Block 15 - part 2 Flashcards
GI cancer prevalent in middle east and china
oesophageal
GI cancer prevalent in russia
gastric
GI cancer prevalent in western world, e.g. UK
colon
dietary intake which increases risk of colorectal cancer
fat intake
evidence base for ‘5 a day’
observational epidemiology that average fruit/veg intake of less than 200g associated with increased risk of cancer, but possibly little additional benefit beyond 400g/day, very little evidence that 5 a day have impact on cancer
relationship between beta carotene and cancer
beta carotene found in fruit and veg, cohort study indicated protective relationship against cancer, RCT showed increased risk of cancer, cohort groups had reduced risk due to confounding factors
problems with measuring diet
random error, homogeneity of exposure, bias, confounding
different measures of diet
food disappearance data, household survey, individual survey
pros of food frequency questionnaires
captures usual diet and less work to code/compete
cons of food frequency questionnaires
doesn’t record actual diet as eaten, overstimulates fruit and veg, poor measure of energy intake, less flexible
food frequency questionnaires
limited checklist of foods and beverages with a frequency response section for subjects to report how often each item was consumed over a specified period of time
pros of diet diaries
records diet as eaten, better estimate of energy and absolute intake, more flexible
cons of diet diaries
required effort to complete and expensive to code
main dietary associations with oesophageal cancer
alcohol, obesity
main dietary associations with stomach cancer
possible salted preserved foods
main dietary associations with pancreatic cancer
overweigh obesity
main dietary associations with hepatic cancer
aflatoxin contamination
main dietary associations with colorectal cancer
preserved and red meat, alcohol, body fat
main dietary associations with breast cancer
alcohol, overweight
main dietary associations with urologic cancer
high calcium
tend of alcohol consumption in UK
lower consumption per capita than many European countries, people start drinking earlier and tend to drink more on single occasions ‘binge drinking’
when was peak of alcohol consumption in UK and why
2008 - affordability
percentage of men and women with alcohol use disorder
38% men, 16% women
percentage of men and women who are binge drinkers
28% men, 25% women
percentage of total population who are alcohol dependant
3.6%
where is identification and brief advice (IBA) delivered
range of settings, primary secondary care, community settings
specialised treatment available for alcohol problems
CBT, behavioural approaches, motivational interviewing, social behaviour and network therapy (SBNT)
medical conditions which are wholly attributable to alcohol (6)
alcoholic liver disease, alcoholic neuropathy, chronic pancreatitis, alcoholic cardiomyopathy, alcoholic gastritis, alcohol related accidents
social consequences of alcohol consumption
death, crime and disorder, domestic violence, poor productivity at work, absences/sick leave from work, family effects
more effective policies for alcohol health promotion
increased prices, restricting availability
moderately effective policies for alcohol health promotion
restricting exposures of young people to adverts, treatment - identification and brief advice
less effective policies for alcohol health promotion
drugs/alcohol education, mass media campaign
key UK departments involved in alcohol policy
home office (focus on public order), department of health (focus on PH)
‘alcohol strategy’ 2012
minimum unit price policy dropped, multi-buy promotion offers not banned as suggested, local health bodies able to investigate review of licences, double fine for selling alcohol to underage people, ‘enforced sobriety’ - 1 year pilots based on US models, overview alcohol consumption guidelines for adults, alcohol included in NHS health check for adults 40-75
efficiency
target resources to those activities that give the greatest health gain for the money spent as this will maximise population health gain
what is required to inform choices for efficiency
estimation of value of what is given up when a patient is treated, and what is gained in terms of improvements in health of pts
allocative efficiency
investing in health care interventions that are worthwile
technical efficiency
investing in health care interventions which make the best use of scarce resources
equity in financing
geographic allocation of funding by weighted capitation, resourcing determined by population weighted by need
class equality/inequality in health care
evidence of social class equality in the use of primary care and social class inequality in use of secondary care
concept of the ‘margin’
incremental change in resources (inputs and their costs) committed to an activity that produces an incremental change in effects (improved pt outcomes)
importance of the margin
incremental investments in an activity may be associated with diminishing returns
why do we need economic evaluation
values both inputs (opportunity costs) and outputs (health outcomes) of any intervention, assess if changes in resource allocation are efficient, important because increasing healthcare expenditure needs best outcome for the money
how is cost measured
cost to NHS - NICE perspective, cost of drug, cost of delivery
cost to pt, carers and society - lost working days
how is benefit measured
health gain = increase in length +QoL
cost-minimisation analysis
chooses cheapest option between treatments that ahve identical outcomes
cost-effective analysis
costs and outcomes are combined into a single measure in the same therapeutic area only
cost-utility analysis
combines multiple outcomes into a single measure (QALY) using QoL instruments e.g. EQ5d
what does cost-utility analysis allow
comparisons between alternatives in different therapeutic categories, e.g. CV and cancer
cost benefit analysis
puts cost and benefit into monetary/numerical terms
when can cost-effectiveness analysis be used
if outcome measures are just clinical, if other generic outcome measures are used use cost analysis to get QALY (NICE use it)
