Brief public health

Question 1

Describe the Transtheoretical model of behavioural change.

Answer 1

1. Pre-contemplation (no intention of giving up smoking).
2. Contemplation (consider quitting).
3. Preparation (get ready to quit in near future).
4. Action (engaged in giving up).
5. Maintenance (steady non-smoker).
6. Relapse- a lapse leads back to resumption of smoking

Question 2

What is the Gini coefficient?

Answer 2

A statistical representation of a nation’s income distributed among it’s residents. It is the most commonly used measure of equality.

Question 3

Responses to health inequalities: what are the main principles of the Acheson Report (1998)?

Answer 3

1. Reduce income inequality.
2. Give high priority to the health of families with children.

Question 4

Responses to health inequalities: what are the main principles of Proportionate Universalism?

Answer 4

1. Focusing on the disadvantaged only will not help to reduce the inequality
2. Action must be universal but with a scale and intensity proportional to the disadvantage
3. A fair distribution of health (wealth?) is important

Question 5

Responses to health inequalities: What are the main principles of the Black Report (1980)?

Answer 5

1. Material (environmental causes, low income, poor education)
2. Artefact (an apparent product of how inequality is measured)
3. Cultural/behavioural (poorer people behave in unhealthy ways)
4. Selection (sick people sink socially and economically)

Question 6

Causes of health inequalities

Answer 6

1) Psychosocial (stress lower’s ability of body’s response to demands

2) Neo-material (poorer people have lower quality goods)

3) Life course (a combination of both psychosocial and neo-material explanations)

Question 7

What are the 3 main notifiable diseases (that must be reported to Public Health England, potentially WHO)

Answer 7

Cholera, Meningitis, yellow fever and plague

Question 8

Briefly describe the chain of infection

Answer 8

1) Infectious agent- microorganism that can cause harmful infections and make someone ill

2) Reservoir- Where the germ lives and grows

3) Portal of exit - Germ finds a way out of the infected person so it can spread

4) Mode of transmission - Once the germ is out, it can spread from one person to another (by hands, equipment, in the air)

5) Portal of entry - The germ finds a way into another person

6) Susceptible host - People at risk of infection (as they are unable to fight the infection)

Question 9

Definition of stress

Answer 9

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

Question 10

What is the stress illness model?

Answer 10

An individuals susceptibility to disease or illness is increased because an individual is exposed to stressors which cause strain upon the individual, leading to
psychological and physiological changes

Question 11

What are the types of stress?

Answer 11

Distress - Negative stress which is harmful and damaging

Eustress- Positive stress which is beneficial and motivating

Question 12

Name potential stressors

Answer 12

Acute stressors - Noise, danger, injuries, hunger

Chronic stressors- home, health, finances, work, family, friends

Internal stressors- Inflammation, infection, Psychological (attitudes, personal expectations)

External stressors- Environment, social and cultural pressures

Question 13

Definition of specificity (in screening)

Answer 13

The proportion of people without the disease who are correctly excluded by the screening test. (how well a test detects those without a disease)

Question 14

Definition of prevalence

Answer 14

The proportion of a population found to have the disease at a point in time

Question 15

Definition of incidence

Answer 15

The number of new cases within a specified time period divided by the size of the population initially at risk.

Question 16

Definition of positive predictive value

Answer 16

The proportion of people with a positive test result who actually have the disease

Question 17

Define error (in patient care)

Answer 17

Any preventable event that can cause or lead to patient harm

Question 18

3 types of human error

Answer 18

Errors of omission (required action is not taken/delayed)

Errors of commission (wrong action is taken)

Error of negligence (the actions or omissions do not meet the level of standard required)

Question 19

What are the 2 outcomes of medical error?

Answer 19

Adverse event - an incident which results in harm to a patient

Near miss - An event which has the potential to cause harm but fails to develop further, thus avoiding harm

Question 20

Definition of skill based errors

Answer 20

When performing a routine or a well learnt task, you may give little attention. If distracted or interrupted, it could result in slips of action or memory lapses.

Question 21

Definition of rule/knowledge based error

Answer 21

When an incorrect plan or course of action is taken (can happen in emergencies or due to lack of experience)

• Mistakes are more likely when the task is complex (insufficient information, communication breakdown)

Question 22

5 factors that can affect performance

Answer 22

Fatigue
Drugs or alcohol
Stress
Distraction
Illness

Question 23

Define swiss cheese theory of errors

Answer 23

A model used to understand how multiple layers of defences can have weaknesses that when aligned, can lead to accidents or failures.

Question 24

Health problems connected to smoking

Answer 24

Cardiovascular problems (strokes, heart attacks)

Stomach ulcers

Diabetes

Negative impact on oral health

Cancer - Pancreas, bladder, stomach, etc

Question 25

4 domains of public health

Answer 25

Health protection

Improving services

Health improvement

Addressing the wider determinants of health

Question 26

Name 5 ethical theories

Answer 26

Virtue

Categorical

Imperative

Utilitarianism

4 principles

Question 27

Describe the Health Belief Model (Becker 1974) of behavioural change.

Answer 27

(Theoretical model that can be used to guide health promotion and disease prevention programs)

The individual needs to believe that there are consequences and that they are susceptible to disease. They need to believe that taking action reduces the risks and that the benefits outweigh any costs.

Question 28

Primary prevention

Answer 28

Preventing a disease/condition from occurring in the first place.
Eliminate exposures/risk factors that contribute to the disease.
e.g. ban or control of use of hazardous products, health and safe habits (exercising regularly, eating a balanced diet, not smoking) - vaccination?

Question 29

Secondary prevention

Answer 29

Detecting a disease as soon as possible in order to alter its course and to improve health outcomes.
E.g. Regular screenings, blood pressure monitoring, routine HIV testing

Question 30

Tertiary prevention

Answer 30

Trying to slow down the progression of a disease and helping people to manage their illness effectively.
e.g. stroke/cardiac rehabilitation programmes, therapy

Question 31

What is the ‘prevention paradox’?

Answer 31

A preventive measure which brings much benefit to the population, although it may offer little benefit to each participating individual e.g salt reduction (benefit population) versus treatment for high blood pressure (benefit individual)

Question 32

What are the 2 levels of behaviour change?

Answer 32

Population level
- Health promotion campaigns (screening, 5 a day)

Individual level
- Patient centered approach - care in response to individual’s needs

Question 33

Theory of planned behaviour Ajzen (1988)- What does it propose and what are the 3 principles?

Answer 33

It proposes that the best predictor of behaviour is intention

Intention is determined by
- ATTITUDES- Patient’s attitude towards something
- SUBJECTIVE NORM- Attitudes of significant others towards something (perceived social pressure to undertake the behaviour)
- PERCEIVED BEHAVIOURAL CONTROL- A belief that one can stop something e.g. stop smoking (an appraisal of your ability to perform the behaviour)

Question 34

What does PICO stand for?

Answer 34

P - patient problem or population.
I - intervention.
C - comparison.
O - outcome.

Question 35

What is a meta analysis?

Answer 35

When data from individual studies in systematic reviews are combined to address the research question

Question 36

3 biological and cognitive features of depression

Answer 36

Biological - Loss of appetite, overeating, early morning wakening, poor memory, concentration loss, loss of libido, insomnia, constipation, diarrhoea, menstrual disturbance

Cognitive - feeling of being a failure, negative thoughts, reduced self-esteem, reduced confidence (poor memory, concentration loss – if not included in answer above) anhedonia

Question 37

Treatment for depression (pharmacological and non pharmacological)

Answer 37

Selective serotonin Reuptake inhibitor

Fluoxetine, sertraline

Non pharmacological
- CBT
- Counselling
- Talking therapy

Question 38

Alcohol harm paradox

Answer 38

Lower socioeconomic status groups consume less alcohol than higher SES groups, but experience greater alcohol related problems

Question 39

2 types of dependence (Alcohol/Drug)

Answer 39

Physical dependence - Without the drug, they will experience withdrawal symptoms like stomach cramps, aches

Psychological dependance - the feeling that life is impossible without the drug OR feelings of fear/guilt without the drug