Public Health for the PharmD Midterm 2

Epidemiology

the study of the distribution and determinants of disease frequency in human populations

a clear definition

What must a disease/health outcome have in order to be counted/studied

Burden of Disease

the total consequences

Epidemic Model

the use of math parameters to model outcomes

Chain of Infection

the infection progression after leaving the reservoir

Chart Abstraction

the information from the medical record

Disease Frequency Rate

the frequency of occurrence in the population

Denominator

the population at risk

Incidence Rate

the rate of new cases appearing in a defined population in a given period of time

Prevalence Rate

frequency in population at a given time

Epidemic Curve

What graphs the “when” of an outbreak through the number of cases day by day?

Time of Incubation + Infectious Window

What does an epidemic curve calculate?

Incidence in population both at and not at convention

What does an epidemic curve compare?

Lessens/Subsides

What happens to the number of cases as transmission slows?

evaluate the association of risk factor + disease

What is the purpose of an experimental study?

Healthy

What kind of particpants are in a cohort study?

Longitudinal, Prospective

What kind of information does a cohort study come up with?

2

How many groups are usually in a cohort study?

Relative Risk (exposed/unexposed)

What does a cohort study come up with/calculate?

Increasing mortality rate from lung cancer since early 1900s

What prompted lung cancer studies?

Increased tobacco smoking and air pollution

What were the possible factors for higher lung cancer rates?

1940s

When did lung cancer studies start?

Cohort Study (Prospective, longitudinal)

What kind of study was the Doll and Hill (1956)?

40,000 British physicians

Who was surveyed in Doll and Hill (1956)?

Smokers, Ex-Smokes, + Non-Smokers

What were the groups in Doll and Hill (1956)?

Causes of Death through Registrar General

What did they use to find information in Doll and Hill (1956)?

4 years

How long did it take for them to find significant trends in Doll and Hill (1956)?

20 years

When were Doll and Hill’s (1956) findings confirmed?

23.7

If there is a 166 lung cancer death rate per 100k among heavy smokers and a 7 among non-smokers, what is the relative risk?

Hammond and Horn

What was the US cohort study following Doll and Hill (1956)?

188,000

How many men were in the Hammond + Horn study?

3.5

How long was the Hammond + Horn study?

Causes of Death from death certificates

What information was used for Hammond and Horn?

confirmed and extended

What did Hammond and Horn do for Doll and Hill (1956)?

Mouth, Pharynx, Larynx, and Esophagus

What kind of cancers are smokers more likely to die from?

2.4x

How many times more likely are heavy smokers to die of heart disease than non-smokers?

1960s

When did smoking trends peak in the US?

minimum 21 age of purchase, ban on flavored cigs/e-cigs, taxation

Name three ways the US has recently discouraged use through policy changes

Reye’s Syndrome (1980s)

a deadly disease in children after viral infections like chicken pox

Was Reye’s Syndrome linked to medications used to treat viral infections?

What question was posed in Reye’s syndrome research?

Outcomes

What do Case-Control studies start with?

those already with the condition

What kind of participants were in the Reye’s Syndrom C-C study?

closely paried but without the condition

What was the control for the Reye’s syndrome study?

Retrospective

What kind of information was found by the Reye’s syndrome study?

possible common exposures

What did the Reye’s syndrome study look for?

Studying Rare Events

What was the Reye’s syndrom study useful for?

shorter duration + targeted study

What were characteristics of the Reye’s syndrome study?

Measures of Association

the link between exposure and disease as well as the strength of the link

Relative Risk

What is the measure of association for a cohort study?

Odds Ratio

What is the measure of association for a cohort study?

Intervention

What kind of study is an experimental study?

Clinical Trials

What kind of trials are used in an E.S?

Treated vs Placebo

What groups are compared in an E.S.?

randomization, double blinded, matched controls

What are characteristics of an E.S.?

Theraputic C.T.

What kind of clinical trial occurs when patients all have the disease?

Institutional Review Boards (IRBs)

Who looks through the ethical standards of research involving human subjects?

Francis Trial (1954)

NAME THE INTERVENTION STUDY:

400,000 schoolchildren, Salk vaccine vs. Placebo, Measured incidence of polio

Physician’s Health Study

NAME THE INTERVENTION STUDY:

22,000 American physicians, asprin/betacarotene, measured incidence of heart disease + cancer

Fluoridation of water + tooth decay

What did the Kingston-Newburgh study look at?

1945 Kingston water (fluoridated) vs. Newburgh water (not)

What was compared in the Kingston-Newburgh study?

Dental exams in school children (prevalence of tooth decay in children after 10 yrs)

What was used to compare in the Kingston-Newburgh study?

½ level missing/filled teeth in children of Kingston

What were the findings in Kingston-Newburgh?

Increased heart valve problems

Why was fen-phn (fenfluramin/phentermine) recalled?

Increased risk of heart attack, investigations about negative data supression

Why was vioxx recalled?

Conflicts of interest influence results and reporting

What was the issue with selective data reporting by pharmaceutical companies?

association is due to chance

What is the source of error when the sample size is too small?

Overall outcome

What is the source of error when there are multiple determinants?

Failure to control other factors

What is the source of error when there are confounding variables?

Selection, Observer, Recall/Reporting

What kinds of bias cause sources of error?

Given to menopausal women to lower CV disease + osteoporosis risk, meopausal symptoms, improve memory, etc.

Why did HRT studies start in the 1960s?

1976 cohort study (observational) that noted benefits

What was the Nurses’ Health Study?

Bernadine Healy (head of NIH)

Who funded the NIH C.T. for HRT in 1991?

dramatic differences among groups

What was noted by the NIH CT of HRT in 2002?

HRT group had lower risk of fractures + colorectal cancer + higher risk of hert attack, stroke, + blood clots

What was found by the Women’s Health Initiative (WHI) C.T.?

Selection bias in NS cohort study (younger/thinner)

What were the discrepancies between the Nurses’ Study and WHI CT?

Publication Bias

when the release of data is controlled by a company

FDA Revitalization Act (2007)

the registration of trials + submission of complete data to public database at national Library of Medicine

National Center for Health Statistics

the fedral agency that states report to (local data on births, deaths, vital statistics, etc.)

health status, lifestyle, health-related behaviors

What surveys do the NCHS use?

Birth Certficate

NAME THE VITAL STATISTIC

• issued by local government

• reported to state + nchs

• family + medical information

• date of birth

Death certificate

NAME THE VITAL STATISTIC

• cause of death

YES

Are marriages/divorces reported to NCHS?

spontaneous fetal deaths, abortions, infant deaths (pre-1st birthday)

What pre + post natal issues are reported to NCHS?

death before 1st birthday/total live births

How is the infant mortality rate calculated?

death < 75 yrs = premature

What are years potential life lost?

50,000

How many households are surveyed in the National Health Interview Survey?

15 countries, 5,000 people

Who is surveyed in the National Health and Nutrition Examination Survey (NHANES)

comprehensive health assessment

What is the NHANES?

conducted by states + reported by CDC

What happens with the Behavioral Risk Factor Survey (BRFS)?

risk factors + preventative care

What does the BRFS look for?

probability

What do epidemiological studies measure?

Statistically significant (5/100 probability the experimental result occurred by chance)

What does a p value of 0.05 mean?

Confidence Interval

the range of values into which the true value falls

lower likelihood of random error

What does a narrow CI mean?

Power

the probability of finding an effect (larger = overcome random chance)

Sensitive Screening Test

has few false negatives

Specific Screening Tests

has few false positives

wants to avoid missing positives so they sacrifice specificity for sensitivity (high # false pos can render test ineffective/too costly)

What are issues with population screening tests?

emergency authorization by the FDA → lower standards/shorter time

What lead to COVID-19 screening tests to get deployed early?

virus, antibody, exposure/immune response (presence of reactive antibodies in blood)

What do COVID-19 tests look for (3 kinds)?