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Flashcards in The Use of Data Deck (63)
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Define disease

Disease – symptoms, signs – diagnosis.

Bio-medical perspective


Define illness

Illness – ideas, concerns, expectations – experience.

Patients perspective


Factors affecting uptake of care?

- Concept of Lay Referral = "Granny knows best"

- Sources of info = Peers, family, TV, internet etc

- Medical factors - New symptoms, increasing severity, duration etc

- Non-medical factors = Crisis, peer pressure ("Wife sent me"), economic, psychological, environmental, culture, age, gender etc


Type of illness?

- Acute
- Chronic
- Self-limiting


What issues can there be in delivery of care due to the patients point of view?

> Believes himself to be healthy.

> Is physically fit.

> Proud not to be using tablets.

> Both he and his wife associate all illnesses to do with the Heart with Ischaemic Heart Disease.

> If treatment is proposed, how would he feel better?


What issues can there be in delivery of care due to the GPs point of view?

> You wish to perform a couple more tests – E.g. a Holter Monitor and an Echocardiogram – why might you do these tests?

> Assuming they return as confirming AF, you are worried about the consequences for Mr Blackwood’s long term health.

> Why might that be – what are you concerned about, and what sources of information might you have used to educate yourself about that?


What are the three main aims of epidemiology?



Disease control


What are the three main aims of epidemiology - Description?

To describe the amount and distribution of disease in human populations.


What are the three main aims of epidemiology - Explanation?

To elucidate the natural history and identify aetiological factors for disease usually by combining epidemiological data with data from other disciplines such as biochemistry, occupational health and genetics.


What are the three main aims of epidemiology - Disease control?

Disease control:
To provide the basis on which preventive measures, public health practices and therapeutic strategies can be developed,
implemented, monitored and evaluated for the purposes of disease control.


What does Epidemiology provide?

It compares groups (study populations) in order to detect differences pointing to:
> Aetiological clues (what causes the problem)

> The scope for prevention

> The identification of high risk or priority groups in society.


Clinical medicine deals with what?

Individual patients


Epidemiology deals with what?



How is the rate determined in epidemiology?

Using ratios:

Events / Population at risk

The numerator is the top line, the number of events (in this example deaths).

The denominator is the bottom line, the population at risk.


What is incidence?

Incidence - is the number of new cases of a disease in a population in a specified period of time

Incidence tells us something about trends in causation and the aetiology of disease.


What is prevalence?

Prevalence - is the number of people in a population with a specific disease at a single point in time or in a defined period of time

Prevalence tells us something about the amount of disease in a population. It is useful in assessing the workload for the health service but is less useful in studying the causes of disease


What is relative risk?

This is the measure of the strength of an association between a suspected risk factor and the disease under study.


How is relative risk calculated?

Relative risk (RR) = (Incidence of disease in exposed group) /
(Incidence of disease in unexposed group)

Slide 28 for examples


Sources of Epidemiological Date?

Include, but not restricted to

Mortality data
Hospital activity statistics
Reproductive health statistics
Cancer statistics
Accident statistics
General practice morbidity
Health and household surveys
Social security statistics
Drug misuse databases
Expenditure data from NHS


Health literacy ?

Health literacy is about people having the knowledge, skills, understanding and confidence to use health information, to be active partners in their care, and to navigate health and social care systems.



Used to determine risk involved in Non-rheumatic AF

C = CHF history
H = Hypertension history
A = Age (65-74 = 1 point, >75 = 2 points)
D = Diabetes history
S = Stroke/TIA/Thromboembolism

V = Vascular disease history

Score of:
1 = Low risk, consider anti platelet or anticoagulation
>2 = Moderate risk, should be on anticoagulation


HAS-BLED score?

Measure risk of major bleed when using warfarin



Measure reduced risk and expense saved using warfarin


How is information gathered for SIGN guidelines?

1) Gather lived experience
2) Identify question
3) Search for evidence
4) Look at the evidence
5) Make judgements and recommendations
6) Ask people for feedback
7) Publish
8) Let everybody know about the guidelines


How is evidence rated by SIGN guidelines?

Alphabetically with A being the best, the following are used in this judgement:

> Methodology checklist 1: systematic reviews and meta-analyses

> Methodology checklist 2: randomised controlled trials

> Methodology checklist 3: cohort studies

> Methodology checklist 4: case-control studies

> Methodology checklist 5: diagnostic studies

> Methodology checklist 6: economic studies


Types of studies - Descriptive studies?

Descriptive studies attempt to describe the amount and distribution of a disease in a given population, for the purposes of gaining insight into the aetiology of the condition or for planning health services to meet the clinical need.

Studies may look at the disease alone or may also examine one or more factors (exposures) thought to be linked to the aetiology.

This kind of study does not provide definitive conclusions about disease causation, but may give clues to possible risk factors and candidate aetiologies.


What are the key things descriptive studies are used for?

Descriptive studies follow the time, place, person framework. Descriptive epidemiological studies are useful in:
> Identifying emerging public health problems through monitoring and surveillance of disease patterns.
> Signalling the presence of effects worthy of further investigation.
> Assessing the effectiveness of measures of prevention and control (eg, screening programmes).
> Assessing needs for health services and service planning.
> Generating hypotheses about disease aetiology.


What are the advantages of descriptive studies?

Such studies are usually cheap, quick and give a valuable initial overview of a problem.


What are the disadvantages of descriptive studies?

They do not provide evidence about the causes of disease.

They do not test hypotheses.


Types of Studies - Analytic Studies - Cross-sectional?

Cross-Sectional (disease frequency, survey, prevalence study)

> In cross-sectional studies, observations are made at a single point in time.

> Conclusions are drawn about the relationship between diseases (or other health-related characteristics) and other variables of interest in a defined population.