Block 1

Question 1

How can normality be defined?

Answer 1

1. Statistical (Gaussian distribution - 95% of population should fall within +/- 2.5 standard deviations from the mean)
2. Social (what is considered acceptable or desirable -subjective)
3. Optimal (what is required for optimal health)

Question 2

Define illness

Answer 2

A subjective experience of ill health (can be ill in the absence of disease)

Question 3

Define sickness

Answer 3

A social role taken on by, or given to, someone perceived to be ill

Question 4

Define disease

Answer 4

Objective diagnosis using specific signs and symptoms

Deviation from the biological norm

Question 5

What is the medical model of health?

Answer 5

Health is the absence of disease

Role of HCP is to cure, treat or lessen symptoms of disease

Question 6

What are the criticisms of the medical model of health?

Answer 6

Focus on the medical professional not the patient
Does not consider social influence on health
Does not account for chronic disease for which there is no cure

Question 7

What is the social model of health?

Answer 7

Health is a social construct determined by a range of external factors (social, cultural and socioeconomic influence)
Takes into account lay knowledges and beliefs
Recognises that a person can have a disease or impairment but still consider themselves to be healthy

Question 8

What is the biopsychosocial model of health?

Answer 8

Emphasises the importance of recognising psychological and social aspects of health and illness, not just biomedical aspects
Useful in clinical practice

Question 9

How does WHO define health?

Answer 9

A state of complete physical, social and mental wellbeing and not merely the absence of disease or infirmary

Question 10

What is a census and what is it used for?

Answer 10

Simultaneous recording of demographic data by the government at a given time pertaining to all the persons living in a particular territory
Uses: service requirements, birth and death rates, to identify and target inequalities

Question 11

How often is a census carried out in the UK?

Answer 11

Every 10 years

Question 12

What is the process for registering a birth?

Answer 12

1) Birth notification completed (e.g. by midwife) – information to local health authority
2) Birth registration by parents within 42 days – information to local registrar for births, deaths and marriages and to the ONS

Question 13

How is crude birth rate determined?

Answer 13

No. of live births/ 1000 people in population

Question 14

How is general fertility rate determined?

Answer 14

No. of live births/ 1000 women between age 15-44

Question 15

How is total fertility rate determined?

Answer 15

No. of live births should every woman live to menopause and give birth in accordance with the current, age specific fertility rate

Question 16

What is the process for registering a death?

Answer 16

1) Medical certificate issued by doctor (incl. cause of death)
2) Death registration by family within 5 days – information to local registrar for births, deaths and marriages and to the ONS

Question 17

How is underlying cause of death defined?

Answer 17

Disease or injury which initiated the train of morbid events leading directly to death OR the circumstances of the accident or violence which produced the fatal injury

Question 18

What are the strengths and weaknesses of how mortality data is collected?

Answer 18

Strengths:
• Complete coverage in UK
• Important information on health of population

Weaknesses:
• Inaccuracies (diagnostic uncertainty, coding issues, variable quality)
• Ethnicity not collected
• Derivation of social status (post-humous inflammation of status)

Question 19

How are population estimates calculated?

Answer 19

Census baseline + births – deaths +/- migration

Question 20

What are the strengths and weaknesses of population estimates?

Answer 20

Strengths: up to date; more accurate than population projections
Weaknesses: less reliable the further away from the census; poor migration information; cannot use for predictions

Question 21

What are population projections?

Answer 21

Forecast about the future based on assumptions about mortality, fertility and migration.

Question 22

What are the strengths and weaknesses of population projections?

Answer 22

Strengths: used for long term planning
Weaknesses: less accurate the further ahead you are projecting; unforeseen changes

Question 23

What is the ageing population phenomena?

Answer 23

Population projection between 2016 and 2041 shows that there will be a larger older population by 2041 as life expectancy increases and the ‘baby boomer’ generation reach their 70s – impact on health service due to increased cost of care for elderly, need for chronic disease management and increased mental health issues (e.g. dementia)

Question 24

What is the purpose of population pyramids?

Answer 24

Allow for resource planning and comparison of different groups across time

Question 25

What is the purpose of the Cancer Registration System?

Answer 25

Monitors cancer rates, evaluates screening and treatment efficacy and aiding research

Question 26

What are the strengths and weaknesses of the Cancer Registration System?

Answer 26

Strengths: detailed, up-to-date, record linkage to cancer deaths (through ONS) Weaknesses: confidentiality can cause access difficulties, expensive

Question 27

What is the purpose of Hospital Episode Statistics?

Answer 27

Monitors admissions, outpatients and ED visits in England incl. personal, clinical, geographical and administrative data Monitors trends in hospital activity, supports service planning and fair access to healthcare Uses ICD-10 (for conditions treated or investigated) and OPCS-4 (for surgery) as clinical classification

Question 28

What are the strengths and weaknesses of Hospital Episode Statistics?

Answer 28

Strengths: complete, accurate and representative Weaknesses: accessibility

Question 29

What is the purpose of the Quality Outcomes Framework?

Answer 29

Points awarded for clinical areas (e.g. management of chronic conditions), public health (e.g. prevention) and additional services (e.g. screening) with a higher income awarded to GPs with higher QoF scores

Question 30

What are the strengths and weaknesses of Quality Outcomes Framework?

Answer 30

Strengths: completeness, improves record keeping, representative, updated annually Weaknesses: unclear whether it actually improves clinical outcomes; no age/ sex breakdown

Question 31

What is the purpose of notification of infectious diseases?

Answer 31

31 notifiable diseases with doctor responsible for notifying local health protection team when disease is suspected. Laboratories notify Public Health England when notifiable organism is identified. Used to prevent further infection, identify outbreaks and monitor trends.

Question 32

What are the strengths and weaknesses of notifying for infectious diseases?

Answer 32

Strengths: timeliness (weekly reporting); representativeness Weaknesses: variable completeness for some diseases (e.g. food poisoning can sometimes be treated at home); reporting of suspected cases means accuracy is questionable (e.g. suspected but never diagnosed)

Question 33

What is the CARTA framework for assessing quality of health information?

Answer 33

``` Completeness Accuracy Representativeness Timeliness Accessibility ```

Question 34

Define incidence

Answer 34

Rate at which new events occur in a population, over a given time period. Expressed as per n people per time period or per n person-years (person-years = no. of people x no. of years)

Question 35

How do you calculate incidence rate?

Answer 35

[no. of new cases/ (no. of people x years observed)] x 1000 (or however many person years the question asks for)

Question 36

Define prevalence

Answer 36

A measure of how common a disease is, expressed as a percentage or number per n people

Question 37

How is prevalence calculated?

Answer 37

P = (no. of people with disease/ total no. of people) x 100 (for %)

Question 38

What are the 3 types of prevalence?

Answer 38

Point prevalence = prevalence at a given point in time Period prevalence = prevalence within a given time period Lifetime prevalence

Question 39

What are the 4 factors affecting prevalence?

Answer 39

Incidence Recovery rate Migration (transfer) Morbidity (death rate)

Question 40

How are confidence intervals calculated?

Answer 40

Upper bound = prevalence + (1.96 x SE) | Lower bound = prevalence – (1.96 x SE)

Question 41

What are confidence intervals used for?

Answer 41

Can be used to determine statistical significance between 2 groups – if range crosses 1 then null hypothesis must be accepted The larger the sample size, the narrower the confidence intervals = good!

Question 42

What is the concept of person-centred care?

Answer 42

Concept of person-centred care is a whole person approach designed to put the person’s needs and preferences, as they define them, first.

Question 43

What are the key principles of person-centred care?

Answer 43

Care is personalised, coordinated, enabling and that person is treated with dignity, compassion and respect

Question 44

What is the importance of using person-centred care in practice?

Answer 44

Positive outcome for patients Increased patient satisfaction Less ED visits and more concordance to treatment Social and political drivers