Public health main things i think Flashcards
What is health? What are the three domains?
= a state of complete physical, mental and social wellbeing, not merely the absence of disease
* Health protection
* Health improvement
*improving services
What is the inverse care law?
Inverse Care Law:
= the availability of medical or social caretends to vary inversely with the need of the population served
What are the determinants of health?
- Genetic
- Environemntal
- healthcare
- Lifestyle
What is a health needs assessment ?
= A systematic approach for reviewing the health issues affecting a population which leads to agreed priorities and resource allocation that will improve health and decrease inequalities
Needs assessment -> Planning -> Implementation -> Evaluation
What are three ways you can carry out a health needs assessment ?
- Epidemiological: defines the problem and the sixe of the problem whilst looking at current services however does not take felt needs into account + data available may be poor
- Comparative- compares services between populations - compairson may not be perfect
- Corporate - Well takes stakeholder views into account and may lead to bias
What is a felt need ?
Individual perceptions of deviations from normal health
Expressed need
Seeking help to overcome variation in normal health - demand
Normative need
Professionals defines interventions for expressed need
Comparative need
Comparison between severity, range of interventions and cost
What are the different types of need?
FENC
Felt, expressed, normative and comparative
What are the three ways you can allocate resources?
- Egalitarian - Provide care that is necessary and required to everyone - equal for everyone however economically restricted
- Maximising: based solely on consequence with allocations to those who are likely to receive the most benefit -less need receive nothing
- Libertarian: Each individual responsible for own health - patient more engaged however not all diseases are self inflicted
How do you assess the quality of a service?
3A and 3E’
(Access, appropriate, accessibility)
(Equity, efficient and effective)
Structure process and outcome for each ! see the ppt
What is health psychology composed of?
- Health behaviour- aimed at preventing disease i.e. going for a run
- Illness behaviour: Seeking remedy - going to the gp for sx
- Sick role behaviour: activity aimed at getting well- taking abx
What is the transtheoretical model and how does it work?
Assesses an individuals readiness to act on a new healthier behaviour :
Precontemplation -> contemplation -> Prep -> action -> maintenance
Obvs can relapse at any given time
disadv:
* some individuals skip steps and change may be continuous and not discrete
* Does not take cultural and social factors into account
What is the theory of planned behaviour?
Built up of three things :
1. Attitudes: towards act or behaviour - belief on whether it makes a + or - impact on their life
2. subjective norm: His or her social network/ cultural norms etc
3. Perceived behavioural control: Persons belief on how hard it is to control a behaviour >
The theory states that a + attitude to the three above leads to intention and eventually that behaviour being established - check you notes for a diagram
What is the health belief model?
Check your notes for the explained diagram and if not just watch the youtube video if all goes to shit
It basically suggests that people perceived benefits of action, and self efficacy explain engagement in health promoting behaviour
What are the bolam and bolitho rules?
used in patient neg:
1. Bolam: Would a reasonable doctor do the same
2. Bolitho: Would that be reasonable.
What is a sloth error?
Laziness - inadequate documentation of notes and noyt checking results for accuracy - can improve conscientiousness
What is a system error
Environemntal, technological or equipment failure- lack of organisational or built in safeguards
to improve: System design
Lack of skill error:
In the name
to improve: effective technical skills -attending training or teaching etc
Communication breakdown:
Unclear instructions or plans - not listening to opinions
to improve: effective communication (lsitening and explaining)
Poor team working error:
Poor direction + independent working with people out of depth + others underutilised
Improve assigning roles and sharing veiws and better leadership
Playing the odds error
Well choosing the common + dismissing the rare
improve: probability assessment
Error of bravado/ timidity :
Working beyond competence or w/o supervision
improve humility and self reflection
Error of ignorance
Lack of knowledge and not knowing what you do not know + unconscious incompetence
Improve - self awareness
Error of fixation or loss of perspective
fixating on one diagnosis + inability to see the bigger picture despite warning signs
Improve: Open mind + situational awarreness
Error of mistriage:
Over/under estimating severity of situation
to improve: Prioritisation
What is the three bucket model for errors:
Based on the understanding that frontline staff can help stop errors and unsafe practice occuring if they develop a risk aware and ‘error wise’ mindset
divided into
1. Self, context and task
Explain cats of bucket model
Self: Level of knowledge, skill, expertise and current capacity to do a task
2. context: Equipement, env, workspace, team and organisation + management
3. Task: Errors, task complexity, novel task process
What is nudge theory?
Probs the easiest health psychology thing - i.e. fruit at checkout
Cross sectional study
Snapshot in time to those with and w/o disease to find associations at a single point in time
Cheap and few ethical issues
Prone to bias and no time reference
Case control study:
Retrospective observational study which looks at a certain exposure and compares similar participants with and without the disease
Negatives: Recall bias and can only show associations not causations
Cohort study
Can show causation
Longitudinal prospective study which takes a population of people recording their exposures and conditions they develop
negs: large amounts of data lost to follow up
RCT:
Similar participants randomly controlled to intervention or control groups to study the effect of the intervention
Gold standard
Ethical issues and time consuming
+’s: can infer causality and less risk of confounders - can double blind!`
What are the different types of bias?
a systematic error that results in a deviation from the true effect of an exposure on an outcome
Selection bias: discrepancy of who is involved
Information bias:
Measurement bias: different equipment
Observer bias
Recall bias: past events incorrectly remembered
Reporting bias: responder doesn’t tell the truth
Publication bias: some trials are more likely to be published than others
What are the 4 comps of negligence?
Duty of care, breach in this, harm, harm because of breach
What are you looking for in a screening criteria?
Disease
Test
Outcomes
Primary prevention:
Preventing disease before it has happened :
5 a day
2ndary prevention:
Catching a disease early -
all screening programmes
tertiary prevention:
Preventing complications of a disease
Example – diabetic foot care, reviews for eyes in diabetic patients, attending physio/rehab after a stroke to prevent immobility and aspiration pneumonia
What is the prevention paradox>
A preventative measure which brings much benefit to the population often offers little to each participating individual
i.e. it’s about screening a large number of people to help a small number of people
What is sensitivity?
The proportion of people with the disease who are correctly identified by the screening test
True positive / (true positive + false negative)
What is specificity?
The proportion of people without the disease that are correctly excluded by the screening test
True negative / (true negative + false positive)
What is PPV>
The proportion of people with a positive test result who actually have the disease
True positive / (true positive + false positive)
NPV
The proportion of people with a negative test result who do not have the disease
True negative / (true negative + false negative)
This is lower if the prevalence is higher
What is lead time bias?
Increased early detection does not increase survival but ptx knows they have disease for loner - apparent inc in survivak time even if screening has no effect on outcome
What is length time bias?
A type of bias resulting from differences in the length of time taken for a condition to progress to severe effects that may affect the apparent efficacy of a screening method
slow growing cancers are picked up and aggressive ones are not so looks like survival is going up
odds
The odds of an event is the ratio of the probability of an occurrence compared to the probability of a non-occurrence
Odds = probability/ (1 – probability)
What is meant by relative risk and how is it calculated?
Ratio of risk of disease in the exposed to the risk in the unexposed
Relative risk = incidence in exposed / incidence in unexposed
Tells us about the strength of association between a risk factor and a disease
What is absolute risk?
Gives a feel for the actual numbers involved i.e. has units (e.g. 50 deaths/ 1000 population)
Whay is NNT and how is it calculated?
NNT= number needed to treat to prevent one bad outcome
1/ absolute risk
What medication can be used for heroin detoxification?
Buphrenorphine (subutex) first line treatment
Naloxone for OD
Which medications can be used in relapse prevention for alcoholics?
Disulfram (ANTABUSE) – gives them horrible flushing and hangovers
Acamprosate – GABA blocker
Naltrexone
What are the two types of equity?
Horizontal equity – equal treatment for equal need (people with the same disease should be treated equally)
Vertical equity – unequal treatment for unequal need (e.g. areas with poorer health may need higher expenditure on health serviceS)
