MIDTERM 2 Flashcards
Ottawa Charter
- International agreement signed at the First International Conference on Health Promotion, organized by the World Health Organization in Ottawa
- 212 participants from 38 countries met from November 17 - 21 1986 in Ottawa to exchange experiences and share knowledge of health promotion’
Health promotion (2)
- Process of enabling people to increase control over, and improve their health.
- To reach a state of complete physical, mental, and social well-being, an individual or group must be able to identify and realize aspirations to satisfy needs
Prerequisites for health (10)
Peace, shelter, education, food, income, stable eco-system, sustainable resources, social justice, and equity
Main aspects of health promotion action (5):
- Build a health public policy
- Create supportive environments
- Strengthen community action
- Develop personal skills
- Reorient health services
Build a health public policy and examples (HEALTH PROMOTION)
- Laws, regulations and rules enforced by governments that lead to improvements in health
- Eg. Smoke free work place, alcohol tax, compulsory wearing seatbelts
Create supportive environments and examples (HEALTH PROMOTION)
- A supportive environment that promotes health and assists people in making healthy life styles
- Eg. AA, Quitline (helps smokers to quit), shade areas in playgrounds
Strengthen community action and examples (HEALTH PROMOTION)
- Full and continuous access to information, learning opportunities for health, and funding support
- Eg. Creation of community health centres
Develop personal skills and examples (HEALTH PROMOTION)
- Increasing options for people to exercise more control over health
- Eg. Anger management programs, health education programs, attending healthy cooking classes
Reorient health services and examples (HEALTH PROMOTION)
- Shifting emphasis in health care towards health promotion by increasing attention to health research and changes in professional education/training
- Eg. Doctors incorporating dietary advice, prescribing exercise programs for high blood pressure
Commitment to health promotion (5)
- Counteract pressure towards harmful products, and focus on unhealthy living conditions and environments
- Respond to health gap within societies
- Acknowledge people as main health resource (friends and family)
- Recognize health as major social investment
- Advocate clear political commitment to health and equity
Lalonde report
Report that recognized that determinants of health went beyond traditional public health and medical care, and argued for the importance of socioeconomic factors.
PARTICIPACTION
Non-profit organization set up to promote physical fitness focusing on social marketing, communications, and partnerships
Goals of PARTICIPACTION (3):
- Raising awareness, educate and inspire people to do physical activity
- Coordinate communication to ensure consistent and uniform messages across the physical activity sector
- Forge partnerships between organizations promoting physical activity
Greek definition of epidemiology
The study of what is upon the people (Epi = among, demos = population)
Endemic
The amount of a particular disease that is usually present in a community. ·
Epidemic
Outbreak of a disease in a localized group of people spread by vectors, carriers, or sudden intro of new pathogens
Pandemic
Epidemics that have spread beyond their local region and are affecting people in various parts of the world
Cholera
Acute diarrheal illness caused by infection of intestine with Vibrio Cholerae
Outbreaks of cholera around the world
- 1817-1824 outbreaks of cholera in India
- 1831-1832 outbreaks in London and disappears until 1848-1849
- 1849 - Aug 1853 disappears again
John Snow (2)
- English physician known for his studies of cholera and is widely viewed as the father of contemporary epidemiology
- Developed 2 theories about cholera causes: Miasma vs germ theory
Miasma
Bad vapours in the air
Germ theory
Small organisms responsible
Grand experiment
Snow’s experiment of cholera of documenting source of drinking water for people dying from cholera
Toxic Shock Syndrome
Associated with menstrual periods and cases are more likely to use tampons
5 important W’s in epidemiology:
- What
- Who
- Where
- When
- Why
Different types of host factors (4):
- Personal factors people are born with
- Acquired host factors
- Transitory host factors
- Behaviors
Place/environmental factors that affect prevalence of disease (7):
- Climate
- Diet
- Cultural practices
- Methods of food preparation and storage
- Population density
- Exposure to pollutants
- Insects and bugs
Agents (4):
- Nutritive agents
- Chemical agents
- Physical agents
- Infectious agents
Applications of epidemiology (5): **
- Identifying cause of new syndrome
- Assessing risks of exposure
- Determining whether treatment “x” is effective
- Identifying health service use needs and trends
- Identifying practical prevention strategies
Epidemiological distribution
Occurrence of cases by time, place and person (Eg. According to a study of deaths in Country X in 2016, women…..)
Epidemiological specific population
A measurable group, defined by location, time, demographics and other characteristics
The epidemiologic approach (3):
- Counting cases and describing them in terms of time, place, and person
- Dividing the number of cases by an appropriate denominator to calculate rates (morbidity/mortality)
- Comparing the rates over time
Cases of children with HIV in 2021
1.7 million
Cases of children orphaned by AIDS in Sub-Saharan Africa in 2007
10 million
Significance of health status indicators
Useful for finding which diseases people suffer from , determining the extent to which the disease causes death or disability, and carrying out disease surveillance
Prevalence
The proportion of individuals in a population with the disease at a given point in time
Rules of prevalence rate (4):
- Calculate by # of cases of disease / total population
- Prevalence is often reported as “prevalence rates” but it is not a rate - NO UNTS
- Can be reported as proportion or percentage
- Must report time period at which people are counted
Point vs period prevalence
Point- a given point in time
Period- during specified time period
Significance and uses of prevalence (4):
- Quantify the proportion of people with a disease
- Estimate the probability that an individual will have the disease during a point in time
- Project health care and other policy needs or issues
- Estimate the costs associated with a particular disease
One thing prevalence CANNOT tell us
How long people have had their disease, or the causes
Cumulative incidence
Proportion of new cases during a specific time
Rules of cumulative incidence (3):
- Calculated by # of new cases in time period / # of people in population at risk at beginning of period
- Exclude people who already have disease and are immune
Significance and uses of cumulative incidence (2):
- Estimates the probability (average risk that a person will develop the disease) during a specific time period
- Enhances research on causes, prevention and treatment of diseases
Incidence rate
Measure of the rate of development of a disease in a population
Rules of incidence rate (3):
- Calculated by # of new cases of disease during given time period / # of person time [years/months/days] when people were at risk of developing the disease
- Denominator represents window of time people are at risk of disease - NOT number of people at risk at the beginning
- Reported in unit of TIME per 100, 1000, or 100,000 person years
Incidence rates can sometimes be called ____
Force of morbidity/mortality or incidence density
The number of cases of disease/total population at a point in time is the formula for ____
Prevalence rate
When calculating an incidence rate, your denominator is ____
The number of person years at risk during observation period of the study
Malignant hypertrophy of the ego
Pathological enlargement of one’s ego
Lifetime prevalence
Number of people who have ever had the disorder at anytime In their lives
Mortality rate
Proportion of people who die from something in a given time
Formula for mortality rate
of deaths due to a disorder in a given time / number of people at risk
Case fatality rate
Proportion of people with a certain disease who die within a given time
Formula for case fatality rate
of deaths due to a disorder in a given time / # of people with the disease
Proportional mortality rate
Compares the proportion of deaths with a standard population
Formula for proportional mortality rate
of deaths due to a disorder / proportion expected for standard population
Standardized mortality rate
Ratio of the number of observed deaths from a given cause in a given time to the expected number of deaths
Formula for standardized mortality rate
of deaths due to a disorder in a given time / # of expected deaths
Risk determinant
Something that is casually related to an outcome
Risk marker
A factor that is related to a higher prevalence of an outcome and may or may not be casually related
Cohort
Group that hares a common characteristic like birth year or exposure to risk
Absolute risk reduction
Decrease in risk in the treatment group compared to the control or comparison group
Population attributable risk
How much the incidence of the outcome can be reduced in the population
Number needed to treat
Number of people who must be treated for there to be one additional positive outcome
Number needed to harm
How many people must be treated to produce undesirable side-effects in one more person
Crude mortality rate
Overall incidence of death in a population
Formula for crude mortality
of new deaths / average population during year x 10^5
Crude mortality rate from IHD in German
211/100,000 per year
rude mortality rate from IHD in Brazil
47/100,000 per year
Two categories of mortality rates
Age-specified mortality rates and sex-specific mortality rates
Infant mortality rate
The number of deaths that die within one year of life expressed per 1,000 live births
Formula for infant mortality rate
of deaths in children up to 1 year in specific year / # of live births in same year
Age-standardized rate
- Weighted average of the age-specific mortality rates per 100 000 persons
- Important because aage structure has an impact on a population’s overall mortality.
To use DIRECT standardization, you need to have _____ (2):
- Age-specific disease/death rates in population of interest
- Age distribution of a standard population
Steps for calculating direct standardization
- Calculate mortality rate for each age group in population
- Multiply age specific rate X standard population
- Add up total of expected deaths in a standard population
- Expected deaths/standard population
Standarized rate
Statistical measure of any rates in a population. It is adjusted to take into account the vital differences between populations that may affect their birthrates or death rates
Why do we use standarized rates **
It removes the confounding effect of variables that we know or think differ in populations we wish to compare
Cause
An event, condition, or characteristic without which the disease would not have occurred
Establishing causation (5):
- Temporality: Exposure must come first Essential
- Strength of association: Strong effect?
- Biological plausibility: What is the likely biological mechanism?
- Consistency: Found across a range of studies?
- Dose response: Level and duration of exposure?
Sufficient cause
Factor (usually several factors) that will inevitably produce disease
Component cause
Factor that contributes towards disease causation but is not sufficient to cause disease on its own
Necessary cause
Any agent (or component cause) that is required for the development of a given disease
Types of exposures (4):
- Infectious agents
- Behaviours
- Intrinsic characteristics of individuals
- Social or environmental factors
Observational studies and purpose (4):
- No intervention
- Measurement of occurrence of disease or health outcome
- Comparing patterns of exposure and disease outcomes
- Identifying risk factors associated with health/disease
Experimental studies
Includes intervention - tries to change something and measure effect on disease outcome
Descriptive studies
Research that describes the occurrence of disease and/or exposure (eg. Routine data: mortality, life expectancy, prevalence surveys, or migrant studies)
Case reports/case studies
Unusual/interesting case of illness
Analytic studies
Evaluate association between an exposure or characteristic and the development of a particular disease
Ecological studies
Compare the prevalence of exposures and disease occurrence in populations
Cross-sectional studies
Study group chosen to be representative of a subgroup of society/cross-section of the population; not targeted specifically for symptoms
Case control study
Choose individuals with disease or outcome of interest (cases) and a comparison group without the disease (controls)
Prospective cohort studies
Follow-up studies: following people over time to see what happens. Compare rates of occurrence of disease in people with or without a particular exposure
Randomized control trial
Test effects of a digital health product to an alternative (eg. Compare diabetic patients with implanted insulin pumps against diabetic patients who receive multiple insulin injections)
Findings about alcohol intake by SMYTH ET. AL (3):
- High alcohol intake associated with increased mortality
- Different associations between alcohol and outcome depending on level of income in region
- Alcohol = increased risk of cancer or injury
Findings about alcohol intake by SMYTH ET. AL (3):
- High alcohol intake associated with increased mortality
- Different associations between alcohol and outcome depending on level of income in region
- Alcohol = increased risk of cancer or injury
Ecoli (4):
- Bacteria that lives in cattle and other animals
- Usually transmitted to humans through food
- Causes cramps and diarrhea that can be bloody
-Can lead to kidney failure/death
About 159 cases/year in BC
Rate ratio
Tells us how many times higher the rate of disease is in one group than in another group
Formula for rate ratio
Incidence rate exposed / incidence rate unexposed
Rate difference
Tells us how much extra disease occurred in one group compared with another group
Formula for risk ratio
Cumulative incidence in exposed / cumulative incidence in unexposed
Sufficient cause
Factor (or more usually a combination of several factors) that will inevitably produce a disease
Component cause
Factor that contributes towards disease causation but is not sufficient to cause disease on its own
Necessary cause
Any agent (or component cause) that is required for the development of a given disease
TB (6):
- Top 10 causes of deaths worldwide in 2015
- 10.4 million people ill from TB 2015
- 1.8 million dead from TB in 2015
- Begins with latent infection and results ro exposure to TB bacillus
- Latest infection is asymptomatic
- TB affects lungs and respiratory tract
TB as disease (3):
- Pulmonary disease (primarily)
- Extra-pulmonary disease
- Systemic infection when lymphatic dissemination spreads TB bacilli throughout body
Symptoms of pulmonary disease (9)
- Bad coughs lasting longer than two weeks
- Chest pain
- Coughing up blood
- Weakness
- Weight loss
- Loss of appetite
- Chills
- Fever
- Night sweats
Robert Koch
Discovered mycobacterium tuberculosis (bacteria that causes TB)
Mycobacterium tuberculosis complex findings by Robert Koch (4):
- Group of five closely related mycobacteria
- Slender, slightly curved rod shaped mycobacteria
- Slow growing generation time
- High molecular weight of lipids in cell wall
TB diagnostic tests:
- TB skin test
- Sputum smear microscopy
- Xpert MTB/RIF
Sensitivity tests
Ideally your test will identify all people with disease
True positive
Have the disease and test positive
False positive
Do not have the disease but test positive
False negative
Have the disease but test negative
True negative
Do not have the disease and test negative
Cons of sensitivity and specificity test
If a screening test is so sensitive that it detects almost every true case, the test is likely to produce a larger percentage of false positives than less sensitive tests. However, if the test is so specific that nearly every case that test negative is truly full of disease, the test is likely to miss a large percentage of true cases.
Formula for sensitivity
True positives x 100 number with disease. True positive/true positive + false negative
Formula for specificity
True negatives x 100 number without disease. True negative/false positive + true negative
Why is increasing sensitivity of TB tests important for TB prevention
Decreases the number of false negatives
Why is improving the specificity of TB test important for TB prevention
Decreases the number of false positives
Factors that influence false positives (7):
- Non-tuberculosis mycobacteria (tropical/subtropical climates)
- BCG vaccination
- Corticosteroid use
- Concurrent viral illness
- Recent TB infection
- Very young age (immune system not developed)
- Malnutrition
TB skin test
Injecting fluid under skin. Errors in technique that can lead to false positive and false negative
Anergy
Non-responsiveness of immune system
Sputum smear microscopy
Sputum specimen spread on microscope slide. Was developed over 100 years ago
Xpert MTB/RIF
Rapid molecular test with diagnosis in 100 minutes
Strengths of XPERT MTB/RIF (4):
- Better sensitivity and specificity than smear microscopy
- Rapid - approx 2 hours
- Operators don’t need laboratory training/biosafety equipment
- Can test HIV viral load and test for resistance bacteria
Weakness of XPERT MTB/RIF:
- Expensive
- Sophisticated hardware and computer training needed
- Need electrical supply and AC
- Cannot differentiate between live and dead M.Tuberculosis
Why is treatment of TB difficult (3):
- Duration of treatment
- Asymptomatic early
- Regimen of pills
DOTS
Directly observed therapy that helps prevent TB from spreading to others. It decreases risk of drug-resistance and the chances of treatment failure and relapse
How can prevention be done for TB? (5):
- Preventing transmission: Recommended guidelines
- Suspected cases in respiratory isolation: ideally in hospital
- Quasi-isolation at home: No work, school public
- No contact with people susceptible to TB
- Compliance with therapy
Two types of prevention
Prevent new cases of infection and prevent activation and reactivation of disease
3 critical things in prevention of TB
Vaccination, diagnosis and treatment
BCG vaccination
Created by Albert Calmette and Camille Guerin, a vaccine for TB disease
How many TB cases in Canada
Approximately 1630 cases of TB per year in Canada n 2015
Vancouver Eastside incidence rate of TB before and after program
Before: 85.1 per 100,000 in 2001
After: 28.9 per 100,000 in 2004
VPM1002 (2):
- Vaccine containing mycobacterium bovis
- The only recombinant BCG vaccine candidate currently in clinical trials
Relationship between media communication of health issues and the health-related beliefs, behaviors, and choices of media audiences:
- Public health decision makers depend on the media when alerting the public about threats of disease and opportunities for health protection strategies
- Media determines what information is relevant to the public
- Media influences policymaking
Stats of immigrants diagnosed with TB
Over the last 40 years, TB increased 3.7 times from 18% to 66%
According to the TB articles, what factors contributed to the health risks
Race, ethnicity, culture, and immigration status
Press coverage cons
- Certain reports can lead to discrimination against communities
- Eg. Press coverage of SARS outbreak contributed to discrimination/harrassment of Chinese and South Asian communities
- Press should not release information about nationality and ethnicity
Population health framework is advanced by ____
Public Health Agency of Canada
Why are TB cases higher in Aboriginals
Crowded and poor quality housing, food insecurity, and barriers to health care access.
Two divisions to which TB reported cases were divided into
- Registered Indians
- Canadian born others
In the article, how were clinical cases diagnosed
Diagnosed based on a positive tuberculin SKIN TEST; an abnormal chest radiograph or physical examination
Manitoba vs Alberta gender aboriginal TB cases
Higher proportion of cases were male in Manitoba compared to Alberta
Epidemiology definition **
The study of the distribution and determinants of health related states in specified populations, and the application of this study to control health problems
Estimated adult and child deaths from AIDS in 2021
650,000
