Chapter 2

Question 1

P.E.R.I.E Approach

Answer 1

5 basic questions that we need to ask that together make up what we will call the evidence-based public health approach

Question 2

P.E.R.I.E stands for

Answer 2

Problem
Etiology
Recommendations
Implementation
Evaluation

Question 3

Problem

Answer 3

What is the health problem?
What is the burden of a disease or other health problem? What is the course of a disease or other health problem? Does the distribution of the health problem help generate hypotheses?

Question 4

Etiology

Answer 4

What are the contributory causes?
Has an association been established at the individual level? Does the “cause” precede the “effect”? Has altering the “cause” been shown to alter the “effect”? (If not, use ancillary criteria.)

Question 5

Recommendations

Answer 5

What works to reduce the health impacts?
What is the quality of the evidence for the intervention? What is the impact of the intervention in terms of benefits and harms? What grade should be given to indicate the strength of the recommendation?

Question 6

Implementations

Answer 6

How can we get the job done?
When should the implementation occur? At whom should the implementation be directed? How should the intervention(s) be implemented?

Question 7

Evaluation

Answer 7

How well does the intervention work in practice?
How well does the intervention work in practice on the intended or target population? How well does the intervention work in practice as actually used? How well is the intervention accepted in practice?

Question 8

Burden of Disease

Answer 8

the occurrence of disability and death due to a disease

Question 9

In public health, disability is often called

Answer 9

morbidity

Question 10

In public health, death is often called

Answer 10

mortality

Question 11

Course of a Disease

Answer 11

how often the disease occurs, how likely it is to be present currently, and what happens once it occurs.

Question 12

Distribution of Disease

Answer 12

Who gets the disease? Where are they located? When does the disease occur?

Question 13

Incidence Rates

Answer 13

measure the chances of developing a disease over a period of time—usually one year

(# of new cases of a disease in a year) /(# of people in the at-risk population)

Question 14

Mortality Rates

Answer 14

a special type of incidence rate that measure the incidence of death due to a disease during a particular year; often used to measure the burden of disease

Question 15

Case-Fatality

Answer 15

the chances of dying from the disease once it is diagnosed

Question 16

Prevalence

Answer 16

the number of individuals who have a disease at a particular time divided by the number of individuals who could potentially have the disease.

(# of living with a particular disease) / (#of people in the at-risk population)

Question 17

3 basic reasons that changes in rates may be artifactual rather than real:

Answer 17

■ Differences or changes in the interest in identifying the disease
■ Differences or changes in the ability to identify the disease
■ Differences or changes in the definition of the disease

Question 18

1st definitive requirement to establish a contributory cause

Answer 18

1The “cause” is associated with the “effect” at the individual level. That is, the potential “cause” and the potential “effect” occur more frequently in the same individual than would be expected by chance.

Question 19

2nd definitive requirement to establish a contributory cause

Answer 19

The “cause” precedes the “effect” in time. That is, the potential “cause” is present at an earlier time than the potential “effect.”

Question 20

3rd definitive requirement to establish a contributory cause

Answer 20

Altering the “cause” alters the “effect.” That is, when the potential “cause” is reduced or eliminated, the potential “effect” is also reduced or eliminated.

Question 21

The 3 basic types of investigations

Answer 21

Case-control studies
Cohort studies
Randomized controlled trials

Question 22

Case-control studies

Answer 22

most useful for establishing requirement number one; that is, the “cause” is associated with the “effect” at the individual level.

Question 23

Cohort studies

Answer 23

most useful for establishing requirement number 2—the “cause” precedes the “effect.”

Question 24

Randomized controlled trials

Answer 24

most useful for establishing requirement number 3—altering the “cause” alters the “effect.”

Using a chance process known as randomization or random assignment, individuals are assigned to be exposed or not exposed to the potential “cause”. Individuals with and without the potential “cause” are then followed over time to determine who develops the “effect.”

Question 25

Efficacy

Answer 25

implies that an intervention works; that is, it increases positive outcomes or benefits in the population being investigated.

Question 26

4 main Ancillary Criteria

Answer 26

■ Strength of the relationship
■ Dose-response relationship
■ Consistency of the relationship
■ Biological plausibility

Question 27

Strength of the relationship

Answer 27

The risk for those with the risk factor is greatly increased compared to those without the risk factor.

Question 28

Relative Risk

Answer 28

Measures the strength of the relationship; the probability of developing the disease if the risk factor is present compared to the probability of developing the disease if the risk factor isn’t present.

Question 29

Dose-response relationship

Answer 29

Higher levels of exposure and/or longer duration of exposure to the “cause” are associated with increased probability of the “effect.”

Question 30

Consistency of the relationship

Answer 30

Studies at the individual level produce similar results in multiple locations among populations of varying socioeconomic and cultural backgrounds.

Question 31

Biological plausibility

Answer 31

Known biological mechanisms can convincingly explain a cause- and-effect relationship.

Question 32

Classification of the strength of the recommendation

Answer 32

A, B, C, D, and I

Question 33

A

Answer 33

Must—A strong recommendation.

Question 34

B

Answer 34

Should—In general, the intervention should be used unless there are good reasons or contraindications for not doing so.

Question 35

C

Answer 35

May—The use of judgment is often needed on an individual-by-individual basis. Individual recommendations depend on the specifics of an individual’s situation, risk-taking attitudes, and values.

Question 36

D

Answer 36

Don’t—There is enough evidence to recommend against using the intervention.

Question 37

I

Answer 37

Indeterminant, insufficient, or “I don’t know”— The evidence is inadequate to make a recommendation for or against the use of the intervention at the present time.

Question 38

Primary interventions

Answer 38

take place before the onset of the disease; they aim to prevent the disease from occurring.

Question 39

Secondary interventions

Answer 39

occur after the development of a disease or risk factor, but before symptoms appear. They are aimed at early detection of disease or reducing risk factors while the individual is asymptomatic.

Question 40

Tertiary interventions

Answer 40

occur after the initial occurrence of symptoms, but before irreversible disability. They aim to prevent irreversible consequences of the disease.

Question 41

3 basic types of interventions when addressing the need for behavioral change

Answer 41

information (education)
motivation (incentives)
obligation (requirements)

Question 42

RE-AIM

Answer 42

reach, effectiveness, adoption, implementation, and maintenance.

Question 43

Reach

Answer 43

Asks: Who is the intervention being applied to in practice? May be groups or populations that are different than those on which it was investigated or intended for (i.e., the target population).

Question 44

Effectiveness

Answer 44

Asks: What is the impact in practice on the intended or target population, including beneficial outcomes as well as harm?

Question 45

Adoption

Answer 45

Asks: How well is the intervention accepted by individuals and providers of services?

Question 46

Implementation

Answer 46

Asks: How should the intervention be modified to reach target population and providers of services, but not those for whom the benefits do not exceed the harms?

Question 47

Maintenance

Answer 47

Asks: How can we ensure long-term continuation of use and success of intervention among individuals and providers of services?