Public health Flashcards
(73 cards)
1
Q
What is the biopsychosocial model?
A
An integrated approach to health and disease where:
- Biological - genetic, biochemical etc.
- Psychological - mood, behaviours, personality etc.
- Social - familial, education, cultural, socio-economic, medical etc.
2
Q
What is the definition of need with regards to health needs?
A
Need is the ability to benefit from an intervention
3
Q
What is the definition of demand with regards to health needs?
A
Demand (want) is what people ask for
4
Q
What is the definition of supply with regards to health needs?
A
Supply is what we actually provide
5
Q
What is Bradshaw’s Taxonomy of need?
A
Felt: individual perceptions of variation of normal health
Expressed: individual seeks help to overcome the variation in normal health (demand)
Normative: Professional defines intervention appropriate for the expressed need
Comparative: comparison between severity, range of interventions and cost
6
Q
What is the capacity to benefit?
A
An individual’s ability to benefit from an intervention
7
Q
What are examples of interventions that are wanted and supplied? (not needed)
A
- Antibiotics fr viral illness
- PSA for prostate cancer - not always clinically appropriate
8
Q
What are examples of wanted and needed? (not supplied)
A
- Cure for cancer
- Cures for chronic disease
- Better mental health services
(ideally nothing should be in this section)
9
Q
What are examples of needed and supplied? (not wanted)
A
- Smoking cessation (not wanted by all)
- Alcohol cessation (not wanted by all)
- Colorectal cancer screening (certain people don’t engage)
10
Q
What are examples of interventions that are wanted, needed and supplied?
A
- Free contraception
- Breast cancer screening
- smoking cessation
11
Q
What may influence need/supply/demand?
A
- Media
- Cultural and ethical determinants
- Current research agenda
- Public and political pressure
- Historical patterns, inertia, momentum
- Social and educational influences
- Medical influences
12
Q
What is the health needs cycle?
A
1) Needs assessment (e.g. PICO - establish what population needs and what service)
2) design
3) launch
4) implementation
5) evaluation
REPEAT
1)…
13
Q
What approaches may be taken to health needs assessment?
A
- Epidemiological (biomedical model)
- Corporate (involves stakeholders - asking what is needed)
- comparative (compares health needs with similar populations)
14
Q
What are the advantages of an epidemiological approach to health needs assessment?
A
Addresses a clear problem
15
Q
What are the disadvantages to an epidemiological approach to health needs assessment?
A
- Can be expensive
- involves analysis of existing data and data collection
reinforces biomedical model
16
Q
What are the advantages of corporate approach to health needs assessment?
A
- recognises people important in the services success
- based upon wishes and needs of relevant parties
17
Q
What are the disadvantages of a corporate approach to health needs assessment?
A
- may be blurring of demands and needs
- may fit an agenda of a particular stakeholder
- can involve political agendas
- BIAS
18
Q
What are the advantages of comparative method for health needs assessment?
A
- Can see evidence of benefit/success in population
- fairly quick and inexpensive
19
Q
What are the disadvantages of comparative method for health needs assessment?
A
- hard to find a similar population
20
Q
What are the evaluation frameworks for interventions?
A
- Donabedian (evaluates programmes looking at the structure/inputs -> process -> output -> outcome)
- Black (e.g. priority setting - looks at effectiveness -> efficiency -> equity -> humanity)
- Maxwell (e.g. looking at screening programme- effectiveness -> efficiency -> equity -> access -> acceptability -> appropriateness)
21
Q
What are ecological studies?
A
A study carried out at a population level rather than an individual one (is descriptive)
22
Q
What is a multi-group ecological study?
A
Compares different groups at one point in time
23
Q
What do Cross-sectional studies do?
A
Measure the frequency (prevalence), examine distribution and determinants, data is collected at a single point in time (a snapshot).
Can be DESCRIPTIVE or ANALYTICAL
24
Q
What are the observational studies?
A
Case-control study
Cohort study
25
What are case-control studies?
(the reverse of cohort)
- identify those with and without the outcome
- determines previous exposure to potential risk factors
- must have a prior hypothesis
26
What are cohort studies?
Measure exposures of interest and follow up study participants over time to measure incidence of outcome and interest
- observational study
- measures incidence
- defined on the basis of absence or exposure to suspected risk factor
27
What are intervention studies?
-RCTs
28
What is a randomised controlled trial?
An experimental study where participants are randomly allocated to intervention or control with predefined rules for eligibility, endpoints, follow-ups, analysis plans and stopping rules
- the gold-standard of study designs
29
Why are stopping rules necessary in RCTs?
- if becomes clear that harm or benefit is being shown - rules say that it should stop
- predefined stopping rules should be in place to ensure:no undue risk to participants, control group aren't being deprived of an effective intervention, no continuing an ineffective intervention
30
What are the strengths of RCTs?
- Minimise bias and confounders
- multiple outcomes can be studied
- 'incidence' of outcome can be measured
- strong evidence of casual relationships between intervention and outcome can be provided
31
What are weaknesses of RCTs?
- expensive
- requires big study teams
- multi-centre studies
- ethical concerns
- complex to manage
- large participant drop out rates
- conflicting evidence from trials can effect meta-analysis
32
What does PICO stand for?
P- population/patient/problem
I- intervention/exposure
C - Comparison/control
O- Outcome
33
What is the prevalence equation?
Prevalence = number of existing cases at one time point / total number of individuals in the defined population at the same time point
- is a proportion that can never be greater than 1
34
How can prevalence be monitored?
Actively - seek out people with the disease to establish prevalence
Passively - taken from data at 'sentinel' GP practices or anonymous information that is given e.g. STI screening tests at sexual health clinics - can establish prevalence from results
35
What are methods of surveillance?
- passive (most common)
- Sentinel (sample surveillance- good for common diseases)
- active
- Enhanced
36
What are the public health notifiable diseases?
- acute encephalitis
- acute infectious hepatitis
- acute meningitis
- acute poliomyelitis
- anthrax
- botulism
- brucellosis
- cholera
- diphtheria
- enteric fever
- food poisoning
- haemolytic uraemia syndrome (HUS)
- infectious bloody diarrhoea
- invasive group A streptococcal disease
- Legionnaire's disease
- Leprosy
● Malaria
● Measles
● Meningococcal septicaemia
● Mumps
● Plague
● Rabies
● Rubella
● Severe Acute Respiratory Syndrome (SARS) ● Scarlet fever
● Smallpox
● Tetanus
● Tuberculosis
● Typhus
● Viral haemorrhagic fever (VHF)
● Whooping cough
● Yellow fever
37
What is the odds equations?
number of new cases in a specified time period / number who did not become a case during that time period
38
What are the three types of incidence:
Odds
Rate
Risk
(from ecological or cohort studies)
39
What is the risk equation?
Number of new cases among contact in a specific time-period/total number of individuals at risk in the population at the start of the time period
40
What is the incidence rate equation?
number of new cases in a specified time period / total person-time at risk during that time period
41
What is primary prevention?
aims to prevent a disease before it ever occurs:
- education
- immunisation
42
What is secondary prevention?
aims to reduce the impact of a disease - halt or slow progression
- screening
- regular check ups
43
What is tertiary prevention?
Reduce the impacts of a disease - improve QoL or function
- treatment
- rehab
44
What is an example of primary prevention?
- change4life - lifestyle changes
- childhood immunisations
- fluoridation of water
45
What is an example of secondary prevention?
- breast cancer screening
| - aspirin treatment to prevent further MIs
46
What is an example of tertiary prevention?
- rehab post stroke
47
What is the prevention paradox?
If something brings about a lot of benefit to the population, then it provides little benefit to the individual
48
Screening can be primary or secondary, what does it screen for in each and why?
Primary - risk factors to reduce them
| Secondary - to detect early disease so can alter disease course
49
What are the two screening criteria?
Wilson and Jungner
| WHO screening criteria
50
How are the screening criteria broken down?
The condition, the treatment, the test, the risks and benefits
51
Examples of screening?
- breast cancer screening
- colorectal screening
- STI screening
- Diabetic retinopathy screening
- Newborn screening programme
- cervical screening programme
- NHS health checks
- these have age restrictions and can be condition dependant
52
What is meant by selection bias?
Those who choose to participate in screening may differ from the general population e.g. those who are at higher risk - FHx of breast cancer may be more likely to attend or those at lower risk e.g. high socioeconomic group may be more likely to attend
53
What is length-time bias?
people may be missed out due to the timing of the screening
| - shorter, more aggressive disease is more likely to be missed whereas if is long-lived is ore likely to be identified
54
What is lead-time bias?
the difference between knowing about disease and making a difference e.g one patient identified at screening at 2 years earlier than another that has the disease but they die at the same time
55
What are false positives??
some people will be screened and the process will show them to be diseased / at risk – on further testing they have no disease.
56
What are false negatives?
some people will be screened and they will be deemed as having no disease but later on in life will develop the disease.
57
What is sensitivity?
The proportion of people with the disease who are correctly identified by the screening process
58
What is specificity?
The proportion of people without the disease who are correctly excluded by the screening process
59
What is the positive predictive value?
The proportion of people who have a positive screening result who, following tests, have the disease
60
What is the negative predictive value?
Proportion of people who do not have the disease following testing
61
What types of errors can occur in healthcare?
```
Sloth
fixation
communication breakdown
playing odds
bravado
ignorance
miss-triage
lack of skill
system error
```
62
Why do mistakes happen?
Human error
Misconduct
neglect
poor performance
63
What are the never events?
```
○ Wrong site surgery
○ Wrong implants
○ Wrong route of administration
○ Wrong prescribing of potassium containing solution
○ Overdose of insulin
○ Overdose methotrexate (non-cancer treatment)
○ Mental health - failure to install collapsible shower rails / door hooks, etc.
○ Falls from windows
○ Entrapment in bedrails
○ Incompatible transfusions
○ Scalding patients
○ Incorrect oro/gastric tube feeding
```
64
What is the Swiss cheese model of adverse events?
Each slice of cheese is a barrier to error propagation, errors happen when the holes line up
65
What is the Bolam standard?
Rules in favour of the general medical opinions around acceptability
not negligent if acting in a way that is in accordance with accepted practice and other practitioners mostly agree
66
The 4 steps that show negligence has occurred?
1) There was duty of care
2) The duty of care was breached
3) A patient came to harm
4) the harm was duet the breach in duty of care
67
What is the Bolitho caveat?
Is a modified 1957 Bolam test
| basically, a judge can disagree with a panel of edits if they think the act is unacceptable
68
What are the four ethical principles and what they mean?
1) Autonomy - right to choose what happens to yourself
2) Beneficence - doing good
3) non-maleficence - doing no harm
4) Justice - being fair to all involved
69
What are the three main models of stages of change?
1) Transtheoretical
2) Health belief
3) Theory of planned behaviour
70
What are transition points in life that may indicate stages of change?
```
leaving school
relationship breakdown
having children
significant health event
bereavement
losing/gettinga. job
retirement
```
71
What is the inverse care law?
Those with the greatest need for healthcare, access healthcare the least
72
What are the social determinants of health
1) age, sex, hereditary factors
2) individual lifestyle factors
3) social and community influences
4) living and working conditions
5) general socioeconomic, cultural and environmental conditions
73
what is included in the Bradford hill criteria? (with regards to research)
1) strength (effect size)
2) consistency (reproducibility)
3) specificity
4) temporality
5) biological gradient
6) plausibility
7) coherence
8) Experiment
9) Analogy
