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Public Health Flashcards

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1
Q

Three domains of public health

A

Health protection

Health Improvement

Improving services

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2
Q

Determinants of health

A

Genetic
Lifestyle
Environmental
Health care

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3
Q

Inverse care law

A

the availability of medical or social care tends to vary inversely with the need of the population served

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4
Q

Health needs assessment definition

A

A systematic approach for reviewing the health issues affecting a population which leads to agreed priorities and resource allocation that will improve health and decrease inequalities

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5
Q

Health needs assessment cycle

A

Needs assessment
Planning
Implementation
Evaluation

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6
Q

Health needs assessment types

A

Epidemiological
Comparative
Corporate

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7
Q

Types of need

A 
FENC
Felt
Expressed
Normative
Comparative
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8
Q

Maslow’s hierarchy of need

A

Physiological -> Safety -> Love/belonging -> Esteem -> Self-actualization

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9
Q

Resource allocation types

A

Egalitarian
Maximising
Libertarian

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10
Q

Wright’s matrix for assessing the quality of a service

A

Maxwell’s Dimensions and Donabedian’s approach

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11
Q

Maxwell dimensions

A

3As and 3Es
Access, appropriateness, Acceptability

Equity, Efficient, Effective

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12
Q

Donabedian’s approach

A

Structure, Process, Outcome

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13
Q

Health Psychology

A

Health behaviour, Illness behaviour, Sick role behaviours

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14
Q

Transtheoretical model

A

PC PAM

precontemplation
Contemplation
Preparation
Action
Maintenance
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15
Q

Transtheoretical advantages

A

Acknowledges individual stages of readiness
Accounts for relapse
Temporal element

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16
Q

Transtheoretical disadvantages

A

Some individuals skip stages
Change may be continuous, not discrete
Doesn’t consider values e.g cultural and social factors

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17
Q

Theory of planned behaviour

A

ASP
Attitudes, Subjective Norms, Perceived behaviour control

Lead to intention

P PAIR takes to Behaviour -

Preparatory actions
Perceived control
Anticipated regret
Implementation intentions
Relevance to self
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18
Q

Theory of planned behaviour advantages

A

Can be applied to wide variety of health behaviours
Useful for predicting intention
Takes into account importance of social pressures

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19
Q

Theory of planned behaviour Disadvantages

A

No temporal element, direction or causality
Doesn’t consider emotions
Assumes attitudes can be measured

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20
Q

Health belief model

A 
Perceived susceptibility
Perceived severity
Health motivation
Perceived benefits
Perceived barriers
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21
Q

Variables contributing to the HBM

A

Demographic variables

Psychological characteristics

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22
Q

HBM advantages

A

Can be applied to wide variety of health behaviours
Cues to action are unique component
Longest standing model (who cares?!)

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23
Q

HBM Disadvantages

A

Other factors may influence the outcome
Doesn’t consider emotions
Doesn’t differentiate between first time and repeated behaviours

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24
Q

Medical negligence process

A

Was there a duty of care?
Was there a breach in that duty?
Was the patient harmed?
Was the harm due to the breach in care?

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25
Medical negligence rules
Bolam Rule: Would a reasonable doctor do the same? Bolitho rule: Would that be reasonable?
26
Types of error
``` Sloth Fixation/loss of perspective Lack of skill System error Mistriage Ignorance Bravado/timidity Playing the odds Communication breakdown Poor team working ```
27
Swiss cheese model of human error causation steps
Latents failures: Organizational influences Unsafe supervision Preconditions for unsafe acts Active failures: Unsafe acts
28
Never event definition
a serious, largely preventable patient safety incident that should not occur if available, preventative measures have been implemented
29
Three bucket model of error
Self, Context, Task
30
Self bucket
Level of: | Knowledge, Skill, Expertise, Current capacity to do task
31
Context bucket
``` Equipment Physical environment Workspace Team/support Organisation and management ```
32
Task bucket
Errors Complexity Novel task Process
33
Screening
identifying apparently well individuals who have (or are at risk of having a particular disease)
34
Screening criteria
Wilson and Jungner Disease test outcome
35
Screening disease criteria
Important, Natural history known, Early treatment better than late
36
Screening test criteria
Acceptable to the population Facilities available Simple, safe, precise and validated
37
Screening outcomes criteria
Ongoing feasibility Treatment available Cost-benefit analysis
38
Cross-sectional study design
Snapshot data of those with and without disease to find associations at a single point in time
39
Cross-sectional study +ves
Quick and cheap | Few ethical issues
40
Cross-sectional study -ves
Prone to bias | No time reference
41
Case-control study design
Retrospective observational study which looks at a certain exposure and compares similar participants with and without the disease
42
Case-control study positives
Good for rare diseases | Inexpensive
43
Case-control study negatives
Can only show association (not causation) | Unreliable due to recall bias
44
Cohort study design
Longitudinal prospective study which takes a population of people recording their exposures and conditions they develop
45
Cohort study positives
Can show causation | Less chance of bias
46
Cohort study negatives
Large amount lost to follow up | Expensive
47
RCT Design
Similar participants randomly controlled to intervention or control groups to study the effect of the intervention Gold standard
48
RCT positives
Can infer causality | Less risk of bias/ confounders
49
RCT negatives
Time consuming and expensive | Ethical issues can interfere
50
Factors to assess causality
Bradford-Hill ``` Biological plausibility Temporal relationship Dose-response relationship Strength association Specificity Consistency Altered by experimentation Coherence with existing themes Consider reverse causality ```
51
Confounders definition
risk factors, other than those being studied, that influence the outcome
52
Bias types
Selection bias: discrepancy of who is involved Information bias: Measurement bias: different equipment Observer bias Recall bias: past events incorrectly remembered Reporting bias: responder doesn’t tell the truth Publication bias: some trials are more likely to be published than others
53
Bias definition
a systematic error that results in a deviation from the true effect of an exposure on an outcome
54
Epidemiological Health needs assessment description
Defines problem and size of problem Looks at current services Recommends improvements
55
Epidemiological Health needs assessment limitations
Data available may be poor May be inadequate evidence base Doesn’t consider felt need
56
Comparative Health needs assessment description
Compares services received by one population to another
57
Comparative Health needs assessment limitations
Data available may vary in quality May be hard to find comparable population Comparison may not be perfect
58
Corporate Health needs assessment description
Takes into account views of any groups that may have an interest eg patients, health professionals, media, politicians
59
Corporate Health needs assessment limitations
May be hard to distinguish need from demand Groups have vested interest – leads to bias Dominant individuals may have undue influence
60
Felt need description
Individual perceptions of deviations from normal health
61
Expressed need description
Seeking help to overcome variation in normal health
62
Normative need description
Professional defines intervention for expressed need
63
Comparative need description
Comparison between severity, range of interventions and cost
64
types of economic evaluation
BUME - Cost/Benefit analysis (Monetary units), Cost utility analysis (QALY)s, cost minimisation analysis (minimise cost for the same outcome), cost effectiveness analysis (natural units)
65
Units economic evaluation
QALYs, Natural units, Monetary
66
equity
fair and just distribution of costs and benefits
67
Opportunity cost
The benefits lost from not allocating resources to the next best option
68
Define efficiency
When resources are distributed in such way as to maximise benefit.

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