HE ED 221 Flashcards
(124 cards)
1
Q
What is the medical model of health?
A
- Narrow and simplistic understanding of health. Medically biased definitions focusing on the absence of disease or disability
- Doesn’t take into account the wider influences on health (outside of the physical body)
- Influenced by scientific and expert knowledge
- Emphasizes personal, individual responsibility for health (puts blame on the individual instead of a group of people
2
Q
What is the social model of health?
A
- Beyond physical body
- Broad or complex understanding of health. More holistic definitions of health taking a wider range of factors into account such as mental and social dimensions of health
- Takes into account wider influences on health such as the environment the impact of inequalities
- Takes into account lay knowledge and understandings
Emphasizes collective, social responsibility for health
3
Q
What is a population?
A
Group of people or individuals (in contrast to the individuals themselves) with a common characteristic
4
Q
What kind of characteristics can a population be based on?
A
○ Place of residence
○ Age
○ Gender
○ Race/ethnicity
○ Religion
- Occurrence of a life event (e.g. giving birth, entering school, serving in the military)
5
Q
What is a fixed population?
A
Permanent, no new people can join this population. You can also not leave this population
6
Q
What are the key elements of a fixed population? provide an example
A
Key elements:
○ Membership is based on an event and is permanent
Example:
Japanese atomic bomb survivors
7
Q
What is a dynamic or open population?
A
You can leave this population as well as you are able to return
8
Q
What are the key elements of a dynamic/open population? provide an example
A
Key elements:
- Membership is based on a changeable state of condition and is transitory
Example:
Residents of a city, hospital patients
9
Q
What is a steady state in regards to a dynamic or open population?
A
The number of people entering the population is equal to the number of people leaving
10
Q
What is population health?
A
- An approach/way of thinking
- “An approach to health that aims to improve the health of the entire population and to reduce health inequities among population groups
- In order to reach these objectives, it looks at and acts upon the broad range of factors and conditions that have a strong influence on our health
11
Q
Explain what a basic type of health research is: (what is it, what is studied, research goals, examples)
A
It is controlled and regulated
What is studied?: Cells, tissues, animals in laboratory settings
Research goals: Understanding disease mechanisms and the effects of toxic substances
Examples: Toxicology, Immunology
12
Q
Explain what a clinical type of health research is: (what is it, what is studied, research goals, examples)
A
Can involve prevention
Diagnose who is sick and then treating them
What/who is studied?: Sick patients who come to health care facilities
Research goals: Improving diagnosis and treatment of disease
Examples: Internal medicine, pediatrics
13
Q
Explain what a population health type of health research is: (what is it, what is studied, research goals, examples)
A
What/who is studied?: Populations or communities at large
Research goals: Prevention of disease, promotion of health
Examples: Epidemiology, environmental health science
14
Q
What are some action areas of the Ottawa Charter?
A
- Strengthen community action
- Develop personal skills
- build healthy public policy
- creative supportive environments
- reorient health services
15
Q
What is population health vs. public health?
A
Population health: The approach
Public health: the action
- The difference is subtle
- Activities (e.g. programs and services) organized and carried out typically by various levels of government to protect, promote, and restore the health of citizens
e.g. Public Health Agency of Canada, Alberta Health Services
16
Q
What is a disease?
A
- Abnormal, medically defined changes in the structure or functioning of the human body
○ Hard to pin point
○ Determined by experts in the field - Epidemiology is focused on disease
17
Q
what is a illness (or sickness)
A
- The individual’s experience or subjective perception of lack of physical or mental well-being and consequent inability to function normally in social roles
- Impacting day to day activity
18
Q
What are the 2 types of diseases?
A
- 2 primary types of disease:
1) Infectious or communicable disease
2) Non-infectious or non-communicable or chronic disease
19
Q
What is an infectious disease?
A
- “Due to a specific infectious agent or its toxic products that arises through transmission of that agent or its products from an infected person, animal or reservoir to a susceptible host”
e.g. COVID, common cold, measles, flu, etc.
20
Q
How does a infectious disease get transmitted?
A
- Transmission
○ It can be transmitted
○ Animal to person
○ Person to person
- There is some sort of transmission
21
Q
What are the infectious disease categories?
A
- outbreak
- epidemic
- Pandemic
22
Q
What is an outbreak?
A
Occurrence of new cases in excess of baseline in a localised area (e.g. institution, city) very localised
23
Q
What is an epidemic?
A
- Occurrence of new cases in excess of baseline across a country or a number of countries
- More cases than would be typical, more wide spread
24
Q
What is a pandemic?
A
Crossing many international boundaries and affects a large number of people
25
can vaccine preventable diseases recur?
Yes
e.g. zika virus, influenza
26
What is a chronic disease?
- "non-communicable diseases (NCDs), also known as chronic diseases, are not passes from person to person. They are of long duration and generally slow progression"
○ Might not be apparent until someone is later in life
○ Diet can lead to chronic disease
e.g. diabetes, cancer, cardiovascular disease
27
what is an important marker if the accumulation of modifiable risk factors for chronic disease?
Ageing
28
Explain risk transition
- As a country develops, the types of diseases that affect a population shift from primarily infectious to primarily chronic
○ Improvements in medical care
○ Public health interventions
- The ageing of population
29
What are the 3 levels of prevention to protect and promote health?
- primary prevention
- Secondary prevention
- tertiary prevention
30
What is primary prevention?
Preventing disease
31
What is secondary prevention?
Early detection of disease
32
What is tertiary prevention?
Reduce complications associated with chronic diseases
33
What is a individual- based approach?
- traditional medical approach
- identify high-risk susceptible individuals and offer individual protection
- screening
- truncates the risk distribution
34
What is a population based approach?
- control the causes of disease in the whole population
- shift the whole risk distribution
35
What are some advantages of the high risk approach?
Intervention appropriate to individual
○ Individual already has a problem
- Go see a doctor, they prescribe something for you
- Something that is appropriate for that individuals problem
- Individual motivation
Have specific motivation to change their behaviour
- Physician motivation
○ Help is wanted
Someone is coming to them for help
36
What are some disadvantages of the high risk approach?
Difficulties and cost of screening (secondary prevention)
Limited potential for the individual and population
- Behaviourally inappropriate
○ Constrained by social norms/built environment
e.g. smoking: if their whole social circle smokes, it will be harder for them to quit smoking
37
What are some advantages to the population based approach
- Radical
○ Remove underlying caused of the disease
§ Figure out the main causes
- Large potential for the population
○ Small individual changes can lead to large effect at the population level
§ Savings on health care system
- Behaviourally appropriate
Change in social norms and environment
38
What are some disadvantages to the population based approach
- Small benefit to individual
○ "prevention paradox"
- Everyone's health will improve by a small amount
§ Seat belts: if you have never been in a car accident these may be less significant
§ It helps on a population level, not necessarily individual levels
- Poor motivation of individual
○ No immediate reward
- Poor motivation of physician
Small benefit to the individual patients
39
What are the 2 main types of epidemiology?
- descriptive epidemiology
- analytic epidemiology
40
What is descriptive epidemiology?
○ Describes the distribution of determinants, morbidity, or mortality by person, place, or time variables
○ One variable specifically
○ Describes what is going on
Used in a practical stand point
41
What is descriptive epidemiology useful for?
○ Assessing health status of a population
○ Generating hypotheses
Examine patterns, establish plans for public health programs
- From a public health perspective:
○ Different patterns
○ Different cities
○ Parts of cities
Provinces
42
What is analytic epidemiology?
○ Studies the associations or causes of diseases
2 variables
- exposure (behaviour, determinant)
- outcome (health outcome, behaviour)
43
What are the 2 types of descriptive study designs?
- Case studies
-cross sectional studies
44
What is a case study?
○ Describes characteristics of a group or cluster of individuals with the same exposure or disease/outcome
○ There is a small group and they have some sort of rare disease
Describing what is going on
45
What is a cross-sectional study?
○ Group of people examined at one point in time
○ Describes the prevalence of an exposure or disease/outcome
○ One snapshot in time
Not what happened in the past, not what is going to happen in the future
46
What is the 1 type of an analytic study design (experimental)
Randomized control trial (RCTs)
47
What is a randomized control trial?
○ Best experimental research design
○ The researcher will manipulate the exposure in order to change it
○ 4 fundamental steps
§ Selection of appropriate study sample
□ Conduct baseline measures: cognitive and physical
§ Randomly assign participants into an Experimental group(s) and a Control Group
§ Application of intervention
Follow-up assessment(s)
48
What are the 3 types of analytic study designs (observational)
- Cohort studies
- case- control studies
- cross-sectional studies
49
What are cohort studies?
○ Looking forward in time
○ Exposure is ascertained prior to the ascertainment of an outcome
2 groups within a population
50
What are case-control studies?
○ Looking backwards in time (the flip of a cohort study)
○ Outcome is ascertained prior to ascertainment of exposure
○ Looking at whether they has the disease
Ask people questions about their exposure from previous time (5,10,15,20 years ago)
51
What is a cross sectional study?
○ Not looking forward or back
○ It is looking at what is happening right now
○ Simultaneous ascertainment of exposure and outcome
'snapshot' in time
52
What is the hierarchy of evidence?
- systemic reviews and meta analyses
- randomised control trials
- cohort studies
- case-control studies
- cross-sectional surveys
- ecological studies
- case series and case reports
- ideas, editorials and opinions
53
What is prevalence rate?
- The proportion of the population (or population subject) that has given disease or condition at a specified time
Used for cross sectional studies
54
What is incidence rate?
- The proportion of the population at risk that develops a given disease or condition during a specified time period
- Used for cohort studies
55
What is relative risk (risk ratio)
- The ratio of the risk of the outcome in the exposed group to the risk of the outcome in the unexposed group (referent group)
Provides an estimate of the increased or decreased risk of an outcome due to a particular exposure
56
what is a prevalence ratio?
- Used in place of the RR in case- control studies and cross-sectional studies
Infectious diseases mostly
57
What is an odds ratio?
Used in place of the RR in case-control studies and cross-sectional studies
The odds of having the outcome among the exposed group compared to the odds of having the outcome among the unexposed group
58
define cause
an event, condition, or characteristic that preceded the disease event and without the disease event would not have occurred at all or would not have occurred until some other time
59
what is the germ theory?
- Mid-to-late 1800's and early 1900's
- Dominant in both clinical medicine and public health
- Thought diseases had a single causative agent
Works well for infectious diseases that dominated much of the world at the time
60
What is the black box theory?
- The disease pattern (developed countries) shifted to one dominated by chronic disease
- Germ theory was no longer up to task by the 1950s
- Black box
Understand the risk factors and the disease but not necessarily the mechanisms
61
What are the 9 causal associations?
1) Temporality*
- The exposure occurred before the disease
2) Strength of association
- Strong measure of association (i.e., OR, RR)
3) Consistency
- Same results for different people, places, and times
4) Specificity*
- Related to infectious disease. Single cause leads to an effect (i.e. germ theory)
5) Dose-Response Relationship (Biological Gradient)
-As the dose of the exposure increases, the risk for the outcome also increases or decreases in a gradient fashion
6) Biological Plausibility
- Existing biological or social model to explain the association
7) Coherence *
- Association does not conflict with known facts about the history and biology of disease
8) Experiment
- Been tested using an experimental design
9) Analogy*
Similarities between the observed association and other associations
62
What are the 4 health behaviours
- Physical activity, Sedentary Behaviour, Sleep, Nutrition
63
What is physical activity?
any bodily movement produced by skeletal muscles that expends energy beyond resting levels
64
What is sedentary behaviour?
Any waking behaviour characterized by an energy expenditure <= 1.5 metabolic equivalents, while in a sitting, reclining or lying posture
65
what is sleep?
Loss of conscious awareness
66
What is nutrition?
The kinds of food that a person, animal, or community habitually eats
67
Why should we measure health behaviours?
- Assess current levels of health behaviour within the populations
- Monitor compliance with national guidelines
- Understand the relationship between the health behaviours and chronic disease
- Understand the factors (determinants) influencing health behaviours
- Determine the effectiveness of intervention in changing health behaviours
68
What is validity?
Refers to the accuracy of an instrument in measuring what it seeks or claims to measure
69
What is reliability?
Refers to the stability and consistency of the instrument
70
What is objectivity?
Free of bias, uncontaminated by the emotional aspects of personal assessment
71
What are the 2 types of behavioural measures?
- subjective measures
- objective measures
72
What are some examples of subjective measures?
○ Self or proxy-report
§ Diary/log
§ Questionnaire
Interview (e.g., phone survey)
73
What are some examples of objective measures?
○ Observation
○ Monitor
§ Pedometer
Accelerometer
74
What are some advantages and disadvantages of self-reports
- Advantages
○ Low cost
○ Quick and efficient
○ Information gathered on context or setting
○ Reliable
- Disadvantages
○ Validity?
Biases (social desirability, recall)
75
What are pedometers? and what are the advantages and disadvantages of pedometers
- Measure
○ Steps/day, cadence (steps/min)
- Advantages:
○ Less biases
○ Fairly inexpensive ($15-30)
- Disadvantages :
○ More participant burden
○ No information on context
○ No information on time
○ Intensity
○ Does not capture non-ambulatory or water based activity
76
What are accelerometers? and what are the advantages and disadvantages of accelerometers
- Main measure:
○ Minutes/day in different intensities of activity
- Advantages
○ Less bias
○ Intensity of activity
○ Time-stamped (period of the day)
○ Detailed - 1 second interval
○ Bluetooth technology
○ Capture physical activity, sedentary behaviour and sleep
- Disadvantages
○ Costly ($225-$450)
○ More participant burden
○ Minimal information on context
○ May not capture non-ambulatory activity
Large amount of data to analyze
77
What are the aspects of the FITT principle?
○ Frequency- How often?
○ Intensity- How much effort or work?
○ Time (duration)- How long
Type- What kind
78
What is organized sport?
Physical activity in individual or team sports or physical activity programs that typically have riles, coaches, and specialized equipment
79
What is physical education?
Physical education is a curricular subject within the school setting designed for students to develop motor skills, movement-related concepts and strategies, personal and social responsibility, personal fitness, and knowledge about the value of physical activity
80
What is active play (children) and leisure activities (12-17)
○ Unstructured physical activity that is volitional, spontaneous, self-directed and fun
○ E.g. Hide and seek, tag
E.g. basketball, weights (non competitive)
81
What is active transport?
○ Physical activity performed to get to and from places
○ e.g. school, friends house
Common one is walking but anything rolling works too
82
What are benefits of having national guidelines?
- Motivates people by giving them a target to aim for
- Gives researchers cut-points to use for determining the % of the population that is inactive/active
Provides practitioners and clinicians with evidence-based recommendations to use with their clients
83
What are the steps to guideline development?
- Step 1: Consensus meeting
○ Discuss process, responsibilities, timelines
○ Finalize systemic review parameters
- Step 2: Review the evidence (Systemic Reviews and additional analyses)
○ Dose response?
- Step 3: Consensus meeting
○ Review evidence
○ Create guidelines
○ Plan launch
- Step 4: Stakeholder Consultations
○ Online survey
Focus groups and interviews
84
What are some PA health outcomes for 5-17 year olds
lower adiposity
higher cardiometabolic health
higher fitness
lower psychological distress
85
What are the sweat guidelines for 5-17 years?
60 minutes per day of moderate to vigorous activity
86
What are some physical activity health outcomes for 0-4 years
higher motor development
higher fitness
higher bone and skeletal health
87
What are the move guidelines for kids less than a year?
several times a day in a variety of ways
non-mobile: tummy time for 30 minutes spread throughout the day
88
What are the move guidelines for kids 1-2 years?
at least 180 minutes spent in a variety of physical activities at any intensities (energetic play)
89
What are the move guidelines for kids 3- 4 years?
at least 180 minutes of PA spread throughout the day
at least 60 minutes of energetic play
90
What percentage of kids (5-17) follow recommended guidleline?
39%
91
What percentage of kids (3-4) follow recommended guidleline?
62%
92
What is physical activity vs exercise?
- A subset of physical activity that is planned, structured, and done regularly to improve or maintain physical fitness or health
Exercise is a subset of physical activity
93
What are the aspects of TDEE
BMR- basal metabolic rate
TEF- thermic effect of food
94
What is non exercise activity thermogenesis (NEAT)
- The energy expended for everything we do that is not sleeping, eating or exercise
- NEAT explains a vast majority of an individual's non-resting energy needs
- Not planned or structured
- Light intensity
- People in a non developed world has more NEAT than developed world
- Examples: It ranges from the energy expended walking to work, typing, fidgeting, doing chores (e.g. chopping veggies), performing yard work, etc.
95
What are household activities (18+)
Housework, yard work, child care, chores, self-care, incidental
96
What are occupation activities (18+)
Work-related physical labor tasks, walking, carrying or lifting objects
97
What is active transportation (18+)
Purpose of going somewhere, walking, rolling, standing while riding transportation
98
What is active recreation/leisure activities (18+)
Discretionary or recreation activities, sports, hobbies, exercise, volunteer work
99
What are some resistance training health outcomes
low mortality
higher physical functioning
lower cardiovascular disease
100
What are some balance/functional training health outcomes (64+)
lower fall related injuries
higher physical functioning
higher physical activity
101
What are the guidelines for PA for 18-64 years
accumulation of 150 moderate to vigorous physical activity per week
several hours of light physical activities
102
What are the guidelines for PA for 65+ years
accumulation of 150 moderate to vigorous physical activity per week
muscle strengthening activities at least 2 times a week
several hours of light physical activities
103
What percentage of adults get the recommended amount of PA?
45%
104
What is the SITT principle
- Sedentary behaviour frequency
○ Number of bouts of a certain duration
- Interruptions
○ Breaks
- Time
○ Duration of sedentary behaviour
- Type
Mode
105
What are some health outcomes related to sedentary behaviour? (5-17)
higher adiposity (screen time)
lower cardiometabolic health
lower fitness
lower self-esteem
106
What are the sedentary behaviour guidelines for ages 5-17
No more than 2 hours per day of recreational screen time
limited sitting for extended periods
107
What are some health outcomes related to sedentary behaviour? (0-4)
lower psychosocial health
lower cognitive development
lower fitness
108
What are the sedentary behaviour guidelines for ages 0-4
not being restrained for more than an hour at a time
when sedentary they should be doing something educational
for those less than 2- no screen time
aged 2- no more than 1 hour
109
What are some health outcomes related to sedentary behaviour? (adults)
lower health-related quality of life
higher depression
lower physical function
110
What are the sedentary behaviour guidelines for adults
limiting sedentary time to 8 hours or less
- no more than 3 hours of recreational screen time
- breaking up long periods of sitting as often as possible
111
Percentage of adults following the sedentary behaviour guidelines
6%
112
What are the 5 dimensions of healthy sleep?
- sleep duration
- sleep continuity or efficiency
-timing
-alertness/sleepiness
-satisfaction/quality
113
What is sleep hygiene
* Habits and practices conducive to sleeping well on a regular
basis
114
what are some sleep and health outcomes (5-17)
shorter sleep
- higher adiposity
Longer sleep
- higher emotional regulation
- higher quality of life
115
What are the sleep guidelines for 5-17 years
uninterupted 9-11 hours of sleep per night for those aged 5-13 and 8-10 hours for those aged 14-17 years
with consistent bed and wake-up times
116
what are some sleep and health outcomes (0-4 years)
shorter sleep
- higher adiposity
- lower emotional regulation
longer sleep
- higher growth
- higher physical activity
117
What are the sleep guidelines for infants (less than a year)
14-17 hours (for those who are 0-3 months) or 12-16 hours (for those aged 4-11 months) of good-quality sleep
118
What are the sleep guidelines for toddlers (1-2 years)
11-14 hours of good quality sleep including naps with consistent bed and wake up times
119
What are the sleep guidelines for preschoolers (3-4 years)
10-13 hours of good quality sleep which may include a nap with consistent bedtimes and wake up times
120
what are some sleep and health outcomes (adults)
inconsistent and/or late sleep timing
- low cognitive functioning
- lower brain health
- lower mental health
- higher adiposity
121
key findings of sleep timing/consistency review (adults)
Later sleep timing & more sleep variability
associated with adverse health outcomes
* Cannot define clear thresholds
* Social jetlag was associated with adverse health
outcomes, while weekend catch-up sleep was
associated with better health outcomes.
122
What are the sleep guidelines for adults (18-64)
7-9 hours of good-quality sleep on a regular basis with consistent bed and wake up times
123
What are the sleep guidelines for adults (65+)
7-8 hours of good-quality sleep on a regular basis with consistent bed and wake up times
124
explain the movement behaviour intensity continuum
Sleep duration, sedentary time, and physical activity are three
co-dependent behaviors that fall on the movement intensity
continuum.
