PMHP

Question 1

Epidemiology

1. 3 roles of epidemiology
2. Define prevalence
3. Define incidence

Answer 1

1. Measure amount of disease, measure distribution and natural history of disease, assess people’s risk of disease, healthcare needs assessment, service planning.
2. Number of disease cases in a population at a given time. Estimates obtained from cross-sectional studies and derived from registers.
3. Number of new disease cases developing over a specific period of time in a defined population. Estimates obtained from longitudinal studies and derived from registers.

Question 2

Define:

1. Risk factor
2. Causative agent
3. Determinant
4. Confounding variable

Answer 2

1. Factor that increases the probability of disease occurring and if removed/absent reduces probability.
2. External factor that causes/results in disease in susceptible individuals.
3. Attribute/circumstance which affects liability of an individual to be exposed to disease/when exposed, to develop disease.
4. Minor variable, left uncontrolled, which may/may not affect results.

Question 3

Define 3 types of risk index

Answer 3

1. Absolute risk - incidence rate of disease in those exposed to the agent (assumes no exposure = no risk).
2. Attributable risk - difference between incidence rates in exposed and non-exposed groups.
3. Relative risk - measurement of proportionate increase in disease rates in exposed group.

Question 4

What are 5 methods of fluoride delivery and what are the different concentrations?

Answer 4

1. Toothpaste - 1,000ppmF (low risk <3), 1,500ppmF (high risk <10/normal concentration), 2,800ppmF (high risk >10), 5,000ppmF (high-risk >16)
2. Fluoride varnish (22,600ppmF, 5% sodium fluoride. 0.25ml for 2-6yrs, 0.4ml for >6yrs. Twice/yr for low risk, 4x/yr for high risk).
3. Mouthwash - for >7yrs, 225ppmF, must be able to spit.
4. Supplements
5. Water (ideal 1ppmF)

Question 5

What is the definition of SIMD?

Answer 5

Scottish index of multiple deprivation.

Area-based index of multiple deprivation. It is a statistical tool used to support policy and decision making. It ranks data zone (almost 7,000) in order of deprivation, where 1 is the most deprived. Datazones are often grouped into quintiles (1-5) or deciles (1-10) for analysis and intervention planning.

Level of deprivation is derived from a number of sources that measure housing, income, geographic access to services, health, education, skills and training, education and crime.

Question 6

What are the components of:

1. Consent
2. Capacity

Answer 6

1. Consent - valid, informed, with capacity, voluntary, not coerced, not manipulated.
2. Capacity - ability to act (decide), make a reasoned decision, understand a decision, communicate a decision, retain the memory of a decision.

Question 7

Describe 3 types of study design

Answer 7

1. Randomised control trial (RCT) - also known as a clinical trial. Gold standard for efficacy and effectiveness. Has 4 design elements - specification of participants (inclusion/exclusion criteria), control, randomisation, blinding/masking.
2. Cohort study - prospective study. Establishes group and measures exposures. Follows group over time, identifies those that develop disease/outcome of interest. Used for estimating incidence, investigating causes and determining prognosis.
3. Case-control study - retrospective study. Identifies 2 groups - those that develop disease and those that don’t. Looks back in time at exposure to a particular risk factor in both groups. Looks at potential causes of disease. Less robust.

Question 8

Define:

1. Absolute risk difference
2. Number needed to treat
3. Confidence intervals
4. Value of no difference

Answer 8

1. ARD - difference in risk between groups.
2. NNT - 1/ARD. Number needed to treat to prevent one patient developing outcome/disease.
3. Range of values the ARD will take in a population. 95% of the time contains the true mean.
4. When ARD=0 or RR (risk ratio)=1. Indicates insufficient evidence for difference between treatment and control groups.

Question 9

Smoking cessation

1. 4 signs/symptoms of withdrawal
2. 3 oral side effects of smoking
3. 3 things to ask about smoking in social history
4. 3 types of quitting advice

Answer 9

1. Irritability, poor concentration, depression/low mood, restlessness, increased appetite, sleep disruption.
2. Staining, halitosis, nicotinic stomatitis.
3. How long have you smoked? How many do you smoke per day? Have you tried quitting before? Would you like to quit now? Would you like help to quit?
4. 5As - ask, advise, assess, assist, arrange FU
   3As - ask, advice (tailored), act (offer help, signpost)
   ABC - ask, brief cessation advice, cessation advice for those who want it
   AAR - ask, advise, refer

Question 10

E-cigarettes

1. Definition
2. 3 benefits
3. 3 risks

Answer 10

1. Simulate tobacco smoking through vaporised nicotine delivery, without burning conventional tobacco.
2. Cheaper, safer (95%), generally successful in helping quit (maintain hand-to-mouth and psychosocial aspects of habit).
3. Unknown LT effects, not 100% safe, gateway into smoking (theory)