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Public Health > Exam 1 - Slides > Flashcards

Exam 1 - Slides Flashcards

1
Q

What is public health?

A

The science and art of preventing disease, prolonging life, and promoting health through organized community effort.

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2
Q

What are the 4 critical health challenges at the beginning of the 21st century?

A
  1. High levels and rapid growth of noncommunicable diseases in developing countries
  2. Unchecked HIV/AIDS pandemic
  3. Possible Influenza pandemic
  4. Persistence of high but preventable mortality and disability from malaria, TB, diarrhea & pneumonia; from malnutrition; and for both mothers and babies, from childbirth
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3
Q

What perspectives does public health use?

A

Epidemiologic
Biomedical
Socio-cultural
Intervention and health systems
political-economic
Ethical & Human rights

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4
Q

What is the social-ecologic framework?

A

Considers individuals influenced by interconnected levels, emphasizing interaction between person and environment.

Levels: Individual, Interpersonal, Neighborhood, community, intercultural.

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5
Q

What is Bronfrenbrenner’s Ecological theory of development?

A

Describes development as influenced by interconnected environmental systems, from immediate surroundings to broader social contexts.

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6
Q

Social-ecological framework systems

A

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

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6
Q

What are proximal, underlying, and basic causes of health-related factors?

A

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

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6
Q

What are the 4 functions of health systems?

A
  1. Provide health services
  2. Raise money to pay for services
  3. pay for services
  4. Govern and regulate the system
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6
Q

What 3 resources make up health systems?

A

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.

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7
Q

Type of pharmaceuticals

A
  1. Proprietary drugs: patent for exclusive manufacturing.
  2. Generic: cheaper, same formula.
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8
Q

What are some human resources?

A

Doctors
Nurses
Allied healthcare professionals – Midwives
Pharmacists

*Community health workers

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9
Q

What is a good healthcare system?

A

Delivers quality services to
all people, when and where they need them

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9
Q

What are the 4 outstanding global challenges?

A
  1. Global shortages
  2. Skill imbalances
  3. maldistribution of available health workers
  4. weak knowledge
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10
Q

What are the 6 challenges to health systems?

A
  1. Staff shortages
  2. Aging population and Increasing prevalence of chronic diseases
  3. Ensuring quality governance
  4. Mobilizing sufficient resources to the health sector
  5. Building a high-quality, equitably distributed healthcare workforce
  6. Ensuring access and equitable provision of healthcare (Creating mechanisms to protect the poor from healthcare costs)
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11
Q

What are the 5 health system initiatives?

A
  1. Training and retaining
  2. Task shifting (CHW)
  3. Improving the quality of services
  4. Improving equity
  5. Study Design
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12
Q

What is task shifting?

A

Task Shifting is the delegation process where tasks are transferred, as suitable, to less specialized healthcare workers.

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13
Q

How do CHW help?

A

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

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14
Q

Give two examples of physical capital, consumables, and healthcare personnel.

A

Physical Capital: Hospitals, Ambulances

Consumables: PPE, Flu shots

Healthcare personnel: Doctors, CHW

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15
Q

What is the advantage of generic drugs in low-resource settings?

A

More affordable and accessible.

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16
Q

Why might training allied health professionals such as community health workers decrease the load of doctors?

A

Task shifting…

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17
Q

What is exposure, outcome, and cofactor?

A

Exposure: independent variable, predictor

outcome: dependent variable, disease, or event

cofactor: covariate, modified, confounder, or interaction term.

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18
Q

What are 3 common epidemiologic measures?

A

Occurrence

Association

Impact

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19
Q

What are the 4 uses of epidemiology?

A
  1. Surveillance
  2. Understanding causation
  3. Evaluate prevention efforts
  4. Inform public health policy
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20
Q

What are the types of epidemiologic studies?

A

Humans make inferences about causes of health-related outcomes in populations.

Observational
Experimental

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21
Q

Epidemiology is focused on the _______ and ______ of disease within a _______.

A

Epidemiology is focused on the amount and distribution of disease within a population.

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22
Q

What are the 3 measures of disease occurrence?

A
  1. Prevalence
  2. Incidence
  3. Risk
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23
Q

What term is fraction of the population is affected by the disease?

A

prevalence

24
Q

How fast is the disease occurring in the population?

A

Incidence

25
Q

What is prevalence?

A

(# of individuals with disease at a time) / (# people in population at risk at a time.)

26
Q

What is the incidence rate?

A

Incidence Rate = A / Person Time

27
Q

What is person-time?

A

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.

28
Q

What are the differences between prevalence and incidence?

A

Incident cases are not resolved but continue over time, then they become existing prevalent cases.

Prevalence = incidence x duration

29
Q

What is risk?

A

measure of disease onset or occurrence.

Risk = A/N

A = # of subjects developing disease

N = # of subjects followed for a certain time period

30
Q

What is a cohort study?

A

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.

31
Q

What is a case-control study?

A

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.

32
Q

What is a experimental study “trial” ?

A

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.

33
Q

Can behavior be changed?

A

Change is possible

Some health behaviors are intentional, whereas others are not motivated by health concerns

34
Q

What is the transtheoretical model & 5 stages?

A

Individual level
Stages of change

  1. Precontemplation- Not thinking about change
  2. Contemplation- thinking about making a change
  3. Preparation- getting ready to make a change (within 30 days)
  4. Action- has made a behavioral change (<6 months)
  5. Maintenance- has continued behavioral change (>6 months)
35
Q

What is the health belief model?

A

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.

36
Q

What is social cognitive theory?

A

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

37
Q

What is the structure of HIV?

A

retrovirus: lentiviruses or slow viruses

Lentiviruses have long induction time- times between initial infection and the onset of serious symptoms.

38
Q

What are the 7 steps in the HIV replication cycle?

A
  1. Fusion of the HIV cell to the host cell surface.
  2. HIV RNA, reverse transcriptase, integrase, and other viral proteins enter the host cell.
  3. Viral DNA is formed by reverse transcription.
  4. Viral DNA is transported across the nucleus and integrated into the host DNA
  5. New viral RNA is used as genomic RNA and to make viral proteins.
  6. New viral RNA and proteins move to the cell surface and a new, immature, HIV forms.
  7. The virus matures by protease releasing individual HIV proteins.
39
Q

How does HIV evolve to evade the immune system?

A

HIV replicated rapidly

Reverse transcriptase- many random errors leading to new strains of HIV in a person infected

Ability to evolve rapidly

40
Q

How does HIV devastate the immune system?

A

Targets cluster of differentiation 4 (CD4+) T cells

Overwhelms the immune system’s ability to regenerate or fight other infections.

41
Q

Routine HIV _____ should be offered to all patients

A

testing

42
Q

What is ART?

A

Antiretroviral therapy prevents disease progression and prolongs survival by use of HIV RNA, and CD4 cell counts.

43
Q

What is the current life expectancy for HIV+ people on therapy?

A

similar to the general population

44
Q

What are the 4 goals of antiretroviral therapy?

A
  1. To suppress HIV RNA (viral load level) as low as possible, for as long as possible
  2. To restore and preserve immune function. Increase CD4+ lymphocytes.
  3. To delay the clinical progression of HIV disease. Reduce risk of illness with HIV-related infection or cancer, prolonging quality and length of life.
  4. Prevent HIV transmission.
45
Q

Where can drugs act in the HIV lifecycle?

A

Attachment and entry

Reverse transcription

Integrations

Transcription and translation

Assemble and budding

46
Q

What is HIV+ disease progression in the absence of ART?

A

9-10 years progression to AIDS

9.2 months of survival after AIDS diagnosis

47
Q

What are the 6 HIV transmission routes?

A
  1. Sexual transmission
  2. Injection drug use
  3. Blood, blood products
  4. Prenatal transmission
  5. Needlestick injury
  6. breastmilk transmission
48
Q

HIV/AIDS Epidemiology

A
  • 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”
49
Q

What are the key regions affected by HIV/AIDS in 2024?

A

Eastern and Southern Africa

Western and Central Africa

Asia and the Pacific

50
Q

What are the key populations affected by HIV/AIDS in 2024?

A

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.

51
Q

How can political organizations coordinate to address the HIV/AIDS pandemic?

A

Send money

Promote awareness of the pandemic

52
Q

What is the simple model of disease risk and causation?

A
53
Q

What are the key socio-cultural factors that have driven the epidemic?

A

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.

54
Q

What are populations at risk?

A

Ethnic minorities

Young women

Injection drug users

Men who have sex with men

Populations that experience historic inequality

55
Q

What is the individual risk behavior paradigm?

A

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.

56
Q

What do HIV interventions seek to achieve?

A

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

57
Q

What are 3 intervention types?

A
  1. PReP: Behavioral + Drug
  2. Human Rights: Multi-faceted
  3. Mother to Child Transmission: Drug
58
Q

What is PrEP?

A

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.

59
Q

What are the Sustainable Development Goals

A

17 Goals, set out to be achieved in 2030

Three “pillars” of sustainability:
Environment (4)
society (8)
economy (4)

60
Q

UNAIDS prioritized 7 human rights programs for inclusion in AIDS responses

A

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

61
Q

What is a logic model?

A

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

62
Q

What are logic models’ key components?

A

Inputes/Activities

Outputs

Intermediate outcomes

Long-term outcomes

63
Q

What are issues and assumptions with logic models?

A

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.

Public Health (5 decks)

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