public Health

Question 1

How do you describe screening?

Answer 1

Like a sieve. Trying to find people at higher risk of a disease

Question 2

How many screening programmes in NHS?

Answer 2

11

Question 3

What nhs screening programmes are offered to female population uk?

Answer 3

1.Breast (50-71 3 yearly)
2.bowel (FIT test age 60-74 2 yearly, reducing to age 50 in future)
3.cervical (25-49 3 yr, 50-64 5yr)

Question 4

What screening programmes are offered to male population uk?

Answer 4

1.AAA
2. Bowel

Question 5

Who decides what screening is implemented in NHS?

Answer 5

Uk screening Committee make recommendations to each of 4 nations govt ministers who tell nhs what to implement-accounts for differences between nations

Question 6

What do uk NSC use for evidence re screening benefit?

Answer 6

RCT ideally that compare outcomes in those undergoing screening with similar group usual care. Looks at full consequences of screening programme.

Question 7

What is role of DHSC in England screening board?

Answer 7

National strategic oversight
Policy
Finances
Holding PHE/nhse to account

Question 8

What is role of PHE in England screening board?

Answer 8

-Advise govt and NHS to ensure screening reflect best evidence and UK NSC advice
-pilot new programmes and demonstrate value

Question 9

What is role of NHSE in England screening board?

Answer 9

Commission and deliver national programmes

Question 10

Which ph services are delegated via govt to NHSE?

Answer 10

‘Section 7a services’

Immunisations
Screening
Child health information
Ph services for people in secure/detained settings
Sarcs

Question 11

Pregnancy screening

Answer 11

10/40-disorders that affect bloods ability to carry oxygen
Sickle cell
Thalasemmia

8-12/40-infections
HIV
Hep B
Syphilis

10-14/40 Combined test-USS and bloods for down/edwards/patau

Quadruple test bloods up to 20/40 if can’t do combined-downs only

18-20+6/40 anomaly (11 conditions)

If diabetes-eye screening

Question 12

Explain to pt why we screen for HIV in pregnancy?

Answer 12

HIV weakens immune system making it difficult to fight infections
If untreated can be passed to baby in pregnancy/birth/BF
Treatment reduces chance of passing on from 1:4 to <3:1000
need early specialist appointments to plan care

Question 13

Explain why screen for syphillis?

Answer 13

can be passed to baby in pregnancy
if untreated can cause serious health problems, miscarriage or still birth

Question 14

explain why screen for Hep B?

Answer 14

-pass from mother to baby
-affects liver and can cause chronic or acute ill health
-if infected and untreated 90% chance of lifelong infection affecting liver including cancer
-treated 10 % chance

Question 15

explain why test for scd and thalassaemia?

Answer 15

-major serious inherited diseases affecting haemoglobin, part of blood that carries oxygen
-passed on by unusual genes
genes are code for body eg eye colour
-work in pairs, need 2 unusual to have scd or thal
-if mum tests positive ideally test father
-if father not available/two genes present offer diagnostic test

Question 16

what are risks of diagnostic tests after pregnancy screening? when are they offered?

Answer 16

CVS and amnio- 1:200 will miscarry as a result of test

CVS 11-14 weeks
Amnio-15+weeks

will confirm diagnosis of
SCD
Thalassemia
Down T21
Patau T13
Edwards T18

Question 17

What is NIPT?

Answer 17

Non- invasive prenatal testing
measures fetal dan in blood
A screening test (better than combined so offered if combined positive)
Detects if extra dna from chromosomes 13/18/21
If result indicates lower chance result diagnostic test not indicated.

Question 18

Why do we offer cervical screening?

Answer 18

reduced deaths from cervical cancer saving 000’s of lives.
If everyone attended 83% deaths could be prevented

Question 19

Who do we invite for cervical cancer screening?

Answer 19

From age 25, 3 yearly until 49.
From age 49 5 yearly until 64

regardless of HPV vacinne/sexual history

transmale not invited-gp to arrange

Question 20

How does cervical screening work?

Answer 20

with a 1 min test, we look for high risk HPV and abnormal cervical cells that could lead to cervical cancer

if find HPV check for abnormal cells can remove before cancer develops

Question 21

What are risks of cervical screening?

Answer 21

main risks are from removing abnormal cells at colp-
1.Infection
2.bleeding
3.may affect future pregnancy if more extensive tissue removed

Question 22

What are 4 possible results of cervical screening?

Answer 22

1. No HR HPV-return to routine screening
   2.HR HPV no abnormal cells-recheck in 1 year for clearance/advise stop smoking
   3.HR HPV abnormal cells-refer to colp
   4.Inadequate sample-repeat in 3/12

Question 23

What affects chances of cervical cancer?

Answer 23

-Persistence of high risk HPV
-Smoking
-HPV vaccination covers most but not all HR
-Condom use reduces infection
-FH does not affect risk.
SCREENING!