Global & Public Health Flashcards
(85 cards)
1
Q
What type of conditions is the global burden of disease heading towards?
A
chronic disease
2
Q
In the poorest nations, what are the tow components that make up the double burden of disease?
A
Infectious/malnutrition/maternal
Chronic
3
Q
Who are typically affected by neglected tropical diseases and why?
A
The “bottom billion”
Little access to healthcare
Abandoned by pharmaceutical companies and governments
4
Q
4 examples of neglected tropical diseases?
A
Dengue
Leprosy
Rabies
Schistosomiasis
5
Q
5 challenges of neglected tropical diseases?
A
Poverty impedes simple prevention Failure of healthcare systems Pharmaceutical companies no profit Death and disfigurement Social taboo Delay may result from traditional beliefs/treatment
6
Q
What are the 8 UN Millenium Development Goals
A
Hunger Primary education infant mortality maternal health environmental protection disease management gender equality
7
Q
What is multimorbidity?
A
the coexistence of two or more long-term conditions
8
Q
What is the “rule of halves” for a condition such as hypertension?
A
half of the cases are not known,
half of those known are not treated
and half those treated are not controlled
9
Q
What is change in disease pattern known as?
A
Epidemiological transition
10
Q
5 possible reasons for epidemiological transition
A
less healthy diets physical inactivity tobacco use urbanization increased life expectancy
11
Q
A woman’s diet and body composition at the time of conception and during pregnancy have important effects on the subsequent health of her offspring refers to which epidemiological hypothesis?
A
Barker
12
Q
What term is defined as: the coexistence of two or more long-term conditions
A
Multimorbidity
13
Q
Practical implication and example of the rule of halves?
A
half of the cases are not known,
half of those known are not treated
and half those treated are not controlled
HTN
14
Q
7 reasons for epidemiological transition
A
less healthy diets physical inactivity tobacco use urbanization increased life expectancy “Demographic transition” Poverty: unhealthy choices! ?Market forces: making unhealthy choices easily accessible
15
Q
What is defined as The rate at which new cases (or events) occur in the population
A
Incidence rate
16
Q
How will the following affect the incidence rate of a disease?
A
Increase it
17
Q
What epidemiology measure is best for acute diseases of short duration?
A
Incidence rate
18
Q
3 types of incidence rate
A
Crude incidence rate (IR)
Age- and sex-specific IR
Age standardised (adjusted) IR
19
Q
What term is defined as the proportion of people in a population who have a disease / condition / attribute at a particular time
A
Prevalence
20
Q
Components of calculating prevalence
A
No. of existing cases at a defined time
No. of persons in the population at that time
21
Q
How does incidence rate differ from prevalence?
A
Incidence is NEW CASES
Prevalence - EXISTING CASES
22
Q
3 types of prevalence
A
Point
Period
Lifetime
23
Q
How will these factors affect prevalence?
Increase in new cases (incidence, improved diagnosis or case ascertainment)
Longer duration of the disease (e.g. due to better treatment / survival)
Prolongation of life of patients without cure
In-migration of susceptible people / cases
Out-migration of healthy people
A
increase it
24
Q
What depends on the incidence and duration of the disease?
A
Prevalence
25
```
Put these in order of hierarchy
Cohort
ecological
case-control
cross sectional
```
cohort
case-control
cross sectional
ecological
26
Best type of study for treatment decision
RCT
27
Best study for For informing patients about prognosis / survival?
Cohort
28
Best study for Understating the barriers to access mental health services / factors leading to positive experience of care / factors associated with delayed diagnosis of cancer in the elderly
Qualitive
29
Case series
Ecological (correlation, time trend, geographical studies)
Cross-sectional (surveys, prevalence studies)
Case–control
Prospective (cohort) studies (incidence, longitudinal, follow-up studies)
Are all what types of study?
Observational
30
Semi-structured interviews, focus groups
| Are what type of study
Qualitative
31
```
Clinical trials (RCTs)
Cluster (community) RCTs
Are what type of study
```
Interventional
32
What type of studies Examine the association between exposures and outcomes by using aggregate (population-level) data
Ecologic
33
What type of study would you use to answer the following questions?
Is dietary fat intake associated with breast cancer mortality?
Do changes in diet over time correlate with changes in CVD over time?
Is naturally occurring lithium in drinking water associated with suicide rates in the population?
Ecologic
34
Cannot determine association or causality at the individual level
Subject to ‘ecological fallacy’
Are weaknesses of what type of study
Ecologic
35
Can examine association at population level
Used for generating hypotheses (initiating further research)
Use existing data – therefore efficient, inexpensive and relatively quick to conduct
Are strengths of what type of study?
Ecologic
36
collect information at one particular point in time (also referred to as prevalence studies)
Measure population prevalence to inform healthcare planning
Explore the association between risk factor(s) and disease
Are characteristics of what type of study?
Cross Sectional
37
What type of studies do this?
Generate hypotheses and examine association between exposure and disease
Describe the experience of patients using a service
Explore the knowledge, attitudes and practice/beliefs of patients and relate this to adherence to treatment regimens (KAP studies)
Cross sectional
38
What type of study is used to calculate prevalence?
Cross sectional
39
As data on exposure and disease are collected simultaneously it can be difficult to assess the temporal relationship between the exposure and the outcome
Is a limitation of what type of study?
Cross sectional
40
Relatively easy and quick to conduct providing timely insight in emerging conditions (e.g. NHS COVID-19 App, King’s College COVID-19 symptoms tracking APP)
Can provide information on a wide range of exposures and outcomes at the same time
Regular surveys of random samples of the population (e.g. Health Survey for England) provide valuable snapshots of exposures and outcomes
Are strengths of what type of study?
Cross sectional
41
people with a condition are compared with those who do not have the condition with respect to one or more exposures of interest
Refers to what type of study?
Case-control
42
To test aetiological hypotheses (i.e. potential causal factors)
To study associations of a disease with several exposures and measure potential confounding factors
Are features of what type of study?
Case-control
43
What study is Efficient for rare diseases and those with long induction/latent period
case-control
44
What type of study is used to identify different clinical patterns, presentations and associations (e.g. evaluation of screening and prevention programmes, vaccine and treatment efficacy, outbreak investigation)
case-control
45
OR = 1 means what?
no association between the exposure and the disease
46
OR > 1 means what?
the exposure is a potential risk factor for the disease (i.e. harmful or positive association)
47
OR < 1 means what?
the exposure is potentially protective for the disease (i.e. beneficial or inverse association)
48
Subject to recall and selection bias if not well designed
Inefficient for rare exposures
Is a limitation of what type of study?
Case-control
49
Quick to conduct than prospective cohort studies
Good for investigating disease with long latent period between exposure and outcome
Efficient for studying rare diseases
Can examine several possible risk factors for a single disease
Are strengths of what type of study?
Case-control
50
What type of study? a group of people are followed over time to determine the incidence of a health outcome or disease – incidence rates in those who are exposed (to a risk factor(s) and those who are not exposed are compared
Cohort
51
2 types of cohort study?
Prospective
| Historical
52
To identify potential causal association between exposure and disease
Understand the physiology, pathogenesis (causal pathways), prognosis, and natural history of disease
Evaluation of screening and prevention programme; vaccine and treatment efficacy (e.g. COVID-19 follow-up studies)
To establish temporality between cause and effect
Are key features of what type of study?
Cohort
53
Possible to study association of an exposure with several outcomes (e.g. British Physicians Study)
Possible to study multiple exposure (when a general population cohort is selected irrespective of any particular exposure (e.g. EPIC studies, The Million Women Study, UK Biobank)
Are key features of what type of study?
Cohort
54
What are the outcome measure in a cohort study?
Incidence (or mortality) rates in the exposed and not exposed groups
55
What is defined as No. of new cases of disease (or event) in the exposed group ÷
Person-years at risk × 100,000 (or per 1000)
Incidence rate in the exposed group (absolute risk)
56
What is defined as
No. of new cases of disease (or event) in the not exposed group ÷
Person-years at risk × 100,000 (or per 1000)
Incidence rate in the not exposed group (absolute risk)
57
What is defined as
| Incidence rate in the exposed (observed) ÷ Incidence rate in the not exposed (expected)
Relative risk (rate (or risk) ratio)
58
What is defined as
| incidence rate in the exposed – incidence rate in the not exposed
Attributable risk (rate (or risk) difference)
59
Expensive to conduct – may take a long time to complete
Inefficient for rare diseases unless cohorts are very large (e.g. UK Biobank)
Are limitations of what type of study?
Cohort
60
Temporality between exposure and disease can be established
Measurement of incidence rate of disease in exposed and not exposed groups
Examination of multiple outcomes (diseases, mortality) for any given exposure
Suitable for examining rare exposures (e.g. asbestos exposure amongst factory employees)
Are strengths of what type of study
Cohort
61
The investigator assigns individuals (or communities) to two or more groups that either receive or do not receive a preventive or therapeutic intervention or treatment
Refers to what type of study?
Intervention
62
active manipulation of the exposure by the investigator is the hallmark of these studies
Like a prospective cohort, the groups are followed into the future to observe the outcome(s)
Are features of what type of study?
Intervention
63
What is defined as Systematic error in the design, data collection procedures, analyses, reporting, or a combination of these factors that can lead to conclusions that are systematically different from the truth
Bias
64
What type of bias is: systematic differences between the characteristics (i.e. those which are related to exposure and/or outcome) of people who take part in a study and characteristics of those who do not
Selection
65
↓ participation by heavy smokers in studies of smoking and disease
↑ participation by health-conscious individuals or those with family history of cancer in voluntary cancer screening
Are examples of what type of bias?
Selection
66
Develop an objective case definition
Achieve high participation (response) rates
Include all cases in a defined time/place (representativeness)
Take diagnostic and other relevant practices into account when designing the study
Will affect what type of bias?
Selection
67
systematic differences in the way information on exposure and/or outcome is collected
→ different quality (accuracy) of information between the comparison groups
Refers to what type of bias?
Information
68
Using different methods and/or instruments to measure BP to classify hypertension
Is an example of what type of bias?
Information
69
Questionnaire design
Mask subjects/interviewers to the study hypothesis
Use different methods to retain and trace subjects
Use the most accurate information source, and sensitive and specific criteria (or clinical equipment/tests) to classify the exposure and disease
Would affect what type of bias?
Information
70
What is defined as a distortion or mixing of effects between an exposure, an outcome, and a third extraneous variable known as a confounder
Confounding
71
3 requirements of a confounding factor?
be associated with the disease
be associated with the exposure
not be an effect of the exposure
72
3 ways of avoiding confounding in analysis stage
Stratification
Standardisation
Multivariable analysis / multiple regression
73
4 ways of avoiding confounding in design stage
Matching (e.g. pairwise/frequency matching for age/gender)
Restriction (e.g. limiting the study population to one gender)
Collecting information on potential confounders (e.g. age, gender, smoking)
Randomisation (e.g. intervention studies)
74
What is defined as the portion of variation in a measurement that has no apparent connection to any other measurement or variable, generally regarded as due to ‘chance’
random error
75
What can random error lead to?
a false association between the exposure and disease
76
```
Individual biologic variation
Sampling variability
Measurement error (errors in assessing exposure/disease)
Are sources of what?
```
Random error
77
2 methods of quantifying random error?
```
The P value (with a threshold of 0.05)
Confidence interval (CI) estimation (around a point estimate, which is either a measure of disease frequency (IR, prevalence) or association (RR, OR)
```
78
preventing onset of disease is what type of prevention?
Primary
79
preventing progression of disease (early diagnosis and treatment) is what type of prevention?
Secondary
80
reducing disability and suffering from disease is what type of prevention?
tertiary
81
```
healthy diet
regular exercise
avoidance of (or exposure to) smoking
sunscreen use
Immunisation (e.g. COVID-19)
policies to maintain a clean supply of water, air, and food
eliminating environmental risks (e.g. safe home/work environment)
Type of prevvention?
```
Primary
82
Screening (breast, cervical, AAA) and other methods of early detection and diagnosis
What type or prevention?
Secondary
83
4 types off screening?
Mass or population –
Multiple or multiphasic –
Targeted –
Case-finding or opportunistic –
84
4 examples of NHS screening
Breast
Cervical
Bowel
AAA
85
drugs to prevent opportunistic infection in HIV+ persons
keeping the level of HbA1c <7% to reduce the effect of the disease
use of statins, beta blockers and aspirin to prevent MI in patients with CHD; risk factor, behaviour, and lifestyle modification
What type of prevention
tertiary
