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Courses > HLTC19: Chronic Diseases (Midterm) > Flashcards

HLTC19: Chronic Diseases (Midterm) Flashcards

1
Q

what is a population?

A

a group of people with common characteristic(s)

eg. gender, age, occupation, etc.

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2
Q

focuses on the distribution of health-related states/events in specified populations

A

descriptive epidemiology

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3
Q

quantifying how often a disease arises in a population

A

disease frequency

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4
Q

quantifying disease frequency involves:

A
  1. developing a definition of disease
  2. instituting a mechanism for counting cases of disease w/in specified population
  3. determining size of said population
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5
Q

focuses on determinants of health-related states or events in specified populations

A

analytic epidemiology

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6
Q

factors that bring about a change in a person’s health or makes a difference in a person’s health

A

disease determinants

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7
Q

what are some goals and applications of epidemiology in relation to chronic diseases?

A
  • control health problems
  • determine extent of disease in a population
  • identify patterns and trends in disease occurrence
  • identify causes of disease
  • evaluate effectiveness of measures that prevent and treat disease
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8
Q

how does the WHO define chronic diseases?

A

chronic diseases are diseases of long duration with slow progression

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9
Q

what are some common themes in defining chronic disease?

A
  • share common risk factors
  • begin slowly and develop gradually over time
  • can occur at any age (but more common in adulthood)
  • impact quality of life and limit daily activities
  • require long-term management with multiple services required
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10
Q

what are the 4 major chronic diseases?

A
  1. CVD
  2. Cancer
  3. Chronic respiratory diseases
  4. Diabetes
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11
Q

what is the goal of public health?

A

to promote the health of the population through organized community efforts

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12
Q

the state of complete physical, mental, and social well-being, not merely the absence of disease

A

health

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13
Q

the study of pattern and causes of health-related outcomes and application of these findings to the improvement of public health

A

epidemiology

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14
Q

a set of criteria that must be fulfilled to identify a person as representing a case of a particular disease

A

case definition

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15
Q

a continuum b/w risk factors and disease as end result of continuum

A

chronic disease continuum

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16
Q

overarching factors that are largely outside the control of the individual that have significant trickle down effects on other, more proximal determinants of public health

A

upstream determinants

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17
Q

type of population where membership is defined at a point in time or an event, is permanent, and does not change

A

close/fixed population

eg. Japanese atomic bomb survivors

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18
Q

type of population where membership is defined on the basis of a changeable state or condition and is transient

A

open/dynamic population

eg. cancer registry (people added as they are diagnosed)

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19
Q

the shift from infectious and deficiency diseases to chronic, non-communicable diseases

A

epidemiological transition

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20
Q

rate of occurrence of new cases of disease in a population at risk during a specified period of time

A

incidence

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21
Q

frequency of current cases of disease (old + new) in a population at risk during a specified period of time

A

prevalence

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22
Q

(proportion/rate)

_____ tell us what fraction of the population is affected; _____ tell us how fast the disease is occurring

A

PROPORTIONS tell us what fraction of the population is affected; RATES tell us how fast the disease is occurring

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23
Q
  • # of new health-related events in a defined population within a specified period of time
  • measures risk
A

incidence

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24
Q

the fraction of people who experience the onset of the event during a specified time period

A

cumulative incidence / incidence proportion

(used when people are followed the entire time!!!)

vs. incidence rate when people are followed for a certain period of time/until disease occurs

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25
Q

what is the formula for cumulative incidence?

A
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26
Q

the rate at which new events occur in a population; takes into account variable time periods at risk

A

incidence density / incidence rate

total amount of time <strong>EACH </strong>person was observed

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27
Q

what is the formula for incidence density / incidence rate?

A
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28
Q
  • the proportion of individuals in a population who have a disease or condition
  • measures burden of an event
A

prevalence

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29
Q

what is the formula for prevalence?

A
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30
Q

percentage of people in a population with the condition at a specific point in time

A

point prevalence

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31
Q

percentage of people in a population with the condition over a specified period of time

A

period prevalence

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32
Q

what are some factors that impact prevalence?

  • as incidence increases, prevalence _____
  • as # of people cured increases, prevalence _____
  • as # of people that survive increases, prevalence _____
  • as more people die from disease, prevalence _____
A
  • as incidence increases, prevalence increases
  • as # of people cured increases, prevalence decreases
  • as # of people that survive increases, prevalence increases
  • as more people die from disease, prevalence decreases
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33
Q

an event/condition/characteristic that preceded disease onset and that, had the event/condition/characteristic been different, the disease would not have occurred at all or would not have occurred until some time later

A

cause

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34
Q

measures public health impact of an exposure (difference in measures)

A

absolute measure of comparison

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35
Q

measures strength of relationship of 2 factors (ratio of measures)

A

relative measure of comparison

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36
Q

difference in rate of occurrence of disease due to exposure

A

risk/rate difference

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37
Q

what is the formula for risk/rate difference?

A

RD = riskexposed - riskunexposed

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38
Q

what does risk difference (RD) = 0 mean?

A
  • risk in exposed = risk in unexposed
  • no increased risk attributed to exposure
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39
Q

what does risk difference (RD) > 0 mean?

A
  • risk in exposed is greater than risk in non-exposed
  • excess risk attributed to exposure
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40
Q

what does risk difference (RD) < 0 mean?

A
  • risk in exposed is less than risk in exposed
  • decreased risk attributed to exposure (“protective*)
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41
Q

risk of disease in exposed compared to risk of disease in unexposed

A

risk/rate ratio (RR)

aka as relative risk

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42
Q

what is the formula for risk/rate ratio (relative risk)?

A

RR = Rexposed / Runexposed

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43
Q

what does it mean when relative risk (RR) = 1?

A
  • risk in exposed is the same as risk in unexposed
  • there is no association b/w disease and exposure
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44
Q

what does it mean when relative risk (RR) > 1?

A
  • risk in exposed is greater than risk in unexposed
  • there is a positive association b/w 2 factors
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45
Q

what does it mean when relative risk (RR) < 1?

A
  • risk in exposed is lesser than risk in unexposed
  • there is a negative association b/w 2 factors
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46
Q

what are the advantages and disadvantages of using an absolute measurement (ie. risk difference)?

A

advantages:

  • public health impact
  • absolute change measured

disadvantage:

  • less commonly used
47
Q

what are the advantages and disadvantages of using a relative measurement (ie. relative risk)?

A

advantages:

  • can measure strength of association
  • commonly used

disadvantage:

  • hard to interpret
48
Q

what is the 2-step process epidemiologists use when approaching causation?

A
  1. assessing whether observation is valid or true
  2. causal inference
49
Q

what are the essential attributes of true causes?

A

association: cause (X) must occur together with effect (Y)

time order: cause must precede the effect (time periods can be short or long)

directionality: asymmetrical relationship b/w cause and effect (want X to cause Y but don’t want Y to cause X)

50
Q

focuses on the origins of the web of causation, including social, political, and economic determinants of health instead of individual-level determinants

A

ecosocial framework

51
Q

a complete causal mechanism that inevitably causes disease

A

sufficient cause

52
Q

each participating factor in a sufficient cause

A

component cause

53
Q

a causal component that it is a member of every sufficient cause

A

necessary cause

54
Q

what are the key attributes of a sufficient-component cause model?

A
  • blocking action of one component stops completion of sufficient cause (just need to know one to prevent disease)
  • completion of sufficient cause leads to biological onset of disease
  • component causes may act far apart in time
55
Q

level of prevention that aims to prevent disease from occurring and reduce incidence

A

primary prevention

56
Q

level of prevention that delays onset and duration of clinical disease and aims to improve survival

A

secondary prevention

57
Q

level of prevention that slow disease progression and aims to improve survival

A

tertiary prevention

58
Q

why is a clear research question important?

A

formulating research questions precisely enables you to design a study with a good chance of answering them

59
Q

what is the PICO framework for research questions?

A

Population: sample of participants in study

Intervention: treatment provided to participants

Comparison: reference group used to compare with intervention

Outcome: measure used to examine treatment effectiveness

60
Q

what is the PECO framework for research questions?

A

P: population of interest

E: exposure level of participants

C: reference group used to compare with exposure

O: measure used to examine effects of exposure

61
Q

aims to collect valid and precise info about causes, prevention, and treatment of disease (to determine relationship b/w exposure and disease)

A

analytic epidemiological research

62
Q

experimental vs. observational studies: PICO or PECO?

A
  • experimental studies follow PICO framework
  • observational studies follow PECO framework/PO (population outcome)
63
Q

what are the different directions for observational studies?

A

cohort study: when looking at exposure BEFORE outcome

case-control study: when looking at exposure AFTER outcome (look at outcome first then exposure)

cross-sectional study: when exposure and outcome are looked at at the same time

64
Q

when the investigator actively manipulates which groups receive the agent under study

A

experimental studies

65
Q

ensures that known and unknown potential confounders are equally distributed among groups and that they have similar baseline characteristics

A

randomization

66
Q

what are some advantages of RCTs?

A
  • prospective
  • randomization
  • clear temporal sequence
    • strong evidence for causation
67
Q

what are some disadvantages of RCTs?

A
  • contrived situation; might not reflect real world consequences
  • ethical restraints
  • human behaviour may be difficult to control
  • exclusions may limit generalizability
  • expensive to conduct
68
Q

when the investigator passively observes as nature takes its course

A

observational studies

69
Q

makes causal inferences about the association b/w exposure and disease

A

observational studies

70
Q

examines the relationship b/w exposure status and disease status at the same time for each subject

A

cross-sectional studies

71
Q

what are some advantages of cross-sectional studies?

A
  • inexpensive
  • quick to conduct
72
Q

what are some disadvantages of cross-sectional studies?

A
  • may exclude those with disease who died before study began
  • cannot establish temporality of relationship
73
Q

type of study that examines multiple health effects of an exposure

A

cohort studies

74
Q

when subjects are defined according to their exposure levels and followed for disease occurrence over time

A

cohort studies

75
Q

any designated group of persons who are followed or traced over a period of time

A

cohort

76
Q

a study where the cohort is assembled at present time and followed toward future (study initiated before outcomes occur)

A

prospective cohort study

77
Q

a study where the cohort is assembled in the past using existing records and is “followed” to present time (study initiated after outcomes occur)

A

retrospective/historical cohort study

78
Q

a combination of a prospective and retrospective cohort study

A

ambidirectional cohort study

79
Q

what are some similarities b/w cohort studies and RCTs?

A
  • both can compare 2 or more exposure groups
  • both follow subjects to monitor outcomes
  • both can monitor more than one outcome
  • select groups for comparability
80
Q

what are the major differences in an RCT vs. a cohort study?

A
  • researcher allocates exposure
  • randomization of exposure status to groups
  • can use placebo and masking/blinding
81
Q
  • interval b/w action of exposure and disease onset
  • time required for a specific cause to produce an outcome
A

induction period

eg. how long does it take for smoking to cause lung cancer?

82
Q
  • interval b/w disease onset and clinical diagnosis
  • the time b/w the disease’s first presence and its recognition
A

latent period

eg. how long after someone develops lung cancer do they start showing clinical symptoms?

83
Q

what are some advantages of cohort studies?

A
  • temporality established (exposure precedes outcome)
  • establishes incidence of disease
  • quality control measures can be implemented (prospective)
  • inexpensive and fast to conduct (retrospective)
84
Q

what are some disadvantages of cohort studies?

A
  • expensive when outcome is rare or follow-up is long (prospective)
  • maintaining participation is difficult/loss to follow-up (prospective)
  • quality of data poor; rely only on available info (retrospective)
85
Q

where data is originally collected

A

data source

86
Q

when original data is collected for a specific purpose by or for an investigator

A

prospective data

87
Q

existing data that was recorded for another purpose

A

retrospective data (secondary use)

88
Q

captures demographic info on all individuals who received a HC # in Ontario (updates addresses)

A

Registered Persons Database (RPDB)

89
Q

arises from a systematic difference in the way that the exposure or outcome is measured b/w compared groups; results in different accuracy of info b/w comparison groups

A

information bias

90
Q

systematic differences b/w study groups in terms of accuracy or completeness of recall of past events

A

recall bias

91
Q

systematic difference in soliciting, recording, or interpreting info involving interviewers

A

interviewer/observer bias

92
Q

probability that test correctly classifies positive individuals who have pre-clinical disease

A

sensitivity

93
Q

probability that test correctly classifies individuals w/o pre-clinical disease as negative

A

specificity

94
Q

proportion of individuals with a positive test who have preclinical disease

A

positive predictor value (PPV)

(↑ prevalence= ↑ PPV)

95
Q

proportion of individuals w/o preclinical disease who test negative

A

negative predictor value (NPV)

(↑ prevalence= ↓ NPV)

96
Q

when a test has an extremely high Specificity, a Positive results tends to rule in the diagnosis

A

SpPin

97
Q

when a test has an extremely high Sensitivity, a Negative result rules out the diagnosis

A

SnNout

98
Q

how to address information bias?

A
  • comprehensive questions to improve recall and self-reporting (eg. close-ended questions)
  • standardized questionnaires, mask interviewer (if possible)
  • self-administered questions
  • validate data with another source
99
Q
  • consistency b/w repeated measurement
  • repeatability or reproducibility of a test (get the same results everytime)
A

reliability

100
Q

the degree to which a variable represents what its intended to represent

A

validity

101
Q
  • the degree to which study results are true for people being studied
  • validity of comparisons made w/in the study
A

internal validity

102
Q
  • probability that observed result is due to chance
  • directly related to sample size
  • variability in data that can’t be explained by the design or still remains after systematic error is eliminated
A

random error

103
Q

occurs when there is a systematic difference b/w individuals included in the study and individuals not included in the study (during selection and follow-up of participants)

A

selection bias

104
Q
  • mixing of effects b/w exposure, outcome, and a 3rd variable (another exposure)
  • effects of the 2 exposure cannot be separated
A

confounding

105
Q

bias can affect the _____ of a study

A

bias can affect the INTERNAL VALIDITY of a study

106
Q

errors that results from procedures used to select subjects and from factors that influence participation in the study

A

selection bias

107
Q
  • comes from selecting study subjects from a larger population
  • extent to which results are generalizable/applicable to another study population
A

external validity (generalizability)

108
Q

what are the major sources of information bias?

A
  • recall bias
  • interviewer/observer bias
109
Q

what are the 3 key characteristics of confounders?

A
  • must be associated with exposure
  • must be a risk factor for the outcome
  • must not be an intermediate step in the causal pathways b/w exposure and disease
110
Q

how can we control for confounding?

A

at the design stage:

  • randomization
  • restriction
  • matching

at the analysis stage:

  • standardization
  • stratification
  • matched analysis (for case-control studies)
  • multivariate analysis
111
Q

when subjects with identical (or near identical) characteristics are selected across compared groups

A

matching

112
Q

separating study population into homogenous categories of a confounder

A

stratification

eg. everyone’s a smoker in the smoker stratum

113
Q

mathematical model that can control for multiple confounders simultaneously

A

multivariate analysis

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