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Global health > Week 8 - population health, epidemiology & communicable diseases > Flashcards

Week 8 - population health, epidemiology & communicable diseases Flashcards

1
Q

what are vital statistics?

A 
Birth rates (births per year per 1000 people in the totally population) 
Death rates (Deaths per year per 1000 people in the total population)
Age adjusted rates make different population with different age structures comparable
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2
Q

what is demography

A

The study of size and composition of human populations

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3
Q

measuring the burden of diseases is…

A

Foundation for evidence-based policy and practice

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4
Q

Global disease burden

A
  • Causes of death (mortality)
  • Causes of disease morbidity
  • Disability
  • Risk factor rates
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5
Q

Incidence

A 
# of total new cases in a specific time period / total # at risk 
(describes outbreaks, acute disease) - often decrease if a new vaccine or other preventative measure is available
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6
Q

Prevalnce

A 
# of total existing cases (new & old) / total # of people in population (describes chronic disease in population) 
Can decrease if there is a new therapy cures a lot of the disease
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7
Q

Challenges of measuring mortality

A

In many lower-income parts of the world vital statistics are not collected (no death registry)

It can be difficult to assign a single cause of death (either b/c the cause is unknown or because there were many contributing causes)

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8
Q

Life expectancy at birth

A

Median expected age at death of all babies born alive (which usually includes some child & young adult deaths and many deaths of older adults)

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9
Q

Healthy life expectancy

A

the number of years the average person born into a population can expect olive without disability

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10
Q

1850-1900

A

Age of hygiene

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11
Q

1950-1970

A

Golden age of abs

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12
Q

What are the 3 aspects of an epidemiological triangle

A

1) Agent
2) Host
3) Environment

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13
Q

what does the epidemiological triangle tell us

A

how disease moves in a population & how to prevent it
posits that the possibility of the disease occurrence is determined by the interactions ebtweent the host, the agent and the environment

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14
Q

What is the host vs. the AGENT in epidemiological triangle

A

HOST: susceptible person
AGENT: etiological factors

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15
Q

Agents have been classified as:

A

1) Nutritive elements
2) chemical agents
3) Physical agents
4) Infectious agents

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16
Q

Factors affecting host susceptibility

A

1) genetics
2) age
3) gender
4) Ethnic group
5) Physiologic state
6) prior immunologic state
7) pre-existing disease
8) human behaviours

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17
Q

what are environmental factors

A

Extrinsic to both the host & the agent, however, can either a moderating or mediating relationship with the agent & the host
CAN BE USED TO INFECTIOUS & NON-INFECTIOUS diseases like CAD

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18
Q

Epidemiological triangle for covid

A

Host: human or animal

agent: infectious agent
environmental: social distances/ masking / or not

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19
Q

CAD epidemiological triangle

A

Agent: genetic susceptibility (intrinsic) / composition
host: person
Environment: external factors such as diet, exercise, environment can influence someones individual genetic susceptibility to develop or express a trait

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20
Q

Health transitions

A

~100 years ago, populations around the world had similar health profiles (high birth rates, high death rates, short life expectancies, many diseases and death d/t infectious & undernutrition)
As economies improved & health profile shifted to lower birth rate, lower death rate, higher burden of chronic diseases (d/t over nutrition)

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21
Q

what is a demographic transition

A

Shift toward lower birth and death rates a populations move from being low-income economies to high-income economies.
population pyramid is a tool used to visualize demographic transition

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22
Q

population will eventually stop growing when the country transitions to high birth & high death rates to

A

LOW BIRTH & LOW DEATH RATES –> stabilizing the population –> occurs in industrialized countries sb/c less developed follow the advanced countries.

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23
Q

Right now most countries have ____ growth rates

A

POSITIVE - keeps getting bigger

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24
Q

what is growth rate

A

Measuring how much the population grows or shrinks over some time period
Calculated - Add both & immigration, subtract death & emigration.
Growth rate = current - individual divided by initial & multiplied by 1000

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25
Q

why do most countries currently have positive growth rate

A

economic benefits - children work, gov’t may have incentives
religion - promotes large families, more in the faith
cultural - children, pass down own family values

26
Q

5 stages of demographic transition model

A

Stage 1 - High stationary (High birth rates, high death rates)
Stage 2 - Early expanding (pop rise as death rates drops, health ,sanitation & food)
Stage 3 - late expanding (death rates continue to drop but birth rates also begin to fall b/c contraceptionn & changing social trend smaller families)
Stage 4 - Low staining (population stabilizes, population is large, USA, AUS)
Stage 5 - speculation Contracting?

27
Q

Epidemiologic transition

A

Occurring b.c infectious disease has fallen, esp. in childhood.

  • Vaccination
  • Insecticide-treated nets
  • Water supply, hygiene, sanitation
  • Prevention & treatment for diarrhea, pneumonia, malaria, TB, HIV, etc.

shift from infectious disease to chronic, non-communicable disease

initially 3 stages but 2 more were proposed

28
Q

What are the 5 stages of epidemiological transition

A

1) Age of pestilence & Famine - no country currently at this level.
When mortality is high and fluctuating, thus precluding sustained population growth. In this stage the average life expectancy is low and variant 20-40 years

2) Age of receding pandemics - when morality declines progressively
the are of decline accelerates as epidemic peaks becomes less frequent or disappear. The average life expectancy at birth increases steadily from about 30-50 years. Population growth is sustained and begins to describe an exponential curve

3) Age of degenerative and man-made diseases
when morality continues to decline & eventually approaches stability at a relatively low levels. The average life expectancy at birth rises gradually until it exceeds 50 years. It is during this stage that fertility becomes a crucial factor in population growth

4) Age of delayed degenerative disease - the length of life expectancy increases (As the major killer disease of later transitions are bettered treated or delayed) but in which health status may deteriorate as the causes of chronic but non-fatal morbidity are yet to be defeated.
Increasing incidence of mental disorders. This stage evident in developed countries in southeast & east asia

5) Age of emergent & re-emergent infections
Associated with the resurgence of infectious and parasitic disease (both old & new) as a serious public health concern in developed countries.
AIDS - young in north america& Europe. TB, unique attributes of this new trend in infectious disease mortality qualify it as a distinct stage in our epidemiological history

29
Q

Ebola crises

A

1976 appears to epidemic / outbreak

2014 - pandemic

30
Q

lessons learned from ebola crisis

A
  • PPE was ineffective
  • Training on protocols (secreening, isolation, decontamination prior to removing PPE)
  • Dedicated ebola centers / teams
31
Q

Factors affected Ebola spread

A

Political context
Access to health services
cultural practice & super stitiuions
stigma

32
Q

Emerging disease (a new modern era disease)

A 
MArbug 
Ebola 
Mad cow 
H5N1 
SARS 
MERS
33
Q

Re-emerging diseases

A 
Re-emergence of older diseases
TB 
Monkey pox
dengue 
Ebola
34
Q

Pandemic

A

A pandemic is the worldwide spread of a anew disease
A pandemic occurs weh na new virus emerges and spreads around he world and most people do not have immunity. Viruses that have caused panemics usually form animal influenza viruses

35
Q

12 Steaps to prevent antimicrobial resistance in hospitalized adults

A

1) Vaccinate (prevent infection)
2) Get catheters out (prevent infection)
3) target the pathogen (Diagnoses and treat effectively)
4) Access the expects (Diagnoses and treat effectively)
5) Practice antimicrobial control *use wisely)
6) use local data (use wisely)
7) Treat infections not contamination (use wisely)
8) Treat infection not colonization (use wisely)
9) Know when to say no to vancomycin (use wisely)
10) Stop antimicrobial treatment (when infection is treated on unlikely)
11) Isolate the pathogen (prevent transmission)
12) Break the chain of contagion (prevent transmission)

36
Q

Rise of emerging and re-emerging disease because

A
  • Non-Adherence
  • Legal Sanctions compelling a patient to complete treatment (TB)
  • septicemia or bloodstream infecion
  • Multidrug resistant organism `
37
Q

Emerging disease & Examples

A

Any disease that has appeared in a population for the first time

  • Marburg
  • Ebola (1976)
  • Mad Cow
  • H5N1
  • Nipah virus
  • SARS
  • Middle east respiratory syndrome
38
Q

Re-emerging disease and examples

A

re-appears after a significant decline in incidence, spreads to new places or emerges in a new form. May come back in a different form

  • Plague
  • Human monkeypox
  • Dengue
  • Ebola 2014
39
Q

Key contributing factors to emergence & re-emergence of infectious disease

A 
Microbial adaptation & change 
Human susceptibility to infection 
climate& water
changing ecosystems
 economic development & land use 
Human demographics & behaviour
technology & industry
International travel & commerce
 breakdown of public health measures 
poverty & social inequality 
war & famine 
lack of political will 
Intent to harm 
MOST ARE ZOONOTIC IN ORIGIN
40
Q

Resistance forms of disease

A

Can emerge or re-emerge when bacteria, parasites and viruses are altered by natural selection
-Eg. Malaria resistant to chloroquine or sulfadoxine-pyimerthamine
Multidrug resistant TB
MRSA

TB leading infectious cause of death in the world 5% of active TB in the world are drug resistant.

41
Q

is drug resistant natural?

A

RESISTANCE IS A NATURAL PHENOMENON, but human action / inaction can spread or make it worse

42
Q

Key factors to the development of drug resistance

A
  • Failure of patient to take appropriate doses of drugs
  • Inappropriate use of drugs by prescribers, dispensers, pt.
  • Poor prescribing & dispensing practices
  • The use of counterfeit or poor-quality drugs that do not contain the appropriate level of therapetuic ingredients
    -Inappropriate use of abx in agriculture
    weak health systems with poor lab capacity to dx disease & test for drug susceptibility
    ADDITIONALLY
  • Weak infection control –> hospital born infections
    -Poor sanitation & hygiene
  • Weak surveillance of infections - difficult to detect, enable their spread
43
Q

the health, social & economic impacts of emerging & re-emerging disease

A

VERY LARGE - only few deaths but the costs & conseuqneces are not related to death, it’s related to how frightening the disease is.

44
Q

Cost of anti-microbial resistance is high too

A

Might be sicker than they usually would be, might die at higher rates
Cost 1x more to treat drug resistance TB than susceptible TB
much more expensive 25-60x more expensive

45
Q

Measures to address emerging & re-emergin infectious disease

A

1) Improve land use planning within countries (Zoonotic)
2) enhance public education about these disease
3) Establish national surveillance systems dn public health laboratories
4) share information across countries about disease outbreaks in a timely manner
5) Strengthen implementation of the international health regulations
6) Enhance the capacity for a coordinated and timely global response
7) Improve the financing for such a response

46
Q

Measures to address anti-microbial resistance

A

1) studies of economic burdens of drug resistance
2) a global surveillance system for resistance
3) Better regulate nand stricter monitoring of prescribing practice for ABX
4) enhanced education of the danger of overprescribing ABX
5) Phase out the use of ABx in animals
6) the development of new models for research and development of ABX
7) ) Involve governance of ABX both nationally and globally

47
Q

what is the public health approach?

A

1) Surveillance - wha tis the problem
2) Risk factor identification - what is the cause
3) Intervention evaluation - what works
4) Implementation - how do you do it? (response)

48
Q

What is epidemiology

A

the study of distribution & determinants of health-related state among specified population & the application of that study to the control of health problems

49
Q

Purpose of epidemiology

A
  • Discover the agent, host & environmental factors that affect health
  • Determine the relative importance of causes of illness, disability & death
  • Identify those segments of the population that have the greatest risk form specific causes of ill health
  • Evaluate effectiveness of health programs and services in improving population health
50
Q

4 steps of solving health problems

A

Step 1 - Data collection (Surveillance, determine time, place & person)
Step 2 - Assessment (inference)
Step 3 - Hypothesis testing (determine how & why)
Step 4 - Action (intervention)

51
Q

Epidemic or outbreak

A

Disease occurrence among a population in excesss of what is expected in a given time & places

52
Q

Cluster

A

group of cases in a specific time & place that might be more than expected

53
Q

endemic

A

Disease or condition present in a population at all times

54
Q

Pandemic

A

a disease of condition that spreads across regions

55
Q

Rate

A

number of cases occurring during a specific period always depending on the size of the population during that period

56
Q

Descriptive epidemiology vs. Analytic epidemiology

A

DESCRIPTIVE: collect info to characterize / summarize problem

  • When was the population affected
  • where was the population affected?
  • Who was affected?

ANALYZED: comparison between groups to test a hypothesis

  • how was the population affected?
  • why was the population affected ?
57
Q

Cross-sectional study:

A

subjects are selected b/c they are members of a certain population subset at a certain time.

  • Random telephone survey at a university, exercise habits, obesity
  • Time is important
  • eg. A study of women 50-60 years old in a community located close to a nuclear power facility
58
Q

Cohort:

A

Subjects are categorized on the basis of their exposure to one or more risk factors
- IF an optional healthy eating choices class - follow up to see patterns. Eg. subjects who have not received nutritional counselling and those who did

59
Q

Case control:

A

Subjects identified as having a disease or condition are compared with subjects without the same disease of condition.
Move backwards form those two have disease (Eg. cruise ship)

60
Q

Four remedies to prepare the world for a global pandemic

A

1) Faster pipelines - such as the coalition on epidemic preparedness - pre-emptively develop vaccines for diseases predicted to cause outbreaks in near future
2) Point of care diagnostics that can be used by frontline responders or patients themselves to detect infectious nright away where they live
3) Greater global coordination to address the currently fragmented responsibility for controlling pandemics
4) Stronger local health systems that con provide routine case & when needed, coordinate with international responders to contain new outbreaks

61
Q

Pandemics now occurs with greater frequency d/t

A

1) Climate change
2) Urbanization
3) International travel
4) Weak health organizations
5) Potentially massive cuts to funding ro US scientific research & foreign Aid including the UN

Global health (6 decks)

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