Pub Health 150

epidemiologic transition

"the worst of both worlds" bc infectious diseases persist while diseases of affluence increase

prevalence

# of cases existing in a given population at a single point in time / population at that time (odometer)

incidence

# of new cases occurring in a given population in a specific time period / population at risk in that time period (speedometer)

c: contact rate

# of partners, concurrency, sexual network, geography, technology, age, norms

closing the gap

- dynamic interaction between social and medical forces - behavior modification - combination of prevention and intervention across life span at multiple levels - new government emphasis on population and community health

essential factors for disease eradication

- epidemiological knowledge - effective tools for diagnosis, treatment, and prevention - knowledge of local culture and politics - community acceptance and mobilization - political will and leadership - adequate and sustained funding

role of public health professional

- establish surveillance - assure lab capacity - develop plans for handling outbreaks - inform physicians about responsible use - promote vaccination

priorities in developing countries

- factors: numbers, severity, impact - barriers: poverty, low education, inadequate health systems, corruption, urbanization and growth of ghettos, cost and access to healthy food, wealth disparities

paradox of improved health and natural system deterioration

- food services increasing while other ecosystem services are diminishing - technology and infrastructure have decoupled wellbeing from nature by increased exploitation of ecosystem services - time lags b/w deterioration of ecosystem services and the resulting reductions in human wellbeing

causes of disease emergence and re-emergence

- genetic/biologic: mutations - human behavior - physical environmental: crowding, sanitation - ecologic: climate changes, deforestation

suicide

- globally kills 800,000 people a year - that's 10.5 per 100,000 - 2nd leading COD for people 15-24 - 2.8% median amount of health budget allocated to mental health - young adults and elderly women in low and middle income countries much higher rates than in high income - higher income countries, middle aged men - 90% suicides associated with mental disorders

suicide in US

- third cause of years of life lost - 3rd COD for 15-24 and 4th for 25-44 - 10th leading COD in US - youth rates increasing, 70% among white males and 77% AA males - occurs every 12.8 mins - twice as freq among males (account for 70% of all suicides) - highest rates in Alaska and mountain states - cost of deaths about $44 bil

causes of COPD

- tobacco smoke number one cause; not curable but there are treatments to relieve symptoms - air pollution indoor and outdoor, occupational dusts and chemicals, frequent lower respiratory infections

water

- trumps oil - most precious commodity next to oxygen - biggest long term problem bc no alternatives

biostatistics - assurance

- use sampling and estimation methods to study the factors related to compliance and outcome - possible inaccuracy

sexual minorities

- women: increased risk of depression, stress, and victimization - men: increased risk of cardiovascular biomarkers and hypertension - both at risk for STDs and sexual trauma

global aging

10% in 2000 --> 21% in 2050 - impacts: health care used will be 3-5x greater - 50% have two or more chronic conditions - currently 1 billion 60 years or over, projected to increase to 3.1 billion

school life expectancy

12 years for males and females

vitamins

13 types, not produced by body on a daily basis - fat soluble: A, D, E, K (easier to store) - water soluble: B, C

poverty

17% live on less than a dollar a day; widening gap according to detels, the biggest public health problem today - 17.4% globally live on less than a dollar a day - most in africa

moderate alzheimer's

2-10 years withdrawal, confusion, difficulty in self-care, poor judgement, anger, anxiety, confusion, frustration, caregiver assistance may be necessary

mild alzheimer's

2-4 years minor memory loss, difficulty learning and remembering new information, long term memory remains intact

schizophrenia

- gray matter loss and abnormal basal ganglia, auditory system, occipital lobe, hippocampus, limbic system, and frontal lobe - illogical and confused thought patterns, hearing internal voices, or beliefs that people are reading their minds/controlling their thoughts - 75% developed from 15-25 affecting men and women equally - 10% commit suicide - types: paranoid, disorganized, catatonic, undifferentiated

sentinel for HIV/AIDS

- groups: homo/bisexual, commercial sex workers, and returning overseas workers, IV drug users, males at STD clinics, plasma donors, etc - sites: previous reports of high prevalence and susceptible/vulnerable groups, exposure to high risk indv, cross border regions, trade centers - products: reservoir, trends in prevalence, trends in incidence, advocacy, prediction

health care crisis in the U.S.

- healthcare disparities - insurance - vaccinations - high per capita health expenditures

second hand smoke

- higher among children, blacks, renters - sidestream and mainstream smoke - sidestream smoke contains more carcinogens - killed more than 600,000 non-smokers in 2010 - increases risk of lung cancer by 30% - no safe level of exposure - 75% of secondhand smoke deaths in women and children

mortality rate

- highest in sub-saharan africa and south asia - africa highest for under five and maternal - africa also has lowest life expectancy - eastern europe have greatest difference in life expectancy males vs females more than 2.5 SDs

suicide prevention

- hotline, psychiatric hospital walk-in clinics, hospital emergency rooms, urgent care centers, reduce access to firearms, student health center, treatment of mental disorders - identify and focus on high-risk families for early prevention - reduce access to lethal means - recognition of intent by health professionals - referral and counseling of high-risk indv

detect outbreaks/early warning

- human disease - zoonotic disease (influence --> watch birds and pigs as early harbingers) - food safety (ex. chipotle - indv outlets or central kitchen) - drug-resistant organisms (bacteria building resistance to vaccinations)

CVD

- include disease of the heart, vascular disease of the brain, and diseases of blood vessels - top COD globally, 3/4 of deaths in low and middle income countries, 17.86 mil deaths per year - higher proportional mortality in China than US due to much greater prevalence of tobacco smoking - significantly higher mortality rate in low income countries

role of public health in mental health

- incorporate mental health promotions into chronic disease prevention efforts - improve evidence base on mental health (surveillance and research) - collaborate to build comprehensive programs

drug dependence

- injection drug use major cause of HIV and HCV - loss of productivity - disruption of families - increase crime rates - over-prescribing of anti-depressive and mood elevation drugs - highest rates of usage among unemployed, but most users are full time employed

US health care system

- insurance coverage is not universal and until 2014 relied on voluntary private insurance (employers did not have to offer coverage, indv did not have to purchase) - no overall budget - rationing carried out on demand not supply side - price rather than personnel or technology is a limiting factor

health behavior theories

- interventions based on indv health behaviors and environmental context - basis for health education practices/strategies - no on theory dominates health education - a theory should be chosen based on the topic and target pop: logical, consistent w everyday observations, similar to those used in prev successful programs, support by past research in the same area - ex. transtheorectical model of change, theory of planned behavior, social cognitive theory

condoms

71% of study participants had any sort of condom error, most accounted for by starting sex without a condom - reduces risk of of chlamydia and gonorrhea by 90% - condom use education

water sources

97% salt water remaining 3% fresh - 2% of which is frozen so 1% is left for use - 70% of that fresh water is used for agriculture

diarrheal diseases

2nd leading COD in children under five but preventable and treatable with safe drinking water and adequate sanitation and hygiene - 1.7 cases in children - leading causes of malnutrition in children under five - 780 mil lack clean water and 2.5 bil lack improved sanitation - oral-fecal route of infection but can also spread person to person or through food --> rapid dehydration and inability to absorb nutrients

other common biostatistical methods

2x2 table --> chi sq correlation analyses regression analyses survival analyses

waterborne illnesses and parasites

3.6% of DALY global burden of disease; cause 1.5 million human deaths; 842,000 (58%) attributable to lack of safe drinking water supply, sanitation and hygiene

education expenditures

4.4% of GDP

contributions to premature death

40% behavioral patterns, 30% genetic predisposition, 15% social circumstances, 10% healthcare, 5% env exposure

hypertension

47% controlled, 53% uncontrolled --> 14.1 mil unaware, 5.7 aware but untreated, 16 mil aware and treated

macros

55-65% carbs, 25-35% fat, 10-20% protein

sexual diseases

LA 1st in the nation for chlamydia and 2nd for gonorrhea

whole grain

all parts of grain are milled rather than germ and bran being separated like in refined grain; decrease in diabetes and CVD

total revenue = total expenditure = total income

T + R + C = P x Q = W x Z aka T taxes + R private insurance premiums + C direct charges to patients = P average price of health care services x Q quantity of health care services provided = W average wage x Z total inputs used (labor and capital)

graph of diagnostic imaging prices

US highest for both MRI and CT scan, with New Zealand second

chart of cost-related access problems

US ranks highest in costs affecting health care, including: - did not fill prescription of skipped doses - had a medical problem but did not visit doctor - skipped test, treatment, or follow up

graph of preventative measures (i.e. cervical cancer screening)

US top for all first world countries; highest number of women screened and highest five-year relative survival rate for breast cancer

graph of total health expenditure per capita

USA (more GDP and more health spending) and Norway (more GDP less health spending) two outliers

41. September 2017 was the hottest month in recorded California history: a. true b. false

a. true

42. The United States has less longevity per health expenditure than most of the developed countries in the world: a. true b. false

a. true

53. Plants can play an important role in reducing water pollution: a. True b. False

a. true

56. Genetic make-up of individuals can play an important role in their response to environmental exposures: a. True b. False

a. true

57. The smaller the particle size of air pollutants, the more likely the particles are to reach the alveoli where gas exchange in normal respiration occurs: a. True b. False

a. true

6. Public health IS politics: a. True b. False

a. true

63. Syphilis and chlamydia are increasing problems among the elderly: a. true b. false

a. true

68. Life-long engagement in physical activities and fitness are key for improving the quality of life for individuals as they age a. true b. false

a. true

69. There are more people older than 65 years than in all human history combined: a. True b. false

a. true

probability

about groups of people, not individuals; science that describes occurrence of events

nutrients

absorbed in small intestine --> epithelial cells --> bloodstream

promote health

access to quality health care services and preventive care to minimize development of chronic disease

health literacy

accessing, understanding, communicating, and engaging in health contexts (comprehending education --> using it in a diff context; one of the outcomes of health education) - low literacy = poorer overall health - low literacy --> misuse of medication and misunderstanding; causes overuse of health services like ER; waiting too long to seek help until crisis state

optimal aging

acknowledges people can age optimally in one domain but not another, norm driven

projected causes of death have seen a decrease in...

actue respiratory infections, perinatal conditions, HIV/AIDS, TB, malaria

prevention of CVD

addressing tobacco use, unhealthy diet and obesity, physical inactivity and harmful use of alcohol

maintain adequate levels of economic and social development

adequate, safe, and healthy job opps for all, support for children and opportunities for education

tertiary prevention

after a health problem has happened, maximize independence and quality of life

medicare

age 65+ or disabled, federal program, closest to other country's programs

d: duration of infectiousness

agent (biology/characteristics), host (immunity), case-finding, access to diagnosis/treatment

disease characteristics

agent, host, environment = state of equilibrium between agent and host

intersectoral linkages for advancing public health

agriculture, environment, education, housing, commerce, wage laws, water resources, transportation

major preventable risk factors

aka behaviors; smoking, alcohol, drugs, seat belt, diet/inactivity, healthcare disparities, gun policy, sex

aflatoxin and liver cancer

alfatoxin is a carcinogen that causes liver cancer

graph of access to improved drinking water source

all countries declining in number of people without access to improved drinking water source except for sub-saharan africa - on the rise but lowest numbers currently

H5N1

avian influenza - highly infectious and pathogenic for domestic poultry - > 50% case fatality, endemic in poultry in SE Asia, spread from South Korea --> Asia --> Europe and Africa - intervention: culling, surveillance strategies, vaccination - barriers: reservoir in wild birds and ducks, economic impacts, "wet markets," resistance to vaccines, distrust

46. The human brain grows in size until the age of: a. 6 months b. 5 years c. 15 years d. 25 years e. 81 years

b. 5 years

44. The high number of destructive hurricanes in September 2017 is due to: a. A lower than usual temperature of the water in the Caribbean b. A higher than usual temperature of the water in the Caribbean c. The rapidly decreasing acidity of the water in the Caribbean d. Persisting withdrawal of the oil from the Gulf States of the southern U.S. e. Cumulative pollution of the Atlantic by the European nations.

b. A higher than usual temperature of the water in the Caribbean

61. The perception that a health problem is part of natural aging: a. Promotes facing reality as we age b. Is a barrier to seeking medical advice/intervention c. Promotes health seeking behavior d. Is an unfortunate fact of life

b. Is a barrier to seeking medical advice/intervention

67. Which a. is more important for the aged? a. Adding years to life b. Adding life to years

b. adding life to years

25. The rate of population growth will be greatest for which area of the world? a. Asia b. Africa c. The Americas d. Europe e. Oceania

b. africa

51. The implementation of tube wells in Bangladesh intended to provide safer water resulted in increases poisoning due to: a. Mercury b. Arsenic c. Tetraethyl lead d. Organic phosphartes e. All of the above

b. arsenic

4. The disease currently rampant in Yemen is: a. Ebola b. Cholera c. West Nile encephalitis d. Dengue e. Small pox

b. cholera

23. Global population growth over the last 75 years has risen gradually but consistently: a. true b. false

b. false

32. Each infectious agent uses a unique portal of exit from the reservoir and entry to the susceptible host: a. True b. False

b. false

45. In recognition of the devastating hurricanes in the southern United States and the raging wild fires in the western United States, the president has increased funding for the NOAA weather satellite programs: a. True b. False

b. false

52. Los Angeles is a model city for management of liquid and solid waste: a. true b. false

b. false

60. The rate of decline in all domains of aging is similar and steady: a. true b. false

b. false

65. Percent GDP spending on health and proportion of the population above 65 years is directly correlated: a. true b. false

b. false

64. The highest proportion of elderly (>65 years) by 2050 will be: a. European-Americans b. Hispanic-Americans c. African-Americans d. Asian-Americans e. Hawaiian-Americans

b. hispanic

59. Healthy aging implies: a. Absence of disease b. Maximizing functioning and well being c. Maintaining one's peak abilities d. All of the above e. a. and c. above

b. maximizing functioning and well being

31. Zika virus can be controlled by: a. Vaccination b. Mosquito control c. Treatment d. Prophylactic drugs e. Post-exposure prophylaxis

b. mosquito control

26. Across the globe, the health of the family is most closely related to: a. Father's education level b. Mother's education level d. Control of malaria d. Control of cholera e. Control of measles

b. mother's education level

12. In epidemiology, the reproductive number is: a. The reproductive rate of women 15-45 years b. the number of secondary cases arising from a primary case c. The rate of reproduction of the vector of the agent d. The fertility of a disease vector e. a.. and c.

b. the number of secondary cases arising from a primary case

3. Gonorrhea is: a. Easy to treat b. Very popular in Los Angeles c. Has a higher incidence than chlamydia in Los Angeles d. All of the above e. a. and c.

b. very popular in LA

sexually transmitted infections

bacteria (chlamydia, salmonella, gonorrhea, etc, all caused by bacteria), protozoa, or viruses (papillomaviruses, herpes, sarcoma, immunodeficiency virus, T-cell lymphotropic virus, hep A, B, and C, ebola, zika)

theory of planned behavior

behavior change is by intent to adopt positive behavior and abandon negative behavior; influenced by behavioral intention, attitude toward a behavior, subjective norm, and perception of behavior control

observational learning

behavioral acquisition by watching actions and outcomes of others' behavior --> credible role models

perceived behavioral control

belief that one has and can exercise control over performing the behavior --> is it up to you?

subjective norm

beliefs about whether key people approve or disapprove; motivation to behave in a way that gains their approval --> agree of disagree that most people approve/disapprove?

human health today

better today than at any time in history by most metrics; rising life expectancy, lowered death rates, and decreased number of people living in extreme poverty

other modifiable behaviors

binge drinking (highest in 18-29 with males more than females), firearm mortality (most common in southern states and alaska)

intervention strategies

biologic (vaccines, PreP, nutrition, sanitation), behavioral (indv and community), political (lobbying, laws, universal access to health care, improve standard of living), structural (surveillance, laws and regulations, taxation, safe water, safe disposal, bans, enforcement)

environment

biologic and chemical pollution, climate change, deforestation

complexities of aging

biological, psychological, and social changes at varying rates, affected by surrounding env but contributed to heterogeneity in pop (substantial indv difference in rates of change lead to diversity among older adults)

catatonic schizophrenia

bizarre/immobile/relentless motor behaviors

graph of racial difference in cancer

black males get cancer more than white; females relatively same (whites a little higher) - overall, black males > white males > white females > black females - 7 year survival rate for all sites b/w white and black people - death rate highest in blacks relatives to sexes

type 1 diabetes

body does not produce enough insulin

type 2 diabetes

body produces insulin but cannot use it well - risk factors: unhealthy diet, physical inactivity, overweight/obesity

2. The objective of public health is to: a. Guarantee positive health for all b. Treat individuals with neurologic diseases c. Assuring access and the tools to achieve a healthy community d. All of the above e. b. and c. above

c. assuring access and the tools to achieve a health community

18. The three countries with the most people are: a. China, India, Indonesia b. India, Pakistan, USA c. China, India, USA d. China, India, Brazil e. China, Pakistan and Brazil

c. china, india, usa

4.Los Angeles and San Diego are currently experiencing an epidemic of what disease among homeless individuals? a. Measles b. Cholera c. Hepatitis A d. Coronary heart disease(heart attack) e. High blood pressure

c. hep A

16. The strongest evidence of person-to-person transmission of Capilleria Philippensis was: a. The geographic distribution of cases b. Gender distribution of cases c. The disappearance of cases after treatment was initiated d. The small number of cases in those under 5 years of age e. Prior studies of Capilleria Philippensis in humans

c. the disappearance of cases after treatment was initiated

BMI

calculated from a person's weight and height, provides a reliable indicator of body fatness for most people and is used to screen for weight categories that may lead to health problems - normal 18-24 - overweight >25 - obese >30

syphilis prevention

campaigns in SF have raised awareness, increased testing

portal of exit vs. entry

can differ: exiting one host and entering another - ex. HIV: exit through sex, enter baby through mother - respiratory: influenza, cold, etc - genitourinary: STD - alimentary track: cholera, salmonella - skin: streptococci - percutaneous: vector borne - eye -transplacental: HIV

projected causes of death have seen an increase in...

cancers, ischaemic heart disease, cerebrovascular disease, traffic accidents

health insurers

cannot turn down people w a history of illness, terminate coverage, must renew coverage, cannot charge more to those w a history of illness (elderly charged max of 3x young person), return at least 80% of premiums in the form of health service benefits

ischaemic heart disease

causal chain from age, education, income --> physical activity, fat intake, overweight, alcohol, smoking --> bp, cholestrol, type 2 diabetes --> ischaemic heart disease

pollution

caused an estimated 9 million premature deaths, 65% worldwide; 3x more than infectious disease, 15x more than violence

chlamydia trachomatis

causes burning with urination, genital discharge, pelvic inflammatory disease, epididymitis, procitis, tubal pregnancy, infertility; most commonly asymptomatic; treatment includes oral medication, partner treatment, and re-testing at 3 months

intervention to promote health aging

change focus from disease to health: - support care and services - preventive > treatment - promotion of functioning and well-being - not too much/too little healthcare change concept that aging is a lifelong process: - early/mid life influences (birth weight, education, physical activity)

structural

change in access, availability, or acceptability (policies, prices, payers, physical and social environments, organizations, communities: iodized salt, purified water, sewers, building regulations, vehicle air bags, etc)

analysis of surveillance systems

change in freq of risk activities, change in HIV prevalence/incidence, consistency of trends, interpretation and implications

action

changed behavior for less than six months --> feedback, problem-solving, social support, and reinforcement

maintenance

changed behavior for more than six months --> coping, reminders, alternatives, avoiding lapses

refined grain

cheaper because higher demand so higher supply; empty calories because no germ/bran; lasts longer

total body burden of potential toxicants

chemical, biological, physical, metabolic, psychological, and hypersensitivity

2x2 tables

chi square statistic indicated an association between two variables; simpler analysis than linear regression --> easier to explain to policymakers but loose a lot of information through simplification

most populous countries

china, india, us, indonesia, brazil, and pakistan

languages

chinese, spanish, english, arabic

religion

christians, muslims, unaffiliated, hindus

provide quality and sustainable environments

clean air, soil, and water, smoke-free, natural and open spaces, and minimized waste, toxic chemicals, and harmful emissions

reasons for a lack of clean water

climate, poverty, rural location, pollution

health factors

clinical care, health behaviors, social and economic factors, and physical environment

mental disorder

clinically significant disturbance in an indv's cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or development progresses underlying mental functioning; associated with significant distress - most common: anxiety, psychosis, mood disturbance, cognitive impairment, and somatic symptoms

genetics

code of gene (DNA); expression varies by DNA methylation, histone modification, single nucleotide polymorphisms, ncRNAs --> determines human health, response when exposed to environmental agent

study designs

cohort, cross-sectional, serial cross-sectional, mortality surveillance, sentinel surveillance, syndromic

modern balanced mental health system

community services, crisis resolution teams, home treatment, assertive outreach, early intervention teams, day treatment facilities, support work programs, decrease emphasis on mental hospitals

quality enhancement

comparative effectiveness research (cannot consider costs, covered services, and reimbursements), bundled payment program, pay hospitals based on performance

case study: gonorrhea

complaints of penis discharge/burning when peeing --> take a specimen --> gram stain of urethral discharge --> identify N. gonorrhoeae infection by detecting organism DNA or RNA --> nucleic acid amplification testing --> point-of-care testing --> same-day results --> treatment: multi-drug combination, restesting in 3 months

CARE

comprehensive adolescent recruitment and engagement strategies for HIV among youth - 1/4 of new HIV diagnosis - black 4x than hispanic and 12x than white - half of 13-24 did not know they had HIV, highest rate of undiagnosed

infant mortality rate

almost double the standard of 3.5, very high for a high income country; due to access to prenatal care and low birthweight, between 1 mo - 1 yr

causes of depression

alternations in brain chemistry, hormonal imbalance, genetics, low self-esteem, anxiety disorders, physical or sexual abuse, substance abuse, certain medications

ten essential functions of public health

assessment, policy development, and assurance

47. According to former Dean Breslow, public health ______ the conditions under which people can lead a healthy life:

assures

social determinants

availability of resources to meet daily needs (safe housing), social support, education and employment, racism and sexism, access to health care services, exposure to crime/violence, social norms and attitudes, socioeconomic conditions, language/literacy

surveillance

continued watchfulness over distribution and trends of incidence through the collection, consolidation, and evaluation of morbidity and mortality - to prevent and control disease - timely dissemination of information so that action can be taken

prevention of the flu

cover sneezes, wash hands frequently, avoid touching eyes/nose/mouth, avoid contact with sick people, avoid crowded and congested environments, don't expose others, follow public health advice, get flu shots, take medication if needed

cross-sectional vs. serial

cross sectional - random sample --. administer questionnaire, single event serial - repeated survey in particular intervals from new sample each time

global public health information network

daily flow: scanning global news, filter and sort, review for relevancy

ebola outbreak

death toll rose in the thousands - prevention: community engagement, isolation of patients, maximum protection for caregivers, quarantine of contacts, gamma globulin from survivors

population growth rate

declining from 2% in 50's and 60's to about 1% now; projected to be 11.2 billion by 2100 - majority of population growth occurs in developing countries, mostly Africa

fertility changes

declining over the last century --> fewer babies

syphilis epidemiology

decreased over time but slowly on the rise again; primarily men 25-29; highest in black and more recently native Hawaiian pacific islanders; rising rates of congenital and primary and secondary

graph of cancer death rate trends

decreasing since 1990's for both sexes although higher rate for males for all cancers esp lung

selecting the population

define selection criteria (human or zoonotic pop), gain access to target pop, and obtain and maintain compliance

graph of mortality amendable to health care

defined by death before 75 due to conditions that could have been treated; highest proportion out of of all countries - 96 per 100,000 - US shortcutting quality of care? - diff in socioeconomic and env factors

paranoid schizophrenia

delusions of persecution, auditory hallucinations, intact intellectual functioning; best prognosis for recovery

secondary prevention

detect problem early and treat before serious harm results

29. Ebola is spread by: a. Direct contact b. Respiratory route c. Indirect contact (e.g. clothes) d. All of the above e. a. and c. above

e. a and c above

71. Why are children more susceptible to the harmful effects of lead poisoning? a. They have a larger surface area to mass ratio b. Their brains are still developing c. They explore their environments more than adults do d. a. and b. above e. All of the above

e. all of the above

35. Nosocomial infections are: a. Acquired at home b. Acquired in hospitals c. Likely to be resistant to many drugs d. All of the above e. b. and c. above

e. b and c above

43. Life expectancy in the United States has risen faster over the last 50 years than in: a. Japan, Canada, Sweden and South Korea b. Germany, Denmark and Greece c. Switzerland, New Zealand and Norway d. All of the above e. none of the above

e. none of the above

70. Which of the following was NOT a source of lead exposure? a. Leaded gasoline b. Soil c. Disposal of car batteries d. Household paint e. None of the above

e. none of the above

causes of schizophrenia

early causes (genetic, complications) --> vulnerability (impairments, social anxiety, odd ideas) --> abuse of drugs/social stress/isolation --> psychosis - highest risk in identical twins, then fraternal, and children

key factors impacting mental health

early life, family structure and function, school experience, workplace, community

syndromic surveillance

early outbreak detection; looking for new and emerging diseases by tracking unusual symptoms and signs

syphilis treatment

early treatment - injection; doxycycline prophylaxis for the reduction of syphilis in MSM, 73% decrease in incident STDs

prevention of diabetes

eat healthy, be physically active, avoid weight gain, check blood glucose, follow medical advice - governments can provide health environments, better data, and better diagnosis and treatment

solutions to keep people out of poverty

educational programs, vocational training, job training, child care supports, literacy programs, english as second lang, earned income tax credit, housing subsidies, supplemental food assistance programs

effective depression prevention strategies

educational, psychotherapeutic, cognitive problem solving, social skills training, pharmacological, life-style, nutritional, coping skills

treatment modalities

educational, psychotherapeutic, pharmacologic, lifestyle, and nutrition - 59% do not get treatment, 22.8% treated by GP and 12.3% by psychiatrist

actions to improve education attainment

expand early childhood development programs, comprehensive k-12 reform, mentorship model, help drop outs receive GED, improve college enrollment

case study: environmental exposome

exposure to airborne biological and chemical agents --> personal monitor --> processing and analysis produces taxonomy, personalized exposome signature, environment cloud, etc human exposome influenced by environmental and spatial variables

health education practice is based on a major dominating theory

false

information is sufficient for behavioral change

false

number one risk of health globally

fielding says climate change; detels says poverty

adverse childhood experiences

harm children's developing brains and lead to changing how they respond to stress and damaging their immune systems --> effects show up decades later 1. abuse 2. neglect 3. household dysfunction

maternal mortality ratio

has risen over past years

health promotion

health education (educational efforts to affect behavior change), health protection (regulations), and prevention (laws to promote health) - education x public policy

global health

health problems across borders (pandemics, regulations, migration.refugees, natural disasters) and health disparities between and within countries - global responsibility

U.S. causes of death

heart disease, cancer, chronic lower respiratory disease

common causes of death 65+ (high mortality)

heart disease, cancer, stroke, lung conditions, alzheimer's, diabetes

top risk factors for death

high blood pressure, tobacco use, high blood glucose

hdl

high density lipoproteins, good cholesterol

abortion

higher in AA

STD

higher in AA - GC and chlamydia rates are highest among 15-24 year olds - HIV highest in AA - 19 mil new cases per year - major cause of infertility - regional variation, higher in the south

teen pregnancy

higher in AA and hispanic

risk of premature death due to NCDs

higher in males because of high risk behavior (unintentional injuries 6.3% of deaths vs. 3.8% for women)

income

higher income percentile, greater life expectancy for both women and men

urban population

highest in Saudi Arabia

population density

highest in bangladesh and south korea, followed by china and india - high density promotes disease

gross domestic product per capita

highest in saudia arabia because oil reserves

child mortality rate

highest in sub-saharan africa

community mental health services

housing, halfway houses, day care and family counseling, suicide hotlines, substance abuse services, self help groups, assessment and medical evaluation

anthropocene

human activities began to have a substantial global effect on the Earth's systems; yet to be recognized as a new epoch

smoking cessation

information, health benefits of stopping smoking, biomedical intervention: patches, support/online resources, positive framing, multiple ways of outreach, uses TMC, tools and tips

determinants of nutritional status

ingestion > digestion > absorption > assimilation > utilization > nutritional status

HIV prevention/treatment framework

initial testing --> positive --> treatment continuum negative --> assessed for risks and needs, linked to prevention services, engaged retained and adherent, retesting

politics affecting ACA

insurance exchanges can only include private companies, no coverage for undoc indv under Trump: - indv mandate repealed - nullified cost sharing subsidies for those w incomes below 250% of FPL - cut open enrollment period for 2018 exchanges in half and drastically cut funding for outreach - sale of short-term policies, potentially severe restrictions - support repeal of ACA

preparation

intends to take action in next 30 days, some behavioral steps --> action plan with gradual goals

contemplation

intends to take action in next six months --> motivate and encourage specific plans

basic elements in preparedness

international health regulations, WHO, global outbreak alert and response network, global public health information network

vaccination resistance

internet false data (childhood immunizations); leads to no herd immunity

healthy people 2020 ecologic model of health

interventions --> outcomes: - behavioral - specific risk factors, disease, and conditions - injuries - well-being - health equity concentric circles of individual behavior, social family and community networks, living and working conditions, and broad social, economic, cultural, health, and environmental condition and policies at each level

treatment of autism

medication, early intervention services, behavior and communication approaches

top ranked longevity countries

men: iceland, switzerland, australia women: japan, spain, switzerland

gynecologic disorders

menstrual, adnexal, fibroids, endometriosis, chronic pelvic pain

most debilitating conditions 65+

mental distress, stroke, vision limitation

micronutrients

metabolic function - problem: deficit results in disease

convergence model

microbe vs human converge with genetic/biological factors, ecological factors, physical env factors, and social/political/economic factors

sentinel surveillance

monitor conditions ex. coal miners and canaries - using birds as an oxygen test - early warning of epidemic - identification of size and scope - short term and long-term evaluation of control efforts - stimulate political and social action

assessment

monitor health and diagnose/investigate

mortality and morbidity

morbidity --> disease but no disability --> disability --> disease and disability --> mortality - if you increase longevity, push mortality line to the right, more people alive with a disability and disease - goal: to compress morbidity, minimize time between onset of disease/disability and death (shift all curves to the right) --> increase health span, not just life span

climate change

more extreme weather conditions, longer droughts and compressed rainfall, crops infected, rising ocean levels, devastating fires

chlamydia epidemiology

most common in Southern US; disproportionately higher in females 20-24; highest in non-hisp blacks

gonorrhea epidemiology

most common in southern US; reported cases on the rise; more common in men but overall most common in 20-24 years old; highest in blacks then AI/AN then native hawaiian pacific then hispanic

holocene

most of the time period during which humanity has grown and developed

health care spending

mostly public spending (most similar across nations), largest sector of private spending; total health care investment in U.S. is less

alcohol-attributable deaths

mostly unintentional injuries, then cancer, liver cirrhosis, CVD and diabetes, intentional injuries, and neuropsychiatric disorders

evaluation and revisions

must be ongoing, continuous testing for relevant data

self-efficacy

confidence in one's ability to take action --> approach change in small steps

10. There are 5,327 cases of black X disease in Epiville. This number figure represents

prevalence not incidence

surveillance vs finding the reservoir

representative sample for surveillance; infected individuals for reservoir

compulsory

required for everyone; ex. mandated by Fidel Castro in cuba

third hand smoke

residual nicotine and other chemicals left on a variety of indoor surfaces by smoke

symptomatic outcomes of influenza

respiratory syndrome, gastrointestinal syndrome, involvement of major organs, death

reinforcements

responses to a person's behavior that increase or decrease likelihood of reoccurrence --> initiated rewards or incentives

antigenic drift

results of errors in replication and lack of repair mechanism to correct errors

population aging

shift in the age distribution of the population toward older ages, more people 65+ than ever before in all of human history - percentages of pop reaching old age - pop distribution across age groups - ratios of older to younger people - longevity and fewer babies

sugar

should add less than 10 teaspoons per day

crowdfunding

shouldn't exist, a symptom of america's sick health care system

US health system performance dependent on

spending, access, and quality

insulin

spikes in response to consumption of carbs --> exhausts pancreas which pumps of insulin - if not enough is pumped out, then diabetes results - insulin lowers blood glucose by storing the sugar - diabetics will have higher blood glucose levels for much longer after eating - can't properly recover from fluctuations throughout the day

SG William H Stewart

testified that the "war against infectious disease has been won" - premature declaration of victory

elements of evaluation

need to evaluate to determine efficacy - appropriate risk groups and areas identified and targeted - culturally and economically acceptable - measure of effectiveness (process variables vs outcome) - cost effective - scaled up

mandatory

needed in order to enter/join something; ex. military

primary issues for vaccine evaluation

testing procedures, level of efficacy against infection, transmissibility, and clinical disease, acceptability

autism spectrum disorder

neurodevelopmental condition present from early childhood characterizes by difficulty in communication and forming relationships and in using language and understanding abstract concepts - prevalence 0.6%-2% (37% increase since 2002-8) - males at greater risk - risk increased with socioeconomic status and parental age at conception (both genetic and env)

unlinked anon

no identifier at all, number attached, untraceable, subjects do not know purpose of test; least selection bias

precontemplation

no intention of taking action within next six months --> increase awareness of need for change and personalize info

health economics

not one source of spending in health care system - total revenue = total expenditure = total income - rev: going into health care system - income: professionals working - every cut cuts the livelihood of someone in the health care system

health outcomes (quality)

not what they should be for how much we spend

standard drink

notional drink that contains a specific amount of pure alc - 0.6 oz in US - 12 oz beer - 8.5 oz malt liquor - 5 oz wine - 1.5 oz of 80 proof

H1N1 epidemic

novel influenza originating from pigs - caused deaths mainly in those aged 25-49 years - response influenced by age, pre-existing immunity, smoking, concurrent health conditions, immunosuppression, and pregnancy

homelessness

number of homeless increasing in the last year for the first time in seven years - large proportion unsheltered

reproductive number

number of secondary infections from one case (R) R0 = reproductive at the beginning of the epidemic - R > 1 epidemic spreads - R < 1 epidemic dies out - R subject to changes in presence and levels of determinants of epidemic spread

life span vs health span

number of years lived vs number of years lived with a good quality of life

graph of access to doctor/nurse

on the lower end but not the worst; patients do not always hear back on the same day, are not always able to book same-day or next-day appt, but often wait six or more days for an appt - due to diff healthcare coverage in the US

graph of access to specialty care

one area where US shines; large proportion wait for an appt for less than four weeks, small number wait for more than two months

zoobiquity

one health = human health + animal health + environmental health - veterinary sciences have taught us a lot about human health - animals share a lot of the same health conditions as humans (breast cancer, heart attacks, STDs)

west nile outbreak

ongoing said to be largest ever in the U.S.

clinical care

only 20% of health factors because it is only part of the answer! includes access and quality of care - most nations spend $1.70 on social services for every $1 on health services - US just 56 cents

postpartum and interconception

opportunity for further prevention, screening, and interventions --> early treatment of complications, information and education - high breast feeding complication in white and hispanic, high fibroids in AA

voluntary confidential

opt in, data recorded with unique identifier; personal info known but kept confidential; linked

herpes treatment

oral drugs

oral cancers

oral, pharangeal, langeal

typhus

outbreak in L.A. reached epidemic levels

infertility

ovarian high in white women; tubal and sterilized high in AA - not known if age-adjusted natural fecundity - failure to conceive after at least 12 months of unprotected intercourse - 12% women - delayed childbearing - $11,000-12,000 for in vitro - increase in U.S. pop but hispanic stable, n/a asain

drug use/incarceration cycle

over 65% of all prisoners meet the diagnostic criteria for drug abuse or dependence but only 11% receive treatment --> relapse and return to criminal behavior

statistics

the art and science of making decisions in the face of uncertainty

goal of public health

the biologic, physical and mental well-being of all members of the global society, regardless of their ethnicity, religions, gender, sexual orientation, country or political views

reproductive health

over 90% of women expect to give birth in their lifeline, 4.1 million births in the U.S., health and well-being of a woman sets the stage for her offspring and family - representative indicators specific to women's health are widely used to reflect the health of a pop - U.S has a relative low maternal mortality rate but high infant mortality rate, ranks 25th internationally - more than just pregnancy

active vs passive surveillance

passive - receiving reports from hospitals, labs, clinics, physicians active - searching for data, examining participants

case study: syphilis

penile chancres, trunk rash, palmar and plantar lesions (hands and feet), mucuous patches on mouth/tongue

behavioral intention

perceived likelihood of performing behavior --> likely or unlikely?

child poverty

percent of children living in households with incomes below 50% median; US ranks second to last among developed nations - 2nd most children living in poverty

epidemiology

the field of medical science which is concerned with the relationship of various factors and conditions which determine the frequencies and distributions of an infectious process, a disease, or a physiologic state of the human community - etiology, prevention, and control of disease - philosophy, a strategy, a methodology, a way of studying a health problem - epi = upon - demos - people - logos = study - core science of public health

maxim of public health

the health of the individual is best ensured by maintaining and improving the health of the community

alcohol burden

the higher number of drinks, the greater the risk of all cancers, diabetes, TB - 1 drink actually decreases relative risk of iscahemic heart disease in females and males and diabetes in males

cohort

thought to be ideal; one sample and no one can join after formation; observe change over time --> representative of population? not good for surveillance - aka longitudinal

disease descriptors

time, place, and person

overall STD prevention

vaccination, condom use, male circumcision, partner reduction, freq testing and early treatment, partner treatment, chemoprophylaxis

maternal mortality

vaccination, motor vehicle safety, control of diseases, safer workplace, decrease in deaths from CAD and stroke, healthier moms and babies, family planning, fluoridation of water, no smoking campaigns - decline in MMR is one of the ten great public health achievements - decline due to hospital births, oxytocin, abortion, etc. - decrease by primary prevention

HPV prevention

vaccine --> 0% incidence; recommended for 11-12 years but FDA approved for 9-26; more effective the younger you are; reduced by male circumcision

biomedical

vaccines, pharmaceutical treatments, medical devices to prevent and treat disease

pancreatic cancer

very fatal, survival is less than 5 years

agent

virus, bacteria, parasite, prion, etc

post reproduction

whites have higher rates of prolapse, incontinence; likely ascertainment bias b/c more likely to seek treatment for these conditions

disparities within vs between countries

within - gender, ethnic minorities, economic, educational, health care and access between - developing, transitional, and developed

is health still improving in the US?

yes, but - great variation by condition - large disparities - life span vs health span - differences by age - demographic changes - is mortality the best measure?

variation

person to person, ubiquitous, makes it difficult to identify the effect of a given factor or intervention on one's health --> overcome by studying properly chosen random groups of people

attitude

personal evaluation about behavior --> do you see the behavior as good, neutral, or bad?

case study: HPV

physical exam of external genital warts reveals type 6 or 11; in vagina, cervix, penis, urethra, anus/rectum; visual inspection 80% accurate; up to 70% of active adults exposed to HPV

violence

physical/sexual violence highest in africa, mediterannean, south east asia, and us - 1 in 3 women - impacts on depression, alc disorders, sexual and reproductive health

case study: 536

plunged Europe into fog and temperatures fell, snow fell in summer in China, people starved, bubonic plague struck Egypt, economic stagnation until 1640 = Dark Ages - dark cloud due to volcanic eruption in iceland, multiple eruptions - revealed in tree ring (climate records) and polar ice core (chemical record) studies

prevention of SA

policy/regulation (taxation, reduced availability, bans of ad, sever penalties), employment of youth, community programs, education of clinical practitioners

legislative change

political will, enforcement, and constant vigilance needed to be effective

causes of mental disorders

poor nutrition, alcohol use during pregnancy, trauma during birth, maternal depression, parental neglect, sexual abuse, lack of stimulation in early life, violence and war, poverty, poor education, unemployment, social isolation, rapid social changes, residential dislocation, overcrowding, freq relocations

environments matter

poverty and homelessness, education, adverse childhood experiences, climate change, racism

graph of workers' wages and inflation

premiums have increased a lot more than workers' earning and inflation --> not the causes of rising health costs

smoking

#1 cause of preventable deaths, >50% of children exposed to second-hand smoke, 24% men and 18% women smoke now, 31% of smokers earn wages below poverty line - number one risk factor for cancer deaths - tobacco kills half its users (6 million) - 16% deaths among men and 7% deaths among women - oral and lung cancer and COPD - smoke has more than 7,000 chemical compounds and damages every part of the body - cuts life expectancy by 10 years

U.S. health dollar

$3.337 trillion - mostly private insurance --> medicare --> medicaid - most money goes to hospitals, MD/clinic, drugs, admin - under avg for both physician supply/use and hospital supply/use but #1 in cost

WHO survey on mental health

- 2/3 countries have a policy or plan and 1/2 have a stand-alone mental health law; most not in line w international human rights instruments and implementation is weak - mental health workers account for 1% of global workforce - 45% of people live in a country w less than 1 psychiatrist per 100,000 - where you live matters: on avg 1 mental health worker per 10,000 people - low income spend $2 per capita per year vs. high income $50

STIs in the US

- 20 million annual new infections - 50% of new infections aged less than 25 years - prevalence of 110 million - over $16 billion each year medically - HPV and chlamydia two most common

poor vs rich countries

- 20:1 death under 5 - 10:1 malnutrition - less than 16 years life expectancy

evolution of eating

- 6 mil BC: vegetarian - 2.5 mil BS: meat --> calorie dense protein, made brain grow - 500,000 BS: cooked food --> more calorically dense - 12,000 BD: domestication of animals - 8,000 BC: invention of agriculture - 7,000 BD: milk consumption

demographics

- 7.4 billion - women higher median age than men (more older) - more males before age 55 - after 55 more females - females higher life expectancy and lower infant mortality rate at birth - 1.06% pop growth rate - 18.5 births/1000 and 7.8 deaths - 2.42 children/woman fertility rate

puberty

- AA girls enter puberty earlier and start menses earlier than all other races - same with AA boys

obesity

- BMI greater than 30 - 31% of US population, 24% mexico, 23% UK, smallest is korea, japan, and norway - doubled since 1980 - 65% of people live in countries where overweight and obesity kills more people than underweight - 43 mil children overweight in 2010 - is preventable - account for 44% diabetes, 23% iscahemic heart disease, and 7-41% of cancers

impact of infectious diseases

- Europe plague - Cairo cholera - Crimean War and Boer War dysentery - Saudi American War against Yemen

epidemics in LA and SD

- Hep A among homeless, transmission occurs through poor sanitation - West Nile encephalitis, mosquito-borne - measles (also in Europe) - STD's ranked first - zika - pesticide --> brain damage

individual behaviors

- a determinant of health - innate individual traits: age, sex, race, and biological factors - tobacco, opioid abuse, physical activity and nutrition, drinking and firearms - 0-99% FPL = higher mortality, higher obesity, lower overweight

evidence for indirect transmission

- age-sex distribution of initial cases - association of disease w occupation - proximity of cases to the sea - decreasing density of cases with distance from coast

evidence for direct transmission

- age-sex distribution of subsequent cases - household distribution - intervals between household cases - distribution of involved households within the barrio - effect of treatment

steps of sampling

- aggregate effect of something on one group as compared to another - identify relationship - not a guarantee, but can increase likelihood of occurrence

present day global health problems

- air pollution, total 7 million deaths, highest in Asia - Ebola outbreak kills thousands - artemisinin resistance in plasmodium falciparum poses threat to elimination of malaria, SE Asia - measles outbreak in Democratic Republic of Congo kills 400 (last year) - cholera outbreak in Yemen - zika - MERS (Saudi Arabia, South Korea) - polio - war, gun violence, climate change, obesity, diabetes, dementia, etc.

fertility

- all groups have higher fertility rates than whites - all relatively similar miscarriage rates

substance abuse

- drugs now kill more people than cars and guns - 38.3% of global pop consume 17 L of alcohol each year - 3.3 mil deaths per year - 15.3 mil americans have drug use disorder - prescriptions > illicit drugs - alc major cause of liver failure and causes 4% of global burden of disease includes: - alcohol - drug dependence

mental health disorders

- among leading disorders causes decreases in productivity and social functioning - accounts for 23% of all years lost - cause more disability than cancer and HIV - five of top 10 causes of disability - 450 mil - 25% of total disability in US, Canada, and western Europe - 22% currently suffering in the US - $150 bil annually US, $2.5 trillion wordlwide - risk factors for hypertension, diabetes, and CVD - half had onset by 14, 75% by 24 - 20% children develop disorder that impairs function - fewer than 50% receive treatment - limited coverage by insurance - depression top burden of disease - stigma and discrimination

WHO guidelines on ethical issues related to surveillance

- appropriate, feasible, sustainable public health surveillance systems - effective mechanisms to ensure ethical surveillance - legitimate public health purpose - sufficient quantity - transparent gov priority setting - obligation to support countries that lack adequate resources - values and concerns of communities - continuously monitor for harm - secure identifiable data - effective communication of results - obligation to share data - share in timely fashion

consequences of diabetes

- can lead to stroke, blindness, heart attack, kidney failure, amputation

graph of annual number of deaths by cause

- cardiovascular disease huge proportion, twice that of cancer - globally COPD 3rd, goes down in the US - different risk factors --> different outcomes

five major NCDs

- cardiovascular disease, cancers, chronic respiratory disease, diabetes, mental health

alcohol

- causes 1/3 of all motor vehicle accidents in the US - increases use of drugs and unsafe sex - loss of employment and productivity - disruption of families - binge drinking and heavy alc use most common 21-25 - higher use of alc in northern areas with lower temperatures - several carcinogens found in alc - highest in russians, canadians, and australians

water sanitation

- causes 88% of diarrhea cases, 1.5 million deaths per year - high infant mortality rate due to dehydration from diarrhea - 884 mil no access to improved water, mostly in Africa - 71% have safe drinking water - 2.3 bil lack sanitation services - 15% have hand washing facilities in sub-saharan africa - chloera outbreaks in africa, india

key elements of surveillance

- collection of health data for use in health planning, disease control/prevention, and/or health promotion - ongoing - timely analysis - easily understood - dissemination of results - action based on results - periodic evaluation of the system - monitor changes or trends in health factors - detect outbreaks/early warnings - provide health information - evaluate the effectiveness of intervention strategies

uses of epidemiology

- community diagnosis - history of disease in pop - natural history of disease in indv - clinical picture - estimate risk - syndromes and precursors - prevention/ intervention programs - investigation - cost effectiveness - strategies for action

benefits of physical activity

- control weight - reduce risk of CVD - reduce risk for type 2 and metabolic syndrome - reduce risk of cancer - strengthen bones and muscles - improve mental health and mood - improve ability to do daily activities - increase chances of living longer

positive changes with aging

- decline in addictive behaviors and crime, reduction in severe psychiatric disorders, and stability in psychological wellbeing - continue increased in vocab - greater selectivity in friendship and increased contact with close family - increase in leisure and altruistic behavior

fertility rate

- declining - highest in Africa (projected pop to increase but fertility rate to decline) - soon half pop growth will take place in 9 countries - associated with poverty and lower level of educational attainment for girls - currently about 2.5, expected to reach 2 by 2100 in most of the world but Africa

negative changes with aging

- decreased reaction time, psychomotor speed, and verbal memory - loss of muscle - decline in strength and walking speed - greater mortality

capillariasis

- describe extent (prevalence) and severity (morbidity and mortality) of epidemic - confirm or refute etiologic agent as nematode C. phillipinesis - identify original source of epidemic - identify mode(s) of transmission - recommend strategy for control of epidemic

biostatistics - assessment

- design general survey - plan experiments - estimate extent of health problems and associated risk factors

strategies to reduce threats

- develop political will and funding - improve global early response capacity - improve global surveillance (diagnostic capacity, communication, data analysis, global positioning systems, geographical information systems, laboratory capacity) - use of vaccines/other drugs - decrease inappropriate drug use - improve vector and zoonotic control - better and more widespread health education - predictive models based on data, surveillance - establish priorities - reduce potential for rapid spread - develop more feasible control strategies - new intervention strategies with low cost technology - mobilization of communities - greater support for research - reduce poverty and inequality

case study: polio outbreak

- diagnosed through acute flaccid paralysis surveillance, not sensitive enough to trigger fast responses needed for eradication - originated in pakistan - potential to mutate proves to be a risk to vaccine --> switch from live poliovirus to inactivated polio vaccination when risk is too great - env surveillance tests for silent circulation bc allows detection of low levels before AFP appears

lack of water

- dirty water and lack of a toilet and proper hygiene kill 3.3 million, most under five - 1 bil have no access to clean water in developing countries - 40% have no safe way of disposing of waste - avg american uses 100 gallons of water at home every day - 443 mil school days are lost to water related diseases

improved standards of living

- less crowding --> lower respiratory spread - better quality of food --> less GI and chronic disease - access to fruits and veggies --> no vitamin deficiencies - refrigeration to preserve food --> reduce cancers - improve nutrtion - promote access to education - reduce poverty - better methods of primary (prevention), secondary (treatment), and tertiary (further prevention)

COPD

- lung disease that causes breathlessness - 5% of all deaths, 3 million - 90% COPD deaths in low and middle income countries - likely to increase in coming years because smoking behavior of aging pop - many cases are preventable

graph of cancer incidence rates

- male spike in the 1990's due to PSA (prostate specific antigen testing) rolled out, not necessarily higher incidence but more people testing for it - breast always highest for females

biostatistics - policy setting

- measure the problem - prioritize the problem - quantify associations of risk factors - predict the effect of policy changes - estimate costs

what is a health community?

- meets basic needs of all - provides quality and sustainable env - maintains adequate levels of economic and social development - promotes health - fosters social relationships that are supportive and respectful

symptoms of alzheimer's

- memory loss/changes in memory - forgetting words or substituting - problems in speaking, reading, writing, and understanding - disorientation to time and place - poor or decrease judgement - problems with abstract thinking - misplacing things in inappropriate places - drastic changes in personality - difficulty performing familiar tasks/routine chores

alcohol and cancer

- metabolizes acetaldehyde that damages DNA and proteins - generates reactive oxygen species that damages through oxidation - impairs body's ability to break down and absorb nutrients - increases blood levels of estrogen - carcinogenic contaminants

effects of discrimination on health

- more depression and internalizing symptoms - greater psychological stress - poorer self esteem - lower academic achievement and engagement - less academic motivation - greater engagement in externalizing behaviors - more associations with deviant peers

fibroids

- most common gyn tumor in women of reproductive age of myometrium - arise from smooth muscle, rapid growth - sig cause of morbidity - very common, AA 3x more likely - no diff in other races

zika

- most common in pacific islands, southern asia, central and southern america, caribbean, U.S. southern states - mosquito borne with incubation of 10 days - host in humans/monkeys - cross reactive diagnosis - similar to dengue - have to rule out before giving ASA or non-steroidal anti-inflammatories - control by taking precautions against mosquitos, protective clothing - neurologic effects on fetuses - mostly travel related cases in the U.S., some local transmission

hysterectomy

- most common non OB surgical procedure in women - more common in AA, less in hispanic and asian

microbial threats

- newly recognized agents - mutation of zoonotic agents - resurgence of endemic diseases - persisting diseases - drug-resistant agents - recognition of etiologic role - use for terrorism and warfare - resistance of vectors to control

cancer

- number two killer; 18.1 million new cases this year and 9.6 million deaths globally this year - 70% deaths in low and middle income - most new cases in china, then US - most deaths in china, then india - lung cancer is top (top killer for males but third for females) - incidence not necessarily tied to survival rate - treatment available in 90% high income countries vs 30% low income - $2.16 trillion

maternal mortality ratio in U.S.

- on the rise, occurs in 1/8 births - U.S. rate is going up while global rate is going down because competition and $$ - hispanics are comparable to whites - foreign born babies do better - increase case ascertainment - delayed child bearing - increase in mother chronic conditions - relative risk much higher in AA - 34% die within 24 hours of birth, 55% within 6 weeks, 11% within a year

diabetes

- on the rise; from 108 million in 1980 to 422 million adults in 2014 - rising more rapidly in low and middle income countries - 1.5 million deaths - much higher in US than in China --> greater proportional mortality of diabetes

disability adjusted life years

- one lost year of "healthy" life - sum of DALYs across pop measure gap between current health status and ideal health condition (ideal: entire pop lives to an advanced age, free of disease and disability) - highest in sub-saharan africa - in developing countries, shifting from communicable disease to noncommunicable -some attributable to climate change - leading causes used to be lower respiratory disease and diarrheal disease, but increasing burden of noncommunicable diseases and injuries

healthcare in the U.S.

- only advanced economy that tolerates having a significant number of its citizens uninsured - has the largest private market for health care financing - spends more per capita on health care services than any other nation, but has far from the best health outcomes in many areas - politically supports incremental changes based on market rather than fundamental reform at the federal level - most nations spend more of GDP on social services, U.S. spends more on total health services

measles

- outbreak in Europe, over 41,000 cases - complication common in children <5 and adults >20 - before vaccine, 3-4 million cases with 450-500 deaths - outbreak in U.S. hit 21 states due to falling level of immunizations

example of individual behaviors: opioid abuse

- overdose deaths have all increased - common prescriptions, heroin, and other synthetics; more ER visits - drug abuse highest in 0-99% FPL - more men die from opioid overdose but rate increasing more rapidly for women

common problems across borders

- pandemics: HIV/AIDS, SARS, H5N1, cholera, MERS, ebola, zika - environmental issues: polluted Songhua in China, crop burning in Indonesia - surveillance and control: H5N1, H1N1 - immunization programs: polio eradication - regulations: inter-country control of toxic/infectious/hazardous materials, climate change factors - migration - refugees - war - global warming - natural disasters - food safety and security

diagnostic criteria

- pathologic: protein losing enteropathy - clinical: diarrhea, weight loss, malaise, anorexia, edema, and "tummy rumbling" - laboratory: presence of eggs/larvae in stool

population growth

- population rising but falling, lower birth rate but longer life expectancy - increase world pop by 1 million every 4.75 days - from 10,000 BCE to 5000 BCE, 1 million increase - population reduction is not a quick fix for environmental problems - had led to missing heritability from GWAS and rare variations in genome

correlation

- positive/negative - correlation coefficient must lie in between -1 and +1 and is interpreted as a measure of how close to a straight line the data lie

monitor changes/trends

- prevalence/ incidence of disease and risk factors - emerging diseases - geographic distribution - risk group distribution

goals of health care 65+

- prevent morbidity/onset of chronic conditions - to maximize function/minimize disability - to maximize life expectancy

prevent mental illness

- prevent school based violence - improve family functioning and promote positive parenting - treat parental depression - research underlying biologic processes - modify env factors - evaluate interventions - train more professional personnel - expand community resources for prevention - network community efforts - identify and target high risk - increase funding - increase awareness of prevention strategies and resources

prevention of falls

- primary: promote exercise, reduce polypharmacy, universal housing design - secondary: strength training, env modifications - tertiary: counseling to decrease fear, improve primary care, social support interventions

other types of insurance

- private insurance - uninsured

drivers of an epidemic

- reproductive number - transmission probability per contact - contact rate/freq - duration of infectiousness - available susceptibles - agent characteristics

factors impacting MMR

- rising cesarean rate - more women in ob, fewer hours, fewer health care providers - less desirable field of practice - medical liability - technology - uninsured - immigration status - abortion/birth control politics

types of depression

- seasonal affective disorder - major depression (recurring) - persistent depressive disorder - bipolar - psychotic

research agenda

- select study site - establish diagnostic criteria - identify affected pop - stop epidemic

carbs

- short term energy - problem: diabetes

surveillance systems

- surveillance vs. finding the reservoir - defining a case - selecting the population - selective appropriate strategy - timely processing/results and action - evaluation and revision - study designs (cohort, cross section, serial cross section w diff random samples) - active vs passive - testing strategies (selection bias) - confidentiality - optimal vs feasible - evidence based reports

endometriosis

- the growth of tissue that is normally found in the lining of the uterus in a location outside of the uterine cavity - estrogen dependent condition - asian 9x more likely than white - no diff hispanic or black - can cause infertility

toxicology extrapolations

- the more frequently a specific adverse health effect can be measured in diff animal species, the greater the likelihood is that a similar effect will occur in a human - genotype, dose, complex mixture, structure activity, developmental timing, in vitro to in vivo - some species specificity

public health

- the science and art of preventing disease, prolonging life and promoting health through organized efforts of society - the process of mobilizing local, state/provincial, national and international resources to assure the conditions in which all people can be healthy (not only individual but community/population health) - does not guarantee optimal health but creates the conditions under which it can be achieved by society

severe alzheimer's

1-3 years complete incapacitation, loss of bodily function control, violent episodes and aggression, low recognition

WHO mental health action plan

1. strengthen effective leadership 2. comprehensive mental health and social care services 3. implement strategies for promotion and prevention 4. strengthen information systems, evidence, and research

hunger

1.02 billion people - Yemen notably impacted - Asia and Africa most affected, high prevalence of undernourished children

causes of cancer

1/3 of cancer deaths due to high BMI, low fruit and veggie intake, lack of physical activity, tobacco use, and alc use - tobacco is the most important risk factor, 22% of cancer deaths - cancer-causing infections such as hep and HPV are responsible for 25% of cases in low and middle income - tobacco, diet, alc

virology of influenza

A causes outbreak, B causes outbreaks, C does not cause outbreaks - antigenic mix of H and N glycoproteins determines severity of disease

newborn mortality

AA babies far higher rates of mortality; Puerto Rican and Hawaiian intermediate rates; Cubans, Japanese, and Chinese equal to white - variation in rates by diff pop subtypes

treatment of SA

AA, 12-step treatment programs, counseling, taxation on alc, drug substitution and rehabilitation programs, needle exchange programs (decreases disease risk), contingency management, drug treatment programs, short and long term residential treatment programs, outpatient

national goals

Healthy People 2000 goal was to reduce health disparities among Americans... still haven't met it 2020 aims to achieve health equity, eliminate disparities, and improve the health of all groups

workers with less education

MORE LIKELY TO have occupational hazards, have poor working conditions, hold lower paying jobs LESS LIKELY TO have paid sick leave and personal leave, receive retirement benefits, and have child or elder care resources

Palaeolithic vs American diet

Palaeo - much more protein, less carbs and fat, more fiber, less simple sugars - nutrition from then cannot be translated to now, our lifestyle has changed a lot

STD transmission theory

R0 = B x c x d = # new infections per case - R0: reproductive number - B: transmission efficacy - c: contact rate - d: duration of infectiousness

health care 65+

U.S. an outlier for % GDP spent on health vs % age 65+ --> smaller health care spending on elderly - improve: increase health span, not life span; increase amount of time without disease and disability

road traffic deaths

U.S. ranks highest and has seen the lowest reduction (Spain highest) - most involving alcohol, less involving speed compared to other countries

leading causes of maternal mortality in the U.S.

VTE, hemorrhage, preeclampsia, infection, cardiomyopathy

environmental factors

WHO says that 1/4 of global disease burden and 1/3 of burden to children was attributable to modifiable environmental factors - 15 fold higher in developing vs developed countries

rising health costs

a lot of population at risk; behaviors (obesity is much more common than other countries); large proportion of country is uninsured - US highest obesity rate

40. the increasing acidity of the oceans is adversely affecting marine life: a. true b. false

a. true

R0: reproductive number

a number of cases that one infected case can generate on average over the duration of infectious period

39. The major factors resulting in greater longevity in the United States in the 20th century was/were: a. Adequate supply of safe water, improved sanitation, and better housing B. Adequate supply of safe water, improved sanitation, and development of effective antibiotics c. Improved sanitation, cholera vaccine, and better housing d. Measles vaccine, better housing and improved transport e. Mumps vaccine, improved housing and adequate supply of safe water

a. Adequate supply of safe water, improved sanitation, and better housing

21. The most prevalent religion world-wide is: a. Christianity b. Islam c. Judaism d. Hinduism e. Buddhism

a. christianity

Zika is of concern because: a. It is associated with severe neurologic deficit in fetuses (in utero) b. Rapid spread among males c. Particularly severe symptoms among males d. Infects only women e. Is spreading primarily in the northern United States

a. it is associated with severe neurologic deficit in fetuses

66. The most debilitating condition affecting the elderly is: a. Mental distress b. Stroke c. Vision impairment d. Hearing impairment e. Diabetes

a. mental distress

48. Pesticides are primarily a problem in: a. Rural areas b. Urban areas c. Slums d. Suburbs

a. rural areas

38. In what town was the largest fire in California history that recently burned thousands of homes? a. Santa Rosa b. Petaluma c. City of Orange d. Palo Alto e. Burbank

a. santa rosa

20. in which city of the world would you have the most company/fellow residents? a. tokyo b. sao paulo c. mumbai d. new delhi e. shanghai

a. tokyo

depression

an illness that involves the body, moods, thoughts, function, and affects the way a person eats, sleeps, feels about themselves, and thinks about things - global burden almost three times of next (anxiety) - depression increasing burden, 2nd leading cause DALY - much higher in females across all ages - symptoms higher in blacks then hispanics - 7.6% of americans 12+ have depression - below poverty level more than twice as likely to have depression

regression equation

an increase in b corresponds, on average, to an increase in m

maternal morbidity

antepartum admissions relatively common because of antenatal or preg loss complications - AA, older, uninsured, unmarried have increased rates of admission

treatment of depression

anti-depressive medications, counseling, transcranial magnetic stimulation, electroconvulsive therapy

expectations

anticipated outcomes of a behavior --> model positive outcomes

genetic changes in influenza

antigenic drift and antigenic shift

lifetime prevalence for mental disorders

anxiety 29% impulse control 25% mood 21% substance abuse 15% one or more above 46%

five categories of mental illness

anxiety, mood, schizophrenia and psychotic disorders, dementia, and eating disorders

strategy of public health

asses the current health issues --> identify the problems --> research --> intervention --> disseminate results --> science-based policy

selecting strategy

cultural sensitivity, implications/limitations

share of world population by major regions

currently Asia large majority with Africa second, then Latin America then Europe --> by 2100 Africa will match Asia in largest majority with all others decreasing

political implications of cost containment

cut taxes --> cut prices or services to deal with reduced rev --> reduced rev means wage or inputs have to be cut - strong forces oppose particular cost containment proposals bc every dollar of costs that are contained means that an income or job is at stake

9. The prevalence of obesity and high blood pressure in the United States is highest among: a. European-Americans b. Asian-Americans c. Hispanic-Americans d. African-Americans e. Equally high among all ethnic groups

d. AA

1. The recent measles epidemic in Southern California was due to: a. Low levels of immunization in young persons b. Concern by mothers for immunization-related autism c. Negative information on the internet d. All of the above e. a. and c. above

d. all of the above

13. Epidemiology can be used to: a. Identify which diseases are most common in a community b. Establish the natural history of a disease c. Identify which factors increase the risk of acquiring a disease d. All of the above e. b. and c. above

d. all of the above

14. To investigate a disease of unknown origin, the epidemiologist: a. Observes time, place and person b. Gathers data c. Formulates hypotheses d. All of the above e. a. and b. above

d. all of the above

15. Epidemiology is used to study: a. Disease etiology b. Prevention effectiveness c. Quality of resource allocation d. All of the above e. a. and b. above

d. all of the above

17. Data supporting indirect transmission of Capilleria Philippensis is: a. The gender distribution of early cases b. The geographic distribution of early cases c. The age distribution of early cases d. All of the above e. a. and b. above

d. all of the above

24. Rapid population growth in a country affects: a. Economics b. The natural environment c. The social structure d. All of the above e. a. and c. above

d. all of the above

33. Chlamydia is associated with: e. Eye disease b. Genital disease c. Heart disease d. All of the above e. b. and c. above

d. all of the above

36. Factors influencing transmission of infectious agents include: a. Behavior b. Host and agent genetic profile c. Economic status d. All of the above e. a. and c. above

d. all of the above

49. The Millennium Ecosystem Assessment issued under Kofi Anan in 2000 cited problems with the: a. Food security b. Climate change c. Over-fishing d. All of the above e. a. and b. above

d. all of the above

50. Increasing urbanization in developing countries over the next decade is likely to: a. Further stress supplies of clean water b. Impede implementation of adequate sanitation c. Increase injuries and deaths from vehicular accidents d. All of the above e. a. and b. above

d. all of the above

58. Aging is associated with: a. Physical decline b. Increased vocabulary c. A decrease in severe psychiatric disorders d. All of the above e. a. and c. above

d. all of the above

62. Continuing social engagement: a. Decreases likelihood of cardiovascular events b. Decreases the probability of suffering depression c. Improves memory d. All of the above e. Is a barrier to self-efficacy

d. all of the above

8. Longevity is: a. Increasing in most countries b. Continues to be shorter in developing countries c. Is correlated with GDP d. All of the above e. a. and b. above

d. all of the above

27. The two countries with the highest proportion of the world's prisoners are: a. Brazil and India b. India and China c. North Korea and Syria d. China and the United States e. Russia and Egypt

d. china and the us

34. The leading infectious disease cause of death globally is: a. Diarrhea b. Lower respiratory disease c. Genital chlamydia d. Gonorrhea e. HIV/AIDS

d. lower respiratory disease

22. The language that is the "mother tongue" of the greatest number of people is: a. English b. Spanish c. Hindi d. Mandarin e. Standard German

d. mandarin

19. Chancellor Merkel welcomed refugees from Syria and the middle east because: a. She is a generous woman b. It was a good political move c. Syrians have very high educational levels d. The population of Germany is rapidly aging e. The United States would not welcome them

d. the population of germany is rapidly aging

28. What country is currently experiencing a cholera epidemic involving over a half million cases? a. India b. Pakistan c. Tajikistan d. Yemen e. Saudi Arabia

d. yemen

37. Which of the following are spread by mosquito vectors? a. Ebola b. MERS-CoV c. SARS d. Zika e. Chlamydia

d. zika

deaths by broad cause group

developed regions: 77% noncommunicable, 14% communicable, 9% injuries undeveloped regions: 55% communicable, 37% noncommunicable, 8% injuries

top ranked noncommunicable diseases

diabetes, cancers, chronic respiratory diseases

requirements for surveillance

diagnostic algorithm to identify disease, staff members, sampling frame to survey, access/network to where disease is occurring, competent lab

top ranked among children

diarrhea, neonatal infections, pneumonia

causes of death

differ for racial groups based on circumstance as well as genetics - malignant neoplasms (cancer) #1 for asians and hispanic but #2 for others

reproductive health disparities

differences in access to or availability of facilties and services; due to - genetic background - env exposures, lifestyle, cultural factors - access to care and specific treatments

disorganized schizophrenia

disorganized speech and behavior

graph of health care spending as a percentage of GDP

disproportionate compared to other countries, US more than 6% higher than other countries ~17.9%

dementia

disproportionate increase in low and middle income countries

obesity/diabetes

disproportionately higher in AA, especially black women; associated with ischaemic heart disease

prisoners

disproportionately more in the US than anywhere else, almost 1/4 of world

hypothesis testing

disprove null hypothesis --> use theory of probability to determine how tenable such a hypothesis is - small probability convinces us that there is an effect

ACA

dramatic reductions in uninsured, ACA has been a resounding success, allows dependents until 26 (added after midterm) - from about 55 to 28 million uninsured, reduced 18% to 10.2% of pop - income based subsidies to uninsured, employer mandate to offer, indv mandate to buy, medicaid expansion - private: state create insurance exchange for those with coverage and small employers - public: medicaid expansion

events

dying from a particular disease during a particular year - for a large group of people, we can make quite accurate statements about the occurrence of events even though for individuals it is uncertain and unpredictable

ecosystem

dynamic complex of plants, animal, and microogranism communities and the non-living environment - substantial changes to support a worldwide pop of over 7 billion people

reciprocal determinism

dynamic interaction of person, behavior, and environment --> adjust environment or influence personal attitudes

30. The reservoir for Zika virus is: a. Humans b. Monkeys c. Pigs d. Birds e. a. and b. above

e. a and b above

5. Los Angeles is currently experiencing an epidemic of: a. West Nile encephalitis b. Hepatitis A c. Mumps d. All of above e. a. and b. above

e. a and b above

54. Great strides have been made in reducing air pollution levels in: a. London b. Los Angeles c. Beijing d. New Delhi e. a. and b. above

e. a and b above

55. Studying the impact of air pollution was recently been enhanced by: a. Satellite imaging b. Geocoding c. Establishing air quality monitoring station d. All of the above e. a. and b. above

e. a and b above

11. The basic strategy of epidemiology involves: a. Agent, host, environment b. Time, place and rate c. Time, place and person d. Agent, place and climate e. a. and c. above

e. a and c

policy development

inform, education, empower; mobile community partnerships; develop policy

ACA employer mandate

employers with more than 50 employees must provide coverage or pay penalty of $2000/employee

case study: human migration out of Africa

enabled by climate change that established vegetated, resource-rich corridors during three time frames

fats

energy storage - problem: obesity, metabolic syndrome - lower overall consumption recommended - saturated, monounsaturated, polunsaturated, transfat

assurance

enforce laws; link to and provide care; assure competent workforce; evaluate

environment health science

environment interactions with human health (heredity) = interaction effect; disease causation is complex

proteins

enzymes, hormones, antibodies - problem: metabolic disorders

defining a case

establish functional criteria (quick and easy to apply), select right test or definition (specific and clear), clinical vs. epidemiological diagnostic criteria (function over precision), disease vs. infection (AIDs vs HIV)

chain of infection

etiologic agent (cause of disease), reservoir (humans, animals, environment, etc), portal of exit, mode of transmission, portal of entry, susceptible host

affected population

evaluate gender/age ratio --> family/household questionnaire --> relationship of infection to disease --> household distribution --> initial vs subsequent cases

ACA individual mandate

everyone must buy coverage or pay a penalty $7000/indv or $2100/family unless this exceeds 8% of income; nor repealed

physical and social environment

everything beyond individual health: community design and social determinants - zip code more important than genetic code (babies born six subway stops apart face a 9 year diff in life expectancy)

epigenetics

ex. BPA altering the epigenome, expression of a gene is decreased over time over the span of generations (methylation increases) BPA = methylation = decreased expression (BPA not necessarily administered to subsequent generations so BPA decreases while methylation still increases) - inheritance via the germline

routine confidential

ex. HIV test before surgery

demand

ex. limit is prices; if you pay, you can get it

big data

ex. microarrays; very large sample sizes but not always good: it can do harm! - Google Flu Trends: early warning signal of impending flue epidemic but always over-estimated the number of cases because it overfitted the data and was not based on a representative sample - quantity of data is not always a substitute for good scientific methods

supply

ex. number of machines, doctors

physical activity for aging

exercise training increase cognitive function and can also promote physical function and reduce the risk of falling

suicide methods

firearms most prevalent, followed by suffocation and poisoning

transtheorectical model of change

five steps: pre-contemplation, contemplation, preparation, action and maintenance

public health informatics

focus on prevention and health of populations

consequences of population growth

food supply, education system, resources and energy, economy and jobs, natural env, social structure, political system, international relations

mortality surveillance

for diseases with high mortality; monitor death but complications can arise when function is compromised but no death

mental health

foundation for individual well-being and the effective functioning of a community; an integral part of health - no health without mental health

behavioral intervention planning

frame issue, provide info, teach tools and skills, provide opps for practice - who: engaging and understanding the priority population - what: assessing the needs and assets of the priority pop - why: developing program goals and objectives - how: planning an intervention - implementing intervention, evaluating importance

HPV treatment

freezing, topical acid, surgery, immune creams

host

genetic profile, immune capacity, poverty, nutritional status

etiology of illness

genome (fixed) + environment (modifiable)

what makes us sick?

germs, deficiencies, toxins, psychological factors, genetics

event-based reports

global public health intelligence network, health map project, epiSPIDER, regional

pregnancy

good opportunity for health promotion and primary preventive services, may be the only period where some women have coverage, prenatal care is a good sign of at least 2 years of healthcare for baby - AA and hispanic lowest for prenatal care - AA 4x maternal mortality

case study: polio vaccine

grew polio in cells then regrew in different cells so they adapted --> not pathogenic; proved effective, cases saw huge decline - crippling disease that enters through contaminated food, dirty fingers or water --> intestinal walls to blood stream--> attacks central nervous system and spinal cord, paralysis - estimated 2 new cases per day but hard to eradicate bc occurring in children in hard-to-reach parts of africa and south asia - prevalent in nigeria, afghanistan, pakistan

factors contributing to emergence/re-emergence

human demographic change (exposure to new env sources or infectious agents), unsustainable urbanization, economic development, global warming, changing human behaviors, social inequity/poverty, international travel and commerce, changes in food processing and handling, evolution of pathogenic infectious agents, development of resistance by infectious agents, resistance of vectors, immunosuppression of persons, deterioration in surveillance systems, illiteracy, lack of political will, biowarfare or bioterrorism, war or civil unrest, famine, manufacturing strategies

most prevalent conditions 65+

hypertension, arthritis, heart disease

medical informatics

important to physicians because they need to receive new research information, use algorithms, manage patient info in infosystems

education

improved education outcomes lead to improved health outcomes and vice versa; life expectancy increases and infant mortality decreases with education level

rural vs. urban

in rural - poorer health, less access to care, poorer quality of care, higher proportion of elderly due to migration of young to urban areas, slower epidemic potential bc lower pop density but lower rates of immunity bc less exposure, higher costs of services

physical environment

includes environmental quality and built environment

NCD risk factors

income, genetic, behavioral: - high BMI - tobacco use - low fruit and veggie intake - lack of physical activity - alcohol use high risk in Asia/Eastern Europe because of drinking and smoking behavior

life expectancy

increased overtime overall; correlated with GDP per capita; at birth, much higher in whites for both males and females - widening inequality by wealth: 13 year gap for men and 14 year gap for women - developed regions > latin america > eastern europe > asia

life expectancy at birth

increasing by 1/10 year every year; currently japan but spain is projected to have the longest life expectancy by 2040 - US lowest

gonorrhea prevention

individual level (reduce exposure, reduce transmission, reduce duration of infection) and population level control (screening, treatment, partner treatment, repeat screening)

STIs vs. STDs

infections develop into disease

scope of public health

infectious diseases, chronic diseases; nutrition, accidents, violence, injuries; health equity, health of vulnerable populations, health care, etc.

high-income causes of death

ischaemic heart disease, stroke, alzheimer and other dementia

global causes of death

ischaemic heart disease, stroke, chronic obstructive pulmonary disease

isolation and quarantine

isolation of cases, quarantine of exposed individuals, culling of diseased flocks/herds

drug use

kills more people than cars and guns; opioid overdose; higher in whites

behavioral capability

knowledge and skill to perform behavior --> mastery through skills training

ageism in care

lack of geriatricians, lacks of clinical trials, harmful assumptions, misconception about sexual activity, risk of under or over treatment) - improve: education to increase number of geriatricians and to change exposures, policies to promote healthy aging

possible risk outcomes of ACE

lack of physical activity, smoking, alcoholism, drug use, missed work, severe obesity, diabetes, depression, suicide attempts, STDs, heart disease, cancer, stroke, COPD, broken bones, higher risk of perpetrating domestic violence

employer-sponsored insurance

large employers are required by ACA to offer insurance or pay a tax, but small employers are still exempt

gun-related deaths

large majority by whites, 85% of gun homicide victims are male often caused by other males

chronic disease

leading COD, responsible for 7 out of 10 deaths - heart disease - cancer - stroke (decreased) - COPD (increased) projected rise in all above in addition to mental disorders, hypertension

NCDs

medical conditions or diseases that are no communicable or infectious - longer duration and slower progression - "chronic" diseases - 40.5 mil deaths in 2016, more than 2/3 - account for 73% of NCD deaths and 57% overall deaths

health education

learning experiences to increase knowledge and influence attitudes; goal to improve the well-being and self-sufficiency of indv, families, orgs, and communities - pros: a lot of education in schools, workplaces, clinics, and communities; wide range of topics covered; health educators are hard-working despite lack of recognition - limited to informational materials, division of labor between work and health edu, limited specialized training, limited access to effective tools, confusion b/w health education and promotion

demographic age shifts in the U.S.

less like a pyramid shape, now column-shaped; numbers of minority populations aged >65 are increasing (hispanic, asian, american indian and alaska native, black) - growing diversity of age 65+

women's health continuum

lifespan approach: puberty, preconception, pregnancy, postpartum, newborn, interconception, menopause, postreproduction

linear vs. stage based changes

linear - gradual, consistent stage - after retirement/widowment (major life stage)

unsaturated fats

liquid at room temp (olive oil), better for you than saturated fats (coconut oil)

racism

literally bad for your health - discrimination in health system, unconscious and automatic bias/attitudes --> negative impacts on health: lower birth weight, higher infant mortality, greater risk for heart disease and cancer

search and contain

look at characteristics, transmission --> intervention program ex. smallpox eradication

medicaid

low-income, joint federal/state funding but state admin - ACA provides enhanced federal funding for medicaid expansion but some states have declined - covers all those whose income is less than 138% of poverty level

low-income causes of death

lower respiratory infections, diarrheal disease, ischaemic heart disease

adverse health from poor community design

lowered traffic safety, water quality and quantity, social capital, elder health and mobility, mental health, physical activity, and more obesity and chronic disease, crime and violence, health disparities, and air pollution

cancer in females US

lung and bronchus, breast, colon and rectum

cancer in males US

lung and bronchus, prostate, colon and rectum

incidence (new cases) of cancer

lung, breast, colorectal, prostate, stomach

mortality of cancer

lung, colorectal, stomach, liver, breast

cancers more common in china

lung, stomach, liver, esophageal cancers; more fatal

corn syrup

major source of monosaccharides in U.S. diet; has largely replaced sucrose as added sugar because cheaper, sweeter

developing countries

majority of world population lives in developing nations; site of a majority of population growth vs. developed countries - shrinking productive age population and growing elderly pop

cancer-related causes of death

male: lung and bronchus, prostate, colon and rectum female: lunch and bronchus, breast, colon and rectum

transfat

man-made from chemical reaction; used to preserve food and make fats solid

preconception

material health during preg is related to health prior to preg; care and health maintenance is important - provide more promotion and prevention services - screening/counseling - use condoms - delay first births - promote birth spacing

reductions in MMR

maximize care of chronic conditions (diabetes, chronic hypertensions, CVD) before preg to reduce MMR -- all due to inflammation - misconception that we can prevent them through antepartum screening programs - risk factors do not predict complications - hard to predict or prevent, but we can treat

post reproduction and menopause

median age 51.4; prior oral contraceptive use and Japanese associated with later menopause - asian women fewest symptoms - hispanic most - AA hot flashes and dryness - white urine leakage and difficulty sleeping

popular opinion leader model

target natural leaders in a social group --> trickle down theory to influence change

vaccinations

prevent infection, disease (cholera), and transmission requirements: - safe, easy, and practical etccc

primary prevention

prevent problem from happening

graph of public vs private payers for hip replacement

private payers spend a lot more everywhere, esp US; US has the highest rates overall and smallest percentage of those covered under public programs, highest percentage uninsured

diet

processed meats and red meats are #1 and #2 carcinogens; huge calorie difference in foods today compared to those 20 years ago

model of population health

programs and policies --> health factors --> health outcomes 50% mortality 50% morbidity

health intervention

programs that can help lead to behavior change: biomedical, behavioral, and structural

behavioral

programs that help people change their behaviors to prevent and manage disease (taking correct dosage at the correct time); directly target people to change their behaviors - adoption of tools/services or adherence to treatment/recommendations

cost of MH/SA disorders

projected to be $203b for MH and $35b for SA; early onset --> high lifetime costs - reduced employment - increased disability - violence - child abuse - martial instability - reduced work productivity - increased absenteeism - motor vehicle accidents - teen preg - homelessness high income indv far more likely to seek treatment

public mental health

providing an env that promotes mental health of pop and healthy societies and promoting the resources to identify and treat mental health

age stereotypes

public health hazard; detrimental to functioning and health, anti-aging beliefs - positive age beliefs = better health outcomes - longitudinal evidence shows that more positive age beliefs lead to better well-being (social engagement, recovery for heart attack, longevity, functional health, etc)

age structure

pyramid right now but by 2050, will look more like a tower --> less young people --> less growth - right now, relative to other countries, small share of population age 65+ - pyramid: young and growing - tower: aging and stable

gestational diabetes

temporary condition in pregnancy

test of correlation

r = .42 declares that the regression is significant at the 5% level; the chance of such a correlation happening by chance alone is less than 1 in 20 --> observed association must be real

gut bacteria

ratio of 10:1 bacteria in your gut vs the number of cells in your body

antigenic shift

reassortment of genetic materials when concurrent infection of different strains occurs in the same host

chlamydia prevention

recently on the rise but screening and treatment have helped

social cognitive theory

reciprocal determinism, behavioral capability, expectations, self-efficacy, observational learning, reinforcements

community intervention

recognize problem, accept responsibility, implement change, change norms, co-opt business marketing strategies

poverty vs disparity

redistribute wealth vs alleviate poverty - averages hide disparities, distribution means a lot - prefer equal distribution - widening gao: poor get poorer, rich get richer

testing strategies

reduce selection bias - compulsory, mandatory, unlinked anonymous, voluntary anonymous, voluntary confidential (identification), routine confidential

assumption of statistical models

rely on two things: - probability that an event occurs is the same for all members of the group (common distribution) - a given person experiencing the event does not affect whether others do (independence)

reducing waterborne disease

safe disposal of human waste, hand washing, education about sanitation, piped and treated water, food safety

requirements for vaccine

safe, easy to administer, elicit a protective immune response, stimulate humoral and cellular immunity, protect against all variants of the agent (too many for HIV), long-lasting immunity, practical to produce, transport, and administer - sociopolitical considerations: cost, liability, funding and distribution, appropriateness and acceptability

meet basic needs of all

safe, sustainable, accessible, and affordable transportation options, food, housing, health care, and communities

reasons for longevity

sanitation, clean water, universal immunization, health education, improved prevention and treatment

tobacco use

second top risk factor; mostly in middle income then low income

evaluation of surveillance system

sensitivity (predictive value, accuracy), timeliness, representativeness (reported vs unreported), predictive value positive (what proportion actually have it), acceptability (encourage or discourage participation), flexibility, simplicity, cost/benefit, dissemination of results, appropriate action

every women every child

series of agendas that have made significant improvement --> political will, investment, implementation, and evaluation - U.S.: safe mother initiative, standard protocols, statewide goals and collaboratives

B: transmission efficacy

sexual act, bacterial or viral (infectious) burden, condom use

case study: STD screening

sexually active female less than 25 years old - recommend chlamydia and gonorrhea annual test - HIV test, at least once in life - consider herpes - defer PAP smear/HPV test until 21 years - cervical cancer screening: pap smear every 3 years after 21 and HPV test every 5 years after 30 until 65

case study: molecular cartography of human skin surface

skin - interface between internal molecular processes and external env; different microbes in diff anatomical regions - sampling on half-body - 3D modeling topographical maps spectra could be matched to daily regimes, exposure matters; greater diversity than microbiota in the gut

ACA subsidies

sliding scale up to 400% poverty level

cancer incidence

smaller incidence in AA but more deaths; larger incidence in hispanic but less deaths; white highest incidence

eradication

smallpox and almost dracunulus; targeting polio and measles now

health education program examples

smoking cessation program and HIV prevention/treatment for youth

major behavioral risk factors

smoking, alcohol, physical activity, obesity, diet

foster supportive and respectful social relationships

social and civic engagement, cohesive relationships, safe communities free of crime and violence

determinants

social and physical environment more important over individual and collective health; improvements over last 100 years due to policy/laws

healthy people 2020

social determinants are conditions in which we are born, live, learn, work play, worship, and age --> affect health, functioning, and quality of life outcomes and risks

health disparities

socioeconomic, racial, age, life stage, gender, geography, sexual orientation - not inevitable, a result of the interplay of several variables - not inevitable, we can do more to lessen the social disadvantage, prevent destructive behaviors, and improve built environments

case study: herpes

sores in genital area; virus has type 1 and 2; mostly asymptomatic, unrecognized; highest in non hisp black; common: 1 in 6

herpes prevention

spread can be reduced with symptom recognition, avoidance of sex when symptomatic, condom use, suppressive treatment (reduces acquisition to susceptible partners), and telling partners

health improvements

stalled, used to increase 1-2 years of life expectancy in each decade but has only since then increased by 0.1 year; decreased because of opioid drug use

positive mental health

state of well-being in which an individual realizes their own abilties, can cope w the normal stresses of life, can work productively, and are able to make a contribution to their community

role in community engagement

statisticians help gather, analyze, and interpret that data necessary for convincing the public and policymakers

biostatistics

statistics as applied to the life and health sciences

barriers to mental health

stigma, failure to respect human rights, lack of public understanding and resulting unease

case study: Wari population

stress from drought resulted in major collapse of population; studies today have shown that the stress during this period led to changes in DNA methylation - stress --> violence, large increase in nonlethal head injuries

example of individual behaviors: physical activity and nutrition

studies show that only 53% of adults are sufficiently active according to guidelines - both obesity and diabetes on the rise with AI/AN highest rates of overweight and AA highest obesity - by poverty level, lowest is most obese and highest is most overweight - MB lowest childhood obesity prevalence and walnut park highest, correlation with average median household income - intervention: implemented SPARK campaign (equipment), child nutrtition lessons, after school programs, Family Fit Fun --> improved test scores and prevention of diabetes and hypertension

graph of medical/lab errors

subjective measures (survey) shows that US ranks close to top for each error but not the leading country: - wrong dose/medication - treatment mistake - incorrect diagnosis - delays in abnormal test results

voluntary anon

subjects know what the test is for, opt in, data recorded but remains anonymous, subject known by assigned random number, give results back to person; unlinked

anxiety as a public health tool

sufficient --> appropriate action

calculating DALYs

sum of the Years of Life Lost due to premature mortality and the Years Lost due to disability YLL = (# of deaths) x (standard life expectancy at age which death occurs)

surveillance vs screening

surveillance - data collection to measure magnitude, changes, and trends in populations --> intervention in defined pops screening - testing to identify individuals with infection or disease --> personal intervention or protection of the public - one exception is blood supply: must be surveilled and screened

risk taking behavior

surveillance system because black/latino males more risk

undifferentiated schizophrenia

symptoms do not clearly fall into one category

alzheimer's

symptoms show impairment in cognitive function; operate on a spectrum from early onset - more females affected - neurons lose ability to function and communicate - three stages: very early, mild to moderate, and severe - neurofibrillary tangles and plaques spread throughout brain --> shrinks brain tissue, widespread damage

population below poverty line

syria, zimbabwe, madagascar, sierra leone, nigeria

goal 65+ maximize life expectancy

target high-mortality conditions (heart disease, cancer, stroke)

goal 65+ maximize function

target most debilitating conditions

goal 65+ prevent morbidity

target most prevalent conditions

aging

the process of growing old

demography

the study of populations with reference to size, density, fertility, mortality, growth, age, distribution, migration, and vital stats of the interaction of these with social and economic conditions

bioinformatics

the study of the inherent structure of biological information and biological systems; brings together biological data with the analytic theory and practical tools of math and CS

goal for aging

to maximize function and well-being across life span = healthy aging - optimal, not successful

example of individual behaviors: tobacco

tobacco use is higher among those below the poverty level

largest urban populations

tokyo, new delhi, shanghai, beijing 54.9% of the world

STDs

top five: gonorrhea, chlamydia, syphilis, herpes, HPV (memorize chart)

high blood pressure

top risk factor; mostly in middle income then high income

literacy

total 86.2%; more males than females; women make up 2/3 of illiterate; 3/4 of illiterate in south asia and sub-saharan africa

GDP

total economy, measures all economic activity - U.S. health care spending as a percent of GDP continues to grow while all other nations remain relatively constant

community design

traffic, water quality, physical activity, and crime and violence

TB

treatment occurred at Olive view-UCLA hospital in Sylmar

net migration

trends of net flow in N America, Oceania, and Europe have remained consistent, decreasing in the last 10 years

almost all biomedical interventions require behavior changes

true

behavior change is required at every level to achieve a goal of health education

true

health education is also targeting stakeholders and professionals

true

low health literacy leads poor overall health and even a crisis state

true

successful aging

unrealistic and implies "failure" if criteria are not met

sexually transmitted disease

urethritis, cervicitis, vaginitis, vaginosis, balanitis, warts, genital ulcer cancer, pelvic inflammatory disease, procitis, pharyngitis, skin rashes, tubo-ovarian abcess, hepatitis, epididymitis, arthritis, conjunctivities, meningitis, cancer, infertility, AIDs

incontinence

urinary (loss of urine), fecal (loss of solid), or pelvic organ prolapse (protruding tissue) - stress or urge incontinence - 25-55% of pop, increases with age, women > men

pesticides

used in agriculture/rural areas in CA