Health improvement / health promotion Flashcards

1
Q

Outline a strategy to …. e.g. improve health? (what steps)

A
  1. Assess need and identify stakeholders (context and cultural relevance)
  2. Identify targets and best practice
  3. Conduct gap analysis
  4. Review evidence to fill gaps
  5. Prioritise interventions (political, professional, public, price, published evidence)
  6. Implementation
  7. Evaluation and monitoring
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2
Q

What are the steps in the audit cycle?

A
  1. Score audit and identify data sources and outcomes
  2. Identify best practice (e.g. NICE guidance)
  3. Assess current performance against best practice (data source? e.g. notes)
  4. Findings - share with stakeholders
  5. Make and share recommendations?
  6. Monitoring, evaluation and re-audit

Ensure legal and governance principles followed

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3
Q

What are the steps in an evaluation?

A

Should be planned prior to implementation!

  1. Scope and agree public health input and timelines (identify and involve stakeholders) - Donebedian (structure, process, output, outcome)
  2. Agree targets / criteria for evaluation (clinical, financial, performance) - should be SMART
  3. Measure performance against standards (data sources?)
  4. Make recommendations and share
  5. Ongoing monitoring and evaluation

Not legal and governance principles

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4
Q

What steps are required in responding to a disease or environmental outbreak?

A

Risk assessment:
1. Establish the facts (is it really an outbreak, what is the source)
2. If confirmed, convene outbreak control group (including all relevant stakeholders)
3. -Descriptive epidemiology - number of cases - people, person time - epidemic curve
-Microbiology / sampling, interviews, etc.
-Environment (source, pathway, recptor)
4. Establish case definition and clinical diagnosis
5. Establish hypothesis and test using study
Risk management
6. Communications
7. Source removal / management (chemoprophylaxis, hand washing etc., contact tracing, environmental)
8. Stand down outbreak control (x2 incubation cycles)
9. Ongoing surveillance and monitoring

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5
Q

What are the components of a health needs assessment?

A
  1. Scope and agree public health input (population, aims, stakeholders, resources, risks)
  2. Assess the needs of the population concerned (prevalence, fingertips)
  3. Assess current service provision
  4. Gap analysis (national guidance, benchmarking(
  5. Findings
  6. Recommendations (evidence based, what works elsewhere) and priorities - interventions should be prioritised that have a high health burden, with effective and evidence based interventions
  7. Change (change management process)
  8. Ongoing monitor and review

Consider inequalities

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6
Q

Describe different levels of intervention for health promotion? (Nuffield ladder)

A
  1. Do nothing
  2. Provide information
  3. Enable choice
  4. Guide choice (though changing default)
  5. Guide choice (through incentives)
  6. Guide choice (through disincentives)
  7. Restrict choice
  8. Eliminate choice
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7
Q

What are the key principles of health promotion and what factors can contribute to its success?

A

-Increase uptake of beneficial (evidence based) interventions
-Harm reduction of risky lifestyle behaviours

Key to success:
-Clear national strategy
-Local coordination
-Accountability / ley lead agency
-Clear commitment and funding
-Partnership working
-Monitoring and evaluation systems

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8
Q

What are the key steps for a health impact assessment?

A
  1. Ascertain the facts (where is the potential hazard?, who is concerned? who is the responsible authority? results of impacts assessments to date?)
  2. Decide if public health input needed and in what regard (personal/professional? conflicts of interest? Independent advice? scope? (can only advise on public health))
  3. Obtain and interpret relevant and available data and information to inform findings
  4. Make recommendations
  5. Facilitate implementation
  6. Monitor and review

Wider considerations: wider impacts political considerations, legislation, conflicts of interest, communication, team stressors

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9
Q

Describe a framework for tobacco control

A

MPOWER
Monitor use
Protect people (smoke free venues)
Offer support
Warn about dangers
Enforce bands
Raise taxes

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10
Q

What are the key steps in outbreak communications?

A
  1. Acknowledge
  2. Reassure
  3. General public health message (e.g. hand washing)
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11
Q

Outline the risk management process?

A

Hazard identification
1. Dose response assessment (based on research)
2. Exposure assessment (field measurements)
Risk management
1. Evaluation of risk (compared to standards)
2. Communication (of risk) so neither frightened or apathetic
3. Control / prevention (including legislation) - source, secondary prevention, person
4. Monitoring (of risk)

Practical steps:
Find out more about incident
Form interdepartmental team (key members?)
-Designate spokesperson
-Consider demographics e.g. elderly, young
-Think about legislative changes

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12
Q

Describe the steps to response to a disease outbreak?

A
  1. confirm outbreak exists (comparison with expected)
  2. Confirm diagnosis (specimins)
  3. case definition (time, person, place, symptoms)
  4. Count cases
  5. Describe data
  6. Generate hypothesis
  7. Test hypothesis
  8. Control / prevention measures
  9. Communication / report
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13
Q

Name some barriers to screening uptake?

A

-Cultural / religious beliefs
-Role of women in society
-Social class
-Access
-Service barriers (language difficulties)
-Mis/disinformation
-Educational levels and understanding

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14
Q

Describe a health promotion framework?

A

Tannahill (venn diagram):

  1. Health education
    -importing knowledge
    -changing attitudes
    -altering behaviour
  2. Disease prevention
    -primary prevention (preventing the disease in the first place e.g. vaccination, lifestyle)
    -secondary prevention (early detection of disease e.g. screening, drugs)
    -tertiary prevention (minimise disability if cannot be cured)
  3. Health protection
    -National / government: legislation (seat belts) or fiscal (taxes)
    -Local/community - environmental control (work environment, speed ramps near school, hygiene regulations in restaurants)
    -Individual - cycle helmets for children
    -
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15
Q

What are the steps of the life course approach?

A

Prenatal, preschool, school age, working age, retirement age

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16
Q

What’s the difference between autosomal dominant and autosomal recessive?

A

Autosomal dominant: an individual can develop the disease with either 1 or 2 copies of the mutant allele. There is no ‘carrier’ state e.g. Huntington’s disease

Autosomal recessive: an individual only develops the disease if they inherit 2 copies of the mutant allele - they must inherit 1 from each parent- 50% chance of passing it on and 25% change of disease (e.g. cystic fibrosis)

Penetrance: the likelihood that a person carrying a disease associated genotype will develop the disease.

Single gene disorders: rare + high penetrance

Polygenic disorders: common and low penetrance

17
Q

What is genetic testing used for?

A

-Diagnosis of disease, predicting disease occurrence of disease in the future, disease management (personalised treatment) and disease prevention (primary and secondary)

18
Q

define the attack rate in an epidemic?

A

Attack rate = number of new cases / population at risk

19
Q

what is the basic reproductive number vs the effective reproductive number?

A

The basic reproductive number is the number of secondary cases if an index case is introduced to a fully susceptible population

The effective reproductive number is the number of secondary cases caused by a disease in a particular population at a particular time

20
Q

what effects the basic reproductive number?

A

Transmissibility, duration of contact, (e.g. behaviours that affect numbers of contacts e.g. sexual transmission vs droplet), duration of infectiousness