Public Health

Question 1

Define adolescent

Answer 1

People between 10-19 years of age

Question 2

Physical changes of puberty

Answer 2

Growth spurt of 10-12cm per year in boys and 8-10cm in girls per year
Change in jaw and forehead (boys)
Proportion of fat increases by 25% for girls and decreases by 15% for boys

Question 3

What is self compassion

Answer 3

Taking an understanding, non-judgemental attitude towards ones inadequacies and failures and recognising that ones experience is part of the common human experience

Question 4

What is prioritisation

Answer 4

To arrange in order of relative importance

Question 5

What is importance

Answer 5

The state or fact of being of great significance and value

Question 6

What is explicit rationing

Answer 6

In full view of the public

For example NICE guidelines are explicit about when an intervention or medication should be available and to whom

Question 7

What is implicit rationing

Answer 7

At the bedside of behind the scenes
Eg GP acting as a gatekeeper to secondary care, delaying healthcare access through waiting lists, or reducing length of stay through early discharge

Question 8

What are the different forms of rationing

Answer 8

Denial: care which is deemed unsuitable or not urgent enough eg commissioner doesn’t fund comsemctic procedure

Selection: those most likely to benefit from treatment are selected eg commissioner specifies eligibility criteria for GP to refer to specialist

Deflection: patients encouraged or turned towards another service eg private, non A &E services etc - implicit, may be used in communications eg using 111

Deterrence: barriers (lack of information) or costs put in place - implicit or explicit

Delay: needs not met immediately eg wait for appointments or waiting lists - implicit although there may be explicit policies to counter this eg 18 week wait or 2 week cancer wait

Dilution: services given to all but amount given reduced eg reducing GP / consultant time - implicit as it isn’t specified as a rationing method

Termination: system no longer treats certain patients eg cessation of cancer screening at primary level - explicit, specified in a policy

Question 9

Types of comparative analysis of interventions in terms of costs and benefits

Answer 9

Cost minimisation analysis (CMA)
Cost effectiveness analysis (CEA)
Cost utility analysis (CUA)
Cost benefit analysis (CBA) N

Question 10

What is a health system

Answer 10

The sum total of all the organisations, institutions and resources whose primary purpose is to improve health

Question 11

What is commissioning

Answer 11

Assessing needs
Deciding priorities
Buying services from providers such as hospitals and clinics

Question 12

How does the money flow

Answer 12

From parliament to department of health to public health England to local authorities (social care , public health)

Also from parliament to department of health and then nhs England and then to CCGs and to departments such as mental health, community services, hospital, ambulance, primary care

Question 13

What is presenteeism

Answer 13

Working when unwell (and underproductive)
Twice as costly for employers as sickness absence
May not help recovery

Question 14

What are the benefits of good work

Answer 14

Provides people with a sense of purpose and fulfilment

Good for physical and mental health

Provides financial benefits

Benefits patients, employers and national prosperity

Question 15

What is leaveism

Answer 15

People taking annual leave (holiday entitlement) to recover from illness

Question 16

What is karoshi

Answer 16

Death due to overwork
Acute cardiovascular events
Very long working hours; not taking holidays

Question 17

What is malingering

Answer 17

Illness deception for material gain eg avoiding work or gaining sickness / insurance benefits

Question 18

What is factitious disorder

Answer 18

Obtaining attention or sympathy

• psychiatric disorder
• identification and management of illness deception in the workplace is a ‘potential minefield’

Question 19

What is illness deception

Answer 19

Deliberate distortion of health related information in order to deceive others

Question 20

Define communicable disease

Answer 20

A disease capable of being directly or indirectly transmitted from an infected person to another from animal to human, from animal to animal or from the environment to humans

Question 21

What is the epidemiological triad

Answer 21

A model for disease causation made up of agent, host and environment

Question 22

What are the 3 phases of an infectious disease

Answer 22

Incubation period: time interval between invasion by an infectious agent and the appearance of the first sign of symptom of the disease
Duration may be determines by the infecting dose

Latent period: the period between exposure and the onset of infectiousness (this may be shorter than the incubation period)

Infectious period: length of time a person can transmit a disease (sheds the infectious agent)

Question 23

What is global health

Answer 23

Improving health and achieving equity in health for all people worldwide

Health issues whose causes or solutions lie outside the capability of one nation state

Interdisciplinary

Question 24

What happens as societies develop

Answer 24

Infectious diseases and malnutrition decline but non communicable diseases increase

Question 25

What is globalisation

Answer 25

Increasing interaction between nations Increasing formal structures / agencies between nations

Question 26

Pros of globalisation for health

Answer 26

Dissemination of knowledge and strategies to address problems International trade - economic growth - investment in health

Question 27

Cons of globalisation for health

Answer 27

International travel - spread of communicable disease Multinational companies promoting smoking, sugary drinks, fast food

Question 28

Effects of conflict on health

Answer 28

``` Injuries Mental health impacts Destruction of healthcare Infrastructure Health professionals leaving ```

Question 29

Determinants of global health: migration

Answer 29

272 million international migrants in 2019 In high income countries, migrants more likely to bolster health services than burden them 85% refugees go to low and middle income countries Deaths in transit (1422 deaths in Mediterranean Sea in 2020) Interruption of care for non communicable diseases Overcrowding and poor sanitation in refugee camps -> communicable diseases

Question 30

Effects of poverty on global health

Answer 30

People cant afford to pay for medication Poor living conditions Lack of health workforce Weak health systems

Question 31

Define screening

Answer 31

Process of identifying apparently healthy people who may have an increased chance of a disease or condition enabling earlier treatment or informed decisions

Question 32

State the different types of screening criteria

Answer 32

Wilson - junger UK national screening committee

Question 33

Outline the Wilson junger criteria

Answer 33

1) the condition should be an important health problem 2) there should be treatment for the condition 3) facilities for diagnosis and treatment should be available 4) there should be a latent stage of the disease 5) there should be a test or examination for the condition 6) the test should be acceptable to the population 7) the natural history of the disease should be adequately understood 8) there should be an agreed policy on whom to treat 9) the total cost of finding a case should be economically balanced in relation to medical expenditure as a whole 10) case finding should be a continuous process, not just a once and for all project

Question 34

Outline the UK national screening committee criteria

Answer 34

Condition: - important health problem - well understood natural history with either latent period or early symptomatic stage Test: - simple, safe, precise, acceptable validated test - agreed policy on investigation of screen +ves Treatment - evidence of benefit for screening identified cases over symptomatic cases through effective treatment - management of disease before screening should be optimised Programme - RCT - acceptable to public - value for money - agree plan for monitoring, management and quality assurance - adequately staffing and facilities - appropriate patient information available

Question 35

Benefits of screening

Answer 35

- produces earlier diagnoses - early diagnosis may improve prognosis for those who develop disease - cases may be prevented - treating early may save money

Question 36

Cons of screening

Answer 36

``` Cost Anxiety to patient Test can be harmful - not 100% accurate - health inequalities - subject to bias ```

Question 37

What is length time bias

Answer 37

Screening more likely to diagnose slower growing, less aggressive disease with poor prognosis

Question 38

What is lead time bias

Answer 38

Apparent improvement in survival due to earlier detection

Question 39

Define sensitivity of a test

Answer 39

Proportion of those with a disease which it correctly identifies

Question 40

Define specificity of a test

Answer 40

Proportion of those without the disease which it correctly identifies

Question 41

Define +ve predictive value

Answer 41

Probability that subject has disease given that have a +ve result

Question 42

Define -ve predictive value

Answer 42

Probability that subject does not have disease given that they have a -ve result

Question 43

State the purpose of screening tests

Answer 43

Assess risk of disease in asymptomatic person to determine the need for further confirmatory diagnostic testing

Question 44

State the purpose of diagnostic tests

Answer 44

Confirm or exclude the presence of a disease

Question 45

State the purpose of prognostic tests

Answer 45

Assess risk of future disease and need for preventative measures

Question 46

State the purpose of monitoring tests

Answer 46

Monitor progress in response to treatment

Question 47

Define case finding

Answer 47

Systematic or opportunistic process that identifies individuals from a larger population for a specific purpose

Question 48

Define risk stratification

Answer 48

Systematic process that can be used to divide a population into different strata of risk for a specified outcome