Phase 1 Public Health

Question 1

Inverse Care Law

Answer 1

those most in need of health care are least able to access it // those who need health care the least are most able to access it

• what barriers can you think of?

Question 2

Incidence

Answer 2

Number of new cases in a certain unit of time

Question 3

Prevalence

Answer 3

Number of existing cases at a certain point in time

Question 4

The sick role

Answer 4

being ill exempts you from social obligation

• not responsible for their condition
• should try and get well
• should seek help from medical professionals

Question 5

Changing Health Behaviours

Answer 5

perceived susceptibility, perceived barriers, benefits and self efficacy are all
influences on changing behaviours

Question 6

Stages of behaviour change

Answer 6

not thinking (pre contemplation) → thinking about changing
(contemplation) → preparing to change → action → maintenance → stable changed
lifestyle/relapse

Question 7

Sensitivity

Answer 7

The probability that a person with the disease tests positive (true positives/ total positives)

Question 8

Specificity

Answer 8

the probability that a person without the disease tests negative (True negative/ total negatives)

Question 9

Positive Predictive Value

Answer 9

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

Question 10

Negative Predictive Value

Answer 10

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

Question 11

Effect of prevalence on PPV

Answer 11

Increase in prevalence = increase in PPV, incidence of false positives falls

Question 12

Principles of Screening

Answer 12

1. The condition should be an important problem
2. There should be an acceptable treatment
3. Facilities for diagnosis and treatment should be available
4. There should be a recognised latent or early stage
5. The natural history of the disease should be known
6. There should be a suitable test
7. The test should be acceptable to the population
8. There should be an agreed policy on whom to treat as patients
9. The cost of case finding should be economically balanced in relation to the possible expenditure
   as a whole
10. Case findings should be a continuous process- not once and for all

Question 13

Types of prevention

Answer 13

Primary, Secondary, Tertiary

Question 14

What is primary Prevention

Answer 14

Stops an illness from happening in the first place

e.g. Change4life, vaccination progammes

Question 15

What is Secondary Prevention

Answer 15

detecting a disease early in its progress to reduce its impact- makes treatment more effective, limits impact of disease.

e.g. Breast cancer/ Bowel cancer screening

Also stops a disease getting worse

e.g. blood pressure monitoring/ blood thinners after MI to prevent another event.

Question 16

What is tertiary prevention

Answer 16

disease is established, symptomatic, reduces complications/ severity of disease.

e.g. physio/rehab after a stroke

Question 17

Prevention paradox

Answer 17

Large group of people with a small risk will result in more cases of disease than a small group at higher risk

Question 18

Unmodifiable risk factors

Answer 18

Age, Gender, Ethnicity, Family History, early life circumstances

Question 19

Modifiable risk factors

Answer 19

Diet, exercise, HNT, T2DM, Smoking status, alcohol

Question 20

Alcohol unit limits

Answer 20

14 units/ week

Question 21

what is a unit of alcohol?

Answer 21

(% alcohol by volume x amount of liquid in millimeters)/ 1000
1 unit = 10ml/g of ethanol

Question 22

Features of Foetal Alcohol Syndrome

Answer 22

Growth Retardation, CNS abnormalities, cranio-facial abnormalities, , congenital defects, increased risk of birth marks/ hernias.

Question 23

Features of Alcohol Withdrawal

Answer 23

Tremors, Activation Syndrome (high BP, tachycardia, agitation, shakes)

Question 24

CAGE questions

Answer 24

Cutting Down?
Annoyed by people telling you to cut down?
Guilty about how much you drink?
Eye-opener - have you ever had a drink first thing in the morning?

Question 25

what is compliance?

Answer 25

professionally focused- how well is a patient doing what you’ve told them to do?

Question 26

what is adherence

Answer 26

takes into account a patient’s beliefs. Dr is an expert giving their advice, but it accepts that patients make their own decisions.

Question 27

What is concordance?

Answer 27

Partnership between Dr and patient. Make decisions about health care together.

Question 28

Ethical Theories

Answer 28

Autonomy
Beneficence
Non-maleficence
Justice

Question 29

Autonomy

Answer 29

Patients are allowed to make their own decisions

Question 30

Beneficence

Answer 30

doing the right thing, benefits others

Question 31

Non-maleficence

Answer 31

preventing/reducing harm ‘Do no harm’

Question 32

Justice

Answer 32

being fair

Question 33

Utilitarianism

Answer 33

act is measured in its consequences. Kill one to save many.

Question 34

Deonotology

Answer 34

The act itself- what you do and how you do it is important

Question 35

Virtue Ethics

Answer 35

what you meant to do- i.e. trying to do the right thing is what is important.

Question 36

5 focal virtues

Answer 36

Compassion
Discernment
Trustworthiness
Integrity 
Conciensciousness

Question 37

Validity

Answer 37

How close to the truth - e.g. skewed by bias makes something less valid.

Question 38

Reliable

Answer 38

How consistent something is. E.g. A broken BP machine might give everyone the same reading - its reliable but not valid.