Epidemiology Final Exam

Front 1

What is screening?

Back 1

Organized, population-wide approaches to disease detection; an examination of a group of usually asymptomatic people to detect those with a high probability of having a given disease; aim is to detect the disease before the usual time of diagnosis.

Front 2

What is case-finding?

Back 2

Opportunistic attempts at early detection when a person comes into contact with the health system for another reason; diagnostic approach used when a person is already suspected of having a disease.

Front 3

What are the levels of prevention?

Back 3

(1) Primary Prevention
(2) Secondary Prevention
(3) Tertiary Prevention

Front 4

What is primary prevention?

Back 4

Preventing a disease or disorder before it happens; health promotion, health education, and health protection are examples.

Front 5

What is secondary prevention?

Back 5

Prevention aimed at the health screening and detection activities used to identify disease; aims to block the progression of disease or prevent an injury from developing into an impairment or disability.

Front 6

What is tertiary prevention?

Back 6

Prevention whose aim is to retard or block the progression of a disability, condition, or disorder in order to keep it from advancing and requiring excessive care; limiting any disability by providing rehabilitation where disease, injury, or a disorder has already occurred and has caused damage.

Front 7

What are the strategies for prevention?

Back 7

(1) high-risk strategy
(2) mass strategy

Front 8

What is the high-risk strategy for prevention?

Back 8

a targeted rescue operation for vulnerable individuals; well matched to individuals and their concerns which should improve the benefit-to-risk and benefit-to-cost ratios; if problem is confined to an identifiable minority and can be successfully controlled in isolation.

Front 9

What is the mass strategy for prevention?

Back 9

Better approach for common or widespread problems; aims to reduce health risks of the entire population; immunization programs and fluoridation of water are examples.

Front 10

What is a risk factor?

Back 10

Anything that increases a person's chance of developing a disease (behavioral, environmental, genetic, and social)

Front 11

What are at-risk behaviors?

Back 11

An activity performed by persons who are healthy, but are at greater risk of developing a particular disease, condition, or disorder because of the behavior.

Front 12

What are predisposing factors?

Back 12

Those existing factors or conditions that produce a susceptibility or disposition in a host to a disease or condition without actually causing it; precede the direct cause.

Front 13

What is blinding?

Back 13

Used in experimental studies to minimize potential bias from a placebo effect.

Front 14

What are the levels of blinding?

Back 14

(1) single blind (subjects)
(2) double blind (investigators)
(3) triple blind (analysis)

Front 15

What is a single blind study?

Back 15

Placebo-controlled study where the subjects are blind but investigators are aware of who is receiving the active treatment.

Front 16

What is a double blind study?

Back 16

Neither the subjects nor the investigators know who is receiving the active treatment.

Front 17

What is a triple blind study?

Back 17

Not only are the treatment and research approaches kept a secret for the subjects and investigators, but the analyses are completed in a way that is removed from the investigators.

Front 18

What are the implications related to blinding?

Back 18

In some situations, it may be impossible or unethical to blind; may be problematic to blind in drug studies where a treatment has characteristic side effects; building side effects into a placebo may also be unethical.

Front 19

What are the strengths of blinding?

Back 19

Demonstrate cause-effect relationships; may produce a faster and cheaper answer than observational studies; only appropriate approach for some research questions; allow investigators to control the exposure levels as needed.

Front 20

What are the weaknesses of blinding?

Back 20

Often more costly in time and money; many research questions are not suitable for experimental designs because of ethical barriers and because of rare outcomes; many research questions are not suitable for blinding; standardized interventions may be different from common practice; may have limited generalizability due to the use of volunteers, eligibility criteria, and loss to follow-up.

Front 21

What are the criteria for establishing causal associations?

Back 21

(1) temporal relationships (absolute requirement)
(2) strength of association
(3) consistency of association
(4) Dose-response relationship
(5) biological plausibility
(6) specificity
(7) experimental evidence

Front 22

What is a temporal relationship?

Back 22

Exposure must precede the disease.

Front 23

What is the strength of the association?

Back 23

Stronger associations between exposure and outcome variables increase the likelihood of there being a causal association; stronger associations are less likely to be explained by chance, bias, or confounding.

Front 24

What is the consistency of the association?

Back 24

When associations are replicated by different investigators in different settings with different methods.

Front 25

What is the dose-response relationship?

Back 25

When an increasing amount of exposure increases the risk of disease.

Front 26

What is biological credibility?

Back 26

Is the association biologically supported? Biological assessment often involves experiments in controlled laboratory environments.

Front 27

What is experimental evidence?

Back 27

Experimental study design is the best for establishing cause-effect relationships because blinding is effective at controlling bias, and randomization is effective for balancing out the effect of known and unknown confounders.

Front 28

What is specificity?

Back 28

If an association is limited to a specific outcome then we would expect to see that outcome in individuals with a specific disease.

Front 29

What is eradication?

Back 29

Removal of a disease from all human populations.

Front 30

What is elimination?

Back 30

Removal of a disease from defined areas.

Front 31

What is control?

Back 31

Reduction of a disease below the threshold of public health significance.

Front 32

What are the 5 elements of causation?

Back 32

(1) consistency of the cause-effect association
(2) strength of the cause-effect association
(3) specificity of the cause-effect association
(4) time factor aspects of the cause-effect association
(5) coherence of the cause-effect association.

Front 33

What is field epidemiology?

Back 33

The application of epidemiology under a set of general conditions: (1) the problem is unexpected, (2) a timely response may be demanded, (3) travel to and work in the field is required by epidemiologists to solve the problem, and (4) the investigation time is likely to be limited because of the need for a timely intervention.

Front 34

What are the steps (14) in conducting a field investigation?

Back 34

(1) establish the existence of an epidemic (or outbreak), (2) confirm the diagnosis, (3) establish criteria for case identification, (4) search for missing cases, (5) count cases, (6) orient the data according to person, place, and time, (7) classify the epidemic, (8) determine who is at risk of becoming a case, (9) analyze the data, (10) formulate a hypothesis, (11) test hypotheses, (12) develop reports and inform those who need to know, (13) execute control and prevention measures, and (14) administration and planning activities.

Front 35

How are epidemics classified?

Back 35

(1) common source
(2) propagated
(3) mixed

Front 36

What is a common source epidemic?

Back 36

at a specific point, through intermittent or continuous exposure to a source over days, weeks, or years.

Front 37

What is a propagated epidemic?

Back 37

through gradual spread from person-to-person

Front 38

What is a mixed epidemic?

Back 38

combination of both common source and propagated outbreaks; typically begin with a common source and are then propagated from person-to-person.

Front 39

How do you construct a web of causation?

Back 39

(1) identify the problem, affirm the condition, and obtain an accurate diagnosis of the disease, (2) place the diagnosis at the center or bottom of the web, (3) brainstorm and list all possible sources for the disease, (4) brainstorm and list all possible risk factors and predisposing factors of the disease, (5) develop sub-webs and tertiary level sub-webs for the various branches of the web, if needed, (6) organize and arrange lists of sources and risk factors from general and most distant from the disease, in steps, being more specific and focused as the steps move closer toward the diagnosis of the disease, and (7) develop and work through causation decision trees for each element under consideration on the way toward the diagnosed disease.

Front 40

Which studies are best for determining cause-effect?

Back 40

The double-blind randomized clinical trial because blinding minimizes bias and randomization minimizes confounding.

Front 41

What are the study designs effective at establishing causal association in rank order? (control confounding)

Back 41

(1) randomized controlled trials, (2) community trials, (3) prospective cohort studies, (4) retrospective cohort studies, (5) case-control studies, (6) cross-sectional studies, (7) ecologic studies, and (8) case report or case series studies.