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402 - General Practice > Global & Public Health > Flashcards

Global & Public Health Flashcards

1
Q

What type of conditions is the global burden of disease heading towards?

A

chronic disease

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2
Q

In the poorest nations, what are the tow components that make up the double burden of disease?

A

Infectious/malnutrition/maternal

Chronic

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3
Q

Who are typically affected by neglected tropical diseases and why?

A

The “bottom billion”

Little access to healthcare
Abandoned by pharmaceutical companies and governments

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4
Q

4 examples of neglected tropical diseases?

A

Dengue
Leprosy
Rabies
Schistosomiasis

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5
Q

5 challenges of neglected tropical diseases?

A 
Poverty impedes simple prevention 
Failure of healthcare systems
Pharmaceutical companies no profit 
Death and disfigurement
Social taboo 
Delay may result from traditional beliefs/treatment
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6
Q

What are the 8 UN Millenium Development Goals

A 
Hunger
Primary education 
infant mortality
maternal health
environmental protection
disease management
gender equality
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7
Q

What is multimorbidity?

A

the coexistence of two or more long-term conditions

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8
Q

What is the “rule of halves” for a condition such as hypertension?

A

half of the cases are not known,
half of those known are not treated
and half those treated are not controlled

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9
Q

What is change in disease pattern known as?

A

Epidemiological transition

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10
Q

5 possible reasons for epidemiological transition

A 
less healthy diets
physical inactivity
tobacco use
urbanization
increased life expectancy
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11
Q

A woman’s diet and body composition at the time of conception and during pregnancy have important effects on the subsequent health of her offspring refers to which epidemiological hypothesis?

A

Barker

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12
Q

What term is defined as: the coexistence of two or more long-term conditions

A

Multimorbidity

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13
Q

Practical implication and example of the rule of halves?

A

half of the cases are not known,
half of those known are not treated
and half those treated are not controlled
HTN

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14
Q

7 reasons for epidemiological transition

A 
less healthy diets
physical inactivity
tobacco use
urbanization
increased life expectancy
“Demographic transition”
Poverty:  unhealthy choices!
?Market forces:  making unhealthy choices easily accessible
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15
Q

What is defined as The rate at which new cases (or events) occur in the population

A

Incidence rate

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16
Q

How will the following affect the incidence rate of a disease?

A

Increase it

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17
Q

What epidemiology measure is best for acute diseases of short duration?

A

Incidence rate

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18
Q

3 types of incidence rate

A

Crude incidence rate (IR)
Age- and sex-specific IR
Age standardised (adjusted) IR

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19
Q

What term is defined as the proportion of people in a population who have a disease / condition / attribute at a particular time

A

Prevalence

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20
Q

Components of calculating prevalence

A

No. of existing cases at a defined time

No. of persons in the population at that time

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21
Q

How does incidence rate differ from prevalence?

A

Incidence is NEW CASES

Prevalence - EXISTING CASES

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22
Q

3 types of prevalence

A

Point
Period
Lifetime

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23
Q

How will these factors affect prevalence?
Increase in new cases (incidence, improved diagnosis or case ascertainment)
Longer duration of the disease (e.g. due to better treatment / survival)
Prolongation of life of patients without cure
In-migration of susceptible people / cases
Out-migration of healthy people

A

increase it

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24
Q

What depends on the incidence and duration of the disease?

A

Prevalence

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25
Q 
Put these in order of hierarchy
Cohort
ecological
case-control
cross sectional
A

cohort
case-control
cross sectional
ecological

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26
Q

Best type of study for treatment decision

A

RCT

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27
Q

Best study for For informing patients about prognosis / survival?

A

Cohort

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28
Q

Best study for Understating the barriers to access mental health services / factors leading to positive experience of care / factors associated with delayed diagnosis of cancer in the elderly

A

Qualitive

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29
Q

Case series
Ecological (correlation, time trend, geographical studies)
Cross-sectional (surveys, prevalence studies)
Case–control
Prospective (cohort) studies (incidence, longitudinal, follow-up studies)
Are all what types of study?

A

Observational

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30
Q

Semi-structured interviews, focus groups

Are what type of study

A

Qualitative

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31
Q 
Clinical trials (RCTs)
Cluster (community) RCTs
Are what type of study
A

Interventional

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32
Q

What type of studies Examine the association between exposures and outcomes by using aggregate (population-level) data

A

Ecologic

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33
Q

What type of study would you use to answer the following questions?
Is dietary fat intake associated with breast cancer mortality?
Do changes in diet over time correlate with changes in CVD over time?
Is naturally occurring lithium in drinking water associated with suicide rates in the population?

A

Ecologic

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34
Q

Cannot determine association or causality at the individual level
Subject to ‘ecological fallacy’
Are weaknesses of what type of study

A

Ecologic

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35
Q

Can examine association at population level
Used for generating hypotheses (initiating further research)
Use existing data – therefore efficient, inexpensive and relatively quick to conduct
Are strengths of what type of study?

A

Ecologic

36
Q

collect information at one particular point in time (also referred to as prevalence studies)
Measure population prevalence to inform healthcare planning
Explore the association between risk factor(s) and disease
Are characteristics of what type of study?

A

Cross Sectional

37
Q

What type of studies do this?
Generate hypotheses and examine association between exposure and disease
Describe the experience of patients using a service
Explore the knowledge, attitudes and practice/beliefs of patients and relate this to adherence to treatment regimens (KAP studies)

A

Cross sectional

38
Q

What type of study is used to calculate prevalence?

A

Cross sectional

39
Q

As data on exposure and disease are collected simultaneously it can be difficult to assess the temporal relationship between the exposure and the outcome
Is a limitation of what type of study?

A

Cross sectional

40
Q

Relatively easy and quick to conduct providing timely insight in emerging conditions (e.g. NHS COVID-19 App, King’s College COVID-19 symptoms tracking APP)

Can provide information on a wide range of exposures and outcomes at the same time

Regular surveys of random samples of the population (e.g. Health Survey for England) provide valuable snapshots of exposures and outcomes

Are strengths of what type of study?

A

Cross sectional

41
Q

people with a condition are compared with those who do not have the condition with respect to one or more exposures of interest
Refers to what type of study?

A

Case-control

42
Q

To test aetiological hypotheses (i.e. potential causal factors)
To study associations of a disease with several exposures and measure potential confounding factors

Are features of what type of study?

A

Case-control

43
Q

What study is Efficient for rare diseases and those with long induction/latent period

A

case-control

44
Q

What type of study is used to identify different clinical patterns, presentations and associations (e.g. evaluation of screening and prevention programmes, vaccine and treatment efficacy, outbreak investigation)

A

case-control

45
Q

OR = 1 means what?

A

no association between the exposure and the disease

46
Q

OR > 1 means what?

A

the exposure is a potential risk factor for the disease (i.e. harmful or positive association)

47
Q

OR < 1 means what?

A

the exposure is potentially protective for the disease (i.e. beneficial or inverse association)

48
Q

Subject to recall and selection bias if not well designed
Inefficient for rare exposures
Is a limitation of what type of study?

A

Case-control

49
Q

Quick to conduct than prospective cohort studies
Good for investigating disease with long latent period between exposure and outcome
Efficient for studying rare diseases
Can examine several possible risk factors for a single disease
Are strengths of what type of study?

A

Case-control

50
Q

What type of study? a group of people are followed over time to determine the incidence of a health outcome or disease – incidence rates in those who are exposed (to a risk factor(s) and those who are not exposed are compared

A

Cohort

51
Q

2 types of cohort study?

A

Prospective

Historical

52
Q

To identify potential causal association between exposure and disease
Understand the physiology, pathogenesis (causal pathways), prognosis, and natural history of disease
Evaluation of screening and prevention programme; vaccine and treatment efficacy (e.g. COVID-19 follow-up studies)
To establish temporality between cause and effect
Are key features of what type of study?

A

Cohort

53
Q

Possible to study association of an exposure with several outcomes (e.g. British Physicians Study)
Possible to study multiple exposure (when a general population cohort is selected irrespective of any particular exposure (e.g. EPIC studies, The Million Women Study, UK Biobank)

Are key features of what type of study?

A

Cohort

54
Q

What are the outcome measure in a cohort study?

A

Incidence (or mortality) rates in the exposed and not exposed groups

55
Q

What is defined as No. of new cases of disease (or event) in the exposed group ÷
Person-years at risk × 100,000 (or per 1000)

A

Incidence rate in the exposed group (absolute risk)

56
Q

What is defined as
No. of new cases of disease (or event) in the not exposed group ÷
Person-years at risk × 100,000 (or per 1000)

A

Incidence rate in the not exposed group (absolute risk)

57
Q

What is defined as

Incidence rate in the exposed (observed) ÷ Incidence rate in the not exposed (expected)

A

Relative risk (rate (or risk) ratio)

58
Q

What is defined as

incidence rate in the exposed – incidence rate in the not exposed

A

Attributable risk (rate (or risk) difference)

59
Q

Expensive to conduct – may take a long time to complete
Inefficient for rare diseases unless cohorts are very large (e.g. UK Biobank)

Are limitations of what type of study?

A

Cohort

60
Q

Temporality between exposure and disease can be established
Measurement of incidence rate of disease in exposed and not exposed groups
Examination of multiple outcomes (diseases, mortality) for any given exposure
Suitable for examining rare exposures (e.g. asbestos exposure amongst factory employees)

Are strengths of what type of study

A

Cohort

61
Q

The investigator assigns individuals (or communities) to two or more groups that either receive or do not receive a preventive or therapeutic intervention or treatment

Refers to what type of study?

A

Intervention

62
Q

active manipulation of the exposure by the investigator is the hallmark of these studies
Like a prospective cohort, the groups are followed into the future to observe the outcome(s)

Are features of what type of study?

A

Intervention

63
Q

What is defined as Systematic error in the design, data collection procedures, analyses, reporting, or a combination of these factors that can lead to conclusions that are systematically different from the truth

A

Bias

64
Q

What type of bias is: systematic differences between the characteristics (i.e. those which are related to exposure and/or outcome) of people who take part in a study and characteristics of those who do not

A

Selection

65
Q

↓ participation by heavy smokers in studies of smoking and disease
↑ participation by health-conscious individuals or those with family history of cancer in voluntary cancer screening
Are examples of what type of bias?

A

Selection

66
Q

Develop an objective case definition

Achieve high participation (response) rates

Include all cases in a defined time/place (representativeness)

Take diagnostic and other relevant practices into account when designing the study

Will affect what type of bias?

A

Selection

67
Q

systematic differences in the way information on exposure and/or outcome is collected
→ different quality (accuracy) of information between the comparison groups
Refers to what type of bias?

A

Information

68
Q

Using different methods and/or instruments to measure BP to classify hypertension
Is an example of what type of bias?

A

Information

69
Q

Questionnaire design

Mask subjects/interviewers to the study hypothesis

Use different methods to retain and trace subjects

Use the most accurate information source, and sensitive and specific criteria (or clinical equipment/tests) to classify the exposure and disease

Would affect what type of bias?

A

Information

70
Q

What is defined as a distortion or mixing of effects between an exposure, an outcome, and a third extraneous variable known as a confounder

A

Confounding

71
Q

3 requirements of a confounding factor?

A

be associated with the disease
be associated with the exposure
not be an effect of the exposure

72
Q

3 ways of avoiding confounding in analysis stage

A

Stratification
Standardisation
Multivariable analysis / multiple regression

73
Q

4 ways of avoiding confounding in design stage

A

Matching (e.g. pairwise/frequency matching for age/gender)
Restriction (e.g. limiting the study population to one gender)
Collecting information on potential confounders (e.g. age, gender, smoking)
Randomisation (e.g. intervention studies)

74
Q

What is defined as the portion of variation in a measurement that has no apparent connection to any other measurement or variable, generally regarded as due to ‘chance’

A

random error

75
Q

What can random error lead to?

A

a false association between the exposure and disease

76
Q 
Individual biologic variation
Sampling variability 
Measurement error (errors in assessing exposure/disease)
Are sources of what?
A

Random error

77
Q

2 methods of quantifying random error?

A 
The P value (with a threshold of 0.05) 
Confidence interval (CI) estimation (around a point estimate, which is either a measure of disease frequency (IR, prevalence) or association (RR, OR)
78
Q

preventing onset of disease is what type of prevention?

A

Primary

79
Q

preventing progression of disease (early diagnosis and treatment) is what type of prevention?

A

Secondary

80
Q

reducing disability and suffering from disease is what type of prevention?

A

tertiary

81
Q 
healthy diet
regular exercise 
avoidance of (or exposure to) smoking 
sunscreen use 
Immunisation (e.g. COVID-19)
policies to maintain a clean supply of water, air, and food
eliminating environmental risks (e.g. safe home/work environment)
Type of prevvention?
A

Primary

82
Q

Screening (breast, cervical, AAA) and other methods of early detection and diagnosis
What type or prevention?

A

Secondary

83
Q

4 types off screening?

A

Mass or population –
Multiple or multiphasic –
Targeted –
Case-finding or opportunistic –

84
Q

4 examples of NHS screening

A

Breast
Cervical
Bowel
AAA

85
Q

drugs to prevent opportunistic infection in HIV+ persons
keeping the level of HbA1c <7% to reduce the effect of the disease
use of statins, beta blockers and aspirin to prevent MI in patients with CHD; risk factor, behaviour, and lifestyle modification
What type of prevention

A

tertiary

402 - General Practice (8 decks)

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