Public health revision session Flashcards
what are the three domains of public health
Health improvement
Health protection
Improving services
What is health protection
Against spillages and risks and dangers and stuff
What is imrpoving services
Clinical governance
Evaluation
Healthy equality
Giving everyone the same thing
Health equity
Giving everyone the things needed to achieve thier health needs
Causes of health inequality
Place of residence Race Occupation Gender Religion Economic status Social capital
Horizontal equity
Equal treatment for equal need
Vertical equity
Unequal treatment for unequal need
Cohort study
Longitudinal study in similar groups with different risk factors and treatments
Advantages of cohort study
Good for rare exposure
Disadvantages of cohort study
Bad for rare diseases
Large sample size needed
Expensive
Case control study
Observational study looking at cause of a disease. Compares similar participants with disease and controls. Retrospectively
Advantages of case control
Quick
Good for rare outcomes
(you choose the people)
Disadvantages of case control
Recall bias
Dificulty finding appropriately matched controls
Cross sectional study
Observational study collecting data from a population at a specific point in time
Advantages of cross sectional
Quick
Cheap
Large sample size
Disadvantages of cross sectional
Risk of reserve causality
Bad for rare outcomes
Lead time bias
Randomised control trial
Interventional
Advantages of RCT
Low risk of bias and confounding
Disadvantages of RCT
Ethical issues (not giving best care)
Expensive
Drop out
How do you get over RCT ethical issues
Have clear stopping rules which are minimum standards of care which must be met and if they arent then participant stops
Incidence
Number of new cases within specific population in a specific time period
Prevalence
Number of cases present within a population in a specific time period
How do you calculate relative risk
Compares incidence or prevalence.
Work out the two rates then divide them
How do you calculate attributable risk
Relative risk - background rate
How do you calculate number needed to treat/harm
1/attributable risk and ALWAYS ROUND UP
Define sensitivity
percentage of people with the disease who have been correctly identified
Define specificity
percentage of people correctly excluded as disease free
Wilson and young screening criteria
Important disease Understand cause Recognisable early or latent phase Simple, safe, precise and validated test Acceptable to the population Effective treatment with early detection, with better outcomes than late detection Policy of who should be treated
What can cause association
Bias Chance Confounding Reverse causality True causation
Define bias
Systematic error which results in a deviation from the true effect of an exposure on an outcome
Selection bias
Non response of certain groups, allocation bias.
Bias in which participants are selected
Information bias
Measurement bias, observation bias, recall bias, reporting bias
Publication bias
Trials with negative results less likely to be published
Lead time vis length time bias
Lead time bias- looks like longer life expectancy because screening has found them earlier (ahead)
Length time bias- Less likely to see people with longer diseases (longer)
Define confounding
Apparent association between exposure and disease. Independently associated with both disease and exposure.
Bradford hill criteria for causation
Temporality (exposure before disease) Reverse causality Dose response Strength of association Reversibility Consistency
Planning cycle for health services
Needs assessment
Planning
Implementation
Evaluation
Define health
A state of complete biomedical, social, physical, spiritual wellbeing and not merely the absence of disease
Bradshaws needs
Felt need
Expressed need
Normative need
Comparative need
Felt need
What the patient thinks they need
Expressed need
What the patient tells you they need
Normative need
What we say they need
Comparative need
Differences in health services available to two populations
Demanded and supplied but not needed
Antibiotics for viral
Needed and supplied but not demanded
Smoking cessation
Three approaches to a health needs assessment
Epidemiological approach
Comparative approach
Corporate approach
Epidemiological approach
Use prevalence and incidence data
Doesnt take into account felt need
Corporate approach
Takes into account stake holders
Takes felt needs into account
Blur need and demand
Influenced more by big dogs
Comparative approach
Compares health access of two populations. Based on comparative need.
Donabedian approach to evaluation
Structure
Process
Outcome
Structure (in evaluation)
Building, staff, equipment
/1000 population
Process (in evaluation)
What is done, how many seen or done
/1000 population
Outcome (in evaluation)
Morbidity, mortality, disability, dissatisfaction
/1000 population
Evaluation
Process which seeks to assess how a service systematically achieves its objectives
Maxmells dimensions of quality
Effectiveness, efficiency, equity
Acceptability, accessibility, appropriateness
Models of behaviour change
Health belief model
Theory of planned behaviour
Stages of change
(Nudging, financial incentives, motivational interviewing)
Health belief model
Influencing patient perception to increase health promoting behaviour. Susceptibility to ill health Severity of ill health Benefits of behaviour change Barriers to taking action
Theory of planned behaviour
Attitudes, subjective norm and percieved behaviour control influence intention. And then they will definitely change behaviour
Transtheoretical/ stages of change
Precontemplation, contemplation, preparation, action, maintenance, relapse
Doesnt take into account personal
Communicable disease control
Kills people, contagious, expensive to treat, effective interventions. (blood borne viruses normally arent)
Who do you tell communicable disease
Public health england, any registered medical practicioner should
When do you tell communicable disease
On basis of clinical suspicion.
Written notification or telephone if urgent
What do you tell about communicable disease
NHS number, DOB, contact details, details of disease/ contamination
Define cluster
Aggregation of cases of a condition which may or may not be linked
Define suspected outbreak
More cases than would be expected in a specific place and time
Confirmed outbreak
Epidiomoligical or pathophysiology link
Epidemic
Occurance within an area in excess of what is expected
Pandemic
Different countries
Endemic
Normal rates
Hyper endemic
Higher than normal levels
What is a secondary prevention
Screening
