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Epi And Public Health > Epi > Flashcards

Epi Flashcards

0
Q

Which study design controls all con founders?

A

RCT

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1
Q

Stratification

A

Analyses patient subgroups separately and then weighted average

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2
Q

Multivariable regression

A

Takes into account a number of confoundeds at the same time

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3
Q

Single estimate of stratification

A

Mantel haenzel

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4
Q

Ecological fallacy

A

Average characteristics of a population

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5
Q

What can you measure in cross sectional?

A

Prevalence

NOT incidence

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6
Q

What do we calculate with case control?

A

Odds ratio

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7
Q

Bias in case control

A

Reverse causality
Selection bias
Measurement- recall and interviewer

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8
Q

Bias in ecological

A

Selection
Measurement
Reverse causality

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9
Q

Trend test

A

Statistical
Presence of a linear increase or decrease in risk associated with increase in exposure
Binary

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10
Q

Trend test 2 effects

A

Dose response effect

Threshold effect

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11
Q

Cohort bias

A 
Reverse causality
Selection
Loss to follow up
Recall
Interviewer
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12
Q

Inclusion or exclusion criteria in rct causes

A

Poor external validity

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13
Q

Good chance of detecting a clinically significant effect

A

Power more than 80%

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14
Q

Not achieving planned sample size

A

High risk of missing a clinically important effect

Can only be published if it proves evidence of an effect

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15
Q

Internal validity

A

The intervention caused the outcome or an observed outcome

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16
Q

Construct validity

A

If what you observed is what you wanted to observe

Or what you did is what you wanted to do.

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17
Q

Minimum effect size

A

Should be big enough to detect the smallest effect that is clinically important

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18
Q

The probability of correctly rejecting the null when the treatment has an effect

A

Power

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19
Q

Outcome reporter bias

A

Form of publication

Only present things that support

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20
Q

Contamination

A

Cluster rcts

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21
Q

Interim analysis

A

If study over years

Data monitoring committee

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22
Q

Disadvantages of interim analyses

A

Open to abuse
Over estimate treatment effect
Completed by confidential committee independent of study researchers

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23
Q

Number needed to harm

A

Round down

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24
Q

Number needed to benefit

A

Round up

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25
Q

Bias in rct

A

Selection
Performance
Detection
Attribution

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26
Q

Concealment is not

A

Blinding

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27
Q

Attrition bias

A

Use an itt
Patients analyses to groups they originally allocated not on whether they completed
Only unbiased up confounded estimate of effectiveness
Reflects reality
Public health impact

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28
Q

Missing data can be assessed with

A

Sensitivity analysis

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29
Q

Sensitivity analysis

A

Primary analysis
Then repeated with missing data filled in (assumed)
If results same as analysis then they are robust
If different then must use caution

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30
Q

Itt minimizes

A

Attrition bias

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31
Q

Consort framework

A

Framework for reporting trials

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32
Q

Forest plot boxes

A

Draw attention to studies with greatest weight

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33
Q

Forest plot diamond

A

Overall summary estimate

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34
Q

Vertical unbroken line forest plot

A

Null wave

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35
Q

Data extraction done by

A

2+ independent observers

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36
Q

Prisma statement

A

Guidance on what to include in systematic review

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38
Q

Examples of fixed effect

A

Hanzel

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39
Q

Basics of fixed effect

A

Assumes one true effect weighted average
Any deviation is due to chance or sampling error
Only looks at variation within samples

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40
Q

Examples of randome effect

A

Dersimonian

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41
Q

Basics of random effects

A

Assumes heterogeneity
Within study variance and between studies
Wider range

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42
Q

Weighted average

A

Bigger weight to bigger studies

Weights use the inverse of the variance of treatment effect

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43
Q

Between study variance

A

Tsquared

Derived from q

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44
Q

Fixed effect weight

A

W=1/v

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45
Q

Random effects weight

A

Includes inter study variance

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46
Q

Random effect weights are

A

Smaller and closer to each other than fixed

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47
Q

Fixed effect

A

Assumes studies are all measuring same treatment effect

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48
Q

Time-trade-off

A

Respondents are asked to choose between remaining in a state of ill health for a period of time, or being restored to perfect health but having a shorter life expectancy.

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49
Q

Standard gamble

A

Respondents are asked to choose between remaining in a state of ill health for a period of time, or choosing a medical intervention which has a chance of either restoring them to perfect health, or killing them.

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50
Q

Visual analogue scale

A

Respondents are asked to rate a state of ill health on a scale from 0 to 100, with 0 representing being dead and 100 representing perfect health. This method has the advantage of being the easiest to ask, but is the most subjective.

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51
Q

the cost effectiveness plane

A

Cost on y and effective on x

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52
Q

Dominant

A

more effective and less costly (South-East)

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53
Q

Dominated

A

expensive and cheaper (North-West)

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54
Q

Incremental cost-effectiveness

A

difference in cost divited by difference in effectiveness.

up to reader to decide cost-effective.

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55
Q

ICER can be misleading unless…

A

one intervention is more expensive and more effective.

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56
Q

Net monetary benefit

A

required to know how much NHS is able to pay per QALY

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57
Q

Statistical variability in economic evaluation

A

due to small sizes, high variability of costs and missing data

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58
Q

Cost effectiveness acceptability curve

A

a sensitivity analysis in economic evaluation

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59
Q

one way sensitivity analysis

A

estimates for each uncertainty varied one at a time to investigate the impact on the results.

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60
Q

scenario analysis

A

best case

worst case

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61
Q

sensitivity

A

probability of a + test in people with the disease

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62
Q

specificity

A

probability of a - trest in people without the disease

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63
Q

SnNout

A

test has a high sensitivity-

a neg result would rule out the disease

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64
Q

SpPin

A

test has high specificity-

a pos result would rule disease in.

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65
Q

when 2 tests are equally costly and convenient we can use the

A

Likelihood ratio

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66
Q

NPV

A

probability of being disease free if test result is negative

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67
Q

spectrum bias

A

diagnostic test only finds barn door cases from the controls

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68
Q

work-up bias

A

gold standard is expensive, risky and unpleasant

cases who test + have gold standard then we underestimate the false -ves and overestimate the true positives

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69
Q

likelihood ratio (+)

A

sensitivity/(1-spec)

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70
Q

likelihood ratio (-)

A

(1-sensitivity)/spec

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71
Q

likelihood ratios

A

the further away from the null (1) the more informative the test.

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72
Q

LR=1

A

equal to chance

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73
Q

LR=1.5

A

greater than chance

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74
Q

when 2 tests are equally costly and conveneient we can use the

A

Likelihood ratio

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75
Q

deductive

A

quantitative

76
Q

inductive

A

qualitative

77
Q

depth

A

qualitative

78
Q

dependability

A

data reliability and dependability.
codes?
independent coding?
triangulation?

79
Q

qualitative data collection methods

A

observation
interviews
focus groups

80
Q

snowballing

A

qualitative

81
Q

max variation sampling

A

sample for heterogeneity

the researcher selects a small number of units or cases that maximize the diversity relevant to the research question.

82
Q

negative/deviant case sampling

A

This involves searching for and discussing elements of the data that do not support or appear to contradict patterns or explanations that are emerging from data analysis.

Deviant case analysis is a process for refining an analysis until it can explain or account for a majority of cases.

83
Q

saturation

A

now themes no longer arise

84
Q

QALY less than 0?

A

Worse than death

85
Q

credibility

A

plausible and trustworthy

been analysed? and grouped.

86
Q

reflexivity

A

awareness of researchers contribution to the construction of meaning throughout the research

(can’t remain ‘outside’ when conducting qualitative)

87
Q

dependability

A

data reliability and dependability.
codes?
independent coding?
triangulation?

88
Q

CASP criteria

A

to help appraise research
qualitative and quantitative
Critical Appraisal Skills Programme assessment criteria

89
Q

DIE CIDRE

A 
Do nothing
Inform
Enable choice
Change default policy
Incentives
Disincentives
Restrict choice
Eliminate choice
90
Q

QALY questionairres

A

EuroQoi
HUI
SF6D

91
Q

CPSPC

A 
Concieved
Performed
Submitted.
Published
Cited
92
Q

QALY 0

A

Dead

93
Q

QALY less than 0?

A

Worse than death

94
Q

Discounting leads to

A

down-weighting the cost/benefit in future years

95
Q

Compound discount per year?

A

3.5%

96
Q

Positive time preference

A

good things now

97
Q

Technical efficiency

A

increases survival now

questionable effect on quality of life

98
Q

Allocative efficiency

A

Which is better? A or B?

99
Q

Small study effect

A

Small studies show bigger effects than larger
(due to pub/reporting bias)
type of heterogeneity

100
Q

CPSPC

A 
Concieved
Performed
Submitted.
Published
Cited
101
Q

Sensitivity analysis for heterogeneity

A

get rid of low quality ones

102
Q

subgroup analysis for heterogeneity

A

does the effect differ across the sub groups?

103
Q

Measure of heterogeneity

A

Q

evidence for heterogeneity

104
Q

What does the Q mean?

A

Nothing on its own
Need the P value.
p will disprove the null hypothesis that there is no heterogeneity

105
Q

I^2 illustrates

A

the MAGNITUDE of the heterogeneity

106
Q

Examples of fixed effect

A

Manetl
Peto
Inverse variance

107
Q

Examples of random effect

A

Dersimionian L.

108
Q

Culmulative effects life course

A

As you age you get more risks

109
Q

gender inequality

A

NOT explained by inherent physiological changes

110
Q

RII

A

assumes linear relationship between poverty and mortality

111
Q

RII=

A

magnitude of the inequality

112
Q

SII=

A

absolute difference

113
Q

RII=1

A

no RELATIVE difference

114
Q

SII=0

A

no ABSOLUTE difference

115
Q

Deprivation indicator

A

small geographical areas
ecological measure
based on census- derived variables.

116
Q

4 inequalities

A

gender
SEP
ethnicity
geography

117
Q

Population strategy

A

treat everyone and protect those that are low risk

118
Q

High risk strategy

A

only treat those at high risk

might miss some who present slowly.

119
Q

Prevention paradox

A

contradictory situation where the majority of cases of a disease come from a population at low or moderate risk of that disease, and only a minority of cases come from the high risk population (of the same disease)

120
Q

Rule of rescue

A

an ethical imperative to save individual lives even when money might be more efficiently spent to prevent deaths in the larger population

121
Q

ICER rejected over

A

30K per QALY

122
Q

20-30K per QALY?

A

Only innovative, Proven benefit

123
Q

Shadow price

A

threshold which you will pay under

124
Q

League table

A

rank everything and most cost effective on top

125
Q

Order of priority setting

A 
NICE
Regional
Local commissioning boards
PCT
Hospitals

Done annually

126
Q

Explicit priority setting

A

tell the patient about ALL options even unavailable

127
Q

Implicit priority setting

A

only talk about the ones that are available.

128
Q

3 aims of public health

A

Protection
Improvement
Service

(PIS easy)

129
Q

Bradford Hill criteria

A 
Temporal
Strength of association
Consistency
Biological gradient
Reversibility
Specificity
130
Q

Ecological fallacy

A

the average person is not equal to all individuals

131
Q

error type 1

A

incorrect rejection of the null

132
Q

error type 2

A

failure to reject a false null.

133
Q

non-differential selection bias

A

non-generalizable

134
Q

differential selection bias

A

over or under estimation

135
Q

Performance bias

A

unequal care because dr. knows

136
Q

Detection bias

A

The doctor’s views affect the measurements

137
Q

NNTB round

A

up

138
Q

NNTH round

A

down

139
Q

selection bias not possible in

A

cohort

140
Q

stratification in confounding

A

estimates association between exposure and disease.

different subgroups then sweighted average.

141
Q

Multivariable models

A

a number of confounders at once.

142
Q

correlation

A

positive or negative.

correlation coefficient is the gradient of the line.

143
Q

Regression

A

mathematical y=mx+c

144
Q

PH outcome framework

A

improve determinants of health
improve health
protect health
health care ph and preventing premature mortality.

145
Q

Joint strategic Needs assessment

A

demographic changes (Population now)
services appropriately tailored (Provisions now)
any unmet needs? (Shortages now)
pressure for future? (Future)

146
Q

Power

A

the strength of the results to be against the null

dependent on sample size

147
Q

Concealment

A

allocation sequence

148
Q

Basic reproduction rate

A

R0
the larger the value, the more difficult to control
(secondary cases from primary)

149
Q

Effective reproduction number

A

Ro x proportion susceptible

150
Q

Control:

A

reduce transmission

151
Q

Eliminate

A

get transmission near 0

152
Q

Eradicate

A

transmission=0

153
Q

DALYs have reduced with all infections except

A

HIV and malaria

154
Q

CIC for an outbreak

A

control
investigate
communicate

155
Q

mucosal vaccines are:

A

live

156
Q

vaccine adjuvant

A

enhance response

157
Q

preservatives

A

protect from bacteria/fungi

158
Q

additives

A

stabilize from heat

159
Q

Egg vaccines

A

flu and fever

160
Q

MMR reaction

A

febrile convulsion

161
Q

Hypotonic hyporesponsive episode

A

whooping cough

162
Q

herd immunity is when

A

transmission less than 1 per case

163
Q

polio transmission

A

oral- replicates in GI tract
lymph nodes- blood- meninges
replicates in mn and affects muscles.

164
Q

Measles complications

A 
Pneumonia
Otitis media
SSPE (fatal)
Encephalitis
Diarrhoea
165
Q

Mumps complications

A 
Pancreatitis
Oophritis
Orchitis
Neuro- deaf
Nephritis
166
Q

standardised mortality ratio

A

indirect SMR=observed deaths/expected*100

167
Q

killed immunization

A

DTaP

168
Q

conjucated vaccine

A

HiB
Men C
13PVC

169
Q

cost effectiveness analysis

A

money differences/ health benefits measured by primary outcome

170
Q

cost utility analysis

A

money differences/ health benefits measured in QALYs

171
Q

cost benefit analysis

A

money differences/ health benefits valued in money

172
Q

cost consequences study

A

money differences/outcomes *benefit or not

173
Q

accuracy

A

how representative the sample is of the population (you are near the true value)

174
Q

precision

A

amount of variation between samples.

high precision means low variation

175
Q

familiar aggregation

A

the tendency for a disease to more common in probands than the public.

176
Q

Power

A

Calculated from type 2 error

177
Q

Non inferiority trial

A

To be able to do a superiority trial or to get on the market

178
Q

Equivalence trial

A

Set delta margins

Margins fall within margins of other drug

179
Q

Standard deviations

A

1- 68.3

  1. 95.4
  2. 99.7
180
Q

Work up bias

A

Gold standard is painful expensive

Only likely to do on worse cases

181
Q

Consort

A

22 principles for rcts

182
Q

Quorma

A

Meta analysis

183
Q

Absolute risk reduction

A

__

184
Q

Interval properties

A

To do with qaly

185
Q

heritability

A

Proportion of total phenotypic variance attributable to genetic effects (h2);

for phenotypes arising from a large number of genetic loci.

h2= additive genetic variance / total variance

Often expressed as a %.
Can be estimated from extended pedigrees, nuclear families siblings, twins or adoptees.
Only applies to measured population; cannot be used to explain differences between populations

Epi And Public Health (1 decks)

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