Epidemiology Flashcards

1
Q

Describe some obesogenic environmental factors:

A
  • Greater car dependence
  • Less active travel
  • Increased processed, high-sugar, high-saturated fat foods that are aggressively marketed
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2
Q

What is evidence based practice?

A
  • Use of current best evidence in making decisions about the care of patients
  • Involves the integration of clinical expertise, best available evidence from systematic research and the incorporation of patient values and research
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3
Q

What is the difference between efficacy and effectiveness?

A

Efficacy: intervention works in a research (clinical trial) setting

Effectiveness: intervention works in the real-life setting

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4
Q

What is cost-utility analysis vs a cost-benefit analysis vs a cost-effectiveness analysis?

A
  • Cost-utility analysis: weighs up the benefits of a treatment in terms cost of the treatment vs the gains in utilities such as quality of life and quantity of life (QALYs)
  • Cost-benefit analysis: a more economical approach that compares the economic cost of the intervention vs the economic gain of achieving a health outcome
  • Cost-effectiveness analysis: considers net costs vs net change in years of life
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5
Q

What is an annual recurrent expenditure on healthcare in Australia and what are the greatest areas of healthcare expenditure?

A
  • The annual recurrent expenditure on health care in Australia is $160 billion
  • The greatest areas of health expenditure include: hospitals, medical services (includes costs covered by medicare) and medications (bulk paid by the federal government via the PBS)
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6
Q

Explain the cost-effectiveness plane:

A
  • On the x axis is net health loss to net health gain
  • On they axis is net negative costs (cost saving) to net positive costs
  • Most health interventions lead to a net health gain and a net positive cost
  • A dominant intervention is when a health intervention leads to net health gain and net negative costs
  • A dominated intervention is one that leads to net health loss and net positive costs
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7
Q

What is allocative vs technical effieciency?

A

Allocative effeciency:

  • Efficient distribution of available resources
  • Considers opportunity costs

Technical efficiency:

  • Efficient management of a single condition
  • Considers cost-effectiveness
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8
Q

How is it decided what to invest in in the healthcare industry?

A
  • The efficiency of a health intervention is measured with incrememental cost-effectiveness ratio (ICER)
  • ICER= net cost/net health effect
  • The ICER is the gradient of the line
  • Anything above the threshold line (historically dialysis) is considered cost effective and anything below the line is not considered cost effective
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9
Q

What is the difference between a narrative and a systematic review?

A
  • Systematic reviews have a focused clinical strategy, have a comprehenive methodology (search strategy, inclusion criteria, appraisal and synthesis) and all inferences are evidence based
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10
Q

What are the advantages of systematic reviews?

A
  1. Condensed: can access consolidated results of huge volumes of information
  2. Objective: reduces risk of bias and error
  3. Balanced: broad range of studies considered through search strategy
  4. Verifiable: transparent process
  5. Replicable: use structured methodology
  6. Flexible: can be updated on a regular basis
  7. Dynamic: in identifying under-researched areas and identifying new questions
  8. Readable: easy to read and understand
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11
Q

What are the disadvantages of systematic reviews:

A
  1. Systematic reviews can be done badly
    - Inappropriate aggregation of studies
  2. Systematic reviews often yield conflicting results
  3. Systematic reviews include an element of judgement irrespective of method used
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12
Q

What is a metaanaylsis?

A
  • Optional element of a systematic review
  • Involves statistically combining results from 2 or more studies
  • Should only be done with studies with low heterogeneity
  • Can be skewn if poor studies are used or reporting biases present an issue e.g. information vias
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13
Q

How is publication bias assessed for?

A
  • Done using a funnel plot
  • Effect size on x axis vs sample size of trial on y axis
  • Should read as an upside down funnel: as sample size goes up, variance should decrease
  • If publication bias exists there may be a skewed plot or a hole in the funnel plot around null
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14
Q

What is stigma?

A
  • Co-occurrence of labeling, stereotyping, status loss and discrimination in a context where power is exercised
  • Stigma becomes the grounds for inequity and disadvantage, social and economic exclusion etc.
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15
Q

Why are mental illnesses so stigmatising?

A
  • In order to be defined with “person-hood” and thus be deserving of moral consideration a being must be:
    1. Self-aware
    2. Capable of perceiving themselves as an entity persisting through time
  • Capable of having preferences e.g. desire to keep living
  • Mental illness compromises many of these elements that we value as human beings
  • Negative stereotypes about mentally ill people being dangerous/violent
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