Public health

Question 1

What are the three domains of public health?

Answer 1

Health protection, health improvement, improving services

Question 2

What is the inverse care law?

Answer 2

the availability of medical or social care tends to vary inversely with the need of the population served

Question 3

What is equity?

Answer 3

equity - to do with what is fair and just. equal treatment for equal need, unequal treatment for unequal need

Question 4

What is a health needs assessment?

Answer 4

A systematic approach for reviewing the health issues affecting a population which leads to agreed priorities and resource allocation that will improve health and disease inequalities

Question 5

What are the three areas/types of health needs assessment?

Answer 5

Epidemiological
comparative
corporate

Question 6

What are the four types of need?

Answer 6

FENC
Felt need
Expressed need
Normative need
Comparative need

Question 7

What is the felt need?

Answer 7

Individual perceptions of deviations from normal health

Question 8

What is expressed need?

Answer 8

seeking help to overcome variation in normal health

Question 9

What is normative need?

Answer 9

Professional defines intervention for expressed need

Question 10

What is comparative need?

Answer 10

Comparison between severity, range of interventions and cost

Question 11

What are the five areas in maslow’s hierachy of needs? (bottom to top)

Answer 11

Physiological - food, water, sex, sleep, breathing
Safety - security of body, home, resources, employment
Love/belonging - friendship, sexual intimacy
Esteem - confidence, achievement
Self-actualisation - morality, creativity, problem solving

Question 12

What is the egalitarian approach to resource allocation?

Answer 12

Provide all care that is necessary and required to everyone (+ equal for everyone, - economically restricted)

Question 13

What is the maximising approach to resource allocation?

Answer 13

Based solely on consequence (+ resources allocated to those most likely to benefit, - those with less need receive nothing)

Question 14

What is the libertarian approach to resource allocation?

Answer 14

Each individual is responsible for own health (+ onus on patient, so more likely to engage, - not all illnesses are self-inflicted)

Question 15

What are maxwell’s 6 dimensions to assessing the quality of a service?

Answer 15

Access, equity, appropriate - relevant to need, acceptability, efficient, effective

Question 16

What is health behaviour?

Answer 16

behaviour aimed to preventing disease (e.g. going for a run)

Question 17

What is illness behaviour?

Answer 17

behaviour aimed at seeking remedy (e.g. going to a GP for a symptom)

Question 18

What is sick role behaviour?

Answer 18

Activity aimed at getting well (e.g. taking antibiotics)

Question 19

What is the transtheoretical model of behaviour change?

Answer 19

(PC PAM) Precontemplation - contemplation - preparation - action - maintenance
(- some individuals skip stages, change may be continues not in discrete stages)

Question 20

What is the theory of planned behaviours model of behaviour change?

Answer 20

ASP
Attitudes, subjective norms, perceived behaviour control
All goes into intention, which then leads to behaviour
(P PAIR - preparatory actions, perceived control, anticipated regret, implementation intentions, relevance to self)

Question 21

What are the advantages and disadvantages of the theory of planned behaviours model?

Answer 21

+ applied to lots of health behaviours
+ takes into account social pressures
- no temporal element
- doesn’t consider emotions

Question 22

What is the health belief model of behaviour change?

Answer 22

• Takes into account demographics, personality and peer groups
• perceived susceptibility
• perceived severity
• health motivation
• perceived benefits
• perceived barriers
  Uses these to assess likelihood of action as well as uses cues to action

Question 23

What are the questions that you ask in medical negligence?

Answer 23

Was there duty of care?
Was there a breach in that duty?
Was the patient harmed?
Was the harm due to a breach in care?
Bolam rule: would a reasonable doctor do the same
Bolitho rule: would that be reasonable?

Question 24

What types of error can occur?

Answer 24

Sloth (inadequate documentation), fixation (fixing on one diagnosis, loss of perspective), communication breakdown, poor teamworking, playing the odds (choosing the common dismissing the rare), bravado/timidity, ignorance, mitriage, lack of skill, system error

Question 25

What is the three bucket model of error?

Answer 25

A model that shows that error is due to a combination of personal, environmental and physical factors

Question 26

What is a never event?

Answer 26

A serious, largely preventable patient safety incident that should not occur if available, preventative measures have been implemented

Question 27

What are the criteria for screening to take place?

Answer 27

Disease: important, natural history known, early treatment better than late
Test: acceptable to the public, facilities available, simple, safe, precise
Outcomes: ongoing feasibility, treatment available, cost-benefit analysis

Question 28

What is a false positive test?

Answer 28

When the test is positive but they do not have the disease

Question 29

What is a false negative?

Answer 29

When the test is negative but they do have the disease

Question 30

What are the most accepted studies and data (top to bottom)?

Answer 30

meta-analysis, RCT, cohort, case-control, cross-sectional, case series, case report

Question 31

What is a cross sectional study?

Answer 31

A snapshot of data of those with and without a disease to find associations at a single point in time

Question 32

What are the advantages of disadvantages of a cross-sectional study?

Answer 32

Quick and cheap, few ethical issues
Prone to bias, no time reference

Question 33

What is a retrospective/case control study?

Answer 33

An observational study which looks at a certain exposure and compares similar participants with and without the disease

Question 34

What are the advantages and disadvantages of a retrospective/case control study?

Answer 34

Good for rare diseases
Inexpensive

Can only show association not causation
unreliable due to recall bias

Question 35

What is a cohort study?

Answer 35

A longitudinal prospective study which takes a population of people recording their exposures and conditions they develop

Question 36

What are the advantages and disadvantages of a cohort study?

Answer 36

Can show causation
Less chance of bias

Large amount lost to follow up
expensive

Question 37

What are the advantages and disadvantages of an RCT?

Answer 37

Can infer causality
less risk of bias/confounders

time consuming and expensive
ethical issues can interfere

Question 38

What are confounders?

Answer 38

Risk factors other than those being studies that influence the outcome

Question 39

What is bias?

Answer 39

A systematic error that results in a deviation from the true effect of an exposure on an outcome

Question 40

What are the three main types of bias in science?

Answer 40

selection bias, information bias, publication bias

Question 41

How do you work out sensitivity?

Answer 41

true +VE / true +ve + false negative

Question 42

How do you work out specificity?

Answer 42

true -ve / true -ve + false +ve