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PPP > WEEK 2 > Flashcards

WEEK 2 Flashcards

1
Q

Define health

A

The state of complete physical, mental and social well-being, not merely the absence of disease or infirmity

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2
Q

What are 5 of the multi-dimensional aspects of health?

A 
Disease
Disability
Frequency of illness
Malaise
Fitness
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3
Q

Is health a fixed concept?

A

No, it is sensitive to society’s demands/ideals

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4
Q

What are the four key determinants of health?

A

1) Biological
2) Lifestyle
3) Environment
4) Health Service

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5
Q

Give three examples of biologically-related determinants of health

A

1) Age (direct link with mortality and morbidity after adolescence)
2) Sex (higher death rate in men)
3) Genetics (obesity/diabetes/heart disease)

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6
Q

Give five examples of lifestyle-related determinants of health

A

1) Tobacco
2) Nutrition (mal/overnutrition)
3) Alcohol
4) Physical activity
5) “Risky” behaviours

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7
Q

What is an important question to do with lifestyle-determinants of health?

A

Are these factors entirely determined by individual choice?

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8
Q

Give three aspects of environment-related determinants of health

A

1) Physico-chemical (air/water/radiation)
2) Biological (microbes)
3) Socioeconomic and sociopolitical (education/employment/political stability/’convenience society’)

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9
Q

Describe the role of the health service in disease/mortality prevention in recent times

A

Clinical medicine has played a smaller role, prevention attributed to fall in infectious disease (eg. hygiene)

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10
Q

Is the fact that vaccination against certain disease not having a large impact an argument against them?

A

No, just that medical interventions fall secondary to environmental changes in some cases

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11
Q

What are five important roles of clinical medicine?

A

1) Preventing deaths
2) Improving length and quality of survival in fatal conditions
3) Treating and improving quality of life in non-fatal conditions
4) Preventing and treating genetic dorsers
5) Care for chronically mentally ill, mentally disabled and elderly

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12
Q

What are the four main reasons for measuring population health?

A

To identify:

1) disease prevalence and incidence
2) longitudinal disease trends
3) if interventions or policies are having an effect
4) differences in disease patterns in different groups/locations

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13
Q

What is the difference in the top causes of disease in HICs and LICs?

A

Most communicable in LICs, most non-communicable and chronic in HICs

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14
Q

Give 9 examples of data sources for measuring population health

A

1) Death certification
2) Census
3) Health Survey for England (HSE)
4) General Lifestyle Survey
5) Hospital Episode Survey
6) Clinical Practice Research Datalink
7) Health protection reports for notifiable infectious diseases
8) Cancer registration
9) National/regional/local audits/surveys

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15
Q

Describe Death Certification

A

A legal requirement (recording Pt age, sex, occupation, where they died and cause/contributing diseases)

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16
Q

Describe Census

A

Occurs every 10 years counting everyone in a household on one particular night (recording age, gender, migration, education, marital status, health, housing conditions, family structure, employment and travelling habits)

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17
Q

What is a Census used for?

A

Measurement of population demographics to make population pyramids

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18
Q

Describe Hospital Episode Statistics

A

Details all admissions to NHS hospitals and outpatient appointments in England (recording diagnoses and operations, age, gender, ethnicity, time waited and date of admission, where treated, outcome-discharge/death)

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19
Q

Describe the Clinical Practice Research Datalink

A

Anonymised longitudinal data from 625 general practices (for clinical research planning, drug utilisation, studies of treatment patterns, drug safety, health outcomes)

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20
Q

Describe the Health Survey for England

A

Annual population survey (recording demographic info., smoking status, illness, treatment, health service usage, height/weight plus additional key theme each year)

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21
Q

Describe the General Lifestyle Survey

A

Sample from whole of GB (recording demographic info., housing, vehicle access, employment/education, smoking/drinking, family info.)

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22
Q

What are notifiable diseases?

A

Certain infectious diseases of particular significance

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23
Q

What are the key methods of measuring health and disease?

A

Birth and fertility rates
Incidence
Prevalence
Mortality rate (crude and standardised)

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24
Q

What are the advantages to using mortality data as a measure of population health?

A

Legal requirement in UK to register each death
Little delay in data collection
International classification of diseases ensures comparability
Cheap source of health data

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25
Q

What are the disadvantages to using mortality data as a measure of population health?

A

Potential for error
Death may result from many diseases acting together
Problems in allocation of resources as some diseases with low mortality rate may be resource intensive

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26
Q

What are two ways to use mortality or morbidity rate?

A

Area comparison or change over time

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27
Q

What is direct standardisation?

A

Where age-specific death rates from a study population are applied to a standard population structure

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28
Q

What are the advantages of direct standardisation?

A

Can be used to compare disease rates across areas and time

Can be used to access the relative burden of different diseases in a population

29
Q

What are the disadvantages of direct standardisation?

A

Requires age-specific rates which are not always available at a local level
Rates may not be stable for small number of events

30
Q

What is indirect standardisation?

A

Where age-specific death rates from a standard population are applied to a study population structure

31
Q

Standardised Mortality Rates (SMR)=

A

observed no. of deaths from study population/expected no. of deaths from study

32
Q

What are the advantages of indirect standardisation?

A

Doesn’t require local rates, only absolute number of events

Easier to interpret rates

33
Q

What are the disadvantages of indirect standardisation?

A

Areas cannot be directly compared

Doesn’t give an idea of actual burden of disease

34
Q

What are the pitfalls of health and disease data interpretation?

A

Different criteria define disease between areas
Not all cases of disease identified in each area
Use of hospital data omits certain cases (GP/community)

35
Q

Define incidence

A

New cases of disease over a defined time period

36
Q

Incidence rate=

A

no. of new cases of a disease over time period/Person-years at risk

37
Q

Person-years at risk=

A

total population at risk x time period

38
Q

What does 1 Person-year at risk equate to?

A

1 individual at risk for 1 year or 2 individuals at risk for 6 months

39
Q

How can Person-years at risk be approximated?

A

The population at the mid-point of the time period

40
Q

Define prevalence

A

How many people have a disease at one point in time

41
Q

What is prevalence often used for?

A

Ascertaining the burden of long-term conditions

42
Q

Point prevalence=

A

no. of people with a disease at a point in time/total population at risk of the disease at the point in time

43
Q

What are three measures of birth and fertility rates?

A

Birth rate
General fertility rate
Total fertility rate

44
Q

Define birth rate

A

Number of live births per 1000 population

45
Q

Define general fertility rate

A

Number of live births per 1000 women aged 15-44

46
Q

Define total fertility rate

A

Average number of children that a woman would bear if they experienced the age-specific fertility rates at that point in time

47
Q

Why is total fertility rate used in preference to general fertility rate?

A

Allows comparison over time/between areas

48
Q

Infant Mortality Rate/IMR (per 1000)=

A

no. of deaths in children aged < 1 year/all live births (x1000)

49
Q

Why measure IMR?

A

highly correlates with life expectancy and overall economic status

50
Q

Crude Mortality Rate=

A

total no. of deaths in 1 year/total mid-year population

51
Q

Disease-specific death rate (per 1000)=

A

no. of deaths from disease/total mid-year population (x1000)

52
Q

What are Merinker’s Three Levels?

A

1) Disease
2) Illness
3) Sickness

53
Q

Define disease

A

a pathological process-often physical-causing deviation from the biological norm

54
Q

Define illness

A

a feeling/experience of being unhealthy which is subjective interior to the patient

55
Q

Define sickness

A

a social status/perception of someone suffering from a disease

56
Q

Define Mental Health

A

A state of well-being in which every individual realises his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community

57
Q

What is the major theory of health and disease contributing to the biomedical model?

A

Germ theory/Pathogenic medicine

58
Q

What are 5 concepts associated with the biomedical model?

A

1) Mind/body dualism (separate entities)
2) Mechanistic (sees body as machine)
3) Over-reliance on technology
4) Reductionist (biological causation)
5) Ignores social, cultural, biographical and environmental explanations

59
Q

How is illness treated in the biomedical model?

A

Vaccination/Surgery/Chemotherapy

60
Q

Who is responsible for treatment in the biomedical model?

A

Medical professional

61
Q

What is the relationship between health and illness in the biomedical model?

A

Qualitatively different, no continuum between them

62
Q

Four reasons for belief that health and illness are social construction

A

1) Different symptomatology experienced by different people
2) Different societies have different methods of treatment and diagnosis
3) Illness isn’t randomly distributed
4) Constructs open to interpretation and moral/social/religious influence

63
Q

What is medicalisation?

A

The process by which non-medical problems become medical problems

64
Q

What is a criticism of the biomedical model?

A

Medicalisation

65
Q

What are the three levels of medicalisation?

A

1) Interaction=telling Dr symptoms
2) Conceptual=signs and symptoms->diagnosis
3) Institutional=organisation uses medical approach to manage problems

66
Q

Give two examples of previous drivers for medicalisaiton

A

Professional dominance and industry pressure (pharmaceutical companies)

67
Q

Give three examples of present drivers for medicalisation

A

Biotechnology, consumerism and ‘care’ industry

68
Q

Define iatrogenesis?

A

The causation of a disease, harmful complication or other ill effect by any medical activity including diagnosis, intervention, error or negligence

69
Q

Give two examples of iatrogenesis

A

Antibiotic resistance and US opioid crisis

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