Lecture 1B part 2

Question 1

Why did infections decline in the 20th century?

Answer 1

Improvements in social conditions
Improved nutrition
Improved sanitation
Improved housing
Lifestyle changes
Improved working conditions

Question 2

What were other contributing factors to declining infections?

Answer 2

Abx (1940s)
Vaccines (1950s)
Medical interventions

Question 3

Who put on the streptomycin TB trial of 1946?

Answer 3

British Medical Research Council
Designed by Sir Austin Bradford Hill

Question 4

What is the significance of the streptomycin TB trial of 1946?

Answer 4

Controlled clinical trial - one of the first modern experimental studies
Randomization of pts (streptomycin/control grps; 55 treated with bed rest and streptomycin, 52 treated with bed rest alone)
Restrictions on the type of pts eligible for the trial
Data collection methods designed to reduce bias
Consideration of ethical issues involved in conducting the trial
Blinding was used

Question 5

What did Richard Doll and Austin Bradford Hill do in collaboration?

Answer 5

Conducted series of studies on lung cancer in the 1950s

Question 6

In the 1950s what shift occurred?

Answer 6

Infectious dz to chronic dz

Question 7

Aspects of the first study by Doll and Bradford Hill

Answer 7

Retrospective case-control study
709 subjects had either lung CA (cases) and 709 had dzs other than CA (controls)

Question 8

What was the conclusion of the first Doll and Bradford Hill study?

Answer 8

“Smoking is an important factor in the cause of lung CA”

Question 9

Aspects of the second Doll and Bradford Hill study

Answer 9

Prospective cohort study initiated in 1951
59,600 male and female members of the British Medical Association
Followed for the next 50 yrs, observed increased death rates among smokers

Question 10

What type of study is the Framingham Heart Study from 1947, and who started it?

Answer 10

Large cohort study started by Dawber and Kannel

Question 11

What was the initial goal of the Framingham Heart Study?

Answer 11

ID latent CV dz among healthy volunteers (5,000)

Question 12

How did the Framingham Heart Study expand?

Answer 12

To determine the causes of CVD and eventually a wide variety of other conditions

Question 13

What did participants of the Framingham Heart Study undergo?

Answer 13

Series of interviews
Physical exams
Lab tests
every 2 yrs

Question 14

Characteristics of modern epidemiology (1970s to today)

Answer 14

Further refinements in study designs/methods
Development of new dz causation models
Increased emphasis on role of bias, confounding, and interactions
Statistical and computing advances
-Handling and analysis of large data sets and multiple risk factors
Focus on health determinants
-Social and biological level
-Molecular/genetic level

Question 15

Analytic approach of sanitary stats era

Answer 15

Demonstrate clustering of morbidity and mortality

Question 16

Preventive approach of the sanitary statistics era

Answer 16

Drainage
Sewage
Sanitation

Question 17

Analytic approach of the infectious dz epi era

Answer 17

Laboratory isolation and culture from dz sites
Experimental transmission
Reproduction of lesions

Question 18

Preventive approach of ID epi

Answer 18

Interrupt transmission (vaccines, isolation of the affected through quarantine and fever hospitals, and ultimately abx)

Question 19

Analytic approach to chronic dz epi era

Answer 19

Risk ratio of exposure to outcome at individual level in pops

Question 20

Preventive approach to chronic dz epi era

Answer 20

Control risk factors by modifying lifestyle (diet, exercise, etc) or agent (guns, food, etc.) or environment (pollution, passive smoking, etc.)

Question 21

Purpose of epidemiological theoretical frameworks

Answer 21

Frame etiologic questions

Question 22

Purpose of causal theories

Answer 22

Form the basis of mathematical models for dz causation

Question 23

Purpose of theories of error (bias)

Answer 23

Guide study design, analysis, and interpretation

Question 24

What are the 3 prevailing modern theoretical frameworks of epidemiology?

Answer 24

Biomedical individualism
Lifestyle/psychosocial
Ecosocial (or social production of dz)

Question 25

Definition of biomedical individualism framework

Answer 25

Explains the occurrence of dz in terms of biologic processes
-How do humans, as biological organisms, become ill?

Question 26

What does the biomedical individualism framework emphasize?

Answer 26

Biologic determinants of dz amenable to intervention through the HC system
-View pops as simply the sum of individuals
-Considers social determinants of dz to be at best secondary

Question 27

What is the solution according to the biomedical individualism model to prevent and treat dzs?

Answer 27

Medical interventions
-Interventions are usually tx-based/medical svcs