Public health and epidemiology Flashcards
Recommended criteria for the assessment of a screening programme
The condition is a suitable candidate for screening
There is a suitable test available
There is an effective and accessible treatment or intervention for the condition identified through early detection
There is high quality evidence that a screening programme is effective in reducing mortality or morbidity
The potential benefit of the screening test should outweigh potential harm
The health sector should be capable of supporting diagnosis, follow-up and programme evaluation
There is consideration of social and ethical issues
There is consideration of cost-benefit issues
Levels of evidence for research
I - The evidence for a treatment or intervention has been obtained from at least one well-designed and well-conducted RCT
II-1 - from well-designed controlled trials, but the assignment to treatment arms has not been random
II-2 - from cohort or case-control studies
The evidence has been obtained by separate studies or groups in different centres
II-3 - Evidence at this level has come from other types of studies, e.g. case studies
III - The opinion of respected authorities, perhaps based on descriptive studies or expert reports
Incidence
The number of new cases of a condition or disease in a given population, over a given time
Way of expressing how likely a person is to develop a condition or disease during a specific time period
Prevalence
The proportion of people in a population who have a particular disease or condition at any given time
How common a condition or disease is
Principles of informed consent
- Must have the capacity to make the decision
- The medical provider must disclose information on the treatment, test, or procedure in question
- Must comprehend the relevant information
- Must voluntarily grant consent, without coercion or duress
Giving informed consent of behalf of another person
The only individuals who are entitled to grant consent on behalf of a patient are:
- A welfare guardian
- A parent of an incompetent child or a guardian appointed under the Care of Children Act
- An attorney holding an EPOA for personal care and welfare
Intellectual disability fertility management - legal
Consultation with others experienced in the care of young women with disabilities prior to considering irreversible approaches is strongly recommended
Offer the least restrictive option
- Reversible methods should be considered in preference to irreversible surgical options
Procedures that are intended or are reasonably likely to render a patient permanently infertile, or involve a TOP
- Mandate an application to an independent statutory body such as a guardianship board or public advocate
If there is doubt as to a patient’s ability to provide informed consent, get advice from a medical professional qualified to make a capacity assessment
Minor reversible medical treatment
- If woman provides verbal consent, may obtain written legal consent from the person responsible, e.g. appointed medical agent under EPOA, patient’s spouse or domestic partner, primary carer, or nearest adult relative
Gillick’s competence
Term used in medical law to decide whether a child (<16y) is able to consent to their own medical treatment, without the need for parental permission or knowledge
The Fraser guidelines
Apply specifically to contraception
The young person will understand the professional’s advice
The young person cannot be persuaded to inform their parents or allow the medical professional to do so on their behalf
The young person is likely to begin, or continue having, sexual intercourse with or without contraceptive treatment
Unless the young person receives contraceptive treatment, their physical or mental health, or both, are likely to suffer
The young person’s best interests require them to receive contraceptive advice or treatment with or without parental consent
‘four principles’ of medical ethics
Respect for autonomy
Beneficence - actions that promote the wellbeing of others
Non-maleficence - do no harm
Justice - fair and just allocation of resources
Case control study
- what is it?
Takes individuals who are known to have a disease or problem of interest, and compares them to others who aren’t affected
Level of exposure to risk factors is compared between two groups
It is almost impossible to prove that a certain factor caused a disease
Pros and cons of case control study
Advantages
- Good for rare outcomes or outcomes with long latent period
- Useful for generating hypothesis
- Quick and cheap
- Few participants required
Disadvantages:
- Only one outcome can be investigated
- Temporal relationship between exposure and outcome difficult to establish
- Cannot calculate incidence or prevalence
- Recall, sampling and observation bias
Cohort study
- what is it?
Follows a group of people to ascertain whether outcome of interest differs between groups with different exposures
Retrospective or prospective
Pros and cons of cohort
Advantages:
- data can usually be collected in a specified (uniform) and standardised way
- can limit issues seen in case control studies - recall bias, important information not being available, or being available in a way that is open to interpretation
- avoids ethical problems of exposure to risk factors
- longitudinal design allows assessment of temporal relationship
- multiple outcomes can be studied
- best method for determining prevalence, incidence and natural history of disease
- Allows computation of risk and rates
Disadvantages:
- expensive
- loss to f/u
- not appropriate for rare outcomes, long latent period
- more bias than RCT
- The nature of the group studied will influence the generalisability of the results
Difference between pragmatic and explanatory RCTs
Pragmatic RCTs mimic usual clinical practice
- Focuses on maximising external validity (generalisability of the results to many real-world settings)
Explanatory RCTs assess efficacy of investigational medicines
- Test hypotheses on whether the intervention causes an outcome of interest in ideal circumstances
