Public Health Flashcards
(198 cards)
1
Q
Define primary prevention?
A
Preventing a disease from occurring in the first place.
2
Q
What are some examples of primary prevention?
A
Change4life,
5-a-day,
Vaccines
3
Q
Define secondary prevention?
A
Detecting a disease in its early or pre-clinical phase to alter its course + improve health outcomes
4
Q
What are some examples of secondary prevention?
A
All screening programmes (breast, bowel, cervical cancer, heel prick)
5
Q
Define tertiary prevention?
A
Attempting to slow down disease progression + prevent complications of a disease, helping people manage their illness effectively.
6
Q
What are some examples of tertiary prevention?
A
Diabetic foot care,
Attending rehab after a stroke to prevent immobility.
7
Q
What is the population approach to prevention?
A
Preventative measure delivered on a population wide basis
Seeks to shift the risk factor distribution curve
8
Q
What are some examples to the population approach to prevention?
A
Dietary salt reduction through legislation to reduce BP
Adding iodine to salt to prevent iodine deficiency
9
Q
What is the high risk approach to prevention?
A
Identifying individuals above a chosen cut-off + treating them
10
Q
What are some examples of the high risk approach to prevention?
A
Screening for HTN + treating them.
11
Q
What is the prevention paradox?
A
A preventative measure which brings much benefit to the population often offers little to each participating individual.
it’s about screening a large number of people to help a small number of people.
12
Q
Define screening?
A
A process which identifies seemingly well individuals who may be at risk of a disease, in the hope of catching the disease at its early stage
13
Q
What is screening not?
A
It’s not a diagnostic process, simply a means of assessing risk + catching diseases in their early stage.
14
Q
Define sensitivity?
A
Sensitivity = the proportion of people with the disease who are correctly identified by the screening test
A / A + C
15
Q
Define specificity?
A
The proportion of people without the disease who are correctly excluded by the screening test
D / D + B
16
Q
Define positive predictive value?
A
The proportion with a positive test result who actually have the disease. Dependent on underlying prevalence
A / A + B
17
Q
Define negative predictive value?
A
The proportion with a negative test result who do not have the disease. This is lower if the prevalence is higher
D / D + C
18
Q
What are some examples of population-based screening programmes?
A
Cervical and breast cancer
19
Q
What are some examples of opportunistic screening programmes?
A
BP measurements in GP surgeries
20
Q
What are some other types of screening?
A
Screening for communicable disease.
Pre-employment + occupational medicals.
Commercially provided screening (pay company to send off blood + get tested for a variety of different genetic issues).
Genetic counselling (genetic testing for people with FHx of diseases).
21
Q
What are some disadvantages of screening programmes?
A
Exposure of well individuals to distressing or harmful diagnostic tests.
Detection + treatment of sub-clinical disease that may have never caused any problems.
Preventative interventions that may cause harm to the individual or population.
22
Q
What are the Wilson + Junger criteria for screening?
A
The condition should be an important health problem.
There should be an accepted treatment available to pts.
Facilities for diagnosis + treatment should be available.
There should be a recognisable latent or early symptomatic stage.
There should be a suitable test or examination.
The test should be acceptable to the population.
The natural history of the condition should be understood.
There should be a policy on whom to treat as patients.
The costs of the screening should be economically balanced.
Screening should be a continuous process, not just a one off.
23
Q
Define lead time bias?
A
When screening identifies an outcome earlier than it would otherwise have been identified + results in an apparent increase in survival time, even if screening has no effect on the outcome
24
Q
What is length time bias?
A
A type of bias resulting from differences in the length of time taken for a condition to progress to severe effects that may affect the apparent efficacy of a screening method.
25
What is an example of lead time bias?
Cancers may be slowly or rapidly progressive. Less aggressive cancers with longer presentations are more likely to be detected by screening.
A comparison of survival in screen detected pts + non-screen detected pts may be biased as there’s a tendency to compare less aggressive to more aggressive cancers.
26
What is an ecological study?
Descriptive/observational study design comprising of case reports or case series studying population or groups rather than individuals.
27
What is an ecological study used for?
Used routinely collected data to show trends in data – often associations between occurrence of disease + exposure to known or suspected causes.
28
What are some advantages of an ecological study?
Few ethical issues, useful for generating hypotheses.
Uses routine data so quick + cheap.
Shows prevalence + association.
29
What are some disadvantages of an ecological study?
Cannot show causation.
Bias – variation in diagnostic criteria.
Inconsistency in data presentation.
30
What is a cross-sectional study?
Descriptive + analytical study design used to generate hypotheses.
Divides population into those without the disease + those with the disease + collects data on them once at a defined time to find associations at that single point in time.
31
What are some advantages to a cross sectional study?
Relatively cheap + quick.
Provide data on prevalence at a single point in time.
Good for surveillance + public health planning.
Large sample size.
32
What are some disadvantages to a cross-sectional study?
Risk of reverse causality (don’t know whether outcome or exposure first).
Cannot measure incidence as no time reference.
Risk of recall bias + non-response.
33
What is a case-control study?
A type of analytical study - retrospective.
Takes people with a disease + matches them to people without the disease for age/sex/class etc + studies previous exposure to the agent in question.
34
What are the advantages of a case control study?
Quicker than cohort of intervention studies as it’s retrospective.
Inexpensive.
Good for rare outcome (e.g. cancer).
Can investigate multiple exposures.
35
What are some disadvantages to a case control study?
Retrospective nature only shows an association (not causation).
Difficulty finding controls to match with cases.
Unreliable due to recall bias.
Prone to selection + information bias.
36
What is a cohort study?
A prospective study.
Start with a population without the disease in question + study them over time to see if they are exposed to the agent in question + if they develop the disease in question or not.
37
What are some advantages of a cohort study?
Prospective so can show causation (where retrospective can’t).
Lower chance of selection + recall bias.
Absolute, relative + attributable risks can be determined.
Good for common + multiple outcomes.
38
What are some disadvantages of a cohort study?
Lots to follow-up, requires a control group to establish causation.
Takes a long time, need a large sample size.
39
What is a randomised control trial?
Pts are randomised into groups:
One group is given an intervention (interventional group).
One group is given a placebo/control (control group).
Then, the outcome is measured. Often blind or double blind.
40
What are the advantages of a randomised control trial?
Can infer causality (gold standard).
Randomisation allows confounding factors to be equally distributed + biases minimised (helped by blinding).
41
What are some disadvantages of a randomised control trial?
Is it ethical to withhold a treatment that is strongly believed to be effective.
Time consuming, expensive.
Volunteer bias – specific inclusion/exclusion criteria may mean the study population is different from typical pts (e.g. excluding very elderly pts).
42
What is a meta-analysis?
A statistical technique where you pool all the results of the available evidence and look at effect.
Different to systematic review which doesn’t involve statistical procedure.
43
Define epidemiology?
The study of the frequency, distribution + determinants of disease + health-related states in populations in order to prevent + control disease.
44
What are the usual factors when measuring epidemiology of a disease?
Time, place, person (age, gender, class, ethnicity).
45
Define incidence?
The number of new cases of a disease that develop in a population (e.g. per 100,000) in a given time frame (e.g. per year).
46
Define prevalance?
The total number of people in a population found to have a disease at a point in time.
Number of existing cases/population/points in time.
47
Define person-time?
Measure of time at risk i.e. time from entry to a study to:
Disease onset.
Loss to follow up.
End of study.
It is the sum of each individual’s time at risk (i.e. length of time they were followed up in the study).
48
Define independent variable?
A variable that can be altered in a study.
49
Define dependent variable?
A variable that is dependent on the independent variables or one that cannot be altered.
50
Define absolute risk?
gives a feel for actual numbers involved i.e. it has units. e.g. deaths/1000 population.
51
Define relative risk?
Ratio of risk of disease in the exposed to the risk in the unexposed i.e. no units.
52
How do you calculate relative risk?
Incidence in exposed ÷ incidence in unexposed
53
What does relative risk tell you?
Tells us about the strength of association between a risk factor + a disease.
54
Define attributable risk?
The rate of disease in the exposed that may be attributed to the exposure.
55
How do you calculate attributable risk?
Incidence in exposed – incidence in unexposed.
56
What is attributable risk an example of?
Attributable risk is a type of absolute risk (absolute excess risk)
57
Define relative risk reduction?
The reduction in rate of the outcome in the intervention group relative to the control group.
58
How do you calculate relative risk reduction?
(Incidence in unexposed – Incidence in exposed) ÷ incidence in unexposed.
59
Define absolute risk reduction?
The absolute difference in the rates of events between the 2 groups. Gives an indication of the baseline risk + the intervention effect.
60
How do you calculate absolute risk reduction?
Incidence in unexposed – incidence in exposed
61
Define odds?
The odds of an event is the ratio of the probability of an occurrence compared to the probability of a non-occurrence.
62
How do you calculate odds?
Odds = probability ÷ (1 – probability).
63
Define odds ratio?
The ratio of odds for the exposed group to the odds for the non-exposed groups.
64
How do you calculate odds ratio?
(P exposed ÷ [1 – P exposed]) ÷ (P unexposed ÷ [1 – P unexposed])
65
What is it not possible to calculate in case control studies?
For case control studies, it’s not possible to calculate the relative risk, so the odds ratio is used.
66
When would odds ratio be used in a cross-sectional / cohort study?
Odds ratio is used if it’s not clear which is the independent and dependent variable.
67
Define number needed to treat?
The number of patients that need to be treated in order to prevent one bad outcome.
68
How do you calculate number needed to treat?
NNT = 1 ÷ absolute risk reduction (risk in non-exposed – risk in exposed).
69
Define bias?
A systematic deviation from the true estimation of the association between exposure + outcome.
70
Define selection bias?
A systematic error either in the selection of study participants or the allocation of participants to different study group.
71
Give some examples of selection bias?
Non-response, loss to follow up.
Those in the intervention group different in some way from the controls other than the exposure in question.
72
Define information bias?
A systematic error in the measurement or classification of exposure or outcome.
73
What are some sources of information bias?
Observer (observer bias).
Past events incorrectly remembered (recall bias).
Responder does not tell the truth (reporting bias).
Wrongly calibrated instrument (measurement bias).
74
Define publication bias?
Where some trials are more likely to be published than others.
75
Define confounding bias?
Where a factor is associated with the exposure of interest + independently influences the outcome but does not lie on the causal pathway.
May affect the validity of a study.
76
What are the Brandford-Hill criteria for assessing causality?
Strength of association – the magnitude of the relative risk.
Dose-response – the higher the exposure, the higher the risk of disease.
Consistency – similar results from different researches using various study designs.
Temporality – does exposure precede outcome?
Reversibility (experiment) – removal of exposure reduces risk of disease.
Biological plausibility – biological mechanisms explaining the link.
Coherence – logical consistency with other information.
Analogy – similarly with other established cause-effect relationships.
Specificity – relationship specific to outcome of interest.
77
If association is not causal, what could it be explained by?
Bias, chance, confounding, reverse causality, a true causal association.
78
Define reverse causality?
Refers to a situation when an association between an exposure + outcome could be due to the outcome causing exposure rather than other way.
79
Give an example of reverse causality?
Case study showing stress causes HTN but HTN could cause increased stress.
80
Define epigenetics?
The study of how genes interact with the environment.
Changes in organisms caused by modification of gene expression rather than alteration of the genetic code itself.
81
Define allostasis?
The stability through change, or homeostasis, of our physiological systems to adapt rapidly to change in environment.
82
Define allostatic load?
Long-term over-taxation of our physiological systems leading to impaired health (stress). The price we pay for allostasis.
83
Define public health?
Defined as the science + art of preventing disease, prolonging life + promoting health through organised efforts of society.
Population perspective – thinks in terms of groups, not individuals.
84
What are the key concerns in public health?
Inequalities in health.
Wider determinants of health.
Prevention.
85
What are the key determinants of health?
Genes (age, gender, ethnicity).
Environment (physical and social + economic, housing, education).
Lifestyle (smoking, wealth, employment).
Access to healthcare (economic factors, access, quality).
86
What are the wider / social determinants of health?
Education,
Socioeconomic status,
Unemployment,
Housing,
Physical environment.
87
What are the domains of public health?
Health improvement
Health protection
Improving services
88
What is health improvement in public health?
Societal interventions aimed at preventing disease, promoting health + reducing inequality.
89
What are some examples of health improvement in public health?
Inequalities,
Education,
Housing,
Employment,
Lifestyles,
Family/community, surveillance + monitoring of some diseases + risk factors -> immunisations, smoking cessation, screening.
90
What is health protection in public health?
Measures to control infectious disease risks + environmental hazards.
91
What are some examples of health protection in public health?
Infectious diseases,
Chemicals + poisons,
Radiation,
Emergency response,
Environmental health hazards.
92
What is improving services in public health?
Organisation + delivery of safe, high quality services for prevention, treatment + care.
93
What are some examples of improving services in public health?
Clinical effectiveness, efficiency, service planning, audit + evaluation, clinical governance, equity.
94
What are the domains in Maslow's hierarchy of needs?
Physiological
Safety
Love / belonging
Esteem
Self-actualisation
95
What are some examples of physiological needs in Maslow’s hierarchy of needs?
Breathing,
Food,
Water,
Sleep
96
What are some examples of safety in Maslow’s hierarchy of needs?
Security of employment,
resources,
Family health,
Property
97
What are some examples of love / belonging in Maslow's hierarchy of needs?
Friendship,
Family,
Sexual intimacy
98
What are some examples of esteem in Maslow's hierarchy of needs?
Self-esteem,
Confidence,
Achievement,
Respect.
99
What are some examples of self-actualisation in Maslow's hierarchy of needs?
Morality,
Creativity,
Spontaneity,
Problem solving,
Lack of prejudice,
Acceptable of facts.
100
Define health interventions?
Interventions are any tactics that are done to improve public health.
101
What are some examples of health interventions?
Health promotion/awareness campaigns –
Change4Life campaign, 5-a-day, Stoptober, Movember.
Promoting screening + immunisations –
Cervical smear, MMR vaccine (both individual + population level).
102
Define equality?
Concerned with equal shares (i.e. on a financial level).
103
Define equity?
Concerned with what is fair + just (i.e. on a moral level).
104
Define horizontal equity?
Equal treatment for equal need.
e.g. pts with same disease should be treated equally.
105
Define vertical equity?
Unequal treatment for unequal need.
e.g. areas with poorer health may need higher expenditure on health services, common cold + pneumonia require different treatment.
106
What are the different forms of health equity?
Equal expenditure
Equal access
Equal utilisation
Healthcare outcome for equal need.
107
What are the factors that affect health equity?
Spatial (geographical)
Social (age, gender, socioeconomic class, ethnicity)
108
What are some examples of spatial factors that affect health equity?
Infant mortality rates high in places like Africa, India whereas healthcare spending is low in these areas too so health inequality + inequity (spatial inequity).
109
What are some examples of social factors that affect healthcare inequality?
Socioeconomic inequity as angina Sx higher in more deprived areas whereas coronary artery revascularisations in those with angina Sx higher in more affluent areas in Sheffield.
110
How may you examine health equity?
Supply/access/utilisation of health care.
Healthcare outcomes.
Health status.
Resource allocation (health services or others like education, housing).
Wider determinants of health.
111
How may you assess health equity?
Typically assess inequality, then decide if inequitable:
Inequalities need to be explained + equality may not be equitable.
Healthcare systems:
Equity often defined in terms of equal access for equal need (NHS).
But measurement usually of utilisation, health status or supply.
112
Define health behaviour?
A behaviour aimed to prevent disease (e.g. healthy eating)
113
Define illness behaviour?
A behaviour aimed to seek remedy (e.g. going to Dr/pharmacist).
114
Define sick role behaviour?
Any activity aimed at getting well (e.g. resting, taking prescribed meds).
115
What two broad categories can health behaviours be split into?
Health damaging/impairing (smoking, alcohol/substance abuse).
Health promoting (exercising, vaccinations, attending health checks).
116
What is the main theory behind health damaging behaviours?
Unrealistic optimism = individuals continue practicing health damaging behaviours due to inaccurate perceptions of risk + susceptibility.
Aware of risks but don’t think it would happen to them.
117
Define medication compliance?
The extent to which a patient’s behaviour coincides with medical advice.
118
What factors may affect medication compliance?
Side effects of medications.
Patient perception of risk.
If the patient is asymptomatic (e.g. continuing with Abx).
Socioeconomic status.
119
Define adherence?
Extent to which the pt’s actions match agreed recommendations.
120
What is the role of the National Centre for Smoking Cessation and Training?
Supports the delivery of effective evidence-based tobacco control programmes + smoking cessation interventions provided by local services.
121
What does the Health belief Model (Becker, 1974) say about why individuals change?
Believe they are susceptible to the condition (perceived susceptibility).
Believe that it has serious consequences (perceived severity).
Believe that taking action reduces susceptibility (perceived benefits).
Believe that benefits of taking action outweigh costs (perceived barriers).
122
What is the most important aspect of the Health belied Model (Becker, 1974)?
Believe that benefits of taking action outweigh costs (perceived barriers).
Shown to be most important. All about the pt having poor self-efficacy (i.e. not being able to stick to a made behaviour change).
123
What are the cues to action in the Health belief Model (Becker, 1974)?
Can be internal or external, not always necessary
for behaviour change.
Internal = increase pain, decrease ADLs.
External = reminders in post, GP advice.
124
What are the advantages of the Health belief Model (Becker, 1974)?
Can be applied to wide variety of health behaviours.
Cues to action are unique component to the model.
Long standing model.
125
What are the criticisms of the Health belief Model (Becker, 1974)?
Does not differentiate between first time + repeat behaviour.
Does not consider the influence of emotions + behaviour.
Cues to action often missing.
Alternative factors may predict health behaviour such as self-efficacy or outcome expectancy (whether they feel they will be healthier as a result).
126
What is the theory of planned behaviour?
Proposes that the best predictor of behaviour is intention to change behaviour.
e.g. I intend to give up smoking.
127
What is intention determined by?
A person’s attitude to the behaviour.
Subjective norm: the perceived social pressure to undertake the behaviour.
Perceived behavioural control: a person’s appraisal of their ability to perform the behaviour.
128
How may you bridge the intention-behaviour gap?
Perceived control (something an individual feels they are
capable of doing).
Anticipated regret (reflecting on feelings once failed, related to
sustained intentions).
Preparatory actions (dividing task into sub-goals increases self-efficacy
+ satisfaction at the point of completion).
Implementation intentions - most important
129
What are the advantages to the Theory of Planned behaviour?
Can be applied to wide variety of health behaviours.
Useful for predicting intention.
Takes into account importance of social pressures.
130
What are some criticisms of the Theory of planned behaviour?
Lack of temporal element + direction or causality, no sense of how long behaviour change may take.
‘Rational choice model’ so does not take into account emotions.
Assumes attitudes, subjective norms + perceived behavioural control can be measured.
Relies on self-reported behaviour.
131
Define the stages of change / transtheoretical model?
Stage theories see individuals located at discrete ordered stages, rather than on a continuum with each stage denoting a greater inclination to change outcome.
132
What are the stages in the Stages of change / transtheoretical model?
Precontemplation - no intention of stopping
Contemplation - considering stopping, probably at some point ill-defined time in the future.
Preparation - getting ready to quit in the near future (28 days)
Action - engaged in stopping behaviour (6 months)
Maintenance - continues + engaged with abstinent behaviour (6 months)
133
When can relapses occur in the Stages of change / transtheoretical model?
At any point in time
134
What are some advantages of the Stages of change / transtheoretical model?
Acknowledges individual stages of readiness (tailored interventions).
Accounts for relapse/allows patient to move backwards in the stages.
Gives temporal element (idea of timeframe/progression, albeit arbitrary)
135
What are some criticisms of the Stages of change / transtheoretical model?
Not all people move through every stage.
Change might operate on a continuum rather than discreet changes.
Does not take into account values, habits, culture, social, economic factors.
136
Define motivational interviewing?
A counselling approach to initiating behaviour change by resolving ambivalence.
137
What is the role of motivational interviewing?
Role of motivational interviewing is to allow someone to change their behaviour by helping them make a decision about the behaviour – helping someone to see whether smoking was bad for them or not.
Clinical impact shown in problem drinkers.
138
What is the social norms theory?
Social norms are behaviours + attitudes that are most common in groups.
One of the most important factors influencing behaviour.
139
Define nudge theory?
Changing the environment to make the best/healthiest option the easiest.
e.g. placing fruit next to checkouts instead of sweets, opt-out schemes.
140
What are some other impacts to consider with behaviour change?
mpact of personality traits on health behaviour (everyone responds differently).
Assessment of risk perception.
Impact of past behaviour/habit.
Automatic influences on health behaviour.
Predictors of maintenance of health behaviours (does it stay 6m down the line?).
Social environment (massively influences behaviour).
141
Define a health needs assessment?
Before a health intervention is done, a health needs assessment must be done.
It’s a systematic method for reviewing the health issues facing a population, leading to agreed priorities + resource allocation that will improve health + reduce inequalities.
Can be carried out for a population or sub-group (Manor practice population), a condition (COPD), an intervention (coronary angioplasty).
142
What is the planning cycle in a health needs assessment?
Needs assessment → planning → implementation → evaluation → repeat.
As qualified Drs we need to improve the health of pts by treating individual pts + influencing the services available to pts.
143
Define needs in terms of a health needs assessment?
Ability to benefit from an intervention.
144
Define demand in terms of a health needs assessment?
What people ask for.
145
Define supply in terms of a health needs assessment?
What is provided.
146
What is the difference between health need and health care need?
Health need = a need for health (concerns need in more general terms).
Measured using mortality, morbidity, socio-demographic measures.
Health care need = a need for health care (more specific + looks at someone’s ability to benefit from health care).
Depends on potential of prevention, treatment + care services to remedy health problems.
147
Define felt need in terms of sociological perspective of need?
Individual perceptions of variation from normal health.
148
Define expressed need in terms of sociological perspective of need?
Individual seeks help to overcome variation in normal health (demand).
149
Define normative need in terms of sociological perspective of need?
Professional defines intervention appropriate for the expressed need.
150
Define comparative need in terms of sociological perspective of need?
Comparison between severity, range of interventions + cost.
151
What is the method of an epidemiological health needs assessment?
Define the problem.
Size of problem (incidence/prevalence).
Services available (prevention/treatment/care).
Evidence base (effectiveness + cost-effectiveness).
Models of care (including quality + outcome measures).
Existing services (unmet need, services not needed).
Recommendations.
152
What are some sources of data for an epidemiological health needs assessment?
Disease registry, hospital admissions, GP databases, mortality data, primary data collection (e.g. postal/pt survey).
153
What are some advantages of an epidemiological health needs assessment?
Uses existing data.
Provides data on disease incidence/mortality/morbidity.
Can evaluate services by trends over time.
154
What are some limitations of a epidemiological health needs assessment?
Required data may not be available + variable data quality.
Evidence base may be inadequate.
Does not consider felt needs of people affected.
155
Define a comparative health needs assessment?
Compares the services received by a population (or subgroup) with others - spatial, social (age, gender, class, ethnicity)
156
What may a comparative health need assessment cover?
Health status.
Service provision.
Service utilisation.
Health outcomes (mortality, morbidity, QOL, pt satisfaction).
157
What are the advantages of a comparative health need assessment?
Quick + cheap if data available.
Indicates whether health or services provision is better/worse than comparable areas (gives a measure of relative performance).
158
What are the limitations of a comparative health need assessment?
Data may not be available + variable data quality.
May be difficult to find a comparable population.
May not yield what the most appropriate level (e.g. of provision or utilisation) should be.
159
What is a corporate health needs assessment?
Ask the local population what their health needs are.
Uses focus groups, interviews, public meetings.
Wide variety of stakeholders e.g. teachers, HCPs,
social workers, charity workers, local businesses.
160
What are the advantages of a corporate health needs assessment?
Based on the felt + expressed needs of the population in question.
Recognises the detailed knowledge + experience of those working within the population.
Takes into account wide range of views.
161
What are some limitations of a corporate health needs assessment?
Difficult to distinguish need from demand.
Groups may have vested interests + may be influenced by political agendas.
Dominant personalities may have undue influence.
162
Define evaluation of a health service?
Evaluation is the assessment of whether a service achieves its objectives.
Process that attempts to determine as systematically + objectively as possible the relevance, effectiveness + impact of activities in the light of their objectives.
163
What are examples of structure in a Donabedian framework?
What is there:
Buildings = locations where screening is provided.
Staff = number of vascular surgeons/1000 population.
Equipment – number of ICU beds/1000 population.
164
What are some examples of process in a Donebedian framework?
What is done:
Number of pts seen in A&E.
Number of operations performed (may be expressed as a rate).
165
What are some examples of outcome in a Donabedian framework?
Classification of health outcomes:
5Ds (death, disease, disability, discomfort, dissatisfaction).
Mortality (e.g. 30-day mortality rate).
Morbidity (e.g. complication rate).
Quality of life/patient reported outcome measures (PROMs).
E.g. Oxford hip + knee score, EQ-5D, Aberdeen varicose vein questionnaire.
Pt satisfaction.
166
What are some issues with health outcomes?
Link (cause and effect)
Time lag between service provided
Large sample sizes needed
Data may not be available
167
What are Maxwell's Dimensions of Quality?
3As + 3Es:
Acceptability
Accessibility
Appropriateness
Effectiveness
Efficiency
Equity
168
What are some factors that promote excessive energy consumption?
Employment (shift work).
Characteristics of food – energy density, portion size.
Social aspect – people usually go out for food.
Genetics.
Advertisements.
169
What are the advantages of breastfeeding?
Less picky eaters in childhood.
More likely to accept novel foods in weaning.
More likely to have a diet rich in fruit + vegetables if >3m.
Bodyweight regulation:
Babies stop feeding when full when breastfeeding whereas bottle-fed infants are usually encouraged to finish bottle.
170
What are the three types of diet?
Restrict the total amount of food eaten.
Restrict the types of food eaten.
Restrict the time-window for eating (intermittent fasting).
171
What are the issues with dieting?
Risk factor for development of EDs.
Results in loss of lean body mass, not just fat mass.
Slows metabolic rate.
Chronic dieting may disrupt normal appetite responses + increase sensations of hunger.
Long-term weight loss is challenging, usually plateau + then regain weight.
172
What are the core principles of the NHS?
Universal – it meets the needs of everyone.
Comprehensive – it’s based on clinical need, not ability to pay.
Free – at the point of delivery.
173
Define inverse care law?
The availability of medical care tends to vary inversely with the need of the population served (those who need it most, don’t access it, vice versa).
174
What are the vulnerable patients within the NHS?
Asylum seekers,
LGBTQ+,
Homeless,
Ex-prisoners,
MH sufferers,
LD pts
175
Define social exclusion?
Process of being shut out from any of the social, economic, political or cultural systems which determine the social integration of a person in society.
176
Define homelessness?
A person without a home, typically living on the streets.
Also includes people living with family, B+Bs etc.
177
What are some causes of homelessness?
Relationship breakdown (#1 stated cause).
Mental illness, domestic abuse.
Disputes with parents.
Bereavement (≥50% say they have no family ties).
Drugs, alcohol.
No money or job.
178
What are some populations that are vulnerable to homelessness?
LGBTQ+.
Ex-service men + women.
Substance misusers.
Failed asylum seekers.
179
What are some health problems faced by the homeless?
Infectious diseases such as TB + hepatitis.
Poor condition of feet + teeth.
Respiratory problems.
Injuries following violence, rape.
Sexual health issues.
Serious mental illnesses (schizophrenia, depression + personality disorders).
Poor nutrition.
Addictions/substance misuse.
180
What are some common causes of death in the homeless?
Accidents
Suicide
Liver problems
181
What are some barriers to healthcare for travellers?
Reluctance of GPs to register travellers + to visit traveller sites.
Poor reading + writing skills (many are illiterate).
Communication difficulties.
Too few permanent sites.
Mistrust of professionals.
182
What are some barriers to healthcare for the homeless?
Difficulties with access to healthcare (opening times, appointment + procedures location, perceived ± actual discrimination).
Lack of integration between primary care services + other agencies (housing, social services, criminal justice system).
Other things on their mind (people do not prioritise health when there are more immediate survival issues).
May not know where to go or may be unable to get there.
183
What are some barriers to healthcare for immigrants?
Language/cultural/communication barriers.
Racism, prejudice, discrimination + stigma.
Different perceptions of care.
May not know how the NHS works.
184
Define asylum seeker?
A person who has made an application for refugee status.
185
Define refugee?
A person granted asylum + refugee status, usually means leave to remain for 5 years and then reapply.
186
Define humanitarian protection?
Failed to demonstrate claim for asylum but face serious threat to life if returned. Usually 3 years then reapply.
187
What are asylum seekers entitled to?
Housing but with no choice of where.
Cash support amounting £37pp in the household (or £35 if refused).
Full access to NHS (free prescriptions, eyesight tests, dental care).
Education for children 5–17.
188
What are some health problems affecting asylum seekers?
Common illness + illnesses specific to country of origin.
Injuries from war + travelling.
No previous health surveillance/neonatal screening/immunisations.
Malnutrition, torture + sexual abuse (including female genital mutilation).
Communicable + blood borne diseases.
PTSD, depression, psychosis, self-harm, sleep disturbance.
189
What assessment tool is used for domestic abuse?
Domestic abuse + sexual harassment (DASH) tool.
This tool encourages you to gather information about everything that is going on in the situation.
There is no “score” that indicates high risk, but they may say something that suddenly makes you think they’re at high risk + need intervention.
190
What would you do if a person is at standard-medium risk of domestic abuse?
It’s their choice what to do.
Give them contact details for domestic abuse services + let them decide.
191
What would you do if a person is at high risk of domestic abuse?
Refer to MARAC/IDVAS wherever possible with consent.
192
What are the negative outcomes for teenage pregnancy for both mother and child?
Poor health.
Lower academic achievement, socioeconomic status, self-esteem.
Under achievement at work.
193
What are the issues surrounding compliance issues in teenage pregnancy?
SEs like acne, weight gain.
Mood changes.
Fertility concerns.
Bleeding patterns.
194
What is the law surrounding teenage pregnancy?
Child <13 cannot consent to sex + so it is rape in any circumstance.
Child 13–15 is underage for sex but can legally consent (mutually agreed teenage sex is legal unless abusive or exploitative).
Confidentiality can be broken in a case of safeguarding or child welfare.
195
Define Fraser guidelines?
Criteria that judges the competence of a young person to make decisions about contraception without parental consent:
196
What are the Fraser guidelines?
Pt understands the advice given.
Pt cannot be persuaded to inform their parents.
It is likely that the pt will continue to have sexual intercourse with or without contraception.
The pt’s physical or mental health may suffer as a result of withholding contraceptive advice or treatment.
It’s in the best interests of the pt + the Dr. to provide contraceptive advice + treatment without parental consent.
197
Define salutogenesis?
Favourable physiological changes secondary to experiences which promote healing + health.
198
Define emotional intelligence?
Ability to identify + manage one’s own emotions, as well as those of others.
