PH Chapter 1-9 Health

List the three levels of prevention.

Primary intervention: prevents illness or injury from occurring at all, by preventing exposure exposure to risk factors. Secondary intervention: seeks to minimize the severity of the illness or the damage due to an injury-causing event once the event has occurred. Tertiary intervention: seeks to minimize disability by providing medical care and rehabilitation services

Summarize the moral and religious opposition to public health measures.

Religious oppositions-mostly when it confronts sexual and reproductive issues: sexed in schools and contraceptives -> opposed by religious groups who believe they promote immoral behavior; Moralism- alcohol and drug policies -> argued by libertarians who believe alcohol and drug consumption is private behave and doesn't effect others, could interfere with scientists studying how to prevent HIV

Bias:

Selection bias - Reporting bias or recall bias Proving cause and effect (large number of subjects)

Identify the functions and responsibilities of state health departments.

States have primary constitutional responsibility and authority for the protection; collects an analyzes data provided by local agencies; maintain standards of competence and quality of care; people who lack private health insurance are concern of state; determine eligibility rules for coverage

Define public health

The fulfillment of society's interest in assuring conditions in which people can be healthy. Organized community efforts aimed at the prevention of disease and the promotion of health.

Incidence:

a measure of the # of new cases occurring in a population within a given amount of time, usually a year

Explain public health's role in the prevention of terrorism.

crashing plane 9/11: emergency plan; secondary prevention: minimizing damage & tertiary prevention: providing medical care to those injured in the disaster, mitigate the effects of obvious disasters and in recognizing and controlling the more insidious effects of bioterrorism

Chronic disease Heart disease, Lung Cancer, Tobacco: Studies:

example - Framingham Study, British Physicians' Study

Rabies:

fatal disease of the nervous system caused by virus -infects only mammals -almost always transmitted when a rabid animal bites another animal or human -bats most dangerous rabies threat

Define the mission of public health.

fulfilling society's interest in assuring conditions in which people can be healthy

Health Education:

instruction that promotes healthy behaviors by informing and education individuals through the use of materials and structured activities

Identify the goal of public health.

maximum health for all

YPLL (years of potential life lost):

measure of premature mortality

Identify the economic impact of public health efforts.

most ph measures have negative economic impact of some segment of popul -industries resist ph efforts (ex.: tobacco harmful to health and causes millions in medical causes annually but only has minor restrictions because it is a major industry in the South, supporting jobs and providing profits for tobacco companies

Illustrate approaches to designing interventions that prevent undesirable health outcomes.

one approach is to think of prevention on 3 levels: primary, secondary, tertiary. another is thinking of an illness or injury as a result of a chain of causation involving an agent, a host and the environment.

Epidemiologic surveillance:

ongoing and systematic collection, analysis and interpretation of health data essential to the planning, implementation, and evaluation of public health practice, closely integrated with the timely dissemination of these data to those who need to know.

Eosinophilia-myalgia syndrome:

outbreak in New Mexico ->high counts of white blood cells -> all victims taking L-Tryptophan (treatment for insomnia, depression and premenstrual symptoms) -> food and drug admin announced nationwide recall of products containing :tryptophan

Give examples of public health nongovernmental agencies and describe the purpose that they play.

play roles in education, lobbying and research; American Heart Association, America Cancer Society - focus on specific disease, provide funding

Prevalence:

proportion of persons in a popul who have a particular disease or attribute at a specified point in time or during a specified time period

Risk assessment:

quantitative estimate of the degree of hazard to a population presented by some agent or technology or decision. A risk benefit assessment attempts to weigh possible risks against possible benefits.

List examples of government regulations that protect the environment.

restrictions on timber harvesting in the pacific northwest are regularly under attack bc they maybe cost jobs in the lumber industry although they may preserve job in the fishing and tourist industries & contribute to long term stable climate; tobacco restrictions

Articulate reasons why restrictions on individual behavior are acceptable.

sometimes it causes direct harms to others, sometimes the individual harms themselves (seatbelt laws), tragedy of the commons: indirect harm to others (air, water, and environment ppl share)

Compare and contrast the roles of state and federal governments in public health.

state govts have laws to collect data about popul, immuniz children before entering school, and regulate environ for santiation and regulate safety; federal govt regulates interstate commerce and collect tax to pay debts and provide for common defense and general welfare

Explain how public health is organized at the local level and how local health departments are funded.

varies from state to state; most common local agency is the county health department; large city might have its own municipal health department

What are strengths and weaknesses of each of the major types of epidemiologic study?

- Randomized controlled trial: subject assigned to treatment group or control group at random - Cohort: Study of a group of people, or cohort, followed over time to see how some disease or disease develop - Case-control: start with people who are already ill and look back to determinetheir exposure, focus on small group and can be completed quickly. People with disease compared w healthy individ - Intervention study: similar to lab experiments on animals. Usually done to test a treatment for a disease. Clinical Trial: treatment group vs. Control group.

What are the basic shapes of common pathogens? (Ex: Tb, Cholera...)

-Bacilli: rod shaped -Cocci: round shaped -Spirochete: corkscrew shaped

Birth and Death certificates

-Birth certificate: child's fam, including names, addresses, age, race, ethnicity, education levels -info on death certificates have uncertainties

Demonstrate the affect of probability in establishing the outcome of a clinical trial.

-Confidence intervals: range of values which the true result probably falls

Life expectancy (Florida, Alaska): the # of additional years of life expected at a specific point in time.

-Expected that a higher percentage of Floridians die each year. After age adjustment, mortality rate for Alaska is higher.

Illustrate how scientific assessment of risk conflicts with the public's perception of risk.

-Familiar risks are more acceptable than unfamiliar ones -risks that people perceive they have control over are more acceptable (driving) -risks with high catastrophic consequences is unacceptable (nuclear power)

Epidemiology John Snow Vauxhall & Lambeth water companies: noticed death ratesfrom cholera were high in parts of city where water was supplied by 2 private companies: Labeth and Southwark (water from Thames which was heavily polluted w sewage).

-Lambeth changed source of water free from population but Southwark didn't, -cholera deaths dropped in place supplied by Lambeth but places supplied by southwark stayed the same

Describe why statistical rates are useful in interpreting the data collected for the assessment of public health.

-Rates put raw numbers into perspective by relating them to the size of the popul being considered -Birth rate: # of live births per 1000 ppl. -Fertility rate: # of live births a yr per 1000 women age 14-45 -Mortality Rate: incidence of deaths per unit of time, most often per yr, in a population -death rates often adjusted for age

Illustrate factors that can be utilized to prove cause and effect in disease.

-Stronger association between exposure and disease means higher relative risk or odds ratio -Dose response relationship: relationship between dose of some agent or extent of some exposure, and a physiological response. It means effect increases with the dose. -evidence more convincing if there is a known biological explanation for an association between an exposure and a disease

Name surveys conducted by the NCHS and other governmental agencies and describe their purpose.

-The National Health and Nutrition Exam Survey: assess health and nutritional status of adults and children in U.S. and to track changes over time; prevalence of chronic conditions -Behavioral Risk Factor Surveillance Survey: collection, analysis, and interpretation of health data essential to the planning, implementation, and evaluation of PH practice, closely integrated with the timely dissemination of these data to those who need to know. The final link in the surveillance chain is the application of these data to prevent and control -National Immunization Survey: gain info on healthcare utilization -Surveillance, Epidemiology and End Results to monitor trends of cancer incidence and mortality

What is Census (vital statistics) accuracy & availability of data?

-Vital Stats: systematically collected stats on birth deaths marriages divorces and other life events. The stats of life health disease and death- stats that measure progress or lack of it against disease -data can improve quality of medical care for future patients as well as improve the accuracy of vital statistics

Who, when, & where:

-Who: characterizes the disease victims by such factors as age, sex, race and economic status -When: looks for trends in disease freq over time, crucial in tracking outbreak of infectious diseases -Where: looks at the comparison of disease frequency in different countries, sates, counties, or other geographical divisions

What are the types of infectious diseases?

-bacteria, virus, parasite

Give examples of past ethical abuse in epidemiologic study and list some guidelines that have been established as a result to prevent it.

-before ppl not concerned with rights of experimental subjects ( poor patients, prisoners, inmates of mental institutions) -poor black men didn't get syphilis treatment that could have helped them- withheld antibiotics (Tuskegee study) -aids study people wanted to try medicine even if risk outweigh the benefit -established rules for conduct of human experimentation. -subjects must freely consent to participate -study must be approved by institutional review board

List vital statistics compiled by public health agencies.

-births and deaths -marriages and divorces -spontaneous fetal deaths -abortions -infants who die within first year of birth

Describe why confidentiality is crucial in the accumulation of personal information.

-can't be divulged without consent of individual -concern that a snoop or employee in agency and obtain confidential info and use it to tht individual's detriment -researchers must explain and justify need for data and promise to safeguard it -institutional review board/ data protection committee -HIV handled differently bc individuals feared they'd be discriminated against

Explain how the pharmaceutical industry has used misleading information to manipulate results of clinical trials.

-company may purposely suppressing info about a drug during approval process. -don't include side effects they knew about in data submitted to the journal -test new drug in clinical trial against placebo, but results can be misleading if there are older well-established drugs already used for same condition (profit)

Explain how infectious diseases are spread.

-directly rom one person to another -indirectly by water, food -indirectly by insets and animals -can be transmitted from person to object to person -from person to person: Pathogen > reservoir (where pathogen lives and multiples) > Method of transmission (travel from one host to another, or from reservoir to new host) > Susceptible host (some ppl are immune)

Summarize how technology is improving accessibility and availability of public health information.

-electronic methods of filing improve quality of data -weekly reports of notifiable disease transmitted electronically databases kept up to date by electronic filings -info tech- PH informatics- improve accessibility -info available on the internet

Describe the benefits of immunization and identify how people's fear of vaccines threatens to cause outbreaks of infectious diseases

-fear of autism bc autism becomes apparent about when vaccines are given -parental concerns -British surgeon published fraudulent paper claiming measles vaccines linked to autism -rare serious side effects of vaccines, this risk is smaller than risk of disease in an unvaccinated popul -pharmaceutical companies reluctant to invest in develop of vaccines, sued by parents

Describe the function of the U.S. Census Bureau and provide examples of statistical inaccuracies that have occurred.

-finds # of people in population which serves as denominator -makes accurate count of American popul -sex, race, age group

Name some long-term studies of chronic diseases and describe how they help identify risk factors that contribute to these diseases.

-framingham heart study: revealed how to predict which subjects where likely to develop heart disease. 3 major risk factors: high blood, high cholester, smoking -> reduced death rates bc of decline in risk factors -Lung cancer: smoking and lung cancer

Describe the steps involved in an epidemiologic investigation.

-hepatitis notifiable disease-local health department recog when outbreak occurs -ask who when where-on what date did first symptom appear -incubation period for hepatits -where did victims obtain food and water during period of likely exposure and what sources did they have in common-might close down restaurant until its cleared and healthy-Examine data on certain diseases. Recognize epidemic occurs before become start dying-Epidemiologic surveillance-require notifiable disease occur before people start dying. Report infectious disease, birth defects, cancers to local health department then reports to state health department and Center for Disease Control and Prevention (CDC). This system helps identify causes of diseases that can be controlled or eliminated.

Explain the importance of screening tests in the detection and treatment of disease.

-identify infected individuals treated and educated on how not to spread disease -false negative: find no effect when there is one -false positive: random variation appears to be a true effect

Identify problems encountered when studying humans in an epidemiologic study.

-impossible to control human behavior, such as diets. It's hard to know whether or not people will stick to it. -2 groups tested for diet and heart disease. One group eat low fat diet vs American diet, someone of those people might already be eating a low fat diet, the low fat diet group also might already be health conscious. -people not likely to self report correctly: embarrassed to admit or forget

Describe the role of epidemiologic surveillance in detecting disease outbreak and developing public health response.

-in the past the solution was quarantine -outbreak detected by surveillance > locate ppl who had contact w individual and immunize them

Role of the CDC

-issue regulations on animals

Probability power (large number of cases):

-large # of sample =power, large number of subjects is more powerful than a small study more likely to be valid

Illustrate the significance of data collection to public health practice.

-make up surveillance systems that form basis of effective PH practice -help the planning and evaluation efforts in PH -need data to know when an epidemic begins

Identify how statistics are used in public health.

-makes possible the translation of data into info about causes and effects, health risks, and disease cures

Identify ways the NCHS collects data on the health of Americans.

-part of cdc -states periodically transmit data they have compiled from local records, vital statistics, including, virtually all births and deaths. -then nchs conducts periodic surveys of representative samples of the population seeking info on certain characteristics such as health status, lifestyle and health related behavior, onset and diagnosis of illness and disability, and the use of medical care

Pathways of disease

-person to person directly -indirectly water, food -by animals

Describe reasons why epidemiologic studies can result in incorrect conclusions.

-random variation -Association merely due to chance -invalidation due to confounding variables (factors associated with the exposure and that may independently affect the risk of developing the disease) -bias/systematic error, selection bias, recall bias

Why is epidemiologic surveillance important for public health?

-recognize epidemic is occurring before many people start dying

Identify some infectious diseases that are considered to be "notifiable" and explain why they are required to be reported.

-reported as soon as they are diagnoses bc they are infectious and spread can be prevented if appropriate actions are taken. -food poisoning outbreaks: :Salmonella or Shigella- contamination -cryptospooridiosis- severe and widespread -cholera

List examples of illness caused by toxic contamination of food.

-salmonella, shigella, bacteria in carelessly prepared or preserved food

Common human infections

-smallpox: infects human, measles, -poliovirus: infects human

Sensitivity vs. specificity rates (crude, adjusted)

-specificity: a test's ability to designate an individual who does not have a disease as negative -Sensitivity: test's ability to designate an individual with disease as positive. -crude: natural or raw state -adjusted: age adjustments when age profiles of the popul are different

Explain how epidemiology is used to control disease.

-studies patterns of disease occurrence in human popul. Count cases of disease then ask who when and where. -with this they make guesses on why diseases are occurring

Provide examples of transmittable diseases that have been successfully contained by public health measures

-surveillance for rabies -universal vaccination -vaccination originated with smallpox -vaccine for measles

Lead exposure: lead poisoning in ohio

-water treatment plant operator accused of falsifying reports -cut water treatment cost > lead poisoning

What are Koch's postulates?

1) The organism must be present in every case of the disease 2) The organism must be isolated and grown in the lab 3) When injected with the lab-grown culture, susceptible test animals must develop the disease 4) The organism must be isolated from the newly infected animals and the process repeated

Explain public health's history with social reform.

19th century reformers pushed for sanitary science and public hygiene, improved housing, trade unions, abolition of child labor, maternal & child health, temperance -conservatives resist broad vision of public health, starve govt of funds for healthcare for all

An example of a source of economic impact on public health controversy is: A. Companies resisting stricter pollution control B. Companies wanting to implement more public health measures C. More people wanting to pay now for long term benefits D. Implementing several public health measures at one time

A. Companies resisting stricter pollution control

Intellectual health, as a part of the 7 dimensions of health, refers to: A. Keeping an open mind and learning new things B. Having high test scores C. Place of employment D. Finding your meaning and direction in life

A. Keeping an open mind and learning new things

An example of politics becoming a source of controversy in public health is the misrepresentation of scientific data to support specific political agendas. A. True B. False

A. True

Even though the link between lung cancer and tobacco smoking were made as early as the 1950s, smoking cessation programs did not begin to be implemented until around 1980. A True B False

A. True

In public health, challenges can arise from politics involved in policy making. A. True B. False

A. True

One possible reason for the impact of lower SES on health is lack of education about health- related issues A. True B. False

A. True

Public health is involved in creating policies and measures that improve the health of the community, such as seat belts and safe water. A. True B. False

A. True

The EPA provides information of a disease and its connection to the environment A. True B. False

A. True

The Surgeon General is heavily involved in politics. A. True B. False

A. True

The physician has a responsibility to report new occurrences of a disease to the public health department. A. True B. False

A. True

The source of Eosinophilia-Myalgia was found to be an active ingredient in L-Tryptophan dietary supplements. A. True B. False

A. True

What disease did Koch discover? A. Tuberculosis Bacillus B. Cancer C. The cold virus D. None of the above

A. Tuberculosis Bacillus

Legionnaire's disease:

American Legion 4 day convention -> before event was over ppl fell ill w symptoms of fever, muscle ache, and pneumonia ->reported to CDC -> site of exposure most likely Hotel Bellevue- Stratford (one hotel where convention was held).- >scientist found bacteria was responsible -> Legionella bacterian found in water of cooling tower used for AC -> inhaled by victims

Summarize the core functions of public health.

Assessment: agency collects, assembles, analyzes and makes avail info on health of popul; Policy Development: scientific knowledge to develop of a straetegic approach for improving the community's health, and Assurance (protect health and prevent disease)- assure services needed for protection of ph in the community are available and accessible to everyone

Health only refers to physical health. For example, if a person does not have any medical conditions, they are considered healthy. A. True B. False

B. False

Spiritual health is always connected to religion A. True B. False

B. False

Which federal agency is best known for supporting research in public health? A. Centers for Disease Control and Prevention (CDC) B. National Institutes of Health (NIH) C. Food and Drug Administration (FDA) D. Department of Health and Human Services (HHS)

B. National Institutes of Health (NIH)

Name agents that cause epidemic disease.

Bacteria: large domain of single-celled microorganisms that lack a nucleus or other membrane-bound organelles. Only a few cause disease Viruses: small pathogen not capable of independent metabolism and can reproduce only inside living cells Parasites: organism that lives off another organism (host) but does not contribute to welfare of the host

The approach for bioterrorism related to infectious disease is: A. How to conquer the infectious disease B. Check who is behind the spread of the infectious disease C. A and B D. None of the above

C. A and B

Random variation errors

Confounding variables

Examples of Cohort Studies include: A. Framingham Heart Study B. Nurse's Health Study C. Fat intake Headache Study D. A and B

D. A and B

An example of moral and religious opposition to public health apporaches includes: A. Sex education B. Use of seatbelts C. Clean needle movement for drug users D. A and C

D. A and C

in the mid 1850s by: A. Questioning households where cholera occurred B. Assuming water was the source of the outbreak C. Finding a common denominator between those infected D. A and C

D. A and C

"Outbreak Investigation" -For example, specimens were sent to laboratory to confirm diagnosis -Incubation period: this can influence decisions you make. For instance, might decide to give a vaccination You are a public health official and there is an E. Coli outbreak. Nobody is sure where the outbreak originated from. You should: A. Work on finding the source B. Gather history from infected patients C. Send specimens to a lab D. All of the above

D. All of the above

Core Functions of Public Health include: A. Assessment B. Policy Development C. Assurance D. All of the Above

D. All of the above

Intervention studies have the following characteristics: A. Two groups: Experimental and Control B. Watch them over time and compare outcomes based on an intervention C. Create groups that only differ based on intervention D. All of the above

D. All of the above

Problems and Limits of Epidemiology Problems with studying humans include: A. Overestimation of Effects B. Confounding variables C. Difficulty isolating factors responsible for health outcomes D. All of the Above

D. All of the above

The public health disciplines include: A. Epidemiology B. Statistics C. Social and Behavioral Sciences D. All of the Above

D. All of the above

List federal agencies involved with public health and describe their missions.

Department of health and human services(HHS): environ health; Centers for Disease Control and Prevention (CDC): main assessment and epidemiologic agency for the nation, mission to prevent human disease; National Institute of Health (NIH): biomedical research

Compare and contrast public health with medical practice.

Diagnosis, treatment planning, therapy. Often focuses on the individual rather than the community as a whole

Describe the disciplines of public health.

Epidemiology: Study of popul to seek the causes of health and disease; the study of the distribution and determinants of disease frequency in human popul; Statistics: a scientific discipline or method, a way of gathering and analyzing data to extract info, seek causation, and calculate probabilities; Biomedical Sciences:aids, flu, hanta virus, cancer; Environmental Health science: new chemicals; Social and Brhavioral Sciences- Latino Paradox; Health and Policy Management

Illustrate ways that the federal government has manipulated the release of scientific information.

Geroge bush admin distort scientific evidence to fit political agenda: global warming; pressure for CDC to remove information on sex education and replace evidence of effectiveness for condoms for effectiveness of abstinence and failure rate of condoms.