Midterm 3: Week 11,12,13,14 Flashcards
(123 cards)
0
Q
Give an example of a Point Estimate Value
A
An example of a Point Estimate Value is a mean, the parameter this estimates is the real mean; μ (myu)
1
Q
Define a Point Estimate
A
A point estimate is a single numerical value that is used to estimate a corresponding population parameter
2
Q
What are Point Estimates usually accompanied with?
A
Point Estimates are usually accompanied with other numerical descriptors
3
Q
Why is it important that Point Estimations are accompanied with other numerical descriptors?
A
It is important that Point Estimations are accompanied with other numerical descriptors because it allows to see if the Point Estimation is a reasonable approximation
4
Q
What are the 2 Numerical Descriptors that accompany Point Estimations?
A
- The strength of an estimation; p-value
2. The possible range of our estimation; confidence interval
5
Q
What are the 2 tests that we are interested in when we’re looking at the relationship between 2 variables
A
- Measure of association: how strong the hypothesized association is between 2 variables
- Significance test: how likely the relationship between the 2 variables is due to chance
6
Q
What does the Null Hypothesis state?
A
The Null Hypothesis states that there is no difference in the exposed and unexposed groups; there is no association between the 2 variables
7
Q
What does the Alternate Hypothesis state?
A
The Alternate Hypothesis states that there is a difference between the exposed and unexposed group; there is an association between the 2 variables
8
Q
Define a Test Statistic
A
A value calculated from the data that is used to evaluate the evidence in support of the null hypothesis.
9
Q
Define a Significance Level
A
A Significance level is a standardized level of probability that we compare our test statistic to (α-value). If the test statistic is smaller than the significance level, then we reject the null hypothesis.q
10
Q
What does the P-Value give a measure of?
A
The P-Value gives a measure of how confident we are about a point estimate
11
Q
What does it mean to get a P-Value of 0.05?
A
A P-Value of 0.05 would mean that there is less than a 5% chance that outcome we observed is due to chance; 95% chance that the outcome we observe is not due to chance.
12
Q
How do we know what an appropriate p-value to use is?
A
We must look at what the possible gains, losses and circumstances are
13
Q
Why is it better to have a large sample size?
A
It is better to have a large sample size because the larger the sample size the more likely it is that the random error of one person will cancel out the random error of another person, meaning there is less net random error
14
Q
Define a Confidence Interval
A
A confidence interval is a measure of uncertainty about the true value of a the estimate; we can never be 100% about the true value of a estimate
15
Q
Is it better to have a wide confidence interval of narrow?
A
Narrow
16
Q
What does a Confidence Interval of 1 or greater indicate?
A
A Confidence Interval of 1 or greater indicates that the cause-effect relationship may not be accurate
17
Q
Are significance tests always black and white? ie: if a Significance Test shows that there is not a causal relationship, or there is, that is correct?
A
No, in a very large sample size the test may be very sensitive to differences and mislead the overall relationship and make it loook like there is no relationship when there really is one.
18
Q
Define Statistical Significance
A
Statistical Significance is when we mathematically test the outcomes of a study
19
Q
Clinical Significance
A
The relevance of research to individuals; builds an understanding of a person
20
Q
Public Health Significance
A
The relevance of a research to the population as a whole; the government etc
21
Q
Define Statistical Power
A
The ability to show association between 2 variables if it exists
22
Q
What are 3 ways Random Error can occur?
A
- Poor Precision
- Sampling Error
- Variability of Measurement
23
Q
What is Poor Precision?
A
Not having accurate measurements
24
What is Sampling Error?
Sampling Errors occur when the samples are not representative of the population, this can happen because of poor study design, chance, or small sample size
25
What can minimize random error?
We can minimize random error by having a large sample size, and repeating measurements/training interviewers
26
Can random error be completely eliminated?
No, it can not
27
Error graphs: Big box, dead centre means what?
Random error is high, but systematic error is low
28
Error graphs: big box, skewed left means what?
Random error and Systematic error
29
Error graphs: Small box, skewed left means what?
Low random error, but high sampling error
30
Error graphs: Small box, dead centre means what?
Low random error, and low sampling error
31
Define Systematic Bias
Systematic Bias is error that results from poor study design, protocol, analysis of the study
32
If Random Error is due to chance, what is Systematic Bias due to?
Systematic Bias is do to the researchers fault
33
What are the 2 main types of Bias?
Selection bias, and Information Bias
34
Define Selection Bias
Selection Bias is a bias that occurs due to the way the exposed and unexposed (cases and controls) were selected
35
How does Selection Bias most likely happen?
Selection Bias most likely happens when subjects are chosen from a sub-group and therefore are not representative of the population. Ex: it would not be appropriate if most of your subjects were chosen from a gym you frequent, if the population of interest was all of Canada
36
Define Information Bias
Errors made in measuring or classifying subjects
37
Name 6 examples of Information Bias?
1. Recall Bias; subject misremember
2. Misclassification Bias; mix up exposed and unexposed etc
3. Wish Bias; change memories because of affection
4. Surrogate Interview Bias; getting information from a 2nd source
5. Surveillance Bias; Look as one group closer, or less close
6. Hawthorne Bias; Those in studies act more cooperatively than the population would
38
Case-control studies are more likely to be affected by what kind of bias?
Case-control studies are more likely to be affected by selection bias
39
Cohort studies are more likely to be affected by what kind of bias?
Cohort studies are more likely to be affected by information bias
40
Define Confounding
Confounding is the distortion of an effect measure because of an other factor that is not part of the causal pathway
41
What is an important note to remember about confounders?
The third variable (the suspected confounder) must be related to both the exposure and the outcome
42
What is a good example of a confounder?
Alcohol consumptions effect on risk of lung cancer, the confounder here would be smoking because those who consume alcohol also commonly smoke
43
Why would hours underground, not be a confounder for lung cancer caused by asbestos mining?
Hours underground would not be a confounder because it is part of asbestos mining; part of the causal pathway
44
What are 5 ways to deal with confounding?
1. Randomization
2. Restriction
3. Matching
4. Stratification
5. Multivariate analysis
45
How is Randomization used to decrease the effect of confounders?
Randomization more equally distributes confounders in the exposed and unexposed group, cancelling out their net impact.
46
How is Restriction used to decrease the impact of confounders?
Restriction restricts the differences in characteristics of the subjects they study in the exposed and unexposed groups so that if everyone has that characteristic, everyone is affected equally. Ex: If age is a confounder, subjects in the exposed and unexposed groups would all be of similar age
47
How is Matching used to decrease the effect of confounders?
Matching forces confounder to be equally distributed on the exposed and unexposed sides by matching a unexposed individual almost exactly to a exposed individual
48
How is Stratification used to decrease the impact of confounders?
Stratification analyzes the exposure and outcome for every confounder, to understand the effect the confounder has on the exposure and outcome.
49
How is Multi-variate Analysis used to decrease the effect of confounders?
Multi-variate Analysis looks at multiple confounders at once to better understand the effect of confounders on the exposure and outcome; stratification in overdrive
50
What are the 5 steps to determining a cause-effect relationship?
1. Description of the Problem: data collection & determining disease frequencies (RR, RD, OR etc.)
2. Development of a Hypothesis: tentative explanations for the patterns of disease observed
3. Testing of Hypothesis: By comparing disease frequency
4. Evaluation and Interpretation of Associations: through Hill's guidelines
5. Refinement of causal model: Adjusting parts of your casual model based on what you have learned from testing testing your hypothesis and evaluating and interpreting associations.
51
Define Public Health
A multidisciplinary field that looks to promote the health of the population through organized community efforts
52
What are the 5 goals of the Public Health Agency of Canada
1. Promote health
2. Prevent and control chronic diseases and injuries
3. Prevent and control infectious disease
4. Prepare for and respond to public health emergencies
5. Strengthen the public health capacity
53
What does the Public Health Agency of Canada Act say?
The bill provides a legislative basis for the Public Health Agency of Canada and says that public health is population focussed, includes 1.disease surveillance
2. disease and injury prevention
3. health protection, emergency health
4. response, promotes health
5. undertakes relevant health research
54
On a government level, who is responsible for public health?
Every level of government is, federal, provincial and municipal
55
What does the BC centre for disease control do?
The BC Centre for disease control provides..
1. Surveillance
2. Detection/Diagnosis
3. Treatment
4. Prevention
5. and Consultation services
for those with a disease of public health importance
56
What are the 2 main Goal of Public Health in Canada?
1. Disease Prevention
| 2. Health Promotion
57
Define Disease Prevention?
Disease Prevention is activities designed to protect members of the public from actual or potential health threats; Disease Prevention is a type of Preventative Medicine
58
Why is it important to understand cause-effect relationships, in terms of disease prevention?
If we understand the cause-effect relationship between an exposure and a disease, we can eliminate the exposure, or limit the public's interactions with the exposure
59
What are the 3 levels of disease prevention?
Primary, Secondary, and Tertiary
60
What happens in Primary Prevention?
- Primary Prevention is put in place before disease happens and includes health promotion and specific protection; precautionary step
- Primary Prevention is health maintenance through individual and community efforts; makes us healthier
- Primary Prevention aims to reduce disease incidence; prevents new cases
61
Define Health Promotion
Health Promotion is the process of enables people to have more control over their health, and improve it
Population at a whole, in their everyday lives
62
What activities usually take place in health promotion?
Health Promotion is about providing the population with useful, user friendly, information that will help them make healthier choices in their daily lives
63
What is an example of health promotion?
Nurses from VCC coming into elementary schools to talk about the importance of brushing
64
What is an example of specific protection against disease?
The deliverance of HPV vaccines to girls in high schools
65
The Ottawa Charter in 1966 states that the fundamental conditions for health are..
1. Shelter
2. Peace
3. Education
4. Food
5. Income
6. Stable eco-system
7. Sustainable resources
8. Social justice, and equity
66
What is Health Promotion strongly tied to?
Health promotion is strongly tied to Determinants of Health
67
What happens in Secondary Prevention?
- reduce the symptoms and severity of clinical illnesses; decrease how bad a disease is
- focuses on intervention after disease; comes after disease has happened
68
What is an example of Secondary Prevention?
An example of Secondary Prevention is Screening Programs
69
Define Disability Limitation
Disability Limitation is a Secondary level prevention method that aims to limit the time in which an individual is disabled from illness and prevent death
70
What happens in Tertiary Prevention?
- Slowing or blocking the disease is attempted
- Tries to reduce disability, improve quality of life, and survival of the ill person
- Happens when a disease is very advanced
71
What is an example of Tertiary Prevention?
Therapies and cures are an example of Tertiary Prevention
72
Define Harm Reduction
Any program or policy that is designed to reduce drug-related harm, without requiring the stop to drug use (illegal drugs)
73
What is an example of Harm Reduction?
An example of Harm Reduction is a Safe Injection Site
74
What are the 3 Perspectives of Health Promotion?
The 3 Perspectives of Health Promotion are Biomedical, Behavioural & Lifestyle, and Socio-environmental
75
How is Health Promotion done Biomedically?
Through the Biomedically , vaccines, and reducing physiological risk factors is done as a part of Health Promotion
76
How is Health Promotion done through the Behavioural and Lifestyle perspective?
Looks to promote good health, by promoting good lifestyle choices such as a healthy balanced diet, no smoking etc
77
How is Health Promotion done through the Socio-environmental perspective?
The Socio-environmental perspective focuses on bettering social determinants of health; family, community, culture, and physical environment etc.
78
Define Primary Health Care
Services that are directly accessible to individuals and communities
79
Define Secondary Health Care
Services provided in hospitals
80
Define Tertiary Health Care
specialist services, ex: gynaecologist
81
What does disease look like with No Intervention?
```
Pathological onset
|
Clinical Symptoms
|
Death/Relapse/Recovery
```
82
What does disease look like with intervention?
```
Pathological Onset
|
Clinical Symptoms
|
Diagnosis
|
Treatment
```
83
Define Pre-clinical Phase
Time between the Pathological Onset and the Clinical Symptoms
84
What is the goal of screening?
The goal of screening is to catch an individual during the pre-clinical phase; after pathological onset, but before clinical symptoms, in order to more quickly catch the disease and increase the individuals chance at recovery
85
What is an important BUT for screening?
Screening catches those who are likely to have a disease, BUT it does not diagnose a disease or illness!
86
What are the assumptions of screening, ie. what is the criteria a disease of illness must meet in order to have a screening program established?
1. Early detection leads to early diagnosis and the early treatment
2. Interventions to better a patients life are available
3. Earlier treatment leads to a better quality of life relative to a later treatment
87
How does screening work?
Screening works by looking at many people and identifying who is at risk, those at greater risk are asked to go on for diagnosis, and those who have a positive diagnosis go on to be treated
88
What 7 points make a disease a good candidate for a screening program?
1. Serious and important
2. Progressive
3. Diagnosis and Treatment available
4. Natural history well understood
5. Critical point in natural history
6. Detectable in Pre-clinical phase
7. Detectable Pre-clinical period must be long
89
Define Lead Time
Lead time is the time gained by screening that can be used in treating or controlling a disease
90
What are 3 examples of screening programs that Canada has?
- Lung Cancer
- Oral Cancer
- Breast Cancer
91
What are the 8 characteristics of a good Screening Test?
1. Acceptable to recipient
2. Inexpensive
3. Highly sensitive (can't miss anyone with disease)
4. Highly specific (without disease should test negative)
5. Be Valid (identifies what is claims to identify)
6. Reliable (consistent)
7. Reduce mortality (make a difference!)
8. Reduce incidence and prevalence
92
When was the Medical Care Act brought in?
The Medical Care was brought in, 1966
93
What happened to the Medical Care structure in 1977?
In 1977, the 50-50 Cost-Sharing Structure was replaced with Block Funding Transfer
94
What level of government is directly responsible for Health Care?
The Provincial Government is directly responsible for Health Care
95
What was positive about the Medical Care Structure change in 1977?
A positive change that came from the Medical Structure change in 1977 is that it allowed provincial governments more flexibility in terms of health care
96
What was negative about the Medical Care Structure change in 1977?
A negative change from the Medical Care Structure change in 1977 was that it made it much easier for federal governments to cut funding for Medical care
97
What were some consequences of reduced spending on health care?
- Put a constraint on hospital budgets and physician reimbursements
- Reduced number of doctors being trained
- Increased wait times
98
The block transfer method that was brought in 1977 is actually called what?
The block transfer method is actually called Canada Health and Social Transfer (CHST)
99
When did health care begin to "improve" again?
In the 2000s
100
What is the fasted growing section of Health Care?
Pharmaceuticals
101
Increased User fees and Extra-billing by doctors in 1984, in part caused what?
Increased User fees and Extra-billing by doctors in 1984, in part caused Trudeau's government to pass the Canada Health Act, which banned this and ordered provincial governments to punish such practices
102
What does the Canada Health Act symbolize?
The Canada Health act symbolizes the Canadian value that health care is a basic right
103
What are the main points of the Canada Health Act?
- protect, promote, and restore the mental and physical well being of Canadians
- provide reasonable access to health services without financial etc barriers
104
Canada does not have a single national plan, what does it have?
We have 13 interlocking provincial and territorial health insurance plans and all of them share certain common features and basic standard coverage which is outlined by the Canada Health Act
105
What are the 5 basic principles of the Canada Health Act?
1. Available to all eligible Canadians
2. Comprehensive in care
3. Accessible without financial barriers
4. Portable within the country and abroad
5. Publicly administered
106
What is the federal governments role in health care?
- The federal government must set and administer national principles defined by the Canada Health Act
- The federal government must provide financial support to the provinces and territories
- Direct delivery of primary and supplementary care for 1 million people with special needs, ie first nations on reserves, some veterans, army, refugees, inmates, Inuit etc
- Public health programs; disease prevention
- Funding for health research and promotion
- Protection and regulation of pharmaceuticals
107
What is the Provincial Governments role in Health Care?
- Administering and delivering most of Canada's health care services while meeting guidelines placed by the federal government
* running health insurance plans
* planning,paying for, and evaluating hospital care, physician care, allied health care, prescription drugs, and negotiating fee schedules for physicians
108
What did Chretien commission in 2001?
In 2001 Chretien commissioned the Romanows report to look at the stability of the health care system
109
What was the task of the commission?
The task of the commission was to talk to Canadians about the future of Canada's Public Health Care and to recommend policies that would ensure, the long term sustainability of a universally accessible, publicly funded, health system
110
What did Romanow conclude from his dialogue with Canadians?
Romanow concluded that Canadians cared alot about a equitable access to high quality health care that is delivered on the basis of need and not ability to pay
111
What are the 7 main points of reccomendations that the Romanows commission made?
1. The federal government needed to increase money given to the provincial governments for health care and watch more carefully where that money was being spent
2. Creation of the Health Council of Canada
3. More integrated, team based care
4. Investment in Diagnostic technology and training programs to decrease wait lists
5. Centralized management of waitlists
6. National home care strategy and improved service to rural communities
7. National Drug Agency and better coverage for prescription drugs
112
What does Recommendation 8 of the Romanow report talk about?
Recommendation 8 of the Romanow report talks about A personal electronic health record for every Canadian; this provides for easily accessible and mobile health care records
113
What does Recommendation 10 of the Romanows report detail?
Individual Canadians should have ownership of their own health care records, the privacy of their records be protected, and have credible access to information about the health care system
114
What does Recommendation 29 of the Romanows report detail?
Funding for Aboriginal health services provided by federal, provinces, and territories should be pooled into a single budget
115
What does the Recommendation 43 in the Romanow report detail?
Any future reforms should be protected under the definition of "Public Services;" including free trade agreements
116
What does Recommendation 46 of the Romanow report detail?
The federal government should play a more active role in international efforts to strengthen the health care systems in developing countries
117
What does Recommendation 47 of the Romanow report detail?
Recommendation 47 of the Romanow report details that all levels of government and health organizations should reduce reliance on recruiting health care practitioners from developing countries; don't steal poor countries doctors
118
What are some challenges facing medicare today?
An ageing population, rising costs of pharmaceutical drugs and changing attitudes, different attitudes across provinces about health provinces
119
How much was Canada forecasted to have spent on health in 2014?
200 billion
120
What percent of Canada's GDP is used for health care finance?
10%
121
What is the ratio spent by the government, how much is spent by the public themselves?
70:30
122
What is the greatest cost to the health care system?
Pharmaceutical and dentistry
