Public Health, EBM & Human Factors Flashcards
1
Q
What is Public Health?
A
The art and science of preventing disease, prolonging life, and promoting health through the organized efforts of society.
2
Q
What are the three domains of public health?
A
Health improvement
Health protection
Health services deliveries
3
Q
What is the difference between Primordial and Primary Intervention?
A
Primordial: involves preventing the development of risk factors for disease.
Primary: This requires modifying existing risk factors to prevent disease development.
4
Q
What are the three drivers of public health?
A
Cost-effectiveness
Population health needs
Ethics and values
5
Q
What are the social determinants of health?
A
The social determinants of health (SDH) are the non-medical factors that influence health outcomes.
6
Q
What are social determinants of health?
A
The social determinants of health (SDH) are the non-medical factors that influence health outcomes.
7
Q
What are the seven domains of social determinants?
A
- Income
- Employment
- Housing
- Education
- Crime
- Access to services
- Health
8
Q
Who was Elizabeth Blackwell?
A
She was the first female to qualify as a doctor in America.
9
Q
What does deprivation mean?
A
Deprived does not just mean ‘poor’ or ‘low income’. It can also mean people have fewer resources and opportunities
10
Q
What are the eight protected characteristics?
A
- Age
- Disability
- Gender reassignment
- Marriage and civil partnership
- Race
- Religion or belief
- Sex
- Sexual orientation
11
Q
In what three ways does poverty affect health outcomes?
A
-Reduced ability to buy health-supportive
products and services.
* Money worries induce physiological stress
responses (children in the most deprived
quintile 4 x prevalence of severe mental
health problems compared to least
deprived).
* Unhealthy coping strategies.
12
Q
What two things affect housing?
A
- Poor quality
- Overcrowded housing
13
Q
What are five risk factors regarding housing?
A
Heating inadequacy increased exposure to damp,
molds.
Insecure tenure
Poor maintenance and repair
Inadequate adaptation for disability and infirmity
Minority ethnic households more likely than white
households to live in overcrowded homes and
experience fuel poverty.
14
Q
What are the five outcomes of inadequate housing?
A
Increased prevalence of CVD
Increased prevalence of respiratory disease
Increased risk of falls
Increased incidence of deaths during winter
Increased transmission of covid 19
15
Q
What is the difference between people who do not have a degree or equivalent to those who do regarding average life expectancy?
A
Those who have a degree live 5 years longer than people with lower levels of education.
16
Q
How does good education help? (4 things)
A
- Income → ↑purchasing power and ↓stress
- ↑Health literacy
- Better employment conditions, e.g. occupational health
- ↑engagement with educational services → exposure to protective factors
17
Q
What are employees with low job security more likely to do compared to those who have job safety?
A
Nearly twice as likely to report poor health as the average employee
18
Q
What is the Inverse care law, who proposed it, and what year?
A
Julian Tudor Hart first proposed the hypothesis in 1971
- Those who most need healthcare are the least likely to receive it.
- Those with the slightest need tend to use health services more frequently and effectively.
19
Q
What are the four pieces of evidence for, and Development of Inverse Care Law
A
Higher disease burden in most deprived areas, but fewer doctors working
with higher caseloads and sicker patients.
* Higher hospital admission rates for chronic disease crises (e.g., asthma).
* Lower rates of immunization and screening
* Compared to patients living in the least deprived areas, those in the most deprived
* More likely to report inconvenient hours to deter from making
appointments.
* more likely to report higher dissatisfaction with staff but less
likely to complain.
20
Q
What are the three elements of Geographic Access?
A
- Car ownership and drive times.
- Public transport reliability and convenience for accessing essential and health-supportive services e.g.
GP, Post Office, and shopping facilities. - Rural disadvantage
21
Q
What are four adverse health outcomes associated with neighborhood criminality?
A
↑prevalence of NCD
↑prevalence of mental health problems, e.g., anxiety, depression, PTSD
↓sense of wellbeing
↑Avoidance behaviors e.g. reduced PA, social interaction
22
Q
What was the name of Darwin’s thesis, when was it published, and what did it describe?
A
Darwin’s thesis, The Origin of Species, was published in 1856 and described the theory of evolution – evidencing we are part of nature, we develop from nature, and we are biological beings.
23
Q
What does Health Psychology challenge?
A
The mind-body split by suggesting a role for the mind in both the cause and treatment of illness.
24
Q
What were the seven key behaviors associated with more illness and shorter life expectancy?
A
Smoking, high alcohol intake, lack of exercise, being overweight, snacking, not eating breakfast, and sleeping less than 7-8 hours a night.
25
What does Health Psychology emphasize?
The role of psychological and social factors in the cause, progression, and consequences of health and illness
26
What two things do we need to understand about human behavior?
1. We are all human…AND we are all different!
2. We are not rational thinkers – just because we say we want to do something or know that we should doesn’t mean we will!
27
What is cognition?
The mental action or process of acquiring knowledge and understanding through thought, experience, and the senses.
Overall perception
28
How can we increase motivation?
The greater the intrinsic (internally driven) motivation, the more likely people will engage with the behavior. We must tap into people’s desires/values and reduce fears/habits.
29
What is the biopsychosocial Model of Health, and what does it attempt to do??
An integrated approach to health and illness – the model attempts to integrate the psychological and environmental with the traditional biomedical model of health
30
How does the biopsychosocial model views health and illness?
As the product of biological characteristics (genes), behavioral factors (lifestyle, stress, health beliefs), and social conditions (cultural influences, family relationships, social support).
31
What are the three key constructs of Social Cognitive Theory?
1. Self-efficacy
2. Outcome expectancies
3. Barriers
32
What is self-efficacy?
A person’s confidence to perform a particular behavior, linked to their capability (the knowledge and skills an individual has to perform a given behavior)
33
What are the four methods of changing self-efficacy?
-Mastery experiences – having the opportunity to practice behavior and then master them
-Modeling – observing others successfully perform the behavior
-Social/verbal persuasion – others expressing confidence in your ability to perform a particular behavior; remembering positive comments/feedback
-Physiological experience – correcting potentially harmful beliefs (e.g., butterflies in the stomach) that are normal/useful.
34
What were the two most effective methods after feedback?
Feedback on one’s past behaviour and modeling found to be the most effective
35
What are Outcome Expectancies?
Outcomes anticipated from the behaviour and the extent to which one’s actions help to achieve the outcome
36
What three things can outcomes be?
1. Physical
2. Social
3. Self-evaluative
37
What four things can barriers be?
1. Environmental
2. Emotional
3. Self-control
4. Goal setting
38
What do some behavior change models consider?
People are at different, classified, ordered stages and describe how they move through these stages as they change their behavior.
39
What are the Transtheoretical Model and its six stages?
The transtheoretical model posits that health behavior change involves progress through six stages: pre-contemplation, contemplation, preparation, action, maintenance, and termination.
40
What is the definition of each six stages of The transtheoretical model?
Pre-contemplation: Not intend to make any changes
Contemplation: Considering a change
Preparation: Making small changes
Action: Actively engaging in a new behavior
Maintenance: Sustaining the change over time
41
What has the Transtheoretical Model been used for?
Has been applied to several health behaviors (tobacco, alcohol, screening)
42
What is the Intention-Behaviour Gap?
It occurs when one's actions do not align with their previous intentions - when people don't do what they intend to do.
43
What is Dual Processing Theory
A dual process theory explains how thought can arise in two different ways or as a result of two other processes.
44
What are the two processes in Dual Processing Theory?
A deliberative or reflective process that represents rational, deliberative, and conscious decision-making influences on behavior
An implicit or impulsive process which represents well-learned, spontaneous, and non-conscious influences on behavior
45
What is the most popular and shared explanation of how thoughts arise?
Dual Processing theory
46
What is the target of Making a Behavioral Diagnosis?
A Behavioural Diagnosis of the target behavior to understand barriers and facilitators to enact behavior based on Capability, Opportunity, and Motivation.
47
What three things does The Behaviour change wheel highlight the importance of?
Defining the problem in behavioral terms
Specifying the behavior
Identifying what exactly needs to change
48
What is the short name for Making a Behavioural Diagnosis?
COM-B
49
What are the three layers of the COM-B Model?
1. Capability
2. Motivation
3. Opportunity
50
Explain Psychological and physical capability
Psychological capability: Comprehension of disease and treatment; cognitive functioning, memory, and decision-making capacity
Physical capability: Physical ability to adapt to lifestyle changes/ to use prosthetics; skills, dexterity
51
Explain Reflective and automatic motivation
-Reflective motivation: Perceptions of illness, beliefs about treatment, and consequences.
-Automatic motivation: Habits, automatic thought processes, emotions, and affective responses.
52
Explain the physical and social opportunity
-Physical opportunity: Access to health clinics and resources, transport availability, cost
-Social opportunity: Social support, quality of the therapeutic relationship, stigma, social/cultural influences
53
What is Evidence-Based Medicine?
The conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.
54
What are the seven examples of EBM impacts?
Venesection (Pierre Louis, 19th-century French physician)
Antibiotics (1940s trials)
Thalidomide (the 1950s)
Smoking (1954 and onwards)
Sudden Unexpected Death in Infancy and sleeping position advice (the 1990s)
HRT and CVD (1997 meta-analysis)
Treatment Covid-19 (ongoing)
55
Define variables
In medical and health research, the term is used for factors (e.g. characteristics of human subjects, treatments, health conditions) that are thought to be involved in a health status change process.
56
What are the two divisions of variables?
Dependent variable
Independent variable
57
Define independent variable
An exposure or treatment - is manipulated in some (measurable) way.
58
Define dependant variable
The variable that depends on other factors that are measured
59
Tell me the example between independent and dependent variable
The type of soda – diet or regular – is the independent variable. The level of blood sugar that you measure is the dependent variable – it changes depending on the type of soda.
60
What are dependent variables monitored and measured for?
Identify the nature and strength of the association (if any) between the dependent and independent variables.
61
Define quantitive research
Involves the structured collection of numeric data or can be transformed into numeric measures. Ideally evaluated using statistical analysis. Some quantitative research can test hypotheses and demonstrate causality by answering questions such as ‘is this effective’? ‘by how much?’
62
Define Qualitative research
Involves the systematic collection, organization, description, and interpretation of textual, verbal, or visual data. Usually used for ‘how,’ ‘why,’ and ‘in what way?’ questions.
Cannot confirm relationships between variables or causality. Often used to generate quantitative research questions.
63
What are two elements of good evidence?
1. Reliability
2. Validity
64
How does reliability helps good evidence?
Under the same conditions, the research design produces the same/stable/consistent results across time, investigator changes, and measurement tool changes
65
Explain what to do with time regarding good evidence in reliability.
Repeat baseline measures of individual patient blood pressure or self-administered questionnaire on satisfaction levels with service are stable/consistent.
66
Explain what to do with investigator changes regarding good evidence in reliability.
Regardless of who measures blood pressure or the device used by respondents to complete the survey.
67
Explain what to do with measurement tool changes regarding good evidence in reliability.
Blood pressure readings using ultrasound vs. auscultatory (listening through a stethoscope) techniques or shifting from face-to-face to online administered survey.
68
Define validity
The extent to which a concept is accurately measured in a quantitative study.
69
Examples of qualitative research in validity
Cross-check analysis of focus group discussions for plausibility and coherence by comparing critical reasoning and interpretation against underpinning theory and results from other studies.
70
Examples of qualitative research in validity
Cross-check analysis of focus group discussions for plausibility and coherence by comparing critical reasoning and interpretation against underpinning theory and results from other studies.
71
Examples of quantitive research in validity
Evaluation of a treatment regime will precisely define the independent variable under investigation and how much it will be manipulated, as the conditions under which the dependent variable is measured (e.g. instrument/tool used, frequency of measurements).
72
Examples of the survey in validity
Pilot test question wording and response options for comprehensibility and comprehensiveness on small individuals who are representative of the respondent groups of interest.
73
What four factors contribute to higher rankings?
-Replicability (transparency, generalisability)
-Sample size/statistical power of the study.
-Controlling/accounting for the effects of other variables.
-Research designs that reduce the risk of biases (including selection, measurement, confounding, and ascertainment bias).
74
Define meta-analysis
Examination of data from a number of independent studies of the same subject, in order to determine overall trends.
75
What are the four fundamental principles?
-Secondary analysis of primary research data (trials or -observational studies).
-Clearly defined research objectives (including research questions, exposure/treatment and outcome variables and how measured, inclusion/exclusion criteria, and quality measures pre-specified in the protocol.
-Explicitly described, systematic, and therefore reproducible methods.
-PRISMA minimum reporting standards.
76
In a randomized control trial, what five fundamental principles should be fully described in the protocol?
PICOS
Population: people included (and excluded).
Intervention (experimental treatment or exposure).
Control/Comparator may be placebo, no treatment/exposure, routine practice, or best practice.
Outcome measures need to be relevant and accurate.
Study design
77
What are three things that are essential in controlled randomized trials?
Ethical review (Benefit vs. harm, informed consent)
Capacity to reveal cause-effect relationships e.g efficacy and/or effectiveness.
CONSORT reporting standards.
78
Define target population
People who would get the drug or intervention if the trial is successful
79
What kind of people do trials generally include?
Children, pregnant women, elderly, people with co-morbidity
80
What does protocol need?
A clear statement of eligibility; inclusion and exclusion criteria.
81
What is considered the Gold standard method to assess the Efficacy of treatment or demonstrate a causal relationship?
RANDOMISED CONTROLLED TRIALS (RCTs)
82
What is the power of RCTs?
RANDOMISATION
83
What is the process of randomization? (4)
Often just a randomized list ABBAAABB….
To ensure treatment balance, use randomized blocks, e.g., size 4 ABBA ABAB BAAB BABA.
Electronic 24 hr telephone randomization may be necessary or web-based
Usually provided by a trials unit – Tayside Clinical Trials Unit (TCTU) uses system Trust
84
What are the phases of drug development?
Phase I – Safety, dose-finding, volunteers
Phase II – Safety, how effective, how often?
Phase III – Efficacy, Safety
Phase IV – Post approval in large populations
85
What are the five potential limitations of randomized controlled data?
1. Poor recruitment
2. Generalisability
3. Ethics committee approval required
4. Double blinding is not always possible
5. Sensitivity to loss of respondents
86
What are cohort studies?
An an approach that follows research participants over a period of time (often many years)
87
What are the four fundamental principles in cohort studies?
1. Observational, so no randomization where a controlled trial is not possible.
2. Longitudinal may be prospective or retrospective.
3. Can reveal correlational relationships (including associative risk) but cannot definitively demonstrate causality…..
4. STROBE minimum reporting standards.
88
Define retrospected study
Refers ta study with planned observations collected predominantly before the study start (By records done in the past)
89
Define confounder
A confounder is a variable associated with the outcome and the exposure where the natural association may be masked or diluted.
90
What is risk in epidemiology?
Risk is the probability or likelihood of a health outcome of interest.
91
Methods used to calculate risk can be used to estimate what?
The probability of negative / adverse AND positive /successful outcomes
92
What can quantitive research help estimate?
Can estimate risk by calculating the strength of an association between a putative risk or protective factor and a health outcome of interest (health status, death, symptom change).
93
What three basic methods of computing basic risk estimates from simple descriptive data?
1. Absolute risk (AR)
2. Relative risk (RR)
3. Odds ratio (OR)
94
What is the formula for Absolute risk? (AR)
Absolute risk= number of new cases of the disease in at-risk populations during a specified time period) / total number of individuals in at-risk populations during the same time period
95
What is the formula for Risk Ratio (RR)?
RR= AR of all individuals exposed to risk factor during the specified time period / AR of all individuals not exposed to risk factor during the same time period
96
What are case-control designs?
It is a type of observational study.
This design identifies a group of subjects with a disease or condition (Cases).
97
What are the five stages of Case-Control Design?
1. In this design, a group of subjects with a disease or condition is identified (Cases)
2. A suitable Control group is identified without the condition (Controls)
3. Frequency of Exposure or risk factor extracted and compared in cases and controls
4. Note the Cases are just the people in a cohort study who had the outcome
5. Outcome expressed as an Odds Ratio (OR) with 95% CI and p-value
98
What is the formula for the Odds ratio?
OR= @Odds of disease in a population exposed to risk factor / Odds of disease in population not exposed to risk factor
99
How do you interpret RR and OR?
1. RR and OR at or close to 1 INDICATE NO DIFFERENCE in probability.
2. RR and OR value >1 INDICATES INCREASED PROBABILITY THAT THE HEALTH OUTCOME OF INTEREST WILL OCCUR WHERE THERE IS A HISTORY OF EXPOSURE TO THE VARIABLE.
3. RR and OR <1 INDICATES REDUCED PROBABILITY THAT THE HEALTH OUTCOME OF INTEREST WILL OCCUR IN CASES EXPOSED TO THE VARIABLE UNDER INVESTIGATION.
100
What are the differences between OR and RR in computed data?
-OR may be computed from data that includes pre-existing health outcomes of interest.
-RR is computed by comparing the frequency of newly identified cases during the study period.
101
When will RR and OR be similar?
RR and OR will only be similar if the health outcome of interest is relatively rare.
102
What is screening?
A process of identifying healthy people who may be at increased risk of a disease or condition.
103
Why is cervical cancer screened for when it is not one of the more common cancers in Scotland?
Over 99% of all cervical cancers are caused by HPV. HPV is prevalent, and four out of five people in Scotland will have it at some point.
104
Why are lung cancer or prostate not currently screened for?
-Because there has been no proof that screening for lung cancer helps people live longer.
-PSA tests are not routinely used to screen for prostate cancer, as results can be unreliable. Other non-cancerous conditions can also raise your PSA level. Raised PSA levels also cannot tell a doctor whether you have life-threatening prostate cancer.
105
What is the incidence, and what is the prevalence?
-Incidence: The occurrence of new cases of disease or injury in a population over a specified period of time.
-Prevalence: A measure of the frequency of a disease or health condition in a population at a particular point in time.
106
What is the Wilson and Jungner Criteria?
The condition should be important. There must be a recognizable latent or early symptomatic stage. The natural course of the condition, including development from latent to declared disease, should be adequately understood.
107
What is the difference between screening and diagnostic testing?
Screening tests are intended for asymptomatic (showing no or disguised symptoms) people, whereas diagnostic tests are intended for those showing symptoms in need of a diagnosis.
108
Define sensitivity in screening
How well the test detects having the disease when it is ‘really’ present. These are TRUE POSITIVES. Hence the sensitivity is the FALSE NEGATIVES.
109
What is the formula for sensitivity?
Number of results where the disease is detected in people with the disease / Number of people with the disease X 100%
110
Define specificity
How well the test detects not having the disease. These are the TRUE NEGATIVES AND FALSE POSITIVE
111
Formula of specificity
Number of ‘normal’ or negative results where the disease is not detected in people without the disease / Number of people without the disease X 100%
112
What are two things about Highly sensitive tests?
-Picks up most of the disease.
-Very few false negatives.
113
What are two things about Highly specific tests?
-Correctly detects no disease when not present.
-Very few false positives
114
What are the two predictive values?
Positive predictive value (PPV)
Negative predictive value (NPV)
115
Define Positive predictive value (PPV)
How reliable is the test result when it shows the disease is present?
116
Define Negative predictive value (NPV)
How reliable is the test result when it shows the disease is not present?
117
Formula of Negative Predictive value (NPV)
Number of people who have a negative test result and do not have the disease / Number of people with a negative test result X 100%
118
The formula of Positive Predictive value (PPV)
Number of people with a positive test result and have the disease / Number of people with a positive test result X 100%
119
What are both PPV and NPV are affected by?
Prevalence
120
Fun fact click
Consider PCR test for SARS CoV-2 when prevalence was low – PPV was poor
When prevalence was high, PPV was higher
BUT
Sensitivity and Specificity remained the same
121
What are the five reasons we do screening?
-Reduce disease incidence
-Reduce disease mortality
-Earlier, less radical treatment
-Cost-effective, earlier treatment
-Overall population benefit
122
What are the six disadvantages of screening?
-False reassurance – negative test does not necessarily mean no disease
-Over-investigation and treatment
-Anxiety increases among participants
-The longer period of morbidity with unaltered prognosis
-Potential harm from screening tests – e.g. x-ray exposure
-Opportunity costs – the money could be spent elsewhere
123
Screening frequency
Trade-off with acceptability
-Must be short enough not to miss new cases
-Must be long enough to be acceptable and cost-effective
124
What is lead time bias?
'Lead time bias' happens when you detect a disease during a health screening procedure. This detection occurs earlier- before the usual diagnosis when the disease is symptomatic.
125
Is screening mandatory?
Nope.
126
What three pieces of information should be provided?
Purpose, potential risks and burdens, pathway following test results
127
What is the test currently used for bowel screening, and when was it introduced?
You use a home test kit, called a fecal immunochemical test (FIT), to collect a small sample of poo and send it to a lab. This is checked for tiny amounts of blood. Blood can be a sign of polyps or bowel cancer.
20th November 2017, replacing the Faecal Occult Blood Test (FOBT)
128
What was used before the FIT, and why did it change?
In the Faecal Occult Blood Test (FOBT), the use was increased after the change because no diet was needed beforehand. Plus, a FIT test may not detect blood from further up the digestive tract (such as the stomach), which means it is more specific to finding blood coming from the lower gastrointestinal tract than the FOBT
129
What is the uptake of invitations for bowel screening?
63%
130
How safe is bowel screening, and what are the risks for patients doing them?
There's a small risk that the colonoscopy test you might have if screening finds something unusual could damage your bowel, but this is rare.
131
How reliable is the FIT test?
97% accuracy
132
Meaning of Global Health
An area for study, research, and practice that prioritizes improving health and achieving equity in health for all people worldwide. Global health emphasises transnational
133
What gender, age, and frequency do patients get screened for bowel cancer?
Male and Female
50 to 74
Every 2 years
134
What gender, age, and frequency do patients get screened for breast cancer?
Female
50 to 70
Every 3 years
135
What gender, age, and frequency do patients get screened for cervical cancer?
Female
25 to 64
Every 3 years 25 to 49, then 5 yearly
136
What gender, age, and frequency do patients get screened for Abdominal aortic aneurysm? (AAA)
Male
65
One-off US scan
137
What gender, age, and frequency do patients get screened for diabetic retinopathy?
Male and Female WITH DIABETES
>12
Annually
138
What is palliative care?
Palliative care is an approach that improves the quality of life of patients (adults and children) and their families who are facing problems associated with a life-threatening illness.
139
What is Advanced Care Planning, and what does it include, and why is planning this important?
Thinking and talking about your wishes for how you're cared for in the final months of your life. This can include treatments you do not want to have. Planning like this can help you let people know your wishes and feelings while you're still able to.
140
Define epidemiology
Epidemiology is the study of the distribution and determinants of health-related states or events in specified populations and the application of this study to control health problems.
141
What are the three aims of Epidemiology?
1- To describe the distribution and magnitude of health and disease problems in the human population.
2- To identify the aetiological factors and risk factors in the pathogenesis of the disease.
3- To provide data essential to planning implementation and evaluation of services for prevention, control, and treatment of diseases and setting priorities among the services.
142
Who is the father of Field Epidemiology?
John Snow
143
What are the two ultimate aims of epidemiology?
1. Eliminate or reduce health problems or their consequences.
2. To promote the health and well-being of society as a whole.
144
Tell me the four differences between Clinical Medicine and Epidemiology.
1. CM has the patients as the unit of study, whereas in E, the study is a population.
2. CM is concerned with the disease within a person, whereas E is concerned with the disease pattern in a sick and healthy population.
3. CM diagnosis, prognosis, and treatment are given to the patients, whereas in E, the interest is in the source of infection, mode of spread, and disease trend.
4. In CM, the patient goes to the clinician whereas, in E, the epidemiologist goes to the community.
145
What are the two broad types of epidemiology?
1. Descriptive: Examining the distribution of disease in a population and observing the basic features of its distribution.
2. Analytic: Examining a hypothesis about the cause of the disease by studying how exposures relate to disease.
146
What three things does analytical epidemiology require information for?
- Know where to look.
- Know what to control for
- Develop viable hypothesis
147
What are the three things descriptive studies need to focus on?
Time, place and person
148
What are the four kinds of studies in epidemiology?
1. Ecological Studies
2. Cross-Sectional Studies
3. Case-Control Studies
4. Cohort Studies
149
Define Ecological Study
Epidemiological evaluations in which the unit of analysis is populations, or groups of people, rather than individuals.
150
Define Cross-sectional Study
A type of research design in which you collect data from many individuals at a single time. Hypothesis generative.
151
Define Case-Control Study
A study that compares two groups of people: those with the disease or condition under study (cases) and a very similar group of people who do not have the disease or condition (controls).
152
Define Cohort Study
The epidemiologist records whether each study participant is exposed or not, and then tracks the participants to see if they develop the disease of interest.
153
The three strengths and four limitations of Ecological Study.
-Strengths:
Rapid and inexpensive
Use existing data
Hypothesis generating
-Limitations:
Do not have individual data
May not be able to identify the temporal sequence
Ecological fallacy – we do not know if any of the individuals with the outcome have the exposure
Requires additional research
154
The four strengths and four limitations of Cross-sectional study
Provide the prevalence of a disease or risk factor.
Relatively fast and inexpensive
Better for chronic infections
Hypothesis generating
It may demonstrate association but not a casual relationship. Exposures and outcomes are measured simultaneously. The temporal relationship between exposure and outcome may be difficult to establish
Impractical for rare diseases or risk factors
Cannot estimate the incidence
Prone to bias e.g. recall bias
155
The four strengths and four limitations of the Case-control study
Quicker and less expensive (compared to cohort studies)
A smaller sample size required
Can evaluation multiple exposures
Useful for rare diseases/outcomes
Cannot determine incidence or prevalence
Cannot determine causality
Not useful for RARE exposures
Prone to recall and selection biasR
156
Two main types of Cohort Studies and define them
1. Prospective: individuals are followed over time and data about them is collected as their characteristics, or circumstances change
2. Retrospective: individuals are sampled, and information is collected about their past.
157
What is primary data, and what are some examples?
- Collected directly from first-hand experience, usually for a particular research project.
- Interviews, surveys, questionnaires, field observations, and case studies.
158
What is secondary data, and what are some examples?
- Data that has already been collected for another purpose. Often routine collected data.
- Previous research, health records, government reports, and official statistics.
159
What are some types of secondary data?
Hospital discharges and outpatient data, deaths, births, prescribing data, performance data, registries, laboratory data and surveillance.
160
What is Planetary Health?
The health of human civilization and the state of the natural systems on which it depends.
161
Why are medical students now critical components of undergraduate medical curricula?
1. Environmental degradation is terrible for human health.
2. Healthcare systems are contributing to environmental degradation
3. Medical institutions require medical students to be aware of it
4. NHS climate change commitments (NHS has committed to achieving net zero carbon emissions by 2040)
162
What are some medicines of nature?
Morphine – Opium Poppy
Aspirin – White Willow Tree
Warfarin – Sweet Clover
ACE inhibitors – Pit Viper
Most antibiotics (e.g. Penicillins, Cephalosporins, Aminoglycosides, Tetracyclines) – Microbes
Statins – microbes
Vincristine and vinblastine – Madagascar Periwinkle
AZT – marine sponge
163
What is the recommended alcohol consumption?
Drinking no more than 14 units of alcohol a week is recommended, spread across three days or more.
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What is Primary Prevention, and how is it done?
Primary prevention aims to prevent disease or injury before it ever occurs. This is done by preventing exposures to hazards that cause disease or injury, altering unhealthy or unsafe behaviors that can lead to disease or injury, and increasing resistance to disease or injury should exposure occur.
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What is Secondary Prevention, and how does it work?
Secondary prevention aims to reduce the impact of a disease or injury that has already occurred. This is done by detecting and treating disease or injury as soon as possible to halt or slow its progress, encouraging personal strategies to prevent reinjury or recurrence, and implementing programs to return people to their original health and function to prevent long-term problems.
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What is tertiary prevention, and is it done?
Tertiary prevention aims to soften the impact of an ongoing illness or injury that has lasting effects. This is done by helping people manage long-term, often-complex health problems and injuries (e.g., chronic diseases, permanent impairments) to improve as much as possible their ability to function, their quality of life, and their life expectancy.
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What is the higher risk of drinking for women and men?
Higher-risk drinking for women is regularly drinking more than 35 units per week, and for men regularly drinking more than 50 units per week.
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What is the High Consequence of Infectious Disease?
Acute infectious disease
Typically have a high case fatality rate
May not have effective prophylaxis or treatment
Often difficult to recognize and detect rapidly
Ability to spread in the community and within healthcare settings
Requires an enhanced individual, population, and system response to ensure it is managed effective, efficiently, and safely
