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PP continued (Defintions (QALY
Capture expected years of life left and…
PP continued
Defintions
QALY
- Capture expected years of life left and quality of that time
- Derived from mortality, morbidity and quality of life value
DALY
- Measure of burden of disease
- Often used in states of chronic disease
- Alternative to QALYs
Endemic
- Disease always prevalent in popn
Epidemic
- Temporary but clear increase in incidence of disease in area
Pandemic
- Epidemic crosses international boundaries and affects large number of people
Ecological Fallacy
- Error of applying conclusions to individuals based on analytical findings from group data
Cohort Effect
- Variation in health and disease for different generations
- Due to exposure different risk factors
- Attributed to environmental and societal changes
Types of Bias
- Selection
- Recall
- Lead time: early diagnosis leads to over estimation of survival/cure rate
- Length time: Disproportionate number of long duration cases
- Observer
Black Report 1980
Proposed inequalities in health
- Artefacts - Nothing exists
- Natural/socieal selection: Poor health = poor people
- Cultural/Behavioral: Poor people = poor health
- Structural: Economics and structural factors
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Stuff
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When a person dies, medical certificate stating cause of death is issue (by hospital/doctor/GP/coroner)
Communicable Diseases
- Certain diseases have to be reported by law under Public Health Act
- usually reported to Consultant in Communicable Disease Control (CCDC)
- Their role:
- Identify source of infection
- Prevent further dissemination
Standardisation
Standardization
- Method removing confounders allow comparison two incomparable popns
Indirect Standardisation
- Produces Standardised Mortality Ratio
- Ratio of number of deaths observed in study population to number that would be expected if study population had specific rate as standard popn
- Produces % to indicate difference between groups
- SMR = 100: Study area same mortality rate as those of standard popn
- SMR < 100: Study area lower mortality rate than seen in standard
- SMR > 100: Study area higher mortality rate than seen in standard
- SMR = 180: Study area mortality rate 80% higher than seen in standard popn
- *Adjusted for age
Direct standardisation
- Standardised mortality ratio
- Actual number can be used to compare study popn with other populations similar to standard popn