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Phase 3A > Public Health > Flashcards

Public Health Flashcards

1
Q

How many grams of alcohol are there in 1 unit?

A

8g

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2
Q

How to calculate no. of units of alcohol?

A

[Strength(%) x volume]/1000

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3
Q

recommended no. of units for men and women?

A

14 units

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4
Q

recommended no. of units for pregnant women?

A

Pregnant women = abstain for first trimester THEN no more than 2 units per week (↑ risk of miscarriage/SGA)

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5
Q

Alcohol Dependence Syndrome (ICD-1): Cluster of 3 of these symptoms in a 12 month period

A
  1. Tolerance-increasing amount of alcohol to achieve the same effect
  2. Characteristic physiological withdrawal
  3. Difficulty controlling onset, amount and termination of use
  4. Neglect of social and other areas of life
  5. Spending more time obtaining and using alcohol
  6. Continued use despite negative physical and psychological effects
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6
Q

Foetal alcohol syndrome presentation

A

Small Underweight babies, Hypotonia
Mental retardation, behavioural and speech problems.
Characteristic facial appearance:
Microcephaly
Epicanthic folds and Short palpable fissures (eyes)
Upturned nose, Smooth philtrum, Thin upper lip
Hypoplastic jaw
Cardiac, renal and ocular abnormalities

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7
Q

Drugs used in relapse prevention for alcohol dependence + MoA

A

Disulfiram (ANTABUSE) to sensitise against alcohol (Alcohol Dehydrogenase Inhibitor)
Acamprosate, GABA blocker

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8
Q

Should bloods be used in screebing for alcohol dependence/abuse?

A

NICE explicitly says no

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9
Q

Most common alcohol dependence screening questionnaires

A

AUDIT: 13 for women and 15 for men indicate alcohol dependence
CAGE: cut down? angry/annoyed? guilty? eye-opener?

PAT, FAST are also used but less frequently

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10
Q

Who should be notified if a notifiable disease is suspected?

A

proper officer of the local authority (usually Consultant in Communicable Disease Control of PHE)

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11
Q

What is notification based on?

A

clinical suspicion (no need to wait for laboratory confirmation)

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12
Q

Do infections and STIs need to be notified?

A

only Hep B!

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13
Q

Urgent (CALL) notifiable diseases

A
  • Acute Bacterial Meningitis
  • Meningococcal septicaemia
  • Acute Infectious Hepatitis
  • Enteric fever (typhoid / paratypoid)
  • Clusters / outbreaks of food poisoning
  • Infectious bloody diarrhoea
  • Haemolytic Uraemic Syndrome (HUS)
  • Invasive Group A Strep disease
  • Legionnaires disease
  • Measles
  • Tuberculosis – only if healthcare worker, suspected cluster or multi-drug resistance
  • Whooping cough – if diagnosed during acute phase
  • Viral Haemorrhagic fever (VHF)
  • Others: Acute poliomyelitis, Anthrax, Botulism, Cholera, Diphtheria, Plague, Rabies, SARS, Smallpox, Tetanus (if asso with injecting drug use)
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14
Q

urgent if UK acquired notifiable diseases

A

brucellosis, yellow fever, plague

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15
Q

nom-urgent notifiable diseases

A

Acute encephalitis
Leprosy
Mumps
Rebulla
Thyphus
Scarlet fever

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16
Q

Which of the following is not a communicable disease of public health importance:
A. Influenza
B. Urinary Tract Escherichia coli Infection
C. Middle Eastern Respiratory Syndrome Corona virus Infection
D. Rabies
E. Rubella

A

Urinary Tract Escherichia coli Infection

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17
Q

what percentage of inuries that send women to the A&E are due to physical abuse from partners?

A

20-30%

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18
Q

what is the best indicator that an injury in A&E due to abuse?

A

Best indicator is ‘reported as unwitnessed by anyone else’.
Others: repeat attendance, delay in seeking help, multiple minor injuries not requiring treatment

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19
Q

what tool is used to assess risk of domestic abuse?

A

DASH tool

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20
Q

what is the framework for health service evaluation?

A
  1. structure: what is there?
  2. process: what is done? + output
  3. outcome
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21
Q

What are the heath outcomes?

A

1) Mortality e.g. 30 day mortality rate
2) Morbidity e.g. complication rates
3) Quality of life / PROMs (pt-reported outcome measures)
4) Patient satisfaction

OR death, disease, disability, discomfort, dissatisfaction

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22
Q

What are Maxwell’s 6 Dimensions of Quality (3Es and 3As)

A

Effectiveness - Does the intervention / service produce the desired effect?
Efficiency - Is the output maximised for a given input (or is input minimised for a given level of output)?
Equity (horizontal & vertical) - Are patients being treated fairly?

Acceptability - How acceptable is the service offered to the people needing it?
Accessibility - Is the service provided? Geographical access; Costs for patients; Information available; Waiting times
Appropriateness – Is right Rx being given to right people at right time? [Overuse? Underuse? Misuse?]

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23
Q

How to calculate pack years?

A

(no. of cigarettes smoked per day/20) x no. of years

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24
Q

Individual factors that are determinants of health (constitutional and lifestyle factors)

A

Constitutional – Age, Gender, Ethnicity, Genetics, Cultural Belief
Lifestyle Factors – Smoking, Diet, Exercise, Alcohol, Substance Misuse

25
Q

socio-economic factors that are determinants of health

A

Socio-economic Factors – Occupation, Housing, Water & Sanitation, Education, Healthcare Services

26
Q

what are primary, secondary and tertiary preventions? + examples of each

A

Primary Prevention – Prevention of disease from establishing in the 1st place (eg. Vaccinations)

Secondary Prevention – Detecting disease at an early stage in order to intervene to alter its course and improve prognosis (eg. Breast Cancer Screening)

Tertiary Prevention – Preventing complications in pre-existing disease (eg. Pulmonary Rehabilitation)

27
Q

what are the 3 domains of the public health practice?

A

health improvement
health protection
improving (healthcare) services

28
Q

What is health needs assessment + what can it be carried out for?

A

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 (NICE 2005).

May be carried out for:
A population or sub-group e.g. Manor practice population
A condition e.g. COPD
An intervention e.g. coronary angioplasty

29
Q

definition of a refugee

A

A person granted asylum & refugee status. Usually means leave to remain for 5 years then reapply

30
Q

definition of a refugee

A

A person granted asylum & refugee status. Usually means leave to remain for 5 years then reapply

31
Q

what does refugee status entitle someone to?

A

Refugee Status – Indefinite leave to remain (ILR): when a person is granted full refugee status and given permanent residence in the UK.
They have all the rights of a UK citizen.
They are eligible for family reunion- one spouse, and any child of that marriage under the age of 18

32
Q

what are asylum seekers (people who have made an application for refugee status) entitled to?

A

Not allowed to work (& not entitle to any other form of benefit) BUT Entitled to:
Money - currently £35 pounds per week
Housing - no choice dispersal
NHS care
If under 18, have the services of a social services key worker and can go to school

33
Q

Maslow’s hierarchy of needs

A
  1. physiological: breathing, food, water, sex, excretion
  2. safety: of body, employment
  3. love and belonging
  4. esteem
  5. self-actualization
34
Q

Resources to help the homeless population

A

HASS, Traveller’s tean, Shelter, charities

35
Q

Common eye conditions in the UK

A
  1. Cataracts (lense becomes less transparent)
  2. AMD: wet and dry
  3. Glaucoma (optic nerve damage)
  4. Retinitis pigmentosa
  5. Hemianopia
  6. diabetic retinopathy
36
Q

helping a visually-impaired person

A

Try to identify whether a person is visually impaired.
Are they blind or partially sighted?
Do they need assistance with guiding?
Be aware this could be an unfamiliar environment for the VIP
Tell them if you are going to examine them.
Explain about medication, other tests etc
Make sure they understand.
Inform VIP of what will happen next, ie referral to hospital or other agency.
Alternative formats for information.

37
Q

5 Domains of Social Exclusion of Older Adults:

A

Material Resources,
Basic Services
Civic Activities
Neighbourhood
Social Relationships

38
Q

What is epidemiology?

A

The study of the frequency, distribution

and determinants of diseases and health-
related states in populations in order to

prevent and control disease

39
Q

incidence vs prevalance - what is the difference?

A

incidence: new cases
prevalance: existing cases in a point in time

40
Q

how to calculate incidence rate?

A

no. of people who have become cases in a given period of time/total person-time at risk during that period

41
Q

absolute risk vs. relative risk

A

absolute risk: has units, gives a feel for actual numbers involved (50 deaths/1000 population)

relative risk: risk in one category relative to another, does not have units

42
Q

attributable risk vs. relative risk

A

Attributable risk: The rate of disease in the
exposed that may be attributed to the exposure
– i.e. incidence in exposed minus incidence in unexposed.
– Attributable risk is a type of absolute risk (absolute excess
risk).

Relative risk: Ratio of risk of disease in the exposed
to the risk in the unexposed
– i.e. incidence in

43
Q

Incidence of Disease A in smokers, 1/1000 person-years
Incidence of Disease A in non-smokers, 0.05/1000 person-years

use this information to calculate attributable and relative risk.

A

Attributable risk = 0.95/1000 person-years (i.e. difference)
Relative risk = 20 (i.e. ratio, no units)

44
Q

Cumulative incidence of Disease X in people given a new treatment
is 6/1000
Cumulative incidence of Disease X in people on placebo is 10/1000

Absolute risk reduction =
Relative risk =
Number needed to treat =
Relative risk reduction =

A

Absolute risk reduction = 4/1000 (over 5 years)
i.e. 1000 people treated and four cases of disease avoided

Relative risk = 0.6
i.e. Incidence in treatment group / Incidence in placebo group

Number needed to treat (to avoid one case of Disease X) = 250

Relative risk reduction = 40% (or 0.4)
i.e. relative risk reduced by 0.4 (1-0.6)

45
Q

2 main types of bias

A

Selection bias
A systematic error in:
the selection of study participants
the allocation of participants to different study groups

  1. Information (measurement) bias
    A systematic error in the measurement or classification of:
    exposure
    outcome
    Sources of information bias
    observer (e.g. observer bias)
    participant (e.g. recall bias)
    instrument (e.g. wrongly calibrated instrument)
46
Q

what are non-causal reasons for association?

A

– Bias
– Chance
– Confounding
– Reverse causality

47
Q

Study design: what study does this describe
Investigators find a high level of correlation between levels of socioeconomic deprivation and cardiovascular mortality across electoral wards in the UK.

A

Ecological study (population based data rather than individual data)

48
Q

Researchers set out to examine the association between alcohol consumption and stroke. They identify all new patients admitted with stroke and compare their alcohol consumption with patients admitted for elective surgery.

A

Case-control study (retrospective observational study looking at population with disease and control population)

49
Q

General practitioners set up a study to estimate the prevalence of depression within their registered population. They decide to start with a random sample of adults aged 45-74 years. .

A

Cross-sectional study (retrospective observational study, collecting data from a population and a specific point in time)

50
Q

how to calculate odds ratio?

A

(odds of exposure in cases)/(odds of exposure in controls)

51
Q

What are the Bradford Hill criteria for causation

A

Temporality
Dose-response
Strength
Reversibility
Consistency
Biological plausibility

52
Q

A clinical trial for an influenza vaccine recruited participants from Sheffield Medical School. They found very promising results. Peer reviewers are concerned that this trial may not be representative of the target population for the vaccine.
What type of bias are the peer reviewers worried about?

A

A. Selection bias

53
Q

What are the stages in a health needs assessment cycle

A

needs assessment –> planning –> implementation –> evaluation

54
Q

What is pharmacodynamics?

A

Effect of the drug on the body

55
Q

What is pharmacokinetics?

A

Effect of the body on the drug

56
Q

What are case control studies?

A
  • usually retrospective
  • takes 2 groups of people (one with a disease, one without) and tries to keep the other factors (age, sex) as similar as possible
  • then retrospectively looks at their histories to see if any risks for the disease can be identified
57
Q

What are cohort studies?

A
  • In a cohort study, two (or more) groups that are exposed to different things are compared with each other
  • the cohorts are observed frequently over a number of years
58
Q

What are cross-sectional studies?

A
  • most commonly, surverys
  • good for things like prevalance
  • data is only accurate as a ‘snapshot’ in time
59
Q

What are RCTs?

A
  • usually compares ‘treatment’ with no treatment
  • provide the best results when trying to find out if there is a cause-and-effect relationship

Phase 3A (10 decks)

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