public health Flashcards
(138 cards)
1
Q
Epigenetics
A
Expression of a genome depends on the environment, biology and biography
genetic disposition- key
everyones experiences are different
2
Q
Allostasis
A
Stability through change, physiological system rapidly reacting to environmental stresses e.g. CVS (to HTN) and endocrine (obesity)
3
Q
Allostatic load
A
Overtaxation of our physiological system that leads to impairment of health (stress)
4
Q
Salutogenesis
A
Favourable physiological change that promotes healing and health
5
Q
Emotional intelligence
A
Having control of your own and others emotions
- identify and manage emotions
6
Q
Primary Care
A
- prevent illness
- promote health
- work along side patients
- managing clinical uncertainty
- getting the best outcome with available resources
7
Q
What it takes to be a GP
A
- generalist- broad knowledge
- coordinator
- excellent com skills
- good listener and has good judgement
8
Q
ABx- which given for OM, sinusitis, tonsillitis, LRTI and UTI
A
OM, sinusitis, LRTI- amoxicillin for 5 days
tonsillitis: penicillin V for 10 days
UTI- trimethoprim or nitrofurantoin for 3 days
9
Q
When to prescribe AB in
1. OM
2. Tonsillitis
What are the complications of the above if not prescribed
A
OM- 1. Bilateral OM under 2 yrs old OR 2. OM with otorrhea (fluid). comp= mastoditis
Tonsillitis: 3 or more in CENTOR CRITERIA or FPAIN
comp= peritonsillar abscess
10
Q
ABx criteria
A
systemically unwell or high risk group (prem, immunocomp)
if above 65 then 2 of the following or above 80 one
1. admitted to hospital in the last 12 months
2. has diabetes
3. congested heart failure
4. on glucocorticosteriods
complications: pneumonia, cellulititis etc
11
Q
Why Abx shouldn’t be over-prescribed
A
- ABX resistance
- unnecessary side effects
- medicalising self limiting conditions
12
Q
Define public health
A
preventing disease
promoting health
prolonging life
through the efforts of society
13
Q
Name the 3 domains of PH and give examples of each
A
- Health improvement- employment, housing, inequalities, LS etc
- Health protection- infectious disease, radiation
- Improving services- audits, clinical governance, equity
14
Q
Determinants of Health
A
4 things- genes, environment, LS and healthcare
15
Q
Key concerns for PH
A
inequality, prevention and wider determinants of health
16
Q
Health intervention
A
can be delivered on an individual/community and popn level. Can be health/non-health related–> for PH
17
Q
Define health needs assessment, need, demand and supply
A
Health needs assessment is a systematic method for reviewing health issues faced to improve health and reduce inequality
need- ability to benefit form an intervention
demand- what is asked for
suuply- what is provided
18
Q
Define health need and health care need
A
health need- need for health e.g. measuring mortality and morbidity
health care need- need for health care, and ability to benefit from it
19
Q
define: felt need expressed need normative need comparative need
A
felt need: is like demand, its what the Indi perceives of variation of normal health
expressed need: indi seeks help to overcome variation
normative need: professional defines intervention appropriate for expressed need
comparative: compares severity, cost and range of intervention
20
Q
how has a doctor will you improve health
A
treating each ptx as an individual
providing and influencing services available
21
Q
Maxwell’s dimensions on quality of health care
A
3E’s and A’s- effectiveness, equity and efficiency
accessibility, acceptability, and appropriateness
22
Q
Define primary, secondary and tertiary prevention
A
Primary: preventing disease before it has happened e.g. LS changes and education
Secondary: catching it in the pre-clinical or early phases e.g. screening
Tertiary: managing the disease and preventing progression e.g. chemo, rehabilitation, meds
23
Q
Define prevention paradox
A
a preventive measure that brings benefit to the population but minimal effect to the individual e.g. lowering alcohol consumption rates per week
24
Q
What is screening
A
Is a secondary preventing measure aimed to identify well patient who may have the condition (or precursors) from those who don’t . NOT DIAGNOSITC
25
Types of screening (name 3)
1. population based
2. opportunistic based
3. pre-employment and occupation based
4. for communicable diseases
26
Wilson and Junger Criteria
1. Condition: natural history, has a preclinical phase, important
2. Test: suitable (cost, sensitivity, specific) and acceptable
3. Treatment: effective and applied policy who to treat
4. Organisation- cost effective, facilities and ongoing process
27
What does true positive and true negative mean
True positive: test said yes and they have disease
| True negative: test said no and they dont have the disease
28
What does false negative and false positive mean
False negative: test said no have it but they have disease
| False positive: test said yes but they don't have disease
29
Disadvantages of screening:
- false positive can cause unnecessary distress
- well ptx are exposed to harmful tests
- over medicalising, some precursors that may not have developed may be treated
30
What is sensitivity
proportion of people with the disease and correctly identified from test
TP/TP and FN
31
What is specificity
proportion of people without the disease and correctly excluded from test
TN/ TN + FP
32
Positive predicted value
number of people from test who had a positive result who actually have the disease
TP/TP + FP
33
Negative predicted value
number of people who were told they were negative and actually dont have the disease
TN/TN +FN
34
what is predicted value dependent on
Prevalence
35
Define lead time bias
when a screening identifies a condition earlier it increases survival time, even if screening has no effect on outcome
36
Define length time bias
Differences in the length of time taken for a condition to progress--> affect efficacy of screening method
37
Examples of descriptive study designs and what they do
1. Case reports- looks at individual reports
| 2. Ecological- use routinely collected date to look for trends- prevalence and association. NOT CAUSATIVE
38
Examples of descriptive and analytic
Cross-sectional study: compares two groups at one specific time. Also generate hypothesis and are also prone to bias
39
Examples of analytic study designs
Case-control: RETROSPECTIVE, interviewing patient with condition and identifying the association
Cohort: longitudinal study that follows risk groups to see if they get the condition
40
Experimental studies
Randomised control trial: placebo vs med etc
ad- less bias, can infer causality
dis- expensive, time consuming and unethical to withdraw treatment
41
Define dependent and independent variable
Dependent: can't not be altered
| independent is the variable that changes in experiment
42
Define incidence and prevalence
incidence: the number new cases in a set time e.g. 5 people were diagnosed with cancer last year
prevalence: the number of existing cases e.g. 15 cases of cancer so far
43
What is incidence rate and absolute risk
incidence divided by the total number of people at risk during that period e.g. 100 farms followed for a year, and 10 got the disease IR is 0.1 or 10%.
Absolute risk is with units e.g. 1 in 10 deaths per year
44
Attributable risk and relative risk
ARR: RATE of disease in exposed that attributed to the exposure: Incidence in exposed minus incidence in unexposed
RR: RATIO of risk of disease in exposed vs unexposed. Incidence in exposed divided by incidence in unexposed
1= no D, less than 1= intervention reduced risk and >1= intervention increased risk of outcome
45
what is relative risk reduction
reduction in rate of outcome in the intervention group vs control group
46
what is absolute risk reduction
absolute difference in the rates of events given baseline and intervention effect
47
Number needed to treat
NNT: number of ptx needed to treat to prevent 1 bad outcome. ARR- attributable risk reduction
1/ARR (if decimal) or 100/ARR (if %)
48
What is epidemiology:
A study of frequency, distribution and determinants of diseases and health related to population to prevent and control disease
* time, place and person (age, gender, ethnicity etc)
49
Define bias and give three types
Bias is a systemic deviation in the true estimation between exposure and outcome
1. selection bias- who the participators are
2. information- recall/observer
3. publication
50
What is a confounding variable
Variable influencing both IV and DV
51
What is reverse causality
What cause --> effect but its the other way around
52
Bradford Hill criteria
For Causality
| SSCC- specificity, strength of association, coherence and consistency
53
Define addiction
Dependence syndrome; craving, lack of control, tolerance, withdrawal state, self neglect and knowing the damage and continuing. Three or more in 12 months Dx.
54
Effect of drugs
Physical: acute (needle stick injury, OD, pregnancy problems) chronic (psychosis, MH, infections, poverty)
Psychological: guilt, fear and craving
Social: criminality, imprisonment, debt etc
55
Heroin- what it is, effects and how long it lasts
Acts on opiod receptors, used 8hrly
Powder
effect: euphoria, relaxation, drowsiness and mitosis
56
Heroin- why you need to reduce reduce
2nd largest cause of death in young men
blood borne transmission- dont share, safe sex, vaccinations
Needle injury- stop or change place
DO NOT take with respect depressors
57
Heroin- management
CBT, STI, hep C referrals
Detoxification:
1. BUPRENOPHRINE, lofexidine (in v young and low add)
Maintenance:
METHADONE (full agonist- fluid, tablet or injection)
- reduced mortality/morbidity, crime, risky behaviour,
Relapse prevention:
NALTREXONE
58
Cocaine and Crack
- mode of intake
- how it works
oral, snorted, IV, smoke
Blood reuptake of serotonin and dopamine at synapse--> INTENSE PLEASURABLE SENSATION
Euphoria, confidence, impulsivity, alert etc- acute
paranoia, psychosis, depression, resp problems- chronic
59
Cocaine Management
- harm reduction: advice, vaccine, STI screen, contraception
- brief intervention: setting limits, CBT
- team working- sexual health, specialists etc.
60
What is the unit limit per week
What is a unit and how do you calculate it
What is ABV
14 units per week - F and males
Alcohol by volume is the percentage in the drink
Unit= 8g of pure alcohol (ABV x vol/1000)
61
What is hazardous drinking and causes
Excessive drinking that can cause harm to self or others
| Stress, depression, bereavement, unemployment, culture
62
Why do women drink more now?
More socially acceptable, financially stable ore designed for female taste, more female drinking spots
63
How can alcohol cause death
- accident and violence
- malignancy: liver, pancreas, stomach and neck
- CVD and cerebrovascular
- cirrhosis (fatty liver is reversible)
64
Alcohol on pregnancy
increased risk of miscarriage, still birth, lbw and FOS
65
FOETAL ALCOHOL SYNDROME
epicanthral folds, small chin, flat mid face
spina bifida, learning difficulties, CP etc
cardial, renal and ocular abnormalities
66
How to manage in primary setting- alcoholism
history (questionnaire- screening ), advice, vitamin, IHD, OP prophylaxis
67
What is the screening method for alcohol in primary care
AUDIT, CAGE AND FAST . not blood tests
68
Relapse prevention medications in alcohol
1. Disulfiram (Antabuse- causes acute sensitivity to ethanol)
2. Acamprosate- GABA blocker
3. Naltrexone
69
Wernicke's encephalopathy and Korsakoff's syndrome
WE: reversible thiamine (B1) deficiency
Ct: ophthalmoplegia, ataxia and change in MS
Tx: Pabrinex
Korsakoff: chronic, irreversible--> AMNESTIC disorder
- CT dx
70
Alcohol Withdrawal Syndrome
Delirum tremens (3-5days)- acute confusion state and tremor
confusion, hallucinations and clouding memory
N+V
seziures
tx: benzodiazepine
71
Marlow's hierarchy of need
bottom to top
| Physical, safety, love, esteem and self-actualisation
72
Define Inverse Law
availability of good medical intervention is inversely present for those who need it
73
Define health inequality
Preventable, unfair difference in health status and access to treatment between groups due ti social, environmental and eco difference
74
What is health psychology
Emphasises the role of psychological factors in causing, progression and consequences of a disease
75
Health behaviour
Can be damaging (smoking) and promoting (exercise)
| Health behaviour is actions aimed at preventing disease e.g. eating healthy
76
Illness behaviour
Behaviour in which you seek remedy e.g. going to the doctors
77
Sick role behaviour
Behaviour in wanting to get better e.g. taking medication
78
Theory of planned behaviour
Best predictor is "intention".
Which is determined by
1. attitude to behaviour
2. subjective norm (received social pressure to undertake behaviour)
3. Perceived behavioural control : appraisal of ability to perform behaviour
criticism: lack of temporal element and direction
79
Stages model of health behaviour
Precomtemplation contemplation preparation action and maintenance
80
Motivational interviewing
counselling approach for initiating behaviour change by RESOLVING AMBIVALENCE
81
Nudge theory
nudge the environment to make the best option the easiest egg, not out scheme for pensions, placing fruits next to check outs
82
other factors to consider on health behaviours
```
personality traits affect HB
assessment of risk perception
impact of past behaviour
social norms
transition points (leaving school, parent, unemployment)
```
83
Intervention at population and individual level is aimed at what
population level: health promotion e.g. PHE
| individual: patient centred care
84
what is a communicable disease
Are infectious diseases that can easily spread.
85
Why do you need to notify communicable diseases
- duty of a medical practitioner
- you may be the only one reporting to HPA
- HPA can take urgent control measures
86
What needs to be notified?
Notifiable disease
| suspected, infected or contaminated in patient or dead people
87
Who to notify
"proper officer" at your local council- if urgent within 24 hours orally or in writing if not urgent in 7 days
88
What are the powers of the local authorities
1. school (keep child away and list of attendees )
| 2. request for cooperation for health protection purposes
89
How to manage an outbreak
1. make a diagnosis
2. Identify if OB (2+ cases)
3. Call for help (micro, ID cons, nurses specialised in ID)
4. meeting
5. Identify cause
6. Control measures
90
How can communicable diseases transmit?
1. food borne e.g. infectious bloody diarrhoea (e.coli)
2. faecal-orale.g. diarrhoea, typhoid, polio and hep
3. respiratory route e.g. meningitis
91
Role of a communicable disease consultant
1. surveillance
2. prevention e.g. immunisation
3. control
92
Causes of homelessness and impact on health
Cause: unemployment, kicked out by landlord, domestic abuse, dispute with parents and bereavement
HP: MH, drug abuse, poor sanity (infection), respiratory disease, SH, violence and rape
93
What are the barriers to HC for homeless, LGBTQ and AS
1. language and illiteracies barriers
2. lack of integration between primary care and other services
3. difficulty to access e.g. appointment procedure
4. reluctance to for GP's to register
5. Stigma
94
Define asylum seeker, refugee and humanitarian protection
Asylum seeker: a person who has made application for a refugee status. Can't work but have assess to NHS
Refugee: a person granted asylum and status, allowed to remain for 5 years
HP: failed to demonstrate claim for asylum but face serious threat to life if returned (3yrs)
95
Health problems in these groups
Same physical illnesses, but MH problems e.g. PTSD, depression, self-harm, psychosis
96
Define culture
A socially transmitted pattern of shared meaning by which people communicate, perpetuate and develop their knowledge and attitudes about life
based heritage, personal choice and upbringing
97
Ethnocentrism
tendency to evaluate groups according to values and culture, believes ones own is more superior
98
Stereotype
generalisation about 'typical' characterisers of members of a group
99
Prejudice
Judgement of person solely based on their membership to a group
100
Discrimination
actual positive or negative action towards the objects of prejudice
101
Ice berg model of culture
Above sea level: age, gender, ethnicity and nationality
| below: occupation, socio-economic status, religion, education, sexual orientation, cultural beliefs etc
102
Why is diversity taught
Better health outcomes for patient
| more satisfying patient doctor relationships
103
Why has rationationing needs increased
Acute problems become chronic
medicalising self limiting conditions
increase in choice and expensive drugs
104
Rationing
resource refusal because of lac of affordability rather than clinical ineffectiveness
105
Allocation theories
Egalitarian principle: provide all care nec and appropriate to everyone
maximising principle: max public utility
libertarian Principle: each is responsible for own health
106
What is right act 2,3,8, 12 and 14
2- right to life (limited)
3- right to free from inhuman and degrading treatment (Absolute)
8- respect privacy and family life (qualified)
12- right to marry and found a family
14- prohibition from discrimination
107
GMC duties of a doctor
care of patient is first concern
protect and promote health of pt and public
provide good standard of practice and care
treat pt as indicual and respect their dignity
work with patients
be honest open nd act with integrity
108
Stages of wound healing
Vascular response- VC, clotting--> scab
inflammatory response- VD, polymorph neutrophils and macro
Proliferation: collagen
Maturation
109
Intention of healing
Primary: little or no tissue lost, wound edge apposed
Secondary: WE is not apposed, granulates
Tertiary: left open and surgically closed
110
Define domestic abuse
any incidence of physical, psychologic, emotional, financial or sexual threat/control to those above age of 16 from a partner or family member (regardless of gender or sexuality)
111
How does domestic abuse affect health
1. trauma from assault
2. somatic/chronic conditions e.g. headaches, NEAD, chronic pain, Prem
3. MH issues e.g. PTSD, personality disorders, depression etc
112
Risk assessment - use dash tool
Standard: current evidence DONT NOT indidicare serious harm
Medium: identifiable indicators of SERIOUS HARM
High: IMMINENT RISK of serious harm
113
Role of responding to domestic abuse
1. DISPLAY posters and raise awareness
2. Provide helplines
3. Patient SAFETY first
4. Ask DIRECT QUESTIONS
5. Be part of the process
6. Refer to MARAC
114
Four domains of negligence
Was there a duty of care
Was the duty of care breached
Was there harm to the patient
Was the harm to the patient due to the breach
115
3 behavioural approaches to weight loss
1. Stimulate control
2. Self monitoring
3. Goal setting
116
what is the rescue rule
pursued duty of care to help an endangered life
117
Liberty protection safeguards
to provide safety for the ptx--> provide care support and treatment
lasts 1 year or in emergency 7 days
managing authority asks supervising--> assessor
used in hospital and care home
118
Utilitarian approach, libertarian and egalitarian approach
U- optimise/maximise the utilities available
L- each is responsible for their own health and well being
E- all care necessary and approproiate to each should be provided
119
Error types
```
sloth
lack of skill
system error
ignorance
bravado
```
120
why do things go wrong
negligence, poor performance and misconduct
121
Swiss cheese model
each slice is a barrier, holes is a failure, when they align causes detrimental damage
122
beneficence, non maleficence, autonomy and justice
B- do good
NM- do no harm
A- patient wish
J- law
123
Arostelian approach similar to good virtue
good to help and provide all care necessary
124
Never event define
serious, largely preventable event that causes harm to pax e.g. surgery at the wrong place
125
Approaches to never event
personal- blame individual
| system- blame system and working condition
126
who to inform of a never event
NHSE and Care quality commissions
127
confounding diagram
affects exposure and expire affects it too
| affects outcome
128
factors that affect outcome
true association
bias
confounding
chance
129
epidemiological needs for assessment
A systematic approach of deciding what a population needs based on the incidence and prevalence of certain diseases
130
comparative needs assessment
A systematic approach of comparing the health needs between two different populations: can be spatial (geographical) or vertical (social classes)
hard to find data, not quantifiable
131
corporate needs for assessment
Getting input from a number of individuals or groups to decide what is needed most (press, patients, professionals, politicians): assessing and improving national & local policies
132
bridging the gap intention behaviour
perceived control
relevance to self
anticipated regrets
133
limitations for theory of planned behaviour
does not account for emotions or personal habits
134
Define structure
what is avaible e.g. staff, equipment funding etc
135
Define process
what is done e.g number of producers
136
define outcome
quality improvement, patient satisfaction
137
SUPPLIED NOT NEEDED OR DEMANDED
chalymida screening under 25
138
deontology vs consequentialism
D- based on the result of actions
| C- based on the actions regardless of result
