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Public Health Flashcards

(102 cards)

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1
Q

what are asylum seekers entitled too

A

-Weekly allowance
-Housing
-Free NHS care

NOT allowed to work or any other benefits

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2
Q

what does it mean when an asylum claim has been apporved

A

-5 years leave to remain in the UK
-Right to work and claim benefits
-Access to mainstream housing
-Can apply for family reunion
-Can apply for travel document

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3
Q

What can be done after 5 years of refugee status ?

A

-Apply for indefinite leave to remain and after a year of ILR, can apply for british citizenship

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4
Q

what are the 3 core principles of the NHS

A

-Meets the needs of everyone
-Free at the point of delivery
-Based on clinical need, not ability to pay

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5
Q

Define the inverse care law

A

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

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6
Q

What is Maslows Hierachy of needs

A

Physiological : air, water, food
Safety : security of body and resources
Love/belonging : friendship, family, intimac
Esteem : confidence
Self-actualisation

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7
Q

what are 3 barriers to healthcare access for homeless people

A

-Difficulties with access to healthcare
-Lack of integration with other agencies
-Other priorities

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8
Q

Define comorbidity

A

More than one illness or disease occurring in one person at the same time

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9
Q

Define multi-morbidity

A

More than two illnesses or diseases occurring in the same person at the same time

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10
Q

Define polypharmacy

A

Concurrent use of multiple medications in an individual (e.g. 5)

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11
Q

what is apporopriate polypharmacy

A

-Medicines have been optimised and where the medicines are prescribed according to best evidence

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12
Q

what is problematic polypharmacy

A

Prescribing of multiple medications inappropriately or where the intended benefit is not realised

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13
Q

Give 4 categories of the determinants of health

A

Genes
Environment : physical, social and economic
Lifestyle
Health care

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14
Q

Define equity

A

what is fair and just

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15
Q

define equality

A

equal shares

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16
Q

what is horizontal equity

A

Equal treatment for equal need

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17
Q

what is vertical equity

A

Unequal treatment for unequal need
E.G Individuals with common cold vs pneumonia need unequal treatment

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18
Q

What are the dimensions of health equity

A

Spatial (ie. geographical)
Social : age, gender, socioeconomic class, ethnicity)

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19
Q

what are the 3 domains of public health practice

A

-Health improvement : inequalities, education, housing etc
-Health protection : control infectious diseases etc
-Health care

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20
Q

What are the 3 levels of intervention when improving public health

A

-Individual : immunisation (delivered to each child)
-Community : E.g. playground for local community
-Ecological (population) level : smoking ban in public places

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21
Q

what is the approach to improving health of a population or population subgroup

A

Needs assessment -> planning -> implementation -> evaluation

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22
Q

Define need, demand and supply

A

Need : ability to benefit from intervention
Demand : what people ask for
Supply : what is provided

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23
Q

define 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 health and reduce inequalities
-Done before designing an intervention

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24
Q

what 3 categories can a health needs assessment be carried out for

A

Population or sub-group
Condition
Intervention

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25
Explain the 4 different definitions of need from a sociological perspective
-Felt : individual perceptions of variation from normal health -Expressed : individual seeks help to overcome variation in normal health -Normative : professional defines intervention appropriate for the expressed need -Comparative : comparison between severity, range of interventions and cost
26
What are the 3 public health approaches to a health needs assessment
Epidemiological Comparative Corporate
27
what is the epidemiological approach to health needs assessment
-Informs health need based on : size of problem, services available, care of the patients and looking at evidence bases for effectiveness of services
28
Give 3 issues with the epidemiological approach to health needs assessment
- Doesn't consider felt needs - Required data may not be available - Variable quality of the data.
29
what is the comparative approach to health needs assessment
-Compares the services received by a population with the same service received by another : spatial, social (age, gender, class, ethnicity). - E.g. breast services in one city compared to another
30
Give 2 + and 2 - of the comparative approach to health needs assessment
- Relies data availability - Populations may be uncomparable
31
What is the corporate approach to health needs assessment
-Asks the local population what their heath needs are -Uses focus groups, interviews, public meetings
32
Give 1 + and 2 - with the corporate approach to health needs assessment
-Difficult to distinguish 'need' from 'demand' -Groups mat have vested interests
33
What is Donabedian's framework for a health service evaluation
Structure Process Outcome
34
What is the structure of a health service
what is there : buildings, staff, equipment etc
35
what is the process of a health service
- What is done : examples -> - No. of pts seen - The process pts go through - No. of operations performed
36
How can the outcome of a health service be classified ?
1. Mortality, morbidity, quality of life / PROMs, patient satisfaction 2. Five Ds : death, disease, disability, discomfort, dissatisfaction
37
what is the issue with using health outcomes to evaluation a service?
-Causal link between service and outcome is hard to establish -Long time lag between service provided and outcome -Large sample sizes are needed -Data may not be available -Issues with data quality
38
what is maxwell's dimensions of quality for assessing quality of health care in evaluation
3 A's =, 3 E's -Acceptability -Accessibility -Appropriateness -Effectiveness -Efficiency : is the output maximised for given input -Equity
39
what is the qualitative method for evaluating a health service
-Observation -Interviews -Focus groups -Reviews of documents
40
what are quantitive methods for evaluating a health service
-Routinely collected date -Review of records -Surveys -Other special studies
41
Define primary prevention
Preventing a disease from occurring by reducing exposure or risk factor levels
42
Define secondary prevention
-Detecting disease early in order to alter the course of disease OR -Prevention of disease from recurring
43
Define tertiary prevention
Minimising disability or other negative effects of disease and precent complications
44
what is the population approach to prevention
Preventative measure delivered on a population wide basis and seeks to shift the RF distribution curve
45
what is the high risk approach to prevention
Identify individuals above a chosen cut off and treat them
46
What is the prevention paradox
A preventative measure which brings much benefit to the population often offers little to each participating individual
47
Define screening
Process which sorts out apparently well people who probably have disease (or precursors or susceptibility to a disease) from those who probably do not.
48
Define sensitivity
-Probability of a person with the disease obtaining a + test
49
Define specificity
-Probability that a person without the disease will test negative
50
How is sensitivity calculated
True positive / true positive + false negative True positive over total no. of people with the disease who are screened
51
How is specificity calculated ?
True negative / True negative + false positive
52
Define positive predictive value
The proportion of people with a positive test result who actually have the disease
53
How is positive predictive value calculated ?
True positive / True positive + false positive
54
what is the negative predictive value
Proportion of people with a negative test result who do not have the disease
55
How is negative predictive value calculated
True negative / True negative + false negative
56
what is lead time bias ?
a patient can appear to have survived longer because the disease was diagnosed earlier, even if earlier detection made no difference to survival
57
what are the 3 categories of health behaviour
- Health behaviour : behaviour aimed to prevent disease (e.g healthy eating) - Illness behaviour : behaviour aimed to seek remedy (e.g. going to the doctor) - Sick role behaviour : any activity aimed at getting well (e.g. taking medications)
58
what is the health belief model of behaviour change
Individuals will change if they : -Believe that they are susceptible to the condition in question -Believe that it has serious consequences -Believe that taking action reduces susceptibility -Believe that the benefits of taking action outweigh the costs
59
What is a negative of the HMB of behaviour change
Doesn't consider emotion
60
what is the theory of planned behaviour as a behaviour change model
-Best predictor of behaviour is intention -Intention is determined by : - persons attitude to the behaviour - the social pressure and societal norms - perceived ability to perform the behaviour
61
Give one + and one - of the theory of planned behaviour
- No emotions considered - Doesn't consider how the 3 interact - Relies on self reported behaviour - Assumes the 3 can be measured
62
What is the trans-theoretical model / stages of change model for behavioural change
- 5 stages of behaviour change -Pre contemplation, contemplation, preparation, action, maintence
63
Give 3 negatives to the trans-theoretical model
- Not all people move through every stage - Change might operate on continuum rather than discrete stages - Doesn't take into account values, habits, culture, social and economic factors
64
Give 8 determinants of health (PROGRESS)
P : place of residence R : race O : occupation G : gender R : religion E : education S : socio-economic S : social capital
65
What is the Wilson Jungner criteria for screening (INASEP)
I : important disease N : natural Hx of disease understood A : acceptable to population S : simple, safe precise test E : effective treatment P : policy agreed on who to treat
66
What is length-time bias ?
-Slowly progressing diseases more likely to be caught in screening, making it appear that screening prolongs life when it is only catching the slow growing types (e.g. cancer)
67
what are the 5 domains of exclusion in older people
1. Material resources 2. Civic activities 3. Basic services 4. Neighbourhood 5. Social relationships
68
what 3 principles guide resource allocation
-> Egalitarian : provide all care that is necessary and required for everyone -> Maximising : act is evaluated soley in terms of consequences -> Libertarian : each is responsible for their own health
69
Give 2 descriptive observational studies
-> Ecological study : prevalence of disease over time -> Case study : study individuals
70
give a descriptive and analytical observational study
Cross sectional : collects data from a population and a specific point in time
71
Give 2 analytical observational studies
-Cohort -Case control
72
what is a cohort study
-Longitudinal study in similar groups but with different RF/treatments -Follow them up, measure who gets disease
73
What is a case control study
Observational study looking at cause of a disease
74
what is an experimental study desgin
randomised control trial
75
How is odds calculated
odds = probability / 1 - probability
76
what is the bradford hill criteria for causality : STD R CRAP
S : strength of association T : temporality : does exposure precede the outcome in time D : dose response : the higher the dose of exposure reduces risk of disease R : reversibility C : consistency
77
Define incidence
- No. of new cases per unit time - Increased by increasing screening - Decreased by decreasing RF
78
define prevalence
- Number of people with a disease at a certain point in time - no. of cases of disease at a point in time / total no. of population at a certain point in time
79
define person time
time of entry to a study until (i) disease onset, (ii) loss to follow-up or (iii) end of study
80
How is incidence rate calculated
new cases in a time period / total person time at risk in time period
81
How is relative risk caclulated ?
- Ratio of risk of disease in the exposed to the risk in the unexposed -Incidence in exposed / incidence in unexposed R = Ratio
82
How is relative risk reduction calculated
1 - relative risk
83
How is attributable risk calculated (DISEASE = EXPOSURE TO DISEASE IS BAD = EXPOSURE IS HIGHER)
Incidence in exposed - incidence in unexposed
84
what is a standard unit of alcohol
10ml/8g
85
What is the unit of alcohol calculation
% alcohol by volume x amount of liquid in ml / 100
86
Define compliance
- Extent to which a patient's behaviour coincides with medical or health advice - Professionally focused, doctor knows best
87
Define adherence
- Acknowledges patients beliefs, regards health professional as expert conveying their knowledge which results in enhanced patient knowledge, satisfaction and adherence to medical regime
88
define concordance
Sees patients as equals in care They will take part in treatment decisions Consultation is a negotiation between equals
89
define utilitarianism
an act is evaluated solely in terms of its consequences, it acts to maximise good
90
define deontology
the theory that the features of an act themselves determines worthiness
91
define validity
how close to the truth something is
92
define reliability
how consistent the results are, if the experiment was repeated would the results be the same/similar
93
what is used in the transition from opiate use (heroin) to abstinence
methadone
94
what can be used as an alternative to methadone?
buprenophine (safer)
95
what is used to prevent heroin relapse?
Naltrexone : opioid antagonist (prevents the pleasure)
96
Relieves opioid withdrawal
Lofexidine
97
Opioid overdose treatment
Naloxone
98
How is attributable risk % calculated
Attributable risk / incidence in exposed X 100
99
How is absolute risk reduction calculated (DRUG = GOOD = EXPOSURE = GOOD)
incidence in unexposed - incidence in exposed
100
How is number needed to treat calculated
1/absolute risk reduction
101
What 2 medications are used in smoking cessation
-> reduce craVVing = Varenicline -> reduces PPleasure = Bupropion
102
What can be used for smoking cessation in pregnancy
Nicotine replacement -> patches, gum etc

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