I&P 1

Question 1

(cause in epidemiology) What is a Necessary cause?

Answer 1

Presence is required for the occurrence of the event. (cant have disease without exposure, but exposure doesn’t always lead to outcome)

Question 2

(cause in epidemiology) What is a Sufficient cause?

Answer 2

A factor whose presence leads to an effect (other exposures may also induce the same outcome)

Question 3

What are inequalities in health?

Answer 3

Variation in health status, life expectancy, mortality & morbidity between different groups. They are systemic differences in healththat are judged to be avoidable by reasonable action.

Question 4

What are some key health-related demographic events and processes?

Answer 4

Birth, marriage, migration, aging and death.

Question 5

To calculate birth or fertility rate, why is mid-year population used?

Answer 5

Because populations are constantly increasing, so mid-year is approximately average.

Question 6

What is period life expectancy?

Answer 6

At a given age for an area is the average age a person would live.

Question 7

What is cohort life expectancy?

Answer 7

Life expectancy calculated using age-specific mortality rates that allow for projected changes in mortality in later years.

Question 8

In population pyramids, what does it look like for:

a) Rapidly growing population
b) Slowly growing population

Answer 8

a) Widening base and narrowing middle/top

b) Bands at base narrower than those in middle due to lower fertility rate

Question 9

What is the natural increase?

Answer 9

The difference between the birth and death rate (demographic transition)

Question 10

What are the 4 stages of demographic transition?

Answer 10

Stage 1: Birth rates and death rates high (population size stable)
Stage 2: death rates fall as improvements in society, birth rates still high. (population grows)
Stage 3: birth rates fall (land shortages, education for women, family planning), population grows but at a declining rate.
Stage 4: birth rate joins death rate at a stable low rate (population size stable)

Question 11

What is sex ratio?

Answer 11

Number of males per 100 females born

Question 12

What is Maslow’s Hierarchy of Need?

Answer 12

• Physiological (breathing, water, sleep etc)
• Safety (security of employment, family, property)
• Love/Belonging (friends, family)
• Esteem (confidence, respect of and by others)
• Self-actualization (morality, creativity, problem solving etc)

Question 13

(need, supply & demand)

Example of Need but no demand or supply?

Answer 13

Family planning & contraceptive services in many low income countries

Question 14

(need, supply & demand) Example of Demand but no need or supply?

Answer 14

Patients demanding expectorants for coughs & colds

Question 15

(need, supply & demand) Example of Supply but no need or demand?

Answer 15

Routine health checks for over 75 year olds

Question 16

(need, supply and demand) Example of Need and demand but no supply?

Answer 16

Help programmes for substance misuse

Question 17

(need, supply and demand) Example of need, supply & demand?

Answer 17

People with insulin-dependent diabetes demand insulin, it is effective (need) and it is supplied.

Question 18

What are 3 types of health needs assessment?

Answer 18

1) Epidemiological (measure health status of population and evaluate means of addressing identified health problems)
2) Comparative (compare with service provision in similar populations)
3) Corporate (ask experts)

Question 19

What are some methods for recording evidence of population health?
(gets better as you go down list)

Answer 19

• Anecdotes and case series
• Cross Sectional survey
• Counterfactual method
• Ecological studies
• Case-control study
• Cohort study

Question 20

What are some pros and cons of Cross-sectional surveys?

Answer 20

(count number of people with a disease in a short time period in a pre-defined population)
Pros: quick, good at estimating PREVALENCE
Cons: cannot estimate INCIDENCE, only represents that point in time

Question 21

Difference between PREVALENCE and INCIDENCE?

Answer 21

Prevalence= cases of disease that are present in the group
Incidence= new cases of disease

Question 22

How can one measure incidence?

Answer 22

A register is commonly used. Records new cases in a pre-specified population

Question 23

How can incidence be decreased in a population?

Answer 23

By prevention of the disease. If a non-infectious disease could suddenly be cured, then incidence would stay the same.

Question 24

Pros and cons of Ecological studies?

OBSERVES groups of people- not individuals

Answer 24

Pros: cheaper, less bias, provides new potential risk factors
Cons: ecological fallacy (do population-level measures hold for the individual?), lots of assumptions.

Question 25

What is a cohort?

Answer 25

People who share a common experience or condition, birth cohort, smokers.

Question 26

Pros and cons for a cohort study?

followed through time for the outcome- looking at who is exposed or not

Answer 26

Pros: direct measurement of incidence, can look at multiple outcomes.
Cons: Inefficient for rare diseases, expensive.

Question 27

What is a randomised controlled trial?

Answer 27

(strongest epidemiology method if done correctly- gold standard)
Randomise study population to assign people to treatment group or control group
Follow groups through time & then look at rate of outcome for both

Question 28

What are the different kinds of blinding?

Answer 28

• Patient doesnt know if they are having treatment or not
• Clinician doesnt know what the patient is having
• Analyst doesn’t know what drug A or B is

Question 29

What are some potential sources of error?

Answer 29

Study design
Sample collection
Lab analysis
Data analysis/ management/ collection

Question 30

What are the 3 categories of prevention?

Answer 30

Primary – preventing the onset of the disease, e.g. behaviour/ environment >immunisation
Secondary – halt progression once started, e.g. early diagnosis/ screening
Tertiary – limit disability and complications in established disease (long term), e.g. rehabilitation

Question 31

What is Geoffrey Rose’s single population theory?

Answer 31

1) Population-wide prevention

2) Target high-risk subjects

Question 32

What is Derek Wanless ‘Securing our future health’ 2002?

Answer 32

An economic analysis on burden of ill health (imbalance between national sickness service to national health service)
Must be a realignment of incentives therefore.

Question 33

What is lead time bias?

Answer 33

Early diagnosis falsely appears to prolong survival (only identifies disease early rather than increasing survival)

Question 34

What is length time bias?

Answer 34

Screening over-represents less aggressive disease (as people with more aggressive disease may be missed- maybe through death). And so makes screening look better.

Question 35

What are some of the Wilson and Jungner principles of screening for a disease?

Answer 35

• The condition sought should be an important problem
• There should be an acceptable treatment for patients with the recognised disease
• There should be a suitable test for it
• The cost of case-finding should be economically balanced in relation to the possible expenditure

Question 36

The main causes of childhood mortality?

Answer 36

Pneumonia (18%), preterm complications (14%), diarrhoeal diseases (11%), intrapartum related complications (9%) and malaria (7%).

Question 37

What 3 strategies did the Ottawa Charter identify for health promotion? (‘the process of enabling people to increase control over and to improve their health)

Answer 37

o Advocating for health (to create the essential conditions for health)
o Enabling people to achieve their full health potential
o Mediating between the different interests in society [in pursuit of health]

Question 38

What are the 4 health promotion disciplines?

Answer 38

1) Fiscal (tax or subsidy, making healthy things relatively cheap)
2) Legislative (making participation in some unhealthy or risky activities illegal)
3) Service provision
4) Education