SocPop and VLE Flashcards
What are differences between illness, disease and sickness?
Illness - subjective, personal feeling
Disease - pathological process confirmed by signs and investigations
Sickness - social role adopted or assigned to ill people
How can normality be determined?
Statistically
Optimal health
Social norm basis
What is the WHO definition of health?
A state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity
What are the two models of health?
Medical and social
What is the medical model of health?
Health is the absence of disease
Disease caused by pathological changes with specific aetiology
Causes of ill health can be identified by signs and symptoms and the process of diagnosis
Medicine’s role is cure or treat to lessen effects or make comfortable
What is the social model of health?
Health is socially constructed; it is varied, uncertain and diverse
Ill health caused by social/cultural factors not only biological factors
Lay beliefs important, people have own ideas about causes of ill-health
May consider themselves ill but not seek help
Concerned with people’s lives and experiences, and how people themselves define health
Can have a disease or an impairment but still consider oneself healthy
What are criticisms of the medical model of health?
Majority of power is in the hands of the medical profession not patients
Shift to chronic/degenerative conditions (often multi-factorial and multi-dimensional in nature) which are not associated with a simple biological cause or amenable to medical cure
In what 4 ways do people think about their health?
Absence of illness
Functional ability
Equilibrium
Freedom to do
What are the three aspects of ethical reasoning?
Principles - professional codes, moral theories
Particulars - context, case comparison, consistency of judgement
Perspectives - patient, HCP, family, society
What professional codes underpin ethical principles?
Hippocratic oath
Declaration of Helsinki
Declaration of Geneva
GMC doctors duties
What 3 moral theories underpin ethical reasoning?
Deontology- duty
Utilitarianism - consequences
Virtue ethics - character
What is deontology?
Rules based: the morally right thing to do is to obey the moral rule/law
Do not kill, Do not lie, Keep promises
Examples of application to health care: Duty of care, Duty of confidentiality
What is utilitarianism?
The morally right thing to do depends on the consequences, maximising the overall good
Relevance to health care: Best interests principle (beneficence), Resource allocation (quality Adjusted Life Years)
What is virtue ethics?
The morally right action is achieved by exercising the relevant virtues
Virtues are developed by practice, Virtues are developed by learning from those who possess them
Relevance to health care: The ‘good’ doctor, Apprenticeship, mentoring, the hidden curriculum
What are incidence and prevalence?
Prevalence – how many people are ill right now?
Incidence – how many new cases are appearing right now?
What is a confidence interval?
How do we sensibly express our uncertainty in the estimates we find?
What 3 types of prevalence are there?
Point - eg flu during winter
Period - eg flu each year
Lifetime - eg Cancer over a lifetime
How do we calculate incidence?
New cases observed / people observed x years observed
What is mortality rate useful for looking at?
Recognising epidemic outbreaks, effectiveness of new treatment/risks inherent in exposure to new influences
Give an example of a condition with high prevalence but low incidence
Type II diabetes
Give an example of an issue with a low prevalence but high incidence
Nose bleed
Give an example of a disease with low prevalence and low incidence
Pancreatic cancer
Give an example of a condition with high prevalence and incidence
Common cold
How do you minimise sampling variation in a study?
Ask more people
How do you calculate a 95% confidence interval?
p - 1.96 x SE, p + 1.96 x SE
How do you interpret a confidence interval?
95% of confidence intervals we create will contain the true value
What are 3 sources of demographic information in the UK?
UK census
Birth/death registration
Population estimates and projections
What is demography?
The study of the size, structure, dispersement, and development of human populations
What do demographic studies allow us to collect statistics on?
Population size and distribution
Birth and death rates
Life expectancy
Migration
What data is gathered from the census?
Age and sex Ethnicity and religion Employment, home ownership and car ownership Health, long term illness, unpaid care Workplace
What method can be used for assessing the quality of health information?
CART Completeness Accuracy Representativeness and relevance Timeliness (Accessibility)
What are some weaknesses of the UK census?
Completeness - low enumeration of some groups
Accuracy - self reported
Representativeness - low enumeration of some groups
Timeliness - 10 years, takes time for release
Accessibility - confidential for 100yrs
What useful information does the census tell health workers?
Population structure - what service needs are required
Base population - determine rates of illness
Material deprivation - target inequalities
What are measures of fertility?
Crude birth rate - live births / 1000
General fertility rate - live births / 1000 in women age 15-44
Total fertility rate - number of children that would be born to a woman if she were to live to the end of her child bearing years and bear
children in accordance with current age-specificfertility rates
What are strengths and weaknesses of mortality data?
Strengths - complete coverage in UK
Weaknesses - Accuracy e.g. underlying cause of death subject to diagnostic uncertainty, coding issues and variable quality, Not reliable as picture of morbidity, Ethnicity not collected, Derivation of socio-economic status - posthumous inflation of status
What are population estimates used for?
Used for planning services / resource allocation
How are population estimates calculated?
Census baseline + births – deaths + migration
What are strengths and weaknesses of population estimates?
Strengths – more up to date than the census, more accurate than projections
Weaknesses - less reliable with time from census, poor information on migration, says nothing about the future
What are strengths and weaknesses of population projections?
Strengths – Can be used for longer term planning
Weaknesses - less accurate the further ahead, unforeseen changes of past trends can invalidate projections
What are sources of mobidity data?
Cancer registration system
Notifications of infectious diseases
NHS activity data
What are Cancer registration data used for?
Evaluation of screening programmes
Clinical (treatment) & epidemiological (causes) research
Planning services for prevention and care
What are strengths and weaknesses of cancer registration data?
Strengths: Detailed information updated over time, Record linkage to cancer deaths (ONS)
Weaknesses: - Expensive, Access is difficult due to confidentiality
How many cancer registries are there?
12
How many notifiable diseases are there in England and Wales?
31
Who collects data about infectious diseases?
Public health England
What are the uses of surveillance of infectious diseases?
Action to prevent further infection
Identify outbreak
Monitor trends
What are strengths and weaknesses of notification of infectious diseases?
STRENGTHS
Timeliness – weekly report by PHE
Representative - Routine national data
Linked to other data to improve accuracy e.g. lab reports
WEAKNESSES
Poor or variable completeness for some diseases e.g.not all food poisoning notified, some treated at home
Accuracy can be questionable due to diagnostic uncertainty, as asked to notify ‘suspected’ cases, although increasingly linked to lab reports
What NHS activity data is collected?
Hospital episode statistics
Quality outcomes framework