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Epidemiology > Exam #1 > Flashcards

Exam #1 Flashcards

1
Q

Which has increased during the Global War on Terrorism compared to previous wars?

A

Disability rates of US active duty personnel

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2
Q

What is the average number of years lost to those who smokes tobacco products?

A

10yrs

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3
Q

What is average reduction in major coronary heart events, e.g. heart attack, from medical treatment with statins and other drugs?

A

30%

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4
Q

What is the approximate average reduction in mortality attributable to cardiovascular disease in patients who use a statin for primary prevention of heart disease?

A

30%

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5
Q

Strict blood sugar control has many benefits for people with diabetes. Which condition has the greatest reduction in incidence with strict blood sugar control?

A

Diabetic retinopathy

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6
Q

What are the 6 study types?

A

Experimental, Observational, Ecological, Clinical Trial, Interventional, Descriptive

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7
Q

Uncorrected visual acuity (VA) was measured in 2000 people between the ages of 43 and 86 years in a Montana community. The results showed that VA was better overall in people in their 40s than people in their 80s, and better overall in women than in men. Thus, age (younger) and sex (women) were independent predictive variables of better VA.

What best describes the study type?

A

Observational

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8
Q

Another study randomly divided the subjects in question 1 (above) into two groups: one group had their visual acuity (VA) measured while wearing their best-corrected prescribed spectacle correction, and the other group had their VA measured without correction. The results showed significantly better overall VAs in the group assigned to spectacle correction versus the control group with no correction. This study showed that accurate spectacle correction improves VA.

What best describes the study type?

A

Experimental

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9
Q

Researchers interviewed 100 gamers about their daily video game exposure (time spent playing video games per 24-hour period) and also measured each subject’s phoria status. The results showed that subjects who spent more than 12 hours per day playing video games had on average an esophoric posture, whereas those who played less then 1 hour of video games per day had on average an exophoric posture after the gaming period. The study showed that excessive video game exposure was associated with esophoria.

What best describes the study type?

A

Observational

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10
Q

Another study randomly divided 100 gamers into three groups: Group #1 subjects were asked to play video games for over 12 hours per day; Group #2 subjects were asked to play video games for no longer than 1 hour per day; and Group #3 subjects (control group) were not allowed to play video games at all. Phoria status was measured at the end of each session. The results showed that those in Group #1 on average had an esophoric posture after the gaming period; Group #2 subjects had an average exophoria of 2 prism diopters; and group #3 subjects averaged an exophoria of 6 prism diopters. The study suggested that excessive video game exposure leads to esophoria development.

What best describes the study type?

A

Experimental

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11
Q

Scenario: Based on anecdotal case reports in the literature, there is a suggestion that chronic vaping increases a person’s chances of developing a corneal ulcer.

Investigators decide to test this hypothesis via a prospective cohort study design. Which best describes the exposure and the outcome variables in the study?

A

Exposure = corneal ulcer, outcome = vaping

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12
Q

Scenario: Based on anecdotal case reports in the literature, there is a suggestion that chronic vaping increases a person’s chances of developing a corneal ulcer. Investigators decide to test this hypothesis via a prospective cohort study design.

How should the investigators first assemble the cohort groups?

A

They should first identify individuals by vaping use or non-use

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13
Q

Scenario: Based on anecdotal case reports in the literature, there is a suggestion that chronic vaping increases a person’s chances of developing a corneal ulcer. Investigators decide to test this hypothesis via a prospective cohort study design.

Which represents the most appropriate selection criteria for the cohort groups?

A

Exposed and unexposed groups should be about equal in age

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14
Q

Scenario: Based on anecdotal case reports in the literature, there is a suggestion that chronic vaping increases a person’s chances of developing a corneal ulcer. Investigators decide to test this hypothesis via a prospective cohort study design.

This study design NOT be able to address what?

A

This cohort study cannot investigate individuals with a corneal ulcer at the beginning of the study.

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15
Q

Scenario: In your private practice, you notice an increasing number of patients showing up with phlyctenulosis, an inflammatory opacification on the corneal-conjunctival junction. The patients’ histories vary by individual, with mentions of past positive tuberculosis skin tests, episodes of blepharoconjunctivitis, and past use of tetracycline antibiotics. You decide to investigate potential explanations for this apparent phlyctenulosis epidemic via a case-control study design, using your own patients as subjects.

What best describes any exposure and outcome variables in the study?

A

Exposure = tetracycline, outcome = phlyctenulosis

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16
Q

Scenario: In your private practice, you notice an increasing number of patients showing up with phlyctenulosis, an inflammatory opacification on the corneal-conjunctival junction. The patients’ histories vary by individual, with mentions of past positive tuberculosis skin tests, episodes of blepharoconjunctivitis, and past use of tetracycline antibiotics. You decide to investigate potential explanations for this apparent phlyctenulosis epidemic via a case-control study design, using your own patients as subjects.

How should study groups be identified for the case-control design?

A

First assemble a group of patients with phlyctenulosis and a matched group without phlyctenulosis

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17
Q

Scenario: In your private practice, you notice an increasing number of patients showing up with phlyctenulosis, an inflammatory opacification on the corneal-conjunctival junction. The patients’ histories vary by individual, with mentions of past positive tuberculosis skin tests, episodes of blepharoconjunctivitis, and past use of tetracycline antibiotics. You decide to investigate potential explanations for this apparent phlyctenulosis epidemic via a case-control study design, using your own patients as subjects.

Your preliminary study data suggest that those subjects with phlyctenulosis have a significantly higher past exposure history of a positive tuberculosis test than those without a positive test. What would best describe a confounding variable in this relationship?

A

A positive tuberculosis finding is the confounding variable

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18
Q

Scenario: In your private practice, you notice an increasing number of patients showing up with phlyctenulosis, an inflammatory opacification on the corneal-conjunctival junction. The patients’ histories vary by individual, with mentions of past positive tuberculosis skin tests, episodes of blepharoconjunctivitis, and past use of tetracycline antibiotics. You decide to investigate potential explanations for this apparent phlyctenulosis epidemic via a case-control study design, using your own patients as subjects.

What statements about this case-control study are true?

A

Selection of cases can result in bias, especially when selected from a specialty practice

The use of questionnaires makes case-control studies prone to recall bias from the subject’s end and interviewer bias from the investigator’s end

Cases and controls should be matched by age, gender, and presenting symptom

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19
Q

What best describes a cross-sectional study design?

A

Investigators examine subjects to determine intraocular pressure, and interview them about their current daily physical activity levels

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20
Q

A cross-sectional study finds a significant association between use of tobacco and glaucoma. Can causation be determined?

A

Tobacco use is correlated with glaucoma but causation cannot be determined

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21
Q

What is NOT true regarding cross-sectional studies?

A

A temporal cause and effect of exposure to outcome can usually be established

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22
Q

Which of the following should raise suspicion for selection bias?

a) Random sampling
b) A well defined target population
c) A consecutive sample of patients from one provider
d) Use of a database with each subject identified by a number

A

C

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23
Q

Which of the following is NOT likely to be generalizable to primary care optometric practice?

a) Anti-vegf study on retinopathy of prematurity
b) Effect of strict blood sugar control on diabetic retinopathy
c) Success of smoking cessation programs in dental offices
d) Corporate sponsored study on multifocal contact lenses for myopia control

A

A

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24
Q

Directional or differential misclassification occurs when:

A

Measures are higher than actual

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25
Q

T or F. Random misclassification does not bias results.

A

False

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26
Q

T or F. Regression to the mean is a statistical phenomenon only; it has no practical significance.

A

False

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27
Q

Which of the following is an example of confounding?

a) Convenience sample leads to non representative sample
b) Random assignment to groups does not lead to equal groups
c) The absence of a time element prevents conclusion as to cause and effect
d) Something differs between experimental and control groups which also affects outcome

A

D

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28
Q

What does the acronym DAG stand for?

A

Direct acyclic graph

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29
Q

T or F. A confounder can always cause the outcome by itself

A

False

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30
Q

T or F. The effect of a known confounder can often be controlled statistically

A

True

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31
Q

Describe the purpose and mission of public health (3)

A

1) The science & art of preventing disease, prolonging life, and promoting health through the organized efforts and informed choices of society, organizations, public and private communities, and individuals

2) Fulfilling society’s interest in assuring conditions in which people can be healthy.

3) Public health aims to provide maximum benefit for the largest number of people

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32
Q

Define key terms used in public health

1) Clinical Care
2) Determinant
3) Epidemic/Outbreak
4) Health Outcome

A

1) Think of Health Care!!
–>Prevention, treatment, and management of illness and the preservation of mental and physical well-being through the services offered by medical and allied health professions; also known as health care

2) Any factor whether event characteristic or other definable entity that brings a change in health condition or other defining characteristic.

3) A health event occurring more than normal.
–>Occurrence in a community or region of cases of an illness, specific health-related behavior, or other health-related event clearly in excess of normal expectancy. Both terms are used interchangeably; however, epidemic usually refers to a larger geographic distribution of illness or health-related events

4) Result of a medical condition that directly affects the length or quality of a person’s life

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33
Q

Public health aims to provide ___ with the right to be healthy and live in conditions that support health.

A

groups of people

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34
Q

A(n) ___ is a disease occurrence among a population that is in excess of what is expected for a given time & place.

A

Epidemic/Outbreak

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35
Q

Identify prominent events in the history of public health

  1. Sanitation and Environmental Health
A

1) 500 BCE
2) 1840s
3) 1970

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36
Q

What happened in 500 BCE?

A

Greeks and Romans practice community sanitation measures

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37
Q

What happened in 1840s?

A

The Public Health Act of 1848 was established in the United Kingdom

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38
Q

What happened in 1970?

A

The Environmental Protection Agency was founded

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39
Q

Identify prominent events in the history of public health

  1. Pandemics
A

1) Influenza
2) Polio
3) HIV

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40
Q

What happened with Influenza?

A

500 million infected worldwide in 1918

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41
Q

What happened with Polio?

A

Vaccine introduced in 1955; eradication initiative launched in 1988

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42
Q

What happened with HIV?

A

34 million living with HIV worldwide; 20% decline in new infections since 2001

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43
Q

Identify prominent events in the history of public health

  1. Prepared for Disaster Response
A

1) Biological Warfare
2) September 2001
3) Hurricane Katrina

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44
Q

What happened with Biological Warfare?

A

Plague used as a weapon of war during the Siege of Kaffa

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45
Q

What happened in September 2001?

A

Public health surveillance conducted after the 9/11 attacks

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46
Q

What happened in hurricane Katrina?

A

Emergency services, public health surveillance, and disease treatment provided

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47
Q

Identify prominent events in the history of public health

  1. Prevention Through Policy
A

1) Book of Leviticus
2) Tobacco Laws
3) Obesity

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48
Q

What happened with the Book of Leviticus?

A

The world’s first health code

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49
Q

What happened with the Tobacco Laws?

A

Banning smoking in public spaces

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50
Q

What happened with Obesity?

A

Food labeling and promotion of physical activity

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51
Q

Recognize the core public functions and services

Public Health Core Sciences [5]

A

1) Prevention Effectiveness
2) Epidemiology
3) Laboratory
4) Informatics
5) Surveillance

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52
Q

TF is cholera? [3]

A

1) Fatal intestinal disease
2) Death to ppl in London in 1800s
3) Thought to be transmitted by air, but actually travels through contaminated feces water

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53
Q

Who was John Snow? [2]

A

1) Father of MODERN epi
2) Traced source of cholera 1854
–> Tracked down cases with a map and if people drank water from a certain pump. He stopped the supply to the area.

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54
Q

Match –> a. Risk Factor identification/ b. surveillance / c. implementation/ d. intervention evaluation

1) What’s the problem?
2) What’s the cause?
3) What works?
4) How do you do it?

A

1) B
2) A
3) D
4) C

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55
Q

Recognize the core public functions and services

Three Core Functions of Public Health

A

1) Assessment
2) Policy Development
3) Assurance

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56
Q

What does assessment entail?

A

Systematically collect, analyze, and make available information on healthy communities on a federal, state and local level

Ex. Monitor tobacco use

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57
Q

What does policy development entail?

A

Promote the use of a scientific knowledge base in policy and decision making on a federal, state and local level

Ex. Increase tobacco tax

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58
Q

What does assurance entail?

A

Ensure provision of services to those in need on a federal, state and local level

Ex. resources to help smokers quit

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59
Q

What types of partners exist in the public health system? [7]

A

1) Community
2) Clinical Care System (Health Care)
–> Ex. Population & Individual patient focus
3) Gov. public health infrastructure
4) Employers and business
5) Academia ex. Harvard
6) The Media
7) Non-gov. organizations ex. American Cancer Society

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60
Q

Describe the role of different stakeholders in the field of public health

1) Media
2) Businesses & employers
3) Gov. Agencies
4) Academia

A

1) Public discourse, health education and promotion ex. social media

2) Provide health insurance, wellness initiatives & healthy workplaces

3) Health policies and city planning

4) Research, education, training and public service

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61
Q

List 4 determinants of health in order of most-least influence

A

1) Social characteristics (most)
2) Health Behaviors * se parecen
3) Medical Care * se parecen
4) Genes & Biology (least)

62
Q

Recognize how the individual determinants of health affect population health

A

In the health impact pyramid:

1) Public health impact grows greater as we go down ex. Socioeconomic factors & reducing poverty

2) Individual health impact increases as we move up ex. counseling and personal education on quitting smoking

63
Q

Epidemiology:

A

“Epidemiology is the study of the distribution and determinants of healthrelated states and events in populations, and the application of this study to control health
problems”

64
Q

Study

A
  • involves multiple disciplines in sciences (medicine, biostat, informatics etc)
65
Q

Distribution

A

how are health conditions distributed across the human population and the pts you see.
Do certain conditions affect more old people or young people?

66
Q

Determinants:

A

what factors predispose us or protect us from developing certain conditions?

67
Q

Health related states and events-

A

health related events can change from positive to negative state. Conditions can be linked to age, gender or
can be associated to certain circumstances.

68
Q

Populations

A

related to community, vs. clinical that is related to individuals. Approaches to develop legislation for the benefit and protection of
the people at risk of accidents or trauma that affects sight.

69
Q

Application-

A

how we use this information, that we found in research, to provide good evidence for a program to improve health of the
population.

70
Q

Measures of Disease Frequency

Prevalence:

A

Number of cases/total number in the population at one point in time.

Multiplied by a constant. Prevalence is reported as a percentage or a decimal.

Prevalence is a proportion; it is not a rate. No units are needed, but the date of measurement should be reported.

71
Q

Measures of Disease Frequency

Incidence:

A

Refers to NEW cases within a population over an observed time period.

Incidence rate is the number of new cases per population at risk per unit time.

Example: incidence of covid 19 in the U.S. observed January 21, 2020 to May 10, 2021 was 9802/100,000 or 9.8% per 15.3 months.

72
Q

Mortality rate

A

of people died/ # of people alive

One of the most reported incidence measures. Is the incidence of death in a defined population over a specified time. Mortality is usually reported as cases per 100,000 people per year or annual cases per 100,000.

73
Q

Numerator

A

Number of people who die during the period. Denominator is the number of people alive.

74
Q

Crude mortality

A

total number of deaths divided by total population per unit time

75
Q

Age specific mortality:

A

number of deaths in certain age group divided by number of people in the age group per unit time

76
Q

Case fatality rate

A

Number of deaths caused by a specific disease divided by the number of people who have the disease per unit time.

77
Q

Cataracts

A

LOCS (lens opacities classification System)- is a repeatable grading system.

78
Q

ARMD

A

Wisconsin Grading Scale – for type location and size of drusen. (0-8)

79
Q

Glaucoma

A

definite or probable photographic criteria of glaucomatous ONH

80
Q

Diabetic Retinopathy

A
81
Q

ETDRS grading system

A
82
Q

Mild NPDR

A

At least 1 MA and definition not met for any other disease severity level.

83
Q

Moderate NPDR MA and Hemes

A

May include soft exudates, venous beading IRMA with definition not met for any other disease
severity level

84
Q

Severe NPDR

A

CWS venous beading and IRMA in at least two of fields 4-7

85
Q

Non High risk EARLY PDR

A

Neovascularization with definition not met for high risk PDR

86
Q

High Risk PDR

A

New vessel growth on or within I DD of optic disc with or w/o VH or pre retinal hemorrage, vitreous or preretinal
hemorrhage with NVD or NVE.

87
Q

Major Epidemiology studies:

Andhra Pradesh Eye disease study

A

Determine the prevalence and risk factors for eye and vision conditions in an Indian population.

Major findings: confirmed smoking as a major risk factor for cataract and macular degeneration

88
Q

Major Epidemiology studies:

Baltimore eye study

A

Estimate prevalence of eye disease in an urban U.S. population of Black and White participants age 40 and older.

Major findings: Confirmed African Americans are at much higher risk for glaucoma.

89
Q

Major Epidemiology studies:

Barbados eye study

A

Describe the epidemiology of visual impairment in a large population of people of African ancestry.

Major findings: Confirmed cataract and glaucoma are much higher and macular degeneration much lower in a Black population compared to published large scale studies of other races.

90
Q

Major Epidemiology studies:

Beaver Dam eye study*

A

Estimate incidence, prevalence, and associated risk factors of cataract, age related macular degeneration, and diabetic
retinopathy in a primarily White rural midwestern U.S. population. Investigation of ocular findings and multiple systemic conditions, particularly cardiovascular and other conditions related to aging.

Findings: Incidence of macular degeneration is significantly lower in each succeeding generation.

The following did not increase or decrease risk of any macular degeneration:
- Use of a statin for cholesterol control. Low to moderate alcohol intake.
- The following was not associated with development of early macular degeneration but decreased risk of advanced or exudative macular degeneration.
- Moderate exercise

91
Q

Major Epidemiology studies:

Blue mountain eye study

A

Determine the epidemiology of eye conditions in a stable homogenous population in urban/suburban Australian
population.

Major findings: Prevalence and incidence of cataract, glaucoma, and macular degeneration similar to other population studies of
primarily White populations (Beaver Dam, Rotterdam, Framingham).

92
Q

Major Epidemiology studies:

Chesapeake Bay study

A

To quantify ultraviolet radiation exposure in Chesapeake watermen workers as relates to cataract and macular
degeneration.

Major findings: UV exposure was associated with cortical cataract but not nuclear cataract nor macular degeneration. “A doubling
in lifetime UV-B exposure led to a 60% increase in the risk of cortical cataract.”

93
Q

Major Epidemiology studies:

Chinese American eye study

A

Determine prevalence of eye conditions in Americans of Chinese ancestry and compare to published studies of
Americans of Latino ethnicity, African ancestry, and White populations.

Major findings: Prevalence of glaucoma, cataract, and diabetic
retinopathy are similar to White and Latino populations. Prevalence of macular degeneration was lower than Whites but not as low as in Blacks.

94
Q

Major Epidemiology studies:

Los Angeles Latino eye study

A

Describe visual impairment burden, incidence of visual impairment and blindness, and risk factors for specific conditions in an American Latino population. Early macular degeneration was similar in prevalence and incidence to White populations. Advance
macular degeneration was lower for ages 40 to 69 but similar over age 70. Annual incidence of cataract was significantly lower than in Black population studies.

***In contrast to Rotterdam and Baltimore, type 2 diabetes slightly increased risk of open-angle glaucoma by 1.4 times.

95
Q

Major Epidemiology studies:

Rotterdam study

A

Initial purpose: Large population cohort study on chronic ophthalmic, cardiovascular, neurologic, and locomotor conditions in the Netherlands

1% overall blindness ppl 55-64
Once 85y/o, increases 11.8%

96
Q

Major Epidemiology studies:

Shahroud eye cohort study (Iran)

A

Original purpose: Describe the epidemiology by age of macular degeneration, glaucoma, and visual impairment in a Middle Eastern population. Prevalence of macular degeneration in this Middle Eastern population was higher than those reported for East Asian and African studies but lower than European and U.S. studies. Prevalence of glaucoma was similar to White, Asian, and Hispanic populations.

97
Q

Major Epidemiology studies:

Tehran eye study*

A

Quantify the frequency of visual impairment and associated conditions in Tehran using a calculated sample size sufficient to
detect at least a 2% prevalence.

Major findings: Prevalence of visual impairment, low vision, blindness, and diagnosed causes reported. Uncorrected refractive error and cataract were by far the most common causes.

Secondary findings: Nuclear sclerotic cataract higher than grade 3 was associated with myopia, but cortical cataract above grade 3 was
associated with hyperopia.

98
Q

Ten Essential Public Health Services

A

Assessment:
1. Monitor Health
2. Diagnose and Investigate

Policy Development:
3. Inform, Educate, Empower
4. Mobilize Community Partnership
5. Develop Policies

Assurance:
6. Enforce Laws
7. Link to/Provide Care
8. Assure a Competent Workforce
9. Evaluate

Base of all:
10. Research

99
Q

What’s health disparity?

A

A difference in the level or treatment that a patient receives that is seen as unfair.

100
Q

What causes health disparities? [6]

A
  • Communication Problems
  • Discrimination
  • Lack of insurance coverage
  • Poor transportation
  • Shortage of care givers
  • Health literacy (patients have problems understanding health information)
101
Q

What’s a health care disparity?

A

A difference or inequality due to gender, education, disability, geographic location and/or sexual orientation.

102
Q

What 3 races are more prone to more chronic disease, cancer and infections?

A

African Americans, Asians & Hispanics

103
Q

Natives race are ___ more likely to have diabetes than whites

A

2.5x

104
Q

What gender & race are more likely to die from breast cancer?

A

African American women

105
Q

Are rural residents more susceptible to diseases? Which ones?

A

Yes; chronic diseases such as diabetes + more likely to die from heart attacks

106
Q

What’s health inequity?

A

Unfair distribution of health determinants, outcomes and resources in different segments of a population based on social, economic and environment

**Unfair distribution of health determinants in society due to social, economic and environmental factors

107
Q

What is the goal of health equity? What barriers must be removed to achieve this goal?

A

1) That everyone can receive a fair & just opportunity to be as healthy as possible

2) Remove structural, political and social barriers

ex. Offering free or low-cost checkups to everyone

108
Q

Define social determinants.

A

1) The conditions in the environment in which people grow, live, learn, work and age that affects health outcomes.

109
Q

What are some social determinants of health [5]?

A

1) Education access and quality: includes educational attainment, language and literacy, and early childhood education

2)Health care access and quality: includes access to health care, health insurance, and health literacy

3) Neighborhoods and built environment: includes transportation access, quality of housing, air and water quality, and crime and violence

4) Social and community context: includes community cohesion, civic participation, workplace conditions, discrimination, and incarceration

5) Economic stability: includes income, poverty, employment, food security, and housing security

110
Q

What’s structural racism?

A

Differential access and distribution of opportunities, goods, and services, such as health care, by race and is increasingly recognized as a significant contributor to societal ill, including health disparities

111
Q

Visual Impairment (VI)

A

Defined as best-corrected visual acuity of 20/70 or worse in the better eye (although some studies use 20/40 or worse in the better eye).

112
Q

Blindness

A

In the United States is defined as a best corrected visual acuity of 20/200 or worse or a central visual field of 20 degrees in the better eye.

113
Q

What are some causes of vision impairment and blindness? [5]

A

refractive errors

cataract

diabetic retinopathy

glaucoma

age-related macular degeneration

114
Q

The prevalence of visual impairment increases with…?

A

Age, ethnicity, race, geographic location, gender, socioeconomic status & level of education

115
Q

Older ppl are more affected by VI than younger ppl. Do they face more health disparities?

A

Yes, including physical and functional disabilities, higher healthcare costs, poor psychological health, lower health-related quality of life, and higher medical morbidity and mortality than their non visually impaired colleagues.

116
Q

What % of the elderly population live in nursing homes?

A

3.6%

117
Q

How many nursing home residents suffer from VI & blindness?

A

63.8% - 73%

118
Q

What is the likeliness of nursing home residents having VI and blindness?

A

3x more likely to have VI

5x more likely to have blindness

119
Q

T or F. The relationship between VI with sex and gender has been established.

A

False, this relationship is not as clear as other factors.

*sex: female or male
*gender: what a person identifies as

120
Q

How is vision loss more prevalent in women than men? [2]

A

Longer life expectancy in women & conditions like thyroid disease

121
Q

American living in __ __ have been found to have high levels of subjective VI.

A

Urban cities (densely populated cities)

122
Q

In what races is there more cataract prevalence + more complex cataract surgeries?

A

Black Americans. Hispanics & Asians

123
Q

Where do you see lower rates of cataract surgeries?

A

Blacks & Hispanics, low income, rural residents & lower education

124
Q

Where do you see worse cataract surgery outcomes?

A

Black & patients with intellectually disabilities

125
Q

Where do you see a higher burden of glaucoma?

A

Social economical status (SES), older age & black patients

126
Q

T or F. Difference in glaucoma prevalence among various groups are multifactorial, racial and ethnic differences in ocular anatomy that may contribute to glaucoma risk. For example: central corneal thickness have been identified.

A

True

127
Q

Who undergoes fewer glaucoma surgeries?

A

Black patients

128
Q

Reasons for poor follow up and medication adherence: [5]
In other words, bad compliance

A

1) Poor understanding of the condition
2) Race
3) Systemic comorbidities [presence of two or more diseases]
4) Distance from the provider
5) Sociodemographic barriers

129
Q

What is the leading cause of vision loss and VI among children and young adults?

What are other diseases?

A

Amblyopia (lazy eye)

Strabismus, Anisometropia, Deprivation

130
Q

What will be the main cause of VI by 2050?

A

Refractive error

131
Q

T or F. Corrected refractive errors contribute to developmental, academic, and social challenges for children and, in some cases, permanent vision loss.

A

False. Undiagnosed and uncorrected refractive error lead to visual challenges for children

132
Q

It is estimated that 1 in __ preschool children and 1 in __ school-aged children in the United States have VI

A

It is estimated that 1 in 5 preschool children and 1 in 4 school-aged children in the United States have VI

133
Q

What % of preschoolers receive an eye exam by an eye care professional? What % receive any type of vision screening?

A

< 15% of preschoolers receive an eye exam by an eye care professional, and < 22% receive any type of vision screening

134
Q

What 2 races have a higher prevalence of refractive error?

A

The Multi-Ethnic Pediatric Eye Disease Study found a higher prevalence of presenting refractive error related VI in both Black children and Hispanic children than in either Asian American or non-Hispanic White children.

135
Q

By 2050, will age-related macular degeneration increase or decrease? What factors affect AMD [mention specific age, gender, diseases + bad habits]?

A

1) The prevalence of AMD in the United States is predicted to double by 2050 as our aging population continues to increase

2) Age >65 yrs

Females (White race)

Cardiac Disease

Smoking

High cholesterol and hypertension

Increased BMI, use of certain anti-inflammatory medications

136
Q

What is the leading cause of legal blindness among people 20-74 years old? What sequalae does this disease have?

A

1) Diabetic retinopathy

2) Presence of Diabetes

Higher A1c

Insulin use

Presence of hypertension

Elevated FBS (fasting blood sugar)

137
Q

Compared with White Americans, __ and __ Americans tend to have a higher and more severe disease burden, but lower rates of recommended screening and eye examinations

A

Black and Hispanic Americans

138
Q

____ is a leading cause of monocular blindness in the United States and is the second most common reason for ocular-related hospitalizations

A

Ocular trauma

139
Q

Ocular Trauma

Approximately ___% of eye injuries in the United States occur in children

A

35%

140
Q

Ocular Trauma

____ patients are at a greater risk of assault, whereas ___ patients were more likely to experience self-inflicted or unintentional injury

A

Black patients are at a greater risk of assault, whereas White patients were more likely to experience self-inflicted or unintentional injury

141
Q

Ocular Trauma

The prevalence of ocular injury among adults is currently estimated to be ____%, and most injuries occur in ____, with particularly high rates among ___ and _____ patients.

A

The prevalence of ocular injury among adults is currently estimated to be 7.5%, and most injuries occur in young men, with particularly high rates among Black and Native American patients.

142
Q

The incidence of open-globe injury is highest… [3]

A

Highest in Black and Hispanic patients and elderly men in rural areas

143
Q

Rehabilitation has the most significant impact on patients with ___? What positive impacts does it have on the patient? [4]

A

1) Rehabilitation after severe ocular trauma has significant impact

2) - on the ability to achieve an optimal functional outcome
- patients’ independence
- family psychosocial stress
-ability to achieve community integration.

144
Q

What is the greatest unmet health need in the US?

A

Vision and eye care

145
Q

T or F. Race, ethnicity, income, insurance coverage, geographic region, and educational attainment have been identified as predictors of outpatient vision care use.

A

True

146
Q

Which patients have fewer outpatient ophthalmic visits?

A

Hispanic and Black patients have fewer outpatient ophthalmic visits than their non- Hispanic White counterparts

147
Q

Obstacles to care [4]

A

(1) access to affordable coverage and services,

(2) availability of eye care professionals,

(3) knowledge about personal risks for VI/blindness, and

(4) primary care physician referral to optometry or ophthalmology

148
Q

What are some internal & external factors that are barriers in obtaining eye care (glasses)?

A

internal factors:

patient’s intrinsic motivations and experiences (past experiences, trust, misperceptions),

external factors:

included cost of glasses, lack of access, and lack of transportation

149
Q

Factors that promote obtaining eye care services [5]

A

Health insurance with vision care services

Diabetes education programs

Personalized follow-up

Screening programs to high risk groups

Mobile screenings in remote areas

150
Q

____ individuals were found to have the lowest eye health knowledge and least access to eye health information. What contributes to this?

A

Hispanic individuals were found to have the lowest eye health knowledge and least access to eye health information.

Differences in educational opportunity, the quality of the schooling, and the factors related to dropping out of the educational system + short of graduation from high school.

151
Q

Pt education preferences [4]

*I have no idea what the prof means
**Idk if pt means patient

A

Language barriers

Use of video media for pt education

Pt education materials

Use of EHR (electronic health record)

152
Q

10 approaches to eliminate disparities in eye care

A
  1. improve access to eye care- federal qualified health centers- increased amount of eye care providers
  2. community context and resources - In communities with limited access to eye care, building relationships and partnering with institutions, such as community centers or faith-based organizations, that have an established, trusted community presence may decrease barriers to using eye care services.
  3. Tele-ophthalmology- tele optometry services
  4. patient education and engagement- bring new pts and enhancing f/u visits
  5. Insurance for Eye care- increase benefits to cover eyecare services and refraction, & materials.
  6. Diversity in residency programs
  7. Improve eye care education for patients-
  8. Create a network of Data to address disparities in eye care.
  9. Address gaps in health disparities research in ophthalmology.
  10. expanding our vision with international collaborations.

Epidemiology (1 decks)

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