I+P Flashcards
(153 cards)
1
Q
What are the 8 steps of the intervention ladder?
A
- Do nothing.
- Provide information.
- Enable choice.
- Guide choice through changing default policy.
- Guide choice through incentives.
- Guide choice through disincentives.
- Restrict choice.
- Eliminate choice.
2
Q
When are intrusive public health efforts justified? (7).
A
When is it evidenced. Publicly supported. Proportionate. Pros > cons. Those impacted will benefit. There are no alternatives. It is specifically focused.
3
Q
Differentiate between birth rate and fertility rate.
A
Birth rate: births per whole population (M+W)
Fertility rate: births per women of childbearing age.
4
Q
Why has life expectancy increased in developed countries?
A
Decreased mortality rate due to increased sanitation.
5
Q
Differentiate between period and cohort life expectancy.
A
Period: using age-specific mortality rates for that time period throughout their life.
Cohort: using known/projected mortality rates as the years change (more appropriate).
6
Q
What do rapid, slow and a decrease in growth look like on a population pyramid?
A
Rapid: mohican
Slow: empire state building
Decrease: narrowing base
7
Q
In the US population pyramid what does the narrowing at 25-39 show? 5-24yrs?
A
25-39: low birth rate during great depression
5-24: baby boom after war
8
Q
What is the rate of natural increase?
A
Difference between the birth rate and the death rate.
9
Q
What are the four stages of classical demographic transition?
A
- high birth and death rate.
- decreased death rate (growth).
- decreased birth rate (slower growth).
- population stabilises.
10
Q
What is the normal sex ratio at birth?
A
106 males to 100 females
11
Q
Differentiate between a necessary and sufficient cause
A
Necessary: presence required for occurrence.
Sufficient: presence leads to effect (both exposures may induce same outcome).
12
Q
How much of the health variance can be explained by individuals?
A
25%
13
Q
What are the layers of Maslow’s hierarchy of need? (5).
A
Physiological. Safety. Love/belonging. Esteem. Self-actualisation.
14
Q
What are the four different types of need as explained by Bradshaw?
A
Normative - seat by norm
Comparative - compared to others
Felt - from people who have it
Expressed - need they say they have
15
Q
Which three factors are considered in a health needs assessment?
A
Need - research, culture, genes, lifestyle
Supply - public/ political pressure, inertia, momentum
Demand - media, medical/ social/ cultural/ educational influences
16
Q
What is a health needs assessment?
A
Systematic method for reviewing the health issues facing a population, leading to agreed priorities and resource allocation that will improve and reduce inequalities, including an assessment of effectiveness and priority setting.
17
Q
Pros and cons of anecdote and case series.
A
Pros: quick, easy, unobserved conditions, new potential risk factors
Cons: can’t test a hypothesis, observer bias, no causal inferences
18
Q
What can a cross sectional survery provide?
A
Prevalence.
19
Q
Pros and cons of cross-sectional surveys.
A
Pros: quick, good prevalence estimate
Cons: one point in time, no incidence, sampling frame bias
20
Q
Pros and cons of ecological studies.
A
Pros: inexpensive, less participation bias, routinely collected data, provides new hypotheses and risk factors
Cons: ecological fallacy (pop->ind?), assumes average risk and incidence applies to everyone, data collection varies
21
Q
Pros and cons of case control studies.
A
Pros: quick, good for rare occurrences
Cons: selection, participation and recall bias; finding control groups
22
Q
What is the best type of observational study?
A
A cohort study.
23
Q
Pros and cons of cohort studies.
A
Pros: good for rarities, multiple outcomes, reduces info/survivor bias, direct incidence measurement
Cons: bad for rarities, expensive, slow, loss to follow-up
24
Q
Pros and cons of a randomised controlled trial.
A
Pros: strongest causal evidence, selection and confounding bias removed, less observer bias
Cons: not real life, high cost, unethical and inappropriate
25
Define error:
The difference between an estimated/measured value and the true value.
26
Define bias:
Systematic, non-random deviation of results and inferences from the truth, or processes leading to such deviation.
27
What is diagnostic bias?
When diagnosis is made based upon the exposure.
28
Name three types of information bias:
Recall bias.
Interviewer bias.
Surrogate bias.
29
Differentiate between primary, secondary and tertiary prevention.
1. preventing onset of disease
2. halting progression once started
3. limiting disability and complication in established disease
30
Differentiate between a high risk and a population approach.
High risk: identify and treat the top end of the population.
| Population: shift the mean of the entire population to the left.
31
What is social capital?
Networks together with shared norms, understandings and values that facilitate co-operation within or among groups.
32
Define sensitivity.
The proportion of people with the disease who get a positive test result.
33
Define specificity.
The proportion of people without the disease who get a negative test result.
34
Define positive predictive value.
The probability that a person with a positive test result actually has the disease.
35
Define negative predictive value.
The probability that a person with a negative test result does not actually have the disease.
36
When is a test with high sensitivity desirable? (2).
Adverse consequences of a missed diagnosis for the individual or society.
Diagnosis is quickly confirmed by other tests (or before treatment is started
37
When is a test high specificity desirable?
Diagnosis is associated with anxiety/stigma. Further investigations are time-consuming, painful or expensive. Cases will be detected anyway later. Treatment is offered without further investigation.
38
What is lead time bias?
Early diagnosis falsely appears to prolong diagnosis.
39
What is length time bias?
Screening over-represents less aggressive disease.
40
What are the wilson and jungner criteria for screening programs? (9).
```
Condition should be important.
Acceptable treatment.
Facilities for diagnosis and treatment.
Latent stage.
Natural history understood.
A suitable test which is acceptable.
Agreed policy on whom to treat.
Cost-effective.
Case finding should be continuous.
```
41
Define health promotion.
The process of enabling people to increase control over, and to improve their health.
42
What are the core themes of the ottawa charter for health promotion? (4).
Strengthen community action.
Develop personal skills.
Create supportive environments.
Reorient health services.
43
What are the five approaches to health promotion?
```
Medical or preventative.
Behaviour change.
Educational.
Empowerment.
Social change.
```
44
Disadvantages of the medical approach to health promotion: (3)
Paternalistic approach led by experts.
Based on medical definition of health (absence of disease or infirmity).
Ignores social determinants of health.
45
Disadvantages of the behavioural approach to health promotion:
Success dependant on individual.
| Ignores social determinants of health.
46
Disadvantages of the educational approach to health promotion: (2)
Relies on individuals to make right choice.
| Little on the social determinants of health.
47
What is the empowerment approach to health promotion?
Enhancing the capacity of individuals/populations to identify and address their concerns.
48
What is the social change approach to health promotion?
Change the physical and social environment, leading to healthier choices. Needs public and political support. E.g. smoking band, school food standards.
49
Name 5 health promotion intervention planning models:
```
Precede proceed.
Strategic rational PM.
SMART.
CD Cynergy.
MATCH.
```
50
What are the precede evaluation takes in the precede proceed model? (4).
Social assessment.
Epidemiological assessment.
Educational and ecological assessment.
Administrative and policy assessment and intervention alignment.
51
What are the proceed asks in the precede proceed model? (4).
Implementation.
Process evaluation.
Impact evaluation.
Outcome evaluation.
52
Differentiate between marketing, social marketing and the social norms approach:
Marketing: aims to increase sales.
Social marketing: used to address lack of knowledge.
Social norms: address misperceptions of the norm.
53
What are the steps involved in the social norms approach? (4)
Understand the norm.
Understand what people believe is the norm.
Evidence of misperception.
Challenge misperception.
54
How do social norms work?
False social norm beliefs encourage the perceived behaviour.
55
What are the characteristics of the social norms approach? (3)
Doesn't use health terrorism.
A participatory process.
Not moralistic in tone.
56
Give some examples of the social norms approach being used.
Unitcheck - Leeds alcohol.
Pinterfields - 99% smoke free entrances.
Smoke free homes across yorkshire.
57
What are the challenges of the social norms approach? (2)
Differentiating pure social norms approach interventions from complex interventions.
Successful integration with more complex interventions.
58
Why is qualitative data collection used?
Gain an understanding of the target population's behaviours/ attitudes/ experiences - the why and how.
59
How is the data qualitative research produces different from quantitative research?
It is unique and non-generalisable.
60
What is a 'theme' in qualitative research?
Recurrent and distinctive features that characterise particular perception/experiences and are relevant to the research.
61
How are themes identified in qualitative research?
Immersing in the data. Coding transcripts until data saturation. Organising codes into meaningful groups. Generating themes.
62
When are qualitative methods useful?
Topic is concerned with interaction, is complex, non quantifiable or sensitive.
Objective is to understand how/why, to explore understudied areas.
63
What is commissioning?
Ensuring services provided meet the need of the population by assessing, prioritising, procuring and managing.
64
Differentiate between purchasing, contracting and procurement.
Purchasing: buying services.
Contracting: selecting provider, negotiating terms, management.
Procurement: identifying supplier, and stimulating market.
65
```
From 1991-7 commissioning was via GP fundholdings.
Size?
Budget?
Scope?
Clinical governance?
Status?
```
```
10,000.
Real and negotiated.
Elective care.
None.
Independant.
```
66
```
From 1994-7 commissioning was via Total Purchasing Pilot.
Size?
Budget?
Scope?
Clinical governance?
Status?
```
```
30,000.
Indicative and negotiated.
Selective hospital +community.
None.
Subcommittee of health authority.
```
67
```
From 2005 until 2013 commissioning was Practice-Based commissioning.
Size?
Budget?
Scope?
Clinical governance?
Status?
```
```
63,000.
Indicative, delegated + negotiated.
Selective hospital + community.
Sometimes.
Voluntary.
```
68
```
From 2013 on commissioning was via GPs.
Size?
Budget?
Scope?
Clinical governance?
Status?
```
```
250,000.
Real.
All hospital and community except NCB + maternity.
Yes.
Statutory organisation.
```
69
What are the stages of planning in the strategic commissioning cycle? (4)
Health needs assessment.
Reviewing current provision.
Identifying gaps + priorities.
Capacity planning.
70
What are the stages of procurement in the strategic commissioning cycle? (4)
Service design/redesign.
Defining contracts.
Procuring appropriate services.
Managing demand.
71
What are the stages of monitoring in the strategic commissioning cycle? (4)
Monitoring activity + quality.
Invoicing and payment.
User and LA views.
Feedback.
72
What is the main aim on NICE?
Provide advice to health and social care in a resource constrained system.
73
What guidance does NICE produce aimed at the NHS?
Technology appraisals (pharmaceuticals).
Guidance on devices.
Medical technology guidance - cost saving.
Interventional procedures: safety +efficacy.
Clinical guidlines.
74
What are clinical guidelines?
Guidelines on appropriate treatment and care for people with specific conditions.
Based on clinical + cost effectiveness.
75
What advice does NICE give regarding interventional procedures?
Wether they are safe enough + work well enough for use.
| Don't use, may use, may used with special arrangements.
76
What are quality standards?
Concise + measurable statements designed to drive quality improvement.
77
What does colloquial evidence include?
Values.
Practical considerations.
Interests of specific groups.
78
What are the 7 principles of NICE guidance making?
```
Comprehensive evidence base.
Expert input.
Patient and public involvement.
Independent advisory committees.
Consultation with all stakeholders.
Regular review.
Open and transparent process – meetings held in public.
```
79
Who are the citizens council and what is their role?
30 people who reflect social make up of population.
| Consider societal and ethical issues.
80
What does NICE consider an interventional procedure? (3).
Making hole to gain access to internal body.
Gaining access to body cavity without hole.
Using EM radiation.
81
What are the three types of economic evaluation?
Cost effective, utility, benefit.
82
How are health gains measured by:
Cost effectiveness?
Cost utility?
Cost benefit?
Single health indicator.
QALYs.
Monetary value.
83
What are patient access schemes?
Mechanisms to share cost of new drug between a company and the NHS.
84
What are the criteria for entry into the cancer drugs fund? (3).
Insufficient evidence for routine commissioning.
Plausible potential for satisfying criteria.
Company agrees to fund data collection for less tan 24 months, with a commercial access arrangement that makes it affordable.
85
When is departure from NICE guidance justified?
Full explanation is given to patient.
Patient gives informed consent.
Clear documentation with reasons.
Acting in good faith.
86
What are the two types of community action?
Community of geography.
| Community of interest.
87
What is a statutory organisation?
Directly funded out of tax + other revenues from central government.
Publicly accountable.
88
What does health protection include? (3).
Preventing + controlling infectious diseases.
Reducing adverse effects of chemical, micro + radio hazards.
Preparing for potential threats.
89
Why are certain infectious diseases remerging? (6).
```
Societal events.
Human behaviour.
Health care.
Environmental change.
Public health infrastructure.
Microbiological adaptation.
```
90
How is scabies transmitted?
Direct contact.
91
What are the three organism factors controlling susceptibility?
Dose.
Virulence.
Length of exposure time.
92
When must medical professionals notify PHE? (3).
Someone has:
A notifiable disease.
An infection that does or could present significant harm to human health.
Is contaminated with could/does present ....
Has died with anything that could/does...
93
What is the chain of infection? (7)
Reservoir, portal of exit.
Agent, mode of transmission, portal of entry.
Host, person to person spread.
94
Define incubation period:
Time from acquiring infection to being symptomatic.
95
Define latent period:
Time from acquiring infection to being infectious.
96
Differentiate between an epidemic and a pandemic:
Epidemic: single community/population/region.
Pandemic: spreads around world, affecting 100,000s in many countries.
97
What are the three types of notifiable diseases? (4)
Very serious diseases.
Diseases that spread v easily.
Vaccine preventable diseases.
Controllable infectious diseases.
98
Differentiate between influenza B and C:
B: sporadic outbreaks, prone to mutation.
C: mild symptoms, stable.
99
Describe influenza A:
Infects pigs, cats, horses, birds, sea mammals.
No proof reading - mutation prone.
Antigenic drift and shift.
100
What is antigenic shift?
Gene swapping during co-infection by two different strains.
101
What does haemagglutinin control?
Subtypes?
Immunity efficacy?
Virus binding and cell entry.
15.
Protection to specific sub type.
102
What does neuraminidase control?
Subtypes?
Immunity efficacy?
Release of formed virus.
9.
Reduces amount of virus released from cells - less severe disease.
103
How many H and N subtypes are there?
15 H.
| 9 N.
104
Which influenza strains have caused pandemics and when?
1918: H1N1 (Spanish flu).
1957: H2N2 (Asian flu).
1968: H3N2 (Hon Kong Flu).
105
Describe Avian Flu:
```
H5N1.
Mild disease in birds.
60% human mortality.
First case: Hong Kong 1997.
Strict avian pathogen. Able to pass to humans, but not between them.
```
106
How is Avian flu controlled? (5).
```
Culling.
Biosecurity + quarantine.
Control poultry movement.
Vaccinate workers.
PPE.
```
107
How are early stages of an epidemic managed? (4).
Containment phase:
Identification of cases.
Treat cases.
Contact tracing.
Large scale prophylaxis.
108
How are the later stages of an epidemic managed?
Treat cases only.
109
Differentiate between global health and international health:
Global: determinants circumvent territorial boundaries, focus' on whole planet.
International: relates to practices, policies + systems of other countries. Stresses differences.
110
What is a demographic transition?
Urbanisation, industrialisation, rising incomes, more education, improved health technology -> decrease in infectious disease mortality -> decreased fertility.
111
What is the epidemiologic transition?
Population ages -> emergence of chronic + non-communicable diseases.
112
How are demographic, edpidemiologic, and health transitions related?
Demographic leads to epidemiologic.
| Both together are health transition.
113
What are the three objectives of health systems?
Improving population health.
Responding to expectations.
Providing financial protection against cost of ill-health.
114
What is the minimum spend per person by a health system to deliver reasonable + minimal services?
60 USD per person.
115
What are the five methods of funding health care systems?
```
Direct payment.
General taxation.
Social health insurance.
Voluntary/private heath insurance.
Donations/community insurance.
```
116
What are the eight millennium development goals?
```
End poverty + hunger.
Universal education.
Gender equality.
Child health.
Maternal health.
Combat HIV/AIDS.
Environmental sustainability.
Global partnership.
```
117
What are the five transformative shifts of the universal agenda?
Leave no one behind.
Sustainable development.
Transform economies for jobs + inclusive growth.
Build peace + effective, open and accountable institutions.
Forge a new global partnership.
118
What is confounding bias?
Relationship between two variables is confounded by a third variable.
119
What is the hierarchy of studies?
```
Anecdote
Cross-sectional study
Register/ecological studies
Case-controlstudy
Cohort
Randomised controlled trial
```
120
What is the counterfactual?
Hypothetical world, in which your hypothetical causation is removed. Would the disease still exist?
121
Why is intention to treat analysis used?
It most closely resembles what might be observed in real practise.
122
What are the key messages of the marmot review?
Lower social position=lower health.
| Productivity losses, reduced tax revenue, higher welfare payments, increased Rx cost.
123
What are the key inequalities mentioned in the marmot review?
```
Child development + education
Employment
Working conditions
Housing + neighbourhood conditions
Standard of living
Freedom to participate equally in benefits of society
```
124
How are health needs addressed on a population level?
Comparative needs assessment (define pop + analyse data)
Corporate " (agree priorities by involving others)
Epidemiological " (measure problem size + effect of current services)
125
What is the epidemiological triad?
Time, place, person
126
What is validity?
How closely it resembles the truth
127
What is reliability?
Ability to give consistent results
128
What is the preventative paradox?
Measures that bring large benefit to the community offer little to each participating individual.
129
What are the characteristics of effective health promotion? (6)
```
Planned
Informed by theory + evidence
Public + political awareness
Size, sophistication + duration
Resources available
Use varied methods
```
130
What is the theory of 'programming' as an epidemiological paradigm?
Stimulus/insult at critical period in foetal/early life has permanent effect on physiology/metabolism, predisposing individuals to chronic disease in later life.
131
What does the adult risk factor approach (as an epidemiological paradigm) fail to explain?
Geographical + social differences in chronic disease risk.
| Ignores broader determinants of health.
132
In the life course approach to epidemiology, differentiate between uncorrelated and correlated exposures.
Uncorrelated: exposure effect independent and irrespective of later exposures.
Correlated: accumulation of exposures related to each other. Chain of risk.
133
In the life course approach to epidemiology, differentiate between additive and trigger effects.
Both part of a chain of risk (each exposure leads to the next).
Additive: exposures increase risk in cumulative manner.
Trigger: only final exposure has marked effect.
134
What are the limitations of the life course approach to epidemiology?
Requires detailed cohort data covering the whole of the life course.
135
How does alcohol behaviour change over the population?
Frequency of drinking increases with age.
Heavy drinking % decreases with age.
Employed drink more than unemployed.
More smokers than non smokers are heavy drinkers.
136
How does smoking behaviour change over the population?
Unemployed smoke more than employed.
Deprivation level increase, making increase.
Increased above M62 corridor + in North East.
137
How is greater physical activity clustered with drinking and smoking on a population level.
Greater physical activity - greater smoking and drinking. (Not a typo).
138
How does clustering of risk vary across SEC?
Increased clustering in lower SEC's.
| Inequality in clustering increased in recent years.
139
Differentiate between co-morbidity and multi-morbidity.
Co: one or more additional disorders co-occuring with a primary disease/disorder.
Multi: two or more medical conditions existing simultaneously regardless of causal relationship.
140
Does two conditions being co-moribities tell you anything about their causal status?
No.
141
What is the theory of the obesogenic environment?
Urban sprawl and land use mix is associated with obesity status.
142
What are the ten King's fund commissioning priorities?
Active self support.
1o prevention.
2o prevention.
Managing ambulatory care sensitive conditions.
Improving physical + mental management.
Integrated health and social care teams.
Improving 1o management of end of life care.
Effective medicines management.
Managing elective activity-referral quality.
Managing emergency/urgent care.
143
How does King's fund suggest integrating health and social care teams?
```
Community based.
Wide range of professionals.
Focus on intermediate care.
Personalised programmes.
Named coordinator.
Shared clinical records.
```
144
How does King's fund propose to effective medicines management?
Medication reviews.
Pharmacist led.
IT decision support tools.
Improved data transportation.
145
What are the 4 overarching themes of the KIng's fund?
Systematic + proactive management of chronic disease.
Patient empowerment.
Population based approach to commissioning.
Integrated models of care.
146
What are the four bits to psychological well being?
Individual vitality.
Activities that are meaningful + engaging which make them feel competent + autonomous.
Stock of inner resources to help them cope.
Sense of relatedness to other people.
147
What are the three domains of psychological well being?
Personal
Social
Work
148
What is an 'asset' in the asset approach to public health?
Asset: Any factor/resource that enhances ability to maintain + sustain health/wellbeing.
149
What is the asset approach to public health?
```
Start with assets.
Identify opportunities + strengths.
Invest in people.
Emphasis on role of civil society.
Focus on communities.
Sees people as citizens.
Help people take control.
Answer = people.
```
150
What is the deficit approach to public health?
```
Focus on deficiencies.
Respond to problems.
Provides services.
Emphasises agencies.
Individual focused, people = clients.
People treated as passive.
Answer = programme implementation.
```
151
How will climate change impact upon global health?
```
Decreased air quality.
Lengthened pollen season.
Change in distribution + behaviour of vectors/rodents.
Hot working environments.
UV radiation.
Hot + cold waves.
Freak weather events increase.
```
152
How is climate change a 'regressive problem'?
Those who contributed least are being affected the most.
153
How can healthcare become more sustainable?
Prevention focus.
Patient partnership.
Leaner care pathways.
Low carbon Rx alternatives.
