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Public health > public health > Flashcards

public health Flashcards

1
Q

Epigenetics

A

Expression of a genome depends on the environment, biology and biography
genetic disposition- key
everyones experiences are different

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2
Q

Allostasis

A

Stability through change, physiological system rapidly reacting to environmental stresses e.g. CVS (to HTN) and endocrine (obesity)

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3
Q

Allostatic load

A

Overtaxation of our physiological system that leads to impairment of health (stress)

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4
Q

Salutogenesis

A

Favourable physiological change that promotes healing and health

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5
Q

Emotional intelligence

A

Having control of your own and others emotions

- identify and manage emotions

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6
Q

Primary Care

A
  • prevent illness
  • promote health
  • work along side patients
  • managing clinical uncertainty
  • getting the best outcome with available resources
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7
Q

What it takes to be a GP

A
  • generalist- broad knowledge
  • coordinator
  • excellent com skills
  • good listener and has good judgement
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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

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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

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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

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11
Q

Why Abx shouldn’t be over-prescribed

A
  • ABX resistance
  • unnecessary side effects
  • medicalising self limiting conditions
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12
Q

Define public health

A

preventing disease
promoting health
prolonging life
through the efforts of society

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13
Q

Name the 3 domains of PH and give examples of each

A
  1. Health improvement- employment, housing, inequalities, LS etc
  2. Health protection- infectious disease, radiation
  3. Improving services- audits, clinical governance, equity
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14
Q

Determinants of Health

A

4 things- genes, environment, LS and healthcare

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15
Q

Key concerns for PH

A

inequality, prevention and wider determinants of health

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16
Q

Health intervention

A

can be delivered on an individual/community and popn level. Can be health/non-health related–> for PH

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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

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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

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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

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20
Q

how has a doctor will you improve health

A

treating each ptx as an individual

providing and influencing services available

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21
Q

Maxwell’s dimensions on quality of health care

A

3E’s and A’s- effectiveness, equity and efficiency

accessibility, acceptability, and appropriateness

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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

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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

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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

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25
Q

Types of screening (name 3)

A
  1. population based
  2. opportunistic based
  3. pre-employment and occupation based
  4. for communicable diseases
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26
Q

Wilson and Junger Criteria

A
  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
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27
Q

What does true positive and true negative mean

A

True positive: test said yes and they have disease

True negative: test said no and they dont have the disease

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28
Q

What does false negative and false positive mean

A

False negative: test said no have it but they have disease

False positive: test said yes but they don’t have disease

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29
Q

Disadvantages of screening:

A
  • 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
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30
Q

What is sensitivity

A

proportion of people with the disease and correctly identified from test
TP/TP and FN

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31
Q

What is specificity

A

proportion of people without the disease and correctly excluded from test
TN/ TN + FP

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32
Q

Positive predicted value

A

number of people from test who had a positive result who actually have the disease
TP/TP + FP

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33
Q

Negative predicted value

A

number of people who were told they were negative and actually dont have the disease
TN/TN +FN

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34
Q

what is predicted value dependent on

A

Prevalence

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35
Q

Define lead time bias

A

when a screening identifies a condition earlier it increases survival time, even if screening has no effect on outcome

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36
Q

Define length time bias

A

Differences in the length of time taken for a condition to progress–> affect efficacy of screening method

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37
Q

Examples of descriptive study designs and what they do

A
  1. Case reports- looks at individual reports

2. Ecological- use routinely collected date to look for trends- prevalence and association. NOT CAUSATIVE

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38
Q

Examples of descriptive and analytic

A

Cross-sectional study: compares two groups at one specific time. Also generate hypothesis and are also prone to bias

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39
Q

Examples of analytic study designs

A

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

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40
Q

Experimental studies

A

Randomised control trial: placebo vs med etc
ad- less bias, can infer causality
dis- expensive, time consuming and unethical to withdraw treatment

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41
Q

Define dependent and independent variable

A

Dependent: can’t not be altered

independent is the variable that changes in experiment

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42
Q

Define incidence and prevalence

A

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

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43
Q

What is incidence rate and absolute risk

A

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

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44
Q

Attributable risk and relative risk

A

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

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45
Q

what is relative risk reduction

A

reduction in rate of outcome in the intervention group vs control group

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46
Q

what is absolute risk reduction

A

absolute difference in the rates of events given baseline and intervention effect

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47
Q

Number needed to treat

A

NNT: number of ptx needed to treat to prevent 1 bad outcome. ARR- attributable risk reduction
1/ARR (if decimal) or 100/ARR (if %)

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48
Q

What is epidemiology:

A

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)

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49
Q

Define bias and give three types

A

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
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50
Q

What is a confounding variable

A

Variable influencing both IV and DV

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51
Q

What is reverse causality

A

What cause –> effect but its the other way around

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52
Q

Bradford Hill criteria

A

For Causality

SSCC- specificity, strength of association, coherence and consistency

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53
Q

Define addiction

A

Dependence syndrome; craving, lack of control, tolerance, withdrawal state, self neglect and knowing the damage and continuing. Three or more in 12 months Dx.

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54
Q

Effect of drugs

A

Physical: acute (needle stick injury, OD, pregnancy problems) chronic (psychosis, MH, infections, poverty)
Psychological: guilt, fear and craving
Social: criminality, imprisonment, debt etc

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55
Q

Heroin- what it is, effects and how long it lasts

A

Acts on opiod receptors, used 8hrly
Powder
effect: euphoria, relaxation, drowsiness and mitosis

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56
Q

Heroin- why you need to reduce reduce

A

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
Q

Heroin- management

A

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
Q

Cocaine and Crack

  • mode of intake
  • how it works
A

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
Q

Cocaine Management

A
  • harm reduction: advice, vaccine, STI screen, contraception
  • brief intervention: setting limits, CBT
  • team working- sexual health, specialists etc.
60
Q

What is the unit limit per week
What is a unit and how do you calculate it
What is ABV

A

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
Q

What is hazardous drinking and causes

A

Excessive drinking that can cause harm to self or others

Stress, depression, bereavement, unemployment, culture

62
Q

Why do women drink more now?

A

More socially acceptable, financially stable ore designed for female taste, more female drinking spots

63
Q

How can alcohol cause death

A
  • accident and violence
  • malignancy: liver, pancreas, stomach and neck
  • CVD and cerebrovascular
  • cirrhosis (fatty liver is reversible)
64
Q

Alcohol on pregnancy

A

increased risk of miscarriage, still birth, lbw and FOS

65
Q

FOETAL ALCOHOL SYNDROME

A

epicanthral folds, small chin, flat mid face
spina bifida, learning difficulties, CP etc
cardial, renal and ocular abnormalities

66
Q

How to manage in primary setting- alcoholism

A

history (questionnaire- screening ), advice, vitamin, IHD, OP prophylaxis

67
Q

What is the screening method for alcohol in primary care

A

AUDIT, CAGE AND FAST . not blood tests

68
Q

Relapse prevention medications in alcohol

A
  1. Disulfiram (Antabuse- causes acute sensitivity to ethanol)
  2. Acamprosate- GABA blocker
  3. Naltrexone
69
Q

Wernicke’s encephalopathy and Korsakoff’s syndrome

A

WE: reversible thiamine (B1) deficiency
Ct: ophthalmoplegia, ataxia and change in MS
Tx: Pabrinex
Korsakoff: chronic, irreversible–> AMNESTIC disorder
- CT dx

70
Q

Alcohol Withdrawal Syndrome

A

Delirum tremens (3-5days)- acute confusion state and tremor
confusion, hallucinations and clouding memory
N+V
seziures
tx: benzodiazepine

71
Q

Marlow’s hierarchy of need

A

bottom to top

Physical, safety, love, esteem and self-actualisation

72
Q

Define Inverse Law

A

availability of good medical intervention is inversely present for those who need it

73
Q

Define health inequality

A

Preventable, unfair difference in health status and access to treatment between groups due ti social, environmental and eco difference

74
Q

What is health psychology

A

Emphasises the role of psychological factors in causing, progression and consequences of a disease

75
Q

Health behaviour

A

Can be damaging (smoking) and promoting (exercise)

Health behaviour is actions aimed at preventing disease e.g. eating healthy

76
Q

Illness behaviour

A

Behaviour in which you seek remedy e.g. going to the doctors

77
Q

Sick role behaviour

A

Behaviour in wanting to get better e.g. taking medication

78
Q

Theory of planned behaviour

A

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
Q

Stages model of health behaviour

A

Precomtemplation contemplation preparation action and maintenance

80
Q

Motivational interviewing

A

counselling approach for initiating behaviour change by RESOLVING AMBIVALENCE

81
Q

Nudge theory

A

nudge the environment to make the best option the easiest egg, not out scheme for pensions, placing fruits next to check outs

82
Q

other factors to consider on health behaviours

A 
personality traits affect HB
assessment of risk perception 
impact of past behaviour 
social norms 
transition points (leaving school, parent, unemployment)
83
Q

Intervention at population and individual level is aimed at what

A

population level: health promotion e.g. PHE

individual: patient centred care

84
Q

what is a communicable disease

A

Are infectious diseases that can easily spread.

85
Q

Why do you need to notify communicable diseases

A
  • duty of a medical practitioner
  • you may be the only one reporting to HPA
  • HPA can take urgent control measures
86
Q

What needs to be notified?

A

Notifiable disease

suspected, infected or contaminated in patient or dead people

87
Q

Who to notify

A

“proper officer” at your local council- if urgent within 24 hours orally or in writing if not urgent in 7 days

88
Q

What are the powers of the local authorities

A
  1. school (keep child away and list of attendees )

2. request for cooperation for health protection purposes

89
Q

How to manage an outbreak

A
  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
Q

How can communicable diseases transmit?

A
  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
Q

Role of a communicable disease consultant

A
  1. surveillance
  2. prevention e.g. immunisation
  3. control
92
Q

Causes of homelessness and impact on health

A

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
Q

What are the barriers to HC for homeless, LGBTQ and AS

A
  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
Q

Define asylum seeker, refugee and humanitarian protection

A

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
Q

Health problems in these groups

A

Same physical illnesses, but MH problems e.g. PTSD, depression, self-harm, psychosis

96
Q

Define culture

A

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
Q

Ethnocentrism

A

tendency to evaluate groups according to values and culture, believes ones own is more superior

98
Q

Stereotype

A

generalisation about ‘typical’ characterisers of members of a group

99
Q

Prejudice

A

Judgement of person solely based on their membership to a group

100
Q

Discrimination

A

actual positive or negative action towards the objects of prejudice

101
Q

Ice berg model of culture

A

Above sea level: age, gender, ethnicity and nationality

below: occupation, socio-economic status, religion, education, sexual orientation, cultural beliefs etc

102
Q

Why is diversity taught

A

Better health outcomes for patient

more satisfying patient doctor relationships

103
Q

Why has rationationing needs increased

A

Acute problems become chronic
medicalising self limiting conditions
increase in choice and expensive drugs

104
Q

Rationing

A

resource refusal because of lac of affordability rather than clinical ineffectiveness

105
Q

Allocation theories

A

Egalitarian principle: provide all care nec and appropriate to everyone
maximising principle: max public utility
libertarian Principle: each is responsible for own health

106
Q

What is right act 2,3,8, 12 and 14

A

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
Q

GMC duties of a doctor

A

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
Q

Stages of wound healing

A

Vascular response- VC, clotting–> scab
inflammatory response- VD, polymorph neutrophils and macro
Proliferation: collagen
Maturation

109
Q

Intention of healing

A

Primary: little or no tissue lost, wound edge apposed
Secondary: WE is not apposed, granulates
Tertiary: left open and surgically closed

110
Q

Define domestic abuse

A

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
Q

How does domestic abuse affect health

A
  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
Q

Risk assessment - use dash tool

A

Standard: current evidence DONT NOT indidicare serious harm
Medium: identifiable indicators of SERIOUS HARM
High: IMMINENT RISK of serious harm

113
Q

Role of responding to domestic abuse

A
  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
Q

Four domains of negligence

A

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
Q

3 behavioural approaches to weight loss

A
  1. Stimulate control
  2. Self monitoring
  3. Goal setting
116
Q

what is the rescue rule

A

pursued duty of care to help an endangered life

117
Q

Liberty protection safeguards

A

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
Q

Utilitarian approach, libertarian and egalitarian approach

A

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
Q

Error types

A 
sloth
lack of skill 
system error 
ignorance 
bravado
120
Q

why do things go wrong

A

negligence, poor performance and misconduct

121
Q

Swiss cheese model

A

each slice is a barrier, holes is a failure, when they align causes detrimental damage

122
Q

beneficence, non maleficence, autonomy and justice

A

B- do good
NM- do no harm
A- patient wish
J- law

123
Q

Arostelian approach similar to good virtue

A

good to help and provide all care necessary

124
Q

Never event define

A

serious, largely preventable event that causes harm to pax e.g. surgery at the wrong place

125
Q

Approaches to never event

A

personal- blame individual

system- blame system and working condition

126
Q

who to inform of a never event

A

NHSE and Care quality commissions

127
Q

confounding diagram

A

affects exposure and expire affects it too

affects outcome

128
Q

factors that affect outcome

A

true association
bias
confounding
chance

129
Q

epidemiological needs for assessment

A

A systematic approach of deciding what a population needs based on the incidence and prevalence of certain diseases

130
Q

comparative needs assessment

A

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
Q

corporate needs for assessment

A

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
Q

bridging the gap intention behaviour

A

perceived control
relevance to self
anticipated regrets

133
Q

limitations for theory of planned behaviour

A

does not account for emotions or personal habits

134
Q

Define structure

A

what is avaible e.g. staff, equipment funding etc

135
Q

Define process

A

what is done e.g number of producers

136
Q

define outcome

A

quality improvement, patient satisfaction

137
Q

SUPPLIED NOT NEEDED OR DEMANDED

A

chalymida screening under 25

138
Q

deontology vs consequentialism

A

D- based on the result of actions

C- based on the actions regardless of result

Public health (1 decks)

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