Term
| Nested Case Control Study |
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Definition
| Conduct a case control study within the context of a cohort study |
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Term
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Definition
| Identify cause of disease by studying how exposed people differ from unexposed people (subjects chosen based on exposure status) |
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Definition
| Follow cohort forward in time from exposure assessment at the start of the study and document who gets the outcome |
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Term
| Retrospective Cohort Study |
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Definition
| Use past exposure status to do the study (Follow-up for disease development is from the time of exposure (past) until the time of study (present)) |
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Definition
| Exposure occurred in the past (Follow up for disease occurrence from past to present and then into future) |
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Definition
| Systematic problems with the way data are gathered and recorded (Hawthorne effect and surveillance bias) |
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Term
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Definition
Describes the risk of exposed for developing the disease compared to those who are unexposed
RR = [a(c+d)]/[c(a+b)] |
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Term
| Nested Case Control Study |
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Definition
| Conduct a case control study within the context of a cohort study |
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Term
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Definition
Test hypotheses by describing associations between risk factors and outcome
Two categories: Observational and experimental |
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Term
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Definition
Type of analytic study that observes the natural exposure-disease relationship
Includes case control, cohort, and nested case control |
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Definition
| Type of analytic study that manipulates the factors that affect outcome |
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Definition
1. Describe health trends
2. Describe correlations between exposure and outcome
3. Formulate hypotheses
Include ecological and cross-sectional studies |
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Definition
| Type of descriptive study that uses group data to show overall trends; cannot be used to asses individual risk (no comparison group!) |
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Definition
| type of descriptive study that measures prevalence and shows general relationships between risk factors and disease (no temporality!) |
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Definition
| Make assumption about individuals based on group data |
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Definition
Described disease from a rational rather than supernatural basis
Observation key to understanding
Studies malaria and yellow fever
Coined terms "epidemic" and "endemic"
Related disease to environment, time, seasons |
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Definition
Described birth and death trends in London
Used mortality tables and stats
Surveillance and stats can help determine research priorities |
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Definition
Cowpox/Smallpox innoculation
One of the earliest clinical trials
Ethical considerations
Development of vaccination programs |
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Term
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Definition
Death rate from "childbed fever" higher in wards staffed by med students than midwives
Behavioral interventions and hygiene measures (hand washing) |
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Definition
London cholera epidemic
Descriptive and analytic research
Outbreak investigations
"Shoe-leather" epidemiology |
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Term
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Definition
Founder of the US surveillance system
EIS |
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Term
| Belmont Report - basic ethical considerations |
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Definition
1. Respect for persons (informed consent)
2. Beneficence (risk-benefit assessment)
3. Justice (equal opportunity in selection of subjects) |
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Term
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Definition
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Term
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Definition
| Rate = Frequency over time/size of population |
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Term
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Definition
Describes how quickly disease develops over a period of time
Incidence = # new cases over time/population at risk |
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Term
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Definition
Proportion
Prevalence = # existing cases (old and new) / total population |
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Term
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Definition
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Term
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Definition
1. Crude rates
2. Specific
3. Adjusted |
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Term
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Definition
| # births within a specific period of time / total population |
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Term
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Definition
| Examine rates within the context of structural differences in a population |
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Term
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Definition
| Allow for comparisons of rates for entire populations, taking into account structural differences |
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Term
| Cause-Specific Death Rate |
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Definition
Rate of death from a particular disease
= (# deaths from a particular disease / population at risk) * 1000 |
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Term
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Definition
Rate of death from a particular disease among those who have the disease
= (# deaths from a specific disease / population with the disease) * 1000 |
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Term
| Behavioral Risk Factor Surveillance System (BRFSS) |
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Definition
Est. in 1984 by the CDC
Largest ongoing telephone health survey in the world
Monthly data collection from about 350,000 people each year
Identify emerging health problems, establish objectives, develop programs, etc. |
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Term
| WHO: Surveillance of Risk Factors |
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Definition
| Country-level data that focuses on non-communicable diseases |
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Term
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Definition
| Trends over long periods of time |
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Term
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Definition
| Trends change with the season |
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Term
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Definition
| There is no difference between the groups |
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Term
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Definition
| The groups differ from one another |
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Term
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Definition
Reject null hypothesis when it is true
Find a difference when there isn't one |
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Term
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Definition
Fail to reject null hypothesis when it is false
Find no difference when one really exists |
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Term
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Definition
Ability to detect with sufficient precision that an association exists (how much Type II error we're willing to take)
Prob. that the study will find an association of a particular size if it truly exists in the general population
80% is a solid study |
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Term
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Definition
Results are unlikely to have happened by chance
Measured by p-value and by 95% Confidence Interval (CI) |
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Term
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Definition
Describes likelihood that results occurred by chance
p<0.05 |
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Term
| 95% Confidence Interval (CI) |
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Definition
Describes the range of results expected 95% of the time the study is done
Null value for RR and OR is 1.0 |
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Term
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Definition
The ability of a factor to impact health
A result might not be statistically significant but might still have clinical significance |
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Term
| Conceptualization of variables |
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Definition
Process of specifying/defining concepts to be studied (defining key terms for your research)
Concept = mental image or idea; summary of observations, ideas, or feelings (ex – quality of life, SES) |
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Term
| Operationalization of variables |
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Definition
| Process of specifying the variables that will measure a concept |
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Term
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Definition
| composite measure that involves combining responses to several questions that are intended to measure the same idea |
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Term
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Definition
| Similar to index, but different weights are given to each question |
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Term
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Definition
| one indicator used to measure a variable |
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Term
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Definition
| multiple indicators needed to measure a variable |
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Term
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Definition
Using two or more different methods to gather information about a same variable (such as, directly asking a question, observation, using existing information)
Lends confidence that we are measuring the “right” concept |
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Term
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Definition
No implied order to response options
Number is simply a “label” without numerical meaning
Ex: race, blood type |
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Term
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Definition
Attributes can be rank-ordered
Distances between attributes does not have meaning
Ex: level of education |
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Term
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Definition
Distance between attributes has meaning
“Equal distances” between points
There is no absolute zero that is meaningful
Ex: blood sugar level, temperature |
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Term
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Definition
| Absolute zero is meaningful |
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Term
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Definition
Range of options balanced between positive and negative
Typically a 5-point scale |
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Term
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Definition
Ability to reproduce the data
Consistency or stability of the measure |
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Term
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Definition
ability to measure the "true" value
extent to which the question, index, or scale measures what it is supposed to measure |
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Term
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Definition
| how well the results can be applied to the target population |
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Term
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Definition
1. The agent is present in every case of the disease.
2. The agent does not occur in any other disease by chance or as a non-pathogenic parasite.
3. The agent can be isolated and causes disease if healthy people are exposed to it. |
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Term
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Definition
Disease is the result of the interaction of three factors: agent, host, and environment
(Works a little better than HK postulates with NCD) |
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Term
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Definition
Criteria to infer a causal relationship
1. Strength of Association
2. Consistency of Observed Data
3. Specificity
4. Temporality
5. Biologic Gradient ("Dose Response")
6. Biologic Plausibility
7. Coherence
8. Experiment
9. Analogy |
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Term
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Definition
Identify cause of disease by studying how diseased people differ from non-diseased people
Select subjects based on disease (outcome) status
Retrospective study --> no temporality! |
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Term
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Definition
measure of association for case control studies
Likelihood that diseased people had the exposure relative to those without
OR = (a*d)/(b*c)
(people that make sense/people that don't make sense) |
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Term
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Definition
Systematic error in choosing the study population
Types:
1. Response bias
2. Exclusion bias
3. Berksonian bias |
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Term
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Definition
Systematic error in the measurement of outcome and/or exposure
Types:
1. Recall bias
2. Interviewer bias |
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Term
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Definition
experimental design
use multicenter randomized controlled trials (RCTs) |
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Term
| Phases of Clinical Trials - Phase I |
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Definition
| Establish effects of new drug and optimal dose range (high risk phase) |
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Term
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Definition
| Determine therapeutic efficacy (what dose will have an effect?) in diseased group |
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Term
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Definition
| Test against other therapies or placebo (very large, many people) |
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Term
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Definition
| Test for other uses of the therapy (after the drug is on the market) |
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Term
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Definition
Minimum of two groups:
1. intervention group - exposed to new intervention
2. control group - not exposed to new intervention (placebo or SOC) |
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Term
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Definition
| subjects serve as own controls |
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Term
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Definition
| use each participant to test two (or more) interventions that act independently of one another |
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Term
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Definition
| stratified groups depending on severity of disease to avoid the confounding variable of how sick people were to begin with |
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Term
| potential problems in intervention studies |
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Definition
| volunteerism, surveillance bias, hawthorne bias, loss-to-follow-up |
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Term
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Definition
| After screening, the experimental group may no longer be generalizable to the reference population |
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Term
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Definition
| Ensure that you do not monitor the experimental group more carefully than the control group in intervention studies |
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Term
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Definition
| people behave differently when they're being watched |
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Term
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Definition
| People who drop out from the study may be different from those who stay in the study |
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Term
| controlling for bias and confounding in intervention studies |
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Definition
1. Restriction
2. Randomization
3. Masking (Blinding) |
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Term
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Definition
| collection and analysis of data that is in the form of words, pictures, sounds, or visual images |
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Term
| what qualitative research is used for in PH |
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Definition
| problem identification, program planning, implementing research, assessment and evaluation |
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Term
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Definition
Develop and refine survey measures
Small group of participants |
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Term
| All-things-considered Technique |
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Definition
| "If you had one minute to tell your professor what you think about attendance, what might you say?" |
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Term
| Deductive Coding vs. Inductive Coding for qualitative research |
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Definition
Deductive - pre-set
Inductive - from the data |
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Term
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Definition
Generate in-depth responses
Gather life histories or narratives
Not influenced by opinions of others |
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Term
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Definition
Observe interaction between participants
Efficient way to generate a range of responses
Decrease power differential between researcher and participant |
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Term
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Definition
White (Origins in any of the original peoples of Europe, Middle East, or North Africa)
Black/African American (Origins in any black racial group of Africa)
Asian (Origins in any original peoples of the Far East, Southeast Asia, or Indian subcontinent)
American Indian and Native Alaskan (Origins in North, South, and Central America; includes people who maintain tribal affiliation)
Native Hawaiian/Other Pacific Islander (Origins in the poeples of Hawaii, Guam, Samoa, or other Pacific Islands) |
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Term
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Definition
| collected by the investigator him/herself |
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Term
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Definition
| data collected by another investigator for another purpose |
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Term
| Criteria for Selecting Data (Know this!!) |
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Definition
1. Nature of data (why, where, how, when)
2. Availability (how accessible)
3. Completeness (generalizable to the population of interest?)
4. Strengths and Limitations (problems? valid? reliable?) |
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Term
| National Center for Health Statistics |
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Definition
Maintains a federal register of vital statistics data
Sets min. guidelines, but states may collect additional info |
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Term
| Rochester Epidemiology Project |
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Definition
Geographically isolated healthcare system
Provides primary, secondary, and tertiary care in all medical specialties
Linkage system gives access to medical information on residents of Rochester, MN, and Olmsted County, MN |
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Term
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Definition
(National Health and Nutrition Examination Survey)
National health study
Three sources of information: health survey, lab tests, physical exams
Provides baseline health info not otherwise available for US population
HHANES - hispanic version |
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Term
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Definition
(Health Information National Trends Survey)
Biennial, cross-sectional survey
Purpose: study health communication, especially internet usage for health information
Good source for questions |
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Term
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Definition
(Youth Risk Behavior Surveillance Study)
Biennial CDC school-based survey
Monitors health-risk behaviors and prevalence of obesity and asthma |
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Term
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Definition
(Medical Expenditure Panel Survey)
Survey families, individuals, and their medical providers and employers
Purpose is to learn about type, frequency, and cost of health services and health insurance
Relationship between disease and employment, evaluate Medicare Part D |
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Term
| primary disease prevention |
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Definition
| reduce incidence of disease |
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Term
| secondary disease prevention |
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Definition
| early detection, reduce mortality |
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Term
| tertiary disease prevention |
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Definition
| reduce recurrence and complications, rehabilitation, improve quality of life |
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Term
| High Risk Prevention Strategies |
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Definition
Difference populations have specific concerns and needs
Target vulnerable populations
Ex - needle exchange |
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Term
| Mass Prevention Strategies |
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Definition
Premise - disease and exposure reflect societal behaviors and circumstances
Targets large-scale population |
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Term
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Definition
| amount of previously unrecognized disease that is identified via screening |
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Term
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Definition
| ability to predict who does and doesn't have the disease |
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Term
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Definition
The ability to correctly identify those with disease
The probability of having a positive test if one has the disease (few false negatives)
Sensitivity = a / (a+c)
= true pos / (true pos + false neg) |
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Term
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Definition
The ability to correctly identify those without disease
The probability of having a negative test if you don't have disease (few false pos.)
Specificity = d / (b+d)
= true neg. / (true neg. + false pos.) |
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Term
| optimize sensitivity when you can... |
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Definition
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Term
| optimize specificity when... |
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Definition
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Term
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Definition
| bias in screening - perception that screening increases survival, but it only increases time from diagnosis to recovery/death |
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Term
| Selection bias (Volunteerism) |
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Definition
| probability of disease is affected by motivation to be screened |
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Term
| Positive Predictive Value |
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Definition
Probability of having disease if you test positive
= a/(a+b)
= true pos / (true pos + false pos) |
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Term
| Negative Predictive Value |
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Definition
Probability of not having disease given a negative test
= d/(c+d)
= true neg / (true neg + false neg) |
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Term
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Definition
Accuracy of the test
= (a+d)/(a+b+c+d) |
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Term
| direct disease transmission |
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Definition
no intermediate source
"person to person"
ex - TB, flu, measles, chlamydia, syphilis |
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Term
| indirect disease transmission |
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Definition
intermediary source involved
common vehicle (ex - potato salad)
vector (ex - rat)
fromite (inanimate objects, like a door handle) |
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Term
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Definition
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Term
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Definition
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Term
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Definition
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Term
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Definition
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Term
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Definition
| time between exposure and first sign of disease |
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Term
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Definition
Ability to invade a host (Of all expose, who gets infected?)
(# infected/# susceptible) * 100 |
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Term
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Definition
Ability to cause clinical disease (Of all infected, who gets the disease?)
(# clinical disease/# infected) * 100 |
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Term
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Definition
Severity of disease (Of all diseased, how many die?)
(# deaths/# of people with disease) * 100 |
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Term
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Definition
| background cases, expected number of cases |
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Term
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Definition
| excess number of cases in a localized area |
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Term
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Definition
| excess number of cases worldwide |
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Term
| Steps to Investigating an Outbreak (Know these!) |
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Definition
1. Verify the outbreak
2. Plot an epidemic curve
3. Calculate attack rates
4. Determine the source of the outbreak
5. Recommend and implement control measures |
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Term
| Point source transmission |
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Definition
| most common type of food-borne outbreak, short exposure period |
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Term
| Continuing source transmission |
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Definition
several peaks of cases
difficult to characterize incubation period |
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Term
| vector borne transmission |
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Definition
Disease accumulates and tapers off slowly
Incubation period estimated by time between first case and peak of cases
ex - seasonal diseases |
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Term
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Definition
| = (# ill/(ill+well)) * 100 |
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Term
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Definition
| Boxed lunch foodborne illness |
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Term
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Definition
Healthcare Associated Infections
Nosocomial infection among the 10 leading causes of death in the US |
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Term
| National Children's Study |
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Definition
National scope - household sampling
Broad approach to environment
long-term longitudinal |
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Term
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Definition
| at low exposure levels, increase in dosage yields no effect |
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Term
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Definition
| lowest dose at which a response occurs |
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Term
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Definition
| time between initial exposure and measurable response |
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Term
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Definition
| combined effect of several exposures is greater than the individual effects |
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Term
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Definition
1932-1968 - 27 tons of mercury compounds dumped into Minamata Bay Chisso Corp.
Mid-1950's - "strange happenings" in Minamata |
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Term
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Definition
Natural component of soil, groundwater, and air
Higher concentrations in urban areas
Non-occupational exposure primarily through water and food
Linked to skin and lung cancer, hypertension, and neurotoxticity |
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Term
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Definition
Odorless, tasteless, colorless gas produced when uranium decays in soil and water
Form of ionizing radiation
#1 cause of lung cancer in non-smokers |
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Term
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Definition
| Acute health effects linked to time spent in a building, with no know etiology |
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Term
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Definition
Toxic waste site near Niagra Falls, NY
Contaminants leached into homes and local water supply
Increased number of congenital birth defects |
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