HSPH extra useful stuff Flashcards
Which is the biggest cause of any disability in the UK? 1, Stroke 2, Arthritis 3, Congenital disorders 4, Traumatic accidents 5, Diabetes
2 arthritis
Which is the most common chronic disease in the UK?
1, Diabetes 2, Cardiovascular disease 3, Asthma 4, COPD 5. Arthritis
Asthma
One of the secondary outcomes was death from noncardiac causes; 8 occurred in the preventive PCI group and 6 in the no preventive PCI group; Hazards ratio = 1.10 95%CI: 0.38-3.18. P = 0.86. What does the P value tell us? (2 marks)
a. P = 0.86 tells us that there is an 86% chance that the hazards ratio would be as large as 1.10 or even larger (1 mark) if preventive PCI has no effect on noncardiac deaths. (1 mark)
Or
b. P > 0.05 so the result is not statistically significant (1 mark) and there is no evidence that preventive PCI increases the risk of non-cardiac deaths. (1 mark)
- Why are patients randomised in trials? (2 marks) Why is the randomisation done after the patients are deemed eligible? (1 mark)
To ensure the treatment groups are similar in all aspects (1 mark) apart from the treatment/intervention. (1 mark)
If the patients are randomised first then this may influence the decisions about eligibility (1 mark) or if large numbers of patients are ineligible it might cause unequal numbers to be randomised to each group (1 mark).
- What is the difference between an intention to treat analysis and an on treatment analysis (2 marks) and when will they give the same answer (1 mark).
a. ITT : people are analysed according to the treatment group they are in regardless of whether they receive the treatment or not (1 mark)
b. On Treatment: people are analysed according to the treatment they receive. (1 mark)
c. If everyone receives the treatment they were randomised to then both analyses are identical. (1
mark
why might a trial be stopped early
a. If there is a clear difference in treatment outcomes (1 mark) it is not ethical to continue with the trial (1 mark)
What is a theoretical framework? Name the components of a generic framework (2 marks; 1/5 mark for each component
Any four of the following (1/2 mark each):
Concepts (1/5 mark), definitions (1/2 mark), explanations (1/2 mark), models (1/2 mark) or processes (1/2 mark) that underpin work (1/2 mark).
- One theoretical Framework is the Common Sense Model of Health and Illness (CSM). Name the components of the CSM of health and illness (3 marks; 1⁄2 mark for each component)
A health threat is mediated by cognitive (1/2 mark) and emotional (1/2 mark) representations of that threat (1/2 mark) based on their current experience (1/2 mark), information (1/2 mark) from the external social environment (1/2 mark) and past illness experience (1/2 mark), and general knowledge (1/2 mark)
Provide four ways in which a method of qualitative research can be determined to be valid (2 marks; 1⁄2 mark each)
Theoretical framework links in to method
Inclusion criteria relevant
Exclusion criteria relevant
Ethics approval gained
Informed consent gained
Setting appropriate
Sampling and recruitment strategy appropriate
Include analysis of people involved and their relationship to participants to ensure no bias
Timing was appropriate to population
Diversity or homogeneity of population under study
Method of data collection is appropriate for subject and participants
Data was analysed sufficiently and in-depth description provided
Process of data analysis was
standard and reliable
- What are some common barriers to carrying out self-management (3 marks
higher level of morbidity,
greater financial constraints,
greater number of compound effects of conditions,
persistent depressive symptoms,
mismatch in level of patient-clinician communication,
lower income.
How do Self-management support goes beyond traditional knowledge-based patient education to include (3 Marks)
The following three answers must be provided (3 marks)
processes that develop patient problem-solving skills (1 mark)
improve self-efficacy (1 mark)
support application of knowledge in real-life situations that matter to patients (1 mark)
Self-efficacy relates to an individual’s perception of the degree to which they are capable of performing a given behaviour and has three elements. Name each element and explain what these mean.
Magnitude describes an individual’s perceived efficacy for their most capable performance
Strength refers to their confidence in their assessment of magnitude
Generality refers to whether this sense of efficacy translates to different situations.
. Name two health models that attempt to explain health behaviour (1 mark) (1/2 mark each)
Health Belief Model (Becker)
Theory of Planned Behaviour (Ajzen)
Transtheoretical Model (Stages of Change) (Prochaska et al.)
Social Cognitive Theory (Bandura)
Leventhal’s Self-Regulatory Theory (Leventhal et al.)
In the case control study of recreational drug use and testis cancer the cases and controls were matched for age – why? (2 marks)
Any four of … Age is a potential confounder (1⁄2 mark). It is associated with testis cancer risk (1⁄2 mark) as younger men more likely to get testis cancer (1⁄2 mark) and it is associated with drug use (1⁄2 mark) younger men more likely to have used certain of the drugs (1⁄2 mark). If the cases and controls were not marched an age difference may cause there to be a difference in drug use totally unrelated to testis cancer. (1⁄2 mark)
The odds ratio of heroin use and testes cancer is 0.92 with a 95% confidence interval of 0.24 to 3.59. What does the confidence interval mean? (2 marks)
The 95% confidence interval tells us that we are 95% confident (1⁄2 mark) that heroin use might decrease the risk of testes cancer by 76% (1-0.24) (1⁄2 mark) or it might increase it by 3.6 times.(1⁄2 mark) There is no evidence that heroin use will reduce the risk of testes cancer (p>0.05). (1⁄2 mark
Give an example of each of the three non-individual focused barriers to engaging with weight loss. (3 marks)
Any example and must include the three types of cultural barriers (3 marks)
Social barriers – bias, stigma, lack of effective knowledge about weight loss, lack of
control over local policies, peer pressure to join in particular eating habits
Political barriers – sugar tax, ideas around how much the state should intervene in
looking after people’s health, tension between health as a human right and fair priority setting; focus on causes championed by relatively wealthy & well-connected which displaces more important activities such as income protection, minimum wage, tax breaks etc
Environmental barriers – widespread availability of fast food that has a high content of salt, fat, and processed carbohydrates
- What does the acronym ACE stand for? (1 mark) Why is this important to know? (1 mark) (2 marks total)
Adverse Childhood Events – includes how early childhood events may affect later health in adults and therefore these need to be attended to in a Trauma Informed Care (TIC).
Outline Michie’s Behaviour Change Wheel. What is it used for (1 mark) and what are the components? (3 marks) How could Lana’s GP use it in his consultation with her about her health? (1 mark) (5 marks in total)
- must be capable (have the knowledge and skills) to engage in the activity. (1 mark)
- be motivated (1 mark)
- have the opportunity i.e. factors outside the individual must allow the behaviour (1 mark)
Lana’s GP could use it as a framework for exploring her initial resistance to taking participating in the cooking lessons.
What is epidemiology
- This is about finding causes of disease and preventing disease
How do you look at protein structure and quantification
Measure using ELISA - often used in clinic to measure the expression of particular protein
Mass spectrometry
X-ray crystallography - gives an idea fo the structure of the protein and how much proteins are available
NMR - structure of the protien
Cryo-EM - Structure of the coronavirus was released using this - get the structure of a protein
How do you look at protein function and expression
Receptors/ion channels/enzymes/transporters e.g. calcium assay (can open the calcium ion channel in the membrane of the cell and allow the entrance of calcium, the more calcium is in the cell the more active the G protein cover receptor is )
Find some way of measuring their activity
Usually measure substrates or products
- Can use ELISA
Common- inflammatory markers, cytokines etc
Products of enzymes can be measured
- Lipids
Determine rates of formation/depletion
- Finds out how badly damaged the enzymes are
What makes up the measure of location
- Median = Middle value when the values are ordered from smallest to largest
- Mode = the most common value
- Mean = average = sum of all of the values divided by the number of values
What makes up the measure of spread
- standard deviation
- interquartile range
What standard deviation correlates to the
- 99% range
- 95% range
- 90% range
99% range (0.5th to 99.5th centile) = mean ± 2.58 SDs
95% range (2.5th to 97.5th centile) = mean ± 1.96 SDs
90% range (5th to 95th centile) = mean ± 1.64 SDs
Define the confidence interval
a range of values so defined that there is a specified probability that the value of a parameter lies within it.
What is a P value
a p-value for a result is the probability of observing a result as or more extreme than the sample result if the underlying assumption in the population is true
When can P values be calculated
When there is a comparison
- 2 means – are they different i.e. is their difference different from 0?
- Association – are the observed results different from those expected
- Regression – is the slope different from 0?
describe the phases in developing and evaluating a new drug
• PRECLINICAL – Non-human study
– In vitro and in vivo animal experiments to obtain preliminary efficacy, toxicity and pharmacokinetic information
• PHASE 0 – First in-human trials (not always done)
– Small number of subjects given subtherapeutic dose of drug to determine pharmacodynamics and pharmacokinetics
• PHASE 1 – Screening for safety
– Testing of drug on (usually) healthy volunteers for dose ranging.
– Determine whether the drug is safe to check for efficacy
• PHASE 2 – Assess efficacy and safety
– To determine whether drug can have a therapeutic effect
– May be designed as case series or randomised controlled trial
• PHASE 3 – Assess efficacy and safety
– Randomised controlled trial on large number of patients to determine what the therapeutic effect is
• PHASE 4 – Post-marketing surveillance
– Safety surveillance (pharmacovigilance
What is the relative risk of death in the treatment group compared to the control group
Relative risk of death = risk of death in treatment group/Risk of death in control group
Work out the absolute difference in risk
Absolute risk = risk of treatment group - risk of control group
What are the results of a meta analysis summarized in
• Results of individual studies and a summary estimate often shown in a Forest plot
What are the issues in meta analysis
Heterogeneity
Publication bias
How can you assess publication bias
Funnel plot
How do you work out funnel plots
Funnel plot
- Relative risk of horizontal
- Standard error associated with relative risk of the vertical standard
- If there is no publication bias the points will be scattered either side of the line
What are the biases in a case control study
Recall bias
- Cases may remember more than controls
Reverse causality
- Has disease caused changes in recent exposures
Selection of cases
- Are they representative of all people with the disease
Selection of controls
- Are they representative of all people without the disease
- Are they similar to the cases
What do you you use instead of relative risk in a case control study
odds ratio
- Use odds ratio = odds exposure in cases/ odds exposure in control
What is attributable proportion
The same information allows you to calculate the proportion of disease in the exposed group that can be attributed to the exposure
