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CPH/PPD > Epidemiology > Flashcards

Epidemiology Flashcards

1
Q

Descriptive epidemiology is fo the purpose of:

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2
Q

Analytic epidemiology is a study for the purpose of:

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3
Q

Experimental epidemiology is a study for the purpsoe of:

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4
Q

Epidemiologic investigation focuses on describing disease distribution, by the characteristics relating to:

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5
Q

The main characteristics of individual (personal) variations, include:

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6
Q

How can Individual Variations in Health and Disease can help us?

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7
Q

If geographical differences in disease do appear to be REAL, what are the 3 main question we could ask?

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8
Q

What are the 4 Potential pitfalls of Geographical variations?

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9
Q

How do we overcome potential pitfalls of Geographical Studies?

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10
Q

Variations in TIme of Epidemiological Study, could provide:

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11
Q

A change in disease rates, can distinguish between:

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12
Q

What is an Ecological Study?

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13
Q

In an Ecological Study, how exposure and disease rates are measured?

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14
Q

What are the 3 types of Ecological Studies in Epidemiology?

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15
Q

What are the Potential Pitfalls of Ecological Studies?

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16
Q

Migration Ecological Studies, can help us to separate effects of:

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17
Q

What is the main difference between Cilnical Medicine Research and Epidemiology / Public Health subjects of concern?

A

Clinical medicine is concerned with the health at the level of the individual patient, while epidemiology and public health are concerend with health at the level of the population.

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18
Q

What is Epidemiology?

A

The study of the distribution and determinants of health related states in human populations

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19
Q

What is Public Health?

A

The Science and Art of:

  • Prolonging life.
  • Preventing disease.
  • Promoting health.

In the population, by organised efforts of society.

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20
Q

What are the questions that Epidemiology is concerened with?

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21
Q

What is the question that Public Policy / Health Promotion, concerned with?

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22
Q

What are the questions that Heath Service Organisation is concerned with?

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23
Q

What’s Public Health’s Top 10 Contributions, in the 20th Century?

A
  1. Vaccinations.
  2. Motor Vehicle Safety.
  3. Infection control (sanitations, water, TB, etc).
  4. Food Safety, nutrition & quality.
  5. CHD/Stroke risk factor reduction.
  6. Safer childbirth/infant mortality.
  7. Family planning.
  8. Tobacco control.
  9. Workplace Safety.
  10. Water Fluoridation (US).
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24
Q

According to the Population Approach, by what criteria do we asses impact of particular illness on population health?

A

Mortality

Morbidity

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25
Q

In what 3 ways do we Measure Diseases?

A
  1. Prvalence rate - Presence of disease (new and old).
  2. Incidence rate - Occurence of new casese of diseases.
  3. Mortality rate - Occurence of death
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26
Q

What is the calculation of Prevalence, Incidence, and Mortality Rate?

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27
Q

In order to show causality, what are the 3 types of studies that are available to us?

A
  1. Case - control studies.
  2. Cohort studies.
  3. Randomized Control tirals.
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28
Q

When it comes to studying diseases, what are the 3 stages and their meaning?

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29
Q

Why is Blood Pressure a problem?(2)

A
  1. Higher BP levels are strongly associated with risk of cardiovascular and cerebrevascular disease, especially coronoary hear disease and stroke.
  2. High blood presure is common in the general population.
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30
Q

High blood pressure increase the risk of:

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31
Q

How do we know BP is associated with risk factors? Based on what?

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32
Q

Which is more important when it comes to risk relating to BP, systolic or diastolic?

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33
Q

What are the BP values that are considered to a be a risk at the UK, and what percentage of the pop’ (men and women) suffers from it?

A

SBP 140+

DBP 90+

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34
Q

What is the average systolic BP levels in the population?

A

150

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35
Q

What is the difference between Primary (essential) BP, and Secondary BP?

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36
Q

What are the causes of essential hypertension?

37
Q

What are the characteristics of population in which BP does not rise substantially with age?

38
Q

What is the strongest evidence that hypertension is due to environemental influence, and what is the exception (relating to genetics)?

39
Q

A reduction of BP for how long will reverse the risk of high BP? What is the effect of lowering diastolic BP by 10mmHg on Stroke and CHD?

40
Q

What would be non-pharmacological measures to remove risks factors for hypertension? What are the top 3?

41
Q

From the epidemiological standpoint, what is the traditional view on reducing BP? What is the newer view? and what is the CVD view? What is the advantage of the CVD view?

A

Traditional: those who’s BP should be lowered are the ones with the high BP.

New: the reason to reduce BP is to reduce CVD.

Middle: PB should be treated on its merits but should take account of overall CVD risk.

The advantage: it is those patients who will benefit the most and where we will have the greatest effect (attributable effect).

42
Q

What is the relation between relative risks when it comes to hypertention (i.e. blood cholesterol and cig’ smoking)?

A

They multiply.

43
Q

What is the most effective strategy to preven high BP in the population in terms of cost? Treating high BP, Treatig high CV risk, or Reducing salt in diet?

A

Reducing salt in diet.

44
Q

Risk factor should NOT be either one of the following three

A
  1. Causal
  2. Independent.
  3. Modifiable.
45
Q

What would you consider a Cause of a disease?

46
Q

What types of studies could help us to establish whether flying is a cause of VTE?

47
Q

What is the definition of Case Control Study?

A

A case–control study (also known as case–referent study) is a type of observational study in which two existing groups differing in outcome are identified and compared on the basis of some supposed causal attribute.

48
Q

What is the definition of Cohort (Longitudianl) Study?

A

A cohort study is a particular form of longitudinal study that sample a cohort (a group of people who share a defining characteristic, typically those who experienced a common event in a selected period, such as birth or graduation), performing a cross-section at intervals through time.

OR

¨A prospective cohort study is one in which a group of people with different exposures is followed over time to see if they acquire a disease/outcome.”

49
Q

What is the definition of Randomized Controlled Trial?

A

A randomized controlled trial (or randomized control trial;[2] RCT) is a type of scientific (often medical) experiment which aims to reduce bias when testing a new treatment. The people participating in the trial are randomly allocated to either the group receiving the treatment under investigation or to a group receiving standard treatment (or placebo treatment) as the control. Randomization minimises selection bias and the different comparison groups allow the researchers to determine any effects of the treatment when compared with the no treatment (control) group, while other variables are kept constant.

50
Q

What are the stregnthes of Case Control Studies?

51
Q

What are key issues to consider when designing a Case Control Study?

52
Q

How do we deal with confounding of a Case Control, in the design stage?

53
Q

How do we deal with a confounder of a Case Control Study, at the analysis level?

54
Q

What are the potential problems with these studies?

55
Q

What is the definition of Case Control’s Random Error?

What is the deifnition of Case Control’s Bias - Systematic Error?

A

Random Error - An error in measurement caused by unpredicatble factors which vary from one measurement to another.

BIas - Systematic Error - An error that is not determined by chance but is introduced by an inaccuracy inherent in the system.

56
Q

Relating to Case Control Studies, what are the 2 types of Biases you have, and what’s their definition?

57
Q

Can Case Control stuides provide us with any indication of disease incidence (development of new disease)?

If yes, how?

If not, whic type of study can?

58
Q

What is the difference beweeen Causal factor and a Risk factor?

A

Risk Factor - Any characteristic which IDENTIFIES a group at increased (decreased) risk of disease now or in the future.

Causal Factor - A cause is a factor which, of itself. increases the risk of a disease occuring - (prevalence, incidence, moratality) - usually a biological phenomenon.

59
Q

What are the strengths of a cohort study?

60
Q

What are the key features of Population Selection for a cohort study? (2)

A
  1. You want a range of exposures from low to high. A highly exposed group vs. low exposed).
  2. General population can be helpful (General Practice population, British doctors, Civil Servants).
61
Q

What is the most important issue regarding size and statistical power , when it comes to Cohort (observational study)?

A

You need to ensure that you design a study big enough to have a good chance of finding an association if present - many studies too small.

62
Q

What are the key sources of bias in a Cohort study?

63
Q

How do you limit the bias of Cohort studies (Selection Bias and Information Bias)?

64
Q

Which type of study is a fundemantally stronger in design and why, Cohort Study or Case Control Study?

Where is it more likely to have a BIas (systematic error), in a Cohort or Case Control Study?

A

Exposure to the potential causal factor is being measured Before disease has developed in Cohort Study, and therfore, has a stronger design.

Bias error is more likely to occur in a Case Control Study.

65
Q

What are the main advantages of Cohort Studies?

66
Q

What are the main disadvantages of cohort studies?

67
Q

The following examples would favor which of the study types, Cohort or Case studies?

a. Rare diseases
b. Rare exposure
c. Valid study, with low risk of bias

A

a. Case Control.
b. Cohort Study.
c. Cohort Study.

68
Q

What is the Bradford - Hill Criteria? And what are the Criteria it defines for causality?

A

These are set of criterai which can be useful in establishing epidemiologicevidence of a causal relationship between a presumed cause and an observed effect and have been widely used in public health research (CATS n’ BIRDS).

  1. Strong
  2. Independent
  3. Dose Response
  4. Temporal sequence
  5. Consistent
  6. Sepcific
  7. Reversible
  8. Biolofical plausability.
  9. Analogy.
69
Q

What are modifiable and non-modifiable risk factors that predispose a patient to coronary heart disease?

A

Modifiable:

High BP, High cholesterol, Cigarette smoking, Weight

Non-modifiable:

Age, Sex, Ethnicity, Family Hx

70
Q

What are primary, secondary, and tertiary preventions?

71
Q

What are the two fundemental approaches regarding Primary Prevention, when it comes to Individuals, High Risks, and Clinical Approach?

72
Q

What are Strengthes of High Risk Strategy?

73
Q

What are weaknesses of High Risk Strategy?

74
Q

What are the strenghtes of Population Strategy?

75
Q

What are the weaknesses of Population Strategy?

76
Q

Which is more effective strategy, Population or High Risk? What does it depend on?

77
Q

What are the key features of Cohort Studies?

78
Q

What’s the difference between Selection Bias and Information Bias?

What is the solution for each of them, in a Cohort studies design.

79
Q

What is the acronym to remember the advantages and disadvantages of Cohort Studies?

A

Advantages:

MINS and S

Distadvatnages:

CSI - NHS- C

80
Q

What’s the purpose of Random Allocation in Experimental Trial design? (3)

A
  1. Eliminate allocation bias - systemaatic difference betweeen participants in the different treatment groups.
  2. Minimizing confounding (treatment groups that are similiar in baseline characteristics, and differentces in outcome betweeen groups due to difference in treatment. NOT differences in participant baseline characteristics).
  3. Facilitate blinding.
81
Q

What are key features of RCT design, when compared to other types of research trials (3)?

A
  1. Random sampling.
  2. Random allocation.
  3. Use of placebo.
82
Q

What are the different types of control treatments?

A
  1. Standard treatment (active/positive).
  2. Placebo (begative control).
  3. No ‘additional’ treatment (unlikely).
83
Q

What is response bias? (3)

A

*Bias introduced in reporting outcomes by participants

*Systematic (not random) difference between patient response and truth

*Subjective self-reported outcomes (ex: report to please researchers)

84
Q

When given treatment to patinets in clinical trials, there are 3 categories of response:

A

§ Natural epidemiology

§ Placebo effect

§ Treatment effect

86
Q
  • What kind of interventions can be tested in experimental studies (4)?
A
  • Medical treatment
  • Surgical treatment
  • Health promotion advice
  • Dietary change
87
Q
  • The ideal experimental study design
A
  • Controlled (placebo controlled or other)
  • Randomized
  • Double blind (outcome assessment)
  • Large
  • Analyzed by ‘intention to treat’ method

CPH/PPD (6 decks)

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