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42 Cards in this Set

  • Front
  • Back
def. an event, condition, or characteristic that increasese the likelihood of the disease of advances its occurrence
cause
define necessary
cause of outcome MUST be present for the outcome to occur
defin sufficient
cause if present ASSURES an outcome
define component cause
event or condition that when combined with other agents or conditions will produce disease
is "does it have to be there?" necessary or sufficient?
necessary
necessary? sufficient?
mycobacterium TB --> TB
yes no
necessary? sufficient?
guillotine --> death?
no yes
necessary? sufficient?
smoking --> lung cancer
no no
high chol --> CHD
no no
cigarettes + poor detox + poor diet = _______ cause
component
why do we need inference?
hard to really PROVE something
might need action
we resort to inference for public health decisions
Explain the levels of evidence
I II1 II2 II3 III
I RCT
II1 randomization
II2 cohort or case
II3 series and uncontrolled trials
III opinions
What are the eight basic Hill guidelines for judging f something is causal
temporal relationship
strength of association
dose response
replication of findings
biologic plasibiltity
consistency with other knowledge
cessation of exposure
consideration of alternative
what studies can establish a temporal relationship
clinical trials
cohort studies
nested case control studies
time series
The ______ the RR the higher the likelihood that the association is causal
RR
T or F. The further the measure is from one the stronger the assoIciation
true!
is RR=.3 or RR=.8 stronger?
.3 (it's further from one)
How can you measure strength
RR
ARR
Attr risk
population attributable risk
what is levin's fromla
pop AR = Pe (RR-1)/pe (RR-1) +1
T or F. Lack of dose response rules out causality
FALSE
define population attributable risk
proprotion of risk in general population that would be removed if exposure were eliminated
Pop AR =
(Ipop - I0)/Ipop
what are the main limitations of meta analysis
quantitative results give false sense of certainty
unrecognized heterogeneity
publication bias
define validity
ability of the test to distinguish who has the disease and who does not
define reliability
reproducibility of the test
does validity lack bias or random error? how about reliability?
validity lacks bias
reliability lacks random error
what are two basic ways to measure validity
sensitivity and specificity
define sensitivity
true +/all disease
how do you setup table to find sensitivity and specificity
test gold standard
calculate going down
what does PPV tell you
the proportion of the positive test results that are truly positive
For a given level of sensitivity/specificity, the PPV and NPV depend heavily on ______ of the condition
prevalnence
what does the ROC durve look like
sensitivity vs (1-spec)
the upper left the better the test
LR =
sensitivity/(1-spec)
likelihood ratio combines info from ____ and _____ of a test
sensitivity and specificity
Post test odds = _____ x pretest odds
LR+
LR - =
(1-sense)/(spec)
T or F. The likelihood ratio is calculated as the ratio of probability of positive result in people with the disease over the probability of a positive result in people without disease
true
deifne likelihood ratio
how many times more likely a positive test result is to be found indiseased individuals compared to non diseased individuals
what is a disadvantage of cost benefit analysis
hard to put money value on life
what are the purporses of screening
treatment
counseling
research
forensic
exclusion
name some ethical elements for screening
test should have known sensitivity specificity and predictive value in a defined populations.
If treatment is goal, well designed peer reviewed studies shoudl establish benefits, risks, and cost.
labeling should be presumed to have risks and no inherent benfits
what are the two most common purposes of screening
treatment and counseling