Midterm 1 Flashcards
(125 cards)
1
Q
“public health” is the ART and SCIENCE of (3 things):
A
- preventing disease
- prolonging life
- promoting physical health
through organized community efforts
2
Q
What type of prevention does “public health” emphasize?
A
primary prevention
3
Q
what is the goal of public health?
A
to make sure everyone in the commuity has an adequate standard of living. to address disparities betwene groups
4
Q
are public health strategies segmented?
A
NO! they are shared across communities, regions, nations
5
Q
The united nations is an example of which level of public health?
A
global level
6
Q
if the ministry of health gives out free flu vaccines, what level of public health is that?
A
provincial
7
Q
if nyc ads try to limit the size of sugar-sweetened drinks, waht level of public health is that?
A
the local level
8
Q
Public health used to be all about infectious disease. now it is more about:
A
chronic disease
9
Q
What types of risk factors are there?
A
modifiable risk ractors
non-modifiable risk factors
10
Q
what % of premature heart disease, stroke type 2 diabetes can be prevented through modifiable risk factors?
A
80%
11
Q
what % of cancers can be prevented through modifiable risk factors?
A
40%
12
Q
What are 3 reasons whi there has been a global shift from under nutrition to overnutrition?
A
- marketing
- ease of access to sweets
- more animal based diets
13
Q
what is the direct, indirect and total cost of sedentary lifestyle in canada?
A
direct cost: 2.4 billion (3.8% of healthcare costs)
Indirect costs: 4.3 billion (3.6% of healthcare costs)
Total healthcare costs: 6.8 billion (3.7% of healthcare costs)
14
Q
what is the most common preventable disease in the world?
A
lung cancer
15
Q
what is the 2nd leading risk factor for morbidity and disability?
A
alcohol use
results in 3 milion deaths wordlwide
16
Q
what are the 4 stages of public health?
A
- promotion (no risk)
- prevention (at risk) - THIS IS THE KEY
- early intervention (early signs of risk)
- treatment/palliative care (disease)
17
Q
how do we intervene to address the risk factors in public health?
A
- employ population strategies
- employ individual interventiona
18
Q
What are the 3 points of intervention in public health?
A
- upstream
- midstream
- downstream
19
Q
Menu labelling is an example of _____ intervention
A
upstream
20
Q
trans fat restrictions is an example of _____ intervention
A
upstream
21
Q
breakfast programs at school are an example of _____ intervention
A
midstream
22
Q
media campaign promoting F&V intake is example of _____ intervention
A
midstream
23
Q
glucose monitoring is an example of _____ intervention
A
downstream
24
Q
_____ intervention is all about prevention
A
midstream
25
_____ is a specific collection of decisions with related actions, established by a government and supported by legislation
policy
26
______ looks at how diet and nutrition help prevent chronic disease and prolong life
public health nutrition
27
how do dietitians bring expertise in nutrition, food systems, and public health services? (4 areas):
1. they ASSES nutrition issues
2. they PLAN nutrition programs
3. they IMPLEMENT population nutrition health plan
4. they EVALUATE and modify plans
28
public health nutrition focuses on a wellness paradigm, not an illness paradigm
29
public health nutrition focuses on primary prevention
30
What are 3 key qualities of public heath nutrition?
1. a TRANSPARENT mechanism to provide scientific nutrition advice to government
2. a RELIABLE means for monitoring diet
3. an EFFECTIVE means of developing and evaluating policies
31
what are 6 main gloabl issues in public health nutrution?
1. micronutrient deficiency disease
2. malnutrution
3. infectious disease
4. chronic dease
5. re-emergence of micronutrient deficiencies
6. nutrition transition
32
what are 3 important functions of effective public health nutrition?
1. evidence, acquisition, synthesis and disseminiation
2. monitoring and surveillance
3. evidence informed policy development
33
why is public health nutrition surveillance valuable? (3)
1. it allows us to identify vulnerable subgroups
2. we can use surveys to calculate the distribution of relevant factors in a population
3. we can make appropriate public health nutrition policy goals
34
when talking about vulnerable subgroups of a community, they are based on 4 things:
1. age
2. sex
3. ethnicity
4. SES
35
if i want to calculate the risk factors in a population, what is a good way to do it?
surveys
36
____ is the area of public health that is interested in integrating primary care, preventative medicine, and public health
clinical public health
37
Remote care monitoring and UHN social medicine are examples of _____
clinical public health
38
What is the purpose of a nutritional assessment? (2)
1. to identify nutritional needs
2. to plan personal healthcare or community programs
Used for individuals and graps.
Used for MALNUTRUTION
39
____ is the state of health as it is influenced by the intake and utilization of nutrients
nutritional status
40
41
What are hte main components of nutritional assessments?
Anthropometric
Biochecmical
Clinical
Dietary
42
What are the 2 types of anthropometric measures?
1. growth
2. body composition (ex: waist circumference)
43
what age is brain circumference used for
< 2 years
44
Is BMI intended for use at a population level or an individual level
population level
45
What are the 7 groups who BMI doesnt apply to?
1. infants
2. children
3. pregnant women
4. lactating women
5 adults > 65
6. athletes
7. people iwth edema
46
Should you use BMI for adolescence?
You can, but need to be careful as they may not have reached full height
47
what waist circumference is associated with excess abdominal fat?
Men > 102 cm (40 inches)
Women > 88 cm (35 inches)
48
_____ indicates a child's position relative to a reference population for age and geder
percentile chart
49
if someone is 98th peercentile on the growth cart, what does that mean?
they are in the top 2% of population distribution
50
WHich populations was BMI based off of?
French
Scottish
51
Why did the US start to use BMI?
US life insurance companies started using it to assess what to charge prosective health policyholders
52
what are key points of the 2020 Obesity guidelines?
1. obesity is a prevalent, complex, progressive, relapsing chronic disease
2. people with obesity face bias and stigma
3. need to focus on improving patient-centred health outcomes
4. must validate patients' lived experiences
53
What are the 5 key steps in obesity management?
1. ask permission
2. assess their story
3. advise on management
4. agree on goals
5. assist with barriers
54
why are clinical methods of nutritional assessment helpfup?1.
they help detect advanced malnutrition
55
What is included in clinical methods of nutrition assessment?
1. health interview / medical history
2. physical exam
- subjective global assessment
56
what is the gold standard for diagnosing malnutrition?
subjective global assessment
57
who created the subjective global assessment (clinical methods)?
the Canadian Malnutrition Task Force
58
when would one use the subjective global assessment (clinical physical assessment)
in acute care (not in population based setting
59
what are 6 examples of dietary nutritional assessment methods?
1. 24 hour recall
2. 3 day food record
3. estimated food record
4. weighed food records
5. food frequency questionnaires
6. diet history
60
____ are groups that would benefit most from public health programs and services
priority populations
61
Identifying priority populations is based on 3 factors:
1. marginalization
2. vulnerability
3. other risk factors
62
_____ is an approach that balances targeted and universal population health perspectives through action propoportionate to needs and levels of disadvantaged in a population
It can address burden of disease across determinants of health
proportionate universalism
63
if imaging the baseball game analogy, people standing on different size boxes is an example of
proportionate universalism
64
_____ is the unnecesssary, avoidable, unjust and unfair differences in health status
health inequities
65
_____ is a process where community members come together to take collective action and generate solutions to common problems.
it can be used to reduce inequities
community development
66
supporting young dads in niagra is an example of
community development initiative to reduce inequities
67
empowering isolated women is an example of
community development initiative to reduce inequities
68
providing stigma-free services for gay men is an example of
community development initiative to reduce inequities
69
____ is a social research and public health model designed to help us better understand the lived experiences of people of oprressed communities
the minority stress model
it says that within the social structure of a certain culture, certain oppressed groups experience more minority stress in the form of prejudice
70
what is the difference between targeted and population approached?
a targeted approach addresses activities of a segment of a population
a population-based approach aims to change factors affecting the netire population
this can be used to directly uplift a smaller group of a population, including a prioriry population
71
72
How do we measure the global burden of disease?
DALY
Disability adjusted life year
73
1 DALY =
1 year of life lost
74
What is the best way to measure the overall burden of disease?
DALY - disability adjusted life year
75
We use this to calculate the gap between current population health status and ideal health status
DALY - disability adjusted life year
76
What are the 2 components that make up DALY?
YLL (years of life lost due to premature mortality) + Years lost to disability
77
what tool do we use to measure life expectancy combined with the quality of life-years remaining or expected?
QALY (quality adjusted life years)
it looks at years of good health
78
What are 6 examples of actions we can take to address public health nutrition problems?
1. develop action plans - give road map on how to meet targets
2. set nutrition targets - ex. DRIs
3.write reports and guidelines)
4. establish collaborative approaches (The world health organization)
5. develop adopt and endorse strategies, like the WHO DIet and Physical Activity strategy
6. establish committes
7. hold international conferences
79
what was the 4 goals of the who diet and physical activity strategy
the goal were:
1. to reduce TFA
2. to reduce salt
3. to increase availability of healthier foods
4. to restrict availability of energy dense foods
80
what were the policy priorities for the who diet and physical activity strategy
1. to practice responsible marketing of foods for kids
2. to make healthy options available
3. to give clear food labels
4. to reshape. the food industry
5. to make physical activity accessible
81
Canada's healthy eating strategy has 3 main goals:
1. improving healthy eating info
2. improving nutrition quality in foods
3. protecting vulnerable populations
82
____ is the process of enabling people to increase control over, and to improve their health
health promotion
83
______ is an example of WHO evidence-based guidelines to support development of nutrition interventions, guide policy development and inform program design
eLENA (e-library of evidence for effective nutrition)
84
What does eLENA stand for?
e-library of evidence for nutrition actions
85
What are the 4 different intervention types in the eLENA database (e-library of evidence of nutrition actions)
1. behavioural interventions
2. regulatory interventions
3. nutrition interventions
4. other health-related interventions
86
What are 8 key aspects of successful interventions?
1. identify at risk groups
2. analyze the costs and benefits (SWOT)
3. identify and engage key stakeholders
4. include community engagement
5. include ongoing promotion to maximize engagement
6. build evaluation methods into the process
7. establish long term effectiveness
8. translate into national policy and legislation
87
if a country is deciding to create a national policy, what are 4 things it thinks of?
1. epidemiological patterns
2. politics
3. administrative capabilities
4. stakeholder engagement
88
what are 5 reasons why policies fail?
1. poor policy planning
2. challenges in governance - who is owning the policy
3. implementation challenges
4. indaquate resources
5. insufficient surveillance
89
What is GINA?
global database on implementation of nutrition action
90
what are 4 different umbrella strategies for public health diet behaviour change interventions?
1. regulation
2. financial policies
3. non-financial policies
4. choice architecture including 'nudges' (environment in which choices are made)
91
the. 2categories of regulation for interventions include
removing choice
restricting choice
92
the. 2categories of financial policies for interventions include
1. disincentives
2. incentives
93
the. 2categories of non-financial policies for interventions include
incentives and disincentives
persuasion
94
the 4 categories of choice architecture for interventions include:
1. provision of information
2. change to the physical environment
3. change to the default situation
4. use of social norms and salience (giving info about what others are doing)
95
any aspect of the choice architecture that alters peoples behaviour in a predictable way without forbidding any options
nudging
96
what is the nourishing framework?
it is a policy framework used by cancer foundation to promote healthy diets and reduce obesity
it includes:
1. food environment
2. food system
3. behaviour change communication
97
What is the ladder of interventions?
1. give info
2. give choice
3. guide choice by changing the default policy
4. guide choice through incentive
5. guide choice through disincentive
6. restrict choice
7. eliminate choice
98
______ is the science that gives basic knowledge about the dietary causes of diseases
nutritional epidemiology
99
2 types of evidence provide direct support for rational practice in public health nutrition:
1. what is the problem, and what are the causes of the problem?
2. how can i best act/intervene? Ex: that a high intake of SFAs increase risk of heart attack. this needs to be placed in context. what portion of adults have high lintake?
100
what is the hiearchy of epidemiological studies for establishing causality (8)
1. SLR
2. RCT
3. cross-sectional study
4. case-control study
5. ecological study
6. case reports/case series
6. editorials, expert opinion
101
what are the 5 aspects of the health impact pyramid (in terms of increasign population impact and decreasing individual effort needed)
1. counselling and education
2. clinical interventions
3. changing context to make different default decisions
4. socioeconomic factors
102
_____ is the planning and implementation of actions to reduce or eliminate risk
risk management
103
_____ characterizes the nature and size of the health risks associated with a particular exposure
risk assessment
104
national surveys or screening are examples of ____ in action
risk assesment
105
____ allows for the estimate of the distribution of usual intake for a population
diet records
24 hour recall
106
______ are often used for national food consumption surveys for children
diet records
107
what is the biggest problem with diet intakes?
often underestimated
108
_____ describes the mean intake of a group
24 hour recall
109
______ are often used for national food consumption surveys for adults
24 hour recall
110
______ food assesment was developed for large epimiological studies
Food frequency questionnaires
111
______ is used for assesment of usual meal patterns
diet history
112
_____ is used in a clinical setting
diet history
113
systematic error reduces ____ of a measurement
accuracy
114
random error is smaller in smaller in larger studies. but thats not the case with systematic error
115
if something is accurate but not precise what does dart board look like
darts scattered all over the board
116
if something is precise but not accurate what does dart board look like
darts all close together, but slightly off the dart board
117
_____ error leads to imprecision, while ____ error leads to inaccuracy
random error leads to imprecision
Systematic error leads to inaccuracy
118
what are 2 ways to fix random error
1. increase sample size
2. improve quality of procedures
119
120
3 behaviour change theories we learned in class:
1. social cognitive theory
2. theory of planned behaviour
3. trans-theoretical model/stages of change
121
what are 6 key aspects of social cognitive theory?
1. reciprocal determinism
2. outcome expectations
3. observational learning
4. incentive motivation
5. facilitation
6. self-efficacy
122
The theory of planned behaviour change theory is a model that predicts human behaviour based on 3 factors:
1. attitude
2. subjective norms
3. perceived behavioural control
123
what are the 4 features of the trans-theoretical model of behaviour change theory?
1. stages of change
2. processes of change
3. decisional balance
4. self-efficacy
124
Getting someone to meditate will, at a bare minimum, require them to intend to meditate. This is an example of:
theory of planned behaviour
125
