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Public Health Flashcards

1
Q

Study design where the frequency of disease and frequency of risk related factors are assessed in the present.

A

Cross sectional study - “What is happening”

Disease prevalence but does not assess causality

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2
Q

Study design that compares a group of people with disease to a group of people without disease. Looks to see if odds of prior exposure or risk factor differs by disease state

A

Case-control study - “what happened”

ODDs ratio

ex) people with COPD had higher odds of a smoking history than those without COPD

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3
Q

Study design that compares a group with a given exposure or risk factor to a group without such exposure. Looks to see if exposure or risk factor is associated with later development of disease.

A

Cohort study - “Who will develop the disease” or “who developed the disease”

Can be prospective or retrospective

Relative risk

ex) smokers have a higher risk of developing COPD than nonsmokers

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4
Q

Clinical trial phases: phase I

A

think “SWIM”

Phase I -“is it SAFE”. Small number of healthy volunteers or pt with dz of interest. Assess safety,toxicity, pharmkinetics, pharmdynamics

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5
Q

clinical trial : phase II

A

think “SWIM”

Phase II- “Does it WORK”. Moderate numbers of patients with disease of interest. Assess treatment efficacy, optimal dosing, and adverse effects

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6
Q

Clinical trial: phase III

A

think “SWIM”

Phase III- “IMPROVEMENT?” . Large number of pt with placebo and then with treatment. Compares new treatment to current standard of care

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7
Q

Clinical trial: Phase IV

A

think “SWIM”

Phase IV: “Can it stay in MARKET”. This is after being approved. Detects rare or long term effects

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8
Q

Sensitivity

A

True positive rate. Probability that when a dz is present then the rest is positive. SCREENING test

If negative then rules OUT a disease. Higher sensitivity has a lower false negative rate.

TP/(TP + FN) = 1- FN rate

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9
Q

Specificity

A

True negative rate. Probability that when the disease is absent the test is negative. CONFIRMATION test

When positive it rules IN a disease. Higher specificity means lower false positive rate

=TN/(TN+FP) = 1-FP rate

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10
Q

positive predictive value

A

probability that a person who has a positive test result actually has the disease

PPV= TP/(TP + FP)

varies directly with pretest probability. High pretest probability results in a high PPV

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11
Q

negative predictive value

A

probability that a negative rest actually does not have the disease

NPV=TN/(TN+FN)

varies indirectly with pretest probability. high pretest probability results in low NPV

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12
Q

Likelihood ratio

A

Likelihood that a given result would be expected in a patient with the target disorder compared to the likelihood that the same result would be expected in a patient without the target disorder

LR+ >10 and or LR- 0.1 indicates a useful diagnostic test

LR+=sensitivity/(1-specificity)=TP rate/FP rate
LR-=1-sensitivity/specificity= FN rate/TN rate

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13
Q

Odds ratio

A

Odds of a certain exposure given an event vs the odds of exposure in the absence of that event. Used in case control studies

OR=ad/bc

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14
Q

Relative risk (RR)

A

the # times risk of cancer in the exposed vs the unexposed. Used in cohort studies

RR=risk in exposure/risk in unexposed
RR=((a/a+b)/(c/c+d))

RR=1 there is not association between exposure and disease
RR>1 there is an association that causes increase in dz
RR<1 there is an association that causes decrease in dz

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15
Q

Attributable risk (AR)

A

The difference in risk between exposed and unexposed groups

Risk in exposed - risk in unexposed

AR=(a/a+b)-(c/c+d)

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16
Q

Relative risk reduction (RRR)

A

The proportion in risk reduction attributed to the intervention as compared to a control

RRR=1-RR

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17
Q

Absolute risk reduction (ARR)

A

The difference in risk (not the proportion) attributable to the intervention as compared to a control

ARR=((c/c+d) - (a/a+b))

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18
Q

Number needed to treat (NNT)

A

Number needed to treat for 1 patient to benefit

low number is better

NNT=1/ARR

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19
Q

Number needed to harm (NNH)

A

number needed to be exposed for 1 patient to be harmed

high number is better

NNH=1/AR

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20
Q

Incidence

A

new cases/#at risk

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21
Q

prevelaence

A

existing cases/total#of people in a population

increase prevalence causes increase in PPV and decreases in NPV

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22
Q

Precision

A

reliability

The consistency and reproduciblity of a test. The absence of random variation in a test

Increase precision causes decrease in standard deviation

increase in precision causes increase in statistical power

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23
Q

Accuracy

A

validity

systemic error decreased accuracy in a test

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24
Q

Berkson bias

A

study population selected from hospital is less healthy than general population

type of selection bias

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25
Q

Non response bias

A

participating subjects differ from non respondents in meaningful ways

type of selection bias

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26
Q

Hawthorne effect

A

participants change behavior upon awareness of being observed

measurement bias

use placebo group to avoid

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27
Q

Procedure bias

A

avoid with blinding and use of placebo

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28
Q

Observer expectancy bias

A

avoid with blinding and use of placebo

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29
Q

Lead time bias

A

early detection is confused with increased survival

avoid by measuring back end survival (Adjust survival according to the severity of disease at the time of diagnosis)

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30
Q

Length time bias

A

Screening test detects diseases with long latency period while those with shorter latency period become symptomatic earlier

i.e. a slowly progressive cancer is more likely detected by a screening test than a rapidly progressive cancer

prevent via a randomized controlled trial

31
Q

Standard error

A

an estimate of how much variability exists in a theoretical set of sample means around the true population mean

SD/sq root(sample size)

32
Q

variance formula

A

SD^2

33
Q

Bimodal distribution

A

suggests two different populations

34
Q

Positive skew

A

mean>median>mode

long tail on right

35
Q

Negative skew

A

mean

36
Q

Normal distribution

A

mean=median=mode

37
Q

Null hypothesis (H0)

A

Hypothesis of no difference or relationship

38
Q

Alternative (H1)

A

Hypothesis of some difference or relationship

39
Q

null hypothesis rejected in favor or alt hypothesis means

A

there is an effect or difference when one exists

40
Q

Type 1 error

A

false positive arror

stating that there is an effect when there isnt

α is the probability of making a type I error

Alpha=An innocent man

41
Q

Type II error

A

False negative error

stating there isnt an effect when there is

β is the probability of making a type II error and is related to statistical power (1- β)

Beta=blindy let the guilty go

42
Q

Confidence interval

A

range of values within which the true mean of the population is expected to fall, with a specified probability

CI for sample mean = mean +/- Z(SE)

95% CI , α=.05, Z=1.96

if CI for a mean difference bteween 2 variables includes 0=null not rejected

if CI for odds ratio or relative risk includes 1 then null not rejected

if the CI between 2 groups do not overlap then there is a statistically significant difference

if the CI between 2 groups overlap then there is no significant difference

43
Q

t test

A

checks difference between means of 2 groups

ex) mean bp between men and women

44
Q

ANOVA

A

checks difference between means of 3 or more gorups

comparing the mean bp between 3 different ethnic groups

45
Q

Chi sq

A

checks the difference between 2 or more percentages or proportions of categorical outcomes (not mean values)

ex) comparing the percentage of members of 3 different ethnic groups who have essential hypertension

46
Q

Pearson correlation coefficient

A

r is between -1 and +1. the closer the absolute value of r is to 1 the stronger the linear correlation between the 2 variables

r^2=coefficient of determination. This is the amount of variance in one variable that can be explained by variance in another variable

47
Q

core principle of ethics : justice

A

treat persons fairly and quitably

all principles are autonomy, beneficence, non maleficence, justice

48
Q

car seats

A

2 yrs old for rear facing
4 yrs old for with harness
booster seat till 8
children <12 should not ride in front

49
Q

primary dz prevention

A

prevent dz before it occurs

hpv vaccine

50
Q

secondary dx prevention

A

screen early for and manage existing but asymptomatic dz

pap smear

51
Q

tertiary dz prevention

A

treatment to reduce complications from dz that is ongoing or has long term effects

52
Q

quaternary dz prevention

A

identifying patients at risk of unnecessary treatment, preventing from the harm of new interventions

53
Q

Exclusive Provider Organization

A

restricted to limited panel except in emergences

no referrel needed for specialist

54
Q

Health maintenance organization (HMO)

A

restricted to limited panel except in emergencies, denies for any service that does not meet establish evidence based quidelines, requires referel from primary care provider

55
Q

Point of service

A

Patient can see providers outside the network, higher copays and deductibles for out of network services, requires referral form primary care provider

56
Q

Preferred provider organization

A

patient can see providers outside network, higher copays and deductibles for all services, no referral required

57
Q

bundled payment

A

healthcare org receives a set amount per service regardless of how much the patient uses the healthcare system

58
Q

capitation

A

physician received a set amount per patient assigned to them per period of time, regardless of how much he patient uses the healthcare system

used by some hmo

59
Q

discounted fee for service

A

patient pays for each individual service at a discounted rate predetermined by providers and payers

60
Q

fee for service

A

patient pays for each individual service

61
Q

global payment

A

patient pays for all expenses associated with a single incident of care with single payment

elective surgeries

62
Q

Medicare

A

elderly

63
Q

medical

A

destitute and poor

A-hospital
B-outpatient
C-Both
D-drugs

64
Q

hospice care

A

medicare, medical, and most private insurance companies pay for hospice care if <6months to live

principle of double effect- prioritize positive effects over negative effects of drugs

65
Q

readmission

A

considered when <30 days from discharge

66
Q

Human factors design

A

forcing functions (those that prevent undesirable actions) are the most effective

standardization and simplification are beneficial

deficient designs hinder workflow and lead to staff workarounds that bypass safety features

67
Q

PDSA cycle

A

P-Plan, define problem and situation
D-Do, test new process
S-study, measure and analyze data
A- Act, integrate new process into regular workflow

68
Q

Quality measures

A

Structural - physical equipment, resources, facilities (number of diabetes educators)

Process- performance of system as planned (percentage of diabetic patients whose HbA1c was measures int he past 6 months)

Outcome- Impact on patients (average HbA1C of patients with diabetes)

Balancing-impact of other systems/outcomes (incidence of hypoglycemia among patients who tried an intervention to lower HbA1C)

69
Q

Swiss cheese model

A

focuses on systems and conditions rather than an individuals error

patient harm can occur despite multiple safeguards when “the holes int he cheese line up”

potential failures in defense strategies

70
Q

Active error

A

occurs at level of frontline operator

immediate impact

71
Q

Latent error

A

occurs in processes indirect from operator but impacts patient care (different types of IV pumps used within the same hospital)

72
Q

Root cause analysis

A

retrospective approach. applied after failure event to prevent recurrence

73
Q

Failure mode and effects analysis

A

forward looking approach. Applied before process implementation to prevent failure occurrences

uses inductive reasoning to identify all the ways a process might fail and prioritizes them by their probability of occurrence and impact on

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