Public Health Flashcards
(164 cards)
1
Q
What is epigenetics?
A
Expression of a gene depends on the environment
2
Q
What is allostasis?
A
Stability through change
Physiology adapts rapidly to environmental stress
3
Q
What is allostatic load?
A
long term overtaxing of physiology leads to impaired health
4
Q
What is salutogenesis?
A
favourable physiological changes secondary to experiences promoting healing and health
5
Q
What is primary care for?
A
Managing illness Finding clinical solutions Prevent illness Promote health Manage clinical uncertainty Best outcomes with available resources Working in health care team Shared decision making with pt
6
Q
Dangers of overprescribing abx?
A
Side effects
Medicalise self-limiting conditions
Antibiotic resistance
7
Q
When to definitely prescribe abx?
A
B/l otitis media <2yo Acute otitis media + otorrhoea Acute sore throat + >2 centor criteria High risk (co-morbs, immunosuppressed) Complications
8
Q
Abx in otitis media?
A
amoxicillin 500mg TDS 5d
9
Q
Abx in sinusitis?
A
amoxicillin 500mg TDS 5d
10
Q
Abx in tonsilitis?
A
Penicillin V 10d
11
Q
Abx in LRTI?
A
Amoxicillin 5d
12
Q
Abx in UTI?
A
Trimethoprim 200mg BD 3d
OR
Nitrofurantoin 50mg QDS 3d
13
Q
Define public health?
A
The science and art of preventing disease, prolonging life and promoting health through organised efforts of society
14
Q
3 domains of public health?
A
Health improvement
Health protection
Improving services
15
Q
Define health improvement?
A
Concerned with SOCIETAL interventions aimed at preventing disease, promoting health and reducing inequalities
16
Q
Define health protection?
A
Concerned with measures to control infectious disease risks and environmental hazards
17
Q
Egs of health improvement
A
education housing employment family surveillance of diseases + RFs
18
Q
Egs of health protection
A
Infectious diseases
chemicals
radiation
emergency response
19
Q
Define improving services?
A
Concerned with the ORGANISATION and delivery of safe, high quality services for prevention, treatment and care
20
Q
Egs of improving services?
A
Clinical effectiveness Efficiency Service planning Audit + evaluation Equity
21
Q
Key concerns in public health? (3)
A
Inequalities
Wider determinants of health
Prevention
22
Q
What is a health needs assessment?
A
Systematic method for reviewing the health issues facing a population, leading to agreed priorities and resource allocation that will improve health and reduce inequalities
23
Q
Define ‘need’
A
Ability to benefit from an intervention
24
Q
Define ‘demand’
A
what people ask for
25
Define 'supply'
what is provided
26
How is 'health need' measured?
need for health eg measured using mortality, morbidity, socio-demographic measures
27
How is 'health care need' measured
the ability to benefit from health care
| Depends on potential of prevention, treatment and care services to remedy health problems
28
Define 'felt need'
Individual perceptions of variation from normal health
29
Define 'expressed need'
individual seeks help to overcome variation in normal health
30
Define 'normative need'
professional defines intervention appropriate for the expressed need
31
Define 'comparative need'
Comparison between severity - range of interventions and cost
32
Advantages of epidemiological approach to a health needs assessment?
Uses existing data
Provides data on disease incidence/mortality/morbidity etc
Can evaluate services by trends over time
33
Disadvantages of epidemiological approach to a health needs assessment?
Relies on quality of data available
Data collected may not be the data required
Does not consider the felt needs/opinions of population
34
How to do epidemiological approach to health needs assessment?
```
Define problem
Size of problem
See what services are available
Evidence base for intervention (effective?cost-effective?)
Models of care
Existing services
Recommendations
```
35
How to do comparative health needs assessment?
Compares services in one population with others (can be spatial, or social)
36
Advantages of a comparative health needs assessment?
Quick and cheap if data is available
| Relative performance indicator
37
Disadvantages of a comparative health needs assessment?
May be hard to find a comparable population
Data may not be available/good quality
May not yield what the best intervention should be
38
Types of health needs assessment?
epidemiological
comparative
corporate
39
How to do corporate health needs assessment
Ask local population what their health needs are
Use focus groups/interviews/meeting
Wide variety of stakeholders..
40
Advantages of a corporate health needs assessment?
Based on felt and expressed need of the population
Recognises the experience of those individuals
Takes into account a wide range of views
41
Disadvantages of a corporate health needs assessment?
Difficult to distinguish need from demand
Groups may have vested interests
May be influenced by agenda
42
Primary prevention?
preventing disease before it occurs
43
Secondary prevention?
Catching disease in early phase
44
Tertiary prevention?
preventing sequelae of disease
45
Approaches to prevention?
Population
| High-risk
46
Population approach?
| Eg?
preventative measures eg dietary salt reduction through legislation to reduce BP of a population
47
High risk approach?
| Eg?
identify individuals above a chosen cut off and treat
| eg screening for high BP
48
Prevention paradox?
A preventive measure which brings much benefit to the population offers little to each participating individual
49
Screening?
Process which sorts apparently well people who probably have a disease from those who probably do not.
NOT DIAGNOSTIC
50
Types of screening?
```
Population based programmes
Opportunistic screening
Screening for communicable diseases
Occupational medicals
Commercial
```
51
Disadvantages of screening?
Exposes well individuals to harmful diagnostic tests
Detection and treatment of sub-clinical disease that would never have cause harm
Interventions may cause harm
52
Wilson+Junger criteria for screening?
The condition
[Important health problem, Latent / preclinical phase, Natural history known]
The screening test [Suitable (sensitive, specific, inexpensive), Acceptable]
The treatment [Effective, Agreed policy on whom to treat]
The organisation and costs [Facilities, Costs of screening should be economically balanced in relation to healthcare spending as a whole, Should be an ongoing process]
53
Sensitivity of a screening test?
The proportion of people with the disease correctly identified by the screening test
54
Specificity of a screening test?
The proportion of people without the disease who are correctly excluded by the screening test
55
PPV?
Proportion of people with a positive test result who actually have the disease
56
NPV?
Proportion of people with a negative test who do not have the disease
57
Define 'lead time bias'
Screening identifies an outcome earlier that it would otherwise have been identified resulting in an apparent increase in survival time, even if screening has no effect on outcome
58
Define 'length time bias'
Difference in lengths of time taken for a condition to progress to severe effects may affect the apparent efficacy of a screening method
Eg less severe diseases is more likely to be found by screening
59
Egs of observational studies?
Descriptive [case reports, ecological studies]
Analytical [cross sectional]
60
Advantages of observational studies?
quick and cheap
provide prevalence data
large sample size
good for surveillance
61
Disadvantages of observational studies?
Risk of reverse causality
Cannot measure incidence
Risk recall bias/non-response
62
Egs of analytical studies?
| how do they work?
Case control studies (RETROSPECTIVE - people with disease + a matched control without)
Cohort studies (study a population without disease over time)
63
Advantages of analytical studies?
Good for rare outcomes
Quicker than cohort/intervention
Investigate multiple exposures
64
Disadvantages of analytical studies?
Difficulty finding control to match with case
| Prone to selection and information bias
65
Egs of experimental/intervention studies?
RCT
66
Advantages of experimental study
Can follow up a group with rare exposures
Can follow multiple outcomes
Low risk of bias and confounding
Can infer causality
67
Disadvantages of experimental study
Takes a long time
Lose people to follow up
Needs large sample
68
Independent variable?
Variable that is altered in a study
69
Dependent variable?
Depends on the independent variable
70
Odds?
Ratio of probability of an occurrence compared to the probability of a non-occurrence
Odds= Probability / (1-probability)
71
Odds ratio?
Ratio of odds for exposed group to the odds for non-exposed group
OR = {Pexposed/(1-Pexposed)} / {Punexposed/(1-Punexposed)}
72
When to use OR?
OR can be interpreted as RR when an event is rare
Case control studies -> cannot calculate relative risk so OR is used
Cohort studies/cross-sectional studies when it is unclear which variable is IV / DV
73
Define 'epidemiology'
The study of the frequency, distribution and determinants of diseases and health related states in populations in order to prevent and control disease
74
Incidence?
New cases over a period of time
75
Prevalence?
Existing cases at a point in time
76
Person time?
Measure of time at risk
| i.e. time from entry to a study to outcome (disease onset; loss to follow up; or end of study)
77
Incidence rate?
incidence / total person-time during the period
78
Absolute risk?
Has a denominator!
| Gives feel for actual numbers i.e. 50 deaths / 1000 population
79
Attributable risk?
The rate of disease in the exposed that may be attributed to the exposure
i.e. incidence in exposed minus the incidence in unexposed
80
Relative risk?
Ratio of risk in disease in the exposed to the risk in the unexposed
Tells us about strength of assosciation
EER/CER
81
How to describe epidemiology of a disease?
TIme
Place
Person [age, gender, class, ethnicity]
82
Relative Risk Reduction?
RRR=(CER-EER)/CER
83
Absolute risk reduction?
ARR = CER-EER
84
Number needed to treat?
NNT = 1 / ARR
85
What can association between exposure and outcome be due to?
```
Bias
Chance
Confounding
Reverse Causiality
True causal assos
```
86
Bias?
Systematic deviation from the true estimation of association between exposure and outcome
87
Types of bias?
Selection
Information (measurement)
Publication
88
Selection bias?
Systematic error in: selection of study participants / allocation of participants to study groups
89
Information bias?
Systematic error in measurement
90
Sources of info bias?
Observer
Participant (recall / reporting)
Instrument (badly calibrated)
91
Publication bias?
More likely to publish positive studies
92
Confounding?
A situation when estimate between exposure and outcome is distorted because the association of exposure with another CONFOUNDING factor that is independently associated with the outcome
93
Reverse causality?
Outcome causes exposure not the other way round
94
Bradford-Hill criteria for causality
```
Strength of assos
Dose-response
Consistency
Temporality
Reversibility
Biological plausibility
Coherence
Analogy
Specificity
```
95
Features of drug-addiction
Craving
Tolerance
Compulsive drug-seeking behaviour
Physiological withdrawal
96
Effects of dependent drug use?
Physical - injection complications, OD, SEs, BBVs, poverty
Social - criminality, imprisonment, exclusion
Psychological - fear of withdrawal, craving, guilt
97
Principles of treating drug-addiction?
Harm reduction
Detoxification
Maintenance
98
Detoxification of heroin?
Buprenorphine
99
Maintenance of heroin abstinence?
Methadone
| Buprenorphine
100
What to offer newly presenting drug user?
```
Health check
Screening for BBVs
Contraception
Sexual health advice
Immunisations
Signposting
Local drug services info
```
101
Health behaviour?
Behaviour to prevent disease
102
Illness behaviour?
Behaviour to seek remedy
103
Sick role behaviour?
Aimed at getting well
104
Theory of planned behaviour?
Best predictor of behaviour is 'INTENTION'
105
What is intention determined by? [in TPB]
Attitude
Subjective norms (social pressure)
Perceived control
106
Criticisms of TPB?
lack of temporal element
| lack of direction/causality
107
5 stage model of health behaviour?
```
Pre-contemplation
Contemplation
Preparation
Action
Maintenance
```
108
Motivational interviewing?
Counselling to resolve ambivalence and initiate behaviour change
109
Nudge theory?
| eg?
'nudge' the environment to make the best option the easiest
eg opt-out schemes
fruit next to checkout
110
Factors in health psychology/behaviour change?
Personality traits
Perception of risk
Past behaviours/habit
Social norms
111
Transition points for behavioural change
```
leaving school
starting work
becoming a parent
unemployment
retirement
bereavement
```
112
What is NCSCT?
National Centre of Smoking Cessation + Training
| social enterprise supporting tobacco control programmes and smoking cessation interventions
113
Actions of NCSCT?
deliver training and assessment programmes
provides support services
conducts research
114
Why notify PHE of communicable disease?
So PHE can take urgent control measures
You may be the only one who can tell PHE
115
Duties in communicable disease control?
Duty to notify suspected disease, infection or contamination in patients and dead people
Duty to notify causative agents found in human samples (orally ASAP; in writing in 7d)
116
Notifiable diseases
```
encephalitis
meningitis
poliomyelitis
hepatitis
anthrax
botulism
brucellosis
cholera
diphtheria
enteric fever
HUS
infectious bloody disarrhoea
group A strep
Legionnaires'
leprosy
malaria
measles
meningococcal septicaemia
mumps
plague
rabies
rubella
SARS
smallpox
tetanus
TB
typhus
VHF
whooping cough
yellow fever
```
117
Role of consultant in communicable disease control?
Surveillance
| Prevention
118
Managing outbreaks?
```
Clarify problem
Decide if it is an outbreak (>2 of a communicable disease)
Get help!
Call outbreak meeting
Identify cause
Initiate control measures
```
119
Modes of transmission?
```
Foodborne
Faecal-oral
Resp
Physical contact
Zoonoses
```
120
Maslow's hierachy of needs
```
Self-actualisation
Esteem
Love/belonging
Safety
Physiological
```
121
Causes of homelessness?
```
RELATIONSHIP BREAKDOWN
mental illness
DA
disputes
bereavement 'no family ties'
```
122
Health problems for homeless?
```
Infectious diseases (TB, hepatitis)
Feet, teeth
Resp
Violence
Sexual health
Mental illness
Poor nutrition
Substance misuse
```
123
Barriers to healthcare for travellers?
```
Reluctance of GPs
Poor reading/writing
Communication difficult
Too few permanent sites
Mistrust of professionals
```
124
Barriers to healthcare for homeless?
Access
Lack of integration
Don't prioritise health
May not know where to find hlep
125
Asylum seeker?
Person who has made an application for refugee status
126
Refugee?
A person granted asylum and refugee status
| Can stay for 5y then must reapply
127
Humanitarian protection?
Failed to demonstrate claim for asylum but face serious threat to life if returned
Stay for 3y then must reapply
128
Rights of asylum seekers?
```
no choice dispersal
vouchers/70% of income support sum
NASS support package
NHS access
Not allowed to work
```
129
Health problems of asylum seekers?
Physical - common illness, injuries, no previous screening/vaccines, malnutrition, infestations, communicable disease, chronic/congenital problems
Mental - PTSD, depression, psychosis, DSH
130
Define error?
an unintended outcome
131
Why is safety compromised so often in healthcare?
```
Complex
High risk environment
Resource intensive
Shared responsibility
Unknowing risk taking
```
132
Common issues in healthcare resulting in error?
Wrong diagnosis -> wrong plan
Medication reconciliation
High conc medication solutions
133
Error classification based on....?
Intention [skill- ; rule- ; knowledge- based mistakes]
Action [generic, task specific]
Outcome [near miss, death, litigation]
Context [
134
Perspectives on error?
Person approach -> blame the individual
System approach -> focus on working conditions
135
Strategies to reduce error
```
Simplify and standardise clinical processes
Checklists - SBAR
Information technology
Team training
Risk management
Mechanisms
```
136
Never event?
Serious, largely preventable patient safety incidents that should not occur if available preventative measures have been implemented
137
Egs of never event?
Surgery - wrong site, retained item
Medication - wrong preparation/route
Mental health - suicide
138
Leadership styles?
Inspirational
Transactional
Laissez-faire
Transformational
139
Why do things go wrong in health care?
```
System failure
Human factors
Judgement failure
Neglect
Poor performance
Misconduct
```
140
Qs to ask when possible negligence?
1. Is there a duty of care?
2. Was there a breach in that duty?
3. Did patient come to harm?
4. Did the breach cause the harm?
141
Bolam test
Would a group of reasonable doctors do the same
142
Bolitho test
Would it be reasonable for them to do so?
| them being the group of reasonable doctors in the Bolam test
143
Approaches to learning?
Tripartite model
- Surface (fear of failure)
- Strategic (desire for success)
- Deep approach (intrinsic desire for understanding)
Kolb's learning cycle
144
Types of learner
Theorist
Activist
Pragmatist
Reflector
145
Key responsibilities of small group tutors
Manage the group, activities and learning
146
How to facilitate learning?
Lead discussions
Open-ended Qs
Guide process
Enable active participation
147
Why teach diversity?
Better health outcomes for patients
More satisfying doctor-patient encounters
148
# Define 'culture'
what is it based on?
socially transmitted pattern of shared meanings.
Based on heritage as well as individual circumstances and personal choice.
149
Define 'ethnocentrism'
the tendency to evaluate other groups according to the values and standards of one's own cultural group.
Conviction that one's own cultural group is superior
150
Define 'stereotype'
generalisations about 'typical' characteristics of members of a group
151
Define 'prejudice'
Attitude towards another person based solely on their membership of a group
152
Define 'discrimination'
positive/negative actions towards the objects of prejudice
153
Why has the need for rationing resources increased?
Shift from acute illness to chronic long term
Normal physiological events medicalised
Increase in choice and cost of drugs
154
Define 'rationing'
resource is refused due to lack of affordability
155
Theories of resource allocation?
Egalitarian - provide all care that is necessary and appropriate to everyone.
Maximising - criteria maximising public utility
Libertarian - each is responsible for their own health
156
Rights in health care?
Right to life
Right to be free from inhuman and degrading treatment
Right to respect for privacy
Right to marry and found a family
157
Benefits of social media
Wide and diverse social/professional networks
Engage in debates
Facilitates public access to health information
Improve patient access to services
158
Risks of social media
Loss of privacy
Confidentiality breach
Online behaviour seen a unprofessional
Risk of being reported
159
GMC duties of a doctor
Care of patient is 1st concern
Protect + promote health of patients and public
Provide a good standard of practice and care
Treat patients as individuals + respect their dignity
Work in partnership with patients
Be honest, open and act with integrity
160
3 features of health economic evaluation?
Cost of service(s)
Benefit of service(s)
Comparison of cost and benefit of the service and any alternate service
161
2 features compromising a QALY?
Number of years
| Quality of life - i.e. utility
162
What system do health economists use to evaluate disability?
DALYS - disability adjusted life years
163
Define health care economic 'efficiency'
Getting the maximum cost/health benefit outcomes from a service
164
What is the term when treatment is given elsewhere and benefit foregone other patients?
Opportunity cost - i.e. money is spent elsewhere because it gives better benefit on another opportunity
