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*CPH Exam 2021 > Epidemiology > Flashcards

Epidemiology Flashcards

1
Q

surveillance

A

ongoing, systematic collection, analysis, and interpretation of health-related data

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2
Q

goal of surveillance

A

to provide information to be used for public health action

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3
Q

Must the CDC be invited by a state before conducting public health surveillance?

A

Yes

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4
Q

Passive surveillance

A
  • diseases are reported by health care providers
  • simple and inexpensive
  • limited by incompleteness of reporting and variability of quality
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5
Q

active surveillance

A
  • health agencies contact health providers seeking reports
  • ensures more complete reporting of conditions
  • time consuming and expensive
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6
Q

sentinel surveillance

A

reporting of health events by health professionals who are selected to represent a geographic area or a specific reporting group

can be active or passive

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7
Q

syndromic surveillance

A

focuses on one or more symptoms rather than a physician-diagnosed or laboratory confirmed disease

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8
Q

Epidemiology

A

the study of the distribution and determinants of health-related states or events in specified populations;

  • study (scientific, systematic, data-driven)
  • distribution (frequency/pattern)
  • determinants (causes, risk factors)
  • populations (neighborhoods, school, city, state, country, state)
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9
Q

Disease Distribution

A

analysis of patterns

describes who gets the disease, where people with the disease are located, and how these aspects of disease change over time

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10
Q

endemic

A

the ongoing, usual level of, or constant presence of a MMD within a given population

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11
Q

epidemic

A

outbreak or occurrence of a MMD clearly in excess of usual level of expectancy in a defined community or region

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12
Q

pandemic

A

worldwide epidemic

Ex: HIV; COVID-19

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13
Q

descriptive epidemiology

A

Answers - Who is getting the disease?

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14
Q

fixed population

A

permanent membership based on an event

ex: Hiroshima survivors

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15
Q

Transient/dynamic population

A

membership based on a condition that changes

ex: where you live

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16
Q

counts

A

of cases

  • answers “How many?”
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17
Q

ratio

A

one number (x) / another number (y)

  • can be related or independent
  • range 0 to infinity
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18
Q

proportion

A

type of ratio; expressed as a percentage

numerator is subset of the denominator;
x/(x+y)

range 0 to 1

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19
Q

risk

A

probability of outcome occurring among at risk population during a time period

a/N
a=# of new onset cases
N = population-at-risk at beginning of follow-up

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20
Q

rate

A

quantity per unit of time; measures speed at which things happen

range: zero to infinity
ex: heart rate - 60 beats per minute

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21
Q

incidence rate/density

A

of new cases (incidence) / # of person-time (PT) of observation

ex: 1 case/4.5 person-years

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22
Q

person-time assumption

A

assumes rate is constant over different periods of time

ex: 100 persons followed for 10 years = 1000 person years
ex: 1000 persons followed for 1 year = 1000 person years

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23
Q

prevalence

A

proportion;

of existing cases of MMD / # of total population

range 0 to 1

“snapshot”

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24
Q

case fatality rate

A

not a rate, is a proportion

of deaths from an illness/# of people with the illness

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25
proportionate mortality
the proportion of deaths caused by a specific disease / all deaths used to determine leading causes of mortality
26
crude mortality rate
of deaths from all causes / total population in a given time period
27
cause-specific mortality rate
deaths from a specific cause / total population in a given time period
28
age-specific mortality rate
of deaths from all causes in a specific age group / # population in specific age group in a given time period
29
control for confounding by:
1. stratification | 2. direct standardization
30
Experimental Study Designs
1. RCT | 2. Clinical trial
31
Observational Study Designs
1. Case reports/series 2. Ecological 3. Cross-Sectional 4. Cohort 5. Case-Control
32
RCT
compares exposure and outcome among different groups exposure is randomly assigned by researcher customary to present patient characteristics table
33
RCT process
1. Identify study population 2. randomly assign into 2+ exposure groups 3. categorize into outcome groups (e.g. cured/not cured)
34
Clinical trial limitations
1. ethical considerations 2. select population (may not be generalized) 3. duration (expensive, time consuming) 4. adherence (ensuring subjects comply with study procedure)
35
placebo
ensures control and treatment group have the same "experience"
36
single blinding
subjects unaware of assigned exposure
37
double blinding
both subjects and researchers do not know assigned exposure standard
38
infant mortality rate
of deaths of infants less than 1 year of age / # of infants less than 1 year of age within a given time period
39
MMD
Mortality, Morbidity, Disability
40
incidence
of new cases of disease
41
disease frequency
how often does the MMD occur in the population?
42
cumulative incidence (CI)
of new cases of disease / # in at risk population over a specified period of time estimates the probability that a person will develop disease during a specified time
43
Cumulative Incidence is used mainly for _____ populations
fixed
44
incidence decreases + people are living longer with the disease =
increased prevalence
45
incidence increases + duration is short =
decreased prevalence
46
incidence decreases + duration is short =
decreased prevalence
47
relative risk
ratio rate in exposed/rate in unexposed
48
relative risk 2x2 table
(a/a+b)/(c/c+d)
49
odds ratio
the odds that an outcome will occur given a particular exposure; compared to the odds of the outcome occurring in the absence of that exposure
50
odds ratios are most commonly used in _____, but can also be used in _____ and _____.
case-control studies cross-sectional and cohort
51
odds ratio 2x2
(a/b)/(c/d) -or- ad/bc
52
RR is approximate to the OR when:
the disease is rare
53
ecological studies: unit of analysis
population or groups
54
ecological studies: exposure status
based on the population
55
ecological fallacy
making assumptions about the individual based on findings at the population level
56
ecological studies: time
varies
57
cross-sectional: time
snap-shot
58
cross-sectional: population
individual level; selected without regard to exposure or disease status
59
cross-sectional: measure
prevalence
60
cross-sectional: Measure of association
odds ratio cannot determine cause and effect
61
case control study
- disease is rare - disease has a long induction and latent period - little is known about the disease
62
case control study: selection of cases based on _____.
outcome
63
cohort study
- 2+ groups begin disease free - selection based on exposure - followed for outcome - observational equivalent of experimental studies, but unable to allocate exposure
64
cohort study purpose
studies causes, preventions, and treatments for diseases
65
randomized control trials
investigate the role of some "agent" in the prevention or treatment of disease researcher allocates agent gold standard
66
goal of randomization
to achieve baseline comparability between compared groups on factors relating to outcome provides balances with respect to known and unknown factors
67
The _____ the groups, the _____ randomization works.
larger, better
68
strategies for increasing compliance?
design | throughout the study
69
purpose of blinding
to avoid bias in ascertainment of outcome
70
internal validity
the degree to which the results are attributable to the independent variable and not some other rival explanation
71
external validity
the extent to which the results of a study can be generalized
72
threats to validity
bias, chance, confounding
73
chance
random variation
74
as we _____ the sample size, the impact of chance _____.
increase; decreases
75
bias
systematic error in the design or conduct of a study; unintended mistake of the researcher not affected by sample size best to control for at the design stage
76
confounding
not a mistake, but needs to be controlled for not impacted by sample size can be controlled for at the design and/or analysis stage
77
selection bias
systematic error in the method of selecting study participants
78
misclassification bias
systematic error in the procedures for gathering exposure/disease information
79
bias leads to:
wrong results leading to misleading conclusions
80
Dealing with bias at design stage
1. subject selection | 2. subject/study personnel blinded to subject status
81
Dealing with bias at data collection
- definitions - measurements - standardization - quality control
82
confounding
distortion in the measures of the association between exposure and outcome
83
mixing of effects
association between exposure and disease is distorted mixed with the effect of another associated factor
84
Confounding arises when important _____ factors are _____ distributed across groups being compared.
extraneous; differentially
85
screening
classifies individuals with respect to their likelihood of having a particular disease
86
potential harms of screening
- false positive - unnecessary interventions and anxiety - over-diagnosis - cost - discomfort - embarrassment
87
WHO recommendations for screenings
- important health problem (prevalence/severity) - treatment should be available - available facilities for diagnosis and treatment - latent stage of disease - available test for the disease
88
prevalence
(TP + FN) / total
89
sensitivity
TP / (TP + FN)
90
specificity
TN / (TN + FP)
91
PPV
TP / (TP + FP)
92
NPV
TN / (TN + FN)
93
Lowering criterion of positivity results in _____ sensitivity and _____ specificity
increased; decreased
94
Increasing criterion of positivity _____ sensitivity and _____ specificity.
decreased; increased
95
for continuous data, the decision for the screening cut point involves weighing the consequences of _____ against _____.
false negatives; false positives
96
Sensitivity should be increased when _____.
the penalty associated with missing a case is high ex: very infectious disease ex: when subsequent diagnostic evals have minimal risk or cost
97
specificity should be increased when _____.
the costs or risks associated with further diagnostics are substantial. ex: invasive diagnostics (biopsies)
98
preclinical phase (Natural progression of disease)
period between developing the disease and symptom onset
99
clinical phase (Natural progression of disease)
diagnosis, seek care, treatment, outcome

*CPH Exam 2021 (10 decks)

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