Improving Health
How do you calculate the efficacy of a vaccine?
(incidence in unvaccinated-incidence in vaccinated) / incidence in unvaccinated)
What are 5 key issues with child health ?
(smoking in pregnancy, low breastfeeding) 1. obesity 2. mental health 3. poor oral health (cleaning teeth) 4. substance abuse (vaping, drugs) 5. vaccine uptake
Give an example of an outbreak with a - point source - continuous source - propagated
- Point source: meningitis - Continuous source: cholera - Propagated source: measles
How should doctors approach disabled patients?
- don't assume (lack of) disability -> invisible disability -> quality of life/Jobs, SES - beware of language (not wheelchair 'bound') - don't assume wishes (e.g. deaf pts must want hearing aid) - book interpretors for BSL - be patient, appreciate pt may be tired/have difficult health encounters in past - listen to patients (they are the experts)
What were the 3 founding principles of the NHS?
- funded by taxes. Rich pay more - available to all (rich and poor, you can use services in any area) - free at point of use
What are the 4 criteria for a good RCT?
- randomisation (assigning by chance, evenly distribute confounders so can be excluded when considering associations) - blinding (reduce observer, recall bias) - good follow up - intention to treat analysis (i.e. all pts randomly assigned to group are analysed together, regardless of if they receive or complete treatment)
What is bias?
- systematic error - in the design, conduct or analysis - which results in a conclusion - that is different from the truth
What are the 6 steps in motivational interviewing?
1. Assess interest: would you like to talk about behaviour change? 2. Assess current status: how is that behaviour currently? 3. Assess importance of changing behaviour - if high: assess confidence in behaviour change - if low: explore pros/cons 4. Assess confidence - if high: set SMARTER goal - if low: reaffirm capability or modify goal 5. Set SMARTER goal 6. Summarise, plan next steps/follow up
What are the 7 steps for managing an outbreak?
1. Decide if outbreak or due to chance 2. Confirm diagnoses (?pathogen) 3. Contact tracing, identify exposures (?source) 4. Draw epidemic curves, formulate hypotheses, studies (case control, cohort) 5. Control measures: treat, isolate, barriers, hygiene 6. surveillance/case notification 7. reflect on lessons learned
How do social workers assess a child's needs? (3 things)
1. Developmental needs (healthy, educational, social, emotional) 2. Parenting capacity (care, safety, boundaries, stimulation, FHx, stability) 3. environmental factors (community resources, social standing, housing, employment, income)
What are the 4 stages of a health needs assessment?
1. Gather info A. Epidemiological - demographics (age, sex, ethnicity, migration etc) - incidence, prevalence - morbidity/mortality - projected trends - review current services (input/output, availability) - review cost effectiveness of different interventions/services B. Corporate - identify views/values of patients, public, staff, 3rd sector (volunteer/charity) (differ from national views?) 2. Comparison - compare with existing services with local priorities/strategies, other areas, national guidelines 3. Recommendations: *need for local strategy to address gaps in provision* 4. Outcomes
What is the epidemiological triad in infectious disease?
1. Host 2. Pathogen 3. Environment
How do you evaluate a health service? What are the 4 Donabedian principles?
1. Look at the structures in place - buildings (enough space?) - facilities (e.g. for sterilisation) - equipment - IT systems - staff 2. Look at the processes - patient pathways (e.g. is referral in line with NICE) - number of sessions of service - number of patients referred - number of false positives/negatives - rate of complications - waiting times - staff adhering to standards (washing hands, reporting incidents) 3. outputs - number of cases of disease (e.g. benign, malignant) - stage of disease 4. assess outcomes - increased early detection of disease/treatment - incidence of cases (infections, harm) - length of admission - mortality, survival - patient satisfaction - cost savings
What is the CASP checklist for critical analysis?
1. Method: RAMMbo - Representative- large sample, appropriate sampling method - Allocation: randomisation (evenly spread confounders so can be excluded when considering associations), matched controls (reduce recall bias) - Maintenance: groups treated equally, outcomes measured for most patients (small dropout rate) - Measurements: blinding, objective (reduce observer/information bias) 2. Results - impactful - comprehensive (include confidence intervals?) - benefits>>risks 3. Application - relevant to patients? - new intervention >> existing one?
What is the hierarchy of research evidence?
1. Systematic reviews and meta-analyses (of RCTs), critically appraised topics 2. Randomised controlled trials 3. Non randomised experimental study 4. Cohort studies (prospective >> retrospective) 5. Case-control studies 6. Cross sectional studies 7. Case series 8. Expert opinion, case reports
How do you calculate DALY?
1. calculate number of years - of life lost due to premature death (88*-age at death) - of good health lost due to disability *highest life expectancy (Japanese woman) 2. Multiply by adjustment factors - death = 1 - disability = anywhere in range 0-1 3. Add together e.g. died at 78 = 10 years lost due to death (1) = 10 years e.g. 10 years of moderate disability = 10 x 0.5= 5 years 10 + 5 = 15 DALYs
What are the 6 objectives for fair society, healthy lives (Marmot review) ?
1. give every child the best start in life 2. allow people to maximise their capabilities, control their lives 3. fair employment, good work for all 4. healthy standard of living 5. healthy/sustainable places and communities 6. strong prevention of ill health
What are 4 examples of long term impacts of ACEs?
1. learning and behaviour problems 2. depression and suicide 3. risk factors: smoking, obesity, multiple partners (sexual health), unwanted pregnancy 4. disease: cancer, IHD, COPD, liver disease
What are 6 factors affecting vaccine uptake?
1. stockpiling, global availability/coordination 2.. Socioeconomic factors 3. Poor coordination between public/private sectors 4. Safety - worry about side effects - worry about allergic reactions (egg, gelatine, neomycin, latex) - pregnant - immunocompromised 5. Acute illness (systemically unwell, neurological) --> don't want to attribute Sx of illness to vaccine 6. Conspiracy - doctors paid by Big Pharma or corrupt - evidence is hiding the truth - natural immunity is better (chicken pox parties in USA) - food/natural supplements are better
What is the routine immunisation schedule in the UK?
2 months: DPT, HHP (6 in 1), men B, rotavirus 3 months: DPT, HHP (6 in 1), pneumococcus, rotavirus 4 months: DPT, HHP (6 in 1), menB 12 months: MMR, Hib, pneumococcus, MenB, menC 2-3: annual influenza 3 years 4 months: MMR, DPT + polio 12/13: HPV 14: MenACWY, DPT (polio) 75: pneumoccocus, influenza, shingles
What are the 3 biases which are problems in screening?
3 reasons for (apparent) increased survival times in screening Lead time bias: simply due to earlier diagnosis Length time bias: screening more likely to detect slowly progressive disease/long latent phase Healthy volunteer bias: those screened less likely to have socioeconomic deprivation, mental health, disability
What is the countdown model for a population approach in public health?
6 principles: (PEPSIP) - Pattern based - Evidence based - Prevention (population vs high risk approach) - Social determinants of health - Inequalities - Partnership 5 steps to take - identify problem - characterise problem - appreciate underlying causes - identify, implement and evaluate intervention - scale up 4 domains to act at - individual - relationship - community - society 3 areas of public health - improving health (improving health behaviour, reduce inequalities) - protecting health (vaccines, screening, infectious disease) - improving healthcare (commissioning safe, effective services)
Give examples of ACEs
Abuse, domestic violence Substance abuse (parents) Mental illness Parental separation Parent in prison
What are 5 clinical areas of major health inequalities - adults - children?
Adults 1. Maternal health 2. Severe Mental health 3. HTN case finding 4. Cancer, early diagnosis 5. Resp disease Kids 1. asthma 2. diabetes 3. epilepsy 4. oral health 5. mental health
What are the 4 models of health systems?
Beveridge - NHS - fully tax funded - government control - non profit providers Bismark - Germany, France, apan - social insurance (from payroll, employers match contribution, covers all) - mix public/private providers National health insurance - Canada - taxation + private insurance - private providers Out of pocket - USA - private insurance (doesn't cover all) OR pay at point of care - private providers
What are the factors influencing behaviour change (COM-B model) ?
Capability - knowledge - skills - physical and psychological capability Opportunity - freedom to enact behaviour - physical, social, *environmental* factors Motivation - Reflection: goals, plan to achieve - Automatic: habits, impulses, inhibitions
What are the causes and effects of poverty?
Causes (HAD A WEB) - poor housing - abuse - discrimination - ACEs - poor work - poor education, literacy - poor benefits system Effects - housing problems, homeless - relationship problems - crime - risk factors: substance abuse, teenage pregnancy - diseases
What 4 reasons lead to a correlation?
Chance Bias Confounding Causation
What are the advantages and disadvantages of cohort vs case control studies?
Cohort: - pros: good for rare exposures, multiple outcomes, can estimate incidence - cons: bad for rare outcomes, timely, validity affected by follow up (retrospective: issue of temporality) Case-control - pros: good for rare outcomes/long latency, multiple exposures, quick and cheap - cons: bad for rare exposures, issue of temporality, bias (selection, information, recall), can't estimate incidence
What are the criteria for a good screening test?
Condition - important - recognisable early stage, known course (evidence that risk --> outcome) - max. primary prevention implemented Test: (NICE) - safe, simple, validated - accepted cut off value (based on distribution of test values) - acceptable to public (in line with values) - agreed policy on next stes (further tests, Tx etc) Treatment - available - better if started early - safe, effective (NICE) - evidence base for which pts should be given which Tx Programme - safe (benefits>>risks). Negative effects on mental health/insurance if known 'at risk'? - efficacy - clinically effective (evidence from RCTs, less morbidity/mortality) - cost effective, small opportunity cost - acceptable to public, eligibility criteria justified - resources available to implement (staff, facilities)
What are 4 terms used in economic evaluation of healthcare? Define them
Cost-benefit analysis: evaluating the monetary benefit of a single intervention --> benefits - costs Cost-effectiveness: evaluating the relative costs and outcomes of 2+ interventions for same problem. Expressed as ratio of associated cost/health gain, associated with intervention --> (cost of A- cost of B)/(outcome of A- outcome of B) --> e.g. £60 extra per case detected Cost-utility analysis: evaluating relative costs/outcomes of a wide range of interventions using QALYs --> e.g. £50 per QALY Opportunity cost: the benefit lost by not applying the same resources to the next best alternative
How might prevalence be difficult to assess?
Definitions: - is there a set definition of the condition/behaviour - are cases easy to quantify? (e.g. for domestic violence, is 1 year of abuse 1 case or 365?) Data sources and availability - are the signs recognisable? - does everyone come forward? under-reporting - is there a register for recording cases? - number of incidents may not represent those at risk (may be at risk but not have incident yet Sources of bias - selection bias - information bias (recall, observer, misclassification)
What is the flow of money in the UK healthcare system?
Department of health/social care - health education England - UK health security agency (public health) - NHS (NHS trusts, ICBs, central admin)
What is the difference between descriptive and inferential statistical methods?
Descriptive: describing characteristics of data set (distribution, variance, average) Inferential: testing hypotheses and making generalisations about a population
What are the institute of medicine's 'dimensions of quality' ?
Desirable outcomes for health service Safety: minimal harm, learning from errors Effectiveness: good outcomes, evidence based Quality: achieved intended safety/effectiveness Equity: Fair. Greater access for greater need Efficiency: good ratio inputs to outputs, avoids waste (financial, material, staff) Accessibility: minimse harmful delays (e.g. waiting lists) Satisfaction: meets individual needs/values
What are the Do's and Don't for discussing domestic violence/abuse with a patient?
Do - see them alone - offer a supportive environment - ask direct questions and be honest - reassure them they are not alone - support them in their decision - create a safety plan Don't - assume its someone else's responsibility - tell them to leave abuser - rush the patient to make a decision - make decisions for them
What are the subtypes of infant mortality (based on age)?
Early neonatal <7 days Late neonatal 7-27 days Neonatal <28 days Post neonatal 28 days - 1 year Infant <1 year
What is the difference between efficacy and effectiveness?
Efficacy: whether the intervention produced the desired effect in ideal circumstances (an efficacy trial) Effectiveness: the beneficial effect of the intervention in real world circumstances (an effectiveness trial)
Define endemic, epidemic and outbreak
Endemic: persistent low-moderate background level of disease Epidemic: occurrence above expected over a time period Outbreak: occurrence above expected over a time period if 2+ people are linked by time/place
How do you set goals using the FITT and FAT approach?
FAT - frequency - amount - type e.g. I will eat 1 apple everyday FITT - frequency - intensity - type - timing e.g. I will do daily speed walking for 20 minutes
What is a PICO format?
Format for a research question Population/patient group Intervention Comparison/control Outcome
Which factors influence the spread of disease as per the epidemiological triad?
Host - immunity (immunosuppressed, vaccinated?) - susceptibility (genetic, malnourished, frail, v. young/old, comorbidities) - dose of pathogen received Pathogen - infectious dose - infectivity, pathogenicity, virulence Environment - herd immunity - route of infection - overcrowding - sanitation, hygiene (PPE, water infrastructure) - animal reservoirs - vectors
What measures can reduce the transmission of infection, as per the epidemiological triad?
Host - vaccinated - prophylaxis (IVIG, PEP) - good health / nutrition Pathogen - isolate cases - treat cases - eradicate vectors/animal reservoirs Environment - barriers (PPE, condoms, nets) - hygiene - reduce overcrowding
Define incidence and prevalence
Incidence: the number of new cases in a specified time period Prevalence: the number of cases in a population = no. of cases/total population at risk = incidence x average survival time
Give examples of the wider determinants of health
Individual Non-modifiable: Age, sex, genetics, ethnicity Modifiable: ACEs, mental health, obesity Other: sexual orientation, gender reassignment, religion/beliefs Social/community - relationship with parents (supportive?) - relationships with peers (supportive?) - social cohesion vs deprivation Living and working conditions - unemployment, working conditions - education - Town planning: housing, water, sanitation, public transport - food (type, prices, availability), agriculture - air pollution - healthcare Socioeconomic, cultural and environmental factors - economic stability, disposable income, taxation - availability of work - customs/traditions - equality vs stigma
How can you categorise the wider determinants of health?
Individual Social/community Living/working conditions Socio-economic, cultural and environmental factors
Define infectivity, pathogenicity and virulence
Infectivity: percentage of exposed people who become infected Pathogenicity: percentage of infected people who develop disease Virulence: percentage of infected people who become seriously ill/die
Which bodies regulate vaccines in UK?
JCVI - recommend vaccines/policy - evaluate safety/efficacy, impact and cost-effectiveness MHRA - regulation - licensing National institute for biological standards and control - part of MHRA - testing for quality, safety
Define latency period, infectious period and incubation period?
Latency period: the time between being infected and becoming infectious Infectious period: the time during which the pathogen can be passed onto another individual Incubation period: the time between being infected and developing symptoms
What are the advantages and disadvantages of live vs inactivated vaccines?
Live vaccines - Pros: stronger immune response, lasts longer, less severe adverse reactions with time - Cons: can revert to virulence, C/I in immunosuppressed, hard to store Inactivated vaccines - Pros: safe, used in immunosuppressed, easier to store - Cons: weaker immune response, need multiple doses, adverse reactions more severe with each dose
Give examples of the different types of vaccine
Live, attenuated - MMR - VZV - rotavirus - yellow fever Inactivated - influenza - polio - hep A - rabies Subunit/composite etc - HbsAg (HBV) - HPV - Hib - pneumococcus, meningococcus - pertussis - shingles Toxoid - diphtheria - tetanus
What are the 2 models of disability? Give examples of interventions to help disabled people as per these models
Medical model - person is disabled by their condition - aims to add help not remove barriers e.g. give carers, wheelchair, medication, home visits Social model - person is disabled by society - aims to remove barriers e.g. sign language interpreters, lifts/ramps, parking places, neurodiverse schools
Define NNT and NNH
NNT= 1/absolute risk reduction number of people needed to treat to gain 1 additional successful outcome NNH= 1/(incidence in treated - incidence in controlled) number of people needed to treat to have 1 additional adverse outcome
What are the public health approaches to reduce teen pregnancy? Local vs national
National: - improve education: inc literacy/maths ability, fewer early leavers, more vocational training - schools: pshe and 'healthy schools' initiative (sex/lifestyle ed) - Every Child Matters (SHEEP: safe, healthy, enjoy/achieve, economic wellbeing, make a positive contribution) - Unemployment: social policy to reduce rates - Reduce poverty (inner city): inc minimum wage, job creation schemes - Alcohol policy: control availability, underage drinking, licensing, opening hours, l abels - Surestart parenting (reduce risk of further teen pregnancy) Local: - Contraception: strengthen access to free advice/condoms/pills - School nursing - health education by GPs - peer to peer learning programmes
Which factors do you need to consider when thinking of removing funding from a service?
Need for service: local morbidity, SES, demographics Impact on other services: absorbing caseload Health economics: --> use of emergency services --> use of hospitals, Gps, 3rd sector Opportunity costs: other services that could be funded with money
Which statistical tests are used for continuous data? In what circumstances are these used?
Normally distributed (comparing means) <2 groups - paired data (same population): paired t test - unpaired data (diff populations): unpaired t test >2 groups - one way ANOVA Not normally distributed (comparing distribution) - Mann-Whitney U/Wilcoxson rank sum
What are the advantages and disadvantages of observational vs interventional studies?
Observational: - Pros: ethical, can determine prevalence - Cons: can't determine causality (manipulate variables) Interventional - Pros: can determine causality (manipulate variable), randomisation balances confounders so can be excluded when considering associations - Cons: limited by ethical considerations, selection bias, expensive, timely
Define odds and odds ratio
Odds: number of events/number of non events Odds ratio: odds in group A/odds in group B ratio of odds of exposure in cases vs odds of exposure in controls
What are the relative values of PPV and NPV in a population with a high disease prevalence?
PPV is high NPV is low i.e. test better at ruling in disease than ruling out disease
Which statistical tests are used in assessing linear association? Under which circumstances are they used?
Pearson's product moment correlation coefficient - explaining variance - used if data is linear, independent, normally distributed, even variance Linear regression - test for association/predict outcomes
What are the vaccines in the selective immunisation schedule?
Pregnancy: influenza, pertussis risk of TB: vaccine at 1 month risk of HBV: vaccine at birth, 1 month, 1 year vulnerable 6m-18y: annual influenza
Give 2 frameworks for describing a public health approach to prevention
Primary Secondary Tertiary Local Regional National International
With regards to vaccines, define - primary failure - secondary failure
Primary failure - failure to mount initial immune response Secondary failure- failure to maintain immune response (decays over time)
What are 3 categories of prevention strategies? Define them with examples
Primary prevention- intervening before disease occurs (e.g. vaccines, behaviour change, education in schools) Secondary prevention- intervening after disease onset to reduce severity of disease by early diagnosis/treatment (e.g. screening, contact tracing, educating GPs on how to recognise signs) Tertiary prevention- reducing complications of established disease (e.g. diabetic eye/foot screening, provision of abuse services)
What are the advantages and disadvantages of qualitative vs quantitative research?
Qualitative: - Pros: flexible, comprehensive, guides quantitative research - Cons: timely, needs expertise, subjective, hard to analyse Quantitative - Pros: easily summarised, objective - Cons: lacks insight, needs expertise,
Define QALY
Quality adjusted life year: the number of years of full health that equal a greater number of years at less than full health
What is the difference between quantitative and qualitative research?
Quantitative research: collecting/analysing numerical data to answer research questions or test hypotheses Qualitative research: collecting/analysing non-numerical data to understand concepts, opinions and experiences
In epidemiology of infection, define R0 and R
R0= basic reproductive rate the transmission of the pathogen (no. of new cases) in a completely susceptible population number of contacts of ill person x length of infectious period R= net reproductive rate the transmission of the pathogen (no. of new cases) in a mixed population (susceptible/immune) --> R0 x proportion susceptible
Why does odds ratio estimate relatve risk when disease is rare?
Relative risk = number of events/(number of events + number of non events) i.e. /total population at risk Odds ratio = number of events/number of non-events When disease is rare, total population at risk is very similar to number of non-events (as very few events)
Define risk, absolute risk, relative risk and absolute risk reduction
Risk: (for a person with a risk factor) how likely pt is to have disease Absolute risk= number of cases/population at risk Relative risk = measure of treatment effect. Ratio of incidence of outcome (exposed) vs (unexposed) absolute risk in untreated (or risk factor) group/absolute risk in treated (or no risk factor) group Absolute risk reduction: risk in untreated (risk factor) group- risk in treated no risk factor) group
Where can you find information about safety, efficacy, clinical and cost effectiveness of an intervention?
Safety: MHRA Efficacy: NICE, cochrane Clinical effectiveness: NICE, journals Cost effectiveness: NICE
What are the types of bias?
Selection bias- sample not representative of population Information Bias- errors in collection/measurement of data e.g. recall bias- pts more likely to remember exposure if it led to outcome Observer bias- researcher has knowledge of subject exposure and this affects how they assess outcome (e.g. not blinded) Publication bias- journals more likely to publish positive results than negative results
Define sensitivity, specificity, PPV and NPV
Sensitivity: the number of people with the disease that are identified as having disease by the test. probability of correctly diagnosing condition = true positives/(true positives + false negatives) PPV: the proportion of people with a positive test who have the disease. probability of disease being present if test positive = true positives/(true positives + false positives) Specificity: the number of people without the disease that are identified as not having disease by the test. probability of correctly ruling out condition = true negatives/(true negatives+ false positives) NPV: the proportion of people with a negative test that don't have the disease. probability of disease being absent if test negative = true negatives/(true negatives + false negatives)
What are SMARTER goals?
Specific Meaningful Achievable Relevant Time based Evaluate Readjust
Which statistical tests are used for binary data? In what circumstances are they used?
Stat. significant difference in proportion of data in each group? <5 pieces of data in at least 1 group: Fischer exact test >5 pieces of data in each group: Chi squared
What are the pros and cons of state vs private funded healtcare?
State funded pros: free, available to all, can reform, prioritise prevention cons: political control, not responsive pt demands, don't innovate private funded pros: respond to pt demands, autonomy, choice (drs/pts) cons: expensive, not full cover, not available to all, don't prioritise prevention
Define health needs assessment
Systematic approach to understanding the health needs of a population
Define screening
a form of secondary prevention identifying potentially healthy people at inc risk of disease to diagnose early and provide info, tests or treatment so as to reduce severity of disease
Define health need
a health problem which may be addressed by an effective treatment or service provision
Define disability
a physical or mental impairment has a substantial, long term (>12 months) negative effect on ability to do normal activities
Which 8 criteria do you need to consider before funding/implementing an intervention?
can results of study be replicated evaluated by NICE? safety efficacy clinical effectiveness (evidence for risks/benefits) cost effectiveness *opportunity cost* *comparison to alternatives (cost/clinical effectiveness)* acceptability to public (local views/priorities) resources available in community demand *is it equitable to fund/not fund?*
What are the Bradford-Hill criteria?
criteria for determining if a correlation is from causation 1. Strong relationship 2. Dose-dependent relationship 3. Reversibility (stop exposure, reduce outcome) 4. Temporality (risk factor precedes disease by expected interval) 5. Biological plausibility 6. consistency (correlation shown in multiple studies)
What is evidence based medicine?
integrating best research evidence with clinical expertise and patient values
What does it mean if an odds ratio confidence interval includes 1?
it is not statistically significant they are saying that it is possible that the true value is 1 i.e. no difference in odds in cases vs controls
Define audit What are the 6 steps in the audit cycle?
measuring outcomes/processes against a pre-defined standard - agree outcome - agree standard (e.g. 100% of pts get test) - monitor performance against standard (good and bad) --> retrospective or prospective --> use clinical coding to identify patients --> appropriate time period --> review notes (does practice meet guideline standard?) - identify deviations from standards and reasons for this --> discuss with department --> develop plan to improve sercice - implement changes to address deviations - re-audit to evaluate those changes
What is an integrated care systems?
partnerships (health/care) that work together to plan/fund care over larger areas integrated care partnership (NHS working with local authorities) integrated care board: group that plans spending/cost effective care, improves health/quality of care
What funding is available for disabled people?
personal independence payment (costs of ill health/wheelchairs, carers) disabled facilities grants (for adjustments to home) charity
What are 6 types of disability?
physical (mobility) cognitive emotional learning sensory speech and language
What is the healthy child programme? Explain the 4-5-6 approach for health visiting/school nursing
policy providing universal prevention services to families/kids from conception to 18 years old Health visiting - 6 high impact areas: --> parenthood, maternal mental health, breastfeeding, --> healthy weight, managing accidents/minor illness, getting ready for school - 5 reviews (antenatal, new baby, 6-8 week, 1 year, 2.5 years) 4 levels of services School nursing - 6 high impact areas --> resilience, keeping safe, healthy lifestyle --> learning, support additional needs, transition - 5 reviews (5, 11, 13, 16, adult)
Why is intention to treat analysis important?
preserves baseline comparability between groups (established by randomisation) guards against bias where drop out affects outcome
How can you prevent domestic violence?
primary prevention: - education in school on relationships - target risk factors: substance misuse, mental illness, poverty secondary prevention - educate healthcare staff: how to re cognise signs - directly ask qs (screening) tertiary prevention - provide services for victims: counselling, psychiatric help, refuges, social workers
What are critically appraised topics?
standardised summary bringing together best evidence to answer research question
Define herd immunity What is the calculation for the threshold for herd immunity?
sufficient proportion of the population is immune so as to prevent transmission to susceptible individuals threshold= 1- (1/R0)
Define commissioning
the continual process of planning procuring and monitoring services
Define DALY
the number of years of life lost due to early death or of good health lost due to disability
Define P value
the probability that an effect at least as big as that measured (e.g. 15% reduction in seizures) was due to chance
Define confidence interval
the range of (theoretical) sample values within which the true population value lies X% of the time
How can you reduce risk of osteoporosis?
vit D/Ca (diet or supplements) --> dairy, green leafy veg (Ca) -> oily fish, egg yolks, red meat, fortified food (vit D) weight bearing exercise (running, jumping) stop smoking reduce alcohol adequate sunlight
What causes most infant mortality?
wider determinants of health -> maternal health -> perinatal mortality
Which demographic is more likely to refuse vaccines?
women 18-24, >50 low education, low employment extreme political (left and right)
