HSPH QS Flashcards
1
Q
Suicide rates are highest in which of
the groups below?
- Men aged 65+
- Men aged 18-24
- Women aged 18-24
- Women aged 65+
- Men aged 35-49
- Women aged 35-49
A
Suicide rates are highest in which of
the groups below?
- Men aged 65+
- Men aged 18-24
- Women aged 18-24
- Women aged 65+
5. Men aged 35-49 - Women aged 35-49
2
Q
If a doctor finds out that a patient is experiencing domestic
violence which of the following should they do?
- Immediately send the patient to A&E
- Refer the patient to a psychiatrist
- Suggest referral for domestic violence advocacy and treat symptoms
- Refer the patient to social services
- Suggest referral to gynaecologist
A
If a doctor finds out that a patient is experiencing domestic
violence which of the following should they do?
- Immediately send the patient to A&E
- Refer the patient to a psychiatrist
3. Suggest referral for domestic violence advocacy and treat symptoms - Refer the patient to social services
- Suggest referral to gynaecologist
3
Q
Self-management in the context of chronic
illness refers to:
- People not going to the doctor
- People attending courses on healthy lifestyles
- Health professionals supporting people to self-care
- Informal care in the community
- People making all their own decisions about how to
manage their illness
A
Self-management in the context of chronic
illness refers to:
- People not going to the doctor
- People attending courses on healthy lifestyles
3. Health professionals supporting people to self-care - Informal care in the community
- People making all their own decisions about how to
manage their illness
4
Q
Which of the following best describes the
social model of disability?
- Disability is viewed as a medical problem
- People are under the care of social workers
- Disabling environments prevent people from
participating in social activities such as work - People are given benefits and not expected to work
- Impairments lead to barriers to social participation
A
Which of the following best describes the
social model of disability?
- Disability is viewed as a medical problem
- People are under the care of social workers
3. Disabling environments prevent people from
participating in social activities such as work - People are given benefits and not expected to work
- Impairments lead to barriers to social participation
5
Q
The bottom 50% of households own
approximately how much of the UK’s wealth?
- 5%
- 10%
- 25%
- 40%
- 50%
A
The bottom 50% of households own
approximately how much of the UK’s wealth?
- 5%
2. 10% - 25%
- 40%
- 50%
6
Q
Which of the items below is a key finding of
the Whitehall II study?
- Diet affects health outcomes
- Smoking affects health outcomes
- Social position affects health outcomes
- Genetics affect health outcomes
- Having a high demand job affects health outcomes
A
Which of the items below is a key finding of
the Whitehall II study?
- Diet affects health outcomes
- Smoking affects health outcomes
3. Social position affects health outcomes - Genetics affect health outcomes
- Having a high demand job affects health outcomes
7
Q
Which item below is a ‘social’ risk factor for
diabetes?
- Obesity
- Ethnicity
- Low level of physical activity
- Cardiovascular disease
- High fat diet
A
Which item below is a ‘social’ risk factor for
diabetes?
- Obesity
2. Ethnicity - Low level of physical activity
- Cardiovascular disease
- High fat diet
8
Q
In order to obtain valid consent for a biomedical
intervention the doctor must:
- Offer the patient adequate information
- Give the patient a detailed information sheet to
read - Check that the patient is over 18 years of age
- Have two witnesses present
A
In order to obtain valid consent for a biomedical
intervention the doctor must:
1. Offer the patient adequate information
2. Give the patient a detailed information sheet to
read
3. Check that the patient is over 18 years of age
4. Have two witnesses present
9
Q
Which one of the following is not recognized
as a level of society?
- The household
- The office
- The global village
- The nation state
- The community
A
Which one of the following is not recognized
as a level of society?
- The household
2. The office - The global village
- The nation state
- The community
10
Q
Social norms are:
- Creative activities such as gardening, cookery and craftwork
- The symbolic representation of social groups in mass media
- Religious beliefs about how the world ought to be
- Rules and expectations about interaction that regulate social life
A
Social norms are:
- Creative activities such as gardening, cookery and craftwork
- The symbolic representation of social groups in mass media
- Religious beliefs about how the world ought to be
4. Rules and expectations about interaction that regulate social life
11
Q
What type of data is:
* Short, medium, tall
* Black, blue, yellow
* Alive, dead
* 10 pencils
* Heights
A
Ordinal (qualitative)
Categorical nominal (qualitative)
Binary nominal (qualitative)
Discrete (quantitative)
Continuous (quantitative)
12
Q
What is the formula for standard deviation? [1]
A
Square root of an average of all the individual points’ (distances from the mean)2
13
Q
What measures of location and spread are used in a data contained in normal distribution? [2]
A
Mean and standard deviation
14
Q
What measures of location and spread are used in the presence of outliers in the data? [2]
A
Median and interquartile range [2]
15
Q
What change in standard deviation flattens the curve and what makes it taller and thinner? [2]
A
Flat: Increased SD
Tall and thin: Decreased SD
16
Q
How many standard deviations from the mean
(+ and -) is 90%, 95% and 99% of population contained? [3]
A
90%:1.64 SD
95%: 1.96 SD
99%: 2.58 SD
17
Q
How is standard error calculated and when is it used? [2]
A
SE = Standard deviation / sq root (sample size)
It is used as a standard deviation of the distribution of all possible sample means (used when dealing with sampling from the population)
18
Q
How is confidence interval calculated? What does 95% CI = 21.4 to 22.6 mean BMI? [2]
A
95% CI = sample mean =/- 1.96 x standard error
It means that we are 95% sure that in the population the mean BMI can be as low as 21.4 and as high as 22.6.
19
Q
What happens to CI if the sample size is increased? [1]
A
The confidence interval gets narrower
20
Q
Which variable in the linear regression equation indicates outcome and which is the predictor? [2]
A
Y – outcome
X – predictor
21
Q
What test is used to establish p-value while comparing two means? [1]
A
Two sample t-test
22
Q
What are different types of clinical trials? [3]
A
Uncontrolled – everyone gets treatment
Controlled – treated group (‘new treatment’) vs untreated group (placebo or ‘standard treatment’)
Randomized controlled – allocation to groups is determined by chance
23
Q
What are the commonstes triad of multi-morbidity conditions? [3]
A
Cardiometabolic (HTN / diabetes)
Joint pain
Mental health
24
Q
What are the benefits of randomized controlled trial? [1]
A
Avoids selection/allocation bias; make sure participants differ only by the treatment; ensures group receiving treatment is similar to control group
25
What are the types of randomized controlled trial? [4]
**Parallel group**: randomized indiv. Into one of the grps
**Crossover**: randomized treatment sequence – participants change the treatment half way through
**Cluster randomized trials:** randomized preexisting grps into one of the two treatments (schools, gp practices, villages)
**Factorial:** assess 2 interventions using the same number of patients as 1 intervention (25% gets both treatments, 25% A and placebo etc)
26
What are the types of blinding? [2]
**Single blind:** patients don’t know what treatment they’re getting
**Double blind:** both patients and observers (examining doctors) don’t know what treatment each patient is getting
27
What type of randomized controlled trail is used if the treatment is irreversible and which if it’s reversible? [2]
Irreversible: **parallel group**
Reversible: **crossover**
28
Name two disadvantages of crossover design? [2]
How can we compensate for one of them? [1]
**Time consuming**
**Carry-over effects**: **washout** period before second treatment
29
How long does it usually take for the drug to be developed (from preclinical to phase 4)?
12-18 years
30
What is the difference between intention-to-treat and on-treatment analyses? [2]
Which one is better and why? [2]
**TT**: compare all subjects in treatment group regardless of whether they complied and acc took the drug
**OT**: compare subjects who acc took the treatment
**ITT is better as it is a better representation of what would happen in real life**
31
When is relative risk statistically significant? [1]
When 95% CI for that relative risk **excludes 1**
32
What would be the relative risk if the treatment didn’t have any effect?
RR = 1
33
What is the type of diagram used in meta-analyses? [1]
**Forest plot**
34
What diagram is used to assess publication bias of meta-analyses?
**Funnel plot**
35
Give overview of a design of cohort studies? [3]
What is the main question of cohort studies? [1]
Identify cohort
Measure exposure
Follow up over time to identify whether they have disease or not
Is the disease more common in exposed or unexposed?
36
What are the sources of bias in the cohort studies? [2]
**Loss** (of people) **to follow-up**
**Measurement** of exposure at only **one point in time** (it can change very rapidly); selection of cohort
37
What are the disadvantages of cohort studies? [3]
Time consuming
Lot of people required
V expensive
38
How is relative risk measured in cohort studies? [1]
Incident of disease in exposed population / incidence of disease in unexposed population
39
What curve is used in survival analyses? [1]
What information does it provide? [1]
**Kaplan-Meier curve**; shows the proportion of people surviving over time
40
What is a hazard ratio? [1]
Risk of dying at any time point in one group compared to the other
41
How can the absolute excess risk be calculated? [1]
Risk in exposed – risk in unexposed
42
How is attributable proportion calculated? [1]
P(RR-1) / 1+p(RR-1) ; p= proportion exposed in population
43
What is the design of case-control studies? [3]
Identify those with disease **[cases]**
Measure exposure (from the past)
Identify those without disease **[controls]** and measure exposure (from the past)
44
What is the main question of case-control studies? [1]
Is exposure more common in cases than in controls?
45
What is undermatching and overmatching in case control studies [2]
**Undermatching** when the cases and controls are not similar enough
**Overmatching** is when they are too similar and may not differ in exposure of interest (siblings and parental smoking)
46
What study design is useful for biomarkers studies where biomarkers are v expensive to measure? [1]
**Nested case-control studies**
47
What is the design of a nested case-control study design? [4]
Identify cohort and take & store blood sample
Follow up over time and detect if have disease.
All people with disease are cases and those without disease are selected for controls.
Measure exposure in cases and controls from the biomarkers.
48
What does odds ratio represent in rare disease? How do you calculate it? [1]
Relative risk; odds exposure in cases/odds exposure in control
49
How do you calculate absolute excess risk? [1]
(Odds ratio x risk of disease) – risk of disease
50
What does cross-sectional study measure? [1]
Measure existing disease and current exposure
51
What exposure is useful when conducting the cross-sectional study? [1]
The exposure that doesn’t change (gender)
52
Which study design has the biggest risk of bias? [1]
Cross-sectional surveys [1]
53
What study design has the strongest proof of causality? [1]
Clinical trials
54
What study design has the bigger risk of confounding: cohort or case-control? [1]
Case-control studies
55
What study design would you use for rare disease? [1]
What study design would you use for rare exposure? [1]
Rare disease: case-control study
Rare exposure: cohort study
56
What is extreme poverty? [1]
Living on less than $1.25/ day
57
How many people in the UK live with chronic illness? [1]
15 million
58
What proportion of medical emergencies are exacerbation of chronic illness? [1]
2/3
59
State the definition of incidence [1] and prevalence [1]
**Incidence**: Number of new cases of the disease occurring within a period of time
**Prevalence**: Number of cases of the disease that are present in a particular population during a period of time/particular date
60
What is the main cause of disability in the UK? [1]
Arthritis
61
What is control theory used for? [1]
Management of chronic illness – focused on quality of life, setting goals, monitoring progress and identification of barriers
62
What is the difference between impairment and disability? [2]
**Impairment** indicates loss or difference of physiological function
**Disability** applies to loss or limitation of opportunities to take part in the society because of that impairment
63
What is trauma informed approach?
Organizational **structure** and **treatment framework** that involves **understanding**, **recognising** and **responding** to the **effects** of all types of **trauma** with the intention of **preventing a re-traumatisation** of the person occurring and potentially improving patient outcomes.
64
Describe health belief model [4]
Whether to take action or not is determined by health motivation:
- **Do I value health**
- **Cues to action** (what triggers to action are there)
- **Threat perception** (especially perceived susceptibility and severity of the problem)
- **perceived benefits and barriers or costs of behavior.**
65
What is Expert Patient Programme based on? [2]
Based on social cognition and social learning theory by Bandura:
* **increase confidence** by **setting** and **achieving** **goals**
* **improve quality of life** by helping patient feeling more in **control** of their **condition** – patients often experts of their condition
66
What is the most common presentation of a female affected by DVA?
**Gynecological problems** – most consistent, longest lasting, largest physical health difference; STIs, PV bleeding, painful intercourse, chronic pelvic pain and recurrent UTIs
67
What is Habitus? [1]
Non-conscious bulk of identity (embodied ID) and so conscious change may be challenging to achieve bc of habitus
68
Distinguish between identity consonance and identity dissonance [2]
**Consonance** – acquiring a new identity when it blends smoothly with other internalized personal identities
**Dissonance** – when one’s personal identities are dissonant with the professional role
69
What are the four rules of ethics? [4]
1. **AUTONOMY**: allowing other to make decisions and to act acc to their own wishes
2. **NON-MALEFICENCE:** above all do no harm
3. **BENEFICENCE** – acting for the good of individuals and society
4. **JUSTICE** – being fair
70
What is the Declaration of Helsinki?
Ethical principles for medical research involving human subjects – promotes and safeguard health, wellbeing and rights of research. It’s the duty of physicians who are involved in medical research to protect life, health, dignity, integrity, right to self-determination, privacy and confidentiality of personal info of research subjects
71
What are three models of stress? [3]
Which is the best? [1]
Stress as stimulus (**engineering**)
Stress as response as response (**medicophysioloical**)
Stress as transaction (**psychological**)
**transaction** between the person and the situation is **best understood**
72
What are the stages of the General Adaptation Syndrome [3] and who described it?
By Selye;
stage 1 – alarm
stage 2 – resistance
stage 3 – exhaustion
73
What are the differences between counselling and psychotherapy [2]
**Counselling** – explore emotional problems, supportive listening, current crisis, psychological issues, no diagnosable disorder
**Psychotherapy** – structured and systematic, exploring both past and current behavior, diagnosable disorder, different training for practitioners
74
What type of therapy is used for borderline personality disorder? [1]
Dialectical behavior therapy
75
Which type of psychotherapy is based on Freud’s theories? [1]
Psychodynamic therapy
76
What are the two explanatory models of human error? [2]
**PERSON APPROACH**: healthcare professional is responsible as error is caused by his/her forgetfulness, poor motivation, carelessness, inattention
**SYSTEMS APPROACH**: error is a consequence of an unworkable procedures, inadequate equipment, fatigue
77
What are heuristics? [1]
**Cognitive/decisional shortcuts** (rule of thumb/common sense/educated guess)
78
List 5 types of cognitive bias [5]
**Availability** (disease seen most recently = most likely)
**Representativeness** (diagnosis more likely if more similar to typical cases)
**Anchoring** (perceived probability of diagnosis based on one trait);
**Diagnosis momentum** (once labelled it’s hard to go back); **Fundamental attribution error** (tendency to blame ppl for their illness and sometime; commission bias (action rather than inaction)
79
What are the two adult stages of development? [2]
**Stage 7:** middle of adulthood, generalivity vs stagnation
**Stage 8**: late adulthood, integrity vs despair
80
What is true if the treatment is 5% and the placebo is 15%? [1]
10 people need to be treated to save 1.
81
The reference range for 95% STD is
mean ± 1.69 SDs
mean ± 1.96 SDs
mean ± 1.64 SDs
mean ± 1.94 SDs
mean ± 2.58 SDs
The reference range for 95% STD is
mean ± 1.69 SDs
**mean ± 1.96 SDs**
mean ± 1.64 SDs
mean ± 1.94 SDs
mean ± 2.58 SDs
82
The reference range for 90% STD is
mean ± 1.69 SDs
mean ± 1.96 SDs
mean ± 1.64 SDs
mean ± 1.94 SDs
mean ± 2.58 SDs
The reference range for 90% STD is
mean ± 1.69 SDs
mean ± 1.96 SDs
**mean ± 1.64 SDs**
mean ± 1.94 SDs
mean ± 2.58 SDs
83
The reference range for 99% STD is
mean ± 1.69 SDs
mean ± 1.96 SDs
mean ± 1.64 SDs
mean ± 1.94 SDs
mean ± 2.58 SDs
The reference range for 90% STD is
mean ± 1.69 SDs
mean ± 1.96 SDs
mean ± 1.64 SDs
mean ± 1.94 SDs
**mean ± 2.58 SDs**
84
What value is changing between the different colours in this Gaussain Distribution?
Standard error
Standard deviation
Mean
Median
Inter quartile range
**STD**
85
What value is changing between the different colours in this Gaussain Distribution?
Standard error
Standard deviation
Mean
Median
Inter quartile range
86
Normal distribution aka? [1]
Gaussian distribution
87
What does 95% STD actually mean? [1]
95% of all values are within 1.96 standard deviations of a mean value
88
What does 95% STD actually mean? [1]
95% of all values are within 1.96 standard deviations of a mean value
89
Which value do you use to calculate 95% confidence interval of a sample mean?
Standard error
Standard deviation
Median
Inter quartile range
Which value do you use to calculate 95% confidence interval of a sample mean?
**Standard error**
95% CI = sample mean ± 1.96 × standard error
90
What does this describe?
*a measure of the statistical accuracy of an estimate, equal to the standard deviation of the theoretical distribution of a large population of such estimates*.
Standard error
Median
Mean
Confidence interval
Inter quartile range
**Standard error**
91
Which of the following do you use to calculate CIs?
SE
STD
**SE** - (for mean values)
92
Which of the following do you use to calculate reference ranges?
SE
STD
**STD** - (for individual values)
93
Which of the following are used to calculate confidence intervals?
Standard deviation and individual values
Standard deviation and mean values
Standard error and individual values
Standard error and mean values
**Standard error and mean values**
94
Which of the following are used to calculate reference ranges?
Standard deviation and individual values
Standard deviation and mean values
Standard error and individual values
Standard error and mean values
Which of the following are used to calculate reference ranges?
**Standard deviation and individual values**
95
When do you use Pearson vs Spearman correlation? [2]
**Pearson correlation** evaluates the linear relationship between two continuous variables.
**Spearman correlation**: Spearman correlation evaluates the monotonic relationship.
96
Which regression model would you use for the following?
Exponential growth
Exponential decay
Sigmoid
Polynomial – quadratic
**Exponential growth**
97
Which regression model would you use for the following?
Exponential growth
Exponential decay
Sigmoid
Polynomial – quadratic
**Polynomial – quadratic**
98
Mann Whitney U test would be used if Gaussian distribution is not followed and for which type of test?
One sample T-test
Paired T-test
Two sample T-test
Equal variance T-test
Mann Whitney U test would be used if Gaussian distribution is not followed and instead of which type test
One sample T-test
Paired T-test
**Two sample T-test**
Equal variance T-test
99
Wilcoxon signed rank test would be used if Gaussian distribution is not followed and for which type of test?
One sample T-test
Paired T-test
Two sample T-test
Equal variance T-test
Wilcoxon signed rank test would be used if Gaussian distribution is not followed and for which type of test?
One sample T-test
**Paired T-test**
Two sample T-test
Equal variance T-test
100
Explain the difference in the following
One sample T-test
Paired T-test
Two sample T-test
**A one-sample t-test** is used to compare a single population to a standard value (for example, to determine whether the average lifespan of a specific town is different from the country average).
**A paired t-test** is used to compare a single population before and after some experimental intervention or at two different points in time (for example, measuring student performance on a test before and after being taught the material).
101
Which of the following uses same person as control
Parallel group randomised controlled trial
Cross over parallel group randomised controlled trial
Cluster randomised controlled trial
Cohort controlled trial
Which of the following uses same person as control
Parallel group randomised controlled trial
**Cross over parallel group randomised controlled trial**
Cluster randomised controlled trial
Cohort controlled trial
102
Which of the following is used when treatment is reversible
Parallel group randomised controlled trial
Cross over parallel group randomised controlled trial
Cluster randomised controlled trial
Cohort controlled trial
**Cross over parallel group randomised controlled trial**
103
Which of the following is used when treatment is irreversible
Parallel group randomised controlled trial
Cross over parallel group randomised controlled trial
Cluster randomised controlled trial
Cohort controlled trial
**Parallel group randomised controlled trial**
104
Investigating the efficacy of chemotherapy to treat cancer would best be studied using a
Parallel group randomised controlled trial
Cross over parallel group randomised controlled trial
Cluster randomised controlled trial
Cohort controlled trial
**Parallel group randomised controlled trial**
105
Which should be designed as a cluster randomised trial?
Trial of aspirin versus placebo to prevent pre-eclampsia
Trial of addition of flocculant disinfectant to drinking water in the prevention of diarrhoea
Trial of text message reminders versus standard care to improve drug adherence
**Trial of addition of flocculant disinfectant to drinking water in the prevention of diarrhoea**
106
What is control theory used for? [1]
**Management of chronic illness** – focused on quality of life, setting goals, monitoring progress and identification of barriers
107
What was suggested by Parsons about sick people within society? [1]
Society must manage sickness as sick people are views as deviant as they cannot contribute to the society in the same way healthy people can
108
What are the main stages in the Leventhal’s self-regulatory model of illness behavior? [1]
**Stage 1** – interpretation;
**Stage x** – emotional response and representation of health threat;
**Stage 2** – coping;
**Stage 3** – appraisal
109
Describe health belief model. [1]
Whether to take action or not is determined by **health motivation** (Do I value health), **cues to action** (what triggers to action are there) as well as **threat perception** (especially perceived susceptibility and severity of the problem) and **perceived benefits and barriers or costs of behavior**.
110
What is Expert Patient Programme based on? [1]
Based on social cognition and social learning theory by Bandura; increase confidence by setting and achieving goals, improve quality of life by helping patient feeling more in control of their condition – **patients often experts of their condition**
111
What is the most common presentation of a female affected by DVA? [1]
**Gynecological problems** – most consistent, longest lasting, largest physical health difference; STIs, PV bleeding, painful intercourse, chronic pelvic pain and recurrent UTIs
112
What is the Bem Sex Role Inventory (BSRI)? [1]
self-rating inventory of masculine, feminine, and neutral personality characteristics
113
What is CBT based on? [1]
Learning theory
114
Label A-C
A: parralel
B: cross over
C: factorial
115
Which type of trial provides the highest level of evidence
meta-analysis
cohort trial
case-control trial
randomised control trial
cross sectional trial
Which type of trial provides the highest level of evidence
**meta-analyse**
cohort trial
case-control trial
randomised control trial
cross sectional trial
116
Which type of trial provides the highest level of evidence
cohort trial
case-control trial
randomised control trial
cross sectional trial
Which type of trial provides the highest level of evidence
cohort trial
case-control trial
**randomised control trial**
cross sectional trial
117
Explain the following:
*NNT of 9 for treating sinusitis with antibiotics*
*NNT of 9 for treating sinusitis with antibiotics*
indicates that 9 patients need to be given anantibiotic to get one more patient better than would have improved without the antibiotics.
118
How can you tell if 95% CI difference for means [1] and for relative risk [1] are significant in a cohort study [2]
If 95% CI difference is means includes 0, result is not statisitically significant; if excludes 0 then is sig.
If 95% CI difference is relative risk includes 1, result is not statisitically significant; if excludes 1 then is sig.
119
Reverse causality is a problem in
cohort trial
case-control trial
randomised control trial
cross sectional trial
**case-control trial**
120
I want to investigate a risk factor for a rare disease. Which should you use?
cohort trial
case-control trial
randomised control trial
cross sectional trial
**case-control trial**
121
I want to investigate if a rare exposure is associated with a disease ? Which should I use and why?
cohort trial
case-control trial
randomised control trial
cross sectional trial
**cohort trial**: are particularly advantageous for examining rare exposures because subjects are selected by their exposure status
122
Odds ratios are used instead of relative risk in which type of trial
cohort trial
case-control trial
randomised control trial
cross sectional trial
case-control trial
123
Does exposure to blue asbestos cause lung cancer - What study should you do?
Case-control
Cohort
Clinical trial
Cross-sectional survey
Cohort: rare exposure
124
Is prevalence of back pain more common in men or women ?
Case-control
Cohort
Clinical trial
Cross-sectional survey
Cross-sectional survey
125
Place the following in order of most to least likely to have bias
Case-control
Cohort
Clinical trial
Cross-sectional survey
126
Place the following in order of most to least likely to have a risk of confounding factors
Case-control
Cohort
Clinical trial
Cross-sectional survey
127
What is What is Fundamental Attribution Error? [1]
**The tendency to blame people for their illness rather than the circumstances**
This occurs particularly for psychiatric patients, minorities, those with substance abuse issues and other marginalised groups
128
Describe the Rockford score [1]
When was it used? [1]
An assessment of friality ; During COVID to determine if should be treated in HDU
129
In a randomised controlled trial of preventive PCI versus infarct artery only PCI in patients with ST elevated myocardial infarction, 10% of patients randomised to receive preventive PCI died, and 30% of patients randomised to receive infarct artery only PCI died.
Calculate the number needed to treat (NNT) with preventive PCI to prevent one death. Show your calculations. [1]
Absolute difference in risk = 30%-10%=20%
NNT = 100/20= 5
130
Explain the design of a nested case-control study of a blood-based biomarker and a disease. [4]
A **cohort** is identified and all have a **blood sample taken and stored** (1 mark).
The cohort is **followed** up over time and at the end of follow-up all people with the **disease are the cases** (1 mark).
For each **case** at least one **member** of the cohort **without the disease** is **selected** as a control (1 mark).
**Blood** **samples** for the **cases and controls are retrieved**, the **biomarker** **measured** and the association between the **biomarker and disease is determined** (1 mark).
131
Lifestyle behaviours are a major focus of public health campaigns.
Name THREE theories of health behaviour change. [3]
Health Belief Model (1 mark)
Theory of Planned Behaviour (1 mark)
Transtheoretical model (Stages of Change) (1 mark)
Social Cognitive Theory (1 mark)
Leventhal's Self-regulatory theory (1 mark)
Michie's Behaviour Change Wheel (1 mark)
132
The Marmot Report 2020 describes how health inequities have increased over the last ten years.
Which group of people have shown a recent decline in life expectancy?
Women [1] in deprived areas [1]
133
There is an increasing awareness of the role that trauma may play in worsening health outcomes for those at risk.
What is Trauma Informed Care (TIC)? [1]
The prevention (1/2 mark) of re-traumatization (1/2 mark) of patients by the healthcare system.
134
In Tower Hamlets and Newham, there are inequalities in mental health service provision and reports of adverse mental health experiences by people of Black, Asian and Minority Ethnic groups. Structural racism is thought to be driving these inequalities.
Give TWO examples of structural racism.
Compulsory admission and treatment (1/2 mark)
Sectioning or detention (1/2 mark)
Subjection to forcible treatment, seclusion or restraint (1/2 mark)
Exclusion and marginalisation by society (1/2 mark)
The way institutions replicate the power dynamics in broader society (1 mark)
135
If a variable follows a Gaussian distribution then how many standard deviations either side of the mean would we expect 95% of values to lie? [1]
1.96
Tick(+-1.96, 1.96, 1.96 sd, 1.96 standard deviations, ± 1.96)
136
A randomised placebo controlled trial of a new treatment showed that the risk of death in the new treatment group was 5% and the risk of death in the placebo group was 10%.
What is the number needed to treat with the new treatment to prevent one death?
20
Tick (20 people, 20, 20%)
137
What do A & B represent on this forest plot? [2]
A: Result of study
B: 95% CI of result
138
How do you determine the size of a study from a forest plot? [1]
This black box also gives a representation of the size of the study. The bigger the box, the more participants in the study.
139
What does the diamond represent on the forest plot? [1]
The diamond represents the **point estimate and confidence intervals when you combine and average all the individual studies together**.
140
Describe the differences in horizontal and box size in forest plots in samll versus big studies [2]
The **bigger the study**, the **smaller the horizontal line and bigger the black box representing the point estimate**.
The **smaller the study**, the **wider the horizontal line and smaller the black box** representing the point estimate.
141
What does the line of null effect represent on a forest plot? [1]
his line is placed at the value where (as the title suggests) there is no association between an exposure and outcome or no difference between two interventions.
142
What is the difference in null difference value for OR & RR compared to absolute stastistics like Absolute risk
**OR or RR** have a null **effect value of 1**.
For absolute statistics like Absolute Risk or ARR or SMD, the **null difference value is 0.**
143
# Forest plots
Compare study A & B [2]
**For study A**- it has quite a wide horizontal line that crosses the line of null effect with a black box that is to the right of the vertical line. This most likely demonstrates a small scale study with few participants where the point estimate result favours the control used in the study. But because the study contains the null value in its 95% confidence interval, it is likely to have a p value >0.05 and not be statistically significant.
**For study B**- it has quite a narrow line that does not cross the line of null effect with a black box that is to the left of the vertical line and is bigger than study A. This most likely demonstrates a larger study with more participants compared to study A, where the result favours the intervention used. Because the 95% confidence interval does not contain the null value, this study is likely to have a p value <0.05 and hence the differences observed in the study can be regarded as statistically significant.
144
The forest plot shows the results of randomised trials of aspirin versus placebo in the prevention of preeclampsia.
Which was the biggest trial?
**Ebrashy**: has the biggest box
145
.Measures of inequality are important to track patterns and trends in ill-health in order to prioritise service provision.
Please show your understanding of these issues by labelling the following graph.
Use the following labels:
*Healthy life expectnacy, multi morbidities percentile, race, gender, healthcare access, neighbourhood deprivation percentiges*
146
Complete the labelling of sources of behaviour in Michie's Behaviour Change wheel that are missing in the green area
Use the following: *motivation, opportuinity, capability*
147
148
Describe the probability of surviving 11months in group A v B [2]
For example, if you are in Group 1, your probability of surviving 11 months is 100%; conversely, if you are in Group 2, your probability of surviving the same time is slightly more than 66.7%. It is obvious that the steepness of the curve is determined by the survival durations (length of horizontal lines).
149
Label A&C of this funnel plot [2]
A: **95% CI**
B: Study precision
C: **Overall effect**
D: Study result
150
Describe the results of this funnel plot [1]
Asymmetrical: **indicates bias**
151
What study types is this graph often used in?
A. Cohort study
B. Case control study
C. Clinical trial
D. Cross-sectional survey
**A. Cohort study**
B. Case control study
C. Clinical trial
D. Cross-sectional survey
Kaplan-Meier curves
Plot proportion of people surviving over time
Compared using a log rank test
Used in cohort studies and randomized trials.
152
What happens to the confidence interval as sample size increases?
A. Doubles
B. Stays the same
C. Gets bigger
D. Gets narrower
**D. Gets narrower**
If the sample size increases, the 95% confidence range stays the same;
however the 95% confidence interval gets narrow since the standard error decreases if the sample size is larger
153
There are different types of analysis used within statistics. What is a t-test used to compare?
A – Medians of a continuous variable between 2 groups
B – Proportions of a binary variable between 2 groups
C – Proportions of binary variable within one group, measured at 2 time points
D – Standard deviations of a continuous variable between 2 groups
E – Means of a continuous variable between 2 groups
There are different types of analysis used within statistics. What is a t-test used to compare?
A – Medians of a continuous variable between 2 groups
B – Proportions of a binary variable between 2 groups
C – Proportions of binary variable within one group, measured at 2 time points
D – Standard deviations of a continuous variable between 2 groups
**E – Means of a continuous variable between 2 group**s
154
Which of the following best describes ‘measure of a statistical accuracy of an estimate’
Standard deviation
Confidence interval
Standard error
Median
Standard error
155
Which one of these is not in the Bradford Hill Criteria for Causation?
Biological plausibility
Dose response
Strength of association
Reverse causality
Which one of these is not in the Bradford Hill Criteria for Causation?
Biological plausibility
Dose response
Strength of association
**Reverse causality**
156
This trial demonstrates a
case-control study
cohort study
factorial study
cross sectional study
**case-control study**
157
This trial demonstrates a
case-control study
cohort study
factorial study
cross sectional study
**cohort study**
158
Why are case control studies useful for general population? [1]
Because **RR & OR are generally robust to different populations** - to everyone who might or might not smoke.
159
One-half of a person’s ability to recover from illness is determined by **[]** factors? [1]
One-half of a person’s ability to recover from illness is determined by **socioeconomic** factors
160
This schematic represents which of the following
Transtheoretical Model (Stages of Change)
Theory of Planned Behaviour
Health Belief Model
Social Cognitive Theory
**Health Belief Model**
161
This schematic represents which of the following
Transtheoretical Model (Stages of Change)
Theory of Planned Behaviour
Health Belief Model
Social Cognitive Theory
**Theory of Planned Behaviour**
162
What is Yentl Syndrome? [1]
A phenomenon where if a woman’s symptoms don’t conform to those of men, they are often misdiagnosed and poorly treated (Criado-Perez, 2019)
163
A study was based on volunteers. Of the three main types of systematic errors
in public health research, what type of bias is most typically associated with the use
of volunteers?
information bias
selection bias
confounding bias
random error
A study was based on volunteers. Of the three main types of systematic errors
in public health research, what type of bias is most typically associated with the use
of volunteers?
information bias
**selection bias**
confounding bias
random error
164
A study was based on self-reported data. Of the three main types of
systematic errors, which is typically associated with self-reporting?
information bias
selection bias
confounding bias
random error
**information bias**
165
Confidence intervals are a good way to deal with
information bias
selection bias
confounding bias
random error
**random error**
166
P-values are a good way to deal with
information bias
selection bias
confounding bias
random error
**random error**
167
*Objective*
*To assess the impact of breast feeding on the risk of being overweight in children at the time of entry to school*
*Methods*
*A group of overweight children were identified when they started school and the same number of normal weight children at the same school were identified.
Their mothers were asked about breastfeeding*
Which of the following best describes this trial?
case-control study
cohort study
factorial study
cross sectional study
**case-control study**
168
*Objective*
*To assess the impact of breast feeding on the risk of being overweight in children at the time of entry to school.*
*Methods*
*Mothers asked about breast feeding shortly after delivery and at 6 months.
At 5 years children were assessed physically.*
Which of the following best describes this trial?
case-control study
cohort study
factorial study
cross sectional study
**cohort study**
169
Interpret this result:
*After adjusting for age, sex and tumour stage the Hazard Ratio for exercisers vs non-exercisers = 0.73*
People who exercised prior to developing colorectal cancer had a 27% lower risk of mortality than non-exercisers at any time during follow-up
170
If want to investigate a study quickly?
case-control study
cohort study
factorial study
cross sectional study
**case-control study**
171
Recall bias is a problem in these studies
case-control study
cohort study
factorial study
cross sectional study
**case-control study**
172
Which of the following can you not calculate risk in?
case-control study
cohort study
factorial study
cross sectional study
Which of the following can you not calculate risk in?
**case-control study**
Can’t use relative risk as do not know risk of the disease (as you have started with cases with the disease)
173
Which of the following woudl you calucate an odds ratio and not a relative risk in?
case-control study
cohort study
factorial study
cross sectional study
Which of the following woudl you calucate an odds ratio and not a relative risk in?
**case-control study**
Can’t use relative risk as do not know risk of the disease (as you have started with cases with the disease)
174
A non-randomised study looking at the association between preventive percutaneous coronary intervention (PCI) versus infarct artery only PCI in patients with ST elevated myocardial infarction was carried out. It found that in 280 patients receiving preventive PCI, 80 died after 5 years of follow-up. Of 120 patients receiving infarct artery only PCI 20 died after 5 years of follow-up.
Calculate the odds ratio of death in the preventive PCI group compared with the infarct artery only PCI group. Show your calculations.
PPCI (case): total =280; died = 80
IPCI (control): total = 120; died = 20
Odds of preventive PCI in patients that died = 80/20 = 4
Odds of preventive PCI in those that did not die = 200/100 = 2
Odds ratio = 4/2 = 2
175
State the reason for association
Randomised placebo controlled trial of candsartan in patients with chronic heart failure found it increased risk; RR = 1.6 (95% CI 1.1-2.2)
Recall bias
Reverse Causality
Chance
Confounding
Selection bias
**chance**
176
State the reason for association
A case control study of stomach cancer patients found that they had a higher antacid usage in the 6 months prior to diagnosis than did the controls.
Recall bias
Reverse Causality
Chance
Confounding
Selection bias
**Reverse Causality**
People with undiagnosed stomach cancer tend to have the same symptoms for which antacids are taken
177
State the reason for association
In a cohort study heavy drinkers were found to be more likely to develop lung cancer. Does drinking cause lung cancer ?
Recall bias
Reverse Causality
Chance
Confounding
Selection bias
**Confounding**
Heavy smokers are more likely to be heavy drinkers.
Smoking causes lung cancer
178
State the reason for association
A case control study of patient’s with Chron’s disease showed that they were much more likely to have reported ever eating Corn flakes.
Recall bias
Reverse Causality
Chance
Confounding
Selection bias
**Recall bias**
Those with Chron’s disease more likely to remember everything they ate. Most people have eaten corn flakes at some time.
179
State the reason for association
Non-randomised studies have shown an increased risk of death in preventive (multivessel) percutaneous coronary intervention versus infarct artery only PCI in patients with STEMI
Recall bias
Reverse Causality
Chance
Confounding
Selection bias
**Selection bias**
Patients who had preventive PCI more likely to be sicker
Randomised controlled trials have shown the benefit of preventive PCI
