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RC2020 > Week of August 3 > Flashcards

Week of August 3 Flashcards

1
Q

Differentiate between population attributable risk

and attributable risk / risk difference

Explain what a PAR of 0.009 is compared to a RD of 0.009

A

Population attributable risk is the amount of the excess risk in the population due to the exposure of interest. It account for the excess risk of the exposure and its prevalence in the population.

Attributable risk tells you the excess risk among the exposed compared to the unexposed. It does not account for the prevalence of an exposure.

a PAR of 0.009 means that the exposure is responsible for an 9 excess cases per 1000 people in the population

a RD of 0.009 means that for every 1000 people who experience the exposure you would expect 9 additional cases compared to if no one was exposed

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2
Q

The incidence of disease in the exposed group is 50 per 1000 and the incidence in the unexposed group is 25 per 1000

Calculate and attributable risk percent

Interpret this value

A

Two options

a) (RR-1)/ RR *100

or

(Incidence exposed - incidence unexposed) / incidence exposed

= 50%

so 50% of the outcome in the group that had the exposure could be attributed to having had the exposure

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3
Q

What can be the public health roles in addressing racial health inequity?

A

NCCDH, 2018

1) Building Capacity to analyze and take action on drivers that foster racial inequities
2) Create knowledge by assessing and reporting on the impact of racialization and racism including analyzing health outcomes utilizing an anti-racism lens, and measuring racism on both individual and structural levels
3) Re-orient/modify Health and social interventsion to eliminate racialized health inequities.
4) Develop Policies with an overt focus on tackling racism including implementing racial equity assessments
5) Develop partnerships with other sectors and communities

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4
Q

Name one Policy framework and describe its element.

A

Kingdom’s Multiple Stream Framework

  • Problem Stream where a problem needs solutions
  • Policy Stream where policies alternatives are debated by a policy community.
  • Political Stream, where power comes into play (three elements= national mood, interest groups, government)
  • When all three streams align, a policy window opens presenting an opportunity for a policy advocate to push their solution or raise awareness of their problem.
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5
Q

A vaccine has been newly licensed for the disease, Cute Aggression caused by the Adorable Bunny Virus with a R0 of 3. In a RCT with 200,000 study participants, 50% had the vaccine administered and 50% had a placebo administered. In the vaccinated group, 5,000 participants developed the disease; in the unvaccinated group, 100,000 participants developed the disease.
Please calculate the vaccine coverage required to achieve the herd immunity.

A 
VE= (Incidence in unvaccinated - Incidence in vaccinated)/ Incidence in unvaccinated x 100%
VE = (0.5 - 0.05)/0.5 x 100% 
VE = 0.45/0.5 x 100%
VE = 0.9 x 100%
VE = 90%
This vaccine has 90% efficacy.

Vaccine Coverage = (1- 1/R0) / VE
Vc= (1-1/3)/0.9 = 0.666/0.9 = 0.74
You need at least 74% of the susceptible population administered to achieve herd immunity threshold.

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6
Q

What are the four population health indicators (according to CIHI)

A

Health Status
- deaths, health conditions, wellbeing

Non-medical determinants of health
- risk behaviours, living conditions, environment, personal resources (social supports)

Health System performance
- can the health system provide timely, accessible, safe and effective care

Community and health system characteristics

  • demographic information (population, teen pregnancy rate)
  • health system demographics (doctors per capita, hospital beds per capita)
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7
Q

List 8 measures and the associated data sources that you would use to assess the health of a population in a population health asesssment

A

Community and health system characteristics

  • Age and sex breakdown (census data)
  • Language spoken
  • Cultural background
  • Mortality, birth rate, infant mortality rate (vital statistics)

Health Status Indicators

  • Immunization Status
  • Chronic Conditions (CCHS)
  • Mental Health Indicators
  • Health Measures - blood pressure, obesity (CHMS)
  • Screening received (i.e. cervical cancer, CRC)

Non-medical Determinants of Health

  • Education
  • Income and finances
  • Personal Health Behaviors (smoking, alcohol, physical activity)
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8
Q

a) Define Program Planning

b) Outline steps in program planning

A

multi-step process that outlines the problem, proposed intervention, and evaluation plan.

  1. Manage the planning process (engage stakeholders, timelines, resources)
  2. Conduct a situational assessment
  3. Identify goals, populations of interest, outcomes and outcome objectives
  4. Identify strategies, activities, outputs process objectives and resources
  5. Develop indicators
    Purpose: to develop a list of variables that can be tracked to assess the extent to which outcome and process objectives have been met
  6. Review the program plan
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9
Q

Outline six steps in program evaluation

A

Six Steps
Engage Stakeholders

Describe Program

  • Need (what does the program address)?
  • Expected effects (what does it accomplish to succeed?)
  • Activities (program logic / theory)
  • Resources (what inputs go in)

Focus Evaluation Design

Gather Credible Evidence

Justify Conclusions

Ensure use and share lessons

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10
Q

What are three types of stakeholders that should be engaged during a program evaluation?

A

Three types of stakeholders

  • Those involved with the program
  • Those Served by the program
  • Users of the Evaluation (decision makers)
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11
Q

What factors go into making a recommendation by the CTPFHC

A
  1. Quality of evidence (GRADE Evidence - Strong, Moderate, Weak)
  2. The balance between desirable and undesirable effects;
  3. The variability or uncertainty in values and preferences of citizens;
  4. Whether or not the intervention represents a wise use of resources.
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12
Q

What are the three GRADE recommendations and what criteria is used to put evidence into these categories?

A

The quality of evidence is categorized as strong, moderate or weak

Strong - a) many studies with no limitations, b) studies are consistent c) estimate of effect has narrow confidence interval

Quality of evidence might be seen as strong when; there is a wide range of studies included in the analyses with no major limitations, there is little variation between studies, and the summary estimate has a narrow confidence interval.

Quality of evidence might be seen as moderate when; there are only a few studies and some have limitations but not major flaws, there is some variation between studies, or the confidence interval of the summary estimate is wide.

We judge evidence to be low or very low quality when the true effect may be substantially different from the estimate of the effect. For example, evidence might be judged as low quality if any of the following applies: the studies have major flaws, there is important variation between studies, or the confidence interval of the summary estimate is very wide.

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13
Q

Outline the differences between social marketing and commercial marketing

A

Social Marketing
Ultimate Goal
- improvement of individual health and societal wellbeing

Proximate Goal
- change in desired behaviour

Target
- population in need / willing to change

Competition
- current behaviour

Commercial Marketing
Ultimate Goal
- Financial Gain

Proximate Goal
- selling product / services

Target
- population that will maximize sales

Competition
- other businesses offering similar services

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14
Q

7 attributes of a effective surveillance system

A

PS-FARTS + SVQ (acronym credit: Laura Bourns)

Positive predictive value: High proportion of positives are actually cases

Sensitivity: Ability of the surveillance system to detect the health problem it was intended to detect***

Flexibility: Ability of the surveillance system to accommodate changes in the operating conditions

Acceptability: To individuals and organizations who must participate

Representativeness: Extent to which surveillance findings accurately portray the event**

Timeliness: Data available rapidly enough for public health authorities to take action*

Simplicity: Ease of operation

Stability: Reliability of resources, personnel, and technology required to support the surveillance system

Validity: Surveillance data are measuring what they are intended to measure

Quality: Complete and valid data

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15
Q

List 4 indicators of health system performance, and one example of each.

A

Accessibility - proportion of population with a family doctor.
Acceptability - patient satisfaction scores.
Safety - incidence of hospital acquired infections.
Efficiency - wait times for diagnostic procedures.

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16
Q

List 4 indicators of health status, and one example of each.

A

Mortality - all cause mortality rate.
Health conditions - type 2 diabetes prevalence.
Well-being - self reported health status.
Function - disability adjusted life expectancy.

17
Q

What are some population level interventions to reduce obesity rates?

A
  • Restriction on marketing and advertising of junk food.
  • Menu labeling.
  • Taxation of sugar sweetened beverages.
  • Nutrition policies in schools; availability of healthier food choices in cafeteria.
  • Increased access to active transport - bike lane infrastructure.
  • Subsidizing gym memberships.
18
Q

A cohort study compares rates of disease by subtracting the rate of disease in an unexposed group from the rate of disease in the exposed group.

List all ways that this measure can be referred to

How do you interpret this measure

A 
Attributable Risk, 
Risk Difference, 
Excess Risk, 
Absolute Risk Reduction, 
Absolute Risk

Subjects who had an exposure X had Y additional cases of outcome Z per 100 people compared to subjects who did not have exposure X.

19
Q

Define Selection Bias

A

selection of subjects into a study or their likelihood of being retained in the study leads to a result that is different from what you would have gotten if you had enrolled the entire target population

20
Q

What are three ways that selection bias can occur in a case-control study and provide an example

A
  1. Control Selection Bias.
    Example - method of selecting controls into the study is more likely to recruit controls who have the exposure of interest than the general population.

Problem because controls are used to estimate prevalence of exposure in source population of cases.

  1. Self-Selection Bias - agreeing to participate in the study is related to the exposure of interest and the outcome.
  2. Differential surveillance / diagnosis of cases and controls. Cases and controls may have been subjected to different levels of case finding.
21
Q

What are three ways that selection bias can occur in a cohort study

A
  1. Differential loss to follow up. Individuals with the exposure are more likely to develop a secondary condition and drop out of the study than individuals without the exposure.
  2. Subject Selection (retrospective only). Example, Individuals who had the outcome and exposure of interest are more likely to participate.
  3. Healthy worker effect (special type of subject selection bias)
22
Q

What are the two general types of biases in a study that can occur and explain them.

A

Information bias: Systematic error in measurement, producing differential accuracy of information by level of exposure or outcome (e.g., recall, reporting, observer)

Example recall bias: respondent does not remember things correctly

Interviewer/observer bias: interviewer unintentionally influences subject’s responses

Example Selection bias: Subjects are selected such that the distribution of a characteristic among the subjects differs from the distribution of the characteristic in the target population (e.g., sampling, attribution, publication)

23
Q

Most common cancers in men and women

A
  1. Prostate or Breast (Sex Specific Cancer)
  2. Lung
  3. Colorectal
24
Q

Top cause of cancer death in men and women

A

Women

  1. Lung
  2. Breast
  3. CRC

Men

  1. Lung
  2. CRC
  3. Prostate
25
Q

THREE GENERAL POLICY RECOMMENDATIONS TO PREVENT OCCUPATIONAL CANCER IN CANADA

A 
1. Strengthen occupational exposure limits
across all Canadian jurisdictions.
2. Reduce or eliminate the use of cancer causing substances with toxic use
reduction policies in workplaces.
3. Create registries of workplace
exposures to occupational carcinogens
that will facilitate the tracking of
exposures over time.
26
Q

What are five commonly used indicators for water quality for municipal scale drink water systems?

A

Biological

  1. Turbidity
  2. Chlorine residual
  3. Total Coliforms
  4. E.coli
  5. Cryptosporidum and giardia

Chemicals

  1. PH (acidity)
  2. Trihalomethanes
  3. Flouride level
27
Q

What does the presence of e.coli in drinking water (assume not false positive) indicate?

A

there has been fecal contamination of the water and the water should be considered unsafe to drink

28
Q

What does the presence of total coliforms in the water indicate?

A

Coliforms: These bacteria are often found in animal waste, sewage, as well as soil and vegetation. If they are in your drinking water, surface water may be entering your well.

29
Q

What four actions should immediately be undertaken when a municipal water system tests positive for e.coli

A
  1. Check other operating parameters of system (high turbidity, loss of chlorine residuals, results from other samples)
  2. Re-sample from test site and adjacent sites
  3. Issue a BWA if more than 1 test is positive or any other indicators (loss of chlorine residual)
  4. Communicate BWA to community and specific populations if issuing one (LTCF, Hospitals)
30
Q

Outline an overall approach (start to finish) related to a adverse event related to a municipal level water system

A

Water advisory steps: VGN-CDR

Verify accuracy of indicator exceedance (retest)

Gather other data (turbidity, chlorine residuals)

Notify authorities (PHU, ministry of health/env)

Corrective action (increase disinfection, flush lines)

Decide on advisory, notify public

Rescind advisory (Rescinded by LPHA)

31
Q

What toxin is associated with cyanobacteria. What level of cyanobacteria and associated toxin are permissible in recreational water?

A

Cyanobacteria

Total cyanobacteria

≤ 100,000 cells/mL

Cyanobacterial toxins

Total Microcystins

≤ 20 μg/L (ppb)

32
Q

Outline 5 steps in wastewater treatment

A

Screening: Large pieces of debris (“chunks”) are removed and disposed of in a landfill

Settling: Solids settle to the bottom of a tank; supernatant is removed

Aeration: Supernatant is aerated (or filtered) to allow aerobic microorganisms to consume organic material

Clarifier: Solids settle to the bottom of the tank (again) and are sent to sludge processing

Sludge processing: Sludge from settling tank and clarifier is digested by microorganisms

Disinfection: Aerated supernatant is disinfected (usually with chlorine) and then returned back to the water cycle (ie. to source water - lake)

Sludge disposal: Processed sludge can be used in agriculture (fertilizer), biofuel (nitrogen, methane), incinerated, or sent to landfill

33
Q

What are 5 elements of the multi-barrier approach to drinking water with examples

A

Multi-barrier approach to safe drinking water: “Source to tap”

  1. Source protection keeps the raw water as clean as possible to lower the risk that contaminants will get through or overwhelm the treatment system.
  2. Treatment often uses more than one approach to removing or inactivating contaminants (e.g., filtration may be followed by chlorination, ozonation, or ultraviolet radiation).
  3. Securing the distribution system against the intrusion of contaminants and ensuring an appropriate free chlorine residual throughout is highly likely to deliver safe water, even when some earlier part of the system breaks down.
  4. Management: Standard operating procedures, operator certification, contingency procedures, communication procedures
  5. Guidelines Standards and Objectives
    - water quality standards, source protection guidelines
  6. Public involvement and awareness: All levels of government should be transparent and communicate regularly with stakeholders and the public regarding issues of water safety; owners of private drinking water systems are responsible for regularly testing their water
  7. Monitoring programs, including equipment fitted with warning or automatic control devices, are critical in detecting contaminants that exist in concentrations beyond acceptable limits and returning systems to normal operation.
  8. Legislative and policy frameworks: Outline who is responsible for which aspects of the drinking water system
34
Q

How do you calculate a DALY?

A

DALY = Years life lost + years lived with disability

Take the difference between the age of death and average life expectancy for a person at the age of death (e.g. died at 50 and life expectancy for 50 year old in Canada is 84 - 34 years) and add the number of years they lived in a disease state multiplied by the disability weight value attributed to that state (5 years of being blind * year of blindness = 0.5 “year being blind is considered to be half the value of a year being sighted”). The higher the disability weight value (closer to 1) the worse the disability.

35
Q

What are 5 psychological workplace factors?

A 
Psychological workplace factors
	• balance
	• civility and respect
	• clear leadership and expectations
	• engagement
	• growth and development
	• involvement and influence
	• organizational culture
	• protection of physical safety
	• psychological competencies and demands
	• psychological protection
	• psychological and social support
	• recognition and reward
	• workload management
https://www.guardingmindsatwork.ca/about/about-psychosocial-factors
36
Q

What are four components of a public health units heats response plan

A

Mitigate and/or Prevent
o Environmental interventions to reduce heat islands, improve building design, etc.
o Surveillance systems for detecting heat events and/or heat-related mortality

Prepare
o Development of protocols and procedures
o Education and information for health workers

Respond
o Targeted outreach for at-risk groups
o Cooling shelters

Recover
o Debrief and evaluate

37
Q

What are four key elements that should be included in a job description when being publically posted?

A
  1. Job Title (PHN), Type (Casual, permanent) and Desired start date
  2. Desired qualifications / pre-requisites
  3. Job details - salary, location
  4. Job expectations / responsibilities
  5. Details on how to apply / required documents
38
Q

PHO 10-steps for program evaluation

A
  1. clarify what is to be evaluated
    1. engage stakeholders
    2. assess resources and evaluability
    3. determine evaluation questions
    4. determine appropriate methods of measurement
    5. develop evaluation plan
    6. collect data
    7. process data
    8. interpret and disseminate results
  2. apply evaluation findings
39
Q

What are the steps in a surveillance system

A

Data Collection - case definition, sampling,
Analysis - time, person, place
Interpretation - evaluation, trends, comparisons
Dissemination - reports, alerts, publication
Action

RC2020 (25 decks)

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