Public Health

Question 1

what is the Gini coefficient?

Answer 1

a statistical representation of the nation’s income distribution - the lower the coefficient, the greater the equality

Question 2

The Acheson Report

Answer 2

1998: said that income inequality should be reduced and that priority should be given to families with children

Question 3

Proportional Universalism

Answer 3

Focusing only on the disadvantaged will not help to reduce inequality. Action must be universal but with scale and intensity proportional to the disadvantage.

Question 4

Theories of causation

Answer 4

i) Psychosocial
ii) Neo-material
iii) Life Course

Question 5

Psychosocial causation

Answer 5

Stress results in inability to respond to body’s demands

There’s also impact on blood pressure and cortisol levels

Question 6

Neo-material causation

Answer 6

Hierarchal societies are less willing to invest in public goods
Poor people also have fewer goods, the quality of which is generally lower

Question 7

Life course as causation

Answer 7

Critical periods - events have greatest impact at certain times in people’s lives. Hazards and their impacts also build up over time. Injuries and disabilities may be self propagating. Childhood abuse leads to mental health issues in later years.

Question 8

Domains of public health

Answer 8

Health protection
Improving services
Health improvement
Addressing the wider determinants of health

Question 9

Ethical levels

Answer 9

Meta-ethics (fundamental questions e.g. right & wrong)
Ethical Theory - (5 levels)
Applied Ethics (e.g. specific areas)

Question 10

Ethical theory

Answer 10

i) virtue
ii) categorical
iii) imperative
iv) utilitarianism
v) 4 principles

Question 11

Structural determinants of illness

Answer 11

i) social class
ii) material deprivation/poverty
iii) unemployment
iv) discrimination/racism
v) gender and health

Question 12

Confidentiality: when is disclosure allowed?

Answer 12

i) required by law
ii) patient consents
iii) there is a public interest xn

Question 13

Confidentiality: criteria for disclosure

Answer 13

i) anonymous if practical
ii) patient’ consent if possible
iii) kept to a necessary minimum
iv) meets current law

Question 14

Three notifiable diseases that must be reported to WHO

Answer 14

i) cholera
ii) plague
iii) yellow fever

Question 15

Difference between health behaviour illness behaviour and sick role behaviour.

Answer 15

HB: to prevent disease (eat healthily)
IB: to seek remedy (go to dr)
SRB: to get well (complianc, resting)

Question 16

5 lifestyle factors that promote morbidity

Answer 16

i) smoking
ii) obesity
iii) excess alcohol
iv) poor diet
v) sedentary lifestyle

Question 17

Two theories of behavioural change

Answer 17

Health Belief Model and Transtheoretical model

Question 18

Health belief model

Answer 18

i) individuals must believe they are susceptible to the condition
ii) individuals must believe it has serious consequences
iii) individuals must believe that taking action reduces their skills
iv) individuals must believe that the benefits of taking action outweigh the costs

Question 19

Transtheoretical model

Answer 19

i) pre-contemplation
ii) contemplation
iii) preparation
iv) action
v) maintenance
vi) ReLaPSe?

Question 20

Utilitarianism/consequentialism (Teleological)

Answer 20

i) an act is evaluated solely in terms of its consequences

ii) maximising good and minimising harm

Question 21

Kantianism (Deontological)

Answer 21

i) features of the act themselves determine the worthiness of the act
ii) follow categorical imperatives (do not lie; do not kill etc)
iii) people are ends not means to an end

Question 22

Virtue ethics (Deontology)

Answer 22

i) focus is on the kind of person who is acting
ii) deemphasises rules
iii) is the person expressing good character or not
iv) five focal virtues

Question 23

Five focal virtues of virtue ethics

Answer 23

i) compassion
ii) discernment
iii) trustworthiness
iv) integrity
v) conscientiousness

Question 24

The 4 Principles

Answer 24

i) autonomy
ii) benevolence
iii) non-malificence
iv) justice

Question 25

GMC duties of a doctor

Answer 25

i) Protect and promote the health of patients and the public ii) provide good standard of practice and care iii) recognise and work within the limits of your competencies iv) work with colleagues in the ways that best serve patients interests v) treat patients as individuals and respect their dignity

Question 26

The Katz ADL Scale | activities of daily life

Answer 26

i) bathing ii) dressing iii) toilet use iv) transfering from bed to chair v) urine and bowel continence vi) eating

Question 27

IADL (Instrumental activities of daily life)

Answer 27

i) use of the telephone ii) travelling by car or using public transport iii) food or clothes shopping iv) meal preparation v) housework vi) medication use vii) management of money

Question 28

Acute illness

Answer 28

a disease of short duration that starts quickly and has severe symptoms

Question 29

Chronic illness

Answer 29

a persistent or recurring conditon which may or may not be severe, often starting gradually with slow changes

Question 30

Polypharmacy

Answer 30

the use of mulitiple medications or administration of more medications than are clinically indicated

Question 31

key challenges of an ageing population

Answer 31

i) strains on pension and social security systems ii) increasing demand for health care iii) bigger need for trained health workforce iv) increasing demand for a long-term care v) pervasive ageism (denying older people the rights and opportunities available to young people) vi) inequality as more affluent groups will be able to afford better care for longer

Question 32

Intrinsic aging

Answer 32

natural, universal and inevitable

Question 33

Extrinsic aging

Answer 33

dependant on external factors (smoking, air polution, UV rays)

Question 34

why women live longer than men

Answer 34

20% biological (premenopausal women are protected from heart disease by hormones) 80% environmental (men take more lifestyle risks than women)

Question 35

Types of dementia

Answer 35

i) alzheimers (62%) ii) vascular dementia (17%) iii) mixed alzheimers and vascular (10%) iv) lewy bodies v) fronto temporal (2%) vi) other types (3%)

Question 36

Institutionalising death

Answer 36

60% of people die in hospital but 70% want to die at home

Question 37

Four contexts for awareness

Answer 37

i) closed awareness - staff know by the patient doesn't ii) suspected awareness - the patient suspects but is uncertain that they're dying iii) mutual pretence - everyone knows but it isn't discussed openly iv) state of awareness - everyone knows and openly admits that death is approaching

Question 38

social death

Answer 38

when people die in social and interpersonal terms before their actual biological death - lonely

Question 39

Death the hospice way

Answer 39

i) open awareness, compassion and honesty ii) multi-disciplinary teams iii) emotion and relationships - modelled on a family approach iv) holistic care

Question 40

Health problems associated with smoking

Answer 40

i) cancers (all types) ii) cardiovascular iii) impotence iv) diabetes v) oral health vi) cateracts

Question 41

Smoking cessation

Answer 41

i) NRT - patches, gum, nasal spray ii) non-nicotine pharmacotherapy - varenicline, bupropion iii) transtheoretical model §

Question 42

Transtheoretical model

Answer 42

i) precontemplation ii) contemplation iii) preparation iv) action v) maintenance

Question 43

3 A's to smoking cessation

Answer 43

i) Ask - your patient's smoking ii) Advise - your patient on cessation methods available iii) Assist - your patient and refer to local NHS stop smoking services

Question 44

The millenium development goals

Answer 44

i) eradicate extreme poverty and hunger ii) achieve universal primary education iii) reduce child mortality iv) improve maternal health vi) combat HIV/AIDS, malaria and other diseases

Question 45

3 leading causes of death in children in the developing world

Answer 45

i) pneumonia ii) diarrhoea iii) malaria

Question 46

examples of migrants

Answer 46

asylum seekers, refugees, trafficked people, migrant workers, family workers, family joiners, international students

Question 47

causes of vulnerability in migrants

Answer 47

persecution, war, political and social unrest, exploitation, torture, rape bereavement, burden of disease and socio-economic status

Question 48

sustainability

Answer 48

meeting the needs of today without compromising the ability of future generations to meet the needs of tomorrow

Question 49

definition of screening

Answer 49

a process that sorts a cohort of symptomless people into a group that are likely to have a disease and a group that are unlikely to have a disease

Question 50

primary, secondary and tertiary prevention

Answer 50

primary - to prevent the disease from occuring secondary - detection of early disease and action to alter the course of disease in order to maximise chances of recovery tertiary prevention - trying to slow down the progression of a disease

Question 51

screening sensitivity

Answer 51

true positives / total with the disease

Question 52

screening specificity

Answer 52

true negative / total without the disease

Question 53

Positive predictive value

Answer 53

true positive / total with positive result

Question 54

Negative predictive value

Answer 54

true negative / total with negative result

Question 55

Prevalence and incidence

Answer 55

prevalence - the proportion of a population with a characteristic incidence - the number of new cases within a specified time period divided by the size of the population initially at risk

Question 56

Wilson and Jugner criteria for screening

Answer 56

THE CONDITION i) it should be a serious health problem ii) the aetiology should be well understood iii) there should be a detectable early stage THE TREATMENT i) there should be an accepted treatment for the disease ii) facilities for diagnosis and treatment should be available iii) there can't be an unmanageable extra clinical workload THE TEST i) a suitable test should be devised for the early stage ii) the test should be acceptable for the patients iii) intervals for repeating the test should be determined THE BENEFITS i) there should be an agreed policy on whom to treat ii) the cost should be balanced against the benefits

Question 57

Types of bias in screening

Answer 57

selection bias lead time bias - identified earlier but survival is not longer length time bias - diseases with longer period of presentation are more likely to be detected by screening

Question 58

Medical error leads to two outcomes

Answer 58

i) adverse effect | ii) near miss

Question 59

Human error types

Answer 59

i) errors of omission ii) errors of commission iii) errors of negligence

Question 60

skill based errors

Answer 60

when performing a task that is well learned and therefore automatic, lapses in concentration cause error

Question 61

Rule/knowledge based error

Answer 61

incorrect plan or course of action is chosen - these mistakes are more likely when the task is more complex or the person has less experience

Question 62

Violations

Answer 62

deliberate deviations from practices, procedures and standards or rules i) routine (cutting corners) ii) necessary (to get the job done) iii) optimising (personal gain, selfish)

Question 63

Approaches to managing errors

Answer 63

individual - errors are the products of the wayward mental processes of individual organisational - adverse events are the effect of wayward causal factors - the whole system is to blame

Question 64

Defining an effective team

Answer 64

i) optimal size ii) good team dynamic iii) a common purpose iv) an identified team leader v) shared knowledge and experiences

Question 65

obstacles of teamwork

Answer 65

Organisational - different offices, shifts and rotation posts Location - based elsewhere Management - different employers Other commitments of the team members

Question 66

SBAR checklist for reporting a case

Answer 66

S - situation B - background A - assessment R - recommendation

Question 67

Mental health definition

Answer 67

a state of wellbeing in which the individual realises his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully and is able to contribute to the community

Question 68

CMHP - common mental health problems

Answer 68

i) depression ii) generalised mental health disorder iii) panic disorders iv) phobias v) social anxiety disorder vi) obsessive compulsive disorder vii) post traumatic stress disorder

Question 69

Psychological definition of stress

Answer 69

stress occurs when the demands made upon an individual are greater than their ability to cope

Question 70

Stressors

Answer 70

acute - noise, danger, infection chronic - health, home, finances internal stressors - physical, psychological external stressors

Question 71

PTSD daignostic criteria

Answer 71

both must be present: i) the person experienced an event that involved actual or threatened death or serious injury or a threat to physical integrity ii) the person's response involved intense fear, helplessness and horror

Question 72

PTSD Symptoms

Answer 72

i) event persistently re-experienced in recollections and dreams ii) persistent avoidance of stimuli associated with the event iii) persistent symptoms of increased arousal (insomnia, irritability)

Question 73

Stress and physical illness

Answer 73

i) peptic ulcers ii) cancer iii) obesity iv) chronic fatigue syndrome

Question 74

Causes of Obesity

Answer 74

i) Americanization of diet and society ii) increasing dominance of car culture iii) numerous technical advances minimising physical work iv) more commuting v) longer working hours

Question 75

Obesity definition

Answer 75

abnormal or excessive fat accumulation resulting from chronic imbalance of energy intake and energy expenditure

Question 76

BMI Brackets

Answer 76

``` <18.4 --> underweight 18.5 - 24.9 --> normal 25 - 29.9 --> overweight 30 - 34.9 --> obese class I 35 - 39.9 --> obese class II >40 --> obese class III ```

Question 77

7 key domains of energy balance

Answer 77

i) food environment (population level energy intake) ii) food consumptions (energy intake on individual level) iii) individual activity iv) activity of the environment (population level) v) societal influences vi) individual psychology vii) individual biology

Question 78

difference between satiation and satiety

Answer 78

satiation - what brings an eating episode to an end | satiety - the inter-meal period

Question 79

the 4 main STIs

Answer 79

i) chlamydia ii) gonorrhoea iii) syphilis iv) trichomoniasis

Question 80

HIV safety ABC

Answer 80

i) abstain ii) be faithful iii) use a condom

Question 81

CAM definition

Answer 81

complementary and alternative medicine - those healing resources other than those intrinsic to the politically dominant healthcare system

Question 82

examples of CAM

Answer 82

manual therapies: osteopathy, chiropractic, reflexology ethic medical systems: chinese medicine acupuncture, herbal medicine mind-body/energy medicine: hypnotherapy, healing, reiki Non-allopathic sysytems: homeopathy

Question 83

House of Lords CAM classification

Answer 83

Group 1: some scientific evidence of efficacy - herbal, chiropractic, osteopathy Group 2: modalities working in a supportive capacity alongside conventional medicine, not offering independent diagnosis - massage, aromatherapy Group 3: traditional systems of medicine backed by historical practice only - chinese medicine

Question 84

Who uses CAM

Answer 84

mainly older women with higher income and higher education level. 60% of users have a chronic illness

Question 85

Major concerns

Answer 85

Unrealistic Expectations Delays in conventional care General safety

Question 86

Basic Health Economic Problem

Answer 86

resources are finite desire for goods and services is infinite no country treats all treatable ill health choice cannot be avoided

Question 87

Economic evaluation

Answer 87

Assessing whether a benefit has been maximised | Costs and effects are analysed in terms of their differences

Question 88

Types of economic evaluation

Answer 88

Cost-effectiveness analysis: cost per life year gained Cost-utility analysis: cost per QALY gained Cost benefit analysis: outcomes measured in monetary units so net gain

Question 89

Equity

Answer 89

Fairness or justice of the distribution of costs and benefits