Epidemiology Flashcards
Describe some obesogenic environmental factors:
- Greater car dependence
- Less active travel
- Increased processed, high-sugar, high-saturated fat foods that are aggressively marketed
What is evidence based practice?
- 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
What is the difference between efficacy and effectiveness?
Efficacy: intervention works in a research (clinical trial) setting
Effectiveness: intervention works in the real-life setting
What is cost-utility analysis vs a cost-benefit analysis vs a cost-effectiveness analysis?
- 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
What is an annual recurrent expenditure on healthcare in Australia and what are the greatest areas of healthcare expenditure?
- 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)
Explain the cost-effectiveness plane:
- 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
What is allocative vs technical effieciency?
Allocative effeciency:
- Efficient distribution of available resources
- Considers opportunity costs
Technical efficiency:
- Efficient management of a single condition
- Considers cost-effectiveness
How is it decided what to invest in in the healthcare industry?
- 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
What is the difference between a narrative and a systematic review?
- Systematic reviews have a focused clinical strategy, have a comprehenive methodology (search strategy, inclusion criteria, appraisal and synthesis) and all inferences are evidence based
What are the advantages of systematic reviews?
- Condensed: can access consolidated results of huge volumes of information
- Objective: reduces risk of bias and error
- Balanced: broad range of studies considered through search strategy
- Verifiable: transparent process
- Replicable: use structured methodology
- Flexible: can be updated on a regular basis
- Dynamic: in identifying under-researched areas and identifying new questions
- Readable: easy to read and understand
What are the disadvantages of systematic reviews:
- Systematic reviews can be done badly
- Inappropriate aggregation of studies - Systematic reviews often yield conflicting results
- Systematic reviews include an element of judgement irrespective of method used
What is a metaanaylsis?
- 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
How is publication bias assessed for?
- 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
What is stigma?
- 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.
Why are mental illnesses so stigmatising?
- 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