PH stuff you forget

Question 1

What is relative risk and attributable risk?

(hint, subtract has an A in it; and R/R)

Answer 1

Relative risk = incidence in exposed / incidence in unexposed
Attributable risk = incidence in exposed - incidence in unexposed

These 2 things can then be compared if one group have a placebo and one a drug. Relative risk of 2.27 means 127% increased risk of disease.

Absolute risk reduction is the same as absolute risk as long as the intervention reduces risk. NB it is still expressed as incidence (/no. of people or person years). For instance if 100 people treated and CVA prevented in 2.5 of them, ARR is 2.5/100.

Question 2

What is NNT?

Answer 2

NNT = 1/absolute risk reduction

Hint NNT is ARR

If drug caused cumulative incidence to go from 10/1000 to 6/1000, absolute risk reduction is 4/1000. Relative risk reduction is 40%, relative risk is 0.6.

Question 3

What is FeverPAIN score and what is output?

Answer 3

Screening tool to identify which people with sore throat have bacterial cause and likely to benefit from abx.

Fever (during past 24hrs)
Purulence (pus on tonsils)
Attend rapidly (within 3 days after onset of symptoms)
Inflamed tonsils
No cough or coryza

0 or 1 - No abx.
2 or 3 - consider delayed abx prescription
4 or 5 - consider immediate abx prescription (or back up)

Abx = 5-10 days phenoxymethylpenicillin qds. Clarithromycin if penicillin allergy.

Question 4

What is equity/equality?
What is horizontal and vertical equity

Answer 4

Equity - what is fair and just
Equality - equal shares

Horizontal equity is like equality, equal Tx for equal need
Vertical equity is unequal Tx for unequal need (cold vs pneumonia).

Question 5

3 domains of public health practice

Answer 5

Health improvement - societal interventions, aimed to preventing disease and promoting health and reducing inequalities.
Health protection - control infectious diseases/environmental hazards
Health care - organisation and delivery of safe services.

Question 6

3 levels of public health interventions and an example

Answer 6

Individual level - e.g. childhood immunisation
Community level - e.g. playground for local community
Ecological level - e.g. clean air act (bans public smoking)

Question 7

Describe health, illness and sick role behaviour

Answer 7

Health behaviour - prevent disease
Illness behaviour - seek remedy
Sick role - any activity aimed at getting well.

Question 8

Why do we do health damaging behaviour?

Answer 8

Unrealistic optimism
1. Lack of personal experience with problem
2. Belief that preventable by personal action
3. Belief that if not happened by now, it’s not likely to
4. Belief that problem infrequent

Other reasons - health beliefs, situational rationality, culture variability, socioeconomic factors, stress, age

Question 9

Difference between incidence and prevalence?

Answer 9

Incidence (AKA cumulative incidence, risk, incidence proprotion) - new cases per unit time, denominator = no. of disease free people at start of the study

Prevalence - existing cases, denominator is no. of people in population. No units.

Question 10

What is person-time and what it is used to calculate?

Answer 10

Person time is total time from entry to study to:
- disease onset
- loss to follow-up
- end of study

Is used to calculate incidence rate (person time is denominator)

Question 11

What is the difference between incidence rate and cumulative incidence (risk)

Answer 11

Cumulative incidence (risk) = No. of new cases in time period / no. of disease free people at start of time period

Incidence rate = no. of new cases in time period / total person time at risk during that time period.

Incidence rate is useful when participants are followed up for varying lengths of time.

Question 12

What are the 2 broad groups of bias?

Answer 12

Selection bias (sampling or randomisation)

Information bias

Question 13

If a relationship is not causal, name 4 things which could explain the trend?

Answer 13

Bias, chance, confounding, reverse causation

Question 14

What is prevention paradox?

Answer 14

Population approaches make little difference to the individual.

It is why we sometimes use the high risk approach rather than the population approach to prevention.

Question 15

Describe 4 reasons a person will change behaviour as part of health belief model

Answer 15

Believe they are susceptible to the condition in question (e.g. heart disease)
Believe that it has serious consequences
Believe that taking action reduces susceptibility
Believe that the benefits of taking action outweigh the costs

Cues to action (internal - MI, getting older; external - family death, what Dr tells you) and health motivation also involved.

Question 16

HBM critique

Answer 16

Alternative factors, e.g. outcome expectancy and self-efficacy
Doesnt consider emotions
Doesnt differentiate first time/repeat behaviour

Question 17

Describe theory of planned behaviour model

Answer 17

Best predictor of behaviour change is intention, which is based on:
- attitude (to behaviour)
- Subjective norm
- Perceived behavioural control

Question 18

Theory of planned behaviour critique

Answer 18

Intentions dont always lead to change
Lacks temporal element
Emotions not included

Question 19

Transtheoretical model critique

Answer 19

Not all move through every stage
Might be a continuum rather than discrete stages
Doesnt take into account emotions, culture

Question 20

What are 5 typical transition points to target behaviour change?

Answer 20

Leaving school
Entering the workforce
Becoming a parent
Becoming unemployed
Retirement and bereavement

Question 21

4 stages of needs assessment and planning

Answer 21

Needs assessment
Planning
Implementation
Evaluation

Question 22

What is need, demand, and supply

Answer 22

Need - ability to benefit from an intervention
Demand - what people ask for
Supply - what is provided

Question 23

What is health needs assessment?

Answer 23

A systematic method for reviewing the health issues facing a population, leading to agreed priorities and resource allocation that will improve health and reduce inequalities

Can be carried out for population/sub-group, condition, or an intervention.

Question 24

What are 4 types of need?

Answer 24

Normative need (usually used) - professional defines intervention appropriate for the expressed need.
Felt need - individual perceptions
Expressed need - individual seeks help to overcome variation in normal health (demand)
Comparative need - comparison between severity, range of interventions and cost.

Question 25

What are 3 types of health needs assessment?

Answer 25

Epidemiological - is it (cost) effective. Data may not be available/homogenous
Comparative - just compare (spatial / social)
Corporate - get views of stakeholders.

Question 26

What is polypharmacy generally?

Answer 26

5+ medications

Question 27

What is domestic abuse and the 5 types?

Answer 27

Any incident or pattern of incidents of controlling, coercive, threatening behaviour, violence or abuse between those aged 16 or over who are, or have been, intimate partners or family members regardless of gender or sexuality. The abuse can encompass, but is not limited to:
- psychological
- physical
- sexual
- financial
- emotional

Question 28

What are some indicators of domestic abuse?

Answer 28

Unwitnessed by anyone else - best indicator
Night presentation
Multiple presentation to A&E (not GP)

Question 29

What are the risk levels of DA?

Answer 29

STANDARD – current evidence does NOT indicate likelihood of causing serious harm.

MEDIUM – there are identifiable indicators of risk of serious harm. Offender has potential to cause serious harm but unlikely unless change in circumstances.

HIGH – there are identifiable indicators of imminent risk of serious harm. Dynamic – could happen at any time and impact would be serious.

Question 30

What is standard framework for health service evaluation?

Answer 30

Structure - what is there (buildings, staff, equipment)
Process (+output) - what is done (no. of pts seen, no. of operations performed)
Outcome - e.g. mortality rate, morbidity, QOL, patient satisfaction

Question 31

What are Maxwell’s 6 dimensions of quality?

Answer 31

Effectiveness - does it do it
Efficiency - is output maximised
Equity - are pts being treated fairly
Acceptability
Accessibility - is it provided? Geographical access
Appropriateness - is right tx being given to right people at right time?

Question 32

what are 5 Maslow’s Hierarchy of need?

Answer 32

(wide base) Physiological - food, water, sleep, excretion
Safety - security of body, employment, family, health
Love/belonging - friendship, family, sexual
Esteem - confidence, achievement
(pointy top) - creativity, spontaneity

Question 33

What is sensitivity and how do you calculate it?

Answer 33

True positive / (true positive / false negative)

A / A+C

The proportion of people with disease who are correctly identified by the screening test

Question 34

What is specificity and how do you calculate it?

Answer 34

True negative / (true negative + false positive)

D / B + D

The proportion of people without the disease that are correctly excluded by the screening test

Question 35

What is the PPV and how is it calculated?

Answer 35

True positive / (true positive + false positive)

A / A + B

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

Question 36

What is NPV and how is it calculated?

Answer 36

True negative / (true negative + false negative)

D / C + D

The proportion of people with a negative test result who do not have the disease

This is lower if the prevalence is higher

Question 37

What is lead time bias and length time bias?

Answer 37

When screening identifies an outcome earlier than it would otherwise have been identified
This results in an apparent increase in survival time, even if screening has no effect on outcome

Differs from length time bias - where disease with longer prognosis are more likely to be picked up by screening.

Question 38

Define negligence

Answer 38

Failure to take proper care over something

A breach of duty of care which results in damage

Question 39

What do you do if standard, medium, high risk for DA?

Answer 39

Standard/medium - it’s their choice. Give them contact details for services

High risk - refer to MARAC/IDVAS wherever possible with consent. In high risk you can break confidentiality.