Case 2- health behaviours and epidemeology

Question 1

Patient self care

Answer 1

The actions that an individual tales for themselves, on behalf of and with others to develop, protect, maintain and improve their health, wellbeing and wellness. Such as exercise, brushing your teeth and over the counter medication

Question 2

Disease

Answer 2

An organic pathology or abnormality. A disease is a result of a causative agent (pathogen) on a susceptible organism, and its biological consequences. Can often be diagnosed due to arbitrary lines in the sand, for example, a certain haemoglobin percentage.

Question 3

Illness

Answer 3

A subjective experience of, and meaning attributed to, ill health by the patient and those around them. May or may not have a biological basis.

Question 4

Sickness

Answer 4

The social experience of ill health. What happens when the illness is acknowledged outwardly. It is linked to stigma.

Question 5

Views on health

Answer 5

Culturally and socially driven. You may think something is normal because its prevalent in your culture. Gender can effect it as well as age, someone who is older may not be concerned about back pain. Can be associated with the medical, functional and idealist model of health

Question 6

Medical model of health

Answer 6

Health is the absence of disease, illness and injury. Very generic terms, what do they mean. It’s a negative definition.

Question 7

Functional (social) model of health

Answer 7

Health is the ability to function in normal social roles. What is a normal social role? may vary between patients

Question 8

Idealist model of health

Answer 8

Health is a state of complete physical, mental and social wellbeing and not merely the absence of a disease or infirmity. Unattainable for most. Links to bio-psycho social model.

Question 9

Iceberg of health

Answer 9

The ice above sea level is the amount of people who see the doctor, so not many. Whilst the ice under the water is the number of people who have symptoms and did something else about it, for example take paracetamol or ask a friend for advice. Most ill health is stuff doctors never see.

Question 10

Zola’s concepts- consulting behaviour

Answer 10

Most people have symptoms of some kind all the time. The frequency and/ or seriousness of the symptoms are not good predictors of attendance at the doctors. Most people make decisions to seek help that are rational, at least when framed in terms of the patients own beliefs and values.

Question 11

Health belief model

Answer 11

Assumes that people are largely rational in their thoughts and actions. And will take the best health supporting action if they:

1) Feel that it is possible to address a negative health issue.
2) Believe that taking the proposed action will be effective in addressing the issue.
3) Believe that they are able to take the proposed action.

Question 12

Why might someone not visit a doctor

Answer 12

Don’t think the treatment will be effective, think it will be painful. You dont want to confirm an illness. We have to know someone’s health beliefs to understand why they do certain actions. Health beliefs can override triggers to consult

Question 13

Zola’s triggers to consult

Answer 13

• Interpersonal crisis- you may not be doing well at work and the last thing you want to deal with is your migraines.
• Perceived interference with social or personal relations
• “Sanctioning”- pressure from others to consult
• Perceived interference with vocational or physical activity
• “Temporalizing of symptomatology”- if its not better by next week I’ll go to the doctor.

Question 14

Quantitative research

Answer 14

Uses objective measures to reach a conclusion, the data collected is numerical results. Simple statistics are used to analyse the data and there is often a large sample size

Question 15

Qualitative research

Answer 15

Aims to collect subjective, non-numerical data. Aims to capture the deeper meaning behind something through data collection methods such as face to face interview or direct observations. The data can not be analysed using simple statistics, instead more descriptive methods are used. Aims to capture ideas, perceptions and behaviours.

Question 16

When to use quantitative research

Answer 16

When collecting data

Question 17

When to use qualitative research

Answer 17

When exploring someone’s ideas or opinions

Question 18

How can data be misrepresented

Answer 18

• Fabrication/falsification of data= making up data (fabrication) or excluding data that doesn’t fit with the researchers conclusion.
• Improper analysis= could be using the wrong statistical test, e.g. assuming the data is normally distributed and using a test which is suited to normally distributed data
• Poorly drawn graphs= are the scales drawn correctly, does it start from 0 or a higher number which will make it seem like there is a bigger difference between the data points.
• Selective reporting= has the author said they have collected data on something and then not included it in the results. Only reporting data that supports the conclusion.
• Over interpretation of results= correlation does not always mean causation.

Question 19

Epidemeology

Answer 19

The study of how often diseases occur in different groups of people and why, useful in prevention

Question 20

Difference between observational and interventional studies

Answer 20

Observational studies are ones we are looking at, describing, or comparing what we find. We are not performing any interventions. Whereas in an interventional study we are performing a change. For example, new medication, prevention measure, surgical approach or method of investigation.

Question 21

Case report/series

Answer 21

A case report concerns only one case whilst a series involves multiple cases. Used to report unusual or new occurrences. They are relatively quick to do and are useful for busy clinicians who want to share information on a case/cases they have seen that they feel are important and will be of benefit to other clinicians. Might be reporting a new disease.

Question 22

Cross-sectional studies

Answer 22

Looks at the population at one point in time. Can be used to determine prevalence, don’t look backwards or forwards. Cheap and easy to do but are open to bias, can be used as a starting point for further research.

Question 23

Correlational studies

Answer 23

Look for a relationship (correlation) between two variables. Is there change in the characteristics of a population after exposure to a substance? They do not try and change any variable, simply aim to see if there is a relationship between them.

Question 24

Cohort studies

Answer 24

Used to investigate the natural history of a condition. A group of participants is selected, and their exposure status is recorded i.e. do they smoke. They are followed up over time to observe for the development of the condition they are interested in. They demonstrate association but not causation. They are normally prospective (look forward in time) but can be retrospective (look backwards in time).

Question 25

Case-controlled studies

Answer 25

Used to see if there is an association between an exposure and an outcome. A group of cases with the disease (outcome) are identified. They are then matched with a group of controls who do not currently have the disease. The two groups are matched as much as possible for demographics, i.e. age, area of residence and socio-economic factors. The past exposure to what they are researching is determines (i.e. smoking). We can then work out if there is a statistically significant association between the exposure and disease. Can determine association but not causation.

Question 26

Randomised control trial

Answer 26

Used to determine whether a cause-effect relationship exists between an intervention and an outcome. Subjects are randomly assigned to either the intervention or control group. They are followed over time to see if there is a difference in outcome between the two groups. The intervention could be new medication or a diet. This is the best way to determine causation. You implement the intervention

Question 27

Community trials

Answer 27

Used to determine the effect of an intervention on an entire community

Question 28

Quasi-experimental studies

Answer 28

An intervention is applied to a group but without randomisation

Question 29

Relationship between epidemiology and public health

Answer 29

Helps us determine how to improve the health of society. For example, epidemiology showed us the link between smoking and cancer, we can now put measures in place to help people quite smoking and stop others from starting. This will reduce the number of people with lung cancer and improve the health of society as a whole

Question 30

How epidemiology helps people understand diseases

Answer 30

We conduct epidemiological studies to determine how to prevent a disease or alter the course of it. Describe the natural history of a disease, identify those at risk of a disease. Identify the causes of a disease and determine the prevalence of it.

Question 31

Talking about risk

Answer 31

If we can communicate to the patient the risk of them getting a disease or the reduction of risk of them dying if they follow a treatment plan, they will be more able to make informed descisions

Question 32

Absolute risk (AR)

Answer 32

The risk of a patient developing a disease over a period of time. For example, the absolute risk of developing cancer over a lifetime is 50%

Question 33

Relative risk (RR)

Answer 33

You compare two groups of people, for example, smokers and non-smokers. If the absolute risk of developing a disease as a non-smoker is 1 in 10 and the relative risk is increased by 50% if you smoke. Then the absolute risk of developing a disease as a smoker is 15%. Relative risk is therefore is the likelihood of you getting a disease following an intervention compared to the group that don’t follow the intervention.

Question 34

Odds ratio (OR)

Answer 34

Measures the association between exposure and outcome. The odds that an outcome will occur if an exposure is present, compared to the odds of the outcome occurring in the absence of exposure.

Question 35

Attributable risk (AR)

Answer 35

A measure of the proportion of the disease occurring that can be linked to a certain exposure.

Question 36

Types of doctor-patient relationships

Answer 36

Paternalistic, mutualistic, consumerist, default

Question 37

Paternalistic doctor-patient relationship

Answer 37

Involves high physician control and low patient control. The doctor decides what is in the patients best interest. Used in emergency care. Some patients find this relationship comforting as they don’t have the burden of decision making, especially if they are in considerable pain

Question 38

Mutualistic doctor-patient relationship

Answer 38

The active involvement of patients as equal partners in a consultation. Used in medical consultants and primary care settings. Exchange ideas to produce a joint belief system.

Question 39

Consumerist doctor-patient relationship

Answer 39

Patient takes an active role and the doctor is more passive. They give the patient what they want, i.e. a sick note or referral. Occurs in private consultations as the patient has greater power because they are paying, and the doctor wants to keep their customer. Plastic surgery, childbirth end of life care. Doctor has little input only there to provide a service.

Question 40

Default doctor-patient relationship

Answer 40

A consultation which lacks sufficient direction as the patient is still passive even though the doctor has reduced some of his power. Occurs when the patient is timid.

Question 41

Why should you include patients in descision making

Answer 41

1) There will be higher rates of adherence and greater improvement in symptoms and physiological function.
2) Patients are less likely to complain, reduces litigation.
3) Improves patients well being, they get more motivated about their treatment plan.
4) Both the patient and doctor will understand what is important to the other person.
5) The patient fells supported and empowered.
6) The treatment plan is tailored to the individual patient.