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PHASE 3A > PUBLIC HEALTH & MISC > Flashcards

PUBLIC HEALTH & MISC Flashcards

1
Q

according to the GMC, in England, Wales and Northern Ireland, under what age can a child consent to but not REFUSE tx?

A

16 (parents can over-rule refusal)

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2
Q

in Scotland, if a competent young person <16 refuses treatment, can their parents override this?

A

no

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3
Q

what are the 5 national screening programmes provided by the NHS?

A
  1. diabetic eye
  2. cervical cancer
  3. breast cancer
  4. bowel cancer
  5. AAA
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4
Q

NHS screening - from what age and how often are these screenings offered?
a) diabetic eye
b) cervical cancer
c) breast cancer
d) bowel
e) AAA

A

a) all people with diabetes from age 12
b) smear every 3 years aged 25-49 and every 5 years aged 50-64
c) mammogram every 3 years to women aged 50-70
d) FIT test every 2 years aged 50-74
e) once for men when they turn 65

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5
Q

benefits of screening programmes (5)

A
  1. may detect problem pre-symptoms
  2. detecting early = more effective tx
  3. helps people make more informed decisions about health
  4. reduce chance of developing a condition/complications
  5. can prevent some deaths
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6
Q

limitations of screening programmes (6)

A
  1. not 100% accurate e.g. false -ve, +ve
  2. can lead to difficult decisions e.g. screening for abnormalities in pregnancy
  3. health anxiety
  4. can still go on to develop condition if result is negative
  5. biases - selection, lead time, length time
  6. exposure of well individuals to distressing/harmful diagnostic tests e.g. colonoscopies for +ve faecal occult BT
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7
Q

define these biases present in screening:
a) selection bias
b) lead time bias
c) length time bias

A

a) those who show up to screen may be at a lower risk of a condition e.g. women in higher SE group more likely to attend cervical/breast screening

b) survival time appears longer because the diagnosis was done earlier (ie by screening), irrespective of whether pt lived longer. apparent increase in survival time even if screening has no effect on outcome

c) overestimation of survival duration due to relative excess cases detected in screening that are asymptomatically slowly growing - fast progressing symptomatic cases less likely to be detected in screening (but on the surface appears that screening results in cancers with better prognosis!)

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8
Q

explain what is meant by:
a) true positive
b) false positive
c) true negative
d) false negative

A

a) disease present, positive result
b) disease absent, positive result
c) disease present, negative result
d) disease absent, negative result

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9
Q

define and show the calculation for
a) sensitivity
b) specificity

A

a) proportion of people with disease who are correctly identified by a test (true positives / true positive + false negatives)

b) proportion of people without the disease who are correctly excluded by screening (true negatives / true negatives + false positives

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10
Q

define
a) positive predictive value
b) negative predictive value

A

a) proportion of people with a positive test result who actually have the disease (true positives / true positives + false positives)

b) proportion of people with a negative test result who actually don’t have the disease (true negatives / true negatives + false negatives)

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11
Q

case control studies

A

a type of analytical retrospective study - study of choice for investigating RFs and the development of a disease

takes people with disease, matches them to those without the disease and then studies previous exposure to an agent

e.g. whether environmental exposure Y is associated with the development of X

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12
Q

advantages and disadvantages of case-control studies

A

advantages - good for rare outcomes (e.g. cancer), quicker than cohort/intervention (as outcome has already happened), can investigate multiple exposures

disadvantages - retrospective so only shows association not causation, difficulties finding controls to match cases, prone to selection and information bias, recall bias

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13
Q

cross-sectional study

A

study of choice for prevalence - analyses data from population/sub-set at a specific point in time

e.g. interviewing children with cerebral palsy from 8 areas in Europe about their daily life experiences

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14
Q

advantages and disadvantages of a cross-sectional study

A

advantages
- relatively quick and cheap
- provides prevalence data
- large sample size
- good for surveillance and public health planning

disadvantages
- risk of reverse causality (did outcome of exposure come first?)
- cannot measure incidence
- risk recall bias and non-response

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15
Q

cohort study

A

prospective - for looking at exposure vs non exposure over time e.g. whether children born via IVF are more likely to suffer from mental disorders in childhood

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16
Q

advantages and disadvantages of a cohort study

A

advantages
- can FU group with a rare exposure e.g. natural disaster
- good for common and multiple outcomes
- less risk of selection and recall bias

disadvantages
- takes a long time!!
- loss to FU (people dropping out)
- need large sample size

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17
Q

incidence of disease

A

number of new cases during a specified time period

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18
Q

randomised controlled trial

A

gold standard prospective study with intervention and control

e.g. can an integrated care programme reduce disability in patients with chronic back pain

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19
Q

advantages and disadvantages of randomised controlled trials

A

advantages
- low risk of bias and confounding
- can infer causality

disadvantages
- time consuming
- expensive
- specific inclusion/exclusion criteria may mean the study population is different from typical patients
- volunteer bias

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20
Q

what is an ecological study

A

descriptive/observational study design consisting of case reports or case series studying the population

uses routinely collected data to show trends

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21
Q

advantages and disadvantages of an ecological study

A

+ve
- few ethical issues
- useful for generating hypothesis
- uses routine data so quick and cheap
- shows prevalence and association

-ve
- cannot show causation
- bias: variation in diagnostic criteria

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22
Q

types of information bias
a) measurement
b) observer
c) recall
d) reporting

A

a) e.g. different equipment used to measure the outcome in different groups

b) e.g. the researcher knows which participants are cases and which are controls, subconsciously reports/measures outcome differently

c) events that happened in the past are not remembered and reported accurately

d) respondents report inaccurate info because they are embarrassed or feel judged

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23
Q

confounding bias

A

estimated relationship between exposure and outcome is distorted because of the association of the exposure with another factor (confounder) that is also independently associated with the outcome

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24
Q

reverse causality

A

outcome causing exposure rather than exposure causing outcome

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25
Q

bradford-hill criteria of causality (what makes causality more likely?)

A
  1. strength - stronger association between the exposure and outcome
  2. consistency - same result observed from various studies and in different geographical settings
  3. dose-response - increased risk of outcome with increased exposure
  4. temporality - exposure occurs prior to outcome
  5. plausibility - reasonable biological mechanism
  6. reversibility - intervention to reduce/remove exposure eliminates or reduces outcome
  7. coherence - logical consistency with other information
  8. analogy - similarity with other established cause-effect relationships
  9. specificity - relationship specific to outcome of interest
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26
Q

purpose of screening

A

identify apparently well individuals who have (or are at risk of developing) a particular disease so that you can have a real impact on outcome

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27
Q

NHS criteria for a screening test - the condition (4)

A
  1. the condition should be an important health problem
  2. the epidemiology and natural history of the condition should be understood and there should be a detectable RF
  3. all cost-effect primary prevention interventions should have been implemented as far as practicable
  4. if the carriers of the mutation are identified as a result, the natural history of people with this status should be understood (including psychological complications)
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28
Q

NHS criteria for a screening test - the screening programme (2)

A
  1. screening should be ongoing and not just performed on a “one-off” basis
  2. the costs of screening should be economically balanced
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29
Q

NHS criteria for a screening test - the test (5)

A
  1. simple, safe, precise and validated
  2. distribution of test values should be known, suitable cut-off defined and agreed
  3. acceptable to population
  4. an agreed policy on further diagnostic investigations
  5. if it’s testing for mutations, criteria for subset of mutations to be covered by screening should be clearly set out e.g. neonatal CF screening- only commonest mutations screened for
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30
Q

NHS criteria for a screening test - the treatment (3)

A
  1. effective tx/intervention for patients identified
  2. policy on whom to treat as patients
  3. clinical management of condition and patient outcomes should be optimised
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31
Q

3 approaches to a health needs assessment

A
  1. epidemiological approach
  2. corporate approach
  3. comparative approach
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32
Q

epidemiological approach of a health needs assessment:
a) what sort of data is used?
b) sources of data?

A

a) - disease incidence & prevalence
- morbidity and mortality
- life expectancy
- services available

b) disease registry, hospital admissions, GP databases, mortality data, primary data collection (e.g. postal/patient survey)

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33
Q

advantages and disadvantages of the epidemiological approach to a health needs assessment

A

advantages
- uses existing data
- provides data on disease incidence/mortality/morbidity etc
- can evaluate services by trends over time

disadvantages
- quality of data is variable
- data collected may not be the data required
- doesn’t consider felt needs/opinions/experiences

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34
Q

what is the corporate approach to a health needs assessment? what methods does it use? stakeholders?

A
  • asks the population what their health needs are
  • uses focus groups, interviews, public meetings
  • wide variety of stakeholders e.g. teachers, healthcare professionals, social workers, charity workers, local businesses, council workers and politicians
35
Q

advantages and disadvantages of the corporate approach to the health needs assessment

A

advantages
- based on felt and expressed needs of the population in question
- recognises detailed knowledge and experience of those working with the population
- takes into account wide range of views

disadvantages
- difficult to distinguish need from demand
- group may have vested interests
- may be influenced by political agendas

36
Q

what does the comparative approach of a health needs assessment do? what may it examine?

A
  • compares the health or healthcare provision/services of one population to another
  • spatial e.g. different towns or social e.g. age, social class
  • ie compares services for a particular health issue in 2 different services
  • may examine health status, service provision, service use, health outcomes e.g. mortality
37
Q

advantages and disadvantages of comparative approach to the health needs assessment

A

advantages:
- quick and cheap if data available
- indicates whether health or services provision is better/worse than comparable areas

disadvantages:
- may be difficult to find comparable population
- data may not be available/high qual
- may not yield what the most appropriate level (e.g. provision/utilisation) should be

38
Q

health needs examples

a) something demanded but not needed or supplied

b) something supplied and needed but not demanded

c) something supplied but not needed or demanded

A

a) cosmetic surgery

b) anti-HTN tx (pt often asymptomatic)

c) >75 health check by GP

39
Q

components of the health belief model: individuals will change if they…

A
  1. believe they’re susceptible to the condition (perceived susceptibility)
  2. believe it has serious consequences (perceived severity)
  3. believe that taking action reduces susceptibility (perceived benefits)
  4. believe that benefits of taking action outweigh costs (perceived barriers)
40
Q

which component of the health belief model has been shown to be most important?

A

perceived barriers

41
Q

two revisions made to the health belief model 1974

A

health motivation and cues to action

42
Q

are cues to action always necessary for behaviour change? what are the two types and give examples

A

no

internal - increased pain, decreased ADLs

external - reminders in the post, GP advice

43
Q

advantages of health belief model

A
  1. can be applied to wide variety of health behaviours
  2. cues to action are unique component
  3. long standing model
44
Q

critiques of health belief model

A
  1. alternative factors may predict health behaviour e.g. outcome expectancy, self-efficacy
  2. doesn’t consider influence of emotions + behaviour
  3. doesn’t differentiate between first time and repeat behaviour
  4. cues to action often missing in research
45
Q

theory of planned behaviour model proposes the best predictor of behaviour is intention. what does it suggest intention is determined by? (3)

A
  1. person’s ATTITUDE to the behaviour
  2. SUBJECTIVE NORM - perceived social pressure
  3. PERCEIVED BEHAVIOURAL CONTROL - person’s appraisal of their ability to perform the behaviour
46
Q

using smoking as an example, describe the different areas of the theory of planned behaviour (4)

A

attitude - i do not think smoking is a good thing

subjective norm - most people who are important to me want me to give up smoking

perceived behavioural control - i believe i have the ability to give up smoking

behavioural intention - i intend to give up smoking

47
Q

theory of planned behaviour - 5 ways to bridge the intention-behaviour gap

A
  1. perceived control - focus on past successes, ensure individual feels capable
  2. anticipated regret - reflecting on feelings once failed, related to sustained intentions
  3. preparatory actions - break task down, plan sequence, achievable steps
  4. implementation intentions - if-then planning e.g. if i need to take my meds in the morning then i will place it here to remind me
  5. relevance to self - can they relate to the behaviour
48
Q

advantages of theory of planned behaviour

A
  1. can be applied to wide variety of health behaviours
  2. useful for predicting intention
  3. takes into account importance of social pressures
49
Q

disadvantages of theory of planned behaviours (4)

A
  1. doesn’t take into account emotion (rational choice model)
  2. no sense of how long behaviour change may take
  3. assumes attitudes, subjective norms and perceived behavioural control can be measured
  4. relies on self-reported behaviour
50
Q

5 stages in the transtheoretical/stages of change model

A
  1. pre-contemplation (not ready yet)
  2. contemplation (thinking ab it - within 6m)
  3. preparation (quitting within 28d)
  4. action (quitting now)
  5. maintenance (steady defined as >6m)
51
Q

advantages of transtheoretical/stages of change model

A
  • acknowledges individual stages of readiness (tailored interventions)
  • accounts for relapses
52
Q

disadvantages of transtheoretical/stages of change model

A
  • not all ppl move through every stage, some move back/skip stages
  • change might operate on continuum, not discrete stages
  • doesn’t take into account values, habits, emotions, culture, social and economic factors
  • people often change behaviour with no planning!
53
Q

define and give examples of

a) primary prevention

b) secondary prevention

c) tertiary prevention

A

a) preventing a disease from happening in the first place e.g. change4life, 5aday, vaccines

b) detecting a disease in early/pre-clinical phase to alter its course and improve health outcomes e.g. screening programmes

c) attempting to slow down disease progression + prevent complications of disease e.g. diabetic foot care, attending rehab after stroke

54
Q

define and give an example of the population approach to prevention

A

preventative measure delivered on a population-wide basis, seeks to shift the risk factor distribution curve

e.g dietary salt reduction through legislation to reduce BP

55
Q

define and give an example of the high-risk approach to prevention

A

identifying individuals above a chosen cut-off and treating them e.g. screening for HTN and treating them

56
Q

what is the prevention paradox?

A

a preventative measure which brings much benefit to the population often offers little to each participating individual

57
Q

types of screening

A
  1. population-based e.g. cervical, breast
  2. opportunistic e.g. BP measurements in GP surgeries
  3. screening for communicable diseases
  4. pre-employment and occupational medicals
  5. commercially provided screening
  6. genetic counselling
58
Q

define allostasis and allostatic load

A

allostasis - the ability through change/homeostasis of our physiological systems to adapt rapidly to change in environment

allostatic load = long-term over-taxation of our physiological systems leading to impaired health (stress)

59
Q

list 4 determinants of health

A
  1. genes (age, gender, ethnicity)
  2. environment (physical, social, housing, education)
  3. lifestyle (smoking, wealth, employment)
  4. access to healthcare
60
Q

Maslow’s hierarchy of needs (5)

A
  1. physiological - breathing, water, food, sleep
  2. safety - employment, resources, family health, property
  3. love/belonging - friendship, family, sexual intimacy
  4. esteem - self-esteem, confidence, achievement
  5. self-actualisation - morality, creativity, spontaneity, problem solving etc
61
Q

what are health interventions?

A

any tactics done to improve public health

62
Q

health interventions
a) individual
b) community
c) population

A

a) pt centred approach e.g. childhood imms

b) community centred approach e.g. new outdoor play area in village, more cycle paths

c) delivered nation-wide, non specific to individuals e.g. PH campaigns, screening, Clean Air act

63
Q

define equality

A

concerned with equal shares of resources/opportunities

64
Q

define equity

A

concerned with what is fair and just

65
Q

horizontal vs vertical equity

A

horizontal - equal treatment for equal need e.g. individuals with same disease should be treated equally

vertical - unequal treatment for unequal need e.g. individuals with common cold vs pneumonia need different tx

66
Q

factors affecting health equity (2)

A
  1. spatial - geographical e.g. infant mortality higher in Africa
  2. social (age, gender, SE, ethnicity) e.g. socioeconomic inequity as angina sx are higher in more deprived areas
67
Q

3 domains of public health and some examples

A
  1. health improvement/promotion - societal interventions to prevent disease, promote health and reduce inequalities e.g. education, housing, employment
  2. health protection - measures to control infectious disease risk/environmental hazards e.g. radiation, emergency response, infectious diseases, poison and chemicals
  3. healthcare - organisation and delivery of safe, high quality services for prevention, tx and care e.g. service planning, audits, clinical governance, equity
68
Q

define epigenics

A

the study of how genes interact with the environment - changes in organisms caused by modification of gene expression rather than alteration of the genetic code itself

69
Q

2 broad categories of health behaviours

A
  1. health damaging/impairing e.g. smoking, alcohol
  2. health promoting e.g. exercising, vaccines, attending health checkups
70
Q

define these health behaviours

  1. health behaviour
  2. illness behaviour
  3. sick role behaviour
A
  1. a behaviour aimed to prevent disease e.g. healthy eating
  2. a behaviour aimed to seek remedy e.g. going to doctor
  3. any activity aimed at getting well e.g. resting, taking prescribed medications
71
Q

what is the main theory as to why people partake in health damaging behaviours? define it

A

unrealistic optimism - individuals continue practising health damaging behaviours due to inaccurate perceptions of risk + susceptibility (Weinstein, 1983)

72
Q

influences of unrealistic optimism perceptions of risk (4)

A
  1. lack of personal experience with the problem
  2. belief that it’s preventable by personal action
  3. belief that it’s not happened by now so it’s unlikely to
  4. belief that the problem is infrequent
73
Q

medication compliance vs adherence

A

compliance - extent to which patient’s behaviour coincides with medical advice. professionally focussed, assumes dr knows best

adherence - extent to which pts actions match agreed recommendations. more pt centred.

74
Q

factors affecting medication compliance (4)

A
  1. side effects
  2. patient perception of risk
  3. if patient is asymptomatic (e.g. continuing to take abx)
  4. SES
75
Q

social norms theory of behaviour. when is this positive and when does it not work?

A
  • social norms are one of most important factors influencing behaviour
  • normally protective
  • but sometimes belief of norms is different to actual norms e.g. allows people who want to do high risk behaviours to think they’re just doing what everyone else is doing
  • and doesn’t work when risk behaviour IS the norm e.g. alcohol
76
Q

nudge theory

A

changing environment to make the best/healthiest options the easiest

e.g. placing fruit next to checkouts instead of sweets, opt-out schemes

77
Q

typical transition points which may influence someone to be more/less likely to change behaviours (6)

A
  1. leaving school
  2. starting work/new job
  3. becoming a parent
  4. becoming unemployed
  5. retirement
  6. bereavement
78
Q

what is a health needs assessment? what can it be carried out for?

A
  • a systematic method for reviewing the health issues facing a population
  • can be carried out for a population or sub-group (e.g. manor practice population), a condition (e.g. COPD), or an intervention (e.g. coronary angioplasty)
79
Q

planning cycle of health needs assessment (4)

A
  1. needs assessment
  2. planning
  3. implementation
  4. evaluation
80
Q

define need, demand and supply

A

need = ability to benefit from an intervention

demand = what people ask for

supply = provided

81
Q

health need vs healthcare need

A

health need = a need for health, more general e.g. mortality, morbidity, socio-demographics

healthcare need = a need for healthcare, more specific, looks at someone’s ability to benefit from health care

82
Q

what does healthcare need depend on?

A

potential of prevention, treatment and care services to remedy health problems

83
Q

sociological perspective of need - what are the 4 categories of needs?

A

felt, expressed, normative and comparative

FELT - individual perceptions of variation from normal health

EXPRESSED - individual seeks help to overcome variation in normal health (demand)

NORMATIVE - professional defines intervention appropriate for the expressed need

COMPARATIVE - comparison between severity, range of interventions and cost

84
Q
A

PHASE 3A (18 decks)

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