Final Exam Review Flashcards
What are the three attributes/ policies determines of MCH policy?
Federalism, • Two major government entities: federal and state Independent Judiciary • Interpretation of the constitution Individualism • The free enterprise economic system
What are the Social Security Ats and titles?
IV,
• Cash payments to mothers who had lost fathers’ support of their children
V,
• 1- mch services, 2- services for crippled children, 3-child-welfare services, 4-vocational rehabilitation
XVIII
• Medicare, 1965- short term hospitalization and medical services to elderly
XIX
• Medicaid, 1965- program of health insurance assistance for the poor
What is the fundamental of Block Grants, 1981?
Alcohol, dug abuse and mental health
Primary care
Preventive health
MCH: (there are 7 programs)
What are the 7 programs of MCH? (optional)
Title V [MCH services and Crippled Children’s Services], Supplemental Security Income Disabled Children’s Services, Hemophilia, Sudden Infant Death Syndrome, Prevention of Lead-Based Paint Poisoning, Genetic Disease, and Adolescent Health
What are the three major challenges of current MCH policy?
disparities in health outcomes,
healthy workforce development
and cost-control
What are the overarching goals of Healthy People 2020? (launched in Dec 2010)
Attain high quality, longer lives free of preventable disease, disability, injury, and premature deaths
Achieve health equity, eliminate disparities, and improve the health of groups
Create social and physical environments that promote good health for all
Promote quality of life, healthy, development , and healthy behaviors across all life changes
What are some of the Healthy People 2021 MCH indicator that are met?
- Homicide rate
- Infant deaths
- Preterm birth rate
- Air quality index
- Aerobic physical activity
- Alcohol or illicit drug use among adolescents
- Tobacco use among adolescents
- Tobacco use among children
What are some of the Healthy People 2021 MCH indicator that are not met?
- Access to health services
- Diabetes
- Family planning
- Suicide*
- Mental health/disorders*
- Obesity among adults
- Obesity among children and adolescents
- Vegetable intake
- Oral health*
- Binge drinking among adults
- Maternal mortality rate*
What is the definition of infant mortality?
• The death of a live born infant before the age of one year
What is the definition of maternal mortality?
• Deaths of a women while pregnant of up to seeks weeks after delivery
What are the types of prevention?
primordial
Primary
Secondary
tertiary
What are the measures of disease frequency?
Incidence (incidence proportion and secondary attack rate) and
Prevalence (point prevalence and period prevalence) calculations
What are the two major groups of epidemiologic studies?
- descriptive/analytic
- Observational/experimental studies
What are the elements of causal inference from observational studies?
validity, temporal relation, strength of association, biologic plausibility, no alternate explanations
What are the causes of Maternal Mortality?
- Maternal hemorrhage
- Maternal hypertensive disorders
- Cardiomyopathy
- Thrombotic pulmonary embolism
- Gestational diabetes
- Obstructed labor and uterine rupture
- Maternal sepsis and other infections
- Ectopic pregnancy and induced/spontaneous abortion
What are some risk factors of infant mortality?
- Physical environment
- Social environment
- Individual behavior
- Biology and genetics
- Health services
What is the definition of public health?
is the science of protecting and improving the health of families and communities through promotion of healthy lifestyles, research for disease and injury prevention and detection and control of infectious diseases.
What is the definition of epidemiology?
the study of the distribution and determinants of health-related states and events in human population and the application of this study to the control of health problems”
What is the definition of distribution?
- descriptive epidemiology
- Case report, case series, cross-sectional studies
What is the definition of determinants?
- Analytical epidemiology
- Hypothesis-generation / hypothesis-testing
- Observational / Experimental studies
What are the 4 types of prevention?
primordial: risk factor
Primary: early disease
Secondary: late disease
tertiary: disability
What are the measures of disease frequency?
Incidence (incidence proportion and secondary attack rate) and
Prevalence (point prevalence and period prevalence) calculations
What is descriptive/analytic analytic epidemiologic studies?
- Evaluate distribution, assess associations
* Health care planning/ hypothesis generation
What is observational/experimental studies?
- Hypothesis generation/ testing
* Hypothesis: exposure (potential risk factor) and outcome (occurrences of disease of event)
What is experimental studies?
- Randomized assignment of exposure
- Prospective in design
- Objectives
o Hypothesis testing
o Assessing efficacy (does it work?)
o Assessing effectiveness (is it practical?)
What are the types of experimental studies?
o Clinical trial: involving patients
o Field trial: involving healthy participants
o Community intervention trial vs individual
What are the strengths of experimental studies?
o Strongest design
Temporal relationship
Confounding control
Comparability: randomization (study population), blinding (information), placebo (effect)
What are the limitations of experimental studies?
- Not always possible to manipulate exposure
- Inefficient for rare or long delayed outcomes
- Ethical issues
- Study conduct: drop-out., cross overs.
- Intents to treat analysis (impossible)
What is cohort studies?
- Perspective: outcome events occur after start of study
- Retrospective: outcome occur before start of study
- Nest case control study: special form of cohort study
what are the strengths of cohort studies?
- Exposure precedes outcome
- Measurements of disease incidence
- Multiple outcome can be studied
-Useful for common disease and conditions
what is case control studies?
- Selection based on outcome status
* Can be cone using either incident (new) or prevalent (existing) cases
what are the strengths of case control studies?
o Efficient for rare outcomes or disease
o Less expensive and time consuming
o Can study multiple exposures
what are the limitations of case control studies?
o Recall bias, confounding ad control selection issues
o Inefficient for rare exposures
o Cannot study multiple incidence or absolute risks
o Temporality issues may not be obvious
what is cross sectional studies?
- Exposure and outcome status refer to same point/period in time
- Information on prevalence of exposure and/or outcome
- Limited information on potential exposures outcome association
- Useful in description and hypothesis-generation
what is ecological studies? (btw is a variant)
- Exposure/outcome measured at the group/population level
- “ecologic fallacy”: population level association different level associations
- correlation is NOT causation
What are the elements for causal inference from observational studies?
- validity,
- temporal relation,
- strength of association, biologic plausibility,
- no alternate explanations
What questions we must consider with internal validity?
- Are the inferences made on the subjects that were eventually included in the study biased in any SYSTEMATIC or NON-SYSTEMATIC way?
- Is the observed association (or lack thereof) due to CONFOUNDING
- Can CHANCE be ruled out? (statistical testing)
What is validity?
relates to the absence of BIAS, CONFOUNDING and CHANCE
What is external validity or generalizability?
relates to how well the inferences we make from the experience of one population reflect the experience in another population, Given the study is internally valid
What is chance?
- Hypothesis testing – Null and Alternate Hypothesis
- Measure of stability - 95% confidence interval; Probability of obtaining test statistic at least as extreme as one observed - p-value
- Type I (False Positive) and Type II (False Negative, study power) errors
What is bias and the different types?
Information bias (interviewer bias, recall bias), Selection bias
How to improve validity of studies?
- Distribution of E is similar to distribution of exposure from whom cases arose (no selection bias)
- Exposure or other characteristic is ascertained in a manner identical among controls and cases (no information bias)
- Controls are identical to cases in distribution of potential characteristics that influence likelihood of E AND are independently related to O or its recognition (no confounding)
How to avoid selection bias?
Case/control verification
1) If cases did not develop disease, would they still be in the study population as controls? 2) If controls developed disease, would they be included in the study population as cases?
What is non-differential misclassification?
- attenuation
- occurs when the probability of individuals being misclassified is equal across all groups in the study
What is differential misclassification?
- unknown direction
- occurs when the probability of being misclassified differs between groups in a study
what is confounding?
when relationship between exposure and outcome is distorted by a third factor that is related to both exposure and outcome and is not on the pathway of association
how to control confounding?
Randomization: study design
simple, blocked, etc.
- Restriction/exclusion: study design
Matching: study design
- one-to-one or frequency
Stratification: analysis
Multivariate modeling: analysis
What is null hypothesis?: Ho
No significant difference exists between specified groups or any observed difference being due to chance, sampling or experimental error
What is alternative hypothesis? Ha
Significance difference exists between specified groups and the difference observed is not due to chance, sampling or experimental error
what is p-value?
probability of obtaining a test statistic at least as extreme as the one that was actually observed, assuming that the null hypothesis is true
What is confidence interval?
the interval in which the true value is likely to be found (usually 95% of the time)
What is type 1 & 2 errors?
Type I error: rejecting the null when the null is true (false positive): False difference
Type II error: failing to reject the null when the null is false (false negative): True difference
- Power of the test: size of study, size of difference, significance level
What is fecundity?
- Biologic capacity for reproduction, irrespective of pregnancy intentions
- Proxy: time to pregnancy (TTP)
- inverse J-shaped (Vs. age)
what is fertility?
- Demonstrated fecundity
- >Measured by live birth / still births
what are the subtypes and causes of infertility?
- 10% unknown
- 40% male factor: congenital anomalies, genetic, immunologic, sexual & ejaculatory
- 40% female factor: cervical, ovulatory, tubal, uterine
- 10% couple factor
what is unintended pregnancy?
A pregnancy that was unplanned, mistimed, or unwanted at the time of contraception.
what are the causes of unintended pregnancies?
- 52% - Non-use of contraception
- 43% - Inconsistent/incorrect use of contraception
- 5% - Contraception failure
what are the risks of unintended pregnancies?
- Late prenatal care
- Decreased breast feeding
- Maternal depression
- Delayed child development
- Child abuse/neglect
- Education/economic limitations
what is teratology?
-The study of Congenital Malformations
what is congenital malformation?
• Structural birth defects present at birth
->Vs functional defects
-Developmental abnormalities
what is the critical window?
-period marked by cellular proliferation and development, and increasing metabolic capabilities; exposure during this time period may disrupt or interfere with physiology of cell, tissue or organ
what is the sensitive window?
may or may not be inclusive of the critical window; period susceptibility resulting in non-structural defects
what are the major causes of developmental abnormalities?
- environmental (maternal: derived abnormalities
- infections: toxoplasmosis, CMV, Syphilis, Rubella, HIV
- maternal drug: smoking tobacco/marijuana, cocaine
- maternal conditions and environment: thyroid disorder, diabetes, obesity, fever, occupation and other exposures to chemical and heavy metals
What are major types of teratogens?
- radiation
- environmental chemicals
- drugs (category C or X drugs)
- infections (bacterial or viral)
- hyperthermia and mechanical injury
- others: cocaine, smoking, alcohol
