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Understanding Research > Defining Abnormality > Flashcards

Defining Abnormality Flashcards

1
Q

Define Epidemiology

A

The study of distribution and determinants of health related states or events in specified populations and application of this study to control health problems

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2
Q

What is health

A

A state of complete physical, mental and social well- being and not merely the absence of disease or infirmity

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3
Q

What are three criteria for establishing abnormality

A

Abnormal as infrequent occurrence
Abnormal as associated with disease/death/disability
Abnormal as treatable

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4
Q

Describe the Statistical definition of Normal

A

Normal distribution:
Frequent (common as normal)
Within 2 SDs above and below mean

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5
Q

Describe the Statistical definition of abnormal

A

Values beyond 2 SDs above and below the mean

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6
Q

List four reasons that the statistical definition of Abnormal can be misleading

A
  • Some illnesses more prevalent than others
  • association with disease may be important only at extreme values
  • some extreme values are beneficial
  • some illnesses have no threshold at which risk of ill-health/ death starts
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7
Q

What is the equation for Sensitivity of a test for disease according to Gold Standard

A

a/a+c

Where

a: true positives
c: false negatives

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8
Q

What is the equation of Specificity of a disease according to Gold Standard

A

Specificity

d/b+d

Where

b: false positives
d: true negatives

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9
Q

What is the equation for percentage true positive values in a test for disease

A

a/a+b

Where a is true positive
b is false positives

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10
Q

What is the equation for percentage true negative values in a test for disease

A

d/c+d

Where c is false negatives and d is true negative

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11
Q

What us done to minimize false negatives in the test for disease

A

Cut-off shifted to minimize false negatives
Continuum shifted to the left
Ie optimise sensitivity

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12
Q

What are consequences of shifting the cut off to minimize false negatives

A

Specificity reduced

A negative result from a sensitive test rules out the diagnosis

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13
Q

What changes are made to minimize false positives in testing for disease

A

Cut-off shifted to the right to minimize false positives and optimize specificity

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14
Q

What are the consequences of minimizing false positives by shifting the cut off to the right

A

Sensitivity is reduced

Positive result from a specific test rules in the diagnosis

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15
Q

For the criterium that states “Abnormal =Treatable”

What is the point at which the individual is designated abnormal

A

At a point at which treatment leads to better outcome (treatment does more good than harm)

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16
Q

What is the basic premise of epidemiology

A

Disease does not occur at random, but pattern of disease reflects the operation of underlying factors

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17
Q

What is the significance of understanding the distribution of disease

A

We can understand the aetiogy of disease and therefore how OR if need to investigate, treat or prevent it

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18
Q

Define descriptive epidemiology

A

Study of the occurrence and distribution of disease

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19
Q

What is the difference between Descriptive and Analytic Epidemiology

A

Descriptive Epidemiology identifies and reports on both the frequency and pattern of health events (what who where when)

While

Analytic Epidemiology searches for determinants of health outcomes (how why)

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20
Q

What are the three objectives of Descriptive Epidemiology

A

Permit evaluation of trends in health and disease

Provide a basis for planning, provision and evaluation of health services

Identify problems to be studied by analytic method

21
Q

What are the three pillars of Descriptive Epidemiology

A

Person
Place
Time

22
Q

“Person” is a pillar of Descriptive Epidemiology

List aspects of Demographic

A 
Age 
Sex
Marital status
Ethnic group
Race
Socioeconomic Status (social class, occupation,employment status, crowding)
23
Q

“Person” is a pillar of Descriptive Epidemiology

List aspects of Lifestyle/Behavior

A 
Alcohol
Smoking
Exercise
Religion
Stress
Nutritional Status
24
Q

Describe the significance of the pillar “place” in Descriptive Epidemiology

A

Where person was exposed or source of infection

  • Geographical boundaries
  • Clustering
  • Effects of Migration
  • International comparisons
25
Q

Who is called the “Father of Epidemiology “

A

John Snow

26
Q

What are the six types of time trends in Epidemiology

A 
Seasonal
Secular
Periodic
Endemic
Epidemic 
Pandemic
27
Q

Describe Seasonal time in relation to Epidemiology

A

Time variation related to seasons of the year

28
Q

Describe Secular trends in relation to Epidemiology

A

Long term trends of disease

29
Q

Describe Periodic time in relation to Epidemiology

A

Temporary interruption of the general trend of secular variations

30
Q

Describe Endemic in relation to Epidemiology

A

Expected level of health events in a specific population in a defined area for that time

31
Q

Describe Epidemic in relation to Epidemiology

A

Increase in incidence above the expected level in a defined geographic area within a defined time period

32
Q

Describe Pandemic in relation to Epidemiology

A

A world wide epidemic affecting an exceptionally high proportion of the global population

33
Q

What kind of chart is ideal for an Epidemiology curve

A

Histogram

34
Q

List four Descriptive study designs for individuals

A
  • Case Report
  • Case Series Report
  • Cross sectional report
  • Surveillance studies
35
Q

List one Descriptive study designs for populations

A

Ecological studies

36
Q

What is a case report

A

A report of a single individual (or group of individuals with the same diagnosis)

37
Q

What is an advantage of a case report

A

Cases can be aggregated from disparate sources to generate hypothesis and describe new syndromes

38
Q

What is one limitation of case studies

A

Can’t test for statistical association because there is no relevant comparison group

39
Q

Define cross sectional studies

A

AKA prevalence studies measure disease and exposure simultaneously in a well defined population

40
Q

What are two advantages of cross sectional studies

A

Studies cut across the general population, not simply those seeking medical care

41
Q

What are two limitations of cross sectional studies

A

You cannot determine whether exposure preceded disease

Since prevalent rather than incident cases determined, results will be influenced by survival factors

42
Q

What is the purpose of Public Health Surveillance

A

Ongoing, systematic collection, analysis and interpretation of health-related data essential to the planning, implementation, and evaluation of public health practice, closely integrated with the timely dissemination of these data to those responsible for prevention and control

43
Q

Describe Ecological Studies

A

These studies use measures that represent characteristics of entire populations (rather than a focus on individuals) to describe outcomes in relation to some factor of interest such as age, time, utilization of services or exposure

44
Q

What are two major types of Ecological studies

A 
Ecologic comparison (cross sectional studies)
Ecologic trend studies
45
Q

List two advantages of Ecological studies

A

Generates hypotheses for analytic studies

Can target high risk populations, time periods, or geographic regions for future studies

46
Q

What are two limitations of Ecological studies

A

Group data - therefore cannot link disease and exposure in individuals

Avoid drawing inappropriate conclusions

47
Q

What is Ecological Fallacy

A

The incorrect attribution of population level associations to individuals in a population

48
Q

What is atomistic fallacy

A

The incorrect attribution of individual associations to population level associations

49
Q

What are the 10 steps in outbreak Investigations

A
  • establishing the existence of an outbreak
  • preparing for fieldwork
  • verifying diagnosis
  • defining and identifying cases
  • using descriptive Epidemiology
  • developing hypotheses
  • evaluating the hypotheses
  • implementing control and prevention measures
  • communicating findings

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