PUBLIC HEALTH & MISC Flashcards
(122 cards)
1
Q
according to the GMC, in England, Wales and Northern Ireland, under what age can a child consent to but not REFUSE tx?
A
16 (parents can over-rule refusal)
2
Q
in Scotland, if a competent young person <16 refuses treatment, can their parents override this?
A
no
3
Q
how many UK screening programmes are there?
A
11
4
Q
what are the 3 UK screening programmes offered in pregnancy?
A
- infectious diseases (hep B, syphilis, HIV)
- sickle cell and thalassemia
- foetal anomaly screening (down’s, edward’s, patau’s)
5
Q
what are the 3 UK screening programmes offered to newborn babies?
A
- NIPE
- newborn hearing screening
- newborn blood spot screening
6
Q
what are the 5 UK screening programmes offered to young people and adults?
A
- AAA
- bowel cancer
- breast cancer
- cervical cancer
- diabetic eye
7
Q
NHS screening - from what age and how often are the 5 young people/adult screenings offered?
a) diabetic eye
b) cervical cancer
c) breast cancer
d) bowel
e) AAA
A
a) all people with diabetes from age 12
b) smear every 3 years aged 25-49 and every 5 years aged 50-64
c) mammogram every 3 years to women aged 50-70
d) FIT test every 2 years aged 50-74
e) once for men when they turn 65
8
Q
benefits of screening programmes (5)
A
- may detect problem pre-symptoms
- detecting early = more effective tx
- helps people make more informed decisions about health
- reduce chance of developing a condition/complications
- can prevent some deaths
9
Q
limitations of screening programmes (6)
A
- not 100% accurate e.g. false -ve, +ve
- can lead to difficult decisions e.g. screening for abnormalities in pregnancy
- health anxiety
- can still go on to develop condition if result is negative
- biases - selection, lead time, length time
- exposure of well individuals to distressing/harmful diagnostic tests e.g. colonoscopies for +ve faecal occult BT
10
Q
define these biases present in screening:
a) selection bias
b) lead time bias
c) length time bias
A
a) those who show up to screen may be at a lower risk of a condition e.g. women in higher SE group more likely to attend cervical/breast screening
b) survival time appears longer because the diagnosis was done earlier (ie by screening), irrespective of whether pt lived longer. apparent increase in survival time even if screening has no effect on outcome
c) overestimation of survival duration due to relative excess cases detected in screening that are asymptomatically slowly growing - fast progressing symptomatic cases less likely to be detected in screening (but on the surface appears that screening results in cancers with better prognosis!)
11
Q
explain what is meant by:
a) true positive
b) false positive
c) true negative
d) false negative
A
a) disease present, positive result
b) disease absent, positive result
c) disease present, negative result
d) disease absent, negative result
12
Q
define and show the calculation for
a) sensitivity
b) specificity
A
a) proportion of people with disease who are correctly identified by a test (true positives / true positive + false negatives)
b) proportion of people without the disease who are correctly excluded by screening (true negatives / true negatives + false positives
13
Q
define
a) positive predictive value
b) negative predictive value
A
a) proportion of people with a positive test result who actually have the disease (true positives / true positives + false positives)
b) proportion of people with a negative test result who actually don’t have the disease (true negatives / true negatives + false negatives)
14
Q
case control studies
A
a type of analytical retrospective study - study of choice for investigating RFs and the development of a disease
takes people with disease, matches them to those without the disease and then studies previous exposure to an agent
e.g. whether environmental exposure Y is associated with the development of X
15
Q
advantages and disadvantages of case-control studies
A
advantages - good for rare outcomes (e.g. cancer), quicker than cohort/intervention (as outcome has already happened), can investigate multiple exposures
disadvantages - retrospective so only shows association not causation, difficulties finding controls to match cases, prone to selection and information bias, recall bias
16
Q
cross-sectional study
A
study of choice for prevalence - analyses data from population/sub-set at a specific point in time
e.g. interviewing children with cerebral palsy from 8 areas in Europe about their daily life experiences
17
Q
advantages and disadvantages of a cross-sectional study
A
advantages
- relatively quick and cheap
- provides prevalence data
- large sample size
- good for surveillance and public health planning
disadvantages
- risk of reverse causality (did outcome of exposure come first?)
- cannot measure incidence
- risk recall bias and non-response (may miss someone with quick recovery time)
18
Q
cohort study
A
prospective longitudinal - for looking at exposure vs non exposure over time e.g. whether children born via IVF are more likely to suffer from mental disorders in childhood
19
Q
advantages and disadvantages of a cohort study
A
advantages
- can FU group with a rare exposure e.g. natural disaster
- good for common and multiple outcomes
- less risk of selection and recall bias, causation more likely cos prospective
disadvantages
- takes a long time!!
- loss to FU (people dropping out)
- need large sample size
20
Q
incidence of disease
A
number of new cases during a specified time period
21
Q
randomised controlled trial
A
gold standard prospective study with exposure and control interventions
e.g. can an integrated care programme reduce disability in patients with chronic back pain
22
Q
advantages and disadvantages of randomised controlled trials
A
advantages
- low risk of bias and confounding
- can infer causality
disadvantages
- time consuming
- expensive
- specific inclusion/exclusion criteria may mean the study population is different from typical patients
- volunteer bias
23
Q
what is an ecological study
A
descriptive/observational study design consisting of case reports or case series studying the population
uses routinely collected data to show trends/compare e.g. across GP practises
24
Q
advantages and disadvantages of an ecological study
A
+ve
- few ethical issues
- useful for generating hypothesis
- uses routine data so quick and cheap
- shows prevalence and association
-ve
- cannot show causation
- bias: variation in diagnostic criteria
25
types of information bias
a) measurement
b) observer
c) recall
d) reporting
a) e.g. different equipment used to measure the outcome in different groups
b) e.g. the researcher knows which participants are cases and which are controls, subconsciously reports/measures outcome differently
c) events that happened in the past are not remembered and reported accurately
d) respondents report inaccurate info because they are embarrassed or feel judged
26
confounding bias
estimated relationship between exposure and outcome is distorted because of the association of the exposure with another factor (confounder) that is also independently associated with the outcome
27
reverse causality
outcome causing exposure rather than exposure causing outcome
28
bradford-hill criteria of causality (what makes causality more likely?) (8)
1. strength - stronger association between the exposure and outcome
2. consistency - same result observed from various studies and in different geographical settings
3. dose-response - increased risk of outcome with increased exposure
4. temporality - exposure occurs prior to outcome
5. plausibility - reasonable biological mechanism
6. reversibility - intervention to reduce/remove exposure eliminates or reduces outcome
7. coherence - logical consistency with other information/theories
8. analogy - similarity with other established cause-effect relationships e.g. similar exposure causes similar outcome
9. specificity - relationship specific to outcome of interest
29
purpose of screening
identify apparently well individuals who have (or are at risk of developing) a particular disease so that you can have a real impact on outcome
30
NHS criteria for a screening test - the condition (4)
1. the condition should be an important health problem
2. the epidemiology and natural history of the condition should be understood and there should be a detectable RF
3. all cost-effect primary prevention interventions should have been implemented as far as practicable
4. if the carriers of the mutation are identified as a result, the natural history of people with this status should be understood (including psychological complications)
31
NHS criteria for a screening test - the screening programme (2)
1. screening should be ongoing and not just performed on a "one-off" basis
2. the costs of screening should be economically balanced
32
NHS criteria for a screening test - the test (5)
1. simple, safe, precise and validated
2. distribution of test values should be known, suitable cut-off defined and agreed
3. acceptable to population
4. an agreed policy on further diagnostic investigations
5. if it's testing for mutations, criteria for subset of mutations to be covered by screening should be clearly set out e.g. neonatal CF screening- only commonest mutations screened for
33
NHS criteria for a screening test - the treatment (3)
1. effective tx/intervention for patients identified
2. policy on whom to treat as patients
3. clinical management of condition and patient outcomes should be optimised
34
3 approaches to a health needs assessment
1. epidemiological approach
2. corporate approach
3. comparative approach
35
epidemiological approach of a health needs assessment:
a) what sort of data is used?
b) sources of data?
a) - disease incidence & prevalence
- morbidity and mortality
- life expectancy
- services available
b) disease registry, hospital admissions, GP databases, mortality data, primary data collection (e.g. postal/patient survey)
36
advantages and disadvantages of the epidemiological approach to a health needs assessment
advantages
- uses existing data
- provides data on disease incidence/mortality/morbidity etc
- can evaluate services by trends over time
disadvantages
- quality of data is variable
- data collected may not be the data required
- doesn't consider felt needs/opinions/experiences
37
what is the corporate approach to a health needs assessment? what methods does it use? stakeholders?
- asks the population what their health needs are
- uses focus groups, interviews, public meetings
- wide variety of stakeholders e.g. teachers, healthcare professionals, social workers, charity workers, local businesses, council workers and politicians
38
advantages and disadvantages of the corporate approach to the health needs assessment
advantages
- based on felt and expressed needs of the population in question
- recognises detailed knowledge and experience of those working with the population
- takes into account wide range of views
disadvantages
- difficult to distinguish need from demand
- group may have vested interests
- may be influenced by political agendas
39
what does the comparative approach of a health needs assessment do? what may it examine?
- compares the health or healthcare provision/services of one population to another
- spatial e.g. different towns or social e.g. age, social class
- ie compares services for a particular health issue in 2 different services
- may examine health status, service provision, service use, health outcomes e.g. mortality
40
advantages and disadvantages of comparative approach to the health needs assessment
advantages:
- quick and cheap if data available
- indicates whether health or services provision is better/worse than comparable areas
disadvantages:
- may be difficult to find comparable population
- data may not be available/high qual
- may not yield what the most appropriate level (e.g. provision/utilisation) should be
41
3 steps to the epidemiological approach to HNA
1. descriptive - identifies health problems by identifying patterns
2. analytical - determines risk factors and causes of health problems
3. evaluative - assesses effectiveness of interventions
42
3 key features of the corporate approach to HNA
1. consultation - engage stakeholders to gather insights
2. collaboration - work together to align goals
3. prioritisation - address needs based on consensus and feasibility
43
3 key objectives to comparative approach to HNA
1. identify inequalities/gaps
2. highlight under-served areas
3. inform resource allocation for equitable service delivery
44
health needs examples
a) something demanded but not needed or supplied
b) something supplied and needed but not demanded
c) something supplied but not needed or demanded
a) cosmetic surgery
b) anti-HTN tx (pt often asymptomatic)
c) >75 health check by GP
45
components of the health belief model: individuals will change if they...
1. believe they're susceptible to the condition (perceived susceptibility)
2. believe it has serious consequences (perceived severity)
3. believe that taking action reduces susceptibility (perceived benefits)
4. believe that benefits of taking action outweigh costs (perceived barriers)
46
which component of the health belief model has been shown to be most important?
perceived barriers
47
two revisions made to the health belief model 1974
health motivation and cues to action
48
are cues to action always necessary for behaviour change? what are the two types and give examples
no
internal - increased pain, decreased ADLs
external - reminders in the post, GP advice
49
advantages of health belief model
1. can be applied to wide variety of health behaviours
2. cues to action are unique component
3. long standing model
50
critiques of health belief model
1. alternative factors may predict health behaviour e.g. outcome expectancy, self-efficacy
2. doesn't consider influence of emotions + behaviour
3. doesn't differentiate between first time and repeat behaviour
4. cues to action often missing in research
51
theory of planned behaviour model proposes the best predictor of behaviour is intention. what does it suggest intention is determined by? (3)
1. person's ATTITUDE to the behaviour
2. SUBJECTIVE NORM - perceived social pressure
3. PERCEIVED BEHAVIOURAL CONTROL - person's appraisal of their ability to perform the behaviour
52
using smoking as an example, describe the different areas of the theory of planned behaviour (4)
attitude - i do not think smoking is a good thing
subjective norm - most people who are important to me want me to give up smoking
perceived behavioural control - i believe i have the ability to give up smoking
behavioural intention - i intend to give up smoking
53
theory of planned behaviour - 5 ways to bridge the intention-behaviour gap
1. perceived control - focus on past successes, ensure individual feels capable
2. anticipated regret - reflecting on feelings once failed, related to sustained intentions
3. preparatory actions - break task down, plan sequence, achievable steps
4. implementation intentions - if-then planning e.g. if i need to take my meds in the morning then i will place it here to remind me
5. relevance to self - can they relate to the behaviour
54
advantages of theory of planned behaviour
1. can be applied to wide variety of health behaviours
2. useful for predicting intention
3. takes into account importance of social pressures
55
disadvantages of theory of planned behaviours (4)
1. doesn't take into account emotion (rational choice model)
2. no sense of how long behaviour change may take
3. assumes attitudes, subjective norms and perceived behavioural control can be measured
4. relies on self-reported behaviour
56
5 stages in the transtheoretical/stages of change model
1. pre-contemplation (not ready yet)
2. contemplation (thinking ab it - within 6m)
3. preparation (quitting within 28d)
4. action (quitting now)
5. maintenance (steady defined as >6m)
57
advantages of transtheoretical/stages of change model
- acknowledges individual stages of readiness (tailored interventions)
- accounts for relapses
58
disadvantages of transtheoretical/stages of change model
- not all ppl move through every stage, some move back/skip stages
- change might operate on continuum, not discrete stages
- doesn't take into account values, habits, emotions, culture, social and economic factors
- people often change behaviour with no planning!
59
define and give examples of
a) primary prevention
b) secondary prevention
c) tertiary prevention
a) preventing a disease from happening in the first place e.g. change4life, 5aday, vaccines
b) detecting a disease in early/pre-clinical phase to alter its course and improve health outcomes e.g. screening programmes
c) attempting to slow down disease progression + prevent complications of disease e.g. diabetic foot care, attending rehab after stroke
60
define and give an example of the population approach to prevention
preventative measure delivered on a population-wide basis, seeks to shift the risk factor distribution curve
e.g dietary salt reduction through legislation to reduce BP
61
define and give an example of the high-risk approach to prevention
identifying individuals above a chosen cut-off and treating them e.g. screening for HTN and treating them
62
what is the prevention paradox?
a preventative measure which brings much benefit to the population often offers little to each participating individual
63
types of screening
1. population-based e.g. cervical, breast
2. opportunistic e.g. BP measurements in GP surgeries
3. screening for communicable diseases
4. pre-employment and occupational medicals
5. commercially provided screening
6. genetic counselling
64
define allostasis and allostatic load
allostasis - the ability through change/homeostasis of our physiological systems to adapt rapidly to change in environment
allostatic load = long-term over-taxation of our physiological systems leading to impaired health (stress)
65
list 4 determinants of health
1. genes (age, gender, ethnicity)
2. environment (physical, social, housing, education)
3. lifestyle (smoking, wealth, employment)
4. access to healthcare
66
Maslow's hierarchy of needs (5)
1. physiological - breathing, water, food, sleep
2. safety - employment, resources, family health, property
3. love/belonging - friendship, family, sexual intimacy
4. esteem - self-esteem, confidence, achievement
5. self-actualisation - morality, creativity, spontaneity, problem solving etc
67
what are health interventions?
any tactics done to improve public health
68
health interventions
a) individual
b) community
c) population
a) pt centred approach e.g. childhood imms
b) community centred approach e.g. new outdoor play area in village, more cycle paths
c) delivered nation-wide, non specific to individuals e.g. PH campaigns, screening, Clean Air act
69
define equality
concerned with equal shares of resources/opportunities
70
define equity
concerned with what is fair and just
71
horizontal vs vertical equity
horizontal - equal treatment for equal need e.g. individuals with same disease should be treated equally
vertical - unequal treatment for unequal need e.g. individuals with common cold vs pneumonia need different tx
72
factors affecting health equity (2)
1. spatial - geographical e.g. infant mortality higher in Africa
2. social (age, gender, SE, ethnicity) e.g. socioeconomic inequity as angina sx are higher in more deprived areas
73
3 domains of public health and some examples
1. health improvement/promotion - societal interventions to prevent disease, promote health and reduce inequalities e.g. education, housing, employment
2. health protection - measures to control infectious disease risk/environmental hazards e.g. radiation, emergency response, infectious diseases, poison and chemicals
3. healthcare - organisation and delivery of safe, high quality services for prevention, tx and care e.g. service planning, audits, clinical governance, equity
74
define epigenics
the study of how genes interact with the environment - changes in organisms caused by modification of gene expression rather than alteration of the genetic code itself
75
2 broad categories of health behaviours
1. health damaging/impairing e.g. smoking, alcohol
2. health promoting e.g. exercising, vaccines, attending health checkups
76
define these health behaviours
1. health behaviour
2. illness behaviour
3. sick role behaviour
1. a behaviour aimed to prevent disease e.g. healthy eating
2. a behaviour aimed to seek remedy e.g. going to doctor
3. any activity aimed at getting well e.g. resting, taking prescribed medications
77
what is the main theory as to why people partake in health damaging behaviours? define it
unrealistic optimism - individuals continue practising health damaging behaviours due to inaccurate perceptions of risk + susceptibility (Weinstein, 1983)
78
influences of unrealistic optimism perceptions of risk (4)
1. lack of personal experience with the problem
2. belief that it's preventable by personal action
3. belief that it's not happened by now so it's unlikely to
4. belief that the problem is infrequent
79
medication compliance vs adherence
compliance - extent to which patient's behaviour coincides with medical advice. professionally focussed, assumes dr knows best
adherence - extent to which pts actions match agreed recommendations. more pt centred.
80
factors affecting medication compliance (4)
1. side effects
2. patient perception of risk
3. if patient is asymptomatic (e.g. continuing to take abx)
4. SES
81
social norms theory of behaviour. when is this positive and when does it not work?
- social norms are one of most important factors influencing behaviour
- normally protective
- but sometimes belief of norms is different to actual norms e.g. allows people who want to do high risk behaviours to think they're just doing what everyone else is doing
- and doesn't work when risk behaviour IS the norm e.g. alcohol
82
nudge theory
changing environment to make the best/healthiest options the easiest
e.g. placing fruit next to checkouts instead of sweets, opt-out schemes
83
typical transition points which may influence someone to be more/less likely to change behaviours (6)
1. leaving school
2. starting work/new job
3. becoming a parent
4. becoming unemployed
5. retirement
6. bereavement
84
what is a health needs assessment? what can it be carried out for?
- a systematic method for reviewing the health issues facing a population
- can be carried out for a population or sub-group (e.g. manor practice population), a condition (e.g. COPD), or an intervention (e.g. coronary angioplasty)
85
planning cycle of health needs assessment (4)
1. needs assessment
2. planning
3. implementation
4. evaluation
86
define need, demand and supply
need = ability to benefit from an intervention
demand = what people ask for
supply = provided
87
health need vs healthcare need
health need = a need for health, more general e.g. mortality, morbidity, socio-demographics
healthcare need = a need for healthcare, more specific, looks at someone's ability to benefit from health care
88
what does healthcare need depend on?
potential of prevention, treatment and care services to remedy health problems
89
sociological perspective of need - what are the 4 categories of needs?
felt, expressed, normative and comparative
FELT - individual perceptions of variation from normal health
EXPRESSED - individual seeks help to overcome variation in normal health (demand)
NORMATIVE - professional defines intervention appropriate for the expressed need
COMPARATIVE - comparison between severity, range of interventions and cost
90
determinants of health (PROGRESS)
Place of residence
Race
Occupation
Gender
Religion
Education
Socioeconomic
91
2 ways of assessing quality of healthcare
1. Maxwell's dimensions (3 As and 3 Es)
2. donabedian model - structure, process and outcome measures
92
Maxwell's dimensions of assessing healthcare (3 As and 3 Es)
Acceptability - how acceptable is service
Accessibility - e.g. geographically, cost, info available
Appropriateness - is right tx being given to right people at the right time
Effectiveness - does it achieve the benefit it should
Efficiency - maximising output for given input
Equity - are people treated fairly and resources distributed fairly
93
define evaluation
the assessment of whether a service achieves its objectives
94
evaluation of health services. define and give examples of:
a) structure
b) process
c) outcome
a) physical and organisational characteristics e.g. buildings, staff, equipment
b) the care that's delivered e.g. services, tests, examinations, prescribing
c) effect of intervention on health e.g. morbidity, mortality, patient satisfaction
95
evaluation of health services: give a quantitative example of
a) structure
b) process
c) outcome
a) number of diabetes nurses per 1000 patients, number of operating theatres per 1000 patients
b) number of HbA1c tests performed in the last 12 months, number of metformin prescriptions in the last 12 months per 1000 T2DM patients
c) post-op improvement in 6m per 1000 OA patients, number of post-op deaths in 12m per 1000 hip-replacement patients
96
qual vs quant methods for evaluation of health services
qual - observation, interviews
quant - routinely collected data, review of records, surveys
97
factors promoting excessive energy intake (5)
1. employment (shift work)
2. characteristics of food - energy, portion
3. social aspect e.g. going out for food
4. genetics
5. ads
98
define malnutrition
deficiencies, excesses or imbalances in a person's intake of energy and/or nutrients
99
types of malnutrition
1. undernutrition
2. overnutrition/weight
100
types of undernutrition (4)
1. stunting (low height for age)
2. wasting (low weight for height)
3. underweight (low weight for age)
4. micronutrient deficiencies/insufficiencies
101
4 early influences on feeding behaviour
1. maternal diet
2. breastfeeding
3. parenting practises
4. age of intro of solid foods/types of foods exposed to
102
advantages of breastfeeding on early feeding behaviour (4)
1. less picky eaters in childhood
2. more likely to accept novel foods when weaning
3. more likely to have diet rich in fruit and veg if BF >3m
4. bodyweight regulation - babies stop feeding when full on breastfeeding but bottle-fed babies often encouraged to finish whole bottle
103
maladaptive parenting practises with food
- coercion
- persuading
- contigencies
104
triple burden of malnutrition
1. undernutrition
2. overnutrition
3. micronutrient deficiency
105
relationship between non-organic feeding disorders (NOFEDS) and parents of these children
parents often use maladaptive styles e.g. pressure to eat, authoritarian style, restriction, using food as reward
106
define food/nutrition insecurity
experiencing one or more of the following:
1. having smaller meals/skipping meals
2. being hungry but not eating
3. not eating for a day
107
four dimensions of food/nutrition insecurity
1. availability - affordability of food
2. access - economic or physical
3. utilisation - opportunity to prep food
4. stability of these dimensions over time
108
3 forms of dieting associated with restricted intake
1. restrict total amount
2. restrict type
3. restrict time-window e.g. intermittent fasting
109
disadvantages of dieting (5)
1. RF for developing EDs
2. loss of lean body mass not just fat mass
3. slows metabolic rate
4. chronic dieting - disrupts normal appetite response, increases hunger sensation
5. long term weight loss challenging, normally plateaus then gains again
110
3 EDs
1. bulimia nervosa
2. anorexia nervosa
3. binge eating disorder
111
types of disordered eating
1. restraint
2. strict dieting
3. disinhibition
4. emotional eating
5. night eating
6. weight and shape concerns
7. inappropriate compensatory behaviours
112
define these types of resource allocation:
a) egalitarian
b) libertarian
c) maximalism
a) provide all care needed for everything
b) everyone is responsible for own health
c) thinks about consequences, use resources efficiently to achieve goals and minimise waste/cost
113
4 steps in a HNA framework
1. identify health probs
2. assess demand for services
3. evaluate available resources
4. prioritise interventions
114
define odds and odds ratio
odds = the ratio of the prob of an event occurring to the prob of it not occurring
odds ratio = measure of association between exposure and outcome, compares the odds of an outcome occurring due to exposure vs odds of it occurring with no exposure
115
calculation for odds and odds ratio
odds = p(event)/p(no event)
OR = odds (exposed grp)/odds (nonexposed grp)
116
define absolute and relative risk
absolute = the prob of an event occurring in a group
relative = ratio of the prob of an event occurring in an exposed group vs nonexposed group
117
absolute risk and relative risk calculations
absolute = number of events/total pop
relative = AR in exposed/AR in nonexposed
118
define domestic abuse
any incident/pattern of incidences of controlling, coercive and threatening behaviour, violence or abuse
between those aged 16 or over who are, or have been, intimate partners or family members
regardless of gender or sexuality
119
types of domestic abuse (5)
1. psychological
2. physical
3. sexual
4. financial
5. emotional
120
assessment tool for domestic abuse/sexual harassment
domestic abuse + sexual harassment tool (DASH)
121
management of patient who you screen as being
a) standard/medium risk
b) high risk
of DA
a) it's their choice, give them contact details for DA services
b) refer to MARAC/IDVAS with consent
122
role of
a) domestic abuse multi-agency risk assessment conference (MARAC)
b) independent domestic abuse advisers (IDIVAS)
a) meeting where info is shared on highest risk DA cases, discusses options for increasing safety of victim, creates action plan
b) helps victims navigate DA with advise, support through court, signposting to specialist services e.g. housing, point of contact in MARAC process
+
