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3A > Stats and ethics > Flashcards

Stats and ethics Flashcards

1
Q

What is sensitivity?

A

Proportion of patients with the condition who have a positive test result

TP / (TP + FN )

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2
Q

What is specificity?

A

Proportion of patients without the condition who have a negative test result

TN / (TN + FP)

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3
Q

What is the positive predictive value?

A

The chance that the patient has the condition if the diagnostic test is positive

TP / (TP + FP)

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4
Q

What is Negative predictive value?

A

The chance that the patient does not have the condition if the diagnostic test is negative

TN / (TN + FN)

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5
Q

What is the likelihood ratio for a positive test result?

A

How much the odds of the disease increase when a test is positive

sensitivity / (1 - specificity)

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6
Q

What is the likelihood ratio for a negative test result?

A

How much the odds of the disease decrease when a test is negative

(1 - sensitivity) / specificity

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7
Q

What is a problem with case control studies?

A

Recall bias

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8
Q

Odds ratio?

A

Odds ratios are the usual reported measure in case-control studies. It approximates to relative risk if the outcome of interest is rare.

Odds in treatment group/odds in placebo

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9
Q

What is a Cohort study?

A

Observational and prospective. Two (or more) are selected according to their exposure to a particular agent (e.g. medicine, toxin) and followed up to see how many develop a disease or other outcome.

The usual outcome measure is the relative risk.

Examples include Framingham Heart Study

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10
Q

What are some advantages and disadvantages of cohort studies?

A

Advantages:
- Can follow-up group with a rare exposure
- Good for common and multiple outcomes
- Less risk of selection and recall bias

Disadvantages:
- Take a long time
- Loss to follow up
- Need a large sample size

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11
Q

What is a case-control study?

A

Observational and retrospective. Patients with a particular condition (cases) are identified and matched with controls. Data is then collected on past exposure to a possible causal agent for the condition.

The usual outcome measure is the odds ratio.

Inexpensive, produce quick results
Useful for studying rare conditions
Prone to confounding

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12
Q

What are the advantages and disadvantages of a case-control study?

A

Advantages:
- Good for rare outcomes
- Quicker than cohort or intervention
- Can investigate multiple exposures

Disadvantages:
- Difficulties finding controls of match with cases
- Prone to selection and information bias

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13
Q

What is a cross-sectional study?

A

Provide a ‘snapshot’, sometimes called prevalence studies

Provide weak evidence of cause and effect

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14
Q

What are some advantages and disadvantages of a cross-sectional study?

A

Advantages:
- Cheap and quick
- Provide data on prevalence at a single point in time
- Large sample size
- Good for public health planning

Disadvantages:
- Risk of reverse causality (don’t know whether outcome or exposure came first)
- Cannot measure incidence
- Risk of recall bias and non-response

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15
Q

What are the advantages and disadvantages of RCT?

A

Advantages:
- Low risk of bias and confounding
- Can infer causality

Disadvantages:
- Time consuming
- Expensive
- Specific inclusion/exclusion criteria may mean the study population is different from typical patients

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16
Q

What are the different factors that can explain associations?

A
  • Chance
  • Bias
  • Confounding
  • Reverse causality
  • A true association
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17
Q

What is selection bias and what can cause it?

A

Systematic error in the selection of study participants of the allocation to different study groups

  1. Non- response
  2. Loss to follow up
  3. Are those in the intervention group different to those in the control group
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18
Q

What are the different types of information bias?

A

Measurement (e.g. different equipment used to measure the outcome in the different groups)

*Observer (e.g. the researcher knows which participants are cases and which are controls and subconsciously reports/measures the exposure or outcome differently depending on which group they are in)

  • Recall (e.g. events that happened in the past are not remembered and reported accurately)
  • Reporting (e.g. respondents report inaccurate information because they are embarassed)
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19
Q

What is a type 1 error?

A

Two types of errors may occur when testing the null hypothesis
type I: the null hypothesis is rejected when it is true

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20
Q

What is a type 2 error?

A

type II: the null hypothesis is accepted when it is false - i.e. Failing to spot a difference when one really exists, a false negative.

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21
Q

How do you work out relative risk?

A

Relative risk (RR) is the ratio of risk in the experimental group (experimental event rate, EER) to risk in the control group (control event rate, CER).

The term relative risk ratio is sometimes used instead of relative risk.

EER/CER

Relative risk reduction (RRR) or relative risk increase (RRI) is calculated by dividing the absolute risk change by the control event rate

Using the above data, RRI = (EER - CER) / CER = (0.6 - 0.25) / 0.25 = 1.4 = 140%

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22
Q

What is absolute risk reduction?

A

Absolute risk reduction (ARR) is calculated as the difference in event rates between two groups. In this context, it represents the additional benefit of one treatment over another in reducing pain.

Subtracting the risk of pain in the usual treatment group (1,340 / 1,530) by the risk of pain in the current best treatment group (1,578 / 1,820). 87.6% - 86.7% = 0.9%

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23
Q

How do you work out odds ratio?

A

Work out the odds in each group.

Then divide the odds of each group together and that gives you the outcome

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24
Q

Different types of plot chart?

A

Funnel plot: Funnel plots are primarily used to demonstrate publication bias in meta-analyses. As publication bias is being investigated here, and the researcher is conducting a meta-analysis, a funnel plot is the best answer

Box-and-whisker plot: This is a graphical representation of the sample minimum, lower quartile, median, upper quartile and sample maximum. This helps show the distribution of quantitative data. However, it does not demonstrate publication bias.

Forest plot Forest plots are usually found in meta-analyses and provide a graphical representation of the strength of evidence of the constituent trials

Histogram A graphical display of continuous data where the values have been categorised into a number of categories

Scatter plot Graphical representation using Cartesian coordinates to display values for two variables for a set of data

Kaplan-Meier survival plot A plot of the Kaplan-Meier estimate of the survival function showing decreasing survival with time

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25
Q

What is the standard error of the mean?

A

Standard error of the mean = standard deviation / square root (number of patients)

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26
Q

What is a cross-sectional study?

A

Provide a ‘snapshot’, sometimes called prevalence studies

Provide weak evidence of cause and effect

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27
Q

NNT?

A

Number Needed to Treat (NNT) is a metric used to determine how many patients need to be treated in order to prevent one additional adverse outcome. It is derived by taking the reciprocal of the absolute risk reduction (ARR), which can be calculated using the formula: 1 / ARR. The ARR itself is found by subtracting the control event rate (CER) from the experimental event rate (EER). In this instance, NNT equals 1 / (EER - CER) = 1 / ((45/89) - (12/102)) = 2.58.

1/ ARR

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28
Q

In the theory of planned behavior what 3 factors influence intentions?

A

Attitude towards the behavior: this refers to an individual’s positive or negative evaluation of performing the behavior

Subjective norm: this reflects the perceived social pressure to engage or not engage in the behavior. It involves the influence of important others (e.g., family, peers, society) and their expectations or approval of the behavior (e.g., “Do people who matter to me think I should do this?”).

Perceived behavioral control (PBC): This refers to the individual’s perception of their ability to perform the behavior, influenced by both internal factors (e.g., self-confidence, skills) and external factors (e.g., availability of resources, opportunities). It is similar to the concept of self-efficacy. The more control a person believes they have over performing a behavior, the more likely they are to intend to do it.

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29
Q

The TPB model

A

Attitude: Beliefs about the behavior → Evaluation of outcomes (positive/negative)

Subjective Norm: Normative beliefs (perceptions of others’ expectations) → Motivation to comply

Perceived Behavioral Control: Control beliefs (resources, opportunities) → Confidence in ability to perform the behavior

Intention: The likelihood of engaging in the behavior

Behavior: The actual action or decision

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30
Q

What are the strengths and weaknesses of the TPB?

A

Strengths:
It provides a comprehensive framework that includes both individual (attitude, perceived control) and social (subjective norm) factors.

It has been empirically supported in many domains, especially health psychology and consumer behavior.

Limitations:
TPB assumes that people are rational decision-makers, which doesn’t always align with real-world, emotional, or impulsive behaviors.

It can be hard to measure some of the constructs, especially perceived behavioral control, which is often subjective.

The model primarily focuses on individual-level factors and might not fully account for systemic or structural barriers.

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31
Q

What are the 3 ways to perform a health needs assessment?

A
  1. epidemiological
  2. Corporate
  3. Comparative
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32
Q

What are Bradshaw’s 4 types of health need?

A

Normative Needs:
These are health needs based on objective, expert-defined criteria, typically related to health standards or guidelines. For example, a health need that is defined by medical experts, such as the need for a specific vaccination or health screening based on age or risk factors.

Felt Needs:
These are health needs that individuals or communities perceive and feel. Felt needs are subjective and based on personal experiences or self-reported symptoms. For example, a person may feel they need support for stress or mental health, even if there is no clear medical diagnosis.

Expressed Needs:
These are health needs that are articulated by individuals or communities through their behaviour, such as seeking medical treatment, making appointments, or using healthcare services. Expressed needs are needs that people actively try to address by accessing health services.

Comparative Needs:
These are health needs identified by comparing different populations or groups. Comparative needs look at disparities between groups, such as differences in health outcomes, health service access, or health behaviours. For example, comparing the incidence of heart disease in one community versus another may reveal differences in health needs.

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33
Q

What is the epidemiological approach to a health needs assessment?

A
  • Disease incidence and prevalence
  • Morbidity and mortality
  • Life expectancy
  • Services avaliable
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34
Q

What are the advantages and disadvantages of the epidemiological approach to the health needs assessment?

A

Advantages:
- Uses existing data
- Provides data on disease
- Incidence
- Can evaluate services by trends over time

Disadvantages:
- Quality of data variable
- Data collected may not be the data required
- Does not consider the felt needs or
opinions/experiences of the people affected

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35
Q

What is the corporate approach to a health needs assessment?

A
  • Ask the population what their needs are
  • Use focus groups meetings etc
  • Wide variety of stakeholders
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36
Q

What are the advantages and disadvantages to the corporate approach?

A

Advantages:
- Based on the felt and expressed needs of the population in question
- Recognises the knowledge of those in the population
- Takes into account a wide range of views

Disadvantages:
- Difficult to distinguish need from demand
- Groups may have vested interest
- May be influenced by political agendas

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37
Q

What is the comparative approach to a health needs assessment?

A

Compare the health or healthcare provision of one population to another
* Spatial (e.g. different towns) or social (e.g. age, social class)
* Can compare health, service provision/utilisation, health outcomes
*Means of evaluating variation in performance/costs of services

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38
Q

What are the Adv vs Dis for comparative approach?

A

Adv:
- Quick and cheap
- Gives a measure of relative performance

Dis:
- May be difficult to find comparable population
- Data may not be available/high quality
- May not yield what the most appropriate level
(e.g. of provision or utilisation) should be

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39
Q

What are the key components of Beckers health belief model?

A

Perceived Susceptibility

Perceived Severity

Perceived Benefits

Perceived Barriers

Cue to action

Self-Efficacy

Social and Environmental Factors

40
Q

What are the 4 main beliefs of the health belief model?

A

Belief they are susceptible to the condition, Belief in serious consequences,
Belief that taking action reduces susceptibility, Belief that the benefits of action outweigh the costs

41
Q

What is Perceived Susceptibility?

A

An individual’s belief about the likelihood of getting a disease or condition. For example, someone who believes they are at high risk of developing diabetes is more likely to take preventive measures (such as dieting or exercising).

42
Q

What is perceived severity?

A

An individual’s belief about the seriousness of a health issue and its consequences. If someone believes that a condition like lung cancer will have severe consequences, they may be more motivated to stop smoking.

43
Q

What is perceived benefits?

A

The belief that taking a specific action will reduce the threat of a health problem. For instance, if an individual believes that wearing a seatbelt significantly reduces the risk of injury in a car accident, they are more likely to wear one.

44
Q

What is perceived barriers?

A

The perceived obstacles or costs associated with taking the recommended health action. Even if an individual believes that exercise will improve their health, they may avoid it due to perceived barriers like lack of time or energy.

45
Q

What is Cue to action?

A

A trigger that motivates a person to take action. This could be an internal cue, such as feeling unwell, or an external cue, such as a health campaign or a doctor’s recommendation.

46
Q

What is self-efficacy?

A

Added later by Becker and others, this refers to the belief in one’s ability to successfully carry out the recommended health behavior. The higher one’s self-efficacy, the more likely they are to take action. This concept emphasizes confidence in personal ability to make health changes.

47
Q

What are the 3 applications of becker’s model?

A

Health promotion campaigns: It can be used to design interventions that target specific beliefs (e.g., promoting awareness about the risks of smoking).

Chronic illness management: For people managing long-term conditions, understanding perceived barriers and benefits (e.g., taking medication regularly) can help improve adherence.

Public health initiatives: The model is used to tailor messages about vaccines, screenings, or health behaviors by addressing individuals’ concerns and motivations.

48
Q

What are the 10 criteria in Wilson and Jugner screening criteria?

A
  • Should be an important health problem
  • Should be an accepted treatment
  • Facilities and treatment should be available
  • Should be a recognizable latent or early symptomatic stage.
  • Suitable test or examination
    -Test should be acceptable to the population
  • Natural history of the condition, including the development from latent to declared disease, should be understood
  • Should be an agreed policy on whom to treat.
  • Costs of the screening program (including diagnosis and treatment) should be balanced against the benefits.
  • Case-finding should be a continuing process
49
Q

What are the factors for causality in the Bradford-hill criteria?

A
  • Strength
  • Consistency: same result from various studies
  • Dose-response
  • Temporality: Exposure occurs prior to outcome
  • Plausibility: Reasonable biological mechanism
  • Reversibility: Intervention to reduce/remove exposure eliminates/reduces outcome
  • Analogy: Similarity with other established cause-effect relationships
  • Specificity: Relationship specific to outcome of interest
50
Q

What is length time bias?

A
  • studies when the detection of a disease or condition is more likely to occur in individuals with a slower progression of the disease, leading to an overestimation of survival rates or the effectiveness of a treatment
51
Q

What is lead time bias?

A

detecting the presence of disease earlier, screening can appear to increase length of
survival even if it has no impact on the course of the disease.

52
Q

What are the stages of the transtheoretical model?

A

Pre-contemplation
Contemplation
Preparation
Relapse
Maintenance
Action

53
Q

Centor score

A
  • Fever above 38
  • Tonsilar exudates
  • under 15
  • No cough
  • Tender lymph nodes
54
Q

Paeds red flags

A

Lost developmental milestones
Not able to hold an object at 5 months
Not sitting unsupported at 12 months
Not standing independently at 18 months
Not walking independently at 2 years
Not running at 2.5 years
No words at 18 months
No interest in others at 18 months

55
Q

Indications to early referral fertility services

A

Age > 35
Amenorrhoea or oligomenorrhea
Previous abdo/pelvic surgery
Previous STI/PID

Previous urogenital surgery
Previous STI
Varicocele
Two abnormal semen results.

56
Q

What is considered a staggered overdose for paracetamol?

A

Staggered overdose is defined as the first and last paracetamol ingested being more than 1 hour apart.

57
Q

causes of health inequalities identified in the Black Report:

A
  1. Socio-Economic Status (SES)
  2. Education
  3. Housing Conditions
  4. Access to Healthcare
  5. Nutrition and Diet
  6. Lifestyle and Behavioural Factors
  7. Work Environment
  8. Environmental Factors
  9. Intergenerational Disadvantage
58
Q

What were the key findings of the black report

A

Social Determinants of Health: It emphasized that health inequalities were largely shaped by social and economic factors, such as poverty, poor housing, and limited access to education and healthcare, rather than biological or genetic factors alone.

Class-Based Health Inequalities: People in lower social classes had worse health outcomes across nearly all measures, and this disparity was particularly pronounced in mortality rates.

Health Inequality Persistence: The report concluded that inequalities in health were persistent over time and not simply the result of lifestyle choices or differences in healthcare access.

59
Q

Venous sinus thrombosis

A

Headache, which is present in 90% of cases

Weakness or impaired control of one or both sides of the body

Difficulty speaking or understanding language

Blurred or double vision
Seizures

Nausea and vomiting

Fainting or loss of consciousness

Coma

Eye pain or swelling of one or both eyes

Rash that looks like small bruises or bleeding under the skin

60
Q

PH definitions: Equity

A

Giving people what they need to achieve equal outcomes

61
Q

PH definitions: Equality

A

Giving everyone the same rights, opportunities and resources

62
Q

Horizontal equity

A

Equal treatment for people with the equal health care needs

63
Q

Vertical equity

A

Unequal treatment for unequal health care needs

64
Q

Inverse care law

A

Availability of health care tends to vary inversely with its need

65
Q

What are the determinants of health?

A

P- Place of residence
R- Race
O- occupation
G- gender
R- Religion
E- Education
S- Socio economic
S- Social capital

66
Q

What are the 3 domains of public health practice?

A
  • Health improvement
  • Health protection
  • Improving services
67
Q

What are the two ways for assessing quality of healthcare?

A
  • Maxwell’s dimensions of quality of healthcare
  • Donabedian’s : Structure (what is there), process (what goes on), outcome
68
Q

What are Maxwell’s dimensions of quality of healthcare?

A

3 A’s and 3 E’s
- Acceptability
- Accessibility
- Appropriateness

  • Effectiveness
  • Efficiency
  • Equity
69
Q

What are the approaches to resource allocation?

A

Egalitarian
Maximising
Libertarian

70
Q

What is the egalitarian approach to resource allocation and what are the advantages and disadvantages?

A

Provide ALL care that is necessary and required for everyone

Good: equal
Bad: expensive

71
Q

What is the maximising approach to resource allocation and what are the advantages and disadvantages?

A

Act is evaluated solely in terms of its consequences

Good: Resources are allocated to those most likely to benefit from it
Bad: Those who don’t make the cut receive nothing

72
Q

What is the libertarian approach to resource allocation?

A

Each is responsible for their own health

Good: promotes positive engagement
Bad: most diseases are not self-inflicted

73
Q

What are the different types of prevention?

A

Primary Prevention:
Preventing the disease from occurring in the first place e.g. vaccine

Secondary Prevention:
Early identification of the disease to alter disease course e.g. screening

Tertiary Prevention:
Limit consequences of established disease e.g. Limit consequences of established disease e.g. preventing worsening renal function in CKD

74
Q

What are some key terms in prevention?

A

Population approach: Prevention approach delivered to everyone to shift the risk factor distribution curve e.g. dietary salt reductions through legislation

High risk approach: Identify individuals above a chosen cut off and treat them e.g. screening people for high blood pressure and treat them

Prevention paradox: “A preventative measure which brings much benefit to the population often offers little impact to each participating individual.” e.g. mass immunisation

75
Q

What are the 3 screening programs in pregnancy?

A
  • HIV, syphilis, Hepatitis B
  • Sickle cell and thalassaemia screening
  • Foetal anomaly screening
76
Q

What are the 3 screening in new-born babies?

A
  • NIPE
  • New-born Hearing Screening Programme (permanent childhood hearing impairment). Otoacoustic hearing test
  • New-born blood spot screening test
77
Q

What are the 5 young people and adult screening programs?

A

AAA screening programme
Bowel Cancer Screening
Breast Cancer Screening
Cervical Screening
Diabetic Eye Screening

78
Q

What are the 4 domains in the Wilson and Jugner criteria?

A

Knowledge of Disease
Important
Disease understood
Recognisable stage

Treatment
Accepted treatment
Enough facilities
Agreed policies on who to treat

The Screening Test
Suitable test
Accepted by public

Organisation and Cost
Cost of case findings balance out to possible expenditure
Ongoing process

I(Important disease)n E(effective treatment available)am S(simple and safe)eason NAP (Natural history, Acceptable, Policy agreed)

In Exam Season NAP

79
Q

How to work out odds?

A

To work out odds, you divide the probability of an event occurring by the probability of the event not occurring

80
Q

Risk and risk ratios

A

Absolute Risk (AR) = the number of events (good or bad) in a treated (exposed) or control (non-exposed) group, divided by the total number of people in that group

  • Absolute Risk Reduction (ARR) = the AR of events in the control group (ARc) - the AR of events in the treatment group (ARt)
  • Relative Risk (RR) = AR(Treatment) / AR(Control)
    (Doesn’t take into account baseline risk)

Relative risk reduction = (EER - CER) / CER

81
Q

What is NNT and NNH?

A
  • Number Needed to Treat (NNT) = 1 / ARR
    (The number of patients needed to treat for one to benefit)
  • Number Needed to Harm (NNH) = 1 / (ARt – ARc
82
Q

What are the 4 types of information bias?

A

Measurement bias
Different equipment measuring differently

Observer bias
Observers expectations influence reporting

Recall bias
Past events not recalled correctly

Reporting bias
People don’t tell the truth because of shame/ judgement

83
Q

What are two other types of bias?

A

Selection bias
Bias in recruiting for a study, and some may be lost to follow up

Publication bias
Trials with negative results less likely to be published

84
Q

What are the 3 types of health behaviour?

A

Health Behaviour - aimed to prevent disease
E.g. regular exercise

Illness behaviour - aimed to seek remedy
E.g. going to the doctor

Sick Role Behaviour - aimed at getting well
E.g. taking medication

85
Q

What are some levels of dependancy?

A

Withdrawal symptoms
Cravings – very strong desire to drink

Drinking despite negative consequences: On their physical health, On their mental health, On their social / work life

Tolerance – this is said to occur when the individual has to drink larger amount of alcohol to obtain a similar effect.

Primacy (put drinking before other activities) – neglecting other activities

Loss of control

Narrowing of repertoire (start to drink only one type of drink in one place)

86
Q

What are the 4 dimensions of food insecurity?

A

Availability (affordability) of food
Access – economic and physical
Utilisation – opportunity to prepare food
Stability of the three dimensions over time

87
Q

What is the Bolam rule in negligence?

A

Would a reasonable doctor do the same

88
Q

What is the Bolitho rule in negligence?

A

Would that be reasonable?

89
Q

What are the different types of Error?

A

Sloth error: being lazy, not bothering to check results/information for accuracy.

Lack of skill: lack of appropriate skills or teaching in practice

Communication breakdown: unclear instructions or plans and not listening to others

System failure: machine/equipment stopped working

Human factors: bravado, timidity

Judgement failure

Neglect

Poor performance

Misconduct

90
Q

Which measure is most appropriate for analysing the varying risk of mortality over time

A

hazard ratio is typically used when analysing survival over time

91
Q

What is point prevalence?

A

Point prevalence = number of cases in a defined population / number of people in a defined population at the same time

92
Q

What is the Hawthorne effect?

A

Hawthorne effect - describes a group changing it’s behaviour due to the knowledge that it is being studied

93
Q

Give TWO models used to describe situations leading to errors

A

Swiss cheese model
Three-bucket model

94
Q

Red flags paeds?

A
  • Grunting
  • Resp rate over 60
  • Seizures
  • bulging fontanelle
  • temp over 38 under 3 months
  • Cyanosis
  • Mottled skin
  • Difficult to rouse
  • Moderate or severe recessions
  • Non-blanching rash
95
Q

What is expectation bias?

A

Expectation bias (Pygmalion effect) - observers may subconsciously measure or report data in a way that favours the expected study outco

3A (11 decks)

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