Behavioral Science Flashcards
Cross sectional study
collects data at particular point in time from group of people o assess freq of disease and related risk factors.
Case control study
Compares group of people with disease/condition with group that does not. Purpose is to determine risk factors. Retrospective. Good for rare diseases.
Cohort study
Examines large group and watches it evolve over time based on different exposures. Prospective.
Types of Bias
Confounding, Sampling, Recall, Selection, Late-Look
Confounding bias
Variable closely related to another. E.g. people who drink coffee more likely to have certain types of cancer. (Confounder–people who drink coffee are more likely to smoke.)
Sampling bias
Sample of people chosen for study not representative. (E.g. study that only looks at men or healthy patients)
Recall bias
When people asked to recall information, might be basied based on new knowledge, e.g. if they were told they were on the placebo, less likely to say they felt a difference.
Selection bias
Investigators chose how to group participants for purpose of study. E.g. disproportionately assigning patients with more severe disease the experimental treatment.
Late-look bias
Results recorded at wrong time, skewing outcomes.
Main ways to reduce bias
Blinding and randomization
Sensitivity
How often the test will detect the presence of the disease in people who truly have the disease, i.e. how reliable it is in identifying people who have the disease.
Specificity
How often the test will detect the absence of a disease in those who do not have the disease, i.e. how well it identifies disease-free individuals
Positive predictive value
Likelihood that a positive test result truly means that the patient has the condition
Negative predictive value
Likelihood that a negative test result truly means that a patient does not have a given condition
Absolute risk
Likelihood of outcome over time without comparison to another group
Attributable risk
How much risk is actually due to the condition being studied. Attrib risk=Absolute risk (if exposed)-Absolute risk (not exposed)
Relative risk
Comparison of risks between two different conditions or groups of people
Odds ratio
Probablility of event happening/probability of event not occuring
Precision
Reproducibility
Accuracy
How close a measurement is to the true value
Systematic error
Errors that occur the same way every time a measurement is taken. Precise, but not accurate.
Random error
Unavoidable. Different each time a measurement is taken.
Positive skew
Tail on right
Type I error
False positive
Type II error
False negative
Power
Probability of rejecting null hypothesis when it is in fact false.
T-test
Compares means of two groups to see if a difference exists
ANOVA
Determines statistical difference between means of three or more groups
Chi-squared
Determines statistical difference btween two or more percentages or proportions of categorical outcomes (not mean values)
Correlation coefficient
Between 1 and -1. Indicates strength and direction of a linear relationship between 2+ different and independent variables.
Secondary disease prevention
Seeks to detect disease early in course before clinically apparent. E.g. cervical cancer screening. Screening tests usually very sensitive.
Tertiary disease prevention
Aims to reduce disability or morbidity from a disease
Reportable infectious diseases
Hep B, hep A, salmonella, shigella, syphilis, measles, mumps, AIDS, rubella, TB, chicken pox, gonorrhea
Leading causes of death-infants
Congenital abnormalities, short gestation/low birth weight, SIDS, maternal complications, RDS
Leading causes of death-ages 1-14
Injuries, cancer, congenital abnormalities, homicide, heart disease
Leading causes of death-ages 15-24
Injuries, homicide, suicide, cancer, heart disease
Leading causes of death-25-64
Cancer, heart disease, injuries, suicide, stroke
Leading causes of death-ages 65+
Heart disease, cancer, stroke, COPD, pneumonia, influenza
Medicare Part A
Covers certain costs for hospitalization, skilled nursing facilities, home health care, hospice care. Requires monthly premium. Available for >65 Y.O.A. or those with chronic renal disease and in need of dialysis or transplantation or those who are disabled.
Medicare Part B
Available for patients who elect to pay a separate monthly premium. Covers medical expenses for physician services, physical/occupational/speech therapy, med equipment, diagnostic tests, preventive care. Outpatient meds and eye, hearing, dental not covered.
Medicare Part D
Administered by private insurance companies to cover prescription drugs. Only for those who are eligible for A or B.
Medicaid
State-sponsored but feds pay 50-80%. Hopsital fees, physician services, lab services, radiographs, prenatal care, preventive care, nursing home care, home health services.
Autonomy
People have the right to accept/refuse treatments. Can be breached if pt is infected with highly infectious and dangerous disease, greatly impaired decision-making capacity, autonomy legally waived by US gov’t (e.g. epidemics). Also does not count if emergency when pt is unconscious and action needs to be taken before consent may be obtained.
Informed consent
Voluntarily chooses to seek treatment and has capacity, receives full objective disclosure, idea where pt and physician are able to engage in conversation which negotiation and conflict resolution of differences are welcomed to enhance patient autonomy
Autonomy-fetus
Pregnant women can refuse tx for fetus but cannot refuse life-saving tx once child is born
Types of advance directives
Living will, medical durable power of attorney
Exceptions to confidentiality
- Indicates may harm self or someone else
- Child abuse or elder abuse. (Spousal abuse laws vary by state)
- Infectious diseases that pose significant health hazards…also “contact tracing” i.e. notification of individuals at risk, e.g. partner of someone recently dx’d with HIV
- Patients driving under the influence
- protection of individuals at risk for some harm that cannot be accomplished by some other means other than breaking confidentiality
- Cases in which there is a reasonable change that by breaking confidentiality the physician may be able to prevent some sort of harm
Tarasoff case
Highlighted limits of confidentiality. (Jealous lover confessed he was going to kill flirtatious gf and therpaist said nothing due to confidentiality. So the boy did kill his girlfriend, whose family then sued the University for not preventing her death)
Malpractice
Due to negligence, malfeasance, nonfeasance by physician or direct subordinate that has caused some type of harm to patient. Four Ds of malpractice: Duty (physician accepts duty to patient), Derelection, Damage, Direct
Apgar Scoring
Appearance (0-cyanotic 1-cyanotic extremities 2-normal)
Pulse (0-Absent 1-100)
Grimace-reflex irritability/response to simulation (0-no response 1-grimace 2-grimace and cough, pull away and/or sneeze)
Activity-muscle tone (0-none 1-weak, irregular 2-strong, regular)
8-10 normal (perfect 10 not usually given)
4-7 some resuscitation may be needed
0-3 immediate resuscitation necessary. Low score usually related to inadequate ventilation as opposed to cardiac pathology.
Low birth weight
<2500g. Caused by premature birth or intrauterine growth restriction.
Risks of low birth weight
Sepsis Infant resp distress syndrome (aka hyaline membrane disease) Necrotizing enterocolitis Intraventricular hemorrhage Persistent pulmonary hypertension
Premature birth
Before 37 weeks
Newborn reflexes
Moro (spreads and unspreads arms when startled).
Babinski
Palmar
Rooting
Normal changes in aging
Sexual changes (Men-slower erection and ejaculation, longer refractory period; women-vaginal shortening, thinning, and dryness)
Sleep pattern changes-decreased REM and slow wave sleep, increased sleep latency
Increased frequency of certain medical conditions
Psychiatric problems common
Higher suicide rate
Thinking becomes less theoretical and more practical
Stages of Grief
Denial, Anger, Bargaining, Despair/Depression, Acceptance
IQ-mild retardation
55-69
IQ-moderate retardation
40-55
IQ-severe retardation
25-40
IQ-profound retardation
<25
Operant conditioning
Reinforcements (pos or neg) or punishments (pos or neg)
Mature Defense Mechanisms
Altruism, humor, sublimation, suppression
Immature Defense Mechanisms
Acting out, dissociation, denial, displacement, fixation, identification, intellectualization, isolation, projection, rationalization, reaction formation, regression, repression, splitting
