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Soc Pop & VLE > Block 3 SocPop > Flashcards

Block 3 SocPop Flashcards

1
Q

Define bias

A

Any trend in the collection, analysis, interpretation, publication of review of data that can lead to conclusions, that are systematically different from the truth

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2
Q

Define confounding factor

A

A confounding factor is something that is associated with both the exposure and the outcome

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3
Q

Compare deterministic vs stochastic approaches to causality

A

Deterministic:

  • Inevitability
  • Validation of hypothesis by systematic observations to predict with certainty future events
  • Newtonian thinking
  • Mechanistic - can take apart to study
  • Objective, quantifiable and certain
  • Whole is sum of parts
  • Very useful in thinking about a single cause for a single disease
  • Eg. tubercle bacillus is the the cause of tuberculosis

Stochastic:

  • Probability
  • Assessment of hypothesis by systematic observations to give risk of future events
  • Quantum thinking
  • Whole greater than sum of parts
  • Probabilities
  • Systems theory; complexity theory, the observer influences the observed, emergent phenomena
  • eg. overcrowded accommodation increases incidence of tuberculosis
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4
Q

Describe Bradford Hill’s Criteria for Inferring Causality (1965)

A

Bradford Hill’s Criteria for Inferring Causality (1965)
 Group of minimal conditions necessary to provide adequate evidence of a causal relationship between an incidence and a consequence.
 Criteria that make a causal link more likely:

Association features:
1. Strength of association – commonly measure by rate ratio or odds
ratio
2. Specificity of association – disease associated with one specific factor
3. Consistency of association – observed in different studies and
different sub-groups

Exposure/outcome

  1. Temporal sequence – exposure to the putative cause has be shown to precede the outcome
  2. Dose response – different levels of exposure to the putative factor lead to different risk of acquiring the outcome
  3. Reversibility – removal or prevention of the putative factor leads to a reduced or non-existent risk of acquiring the outcome, strongest evidence for a causal link

Other evidence
1. Coherence of theory – association confirms with current knowledge
2. Biological plausibility – biologically plausible mechanism is likely or
demonstrated
3. Analogy – analogy exists wit other disease, species or settings
o E.g. epidemiology of Hepatitis B virus was successfully used to predict how HIV virus would spread

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5
Q

Describe reverse causality

A

Reverse Causality
 High correlation between unemployment and mental illness o Is it because mental illness causes unemployment
OR
o Is it because unemployment causes mental illness o Both are true!

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6
Q

What is the hierarchy of evidence?

A
  1. Systematic reviews
  2. Experimental studies
    a. Randomised Controlled Trials
    b. Controlled trials
  3. Observational studies
    a. Cohort studies
    b. Case control studies
  4. Descriptive studies
    a. Cross sectional
    b. (Qualitative studies)
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7
Q

What are the different types of bias?

A
  1. Selection
  2. information
  3. Confounding

Selection - Design phase, execution

  1. Admission
  2. Prevalence/incidence
  3. Detection
  4. Volunteer
  5. Loss to follow up

Information – data collection phase

  1. Interviewer
  2. Questionnaire
  3. Recall
  4. Diagnostic suspicion
  5. Exposer
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8
Q

What are lay beliefs/knowledge?

A
  1. Beliefs are things we believe to be true
  2. Perspectives of ‘ordinary’ people
  3. Often complex and sophisticated
  4. May be sensible or irrational
  5. E.g. I’m thin therefore I’m not at risk of heart disease
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9
Q

Where do lay beliefs/knowledge come from?

A
  1. Rooted in socio-cultural contexts in which we live
  2. Shaped by people’s:
    a. place in society
    b. culture
    c. personal biography (experience)
    d. social identify eg gender, sexuality, ethnicity, occupation
  3. Can be informed by medical and health knowledge
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10
Q

Define culture. And what is culture’s role in health beliefs?

A

Definition
values, norms, and traditions that affect how individuals of a particular group perceive, think, interact, behave, and make judgments about their world (Chamberlain 2005 p197).

Role in health beliefs:
Culture shapes the way we think, feel and experience our lives.

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11
Q

Why is it important for doctors to know lay beliefs/knowledge?

A
  1. Insights into needs of your patients: a. information and support
  2. Influence health seeking behaviour:
    a. How people respond to symptoms
    b. Decisions about consulting
    c. Expectations about treatment
    d. Concordance with treatment plans
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12
Q

How does health seeking behaviour ‘symptom iceberg’ influence on whether patients visit a doctor?

A

 1/3 will respond to symptomSee GP (or other healthcare professional)
 2/3 will NOT respond to symptoms by seeing a clinician even if they indicate something serious:
1. Do nothing
2. self medicate
3. consult someone else e.g. parent, friend

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13
Q

What are some social triggers to seeking medical help?

A
  1. Interference with social and personal relationships
  2. Interference with vocational or physical activity
  3. ‘Sanctioning’ by others – influence of lay referral system
  4. A ‘temporalising’ of symptomology
  5. Interpersonal crisis
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14
Q

Define health behaviours. What are the 3 types of health behaviours?

A

“Behaviours that are related to the health status of the individual” (Ogden, 2007).

3 types:

  1. Good health behaviours e.g. sleeping 8 hour/day
  2. Health protective behaviours e.g. wearing seatbelt
  3. Health impairing habits e.g. smoking
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15
Q

What is the dual pathway model?

A

Two broad ways in which psychological processes may influence physical health

  1. Direct path: stress having a direct impact on physical health
  2. Indirect: stress resulting in change in Behaviour e.g. drinking alcohol impact on physical health.
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16
Q

What are the four groups of determinants of social behaviour?

A
  1. Background factors: Characteristics that define the context in which
    people live their lives
  2. Stable factors: Individual differences (personality) in psychological
    activity that are stable over time and context
  3. Social factors: Social connections in the immediate environment
  4. Situational factors: Appraisal of personal relevance that shape
    responses in a specific situation
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17
Q

What are individual differences (stable factors)?

A

Stable factors: Individual differences (personality)
1. variations between people in psychological activities that, within
people, produce responses that are stable across time and context
2. Influence appraisal in 3 ways:
a. they determine if, and to what extent, an event is salient, i.e. sensitivity towards particular types of event
b. they provide a generalised framework for understanding and evaluating the event, e.g. as threat or challenge
c. they make available, or suggest, potential responses, i.e. initial response options

Types of individual differences

  1. Emotional dispositions: Psychological processes involved in both the experience and expressionpresent
  2. Generalised expectancies: Psychological processes involved in formulating expectations in relation to future outcomes  future
  3. Explanatory styles: Psychological processes involved in explaining the causes of negative eventspast
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18
Q

What are the 5 different emotional dispositions (OCEAN)?

A

Openness to new experiences - Intellect and interest in culture; artistic, curious, imaginative, wide range of interest.

Conscientiousness - The will to achieve; self disciplined, efficient, organised, reliable, thorough

Extroversion - Outgoing; talkative, enthusiastic, seeking excitement, assertive and active

Agreeableness - Loving, friendly and compliant; sympathetic, appreciative, trusting, kind, forgiving, generous

Neuroticism - Experience more negative emotions; anxious, tense, worried, hostile, self-pitying, vulnerable

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19
Q

What is locus of control?

A
  1. Expectations that future outcomes will be determined by factors that are either internal (self) or external (powerful others, and chance)
  2. associated with more favourable outcomes, and performance of health behaviours, but is dependent on situational factors
  3. People with an internal locus of control believe:
    a. they are responsible for their own health,
    b. Illness can be avoided by taking care of themselves
    c. ill health results in part from not eating correctly or not getting
    enough exercise (Hayes and Ross, 1987).
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20
Q

What is self-efficacy?

A

Belief in one’s own ability to organise and execute a course of action, and the expectation that the action will result in, or lead to, a desired outcome

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21
Q

What are the social cognition theories?

A 
• attempt to explain the relationship between social cognitions (e.g. beliefs, attitudes, goals, etc.) and behaviour
• there are 3:
1. health belief model HBM
2. theory of planned behaviour
3. transtheoretical model
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22
Q

What is the difference between social carers (paid carers) and unpaid carers?

A 
Paid carers (social care workers):
include staff who work with people in residential care homes, in day centres and who provide personal care in someone’s home.

Unpaid carers:
‘Carers provide unpaid care by looking after an ill, frail or disabled family member, friend or partner

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23
Q

What are the main types of carers?

A
  1. Unpaid or paid
  2. Non-contractual or contractual
  3. Private or public
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24
Q

What kinds of support do unpaid carers provide?

A
  1. Other practical help
  2. Keeping an eye on person cared for
  3. Keeping person cared for company
  4. Taking person cared for out
  5. Helping with other paperwork or financial matters
  6. Helping with dealing with care services and benefits
  7. Personal care
  8. Physical help
  9. Giving medicines
  10. Other help
25
Q

What are the advantages and disadvantages of using the term ‘carer’?

A

Advantages

  1. Identify need and provide/signpost to services accordingly
  2. Recognition of work and contribution of carers
  3. Sense of identityMore likely to attend support groups etc.

Disadvantages

  1. Only seen in terms of being a carer
  2. Lock people into a role they do not want
  3. May prefer to define themselves as son, daughter mother etc.
  4. Undermines person being cared for
26
Q

What are the main impacts of caring on carers (including young carers)?

A
  1. Financial and work
    a. Lower incomes
    b. Higher costs e.g. laundry, heating bills etc
    c. Carers UK (2014) – 1/2 struggling to pay household bills or make
    ends meet
    d. 1/3rd cutting back on essentials
  2. Relationships and social exclusion
    a. Difficulty accessing holidays, leisure pursuits and other social
    activities
    b. May be harder to maintain relationships and social networks
    c. May get few or no breaks from caring responsibilities
    o Individuals cared for by relatives less likely to receive services
    o Black and minority ethnic carers less likely to receive practical support
  3. Health
    a. May have poorer mental and physical health than non-carers
    o 92% said it had a negative impact on mental health (Carers UK 2014)
    b. Evidence that caring for a child with LLTI/disability increases risk of parent developing LLTI/disability (Blackburn et al, 2011, Kelly et al, 2007)
    c. Injuries due to manual handling
    d. Lack of time to care for own health
  4. Young people
    a. Impact on education – no time for school work, lack of sleep,
    impact higher education
    b. Social life – difficulty making friends, bullying, isolation-going out
    as parent may not be able to take them
27
Q

What support is there for adult carers?

A

Financial support:

a. Carer’s Allowance if caring for at least 35 hours a week for someone on a qualifying disability benefit and not earning more than £116 per week
b. Carer Premium payable with means-tested benefits

Carer’s Assessment:
a. Care Bill (2014) gives local authorities a responsibility to assess a adult carer’s own needs for support.
Carers’ organisations and support groups

28
Q

What support is there for young carers?

A

Social services: legal entitlements
a. Since April 2015 a social worker from the local authority must visit
to carry out a “young carer’s needs assessment” – identify
support needed

Schools

Young carers projects
a. Take a break from caring, spend time with other young carers
b. Support use of local services e.g. sports clubs
c. Advice/emotional support, counselling
d. Liaising with schools
e. Provide opportunities for young carers to learn more about
parent’s illness/disability

29
Q

What are some key ways of improving health and wellbeing of carers?

A
  1. Better access to social care
  2. Better social security benefits for carer and person cared for
  3. Carer-friendly employment policies
  4. Increased awareness of and services for:
    a. Black and minority groups
    b. Child carers
  5. Doctors role
30
Q

What is the role of doctors in supporting carers?

A
  1. Identify whether someone has caring responsibilities when discussing their health
  2. Responsive health care for carer and person they care for
  3. Consider carer when planning care of patient and discharge planning
    a. Involved carer in all stages of discharge planning (NHS guidance:
    Ready to Go (2010)
    b. Carer, as well as patient, can have an assessment prior to
    discharge
    c. Families and friends have a choice whether to take on caring
  4. Give early information about rights and entitlements
  5. Signposting carers to services: Carers Assessment, Carers Allowance,
    Social Services, other services, support groups
31
Q

Define chronic illness

A

The experience of a long-term condition for which there is currently no cure, and which is managed with drugs and other treatment

32
Q

What is the approximate proportion of people living with a chronic illness

A

1 in 3 have at least 1 long term condition Of these:
24% have 2 LTCs
20% have 3 or more LTCs

33
Q

What are some common elements of patients’ illness narratives?

A
  1. Search for meaning and explanation
  2. Uncertainty and unpredictability
  3. Coping and Resilience
34
Q

What is the impact of chronic illness?

A
  1. Daily activities e.g. work, hobbies, self caring, caring
  2. Social relationships
  3. Sense of self (biographical disruption)
  4. Social identity – how others see you
35
Q

What are some common coping strategies for chronic illness?

A
  1. Denial: early stages, helps person take stock, presents difficulty if persists
  2. Normalisation:
    a. ‘Passing’ (Bury 1988)
    b. Re-designation of ‘normal’ life
  3. Resignation
  4. Accommodation
36
Q

What are expert patients?

A

Patients can take the lead in managing their conditionbetter outcomes
An expert patient is someone who:
1. feels confident and in control of their life
2. aims to manage their condition and its treatment in partnership with
healthcare professionals
3. communicates effectively with professionals and is willing to share
responsibility for treatment
4. is realistic about how their condition affects them and their family
5. uses their skills and knowledge to lead a full life

37
Q

What is the expert patient programme?

A
  1. A peer-led self management programme
  2. Aims to improve self-management
  3. Six-week programme suitable for any long-term health condition
  4. Covers topics such as: healthy eating, exercise, pain management,
    relaxation, action planning and problem solving.
  5. Are also some disease specific programmes
38
Q

What are some benefits and issues with expert patient programmes?

A

Benefits:

  • Felt more confident that their symptoms would not interfere with their lives
  • Felt better prepared for appointments with health care professionals
  • Fewer visits to GP
  • Fewer visits to ED

Problems:

  • Not attractive to everyone
  • Everyone not able to participate
  • Extra pressure on patient organisations
39
Q

What is the self-regulatory model and its elements?

A

Self-regulatory model:

  • Representation of illness
  • Interpretation
  • Coping
  • Appraisal
  • Emotional response to illness

Clinical application:

  1. Has been applied to range of chronic illnesses to help understand adaptation and coping, e.g. Multiple Sclerosis, Chronic Fatigue Syndrome, Diabetes….and more.
  2. Illness Perception Questionnaire (IPQ-R), Brief-IPQ (Broadbent et al, 2006). Nine items, used by clinicians and researchers.
  3. Develop appropriate management plan, work with the patient.
40
Q

What is the impact of chronic illness on the patient - psychological perspective?

A
  1. Changes in life – reduced quality of life
  2. Shock
    Patients need to:
  3. adjust to symptoms and disability
  4. Maintain a reasonable emotional balance
  5. Preserve a satisfactory self-image and sense of competence
  6. Learn about symptoms and treatment and most importantly self
    management
  7. Relationships with friends and family
  8. Forming and maintaining relationships with health care professionals
  9. Preparing for an uncertain future
41
Q

What is crisis theory?

A
  1. How do people manage and cope with chronic illness?
  2. They need to find a social and psychological equilibrium.
  3. Challenges, setbacks and social influences (family) are important and
    can influence coping responses.
42
Q

What are the features of a pain management programme and what are the pros and cons?

A
  1. Reinforce message of gate control theory – a combination of psychological and physical factors can open and close the gate.
  2. Involve – clinicians, specialist nurses, physiotherapists and psychologists.
  3. Intense, residential or spread over 6-8 weeks.

Pros

  1. Helps patients manage their pain rather then the pain managing/controlling them.
  2. Learn to change cognitive perceptions of pain, less catastrophising, challenging unhelpful thoughts
  3. Management of stress and anxiety as well as low mood, depression.
  4. Not feeling so isolated with the condition when in a group.

Cons

  1. Managing group dynamics
  2. Stages of change – are they ready to change their behaviours
  3. Commitment
  4. Managing fears
43
Q

What is the difference between observational studies and experimental studies?

A
  1. Observational studies observe rather than intervene or manipulate distributions and determinants of health
  2. How much disease, causes, what puts people at risk
  3. Observational informs health policy, planning, provision and
    future research
  4. Intervention not given or planned by investigator
44
Q

What are the two types of observational studies?

A
  1. Descriptive – examine distributions
    e. g. How much measles is there in different states in the US?
  2. Analytical – examine determinants
    e. g. is vaccination related to measles incidence?
45
Q

What are ecological studies?

A

Studies at the area level of distributions and distributions of determinants,
generally use available administrative or population-level data

They measure prevalence and incidence of disease

Advantages:

  • Good for hypothesis generation
  • Cheap and simple to do

Disadvantages:

  • Can only establish association not causation
  • Data may be unreliable
46
Q

What is the limitation of “ecological fallacy”?

A

Inferences are drawn about individuals because of conclusions drawn from data relating to the group

47
Q

What are cross-sectional studies/surveys?

A

Studies where data are collected from sample at one point in time. Can be descriptive or analytical.

Descriptive is used for prevalence
Analytic is used to see which exposure/risk factors are associated with a specific outcome

Advantage - good for hypothesis generation

Disadvantage - Can only establish association, not causation

48
Q

What are case-control studies?

A
  1. Analytic studies comparing exposure for a group with a condition (cases) and a group without the condition (controls)
  2. Look backwards

Used for rare disease or diseases that have long latent (undetectable or undetected periods)

49
Q

How should controls for case-control studies be selected?

A
  1. Matching controls to cases
  2. Must consider effect of different sources of recruitment e.g. cases
    from hospitals and controls from local youth clubs.
  3. If controls also from hospitals, too similar to cases, may not find
    difference you are looking for

Usually working with small number of cases, therefore, increasing the number of controls – 4-6 times as many, can improve precision of effect estimate

50
Q

What are the advantages and disadvantages of case-control studies?

A

Advantages:

  1. Useful for rare diseases/long latent diseases
  2. Fast and cheap
  3. Loss to follow up is not an issue
  4. Good to examine multiple exposure/risk factors

Disadvantages:

  1. Recall bias especially for exposures
  2. Cannot measure incidence or prevalence
51
Q

What are cohort studies?

A

An analytical study in which a group of people e.g. a population sample (UK) or occupational sample (US Nurses Health Study) is followed up over time to compare incidence of an outcome in exposed and unexposed groups

What are they used for:
1. Rare exposures but not for rare diseases
2. For understanding aetiology and prognosis – can see if cause
precedes an effect
3. Detecting small increases in risk with big public health consequences
4. Detecting threshold effects, does-response relationship, interaction
effects e.g. in relation to healthy lifestyle, refugee status
5. Used when an RCT cannot be used

Prospective vs. retrospective
1. Usually prospective
2. Can be retrospective e.g. using administrative data, choose a start
point, ‘recruit’ disease-free individuals and follow them forward as far as records allow

How are they analysed?
Two ways depending on population used:
1. Incidence rate ratio (IRR)
2. If an external reference population is used then, Standardised
mortality/morbidity ratio (SMR)
52
Q

What are the advantages and disadvantages of cohort studies?

A

Advantages:

  1. Can establish incidence
  2. Can establish causality - exposure precedes outcome/disease
  3. Can study a range of outcomes or diseases for each exposure

Disadvantages:

  1. Lengthy and expensive
  2. Selection bias
  3. Selective non-response
  4. Migration
  5. Loss to follow-up are major issues
53
Q

Define controlled clinical trial

A

A controlled clinical trial is a prospective study comparing effect(s) and value of an intervention against a control in human subjects

54
Q

Define randomised clinical trial

A

A randomised clinical trial (RCT) is a controlled clinical trial where the therapies are allocated by a chance mechanism

55
Q

Uncontrolled clinical trial

A

An uncontrolled clinical trial involves no control group

56
Q

What is the purpose of a clinical trial?

A
  1. A clinical trial is a scientific way of testing a clinical question
  2. May want to assess:
    a. Treatments
    b. Supportive care
    c. Devices
    d. Screening programmes
    e. Information
    f. Diagnostic tests
    g. Biomarkers
  3. Need to compare with control group
57
Q

What are the features of randomised controlled trials and why are they important in the design?

A
  1. concurrent controls
    have all patients undergo the two types of treatments at the same time, prevents historical controls process and thus eliminates bias and makes the trial fairer
  2. type of comparator
  3. Differences in outcomes between treatment groups may be due to:
    a. Treatment effect
    b. Bias
    c. Chance
  4. Groups must be alike in all important aspects except for the treatments under evaluation (possible bias)
  5. Large enough sample (limit chance imbalances)
  6. random allocation / randomisation
  7. want groups to differ only in treatment they receive
  8. Random allocation
    a. gives equal chance of receiving each treatment
    b. in long run leads to groups that are likely to be similar in
    characteristics by chance
    c. reduces selection bias if patients enter trial before
    randomisation
    d. is used in other experimental settings
  9. placebo effect.
  10. A difference between ‘new treatment’ group and ‘no treatment’ group could be due to:
    a. true treatment effect
    b. placebo effect as one group is receiving care
  11. Even if the therapy is irrelevant to the patient’s condition, the
    patient’s attitude to his or her illness, and indeed the illness itself, may be improved by a feeling that something is being done about it
  12. blinding
  13. strengthens randomisation
  14. Aims to remove differential placebo effect that could bias
    comparison between treatments
  15. Single blind – one of patient, clinician, assessor does not know the
    treatment allocation
    (usually patient)
  16. Double blind – two or more of patient, clinician, assessor does not know the treatment allocation
    (usually patient + clinician/assessor)
58
Q

In RCTs, how does as-treated analysis differ from intention to treat analysis

A

As-treated analysis: tend to give larger sizes of effect
Intention to treat analysis: tends to give smaller effect sizes and reflect effect in clinical practice.
Intention to treat analysis is preferred for assessing treatment in clinical practice.

59
Q

What are the ethical issues in a trial?

A
  1. Clinician should provide best treatment for each individual patient
  2. Scientific integrity requires treatment chosen randomly
  3. Clinical equipoise
  4. reasonable uncertainty about which treatment (including non- treatment) is better
  5. Randomisation does not deny any patient the best treatment
  6. Informed consent
  7. It should be explained
    a. that the patient is invited to be in a trial
    b. what the alternative treatments are (including known side
    effects)
    c. that treatment will be allocated at random
    d. that patients may withdraw at any time
  8. Information should be given
    a. verbally and in writing with ‘cooling off’ time
    b. by a knowledgeable informant

Soc Pop & VLE (12 decks)

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