PB 2 MID ch 6, ch 7, ch 8, ch 4 Flashcards
BIG GEMSand what are determinants of health
- catalogs determinants
- behavior, infection, genetics, geography, environment, medical care, socioeconomic-cultural
—economic and social conditions that influence individual and group differences in health status
Morbidity and Mortality
Morbidity- disability, sickness, injury, any departure from a state of physiological or psychological well-being
Mortality- death
Confounder/confounding variable
no evidence of an association at the individual level (ice cream and drowning example)
Ecological analysis
analyze surrounding area and the confounding factors that may cause disease OR an assessment of the impact of an alteration of the physical environment
Case-Fatality Rate
- the chances of dying from the disease once its diagnosed
Mortality / incidence rate times 100 percent
Case-Control Study
for requirement #1 (potential cause is associated with the potential effect, a correlation)
Compares individuals with a disease with individuals who do not to identify possible exposure
Cohort Study
for requirement #2 (potential causes precedes the potential effect, does time ordering exist)
Compares individual exposed and individuals not exposed and follow both over some time to compare the incidence of disease/ who develops it
Randomized Controlled Trial (RCT)
for requirement #3 (altering the potential cause, alters the potential effects)
Randomly assign exposure or control studies and follow over time to compare results
Efficacy vs. effectiveness
Efficacy- an intervention increased positive outcomes pr benefits in the population that it was investigated for
Effectiveness - an intervention has been shown to increase in positive outcomes in the population in which it will be used
Non-Communicable Disease (NCDs)
- Tend to be long duration
- Results of a combination of big gems
- Not deadly in short term, but have impacts on the quality of life
- Do not spread
- Have multiple causes and risk factors are less recognizable
- We are living longer, but with more unhealthy or chronic condition
Prevention Pyramid (Primordial→Tertiary)
Primordial Prevention - targets social and economic policies affecting health, what is creating this
Primary Prevention - targets risk factors leading to injury/disease
Secondary Prevention - prevents injury/disease once exposure to risk factors occurs but still in early preclinical stage
Tertiary Prevention - rehabilitating persons with disease/injury to reduce complication
Test Sensitivity
What does a high one mean?
a test’s ability to designate an individual with disease as positive for that disease
few false negative results, so fewer cases missed
Test Specificity
What does a high one mean?
a tests ability to designate an individual who does not have a disease as negative for that disease
few false positives
False negative results
have negative results on a screening test but turn out to have the disease
False positive results
individuals who have positive test results on a screening test but do not turn out to have the disease
Multiple risk factor reduction
- a special form of intervention aimed at risk factors
- Intervenes simultaneously in a series of risk factors, all which contribute to a particular outcome
Cost and net-effectiveness
–Cost effectiveness- a concept that combines issues of benefits and harms with issues of financial costs, starts by considering the benefits and harms of an intervention to determine its net-effectiveness (Combine issues of benefits and harms with issues of financial costs)
–Net effectiveness- implies that the benefits are substantially greater than the harms
Causes of communicable diseases
Bacteria - tuberculosis, syphilis
Viruses - smallpox, measles
Parasites - malaria, roundworms
Epidemic vs. Endemic vs. Pandemic
–Epidemic - an increase in the frequency of a disease above the usual and expected rate(endemic rate)
–Endemic- present at all times but at a low rate
–Pandemic- an epidemic occurring worldwide or over a wide area, crossing international boundaries, and affecting a large number of people
Koch’s Postulates
to establish if an organism is a contributory cause of a communicable disease
–The organism must be shown to be present in every case of the disease by isolation of the organism
– the organism must not be found in cases of other disease
–Once isolated, the organism must be capable of replicating the disease in an experimental animal
–The organism must be recoverable from the animal
R0 or R-naught, what used for and what represent
-Used to determine the degree of communicability of a disease and the potential of the disease to lead to an epidemic
- represent , on average, the number of people that a single infected person can be expected to transmit that disease to
-Can be used to determine what percent of the population needs to be vaccinated to prevent the spread
Quarantine
–Quarantine occurs when those suspected of having a disease but without current symptoms are separated from others
–separates/restricts movement of people exposed to a contagious disease to see if develop the disease
Isolation
–Isolation occurs when individuals with symptoms of a disease are separated from those who do not have symptoms
–Separates sick people with contagious disease from those who are not sick
Herd immunity
–Herd immunity- protection of an entire population from a communicable disease by obtaining individual immunity through vaccination or natural infections by a large percentage of the population (70-90%)
–Not everyone can be vaccinated
–Limits the ability for the disease to spread
Public Health tools to address burden of communicable diseases
- Barrier protections, including isolation and quarantine
–Separate individuals with the disease from the healthy population to prevent exposure - Immunization designed to protect individuals as well as population
–Protects a vaccinated person from infection
–Protects others from being infected by that person
–Strengths the immune system to prevent or control disease - Screening and case finding
–Screening implies the use of tests on individuals who do not have symptoms for a specific disease
–Screening can result in detection of disease at an early stage under the assumption that early detection will allow for treatment that will improve the outcome.
–Screening can result in reduced disability and/or deaths
—Casefinding is a system for locating every patient- inpatient or outpatient - who is diagnosed and/or treated with a reportable diagnosis - Treatment and contact treatment
–Direct treatment, treatment of symptomatic disease may in and of itself reduce the risk of transmission
–Epidemiological treatment- treatment of contacts with the disease - Efforts to maximize the effectiveness of treatments by preventing resistance
- Swiss cheese defense
–multiple layers improve success
–Each intervention has holes
Chain of infection
–The transmission pattern by which an infectious disease is passed from person to person
Composed of 4 links:
–Pathogen - infectious agent
–Reservoir- pace where pathogen lives and multiplies
-Come pathogens have no reservoir (direct transmission)
-Some pathogen infect non-human species and spread to humans
–Means of transmission- from host to new host or from reservoir to new host
–Susceptible host- susceptibility is key (depends on prior infection, biological adaptation, vaccination)
Physical Environment
- Unaltered - “natural” environment
- Altered- results of added chemicals, radiation, and biological products
- Built environment - results of human constructions, injuries and exposures in the home, the transportation system, and where we work and play
4 approaches to address complex interactions between humans and physical
Environment
- Risk assessment
–a formal process that aims to measure the potential impact of known hazards
–Aimes to take into account the inherent danger but also the quantity, route, and timing of exposure
–Attempts to evaluate the impact of environmental exposures one at a time
–Measures the types and magnitudes of the impacts
Four step risk assessment process - Hazard identification- what health effects are caused by the pollutant?
- Dose response relationship- What are the health problems at different exposures?
- Exposure assessment - How much of the pollutant are people exposed to during a specific time period? How many people are exposed?
- Risk characterization- What is the extra risk of health problems in the exposed population?
- Public health assessment
–Goes beyond a risk assessment by including data on actual exposure in a community
–Addresses not just the risks in a specific location, but also the risks to large numbers of individuals and often to the population as a whole
–Often very controversial- can take years, or even decades, to complete - Ecological assessment
–Examines the impacts of contaminants on ecological systems ranging from chemicals, to radiation, to genetically altered crops
–Examines not only human health effects of exposure, but also the impact of contamination or pollution on plants and animals and the ecosystems in which they exist - Interaction analysis
–Implies that to understand and control the impacts of environmental exposures, it is necessary to take into account the effect of two or more exposures
Sociological Imagination
–Mills 1959
–enable us to grasp history and biography and the relations between the two within society
– Personal troubles - lie within the individual as a biographical entity and within the scope of his immediate milieu, your life story
–Public issues- history- matters that transcend these local environments of the individual and the range of his inner life, entail the organization of personal milieus into larger societal structures
–Personal troubles connected to societal (public) issues, history, and society (social structures)
Social determinants of health (as a general definition or classification of health
determinants)
–The condition in which people are born, grow up, live, learn, work, play, worship, age, and systems put in place to deal with illnesses that affect health and quality of life
–These conditions are shaped by a wide set of forces, including economics, social policies, and politics
OR
10 categories
Social status
Social support or alienation
Food
Housing
Education
Work
Stress
Transportation
Place
Access to health services
Health Disparities
differences in health closely linked with social or economic disadvantages
Socioeconomic status (SES) and how measured
The position of individuals within a socially stratified system that differently distributes socioeconomic resources that people need to obtain desired outcomes or goals
Considers stratification as encompassing economic (class) plus status (prestige) and power
Measured by education, income, occupational prestige, wealth
Social Class
Pierre Bourdieu
Class position determined by degree of possession of 3 types of capital
1. Economic capital
Wealth money
- Cultural capital
Education, employment - Social capital
The value of your relationships
Race vs. Ethnicity
Race - classification of humans into one of several subpopulations distinguished by perceived common physical characteristics
Historically made on the assumption of a biological basis
Ethnicity- defined by perceived common ancestry, history, and cultural practices
Types of Racism
Cultural racism- racist beliefs, attitudes, stereotypes, ingrained in a culture
Institutional racism- institutional mechanisms/ processes can manifest as discriminatory policies and practices, a red line where banks would not loan to black families
Interpersonal racism- experienced in everyday interactions with others (overt, unintended, microaggressions)
Culture as a determinant of health
helps people make judgements about the world and decisions about behavior
How culture can affect health
- Behaviors: social practices may put individuals and groups at increased or reduced risks
–Diets, cooking methods, exercise - Response to symptoms, such as level of urgency to recognize symptoms, seek care, communicate symptoms
- Types of interventions that people find acceptable
–Variations in degree of acceptance of traditional western medicine, including reliance on self help and traditional healers - Response to disease and to interventions
–Cultural differences in follow up, adherence to treatment, and acceptance to adverse outcome
Stress and its three types
–Major life events, chronic strains, daily hassles
-Mortality increases after the death of a spouse, job loss, etc.
-Increased risk of heart disease and common cold
Social support
Important means to prevent and/or buffer effects of stress
Self-efficacy
–Sense of having control over one’s life
–Increased by previous successful performance and seeing other perform successfully
Theory and categorized by
a set of interrelated concepts, definitions, and propositions that explain or predict events or situations by specifying relations among variables
categorized by intrapersonal(individual), Interpersonal(relationships) and population and community(social structures)
Model and categorized by
a combination of ideas and concepts taken from multiple theories and applied to specific problems in specific settings
categorized by intrapersonal(individual), Interpersonal(relationships) and population and community(social structures)
Health Belief model
–Intrapersonal
People are more likely to take action if they believe:
—-They are susceptible to the condition and it has serious consequences
—-Taking action would benefit them, and the benefits outweigh the harms
—-They have the ability to successfully perform the action
Transtheoretical Model
–intrapersonal
Stages of change model
Behavior change as a process
1st stage- precontemplation- no intention to change yet
2nd stage- contemplation- aware of benefits of changing
3rd stage- preparation- decides to change and planned actions to do so
4th stage- action phase- actual behavior change/modification
5th stage- maintenance- change achieved but must strive to prevent relapse
Theory of Planned Behavior
–intrapersonal
–Intention is the main predictor of behavior
Behavior intention is influenced by:
–Individuals attitude toward performing a behavior
–Their beliefs about whether people important to them approve or disapprove of the behavior
–Their beliefs about their control over performing the behavior
Social Cognitive Theory and reciprocal determinism
–Interpersonal
Interaction between individuals and their social systems
Changing behavior requires an understanding of individual characteristics, influences in the social and physical environment, interaction among all these factors
Reciprocal determinism- the dynamic interplay among personal factors, the environment, and behavior
Changing one factor will change them all
Ecological Model
Of health behavior
Describes 5 levels of influence that determine health related behavior
- Intrapersonal level - psychology
- Interpersonal level- family, friends, coworkers
- Institutional level- school, workplace
- Community level - churches, community organizations
- Public policy level - government regulations
Fundamental Cause Theory
Theory of health disparities
For socioeconomic status and racial-ethnic disparities
Fundamental causes are resources (knowledge, social connections, money, power), that determine capacity(the extent to which people are able to avoid risk and adopt protective strategies) so as to reduce morbidity and mortality
Resources can be used in different ways in different situations, causes have the effects even when risk and protective factors and diseases change radically
People use resources to obtain healthy outcomes but resources also provide access to health-improving contexts
Diffusion of Innovation Theory, how affected, and types of adopters
Population and community level model
How a new idea, product or social practice is disseminated and adopted in a population
Diffusion and adoption/rejection are affected by attributes of the innovation (relative advantage, compatibility, complexity, trialability, observability)
Different types of adopters
——–early- seek to experiment with innovative ideas
——-early majority adopters- often opinion leaders whose social status frequently influences others to adopt the behavior
——-late- needs support and encouragement to make adoption as easy as possible
