, often starting gradually with slow
changes (can’t be cured but can be treated)
22
Q
What is Polypharmacy?
A
The use of multiple medications or
administration of more medications than are clinically indicated
23
Q
What is the chain of infection?
A
A susceptible host causative infectious organism Reservoir (somewhere to spread to) Portal of exit Mode of transmission Portal of entry New susceptible host
24
Q
What are some protective infection control precautions?
A
Gloves and aprons and hand hygeine
Correct sharps manipulation
Correct clinical waste and linen handling
25
What are the different types of transmission?
Direct - Contact such as with STIs
- Faecal oral route - viral gastroenteritis
Indirect - Vector borne - malaria dengue
- Vehicle Borne - hep B
Airborne - Respiratory route - TB/legionella
26
What is stress?
Stress occurs when the demands made upon an individual are greater than their ability to cope
27
What is good stress?
Eustress - motivational and helpful
28
What is bad stress?
Distress - Damaging or harmful
29
What is the bodies stress response?
● Lungs – increased resp rate
● Blood flow – BP increases, HR increases
● Skeletal muscle – tenses
● Spleen – more RBCs discharged
● Skin – blood flow redirected to muscles and heart
● Mouth – mucous and saliva production decreases, dries
● Immune System – redistribution of WBCs
30
What is the stress illness model?
An individuals susceptibility to disease or illness is increased when an individual is exposed to stressors which cause strain upon the individual leading to psychological and physiological changes
31
What is Screening?
A process which sorts out apparently well people who probably have a disease from those who probably do not
32
What is the main purpose of screening?
Prevention of disease
33
What are the Wilson Jungner Criteria?
● it should be a serious health problem
● the aetiology should be well understood
● should be a detectable early stage
● should be an accepted treatment for the disease
● facilities for diagnosis and treatment should be available
● there can't be an unmanageable extra clinical workload
● a suitable test should be devised for the early stage
● the test should be acceptable for the patients
● intervals for repeating the test should be determined
● there should be an agreed policy on whom to treat
● the cost should be balanced against the benefits
34
What is Primary Prevention?
Prevention of the disease occurring
35
What is Secondary Prevention
Early detection of disease in order to alter the course of the disease and maximise the chances of a complete recovery
36
What is Tertiary Prevention?
Ways of slowing down the progression of the disease
37
Give some examples of Primary, Secondary, and Tertiary Prevention for Type 2 Diabetes
Primary - reduce risk factors by losing weight, having a balanced diet, increasing physical exercise
Secondary - Population screening - diabetic eye screening
Tertiary - Medications such as metformin, bariatric surgery to treat the condition and prevent progression
38
What is an error?
Any preventable event that may cause or lead to patient harm
39
What are the possible outcomes of errors?
An Adverse Event
| A Near Miss
40
What are the different types of error?
Errors of Omission
Errors of Commission
Errors of Negligence
41
What are errors of Omission
When the required action is delayed or not taken
42
What are errors of Commission?
When the wrong action is taken
43
What are errors of Negligence?
When the actions or omissions do not meet the standard of an ordinary skilled person professing
44
How can errors be managed?
At an individual level or organisational level
45
What is individual error management?
Errors are the products of wayward mental processes of individual people in the system
46
What is organisational error management?
Adverse events are the product of many causal factors (swiss cheese model) and so the whole system is to blame.
47
Define Prevalence?
The proportion of a population that are found to have the disease
48
Define Incidence?
The number of new cases of a a disease arising within a specified time period
49
When can you breach confidentiality?
When required by law
When the patient provides consent
When it is in the public interest
50
What are the criteria for disclosure when breaching confidentiality?
```
Anonymous
Patients consent
Kept to a necessary minimum
Meets current law
After death confidentiality continues
```
51
How would you approach a patient about quitting smoking?
3 As
Ask
Advice
Assist
52
Give 4 examples of UK screening programmes
Breast cancer
Bowel Cacner
Diabetic Retinopathy
Fetal Abnormalities
53
What is Sensitivity?
The proportion of people with the disease who are correctly identified by the screening test
(TP / TP + FN)
54
What is Specificity?
The proportion of people without the disease who are correctly excluded by the screening test.
(TN / FP +TN)
55
What is the Positive Predictive Value?
The proportion of people correctly identified as having the disease
(TP / TP + FP)
56
What is the Negative Predictive Value?
The proportion of people correctly identified as not having the disease
(TN / FN + TN)
57
What is the role of the doctor in combating health inequalities?
```
Changing systems
Changing perspectives
changing education
working hollistically
advocating on the social determinants of health
```
58
What are the social determinants of health?
Societal factors which influence an individuals health
59
What are the social determinants of health based on?
Fair society and healthy lives - the marmot report (2010)
60
Give some examples of social determinants of health
```
Education
housing
income
access to care
occupation
```
61
Why are social determinants of health important?
Health problems are worse in more unequal societies
Above a certain level, health ceases to improve in proportional and income disparities within a country affect health
Despite equal access to healthcare in the UK, health outcomes are not equal within society.
62
What is the Black Report?
From 1980
Stated that health inequalities are affected by:
Material - environmental causes
Artifact - there are not inequalities, it is how it is measured
Cultural/behavioral - poorer people behave in unhealthy ways
Selection - sick people sink socioeconomically
63
What is the Marmot Report?
From 2010
Health inequalities are a matter of faireness and social justice
There is a social gradient in health - the lower a persons social position the worse their health
Action should focus on reducing the gradiant in health.
64
What is proportionate Universalism?
Part of the Marmot report
Focusing on the most disadvantaged will not reduce health inequalities
Any action taken must be universal
Must be scaled with intensity proportional to the disadvantage
65
What health inequalties require action on according to the Marmot Report?
Give every child the best start in life
Enable all children, young people and adults to maximise their capabilities and have control over their lives
Create fair employment and good work for all
Ensure health standard of living for all
Create and develop healthy and sustainable places and communities
Strengthen the role and impact of ill health prevention
66
What is nudge theory?
Changing the environment to make the healthy option the easiest option
67
What are the millennium development goals?
1. Eradicate Poverty and Hunger
2. Universal Primary Education
3. Gender equality
4. reduce child mortality
5. improve maternal Health
6. Combat Malaria and HIV and other diseases
7. Ensure environmental sustainability.
8. Develop global partnerships for development
68
Define Probability
How likely an event is to happen
69
Define odds Ratio
A Ratio of odds relative to two groups
70
Define Risk
Probability of an event occurring within a given time period
71
Define Absolute Risk
The risk of developing a disease over a certain time
72
Define Relative Risk
The risk of developing a disease in one category compared to another
Eg. lung cancer in smokers vs non-smokers
73
What is absolute risk reduction?
Attributable risk:
The rate of risk reduction due to the exposure
(incidence exposed - incidence non-exposed)
74
What is number needed to treat
The number of people needed to treat to save one life
| 1/absolute risk reduction
75
What are confidence intervals?
The range of values that are believed to contain the true parameter value
76
What are confounding variables?
effects of 2 or more variables on one another
77
What are some types of screening?
Population-based
| opportunistic
78
What types of bias are screening tests affected by?
Selection bias
Lead time bias
Length time bias
79
What is Selection Bias?
The people who choose to participate in screening programmes may be different from those who don't; proper randomisation is not achieved.
80
What is Lead time bias
Screening identifies diseases earlier and therefore gives the impression that survival is prolonged but survival time is actually unchanged.
81
What is Length time bias?
Diseases with a longer period of presentation are more likely to be detected by screening than ones with a shorter time of presentation.
82
Give some general examples of Primary, Secondary and Tertiary Prevention
Primary - risk factor awareness, immunisations
Secondary - Screening, reducing impact of early-stage disease
Tertiary - Medications to prevent progression, Rehabilitation
83
What is the hierarchy of the study designs pyramid?
```
Top:
Systematic reviews + meta-analysis
Clinical Trials (RTCs)
Observational studies (Cohort, Cross-sectional, Case-control)
Case Reports / Case series
Anecdotal findings, opinions, or ideas
Bottom
```
84
What are the types of descriptive observational studies?
Individuals - Case report / Case series
| Populations - Ecological study, Cross-sectional study
85
What are the types of analytical observational studies?
Cross-sectional
Case-Control
Cohort
86
What is the Bradford-Hill Criteria?
The minimum set of conditions necessary to provide adequate evidence of a causal relationship
87
What are some methods of collecting qualitative data?
Interviews,
Focus groups
Observation
88
What is the concept of medicalisation?
When aspects of normal life become the focus of medicine and intervention, medical problems/conditions are thus created.
89
What are the 3 main behaviours relating to health and what do they mean?
Health behaviour - Behaviour aimed at preventing disease
Illness behaviour - Behaviour aimed at seeking a remedy
Sick role behaviour - Behaviour aimed at getting well
90
What can health behaviours be?
Health Damaging - eg. smoking
| Health Promoting - eg. exercise
91
Why is it important to understand health behaviours?
For adequate measures in disease prevention
For assessing where funding should be aimed
For understanding where interventions are best placed (at individual and population-based levels)
92
Give some examples of health promotion campaigns
```
Change 4 life
Movember
Dry January
Screening Promotion
F.A.S.T
```
93
What is unrealistic optimism?
When individuals continue to practice health-damaging behaviours due to inaccurate perception of risk and susceptibility
94
What are some examples of theories of behavioural change?
Health belief model
Theory of planned behaviour
Transtheoretical model
Nudging
95
What factors are important to consider when promoting behaviour change?
How personality and behaviour interact
Assessment of risk perception
chan ging societal norms
96
What is the WHO definition of health?
Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity
97
What are some social influences on health?
```
Life expectancy decreases as social class decreases
Gaps between upper and lower class are rising
```
98
What determines population health?
The extent of income division within a society. Therefore more unequal societies have worse health
99
What is Sociology?
The study of social relations (bonds between people or groups of people) and social processes. It is the measure of social interdependencies.
100
What are the social roles of a sick person?
Exempt from normal social roles
not responsible for their condition
should try to get well
should seek help from and co-operate with the medical profession
101
What is Iatrogenesis?
The unintended adverse effects of a therapeutic intervention.
They can be clinical, social or cultural
102
What is the effect of prevalence of a disease on screening results?
A high disease prevalence would mean the incidence of false positives falls. The positive predictive value therefore increases and the negative predictive value would decrease
103
What are some benefits to screening?
Prevent suffering
early identification is beneficial
early treatment is cheaper and often more effective
Patient satisfaction tends to be high
104
What are some negatives to screening?
Damage caused by false positives and false negatives
Adverse effects of screening tools on healthy individuals
Personal choice is compromised
105
What is the prevention paradox?
When a large number of people at a small risk of disease may contribute more cases of that disease than a smaller number of people who individually are at a greater risk.
106
Why does high-risk approach to screening favour those who are more affluent and better educated?
More likely to engage with health services
More likely to comply with treatments
More likely to have the necessary means to change their lifestyle
107
What percentage of deaths in the UK are attributed to CHD?
Roughly 40%
1 in 5 men
1 in 8 women
108
What are the unmodifiable risk factors of CHD?
```
Sex
Age
Ethnicity
Family Hx
Early life circumstances
```
109
What are the potentially modifiable risk factors of CHD?
Physiological/clinical:
High cholesterol
Hypertension
T2DM
```
Lifestyle:
Smoking
Physical Inactivity
Overweight
Poor nutrition
Alcohol
```
110
What is the Primary prevention of CHD?
Lifestyle changes (SNAP)
Smoking, Nutrition, Alcohol, Physical Activity
Medical (anti-hypertensives, Statins, Metformin/insulin)
Cardiac Rehabilitation
111
What is the secondary prevention in CHD?
```
Primary care CHD registers
Medical Management (Apsirin, ACE Inhibitors, Statins)
Phase 4 cardiac Rehabilitation
```
112
What are some psychosocial influences in CHD?
```
Personality
Depression
Anxiety
Work
Social Support
```
113
Give some general facts about smoking
Men smoke more than women
Smoking prevalence is decreasing
Lower Socioeconomic groups smoke more
114
What government rules have been put in place to reduce smoking?
2005 - Ban smoking in public places
| 2007 - Minimum age was raised to 18
115
What are some reasons that people smoke?
Habit
Stress
Nicotine addiction
Socialisation
116
What are some forms of nicotine replacement therapy?
```
Patches
Gums
Nasal Spray
lozenges
All available on the NHS
```
117
What is Influenza?
Flu that is spread via coughing, sneezing and touch.
Incubation period is 1-3 days
Infectious with symptom onset 4-5 days
118
Which influenza causes pandemics and which influenza is seasonal?
Type A - Pandemics
| Type B - Seasonal
119
What virus family does influenza come from?
Orthomyoxoviridae
120
What are the surface antigens of influenza?
Haemagglutinin
| Neuraminidase
121
What are the criteria for pandemic spread?
```
Novel virus
Capable of infecting humans
Capable of causing illness in humans
Large pool of susceptible people
Ready and sustainable transmission from people
```
122
What are the phases of a pandemic?
Phases of a pandemic:
● Phases 1-3 (mostly animal infections with few human infections)
● Phase 4 (sustained human to human transmission)
● Phases 5-6 ( Widespread human infection)
● Post peak (possibility of recurrent events)
● Post pandemic (disease returns to seasonal levels)
123
What are some diseases that cause diarrhoea?
Dysentry
Typhoid
Hepatitis
Cholera
124
What are some Causative organisms of Diarrhoea?
```
Rotavirus
Shigella
E.coli
Salmonella Typhi
Campylobacter
Norovirus
Clostridium Difficile
```
125
What is S.I.G.H.T?
```
Prevention of C.Diff:
Suspect C.diff
Isolate the case
Gloves
Hand wash
Test stool for toxin
```
Treat with Metronidazole or Vancomycin
126
Why is diarrhoea in children important?
Kills more children than AIDS malaria and measles combined
Prevention is via a package from WHO-UNICEF
Fluid replacement therapy and Zinc treatment
127
Who are at risk of diarrhoea?
Poor hygiene
children at pre-school/nursery
Those preparing uncooked foods
Health care and social workers
128
What are the limits for alcohol?
14 units a week for men and women
| Pregnant women recommended not to drink
129
What is a standard unit of alcohol?
10mL/8g of ethanol
(% alcohol by Volume X amount of liquid in mL) / 1000
130
What are some social implications of Alcohol?
```
Violence
rape
depression
anxiety
driving offences
```
131
What are the CAGE Questions for alcohol dependency?
Ever felt like you should CUT down?
Been ANNOYED by people telling you to cut down?
Do you feel GUILTY about the amount you drink?
EYE OPENER - Ever had a drink first thing in the morning?
132
What is compliance?
The extent at which a patient's behaviour coincides with medical or health advice
133
What are some reasons for non-compliance?
Unintentional - Forgetting/not understanding instructions
| Intentional - the patient has their own beliefs about their condition or treatment
134
What is adherence?
Acknowledges the importance of the patient's beliefs and it regards the HCP as the expert conveying the information to the patient which increases their adherence to the recommended regime
135
What is concordance?
Patients and HCP are equals. The patient is expected to take part in the treatment decisions.
The consultation is a negotiation.
136
What is Palliative Care?
Palliative care improves the quality of life of patients and families who face life-threatening illness by
providing pain and symptom relief, spiritual and psychosocial support from diagnosis to the end of life
and bereavement.
137
What is the difference between Specialist palliative care and generalist palliative care?
Specialist:
HCPs who specialise in palliative care within an MDT. often used for patients with cancer.
Generalist:
Available to anyone with advanced progressive disease likely to end in death. Provided by GPs. district nurses, hospital doctors, social workers etc.
138
What is ethics?
The attempt to arrive at an understanding of the nature of human values of how we ought to live and of what constitutes right conduct
139
What is Top Down Deductive?
Where one specific ethical theory is consistently applied to each problem
140
What is Bottom Up Inductive?
Using past medical problems to create guidelines to practice
141
What is the doctrine of dual effect?
If you carry out an action knowing that X is a likely consequence of that action. Then in the eyes of the law you are regarded as intending to cause X
142
What is validity?
How close to the truth something is
143
What is Reliability?
How consistent the results are
144
What is Applicability?
How relevant a study is to clinical medicine
145
What is positive Skew?
Tail to the right
The mode is less than the median which is less than the mean
(household income)
146
What is negative skew?
Tail to the left
The mode is greater than the median which is greater than the mean
(age of death)
147
What are Glaser and Strauss (1965) 4 awareness contexts?
Closed awareness
Suspicion awareness
Mutual pretense
Open Awareness
148
What is closed awareness?
When the patient is unaware of their own impending death but others (staff and family) are aware
149
What is suspicion awareness?
The patient suspects that they are dying and tries to seek confirmation of this
150
What is Mutual pretense?
Everyone knows the patient will die including the patient but it is not discussed
151
What is Open awareness?
Everyone knows the patient is likely to die and talks openly about it
152
What is the sequence of the stress response?
Alarm
adaptation
exhaustion
153
What is cost utility analysis?
describes outcomes measured in quality adjusted life years e.g. incremental cost per QALY gained. It is the most common economic evaluation in health.
154
What is economic efficiency?
when resources are allocated between activities in such a way as to maximise profit and is NOT a type of economic evaluation.
155
what is cost effective analysis?
describes outcomes measured in natural units e.g. incremental cost per life year gained.
156
what is cost benefit analysis?
describes outcomes measured in monetary units e.g. net monetary benefit.
157
what is minimilisation analysis?
describes outcomes measured in any units and are the same in both treatments (and therefore just minimise cost).
158
how do you work out the incremental cost effectiveness ratio for a new drug?
ICER = difference in costs/difference in benefits.
eg. Difference in costs would be £25,000-£10,000 = £15,000. Difference in benefits is 6 QALY – 5 QALY = 1 QALY. £15,000/1 = £15,000 per QALY gained.
159
What are the big 5 CAM (complementary and alternative medicine)
```
Acupuncture,
chiropractic
herbal medicine
homeopathy
osteopathy
```
