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CJ: UoL Medicine Semester Two (ESA2) > ASBHDS - Session 2 > Flashcards

ASBHDS - Session 2 Flashcards

1
Q

Define ‘determinants of health’

A

A range of factors that have a powerful and cumulative effect on the health of populations, communities and individuals. Eg. physical environment, social/economic environment, individual genetics, characteristics and behaviours

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2
Q

Describe briefly the history of health promotion in developed countries

A

1910s-1940s: Public Health (reform of physical environment)
1950s-1960s: Health Education (target individual health behaviour)
1970s onwards: Health Promotion (broader political/social approach to health)

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3
Q

Define ‘health promotion’

A

The process of enabling people to increase control over and to improve their health

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4
Q

What are the seven principles of health promotion?

A

1) empowering
2) participatory
3) holistic
4) intersectoral
5) equitable
6) sustainable
7) multi-strategy

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5
Q

What’s the difference between health promotion and public health?

A

Public health places more emphasis on the end goals, while health promotion is about the MEANS of achieving the goals (education and healthy public policy).

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6
Q

What are the three aspects of health which are critiqued in a sociological perspective on health promotion?

A

1) structural critiques
2) surveillance critiques
3) consumption critiques

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7
Q

What are the five approaches to health promotion?

A

1) medical/preventative
2) behaviour change
3) educational
4) empowerment
5) social change

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8
Q

What is the aim of primary prevention?

A

The prevent the onset of disease or injury by reducing exposure to risk factors

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9
Q

What are the approaches to primary prevention?

A
  • immunisation
  • prevention of contact with environmental risk factors
  • taking appropriate precautions concerning communicable disease
  • reducing risk factors from health related behaviours
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10
Q

What is the aim of secondary prevention?

A

To detect and treat a disease or its risk factors at an early stage to prevent progression/potential future complications and disabilities from the disease - mostly types of screening, eg screening for cervical cancer

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11
Q

What is the aim of tertiary prevention?

A

To minimise the effects of established disease, eg renal transplants or steroids for asthma

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12
Q

Explain this ‘health promotion dilemma’: the ethics of interfering in people’s lives

A
  • potential negative psychological impact of health promotion messages
  • state intervention into individuals’ lives may be seen as too great
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13
Q

Explain this ‘health promotion dilemma’: victim blaming

A

Focusing on individual behavioural change plays down the impact of wider socioeconomic and environmental determinants of health

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14
Q

Explain this ‘health promotion dilemma’: ‘fallacy of empowerment’

A

Giving people information does not give them power, and unhealthy lifestyles are not due to ignorance but due to adverse circumstances

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15
Q

Explain this ‘health promotion dilemma’: reinforcing of negative stereotypes

A

Health promotion messages have the potential to reinforce negative stereotypes associated with a condition or group, eg leaflets aimed at HIV prevention in drug users suggest that they are to blame

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16
Q

Explain this ‘health promotion dilemma’: unequal distribution of responsibility

A

Implementing healthy behaviours in the family is often left to women

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17
Q

What is the ‘prevention paradox’?

A

The idea that interventions that make a difference at population level might not have that much effect on the individual. This has a link with lay beliefs, as people may not see themselves as a ‘candidate’ for disease and therefore ignore the health warnings, and may also be aware of anomalies and randomness of disease

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18
Q

Define ‘evaluation’

A

The rigorous and systematic collection of data to assess the effectiveness of a program in achieving predetermined objectives

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19
Q

Why must health programmes be evaluated?

A
  • need for evidence based interventions
  • accountability
  • ethical obligation
  • programme management and development
20
Q

What is process evaluation?

A

Focuses on assessing the process of programme implementation, and employs a wide range of mainly qualitative methods. AKA formative/illuminative evaluation

21
Q

What is impact evaluation?

A

This assesses the immediate effects of an intervention. It is the more popular choice, as it is the easiest to do

22
Q

What is outcome evaluation?

A

This measures more long-term consequences, eg improvement in patients’ lives. The timing of the evaluation can influence outcome, as some interventions may take a long time or wear off quickly

23
Q

What difficulties are there in demonstrating an attributable effect?

A
  • design of intervention
  • possible time lag to effect
  • many potential intervening or concurrent confounding factors
  • high cost of evaluation research (studies are likely to be large scale and long term)
24
Q

What are the three ways in which a health professional may discover an illness in a patient?

A
  • spontaneous presentation (patient presents with symptoms at GP/A&E/etc)
  • opportunistic case finding (health professional takes opportunity to check for other potential conditions when person presents with symptoms related to a disease/problem)
  • screening
25
Q

Define ‘diagnosis’

A

The definitive identification of a suspected disease or defect by application of tests, examinations or other procedures (which may be extensive) to label people as either having or not having a disease

26
Q

What is screening?

A

A systematic attempt to detect an unrecognised condition via tests, examinations or other procedures which may be applied rapidly and cheaply to distinguish apparently well persons who probably have a disease from those who probably do not

27
Q

What is the purpose of screening?

A

To give a better outcome compared with finding something in the usual way, as treatment cannot wait until there are symptoms

28
Q

What are the areas of criteria for whether there will be a national screening programme or not?

A

1) condition
2) test
3) intervention
4) screening programme
5) implementation

29
Q

What are the requirements of a particular condition for it to be screened for nationally?

A
  • must be an important health problem in terms of frequency/severity with epidemiology, incidence, prevalence and natural history understood
  • cost-effective primary prevention should have been implemented
30
Q

What is a false positive?

A

This is when a test refers well people for further investigation

31
Q

What are the impacts of a false positive?

A
  • puts them through stress, anxiety and inconvenience of invasive diagnostic testing
  • direct and opportunity costs
  • may lead to lower uptake of screening in future
32
Q

What is a false negative?

A

When people who have an early form of a disease are not referred

33
Q

What are the impacts of a false negative?

A
  • inappropriate reassurance may delay presentation with symptoms
  • they will not be offered diagnostic testing which they needed
34
Q

What are the general features of test validity?

A
  • sensitivity (detection rate)
  • specificity
  • positive predictive value
  • negative predictive value
35
Q

What is the detection rate?

A

The proportion of the people with the disease who test positive. This measures the sensitivity of the test.

36
Q

How is sensitivity of a test calculated?

A

Divide the number of true positives by (true positives + false negatives) - basically divide amount of people who test positive by all the people who have the disease

37
Q

What is the ‘specificity’ of the test?

A

The proportion of the people without the disease who test negative (correctly)

38
Q

How is specificity calculated?

A

Divide true negatives by (false positives + true negatives) - basically divide people who don’t have it and test negative by all the people who don’t have it

39
Q

What is a positive predictive value?

A

The probability that someone who tests positive for a disease actually has it - strongly influenced by prevalence of the disease

40
Q

How is positive predictive value calculated?

A

True positives are divided by (true positives + false positives) - basically divide people who really have it and test positive by all the people who test positive

41
Q

What is the negative predictive value?

A

The proportion of people who test negative who do not have the disease

42
Q

How is negative predictive value calculated?

A

True negatives are divided by (false negatives + true negatives) - basically divide everyone who tests negative and doesn’t have it by everyone who tests negative

43
Q

What attributes must a screening programme have in order to be used nationally?

A
  • proven effectiveness in reducing mortality/morbidity
  • evidence that it is clinically, socially and ethically acceptable to health professionals and public
  • benefit gained from individuals must outweigh harms
  • opportunity cost must be economically balanced
44
Q

What is lead time bias?

A

The idea that early diagnosis of a condition falsely appears to prolong survival when it does not. Patients live the same amount of time, but longer knowing they have the disease

45
Q

What is length time bias?

A

The idea that screening programmes are better at picking up slow growing, unthreatening cases than aggressive, fast-growing ones, creating the illusion that screening helped loads when really it only picks up the easy cases

46
Q

What is selection bias?

A

Studies of screening are often skewed by ‘healthy volunteer’ effect - those who have regular screening are also likely to do other protective activities

47
Q

Give some sociological critiques of screening

A
  • victim blaming/individualising pathology
  • individuals/populations are increasingly subject to surveillance
  • moral obligation
  • feminist critiques

CJ: UoL Medicine Semester Two (ESA2) (87 decks)

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