Public health Flashcards
(195 cards)
1
Q
Epigenetics
A
how the environment effects genes
2
Q
Allostasis
A
how our systems have adapted to react rapidly to environmental stressors to maintain homeostasis
3
Q
Allostatic load
A
Overtaxation of our systems leads to impaired health
4
Q
Salutogenesis
A
physiological changes from experiences that promote health
5
Q
Purpose of primary care
A
Manage illness and clinical relationships over time, promote health, shared decision making, preventing illness
6
Q
Health needs assessment
A
A systematic method for reviewing the health issues facing a population - allocation of resources that reduces health inequalities
7
Q
What are the 4 types of need
A
Felt need (individual perceptions), Expressed need (seek to overcome variation in normal health), normative need (professional defines intervention for expressed need), Comparative need (comparing interventions)
8
Q
Define primary, secondary and tertiary prevention
A
Primary (preventing disease before it happens),
Secondary (catching disease at early phase),
Tertiary (preventing complications)
9
Q
Criteria for screening programme
A
Important condition, history of condition known, condition has a latent stage, the screening test is suitable and acceptable, the treatment is effective, agreed population to treat, cost of screening economical
10
Q
Define sensitivity
A
the proportion of people with the disease who are correctly identified by the screening test
11
Q
Define specificity
A
the proportion of people without the disease who are correctly excluded by the screening test
12
Q
Positive predictive value
A
the proportion of people with a positive result who actually have the disease
13
Q
Negative predictive value
A
the proportion of people with a negative test who do not have the disease
14
Q
Define incidence
A
New cases over time
15
Q
Prevalence
A
existing cases in a point of time
16
Q
Attributable risk
A
incidence in exposed minus incidence in unexposed
17
Q
Relative risk
A
incidence in exposed divided by the incidence in unexposed
18
Q
Number needed to treat
A
the number of patients we need to treat to prevent one bad outcome
19
Q
What is confounding?
A
When there is another IV acting on the DV
20
Q
Reverse causality
A
outcome causes the exposure rather than the exposure causing the outcome
21
Q
Sources of information bias
A
Observer, Participant, Instrument
22
Q
4 factors of the health belief model
A
1) perceived benefits/perceived barriers 2) perceived threat 3) self-efficacy 4) cues to action
23
Q
6 stages of change
A
Precontemplation, contemplation, preparation, action, maintenance, relapse
24
Q
Maslows hierarchy of needs from bottom to top
A
physiological, safety, belonging, esteem, self-actualisation
25
Biggest cause of homelessness
relationship breakdown
26
What types of error can be made?
Skill based errors (action is made that is not intended), Rule based errors (incorrect application of a rule), Knowledge-based errors
27
What are the different perspective on error?
Person approach (individuals fault) System approach (many causal factors, need more safety nets)
28
What is a never event?
Serious, largely preventable patient safety incidents that should not occur if preventative measures are in place
29
How to reduce harm
Simplification and standardisation, checklists, IT, team training, risk management programmes, implementing evidence based findings
30
Why do things go wrong?
System failure, Human factors, Judgement failure, Neglect, Poor performance, Misconduct
31
Types of learner
Theorist (questions ideas likes challenges), Activist (likes experiences), Pragmatist (likes feedback), Reflector (watches others)
32
Kolb's learning cycle
Experience (activist) -> Reflect (reflector) -> Conclusions (theorist) -> Plan for next time (pragmatist)
33
Ethnocentrism
The tendency to evaluate other groups according to the values and standards of one's own cultural group with the conviction that ones own cultural group is superior to other groups
34
4 pillars of ethics
autonomy, beneficence, non-maleficence, justice
35
3 types of resource allocation
Eqalitarian - provide all care that is necessary to everyone
Maximising - based solely on consequence
Libertarian - each individual responsible for their own health
36
What is Jonsens rule of rescue
We have an obligation to help others regardless of the expense
37
Define utilitarianism
Best option to maximise happiness for the greatest number of people
38
Deontology
the food of the action themselves rather than the consequences
39
Virtue Ethics
Character based ethics
40
What is the bolam rule
would a group of reasonable doctors do the same?
41
Wat is the bolitho rule?
would that be reasonable for them to do so?
42
3 domains of public health
Health improvement, health protection, improving services
43
What is the nudge theory?
nudge the environment for positive change - fruit near checkouts
44
What is selection bias?
selection of study population
45
What is information bias?
measurement bias, observers expectations influence reporting
46
What is publication bias?
trials with negative results less likely to be published
47
What is article 8 of the human rights act
right to respect for privacy and family life
48
What is article 3 of the human rights act
right to freedom from inhuman degrading treatment
49
What is article 2 of the human rights act
right to life
50
What is article 14 of the human rights act
right to freedom from discrimination
51
what is article 12 of the human rights act
right to marry and found a family
52
What is included in the newborn screening
Sickle cells, congenital hypothyroidism, CF, PKU, MCADD, MSUD
53
Name 5 features of high risk assessment of a child
Pale/mottled/ashen/blue skin, no response to social cues, does not wake, weak/high-pitched/continuous cry, RR>60, grunting, chest undraping, reduced skin turgor, bulging fontanelle
54
Signs of dehydration
prolonged cap refill, abnormal respiratory pattern, abnormal skin turgor, weak pulse, cool extremities
55
What are the 3 types of emergency contraceptions and the hours within they can be used
POP (72 hours), Ulipristal acetate pill (120 hours), ICUD (120 hours)
56
Name 5 pros and 5 cons to the OCP
Pros (reduce endometrial cancer risk, reduce heavy, irregular and painful bleeding, reduce iron deficiency anaemia, reduce pain due to endometriosis, stop acne, reduce chance of ectopic pregnancy) Cons (blood clots, increase LDL, migraines, cervical)
57
Name a anticholinesterase inhibitor
Donepezil, Galatamin, Rivastigmine
58
Name a NMDA receptor blocker
Memantine
59
What is the mental capacity COP3
An expert opinion of a mental capacity assessment for an application to make decisions for them
60
What is DOLS
procedure prescribed in law when it is necessary to deprive someone of their liberty who lacks capacity to keep them safe
61
What is an IMCA
Independent mental capacity advocacy - the right to receive independent support and representation
62
Name 5 differentials of low mood
Dementia, anxiety, depression, OCD, hypothyroidism, MS, adjustment disorder, bit b12 deficiency
63
Risk factors for depression
Isolation, lack of employment, no family support, substance abuse, chronic illness, PD, traumatic event
64
Risk factors for suicide
Previous attempts, plan, history of depression, substance abuse, physical illness
65
Treatment of TB
R- rifampicin, I - isoniazid, P - pyrazinamide, E - ethambutol
66
How long can a managing authority deprive someone of their liberty in an emergency?
7 days for urgent authorisation
67
What is common law?
The framework that govern the emergency management of patients who refuse treatment
68
what is the health needs made up of?
need - ability to benefit from an intervention
demand - what people ask for
supply - what we provide
69
factors that affect need
current research agenda
| cultural and ethical determinants
70
factors that affect demand
media
medical influences
social/educational influences
71
factors that affect supply
public and political pressure
| historical patterns
72
what are the 4 types of need
felt need - individual perception
expressed need - demand
normative need - professional defines the intervention appropriate for the demand
comparative need - comparison between severity, range of interventions and cost
73
what is the health needs assessment
establish what population needs what service
74
cycle of health needs assessment
plan
implement
evaluate
assess
75
what is the epidemiological approach to health needs assessment
its the biomedical model
| looks at the problem and addresses them based on the extent of the issue
76
advantages of epidemiological health needs assessment
addresses a clear problem
77
disadvantages of the epidemiological approach
expensive
| data collection and analysis
78
What is the corporate approach to health needs assessment
stakeholders ask what is needed
79
advantages to corporate approach
based upon the wishes and needs of the relevant parties
80
disadvantages to corporate approach
demands and needs blur
| may fit the agenda of the stakeholder -- bias
81
What is the comparative approach to health needs assessment
compares the health needs and supplies of one population with that of a similar population
82
advantages to comparative approach
can see evidence of success in population
| fairly quick and inexpensive
83
disadvantages to comparative approach
hard to find similar population
84
What are the 3 evaluation frameworks
Donabedian (inputs --> outcomes)
Black (efficacy --> humanity)
Maxwell (efficacy --> acceptability)
85
What is an ecological study
carried out at population level rather than individual level
86
what is a cross sectional study
measures prevalence
| data collected at a single point in time 'snapshot'
87
what is a case control study (reverse of cohort)
identifies those with and without the outcomes and determines the previous exposure to potential risk factors
outcome -->exposure
88
what is a cohort study
measures the exposures of interest and follows up participants to measure incidence of the outcome of interest
exposure --> outcome
no exposure --> outcome
89
what is an intervention study
participants are actively allocated an intervention by the investigators
90
what is a randomised control trial
random allocation to intervention or control
91
what is prevalence
the number of existing cases in a defined population at a defined point in time divided by the total number of pepole in the population at that time
92
Types of surveillance
passive
sentinel
active
enhanced
93
notifiable diseases
S - scarlet fever
T - TB
```
M - MMR
A - acute meningitis
D - diphtheria
A - acute encephalitis
M - meningococcal septicaemia
M - malaria
W - whooping cough
```
94
what is incidence
number of new cases in a specified time period divided by the population at risk during this time period
95
what is odds
number of new cases in a specified time period divided by the number of people who did not become a case in that time period
96
what is risk
number of new cases among contact in a specified time period over the total number of contacts of a primary case in that time period
97
what is primary prevention
prevent the disease before it ever occurs
| education/immunisation
98
what is secondary prevention
reduce the impact of the disease by detecting it early
| screening
99
what is tertiary prevention
improve quality of life/prevent complications
| treatment
100
what is the prevention paradox
if something brings about a lot of benefit to the population then it provides little benefit to each individual
101
Wilsons and Jungners screening criteria
```
the condition should be important
the natural history of the disease should be well known
detectable at an early stage
suitable test at early sage
acceptable test
test is repeatable
accepted treatment
facilities available
adequate health provision
agreed policy on who to treat
cost effetive
risks < benefits
```
102
New born screening all of them
```
sickle cell
CF congenital hypothyroidism
MSD
MCADD
PKU
GAT1
Isovaleric acidaemia
homocysteine uria
```
103
what is selection bias with regards to screening
people who choose to participate in screening may differ from the general population
those at higher risk may go due to a FH
those at lower risk may go because they are more educated
104
Length time bias with regards to screening
screening happens at regular intervals
what if the disease is missed during the interval
shorter aggressive disease is usually missed
105
lead time bias with regards to screening
difference between knowing about the disease and making a difference
106
what is sensitivity
correctly identified by the screening test a/a+c
107
what is specificity
correctly excluded by the screening test d/b+d
108
what is positive predictive value
proportion of people with a positive test who have the disease a/a+b
109
what is negative predictive value
proportion of people with a negative result who do not have the disease d/c+d
110
types of errors
```
sloth
fixation
ignorance
communication breakdown
playing the odds
bravado
miss-triage
lack of skill
system errors
```
111
Why do errors happen
```
human error
misconduct
judgement failure
neglect
poor performance
```
112
what is a never event
adverse events that should never happen
113
what do the components of the swiss cheese model represent
cheese slices - barriers to error propagation
| holes - failures in the barriers
114
negligence has occurred if..
there was a duty of care
that was breeched
and a patient came to harm
and that harm was due to the breech in the duty of care
115
What is bolams test
would another doctor do the same
116
what is bolithos test
would it be reasonable for them to do so
117
stages of change
transtheoretical
health belief
theory of planned behaviour
118
what is the inverse care law
those with the greatest need for health care access healthcare the least
due to: no transport, lack of understanding, missed days of work, no childcare
119
Bradfords causation
```
B - biologically plausible
R - reverse causality
A - association
D - definite
F - faithful (do our results match others)
O - obscure (any confounders)
R - reversible
D - dose-response
```
120
Relative risk
the risk of getting the disease taking the drug relative to the risk of getting the disease not taking the drug
drugAR/placeboAR
121
Absolute risk
the number of cases who got the disease divided by the population
122
NNT
100/(drugAR - placeboAR)
123
Absolute risk reduction
people with disease in control group - proportion of disease in exposed group
124
Attributable risk
proportion of disease in exposed group - proportion of disease in unexposed group
125
5 stages of grief
```
denial
anger
bargaining
sadness
acceptance
```
126
4 essentials to grieving
accept the reality of loss
experience grief
adjust to life without the person
withdraw emotional energy
127
What is horizontal equity
equal treatment for equal need
128
What is vertical equity
unequal treatment for unequal need
129
how many grams of alcohol in 1 unit
8g
130
3 domains of public health
health improvement
health protection
improving services
131
in the AUDIT alcohol screening questionnaire what score is counted as hazardous and what is counted as dependence
> 8 hazardous
> 13 (women) dependence
> 15 (men) dependence
132
Signs of alcohol dependence syndrome
```
> 12 months
tolerance
physiological withdrawal
difficulty controlling quantity
neglect of social life
```
133
Wernickes triad
1) mental confusion
2) opthalmoplegia
3) ataxia
134
What drug reverses opiate overdose
naloxone
135
what drugs are used for alcohol detoxification
lofexidine, buprenorphine
136
What drugs are used for maintenance in alcohol dependence
methadone
137
What drug is used for relapse prevention in alcoholics
naltrexone
138
What is the theory of planned behaviour
involves attitude, subjective norm, perceived behavioural control and behavioural intention
139
What does the transtheoretical model involve
```
precontemplation
contemplation
preparation
action
maintenance
```
140
what is the nudge theory
modifying the environment to make the best option easiest
141
Maxwells 6 dimensions of quality
```
effectiveness
efficiency
equity
accessibility
acceptability
appropriateness
```
142
What is the centor criteria
fever
tonsillar exudates
absent cough
lymphadenopathy
143
What is the main cause of homelessness
relationship breakdown
144
What is passive surveillance?
routine reporting
eg notifiable diseases
adv - low cost
disadv - under reporting
145
What is active surveillance?
health data actively sort out
| eg outbreaks, health surveys
146
What is sentinel surveillance?
selective institutions survey data eg GP
look at trends at their practice
disadv - not good for uncommon disease
147
What is enhanced surveillance?
active surveillance in a particular area
148
What is length time bias
missing the disease as screening is at regular intervals
| disease may be more aggressive or short lived
149
what is lead time bias
the time between knowing about the disease and making a dfiference
150
Reasons for association (why the results may be what they are)
```
Bias
Confounding
Chance
Reverse causality
True association
```
151
Methods of prevention
```
vaccines
education
prophylaxis
contact tracing
surveillance
treatment
```
152
Define endemic
persistent level of disease occurence
153
Define hyper-endemic
persistently high levels of disease occurence
154
Define sporadic
irregular pattern of occurence
155
Define epidemic
occurrence within an area in excess of expected for given time
156
Define pandemic
epidemic widespread over several countries
157
Define passive surveillance
notifiable disease reporting
158
Define sentinel surveillance
GP survey their info from patients
159
Define active surveillance
surveys
positive and negative reporting
good for rarer stuff
160
Define enhanced surveillance
form of active surveillance but in one area - checking out the effect of a new vaccine
161
WHat are the strengths of a RCT
minimise bias and confounders
multiple outcomes can be studied
incidence can be measured
look at causal relationships
162
What are the weaknesses of a RCT
```
expensive
big study teams needed
ethical concerns
complex to manage
large drop outs
conflicting evidence
```
163
What is the Bradford-Hill Criteria
look at how good the findings are
A - analogy - effect of similar factors
C - consistency - are findings reproducible
C - coherence - are the coherent with existing findings
E - experimental evidence
S - strength - effect size
S - specificity - more specific an association the stronger the relationship
164
what is a p value
the probability of an event occurring given that the null hypothesis is true
165
what is type 1 error
accidentally reject the null
| false positive
166
what is type 2 error
accidentally accepting the null
| false negative
167
what is bradshaws taxonomy need
felt need - individual perception
expressed need - demand
normative need - professional defines need
comparative need - comparison of needs
168
needs led planning cycle
needs assessment
planning
implementation
evaluation
169
what is wanted and needed by not supplied
cure for cnacer
170
what is needed and supplied by not demanded
smoking cessation
171
what is wanted and supplied but not needed
antibiotics
172
what is needed, wanted and supplied
free contraception
173
advantage of epidemiological assessment
addresses clear problem
174
disadvantage of epidemological
can be expensive
175
advantage of corporate apprach
recognises people important in the services success
176
disadvantage of the corporate approach
bias
177
advantage of comparative approach
see benefit in the population
| quick and inexpensive
178
disadvantage of comparative approach
hard to find a similar population
179
what is the donabedian evaluation framework
eg evaluating a programe
inputs
process
outputs
outcomes
180
what is the black evaluation framework
eg priority setting
efficacy
efficency
equity
humanity
181
what is the maxwell evaluation framework
eg screening programme
```
efficacy
efficiency
equity
access
acceptability
```
182
maslows hierarchy of need
```
physiological needs
safety needs
belongingness and love needs
esteem needs
self-actualisation
```
183
Services for drug users
S-sexual health screening
EX - needle exchange
C - contraception
S - signposting
H - health check
I - immunisations
T - treatment
184
what drug detoxification drug is associated with rapid withdrawal symptoms
lofexidine
| full agonist so associated with rapid and severe withdrawal symptoms
185
opiate withdrawal symptoms
```
low energy
irritability
anxiety
insomnia
aches and pains
abdominal cramping
```
186
transtheoretical model
```
stages of change
precontemplation
contemplation
preparation
action
maintenance
relapse
```
187
health belief model
perceived benefits vs perceived barriers
perceived threat
self-efficacy
cues to action
188
theory of planned behaviour
(attitute) behavioural beliefs - what do i think will happen
(subjective norm) normative beliefs - what do others think
(perceived behavioural control) control beliefs - do i think i can realistically do it
189
What is DoLS
procedure prescribed in law when it is necessary to deprive of their liberty a resident or patient who lacks capacity to consent to their care and treatment in order to keep them safe from harm.
190
5 principled of MCA
1) presume capacity 2) support decisions
3) unwise decision does not mean they lack capacity
4) if no capacity act in best interests
5) least restrictive intervention
191
what is the acid test of DoLS
- does the person lack capacity to consent to the arrangements
- is the person subject to continuous supervision
- is the person free to leave
192
what are the 3 types of resource allocation
Egalitatianism - care accessible to everyone
Maximising - based on consequence (the ones that are most in need)
Libertarianism - each individual responsible for their own health
193
Define deontology
looks at the good of the action itself rather than the consequences
194
Virtue ethics
Looks at the moral character of the person rather than the action
195
Name 5 types of error
```
Sloth
Fixation
Communication breakdown
Poor team work
Playing the odds
Ignorance
Mis-triage
Lack of skill
System error
```
