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Phase 3a > public health/PPD 2 > Flashcards

public health/PPD 2 Flashcards

1
Q

what is epidemiology?

A

The study of the frequency, distribution and determinants of diseases and health related states in populations in order to prevent and control disease.

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2
Q

what is incidence?

A

new cases in a time period

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3
Q

what is prevalence ?

A

existing cases at a point in time

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4
Q

what is person time and when is it used?

A

person time is a measure of time at risk

it is used to calculate incidence rate which uses person time as denominator

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5
Q

what is absolute risk?

A

gives a feel for actual numbers involved

e.g. 50 deaths per 1000 population

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6
Q

what is relative risk ?

A

risk in one category relative to another
e.g. ration of risk of disease in the exposed to the risk in the unexposed

incidence in exposed divided by incidence in unexposed

e.g. how times ore likely it will occur in the intervention group relevant to the control group
RR= 1 means no difference
RR>1 means the intervention increased the risk of the outcome
RR<1 means the intervention decreased the risk of the outcome

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7
Q

what is attributable risk?

A

the rate of disease in the exposed that may be attributed to the exposure
e.g. incidence in the exposed minus incidence in unexposed
a type of absolute risk (absolute excess risk)

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8
Q

Why is the attributable risk smaller for Disease A compared with Disease B even though the relative risk is much larger?

A

because disease B is more common

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9
Q

what is relative risk reduction ?

A

RRR is the reduction in rate of the outcome in the intervention group relative to the control group

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10
Q

what is absolute risk reduction?

A

ARR is the absolute difference in the rates of events between the two groups and gives an indication of the baseline risk and intervention effect

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11
Q

what is the number needed to treat?

A

NNT tells us the number of patients we need to treat to prevent one bad outcome
1 over the absolute relative risk

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12
Q

if a study finds an association between an exposure and an outcome, this could be due to:

A 
bias
chance
confounding
reverse causality 
a true casual association
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13
Q

what is bias?

A

Asystematic deviation from the true estimation of the association between exposure and outcome
–i.e. a systematic errorwhich leads to a distortion of the true underlying association

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14
Q

what are the main groups of bias?

A

selection bias (a systematic error in: the selection of study participants, the allocation of participants to different study groups)

Information (measurement) bias - a systematic error in the measurement or classification of exposure or outcome

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15
Q

what are the sources of information (measurement) bias?

A

observer (observer bias)
participant (recall bias)
instrument (wrongly calibrated instrument)

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16
Q

what is confounding?

A

The situation where a factor is associated with the exposure of interest and independently influences the outcome (but does not lie on the causal pathway)

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17
Q

when thinking about association and causation what should you consider?

A

bias
chance
confounding
criteria for causality

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18
Q

what is reverse causality?

A

This refers to the situation when an association between an exposure and an outcome could be due to the outcome causing the exposure rather than the exposure causing the outcome.

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19
Q

what are the criteria for causality?

A

Criteria for causality (Bradford-Hill criteria

Strength of association – the magnitude of the relative risk
Dose-response - the higher the exposure, the higher the risk of disease

Consistency – similar results from difference researchers using various study designs

Temporality – does exposure precede the outcome

Reversibility (experiment) – removal of exposure reduces risk of disease

Biological plausibility - biological mechanisms explaining the link.

Coherence – logical consistency with other information

Analogy – similarity with other established cause-effect relationships

Specificity – relationship specific to outcome of interest

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20
Q

what are person years?

A

measure of time at risk, i.e. time from entry to a study to (i) disease onset, (ii) loss to follow-up or (iii) end of study. Used to calculate incidence rate which uses person time as the denominator.

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21
Q

what are the different types of health behaviours?

A

a health behaviour - a behaviour aimed to prevent disease (eating healthy)

an illness behaviour - a behaviour aimed to seek remedy (e.g. going to the doctor)

a sick role behaviour - any activity aimed at getting well (taking medications, resting)

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22
Q

what is the theory of planned behaviour?

A

it proposes the best predictor of behaviour is intention e.g. I intend to give up smoking

23
Q

what is intention determined by in the theory of planned behaviour?

A

a persons attitude to the behaviour
the perceived social pressure to undertake the behaviour or subjective norms
a persons appraisal of their ability to perform the behaviour or the perceived behavioural control

24
Q

what are the criticisms of the theory of planned behaviour?

A

lack of temporal element

lack of direction or causality

25
Q

what is the stage models of health behaviour

A

proposes 5 stages of change

  1. precontemplation
  2. contemplation
  3. preparation
  4. action
  5. maintenance
26
Q

what is motivational interviewing?

A

a counselling approach for initiating behaviour change by resolving ambivalence

27
Q

what is the nudge theory ?

A

nudge the environment to make the best option the easiest e.g. opt-out schemes such as pensions, placing fruit nex to checkouts

28
Q

what factors should you consider when thinking about behaviour change?

A

– Impact of personality traits on health behaviour
– Assessment of risk perception
– Impact of past behaviour/habit
– Automatic influences on health behaviour
– Predictors of maintenance of health behaviours
– Social norms

29
Q

what are the transition points which can lead to a behaviour change (positive or negative)?

A 
–	leaving school, 
–	entering the workforce
–	becoming a parent
–	becoming unemployed
–	retirement and bereavement.
30
Q

what is the NCSCT?

A

National Centre of Smoking Cessation & Training (NCSCT) = A social enterprise to support the delivery of effective evidence-based tobacco control programmes and smoking cessation interventions provided by local stop smoking services. The NCSCT:
– delivers training and assessment programmes
– provides support services for local and national providers
– conducts research into behavioural support for smoking cessation

31
Q

why notify about communicable diseases?

A

so the health protection agency can take urgent control measure
may be the only one who can tell the health protection agency
it is a duty of medical practitioners

32
Q

when is it the duty of medical practitioner to notify the proper officer of local authority?

A

. Notifiable diseases
. Infection which could present (or have presented) significant harm to human health
. Contamination which could present (or have presented) significant harm to human health (chemical/biological/radiological)

33
Q

when is it the duty of diagnostic laboratory operators to notify?

A
  • when causative agents are found in human samples
  • must be provided in writing within 7 days
    must be provided orally as soon as practicable if urgent
    Duty to provide information to the HPA
    . HPA may require requesting clinician to provide supplementary information to a laboratory test result
    . Information must be provided in writing within 3 days of the HPA request
34
Q

what powers do the local authorities have?

A

• Schools:
Requirement to keep children away from school
Requirement for school to provide list of attendees
• Requests for cooperation for health protection purposes
A local authority may serve notice on any person or group of persons requesting them to do or refrain from doing anything for the purpose of preventing, protecting against, controlling or providing a public health response to the incidence or spread of infection or contamination which presents or could present a sig harm to health. LA MAY offer compensation

35
Q

what might a magistrate order require in terms of communicable diseases?

A

people - medical examination, removal to and/or detention in a hospital isolation or quarantine, disinfection or quarantine, disinfection or decontamination, to wear protective clothing, to provide information, power to monitor, attendance at training or advice sessions, restriction on movements, prohibition from working or trading

Things - seizure or retention, isolation or quarantine, disinfection or decontamination, destruction

premises - closure, detention of conveyances or movable structures, disinfection or decontamination, destruction

36
Q

what is the role of the consultant in communicable disease control?`

A

surveillance - using notification, lab and other data to monitor communicable diseases
Prevention - trying to stop people getting infectious disease in the first place e.g. immunisation programmes
Control - what we do when routine cases and outbreaks occur

37
Q

how can outbreaks of communicable diseases be managed?

A
  • clarify the problem (make a diagnosis)
  • decide if it is an outbreak (2 or more related cases of a communicable disease)
  • if so get whatever help you need e.g. microbiologists, health visitors, consultants physician in infectious disease, control of infection nurse
  • call an outbreak meeting ( a public health equivalent to the ward round)
  • identify the cause
  • initiate control measures
38
Q

what are the modes of transmission for communicable diseases?

A

foodborne - acquired from food or water

  • faecal-oral spread
  • resp routes
  • direct physical contact
  • acquired from animals
39
Q

what is Maslow’s hierarchy of needs?

A

physiological (most important) - breathing, food, water, sex, sleep, homeostasis, excretion
Safety - security of body, of employment, of resources, of the family, of health, of poverty
Love/belonging - friendship, family sexual intimacy
esteem - self esteem, confidence, achievement, respect of others, respect by others
Self actualization - morality, creativity, spontaneity, problem, solving, lack of prejudice, acceptance of the facts

*If there is a level of the hierarchy that a person has not fulfilled, then finding something to fulfill that level is what they will want or desire. For instance, if someone does not have a home to live in (which would fall under the Safety level), but have things like food and water, then the most important thing that they would want is to find a home. They would think about this need before the need to find someone to marry, which would fall under the Love and Belonging level.

40
Q

what can cause relationship breakdown which can lead to homelessness?

A

mental illness/breakdown
domestic abuse
disputes with parents
bereavement - more than half say they have no family ties

41
Q

what health problems do homeless people face?

A

infectious disease such as TB and hepatitis
poor condition of feet and teeth
respiratory problems
injuries following violence, rape
sexual health, smears, contraception often not accessible
serious mental illness - schizophrenia as well as depression and personality disorders
poor nutrition
addicitons
substance misue

42
Q

what barrier to healthcare do travellers/gypsies have?

A

Reluctance of GPs to register Gypsies and Travellers, and to visit sites.
Poor reading and writing skills. Many are illiterate.
Communication difficulties
Too few permanent and transient sites
Mistrust of professionals
Lack of choice

43
Q

what barriers to healthcare do homeless people face?

A
  • difficulties with access to health care - due to opening times, appointment procedure locations and perceived or actual discrimination)
  • lack of integration between mainstream primary care services and other agencies (housing, social services, criminal justice system and voluntary
  • they may not know where to find help
44
Q

what is an asylum seeker?

A

a person who has made an application for refugee status

45
Q

what is a refugee?

A

a person granted asylum and refugee status, usually means leave to remain for 5 years and then reapply

46
Q

what is the humanitarian protection?

A

failed to demonstrate claim for asylum but face some serious threat to life if returned - usually 3 years then reapply

47
Q

how do asylum seekers live?

A
  • No choice dispersal
  • Vouchers/70% of income support sum
  • NASS support package
  • Full access to NHS
  • Not allowed to work
48
Q

what physical and mental health problems do asylum seekers face?

A

physical health

  • common illness
  • illness specific to country of origin
  • injuries from war and travelling
  • no previous surveillance/neonatal screen/immunisations
  • malnutrition
  • torture and sexual abuse
  • infestations and deliberation
  • communicable disease/blood borne disease
  • untreated chronic disease/congenital problems

Mental health

  • PTSD
  • depression
  • sleep disturbance
  • psychosis
  • self harm
49
Q

rule of rescue

A
  • ‘a perceived duty to save endangered life where possible’
  • ‘the sense of immediate duty that people feel towards those who present themselves to a health service with a serious condition’
  • ‘an ethical imperative to save individual lives even when money might be more efficiently spent to prevent deaths in the larger population’
  • ‘the powerful human proclivity to rescue a single identified endangered life, regardless of cost, at the expense of any nameless faces who will therefore be denied health care’
50
Q

evaluation of healthcare - what is evaluation? two approaches…

A 
evaluation = process that attempts to systematically assess whether service meets its objectives.
1 = donabedian
2 = maxwells dimensions of equality
51
Q

donabedian evaluation method

A
  • structure - what their is - eg beds per 1000
  • process - what is done - eg no of pts seen in A&E
  • outcome - 5D’s - death, disability, disease, discomfort, dissatisfaction
52
Q

maxwells dimensions of equality evaulation method

A
  • Access to services (for example, taking a population-based approach, do some sub-groups find services easier to access than other sub-groups? This could be about the physical location of services as well as different attitudes on seeking care)
  • Relevance to need (for the whole community)
  • Effectiveness (on an individual patient basis)
  • Equity (could the service in any way be made more fair? Is it reaching different population groups?)
  • Acceptability (is this a procedure which many find too uncomfortable/embarrassing/ painful to undertake and so avoid treatment?)
  • Efficiency and economy (is the service making the best use of available funds?
53
Q

quant vs qualitative methods of research

A

quant – PROMs, mortality, no. hospital admissions etc, qual – focus groups, surveys, review of documents

54
Q

8 models of behaviour change

A 
Health Belief Model
Theory of Planned Behaviour
Stages of Change/Transtheoretical Model
Social norms theory
Motivational Interviewing
Social Marketing
Nudging
Financial Incentives

Phase 3a (41 decks)

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