Public Health Flashcards

(76 cards)

1
Q

What are the 3 domains of public health?

A

Health Improvement, health protection, improving services

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2
Q

What is the inverse care law?

A

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

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3
Q

What is horizontal equity?

A

Equal treatment for equal need - e.g. all people with pneumonia deserve equal treatment

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4
Q

What is vertical equity?

A

Unequal treatment for unequal need - e.g. individuals with pneumonia deserve different treatment from those with a common cold

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5
Q

What are the 9 parts of the Bradford Hill Criteria for causation?

A

Dose-response, reversibility, biological plausibility, consistency, strength, temporality, coherence, analogy, specificity

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6
Q

What is bias?

A

Systematic differences between comparison groups which may misrepresent the association being investigated

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7
Q

What is a confounding factor?

A

Situation where a factor is associated with the exposure of interest and independently influences outcome

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8
Q

What is chance?

A

Possibility that there is a random error

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9
Q

What is selection bias?

A

Systematic error in selection of study participants or allocation of participants to different study groups

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10
Q

What is information bias?

A

Systematic error in the measurement or classification of exposure or outcome e.g. observer, recall bias, instrument

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11
Q

What is lead time bias?

A

Early identification doesn’t alter outcomes but appears to increase survival (patients have disease for longer)

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12
Q

What is length time bias?

A

A disease that progresses more slowly is more likely to be picked up by screening which makes it appear that screening prolongs life

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13
Q

What is a cross-sectional study?

A

Observation study collecting data from a population at a specific point in time (snap shot)

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14
Q

What are some advantages and disadvantages of cross-sectional?

A

+ large sample size, rapid, repeated studies can show change over time

  • sample too small for rare outcomes/diseases, reverse causality, disease length bias (those who recover quickly won’t be included)
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15
Q

What is a case control study?

A

Retrospective study looking at population with disease and control population - looking for causes of the disease

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16
Q

What are the advantages and disadvantages of a case control study?

A

+ good for rare outcomes/diseases, rapid

  • prone to selection bias and information bias, resource consuming trying to find well matched controls
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17
Q

What is a cohort study?

A

Prospective study looking at separate cohorts with different treatments/exposures applied and wait to see if disease occurs

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18
Q

What are the advantages and disadvantages of a cohort?

A

+ can establish disease risk factors (no chance for reverse causality as disease hasn’t occurred yet), can follow rare exposures, data on confounders can be collected prospectively

  • difficult to assess rare disease (may not develop), loss to follow up, large samples size required
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19
Q

What are the advantages and disadvantages of a RCT?

A

+ two groups can be compared accurately, risk of bias and confounding minimised by it being prospective and randomised

  • Ethical issues, drop outs, expensive and time consuming
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20
Q

What is an ecological study?

A

Population based data rather than individual data - compares two areas/two years

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21
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 health and reduce inequalities

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22
Q

What is a felt need?

A

Individual perceptions of variation from normal health e.g. cannot walk as far

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23
Q

What is an expressed need?

A

Individual seeks help to overcome variation in normal health e.g. seeks help from doctor

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24
Q

What is a normative need?

A

Professional defines intervention appropriate for the expressed need e.g. go to cardiopulmonary rehab

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25
What is a comparative need?
Comparison between severity, range of intervention and cost e.g. patient improves and then service is oversubscribed, there are worse patient than them so in comparison they are no longer a priority
26
What are the 4 stages of the planning cycle?
Needs assessment, planning, implementation, evaluation
27
What are the problems with an epidemiology approach to health needs assessment?
Does not consider felt needs of people it is catering for, reinforces purely biomedical approach, requires existing data to compare off to be of high quality
28
What are the problems with a comparative approach to health needs assessment?
Difficulty in finding comparable groups, may be comparing 2 poor quality services, requires existing data to be of high quality
29
What are the problems with a corporate approach to a health needs assessment?
May be difficulty to distinguish need from demand, certain groups may have vested interests or be influenced by political agendas, dominant personality may have undue influences
30
What is the Donabedian approach to evaluation?
Death, disease, disability, discomfort, dissatisfaction
31
What are the Maxwell's dimensions?
Effectiveness, efficiency, equity, acceptability, accessibility, appropriateness
32
What is the Wright's matrix?
Brings together Maxwell's dimensions and Donabedian approach
33
What is incidence?
Number of new cases in time period / size of population
34
What is prevalence?
The number of existing cases in a population at a specific point in time
35
What is relative risk?
Compares disease in exposed versus the unexposed (a/a+b) / (c/c+d)
36
What is the attributable risk/absolute risk reduction?
The difference in the disease rates in exposed and unexposed individuals (a/a+b) - (c/c+d)
37
What is the number needed to treat?
The number of patients who need a specific treatment to prevent 1 bad outcome NNT = 1/attributable risk
38
What is screening?
A process which sorts out apparently well people who probably have a disease from those who do not
39
What is primary prevention?
Preventing a disease from occurring in the first place
40
What is secondary prevention?
Detection of early disease in order to alter the course of the disease and maximise the chances of a complete recovery
41
What is tertiary prevention?
Trying to slow down the progression of disease and stop complications
42
What is sensitivity?
The proportion of people with the disease who are correctly identified by the screening test a/a+c
43
What is specificity?
The proportion of people without the disease who are correctly excluded by the screening test d/b+d
44
What is the PPV?
The proportion of people with a positive test result who actually have the disease a/a+b
45
What is the NPV?
The proportion of people with a negative test result who do not have the disease d/c+d
46
What are the parts of the Wilson and Junger criteria?
Condition - serious health problem, causes should be well understood, should be a detectable early stage Treatment - should be an accepted treatment for the disease, facilities for diagnosis and treatment should be available, cannot be an unmanageable extra clinical workload Test - suitable test should be devised for the early stage, test should be acceptable for patients, intervals for repeating test should be determined Benefits - should be an agreed policy on whom to treat, cost should be balanced against benefits
47
What is health behaviour?
Behaviour aimed at preventing disease e.g. going for a run
48
What is illness behaviour?
Behaviour aimed at seeking remedy e.g. going to GP for a symptom
49
What is sick role behaviour?
Behaviour aimed at getting well e.g. taking antibiotics
50
What is an example of individual level health intervention?
Reducing level of alcohol consumption
51
What is an example of a community level health intervention?
Improved alcoholic referrals/support in A+E
52
What is a population level health intervention?
Nationally increased tax on alcohol sales
53
What is the health belief model?
Individuals will change their behaviour if: they believe they are susceptible, they believe in serious consequences, they believe taking action reduces susceptibility, benefits outweigh costs
54
What are the advantages and disadvantages of health belief model?
+ can be applied to wide variety of health behaviours, cues to action are unique component - other factors may influence outcome, doesn't consider emotion, doesn't differentiate between first time and repeated behaviours
55
What are the 5 stages of the transtheoretical model of change?
Pre-contemplation, contemplation, preparation, action, maintenance
56
What is a system error?
Inadequate built in safeguards, lack of surgical equipment due to failure to stock check
57
What is a fixation error?
Focus on one diagnosis only e.g. decide its meningitis when it SAH
58
What is a bravado error?
Working beyond competency e.g. deciding to treat complex patient alone without requesting senior opinion
59
What is a playing the odds error?
Deciding it is a common disease and then it turns out to be a rare one
60
What is a sloth based error?
Laziness leading to error
61
What is an error of inherited thinking?
When a working diagnosis is passed over and it is assumed to be correct
62
What are the components of the three bucket model?
Self, context, task (situations that lead to error)
63
What are the outcomes of errors?
Adverse events and near misses
64
What is a never event?
A serious largely preventable patient safety incident that should not occur if available preventative measures have been implemented
65
What are the 4 parts of PDSA model of quality improvement?
Plan, do, study, act
66
What is an error of omission?
A mistake that consists of not doing something you should have done
67
What is an error of comission?
Quality problems such as excessive doses of medications, giving wrong medication or contraindicated medications
68
What is negligence?
A breach of duty of care which results in damage 1. Is there a duty of care? 2. Was there a breach in that duty? 3. Did the patient come to any harm? 4. Did the breach cause the harm?
69
What is a duty of candour?
Duty of a doctor to be open, honest and transparent - disclose errors
70
What is ethnocentrisim?
Evaluate other groups according to the values and standards of one's own culture group especially with the conviction that ones own culture group is superior to that of others
71
What is unrealistic optimism?
Health damaging behaviour because people do not understand consequences e.g. not wearing suncream because do not get sunburnt
72
What is a transactional leader?
Promotes compliance with reward and punishment
73
What is a Laissez faire leader?
Delegates, hands off approach, allows team members to make decision for themselves
74
What is a transformational leader?
Inclusive leadership distributes throughout all levels of organisation
75
What is the prevention paradox?
A preventative measure that brings much benefit to the population but very little effect to the participating individual e.g. seatbelts
76
How do you calculate alcohol units?
Units = (strength x volume) / 1000