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Mine ESA 1 > Health and Disease in Populations > Flashcards

Health and Disease in Populations Flashcards

0
Q

What is the Stochastic Approach?

A

Having a random probability distribution or pattern that can be analysed statistically it may not predict future events but it can give the likelihood e.g. Overcrowding and TB

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1
Q

What is deterministic approach?

A

Is lab approach, test validity of hypothesis by systematic observations to pick with certainty future events e.g. TB and tubercule bacillus

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2
Q

Define a Cenus?

A

The simultaneous recording of demographic data by the government at a particular time pertaining to all persons who live in a particular territory

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3
Q

Features of a Cenus?

A

Run by government, covers a defined area, personal enumeration, occurs simultaneously, universal coverage, occurs at regular intervals

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4
Q

Uses of a Cenus?

A

Population - size, structure, characteristics used to see service needs, give indication of grant sizes to trusts
Health - can use to plan health care + resources
Housing - see if overcrowding is present and if so indicates need for new housing
Employment - plans jobs + training programmes
Transport - planning of roads + public transport
Ethnic Groups - measure success of equal opportunities, plan programmes for minority groups, identify nature and extent of nanny disadvantages
Emp

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5
Q

Define crude birth rate and state it’s use

A

No of live births per 1000 population (includes men)

- used to see the I lactate of births on size of a population

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6
Q

Define General fertility rate and state it’s use

A

No of live births per 1000 females aged 15 to 44 years

- used to compare fertility rate of fertile female populations

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7
Q

Define total period fertility rate and state it’s use

A

The average number of children that should be born to a hypothetical women in her life (sum of current age specific fertility rates)
- used to remove the influence of age group structure when co spring fertility of female populations

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8
Q

What is fecundity? And what effects it?

A

The physical ability to reproduce

Effected by sterilisations and hysterectomies (if they increase then there is a decease in fecundity)

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9
Q

What is fertility? and what effects it?

A

Realisation of this potential as births
Effected by sexual activity, economic climate (if increase then increase in fertility), contraception and abortion/termination (if increase then fertility decreases)

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10
Q

Define crude death rate

A

No of deaths per 1000 population

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11
Q

Define age specific death rate

A

No of deaths per 1000 in an age group

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12
Q

Define standard mortality rate

A

Observed number of deaths with number expected if age, sex distributions of populations were identical

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13
Q

Reasons behind collecting mortality data

A
  • is as proxy measure for incidence of disease
  • used to identify health problems and therefore plan care services & prevention programmes
  • used in population estimates and projections
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14
Q

What is population size effected by?

A

Number of births, amount of migration, deaths

- most effected by fertility rates and migration as death is more certain and is easy to predict

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15
Q

What are the 3 uses of healthcare information?

A
  1. Identify health & health care needs (morbidity data, NHS data, disease registration e.g cancer , deportment of work and pensions, health surgery for England)
  2. Monitor trends in disease
  3. Monitor performances in healthcare (dr foster, health statistics, QOF, qualities and outcomes framework)
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16
Q

What are the contentious issues associated with health information?

A

Purpose (past or future), User (manager or academic) quality (real time or validated), compatibility (has the data been customised), relationship (integral to NHS or independent), publication ( NHS only or public), access (data protection and confidentiality), funding (NHS or private)

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17
Q

Define incidence and how do you calculate it?

A

The number of new cases arising in a given time
IRR= new events / (no of people in population x time in years)
= events per person per year

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18
Q

What are person years/person-time at risk?

A

No of people x time

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19
Q

Define prevalence? And what is it?

A

The number of people affected by the disease

- is a proportion not a rate

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20
Q

How do we calculate prevalence and what influences it?

A

Point prevalence = no of suffers / no of people at risk, a population
Prevalence = incidence x length of disease
So effected by incidence, death from disease, cured of disease, length of disease

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21
Q

What can an incidence rate ratio be used for?

A

Comparing the incidence between two populations

  • can show if a new treatment is working or not
  • see if an exposure really is hazardous
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22
Q

What is a standardise mortality ratio, SMR?

A

Is a summary figure describing the mortality experience of a local population compared with a standard reference population which into account the confounding influences e.g. Age + Sex
- often expressed as a percentage or relative to 1

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23
Q

What does an SMR of 100 or 1 suggest?

A

That our population is the same as the standard reference population

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24
Q

What does and SMR greater than 100 or 1 mean?

A

That our population has an excess mortality in comparison to the standard reference population

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25
Q

What does an SMR less than 100 or 1 mean?

A

That our population has lower than average mortality

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26
Q

What does a confounder has the potential to do?

A

Explain all of or part of the association between an exposure and a disease

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27
Q

What is a confounder?

A

Is a factor that links the exposure with the outcome spuriously I.e. It is not on the causative pathway

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28
Q

Define the placebo effect

A

Is the psychological benefit that derives from being looked after/cared for different or from being on a new/special treatment
Can result in impaired clinical condition even if the new treatment is not as effective as standard treatment.

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29
Q

What is a placebo?

A

An inert substance which looks, tastes and is packaged identically to the comparison drug

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30
Q

When do we we use a placebo?

A

If no standard treatment exists
(Has ethical considerations as for, of deception so it is essential that patients are aware that they may receive a placebo)

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31
Q

Why do we predefine outcomes in RCTs?

A

Prevent data dredging
Practical for data collection
Agreed criteria for measurement and assessment of outcomes

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32
Q

What is the difference between primary and secondary outcomes?

A

Primary: only 1 and used in sample size calculation, main purpose of study
Secondary: other outcomes of interest e.g. occurrence of side effects

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33
Q

What are the three types of outcome?

A

Pathophysiological e.g. tumour size
Clinically e.g. Death, disease
Patient focused e.g. Quality of life

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34
Q

What are the 6 pairs of features if a ideal outcome?

A
  1. Appropriate and relevant (to pt, clinicians, society)
  2. Valid and attributable
  3. Sensitive and specific (chosen method of measurement can see effects accurately)
  4. Reliable and robust (outcome measurable by different people)
  5. Simple and sustainable (method easily carried out repeatably)
  6. Cheap and timely
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35
Q

What are the timing of measurements?

A

Before: baseline measurement of revelant factors
During: monitor outcomes during the trial (positive and adverse)
After: final measurement of outcomes, comparing final effects of treatments in trial

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36
Q

Why do we get losses to follow up?

A

Condition requires them to be removed

Patient choses not to continue

37
Q

How do we go minimise losses to follow up?

A

Make follow up practical and minimise inconvenience
Be honest about commitment required by pt
Avoid coercion of inducements
Maintain contact with participants

38
Q

Why do we go get non compliance?

A 
Misunderstood the instructions 
May not like taking the treatment
May not think treatment is working 
May prefer to take another treatment 
Cannot be bothered with treatment
39
Q

How do we maximise compliance?

A

Simplify instructions
Check compliance
Ask about side effects and reassure
Monitor compliance (tablet count, urine level, blood test)

40
Q

What does a as treated analysis give?

A

A larger size of effect

41
Q

What are the advantages to intention to treat analysis?

A

Randomisation is preserved
Problems due to confounding are avoided
Minimal selection bias
Gives us the more realistic effect of the drug = useful clinical practise

42
Q

What are the ethics of an rct?

A
  • Clinical equipoise (uncertainty over which treatment is better so not subjecting pt to treatment you know it worse)
  • scientifically robust (addresses important issues with a good question, comparable treatment, gives definitive conclusion, protects data, means to report and publish)
  • ethical recruitment (don’t inappropriate include I.e. Won’t benefit from drug, excluded form analysis, high rush do harm Don’t inappropriate exclude I.e. Results cannot be applied to a group of people as not included in trial, difficult to get consent)
  • valid consent (properly explained, cooling off period, withdraw at anytime)
  • voluntariness (not been manipulated/coerced into trial)
  • ethical recruitment ( inappropriate inclusion I.e. Not going to benefit form drug in future, pt likely to be excluded from analysis, high risk of harm or inappropriate exclusion I.e. Group of people not recruited into clinical trial so results cannot be applied to that group, people difficult to get consent E.g. Children, mentally ill, prisoners, immigrants)
43
Q

Then with any medical role ethics….

A 
Principles of......
Beneficence (do good) 
Non-maleficence  (do not do harm) 
Autonomy (let the patient decide) 
Justice (be fair)
44
Q

Define a clinical trial

A

Any form of planned experiment which involves patients and is designed to elucidate the most appropriate method of treatment of future patients with a given medical condition
Are experimental/interventional not just observance

45
Q

What is the purpose of a clinical trial?

A

To provide reliable evidence of treatment efficacy and safety

46
Q

Define efficacy

A

Ability of a health care intervention to improve the health of a defined group under specific conditions

47
Q

Define safety

A

The ability of a health care intervention to not harm a defined group under specific conditions

48
Q

Disadvantaged to randomised control trials and using historical controls

A
  • selection criteria for standard treatment less defined than for new treatment
  • selection of patients for standard treatment is less vigorous
  • patients under standard treatment may have been treated differently
  • less information about patients on standard treatment
  • adjustment for confounders is difficult due to lack of additional information about pt
49
Q

Steps involved in a randomised control trial

A
  1. Define: disease, treatments, outcomes, possible bias and confounders, pts eligible
  2. Invite/recruit eligible pts
  3. Gain consent
  4. Allocate to treatment
  5. Follow up
  6. Obtain results, then analyse and compare data
50
Q

Why might a difference in outcome between treatment groups occur?

A

Requires a larger trial - groups may be unbalanced/incomparable
If patient knows treatment they are on could change behaviour/expectations - distort outcome
If clinicians know - care/interest given may be different
If assessor knows - different approach to sensitivity and measurement of outcomes

51
Q

What is a systematic review?

A

Is an overview of primary studies (compilation) I.e. Rct, cohort, case
Is an extremely credible source of evidence

52
Q

What should the studies used in systematic reviews be?

A

Transparent
Reproducible
Explicit

53
Q

What is a meta analysis?

A

A quantitative synthesis of the results of two or more primary studies that addressed the same hypothesis in the same way
- may not be included in clinical heterogeneity is too great (can do statistical test for this but isn’t that strong!)

54
Q

How is a systematic review prone to bias?

A
  • failing to include relevant trials due to publication bias (idea that only statistically significant trials get published or large sample size)
  • failing to exclude poor quality trials
  • only include trials for a particular situation so can’t apply elsewhere
  • inappropriate combing of result e.g. Pooling of heterogenous results on neonates and adults
55
Q

In what ways are RCTs prone to bias?

A

Selection (unrepresentative group of pts)
Allocation (not random)
Treatment (differential treatment of pt depending on what treat,net group they are in)
Assessment (treatment group outcome measured more favourably)

56
Q

What are the advantages to systematic reviews?

A
  • large amount of info can be assimilated quickly by a health care professional
  • reduction in time between research breakthroughs and implentation of it in a clinical setting
  • used in evidence based practise guidelines
    Meta analysis provides overall figure for studies
  • explicit methods can reduce bias and exclusion of poor quality studies
57
Q

If a funnel plot is varied in shape what does this mean?

A

That the systematic review is biased

58
Q

What is the difference between absolute and relative risk?

A

Absolute: incidence of disease in any defined population
Relative: ratio of incident in exposed group to the incidence rate in the non exposed group (case control can only do this one as you require and incidence rate for absolute risk which you cannot calculate from this)

59
Q

Define the placebo effect

A

Is the psychological benefit that derives from being looked after/cared for different or from being on a new/special treatment
Can result in impaired clinical condition even if the new treatment is not as effective as standard treatment.

60
Q

What is a placebo?

A

An inert substance which looks, tastes and is packaged identically to the comparison drug

61
Q

When do we we use a placebo?

A

If no standard treatment exists
(Has ethical considerations as for, of deception so it is essential that patients are aware that they may receive a placebo)

62
Q

Why do we predefine outcomes in RCTs?

A

Prevent data dredging
Practical for data collection
Agreed criteria for measurement and assessment of outcomes

63
Q

What is the difference between primary and secondary outcomes?

A

Primary: only 1 and used in sample size calculation, main purpose of study
Secondary: other outcomes of interest e.g. occurrence of side effects

64
Q

What are the three types of outcome?

A

Pathophysiological e.g. tumour size
Clinically e.g. Death, disease
Patient focused e.g. Quality of life

65
Q

What are the 6 pairs of features if a ideal outcome?

A
  1. Appropriate and relevant (to pt, clinicians, society)
  2. Valid and attributable
  3. Sensitive and specific (chosen method of measurement can see effects accurately)
  4. Reliable and robust (outcome measurable by different people)
  5. Simple and sustainable (method easily carried out repeatably)
  6. Cheap and timely
66
Q

What are the timing of measurements?

A

Before: baseline measurement of revelant factors
During: monitor outcomes during the trial (positive and adverse)
After: final measurement of outcomes, comparing final effects of treatments in trial

67
Q

Why do we get losses to follow up?

A

Condition requires them to be removed

Patient choses not to continue

68
Q

How do we go minimise losses to follow up?

A

Make follow up practical and minimise inconvenience
Be honest about commitment required by pt
Avoid coercion of inducements
Maintain contact with participants

69
Q

Why do we go get non compliance?

A 
Misunderstood the instructions 
May not like taking the treatment
May not think treatment is working 
May prefer to take another treatment 
Cannot be bothered with treatment
70
Q

How do we maximise compliance?

A

Simplify instructions
Check compliance
Ask about side effects and reassure
Monitor compliance (tablet count, urine level, blood test)

71
Q

What does a as treated analysis give?

A

A larger size of effect

72
Q

What are the advantages to intention to treat analysis?

A

Randomisation is preserved
Problems due to confounding are avoided
Minimal selection bias
Gives us the more realistic effect of the drug = useful clinical practise

73
Q

What are the ethics of an rct?

A
  • Clinical equipoise (uncertainty over which treatment is better so not subjecting pt to treatment you know it worse)
  • scientifically robust (addresses important issues with a good question, comparable treatment, gives definitive conclusion, protects data, means to report and publish)
  • ethical recruitment (don’t inappropriate include I.e. Won’t benefit from drug, excluded form analysis, high rush do harm Don’t inappropriate exclude I.e. Results cannot be applied to a group of people as not included in trial, difficult to get consent)
  • valid consent (properly explained, cooling off period, withdraw at anytime)
  • voluntariness (not been manipulated/coerced into trial)
  • ethical recruitment ( inappropriate inclusion I.e. Not going to benefit form drug in future, pt likely to be excluded from analysis, high risk of harm or inappropriate exclusion I.e. Group of people not recruited into clinical trial so results cannot be applied to that group, people difficult to get consent E.g. Children, mentally ill, prisoners, immigrants)
74
Q

Then with any medical role ethics….

A 
Principles of......
Beneficence (do good) 
Non-maleficence  (do not do harm) 
Autonomy (let the patient decide) 
Justice (be fair)
75
Q

Define a clinical trial

A

Any form of planned experiment which involves patients and is designed to elucidate the most appropriate method of treatment of future patients with a given medical condition
Are experimental/interventional not just observance

76
Q

What is the purpose of a clinical trial?

A

To provide reliable evidence of treatment efficacy and safety

77
Q

Define efficacy

A

Ability of a health care intervention to improve the health of a defined group under specific conditions

78
Q

Define safety

A

The ability of a health care intervention to not harm a defined group under specific conditions

79
Q

Disadvantaged to randomised control trials and using historical controls

A
  • selection criteria for standard treatment less defined than for new treatment
  • selection of patients for standard treatment is less vigorous
  • patients under standard treatment may have been treated differently
  • less information about patients on standard treatment
  • adjustment for confounders is difficult due to lack of additional information about pt
80
Q

Steps involved in a randomised control trial

A
  1. Define: disease, treatments, outcomes, possible bias and confounders, pts eligible
  2. Invite/recruit eligible pts
  3. Gain consent
  4. Allocate to treatment
  5. Follow up
  6. Obtain results, then analyse and compare data
81
Q

Why might a difference in outcome between treatment groups occur?

A

Requires a larger trial - groups may be unbalanced/incomparable
If patient knows treatment they are on could change behaviour/expectations - distort outcome
If clinicians know - care/interest given may be different
If assessor knows - different approach to sensitivity and measurement of outcomes

82
Q

What is a systematic review?

A

Is an overview of primary studies (compilation) I.e. Rct, cohort, case
Is an extremely credible source of evidence

83
Q

What should the studies used in systematic reviews be?

A

Transparent
Reproducible
Explicit

84
Q

What is a meta analysis?

A

A quantitative synthesis of the results of two or more primary studies that addressed the same hypothesis in the same way
- may not be included in clinical heterogeneity is too great (can do statistical test for this but isn’t that strong!)

85
Q

How is a systematic review prone to bias?

A
  • failing to include relevant trials due to publication bias (idea that only statistically significant trials get published or large sample size)
  • failing to exclude poor quality trials
  • only include trials for a particular situation so can’t apply elsewhere
  • inappropriate combing of result e.g. Pooling of heterogenous results on neonates and adults
86
Q

In what ways are RCTs prone to bias?

A

Selection (unrepresentative group of pts)
Allocation (not random)
Treatment (differential treatment of pt depending on what treat,net group they are in)
Assessment (treatment group outcome measured more favourably)

87
Q

What are the advantages to systematic reviews?

A
  • large amount of info can be assimilated quickly by a health care professional
  • reduction in time between research breakthroughs and implentation of it in a clinical setting
  • used in evidence based practise guidelines
    Meta analysis provides overall figure for studies
  • explicit methods can reduce bias and exclusion of poor quality studies
88
Q

If a funnel plot is varied in shape what does this mean?

A

That the systematic review is biased

89
Q

What is the difference between absolute and relative risk?

A

Absolute: incidence of disease in any defined population
Incidence: ratio of incident in exposed group to the incidence rate in the non exposed group (case control can only do this one as you require and incidence rate for absolute risk which you cannot calculate from this)

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