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Phase 1 Public Health > Public Health > Flashcards

Public Health Flashcards

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1
Q

What are the public health domains?

A

Health protection eg infectious diseases, pollution
Health improvement eg lifestyle, housing, education
Healthcare public health eg clinical effectiveness, efficiency, equity

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2
Q

What are the different health behaviours?

A

Health behaviour - looking to prevent disease
Illness behaviour - looking to seek remedy from eg GP
Sick role behaviour - aiming to get better

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3
Q

When can you disclose patient information?

A

If required by law eg notifiable diseases (cholera, yellow fever, plague), court order
If patient has consented
If their is public interest eg serious communicable disease or serious crime

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4
Q

What is the criteria for breaching confidentiality?

A

Anonymity if practicable
Patient consent
Keeping details to minimum
Meets current law (data protection)

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5
Q

What are the 4 elements to the health belief model? (behaviour change)

A

Individual must believe;

  • they are susceptible to disease
  • disease has serious consequences
  • taking action reduces their risks
  • benefits of taking action outweigh the costs
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6
Q

What are the stages of the transtheoretical model of behaviour change? Apply to smoking

A
  1. Pre-contemplation (smoker is not thinking about giving up)
  2. Contemplation (smoker is considering but not ready to quit)
  3. Preparation (smoker is thinking about quitting and is taking steps to prepare)
  4. Action (ex-smoker, quit for <6 months)
  5. Maintenance (non-smoker, quit for >6 months)
  6. Relapse (quit then lapse led to smoking being resumed)
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7
Q

What are the stages of the Nuffield ladder of intervention?

A
  1. Do nothing/observe
  2. Provide info
  3. Enable choice
  4. Guide choice through changing default
  5. Guide choice through incentives
  6. Guide choice through disincentives
  7. Restrict choice
  8. Eliminate choice
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8
Q

What are the 3 levels of ethics?

A

Meta-ethics - fundamental questions eg right/wrong/good
Ethical theory - philosophical attempts to create ethical theories
Applied ethics - investigation into specific areas eg environment

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9
Q

What are the 4 ethical arguments?

A

Deductive - generalised theory applied to all situations
Inductive - generate theory for situation
Considering what we believe in - intuition and feelings
Ethical analogies

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10
Q

What are the ethical fallacies?

A

Ad hominem (attack person’s character rather than content of argument)
Authority claims
Begging the question (assuming the initial point of the argument)
Dissenters (identifying those who disagree)
Motherhoods (soft statement to disguise disputable one)
Confusing necessary and sufficient
No true Scotsman

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11
Q

What is consequentialism?

A

Evaluating an act solely in terms of its consequences

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12
Q

Utilitarianism sub categories? (type of consequentialism)

A

Utilitarianism- maximising good
Preference utilitarianism - utility increases as preference satisfied
Hedonistic - maximise pleasure over pain
Act- which consequence is of best value
Rule - likelihood of adherence to different actions

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13
Q

What is deontology? - Kantianism

A

The features of the act themselves determine worthiness.

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14
Q

What is virtue ethics?

A

Focusing on the character, integrates reason and emotion

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15
Q

What are the five focal virtues?

A

Compassion, conscientiousness, discernment , integrity, trustworthiness

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16
Q

What are the 5 ethical theories?

A

Virtue, categorical, imperative, utilitarianism, 4 principles

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17
Q

What are the 4 principles/ prima facie?

A

Autonomy (respect decisions of patients)
Benevolence (provide benefits)
Non-maleficence (do no harm, reduce/prevent harm)
Justice (need/benefit, fairness, utility/QALY)

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18
Q

What are the GMC duties of a doctor?

A

Protect and promote health
Provide good standard of practice and care
Recognise and work within your limits of competence
Work with colleagues to best serve patient interest
Treat patients as individuals and respect their dignity

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19
Q

What is the chain of infection?

A 
Susceptible host
Causative micro-organism 
Reservoir 
Portal of entry/exit
Mode of transmission (exogenous/endogenous spread)
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20
Q

Three levels of hand-washing?

A

Level 1=social/routine
Level 2=antisepsis
Level 3=surgical

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21
Q

Models of health and illness?

A

Biomedical model- mind/body treated separately

Social model- hollistic approach

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22
Q

EBM: what is the PICO framework?

A

P=population/patient under study
I=intervention (exposure/treatment/procedure)
C=control/comparator
O=outcome

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23
Q

3 A’s for smoking cessation?

A

Ask-about current smoking status
Advise-health consequences of smoking and benefits of quitting
Assist-refer to local cessation services

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24
Q

Regulatory interventions to aim to reduce smoking?

A 
Ban on smoking in public
Minimum legal age for purchase
Ban on advertising 
Ban on cigarette vending machines in public areas
Ban on smoking in cars with children
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25
Define primary prevention
Prevent a disease from occurring; change people's exposure to risk eg. change 4 life, fluoridation of water, MMR immunisation
26
Define secondary prevention
1. Detect early disease to alter its course eg breast cancer screening 2. Interventions to prevent recurrence of disease eg aspirin treatment to prevent further MIs
27
Define tertiary prevention
Minimise disability and prevent complications of a disease, slow down progression of disease eg rehab post stroke
28
What is the prevention paradox?
Something brings lots of benefit to a population but it provides little benefit to each individual eg only 1 life saved for every 400 wearing seat-belts
29
Screening criteria? Wilson and Jungner criteria.
CONDITION; serious/important, natural history well understood, detectable early stage TREATMENT; acceptable, facilities for diagnosis and treatment available, adequate provision (not unimaginable extra workload) TEST; suitable for early stage, acceptable to patients, repeated BENEFITS; agreed policy on whom to treat, costs balanced against benefits, risks
30
Define sensitivity
The proportion of people with the disease who are correctly identified by the screening test. True positive/disease total
31
Define specificity
The proportion of people without the disease who are correctly excluded by the screening test True negative/no disease total
32
Define positive predictive value
The proportion of people with a positive test result who actually have the disease
33
Define negative predictive value
The proportion of people with a negative test result who do not have the disease
34
Define prevalence
The proportion of a population found to have the disease at a point in time
35
Define incidence
The rate at which new cases occur in population in a certain time period
36
3 different biases arising from screening
SELECTION bias- who participates may be different from who doesn't LEAD TIME bias- screening gives impression of longer survival time LENGTH TIME bias- more likely to identify eg long lived slow growing tumours rather than those with shorter presentation time
37
Two outcomes of medical error?
Adverse event or near miss
38
What are the types of human error?
Errors of OMISSION (required action not taken) Errors of COMMISSION (taking wrong action) Errors of NEGLIGENCE (not meeting the standard) SKILL based errors (frequently memory lapses during routine task) RULE/KNOWLEDGE based errors (more likely when task is complicated)
39
What are the information processing limitations?
Automaticity, cognitive interference, selective attention, cognitive bias, transferring expectations to similar new events
40
Interventions for mental health
Community level, service organisation level, individual level, IAPT service model: high/low intensity care Behavioural eg sex education Biomedical eg voluntary male circumcision Structural eg decriminalisation of sex work
41
Stress and stressors types
Distress (negative-damaging and harmful) Eustress (positive-beneficial and motivating) ``` Stressors: Chronic (health, finances, family) Acute (noise, danger, infections) Internal (physical and psychological) External (environment, social, cultural) ```
42
Types of responses to stress?
Biochemical/chemical/hormonal (metabolic changes) Physiological (shallow breathing, increased bp) Emotional (mood swings, tearful)- positive effect and negative effect Cognitive (negative thoughts, loss of concentration) Behavioural (smoking, alcohol, food consumption, sleep disturbance)
43
Two levels of behaviour change?
Population level-health promotion eg screening, 5-a-day | Individual level-patient centred approach, care in response to individual's needs eg NRT
44
BMI formua
weight(kg)/height^2(m^2)
45
BMI ranges
<18.5=under weight 18.5-25=normal 25-30=over weight >30=obese
46
7 domains of energy balance
Food environment, food consumption, individual activity, activity of the environment, societal influences, individual psychology, individual biology
47
Macronutrients kcal/g
Protein=4.7kcal/g Carbohydrate=3.6kcal/g Fat=9.5kcal/g Alcohol=7.0kcal/g
48
Factors promoting overeating
Meal size, satiation (what brings eating to an end), satiety (inter-meal period), energy density of foods, alcohol, variety, social facilitation, stress, sleep, liquids/solids
49
NHS big 5 for CAM
chiropractic, acupuncture, homeopathy, osteopathy, herbal medicine
50
House of Lords classification CAM?
Group 1- some evidence = NHS big five Group 2- complementary/supportive capacity alongside conventional medicine eg massage, aromatherapy Group 3- traditional systems backed by historical practice eg traditional Chinese medicine
51
Classification of CAM by therapeutic similarity?
``` Whole/alternative Mind-body Energy Manipulative Biologically-based ```
52
Who uses CAM?
<35-60>, women, higher income, poorer health status
53
Why use CAM?
``` effectiveness gaps in conventional medicine eg IBS, eczema, chronic pain concerns regarding side effects history of poor communication with doctors naivety disease not life threatening gain control and improve coping skills ability to avoid medication improved satisfaction ```
54
Issues around CAM?
unrealistic expectations delayed conventional care general safety- unregulated practitioners, drug interactions
55
Causes of the ageing population?
Improved interventions, sanitation, housing, nutrition Decrease in fertility Decrease in premature mortality
56
Consequences of ageing population?
``` Pension pay outs larger than planned Strain on health and care services Rising inequalities-more affluent social groups use services for longer Mental health Social isolation and loneliness Bed blocking Informal care burden (elderly wives with conditions themselves) Comorbidity and polypharmacy ```
57
Define opportunity cost
the sacrifice in terms of benefits forgone from not allocating resources to the next best activity
58
Define economic efficiency
resources allocated between activities in order to maximise benefit
59
Define economic evaluation
assessing whether benefit is maximised ie measuring and assessing economic efficiency
60
How to perform economic evaluation
Cost effectiveness analysis: measured in natural units-incremental cost per life year gained Cost utility analysis: measured in QALY-incremental cost per QALY gained Cost benefit analysis: measured in monetary units-net monetary benefit Cost minimisation analysis
61
QALY?=
quality adjusted life year=lengthxquality
62
ICER?=
Incremental cost effectiveness ratio=difference in cost/difference in benefits NB/units change depending on question
63
Define equity
the fairness/justice of distribution of costs and benefits

Phase 1 Public Health (1 decks)

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