Phase 4 Public Health Flashcards
(98 cards)
1
Q
Utilitarian
A
Maximise benefit and consider all beings equal
2
Q
Deontology
A
Action is right or wrong
3
Q
Consequentialist
A
Consequences are right are wrong e.g. white lies
4
Q
Virtue
A
Character traits - mind, character, honesty
5
Q
Libertarianism
A
Maximise freedom, autonomy and choice
6
Q
Which allocation theory is the NHS founded on
A
egalitarian
7
Q
3 allocation theories and their definitions
A
Egalitarian - equal access, equity
Maximising
Libertarian - autonomy and responsibility
8
Q
rule of rescue
A
duty to save a life even if that money could prevent more deaths elsewhere
9
Q
public health
A
the science and art of preventing disease, prolonging life and promoting health through the organised efforts of society
10
Q
3 domains of public health and examples
A
health improvement - education, housing
health protection - ID, environmental hazards and emergency response
improving services - clinical governance, service planning
11
Q
Lalonde determinants of health
A
E - environment (physical, social, economic)
F - lifestyle
G - genes
H - health care
12
Q
6 measurements of equity
A
supply access utilisation outcomes health status allocation
13
Q
dimensions of equity
A
spatial - geographic
social - age, gender, class, socioeconomic, ethinicity
14
Q
levels of health interventions
A
individual
community
population
15
Q
levels of health preventions
A
high risk - cut off the curve
population - shift the curve
16
Q
prevention paradox
A
prevention measure bringing great benefit to the population offers little to each participating individual
17
Q
2 major types of screening
A
population based e.g. smear
opportunistic e.g. chlamydia
18
Q
10 Wilson and Jugner criteria
A
important problem history understood latent phase effective treatment policy on who to treat facilities acceptable test suitable test economic ongoing process
19
Q
first in S/S
A
disease
20
Q
first in NPV/PPV
A
test
21
Q
impact of prevalence on S/S/NPV/PPV
A
no impact on S/S
impact on NPV/PPV
22
Q
lead time bias
A
survival looks longer because it was noticed sooner
23
Q
length time bias
A
aggressive disease is missed
24
Q
3 descriptive studies
A
case reports
ecological studies
cross sectional
25
3 analytical studies
cohort
case control
cross sectional
26
retrospective study
case control - shows RF
27
why is prospective important
can show causation
28
study for rare exposures
cohort
29
study for rare diseases
case control
30
odds formula
with exposure/#without exposure
31
odds ratio formula
(# cases exposed/# cases unexposed)
-----------------------------------------
(#controls exposed/#controls unexposed)
32
when must an odds ratio be used
case control
33
when may an odds ratio be used
cross sectional
cohort
(where IV/DV is unclear)
34
how to state odds ratio
individuals with [DISEASE] are x5 more likely to be exposed to [EXPOSURE]
35
when is incidence rate useful
when Ps are followed up for varying lengths of time (denominator is person-time)
36
what does relative risk show
strength of association
37
reasons for association
```
BRACC
bias
chance
confounders
reverse
causal
```
38
bias
systematic deviation form the true estimation of the association
39
3 types of bias
selection
information - observer, P, instrument
publication
40
Bradford Hill criteria for causal link
```
strenght of assocaition
dose response
consistency
temporality
reversibility
biological plausibility
coherence
analogy
specificity
```
41
health needs assessment
a systematic method for reviewing the health issues facing a population, leading to agreed priorities and resource allocation that will improve health and reduce inequalities
42
4 parts of health needs assessment
needs assessment
planning
implementation
evaluation
43
define need
ability to benefit
44
health need vs healthcare need
health - wider social and environmental determinants of health e.g. housing and education
healthcare - ability to benefit from healthcare e.g. health education, diagnosis, rehab
45
an intervention must be directed at
a population and a condition
46
3 health needs assessment approaches
epidemiological
comparative
corporate
47
advantages and disadvantages of epidemiological approach
+: uses existing data, provides data, evaulate over time
-: variable data quality, data collected may not be data required, ignores felt needs
48
describe epidemiological approach
SMEAR
S - size of problem - incidence, prevelance
M - models of care
E - evidence base
A - available services - unmet and overmet need
R - recommendations
49
advantages and disadvantages of comparative approach
+: quick and cheap. shows relative performance
-:incomparable population, low quality data, doesn't show whats right
50
advantages and disadvantages of corporate approach
+: felt and expressed needs, range of views
-: difficult to distinguish need from demand, vested interests, politics, dominant voices
51
define evaluation
assessment of whether a service achieves its objectives with regard to relevance, effectiveness and impact
52
Framework for service evaluation
Structure
Process
Outcome
53
6 dimensions of quality
```
effective
efficient
equity
acceptable
accessible
appropriate
```
54
3 qualitative approaches of health outcome measures
observation
interview
focus group
55
health, illness and sick role behaviours
health - prevent disease
illness - seek remedy
sick role - getting well
56
unrealistic optimism components
HIPPy
H - hasn't happened yet
I - infrequent
P - preventable by personal action
P -personal experience lacking
57
health belief model components
4 beliefs - susceptible, serious consequences, taking action reduces risk, benefits outweigh costs
cues to action
perceived barrier (most important)
58
critique of health belief model
ignored impact of emotions on behaviour
doesn't differentiate first and repeat behaviours
no temporal element
59
critique of theory of planned behaviour
ignores impact of emotions
no temporal element
bridging the gap
60
stages of change
```
precontemplation
contemplation
preparation
action
maintenance
```
61
Theory of planned behaviour. 50% of intenders fail to change behaviour. Give 5 bridging methods.
```
perceived control
anticipated regret
preparatory actions divided into chunks
If-then plans (implementation intention)
relevence to self
```
62
aim of motivational interveiwing
resolve ambivalence
63
4 types of undernutrition
stunting (height for age)
wasting (weight for height)
underweight (weight for age)
insufficiency
64
3 early influences on eating behaviour
maternal diet
breastfeeding
parenting practices
65
4 tips for parents on healthy eating
responsive feeding
provide variety
avoid pressure to eat
don't usee food as a reward
66
3 main components of restraint theory
dieters rely on conscious control to regulate intake
dieters have greater hunger-satiety gap
what the hell effect if cognitive boundary is broken
67
3 eating behaviour models
Restraint theory
Externality
Goal conflict
68
6 services for newly presenting IVDU
```
BB virus screen
Immunisations
Smear and STI screen
Drug service signposting
General Health check
Needle exchange
```
69
5 domains of social exlcusion
```
material
civic activities
basic services
neighbourhood
social relationships
```
70
what is an asylum seeker and what rules must they live by
application for refugee status in progress
```
Not allowed to work
£35 a week, housing, 70% income support
Full NHS access
Full education and social care access if <18yo
NASS support package
```
71
NHS care for rejected asylum seekers
```
primary care
A&E
communicable diseases and STI
family planning
treatment of trauma problems
```
72
rights of ILR
all UK citizen rights
| family reunion
73
maslows hierarchy
so everyone loves stupid pyramids
```
self actualisation
esteem
love and belonging
safety
physiological
```
74
epigenetics
the expression of a gene is dependent on its environement
75
allostasis and allostatic loas
allostasis is stability through time and allostatic load is the physiolocial burden of acheiving this
76
how does major life change affect us
radical change of working model
77
percent of female injuries caused by domestic abuse
25%
78
domestic abuse tool and levels
DASH
standard - serious harm unlikely
medium - potential to cause serious harm is circumstances change
high - potential to cause serious harm imminently
79
2 referrals for high risk domestic abuse
MARAC - multi agency risk assessment conference
IDVA - independent domestic abuse advocate
80
Process after murder by domestic abuse
domestic homicide review
81
1,2,3 wound healing
```
1 = apposed edges e.g. sutures
2 = unopposed edges, allow granulation and epithelialisation
3 = open, close later
```
82
5 local factors influencing wound healing
```
site
infection
oedema
vascular insufficiency
previous RT
```
83
hydrogel
rehydrate dry wounds
84
alginate
highly exudative wounds
85
hydrocolloid
sloughy, moderately exudative wounds
86
non adherent
low exudate, delicate wounds
87
slips
attentional error causing observable action
e.g. pushing the patient buzzer instead of emergency alarm
88
lapse
internal event, memory, action based
e.g. forgetting to flush a cannula
89
mistake
action is carried out according to plan but the plan is wrong
90
two types of mistake and describe
rule based - wrong rule or bad rule, e.g. treating an MI as pneumonia
knowledge based - novel and cognitively effortful situation, e.g. suturing using random stitches because you don't know how to do it
91
3 types of violations
routine - cutting corners
necessary - no other option
optimising - personal gain
92
individual factors of error
IM SAFE
```
Illness
medication
stress
alcohol
fatigue
emotion
```
93
situation factors of error
SIT REP
```
S - situation misunderstood
I - inadequate checking
T - time pressures
R - regular teams missing (unfamiliar)
E - experience lacking
P - poor procedures e.g. staffing and training
```
94
ways to learn from error
incident reporting - identify error traps and culture
| root cause analysis
95
learning theories and describe
behaviourism - learning through reinforcement e.g. clinical skills, lectures
cognitivism - learning through processing e.g mindmaps, discussions, flipped lectures
constructivism - learning through safe experience e.g placement
96
features of effective small group session
clarify roles and purpose
active, specific and reflective
safe environment promotes discussion
safe questioning identify edge of knowledge
Problems: silent group, alpha student, tangents, lack of prep
97
leadership vs management
leader - influence and engage, create a vision and culture, work in the future
manager - specific technical skills and expertise, follow a vision and culture, work in the present
98
standard of proof for medical negligence
balance of probabilities (>50%), not beyond reasonable doubt
