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Foundations of Primary Care Year 3 > Epidemiology - Tutorial 1 > Flashcards

Epidemiology - Tutorial 1 Flashcards

1
Q

What is epidemiology?

A
  • study of changing patterns of disease with the aim of improving the health of the population
  • looks at the time, place and person affected
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2
Q

What can epidemiological information be used for?

A
  • assisting in making a diagnosis
  • assess which services are required for prevention, diagnosis, primary care, secondary care and rehabilitation
  • ensure a high quality of these services
  • carry out healthcare needs assessments to provide a rational framework for decisions on prioritisation of healthcare resources
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3
Q

What use does epidemiology have by comparing groups?

A
  • detect etiological cues
  • decide the scope for intervention
  • identify high risk groups
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4
Q

What are 10 sources of epidemiological data?

A
  • mortality data
  • hospital activity statistics
  • reproductive health statistics
  • cancer statistics
  • accident statistics
  • GP morbidity
  • health and household surveys
  • social security statistics
  • drug misuse databases
  • expenditure data from the NHS
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5
Q

What are the 3 aims of epidemiology?

A
  • description - amount, numbers, distribution
  • explanation- natural history, cause, high risk groups
  • disease control - advice eon treatments and prevention
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6
Q

What is meant by ‘incidence’?

A
  • the number of new cases of disease in a population in a specified period of time
  • tells us about causation and aetiology
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7
Q

What is meant by ‘prevalence’?

A

number of people in a population with a specific disease at a single point in time or in a defined period

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8
Q

What is an example of a high incidence, low prevalence disease?

A

motor neuron disease

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9
Q

What is an example of a low incidence, low prevalence disease?

A

Ebola

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10
Q

What is an example of a high incidence, high prevalence disease?

A

winter flu

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11
Q

How is the relationship between incidence and prevalence affected?

A

by the duration of the disease - prevalence can only change upon cure or death

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12
Q

What is relative risk?

A

measure of strength of association between a risk factor and the disease under study i.e. risk of event relevant to exposure
measure of disease in exposed group/measure of disease in unexposed group

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13
Q

What is absolute risk?

A

probability of harm occurring as a result of a specific risk factor

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14
Q

What are 4 different types of study?

A
  • trials (double-blind, placebo-controlled,RCT)
  • surveys
  • case-control studies (retrospective)
  • cohort studies (prospective)
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15
Q

What do descriptive studies do?

A
  • attempt to describe the amount and distribution of a disease in a given population, for the purposes of gaining insight into the aetiology of the condition or for planning health services to meet the clinical need
  • studies may look at the disease alone or may also examine one or more factors (exposures) thought to be linked to the aetiology
  • does not provide definitive conclusions about disease causation, but may give clues to possible risk factors and aetiologies
  • usually cheap, quick and give a valuable initial overview of a problem
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16
Q

What are descriptive studies useful for?

A
  • finding emerging public health problems through monitoring and surveillance of disease patterns
  • signalling the presence of effects worthy of further investigation (flagging up)
  • assessing the effectiveness of current measures of prevention and control
  • assessing needs for health services and service planning
  • generating hypotheses about aetiology
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17
Q

What happens in a cross-sectional study?

A
  • observations are made at one point in time

- able to provide results quickly but impossible to infer causation

18
Q

What happens in case-control studies?

A
  • two groups of people are compared e.g. with and without disease
  • data is then gathered on each individual to determine whether they have been exposed to the suspected etiological factors
  • the average exposure in the 2 groups, cases and controls, is compared.
  • if there is a significant difference then it can give clues to factors which elevate the risk of the disease under investigation
  • results expressed as ‘odds ratios’ or ‘relative risks’
19
Q

What happens in cohort studies?

A
  • baseline data on exposure are collected from a group of people who do not have the disease under study
  • the group is then followed through time until a sufficient number have developed the disease to allow analysis
  • the original group is separated into subgroups according to original exposure status and these subgroups are compared to determine the incidence of disease according to exposure
  • longitudinal, observational study
  • analysis of risk factors’ and follows a group of people who do not have a disease under question, and uses correlations to determine the absolute risk
20
Q

Why are cohort studies better than case control studies?

A

issues relating to time can be established in a prospective study like short, and confounders are more easy to control for

21
Q

What happens in a randomised control trial?

A
  • examines two groups at risk of developing a disease (a study group and a control group)
  • the study group has a suspected causative factor to the disease neutralised whereas the control group does not
  • data on subsequent outcomes are collected in the same way from both groups
  • the aim is to determine whether the modification of the factor alters the incidence if the disease
22
Q

What are 3 challenges for researches in RCTs?

A
  • how to reduce the effect of the result occurring by chance
  • how to account for biological variation
  • how to ensure that the only difference between the groups is the intervention in the research study
23
Q

What are 5 features of a randomised control trial?

A
  • an appropriate sample of representative study population
  • participants are allocated randomly to each treatment group
  • possesses a double-blind design
  • there is an objective measure of outcome
  • the follow up of participants is complete
24
Q

What kind of study is deemed the ‘gold standard’ for testing the benefits of one treatment against another?

A

double blind randomised control trial

25
Q

What are disadvantages of randomised control trials?

A
  • costly and time consuming
  • recruits may not be typical patients (selection bias)
  • cannot address all research questions
  • limited to people who consent to take part and do not have exclusion criteria
  • may lead to false negative conclusions
26
Q

What is standardisation?

A

a set of techniques used to remove the effects if differences in age or other confounding variable, when comparing two or more populations

27
Q

What is a standardised mortality ratio?

A

special kind of standardisation which is simply a standardised death rate converted in to a ratio for easy comparison

28
Q

What problems can occur with data?

A
  • quality - is the data trustworthy?
  • case definition - do doctors mean the same thing when they call a patient a ‘case’ in a disease?
  • coding and classification - ICD-10, DSM?etc or have you used the right code within your system?
29
Q

What is bias?

A

any trend in the collection, analysis, interpretation, publication or review of data that can lead to conclusions that are systematically different from the truth

30
Q

What is selection bias?

A

when the study sample is not truly representative of the whole study population about which conclusions are drawn

31
Q

What is information bias?

A

arises from systematic errors in measuring exposure or disease e.g. researcher being aware of who is a case or a control in an interview with a patient in a case control study

32
Q

What is follow up bias?

A

arises when one group of subjects is followed up more assiduously than another to measure disease or outcomes

33
Q

What is systematic error?

A
  • a form of measurement bias where there is a tendency for measurements to always fall one side of the true value
  • e.g. instrument calibrated wrong
34
Q

What is a confounding factor?

A

one which is associated independently with both the disease and with the exposure under investigation and so distorts the relationship between the exposure and the disease

35
Q

How can we alter study design to control for confounders?

A
  • randomisation in trials
  • restriction of eligibility criteria to only certain kinds of study subjects
  • subjects in different groups can be matched for likely confounding factors
  • results can be stratified according to the confounding factors
  • results can be adjusted to take account of suspected confounding factors
36
Q

How can we decide if there is causation between an exposure and a disease? (9)

A
  • strength of association (relative risks or odds ratios)
  • consistency - repeated observation of an association in different populations under different circumstances
  • specificity - a single exposure leading to a single disease
  • temporality - the exposure comes before the disease
  • biological gradient - dose response relationship. As exposure increases, so does the risk of the disease.
  • biological plausibility- the association agrees with what is known about the disease’s biology
  • coherence- the association does not conflict with what is known about the disease’s biology
  • analogy - another exposure-disease relationship exists which can act as a model for the one under investigation
  • experiment: a suitably controlled experiment to prove the association as causal
37
Q

What is the only ABSOLUTE criterion for determining causality?

A

temporality - the exposure must come before the disease

38
Q

What is an audit?

A

a quality improvement process that seeks to improve patient care and outcomes by measuring these against explicit criteria and then implementing changes

39
Q

What are 5 reasons for audits?

A
  • where national standards and guidelines exist; where there is conclusive evidence about effective clinical practice (i.e. evidence based medicine).
  • areas where problems have been encountered in practice.
  • what patients & public have recommended that be looked at.
  • where there is a clear potential for improving service delivery.
  • areas of high volume, high risk or high cost, in which improvements can be made.
40
Q

List the hierarchies of evidence (least biased at top, most biased at bottom).

A
  • systematic review of RCTs with or without meta-analyses
  • RCT
  • cohort studies
  • case-control studies
  • case series
  • case reports
  • opinion

Foundations of Primary Care Year 3 (6 decks)

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