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Phase 3a Everything > public_health_20231205142339 > Flashcards

public_health_20231205142339 Flashcards

1
Q

What is a case-control study?

A

A retrospective and observational study used to determine if there is an association between an exposure and a specific health outcome

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2
Q

What are the advantages of case-control studies?

A

Good for rare outcomes
Quicker than cohort or intervention studies
Can investigate multiple exposures

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3
Q

What are the disadvantages of case-control studies?

A

Difficulties finding controls to match with cases
Prone to selection and information bias
Cannot determine causality
Not good for rare exposures

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4
Q

What is a cohort study?

A

An epidemiological study where a group of individuals with a particular characteristic are followed up over time

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5
Q

What are the advantages of a cohort study?

A

Can follow up a group with a rare exposure Good for common outcomes Can investigate multiple outcomes Less risk of selection and recall bias

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6
Q

What are the disadvantages of a cohort study?

A

Takes a long time
Loss to follow up
Need a large sample size

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7
Q

What is a cross-sectional study?

A

An observational study that analyses data from a specific population at one point in time (snapshot)

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8
Q

What are the advantages of a cross-sectional study?

A

Relatively cheap and quick
Provide data on prevalence at a single point in time
Large sample size
Good for surveillance and public health planning

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9
Q

What are the disadvantages of a cross-sectional study?

A

Risk of reverse causality (did the exposure or outcome come first?)
Cannot measure incidence
Risk recall bias and non-response

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10
Q

What is a randomised controlled trial?

A

Subjects are randomly assigned to one of two groups - one receiving the intervention that is being tested, and one receiving an alternative (conventional) intervention

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11
Q

What are the advantages of a RCT?

A

Low risk of bias and confounding
Can infer causality

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12
Q

What are the disadvantages of a RCT?

A

Time consuming
Expensive
Specific inclusion/exclusion criteria may mean the study population is different from typical patients
Drop outs

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13
Q

What is selection bias?

A

A systematic error in the selection of study participants and allocation of participants to different study groups

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14
Q

Why does selection bias occur?

A

Non-response
Loss to follow up
Those in an intervention group might be different in some way to those in the control group

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15
Q

What types of information bias are there?

A

Measurement bias
Observer bias
Recall bias
Reporting bias

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16
Q

What is measurement bias?

A

Different equipment used to measure the outcome in the different groups

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17
Q

What is observer bias?

A

The researcher knows which participants are cases and which are controls and subconsciously reports the exposure or outcome differently depending on the group

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18
Q

What is recall bias?

A

Events that happened in the past are not correctly remembered and reported accurately

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19
Q

What is reporting bias?

A

Respondants report inaccurate information because they are embarassed or feel judged

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20
Q

What is confounding?

A

A situation in which the estimate between an exposure and an outcome is distorted because of the association with another factor that is also independently associated with the outcome

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21
Q

What is reverse causality?

A

A situation when an association between an exposure and an outcome could be due to the outcome causing the exposure

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22
Q

What factors increase the likelihood of causality?

A

Strength of association
Consistency of results
Dose-response association
Plausibility
Reversibility
Coherence with other information

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23
Q

What is the purpose of screening?

A

Identifying apparently well individuals who have a particular disease in order to reduce adverse outcomes

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24
Q

What are the disadvantages of screening?

A

Exposure of well individuals to distressing or harmful diagnostic tests Detection and treatment of sub-clinical disease that would never have caused any problems Preventative interventions that may cause harm to the individual or population

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25
What is sensitivity?
The proportion of those with the disease who are correctly identified by the screening programme
26
What is specificity?
The proportion of people without the disease who are correctly excluded by the screening programme
27
What is the positive predictive value?
Proportion of people with a positive test result who actually have the disease
28
What is the negative predictive value?
Proportion of people with a negative test result who do not have the disease
29
What makes a condition suitable for screening?
The condition should be an important health problem The epidemiology and natural history of the condition should be well understood Cost effective primary prevention measures should have been implemented as far as possible If carriers of a mutation are identified, as well as disease, the implications of this should be understood
30
What makes a screening programme suitable?
Screening should be ongoing and not just performed on a one off basis The costs of the programme should be balanced in relation to healthcare spending as a whole
31
What makes a test suitable for a screening programme?
There should be a simple, safe, precise and validated test The distribution of test values in the target population should be known, and a suitable cutoff identified The test should be acceptable to the population There should be an agreed policy on further diagnostic investigations
32
What makes a treatment suitable for a condition being screened for?
There should be an effective treatment or intervention for patients identified through early detection There should be evidence that early treatment leads to better outcomes There should be a policy as to which individuals should be offered treatment Clinical management of the condition should be optimised in all health care providers prior to screening
33
What is lead time bias?
When screening identifies an outcome earlier than it would otherwise have been, this results in an apparent increase in survival time, even if screening has no effect on the actual outcome
34
What is length time bias?
Bias resulting from differences in the length of time taken for a condition to progress to severe effects, may affect the apparent efficacy of a screening method
35
What are the approaches to health needs assessment?
Epidemiological approach Corporate approach Comparative approach
36
What is an epidemiological approach to health needs assessment?
An approach to health needs assessment based on:- Disease incidence and prevalence - Morbidity and mortality - - Life expectnacy - - Services available - - Sources of data
37
What are the advanatages of an epidemiological approach?
Uses existing data Provides data on disease incidence/mortality and morbidity Can evaluate services by trends over time
38
What are the disadvantages of an epidemiological approach?
Quality of data variable Data collected may not be the data required Does not consider the felt needs or opinions/experienes of the people affected
39
What is a corporate approach to health needs assessment?
An approach to health needs assessment that asks the local population and a wide range of stakeholders what their health needs are - through focus groups, interbiews and public meeting
40
What are the advantages of a corporate approach?
Based on the felt and expresed needs of the population in question Recognises the detailed knowledge and experience of those working with the population Takes into account a wide range of views
41
What are the disadvantages of a corporate approach?
Difficult to distinguish need from demand Groups may have vested interests May be influences by political agendas
42
What is a comparative approach to health needs assessment?
An approach to health needs assessment that compares the health or healthcare provision of one population to another
43
What are the advantages of a comparative approach?
Quick and cheap if data is available Indicates whether health or services provision is better/worse than comparable areas
44
What are the disadvantages of a comparative approach?
May be difficult to find a comparable population Data may not be high quality May not yield what the most appropriate level of provision should be
45
What is equity?
Equity is about what is fair and just
46
What are the Dahlgren and whitehead determinants of health?
Constitutional factors, age and sex Individual lifestyle factors Social and community networks Living and working conditions General socio-economic, cultural and environmental conditions
47
What is equality?
Equality is concerned with equal shares
48
What is horizontal equity?
Equal treatment for equal need
49
What is vertical equity?
Unequal treatment for unequal need
50
How can health equity be examined?
Supply of healthcareAccess to healthcare Utilisation of healthcare Healthcare outcomes Health status Resource allocation Education and housing Wider determinants of health
51
What are the three domains of public health practice?
Health improvement Health protection Health care
52
What are the approaches to improving public health?
Ecological level Community level Individual level
53
What are the three main health behaviours?
Health behaviour Illness behaviour Sick role behaviour
54
What is health behaviour?
A behaviour aimed to prevent disease
55
What is illness behaviour?
A behaviour aimed to seek remedy
56
What is sick role behaviour?
Any activity aimed at getting well
57
What is unrealistic optimism?
Individuals continue to practice health damaging behaviour due to inaccurate perceptions of risk and susceptibility
58
What are perceptions of risk influenced by?
Lack of personal experience with the problem Belief that it is preventable by personal action Belief that if it has not happened by now, it is not likely to Belief that the problem is infrequent
59
What is the health belief model?
Individuals will change if they:- Believe they are susceptible to the condition - Believe that is has serious consequences - Believe that taking action reduces susceptibility - Believe that the benefits of taking action outweight the costs
60
What is the theory of planned behaviour?
Proposes that the best predictor of behaviour is intention
61
What is intention determined by?
A persons attitude to the behaviour The preceived social pressure to undertake the behaviour A persons appraisal of their ability to perform the behaviour
62
What are the stages of the transtheoretical model?
Precontemplation Contemplation Preparation Action Maintenance
63
What are the advantages of the transtheoretical model?
Acknowledges individual stages of readiness Accounts for relapse Temporal element
64
What are the critiques of the transtheoretical model?
Not all people move through every stage Change might operate on a continuum rather than in discrete stages Doesn't take into account values, habits, culture, social and economic factors
65
What types of transition points are interventions more likely to be effective in behaviour change?
Leaving school Entering the workforce Becoming a parent Becoming unemployed Retirement and bereavement
66
What is malnutrition?
Deficiencies, excesses or imbalances in a perons's intake of energy and or nutrients - covers undernutrition and being overweight/obese
67
What are the early influences on feeding/eating behaviour?
Maternal diet and taste preference development Breastfeeding Parenting practices Ages of introduction of solid food Types of food exposed to during weaning
68
What is food poverty?
Experiencing one or more of the following:- Having smaller meals than usual or skipping meals - Being hungry but not eating - Not eating for a whole day Due to being unable to afford or access food
69
What are the four dimensions of food insecurity?
Availability (affordability) of foodAccess - economic and physicalUtilisation - opportunity to prepare food Stability of the three dimensions over time
70
What is the inverse care law?
Good healthcare varies inversely with the need for healthcare
71
What is health needs assessment?
A systematic approach for reviewing health issues affecting a population in order to enable agreed priorities and resource allocation to improve health and reduce inequalities
72
What are the three areas of health needs assessment?
Need Demand Supply
73
What are the types of need?
Felt need Expressed need Normative need Comparative need
74
What is egalitarian resource allocation?
Providing all care that is necessary and required for everyone
75
What is maximising resource allocation?
Act is evaluated solely in terms of its consequences
76
What is libertarian resource allocation?
Each is responsible for their own health
77
What is primary prevention?
Preventing a disease from occuring in the first place
78
What is secondary prevention?
Eearly identification of the disease to alter disease course
79
What is tertiary prevention?
Limiting the consequences of an established disease
80
What is a population approach to prevention?
The prevention approach is delivered to everyone to shift the risk factor distribution curve
81
What is a high risk approach to prevention?
Identify individuals above a chosen cut off and treat them
82
What is prevention paradox?
A preventative measure which brings much benefit to the population often offers little impact to each participating individual
83
What are the harms of screening?
Over treatment Treatment risks - invasive treatment Difficult decisions Anxiety or false reassurance Incorrect results Incidental findings that would not have been of harm
84
What are the benefits of screening?
Early detection of disease Better future health More effective treatment Reassurance Informed decision
85
What screening programmes exist in the UK?
Pregnancy - Sickle cell and thalassaemia - Infectious disease- Fetal anomaly screening Newborns - NIPE - Hearing screening programme - Blood spot screening AAA Breast cancer Cervical cancer Bowel cancer Diabetic eye
86
What is length time bias?
Occurs when screening is more likely to detect slow growing disease that has a long phase without symptoms
87
What is lead time bias?
Occurs when patients diagnosed earlier appear to live longer because they know they have the disease for longer
88
What is odds?
Probability of the event occurring divided by the probability that the event does not occur
89
What is an odds ratio?
Odds of an event, divided by the odds of another event
90
What does an odds ratio 1 mean?
No association betwen condition and event occurrence
91
What does an odds ratio of more than 1 mean?
The event's odds are high for the group/condition - risk factor for event
92
What does an odds ratio of less than 1 mean?
The proability of the outcome occurring is lower for the group/condition - protective factor for outcome
93
What are the bradford-hill criteria?
Strength Consistency Dose response Temporality Plausibility Reversibility Coherence Analogy Specificity
94
What are some causes of association?
Bias Confounding factors Chance Reverse causality True association
95
What is incidence?
The number of new cases in population in a given amount of time
96
What is prevalence?
The current percentage of people with the condition in the population
97
What is relative risk?
Risk among exposed group divided by the risk in the unexposed group
98
What is attributable risk?
Works out how much of the event occurs because of the exposure (subtract the risk of the control group from the exposed group)
99
What is the number needed to treat?
The number of patients you need to treat for one to benefit (1 divided by absolute risk)
100
What are perceptions of risk influenced by?
Lack of personal experience with the problem Belief that it is preventable by personal action Belief that if it has not happened by now, it's not likely to Belief that the problem is infrequent
101
What is a transition point?
A point at which interventions are thought to be more effective
102
What are the models of behaviour change?
Healthy belief model Theory of planned behaviour Stages of change/transtheoretical model
103
What is the health belief model?
Individuals will change their behaviour if they believe that: - Benefits of the action outweight the cost - - They are susceptible to the condition - - There are serious consequences - - Taking action reduced susceptibility
104
What is the theory of planned behaviour?
There are three factors that determine health behaviour: - Attitude towards behaviour - - Subjective norm - - Perceived behavioural control - belief that they can perform the behaviour
105
What is the advantage of the theory of planned behaviour?
It takes into account social influences on behaviour
106
What are the stages of the transtheoretical model?
Pre-contemplation Contemplation Preparation Action Maintenance (potential) relapse
107
What can you offer to a newly presenting drug user?
Screening for blood bourne viruses Health check Sexual health advice Immunisations
108
What are the dimensions of food insecurity?
Availability Access Utilisation - opportunity to prepare food
109
What are errors in practice?
Sloth error - being lazy Lack of skill Communication breakdown System failure Human factors Judgement failure Neglect Poor performance Misconduct
110
How is an error classified?
Intention Action - what task was supposed to be done Outcome - near miss? death? Context
111
What is negligence?
4 parts: - Proven duty of care - - Breach in duty of acre - - Was the patient harmed? - - Was the harm because of the breach?
112
What is bolam and bolitho?
Bolam - would a group of reasonable doctors do the same Bolitho - would that be reasonable
113
What is a never event?
A serious largely preventable patient safety incident - should not occur if the available preventative measures have been implemented
114
What is a person approach?
Holds one person accountable

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