Title: MD / Population Health

Q: what do you do in PCRA?
[...]
A: observe envir then don the appropriate PPE
Extra: PCRA = point of care risk assessment

Q: how is the crude mortality rate calculated?
[...]
A: CMR = deaths / (mid-year pop)

Q: how is infant mortality rate calculated?
[...]
A: IMR = deaths under 1 yr old / live births per year
Extra: expressed per 1000 live births per year

Q: how to calculate neonatal mortaility rate?
[...]
A: NMR = deaths under 28 days of age / live births per year

Q: how to calculate maternal mortality ratio?
[...]
A: MMR = deaths of women in pregnancy and childbirth / live births in year
Extra: expressed per 1000 live births per year

Q: how to calculate case fatality rate?
[...]
A: CFR = deaths due to disease / cases of disease

Q: what is diff btw prevalence and incidence?
[...]
A: prevalence is # of existing cases in popn whereas incidence is number of new cases in a specified time period

Q: how to calculate point prevalence?
[...]
A: PP = cases at fixed time / popn

Q: how to calculate period prevalence?
[...]
A: PP = cases over time interval / popn at midpnt of interval

Q: how to calculate incidence RISK?
[...]
A: IR = new cases over interval of time / popn at start of interval

Q: how to calculate incidence RATE?
[...]
A: IR = new cases over interval / person-years over interval
Extra: person-year = sum of all years

Q: how to calculate relative risk?
[...]
A: RR = disease incidence in those exposed / disease incidence in unexposed

Q: how to calculate potential years of life loss?
[...]
A: [$] \text{PYLL} = \sum (\text{deaths at each age}) \cdot (\text{life expectancy at each age}) [/$]

Q: how to calculate potential years of life disabled?
[...]
A: [$] \text{PYLD} = (\text{incident cases}) \cdot (\text{avg duration}) \cdot (\text{weight}) [/$]
Extra: weight ranges from 0 (perfect health) to 1 (death)

Q: how to calculate disability adjusted life year?
[...]
A: DALY = PYLL + PYLD
Extra: [$] \text{PYLL} = \sum (\text{deaths at each age}) \cdot (\text{life expetancy at each age}) \\ \text{PYLD} = (\text{incident cases}) \cdot (\text{avg duration}) \cdot (\text{weight}) [/$]
weight ranges from 0 (perfect health) to 1 (death)
PYLL = potential years of life lost
PYLD = potential years of life disabled

Q: how to calculate standardized mortality ratio?
[...]
A: SMR = total observed deaths / total expected deaths
Extra: this is indirect standardization

Q: what is ecological fallacy?
[...]
A: stuff measured at aggregate lvl might not apply to any indivs

Q: what is attributable risk?
[...]
A: propn of health outcome in exposed indivs which can be attributed to a risk factor
Extra: AR = p_1 - p_2
p_1 is propn exposed to risk; p_2 is propn unexposed

Q: what is the diff btw health equity and equality?
[...]
A: equity = ppl have opportunity to attain full health potential w/o disadvantage; equality = pops have equal or similar health status
Extra: inequity = unjust inequality

Q: what are environmental DOH?
[...]
A: modifiable factors in physical envir which influence health and under INvoluntary ctrl
Extra: smoking is not envir DOH; poor air quality is envir DOH

Q: what is the goal of the biomedical model of healthcare (Louis Pasteur)?
[...]
A: restore pt physiology to "normal"

Q: what is diff btw pop vs public health?
[...]
A: pop health = dist'n and disease in pops; public health = efforts of society to keep ppl healthy & prev bad stuff
Extra: pop health is in a sense broader / higher lvl than public health
pop health considers more abstract concepts whereas public health are more focused on things we can do

Q: what does it mean when subpopn's are unequally affected?
[...]
A: it means physical risks are socially distributed

Q: what is the diff btw disease and illness?
[...]
A: disease is more medically focused whereas illness is an indiv's subjective perception of lack of physical / mental well-being

Q: what is sickness?
[...]
A: views indiv + society hold towards a health condition, affecting their thoughts + actions

Q: explain the scale for DALY:
0 = [...]
1 = [...]
A: perfect health; death
Extra: DALY = disability adjusted life year
life exp weighted by amount of disability experienced

Q: which measure to use to estimate frequency with which disease is occurring?
[...]
A: incidence density (aka incidence rate)
Extra: ID = (new cases during time period) / (# of person-years of observation)

Q: what measure to use for probability a person in popn gets disease in a set time frame?
[...]
A: cumulative incidence

Q: what is the issue w/ cumulative incidence (aka incidence risk)?
[...]
A: tends to underestimate the true value
Extra: e.g., ppl who die of other causes increases the denominator

Q: what's the diff btw gender and gender identity?
[...]
A: gender = societal expectations / culture; gender identity = how indivs perceive themselves

Q: what is the diff tw bisexual and pansexual?
[...]
A: bisexual = romantic / sex attraction to both men and women; pansexual = romatic / sex attraction to ppl regardless of sex OR gender

Q: what is heteronormativity?
[...]
A: favouring cisgender indivs and heterosexual orientation / sexual activity

Q: what is a syndrome?
[...]
A: recognized constellation of sx that have no clear pathophysiologic cause
Extra: disease has pathophysiological cause
exceptions: Down's syndrome is a disease b/c we know what causes it (extra 21st chromosome)

Q: what is the diff btw PPV and sensitivity?
[...]
A: PPV gives prob that pt w/ +ve test actually has the disease WHEREAS sensitivity gives test's prob that someone w/ the disease is +ve
Extra: PPV is for pts (actually has disease)
sensitivity is for doctors (is actually positive)

Q: what is incidence density also called?
[...]
A: incidence rate

Q: what is cumulative incidence also called?
[...]
A: incidence risk

Q: which of incidence risk vs incidence rate uses person-yrs?
[...]
A: incidence RATE

Q: what is the "Nordic" model for sex work?
[...]
A: client-side criminalization and programs to move women out of sex work
Extra: New Zealand model: full decriminalization and licensing under existing health and workplace regulations

Q: what counts as drug abuse?
[...]
A: ongoing misuse of medications despite overt negative health consequences
Extra: all drugs potentially harmful
routes of admin are also potentially harmful (e.g., needle injections)

Q: what is the generic name for vicodin?
[...]
A: hydrocodone
Extra: hydromorphone = dilaudid
hydrocodone = vicodin
oxycodone = percocet
meperidine = demerol
1996 Purdue Pharma: oxycontin

Q: what is the generic name for percocet?
[...]
A: oxycodone
Extra: hydromorphone = dilaudid
hydrocodone = vicodin
oxycodone = percocet
meperidine = demerol
1996 Purdue Pharma: oxycontin

Q: what drug is the gold standard for tx of acute pain & palliative care?
[...]
A: morphine
Extra: side effects of opioid w/drawal: diarrhea, stomach pain, sweatiness, jitteriness, anxiety, diffuse aches, tachycardia, runny nose, etc.

Q: what is the diff btw addiction and dependence?
[...]
A: addiction is compulsive use and loss of ctrl of drug despite overt social or physical harm; dependence is physiological adaptation phenomenon
Extra: tolerance = decline in response to specified dose of drug over period of continuing use (e.g., desensitization and downregulation)

Q: what is iatrogenic addiction?
[...]
A: when doctors cause the addiction
Extra: doctor puts a patient on long term opioids, tolerance develops and leads to ever increasing doses, the patient becomes physically dependent, the doctor becomes skittish with the amount of drug being used and stops it cold turkey, and the patient is left drug sick with no way to source relief but to turn to friends or shady sources

Q: what does tertiary prevention focus on?
[...]
A: decreasing impacts rather than addressing the root cause (e.g., harm reduction)

Q: why is methadone (or OATs for that matter) effective in tx opioid dependency?
[...]
A: b/c of its long half-life
Extra: pt only needs to take it once daily
tx called Methadone Maintenance Therapy: NOT abtinence; designed to meet pt's dependency in controlled and affordable manner

Q: why is buprenorphine considered 1st line tx for opioid use disorder (and not methadone)?
[...]
A: b/c of its superior safety profile and low stigma
Extra: suboxone combines bup w/ naloxone, resulting in reduced risk of diversion

Q: why is withdrawal management not recommended?
[...]
A: b/c of its HUGE relapse rate (~61-89% of ppl relapse w/ this tx)

Q: define provisionally housed ppl
[...]
A: ppl who have accomodations w/ no prospect of permanence
Extra: e.g., detox centers, jail

Q: what 3 things does disability refer to?
1. [...]
2. [...]
3. [...]
A: impairments; activity limitations; participatory restrictions
Extra: impairments = problems in body fn or alterations in body structure
activity limitations = difficulties in executing activities
participatory restrictions = problems w/ involvement in any area of life

Q: from what does disability arise?
[...]
A: interaction btw ppl w/ health condition and their envir
Extra: a blend of medical and social factors; ppl w/ disability usually have worse health and DOH outcomes

Q: define capacity in terms of (dis)ability
[...]
A: what person can do in standardized envir; often clinical setting w/o barriers or facilitators of person's usual envir
Extra: performance = what person can do in their usual envir, w/ all barriers and facilitators in place

Q: define performance in terms of (dis)ability
[...]
A: what person can do in their usual envir, w/ all barriers and facilitators in place
Extra: capacity = what person can do in standardized envir; often clinical setting w/o barriers or facilitators of person's usual envir

Q: what are 4 methods to help ppl w/ disability and their support network?
[...]
A: console, relieve, heal, improve
Extra: CRHI
console: e.g., prenatal screening, selective abortion, institutionalization
relieve: decrease disabling barriers, including OTs and social workers to help
heal: e.g., cochlear implants, cardiac rehab
improve: pretty self-explanatory haha

Q: where does the most exposure occur globally in terms of particulate matter?
[...]
A: inside the home

Q: what are intermediate factors relating to SDH?
[...]
A: factors related to community infrastructure, systems, resources and capacities that influence proximal DOH

Q: what is structural competency?
[...]
A: ability to discern how medical problems rep downstream implications of upstream decisions
Extra: ex. of upstream decisions: health care, food delivery systems, zoning laws, urban and rural infrastructures, medicalization
1. recognize structures that shape clinical interactions
2. rearticulate cultural presentations in structural terms
3. develop an extra-clinical language of structure
4. observe and imagine structural intervention
5. develop structural humility

Q: what is enfranchisement?
[...]
A: to give full status to a person as the citizen of a country or member of a group

Q: what is the diff btw epistemic and systemic racism?
[...]
A: epistemic is about dominance of ideas whereas systemic is about racist economic, social, and political institutions

what are the 12 social determinants of health?
1. gender and sex
2. biology and genetic endowment
3. health services
4. income and social status
5. employment
6. education and literacy
7. social support networks
8. social environments
9. early childhood development
10. culture
11. physical environments
12. personal health practices and coping skills

Q: what will increased tx w/ effective prevention do to prevalence and incidence?
[...]
A: prevalence increases whereas incidence decreases

Q: why does prevalence NOT affect sensitivity or specificity?
[...]
A: b/c their null hypothesis already accounts for ppl who have the disease / don't

Q: what happens to PPV and NPV as prevalence increases?
[...]
A: PPV increases and NPV decreases
Extra: PPV = TP / (TP + FP)
NPV = TN / (TN + FN)

Q: what are the 3 factors contributing to disease in the epidemiologic triad?
1. [...]
2. [...]
3. [...]
A: agent / pathogen; host; environment

Q: what interventions can we do for the "host" factor of the epidemiological triad?
1. [...]
2. [...]
3. [...]
A: tx and isolate; immunize; prov good nutrition

Q: what can we improve for the "environment" factor of the epidemiological triad?
1. [...]
2. [...]
3. [...]
A: housing quality; sanitation and water; preventative services

what are the 10 steps of outbreak management?
1. confirm cases and det OB
2. institute immediate ctrl methods
3. establish OB mngmt team
4. det type of investigation
5. est case def
6. id and manage cases
7. describe data
8. dev and test hypothesis (src and transmission)
9. implement definitive host-agent-envir ctrl measures
10. communicate and evaluate

Q: what is an endemic?
[...]
A: pathogen consistently present but limited to a particular region (e.g., common flu)

Q: what is the diff btw an epidemic and a pandemic?
[...]
A: epidemic is OB in a large area (e.g., Western Canada) whereas pandemic is a global OB

Q: what are some immediate ctrl measures for OB?
1. [...]
2. [...]
3. [...]
4. vaccine
A: isolation / quarantine; contact tracing; education

Q: what is the diff btw a public health and envir measure in OBs?
[...]
A: public health are societal actions whereas environmental measures are physical changes to reduce risk of exposure (e.g., ventilation)

what are the 5 Cs to deal w/ vaccine hesitancy?
1. confidence
2. complacency
3. convenience
4. communication
5. context

Q: what does complacency mean in the 5 Cs of vaccine hesitancy?
[...]
A: perception of low risk and disease severity

Q: what are the 3 stages of containment / mitigation of pandemics?
1. [...]
2. [...]
3. [...]
A: full containment; targeted containment; full mitigation

Q: what is the goal of targeted containment?
[...]
A: prevent spread and break transmission b4 it affects vulnerable pops

Q: what does PPRR mean in the emergency response framework?
[...]
A: plan & prepare, response, recovery

Q: what are the primary risks associated w/ drug use?
1. [...]
2. [...]
3. [...]
A: route of admin (e.g., injections); OD; social consequences
Extra: harm reduction addresses route of admin and OD through outreach, education, housing-first programs, needle exchanges, safe smoke kits, wound care, supervised consumption sites, etc.

Q: what are disabling barriers?
[...]
A: physical limitations and negative attitudes
Extra: also financial barriers (e.g., paying for insulin)

Q: what does the social model of disability refer to?
[...]
A: how social and physical envir largely det how disabling an impairment is and if intervention needs to occur to reduce barriers

Q: what is the basic organization of the ecological model of health?
[...]
A: scaffolded factors that det the health of ppl

Q: what is the diff btw illness and sickness?
[...]
A: illness is person's xp of the disease whereas sickness are cultural conceptions
Extra: illness: subjective sense of feeling unwell (e.g., tired, malaise, discomfort)
sickness: socially and culturally held conceptions of health conditions which influence how the pt reacts (e.g., stigma of mental illness)

Q: what is the diff btw activity limitation and participation restrictions?
[...]
A: activity limitation = difficulty in executing the activity; participation restriction = problems w/ involvement in ANY area of life
Extra: impairment = problems in body fn or alterations in body structure

Q: what is the diff btw Aboriginal and First Nation?
[...]
A: Aboriginal = blanket term for FN, Inuit, and Metis ppl; First Nations replaced "Indian" (in 1970s)

Q: what are the 3 major pathways linking chronic disease and inequity?
1. [...]
2. [...]
3. [...]
A: neomaterialist pathway; psychosocial pathway; political / economic pathway
Extra: materialist: poverty and access to resources, employment, education (e.g., affording fruits)
psychosocial: social isolation, chronic stress
political / economic: gov't policies, societal structures

Q: what did Michael Marmot's Whitehall study conclude about a gradient in health outcomes amongst British civil servants?
[...]
A: there were improvements in health outcomes with an increase in social status, regardless of material wealth

Q: what metric does this graph show?
[...]
A: incidence rate (aka incidence density)
Extra: telltale label: person-years

Q: is prevalence of disability higher in men or women?
[...]
A: higher in women

Q: what was the gist of Geoffrey Rose's paper on “Sick Individuals and Sick Populations”?
[...]
A: prevention paradox AND high risk strategy vs popn approach

what are the 6 major public health fns?
1. health surveillance
2. disease and injury prevention
3. health promotion
4. health protection
5. health needs assessment
6. emergency and disaster management
Extra: health protection's aim is to eliminate, as far as possible, the risk of adverse consequences of health attributable to environmental hazards

Q: what are the actions for each term in the source-path-receiver framework?
1. source: [...]
2. path: [...]
3. receiver: [...]
A: modify, redesign, substitute, relocate; absorb, block, dilute; enclose, protect, relocate

Q: what 3 things affect exposure to adverse health effects?
[...]
A: dose, route, duration
Extra: age, comorbidities, and genetics increase susceptibility

draw Haddon's matrix

Header: what is the occluded term?

what are the major factors to ask for in an exposure hx?
1. community
2. home
3. hobbies
4. occupation
5. personal habits
6. diet
7. drugs
Extra: CH^2OPD^2

Q: what are the 3 factors in Klein's triad?
1. [...]
2. [...]
3. [...]
A: overest risk of condition to pt's health; overest absolute risk reduction of intervention; underest risk of tx

Q: what is the goal of primary prevention?
[...]
A: prevent occurrence of disease

Q: what is the goal of secondary prevention?
[...]
A: healting or slowing progression of a disease (current focus of clinical medicine)

Q: what is the goal of tertiary prevention?
[...]
A: preventing deterioration and maximizing QOL

Q: what are the 2 factors in the prevention paradox (Geoffrey Rose)?
1. [...]
2. [...]
A: large # of ppl exposed to small risk may generate more cases than small # of ppl exposed to large risk; a prev measure that brings large benefits to community offers little to each participating indiv

Q: what are the strengths of a population approach (Geoffrey Rose)?
1. [...]
2. [...]
A: radical change w/ small changes; behaviourally appropriate

draw the diff btw a pop approach and a high-risk strategy

Q: what type of prevention is harm reduction (i.e., primary, secondary, tertiary)?
[...]
A: tertiary

Q: what does Haddon's matrix allow us to do?
[...]
A: divide risk into different categories (based on event timing, host, agent, and envir)