1
Q
what is epidemiology?
A
is the study of the distribution and determinants of health-related states or events (including disease), and the application of this study to the control of diseases and other health problems
2
Q
what does epidemiology measurements and analysis help with
A
health professionals make informed decisions about how to best use resources to prevent disease and promote health
3
Q
why is it important to measure health
A
to be able to look at interventions and try and make things better.
- you don’t know if your making things better or worse unless you measure before and after interventions
- what’s working or not working
4
Q
critical role that measurement plays in informing foreign aid decisions
A
- whether things working or not
- did the camping reach the intended population
5
Q
examples of epidemiological questions
A
- what is the impact of the opioid crisis on mortality in Canada?
- what interventions are effective in reducing this mortality?
- should the government spend more money on facilitating access to naloxone kits or on supervised consumption site to reduce opioid-related deaths ?
6
Q
data collection on minority groups
A
comes from a place of colonization
(example Indian Registry)
7
Q
conditions for Indigenous peoples to reach data sovereignty
A
the decolonization of data or Indigenous data governance
8
Q
collection of data ; Indigneous
A
- sometimes data is collected to benefit Indigenous communities it likely collected through colonial frameworks
9
Q
Maggie Walter has five categories, or “five D’s”, of the colonization of Indigenous data
A
- disparity
- depravation
- disadvantage
- dysfunction
- difference
10
Q
what are the 5D’s used for
A
to classify Indigenous populations as “problematic” and in need of help
11
Q
why is 5D’s harmful
A
This kind of data can be used to justify taking power and land from communities and make it seem like they are naturally dependent, instead of showing how systems created those conditions.
12
Q
Indigenous Data Governance
A
- ## Once data is collected, deciding who should have governance, and who should use that data needs to be considered
13
Q
O C A P
A
The First Nations Principles of O C A P™ (ownership, control, access, and possession) means
that First Nations control data collection processes in their communities
14
Q
why is increased access to Indigenous data important
A
for communities to determine,
under appropriate mandates and protocols, how to make decisions regarding why, how, and by whom
information is collected, used, or shared
15
Q
incidence
A
disease risk
16
Q
prevelance
A
disease burden
- tells us about the number of existing cases of that diseasse in a given population
- can be reffered to as point prevalence or indicative of a period of time (period prevlence)
17
Q
incidence =
A
new case over time / persons at risk
(persons on bottom must have potential to become a person in the top)
18
Q
prevalence =
A
of affected person in the pop / all person in the population at a specific time that are at risk
19
Q
point prevalence
A
- a measure of the propotion of the population that has a certain disease at a specific point in time
20
Q
how to calculate point prevalence
A
the number of cases of a disease and the population count for a specific time is needed
21
Q
use of point prevalence in global health research
A
- is rare
- may require six months to survey a region of Somalia and determine the number of existing cases of tuberculosis, in which case period prevalence must be used
22
Q
point prevalence =
A
of cases at a specific time / total pop at that time
23
Q
period prevalence
A
is a measure of the proportion of the population that has a certain disease over a defined period of time
24
Q
period prevalence =
A
of cases at a period of time / average population during that period of time
25
what is incidence?
measures how quickly new cases of a disease arise in a population over a define period of time
26
Why is incidence different from prevalence
because the measure only considers new cases within the "at-risk" population, within the time period
27
cumulative incidence
is a measure of the proportion of the population who develop the disease over a period of time
- is a measure of risk
28
cumulative incidence =
of new cases of a disease over a time period / total population at risk
29
total population at risk =
total population at risk excludes individuals who already have the disease or who are incapable of developing the disease
30
how is total population at risk calculated
total pop - # of existing cases
31
sometimes the at-risk population is constant however...
it is not safe to assume the at-risk pop is constant in certain situations
32
reasons for increased at risk pop
- births
- immigration
33
reasons for decreased at-risk population
- high incidence
- high death rate from other causes
- emigration
34
onset of disease in the population of incidence
proportion of population developing new cases of disease
35
onset of disease in the population of prevalence
proportion of population with disease
36
units of incidence
- cumulative incidence: cases/ population at-risk
- incidence rate : cases/person-time
37
units of prevalence
cases/total population (cases include all current active cases, no matter when they occurred)
38
time of disease diagnosis incidence
newly diagnosed
39
time of disease diagnosis prevalence
current surviving cases, whether diagnosed recently or at any time in the past
40
denominator of incidence
- cumulative incidence : number of persons free of disease at baseline
- incidence rate: number of person-year free of the disease of interest
41
denominator of prevalence
number of at-risk persons present in the population of interest
42
what do prevalence and incidence not describe
how or why people stop having that disease
- These measures do not explain whether
those infected are cured of the disease, die of the disease, or die of another cause altogether.
43
Crude
mortality rate
is the count of all the deaths over a specified time period divided by the population at
the midpoint of the time period being considered
- reported in 100,00 people and the time period is usually a year
44
Crude Mortality Rate =
of deaths over a time period × 100 000 / population at midpoint of time
period
45
how many types of crude mortality rates are there
2
46
types of crude mortality rates
- all cause morality rate
- cause specific mortality rate
47
All-Cause Mortality Rate
Considers deaths for any reason in the population.
48
Cause-Specific Mortality Rate
Measures the deaths in a population from a specific disease
Subgroups are involved.
49
Specific Mortality Rate =
of deaths over a time period (in a certain subgroup) × 100 000 /
subgroup population at midpoint of time-period
50
standardization of mortality rate is used when
comparing the mortality in two populations that differ in
terms of characteristics that are known to influence mortality (i.e. age, sex, etc.).
51
Crude and specific
mortality rates don’t take
sex, age, or the general composition of a population into account.
- which can make them misleading
52
what is most common metric to standardize mortality by
is age
53
All-cause mortality will always be
greater than any single disease specific mortality
54
why can't specific death rate be generalizable
since in specific mortality rates both the numerator and the denominator are changed
55
why can be difficult to obtain reliable measurements of population morbidity and
mortality in developing countries
- the system
- where and how people live,
make it difficult for vital event registration to be up to date
- many people die at home, never having been to a health facility.
56
Vital event registration:
A system by which a country’s government records and tracks statistics on any vital events, including births, deaths, marriages, divorces, and fetal deaths. Such a system creates a
permanent record for every event and statistics on population dynamics and health indicators on a continuous basis. It also helps quantify the prevalence, distribution, and causes of mortality, while identifying health inequalities.
57
relative risk and odds ratio, used for
calculating the underlying
cause of a disease or disease occurrence.
58
Relative Risk (R R) refers to
how many times more likely it is that one group of people will become ill
compared to another group.
59
Risk is simply the
cumulative incidence of being exposed to an illness.
60
Groups can be defined by
demographic factors (e.g. age-group, sex) and exposures to a suspected risk
(e.g. lives within 1km of open water, does not live within 1 km of open water)
61
Relative Risk =
a/(a+b) / c/(c+d)
62
a/(a+b)
The primary group (E+) normally refers to the group exposed to the risk.
a = primary group (E+) with the disease (D+)
b = primary group (E+) without the disease (D-)
63
If R R<1
The primary interest group has a lower risk of disease.
63
c/(c+d)
the comparative group (E-) refers to the group not exposed to the risk.
c = the comparative group (E-) with the disease (D+)
d = the comparative group (E-) without the disease (D-)
64
If R R=1
The risk of disease is equal in both groups.
65
If R R>1
The primary interest group has a higher risk of disease.
66
Before R R values can be interpreted, they need to be
subjected to statistical tests of significance.
67
Significance tests check
whether or not the discrepancy between risks could have occurred by chance
alone
68
relative risk is contingent upon
being able to calculate
incidence.
69
In the absence of information about the incidence of an entire population, you can calculate an
odds
ratio based on information about the primary group (E+) and the comparative group (E-).
70
odds ratio is considered a reasonable approximation of the relative risk. when
when the outcome is rare or when you cannot quantify the at-risk population such as in retrospective case-control studies
71
a =
primary group (E+) with the disease (D+)
72
Odds Ratio =
a × d / b x c
73
d =
the comparative group (E-) without the disease (D-)
74
b =
primary group (E+) without the disease (D-)
75
c =
the comparative group (E-) with the disease (D+)
76
An odds ratio is calculated to
approximate relative risk when incidence information is missing.
77
Mortality
doesn’t
indicate anything about the age that people die of a specific disease or their quality of life.
78
most accepted metric for global
burden of disease (G B D) is
the Disability Adjusted Life Year (DALY) - which WHO uses
79
benefits of DALY
- allow direct comparison for burden across diseases
- summing burden across diseases
- permit comparing treated and untreated diseases
- compare different diseases interventions
- treatment expansion VS prevention campaigns
80
limitations of DALY
- collected alot of data
81
DALY is
mortality + morbidity
82
mortality (Years of life lost (Y L L) =
life expectancy - age at death
83
morbidity YLD (years lived with disability) =
disability weight (per disability) X duration of disability (prevalence)
84
Once Y L D has been calculated for a disability,
it can be compared to other Y L Ds from different
disabilities
85
(Years of life lost (Y L L)=
(# of deaths) x (Life Expectancy – Death)
86
Years of life lost (Y L L) is an indicator of premature mortality and has two defining characteristics
* It takes age of death into account by subtracting life expectancy by the average age of death.
* It places more weight on illnesses that result in early mortality because dying young has a bigger impact on both the individual and society at large.
87
What assumptions can be made for a disability that disproportionately affects older people, for
instance Alzheimer’s? Why might this be the case?
We might assume that a disability that disproportionately affects older people compared to younger
people is associated with their age; therefore, the disability is not as prevalent in younger populations.
88
Criticisms of DALYs
- it evaluates health through an ableist lens
- By weighting disability,
able-bodied people are valued more highly than people with disabilities
- doesn’t account for the age of people, which is related to a person’s
ability to contribute to society.
- Through a second weighting scheme (not discussed in this section), DALY can be adjusted for age such that middle-aged years have the highest weighting
89
Support of DALY
that prioritizing interventions based on people’s
potential to contribute to society is currently the best option
90
Indigenous communities
around the world, keep track of and pass on knowledge of the burdens of a specific disease through
storytelling, oral history, and oral record keeping in addition to written record keeping.
91
Western communities have placed an emphasis on the
written word as the main form of
record keeping
92
Indigenous communities have utilized and relied on
the transmission of oral histories, lessons, and other knowledge to keep a historical record of events.
93
Oral histories and storytelling both convey
events from the past and offer lessons or cautionary tales to
the listener
94
. Oral histories are more specific to
a time period or special event that happened, and are
often considered historically accurate.
95
storytelling gives
the storyteller more creative and
imaginative liberty to better emphasize the teaching or lesson
96
In some Indigenous communities, specific individuals are selected to be the
orators,
97
why are specific individuals selected to be orators
to carry forward these stories and histories
98
These orators would have the
permission to tell the stories even if they
were not their stories originally.
99
Each orator has the ability to
add their own experience to the story,
therefore increasing the protective knowledge held within the stories
100
If the community loses the
people that have the protective stories then
these communities lose that protective effect.
101
Orators
are the public speakers of the community. Typically, these individuals are selected
for their position based on the community’s clan system.
For example, within the Mohawks of the Bay
of Quinte, the Turtle clan is generally regarded as the storytellers
102
Although they do not include quantitative records, many stories that are shared within Indigenous
communities make reference to
healing
103
do western communities often consider oral record keeping as less accurate?
yes - but this is not the case
104
how does Indigenous record keeping occur
through complex and sophisticated ways including performative practices such as dancing and drumming
105
Oral Traditions
The means by which knowledge is reproduced, preserved and conveyed from generation to
generation. Oral traditions form the foundation of Aboriginal societies, connecting speaker and listener
in communal experience and uniting past and present in memory
106
Dancing and drumming:
From early times, many Indigenous communities have used songs and
dancing to recount legends, stories, and traditions. Accompanied by the rhythmic beat of drums, dancers use motions that act out the words of the songs - usually reenactments of great feats
accomplished by previous generations
107
Many societies that use oral record keeping have now begun to
utilize written word to document
events;
108
many communities continue to use oral traditions as their main form of knowledge
transmission, and consider it an
intrinsic component of their culture and society.
109
example of the blending of oral and written record keeping
during both the SARS outbreak
and smallpox pandemic. Many Western communities leveraged their knowledge, previous experience,
and records from the SARS outbreak to prepare and combat the COVID-19 pandemic.
110
some Indigenous communities in Canada have used not only their previous
experience and knowledge of SARS, but their experience with smallpox to help in the fight against
COVID-19
111
how did Indigneous communities help fight COVID
- oral histories of how dangerous previous diseases can be
- written stories
- epidemiology
- reminded many Indigenous communities of one thing; to stay together like one big
family
GLPH 271
flashcards
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