God i hate public health Flashcards
(99 cards)
1
Q
- What is the definition of public health ?
A
- Public health is the science and art of preventing disease, prolonging life, and promoting health through organized efforts of society, organizations, public and private sectors, communities, and individuals.
2
Q
- What are the main objectives of public health ?
A
- Preventing disease, promoting health, prolonging life, and improving quality of life through the organized efforts of society.
3
Q
- What is primary prevention ?
A
- Preventing disease before it occurs
4
Q
- What is secondary prevention ?
A
- Detecting disease early to prevent progression
5
Q
- What is tertiary prevention ?
A
- Reducing the impact of an established disease
6
Q
- What are the 3 key determinants of health ?
A
- Social factors
- Physical factors
- Health services
7
Q
- What is epidemiology and how is it used in public health ?
A
- Epidemiology is the study of the distribution and determinants of health-related events in populations.
- It is used to identify risk factors, track health trends, inform public health interventions, and evaluate the effectiveness of health programs.
8
Q
- What are the various types of studies ?
A
- Experimental studies e.g. RCT
- Observational studies e.g. Cohort, Case control, cross sectional and prospective
- Systematic review and meta-analyses
- Qualitative research
9
Q
- What is a randomised controlled trial ?
A
- A study where participants are randomly assigned to either an experimental group receiving the treatment or a control group receiving a placebo or standard treatment.
10
Q
- What is a cohort study ?
A
- Differs from an RCT as it observes groups based on exposure status over time without randomisation
11
Q
- What is a case-control study ?
A
- Compares individuals with a disease (cases) to those without
(controls) to identify risk factors.
12
Q
- What is a cross-sectional study ?
A
- Collects data at a single point in time and is used for prevalence studies.
13
Q
- What is a systematic review ?
A
- Synthesizes existing studies on a topic, while a meta-analysis statistically combines data from multiple studies.
14
Q
- What types of bias are there ?
A
- Selection bias – when participant selection is non-random
- Information bias – arises from measurement errors
15
Q
- What does a relative risk of 2.0 mean ?
A
- There is x2 the likelihood of an outcome
16
Q
- What does an odds ratio of 1.5 mean ?
A
- 50% higher odds
17
Q
- What does a hazard ratio of 0.75 mean ?
A
- Indicates a 25% risk reduction
18
Q
- What are the 6 steps of a clinical audit ?
A
- Identify an area of concern
- Set standards
- Collect data
- Compare results with standards
- Implement changes
- Re-audit to measure improvement
19
Q
- What national organisations are involved in quality improvement ?
A
- Care quality commission
- National institute for health care and excellence
20
Q
- What are the 4 main principles of medical ethics ?
A
- Autonomy
- Beneficence
- Non-maleficence
- Justice
21
Q
- What is an advance decision ?
A
- A legally binding decision under UK law that allows a patient to refuse treatment in advance
22
Q
- What is lasting power of attorney ?
A
- Enables a designated individual to make healthcare decisions on behalf of the patient who lacks capacity
23
Q
- What is a case control study
A
- Looks at 2 sets of participants. One group has the condition you are interested in (the cases) and one group does not have it (the controls).
24
Q
- What are the advantages of a case-control study ?
A
- Good for rare outcomes e.g. cancer
- Quicker than cohort or intervention studies as outcome has already happened
- Can investigate multiple exposures
25
3. What are the disadvantages of a case-control study ?
- Difficulties finding controls to match cases
- Prone to selection bias
26
4. What is a cohort study ?
- Participants who do not have the outcome at baseline are followed over time to estimate the incidence of the outcome.
27
5. What are the advantages of a cohort study ?
- Can follow-up a group with a rare exposure e.g. natural disaster
- Good for common or multiple outcomes
- Less risk of selection and recall bias
28
6. What are the disadvantages of a cohort study ?
- Take a long time
- Loss to follow up
- Need a large sample size
29
7. Cross-Sectional Studies
- Observational studies that analyze data from a population at a single point in time
30
8. What are the advantages of a cross sectional study ?
- Relatively quick and cheap
- Provide data on prevalence at a single point in time
- Large sample size
- Good for surveillance and public health planning
31
9. What are the disadvantages of a cross sectional study ?
- Risk of reverse causality
- Cannot measure incidence
- Risk recall bias and non-response
32
10. What is a randomised control trial ?
- Gold standard trial
- A trial in which subjects are randomly assigned to one of two groups: one (the experimental group) receiving the intervention that is being tested, and the other (the comparison group or control) receiving an alternative (conventional) treatment (fig 1).
33
11. What are the advantages of a randomised control trial ?
- Low risk of bias and confounding
34
12. What are the disadvantages of a randomised control trial ?
- Time consuming and expensive
- Specific inclusion/exclusions criteria may mean the study is different from typical patients e.g. excludes elderly
35
13. How can an association between 2 things be explained ?
- Chance
- Bias
- Confounding
- Reverse causality
- A true causal association
36
14. Selection bias can result from
- Selection of study participants
- Allocation of participants to different study groups
37
15. How can the selection of study participants and there allocation to different study groups impact selection bias ?
- Non response e.g. are those who don’t respond likely to be from a specific group e.g. elderly
- Loss to follow up e.g. are those who drop out more likely to be better or worse ?
- Are those in the intervention group (or the cases) in some way from the controls other than the exposure in question
38
16. What types of information bias are there ?
- Measurement
- Observer
- Recall Reporting
39
17. What types of Bias are there ?
- Information
- Selection
- Publication
40
18. What is publication bias ?
- Not all trial results are published
- Papers with less positive results are less likely to be published
41
19. What is confounding ?
- A situation in which estimates between an exposure and outcome is distorted because of the association of the exposure with another factor (confounder) that is also independently associated with the outcome
- E.g. More shark attacks while there are more ice cream sales
42
20. Reverse causality
- Refers to the situation when an association between an exposure and an outcome could be due to the outcome causing the exposure rather than the exposure causing the outcome
43
21. What is the Bradford-Hill Criteria for Causality
- List of things required to say that one thing causes another
44
22. Features of the Bradford Hill Criteria
- Strength
- Consistency
- Dose-response
- Temporality
- Plausibility
- Reversibility
- Coherence
- Analogy
- Specificity
45
23. Explain Strength from the Bradford Hill Criteria
- Stronger the association between exposure and outcome
46
24. Explain Consistency from the Bradford Hill Criteria
- Same results observed from various studies in different geographical settings
47
26. Explain Temporality from the Bradford Hill Criteria
- Exposure occurs prior to outcome
48
27. Explain Plausibility from the Bradford Hill Criteria
- Reasonable biological mechanism
49
28. Explain Reversibility from the Bradford Hill Criteria
- Intervention to reduce/remove the exposure eliminated/reduces outcome
50
29. Explain Coherence from the Bradford Hill Criteria
- Logical consistency with other information
51
30. Explain Analogy from the Bradford Hill Criteria
- Similarity with other established cause-effect relationships
52
31. Explain Specificity from the Bradford Hill Criteria
- Relationship specific to outcome of interest
53
32. What is the purpose of screening ?
- To identify apparently well individuals who have or are risk of developing a particular disease so that you can have a real impact on the outcome
54
33. What does cervical screening detect ?
- Pre-cancerous dyskaryosis and treats it to prevent it developing into carcinoma of the cervix
55
34. Disadvantages of screening
- Exposure of well individuals to distressing or harmful diagnostic tests e.g. colonoscopies to those with positive faecal occult
- Detection and treatment of subclinical disease that would have never cause any problems e.g. non-aggressive prostate cancers in elderly men
- Prevention interventions that may cause harm to the individual or population
56
35. What is sensitivity
- The proportion of those with the disease who are correctly identified by the screening test
57
36. What is specificity ?
- The proportion of people without the disease who are correctly excluded by the screening test
58
37. Positive predictive value
- Proportion of people with a positive test result who actually have the disease
59
38. Negative predictive value
- Proportion of people who have a negative test result who do not have the disease
60
39. What is the NHS criteria for a condition to screen for
- Should be an important health condition e.g. 1/8 women will develop breast cancer
- Epidemiology and natural history must be adequately understood
- There should be detectable RF, disease markers, latent period and early symptomatic stage
61
40. What is the NHS criteria for a test used in screening ?
- Simple, safe and valid
- Distribution of test values in the target population should be known and a suitable cut-off level defined and agreed
- The test should be acceptable to the population
62
41. What is the NHS criteria for a screening program ?
- Screening should be ongoing
- The cost of screening should be economically balanced to healthcare spending as a whole
63
42. What is the NHS criteria for a treatment secondary to a screening program ?
- Effective intervention or treatment for patients with evidence that early treatment leads to better outcomes than late treatment
- Agreed evidence based policies determining who should be offered the appropriate treatment
- Clinical management of the condition and the patient outcomes should be optimized in all health care providers prior to participation in the programme
64
43. What is lead time bias
- When a screening identifies an outcome earlier than it otherwise would have been identified resulting in an apparent increase in survival even if screening has no effect on the outcome
65
44. What is length lead bias
- An overestimation of survival duration due to the relative excess of cases detected that are asymptomatically slowly progressing, while fast progressing cases are detected after giving symptoms
66
45. What are different approaches to a Health Needs Assessment
- Epidemiological
- Corporate
- Comparative
67
1. What is a health behaviour ?
- A behaviour aimed at reventing disease or illness e.g. eating healthily
68
2. What is an illness behaviour ?
- A behaviour aimed at seeking remedy e.g. going to the GP
69
3. What is a sickness behaviour ?
- An activity aimed at getting well e.g. taking prescribed medications or resting
70
4. What are the 5 models of behaviour change ?
- Theory of planned behaviour
- Nudge theory
- Stages of change model
- Health belief model
- Motivational interviewing
71
5. List the study designs that are retrospective ?
- Case report
- Case series
- Cross-sectional
- Case control
- Cohort
- Randomised control trial
72
6. Which study designs are prospective ?
- Cohort
- Randomised control trial
- Systematic review
73
7. What are the areas of health determinants ?
- Lifestyle
- Genetic
- Environmental
- Health
74
8. What impacts Lifestyle as a determinant of health ?
- Smoking status
- Wealth
- Employment
75
9. How does genetics impact determinants of health ?
- Age
- Gender
- Ethnicity
76
10. How does environment impact determinants of health ?
- Housing
- Socioeconomic status
- Access to education
77
11. How does healthcare impact determinants of health ?
- Economic factors
- Access
- Quality
78
12. Pneumonic for remembering influences on health inequalities ?
- PROGRESS
- Place of residence
- Race or ethnicity
- Occupation
- Gender
- Religion
- Education
- Socioeconomic status
- Social capital/resources
79
13. What is the inverse care law ?
- Availability of medical and social care tends to vary inversely with the need of the population served
80
14. What does equality mean ?
- Treating everyone the same and giving everyone equal shares e.g. giving £100 to the rich and £100 to the poor
81
15. What does equity mean ?
- About being fair and just e.g. giving everyone what they need to be successful e.g. giving £500 to the poor and nothing to the rich
82
16. What does Horizontal mean in the context of health inequalities ?
- Equal treatment for equal need e.g. all people with pneumonia deserve equal treatment
83
17. What are the types of error ?
- Sloth
- System error
- Lacking skill
- Fixation
- Bravado
- Playing the odds
- Poor team working
- Mis-triage
- Error of inherited thinking
84
18. What is an adverse event ?
- An event where a patient comes to harm
85
19. What is a Near Miss ?
- An event which has the potential to cause harm but fails to develop further: avoids harm
86
20. What is the bucket model of error ?
- Error evolves due to interaction between personal environmental and physical factors as well as organizational
- Systems approach is the recognition that we need to look at our systems rather than individual people
- 3 bucket model looks at situations leading to error
87
21. What are the 3 buckets of error ?
- Self – poor knowledge, fatigue, little experience and currently capacity to do task
- Context – equipment failure, physical environment, inadequate handover, team, support leadership
- Task – task complexity, novel task, overlapping tasks, multitasking
88
22. What are Never Events ?
- A serious preventable patient safety incident that should not occur if available preventable measures have been implemented
- E.g. Wrong chemo route, wrong surgical site or escape of sectioned patient
- Results in reputation loss, care quality commission investigation and financial penalty
89
23. What are the 3 types of Public Health Interventions ?
- Primary – preventing the disease
- Secondary – catching a disease in its early/preclinical stage e.g. cervical screening
- Tertiary – preventing complications of disease e.g. diabetic foot care
90
24. What are the 2 general approaches to public health interventions ?
- Population = preventative measures e.g. legislation of dietary salt reduction
- High risk = identifying individuals above a chosen cut off and treating e.g. screening for HTN
91
25. What is the prevention paradox ?
- Preventative measures which bring much benefit to the population often offers little to each individual
- E.g. screening a large number of people only helps a small number
92
26. What is a false positive ?
- Disease is identified by a screen in a person who has not disease
93
27. What is a true positive ?
- Disease identified correctly by a test or screen in someone who has the disease
94
28. What is a false negative ?
- When a test or screen fails to identify someone with disease
95
29. What is a true negative ?
- When a disease is not present and a test or screen identifies it correctly
96
30. What is sensitivity ?
- The proportion of people with the disease who are correctly identified by screening test
97
31. What is specificity ?
- The proportion of people without the disease who are correctly excluded by the screening test
98
32. What is the positive predictive valve ?
- The proportion of people with a positive test result who have the disease
99
33. What is the negative predictive valve ?
- Proportion of people with a negative test result who don’t have the disease
