Public Health and Psychology

Question 1

Determinants of health as established by Lalonde report 1974?

Answer 1

Genes
Environment (physical, social and economic)
Lifestyle
Health care

Question 2

Describe Dahlgren and whitehead 1991 determinants of health classification

Answer 2

Rainbow model. Individuals placed at centre with various layers of influences on health surrounding them

Question 3

What are the layers in the Dahlgren-Whitehead model?

Answer 3

Centre=age/sex/constitutional factors
Next=individual lifestyle factors
Next=social and community networks
Next=living and working conditions
Outer=general socio-economic, cultural and environmental conditions

Question 4

Describe the 7 boxes in the living and working conditions element of the Dahlgren-Whitehead model

Answer 4

Agriculture and food production
Education
Work environment
Unemployment 
Water and sanitation
Health care services
Housing

Question 5

Equity vs equality

Answer 5

Equity=what is fair and just

Equality=equal shares

Question 6

Describe horizontal equity with example

Answer 6

equal treatment for equal need

individuals with pneumonia with all other things being equal should be treated equally

Question 7

Describe vertical equity with example

Answer 7

unequal treatment for unequal need

individuals with common cold vs pneumonia need unequal treatment

Question 8

List 5 different forms of health equity

Answer 8

Equal expenditure for equal need
Equal access for equal need
Equal utilisation for equal need
Equal healthcare outcome for equal need
Equal health

Question 9

Classification of health equity?

Answer 9

Spatial ie geographical

and Social -age/gender/class/ethnicity

Question 10

What are the three domains of public health practice?

Answer 10

Health improvement (societal interventions aimed at preventing disease, promoting health and reducing inequalities)
Health protection (control infectious disease risks and environmental hazards)
Health care (organisation and delivery of services)

Question 11

What levels can interventions to improve public health be delivered at? Give example for each

Answer 11

Individual level eg childhood immunisation
Community level eg playground for local community
Ecological (population) level eg clean air act

Question 12

Primary prevention? example

Answer 12

Prevent disease or injury before it even occurs

eg eating well, exercise regularly

Question 13

Secondary prevention? example

Answer 13

Reduce the impact of a disease or injury that has already occurred
eg screening for breast cancer, daily aspirin post MI

Question 14

Tertiary prevention? example

Answer 14

Reduce the impact of an ongoing illness or injury that has lasting effects , reduce mortality
eg stroke rehab programs

Question 15

Describe the different health behaviours with an example

Answer 15

Health behaviour=prevent disease eg eat well
Illness behaviour=seek remedy eg act of going to doctor
Sick role behaviour=actively aimed at getting well eg taking prescription

Health behaviours=health damaging or health promoting

Question 16

Why do people engage in health damaging behaviours?

Answer 16

Self-serving bias
Unrealistic optimism (inaccurate perceptions of risk and susceptibility)

Perceptions of risk influenced by lack of personal experience, belief preventable by personal action, belief not happened now not likely to, belief problem infrequent

Health beliefs, situational rationality (felt like a good idea at the time), culture variability, socioeconomic factors, stress, age

Question 17

Describe the needs assessment cycle

Answer 17

Needs assessment-planning-implementation-evaluation

Weighing up need, demand and supply

Question 18

What is meant by health need?

Answer 18

Need for health. Measured using mortality, morbidity, socio-demographics

Question 19

What is meant by health care need?

Answer 19

Much more specific than health need. Ability to benefit from health care, depends on potential of prevention, treatment and care services to remedy health problems

Question 20

Sociological perspective of need?

Answer 20

Felt need (individual perceptions)
Expressed need (individual seeks help to overcome variation)
Normative need (professional defines intervention appropriate)
Comparative need (between severity, range of interventions and cost)

Question 21

Public health approaches to needs?

Answer 21

Health needs assessment by either epidemiological , comparative, corporate

Question 22

Describe epidemiological approach for health needs assessment

Answer 22

Define problem
Size of problem; incidence/prevalence
Services available; prevention, treatment, care
Evidence based; (cost) effectiveness
Models of care (quality and outcome measures)
Existing services (unmet need, services not needed)
Recommendations

Question 23

Problems with epidemiological approach to health needs assessment

Answer 23

Required data may not be available, variable data quality, evidence base may be inadequate, does not consider felt needs of people affected

Question 24

Describe comparative approach for health needs assessment

Answer 24

Compare services. May examine health status, service provision, service utilisation, health outcomes

Question 25

Problems with comparative approach for health needs assessment?

Answer 25

May not yield most appropriate level of eg provision should be, data may not be available, data may be of variable quality, may be difficult to find comparable population

Question 26

Describe corporate approach for health needs assessment

Answer 26

Obtaining views of a range of stakeholders eg opinion leaders, commissioners, providers, professionals, patients, press

Question 27

Problems with health needs assessment corporate approach

Answer 27

Difficult to distinguish need from demand, groups may have vested interests, may be influenced by political agendas, dominant personalities may have undue influence

Question 28

What form can be used for domestic violence? What levels of risk

Answer 28

DASH and MARAC (multiagency risk assessment conference) forms Standard risk=serious harm not likely Medium risk=potential to cause serious harm but unlikely unless a change in circumstances High risk=high risk of serious harm

Question 29

What question format can be used in asking about domestic violence in consultations?

Answer 29

HARK H=humiliation eg does partner make you feel bad about yourself A=afraid eg what does your partner do that makes you feel scared R=rape=ever forced to do anything your not comfortable with K=kick eg does your partner threaten to hurt you

Question 30

Cut off between child abuse and domestic abuse

Answer 30

16 years=domestic abuse

Question 31

6 most common causes of visual impairment

Answer 31

cataracts, diabetic retinopathy, retinitis pigmentosa, glaucoma, age related macular degeneration, hemianopia

Question 32

3 types of cane for visually impaired people

Answer 32

Symbol cane; hold to notify of condition Guide cane; find obstacles on the ground and help measure depth of steps Long cane; avoid obstacles and navigate, ball on end, used in sweeping motion

Question 33

What is Charles Bonnet syndrome?

Answer 33

"Phantom visions" Brain tries to compensate for not seeing by creating visual hallucinations=side effect of sight loss. Affects up to 50% of people who lose their sight, especially in early stages.

Question 34

Describe the Donabedian model

Answer 34

Used for evaluation of health services Structure, process, [output], outcome NB/outputs frequently all come under process

Question 35

Donabedian framework: describe structure

Answer 35

What is there- buildings, staff, equipment | eg number of ICU beds per 1000 population

Question 36

Donebadian framework: describe process

Answer 36

What is done eg number of patients seen in A&E-the process through which patients go in to A&E-where and when first seen, who triages, assessing priority etc

Question 37

Donebadian framework: describe outcome

Answer 37

Classification of health outcomes: mortality, morbidity, quality of life/PROMs (patient reported outcome measures) and patient satisfaction Can also use 5Ds: death, disease, disability, discomfort, dissatisfaction

Question 38

Problems with measuring health outcomes

Answer 38

Cause and effect link may be difficult to establish as many other factors may be involved Time lag between service provided and outcome may be long Large sample sizes may be needed to demonstrate statistically significant effects Data may not be available May be issues with data quality (CART-completeness, accuracy, relevance, timeliness)

Question 39

Describe Maxwell's dimensions of quality to be used in assessment in quality of health care

Answer 39

3Es and 3As Effectiveness (desired effect?), efficiency (output maximised for given input?), equity (patients treated fairly) Acceptability (acceptable to patients?), accessibility (geographical, costs, waiting times etc?), appropriateness (relevance?)

Question 40

What methods can be used in evaluation of health care

Answer 40

Qualitative-via observation, interviews, focus group, review of documents. Consult relevant stakeholders Quantitative- via routinely collected data, review of records, surveys, special studies Mixed

Question 41

Overview of evaluating health services: general framework?

Answer 41

Define what the service is Aims/objectives of service-are they stated and are they appropriate Framework: structure, process, outcome (+/- dimensions of quality) Methodology to be used: quali/quanti/mixed Results, conclusions and recommendations

Question 42

Name 4 models of behaviour change

Answer 42

Health belief model, theory of planned behaviour, stage models (transtheoretical/stages of change), motivational interviewing, social marketing, nudging (choice architecture, make best choice the easiest eg fruit at checkouts), financial incentives, social norms

Question 43

Describe the health belief model

Answer 43

Change if the individual believes they are susceptible to the condition, the condition has serious consequences, taking action will reduce their susceptibility, benefits of taking action outweighs the costs Also contributed to by health motivations/self efficacy and cues to action Longest standing model. Successful for range of health behaviours eg breast self exam. Perceived barriers are the most important factor for addressing behaviour change

Question 44

Critique of health belief model?

Answer 44

Alternative factors may predict health behaviour Cognitive based model-doesn't consider influence of emotions No differential between 1st time and repeat behaviour Cue to action often missing

Question 45

Describe the theory of planned behaviour

Answer 45

Proposes best predictor of behaviour is intention. Rational choice model. Major determinants=attitudes, subjective norms, perceived behavioural control. Can predict for wide range of behaviours eg smoking Accounts for social pressures and norms

Question 46

Under the theory of planned behaviour, what determines intentions?

Answer 46

Person's attitudes to the behaviour, subjective norms (perceived social pressure) and perceived behavioural control (appraisal of self's ability to perform the behaviour)

Question 47

What techniques can be employed to help bridge the gap between intention and behaviour?

Answer 47

Perceived control, anticipated regret, preparatory actions, implementation intentions, relevance to self

Question 48

Critique of theory of planned behaviour?

Answer 48

Lack of temporal element and lack of direction or causality Rational choice model Habits and routines undermine model Assumes attitudes, subjective norms and perceived behavioural control can be measured Relies on self reported behaviour

Question 49

Describe the transtheoretical model/stages of change model of behaviour change?

Answer 49

Discrete stages and with each stage a greater inclination to change 5 stages=pre-contemplation, contemplation, preparation, action (6months), maintenance (6months) Progress and relapse. Temporal element and acknowledges individual stages of readiness Allows interventions to be tailored to each stage/each individual

Question 50

Critique of transtheoretical model?

Answer 50

not all people go through every stage change may operate on a continuum rather than discrete stages doesn't account for values, habits, culture, social and economic factors

Question 51

Basis of the social norms model?

Answer 51

Misperceptions of how peers think and act, need to alter perceptions of these pseudonorms.

Question 52

NICE defined transition points for behaviour change?

Answer 52

Leaving school, entering workforce, becoming a parent, becoming unemployed, retirement, bereavement

Question 53

Define allodynia

Answer 53

Perception of pain to a non painful stimulus (chronic pain-sensitisation)

Question 54

Define hyperalgesia

Answer 54

Minimally painful stimulus produces disproportionate response (Chronic pain-sensitisation)

Question 55

3 opioid receptors? Where?

Answer 55

MOR, KOR, DOR (mu, kappa, delta) | CNS, less so PNS. Occupy sites in vas deferens, knee joint, GI tract, heart and immune system

Question 56

Describe 5 negative effects of opioids

Answer 56

GI system-constipation and nausea Resp system-resp depression, sleep apnoea, CO2 retention CNS- dizziness, sedation, hyperalgesia MSK-fracture risk Immune system-mu receptor on immune cells leads to apoptosis Addiction and misuse, depression Endocrine system-hypogonadism (opiate induced androgen deficiency), decreased fertility, ED

Question 57

Non pharm management of chronic pain?

Answer 57

Physical eg wt loss, smoking cessation, stretching, physio Psychological eg CBT, counselling, meditation Complementary eg massage and reflexology Occupational eg work place based review

Question 58

Analgesic ladder?

Answer 58

Non-opioid eg NSAID, COX-2 inhibitors, paracetamol Mild opioid eg codeine Strong opioid eg morphine Adjuvants=anti convulsants, anti depressants, lidocaine patches

Question 59

Name 5 factors that promote excessive energy intake

Answer 59

Genetics, employment (shift work), early developmental factors, TV viewing/advertisements, characteristics of food (energy density, macronutrient composition, satiety/satiation, portion size), decreased physical activity, sleep, environmental cues, psychological factors

Question 60

Define malnutrition

Answer 60

Deficiencies, excesses or imbalances in a person's intake of energy and/or nutrients

Question 61

What are three early influences on feeding behaviour?

Answer 61

Maternal diet during pregnancy and breast feeding. Influence of parents to consume new food Parental feeding practices and infant feeding patterns

Question 62

Briefly describe the impact of maternal diet on feeding behaviour

Answer 62

Taste and olfactory systems can detect flavour in utero Foetus swallows amniotic fluid (by third trimester=1L a day) Amniotic fluid and human milk transmit volatiles from maternal diet providing early chemosensory experience (esp garlic, chilli, anise) Neonates orientate towards odour of own amniotic fluid and mother's breast milk

Question 63

Regarding feeding behaviour influences, advantages of breast feeding?

Answer 63

Acceptance of novel foods during weaning, less picky eaters in childhood, have a diet richer in fruit and veg Early experiences of breast milk/amniotic fluid shown to last after 10 years of age

Question 64

Describe paradoxical effect of parents using coercion when feeding

Answer 64

Coercion/persuasion/contingencies to encourage children to consume new food= using other food as an incentive to eat novel food increases liking for the reward not the novel food (reduces liking for novel food)

Question 65

Describe 3 features of "healthful" eating behaviours

Answer 65

``` Responsive feeding-recognise hunger and fullness cues Provide variety of food Avoid pressure to eat Authoritative parenting Not using food as a reward ```

Question 66

What are non-organinc feeding disorders (NOFEDs)?

Answer 66

Feeding aversion/refusal, food selectivity, fussy, failure t advance to age appropriate foods, negative mealtime interactions, high prevalence in under 6s Parents have often used maladaptive feeding practices

Question 67

Name the eating disorders

Answer 67

3 distinct= anorexia nervosa, bulimia nervosa, binge eating disorder. OSFED= other specified feeding or eating disorder

Question 68

Define eating disorder

Answer 68

Clinically meaningful behavioural or psychological pattern re eating or weight associated with distress/disability/substantially increased risk of morbidity or mortality

Question 69

Define disordered eating

Answer 69

Restraint, strict dieting, disinhibition, emotional eating, binge eating, night eating, weight and shape concerns. Inappropriate compensatory behaviours that do not warrant a clinical diagnosis

Question 70

Name 5 challenges/disadvantages of diets

Answer 70

Risk factor for development of eating disorder Loss of lean body mass not just fat mass Slows metabolic rate and energy expenditure Chronic dieting may disrupt normal appetite responses and increase subjective sensations of hunger LT wt loss challenging-normal pattern is wt loss, plateau then wt gain Non-obese dieters at increased risk of fat overshooting Wt cycling (repeated diet relapse) may accelerate wt gain

Question 71

In epidemiology, what factors contribute to association rather than a causative link?

Answer 71

Bias-studies finding associations more likely to have been published resulting in publication bias Chance Confounding Reverse causation eg people who are already unwell don't drink coffee

Question 72

2 methods of approaching epidemiological intervention?

Answer 72

Population approach: preventative measure seeking to shift risk factor distribution curve eg dietary salt restriction through legislation High risk approach: seeks to identify individuals above a chosen cut off and treat them eg screening for hypertension and subsequent treatment

Question 73

Describe the prevention paradox

Answer 73

Preventive measure which brings much benefit to population often offers little to each participating individual eg seat belt use