studies Flashcards
studies aim
to give an available source of data that gives an epidemiological picture of the UK society
descriptive studies show
- Amount and distribution of disease in a population
- Insight into aetiology = health service needs
descriptive studies are useful because they
- Identifying health problems + monitoring and surveillance
- Any effects worthy of further investigation
- Assess effectiveness of measures of prevention and control
- Assess needs for health services and planning
- Ideas on disease aetiology
advantages of descriptive studies
cheap, quick, good overview
disadvantages of descriptive studies
no evidence about cause, doesn’t need hypotheses
examples of analytical studies
cross sectional
case control
cohort
cross sectional studies investigate
disease frequency, survey, prevalance
process of cross sectional studies
- Observations made at a specific point in time
- Conclusions made about relationship of disease and variables in a defined population
+ and - of cross sectional studies
- Advantages: Quick and easy
- Disadvantages: gives no cause
case control study process
- Compare two groups of people; a group who have the disease and group who don’t (ie cases and controls)
- Data gathered to see if individuals have been exposed to the suspect aetiological factors
- Results are given as RR
cohort study process
- Collect baseline data from a group of people who don’t have the disease
- Group then followed until a sufficient number have developed the disease to allow analysis.
- Original group separated into subgroups according to original exposure and then compared to see incidence of disease according to exposure.
- Allow calculation of cumulative evidence for follow up over time
study called that involves trials?
randomised controlled trial
point of trials?
Experiments used to test ideas about aetiology or evaluate interventions
RCT used to
assess new treatment
process of RCT
- 2 groups at risk of developing disease are assembled; split into study (intervention) group and control group)
- Study group = new drug and the control = placebo.
- Treatment outcomes are compared.
- Calculate a relative risk (aetiological components)
standardisation?
removal/adjustments of confounding variables (e.g. age) when comparing pops
SMR?
standardised mortality ratio - death rate converted into ratio for easy comparison
quality of data - is a measurement of
trustworthiness
case definition
Purpose is to decide if an individual has the condition or interest or not
coding and classification
data converted into coding via analysis + storage - rules for this
ascertainment
data set complete? missing subjects
Bias is
any trend in the collection, analysis, interpretation, publication or review of data that can
lead to conclusions that are systematically different from the truth.
types of bias x4
selection bias: not representative of whole study pop
information bias: errors in measuring exposure
follow up bias: 1 group followed up more than another
systematic error bias: measurements tend to always fall on one side of the true value
confounding factor?
one that’s INDEPENDENTLY associated with the disease and the exposure under investigation
EG AGE, SEX,
ways to deal with confounding factors
- randomise
- restrict eligibility criteria
- stratify
- adjust
- matching
criteria for causality means
Criteria demonstrate weight of evidence in favour of a causal relationship.
aspects of the criteria of causality
- strength of association as measured by RR
- consistency: different pops
- specificity: single exposure leads to single disease
- temporality: exposure before disease
- biological gradient: increase exposure increase risk of disease
- bio plausibility: makes sense in bio
- coherence: doesn’t conflict with bio
- analogy: use another disease to act as model
- experiment: controlled experiment to prove association
levels of health promotion - prevention
primary: prevention - vaccines
secondary: prevention of disease: screening - cervical smear
tertiary: prevent disease progression, limit disability, distress: rehab
primordial: wider environ and social - smoke free cities
health promotion definition
over arching principle. enhances:
- health
- disease prevention
- health protection
- health education
planned or opportunistic
health education definition
strategies to improve health knowledge, attitudes, skills or behaviours
health protection definition
collective activities directed at factors that are OUTSIDE of the control of the individual
e.g. smoking ban
empowerment
helping people identify their OWN concerns
Health and life skills to facilitate control
- Communicate effectiveness
- Influence people and systems
- Make relationships
- Be assertive
- Work in groups
- Manage conflict
- Build strengths in others.
many approaches to health promotion…
assessment of ongoing health problems
assess RFs
check ups
advice on healthy lifestyle
services comply with own advice
stress reduction protocol
counselling services
travel advice
sexual health advice
why has health promotion become a component of NHS
more cost effective that treating disease
wider public health + wellbeing
advances health status
challenges to assessing the quality and outcomes of health promotion
hard to achieve long term behaviour change
hard to devote resources to 50yrs
hard to measure QOL
pts can be cyclical or dismissive
people continue to do harmful behaviours despite understanding health implications
NHS dont dedicate resouces
NNT?
number needed to treat
number of people you need to give a drug to to prevent one additional bad outcome
NNH?
number needed to help
number needed to be exposed to risk factor to cause harm that wouldn’t other wise have been harmed
fit notes
note of inclusion
sick note (of exclusion
life limiting illness
reduces life expectancy or/+ quality of life
palliative care
improve QOL for pts, carers, families - providing pain relief, spiritual, psychosocial support
from diagnosis to end of life bereavement
ACP?
anticipatory care pplan
aspects of ACP?
- Where do they want to receive care
- DNR?
- Natural death?
- Do they want to be informed about any changes in their condition
- Are they fully aware of the prognosis
- Are family involved in the care
- placed on palliative care register
palliative performance scale (%)
ambulation self care evidence of disease intake (food drink) conscious level
ACP psychological impact:
shock denial, disbelief
anger, bargaining
despair depression
acceptance and adjustment
ACP social impact
social withdrawal strain on relationships disputes with families financial isolation
ACP medical impact
pain Mx
depression
cost
aspects of a good death in western culture
- personal preference
- personal growth
- awareness
- at home
- with family
- power of attorney
- dignity, consent
- PAIN FREE
ethical aspects of ACP
Dignity, confidentiality, consent, use of DNRs, autonomy, following their wishes.
impacts of palliation of family
- reduced hobbies
- lack of privacy
- financial strain
- satisfaction
- grief
- anxiety/depression
- work less
- restriction socialising
- adapt house
support for families/carers
meals on wheels OT - adjust home rest bite chairites voluntary groups support groups palliation nurses social worker counsellor
how does age affect health
- Increases risk of disease
- Social stigma impacting on mental health
- Reduced mobility
- Isolation
- Inability to work; financial problems impact on well-being
- Cognitive decline
- Reduced ADLs
how does age affect own views on health
- More accepting of conditions
- Understanding of normality; range changes
- Active Ageing = optimisation of physical, social and security
- More likely to seek help as believe more likely to have serious illness
how does age affect others views on your health
- Detrimental
- Burden
- Costly
- Take up space in hospital
- Wisdom, knowledge, life experience.
challenges of ageing pop on NHS
- increased need for geriatricians
- increased need for nurse/wards
- increased prevalence of long term conditions
- need to for specific elderly health promotion
challenges of ageing pop on social aspects
- increased need for care homes, sheltered housing, carers
- dependence on families
- emphasis on social activities for elderly
- house demands
- pensions
services available to the elderly community
panic alarms home care assisted living sheltered housing very sheltered housing care house nursing house hospice/hospital
how elderly people feel when depending on others
- Guilt/burden
- Resentment
- Depression
- Loss of independence
- Social isolation
- Decreased will to live
- Well look after
- Comfortable
- Relieved
- Happy to be with family
- Feel safe
- Better social life/activities/don’t have to sort out shopping
