2018 Test Flashcards
(352 cards)
1
Q
Describe a high risk approach to preventing disease
A
Focus is on interventions for people at the HIGHEST RISK of getting disease.
2
Q
5 major barriers that disabled people face in accessing services
A
(1) HEALTH
(2) INFORMATION
(3) TRANSPORT
(4) EDUCATION
(5) EMPLOYMENT
3
Q
Define ableism
A
Favouritism of species-typical abilities (i.e. normal is right, not normal is substandard)
4
Q
The relative risk of dying from breast cancer for women age 40-49 is reduced 15% with routine mammogram. Exaplain why this is bullshit.
A
This is an example of ECOLOGICAL FALLACY (aka applying population data on an individual level). Remember that the likelihood of dying from breast cancer in THAT AGE RANGE (40-49)is already fucking low so thhe absolute risk reduction on individual level is only 0.05% (from 0.32% to 0.27%). When you factor in the pain from mamagoram malifience is not there.```
5
Q
____% of the worlds population experiences some form of disability
A
15% which amounts to about 110-119 million people
6
Q
Describe the difference between dependence and addiction.
A
Dependence is the physical withdrawal symptoms accompanying the reduction in dose/drug use after continual use. While this can happen in addiction, addiction is the COMPULSIVE use and LOSS OF CONTROL of use in people despite overt social and physical harm. IT INVOLVES A SOCIAL COMPONENT.
7
Q
Describe the pattern of diabetes in indigenous populations
A
It is higher than the rest of Canada (10% vs 5%)
8
Q
Briefly outline the 7 calls to action regarding health from the truth and r3econcilliation commission
A
(1) acknowle3dge that current state of Aboriginal health is direct result of previous governmental policies
(2) establish measurable goals to close gaps in health
(3) address jurisdictional disputes & recognize the distinct health needs of Metiis, Inuit, and off-reserve aboriginal people
(4) sustainable funding for new aboriginal healing centres making Nunavut/NWT a priority
(5) recognize value of Aboriginal healing practice and use them in aboriginal pt to in collaboration w healers/elders as requested
(6) increase aboriginal professionals working in health care
(7) all nursing/medial schools take a course on dealing with aboriginal health issues
9
Q
Define lateral violence.
A
A range of damaging behaviours expressed by those in a minority oppressed group towards others of that group rather than towards the system of oppression. BEHAVIOUR TOWARDS PEERS.
10
Q
The aim of the physician is to sometimes heal, often relieve, and always console. Medical advancements including physiatry, OT/PT, social work, disability rights movement, technology/medicine/pharmacy, and accessibility culture falls under which heading.
A
RELIEVING. There has been a shift as doctors from CONSOLING to RELIEVING the burden of disease of disability.
11
Q
Disability disproportionately affects _______ populations. These include _____, _______, and _____ households.
A
Vulnerable, women, elderly, poor
12
Q
There is a critical window where the dose-dependent relationship of healthy childhood development and its influence on later risks in life including behaviour and mental/physical health is especially important. What is this time frame?
A
BIRTH-6 YEARS OF AGE
13
Q
Using drinking and driving as an example. Prevention method A uses ignition locks that require a breathalyzer to unlock your car. (1)which population will this affect (2) why is this not ideal (3) what would this method e classified as?
Prevention B wants to shift alcohol level down in all drivers through an educational program. (1) which population will this affect (2)why is this not ideal (3)what would this method be classified as?
A
PREVENTION METHOD A would be a classic example of HIGH RISK PRVENTION. You are targeting those with a history of drinking and driving (aka that high risk group that creates the greatest risk). HOWEVER some high risk individuals will always be missed (bc they haven’t been caught) AND you miss out on the entire moderate risk group that actually causes more cases of accidents.
PREVENTION METHOD B would be a classic example of POPULATION PREVENTION wherein you are trying to shift the entire risk left without a huge burden on the individual level. This would effect the entire population but is not ideal because you leave those at extreme risk unaffected [i.e. those extreme drunks/alcohols will not change their behaviour].
14
Q
The Indian Act was officially legislated in Canada in ______. Canadian Aboriginals received federal voting rights in _____. The federal government pays each First Nations person an annum of $____ according to historical negotiated treaties.
A
1976; 1960; $5.00
15
Q
Incidence is influenced by 3 things, and prevalence is influenced by 3 things, what are they?
A
Incidence: (1)variation in RISK i.e. rate (2) true incidence of disease (3) likelihood of fining/reporting it
Prevalence: (1) incidence i.e. rate being added to existing disease pool (2) death/cure rate (3) likelihood of finding/reporting it
16
Q
What is effect modification
A
A third variable positively or negatively effects the observed effect of a risk factor on an outcome.
17
Q
What directly contradicts the notion that disability is inevitable and acceptable variations of the human form.
A
Ableism or the idea that normal is right (i.e. favouritism of species-typical ability) and non normal is abnormal/abhorrent.
18
Q
DESCRIBE 10 HEALTH BURDENS TO HOMELESSNESS
A
(1) mortality (2) mental health approx 1/3 (3) substance abuse approx 1/2 (4) chronic conditions- because of delays in seeking care, poor adherence, lack of resources
(5) upper respiratory tract infection (6) unintentional injury (7)physical/sexual assault
(8) d3ecreasd access to healthcare (9)poor oral/dental hygiene (10) shelter specific concerns like overcrowding- which favours upper respiratory tract infection
19
Q
What are the leading causes of mortality in Canada’s Aboriginal Population
A
Injury/Poisoning
20
Q
Describe difference between gender and gender identity
A
Gender= attitudes, feelings, behaviours, expectations a culture characterizes as male, female, or others.
Gender identity= how you in your heart feel about yourself.
21
Q
What are 5 major ways to improve health outcomes of disabled people?
A
(1) legislation against discrimination
(2) income support
(3) financial support
(4) education/awareness mainly to remove negative attitudes
(5) see BEYOND disability when treating patients to see if there are other problems
22
Q
What are 4 major barriers to preventative/curative services to homeless people?
A
(1) societal barriers (2)racism/discrimination (3)lack of affordable/appropriate housing (4)individual mental/cognitive/behaviour
23
Q
____ mortality rate is used in large populations to compare health outcomes
____ mortality rate is used to compare neonate healthcare access
____ mortality rate is used to study women’s health
A
Infant [bc it’s a direct measure of child health and indirect of maternal health], neonatal, maternal
24
Q
What would be the difference in physician individual-level care vs. Public/population health?
A
The major difference is the level of treatment. At the physician level you are focused on individualized/personalized care vs. Pop/public health level where you are concerned with patterns of health/illness in GROUPS of people
25
Which province has the largest # of emergency beds (at 100 000)
Alberta
26
Use climate control to describe how the human tendency to modify living environments is both a cause and a cure for environmentally mediated disease.
We are attempting to IMPROVE CLIMATE CONTROL by using manmade landscapes and this has led to reduced health risks associated with extreme cold/heat. CONVERSELY we have now introduced problems with poor circulation/indoor pollution. In this sense, the manmade environ is both cause/cure.
27
What statistic is most commonly used to find cause/risk factors
RELATIVE RISK
28
Improvement of treatment WITHOUT A CURE OR EARLIER DETECTION will (increase/decrease) prevalence
Nothing more is leaving the barell (because have halted death rate BUT NOT CURED anyone) but you will still have same rate of INCIDENCE (b/c not earlier detection/prevention) therefore your PREVALENCE INCREASES.
29
Drug A causes mild liver damage.
Drug B causes no liver damage when taken alone.
When Drug A and B are taken simultaneously, there is increased or decreased liver damage as a result.
What is this an example of?
Effect modification- Drug B is the EFFECT MODIFIER because changing the effects of Drug A (exposure) on liver damage (outcome).
This is different than a confounder, because a confounder is INDEPENDENTLY ASSOCIATED WITH EACH.
30
Finish this sentence. Some have suggested that establishing a comprehensive _____ ______ _____ program in Canada would be the single best way of improving Canadian health outcomes.
Early childhood development
31
```
Approximately how many people in Canada are homeless.
(A) 150000-300000
(B) 1 mil- 1.5mil
(C) 50000-100000
(D)500000-750000
```
A, approximately 150 000 to 300 000 people are currently homeless in Canada
32
Formula for standard morbidity ratio
Total # observed death/ total # expected death. If expected SMR is 100 but you calculate a 110 SMR the death rate is 10% higher than expected.
33
Complete this chain of events in the neomaterial model of social determinants: economic process/political decisions —> ___________ —> neomaterial matrix of life —> health
Resources available to people + public infrastructure
34
Which feature most clearly differentiates opiod ADDICTION from opiod DEPENDENCE
(A)increasing frequency of use/daily dosage over time
(B) loss of control of use despite overt harm
(C) intolerable withdrawal symptoms
(D) intolerable physical side effects
(E) inability to stop using opiod at will
Opiod dependence is a physiologic process (can get drug sick/jonesing) where you use drugs solely to prevent withdrawal symptoms vs. Opiod addiction defined as the COMPULSIVE USE/LOSS OF CONTROL OF USE DESITE OVERT SOCIAL/PHYSICAL HARM (it adds a social component).
A would be be related to TOLERANCE [characterized by a decline in the response to specified dosed of drug over time bc of continued use] therefore have to up dose
C/D would fit into physical dependence
35
The societal collapse of the Soviet Union was predicted by an increase in mortality and outbreak of diphtheria before the collapse. What SDOH would this fall under?
Social environment (the policies/economy of Soviet Union influenced the breakout of disease and thus health outcomes).
36
Tolerance for error, low physical effort, proper size/space, equitable, perceptive, simple/intuitive, flexible are all principles of:
Universal design [or reducing barriers to disabled persons]
37
Define Sickness
Social/cultural conception of health conditions —> influences how a patient reacts
38
______ _____ are central to the definitional elements of complex trauma and affect a traumatized individuals’ relationship to her or his self and to others.
DISRUPTED ATTACHMENT
39
Define dependence
The physiological phenomenom related to adaptation to long-term drug use such that reduction in dose/drug results in withdrawal symptoms
40
Formula for Quality-Life Adjusted Years
Used to evaluate therapy = (average # of additional years gained from intervention) * (QOL in those years)
Ranging from 0-1 where 1 is healthy and 0 is not good QOL
41
WHAT HAPPENS WHEN OU SUPERIMPOSE risk curve with distribution of risk (2 things)
(1) see that MANY PEOPLE EXPOSED TO A SMALL RISK results in MORE CASES than few people exposed to a HIGH RISK
(2) PREVENTION PARADO: prevention measure that brings large benefit to community might offer little to each individual [shift curve approach instead to not cause burden to individaul]
42
Define capacity and performance
```
CAPACITY= what a person can do in a standardized environment (optimal conditions/often clinical setting) without barriers or facilitators of their usual environment
PERFORMANCE= what a person can do in their current/usual environment with all barriers/facilitators in place [aka their usual environment)
```
43
What are the 3 major ethical considerations in health prevention?
(1) beneficence and non-malificence
(2) patient autonomy
(3) equity
44
What is the difference between addiction and iatrogenic addiction.
While addiction is the loss of control & compulsive use of drugs despite social/physical harm, iatrogenic addiction is a SUBSET that is driven solely by the physician prescribing behaviour.
45
What is Simpson’s paradox
A type of ecological fallacy (where something learned @ population level does not apply to individual level). Basically, aggregate results from population data complete obscure data at the individual level (and the association observed in aggregate data is OPPOSITE of subgroups that comprise it).
46
Personal habits/coping skills are strongly influenced by 4 other SDOH. Which factors might this include.
Social, Environmental, Income, Culture would be the major ones influencing personal habits.
47
Define Wellness
Subjective experience of physical, mental, social, spiritual well-being allowing a person to achieve full potential
48
____ ______ is behaviour/gender expression that doesn’t match cultures masculine or feminine norms. __________ ______ is a term used by some who identify with unrestricted gender norms.
Gender nonconformity, gender queer
49
Define tolerance of a drug.
A decline in response to specified dose/drug over a period of continued use.
50
Although there is a huge variety of medications that can be abused, they all have ONE THING IN COMMON. What is it?
Abuse is the continued misuse of a drug despite overt negative health consequences. All medications the abuser must have made a RISK-BENEFIT analysis to justify continued misues. THE USER HAS TO GET SOMETHING OUT OF IT TO MAKE IT WORTHWHILE.
51
```
What is the leading cause of mortality in Canada’s indigenous population
A) external causes
B) cancer3
C) circulatory disease
d) respiratory disease
E)endocrine/immune
```
A) EXTERNAL CAUSES like self harm (5-6X higher in aboriginal youth), violence/trauma, accidents
52
Complete the sentence. Testing will ___ prevalence and ____ incidence as previously unknown cases are discovered. Prevention will ___ incidence. Effective treatment (that does not cure) will _____ prevalence in the case of fatal disease as disease duration is lengthened.
INCREASE, INCREASE. DECREASE. INCREASE.
53
Describe some individual level factors that may apply to homelessness
Could be anything but should be along this list: adverse childhood experiences, low educational attainment, lack of employment skills, family breakdown, mental illness, substance abuse, poverty
54
Define Illness
Subjective sense of feeling unwell (a persons experience of disease - can be experienced by cultural/social)
55
Define Disease
PATHOLOGICAL process (threshold) that may or may not produce symptoms resulting in pt illness (i.e. can HAVE DISEASE but not be ill)
56
in 2008 a 4 year $110 million national randomized control trial in Canada was conducted for what health initiative?
HOUSING FIRST- providing subsidized/secure housing to homeless populations because housing insecurity is one of the major causes of health inequity in Canada [barriers to healthcare etc]
57
Formula for Disability Adjusted Life Years
PYLL + PYLD = years lost + (weight)*(avg duration of disease)
58
(A) incidence and (b) prevalence will (increase/remain stable/decrease) with INCREASED TESTING ONLY
(A) increased (b) increased
Previously unknown cases are discovered increasing incidence BUT bc no death/cure rate are mentioned the “water tank” will also increase, increasing prevalence.
59
Formula for potential years of life disabled (PYLD)
=(average duration) * (weight) where weight reflects severity of disease ranging from 0 (perfect health) to death (1)
Can also be (average duration) * (weight) * (# of incident cases) when PREDICTING PYLD
60
What is the major problem with the medial model of disability?
If we think of disability solely as a health condition we UNDERESTIMATE our ability to correct factors that could be contributing to disability
61
What measurement uses person-years, person-days etc?
INCIDENCE DENSITY= number of new cases in @ risk pop over interval / PERSON-YEARS OF OBSERVATION*
62
Social environment incorporates 4 factors that are not under the control of a single individual. What are they.
(1) political (2) economic (3) familial (4) cultural
63
If a year following stroke is equivalent to 0.8 normal years and Bob/Bill are twins. Bot gets a stroke at 55 and dies 10 years later. Bill is healthy but is hit by a bus at 65 [therefore both twins have the same lifespa]. How many years did Bob actually lose in lifespan compared to Bill due to stroke?
(10years from intervention) * (0.8) = 8 YEARS compared to Bill’s 10 years. Therefore He lost an equivalent of 2 years from his stroke and his QALY was 2 years shorter than bills
64
The __ treaty areas of Alberta encompass ____ reserve and ____ First Nations
3; 140; 45
65
What would be the opposite of ableism?
To see disability as diversity, akin to gender, sexual orientation, or ethnicity . I.e. the idea that some disabilities are not species-typical or representative of normative function but they are INEVITABLE, AND ACCEPTABLE VARIATIONS OF THE HUMAN FORM.
66
Barriers exist in the physical and social environment and can be (1) (2) (3)
Structural, attitudinal, or financial
67
What would 1 DALY MEAN
1 lost year of healthy life (i.e. 1 year * 1 weight) = 1 death.
68
Describe the paradigm shift in disability
From a medical understanding towards social in the sense that disability arises from an interaction between people with a HEALTH CONDITION/IMPAIRMENT and their ENVIRONMENT. Basically disability is the experience of an impaired individual with their environment
69
The 2012 removal of OxyContin resulted in a balloon effect and the seismic shift in early 2000s to heroin/injectables. Fentanyl has increased recently and is (number-number)X more powerful than OxyContin, while cafentanil is (number)X more powerful.
Fentanyl is 50-80X more powerful than OxyContin.
| Cafentanil is 10000X more powerful than OxyContin.
70
What are the 2 approaches to preventing disease?
High risk and population
71
What is a crucial first step when trying to implement a prevention program?
Know the natural history/progression of disease
72
How is harm reduction an extension of tertirary care?
The goal of tertirary care isn’t to CURE but rather to PREVENT PHYSICAL DETERIORATION/MAXIMIZE QOL therefore harm reduction doesn’t focus on preventing use per se, but on minimizing harm.
73
Define environmental determinant of health
Modifiable factors in the PHYSICAL ENVIRONMENT that influence health and aren’t under voluntary control. Basically everything outside the body [EXTERNAL AGENT] that influences health/causes disease
74
Explain the effort reward imbalance model
High efforts [overcommitment which is a crucial aspect of this model] —> strain —> poor health & low rewards
75
An improvement in health outcomes with an increase in social status regardless of material wealth describes WHAT FAMOUS STUDY?
Whitehall study showing mortality/morbidity improvements are not equal across classes
76
What is the difference between the world health survey and the global burden of disease project? what is the similarity
Both strive to estimate the global burden of disease BUT WHS is just surveys (64% of the population) vs. GBD project which uses DALYS and categorizes them
77
What are the 3 main theoretical directions by current SOCIAL epidemiologists?
(1) PSYCHOSOCIAL: ppls perception/experience of personal status being unequal in society leads to poor health/stress
(2) NEOMATERIALIST: it’s perception of disease (like social production) AND STRUCTURAL CAUSES (policy/economy in health)
(3) ECOSOCIAL: sociology/biology inseparable- no aspect of biology can be understood divorced from knowledge of history of individuals’ societal way of living
78
Describe some health issues facing LGBTQ community
SO MANY. Could include things like violence/trauma, mental health issues, suicide, substance abuse, risk taking behaviour, lack of self care, higher tranmission of STI, less access to health services (due to discrimination and lower income status), missing gender specific needs [a trans man still needs to be screened for cervical cancer, an a trans woman still needs a prostate exam] etc.
79
A _________ is independently associated with an exposure and outcome
Confounded
80
Trauma and noise would fall under what type of environmental exposure
PHYSICAL
81
Fill in the blanks. An individuals _____ orientation does not determine their behaviour. Choice of sexual rather or identification of _____ orientation says nothing about an individuals sexual ______.
Sexual, sexual, behaviour
82
How does iatrogenic addiction occur?
Doc puts pt on long term opiod use —> tolerance leads to increasing dose —> pt becomes dependent —> doc skittish about amount prescribing and stops pt cold turkey —> pt is left w withdrawal symptoms —> has to relieve symptoms by turning to shady sources.
83
What are the 6 major historical determinants of health for Aboriginals?
(1) COLONIALISM
(2) ASSIMILATION (including residential schools)
(3) ECONOMIC CHANGE (shift then eventually poverty)
(4) ALCOHOL INTRODUCTION
(5) EPIDEMICS
(6) RACISM
84
Children with _____ impariements generally fare better than those with _____ or _____ impairments.
Physical, sensory, intellectual
85
Internal phobias, or the internationalization of society’s negative perceptions can turn into 4 major health consequences:
(1) substance abuse (2) poor mental health/suicide (3) lack of self care (4) risk taking behaviour
86
Infectious disease carried through food/water/insect/animal would fall under what TYPE of environmental exposure?
BIOLOGICAL
87
Dif between point and period prevalence
```
POINT= (all existing cases)/ (population size NOW) aka at a specific time
PERIOD= (all existing cases over an interval) / (pop @ mIDPOINT of interval) aka during specific interval
```
88
The six major effects of complex post-traumatic stress are
(1) disregulation of emotion/impulses
(2) changes in attention/consciousness
(3) altered self-perception
(4) altered relationships with others
(5) somatization (physical pain)
(6) alterations in systems of meaning (hopelessness)
89
There are 3 types of adverse childhood experiences that tend to cluster, what are they?
(1) Abuse (2) Neglect (3) Household dysfunction
90
Describe some community or society level factors contributing to homelessness.
Could be anything including LACK OF AFFORABLE HOUSING, labor market conditions, income inequity, and racism/discrimination
91
The compulsive use and loss of control of a drug despite overt SOCIAL or PHYSICAL harm is known as _____
Addiction
92
What is the social prejudice that views normal as right and not normal as “abnormal, abhorrent, or wrong”
Ableism
93
Formula for (a) infant mortality rate (b) neonatal mortality rate (c) maternal mortality rate
(A) deaths in children <1 / live births in same year
(B) deaths in children <28 d / live births in same year
(C) death during pregancy or childbirth / live births in same year
94
What was housing first based off of? I.e. how is it “evidence based”
Pathways to Housing in NYC that worked
95
Define disability
Not part of the health condition, or an impairment itself, but the interaction bw individual WITH impairment + his/her environment
96
The distribution of risk is usually
Bell curved
97
Describe difference between endemic, epidemic, pandemic
```
ENDEMIC= disease that exists permanent in particular region
EPIDEMIC= outbreak of disease attacking many ppl @ same time through dif communities
PANDEMIC= epidemic spreads globally
```
98
If life expectancy is 75 years and someone dies from myocardial infarction at age 55 what is there PYLL?
20 PYLL
99
What is Klein triad
When treating a risk factor in a pt
(1) overestimate the actual risk to the pt
(2) overestimate the absolute risk REDUCTION that intervention will have
(3) underestimate risk that INTERVENTION carries itself
100
________ is the proper way of consuming a pharmacologic agent. ____ is using a drug for purposes other than what it was prescribed for. _____ is continued misuse of medication despite overt negative health consequences. The user has to be _____ _____ out of it in order to make it worthwhile.
Use, Misuse, Abuse, Getting something
101
What fraction of the homeless population has a mental illness or substance abuse?
1/3 of the population have a mental illness, 1/2 experience substance abuse
102
Describe the difference between health inequity/health inequality
HEALTH INEQUALITY= difference in health status/distribution of health determinants between population groups
HEALTH INEQUITY: health differences that are AVOIDABLE, UNECESSARY, AND UNJUST and can be fixed
103
A strategy focused on not removing the underlying cause but on LESSING ITS IMPACT/COMPLICATIONS for patients.
Harm Reduction
104
LGBTQ stands for
Lesbian, Gay, Bisexual, Trans, Queer/Questioning
105
The aim of the physician is to sometimes heal, often relieve, and always console. Where does prenatal screening, selective abortion, institutionalization of children in group homes, and disabled adults in care centres fall.
CONSOLE
106
____% of registered First Nations live on-reserve and crown land. There are _____ reserves as of 2018.
61%; 140 reserves
107
Use the worst case of mass poisoning (in Bangladesh) to describe how the human tendency to modify living environments is both a cause and a cure for environmentally mediated disease.
Put arsenic in ground water to SUCCESSFUL reduced diarrheal disease in children, however this conversely exposure millions of Bangladeshis to carcinogenic levels of arsenic.
108
____ is an inequality that is unjust. It is due to modifiable correctable causes
INEQUITY
109
Define health protection, promotion, and prevention
HEALTH PROTECTION: aims to protect population from hazards
HEALTH PROMOTION: aims for population to live AS HEALTHY AS POSSIBLE
HEALTH PREVENTION: aims to prevent progression of specific disease [via DALYS]
110
5 mortality formulas, what are they?
(1) CRUDE= (deaths in year)/(mid point population) OR (deaths during specified period) / (population specified)
(2) neonate= (deaths < 28d) / (live births in same year)
(3) infant= (deaths <1 yr) / (live births in same year)
(4) maternal = (deaths during pregnancy/childbirth) / (live births in same year)
(5) case= (deaths due to specific DISEASE) / (cases of that disease)
111
Define the general term queer
It is an identity label in DEFIANCE of gender/sexual restrictions and is a general term for people whose sexual orientation doesn’t correspond to societal norms.
112
Using childhood obesity give an example of public vs. Population health initiatives.
Could be anything. Basically the distinction that needs to be made is the public health is an organized effort of society to keep people healthy/prevent injury, illness and premature death VS. Population health which is addressing underlying determinants (broader) and linking disciplines from biological —> social to foster health.
Ex. Public health: subsidize healthy lunch programs, ban soft drinks from schools, promote physical activity. Population health: URBAN FOOD DESERTs- do sig parts of population lack access to a grocery store? Or tackling the food system itself [agricultural system].
113
```
The dread of cancer or stigma of mental illness would fall under:
(A) sickness
(B) illness
(C) disease
(D) health
```
Sickness- the social/cultural conceptions of health conditions which influence how a patient will react
114
Describe the difference between the social selection and causation perspectives.
Social selection: health influences social mobility/SES position
Social causation: social position determines health through intermediate factors
115
Housing should cost < ___% of your total income before tax
30
116
______ ____ is defined as a recovery-oriented approach to ______ that involves moving people into independent and permanent housing as quickly as possible, with no preconditions, and then providing them with additional services/supports as needed.
Housing First; homelessness
117
Define the term abuse
Ongoing MISUES of a medication DESPITE OVER NEGATIVE HEALTH COSNEQUENCES.
118
The following would be examples of what type of ethic consideration:
(A) the fact that prevention programs like cardiac rehab often don’t target the population most affected (like homeless/heart disease)
(B) Disease Screening may make healthy patients worse
(C) doctors can coerce patients into getting unnecessary screening/testing
(A) EQUITY - vulnerable populations most at risk of disease often worse served by preventative programs
(B) MALIFIENCE
(C) AUTONOMY - coercive power of doctors can make healthy people believe they are sick
119
Of the 6 historical determinants in aboriginal culture (colonialism, epidemic, alcohol, racism, assimilation, economic change) this can lead to a historical trauma response (psychological, social, or physical). Give an example of each.
This could be many things (examples shown below):
(1) PSYCHOLOGICAL: PTSD, depression, anxiety/stress
(2) pHYSICAL: nutritional stress and compromised immune system
(3) SOCIAL: domestic violence, childhood abuse/maltreatment, substance abuse, suicide, unemployment poverty
120
A patient becoming physically dependent due to physician prescribing pattern describes:
Iatrogenic addiction
121
There are 2 major theories as to why opiods fit so perfectly into human opiod receptors, what are they/
THEORY 1: We developed a symbiotic coevolution with opiods OR
THEORY 2: opiod poppies actually SHAPED the development of human conciousness/evolution
122
What is the most important measurement of burden of disease and why?
DALY. Daly’s (PYLL + PYLD) allow you to envision how disability negatively impacts health [as compared to crude mortality rates]. Something like depression could be low on mortality lists BUT VERY HIGH on DALY’s [bc of the disability attributed to the disease].
123
Describe 6 disease outcomes that differ bw men/women.
Could be anything. Some examples include women are more at risk of (1) domestic violence (2) maternal mortality (3) social status (4) chronic pain (5) breast/ovarian cancer
Vs.
Men more at risk of (1) interpersonal violence (2) aggression (3) smoking/alcohol (4) occupational hazards
124
Ongoing misuse of a medication despite overt negative health consequences is
ABUSE
125
What are the THREE STANDARDS that acceptable housing must meet
(1)adequate- no major repairs (2) affordable (<30% of income before tax) (3)suitable (bedrooms/size)
126
There are many spectrums of gender, identity, sex etc.
Woman, Genderqueer, Men are examples of ____
Feline, androgynous, masculine are examples of _____
Female, intersex, male are examples of _____
Heterosexual, bisexual, homosexual are examples of ____
GENDER IDENTITY
GENDER EXPRESSION
BIOLOGICAL SEX
SEXUAL ORIENTATION
127
What are the 5 major values of harm reduction?
(1) universality/interdependence of human rights [ppl using drugs don’t forfeit human rights]
(2) evidence [in public health]
(3) focus on harms
(4) pragmatism [knowing some use of mind-altering substances is inevitable and some level of drug use is normal]
(5) dignity/autonomy [community integration OVER social isolation]
128
An increased death rate will (increase/decrease) prevalence
DECREASE (water leaving barrel @ faster rate than is entering it)
129
Describe how the legislation of Purdue Pharma/ OxyContin was a balloon effect.
The balloon effect is a phenomenom when trying to intervene in one part of a market (in this case drugs) makes things worse. Basically, the legislation against OxyContin/Purdue Pharma saw an EXPLOSION/SEISMIC SHIFT of heroine/injectables in working class white people on the market [had to get pain killers somewhere].
130
_____ insecurity is one of the major causes of health inequity in Canada
Housing
131
The rates of suicide in Aboriginal youth are HIGHLY REDUED BY
THE ESTABLISHMENT OF SELF-GOVERNMENT
132
In Aboriginal populations what is the MAJOR FACTOR contributing to early death?
ADVERSE CHILDHOOD EXPERIENCE [ABUSE, NEGLECT, HOUSEHOLD DYSFUNCTION]
133
The medical officers of health oversee health _______ via infrastructure and regulation with the goal to _____________________.
The Health Education/Ottawa Charter oversees health _______ via individual and community level interventions with the goal to________.
___________ aims to prevent progression of a specific disease.
PROTECTION, PROTECT POPULATION FROM HAZARDS
PROMOTION, HAVE POP LIVE AS HEALTHY AS POSSIBLE
HEALTH PRVENTION.
134
Why is work/income so important in a disabled population?
While they don’t necessarily drive poverty/disability, having an income allows disabled people to modify their environment and overcome societal/environmental barriers
135
Why does tolerance happen?
Thought to be RECEPTOR DESENSITIZTATION/DOWNREGULATION
136
Fill in the blanks for mortality:
In a large stable population, the mid to end year mortality rate will be _______.
In a small population with a lot of flux in deaths the _____ of the crude mortality rate will be affected.
In a small population with few deaths the ____ of the crude mortality rate will be affected.
Stable, denominator [aka the population specified/mid year population will be affected bc the pop might change drastically], numerator [if you have a small pop with few deaths ANY DEATH WILL CHANGE THE NUMERATOR DRASTICALLY but have limited effect on denominator].
Remember crude mortality rate= (Deaths in year)/ (mid year population) OR (deaths during specified period)/ (population specified)*10n
137
The physician historically _______ disabled patients, but now with the advent of rehabilitation, pharmacy, disability rights this shift is now to _____.
CONSOLED, RELIEF
138
The goal of ______ therapy is to provide opiods to meet a patients DEPENDENCY but in a controlled/affordable manner without significant highs or withdrawal symptoms.
Methadone
139
Which statistic is used to estimate frequency with which disease is occurring or avg time delays between cases
INCIDENCE DENSITY/RATE. Ex. Ebola the mortality rate was fairly role (1000 deaths/ 2 mill = deaths/ pop specified) BUT .... those deaths occurred in 1800 cases of Ebola for a CASE FATALITY RATE (1000/1800) > 50%
140
______ ____ are structural/individual conditions that may lead to loss of current stable housing, _____ ____ are those who maintain housing but at a significant burden to other basic needs
Imminent risk; precariously housed
141
Define health
Extent to which an individual or group are able to realize aspirations/satisfy needs & change/cope with the environment
Health incorporates physical, mental, social well being
142
EVEN AFTER PHYSICAL BARRIERS HAVE BEEN REMOVED ____ _____ CAN PRODUCE BARRIERS IN ALL DOMAINS (Health, information, education, transport, and employment)
Negative Attitudes
143
Define the term prescription drug use.
The consumption of a pharmacological agent in the manner in which it was prescribed by the person who prescribed it. I.E. THE PROPER WAY TO COSUME THE AGENT.
144
______ is a disability category resulting in problems with any involvement in any area of life
Participation restriction
145
Finish this sentence.
The WHO estimates that ___ % of total burden of disease in canada and ___ % worldwide is attributed to risk factors associated with the PHYSICAL ENVIRONMENT. In Alberta alone occupational hazards account for $__ million dollars in economic burden.
13, 25, 80
146
What is the major goal of methadone therapy?
It is a harm reduction strategy where the main goal is to provide opiod need to meet a pts dependency in a controlled/affordable manner WITHOUT significant highs or withdrawal symptoms.
147
Death of a neonate is usually due to __________ compared to death of older children which is mainly affected by _____ and _____ conditions
Access to healthcare, environmental, social
148
The success of Purdue Pharma in bringing the slow release pill OxyContin to market, is mainly attributed to what.
Purdue pharma targeted DOCTORS using geographic data to identify those doctors with the highest prescribing patterns of OxyContin and heavily marketing these doctors.
149
Social capital/cohesion together are factors of the community social network that enable individuals to work together to address social/economic issue s and improve wellbeing and health. Describe the difference between social capital/cohesion.
SOCIAL CAPITAL= features of social life (like network, norms, trust) that allow a group to work together
SOCIAL COHESION = the actual QUALITY of social relationships [i.e. strong ties]
150
Describe the three stages of prevention.
(1) PRIMARY: PREVENTS OCCURENCE OF DISEASE
(2) SECONDARY: SLOW PROGRESSION OF DISEASE
(3) TERTIRARY: PREVENT DETERIORATION/MAXIMIZE QUALITY OF LIFE
151
An enduring pattern of emotional, romantic, and/or sexual attractions that result in persons sense of identity being BASED on those attractions and resulting behaviours, and membership in a community of others who share like-mindedness is ________
AFFILIATIVE ORIENTATION
152
The theory that links the relationship between the perception of social inequality, psychobiological mechanisms, and health status is
PSYCHOSOCIAL. People’s experience/perception of status leads to feelings of shame —> chronic stress & disintegration of social ties —> poor health
153
(A) incidence and (b) prevalence will (increase/remain stable/decrease) with INCREASED PREVENTION ONLY
(A) Decreased (b) stable
Because you are preventing new cases without changing any new variables (for incidence) and prevalence will stay stable bc not adding to water basin, but not taking away from it either
154
Men seeking viagra to achieve better erections, and women eliminating unecessary menstrual cycles with the use of IUD/ low dose OCs would be an example of what type of medicine?
Enhancement medicine or the idea that there has been a shift from an ableist way of healing (i.e. restoration of normative function) to IMPROVING.
155
Group X has characteristic Y
Person 1 is in Group X
Therefore Person 1 has characteristic Y.
This is an example of:
Ecological Fallacy
156
In 2007 the Canadian National Drug Strategy excluded WHAT from its policy?
Harm reduction- focus on (1) prevention (2) treatment (3)enforcement as part of the “war on drugs”
157
Is smoking an environmental determinant of health?
No- smoking is a VOLUNTARY action & environmental determinants of health are modifiable factors in the physical environment that AREN’T under voluntary control. Therefore SECOND HAND SMOKING would be (bc involuntary) but smoking would not.
158
Why is tapering off methadone easier that other opiods ? (2)
(1) LONG HALF LIFE means less administration and pt is kept in functional state
(2) FLEXIBLE DOSING PERIOD directly related to long half life.
159
Describe the difference between cis and transgender
CISGENDER: individuals GENDER IDENTITY is in harmony with assigned biological sex
TRANSENDER: individuals GENDER IDENTITY does not match assigned biological sex
160
Describe the difference between (1) unsheltered (2) emergency sheltered (3) provisionally sheltered
Unsheltered are people living in private/public spaces without consent or contract, or people living in spaces not intended for permanent habitation.
Emergency sheltered are those staying in homeless/specialized centres
Provisionally housed are people who have accommodations that offer no prospect of permanence (such as couch surfers, interim housing for homeless)
161
Explain the population approach to preventing disease.
When you look at a risk curve superimposed with a risk distribution we see that a large group of ppl exposed to a small risk actually have MORE CASES than the small group of ppl exposed to a high risk. When we look at the population approach the aim is to DECREASE PREVALENCE OF DISEASE AND SHIFT DISTRIBUTION TO THE LEFT [without causing burden to the individual].
162
Describe the difference between incidence/prevalence
Incidence is measures of NEW EVENTS among ppl AT RISK vs. Prevalence which is measure of DISEASE PRESENCE
163
What are 2 opiod agonists used in harm reduction?
Methadone is the main one, but buprenorphine (a partial opiod agonist) is also used (usually in combination with naloxone).
164
What are 3 reasons that cumulative incidence is not as good a measure as incidence density?
Cumulative incidence= (number of new cases)/ (pop @ risk @ start of interval).
(1) BIASED DOWNWARD bc we can lose ppl to follow-up which would reduce the numerator, while the denominator would stay the same- DOESN’T TAKE INTO ACCOUNT PPL MOVING IN/OUT OF A POPULATION
(2) inflation of denominator by those that don’t die
(3) recurrence
165
Rates of death due to ________ ______ are over 2.5 times higher in First Nations compared to non-first nations
UNINTENTIONAL INJURY
166
Aboriginal people’s life expectancy is _____ years _____ than the general population
10 YEARS LESS
167
3 types of misuse, what are they?
(1) using drugs for purposes other than they were prescribed for
(2) by someone other than the pt for whom they were prescribed
(3) using any other meds Wo knowledge or involvement of physician/pharmacist prescribing/dispensing them.
168
Formulas for incidence density/rate vs. Cumulative incidence
Incidence density/rate= (number of NEW cases in pop @ risk)/ (person-years) OR (number of NEW cases)/ (time of observation)
Cumulative incidence: (# of NEW cases in pop @ risk) / (number of ppl @ risk @ START of interval)
169
________ is the decline in response to a specified dose of drug/drug over a period of continuing drug use. Classically thought to be due to receptor ______ or _____. It can result in ____ dependence which is the physiologic process of withdrawal. Addiction is the ______ use and ____ of ____ of drug use despite overt ____ and ____ harm.
Dependence, desensitization, downregulation, physical, compulsive, loss of control, social, physical
170
Needle exchange sites, methadone maitenance, safe injection sites, naloxone distribution, abscess management, and wound care services are all examples of
Harm Reduction
171
What are the 12 social determinants of health?
```
CULTURE
HEALTH SERVICES
EDUCATION/LITERACY
WORK/EMPLOYMENT
INCOME/WAGE
SOCIAL SUPPORT NETWORKS
GENDER
```
```
BIOLOGY
SOCIAL ENVIRONMENT
PHYSICAL ENVIRONMENT
HEALTHY CHILD DEVELOPMENT
PERSONAL HABITS
```
172
Difference between ABSOLUTE RISK, RELATIVE RISK, AND ATTRIBUTABLE RISK using 2X2 table
EXPOSURE/EVENT
A B
C D
ABSOLUTE RISK= (a)/(a+b) or (c)/(c+d)aka the number of events in a group
RELATIVE RISK= (incidence of disease in those exposed) / (incidence of disease in those unexposed) aka [(a)/(a+b)]/[(c)/(c+d)] BASICALLY ABSOLUTE RISK OF THOSE EXPOSED/ ABSOLUTE RISK OF THOSE UNEXPOSED
ATTRIBUTABLE RISK = difference in rate of a condition bw exposed and unepxposed populations BASICALLY ABSOLUTE RISK EXPOSED-ABSOLUTE RISK NOT EXPOSED to give you the proportion of total risk attributable to exposure. [(a)/(a+b)]-[(c)/(c+d)]
173
Health prevention works best when both high risk & population approaches are used together. Describe 1 strength/weakness of each.
Could be anything.
HIGH RISK PREVENTION (+) individual specific, doesn’t interfere with low risk people, cost-effective
HIGH RISK PREVENTION (-) some high risk individuals missed, no intervention for moderate risk people, contribution to overall control of disease may be small
POPULATION (+) offers radical change and high return on investment bc SHIFT LEFT, small change can have powerful impact on disease, INVISIBLE TO INDIVIDUAL [no burden]
POPULATION (-) leave those at extreme risk unaffected, life becomes MEDICALIZED, often partisan
174
5 major things to fear if you do not fit in to societal expectations of gender/sexual orientation.
(1) external phobia- based on “non normativitiy” leading to discrimination
(2) internal phobia based on society’s negative perceptions of you
(3) heteronormativity - or favouring of cis gender individuals & heterosexual orientation
(4) coming out (the stress of accepting ones own non-heteronormative sexual orientation or gender identity)
(5) stereotype (+, neutral, -)
175
Define syndrome
This is a pattern that eludes biological understanding. A complex of symptoms that occurs together more often that they would be expected by chance alone.
176
What is the Jordan’s Principle:
(A) protects FN right of first placement, keeping more children apprehended by chid welfare within their own communities
(B) outlines FN sovereignty over provision of care to FN children, promoting culturally safe education, health, early childhood, recreation, and cultural/language services
(C) mobilizes emergency mental health services for communities declaring states of emergency, equalizing suicide prevention resources
(D) ensures FN children can acces all public services when they need them, overcoming payment disputes betwen levels of government
D****
177
Radon & manmade (cellphones) would fall under what TYPE of environmental exposure
RADIATION
178
What are the 4 characteristics of a confounder?
(1) Associated with exposure
(2) Associated with outcome
(3) Not in causal pathway from exposure to outcome
(4) Distribued unevenly between exposure and outcome
179
Give an example of an environmental exposure that falls within geographic balls [i.e. distributed more evently within a community at a local level].
What would be a point source of environmental exposure?
Watersheds or airsheds.
| Point source= air or water contamination
180
____ is the physiological phenomenom related to long-term continued drug use such that reduction in dose/drug will lead to withdrawal symptoms.
DEPENDENCE
181
What is the different between indirect standardization/direct?
```
Indirect= applying standard rate to observed population (calculated the SMR aka standard morbidity ratio)
Direct= applying observed population to standard rate
```
182
2 international efforts to estimate the global burden of disability
World Health Survey and Global Burden of Disease Project
183
Maternal Mortality rates globally would be an example of heath ________.
Inequity- this is a key indicator of health inequity that shows the wide gaps between rich and born both within and between countries, and is preventable
184
The first residential school in canada opened in 1831 in ______, Ontario, and the last one (in Saskatchewan) closed in ____.
Brantford, 1996
185
What is the formula for crude mortality rate
Can either be:
(Deaths in year/ MIDYEAR population) OR
(Deaths during specified period/ population specified) * 10n
186
3 things determine if an exposure is an environmental determinant
(1) TYPE OF EXPOSURE
(2) ROUTE OF IMPACT
(3) LOCATION/LEVEL OF EXPOSURE
187
What is iatrogenic addiction?
Where a previously healthy individual is driven to using street drugs by none other than the prescribing pattern behaviour of the physician.
188
Admissions at UC Berkeley showed that men applying were more likely than women to be admitted and this difference was so large it was unlikely to do with chance. BUT when examining the individual departments it appeared that 6/85 departments were significantly biased against men, whereas only 4 were biased against women. The conclusion was that women tended to apply to competitive departments with low rates of admission even among qualified applicants, whereas men tended to apply to less-competitive departments with high rates of admission. What is this an example of?
This is a type of ecological fallacy [applying aggregate data to the individual, in this case saying men are more likely to be admitted than an individual woman because the aggregate data shows more men are admitted]. SPECFICIALLY this is an exmample of SIMPSON’S PARADOX where the aggregate results [here showing men are more likely to be admitted than women] is actually completely opposite of the subgroups that comprise it [here showing that more departments were actually biased towards women].
189
Outline the 4 steps to calculate the standard morbidity ratio for INDIRECT STANDARDIZATION (or apply a standard population to an observed population).
(1) find expected rate in standard population [# exposed/ standard population]
(2) apply expected rate to the population of interest for each strata [expected rate * pop of interest stratified]
(3) add totals [sum of observed exposure for each strata], [sum of expected exposure for each statra]
(4) TOTAL STANDARD MORBIDITY RATIO= [observed/expected for population of interest] / [observed/expected for comparator group]
190
Fill in the blanks. ____ standardization is applying a standard population to the observed population. ____ standardization is applying an observed population to a standard population.
Indirect, Direct
191
Define what pansexual and asexual are. They fall under types of _____ _____.
```
Pansexual= romantic/sexual attraction to people REGARDLESS of sex/gender
asexual= not romantically/sexually attracted to people.
```
These would fall under SEXUAL ORIENTATION.
192
Early use of DMARDS for RA would be an example of which level of prvention?
SECONDARY. Would not be primary bc that is preventing occurence and RA has already occurred. Tertirary is into palliative care/QOL and this is EARLY USE of drug so can’t be too bad. Secondary prevention means delaying the progression of disease, just like above example.
193
Define the term misuse
Using drugs for purposes OTHER than that for which they were prescribed or by someone other than the pt they were prescribed for
194
Define the physical environment SDOH.
All external physical factors that influence health and aren’t under voluntary control.
195
_____ _____ is a strategy for drug use that doedsn’t focus on preventing use but on minimizing sequelae.
Harm Reduction
196
What are the 5 P’s when discussing sexual health, substance use, and transmitted disease?
(1) PRACTICES - sexual BEHAVIOUR not orientation
(2) PARTNERS
(3) PROTECTION
(4) PAST HISTORY of STIS
(5) PREGNANCY
197
Define gender expression.
How you demonstrate your gender (based on traditional gender roles) through the way you act, think, behave
198
The aim of the physician is to sometimes heal, often relieve, and always console. Where would cardiac rehab programs and cochlear implants fall.
Heal. We now see some cardiac rehab programs improve capacity in pts who a generation ago would have been cardiac cripples, or seen how cochlear implants can “cure” deafness.
199
SECONDARY PREVENTION involves 2 things:
Screening and early treatment
200
WHAT IS MORE IMPORTANT CLINICALLY - SEXUAL BEHAVIOUR OR SEXUAL ORENTATION AND WHY?
SEXUAL BEHAVIORU IS MORE IMPORTANT- we as clinicians need to know who you are sleeping with because it changes the risk [i.e. penetrative anal>vaginal>nonpenetrative] but we should not care what your sexual orientation is. By asking that, it can be misleading as well- i.e. ask what sexual orientation and a female tells you she is heterosexual BUT you don’t realize that sometimes she has sex with women. If you asked her what her sexual behaviour was like she may tell you she’s had sex with a woman.
201
Define harm reduction
A strategy used that doesn’t remove underlying casue but on lessening it’s impact and complications for patients.
202
Healing and stress-coping involve (1) interdependence/_______ (2)transcendence/_________ (3)facilitation of aboriginal cultural identity/_______ (4)self control and determination/ _______ (5) role of leisure as a means of self-coping
Connectedness; spirituality; enculturation; expression
203
A major focus of disability should be closing the gap between _____ and ______ with a focus on removing or reducing disabiling barriers in the physical and social environment.
CLOSING THE GAP BETWEEN CAPACITY (optimal conditions) AND PERFORMANCE (usual conditions)
204
How is self-continuity a hedge against suicidal behaviour?
FN communities vary dramatically in rates of youth suicide and these differences are strongly associated with degree to which different bands are ENGAGED IN COMMUNITY PRACTICES THAT WORK TO HELP PRESERVE/RESTORE (aka self government)
205
What should the denominator of the SMR be?
1
206
What are the 7 principles of universal design in overcoming barriers in disability
(1) equitable use
(2) flexibility in use
(3) simple/intuitive use
(4) perceptive information
(5) tolerance for error
(6) low physical effort
(7) appropriate size/space
207
What is the underlying philosophy of housing first?
The belief that all people deserve housing and anyone van be supported into housing directly from homelessness. It prioritized housing as the first and most primary need to address for people experiencing homelessness and is based on the idea that homeless is a major health inequity in Canada.
208
For aboriginals, within 3 years the _______ _____ brought more destruction to the plains natives than a hundred years of tribal warfare.
WHISKEY TRADE
209
_____ is attitudes, feelings, behaviours, and expectations a culture characterizes as male, female, or other. ____ ___ are cultural expectations/restrictions placed on individuals perceived as male or female.
Gender; gender role
210
Describe the shift in the focus of physicians on disability.
Historically, physicians main focus in disability was CONSOLATION. However with the advent of pharmacy, rehabilitation, and disability rights there is a focus to RELIEF.
211
The rate of disability in aboriginal people in Canada is (number)times the amount of the general population. The general population 15% experience disability compared to ____% in aboriginal populations.
2 times as high in aboriginal populations for estimated 30%
212
Why is methadone therapy and example of harm reduction?
Methadone has a long half life which makes it ideal to treat opiod dependency because it can be an ongoing stable dose taken once daily to maintain a dependent pt in a functional state free of withdrawal/craving for a prolonged period.
213
_______ is a harm reduction strategy that allows users a continued use of drug without the loss of function and withdrawal/cravings.
Methadone therapy
214
First Nations people reporting drinking ___ and ____ more as compared to the general Canadian population. However aboriginal drinkers reported ______ frequent use (5/more drinks/episode) more often than non-aboriginal drinkers (16 vs 9%).
LESS; ABSTAINIG; HEAVY
215
Men score better on math than women.
Jerry is a man.
Therefore, Jerry is better at math than Sylvia, who is a woman.
This is an example of
Ecological Fallacy
216
Defined precariously housed
Those who are managing to maintain their homes but at the cost of other basic needs
217
Match the following terms:
Genderqueer, Gender Identity, Transgender, Gender Expression, Sexual Orientation, Sexual behaviour
With:
(A) Who you are physically, spiritually and emotionally attracted to based on their sex/gender in relation to your own
(B) Individuals whose gender identity as M/F doesn’t match with their biological sex
(C) How you, in your head, think about yourself
(D) MSM and WSW
(E) Someone who is unrestricted/deconstructed from gender norms
(F) how you demonstrate your gender (based on traditional gender roles) by the way you dress, act, behave, interact
```
A) SEXUAL ORIENTATION
B) TRANSGENDER
C) GENDER IDENTITY
D) SEXUAL BEHAVIOUR
E) GENDERQUEER
F) GENDER EXPRESSION
```
218
Morphine is mainly used for (2 things) while opioids are mainly used for (1 thing)
Morphine is mainly used for ACUTE PAIN/PALLIATIVE CARE
| Opiods are mostly used for CHRONIC NON-MALIGNANT PAIN
219
6 key points from WHO on disability what are they
(1) PARADIGM SHIFT (MEDICAL —> SOCIAL INTERACTION)
(2) PREVALENCE IS IGH AND GROWING
(3) DISPROPORTIONATELY AFFECTS VULNERABLE POPULATIONS
(4) DIVERSE
(5) WIDESPREAD BARRIERS TO ACCESSING SERVICES
(6) WORSE HEALTH/SES OUTCOMES
220
Explain in 5 steps how adverse childhood experiences can contribute to early death in the aboriginal population.
(1) Adverse childhood experiences [which cluster in abuse, neglect, household dysfunction] —>
(2) social/emotional/cognitive ipariement —>
(3) adaptation of health risk behaviours —>
(4) disease/disability/social isolation—>
(5) early death
221
In Nunavut 4% of residences lack ______ housing and 50% of homes are severely _______
Permanent, overcrowded
222
What is controversial about section 67 of the Canadian Human Rights Act?
It denies Aboriginal Canadians full access to the human rights complaint resolution system “nothing in this act affects any provision of the Indian act’
223
What is the balloon effect. Give an example using OxyContin/heroin
It is a phenomenom where intervening in one part of a market, makes things worse elsewhere.
When OxyContin was discovered to be bad, and doctors stopped prescribing it, it caused a shift in the early 2000s to white working class people starting to use heroin/injectables instead, in order to relieve their pain.
224
Man who identifies as heterosexual may still be having sex with a man shows the incongruence of what?
Sexual Identity (in this case heterosexual) and sexual behaviour (MSM)
225
Formula for potential years of life lost (PYLL)
Sum [# of deaths at each age* life expectancy at each age]
226
The aim of the physician is to sometimes heal, often relieve, and always console. Which is strongly rooted in the ableist framework.
CONSOLATION. Historically physicians mainly consoled disabled patients- whether this be via prenatal screening, institutionalizing children in group homes and putting disabled adults in care Centers, and selective abortion.
227
Describe how education is beneficial for health outcomes
Knowledge/skills for problem solving + increased occupation prospects + health literacy (access/understanding health related info) + work/income opportunities + neural stimulation
228
```
Pick 2 of the following that would be most important when dealing with a patients disease:
(A) health
(B) wellness
(C) illness
(D) syndrome
```
B&C. Wellness & Illness [the subjective experience of both wellbeing & disease] can give you the most hints into how to treat a patients disease. Basically, the state of homeostasis is best measured by SELF RATED HEALTH
229
Healthy Childhood Development can be influenced/altered by many factors. Describe some.
*hint (7 major)
```
SES-strong predictor of child’s future SES/family income (1)
Housing (2)
Neighbourhood (3)
Parental education (4)
Access to healthy food/recreation (5)
Genetics (6)
Access to healthcare (7)
```
230
The homeless number in Calgary remains _____ despite _____ population and record in-migration
Flat; increasing
231
How does wound care and abscess management fall under harm reduction?
Treatment for soft tissue injury is usually hospital based (so $$) therefore syringte exchange programs that treat injection-associated wounds and soft tissue infections can reduce the negative sequelae of infection.
232
Toxic agents and carcinogens (both man-made/naturally occurring) would fall under what type of environmental exposure?
CHEMICAL
233
What is the formula for prevalence
Total # of cases / population
234
Considering age distribution, which of the following should be a higher priority for Alberta First Nations?
(A)cancer screening
(B)cardiovascular disease awareness promotion
(C)neurodegenerative disease surveillance
(D)maternal/child health
(E)endocrine/immune disease clinical networks
D. Maternal/child health promotion because FN populations registered in Alberta bands are actually SKEWED TOWARDS YOUNGER******
235
What is the difference betwen use, misuse, and abuse.
Use is using a pharmacological agent in the manner it was prescribed and by the person for whom it was prescribed. When we use drugs (1) for things othr than what they were prescribed (2) allow ppl other than the pt to use them (3) or use drugs in any way unbeknownst to physician prescribing them this is considered MISUSE. When misuse becomes habitual this is ABUSE or the continued misuse of a drug DESPITE OVERT NEGATIVE HEALTH CONSEQUENCES.
236
_____ is a category of disability due to problems in body function or alterations in body structure
Impairment
237
What would be the formula for direct standardization?
Sum for each stratum [observed rate in pop of interest]*[entire strata pop- can be observed+standard] divided by total combined population.
238
Describe 3 environmental events/exposures that impact entire populations
Could be something like weather, drough, natural disaster
239
______ is a statistic used for studying causes, and ____ is a statistic used for estimation health service needs and burden of chronic disease
Incidence, prevalence
240
Up to ___% of disease burden is attributed to the physical environment
25
241
When it’s said that the GOAL OF HEALTH PREVENTION is to SQUAR THE DISABILITY CURVE what does this means?
The primary goal of prevention (which is to prevent th occurence of disease) IS TO CLOSE THE GAP between disability and the maximum health limit (aka IMPROVING FUNCTION & DELAYIN DEATH)
242
Describe the social selection perspective
Health determines SES position (healthy status influences social mobility)
243
_______ looks at BURDEN of specific disease in a population while ____ look at BURDEN of DEATH
Potential Years Life Disabled, Potential Years of Life Lost
244
Infant mortality rate, neonatal mortality rate, and maternal mortality rate all share the same denominator which is:
LIVE BIRTHS IN SAME YEAR
245
Define ecological fallacy
Applying something learned at the population level to the individual level.
246
Describe approach to confounding variables using PCP, MSM, and potential confounder IVDU as an example.
Hint (5 steps)
(1) Calculate crude risk ratio of exposure —> outcome = (pcp in MSM pop/ MSM pop) / (pcp in nonMSMpop/nonMSMpop) I.E. FIND THE RELATIVE RISK BY DIVIDING THE ABSOLUTE RISKS*
(2) calculate relative risk of potential confounding variable on outcome= (pcp in IVDU+ pop/IVDU+ pop) / (pcp in IVDU- pop/IVDU- pop)
(3) calculate relative risk of potential confounding in variable on exposure = (MSM in IVDU+ pop/ IVDU+ pop) / (MSM in IVDU - pop/ IVDU- pop)
1-3 show you that IVDU is associated with both exposure and outcome BUT WE DON’T KNOW WHERE ON PATHWAY YET .
(4)STRATIFY TO MAKE SURE IVDU IS NOT ON CAUSAL PATHWAY - remove effect of IVDU to make sure it’s not an effect modifier. Look at (a) risk of PCP in MSM in IVDU+ POP ONLY and (b) risk of PCP in MSM in IVDU- POP ONLY
(A) (PCP in MSMIVDU+ /IVDU+ pop) / (PCP in nonMSMIVDU+ / IVDU+ pop)
(B) (PCP in MSMIVDU-/IVDU- pop) / (PCP in nonMSMIVDU- / IVDU- pop)
IF STRATIFIED IS SIMILAR TO THE CRUDE RISK RATIO OF PCP IN MSM THEN THERE IS NOT CONFOUNDING
IF STRATIFIED IS DIFFERENT THAN CRUDE RISK RATIO OF PCP IN MSM THEN THIS IS CONFOUNDING
IF STRATIFIED RATIOS ARE SIMILAR THEN THE CONFOUNDING VARIABLE IS NOT AN EFFECT MODIFIER
(5) CONFIRM INDEPENDENCE: look only at “nonexposed group” IS IVDU AN INDEPENDENT* RISK FACTOR FOR PCP IRREGARDLESS OF “exposure aka MSM?” = (PCP in IVDU non MSM/ nonMSM pop) / (PCP in IVDU- nonMSM/ nonMSMpop)
247
Which statistic takes into account individuals moving in/out of population, death from competing causes & individuals no longer at risk once they get disease?
INCIDENCE RATE/DENSITY
248
There are 2 main models for how social determinants of health operate @ every level of development and immediately influence health/become basis for health/illness, what are they?
(1) CRITICAL PERIODS MODEL: exposure during specific period has lifelong effect
(2) ACCUMULATION ROISK MODEL: factors that raise disease risk may accumulate over your lifetime
249
The war on drugs is incongruent with what strategy?
Harm reduction.
250
Who makes up the largest demographic of homeless people (and what percentage)
Single men make up 70% of the homeless population
251
In 2014 Calgary had approximately 35000 homeless (256 per 100 000 population) with the majority in ________ _____ followed by short term supportive housing. _____ ____ comprise the largest segment of homeless individuals accounting for ___% of homeless population. Single females account for ___% of the homeless population in Calgary.
Emergency shelters; single men, 70%; 10%
252
The focus of ____ _____ is not on removing the underlying cause, but rather on lessening its impacts and complications for the patient.
Harm Reduction
253
What is the major health burden in Aboriginal Youths?
SUICIDE RATES among ABoriginal youth is 5-6 times HIGHER than non-aboriginal youth.
254
What is the formula for Standard Morbidity Ratio
Observed/ # Expected
255
When is mid-point population used in the denominator, and when is population @ start of population used?
PERIOD PREVALENCE uses midpoint population (all existing cases in interval/ midpoint pop of interval) as a better estimate of population over long period of time vs. POINT PREVALENCE (existing cases now/ pop now), GENERAL PREVALENCE (existing cases/total pop) and CUMULATIVE INCIDENCE (# new cases over interval/ pop of ppl @ risk @ start of interval)
256
Describe the pattern of substance use in Aboriginal culture
The INCIDENCE of substance abuse is lower but the use of CHRONIC ALCOHOL is HIGHER
257
What is the major opiod slow release pill
OXYCOTIN (oxycodon)
258
Dahlgren & Whitehead’s model of health determinants has 5 major factors including: (1) biological (2) individual lifestyle factors/behavioural choices (3) ___________________ (4) Living/Working Conditions (5) General SES, cultural, and environmental conditions. Fill in the missing term.
Social and community networks
259
Which determinant of health is considered the most important for health outcomes?
INCOME/SOCIAL STATUS (higher income=better health + Whitehall studies)
MORE WEALTH=MORE HEALTH
260
(A)incidence and (b) prevalence should (increase/decrease/remain stable) if EFFECTIVE TREATMENT/PREVENTION STRATEGY
(A) decrease b/c of effective prevention and (b) INCREASE bc of longer disease duration without change in cure/case fatality rate.
261
(A) What is the QALY if hypertensive therapy for 30 years prolonged life by 10 years at a 0.9QOL compared to healthy value of 1.
(B) Further continued drug therapy overf 30 years slightly reduces QOL by 0.03
(A) (10 Years gained)*(0.9QOL)= 9 QALY
| (B) (10 yrs gained)(0.9) - (30 years on therapy)(0.03 reduction in QOL) = 8.1 years gained
262
_____ addiction is the process by which a previously health individual is driven to using street drugs solely by the prescribing behaviour of the physician.
Iatrogenic.
263
__________ is the experience of an impaired individual (or person with a health condition) and their environment
Disability
264
(A) incidence and (b) prevalence will (increase/remain stable/decrease) with INCREASED TESTING AND PREVENTION
(A)decrease incidence (b) decrease/remain stable for prevalence
If you are increasing testing you would expect and increase of incidence BUT you are also preventing disease so incidence should decrease. Prevalence should decrease if incidence is decrease with a stable case fatality rate [nothing going out BUT NOTHING GOING IN EITHER] however if incidence remained STABLE prevalence would increase [same incidence rate, no cure= more in pot]
265
Formula for case fatality rate
(Deaths due to DISEASE) / (cases of DISEASE)
266
Describe the results of the Whitehall studies
Improvement in health outcomes is associated with an increase in PERCEIVED social status regardless of material wealth. I (mortality across classes) II (morbidity across classes).
Low status/satisfaction @ work —> increase behaviour factors like smoking/obesity —> associated increase in mortality/morbidity
Ultimate takeaway: DISEASE OUTCOMES ARE CORRELATED WITH CONSTRUCT OF SOCIAL CLASS.
267
3 major factors are involved in enhancement medicine (i.e. IMPROVING rather than just restoring normative function). What are they?
(1) TECHNOLOGICAL ADVANCEMENTS (including pharmaceuticals such as viagra to achieve a BETTER than normal erection)
(2) PHILISOPHICAL SHIFT in what is considered normal/desirable
(3) MARKET FORCES (things like viagra or IUDs or low dose OCs are heavily marketed) contributing to the philisophical shift.
268
______ mortality rate is often used as an indicator of overall health in a community because it measures the health of children _____ and mothers _____.
Infant, directly, indirectly
269
```
All the following are examples of harm reduction strategies EXCEPT
(A)needle exchange sites
(B)supervised injection sites
(C) use of condoms
(D) provision of crack pipes
(E) drug use screening
```
E. Drug use screening. This would be a health prevention act, but harm reduction does not aim to reduce the ACTION but to reduce the HARM CAUSED BY THAT ACTION. Drug screening is the only answer that doesn’t try and reduce the harm of the action.
270
What is the main difference between the social selection and social causation perspective?
Social selection is saying that HEALTH DETERMINES WEALTH (i.e. social mobility) while social causation says WEALTH DETERMINES HEALTH (mediated by intermediate factors).
271
(A) incidence and (b) prevalence will (increase/remain stable/decrease) with EFFECTIVE TREATMENT ONLY (no cure) in a fatal disease
(A)stable (b)increase
If we have effective treatment only, the rate of incidence should remain the same. However, we are treating a disease (lengthening duration of disease) but NOT curing disease. Therefore same amount of incidence, same amount of death [in/out] BUT INCREASING DURATION MEANS MORE PPL WILL BE IN WATER BASIN therefore increasing prevalence
272
________ is a physiologic process often called “drug sick”
Physical dependence
273
3 categories of disability
Impairment, activity limitation, and participation restriction
274
Describe 3 definitions of health
(1) WHO DEFINITION: health is the extent to which an individual/group is able to realize aspirations/satisfy needs & change/cope with the environment.
(2) health is linked to well being “physician, mental, social” not merely the absence of disease
(3) Health is a RESOURCE for everyday life and the ability to maintain homeostasis/recover from insults
275
A 10% reduction in an individual’s salt intake will not impact their blood pressure much BUT a 10% Reduction in the populations salt intake will have a significant impact on stroke rate. What is this an example of?
THE PREVENTION PARADOX - prevention measures that bring large benefit to the community might offer little to 3each individual
276
Explain how materialist pathway —> psychosocial —> political/economy works
In the materialist pathway you have (1) poverty/access to resources (2)employment (3) education that leads to PSYCHOSOCIAL (1)social isolation (2)chronic stress that leads to POLITICAL/ECONOMIC (1)governmental policies and (2)societal structures
277
Describe the 4 types of exposure
PHYSICAL, BIOLOGICAL, CHEMICAL, RADIOLOGICAL
278
Describe the difference between aboriginal, First Nations, and status First Nations
ABORIGINAL= all encompassing referring to First Nations, Inuit, and metis people of Canada
FIRST NATIONS: term that replaced “Indian” in 1970s
STATUS FIRST NATIONS: individuals registered as First Nations under the Indian act
279
______ is a disability category resulting in difficulty executing activities
Activity limitation
280
What is housing first?
An EVIDENCE BASED housing strategy with the goal to provide SECURE/SUBSIDIZED HOUSING based on the belief that housing is a human right.
281
The aim of the physician is to sometimes ___, often _____, always ____.
Sometimes HEAL, often RELIEVE, always CONSOLE.
282
What are the 5 routes of environmental determinants of health? Give an example of each.
```
Air, Water, Soil, Radiation, Direct
Air=POLLUTION
Water= biological hazards in water/naturally harmful metals
SOIL= ^^
Radiation= ozone depletion
Direct= natural disasters
```
283
Who is Sandra Lovelace?
She was a FN who married an American man and lost her “Indian” status and was denied housing, healthcare, and education. She petitioned the UN and presented her case to the Human Rights commission arguing that Canada’s Indiain Act discriminated against Native women by depriving them of their “Indian” status when they married a non-native person. The bill was amended.
284
What are the 2 major reasons for the rise in prevalence of disability globally?
AGING POPULATION + EMERGENCE OF CHRONIC DISEASE
285
Define enhancement medicine.
Medicine (due to technological advancements and a philisophical shift) is moving from a species-typical framework of healing (aka restoration of NORMATIVE function/ableism) to ENHANCEMENT MEDICINE (aka IMPROVING).
286
The definition: groups to which we belong, neighbourhoods in which we live, organization of our workplace, and policies we create to order ourself describes which SDOH:
```
(A)work/occupation
(B) social support networks
(C) Income/social status
(D) social environment
(E) physical environment
```
D. The social environment is a broader concept describing societal structures/norms that we live within.
287
Fill in the blanks: hydrocodone (_), oxycodon (_), meperidine (_), methodone, oxymorphone, and fentanyl.
VICODIN is the trade name for hydrocone
PERCOCET is the trade name for oxycodon
DEMEROL is the trade name for meperidine
288
What is Klein’s triad
Clinicians (1)overestimate risk to pt (2)overestimate benefit of intervention (3)underestimate risk of intervention
289
7 CHARACTERITICS OF A SCREENING TEST THAT MAKE IT GOOD
(1) Important Condition
(2) Natural history is known - finding disease is not helpful if you don’t know what happens next
(3) recognizable pre-clinical or latent stage- without latent stage no window to screen
(4) early treatment helps- does knowing help your patient?
(5) suitable screening test
(6) diagnosis/tx are cost effective
(7) SCREENING REDUCES MORTALITY- THE HOLY GRAIL
290
What is the holy grain of screening?
That it REDUCES MORTALITY
291
How does PSA fail the 7 criteria for suitable screening?
(1) is the condition important- YES (pass)
(2) Is the natural history known- yes BUT it is slow so how helpful is screening? You are more likely to die from other causes (fail)
(3) Latent/preclinical stage - YES (pass)
(4) suitable screening test - YES (pass)
(5) early treatment - NO it usually causes serious complications in about 50% of men (fail)
(6) cost-effective- NO - for every 1000 men screened 1 death is averted (fail)
(7) reduce morality - NO! ONLY 1 DEATH AVERTED compared to 50% of men who had to experiencing complications!
292
What is the difference between sensitivity and specificity? What are their formulas?
Sensitivity is the TRUE POSITIVE and specificity is the TRUE NEGATIVE.
Sensitivity= true positive / true positive + false negative
Specificity= true negative/ true negative + false positive
293
What are the formulas for positive and negative predictive value.
```
PPV= true positive/ true positive + false positive
NPV= true negative/ true negative + false negative
```
294
How does INCREASING PREVALENCE affect sensitivty, specificity, PPV and NPV
Should not affect sensitivity/specificity which are intrinsic properties of the test. As prevalence increases the positive predictive value increases (i.e. encompassing more of the actual true positives) while negative predictive value decrease
295
If PPV was 15% and NPV was 75% fill in the blanks: Of the people testing NEGATIVE ______ do not have the disease, and of people testing POSITIVE _______ have the disease
75; 15
296
Fill in the blanks. If EVERYONE had a disease any negative result is necessarily a _____ ______. If NOBODY had the disease any positive result is necessarily a _____ _____
False negative; false positive
297
Using the terms sensitivity, specificity, PPV and/or NPV describe why there is poor performance of mammograms in women age 40-49.
A mammogram is quite specific (true negative= 98.8) and sensitive (true positive= 77.6). HOWEVER in women age 40-49 breast cancer prevalence is lOW. Regardless of how sensitive/specific a test is IF YOU DECREASE THE PREVALENCE THE POSITIVE PREDICTIVE VALUE DECREASES (i.e. the number of actual positives from those that test positive). THE PERFORMANCE OF A SCREENING TEST IS IMPROVED BY RESTRICTING ITS USE TO POPULATIONS AT GREATER RISK RATHEER THAN TINKERING W SPECIFICITY/SENSITIVITY
298
___ ____ ___ and ___ ___ __ are influenced by PRE-TEST PROBABILITY/PREVALENCE of disease in a population
Negative predictive value and positive predictive value [NOT sensitivity/specificity which are intrinsic to the test]
299
Each level of prevention has 2 major approaches, what are they.
Primary prevention [preventing occurence of disease] has a high risk approach and population approach [shift left]
Secondary prevention [slwoing progression of disease] has treating early and screening [7 characteristics of good screen]
Tertirary prevention [minimizing deterioration/maximizing QOL] has palliation and harm reduction
300
Describe the difference between primary, secondary, and tertirary prevention
```
PRIMARY= PREVENT OCCURENCE
SECONDARY= SLOW PROGRESSION
TERTIRARY= MINMIZE DETERIORATION/MAXIMIZE QOL
```
301
Allied health is most significantly utilized in what level of prevention?
TERTIRARY- minimizing deterioration and maximizing QOL.
302
____ ____ is a strategy that is most helpful when repeated attempts to eradicate behaviour have been unsuccessful
HARM REDUCTION where the focus isn’t on removing the underlying cause, but rather lessening its impacts/complications for the patient
303
________ are the leading cause of death in YOUNG PEOPLE and are somewhat preventable. They cause an increase in _______ because youth have a longer duration of life. ________ populations have th highest rate of injury [northern/remote communities are the worst].
Injuries; DALYS; Aboriginal
304
Haddon’s Matrix can be applied when looking at the circumstances in preventing injury. What is included in haddon’s matrix?
(1) HOST/VICTIM
(2) AGENT/VECTOR/MECHANISM
(3) ENVIRONMENT
And pre/during/post
ESSENTIALLY 9 BOXES **
305
_____ ___ is enhancing environment and behaviours to increase a healthy lifestyle.
Health Promotion
306
What are the 5 main mandates in the Ottawa Charter?
(1) build health polices to change inequity
(2) create supportive environments
(3) strengthen community action
(4) develop resonates skills [to know people’s comfort zones and how you can facilitate them individually]
(5) reorient health services- distribute resources and be sensitive to all sectors
307
How can a clinician help in promoting health at the community level?
Could be a number of things but could also include (1)capitalizing on teachable moments (2)be aware of myth of choice (3) only help if its enabling (4) understand individual/community context
308
In the health belief model, perceived _____ of disease is influenced by perceived servility/susceptibility of/to disease, and perceived _____ of taking action influences the ________ of taking action.
Benefit; susceptibility; likelihood
309
At what age shoud asymptomatic women without a family history first get a mammogram?
At what age should a man first get a prostate antigen test done?
50; when symptomatic
310
```
Which of the following is the LARGEST MODIFIABLE RISK FACTOR affecting your life expectancy?
(A) diet
(B)smoking
(C) alcohol
(D) physical inactivity
```
A. Diet is the most modifiable risk factor
311
Define health promotion vs. Disease and injury prevention
Health promotion is ENHANCING ENVIRONMENT/BEHAVIOURS and encouraging people to live as healthy lives as possible whereas prevention aims to prevent progression of a SPECIFIC disease
312
RISK=_____ + ______ + _____
Hazard + exposure + susceptibility
313
4 types of hazard, 5 routes of exposure, 3 things that increase susceptibility
HAZARD: (1) physical (2) biological (3) chemical (4) psychological
EXPOSURE: (1) inhalation (2)ingestion (3)dermal [contact] (4) parental [ingest/pharm] (5) direct [radiation]
SUSCEPTIBILITY IS INCREASED WITH (1) development - infants more susceptible (2) disease (3) genetics
314
Give some examples of public policies that had an effect on population health
*hint we’ve been given 10 examples in class
This could be anything.
(1) vaccinations (2) recognition of tobacco as a health hazard (3) family planning (4) healthier moms/babies (5)decrease of coronary disease (6) motor vehicle safety (7) fluoridation of drinking water (8) safer/healthier food (9)control of infectious disease (10) safer workplaces
315
_____ _____ is a core function of the public health system, tasked to eliminate as far as possible the risk of adverse consequences to health attributable to ENVIRONMENTAL HAZARDS.
Health Protection
316
6 Core health protection [reducing environmental hazard] strategies, what are they?
(1) legislation
(2) regulation
(3) inspection
(4) taxation
(5) encforcement
(6) persecution
* enforcemenet/persecution are escalation measures
317
What are the 3 major environmental burdens of disease?
AIR (especially long term exposure), food, water
318
Air causes ________ deaths /year more than AIDS/motor vehicle accidents combined, and _______ in Canada. It can also lead to respiratory, cardiovascular problems, are premature death. Food causes ______ illnesses/year, and water causes ______ illnesses/year that are combated with treated water.
Air causes 7 MILLION DEATHS/YEAR and 21 000 in Canada
Food causes 3.5 MILLION ILLNESS/YEAR
Water causes 300 000 ILLNESSES/YEAR
319
Rank the following in order of total global exposure to particulate matter pollution.
Outdoor air pollution in industrialized countries, outdoor air pollution in developing countries, indoor air pollution in industrialized countries, indoor air pollution in developing countries.
INDOOR AIR IN DEVELOPING > OUTDOOR AIR IN DEVELOPING > INDOOR AIR IN INDUSTRIALIZED > OUTDOOR AIR IN INDUSTRIALIZED we can see that indoor air has the highest incidence of particulate matter
320
The EPH ____ ___ ___ body is concerned with all aspects of natural/built environments that affect human health and is composed of 60 PHIs ___ ____ ___ divided into knowledge/education and healthy ____ ___.
Environment Public Health; Public Health Inspectors; physical environ
321
The great smog in London, Minimata disease (mercury poisoning in Asia), the love canal in USA (toxins) were all death with using legislation which is an example of _____ ______
Health protection
322
Ministers of health have 4 powers, what are they?
(1) suppress disease in those who may be infected
(2) protect those who haven’t been exposed
(3) break chain of transmission/prevent spread of disease
(4) remove source of infection
323
4 major roles of physician in health protection are
(1) notify Public Health (public health act) involves PHS, EHO, MOH
(2) take appropriate exposure history
(3) communicate risk
(4) advocate
324
Children are more susceptible disease due to:
INCREASED _______
(A) faster ________ rate [aka breath faster]
(B) behaviours that increase ingestion such as eating everything/always on the group
(C) larger _____ ____ to volume
(D) dirtier
(E) _____ to the ground
INCREASED TOXIC EFFECTS
(A) small body mass
(B) stilll learning/developing
(C) less effective _____ (liver/kidneys have decreased detox abilities)
(D) ________ organs susceptible to damage
LONGER LIFE AHEAD (____ OF DISEASE)
EXPOSURE; RESPIRATORY; SURFACE AREA; LOW
CLEARANCE; DEVELOPING
LATENCY
325
Normal levels of contaminants _____ over time and populations vs. Harmful levels of contaminants but unless there is a _____ _____ then there is truly no _____ ____.
Change; definite threshold; safe dose
326
4 major things that increase risk perception are
(1) PERCEIVED LACK OF CONTROL
(2) IMMEDIACY [proximal values more greatly than delayed]
(3) AGENCY/OWNERSHIP [more likely to fear neighbors dog than your own]
(4) SEVERITY
327
WHO, IARC, Environmental Protection agencies are all ______. Health Canada, Public Health Agency of Canada and Environment Canada are all ________ Alberta Health-Health Protection Program, Population Health, and aboriginal health are all _____.
International; national; provincial
328
Prevention, preparedness, response, and recovery are the 4 steps of
Emergency preparedness
329
7 key areas of health protection
(1) disease/injury control
(2) safe food
(3) safe drinking water
(4) safe recreational water
(5) safe indoor air
(6) healthy environments
(7) safe built environments
330
What is CH2OPD2 ad what are the 6 main ones for ID
CH2OPD2= Community, Home, Hobbies, Occupation, Personal Habits, Diet ,Drugs NEEDED FOR ENVIRONMENTAL EXPOSURE HISTORY.
6 main ones for infectiou S Disease are= work, Home, diet, travel, water source, sick contacts
331
Risk communication = (1/X) empathy, (1/X) expertise, (1/X) commitment, (1/X) honest
1/2 EMPATHY, 1/6 EXPERTISE, 1/6 COMMITMENT, 1/6 HONESTY
332
What are 4 major concerns as of 2017 for Public Health?
(1) downgrading status of public health (officials) in the government [both at national level and regionally]
(2) erode independence of medical offices
(3) limit public health scope by combining it with primary care
(4) decreased funding for public health
333
The central core of public health is social _____ and trying to bring actions to change these unfair ______ ad improve the health of the world population
JUSTICE; DISTRIBUTIONS
334
8 major components of population health are
(1) focus on population health
(2) determinants of health & their interactions
(3) evidence based decisions
(4) increase upstream investments
(5) multiple strategies
(6) multisectorial /ointerprofessional collab
(7) public involvement/interest
(8) accountability
335
```
Match the following terms with the type of health system::
PARALLEL PUBLIC/PRIVATE (DUPLICATE)
COPYAMENT (SUPPLEMENTARY)
GROUP BASED (PRIMARY)
SECTORS (COMPLEMENTARY)
```
A) given range of services a separate privately financed system exists
(B) certain sectors are primarily publically financed, others are primarily private
(C) certain groups are eligible for pubic coverage while others are private purchase
(D)across a broad range of services financing is partially public/private
(A) PARALLEL PUBLIC/PRIVATE
(B) SECTORIAL [canada is like this]
(C) GROUP BASED
(D) COPAYMENT
336
Health care spending per captain by the public sector in Canada is ______ than the OECD average
LESS; Canaa spends 70.6% public health while the OECD average is 73.8%
337
Finish this sentence. Canada has (above/below/average OECD) hospital beds, and (above/below/average OECD) hospital disracharges. However the average length of stay when put people in the hospital is (above/below/average OECD) and we spend (above/below/average OECD) money on them.
BELOW AVERAGE HOSPITAL BEDS & BELOW AVE3RAGE DISCHARGE - WE DON’T HAVE A LOT OF BEDS & WE’RE NOT PUTTING PEOPLE INTO THEM
ABOVE AVERAGE LENGTH OF STAY AND SPENDING A LOT OF MONEY ON THEM
338
Describe the difference between a social health insurance, tax-funded, and market model of healthcare.
SOCIAL HEALTH INSURANCE= employer/employee funding
TAX-FUNDED MODEL= Public insurance central concepts are universality, governments, public policy
MARKET MODEL: private insurance or OOP - risk based and must qualify for insurance
339
What is unique about Australia’s payment system?
They have (1) a levy on insurance- add 1% tax to incomes over $70K AND (2) they incentivize privatization (subsidizing 30% of these programs)
340
_______ was a US policy in which people had to buy healthcare or face a penalty. This policy increased the role of _______.
Obamacare; employers
341
(A) do health systems influence health outcomes [i.e. NFP vs. Private]
(B) are for profit hospitals cheaper than not-for-profit
(C) does mortality differ in for-profit vs. NFP
(D) does quality of care differ in for-profit vs NFP
(E) does private care reduce waiting time?
(A) NFP achieves comparable health outcomes to private @ 2/3 cost
(B) NO
(C) for-profit actually has higher mortality rate
(D) for-profit actually seems to have lower quality of care
(E) NO comparable wait times
342
using WHO, WHAT, FUND, DELIVERY describe Germany’s social insurance model
WHO: everyone via sickness funds
WHAT: broad [including prescription, long term care etc.] more comprehensive than canada
FUND: central gov + regional sickness funds via employees [GROUP BASED]
DELIVERY: self governed hospitals, docs FFS
343
WHO: universaility by national health services
WHAT: broad-hospital, ambulatory, DENTAL
FUND: By central government national health services - no charge @ point of care
DELIVERY: private docs contracted to national health service
Which system is this?
UK’s tax-funded model
344
WHO: UNIVERSAILITY
WHAT: 30% subsidy for private, publicly funded, 1% levy
FUND: public/private [federal minister of health].
Delivery: FFS & user fees
Which system is this
Australia’s tax funded model
345
WHO: UNIVERSAILITY
WHAT: broad- hospital, pharma, DENTAL, HOMECARE, LONG TERM CARE
FUND: COPAYMENT partial private/public and focused on central & municipal gov [national funds and country/local actually run]
Delivery: TRUE PATIENT CENTERED CARE and salaried docs
What system is this
SWEDENS social welfare system
346
WHO: UNIVERSAILTY
WHAT: universal
FUND: gov and mandatory national health insurance (70-100%) the rest is supplemented by private
Thought of as a close to ideal model, what is this.
FRANCES tax-funded model
347
WHAT: private, Medicare (old), Medicaid (poor- not as good) with 40 million uninsured
WHAT: whatever is covered in the insurance you pay for
FUND: group-base, multiplayer, no single regulating body
DLIVERY: mixed private public, profit hospitals, bundles, specialist etc.
What terrible health system is this
US MARKET MODEL
348
WHO: UNIVERAILITY
WHAT: ONLY HOSPITAL/PHYSICIAN SERVICES [no point of care chrages]
FUND: sectorial 70% gov [2/3 provincial 1/3 federa] 30% private
DELIVERY: mix private/NFP, docs have mixed but most are FFS
Which healthcare sys is this?
CANADA’S TAX-FUNDED MODEL
349
In Canada the % of public funding is mainly for _______ services and ______ with lesser impact on pharmaceuticals/dental.
Physician; hospitals
350
Key history of Canadian healthcare system:
Before the 1940s access was based on ability to _____. In 1947 SK introduced public insurance plan for _____ which was extended in 1962 to _____. The FEDERAL MEDICAL CARE ACT of 1968-1972 was where all province/territories agreed to provide ______ public coverage for hospital and physician care. The core legislative framework is the _____ ____ ___ (1984). In 1973 there was federal agreement of __/___ costs of Medicare but this dwinles.
Pay; hospitals; physicians; universal; CANADA HEALTH ACT; 50/50
351
6 types of reimbursement for physicians, what are they?
(1) fee for service (2) salary (3) capitation [paid per head] (4) alternate funding [mix] (5) other like profit sharing/bundle (6) GP fund holding [income tied to utilization]
352
(1) Pro/con of FFS?
(2) pro/con of salary
(3) pro/con of capitation
(4) pro/con of alternate funding
(5) pro/con of GP fund holding
(1) promotes activity, but can lead to uncessary services
(2) certainty, but can be undermotivated
(3) clarifies responsibility/pt alignment (because ALL OF THE PTS CARE IS IN YOUR HAND), inflexibility/under-servicing [bc a complicated pt you get paid the same as a simple pt]
(4) enables balance of (a)pt care (b)education (c) research but underperformance in one/all
(5) income tied to utilization but can provide less than quality/accessible care
