kin 440 Exam 1

Alzheimers economic burden

- $236 billion (health care, long term care, hospice) - 15 million Americans provide unpaid care for people with dementia (stressful, financial, emotional)

What are the main PA guidelines for adults 18-64

- 150 min/week moderate intensity - 75 min/week vigorous intensity - 2+days/week muscle strength of all major muscle groups

What are the main PA guidelines for KIDS?

- 60+ min/day moderate to vigorous aerobic PA - 3 days/week bone and muscle strengthening

oldest old population

- 85+ years - Alzheimers, dementia, diabetes, falls, depression, arthritis - social isolation - high cost of retirement - loss of independence

Depression

- symptoms must be present for at least 2 weeks - persistant sad, anxious, empty mood - hopelessness, worthlessness, guilt - fatigue - appetite/weight change - suicidal thoughts - irritability

Older Adults PA Guidelines

- as active as possible - balance improving PA - PA relative to fitness level

Societal sectors

- business industry - community recreation, parks - education - faith - healthcare - mass media - public health - sports - transportation

Heroin Epidemic

- death rates on rise in recent years (quadrupled since 2010) risk factors - addiction to prescription painkillers, cocaine, marijuana, alcohol - no insurance - non hispanic white - males - 18-25 years old

social determinants and poor health outcomes

- high allostatic load - access to health care - access to healthy food/water

mental illness in US

- high prevalence - severe mental illness less common but high burden

Public Health Achievements

- immunizations - motor vehicle safety - workplace safety - control of infectious disease - safer/healthier foods - family planning - healthier mothers/babies - tobacco as health hazard - fluoridation of drinking water - declines in deaths from heart disease and stroke

Intervention studies

- independent variable = what you are manipulating - dependent variable = the outcome of interest - confounding variable = factors that might influence relationship --> control for these

Environmental Health

- where we live, work, play - air, water, food

sarcopenia

- loss of muscle mass, strength, function related to aging - even if you are active you'll have muscle loss - affects balance, gait, overall function

relative vs. absolute intensity

- low fitness level = perceived high intensity - high fitness level = perceived low intensity look @ graph

underserved populations

- low income - disabilities - illness - homeless - drug addiction - old adults

Years lived with disability (YLD)

- measurement of burden of disease - calculated by multiplying prevalence of disorder by short or long term loss of health associated with disability

mental health

- mood disorders - anxiety/depression - addiction - stress - schizophrenia - ADHD - sleep - self esteem

San Francisco Longshoreman 1970

- most active group of cargo handlers had lower coronary artery disease death rates

Symptoms of dementia due to Alzheimers

- most common = worsening ability to remember new information - challenges in planning or solving problems - difficulty completing tasks - confusion w/ time or place - poor judgment - withdrawal from work - changes in mood/personality

Age is a risk factor for

- musculoskeletal conditions - dementia - social isolation many more

What is the leading cause of YLD in the US

- neuropsychiatric disorders followed by musculoskeletal disorders and non communicable diseases

Alzheimers Incidence and Prevalence

- prevalence = 5.4 million - incidence = 476K new cases - 6th leading cause of death in US - at 65 y/o risk of developing AD is 17% for women and 9% for men

The two "P" of public health, which differentiate public health from the field of medicine are

- prevention and population - medicine = individuals and treatment

This theory suggests that performing physical, social and mental activities can delay the onset of dementia despite advancing Alzheimer pathology

Cognitive reserve theory

Study of distribution and determinants of disease and disability in populations

Epidemiology

PA vs. Exercise

Exercise - planned - repetitive - structured - goal of improving fitness PA - any bodily movement - health

Higher rates of cardiovascular disease and other chronic condition among African Americans are largely attributable to these

Social determinants - residential environment - race - accessibility - access to health care - social relations/support

The gold standard study design in PA and public health, or in other words the study design that is capable of producing strongest level of evidence for benefits of PA

Randomized control trials

What is the aging paradox

mental health increases with age despite declines in physical health

Risk Factors CVD

modifiable - diet - PA - Hypertension - smoking status - BMI non modifiable - race/ethnicity - age - gender

PA & Anxiety

more research and studies need to be performed - small trials show benefit of PA and anxiety

Dementia

most common cause = Alzheimer's disease (60-80% of cases)

Alzheimer Risk Factors

non modifiable - age - gender - race/ethnicity - family history - APOE0e4 gene modifiable - smoking - obesity - diabetes - hypertension - high cholesterol - diet / PA - social/cognitive engagement - traumatic brain injury

Southwest Baltimore was a unique neighborhood to study health disparities because

equal percent blacks and whites that have equal high school grads and equal income --> similar socioeconomic status

Health administration and policy

focus on delivery of public health services

Health promotion and health education

genetics, environment, behavior affect health status - promote exercise/healthy food - avoid tobacco - use condoms

Longitudinal/prospective study

group is followed for a defined period of time to ascertain occurrence of health outcome

The wear and tear on the body that results from coping or adapting to a stressor is known as (cost of coping/adapting to a stressor)

allostatic load

What is the difference between the National Physical Activity Guidelines and the National Physical Activity Plan

guidelines = target individuals plan = target policy makers

Quasi-experiment

control group without randomization

To qualify as a public health issue, a condition must be preventable, highly prevalent or increasing in incidence, burdensome, and

costly

PA & depression

cross sectional evidence - people who are more active are less depressed - correlation does not equal causation prospective evidence - less active = greater risk for depression - PA defend against depression

when the exposure of interest and the outcomes of interest are measured at the same time the study is a

cross sectional study

The extent to which conclusions drawn from experimental data are free from confounding issues which cause bias such as reactivity and missing data is known as

internal validity

The major public health message that can be draw from this figure is

less active people benefit more from PA

isolation

pervasive lack of social contact or communication, participation in social activities, confidant

These two pathological features are the hallmarks of Alzheimer's disease in the brain

plaques and tangles

osteoarthritis

prevalece - over 30 million Americans - 1 in 2 adults develop symptoms of knee OA - 1 in 4 develop symptoms of hip OA risk factors - age - gender - obesity - joint injury - family history

osteoporosis

prevalence - 54 million Americans - 1 in 2 women, 1 in 4 men age 50+ will break bone due to osteoporosis - 20% seniors who break hip die within a year risk factors - age (menopause in women) --> peak bone mass around 30 - gender - family history - bone structure/weight - ethnicity - diseases/medications - smoking, drinking, sedentary

purpose of public health

prevent, protect, promote, respond - assure quality and accessibility of services

The changing burden of disease in US over the past 100 years refers to

rising chronic disease, falling infectious disease

Mental Health affect public health

risk of losing job risk of addiction risk of failing school risk of CVD poor diet social relationships decrease quality of life

This PA measurement approach is inexpensive and provides context

self report

medically underserved population (MUP)

specific sub-groups of people living in a defined geographic area with a shortage of primary health care services

Dramatic spike in opioid deaths in 2016 due to this type of opioid drug

synthetic drugs

social determinants

the circumstances in which people are born, grow, live, work, and age and the systems put in place to deal with illness - socioeconomic status - race/ethnicity - social support - culture - access to medical care - residential environments

Stigma can lead to poor health outcomes in people living with HIV/Aids or people with mental illness. These vulnerable populations are considered?

underserved

validity vs. reliability

validity - exact representation of what happened, free from sources of error of bias reliability - tool gives consistent, stable, repeatable measurements

Severe musculoskeletal conditions can limit an older person's ability to function independently and perform these activities, including showering and getting dressed

activities of daily living (ADL)

lonliness

feels of isolation, disconnection, not belonging

The first study to demonstrate the exercise heart hypothesis was the

1953 London bus study - physically active conductors had lower rate of CHD than the sedentary drivers

In 1854, John Snow traced the source of Cholera to this location

Broad street water pump

This infectious disease outbreak led to the collection of the 1st ever public health statistic

Bubonic (black) plague

Socio-ecological model of health behavior

PA behavior influenced by - personal - family - institutional - community - public policy

mechanisms linking social determinants with chronic disease

Psychological - through effects on mental health (stress, anxiety, depression) Behavioral - through effects on poor health (smoke, low PA, poor diet, low medical adherence)

Global - Heart disease National - Obesity Regional - Opioid addiction Local - homelessness Umass - STI

Public Health Issues

Loss of a partner; inability to drive a car, and ageism can cause this, a major risk factor for mortality, among older adults

social isolation

Dementia and PA

- PA delays incidence of dementia and onset of cognitive decline

Generalized Anxiety Disorder

- excessive anxiety or worry for months - restlessness - fatigue - difficulty concentrating - irritability - muscle tension

Little Rock 9 - Sept 25, 1957

Arkansas president sent troops to escort African American students into an all white school

Biostatistics

Quantitative methods to analyse data and interpret study results - look @ trends - determine effectiveness of interventions

experimental validity

determine whether data is free from bias & generalizable to wider populations

measurement of PA

device based measures -accelerometers -pedometers self report -logs -interviews -questionnaire direct observation -watch and record

The extent to which conclusions drawn from the data are generalizable to wider populations. Assessed by examination of age, sex, ethnic origin, socio-economic status of study sample

external validity

medically underserved areas (MUA)

shortage of primary health services for residents within a geographic area