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MRCPsych Part B > Causality > Flashcards

Causality Flashcards

1
Q

Who created the postulates of determining that a disease was caused by a bacteria?

A

Robert Koch 1890

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2
Q

What are Koch’s postulates?

A

Consistency
Specificity
Biological coherence
Predictive or experimental performance

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3
Q

Explain consistency re Koch

A

Agent must be shown to be present in every case of the disease by isolation in pure culture

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4
Q

What is Koch’s specificity?

A

Agent must not be found in the case of another disease

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5
Q

What is Koch’s biological coherence?

A

Once isolated, the agent must be capable of reproducing the disease in experimental animals

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6
Q

What is Koch’s predictive performance?

A

The agent must be recovered from the experimental disease produced

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7
Q

What criteria of causality can be used?

A 
Koch
Bradford Hill
Susser
Rothman's Sufficient
Web of causation
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8
Q

What is Bradford Hill’s criteria of causality?

A 
Temporal association
Dose-response association
Specificity
Consistency
Plausible biological association
High strength of oassociation
Absence of reverse causality
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9
Q

Susser’s categories of causation

A 
Strength
Specificity - in cause and effect
Consistency
Predictive Performance
Coherence/plausability
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10
Q

How can one measure Susser’s consistency?

A

Replicability

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11
Q

Subcategories of Susser’s Coherence category?

A

Theoretical
Factual
Biological
Statistical

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12
Q

Essential categories of Susser’s causality

A

Association
Direction of prediction
Time order

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13
Q

How is Susser’s association category judged?

A

By strength of probabilities based on preset expectations of chance occurrences and consistency upon replication.

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14
Q

Explain Susser’s category of Direction of Prediction

A

Change in one state assumed to be the effect must be consequent on change in independent antecedent states presumed to be the cause.

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15
Q

Which essential criteria of Sussers is more critical in defining causality?

A

Direction of Prediction

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16
Q

Explain Susser’s time order category

A

Reversal of time order assures elimination of putative cause

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17
Q

What is sufficient cause?

A

Minimal set of conditions that produce an outcome rather than just one

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18
Q

In which studies does one see sufficient cause

A

Epidemiology

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19
Q

What makes up sufficient cause?

A

Component cause

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20
Q

Importance of component cause

A

Outcome will not occur by a causal pathway if any of the components are missing

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21
Q

Why is the idea of component cause relevant to public health?

A

Suggests that it is not necessary to identify all of the component causes to prevent a disease outcome

22
Q

What is a necessary cause?

A

A component cause that must be present in every sufficient cause for the outcome

23
Q

What terms are associated with Rothman’s Sufficient Model?

A

Sufficient cause
Component cause
Necessary cause

24
Q

Who created the term web of causation?

A

MacMahon and Pugh in 1960

25
Q

What was web of causation used to describe?

A

Complexity of the relationship among antecedents when investigating cause of disease

26
Q

What is the concept in web of causation?

A

Mutual interactions among risk factors which have both direct and indirect effects on outcomes.

27
Q

Who expanded the web of causation?

A

Murray and Lopez

28
Q

What did Murray and Lopez do to the web of causation?

A

Separated proximal risk factors from distal

29
Q

What are proximal risk factors?

A

Established pathophysiological mechanisms

30
Q

What are distal risk factors?

A

Based on empirical evidence

31
Q

What is another name of the model Murray and Lopez created from the web of causation?

A

Hierarchical causal model

32
Q

How can positive result from a study be explained?

A

Selection differences between two groups
Measurement differences between two groups
Confounding factors causing indirect association
Chance causing spurious association (Type 1 error)
Presence of true causal assocation

33
Q

What is the independent variable?

A

The one which is having the effect

34
Q

What is the dependent variable?

A

Outcome of interest

35
Q

What criteria are needed for a characteristic to be a confounder?

A

Must be related to exposure in some way
Must be related to outcome in terms of prognosis or susceptibility
Will not be on causal pathway between exposure and outcome
Distribution of characteristic must be different in groups compared (mean or standard deviation)

36
Q

What is needed to withstand confounding effects in analytical studies?

A

Systematic effort to identify and measure potential confounders
Data on distribution of potential confounders across groups must be available

37
Q

Methods to control confounders in design of study

A

Restriction
Matching
Randomisation

38
Q

Methods t control confounders in analysis of study

A

Stratification

Multivariate methods

39
Q

What is restriction?

A

Avoid groups with significant confounding influence in study

40
Q

Disadvantages of restriction

A

Will limit sample size

41
Q

What is matching?

A

Make sure confounders are equally distributed

42
Q

Impact of randomisation on confounders

A

Will ensure two groups are more likely to b similar in terms of confounder distribution

43
Q

What must one do if randomisation does not lead to equal distribution of confounders?

A

Consider stratification or multivariates

44
Q

Which design method helps control both known and unknown confounders

A

Randomisation only

45
Q

What is stratification?

A

Tabulate data for various categories of exposure to confounder separately and analyse variable influence

46
Q

What are multivariate methods?

A

Regression methods to analyse effect of various confounders.

47
Q

What do multivariate methods produce?

A

Adjusted rates and crude rates

48
Q

What is an effect modifier?

A

A third factor existing as a sub-group but nor related to outcome or exposure

49
Q

How can effect modifiers be eliminated?

A

Stratified analysis

50
Q

How do confounders result in bias?

A

Affect internal validity of a study

MRCPsych Part B (64 decks)

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