CST Flashcards
What does PECOT stand for
Participants, Exposure group, Comparison group, Outcome, Time
What does RAMBOMAN stand for
Recruitment, Allocation, Maintenance, Blind, Objective, Measurement, Analyse -> Not needed
What is Incidence
Measured over a period of time
What is prevalence
Measured at one point in time
How to calculate risk difference
EGO - CGO
How to calculate risk ratio
EGO / CGO
Does risk ratio have units
No
Does risk difference have units
Yes
What is relative risk called if the RR is less than 1
Relative Risk Reduction (RRR)
What is the relative risk called if RR is more than 1
Relative risk increase (RRI)
What does the Recruitment of RAMBOMAN look at
Does the study take a representative sample of the population, is it possible to define who the findings are applicable to?
What is the Allocation of RAMBOMAN looking at
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
What is the Maintenance of RAMBOMAN looking at
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.
What is the Blind and Objective Measurement of RAMBOMAN looking at
We’re the outcomes measured accurately, objective measurements are not influenced by personal interpretation.
What is a confidence interval
A standard measure of random error
Definition of 95% confidence interval
In 100 identical studies using samples from the same population 95/100 of the CI’s will include the true value for the population
Ways to reduce random error
Take multiple measurements, take a larger sample size
What do wide confidence intervals indicate
More uncertainty
What do narrow confidence intervals indicate
More certainty
How can we tell by looking at the confidence interval if something is statistically significant
If the the CI does not include 0, then it is statistically significant
How can we tell looking at a confidence interval if there is a difference
If the CI’s overlap, cannot be sure of difference, if not yes there is a difference
What are the causes of the causes
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
What are downstream interventions
Interventions that operate at the micro (proximal) level, including treatment systems and disease management
What are upstream interventions
Interventions at the macro (distal) level, like government policies and international trade policies
What are the three levels of the Dahlgren and Whitehead model
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
What is ‘structure’ referring to
Social and physical environmental conditions that influence choices and opportunities available
What is ‘agency’ referring to
The capacity of an individual to act independently and make free choices
What is individual health care
Generally deals with the individual, aims to treat the disease and restore health
What is population health care
Concerned with groups of individuals in relation to their environment. Aims to provide maximum benefit to the largest number of people
Features of the Bradford hill framework
Temporality, strength of association, consistency of association, biological gradient, biological plausibility of association, specificity of association, reversibility
What should the Bradford Hill framework be used as
Should be used as an aid to thought to help make an overall judgment on causality
What is temporality
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
What is strength of association
The stronger the association, the more likely it is to be a causal relationship
What is consistency of association
That multiple studies have shown similar results. Replication of findings by different investigators at different times, different places with different methods show similar results.
What is the biological gradient
(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
What is biological plausibility
Does this association make sense biologically
What is specificity of association
A cause leads to a single effect or an effect has a single cause, but health issues have multiple causes and outcomes share causes
What is reversibility
The demonstration that under controlled conditions changing the exposure causes a change in the outcome
What is a component cause in the causal pie
Each component cause is a factor that contributes to disease causation. Component causes interact to produce the disease
What is a necessary cause in the causal pie
A factor or component cause that must be present for the disease to occur.
Are population based strategies beneficial to individuals
No
What is the population (mass) based strategy
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
What is the high risk individual strategy
Focuses on individuals at high risk, example is interventions targeting obese adults, intravenous drug users
Advantages of population based strategies
Addresses underlying causes, benefit for the whole population, behaviourally appropriate
Disadvantages for population based strategies
Small benefit to individuals, low motivation for individuals, whole population exposed to downside of strategy,
Advantages for individual based strategies
Appropriate to individuals, individuals have motivation, favourable benefit to risk ratio
Disadvantages for individual based strategies
Cost of screening to identify individuals, temporary effect, limited potential, behaviourally inappropriate
What is tertiary care
Hospital based care, rehabilitation
What is secondary care
Specialist care, eg neurologist, cardiologist, dermatologist
What is primary care
Patients regular source of healthcare, like GP, pharmacist etc.
What are the 3 basic strategies in the Ottawa Charter
Enable, Advocate, Mediate
What is enable in the Ottawa charter
Provide opportunities for individuals to make healthy choices through access to information, life skills and supportive environments.
This is an individual level strategy
What is advocate in the Ottawa charter
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
What is mediate in the Ottawa charter
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
What is health promotion
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
What is health protection
Focusses on environmental hazards, acts on risk/ hazard management, risk communication, occupational health, like safety regulation on work sites
What is disease prevention
Focusses on the disease itself, looks at ways of preventing incidence, prevalence, risk factors or impacts, example is immunisation and airbags in cars
What is primary level interventions
These limit the occurrence of disease by controlling specific causes and risk factors
Eg, vaccinations
Secondary level interventions
Reduce the more serious consequences of a disease
Eg, screening women for breast and cervical cancer
Tertiary level interventions
Reduced the progress of complications of an established disease
Eg, rehabilitation services for burn survivors etc
What is the screening criteria
Suitable disease, suitable test, suitable treatment, suitable screening programme
What constitutes a suitable disease for screening
Relatively common, or if uncommon we know that early detection leads to a better outcome, detectable early,
What constitutes a suitable test
Reliable- provides consistent results, safe, simple, affordable, acceptable, accurate
What is sensitivity
The likelihood of a positive test in those with the disease
How to calculate sensitivity
True positives/all with the disease x 100
What is specificity
The likelihood of a negative in those without the disease
How to calculate specificity
True negatives/all without the disease x 100
What does it mean if sensitivity is high
That the proportion of true positives is high
What does it mean if specificity is high
The proportion of true negatives is high
What is positive predictive value
The proportion of people who really have the disease out of all who test positive
How to calculate the positive predictive value
True positives/all who test positive x 100
What is negative predictive value
The proportion of individuals who do not have the disease out of those who test negative
How to calculate negative predictive value
True negatives/all who test negative x 100
What is lead time bias
Lead time bias happens when survival time appears longer because diagnosis was done earlier, irrespective of whether the patient lived longer or not.
What is length time bias
Length time bias is an overestimation of survival duration due the the excess of cases detected that are slowly progressive
What is attributable risk
The amount of extra disease attributable to a particular risk factor in a particular population.
How to calculate population attributable risk
Occurrence in total population (PGO) - Occurrence in unexposed population (CGO)
What are the measures of socioeconomic position (SEP)
Education, Income, Occupation, Housing, Assets and Wealth
What variables were included in the NZDep 2013
Communication, income x2, employment, qualifications, owned home, support, living space and transport
Description of communication in NZDep 2013
People age <65 with no access to the internet at home
Description of both incomes in the NZDep 2013
People aged 18-64 receiving a means tested benefit
People living in equivalised households with income below an income threshold
Description of employment in the NZDep 2013
People age 18-64 unemployed
Description of qualifications in the NZDep 2013
People age 18-64 with no qualifications
Description of owned home in the NZDep 2013
People not living in own home
Description of support in the NZDep 2013
People age <65 living in a single parent family
Description of living space in the NZDep 2013
People living in equivalised households below a bedroom occupancy threshold
Description of transport in the NZDep 2013
People with no access to a car
What are the 5 A’s
Availability, Accessibility, Accomodation, Affordability and Acceptability
What is availability in the 5 A’s
Relationship of the volume and type of existing services to the clients volume and type of needs
What is accomodation in the 5 A’s
Relationship between the manner in which supply resources are organised and the expectation of clients
What is acceptability in the 5 A’s
Relationship between clients and providers attitudes to what constitutes appropriate care
What is accessibility in the 5 A’s
Relationship between the location of supply and the location of clients, taking into account client transportation resources and travel time, distance and cost
What is affordability is the 5 A’s
Cost of provider services in relation to clients ability and willingness to pay for these services
Why is IDI information de-identified
To preserve confidentiality
What is numerical ageing
The absolute increase in the population that is elderly
What is structural ageing
The increase in the proportion of the population that is elderly
When does natural decline of the population occur
When there are more deaths than births in a population
When does absolute decline of a population occur
When there is insufficient migration to replace the ‘lost’ births and increased deaths
What is equality
Giving everyone the same thing, giving everyone a box
What is equity
Responding to needs, make it fair, focus on giving things to people that need them
What are inequalities
Measurable differences in health. Difference in health experience and outcomes between different populations
What are inequities
The inequalities that are deemed to be unfair or stemming from injustice
What are structural interventions
No physical barriers, ie more lifeboats
What are social interventions
A rights based approach, equal access
What is an outbreak
A localised outbreak of a disease
What is an epidemic
An outbreak with more than expected cases
What is a pandemic
A widespread outbreak, worldwide
What are the pandemic response strategies
Control, elimination, mitigation, suppression and eradication
What is control as a response strategy
Reducing to an acceptable endemic level using feasible means
What is elimination as a response strategy
Reducing to zero in a country or region for prolonged periods
What is mitigation as a response strategy
Reducing to avoid overwhelming the healthcare system
What is suppression as a response strategy
Reducing to minimise negative health impacts
What is eradication as a response strategy
Reducing to zero at a global level permanently
What approach do deprivation measures use
They use a deficit approach
What are the domains in the IMD
Employment, income, crime, housing, health, education and access
What is employment is the IMD
measures the degree to which working age people are excluded from employment
What is income in the IMD
Extent of income deprivation in data zone by measuring state funded financial assistance to those with insufficient income
What is crime in the IMD
Measures the risk of personal and material victimisations, or damage to person or property
What is housing in the IMD
Proportion of people living in overcrowded housing and the proportion living in rented accommodation
What is health in the IMD
Identifies areas with a high level of I’ll health, eg hospitalisations or mortality
What is education IMD
Captures youth disengagement, and the proportion of the working age without a formal qualification
What is access in the IMD
Measures the cost and inconvenience of travelling to access basic services, like doctors, gas stations, schools etc
Is NZDep better or IMD
IMD because when using NZDep you cannot tell what is driving deprivation
What is the built environment
Everything above ground built by humans, like homes, schools, workplaces, parks, business areas and roads
What sustainable development goals cannot be linked back to a living standards framework well-being domain
Gender equality and reduced inequalities
This is because they are fundamentally found all the way through government policies and legislations
What are you the 4 V’s of big data
Volume, Velocity, Variety, Veracity
Volume=
The capacity required to store and analyse data
Velocity=
The speed at which the data are created and analysed
Variety=
The types of data sources available
Veracity=
The accuracy and credibility of the data
Why do we worry about priorities in healthcare
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
Aim of the global burden of disease project
Is to take into account deaths as well as non fatal outcomes eg disability when estimating the burden of disease
Disability adjusted life years (DALY) is
A measure of population health that combined data on premature mortality and non fatal outcomes
How to calculate DALY
Years lived with disability (YLD) + Years of life lost (YLL)
What is years of life lost
Represents the mortality by counting the years lost due to premature death caused by a disease
What is years lived with a disability
Represents morbidity by counting the years lived with the disease
What are communicable diseases
They are infectious disease, like TB, measles, aids, malaria etc
What are non communicable diseases
Chronic diseases, non infectious, like heart disease, strokes, cancer and diabetes
What are the trends of non communicable and communicable diseases
Over time, non communicable diseases are increasing while communicable diseases are decreasing
What does the burden of disease look like in high income countries
More non communicable diseases are contributing towards the burden of disease
What does the burden of disease look like in lower middle income countries
A mix on communicable and non communicable diseases contributing giving rise to a double burden of disease
What does the burden of disease look like in low income countries
More communicable diseases contributing to the burden of disease
Advantages of using the DALY approach
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
Disadvantages of using DALYS’s to quantify burden of disability
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
What model of disability does the GBD Project use
The medical model of disability
What is the medical model of disability
Looks at people with a disability as a deficit, an impairment that needs fixing. Sees the disabled person as the problem, not society
What is the social model of disability
Disability is not seen as the individuals problem, but a societal issue. This model Focusses on ridding barriers rather than curing these people
What is an epidemiologic transition
The shift in causes of death from communicable diseases, to non communicable diseases
What do DALY’s allow comparison between
Allow comparison between risk factors
As countries become wealthier, what do we see in relation to NCD’s
Increase in NCD risk
Where does the double burden of disease mainly occur
In lower middle income countries
What is risk transition
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
What issue does the double burden of disease cause
It causes major challenges for health policies
What populations are mostly affected by non communicable diseases
People living in poverty, those living in lower and middle income countries
What role does the commercial sector play in the NCD epidemic
It drives the uneven distribution of risk, eg smoking, fast food outlets in more deprived areas etc , driven by a commercial interest
Determinants of HIV infection
Gender inequities, poverty and low social status, socials norms, stigma and discrimination
What income countries is HIV/AIDS most prevalent in
Low income countries
Globally, what is the dominate mode of transmission for HIV
Heterosexual transmission
What countries/regions have the highest rates of obesity in the world
Polynesia and Micronesia
In America, as years go by, what is the trend of obesity prevalence
Obesity prevalence is increasing
Who gets fatter first?
Women, urban areas, high income countries, middle aged people
What was lockdown in regards to obesity prevalence
Lockdowns were an obesogenic stimulus
Why did lockdowns increase obesity rates
Decreased physical activity, more screen time, more baking, increased marketing of takeaways and home deliveries, food insecurities
What are the top obesity prevention policies for NZ
Regulation on junk food marketing to children, tax on sugary drinks, healthy food policies in schools and early childhood and front of pack labelling
Is the Māori population younger or older than non Māori
The Māori population is younger than Māori
What are the determinants of ethnic inequities in health
Differential accessto health determinants or exposures, differential access to health care, differences in quality of care received
Right to health, what are the three things required
Respect- no discrimination
Protect- no interference from 3rd parties
Fulfil- adopt measures to achieve equity
What is the right to health
An inclusive right, associated with access to healthcare and other determinant including housing etc
What is the right to health freedoms
The right to be free from non consensual medical treatment
What is a misconception about the right to health
The right to health is not the right to be healthy
What is a triple dividend
Brings benefit to adolescents now, in their future adult lives, and for their children
What are the main causes of DALYS for adolescents in high income countries
Mental health related
In the YOUTH survey, who did they identify has experienced difficulties accessing health care
Māori, Pasifika and Asian students
Students in more deprived areas
Students with a disability or health condition
Students worried about drinking
What is the inverse care law
The availability of good medical care varies inversely with the need for it in the population served
What are the trends of depression in adolescents
Increasing trends in clinical depression, this is higher for females
What is driving the decline in mental health
Parental monitoring, financial stress, political polarisation, low resilience, social media, job insecurities, climate crisis
What are the hypothesis related to the factors driving the decline in mental health
Snowflake hypothesis, igen hypothesis and doomer hypothesis
What is a limitation of the YOUTH 2000 surveys
Examining causal relationships
