Public health peer teaching Flashcards
1
Q
What are the 4 perceptions that will affect likelihood of engaging in health promoting behaviour, according to the health belief model
A
Susceptibility to ill health
Severity of ill health
Benefits of behaviour change
Barriers to taking action
2
Q
7 steps of change/ transtheoretical model
A
Precontemplation Contemplation Preparation Action Maintenance Relapse
3
Q
Describe theory of planned behaviour
A
Attitudes, subjective norm and percieved behaviour control affect intention which affects behaviour
4
Q
What are the three aspects of communicable disease control?
A
Surveillance
Prevention
Control
5
Q
What makes a communicable disease important to public health authorities
A
High mortality and morbidity
Highly contagious
Expensive to treat
Effective interventions
6
Q
When do you notify of notifiable disease and how
A
On clinical suspicion, name, NHS no, DOB, contact details. What disease, diagnosis, samples, outcome.
Written notification, can be telephone first but followed by written.
7
Q
Notifiable diseases
A
Acute encephalitis, infectious hepatitis, meningitis, polymyelitis. Anthrax Botulism Brucellosis Cholera Diptheria Enteric fever Food poisoning Haemolytic uraemic syndrome Infectious bloody diarrhoea Invasive GABHS Legionnaires Leprosy Malaria Mumps Measles Meningococcal septicaemia Rubella Plague Rabies SARS Scarlet fever Small pox Tetanus TB Typhus Viral haemorrhagic fever Whooping cough Yellow fever
8
Q
Is food poisoning a notifiable disease
A
Yes
9
Q
Things other than diseases that are notifiable
A
Infection/ contamination which could be a signficant risk to human health (chichen pox in a healthcare worker), notification of suspected outbreaks/ clusters
10
Q
Define a cluster (outbreak)
A
A aggregation of cases which may or may not be linked
11
Q
Define a suspected outbreak
A
Occurence of more cases than normally expected within a specific group/ over a given period of time.
2+ cases linked through common exposure/ characteristic/ time/ location
Single case of rare/serious disease
12
Q
Define confirmed outbreak
A
Link confirmed through epidemiological/ microbiological investigation
13
Q
Define epidemic
A
Occurence within an area in excess of what is expected for a given time period
14
Q
Define pandemic
A
Epidemic widespread over several countries
15
Q
Define endemic
A
Persistent level of disease occurrence
16
Q
Define hyperendemic
A
Persistently high level of disease occurrence
17
Q
What is health
A
A state of complete physical, mental and social wellbeing; not merely the absence of disease
18
Q
What are the three domains of public health
A
Health protection
Health improvement
Improving service
19
Q
What does health protection mean
A
Measures to control infectious disease risk and environmental hazards
20
Q
What does health improvement mean
A
Social interventions aimed at preventing disease, promoting health and reducing inequality
21
Q
What does improving services health domain do
A
Organisation and delivery of safe, high quality services
22
Q
What is the inverse care law
A
The availability of medical or social care tends to vary inversely with the need of the population served
23
Q
4 categories for the determinants of health
A
Genetic
Lifestyle
Environmental
Health care
24
Q
What are genetic determinants of health
A
Age
Gender
Ethnicity
25
What are environmental determinants of health
Housing
Socioeconomic status
Access to education
26
What are lifestyle determinants of health
Smoking status
Wealth
Employment
27
What are healthcare determinants of health
Access
Quality
Economic factors
28
What is equity
What is fair and just
29
What is horizontal equity
Equal treatment for equal need
30
What is vertical equity
Unequal treatment for unequal need
31
Define 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
32
What is the health needs assessment cycle
Needs assessment
Planning
Implementation
Evaluation
33
Describe epidemiological health needs assessment
Defines problem and size of problem
Looks at current services
Recommends improvements
34
What are the limitations of epidemiological health needs assessment
Data available may be poor
May be inadequate evidence base
Doesnt consider felt need
35
Describe the comparative health needs assessment
Compares services recieved by one population to another
36
What are the limitations of a comparative health needs assessment
Data available may vary in quality. May be hard to find comparable population. Comparison may not be perfect
37
Describe corporate health needs assessment
Takes into account views of any groups that may have an interest e.g. patients, media, proffesionals, politicians
38
What are the limitations of corporate health needs assessment
May be hard to distinguish need from demand
Groups have vested interest leading to bias
Dominant individuals may have bias
39
Define health need
The ability to benefit from an intervention
40
Define supply
What is provided
41
Define demand
What people ask for
42
What are the four types of need
Felt need
Expressed need
Normative need
Comparative need
43
Define felt need
Individual perceptions of deviations from normal health
44
Define expressed need
Seeking help to overcome variation in normal health
45
Define normative need
Professional defines intervention for expressed need
46
Define comparative need
Comparison between severity, range of interventions and cost
47
What are the steps in maslows heirachy of needs
```
Physiological
Safety
Love and belonging
Esteem
Self actualisation
```
48
What is the egalitarian approach to resource allocation
Provide all care that is necessary and required to everyone
49
What are the pros and cons of egalitarian resource allocation
Equal for everyone but economically restricted
50
What is the maximising approach to resource allocation
Based solely on consequence
51
What are teh pros and cons of a maximising approach to resource allocation
Resources allocated to those likely to recieve most benefit but those with 'less need' receive nothing
52
What is the libertarian approach to resource allocation
Each individual is responsible for their own health
53
What are the pros and cons of libertarian approach to resource allocation
Leads to more patient engagement but not all diseases are self inflicted
54
What are maxwells dimension to assessing the quality of service
```
Access
Equity
Appropriate
Acceptable
Efficient
Effective
```
55
Define health behaviour
Behaviour aimed at preventing disease
56
Define illness behaviour
Behaviour seeking remedy
57
Define sick role behaviour
Activity aimed at getting well
58
Name 6 models of behaviour change
```
Health belief model
Motivational interviewing
Transtheoretical model
Financial incentives
Theory of planned behaviours
Nudge theory
```
59
Advantages of the transtheroetical model
Acknowledges individual stages of readiness
Accounts for relapse
Temporal element
60
Disadvantages of transtheoretical model
Some individuals skip stages
Change may be continuous
Doesnt consider values
61
What things affect intention of planned behaviour
Attitudes
Subjective norms
Perceived behvaiour control
62
What factors influence relationship between intention and behaviour
```
Prepatory actions
Percieved control
Anticipated regret
Implementation intentions
Relevance to self
```
63
Advantages of theory of planned behaviours model
Very applicable
Useful for predicting intention
Takes importance of social pressures into account
64
What are the disadvantages of theory of planned behaviours
No temporal element, direction or causality
Doesnt consider emotions
Assumes attitudes can be measured
65
What are the 5 perceptions which are part of health belief model
```
Susceptibility
Severity
Motivation
Benefits
Barriers
```
66
Advantages of health belief model
Very applicable
Cues to action
Longest standing model
67
What things affect action in health belief model
Health beliefs affect likelihood of action which affects action. Cues to action also affect action
68
Disadvantages of health belief model
Other factors may influence outcome
Doesnt consider emotions
Doesnt differentiate first and repeated behaviours
69
What is the bolam rule of medical negligence
Would a reasonable doctor do the same?
70
What is the bolitho rule of medical negligence
Would that be reasonable?
71
What are the four key questions when it comes to medical negligence
Was there a duty of care?
Was there a breach in that duty?
Was the patient harmed?
Was the harm due to the breach in duty of care?
72
Name some types of error
```
Fixation and loss of perspective
Communication breakdown
Poor team working
Playing the odds
Bravado
Timidity
Ignorance
Mistriage
Lack of skill
System error
Sloth
```
73
Explain how the swiss cheese model works
A series of latent failures and absent defenses lead to active failures and unsafe acts
74
What is the three bucket model of error
Self
Context
Task
Error is due to interaction of personal, environemtnal and physical factors
75
Define a never event
A serious, largely preventable patient safety incident that should not occur if available, preventative measures should have been implemented
76
Examples of never events
Wrong route chemo
Wrong site surgery
Escape of mental health patient
77
Consequences of never event
Financial penalties, CQC visit, reputation loss
78
Define screening
Identifying apparently well individuals who have or at risk of having a particular disease
79
Give four examples of screening
Newborn
Breast cancer
Cervical cancer
Bowel cancer
80
What are wilsons criteria
Requirements that screening must fulfil for it to be effective
81
Wilsons criteria: Disease
Important
Natural history known
Early treatment better than late
82
Wilsons criteria: test
Acceptable for the population
Facilities available
Simple, safe, precise and validated
83
Wilsons criteria: outcomes
Ongoing feasibility
Treatment available
Cost benefit analysis
84
Ranking of study designs
```
Systematic review/ meta analysis
RCT
Cohort
Case control
Cross sectional
Case series
Case report/anecdote
```
85
Describe cross sectional study design
Snapshot data of those with and without disease to find associations at a single point in time
86
Pros and cons of cross sectional studies
Quick, cheap, few ethical issues but prone to bias and no time reference
87
Describe case control studies
RETROSPECTIVE observational study which looks at a certain exposure and compares similar participants without the disease
88
Pros and cons of case control (patients notes)
Good for rare diseases, inexpensive but it can only show association and is unreliable due to recall bias
89
Describe cohort studies
Longitudinal PROSPECTIVE study which takes a population of people recording their exposures and conditions
90
Pros and cons of cohort studies
Can show causation and have less chance of bias but large amount lost to follow up and they are expensive
91
Describe randomised control trial
Similar participants randomly controlled to intervention or control groups to study the effect of the intervention
92
Pros and cons of RCTs
Can infer causality and have less bias but time consuming, expensive and ethical issues can interfere
93
Factors to assess causality (bradford hill criteria)
```
Biological plausability
Temporal relationship
Dose response relationship
Strength of association
Specificity
Consistency
Altered by experimentation
Coherence with existing themes
Consider reverse causality
```
94
Define confounder
Risk factors, other than those being studied that influence the outcome
95
Do confounders affect the exposure or outcome
Both
96
Define bias
A systematic error that results in a deviation from the true effect of an exposure on an outcome
97
Describe selection bias
Discrepancy of who is involved
98
Describe publication bias
Some trials are more likely to be published than others
99
Name four types of information bias
Measurement bias
Observer bias
Recall bias
Reporting bias
100
What is measurement bias
Different equipment may give different values
101
Describe recall bias
Past events incorrectly remembered
102
Describe reporting bias
Responder doesnt tell the truth
103
Define incidence
Number of new cases in a population during a specific time period
104
Define prevalence
Number of existing cases at a specific point in time
105
What is attributable risk
Number of cases that are specifically due to one risk factor.
Total - Number of cases that would have happened anyway
106
How are the attrituble risk and number needed to treat related
NNT=1/attributable risk
107
Define sensitivity
% correctly identified with the disease
108
Define specificity
% correctly excluded as disease free
109
Define positive predictive value
% of those with a positive test that actually have the disase
110
Define negative predictive value
% of those with a negative test who are actually disease free
111
Define chance
Possibility that there is a random error
112
Define reverse causality
Outcome results in exposure
113
Name 5 factors that can cause association
```
Bias
Chance
Confounding
Reverse causality
True association
```
114
What is lead time bias
Early identification doesnt alter outcome but appears to increase survival
115
What is length time bias
Disease that progresses more slowly is more likely to be picked up by screening, whih makes it appear that screening prolongs life
116
Name the 9 bradford hill criteria for causation
```
Temporality
Dose response
Strength
Reversibility
Consistency
Plausability
Coherence
Analogy
Specificity
```
117
What is the planning cycle for health services
Needs assessment
Planning
Evaluation
implementation
118
What are bradshaws needs
Felt need
Expressed need
Normative need
Comparative need
