Epi Flashcards
(218 cards)
1
Q
Give the evidence hierarchy
A
Systematic Reviews + Meta-analysesRandomised control trials Cohort studies Case-control studies Ecological studies Descriptive/cross-sectional studies Case report/series
2
Q
What is a systematic review?
A
A review of a clearly formulated question that uses a systematic and explicit method to identify, select and critically appraise relevant research and to collect and analyse data from the studies
3
Q
What are the advantages of a systematic review?
A
=Compare results of different studies for generalisation and consistency =Transparent process because of the explicit methods in identifying and rejecting studies =Meta-analysis, if appropriate, will enhance the precision of estimates of treatment effects =May demonstrate the lack of adequate evidence and thus identify areas where further studies are needed
4
Q
What are the limitations of systematic reviews?
A
=If the methodological quality of studies is inadequate then the findings of reviews of this material may also be compromised. =Publication bias can distort findings because studies with statistically significant results are more likely to get published.
5
Q
Prevalence
A
The frequency of a disease within a defined population, measured at a specific point in time. = # of cases/# of people
6
Q
The frequency of a disease within a defined population, measured at a specific point in time. = # of cases/# of people
A
Prevalence
7
Q
Incidence
A
The number of new cases of a disease within a defined population measured at a specific time interval. = # of new cases/ # of disease-free at the beginning of time period
8
Q
The number of new cases of a disease within a defined population measured at a specific time interval. = # of new cases/ # of disease-free at the beginning of time period
A
Incidence
9
Q
Incidence measures ….. while prevalence measures…..
A
Incidence measures new cases whilst prevalence measures all cases
10
Q
Mortality
A
The number of deaths from a specific disease/condition a given time period =deaths from disease/population at the start
11
Q
The number of deaths from a specific disease/condition a given time period =deaths from disease/population at the start
A
Mortality
12
Q
Morbidity
A
The number of cases of ill health/complications/sides effects attributed to a particular condition in a given time
13
Q
The number of cases of ill health/complications/sides effects attributed to a particular condition in a given time
A
Morbidity
14
Q
Confounding
A
When a variable is related to both the study variable and the outcome so the effect of the study variable of the outcome is distorted.
15
Q
When a variable is related to both the study variable and the outcome so the effect of the study variable of the outcome is distorted.
A
Confounding
16
Q
Association
A
The statistical dependence between 2 variables
17
Q
The statistical dependence between 2 variables
A
Association
18
Q
Chance
A
Make inference from samples rather than the whole populations
19
Q
Make inference from samples rather than the whole populations
A
Chance
20
Q
Bias
A
A systemic error
21
Q
A systemic error
A
Bias
22
Q
Causal effect
A
Judgement of a cause-effect relationship
23
Q
Judgement of a cause-effect relationship
A
Causal effect
24
Q
What are the 6 most common infectious causes of world mortality?
A
=Lower respiratory infections - 3.9 million =HIV/AIDS - 2.8 million =Diarrhoeal diseases - 1.8 million =Tuberculosis - 1.6 million =Malaria - 1.2 million =Measles - 0.6 million
25
Give some common confounders
Age Sex Socio-economic Geography
26
List the Bradford Hill criteria for establishing causation
1. Strength of association
2. Consistency of results
3. Specificity of the exposure increasing risk of a certain disease
4. Temporal relationship (ESSENTIAL) to ensure the risk factor precedes the disease to be the cause
5. Dose-response relationship where increased exposure increases risk of disease
6. Plausability when the association is more realistic if consistent with other knowledge
7. Experimental evidence on humans/animals
8. Coherence implies that a cause-effect interpretation doesn't conflict with natural history
9. Analogy provides a source of more elaborate explanations for the association
27
Case
A person with disease/health disorder
28
A person with disease/health disorder
Case
29
Observational study
Where the investigator observes populations/individuals but doesn't manipulate the exposure
30
Where the investigator observes populations/individuals but doesn't manipulate the exposure
Observational study
31
Experimental study
Where the investigator determines the exposure and who receives which intervention
32
Where the investigator determines the exposure and who receives which intervention
Experimental study
33
Descriptive study
Examine the distribution of disease
34
Examine the distribution of disease
Descriptive study
35
Analytical study
Study the determinants of disease
36
Study the determinants of disease
Analytical study
37
Name some descriptive study types
Ecological Cross-sectional/descriptive
38
Name some analytical studies
Cohort Case-control Case report/series Experiment Systematic reviews Meta-analysis
39
What is a cohort study?
Observation of a group of people (cohort) over time Prospective: measure exposure prior to development of disease Retrospective: measure the exposure after development of disease
40
What are the advantages of a cohort study?
- Able to look at multiple outcomes Incidence (number of new cases in a defined time period) can be calculated Good to look at rare exposures Causal effect can be studied in prospective design
41
What are the disadvantages of a cohort study?
-Time-consuming (prospective design) Expensive (prospective design) Loss to follow up may introduce bias Healthy worker effect may cause bias in occupational cohorts Inefficient for studying rare diseases
42
How would you design a cohort study?
1. Choose the cohort dependent on prospecitve/retrospective -age -georgraphy -occupation -disease -exposure event 2. Method for measuring exposure/outcomes -Clinical tests -Questionnaire -Records 3. Compare the outcomes from the exposure Question: Does exposure X relate to outcome Y or the resverse for retrospective of does the outcome Y relate to the pre-exposure X?
43
What is relative risk?
The likelihood to deveop the disease if you are exposed RR = Incidence in exposed/incidence in unexposed
44
What is a case-control study?
Where individuals with disease (cases) are compared with a group of individuals without disease but same characteristics (controls). Info on past exposures is obtained and compared.
45
What is the odd ratio?
The likelihood of having the exposure if you have the disease relative to those without disease
46
What are the advantages of case-control studies?
Ideal to study rare disease Can collect more detailed clinical information Quick Cost-effective
47
What are the disadvantages of case-control studies?
Possible bias in control selection Bias in exposure assessment Can't estimate incidence Uncertain of exposure-disease time relationship
48
What are the advantages of descriptive studies?
Cheap Data already collected and available Standardised collection procedures Wide range of recorded items Available for past years
49
What are the disadvantages of descriptive studies?
Incomplete ascertainment Variable quality Variable validity Careful interpretation needed Coding changes may create artefactual increases/decreases
50
Give some types of routine data
Health outcome data Exposures and health determinant data Demographic data Geographical data Health service provision
51
What is a cross-sectional survey?
Measures the prevalence of health outcomes/determinants of health in a population at a point in time Disease and exposure are meausred at the same time
52
What are the advantages of a cross-sectional study?
Quick Easy Generate ideas of causation
53
What are the disadvantages of cross-sectional studies?
Can't distinguish if exposure preceeded disease as they occur at the same time
54
What is standardised mortality ratio?
Ratio of the # of observed deaths to # of expected deaths in a standard population corrected for age structure differences
55
What is a clinical trial?
A planned experiment in humans designed to measure the effectiveness of an intervention (drug, surgery, vaccine)
56
How would you design a clinical trial?
Define intervention Define comparator (placevo, alternative treatment, standard of care) Define inclusion criteria Define exclusion criteria
57
Control group
A group of people eliglbe for intervention but receive the comparator instead
58
A group of people eliglbe for intervention but receive the comparator instead
Control group
59
What is block randomisation?
When you assign people to 2 groups randomly
60
Give the types of randomisation
Block randomisation Stratification Minimisation
61
Why use blind/double-blind trials?
Ensure the patient doesn't know whether they receive treatment or not and/or the clinical team are unaware to avoid bias in measuring outcome or with subjective symptoms from hope of effective treatment
62
What are the ethical regulations of clinical trials?
Registered Reviewed by independent scientific committee Approved by Research Ethic Committee Adhere to government and international guidelines
63
What is the difference between efficacy and effectiveness?
Efficacy - true biology effect Effectiveness - effect when used in normal practice (some may be hard to adhere to etc. difficult to swallow)
64
Trials must be reported according to the what guidelines?
CONSORT guidelines
65
What are the trial outputs?
Experimental event rate (incidence with intervention) Control event rate (incidence with control) Relative risk = EER/CER Absolute risk reduction = EER-CER Number needed to treat = 1/ARR
66
Give the phases of a clinical trial
Phase 1 -test safety of a new treatment -small # healthy -see side effects Phase 2 -test safety -larger # of diseased people Phase 3 -compare with current available treatment/placebo ->1000 from multiple locations -side effects and efficacy Phase 4 -after drug has been licensed to gather long-term use side effects and different population effects
67
What is the relative risk reduction?
The reduction in the risk of events in people taking treatment vs control
68
Why is Evidence-based medicine important?
Better service to patients Patient care and safety Medical knowledge Professionalism
69
Why has the prevalence of HIV declined amongst pregnant women?
Safer sex Safer injection practices Condom use Male circumcision
70
When was the AIDS virus discovered?
1983
71
When was the test for the AIDS virus created?
1984
72
When did the Antiretroviral Therapy become available?
mid 90s
73
When the case-control study for HIV was carried out when it was still unkown, what were the results?
Cases had twice as many sexual partners Cases had history of syphilis Only common factor was the disease was seen amongst young gay men and seemed to be related to sexual contact (CASE CLUSTERING) so was named GRID Gay Related Immune Deficiency
74
What are the successes of the response to the AIDS epidemic?
Very broad access to ART in poor countries -10-fold growth of access in Africa '02-'07 Decline in pregnant women HIV prevalence Effective prevention methods available
75
What are the challenges of the response to the AIDS epidemic?
For every 1 treated person, 5 newly infected People choose not to get tested Preventing HIV infections would reduce HIV-related costs
76
Briefly describe the HIV infection in the UK
Incidence is increasing (new cases) whilst mortality is declining therefore the prevalence of HIV has increased
77
What is the epidemiological transition?
The changes in levels and causes of mortality
78
Give some examples of epidemiological transition
Emergence of new infectious disease = AIDS Increase in previously controlled infections = TB and Dengue Fever Stroke shifted to heart disease Rise and fall of lung cancer (smoking decline since knowledge of its carcinogenic properties)
79
Compare the difference between demographic transition and epidemiological transition
Demographic is from high birth and death rates to low BR and DR Epidemiological is the replacement of infectious disease with degenerative and man-made diseases
80
What are the most commonly diagnosed cancers and most common cancers causing death?
Common: lung, breast, colorectal Death: lung, liver, stomach
81
What is the largest preventable causes of cancer in the world?
Smoking
82
Smoking is the largest preventable cause of what?
Cancer
83
What are the risk factors for cancer?
Tobacco Alcohol Air pollution Occupational Agents Infections Diet Obesity
84
For men, what cancer has the leading incidence rate?
Lung
85
For women, what cancer has the leading incidence rate?
Breast 2nd cervical
86
Give the risk factors for CVD
High blood pressure Smoking Serum cholesterol levels High blood glucose Physical inactivity High BMI Alcohol Low fruit and vegetable intake
87
What do the epidemiological patterns of CVD indicate?
The environmental factors rather than genetic underlie variation in world CVD
88
The number of deaths from CHD ……. with age but ….. after 80
The number of deaths from CHD increases with age but decreases after 80
89
Deaths from CHD is higher in …. Males compared to ….. males in the US
CHD deaths are higher in black than white
90
Difference in blood pressure between Kenya and the UK is due to what?
Diet
91
Public Health
The science and art of preventing disease, prolonging life and promoting health through efforts of society
92
The science and art of preventing disease, prolonging life and promoting health through efforts of society
Public Health
93
Give indicators of health
Life expectancy Mortality Rates
94
Give the determinants of health
Education Social Class Lifestyle -Smoking -Weight -Alcohol -Unsafe sex Gender differences
95
How would you design a systematic review/met-analysis?
1. Plan the review =specify the research question around PICOS -population -intervention -outcomes 2. Conduct review =clearly identify research criteria and search several sources 3. Report findings =details of study in a tabulated meaningful way
96
Health Promotion
The process of enabling people to increase control over and to improve thier health
97
The process of enabling people to increase control over and to improve thier health
Health Promotion
98
Give the 3 health promotion approaches in the Tannahill Model
1. Education =giving knowledge and concepts to prevent ill-health
2. Protection =regulation, legislation and fiscal measure to ensure health is considered in all government and commercial policies
3. Prevention =political, educational and medical prevention of expsoure to patterns that increase risk of disease
99
Wanless report
This report has a focus on prevention and the wider determinants of health. It encourages cost effectiveness of actions to improve health and reduce inequalities.
100
This report has a focus on prevention and the wider determinants of health. It encourages cost effectiveness of actions to improve health and reduce inequalities.
Wanless report
101
Marmot review
A policy with 6 objectives: =Give every child the best start in life =Enable all children, young people and adults to maximize their capabilities and have control over their lives =Create fair employment and good work for all =Create and develop healthy places and communities =Ensure a heathy standard of living for all =Strengthen the role and impact of ill health prevention
102
A policy with 6 objectives: =Give every child the best start in life =Enable all children, young people and adults to maximize their capabilities and have control over their lives =Create fair employment and good work for all =Create and develop healthy places and communities =Ensure a heathy standard of living for all =Strengthen the role and impact of ill health prevention
Marmot review
103
Briefly explain the UK example of health promotion -smoking cessation
Legislation (primordial intervention) Taxation on cigarettes Media campaigns School activites (primary intervention) One-to-one support offered (secondary intervention) Nicotine Replacement Therpay
104
Name some health promotion policies in the UK and briefly describe
Alcohol harm reduction strategy -ban of alcohol sold below VAT + duty cost -ban of irresponsible promotion Sexual Health -national Chlamydia screening Vaccination programmes -Men ACWY -MMR -Tetanus -Polio Tackling obesity-change for life -educate children on healthy eating
105
Name the 4 levels of prevention
Primordial Primary Secondary Tertiary
106
What is primordial prevention?
Prevention of factors promoting the emergence of lifestyles, behaviours, exposure patterns which contribute to increased risk of disease.
107
What is primary prevention?
Actions to prevent the onset of disease and limit exposure to risk factors by individual behaviour change and community action -health promotion (education, diets) -protection (vaccines)
108
What is secondary prevention?
Halting the progression once the illness is established. -early detection + prompt, effective treatment
109
What is tertiary prevention?
Rehabilitation of people with established disease to minimise residual disability and complications -QOL action, even if no cure
110
Name the approaches to disease prevention
High risk Population
111
What is high-risk disease prevention?
Identify those in need and a) controlling the exposure or -reduce dust mite in an asthmatic child's house b)providing protection against the effect of exposure -vaccination
112
What is the population approach to disease prevention?
Recognising the occurence of common diseases and exposures reflects the behaviour and circumstances of the society as a whole
113
Give the advatanges of a high-risk approach to disease
Effective (motivation of patient) Efficient (cost-effective) Benefit to risk ratio is favourable Appropriate to the individual Easy to evaluate
114
Give the disadvantages of a high-risk approach to disease prevention
Risk prediction isn't accurate Limited potential Hard to change indivdual behaviours Palliative Temporary
115
Give the advantages of a population approach to disease prevention
Equitable (attributable risk may be high where risk is low if a lot are exposed to the low risk) Radical Large potential for population Behaviourally appropriate
116
Give the disadvantages for the population approach to disease prevention
Small advantage to the individual Poor motivation of individual Poor motivation of physician Benefit to risk ratio is worrisome
117
Name the key health programmes in the UK
Smoking Cessation Alcohol Harm Reduction Strategy Sexual Health -National Chlamydia Screening Programme Tackling Teenage Pregnancy Tackling Obesity Immunisation Programmes
118
Name some examples of cross-sectional surveys
2001 Census Health Survey for England NHS Patient Survey on patient experience
119
Routine Data
Data that is collected and recorded in an ongoing systematic way without a specific research question in mind
120
Data that is collected and recorded in an ongoing systematic way without a specific research question in mind
Routine Data
121
Give an example of routine data
Health outcome data - deaths, hospital admissions Exposures and health determinant data - smoking, air pollution, crime Disease prevention data - screening and immunisation uptake Demographic data - census population counts Geographical data - location of GP Cancer registrations Prescriptions Births
122
Give the advantages of routine data
Relatively cheap Already collected and available Standardised collection procedures Relatively Comprehensive Wide range of recorded items Available for past years Experience in use and intepretation
123
Give the disadvantages of routine data
May not answer question Incomplete ascertainment (not every case captured) Variable quality Variable validity Disease labelling vary over time Coding changes create artefactual increase/decrease in disease (International Code for Disease 9 to 10)
124
What is the Quality and Outcomes Framework?
A component of the new GPs contract from 2004 where practices are rewarded for the provision of quality care to help fund further improvements
125
Give real life examples of descriptive studies
The death rate in England and Wales over time
126
Define episode
The time spent under the continuous care of a specific consultant
127
Define admission
A patient's stay in hospital so comprises of 1+ episodes and/or transfers between hospitals
128
How would you design a case-control study?
1. Select cases with disease and controls without disease 2. Obtain information on past exposures and other factors 3. Compare proportions of people exposed in cases and controls EXAMPLE: 1.Cases - brain tumours Controls - from population without cancer 2.Examine mobile phone use to classify people into exposure categories 3.Compare proprtion of frequent mobile phone users in cases and controls
129
How do you calculate the odds ratio?
Odds ratio = odds of being exposed in the cases/ odds of being exposed in the controls
130
Briefly desccribe the ACCOMPLISH trial
A randomised control trial on hypertensive patients Compare benazepril + amlodipine (intervention) to benazepril + hydrochlorothiazide (control) Endpoint was vascular event Experimental Event Rate = 552/5744=9.6 Control Event Rate = 679/5762=11.8 Relative Risk Reduction = (CER-EER)/CER = (11.8-9.6)/11.8 = 18.6 -19% reduction in events in people taking the new treatment compared with controls Absolute Risk Reduction = CER-EER=11.8-9.6 = 2.2 -The risk of an event was 2.2% lower in those taking new treatment Number Needed to Treat = 1/AAR =1/0.022=45 -need to treat 45 people with new treatment for average of 3 years to avoid 1 additional vascular event
131
Explain how you would calculate:
1. Overall incidence
2. Non-circumcised incidence
3. Circumcised incidence
4. Relative risk
1. 24/293 = 8.2 per 100
2. 18/79 = 22.8 per 100
3. 6/214 = 2.8 per 100
4. 22.8/2.8 = 8.14 (incidence exposed/incidence non-exposed)
132
Screening
The practice of investigating apparently healthy individuals to detect unrecognised disease or its precursors so that measures can be taken to prevent or delay the development of disease/improve prognosis
133
The practice of investigating apparently healthy individuals to detect unrecognised disease or its precursors so that measures can be taken to prevent or delay the development of disease/improve prognosis
Screening
134
What is the purpose of screening?
To detect disease at an early stage that leads to improved prognosis -breast cancer Used for risk factors -high blood pressure/cholesterol to offer lifestyle changes Used to identify people with infectious diseases where treatment/control meausres will improve the outcome for the individual or prevent ongoing transmission -chlamydia screening -food handlers for salmonella
135
What should be considered when talking about carrying out a population screening?
The benefits should always outweigh the harms
136
Validity of a test
The ability of the test to distinguish between subjects with and without the condition.
137
The ability of the test to distinguish between subjects with and without the condition.
Validity of a test
138
Sensitivity
The ability of the test to correctly identify people with disease =positive diseased/(positive diseased + negative diseased)
139
The ability of the test to correctly identify people with disease =positive diseased/(positive diseased + negative diseased)
Sensitivity
140
Specificity
The ability of the test to correctly identify people without disease =negative non-diseased /(negative non-diseased + positive non-diseased)
141
The ability of the test to correctly identify people without disease =negative non-diseased /(negative non-diseased + positive non-diseased)
Specificity
142
Positive predictive value
The likelihood that a patient with a + test will actually have disease = postive diseased/ (positive disease+positive non-diseased)
143
The likelihood that a patient with a + test will actually have disease = postive diseased/ (positive disease+positive non-diseased)
Positive predictive value
144
Negative Predictive Value
The likelihood that a patient with a - will not have the disease =negative non-diseased/(negative non-diseased + negative diseased)
145
The likelihood that a patient with a - will not have the disease =negative non-diseased/(negative non-diseased + negative diseased)
Negative Predictive Value
146
Give the equations you would use to calculate: 1. Sensitivity 2. Specificity 3. Positive Predictive Value 4. Negative Predictive Value
1. Sensitivity = a / (a+c) 2. Specificity = d / (b+d) 3. PPV = a / (a+b) 4. NPV = d / (c+d)
147
Name the different approaches to screening
Mass Targeted As well as systematic/opportunistic
148
Name major screening programmes in the UK
Antenatal screening -syphilis -HIV -Hep B -rubella -chromosome abnormalities Neonatal + childhood -phenylketonuria -hypothyroidism -sickle cell disease -hearing and development Cancers -breast and cervical in women -60-69 for bowel cancer Infections -chlamydia in U25 (opportunistic) -Hep B for healthcare -HIV in sex clinics CVD -men 65 aortic aneurysm -diabetic retinopathy in 1 in 12 with diabetes -BP, cholesterol and diabetes targeted and opportunistic
149
What is evaluated in a potential screening program?
Feasibility -easy to organise? -acceptable test? -resources to conduct? Effectiveness -extent that its implementation will affect subsequent outcomes Cost -limited resources so need careful consideration
150
Give and explain the different types of bias that occur in studies
Selection bias -particpants offten differ from non-participants Lead time bias -screening identifies disease that would other wise be identified at a later stage and may result in apparent improvement of length of survival but is really due to earlier prognosis Length bias -some conditions take longer to develop to health threatening stage so preclinical is longer and is more likely detected in this stage so a favourable prognosis can occur and false idea of lengthening the lives of those found +
151
Gold Standard
A recognised way of determining who really has the disease
152
A recognised way of determining who really has the disease
Gold Standard
153
Give some ethics of screening
Screening may do harm as well as benefit Risk attached to screening test/subsequent diagnostic test False positive may cause unnecessary anxiety Other unplanned effects of a + A false - will give false assurance
154
What is the difference between a systematic review and a meta-analysis?
Systematic review answers a defined research question Meta-analysis refers to statistical techniques used in a systematic review to integrate results of the studies matching the criteria
155
Give the advantages of a meta-analysis
A pooled risk estimate More reliable and precise estimate effect Explore differences between studies Identify whether a publication bias is occuring
156
Give the disadvantages of a meta-analysis
Publication bias Labour intensive Inconsistency of results (different style of design, populations, interventions etc.) Low study quality
157
Name the most common way of summarising meta-analysis results
Forest plot
158
Publication bias
The greater likelihood that research with statistically significant results will be published in peer-reviewed journals compared to null/non-significant
159
The greater likelihood that research with statistically significant results will be published in peer-reviewed journals compared to null/non-significant
Publication bias
160
What is used to determine publication bias within a meta-analysis?
Funnel plots
161
How is heterogeneity within a study explored?
Radial plots
162
What organisation has set many standards in the medical research field?
Cochrane
163
What is PRISMA?
Preferred Reporting Items for Systematic reviews and Meta Analyses -evidence-based minimum set of items for Sr or MA
164
Name the achievements of the NHS Healthcare so far
Longevity Access to Health Services
165
Name the challenges to medicine
Burden of Disease Ageing population Obesity Personalised Medicine Antibiotic Resistance Technology, information and evidence Workforce
166
Explain the burden of disease as a challenge to medicine
The magnitude in that some are more affected than others -mental illness -CHD
167
Explain the ageing population as a challenge to medicine
Increased life expectancy so increased prevalence of chronic diseases meaning more resource use on the elderly
168
Explain how obesity is a challenge to medicine
Due to the increased unhealthy diet of the nation, BP and cholesterol and obesity have risen and all of which are often linked to other disease (CHD, diabetes, cancer) and puts a strain on resources
169
Explain how personalised medicine is a challenge to medicine
It is an intervention that is adaptable to each patient's genetic makeup so creates unnecessarily high expectations and large use of resources as well as patients wanting access to more information about their risks etc.
170
Explain how antibiotic resistance is a challenge to medicine
The misuse, lack of control, competencies and patient demand for antibiotics has increased the resistant bacterial strains and with no new investments into antibiotics it will cause excess harm (worse conditions/no cures etc.) as well as continous research needed to create new antibiotics
171
Explain how technology, information and evidence is a challenge to medicine
Increased development in technology may lead to overdiagnosis and more harm than good from several diagnostic tests being performed perhaps unnecessarily?
172
Explain how the workforce is a challenge in medicine
Shortage of health professionals both # and types Multidisciplinary team/skills?
173
Critical appraisal
The process of systematically examining research evidence to assess its validity, results and relevance before using it to make an informed decision
174
The process of systematically examining research evidence to assess its validity, results and relevance before using it to make an informed decision
Critical appraisal
175
What should be considered when critically appraising a paper?
Question Design Population Methods Analysis Confounders Bias Ethics Interpretation (Bradford-Hil causation)
176
What can be used to assist in critical appraisals?
Review checklists
177
What does DALY stand for?
Disability Adjusted Life Years
178
What is Schistosomiasis?
A bloodborn fluke of schistosoma that causes a chronic debilitating disease
179
How do shcistosoma infect humans?
Within their lifecycle they use a snail as a host to infect water and penetrate unbroken skin of a human where they will migrate to liver, blood vessels and intestines
180
What are the health consequences of Schistosomiasis?
Gross haematuria (blood in urine) Growth retardation Cognitive impairment Malnutrition + anaemia Chronic health problems -inflammation -fibrosis of bladder wall, colon, liver, spleen and lungs Bladdder cancer
181
What is the treatment for Schistosomiasis?
Praziquantel
182
What do Soil-Transmitted Helminth Infections lead to?
Stunting and decreased school performance
183
What is the treatment for STHs?
Albendazole Mebendazole
184
What is onchocerciasis?
A tropical disease transmitted by the blackfly that causes blindness and severe skin disease
185
What is the treatment for onchocerciasis?
Mectizan
186
What is lymphatic filariasis?
A parasitic disease transmitted by mosquitoes
187
How is lympahtic filariasis treated?
Albendazole + Mectizan (africa) Albendazole + DEC (asia + Far E)
188
What is blinding trachoma?
Infectious disease caused by chlamydia trachomatis that leads to blindness
189
What is used to treat blinding trachoma?
Zithromax
190
What is MDA?
Mass Drug Administration
191
How has rabies been controlled?
Canine vaccination Immediate human vaccination post-exposure Management of dogs
192
What is Loa Loa?
A filarial worm transmitted by Tabanids (horseflies)
193
What is cysticercosis?
Parastic infection cause by Taenia solium causing epilepsy
194
How can cysticercosis be treated?
Praziquantel
195
What is Leprosy?
A contagious chronic disease affecting skin, mucous membranes and nerves leading to discolouration and lumps
196
What is podoconiosis?
A lymph vessel disease from irritant soils causing leg swelling
197
What is Leishmaniasis?
A disease transmitted by sandflies affecting skin and internal organs
198
What is trypanosomiasis?
(sleeping sickness) is insect-borne transmitted by the Tsetse fly
199
How are confounding factors dealt with?
Stratification Standardisation Regression
200
Stratification
Method of controlloing effects of confounding in analysis where risk is calculated separately for each confounding variable
201
Method of controlloing effects of confounding in analysis where risk is calculated separately for each confounding variable
Stratification
202
Standardisation
A method for controlling the effect of confounding factors at analysis like SMR
203
A method for controlling the effect of confounding factors at analysis like SMR
Standardisation
204
Regression
Method to control confounding factors in analysis as a statistical model to control 1 + variables
205
Method to control confounding factors in analysis as a statistical model to control 1 + variables
Regression
206
What occurs when confidence intervals don't include 1?
Chance can be excluded as a likely explanation of the findings
207
What does a relative risk of 1 mean?
The same risk of developing disease with/without exposure so no effect
208
What is the leading cause of death in Sub-Saharan Africa?
Infectious disease
209
What is the difference between incidence and prevalence?
Incidence is over time whilst prevalence is at one point
210
Give some chronic non-communicable disease
Cancer CVS Chronic respiratory disease Diabetes
211
What causes gastric cancer?
H pylori
212
What does H pylori cause?
Gastric cancer
213
What causes cervical cancer?
HPV
214
What does HPV cause?
Cervical cancer
215
What causes Hodgkins lymphoma and stomach cancer?
EBV
216
EBV causes what?
Hodgkins lymphoma and stomach cancer
217
What does an SMR value above 1 indicate?
There were 'excess death' from what was expected
218
Morbidity is..... in a population whilst mortality is the .....in a population
Morbidity is [the incidence of ill health] in a population whilst mortality is the [incidence of death] in a population
