SocPop and VLE

Recap Quiz

What are the 4 definitions of health?Which 2 are positive?

What are the 4 definitions of health?Which 2 are positive?

1. Absence of illness – not sick2. Functional ability – daily tasks3. Equilibrium – mind, body, spirit ‘in sync’4. Freedom – capacity to do as you want

Give 1 criticism of the medical model of health.

Give 1 criticism of the medical model of health.

• Power is in the hands of the HCPs, not patients• Shift to chronic diseases – and these don’t fit into

simple biological causes/medical cure• Doesn’t include social or cultural influences on

health• People do not all view ‘normal’ in the same way

Define incidence.What is the equation?

Define incidence.What is the equation?

The rate at which new cases appear = ‘number of new cases per person-years’

new cases observed . people observed x years observed

Define prevalence.Different types of prevalence?

Define prevalence.Different types of prevalence?

Proportion of current sufferers with the disease in the population at a given time/period

Point – at given timePeriod – at given periodLifetime

Define the 95% confidence interval for prevalence – what does a 95% CI mean?

Define the 95% confidence interval for prevalence – what does a 95% CI mean?

95% CI = [p-(1.96xSE), p+(1.96xSE)]

Where SE = √[p(1-p)/n]

Confidence intervals are the way in which we sensibly express our uncertainty in the estimates we findA 95% CI means: 95% of intervals created in this way will contain the true value

Name 2 professional codes for doctors

Name 2 professional codes for doctors

• Hippocratic oath• Declaration of Helsinki• Declaration of Geneva• Duties of a Doctor ~ GMC

What are Ewle’s and Simnett’s 5 approaches to Health Promotion?

What are Ewle’s and Simnett’s 5 approaches to Health Promotion?

• Behaviour change• Client-centred• Educational• Medical• Societal change

(Ewle Can Suck My Balls)

Name 3 theories explaining the health inequality across social status.

Name 3 theories explaining the health inequality across social status.

• Behavioural/cultural• Material Neomaterial• Psychosocial

Give an example of primary, secondary, tertiary prevention

Give an example of primary, secondary, tertiary prevention

• Primary – immunisation, school education on e.g. alcohol…

• Secondary – screening, education on self-checking…

• Tertiary – rehabilitation, pain management…

Define health inequality

Define health inequality

A marked social patterning of systematic differences in health and illness distribution in a population – certain groups experience less morbidity and mortality and these variations between groups are not random.

Give 2 explanations for gender differences in health

Give 2 explanations for gender differences in health

1. Biological2. Men are exposed to more accidents/disease

at work3. Men engage in more health risking

behaviours – drinking, smoking etc4. Men cope with illness using ‘masculine-

sanctioned’ behaviour e.g. alcohol5. Men engage less with health services

Name 2 ways that doctors can tackle health inequality

Name 2 ways that doctors can tackle health inequality

• Provide access to high quality healthcare for vulnerable groups, including referrals

• Advocate development of services in vulnerable areas

• Provide education to vulnerable groups• Take part in research into social determinants

of health

What are the 5 dimensions of belief that form a patient’s representation of their illness?

What are the 5 dimensions of belief that form a patient’s representation of their illness?

• Identity (labels)• Cause• Time (acute/chronic)• Consequences• Control-cure

What are the 5 stages of the Transtheoretical model of health behaviour?

What are the 5 stages of the Transtheoretical model of health behaviour?

• Precontemplation• Contemplation• Preparation• Action• Maintenance

• Relapse

What are ‘SMART’ goals?

What are ‘SMART’ goals?

• Specific• Measurable• Attainable• Realistic• Timed

What are the 5 tasks of the Calgary-Cambridge guide to consultation? And its 2 functions?

What are the 5 tasks of the Calgary-Cambridge guide to consultation? And its 2 functions?

• Commencing the consultation• Gathering information• Physical examination• Explanation and Planning• Closing the consultation

Provides structure and helps build relationship

What are the 3 types of doctor-patient relationship? Which ethical principle is linked to each?

What are the 3 types of doctor-patient relationship? Which ethical principle is linked to each?

• Paternalistic – principle of beneficence• Shared - both• Informed – principle of respect for autonomy

What are the 4 criteria for capacity?

What are the 4 criteria for capacity?

• Able to UNDERSTAND relevant information needed for decision

• Able to RETAIN this information• Able to USE/BALANCE this information in their

decision-making• Able to COMMUNICATE their decision

Over and above the 4 conditions for ADRTs to be valid, what are the 4 conditions that must be fulfilled for an

Advanced Decision to Refuse lifesaving Treatment to be valid?

Over and above the 4 conditions required for ADRTs to be valid, what are the 4 extra conditions that must be fulfilled for an Advanced Decision to Refuse lifesaving

Treatment to be valid?• Written• Signed• Witnessed• State that the patient understands that this

may result in their death

What 3 things make for valid consent?

What 3 things make for valid consent?

• Voluntariness• Informed• Capacity

Give 3 examples where you may break confidentiality without consent

Give 3 examples where you may break confidentiality without consent

• Statutory obligation – e.g. communicable disease, Terrorism Act…

• Legally required – e.g. via court order• Public interest - to protect individuals or society

from risks of serious harm or death• Person lacks capacity to consent, and breaking

confidentiality is in their best interests

Give 2 examples of where doctors can refuse a patient’s request for treatment

Give 2 examples of where doctors can refuse a patient’s request for treatment

• Treatment not be funded by/offered on the NHS

• Treatment considered ‘futile’• Treatment that, with consideration of the

patient’s views, is still not considered to be in the patient’s best interests

Name 2 things that are required for an advanced decision about treatment to remain valid?

Name 2 things that are required for an advanced decision about treatment to remain valid?

• Made by a person who has capacity• Not since been withdrawn by the person (with

capacity)• There is no opposing lasting power of attorney

with authority • The person has not done anything inconsistent

with the decision to make you suspect it should not still be in place

Name 2 of the values in the NHS constitution

Name 2 of the values in the NHS constitution

1. Patients come first2. Every person is respected and their dignity

valued3. Commitment to quality of care4. Compassion is central to care5. Everyone counts6. The improvement of health and wellbeing

Give 2 examples where a coroner will be required to investigate a death

Give 2 examples where a coroner will be required to investigate a death

• The death is violent or unnatural• The cause of death is unknown• The person died in prison, police custody, or

another type of state detention

Suggest 2 ways in which a carer’s life may be impacted by their role as a carer

Suggest 2 ways in which a carer’s life may be impacted by their role as a carer

• Financial• Social exclusion• Health• Education

What is ‘lay belief/knowledge.?

What is ‘lay belief/knowledge.?

• Common sense understanding that is generally rooted in one’s own experiences

Give 3 examples of where a person’s lay beliefs may stem from

Give 3 examples of where a person’s lay beliefs may stem from

• Personal knowledge/experience• Previous medical encounters• Folk knowledge• Media/internet• Spiritual beliefs• Alternative/complementary medicine

People often seek advice from others before consulting a doctor – list 2 ‘triggers’ that lead them to book a

doctor consultation.

People often seek advice from others before consulting a doctor – list 2 ‘triggers’ that lead them to book a

doctor consultation.

• Interpersonal crisis• Symptom(s) begin to interfere with personal

relationships• Symptom(s) begin to interfere with work or

other activities• ‘Sanctioning’ – being told to• Symptom(s) go on for longer than expected

What is a confounding variable?

What is a confounding variable?

Something that is associated with both the exposure and the outcome

Name 4 of the Bradford Hill Criteria for inferring causality from correlation

Name 4 of the Bradford Hill Criteria for inferring causality from correlation

Association – 1. Strength of; 2. Specificity of; 3. Consistency of

Exposure/Outcome – 4. Temporal sequence; 5. Dose response; 6. Reversibility

Other evidence – 7. Coherence of theory; 8. Biological plausibility; 9. Analogy

Give 2 examples of selection bias

Give 2 examples of selection bias

• Sampling bias (non random selection)• Allocation bias (non random allocation)• Responder bias • Attrition bias• Publication bias• Healthy worker effect (cohort not comparable

to population)

What is the hierarchy of study design?

What is the hierarchy of study design?

1. Systematic review2. RCT3. Cohort studies4. Case-control studies5. Cross-sectional surveys

Give 2 examples of information bias

Give 2 examples of information bias

• Recall bias• Reporting/interviewer bias• Social desirability bias

What is the attributable risk of disease y, to exposure to x?

What is the attributable risk of disease?

(Incidence of disease in exposed) – (incidence of disease in unexposed)

It is the risk difference between the exposed and unexposed groups

What is the relationship between the attributable risk (AR) and number needed to treat (NNT)

What is the relationship between the attributable risk (AR) and number needed to treat (NNT)

NNT = 1/AR

i.e. number needed to treat to save one additional person, is 1/(chance of getting disease due to exposure to x)

What is the equation for the odds ratio?

What is the equation for the odds ratio?

OR= exposed cases x unexposed controls unexposed cases x exposed controls

i.e. support of hypothesis doesn’t support hypothesis

What is the 95% CI for the odds ratio?

What is the 95% CI for the odds ratio?

95% CI = [OR ÷ e.f, OR x e.f] (put smaller value first)

where:

e.f = exp{1.96x √[(1/a)x(1/b)x(1/c)x(1/d)]}

a=exposed cases, b= unexposed cases, c= exposed controls, d=unexposed controls

Define incidence rate ratio

Define incidence rate ratio

IRR = incidence in exposed/incidence in unexposed

Define relative risk.

Define relative risk.

RR = risk in exposed/risk in unexposed

Give 2 principles of data protection enshrined in the Data Protection Act.

Give 2 principles of data protection enshrined in the Data Protection Act.

Personal data should be:• Fairly and lawfully processed• Processed for limited purposes• Adequate, relevant and not excessive• Accurate and up to date• Kept secure• Not kept for longer than necessary• Must be kept inside the EU

Under the MCA, if a person lacks capacity, what 2 things must be borne in mind if restraint is required for

treatment?

Under the MCA, if a person lacks capacity, what 2 things must be borne in mind if restraint is required for

treatment?

1. Restraint must be proportionate, and the minimum necessary, to achieving the treatment goal

2. Treatment must be in the patient’s best interests, and be done to prevent harm

What 2 ethical principles can be used to allow treatment without consent in the

emergency setting?

What 2 ethical principles can be used to allow treatment without consent in the

emergency setting?

• Doctrine of necessity• Principle of best interests

Who can give consent for minors?

Who can give consent for minors?

• 16-17-year-olds (except those who lack capacity) as presumption of capacity to consent from the age of 16 (Family Law Reform Act 1969)

• Gillick-competent under-16 year olds (Gillick v West Norfolk and Wisbech Area Health Authority [1986])

• a person or Local Authority with Parental Responsibility (Children Act 1989)

• a court

What is Gillick competence?

What is Gillick competence?

Gillick competence is a term used in medical law to decide whether a child (16 years or younger) is able to consent to his or her own medical treatment, without the need for parental permission or knowledge.

Gillick competent under 16s should have sufficient understanding and intelligence to be capable in making up his/her mind on the matter requiring decision and sufficient maturity to understand what is involved in the decision, and the consequences thereof

Give 2 of the 5 key elements of the Human Fertilisation and Embryology Act 2008 (1990)?

Give 2 of the 5 key elements of the Human Fertilisation and Embryology Act 2008 (1990)?

1. It is unlawful to store or use embryos or gametes except with a license granted by the HFEA.

2. Appropriate counselling is acquired

3. Consideration of the welfare of any child born as a result of treatments and any other child who may be affected by the birth

4. It specifies who is legally recognised as the mother and father of a child created by IVF

5. It is prohibited to preferentially use gametes/embryos that carry a gene, chromosome or mitochondrial abnormality (or are of a particular sex with such an abnormality) involving significant risk that a person having that abnormality would have some serious medical condition.