Epidemiology Flashcards
Activities of daily living (ADL) scale
A scale for recording a person’s functional capability based on answers to questions about mobility, self-care, grooming and ability to dress, wash, keep house, shop for food. The ADL scale and many modifications assign a numerical score to physical ability and outcomes of interventions for people with known or suspected disabilities, such as those caused by arthritis. The ADL scale is used to assess health status and to evaluate progress and response to treatment.
Acute
Referring to a disease or condition, this means sudden in onset, loosely used [in everyday lay language] to mean severe or intense. [This use is to be discouraged in medical parlance] See also and contrast CHRONIC.
Adherence
Health-related behaviour that abides by the recommendations of a health care professional or the investigator in a research project. The word “adherence” is preferred by some who consider the alternative, COMPLIANCE, to imply coercion or excessive authoritarianism.
Adiposity
Overall expansion of body fat, often with depletion of muscle mass, physical strength, and agility.
Allocative efficiency
A terms used by health economists to describe the degree to which resources are allocated efficiently. The economic analysis may or may not take ethical issues into account, and equitable resource allocation is as important as economic efficiency. See also EFFICENCY.
Ambulatory care
Literally, medical care of people who are able to walk in and out of a clinic. The care may be primary, episodic, or part of continuing care for an existing condition.
Antecedent cause of death
The condition(s) that led to or precipitated the immediate cause of death, as recorded on a DEATH CERTIFICATE. For example, myocardial ischemia caused by coronary artery disease is an antecedent cause of heart failure (the IMMEDIATE CAUSE OF DEATH), where the underlying cause is coronary arterial atherosclerosis.
Antenatal
Literally, before birth; pertaining to the provision of services for pregnant women and for their unborn children.
Avoidable risk
The risk of disease at some unspecified future period that could be avoided by a specified shift to a more favourable exposure distribution of recognized risks. For example, the risk of disease and premature death from smoking-related diseases could be reduced by reduction of smoking rates.
Barker hypothesis
Syn: THRIFTY PHENOTYPE HYPOTHESIS. A hypothesis proposed in 1990 by the British epidemiologist David Barker that INTRAUTERINE GROWTH RETARDATION, low birth weight, and premature birth have a causal relationship to the origins of hypertension, coronary heart disease, and type 2 diabetes, in middle age. Barker’s hypothesis derived from a RETROSPECTIVE COHORT STUDY that revealed a significant ASSOCIATION between the occurrence of hypertension and coronary heart disease in middle age and premature birth or low birth weight.
Bayesian inference
A form of reasoning widely used in CLINICAL EPIDEMIOLOGY. It begins with description of the facts before exposure or intervention under investigation and adds fresh information gathered during the course of study to yield probabilities of the state of affairs after the exposure or intervention.
Behavioural risk factors
These are common risk factors associated with ways people behave. They include taking insufficient physical activity, eating to excess, smoking, overindulgence in alcohol and other mood-modifying substances, reckless driving, and aggressive and violent conduct toward others, all of which are associated causally with disease, injury, and premature death.
Benefit-cost ratio
The ratio of quantifiable benefits to actual or estimated costs expressed in monetary terms. It is used to assess the economic feasibility or success of a health intervention. The term COST-BENEFIT RATIO is more often used.
Biological plausibility
The criterion that an observed, presumed or putatively causal association is coherent with previously existing biological or medical knowledge.
Body mass index (BMI)
The body weight in kilograms divided by the square of the height in metres. This anthropometric measure is an indicator of fatness and obesity. It correlates closely with skinfold thickness and density of the body.
Burden of disease
The amount of ill health from a given cause (disease, injury, cause of disease, or risk factor) in a population of interest. See also DISABILTY-ADJUSTED LIFE YEARS (DALYs).
Burkitt’s lymphoma
A malignant lymphoma first identified in East Africa, where the British surgeon Denis Burkitt (1911-1993) observed that its distribution coincided with that of malaria-carrying anopheline mosquitoes, and this recognized that the condition was probably caused by an agent transmitted by mosquitoes. This agent was found to be a herpes virus, the Epstein-Barr virus, which has been detected in more than 95% of cases.
Capitation
A method of payment for services based on the number of people registered as potential users of the service, rather than on fees for each item of service rendered. The basis for part of the payment of general practices under the UK’s General Medical Services (GMS) contract.
Carstairs index
A measure developed in a similar fashion to the TOWNSEND INDEX to classify localities in relation to social deprivation. The index is based on four measures recorded in the UK census: low social class, lack of car ownership, overcrowding and male unemployment.
Cause
In general, something that produces an effect. In medicine and public health it is customary to distinguish NECESSARY CAUSE and SUFFICIENT CAUSE.
Cause-specific rate
The incidence or death rate from a specific cause such as cancer or coronary heart disease. Cause-specific incidence and death rates for cancer are further classified by the site of the cancer to yield rates for common cancers, such as lung, breast, prostate, and colon.
Clinical Epidemiology
Epidemiological study conducted in the clinical setting with patients as the subjects of study.
Clinical significance
A difference in effect size considered to be important in clinical or policy decision Cf. STATISTICAL SIGNIFICANCE.
Cluster
A collection of events such as new cases of an uncommon or rare disease that occur so closely together in space and/or time as to arouse suspicion that this is not a chance occurrence but has a cause that should be investigated.
Cluster analysis
A set of mathematical and statistical procedures that are used to calculate the probability that a presumed cluster of cases is an epidemic, not a random event.
Community diagnosis
A term used to describe the summarized health and social statistics of a defined community, whether it be a nation or a social group within the nation.
Completed fertility rate
The cumulative fertility rate in a cohort of women who have passed the end of their reproductive life, e.g. the total number of births per 1,000 to women aged 49 years and older in a specified population.
Compliance
Abiding by the advice or instructions of a health professional. Many behavioral scientists prefer to allude to ADHERENCE and suggest that “compliance” is a pejorative word, implying coercion.
Cost
The value of resources invested in a service, including costs of buildings, equipment, etc., operating cost of upkeep, maintenance, wages and salaries, dressings, medications, etc., each separately itemized in the budget that records where the money comes from and where it goes. Economists, accountants, and auditors distinguish several aspects, including DIRECT, FIXED, INDIRECT, MARGINAL, OPPORTUNITY, UNIT and VARIABLE costs.
Cost-benefit analysis
Calculation or estimation of monetary and other costs, social costs such as time lost from work, years of active life lost to disability and premature death, and an estimate of the financial benefits attributable to the activities of a health service. All are expressed as far as possible in monetary terms. The benefits include ability to engage in work and valued familial and social activities, and estimates of added years of active productive life. Value judgments and approximations are inevitable parts of many costs-benefit analyses.
Cost-benefit ratio
The ratio of quantifiable costs to actual or estimated benefits expressed in monetary terms. It is used to assess the economic feasibility or success of a health intervention. See also BENEFIT-COST RATIO.
Cost-effectiveness
The ratio of quantifiable costs to actual or estimated benefits expressed in monetary terms. It is used to assess the economic feasibility or success of a health intervention. See also BENEFIT-COST RATIO.
Cost-effectiveness
Estimation of expenditure and “returns” on this expenditure as health gains, compared with what might have been achieved by using available funds in another way.
Cost-effectiveness analysis
A variant of COST-BENEFIT ANALYSIS that seeks to identify the least costly way to meet a specified objective. It may be conducted by comparing costs and outcomes in systems that have applied different modalities, or as an abstract exercise using economic and other modelling techniques.
Cost-utility analysis
A variation of COST-EFFECTIVENESS ANALYSIS in which the UTILITY of an action or a system is estimated. Utility means the merits, or value, of a specified state of health, such as a health state on the continuum from full functional status to total dependency on others.
Coverage
- The extent to which the health services provided for or available to the population of a country or region meet the potential or perceived needs of the people. 2. The extent to which a population is protected against a communicable disease by appropriate vaccination or other preventing regimen. 3. The extent to which a screening programme reaches its target population (e.g. the proportion of women eligible for mammographic breast cancer screening who receive invitations to be screened.
Chronic
Prolonged, long lasting or long term in relation to illness. Chronic diseases are frequently referred to now as “long term conditions”.
Data protection
Procedures adopted to ensure that the confidentiality of sensitive personal information is maintained. Examples include secure record storage systems (filing cabinets that are locked at all times and accessible only with a key held by authorized persons) and encryption of computer-stored files to ensure that they are accessible only to authorized persons who possess the access code
Death Certificate
A document, signed (in most countries) by a registered doctor containing personal details (name, date of birth, place of residence etc.) of the deceased together with the suspected or established cause of death.
Death registration
The formal procedure of recording and notifying death has been a statutory legal requirement in most countries for more than 100 years. The details are contained in the death certificate. This is a legal document, as well as the source of tabulated data on causes of death.
Demand
A term used in economics to describe willingness or ability to pay for goods or services. In the terminology of health economics, it means desire for or willingness to seek health care.
Demography
The scientific study of populations that focuses on their size, distribution, age structure, fertility, marital patterns, migrations, mortality, and the social, cultural, economic, and other determinants of variations in any or all of these features.
Deprivation
In public health, this term usually applies to the status of people who are deprived of food, shelter, adequate clothing, or other necessities of life, such as protective immunizations against common infectious diseases. Deprivation scores such as TOWNSEND and CARSTAIRS are used to classify localities in the UK.
Determinant
Any factor, whether event, characteristic, or other definable entity, that brings about a change in a disease or health-related state. It could be inherited or acquired. The former are usually termed genetic, the latter environmental. Environmental determinants may be biological, behavioural, social, economic, cultural or other factors.
Direct cost
The economic consequences of treatment or care including such items as investigations, therapy, rehabilitation, pro rata wages and salaries of those professionals involved and other similar items.
Disability
Reduced capacity of a person to perform usual functions, usually the consequence of an IMPAIRMENT, such as impaired mobility or intellectual impairment. May cause HANDICAP.
Disability-adjusted life years (DALYs)
A population-based measure of the burden of disease and injury expressed in terms of hypothetical healthy life years that are lost as a result of specified diseases and injuries. DALYs comprise lifetimes lost completely because of death and health life years “lost” from onsets of nonfatal diseases and injuries, weighted to equivalent years completely lost (e.g., 2 years in a state half as bad as death has a “disability weight” of 0.5).
Discounting
An adjustment to cost estimates to allow for the fact that future monetary units (dollars, pounds, Euros, etc.) will have a different value from those at present, usually a smaller value because of the effects of inflation.
Early detection
A phrase describing prompt identification of incipient or early disease and, by implication, intervention to arrest, treat, and cure it in a timely manner. Methods of early detection include questionnaires, interviews, physical examinations, SCREENING tests. Early detection is an important role of primary care physicians, who can use many opportunities that arise in the course of incidental and continuing care of patients to conduct simple screening tests for early evidence of serious conditions, such as cardiovascular disease, diabetes, and cancer.
Early neo-natal mortality rate
The number of infant deaths in the first week of life per 1000 live and still births.
Effectiveness
The effect of a drug (or other intervention) in “the real world” (i.e. taking into account factors such as non-compliance (non-adherence))
Efficacy
The ability of a drug (or other intervention) to produce a therapeutic effect under circumstances close to “the ideal” (i.e. only looking at the effect in people who are thought to be taking the drug at the prescribed dose).
Efficiency
- The end results achieved in relation to expenditure of money, resources, effort, and time that have been aimed at achieving these results. This is a measure of the economy or resource costs in relation to the output or end results of an intervention. In HEALTH ECONOMICS, several categories of efficiency are recognized, including: ALLOCATIVE EFFICIENCY, concerned with resource allocation; PRODUCTIVE EFFICIENCY, concerned with identifying the best way to produce desired health outcomes; and TECHNICAL EFFICENCY, concerned with the suitability and quality of equipment, facilities, etc.
