PPD/public health

Question 1

what is epigenetic?

Answer 1

expression of genome depends on the environment

Question 2

what is allostasis?

Answer 2

stability through change, our physiological systems have adapted to react rapidly to environmental stressors

Question 3

what is allostatic load?

Answer 3

long term overtaxation of our physiological systems leads to impaired health (stress)

Question 4

what is salutogenesis?

Answer 4

favourable physiological changes secondary to experiences which promote healing and health

Question 5

what is emotion intelligence?

Answer 5

the ability to identify and manage one’s own emotions, as well as those of others

Question 6

what is the purpose of primary care?

Answer 6

• managing illness and clinical relationships over time
• finding the best available clinical solutions to clinical problems
• preventing illness
• promoting health
• managing clinical uncertainty
• getting the best outcomes with available resources
• working in a primary health care team
• shared decision making with patients

Question 7

what are the dangers of overprescribing antibiotics?

Answer 7

unnecessary side effects
medicalise self-limiting conditions
antibiotic resistance

Question 8

what antibiotics would you prescribe otitis media?

Answer 8

amoxicillin

Question 9

what antibiotic would you prescribe sinusitis?

Answer 9

amoxicillin

Question 10

what antibiotic would you prescribe for tonsillitis?

Answer 10

penicillin

Question 11

what antibiotics would you treat LTRI?

Answer 11

amoxicillin

Question 12

what antibiotic would you use for UTI?

Answer 12

trimethoprim
or
nitrofurantoin

Question 13

what is public health?

Answer 13

The science and art of preventing disease, prolonging life and promoting health through organised efforts of society

Question 14

what are the 3 domains of public health?

Answer 14

health improvement
health protection
improving services

Question 15

what are the key concerns of public health?

Answer 15

inequalities in health
wider determinants of health
prevention

Question 16

what is health improvement in public health?

Answer 16

Concerned with societal interventions (not primarily delivered through health services) aimed at preventing disease, promoting health, and reducing inequalities

Inequalities, education, housing, employment, lifestyles, family/community, surveillance and monitoring specific diseases and risk factors

Question 17

what is health protection in public health?

Answer 17

Concerned with measures to control infectious disease risks and environmental hazards

• infectious diseases , chemicals and poisons, radiation, emergency response, environmental health hazards

Question 18

what is improving services in terms of public health?

Answer 18

concerned with the organisation and delivery of safe, high quality services for prevention, treatment and care

• clinical effectiveness, efficacy, service planning, audit and evaluation, clinical governance, equity

Question 19

what are interventions following health needs assessments?

Answer 19

delivered at individual, community or population level.
may be health/non-health intervention which have an impact on public health

before intervening - health need have to be assessed?

Question 20

what is a health needs assessment?

Answer 20

Health needs assessment is a systematic method for reviewing the health issues facing a population, leading to agreed priorities and resource allocation that will improve health and reduce inequalities.

Question 21

what is need, supply and demand in terms of health needs assessment?

Answer 21

Need – ability to benefit from an intervention
Demand – what people ask for
Supply – what is provided

Question 22

what is a health need?

Answer 22

need for health e.g. measured using mortality, morbidity, socio-demographic measures

Question 23

what is health care need?

Answer 23

Health care need – need for health care, ability to benefit from health care. Depends on the potential of prevention, treatment and care services to remedy health problems.

Question 24

what are the different types of need from a sociological perspective?

Answer 24

• Felt need- individual perceptions of variation from normal health
• Expressed need- individual seeks help to overcome variation in normal health (demand)
• Normative need- professional defines intervention appropriate for the expressed need
• Comparative need- comparison between severity, range of interventions and cost

Question 25

what are the different approaches for health needs assessment?

Answer 25

epidemiological comparative corporate

Question 26

what is the epidemiological approach for health needs assessment?

Answer 26

Define problem Size of problem - incidence / prevalence Services available - prevention / treatment / care Evidence base - effectiveness and cost-effectiveness Models of care - including quality and outcome measures Existing services- unmet need; services not needed Recommendations Sources of data: disease registry, hospital admissions, GP databases, mortality data, primary data collection (e.g. postal/patient survey)

Question 27

what are the advantages and disadvantages of the epidemiological approach for health needs assessment?

Answer 27

advantages - uses existing data, provides data on diseases incidence/mortality/morbidity, can evaluate service trends over time Disadvantages - quality of data variable, data collected may not be the data required, data does not consider the felt needs or opinions/experiences of the people affected

Question 28

what is the comparative approach for health needs assessment?

Answer 28

compare the services received by a population (or subgroup) with others - spatial or social (age, gender, class, ethnicity) may examine health status, service provision, service utilisation, health outcomes (mortality, morbidity, quality of life, patient satisfaction)

Question 29

what might a health needs assessment be carried out for?

Answer 29

a population or sub group a condition an intervention

Question 30

what are the advantages and disadvantages of the comparative approach to health needs assessment?

Answer 30

advantages - quick and cheap if data is available, indicated whether health or services provision is better/worse than comparable areas - gives a measure of relative performance disadvantages - may be difficult to find a comparable population, data may not be availbale/high quality, may not yield what the most appropriate level (e.g. of provision or utilisation) should be

Question 31

what is the corporative approach to the health needs assessment?

Answer 31

ask the local population what their health needs are use focus groups, interviews, public meeting etc.. wide variety of stakeholders, e.g. teachers, healthcare professionals, social workers, charity workers, local businesses, council workers, politicians

Question 32

what are the advantages and disadvantages of the corporate approach to health needs assessment?

Answer 32

advantages - based on the felt and expressed needs of the population in question, recognises the detailed knowledge and experience of those working within the population, takes into account wide range of views disadvantages - difficult to distinguish need from demand, groups may have vested interests, may be influenced by political agendas

Question 33

what is the need assessment and planning cycle?

Answer 33

needs assessment --> planning --> implementation --> evaluation --> assessment

Question 34

what are the three types of prevention ?

Answer 34

- primary prevention - preventing disease before it has happened - secondary prevention - catching the disease in the pre-clinical or early phase - tertiary prevention - preventing complication of disease

Question 35

what are the different approaches to prevention?

Answer 35

``` population approach (work with food industry to reduce salt in foods to reduce BP) high risk approach - identify individuals (screen for people with high BP and treat them) ```

Question 36

what is prevention paradox?

Answer 36

A preventive measure which brings much benefit to the population often offers little to each participating individual

Question 37

what is screening?

Answer 37

a process which sorts out apparently well people who probably have a disease or precursors or susceptibility to a disease from those who probably do not NOT DIAGNOSTIC

Question 38

what are the different types of screening?

Answer 38

``` Population-based screening programmes Opportunistic screening Screening for communicable diseases Pre-employment and occupational medicals Commercially provided screening ```

Question 39

what are the disadvantages of screening?

Answer 39

exposure of well individuals to distressing or harmful diagnostic tests detection and treatment of sub-clinical disease that would have never cause any problems preventative interventions may cause harm to the individual or the population

Question 40

before implementing a screening programme, what criteria should be considered?

Answer 40

most criteria based on the Wilson and Junger model The condition - important health problem, latent/preclinical phase, natural history known. The screening test - suitable (sensitive, specific, inexpensive), acceptable the treatment - effective, agreed policy on whom to treat The organisation and costs - facilities, costs of screening should be economically balanced in relation to healthcare spending as a whole, should be an ongoing process

Question 41

what is sensitivity and specificity?

Answer 41

Sensitivity –the proportion of people with the disease who are correctly identified by the screening test Specificity –the proportion of people without the disease who are correctly excluded by the screening test

Question 42

what is positive predictive value and negative predictive value?

Answer 42

Positive predictive value –the proportion of people with a positive test result who actually have the disease Negative predictive value –the proportion of people with a negative test result who do not have the disease

Question 43

what is lead time bias?

Answer 43

Lead time bias: When screening identifies an outcome earlier than it would otherwise have been identified this results in an apparent increase in survival time, even if screening has no effect on outcome.

Question 44

what is length term bias?

Answer 44

Length time bias: Type of bias resulting from differences in the length of time taken for a condition to progress to severe effects, that may affect the apparent efficacy of a screening method

Question 45

what are the different types of observation studies?

Answer 45

``` descriptive (case reports or ecological studies) descriptive and analytical (cross sectional study/survey) analytical studies (case-control studies, cohort studies) ```

Question 46

what are the different types of experimental/intervention studies?

Answer 46

RCT | non RCT

Question 47

what is an ecological study?

Answer 47

• Ecological studies use routinely collected data to show trends in data and thus is useful for generating hypotheses. Shows prevalence and association, cannot show causation.

Question 48

what is a cross sectional study/survey? | what are the advantages and disadvantages of it?

Answer 48

divides population into those without the disease and those with the disease and collect data on them at a defined time to find associations at the point in time advantages: relatively quick and cheap, provide data on prevalence at a single point in time, large sample size, good for surveillance and public health planning Disadvantages - risk of reverse causality (don't know whether the outcome or exposure came first), cannot measure incidence, risk recall bias and non-response

Question 49

what are case control studies and what are their advantages and disadvantages?

Answer 49

these are retrospective studies that take people with a disease and match them to people without the disease for age/sex/habitat/class etc and study previous exposure to the agent in question. It is quick and inexpensive but the retrospective nature shows only an association and data may not be reliable due to problems with patients memories advantages: good for rare outcome (e.g. cancer), quicker than cohort or intervention studies (as the outcome has already happened), can investigate multiple exposures Disadvantages: difficulties finding controls to match with cases, prone to selection and information bias

Question 50

what is a cohort study and what are the advantages and disadvantages of cohort stidues?

Answer 50

These studies start with a population without the disease in question and study them over time to see if they are exposed to the agent in question and if they develop the disease in question or not. The advantage is that it is possible to distinguish preceding causes from concurrent associated factors. There is a lower chance of bias and absolute, relative and attributable risks can be determined. Requires controls to establish causation. It is prospective which can show causation where retrospective studies cannot. advantages: can follow-up a group with a rare exposure, good for common and multiple outcomes, less risk of selection and recall bias Disadvantages - takes a long time, loss to follow up, needs a large sample size

Question 51

what are randomised control studies and what are the pros and cons?

Answer 51

• Randomised control trial: patients are randomised into groups, one group is given an intervention, the other is given a control and the outcome is measured. Randomisation allows confounding features to be equally distributed. Confounding and biases are minimalized. They tend to be large and expensive and show volunteer bias. Ethical issues – is it ethical to withhold a treatment that is strongly suspected to be effective? Show causation. advantages: low risk of bias and confounding, can infer causality disadvantages: time consuming, expensive, specific inclusion/exclusion criteria may mean the study population is different from typical patients.

Question 52

what is odd ratio?

Answer 52

the odds ratio is the ratio of odds for exposed group to the odds for the not exposed group exposed odds/ unexposed odds OR can be interpreted as a relative risk when the event is rare

Question 53

what is the odds of an event mean?

Answer 53

is the ratio of the probability of an occurrence against the probability of a non-occurrence. odds = probability / (1-probability)

Question 54

helping people to act on their interventions - the theory of planned behaviour - bridging the gap interventions

Answer 54

``` Perceived control Anticipated regret Preparatory actions Implementation intentions Relevance to self ```

Question 55

test for tubal potency (O+G) in female infertility

Answer 55

laproscopy and dye and hysteroscopy TVUS and ultrasound opaque liquid HSG

Question 56

effects of steroids on kids from mark scheme on 2016 paper

Answer 56

- weight gain - increased infections - osteoporosis - bruising - thinning of the skin - puffy face - increased risk of stomach ulcers

Question 57

who to report a never event to

Answer 57

national reporting and learning system | strategic executive information systems

Question 58

what influences health inequalities?

Answer 58

``` PROGRESS Place of Residence (rural, urban, etc.) Race or ethnicity Occupation Gender Religion Education Socioeconomic status Social capital or resources ```