Lesson 4 Flashcards

1
Q

What are some interchangeable terms for S.E.P?

A

Social class, social stratification, socio-economic background, socio-economic status (SES)

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2
Q

What is S.E.P?

A

Social and economic factors which affect the position where groups or individuals stand, within the societal structure.

The determinants must be objective, measurable and meaningful

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3
Q

What are some of the determinants regarding S.E.P?

A

Income, Education, Occupation, NEET (NOT in education employment, or training)

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4
Q

Why measure S.E.P?

A

SEP is used to quantify the level of inequality within or between societies
May highlight changes to population structures over time, between census periods or even between generations.

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5
Q

How is S.E.P measured for individuals? (E.I.O.H.A)

A

Education (more likely to take on board health issues and messages)

Income- more material goods

Occupation- status and power

Housing

-Assets and Wealth

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6
Q

How is S.E.P measured for populations?

A

Area measures
i.e deprivation and access
Who has the best access why and how?

Population Measures
income inequality
Literacy Rates
GDP ( gross domestic product per capita

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7
Q

Advantages and disadvantages of each individual determinant of S.E.P?

A

Income = sensitive topic

Education = Usually easier to obtain (less sensitive)
Different standard in different countries or population

Occupation =Hard to determine which occupation should be measured (e.g. should past occupation be taken into account?)
Can see social mobility

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8
Q

Which measure of S.E.P is the best/gold-standard?

A

There is no gold standard!

Income is the best option

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9
Q

What does screening in health involve?

A

Screening involves identifying risk factors for disease or unrecognised disease by applying tests on a large scale to a population

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10
Q

What is the screening criteria?

A

Suitable test, suitable treatment, suitable screening programme

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11
Q

Why do we need the screening criteria?

A

Not enough money in the health care system to fund every single health problem, so the screening helps us to decide what does get screened and how

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12
Q

How is a suitable disease determined?

A
  1. Relatively common or uncommon (early detection leads to better outcome)
  2. Knowledge of the natural history of disease.
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13
Q

Is screening women for alcohol intake to prevent breast cancer primary, secondary or tertiary?

A

Primary

Dealing with a risk factor- screening for alcohol intake to prevent breast cancer.

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14
Q

Is screening for bone density following chemotherapy for breast cancer primary, secondary or tertiary?

A

Tertiary
After clinical diagnosis- have had treatment. They are screening for bone density which is a complication of breast cancer.

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15
Q

Is breast cancer screening primary, secondary or tertiary?

A

Secondary

Is to prevent further complications.

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16
Q

What are the two measures of accuracy in a screening test?

A

Sensitivity and specificity

17
Q

Define sensitivity:

A

The ability of the test to correctly identify those who have the disease (a), from all individuals with the disease (a+b)

Represents the likelihood of a + test in those who have the disease

18
Q

How is sensitivity calculated?

A

a / a+b x 100%

(True positives / those with disease) x 100%

19
Q

Define specificity?

A

The ability of the test to correctly identify those who do NOT have the disease (d), from the individuals free from the disease (b+d)

Represents the likelihood of a – test in those who do NOT have the disease

20
Q

How is specificity calculated?

A

d / b+d x 100%

(True negatives / those without disease) x 100%

21
Q

Are sensitivity and specificity fixed characteristics?

A

Yes!

Think of it as how good the test actually is, and the science behind it!

22
Q

When is the sensitivity of a screening test high?

A

If the proportion of true positives (a) is high.

23
Q

When is the specificity of a screening test high?

A

if the proportion of true negatives (d) is high.

24
Q

What do the predictive values show?

A

Are a reflection of the proportion of disease in the population AND a reflection of the ability of the screening test to detect a +/- result

25
Q

What is the positive predictive value?

A

The proportion who actually have the disease, of those who tested positive

Represents the probability of having the disease if tested positive

26
Q

How is PPV calculated?

A

a / a+b x 100%

(True positives / those tested positive) x 100%

27
Q

What is the Negative predictive value?

A

The proportion who actually do NOT have the disease, of those who tested negative

Represents the probability of NOT having the disease if tested negative

28
Q

How is NPV calculated?

A

d / c+d x 100%

(True negatives / those tested negative) x 100%

29
Q

Are PPV and NPV fixed characteristics of the test?

A

No!
They reflect both test accuracy AND prevalence of the disease!
Depends on both specificity and sensitivity and the prevalence of disease in a population

30
Q

What are the negative aspects of screening tests?

A

Lead time bias

Length time bias

31
Q

What is lead time bias?

A

Apparent increase in lead time or life expectancy, when you only actually ‘lengthened’ the time between where is disease is detectable by screening and clinical diagnosis
(The whole time line is the same length overall!)

32
Q

What is length time bias?

A

We are only picking up and identifying patients with slower progressive disease (Mean survival time appears to be longer than those rapidly progressive disease as they were not actually included in the tests!)

33
Q

What is population attributable risk?

A

The amount of extra disease attributable to a risk factor in a population

34
Q

How is attributable risk calculated?

A

AR = R.D

EGO - CGO

35
Q

What does attributable risk reflect?

A

Represents the amount of disease we could prevent if we removed the risk factor from the exposure group.

36
Q

What is population attributable risk?

A

The amount of extra disease attributable to a risk factor in a particular population

37
Q

How is PAR calculated?

A

PGO – CGO

(a+b)/P – CGO

38
Q

What does PAR represent?

A

Represents the amount of disease we could prevent if we removed the risk factor from the whole population.