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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| show | group of people with a common characteristic such as place of residence, gender, age, or use of certain medical services
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| show | 1) descriptive
2) analytical
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| show | WHO, WHERE, WHEN
- quantifying how often a disease arises in population
- frequency of disease may vary from one population group to another
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| measures of disease frequency | show 🗑
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| show | to identify subgroups in the population who are at high risk for disease, really focuses on the most vulnerable
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| EpiCurve | show 🗑
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| show | when an outbreak starts or when a large amount in the population become infected
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| show | describes changing patterns of population distributions in relation to changing patterns of mortality, fertility, life expectancy, and leading causes of death (ex: from 1900s to now)
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| show | descriptive epidemiology
- provides rationale for future studies and evaluation
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| show | analytical
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| determinant (definition) | show 🗑
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| show | causes or exposures that influence health events
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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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| Examples of non-modifiable risk factors | show 🗑
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| show | many different types of health outcomes
- infectious diseases
- chronic diseases
- disability, injury, limitation of activity
- mortality
- active life expectancy
- mental illness, suicide, drug addiction
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| show | through epidemiological research and surveillance
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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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| measures of association (examples) | show 🗑
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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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| secondary prevention (definition) | show 🗑
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| secondary prevention (examples) | show 🗑
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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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| John Snow | show 🗑
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| show | developed Smallpox vaccine
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| show | - studied childbed fever
- championed hand washing
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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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| show | once an agent infects a host, degree/severity of the infection will depend on the host's ability to fight off infectious agent
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| show | - nonspecific: diff defense mechanisms that body produces
ex: skin, mucosal surfaces, tears, saliva, gastric juices
- disease-specific: certain pathogen/disease
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| show | - biological
- physical
- chemical
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| show | - bacteria
- viruses
- mycoses (fungal diseases)
- protozoa
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| show | - noise
- repetitive motion
- violence
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| show | - tobacco
- air pollutants
- water pollutants
- cleaning chemicals
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| show | any mechanism by which an agent is spread to the host
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| show | - Direct (person to person)
- Indirect (airborne, droplet, fecal/oral, bodily fluids)
- Vector
- Vehcile
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| show | - most often an insect or arthropod, conveys the infectious agent from reservoir to a susceptible host
(ex: mosquito, flea, tick)
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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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| show | likely to infect
- capacity of an agent to produce infection/disease
- measured by secondary attack rate
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| pathogenicity (definition) | show 🗑
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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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| show | incubation period for noninfectious disease
- ex: mesothelioma resulting from Asbestos exposure may be 20-30 years
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| Herd Immunity (definition) | show 🗑
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| Herd Immunity Threshold (definition) | show 🗑
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| certain conditions for herd immunity | show 🗑
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| show | increase in the number of cases of a disease above what is normally expected in that population area
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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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| endemic (definition) | show 🗑
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| pandemic (definition) | show 🗑
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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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| show | Common point source
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| show | - common underlying cause, exposure to an infectious agent/toxin from same source
- exposure to the source is prolonged over an extended period of time
- people become exposed at all different times and areas
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| show | Common continuous Source Outbreak
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| Propagated source (definition) | show 🗑
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| What type of outbreak is COVID-19? | show 🗑
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| cluster (definition) | show 🗑
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| show | learning how cases are connected
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| outbreak (definition) | show 🗑
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| Steps of an Outbreak Investigation (1-6) | show 🗑
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| Steps of an Outbreak Investigation (7-9) | show 🗑
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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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| show | # of people affected present in a pop at a specific time/# of people in pop at that specific time
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| show | # of new cases of a disease in a specific period of time in a population at risk for developing the disease
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| show | new cases/total population at risk (as a percent)
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| How do you find the food-specific attack rate? | show 🗑
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| show | - rely on health care providers /laboratories to report cases of disease
- often incomplete
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| active surveillance | show 🗑
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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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| T or F: If duration of disease is short and incidence is high, prevalence becomes more similar to incidence. | show 🗑
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| show | - longer duration of disease
- prolongation of life of patients w/o cure
- increase in new cases
- in-migration of cases/susceptible people
- out-migration of healthy people
- improved diagnostic facilities (better reporting)
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| show | - shorter duration of disease
- high case-fatality rate from disease
- decrease in new cases
- inmigration of healthy people
- outmigration of cases
- improved cure rate of disease
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| Why do we use midyear population for Annual Mortality rate? | show 🗑
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| What is fertility rate used for? | show 🗑
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| show | specific rates refer to a particular subgroup of the pop defined in terms of race, age, sex, or single cause of death/illness
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| How are category specific rates helpful? | show 🗑
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| screening (definition) | show 🗑
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| validity of a screening test | show 🗑
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| What are the two components of validity? | show 🗑
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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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| Sensitivity (definition) | show 🗑
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| true positive | show 🗑
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| false positive | show 🗑
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| show | does not have the disease and tests negative
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| show | have the disease but test negative
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| show | distribution in which there are two peaks
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| show | positive predictive value
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| show | negative predictive value
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| show | higher, higher
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| show | - simple
- rapid
- inexpensive
- safe
- acceptable
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| observation studies | show 🗑
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| show | intervention of the researcher, observe what happens to study participants as a result of intervention
- investigators apply treatment to subjects
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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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| show | no explicit comparison group
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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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| ecological fallacy/bias | show 🗑
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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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| show | study/survey that examines the relationship between an exposure/disease at a single point in time
- single point of observation
- takes a snapshot
- measures exposure prevalence in relation to disease prevalence
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| Many government studies are _________ | show 🗑
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| limitations of cross-sectional studies | show 🗑
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| show | - immutable characteristics (genetic traits, blood type)
- measure of long term exposure (lead in bones)
- historical exposure (activity level over 30 years)
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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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| observational studies | show 🗑
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| show | - investigators apply treatments to individuals
- investigates role of some factor/agent in the prevention/treatment of a disease
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| types of observational studies | show 🗑
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| show | - randomized clinical trials
- community trials
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| show | 1) define hypothesis
2) define source pop
3) identify cases from the source pop
4) identify valid comparison group (controls) from the same source pop
5) ascertain exposure for cases&controls
6) calculate measure of association b/w cases&control
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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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| How do investigators cases/controls? | show 🗑
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| show | estimate the exposure distribution in source population that produced the cases
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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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| Where to find controls? | show 🗑
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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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| strengths of case-control studies | show 🗑
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| show | - does not provide direct estimate of risk
- timing of exposure-disease relationship difficult to determine
- not efficient to study rare exposure
- prone to recall bias
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| measures of disease frequency (definition) | show 🗑
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| show | assess the strength of the statistical relationships between a given study factor and a disease
examples: prevalence ratio, odds ratio, relative risk
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| show | cross sectional
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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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| prospective cohort studies | show 🗑
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| show | - identifies the original population using historical data and exposed/nonexposed people in the case, regardless of outcome status
- traces individuals forward in time the present day and will then assess if disease develops or not
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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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| show | 1) manipulation of the study factor
2) randomization
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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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| intent to treat analysis | show 🗑
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| show | - informed consent
- monitoring for side effects
- deciding when to withdraw a patient
- protecting the interests of patients
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| measures of effect | show 🗑
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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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| show | attributable risk
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| population attributable risk | show 🗑
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| random error (definition) | show 🗑
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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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| systematic error | show 🗑
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| sources of systematic error | show 🗑
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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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| non-differential misclassification | show 🗑
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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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| show | - masking interviewers and subjects to the study hypothesis (interviewer and recall)
- using control group that is composed of diseased info (recall)
- carefully designing study questionnaire (both)
- relying on non interviewer data (both)
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| When can selection bias occur? | show 🗑
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| show | data collection
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| When can confounding bias occur? | show 🗑
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| confounding bias (definition) | show 🗑
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| When does confounding bias occur? | show 🗑
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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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| show | ensures the internal validity we must account for confounding variables
- results may not reflect the actual relationship/association between the exposure and outcome if outside variables are not considered
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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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