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Community medicine > Epidemiology (final exam) > Flashcards

Epidemiology (final exam) Flashcards

Includes demography and standardization, smoking cessation, and epidemiology of infectious disease

1
Q

Define

Demography

A

The study of populations, especially with reference to

  • size and density,
  • fertility,
  • mortality,
  • growth,
  • age distribution,
  • migration, and
  • vital statistics;

and the interaction of all these with social and economic conditions

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2
Q

What factors determine population size?

A
  • Birth
  • Death
  • Migration
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3
Q

How is population size calculated?

A

P2 = P1 + B – D + IM – EM, where

  • P1 is the previously recorded population size
  • B is the number of births
  • D is the number of deaths
  • IM are immigrants (migrants into the area)
  • EM are emigrants (migrants out of the area)
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4
Q

How do natural population increase and decrease occur?

A
  • Increase: when births outnumber deaths
  • Decrease: when deaths outnumber births
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5
Q

How can population growth rates be described?

A
  • Annual percentage increase
  • Population doubling time (PDT)
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6
Q

Define

Population doubling time

A

The number of years it will take for the population to double in size

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7
Q

How is PDT calculated?

A

PDT = 70/annual percentage increase

(annual percentage increase is kept as a percentage, i.e. if it’s 2.3%, it is left as 70/2.3, not 70/0.023)

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8
Q

What is the PDT for a population growing at 3% per annum?

A

PDT = 70/3%
= 23.33
≈ 23 years

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9
Q

What are sources of demographic information?

A
  • Censuses
  • Population registers
  • Registration of vital events
  • Sample household survey
  • Governmental and private record systems
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10
Q

What are the types of censuses?

A
  • Decennial: a poll count on a 100% sample, held every 10 years
  • Midcensus: a poll count on a 10% sample, held every 10 years between full censuses
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11
Q

What are the limitations of censuses?

A
  • Costly
  • Slow
  • Censuses in developing countries are likely to be incomplete and inaccurate
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12
Q

What is a population register?

A

More or less equivalent to a continuous census

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13
Q

What kinds of events are recorded in vital event registers?

A
  • Births
  • Deaths
  • Marriages
  • Divorces
  • Stillbirths
  • Adoptions
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14
Q

What systems are included in governmental/private record systems?

A
  • Health services
  • Education
  • Armed forces
  • Social security
  • Insurance
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15
Q

What are the types of population data?

A
  • Population size
  • Mortality (death) rates
  • Fertility: birth rate, fertility rate
  • Residential mobility
  • Population composition
  • Geographic distribution of the population
  • Population characteristics: marital and family status, education, occupation, income
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16
Q

Why are age and sex composition chosen to make population pyramids?

A

These two factors influence to pattern of mortality and natality more than any other factors

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17
Q

What are the common shapes of population pyramids?

A
  • Spike
  • Wedge
  • Barrel
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18
Q

What are the characteristics of a spike-shaped population pyramid?

A
  • Wide base with a rapidly narrowing apex
  • High birth rate and high death rate at all ages
  • Low total growth rate
  • Characteristic of an underdeveloped country in primitive demographic equilibrium
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19
Q

Which population pyramid shape is typical of an underdeveloped country in a primitive demographic equilibrium?

A

Spike shape

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20
Q

What are the characteristics of a wedge-shaped population pyramid?

A
  • Wide base and gradually narrowing apex
  • High birth rate and low death rate
  • High total growth rate
  • Characteristic of a country in demographic transition with a rapidly growing population
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21
Q

Which population pyramid shape is typical of a country in demographic transition?

A

Wedge shape

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22
Q

What challenges face a country with a wedge-shaped population pyramid?

A
  • Imbalance of its dependency ratio
  • Severe socioeconomic stress
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23
Q

What are the characteristics of a barrel-shaped population pyramid?

A
  • Narrow base with little further narrowing towards the apex
  • Low birth rate and low death rate
  • Characteristic of developed country in an evolved demographic equilibrium
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24
Q

Which population pyramid shape is typical of developed countries in an evolved demographic equilibrium?

A

Barrel shape

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25
Q

What are the factors affecting mortality?

A
  • Age structure (the main determinant)
  • Environment
  • Economic development
  • Technological advance
  • Medical services/development of public health
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26
Q

What are the common causes of death in primitive, developing, and developed societies?

A
  • Primitive: plague, cholera, typhus, smallpox (formerly)—i.e. epidemic infectious diseases
  • Developing: dysentery, tuberculosis, pneumonia—i.e. endemic infectious diseases
  • Developed/modern: chronic diseases—mainly cancer and ischemic heart disease
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27
Q

What kinds of death rates can be compared for populations?

A
  • Crude death rate
  • Age-specific death rate
  • Standardized death rate
  • Standardized mortality ratio (SMR)
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28
Q

Why is comparing crude death rates not advisable?

A

The differences could be due only to the demographic differences between the populations, e.g. proportion of elderly people

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29
Q

How is the difference in age composition of populations adjusted for when comparing death rates?

A

Standardization

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30
Q

What are the methods of standardization for death rates?

A
  • Direct: using a standard population for age distributions (the number of people in each age tier)
  • Indirect (SMR): using a standard population for age-specific death rates (the death rates themselves)
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31
Q

When is direct standardization used?

A

To compare large populations

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32
Q

What is a standard population?

A

Any population chosen to provide the data for standardized death rates. It can be either of the populations being compared, or one entirely unrelated

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33
Q

What are the advantages of direct age standardization?

A
  • Consistency: if the age-specific death rates in population A are all higher than those in population B, this will still be reflected in the standardized rates
  • Directly standardized rates can be compared over time if the same standard population is used
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34
Q

What are the limitations of direct age standardization?

A
  • Data on death rates by age must be available
  • Not suitable for small populations, as the age-specific rates are based on small numbers and thus very unstable
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35
Q

What is indirect standardization?

A

Adjusting for differences in age by calculating the number of deaths expected in the population if it had the same mortality experience as a reference population

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36
Q

What are the benefits of using a SMR?

A
  • Easier to use
  • Permits for statistical calculations (confidence interval)
  • The information necessary is more easily available than for direct standardization
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36
Q

When is SMR more useful than direct standardization?

A
  • Small populations
  • When the age-specific death rates are unknown
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37
Q

How is SMR calculated?

A

SMR = (observed deaths × 100)/expected deaths

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38
Q

How are expected deaths calculated for SMR?

A

Multiplying the age-specific death rate for the reference population by the age range population of the population under study

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39
Q

How is SMR interpreted? What does an SMR of 120 mean? What does an SMR of 60% mean?

A
  • SMR = 100: the study population has the same mortality rate as the reference population
  • SMR > 100: the study population has a mortality rate higher than the reference population
  • SMR < 100: the study population has a mortality rate lower than the reference population

SMR of 120 means the study population’s mortality rate is 20% higher than the reference population’s
SMR of 60 means the study population’s mortality rate is 50% lower than the reference population’s

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40
Q

What is the effect of chronic nicotine exposure on the central nervous system?

A
  • Neuroadaptation: an increase in the number of brain nicotinic cholinoceptors
  • Changes in gene expression and neural plasticity
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41
Q

What is the biology of nicotine addiction and the role of dopamine?

A
  1. Nicotine stimulates dopamine release
  2. Dopamine triggers pleasurable feelings
  3. Repeat administration to experience pleasure
  4. Development of tolerance and increase in the needed dose
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42
Q

What are the steps in the dopamine reward pathway?

A
  1. Nicotine enters the brain
  2. Nicotine binds to α4β2 nicotinic receptors
  3. Stimulation of α4β2 receptors leads to stimulation of the ventral tegmental area (VTA)
  4. The VTA has dopaminergic neurons that extend to the nucleus accumbens
  5. The nucleus accumbens and VTA ultimately stimulate the prefrontal cortex
  6. The prefrontal cortex begins the cascade of reactions resulting in the neuroendocrine and visceral responses to reward
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43
Q

What are the biologic factors for tobacco addiction?

A
  • Desire for the direct pharmacologic actions of nicotine
  • Relief of withdrawal symptoms
  • Learned associations and behavior
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44
Q

What are some reasons smokers provide for their continued smoking?

A
  • Pleasure
  • Arousal
  • Enhanced vigilance
  • Improved performance
  • Relief of anxiety or depression
  • Appetite suppression
  • Control of body weight
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45
Q

What are the symptoms of nicotine withdrawal?

A
  • Depression
  • Insomnia
  • Irritability, frustration, and anger
  • Anxiety
  • Difficulty concentrating
  • Restlessness
  • Increased appetite and weight gain
  • Decreased heart rate
  • Cravings for nicotine
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46
Q

What is the onset and duration of nicotine withdrawal symptoms?

A
  • Symptoms peak 24–48 hours after quitting
  • Symptoms subside within 2–4 weeks
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47
Q

What are the immediate benefits to smoking cessation (< 1 week)

A
  • Easier breathing due to relaxation of bronchial tubes
  • Energy levels increase
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48
Q

What are the medium-term benefits to smoking cessation (months–1 year)

A

1 month

  • Skin appearance improves due to improved skin perfusion

3–9 months

  • Cough, wheezing, and breathing problems improve
  • Lung function increases by up to 10%

1 year

  • Risk of heart attack falls to half that of a smoker
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49
Q

What are the long-term benefits to smoking cessation (years)

A

10 years

  • Risk of lung cancer falls to half that of a smoker

15 years

  • Risk of heart attack falls to the same level as a person who has never smoked
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50
Q

How is smoking cessation managed?

A
  • Behavioral therapy, AND
  • Nicotine replacement therapy OR nicotinic partial agonists
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51
Q

What is nicotine replacement therapy (NRT)?

A

Providing the smoker with nicotine without using tobacco, thereby relieving symptoms of nicotine withdrawal

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52
Q

What is the principle behind NRT?

A
  • Many of the difficulties in sustained smoking cessation are due to nicotine withdrawal
  • NRT attenuates the severity of withdrawal, making it easier for ex-smokers to cope with abstinence
  • When combined with unlearning the habitual elements of smoking addiction, this results in higher chances of success
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53
Q

What are the kinds of NRT?

A
  • Nicotine patches
  • Nicotine gum
  • Nicotine lozenges
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54
Q

What is the typical length of nicotine patch treatment?

A

12 weeks

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55
Q

How long do the effects of nicotine patches last?

A

16–24 hours

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56
Q

What is the typical treatment regime of nicotine patches?

A

21–24 mg/24 h, 14 mg/24 h, 7 mg/24 h

Administered for 6, 3, and 3 weeks, respectively, or 8, 2, and 2 weeks

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57
Q

What are the contraindications and precautions of using nicotine patches?

A
  • Pregnant or breastfeeding women
  • Smokers with cardiovascular conditions
  • Smokers using other NRT products
  • Children
  • Non-smokers
  • Smokers of fewer than 10 cigarettes a day
58
Q

How should nicotine patches be applied?

A
  • Apply to non-hairy, clean, dry skin
  • Rotate between sites to prevent irritation
  • Choose a flat surface
  • Avoid joints or skin folds
  • Replace at the same time everyday
  • Do not smoke while using the patch
59
Q

What is the rationale behind using 24-hour nicotine patches, when 16-hour patches (giving 8 nicotine-free hours) exist?

A

Many dependent smokers wake up at night to smoke or otherwise cannot withstand being nicotine free overnight

60
Q

When are nicotine lozenges preferred over nicotine gum?

A

Smokers with dentures or poor dentition

61
Q

What is the best course of treatment for smokers with ischemic heart disease?

A

Beginning with behavioral therapy and only using NRT if this fails

62
Q

What is varenicline?

A

A partial agonist of the α4β2 nicotinic cholinoceptor

(In the presence of actual nicotine, it acts as an antagonist)

63
Q

What is the usual treatment regimen of varenicline?

A

Week 1: 0.5 mg once daily for 3 days, then 0.5 mg twice daily for 4 days

Then: 1 mg twice daily for 8–12 weeks

64
Q

What are the contraindications of varenicline?

A
  • Should not be used in those under 18, as it has not been tested on children
  • Varenicline may pass into breast milk
  • Lower doses are advisable for people with kidney problems
  • Has not been tested for teratogenicity and so should not be used by pregnant women
  • Caution is advised for patients with history of psychiatric illness
65
Q

What are the side effects of varenicline?

A
  • Vomiting and nausea
  • Headaches
  • Sleep disturbances and atypical dreams
  • Flatulence (wind)
  • Dysgeusia (changes in how food tastes)
  • Constipation
  • Suicide ideation
66
Q

What is the main use of bupropion (Zyban)?

A

Atypical antidepressant (norepinephrine–dopamine reuptake inhibitor)

67
Q

What are the side effects of bupropion?

A
  • Insomnia
  • Agitation
  • Dry mouth
  • Headache
  • Lowering of the seizure threshold
68
Q

How does bupropion function in smoking cessation?

A

It prevents dopamine and norepinephrine reuptake, enhancing CNS noradrenergic and dopaminergic release

69
Q

What are the outcomes of the Fagerstorm scoring system?

A
  • 7–10: highly dependent
  • 4–6: moderately dependent
  • < 4: minimally dependent
70
Q

What are the questions asked in the Fagerstorm scoring system?

A
  1. How soon after waking up the person smokes
  2. If the person can resist smoking in places where smoking is inappropriate (e.g. hospitals, schools)
  3. Which cigarette the person treasures most: the first one in the morning, or any other
  4. How many cigarettes the person smokes
  5. If the person smokes more during the first few hours after waking up
  6. If the person still smokes when badly ill
71
Q

Define

Acute disease

A

Disease in which symptoms develop rapidly and that runs its course quickly

72
Q

Define

Chronic disease

A

Disease with usually mild symptoms that develop slowly and last a long time

73
Q

Define

Subacute disease

A

Disease with time course and symptoms between acute and chronic

74
Q

Define

Asymptomatic disease

A

Disease without symptoms

(Shocker, I know)

75
Q

Define

Communicable disease

A

Disease transmitted from one host to another

76
Q

Define

Latent disease

A

Disease that appears a long time after infection

77
Q

Define

Contagious disease

A

Communicable disease that is easily spread

78
Q

Define

Noncommunicable disease

A

Disease arising from outside of hosts or from opportunistic pathogen

79
Q

Define

Local infection

A

Infection confined to a small region of the body

80
Q

Define

Systemic infection

A

Widespread infection in many systems of the body; often travels in the blood or lymph

81
Q

Define

Focal infection

A

Infection that serves as a source of pathogens for infections at other sites in the body

82
Q

Define

Primary infection

A

Initial infection within a given patient

83
Q

Define

Secondary infection

A

Infections that follow a primary infection; often by opportunistic pathogens

84
Q

What is the importance of studying the epidemiology of communicable diseases?

A
  • Changes of the pattern of infectious disease
  • Discovery of new infections
  • The possibility that some chronic diseases have an infective origin
85
Q

Define

Hyperendemic

A

A disease that is constantly present at high incidence and/or prevalence rates and affects all age groups equally

86
Q

Define

Holoendemic

A

A disease with a high level of infection beginning early in life and affecting most of the child population, while the adult population shows evidence of the disease much less, e.g. malaria

87
Q

What is an example of a holoendemic disease?

A

Malaria

88
Q

Define

Sporadic disease

A

A disease where cases are few and separated widely in time and place, with irregular, haphazardly and generally infrequent incidence, e.g. polio, meningococcal meningitis, tetanus

89
Q

What are examples of sporadic diseases?

A
  • Polio
  • Meningococcal meningitis
  • Tetanus
90
Q

Define

Exotic disease

A

A disease that is imported into a country where it normally does not occur, e.g. rabies in the UK, yellow fever in India

91
Q

What are examples of exotic diseases in specific countries?

A
  • Rabies: UK
  • Yellow fever: India
92
Q

Define

Nosocomial infection

A

A hospital-acquired infection originating in a patient while in a hospital or other healthcare facility. Must be a disorder unrelated to the patient’s primary condition, e.g. infection of surgical wounds, hepatitis B, UTIs

93
Q

Define

Opportunistic infection

A

Infection by organisms that take the opportunity presented by a defect in host defense systems to infect the host and cause disease, e.g. herpes simplex virus, cytomegalovirus, and tuberculosis in AIDS patients

94
Q

What are examples of opportunistic infections in AIDS patients?

A
  • Herpes simplex virus
  • Cytomegalovirus
  • Mycobacterium tuberculosis
95
Q

Define

Iatrogenic disease

A

Adverse consequences of a preventive, diagnostic, or therapeutic regimens or procedures that cause impairment, handicap, disability, or death in relation to a physician’s professional activity, e.g. hepatitis B infection following blood transfusion

96
Q

Define

Eradication

A

Termination of all transmission of infection by the extermination of the infectious agent through surveillance and containment

97
Q

Define

Elimination

A

Eradication of a disease from a large geographic region, e.g. polio, measles, leprosy, diphtheria

98
Q

What is an example of an eradicated infection?

A

Smallpox

99
Q

What are examples of infections that are amenable to elimination

A
  • Measles
  • Diphtheria
  • Leprosy
  • Polio
100
Q

Define

Case

A

A person in the population or study group identified as having the particular disease, disorder, or condition under investigation

101
Q

Define

Index case

A

The first person with the condition who comes to the attention of public health authorities

102
Q

Define

Primary case

A

A person who acquires the disease from an exposure

103
Q

Define

Secondary case

A

A person who acquires the disease from an exposure to the primary case

104
Q

What is the secondary attack rate? How is it calculated?

A

The number of exposed persons developing the disease within the range of the incubation period, following exposure to the primary case

SAR = (# of people developing the disease within the range of incubation period) × 100 / (total # of exposed)

105
Q

Define

Virulence

A

The disease evoking power of a microorganism in a given host

(number of deaths/number with disease) × 100

106
Q

Define

Infectivity

A

The power of a microorganism to establish infection in a given host

(number infected/number susceptible) × 100

107
Q

Define

Pathogenicity

A

(number with clinical disease/number infected) × 100

108
Q

What are the types of influenza viruses?

A
  • Type A
  • Type B
  • Type C
109
Q

What are the characteristics of type A influenza?

A
  • Affects both humans and animals
  • Divided into subtypes based on the presence of two surface proteins: hemagglutinin (H) and neuraminidase (N)
  • Two commonly circulating strains: H1N1, H3N2
110
Q

What are the characteristics of type B influenza?

A
  • Predominantly affects humans
  • Two lineages: Victoria and Yamagata
111
Q

What are the characteristics of type C influenza?

A
  • Rarely reported in humans
  • Cases are usually subclinical
112
Q

How do surface antigens of influenza viruses change?

A
  • Antigenic drift: minor changes associated with annual outbreaks or epidemics. This is why vaccines must be updated yearly
  • Antigenic shift: major changes resulting in new subtypes with a new H protein (and sometimes new N). New subtypes may cause pandemics
113
Q

What are the groups recommended to be vaccinated for influenza?

A

People at risk of complications

  • Pregnant women (highest priority)
  • Children aged 6 months to 5 years
    • children aged 6–23 months take priority, then
    • children aged 2–5 years
  • Elderly people (≥ 65 years)
  • People with underlying health conditions (e.g. diabetes, asthma, chronic heart or lung disease, HIV/AIDS)
  • International travelers who belong to any of the above groups

People at high risk of exposure and transmission

  • Healthcare workers
114
Q

What are the components of the trivalent influenza vaccine (TIV)?

A
  • H1N1
  • H3N2
  • Yamagata OR Victoria lineage influenza B
115
Q

What are the components of the quadrivalent influenza vaccine (QIV)?

A
  • H1N1
  • H3N2
  • Yamagata AND Victoria lineage influenza B
116
Q

What is the seasonality pattern of influenza viruses?

A
  • Northern hemisphere: November–March
  • Southern hemisphere: May–October
  • Tropics: year-round transmission with several peaks
117
Q

How is penumococcus transmitted?

A

Aerosol spread from person to person

118
Q

What is the typical course of pneumococcal infection?

A

Local spread to tissues or invasion of the circulatory torrent and hematogenous spread

119
Q

Under which circumstances is pneumococcal colonization possible?

A
  1. Colonization with a pneumococcal strain against which immunity has not been established
  2. Alteration of the natural barriers or host immune system
120
Q

What types of diseases can pneumococcus cause?

A

Non-invasive

  • Acute otitis media
  • Sinusitis
  • Conjunctivitis
  • Bronchitis
  • Pneumonia

Invasive

  • Bacteremia
  • Bacteremic pneumonia/empyema (accumulation of pus in pleura)
  • Sepsis
  • Meningitis
  • Peritonitis
  • Arthritis
  • Osteomyelitis
121
Q

What are the at-risk groups for pneumococcus?

A

Immunocompetent children

  • Chronic pulmonary disease: asthma, bronchopulmonary dysplasia, cystic fibrosis, A1AT deficiency, bronchiectasis
  • Chronic heart disease
  • Down syndrome
  • Diabete mellitus
  • Chronic liver disease
  • Subarachnoid space fistulas (inflammation of the pleura)
  • Children with cochlear implants (hearing aids)

Children with anatomic or functional asplenia (absence of spleen)

  • Sickle-cell anemia and other hemoglobinopathies
  • Congenital or acquired asplenia or splenic dysfunction

Immunocompromised children

  • HIV/AIDS patients
  • Primary immunodeficiency (except isolated IgA deficiency)
  • Chronic kidney failure and nephritic syndrome
  • Diseases that require treatment with immunosuppressant drugs or radiotherapy (e.g. leukemia, lymphoma, bone marrow or organ transplant)
122
Q

Which two at-risk groups have the highest incidence of invasive pneumococcal disease (IPD)?

A
  • HIV/AIDS patients
  • Hematological cancer patients

Both have a 20-fold increased risk

123
Q

What characterizes tobacco dependence?

A
  • A physiologic dependence due to nicotine addiction
  • A behavioral pattern of using tobacco
124
Q

What is the addictive substance in tobacco?

A

Nicotine

125
Q

What is the substance that is introduced to the lungs during smoking?

A

Tar droplets, containing nicotine among other things

126
Q

How much nicotine is usually absorbed systemically from a single cigarette?

A

1 mg

127
Q

What dose of nicotine per day can facilitate addiction to tobacco products?

A

5 mg

128
Q

How long does it take for nicotine to reach the brain if inhaled (e.g. by smoking)

A

15–20 seconds

129
Q

What is the difference in systemic levels of nicotine when orally administered (e.g. from smokeless tobacco) compared to traditional smoking?

A

Nicotine levels from oral administration rise more gradually and are sustained for longer

130
Q

Where is most of the nicotine absorbed from tobacco metabolized?

A

Liver

131
Q

What is the typical product of nicotine metabolism?

A

Cotinine

132
Q

Where is nicotine excreted?

A

Kidneys

133
Q

Where does nicotine accumulate other than in the kidneys (and urine) and liver?

A
  • Amniotic fluid
  • Breast milk
  • The blood and urine of nursing infants whose mothers use tobacco
134
Q

What is the half-life of nicotine?

A

2 hours

135
Q

What are the target organs of nicotine?

A
  • Brain
  • Cardiovascular system
  • Peripheral nervous system
  • Gastrointestinal system
136
Q

What are the daily tasks commonly accompanied by smoking?

A
  • Drinking coffee
  • Waking up
  • Eating
  • Watching television
137
Q

When, in relation to nicotine levels, does a chronic smoker typically smoke their next cigarette?

A

When their blood nicotine levels fall below a threshold, causing withdrawal symptoms. This threshold changes over the course of the day

138
Q

What is the typical amount of nicotine per day that a chronic smoker consumes?

A

10–40 mg

139
Q

When is a person with influenza contagious?

A

Up to 1 day before symptoms begin and 2 weeks after symptoms end

140
Q

What are the modes of influenza vaccination?

A
  • Injection
  • Nasal spray
141
Q

How often per year are influenza vaccines updated?

A

Twice

142
Q

What is the effect of the influenza vaccine on the risk of infection?

A

Reduces it by half, from 10% to 5%

143
Q

In which groups is the influenza vaccine contraindicated?

A
  • Infants under 6 months
  • People with severe egg allergy
  • People with history of Guillain–Barré syndrome

Community medicine (7 decks)

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