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1
Q

Define health

A

a state of complete physical, mental and social wellbeing, not merely the absence of disease

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2
Q

what are the 3 domains of public health

A

health protection - measures to control infectious disease risk & environmental hazards

health improvement - social interventions aimed at preventing disease, promoting health and reducing inequality

improving services - organisation and delivery of safe, high quality service

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3
Q

Acronym for determinants of health

A

PROGRESS

Place of residence
Race/ethnicity
Occupation
Gender
Religion
Education
Socio-economic status
Social capital / resources
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4
Q

genetic determinants of health

A

age
gender
ethnicity

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5
Q

environmental determinants of health

A

housing
socioeconomic status
access to education

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6
Q

lifestyle determinants of health

A

smoking status
wealth
employment

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7
Q

health care determinants of health

A

access
quality
economic factors

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8
Q

the inverse care law

A

the availability of medical or social care tends to vary inversely with the need of the population served

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9
Q

Equality vs quity

A

equality - concerned with equal shares

equity - what is fair and just

  • horizontal: equal treatment for equal need e.g. everyone with pneumonia treated same
  • vertical: unequal treatment for unequal need e.g. people with pneumonia given dif rx to people with colds
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10
Q

Health needs assessment

A

A systematic approach for reviewing the health issues affecting a population which leads to agreed priorities and resource allocation that will improve health and decrease inequalities

  1. needs assessment –> 2. planning –> 3. implementation –> 4. evaluation –> back to start
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11
Q

what is the epidemiological health needs assessment

A
  • it defines the problem and the size of the problem
  • it looks at current services
  • it recommends improvements
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12
Q

limitations of the epidemiological approach to health needs assessment

A

data available may be poor

doesnt consider felt need

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13
Q

what is the comparative health needs assessment

A

compares services received by one population to another

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14
Q

limitations of the comparative approach to health needs assessment

A
  • data available may vary in quality
  • may be hard to find comparable population
  • comparison may not be perfect
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15
Q

what is the corporate health needs assessment

A
  • takes into account views of any groups that may have an interest eg pts, health professionals, media, politicians
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16
Q

limitations of the corporate approach to health needs assessment

A
  • hard to distinguish need from demand
  • groups have vested interest - leads to bais
  • dominant individuals may have undue influence
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17
Q

What is need, supply and demand in the health needs context

A

need = the ability to benefit from an intervention

supply = what is provided

demand = what people ask for

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18
Q

What are the types of need

A

FENCe
Felt need - individual perceptions of deviations from normal health

Expressed need - seeking help to overcome variation in normal health. A felt need becomes an expressed need when people put what they want into actions.

Normative need - professional defines intervention for expressed need

Comparative need - comparison between severity, range of interventions and cost

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19
Q

Maslow’s heirarchy of need

A

Top

Self-actualisation - morality, creativity, problem solving. A person’s motivation to reach his potential. The hierarchy shows a person’s basic needs must be met before self-actualisation can be achieved.

Esteem - self-esteem, confidence, achievements, respect of/by others

Love/ belonging - friendship, family, sexual intimacy

Safety - security of body, employment, resources, morality, family, health, property

Physiological - breathing, food, water, sex, sleep, homeostasis

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20
Q

Methods of resource allocation

A

egalitarian
maximising
libertarian

ELMo likes to allocate the boxed (resources) “happy happy happy dance” whilst dishing on out

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21
Q

what is egalitarian resource allocation? benefits and drawbacks

A

provide all care that is necessary and required to everyone

+ equal for everyone
- economically restricted

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22
Q

what is the maximising resource allocation method? benefits and drawbacks

A

based solely on consequence

+ resources allocated to those likely to receive most benefit
- those with ‘less need’ receive nothing

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23
Q

what is libertarian resource allocation? benefits and drawbacks

A

each individual responsible for own health

+ onus on pt so may be more engaged
- not all diseases are self inflicted

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24
Q

How can you assess the quality of a service?

A 
3 A's and 3 E's
Access
Appropriate (relevant to need)
Acceptability 
Equity
Efficient
Effective
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25
What is a health behaviour
something aimed at preventing disease e.g. going for a run
26
what is illness behaviour
seeking remedy e.g. going to gp for a symptom
27
what is sick role behaviour
an activity aimed at getting well e.g. taking abx
28
Transtheoretical model
PC Pam Precontemplation --> contemplation --> preparation --> action --> maintenance (and potential relapse throughout)
29
Transtheoretical model - advantages
- acknowledges individual stages of readiness - accounts for replace - temporal element
30
Transtheoretical model - disadvantages
- some individuals skip stages - change may be continuous, not discrete - doesn't consider values e.g. cultural and social factors
31
Theory of planned behaviours
ASP (decy plans to get ASPergillous) Attitudes + Subjective norms + perceived behaviour control = intention === behaviour Bridging the gap between intention & behaviour: P PAIR
32
In the theory of planned behaviours model what does the acronym P PAIR stand for with relation to bridging that gap between intention and behaviour
P PAIR - preparatory actions - perceived control - anticipated regret - implementation intentions - relevance to self
33
Theory of planned behaviours - advantages
- can be applied to a wide range of health behaviours - useful for predicting intention - takes into account importance of social pressures
34
Theory of planned behaviours - disadvantages
- no temporal element, direction or causality - doesnt consider emotions - assumes attitudes can be measured
35
What is the health belief model
Demographic variables (age, gender, socioeconomic status) + psychological characteristics (personality, peer group pressures) all contribute to: - perceived susceptibility - perceived safety - health motivation - perceived benefits - perceived barriers which lead to: the likelihood of an action and the action happening. Or there can be a cue to action before the action
36
Advantages to the health belief model
- can be applied to wide range of health behaviours - cues to action are unique component - longest standing model
37
Disadvantages to the health belief model
- Other factors may influence the outcome - Doesnt consider emotions - Doesnt differentiate between first time and repeated behaviours
38
Medical negligence - what are the 4 questions to be considered What rules are there
1. Was there duty of care 2. Was there a breach in that duty 3. Was the pt harmed 4. Was the harm due to the breach in care Bolam rule, bolitho rule
39
Bolam rule
Would a reasonable dr do the same?
40
Bolitho rule
Would a reasonable dr do the same AND would that be reasonable?
41
What types of error are there
``` Sloth System error Fixation and loss of perspective lack of skill Mis-triage Ignorance Bravado/timidity Playing the odds Poor team working Communication breakdown ```
42
Error: Communication breakdown Example? Skill to improve?
Communication breakdown e.g. unclear instructions, not listening to others opinions Skill to improve: effective communication (listening, explaining, approachability)
43
Error: Poor team working Example? Skill to improve?
Poor team working e.g. poor direction and independent working skills to improve: assign roles, logical leadership
44
Error: Playing the odds Example? Skill to improve?
Playing the odds e.g. choosing the common and dismissing the rare skill to improve: probability assessment
45
Error: Bravado/ timidity Example? Skill to improve?
Bravado/timidity e.g. working beyond competence/ without adequate supervision+ showing confidence to hide underlying deficiencies skill to improve: humility - accurate self evaluation
46
Error: ignorance Example? Skill to improve?
ignorance e.g. lack of knowledge + unconscious incompetence skill to improve: self awareness of abilities/ limitations
47
Error: Mistriage Example? Skill to improve?
Mistriage e.g. over/under-estimating severity of a situation skills to improve: prioritisation + understanding of relative emergencies
48
Error: lack of skill Example? Skill to improve?
Lack of skill e.g. not having appropriate skills/ training / practice skill to improve: effective technical skills - attending training for your role
49
Error: System error Example? Skill to improve?
System error e.g. environmental, technological or equipment failure, lack of organisational fts or inadequate built in safeguards skill to improve: system design
50
Error: sloth Example? Skill to improve?
sloth e.g. inadequate documentatio, not checking results for accuracy skill to improve: conscientiousness
51
Error: fixation and loss of perspective Example? Skill to improve?
fixation and loss of perspective e.g. early unshakeable focus on one dx and inability to see bigger picture despite signs skills to improve: open mindedness & situational awareness
52
Error: The swiss cheese model
The swiss cheese model of human error So you have a number of latent failures which eventually lead to an active failure e.g. organisational failure > unsafe supervision > preconditions for unsafe acts > unsafe acts > active failures
53
Error: the three bucket model
error evolves due to interaction between personal, environmental & physical factors as well as organisation systems approach: recognition that we need to look at systems rather than individual people or incidents for source of error, then can adapt the system to prevent recurrence = inc services + inc morale It considers 3 buckets: self, context and task
54
What kind of things are in the self bucket in the 3 bucket model
``` Self: Level of knowledge - newly qualified - aware of protocols - senior support available ``` Level of skill - competence - experience Level of expertise - automacity - confidence - expectation Current capacity to do task - fatigue - stressors - illness - negative life events
55
What kind of things are in the context bucket in the 3 bucket model
``` equipment and devices physical environment workspace team and support organisation and management ```
56
What kind of things are in the task bucket in the 3 bucket model
errors task complexity new task process - eg multitasking
57
Error: never events
a serious, largely preventable pt safety incident that should not occur if available, preventative measures have been implemented
58
consequences of never events
financial penalties CQC visit reputation loss
59
define screening
identifying apparently well individuals who have or are at risk of having a disease e.g. new born (heel prick), br cancer, cervical cancer, bowel cancer
60
what are the criteria for screening
disease: - important - natural hx known - early rx better than late test: - acceptable to the population - facilities available - simple, safe, precise and validated outcomes: - ongoing feasibility - rx available - cost- benefit analysis
61
define sensitivity
the proportion correctly identified who have the disease true positives / (true positives + false negatives)
62
define specificity
proportion correctly excluded who do not have the disease true negatives / (true negatives + false positives)
63
what is the positive predictive value
proportion with positive result who actually have the disease true positives / (true positives + false positives)
64
what is the negative predictive value
proportion with negative result who do not have the disease true negative / (true negative +false negative)
65
study designs in order of goodness
bottom case report > case series > cross-sectional > case-control > cohort > randomised control trial > systematic review/ meta-analysis
66
study design: cross sectional | what is it? positives and negatives?
cross-sectional snapshot data of those with and without disease to find associations at a single point in time + quick and cheap. + few ethical issues - prone to bias - no time reference
67
study design: case-control | what is it? positives and negatives?
case control retrospective observational study which looks at a certain exposure and compares similar participants with and without disease + good for rare diseases + inexpensive - can only show association (not causation) - unreliable due to recall bias
68
study design: cohort | what is it? positives and negatives?
cohort study longitudinal prospective study which takes a population of people recording their exposures and conditions they develop + can show causation + less chance of bias - large amount lost to follow up - expensive
69
study design: randomised control trial | what is it? positives and negatives?
RCT similar participants randomly controlled to intervention or control groups to study the effect of the intervention GOLD STANDARD + can infer causality + less risk of bias/confounders - time consuming and expensive - ethical issues can interfere
70
Factors to assess causality
- biological plausibility - temporal relationship - dose response relationship - strength of association - specificity - consistency - altered by experimentation - coherence with existing themes - consider reverse causality
71
what is a confounder
risk factors other than those being studied that influence the outcome
72
What is bias
a systematic error that results in a deviation from the true effect of an exposure on an outcome
73
types of bias
SIP Selection bias: discrepancy of who is involved Information bias: measurement bias (dif equipment), observer bias, recall bias (past events remembered incorrectly), reporting bias (responder doesnt tell the truth) Publication bias: some trials are more likely to be published than others
74
What is the difference between equity and equality?
Equality is the same for everyone v equity is what is fair and just
75
The three approaches to a health needs assessment?
Epidemiological, comparative and cooperate
76
Name one type of resource allocation method and give both an advantage and a disadvantage of this method?
Eg egalitarian – everyone gets what they need but expensive
77
The 5 stages of the transtheoretical model (remember our police lady?)
Precontemplation Contemplation Preparation Action Maintenance PC PAM
78
Name the 4 components of negligence
Duty of care, breach in this, harm, harm because of breach
79
Three types of error
Sloth, poor team work, lack of communication etc
80
What is a never event and give an example
A serious, largely preventable patient safety incident that should not occur if available, preventative measures have been implemented. Eg wrong site surgery
81
Name 4 screening criteria
Important disease, easy and acceptable test, benefits outweigh risks etc
82
Three factors to assess causality
Biological plausibility, temporal relationship, specificity, consistency
83
An advantage and disadvantage to RCT
Gold standard , can infer causality and minimises bias but time consuming and expensive

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