PUBH Chapter 3

Health-related quality of life (HRQOL)

- A broad multidimensional concept that usually includes self-reported measures of physical and mental health - Incorporates a measure of unhealthy days, which are measured by asking a representative sample of individuals the number of days in the last 30 during which their mental or physical health kept them from their usual activities

Risk avoider

- A decision maker who would choose a guaranteed payoff over a lottery with a better expected payoff - When conditions are tolerable

Risk taker

- A decision maker who would choose a lottery over a better guaranteed payoff - When conditions are intolerable

Long-shot effect

- A decision making attitude in which a decision making perceives the status quo as intolerable and is willing to take an action with only a small chance of success and a large chance of making the situation worse - People who are willing to take their chances and "go for it" when the quality of life is bad enough

Death certificate

- A legal document containing vital statistic, disposition, and final medical information pertaining to the deceased - Cause of death information recently added - ICD (International classification of disease) code of morbidity has been used since 1990

Three basic approaches to using health information to make healthcare decisions

- Inform of decision: Clinician has all essential information to make the decision that is in the patient's best interest - Informed consent: Ultimately patients need to give their permission or consent before major interventions (such as surgery, radiation, or chemo) can be taken - Shared decision making: The clinicians job is to provide information to the patient in which he or she can make a decision

Databases

- Integrated health data systems - Can be rapidly and flexibly accessed by computers to address a wide range of questions

Syndromic surveillance 7 S's of quantitative sources of public health surveillance data

- May be able to detect unexpected and subtle changes, such as bioterrorism or new epidemic producing commonly occurring symptoms - Use of symptom patterns (ex. headaches, cough/fever, or gastrointestinal symptoms, plus increased sales of over-the-counter drugs) to raise alert of possible new or increased disease - May be used for early warning even when no disease is diagnosed, does not provide a diagnosis and may have false positives

Population health status measures

- Measurements that summarize the health of populations

Discounting

A quantitative process in which we give greater emphasis or weight to events that are expected to occur in the immediate future compared to events that are expected to occur in the distant future - Most people view the occurrence of a bad outcome as worse if it occurs in the immediate future compared to years from now

Choice node

A square in a decision tree that indicates that a selection needs to be made

Inform of decision

- Implies that the clinician has all the essential information and can make decisions that are in the patient's best interest - Role of the clinician is then to inform the patient of what needs to be done and to prescribe the treatment or write the order - A decision-making approach in which a clinician is merely expected to inform the patient of what is planned

Certainty effect

- In decision making, the greater weight given to definite outcomes than to probabilities - When one wants to guarantee a tolerable level of health

Health adjusted life expectancy (HALE)

- A measure of burden of disease based on life expectancy at birth, but including an adjustment for time spent in poor health - The number of years in full health that a person can expect to live, based on current rates of ill health and mortality - Measurement incorporates key components, including Mobility - the ability to work without assistance Cognition - mental function, including memory Self-care - activities of daily living, including dressing, eating bathing, and use of the toilet Pain - regular pain that limits function Mood - alteration in mood that limits function Sensory organ function - impairment in vision or hearing that impairs function - From these measurements, an overall quality of health score is obtained - Used by the WHO as the standard measures reflecting child health and the overall health of a population

Disability adjusted life year (DALY)

- A measure of burden of disease, one DALY equals one year of healthy life lost due to premature death and time lived with illness, disease or injury - Designed to examine the impacts that specific diseases and risk factors have on population and provide a measure of the population health status - Measurement is usually DALYs per 1000 population in a country - Data on DALYs is divided into the following conditions → communicable disease (maternal, neonatal, and nutritional conditions), noncommunicable diseases, injuries

Quality-adjusted life years (QALYs)

- A measure of how many years of high-quality life a person lives - This is distinct from DALYs, in that a person could have a disability and nonetheless have a high quality of life - Incorporates the decrease or increase in life expectancy as well as the probabilities and utilities of each outcome

Health literacy

- A person's capacity to learn about and understand basic health information and services, and to use these resources to promote one's health and wellness - Refers to the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions

U.S. Census Bureau

- A principal agency of the U.S. Federal Statistical System responsible for producing data about the American people and economy - Naturally born citizen → born in the US - Naturalize citizen → abandoned their citizenship in a different country to get a US citizenship - Resident → "green card residers", have a right to be here, but don't have a citizenship - Useful in establishing the population at risk of the nation or regions or neighborhoods

Utility scale

- A scale that goes from zero to one, with zero reflecting immediate death and one reflecting full health - used to measure the value or importance that an individual or a group places on a particular outcome

Decision analysis

- A set of quantitative decision-making techniques for decision situations in which uncertainty exists - Focuses on three key types of information that need to be combined as the basis for making decisions

Birth certificate

- An official document issued when a baby is born by the Department of Health in the county and state where the baby is born - APGAR score informs the care providers if the child will survive the next five months

Risk-taking attitudes

- Attitudes toward risk greatly influence the choices that we all make in the prevention and treatment of disease - We disagree and differ on our behaviors about the risks we take - Certainty effect, long shot effect, risk takers, and risk avoiders

Single case or small series 7 S's of quantitative sources of public health surveillance data

- Case reports of one or a small number of cases, such as SARS, anthrax, mad cow, disease and new diseases - Alert to new disease or resistant disease; alert to potential spread beyond initial area - Useful for dramatic, unusual conditions; requires alert clinicians and rapid ability to disseminate information

Social media 7 S's of quantitative sources of public health surveillance data

- Detect and monitor course of influenza pandemic - Data on outbreaks using key words from social media - Potential for immediate data obtained from a large number of individuals - Accuracy and precision fo the data for early and ongoing surveillance needs to be established

Surveys and sampling 7 S's of quantitative sources of public health surveillance data

- Drawing conclusions about overall population and subgroups from representative samples, registries attempt to include all of those with a disorder in order to be representative about the population - National Health and Nutrition Examination Surveys (NHANES), Behavioral Risk Factor Surveillance System (BRFSS), also includes disease specific registries (Ex. surveillance, epidemiology, end results (SEER) cancer registry) - Well conducted surveys allow inferences to be drawn about larger populations - Frequent delays in reporting data - Difficult to include all potential patients in disease registries

Three types of effects that influence our perceptions of potential harms and benefits

- Dread effect: Present with hazards that easily produce very visual and feared consequences - Unfamiliarity effect: The degree of familiarity with a potential harm or benefit can influence how we perceive data and translate it for our own situation - Uncontrollability effect: We consider hazards that we perceive as in our control as less threatening than ones we perceive as out of our control

Sentinel monitoring 7 S's of quantitative sources of public health surveillance data

- Early warnings or warning of previously unrecognized events - Influenza monitoring to identify start of an outbreak and changes in virus type - Can be used for "real time" monitoring: requires considerable knowledge of patterns of disease and use of services to develop

Loss framing

- Focus on downside of inaction (or action) - Indicates harm of doing something or avoiding something - Ex. detecting breast cancer early can prolong your life, avoiding/delaying breast screening increases your chances developing a deadly disease

Gain framing

- Framing an event or information in a way that focuses on the positive/what you gain - Indicates benefits of doing something or avoiding something - Ex. Using sunscreen is the surest way to prevent skin cancer, not using sunscreen increases your risk of skin cancer

Health communications

- Methods for collecting, compiling, and presenting health information - Addresses how we percieve, combine, and use information to make decisions - Collecting data: Where does the public health data come from? - Compiling information: How is public health information compiled or put together to measure the health of a population? - Presenting information: How can we evaluate the quality of the display and presentation of public health information? - Perceiving information: What factors affect how we perceive public health information? - Combining information: What types of information need to be combined to make health decisions? - Decision-making: How do we utilize information to make health decisions?

Public health surveillance

- Methods that public health data is collected - The systematic collection, analysis, interpretation, and dissemination of health data to gain knowledge of the pattern of disease occurrence in order to control and prevent disease in the community

Mechanisms of bad decision making

- Optimism bias → letting "personal" information trump "public" knowledge (Ex. you drink and expect to be unimpaired, you believe pain will go away, you will do well in PUBH1001 wile studying less) - Contextual bias → altering decisions according to time, place, person, setting; with whom you are and where you are (Ex. you are worried to go out alone when you think it's unsafe, you take advice of friend's over parents and others) - Choice fatigue → Decision making deteriorating over time (Ex. you eat one more Oreo, given 3+ choices you settle for the "in between" option, oral presentations later in the day get off easier, making choices gets tiring after a while) - Arousal, anger, pride, hunger, frustration, envy: Appearance and circumstances trumps judgement (Ex. you purchase to "please" the seller, you equate "fairness" with "retribution")

Dread effect

- Present with hazards that easily produce very visual and feared consequences - Explains why we fear shark attacks more than drowning - May also be elicited by the potential for catastrophic events, ranging from nuclear meltdowns to a poisoning of water supply

Expected utility

- Probabilities and utilities (both on a scale of 0 to 1) are often combined by multiplying the probability by the utility to obtain a probability that takes into account the utility or what is called "expected utility" - Displayed using decision trees; choice nodes and chance nodes - Sum of the utilities associated with all possible outcomes, weighted by the probability that each outcome will occur

Shared decision making

- The clinician's job is to provide information to the patient in which he or she can make a decision - Can include directly giving information to the patient, providing consultations, or referring patients to sources of information, like the internet - A decision-making approach in which a clinician is expected to directly or indirectly provide information and options for intervention to a patient and then rely on the patient to synthesize the information and make his or her own decision

Unfamiliarity effect

- The degree of familiarity with a potential harm or benefit can influence how we perceive data and translate it for our own situation - Knowing a friend or relative who died of lung cancer may influence how we perceive the information on the hazards of smoking or the presence of radon

National Center for Health Statistics (NCHS)

- The federal agency responsible for collecting and disseminating information on health services utilization and the health status of the population in the United States - National Vital Statistics Reports, National Hospital Discharge Survey, National Ambulatory Medical Care Survey, National Nursing Home Survey, Health Interview Survey, National Health & Nutrition Examination Survey (N-HANES)

Infant mortality rate

- Type of population health status measure - Estimates the rate of death in the first year of life - Has been used as the primary measurement of child health

Under 5 mortality

- Type of population health status measure - The death of a child under 5 years of age - Has become the new standard health status measure used by the World Health Organization (WHO) to summarize the health of children

Life expectancy

- Type of population health status measure - Used to measure the overall death experience of a population - Probability of dying at each year of life - Tells us how well a country is doing in terms of deaths in a particular year

Informed consent

- Ultimately patients need to give their permission or consent before major interventions (such as surgery, radiation, or chemo) can be taken - Implies that individuals have the right to now what will be done, why it will be done, and what the known benefits and harms are - An ethical principle requiring that research participants be told enough to enable them to choose whether they wish to participate

Statistics ("vital statistics") and reportable diseases 7 S's of quantitative sources of public health surveillance data

- Vital statistics: birth, death, marriage, divorce; reporting of key communicable and specially selected noncommunicable diseases - Required by law; birth and deaths key to defining leading causes of disease - Vital statistics are very complete because of social and financial consequences - Reportable diseases often relies on institutional reporting rather than individual clinicians, frequent delays in reporting data

Uncontrolability effect

- We consider hazards that we perceive as in our control as less threatening than ones we perceive as out of our control - Automobile collisions are seen as less hazardous than airplane crashes

Self-reporting 7 S's of quantitative sources of public health surveillance data

- When survey respondents are asked to report their own behaviors or characteristics - May help identify unrecognized or unusual events - Adverse effect monitoring of drugs and vaccines as reported by those affected - Useful when dramatic unusual events closely follow initial use of drug or vaccine - Tends to be incomplete - Difficult to evaluate meaning because of selective process of reporting

SUCESs approach

- focuses on the perception of ideas and identifies six principles of highly successful communications - Simplicity → requires a short, memorable statement that captures the core of its message (Ex. The Back-To-Sleep campaign was able to convey the core of its message in just three words) - Unexpectedness → getting and holding people's attention is achieved by presenting unexpected facts that are counterintuitive at least to your audience - Concreteness → proverbs provide specific examples that can be remembered and generalized (Ex."An apple a day keeps the doctor away" has become a memorable way of conveying the importance of diet in health, bad breath and brown teeth may be more convincing reasons to stop cigarette smoking than the long-term consequences, which are not immediately obvious) - Credibility → relies not so much on numbers but the source of information (Ex. "Today the CDC announced...") - Emotions → connecting with people's emotions is key in getting their attention and ensuring that they will retain the idea - Stories → we remember and relate to stories about real or realistic people (Ex. Sharing "war stories" is an example of how people relate to events in eachother's lives)

Chance node

A circle in a decision tree that indicates that once a decision is made, outcomes occur with known probabilities indicated in the decision tree

Health informatics

Collect → Compile → Analyze → Present → Perceive → Decide → Act Collect...

7 S's of quantitative sources of public health surveillance data

Single case or small series: Alert to new disease or resistant disease; alert to potential spread beyond initial area Statistics ("Vital Statistics") and reportable diseases: Required by law, birth and deaths key to defining leading causes of disease, reportable disease may be helpful in identifying changes over time Surveys (Sampling): Draws conclusions about overall population and subgroups from representative samples, registries to attempt to include all of those with a disease in order to be representative about the population Self-reporting: May help identify recognized or unusual events Sentinel monitoring: Early warnings or warning of previously unrecognized events Syndromic surveillance: May be able to detect unexpected and subtle changes such as bioterrorism or new epidemic producing commonly occurring symptoms Social media: Detect and monitor course of influenza pandemic