Using Evidence to Ensure Public Health Flashcards
Determinants of Health
Socioeconomic, Enviornmental, Genetics, Health Care
Assessment
Monitor health status and invesitgate health problems to protect people from health hazards
What US fed cabinet department is responsible for public health?
Department of health and human services
Incidence and what increases it?
New cases during a time interval…more liberal case definitions and improved diagnostic methods
Prevalence and what increases?
Number with a given disease at a given time divided by pop atrisk
Does not distinguihs new from established
Txs preventing death will increase
Adv and disadv to crude mortality
Easy
Underestimates true difference and should be higher in older populations
Case fatality
Proportion of death from a certain cause over certain time
Standardizes data based upon specific condition
Only meaningful for short periods
Screening decreases fatalities…even if not better outcomes
Poor access to care increases fatality…even if good txs
Infant mortlaity rate
Proportion of live born infants who die by 1 yr
Most sensitive indicator of overall societal health
Life expectancy
Overall measure of pop health…not affected by age composition of the population
Altered by rare events
Not estimate of future expereince
May not reflect individual demographic differences
QALY
Health related to quality of life scale
Captures both morbidity and mortality
Allows comparison of health system and health interventions
Std for health impacts and cost effectiveness analysis
Not translatable into a patient experience
Policy Development
Give people information
Engage community
Develop Policies
Assurance
Enforce public health law
Help ppl recive services
Maintain a competent health workforce
Evaluate and imrpvoe programs
System Managment
Contribute to and apply the evidence base of public healt h
T0, 1,2,3,4,
Basi science
Humans
Pts
Practice
Community
Case control benefits
INexpensive, Timely, high yield for rare or long-term outcomes
Selection bias
Study sample not representative of population at risk
Confounding
A factor distorts the effect of another related factor
Recall and interviewer bias
Inaccurate memory
Information bias
Different collection
Benefits of cohort studies
Generalizable…accurate slice of a population
Best study design if randomization is not possible…the observational design least susceptible to bias
Cohort study problems
Selection bias, confounding, interviewer bias
Surveillance bias - more aggressive diagnostic approahc in one group
Loss to follow up…those lost have different outcomes than those who remain (less than 5 is little, 5-20 could be biased, more than 20 often substantial bias)
Def of a confounder
Factor associated with both exposure and outcome
THink age with smoking intensity and dz
Strength
Temporality
Reversibility
Size of effect not due to plausible confounding
Cause precedes the outcome
Reduction in exposure decreases effect
Biologic plausibility
Dose-response
Consistency
Similarity
Link
Effect increase with exposure
Relationship is repeated
Similar exposure lead to similar dz
