SM02 Mini1 Flashcards
approximately how many people are killed by NCDs worldwide per year?
35 million or 2/3 of all death
what percentage of NCD deaths occur in low & middle income countries?
80%
How much do NCDs usually cost the US per year?
billions
4 behavioral risk factors for NCDs
- poor diet
- little to no exercise/physical inactivity
- smoking
- alcohol/drug abuse
4 biological risk factors for NCDs
- raised BP (HTN)
- raised blood sugar (diabetes)
- raised cholesterol
- raised BMI (obesity &/or overweight)
what are the top to leading causes of death in the US over the last 75 years?
heart dz & cancer, respectively
What is a positive trend seen in heart dz in the last decade?
downward trend in percentage of adults w/at least one of three risk factor (uncontrolled HTN, uncontrolled LDL, or smoking)
primordial prevention
create framework or environment for prevention of production or exposure to risk factor
target: reduce initial exposure
ex. age legislation on purchase of cigarettes or banning of smoking in ppublic
primary prevention
removal of risk factor or increasing resistance before dz process begins
target: asymptomatic persons to prevent dz (exposed but not diseased- ex. second hand smoker)
ex. smoking cessation programs/respirators for silica
secondary preventation
detection of asymptomatic dz
target: those early in dz process to prevent progression to symptomatic stages
seeks to improve prognosis
ex. screening programs
tertiary prevention
management or rehabilition of established dz
targets: those w/established dz to halt/retard dz progression & limit complication and/or disability OR to rehabilitate those w/functional and/or socla disabilites
ex. tx of COPD pts/drug abusers
screening
presumptive identification of unrecognized dz or defect by application of tests, examinations or other procedures that can be applied rapidly
form of secondary prevention
validity measured by sensitivity & specificity
sensitivity
ability of screening test to identify person who have dz
sensitivity= (pts w/dz who tested +)/(all pts w/dz)= a/(a+c)
specificity
ability of screening test to identify persons who do not have dz
specificity= (tested -)/(true- + false+)= d/(b+d)
positive predictive value
probability that pt w/+ test result is true + for dz
PPV= (pts w/dz who tested +)/(all pts who tested +)= a/(a+b)
negative predictive value
probability that pt w/- test result is true - for dz
PPV= (pts w/o dz who tested -)/(all pts who tested -)= d/(c+d)
prevalence
measure of dz frequency
proportion of persons in defined population that has the outcome of interest at a defined instant in time
includes old & new cases
incidence
measure of dz frequency of NEW cases
risk, odds, or rate
Risk
measure of incidence
probability of occurrence of an outcome in an outcome-free population during a specified time period
risk= (#of new cases)/(population initially at risk)= d/N
usually applied to non-recurrent dz or first episode
Odds
total # of new cases divided by total # of person who remained dz-free over study period
Odds= d/(N-d)
ratio of probability of getting dz to probability of not getting dz in a given time period
Rate
express # of people w/condition or #of events in relation to total population at risk
rate= (# ppl w/condition)/(#total pop. at risk) for given time frame
age-specific rate
numerator & denominator refer to same specific age group
crude rates
rates calculated on total numbers of persons
NOT specific for age, ethnicity, socioeconomic class, etc. (risk factors)
case fatality rate
proportion of case of a specified cause which dies in a specified period of time
usually expressed as a percentage
cause specific mortality rate
of death by specific cause in defined pop./ unit population in defined period of time
infant mortality rate (IMR)
of deaths in children under 1yrs of age/ # of live births in same period
in specified population
maternal mortality rate
of maternal deaths/ # of live births in same geographic area in same year
pregnancy-related mortality ratio
estimated # of pregnancy-related deaths for every 100,000 live births
perinatal mortality rate
[# of fetal deaths (20+ weeks) + early neonatal deaths (0-28 days)] / [total # of live births + fetal deaths]
in a year in defined pop.
survival rate
proportion of survivors in a group (usually pt w/dz) ,who survive a specified period of time
characteristics of a systems-based physcian
- interdisciplinary team-based care
- robust electronic health record & practice management data
- research rich
- participation & leadership in all aspects of healthcare
3 core functions of public health
- assurance
- assessment
- policy development
10 essential services of public health
- enforce laws
- link to/provide care
- assure competent workforce
- evalute
- monitor health
- diagnose & investigate
- inform, educate, empower
- mobilize community partnerships
- develop policy
- Research
FQHC
federally qualified health centers
what is the primary Federal agency for improving access to health care services for uninsured, isolated or medicall vulnerable populations?
Health Resources & Services Administration (HRSA)
also oversees organ, bone marrow & cord blood donation
compensates individuals harmed bu vaccination
maintains databases that protect against healthcare malpractice, waste, fraud, & abuse
What organization is in charge of healthcare organization accreditation, certification, & standards of care?
Joint Commission on Healthcare Organization
what important cahnges did the Affordable Care Act of 2010 make for health insurers?
- cannot turn applicants down for hx of illnes
- cannot terminate coverage/must renew
- cannot charge more to those w/hx of illness
- older persons maxed at 3x that of younger
- return at least 80% of premiums in form of health service benefits
correlation coefficient
closeness by which scatter points lie to a regression line
r
between -1 & 1
2 variable are said to be associated if…
distribution of one variable varies according to the value of the other variable
Power of a study
probability of finding & declaring a treatment effect when an effect really exists
probability of finding and properly recognizing a correlation
important to avoid type II errors while minimizing costs thru involving the optimal # of participants
Power = 1 - beta
P-value
probability of committing a type I error
computed based on difference of the means for treated & control groups
if P-value >/= 0.05, then null hypothesis is accpeted
beta
probability of committing type II error
alpha
maximum risk of committing type I error
commonly set at 0.05-5% risk of committing type I error
type II error
failing to identify a correlation via sample population when it in fact exists in the general population
type I error
claiming a correlation based on sample group data that does not apply to general population
one-tailed null hypothesis
difference between groups or populations or the treatment effect is anticipated in one direction only
two-tailed null hypothesis
difference is expected but the direction of difference is not anticipated
alternative hypothesis
effect that the investigator is trying to demonstrate
null hypothesis
no difference in population parameters among groups being compared
statement of no difference or no treatment effect
no association of variable
confidence intervals
indicates how precise an estimate is
95% confidence interval = mean +/- 2 standard error of the mean
standard error of the mean
measur of dispersion or variability of sample means about the true population mean
applies variability in sample pop to variability in general pop
SE = standard deviation / square root(sample size)
statistical inference
generalization of results of a sample to the population from which the sample came from
standard deviation
square root of variance
s = square root{[sum(xi - mean)2] / (n-1)}
divide by n for population
divide by n-1 for sample
box plot
median, minimum, maximum, first & third quartiles plotted on a line
when is median v. mean used?
median is used to measure central location when distribution is skewed
mean is measure of central location when distribution is normal
variance
“average” squared deviation of values of observations in a ser of data from the mean
variance = s2 = [sum of (xi - mean)2] / (n-1)
personality traits related to smoking
externalizing personality traits
mood disorders
ADD or conduct disorder in children
occupational respiratory disorders
coal miners pneumoconiosis
asbestosis
silicosis
farmer’s lung
what genetic disorders are related to COPD?
alpha-1 antitrypsin deficiency→ damage caused bu elastases (HLE)
accelerated by smoking
chronic cough for 3 months in 2 consecutive years is ______.
chronic bronchitis
COPD is secondary to what dz?
emphysema or chronic bronchitis
what histological changes are caused by smoking?
cell necrosis & apoptosis due to increased free radicals
squamous metaplasia
mucous gland enlargement
ciliary damage
distortion of the airway
what are blue bloaters?
COPD pt w/chronic bronchitis
cyanosis & edema
can lead to cor pulmonare & pulmonary HTN
