Exam 1 - Slides Flashcards
What is public health?
The science and art of preventing disease, prolonging life, and promoting health through organized community effort.
What are the 4 critical health challenges at the beginning of the 21st century?
- High levels and rapid growth of noncommunicable diseases in developing countries
- Unchecked HIV/AIDS pandemic
- Possible Influenza pandemic
- Persistence of high but preventable mortality and disability from malaria, TB, diarrhea & pneumonia; from malnutrition; and for both mothers and babies, from childbirth
What perspectives does public health use?
Epidemiologic
Biomedical
Socio-cultural
Intervention and health systems
political-economic
Ethical & Human rights
What is the social-ecologic framework?
Considers individuals influenced by interconnected levels, emphasizing interaction between person and environment.
Levels: Individual, Interpersonal, Neighborhood, community, intercultural.
What is Bronfrenbrenner’s Ecological theory of development?
Describes development as influenced by interconnected environmental systems, from immediate surroundings to broader social contexts.
Social-ecological framework systems
Mesosystem: relations between microsystems, connections between contexts
Exosystem: Links between the individual and contexts in which they do not have an active role.
Macrosystem: culture, socio-economic status, ethnicity
Chronosystem: environmental events and transitions over the life course
What are proximal, underlying, and basic causes of health-related factors?
Proximal: causes are most immediately related to the outcome
Underlying causes: which are less immediately related to the outcome
Basic causes: the most fundamental, macro-level causes
What are the 4 functions of health systems?
- Provide health services
- Raise money to pay for services
- pay for services
- Govern and regulate the system
What 3 resources make up health systems?
Human Resources
Physical Capital: non-human healthcare infrastructure, such as hospitals and medical equipment.
Consumables: disposable resources that are used regularly in the delivery of healthcare.
Type of pharmaceuticals
- Proprietary drugs: patent for exclusive manufacturing.
- Generic: cheaper, same formula.
What are some human resources?
Doctors
Nurses
Allied healthcare professionals – Midwives
Pharmacists
*Community health workers
What is a good healthcare system?
Delivers quality services to
all people, when and where they need them
What are the 4 outstanding global challenges?
- Global shortages
- Skill imbalances
- maldistribution of available health workers
- weak knowledge
What are the 6 challenges to health systems?
- Staff shortages
- Aging population and Increasing prevalence of chronic diseases
- Ensuring quality governance
- Mobilizing sufficient resources to the health sector
- Building a high-quality, equitably distributed healthcare workforce
- Ensuring access and equitable provision of healthcare (Creating mechanisms to protect the poor from healthcare costs)
What are the 5 health system initiatives?
- Training and retaining
- Task shifting (CHW)
- Improving the quality of services
- Improving equity
- Study Design
What is task shifting?
Task Shifting is the delegation process where tasks are transferred, as suitable, to less specialized healthcare workers.
How do CHW help?
Undertake less specialized tasks, easing the workload of medical professionals (doctors, nurses)
Diminish social and geographical gaps between community members and the health system
Ultimately empowers the community’s voice within the health system
Give two examples of physical capital, consumables, and healthcare personnel.
Physical Capital: Hospitals, Ambulances
Consumables: PPE, Flu shots
Healthcare personnel: Doctors, CHW
What is the advantage of generic drugs in low-resource settings?
More affordable and accessible.
Why might training allied health professionals such as community health workers decrease the load of doctors?
Task shifting…
What is exposure, outcome, and cofactor?
Exposure: independent variable, predictor
outcome: dependent variable, disease, or event
cofactor: covariate, modified, confounder, or interaction term.
What are 3 common epidemiologic measures?
Occurrence
Association
Impact
What are the 4 uses of epidemiology?
- Surveillance
- Understanding causation
- Evaluate prevention efforts
- Inform public health policy
What are the types of epidemiologic studies?
Humans make inferences about causes of health-related outcomes in populations.
Observational
Experimental
Epidemiology is focused on the _______ and ______ of disease within a _______.
Epidemiology is focused on the amount and distribution of disease within a population.
What are the 3 measures of disease occurrence?
- Prevalence
- Incidence
- Risk
What term is fraction of the population is affected by the disease?
prevalence
How fast is the disease occurring in the population?
Incidence
What is prevalence?
(# of individuals with disease at a time) / (# people in population at risk at a time.)
What is the incidence rate?
Incidence Rate = A / Person Time
What is person-time?
Accounts for all the time each person in the population is at risk.
The length of time for each person is called person time.
Sum of person-times is the total person-time of the population.
What are the differences between prevalence and incidence?
Incident cases are not resolved but continue over time, then they become existing prevalent cases.
Prevalence = incidence x duration
What is risk?
measure of disease onset or occurrence.
Risk = A/N
A = # of subjects developing disease
N = # of subjects followed for a certain time period
What is a cohort study?
Any designated group of individuals followed or traced over some time.
Comprised of persons with a common characteristic.
Measures occurrence of a specific disease (s) within 1+ cohorts.
Typically compares incidence rates or risks between two or more cohorts, enabling the calculation of a measure of association, such as the Rate Ratio or Risk Ratio.
What is a case-control study?
Uses sampling to achieve similar goals of the cohort study, but more efficiently.
Cases are those who develop disease.
The control group is sampled from the source population that gave rise to cases, but does not have the disease.
Individuals classified as exposed or unexposed.
What is a experimental study “trial” ?
Compare incidence rate or risk between 2+ cohorts, after assigning cohort members to exposure.
People are assigned “exposure characteristics” based on study protocol, usually randomization.
The difference between a community “intervention trial” and a “clinical trial” is that participants are not patients.
Can behavior be changed?
Change is possible
Some health behaviors are intentional, whereas others are not motivated by health concerns
What is the transtheoretical model & 5 stages?
Individual level
Stages of change
- Precontemplation- Not thinking about change
- Contemplation- thinking about making a change
- Preparation- getting ready to make a change (within 30 days)
- Action- has made a behavioral change (<6 months)
- Maintenance- has continued behavioral change (>6 months)
What is the health belief model?
Individual-level health behavior theory
People are more likely to take health-related actions if they perceive themselves to be susceptible to a health problem, believe the problem has serious consequences, believe that taking action would be beneficial in reducing the risk, and feel capable of performing the recommended actions.
What is social cognitive theory?
Emphasizes learning within a social context where individuals both influence and are influenced by their environment.
Behavior imitation is more likely with positive or negative reinforcement but less likely with punishment.
Individuals strive to develop agency and control over significant life events
What is the structure of HIV?
retrovirus: lentiviruses or slow viruses
Lentiviruses have long induction time- times between initial infection and the onset of serious symptoms.
What are the 7 steps in the HIV replication cycle?
- Fusion of the HIV cell to the host cell surface.
- HIV RNA, reverse transcriptase, integrase, and other viral proteins enter the host cell.
- Viral DNA is formed by reverse transcription.
- Viral DNA is transported across the nucleus and integrated into the host DNA
- New viral RNA is used as genomic RNA and to make viral proteins.
- New viral RNA and proteins move to the cell surface and a new, immature, HIV forms.
- The virus matures by protease releasing individual HIV proteins.
How does HIV evolve to evade the immune system?
HIV replicated rapidly
Reverse transcriptase- many random errors leading to new strains of HIV in a person infected
Ability to evolve rapidly
How does HIV devastate the immune system?
Targets cluster of differentiation 4 (CD4+) T cells
Overwhelms the immune system’s ability to regenerate or fight other infections.
Routine HIV _____ should be offered to all patients
testing
What is ART?
Antiretroviral therapy prevents disease progression and prolongs survival by use of HIV RNA, and CD4 cell counts.
What is the current life expectancy for HIV+ people on therapy?
similar to the general population
What are the 4 goals of antiretroviral therapy?
- To suppress HIV RNA (viral load level) as low as possible, for as long as possible
- To restore and preserve immune function. Increase CD4+ lymphocytes.
- To delay the clinical progression of HIV disease. Reduce risk of illness with HIV-related infection or cancer, prolonging quality and length of life.
- Prevent HIV transmission.
Where can drugs act in the HIV lifecycle?
Attachment and entry
Reverse transcription
Integrations
Transcription and translation
Assemble and budding
What is HIV+ disease progression in the absence of ART?
9-10 years progression to AIDS
9.2 months of survival after AIDS diagnosis
What are the 6 HIV transmission routes?
- Sexual transmission
- Injection drug use
- Blood, blood products
- Prenatal transmission
- Needlestick injury
- breastmilk transmission
HIV/AIDS Epidemiology
- Fewer aids-related deaths due to significant scale of ARV’s over the last 20 years.
- New infections are decline, but levels of new infections overall are still high
- With significant reductions in mortality, the number of PLWWHA has increased
- “People Living With HIV/AIDS”
What are the key regions affected by HIV/AIDS in 2024?
Eastern and Southern Africa
Western and Central Africa
Asia and the Pacific
What are the key populations affected by HIV/AIDS in 2024?
Globally 46% of all new HIV infections were among women and girls in 2022.
In sub-Saharan Africa, adolescent girls and young women accounted for more than 77% of new infections among young people aged 15-24 years in 2022.
How can political organizations coordinate to address the HIV/AIDS pandemic?
Send money
Promote awareness of the pandemic
What is the simple model of disease risk and causation?
What are the key socio-cultural factors that have driven the epidemic?
Ethnicity, poverty, gender, and location are risk factors
Increase in Middle East and North Africa
Reversal of the decline in new infections since 2005 for Eastern Europe and Central Asia.
What are populations at risk?
Ethnic minorities
Young women
Injection drug users
Men who have sex with men
Populations that experience historic inequality
What is the individual risk behavior paradigm?
The individual risk behavior paradigm is a model that says our health is mostly affected by our actions and choices. It’s about taking personal responsibility for our behaviors to stay healthy.
What do HIV interventions seek to achieve?
Prevention of new infections among all people, especially women and children, and key populations
Increase knowledge of serostatus
Increase proportions of PLWHA that are on ARVs
Improve care and quality of life of PLWHA
Address human rights and structural issues that silently fuel the epidemic
What are 3 intervention types?
- PReP: Behavioral + Drug
- Human Rights: Multi-faceted
- Mother to Child Transmission: Drug
What is PrEP?
PrEP reduces the risk of getting HIV from sex by about 99% when taken as prescribed.
PrEP is less effective when not taken as prescribed.
PrEP shots are not recommended for people who inject drugs.
What are the Sustainable Development Goals
17 Goals, set out to be achieved in 2030
Three “pillars” of sustainability:
Environment (4)
society (8)
economy (4)
UNAIDS prioritized 7 human rights programs for inclusion in AIDS responses
Reduce violence against women, increase women’s control over resources
(1) HIV-related stigma and discrimination reduction programs;
(2) HIV-related legal services;
(3) monitoring & reforming laws, policies, and regulations;
(4) rights and legal literacy programs;
(5) sensitization of lawmakers & law enforcement agents;
(6) training for health care providers on human rights and medical ethics related to HIV; and
(7) reducing discrimination against women in the context of HIV
What is a logic model?
A “logical” framework to understand how an intervention or program achieves its outcomes
Measures inputs, outputs, and outcomes related to a program’s processes and goals
Describes relationships between steps/processes
What are logic models’ key components?
Inputes/Activities
Outputs
Intermediate outcomes
Long-term outcomes
What are issues and assumptions with logic models?
Only used in planning
False assumptions
Unrealistic connections + casualty
Processes that link program inputs and outcomes may not be linear
Qualitative measures can be included as outcomes, but need to be well-defined.
