Health and Society

Question 1

What’s the best way fo measure burden?

Answer 1

death (most common, easiest), illness, costs, time (years of life lost)

Question 2

disability adjusted life year

Answer 2

principle 1 - the only differences in the rating of a death or disability should be due to age and sex, not to income, culture, location, social class

principle 2 - everyone in the world has right to bes life expectancy in world

DALY = YLL + YLD

Question 3

What is meant by disability?

Answer 3

impairment - symptoms at organ level

disability - objective alteration of behavior or performance at individual level

handicap - change dinteraction at the social/environmental level

Question 4

schema for assessing non-fatal health outcomes

Answer 4

disease -> impairment -> handicap

Question 5

What is the estimated level of disability?

Answer 5

IHD - 28.8 (worse than below the knee amputation)

Stroke 60.9 (around the level of unipolar depression, tetanus)

Question 6

What are the leading causes of death globally?

Answer 6

Ischemic heart disease and storke

Question 7

What are some major problems with data collected for NCD mortality?

Answer 7

major problems with death registrations in many coutnries

ex. over 80% of countires in Africa are not registered

Question 8

political reasons why NCDs might be neglected

Answer 8

apathy - difficult/complex to tackle, myth that risk factors only account for 50% of deaths

inadequate funding

NCDs are invisible

Question 9

What was the problem with the Denmark fat tax?

Answer 9

tax was levied on the carcass instead of the cut of beef

Question 10

What are the top three NCD funders?

Answer 10

WHO, Welcome Trust, Bloomberg + Gates

Question 11

five types of political incentives

Answer 11

political - squeaky wheel

economic - seek to shift priorities

organizational - sustaining status quo

symbolic - maintaining MDGs

scientific

Question 12

Possibilities of polypill

Answer 12

80% reduction in CVD events

increased adherence

less reliance on physicians

lower cost

Question 13

Problems with polypill

Answer 13

primary vs. secondary prevention

emphasis on pills > lifestyle > policies

dose titration, side effects

lower margins

Question 14

What are the top three sources of salt in the US diet?

Answer 14

bread

cured meat/cold cuts

pizza

Question 15

Why is salt so heavily used in food?

Answer 15

flavor

safety - antimicrobial

processing - changes how other ingredients behave

economics - profitability

Question 16

Class I treatment effect

Answer 16

benefit >>> risk

should be performed

Question 17

Class IIa treatment effect

Answer 17

benefit >> risk

reasonable to perform

Question 18

Class IIb treatment effect

Answer 18

benefit >/= risk

may be considered

Question 19

Class III treatment effect

Answer 19

no benefit or harm

should not be performed

Question 20

Level A evidence

Answer 20

multiple populations

data derived from multiple RTCs or meta-analysis

Question 21

Level B evidence

Answer 21

limited populations

data derived from a single RCT trial or non-randomized studies

Question 22

Level C evidence

Answer 22

very limited data

expert consensus of opinion, case studies, or standard of care

Question 23

What are the gaps in research and translation?

Answer 23

efficacy and effectiveness

moving new therapies to the bedside

making sure the quality, outcomes, and effectiveness are good

Question 24

performance measurements

Answer 24

structure measures - quality of staff and equipment

process measures - the process of treatment

outcomes measures - benefit of treatment

Question 25

What are performance measures used for?

Answer 25

quality improvement

public reporting

accountability

Question 26

attributes of satisfactory performance measures

Answer 26

useful in improving patient outcomes - evidence-based, interpretable, actionable

measure design - denominator precisely defined, numerator precisely defined, validity, reliability

measure implementation - feasibility

Question 27

primordial prevention

Answer 27

prevention of risk factors in the first place in disease free individuals

Question 28

secondary prevention

Answer 28

interventions geared to early detection and prompt treatment of disease, preferable before the development of clinical symptoms

Question 29

tertiary prevention

Answer 29

interventions geared towards minimizing the effects of disease or disability by preventing complications and premature deterioration