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Exam 1 > Health Pop > Flashcards

Health Pop Flashcards

1
Q

What is a census?

A

simultaneous recording of demographic data to ALL persons in a defined area

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2
Q

What is a census used for?

A
  1. allocation of resources
  2. projection of populations (estimate for future)
  3. trends e.g. ethnicity or age
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3
Q

What is crude birth rate (CBR?)

A

the number of LIVE births per 1000 population

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4
Q

What is general fertility rate (GFR)?

A

number of LIVE births per 1000 FERTILE women between 15-44 (accurate but not always possible)

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5
Q

What is total period fertility rate (TPFR)?

A

average number of children born to a hypothetical women in her lifetime - sum of age specific boundaries

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6
Q

What is crude death rate (CDR)?

A

number of deaths per 1000 population

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7
Q

What is age specific mortality rate?

A

number of deaths per 1000 in a specific age group

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8
Q

What is incidence rate?

A

number of new cases of the disease per 1000 people per YEAR

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9
Q

What is prevalence?

A

amount of people who currently have the disease in a set population (no time frame)

no follow up, NOT rate

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10
Q

What is incidence rate ratio (IRR)?

A

incidence rates of 2 SEPARATE populations with VARYING exposure compared to see if exposure CAUSES certain diseases

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11
Q

How do you work out incidence rates and prevalence?

A

e^2√(1/d)

d is events observed in a population

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12
Q

What’s another formula to work out incidence rate?

A

new cases exposed / (population x year)

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13
Q

How do you work out incidence rate ratio (IRR)?

A

(new cases exposed / population x year) ÷ (new cases UNexposed / population x year)

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14
Q

What does it mean if IRR = 2?

A

2 x more likely to have the disease in an exposed region compared to an unexposed region

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15
Q

What’s another way to work out IRR?

A

e^2 √ ((1÷d1) + (1÷d2))

d1 & d2 = cases in each population respectively

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16
Q

What are confounding factors?

A

something that is associated with both outcome and exposure of interest, but is not on the casual pathway between exposure and outcome

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17
Q

What is disadvantage about confounding factors?

A

distorts results and give misleading results

they can show potential casual links which are actually unfounded

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18
Q

What is standardised mortality rate (SMR)?

A

takes into account confiding factors to provide summative figure compared to general population

compares observed VS expected number of deaths, takes into account age-sex distribution

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19
Q

How do you work out SMR? what do the figures mean?

A

O/E x 100
age & sex most commonly accounted for confounding factors
SMR > 100 suggest EXCESS mortality
SMR

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20
Q

How else can SMR be calculated and how come other numbers are not required?

A

e^2 (1/O)
O = observed number of events in a population

no need for other values as SMR is compared to the standard population

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21
Q

What is incidence?

A

measurement of population’s average risk of disease

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22
Q

What is variation?

A

occurs in an epidemiological study whereby there is a difference between observed and expected value

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23
Q

What is carried out to allow for variation?

A

error factor is produced and from that confidence intervals are worked out

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24
Q

What is the confidence interval?

A

a range of values that we can say (with 95% confidence) that the actual value will lie in between this range

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25
Q

How do you work out confidence interval?

A

lower bound = observed value ÷ error factor

upper bound = observed value x error factor

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26
Q

What is biasing?

A

deviation of the results from the truth via certain processes

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27
Q

What is selection bias?

A

error due to SYSTEMATIC differences in ways in which the two groups were collected

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28
Q

information bias

A

error due to systematic misclassification of subjects in the group

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29
Q

recall / publication bias

A

studies with statistically significant or favourable results are more likely to be published

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30
Q

RIP HS(U)A

A 
Recall bias
Information bias
Publish bias
Healthy worked effect
Selection bias
Allocation  bias
31
Q

What are cohort studies?

A

recruiting disease FREE individuals and classifying them according to EXPOSURE status
then followed up for extended periods, disease progress monitored and incidence rates (IR) are calculated

32
Q

What are cohort studies good for?

A

rare exposure or diseases which take a long time to develop

33
Q

Prospective studies

A

disease free individuals recruited and followed up

‘look to the future’

34
Q

Retrospective studies

A

disease free individuals recruited then exposure status calculated from historical documentation and followed up

can be prone to recall bias
use IR

35
Q

Internal comparisons

A

when you have sub cohorts within your original group then compare exposed and unexposed within your within the cohort

use IRR

36
Q

External comparison

A

exposed population compared against reference population e.g. general population

use SMR to remove cofounders

37
Q

Case control studies, how are they carried out?

A

recruiting disease free individuals (control) and diseased individuals (control) and their exposure status determined (recorded)
then word out the odds ratio
(a x d) / (b x c)

38
Q

What does null hypothesis assume?

A

2 things are equal / no difference

39
Q

What does p

A

strong suggestion that the null hypothesis is false (statistically significant)

40
Q

What does p>0.05 mean?

A

observed findings consistent with null hypothesis (2 things are equal) (NOT true, just consistent, so can’t reject)

41
Q

If the CI includes IRR = 1 then what does that mean?

A

p>0.05, can’t reject null hypothesis

42
Q

What value is the null hypothesis normally given? what does it mean?

A

null hypothesis = 1
being exposed will give the same odds for developing the disease as unexposed
(being exposed will give the odds of developing the disease for the odds calculated)

43
Q

When is case control studies used?

A

for rare diseases
number of controls usually 5x amount of cases, controls easier to find - minimising EF

(more control, less error - more representative of the population of the disease being rare)

44
Q

What are pros and cons of cohort study?

A

pros: good for rare EXPOSURES
cons: expensive, time-consuming (esp. if disease has long latent period - takes long time to develop)
but can calculate absolute risk
opportunity to look for different potential outcomes at once from varying exposures

45
Q

What are the pros and cons of case-control studies?

A

good for rare DISEASE
opportunity to look for different EXPOSURES
cheap and quick (pt already have the disease)
can’t obtain absolute risks
heavily affected by recall + selection bias

46
Q

What types of bias are in case control bias?

A
  1. selection bias - participants not representing general population e.g. diseased and control from the same ward (heart disease), SIMILAR risk factors / exposures
  2. recall bias - exposure status incorrectly determined - due to retrospective (looking back to history to determine exposure)
47
Q

What can be removed using case control studies?

A

confounders

matching up same band controls with similar details

48
Q

What does randomised controlled trial involve?

A

identify a source of eligible pts
allocate participants to treatment fairly - randomisation
follow up participants in identical ways
minimise losses to follow up (try and follow up often) and maximised compliance with treatment (follow the treatment plan given)
analyse data obtained and results

49
Q

Why use randomisation?

A

used to remove any confounders that may be present in the study, known or unknown

50
Q

What is double blinding?

A

neither the patient nor the doctor now which treatment they are on - removing selection bias (doctors are more likely to place healthy patients in new drug groups and show more positive results for the new drug to produce statistically significant results)

51
Q

When are Placebo’s used?

A

if no current treatment already in place for disease in question
to remove placebo effect from the trial

52
Q

what does loosing compliers lead to?

A

loss of randomisation as the patients who remain in the trail are normally ones who are predisposed to or have the disease, so want a cure

53
Q

How are outcomes measure in randomised controlled trial?

A

intention to treat analysis

ignores noncompliance, withdrawal, and anything that happens after randomisation

54
Q

What is the bradford hill criteria used for?

A

to determine whether causal-effect relationship has been established (once confounders, bias and chance have been removed)

55
Q

What are the association features in the bradford hill criteria?

A
  1. STRENGTH of association: stronger association, more likely to be causal
  2. SPECIFICITY of association: outcome associated with specific factor (mesothelioma caused by asbestos)
  3. CONSISTENCY of association: association occurs in other studies too
56
Q

What are the exposure / outcome factors of the Bradford Hill criteria?

A
  1. temporal sequence: causative factor precedes outcome (cause before outcome)
  2. Dose response: increasing exposure increases outcome
  3. Reversibility: removing causative factor reduces risk of outcome
57
Q

What are the other evidence of the bradford hill criteria?

A
  1. Coherence of theory: observed observation confirms current scientific thinking
  2. Biological plausibility: biological mechanism support theory
  3. Analogy: study more likely if there is a link with another study
58
Q

How do you minimise losses in randomised controlled trial?

A

follow up participants at appropriate times
no coercion or inducements (don’t force anything!)
honest to patients

59
Q

Ho do you maximise compliance in a randomised controlled trial?
How can compliance be measured?

A
  1. simplify instructions
  2. patient allowed to ask any questions they have
  3. made simple and accessible for patients

measuring blood test urine samples etc.

60
Q

What are ethics of randomised control trial?

A
  1. clinical equipoise - reasonable, certain which drug is better for patient, not subjecting patient to less effective treatment
  2. scientifically robust - in search for good of the general population
  3. ethical recruitment - recruitment for region where drug will take affect (all factors taken in - side effects etc.)
  4. valid consent - participants given sufficient knowledge cooling off period
61
Q

What is systematic review?

A

an overview of primary studies that used explicit and reproducible method
large amount of studies identified and narrowed down with the most relevant and credible
studies should be transparent, reproducible and explicit (stated clearly)

62
Q

What is meta analysis?

A

quantitive synthesis of primary studies within systematic review (continuos outcome e.g. long term effects)
provides overall value with associated confidence intervals
results shown via forest plots

63
Q

What are the 2 types of systematic reviews?

A
  1. fixed effects model

2. random effects model

64
Q

What is fixed effect model?

A

assumes that the studies used are homogenous and any variation between data comes from within - study variation
(study estimating SAME effect size)

65
Q

What is random effects model?

A

assumes the studies are heterogeneous and variation between the data comes from between - study variation and in between study variation
(study estimating SIMILAR effect size)

66
Q

What does systematic review rely on?

A

quality of primary studies AND publication bias

should use published AND unpublished trial

67
Q

what is publication bias?

A

a study is more likely to be published if the results are statistically significant or has a large sample size - results will be biased

68
Q

How can publication bias be determined?

A

using funnel plot
well shaped and balanced systematic review - funnel shape in its studies when plotted
a biased systematic review will vary in shape

69
Q

Advantages of systematic review

A

explicit methods can reduce bias and exclusion of poor quality studies
meta-analysis provides overall figure for the studies
large amounts of information can be assimilated quickly by healthcare professionals
reduction in time between research discovery and implementation of clinical use
uses evidence based practice guidelines

(quick, large amount of information assimilated, short time period between discovery and use of treatment)

70
Q

What is Henle-Koch’s Postulates?

A
  1. Necessary: cause BEFORE disease
  2. Specific: cause ABSENT in other diseases
  3. Sufficient: cause ALONE can cause disease
71
Q

What is epidemiology?

A

the study of the distribution and determinants of health-related states or even in specified populations, and the application of this study to the control of health problems

72
Q

What is clinical trail?

A

any form of planned experiment which involves patients and is designed to elucidate the most appropriate method of treatment of future patients

73
Q

what is the purpose of a clinical trial?

A 
reproducible
controlled - comparison of interventions
fair - unbiased without confounding
autonomy - patient has a say
pt able to withdraw anytime
74
Q

What is the placebo effect?

A

even if the therapy is irrelevant to the patient’s condition, the patient’s attitude to his or her illness and indeed the illness itself, ay be improved by a feeling that something is being done about it

Exam 1 (39 decks)

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