Flashcards in Public Health Deck (35)
Likelihood of a test to be positive in someone who actually has the disease.
TP/ TP + FN
The likelihood of a test to be negative in people who do not have the disease.
Positive predictive value
Of the test is positive how likely is it that the person has the disease
Negative predictive value
Of the people that test negative what percentage are truly negative
Possible reasons to criminalize drinking in preg
Coerce women to treatment
Punish those who break social norms
Act as deterrent for behavior that risks fetus.
Reasons why criminalization of drinking in preg is bad
Lack of evidence that coercion is effective.
Shouldn't be punished when behavior is routes in social causes.
Punishment may be discriminatory (eg father not sentenced)
Health professional drawn into criminal justice system = ethical contradiction.
Woman more likely to stay away from health services.
Taking woman to prison after giving birth isn't wise.
Health promotion principles that should be applied when arguing against criminalization of drinking in preg
Re-orientating health services
Policy intervention rather than individual victim blaming
Disease specific factors for screening test suitability
Cause serious morbidity or mortality
Is the natural history understood
Is presymptomatic stage easy to detect
Does early detection improve prognosis
Is there an effective treatment
Features of RCT that make it superior to other study designs
Participants randomly selected - prevents selection bias
Both control and intervention groups have same baseline characteristics including known and unknown risk factors (random selection = equal chance)
Assists with control of confounding.
Blinding of researchers and participants = minimize measurement bias
What extent has smoking legislation been effective in SA
Millions have stopped smoking
Drastic annual decrease in consumption
Number of students who have never smoked increased
Number of frequent smokers declined
Possible reasons why percentage deaths could be lower over time
Actual death rates decrease
Percentage could lower due to another cause increasing = competing cause of death
Data collection methods may have changed
The way the data was analyses may have changed
Public health strategies to decrease a lifestyle disease
Change certain policies
Health promotion campaigns (awareness, education)
Advise population on specific lifestyle changes
Difference between a CIT and a RCT
In RCT individuals are selected at random. In CIT groups, facilities or entire communities selected at random.
Design features of a CIT that minimize bias
Blinding of both participants and researchers
A prospective design shows temporality
Do all woman have access to safe a abortion services in SA
Most HCW refused to perform TOP.
Legislation alone cannot ensure implementation.
Legal TOP often inaccessible and seen as unacceptable.
Shortage of trained staff
Despite legislation only 15% or centers were open one year later.
TOP faces stiff opposition therefore hard to implement outside major urban centers.
Risk factors for FAS
Drinking weekly, binging, smoking, drug abuse, alcoholic partner, many family members who drink, FASD in the family, drinking from an early age, no reduction of drinking in preg, rural areas, employee on farm, low SES, low education status, small mothers (height and weight) history of stillborn children.
Policy level intervention strategies against alcohol
Improve enforcement of existing strategies (min age, drink driving, retail sales)
Increase restrictions on alcohol marketing
Counter marketing for alcohol
Encouraging community mobilization
Implementing restrictions on size of container
Restricting products with clear appeal to underage
Specific labeling on alcohol
Warning stickers on alcohol
Implementing a graduated licensing policy for novice drivers.
Describe current TOP legislation
The choice of termination of pregnancy act
Woman may terminate on request in first 12 weeks, can be provided by trained HCW (nurse, midwife)
After 12 weeks abortion must be provided by doctor
Between 12 and 20 weeks following circumstances
Adverse effect on woman's mental/physical health
Rape or incest
Fetus at risk of severe mental/physical abnormality
Beyond 20 weeks = very limited conditions
Rights of HCW objecting to performing TOP
May refuse to perform TOP. Obliged to inform woman about their right to TOP and refer her to another person or centre.
Must provide nursing care to that patient.
A HCW refusing to perform TOP must lodge in writing his/her refusal to do so.
A bias that occurs in observational studies when a third variable results in an apparent association between an exposure and outcome.
To be a confounder 1. Independent determinant of disease 2. Associated with exposure
Define a hazard
Environmental stressor that has capacity to do harm
The likelihood or possibility that a harmful event may take place
Public health response to meningococcal disease
Immediate telephone notification (written given later)
Rapid investigation of case
Identify close contacts
Identify other cases in institution
Potential disadvantages of a medical aid healthcare scheme
Patient not aware of costs
Dr no incentive to keep cost down
Imbalance between Dr and patient knowledge -> unnecessary procedures
Over servicing or 'moral hazard'
7 Bradford Hill criteria for causation
Strength of association
Dose response effect
Cessation of exposure
Factors (of the test itself) regarding suitability of test for screening
Sensitivity and specificity
Easy to do
Acceptable to patients
Health service requirements for screening test
Adequate facilities for screen and for follow up
Is treatment effective, safe and acceptable
What are costs/ benefit of screening vs not
Advantage of randomly selecting groups
Randomization prevents bias (no subjective choosing of group)
Assists with controlling confounding