Epi Final
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| epidemiology (definition) | show 🗑
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| show | epi: upon
demi: people
ology: study
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| show | - identify etiology/cause of disease
- determine extent of disease
- study natural history (disease over time)
- evaluate new modes of health care delivery and new preventative/therapeutic measures
- provide foundation for developing public policy
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| T or F: epidemiology mainly studies population groups, not individuals. | show 🗑
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| population (definition) | show 🗑
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| show | 1) descriptive
2) analytical
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| descriptive epidemiology (definition) | show 🗑
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| measures of disease frequency | show 🗑
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| major use of epidemiological evidence | show 🗑
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| show | shows progression of illnesses in an outbreak over time
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| show | when an outbreak starts or when a large amount in the population become infected
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| epidemiological transition | show 🗑
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| show | descriptive epidemiology
- provides rationale for future studies and evaluation
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| show | analytical
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| show | - any physical, biological, social, cultural, or behavioral factor that affects the study outcome
- factors or events that are capable of bringing about a change in health
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| risk factors (definition) | show 🗑
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| What questions do risk factors help to answer? | show 🗑
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| show | - risk factors
- causes
- modes of transmission
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| show | - direct preventative efforts, such as screening programs for early disease detection/intervention
- to identify modifiable risk factors
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| Examples of modifiable risk factors | show 🗑
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| show | - age
- gender
- family history
- ethnicity
- disabilities/genetics
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| What does epidemiology investigate? | show 🗑
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| How is disease control accomplished? | show 🗑
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| surveillance (definition) | show 🗑
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| show | - by federal (CDC)
- state (state health departments)
- local agencies (local health departments)
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| measures of frequency (definition) | show 🗑
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| show | - counts
- prevalence
- incidence rates
(typically expressed in ratios, n/d)
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| show | relationship between exposure and disease among the two groups
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| show | - relative risk
- odds ratio
- prevalence ratio
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| statistical inference (definition) | show 🗑
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| show | - p value
- confidence limits
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| primary prevention (definition) | show 🗑
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| primary prevention (examples) | show 🗑
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| show | early detection of existing disease to reduce severity/complications
- prevents further complications/mortality
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| show | - screening for cancer
- exercise/diet to prevent further health problems
- use of aspirin
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| show | reducing impact of disease for an individual who has already reached a point of disability, impairment, or dependency
- avoids present complications from getting worse
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| show | - rehab
- support groups
- antibiotics/insulin
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| show | - father of epidemiology
- investigated cholera outbreak in Broad Street, Golden Square, London
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| Edward Jenner | show 🗑
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| Ignaz Semmelweis | show 🗑
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| show | host, agent, environment, vector
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| host (epi triad) | show 🗑
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| show | What pathogen/what is causing the disease?
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| environment (epi triad) | show 🗑
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| show | movement of the disease
ex: mosquito, tick for lyme disease
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| show | to break at least one of the sides of the triangle, disrupting connection between the environment, host, agent, and stopping the continuation of the disease
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| characteristics of a host | show 🗑
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| Two types of defense mechanisms present in host | show 🗑
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| Three types of agents of infectious diseases | show 🗑
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| Examples of biological agents | show 🗑
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| show | - noise
- repetitive motion
- violence
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| Examples of chemical agents | show 🗑
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| Modes of transmission (definition) | show 🗑
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| Types of modes of transmission | show 🗑
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| Vector (definition) | show 🗑
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| show | - non-living intermediary, such as food, water, biological product, or inanimate object (handkerchief, bedding, surgical scalpel) that conveys infectious agent from its reservoir to a susceptible host
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| infectivity (definition) | show 🗑
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| show | likely to cause illness
- capacity of the agent to cause disease in the infected host
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| show | severity of the illness
- measured by the proportion of severe/fatal cases
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| show | capacity of an agent to produce a toxin/poison
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| incubation period (definition) | show 🗑
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| show | separates and restricts movement of people who were exposed to a contagious disease to see if they become sick
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| show | separates sick people with a contagious disease from people who are not sick
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| latency period (definition) | show 🗑
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| show | aka community immunity
- individuals who are not immune to a pathogen from exposure by the large amounts of immune individuals within the community
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| Herd Immunity Threshold (definition) | show 🗑
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| certain conditions for herd immunity | show 🗑
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| epidemic (definition) | show 🗑
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| show | carries the same definition as epidemic, but is often used for a more limited geographic area
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| show | constant presence of disease or infectious agent in a population within a given geographic area
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| show | worldwide epidemic
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| show | - common-source point
- common-source continuous
- propagated/progressive souce
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| show | - group of people are all exposed to an infectious agent or a toxin from the same source
- same pathogen (common source)
- sudden and rapid increase in # of cases of disease
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| What type of outbreak is most common for foodborne outbreaks? | show 🗑
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| Common continuous source (definition) | show 🗑
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| What type of outbreak is most common for waterborne illnesses? | show 🗑
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| Propagated source (definition) | show 🗑
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| show | Propagated source
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| cluster (definition) | show 🗑
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| show | learning how cases are connected
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| show | increase in number of cases of a disease above what is normally expected in that population in that area
- cases have confirmed contact/common source of infection (clear epi link)
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| Steps of an Outbreak Investigation (1-6) | show 🗑
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| show | 7) Evaluate Hypothesis & test/perform additional studies
8) Recommend control measures to control/prevent future similar outbreaks
9) Communicate findings to those involved in public development and to the public
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| What does a case definition include? | show 🗑
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| line listing (definition) | show 🗑
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| show | those with disease/those with a chance they could get it
example: ovarian cancer - those with it/those with ovaries
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| How do you find the prevalence? | show 🗑
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| How do you find the incidence rate? | show 🗑
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| How do you find the attack rate? | show 🗑
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| show | number of people who ate that food and became ill/total number of persons who ate that food
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| show | - rely on health care providers /laboratories to report cases of disease
- often incomplete
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| show | - health department is proactive
- more costly/labor intensive
- provides a more complete picture
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| show | T
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| public health surveillance (definition) | show 🗑
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| total person-time (definition) | show 🗑
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| calculation of person-time | show 🗑
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| show | T
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| What factors increase prevalence? | show 🗑
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| What factors decrease prevalence? | show 🗑
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| show | pop changes over time, # of persons in the pop at midyear is used as an approximation of average pop
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| What is fertility rate used for? | show 🗑
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| category specific rates | show 🗑
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| How are category specific rates helpful? | show 🗑
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| screening (definition) | show 🗑
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| show | ability of a test to distinguish between those who have a disease and those who don't
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| show | - specificity
- sensitivity
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| show | ability of the test to identify correctly those who do not have the disease
- proportion of non-diseased people who were correctly identified as negative
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| show | - ability of a test to identify correctly those who truly have the disease
- proportion of disease people who were correctly identified as "positive" by the test
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| true positive | show 🗑
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| show | does not have the disease but test positive
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| true negative | show 🗑
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| show | have the disease but test negative
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| bimodal curve | show 🗑
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| show | positive predictive value
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| What is the likelihood that this patient actually doesn't have the disease? | show 🗑
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| The _______ the prevalence of the disease, the _______ the positive predictive value. | show 🗑
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| Characteristics of a good screening test | show 🗑
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| observation studies | show 🗑
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| experimental studies | show 🗑
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| show | detailed report on one patient, usually new or unusual problem/symptom
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| case series (definition) | show 🗑
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| benefits of case report/series | show 🗑
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| limitation of case report/series | show 🗑
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| show | study that examines rates of disease in relation to a population-level factor
- unit of observation=group
- exposure and outcome data at group level
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| show | exposure is measured as an average for a population, not a person, so there is no real link between exposure and disease
- group-level association may not transfer to the individual level
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| show | - inexpensive and fast, conducted on available data
- good for early knowledge
- wider range of knowledge than other types of studies
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| cross-sectional studies (definitions) | show 🗑
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| Many government studies are _________ | show 🗑
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| show | problematic when exposure is interchangeable (smoking, drinking, physical activity)
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| What are cross-sectional studies OK for? | show 🗑
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| show | - relatively quick and inexpensive
- highly generalizable
- hypothesis generation
- health care planning
- estimation of magnitude/distribution of a health problem
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| Purpose of case control studies | show 🗑
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| show | - investigators observe the natural history of the disease in subjects without assigning treatments to the subjects
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| experimental studies | show 🗑
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| show | - cohort
- case control
- cross sectional
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| show | - randomized clinical trials
- community trials
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| Process of case-control studies | show 🗑
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| show | case: group of people with the disease
control: group of people without the disease
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| Control group is also called.... | show 🗑
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| source population (definition) | show 🗑
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| show | identifies CASES of disease and selects CONTROLS who represent a sample of the source pop that produced the cases
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| purpose of controls | show 🗑
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| show | - controls must come from the same source population as the cases
-controls must be selected independently of exposure
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| show | - population based controls
- hospital or clinic based controls
- friends/relatives identified by cases
- nested controls from cohort population/study
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| population-based controls | show 🗑
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| show | - must come from the same source population as the cases
- controls must be selected independently of exposure
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| show | - tend to use smaller sample sizes than surveys or prospective studies
- quick and easy
- cost effective
- useful for studies of rare diseases
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| limitations of case-control studies | show 🗑
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| measures of disease frequency (definition) | show 🗑
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| measures of association (definition) | show 🗑
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| What type of study uses prevalence ratio? | show 🗑
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| What type of study uses odds ratio? | show 🗑
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| show | cohort and experimental
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| show | pr=1 no association
pr>1, prev in exposed is greater than prev in non exposed RISK FACTOR
pr<1, prev in exposed less than prev in non exposed PROTECTIVE FACTOR
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| interpretation of an odds ratio | show 🗑
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| show | - identifies the original pop at the beginning of the study and subjects who are exposed and unexposed
- follows subjects real-time until the point at which the study ends OR to assess if the disease develops or not
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| retrospective cohort studies | show 🗑
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| Prospective is _______ in time, retrospective is ______ in time | show 🗑
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| show | 1) begin with a defined population
2) participants are randomized to receive with a new treatment/current treatment
3) subjects are followed in both groups to determine who improved and who did not improve
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| Two characteristics of experimental studies | show 🗑
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| show | subject unaware of group assignment
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| show | neither subject nor experimenter is aware of group assignment
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| show | gives information on the effectiveness of a treatment under everyday practice conditions
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| ethical issues of human experimentation | show 🗑
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| show | measure's expected contribution of a study factor to the frequency of a disease in a particular population
- useful in predicting the efficacy/effectiveness and facilitates in planning/evaluation of intervention
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| show | only can be computed directly from a cohort study
- portion of the incidence of a disease in the exposed that is due to the exposure
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| How much of the disease that occurs can be attributable to a certain exposure? | show 🗑
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| show | determining which exposures have the most relevance to the health of a pop/community
- interested in total pop and not just in exposed groups
- total pop consists of exposed and non-exposed groups
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| show | occurs because the estimates we produce are based on samples, and samples may not accurately reflect what is really going on in the pop at large
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| show | systematic error is the design, conduct, or analysis of a study that leads to an erroneous association between the exposure and disease (low validity)
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| reliable=_____ | show 🗑
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| show | valid
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| bias towards the null means... | show 🗑
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| bias away from the null means... | show 🗑
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| show | the extent to which the association results represent the truth in the pop we are studying
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| random error | show 🗑
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| show | - affects accuracy (how close values are to true value)
- same error in same direction in all measurements
- cannot be minimized with larger sample size
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| show | selection bias: selection of study participants
information bias: classification and measurement
confounding bias: comparison and interpretation
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| non-response bias | show 🗑
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| What is the best way to avoid non-response bias? | show 🗑
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| show | may occur in cohort studies if the exposed and unexposed groups are not truly comparable
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| show | type of selection bias that may occur when a group of people exposed to an occupational hazard is compared with the sample of the general population
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| differential loss to follow up | show 🗑
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| information bias (definition) | show 🗑
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| show | case-control studies: cases may be misclassified as controls and controls may be misclassified as cases
cohort studies: exposed group may be misclassified as non exposed and unexposed group may be misclassified as exposed
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| show | problem inherent in the data collection methods
- occurs when there is an equal likelihood of both groups being misclassified
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| non-differential misclassification (consequence) | show 🗑
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| recall bias | show 🗑
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| show | context of case control studies, when cases and controls are asked about exposures in the past
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| interviewer bias | show 🗑
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| methods to avoid information bias | show 🗑
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| show | beginning of the study/subject enrollment
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| show | data collection
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| show | data analysis or beginning of the study
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| show | distortion (inaccuracy) in the estimated measure of association (OR, RR)
- problem of comparison, a problem that arises when extraneous but important factors are differently distributed among groups being compared
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| show | when primary exposure of interest is mixed up with some other factor that is associated with the outcome
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| confounding variable (definition) | show 🗑
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| show | 1) must be a risk factor for the disease even in the absence of exposure
2) must be independently associated with the exposure
3) must not be in a causal pathway (not be the result of the exposure)
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| Why do confounding variables matter? | show 🗑
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| show | 1) a priori confounding (based on prior knowledge)
2) data based confounding (based on data)
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| show | an event, condition, or characteristic that plays an essential role in producing an occurence of the disease
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| sufficient cause | show 🗑
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| show | any agent that is required for the development of a given disease
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