module 1: measuring health and dis-ease in populations

Question 1

What is epidemiology

Answer 1

The study of frequency (or occurrence) of dis-ease in different populations

Question 2

What does “dis-ease” mean?

Answer 2

Any health related event or health-related ‘state’

Question 3

What is an occurrence

Answer 3

The transition from a non-diseased state to a dis-eased state

Question 4

How do epidemiologists define health & dis-ease?

Answer 4

Narrow: the absence of death, disease or disability
Broad: the capacity to do what matters most to you

Question 5

What is a population?

Answer 5

Any group of people who share a common factor

Question 6

What are the visual components of the GATE frame?

Answer 6

Triangle, Circle, Square, Arrow

Question 7

What does the triangle represent in the GATE frame?

Answer 7

The participant (or study) population
Divided into 3 parts:
Setting, eligible population, number of study population

Question 8

What does the circle represent in the GATE frame?

Answer 8

Specific sub-denominators (exposure group and comparison group)

Question 9

What does the square represent in the GATE frame?

Answer 9

The numberators (dis-ease outcomes)

Question 10

What does the arrow represent in the GATE frame?

Answer 10

Time

Question 11

How to deal with numerical data in GATE frame?

Answer 11

They can be converted to categorical data or average values can be calculated as dis-ease occurrence

Question 12

What is incidence?

Answer 12

The measure of onsets of dis-ease occurring during a period of time from the population

Question 13

What is prevalence

Answer 13

A measure of the number of people with dis-ease at a point of time

Question 14

What is PECOT

Answer 14

Population, Exposure/Comparison groups, Outcomes, Time

Question 15

What are the components of RAMBOMAN

Answer 15

Recruitment error
Allocation error
Maintenance error
Blind or objective measurement
Analyses

Question 16

What are the types of epidemiological studies

Answer 16

Individual participant cohort study
Individual participant RCTs
Individual participant Cross-sectional study
Ecological studies

Question 17

Describe the properties of individual participant RCTs

Answer 17

Longitudinal, experimental
Random allocation minimises confounding
Ethical limitations
Expensive, small studies
Often combined in a meta-analysis (due to high random error)

Question 18

Describe the properties of individual participant cohort studies

Answer 18

Longitudinal, observational,
Allocation by measurement
Cheaper than RCTs
Confounding common
Maintenance error common

Question 19

Describe the properties of individual participant cross-sectional studies

Answer 19

Measures prevalence
Observational
Allocation by measurement and prevalence measured at same time
No maintenance error
Possible reverse causality and confounding

Question 20

What are the properties of ecological studies

Answer 20

Investigates international trends (incidence and prevalence)
Cheaper and quicker than other studies because data is already collected
Low random error
Confounding and measurement error common

Question 21

What is the equation for RR and RD

Answer 21

RR = EGO/CGO
RD = EGO-CGO

Question 22

What is confounding

Answer 22

When the exposure is mixed with another factor that is also associated with the outcome

Question 23

What is the criteria in the Bradford Hill Framework

Answer 23

1. Temporality
2. Strength of association
3. Reversibility
4. Biological gradient (dose-response)
5. Biological plausability of association
6. Consistency of association
7. Specificity of association

Question 23

What is the definition of a 95% confidence interval (95% CI)

Answer 23

There is about a 95% chance that the true value in a population lies within the 95% confidence interval

Question 24

What is temporality

Answer 24

The cause must come first before the disease Essential to establish a causal relation

Question 25

What is strength of association

Answer 25

The stronger an association, the more likely to be causal in absence of known biases

Question 26

What is reversibility

Answer 26

Under controlled conditions, a change in exposure results in a change in outcome (removing outcome)

Question 27

What is Biological gradient (dose-response)

Answer 27

Incremental change in disease rates in conjunction with corresponding changes in exposure

Question 28

What is biological plausibility

Answer 28

Does the association make sense biologically?

Question 28

What is consistency of association

Answer 28

Replication of the findings by different researchers at different times, in different places, with different methods

Question 29

What is specificity of association

Answer 29

A cause leads to a single effect An effect has a single cause

Question 30

What is a 'cause' for an individual in health

Answer 30

Any event, characteristic or other definable entity, that brings about a change for better or worse in health

Question 31

How does the 'causes of the causes' differ for populations compared to individuals

Answer 31

Determinants of health in populations are related to the context in which the population exists

Question 32

What are downstream interventions

Answer 32

Interventions occurring at the micro level including treatment systems and disease management

Question 33

What are upstream interventions

Answer 33

Interventions operating at the maco level, such as government policies and international trade agreements

Question 34

What is a proximal determinant

Answer 34

A determinant of health that is near to the change in health status

Question 35

What is a distal determinant

Answer 35

A determinant of health that is either distant in time and or place from the change in health status (i.e upstream factors)

Question 36

What is level 1 of the Dahlgren and Whitehead model?

Answer 36

The individual: Age, sex and constitutional factors that are non-modifiable Individual lifestyle factors

Question 37

What is level 2 of the Dahlgren and Whitehead model?

Answer 37

The community: Social and community networks & living and working conditions

Question 38

What is level 3 of the Dahlgren and Whitehead model

Answer 38

The environment: General socioeconomic, cultural and environmental conditions Examples: Physical environment - water quality Built environment - infrastructure Cultural environment - knowledge, beliefs and values Biological environment - disease and toxins The ecosystem - biodiversity, climate change Political environment - government approaches to health

Question 39

What are the components of the Living Standards Framework

Answer 39

Our individual and Collective wellbeing Our Institutions and Governance The Wealth of Aotearoa

Question 40

What are the Four Capitals in The Wealth of Aotearoa

Answer 40

Natural capital - aspects of the natural environment Human capital - people's skills, knowledge and physical/mental health Social capital - norms and values that underpin society Financial/Physical capital - all things like houses, roads, infrastructure etc.

Question 41

What is structure?

Answer 41

Social and physical environmental conditions and patterns that influence choices and opportunities available

Question 42

What is agency?

Answer 42

The capacity of an individual to act independently to make free choices