Unit I and II Flashcards
(65 cards)
1
Q
Top ten public health achievements
A
1) vaccination
2) motor vehicle safety
3) safer workplaces
4) Control of infectious diseases
5) Decline in deaths from coronary heart disease and stroke
6) Safer and Healthier foods
7) Healthier mothers and babies
8) Family Planning
9) Fluoridation of drinking water
10) Recognition of tobacco use as a health hazard
2
Q
Epidemiology
A
the study of how disease is distributed in populations and the factors that influence or determine this distribution
3
Q
Aim of epidemiology
A
1) identify the cause or etiology of disease
2) determine extent of disease
3) Study the natural history and prognosis and disease
4) Evaluate both existing and newly developed preventative and therapeutic measurements
5) Provide foundation for developing public policy
4
Q
primary prevention
A
preventing initial development of disease (immunization)
5
Q
secondary prevention
A
early detection of existing disease to reduce severity and complications (i.e screen for cancer)
6
Q
tertiary prevention
A
reducing impact of disease (i.e. rehabilitation for stroke)
7
Q
Preventative medicine
A
introduction to population health principles and application of these principles to health topics
8
Q
Evidence-Based Medicine
A
-focuses on finding, critically appraising,and applying best research evidence to practice
9
Q
What is preventative medicine?
A
-specialty of medical practice with focuses on the health of individuals and defined populations in order to protect, promote, maintain health and well being and prevent disease, disability and premature death
10
Q
Traditional/Population based model
A
- traditional medical model focuses on the one to one physician patient relationship
- population-based model focuses on the one to many physician patient/group relationship; consider factors in the patient’s community if they contribute to the patient’s health and well-being
11
Q
Online resources and physicians
A
-want to critically appraise the literature:
appropriateness of study design, appropriateness of statistical methods, how to interpret the results, how does the study apply to the patient
12
Q
Board certification in preventative medicine
A
- aerospace medicine
- occupational medicine
- public health and general preventative medicine
13
Q
where do preventative medicine physicians work?
A
- primary care and outpatient settings
- public health agencies
- community organizations
- industry
- managed care plans
- Academia
- international health agencies, NGOs
14
Q
What do preventative medicine physicians do?
A
- provide patient care
- manage public and community health programs
- develop disease prevention and control programs
- identify health and safety hazards in the workplace
- work to improve access to health services for vulnerable and high risk populations
15
Q
Public health
A
- an organized effort to improve the health of a community
- to improve the community’s health, must understand how disease is distributed, what causes disease, and what influences disease
16
Q
Agent-Host-Environment
A
-model of causation: determinants of health
Host: age, SES, race/ethnicity, occupation, PMHx
Agent: A/B, H3N2, H5N1 etc
Environment: Geographic, congregate living
17
Q
Why is epidemiology important
A
- population health- use to identify major causes of morbidity and morality and their modifiable/preventable risk factors
- clinical medicine: inform clinicians about- natural history of disease, differential diagnosis, testing, screening, counseling
18
Q
Leading causes of death
A
1900- infectious diseases
2010- heart disease, cancer, COPD, stroke
19
Q
Principles of epidemiology: study or investigate person, place, time
A
- describe natural history, etiology, and risk factors of disease
- predict disease occurrence
- develop and evaluate interventions to control/prevent disease
20
Q
Outbreak of unknown disease
A
- look at who, when, and where to determine
- what, why, and how (transmission)
often but not always infectious/communicable disease (AIDS and SARS
21
Q
Occurrence of known disease
A
- Know what-
- go back to look at who, when, and where
- to determine how and why
- often but not always, chronic disease
(ex. mesothelioma and asbestos
22
Q
Principles of Epidemiology: Person
A
- identify who is already affected by disease or condition (age, gender, SES, occupation and so on)
- to find out: (who is at-risk, what case patients had in common)
23
Q
Principles of Epidemiology: Place
A
- identify where exposure occurred (geographic, school, work site)
- to find out: who is at-risk, potential contributing factors
24
Q
Principles of Epidemiology: Time
A
- identify when exposure occurred, when illness/death occurred, how long symptoms lasted
- to find out: who is at risk based on potential exposure time, natural history of disease
25
Easiest diseases to study
-clear onset
-narrow range of clinical expression
-high attack rate
-short incubation/latency period
Ex- Measles, mumps, chickenpox
26
Incidence
of new cases of disease/ # of individuals at risk for developing disease
- over a given time frame
- usually expressed per 1,000 but can be per 100,000 for rare diseases
27
Prevalence
of cases of disease (old and new)/ # of individuals in population at time
-a change in prevalence may occur if either a change in this incidence or the duration of a disease occurs
28
Attack rate
number of ill patients/ number of individuals at risk
29
Endemic
-baseline rate of disease (in incidence or prevalence)
30
Epidemic
-an increase in the number of cases, compared to baseline for a given population, time and place
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Pandemic
-worldwide epidemic
32
Essential ingredients of an epidemic
- introduction of, or an increase amount of, pathogenic agent
- an adequate number of exposed and susceptible persons
- an effective means of transmission between the source of the pathogen or agent of disease and the susceptible hosts
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Single source epidemic
-epidemic arises from a specific source. Many cases in a very short time frame
34
Propagated
epidemic occurs as disease is transmitted from person-to-person. Ongoing transmission occurs over more extended period of time
35
Epidemics and time frames
```
Hours- acute food poisoning
Days-viral infections
Weeks- Hep A (2-6 weeks)
Months- Hep B (2-6 months)
Years- Atomic bomb radiation-induced leukemia (5-10 years)
```
36
When should you conduct an epidemiological investigation
- apparent number of persons affected
- presence of unusual or severe clinical symptoms
- lack of an obvious explanation for disease occurrence
- perceived need to implement control measures
- level of public concern
- potential for contributing to medical knowledge
37
Purpose of Epidemiologic Investigations
- conform the threat or existence of an epidemic
- identify causative agent of disease, its source and mode of transmission
- determine the geographic distribution
- determine the public health impact, identifying those persons who are at highest risk for disease
- assess local response capacity
- identify the most effective control measures
38
Fundamental Concepts of Epidemiology
- human disease is not randomly distributed throughout a population
- there are causal and preventative factors that can be identified through systemic investigation of different populations
39
Cohort study
- relative risk
- analysis of risk factors
- looks at people who do not have the disease
40
Case-control study
- odds ratio
- It is a type of observational study in which two existing groups differing in outcome are identified and compared on the basis of some supposed causal attribute
41
Two by Two table
Disease
Yes No
Exposure Yes and No (vertical)
42
Relative Risk
- estimate the magnitude of an association between exposure and disease
- indicates the likelihood of developing the disease in the exposed group relative to those who are not exposed
- ad/bc
RR= 1 - no association
RR > 1- positive association
RR < 1- negative association
43
When is the odds ratios a good estimate of relative risks
- when the cases in the study are representative of all people with disease in the population
- when the controls in the study are representative of all people in the population that produced the cases
- when the disease being studied does not occur frequently
44
Attributable Risk
- the amount of disease in exposed persons that is due to that exposure
- AR = le - ln (incidence in exposed group- incidence in non-exposed group)
- the risk in those exposed minus the background risk
45
Attributable Risk Percent
- the proportion of disease in exposed person due to that exposure
- AR% = (le- ln)/le x 100
- the proportion of risk in those exposed that is due to the exposure
46
Criteria for causation
Temporality- must precede the event
strength of association- stronger = more causal
Dose-response-exposure increases frequency
Replication of findings
Biological Plausibility
Consideration of alternate findings
Cessation of exposure- exposure taken away- disease decrease
Consistency with other knowledge
Specificity
47
What is Health
-defined in World Health Organization's Constitution as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity
48
Public health
- an organized effort to improve the health of a community
- changes in health status can best be achieved through partnership between clinical efforts focusing on individual patients and community wide public health interventions addressing environmental and social determinants that place individuals at greater risk of disease
- emphasizes primary and secondary prevention
- recognizes that individual health and community health are elements of a continuum
49
History of Public health
- 2000-450 BCE Troy- water systems, covered sewers
- Middle Ages: Plague,smallpox- quarantine
- North America/Europe 1700-1800s- prevent sickly vessels from coming in, broad street pump, association of poverty and living conditions with disease
- North America/Europe late 1800s/1900s- germ theory, pasteurization, sterilization, chlorination
50
Priorities for public health in the 21st century
- disparities
- population based management of chronic diseases-challenging the built environment
- public health preparedness
51
Leading causes of death in the US 1900
1) influenza and pneumonia
2) TB
3) Diarrhea and enteritis
4) Heart disease
5) Stroke
6) Kidney disease
7) Accidents
8) cancer
9) Senility
10) Diptheria
52
Leading causes of death in the US 2010
1) Heart disease
2) Cancer
3) COPD
4) Stroke
5) Accidents
6) Alzheimer's disease
7) Diabetes
8) Kidney disease
9) Influenza and pneumonia
10) Suicide
53
Independent variable
- variables that are manipulated
- experimental manipulation - randomized assignment
-Quasi-experimental manipulation-assignment by non-random methods
54
Dependent Variables
-the variable in which you will measure change and/or differences
55
Classification of variables
- extraneous (nuisance) variables)- variables that may confound the primary effect or relationship of interest
- explanatory variables- attributes or factors that contribute toward and understanding of the relationships or effects studied
56
Research validity
Internal validity- extent to which the study lacks bias
External validity- degree to which the results are generalizable
57
Reasons to do experiments
- reduce bias (increase internal validity)
- support cause and effect
- achieve optimal "control" of confounding variables
- provide strongest evidence for efficacy and effectiveness of interventions
- consider: some strategies that increase internal validity (e.g. exclusion) reduce external validity
58
Achieve control
- use a "control" group
- randomized assignment
- repeated measures design (subjects are their own controls)
- measure and adjust for potential confounders
- use homogeneous groups (exclusion)
- matching on a characteristic (e.g. sex)
- statistical "adjustment" (e.g. regression)
59
Randomized Controlled Trials (RCT)
- randomized assignment
- concealed allocation (prevents clinician from altering assignment)
- masking/blinding: various parties are kept unaware of treatment/control status
- masking/binding may not be possible
- institutional or participant resistance to randomization
- must include important sub-populations in clinical research
60
RCT Designs
- pretest-posttest control group designs (including mult-group)- you can do usual care, or no treatment
- factorial designs (including repeated measures)
- cross-over studies
61
Quasi-experimental Designs
- non-equivalent control-group designs
| - before-and-after designs
62
Factorial Designs
- tests >1 indep. variable (two factors 2x2)
- main effects: A only, B only
- interactions effects: A+B, or A x B
-assessment of 1) group (treatment) effect 2) within subject effects (repeated measures) 3) Group x time interaction
63
Cross-over trial
-start with the intervention and then go to the control and then switch over
64
Advantages of RCT
- randomization minimizes bias
- supports a causal relationship
- highest level of evidence
65
Disadvantages of RCT
- treatments must be standardized
- environment is tightly controlled
- selective recruitment of participants
- limited external validity
