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POPH192 > Module 6: Using the evidence > Flashcards

Module 6: Using the evidence Flashcards

1
Q

What is epidemiology

A

The study of occurrence and distribution of health related events, states or processes in specified populations, including the study of the determinants influencing such processes and the application of this knowledge to control relevant health problems

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2
Q

What is public health

A

The science and art of preventing disease, prolonging life and promoting health through organised efforts of society

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3
Q

What is primary prevention

A

Interventions that attempt to prevent disease from occurring, i.e reduce the incidence of disease. E.g immunisation

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4
Q

What is secondary prevention

A

Interventions that attempt to reduce the impact of disease by shortening its duration, reducing severity or preventing recurrence. E.g cures, earlier treatments and diagnoses

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5
Q

What is tertiary prevention

A

Interventions that attempt to reduce the number or impact of complications and improve rehabilitation. E.g rehabilitation

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6
Q

What are the two strategies for primary prevention

A

High risk (individual) strategy: individuals in need are identified, preventive process controls level of exposure
Population (mass) strategy: reduce the health risks of the entire population

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7
Q

What are some examples of mass primary prevention

A

Increasing price of tobacco, regulation of salt content of foods, cycleways

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8
Q

What are the pros and cons of the mass strategy

A

Radical, large potential for whole population, behaviourally appropriate. Small benefit to individuals, poor motivation of individuals, benefit to risk ratio may be small

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9
Q

What are the pros and cons of the high risk strategy

A

Appropriate to individuals, individual motivation, clinician motivation, favourable benefit to risk ratio for individuals. Need to identify individuals, might be against population norms, can be hard to sustain behavioural change

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10
Q

What is the prevention paradox

A

A large number of people at small risk may give rise to more cases of disease than the small number who are at high risk. But a prevention that brings large benefit to the community may offer little to each participating individual

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11
Q

What is evidence based practice

A

Treatment taking into account patient values and choices, best available evidence and clinical expertise. Research provides the evidence to guide your practice, evidence is evolving, you need to know how to evaluate it

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12
Q

What is the lowest in the hierarchy of evidence

A

Anecdotes

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13
Q

What is the highest in the hierarchy of evidence

A

Systematic review and meta analyses

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14
Q

What are the best study designs to work out how common a disease is and who is most likely to get it

A

Cross sectional or cohort studies of incidence and prevalence

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15
Q

What are the best study designs to work out the causes of a disease

A

Cohort or case control

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16
Q

Diagnostic accuracy studies tend to be (study design type)

A

Cross sectional

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17
Q

What is the best study to work out the natural history of a condition (what happens if you do nothing)

A

Cohort

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18
Q

What are the best studies to work out the best treatment

A

RCTs

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19
Q

Why is good evidence vital

A

To prevent ineffective treatments, treatments for which the harms outweigh the benefits, fail to provide effective interventions

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20
Q

What is epidemiological surveillance

A

Ongoing systematic collection, analysis, interpretation and dissemination of data regarding a health event for use in public health action to reduce morbidity and mortality and to improve health. Ongoing descriptive epidemiology

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21
Q

What are the elements of surveillance

A

Data collection, analysis, interpretation, dissemination, action

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22
Q

What is surveillance used for

A

Characterising patterns of disease, detecting epidemics, further investigation, research, disease control programmes, setting priorities, evaluation

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23
Q

What are the two types of surveillance

A

Indicator based and event based

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24
Q

What is indicator based surveillance

A

Specific selected indicators are under surveillance (generally specific diseases/cancers), report on rates of disease by demographic characteristics of affected individuals

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25
Q

What is event based surveillance

A

Organised monitoring of reports, media stories, rumours, other information about health events that could be a serious risk to public health

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26
Q

What are the types of indicator based surveillance

A

Passive (most common), active, sentinel

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27
Q

What is passive surveillance

A

Relying on individuals to present with a disease. Routine reporting of health data: notifiable diseases, disease registries, hospital data

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28
Q

What are some examples of notifiable diseases (diseases which must be reported by law)

A

Measles, monkeypox

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29
Q

What is active surveillance

A

Serosurveillance: the monitoring of the presence or absence of specific substances in the blood serum of a population
Health survey

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30
Q

What is sentinel surveillance

A

Monitor diseases or trends, detect outbreaks. Selected institutions or groups provide health data. E.g testing someone for HIV when they came in to be tested for syphilis

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31
Q

What are the characteristics of a good surveillance system

A

Clear case definition, organised, workable/practical/simple, uniform, continuous, timely, sensitive, acceptable (to the public and key stakeholders)

32
Q

What is screening

A

The widespread use of a simple test for a disease in an apparently healthy population

33
Q

What is a screening programme

A

Organised system using a screening test among asymptomatic people in the population to identify early cases of disease in order to improve outcomes

34
Q

What is a screening test

A

A test to test large numbers of apparently healthy people to identify individuals suspected of having early disease who will then go on to have further diagnostic tests to confirm the diagnosis. Differs from diagnosis test as there is greater emphasis on cost and safety and less on definitive diagnosis

35
Q

Why try to detect early? (screening)

A

Example of secondary prevention, aim to limit consequences of disease through early diagnosis and treatment

36
Q

What is the purpose of screening

A

To improve outcomes and reduce mortality. All screening programmes do harm, some do good as well

37
Q

When should we screen

A

Consider seriousness of disease, ability to alter course of disease, lead time (longer lead time = more likely to detect disease early), prevalence of pre-clinical disease (must be high). Need to consider costs to benefits. Must improve quality of life (e.g diagnosed with something uncurable)

38
Q

What is sensitivity in screening

A

Proportion of people with the disease which test positive

39
Q

What is specificity in screening

A

Proportion of people without the disease who test negative

40
Q

Want to maximise specificity and sensitivity but

A

There is a trade off between the two

41
Q

What is the positive predictive value

A

Proportion of people who test positive and have the disease (true positive / all positives)

42
Q

What is the negative predictive value

A

Proportion of people who test negative and don’t have the disease (true negative / all negatives)

43
Q

Unlike specificity and sensitivity, PVs are influenced by

A

Disease prevalence in the population

44
Q

What is lead time bias

A

Increasing the morbidity of a disease without reducing mortality

45
Q

What is length bias

A

Diagnosing a disease that would never have become apparent.

46
Q

What influences the spread of disease

A

Properties of the agent, sources of infection, biological reservoirs, host factors, exposure variation, environment

47
Q

What is the epidemiological triangle

A

Host (who gets the disease): descriptive epidemiology
Environment (what conditions led to the disease): environmental investigation
Agent (what causes the disease): laboratory investigation
Immunity, transmission and survival

48
Q

What are infectious agents

A

Bacteria, viruses, fungi, protozoa, helminths

49
Q

What is infection

A

Entry of a microbiological agent into a higher order host and its multiplication within the host

50
Q

What is infestation

A

External surface only

51
Q

What is infectivity

A

Ability of an organism to invade and multiply in a host

52
Q

What is pathogenicity

A

Ability of an organism to produce clinical symptoms and illness (proportion of those exposed who get ill)

53
Q

What is virulence

A

Ability of an organism to produce serious disease (case-fatality rate)

54
Q

What is direct transmission

A

Touching or inhaling infectious secretions

55
Q

What is indirect transmission

A

Always involves a vehicle (fomites, food, water, animal, etc)

56
Q

What is the infectious process

A

Infection, incubation period, clinical disease, recovery, immunity
Latent -> infectious period

57
Q

What is an epidemic

A

Unexpected increase in the incidence of a disease (localised). Two or more cases identified from a common source, cases in excess of the expected number in a given time or place

58
Q

What is an endemic

A

Constant presence of a disease or infectious agent within a geographical area or population group

59
Q

What is a holoendemic

A

Constant presence of a disease or infectious agent within a geographical area or population group

60
Q

What is a hyperendemic

A

Intense disease with time periods of no transmission

61
Q

What is a pandemic

A

Disease affecting a large number of people across international borders

62
Q

What is a cluster

A

Aggregation of relatively uncommon events or diseases in space or time that are thought to be greater than could be expected by chance. Usually rare, non-infectious. May have a suspected environmental cause. Many emerging diseases first become apparent in clusters

63
Q

What is the secondary attack rate

A

Spread of disease from primary case to other (secondary) cases

64
Q

What is the pattern of rate of infection

A

Slows down as more people become immune (around generation 3)

65
Q

Why do we need to investigate outbreaks

A

Stop and prevent further illness, prevent further outbreaks from similar sources, address public concerns and involve public in disease control, reduce direct and indirect costs, identify new mechanisms of transmission of known diseases, identify new or emerging disease agents

66
Q

What are the steps to outbreak investigation

A

Preparation, surveillance, confirmation, outbreak description, outbreak investigation (analytic epidemiology component, environmental component, laboratory component), outbreak control, outbreak communication, outbreak documentation

67
Q

What is outbreak confirmation

A

Taking seasonal changes into account and decide if a spike in cases is unusual

68
Q

What are the types of outbreaks

A

Common source (point source, continuous common source, intermittent source), propagated source (person to person), mixed (e.g point source then propagated person to person)

69
Q

What does a common source epi curve look like

A

Normal distribution, not everyone exposed at the same time gets sick at the same time (differing incubation periods)

70
Q

What does a continuous source epi curve look like

A

More continuous

71
Q

What does a intermittent source epi curve look like

A

Clustered

72
Q

What does a propagated source epi curve look like

A

Intermittent (one case to begin with), then exponential growth and decay

73
Q

Surveillance vs screening

A

Fundamental purpose of surveillance is prevention, fundamental purpose of screening is clinical

74
Q

What is the process of investigation of an outbreak

A

Examine cases, environmental scan for additional cases, look for more details by conducting detailed analysis for possible causes

75
Q

What is geospatial mapping

A

Enables distribution of cases to be visually represented

76
Q

What is the pandemic plan for Aotearoa

A

Plan for it, keep it out, stamp it out, manage it, recover from it

POPH192 (6 decks)

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