Public Health

Question 1

What is the definition of allostatic load?

Answer 1

Longterm overtaxation of our physiological systems leading to impaired health

Question 2

What is the definition of salutogenesis?

Answer 2

Favourable physiological changes secondary to experiences that promote healing and health

Question 3

What are the four stages of health needs assessment?

Answer 3

Needs assessment
Planning
Implementation
Evaluation

Question 4

Name and describe 4 different types of need

Answer 4

Felt need - individual’s perception of variation from normal health
Expressed need - individual seeks help (same as demand)
Normative need - Professional defined intervention appropriate for expressed need
Comparative need - severity versus range of interventions versus cost

Question 5

What are the pros of the epidemiological approach to health needs assessment? (2)

Answer 5

It uses existing data

It can evaluate trends over time

Question 6

What are the cons of the epidemiological approach to health needs assessment? (3)

Answer 6

Data quality is variable or data is not available
The data collected already may not be the data required
It does not consider felt need

Question 7

What are the pros of the comparative approach to health needs assessment? (2)

Answer 7

Quick and cheap

Gives a measure of relative performance and health inequalities

Question 8

What are the cons of the comparative approach to health needs assessment? (2)

Answer 8

Can be difficult to find a suitable comparison population

May not determine the appropriate service needed

Question 9

What are the pros of the corporate approach to health needs assessment? (2)

Answer 9

Based on felt and expressed need

Recognises local knowledge and experience

Question 10

What are the cons of the corporate approach to health needs assessment? (2)

Answer 10

Hard to distinguish need from demand

Can be influenced by political agendas

Question 11

What are the three components of Donabedian Framework for health needs assessment?

Answer 11

Structure - what is there
Process/Output - what is done
Outcome - 5 Ds

Question 12

What are the 5 Ds of outcome in Donabedian framework of health needs assessment?

Answer 12

Death, disease, disability, discomfort, dissatisfaction

Question 13

What are Maxwell’s Dimensions of Quality? (6)

Answer 13

Effectiveness
Efficiency
Equity
Acceptability
Accessibility
Appropriateness

Question 14

What 10 criteria must be met for a screening programme to be valid? (10)

Answer 14

The condition

1) It must be an important health problem
2) Have a latent/preclinical phase
3) Have a known natural history

The test

4) Must be suitable (sensitive, specific, cost effective)
5) Acceptable (level of invasiveness, risk etc.)

The treatment

6) Must be effective
7) Agreed policy on who to treat

The organisation and costs

8) Facilities must be available
9) Costs must be acceptable
10) Ongoing process in place

Question 15

Define sensitivity

Answer 15

The proportion of people with the disease that are identified

Question 16

Define specificity

Answer 16

Proportion of people without the disease that are correctly excluded

Question 17

Define positive predictive value

Answer 17

Proportion of people with a positive test result that have the disease

Question 18

Define lead time bias

Answer 18

When screening identifies an outcome earlier than it would have, it can cause an apparent increase in survival time even if screening had no effect on outcome

Question 19

Define length time bias

Answer 19

Variation in length of time taken for a condition to progress to severe effects can effect the apparent efficacy of screening
More likely to identify slower, less aggressive tumours
More likely to miss the faster growing, more aggressive tumours

Question 20

What is the Bradford-Hill criteria for causality? (9)

Answer 20

Strength of association
Dose-response
Consistency
Temporality
Reversibility
Biological plausibility
Coherence
Analogy
Specificity

Question 21

Define incidence

Answer 21

the number of new cases over a specified time (e.g) 200 per year)

Question 22

Define prevalence

Answer 22

The proportion of a population affected at a point in time

Question 23

How is relative risk calculated?

Answer 23

Risk for exposed group/ Risk for unexposed group

Question 24

How are odds calculated?

Answer 24

Probability / (1 - probability)

Question 25

In models of health behaviour change, in the health belief model, what 4 criteria must be met for change to occur? What is the biggest obstacle for behaviour change?

Answer 25

Belief that they are susceptible to the condition Belief that it has serious consequences Belief that taking action will reduce susceptibility Belief that benefits will outweigh the costs Perceived barriers

Question 26

What are the stages of the transtheoretical/stage model of health behaviour change? (5)

Answer 26

``` Pre-contemplation Contemplation Preparation Action Maintenance ```

Question 27

What can be prescribed to aid smoking cessation, how do they work? (4)

Answer 27

Bupropion - decreases nicotine cravings and withdrawal symptoms Varenicline (Champix) - decreases cravings and pleasurable effects

Question 28

In the theory of planned behaviour what are the three things that determine intention?

Answer 28

The person's attitude to the health behaviour Perceived social pressure Self efficacy/perceived behavioural control

Question 29

What are the five levels of Maslow's Hierarchy of Needs?

Answer 29

``` Physiological Safety Love/Belonging Esteem Self actualisation ```

Question 30

What must be fulfilled to satisfy Fraser Guidelines? (5)

Answer 30

1) They must have sufficient maturity and intelligence 2) The cannot be persuaded to tell their parents 3) They are likely to continue to have sexual intercourse regardless 4) Their mental health is likely to suffer if they do not receive advice +/- treatment 5) The advice/treatment is in the young person's best interest

Question 31

What three medications other than metformin can be used to manage type 2 diabetes before insulin therapy is considered?

Answer 31

DPP4 inhibitor ('gliptin' e.g.) Saxagliptin) Pioglitazone Sulfonylurea

Question 32

What is the Bolam test?

Answer 32

It determines if a group of their professional peers would have acted the same

Question 33

What is the Bolitho test?

Answer 33

Would it be reasonable and logical for a group of doctors to act in a certain way

Question 34

What is a lapse error (type of human error)?

Answer 34

The action plan put in place is correct but one or more of the planned actions was skipped

Question 35

What is a slip error (type of human error)?

Answer 35

The action plan put in place was correct but one or more of the planned actions was performed incorrectly

Question 36

What is a rule-based mistake?

Answer 36

When an action plan is incorrect due to choice of the wrong rule after misinterpreting a situation

Question 37

What is a knowledge based mistake?

Answer 37

When an action plan is incorrect due to lack of knowledge or incorrect application

Question 38

What type of study is this: | Follows a group of people to track risk factors and outcomes over time

Answer 38

Cohort study

Question 39

Describe a case control study

Answer 39

Compares the histories of people with a condition to people without a condition

Question 40

Describe a cross-sectional survey (1)

Answer 40

Assesses the prevalence of an outcome in a broad population and one point in time

Question 41

What is the WHO definition of health? (1)

Answer 41

A state of complete physical, mental, and social well-being and not merely the absence of disease of infirmity

Question 42

What is PICO? (4)

Answer 42

Patient/Population/Problem Intervention/Exposure Comparison/Control Outcome

Question 43

What is Utilitarianism? (1)

Answer 43

Utilitarianism holds that the most ethical choice is the one that will produce the greatest good for the greatest number. QALYs are based on utilitarianism principles.

Question 44

What is the acid test? (4)

Answer 44

Determines if a person requires DoLS 1) Does the person lack capacity to consent to the arrangements? 2) Is the person subject to continuous supervision and control? 3) Is the person free to leave?