FMHC II Exam 1

Health Policy: Definition Difference between decision and policy:

"A definite course or method of action selected from among alternatives... to guide and determine present and future decisions Decision: Individual Concern Policy: Effects the greater community

The Basis of Policy

*National values • National mood • Ideology (democratic principles) • Political bargaining • Evidence- Not usually the main influence on policy, but worth striving for- The main contribution of epidemiology

Isolation and Quarantine: A ___________ power

A police Power Isolation- Separates sick people with a contagious disease from people who are not sick • Quarantine - Separates and restricts the movement of people who were exposed to a contagious disease to see if they become sick

Epidemiologic Triangle

All inter-related Host - Agent - Environment Each represents an opportunity to intervene

What information can be gleaned from an Epidemic Curve?

An epidemic curve (epi curve) is a graphical depiction of the number of cases of illness by the date of illness onset - Pattern of spread (e.g., Did person-to-person transmission occur?) - Magnitude - Time trend - Exposure and/or period of incubation Different shapes reveal the type of outbreak - Point source/ with propagation - Intermittent source - Continuing source

Sample Size Determination

Needs to be larger when population is more heterogeneous, outcome is rare, less error is required Bigger samples always better For non-probability, minimum is usually 30 samples Statistical software can help you calculate the exact required number of samples (beyond the scope of this course) Rule of thumb: More is Better!

Medical and Public Health Authorities: What does the constitution say about health/medicine The ____ amendment delegates power to _______ True federal power is through:

No legal basis for Federal health care or public health! - US Constitution does not mention health or medicine (term public health not mentioned) *Enables some federal public health-related activities (Interstate commerce, taxation) - Per the 10th Amendment, this is delegated to the States True federal power through provision of money

Is policymaking solely a government function Sources of New policy Medical Policies: Comprehensive, State by State, Local:

No, private entities also make health policy: Insurance companies, employers, educational institutions *Sources of new policy: Cataclysmic events, personal experiences (shootings, congential defects, crime) -Organized Constituencies (AARP, NCBA) -Books -Be a change agent! It's only a law! Comprehensive: - Principles of Medical Ethics - Hippocratic Oath - Accrediting bodies - The Golden Rule • State by State: - Practice Acts - Statutes & Rules (to include licensing) - State and local medical associations • Local- Practice by practice

1. Confirm an outbreak 2. Verify the diagnosis 3. Establish a case definition

Standard set of criteria for deciding whether a person has a particular health condition Defines who is included (as the numerator) in an outbreak investigation Can be sensitive, specific, influenced by # of cases

Which level of government is granted the primary power to regulate health, safety and welfare for the common good (known as "police power")? a. County b. Federal c. Local d. State

State

Bites to which part of the body carry the highest risk of infection? a. Face b. Foot c. Genitals d. Hand

Hand

Immunity: Active vs passive

Immunity: Hosts ability to resist infection by agent Active: Developed as result of natural infection with a microbial agent • Also can be acquired from an injection of a vaccine that contains an antigen - Antigen: A substance that stimulates antibody formation, e.g., a microbial agent • Usually of long duration (measured in years) Passive: Usually shorter: Newborn natural immunity from mom or Immunity conferred by injections of antibodies

Hepatitis A (HAV)

Infected people (NOT zoonotic) Transmission - Direct (fecal-oral) contact with an infected person - Indirect also can occur by ingesting foods prepared by a person with HAV • Symptoms - Usually self-limiting- When s/s are present, inc. lethargy, abdominal pain, nausea, vomiting, dark urine, yellowish skin & eyes (jaundice) and gray to chalk-colored stool - Rest, maintain hydration, eat healthy foods • Control - Standard childhood vaccination, also to int'l travelers - Food/hand/water/sexhygiene RNA Virus: Contaminated water, shellfish, salads Feces of infected people: human to human *Infection, no toxin *Incubation period of 30 days, jaundice WASH HANDS

infectivity vs virulence

Infectivity: The capacity of an agent to enter and multiply in a susceptible host and potentially produce infection or disease Virulence: Refers to the severity of the disease produced; i.e., the degree to which the disease has severe clinical manifestations or is fatal in a large number of cases *Some diseases vary in virulence (Flu, E.coli, ebola)

Local and State Public Health Investigation of Outbreaks

Investigate when outbreak is threat, increase in cases, extra dangerous (even single case), occurence of new disease Each state has certain diseases that are required to be reported For outbreaks that involve large numbers of people or severe/unusual illness, state may ask for help from CDC CDC has to be invited, they can't just show up

Once either president or governor declares emergency, legal rules change: Impact preparedness and response at every level: Types of Emergency Declarations: All disasters are ____________ regardless of declaration level

- Balance civil liberties & collective protection - Determine what constitutes an emergency - Help dictate the emergency response- Authorize individuals to respond - Limit liability for responders "All disasters are local: regardless of declaration level, responses directed at local level

Emergency Management Assistance Compact (EMAC) of 1996

- Facilitates resource sharing across states during an emergency. - Triggered by a governor's declaration of emergency and a request for assistance. - Requesting state is responsible for compensating the assisting state for any expenses incurred. - Has been enacted by all states.

State Emergency Declarations Public Health Emergency: Governor, with health director, may:

- Mandate medical exams for exposed persons - Ration medicine and vaccines - Provide for transportation of medical support personnel and ill and exposed persons - Provide for procurement of medicines and vaccines - Mandate treatment or vaccination of persons - Isolate and quarantine persons

Core Functions of Public Health

1. Assessment: Systematically collect, analyze, and make information available to all 2. Policy Development: Promote knowledge use in policy development and decision making 3. Assurance: Ensure provisions of services

4 Steps of Public Health Approach

1. Surveillance: Determine problem 2. Risk Factor Identification: Determine cause 3. Intervention Evaluation: Determine what has worked/solution 4. Implementation: How to intervene

Primary Influences on Elected Policymakers (4): Policy Instruments:

1. Votes 2. Money 3. Good Publicity 4. Constituent input (Outrage!) Policy instruments: • Legislation and regulations • Taxation and financial incentives • Information and coordination • Provision of direct service

Ten Essential Public Health Services

1.Assess and Monitor 2.Investigate, Diagnose and Investigate 3.Effective Communication 4.Strengthen, Support, and Mobilize 5.Create, Champion, and Implement 6.Utilize Legal and Regulatory Actions 7.Enable Equitable Access 8.Build a Diverse and Skilled Workforce 9.Improve and Innovate 10.Build and Maintain

Approximately how many illnesses are caused by foodborne pathogens in U.S. each year? a. 1.3 million b. 4.2 million c. 6.7 million d. 9.6 million

9.6

Federal Emergency Laws: Public Health Service Act: ____________________ can declare public health emergency Example of ________________ __________ type of legislation

Authorizes the Secretary of HHS to determine that a public health emergency exists because of: A disease or disorder, Significant outbreaks of infectious diseases, or A bioterrorism attack. - Secretary can use Public Health Emergency Fund and "take such action as may be appropriate." The prevention and suppression of communicable diseases and The enforcement of quarantine regulations. - Can be terminated by the Secretary. Terminates automatically after 90 days if not renewed. DHHS Secretary (delegated to CDC Director) can declare public health emergency, make and enforce regulations, do stuff to stop spread of disease An example of a 'commerce clause' type of legislation

Intoxication or infection? Bacillus cereus Campylobacter jejuni Clostridium botulinum Clostridium perfringens

Bacillus cereus - Intoxication• Campylobacter jejuni - Infection• Clostridium botulinum - Intoxication• Clostridium perfringens - Intoxication (sometimes a toxico-infection)

Attack Rate

Basically, an incidence rate applied to a narrow population over a narrow time period AR = (new cases in time period/ population at risk at beginning of time period ) X 10^2 Usually expressed as a percent (n=2) - Commonly used in epidemics - AGE in 46 of 75 party attendees equals AR of 61%

Who makes federal policy? What is Chief executive's agenda?

Chief executives agenda: President/governor *State of Union/state address *Press release, speeches, executive orders (Presidential study/policy directives)

What gives citizens/lobbyists a voice?

Clear, succinct message ('elevator speech') • Extensive use of the media• Organization!• Coalition formation • Contributing and volunteering • Persistence (calls, e-mails, visits, petitions, etc.) - At State level, 5 letters constitutes general consensus - "Light pressure, constantly applied"

E. coli Colibacillosis

Etiology - Escherichia coli (toxin-producing bacteria) Source - Zoonotic; can be contracted from infected humans or animals (pets, wildlife, livestock) Transmission - Direct (fecal-oral) or indirect through contaminated food (esp. meat & poultry) and water Symptoms - Can be limited to GI signs; also urinary tract or elsewhere - Fever, vomiting, diarrhea (may be bloody), stomach cramps, bloating, dehydration - Commonly associated with traveler's diarrhea - Gastrointestinal & renal sequelae can be life-threatening Treatment - Rehydration therapy + antibiotics - Fluoroquinolones, azithromycin are commonly utilized • Control - Food/hand/water/sex hygiene

CDC outbreak investigation steps 13 steps

Confirm the existence of an epidemic Verify the diagnosis Develop a case definition Develop a case report form Count the cases Orient the data (time, place, person) Analyze the data Test the hypothesis Plan and implement control and prevention 10.Evaluate the implemented measures 11.Establish or improve disease surveillance 12.Write a report13.Plan and conduct additional studies

Count Ratio

Count Ratio: -Proportion -Percentage -Rate: Incidence, prevalence, mortality

Role of the CDC

Detecting and responding to new and emerging health threats Tackling the biggest health problems causing death and disability for Americans Putting science and advanced technology into action to prevent disease Promoting healthy and safe behaviors, communities and environment Developing leaders and training the public health workforce, including disease detectives Taking the health pulse of our nation

Sampling Error

Difference between survey result and population value due to random nature of sample - Unavoidable unless sampling the entire population Influenced by: - Sample size - Sampling scheme Unlike nonsampling bias and sampling bias, sampling error can be predicted, calculated, and accounted for Measures of sampling error: - Confidence limits- Standard error- Coefficient of variance - P values • Use these measures to:- Calculate sample size prior to sampling- Determine how sure you are of analytic results

Proffessional Licensure Waiver

Emergency Management Assistance Compact (EMAC) - Reciprocal recognition of professional licenses and certificates among State that adopt EMAC • All states have adopted EMAC - Another state, its officers, and its employees are immune from any claim for actions taken while rendering aid pursuant to the compact • Governor may prescribe limitations and conditions NO PROTECTION for willful misconduct, gross negligence, bad faith

Epidemic vs Endemic vs Pandemic

Epidemic: Occurence in community/region of cases of illness/events in excess of normal expectancy Endemic: Infectious disease agent that is habitually present (plague in arizona, rabies in some animals, valley fever) *Most common way to get plague is from flea Pandemic: Epidemic occuring worldwide/crossing international boundaries

Giardiasis

Etiology - Giardia duodenalis/lamblia/intestinalis (parasite) Source - Infective cysts are shed in feces of infected people; may also be zoonotic Transmission - Direct (fecal-oral) or indirect through contaminated foods (esp. meat and FF&V) and water Symptoms - Majority of human infections may be asymptomatic - When s/s are present, includes watery diarrhea (which commonly floats), bloat & gas, low grade fever, weight loss, nausea +/- vomiting Treatment - When prescribed, includes metronidazole, nitazoxanide, or tinidazole Control - Food/hand/water/sex hygiene

Amoebiasis

Etiology - Various free-living amebae (ex. Entamoeba histolytica & N. fowleri) Source - Zoonotic; can be contracted from infected humans or animals (pets, wildlife, livestock) Transmission - Direct (fecal-oral) or indirect through contaminated food (esp. meat & poultry) and water Symptoms - Usually asymptomatic - When s/s are present, includes abdominal pain, diarrhea (may be bloody) - Naegleria fowleri causes primary amoebic meningoencephalitis, which is commonly fatal Treatment - Metronidazole or perhaps chloroquine Control - Food/hand/water/sex hygiene

On a state level, which governmental branch is responsible for setting healthcare policies that are a matter of public concern? a. Executive b. Judicial c. Legislative

Executive

Which branch of the U.S. Government is responsible for binding the U.S. to international treaties? a. Executive b. Judicial c. Legislative

Executive

State Public Health Laws: State Police Power

Exists even in absence of declared emergency Inherent, sovereign power of the state Means to establish civil self-protection laws Promote the public health, safety, morals, and the general well-being of the community Control, regulate, or prohibit non-criminal behavior State Police power examples: Investigate infectious disease, childhood vaccinations, ban on free cigarettes, involuntary detention, property seizure/destruction to control toxins *State animal/ wildlife disease laws do not require an emergency declaration

In the U.S., foodborne diseases are generally reportable. True False

False

Individual states do not have the power to oversee professional healthcare licensures. True False

False

Puncture wounds should be closed immediately. True False

False

The scope of public health law is very narrow and only applies to questions of legal interpretation of existing laws. True False

False

Health Determinants Mostly determined by:

Genes and biology (sex, etc) Health behaviors (smoking, eating habits, physical active) Social or societal characteristics (discrimination, living quarters, air, water) Health services or medical care (quality of care, insurance)

NRF (National Response Framework Doctrine) Purpose and Scope

Guide for how nation responds to all hazard types/emergencies Coordination across "whole community" In accordance with (IAW) NIMS (National incident management system), aligns key roles & responsibilities - Describes doctrine for all types of disasters & emergencies - Links all levels of government, private sector, and nongovernmental organizations in a unified approach to emergency management - ALWAYS in effect: can be partially or fully implemented - Coordinates Federal assistance without need for formal trigger A Lead Federal Agency (LFA) is designated- Activates appropriate responses relevant to its authority - Coordinates the Federal response IAW NIMS *ESFs (emergency support functions) may be activated/deployed to support LFA

Which branch of the U.S. Government is responsible for enacting "necessary and proper laws?" a. Executive b. Judicial c. Legislative

Legislative

Clostridium Botulinum *Low incidence, high mortality

Low oxygen foods, infant botulism (honey) Anaerobic Intoxication: Potent neurotoxin formed by bacterial phase Inactivated by boiling 18-36 hours after ingestion: preformed toxin Double/blurred vision, slurred speech

Normal Distribution Mean, median, mode

Mean: Average Median: Value which comes half way when data ranked in order Mode: most common In a normal distribution, mean and median are the same • If median and mean are different, indicates that the data are not normally distributed (usually skewed in one direction) • The mode is of little if any practical use

Clostridium Perfringens

Meat Poultry Pig Bel disease In soil Intoxication: 16 hours after ingestion

Which is the last phase of the policy process? a. Community process b. Legislative process c. Modification process d. Operations process

Modification

Morbidity vs Mortality Rate

Morbidity: Numerator is the total number of illnesses in a population over a specified period of time Denominator is the average population at risk over that same time period (# of illnesses due to disease in time period/ average number in population during the time period) X 10^n Mortality Rate: Numerator is the total number of deaths in a population over a specified period of time Denominator is the average population at risk over that same time period (# of deaths due to disease in time period/ average number in population during the time period) X 10^n

Nonsampling vs Sampling Bias

Nonsampling: Present even if sampling and analysis done correctly • In sum, you either sampled the wrong people or erred in your measurements - Sampled population not actually a subset of overall population • Incorrect sampling frame• Systematic non-response among sampled units - Measurement error• Flaws in weights, heights, BPs, etc.• Flaws in survey questions (e.g., misleading, etc.) • Various types of bias (e.g., recall, observer, etc.) Sampling: Sampled population is not representative of overall population • Failure to allow for statistical weighting of samples of unequal probability

Point Prevalence vs Period Prevalence

Point Prevalence: All cases of a disease, health condition, or deaths that exist at a particular point in time relative to a specific population from which the cases are derived # of persons affected / total number in group at a point in time Period Prevalence: All cases of a disease within a period of time • Examples:- Percentage of people in the U.S. who had asthma during the past 12 months of any particular year - Percentage of veterinary students who had diarrhea during their freshman year

Population Sampling vs Random Sampling

Population Sampling: Population sampling is the process of taking a subset of subjects that is representative of the entire population. The sample must have sufficient size to warrant statistical analysis Sampling is done usually because it is impossible to test every single individual in the population. It is also done to save time, money and effort while conducting the research Random Sampling: Random sampling is a selection process that gives each member of the population being studied an equal chance to be chosen Attempts to replicate the characteristics of the Target Population using a sample

Normal and Skewed Distributions Negatively vs positively skewed

Positively skewed = skewed right (Tail on right)

Stafford Act Declaration

President may declare a "major disaster" or "emergency" for an event that overwhelms state or local governments. - Declaration triggers access to federal assistance. - Governor must execute the state's emergency plan before requesting a presidential declaration. - President can declare an emergency without a request if there is "federal primary responsibility."

HIV/ AIDS Prevalence and Incidence

Prevalence has increased Incidence has decreased

Prevalence vs Incidence Interrelated concepts

Prevalence is the number of existing cases of disease in the population during a defined period • Incidence is the number of new cases of disease that develop in the population during a defined period Factors that cause prevalence to increase: ─ Increase in incidence ─ Longer duration of the case─ In-migration of cases─ Prolongation of life of patients without a cure • Factors that cause prevalence to decrease: ─ Decrease in incidence ─ Shorter duration of disease─ In-migration of healthy people ─ Improved cure rate of disease

US Department of Health and Human Services

Primary federal health agency, includes: - Centers for Disease Control and Prevention (CDC) - National Institutes of Health (NIH) - Food and Drug Administration (FDA) - Indian Health Service (IHS)

Probability vs Odds Probability varies between : Odds varies between :

Probability: Chance or risk of an event occurring (a proportion) # of times event occurs/ # of times event can occur *Rate of how likely event is to take place (# of favorable outcomes/ # of all possible outcomes) *Probability of surviving Odds: Ration of probability of event occuring to probability of event not occuring Odds = P/ (1-P) *Number of successess/ number of failures Probability varies between 0 and 1 Odds varies between 0 and ∞ Directly related First # is same in each case

Count

Refers to the number of cases of a disease or other health phenomenon being studied • Reports of single cases may have public health significance ─ Case reports of patients with particularly unusual presentations or combinations of symptoms often spur epidemiologic investigations ─ Examples:➢ Four cases of Ebola Virus Disease➢ One case of human rabies➢ Three cases of human botulism➢ 1.5 million cases of foot and mouth disease in swine

Incidence Incidence Rate

Refers to the occurrence of new disease or mortality within a defined period of observation (e.g., a week, month, year, or other time period) in a specified population ✓ Cases that already existed at the beginning of the period are not counted Incidence Rate: A rate formed by dividing the number of new cases that occur during a time period by the number of individuals in the population at risk • Probably the most common frequency or risk measure ✓ Used to roughly compare risk between similar populations

Reservoir (carrier) vs Vector vs Fomite

Resevoir: Where infectious agents normally live and multiply (humans, animals, insects, soils, plants *Usually unaffected by agent Vector: *Animate, living insect/animal involved in transmission of disease (mosquito, tick, etc) Fomite (vehicle): inanimate object that harbors infection: Dust, food/water, rusty nail, blankets

Enterohemorrhagic Escherichia coli

Shiga toxin: not preformed -3-4 day incubation period In all sorts of food: WATCH OUT FOR GROUND MEAT Cattle = animal reservoir Hemolytic uremic syndrome (HUS): Acute renal failure

State Authorities vs Local Authorities

State: Primary Public health authority Collect vital health data Diagnostic and public health laboratory State-wide nutrition programs Regulation of health facilities State Medicaid program Licensing of medical professionals (DO, DVM, DMD) May delegate authorities to local level Local Authorities: Immunizations not covered under insurance Disease surveillance and investigation Communicable disease control Food establishment licensing & inspection Public health screening programs Tobacco control programs Disaster preparedness and response

Statistical Significance P-Value *Clinical significance not same as statistical significance, because even if its statistically significant it may not make much sense for patient (increase life by one month)

Statistical Significance is the probability that an effect observed is occurring because of chance Statistical Significance is usually expressed as a p- value The smaller the p-value, the less likely it is that the results are due to chance (and more likely that the results are true) In general, medical researchers have chosen a p- value of less than 0.05 (p<.05) for 'statistical significance' Null hypothesis = due to chance?

Outbreak Investigation Steps for the CDC *steps may be done concurrently *May have some variation *DOES NOT influence individual patient managment by provider

Step 1: Establish existence of outbreak Step 2: Prepare for field work (research, supplies, travel) Step 3: Verify diagnosis (speak with patients, review lab stuff) Step 4: Define and identify cases (establish case definition by using standard set of criteria Step 5: Using descriptive epidemiology (person, place, time) Step 6: Develop focused hypothesis Step 7: Evaluate hypothesis for validity Step 8: Refine hypothesis Step 9: Implement control and prevention measures Step 10: Communicate findings (who needs to know, determine how to tell them, identify why they need to know)

When does the CDC get involved in an outbreak?

Suspect bioterrorism Have tests for unusual disease (ebola in US) Consults for unusual disease (botulism, only a small supply of anti-toxin) International exposure/ travelers (rabies from another country)

Physical Effects of climate change

Temp continue to rise, but not uniformly Longer frost free growing season Rain increase (leads to contamination), but also more droughts (increased concentration of contaminants) and heat waves Hurricanes stronger/more intense Sea level rise 1-4 feet by 2100 (influc of marine pathogens, flooding) *range expansion among zoonotic agents/hosts *excess precipitation = more waterborne diseases Diarrheal diseases = Leading cause of child global mortality with ~ 1.6 million annual deaths *Vibrio and Leptospira infections

The ______________ ___________ ___________ is activated upon federal declaration Mandating Authorities

The National Response Framework is activated upon a Federal declaration Mandating Authorities: -Homeland Security Act of 2002 • Created Department of Homeland Security - Homeland Security Presidential Directive 5 (2003) • Enhanced the US ability to manage domestic incidents by establishing the national incident management system (NIMS) • Precedent documents - Federal Response Plan, 1992 - National Response Plan, 2004

Case Fatality Rate

The number of deaths due to a disease that occur among persons who are afflicted with that disease. More than 2% = bad

Prevalence

The number of existing cases of a disease or health condition, or deaths in a population at some designated time • Variations: ─ Point prevalence ─ Period prevalence ─ Lifetime prevalence

Ratio: Rates, proportions, percentage

The value obtained by dividing one quantity by another" Examples include: o Rates o Proportions o Percentages Usually numerator = subset of denominator Fetal death ratio = # of fetal deaths/ # of live births Student sex ratio = # of males/ # of females Proportion: Type of ratio where numerator part of denominator -May be expressed as percentage -Prevelence (# of cases/PAR) -Case fatality (#deaths/ total cases) Percentage: Proportion multiplied by 100 *(A/A+B) X 100 Rate: Type of ratio, differs from proportion because denominator involves measure of time (incidence, mortality, morbidity, attack rate)

Incubation Period

Time interval between invasion by an infectious agent and the appearance of the first sign or symptom of the disease

Total Deviation = __________ + ______________

Total Deviation = bias + error

Epidemiologists and Policy: Translational Epidemiology Limiting Factors

Translational epidemiology: "The effective transfer of new knowledge from epidemiologic studies into planning of population-wide and individual-level disease control programs and policies." Examples: Cigarette ad bans, pollution standards, food labeling Limiting Factors: Focus on individual level risk factors, policymakers aren't scientists, different time scales of science vs policy, credibility issues ("real MDs")

Bulk food shipments across international borders are a contributing factor to which foodborne illness? a. E.coli b. Norovirus c. Salmonella d. Traveler's diarrhea

Traveler's diarrhea

A fight bite is the most common human bite wound. True False

True

The main purpose of a healthcare policy is to address a problem, need and/or public concern. True or False

True

Tribal governments possess independent authority to address public health concerns in their communities. True False

True

While the overall number of farms in the U.S. is decreasing, the average number of livestock animals on these remaining farms is increasing. True False

True

Reportable and Notifiable Diseases *Animal diseases of great economic importance are included on animal lists

Usually infectious/communicable disease that might endanger population -> required to report Deficiencies of these statistics: Population coverage may be incomplete, no info from those who don't seek medical care, may be asymptomatic, providers may no fill out forms

Terminology of Analytic Epidemiology: Variable

Variable- Any observable event that can vary • Examples: weight, age, disease status, exposure • Variables are either associated or they are not - If not, they are said to be 'independent' - If so, they are 'dependent' and may be:• Positively associated - they both increase/decrease together • Negatively associated - they increase/decrease inversely

Does the structure of the COVID-19 response differ from what is laid out in the NRF?

Yes...the creation of the Task Force under VPOTUS was a departure from the NRF However, LFA Remains with HHS (health and human services )

Regulatory decisions and the laws that govern executive branch actions, are known collectively as what? a. Administrative law b. Case law c. Constitutional law d. Judicial law

a. Administrative law

What is the first step in treating a bite wound? a. Apply a local anesthetic b. Clean with antibacterial soap c. Debride any dead or devitalized tissue d. Irrigate with saline

b. Clean with antibacterial soap

In the U.S., approximately 10 to 20 people die each year from which type of bite wound? a. Cat bite b. Dog bite c. Human bite d. Monkey bite

b. Dog bite

Approximately how many pounds of meat products are confiscated from travelers each month from Haiti to the U.S.? a. 2,000 b. 3,000 c. 4,000 d. 5,000

c. 4,000

Clustering Spatial vs temporal

losely grouped series of events or cases of a disease or other health-related phenomena with well-defined distribution patterns in relation to time or place or both Aggregation of uncommon conditions like leukemia may reflect common exposure Spatial clustering—refers to aggregation of events in a geographic region Temporal clustering—denotes the occurrence of events related to time

Index Case

the first identified case in a group of related cases of a particular communicable or heritable disease

Public Health

the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals

Nongovernmental Organizations: Major providers of ______________________________ health

• American Red Cross • American Cancer Society • American Lung Association • March of Dimes • Bill and Melinda Gates Foundation Major providers of international public health

Quantitative (Discrete vs continuous) vs Qualitative

• Quantitative- Can be counted, measured, and expressed using numbers - Structured Broken down into 2 categories: -Discrete - Cannot be broken down into smaller parts • How much $ in your wallet, how may iPhones were sold, etc. • Continuous - Can be infinitely broken down into smaller parts • Weight, height, age, speed, etc. • Qualitative - Descriptive and conceptual (non-statistical)- Can be categorized based on traits and characteristics - Un- or semi-structured

Herd Immunity

• The resistance of an entire community to an infectious agent as a result of the immunity of a large proportion of individuals in that community to the agent - Applies equally well to a herd of animals

Types of Associations • Relationships between variable X (exposure factor) and variable Y (outcome):

─ No association (X and Y are independent) ─ Associated (X and Y are dependent) • Non-causally (X does not cause Y) • Causally (X causes Y) Association does not prove causation A scatter plot graphs two variables, one on the X axis (horizontal) and one on the Y axis (vertical) • The measurements for each case are plotted as a single data point • The closer the points lie with respect to the straight line of best fit through them (called the regression line), the stronger the association between variable X and variable Y