Public Health Flashcards
1
Q
Define epidemiology
A
The study of distribution and determinants of health-related states or events in specified populations, and application of this study to control health problems
2
Q
Define clinical epidemiology
A
Uses information about distribution and determinants in a clinical setting, especially in diagnosis
3
Q
What are DALYs on a graph
A
Disability adjusted life years
4
Q
Why do doctors seek consent to medical treatments
A
Legal
Ethical
5
Q
What must consent be
A
Voluntary
Informed
Made by someone with capacity
6
Q
What should informed consent be (5)
A
Honest discussion
Full details of intervention
Risks - significant risks
Benefits
Alternatives and their risk/benefits
7
Q
Define the mental health capacity act 2005
A
A person must be presumed to have capacity unless its established that he lacks capacity
An act done or a decision made, under this act for or on behalf of a person who lacks capacity must be done, or made in his best interests
8
Q
Name 4 causes of reduced capacity
A
Learning disability
Dementia
Mental illness
Impaired consciousness
9
Q
What happens if someone does not have capacity
A
Is there a lasting power of attorney or advance directive?
A healthcare professional can act in the patient’s best interest
Always involve the patient as much as possible in the decision
10
Q
Who can make a medical decision for someone else
A
No one can give consent on behalf of another adult - unless lasting of Attorney
Independent mental capacity advocate - be appointed if no family/friend to advise and support patient
Doctor in charge of case usually makes the decision
Judge/court of protection
11
Q
When would a judge/court of protection make a decision for someone else
A
If very serious or complex decision
Conflict between health care team and patient views/representatives
Examples
- sterilisation
- donation of organs or regenerative tissue e.g. bone marrow
- withdrawal of nutrition and hydration from a person who’s in a permeant vegetive state or minimally conscious state
12
Q
Describe DOL safeguards
A
Mental capacity act
Extra safeguard needed if the restrictions and restraint used will deprive a person of their liberty
Person has someone appointed with legal powers to represent them
13
Q
What are the domains of liberty
A
Movement
Eating and drinking
Washing and appearance
Living environment
Family and social life
Privacy
Healthcare
14
Q
What are the 5 points of making a best interest decision
A
- Whether the patient could have capacity and when that might occur
- The patient’s past and present wishes and feelings
- Patient’s beliefs and values that would be likely to influence any decision
- Other factors he might consider to decide
- Consultation about 2-4 with anyone named as needing to be consulted, carers, persons interested in his welfare, donees of a lasting power of attorney
15
Q
If in an emergency and someone is notable to give consent what happens
A
Give treatment - strong presumption that life sustaining treatment is best interest
16
Q
What is primary prevention of stroke
A
Smoking, alcohol, diet and physical activity
17
Q
What is secondary prevention of stroke
A
Screening for risk factors
Risk of hypertension is 75%
18
Q
What is tertiary prevention of a stroke
A
Stroke units, rehabilitation
19
Q
Define Gillick competence
A
As a matter of law the parental right to determine whether or not their minor child below the age of 16 will have medical treatment terminates if and when the child achieves sufficient understanding and intelligence to understand fully what is proposed
20
Q
How is dementia looked as as part of dementia
A
Awareness raising and opportunistic screening for memory loss
21
Q
Can under the age of 16 refuse treatment
A
Parents cannot refuse treatment
Young person can refuse if competent
Involve MDT - often helpful to take legal advice
22
Q
Define Race
A
Differentiates groups of people biologically on the basis of supposed differences in their genetic make-up
23
Q
Define ethnicity (ethnic minority)
A
Refers to ‘real collectives, with common and distinctive forms of thinking and behaviour, of language, custom, religion and so on: not just modes of oppression but modes of being.
24
Q
Define culture
A
Shared beliefs and values
25
Define racism
Conduct or words or practices which disadvantage or advantage people because of their colour, culture or ethnic origin
26
Describe smoking and Parkinson's
Current smokers have up to 60% lower risk of both symptomatic disease and death
27
Define stereotypes
Generalised assumptions about, or representations of a social group
28
Describe women from ethnic minority groups have:
Poorer access to maternal care
Clinicans are more likely to ignore the concerns of women from minority groups
Experience racial discrimination in society
Have lower health literacy
Experience structural racism in countries where public policies and institutional practices reinforce racial inequality
29
Define survival analysis
Model the time taken for an event to occur and one or more variables that may be associated with that amount of time
30
Why would you use survival analysis rather than linear or logistic regression
Time to event data tend to be skewed
Censoring
31
Survival analysis - define survival probability
Probability an individual survives from the time origin to a specified future time
32
Survival analysis - define hazard
Probability an individual under observation at a specified time has an event at that time
33
Survival analysis - describe the key terminology
Hazard relates to the incident event rate
Survival to the cumulative non-occurrence of the event
34
Describe the hazard ratio in survival analysis
Ratio of two hazards
HR = 1 = no difference in survival
HR < 1 lower event hazard/increased survival in numerator
HR > 1 higher event hazard/decreased survival in numerator
35
Define the precautionary principle
Approach to risk management that emphasis caution, pausing and review before leaping into new innovations that may prove disastrous e.g. vaping
36
Describe the cox proportional hazard model
Allows comparison hazards between groups - measure the effect size is hazard ratio
Allows prediction survival probabilities
'Semi-parametric' as no distribution is assumed for survival times
37
Describe the BODE Index PH model to predict the 4 year survival in COPD patients
Predictors include:
FEV1 precent predicted
6-minute walk test
mMRC dyspnea (SOB) scale
BMI
38
How are survival curves presented
Kaplan-Meier plots
39
Describe clostridium difficle prevention
Produce spores highly resistant to chemicals (spores)
Alcohol hand rubs will not destroy spores
Hand washing with soap and water!!!
40
Describe SIGHT as a prevention of c. diff
Suspect C diff as a cause of diarrhoea
Isolate the case
Gloves and aprons must be worn
Hand washing with soap and water
Test stool for toxin
41
What is the second leading cause of death among children under 5 globally
Diarrhoea
42
What is the WHO-UNICEF 2004 prevention package of diarrhoea
1. Rotavirus and measles vaccination
2. Promote early and exclusive breastfeeding + vitamin A supplementation
3. Promote hand washing with soap
4. Improved water supply quantity and quality, including treatment and safe storage of household water
5. Community-wide sanitation promotion
43
Describe the WHO-UNICEF 2004 Diarrhoea treatment package
1. Fluid replacement to prevent dehydration
2. Zinc treatment
44
Define primary prevention
Aim to prevent the 1st occurrence of the disease
45
Define secondary prevention
Aim to prevent recurrence of the disease
Aim = detect and treat early = minimise consequences.
46
Define tertiary prevention
Aims to soften the impact of disease on its lasting effects
47
Name the domains of public health
Health promotion/involvement
Health protection
Improving health services
48
Describe the role of health promotion/involvement
Inequalities, education, housing, employment, family/community, lifestyles, surveillance and monitoring of specific diseases and risk factors
49
Describe the role of health protection
Infectious diseases, chemicals and poisons, radiation, emergency response, environmental health hazards
50
Describe the role of improving health services
Clinical effectiveness, efficiency, service planning, audit and evaluation, clinical governance, equity
51
Describe the public health response
Surveillance - what is the problem?
Risk factor identification - what is the cause?
Intervention and evaluation - what works?
Implementation - how do you do it?
52
What is medicine optimisation
Looks at the value which medicines deliver, make sure they are clinically-effective and cost-effective.
Ensure people get the right choice of medicines, at the right time and are engaged in the process by their clinical team.
53
Name the 5 goals of medicine optimisation
Improve their outcomes
Take medicines correctly
Avoid taking unnecessary medicines
Improve medicines safety
Reduce wastage of medicines
54
What is adherence
older term = compliance (assumes doctor knows best)
Acknowledges importance of the patients beliefs
= The extent to which a person's behaviour - taking medication, following a diet/or executing lifestyle changes - corresponds with agreed recommendations from a health care provider
55
Name 4 unintentional reasons for non adherence
Practical barriers - capacity and resource
Difficulty understanding instructions
Poor dexterity
Inability to pay
Forgetting
56
Name 3 intentional reasons for non adherence
Motivational barriers - perceptual barriers
Patients beliefs about their health/condition
Beliefs about treatments
Personal preferences
57
Describe the necessity-concerns framework
Key beliefs = influencing patients evaluations of prescribed medicines can be grouped into two categories
Necessity beliefs - perceptions of personal need for treatment
Concerns - about a range of potential adverse consequences
Validated questionnaire - beliefs about medicine
58
Describe the necessity-concerns framework impact on adherence
Increase necessity beliefs
Decrease concerns
59
What are the ethical considerations of adherence
Mental capacity
Decision that may be detrimental to a patient's wellbeing
Potential threat to health of others
60
Describe the public health act (2010) on ethical considerations of adherence
Provides legal basis to detain and isolate infectious individuals
No power to compel treatment.
61
Describe Gillick competent
Child under 16 can give consent to their own treatment if they are believed to have enough intelligence and understanding to fully appreciate what is involved in their treatment
62
A 50 year old patient found to be at increased risk of cardiovascular disease mentions at a routine GP check-up that they have not been taking the statin prescribed at their last visit. The patient comments that they are “not anti-medication” but “feel fine without it”.
Which of the following seems to be the most pertinent reason for this non adherence?
Necessity beliefs about medication
63
What type of term is sex
Biological
64
What type of term is gender
Cultural
65
What are the 3 different explanations for gender differences in health
Biological
Social factors
Structural factors
66
Describe the structural impact on gender differences in health
Power and resources in the home can leave women disadvantaged
67
Describe meningitis (any cause) and meningococcal septicaemia as a notifiable disease
Notify on suspicion
Contact tracing
Chemoprophylaxis
Vaccination
Alerting and informing close contacts and the public
68
Describe what happens in public health in meningitis
Confirmed case - immediate PH action
Probable case - not confirmed by lab, but meningococcal disease is most likely - immediate PH action
Possible cause - no lab and other diagnosis equally likely - no immediate PH action
69
Who are close contacts of meningitis
People living in same household
Anyone who slept overnight in the same household in the previous 7 days
Other household members if case stayed overnight elsewhere in previous 7 days
Intimate kissing contacts in last 7 days
70
Describe antibiotics given to close contacts of meningitis
Antibiotics given to eradicate throat carriage
Single dose ciprofloxacin (recommended everyone)
Alternative - rifampicin
Offered up to 4 weeks after case became ill
71
What is a meningitis cluster in a school
Two probable or confirmed cases of the same type in 4 weeks
Need to define risk group
72
Where is group B and C meningitis more common
Europe and Americas
73
Where is group A meningitis most common
Africa and Asia
74
Does meningitis have a vaccine
Yes
75
What are the 3 goals of defeating meningitis by 2030
Elimination of bacterial meningitis epidemics
Reduction of cases of vaccine-preventable bacterial meningitis by 50% and deaths by 70%
Reduction of disability and improvement of quality of life after meningitis due to any cause
76
Describe the immunisation schedule of meningococcal
8 weeks - primary (B vaccine)
16 weeks - primary (B vaccine)
One year - Primary (MenC), booster (Hib), booster (MenB)
Around 14 years - primary (menAWY), booster (MenC)
77
Describe polysaccharide vaccines in meningitis
Short term 3-5 years
No immune response in children under 2 years
78
Describe conjugate vaccines in meningitis
Polysaccharide-conjugate vaccines - immunogenic across all ages
Prevents acquisition of carriage
Serogroup specific
79
Describe the meningitis B vaccine
Difficult to produce
Not one size fits all
Given routinely to infants - uncertain effectiveness and high costs
Not used in outbreaks
80
Name the 5 immunoglobulins
G
M
A
D
E
81
Name the two forms of active immunity
Cell-mediated
Antibody mediated
82
Name the ways in which someone can gain passive immunity
Cross-placental transfer of autoantibodies from mother to child (measles, pertussis)
Transfusion of blood or blood products (Hep B)
Temporary
83
What are the 5 things vaccines are made from
Inactivated (killed) - pertussis, inactivated polio
Attenuated live organisms - yellow fever, MMR, polio, BCG
Secreted products - tetanus, diphtheria toxoids
Constituents of cell walls/subunits - Hep B
Recombinant components - experimental
84
Define primary vaccine failure
Person does not develop immunity from vaccine
85
Define secondary vaccine failure
Initially responds but protection wanes over time
86
Give examples of vaccine preventable diseases
Diphtheria
Tetanus
Pertussis - whooping cough
Polio
Haemophilus influenza type B
Meningococcal disease
87
Describe the role of surveillance
Detection of any changes in disease
- outbreak detection
- early warning
- forecasting
Track changes in disease
- extent and severity of disease
- risk factors
88
Name the route of disease transmission
Source
Pathway
Receptor
89
What is the obescogenic environement
Physical environment - e.g. tv remove, lifts, car culture
Economic environment - e.g. cheap Tv watching. expensive fruit and veg
Sociocultural environment - e.g. safety fears, family eating patterns
90
Describe primary prevention of obesity
Before overweight/obesity occurs
Wider determinants breastfeeding and early years, food environment, physical activity advertising, marketing
91
What are the alcohol guidance
No more than 14 units per week
Spread over 3 or more days
92
How do you calculate the units of a drink
Strength of a drink (%ABV) x amount of liquid (Litres)
93
How many grams is in a UK unit of alcohol
8g
94
What is a UK unit of alcohol
8 grams or 10ml of pure alcohol
95
Describe the treatment of semaglutide in obesity
Prescribed alongside diet, physical activity and behavioural support
BMI of at east 35 and a weight related condition (hypertension, DM)
Only via specialist services
96
Describe the link between trauma and obesity
Significant link
Adverse childhood experiences
Socioeconomic factors - disadvantaged areas
Intergenerational impact - trauma in parents
Health inequalities
97
What is the relationship between adverse childhood experiences and obesity
Individuals who have experienced trauma, especially during childhood (abuse, neglect or household dysfunction) are more likely to develop obesity later in life.
98
Describe tertiary prevention of obesity
After overweight/obesity has occurred
Physical activity, healthy diet, compassionate approach, stigma reduction, mental health support, pharmaceuticals, surgery
99
Describe secondary prevention of obesity
During development of overweight/obesity
Healthy diet intervention, physical activity, weight loss support programmes, education, labels
100
Describe primary prevention of obesity
Before overweight/obesity occurs
Wider determinants breastfeeding and early years, food environment, physical activity advertising, marketing
101
Describe the sugar drinks industry levy
Introduced as an anti-obesity policy 2016 Childhood obesity strategy
Implemented 2018
Tax on sugary drinks
102
What are examples of government policies aimed to reduce obesity
Sugar Drinks industry levy (2016)
Restrict volume promotions such as buy one get one free (2025)
Restrict HSFF food locations both online and in stores (2022)
Calorie labelling in large out of home food businesses (2022)
Advertising restrictions on HFSS foods (2025)
103
What is the calculation of BMI
Weight (kg) divided by square of height (in metres)
104
Name the 4 research topics for risk factors of CHD
Coronary prone behaviour pattern
Depression/anxiety
Psychosocial work characteristics
Social support
105
What did the Whitehall study conclude
1 (only men) - men in the lowest grade had a higher CHD mortality rate than men in highest grade
2 - working 11-hours or more a day were 67% more likely to have a heart attack
106
Do anxiety and depression increase the risk of development of CHD
Depression is a higher risk factor than anxiety but both are risk factors
Can share similar antecedents with CHD e.g. deprivation
More research is needed
107
Describe 'hostility' as a risk factor of CHD
Feelings of anger
Annoyance and resentment
Verbal or physical aggression
108
What were the findings from the recurrent coronary prevention project
Reduction in type A behaviours reduces morbidity and mortality in post infarction patients
109
Describe the coronary prone behaviour pattern
Friedman and Rosenman (1959)
Competitive Hostile Impatient
Type A behaviour
110
What are the psychosocial risk factors for CHD
Behaviour pattern
Depression/anxiety
Work
Social support
111
What are the demographic risk factors for CHD
Age
Sex
Ethnicity
Gender
112
What are the environmental risk factors for CHD
Air pollution
Chemicals
113
What are lifestyle risk factors for CHD
Smoking
Diet
Physical inactivity
114
Which of the following is the most appropriate term to describe physical activity as a risk factor for Coronary Heart Disease?
1. Lifestyle risk factor
2. Environmental risk factor
3. Demographic risk factor
4. Clinical risk factor
5. Psychosocial risk factor
Lifestyle risk factor
115
Which of the following is the most appropriate term to describe diabetes as a risk factor for Coronary Heart Disease?
1. Lifestyle risk factor
2. Environmental risk factor
3. Demographic risk factor
4. Clinical risk factor
5. Psychosocial risk factor
Clinical risk factor
116
Define psychosocial factors
Factor influencing psychological responses to the social environment and pathophysiological changes
117
What are the current screening tests for pre-diabetes/diabetes
HbA1c
Random capillary blood glucose
Random venous blood glucose
Fasting venous blood glucose
Oral glucose tolerance test (venous blood glucose 2 hours after oral glucose load)
118
Name the 3 mechanisms that maintain overweight
Physical/physiological - more weight = more difficult to exercise (arthritis, stress incontinence) and dieting = metabolic response
Physiological - low self esteem and guilt. comfort eating
Socioeconomic - reduced opportunities employment, relationships, social mobility
119
Describe the runaway weight train in obesity
Steep slope = obesogenic environment
Ineffective breaks = knowledge, prejudice, physiology
Accelerators = vicious cycles of mechanical dysfunction, psychological impact, ineffective dieting, low socioeconomic background
120
What is the obesogenic environment
Physical environment - e.g. tv remove, lifts, car culture
Economic environment - e.g. cheap Tv watching. expensive fruit and veg
Sociocultural environment - e.g. safety fears, family eating patterns
121
What does prevalence depend on
Primary prevention - incidence of the condition
Secondary prevention - % of incident cases diagnosed
Tertiary prevention - survival from diagnosis
122
Name 4 reasons why diabetes is a key health issue
Mortality
Disability
Co-morbidity
Reduced quality of life
123
Name the clinical alcohol withdrawal syndromes
Tremulousness
Activation syndrome
Seizures
Hallucination
Delirium tremens - can be severe/fatal
124
Describe the activation syndrome in alcohol withdrawal
Characterised by tremulousness, agitation, rapid heart beat and hight blood pressure
125
Describe foetal alcohol spectrum disorder
Caused by pre-natal exposure to alcohol
Pre/post-nasal growth retardation
CNS abnormalities
Craniofacial abnormalities
Associated abnormalities
126
What age group in men and women have the highest proportion of drinking
55-64
127
What are the NICE recommendations of alcohol policy
Price - make alcohol less affordable
Availability - licensing and import allowances
Marketing - limit exposure, especially to children and young people
128
What are the NICE recommendations for alcohol practice
Licensing
Screening and brief interventions
Supporting children and young people ages 10-15 years
Referral - consider referral for specialist treatment
129
Name 3 ways of alcohol harm prevention
Restrict choice - restriction on alcohol advertising, minimum unit pricing
Enable choice - dry January, alcohol-free/low alternatives
Provide information - labelling, drinking guidelines media campaigns
130
What are the benefits of dry January
Amongst weekly drinkers
- insulin resistance
- blood pressure
- cancer related growth factors
Reduces drinking at 6 moths follow up
Increased ability to refuse drinks
Improved self rated heath and wellbeing
131
What is alcohol use disorder or alcohol dependence diagnosed on
DSM-V criteria
132
What are the screening tools for alcohol
FAST - fast alcohol screening test
AUDIT - alcohol use disorders identification test
CAGE questions
133
Name the medical/pharmacological treatment of alcohol dependence
Acamprosate (campral)
Disulfiram (antabuse)
Nalmefene (selincro)
Naltrexone
134
Define primary prevention
Reduce prevalence of risk factors
135
What form of prevention is screening
Secondary
136
Define tertiary prevention
Management of conditions to reduce impact
137
What is an online page about MSK health
MovingMedicine
1 minute, 5 minute and more minutes conversation
138
What are the main theoretical models that explain substance misuse
Disease model - used substitution medicines
Moral model - parenting classes, religious education
Socio-cultural model - target health inequality
Behavioural model - law/criminal justice to deter through fines and prison
Volitional model - raise self-efficacy
Disease model - explore gene therapies
139
What are the 3 diagnostic codes for substance misuse
Acute intoxication
Harmful use
Dependence
140
What is used to measure substance misuse
ICD-10
Diagnostic and statistical manual of mental disorders (DSM-V)
141
Describe ICD-10: F10-19.2 substance misuse
Experienced 3/6 or more in the past 12 months
1. strong desire or compulsion to use
2. difficulties controlling substance-taking behaviour
3. physiological withdrawal state when reduce use
4. tolerance
5. progressive neglect of pleasures/interests, increased time spent using
6. persistent use despite evidence of harmful consequences
142
Describe the diagnostic and statistical manual of mental disorders (DSM-V) - substance use disorder
Experienced out of 11 in the past 12 months
2-3 mild
4-5 moderate
6+ severe
143
Describe community prescribing in substance misuse
Delivered by GP/specialist services
Goal - stop patient using illicit drugs, enable a more stable life
144
What is tertiary prevention of strokes
Stroke units - rehabilitation
84% patients return home following a stroke but few return to work
145
Describe secondary prevention of strokes
Screening for risk factors
Attributable risk of hypertension is 75%
146
Describe primary prevention of strokes
Smoking, alcohol, diet and physical activity
147
What is current policy of dementia
Awareness raising and opportunistic screening for memory loss (part of NHS health checks)
Screening = controversial - due to lack of evidence that benefits outweigh the harms
148
Describe the epidemiology of epilepsy
Incidence highest in elderly in children
Prevalence difficult to ascertain if no seizures to to effective treatment
149
Describe the epidemiology of Parkinson's disease
Incidence - increases with age
Prevalence - 1 in 200 over 70 years
Variable progression - mean survival 10-15 years
Risk factors - less common in smokers
150
Describe the epidemiology of multiple sclerosis
Onset commonest 20-35 years
Reduced risk associated with fish consumption and living closer to the equator
Increased risk with specific HLA antigens, nutritional deficiencies and exposure to infections (EBV)
151
Describe Creutzfeldt-Jakob Disease
Neurogenerative disease (dementia)
Average onset 55-75 years
Rapidly progressive dementia, abnormal ECG, cerebellar signs, myoclonus
Rare
152
Describe Variant Creutzfeldt-Jakob Disease
Neurogenerative disease similar to CJD
Peak incidence 27 years - genetic susceptibility (methionine homozygosity at codon 129 of prion protein gene)
Different brain appearance on post-mortem
Linked to beef scandal? Iatrogenic exposure via blood products and surgical instruments. 4 cases related to transfusion
153
What level of prevention are vaccinations
Primary prevention
154
What are the symptoms of gonococcal arthiritis
Fever, arthiritis, tenosynovitis
Maculopapular - pustular rash
155
Name 5 ethical theories
4 principles
Imperative
Virtue
Categorical
Utilitarianism
156
Describe the transtheoretical model of behavioural changes
Pre-contemplation - no intension of giving up smoking
Contemplation - consider quitting
Preparation - get ready to quit in the near future
Action - engaged in giving up
Maintenance - steady non-smoker
Relapse?
157
What is the Gini coefficient
A statistical representation of nation's income distributed among it's residents.
It is most commonly used to measure equity.
158
What is utilitarianism ethics
An act is evaluated solely in terms of its consequences
Maximise good and minimise harm
159
What are the main principles of virtue ethics
Focuses on the person who is acting - are they expressing good character
Integrates reason and emotion
Virtues are acquired.
An action is virtuous only if the person is acting with genuine intention of doing the right thing
160
What are the principles of ethics?
Autonomy - respect the patients decision
Benevolence - provide benefits to the patient
Non-maleficence - do no harm
Justice - ensure fairness in the distribution of treatment
161
What does the GMC stay are the 5 main 'duties of a doctor'
Protect and promote health
Provide a good standard of care
Recognise and work within the limits of your competence
Work with colleagues in a way to best serve your patients
Treat patients as individuals and respect their dignity
162
Name 4 ways to assess the function limitations among older people
The Katz ADL scale
IADL
The Barthel ADL Index
MMSE
163
What does the MMSE test for?
Orientation, immediate memory.
Short-term memory
Language functioning
164
Glaser and Strauss - what 4 awareness contexts did they identify
Closed awareness
Suspicion awareness
Mutual pretence
Open awarness
165
Describe the chain of infection
Susceptible host
Causative micro-organism
Reservoir (patients, visitors etc.)
Portal of entry/exit
Transmission
166
How can infection be transmitted
Exogenous spread - direct contact (STIs), airborne (TB), vector spread (malaria)
Endogenous spread - self-spread
167
Give 3 types of handwashing
Routine handwash
Hygienic hand antisepsis
Surgical hand scrub
168
Describe the physiological effects of nicotine
Activation of nicotinic Ach receptors in the brain - causes dopamine release
Dopamine = stimulant
Tolerance increases and cessation will result in withdrawals
169
Which methods can be used in smoking cessation
Nicotine replacement therapy - patches, gums, nasal spray
Non-nicotine pharmacotherapy - varenicline, bupropion
Transtheoretical model
170
What are the 3 A's?
Ask - ask the patient about smoking
Advice - advice on smoking cessation methods
Assist - refer to local NHS stop smoking services
171
What is the Bradford Hill Criteria
A group of minimal conditions necessary to provide adequate evidence of a causal relationship
172
Define sensitivity
The proportion of people with the disease who are connectively identified
True positive / (true positive + false negative)
173
Define specificity
The proportion of people without the disease who are correctly excluded by the screening test
How well a test detects those without a disease
True negative / (true negative + false positive)
174
Define positive predictive value (PPV)
The proportion of people with a positive test result who actually have the disease
True positive / (true positive + false positive)
175
Define negative predictive value (NPV)
The proportion of people who test negative who do not have the disease
True negative / (true negative + false negative)
176
Define prevalence
The proportion of people found to have the disease at a point in time
177
Define incidence
The rate at which new cases occur in a population in at a point in time
178
What is the calculation for specificity
True negative / (true negative + false positive)
179
What is the calculation for sensitivity
True positive / (true positive + false negative)
180
What is the calculation for positive predicted value
True positive / (true positive + false positive)
181
What is the calculation for negative predicted value
True negative / (true negative + false negative)
182
What is the Wilson and Jungner criteria used for
To determine whether a condition should be screened for
183
What are the 10 Wilson and Jungner criteria for screening
The condition should be serious health problem
The natural history of the condition should be understood
Early detectable stage
Treatment available
Facilities for detection and treatment
Suitable test
Test acceptable to the population
Should be agreed policy of whom to treat
Cost should be balanced against the benefits
Should be a continous process, not just a one off
184
Describe selection bias in regards to screening
Diseases with longer period of presentation are more likely to be detected by screening than ones with shorter time presentations
185
Define lead-time bias
Screening identifies a disease earlier and therefore gives the impression that survival is prolonged but survival remains unchanged
186
Give 2 examples of check lists used in the NHS
SABR check list - reporting a case
Surgical safety checklist
187
What is SBAR checklist
It is used for reporting a case
S - situation
B - background
A - assessment
R - recommendation
188
What is the WHO definition of health
Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmly
189
What is the WHO definition of mental health
Mental health is a state of well-being in which individuals realises his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully and is able to make a contribution to his or her community.
190
What are the two types of stress
Eustress
Distress
191
What is eustress
Positive stress
Often beneficial and motivating
192
What is distress
Negative stress
Often damaging and harmful
193
What are the 3 stages of general adaptation syndrome (GAS)
Alarm
Adaptation
Exhaustion
194
What is the diagnostic criteria for PTSD
The person experienced an event or events that involved actual or threatened death or serious injury, or a threat to physical integrity of self or others
The person's response involved intense fear, helplessness or horror
195
How is BMI calculated
Weight (kg) / height m^2 (m)
196
What is the range of normal BMI
18.5 - 24.9
197
Describe Prader Willi syndrome
Paternal chromosome 15 deletion
The individual will have learning difficulties, growth abnormalities and obsessive eating
198
What genetic conditions are linked to obesity
Prader Willi syndrome
Mutations of leptin and melanocortin receptors
Congenital leptin deficiency
199
What is leptin
Appetite inhibitor
200
What is meant by indirect controls of meal sizes
Metabolic, endocrine, cognitive, social and environmental factors
Can override direct controls
201
What is meant by direct control of meal size
All the factors relating to direct contact of food with the GI mucosa receptors
202
Define satiation
What brings an eating episode to end
203
Define satiety
The inter-meal period
204
What is the satiety cascade
Sensory - cognitive - post-ingestive - post absorptive
205
What is the ABC of HIV safety
Abstain
Be faithful
Condom use
206
What has the most significant effect on the reduction of TB
Improvements of social conditions
207
How can you reduce the incidence rates of a disease
Decrease risk factors e.g. primary preventions
208
What can decrease the prevalence
Cures and decreasing risk factors
209
What can increase prevalence
Screening and identifying new cases
Increased life expectancy
210
What is the equation used to work out how many units of alcohol there are in a drink
% ABV x volume of drink (ml) / 1000
211
What is the doctrine of double effect
If you administer a drug to relieve pain in doses you know may be fatal, provided your intention is to relieve pain and not to shorten life the administration is ethically okay
212
What are the 5 focal virtues
Compassion
Trustworthiness
Discernment
Integrity
Conscientiousness
213
What is the gold standard of evidence based medicine
Systematic reviews of RCT
214
What are confounding factors
Factors that can effect the validity of a study
They may be responsible for a result seen
215
What is the critical appraisal and why is it important
Critical appraisal is about assessing validity, reliability and applicability
Important - means you can provide your patients with the best possible evidence and information
