PUBLIC HEALTH

Epigenetics
how the environment effects genes
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Allostasis
how our systems have adapted to react rapidly to environmental stressors to maintain homeostasis
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Allostatic load
Overtaxation of our systems leads to impaired health
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Salutogenesis
physiological changes from experiences that promote health
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Purpose of primary care
Manage illness and clinical relationships over time, promote health, shared decision making, preventing illness
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Health needs assessment
A systematic method for reviewing the health issues facing a population - allocation of resources that reduces health inequalities
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What are the 4 types of need
Felt need (individual perceptions), Expressed need (seek to overcome variation in normal health), normative need (professional defines intervention for expressed need), Comparative need (comparing interventions)
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Define primary, secondary and tertiary prevention
Primary (preventing disease before it happens), Secondary (catching disease at early phase), Tertiary (preventing complications)
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Criteria for screening programme
Important condition, history of condition known, condition has a latent stage, the screening test is suitable and acceptable, the treatment is effective, agreed population to treat, cost of screening economical
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Define sensitivity
the proportion of people with the disease who are correctly identified by the screening test
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Define specificity
the proportion of people without the disease who are correctly excluded by the screening test
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Positive predictive value
the proportion of people with a positive result who actually have the disease
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Negative predictive value
the proportion of people with a negative test who do not have the disease
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Define incidence
New cases over time
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Prevalence
existing cases in a point of time
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Attributable risk
incidence in exposed minus incidence in unexposed
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Relative risk
incidence in exposed divided by the incidence in unexposed
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Number needed to treat
the number of patients we need to treat to prevent one bad outcome
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What is confounding?
When there is another IV acting on the DV
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Reverse causality
outcome causes the exposure rather than the exposure causing the outcome
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Sources of information bias
Observer, Participant, Instrument
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4 factors of the health belief model
1) perceived benefits/perceived barriers 2) perceived threat 3) self-efficacy 4) cues to action
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6 stages of change
Precontemplation, contemplation, preparation, action, maintenance, relapse
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Maslows hierarchy of needs from bottom to top
physiological, safety, belonging, esteem, self-actualisation
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Biggest cause of homelessness
relationship breakdown
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What types of error can be made?
Skill based errors (action is made that is not intended), Rule based errors (incorrect application of a rule), Knowledge-based errors
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What are the different perspective on error?
Person approach (individuals fault) System approach (many causal factors, need more safety nets)
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What is a never event?
Serious, largely preventable patient safety incidents that should not occur if preventative measures are in place
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How to reduce harm
Simplification and standardisation, checklists, IT, team training, risk management programmes, implementing evidence based findings
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Why do things go wrong?
System failure, Human factors, Judgement failure, Neglect, Poor performance, Misconduct
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Types of learner
Theorist (questions ideas likes challenges), Activist (likes experiences), Pragmatist (likes feedback), Reflector (watches others)
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Kolb's learning cycle
Experience (activist) -> Reflect (reflector) -> Conclusions (theorist) -> Plan for next time (pragmatist)
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Ethnocentrism
The tendency to evaluate other groups according to the values and standards of one's own cultural group with the conviction that ones own cultural group is superior to other groups
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4 pillars of ethics
autonomy, beneficence, non-maleficence, justice
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3 types of resource allocation
Egalitarian (provide all care that is necessary and required to everyone), Maximising (based solely on consequence-resources allocated to those that will receive the most benefit), Libertarian (each individual responsible for their own health)
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What is Jonsens rule of rescue
We have an obligation to help others regardless of the expense
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Define utilitarianism
Best option to maximise happiness for the greatest number of people
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Deontology
the food of the action themselves rather than the consequences
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Virtue Ethics
Character based ethics
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What is the bolam rule
would a group of reasonable doctors do the same?
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Wat is the bolitho rule?
would that be reasonable for them to do so?
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3 domains of public health
Health improvement, health protection, improving services
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What is the nudge theory?
nudge the environment for positive change - fruit near checkouts
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What is selection bias?
selection of study population
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What is information bias?
measurement bias, observers expectations influence reporting
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What is publication bias?
trials with negative results less likely to be published
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What is article 8 of the human rights act
right to respect for privacy and family life
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What is article 3 of the human rights act
right to freedom from inhuman degrading treatment
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What is article 2 of the human rights act
right to life
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What is article 14 of the human rights act
right to freedom from discrimination
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what is article 12 of the human rights act
right to marry and found a family
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What is included in the newborn screening
Sickle cells, congenital hypothyroidism, CF, PKU, MCADD, MSUD
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Name 5 features of high risk assessment of a child
Pale/mottled/ashen/blue skin, no response to social cues, does not wake, weak/high-pitched/continuous cry, RR>60, grunting, chest undraping, reduced skin turgor, bulging fontanelle
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Signs of dehydration
prolonged cap refill, abnormal respiratory pattern, abnormal skin turgor, weak pulse, cool extremities
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What are the 3 types of emergency contraceptions and the hours within they can be used
POP (72 hours), Ulipristal acetate pill (120 hours), ICUD (120 hours)
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Name 5 pros and 5 cons to the OCP
Pros (reduce endometrial cancer risk, reduce heavy, irregular and painful bleeding, reduce iron deficiency anaemia, reduce pain due to endometriosis, stop acne, reduce chance of ectopic pregnancy) Cons (blood clots, increase LDL, migraines, cervical)
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Name a anticholinesterase inhibitor
Donepezil, Galatamin, Rivastigmine
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Name a NMDA receptor blocker
Memantine
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What is the mental capacity COP3
An expert opinion of a mental capacity assessment for an application to make decisions for them
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What is DOLS
procedure prescribed in law when it is necessary to deprive someone of their liberty who lacks capacity to keep them safe
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What is an IMCA
Independent mental capacity advocacy - the right to receive independent support and representation
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Name 5 differentials of low mood
Dementia, anxiety, depression, OCD, hypothyroidism, MS, adjustment disorder, bit b12 deficiency
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Risk factors for depression
Isolation, lack of employment, no family support, substance abuse, chronic illness, PD, traumatic event
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Risk factors for suicide
Previous attempts, plan, history of depression, substance abuse, physical illness
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Treatment of TB
R- rifampicin, I - isoniazid, P - pyrazinamide, E - ethambutol
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How long can a managing authority deprive someone of their liberty in an emergency?
7 days for urgent authorisation
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What is common law?
The framework that govern the emergency management of patients who refuse treatment
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Card 2

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Allostasis

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how our systems have adapted to react rapidly to environmental stressors to maintain homeostasis

Card 3

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Allostatic load

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Card 4

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Salutogenesis

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Card 5

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Purpose of primary care

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