PBL, TBL, HS, LM, MDM, and HQPS Flashcards
five stages of readiness to change
pre-contemplation, contemplation, preparation, action, and maintenance
four of the most useful processves of change
consciousness raising, environmental reevaluation, helping relationships, self-reevaluation
Health Belief Model
the principle that health behavior change is a function of the individual’s perceptions regarding his or her vulnerability to illness and perceived effectiveness of treatment
Self-Determination and Motivational INterviewing
people are motivated to act by very different types of factors, either because thye value a particular activity (internal motivation) or because there is strong external coercion (external motivation)
sequence that all behaviors pass through
control by others, control by self, and automatization
four general principles of MI to explore resolve ambivalence
express empathy, develop discrepancy, support self-efficacy, and roll with resistance
behavioral gap
the importance of change and the distance a patient’s behavior would need to travel in order to reach the desired level
social cognitive theory/ecological models
emphasizes the interactions between the person and his or her environment
behavior is a function of aspects of both the environment and the person, all of which is in constant reciprocal interaction
two central concepts of social learning theory
self-efficacy - patient’s belief to in his or her ability to change or maintain a specific behavior under a variety of circumstances
outcome expectations - the degree to which a patient believes that a given course of action will lead to a particular outcome
theory of planned behavior
the intention to act is guided by three belief considerations - behavioral beliefs, normative beliefs, and control beliefs
behavioral chagne is always immediately preceded by intetnion as well as perceived and actual control
behavioral belief
the patient’s perceived outcomes and attitudes toward engaging in the behavior
normative beliefs
the subjective norms or pressure of others in the family or community regarding the behavioral change
control beliefs
the presence of factors that may facilitate or iumpede performance of the behavior and the perceived power of these factors
cognitive behavioral therapy
focuses on short-term, problem-oriented tratements that address the present and future
primary goal is cognitive change, paying attention to inner thoughts, attitudes, and emotions as well as the events that both trigger and result from our actions
three key traditional cognitive behavior therapy techniques for treating patients with obesity
self-monitoring - recording behavior
stimulus control - avoiding behavior or thoughts that incite a behavior
cognitive restructuring - change internal dialogue and be more aware of distructive or distorted thoughts and beliefs
three content areas of HS
personal health, population health, and global health
five determinants of health
socail environment, individual behavior, biology and genetics, health services, physical environment
HS covers everything except biology and genetics
barriers to accessing health services
lack of availability
high cost
lack of insurance coverage
limited language access
non-communicable diseases
cardiovascular diseases
chronic respiratory disease
diabetes
boesity
cancer
calculation of LDL cholesterol
LDL = Total cholesterol - (HDL + triglycerides/5)
HbA1C
correlates with blood glucose levels, monitors long-term blood glucose levels
blood cholesterol measurements
less than 200 - desirable
200-239 - borderline high
>= 240 - high
LDL choleserol level
less than 100 - optimal
100-129 - near optimal
130-159 - borderline high
160-189 - high
>=190 - very high
triglyceride level
less than 150 - normal
150 - 199 - borderline-high
200-499 - high
>= 500 - very high
glucose levels
51-99 - normal
100-125 - pre-diabetes
>= 126 - diabetes
HbA1c levels
- 0-5.6 - normal
- 7-6.4 - pre-diabetes
>=6.5 - diabetes
What is social medicine?
seeks to understand individual clinical problems in a social context and to improve health at multiple levels:
clinical care
community outreach
research and advocacy
social determinants of health
The social determinants of health are the conditions in which people are born, grow, live, work and age, including the health system. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels, which are themselves influenced by policy choices.
public health
Health-activities that society undertakes to ensure the conditions in which people can be healthy. These include organized community efforts to prevent, identify and counter threats to the health of the public.
population health
the physical, mental, and social well-being of defined groups of individuals and the differences or disparities in health between and among population groups
global health
the area of study, research and practice that places a priority on improving health and achieving equity in health for all people worldwide
epidemiology
study of risk factors and causes of health problems
upstream determinants
those that occur at the macro level and include global forces and government policies
midstream determinants
intermediate factors such as health behaviors
downstream determinants
occur at micro level and include one’s genetics
prevalence
proportion of a given disease or condition in a population at a snap shot in time (cross-section)
incidence
number of new diagnoses of a disease or condition that develop over time in a population (rate)
cumulative incidence
accumulated number of events in a population in a fixed time: good for short and consistent follow-up time
25 events out of 108 students with normal baseline BP: 25/108 = 23% phase I CUMULATIVE incidence
incidence rate
number of events per person-years of follow-up time: good for long and variable follow-up time
25 events per (108 students x 20 months of phase I = 2,160 person-months or 180 person-years), which is 14 per 100 person-years incidence RATE
PDSA cycle
PLAN - the change to be tested or implemented
DO - carry out the test or change
STUDY - data before and after the change and relfect on what was learned
ACT - plan the next change cycle or full implementation
Heisenberg Principle
The very act of observing a phenomenon alters that phenomenon in some way
Hawthorne Effect
The tendency of some people to work harder and perform better when they are observed
Individuals may change their behavior due to the attention they are receiving
Developing Goals - SMART
- S Specific: choose one specific behavior modifier per goal to work on
- M Measurable: Can you measure this against a baseline?
- A Attainable or Action Based behavior: Is the goal attainable? Use action words when writing goals such as “I will” or “I do”, rather than “try, should, would, could.”
- R Realistic: Do you have honest and realistic expectations of yourself with your time, body, likes/dislikes?
- T Timely: is the time allotted reasonable and manageable for you right now?
Health Equity
depends vitally on the empowerment of individuals to challenge and change unfair and steeply graded distribution of social resources to which everyone has equal claims and rights
inequity in power interacts across four main dimensions - political, eocnomic, social, and cultural - atogether constituting a continuum along which groups are to a varying degree excluded or included
cultural competence
implies having the capacity to function effectively as an individual and an organization within the context of the cultural beliefs, behaviors, and needs presented by consumers and their communities
cultural knowledge
familiarization with selected cultural characteristics, history, values, belief systems and behaviors of the members of another ethnic group
cultural awareness
developing sensitivity and understanding of another ethnic group. This usually involves internal changes in terms of attitudes and values. Awareness and sensitivity also refer to the qualities of openness and flexibility that people develop in relation to others
cultural sensitivity
knowing that cultural differences as well as similarities exist, without assigning values, i.e better or worse, right or wrong, to those cultural differences
reccommended daily nutrition intake
less than 2,300mg of salt
10% of calories from saturated fatty acids
less than 300mg of dietary cholesterol
reduce sugar and fat intake
limit refined grains
no more than two drinks per day
food desert
areas that lack access to affordable fruits, vegetables, whole grains, lowfat milk, and other foods that make up the full range of a healthy diet
food security
high food security - no reported indications of food-access problems or limitations
marginal food security - anxiety over food sufficiency or shortage of food in teh house, little or not indication of changes in diets or food intake
food insecurity
low food security - reports of reduced quality, variety, or desirability of diet, little or no indication of reduced food intake
very low food security - reports of multiple indications of disrupted eating patterns and reduced food intake
WIC
women, infants, and children - a federally funded health an dnutrition program for women, infants, and children
SNAP
the Supplemental Nutrition Assistance program - helps low-income people and families buy the food they need for good health
Link
the Illinois Link card is a plastic card that looks and works like a debit card
NSLP
National School Lunch Program - available nationwide for low income children to provide free or reduced cost for lunches depending upon the family income
DRIs
Dietary Reference Intakes - reference values used to plan and evaluate diets for healthy populations with an emphasis on prevention of chronic diseases and promotion of optimal health
social-ecological model of influences on health behavior
SEGUE
Set the stage
Elicit informatin
Give information
Understand patient’s perspective
End the encounter
blood pressure ranges
120-139/80-89 prehypertension
140-159/90-99 Stage I Hypertension
>160/>100 Stage II Hypertension
BMI ranges
18.5-24.9 healthy weight
25-29.9 overweight
30-34.9 class I obesity
35-39.9 class II obesity
>= 40 class III obesity
normal waist circumference
men
women >35 in
OLDCARTS
Onset, Location, Duration, Characteristics/quality, Aggravatin/alleviating factors, Radiation, Treatment, Significance
health literacy
the degree to which people have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions
past medical history
general state of health
childhood diseases
mediucal illnesses
surgeries
gynecological history
psychiatric
hospitalizations
exposes to contageons
immunizations
screetning tests
medications
name, strength, dose, frequency
inhalers, birth control, over-th-counter, home remedies, supplements, herbal medications
Levels of System in quality
topology of quality measures
structures - measure of a static characteristic such as policy or procedure
processes - measurements of what takes place during the delivery of care such as the tratments prescribed or the procedures done
outcomes - measurements of health status or clinical condition, can include costs or reported outcomes of the consumer
swiss cheese model
brain-to-brain loop
methods of PCR fluorescent detection
SYBR Green, Taqman, Molecular Beacons, Light Cycler
Sanger Sequencing
limitations - cis vs. trans ambiguity, only see what is sequenced, cannot detect low-level mosaicism or allele burden, cannot detect whole exon deletions or duplications, not quantitative
explain the advantages and disadvantages of Sanger sequencing v. gene panel sequencing v. whole exome/ whole genome sequencing
2x2 table
ROC curve
