Population and global health

Question 1

What is DALY?

Answer 1

Disability adjusted life years = years lived with disability + years of life lost

Question 2

What are the 4 main non-communicable diseases?

Answer 2

CVD, cancer, diabetes, respiratory

diseases

Question 3

What are the levels of health care prevention?

Answer 3

• Primary prevention reduces the likelihood
  of the development of a disease
• Secondary prevention prevents or
  minimises the progress of a disease
• Tertiary prevention halts the progression
  of damage already done.

Question 4

Why do we need ethics in medicine?

Answer 4

• Complex, technical, high-risk nature of medical practice

- Part of professional knowledge base

Question 5

What are the 5 ethical principles?

Answer 5

1. Beneficence (provide help, do good)
2. Non-maleficence (do not cause or allow harm)
3. Respect for persons and autonomy – informed consent
4. Respect for privacy – confidentiality
5. Justice (equity, fairness, non-discrimination)

Question 6

What are the elements of informed consent?

Answer 6

Pre-condition: competence
Elements:
1. Information
2. Understanding
3. Voluntariness

Question 7

What is refusal of treatment?

Answer 7

• Patients who are mentally competent and adequately informed have a right to make their own decision about their treatment, including deciding not to have recommended treatment.

Question 8

What is the difference between prevalence and incidence?

Answer 8

Prevalence: Occurrence/proportion in a specified population at one time

Incidence: Occurrence in a specified time period (only longitudinal studies)

Question 9

What is the difference between risk and rate?

Answer 9

Risk = n (new cases in defined period)/ p (popn at risk) (assume full population is followed up)

Rate = n / total person-time of follow up - takes into account variable participation times

Question 10

What is the difference relative risk and attributable risk?

Answer 10

Relative risk (RR) = Re/Ru , indicates relative magnitude of change in risk of outcome associated with exposure e.g. % of greater risk

Attributable risk (AR) = Re - Ru, indicates absolute magnitude of change in risk of outcome associated with exposure

AR % = [(Re - Ru)/ Re] x 100 - indicates proportion of incident disease among exposed people that is due to exposure e.g. if 50% means 50% of the incidence of disease is due to exposure and other 50% is due to something else.

Question 11

What is population attributable risk?

Answer 11

Population attributable risk
PAR = Rt (risk/rate in whole population both exposed and unexposed) - Ru, indicates the additional or excess risk/rate of the outcome in the population, due to the exposure

PAR% = [(Rt - Ru)/Rt] x 100, indicates proportion of incident disease among whole population that is due to exposure, i.e. burden of disease on the population (synonym: preventable fraction)