PH

Question 1

What are the 3 domains of public health?

Answer 1

1) Health improvement (societal interventions aimed at preventing disease, promoting health and reducing inequalities)
2) Health protection (Measures to control infectious diseases and environmental hazards)
3) Improving health services in health care (the organisation & delivery of safe and high quality services)

Question 2

What is epigenetics?

Answer 2

Epigenetics = genetic predisposition but the fact that the environment contributes to the expression of the genome

Question 3

Allostasis

Answer 3

allostasis = the process of achieving stability

Homeostasis

Question 4

Allostatic load

Answer 4

Allostatic load = ‘wear and tear’ on the body which grows over time due to chronic stress on the body
Physiological consequences of chronic exposure to heightened neurological activity

Question 5

Explain the difference between primary and secondary prevention

Answer 5

Primary prevention = no disease - preventions to stop the getting the disease (vaccinations)
Secondary prevention = pre-clinical Screening to catch the disease early & preventing the disease progressing (statins to stop CVD)

Question 6

What are population and high risk approaches to prevention?

Answer 6

Population = preventative measures delivered on a population wide approach and it seeks to shift the risk factor distribution curve of disease to the left (e.g. reducing salt through registration to reduce BP)
High risk = identifies those at high risk and treats them - high BP give antihypertensives

Question 7

What is the prevention paradox?

Answer 7

A preventative measures that has little benefit to the individual but overall reduces prevalence in the population - benefits the population more

Question 8

What is screening?

Answer 8

A process that identifies people with a disease or who may have a susceptibility to a disease competed to those who don’t

Question 9

Give examples of screening

Answer 9

Population based screening
Opportunistic screening
Screening for communicable disease

Question 10

Define sensitivity

Answer 10

Sensitivity = proportion of the people who HAVE THE DISEASE who are correctly identifies as having the disease

Question 11

Define specificity

Answer 11

Specificity = proportion of people WITHOUT the disease who are correctly identified

Question 12

What is lead time bias?

Answer 12

Length of time between the detection of the disease and its usual clinical presentation and diagnosis
Time between early diagnosis due to screening and the time it would have been made without screening.

Question 13

Length time bias?

Answer 13

A form of selection bias that occurs when screening over represents a slow progressive disease and appears to falsely improve survival
Detects less aggressive tumours due to longer asymptomatic periods - and improves to improve survival compared to more aggressive tumours when actually they are less dangerous in the first place.

Question 14

Define Health Needs Assessment

Answer 14

A systematic method of identifying unmet health and healthcare needs of a population and making changes to meet those unmet needs. Provides information to improve health, for service planning, for priority setting and for policy dependant

Question 15

What are the 3 parts of the framework for health service evaluation

Answer 15

Structure
Process
Outcome

Question 16

Give the classification of health outcomes

Answer 16

Mortality
Morbidity
QOL/PROMS
Patient satisfaction

Question 17

What is evaluation of health services?

Answer 17

Evaluation is the assessment of weather a service achieves its objectives

Question 18

What are the 4 models of behaviour change?

Answer 18

1) Health belief model
2) Theory of planned behaviour
3) Transtheoretical model/stages of change model
4) S ocial norms

Question 19

Give reasons why associations between and exposure and an outcome occur.

Answer 19

Bias 
Chance 
Confounding 
Reverse causality 
A true causal association

Question 20

What is included in the bradford hill criteria for causation?

Answer 20

Temporal 
Dose-reponse
Strength 
Reversibility 
Consistency 
Plausable 
Coherence 
Analogy 
Specific

Question 21

What are the GMC duties of a dr?

Answer 21

• Care of the patient is the 1st priority
• Protect and promote the health of patients and the public
• Provide a good standard of care
• Treat patients as individuals and respect their confidentiality
• Work in partnerships with patients
• Be honest, open and act with integrity

Question 22

Health economics:

What is the opportunity cost?

Answer 22

The opportunity cost of an activity is the sacrifice in terms of benefits forgone from not allocating the resources to the next best activity

Question 23

How is economic efficiency achieved?

Answer 23

When resources are allocated between activities in such a way to maximise benefit

Question 24

What is an economic evaluation?

Answer 24

It is a comparative study of the costs and benefits of health care interventions.
Costs and effects are analysed in terms of ‘increments’

Question 25

How do we measure health benefit?

Answer 25

1) Quality adjusted life year QALY (combines length of life with quality of life) 2) Natural units (BP/pain score) 3) Monetary value

Question 26

What is the Incremental cost effectiveness ratio (ICER)

Answer 26

Incremental cost effectiveness ratio (ICER): A statistic used to summaries the cost effectiveness of a health care intervention = Difference in cost / difference in benefit

Question 27

``` Life time cost: Old £5,000 New £27,000 Utility: Old 0.8 New 0.9 Life expectancy: Old 9 New 10 What is the incremental cost of new treatment over the old treatment? ```

Answer 27

Incremental cost = difference in cost 27,000 - 5,000 = £22,000

Question 28

``` Life time cost: Old £5,000 New £27,000 Utility: Old 0.8 New 0.9 Life expectancy: Old 9 New 10 Work out the QALYs for the new and old treatments ```

Answer 28

``` QALY = utility x length of life New = 0.9 x 10 = 9 Old = 0.8 x 9 = 7.2 ```

Question 29

``` Life time cost: Old £5,000 New £27,000 Utility: Old 0.8 New 0.9 Life expectancy: Old 9 New 10 Work out the incremental QALYs of new over old ```

Answer 29

Incremental QALYs = difference in QALYs | 9 - 7.2 = 1.8

Question 30

``` Life time cost: Old £5,000 New £27,000 Utility: Old 0.8 New 0.9 Life expectancy: Old 9 New 10 Work out the incremental cost-effectiveness rations ICERs ```

Answer 30

ICER = difference in cost/ difference in benefit 22,000/1.8 = £12,222

Question 31

Give the 10 WHO screening Crieria

Answer 31

``` The disease: 1) Important 2) Recognisable early stage 3) Known NH of disease Test: 4) Suitable test 5) Acceptable test Rx: 6) Accepted treatment 7) Agreed policy of who to treat Facilities: 8) Facilities for dx and rx should be available 9) Cost benefits of screening and rx 10) Screening should be a continuous process ```

Question 32

What are the Fraser Guidelines?

Answer 32

1) The girl understands the advice 2) They cannot be persuaded to tell their parents 3) They are likely to continue having intercourse if contraceptives are not given 4) Harm may come if they are not given (mental or physical) 5) It is in their best interests

Question 33

What is Gillick Competence?

Answer 33

Weather a child under 16 can give consent for medical treatment without the need for parental permission or knowledge. Can they: understand, retain, weigh up and communicate their decision?

Question 34

Describe a Cohort study

Answer 34

Cohort Is usually a longitudinal prospective study that takes a population and records exposures + the conditions they develop over time It measures incidence

Question 35

Give 3 advantages and disadvantages of cohort studies

Answer 35

Advantages: Rare exposures, allows for identification of RF, and data on confounders Disadvantages: Not good for rare diseases, expensive and large sample sizes are needed

Question 36

Describe Case-Control

Answer 36

Case-control compares groups with and without disease and looks back for exposures/causes

Question 37

Give some advantages and disadvantages of case control

Answer 37

``` Advantages = Quicker and good for rare outcomes Disadvantages = Can only show association, not causation. Unreliable due to recall bias. Difficulty finding controls ```

Question 38

Describe a cross-sectional study

Answer 38

Takes a snapshot of the data of those with and without the disease at one point in time. It looks at prevalence of the disease.

Question 39

Give some advantages and disadvantages of cross-sectional study

Answer 39

Advantages: Quick and cheap, few ethical considerations Disadvantages: Prone to bias, no time reference, risk of reverse causality

Question 40

What is bias?

Answer 40

Bias = systematic error that results in a deviation for the true effect

Question 41

Give some of the Bradford hill criteria for causation (9 Principles that can be used to establish a causal relationship)

Answer 41

1) Temporal (exposure before outcome) 2) Strength (very high relative risk) 3) Reversibility (reducing exposure reduces outcome) 4) Dose response (increasing exposure increases outcome) 5) Specific 6) Consistent 7) Plausible 8) Analogy 9) Coherence

Question 42

A study finds an association between an exposure and an outcome - what could this be due to?

Answer 42

``` Bias Chance, Confounding, Reverse causality A true causal association ```

Question 43

Define the P value

Answer 43

The probability of an event occurring, given that the null hypothesis is true Null hypothesis means there is no difference

Question 44

What does a P value of <0.05 mean?

Answer 44

That it is statistically significant | - There is sufficient evidence to reject the null hypothesis and accept the alternative hypothesis

Question 45

What is a utilitarian approach to resource allocation?

Answer 45

Greatest benefit to the greatest number of people

Question 46

What is health behaviour?

Answer 46

Activity that is undertaken to prevent disease | E.g: exercising/healthy eating

Question 47

What is Illness behaviour?

Answer 47

Activity taken by someone who feels ill in order to find a remedy E.g: going to GP/pharmacist

Question 48

What is sick role behaviour?

Answer 48

Activity taken by someone to make them selves feel better - aimed at no longer being sick (usually involves neglecting some usual duties) E.g: taking abx from GP and taking time off work

Question 49

Negligence has occurred if...

Answer 49

1) There was a duty of care 2) that duty of care was breeched 3) the patient came to harm 4) the harm was caused by the breech in the duty of care

Question 50

What is the deprivation of liberty safeguards DOLS

Answer 50

DOLS = A procedure in law when it Is necessary to deprive a resident/patient of their liberty when they lack capacity to consent to their care/treatment - in order to keep them safe and from harm

Question 51

What is the acid test in relation to DOLS?

Answer 51

It was made to clarify the definition or a deprivation of liberty 1) Do they lack capacity? 2) Is the person subject to continuous supervision and control? 3) is the person free to leave?

Question 52

What are the 5 statutory principles of the mental capacity act?

Answer 52

1) Presumption of capacity 2) Every action taken to help them make a decision 3) They have the right to make an unwise decision 4) best interests 5) least restrictive intervention

Question 53

What are some of the cons of a public health system?

Answer 53

- Often argued that it is underfunded through rationing - Less incentives to improve efficiency/quality for staff and institutions (wont get paid more) - Perverse insentives (Efficient hospitals get budget cuts)

Question 54

What are some of the disadvantages of private health systems?

Answer 54

- Inequitable system (linked to ability to pay for service, not need) - Adverse selection (individuals excluded on basis of ill health) - No gatekeeping --> inappropriate use of specialists for general advice - Inflation of health care expenditure (USA) - Lack of restricitons on the demand side (pts may demand and over use services even when not needed)