HSPH QS Flashcards
Suicide rates are highest in which of
the groups below?
- Men aged 65+
- Men aged 18-24
- Women aged 18-24
- Women aged 65+
- Men aged 35-49
- Women aged 35-49
Suicide rates are highest in which of
the groups below?
- Men aged 65+
- Men aged 18-24
- Women aged 18-24
- Women aged 65+
5. Men aged 35-49 - Women aged 35-49
If a doctor finds out that a patient is experiencing domestic
violence which of the following should they do?
- Immediately send the patient to A&E
- Refer the patient to a psychiatrist
- Suggest referral for domestic violence advocacy and treat symptoms
- Refer the patient to social services
- Suggest referral to gynaecologist
If a doctor finds out that a patient is experiencing domestic
violence which of the following should they do?
- Immediately send the patient to A&E
- Refer the patient to a psychiatrist
3. Suggest referral for domestic violence advocacy and treat symptoms - Refer the patient to social services
- Suggest referral to gynaecologist
Self-management in the context of chronic
illness refers to:
- People not going to the doctor
- People attending courses on healthy lifestyles
- Health professionals supporting people to self-care
- Informal care in the community
- People making all their own decisions about how to
manage their illness
Self-management in the context of chronic
illness refers to:
- People not going to the doctor
- People attending courses on healthy lifestyles
3. Health professionals supporting people to self-care - Informal care in the community
- People making all their own decisions about how to
manage their illness
Which of the following best describes the
social model of disability?
- Disability is viewed as a medical problem
- People are under the care of social workers
- Disabling environments prevent people from
participating in social activities such as work - People are given benefits and not expected to work
- Impairments lead to barriers to social participation
Which of the following best describes the
social model of disability?
- Disability is viewed as a medical problem
- People are under the care of social workers
3. Disabling environments prevent people from
participating in social activities such as work - People are given benefits and not expected to work
- Impairments lead to barriers to social participation
The bottom 50% of households own
approximately how much of the UK’s wealth?
- 5%
- 10%
- 25%
- 40%
- 50%
The bottom 50% of households own
approximately how much of the UK’s wealth?
- 5%
2. 10% - 25%
- 40%
- 50%
Which of the items below is a key finding of
the Whitehall II study?
- Diet affects health outcomes
- Smoking affects health outcomes
- Social position affects health outcomes
- Genetics affect health outcomes
- Having a high demand job affects health outcomes
Which of the items below is a key finding of
the Whitehall II study?
- Diet affects health outcomes
- Smoking affects health outcomes
3. Social position affects health outcomes - Genetics affect health outcomes
- Having a high demand job affects health outcomes
Which item below is a ‘social’ risk factor for
diabetes?
- Obesity
- Ethnicity
- Low level of physical activity
- Cardiovascular disease
- High fat diet
Which item below is a ‘social’ risk factor for
diabetes?
- Obesity
2. Ethnicity - Low level of physical activity
- Cardiovascular disease
- High fat diet
In order to obtain valid consent for a biomedical
intervention the doctor must:
- Offer the patient adequate information
- Give the patient a detailed information sheet to
read - Check that the patient is over 18 years of age
- Have two witnesses present
In order to obtain valid consent for a biomedical
intervention the doctor must:
1. Offer the patient adequate information
2. Give the patient a detailed information sheet to
read
3. Check that the patient is over 18 years of age
4. Have two witnesses present
Which one of the following is not recognized
as a level of society?
- The household
- The office
- The global village
- The nation state
- The community
Which one of the following is not recognized
as a level of society?
- The household
2. The office - The global village
- The nation state
- The community
Social norms are:
- Creative activities such as gardening, cookery and craftwork
- The symbolic representation of social groups in mass media
- Religious beliefs about how the world ought to be
- Rules and expectations about interaction that regulate social life
Social norms are:
- Creative activities such as gardening, cookery and craftwork
- The symbolic representation of social groups in mass media
- Religious beliefs about how the world ought to be
4. Rules and expectations about interaction that regulate social life
What type of data is:
* Short, medium, tall
* Black, blue, yellow
* Alive, dead
* 10 pencils
* Heights
Ordinal (qualitative)
Categorical nominal (qualitative)
Binary nominal (qualitative)
Discrete (quantitative)
Continuous (quantitative)
What is the formula for standard deviation? [1]
Square root of an average of all the individual points’ (distances from the mean)2
What measures of location and spread are used in a data contained in normal distribution? [2]
Mean and standard deviation
What measures of location and spread are used in the presence of outliers in the data? [2]
Median and interquartile range [2]
What change in standard deviation flattens the curve and what makes it taller and thinner? [2]
Flat: Increased SD
Tall and thin: Decreased SD
How many standard deviations from the mean
(+ and -) is 90%, 95% and 99% of population contained? [3]
90%:1.64 SD
95%: 1.96 SD
99%: 2.58 SD
How is standard error calculated and when is it used? [2]
SE = Standard deviation / sq root (sample size)
It is used as a standard deviation of the distribution of all possible sample means (used when dealing with sampling from the population)
How is confidence interval calculated? What does 95% CI = 21.4 to 22.6 mean BMI? [2]
95% CI = sample mean =/- 1.96 x standard error
It means that we are 95% sure that in the population the mean BMI can be as low as 21.4 and as high as 22.6.
What happens to CI if the sample size is increased? [1]
The confidence interval gets narrower
Which variable in the linear regression equation indicates outcome and which is the predictor? [2]
Y – outcome
X – predictor
What test is used to establish p-value while comparing two means? [1]
Two sample t-test
What are different types of clinical trials? [3]
Uncontrolled – everyone gets treatment
Controlled – treated group (‘new treatment’) vs untreated group (placebo or ‘standard treatment’)
Randomized controlled – allocation to groups is determined by chance
What are the commonstes triad of multi-morbidity conditions? [3]
Cardiometabolic (HTN / diabetes)
Joint pain
Mental health
What are the benefits of randomized controlled trial? [1]
Avoids selection/allocation bias; make sure participants differ only by the treatment; ensures group receiving treatment is similar to control group
What are the types of randomized controlled trial? [4]
Parallel group: randomized indiv. Into one of the grps
Crossover: randomized treatment sequence – participants change the treatment half way through
Cluster randomized trials: randomized preexisting grps into one of the two treatments (schools, gp practices, villages)
Factorial: assess 2 interventions using the same number of patients as 1 intervention (25% gets both treatments, 25% A and placebo etc)
What are the types of blinding? [2]
Single blind: patients don’t know what treatment they’re getting
Double blind: both patients and observers (examining doctors) don’t know what treatment each patient is getting
What type of randomized controlled trail is used if the treatment is irreversible and which if it’s reversible? [2]
Irreversible: parallel group
Reversible: crossover
Name two disadvantages of crossover design? [2]
How can we compensate for one of them? [1]
Time consuming
Carry-over effects: washout period before second treatment
How long does it usually take for the drug to be developed (from preclinical to phase 4)?
12-18 years
What is the difference between intention-to-treat and on-treatment analyses? [2]
Which one is better and why? [2]
TT: compare all subjects in treatment group regardless of whether they complied and acc took the drug
OT: compare subjects who acc took the treatment
ITT is better as it is a better representation of what would happen in real life
When is relative risk statistically significant? [1]
When 95% CI for that relative risk excludes 1
What would be the relative risk if the treatment didn’t have any effect?
RR = 1
What is the type of diagram used in meta-analyses? [1]
Forest plot
What diagram is used to assess publication bias of meta-analyses?
Funnel plot
Give overview of a design of cohort studies? [3]
What is the main question of cohort studies? [1]
Identify cohort
Measure exposure
Follow up over time to identify whether they have disease or not
Is the disease more common in exposed or unexposed?
What are the sources of bias in the cohort studies? [2]
Loss (of people) to follow-up
Measurement of exposure at only one point in time (it can change very rapidly); selection of cohort
What are the disadvantages of cohort studies? [3]
Time consuming
Lot of people required
V expensive
How is relative risk measured in cohort studies? [1]
Incident of disease in exposed population / incidence of disease in unexposed population
What curve is used in survival analyses? [1]
What information does it provide? [1]
Kaplan-Meier curve; shows the proportion of people surviving over time
What is a hazard ratio? [1]
Risk of dying at any time point in one group compared to the other
How can the absolute excess risk be calculated? [1]
Risk in exposed – risk in unexposed
How is attributable proportion calculated? [1]
P(RR-1) / 1+p(RR-1) ; p= proportion exposed in population
What is the design of case-control studies? [3]
Identify those with disease [cases]
Measure exposure (from the past)
Identify those without disease [controls] and measure exposure (from the past)
What is the main question of case-control studies? [1]
Is exposure more common in cases than in controls?
What is undermatching and overmatching in case control studies [2]
Undermatching when the cases and controls are not similar enough
Overmatching is when they are too similar and may not differ in exposure of interest (siblings and parental smoking)
What study design is useful for biomarkers studies where biomarkers are v expensive to measure? [1]
Nested case-control studies
What is the design of a nested case-control study design? [4]
Identify cohort and take & store blood sample
Follow up over time and detect if have disease.
All people with disease are cases and those without disease are selected for controls.
Measure exposure in cases and controls from the biomarkers.
What does odds ratio represent in rare disease? How do you calculate it? [1]
Relative risk; odds exposure in cases/odds exposure in control
How do you calculate absolute excess risk? [1]
(Odds ratio x risk of disease) – risk of disease
What does cross-sectional study measure? [1]
Measure existing disease and current exposure
What exposure is useful when conducting the cross-sectional study? [1]
The exposure that doesn’t change (gender)
Which study design has the biggest risk of bias? [1]
Cross-sectional surveys [1]
What study design has the strongest proof of causality? [1]
Clinical trials
What study design has the bigger risk of confounding: cohort or case-control? [1]
Case-control studies
What study design would you use for rare disease? [1]
What study design would you use for rare exposure? [1]
Rare disease: case-control study
Rare exposure: cohort study
What is extreme poverty? [1]
Living on less than $1.25/ day
How many people in the UK live with chronic illness? [1]
15 million
What proportion of medical emergencies are exacerbation of chronic illness? [1]
2/3
State the definition of incidence [1] and prevalence [1]
Incidence: Number of new cases of the disease occurring within a period of time
Prevalence: Number of cases of the disease that are present in a particular population during a period of time/particular date
What is the main cause of disability in the UK? [1]
Arthritis
What is control theory used for? [1]
Management of chronic illness – focused on quality of life, setting goals, monitoring progress and identification of barriers
What is the difference between impairment and disability? [2]
Impairment indicates loss or difference of physiological function
Disability applies to loss or limitation of opportunities to take part in the society because of that impairment
What is trauma informed approach?
Organizational structure and treatment framework that involves understanding, recognising and responding to the effects of all types of trauma with the intention of preventing a re-traumatisation of the person occurring and potentially improving patient outcomes.
Describe health belief model [4]
Whether to take action or not is determined by health motivation:
- Do I value health
- Cues to action (what triggers to action are there)
- Threat perception (especially perceived susceptibility and severity of the problem)
- perceived benefits and barriers or costs of behavior.
What is Expert Patient Programme based on? [2]
Based on social cognition and social learning theory by Bandura:
- increase confidence by setting and achieving goals
- improve quality of life by helping patient feeling more in control of their condition – patients often experts of their condition
What is the most common presentation of a female affected by DVA?
Gynecological problems – most consistent, longest lasting, largest physical health difference; STIs, PV bleeding, painful intercourse, chronic pelvic pain and recurrent UTIs
What is Habitus? [1]
Non-conscious bulk of identity (embodied ID) and so conscious change may be challenging to achieve bc of habitus
Distinguish between identity consonance and identity dissonance [2]
Consonance – acquiring a new identity when it blends smoothly with other internalized personal identities
Dissonance – when one’s personal identities are dissonant with the professional role
What are the four rules of ethics? [4]
- AUTONOMY: allowing other to make decisions and to act acc to their own wishes
- NON-MALEFICENCE: above all do no harm
- BENEFICENCE – acting for the good of individuals and society
- JUSTICE – being fair
What is the Declaration of Helsinki?
Ethical principles for medical research involving human subjects – promotes and safeguard health, wellbeing and rights of research. It’s the duty of physicians who are involved in medical research to protect life, health, dignity, integrity, right to self-determination, privacy and confidentiality of personal info of research subjects
What are three models of stress? [3]
Which is the best? [1]
Stress as stimulus (engineering)
Stress as response as response (medicophysioloical)
Stress as transaction (psychological)
transaction between the person and the situation is best understood
What value is changing between the different colours in this Gaussain Distribution?
Standard error
Standard deviation
Mean
Median
Inter quartile range
STD
What value is changing between the different colours in this Gaussain Distribution?
Standard error
Standard deviation
Mean
Median
Inter quartile range
What does 95% STD actually mean? [1]
95% of all values are within 1.96 standard deviations of a mean value
What does 95% STD actually mean? [1]
95% of all values are within 1.96 standard deviations of a mean value
Which regression model would you use for the following?
Exponential growth
Exponential decay
Sigmoid
Polynomial – quadratic
Exponential growth
Which regression model would you use for the following?
Exponential growth
Exponential decay
Sigmoid
Polynomial – quadratic
Polynomial – quadratic
What are the main stages in the Leventhal’s self-regulatory model of illness behavior? [1]
Stage 1 – interpretation;
Stage x – emotional response and representation of health threat;
Stage 2 – coping;
Stage 3 – appraisal
Label A-C
A: parralel
B: cross over
C: factorial
Place the following in order of most to least likely to have bias
Case-control
Cohort
Clinical trial
Cross-sectional survey
Place the following in order of most to least likely to have a risk of confounding factors
Case-control
Cohort
Clinical trial
Cross-sectional survey
What do A & B represent on this forest plot? [2]
A: Result of study
B: 95% CI of result
What does the diamond represent on the forest plot? [1]
The diamond represents the point estimate and confidence intervals when you combine and average all the individual studies together.
Describe the differences in horizontal and box size in forest plots in samll versus big studies [2]
The bigger the study, the smaller the horizontal line and bigger the black box representing the point estimate.
The smaller the study, the wider the horizontal line and smaller the black box representing the point estimate.
Forest plots
Compare study A & B [2]
For study A- it has quite a wide horizontal line that crosses the line of null effect with a black box that is to the right of the vertical line. This most likely demonstrates a small scale study with few participants where the point estimate result favours the control used in the study. But because the study contains the null value in its 95% confidence interval, it is likely to have a p value >0.05 and not be statistically significant.
For study B- it has quite a narrow line that does not cross the line of null effect with a black box that is to the left of the vertical line and is bigger than study A. This most likely demonstrates a larger study with more participants compared to study A, where the result favours the intervention used. Because the 95% confidence interval does not contain the null value, this study is likely to have a p value <0.05 and hence the differences observed in the study can be regarded as statistically significant.
The forest plot shows the results of randomised trials of aspirin versus placebo in the prevention of preeclampsia.
Which was the biggest trial?
Ebrashy: has the biggest box
.Measures of inequality are important to track patterns and trends in ill-health in order to prioritise service provision.
Please show your understanding of these issues by labelling the following graph.
Use the following labels:
Healthy life expectnacy, multi morbidities percentile, race, gender, healthcare access, neighbourhood deprivation percentiges
Complete the labelling of sources of behaviour in Michie’s Behaviour Change wheel that are missing in the green area
Use the following: motivation, opportuinity, capability
Describe the probability of surviving 11months in group A v B [2]
For example, if you are in Group 1, your probability of surviving 11 months is 100%; conversely, if you are in Group 2, your probability of surviving the same time is slightly more than 66.7%. It is obvious that the steepness of the curve is determined by the survival durations (length of horizontal lines).
Label A&C of this funnel plot [2]
A: 95% CI
B: Study precision
C: Overall effect
D: Study result
Describe the results of this funnel plot [1]
Asymmetrical: indicates bias
What study types is this graph often used in?
A. Cohort study
B. Case control study
C. Clinical trial
D. Cross-sectional survey
A. Cohort study
B. Case control study
C. Clinical trial
D. Cross-sectional survey
Kaplan-Meier curves
Plot proportion of people surviving over time
Compared using a log rank test
Used in cohort studies and randomized trials.
This trial demonstrates a
case-control study
cohort study
factorial study
cross sectional study
case-control study
This trial demonstrates a
case-control study
cohort study
factorial study
cross sectional study
cohort study
This schematic represents which of the following
Transtheoretical Model (Stages of Change)
Theory of Planned Behaviour
Health Belief Model
Social Cognitive Theory
Health Belief Model
This schematic represents which of the following
Transtheoretical Model (Stages of Change)
Theory of Planned Behaviour
Health Belief Model
Social Cognitive Theory
Theory of Planned Behaviour
