Public Heath Flashcards

Question

Pros / cons of epidemiological approach to HNA

Answer 1

pros Uses existing data Provides incidence mortality and morbidity data Can evaluate services by trends over time Cons Quality of data is vsriable Data collected might not be the data required Doesn’t consider the felt needs or opinions of those its looking at

Answer 2

Comparative Pros Quick and cheap if data available Indicates whether services are better or worse in comparable areas Cons Difficult to find a comparable

Answer 3

Corporate Pros Based on felt and expressed needs Recognises the knowledge and experiances of those working in the population Takes into account a wide range of views Cons Difficult to establish need from demand Groups may have vested interests May be influences by political agendas

Answer 4

Health behaviour Prevent disease E.g go for a run, wear sun screen etc Illness behaviour Going to the DR Sick role behaviour Taking medications

Answer 5

Transtheorectical model- Pre contemplation- not ready yet Contemplation Preparation Action Maintenance / relapse Nudge – nudge the environment for positive change – fruit near the checkouts Theory of planned behaviours – best predictor of change is intention Persons attitude to the behaviour (smoking is bad) Subjective norms- percieved social pressures/norms (GP wants me to give up) Perceived behaviours – how well the person thinks they can do it (I can do it!!)

Answer 6

Egalitarian Based on the idea that the NHS was founded on the requirement to provide all care that is necessary and required to everyone Equal for everyone Maximising Maximise public utlity/ profits? – an act is evaluated soley in terms of its consequences – will it be beneficial? Give to those who it is most likely to benefit the most Libertarian Each is responsible for their own health The german health incentive scheme – change health behaviours and get bonuses for partipating

Answer 7

Serious, largely preventable patient safety incidents that should not occur if the available preventative measures have been implemented Financial penalties, affect trust reputation, CQC visits Surgical - wrong site / retained foreign object Psych - escape of a transfer pt Medical - wrong route of chemo administration / opioid overdose

Answer 8

Retrospective case-control E.g. work exposure, gender, type of tobacco, level of passive smoking Selection bias e.g allocation bias (inappropriately matched controls) and information bias e.g. recall and reporting bias

Answer 9

Identify causation Ethical assessment of RF (if exposure was thought to be dangerous would not be fair to do a RCT ) Allows assessment of multiple risk factors

Answer 10

85% 75% 85% specific means 85% of people without the disease were correctly excluded. 75% PPV means of those who had a positive result, 75% actually had the disease.

Answer 11

So HPA can take control measures You may be the only one to tell them Duty of registered medical practitioners

Answer 12

Surveillance - Notification / lab data to monitor diseases Prevention - Eg vaccination Control

Answer 13

Clarify problem - make a diagnosis Decide if its an outbreak - 2 or more related cases Gain help - microbiologist, consultant in infectious disease, health visitors Call an outbreak meeting Identify cause Control measures

Answer 14

Relationship breakdown Domestic abuse Dispute with parents Bereavement

Answer 15

Infectious disease Foot and teeth health Resp problems Violence / rape Sexual health Mental illness Nutrition Addiction

Answer 16

Reluctance of GPs to register them Illiteracy Communication difficulties Lack of permanent site Mistrust of professionals

Answer 17

Access -Location / discrimination Lack of integration between primary care and other agencies -housing, social services, criminal justice Other things on mind -don’t prioritise health May not know where to find help

Answer 18

AS- someone who has made application for refugee status R- granted asylum - usually lasts 5 years HP - failed to get asylum but serious threat if returned - usually lasts 3 years

Answer 19

Vouchers to live off NASS support package Access to NHS Not allowed to work No choice where they go

Answer 20

Common illnesses / those specific to country Injuries from war / travelling Lack of health screening / immunisations Malnutrition Abuse Untreated chronic disease Communicable disease Mental -PTSD Depression Psychosis Self harm

Answer 21

Complexity Resource intense Shared responsibility

Answer 22

I - failure of planned action to achieve desired outcome -skill based -rule based - didn’t follow rules -knowledge based Action -task specific - eg wrong vessel -Generic factors - Eg wrong order / omission Outcome -Near miss / death Context -Interuptions, team factors

Answer 23

Person approach -error due to individual, focuses on the unsafe act -Anticipation of blame -> cover up System -Errors are due to many factors

Answer 24

Simplification and standardisation of clinical practice Checklists IT Team training Risk management programs

Answer 25

Incident reporting Complaints and claims Audits External accreditation Active measurement

Answer 26

Preventable patient safety incident which should not occur

Answer 27

Is there a duty of car? Is there a breech of this duty Did the patient come to harm Did the breach cause the harm

Answer 28

System failure Human factors -Personal Teamwork Environment Judgement failure -Analytical / intuitive -defective decision making Neglect Poor performance Repeated small mistake Misconduct

Answer 29

Better outcomes for patients -doctors identify their problems more accurately -better patient adherence More satisfying patient encounters -more Effcient time spending -patients more satisfied

Answer 30

Benefits -Esablish good networks -enagange in debates -improve patient access to services Risks -Loss of personal privacy -potential breaches of confidentiality -risk of posts being reported

Answer 31

Make the care f your patient your first concern protect and promote the health of the public Provide a good standard of practice and care Treat patients as individuals and respect their dignity Work in partnership with patients Be honest and open and act with integrity

Answer 32

Risk unexposed - risk exposed All over unexposed

Answer 33

Health check Screening for BBVs Contraception Smear Immunisation Information on drug services Eg needle exchange status

Answer 34

Harm reduction -Advice on risky behaviour -BBV advice -Testing 0contraception Brief intervention -Explain risks / effects -advice on controlled use -setting limits -cognitive based approaches Team working -referral to sexual health -referral for specialist advice

Answer 35

Reduce harm to user, family and society Improve health Stablise lifestyle Reduce crime

Answer 36

Any pattern of controlling, threatening, or violence / abuse between those aged 16 and over who may have been family members or intimate partners

Answer 37

Trauma Somatic problems - Headche, GI, chronic launch , LBW / premature Psychological / psychosexual -PTSD, suicide, -depression, anxiety, eating disorder -Substance misuse

Answer 38

Healthcare records important in court Display helpline and give contact cards Focus on patients safety Ask direct questions Be non judgemental

Answer 39

Standard - evidence does not suggest likelihood of causing serious harm Medium - Identifiable indicators of risk of serious harm -Unlikely to happen without change in circumstance ->Give DA abuse contact details High - Risk of imminent harm -> Refer to -MARAC (multi-agency risk assessment conference) - Identifies risk and provides appropriate services -IDVAS - supports women (a voice for MARAC) -DHR - Domestic homicide review - if death of a persons aged over 16 and related to violence

Answer 40

DASH Domestic, abuse, stalking, harassment

Answer 41

Inequality is assessed and must be explained to decide if its inequitable Equality may not always be equitable

Answer 42

Need - Ability to benefit from an intervention Demand - What people ask for Supply - What is provided

Answer 43

Positive - increased intensity of desire to use Negative - do not quit as poor experiences Eg nausea

Answer 44

Physical Injection complications Overdose BBV Side effects Eg constipation Social Criminal acts Social exclusion Poverty Psychological Guit Cravings

Answer 45

Need 3 features Tolerance Withdrawal Neglect of other activities Spending more time Continued use despite negative effects Failure to control use CANT STOP

Answer 46

Ataxia Opthamoplegia Acute mental confusion

Answer 47

Disurfiram Acamprosate - GABA Blocker Naltrexone

Answer 48

Structure Process Outcome

Answer 49

Time lag Large sample sizes needed Data quality issues

Answer 50

Effectiveness Efficiency Equity Accessibility Appropriateness Acceptability

Answer 51

Define the service What are the AIMS of the service Framework - structure, process outcome Methodology - Qual / quantitative Results - recommendations

Answer 52

[PISAA] Security Attention Autonomy Intimacy Part of wider community

Answer 53

intention - best predictor of change Persons attitude to the behaviour (smoking is bad) Subjective norms- perceived social pressures/norms (GP wants me to give up) Perceived behaviours – how well the person thinks they can do it (I can do it!!) [perceived behaviours are Subjective to Attitudes and Intention]

Answer 54

Epigenetics – expression of genome depends on he environment Allostasis – stability through change, our physiological systems have adapted to react rapidly to environmental stressors. Allostatic load – long term overtaxation of our physiological systems leads to impaired health (stress) Salutogenesis – favourable physiological changes secondary to experiences which promote healing and health. Emotional intelligence – the ability to identify and manage one’s own emotions, as well as those of others

Answer 55

Preventing illness promoting health working in a primary health team Shared decision making with pts Managing illness over time

Answer 56

o Inequalities o Education o Housing o Employment o Lifestyles o Family/community o Surveillance and monitoring of specific diseases and risk factors

Answer 57

o Infectious diseases  o Chemicals and poisons  o Radiation  o Emergency response  o Environmental health hazards

Answer 58

o Clinical effectiveness o Efficiency  o Service planning  o Audit and evaluation o Clinical governance Equity

Answer 59

• Population-based screening programmes • Opportunistic screening • Screening for communicable diseases • Pre-employment and occupational medicals • Commercially provided screening

Answer 60

A process which sorts out apparently well people who probably have a disease (or precursors or susceptibility to a disease) from those who probably do not.

Answer 61

A preventive measure which brings much benefit to the population often offers little to each participating individual

Answer 62

• Population approach – preventative measure eg. dietary salt reduction through legislation to reduce bp • High risk approach – identify individuals above a chosen cut off and treat – eg. screening for high bp

Answer 63

• The condition  o Important health problem o Latent / preclinical phase o Natural history known • The screening test  o Suitable (sensitive, specific, inexpensive) o Acceptable • The treatment o Effective o Agreed policy on whom to treat • The organisation and costs o Facilities o Costs of screening should be economically balanced in relation to healthcare spending as a whole o Should be an ongoing process

Answer 64

Lead time bias: When screening identifies an outcome earlier than it would otherwise have been identified this results in an apparent increase in survival time, even if screening has no effect on outcome. Length time bias: Type of bias resulting from differences in the length of time taken for a condition to progress to severe effects, that may affect the apparent efficacy of a screening method

Answer 65

• Time • Place • Person [Age Gender Class Ethnicity]

Answer 66

(No.of persons who have become cases in a given time period) / (Total person-time at risk during that period)

Answer 67

The rate of disease in the exposed that may be attributed to the exposure Incidence in exposed - Unexposed

Answer 68

Ratio of risk of disease in the exposed to the risk in the unexposed Risk in exposed / unexposed [Shows strength of association]

Answer 69

reduction in rate of the outcome in the intervention group relative to the control group 1-Relative risk

Answer 70

Risk in unexposed – Risk in exposed

Answer 71

number of pts need to treat to prevent 1 outcome 1/ARR

Answer 72

no temporal element lack of direction / causality

Answer 73

to spend resources on ONE activity – means a sacrifice in terms of lost opportunity cost elsewhere

Answer 74

achieved when resources are allocated between activities in such a way as to maximize benefit (may not be equal/fair distribution) - May save more lives by trading efficiency with equity (i.e. save more lives, but may not be fair)

Answer 75

comparative study of the costs and benefits of health care interventions.

Answer 76

QALY Monetary value – how much someone is going to pay in tax/earn natural units” (BP/pain scoref/number of cases detected)

Answer 77

•Cost-utility analysis: outcomes measured in QALYs •Cost-benefit analysis: outcomes measured in monetary units

Answer 78

Cost of new treatment Effectiveness of new treatment Dominated = cost is positive, but incremental QALYs negative, Dominant = cost negative but incremental QALY positive