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Poplhlth 111 > CST > Flashcards

CST Flashcards

1
Q

What does PECOT stand for

A

Participants, Exposure group, Comparison group, Outcome, Time

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2
Q

What does RAMBOMAN stand for

A

Recruitment, Allocation, Maintenance, Blind, Objective, Measurement, Analyse -> Not needed

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3
Q

What is Incidence

A

Measured over a period of time

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4
Q

What is prevalence

A

Measured at one point in time

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5
Q

How to calculate risk difference

A

EGO - CGO

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6
Q

How to calculate risk ratio

A

EGO / CGO

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7
Q

Does risk ratio have units

A

No

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8
Q

Does risk difference have units

A

Yes

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9
Q

What is relative risk called if the RR is less than 1

A

Relative Risk Reduction (RRR)

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10
Q

What is the relative risk called if RR is more than 1

A

Relative risk increase (RRI)

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11
Q

What does the Recruitment of RAMBOMAN look at

A

Does the study take a representative sample of the population, is it possible to define who the findings are applicable to?

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12
Q

What is the Allocation of RAMBOMAN looking at

A

Looking at allocation in EG & CG. Were they randomly allocated- were they similar at baseline
We’re they allocated by measurement- was this done accurately

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13
Q

What is the Maintenance of RAMBOMAN looking at

A

After allocated into groups, we’re these groups maintained, we’re they lost to follow up, we’re more lost from one group than the other etc.

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14
Q

What is the Blind and Objective Measurement of RAMBOMAN looking at

A

We’re the outcomes measured accurately, objective measurements are not influenced by personal interpretation.

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15
Q

What is a confidence interval

A

A standard measure of random error

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16
Q

Definition of 95% confidence interval

A

In 100 identical studies using samples from the same population 95/100 of the CI’s will include the true value for the population

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17
Q

Ways to reduce random error

A

Take multiple measurements, take a larger sample size

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18
Q

What do wide confidence intervals indicate

A

More uncertainty

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19
Q

What do narrow confidence intervals indicate

A

More certainty

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20
Q

How can we tell by looking at the confidence interval if something is statistically significant

A

If the the CI does not include 0, then it is statistically significant

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21
Q

How can we tell looking at a confidence interval if there is a difference

A

If the CI’s overlap, cannot be sure of difference, if not yes there is a difference

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22
Q

What are the causes of the causes

A

Any event, characteristic or definable entity that brings a change for better or worse- eg, income, education, societal characteristics, employment, housing and neighbourhoods, autonomy and empowerment

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23
Q

What are downstream interventions

A

Interventions that operate at the micro (proximal) level, including treatment systems and disease management

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24
Q

What are upstream interventions

A

Interventions at the macro (distal) level, like government policies and international trade policies

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25
Q

What are the three levels of the Dahlgren and Whitehead model

A

The individual- age, sex, constitutional factors and individual lifestyle factors

The community- social and community networks and living and working conditions

The environment- physical environments, water and air quality

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26
Q

What is ‘structure’ referring to

A

Social and physical environmental conditions that influence choices and opportunities available

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27
Q

What is ‘agency’ referring to

A

The capacity of an individual to act independently and make free choices

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28
Q

What is individual health care

A

Generally deals with the individual, aims to treat the disease and restore health

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29
Q

What is population health care

A

Concerned with groups of individuals in relation to their environment. Aims to provide maximum benefit to the largest number of people

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30
Q

Features of the Bradford hill framework

A

Temporality, strength of association, consistency of association, biological gradient, biological plausibility of association, specificity of association, reversibility

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31
Q

What should the Bradford Hill framework be used as

A

Should be used as an aid to thought to help make an overall judgment on causality

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32
Q

What is temporality

A

Seeing if it was first the cause then the disease, it is essential to establish a causal relationship

Example smoking leads to lung cancer deaths

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33
Q

What is strength of association

A

The stronger the association, the more likely it is to be a causal relationship

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34
Q

What is consistency of association

A

That multiple studies have shown similar results. Replication of findings by different investigators at different times, different places with different methods show similar results.

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35
Q

What is the biological gradient

A

(Dose response) Incremental change in disease rate is in conjunction with corresponding changes in exposure, eg deaths from lung cancer increase with the number of cigarettes smoked per day

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36
Q

What is biological plausibility

A

Does this association make sense biologically

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37
Q

What is specificity of association

A

A cause leads to a single effect or an effect has a single cause, but health issues have multiple causes and outcomes share causes

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38
Q

What is reversibility

A

The demonstration that under controlled conditions changing the exposure causes a change in the outcome

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39
Q

What is a component cause in the causal pie

A

Each component cause is a factor that contributes to disease causation. Component causes interact to produce the disease

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40
Q

What is a necessary cause in the causal pie

A

A factor or component cause that must be present for the disease to occur.

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41
Q

Are population based strategies beneficial to individuals

A

No

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42
Q

What is the population (mass) based strategy

A

Focuses on the whole population, tries to reduce health risks, useful for a widespread or common disease. Examples include immunisation programmes, legislated use of seatbelts, low salt foods at supermarkets

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43
Q

What is the high risk individual strategy

A

Focuses on individuals at high risk, example is interventions targeting obese adults, intravenous drug users

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44
Q

Advantages of population based strategies

A

Addresses underlying causes, benefit for the whole population, behaviourally appropriate

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45
Q

Disadvantages for population based strategies

A

Small benefit to individuals, low motivation for individuals, whole population exposed to downside of strategy,

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46
Q

Advantages for individual based strategies

A

Appropriate to individuals, individuals have motivation, favourable benefit to risk ratio

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47
Q

Disadvantages for individual based strategies

A

Cost of screening to identify individuals, temporary effect, limited potential, behaviourally inappropriate

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48
Q

What is tertiary care

A

Hospital based care, rehabilitation

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49
Q

What is secondary care

A

Specialist care, eg neurologist, cardiologist, dermatologist

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50
Q

What is primary care

A

Patients regular source of healthcare, like GP, pharmacist etc.

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51
Q

What are the 3 basic strategies in the Ottawa Charter

A

Enable, Advocate, Mediate

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52
Q

What is enable in the Ottawa charter

A

Provide opportunities for individuals to make healthy choices through access to information, life skills and supportive environments.

This is an individual level strategy

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53
Q

What is advocate in the Ottawa charter

A

Create favourable political, economic, social, cultural and physical environments by promoting and advocating for health and focussing on achievable equity in health,

This is a systems level strategy

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54
Q

What is mediate in the Ottawa charter

A

To facilitate and bring together individuals group’s and parties with opposing interests to work together and come to a compromise for the promotion of health

This is a Strategy that joins individuals groups and systems

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55
Q

What is health promotion

A

It acts on the determinants of well-being, it has a health and well-being focus, involves the whole population in everyday context, enables people to have control

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56
Q

What is health protection

A

Focusses on environmental hazards, acts on risk/ hazard management, risk communication, occupational health, like safety regulation on work sites

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57
Q

What is disease prevention

A

Focusses on the disease itself, looks at ways of preventing incidence, prevalence, risk factors or impacts, example is immunisation and airbags in cars

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58
Q

What is primary level interventions

A

These limit the occurrence of disease by controlling specific causes and risk factors

Eg, vaccinations

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59
Q

Secondary level interventions

A

Reduce the more serious consequences of a disease

Eg, screening women for breast and cervical cancer

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60
Q

Tertiary level interventions

A

Reduced the progress of complications of an established disease

Eg, rehabilitation services for burn survivors etc

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61
Q

What is the screening criteria

A

Suitable disease, suitable test, suitable treatment, suitable screening programme

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62
Q

What constitutes a suitable disease for screening

A

Relatively common, or if uncommon we know that early detection leads to a better outcome, detectable early,

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63
Q

What constitutes a suitable test

A

Reliable- provides consistent results, safe, simple, affordable, acceptable, accurate

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64
Q

What is sensitivity

A

The likelihood of a positive test in those with the disease

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65
Q

How to calculate sensitivity

A

True positives/all with the disease x 100

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66
Q

What is specificity

A

The likelihood of a negative in those without the disease

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67
Q

How to calculate specificity

A

True negatives/all without the disease x 100

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68
Q

What does it mean if sensitivity is high

A

That the proportion of true positives is high

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69
Q

What does it mean if specificity is high

A

The proportion of true negatives is high

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70
Q

What is positive predictive value

A

The proportion of people who really have the disease out of all who test positive

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71
Q

How to calculate the positive predictive value

A

True positives/all who test positive x 100

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72
Q

What is negative predictive value

A

The proportion of individuals who do not have the disease out of those who test negative

73
Q

How to calculate negative predictive value

A

True negatives/all who test negative x 100

74
Q

What is lead time bias

A

Lead time bias happens when survival time appears longer because diagnosis was done earlier, irrespective of whether the patient lived longer or not.

75
Q

What is length time bias

A

Length time bias is an overestimation of survival duration due the the excess of cases detected that are slowly progressive

76
Q

What is attributable risk

A

The amount of extra disease attributable to a particular risk factor in a particular population.

77
Q

How to calculate population attributable risk

A

Occurrence in total population (PGO) - Occurrence in unexposed population (CGO)

78
Q

What are the measures of socioeconomic position (SEP)

A

Education, Income, Occupation, Housing, Assets and Wealth

79
Q

What variables were included in the NZDep 2013

A

Communication, income x2, employment, qualifications, owned home, support, living space and transport

80
Q

Description of communication in NZDep 2013

A

People age <65 with no access to the internet at home

81
Q

Description of both incomes in the NZDep 2013

A

People aged 18-64 receiving a means tested benefit

People living in equivalised households with income below an income threshold

82
Q

Description of employment in the NZDep 2013

A

People age 18-64 unemployed

83
Q

Description of qualifications in the NZDep 2013

A

People age 18-64 with no qualifications

84
Q

Description of owned home in the NZDep 2013

A

People not living in own home

85
Q

Description of support in the NZDep 2013

A

People age <65 living in a single parent family

86
Q

Description of living space in the NZDep 2013

A

People living in equivalised households below a bedroom occupancy threshold

87
Q

Description of transport in the NZDep 2013

A

People with no access to a car

88
Q

What are the 5 A’s

A

Availability, Accessibility, Accomodation, Affordability and Acceptability

89
Q

What is availability in the 5 A’s

A

Relationship of the volume and type of existing services to the clients volume and type of needs

90
Q

What is accomodation in the 5 A’s

A

Relationship between the manner in which supply resources are organised and the expectation of clients

91
Q

What is acceptability in the 5 A’s

A

Relationship between clients and providers attitudes to what constitutes appropriate care

92
Q

What is accessibility in the 5 A’s

A

Relationship between the location of supply and the location of clients, taking into account client transportation resources and travel time, distance and cost

93
Q

What is affordability is the 5 A’s

A

Cost of provider services in relation to clients ability and willingness to pay for these services

94
Q

Why is IDI information de-identified

A

To preserve confidentiality

95
Q

What is numerical ageing

A

The absolute increase in the population that is elderly

96
Q

What is structural ageing

A

The increase in the proportion of the population that is elderly

97
Q

When does natural decline of the population occur

A

When there are more deaths than births in a population

98
Q

When does absolute decline of a population occur

A

When there is insufficient migration to replace the ‘lost’ births and increased deaths

99
Q

What is equality

A

Giving everyone the same thing, giving everyone a box

100
Q

What is equity

A

Responding to needs, make it fair, focus on giving things to people that need them

101
Q

What are inequalities

A

Measurable differences in health. Difference in health experience and outcomes between different populations

102
Q

What are inequities

A

The inequalities that are deemed to be unfair or stemming from injustice

103
Q

What are structural interventions

A

No physical barriers, ie more lifeboats

104
Q

What are social interventions

A

A rights based approach, equal access

105
Q

What is an outbreak

A

A localised outbreak of a disease

106
Q

What is an epidemic

A

An outbreak with more than expected cases

107
Q

What is a pandemic

A

A widespread outbreak, worldwide

108
Q

What are the pandemic response strategies

A

Control, elimination, mitigation, suppression and eradication

109
Q

What is control as a response strategy

A

Reducing to an acceptable endemic level using feasible means

110
Q

What is elimination as a response strategy

A

Reducing to zero in a country or region for prolonged periods

111
Q

What is mitigation as a response strategy

A

Reducing to avoid overwhelming the healthcare system

112
Q

What is suppression as a response strategy

A

Reducing to minimise negative health impacts

113
Q

What is eradication as a response strategy

A

Reducing to zero at a global level permanently

114
Q

What approach do deprivation measures use

A

They use a deficit approach

115
Q

What are the domains in the IMD

A

Employment, income, crime, housing, health, education and access

116
Q

What is employment is the IMD

A

measures the degree to which working age people are excluded from employment

117
Q

What is income in the IMD

A

Extent of income deprivation in data zone by measuring state funded financial assistance to those with insufficient income

118
Q

What is crime in the IMD

A

Measures the risk of personal and material victimisations, or damage to person or property

119
Q

What is housing in the IMD

A

Proportion of people living in overcrowded housing and the proportion living in rented accommodation

120
Q

What is health in the IMD

A

Identifies areas with a high level of I’ll health, eg hospitalisations or mortality

121
Q

What is education IMD

A

Captures youth disengagement, and the proportion of the working age without a formal qualification

122
Q

What is access in the IMD

A

Measures the cost and inconvenience of travelling to access basic services, like doctors, gas stations, schools etc

123
Q

Is NZDep better or IMD

A

IMD because when using NZDep you cannot tell what is driving deprivation

124
Q

What is the built environment

A

Everything above ground built by humans, like homes, schools, workplaces, parks, business areas and roads

125
Q

What sustainable development goals cannot be linked back to a living standards framework well-being domain

A

Gender equality and reduced inequalities

This is because they are fundamentally found all the way through government policies and legislations

126
Q

What are you the 4 V’s of big data

A

Volume, Velocity, Variety, Veracity

127
Q

Volume=

A

The capacity required to store and analyse data

128
Q

Velocity=

A

The speed at which the data are created and analysed

129
Q

Variety=

A

The types of data sources available

130
Q

Veracity=

A

The accuracy and credibility of the data

131
Q

Why do we worry about priorities in healthcare

A

Health resource are limited, finite
Each prioritisation has an opportunity cost
Rationing involves ethical as well as evidence based judgement
It’s difficult to compare outcomes
Individual versus population need

132
Q

Aim of the global burden of disease project

A

Is to take into account deaths as well as non fatal outcomes eg disability when estimating the burden of disease

133
Q

Disability adjusted life years (DALY) is

A

A measure of population health that combined data on premature mortality and non fatal outcomes

134
Q

How to calculate DALY

A

Years lived with disability (YLD) + Years of life lost (YLL)

135
Q

What is years of life lost

A

Represents the mortality by counting the years lost due to premature death caused by a disease

136
Q

What is years lived with a disability

A

Represents morbidity by counting the years lived with the disease

137
Q

What are communicable diseases

A

They are infectious disease, like TB, measles, aids, malaria etc

138
Q

What are non communicable diseases

A

Chronic diseases, non infectious, like heart disease, strokes, cancer and diabetes

139
Q

What are the trends of non communicable and communicable diseases

A

Over time, non communicable diseases are increasing while communicable diseases are decreasing

140
Q

What does the burden of disease look like in high income countries

A

More non communicable diseases are contributing towards the burden of disease

141
Q

What does the burden of disease look like in lower middle income countries

A

A mix on communicable and non communicable diseases contributing giving rise to a double burden of disease

142
Q

What does the burden of disease look like in low income countries

A

More communicable diseases contributing to the burden of disease

143
Q

Advantages of using the DALY approach

A

Draws attention to hidden burden of mental health problems and injuries as major health problems

Recognises non communicable diseases as a major and increasing problem in low and middle income countries, not just a rich country problem

144
Q

Disadvantages of using DALYS’s to quantify burden of disability

A

Who decided what weights should be assigned to different disabilities.

Is it reasonable to apply one set of disability weights, do all people with a level of disability have similar opportunities

How does the physical and social environment

145
Q

What model of disability does the GBD Project use

A

The medical model of disability

146
Q

What is the medical model of disability

A

Looks at people with a disability as a deficit, an impairment that needs fixing. Sees the disabled person as the problem, not society

147
Q

What is the social model of disability

A

Disability is not seen as the individuals problem, but a societal issue. This model Focusses on ridding barriers rather than curing these people

148
Q

What is an epidemiologic transition

A

The shift in causes of death from communicable diseases, to non communicable diseases

149
Q

What do DALY’s allow comparison between

A

Allow comparison between risk factors

150
Q

As countries become wealthier, what do we see in relation to NCD’s

A

Increase in NCD risk

151
Q

Where does the double burden of disease mainly occur

A

In lower middle income countries

152
Q

What is risk transition

A

Changes in risk factors as countries move from low to higher income where risks for communicable diseases are replaced with risk for non communicable diseases

153
Q

What issue does the double burden of disease cause

A

It causes major challenges for health policies

154
Q

What populations are mostly affected by non communicable diseases

A

People living in poverty, those living in lower and middle income countries

155
Q

What role does the commercial sector play in the NCD epidemic

A

It drives the uneven distribution of risk, eg smoking, fast food outlets in more deprived areas etc , driven by a commercial interest

156
Q

Determinants of HIV infection

A

Gender inequities, poverty and low social status, socials norms, stigma and discrimination

157
Q

What income countries is HIV/AIDS most prevalent in

A

Low income countries

158
Q

Globally, what is the dominate mode of transmission for HIV

A

Heterosexual transmission

159
Q

What countries/regions have the highest rates of obesity in the world

A

Polynesia and Micronesia

160
Q

In America, as years go by, what is the trend of obesity prevalence

A

Obesity prevalence is increasing

161
Q

Who gets fatter first?

A

Women, urban areas, high income countries, middle aged people

162
Q

What was lockdown in regards to obesity prevalence

A

Lockdowns were an obesogenic stimulus

163
Q

Why did lockdowns increase obesity rates

A

Decreased physical activity, more screen time, more baking, increased marketing of takeaways and home deliveries, food insecurities

164
Q

What are the top obesity prevention policies for NZ

A

Regulation on junk food marketing to children, tax on sugary drinks, healthy food policies in schools and early childhood and front of pack labelling

165
Q

Is the Māori population younger or older than non Māori

A

The Māori population is younger than Māori

166
Q

What are the determinants of ethnic inequities in health

A

Differential accessto health determinants or exposures, differential access to health care, differences in quality of care received

167
Q

Right to health, what are the three things required

A

Respect- no discrimination
Protect- no interference from 3rd parties
Fulfil- adopt measures to achieve equity

168
Q

What is the right to health

A

An inclusive right, associated with access to healthcare and other determinant including housing etc

169
Q

What is the right to health freedoms

A

The right to be free from non consensual medical treatment

170
Q

What is a misconception about the right to health

A

The right to health is not the right to be healthy

171
Q

What is a triple dividend

A

Brings benefit to adolescents now, in their future adult lives, and for their children

172
Q

What are the main causes of DALYS for adolescents in high income countries

A

Mental health related

173
Q

In the YOUTH survey, who did they identify has experienced difficulties accessing health care

A

Māori, Pasifika and Asian students
Students in more deprived areas
Students with a disability or health condition
Students worried about drinking

174
Q

What is the inverse care law

A

The availability of good medical care varies inversely with the need for it in the population served

175
Q

What are the trends of depression in adolescents

A

Increasing trends in clinical depression, this is higher for females

176
Q

What is driving the decline in mental health

A

Parental monitoring, financial stress, political polarisation, low resilience, social media, job insecurities, climate crisis

177
Q

What are the hypothesis related to the factors driving the decline in mental health

A

Snowflake hypothesis, igen hypothesis and doomer hypothesis

178
Q

What is a limitation of the YOUTH 2000 surveys

A

Examining causal relationships

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