chapter 2; evidence based public health + Chapter 3; Flashcards
the first step in addressing a health problem is to describe its […] of disease, which is the occurrence of disability and death due to a disease
burden
in public health, disability is often called […] and death is called […]
morbidity
mortality
in addition to describing the burden of disease, it is important to describe what we call the […] of a disease
course
e.g. how often it occurs, how likely it is to e present currently, and what happens once it occurs
in addition to describing the burden and the course of a disease or other health problem, we need to ask: what is the […] of disease
distribution
e.g. who gets the disease, where are they located, when does the disease occur,
defining the criteria they are using to measure the occurrence of the disease; is known as case […]
definition
public health professionals called epidemiologists investigate factors known as “person” and “place” to see if they can find patterns or associations in the […] of a disease. aka group associations
frequency
three basic reasons that changes in rates may be artifactual rather than real
- differences or changes in the interest in identifying the disease
- differences or changes in the ability to identify the disease
- differences or changes in the definition of the disease
group associations are established by investigations that use information on the specific individuals within the group; population […] or ecological studies
comparisons
to conduct age adjustment, epidemiologists look at the rates of the disease in each age group and also the age distribution, or the number of people in each age group in the population
yes
contributory cause can be related with cause and effect at the individual , preceding in time, and altering the effect
yes
using a chance process known as […] or random assignment, individuals are assigned to be exposed or not exposed to the potential “cause”
randomization
[…] criteria, or ancillary criteria, that we can use to help us establish the existence of contributory cause
supportive
efficacy implies that an […] works, that is, it increases positive outcomes or benefits in the study group compared to the control group being investigated
intervention
the […] of the relationship implies that we are interested in knowing how closely related the risk factor is to the disease
strength
biological plausibility implies that we can explain the occurrence of disease based upon known and accepted biological mechanisms
yes
evidence based recommendations are built upon the evidence from studies of […]
interventions
evidence based recommendations are based upon two types of criteria: the [..]of the evidence and the magnitude of the [..]
quality
impact
well conducted [..] [..] trials that fully address the health problem are considered the highest quality evidence
randomized controlled
the quality of the evidence also includes determining whether the data collected during an intervention are relevant to their use in a particular […] or […]
population
setting
poor quality evidence implies that there are fatal flaws in the evidence and […] cannot be made
recommendations
the magnitude of the impact is the benefits minus the harms, or the “net benefits”
yes
why?
- due to evidence based recommendations taking into account the potential benefits of an intervention, as well as the potential harms
primary interventions take place […] the onset of the disease. they aim to […] the disease from occurring
before
prevent
secondary interventions occur […] the development of a disease or risk factor, but […] symptoms appear. they are aimed at early detection of disease or reducing […] factors while the individual is asymptomatic
after
before
risk
tertiary interventions occur after the initial occurrence of symptoms, but before […] disability . they aim to prevent irreversible […] of the disease
irreversible
consequences
victim blaming is when they blame the consequences of the disease on the individual
yes
effectiveness is when evaluating how well an intervention works in public health or clinical practice. the term efficacy, in contrast, is used when we address how well an intervention works under research conditions
population prediction models aim to predict the […] and also enhance […] of how that future can be improved by potential interventions
future
understanding
the term health communications deals with the methods for […], […], and […] health information
collecting, compiling, and presenting
since the field of health communications has been growing at the speed of the internet. along with this is the growth has come the dramatic increase in ‘incomplete information’, ‘misinformation’, and ‘disinformation’
following aspects of health communications, ask the following questions;
collecting data: where does public health data come from?
compiling information: how is public health information compiled or put together to measure the health of a population
presenting information: How can we evaluate the quality of the display and presentation of public health information
perceiving information; what factors affect how we perceive public health information
combining information: what types of information need to be combined to make health decisions
decision making; how do we utilize information to make health decisions
the methods in which public health data are collected, is public health […]. data from public health surveillance are […], […], and […] without identifying specific individuals
surveillance
collected, published, and distributed
the public health data, health communication, and the flow of information is
collect, compile, present, perceive, combine, and decision making
yes
single case or small series
e.g. case reports of one or a small number of cases (first report of AIDS)
user; alert to new disease or resistant disease, alter to potential spread beyond initial area
advantages/disadvantages; useful for dramatic, unusual and new conditions, requires alert clinicians, and rapid ability to disseminate information
statistics I “vital statistics” I and reportable disease
e.g. vital statistics: birth, death, fetal death after 20 weeks, marriage, divorce, reporting of key communicable and specially selected noncommunicable disease [e.g. elevated lead levels, child and spouse abuse, etc.] also may include other government records such as motor vehicle injury and police reports
users; required by law - sometimes penalties imposed for noncompliance, births and deaths key to defining leading causes of disease
advantage/disadvantages; vital statistics very complete because of social and financial consequences, reportable disease often relies on institutional/laboratory reporting rather than individual clinicians, frequent delays in reporting data
surveys sampling
e.g. National Health and Nutrition Examination Survey [NHANES]
Behavioral Risk Factor Surveillance system [BRFSS], also includes disease specific registries
users; drawing conclusions about overall population and subgroups from representative samples, registries attempt to include all those with a disease in order to be representative of the population
advantages/disadvantages; well conducted surveys allow inferences to be drawn about larger populations, frequent delays in reporting data, difficult to include all potential patients in disease registries
self reporting
e.g. adverse effect monitoring of drugs and vaccines as reported by those affected
users; may help identify unrecognized or unusual events
advantage/disadvantage; useful when dramatic, unusual events closely follow initial use of drug or vaccine; tends to be incomplete; difficult to evaluate meaning because of selective process of reporting
sentinel monitoring
e.g. influenza monitoring to identify start of outbreak and changes in virus type
users; early warnings of previously unrecognized events
advantages/disadvantages; can be used for “real time” monitoring; requires considerable knowledge of patterns of disease and use of services to develop
syndrome surveillance
e.g. use of symptom patterns (headaches, cough/fever, or gastrointestinal symptoms) plus increased sales of over the counter drugs to raise alert of possible new or increased disease
users; may be able to detect unexpected and subtle changes, such as bioterrorism or new epidemic producing commonly occurring symptoms
advantages/disadvantages; may be used for early warning even when no disease is diagnosed; does not provide a diagnosis and may have false positives
social media
e.g. data on outbreaks using key words from social media
users; detect and monitor course of influenza epidemic
advantages/disadvantages; potential for immediate data obtained from a larger number of individual, accuracy and precision of the data for early and ongoing surveillance needs to be established
data from different sources are increasingly being […] to create integrated health data systems or databases that can be rapidly and flexibly accessed by computers to address a wide range of questions
combined
integrated databases also create the potential for […] of the most intimate health information. thus, protecting the privacy of data and ensuring their anonymous collection and distribution is now of great concern as part of the development of integrated databases
abuse
measurements that […] the health of populations are called population health status measures.
summarize
in the 20th century, two measurements became standard for summarizing the heath status of populations the […] mortality rate and life […]
infant
expectancy
the infant mortality rate estimates the rate of death in the […] year of life. has been used as the primary measurement of child health
first
life expectancy has been used to measure the overall death experience of the population, incorporating the probability of dying at each year of life
yes
the degree of success in reducing mortality among children aged 2 to 5 has not been as great. malnutrition and old and new infectious diseases continue to kill young children.
however, improvements in the care of severely ill newborns have extended the lives of many children - only to have them die after the first year of life
once a child survives to age 5, he or she, has a very high probability of […] into adulthood in most countries . thus, a new measurement known as under-5 mortality has now become the standard health status measure used by the World Health Organization (WHO) to summarize the health of children
surviving
life expectancy is a snapshot of a population incorporating the probability of dying at each […] of life in a particular year
age
despite its name, life expectancy cannot be used to accurately predict future life spans, especially for the young
yes
life expectancy does not reflect the impact of […] only of dying. when considering the health status of a population in the 21st century, we need to consider disability, as well as death
disabilities
two important measures of mortality are “years of potential life lost (YPLL)” and “excess mortality”. measured from premature deaths before age […]. puts more importance on deaths at younger ages
75
e.g. death at age 74 counts as only 1 year of life lost, at age 5, as 70 years lost
measurement of YPLL has highlighted the “deaths of […]” from drug overdoses, alcohol abuse, and suicide which have all increased substantially among those in the “[…] of life” from ages 15 to 64
despair
prime
[…] deaths are increasingly being used to measure the impact of disasters, epidemics, pandemics, and other large-scale events. measure the number of deaths that occur in a geographic area of interest during each month of the event […] to the number of deaths that occurred during the same month in the same geographic area during several previous years
excess
compared
side note; do not generally take into account the age of the individuals who died
today, the WHO uses a measurement known as the health-adjusted life expectancy (HALE) to […] the health of populations. starts with life expectancy and then […] measurement of the quality of health
summarize
incorporates
the health-adjusted life expectancy (HALE) includes; mobility, cognition, self care, pain, mood, sensory organ function
mobility (ability to walk without assistance)
cognition (mental function, memory)
self care (activities of daily living, dressing, eating)
pain (regular pain that limits function)
mood (alteration in mood that limits function)
sensory organ function (impairment in vision or hearing that impairs function)
an additional measure known as the disability-adjusted life year (DALY), has been developed and used by the WHO to allow for […] and […] based on categories of diseases and conditions
comparisons
changes
DALYS are designed to examine the impacts that […] disease and […] factors have on populations, as well as provide an overall […] of population health status
specific
risk
measure
DALYs are measured by comparing a country’s performance to the country with the longest life […], which is currently Japan of 85 years. in a country with zero (DALYs) the average person would live approximately 85 years without any [….] and would then die suddenly
expectancy
disability
(ALL countries have DALYs greater than zero)
the WHOs Global Burden of Disease (GBD) project has produced a number of important conclusions using DALYs
- Depression is a leading cause of disability and may become the top contributor in both developing and developed countries in the coming decades.
- Chronic diseases like hookworm, malaria, HIV, and asthma, which affect young and working-age people, are major causes of disease in many developing countries.
- Cancers (e.g., breast, liver, colon) in working-age adults are significant contributors to the disease burden in developing countries.
- Injuries from accidents, including motor vehicle and workplace accidents, cause long-term disabilities and deaths, especially in younger people, impacting the disease burden more than just deaths alone.
- Obesity is becoming a bigger problem than malnutrition in developing countries, with rising cases of diabetes, heart disease, and strokes among younger populations.
toady, the internet is a great source of information but it also includes; incomplete information, misinformation, and disinformation
- incomplete information is correct or accurate information that does not provide the full picture and may therefore be misleading. decisions that could have been different
- misinformation is any inaccurate or false information which is believed by the user to be accurate. need to identify in order to address
- disinformation is incorrect information intentionally presented to encourage specific actions. increased dramatically w/ social media
public health information is often presented as […], which may be combined with other ways to display information into an infographic
graphics
understanding the degree of health literacy of the intended audience is so important . it refers to the degree to which individuals have the […]to obtain, process, and understand basic health information and services needed to make appropriate […] decisions
capacity
health
at least three types of effects can greatly influence our perceptions of potential harms and benefits. called the […] effect, the […] effect, and the […] effect
dread
unfamiliarity
uncontrollability
the dread effect is present with hazards that easily produce very […] and feared […]
visual
consequences
the uncontrollobility effect may have a major impact on our perceptions and actions
perceptions
actions
the unfamiliarity effect
