publid health Flashcards
number needed to screen
A number needed to screen is a reference to the number of patients who will need to be screened by the programme to prevent one excess death /morbidity
types of need
FENC
felt need
expressed
Normative
Comparitive
resource allocation
egalitarian
maximising
libertarian
maxwells dimensions to assesing wuality of service
3As 3Es
access
acceptibility
appropriat, relevant to need
equity
efficient
effective
donabedians aproach to assesing quality of service
structure
proces
outcome
wrights matrix of assesing service quality
maxwells dimensions= donabedians approach
health behaviour
aimed to prevent disease oe going for a run
illness behaviour
seeking remedy
ie going to gp for sx
sick role behaviour
activity aimed at getting well ie taking abx
transtheoretical model
smoker eg
precontemp - smoker
contemp - smoker thinking abt quit
prep -
action - ex smoker <6mths
maintence >6mths
stable changed lifestyle/relapse
transtheoretical model +ves
aknowledges different stages of readiness
accounts for relapse
temporal element
transtheoretical model -ves
some individuals skip stages
change maybe continous not discreet
doesnt consider values ie cultural and social factors
theory of planned behavoiurs
structure and influences
sees behavour change in terms of intention and behaviour aim is to bridge gap
intention is affected by; attitudes, subjective norms, percieved behaviour control
theory of planned behavoiurs
how to bridge gap between intention and behaviour
P PAIR
prepatory actions
percieved control
anticipated regret
implementation intentions
relevance to self
theory of planned behavoiurs +ves
applicable to variety of health behaviour
useful for predicting intention
takes into account importance of social pressures
theory of planned behavoiurs -ves
no temporal element direction or causality
doesnt consider emotions
assumes attitudes can be measured
health belief model
perceived susceptibility
perceived severity
health motivation
perceived benefits
perceived barriers
influence likelhood of action-> action <- cues to action
med negligence
1 duty of care ?
breach in duty?
pt harmed?
harm due to breech?
med negligence
bolam rule
would reasonable dr do the same
med negligence
bolithos rule
would that be reasonable ?
screening eg
newborn heel prick
breast ca mammography
cerv ca smear
bowel ca poo in post
screening test criteria
disease test outcomes
important
natural hx known
early tx better than late
test
acceptable to pop
facilities available
simple, safe precise and validated
outcomes
ongoing feasibility
tx available
cost benefit analysis
study design top to bottom
meta analysis
rct
cohort
case control
cross sec
case series
case report/anecdote
cross sec study
snapshot of w and w/o to find associatians at single time point
quick and cheap
few ethical issues
prone to bias
no time reference
case control
retrospective
observational - looks at certian exposure and compares similar particants w and w/o dz
good for rare isease
not expensive
can only show association not causation
unreliable bc recall bias
cohort
longtidunial perspective study takes a pop of ppl recording exposures and conditions they develop
can show causation
less chance of bias
large amount lost due to follow up
expensive
RCT
gold standard
similar participants randomly controlled to intervention or control groups to study the effect of the intervention
can infer causality
less risk bias/confounders
time consuming and expensive
ethical issues can intefer
confounders
rfs other than those being studies that influence outcome
types of Bias
SIP
selection
information (measurement,observer,recall,reporting)
publication
3 domains public health
health protection
health improvement
improving services
measures control infectious disease and envronmental hazards
social interventions aim preventing disease, promoting health and reducing inequality
organisation and deliv of safe high quality services
inverse care law
availabilty of medical or social care tends to vary inversely with the need of the population served
determinents of health
PROGRESS
place of residence
race/ethinicity
occupation
gender
religeon
educaton
sociecon status
social capital/resources
equality
= equal shares
equity
equal tx for equal need
unequal tx for unequal need
what is health needs assesment
systematic approach for reveiwing the health needs of a pop which leeds to agreed priorities and resource allocation that will improve health n dec inequalities
3 types of health needs assesment
epidemiological
comparative
corporate
incidence
no. of new cases per unit time
increased by: screening n inc RFs
reduced by: decreasing RFs ie primary preventions
prevelance
no. of existing cases at a particular point in time
nudge theory
changing environment to make the healthy option the easiest option
sensitivity
probabilty of pt w dz obtaining +ve test
ie how well it picks it up
true pos/(tp-fn)
specificity
pt w/o disease testing -ve
ie how well recog those w/o disease
tn/(tn+fp)
positive pred value
prop of pplw +ve result that have dz
negative pred value
prop of ppl w/o dz correctly excluded by screening test
agaisnt screning programm
damage caused by false pos and false neg
adverse effects of screening tool on healthy ppl
personal choice is compromised
prevention paradox
preventative measure which brings much benefit to the pop often offers little to each participating indivifual
high risk approach to screening
target highest risk individuals
aims to reduce rsik to below set limit
accepted by society - treat those outsidenormal
favors priveleged bc engage , comply,means to change
population approach to screening
target all indiv
aim to reduce risk for each individuals
recognises that low risk majority may contribute to most cases
concerns over treating the well and the ‘nanny state’
generally reduces social inequalityes
primary prevention CHD
SNAP
smoking
nutrition
alcohol
physical activity
cardiac rehab phases
in hospital
early post discharge
4 mths
long term maintence of lifestyle changes (snap)
modifiable chd rf
high cholest
htn
t2dm
smoking
inactivity
obesity
poor nut
alcohol
unmod chd rf
sex
age
ethnicity
fhx
crit for pandermic spread
novel
capable infect humans
capable causing human illness
large pool suscept ppl
ready and sustaible transmission from person to person
chain of infection
suscept host (reservoir)
person to spread (reservoir)
portal of exit for agent
mode of trans ie feacooral
port of enrty to suscept host
suscept host
c.diff SIGHT
SIGHT
suspect c.diff
isolate case
gloves n apron
hand washing
test stool
cage
ever felt u should cut down
been annoyed by people telling u to cut down
guilty abt how much drink
ever had drink first thing in the morning
assessment of limitation
Katz barthel
instrumental activity of daily livig scakes
gerontology
studying changesin the body and mind that acompany anging
geriatrics
dx and tx of disorder that occur in old age
doctrine of double effect
If you administer a drug to relieve pain in doses that you know may be fatal, then provided your intention is not to shorten life but to relieve pain, the administration is not unlawful.
utilitarianism
An act is evaluated solely in terms of its consequences. It acts to maximise good e.g. killing one to save many.
deontolgy
Deontology
The theory that the features of the act themselves that determine worthiness.
virtue ethics
These focus on the character of the person, integrating reason and emotion.
An action can be virtuous only if it is performed by a person in the right state of mind (i.e. genuinely intending to do the right thing).
5 focal virtues
compassion
discernment
trustworthiness
integrenty
consciencousness
Pico
population
intervention
comparator
outcome
validity
how close to truth it isr
reliability
how consistent results are
appilicability
how relevant study is to clinical med
study types
observational
experimental
interventional
observational studies
descriptive
descriptive and analytucal
analytical
descriptive
case reports
ecological studies
descriptive and analytucal
cross sectional
analytical
case control
cohort
experimental/interventional study eg
RCT
non RCT
reverse causality
unclear which variable independant and which dependant
crit for likelihood association is causal
Consistency
Strength of association
Specificity (single cause for a single effect)
Dose-response relationship
Temporal relationship
Biological plausibility
Coherence with existing theories
Altered by experimentation
how can meta analyiss be graphucally rep
forest plot
graphs continousdata
stem and leaf
histogram
graphs showing discrete categorical ata
bar charts
pie charts
standard deviation
average distance of observations from the mean vale
used to find outliers
non random sampling types
conveience -all pt avaible at point in time
purposive/ quota sampling
random sampling types
simple random
stratified random
cluster sampling
standard error
precsion
confidence interval use what
sample mean and standard error
p value
probabilty of result being due to chance given that the null hypothesis is true
NNT
1/ARR
NNH
1/ARD
odds ratio
ratio of odds for exoposed group to odds fot not exposed group
(Pexposed/1-Pexposed) / (punexpo/1-punexpos)
cant calculate relative risk which study what insteas
case control
odds ratio
sore throat critera
centor
tonsillar exudate
absence of cough
tender/large cerv ln
fever
key concerns of public health
inequalties in health
wider determinants ofhealth
prevention
what needs to be done before health intervention is made
health needs assesment
1,2,3 orevention eg
change 4life 5 day
breast screening programme
diabetic foot care and eye care
physio post stroke to prevent immobility
