1. 2017

2. Public Health
Phase 1 Revision Session Lucy Faulkner Tuesday 9th May 2017
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3. Public Health Epidemiology Screening Alcohol Smoking Obesity
Prevention
Notifiable diseases
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4. Epidemiology
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5. Epidemiology
Incidence: number of individuals who develop a condition in a defined period of time
Measure of rate at which a disease occurs
Units: eg. people per year per 1000 of the population
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6. Epidemiology Prevalence: number of individuals who have a condition
Measure of disease burden
Units: eg. people per 1000 of a population
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7. Epidemiology
Absolute risk: risk of developing a condition over a period of time
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8. Epidemiology
Relative risk: ratio of risk in the exposed to risk in the unexposed
Relative risk= risk in the exposed ÷ risk in the unexposed
No units
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9. Epidemiology
Attributable risk: rate of disease in the exposed that may be attributed to the exposure
Attributable risk= risk in the exposed - risk in the unexposed
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10. Screening
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11. Screening Disease state Screening test result Disease No disease
Positive
Negative
‘positive’ or ‘negative’- results of the screening test
‘true’ or ‘false’- whether this result matches that of the screening test
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12. Screening Disease state Screening test result Disease No disease
Positive
True positive
False positive
Negative
False negative
True negative
‘positive’ or ‘negative’- results of the screening test
‘true’ or ‘false’- whether this result matches that of the screening test
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13. Sensitivity= True positive True positive+False negative = TP TP+FN
Screening
Sensitivity: proportion of people with the disease correctly identified as positive by the screening test
Sensitivity= True positive True positive+False negative = TP TP+FN
Denominator: everyone with the disease
How good the test is at picking up people with the disease
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14. Screening
Specificity: proportion of people without the disease correctly identified as negative by the screening test
Specificity= True negative True negative+False positive
= TN TN+FP
Denominator: everyone without the disease
How good the test is at correctly identifying those without the disease
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15. Screening
Positive predictive value: proportion of people with a positive result on screening test who have the condition
Positive predictive value= True positive True positive+False positive
= TP TP+FP
Denominator- everyone with a positive result
Numerator- everyone in whom this positive result is correct
If you have a positive result the chances that you actually have the disease
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16. Screening
Negative predictive value: proportion of people with a negative result on the screening test who don’t have the disease
Negative predictive value= True negative True negative+False negative
= TN TN+FN
Denominator- everyone with a negative result
Numerator- everyone in whom this negative result is correct
If you have a negative result chance that you don’t have the disease
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17. Screening Wilson and Jungner criteria
Criteria for appraising the viability, effectiveness and appropriateness of a screening programme
Basically looks at how good a screening program is to determine if it should be offered on the nhs
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18. Screening Wilson and Jungner criteria: The condition The test
Important health problem
Natural history understood
Have a latent stage
The test
Suitable
Acceptable
Interval determined
Important health problem: common, serious
Natural history understood: disease progression eg benign to malignant cancers- bowle
Latent stage- symptom free stage, when screening aims to pick up diseases
Suitable- can detect disease
Acceptable- not too invasive
Intervals- how frequently you need to screen eg breast cancer in women aged every three years with mammogram
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19. Screening Wilson and Jungner criteria: Treatment Other Acceptable
Facilities available
Adequate health service provision
Other
Agreed policy on who to treat
Cost effective
Risk outweigh benefits
Acceptable- not too invasive
Facilities- equipment, scanners
Adequate health service provision : staff for extra workload
Agreed policy on who to treat- cut off values for what is positive/negative, problem in with psa
Cost effective: saves money from early disease detection vs cost of testing
Risk outweigh benefits: radiation exposure
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20. Alcohol

21. Alcohol One unit of alcohol= 8g of alcohol or 10ml of pure alcohol
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22. Alcohol List some health problems associated with alcohol
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23. Alcohol Cardiovascular Gastrointestinal Liver Brain Hypertension
Ischaemic heart disease
Alcoholic cardiomyopathy
Gastrointestinal
Pancreatitis
Peptic ulcers
Liver
Alcoholic hepatitis-> cirrhosis
Hepatocellular carcinoma
Brain
Cognitive impairment
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24. Alcohol
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25. Alcohol
Q. What is a positive result?

26. Alcohol
A score of 2 or greater is considered clinically significant

27. Alcohol
AUDIT
Scores of 8 or more are considered an indicator of hazardous and harmful alcohol use.

28. Alcohol
At risk drinking: (hazardous drinking) a pattern of drinking which brings about the risk of physical or psychological harm
Alcohol abuse: (harmful drinking) a pattern of drinking which is likely to cause physical or psychological harm
Alcohol dependence: set of behavioural, cognitive and physiological responses that can develop after repeated substance use
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29. Smoking

30. Smoking List some health problems associated with smoking
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31. Smoking
Lung cancer
Other cancers: stomach, kidney, pancreas, bladder, cervix, mouth, throat, oesophagus or larynx
Cardiovascular disease: ischaemic heart disease, stroke, peripheral vascular disease
Peptic ulcers
Subfertility
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32. Smoking Ready: understand process
Steady: set a quit date, throw away lighters and ashtrays
Stop: avoid triggers, rewards
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33. Smoking Q. List some reasons people smoke?
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34. Smoking Q. List some reasons people smoke? A. Reasons people smoke:
Nicotine addiction
As a method of coping with stress
Habit/behavioural addiction
As a means of socialising
Fear of weight gain after cessation
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35. Smoking Nicotine replacement therapy
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36. Obesity
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37. Obesity Definition: BMI> 30kg/m2
BMI= weight (in kg) ÷ height (in meters) squared
Becoming increasingly more common in Western societies
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38. Obesity Classification Class I: 30-34.9 Class II: 35-39.9
Class III: over 40
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39. Obesity Classification
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40. Obesity List some health problems associated with obesity
Diabetes causes a number of complications itself: macrovascular (mi, stroke, peripheral vascular disease) and microvascular (diabetic retionopthy, diabetic neuropathy, diabetic nephropathy)
Ischaemia heart disease: angina, acute coronary syndromes
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41. Obesity: complications
Type II diabetes mellitus
Ischaemic heart disease
Stroke
Osteoarthritis
Obstructive sleep apnoea
Diabetes causes a number of complications itself: macrovascular (mi, stroke, peripheral vascular disease) and microvascular (diabetic retionopthy, diabetic neuropathy, diabetic nephropathy)
Ischaemia heart disease: angina, acute coronary syndromes
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42. Obesity: Treatment Diet Exercise Medication: orlistat
Bariatric Surgery:
Restrictive procedures: gastric banding, sleeve gastroplasty
Malabsorptive procedures: gastric bypass, biliopancreatic diversion
Mixed restrictive plus malabsorptive procedures: Roux-en-Y procedure
Orlistat inhibits gastric and pancreatic lipases in the intestine preventing the breakdown of triglycerides into absorbable free fatty acids. Instead triglycerides are excreted unchanged.
Restrictive procedures limit the quantity of food the person can eat
Malabsorptive procedures
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43. Metabolic syndrome Three or more from
Central obesity- raised waist circumference
Elevated triglyceride
Low HDL
Hypertension
Raised fasting plasma glucose
Collection of risk factors of metabolic origin that increase a persons risk of ischaemic heart disease, stroke etc. Insulin resistance is the basic underlying mechanism
Also known as syndrome x
Central obesity is more highly correlated with the metabolic risk factors than body mass index (BMI) and therefore measurement of waist circumference (around the navel) is recommended to identify the bodyweight component of metabolic syndrome
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44. Prevention
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45. Prevention Primary prevention: preventing disease occurrence
Secondary prevention: detecting diseases in their early stage
Tertiary prevention: preventing complications
Primary- vaccinations, healthy eating, folic acid
Secondary- screening- breast, cervical, bowel,
Tertiary- screening for retinopathy in those with diabetes
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46. Notifiable diseases
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47. Notifiable diseases
Registered medical practitioners have a statutory duty to report individual cases of notifiable diseases
Notify the proper officer of the local authority
Notification form must be received within three days
If urgent verbal notification must be received within 24 hours
Laboratories also have a duty to notify
proper officer of the local authority is usually a consultant in communicable disease control
RMPs should notify even if the laboratory has already notified the case
Based on clinical suspicion, do not wait for lab confirmation
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48. Notifiable diseases Acute encephalitis Infectious bloody diarrhoea
Acute infectious hepatitis
Acute meningitis
Acute poliomyelitis
Anthrax
Botulism
Brucellosis
Cholera
Diphtheria
Enteric fever
Food poisoning
Haemolytic uraemic syndrome
Infectious bloody diarrhoea
Invasive group A streptococcal disease
Legionnaires’ disease
Leprosy
Malaria
Measles
Meningococcal septicaemia
Mumps
Plague
Rabies
Rubella
Severe Acute Respiratory Syndrome
Scarlet fever
Smallpox
Tetanus
Tuberculosis
Typhus
Viral haemorrhagic fever
Whooping cough
Yellow fever
List of notifiable diseases
Red: urgent, verbal notification within 24 hours
Black: written notification within 3 days

49. Details to go on form: patient details, occupation (food industry), recent foreign travel, current location

50. Quiz
proper officer of the local authority is usually a consultant in communicable disease control
RMPs should notify even if the laboratory has already notified the case
Based on clinical suspicion, do not wait for lab confirmation
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51. Quiz List the four questions in the CAGE questionnaire
proper officer of the local authority is usually a consultant in communicable disease control
RMPs should notify even if the laboratory has already notified the case
Based on clinical suspicion, do not wait for lab confirmation
The Peer Teaching Society is not liable for false or misleading information…

52. Quiz CAGE questionnaire
Have you ever felt you should cut down on your drinking?
Have people annoyed you by criticizing you drinking
Have you ever felt guilty about your drinking
Have you ever had a drink first thing in the morning- eye opener
proper officer of the local authority is usually a consultant in communicable disease control
RMPs should notify even if the laboratory has already notified the case
Based on clinical suspicion, do not wait for lab confirmation
The Peer Teaching Society is not liable for false or misleading information…

53. Quiz
proper officer of the local authority is usually a consultant in communicable disease control
RMPs should notify even if the laboratory has already notified the case
Based on clinical suspicion, do not wait for lab confirmation
The Peer Teaching Society is not liable for false or misleading information…

54. Quiz How many grams of alcohol in one unit?
proper officer of the local authority is usually a consultant in communicable disease control
RMPs should notify even if the laboratory has already notified the case
Based on clinical suspicion, do not wait for lab confirmation
The Peer Teaching Society is not liable for false or misleading information…

55. Quiz How many grams of alcohol in one unit?
proper officer of the local authority is usually a consultant in communicable disease control
RMPs should notify even if the laboratory has already notified the case
Based on clinical suspicion, do not wait for lab confirmation
The Peer Teaching Society is not liable for false or misleading information…

56. Quiz List some forms of nicotine replacement therapy
proper officer of the local authority is usually a consultant in communicable disease control
RMPs should notify even if the laboratory has already notified the case
Based on clinical suspicion, do not wait for lab confirmation
The Peer Teaching Society is not liable for false or misleading information…

57. Quiz List some forms of nicotine replacement therapy
proper officer of the local authority is usually a consultant in communicable disease control
RMPs should notify even if the laboratory has already notified the case
Based on clinical suspicion, do not wait for lab confirmation
The Peer Teaching Society is not liable for false or misleading information…

58. Quiz How does orlistat work?
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59. Quiz How does orlistat work?
Orlistat inhibits gastric and pancreatic lipases in the intestine preventing the breakdown of triglycerides into absorbable free fatty acids. Instead triglycerides are excreted unchanged.
The Peer Teaching Society is not liable for false or misleading information…

60. Quiz Fill out this table Classification BMI Underweight Healthy
Overweight
Class I obesity
Class II obesity
Class III obesity
Fill out this table
The Peer Teaching Society is not liable for false or misleading information…