Measuring Population Health Flashcards

1
Q

What is Individual perspective

A

focus on health, risk factors, exposures, causal mechanisms in people as individuals

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2
Q

What is Population perspective

A

focus on disorders (“mass disease”), exposures, causal mechanisms in people as a group

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3
Q

What are the three key descriptive terms for populations?

A

dynamic, diverse, and heterogeneous.

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4
Q

What Demographic characteristics have impacts on health?

A

Sex ratio, place, education, economic resources, gender, ethnicity

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5
Q

Mothers are getting older. What are the reasons for these delays

A

Contraception – more accessible

Education – both in terms of delaying marriage and providing skills to control contraception.

Changes in support for families (for example maternity and paternity leave and tax credits)

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6
Q

How do you calculate Birth/fertility rate?

A

births in said year / mid year population

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7
Q

why is overall death rate not used often?

A

The mortality rate for females is lower than that for men and rises more slowly than that for men, at every age. Thus, any comparison of mortality rates across populations or groups within a population must in some way account for the age and gender distributions of the groups being compared.

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8
Q

what is used to compare death rates normally?

A

death rates are calculated for specific subgroups defined by gender and age.

When an overall figure is desired, the rates for the different age groups are combined as a weighted average – the resulting average is called an “age-adjusted” or “age-standardized” mortality rate and is typically computed separately for males and females.

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9
Q

Life expectancy is essentially a summarization of the mortality rates at each age.

Whats the difference between Period and cohort life expectancy?

A

period life expectancy at age 65 in 2000 would be worked out using the mortality rate for age 65 in 2000, for age 66 in 2000, for age 67 in 2000, and so on.

Cohort life expectancy at age 65 in 2000 would be worked out using the mortality rate for age 65 in 2000, for age 66 in 2001, for age 67 in 2002, and so on.

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10
Q

describe the pattern seen in migration

A

cyclic pattern. The reasons people move in/out are social, political and economic

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11
Q

What are the important parts of a pyramid diagram to consider in terms of healthcare?

A

how top heavy it is. A base is needed in order to support the old

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12
Q

what would cause a bulge in a pyramid diagram?

A

if death rates are decreased or if birth rates or net migration increase.

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13
Q

whats TFR?

A

the number of babies that the average woman will have during her reproductive lifetime.

A TFR of two is approximately replacement level, since the two births to the average woman will take the place of herself and her mate

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14
Q

why should life expectancy be considered when allocating resources?

A

places with low life expectancy, or high mortality, are in need of more resources.

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15
Q

Describe the levels in Maslow’s Hierarchy of Need

A
Self - actualization
Esteem
Love/Belonging
Safety
Physiological
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16
Q

What is the need for Self - actualization?

A

the need for morality, creativity, spontaneity, problem solving, lack of prejudice and acceptance of facts.

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17
Q

What is the need for Esteem?

A

the need for self esteem, confidence, achievement and respect.

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18
Q

What is the need for Love/Belonging?

A

the need for friends, Family and Sexual intimacy.

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19
Q

What is the need for safety?

A

need for security of body, employment, resources, family, health and property

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20
Q

What are Physiological needs

A

breathing, food, water, sex, sleep, homeostasis, excretion.

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21
Q

What is a Normative need

A

need which is identified according to a norm (or set standard); such norms are generally set by experts e.g. means-tested benefits

22
Q

what is a Comparative need

A

problems which emerge by comparison with others who are not in need e.g. comparison of social problems in different areas in order to determine which areas are most deprived

23
Q

what is a felt need?

A

need which people feel - that is, need from the perspective of the people who have it

24
Q

what is expressed need?

A

the need which they say they have. People can feel need which they do not express and they can express needs they do not feel = Demand

25
Q

what is a HNA? (health needs assessment)

A

a systematic method for reviewing the health issues facing a population, leading to agreed priorities and resource allocation that will improve and reduce inequalities

26
Q

What is prevalence?

A

the number of people who have a disease AT A POINT IN TIME. Often expressed as a percentage (ie 23/100 have the disease in the population)

27
Q

what is incidence?

A

the number of new cases that present with a disease over a certain time frame (ie how many new cases this year)

28
Q

what is a case series?

A

looking at a set of cases and observing outcomes. They don’t prove anything in particular, and are very subject to bias (MMR scandal), but are quick and easy with the potential of finding new risk factors.

29
Q

what is a cross sectional survey?

A

A cross- sectional survey is a snapshot of a population looking at a certain outcome. These outcomes can then be compared. this is good at measuring prevalence, but only represents that point in time and is subject to bias

30
Q

what is an Ecological Study?

A

Ecological studies are studies which observe entire groups and look for trends between common characteristics of the group and disease. (nuns and cervical cancer)

31
Q

what is analytical epidemiology ?

A

Figuring out determinants (causes)

32
Q

what is ecological fallacy?

A

the fact that population measures (risk and incidence) dont hold for the individual

33
Q

What is a case-control study?

A

Compare a group with diseases to an unexposed control group (often the general public).

The two groups are compared to see what affect the ‘exposure’ has.

This design is ‘retrospective’ – the study is done after the disease has been diagnosed.

34
Q

what is a Cohort Study?

A

Get a population of people none of which have the disease you are interested in. watch them over a long time, and see how many of them are diagnosed with the disease.

you can look at many outcomes with the same population at once. it is however very expensive and hard to follow up

35
Q

what is the order of preference in study types?

A

Cohort > Case Control > Ecological > Cross sectional > Anecdote

36
Q

what type of study does a clinical trial fall into?

A

Randomised controlled trial

37
Q

what is a randomised controlled trial?

A

it is a case control study using:

Blinding of clinicians to prevent bias.

Use of placebos to avoid the placebo effect

Randomised groups to prevent selection bias

38
Q

in a RCT, what should you do if a patient stops taking the treatment?

A

leave them in the group and include them in statistics. Their non compliance reflects real life.

39
Q

what are the pros of a RCT?

A

Strongest evidence for causality

no bias.

40
Q

what is self selection bias?

A

People likely to agree to participate are likely to not reflect the whole population – they are likely to be young, educated and reasonably but not too wealthy. Family history reflects on likelihood to participate

41
Q

what is error?

A

“Difference between a measured value and the true value”

42
Q

what are the cons of a RCT?

A

it is high cost and inappropriate or unethical for many research questions.

43
Q

what sources of error are there in a RCT?

A
Data collection
Data management
Data analysis
Lab analysis
Sample collection
Study Design
44
Q

in a questionnaire based study, what is Information/recall Bias

A

When asked questions relevant to the health outcome, those who suffer from it are likely to give more precise information because they have thought about it previously.

also note potential for people to lie about exposures if they are embarrassing.

45
Q

what does counterfactual mean?

A

the human tendency to create possible alternatives to life events that have already occurred.

Counterfactual thinking is exactly as it states: “counter to the facts.

“if only i hadnt been speeding i wouldnt have crashed”

46
Q

what is information bias?

A

Information bias refers to bias arising from measurement error.

47
Q

what is a prospective study?

A

an epidemiologic study in which the groups of individuals (cohorts) are selected on the bases of factors that are to be examined for possible effects on some outcome.

48
Q

what is intention to treat

A

Intention-to-treat analysis (ITT) A method of analysis for randomized trials in which all patients randomly assigned to one of the treatments are analysed together, regardless of whether or not they completed or received that treatment.

49
Q

what is a cofounder?

A

A confounder is a third variable that can make it appear (sometimes incorrectly) that an observed exposure is associated with an outcome

50
Q

what is epidemiology?

A

the study and analysis of the patterns, causes, and effects of health and disease conditions in defined populations