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3F Epidemiology FINAL > Landmark Epidemiological Studies > Flashcards

Landmark Epidemiological Studies Flashcards

1
Q

Framingham HEart Study

A

Originated to address non-infectious problems

-1940s-1950s cardiovascular disease became more prevalent

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2
Q

What kind of study is Framingham Heart study

A

Prospective cohort study

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3
Q

The study population in Framingham heart study

A

5200 persons between 30-52 WITHOUT cardiovascular disease were examined and potential risk factors recorded

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4
Q

Later on in the Framingham Heart study

A
  • children and spouses were also given similar evaluation

- later on, an OMNI COHORT, reflected more diverse population

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5
Q

The Framingham heart study has produced _______ in leading medical journals

A

1200 articles

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6
Q

Generates in Framingham

A

3rd generation-grandchildren of original cohort

2nd group of Omni participants

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7
Q

Much of what we know about _____ come from Framingham

A

Risk factors for CVD

  • HTN, cholesterol, HDL/LDL, trigs, smoking, DM, physical inactivity
  • age, gender, psychosocial factors
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8
Q

Framingham Heart study: relative risk for CHD for individual risk factors

A

Smoking had a greater relative risk for CHD

All between 1 and 2x relative risk

Measure of incidence

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9
Q

Framingham HEart Study: multiple risk factors

A

The more risk factors you have, the greater the odds of CHD

If you have all of the risk factors, you have a 14x odds ratio of having CHD

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10
Q

HDL and LDL: Framingham

A

The lowest risk

  • least LDL and the highest HDL
  • RR is less than 1, its protective

Highest risk

  • lowest HDL and highest LDL
  • RR is 3
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11
Q

Framingham: DM and CHD

A

Among men and women, the number of deaths from CHD among diabetics was much higher

  • men: 2x deaths in DM
  • women: 4x as many deaths in DM

DM is a risk factor death and directly related to CHD

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12
Q

Framingham Eye Study

A

2600 of the 4000 still living members 52-85 were given eye exam and looked at PREVALENCE of eye diseases in this population
-gave us some info on the conditions on this cohort

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13
Q

Framingham and dementia

A
  • although PREVALENCE is increasing due to longer living, INCIDENCE was found to have decreased. This is consistent with other recent studies
  • looked at 4 EPOCHS
  • incidence increasingly DECLINED in each epoch compared to baseline
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14
Q

Framingham and dementia: caveat

A
  • decrease in incidence of dementia was only seen in individuals with at least a high school diploma
  • the reduction in cardiovascular risk factors (except diabetes and obesity) may explain some, not all of the results
  • stable or decreased incidence of dementia has been noted in OTHER PARTS OF THE WORLD. Reason-improvements in living conditions, health care, eduction
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15
Q

BEaver Dam health outcomes study

A
  • PROSPECTIVE COHORT STUDY of health status and health related quality of life in adults
  • random sample of adults, inital age range 45-89; mean 64
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16
Q

BEaver dam eye study

A
  • examined PREVALENCE AND INCIDENCE of AMD, cataract, DR, glaucoma and other eye diseases
  • 5000 people had baseline exams in early 90s
  • 5,10,15,20, and now 25 year follow up
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17
Q

Publications from beaver dam eye study

A

360

18
Q

Modifiable risk factors and Disease: beaver dam eye study

A

Doing link between modifiable risk factors and disease

  • cigarette smoking and both cataracts and AMD
  • lutein intake and lower risk of cataract

Systems developed to photograph cataracts and AMD, including a standardized scale

19
Q

Beaver dam and drusen

A

-connection between retinal drusen and RPE loss with progression to late stage AMD

Currently studying incidence of AMD in relation to

  • modifiable risk factors
  • glycooxidative stress
  • inflammation
  • atherosclerosis
20
Q

Nurses health study

A
  • ongoing PROSPECTIVE COHORT STUDY began in 70s-cardiovascular disease, cancer, DM, women’s health, lifestyle
  • RNs were selected to be followed prospectively
  • inital phase-122,000 nurses
  • every two years, follow up exam AND QUESTIONNAIRE FOR HEALTH RELATED TOPICS including smoking, hormone use, menopausal status, diet
21
Q

Women and physical activity: nurse study

A

The more physical activity women have, the less RR for DR

As physical activity increases, RR decreases
Physical activity is protective against DM, RR is below 0

22
Q

Baltimore eye survey

A
  • CROSS SECTIONAL study conducted from 1985-1988, residents of east Baltimore
  • 40+ age
  • 2400 BLACK, 2900 WHITE
  • all received glaucoma testing: tonometry, VF, stereo disc photography
  • first large-scale study to employ MODERN DIAGNOSTIC TECHNIQUES for glaucoma
23
Q

Firs large scale study to employing modern diagnostic techniques for glaucoma

A

Baltimore eye survey

24
Q

Baltimore eye study findings

A
  • risk factors for glaucoma looked at-race, age, IOP, HTN, DM (not a risk factor), family Hx
  • prevalence rates for POAG were 4-5X HIGHER IN BLACKS as compared with whites

Over the age of 80, blacks had 11% increase in POAG. It increases in whites but not nearly as much as in whites

Blacks had 2x prevalence of BLINDNESS AND VISUAL IMPAIRMENT than whites

25
Q

Baltimore eye surgery and sex

A

No differences in sex

26
Q

Blue mountains eye study

A
  • CROSS SECTIONAL/COHORT STUDY of causes of age related vision loss conducted in 2 urban areas of Blue mountains region, near SYdney, Australia.
  • WENT DOOR TO DOOR and gave eye exams
  • 49-97
  • 3600 participants
27
Q

Blue mountains study and AMD/drusen

A
  • smaller the drusen, the less severe it is (no Association with AMD) <63um
  • RR 3 for those with drusen >63um (3x risk)
  • > 125um

Soft drusen: none=no risk
Distinct soft RR 4.6
Indistinct or reticular is more risky

Location: <63um to 250um, higher risk of AMD
Closer to the fovea center=risk much higher (over 11%). As you get right close to the fovea, it actually drops a little some reason

Hyperpigmentation: no=no risk, no association, If present=RR 8x the risk

28
Q

LA Latino Eye Study (LALES)

A
  • POPULATION BASED ON CRESS SECTIONAL/COHORT STUDY
  • lived in and around LA county
  • average age 55
  • 80% MEXICAN origina
  • baseline exam phase 200-2003, follow ups 2004-2008
29
Q

LALES outcomes

A
  • primary: PREVALENCE of visual impairment, blindness, cataract, glaucoma, DR, AMD
  • secondary: RISK FACTORS assocaited with eye disease, health related quality of life and vision related quality of life
30
Q

Prevalence of types of DR among diabetics in LALES

A

As the patient has had diabetes longer, the prevelance of any type of DR climbs
-DM over 15 years, DR prevalence is almost 80% in Latinos

The long you have DM, the more likely you are to have DR

31
Q

Mild NPDR and length of time with DM

A

Peaks at 5-9 years with DM, and then declines with duration of DM for some reason

32
Q

Orinda study: school screening

A
  • kids

- 1950s

33
Q

Goal of the Orinda study

A
  • the design the least expensive, least technical and most effective SCREENING PROGRAM for finding essentially all elementary school children with vision problems
  • study WORKED BACKWARDS-did a comprehensive eye exam to identify chidlren who needed professional attention, then evaluated 6 SCREENING PROTOCOLS that would best pick them up
34
Q

Most effective technique of the Orinda study

A
  • MODIFIED CLINICAL TECHNIQUE (MCT)
  • distance and near VA
  • distance and near CT
  • ret with lens rack
  • direct ophthalmoscope
35
Q

Referral for VA: Orinda

A

20/40 or worse

36
Q

Ret cut off for referral: orinda

A

+1.50 or more
-0.50 or more myopia
+/-1.00 DC ore mor eastigmatism
+/-1.00 anisometropia

37
Q

Distance CT referral: CT

A

Any tropia
5 EP
5XP
2 hyper

38
Q

Near CT referral orinda

A

Any tropia
6 EP
10 XP
2 hyper

39
Q

MCT results: orinda

A

96% sensitivity

98% specificity

40
Q

Other important findings of Orinda

A
  • incidence of vision problems increases at rate of 1.6%/year
  • ages 5-7, 18% had vision problems
  • ages 13-15, 31% had vision problems
41
Q

Importance of Orinda study

A
  • performed by INTERDISCIPLINARY TEAM; ODs, OMD, stats, school psychologists, parents, teachers
  • those who had previous eye care more likely to be easily managed at follow up, even if they still failed the screening
  • MCT most economical screening programs INCLUDING COST OF NEEDING OD, WHEN TAKING INTO ACCOUNT COSTS TO THE COMMUNITY FOR OVER REFERRALS
42
Q

Criticisms of the orinda study

A
  • generalizability
  • MCT reliance on professionals
  • not diverse
  • limited evaluation of visual skills related to school performance
  • other studies have replaced it. Vision in preschoolers (VIP) study. Designed to identify high refractive error, strab in younger kids

3F Epidemiology FINAL (5 decks)

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