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PPS > PPS Public Health > Flashcards

PPS Public Health Flashcards

1
Q

Definition of Public Health

A

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

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2
Q

What is the role of doctors in addressing public health inequalities

A

ADVOCATE (incl. use of quantitative evidence)
MITIGATE (to reduce links between deprivation and poor health outcomes)
COLLABORATE (partner with other health sectors to improve outcomes)

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3
Q

Defining a Disease

A

1 or >
• Basis of biological test
• Basis of symptoms, clinical abnormality
• Statistical basis
• On predictive grounds
• On grounds of treatability

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4
Q

Definition of Epidemiology

A

Study of distribution & determinants of disease in human pops.

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5
Q

Epidemiology questions which 3 areas

A

1) describing disease burden/ health status
2) aetiology
3) treatment.

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6
Q

Epidemiology and your needs as a future clinician

A

• Using and interpreting changing evidence
• Explaining evidence to your patients
• Generating evidence by doing research
• “Prevention is better than cure” : the role of the clinician

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7
Q

Biomedical view vs Public Health view for primary prevention of a disease

A
  • Biomedical view: Removing cause of disease, strengthening resistance of individual’s risk, interfering with pathogenesis of disease.
  • Public health view: Using epidemiological and other evidence to design, implement and evaluate a preventive intervention.
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8
Q

Changes & difs in incidence between groups tells us about

A

Changing causes of disease (useful to evaluate prevention)

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9
Q

Changes & difs in mortality between groups tells us

A

About a COMBINATION of changes in the causes (how likely people are to get disease) and changes in treatment (how likely people are to survive from disease).
Useful to evaluate healthcare.

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10
Q

What does prevalence depend on, and what is is useful for

A

both incidence and duration of disease, which is influenced by healthcare.
Useful to plan healthcare needs.

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11
Q

3 main features of RCT design

A

Randomised
Blind
ITT analysis

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12
Q

Why is it important to randomise RCT

A

To control for confounders (both known and unknown)

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13
Q

What is it important for RCT to be blinded

A

To prevent assessment bias in reporting outcome (placebo effect, observer bias)

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14
Q

Why is it important to do ITT analysis?

A

To prevent randomisation being broken during course of trial

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15
Q

List types of RCTs

A

Parallel group trial
Factorial design (Parallel)
Crossover trial
Cluster trial

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16
Q

Safety issues in RCT

A

• RCTs must measure both benefits of the new treatment, and harm.

• Protocol will specify harm endpoints to measure (including death)
- Reasons for pts withdrawing from trial should be noted & analysed – look for both known and unknown potential harm.
• No. needed to harm (NNH) =average no. of people taking a medication for 1 to suffer an adverse event. NNH = 1 / (ARt – ARc) where AR is Absolute Risk of adverse event, t=treatment arm, c=control arm.

Phases of drug testing:
• Phase 1 & 2 look for toxic/safety concerns in smaller numbers of pts.
• Phase 3 is RCTs on larger no. of pts including safety.
• Phase 4 is post marketing surveillance for less common S/Es, late manifesting effects, or in a more diverse pt pop.

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17
Q

Ethical Issues of RCT

A
  • Pt and clinician don’t choose tx
  • Pts need to be fully informed that they may get the experimental tx and they may not personally benefit from the research
  • Clinical equipoise: only ethical to randomise if there is lack of evidence about whether one to is superior to another
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18
Q

Features of an ideal experimental study

A

Controlled (placebo)
randomized
Double blind
large
analysed by ‘intention to treat’ method.

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19
Q

Why need to control RCT

A

Controlled = comparison group (untreated or differently treated)

Clinical experience can be misleading:
- sick people tend to get better even without tx
- drs don’t follow up all of their pts/ only selectively follow up
- each dr sees a limited number of pts and the play of chance is great

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20
Q

Definition of disease

A

A deviation in bodily structure/function placing an individual @ biological/social disadvantage, now or in future

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21
Q

Define illness

A

Impact of disease on functioning, relationships, social interactions

22
Q

Define condition

A

Refers to a person’s state of health
Can be more acceptable for congenital anomalies/deafness

23
Q

Asthma “case” in an Epidemiologic Study

A

• Death due to asthma
• Diagnosis by GP
• Hospitalisation // of asthma
• Use of asthma medication
• Symptoms requiring treatment
• Standardised validated survey questionnaire for symptoms
• Measure peak expiratory flow before & after symptoms
• Bronchial challenge testing in surveys

24
Q

What are artefacts in an epidemiological study?

A

Disease variations arise from data errors.

25
Q

Potential artefacts/ differences in health service that could cause misinterpretation of results in geographic studies

A
  1. Difs in diagnosis between countries
  2. Difs in case ascertainment
    a. Difs in recording of info.
    b. Difs in access to or uptake of care between countries?
    c. Difs in population structure (mainly age)
26
Q

Ecological study

A

Unit of observation is the pop/community (rather than the individual) and both “exposures” & disease rates are measured in each of a series of (geographical) pops and their relation is examined

27
Q

Define exposure

A

An epidemiological term relating to any risk factor under study which may cause or be associated with disease risk.

28
Q

Potential Pitfalls in ecological studies

A
  1. Analyses based on pop groups rather than individuals – assumption that exposure & outcome are also related in individuals may not be true (`ecological fallacy’)
  2. Often groups differ from 1 another in many ways – always a possibility of confounding (i.e. another factor in play related to both exposure and disease)
    - Socioeconomic status = common confounder – i.e. under that interpretation, deprived pops are more at risk of asthma, & are more at risk of being exposed to air pollution, but it is not the air pollution that causes the asthma.
29
Q

Potential Pitfalls in Migration studies

A

• Selection bias: Are the people who migrated the same as the people who were left behind?
• Healthy migrant effect
• Info bias: Do immigrants provide info consistent with non-migrants in surveys?
• Potential influence of stress of migration, and living conditions of migrants: Could this contribute to disease patterns observed?

30
Q

Application of migration studies

A

Studying people migrating between geographic locations with different disease experience can help to separate effects of:
• Adult environment
• Early environment and/or genetic factors

31
Q

Potential variation by person

A

Age
Gender
Socioeconomic status/ social class
Occupation
Ethnicity

32
Q

Potential risk factors for asthma

A

• Vitamin D deficiency during foetal and childhood development
• GI and respiratory microbiome
• Exposure to microorganisms in early life – immune response; Lower asthma rates in children who grow up on farms; Early life exposure to ABX.
• Tobacco smoke – in utero, early life, adult; active/passive.
• Air pollution – from in utero throughout life.
• Stress – from in utero throughout life.
• Indoor allergens - Dust mites, mould, cockroach allergens (affected by humidity, housing quality and other factors)
• Genetics.

33
Q

Variations in Health and Disease by Place, Time, Person: How can the evidence help us?

A

• Show us that high rates of disease are not inevitable, and potentially preventable.
• Clues to causation of disease.
• Provide opportunities for testing whether potential causes are important.
• Help with process of diagnosis (e.g. age-specific variation)
• ID high risk groups who could especially benefit from disease prevention.
• ID health inequalities that need to be reduced.
• Help to assess how healthcare may be affecting mortality or prevalence.
• Help to assess how public health preventive interventions are affecting incidence.

34
Q

Causes of Global Inequalities in Health

A

o Safe water: diarrhoeal diseases if contaminated.
o Housing & shelter: temp, humidity, air quality, space, light.

35
Q

Forms of Malnutrition

A

Undernutrition – protein and energy
- Wasting – low weight for height
- Stunting – low height for age,
- Underweight (children) – low weight for age
Micronutrient-related malnutrition
- Iodine deficiency (thyroid, brain)
- Vit A deficiency (eyesight)
- Iron deficiency (anaemia)
- Zinc deficiency (immune function)

36
Q

Factors contributing to the rise in Non-communicable Diseases in Low & Low Middle-Income Countries

A

• Rise in urban pops
• Pop. ageing
• Rise in nutritional risk factors (high saturated fat, salt, energy)
• Rise in tobacco smoking (while declining in HIC)
• Rise in physical inactivity
• Poor access to health services

37
Q

Underlying Causes of Death & Disability In Western Europe vs Sub-Saharan Africa

A

Western Europe
• Tobacco smoking (incl. passive), high BP, obesity, physical inactivity, high blood glucose, alcohol effects, low fruit intake, high cholesterol.
Sub-Saharan Africa
• Child underweight, indoor air pollution (solid fuel), suboptimal breastfeeding, iron deficiency, high BP, vit A deficiency, poor sanitation, unsafe drinking water, zinc deficiency.

38
Q

What are the UN Sustainable Development Goals

A

• End poverty & hunger in all forms everywhere.
• Achieve gender equality: empower women + girls.
• Promote sustained, inclusive and sustainable economic growth and full employment.
• Promote peaceful inclusive societies for sustainable development, provide access to justice for all; build effective, accountable and inclusive institutions.

39
Q

Role of Public Health in Tackling Global Health Inequalities

A

Advocacy and Partnership
- Climate & clean air, poverty, conflict, migration, tobacco control, water & sanitation, food security & agriculture
Mitigation via disease prevention and treatment
- Vaccination, Health education, Breastfeeding promotion
- Occupational health standards
- Improving structure of and access to health services including primary care, reproductive health care, medicines (affordable, quality e.g. WHO essential drugs list)
- Low-cost intervention access e.g. oral rehydration, supplements
- Vertical programs for HIV/AIDS, Malaria, TB, NTDs

40
Q

Factors Increasing Risk of VTE

A

Virchow’s triad:
• Reduced rate of blood flow
• Increased coagulability of blood
• Damage to venous endothelium (e.g. by trauma/severe injury to lower limbs and pelvis)

41
Q

What is a case-control study

A

The study starts by categorising study subjects (or population members) into having the disease (outcome) or not, then retrospectively goes back in time to find out what proportion of each were exposed to the factors of interest.

42
Q

What is a cohort (longitudinal) study

A

The study starts by categorising study subjects (or population members) by whether they were exposed or not to one or more risk factors of interest, then prospectively follows up the exposed and unexposed to find out the proportion of each who developed the disease (outcome)

43
Q

Distinguish between accuracy and precision

A

• Accuracy: how close a measured value is to the actual value.
• Precision: how close a series of measurements are to 1 another/ how reproducible the numbers are.

44
Q

Main Sources of Bias in Case-Control Studies

A

• Selection bias: selection of either the cases/controls (or both) is systematically related to the exposure under scrutiny.

• Information bias: In which info on exposure obtained from the cases and controls is not comparable (e.g. recall bias – where cases are more motivated to recall exposure than controls)

45
Q

Selection of Cases: Guiding Principles

A

• Standard definition if possible
• Homogeneous in relation to potential to be caused by the RF under study (don’t mix apples and oranges – don’t mix DVT and PE)
• Newly diagnosed (incident) cases or established (prevalent) cases?

46
Q

Advantages and disadvantages of a cohort approach (compared to case-control)?

A

Adv
• Can study many outcomes in relation to the exposure
• Can study rare exposures
• Obtain a measure of incidence in both exposed and unexposed, and relative risk and absolute excess risk
• Can measure exposure prospectively, with standardised approach, and avoid recall bias
• Can be sure that exposure precedes outcome

Disadv
• Not good for rare outcomes
• Large sample size needed
• May take years of follow up to determine outcome*
• Expensive due to large size and long study period
• Can suffer from loss to follow up (attrition)
Also:
• Repeated collection of data may alter behaviour
• Problems keeping standards and diagnostic criteria with time
• Ascertainment of outcome status may be influenced by knowledge of exposure

47
Q

What is Analytic Epidemiology

A

Observational cohort studies and case-control studies which look for the association between “exposures” (risk factors/causes) and “outcomes” (health/disease endpoints) at the individual level

48
Q

What is a confounding factor?

A

A factor associated both with the exposure and the outcome of interest.

49
Q

What is attributable risk?

A

Risk in exposed group - risk in unexposed group

50
Q

What is relative risk?

A

risk in exposed/ risk in unexposed

RR=1 mean both groups equal risk

51
Q

Advantages of a case-control study

A

Quick
Cheap
Small sample size
Good for rare diseases
Multiple exposures

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