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EPI > epi STATS > Flashcards

epi STATS Flashcards

1
Q

How is the stomach cancer prevalence

A

decrease in stomach cancer

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2
Q

How the prevalence of lung cancer

A

rise and fall of lung cancer

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3
Q

from what to what disease has there been a shift

A

stroke to coronary heart diesease

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4
Q

How many world wide deaths were due to cardiovascular disease

A

15.6 million deaths worldwide in 2010

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5
Q

What are the main cardiovascular events

A

stroke and CHD

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6
Q

What percentage of total deaths were due to coronary heart disease

A

29.5% of all deaths in 2010

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7
Q

Where are cardiovascular problem more of an issue in the developing countries or in the developed countries

A

More such deaths occurred in the developing world than the developed world.

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8
Q

What are the rank first and second among cause-specific mortality worldwide?

A

CHD and Stroke respectively rank first and second among cause-specific mortality worldwide.

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9
Q

Where are the incidence of the lowest?

A

Japan, UK and western countries

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10
Q

Where is the CHD risk the highest ?

A

Middle east and former socialist economies

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11
Q

Are rates of CHD higher in men or in women

A

men

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12
Q

When are the risks of CHD the highest in females

A

post menopause

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13
Q

What is the overalll trend in the world of CHD and strokes and which countries do not follow this trend

A

On the decline in all other countries

Rise in CHD and stroke mortality in the formerly socialist economies of Europe and South Asia.

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14
Q

What percentage of death is caused by cancer in many countries

A

more than 25% of deaths in many countries

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15
Q

what percentage of deaths is caused by cancer worldwide

A

15.1% of deaths worldwide in 2010

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16
Q

How many people died of cancer in 2010

A

8 millions people dies of cancer in 2010

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17
Q

How many percent of

deadly cancers occur in less developed countries

A

60% of these cases are likely to occur in less developed countries

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18
Q

most commonly diagnosed

A

Lung

Breast

Colorectal

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19
Q

Most commonly died from cancer

A

Lung

Liver

Stomach

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20
Q

Does cancer risk chnage when migrants change from country to country

A

Cancer rates in migrants converge towards local cancer rates over time - role for modifiable risk factors

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21
Q

How many cancers are preventable

A

1/3

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22
Q

What is the largest preventable cause of cancer

A

SMOCKING

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23
Q

MAJOR KNOWN CARCINOGENS:

A

Tobacco

Alcohol

Air Pollution

Occupational Agents

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24
Q

What is the prevalence?

A

Prevalence = the frequency of a disease in a population at a point in time

Hence it is often called point prevalence

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25
Q

What measurment can be interpreted as a probability?

A

he measure of incidence can be interpreted as the probability, or risk, that an individual will develop the disease during a specific time period.

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26
Q

Successes for the AIDS epidemic

A

Decline in HIV prevalence in pregnant women

HIV Prevention:

Safer sex

Safer injection practices

Condom use

Male circumcision

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27
Q

For every how many people treated for HIV how many are newly infected

A

For every person put on HIV treatment, FIVE are newly infected with HIV.

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28
Q

how many people die each year?

A

57 million

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29
Q

Standardiesed mortality ration

A

Age Standardised Death Rates: Measuring how many people die each year and why they have died is one of the most important means of assessing the effectiveness of a country’s health system.

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30
Q

What is the leading cuase of death in subsahran africa

A

INFECTIOUS DISEASES ARE THE LEADING CAUSE OF DEATH IN SUB-SAHARAN AFRICA

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31
Q

what are the top causes of infectious diseases in the wolrd? What is the percentage of people dyingfrom these top theses infectious in comparison to all other infectious diseases?

A

Epidemiology of Infectious Diseases

MORE THAN 90% OF DEATHS FROM INFECTIOUS DISEASES ARE CAUSED BY:

Lower respiratory infections

HIV/AIDS

Diarrhoeal Diseases

Tuberculosis

Malaria

Measles

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32
Q

What country has the highest death rate? What countries follow it ?

A

Swaziland

Angola, Lesotho, Sierra Leone and Zambia.

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33
Q

Leading causes of death

A

Heart Disease

Cerebro-Vascular Disease

Respiratory Infections

HIV/AIDS

COPD

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34
Q

What is morbidity and how is it expressed

A

Morbidity - the number of cases of ill health, complications, side effects attributed to a particular condition over a particular time period

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35
Q

How many deaths in third world countries are due to malnutrietion

A

58%

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36
Q

Hierachy of evidence

A

Hierarchy of Studies

Systematic reviews and meta-analyses

Randomised Control Trials

Cohort Studies

Case-Control Studies

Cross-sectional Studies

Case Series

Case Reports

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37
Q

Definition of Bias

A

Bias = a systematic error in design, conduct or analysis of a study which produces a mistaken estimate of treatment effect.

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38
Q

definition of Confounding

A

= when a variable (or factor) is related to both the study variable and the outcome so the effect of the study variable on the outcome is distorted.

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39
Q

Experiment design ? What single type of studz does it include? What does it test?

A

A planned experiment in humans.

Designed to measure the effectiveness of an intervention:

A new drug

A surgical procedure

A vaccine

Complementary therapy

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40
Q

What are observational studies

A

Don’t influence the exposure cohort study, case control, ect…

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41
Q

What has to be in a clinical trial

A

Features of a Clinical Trial

Define your intervention

Define your comparator:

Placebo

Alternative treatment

Standard of care

Define your inclusion criteria

Define your exclusion criteria

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42
Q

Describe the 4 phases of randomized control trial

A

Phases of Clinical Trials

Phase I

Test the safety of a new treatment

Small number of, usually healthy, volunteers

Phase II

Test to see if the treatment is efficacious - at least in the short term

Continue to look at safety

A few hundred people usually with the condition

Phase III

Compare the new treatment with the current or placebo

Look at how well the new treatment works (effectiveness)

Continue to monitor side effects

Several thousand patients

Phase IV

After the drug has been marketed

Measure effect in various populations

Look out for rare side effects

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43
Q

Control Event Rate (CER)

A

incidence in the control arm

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44
Q

Experimental Event Rate (EER)

A

Experimental Event Rate (EER) - incidence in the intervention arm

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45
Q

Absolute Risk Reduction

A

Absolute Risk Reduction (ARR) = CER - EER

46
Q

Relative Risk Reduction (RRR)

A

= ARR/CER

47
Q

Number Needed to Treat (NNT)

A

Number Needed to Treat (NNT) - number of patients that need to be treated for one to get benefit

1/ARR

48
Q

How to know the Sample Size needed for a trial

A

Prospective Power Calculation

49
Q

How to eliminate allocation bias?

A

Randomisation

Ensured balance and eliminates bias.

Avoids bias in treatment allocation

Methods of Randomising:

Block Randomisation - assign people to group A or group B randomly

Stratification - done by centre - can be divided by important patient characteristics e.g. male/female

Minimisation - adaptive stratification - calculates imbalance and allocates to maintain balance

50
Q

how to eliminate measurement bias

A

Minimising Measurement Bias

Blinding - single, double, triple

Endpoint Selection

Objective/Subjective

Accurate and Precise

Consistent and Repeatable

Primary/Secondary/Tertiary end points

Loss to Follow-up

Missing data

Different between groups

Intention-to-treat analysis

51
Q

What are the descriptive studies

A

ndividuals - case reports, case series, cross-sectional studies

Populations - ecological studies

52
Q

What are the analytical studies

A

Observational: case control, cohort

Experimental: clinical control trial

53
Q

What gets measured in a cohort study

A

relative risk

54
Q

What get calculated in a case control study

A

odds ratio

55
Q

Measures how to asses exposure in case control study

A

Self-Reported

Measured in clinic (e.g. BMI)

Existing Records (e.g. medical/pharmacy records)

56
Q

Measurment outcome can be….?

A

inary Outcome

With or without the disease of interest

Continuous Outcome

E.g. blood pressure

Can use an arbitrary cut point

57
Q

Advantages and disadvantages of cohort studies

A 
Avantages:
- look at multiple outcomes
- good for rare exposures
- allows the calculation of relative risk 
- calculation of incidence  - temporal relationship
- minimise biases
- no ethical consideration
Disadvantages:
- long follow up periods
- expensive
time consuming
- loss to follow up might introduce bias
- Healthy worker effect
- not for rare diseases
58
Q

Case control study, advantages and disadvantages

A 
Advantages:
- good to look at rare diseases
- good to look a multiple risk factors
- cheap
- quick
- calculate odds risk
Disadvantages
- can not calculate incidence
- bias in exposure assessment (recall bias)
- lack of temporal relationship]
59
Q

Measurement errors in case control study

A

Measurement Error in Case-Control Studies

Recall Bias

Patients with the disease may be more inclined to answer questions carefully - may have a distorted view of exposure

Interviewer Bias

If the interviewer knows who has the disease, they may be more inclined to over-report exposures known to be associated with the disease of interest

Outcome Bias

Diagnostic bias

EXAMPLE: women taking menopausal hormone therapy may be screened for breast cancer more regularly

60
Q

Examples of cross sectional studies

A

Health Survey for England

2001, 2011 Census

National Survey of NHS Patients

61
Q

Advantages of routine data

A

Advantages of Routine Data

Relatively cheap

Already collected and available

Standardised collection procedures

Relatively comprehensive (population coverage - large numbers)

Wide range of recorded items

Available for past years

Experience in use an interpretation

62
Q

Disadvantagfes of routine data

A

Disadvantaged of Routine Data

May not answer the question (not enough detail)

Incomplete ascertainment (not every case captured)

Variable quality

Validity may be variable

Disease labelling may vary over time or by area

Coding changes could create artefactual increases or decreases in rates

Need careful interpretation

63
Q

Types of routine data

A

Types of Routine Data

Health outcome data (e.g. deaths, hospital admissions, primary care consultations or prescriptions)

Exposure and health determinant data (e.g. smoking, air pollution, crime statistics)

Disease prevention data (e.g. screening and immunisation uptake)

Demographic data (e.g. census population counts)

Geographical data (e.g. health authority boundaries, location of GP practices)

Health service provision (e.g. bed/staff counts)

64
Q

Most commonly

A

Breast

Lung

Large Bowel

Prostate

Bladder

65
Q

Why are single studies unreliable

A

Poor study design or small numbers - low power - false-negative results

Study will often only look at one subset of the potential study population

66
Q

Stages of planning a systematic review

A

Stage I: Planning a Review

Specify the question to be addressed

Usually framed around PICOS:

Population

Intervention/Comparison

Outcomes

Study Design

Stage II: Conducting the Review

Identification of Research

Clearly defined search criteria

Search published medical literature

Search other sources

Missing Studies = BIAS

Selection of Research

Study Quality Assessment

META-ANALYSIS

The use of statistical techniques in a systematic review to integrate the results of included studies.

Stage III: Reporting and Dissemination

Study details tabulated in a meaningful way

Should include details of PICOS

67
Q

Issues in systematic reviews and meta analysis

A

Issues in Systematic Reviews and Meta-Analyses

Publication bias

Inconsistency of results

Low study quality

NOTE: Null or non-significant findings are less likely to be reported/published than statistically significant findings

This BIAS may distort meta-analyses and systematic reviews

Inconsistency of Results

Different PICOS

68
Q

Advantages of meta analysis

A

Generate a pooled overall risk estimate

Produce a more reliable and precise estimate of effect

Explore differences (heterogeneity) between published studies

Identify whether publication bias is occuring

69
Q

Does alcohol consumption decrease or increase with social class

A

lcohol consumption decreases with socioeconomic class

70
Q

Does obesity increase or decrease with deprivation

A

Obesity increases as deprivation increases

71
Q

Does smocking decrease with age? IN some social classes when is the peak age?

A

Smoking generally decreases with age though in some socioeconomic classes there is a peak around 45-54 years

72
Q

What is used to treat schistosomiasis

A

praziquantel

73
Q

What is used to treat helminths?

A

Albendozol

74
Q

What is used to lymphatic Filariasis

A

Albendozol

75
Q

What else is used to treat helminths

A

Mebendazol

76
Q

What is used to treat onchocerchiasis

A

Mectizan

77
Q

What is used to treat trachoma

A

Zithromax

78
Q

What are the Protozoa infections

A

Chagas, leishmenias, trypanosomiasis

79
Q

What are the helminth infections

A

Lymphatic filariasis, Schistosmiasis, Onchociriasis,

80
Q

What are bacterial infection

A

leperosy, buroliosa, trauchoma,

81
Q

What is the host in schistosomiasis

A

snail

82
Q

what iss the host in onchoceriasis

A

Blacklfly

83
Q

what is the host in lymphatic filariasis

A

Mosquito

84
Q

What are the soil helminths

A

Hookworm, trichuriasis, ascarias

85
Q

Three key policy documents

A

Ottawa Charter

Jakarta Declaration

Bangkok Charter

86
Q

Tannahill prevention module

A

Prevention

Health Education

Health Protection (legal, fiscal)

87
Q

Current public health initiatives

A

Smoking Cessation

Alcohol Harm Reduction Strategy

Tackling Obesity - Change for Life

Sexual Health - National Chlamydia Screening Programme

Tackling Teenage Pregnancy

Vaccination Programmes

88
Q

Bradfort hill criteria

A

TAPED SSCC
Strength - a small association does not mean that there is no causal relationship

Consistency

Specificity - the more specific the association between a factor and an effect, the bigger the probability of a causal relationship

TEMPORALITY - exposure has to occur before the event

Dose-Response Relationship - greater exposure should generally lead to greater incidence

Plausibility

Coherence - between epidemiological and laboratory findings

Experiment

Analogy - the effect of similar factors may be considered

89
Q

What is the critical appraisal checklist for randomised control trails

A

consort

90
Q

what the is the checklist for observational studies

A

STROBE

91
Q

Checklist for meta analysis

A

MOOSE

92
Q

Checklist for Systematic reviews

A

PRISMA

93
Q

Statistical association due to

A

Chance

Bias

Confounding

Cause

94
Q

Control confounding factors

A

Design Stage:

Restriction (all about inclusion and exclusion criteria)

Randomisation

Analysis Stage:

Stratification (risks are calculated separately for each category of confounding variable)

Standardisation

Regression

95
Q

GRaphs used in systematic reviews and meta analysis

A

Galbraith (Radial) Plot - heterogeneity in results

Funnel Plot - publication bias

Forest Plot - showing all the results of the individual studies and the overall result of the meta-analysis (diamond)

96
Q

Cervical cancer screening

A

every 3 years for women aged 25-49, every 5 years to women 50-64

97
Q

Breast cancer screening

A

Breast Cancer - every 3 years for women aged 50-70, women aged 70 and over can self-refe

98
Q

Bowel cancer

A

Bowel Cancer - every 2 years for men and women aged 60-74

99
Q

Abdominal aortic aneurysm

A
  • offered to men in their 65th year
100
Q

Diabetics eye

A

Diabetic Eye Screening - offered to people with type 1 or type 2 diabetes over the age of 12

101
Q

Cervical cancer mortality has …

A

decreased

102
Q

breast cancer mortality has

A

decreased

103
Q

incidence of cervical cancer

A

stays same

104
Q

Cox regression

A

Cox Regression - considers whether the effect of a treatment has a multiplicative effect on the subject’s hazard rate (e.g. taking a statin may halve our immediate probability of having a MI)

105
Q

Hazard Ratio

A

Hazard Ratio - the effect of an explanatory variable on the risk of an event

106
Q

What tropical diseases do not cause death?

A

Hookworm, lymphatic filariasis, onchiocerciasis, trachoma

107
Q

What is the ntd which causes the most amount of DALY? what is the number?

A

Lymphatic filariasis

108
Q

HOw many people die every year of schistosomiasis?

A

41000

109
Q

How many people die of leprosy?

A

5000

110
Q

What is the neglected tropical disease with the most deaths? What is the number?

A

Leishmaniasis 47000

EPI (1 decks)

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