Screening and Health Promotion

Question 1

what is the purpose of screening ?

Answer 1

detect disease at pre-symptomatic stage,
interrupt the natural history of disease,
detect individuals vulnerable to disease and reduce risk,
enable informed reproductive choices,
protect public health

Question 2

what is screening ?

Answer 2

a process that identifies unrecognised conditions by rapidly applied tests on a large scale
not diagnostic and requires follow up investigations and treatment

Question 3

what are the three types of screening ?

Answer 3

selective, mass and opportunistic

Question 4

give an example of selective screening for a single disease

Answer 4

chest x-ray in coal miners

Question 5

give an example of selective multiphase screening

Answer 5

antenatal examinations

Question 6

give an example of mass screening for a single disease

Answer 6

cervical, breast, prostate screening

Question 7

give an example of mass multiphase screening

Answer 7

routine check ups over 75 year olds

Question 8

describe the selective screening mechanism

Answer 8

identify individuals at high risk of disease,
screen for early disease,
convert to low risk by behaviour modification and/or intervention

Question 9

what are the benefits of effective screening?

Answer 9

preventive measure,
reduces morbidity and mortality,
reduces costs,
less radical treatment,
reassurance for those deemed healthy

Question 10

what are the principles of screening ?

Answer 10

condition should be important health problem,
natural history understood, 
recognisable symptoms,
suitable test for examination,
acceptable test and treatment,
effective in reducing mortality/morbidity,
benefits outweigh harm,
economic, 
agreed policy on whom to treat

Question 11

what characteristics should diseases have in order to be suitable for screening?

Answer 11

slow but progressive natural history,
major effects,
high prevalence

Question 12

what are the stages of screening?

Answer 12

identify at risk group
apply screening test
apply appropriate diagnostic tests
treat those with positive results

Question 13

what is meant by sensitivity ?

Answer 13

probability that the test will be positive if the disease is truly present

Question 14

what is meant by specificity ?

Answer 14

probability that the test is negative if the disease is truly absent

Question 15

what is meant by positive predictive value?

Answer 15

probability of truly having the disease when a screening test is positive

Question 16

what is meant by negative predictive value ?

Answer 16

probability of being disease free when the screening test is negative

Question 17

who is responsible for setting the principles of screening ?

Answer 17

National Screening Committee

Question 18

what are the factors influencing health ?

Answer 18

human biology,
physical environments,
social environments,
behaviour and lifestyles,
health services

Question 19

how does environment and lifestyle influence health ?

Answer 19

behaviour is a product of routine and social encounters,
behaviour is psychological,
social and physical environments provide and restrict the range of options from which people are able to make choices

Question 20

what percentage of public expenditure relates to oral health in high income countries ?

Answer 20

5-10%

Question 21

what are the aims of health promotion ?

Answer 21

tackle the determinants of health,
work in partnership with agencies and sectors,
adopt a strategic approach with a range of actions to promote population health

Question 22

what is the definition of health promotion ?

Answer 22

the process of enabling people to increase control over and to improve their health

Question 23

what are the principles of health promotion?

Answer 23

involve the population as a whole,
directed towards action on determinants,
effective and concrete public participation,
not a medical service,
health professionals have a role in enablement, mediation, advocacy and education

Question 24

what are the 5 approaches to health promotion?

Answer 24

prevention, behaviour change, education, empowerment, social change

Question 25

what does health promotion lead to ?

Answer 25

healthy public policy

Question 26

what do health promotion interventions need to be supported by ?

Answer 26

evidence

Question 27

what is meant by opportunity cost ?

Answer 27

the benefit of an intervention compared to its cost

Question 28

how is the cost effectiveness of public health interventions measured ?

Answer 28

cost per QALY (quality adjusted life years)

Question 29

what are the settings for oral health promotion ?

Answer 29

population, community, school, workplace, dental practice

Question 30

what are the 5 strategic elements of the WHO Ottawa Charter 1986?

Answer 30

``` building healthy public policy, creating supportive environments, strengthening community action, developing personal skills, reorienting health services ```

Question 31

what are the problems with health promotion ?

Answer 31

long interval between preventive strategy and measurable improvements. time consuming, politically controversial, must be rigorously evaluated, politicians place emphasis on personal lifestyle choices

Question 32

what are the dilemmas for health promotion?

Answer 32

``` healthism, victim blaming, inaccessibility of information, appropriation of health promotion by specialist groups, evaluation and effectiveness ```

Question 33

what are the main overall focusses of health promotion ?

Answer 33

focus on the population as a whole, make the healthy choices the easy and inexpensive choices

Question 34

How can healthy public policy be achieved ?

Answer 34

Remove barriers to healthy policy to make them the easier choices, Health impact assessment, Legislation and regulation eg seat belts Fiscal policies eg taxes on food/tobacco

Question 35

How can supportive environments be created ?

Answer 35

Create work environments that are safe and satisfying Encourage communities to work together and conserve natural resources Wider environment - access to healthy food Work/school - food and smoking regulations, exercise facilities, health and safety Home - facilities

Question 36

How is strengthening of community action achieved ?

Answer 36

Set priorities, make decisions, plan local strategies, implement plans Eg food co operatives, farmers markets, smoking cessation, cookery clubs

Question 37

How can personal skills be developed ?

Answer 37

``` Health education, Knowledge, attitudes, behaviour, Coping strategies, Self esteem, Self efficacy, Empowerment ```

Question 38

How are health services reoriented ?

Answer 38

Ensure health services aimed at the pursuit of health not just curing disease Primary healthcare approach - address inverse care law