Public Health Flashcards

Question

What is lead time bias?

Answer 1

Early identification doesn’t alter outcome but appears to increase survival e.g. patient knows they have the disease for longer

Answer 2

Disease that progress more slowly is more likely to be picked up by screening (i.e. symptom free and around for longer), which makes it appear that screening prolongs life.

Answer 3

When an apparent association between an exposure and an outcome is actually the result of another factor

Answer 4

Think retrospective vs prospective Most useful are- systematic review/meta analysis then randomised control trial then cohort

Answer 5

Retrospective observational study collecting data from a population and a specific point in time

Answer 6

Larger sample size Rapid Repeated studies show changes over time

Answer 7

Risk of reverse causality- which came first? Cannot measure incidence Risk recall bias and non response

Answer 8

Retrospective observational study looking at population with disease and control population

Answer 9

Good for rare outcomes Rapid

Answer 10

Prone to selection bias and information bias Resource consuming to find well matched controls

Answer 11

Prospective longitudinal study looking at separate cohorts with different treatments/exposures applied – await to see if disease occurs

Answer 12

Can establish disease risk factors (no chance or reverse causality as disease not happened yet) Can follow rare exposure Data on confounders can be collected prospectively Less risk of selection and recall bias

Answer 13

Takes a long time People may drop out Large sample size required, expensive, time consuming Difficult to assess rare diseases as may not develop

Answer 14

Prospective study where all participants are randomly assigned an exposure or control intervention

Answer 15

Two groups can be compared accurately Low risk of bias and confounding as it is prospective and randomised Can infer causality

Answer 16

Expensive Time consuming Ethical issues Drop outs Specific inclusion/exclusion criteria may mean study population different from typical patients

Answer 17

Population based data rather than individual data – comparative 2 key comparisons: Geographical (e.g all pts in a GP practice vs all patients in another GP practice) Time trends (e.g 1950-2000)

Answer 18

Ecological different to a cross sectional because COMPARES two areas/two years whereas a cross sectional would just look for prevalence for example in England at one point in time with no comparison

Answer 19

Need- ability to benefit from an intervention Demand- what people ask for Supply- What is provided

Answer 20

A health needs assessment is 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

Answer 21

Felt need- individual perceptions of variation from normal health Expressed need- individual seeks help to overcome variation in normal health (demand) Normative need- professional defines intervention appropriate for the expressed need Comparative need- comparison between severity, range of interventions and cost

Answer 22

FENC Felt – Can’t walk as far. Expressed – Seeks help from doctor. Normative – doctor says should go to cardiopulmonary rehab. Comparative = Pt improves and then service is oversubscribed – there are worse pts than them so in comparison they no longer get priority for the rehab.

Answer 23

1. Needs assessment 2. Planning 3. Implementation 4. Evaluation

Answer 24

Epidemiological Comparative Corporate

Answer 25

A top down approach Define issue/disease → Assess size (incidence/prevalence)→ Assess services available and match against existing evidence base for cost effectiveness and quality of care. Look at services already available and recommend how to improve.

Answer 26

Uses existing data Provides data on disease incidence/mortality/morbidity Can evaluate services by trends over time

Answer 27

Does not consider the felt needs of the people it is catering for Quality of data variable Data collected my not be the data required

Answer 28

Compares the services received by a sub-group with services received by a different subgroup

Answer 29

Quick and cheap if data available Indicates whether health or service provision is better or worse than comparable areas

Answer 30

Difficulty in finding comparable groups Data may not yet be available/of high quality May not yield what most appropriate level should be

Answer 31

Takes into account views from patients, politicians, press, professionals, commissioners, etc

Answer 32

Based on the felt and expressed needs of the population in question Recognises the detailed knowledge and experience of those working in the population Takes into account wide range of views

Answer 33

May be difficult to distinguish need from demand Certain groups may have vested interest May be influenced by political agenda

Answer 34

Process that attempts to systematically assess whether service meets its objectives

Answer 35

Donabedian approach Maxwell's dimensions Can tie them together- do structure, process, outcome for each of the 3 Es and 3 As Called Wright's matrix

Answer 36

1. Structure- what there is 2. Process- what is done 3. Outcome- Mortality, morbidity, PROMS (patient reported outcome measures) (quantitative score), patient satisfaction focus groups (qualitative) OR “the 5 Ds” (death, disease, disability, discomfort, dissatisfaction)

Answer 37

3Es + 3As Effectiveness Efficiency Equity Acceptability Accessibility Appropriateness

Answer 38

The number of new cases in a population during a specific time period

Answer 39

The number of existing cases at a specific point in time

Answer 40

Risk in one catagory compared to another e.g. comparison of disease in the exposed and unexposed Tells us about the association between risk factor and disease RR >1 indicates risks increased due to factor exposure Relative risk = Absolute risk or incidence in an exposed group/ Absolute risk or incidence in non-exposed group

Answer 41

The amount of the disease that is specifically due to the exposure The difference in the disease rates in exposed and unexposed individuals What is the risk of lung cancer that is attributable to smoking? Risk of lung cancer in smokers = 45/300 = 15% Risk of lung cancer in non-smokers = 5/700 = 0.7% Attributable risk = 15% - 0.7% = 14.3%

Answer 42

The number of patients who need a specific treatment to prevent one bad outcome NNT= 1/attributable risk Always round up NNT as can't treat a fraction of a person Number needed to give up smoking to prevent one lung cancer case

Answer 43

1. The condition- important, known natural history, identifiable latent/preclinical phase 2. Organisation and cost- facilities, costs and benefits, ongoing process 3. The screening test- Suitable (sensitive, specific, inexpensive) 4. The treatment (effective, agreed policy on whom to treat)

Answer 44

Sensitivity – does the test pick up the disease? Specificity – does the test identify people who do not have the disease? Positive predictive value is the probability that subjects with a positive screening test truly have the disease Negative predictive value is the probability that subjects with a negative screening test do not have the disease.

Answer 45

Check slide 17 med school 53 presentation Sensitivity: a/(a+c) Proportion of those with the disease who are correctly identified by the screening test (if this is too low, you will miss too many cases) Specificity: d/(b+d) Proportion of people without the disease who are correctly excluded by the screening test (if this is too low you will have many people who undergo unnecessary diagnostic interventions because they don’t have the disease) Positive predictive value: a/(a+b) Proportion of people with a positive test result who actually have the disease (this is higher if the prevalence is higher) Negative predictive value: d/(c+d) Proportion of people with a negative test result who do not have the disease (this is lower if the prevalence is higher)

Answer 46

Sensitivity – does the test pick up the disease? % correctly identified with the disease Specificity – does the test identify people who do not have the disease? % correctly excluded as disease free Positive predictive value is the proportion of people with a positive test result who actually have the disease Negative predictive value is the proportion of people with a negative test who do not have the disease

Answer 47

Aimed at preventing disease Doing exercise

Answer 48

Seeking remedy Going to GP for a symptom

Answer 49

Activity aimed at getting well Taking antibiotics

Answer 50

1. Health belief model 2. Theory of planned behaviour 3. Stages of change/transtheoretical model 4. Social norms theory 5. Motivational interviewing 6. Social marketing 7. Nudging 8. Financial incentives

Answer 51

Individuals will change their behaviour if- 1. Believe are susceptible to the condition 2. Believe in serious consequences 3. Believe taking action reduces susceptibility 4. Believe that benefits of action outweigh the costs + cue to action

Answer 52

Pre-contemplation (not ready yet) Contemplation (thinking about it) Preparation (getting ready) Action (doing it) Maintenance (sticking with it) Can make progress or relapse between steps Advantages: Account for relapse (6th stage) and is the only model to do this, acknowledges a variation of mindsets in the individual (e.g each specific stage) Disadvantages: Isn’t accurate for all forms of health behaviour – some people move backwards through or skip stages, doesn’t take into account social factors such as values, habits, culture and socioeconomic factors

Answer 53

3 factors- 1. Attitudes 2. Subjective norm 3. Percieved behvioural control These lead to Intentions then Behaviour Advantages = Takes into account social factors, works with a wide range of health behaviours e.g smoking to abortion Disadvantages = Lack of causality, not temporal, doesn’t take into account emotions, relies on self reported behaviour

Answer 54

Social norms = Evidence to show if inform other of what the majority do they will follow that. (This fails if the sick behaviour e.g alcohol, obesity is the norm) Motivational interviewing = Counselling technique Nudge theory = Placing healthy food (fruit) next to checkout Financial Incentives

Answer 55

Units = %ABV x volume (mls)/1000 Recommended limit = 14 units per week for men AND women. Binge = 6 women, 8 men in a single session Higher risk drinking = 50+ units in men. 35+ units in women. Men metabolise quicker due to difference in body fat percentage. Screening: CAGE or AUDIT

Answer 56

“Pt describes drinking 2 cans of 500ml 8% cider a day, what is their units of intake per week?” ((8 x 500)/1000) x2 x7 = 56 units a week.

Answer 57

Sloth = Lazy = inadequate documentation System error = Inadequate built in safeguards, lack of surgical equipment due to failure of rota for someone to check stock Lack of skill = Not having appropriate training – unable to do ABG Fixation = Focus on one diagnosis only – patient comes in with photophobia, you decide is meningitis actually turns out to be SAH Bravado = Working beyond competence, deciding to treat complex patient alone without requesting senior opinion Playing the odds = Deciding it is a common disease and then turns out to be a rare one Poor team working = Communication breakdown

Answer 58

DO EPIDEMIOLOGY REVISION POWERPOINT QUESTIONS AT END Ethics/PPS e.g: Negligence, types of leadership, ethics of resource allocation

Answer 59

The purpose of screening is to identify apparently well individuals who have (or are at risk of developing) a particular disease so that you can have a real impact on the outcome

Answer 60

Exposure of well individuals to distressing or harmful diagnostic tests Detection and treatment of sub-clinical disease that would never have caused any problems Preventive interventions that may cause harm to the individual or population

Answer 61

1. Availability (affordability) of food 2. Access – economic and physical 3. Utilisation – opportunity to prepare food 4. Stability of the three dimensions over time

Answer 62

Primary Prevention—intervening before health effects occur, through. Secondary Prevention—screening to identify diseases in the earliest. Tertiary Prevention—managing disease post diagnosis to slow or stop Primary- before disease or symptoms Secondary- Before symtpoms but not disease- screening Tertiary- reduce symptoms and effects of the disease Quaternary- reduce the negative effects of treatments In primary prevention, the intervention aims to remove or reduce a risk factor or introduce a protective factor (in this case folic acid) to prevent a disease before it has developed (in this case neural tube defects). Secondary prevention aims to intervene to prevent progression of a disease whilst it is asymptomatic or in the early stages (e.g. screening) or to prevent recurrence (e.g. after a myocardial infarction), whereas in tertiary prevention the disease is already established and the aim is to minimise disability and other negative effects of the disease and reduce complications

Answer 63

A serious, largely preventable patient safety incident that should not occur if available preventive measures have been implemented

Answer 64

Where interventions are more likely to be effective Leaving school Entering the workforce Becoming a parent Becoming unemployed Retirement and bereavement

Answer 65

Self actualisation Esteem needs Love and belonging Safety Physiological needs

Answer 66

What four principles make up medical negligence? Duty of care? Breech of the duty of care? - Bolam – would 2 doctors do the same thing? - Bolitho – would it be reasonable for them to do so? Did the patient come to any harm? Did the breech cause the harm?

Answer 67

The science and art of preventing disease, prolonging life and improving health through organised efforts of society

Answer 68

Availability of health care tends to vary inversely with its need

Public Health Flashcards

(93 cards)