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Phase 3a > Public Health > Flashcards

Public Health Flashcards

1
Q

Advantages case control study

A
  • Good for rare outcomes
  • Quicker than cohort or intervention
  • Can investigate multiple exposures
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2
Q

Disadvantages case control study

A
  • Difficulty finding controls to match with cases
  • Prone to selection and information bias
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3
Q

Case control study

A
  • Compares 2 groups of people
  • Groups with and without the disease are selected and their past exposures are identified- a retrospective study
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4
Q

cohort study

A
  • Longitudinal study
  • Follows participants over period of time
  • a sample is taken from the study population (those at risk of outcome) and split into subgroups, one being exposed and the other not being exposed. Incidence of the disease amongst the sub groups is later compared.
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5
Q

Advantages cohort study

A
  • Can follow up a group with a rare exposure
  • Good for common and multiple outcomes
  • Less risk of selection and recall bias
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6
Q

Disadvantages cohort study

A
  • Takes long time
  • Loss to follow up
  • Large sample size needed
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7
Q

Cross sectional studies

A

Looks at data at a single point in time
- exposure and outcome are measured simultaneously in a given population at a particular point in time

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8
Q

Advantafes cross sectional

A
  • Quick and cheap
  • Provide data on prevalence at single point in time
  • Large sample size
  • Good for surveillance and PH planning
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9
Q

Disadvantages cross secional

A
  • Risk of reverse causality
  • Cannot measure incidence
  • Risk recall bias and non-response
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10
Q

RCT

A
  • Subjects are randomly assigned to groups
  • a sample from the population is split into two groups, one group is given treatment and the other is the control group.
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11
Q

Advantages RCT

A
  • Low risk of bias and confounding
  • Can infer causality
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12
Q

RCT disadvantages

A
  • Time consuming
  • Expensive
  • Specific inclusion/exclusion criteria may mean study population different from typical patients
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13
Q

Selection bias

A

Systemic error in
- Selection of study participants
- Allocation of participants to different study groups
- Non response
- Loss to follow up

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14
Q

Information bias

A
  • Measurement
  • Observer
  • Recall
  • Reporting
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15
Q

Publication bias

A
  • Not all trial results are published
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16
Q

Confoudning

A
  • Estimate between an exposure and an outcome is distorted because of the association of the exposure with another factor that is also independently associated with the outcome
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17
Q

Reverse causality

A
  • Association between an exposure and an outcome could be due to the outcome causing the eposure rather than the exposure causing the outcome
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18
Q

Sensitivity

A

a/(a+c)
a = +ve screening test and have disease TP
c = negative screening test and have disease FN
= those with the disease who are correctly identified

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19
Q

Specificity

A

d/(b+d)
d = negative test and dont have disease TN
b = positive screening test and dont have disease FP
- proportion of people without the disease who are correctly excluded by the screening test

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20
Q

PPV

A

a/(a+b)
a= +ve test and have TP
b = +ve test and dont FP
= proportion of people with +ve test who have the disease

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21
Q

NPV

A

d/(d+c)
d = -ve test and dont have TN
c = -ve test and do have FN
= Proportion with a -ve test who do not have disease

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22
Q

NHS criteria for screening test

A

The condition
- Important
- Epid understood
- Primary prevention implemented
- Mutation
Screening
- ongoing
- Cost balanced in relation to spending as a whole
Test
- Safe test
- Test values known and cut off defined
- Acceptable to population
- Further ix agreed
Treatment
- Effective treatment/intervention
- What and who to offer to
- Outcomes optimised

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23
Q

Lead time bias

A

When screening identifies an outcome earlier than it would otherwise have been identified this results in an apparent increase in survival time even if screening has no effect on outcome

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24
Q

Length time bias

A
  • Differences in the length of time taken for a condition to progress to severe effects, that may affect the apparent efficacy of a screening method
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25
Q

Health needs assessment - epidemiological approach

A
  • Disease incidence and prevalence
  • Morbidity and mortality
  • Life expectancy
  • Services available
  • Sources of data
    advantages
  • Uses existing data and provides data on disease
  • Can evaluate over time
    disadvantages
  • Quality of data variable
  • May not be data required
26
Q

HNA - corporate approach

A
  • Ask local population what health needs are
  • Focus groups, interviwes…
  • Wide variety of stakeholders
    advantages
  • Based on population needs
  • Wide range of views
    disadvantages
  • Difficult to distinguish need rom demand
  • Vested interest
  • Political agendas
27
Q

HNA - comparative approach

A
  • Compare health or healthcare provision of 1 pop to another
  • Spatial or social
    Advantages
  • Quicj and cheap if data available
    Disadvantages
  • Difficult to find comparable populaiton
28
Q

The 3 domains of public health

A
  • Health improvement
  • Health protection
  • Health service quality
29
Q

Indivisual level interventions

A
  • e.g. childhood immunisations
30
Q

Ecological level interventions

A
  • e.g. clean air act
  • General interventions and not specifically delivered at the individual level
31
Q

Community level

A
  • Similar to ecological level interventions but delivered al local/community level
  • e.g. playground for local community
32
Q

Horizontal equity

A
  • Equal treatment for equal need
33
Q

Vertical equity

A
  • Unequal treatment for unequal need
34
Q

Health needs assessment

A
  • Systemic method for reviewing the health issues facing a population
  • Leads to agreed priorities and resource allocation that will improve health and reduce inequalities
35
Q

Framework for health service evaluation

A
  • Structure = what is there
  • Process = what is done
  • Outcome = morbidity, mortality, QOL
36
Q

Classification of health outcomes

A
  • Mortality
  • Morbidity
  • QOL
  • Patient satisfaction
37
Q

Maxwell’s dimensions of quality

A
  • Acceptability
  • Accessibility
  • Appropriateness
  • Effectiveness
  • Efficiency
  • Equity
38
Q

Qualitive methodology

A
  • Observation
  • Interviews
  • Focus group
  • Review of documents
39
Q

Incidence

A
  • New cases
  • Denominator
  • Time
40
Q

Prevalence

A
  • Existing cases
  • Denominator
  • Point in time
41
Q

Attributable risk

A
  • Rate of disease in the exposed that may be attributed to the exposure
42
Q

Relative risk

A
  • Ratio of risk of disease in the exposed to the risk in the unexposed
43
Q

Primary prevention

A
  • Prevent a disease from occurring by reducing exposire or risk factors
  • Lifestlye
  • Vaccines
44
Q

Secondary prevention

A
  • Detect early disease to alter course
  • Treatment with aspiring to prevent recurrence of MI
45
Q

Tertiary prevention

A
  • Minimise disability
  • Stroke rehab
46
Q

what 3 factors determine an individuals health behaviour

A
  • Attitude
  • Behaviour
  • Subjective norms and percieved behavioural control
47
Q

Wilson and junger criteria for screening

A

Condition
- must have latent stage
- natural history is understood
Test
- Suitable
- Acceptable
- Interval determined
Treatment
- Acceptable
- Facilities available
Other
- Cost effective
- Risk outweighs benefits
- Agreed policy on who to treat

48
Q

Health behaviours 3

A
  • Health behaviour - behaviour aimed at preventing disease
  • Illness behaviour - behaviour aimed to seek remedy
  • Sick role behaviour - any activity aimed at getting well
49
Q

externality theory of obesity

A

Normal weight people respond to internal homeostatic cues
Overweight individuals respond to external cues, time of day, sensory food cues
Weaknesses- theory is too generalised

50
Q

restraint theory

A

Dieters stop eating at their cognitive diet boundary, before they reach satiety
Overtime dieters get a larder range between hunger and satiety
If dieters exceed the diet boundary they will continue to eat until satiety (which is higher than a normal eater) leading to weight gain
Weaknesses- suggests a rigid diet plan

51
Q

Domestic abuse risk

A

Standard risk: Does not suggest imminent serious harm 🡪 signpost
Moderate risk: Potential for serious harm but unlikely unless there is a change in circumstances 🡪 signpost
High risk: Imminent risk of serious harm 🡪 MARAC/IDVAS

52
Q

Health belief

A
  • Beleive susceptible
  • Believe disease has serious consequences
  • Believe that taking action reduces susceptibility
  • Believe that benefit outweighs cost
53
Q

Theory of planned behaviour

A
  • Intention is the most important aspect
  • Determined by attitude, social pressure and percieved behaviour control
54
Q

Social norms

A
  • Re-align perceptions of norms with reality
  • Used in adolescents
55
Q

Transtheoretical model

A
  • Pre contemplation
  • Contemplation
  • Preparation
  • Action
  • Maintenance
56
Q

felt need

A

individual perceptions of variation from normal health

57
Q

expressed need

A

individuals seeking help to overcome variation from normal health

58
Q

normative need

A

professionals define interventions/approach for expressed need

59
Q

comparative need

A

relative to a reference or peer group

60
Q

transition points in life

A
  • becoming a parent
  • becoming unemployed
  • bereavement
  • leaving school

Phase 3a (23 decks)

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