Public health Flashcards
(227 cards)
1
Q
Define social class
A
A measure of occupation, stratification, social position, access to power and resources. Models = NS-SEC ot Registrar General’s
2
Q
Define incidence
A
The no. of new cases per unit time
3
Q
How can incidence be increased?
A
Screening
Increasing risk factors
4
Q
How can prevalence be increased?
A
Screening
Increasing risk factors
Increasing life expectancy
5
Q
How can incidence be decreased?
A
Decreased risk factors (primary prevention)
6
Q
How can prevalence be decreased?
A
Cures
Decreased risk factors
7
Q
How may someone enter the prevalence pool?
A
Diagnosis
8
Q
How may someone leave the prevalence pool?
A
Cure
Death
9
Q
Define sociology
A
It is the study of social relations and social processes
It is a measure of social INTERdependecies
10
Q
What is the role of a sick person in society?
A
They are exempt from normal social responsibilities
They should focus on getting better
They should seek help from medical professionals
11
Q
Define global health
A
Issues, concerns, ideas regarding health that transcend national boundaries
12
Q
State the 3 millennium goals that relate to health
A
Reduce child mortality of under 5’s by 2/3rds
Improve maternal health
Combat AIDS/HIV
13
Q
Define prevalence
A
The no. of existing cases of a disease at a point in time
14
Q
Define sensitivity
A
The probability of a person with the disease testing positive
a/a+c
15
Q
Define positive predictive value
A
The proportion of people with a positive result that actually have the disease
a/a+b
16
Q
Define specificity
A
The probability of a person without the disease testing negative
b/b+d
17
Q
Define negative predictive value
A
The proportion of people with a negative result correctly excluded by screening
d/c+d
18
Q
What effect does screening of a common disease have on PPV and NPV?
A
Increased PPV
Decreases NPV
19
Q
What effect does screening of a rare disease have on PPV and NPV?
A
Decreases PPV
Increases NPV
20
Q
State the principles of screening
A
1) Important condition
2) Treatment available
3) Suitable test
4) Recognised latent and early phase of disease
5) Cost of screening balanced with that saved by early diagnosis
6) Known history of disease
7) Policy regarding who to treat
8) Facilities for test available
21
Q
State the reasons for screening
A
Early diagnosis - better outcome
Early diagnosis - cheaper treatment
Prevention of suffering
Patient satisfaction
22
Q
State the reasons against screening
A
Screening may have adverse effects on healthy individuals
Damaging effects of wrong diagnosis (hopes up/ fear or later diagnosis)
Personal choice comprimised
23
Q
State the changing health behaviour models that exist
A
1) Health belief model
2) Stages of change model
3) Nudge theory
4) Financial incentives
5) Motivational interviewing
6) Social marketing
7) Mindspace
24
Q
Describe health belief model
A
Perceived susceptibility
Perceived barriers
Perceived benefits
Self-efficacy
25
Describe the stages of change model
```
Pre-contemplation
Contemplation
Preparing
Action
Maintenance
Stable changed lifestyle/replace
```
26
Describe the nudge theory model
Changing the environment to make the healthiest option the easiest one
27
Define primary prevention
Actions that aim to reduce the risk of a disease becoming ESTABLISHED
e.g. behaviour change/vacinations
28
Define secondary prevention
Action that aim to slow/halt the progression of a disease identified in its early stage
29
Define tertiary prevention
Actions that aim to reduce the complication or severity of a an established, detectable and symptomatic disease using treatments/interventions
30
What is the prevention paradox?
Whether to target many low risk individuals(population approach) or few high risk individuals
31
What sort of people does the high risk prevention approach target and why?
```
Affluent/well educated individuals
These people are more like to:
-engage with health services
-comply with treatments
-have means to change their lifestyle
```
32
What is the advantages of using the population approach to prevention?
Reduces social inequalities
33
State the primary prevention for CHD
Smoking cessation
Nutrition improved
Alcohol consumption decreased
Physical activity increased
34
Give 3 unmodifiable risk factors of CHD
Age
Sex
Ethnicity
35
Give 5 modifiable risk factors of CHD
```
Diet - cholesterol - type 2 diabetes
Blood pressure
Physical activity
Smoking
Alcohol
```
36
Give a psychological risk factor of CHD
Depression
37
Which personality type is more at risk of developing CHD
Type A personality - competitiveness, hostility, impatient
| Under assessed using questionnaires/self report
38
How does work impact risk of CHD
High demand/low control job = stress = increased risk of MI/CHD
39
How does social support influence health
Increased social support = decreased morbidity/mortality
40
What is the link between smoking and men and women?
Men smoke more
| But gap is closing
41
What is the link between smoking and social economic status?
People of LES tend to smoke more
42
What is the age limit for smoking?
18
43
When was smoking banned in public placed in the UK?
2007
44
What are the reasons for smoking
```
Nicotine addition
Coping with stress
Habit
Socialising
Fear of weight gain
```
45
What is the daily alcohol limit for a man?
3-4 units a day
46
What is the daily alcohol limit for a women?
2-3 units
47
What is standard unit of alcohol?
10ml/8g ethanol
48
How many units are there roughly in a bottle of wine?
10
49
What percentage of A&E admissions relate to alcohol?
55%
50
What are the social implications related to alcohol consumption
Disease
Danger - rape, accidents, violence
Driving offences
Depression
51
What are the withdrawal symptoms of alcohol
Tremor
Hallucinations
High BP/HR
52
What does CAGE stand for?
Have you ever thought about CUTTING down
Have you ever felt ANNOYED by people telling you to cut down
Do you feel GUILTY about how much you drink?
EYE OPENER: ever had a drink first thing in the morning
53
Define ethics
The attempt to arrive at an understanding of the nature of human values, of how we ought to live and what constitutes right conduct
54
State the rivals to ethics
Law
Religion/cultural beliefs
Personal conscience
55
What is meant by a bottom up inductive ethical argument?
Using past medical problems to create new guides for practice
56
What is meant by a top down deductive ethical argument?
Applying one specific ethical principle to all problems
57
What are the 4 ethical principles
Autonomy
Beneficence
Non-maleficence
Justice
58
What is meant by autonomy?
Allowing the patient to make a rational and informed decision
59
Define beneficence
Doing good
60
Define non-maleficence
Preventing harm/reducing harm/doing no harm
61
Define justice
Being fair e.g. distribution of health resources
62
What is utilitarianism
Act evaluated solely in terms of its consequences
| Maximising good
63
Define deontology
Doing what you believe is morally right
| It is the act itself that determines worthiness
64
Define virtue ethics
Focuses on the character of the person, integrating reason and emotion (person in their right state of mind intending to do the right thing)
65
State the 5 focal virtues
```
Compassion
Trustworthiness
Conscientiousness
Integrity
Discernment
```
66
Which strain of influneza caused pandemics?
A
67
What is the criteria for pandemic spread?
```
Novel virus
Capable of infecting humans
Capable of causing human illness
Large pool of susceptible people
Ready and sustainable transmission from person to person
```
68
What are the different phases of a pandemic?
1-3 animals mostly
4 human to human transmission sustained
5-6 widespread human infection
Post peak - possibility of recurrent events
Post pandemic - disease returns to seasonal levels
69
State the changes affecting the risk of pandemics
```
International travel
Larger population
Crowding
------
Improved population health
Interdependency between countries
Changes in animal husbandry
```
70
Define patient-centred medicine
Medicine involving shift in focus from treatment to care
71
Define compliance
The extent to which a patient's behaviour coincides with medical/health advice. Professionally rather than patient focused 'doctor knows best'
72
Give an example on unintentional non-compliance
Forgetting
73
Give a reason for intentional non-compliance
Religion/beliefs/personal preferences
74
Define adherence
Similar to compliance
Acknowledges a patient's beliefs
Health professional = expert, convey their knowledge, results in increased patient satisfaction, knowledge and adherence
75
Define concordance
Patients as equals in care
| Expected patients will take part in treatment decisions
76
What are the ethical considerations of concordance?
Mental capacity
Decision's detrimental to patients health
Potential threat to the health of others
Children: sufficient understanding, can give consent
77
Give some examples of public health interventions (regarding influenza/pandemics)
```
Hand washing
Respiratory hygiene
Travel restrictions, Screening those entering UK
Reducing social contact
Restricting mass gatherings
School closures
```
78
State the types of transmission of diarrhoeal diseases
Direct
Indirect
Airborne
79
Give 2 examples of bacteria that cause diarrhoea
E.coli
| Rotavirus
80
What measures can be taken to reduce the risk of diarrhoea?
```
Hand washing with soap
Safe drinking water
Safe disposal of waste
Breastfeeding infants
Safe handling of food
Control of flies/vectors
Vaccination
```
81
Which groups are most at risk of developing diarrhoea?
Those with poor hygiene/sanitation
Children at pre-school
Health care and social workers
Those preparing unwrapped/uncooked foods
82
State the way in which disability can be divided
Cognitive V Physical
83
What subtypes of cognitive/physical disability exist?
```
Congenital
Developmental
Addicents
Diseased of early/mid life
Functional limitation of older people
```
84
Why is disability increasing?
Healthy life expectancy not increasing as much as life expectancy
85
Give an example of how disability can be assesed (elderly)
Activities of Daily Life scale
| MMSE
86
Define palliative care
Care aiming to improve the quality of life of patients and families who face life-threatening illness by providing pain/symptom relief, spiritural, and psychosocial support from diagnosis to end of life and bereavement
87
What types of palliative care exist?
Specialist and generalist
88
Define specialist palliative care
Involves health professionals who specialise in palliative care within a MDT. Delivered in hospitals/care home etc
89
Define generalist palliative care
GPs, hospital doctors, district nurses social workers
90
Describe the relationship between age and comorbidities
Increase in age increase in comorbidity
91
Describe the relationship between chronic disability and SES
Lower SES, increased chronic disability
92
Describe the relationship between poverty/living conditions and age
Increase age, increase in poverty/poorer living conditions
93
Why do elderly people require more specialist care need?
```
More comorbidities, more impairment
Greater risk of impairment from treatment complications
Increased social isolation
Increased psychosocial distress
Increased economic hardship
```
94
Define gerontology
The study of changes in the body and mind with age
95
Define geriatrics
Diagnosis and treatment of disorders that occur with old age
96
Describe the difference in palliative care between COPD and lung cancer sufferers
Lung cancer patients receive more palliative care
| COPD patients have a low QOL
97
What does evidence based medicine involve?
```
Asking a focused question
Finding evidence
Critical appraisal
Making a decision
Evaluating performance
```
98
What are the 4 components of asking a focused question in EBM?
Population
Intervention
Comparator
Outcome
99
Define the gold standing in EBM
Systematic reviews/meta analysis of multiple RCTs
100
Describe the hierarchy of evidence
1a - Systematic reviews/Meta analysis of multiple RCT *GOLD STANDARD*
1b - at least one RCT
2a - at least one controlled trial without randomisation
2b - at least one type of quasi-experimental study
101
What components should be assessed in critical analysis? And what other factors can affect these?
```
Validity
Reliability
Applicability
---------
Stats
Chance
Bias
Confounding factors
```
102
Define validity
How close to the truth something is
103
Define reliability
How consistent results are; same every time experiment repeated
104
Define applicability
How relevant a study is to clinal medicine
105
What makes a good study?
Randomisation - allocation of intervention
Have outcome measures for at least 80% of the population
Show causation rather than association
106
State the main two categories of study
Observational
| Experimental/interventional
107
What are the subtypes of observational studies?
Descriptive
Descriptive/analytical
Analytical
108
What are the 2 types of descriptive observational studies?
Case report
| Ecological
109
State the advantages of ecological studies
Quick/cheap
Help generate hypotheses
Few ethical issues
110
State the disadvantages of ecological studies
Can't show causation
| Diagnostic criteria bias
111
Give an example of a descriptive/analytical study
Cross-sectional
112
State the advantages of cross sectional studies
Quick cheap
Generate hyp
Few ethical issues
113
State the disadvantages of cross sectional studies
Prone to bias e.g. sampling
114
State the types of analytical observational studies
Case control
| Cohort
115
Give an advantage of a case control trial
Quick, inexpensive (don't have to wait for disease to develop)
116
Give a disadvantage of case control trial
Retrospective therefore relies on people's memories
| Can only show association not causation
117
Give an advantage of cohort study
Can distinguish causes from associated factors
| Can measure more than one outcome for a single exposure
118
Give a disadvantage of cohort study?
Long - expensive, drop out rate high
| Advances in diagnosis influence results
119
Describe the criteria for an association to be causal
```
Strength of association
Consistency
Coherence with existing theories
Temporal relationship
Dose-response relationship
Specificity
```
120
What are the 3 types of causes?
1) X necessary for disease
2) Exposure of X is sufficient to cause disease
3) X contributes to the disease
121
Define a systematic review
A review of a clearly formulated question that uses symptomatic and explicit methods to identify, select and critically appraise relevant research, and to analyse the data from studies included in the review
122
Define meta-analysis
Review/analysis of results using STATISTICAL METHODS
123
Why is routine health data collected?
1) Monitor changes in health
2) Generate hypotheses of ill health
3) Improve planning of health services
4) Evaluate performance of policies/services
124
What information in collected in routine health data collection?
1) Morbidity
2) Mortality
3) Use/quality of health care
4) Individual lifestyle
5) Quality of life
6) Socioeconomical/cultural and environmental conditions
125
Define Ethnograph, and state what type of research it is involved in?
Emersing yourself in someone else lifestyle
| Qualitative
126
What other types of qualitative research is there?
Interviews
| Documentary analysis
127
What are the associated problems with qualitative research?
Subjective - open to personal interpretation
| Not truly understanding what someone means
128
What are the disadvantages of quantitive research?
Requires a large population
| Expensive
129
Quantitive data can be divided into what two categories?
Continuous
| Discrete
130
What type of graphs can continuous data be show by
Histogram
Stem and leaf
Box and whisker
131
What types of graphs can discrete data be shown by?
Pie chart
| Bar chart
132
Define normal distribution
The AVERAGE DISTANCE of observations from the MEAN value
133
How is a an outlier determined by a box and whisker plot?
Outliers more than 1.5 X IQR from the upper/lower ends of the box
134
Describe normal distribution curve
Bell shaped
66% data within 1 SD
95% data within in 2 SD
135
Describe the relation ship between the median and mean in normal distribution
They are the same
136
If the data is symmetrical what should be used to summarise the data
Mean and SD
137
If the data is skew what should be used to summarise the data?
Median and IQR
138
Describe the relationship between mean, median and mode in a positive skew
Mode is less than Median which is less than Mean
139
Define reference range
The limits in which you would expect the majority of your data to fall
140
What is the difference between population and sample
```
Pop = all the people we are interested in
Sample = group within the pop which we will study
```
141
What is standard error?
The SD of all the sample means
SD/ square root of n
Standard error quantifies how good a sample result is likely to be
Estimate of precision
142
What are the different types of random sampling?
1) Simple
2) Stratified - divided into groups - sampled w/i groups
3) Cluster - groups of individuals sampled
143
Describe the relationship between sample size and confidence intervals
Sq sample size
| Half CI
144
What is the role of the confidence intervals?
Assesses the sample mean against the population mean
145
Give the stages of hypothesis testing
```
Set null hypothesis H0
Carry out experiment H1
Carry out significance test
Obtain test statistic
Compare to critical value
Obtain P value
Make a decision e.g. reject null hypothesis if P value less than 0.05
```
146
Define (absolute risk)
Incidence/ population
147
What is absolute risk difference?
Absolute additional risk following exposure
| Risk in exposed group - risk in unexposed group
148
What is meant in terms of absolute risk value when the confidence intervals include 0
No difference
149
Define no. needed to treat
The ADDITIONAL no of people you would have to treat to cure one extra person compared to the old treatment
150
Define no. needed to harm
The ADDITIONAL no of people who need exposure to the risk in order to have one extra person DEVELOP the disease
151
State the eq for NNT
1/absolute risk REDUCTION
152
State the eq for NNH
1/absolute risk DIFFERENCE
153
Define odds and give eq
The ratio of the probability of an occurrecne compared to the prob of a non-occurrence
Odds=prob/(1-prob)
154
Define odds RATIO
Ratio of odds for the exposed group and unexposed groups
155
Give an example of a study that OR is used
Case control study (relative risk can't be used here)
156
Why might OR be used in a cohort study / crossectional study? (where relative risk can be used)
Not clear which is IV and DV
157
What is the result of a medical error?
Adverse effect or near miss
158
Define adverse effect
harm caused to patient that is not a direct result to their illness or due to chance
159
Define error
Failure of a planned action to completed as intended, preventable event
160
State the different types of error
Error of omission
| Error of commission
161
Define error of omission
Delayed / not taken action
162
Define error of comission
Wrong action taken
163
What are the types of errors of omission/comission?
1) Professional negligence - skills not up to standard
2) Skill based error - routine task but distracted
3) Rule base - wrong plan
164
Define violation
Deliberate deviations from the practicals and rules
165
Disadvantage of personal error model?
Anticipation of blame encourages cover up (could make situation worse)
Dependant on trust
166
Advantages of systematic error model
Proactive rather than reactive
| Early event stopped than could have late damaging effects
167
Define team
A group of of people working together to achieve a common goal
168
Define stress
A state of mental, physical or emotional strain causing great worry
Demands > ability to cope
169
Give examples of acute stress
Danger
Hunger
Noise
Short term inf
170
Give examples of chronic stressors
Relationships
Financial
Work
Lack of friends
171
How can work causes stress?
High demand, low control
| Bullying/violence
172
Give example of internal stressors
Phys - inflammation
| Psych - personal expectations/beliefs
173
What are the 5 types of stress
```
Biochemical
Physiological
Behavioural
Cognitive
Emotional
```
174
State the signs of biochemical stress
Increased cortisol
175
State the signs of physiological stress
Shallow breathing
Increased HR
Increased acid in stomach
176
State the signs of behavioural stress
No sleeping
Not eating well (increased/decreased)
Increased alcohol consumption
Increased smoking
177
State the signs of emotional stress
```
Tearfulness
Mood swings
Aggression
Bored
Apathy (lack of emotion)
```
178
State the signs of cognitive stress
Headaches
Negative thoughts
Loss of concentration
179
What are the 3 ways in which one can respond to stress?
1) Fight/flight
2) General adaptation system
3) Interaction model (impact of stressor influenced by coping methods adopted/past experiences with stressors)
180
What are the mediating factors of stress
```
Social support
Beliefs/attitudes
Perception
Personality
Coping strategies
Lifesyle
Gender
```
181
3 stress management methods
1) CBT
2) Exercise
3) Self-help/support
182
Why is public health v imp in neurology?
Lack of curative treatment
| Need for prevention! And rehabilitation
183
Describe type A personality
```
Impatient
Competitive
Confident
Achievement orientated
Angry
> risk CHD
```
184
Define frailty
Weak physical and psychological states, low vigour, low resilience, and vulnerability
185
What are the 2 types of aging
Intrinsic - natural
| Extrinsic - due to external factors - UV/smoking
186
What are the effects of decreasing hospital stay?
- Pts return home w/ higher dependancy
- Increased pressure on commutity services
- Increase re-admission rate
187
How can we reduce hospital re-admissions for elderly people?
Increased support to discharged patients
| Managing chronic disease in the community
188
Why is back pain increasing? What can doctors do to reduce it?
```
Reduced phy activity
Inc obesity
Ageing pop
Education
Advise exercise
```
189
State factors affecting sexual repro health
Decrease age of puberty
Increasing age of first marriage
Media
190
State problems with sexual health education
In schools - poor attendance, teachers lack training
Not youth friendly (should involve youth in design)
Fear of judgement
191
State the 1 prevention for STIs
Education/awareness
| Vaccination
192
State the 2 prevention of STIs
Screening
| Partner notification
193
State the 3 prevention of STIs
Treatment
194
State causes of obesity
```
(Imbalance of energy intake and energy expenditure)
Car use/ decreased activity
Work - long hours/shift/sedentary
Grazing
Consumption increased
Food - high in fat, sugar, low in fibre (calorie dense)
Sugary drinks
Obesogenic lifestyle - watch TV/game
```
195
3 Diseases associated with obesity
Type II diabetes
CVR
Hypertension
196
Eq for BMI (N.B. doesn't measure adiposity)
Kg/m2
197
Normal BMI range
18.5-25
198
What are the public health implications of obesity?
Disease
| Increase pressure on health services
199
Give the risk factors of diabetes type II
```
Age
Gender
Ethnicity
BMI
Waist circumference
Hypertension
Impaired glucose tolerance
```
200
1 prevention for diabetes
Education - promotion exercise, change diet/weight loss
201
2 prevention for diabetes
Screening/routine bloods
202
3 prevention for diabetes
Management
| Treating symptoms
203
Why is it more difficult for someone who it already overweight to lose weight?
More difficult to exercise
Low-self esteem/embarrassed/scared
Employment/relationships
204
Describe the run away weight gain train model
Obesogenic environment
Ineffective breaks - physiological, prejudice, knowledge
Accelerators - ineffective dieting, low SES, self-esteem
205
Risk factors of CKD
Alcohol/drugs
Hypertension
Diabetes
206
What does small birth body size indicate in terms of health in later life?
```
CVR disease
Type II diabetes
Osteoporosis
Schizoprenia
Depression
```
207
What does large birth body size indicate in terms of health in later life?
Cancer
208
What are the 4 key concepts of health economics
1) Opportunity cost - sacrifice in terms of benefits forgone by not allocating all the resources to the next best activity
2) Economic efficiency - Quality Adjusted Life Years/max benefit
3) Increments and margins - new vs old
4) Equity - fairness
209
What makes a good team
```
Communication
Clearly identified common goal
Identified team leader
Feeling valued/team dynamic
Appropriate size
```
210
Benefits/importance of working in a team
Efficient
Improves decision making
Reduces medical error
211
Disadvantages of working in a team
Difficult to monitor due to involvement of different health professions(different managers)/environmental problems - diff offices/shifts
Feeling of lack of responsibility when problem shared
212
State the 7 steps to pt safety
1) Safe culture
2) Lead/support staff
3) Integrate risk management activity
4) Promote reporting
5) Communicate w/ patients/public
6) Learn and share safety lessons
7) Implement solutions to prevent harm
213
What is the SBAR checklist
```
For asking advice from senior e.g. over phone
Situation
Background
Assessment
Recommendation
```
214
What are the types of violation
Routine - cut corners
Necessary
Optimising - personal gain
215
Give an example of a hard defence
Engineered safety features
216
Give an example of a soft defence
Law, rules, regulations, checklists, handovers
217
Why is safety in healthcare compromised so often
Complex environment
Shared responsibilities
Resource intensive
System, patient and practitioner interaction
218
What is heterogeneity
Variability of results
219
Homogeneity?
Similarity of results
220
Define substance abuse
Ingestion of substance affecting the CNS which leaves to behavioural and psychological changes. Implicitly not for therapeutic use
221
RFs for substance abuse
```
FHx
Family conflict
Low SES
Friends (peer pressure)
Academic failure
```
222
Define addition
Physical and psychological dependance on a substance
Physical - w/o = withdrawal symptoms
Psychological - feel like you can't live w/o, fear, pain, guilt
223
Define an autonomous action
An intentional action, done with understanding and w/o controlling influences
224
Define malnutrition
A state nutrition in which the excess or deficiency of energy, protein and other nutrients causes measurable adverse effects on the body and clinical outcome
225
Describe the MUST tool
BMI
Unexplained weight loss/gain in last 3-6 months
Assess acute disease (e.g. NBM more than 5 days)
226
Define alcohol abuse
```
1 or more in the last 12 months of:
Role failure
Relationship problems
Risk of bodily harm
Problems with the law
```
227
Define alcohol dependance
```
3 or more in the last 12 month of:
Withdrawal sym
Tolerance
Can't stay w/i limit
Keep drinking despite problems
```
