public health

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jaz_walker
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302910
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public health
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2015-05-18 10:14:13
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  1. Know that
    25% of all deaths occur in children under 5 and almost all of these are in the developing world.
  2. Crude birth rate
    number of births/population size
  3. 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.
  4. 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.
  5. Premature death
    number of years of potential life lost prior to age 75 per 10000 people.
  6. Life expectancy
    the expected life length if people died at the current mortality trends.
  7. 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.
  8. What are the causes of an ageing population?
    Fertility decline + increasing life expectancy.
  9. What are the five stages of demographic transition?
    High stationary, early expanding, late expanding, low stationary, declining
  10. What is the epidemiological transition?
    Changes in patterns of sickness and disability i.e. from pestilence + famine > receding pandemics > non-communicable diseases.
  11. 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.
  12. What is the standardised mortality ratio?
    Mortality ratio as applied to a standard population, in order to compare mortality statistics.
  13. What are the challenges of measuring and comparing mortality rates?
    Accuracy of data, migration, different distributions of populations
  14. Who studied and tested scurvy?
    James Lind.
  15. Who developed ICD-10?
    William Farr
  16. How do you measure rate of a disease?
    Number of cases/total at risk population / unit of time
  17. What is point prevalence?
    Number of cases at time T / number of people in the given population at the time
  18. Period prevalence
    Number of cases during a defined period / total number of people in the population.
  19. Incidence
    Number of new cases /personxtime risk (amount of cumulative disease free time for people at risk)
  20. Which is better for chronic disease, prevelance or incidence?
    Prevalence for chronic disease and incidence for shorter illnesses.
  21. Case fatality rate
    Number of deaths / number of cases
  22. Relative risk
    Risk in one population / risk in another population (cohort studies)
  23. Odds ratio
    Number who died / number who survived (case-control studies)
  24. Absolute risk
    Difference in risk for an individual between study and control populations. More useful for assessment of individuals.
  25. Attributable risk
    (difference between exposed and unexposed cases)/incidence in unexposed
  26. What is a type 1 random error?
    Assigning an association where there is none present
  27. What is a type 2 random error and what are causes?
    Not picking up an association. Sampling error, power.
  28. How may systematic errors occur?
    Selection bias, information bias (blinding(, confounding factors
  29. What is crude death rate?
    Deaths in a given population size over a time.
  30. 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.
  31. What is standardised mortality ratio?
    The ratio of deaths in the study population compared to a reference population, multiplied by 100.
  32. What is attributable mortality?
    Deaths due to a particular cause in 1 year / total deaths in that year * 100
  33. What is perinatal mortality?
    (still births + first week deaths) / total births
  34. What is neonatal mortality rate?
    Deaths in the first 28 days per 1000 live births
  35. Post-neonatal mortality rate
    First year deaths after 28 days per 1000 live births
  36. Maternal mortality rate
    Complications of pregnancy/top/childbirth/puerperium within 42 days per 1000 live births
  37. Still birth rate
    Stillbirths per 1000 total births
  38. Infant mortality rate
    First year deaths per 1000 live births
  39. Under 5 mortality rate
    First 5 year deaths per 1000 live births
  40. Which two birth rates use ‘per total births’ instead of ‘per 1000 births’?
    Still birth rate and perinatal mortality rate
  41. Years of life lost
    75 years – age
  42. What is the PICO approach?
    Population, intervention, comparison, outcome
  43. What is Bradshaw’s model of needs?
    Expressed needs (by say doctor), normative needs (epidemiological), comparative needs (compared to others), felt needs
  44. How can locally needs be evaluated?
    Joint strategic needs assessment
  45. What is a measure of cost utility?
    QALY
  46. What is the beauchamp and childress principle of biomedical ethics?
    Autonomy, non-maleficence, beneficence, justice
  47. What was Geoffrey rose’s contribution to public health?
    Prevention can be ‘high risk’ populations or ‘population level’ populations
  48. What are the three kinds of screening?
    Mass screening, targeted screening, opportunistic screening
  49. 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).
  50. What does the Guthrie test test for?
    Hypothyroid, PKU, CF, Sicle, MCADD
  51. Which antenatal screening exists?
    Anaemia, blood group, rhesus, hep B, HIV, Down’s
  52. What adult screening exists?
    Breast cancer (50-70), cervical cancer (25-64), colorectal (60-69), AAA (65YO), retinopathy (diabetics), TB (immigrants > 6 months)
  53. What is the false positive rate?
    Of the people without the disease, which will have a positive result?
  54. What is the false negative rate?
    Of the people with the disease, which will have a negative result?
  55. What is the positive predictive value?
    Of the people whose test was positive, what percentage are people with the disease?
  56. What is the negative predictive value?
    Of the people whose test was negative, what percentage of people are without the disease?
  57. What is the positive likelihood ratio?
    Sensitive / (1-specificity) – useful for individuals
  58. What is the negative likelihood ratio?
    (1-sensitivity) / specificity – useful for individuals
  59. What is lead time bias?
    When identification of disease is earlier, so survival time
  60. In terms of infectiousness, what is R0?
    Basic reproductive rate. If R0>1 then disease will spread.
  61. What proportion of the population needs to be vaccinated?
    1 – (1/R0)
  62. What are the six dimensinos of quality and who invented them?
    Maxwell: effectiveness, efficiency, equity, accessibility, acceptability, relevance.
  63. 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.
  64. 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.
  65. How can quality of healthcare be problematic?
    Underuse, overuse, misuse.
  66. Who invented six sigma?
    Motorola – near perfect error rates can be achieved e.g. in anaesthesia.
  67. Where are rights of the child set out?
    UN convention ‘rights of the child’
  68. Name community based parental support initiatives
    SureStart, Health schools.
  69. 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.
  70. What areas can determine child health?
    Individual/congenital, ethnicity, parenting, family structure, childcare, peers, community + poverty, physical environment, lifestyle, media, public services.
  71. What committee recommended more fruit/veg and less saturated fat?
    1994 Committee on Medical Aspects of Food and Nutrition Policy
  72. What is the total dependency ratio?
    Children and >65’s : economically active adults
  73. What is active ageing?
    Optimising opportunities for health as people age.
  74. What is public policy?
    formal decisions or explicit proposals of governments or public agencies
  75. 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)
  76. 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).
  77. 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.
  78. What are the outcomes of the Marmot Review?
    Best start in life (child), maximise people’s capabilities, fair employment, health standard.
  79. 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.
  80. Discuss access to healthcare.
    Vertical approaches criticised by Alma-Ata declaration of 1978 as short-sighted and top down.
  81. Discuss financing in different healthcare models.
    Private public partnerships supported by UKAID and USAID.
  82. Discuss better access to medicine.
    Doha TRIPS decision (2003) allows medicine reverse engineered.
  83. Discuss women and healthcare.
    Hilary Clinton’s Beijing address (1995). Amartya Sen “100 million women are missing from the world”.
  84. 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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