Public Health Final

Front 1

What are research studies that prospectively assign groups ofhumans to one or more health‐related interventions to evaluate theeffects on health outcomes?

Back 1

Clinical Trials

Front 2

A phase of clinical trials which tests a drug or a vaccine in a small group of humans todetermine its safety, mode of action, dosage, & route of administration

Back 2

Phase 1

Front 3

A phase of clinical trials whichexamines the efficacy of a drug or a vaccine in a small groupof patients in comparison to existing regimens

Back 3

Phase 2

Front 4

A phase of clinical trials which provides complete assessment of a drug or a vaccine safety &efficacy in larger numbers of patients with the disease or condition ofinterest; it uses random allocation to the intervention & comparisongroups

Back 4

Phase 3

Front 5

A phase of clinical trials which is conducted after the regulatory authority has approvedregistration & marketing begins

Back 5

Phase 4

Front 6

________means that every patient has the same probabilityof being in the intervention or comparison groups

Back 6

Random Allocation

Front 7

The goals of random allocation

Back 7

ensures that the groups are comparable for bothknown & unknown confounders,

& that any differences betweengroups are due to chance but not bias

Front 8

Design issues in RCTs

Back 8

1) Eligibility criteria for inclusion/exclusion
2) Definition of intervention & control groups

3) Sample size calculation

Front 9

How do we deal with selection bias in RCTs?

Back 9

Random Allocation & Allocation Concealment

Front 10

How do we deal with measurement (performance & detecting) bias in RCTs?

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Blinding

Front 11

A method of generating a sequence that ensuresrandom allocation between the intervention & comparison groups of astudy without revealing this to study subjects or researchers

Back 11

Allocation Concealment

Front 12

the biased assessment of outcome, where theoutcome assessor or the participant is more or less likely to report aspecific outcome in the intervention & comparison groups dependingon their beliefs or preferences

Back 12

Detection Bias

Front 13

the process in which the participants, investigatorsand/or assessors remain unaware of the intervention whichparticipants are receiving

Back 13

blinding

Front 14

Types of blinding

Back 14

A single blind study

A double blind study

Front 15

How to deal with loss to follow-up bias?

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Intention to treat analysis

Front 16

The number of persons needed to be treated, on average, to preventone more event

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Number Needed to Treat= 1/|RD|

Front 17

The number of persons needed to be treated, on average, to produceone more adverse event

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Number Needed to Harm= 1/|RD|

Front 18

Uses of NNT & NNH

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to summarize results of studies & to assist inclinical decision making

Front 19

How do we interpret observed differences in RCTs?

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1.Chance reflection of the sampling variation & randomization procedure

2. True differences due to effectof the intervention

3. Differences in characteristics between initial composition of the groups

4. Differences between the management of the groups during the trial

Front 20

Rejecting the null hypothesis when it is true is known as _____

Back 20

type 1 error

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Accepting the null hypothesis when it is false is known as _____

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type 2 error

Front 22

experiments in which groups (clusters) of subjectsrather than individual subjects are randomly allocated to interventiongroups

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Cluster RCTs

Front 23

What type of study do we use in evaluating public health & complexinterventions delivered at a group level?

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Cluster RCTs

Front 24

In what study are all participants randomly assigned to receive both the activeintervention & the comparison intervention?

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Crossover RCTs

Front 25

In which type of study do subjects act as their own control?

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Crossover RCTs

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What's that stage in the crossover RCT when the active treatment iswithdrawn so that its effects disappear & the subject’s characteristics return to theirbaseline state?

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washout phase

Front 27

In which study are smaller sample sizes required since there is lessvariation in outcome within participants than between participants?

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Crossover RCTs

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studies of studies that offer a systematicapproach to reviewing & summarizing evidence a bout a particularresearch question

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Systematic Reviews

Front 29

How many reviewers should be involved in all stages of the review process?

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At least two

Front 30

Which studies allow researchers to keep up to date with the constantly expandingnumber of primary studies?

Back 30

Systematic Reviews

Front 31

Which studies critically appraise primary studies addressing the same research question, & investigate possible reasons for conflicting results among them?

Back 31

Systematic Reviews

Front 32

Which studies provide more precise & reliable effect estimates than is possible from individual studies, which are often underpowered?

Back 32

Systematic Reviews

Front 33

Which studiesidentify gaps in the evidence base ?

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Systematic Reviews

Front 34

Which studies allow individuals & policy makers to make evidence based decisions & to inform the development of clinical guidelines

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Systematic Reviews

Front 35

Steps in conducting systematic reviews

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1)Formulating a review question and defining inclusion criteria

2)Identifying relevant studies

3)Extracting data and assessing study quality

4)Analyzing data

5)Presenting results

Front 36

Data should be extracted using __________________ to ensure that data are extractedconsistently across different studies

Back 36

a standardized form designed specifically for the review

Front 37

Terms of assessment of study quality

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Internal validity (risk of bias)

External validity (generalizability)

Front 38

When can we calculate risk ratios, odds ratios or riskdifferences in synthesis of findings across studies?

Back 38

When study outcomes are binary

Front 39

When isthe intervention effect quantified as the mean difference betweenthe intervention and control groups in systematic reviews?

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When study outcomes are continuous

Front 40

Methods of synthesis of findings of systematic reviews

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Narrative Synthesis

Meta Analysis

Front 41

When do we use narrative synthesis?

Back 41

when the number of includedstudies is too small or when the included studies are using differentoutcome measures (OR, RR, etc)

Front 42

Why do we use meta analysis?

Back 42

to produce a singlesummary estimate by combining the estimates reported in theincluded studies

Front 43

How are the results of a meta-analysis displayed?

Back 43

as a forest plot

Front 44

Biases in systematic reviews

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Language bias

Publication Bias

Reporting Bias

Front 45

How do we check for reporting bias?

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By using a funnel plot - If reporting bias is present, it will lead to a symmetrical appearance of afunnel plot

Front 46

In which study can results can be generalized into the general population more broadly?

Back 46

Systematic Reviews

Front 47

Which study is considered an evidence‐based resource?

Back 47

Systematic Reviews

Front 48

Which study is very time‐consuming?

Back 48

Systematic Reviews

Front 49

an illness due to a specificinfectious agent or its toxic products

Back 49

a communicable disease

Front 50

How does the chain of infection go?

Back 50

Reservoir-->Portal of Exit-->Mode of Transmission-->Portal of Entry-->Susceptible Host-->Infectious Disease

Front 51

How can we stop the transmission of infection?

Back 51

By breaking any ink in the chain of infection

Front 52

What's the habitat in whichthe agent normally lives, grows, & multiplies called?

Back 52

A reservoir

Front 53

In human reservoirs, how are infectious diseases transmitted from person to person ?

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without intermediaries

Front 54

Who are those who never experiencesymptoms despite being infected?

Back 54

Asymptomatic / Passive/ Healthy Carriers

Front 55

Who are those who can transmit the agent during the incubationperiod before clinical illness begins?

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Incubatory carriers

Front 56

Who are those who have recovered from their illness but remaincapable of transmitting to others?`

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Convalescent Carriers

Front 57

Who are those who continue to harbor a pathogen?

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Chronic carriers

Front 58

What's an infectious disease that is transmissible undernatural conditions from vertebrate animals to humans?

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Zoonosis

Front 59

Where does Brucellosis come from?

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Cows and pigs

Front 60

Where does Anthrax come from?

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Sheep

Front 61

Where does the Plague come from?

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Rats

Front 62

The portal of exit usually correspondsto ______

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the site where the pathogen is localized

Front 63

How do Influenza viruses & Mycobacterium tuberculosis spread?

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By the respiratory tract

Front 64

How does Schistosomes spread?

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Through urine

Front 65

How does Cholera spread?

Back 65

Through feces

Front 66

Modes of disease transmission?

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Direct and indirect

Front 67

Modes of direct disease transmission?

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Direct contact & droplet spread

Front 68

Modes of indirect disease transmission?

Back 68

• Airborne: dust or droplets

• Vehicleborne: food, water

• Vectorborne (mechanical or biologic): mosquitoes or flies

Front 69

What's the manner in which a pathogen enters asusceptible host?

Back 69

The portal of entry

Front 70

What does the susceptibility of a host depend on?

Back 70

1)Genetic factors

2)Host immunity

3)Nonspecific factors that affect an individual's ability to resist infection includethe skin, mucous membranes, gastric acidity, cilia in the respiratory tract, & thecough reflex, nutritional status, etc.

Front 71

Why do we need to know portals of exit and entry and modes of transmission?

Back 71

to determine appropriate control measures

Front 72

What do we call the immunity of a group or community?

Back 72

Herd immunity

Front 73

What do we call a disease that occurs infrequently &irregularly?

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A sporadic disease

Front 74

What do we call the constant presence and/or usualprevalence of a disease or infectious agent in a population within ageographic area?

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An endemic

Front 75

What do we call persistent & high levels of disease occurrence

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A hyperendemic

Front 76

What do we call a sudden increase in the number of casesof a disease above what is normally expected in that population inthat area?

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An epidemic

Front 77

What do we call a sudden increase in the number of cases of a disease in a limited geographic area?

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An outbreak

Front 78

What do we call an aggregation of cases grouped in place & time thatare suspected to be greater than the number expected?

Back 78

A cluster

Front 79

What do we call an epidemic that has spread over severalcountries or continents?

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A pandemic

Front 80

What do we call the separation, for the period of communicability of infected persons or animals from others?

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Isolation

Front 81

What do we call the restriction of activities of healthy persons oranimals who have been exposed to an infectious person?

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Quarantine

Front 82

What do we call the reduction of case transmission toa predetermined very low level?

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Elimination of disease

Front 83

What do we call the termination of all transmission ofinfection by extermination of the infectious agent

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Eradication of disease

Front 84

What do we call the process where the specific infectious agent no longer exists in the natureor in the laboratory?

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Extinction

Front 85

Epidemiological methods to monitor &control communicable diseases

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1. Active & passive disease surveillance

2. Disease & outbreak investigations

3. Contact tracing & follow‐up of those who have come into contactwith infected persons

4. Prevention of disease transmission

5. Education

(She is pretty-freaking educated)

Front 86

In which type of surveillance is no stimulation or feedback onreporting performance given by public health authorities?

Back 86

Passive

Front 87

Which type of surveillance is often incomplete because there are few incentives for healthworkers to report ?

Back 87

Passive

Front 88

In which type of surveillance do the authorities monitor health care providers' reporting frequency?

Back 88

Active

Front 89

In which type of surveillance do public health authorities provide feedback to improve reporting performance?

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Active

Front 90

In which type of surveillance do health care providers report disease voluntarily?

Back 90

Passive

Front 91

In which type of reporting to we get incentives for complete reporting/ punishment for incomplete reporting?

Back 91

Passive

Front 92

The epidemiological process in controlling communicable diseasesrequires the following information:

Back 92

• Source of infection

• Mechanism of transmission

• Susceptibility of the population

Front 93

Communicable disease prevention or controlmeasures

Back 93

• Measures to eliminate or decontaminate the source of infection

• Measures to stop the mechanism of transmission of infection

• Measures to reduce the susceptibility of the population to a certaincommunicable disease

Front 94

What do we call elimination of sick animals(carriers of infectious disease)?

Back 94

Extermination

Front 95

What do we call elimination of rats after theirsurvival from an infectious disease?

Back 95

Deratization

Front 96

How do we administer Urgent Prevention?

Back 96

through the use of passive immunity measures(antiserum, immune globulin) or prophylactic antibiotics

Front 97

How are outbreaks discovered?

Back 97

• Hospital infection control practitioners (e.g. nosocomial or hospital-acquired infections)

• Alerts from medical practitioners (e.g. specialists & laboratories)

• Patients or other community members

• Review of surveillance data

Front 98

Aims of outbreak investigation

Back 98

1. Implement control measures

2. To improve our knowledge to prevent future outbreaks

Front 99

Decisions to investigate a potential outbreak depend on:

Back 99

1. The disease

2. Health authorities

3. Public concerns

Front 100

Steps of an outbreak investigation & management

Back 100

1. Establishing that an outbreak exists

2. Confirming the diagnosis

3. Find cases systematically & record information

4. Describing the outbreak

5. Generating hypothesis regarding the cause of the outbreak

6. Testing the hypothesis

7. Implement control & prevention measures

8. Initiate or maintain surveillance

9. Disseminate findings to local authorities

Front 101

When investigating an outbreak, what should data collection include?

Back 101

A. Identifying information:

B. Demographic information:

C. Clinical information

D. Risk factor information

E. Reporter information:

Front 102

agraph showing the number of cases by their date of onset

Back 102

an epidemic curve

Front 103

Examining dates & times of onset of an outbreak may suggest ______

Back 103

a point source outbreak or infection with a characteristic incubation period

Front 104

The age distribution of cases of an outbreak may suggest _____________

Back 104

the vehicle of infection (e.g. milkborne outbreaks characteristically affect children rather than adults)

Front 105

The geographical distribution of cases of an outbreak may suggest ____________

Back 105

the source of infection & its transmission route

Front 106

A characteristic of public health surveillance that allows identification of individual persons with disease

Back 106

Sensitivity

Front 107

A characteristic of public health surveillance that excludes people not having the disease

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Specificity

Front 108

The criteria that are applied to determine disease ‘importance’ in surveillence

Back 108

1) Public health importance

2) Ability to prevent, control or treat the problem

3) Capacity of health system to implement control measures

Front 109

After establishing a case definition, it is important to determine thespecific information needed from surveillance to ______________

Back 109

implement control measures,

Front 110

Sources for gathering health data

Back 110

• Individual persons

• The environment

• Health‐care providers

Front 111

the diseases or conditions to be reported when reporting is required by law

Back 111

notifiable diseases

Front 112

After morbidity, mortality, & other relevant data about a healthproblem have been gathered, the data should be analyzed by:

Back 112

Time, place and person

Front 113

Common causes of artifactual changes in disease incidence or prevalence

Back 113

1) Changes in local reporting procedures

2) Changes in case definition

3) Increased health‐seeking behavior

4) Increase in diagnosis

5) Increased physician awareness of the condition

6) Outbreak of a similar disease, maldiagnosed as disease of interest

7)Lab error

8) Batch reporting

Front 114

A problem in which reports from previous periods are held & reported all at onceduring another reporting period

Back 114

Batch reporting

Front 115

Data & interpretations should be sent to those who:

Back 115

• Provided reports or other data

• Use them for health‐related decision‐making

Front 116

1. Building healthy public policy

2. Creating supportive environments

3. Strengthening community action

4. Developing personal skills

5. Reorientation of health services

These are???

Back 116

Ottawa's key components for health promotion

Front 117

the resistance of a host to a specific antigen

Back 117

immunity

Front 118

a naturally existing resistance to a disease agent and does notrequire prior sensitization to disease agent

Back 118

natural immunity

Front 119

resistance acquired by a host as a result of previous exposure(sensitization) to a disease agent

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Acquired immunity

Front 120

resistance developed in response to stimulus by an antigen(infecting agent or vaccine) and usually characterized by the presence of antibodyproduced by the host

Back 120

active immunity

Front 121

immunity given by an antibody produced in another host &acquired naturally by an infant from its mother or artificially by administration of anantibody‐containing preparation (antiserum or immune globulin)

Back 121

passive immunity

Front 122

Herd immunity of a population is determined by:

Back 122

-the ratio of resistant to susceptible members & -their distribution

Front 123

what is the most cost‐effective public healthintervention???

Back 123

immunization

Front 124

Factors influencing vaccination coverage

Back 124

1) Access

2) Cost

3) People's interest (autism)

Front 125

Why do we always introduce new tests into clinical practice?

Back 125

• Reduce the risk

• Less invasive or painful for the patient

• Cheaper, quicker or easier to perform

• More accurate than existing tests

Front 126

How do we evaluate test accuracy?

Back 126

By comparing the results of the new index test to those of a reference (gold) standard

Front 127

Measures used to calculate test accuracy

Back 127

Sensitivity

Specificity

Negative and Positive Predictive Values

Front 128

the probability of a positivetest in people with the disease

Back 128

sensitivity

Front 129

the probability of a negativetest in people without the disease

Back 129

specificity

Front 130

theprobability of the person having thedisease when the test is positive

Back 130

positive predictive value

Front 131

theprobability of the person not having thedisease when the test is negative

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negative predictive value

Front 132

Sensitivity & specificity are determined mainly by

Back 132

the characteristics of the test itself

Front 133

Positive & negative predictive values are determined by

Back 133

prevalence of disease in the target population

Front 134

In a screening program where the focus is to avoid false negative results, do I want high sensitivity or high specificity?

Back 134

High sensitivity.

Front 135

In a test where the focus is to avoid false positives because treatment is very harmful and invasive, do I want high sensitivity or high specificity?

Back 135

High specificity.

Front 136

Are screening tests used to establish a diagnosis?

Back 136

Nope, but rather thepresence or absence of an identified risk factor, & thus requireindividual follow‐up & treatment

Front 137

A type of screening that aims to screen the whole population

Back 137

Mass screening

Front 138

A type of screening that uses several screening tests at thesame time

Back 138

Multiple/ Multiphasic screening

Front 139

A type of screening that aims to screen groups with specific exposures

Back 139

Targeted screening

Front 140

A type of screening that aims to screen patients whoconsult a health practitioner for some other purpose

Back 140

Case-finding/ Opportunistic screening

Front 141

Biases in screening programs

Back 141

Lead time bias

Length bias

Front 142

The screening program (which is more likely to detect slower progressing diseases which have better prognosis than aggressive diseases) may thus falselyappear to improve survival in patients lessaggressive disease as compared to patientswith more aggressive disease

Back 142

Length bias

Front 143

If a test provides consistent results, it is____

Back 143

reliable

Front 144

If a test correctly categorizes people into groups with or without disease depending on sensitivity and specificity, it is _____

Back 144

valid

Front 145

Types of health care service planning

Back 145

National

Strategic

Evidence-Based

Front 146

For targets to be effective, they need to be

Back 146

Achievable

Realistic

Monitored

Front 147

Important issues in planning health care services

Back 147

equity

Healthcare needs assessment

Front 148

Types of evaluation of health care services

Back 148

Outcome evaluation

Cost-effective evaluation

Process evaluation

Front 149

Features of global health

Back 149

Trans-national

Equity for all

Collaborative action

Front 150

a study which used various data sources & techniques to estimatethe numbers of deaths and disability adjusted life years (DALYs)attributable to specific causes

Back 150

The Global Burden of Disease (GBD) study

Front 151

In developed countries, deaths from acute infectious diseases decline, & deaths due tochronic non‐communicable diseases rise

Back 151

epidemiological transition

Front 152

This epidemiological transition is also occurring the developing countries butat a higher speed because old disease are still there

Back 152

double burden of disease

Front 153

A set of processes intensifying human interaction across economic,political, sociocultural, environmental & technological fields

Back 153

Globalization