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Block 1 > SocPop > Flashcards

SocPop Flashcards

1
Q

Outline different ways of identifying normality

A
  • Norms
  • Socio-cultural Relativism
  • Medico-statistical Normality
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2
Q

What are the Types of Normality?

A 
Sociocultural 
Functional
Historical
Situational
Medical 
Statistical
Context dependent and Maladaptive Focus
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3
Q

Define Socio-Cultural Normality

A

Characteristic patterns of normal behaviours, attitudes, and beliefs within a group as a result of real or imagined group pressure
- Myers & Zimbardo

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4
Q

Define Functional Normality? How can this affect health?

A

Can individual function in the roles that have developed around them?
Depends on Context
Someone may think they can go to work so are fine but are suffering with disease

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5
Q

Define Historical Normality

A

How norms have changed from the past.

Smoking after WW2 thought to improve lung function but now know it does not. Banned in public spaces.

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6
Q

Can norms change?

A

Yes

Flexibility and progress

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7
Q

What is Maladaptation

A
  • Adapting to behaviour/norm but to their detriment

- Can occur at self- to social level

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8
Q

Medical Normality

A

An expected state, Defined as Abnormal/Normal.
Abnormality establishes ‘the sick role’
Includes beliefs and attributions

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9
Q

What is Statistical Basis of Normality? Give an Example

A

Normal Distribution - 95% of Pop should be within +/- 2 Standard Deviations. Rest are Abnormal. Derived from measures of large populations
E.g. Birth Weight, Sperm Count, Serum Cholesterol, Blood Pressure

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10
Q

What is meant by Optimal Values

Give an Example

A

‘Normal value’ determined by what is required for optimal health. Not based on pop. averages.
e.g. BMI 20-25 Optimal Value. Glomerular Filtration Rate >90ml/min/1.73m2, Vitamin D >25nmol/l

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11
Q

What is Normality?

How does this relate to Medicine?

A
  • Complex and Multi-factorial Concept
  • Patients and Clinicians views may have very different views on Normality
  • Norms change over time
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12
Q

Cite the sources of routinely collected demographic information

A

UK Census
Birth/Death Registration in UK
Population estimates and projections

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13
Q

Cite the sources of routinely collected Health Information

A

Cancer Registration
Hospital Episode Statistics
Quality and Outcomes Framework
Notifications of Infectious Disease

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14
Q

Cite the Source of Routinely Collected Health Information

A

Cancer Registration System
Hospital Episode Statistics
Quality and Outcomes Framework
Notifications of Infectious Disease

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15
Q

What is demography?

A

The study of the size, structure, dispersement, and development of human populations

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16
Q

What Information is collected in the UK Census

A

Demographic data, age/sex
Cultural characteristic, ethnicity/religion
Material deprivation - Employment, Home ownership, Overcrowding, Car access, Lone parents/Pensioners
Health
Workplace and journey

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17
Q

What is CART for Assessing Quality of Health information

A 
Completeness
Accuracy
Representiveness/relevance
Timeliness
Accessibility
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18
Q

State Strengths of The UK Census

A
  • 98% Complete
  • Check of forms, coverage and quality surveys
  • Data available for different levels from very local to whole country
  • Access given to local councils
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19
Q

State Weaknesses of the UK Census

A

Low enumeration of some groups (e.g. undocumented migrants, uni students, travellers),
Self-reported
every 10 years, takes time for release
access - Individual returns confidential for 100 years

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20
Q

How is the UK Census used in service planning and delivery of care

A
  • Population size & Structure: Young, old, minorities - Service needs them
  • Base population (denominator) - Rates of disease
  • measures of material deprivation - To identify and target inequalities
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21
Q

What is Birth Registration?

A

Measures of fertility. Crude births = Live births/1000 pop
General fertility rate
Total Fertility Rate (average number of children born per woman)

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22
Q

How is Birth Registration used in service planning and delivery of care?

A

Important for maternity services to know

Are there enough resources, anything abnormal?

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23
Q

What is Death Registration?

A

Collected by ONS - Death Certificates filled out after death. Cause of death very important for mortality statistics. Also covers underlying causes

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24
Q

How is Death Registration used in service planning and delivery of care?

A

Collected by ONS - Evaluating health and future needs to patients.

  • Mortality Statistics
  • Preventing the first disease or injury will result in the greatest population health gain
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25
Q

What are the Strengths of Using Mortality Data (Birth/Death Registrations)

A
  • Complete coverage in UK
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26
Q

What are the weaknesses of using Mortality Data? (Birth/Death Registrations)

A
  • Accuracy? Underlying cause of death subject to diagnostic uncertainty
  • Ethnicity not collected, hard to evaluate differential survival rates
  • Derivation of socio-economic status is posthumously inflated
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27
Q

Why are Population Estimates & Projections useful for planning services?

A
  • Resource allocation
  • in the past: Understand what has been happening in pop
  • Present
  • Future: to predict what is going to change/how change will affect pop
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28
Q

How are Population Estimates derived?

A

Estimate of population size & Structure between census
Census baseline + births - deaths + migration
Applies what is known to present

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29
Q

What are the Strengths of Using Population Estimates?

A
  • More up to date figures than the census

- More accurate than projections

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30
Q

What are the limitations of using Population Estimates

A
  • Less reliable with time from census (if it was done 8 years ago)
  • Poor information on migration
  • Says nothing about the future
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31
Q

What are Population Projections? How are they derived?

A

Forecast future population size and structure

- Based on assumptions about Mortality, Fertility, Migration

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32
Q

What are the strengths of Population projections? (1)

A

Can be used for longer term planning

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33
Q

What are the weaknesses of Population Projections?

A
  • Less accurate the further ahead

- Unforeseen changes of past trends can invalidate projections

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34
Q

Give an Example of a Population Projection

A
  • Projected age structure of the UK population over time.
35
Q

What Implications can Population Projections have to health services if they show a projected increased life expectancy as disease management improves in the baby boom population?

A
  • Increased cost of care for the elderly
  • Increased need for chronic disease management
  • Increased mental health issues e.g. Dementia
36
Q

Explain the 3 Measures of Fertility

A
  • Crude birth rate = Live births/1,000 pop
  • General Fertility Rate = Live births/1,000 women aged 15-44yr
  • Total Fertility Rate = Average number of children born per woman
37
Q

What is the Cancer Registration System?

A
  • National Cancer Registration and Analysis Service (NCRAS): Public Health England
  • When someone diagnosed with cancer, triggers registration
  • Data: Personal details, Diagnosis, Treatment, Outcomes
38
Q

What are the Uses of the Cancer Registration System? (4)

A
  • Prevalence of different cancers
  • Evaluation and improvement of cancer treatment
  • Evaluation of screening programmes
  • Aiding Cancer Research
39
Q

What are the Strengths of the Cancer Registration System?

A

Detailed information updated over time

Record linkage to cancer deaths (ONS) (Office of National Statistics)

40
Q

What are the Weaknesses of the Cancer Registration System?

A

Expensive

Access is difficult due to confidentiality

41
Q

What are Hospital Episode Statistics (HES)?

A
  • Main source of all hospital data in the NHS

* Includes: All admissions, out-patient and A&E visits to NHS hospitals in England

42
Q

What information is collected in Hospital Episode Statistics (HES)?

A
  • Personal info (age, gender, ethnicity)
  • Clinical Information (diagnosis and operations)
  • Administrative date (Date of admission, discharge)
  • Geographical Information - Where treated & lives
43
Q

What are the Uses of HES

A
  • BY: Commissioning orgs (payment), Provider orgs, Researchers
  • For:
  • Trends in NHS hospital activity
  • Supports local service planning
  • Health trends over time
  • Fair access to healthcare
44
Q

What are the two Main Coding classifications currently used in HES?

A
  1. ICD-10 (Internation Classification of Diseases, 10th Revision, WHO)
  2. OPCS-4 (OPCS Classification of Surgical Operations and Procedures, 4th Revision)
45
Q

What are Strengths of HES

A
  • Completeness - Covers all hospital activity
  • Accuracy - Gold standard codes ICD-10, OPCS-4
  • Representative - Routine National Data
46
Q

What are Weaknesses to HES?

A

Accessibility - To individual data

47
Q

What is QOF

A

Quality and Outcomes Framework

- Introduced in GP contract in 2004: Linked to GP payments, voluntary, rewarding good practice to improve care

48
Q

What does QOF entail? 4 domains

A
  • Clinical - Managing chronic diseases AF, Diabetes, CKD, Asthma, Dementia
  • Public Health (CVD, BP, Obesity 18+, Smoking 15+)
  • Public Health - Additional Factors (Cervical screening)
  • Quality Improvement - Prescribing safely, end of life care
49
Q

How does QOF work?

A

Points system - GP practices scored against indicators. Higher score = Higher GP income
- Significant Expenditure and significant incentive

50
Q

Does Quality and Outcomes Framework improve outcomes?

A

NICE summary

  • Recording? yes
  • Process? - Mostly
  • Intermediate/proxy outcomes? - yes for some
  • Clinical outcomes? Unclear. Evidence for initially improved health outcomes for some conditions but subsequently fell to pre-existing trend.
51
Q

Strengths of QOF

A
  • Completeness - Almost 100% Response from GPs
  • Representative - Representative of all population: Data at surgery, CCG, national levels
  • Timeliness - Updated annually
  • Access - QOF Online
52
Q

Weaknesses of QOF?

A
  • Completeness - Some do not participate
  • Accuracy - Not sure how accurate/complete disease registers are for ind practices
  • Representative - Only get aggregated data, no age/sex breakdown
  • Access - Aggregated data only
53
Q

What are Notifications of Infectious Diseases?

A

32 Notifiable diseases in England and Wales: E.g. Acute encephalitis, Infectious bloody diarrhoea, Mumps, Rubella, SARS, Tuberculosis.

  • Doctor suspects notifiable disease case, must notify Public Health England, or labs.
  • PHE collates and produces national trends each week
54
Q

What are the uses of Notifications of Infectious Diseases?

A
  • Surveillance
  • Action to prevent further infection
  • Identify outbreak
  • Monitor trends
55
Q

What are Strengths of using Notifications of Infectious Disease?

A
  • Timeliness - Weekly Report by PHE
  • Representative - Routine National Data
  • Linked to other data to improve accuracy e.g. lab reports
56
Q

What are the weaknesses of using Notifications of Infectious Diseases

A
  • Poor or variable completeness for some diseases, e.g. not all food poisoning notified.
  • Accuracy can be questionable due to diagnostic uncertainty. Asked to notify suspected cases
57
Q

Name the National Source of Data for Prevalence of Diabetes

A
  • Quality and Outcomes Framework

- Health survey for England

58
Q

Name the National Source of data for Cancer Survival (2)

A
  • National Cancer Registration and Analysis Service

* Hospital Episode Statistics

59
Q

What data coding system is used in hospital for Surgical Procedures?

A
  • OPCS-4
  • Classification of Surgical Operations and Procedures, 4th Revision
  • Records details of operations
60
Q

What data coding system is used in hospital for the medical condition treated?

A
  • ICD-10
  • International Classification of Diseases, 10th Revision
  • Describes conditions treated or investigated
61
Q

Give 1 strength and 1 weakness of Death Statistics

A
  • Advantage: Completeness - Complete record for all of UK
  • Disadvantage: Accuracy - Underlying cause subject to diagnostic uncertainty
    Ethnicity not collected
62
Q

A patient is suspected to have malaria. After appropriate clinical management, what is the next step?

A

Notify ‘proper office’ at local council / Local Health Protection Team, part of Public Health England

63
Q

What is Prevalence?

A

A measure of how common a disease is

Can be expressed as 1. Percentage 2. Number per n people

64
Q

What are the different types of Prevalence?

A
  • Point Prevalence
  • Period Prevalence
  • Lifetime Prevalence
65
Q

How to Calculate Prevalence?

A

Proportion Prevalence = Number of People with Condition / Number of people in total

May have to multiply by n if it must be within n pop.

Must then accompany statistic within interpretation.

66
Q

What is the Use of Prevalence? What are the Weaknesses of this?

A
  • To gauge BURDEN of disease
  • Prevalence can be affected by disease duration
  • Does not consider when people got disease
67
Q

What is Incidence (rate)?

A

The rate at which new events occur in a population, over a defined period of time
* Can be expressed as: 1. Per n people per time period 2. Per n person-years

68
Q

Define Person-years

A

A measurement combining the no. of people observed and no. years observed for

Person-years = No. people x No. years

69
Q

How to Calculate Incidence

A

Incidence rate = Number of NEW cases / (Number of People x Years observed)

May have to multiply by n to get per n person-years

Must accompany statistic with interpretation

70
Q

How does Incidence and Prevalence Relate?

A
  • High Prevalence + High Incidence = Common, not brief condition
  • Low Prevalence + High Incidence = Common, very brief condition
  • High Prevalence + Low Incidence = Uncommon, Long-term Condition
  • Low Prevalence + Low Incidence = Uncommon, Short-term condition
71
Q

What does it mean if a Disease has High Incidence + High Prevalence?

A
  • High Incidence - High rate of new cases per year
  • High Prevalence - At any point can find many people with disease
  • E.g. Common cold
72
Q

State Factors Affecting Prevalence

A
  • Incidence Rate
  • Recovery (cure) rate
  • Transfer/Migration In and Out
  • Death rate
73
Q

What is Statistical Inference?

A
  • Given that can’t sample entire population, don’t know true value. We make a best guess based on data
  • Must describe our level of uncertainty around the best guess
74
Q

What is Point Estimation

A

Best Guess based on Sample data

- Would a repeat generate same results? Unlikely

75
Q

What is Sampling Error?

A
  • Point estimates upon repeating experiment can be different. Will be clustered around the true value
  • Differences between sample point estimates and the truth is the sampling error.
76
Q

How can you Reduce Sampling Error?

A

Can test a larger sample

77
Q

What is Standard Error

A

Is a numerical value that represents the sampling error

  • Can be calculated
  • Large SE suggests our best guess may be far from truth
  • Larger sample size, smaller Numerical SE
78
Q

What is Standard Error

A

Is a numerical value that represents the sampling error

  • Can be calculated
  • Large SE suggests our best guess may be far from truth
  • Larger sample size, smaller Numerical SE
79
Q

What are Confidence Intervals?

A

When giving estimate from a sample, should also give a range of plausible values, to represent level of uncertainty

80
Q

How to Interpret Confidence Intervals?

A

’ You can be 95% Confident that, in reality, somewhere between … and … of … rest of interpretation.

81
Q

What is the Calculation for Confidence Intervals?

A
  • Lower bound: Point Estimate - (1.96 X SE)

* Upper bound: Point Estimate + (1.96 X SE)

82
Q

Interpret: For Mothers holding their babies on the left.
• Sample proportion 0.8
• 95% CI of (0.76, 0.84)

A
  • In our study, we found that 80% of mothers held their
  • However, we can be 95% confident that the true proportion of mothers that hold their babies on the left is somewhere between 76% and 84%
83
Q

How Can CIs be used to compare different groups?

A
  • Can be used to see if there is a real (statistically Significant) difference between two groups.
  • I.e. If CIs overlap - Not Significant
  • If CIs do not Overlap - Significant
84
Q

Who should the doctor notify in case of a Notifiable Infectious Disease case?

A
  • Local Health Protection Team, Public Health England

* ‘Proper Office’ at Local Council

Block 1 (4 decks)

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