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Z MD1 Cardiac physiology > epidemiology and social determinants of health > Flashcards

epidemiology and social determinants of health Flashcards

1
Q

how is incidence reported

A

as a rate (denominator includes time)

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1
Q

are cohort studies prospective or retrospective?

A

prospective - we recruit people according to risk factor status (exposed or not-exposed) outcome happens after recruitment

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1
Q

what is the income where once you go past - life expectancy doesnt change much

A

$10000 per annum

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2
Q

what kind of studies can you get incidence from?

A

only from longitudinal studies

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2
Q

what are the 4 stages of health transition

A

age of infection and famine age of receding pandemics age of degenerative and man-made diseases age of delayed degenerative diseases

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4
Q

which study designs are observational?

A

case series, ecological, cross-sectional, case-control, cohort

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4
Q

what did the whitehall study find

A

that the lower in the work hierachy you are the greater the risk of death

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4
Q

what is the bonus of using 95% confidence intervals over p vales?

A

CI also provides an indication of the precision of the result

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5
Q

is case control studies prospective or retrospective

A

retrospective - we come in after disease has already occurred

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5
Q

how do you minimize confounding in the analysis of a study

A

restriction stratification - analysis of sub group multivariate analyses

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5
Q

what is intention to treat analysis

A

analyse results assuming that subjects remained in randomized group, regardless of cross over

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6
Q

what is number needed to harm

A

the number of people needed to undergo the intervention in order to harm one person (when interventions increase the risk/rate of outcome)

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7
Q

selection bias

A

systematic difference in characteristics of people selected for the study and those not selected

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7
Q

what are the 10 social determinants of health

A

AEFSSSSTUV the social gradient stress early start social exclusion work unemployment social support addiction food transport

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7
Q

a ROC indicates how well a test discriminates….

A

people with disease from people without disease

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7
Q

proximate risk factors for TB

A
  • exposure - decreased IS - malnutrition - indoor air pollution - alcohol abuse - other disease - depression and stress
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8
Q

pros and cons of cross sectional studies

A

pros: relatively cheap and easy cons: need for representative sample, no temporal relationships (association only), weak evidence of causality

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8
Q

how does the social gradient determine health

A

life expectancy is shorter and disease is more common down the social ladder in each society

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8
Q

what are PPV and NPV dependent on

A
  • sensitivity and specificity - underlying prevalence of the disease (lower prevalence = lower PPV)
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10
Q

hazard

A

special type of rate that is continuously updated as a longitudinal study progresses

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10
Q

what is confounding

A

the relationship between exposure and outcome may be influenced by exposure to a confounding factor related to the exposure

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11
Q

how do you try to reduce confounding in clinical trials

A

try and get treatment groups identical in all aspects other than the intervention

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13
Q

which study designs are interventional?

A

clinical trials

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15
Q

Risk

A

probability of disease occurring in a disease free population during a specified time period

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16
Q

how are controls matched for cases in case control studiest

A

by confounders - eg. age, sex

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16
Q

what is a retrospective cohort study

A

researchers come in at a time when the cohort has already been assembled and use the data available for examination

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17
Q

how is risk calculated

A

risk = new cases in a defined period / population at risk

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18
Q

what is internal validity dependent on?

A

appropriate study design data collection data analyses - need to have reduced confounding, information bias and selection bias

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19
Q

what is health

A

health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity

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20
Q

What are the 2 broad types of research questions?

A

descriptive - describing a condition or the risk factors for a condition analytical - case and effect

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21
Q

what is the rationale for randomisation of participants in a trial?

A

to try and reduce confounding and reduce selection bias

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22
Q

cohort studies

A

comparison of outcomes between subgroups - longitudinal with follow up of subjects

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23
Q

rate

A

probability of disease occurring in a disease free population during the SUM OF INDIVIDUAL FOLLOW UP PERIODS

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23
Q

key output of case control studies

A

odds ratio - (approximation of relative risk)

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24
Q

bias leads to what

A

systematic difference between groups and therefore under/over estimation of true results

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25
Q

how does stress determine health

A

stressful circumstances –> worry and anxiety –> damaging to health and may lead to premature death

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25
Q

how does having a job determine health

A

people who have more control over their work have better health

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26
Q

p value measures…

A

the probability that the observed result arose from change

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26
Q

definition of sensitivity and formula

A

% of people with disease that test positive TP/TP+FN

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28
Q

outputs of cross sectional studies are mostly what?

A

descriptive - especially prevalence

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29
Q

which study designs are longitudinal?

A

cohort, clinical trials

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30
Q

When looking at the clinical setting of a trial, what do you have to look for?

A

PICOT Population Intervention Comparator/control Outcome Timing

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31
Q

how does food determine health

A

a good diet and adequate food supply are central for promoting health and well-being

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32
Q

what are clinical trials

A

longitudinal studies designed to assess if an intervention changes the incidence of an outcome

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32
Q

what does a hazard ratio tell you

A

at any given point in time within the period of follow-up, the probability of outcome in intervention group is….. compared to that of the control group

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34
Q

relative risk

A

indicates the relative magnitude of change in risk/rate of outcome, associated with exposure

35
Q

definition and forumla for positive predictive value

A

% of positive tests that is truly positive TP/TP+FP

37
Q

how is prevalence reported

A

as a proportion/percentage

38
Q

how does unemployment determine health

A

job security increases health, well-being and job satisfaction. Higher rates of unemployment cause more illness and premature death

39
Q

definition and formula for negative predictive value

A

% of negative tests that is truly negative TN/TN+FN

40
Q

what is the advantage of randomisation

A

we can even out confounders that we are not even aware of - just be change

41
Q

screening limitation

A
  • selection - healthy more likely to be screened - lead-time - early detection, not necessarily prolonged survival - length-time - detection of non-aggressive disease
43
Q

which study designs are analytical?

A

case-control, cohort, clinical trials

44
Q

main outputs of cohort studies

A

incidence relative risk

46
Q

which study designs are non-longitudinal?

A

case series, ecological, cross-sectional, case-control

47
Q

what factors push towards higher life expectancy and higher income

A

new technology emerging economy aid trade peace industrialisation

48
Q

what is the focus for improving global health?

A

improving health and achieving equity in health in all people

49
Q

population attributable risk

A

indicates the additional or excess risk/rate of the outcome in the population, due to the exposure

50
Q

What is the defining factor between longitudinal and non-longitudinal studies?

A

longitudinal studies involve follow up of study subjects (information progressively collected over multiple encounters) while non-longitudinal does not (information collected in only one encounter).

50
Q

case control studies

A

compares previous exposure to a risk factor to cases and conrol

51
Q

what is a receiver operator characteristic curve

A

a plot showing 1-specificity vs sensitivity for various thresholds for a test - graphical representation of trade-off between sensitivity and specificity in tests

52
Q

instantaneous rate

A

rate applies to an exact point in time

53
Q

attributable risk percent

A

proportion of incident disease among exposed people that is due to exposure

54
Q

what is the rationale for blinding?

A

reduce information bias so the prejudice about the intervention does not influence the outcome

56
Q

how is rate calculated

A

rate = new cases in a defined period total person time / total person time of follow up

57
Q

effects of chronic stress

A

impaired memory, increased risk of depression, deteriorated immune response, hypertension, high hormone levels, higher risk of infertility and miscarriage

57
Q

how are outcomes ascertained?

A

according to strict, standardised, objective criteria. Determined by centralized committees (blinded as well)

59
Q

what is blinding

A

non-awareness of intervention allocation (single-blind or double-blind)

61
Q

absolute risk/rate

A

isolated measurement of risk/rate (no indication of association with exposure)

62
Q

what is the number needed to treat

A

the number of people needed to undergo the intervention in order to prevent outcome in one person

63
Q

what are the risk factors for CVD?

A

smoking, hypertension, diabetes, male, older, genetics, obesity, hypercholesterolaemia, inactivity, chronic stress, alcohol

64
Q

what was the main reason for the decline in TB incidence over the 20th century

A

due to the economic growth, social reform, poverty reduction, improved living conditions and advances in medicine and public health

65
Q

what is a meta-analysis

A

an analysis of combined data from multiple studies

66
Q

purpose of a diagnostic versus a screening test

A

diagnostic test - provides confirmation of a disease (results definitive) screening test - provides identification of patients who may have disease (results are preliminary)

68
Q

how is population attributable risk calculated?

A

PAR = risk/rate in whole population (exposed and unexposed) - risk/rate among unexposed

70
Q

which study designs are descriptive?

A

case series, ecological, cross sectional

71
Q

what are the effects of acute stress?

A

increased alertness, less perception of pain, immune system readied, HR increases and vasoconstriction to bring more oxygen to the muscles, mobilize energy supplies, reproductive functions temporarily suppressed

73
Q

cons of cohort studies

A

difficult to study rare outcomes not cheap or easy

74
Q

how does addition determine health

A

individuals turn to alcohol, drugs and tobacco and suffer from their use

75
Q

how do you minimize confounding in the design and execution of a study

A

matching by confounder (match age and sex between groups) restriction (only recruit certain sex or age)

76
Q

pros of case control studies

A

can gain temporal relationship between exposure and outcomes useful for studying rare outcomes

77
Q

attributable risk

A

indicates the absolute magnitude of change in risk/rate of outcome, associated with exposure

77
Q

what is survival analysis

A

measure the time to event

78
Q

key statistical information gained from meta-anaysis

A
  • outcome - weighted average effect size - weighting of individual studies - heterogeneity
80
Q

population attributable risk percent

A

proportion of incident disease among whole population that is due to exposure

81
Q

what is the advantage and disadvantage of intention to treat analysis

A

advantage - reduces selection bias disadvantage - always under-estimates any treatment effect

82
Q

best kind of trial is what

A

a systematic review of randomized controlled trials

83
Q

Cross sectional studies

A

sample of population. Information obtained one one point/period in time (participant only contributes data once)

84
Q

4 purposes for a meta-analysis

A
  • increase power - resolve uncertainty - improve estimates of effect size - answers other questions
86
Q

what was major the reason for the results found in the whitehall study

A

stress! lower down the hierachy - more chronic stress - less control in the workplace

87
Q

definition of specificity and formula

A

% of people without disease that test negative TN/TN+FP

89
Q

how is attributable risk calculated?

A

AR = risk/rate among exposed - risk/rate among unexposed

90
Q

how is number needed to treat calculated

A

1 / (absolute risk/rate reduction)

91
Q

what are the bradford hill criteria for causality?

A

temporal relationship strength dose-response relationship consistency plausibility exclude alternatives experimental evidence specificity coherence

92
Q

how is survival analysis shown

A

on a Kaplan-Meier curve

93
Q

what is internal validity

A

the extent to which the results of a study are valid for the sample of patients being studied

94
Q

What does the WHO think the major determinant of health is

A

the factors in the social environment - determine access to health services and influence lifestyle choices

95
Q

universal confounders

A

age and sex

96
Q

prevalence

A

the number of EXISTING cases of an outcome of interest in a defined population, AT ONE POINT IN TIME

97
Q

what was the main reason for the increased TB incidence in the 17th-18th centuries

A
  • rapid industrialisation and urbanisation - urban poor (increased population density, crowded living conditions, poor nutritional status)
98
Q

key outcomes of clinical trials

A

relative risks hazard ratios absolute risk/rate reduction number needed to treat survival analysis

99
Q

2 main types of bias

A

selection bias information (measurement bias)

100
Q

what is the 95% confidence interval

A

the interval, within which, there is 95% confidence that the true” value lies”

102
Q

how does transport determine health

A

healthy transport means less driving and more walking and cycling backed by better public transport

103
Q

when is a 95% confidence interval statistically significant?

A

when the null hypothesis is not included in the interval

105
Q

what factors push towards poor life-expectancy and poor income

A

epidemic disease global and intra-country inequality poverty colonization world and civil war

106
Q

incidence

A

number of NEW CASES of an outcome of interest arising from a defined population DURING A TIME INTERVAL

108
Q

What is external validity?

A

the extent to which the results of this trial are applicable to the population that I want to apply these results to

109
Q

pros of cohort study

A

explicit knowledge on temporal relationships between exposure and outcome can include multiple exposures and outcomes research hypotheses can be addressed post hoc

110
Q

associations make inferences about what

A

cause and effect correlation

111
Q

definition of likelihood ratios

A

likelihood that a given test result would be expected in a patient with the disease compared to a patient without the disease

112
Q

information bias

A

systematic difference in the way information is collected between/among groups being compared

113
Q

how is relative risk calculated?

A

RR = Risk/rate among exposed / risk/rate among unexposed

114
Q

In cross sectional studies, how is data collected?

A

mainly questionnaires

Z MD1 Cardiac physiology (13 decks)

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