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What factor has the greatest impact on health?
What are the two main things that Social Epi studies?
- Social Distribution of health
- Social Determinants of health.
Define 'Social Determinants of Health'.
- The conditions in which people are:
List 3 key social determinants of individual health.
- Any three of:
- Food insecurity
- Early child trauma
- Racial Descrimination
- Social Support.
List 3 key social determinants of group-level health.
- Any three of:
- Gross domestic Product
- Economic recession
- Unemployment Level
- Income inequality
- Neighbourhood quality
- Social Capital
What three ways to Social Determinants influence health?
- Biological pathways
- Deprivation pathways
What are the three steps in the deprivation pathway?
- 1: Low socioeconomic status
- 2: Restricted choices and access to resources
- 3: Reduced Health
Explain Biological pathways of Social Determinants.
The body's response and subsequent alteration to social conditions over time (especially negative conditions).
Define embodiment with respect to Social Epidemiology.
The changes in internal biological systems due to prolonged exposure to adverse social conditions.
Describe the Biologic Pathway of social determinants of health
- >Social Determinants
- ->Biological responses
- ->Emotional Responses
- ->Attempting to Cope (eg: Drugs, alcohol, etc)
- ->Health inequities.
Describe the Health Impact Pyramid.
- Counseling and Education
- Clinical intervention
- Long lasting protective interventions
- Changing context to change default decisions
- socioeconomic factors
- (Top to bottom is more individual based to more public based)
Name three toxicological concepts discussed in class (out of 4)
Often portrayed in a curve; the response of the body to particular dose amounts.
Define threshold with respect to toxicology.
The minimum dose needed to cause a particular response in an individual.
The time period between exposure and a measurable response.
- The phenomenon whereby multiple exposures to a toxin produces a response greater than sum of the individual exposures.
- (ex: Asbestos + Welding exposures)
Describe the study quality pyramid
- SR's (Systematic Reviews)
- RCTs (Randomized Controlled Trial)
- Cohort Study
- Case-control study
- Cross Sectional & Ecological Studies
- Case Reports, series
- The change in expressed genetic information via methylation based on environmental and social factors.
- Sometimes transferable through generations
What study designs are best for Genetic Epi?
- Cohort (Repeated measures to examine epigenetic effects)
- Twin studies (unique to genetic studies)
What is the 'thrifty-gene' hypothesis?
The hypothesis states that, because humans went through phases of feasting and famine, they evolved genetically to be able to store more carbs etc. from feasting phases to allow survival through famine.
Epigenetic traits can be passed through generations.
True or False?
- Note: It's not as reliable a transfer as DNA it's self. But it does happen.
- The misinterpretation of an outcome's cause.
- (ex: Those who carry matches or a lighter are more likely to develop (lung) cancer. They probably only carry a lighter or matches because they smoke, and smoking is the cause.)
What is the Cycle in Epidemiologic Work?
Descriptive Epi -> Analytic Epi -> Taking action -> Descriptive...
What is Primary prevention?
The prevention of disease by altering risk factors in the population.
What is secondary prevention?
Screening of those who are presymptomatic, but are relatively highly exposed to risk factors, making them prime candidates for a disease.
Define Tertiary Prevention.
Treatment of those with the active disease.
Screening is a quick way to establish a diagnosis.
False. It's a good way to identify those who should be tested & diagnosed.
What is a 'Gold-Standard' Test?
- A [invasive] test which definitively provides a diagnosis.
- Ex: Biopsy
Define Sensitivity of a screening test.
The ability of the screen to identify correctly individuals who have the disease.
Define Specificity with respect to screening processes.
The ability of a screen to identify correctly those who do NOT have the disease.
It is possible for a test to be reliable, but not accurate.
TRUE. A screen can be reliably inaccurate (Ie: It's always inaccurate). However, a screen which is accurate must be reliable.
Describe lead time bias.
The bias produced by an early diagnosis due to a screening process where the patient appears to live longer than an unscreened, later diagnosed patient when the reality is the time between onset and death was the same.
What is Helminthic Therapy?
The inoculation of a patient with specific intestinal parasites (usually hookworm or whipworm), with the desired result being increased immunity to infectious disease.
Describe the epidemiological triangle.
- Top: Host
- Bottom left: Agent
- Bottom middle: Transmission
- Bottom right: Environment
Define a vehicle of transmission.
Contaminated food or water.
What is the difference between fomite and vector transmission?
Fomite transmission occurs on inanimate objects which carry the infective agent, while vectors are living objects which carry it and [often] deliver it to you.
Describe the difference between quarantine and isolation.
- Quarantine is the restricted movement of a person who is well but may have come into contact with an infectious disease.
- Isolation is the separation of those who are symptomatic of a disease from the general, healthy population.
Describe Point-Source epidemic.
Occurs from sudden exposure to on source of an infection.
What is an incubation period?
The time it takes from exposure to the appearance of symptoms.
Describe a Contagious epidemic.
Introduced into a population, followed by individual-individual spread (Either indirect or direct).
What is the difference between a prospective (longitudinal) cohort study and a retrospective cohort study?
- A prospective cohort study is the following of a group of exposed and unexposed people, noting their health outcomes and comparing between the two groups to draw conclusions.
- Retrospective cohort studies are done one groups of people who have already gone from exposure to clinical endpoint and conclusions are drawn from them.
Describe, in general, case-control studies.
What is one particularly important use for these studies?
- A case-control study identifies a group of people with the disease of interest and notes particular patterns in previous exposures which may have caused the disease, comparing the results to a control group - a group who does not have the disease.
- It is most useful for studying rare diseases.
Describe, in general, cross-sectional studies.
A cross-sectional study looks at a large sample group (as random as possible to accurately represent whole populations) with the goal of identifying prevalence of a disease in a population and finding possible exposures which cause it. It is an inaccurate study; usually a precursor to a more in-depth one.
What is an ecological study?
The comparison of an exposure and a disease to attempt at a link between the two. Because of the study design, it is often impossible to discern whether the disease is actually caused by the exposure, or if the results have been confounded.
What is a systematic review?
- A systematic review is the review of all primary research studies relevant to the topic, with the findings as a whole summarized with conclusions drawn.
- *Accuracy is increased with a meta-analysis of the component studies, and even more by a reanalysis (using all original data).