Module 3

Question 1

Epidemiology definition

Answer 1

The study of the distribution and determinants of health-related states or events in specified populations, and the application of this study to the control of health problems.

Question 2

Population based (mass) strategy

Answer 2

Attempts to move the whole distribution of disease exposure and outcomes in a more favourable direction

Question 3

High risk (individual) strategy

Answer 3

Only affects individuals over a certain threshold of the distribution

Question 4

Population-based strategy advantages

Answer 4

• radical (addresses underlying causes)
• large potential benefit for whole population
• behaviourally appropriate

Question 5

Population-based strategy disadvantages

Answer 5

• small benefit to individuals
• poor motivation of individuals
• whole population is exposed to downside of strategy (less favourable benefit-to-risk ratio)

Question 6

High-risk strategy advantages

Answer 6

• appropriate to individuals
• individual motivation
• cost effective use of resources
• favourable benefit-to-risk ratio

Question 7

High-risk strategy disadvantages

Answer 7

• cost of screening
• temporary effect
• limited potential
• behaviourally inappropriate

Question 8

Health promotion

Answer 8

acts on determinants of wellbeing of the whole population in everyday contexts

Question 9

Ottawa charter

Answer 9

health promotion: ‘mobilise action for community development’

Question 10

Ottawa charter acknowledges that health is: [4]

Answer 10

• a fundamental right for everybody
• that it requires both individual and collective responsibility
• the opportunity to have good health should be equally available
• good health is an essential element of social and economic development

Question 11

Ottawa charter basic strategies: [3]

Answer 11

1. Enable
2. Advocate
3. Mediate

Question 12

Enable (OC)

Answer 12

To provide opportunities for all individuals to make healthy choices through access to information, life skills and supportive environments

• An individual level strategy

Question 13

Advocate (OC)

Answer 13

to create favourable political, economic, social, cultural and physical environments by promoting/advocating for health and focusing on achieving equity in health

• A systems level strategy

Question 14

Mediate (OC)

Answer 14

To facilitate/bring together individuals, groups and parties with opposing interests to work together/come to a compromise for the promotion of health

• A strategy that joins up individuals, groups and systems

Question 15

Ottawa charter priority action areas: [5]

Answer 15

• develop personal skills
• strengthen community action
• create supportive environments
• reorient health services towards primary health care
• build healthy public policy

Question 15

Primary prevention strategy

Answer 15

• limit the occurrence of disease by controlling specific causes and risk factors
• reduces disease incidence

Question 16

Secondary prevention strategy

Answer 16

• early detection to reduce the more serious consequences of disease
• reduces prevalence

Question 17

Tertiary prevention strategy

Answer 17

• reduce the complications of established disease

Question 18

Health protection

Answer 18

• predominantly environmental hazard focused
• risk/hazard assessment
• occupational health & monitoring
• risk communication

Question 19

systematic inequities for Māori: [4]

Answer 19

• in health outcomes
• in exposure to the determinants of health
• in health system responsiveness
• in representation in the health workforce

Question 20

Māori health promotion

Answer 20

the process of enabling Māori to increase control over the determinants of health and strengthen their identity, thus improving their health and position in society

Question 21

cultural identity

Answer 21

Mauriora

Question 22

participation in society

Answer 22

Te Oranga

Question 23

healthy lifestyles

Answer 23

Toiora

Question 24

environmental protection

Answer 24

Waiora

Question 25

community leadership

Answer 25

Ngā Manukura

Question 26

autonomy

Answer 26

Te Mana Whakahaere

Question 27

estabilishing population health priorities: evidence based measures: [3]

Answer 27

- descriptive - explanatory - evaluative

Question 28

descriptive evidence (prioritisation)

Answer 28

who is most least affected? - historical trends - future trends

Question 29

explanatory evidence (priorisation)

Answer 29

what are the determinants/risks? why are we getting worse/better? why are populations different (equity)?

Question 30

PAR

Answer 30

if the association is causal then this is the amount of disease (theoretically) we could prevent if we removed the risk factor from the particular population

Question 31

evaluative evidence (prioritisation)

Answer 31

what can improve health outcomes (and in whom)? is the intervention improving health outcomes? economic feasibility?

Question 32

Screening

Answer 32

This can apply to all levels of disease prevention. Pop gets screened --> those who test pos go to gold standard test---> if pos then treatment. All neg will get rescreened at a time interval of choice

Question 33

Screening Criteria

Answer 33

1. suitable disease 2. suitable screening test 3. suitable treatment 4. suitable screening programme

Question 34

Suitable disease (screening)

Answer 34

needs to be an important health problem can be common or uncommon so detection leads to better health outcome

Question 35

Suitable test (screening)

Answer 35

reliable safe affordable accurate go against the gold standard

Question 36

Specificity

Answer 36

d/cg x 100 is high if the proportion of true negatives is high fixed measure

Question 37

Sensitivty

Answer 37

a/eg x 100 high if proportion of true pos is high fixed measure

Question 38

PPV

Answer 38

a/a+b proportion who really have the disease of all who tested positive changes with prevalence if higher prev then a higher so higher PPV

Question 39

NPV

Answer 39

d/c+d x 100 probability of not having the disease if test is negative not fixed

Question 39

Suitable treatment Screening

Answer 39

evidence of early treatment leading to better outcomes

Question 40

Suitable screening programme

Answer 40

benefits must outweigh harm RCT evidence screening result is less deaths or increased survival time reach all of community cost effective

Question 41

Lead time Bias

Answer 41

survival time = time of death - time of diagnosis if diagnosed earlier then appearance of more survival time even though disease progression is the same

Question 42

Length time bias

Answer 42

slower cases of disease progression more likley to be diagnosed than rapid cases

Question 43

Reasons for GBD Project

Answer 43

wanted info for policy on both death and disability burden of disease take account of fatal and non fatal outcomes

Question 44

DALY

Answer 44

Disability Adjusted Life Years DALY = YLL + YLD says burden of disability is the same in very country

Question 45

YLL

Answer 45

years of life lost - number of deaths per year - years lost per death relative to ideal age

Question 46

YLD

Answer 46

years lived with disability - disability weight - number of cases - average duration until recovery or death

Question 47

Communicable Diseases

Answer 47

infectious diseases which can be transmitted e.g HIV

Question 48

Non Communicable Diseases

Answer 48

not able to spread e.g CVD

Question 49

Low income country DALY

Answer 49

mostly CD few NCD lower age of death

Question 50

High Income country DALY

Answer 50

mostly NCD few CD higher age of death Better healthcare

Question 51

Gains of the DALY approach

Answer 51

1. drew attention to previously hidden burdens such as mental health 2. NCD as an issue in both LIC and MIC and HIC

Question 52

Medical vs Social model of disability

Answer 52

Medical - thinks of those with a disability as a burden, individual problem, seen as dependent Social - not the problem of the person but caused by social and environmental barriers