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109 Cards in this Set
- Front
- Back
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What pump was the source of the cholera outbreak in 1854?
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Broad Street Pump
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Why didnt the guys at the brewery get cholera in 1854?
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Because they didnt drink from the broad street pump
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The three aspects of the "Public Health Model":
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1) Study health status in populations = identify risk factors
2) Design and Implement strategies 3) Monitor Population for effectiveness |
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Cost Benefit
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Comparison of the cost of medication (intervention) vs. savings from disease prevented
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Cost Effectiveness
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Comparison of the cost of two different med. for same disease with relation to their relative efficacy.
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Primary Prevention
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Stop disesase in the frist place (health promotoion)
This is always preferred |
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Secondary Prevention
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Identify Disease early and slow it..usually in preclinical phase of disease
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Tertiary Prevention
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Do nothing to stop full-blown disease, just treat symptoms/restore ADLs (basic and instrumental)
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Clinicians are ___________ of Epidemiology
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Consumers
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True/False :
Cochran Library is only for USA |
False:
Has articles from over 90 Countries |
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What two types of reviews are within the Cochrane Library?
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1) Cochrane controlled trials register
2) Systematic Reviews |
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True/False:
You can search both types of reviews in the Cochrane Library simultaneously. |
That is so fucking true.
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What the heck is MEDLINE?
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Medical Literature Analysis and Retrieval System Online.
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What in the heck is MEDLINE a database for?
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The National Library of Medicine
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Somebody tells you to search MEDLINE. What the heck are you gonna use?
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I'm gonna use PubMed
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How far back does EMBASE search?
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1974
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true/false:
EMBASE contains MEDLINE |
You are so true!
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What the heck is OLD MEDLINE?
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medline from '58-'65. Be prepared to have a hard time finding abstracts in this bitch.
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Accuracy
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How CLOSE the measurement is to TRUE VALUE.
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Reliability
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Consistency on repeat measurements
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Precision
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Limit of detection of the test. (how many lines are on YOUR ruler?)
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Validity
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Whether the test measure what it says it measures.
Does this shit even work? |
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Honest/Liar
I can get the same result over and over again. This means I'm precise |
You're a LIAR! You're reliable.
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Screening
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Form of 2ndary Prevention. FOCUS ON INDUVIDUALS.
trying to get to disease before full manifestation of disease. |
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Surveillance
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FOCUS ON GROUPS.
Primary Prevention...indirectly. Watch a certain population and study risk for disease. |
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What the heck is a 2 x 2 table
for? |
used to dichotomize continuous results in to + and - categories
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Sensitivity
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a/(a+c) = How often we pick up on the person ACTUALLY having it....
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Specificity
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d/(d+c) = How often we pick up on the person NOT having it...
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Positive Predicitive Value
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a/(a+b) = How many times were we actually right when we said "POSITIVE!!"
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Negative Predictive Vaule
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d/(c+d) = How many times were we actually right when we said "NEGATIVE!!"
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Where should cutoff for a screening test be?
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In area (normally left-most) where we get highest number of positives.
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Honest/Liar:
I can use an ROC curve for both a diagnostic and screening test, because I'm great! |
you're a LIAR!!
ROC Curves are only for diagnostic tests!! |
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ROC Curve: What is it and what does it plot?
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Receiver Operator Curve
Sensitivity (y) x (1-specificity) (x) |
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Ideal cutoff point for an ROC curve?
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Upper left-most point.
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Area under ROC curve represents __________
((say "Blaaaaank")) |
the accuracy of the test
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As prevelance goes up, ____ goes up.
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Positive Predictive value
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Kappa statistic
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Measure of intra-or inter-observer agreement rate: how much the observers agree above what is expected by chance curve....
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Kappa statistic
(calculation) |
((% agreement obs. - % agreement by chance)
-------------------------- 100% - % agreement by chance |
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What is considered a good value for kappa?
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>0.75
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whats a BAD value for kappa?
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<0.40
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Point Prevalence
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# of cases at a specific time/
population at risk at a specific time |
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Period Prevalence
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# cases during a pd. of time/
population at risk during pd. |
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Is prevalence a rate? (yes/no)
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NO! There is no unit of time.
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Incidence
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Measures number of new cases that OCCUR DURING SPECIFIED period.
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Cumulative Incidence
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basic calc. of incidence. you have number of 'incidents" andnumber of years -- person years.
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What the heck is a person year?
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1 person for 10 years, 10 people for 1 year... 10 person-years
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prevalence calc.
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Prevalence = Incidence x duration
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Top 5 causes of death in the US..in order!
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1) Heart Disease
2) Cancer 3) Stroke 4) COPD/Chronic Lower resp. disease 5) Unintentional injury |
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Are the top 5 causes of death in the US skewed?
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Yes. This is from all the oldies dying form the first 4 -- most of the people dying are old-heads...so it wieghts the list.
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So whats the leading cause of death for peeps from 1 to 44?
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Unintentional injury....ooops!
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Whats the leading CANCER cause of death in men?
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LUNG CANCER!!
puff puff |
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What is the leading CANCER cause of death in women?
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LUNG CANCER!!
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Why did women show a lag in the incidence of lung cancer over men?
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Because they picked up the habit later on in the 20th century. Guys are cool, they set the trend.
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Honest/Liar:
Rates, ratios and proportions are different things. |
You are HONEST!!!
Because of this, you don't need to really know what these things are!! |
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Crude Annual Mortality Rate
(CDR) |
# deaths in year/midyear pop.
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Case-Specific Mortality Rate
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Deaths due to specific disease/midyear population
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case-fatality Rate
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Those who died of disease/
Everybody who had the disease |
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What do you use as denominator when measuring deaths/birts....?
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LIVE BIRTHS...not preggos.
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Proportionate Mortality RATIO
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Deaths from cause/All deaths
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What are the 4 things recorded for a mortality on a death certificate?
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1)immediate (principle) cause
2)Underlying (intermediate) Cause 3)underlying (contributory) Causes 4)Mechanism of death |
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What do epidemiologists look for on a death certificate?
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Continutory causes (underlying) -- what was present before, and lead to intermediate or immediate .... smoking.
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Which edition of the ICD do you use for billing?
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9th
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Which edition of the ICD do you use for death certificate?
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10th
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What is DIRECT STANDARDIZATION?
lets say (a) is study lets say (b) is control |
Take the RATE of the STUDY(a)population times the AGE of the CONTROL(b) population.
...so what (a) would look like with population of (b) |
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What is INDIRECT STANDARDIZATION?
lets say (a) is study lets say (b) is control |
Take the AGE of the STUDY(a)population times the RATE of the CONTROL(b) population.
...so what (a) would look like with rates of (b) |
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Simpsons Paradox
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Success of a groups seem reversed when combined...
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SMR
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Standard Mortality ratio
(Observed deaths/Expected deaths) x 100 only use when doing INDIRECT standardization |
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YPLL
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years of poptential life lost=
Subtract age at death from 65 for each person and summate. |
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Which cause of death has highest YPLL?
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5) unintentional injury
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DALY
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Disability Adjusted Life Years
Only metric that combines mortality and morbidity |
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QALY
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Quality adjusted life years
Number of FULLY HEALTHY years lost due to a particular disease or risk factor. |
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What gives a good indication of health status of a country?
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Death Rate for <5 yrs. old
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Survival Analysis
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table that gives adjusted years expected of life for a given age Example:
0 = 75, 81 = 7..... |
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Censoring Data
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Keep data from people that are lost due to follow up.
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Ecological Fallacy
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Drawing conclusions about induviduals based on group data
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P value
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Measure of likelihood of getting results by chance.
between very small and 1 (never 0) |
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what is our alpha level (typically)
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0.05
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If our P is less than alpha, what does this mean?
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Results are statistically significant. REJECT NULL
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Relative Risk
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Description of the strength of the association.
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RR = 1
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no difference between groups.
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CI (confidence interval)
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Gives a range of numbers (low to high) where you're 95% confident of being able to replicate result.
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What happens if CI crosses 1?
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Your results are bullshit.
they are not statistically significant. And neither are you. |
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What does a large range mean (normally) for a CI?
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A small data set
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Bias
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systematic error that preferentially influences one group in the study. ALWAYS SKEWS RESULTS IN SAME DIRECTION
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Confounding
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A more powerful cause of the disease than exposure of interest.
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Effect Modifier
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An additional variable that influences disease frequencey
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Induction period
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causal action to disease onsent
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latency
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disease occurence to disease detection
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Hill's Criteria (yes, all 8.)
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1) Temporal relationship
2)Strength of association 3) dose/response relationship 4) replication of findings 5) biological plausibility 6) consideration of alternate explanations 7) cessation of exposure 8) specificity of association |
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Probable
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>50% chance of happening
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Possible
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>0% chance
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Hierarchy of study designs:
(from least rigorous to most rigorous) |
1) clinical observations
2) available data 3)Case-control studies 4) cohort studies 5) randomized trials |
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what are the two types of Analytical Epidemiology
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Observational and interventional
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what is an observational study? examples?
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Passive investigator, no influence on exposure, case control, cohort.
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what is an interventional study? examples?
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investigator allocates exposure and follow-up for disease.
clinical trials. |
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Three types of descriptive studies
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case reports or series
correlational studies cross sectional studies |
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What is a case-report or case series study?
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n=1 case report
n>1 case series description of a disease case. |
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Correlational study
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disease frequency versus factor or exposure at the population level
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cross sectional studies
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number of cases among individuals at one point in time.
ONE AT A TIME, INDUVIDUAL DATA |
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Cohort study
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can be Prospective or retrospective.
Follow disease-free individuals with determined risk factors. See who gets it!! |
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Case control study
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Selected for having disease (cases) or NOT having disesae (controls)
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How many phases in clincal trial
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Phases 1-4 official, plus a preclinical and postmarketing surveillance phase...so 6.
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Phase 1 of clinical trials
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Safety and Pharm.
1 year small sample how does it work, and will it kill you? |
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Phase 2 of clinical trials
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Pilot efficacy
2 years 200-500 (sample) does it work with people who are actually sick? |
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phase 3 of clinical trials
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Extensive Clinical trial
New Drug App 1000-3000 sample (with disease) 3 years |
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Phase 4 clinical trials
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long term clinical effects
clinical use tens of thousands of people |
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Post-Marketing Surveillance
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Healthwatch
people make sure the shit doesnt hit the fan |
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Preclinical Phase
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test on animals
IND approval |
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How long does a New Drug App take...?
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about 2.5 years
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