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POPLHLTH 111 > Module 2 > Flashcards

Module 2 Flashcards

Don't fail Midsems

1
Q

Bradford-Hill’s Criteria

A

Temporality, strength of association, consistency, biological gradient, biological plausibility, reversibility, specificity

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2
Q

Define: Population Health

A

Concerned with the health and wellbeing of a group of individuals. Pre-emptively prevents dis-ease by the use of statistics.

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3
Q

Define: Individual Health

A

Deals with health of individual. Curative.

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4
Q

Temporality

A

Cause must occur before dis-ease onset. Prevents reverse causality from being counted.

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5
Q

Strength of Association

A

If the EGO is significantly higher than the CGO (ie: large RR), it’s more likely that the exposure leads to dis-ease.
Smaller RRs are equally likely to be due to confounding factors or chance alone.

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6
Q

Consistency

A

The same test done on different population samples will give similar outcomes.
However, this isn’t reliable since people are different and will respond differently to exposure.

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7
Q

Biological gradient

A

In theory, if the magnitude of the exposure increases, then the magnitude of the effect will also increase.
However, not all exposures will vary linearly with effect.

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8
Q

Biological Plausibility

A

Whether the cause-effect relationship is viable given our current understanding of biology. However, we have limited biological knowledge so if it doesn’t fit now it doesn’t mean that it’s wrong.

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9
Q

Specificity

A

(Seriously if it conforms to this it’s probably wrong)
The idea that an exposure can lead to ONLY one dis-ease and a dis-ease can only have one cause.
Biological factors are interconnected and one effect is rarely independent from the others.

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10
Q

Reversibility

A

If exposure causes an effect then the reverse is also true.

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11
Q

Determinant

i) Proximal
ii) Distal

A

Any event,characteristic or other definable entity which brings about a change from a non-dis-eased to a dis-eased state.

i) Determinants under the individuals control that directly affect the health and wellbeing. Affects the wellbeing of each individual only.
ii) Determinants which affect individual health by acting on the proximal determinants. This has a wider effect on many individuals.

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12
Q

Inequality

A

Differences in healthcare experience due to inherent differences, or different amounts of healthcare given to different individuals.

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13
Q

Inequity

A

Inequalities brought about by injustices or distribution of services in a way that doesn’t reflect the needs of more disadvantaged individuals.
Distribution can be equal, but benefit from them will not necessarily be equal.

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14
Q

Constitutional factors

A

Determinants inherent to the individual such as age and sex-cannot be changed.

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15
Q

Individual Lifestyle factors

A

Choices made by the individual that directly affects personal well-being.

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16
Q

Social and Community Network

A

Living and working CONDITIONS which affect the formation of lifestyle habits, such as social norms.
Ability to develop and maintain connections in a community to better protect against dis-ease.

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17
Q

Living and Working Conditions

A

Agriculture and production of food, work conditions, education, availability of clean water, housing, unemployment.
Refers to the affluence of the surroundings. Unavailability of these factors can lead to limited abilities to make healthy choices.

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18
Q

General socioeconomic, cultural and environmental factors

A

Affects everyone in the population. Enables people in the population to improve lifestyle, or similarly prevent people from doing so.

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19
Q

Structure

A

Distal determinants which influence by limiting or enabling people from making choices they want to change their lifestyle.

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20
Q

Agency

A

The way that people choose to change their lifestyles.

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21
Q

Prerequisites of the Ottawa Charter

A

Peace, Social justice, shelter, education, food, income, sustainable resources.

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22
Q

Basic Strategies of the Ottawa Charter

A

Enable: Allows everyone the opportunity to take advantage of the healthcare infrastructure available to them, so all individuals are able to control their wellbeing.
Advocate: Making health an important consideration when designing policies, and calling for changes to the political, social and physical environment so it is more conducive to the betterment of health.
Mediate: Coordinate efforts between different sectors as well as parties with opposing interests to put the promotion and protection of public health first.

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23
Q

Action areas of the Ottawa Charter

A

Individual empowerment (development of personal skills)
Strengthen community action
Creating Supportive Environments
Build healthy public policies
Reorientation of healthcare resources to primary health care (treatment provided by a general practioner-healthcare professional that sees a patient first)

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24
Q

Individual Empowerment/Example

A

Enabling people to make correct lifestyle choices by making them aware of them and teaching them skills to do so.
Awareness campaigns

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25
Q

Building healthy public policies/Example

A

Policymakers must consider how their policies will affect public health.
Obstacles to health betterment in society must be identified and removes.
Taxes on unhealthy goods to discourage consumption

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26
Q

Creating Supportive Environments/Example

A

Incorporation of means to benefit health into daily life in a way that is logical and enjoyable.
Creation of environments free from risk factors and conducive to improving health.
Understanding how health policies can affect other sectors.
Water sanitation/ green spaces to encourage exercise.

27
Q

Strengthening Community Action/Example

A

Granting autonomy to communities to how they choose to pursue health-mana whakahaera.
Using existing human resources and connections in the community to help facilitate efforts towards improving health.
Community lead initiatives.

28
Q

Reorienting Healthcare resources to primary healthcare/ Examples

A

Healthcare should be targeted towards preventative measures (primary healthcare is more preventative rather than curative) to reduce occurrence of dis-ease.
Identification of needs of different cultures and ways to provide health advice while also respecting cultural limitations.
Healthcare structures sensitive to needs of specific cultures-Te Pae Mahutonga.

29
Q

Te Pae Mahutonga

A

Mauiora, Waiora, Toiora, Te Oranga

Nga Manukura, Te mana whakahaera

30
Q

Mauiora

A

The ability to access Maori culture-Te Ao Maori.
Respecting and understanding aspects of Maori culture and revolving healthcare around that.
Securing sense of Maori identity by allowing free access to symbols of Maori culture.

31
Q

Waiora

A

The ability to live in and experience an environment free from pollution.
Maori culture states that physical wellbeing is linked spiritually to the wellbeing of the land.

32
Q

Toiora

A

Advocating for a community that is protected against risk factors of dis-ease, such as binge drinking or drug use. Achieved by promotion of healthy norms, and ensuring that everyone has the same degree of choice when it comes to risk avoidance.

33
Q

Te Oranga

A

Encouraging Maori to participate in society, so they are able to acquire goods and resources to depend on, and a voice so they can control the decision regarding their wellbeing.
Improving Maori socioeconomic status reduces limitations of choice.
Improving Maori representation in the health sector.

34
Q

Nga Manukura

A

Leadership.
Involving community leader in the creation and maintenance of healthcare infrastructure.
Encouraging cooperation between different community groups to promote health.

35
Q

Te Mana Whakahaera

A

Autonomy
Allowing community groups to independently determine causes of poor health and strategies to improve.
Enabling communities to take control of the effort to improve their own wellbeing/

36
Q

What are population based prevention strategies

A

Lowering occurrence of dis-ease by reducing occurrence of determinants so the population has reduced exposure to risk factors.
Works with more distal determinants.
Preventative, trying to remove dis-ease causing determinants en-masse.

37
Q

Advantages and Disadvantages of Population-Based

A

ADV:
Radical-removes dis-ease at the determinant level.
Behaviourally appropriate- reconfigures social norms to be healthier.
Large potential benefit, prevents all instances that would occur in the future if the intervention was not implemented.
DIS:
Small benefit to individuals-prevention paradox. All must partake in the intervention for few at-risk individuals (and the overall population) to reap benefits.
Poor motivation. People don’t believe that they are at risk, and this kind of intervention does not show an immediate improvement.
Low benefit:risk ratio : All of the popn will be affected by any downsides, but only for a few people will the benefit outweigh the downside.

38
Q

What is the High Risk Strategy

A

Identification of individuals at high risk of dis-ease via screening and providing individual-specific intervention. Works with proximal determinants.
In a way, since the target population is already exposed to risk factors, dis-ease onset has already begun and the intervention is more curative to prevent further onset.

39
Q

Advantages and disadvantages of the High Risk Strategy

A

ADV
intervention designated for high risk individuals with specific needs in mind. Treatment is relevant to the specific condition.
More motivating as the patient has been identified as high risk (patient understands that they hecc’ed up)
Increase cost efficiency and benefit:risk ratio. Only affecting high risk individuals, so most of them will benefit and outweigh risks.
DIS
Short term effect. Does not address cause. Intervention must be continually provided as risk factors still present so more become high risk.
Screening is an expensive process.
Behaviourally inappropriate as it does not change the norm, but changes behaviour so it’s no longer ‘normal’.

40
Q

Dis-ease Prevention

A

Primary: Limits exposure of population to risk factor by acting on determinants to change high-risk lifestyles.
Secondary: Occurs after exposure to risk factor. Screening for dis-ease and curative measures to prevent further onset of dis-ease.
Tertiary: Step taken after clinical analysis shows dis-ease onset. Attempts to reduce more serious consequence of the dis-ease such as PTSD or death.

41
Q

Health Protection

A

Reduction of exposure to dis-ease causing determinants in the physical environment (level 4 of Dahlgren)
Assessing risks and sources of determinants
Keeping track of the presence of determinants
Communication of the presence of determinants
Regulations to ensure determinant-free environment.

42
Q

Define: Screening

A

Identification of risk factors of dis-ease by subjecting an entire population to a screening test

43
Q

Primary Screening

A

Screening the entire population for risk factors to reduce its occurrence.

44
Q

Secondary Screening

A

Screening a population/ group of at-risk individuals for early features of dis-ease onset so development of dis-ease onset can be avoided.

45
Q

Tertiary Screening

A

Screening a group of individuals diagnosed with a dis-ease to identify complications related to the dis-ease or its treatment. Used to determine if an individual requires tertiary treatment.

46
Q

Criteria for screening to be applied.

A

Suitable: dis-ease, test, treatment options, screening program.

47
Q

Criteria for dis-ease suitability

A

Common: Widespread, so identification has high benefit.
Severe: As severity increases, the disease can be less common. Debilitating diseases must be reduced as much as possible.
Easily detectable: Does not require large amounts of resource to determine if dis-ease is present, but if detected can save a lot of suffering. (See also, Easily Treatable)
Long preclinical period: More time to ‘catch’ dis-ease and apply treatment.

48
Q

Criteria for screening TEST suitability

A

Reliable (consistent results-low random error),safe, simple and affordable (necessary for widespread application), socially acceptable and ACCURATE

49
Q

Accuracy of screening tests

Sensitivity and Specificity

A

Sensitivity: Likelihood of a positive test in those with the dis-ease. n(true positive)/n(people with dis-ease)
Specificity: Likelihood of a negative test in those without the dis-ease.
n(true negative)/n(people without dis-ease)
The ability to detect ONLY those with dis-ease.

50
Q

Accuracy of screening tests II

PPV and NPV

A

Reflects accuracy of the screening test and prevalence of dis-ease.
Positive predictive value: The likelihood that an individual with a positive test result actually HAS dis-ease.
Negative predictive value: The likelihood that an individual with a negative test result was really WITHOUT dis-ease.
Low prevalence= small true positive value, larger false negative value due to CG skews value of PPV.

51
Q

Suitability of Treatment (3)

A

Evidence that the early treatment, brought about by early detection of dis-ease by the screening process, can prolong lifetime.
Established evidence based policies to ensure that all individuals requiring treatment will receive the appropriate treatment.
Treatment must be effective, behaviorally appropriate, and equitable (everyone requiring it must be able to benefit from it to the same extent).

52
Q

Suitability of Screening Program (6)

A

RCT evidence that screening for the dis-ease will lead to longer survival time.
Benefit of dis-ease outweighs harm
Agreed financial policy to support the screening and treatment program.
Cost effective
All steps of the screening and treatment program must be within the capabilities of the healthcare framework.
Need to reach all who will benefit from it.

53
Q

Lead time bias

A

The illusion that screening prolonged lifetime, as the dis-ease is detected earlier, so the patient lives longer with the knowledge of their dis-ease. Time of death has not changed.

54
Q

Length time bias

A

If a dis-ease has fast and slow progression variants, then screening is more likely to detect slow progression variants. This skews the mean value of survival time, because the ‘sample’ of dis-eases contain MORE slow progression variants.

55
Q

Criteria for Prioritisation: Descriptive Evidence

A

Defines the problem.

Dis-eases with increasing or constant prevalences should be prioritised.

56
Q

Criteria for Prioritisation: Explanatory Evidence

A

Identifying the risk and protective factors

What are the determinants and what’s its prevalence? Does it unfairly affect some groups more?

57
Q

Third Criterion for Prioritisation

A

Evaluative Evidence

58
Q

Attributable Risk

A

The additional occurrence of dis-ease that can be attributed to a risk factor.

59
Q

Population Attributable risk

A

The additional dis-ease occurrence in a population attributable to a risk factor.
PAR= PGO (positive outcome in both EG and CG)- CGO.

60
Q

Evaluation

A

Investigating how widespread interventions can be and how efficient it can be.
Does its opportunity and explicit cost outweigh the potential healthcare surplus?

61
Q

Considerations for Prioritisation

A

Acceptability: Is the intervention going to achieve an outcome that the community wants.
Is it equitable- ie: Do the individuals at highest risk get the most resources allocated.
Does it mediate the competing interests.

Community expectations: 
Does it respect the community's trust and confidence in the health system to meet their needs. 
Access to necessary care. 
Information about treatment options. 
Respect for cultural specifications.
62
Q

What is the Prevention Paradox

A

The idea that most of the absolute occurrence of dis-ease occurs in the low-risk groups just because that group is larger.
Neither population based (low individual benefit) nor high risk strategies (deals with fewer incidences) will be effective.

63
Q

The Public Health Framework

A

Defining the Disease
Identifying Risk and Protective Factors
Developing and Testing Interventions
Ensuring Widespread Adoption

POPLHLTH 111 (5 decks)

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