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Know that
25% of all deaths occur in children under 5 and almost all of these are in the developing world.
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Crude birth rate
number of births/population size
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Total fertility rate
the number of children a woman would theoretically have if she gave birth throughout her entire life at the current rate that people are right now.
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Maternal mortality rate
ratio of pregnancy related deaths to live births. over 700 mothers die per 100,000 births in sub-Saharan Africa vs. 10 per 100,000 in developed countries.
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Premature death
number of years of potential life lost prior to age 75 per 10000 people.
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Life expectancy
the expected life length if people died at the current mortality trends.
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What is a demographic life table?
Number of people who would be alive at current mortality rates. Useful for comparing mortality across populations. To estimate life expectancy at birth.
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What are the causes of an ageing population?
Fertility decline + increasing life expectancy.
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What are the five stages of demographic transition?
High stationary, early expanding, late expanding, low stationary, declining
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What is the epidemiological transition?
Changes in patterns of sickness and disability i.e. from pestilence + famine > receding pandemics > non-communicable diseases.
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What is a DALY?
Disability adjusted life year i.e. the sum of years of potential life lost due to premature mortality, and the years of productive life lost due to disability.
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What is the standardised mortality ratio?
Mortality ratio as applied to a standard population, in order to compare mortality statistics.
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What are the challenges of measuring and comparing mortality rates?
Accuracy of data, migration, different distributions of populations
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Who studied and tested scurvy?
James Lind.
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Who developed ICD-10?
William Farr
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How do you measure rate of a disease?
Number of cases/total at risk population / unit of time
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What is point prevalence?
Number of cases at time T / number of people in the given population at the time
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Period prevalence
Number of cases during a defined period / total number of people in the population.
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Incidence
Number of new cases /personxtime risk (amount of cumulative disease free time for people at risk)
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Which is better for chronic disease, prevelance or incidence?
Prevalence for chronic disease and incidence for shorter illnesses.
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Case fatality rate
Number of deaths / number of cases
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Relative risk
Risk in one population / risk in another population (cohort studies)
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Odds ratio
Number who died / number who survived (case-control studies)
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Absolute risk
Difference in risk for an individual between study and control populations. More useful for assessment of individuals.
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Attributable risk
(difference between exposed and unexposed cases)/incidence in unexposed
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What is a type 1 random error?
Assigning an association where there is none present
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What is a type 2 random error and what are causes?
Not picking up an association. Sampling error, power.
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How may systematic errors occur?
Selection bias, information bias (blinding(, confounding factors
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What is crude death rate?
Deaths in a given population size over a time.
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What is a directly standardised death rate?
The death rate that would have occurred in an imaginary reference population if it had the same characteristics as the study population.
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What is standardised mortality ratio?
The ratio of deaths in the study population compared to a reference population, multiplied by 100.
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What is attributable mortality?
Deaths due to a particular cause in 1 year / total deaths in that year * 100
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What is perinatal mortality?
(still births + first week deaths) / total births
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What is neonatal mortality rate?
Deaths in the first 28 days per 1000 live births
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Post-neonatal mortality rate
First year deaths after 28 days per 1000 live births
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Maternal mortality rate
Complications of pregnancy/top/childbirth/puerperium within 42 days per 1000 live births
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Still birth rate
Stillbirths per 1000 total births
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Infant mortality rate
First year deaths per 1000 live births
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Under 5 mortality rate
First 5 year deaths per 1000 live births
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Which two birth rates use ‘per total births’ instead of ‘per 1000 births’?
Still birth rate and perinatal mortality rate
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Years of life lost
75 years – age
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What is the PICO approach?
Population, intervention, comparison, outcome
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What is Bradshaw’s model of needs?
Expressed needs (by say doctor), normative needs (epidemiological), comparative needs (compared to others), felt needs
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How can locally needs be evaluated?
Joint strategic needs assessment
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What is a measure of cost utility?
QALY
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What is the beauchamp and childress principle of biomedical ethics?
Autonomy, non-maleficence, beneficence, justice
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What was Geoffrey rose’s contribution to public health?
Prevention can be ‘high risk’ populations or ‘population level’ populations
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What are the three kinds of screening?
Mass screening, targeted screening, opportunistic screening
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Who developed the screening criteriae and what are they?
Wilson and Jungner, 1968. Important, early tage, primary prevention already exists. Test (simple, acceptable,) treatment (accepted, useable), programme (cheap, acceptable, doable).
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What does the Guthrie test test for?
Hypothyroid, PKU, CF, Sicle, MCADD
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Which antenatal screening exists?
Anaemia, blood group, rhesus, hep B, HIV, Down’s
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What adult screening exists?
Breast cancer (50-70), cervical cancer (25-64), colorectal (60-69), AAA (65YO), retinopathy (diabetics), TB (immigrants > 6 months)
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What is the false positive rate?
Of the people without the disease, which will have a positive result?
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What is the false negative rate?
Of the people with the disease, which will have a negative result?
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What is the positive predictive value?
Of the people whose test was positive, what percentage are people with the disease?
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What is the negative predictive value?
Of the people whose test was negative, what percentage of people are without the disease?
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What is the positive likelihood ratio?
Sensitive / (1-specificity) – useful for individuals
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What is the negative likelihood ratio?
(1-sensitivity) / specificity – useful for individuals
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What is lead time bias?
When identification of disease is earlier, so survival time
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In terms of infectiousness, what is R0?
Basic reproductive rate. If R0>1 then disease will spread.
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What proportion of the population needs to be vaccinated?
1 – (1/R0)
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What are the six dimensinos of quality and who invented them?
Maxwell: effectiveness, efficiency, equity, accessibility, acceptability, relevance.
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Who wrote about healthcare aspirations of patients and what are some of them?
Coulter – access, effective, clear, comprehensive, emotional support, support for family and carers, continuity of care.
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Who wrote about 4 elements of evaluation (e.g. of a programme) and what are they?
Donabedian – structure (infrastructure), process (things done to patients), outputs (results of the intervention), outcomes (gains in health status). Consider both process and outcome of a programme.
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How can quality of healthcare be problematic?
Underuse, overuse, misuse.
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Who invented six sigma?
Motorola – near perfect error rates can be achieved e.g. in anaesthesia.
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Where are rights of the child set out?
UN convention ‘rights of the child’
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Name community based parental support initiatives
SureStart, Health schools.
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Name interesting points on child health from the 2001 census
18% children have minor disabilities, 7 per 10,000 children have severe disability including autism.
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What areas can determine child health?
Individual/congenital, ethnicity, parenting, family structure, childcare, peers, community + poverty, physical environment, lifestyle, media, public services.
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What committee recommended more fruit/veg and less saturated fat?
1994 Committee on Medical Aspects of Food and Nutrition Policy
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What is the total dependency ratio?
Children and >65’s : economically active adults
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What is active ageing?
Optimising opportunities for health as people age.
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What is public policy?
formal decisions or explicit proposals of governments or public agencies
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In policy production, what’s the differences between rationalists and incrementalists?
Rationalists identify a problems and create a solution (Walt). Incrementalists produce small changes to current rules (Lindbolm)
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Which 4 factors impact on production of policy and who invented this categorisation?
Leichter: situational (transient conditions e.g. emergencies), structural (e.g. politics), cultural (values), environment (global factors).
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What is the ladder of intervention?
Nuffield council of bioethics ladder of intervention is moving from doing nothing, to informing, guiding, incentivisation, disincentivisation, regulation, banning.
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What are the outcomes of the Marmot Review?
Best start in life (child), maximise people’s capabilities, fair employment, health standard.
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Talk about preventable maternal and neonatal deaths.
International Conference on Population and Development in Cairo (1994) for contraceptive and family planning, perinatal care, HIV care. 13% of under 5 deaths preventable by breast feeding and policy.
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Discuss access to healthcare.
Vertical approaches criticised by Alma-Ata declaration of 1978 as short-sighted and top down.
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Discuss financing in different healthcare models.
Private public partnerships supported by UKAID and USAID.
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Discuss better access to medicine.
Doha TRIPS decision (2003) allows medicine reverse engineered.
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Discuss women and healthcare.
Hilary Clinton’s Beijing address (1995). Amartya Sen “100 million women are missing from the world”.
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Discuss sustainable development
Climate change act 2008. Ethical sourcing. NHS route map for sustainable health 2010 (3 main areas: behaviour, governance + technology)
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