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BIOSTAT > FINALS: EPIDEMIOLOGY > Flashcards

FINALS: EPIDEMIOLOGY Flashcards

1
Q

Study of distribution and determinants of health-related event

A

EPIDEMIOLOGY

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2
Q

EPIDEMIOLOGY COMPONENTS:
GOAL: GENERATE hypothesis
1. Distribution of health-related space
2. Describes the pattern of disease as to
a. P – Person
b. P – Place
c. T – Time

DESCRIPTIVE OR ANALYTIC?

A

DESCRIPTIVE

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3
Q

EPIDEMIOLOGY COMPONENTS:
GOAL: TEST hypothesis
1. Determination of health-related states
a. Understanding the causes of risk
factors that lead to the disease

  1. Designs
    a. Cross-sectional
    b. Longitudinal
    i. Prospective
  2. Observational: Cohort study
  3. Interventional: Experimental
    ii. Retrospective
  4. Case control

DESCRIPTIVE OR ANALYTIC?

A

ANALYTIC

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4
Q

EPIDEMIOLOGY FUNCTIONS

A
  1. DESCRIBE HEALTH STATUS
  2. EXPLAIN CAUSES
  3. PREDICT
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5
Q

HISTORY
shoe leather theory

A. HIPPOCRATES
B. ROBERT KOCH
C. JOHN SNOW
D. THOMAS DRAWBER

A

JOHN SNOW

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6
Q

HISTORY
germ theory

A. HIPPOCRATES
B. ROBERT KOCH
C. JOHN SNOW
D. THOMAS DRAWBER

A

B. ROBERT KOCH

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7
Q

HISTORY
- pneumonia among American Legion Convention attendees in Philadelphia Hotel (1976)

A. FRAMING HEART STUDY
B. LEGIONNAIRE’S DISEASE
C. BRITISH DOCTORS STUDY
D. TOXIC SHOCK SYNDROME

A

B. LEGIONNAIRE’S DISEASE

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8
Q

HISTORY
- use of tampons among menstruating women (1980)

A. FRAMING HEART STUDY
B. LEGIONNAIRE’S DISEASE
C. BRITISH DOCTORS STUDY
D. TOXIC SHOCK SYNDROME

A

D. TOXIC SHOCK SYNDROME

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9
Q

HISTORY
- by Thomas Drawber
- risk factors for development of Coronary Heart Disease (1948)

A. FRAMING HEART STUDY
B. LEGIONNAIRE’S DISEASE
C. BRITISH DOCTORS STUDY
D. TOXIC SHOCK SYNDROME

A

A. FRAMING HEART STUDY

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10
Q

HISTORY
- R. Doll and R. Peto (1951) – smoking and death among british docs – harmful effects of during smoking
A. FRAMING HEART STUDY
B. LEGIONNAIRE’S DISEASE
C. BRITISH DOCTORS STUDY
D. TOXIC SHOCK SYNDROME

A

C. BRITISH DOCTORS STUDY

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11
Q

Theories of Disease Causation

– linearity, cause precedes the
effect

A. CONFOUNDERS
B. CAUSATION
C. RISK FACTORS
D. ASSOCIATION

A

CAUSATION

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12
Q

CAUSATION
- Specific agent, specific disease
(Agent – Disease)

SPECIFIC CAUSATION OR MULTIPLE CAUSATION?

A

SPECIFIC CAUSATION

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13
Q

CAUSATION:
i. Interplay of different components
1. Susceptible host + Pathogenic Agent + Environment = DISEASE

ii. Sufficient component cause
1. Each component should be present
2. C1+C2+C4+C5=Disease

SPECIFIC CAUSATION OR MULTIPLE CAUSATION?

A

MULTIPLE CAUSATION

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14
Q

Theories of Disease Causation

a. Personal behavior/ lifestyle/ practices
b. Environmental exposure
c. Genetic makeup (predisposing factor)

A. CONFOUNDERS
B. CAUSATION
C. RISK FACTORS
D. ASSOCIATION

A

C. RISK FACTORS
(it is not the cause but only the “ENABLE”)

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15
Q

Theories of Disease Causation

a. Identifiable relationship
b. Associated variables mean that they co-exist
c. Does not necessarily imply cause and effect relationship

A. CONFOUNDERS
B. CAUSATION
C. RISK FACTORS
D. ASSOCIATION

A

D. ASSOCIATION

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16
Q

Theories of Disease Causation

a. Extraneous variables whose effect may influence the relationship of the variables to be studied on
b. It has to be “controlled” since it has an influence to both cause and effect;
“without the confounder, the causation will not push thru”

A. CONFOUNDERS
B. CAUSATION
C. RISK FACTORS
D. ASSOCIATION

A

A. CONFOUNDERS

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17
Q

Set of standard criteria for deciding whether an individual ha sa disease or
health event of interest

A. PROPORTION
B. RATE
C. CASE
D. PERSON TIME

A

CASE

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18
Q

CASE:
e.g. Syndromes; Chronic and Psychiatric Diseases

CAUSAL OR MANIFESTATIONAL CASE?

A

MANIFESTATIONAL CASE

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19
Q

CASE:
e.g. Infections

CAUSAL OR MANIFESTATIONAL CASE?

A

CAUSAL

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20
Q

Natural History of Disease:
– infectious disease

INITIATION OR INDUCTION?

A

INITIATION

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21
Q

Natural History of Disease:
– non- infectious disease

INITIATION OR INDUCTION?

A

INDUCTION

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22
Q

PHASE OF DISEASE: Underlying economic/social/environmental/conditions leading to causation
e.g. helmet use/ wash of hands

GOAL: Minimize hazard

A. PRIMORDIAL
B. PRIMARY
C. SECONDARY
D. TERTIARY

A

PRIMORDIAL

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23
Q

PHASE OF DISEASE: Specific causal factor
Eg. HPV vaccine

GOAL: Reduce INCIDENCE of disease

A. PRIMORDIAL
B. PRIMARY
C. SECONDARY
D. TERTIARY

A

PRIMARY

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24
Q

PHASE OF DISEASE: early stage of disease

GOAL: reduce PREVALENCE of disease by shortening duration

A. PRIMORDIAL
B. PRIMARY
C. SECONDARY
D. TERTIARY

A
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25
Q

PHASE OF DISEASE: Late stage

GOAL: reduce the number and impact of complication

A. PRIMORDIAL
B. PRIMARY
C. SECONDARY
D. TERTIARY

A

TERTIARY

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26
Q

EPIDEMIOLOGIC APPROACH FLOW

A
  1. EXAMINE EXISTING FACTS
  2. GENERATE NEW HYPOTHESIS
  3. TEST HYPOTHESIS
  4. CONCLUDE/GENERATE NEW FACTS
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27
Q

Components of an Epidemiologic hypothesis

A
  1. Cause is considered
  2. Anticipate the effect
  3. Characterize the population
  4. Exposure-response is established
  5. Time-response relationship
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28
Q

Method of hypothesis testing:
o There is a common circumstance in
agreement with all instance
o E.g. common factor X results to
disease Y

A. METHOD OF AGREEMENT (COMMONALITY)
B. METHOD OF DIFFERENCE
C. CONCOMITANT VARIATION

A

A. METHOD OF AGREEMENT (COMMONALITY)

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29
Q

Method of hypothesis testing:
o Level of severity
o Eg. More factor X results to Severe
form of disease than those with less
factor X

A. METHOD OF AGREEMENT (COMMONALITY)
B. METHOD OF DIFFERENCE
C. CONCOMITANT VARIATION

A

C. CONCOMITANT VARIATION

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30
Q

Method of hypothesis testing:
o Disease A = has factor X Y Z; Disease
A = W Y Z; therefore Disease A is not caused by Factor X

A. METHOD OF AGREEMENT (COMMONALITY)
B. METHOD OF DIFFERENCE
C. CONCOMITANT VARIATION

A

B. METHOD OF DIFFERENCE

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31
Q

Descriptive Epidemiology:
- Detailed account of a patient’s
experience and clinical manifestation
that comprise a new or an atypical
health event or disease

Eg. VACTRL syndrome

A. CASE REPORT
B. CASE SERIES
C. PREVALENCE STUDIES
D. ECOLOGICAL STUDY

A

A. CASE REPORT

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32
Q

Descriptive Epidemiology:
- Multiple case reports in one disease

A. CASE REPORT
B. CASE SERIES
C. PREVALENCE STUDIES
D. ECOLOGICAL STUDY

A

B. CASE SERIES

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33
Q

Descriptive Epidemiology:
- Determine proportions of individuals
with the disease or a health event in a
defined population at a GIVEN TIME

E.g. parasitism among children

A. CASE REPORT
B. CASE SERIES
C. PREVALENCE STUDIES
D. ECOLOGICAL STUDY

A

C. PREVALENCE STUDIES (existing case) or INCIDENCE STUDIES (new case)

34
Q

Descriptive Epidemiology:
- Aka correlational study
- Correlation of factors in different
groups

A. CASE REPORT
B. CASE SERIES
C. PREVALENCE STUDIES
D. ECOLOGICAL STUDY

A

D. ECOLOGICAL STUDY

35
Q

Analytical Epidemiology:
- Counterfactual Scenario/ Alternative History
- The “what if” in epidemiology
- An alternative parallel timeline that differ from reality
- Contingency tables
- Measurement of exposure and outcome variables at one time point

A

ANALYTICAL STUDIES

36
Q

Measured at one point of time

CROSS - SECTIONAL or LONGITUDINAL?

A

CROSS - SECTIONAL

37
Q

CANNOT be measured at one point of time

CROSS - SECTIONAL or LONGITUDINAL?

A

LONGITUDINAL

38
Q
  • Aka Prevalence study

E.g. survey of group with exposure and
without

A. CROSS-SECTIONAL
B. COHORT STUDY
C. RETROSPECTIVE COHORT STUDY
D. CASE CONTROL STUDY
E. EXPERIMENTAL STUDY

A

A. CROSS-SECTIONAL

39
Q
  • Prospective study between with exposure and without exposure

A. CROSS-SECTIONAL
B. COHORT STUDY
C. RETROSPECTIVE COHORT STUDY
D. CASE CONTROL STUDY
E. EXPERIMENTAL STUDY

A

B. COHORT STUDY

40
Q
  • Aka historical cohort study
  • Retrospective study between group with or without exposure and its present outcome (with or without the disease)

A. CROSS-SECTIONAL
B. COHORT STUDY
C. RETROSPECTIVE COHORT STUDY
D. CASE CONTROL STUDY
E. EXPERIMENTAL STUDY

A

C. RETROSPECTIVE COHORT STUDY

41
Q
  • Aka trohoc study
  • Outcome is MEASURED AT PRESENT TIME and E of the participants in the past is estimated
  • Subjects should be the SAME
    1. Eg. All should be 7 yrs old, same
    outcome

A. CROSS-SECTIONAL
B. COHORT STUDY
C. RETROSPECTIVE COHORT STUDY
D. CASE CONTROL STUDY
E. EXPERIMENTAL STUDY

A

D. CASE CONTROL STUDY

42
Q
  • A cohort study with MANIPULATION OF EXPOSURE or non exposure with
    randomization
  • Cohorts are randomly assigned

A. CROSS-SECTIONAL
B. COHORT STUDY
C. RETROSPECTIVE COHORT STUDY
D. CASE CONTROL STUDY
E. EXPERIMENTAL STUDY

A

E. EXPERIMENTAL STUDY

43
Q

Measurements in Epidemiology:
- To investigate distributions and determinants of disease, it is necessary to know the following:
● Size of the population
● Time period during which data were collected

A. QUANTIFICATION OF DISEASE OCCURRENCE
B. MEASURES OF DISEASE FREQUENCY
C. MEASURE OF OCCURENCE

A

QUANTIFICATION OF DISEASE OCCURRENCE

44
Q

● a/b
● Obtained by dividing one quantity by another without implying relationship between the numerator and
the denominator

A

RATIO

45
Q

RATIO:
- Type of ratio in which who are
included in the numerator are also
included in the denominator
- a/a+b

A. PROPORTION
B. PERCENTAGE
C. RATE

A

A. PROPORTION

46
Q

RATIO:
-There is a distinct relationship between the numerator and denominator
b. Time – included in the denominator

A. PROPORTION
B. PERCENTAGE
C. RATE

A

C. RATE

47
Q

Quantify how often disease occurs in a population that is given

A. QUANTIFICATION OF DISEASE OCCURRENCE
B. MEASURES OF DISEASE FREQUENCY
C. MEASURE OF OCCURENCE

A

B. MEASURES OF DISEASE FREQUENCY

48
Q

MEASURE OF OCCURENCE:
- NEW RATE
● Incidence proportion (risk)
● Incidence rate (incidence density)

INCIDENCE OR PREVALENCE?

A

INCIDENCE

49
Q

MEASURE OF OCCURENCE:
- PRESENT CASES
● Number of total cases

INCIDENCE OR PREVALENCE?

A

PREVALENCE

50
Q

TYPES OF POPULATION:
- Aka COHORTS
- NO GAINS for members after it is
established but may be reduced due to
losses (e.g. death)
- if members are no longer at risk hence
called now a CASE

CLOSED OR OPEN POPULATION?

A

CLOSED POPULATION

51
Q

TYPES OF POPULATION:
- Aka DYNAMIC
- ADDS NEW MEMBERS through birth and immigration and lose through death and emigration
- Through time, the open population MAY GROW, REMAIN CONSTANT or DECLINE

CLOSED OR OPEN POPULATION?

A

OPEN POPULATION

52
Q

NUMBER OF NEW CASES that develop in a population at risk during a specified time interval
- The disease is assessed in a population that is initially disease free but at risk to develop the disease

A. MEASURES OF DISEASE FREQUENCY
B. MEASURE OF INCIDENCE
C. MEASURE OF OCCURENCE

A

B. MEASURE OF INCIDENCE

53
Q

Basic Formulation of Incidence Measures:
- MEASURE OF EVENTS – transition from diseased state, thus can be a measure of risk

NUMERATOR OR DENOMINATOR?

A

NUMERATOR

54
Q

Basic Formulation of Incidence Measures:
- individuals who are at risk and who
was at risk and now acquired the
disease state

NUMERATOR OR DENOMINATOR?

A

DENOMINATOR

55
Q

Basic Formulation of Incidence Measures:
- Proportion of individuals who become diseased during the SPECIFIED PERIOD OF TIME
- (no.of new cases given a period of time)/(total population at risk)
- Assumes the entire population is at risk at the beginning of the study period that was followed over a
specified time interval for the development of outcome under investigation

INCIDENCE PROPORTION OR INCIDENCE RATE?

A

INCIDENCE PROPORTION

56
Q

Basic Formulation of Incidence Measures:
- Called force of morbidity or mortality or incidence density
- Measures INSTANTANEOUS RATE of development of disease in a population
- (no.of new case during a period of time)/(total person time of observation)
- Represent the speed or intensity at which the populations are expected to generate new cases
- Reflects the incidence proportion (risk) of the disease when the disease is rare

INCIDENCE PROPORTION OR INCIDENCE RATE?

A

INCIDENCE RATE

57
Q
  • AMOUNT OF TIME THE PERSON IS OBSERVED during the study, and is counted only when a person is at risk
    of being detected as a case
  • Not counted after:
    1. The person DEVELOPS THE DISEASE under investigation
    2. The person WITHDRAWS from the study
    3. The STUDY ENDS
  • Add the time of every case until the person developed the disease
A

PERSON TIME

58
Q
  • Sum of individual’s time at risk or time
    each person remained under observation and free from disease

Individual Person time is _________

KNOWN OR NOT-KNOWN?

A

KNOWN

59
Q
  • Total person time = average population
    size x length of follow-up periods
  • Average population = population at start + population at the end/2

Individual Person time is _________

KNOWN OR NOT-KNOWN?

A

NOT-KNOWN

60
Q
  • Quantifies the proportion of individuals in a population who HAVE THE DISEASE a specified time
  • Snapshot through the population at a point in time to determine who has the disease and who does not
    = (no.of existing cases)/(total
    population) x 100

A. PREVALENCE
B. INCIDENCE
C. POINT IN TIME

A

PREVALENCE

61
Q
  • SPECIFIC POINT IN CALENDAR
    eg. Onset of menopause, Menarche
  • Fixed point in the course of events that varies in real person to person

A. PREVALENCE
B. INCIDENCE
C. POINT IN TIME

A

C. POINT IN TIME

62
Q

Relationship between prevalence ad incidence

A

P = I x D

63
Q

Relationship between prevalence ad incidence
ASSUMPTIONS
Incidence of the disease is ________
over time

CONSTANT OR NOT CONSTANT?

A

CONSTANT

64
Q

Relationship between prevalence ad incidence
ASSUMPTIONS
Duration of the disease is ________
over time

CONSTANT OR NOT CONSTANT?

A

CONSTANT

65
Q

Relationship between prevalence ad incidence
ASSUMPTIONS
Prevalence of the disease is ______

low <10% or high <10% ?

A

low <10%

66
Q
  • An important and useful measure of the burden of disease in a community
    ● Prevalence data may be suggested if not confirmatory of the etiology of certain diseases
A

Prevalence Measures

67
Q
  • UPSURGE OF CASES in a defined geographic region or easily defined sub-population
  • MORE CASES than expected given area, group of people and period of time
  • Usually comes to the attention of PH units by:
    1. Epidemiology surveillance system
    2. Direct notification

A. EPIDEMIC
B. OUTBREAK
C. PANDEMIC
D. DISEASE CLUSTER

A

OUTBREAK

68
Q
  • outbreak on a larger area
  • Occurrence of more cases of a disease than expected over a larger area than that experienced in an outbreak

A. EPIDEMIC
B. OUTBREAK
C. PANDEMIC
D. DISEASE CLUSTER

A

EPIDEMIC

69
Q
  • aggregates of cases in an given area,
    group of people and period of time regardless if the number of cases is more than expected
  • The used population size at risk is UNKNOWN

A. EPIDEMIC
B. OUTBREAK
C. PANDEMIC
D. DISEASE CLUSTER

A

D. DISEASE CLUSTER

70
Q

Factors affecting to mount outbreak investigation

A

a. Number of cases is significantly higher than expected
b. Scale and severity
c. Potential for spread
d. Political and public health consideration
e. Resource availability

71
Q

Agencies Involved in an Outbreak Investigation

A

a. Local health departments
b. Higher level health agencies (DOH-Epid Bureau)

72
Q

Objectives of Outbreak Investigation

A

a. ASSESS THE EXTENT of the outbreak
b. REDUCE THE NUMBER OF CASES associated with the outbreak by identifying and eliminating the source
c. IDENTIFY NEW DISEASES syndromes
d. ASSESS EFFICACY of employed prevention strategies
e. ADDRESS LIABILITY CONCERNS, measures damage
f. TRAIN EPIDEMIOLOGIST
g. PROVIDE GOOD PUBLIC RELATIONS and public education

73
Q

Steps in an Outbreak Investigation (US CDC 1992)

A
  1. PREPARE FOR FIELDWORK
  2. ESTABLISH OUTBREAK
  3. VERIFY DIAGNOSIS OF CASES
  4. ESTABLISH CASE DEFINITION AND SEARCH FOR ADDITIONAL CASES
  5. CONDUCT DESCRIPTIVE EPIDEMIOLOGICAL STUDIES
74
Q

Prepare field work:
1. Travel arrangements
2. Supplies, equipment, logistics
3. Administrative and scientific contacts

A. ADMINISTRATIVE
B. PERSONAL

A

ADMINISTRATIVE

75
Q

Prepare field work:
1. Knowledge updates
2. Understanding of role in the field
3. Familiarity of the chain of authority involved in the process

A. ADMINISTRATIVE
B. PERSONAL

A

PERSONAL

76
Q

i. POINT SOURCE EPIDEMIC
ii. CONTINUOUS COMMONS SOURCE OR EPIDEMIC
iii. SPORADIC
iv. PROPAGATED EPIDEMIC

EPIDEMIC CURVE OR EPIDEMIC MAPS?

A

EPIDEMIC CURVE

77
Q

i. Dot maps
1. Geographical extent
2. Evidence of clustering

EPIDEMIC CURVE OR EPIDEMIC MAPS?

A

EPIDEMIC MAPS

78
Q

EPIDEMIC CURVE
-EXPOSED to the SAME TIME in a short period of time
- PEAK

A. POINT SOURCE EPIDEMIC
B. CONTINUOUS COMMONS SOURCE OR EPIDEMIC
C. SPORADIC CURVE
D. PROPAGATED EPIDEMIC

A

A. POINT SOURCE EPIDEMIC

79
Q

EPIDEMIC CURVE
- plateau

A. POINT SOURCE EPIDEMIC
B. CONTINUOUS COMMONS SOURCE OR EPIDEMIC
C. SPORADIC CURVE
D. PROPAGATED EPIDEMIC

A

B. CONTINUOUS COMMONS SOURCE OR EPIDEMIC

80
Q

EPIDEMIC CURVE
- common intermittent
source
- CURVE IS JAGGED

A. POINT SOURCE EPIDEMIC
B. CONTINUOUS COMMONS SOURCE OR EPIDEMIC
C. SPORADIC CURVE
D. PROPAGATED EPIDEMIC

A

C. SPORADIC CURVE

81
Q

EPIDEMIC CURVE
- Disease spread is person to person with INCREASING NUMBER OF CASES in each generation
- Progressively TALLER PEAKS

A. POINT SOURCE EPIDEMIC
B. CONTINUOUS COMMONS SOURCE OR EPIDEMIC
C. SPORADIC CURVE
D. PROPAGATED EPIDEMIC

A

D. PROPAGATED EPIDEMIC

BIOSTAT (5 decks)

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