Public Health + PPS Flashcards

Question

what is an ecological study?

Answer 1

a study carried out at the population (or group) level rather than at the individual level

Answer 2

aka ecological correlation study. | compares different groups (or areas) at a point in time

Answer 3

a type of ecological study, aka a time series study. examines data in a population over time. investigates if changes in incidence correlate with changes in exposures over time. can be long (e.g. seasonal variation) or short (e.g. daily variation)

Answer 4

``` pollution income GDP and other national statistics per-capita consumption climate diet etc. etc. ```

Answer 5

- to investigate differences between populations - to study group-level effects (e.g. seat belt law only works at a group level!) - convenience and availability of group level data (e.g. air pollution data is only available at a group level) - quick and cheap study design!

Answer 6

1. confounders - often, you can't adjust for these due to lack of data 2. bias - data may be collected using different methods or definitions over time or in different places 3. ecological fallacy 4. migration of populations between groups can dilute differences

Answer 7

cannot assume that group level associations between exposure and outcome will also apply at the individual level e.g. increased meat consumption and breast cancer rates - is it the meat-eaters who get the cancer?

Answer 8

a "follow up" or "observational" study. a cohort = a group of individuals sharing a common characteristic. cohort studies take exposed and unexposed cohorts and follow them up over time, measuring incidence. may be prospective or retrospective. exposure is decided before outcome is observed.

Answer 9

compares INCIDENCE of an outcome in individuals with different exposure to a risk. useful for investigating rare exposures, and/or several outcomes.

Answer 10

risk ratio, odds ratio or rate ratio. derived from incidence that is measured over the course of the study. can use these to calculate AR and PAR

Answer 11

prospective and retrospective. prospectives start now and follow-up into future. retrospective use existing data on exposures and outcomes.

Answer 12

all the events have already taken place, and records of them must exist. a 'start date' for the study is in the past, and then records are checked to see what outcome(s) developed after the start date. does NOT look back from an outcome to find the exposures!!

Answer 13

if it's a common exposure, select your population before classifying by exposure - if it's a rare outcome, you may need to recruit on the basis of exposure. in selecting an unexposed group, you may choose either an internal or external comparison group, or compare with general population - but beware healthy worker effect

Answer 14

might need a long follow-up period - loss to follow up (aka attrition) may be a serious problem! data should be collected without knowledge of exposure status

Answer 15

if follow up times for all participants are similar, use risk. if they vary, use rate so that person-time at risk is taken into account.

Answer 16

1. true association 2. bias 3. confounding 4. chance 5. reverse causality

Answer 17

1. strength 2. consistency 3. dose-response 4. temporality 5. plausibility 6. reversibility 7. coherence 8. analogy 9. specificity

Answer 18

temporality! | one of the few study designs that definitely meet this criteria

Answer 19

any error that results in a systematic deviation from the true estimation of the association between exposure and outcome (a systematic error which leads to a distortion of the truth)

Answer 20

loss to follow up (selection bias) non-participation (selection bias) classification of outcome and exposure (observer bias)

Answer 21

situation where a factor is associated with the exposure of interest, and independetly influences the outcome, but does NOT lie on the causal pathway e.g. grey hair and back pain are associated - is this a causal relationship? no! age is a CONFOUNDER here.

Answer 22

- useful for rare exposures - can study effect of exposure on a range of outcomes - if accurate and detailed exposure assessment is carried out, can assess for a dose-response relationship - data on potential confounders can also be collected (if prospective) - meets temporality!!

Answer 23

- large sample size may be required - can't use for rare outcomes - costs (with propsective) - time required for follow-up (with prospetive) - retrospectives don't usually have as accurate and consistent exposure assessment, or data on confounders

Answer 24

cohort study

Answer 25

cross-sectional | cohort

Answer 26

individuals with the outcome of interest (cases), and individuals without the outcome (controls) that match the cases on some demographic factors, are identified from a population. then look back to identify how many individuals in each group were exposed/unexposed.

Answer 27

need a precise case definition, with clear inclusion and exclusion criteria set BEFORE selection begins. will you be using prevalent or incident cases?

Answer 28

generally, incident cases preferred. prevalent cases may be abnormally more or less severe (e.g. if less severe ones have recovered, or if more severe ones have died) the disease influences how many cases picked up by prevalent or incident cases. if you use prevalent cases, you can't distinguish between factors associated with the rates of the disease, and factors associated with the disease PERSISTING

Answer 29

controls should represent exposure distribution of the population from which the cases were drawn. need inclusion and exclusion criteria that are similar to that for cases (but obvs no disease!). need to be careful where you source controls from e.g. if cases are hospital based, should controls also be hospital based? won't represent general population but would be more similar to cases... Matching can be done at individual or group level (e.g. match individual controls to a case, or e.g. if case group is 70% male, ensure control group is also 70% male) Beware overmatching - when matching variable is closely related to exposure variable

Answer 30

a case-control study carried out within a full cohort study. e.g. cohort study of outcome A following exposure A, could also carry out a nested case-control looking at exposures B, C and D in relation to outcome A. (i think??) avoids selection bias, as cases and controls arose from same population. also avoid info bias as all the same data collection is carried out on all participants. avoids reverse causality

Answer 31

odds ratio of exposure

Answer 32

observer bias - ideally, researcher collecting exposure should not know case-control status reporting (response/recall) bias - cases may remember exposures better than controls e.g. cases of asbestosis more likely to remember that an old work place has asbestos than controls!

Answer 33

- relatively cheap and quick - useful for rare outcomes - can study effect of multiple exposures on disease risk for a single disease

Answer 34

- potential for selection/information bias - problems with temporality - possible reverse causality - no good for rare exposures - no good for multiple outcomes for a single exposure - can't estimate incidence or prevalence of a population

Answer 35

case-control

Answer 36

a study in which participants are actively allocated an intervention by the investigators i.e. an experiment

Answer 37

Randomised allocaation to intervention or control. Controlled - use of a contemporary comparison arm, with participants given nothing/placebo/usual treatment. Trial - an experimental study

Answer 38

observation studies are more subject to bias and confounding. RCTs provide GOLD STANDARD for causality

Answer 39

stratified randomisation blocked randomisation systematic randomisation simple randomisation

Answer 40

avoids measurement/reporting/analytical bias. | investigator, participant and statistical analyst should all ideally be blind.

Answer 41

in an efficacy trial, you are testing the maximum effect of an intervention if used in a closely monitored setting (e.g. the effect of a drug when patients are supervised taking it each day, or given lots of reminders etc). in an effectiveness trial, you are looking at what the effect of an intervention is in routine clinical practice - this is more generalisable. i.e. in an efficacy trial a drug might have X effect, with patients receiving daily reminders to take the drug at correct dose, time etc. but in an effectiveness trial, the drug will then have Y effect (lower than X), because some patients will take it at the wrong time of day, or miss doses etc

Answer 42

allocation of groups rather than individuals e.g. entire schools, or GPs. needed when the intervention is at group level e.g. free milk in schools. also useful if contamination between intervention and control groups is likely. BUT - need larger sample size

Answer 43

ITT should always be the primary analysis of an RCT - outcome is compared between study groups according to their initial allocation, regardless of any loss to follow up, or switching between groups. this ensures comparability and avoids potential selection biases that might arise. a per-protocol analysis can tell you the true potential effect of an intervention, if e.g. compliance was improved. only participants who received intervention according to protocol are included in analysis.

Answer 44

risk ratio, rate ratio, relative risk reduction. absolute risk reduction numbers needed to treat (NNT)

Answer 45

control group actively denied the intervention use of placebo - generally, give the current "usual" treatment, rather than replacing that with a placebo informed consent

Answer 46

to meet ethical requirements, RCTs will usually have predefined stopping rules to ensure that if a trial is showing clear harm or benefit early on, it is not continued. This avoids undue risk to participants, depriving control group of an effective intervention, or continuing an ineffective intervention

Answer 47

- minimise risk of bias and confounding (especially if properly randomised and blinded) - can study multiple outcomes - can measure "incidence" of outcome - provides strong evidence of causal relationship

Answer 48

- EXPENSIVE - may need long follow up - risk of high drop out rates - ethical concerns - RCTs may end up with conflicting results anyway

Answer 49

to prevent a disease from occurring. | carried out when no disease is present, done by reducing exposure or risk factor levels.

Answer 50

lifestyle changes to reduce CVD risk. fluoridation of drinking water to prevent tooth decay. childhood imms to prevent communicable diseases.

Answer 51

detect early disease in order to alter the course of the disease. also, prevention aimed at preventing a disease from recurring.

Answer 52

SCREENING! e.g. screening for breast cancer allows earlier treatment, altering course of disease. also, treatment with aspirin to prevent recurrence of a heart attack.

Answer 53

to minimise disability and prevent complications

Answer 54

rehabilitation after a stroke. | treatment to prevent death after a heart attack.

Answer 55

a preventative measure which brings a big benefit to the population, often offers little to each individual. e.g. seat belt law - for every 1 life saved, 400 people have to wear their seatbelt everyday for 40 years. so there's 399 people who have received no benefit to their survival from wearing a seatbelt daily for 40 years! healthcare e.g. is statins for CVD

Answer 56

population approach means targeting an entire population with a preventative measure, offering each individual little benefit in exchange for a reduction in overall population risk. high risk approaches target only those at high risk of an outcome. NB - pop. approach isn't always EVERYONE, might be e.g. all infants

Answer 57

- potential to benefit the whole population - "behaviourally appropriate" ? not sure what this means - maybe that it's seen as good to spend public money on strategies that can benefit everyone?

Answer 58

- small benefit to individuals - poor motivation of subjects - poor motivation of physicians - benefit-to-risk ratio may be low

Answer 59

- intervention is appropriate to the individuals targeted - subjects and physicians are more motivated - benefit-to-risk ratio is good

Answer 60

- screening costs (have to identify who is at high-risk, and this costs money/resources!) - temporary effect - limited effect - "behaviourally inappropriate" ??

Answer 61

a process which sorts out apparently well people (i.e. those without symptoms) who PROBABLY have a disease (/precursors/susceptibility to a disease) from those who PROBABLY do not. NB - not intended to be diagnostic

Answer 62

primary or secondary prevention. secondary - e.g. screening by mammogram for breast Ca to treat it early primary - screening to identify people with risk factors and reduce risk factor levels (e.g. NHS health checks, well man/woman checks)

Answer 63

- reduce risk of developing disease - provide treatment - provide information (e.g. pre-natal screening for genetic disorders)

Answer 64

proportion of people with the disease who are correctly identified by the screening test

Answer 65

the proportion of people without the disease who are correctly excluded by the screening test

Answer 66

the proportion of people with a positive test result who actually have the disease

Answer 67

the proportion of people with a negative test result who do not have the disease

Answer 68

PPV and NPV. sensitivity and specificity are specifically about the screening TEST - they will not change unless the test is altered.

Answer 69

PPV will decrease, NPV will increase

Answer 70

1. condition should be an important health problem 2. natural history of the condition should be understood 3. there should be a detectable early stage

Answer 71

1. there should be an accepted treatment for the disease 2. facilities for diagnosis and treatment must be available 3. adequate health service provision should be made for extra clinical workload resulting from screening (e.g. need to be able to do the extra breast surgeries before you start screening people for breast Ca!)

Answer 72

1. a suitable test should be devised for the early stage of a condition 2. the test should be acceptable 3. intervals for repeating the test should be determined (e.g. cervical screening every 3-5 years)

Answer 73

1. there should be an agreed policy on whom to treat 2. costs must be balanced against benefits also - risks (physical and psychological) should be less than benefits!

Answer 74

Wilson and Jungner only important in case they say 'list the Wilson screening criteria'

Answer 75

selection bias lead-time bias length-time bias

Answer 76

RCT - individual or cluster

Answer 77

people who choose to participate in screening programmes may be different from those that don't bother e. g. may be at higher risk - family hx of breast Ca = more likely to attend breast screening e. g. may be at lower risk - women in higher SE groups are more likely to attend cervical screening, but are at lower risk

Answer 78

can occur when survival time is used as outcome to assess screening. patients in screening group appear to have a longer survival time, as disease is being diagnosed earlier (at point of screening, rather than when symptoms develop) - however, survival time is actually the same.

Answer 79

a bias in which individuals with slower growing/progressing, less aggressive disease are more likely to be detected by screening, making screening appear to have better outcomes (as these individuals would have had a better outcome than those with a rapidly progressing, aggressive disease anyway)

Answer 80

- population- based ("mass") screening programmes - opportunistic screening e.g. GPs doing BPs when patients come in for any health issue - Screening for communicable diseases - Pre-employment and occupational medicals e.g. vision tests for commercial drivers

Answer 81

systematic deviation from a true estimate of the association between exposure and outcome

Answer 82

selection bias | information (aka measurement) bias

Answer 83

a systematic error in selection of study participants, or in their allocation to different study groups

Answer 84

non-response

Answer 85

healthy worker effect | loss to follow-up

Answer 86

selection of cases | selection of controls

Answer 87

systematic selection for intervention/control groups (rather than true randomisation)

Answer 88

the degree to which a measurement measures what it is meant to measure

Answer 89

the degree to which the results obtained by a measurement procedure can be replicated

Answer 90

inaccurate measurement/classification of either exposure or outcome. misclassification can be differential or non-differential

Answer 91

observer/researcher - observer bias participant - recall bias instrument - e.g. wrongly calibrated instrument

Answer 92

bias - in either direction. e.g. measurement of BP in two samples by two nurses using two BPs

Answer 93

underestimation of any true association (i.e. moves RR closer to 1) this is a random misclassification, that's completely independent of exposure/outcome status

Answer 94

- blinding - use of objective measures - use of records rather than recall - use of automated instruments rather than observers

Answer 95

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

Answer 96

- restriction - randomisation - matching

Answer 97

- stratification | - statistical modelling

Answer 98

``` no. cases of the disease at specific time point/period ////////////// total no. people in the population at same time point/period ```

Answer 99

``` all NEW cases of disease in population over specific time period ///////// total population at start of time period ```

Answer 100

``` no. new cases of disease //// no. people still disease free ``` (all in a specified time period)

Answer 101

``` no. NEW cases of disease in a specified time period //// person-time at risk in that time period ```

Answer 102

risk in the exposed group // risk in the unexposed group

Answer 103

odds of outcome in exposed group /// odds of outcome in unexposed group

Answer 104

incidence rate in the exposed group /// incidence rate in unexposed group

Answer 105

incidence (rate) in exposed - incidence (rate) in unexposed

Answer 106

AR ///// incidence in exposed group express as decimal or %

Answer 107

incidence in whole population - incidence in unexposed group

Answer 108

PAR /// incidence in whole population

Answer 109

``` odds of exposure among cases // odds of exposure among controls ```

Answer 110

incidence in control group - incidence in treatment group

Answer 111

true positives / no. people with the disease | a / a+c

Answer 112

true negatives / no. people with no disease | b / b+d

Answer 113

true positives / no. positive results TP / TP+FP a / a+b

Answer 114

true negatives / no. negative results TN / TN+FN d / c+d

Answer 115

sugar tax folic acid in flour legislation for dietary salt reduction

Answer 116

enhanced screening for other CVD risk factors for people with high blood pressure. only giving BCG vaccine to babies with certain risk factors.

Answer 117

``` genetics employment type (shift work) early developmental factors TV viewing/advertisements characteristics of food eaten (e.g. energy density, portion size might mean more calories consumed in one sitting) reduced physical activity (less energy needed) sleep environmental cues psychological factors ```

Answer 118

deficiencies, excesses or imbalances in a person's intake of energy and/or nutrients - includes undernutrition (stunting, wasting, underweight, micronutrient deficiencies) and overweight (obesity, diet-related NCDs)

Answer 119

``` cancer CF coeliac IBD/IBS T1DM T2DM failure to thrive EDs overweight/obesity ``` Drs should be able to understand and respond to/advise patients

Answer 120

- maternal diet and taste preference development - breastfeeding - has role for taste preference and bodyweight regulation - parenting practices/styles - age of introduction of solid food - types of food exposed to during weaning and beyond

Answer 121

- modelling 'healthful' eating behaviours - responsive feeding (recognising hunger and fullness cues) - providing a variety of foods - avoiding pressure to eat - restriction - authoritative parenting - not using food as a reward - indulgent/neglectful feeding practices

Answer 122

feeding aversion, food refusal, food selectivity, fussy eaters, failure to advance to age-appropriate foods, negative mealtime interactions. high prevalence in <6 yo parents with NOFEDs shown as often using maladaptive parental feeding practices.

Answer 123

anorexia nervosa bulimia nervosa binge eating disorder OSFED - other specified feeding or eating disorder

Answer 124

1. restricting total amount of food eaten 2. not eating certain types of food 3. avoid eating for long periods of time

Answer 125

1) RF for developing eating disorders 2) often loss of lean body mass, not just fat 3) slows metabolic rate and energy expenditure 4) chronic dieting can disrupt 'normal' appetite responses and increase subjective sensations of hunger 5) weight cycling (repeated diet - relapse) often leads to 'overshoot' - accelerates overall weight gain

Answer 126

idea that normal weight people are responsive to internal homeostatic cues, while overweight people eat according to: - external cues - no compensation after preload - time of day - offer lurid descriptions of desserts - sensory food cues but this theory is a bit too broad/general

Answer 127

idea that 'normal' eaters have a min level of food intake (hunger boundary) and a max level (satiety) - eat intuitively within that. restrained eaters have a 'cognitive dietary boundary' - how much they think they should eat, that's lower than satiety. if they break that boundary (as still hungry) - 'what the hell' effect, become disinhibited, and eat to satiety or beyond (often their satiety point is higher than normal as well). leads to overall weight gain.

Answer 128

high energy preloads/belief of high energy preload (e.g. went on a run today therefore I can eat alllll the cake) large portion size alcohol stress/cognitive load strong emotion - positive or sad (celebratory vs comfort)

Answer 129

needs assessment --> planning --> implementation --> evaluation --> needs assessment (repeat)

Answer 130

need - ability to benefit from an intervention demand - what people ask for supply - what is provided

Answer 131

ability to benefit from an intervention

Answer 132

a systematic method for reviewing the health issues facing a population, leading to agreed priorities and resource allocation that will improve health and reduce inequalities

Answer 133

health need = need for health, concerning need in more general terms (e.g. measured through mortality, morbidity etc) health care need = more specific, ability to benefit from health CARE - depends on potential of prevention/treatment/care services to remedy health problems. HNAs usually cover both.

Answer 134

felt need expressed need normative need comparative need

Answer 135

individual perceptions of a variation from normal health i.e. they feel they're lacking in a certain aspect of health limited by individual perceptions and knowledge of services.

Answer 136

individual seeks help to overcome variation in normal health (demand) i.e. they seek treatment/support to address an aspect of their health

Answer 137

where a professional defines an intervention appropriate for the expressed need i.e. doctor says the patient needs to improve diet and exercise to reduce weight

Answer 138

comparison between severity, range of interventions and cost - compare one group of people to another, what is the difference in what they have? does that mean one group needs something? e.g. a rural village may identify a need for a well or a school if the neighbouring village has one

Answer 139

epidemiological comparative corporate

Answer 140

very top-down approach, basically uses surveys and secondary data sources (census, mortality and morbidity records, GP data etc) to evaluate burden of disease etc affecting a population takes into account: Person - who are the affected people - age, gender etc Place - where and why, do prevalence and incidence vary geographically Time - when do people get diseases? does it vary by season, cycles? Statement of the problem - case definition Prevalence and incidence Services available and their costs Effectiveness and cost-effectiveness of services Quantified models of care and recommendations Information and research requirements

Answer 141

``` very top down! required data may not be available variable data quality does not consider felt needs of people affected reinforces biomedical model of health ```

Answer 142

supply - staffing, budget, equipment, hospital beds, GP practices demand - admissions, local population, waiting times

Answer 143

compares services received by a population/subgroup with others e.g. geographically, by social class, by age etc. looks at - health status, service provision, service utilisation, health outcomes. measures variation in cost and service use. fairly quick and inexpensive to achieve

Answer 144

- may not identify the ideal/most appropriate level of provision/utilisation should be (you don't know whether your point of reference is getting it right!) - data might not be available/may be of variable quality - hard to find appropriate comparative population - links between usage rates and health outcomes can be hard to demonstrate

Answer 145

structured collection of knowledge and views of stakeholders - focus group, interviews used based on the demands, wishes and perspectives of interested parties - professional, political and user/public views recognises importance of knowledge available from those who have been involved in local service

Answer 146

- can be difficult to distinguish between need and demand e.g. do they NEED experimental drugs, like the Charlie Gard case - groups may have vested interests! - may be influenced by political agendas - dominant personalities might have undue influence

Answer 147

patients, trust managers, doctors, nurses, public health practitioners, commissioning managers, voluntary organisations, community health councils

Answer 148

Structure Process [Output] Outcome NB - outputs usually classified under process but was originally separate

Answer 149

structure - what is there i.e. buildings, staff, equipment e.g. number of ICU beds per 1000 population process - what is done e.g. number of patients seen in A&E, what the process they go through is (e.g. where and when seen, who triaged, how is priority assessed), no. ops performed (might be classed as outputs) Outcome - classification of health outcomes by mortality, morbidity, QoL/PROMs, patient satisfaction

Answer 150

- link between health service provided and health outcome may be difficult to establish - lots of other factors in play - time lag between service provided and outcome may be long e.g. childhood health eating and T2DM as older adult - large sample sizes needed for statistically significant effects - might not have the data - issues with data quality

Answer 151

Effectiveness Efficiency Equity Acceptability Accessibility Appropriateness (relevance)

Answer 152

Effectiveness - does the intervention produce desired effect? Efficiency - is the output maximised for given input? Equity - are patients being treated fairly? Acceptability - how acceptable is the service offered to the people needing it? Accessibility - is the service provided? geographical access, costs for patients, waiting times Appropriateness - is the right treatment being given to the right people at the right time?

Answer 153

qual - consulting stakeholder (e.g. staff, patients, carers, commissioners) - observation, interviews, focus groups quant - routine data (e.g. hospital admissions, mortality), review of records, surveys

Answer 154

- define what the service is - what are the aims/objectives of service? - framework - structure, process, outcome ± dimensions of quality - methodology used/to be used (quant/qual/mixed methods) - results, conclusions and recommendations

Answer 155

emphasises role of psychological factors in the cause, progression and consequences of health and illness. - aims to put theory into practice by promoting healthy behaviours and preventing illness

Answer 156

health behaviour - behaviour aimed to prevent disease e.g. healthy eating illness behaviour - a behaviour aimed to seek remedy e.g. going to the doctor sick role behaviour - any activity aimed at getting well e.g. taking prescribed medications

Answer 157

damaging e.g. smoking, alcohol use, sun exposure, unprotected sex promoting - exercise, health eating, vaccinations

Answer 158

the process of enabling people to exert control over the determinants of health, thereby improving health

Answer 159

health promotion/awareness campaigns - Change 4 Life, 4 a days, Stoptober, Sober October campaigns promoting screening and immunisations - cervical smear, MMR vaccine

Answer 160

1) individual behaviour - level of consumption, individual health outcomes, incidence domestic violence 2) local community - local alcohol sales, alcohol-related crime, A&E attendances 3) population level - national sales/consumption, national alcohol-related crime/A&E etc

Answer 161

1) lack of personal experience with the problem 2) belief that it's preventable by personal action 3) belief that if it's not happened now, it's not likely to 4) belief that the problem is infrequent individuals continue to practice health damaging behaviour due to inaccurate perceptions of risk and susceptibility e.g. "my dad smoked 40 a day from the age of 14 and lived to 102 - why should I bother quitting?"

Answer 162

- inaccurate perceptions of risk/susceptibility - health beliefs - situational rationality - culture variability - socioeconomic factors - stress - age

Answer 163

1) planning interventions 2) assessing the social context 3) education and training 4) individual-level interventions 5) community-level interventions 6) population-level interventions 7) evaluating effectiveness 8) assessing cost-effectiveness

Answer 164

- work with your patient's priorities - aim for easy changes over time - set and record goals - plan explicit coping strategies - review progress regularly - remember the public health impact of lots of doctors making small differences to individuals

Answer 165

1) health belief model 2) theory of planned behaviour 3) stages of change/transtheoretical model 4) social normals theory 5) motivational interviewing 6) social marketing 7) nudging (choice architecture) 8) financial incentives

Answer 166

individuals will change if they: - believe they're susceptible to the condition in question - believe that it has serious consequences - believe that taking action reduces susceptibility - believe that the benefits of taking action outweigh the costs model says all of the above interact with health motivation (how much they care about being healthy) and cues to action to determine the likelihood of action

Answer 167

can be internal/external cues - just something which triggers action e.g. brief advice on smoking cessation from a GP unique component of the HBM not always necessary for behaviour change to occur though

Answer 168

- alternative factors may predict health behaviour e.g. outcome expectant or self-efficacy (belief in ability to carry out the preventative behaviour) - as a cognitive based model, doesn't account for influences of emotions on behaviour - does not differentiate between first time and repeat behaviour

Answer 169

perceived barriers

Answer 170

- best predictor of behaviour is 'intention' e.g. I intend to quit smoking. intention determined by: - person's attitude to the behaviour - perceived social pressure to undertake the behaviour, or subjective norms - person's appraisal of their ability to perform the behaviour, or their perceived behavioural control

Answer 171

person's attitude to the behaviour the subjective norm (perceived social pressure to undertake the behaviour) perceived behavioural control - whether they believe they're able to change the behaviour

Answer 172

- perceived control - anticipated regret - preparatory actions - implementation intentions - relevance to self

Answer 173

- lack of temporal element, lack of direction or causality - rational choice model - ignores emotions which can disrupt our rational decision making - doesn't explain how attitudes, intentions and perceived behavioural control interact

Answer 174

``` pre-contemplation contemplation preparation action maintenance ``` (relapse)

Answer 175

- acknowledges individual stages of readiness - can tailor interventions - accounts for relapse - some temporal element (although arbitrary)

Answer 176

- not everyone goes through each stage in sequence, can skip some, can go back and forward - change might be more of a continuum than discrete stages - doesn't take into account values, habits, culture, social and economic factors

Answer 177

a counselling approach for initiating behaviour change by resolving ambivalence

Answer 178

'nudge' the environment to make the best option the easiest e.g. opt-out pensions, placing fruit by check outs

Answer 179

- genes - environment - physical and socioeconomic - lifestyle - healthcare

Answer 180

equity is about what is fair and just, equality is concerned with equal shares equity = giving everyone what they need to succeed on the same level equality = treating everyone the same

Answer 181

1) health improvement - inequalities, education, housing etc 2) health protection - infectious diseases, chemicals, radiation, emergency response 3) improving services - clinical effectiveness, efficiency, service planning etc

Answer 182

``` PROGRESS Place of residence (rural, urban etc) Race or ethnicity Occupation Gender Religion Education Socioeconomic status Social capital or resources ```

Answer 183

``` horizontal = equal treatment for equal need vertical = unequal treatment for unequal need ``` e.g. horizontal - all else being equal, everyone with pneumonia should receive the same treatment. vertical - individuals with pneumonia deserve different treatment from those with a common cold vertical - areas with poorer health may need higher expenditure on health services

Answer 184

``` equal expenditure for equal need equal access for equal need equal utilisation for equal need equal health care outcomes for equal need equal health ``` listed top to bottom in order of what is more feasible to actually influence - can easily (ish) influence how much is spent on healthcare, but how easy is it to make sure everyone has completely equal health?

Answer 185

- supply of health care - access to health care - utilisation of health care - health care outcomes - health status - resource allocation - wider determinants of health in the area being examined typically you'd assess inequality, then decide if inequitable - inequalities need to be justified, but remember that equality may not be equitable (e.g. people of all SE classes using same no. GP appts per year - equal utilisation, but likely there's unequal need!) NHS likes to view equity as equal access for equal need (as harder to control whether patients actually use the services available! e.g. STI testing) - equity assessments should measure utilisation as well.

Answer 186

domain of public health concerned with societal interventions aimed at preventing disease, promoting health, and reducing inequalities not primarily health services - things like education, housing, employment

Answer 187

domain of public health concerned with measures to control infectious disease risks and environmental hazards

Answer 188

domain of public health concerned with organisation and delivery of safe, high quality services for prevention, treatment and cure

Answer 189

cluster = aggregation of cases (may or may not be linked) outbreak = more cases of disease than normally expected, within a specific place or group of people over a given period of time needs 2 or more cases linked through common exposure/location OR single case of rare/serious disease e.g. rabies, polio, diphtheria confirmed outbreak is when the case has been confirmed through investigation

Answer 190

'any disease of an infectious or toxic nature caused by, or thought to be caused by, the consumption of food/water' includes illness caused by toxic chemicals if transported in food. actions: - identify affected cohort - identify source - ?close restaurant - people sampling, food sampling, questionnaires (to detect cause)

Answer 191

- human error - neglect - poor performance - misconduct can be one or a combo of these

Answer 192

basically there lots of levels of defence - the slices of cheese - systems put in place to prevent error e.g. separate appts, fridges etc for different chemo drugs the holes in the cheese = latent conditions leading to error e.g. patient misses first appt so decide to give drugs together (poor management decision), also poor design or procedures active errors = mistakes made that then means all the little holes line up and there's an error in patient care

Answer 193

care falling below accepted standard results in frequent minor mistakes develops from culture of not caring can involve neglect of necessary/personal care, safeguarding neglected, medical care not given Mid-Staffs!!!

Answer 194

problem of attitude - laziness, lateness, not caring failure to learn from mistakes or listen to advice of others affects patient care

Answer 195

deliberate harm - can be minor (e.g. rough handling) lack of candour - hiding own/others mistakes, ignoring mistakes (hoping they'll go away!), altering medical records, failure to report concerns inappropriate relationships - patients, relatives, supervisors fraud/theft - false expense claims, false 'sick' days, drug and alcohol problems

Answer 196

legal entity - outcome of a court case NOT a crime - civil claim for damages - you pay these, rather than go to prison you can be found liable (but can't be found guilty) this is why we have MDU/MPS

Answer 197

- did this dr have a duty of care to the patient? - was their a breach in the duty of care? - did the patient come to some harm? - on the patien - did the breach in duty of care cause the harm?

Answer 198

usually pretty clear all patients - often also relatives when on the ward etc (fair of them to expect you to help if they arrested) sometimes includes fellow passengers/passers-by if you offer medical advice, you accept a duty of care - even if student!

Answer 199

Bolam test - would a group of reasonable drs do the same? Bolitho test - would it be reasonable of them to do so? best defence is NICE guidelines, local or college policies

Answer 200

onus is on patient recognised complications not negligent e.g. wound infections standard of proof is 'on the balance of probabilities' i.e. it is more likely than not that this breach in duty of care led to this harm (lower standard than criminal 'beyond reasonable doubt')

Answer 201

considers: - loss of income - costs of care required as a result - pain and suffering in USA they also award punitive damages i.e. to punish the doctor

Answer 202

'ability to understand something instantly without cognitive reasoning' advantages - fast and frugal disadvantages - prone to biases, cognitively overpower (i.e. you struggle to override it once you've linked one answer/diagnosis)

Answer 203

cognitive short cuts - availability, anchoring and adjustment etc e.g. people overestimate risk of death from plane crash after there's been one in the news

Answer 204

error of over-attachment - confirmation bias (running tests to get confirmation of the diagnosis you've decided it is, rather than running full investigations), premature closure, sunk costs error due to inherited thinking - diagnosis momentum (e.g. handed over as ?something, stay focussed on that), framing effect error due to failure to consider alternatives - search satisfaction, multiple alternatives bias errors in prevalence perception or estimation - availability bias, base-rate neglect, Gambler's fallacy

Answer 205

using evidence based medicine to make decisions - based on known odds/values adv. - accurate and reliable dis - slow (patients waiting), resource intensive, cognitively demanding

Answer 206

1) decision environment/processes - reduce distractions, having to make multiple decisions at once, reduce interruptions etc 2) personal debiasing - acknowledging them, acknowledging our limitations (e.g. recognising when we're distracted by personal issues or just being hungry), also consciously trying to slow cognition and think things through 3) structural debiasing - training in dual process theory, cognitive strategies to reduce bias, checklists, group decision making (MDT, ward rounds)

Answer 207

combining intuitive cognition with analytical thinking - reduces labourious process of analytical thinking, but also reduces biases associated with intuitive decision making

Answer 208

1) sloth - not bothering to check results/complete exam/document fully etc 2) fixation/loss of perspective - focussed on a specific diagnosis early, so miss later signs 3) communication breakdown - unclear instructions/plans, ignoring others opinions 4) poor team working - poor direction, independent working, some members of team out of depth 5) playing the odds - choosing common and dismissing rare event 6) bravado - working beyond confidence/without supervision 7) ignorance - lack of knowledge, don't know what you don't know 8) mis-triage - over/under estimating seriousness of situation 9) lack of skill - lack of appropriate skills/teaching/practice 10) system error - environmental, tech, equipment or organisation features

Answer 209

- establishing wider and more diverse social and professional networks - engaging with the public and colleagues in debates - facilitating public access to accurate health info - improving patient access to services

Answer 210

- loss of personal privacy - potential breaches of confidentiality - online behaviour that might be perceived as unprofessional, offensive or inappropriate by others - risks of posts being reported by media or sent to employers

Answer 211

events that cause harm/death to patients data on them published - shows gaps in provision of quality care, can affect reputation of Trust have financial penalties prompt visits by external agencies e.g. CQC, comissioners

Answer 212

surgery - wrong site/implant, retained foreign object medications - wrong preparation, wrong route, OD etc mental health - suicide general health - falls from windows, entrapment in bed rails etc maternity - PPH deaths

Answer 213

"socially transmitted pattern of shared meanings by which people communicate, perpetuate and develop their knowledge and attitudes about life" "the collective programming of mind which distinguishes members of one group/category of people from another" it informs our internal worldview (way we interpret things and events)

Answer 214

belief that health care providers, educated and socialised within a bio-med context have a superior value system and correct, accurate approach to healthcare (basically - drs etc know best) bad for patients, particularly for communication - might mean patients refuse to communicate their beliefs/behaviours for fear of negative reaction, can mean significant info not obtained

Answer 215

- heritage e.g. language, country of origin, ethnicity, family etc - individual circumstances e.g. gender, age, SE status - personal choice e.g. religion, lifestyle dynamic entity more than what we can see (iceberg model of culture)

Answer 216

generalisations about "typical" characteristics of members of a group - and we have a natural tendency to confirm stereotypes by looking for info consistent with it

Answer 217

holding a particular attitude towards another person based solely on their membership of a group. there are cognitive and affective components - cognitive involves stereotypes, affective involves negative or positive feelings towards someone

Answer 218

actual positive or negative actions towards the objects of prejudice (rather than just holding the attitude)

Answer 219

- effortful - energising/exhausting - assumptions more likely to be wrong - humour/rapport - language - different expectations of roles for dr and patient - different explanatory model the greater the cultural distance, the more likely it is that any assumptions you make will be wrong - so you have to ask more questions of both patient and of yourself

Answer 220

- forms part of decision making processes when making decisions about people's rights - part of all policy making - states that all people are entitled to certain rights, regardless of age, sex, religion etc etc rights frequently involved in healthcare - right to life, right to be free from inhuman and degrading treatment, right to respect for privacy and family life, right to marry and found a family

Answer 221

health is the state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity ... the highest attainable level of health is the fundamental right of every human being

Answer 222

absolute rights apply to everyone, always e.g. prohibition of slavery limited/qualified rights - limited under explicit and finite circumstances e.g. right to liberty can be restricted to protect public safety

Answer 223

there's a right to life, but can't always demand right to healthcare article 2 states - positive obligation upon the state to take appropriate steps to safeguard life - but cannot impose an impossible or disproportionate burden on authorities e.g. we have human right to family life, but doesn't mean every patient has right to demand IVF

Answer 224

no absolute duty on secretary of state to provide funds for NHS, only obliged/duty to provide services to such extent as he considers necessary to meet all reasonable requirements god knows what that means

Answer 225

opportunity for an individual to challenge the exercise of power by a public body - i.e. patient/groups of patients could challenge local decision makers as being 'unjust' for not providing certain healthcare

Answer 226

where local authorities have policy regarding healthcare provision, but can also make exceptions at their discretion - in 'exceptional circumstances', and they're able to leave those circumstances undefined BUT this can't breach human rights e.g. can't refuse treatment cos of a patient's age

Answer 227

- shift from acute illness to chronic long term diseases - normal physiological events becoming medicalised - increase in choice and increase in expensive drugs also - real term NHS spending not increasing annually by as much - push for more productivity and efficiency

Answer 228

1) egalitarian principles - same principles that NHS founded on - emphasises providing all care necessary and appropriate to each person - not necessarily same treatment e.g. someone with T1DM costs a lot more than healthy person - equal access 2) maximising principle - same as utilitarianism - act to maximise public utility - but how do we decide what conditions achieve this really? 3) libertarian principles - state that each is responsible for their own health, wellbeing and fulfilment of their life plan - must be willing to invest in their health and pay cost of consequences e.g. German health incentive schemes - everyone contributes % of income, and there's incentives for positive health behaviour change e.g. bonuses for participating in screening or weight reduction etc, co-payment increases when non-compliance

Answer 229

1) respect to autonomy - respect people's wishes 2) non maleficence - do no harm 3) beneficence - obliged to bring about good with all actions 4) justice - treat everyone equally

Answer 230

ethical principle which says best action is the one that maximises utility (utility defined various ways, just generally means best option for total overall best outcome)

Answer 231

ethical theory that the morality of an action is determined based on whether that action itself is right or wrong - not on consequences of the action (that would be consequentialism)

Answer 232

states that morality of action is defined by how moral the person doing it is - an individual's character is important rather than the act itself

Answer 233

intensive weight loss support | sexual education in conservative cultures

Answer 234

local hospitals (e.g. cottage hospitals), local A&E departments being closed, OPD appts (long waiting lists = not enough supply)

Answer 235

specialist services/treatments e.g. Charlie Gard, new cancer drugs. antibiotics for viral illness - although sometimes supplied!

Answer 236

repeat prescriptions e.g. for salbutamol inhalers, that are no longer used paracetamol prescriptions a lot of health promotion

Answer 237

the holy grail! | free contraception - usually

Answer 238

cosmetic surgery | abx for viral illness

Answer 239

smoking cessation/alcohol reduction services