UCLA PUBLIC HEALTH Midterm 2
When the reproductive number (Ro) = B*c*d is greater than 1, that means that the infection rate will: A. lead to extinction B. lead to an epidemic C. is at a steady rate
B. lead to an epidemic
T/F: The mortality rates of CVD in high-income and low-income countries are the same.
F, low-income countries have much higher mortality rates of CVD.
There is a direct correlation between low socio-economic status and mortality across the entire population: a. True b. False
b. False
In 15 years the world has _____ the % of people who are 60+
doubled - from 10% to 21%
What is the purpose of Vaccination?
prime the adaptive immune system to the antigens of a particular microbe so a first infection induces a secondary response create herd immunity
Disability-Adjusted Life Year (DALY)
*Years of "healthy" life lost due to: - years living with disability/disease (YLD) - early death (YLL) (Years of Life Lost DALY = YLD + YLL
T/F: The extended parallel process model proposes that people engage in two appraisal processes, whether they are susceptible to the threat and whether the threat is severe.
T.
T/F: The majority of cancers are diagnosed in persons 55 years of age and older.
T.
T/F: The sea level is projected to rise 1- 2 meters by year 2100.
T.
Regardless of the outcome of the next election in the United States, the major components of the Affordable Care Act are unlikely to change dramatically: a. True b. False
a. True
Sentinel surveillance can be used for advocacy to stimulate action: a. True b. False
a. True
Skepticism is one of the core principles of science: a. True b. False
a. True
Surveillance is useful for evaluating the impact of community intervention programs. a. True b. False
a. True
Syphilis is relatively easier to treat than other STIs: a. True b. False
a. True
The new frontier in nutrition research is identifying the interaction of the gut microbiome with different foods: a. True b. False
a. True
The populations of poor countries globally in 2050 is estimated to be 6 times higher than the population of wealthy countries: a. True b. False
a. True
The rapid growth of international travel has promoted spread of infectious diseases: a. True b. False
a. True
The risk of autism spectrum disorder increases as the parents' age at conception increases: a. True b. False
a. True
The very high co-prevalence of schizophrenia in identical twins suggests that genetic factors play a role in risk of the illness: a. True b. False
a. True
Screening is a useful technique to establish the prevalence of a disease in a human population: a. True b. False
b. False
The United States has been at the forefront of the international effort to declare access to clean water as a basic human right: a. True b. False
b. False
The dramatic decline in death rates in the United States from 1900-2000 was primarily due to the development of new drugs and effective vaccines: a. True b. False
b. False
The transmission efficiency of HIV with oral sex is very high: a. True b. False
b. False
Over half of the population of the world currently lives in urban areas True or False?
True
Over 20% of the women in the world will experience physical and/or sexual violence this year: a. True b. False
a. True
Over half of the population of the world currently lives in urban areas: a. True b. False
a. True
Power relationships in the workplace reflect power relationships in society: a. True b. False
a. True
Randomization is a strategy to reduce bias due to variations in individuals: a. True b. False
a. True
Rationing of health care in the United States is due to demand rather than supply: a. True b. False
a. True
What is the most commonly spoken first language in the world?
Mandarin Chinese (12.44%)
OSHA protection is:
Under-utilized by eligible workers & not available in al situations
Where is Cholera still a problem
africa, bangladesh
Calcium Deficiency
osteoporosis
Pattern of Dementia since 2000
rates doubled from 2000-2016. More old people?
Global leading causes of Morbidity based on YLD
Back/Neck pain, other hearing loss, and depressive disorders
The three languages with the most number of first language speakers are: _____ > ______ > ______. (a) Mandarin, English, Spanish (b) English, Spanish, Mandarin (c) Spanish, English, Mandarin (d) Mandarin, Spanish, English
(d)
Why are there systematic differences among groups of workers - i.e. why are workers affected differently? (a) power relations (b) policies (c) 'isms' (d) all of the above (e) none of the above
(d)
correlation coefficient
"r" - must lie between -1 and +1 ( how close to a straight line the data lie) - used to estimate the degree of relationship between two variables
correlation coefficient
"r" - values near -1 or +1 are nearly perfect line (strong relationship between the variables) - values near 0 have no linear relationship, though there may be a non-linear relationship
What is the Incidence equation?
# NEW cases of disease within a given time period --OVER-- # people at risk during that time period (Incidence is a RATE, so needs a time component → if you see time that's the hint that it's incidence)
What is the prevalence equation?
# cases of EXISTING disease at a point in time --OVER--- # people in population at that same time
The highest number of U.S. deaths from behavioral causes is due to: (a) guns (b) drug induced (c) obesity and inactivity (d) smoking
(d), smoking is the #1 cause of preventable deaths.
The physical activity guidelines for children is _____ and adults is _____. (a) 1 hour, 2 hours (b) 2 hours, 1 hour (c) 2 hours, 2.5 hours (d) 1 hour, 2.5 hours
(d), two or more days a week of muscle-strengthening activities should be included.
Lead poisoning was documented in _____. (a) ancient Rome (b) Greece (c) China (d) a and b (e) all of the above
(e)
Life expectancy at birth is: (a) 16.5 years (b) 29.7 years (c) 36.9 years (d) 50.4 years (e) 68.35 years
(e)
Which of the following factors impact mental health? (a) early life (b) family (c) workplace (d) a and b (e) a, b, and c
(e)
Which of the following is the highest attributable risk of death? (a) Unsafe sex (b) elevated blood pressure (c) physical inactivity (d) smoking (e) elevated blood pressure
(e)
Ecologic/Population Health Model
(focuses on environmental factors that affect the population as a whole) -Takes a broader perspective -Examines the relationship between individuals and their interactions with their peer groups, families, communities, schools and workplaces -Examines the broad economic, cultural, social, and physical environmental conditions at local, national, and global levels -Provides a conceptualization of important determinants of health not easily identifiable or rectifiable within the medical model -Healthy communities, which are defined by having the capacity to allow each individual to be health, must address all these components
Medical Model:
(focuses on mortality / effects of diseases / individuals) -Focuses largely on disease and injury and their outcomes -Is built upon a pathophysiologic approach -Is typified by a technology-intensive medical care system that has led to extraordinary medical advances in diagnostics, pharmaceuticals, devices, and procedures -Ranks leading cause of death categorized by organ or by disease type --Diseases of the heart, cancer, or pneumonia -Intrinsically focuses on individuals
How do you calculate PAF?
(proportion of cases exposed) x (attributable proportion in the exposed)
Rural Areas (vs urban)
* less access & poorer quality of health care * higher proportion of elderly * lower spread of diseases (bc of less pop density) - but this also means lower immunity * higher cost of water, electricity, waste disposal
Major Reasons for Increased Longevity (longer life)
*Improved sanitation *Provision of clean water *Universal immunization programs *Health education and prevention practices *Improved treatment and prevention of chronic diseases (for recent advances)
What drives an epidemic?
1. reproductive number 2. transmission probability per contact 3. contact rate/frequency 4. duration of infectiousness 5. available susceptible 6. agent characteristics
What measures helped clear the pollution fog in LA from the 1940s?
1947 LA Air Pollution Control District was established Nation's first air quality regulator 1948 true cause was identified: cars and gasoline 1967 California Air Resources Board formed 1984 Smog checks required, regulations passed on oil refineries and cement plants
What period of time has the highest increase of population? Why?
1950-2000 There was an overall improvement of public health.
world's total fertility rate?
2.46 children born/woman
children are ____ times more likely to die in a poor country than a rich country
20X
% of men that smoke % of women that smoke
24% of men 18% of women
pregnancy related mortality
= death occurring during pregnancy resulted from: - complication of the pregnancy - chain of events that was initiated by the pregnancy - aggravation of unrelated condition by physiologic effects of pregnancy
What is a determinant of health? Be able to provide examples.
A parameter than determines how health a person is EXAMPLES: income, employment, gender, culture, literacy level, geography
Be able to define the prevention paradox and provide an example.
A prevention measure that brings large benefits to the community that requires little effort from each participating individual -Seatbelts, immunization, recycling
According to the IOM report in 1998: Evaluation
A theme that cuts across all these functions (assessment, policy setting, assurance) i.e. How well are they performed?
intervention ladder
A tool in thinking about the different ways in which public health policies affect people's choices. Interventions higher in the ladder are more intrusive and require stronger justification.
Which of the following subtypes of Influenza causes outbreaks/ does not cause outbreaks?
A- Causes Outbreaks B- Causes Outbreaks C- Does Not Cause Outbreaks
How much money is spent on social services per $1 spent on healthcare in the US? A. $0.55 B. $0.75 C. $1.00 D. $2.00
A. $0.55
What was the goal of Healthy People 2000? A. Reduce health disparities among Americans B. Eliminate + reduce health disparities C. Achieve health equity, eliminate disparities, and improve health of all groups D. All of the above
A. Reduce health disparities among Americans
Which country has the shortest wait time for access to a specialist appointment? A. Switzerland B. Germany C. Canada D. US
A. Switzerland
Lowest Life Expectancy by Country (2017)
Afghanistan, Guinea-Bissau, Chad
what countries have the highest % of people under the age of 15
Africa indonesia Saudi Arabia?
Strategies of Public Health (how to help)
Assess the current health situation Identify the problem Research correlates of occurrence Develop and evaluate interventions Disseminate results Influence policy to incorporate results (science-based policy)
According to the IOM report in 1998: What are the Functions Of Public Health
Assessment Policy Setting Assurance
By how many years does the current rate of obesity reduce life expectancy? A. 0.13-0.43 B. 0.33-0.75 C. 0.44-0.82 D. 1-1.2
B. 0.33-0.75
How many prevalent cases of STIs are currently in the US? A. 75 million B. 110 million C. 200 million D. 225 million
B. 110 million prevalent cases of STIs occur right now in the US
How many months should be in between pregnancies to ensure prime health for a woman's body? A. 12-18 months B. 18-24 months C. 24-36 months D. 1.5-2 yrs
B. 18-24 months
What year was Medicare, Medicaid, CHIP, and ACA implemented? A,. All in 1965; 2010 B. 1965; 1965; 1997; 2010 C. 1965; 1997; 1997; 2010 D. All in 1997; 2010
B. 1965; 1965; 1997; 2010
If the current rates of obesity and diabetes continue, by how many years will the life expectancy be reduced? A. 1-3 B. 2-5 C. 3-5 D. 4-5
B. 2-5
Approximately how many people in the US not living in nursing homes/care facilities had a disability? A. 10% B. 20% C. 30% D. 40%
B. 20%
What percentage has the prevalence of adult obesity risen to in LAC in 2015? A. 20% B. 23% C. 28% D. 31%
B. 23%
Which group has the highest prevalence of smoking in LAC 2011? A. 18-24 B. 25-29 C. 30-39 D. 50-59
B. 25-29
By what percentage did hospitalizations increase between 2006-2013? A. 15% B. 30% C. 85% D. 171%
B. 30%
Below what %FDL were the most uninsured people found? A. 400% B. 300% C. 200% D. 100%
B. 300%
When does the fertility for women significantly drop? A. Early 30's B. 35 C. Early 40's D 45
B. 35
What percentage of LA County high school students have used marijuana? A. 25% B. 35% C. 45% D. 55%
B. 35%
What percentage of expenditures for Medicaid were those who used long-term services and supports? A. 25% B. 50% C. 75% D. 80%
B. 50%
How many people are estimated to be living with HIV in LA County? A. 58,000 B. 59,500 C. 60,000 D. 60,500
B. 59,000
When is the HPV vaccine most effective for women? A. Ages 9-11 B. Ages 12-13 C. Ages 14-17 D. Ages 18-26
B. Ages 12-13
What is one of the biggest elder health problems? A. Stroke B. Alzheimer's C. Coronary heart disease D. Type 2 diabetes
B. Alzheimer's
illiterate adults are found in what 8 countries? What fraction of the worlds illiterate adults are found there?
Bangladesh, China, Eqypt, Ethiopia, India, Indonesia, Nigeria, Pakistan - 2/3
Why do we study patterns of disease & distribution?
Because distribution can say a lot about the cause of a health outcome
Biomedical Interventions (vs) Behavioral Interventions
Bio = drugs/vaccines/treatment behavioral = programs - to change behavior
bioinformatics definition
Bioinformatics is the study of the inherent structure of biological information and biological systems. It brings together the avalanche of systematic biological data (e.g. genomes) with the analytic theory and practical tools of mathematics and computer science.
In terms of the world, which is higher, the birth rate or death rate?
Birth rate exceeds the death rate almost 2:1
How often does herpes occur in the population? A. 1 in 4 B. 1 in 5 C. 1 in 6 D. 1 in 7
C. 1 in 6
How many people were newly enrolled in Medicaid after the implementation of the ACA? A. 10.5 million B. 12.5 million C. 14 million D. 20 million
C. 14 million
What percentage of people are uninsured in the non-elderly population? A. 17% B. 18% C. 19% D. 20%
C. 18%
What is the maximum about of employees a company may have before needing to supply HI for its employees? A. 100 B. 150 C. 200 D. 250
C. 200+ employees will require HI
What year did CD4+ T-cell reporting begin? A. 2002 B. 2006 C. 2008 D. 2010
C. 2008
How many levels are mentioned in reducing the overall disease and injury burden? A. 1 (Treating) B. 2 (^ + Reducing) C. 3 (^ + Underlying determinants) D. 4 (^ + Research and application)
C. 3 levels (Treating, Reducing risk factors, underlying determinants)
What percentage of deaths are estimated to be preventable or as a result of health system limitations? A. 15-30% B. 20-40% C. 30-50% D. 40-60%
C. 30-50%
What percentage of women die within 24hrs of ending pregnancy? A. 15% B. 24% C. 34% D. 40%
C. 34%
Approximately how many people in the US identified themselves as belonging to a racial or ethnic minority? A. 30% B. 40% C. 50% D. 60%
C. 50%
What ranking is US in terms of maternal mortality? A. 40/59 B. 45/59 C. 50/59 D. 52/59
C. 50/59
By how much does a child's risk for obseity increase with every additional daily serving of soda? A. 40% B. 50% C. 60% D. 70%
C. 60%
How does California compare to other states in mortality rates and causes?
California has higher death rates for many conditions such as Alzheimer's, diabetes, influenza #2 in the nation for hypertension
The cost of occupational injuries in the United States in the 1990's is exceeded only by the cost of:
Cancer
Which group of diseases were responsible for 17.5 million deaths per year (31% of all deaths) and are the leading causes of death in the world based on 2012 WHO data?
Cardiovascular diseases
Which health problems are projected to increase in the next decade?
Cardiovascular, Cancer, & Road traffic accidents.
Control measures for Infected humans
Chemotherapy, isolation, quarantine, restriction of activities, and behavioral change
What are problems with Children and Lead?
Children are particularly vulnerable to environmental exposures Danger of lead found in both paint and gasoline Negative effect on child brain development
How does children's health relate to environmental exposure?
Children breathe more air, eat more food than adults, so even low levels of toxic exposure can impact development Behaviors such as playing on the floor and putting hands and objects on their mouths can increase the risk of environmental exposure Minority children and children in poverty have higher rates of environmental exposure Fetal period can be affected by air pollution; low birth weight and other congenital abnormalities can be observed
Of the 10 most polluted cities in the world, 6 of them are in what country?
China
What is the most populous country?
China
Most Populated Countries
China India USA Indonesia Brazil Pakistan
What is the 2 most populous religion in the world?
Christianity (31%) and Islam (23%)
What is the difference between clinical ethics and public health ethics?
Clinical Ethics - Focus on individual patient-provider interactions Individual liberty, autonomy - Authority vested in prestige of physicians and medical professionals - Patient consent - Beneficence and non-maleficence - Justice Public Health Ethics -Focus on populations, institutions, communities -Interdependence of people -Authority vested in the police powers of states -Societal consent through the political process; public engagement -Social good and avoiding social harm -Social justice and equity
Pros and cons of a cross-sectional study design
Cons: Limited by no regard for duration of disease or exposure, cannot measure disease risk Weaker than the other two types of observational studies, Pros: inexpensive and convenient and can be used for exploratory purposes Also must know exposure came before disease
Control measures applied to the agent
Control of some infectious disease can be achieved through means that remove the infectious agents from the environment or inactivate the agents Physical+chemical measures
What is the demographic transition?
Corresponds to reductions in fertility and increases in survival Countries/regions entering the demographic population drives population aging
Which of the following is not a reason maternal mortality is increasing? A. Delayed childbearing (older at more risk) B. Increased prevalence of chronic conditions (also related to age) C. Increased the range to be considered as maternal mortality by a year D. More women are drinking alcohol after to cope with the depression
D.
What are the differences between HSV-1 and HSV-2? A. 1 is more around genitals and doesn't reoccur B. 2 is more around the mouth and doesn't reoccur C. 1 is more around mouth and high reoccurrence D. 2 is more around genitals and high reoccurrence
D. 2 is around genitals with high reoccurrence (1 is around mouth and doesn't reoccur)
What is the cutoff of BMI to be considered as obese? A. 15 B. 20 C. 25 D. 30
D. 30
Built environment
Design of cities and local streets shape ability to incorporate walking into our daily lives and defines sense of community and safety Safe homes and buildings reduce injury and toxic exposure Public transport enhances accessibility, reduces stress, promotes physical activity Parks and recreation focal points for communities, encourage physical activity
Secondary Prevention
Detecting problem an and treating it before serious harm
Modes of Infection for infectious disease
Direct=Direct Contact, Droplet spread Indirect=Airborne, Vehicleborne, Vectorborne
Compromised mental heath is best measured by....?
Disability Adjusted Life Year (DALY)
What is a DALY?
Disability- Adjusted life year. It is 1 year of healthy life lost.
T/F: Reducing blood lead levels by 5 ug/dL raises IQ by 2.6 points and the economic value of an IQ point is around $15,000.
F, reducing blood lead levels by 10 ug/dL raises IQ by 2.6 points.
What's wrong with Downey?
Don't drink the water! - Coliform Bacteria in city water supply
US Drug Overdose Death Rates by Age+Gender:
Drug overdose has risen most sharply for males; females have increased as well although not by as much middle class overdosing the most
What health-related states is epidemiology investigating?
Epidemic communicable diseases Endemic communicable diseases and non-communicable diseases Chronic diseases, injuries, birth defects, maternal-child health, occupational, environmental health Behaviors related to health and well-being and genetic markers of disease risk
Obesity rates in the United States are lowest among...
European-Americans
The objective of public health is to guarantee the health of all, regardless of ethnicity, religion, gender, sexual orientation, country, or political views: a. True b. False
False
What is the peak month for influenza?
February (nearly 50% of cases) - January 20%
A major source of lead for low-income children is
Flaking paint from old buildings painted years ago
What is Environmental Health and its function?
Focuses on the relationship between people and their environment Promotes human health + well being Fosters healthy and safe communities Reducing chemical exposures in air, water, and food
Be able to summarize some main takeaways from the White paper on Family Leave and Health.
Gaps in current laws on paid sick and family leave contribute to health inequities beginning early in life and have significant implications for other disparities among children. Inadequate access to paid leave adds significant costs to Minnesota employers' health care expenses and adds to the costs of publicly funded health care programs. Research supports increasing access to paid leave to improve health and income, reduce inequities and disparities starting in childhood, and reduce disease outbreaks.
What is considered as the most effective ingredient to a successful behavioral intervention?
Framing the issue
Quantifying Distribution
Frequency and pattern
Mortality Rate
Frequency of occurrence of death in a defined population during a specified interval Denominator is commonly the size of the population @ the middle of a time period
What was the Capillariasis Case Study
Goal of investigation was to confirm etiology (cause) of outbreak and ultimately stop it Direct vs. indirect transmission Distribution of multiple/single cases in households Attack rate and case fatality rate higher in men 10-59 for initial cases Geographic distribution different for initial vs. subsequent cases
What is a reservoir of infection?
Habitat in which an infectious agent normally lives, grows, and multiplys
Screening test sensitivity
How good is the test at identifying all those without disease and therefore being to identify only those who actually have the disease (i.e. more specific = fewer false positives)
Lead exposure and health effects
How? 1. Inhalation of particles released by industry or recycling 2. Ingestion (esp. for children) a. In some traditional medicines or cosmetics 3. Food or water 4. Lead-containing products What happens: - mimics calcium --> enters bones - mimics magnesium --> crosses blood-brain barrier - damages kidneys which try to filter it out
What are the Three reservoir types?
Humans- STDs, measles, mumps, strep, smallpox Carrier=Person with no apparent infection Animals- transmitted from animal to animal, humans can be incidental hosts Zoonosis- infectious disease transmissible under natural conditions from vertebrate animals to humans; Anthrax(sheep), plague(rodents) Environment- fungal agents live and multiply in soil; Legionnaires disease Earthquakes shake up sediment and cause particles to fly
Incidence vs Prevalence
I = Specified time Period - a span of time P = Single point in time
what country has the longest longevity among males?
Iceland
What is the dilemma between clinical ethics and PH ethics?
In many instances, the best interests of the population or community are at odds with the preferences of some members of the community
Incidence is like a ______ Prevalence is like a ______
Incidence ~ Speedometer Prevalence ~ Odometer
Overall trend of Global disease Burden by Income
Income of country is strongly correlated with rate of disease burden Communicable disease DALYs correlated with income; Non-communicable disease DALYS less strongly correlated with income
Diabetes global prevalence from 2000-2016
Increasing: killed < 1 million in 2000, and killed 1.6 million in 2016
Which one of the following characteristics is the MOST definitive of malignancy compared to benign tumors?
Invasion and metastasis
what is the top cause of death globally?
Ischemic heart disease
Top 3 Causes of Mortality in High-Income Countries
Ischemic heart disease Stroke Alzheimer's and other dementias
Know the difference between leading causes of death (diseases such as heart diseases and cancer) and actual causes of disease and death (such as tobacco use, poor diet and physical inactivity, alcohol consumption, etc.).
Leading Causes - what causes the decrease in health and eventual death -heart disease, cancer Actual Causes - what initiates the disease -tobacco use, poor diet, alcoholism, drug abuse
What is the epidemiological pattern of Oropharyngeal cancers (OPCs)
OPCs: on the rise and 80% in North America and Europe are HPV driven
What is Population Attributable Fraction (PAF)?
PAF= the proportional reduction in death or disease that would occur if exposure to a risk were removed or maximally reduced to an alternative level
Behavioral Interventions
PROGRAMS that help people change their behaviors to prevent and manage disease
Define the working poor.
People who spend 27 weeks or more in a year in "labor force" either working or looking for work but whose incomes fall below the poverty level
what is a very important determinant of healthcare?
Poverty. It makes the difference between healthcare, healthy food, exercise, etc.
What are the positive changes regarding aging?
Rates of severe disability have declined in high-income countries over the past 30 years
what is epidemic driven by?
Reproductive number, availability of susceptible of individuals transmissions,
Mortality
Risk of death
What is the number 1 cause of preventable deaths?
SMOKING
where are poor sanitation and hunger primarily concentrated?
Saharan Africa South Asia
Memorize the definition of public health covered in lecture.
Science and art of preventing disease, prolonging life, and promoting health and efficiency through organized community efforts to ensure every individual in the community has a standard of living adequate for the maintenance of health
The following characteristics should be evaluated in assessing quality of surveillance:
Sensitivity, Flexibility
Can statistics tell us anything about individuals?
Since variation from person to person is ubiquitous, statistics cannot make a prediction about an individual, rather provide probabilities among populations (bigger picture)
Who does the ACA provide subsidies to?
Sliding scale up to 400% poverty level
Incubation/Latent Period of infectious disease
Stage of subclinical disease extending from the time of exposure to the onset of disease symptoms Also referred to as the latency period for chronic disease
According to the World Health Organization (WHO), what is the definition of health?
State of complete physical, mental, and social well-being and not merely the absence of disease or infirmity
How does the US rate on healthcare spending per capita among OECD countries?
The US spends 16.6% of GDP on healthcare, where the next highest spender is Switzerland at 11.4% US spends more on healthcare per capita than any other affluent country Average healthcare spending per capita for Americans is ~$10,000
The epidemiologist investigating an outbreak establishes a hypothesis regarding the disease in the order of:
The probability of the hypothesis being correct commensurate with the observed characteristics of the health problem under investigation
What does descriptive epidemiology cover?
Time- Displaying patterns of disease occurrence by time is critical for monitoring and assessing the need for interventions Place-Displaying patterns of disease occurrence by place provides insight into the extent and the geographic variation of a condition Person- Personal characteristics that affect illness; age and sex are most analyzed person attributes
Key elements of surveillance include
Timely anaylsis Dissemination of Results Action based results
Role of governmental public health
To create an environment where everyone has the capacity to be healthy and live a full and fulfilling life To accomplish this governmental public health is required to perform 10 essential services Services are based on 3 core functions
Where is the largest urban population?
Tokyo
US Death Rates by Race+Ethnicity:
Top 3=Black men+women and White men non-Hispanic white men and non-Hispanic white females saw the most significant increase Overall age-adjusted death rate increased as well
basic principles of cost containment
Total Revenue = Total Expenditures = Total Income T + R + C = P x Q = W x Z T = taxes R = private insurance premiums C = direct charges to patients P = average price of health care services Q = quantity of health care services provided W = average wage Z = total inputs used (labor and capital) i.e. If we cut taxes, we either have to cut prices or services provided to deal with reduced revenue i.e. If revenue is reduced, either wage or inputs (e.g. employment) will have to be cut
Which of the following mental disorders is projected to be the second most frequent cause of disability adjusted life years globally by 2020?
Unipolar major depression
What is hypothesis testing?
Using probability to test how likely the null hypothesis is (probability of an event occuring by chance)
Focus Group structure:
Usually consisting of small group of respondents guided by a skilled moderator to explore key issues and norms
What nutritional deficiency can cause blindness?
Vitamin A deficiency
Which of the following has the highest proportion of Americans whose usual intake is below recommended levels?
Vitamin D
Measure of Mortality and Morbidity
YLD - Years Lost to Disability (# of incident cases) x (avg. duration of disease) x (disease weight factor)
YLL
Years of life lost (# deaths times standard life expectancy at age of death)
YLD
Years of life lost due to disability. Measure of morbidity.
The top cause of death among African-American males aged 15-24 years is: a. Homicide b. Suicide c. Heart disease d. Cancer e. Diabetes
a Homocide
epidemiology is:
a methodology and the core strategy of public health
prevalence
a proportion used in epidemiology. The number of cases existing in a given population at a single point in time over the population at that time
The risk of ischemic heart disease is highest in: a. Males b. Females
a. Males
Which of the countries below spends the highest percent of GDP on health care and has the lowest percent of the population older than 65 years? a. United States b. Spain c. Italy d. United Kingdom e. Japan
a. United States
What is "Statistics"?
the art and science of making decisions in the face of uncertainty
T/F: Epidemic curves plot number of new cases (incidence) by the time.
T.
T/F: Global climate shapes diet choices and vice versa.
T.
T/F: Infection with the Zika virus has no treatment and causes microcephaly and neurologic damage.
T.
T/F: Mental disorders cause more disability than cancer and HIV.
T.
T/F: No countries have sufficiently reduced adult obesity rates.
T.
T/F: Surveillance systems recognize what is optimal versus what is feasible for the specific culture.
T.
T/F: The U.S. spends the most accumulative money on healthcare but is not ranked in terms of quality.
T.
What is the Transtheoretic Model of Change?
assesses an individuals readiness to act on a new healthier behavior
Most logical interventions are successful and don't need to be evaluated. a. True b. False
b False
Health span as opposed to life span is defined by: a. Age b. Function c. Philosophy d. Attitude
b. Function
Which of the following has the highest number of global NCD deaths? (a) cancers (b) diabetes (c) cardiovascular disease (d) digestive diseases
(b)
_____ is the leading cost of occupational injuries. (a) occupational injuries (b) cancer (c) COPD (d) AIDS
(b)
In what country(s) does every $1 spent on healthcare services equal $2 spent on social services? A. Japan B. Switzerland C. OECD D. US
C. OECD
Education of the mother affects all but which of the following? A. Poverty levels B. Life expectancy C. Life expectancy of infants D. All of the above
D. All of the above
T/F: Men are at a higher risk of developing Alzheimer's disease than women and autism spectrum disorder.
F, women are at a higher risk of developing Alzheimer's disease than men.
Increasing health literacy can be considered as one of the outcomes of health protection. True or false?
FALSE.
The Environmental Protection Agency initiated more law suits under: a. William (Bill) Clinton b. George Bush c. Hilary Clinton d. Donald Trump
a. William (Bill) Clinton
The most recent epidemic confronting public health is: a. Zika b. MERS c. Ebola d. Measles e. Cholera
a. Zika
What is Vectorborne spread for infection of infectious disease?
spread by vectors such as mosquitoes, flies, ticks, fleas
What is Vehicleborne spread for infection of infectious disease?
spread through food, water, blood, container
What is an emerging disease?
things we have not seen before (e.g. Zika, SARS, MERS)
emerging diseases
things we have not seen prior ex: Zika, SARS, MERS
A high proportion of the homeless in Los Angeles suffer from: a. Autistm b. Bipolar disorder c. Schizophrenia d. Catatonia e. Seasonal depressive disorder
c. Schizophrenia
Which mental disorder is characterized by confused thinking, hallucinations, and unusual perceptions and changes in social relationships? a. Severe depression b. Anxiety disorder c. Schizophrenia d. Substance abuse e. Bipolar disorders
c. Schizophrenia
The most commonly used study design for conducting surveillance is: a. Cohort b. Cross-sectional survey c. Serial cross-sectional surveys d. Ecologic e. Nested case-control
c. Serial cross-sectional surveys
case-control design
can be used to determine if there are differences in the proportion of cases and non-cases who received the intervention program
What are common air pollutants measured?
carbon monoxide (CO), nitrogen dioxide (NO2), super dioxide (SO2), ozone (O3)
What are Determinants in epidemiology?
causes and other factors that influence the occurrence of disease and other health-related events
survey instruments should be designed to make it possible to:
check for inaccuracies, and to correct for non-responce and missing values
Proportion
comparison of a part to a whole, calculated by (# of subjects with a particular characteristic) / (total # of subjects of which the numerator is a subset)
what assumptions are made when detecting correlation?
constant probability and independence
Environmental control for controlling vector borne spread of disease
constructing areas in a way where vector populations cannot flourish
Benefits of breast milk
- sterile - tailored to needs of baby's developmental state - brain, visual & digestive development - attachment - "lactational amenorrhea" - suppresses ovulation (prevents pregnancy)
What happens to the WORLD's "sex ratio" as people age?
-gender ratio at birth is not 1:1 (1.07M/1F) -15-64 years = still slight excess of males -65+ = about a quarter of males died off
how many illiterate adults are there in the world?
793 million
what % of the WORLDS population is 65+?
8%
What is the anticipated population for 2030, 2050, and 2100?
8.6 billion, 9.9 billion, 11.2 billion.
Which of the following is not a protective factor for MMR? A. Parity B. Prenatal care C. Education D. Marriage
A. Parity
To what factor are most health improvement due? A. Policy/Laws B. Collective mindset change C. Newly discovered severe consequences D. Improved technology for treatment
A. Policy/Laws
Which country has the highest percentage of women who do cervical screenings? A. US B. UK C. Japan D. Canada
A. US
How do most cases of genital herpes present themselves? A. Unrecognized B. Mouth Sores C. Genital warts D. Genital discharge
A. Unrecognized
Prevalence is ______, while incidence is a ______. (a) rate, rate (b) ratio, rate (c) rate, ratio (d) ratio, ratio
(b), prevalence is measured at a single point in time and incidence is measured over a period of time.
Health promotions consists of: (a) surveillance, dissemination, awareness (b) health education, prevention, laws (c) health education, prevention, health protection (d) all of the above (e) none of the above
(c)
Medical care is considered a ______ prevention, while health screenings are considered a ______ prevention. (a) primary, secondary (b) secondary, tertiary (c) tertiary, secondary (d) secondary, primary (e) none of the above
(c)
Mental health expenditures range from U.S. _____ to ______ per capita. (a) $0.10 to $21.41 (b) $0.15 to $33.45 (c) $0.20 to $44.81 (d) $0.25 to $55.32
(c)
The major cause of poor health globally is: (a) tobacco (b) lack of exercise (c) poverty (d) environmental problems (e) poor diet
(c)
The prevalence of cancer-related death in men occurs: ______ > _______ > _______. (a) lung, colon, prostate (b) colon, prostate, lung (c) lung, prostate, colon (d) prostate, colon, lung (e) prostate, lung, colon
(c)
The prevalence of cancer-related death in women occurs: ______ > _______ > _______. (a) lung, colon, breast (b) colon, breast, lung (c) lung, breast, colon (d) breast, colon, lung (e) breast, lung, colon
(c)
Prevalence
# of cases in a single point in time/ population at that time period
Incidence
# of cases in a time period/ population at risk in that time period
Control measures for Animal-borne infection
(Vector borne transmission) Active immunization, restriction or reduction,and chemoprophylaxis and chemotherapy
The #1 cause of death in ages 15-24 is: (a) unintentional injuries (b) homicide (c) suicide (d) cancer (e) heart disease
(a)
The number of deaths caused by NCDs is: (a) increasing (b) decreasing (c) stabilizing
(a)
The number one cause of death in low-income countries is: (a) lower respiratory infections (b) diarrheal diseases (c) HIV/AIDS (d) ischaemic heart disease (e) malaria
(a)
The three types of interventions are: (a) biomedical, behavioral, structural (b) medical, psychological, spiritual (c) health education, prevention, health protection (d) none of the above (e) b and c
(a)
The world's population of >60 years old is: (a) increasing (b) decreasing (c) stabilizing
(a) This is due to the advancements of technology and medicine.
Hospitals, laboratories, clinics, and physicians are part of the _______ surveillance system. (a) active (b) passive (c) none of the above
(b)
Inadequate levels of physical activity are associated with _____ in annual health care costs. (a) 117-147 million (b) 117-147 billion (c) 557-867 million (d) 557-867 billion (e) none of the above
(b)
Surveillance is measured in ______ and screening is conducted in ______. (a) populations, populations (b) populations, individuals (c) individuals, individuals (d) individuals, populations
(b)
The percent of those in a workforce union is ______. (a) 5.7% (b) 11.1% (c) 20.1% (b) 40.7%
(b)
The probability one will develop cancer for males is ______ and ______ for females. (a) 25%, 25% (b) 25%, 33% (c) 33%, 33% (d) 33%, 50% (e) 50%, 50%
(b)
The rate of breastfeeding at six months in the U.S. is about ______. (a) 25% (b) 50% (c) 75% (d) 100%
(b)
What is the median age? (a) 16.5 years (b) 29.7 years (c) 36.9 years (d) 40.4 years (e) 68.35 years
(b)
The word population by religion is as follows: ______ > ______ > ______. (a) no religion affiliation, Christians, Muslims (b) Chrisitians, no religion afiiliation, Muslims (c) Christians, Muslims, no religion affiliation (d) Muslims, Christians, no religion affiliation (e) none of the above
(c)
Type _____ diabetes results from the body's ineffective use of insulin and type _____ diabetes is characterized by a lack of insulin production; type ______ is gestational diabetes. (a) 1, 2, 3 (b), 2, 3, 1 (c) 2, 1, 3 (d), 3, 2, 1
(c)
_____ has the highest rates of mental health; _____ has the highest prevalence of MH/SA disorders. (a) Iceland, Japan (b) U.S., New Zealand (c) New Zealand, U.S. (d) Iraq, Switzerland
(c)
For surveillance, one wants to find a ______ sample; for the reservoir, one wants to find ______. (a) representative, representative (b) infected, infected (c) infected, representative (d) representative, infected
(d)
Life expectancy at birth is highest among men in _____ and women in _____. (a) Iceland, Iceland (b) Switzerland, Spain (c) New Zealand, U.S. (d) Iceland, Japan (e) none of the above
(d)
The Zika virus is a ______ and the vector is the ______. (a) adenovirus, Horse fly (b) flavivirus, Horse fly (c) adenovirus, Aedes mosquito (d) flavivirus, Aedes mosquito
(d)
The global cost of mental health conditions is $2.5 ______. (a) thousand (b) million (c) billion (d) trillion
(d)
The number one cause of death in high-income countries is: (a) lower respiratory infections (b) diarrheal diseases (c) HIV/AIDS (d) ischaemic heart disease (e) malaria
(d)
The power dynamics influencing working conditions consists of: (a) workers (b) government (c) employers (d) all of the above (e) none of the above
(d)
The top three causes of deaths world-wide are: _____ > _____ > ______. (a) ischaemic heart disease, lower respiratory infections, stroke and other cerebrovascular disease (b) stroke and other cerebrovascular disease, ischaemic heart disease, lower respiratory infections (c) lower respiratory infections, ischaemic heart disease, stroke and other cerebrovascular disease (d) ischaemic heart disease, stroke and other cerebrovascular disease, lower respiratory infections (e) none of the above
(d)
_____ have contributed to the majority of work-related insurance claims. (a) fatal injuries (b) non-fatal injuries (c) fatal illnesses (d) non-fatal illnesses
(d)
Acheson Report said that the definition of public health are what (3) things?
*The science and art of preventing disease *Prolonging life *Promoting health through the organized efforts of society.
Correlation coefficient: -1; 0 and +1
+1/-1 = nearly a perfect line 0 = no linear relationship ( but there may be a non-linear relationship)
what are some methods for ebola prevention?
- community engagement: case finding, case management, surveillance, contact tracing - isolation of patients in maximum containment facilities - maximum protective apparel for caregivers (sufficient?) - quarantine of contacts - gamma globulin from survivors (?)
Tuskegee syphilis study and it's impact on ethical research regulation
- At the start of the study, penicillin was not available to treat syphilis. However, when it was established to be a good treatment, penicillin was withheld from the group and information about treatment of syphilis was withheld as well - Leak to the press stopped the study in 1979, established Belmont Report after
What are some impacts of poor water and sanitation?
- Causes 88% of diarrhea cases; 1.5 million deaths annually - high infant mortality due to dehydration resulting from diarrhea - no access to improved water - 884 million (13% of the global population)
Melamine-contaminated baby formula
- China
Why are privacy and confidentiality the issues and what are the recommendations to solve them?
- Data collection is a fundamental activity of public health practice - Public health has a duty both to act on evidence it collects and to protect data confidentiality - These duties, which sometimes come into tension, play out against a backdrop of information technology advances and complicated privacy laws - The ethical challenge in this area is often to find ways to use data innovatively to address disease burden, while ensuring privacy and protecting confidentiality
How does the US rate on health outcomes among other OECD countries?
- Infant mortality is higher in the US than in comparable countries - Highest mortality amenable to healthcare in 2014 - When people who shouldn't have died based on available healthcare did due to lack of quick access 18% of people readmitted to hospital or went to ER from complications during recovery, 1% higher than NETH and CAN, but 7% higher than the next highest country - Highest breast cancer five-year relative survival rate - Highest cervical cancer screening rates by 7%
How has the public insurance landscape changed since 2016? (since Trump Administration)
- Marketplace enrollment down by 4% in 2019 - Medicaid waivers requiring proof of work - Legalization of short-term policies not meeting ACA's mandated benefit requirements (policies cheaper) - Supporting efforts by attorneys in Republican-controlled states to repeal the ACA
Big Data analysis of Facebook "likes"
- Facebook "likes" predicted individual's gender, race, sexual orientation and excessive drinking - banks must report detailed statistics about their actual lending acuity to regulators but a lender exclude borrowers of a certain race by making online offers only to people who's social network activities fit certain patterns - by not formally rejecting certain borrowers, those who engage in online discrimination could sidestep fair lending laws
Public Option
- Get to keep employer health insurance if you want or give to gov if you don't like - Supported by Joe Biden, Pete Buttigieg, and Amy Klobuchar
Epidemiology of HPV
- Most common STI: about 12% of women globally being infected at any given time and most people infected at some point in their lives - More common in developing world - Highest prevalence for individuals in 20s-early 30s
What is the role of the biostatistician in assessment?
- deciding what information to collect - identifying patterns in collected data - summarizing the characteristics of the population and associated problems - judging the situation
What are some early and mid life influences of aging?
- birth weight - education - physical activity and other health behaviors effects degree to which enter late life with cognitive and physical reserves
What was the result of "Infant Mortality: Genesse County"
- Programs to Reduce Infant Deaths effectively (PRIDE) - community-based public health used to identify contributing factors - 3 areas emerges as important underlying determinants of infant mortality
What knowledge gaps do qualitative research fill?
- Provides a deeper understanding of the issues including social and cultural factors influencing behavior. - Concerns context transferability.
Single-payer system
- Run by gov, everyone has the same insurance, covers everything - Employees pay gov over private insurance - Private insurance companies would no longer exist - Supported by Bernie Sanders and Elizabeth Warren
Hep A
- San Diego's homeless
life expectancy is increasing in developed countries, developing countries, or both?
- both
Vitamin B12 plays a key role in
- brain & CNS development -red blood cell formation -immune function
How does the US rate on healthcare wait times among OECD countries?
- US had 42% of respondents to a questionnaire respond yes to cost-related access problems in the past year, highest of any country Australia came in second with 30% - Cost-related access barriers for all adults in the US. 43% low income adults face a barrier, 32% all other adults Wait times in the US are longer for primary care but shorter for specialty care
Ebola outbreak
- West Africa
Cholera
- Yemen
psychological or individual-level determinants of population health measurements
- age - sex - education - religion - language
Disease characteristics
- agent = what causes disease (ex: virus, bacteria, fungus) - host = who gets disease (based on immune status, nutritional status, age) - environment = where they get disease (based on climate, sanitation, population density)
individual-level Health Behaviors of population health measurements
- alcohol use - poverty - domestic violence
what are the 3 functions of public health? describe them.
- assessment = identify public health problems and quantify them/ evaluate potential impact - policy-setting = prioritize problems and evaluate potential solutions - assurance = implement policy and evaluate effectiveness
examples of positives of aging
- declines in addictive behaviors and crime, reduction in severe psychiatric disorders, and stability in psychological wellbeing - continuing increases in vocabulary - greater selectivity in friendship and increased contact with close family - increases in leisure time and altruistic behavior
examples of negatives of aging
- decreased reaction time, psychomotor speed, and verbal memory - declines in strength and walking speed - loss of skeletal muscle - greater mortality
In terms of the Role of Biostatistics in "Assessment" - it may be necessary to...
- design general surveys of the population needs - plan experiements in estimating the extent of health problems and associated risk factors
ex of how responding to disasters and assisting communities in recovery promotes healthy aging
- develop and implement response strategies that address unique concerns of older adults
ex of how ensuring the quality and accessibility of health services promotes healthy aging
- development of quality indicators - training medical professionals about aging
Social or population-level determinants of population health measurements
- economic - urbanization - sanitation and drinking water - food security - prisoners - utilities - electricity & telephone
Youth engagement in Boston: Sociedad Latina
- empower latino youth and their families - tobacco use a major community problem - in 2004, petitioned boston city council to pass laws that would (increase merchant fees, strengthen enforcement laws and regulate advertising of tobacco products)
The strategy of using predictive models to reduce threats of emerging and re-emerging infectious diseases is based on what?
- epidemiologic data - climate change surveillance - human behavior
What is the role of the public health professional?
- establish surveillance for unusual diseases & drug resistant agents - assure laboratory capacity to investigate new agents - develop plans for handling outbreaks of unknown agents - inform physicians about responsible antimicrobial use - promote vaccination
what does hypothesis test evaluate?
- evaluates whether data that diverges from the null hypothesis is likely due to chance or due to an actual association
What is the value of promoting physical activity in late life?
- exercise training (Especially aerobic) increases cognitive function, even for people with dementia and related cognitive impairments - can promote physical function and reduce risk of falling
ex of how preventing injuries promotes healthy aging
- fall prevention programs - wander prevention programs for dementia - interventions to reduce motor vehicle crashes among older adults
population determinants
- fertility rates (overall global decline, global rate) - mortality rates (infant mortality rate, maternal mortality rate) - life expectancy (over time and region, sex, race) - immigration and emigration migration (internal migration urbanization)
Microarrays. What can they tell us?
- gene expression patterns (when tissue samples are compared) - diagnosis, prognosis, treatment
Capillariasis case study
- goal of investigation was to confirm etiology (cause) of outbreak and ultimately stop it - attack rate and case fatality rate was higher in men 10-59 for initial cases - ultimately confirmed agent (C. philippinenesis) but not mode of transmission
Public health
- health of individual best assured by maintaining and improving the health of the community - science and art of preventing disease, prolonging life, and promoting health through organized efforts of society - mobilizing resources to assure the conditions in which all people can be healthy
ageism
- healthcare leads to misconception of sexual activity - doctor attributes symptoms to aging rather than disease - risk of both under and over treatment
How can global surveillance be improved?
- improve diagnostic capacity (training, regulations) - improve communication systems (web, e-mail, etc.) and sharing of surveillance data - rapid data analysis - develop innovative surveillance and analysis strategies - utilize geographical information systems - utilize global positioning systems - Utilize the Global Atlas of Infectious Diseases (WHO) - Increase and improve laboratory capacity - coordinate human and animal surveillance
How can use of vaccines be improved?
- increase coverage and availability (Ex: oral) - new strategies for delivery (Ex: nasal spray administration) - develop new vaccines - decrease cost - improve storage requirements and ease of administration - develop and implement more effective compliance strategies
what are benefits of physical fitness in later life?
- increases cognitive function - reduces risk of falling
ex of how preventing epidemics and the spread of disease promotes healthy aging
- influenza immunization - screen for chronic diseases
Epidemiology
- it is a strategy, a way of studying a health problem NOT a body of knowledge - factors which determine frequencies and distributions of an disease in population - to control health problems
What are essential factors for disease eradication?
- knowledge of its epidemiology and transmission patterns/mode - availability of effective tools for diagnosis, treatment and prevention - knowledge of local cultural and political characteristics - community acceptance and mobilization - political will and leadership - adequate and sustained funding
how does ageism play out in health care?
- lack of geriatricians (bc low pay) - lack of representation in clinical trials - attributing symptoms to aging instead of disease, less likely to treat it - risk of both under-treatment and over treatment - ex: misconceptions about older adults' sexual activity leading to increased cases of HIB
predicting the occurance of "events" - large groups of people - specific individuals
- large - we can make quite accurate statements about the probability - individual (cant do this) uncertain/unpredictable
High Fertility Rate and education
- negative correlation - education costs money & loses money (loses workers)
What causes re-emergence of infectious disease?
- old bugs infecting new hosts - drug resistance - vector resistance to pesticides - immune supression - changes in disease surveillance - illiteracy - lack of political will - bioterrorism/ war - famine
Measles outbreak
- originating at Disneyland - cause: under vaccination of the population - impact: outbreak across many states - what has been done: new policy for vaccination in CA (no more "personal belief exemptions")
How do age stereotypes effect public health?
- perceiving aging as a primarily negative process seems to lead to worse outcomes - ageism in health care setting - less frequent preventative health behaviors occur when you have negative expectations about aging - exposure to negative age stereotypes is a direct stressor with impact on cardiovascular responses
What are problems rural areas face compared to urban?
- poorer health - less access to health care - poorer quality of health care - higher proportion of elderly, due to industrialization and migration of young workers to urban areas - slower epidemic potential (population density), but lower rates of immunity - higher cost of providing services; ex: water, electricity, waste disposal
what do physicians understand by medical informatics?
- practitioners will look up Best Practices on-line - Hospital Infosystems will be available 24x7 through the Internet - Clinicians will receive new research information directly relevant to their practice - physicians will routinely use computer facilitated diagnostic & therapeutic algorithms - physicians will manage similar patient problems using computer facilitated tools
what is the focus of public health informatics?
- prevention - the health of populations
ex of how promoting and encouraging health saviors and mental health promotes healthy aging
- promote engagement - enhance chronic disease and self-management
Zika
- rapid geographic distributions across western hemisphere - transmitted by mosquitoes and sexual activity -cause microcephaly and Guillain-Barre syndrome - response is increasing reporting capacity and risk communication
ex of how protecting against environmental hazards promotes healthy aging
- recognize/reduce of risks in homes - develop age friendly communities that promote physical activity
What is an epidemic driven by?
- reproductive number - availability of susceptible individuals - transmission probability per contact - morality rate
what are some factors that determine the spread of epidemics?
- reproductive number - transmission probability - contact rate/ frequency - duration of infectiousness - available susceptible - agent characteristics
what are some CDC individual level actions by health practitioners to reduce maternal and infant mortality and promote the health of all childbearing-aged women at preconception/interconception visits?
- screening for preexisting chronic conditions and health risks - counseling about contraception and access to effective family planning to prevent unintended pregnancy and unnecessary abortion - counseling about good nutrition including iron, folic acid - advise re: regular exercise, ETOH, smoking, drugs
What are some positive outcomes of more positive age-beliefs?
- social engagement - likelihood and timing of cardiovascular events - recovery from heart attack - longevity - functional health - memory - hearing
When trying to reduce the threat of emerging and re-emerging infectious disease, what are the priorities that should be established?
- the risk of disease - the magnitude of disease burden (based on morbidity/disability, mortality, and economic cost)
disease descriptors
- time = does this disease follow any temporal pattern? how has occurrence changed over time? - place = where is this disease happening? where is it not happening? - person = who gets this disease? who doesn't?
what factors lead to emergence/re-emergecne of diseases?
- urbanization and habitat encroachment - economic development - social inequality/poverty - globalization - evolution of agents (Resistance, virulence) - lack of resources (Ex: no funding available from governments or no surveillance or laboratory systems in place) - global warming (especially significant for vector-borne diseases as habitats expand with temperature increases) - human behaviors (ex: medical interventions in host that affect vulnerability to infectious agents) - illiteracy and thus difficulty in communicating risk to public - humanitarian crises (famine, war, civil unrest), usually drive people whose health is already vulnerable together which create conditions for transmission of disease and breakdown of human services
Role of Biostatistics in: Assurance & Evaluation
- use sampling and estimation methods to study the factors related to compliance and outcome - decide if improvement is dues to compliance or something else, how best to measure compliance, and how to increase the compliance level in the target population - take into acct possible inaccuracy in responses and measurements, both intentional and unintentional
what has helped decrease maternal mortality?
- vaccination - motor vehicle safety - safer workplaces - control of infectious diseases - decrease in deaths from CAD and stroke - healthier moms and babies - family planning - fluoridation of water - identification of tobacco as a health hazard and success of smoking cessation public health campaign
Factors of Ecologic/Population Health Model
--Biologic factors: genetic characteristics, lipid levels --Individual behaviors: physical activity, diet, tobacco use --Social, family and community networks: social support, social capital, intact families, schools --Living and working conditions: employment/living wage, income, educational attainment, healthy homes, walkable communities, transportation systems --Broad social, econ, cultural, health, and env conditions/policies at the global, national, state and local levels: climate change, medical care system, air pollution, discrimination and stigma, war, terrorism, natural disaster, agricultural policy
Capillariasis: Evidence in favor of "indirect" transmission
-Age-sex distribution of initial cases -disease associated with occupation -close to the sea - less density of cases the further you are from the coast
Capillariasis: Evidence in favor of "direct" transmission
-Age-sex distribution of subsequent cases -Distribution of cases within multiple case households -Intervals between household cases suggesting sequential infection -Distribution of involved households within the barrio -Effect of treatment on the spread of the epidemic
Behavioral Interventiosn for HIV
-Behaviorally targeted structural interventions -consort intervention reporting domains -evidence based interventions
Understand John Snow's role in epidemiology.
-British physician -leader in adopting anesthesia and medical hygiene -work in tracing source of cholera outbreak in Soho, London -inspired changes in other cities and improvement in world public health
Examples of Community Engagement
-Infant Mortality: Genesse County - Tobacco Control Initiatives in the US - Youth engagement in Boston: Sociedad Latina - Health Research Center: Northern Ghana - Motor Cycle Helmets
Chlamydia and gonorrhea
-LA
Ecologic studies
-correlations/trends -unit of analysis is a population rather than an individual -no information available about the individual members of the populations compared -can be carried out easily, quickly and inexpensively using data that are generally already available
1. What were some of the major reasons behind the enormous gains in health in the 19th and 20th centuries?
-Sanitation movement curbed the most burdensome infectious diseases by: --Eliminating some human disease vectors --Developing effective sewage systems --Requiring pasteurized milk, safer foods, safer drinking water --Enforcing tougher safety standards for homes and worksites -Life expectancy grew by average of 0.3 years annually throughout 20th century -food and leisure became plentiful = chronic diseases became the new frontier of public health
Case-Control Study
-compares the prevalence of suspected causal factors between individuals with disease and controls who do not have the disease -can identify associations, they do not measure risk -hypoth is necessary - relatively cheep
Role of Biostatistics in: Assessment
-decide which information to gather - find patterns in collected data - make the best summary description of the population and associated problems
Cross-Sectional Survey
-establish the frequency of disease and other factors in a community -require the collection of data - can be expensive -co-occurance of disease in pop & individuals
Cohort studies
-follow defined groups of people without disease to identify risk factors associated with disease occurrence
What is public health nutrition?
-quantity/quality of food - excessive/inadequate intake of food - food related problems - nutrition problems & identifying risk factors - global warming
T/F: The social cognitive theory asserts that the following factors affect if a person will change a health behaviors: reciprocal determinism, behavioral capability, expectations, etc.
T.
What is public health?
-the health of the individual best assured by maintaining and improving the health of the community -The science and art of preventing disease, prolonging life, and promoting health through organized efforts of society - mobilizing resources to assure the conditions in which all people can be healthy
Artemisinin-resistant malaria
...
Barker Hypothesis
...
Evidence Based Interventions
...
obesity/ diabetes epidemic
...
Capilleria Philippinensis Evidence in favor of INDIRECT transmission
1) Age-sex distribution of "initial" cases 2) Association of disease with occupation 3) Proximity of cases to the sea 4) Decreasing density of cases with distance from coast
Capilleria Philippinensis Evidence in favor of DIRECT transmission
1) Age-sex distribution of subsequent cases 2) Distribution of cases within multiple case households 3) Intervals between household cases suggesting sequential infection 4) Distribution of involved households within the barrio 5) Effect of treatment on the spread of the epidemic
Health is a state of equilibrium betweenn
1) Agent 2) Host 3) Environment
Disease Characteristics
1) Agent -- virus, bacteria, parasite 2) Host -- genetic profile, immune capacity, poverty, nutritional state 3) Environment -- biologic and chemical pollution, climate change, deforestation
Largest countries in terms of population size
1) China 2) India 3) USA 4) Indonesia
most common religions
1) Christianity 2) Muslim
A "statistical model" for the event "dying from lung cancer" relies on what 2 assumptions?
1) Common Distribution - the probability that an event occurs is the same for all members of the group 2) Independence - a given person experiencing the event does not affect whether others do
Uses of Epidemiology
1) Community Diagnosis 2) Establishing the history of a disease in a pop 3) desc. the natural hist. of disease in the individual 4) Desc. the clinical picture of disease 5) estimating risk 6) identify syndromes & procedures 7) evaulating prevention/intervention programs 8) investigating epidemics/diseases of unknown etiology
What are the five Public health framework criteria proposed by Lawrence Gostin?
1) Demonstrate risk 2) Demonstrate Effectiveness 3) Assess Economic Cost 4) Assess Burden on Human Rights 5) Assess Fairness of Intervention (Those with greatest need should have a claim)
Epidemiology - Study Types:
1) Ecologic 2) Cross-sectional 3) Case-Control 4) Cohort 5) Experimental 6) Meta-Analysis
What does the Belmont report establish?
1) Ethical Principles and Guidelines for Research Involving Human Subjects 2) Boundaries Between Practice and Research 3) Applications in informed consent, assessment of research risk and benefits, and selection of research subjects
The cross-sectional study design is used in two special types of studies
1) Field studies - investigations of acute outbreaks, which require immediate attention 2) Surveillance - monitoring of disease or health-related factors over time (uses cross-sec surveys to do this)
What are some limitations of using qualitative research methods?
1) Highly dependent on interviewer skill - requires intensive training 2) Small sample size + limited representativeness → cannot generalize 3) Data collection and analysis takes a long time 4) Underutilized as a technique
Epidemiology -- study types redux:
1) Incidence Studies 2) Incidence Case-ControlInitial cases Gender ratio (M:F) = 7:1 Percentage of males aged 10-59 = 79% Close to sea Subsequent cases Gender ratio (M:F) = 1:1 Age distribution = same as population Even geographic distribution 3) Prevalence Studies 4) Prevalence Case-Control
What are the four characteristics that provide much of the subject matter for public health ethics?
1) It is a public or collective good 2) Its promotion involves a particular focus on prevention 3) Its promotion often entails government action 4) It involves an intrinsic outcome-orientation
Nutrition deficiency syndromes and conditions
1) Kwashiorkor - protein deficiency; mainly in young children 2) Marasmus - total energy depletion
outcomes of overnutrition
1) Obesity 2) Diabetes II 3) High Cholesterol & Triglycerides 4) Risk factor for Cardiovascular Disease
What are 4Ps of Public Health Ethics?
1) Principles: Rules, norms and values relevant to PH 2) Problems: recurrent ethical challenges in PH 3) Procedures: Systematic approaches to address ethical dilemmas 4) Practice: upstream ethics-in-all-policies approach to decision making
What "behavior patterns" cause the most deaths in the US
1) Smoking 2) Obesity & Inactivity
US Federal Nutrition Assistance Programs
1) Special Supplemental nutrition program for women, infants and children (WIC) 2) Supplemental Nutrition Assistance Program (SNAP)
Components of the Influenza Virus
1) Surface Glycoproteins 2) 15 Hemagglutinin (H1-H15) 3) 9 neurominidases (N1-N9)
Disease Descriptors
1) Time 2) Place 3) Person
When is it appropriate to use quantitative research?
1) Used when you need to calculate numerical indicators or estimates of population 2) Can only be used once important categories are known and we want to understand the relative distributions within those categories
When would we use qualitative research instead of quantitative?
1) When seeking a richer picture of individual motives, decisions or practices. 2) When we want to understand existing categories that help define an area of investigation
Leading causes of death: Low-Income Countries
1) pneumonia 2) heart disease 3) diarrhoea 4) HIV/AIDS 5) stroke
Leading Causes of Death: High-Income/Developed Countries
1)heart disease, followed by stroke, lung cancer, pneumonia and asthma or bronchitis
assumptions of typical statistical models
1. Common probability distribution: Probability that an event occurs is the same for all the members of the group 2. Independence of observations: A given person experiencing the event does not affect the probability of another person experiencing the event (independence)
Uses of Epidemiology
1. Community diagnosis 2. establishing the history of a disease in a population 3. describing the natural history of disease in the individual 4. describing the clinical picture of disease 5. estimating risk 6. identifying syndromes and precursors 7. evaluating prevention/intervention programs 8. investigating epidemics/diseases of unknown etiology 9. assessing the cost-effectiveness of interventions 10. assessing strategies to translate science to action ("implementation science")
What are the top 3 causes of deaths world wide in order from first to third?
1. Ischaemic heart disease 2. stroke and other cerebrovascular disease 3. lower respiratory infections
10 essential services:
1. Monitor health status to identify and solve community health problems 2. Diagnose and investigate health problems and health hazards in the community 3. Inform, educate, and empower people about health issues 4. Mobilize community partnerships to identify and solve health problems 5. Develop policies and plans that support individual and community health efforts 6. Enforce laws and regulations that protect health and ensure safety 7. Link people to needed personal health services and assure the provision of health care when otherwise unavailable 8. Assure a competent public and personal healthcare workforce 9. Evaluate effectiveness, accessibility, and quality of personal and population based health services 10. Research for new insights and innovative solutions to health problems -Assessment: -Monitor health -Diagnose & Investigate -Policy Development: -Inform, educate, & empower -Mobilize community partnerships -Develop policies -Assurance: -Enforce laws -Link to/provide care -Assure competent workforce -Evaluate -Research
portals of entry/exit of infectious agents (route of entry and exit not necessarily the same for a single agent)
1. Respiratory - influenza, common cold agents, measles 2. genitourinary - sexually transmitted agents 3. alimentary track (gut) - cholera, salmonella 4. skin 5. percutaneous (vector born diseases) - arboviruses 6. eye 7. transplacental - HIV
Strategies of public health:
1. asses the current health situation (surveys, surveillance, morbidity and mortality reporting) 2. identify the problem 3. research correlates of occurrence 4. develop, implement, and evaluate interventions 5. disseminate results 6. influence policy to incorporate results (science-based policy)
What are the functions of public health?
1. assessment 2. policy setting 3. assurance (and constant evaluation)
What are some strategies to reduce threats of emerging and reemerging infectious diseases?
1. develop political will and funding 2. improve global early response capacity 3. improve global surveillance 4. use of vaccines 5. new drug development 6. decrease inappropriate drug use 7. improve vector and zoonotic control 8. better and more widespread health education 9. development of predictive models 10. establish priorities 11. reduce potential for rapid spread 12. develop more feasible control strategies 13. develop new intervention strategies requiring low-cost technology 14. social and political mobilization of communities 15. greater support for research 16. reduce poverty and inequality
dependent population represents what fraction of the worlds population
1/3 of the worlds population are dependents
what fraction of the WORLDS population is under 14 years old?
1/4
What are important strategies research centers should use for successful community engagement
1. identifying and understanding structure of local authorities and decision-making 2. using strategies familiar to community 3. ensuring that tangible benefits flow from research to the community 4. planning, flexibility, and funding
Global Public Health Information Network (GPHIN)
1. info gathered from many media sources 2. hundreds of articles selected daily using established search criteria 3. these selected articles are further filtered and sorted automatically 4. GPHIN analysts review all filtered articles for subject relevancy
Microbial Threats
1. newly recognized agents 2. mutation of zoonotic agents that cause human disease 3. resurgence of endemic diseases 4. persisting diseases 5. development of drug-resistant agents 6. recognition of etiologic role in chronic diseases 7. use of infectious agents for terrorism and warfare
What are some ways public health promotes healthy aging?
1. prevent epidemics and the spread of disease 2. protect against environmental hazards 3. prevent injuries 4. promote and encourage healthy behaviors and mental health 5. respond to disasters and assist communities in recovery 6. ensure the quality and accessibility of health services
what are prevention strategies for falls in each of the 3 public health prevention categories?
1. primary - promote physical activity, reduce polypharmacy, universal housing design (for all older adults) 2. secondary - strength training, environmental modifications (for at-risk older adults) 3. Tertiary - counseling to decrease fear of falling, improve primary care ID/treatment of falls, social support interventions
what are the 3 categories of public health prevention strategies?
1. primary = prevent problem from happening (Ex: immunizations) 2. secondary - detect problem early and treat before serious harm results (Ex: blood pressure or breast cancer screening) 3. tertiary = after a health problem has happened, maximize independence & quality of life (ex: rehab, in-home supportive services)
Model of probability of an "event" (ex: dying from lung cancer) relies on what 2 assumption?
1. the probability that an event occurs is the same for all members of the group (common distribution) 2. a given person experiencing the event does not affect whether others do (independence)
what fraction of the population of africa has aids?
1/3
what % of the worlds population is living on less than $1.25 per day?
17%
Mass index (BMI) is given by the following: below _____ is underweight, below ______ is normal, below _____ is overweight and above ______ is obese.
18.5, 25, 30, 30
what is the WORLDS median age?
28 years old
How many americans do not have Health Insurance?
30 million
% of smokers that earn wages below the poverty line
31%
In 2012, ____ million deaths were to due to Non-Communicable Diseases ( NCDs) in the world, accounting for ____ overall deaths globally:
38,67, .9
the human brain grows in size until what age?
4 years of age
The human brain grows in size until:
4 years of age.
education expenditures
4.4% of GDP
What is the worlds total infant mortality rate?
41.61 deaths/ 1,000 live births
# of smoking deaths per year
446,000/year
Suicide rates are highest among women in which age group?
46-65 years old
When should you start adding in solid foods to a child's diet?
5-6 months
what % of 60+ have 2 or more chronic conditions ( that require long term care)?
50%
cholera vaccine only has and efficacy of __%
60%
Suicide rates are highest among men in which age group?
75+ years old
Life expectancy at birth of males compared to females
76 vs 81
T/F: The theory of planned behaviors asserts that behavior changes requites adoption of a positive behavior in place of a negative one.
T.
Poor water sanitation causes what % of diarrhea cases?
88%
How many people do not have access to "improved water"
884 million 13% of the worlds population
DALYS
= Disability-Adjusted Life Years. One DALY can be thought of as one lost year of "healthy" life
indirect maternal death
= death of mother not directly due to ob cause, but resulting from previously existing disease, or a disease that developed during pregnancy, labor or puerperium, but which was aggravated by maternal physiological adaptation to pregnancy
nonmaternal death
= death of mother resulting from accidental or incidental causes not related to pregnancy
direct maternal death
= death of mother resulting from ob complications of pregnancy, labor or puerperium, and from intervention, omissions, incorrect treatment, or a chain of events resulting from any of these factors
healthcare disparities
= differences in access to or availability pr facilities and services
health disparities
= differences in the incidence, prevalence, mortality, and burden of diseases and other adverse health conditions that exist among specific population groups in the U.S. observed differences could be due to: - true biologic differences because of genetic background - variations in environmental exposures, lifestyle, cultural factors - access to care and specific treatments once care has been accessed
T/F: addiction to prescription medication exceeds illicit drug use.
T.
DALY
= disability-adjust life year = 1 year of healthy life lost - useful for measuring the burden of diseases that don't necessarily kill you, but prevent a person from living a "healthy" life ex: arthritis, depression, blindness
GBD
= global burden of disease
The function of assessment in public health
= identify problems related to the public's health, and measure their extent -biostatiscians decide which info to gather, find patterns in collected data, and make the best summary description of the population and associated problems - biostatisticians may design general surveys of the population needs, plan experiments to supplement these surveys, and assist scientists in estimating the extent of health problems and associated risk factors
healthy aging
= maximizes functioning and well-being across lifespan
maternal mortality ratio
= number of maternal deaths that result from the reproductive process/ 100,000 livebirths
independence
= one occurrence of the event of interest does not affect the event's probability
The function of policy setting in public health
= prioritize problems, find possible solutions, set regulations to achieve change, and predict effect on the population - biostatisticians develop mathematical tools to measure the problems, prioritize the problems, quantify associations of risk factors with disease, predict the effect of policy changes, and estimate costs (including monetary and undesirable side effects of preventive and curative measures)
The function of assurance in public health
= provide services as determined by policy, and monitor compliance - biostatisticians use sampling and estimation methods to study the factors related to compliance and outcome - biostatisticians decide if improvement is due to compliance or something else, how best to measure compliance, and how to increase the compliance level in the target population - biostatisticians take into account possible inaccuracy in responses and measurements, both intentional and unintentional
population aging
= shift in the age distribution of the population toward older ages - increases in the percentages of the population reaching old age - change in population's distribution across age groups - changes in ratios of older to young population
biostatistics
= statistics as applied to the life and health sciences
demography
= study and measurement of population change
epidemiology
= study of distribution and determinants of health-related state and events in specified populations, and the application to control health problems - strategy for studying factors related to etiology, prevention, and control of disease; to promote health, effectively allocate efforts/resources - the method we use to study health problems in populations and the CORE of public health - looks at distribution of health outcomes and why they are like that how they can make it more equally distributed
statistics definition
= the art and science of making decisions in the face of uncertainty
Epidemiology definition
= 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 in a human community. NOT A BODY OF KNOWLEDGE. CORE SCIENCE OF PUBLIC HEALTH because it is the method/strategy of studying disease/health in human populations
constant probability
= the probability of the event is consistent across the population
demography definition
= the study of populations, especially with reference to size and density, fertility, mortality, growth, age, distribution, migration, vital statistics and the interaction of these with social and economic conditions
healthy aging definition
= to balance prevention of disease and injury with promotion of behaviors and environments in a way that MAXIMIZES FUNCTIONING AND WELL-BEING ACROSS THE LIFE SPAN - not negative - limit morbidity/ chronic or debilitating conditions
health status disparities
= variation in rates of disease occurrence and disabilities between socioeconomic and/or geographically defined population groups
aging definition
= what changes over time - adult development
T/F: cardiovascular disease is responsible for between 50% and 80% of deaths in people with diabetes.
T.
At what income level does the life expectancy essentially not depend on income anymore? (i.e. the minimum income for the max life expectancy at birth) A. $60,000+ B. $75,000+ C. $90,000 D. $150,000+
A. $60,000
What percentage of women die within the first year? A. 11% B. 23% C. 34% D. 55%
A. 11%
Which age group of women have the highest prevalence of chlamydia? A. 14-19 B. 20-24 C. 25-29 D. 30-34
A. 14-19
What percentage of the uninsured non-elderly are children? A. 16% B. 25% C. 51% D. 59%
A. 16%
When was health insurance first implemented? (Not including worker's comp) A,. 1929 B. 1945 C. 1970 D. 1997
A. 1929
What percentage of Californians live in Los Angeles County? A. 26% B. 31% C. 38% D. 41%
A. 26%
Approximately how many people in the US identify as LGBTQ+? A. 4% B. 8% C. 12% D. 16%
A. 4%
How many premature deaths are a result of the health impacts of air pollution? A. 6,500 B. 9,000 C. 1,300,000 D. 1,700,000
A. 6,500
Women of which ethnicity develop breasts at the earliest age? A. African American B. Hispanics C. Asians D. Caucasians
A. African Americans
Women of which ethnicity have the lowest pre-natal care rates? A. African Americans B. Caucasians C. Hispanics D. Asians
A. African Americans
What are the (3) core functions that define public health? A. Assessment, Policy Development. Assurance B. Community Health, Local Health, International health C. Local communities, Education, Policy Development D. Assessment, Maintenance, Criticisms
A. Assessment, Policy Development, and Assurance
What became the #1 cause of death in the US in 2014? A. Cancer B. Heart disease C. Chronic lower respiratory disease D. Cerebrovascular disease
A. Cancer
Which cause of death has been steadily increasing since 1973 in China? A. Cerebro-cardiovascular disease B. Cancer C. Chronic obstructive pulmonary disease D. Injuries
A. Cerobro-cardiovascular
What tests for STI should be done annually on sexually active females younger than 25? A. Chlamydia and gonorrhea B. Chlamydia and herpes C. Herpes and PAP smears D. Gonorrhea and herpes
A. Chlamydia and gonorrhea
Which of the following is the #1 leading cause of death and premature death in LA County? A. Coronary heart disease B. Diabetes C. Stroke D. Lung cancer
A. Coronary heart disease
What disease topped all other diseases in the SEARO and WPRO regions in 2004, accounting for 4.8% of all DALYS worldwide due to both infectious and non-infectious diseases? A. Diarrheal B. Tuberculosis C. Cardiovascular D. Cancer
A. Diarrheal
Which disease is the 3rd leading cause of mortality and morbidity after lower respiratory infections and cardiovascular diseases? A. Diarrheal B. Tuberculosis C. Liver D. Cancer
A. Diarrheal
What new people qualified for Medicare in 1972 and 2001, respectively? A. Disabled individuals who qualify for SS benefits, and end-stage renal patients; ALS patients B. Children of the primarily insured individuals; grandchildren C. Individuals 65+ with no significant other; their immediate family D. Disabled individuals who qualify for SS benefits, and terminally ill patients; ALS patients
A. Disabled individuals who qualify for SS benefits, and end-stage renal patients; ALS patients
What type of deaths now exceed motor vehicle mortality in the US? A. Drug abuse B. Cancer C. Homicide D. Suicide
A. Drug abuse
Where do the richest quintile of 65+ people receive most of their income? A. Earnings B. Social Security C. Assests D. Pensions
A. Earnings
What outbreak happened recently in the US that required Obama to increase the response rate since fatality was close to 100%? A. Ebola B. MRSA C. West Nile D. HIV
A. Ebola outbreak
From largest to smallest percentage of HI coverage, what kind plays the largest role? A. Employer > Medicare > Medicaid > Private B. Medicare > Employer > Medicaid > Private C. Private > Medicare > Medicaid > Employer D. Medicare > Medicaid > Private > Employer
A. Employer > Medicare > Medicaid > Private
By what is endometriosis affected? A. Estrogen B. Luteinizing hormone C. Access to health services D. Presence of fibroids
A. Estrogen
Which gender is more likely to be obese? Overweight? A. Females; Males B. Female; Female C. Males; Males D. Males; Females
A. Females; Males
What is the most common gynecology tumor in women of reproductive age? A. Fibroids B. Cysts C. Benign masses D. Scar tissue
A. Fibroids
Which country is most likely to have same-day or next-day appointments? A. Germany B. Canada C. Netherlands D. Norway
A. Germany
What type of STI case increased the most? A. HPV B. Chlamydia C. Gonorrhea D. Syphillis
A. HPV has the most number of new cases
What is the difference between healthcare disparities and health status disparities? A. Healthcare is access/availability of facilities and service; status if the variation in rates of disease occurrence and SES groups B. Healthcare is the variation in rates of disease and SES; status is access to or availability of facilities and services
A. Healthcare is access to or availability of facilities and services; status is rate of diseases and SES group differences
Which of the following one of the leading causes of premature death? A. Homocide B. Pneumonia C. Colorectal cancer D. Hypertension
A. Homocide
Where is most of the money spent on healthcare going? A. Hospitals B. Clinics C. Drugs D. Dental
A. Hospitals
When do factors start affecting a woman's health during pregnancy? A. In utero B. Infancy C. Puberty D. Fertilization
A. In utero
Which of the following resources were not mentioned by Detel's definition of public health? A. Individual B. Local C. State/Provincial D. National/International
A. Individual
Which of the following is one of the leading causes of death in LA County? A. Liver disease B. Suicide C. Breast Cancer D. Drug overdose
A. Liver disease
What is the difference between Medicare A and Medicare B? A,. Medicare A is not optional, and if you receive a payroll, you pay into it; Medicare B is optional and accessible for 65+ if they pay a monthly premium B. Medicare B is not optional, and if you receive a payroll, you pay into it; Medicare A is optional and accessible for 65+ if they pay a monthly premium C. Both are essentially the same except that part B was determined to include disabled individuals and those with end-stage renal disease patients D. Both A and B require payments into the system, but you can access more healthcare benefits after 75+ with part B
A. Medicare A is not optional, and if you receive a payroll, you pay into it; Medicare B is optional and accessible for 65+ if they pay a monthly premium
What service has had the largest reduction in the uninsured after its implementation? A. Medicare and Medicaid B. Affordable Care Act C. CHIP D. Private insurance
A. Medicare and Medicaid
Which of the following is not one the the criteria for creating and maintaining a healthy community? A. Meets basic needs of children B. Provides quality and sustainable environment C. Promotes health D. Maintains adequate levels of economic and social development E. Fosters social relationships that are supportive and respectful
A. Meets basic needs of children (Should be basic needs of all)
What does the acronym PAGA mean? A. Public Assistance Guidelines for Americans B. Physical Activity Guidelines for Americans C. Pediatric Guidelines for Americans D. Physical Addiction Guidelines for Americans
B. Physical Activity Guidelines for Americans
Which of the following does not count as one of the criteria for meeting PAGA? A. Vigorous activity for 20+ min, >3days/wk B. Moderate Activity for 30+ min >5days/wk C. Light Activity for 40+ min >6days/wk D. A combination of vigorous and moderate activity meeting time criteria for >5days/wk
C. Light activity does not exist
What is one of the most important tasks for providing quality and sustainable environments? A. Clean air, soil, and water B. Tobacco and smoke free C. Preserve natural and open spaces D. All of the above
D. All of the above
Where are common secondary locations for syphilis symptoms to appear? A. Trunk B. Hands/Feet C. Mucus patches on mouth and anus D. All of the above
D. All of the above
Which of the following is one of the (10) great public health achievements since 1990? A. Identification of tobacco as a health hazard B. Success of smoking cessation public health campaign C. Decrease in deaths from CAD and stroke D. All of the above
D. All of the above
Which of the following is one of the (10) great public health achievements since 1990? A. Safer workplaces B. Healthier moms and babies C. Family planning D. Flouridation of water E. All of the above are acheievements
E. All of the above are achievements
Sexual Behavior change
Abstinence, delaying age of intercourse, restricting frequency of sexual activity, limiting number of sexual partners
T/F: The transtheoretical model of change is viewed as a progression of three stages - e.g. precontemplation.
F, there are five stages.
What are some effects of girls who experience early maturation? which population is most at risk?
African American girls have a trend towards early maturation - Girls with earlier maturation are at risk for lower self esteem, and higher rates of depression. Morel likely to be influenced by older peers and more deviant peers, and initiate intercourse, substance use, and other norm breaking behaviors at younger ages. - Impact on adult women who matured early includes greater rates of depression, lower levels of academic achievement and greater number of sexual partners - Biologic impact of earlier maturation includes greater risk of several cancers including breast, ovarian, and endometrial CAa, increased risk for obesity, diabetes, and hypertension - appear to age rapidly ("weathering")
What are disease characteristics and what do they mean?
Agent - What causes diseases (virus, bacteria, fungus) Host - Who gets disease (immune status, age) Environment - where they got the disease from?
What is aging versus healthy aging?
Aging=accumulation of molecular+cellular damage (non-linear) Healthy aging= defined as the process of developing and maintaining the functional ability that enables well-being in older age
LA trends of Air pollution
Air is a lot cleaner than it was before as we see a steady decrease in smog levels Levels are still concerning and may even be on the rise
What is the difference between airborne transmission and droplet transmission?
Airborne transmission can occur at a further range than droplet transmission
Causal Pies: what are they for and what do they tell us?
Alternative model for disease causation Each piece of the pie is an individual factor that contributes to cause a disease Sufficient cause: disease can occur if this cause is present but disease can also occur if this cause is absent Necessary cause- a component cause that appears in every pie; the disease cannot happen without it
Be able to list many of the Ten Essential Benefits that private health insurance must provide as part of the Affordable Care Act (ACA).
Ambulatory patient services Emergency services Hospitalization Maternity and newborn care Mental health and substance use disorder services Prescription drugs Rehabilitative and habitative services and devices Laboratory services Preventive and wellness services and chronic disease management Pediatric services w/oral and vision care
What are the implications of America's percent GDP spending on health verse percent population age 65+
America percentage of spending GDP on health is way higher than other countries, yet the percentage of population age 65+ is way lower...
What programs was launched in 2007 that was essentially in charge of meeting the basic needs of all? A. CHIP B. PLACE C. ACA D. PAGE
B. PLACE
What was the purpose of Part C addition to Medicare coverage? A. Prescription drug benefits B. Paying monthly premium to healthcare organizations C. Allowing ALS patients to have coverage D. Allowing pre-existing condition patients to have coverage
B. Paying monthly premium to health care organizations
What is one result of people living in countries marked by sprawling development? A. People walk more in their leisure time because of unattainable health ideals B. People are more like to have high blood pressure C. People are more likely to be obese D. People are likely to have lower body mass indexes
B. People are more likely to have high blood pressure
Know the three functions of public health.
Assessment -Monitor health -Diagnose and investigate Policy Development -Inform, educate, and empower -Mobilize community partnerships -Develop policies Assurance -Enforce laws -Provide care -Assure competent work force -Evaluate
3 core functions of Public Health:
Assessment: ability to conduct public health surveillance to measure the health of the population and determinants, investigate health problems and identify causes Policy development: ability to inform leaders and the general population about health, to develop policy solutions and mobilize support Assurance: ability to ensure the health of the population by having a competent workforce to enforce laws, to have medical care available to all, to evaluate progress as part of a virtuous cycle of quality improvement (plan/do/study/act)
According to the IOM report in 1998: The mission of public health is defined as?
Assuring the conditions in which the people can be healthy
What was the purpose of the ACA? A. To implement a program that covers some of the "holes" left in the current insurance system B. A law that expands some of the access to the current system C. Giving control of health insurance coverage over to individual states D. Decrease private health insurance markets so allow more government assistance
B. A law that expands some of the access to the current system
What ethnicity has the highest rate of reported cases of gonorrhea? A. Hispanics B. Blacks C. Multirace D. Asian
B. Blacks have the highest rate of reported cases in the US
Women of which ethnicity have the lowest birth rates? A. African Americans B. Caucasians C. Hispanics D. Asians
B. Caucasians
What population does CHIP serve? A. Children over 19 who are orphaned B. Children less than 19 with families above Medicaid eligibilities C. Children between 0-14 with families above Medicaid eligibilities D. Children between 19-24 who do not qualify for dependent or independent status
B. Children younger than 19 with families above Medicaid eligibitilies
What is one way to shut down a law without needing the majority vote for repeals? A. The president can veto the law B. Congress can vote to stop funding the programs C. The house can vote to repeal the law instead D. Popular vote can repeal a law
B. Congress can defund a programs thereby essentially killing it
Where did the West Nile virus epidemic begin in the US? A. Southeast B. East Coast C. West Coast D. Northwest
B. East coast
When was the prescription drug benefit added to Medicare terms, and what part was it? A. Effective in 2003, Part D B. Effective in 2006, Part D C. Effective in 1997, Part C D. Revised in 2003, Part C
B. Effective in 2006; Part D
What was the goal of Healthy People 2010? A. Reduce health disparities among Americans B. Eliminate + reduce health disparities C. Achieve health equity, eliminate disparities, and improve health of all groups D. All of the above
B. Eliminate + reduce health disparities
What event lead to a large increase in cigarette consumption in the US? A. Great Depression B. End of WWII C. Beginning of advertisements D. End of the Great Depression
B. End of WWII
What cause of death has decreased the most in LAC since 2009? A. Coronary heart disease B. HIV/AIDS C. Homicide D. Lung cancer
B. HIV/AIDS
What STI rates can be lowered by circumcision? A. HSV-1 and HPV B. HSV-2 and HPV C. HPV and syphilis D. HSV-1 and HSV-2
B. HSV-2 and HPV
What was the most common opioid prescribed between 2007-2012? A. Oxycodone B. Hydrocodon C. Codeine D. Opioid
B. Hydrocodone
What is not one of the top (10) accomplishments of public health during the 20th century? A. Recognizing tobacco use is harmful B. Increasing funding for children's healthcare C. Developing motor-vehicle safety policies D. Improving health for mothers and babies
B. Increasing funding for children's health
What is the second most common chronic disease that comes after cancer? A. Diabetes B. Mental Disorders C. Heart disease D. Hypertension
B. Mental disorder
Which areas in California have seen increases in the west nile virus? A. LA and OC B. OC and San Fernando C. LA and SGV D. SF and Norcal
B. OC and San Fernando
How many deaths were due to Ebola through Sept. 2014? A. Over 1,000 B. Over 2,000 C. Over 3,000 D. Over 4,000
B. Over 2,000
What was not a major element of the ACA? A. Mandates to prevent cost-shifting and "free rider" from opting out on insurance until necessary B. Providing children under 19 who have families above Medicaid requirements from accessing healthcare C. Subsidies to make insurance more affordable to low and middle income families and expansion of Medicaid D. Insurance market reforms that prevent private insurers from avoiding "high-risk" members
B. Providing children under 19 who have families above Medicaid requirements from accessing healthcare
Which of the following is not one of the major public health responsibilities? A. Preventing and controlling disease B. Reducing healthcare costs C. Promoting good health D. Protecting health with safe and healthy environments
B. Reducing healthcare costs
Where do the poorest quintile of 65+ people receive most of their income? A. Earnings B. Social Security C. Assets D. Pensions
B. Social Security
Which country has the highest rate of new cases of HPV transmission at 1000/day? A. Australia B. South Africa C. US
B. South Africa has about 1000 cases/day (Australia is ~1000/year and US is ~1000/week)
What time periods does the WHO advocate that women should visit providers for care? A. The 4 rule (4 hrs, days, weeks, and months) B. The 6 rule (6 hrs, days, weeks, and months) C. The 8 rule (8 hrs, days, weeks, and months) D. The 12 rule (12hrs, days, weeks, and months)
B. The 6 rule (6hrs, days, weeks, and months)
Why are cases for syphilis so much higher in men? A. Men are less likely to notice primary symptoms B. Men participate in the "MWM" subset C. Treatment is more effective for women D. Men are more likely to report cases
B. The core group of men having sex with men are undergoing an epidemic
What is the single most preventable cause of death at 10 million annual deaths by 2030? A. Diabetes B. Tobacco C. Coronary heart disease D. Suicide
B. Tobacco
Which ethnicity is growing at the fastest rate in LA County? A. Hispanic/Latinx B. Two or more races C. Asian D. African American
B. Two or more races
What country has the highest healthcare spending as a % of GDP? A. United Kingdom B. United States C. Sweden D. New Zealand
B. United States
Why did HI take off so quickly during WWII? A,. Families wanted to protect against potential war injuries B. Wages were on a freeze so this was a new incentive for jobs C. People wanted to secure care for when they got older D. Injuries were becoming more common and people could not afford all of the hospital bills
B. Wages were frozen so HI was a new incentive
What city/community has the highest prevalence of obesity? A. Manhattan Beach B. Walnut Park C. South El Monte D. Calabasas
B. Walnut Park (Manhattan has the lowest)
What indicators can be used to indicate the health of a population? A. Local health B. Women's health C. Men's health D. Community health
B. Women's health
Behavioral Interventions (vs) Structural Interventions
Behavioral = targets PEOPLE to change - ex) condom use Structural = targets STRUCTURAL changes - change access, availability, acceptability - policies, laws, culture - ex) condom availability
What is the proportional contributions to premature death?
Behavioral patterns is 40% and genetic predisposition is 30%
What happened to China in 2008 that caused severe damage in children? A. Extreme amounts of lead were found in the paint for sippy cups B. The pollution reached such levels that caused severe lung infections C. Melamine, a compound used in making plastics, was in infant formula D. Mercury was leaking from thermometers used for children
C. Melamine was in infant formula.
What is the goal of public health according to Detels? The biologic, physical, and ____ well-being of all members of the _____ _____, regardless of ethnicity, religion, gender, sexual orientation, country, or political views.
Biologic, physical, and mental well-being of all members of the global society.
What are the respective %s for adults meeting the PAGA? (Self-reported ; Objectively measured) A. 72% ; 5.4% B. 81% ; 6.9% C. 62% ; 9.6% D. 53% ; 11.3%
C. 62% ; 9.6%
How many deaths are chronic diseases responsible for out of every 10 deaths? A. 5 B. 6 C. 7 D. 8
C. 7
How many children were provided health insurance coverage in 2014? A. 1.3 million B. 2.4 million C. 8.1 million D. 10.2 million
C. 8.1 million
By what percentage was transmission of gonorrhea decreased when condoms were used correctly? A. 70% B. 80% C. 90% D. 100%
C. 90%
What percentage of families would need to breastfeed in order to reduce expenses by $471 million annually, and prevent 33 excess deaths? (Current rate is 88.1%) A. 89% B. 90% C. 91% D. 95%
C. 91%
Which of the following is not a part of the mission of the LACDPH? A. Protect health B. Prevent health C. Access to all D. Promote health and well-being
C. Access to all
What was the goal of Healthy People 2020? A. Reduce health disparities among Americans B. Eliminate + reduce health disparities C. Achieve health equity, eliminate disparities, and improve health of all groups D. All of the above
C. Achieve health equity, eliminate disparities, and improve health of all groups
Women of which ethnicity are more likely to have endometriosis? A. African Americans B. Hispanics C. Asians D. All are equal
C. Asians
What ethnicity has the highest rate of coronary heart disease mortality? A. White B. Hispanic C. Black D. Asian/Pacific Islander
C. Black
Which of the following is not a large subset of the things that affect health factors in the modal of population health? A. Clinical care B. Physical environment C. Educational level D. Health behaviors
C. Educational level
Who funds Medicaid? A. Government only B. States only C. Government and states D. Private insurance companies
C. Government and states
What defined a health disparity as "a particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage"? A. NIH B. LACDPH C. Healthy People 2020 D. Detels
C. Healthy People 2020
What was cause of the spike in crude death rates in 1918? A. West nile virus B. Great Depression lead to poor sanitation C. Influenza pandemic D. Emergence of resistance parasites
C. Influenza pandemic
What country has the highest number of physician visits annually per capita? A. US B. New Zealand C. Japan D. Germany
C. Japan
What level does "supporting anti-poverty programs so people can afford to eat healthfully" fall under in reducing the overall disease and injury burden? A. Level 1 (treating disease conditions) B. Level 2 (reducing risk factors and promoting protective factors) C. Level 3 (focus on underlying determinants) D. All of the above
C. Level 3 (focusing on determinants)
What is the difference between primary care and tertiary care? A. Primary care deals with issues when someone is near death; tertiary includes preventative services B. Primary care addresses issues such as assisted living and hospice; tertiary includes school health C. Primary care includes clinical preventative services and school health; tertiary care includes disease management and hospital systems D. Both types of care are necessary, but you must see a tertiary care service before a primary service.
C. Primary case includes clinical preventative services and school health; tertiary includes disease management and hospital services
What is one of the side effects for the only working drug against malaria? A. Depression B. Alzheimer's C. Schizophrenia D. Auto-immune disorders
C. Schizophrenia
What is the biggest contributor to health factors out of the (4) factors below? A. Health Behaviors B. Clinical Care C. Social and Economic Factors D. Physical Environment
C. Social and Economic Factors
What determinants is the most important? A. Individual health B. Collective health C. Social and physical environment D. Global health
C. Social and physical environment
What is the second leading cause of death across all ethnicities except caucasians in 2010? A. Coronary heart disease B. Lung cancer C. Stroke D. Alzheimer's
C. Stroke
What is the largest single source of added sugar and calories in the American diet? A. Junk food B. Artificially sweetened candy C. Sugar sweetened beverages D. Sugar sweetened desserts
C. Sugar sweetened beverages
The majority of healthcare investment goes into what services for Type 2 Diabetes? A. Primary Care (Behavioral interventions to reduce screen time, etc.) B. Secondary care (Worksite programs for overwieght and obesity) C. Tertiary care (Dialysis, disease management, controlling blood pressure, etc.) D. Quaternary care (self-management education of home and community, etc.)
C. Tertiary care ( dialysis, disease management, etc.)
What is the equation for calculating the number of new infections per case? A. Transmission rate*contact efficiency*duration of infectiousness B. Transmission duration*contact efficiency*rate of infection C. Transmission efficiency*contact rate*duration of infectiousness
C. Transmission efficiency*contact rate*duration of infectiousness
Why does the US have such a high rate of spending on healthcare? A. US uses more healthcare services B. US has poor prevention programs C. US healthcare costs more per unit D. Other countries are more efficient
C. US healthcare costs more per unit
What was not one of the top (3) leading causes of death in the US between 2005-2011? A. Heart Disease B. Cancer (Malignant neoplasms) C. Unintentional injuries D. Chronic lower respiratory disease
C. Unintentional injuries
The core theory states that public health efforts should be focused on: A. the entire population B. a select few at-risk individuals C. at-risk core group D. predisposed families
C. core groups that are more likely to be affected by the disease
What ethnicity has the highest percentage of people living below the federal poverty level? A. African Americans B. American Indians C. Hispanics D. A and B E. All of the above
D. African americans and American Indians
Are communicable diseases more often the cause of death in developed or developing regions?
Communicable diseases are the cause of death 55% of the time in developing regions
The "public health system" includes
Community Health care delivery system Employers & buisnesses The Media Academia Governmental Public Health Infrastructure
Which of the following are not one of the 3 core functions of public health? A) Assessment B) Policy Development C) Community Development D) Assurance
Community Development
Women of which ethnicity are more likely to have early menopause? A. African Americans B. Hispanics C. Asians D. All are equal
D. All are equal
Women of which ethnicity are more likely to have fibroids? A. African Americans B. Hispanics C. Asians D. All are equal
D. All are equal, but African Americans show first
Which ethnicity has the second highest infant mortality rate after African Americans? A. Asians B. Hispanics C. Caucasians D. 2+ races
D. 2+ races
How many lost workdays are a result of the health impacts of air pollution? A. 9,000 B. 1,300,000 C. 1,700,000 D. 2,800,000
D. 2,800,000
How many new cases of STIs occur each year? A. 5 million B. 10 million C. 15 million D. 20 million
D. 20 million new cases of STIs each year
Approximately how many people in the US live in rural vs urban areas? A. 50/50 B. 40/60 C. 30/70 D. 20/80
D. 20/80
What percentage of people that are uninsured in the non-elderly population fall under 138% FDL? A. 48% B. 49% C. 50% D. 51%
D. 51%
What is the 2011 projected for cost of being overweight, obesity, and physical activity predicted for CA in 2006? A. 25.7 million B. 25.7 billion C. 52.7 million D. 52.7 billion
D. 52.7 billion
What percentage of women die within 6 weeks? A. 23% B. 34% C. 46% D. 55%
D. 55%
What age group has the highest percentage of overweights? A. 18-24 B. 25-29 C. 40-49 D. 65+
D. 65+
What is the most recent life expectancy age if someone was born in 2012? A. 74.7 B. 75.8 C. 77.6 D. 78.8
D. 78.8
How accurate is genital warts diagnosis just by physical examination? A. 50% B. 60% C. 70% D. 80%
D. 80% accurate
How many times more likely are African American men 20-24 to get gonorrhea and chlamydia than white peers? A. 2x B. 4x C. 6x D. 8x
D. 8x
Why is pregnancy a good time to address other health concerns? A. Pregnant are most open to health behavior changes B. Pregnancy is the only period when some women have coverage C. Most families will encourage healthy habits for pregnant women D. A and B
D. A and B
Which of the following is not addressed by the NIH in its definition of health disparities? A. Incidence and prevalence of disease B. Mortality of disease C. Burden of disease D. Access to healthcare
D. Access to healthcare
Which of the following is one of the top (10) causes of year of potential life lost (YPLL) that were not also one of the top (10) causes on death in the US between 2005-2011? A. Diabetes mellitus B. Kidney Disease C. Alzheimer's D. All of the above are both leading causes of YPLL and deaths
D. All of the above
What ethnicity has the highest % of overweight? A. Blacks B. Hispanics C. Latinx D. American Indian
D. American Indian
Women of which ethnicity are more likely to have incontinence? A. African Americans B. Hispanics C. Asians D. Caucasians
D. Caucasians
What is not one of the problems contributing to the current state of nutrition? A. Increased marketing of junk food, tobacco, and alcohol B. Decreased access to fresh, nutritious, and affordable food C. Proliferation of fast food restaurants D. Decreased time to prepare healthy and nutritious food options for children
D. Decreased time to prep food
What is not one of the top (10) accomplishments of public health during the 20th century? A. Developing vaccinations B. Ensuring safer workplaces C. Controlling infectious Diseases D. Increasing exercise habits
D. Increasing exercise habits
Which countries were not affected by the melamine incident in China? A. Japan B. Hong Kong C. Singapore D. India
D. India
Which of the following were not required categorically eligibility requirements for Medicaid? A. Children and adults who would qualified for AFDC as of July 1996 B. Pregnant women and children <6 with income <133%FPL; all children <19 with income <100%FPL C. Low-income seniors, blind, and disabled individuals who qualify for federal SSI D. Pregnant women with income >133%FPL
D. Individuals who fall into above categories, but do not qualify for mandatory since they are above the mandatory income threshold
Prior to the Affordable Healthcare Act, which states were the only ones to require health insurance for their employees? A. Michigan B. Hawaii C. California D. A and B
D. Michigan and Hawaii
What country has the lowest healthcare spending per capita? A. United Kingdom B. United States C. Sweden D. New Zealand
D. New Zealand
What is not one of the top (10) accomplishments of public health during the 20th century? A. Decreasing deaths from heart disease/stroke B. Ensuring safer and healthier foods C. Increasing family planning options D. Reducing the amount of pollution
D. Reducing the amount of pollution
Which of the following is not mentioned as a way contributing towards public health? A. Using preventative medicine to reduce the community risk for various disease B. Educating the public about things they can do to improve their health C. Monitoring environmental hazards D. Reducing the cost of easily accessible healthcare measures
D. Reducing the cost of easily accessible healthcare measures
Which of the following are not ways to prevent and reduce STDs? A. Vaccination B. Male circumcision C. Partner treatment D. Self-treatment
D. Self-treatment
What was the most common error in condom use? A. Fillping the condom over B. Condom slippage or breakage C. Taking off condom before finishing sex D. Starting sex without a condom
D. Starting sex without a condom
What is not mentioned as a thing that the CDC says Americans can do in order to prevent up to an estimated 40-80% of the most common diseases? A. Stop smoking B. Start eating healthy C. Get in shape D. Stop drinking
D. Stop drinking
What was not one of the top (10) leading causes of death in the US between 2005-2011? A. Nephritis B. Suicide C. Stroke D. Tuberculosis
D. Tuberculosis
Why are African American women at higher risks for MMR? A. Differences in diagnosis B. SES factors C. Poor initial health conditions D. Unknown
D. Unknown
Which area was not one of the (5) PLACE grantees? A. El Monte B. Culver City C. Long Beach D. Walnut Park
D. Walnut Park
Biomedical Interventions
DRUGS/TREATMENTS/DEVICES - Vaccines, pharmaceutical treatments & medical devices to prevent/treat disease
According to the text, be able to explain why data is essential to the public health system.
Data is imperative, because it helps to draw conclusions about diseases, evaluate how well preventions were implemented, evaluate prevalence and incidence of diseases
Asia's Looming Social Challenge
Dealing with the "Elder Boom" - BIG problem for Japan (by 2050 it should be around 35-40% of population is 65+ years) - Then China (20-25%), Indonesia (20%) & India (15%)
Outline and explain the public health approach to prevention.
Define the problem: surveillance Identify causes: risk & protective factor research Develop and test interventions Implement interventions Evaluate interventions
What is the Health Impact Pyramid? Be able to draw the pyramid and explain its levels.
Definition: factors that affect public health from largest impact to smallest (bottom to top) Top: Counseling & Education -Eat healthy, be physically active Clinical interventions -Check for high blood pressure, cholesterol, and diabetes Long-lasting Protective Interventions -Immunizations, brief intervention, cessation treatment colonoscopy Changing the Context (to make individuals' default decisions healthy) -Fluoridation, trans fat, smoke-free laws, tobacco tax Socioeconomic Factors Poverty, education, housing, inequality
Women of which ethnicity have the highest rates of miscarriages? A. African Americans B. Caucasians C. Hispanics D. Asians E. All are equal
E. All are equal
Which of the following is one of the (10) great public health achievements since 1990? A. Vaccinations B. Motor vehicle safety C. Control of infectious diseases D. Decrease in deaths from CAD and stroke E. All of the above are achievements
E. All of the above are achievements
Outline the criteria for adequate health care systems.
Equal access to quality care (prevention and treatment services) for rural and urban Affordability - even with people who do not have to funds to pay/receive services Sustainability - system has long-term political and financial support
Who does Medicaid serve?
Everyone covered whose income is less than 138% of poverty level - if state agrees, and 32 have
T/F: OSHA protection has been equal and sufficient in providing for workers.
F, there has been limited OSHA jurisdiction excluding farmworkers and domestic household workers with weak or no regulations; there are also barreirs to participation in OSHA enforcement process.
Why might we prefer observational over experimental designs?
Experimental studies are least used due to ethical reasons. We can only use them for factors/exposure that are protective such as vaccines, exercise, and diet. Experimental studies also cost so much more, and we see from the observational studies that they are all very cost effective.
What is the main difference between observational and experimental study designs?
Experimental study- investigator determines through a controlled process the exposure for each individual or community, then follows them over time to detect the effects of exposure Observational Studies- Investigator observes rather than determines each individual's exposure status.
How strong is the association (between disease/sickness and habits) Is there a clear temporality?
Exposure to agent or risk factor must precede the development of the disease, and the disease should follow exposure within predictable time frame.
The Third Wave of Modern Public Health is A) Extending the Quality of Life B) Infectious Disease Control C) Chronic Disease Control
Extending the Quality of Life
T/F: 76.9% of the 56 million deaths that occurred globally in 2012 were due to NCDs.
F, 67.9% of 56 million deaths = 38 million and the majority occurred in low- and middle-income countries.
T/F: 90% of COPD deaths occur in high-income countries.
F, 90% of COPD deaths occur in low- and middle-income countries.
T/F: COPD due to air pollution is considered an acute injury/illness.
F, COPD due to air pollution is considered a chronic injury/illness.
T/F: It is possible to conduct surveillance for HIV infection.
F, HIV has a 9-10 year incubation period and surveillance can only be conducted for the disease - not the infection.
T/F: Los Angeles county ranks first in the number of gonorrhea cases and second in the number of chlamydia cases.
F, Los Angeles county ranks first in the number of chlamydia cases and second in the number of gonorrhea cases.
T/F: The number of deaths caused by communicable diseases are higher than that caused by non-communicable diseases in developed regions.
F, The number of deaths caused by communicable diseases are higher than that caused by non-communicable diseases only in developing countries.
T/F: The projected number of people with dementia in high-income countries is higher than that of low- and mid-income countries.
F, The projected number of people with dementia in low- and mid-income countries is higher than that of high-income countries.
T/F: There is currently overreporting in limiting workers comp data and physician reporting.
F, There is currently underreporting in limiting workers comp data and physician reporting.
T/F: An example of a health protection is a legislation for mandatory seat belts.
F, an example of a health protection is regulation such as the levels of fluoridation, while the aforementioned would be an example of prevention.
T/F: Structural interventions directly target people to change their behaviors.
F, behavioral interventions do; structural interventions change in access, availability, or acceptability.
T/F: The number of premature deaths caused by genetic predisposition is higher than behavioral patterns.
F, behavioral patterns > genetic predisposition (genetic predisposition does not guarantee contraction of disease).
T/F: Cardiovascular (disease or heart) and malignant neoplasms are the leading causes of death in the U.S. only in White individuals.
F, cardiovascular (disease of heart) and malignant neoplasms are the leading causes of death across all demographics.
T/F: Cancer is the leading cause of blindness, amputation and kidney failure.
F, diabetes is the leading cause of blindness, amputation and kidney failure.
T/F: Epidemiology is a body of knowledge.
F, epidemiology is not a body of knowledge.
T/F: The majority of those with diagnosable mental illness receive treatment.
F, fewer than 50% with diagnosable mental illness receive treatment
T/F: A fourth of mentally ill had onset by 14 years of age, and half by 24 years.
F, half of mentally ill had onset by 14 years of age, and 75% by 24 years.
T/F: the transtheoretical model of change proves more effective than the extended parallel process model.
F, no one theory dominates the health education practice.
T/F: Public health guarantees optimal health, by creating the infrastructure achieved by society
F, public health does not guarantee optimal health, but only makes optimal health conditions possible.
T/F: Rural areas have a higher epidemic potential but higher rates of immunity.
F, rural areas have a lower epidemic potential but lower rates of immunity.
T/F: Cross-sectional studies are a good way to measure incidence.
F, serial cross-sectional studies are a good way to measure incidence; cross-sectional studies are a good way to measure prevalence.
T/F: The number of deaths caused by communicable diseases are higher than that caused by non-communicable diseases.
F, the number of deaths caused by non-communicable diseases are higher than that caused by communicable diseases due to more people in developed countries.
Chelation to remove blood levels of lead of children is associated with very few side effects (True or False?)
False
T/F: Public health creates and guarantees the optimal health and conditions under which it can be achieved by society.
False, it can create the conditions, but cannot guarantee.
T/F: The fundamental maxim of public health is that the health of the individual is best ensured by maintaining and improving the health of that person. (Satcher)
False, it is by maintaining the health of the community.
What are some determinants for populations?
Fertility Rates Mortality Rates Life Expectancy Immigration and emigration migration.
What is an epidemic curve? What does it show?
Figure that shows the number of new cases of disease caused by an infection over time
What is the difference between frequency and pattern?
Frequency: Number of health-related events in a population and relationship of that number to the size of the population Pattern: Occurrence of health-related events by time, place, and person
What are the factors influencing healthy aging?
Functioning at a normal level at older age Genetics, personal characteristics Behaviors through life (diet, physical activity, tobacco use) Behaviors in old age (strength training, good nutrition) Safe+accessible environments Sex, Ethnicity, socioeconomic status
Background of HPV
Group of related viruses that are transmitted through direct skin-to-skin contact (vaginal, anal, oral sex) If it doesn't go away on its own, many types cause warts and some cause cancers
Understand the link between income and health. Specifically, outline three likely health outcomes of Minnesotans with higher incomes and Minnesotans with lower incomes.
HIGH INCOMES - higher life expectancy, receive adequate prenatal care, be insured LOW INCOMES - have an infant die in first year of life, report having diabetes, report that their health is fair/poor
Know and be able to describe the four principles for distributing scarce resources.
Health Maximization -Resources allocated in a way that allows total benefits of public's health to be as large as possible Equity -Ensure erryone has equal chance of receiving a scarce resource Priority to the worst Personal Responsibility -Lower priority to people whose problems are related to own health behaviors -People who contribute to society given greater priority
Top 3 causes of Mortality in California
Heart disease, Cancer, Stroke
What are the leading causes of Death in the U.S.?
Heart disease, cancer, chronic lower respiratory diseases, accidents (unintentional injuries), stroke (cerebrovascular disease), alzheimer's disease, diabetes, influenza/pneumonia, kidney disease, suicide
What are the top 3 causes of death in the U.S. when data are adjusted for age?
Heart disease, cancer, unintentional injuries
Which global income group has the highest crude cancer mortality rate based on World Bank Income Group in 2012?
High income
What is the main difference between mortality causes in high-income countries and low-income countries?
High-income: primarily due to NCDs Low-income: primarily due to communicable diseases
What are the essential elements or actions to build a healthy community? Like human-made features?
Human Made Features: Sidewalks, public transport, access to community cultural spaces, city planners + housing developers, affordable housing free of lead and asthma triggers, addressing physical and mental health, bike friendly routes
The Functions of Public Health: Assesment
Identify Problems related to the public's health and measure their extent
Assessment
Identify problems related to the health of populations and determine their extent.
Is there a dose-response effect?
If exposure to radiation is harmful, people w/ higher radiation exposure should be sicker than people w/minimum exposure
If an experiment removes risk factor, does it reduce the risk of disease?
If someone is exposed to risk factor, they should develop the disease more frequently than those who don't have exposure, and exposure to risk factor should be more frequent among those with the disease than those without
Analytic Epidemiology
Key feature is a comparison group. Examines the why and the how, or the association between exposure and disease. If there is unequal distribution, exposure is said to be associated with disease
Intervention Strategies
Immunization programs Health education Behavioral modification strategies Community intervention/mobilization Structural interventions (laws, regulations)
How is Environmental health a determinant of many health issues?
Impacted by ambient air pollution, household air pollution, lead, and second-hand smoke --> determinant of Cardiovascular Disease, Stroke, and Ischemic Heart Disease
Minamata Disease
In Minamata, Japan a factory had rebuilt its waste water drainage channel, diverting water waste directly into the Minamata River resulting in methylmercury contamination spreading throughout the entire Shiranui Sea. From this, a casual relationship between wastewater from the factory and neurologic disorders was recognized
What would you use to measure the spread of an outbreak?
Incidence.
Understand the measures of disease frequency: incidence and prevalence.
Incidence: number of new cases in the population; measures the appearance of the disease in a population in a defined period of time Prevalence: total number of cases existing in a defined population at a defined point in time
How is climate change a major environmental health issue?
Increase in extreme weather events threaten both health and health systems Climate change elevates incidents such as risk of mosquitos, ticks, and water-borne diseases - Vector-borne disease have tripled Small islands and coastal changes are being affected by rising sea levels Heatwaves occurring more often and lasting longer, increasing risk for strokes and heat exhaustion
How did insurance coverage change under the ACA?
Increased insurance coverage (55 million --> 28 million uninsured) How? o Individual mandate: penalty if do not abide (repealed) § Must have health insurance or pay a penalty o Subsidies § Receive from government to purchase healthcare o No exclusions or differential pricing unless over 65 o Students covered until 26 - Employer mandate for companies with >50 employees
Types of Microbial Threats
Infectious Agents: bacteria, virus, fungus, parasite New Agents: SARS, HIV Zoonotic Agents: Flu Resurgence of old foes: Pertussis Persistent Foes: Polio, measles Drug Resistant Foes: Ghonorrhea, TB Bioterrorism Agents: Anthrax
Scope of Public Health (what we study)
Infectious diseases Chronic diseases Nutrition disorders Health of the vulnerable Accidents/violence/injuries Health equity Occupational health Environmental health Access to health care Quality of health care War
Capillariasis: Initial Cases vs. Subsequent Cases
Initial cases -Gender ratio (M:F) = 7:1 -Percentage of males aged 10-59 = 79% -Close to sea Subsequent cases -Gender ratio (M:F) = 1:1 -Age distribution = same as population -Even geographic distribution
Using chemical controls to kill vectors
Insecticides, larvicides, pesticides Problem with this is we are seeing insect resistance to pesticides and they are harmful to other animals/to the environment Ex: DDT; most commonly used but has extremely negative environmental effects such as the thinning of egg shells in bald eagles
Be able to provide an example for each of the criterion in the causation table.
Is the association strong? -smokers more likely to get lung cancer Is there clear temporality? -exposure to agent must precede development of disease -rash from touching poison ivy Is there a dose-response effect? -if radiation exposure is harmful, the more exposed a person is the sicker they should be
Top 3 global causes of mortality
Ischemic heart disease Stroke Chronic obstructive pulmonary disease
Global leading causes of DALYs
Ischemic heart disease, stroke, lower respiratory infections
What is a historical control study and is it an observational or experimental study?
It is an experimental study you test a new therapy on a group of patients, using records of patients with same disease treated before new therapy
What is a simultaneous non-randomized control study and is it an observational or experimental study?
It is an experimental study allowing clinicians to choose which children from a set of candidates will receive the vaccine and which will not
What is a randomized controlled trial study and is it an observational or experimental study?
It is an experimental study randomly assigning subjects to placebo, drug, or lifestyle intervention and recording subsequent disease occurrence
What is a Case-Control study and is it an observational or experimental study?
It is an observational study Enroll group of people with disease as well as a group without disease (controls). Compares the previous exposures between the two groups.
What is a Cross-sectional study and is it an observational or experimental study?
It is an observational study Enroll group of people. Measure health outcomes and exposures simultaneously example: participants called and asked how much they exercise per week and if they have heart disease
What is a Cohort study and is it an observational or experimental study?
It is an observational study investigator records whether each study participant is exposed or not, and then tracks the participants to see if they develop the disease of interest
What is demography?
It is the study & measurement of population change.
Why is the DALY useful?
It useful measuring the burden of diseases that dont kill you, but prevent someone from living a healthy life. (ex. Arthritis, depression, blindness doesn't kill you, but one still lives with some sort of disability.
How is the life expectancy at age 65 of males compared to females different than that measured at birth?
LE difference at age 65 is smaller than the difference at birth
4. What are the determinants of health?
Leading causes of death in US = heart disease, cancer, stroke Reframing causes of death based on the "ACTUAL causes of death": risk factors such as tobacco, physical activity, nutrition, alcohol use Disease has underlying reasons Underlying determinants of health are largely a product of our social and physical environments Social and economic factors: Family, community and societal structures Physical environment: Natural and built environments Built environment
What are the basic aging trends in the world and in the U.S.?
Least developed countries and Less developed countries are sharply aging, more developed countries are increasing in aging but much more gradually # of older people is growing faster than # of people in all younger age groups In most countries growth in the # of older persons occurs in the context of low or declining fertility Fewer babies being born per woman but increasing shares in older people Highest rates of elderly death occur @ the beginning of a new year
Morbidity
Level of health of well-being
What are the negative changes regarding aging?
Little evidence to suggest older people are actually experiencing better health in their old age relative to their parents No significant change in mild to moderate disability rates Not enough resources and services to support rapidly increasing aging population Health concerns: hearing loss, compromised vision, diabetes, depression, multi-morbidity, geriatric syndromes etc
What are the challenges when assessing environment related disease?
Long lag times (time between exposure and visible effects) Multiple toxic exposures, as it is hard to disaggregate multiple factors Complex pathways Difficulty assessing exposure
How do the causes of death vary in low-income countries compared to high-income countries.
Low income income counties - lower respiratory infections high income countries - ischemic heart disease
Which of the following is responsible for the most infectious disease deaths globally?
Lower respiratory infections
"Infant Mortality: Genesse County" What were the 3 underlying determinants of infant mortality?
MATERNAL-INFANT HEALTH - enhancing the perinatal system - fostering community mobilization -reducing racism
Jacobson v. Massachusetts case
Main idea: individual liberty vs collective benefit Cambridge, MA, had a mandatory vaccination Jacobson refused to comply (sickness concern) Refused to pay fine US Supreme Court upheld state authority to enforce compulsory vaccination laws Individual freedom must sometimes be subordinated to the common welfare "The whole people covenants with each Citizen, and each Citizen with the whole people, that all shall be governed by certain Laws for the Common good" - Justice John Marshall Harlan
Assurance
Make certain that necessary services are provided to reach the desired goals, as determined by policy measures, and monitor how well the regulators and other sectors of the society are complying with policy.
What is one of the problems that affects globally? Why?
Malaria. Artemisinin resistance is spreading, so a lot of drugs aren't working anymore.
In terms of the world's infant mortality rate, which is higher boys or girls?
Male infant mortality is higher than girls
basic definition of geriatric syndromes
Medical conditions that occur in older adults and negatively impact their quality of life
Be able to compare and contrast Medicare and Medicaid and who receives benefits from each.
Medicare: -Attached to social security -Available for 65+ regardless of income Medicaid: -Federal and state program to help low-income individuals and families -Federal gov't fund up to 50% cost of each state's Medicaid program -Strict eligibility requirements w/rules varied by state Both: paid for by gov't
Explain the differences between public health and medical care.
Medicine - concerned with the individual health of patients; focuses on healing ill patients Public Health - concerned with the health of the community and population as a whole; it focuses on preventing illness
What country has the highest life expectancy for men and the highest for women?
Men - Iceland Women - Japan US spends the most on healthcare, but isnt the healthiest.
Understand the Health Belief Model and its use in health promotion. Be able to outline some of its key concepts.
Model developed to explain and predict health-related behaviors, particularly in regard to the uptake of health services Perceived Severity -Individuals who perceive a given health problem as serious are more likely to engage in behaviors to prevent the health problem from occurring (or reduce its severity) Perceived Susceptibility -Individuals who perceive that they are susceptible to a particular health problem will engage in behaviors to reduce their risk of developing the health problem. Individuals with low perceived susceptibility may deny that they are at risk for contracting a particular illness. Others may acknowledge the possibility that they could develop the illness, but believe it is unlikely. Individuals who believe they are at low risk of developing an illness are more likely to engage in unhealthy, or risky, behaviors. Individuals who perceive a high risk that they will be personally affected by a particular health problem are more likely to engage in behaviors to decrease their risk of developing the condition. Perceived Benefits -Individual's assessment of the value or efficacy of engaging in a health-promoting behavior to decrease risk of disease. If an individual believes that a particular action will reduce susceptibility to a health problem or decrease its seriousness, then he or she is likely to engage in that behavior regardless of objective facts regarding the effectiveness of the action. Perceived Barriers -The perceived benefits must outweigh the perceived barriers in order for behavior change to occur Modifying Variables -Demographic, psychosocial, and structural variables can affect perceptions of health-related behaviors Modifying variables affect health-related behaviors indirectly by affecting perceived seriousness, susceptibility, benefits, and barriers Cues to Action -A cue, or trigger, is necessary for prompting engagement in health-promoting behaviors A reminder postcard from a dentist, the illness of a friend or family member, and product health warning labels Self-efficacy -An individual's perception of his or her competence to successfully perform a behavior -Confidence in one's ability to effect change in outcomes (i.e., self-efficacy) was a key component of health behavior change
What are the two categories of determinants?
Modifiable: things you can change such as gender, behavior Non-modifiable: things you cannot change such as age, sex, genetics
Eating behavior change
Modification of dietary patterns, cooking food like beef and pork, handwashing before eating'
Highest Life Expectancy by Country (2017)
Monaco, Japan, Singapore
Overall trend of Global disease burden by Cause
NCDs increasing CDs decreasing (but large differences based on income of nation) injuries stay the same Top 3 are Cardiovascular Diseases, Diarrhea, and Cancers
Physical environment:
Natural and built environments -Natural environment in US and globally have undergone massive change --Entire ecosystems eliminated, leading to loss of species and biodiversity Contamination of air, ground, water --Climate change due to industrialization and transportation ---Rises in sea level, changes in weather, alterations of disease vector environments
How can water be purified?
Natural methods- evaporation+condensation, filtration through earth, plant growth, aeration, reduction of organic material by bacteria human intervention - Done through coagulation of colloids by aluminum salts Filtration through materials such as coal, sand, or diatomaceous earth Disinfection with chemicals such as chlorine derivatives Boiling, distillation in special circumstances
Health is the result of a dynamic equilibrium involving agent, host and environment. TRUE OR FALSE?
TRUE
Are bigger samples always better?
No! ex: Google overestimated number of flu cases based on google searches - not always based on representative sample - quantity of data is not a substitute for good scientific (Statistical) methods
How is application involved in epidemiology?
Not just the study of health in a population; involves applying knowledge via the studies into community based practice Both a science and an art Combines descriptive and analytic epidemiology, experience, judgement, and understanding to "diagnose" health of a community and propose intervention/preventative actions
In-depth Interviews:
One-to-one interview with an individual based on open-ended questions
Behavior change as method of prevention
Perhaps the most challenging tool for the control of infectious diseases; habits are not easily changed example: using condoms, wearing long sleeves, bed nets
Cancer and HPV
Persistent infection of high-risk type (16 and 18) of HPV → cancer 70% of cervical cancers due to HPV types 16 and 18 Infection → cancer usually takes decades Impact of Pap test on cancer rates: 75% decrease since 1950s
The hierarchy of controls for occupational health and safety in order of increasing effectiveness is:
Personal protective equipment, administrative controls, engineering controls, isolation, substitution, elimination
What are Gostin's seven models of public health intervention? Be able to provide examples for each of his models.
Power to tax and spend -Taxing cigarettes to try and decrease usage Power to alter the informational environment -Making a campaign for safe sex to educate people and prevent STD's and unwanted pregnancies Power to alter the built environment -Put fire codes in place to protect people Power to alter socio-economic environment -Allocate resources to provide health treatment to people who cannot afford it Direct regulation of persons, professionals, and business -Making laws that force people to use seatbelts Indirect regulation through tort system -Redress the problems with toys or food, like rotten applesauce in those squishy packs Deregulation: law as a barrier to health -Not handing out clean needles to those who illicitly use drugs
What are the stages of the transtheoretic model of change?
Pre-contemplation Contemplation Preparation Action Maintainence
Be able to draw and explain the steps of the Stages of Change model.
Precontemplation -No intention or changing behavior Contemplation -Aware a problem exists -No commitment to action Preparation -Intent upon taking action Action -Active modification or behavior Maintenance -Sustained change -New behavior replaces old Relapse -Fall back into old patterns of behavior
Primary Prevention
Prevent problems from happening ( (immunization)
Public Health Ethics Focus/Tendency
Prevention Wide array of intervention types Authority based on police powers Law/policy a key tool of the profession Public stewardship Populations and communities Greatest net social good Social justice and health equity primary Community consent and engagement Relational autonomy, solidarity, interdependence
List and define the three types of prevention and be able to provide examples of each.
Primary - aims to prevent disease/injury before it occurs -Prevent exposures to hazards that cause disease/injury, altering unhealthy or unsafe behaviors that can lead to disease/injury EX: education about healthy/safe habits, immunization against diseases Secondary - aims to reduce impact of a disease/injury that has already occurred by detecting and treating disease/injury asap to halt its progress -Encourage personal strategies to prevent reoccurrence, implement programs to return people to original health and function EX: regular exams and screening tests, daily meds or exercise programs to prevent more strokes or heart attacks Tertiary - aims to soften the impact of an ongoing illness/injury that has lasting effects by helping manage long-term health problems and injuries to improve as much of their ability to function EX: cardiac rehab programs, support groups, rehab
Identify primary, secondary, and tertiary sources of information.
Primary - original source that presents original thinking, reports a discovery or provides new information -Original journal article -Editorial review board -Methods and data given -Authors identified EX: British Journal of Addiction Secondary - interpretations and evaluations of primary sources; written after the fact; not as complete as methods and data aren't given EX: textbooks, encyclopedias Tertiary - provides overview by synthesizing information gathered from other sources; info provided in a user-friendly form with context for interpretation; lacks data/research specifics EX: newspaper, online news like Time, Huffington Post
What are the types of preventions? Primary: Secondary: Tertiary:
Primary: Prevention Secondary: Detection + Treatment Tertiary: Treatment after health problem
List and define the six principles of public health.
Principle of the Aggregate: focuses on needs of the entire population Principle of Prevention: emphasizes prevention Principle of Epidemiology: relies on epidemiology (the science of understanding the causes, distribution, and control of disease in populations) as its method of inquiry Principle of Community Organization: organizes community resources to meet health needs Principle of Leadership: leads when others cannot or will not Principle of the Greater Good: gives first consideration to interventions that provide greater good for the greatest number of people
Policy Setting
Prioritize the identified problems, determine possible interventions and/or preventive measures, set regulations in an effort to achieve change, and predict the effect of those changes on the population.
Mechanisms of ACA improved coverage
Private: each state create insurance marketplace for individuals w/o coverage and small employers Public: the Medicaid expansion
Natural History of Disease
Progression of disease in an individual over time, in the absence of treatment
Prevalence
Proportion of people in a population who have a particular disease or attribute @ a specified point in time or over a specified period of time Point prevalence= single period of time, Period prevalence=over an interval of time Ex: In a survey of 1,150 women that gave birth in Maine in 2000, a total of 468 reported taking a multivitamin during the month before becoming pregnant. Prevalence= (468/1150) x 100 = 40.7%
What is the difference between a prospective and a retrospective cohort study?
Prospective cohort study- outcomes have not occurred yet Retrospective Cohort Studies- Exposure and outcomes have already occurred
What protections were afforded to patients under the ACA?
Protection against discrimination by Health insurers Quality enhancement
Control measures for Environment-caused infection
Provision of safe water, proper disposal of feces, food sanitation, milk sanitation, and other methods
Reproductive number
R = number of secondary infections from one individual Ro = reproductive at the beginning of an epidemic R>1 Epidemic spreads R<1 Epidemic dies out R subject to changes in presence and levels of determinants of epidemic spread
What are the base measures in epidemiology?
Ratio, Proportion, Rate
What are some frequency measures used in Epidemiology?
Ratio, Proportion, Rate, Incidence Rate, Prevalence
what are some factors that determine the spread of epidemics?
Reproductive number, transmission probability, contact rate, duration of infectiousness.
Observational techniques:
Researcher observes an interaction and records the process (e.g., client/provider interaction) via structured interviews, spot checks, continuous monitoring, or unstructured participant observation
What are the top 3 causes of environmental related disease among children?
Respiratory infections, diarrhea, neonatal conditions
US Drug Overdose Deaths by Drug Type
Sharpest increase related to Fentanyl, Synthetic Opioids Next 2 are heroin, semi-synthetic opioids
What populations are less likely to be covered by their employers?
Small employers Low wage Retail Service industry
What is the #1 cause of preventable deaths
Smoking
Be able to name and describe the six protocol conditions that must be met for clinical research.
Social value Scientific validity Fair subject selection Acceptable risk-benefit ratio Informed consent Respect for enrolled subjects/participants
The World Health Organization definition of health does not include A) Physical Well-Being B) Spiritual Well-Being C) Mental Well-Being D) Social Well-Being
Spiritual Well-Being
T/F: Depression is a seasonally affective disorder.
T.
Three waves of public health emphasis:
Still a concern with infectious and chronic diseases, but also now embarking on a third wave of modern public health- extending the quality of life Three waves: Infectious disease (19th century) Chronic disease (20th century) Extending quality of life (21st century)
The major objective of the investigation into the unknown disease studied by Professor Detels in northern Luzon, Philippines in the 1960s was to:
Stop the epidemic
Top 3 causes of environment related death
Stroke, Ischemic Heart Disease, and Unintentional injuries
What is epidemiology?
Study of distribution and determinants of health-related state and events in specified populations, and the application to control health problems (looks at how they are distributed and looks to see why, and see what can be done about it)
What are the the major PREVENTABLE risk factors - of an early death?
Substance Abuse (smoking, alc, drugs) Unhealthy Diet Physical Inactivity Environmental/Occupational Hazards
what are major preventable risk factors?
Substance abuse (tobacco, alcohol, drugs), unhealthy diet, physical inactivity, environmental/occupational hazards
Social and economic factors:
Supportive families and communities foster safe, secure environments and build social capital Breakdowns in family, neighborhood, community structure lead to social isolation and violence Individuals benefit from receiving a good education and having meaningful employment that provides a living wage -Disparities in education and income are a product of unequal opportunities --Discrimination on the basis of age, race, gender, ethnicity, sexual orientation creates stigmatization and lost opportunity --Disparities impair the capacity of individuals to live full, rich lives and are strongly related to variations in health outcomes
T/F: All forms of biomedical intervention require behavioral changes.
T, by patients, providers, organizations, etc.
T/F: Identical twins are at a high risk of developing schizophrenia.
T, suggests genetic component in the disorder.
T/F: Type 2 diabetes accounts for around 90% of all diabetes.
T, type 2 diabetes is the leading cause of blindness, amputation and kidney failure.
T/F: Construction, agriculture, mining, transportation and warehouse occupations are most at risk for work-related injuries.
T.
The cause of the high lead content in the Flint, Michigan water was:
The high acidity of the new water supply leaching lead from the pipes
After watching the Unnatural Causes video, understand the relationship between average income of the district and average life expectancy of the district.
The higher the income of a district, the higher the average life expectancy People with more money can afford better/more food, better health care, and tend to have more time to take care of themselves because they have less financial worries
How are fertility rates, education, and poverty related?
The more educated one is, fertility rates decline The more impoverished you are, fertility rates decline.
What is the reproductive rate?
The number of people that one sick person will infect on average.
The "predictive value positive" is
The proportion of persons testing positive who truly have the disease
What is the role of the public health?
The purpose of public health is...to assure the conditions in which people can be healthy. It is important to emphasize that public health still leaves it to the individual to make healthy choices--it can only maximize the conditions for that to happen.
Why is Life expectancy increasing?
There is an overall improvement in sanitation, water, housing, treatment & prevention of chronic diseases
Holy Trinity of Epidemiology: Disease Descriptors
Time Place Person
What are disease characteristics and what do they mean?
Time, Place, & Person These characteristics describe disease allows you to ID patterns, which can help epidemiologists create hypotheses for the cause of disease and what interventions may help alleviate the problem
Epidemiologists describe disease states in terms of
Time, Place, Person
Clinical Ethics Focus/Tendency
Treatment Clinicians making medical interventions Authority based on doctor/profession Enforcing rules of professional conduct Fiduciary relation to patient Individual patients Individual benefit and harm Justice focus largely on access to care Individual informed consent Individual autonomy
What most likely explains the "bump" in cancer incidence in males in the U.S. during the early 1990s?
Utilization of the PSA screening test.
Zika Virus
Vector is mosquitoes and the extrinsic incubation is 10 days. The incubation period is 3-7 days. Symptoms are mild and include fever, rash, joint pain, pinkeye, muscle pain, headache. Symptoms last about 3-7 days. There is no treatment and it is recommended to avoid aspirin. Can cause pregnancy complications if infected in first trimester of pregnancy. Prevalent in equatorial belt including Pacific, Asia, Africa, Latin America, Caribbean, and Florida.
Body mass index (BMI) is a simple index of weight-for-height that is commonly used to classify underweight, overweight and obesity in adults. It is defined as:
Weight in kilograms divided by the square of the height in meters (kilograms/meters^2 )
US Drug Overdose Death rates by state
West Virginia had most deaths in 2016 Ohio, New Hampshire, Pennsylvania saw the largest increase in overdose deaths between 2006 and 2016
Chi-squared Analysis
What is it: 2 x 2 table When to use it: when you have 2 dichotomous variables (clear yes or no)
Secondary prevention
What is it: Identifying diseases prior to the onset of signs and symptoms, however, disease is already present Examples: screening procedures like mammography for breast cancer and pap smear for cervical cancer
Primary prevention:
What is it: Intervening before health effects occur Examples: vaccinations, altering risky behaviors, and banning harmful substances
Tertiary prevention
What is it: Managing disease post-diagnosis to slow or stop disease progression Examples: Treatment procedures like chemotherapy and rehabilitation
Logistic Regression
What is it: analysis of multiple IVs' effect on DV When to use it: when DV (y) is binary (example: y=1= yes disease; y=0= no disease)
Multiple Regression
What is it: analysis of multiple independent variables' effect on one dependent variable When to use it: when dependent variable (y) is continuous
Survival Analysis
What is it: analyzing the expected duration of time until one or more events happen, such as death or onset of disease When to use it: when y predicts time to an event
Correlation Analysis
What is it: basic way to find a relationship between variables using correlation coefficient r When to use it: when you have 2 continuous variables
Questions to thinking about when discussing public health.
Where is the issue? What is the cause? What is the impact? What was/has been done?
Are noncommunicable diseases more often the cause of death in developed or developing regions?
While noncommunicable diseases are the cause of death about 37% of the time in developing regions, in developed regions noncommunicable diseases are the cause of death 77% of the time
NHANES is
a national survey measuring health-related factors in a sample of Americans
incidence
a rate used in epidemiology. The number of new cases occurring in a given population in a specified time period over the population as risk in that time period
WHO definition of health:
a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity
The country with the largest proportion of the global extremely poor is: a. India b. China c. Brazil d. Indonesia e. United States
a. India
What can lead to decreases in spread of respiratory diseases? a. Less crowding b. Better quality of food c. Year-round access to vegetables and fruit d. All of the above
a. Less crowding
Over half of mental illnesses have onset during which of the following age periods? a. 5-24 years b. 25-34 years c. 35-44 years d. 45-54 years e. >54 years
a. 5-24 years
Between 1950 and 2015, the only region whose share of the global population did NOT decline was: a. Africa b. Asia c. Europe d. North America e. Latin America
a. Africa
.One of the two main concepts of epidemiology is: a. Agent, host, environment b. Agent, host, person c. Agent, environment, setting of host d. Agent, time, place e. Time, place environment
a. Agent, host, environment
The onset of most mental illnesses occurs: a. Before 24 years of age b. Midlife (25-54 years) c. Early elderly (55-79 years) d. 80+ years
a. Before 24 years of age
The cost of occupational injuries in the United States in the 1990's is exceeded only by the cost of: a. Cancer b. Chronic obstructive lung disease c. HIV/AIDS d. Diabetes e. Cerebrovascular disease
a. Cancer
The largest proportion of chronic diseases is/are: a. Cardiovascular b. Malignancies c. Diabetes d. Chronic obstructive respiratory disease e. Chlamydia
a. Cardiovascular
Diseases which are spread by the fecal/oral route usually infect primarily: a. Children under 5 years b. Adults above 65 years c. Young adults d. Middle-age adults
a. Children under 5 years
In the last 30 years, union membership has: a. Declined b. Increased c. Remained stable
a. Declined
Compromised mental health is best measured by which of the following metrics? a. Disability adjusted life years b. Mortality c. Years of productive life lost d. Prevalence e. Incidence
a. Disability adjusted life years
Completed suicide is ranked most highly as a cause of death among which of the following ethnic/age groups? a. European-American males 15-24 years b. African-American males 15-24 years c. Asian-American youth 15-24 years d. European-American females 25-44 years e. African-American females 15-24 years
a. European-American males 15-24 years
Obesity rates in the United States are lowest among: a. European-Americans b. Hispanic-Americans c. African-Americans d. Asian-Americans
a. European-Americans
A major source of lead for low-income children is: a. Flaking paint from old buildings painted years ago b. Ground lead c. Lead from waste dump sites d. Increasing levels of lead in well water e. Lead in fruits imported from developing countries
a. Flaking paint from old buildings painted years ago
The first step in implementing community change is to: a. Get the community to recognize the problem b. Getting the community to take responsibility for implementing change c. Changing community norms d. Imposing intervention strategies that have been proven to work in the United States
a. Get the community to recognize the problem
The concept of health promotion can be presented as an intersection of: a. Health education, prevention, and health protection b. Behavioral intervention, structural intervention, and biomedical intervention c. Health inspection, health literacy, and health education d. None of the above
a. Health education, prevention, and health protection
What was the most common disability among elderly Americans in 2010-20111? a. Hypertension b. Diabetes c. Stroke d. Asthma e. Heart disease
a. Hypertension
The most cost-effective strategy to reduce childhood obesity is: a. Improved nutritional standards for school lunches b. Tax on products with high sugar content c. Restaurant menu labeling d. Early care and education
a. Improved nutritional standards for school lunches
Which of the following metrics should be used to measure the spread of an epidemic? a. Incidence b. Prevalence c. Disability adjusted life years d. Years of potential life lost e. Morbidity
a. Incidence
The lifetime probability of developing tumors is higher for: a. Males b. Females
a. Males
In terms of weight distribution, is it healthier to be a pear or an apple? a. Pear b. Apple
a. Pear
The hierarchy of controls for occupational health and safety in order of increasing effectiveness is: a. Personal protective equipment, administrative controls, engineering controls, isolation, substitution, elimination b. Elimination, engineering controls, isolation, substitution, personal protective equipment, administrative controls c. Isolation, substitution, personal protective equipment, administrative controls, elimination, engineering controls d. Administrative controls, isolations, engineering controls, isolation, substitution, elimination
a. Personal protective equipment, administrative controls, engineering controls, isolation, substitution, elimination
The denominator for point incidence is: a. Population at risk at a single point in time b. Population at risk during a specified time period c. The population at the beginning of the interval being studied d. The population at the end of the interval being studied
a. Population at risk at a single point in time
Farming food organically is an example of: a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Quaternary prevention
a. Primary prevention
Immunization of elderly persons is an example of : a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Cure
a. Primary prevention
Promoting physical activity for the elderly is an example of: a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Sadism e. Unwarranted optimism
a. Primary prevention
Putting a "funnel lock" to prevent burns from multiple coffee makers is an example of: a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Quaternary prevention
a. Primary prevention
The segment of the labor market that has increased most rapidly from 1970 to 2005 has been: a. Self-employed workers b. Part-time workers c. Temporary workers d. Multiple-job holders e. Occasional workers
a. Self-employed workers
Which of the following diseases has been eradicated globally? a. Smallpox b. Ebola c. Dracunculus d. Polio e. Measles
a. Smallpox
The leading cause of death among rural women in China is: a. Swallowing pesticides b. Firearms c. Suffocation d. None of the above
a. Swallowing pesticides
Which of the following sexually transmitted infections disproportionally affects men who have sex with other men in Los Angeles? a. Syphilis b. Gonorrhea c. Chlamydia d. Papilloma
a. Syphilis
Concern about social norms is a component of: a. The Theory of Planned Behavior b. The Extended Parallel Process Model c. The Transtheoretical Model of Change d. Health education e. Health literacy
a. The Theory of Planned Behavior
Physician fees are highest in: a. The United States b. Germany c. Austria d. United Kingdom
a. The United States
The lifetime prevalence of diagnosed mental disorders is highest in which of the following countries? a. The United States b. Mexico c. New Zealand d. Ukraine e. South Africa
a. The United States
The proportion of the population covered under public health care programs in 2011 was lowest in: a. The United States b. Canada c. France d. Germany e. Netherlands
a. The United States
Which of the following countries has the most hours worked annually? a. The United States b. Japan c. Canada d. Britain e. Norway
a. The United States
Los Angeles is currently experiencing an epidemic of what arboviral (mosquito)-born virus? a. West Nile b. Japanese encephalitis c. Chikungunya d. Dengue e. Rift Valley fever
a. West Nile
The epidemiologist investigating an outbreak establishes a hypothesis regarding the disease in the order of: a. The probability of the hypothesis being correct commensurate with the observed characteristics of the health problem under investigation b. The time interval involved c. The characteristics of the persons most frequently involved d. The place characteristics of the health problem e. The time interval in which the health problem occurs
a. The probability of the hypothesis being correct commensurate with the observed characteristics of the health problem under investigation
The "predictive value positive" is: a. The proportion of persons testing positive who truly have the disease b. The proportion of persons with the disease who were tested c. The proportion of persons with the factor who test positive d. The proportion of persons testing negative who have the factor
a. The proportion of persons testing positive who truly have the disease
A high proportion of the homeless in Los Angeles suffer from mental disorders: a. True b. False
a. True
Although alcohol is considered to be a major risk factor for several chronic diseases, 1-2 glasses of red wine with dinner have been shown to reduce cardiovascular disease risk: a. True b. False
a. True
Although different methods to purify the water supply are used in different localities in the United States, the standards for drinking quality water are similar: a. True b. False
a. True
Behavioral Interventions directly target individuals to change their behavior: a. True b. False
a. True
Biostatistics is based on the principles of probability: a. True b. False
a. True
Confusion between health education and health promotion is one of the challenges for providing effective health education: a. True b. False
a. True
County hospitals are the last resource for health care for the uninsured in the United States: a. True b. False
a. True
Diabetes-related death rates among African-Americans in California are more than double those in European-Americans: a. True b. False
a. True
Dust, damp, wood smoke, and pollen are naturally occurring pollutants: a. True b. False
a. True
Epidemiology can be used to evaluate strategies used in implementation "science". a. True b. False
a. True
Exposure of the mother to high levels of ozone and associated pollutants is associated with elevated risk of poor reproductive outcome: a. True b. False
a. True
Folic acid supplementation for pregnant women reduces their risk of having a baby with spina birida, but can increase the mother's cancer risk: a. True b. False
a. True
Half of all health care dollars in the US go to 5% of the population: a. True b. False
a. True
Health is the result of a dynamic equilibrium involving agent, host and environment: a. True b. False
a. True
Health policy in the United States is largely determined by what health insurances pay: a. True b. False
a. True
Herpes infection is for life, unlike love, but treatment can suppress the likelihood of infecting others: a. True b. False
a. True
In the first decade of the 21st century, there was virtually no change in the low proportion of Americans who eat five varieties of fruits and vegetables per day: a. True b. False
a. True
Indoor pollutants cause more DALYs globally than outdoor pollutants: a. True b. False
a. True
Inducing anxiety regarding a health issue is an essential public health tool: a. True b. False
a. True
Measuring of lead levels in the blood can now be conducted in the home, workplace and other sites: a. True b. False
a. True
One problem with using averages in statistics is that they hide disparities. a. True b. False
a. True
Over 20% of persons with high blood pressure are unaware of their condition. a. True b. False
a. True
The "healthy penis" is a positive way to frame the topic of syphilis prevention and resulted in an increase in syphilis testing in San Francisco: a. True b. False
a. True
The Christian faith has more adherents than any other religion globally: a. True b. False
a. True
The cardiovascular disease *death rate* tends to be higher in low-income countries than in high-income countries: a. True b. False
a. True
The global population is predicted to reach at least 9 billion in the future: a. True b. False
a. True
Under the "Affordable Health Care Act (Obama-Care), physicians are required to reveal payments from drug companies and other health related organizations: a. True b. False
a. True
Which of the following testing strategies most strongly guarantees anonymity? a. Unlinked anonymous b. Voluntary confidential c. Mandatory d. Routine confidential e. Compulsory
a. Unlinked anonymous
Which is the most dangerous risk factor for cardiovascular disease? a. Visceral (belly) fat b. Butt fat c. Excess weight
a. Visceral (belly) fat
Which of the following has the highest proportion of Americans whose usual intake is below recommended levels? a. Vitamin D b. Vitamin E c. Vitamin C d. Niacin e. Vitamin B12
a. Vitamin D
Body mass index (BMI) is a simple index of weight-for-height that is commonly used to classify underweight, overweight and obesity in adults. It is defined as: a. Weight in kilograms divided by the square of the height in meters (kilograms/meters2) b. Weight in pounds divided by the square of the height in feet (pounds/feet2) c. Height in meters divided by the square of the weight in kilograms (meters/kilograms2) d. Height in feet divided by the square of the weight in pounds (feet/pounds2) e. None of the above
a. Weight (kg) / height (m)^2
IVDU behavior change
abstinence behavior, refraining from intravenous drug use Using sterile needle + syringe and sterile works
Tertiary Prevention
after a health problem has happened, maximize independence & quality of life (rehab)
Holy Trinity of Epidemiology: Disease Characteristics
agent host environment
How infectious diseases spread depends on
agent, host & enviornment
relationship between biomedical and behavioral interventions
almost all biomedical interventions ALSO require behavior changes
High income country highest cause is _________ air pollution; low-income country highest cause is __________ air pollution
ambient; household
The hypothesis used to explain the Hispanic Paradox that states that immigrants migrate back to where they originated from is the: a. Data Reliability Hypothesis b. "Salmon Bias" Hypothesis c. Healthy Migrant Hypothesis d. Risk Factor Hypothesis
b. "Salmon Bias" Hypothesis
Gonorrhea and chlamydia rates in the United States are highest in which age group? a. 15-19 year-olds b. 20-24 year-olds c. 25-29 year-olds d. 30-39 year-olds e. 75-80 year-olds
b. 20-24 year-olds
The human brain grows in size until: a. 1 year of age b. 4 years of age c. 10 years of age d. 25 years of age e. 80 years of age
b. 4 years of age
Epidemiology is: a. A body of knowledge b. A strategy/methodology for studying disease occurrence c. Primarily applicable to the clinical sciences d. All of the above e. a. and c. above
b. A strategy/methodology for studying disease occurrence
Removal of the pump handle in Golden Square by John Snow is an example of: a. The theoretical model of change b. A structural intervention c. Legislative intervention d. Behavior modification e. Malice
b. A structural intervention
The prevalence of obesity in the United States is highest among which of the following groups? a. European-Americans b. African-American women c. African-American men d. Asian-American men e. Hispanic-American women
b. African-American women
The prevalence of self-reported obesity is highest among which of the following groups in the United States? a. European-Americans b. African-Americans c. Hispanic-Americans d. Asian-Americans
b. African-Americans
In epidemiology, health can be described as an equilibrium between: a. Time, place and person b. Agent, host and environment c. Genetic and environment factors d. All of the above e. a. and c. above
b. Agent, host and environment
Cardiovascular disease was the leading cause of death among women in all of the ethnic groups below EXCEPT: a. African-Americans b. Asian-Americans c. European-Americans d. Hispanic-Americans
b. Asian-Americans
What can lead to decreases in gastrointestinal and chronic diseases? a. Less crowding b. Better quality of food c. Year-round access to vegetables and fruit d. All of the above
b. Better quality of food
Which of the following countries has the longest wait times to see a specialist? a. United States b. Canada c. Netherlands d. United Kingdom e. New Zealand
b. Canada
The death rates for which of the following diseases in Los Angeles is declining most rapidly? a. Diabetes b. Cardiovascular diseases c. Mental disorders d. Cancer e. Unintentional injuries
b. Cardiovascular diseases
If data can be organized in a 2X2 table, the appropriate test of significance is: a. Correlation analysis b. Chi square test c. Multiple regression analysis d. Logistic regression analysis
b. Chi square test
Which of the following surveillance strategies provides the least biased sample? a. Unlinked anonymous b. Compulsory c. Voluntary confidential d. Voluntary anonymous e. Voluntary participation
b. Compulsory
Disability rates among those older than 65 years in the United States are: a. Increasing b. Decreasing c. Remaining steady
b. Decreasing
Which disease is close to being eradicated next? a. Smallpox b. Dracunculus c. Polio d. Measles
b. Dracunculus
Which of the following interventions reduce drug use and risk of infection with HIV, HBV and HCV? a. Needle exchange programs b. Drug substitution programs c. Health promotion programs d. Overdose treatment programs
b. Drug substitution programs
The percent of Americans voting for Democratic candidates is declining among: a. Hispanic-Americans b. European-Americans c. African-Americans
b. European-Americans
Obesity is defined by nutritionists as: a. Excess body weight b. Excess fat c. BMI 25-30 kg/m2 d. a. and c. above
b. Excess fat
Prevalence measures: a. New cases b. Existing cases c. Deaths d. Susceptible persons e. The size of the denominator
b. Existing cases
Beta carotene supplements can reduce your risk of cancer: a. True b. False
b. False
Biomedical interventions do not require behavioral changes: a. True b. False
b. False
Chelation to remove blood levels of lead of children is associated with very few side effects: a. True b. False
b. False
Collective bargaining through unions in the US has increased in recent years: a. True b. False
b. False
Condoms are 100% effective in prevention of gonorrhea and chlamydia: a. True b. False
b. False
Congress recognizes the cost-effectiveness of shifting more health care dollars to prevention: a. True b. False
b. False
Disability adjusted life years due to mental illness are second only to cancer in frequency in the United States: a. True b. False
b. False
Diseases with a long incubation period are particularly suitable for sentinel surveillance of clinical cases to determine the current spread of infection: a. True b. False
b. False
Genetics is the most important factor in determining health status: a. True b. False
b. False
Health education is an essential element of health promotion: a. True b. False
b. False
Heart disease death rates for Asians/Pacific Islanders in the greater Los Angeles area are among the lowest in the United States: a. True b. False
b. False
In developed countries such as the United States, most individuals with mental disorders receive treatment: a. True b. False
b. False
Increasing health literacy can be considered as one of the outcomes of health protection: a. True b. False
b. False
Internationally, the health care costs of a country predict the quality of care: a. True b. False
b. False
More than half of the countries of the globe have reduced their obesity rates in adults in the last ten years: a. True b. False
b. False
Occupational diseases usually result in early symptoms, making diagnosis easy but attribution difficult: a. True b. False
b. False
Public health is an important component of medical care: a. True b. False
b. False
Routine reporting of positive laboratory tests is an example of active surveillance: a. True b. False
b. False
The fertility rate in the US in the last few decades has been enough to reproduce the population (sustain itself): a. True b. False
b. False
The majority of the world's population still lives in rural areas: a. True b. False
b. False
The mission of public health is to guarantee the health of the public: a. True b. False
b. False
Using a positive message to induce behavioral change is less effective than using a negative message to point out the consequences of continued bad health behavior: a. True b. False
b. False
Very detailed figures and graphs should be used to stimulate action by decision makers: a. True b. False
b. False
Worker contributions to health insurance have been increasing faster than employer contributions in the United States: a. True b. False
b. False
Only 2% of the planet's water is available for drinking, and agriculture accounts for 80% of all water use. a. True b. False
b. False (1%; 70%)
The highest proportion of persons with mental illness in the United States are treated by: a. Psychiatrists b. General practitioners c. Other mental health professionals d. By human services providers e. Alternative medicine practitioners
b. General practitioners
Smoking rates for youth aged 12-17 years are higher among: a. Boys b. Girls
b. Girls
Which of the following sexually transmitted infections is most difficult to treat? a. Syphilis b. Gonorrhea c. Chlamydia d. Papilloma (HPV)
b. Gonorrhea
The risk of breast cancer for women is highest among: a. Teachers b. Hairdressers and cosmetologists c. Lawyers d. Doctors e. Flight attendants
b. Hairdressers and cosmetologists
In 2015, the majority of Los Angelenos were: a. European-Americans b. Hispanic-Americans c. Asian-Americans d. African-Americans e. No single group was a majority
b. Hispanic-American
The highest proportion of poor and near-poor in California is among: a. African-Americans b. Hispanic-Americans c. European-Americans d. Asian-Americans e. Residents of Beverly Hills
b. Hispanic-Americans
The largest proportion of health care dollars in the United States goes to: a. M.D.s b. Hospitals c. Drugs d. Health care administrators
b. Hospitals
Among Americans older than 65 years, their greatest expenditure is for: a. Medications b. Housing c. Food d. Transportation e. Health care
b. Housing
The four major NCDs in the world include the following, EXCEPT: a. Cardiovascular diseases b. Hypertension c. Chronic respiratory diseases d. Diabetes e. Cancer
b. Hypertension
The major reason for the decline in the incidence of tuberculosis prior to the discovery of streptomycin was probably: a. Penicillin b. Improved housing and reduced crowding c. Development of more efficient modes of transportation d. Improved sanitation e. Flush toilets
b. Improved housing and reduced crowding
. Which one of the following characteristics is the MOST definitive of malignancy compared to benign tumors? a. Lack of differentiation b. Invasion and metastasis c. Polymorphism d. Abnormal mitoses e. Increase in nuclear-cytoplasmic ratio
b. Invasion and metastasis
Fertility and education are: a. Directly correlated b. Inversely correlated c. Not correlated
b. Inversely correlated
The top cause of death globally is: a. Lower respiratory infections b. Ischemic heart disease c. Diabetes d. HIV/AIDS e. Malaria
b. Ischemic heart disease
The country with the greatest proportion of its population over 65 years of age is: a. The United States b. Japan c. Brazil d. Italy e. China
b. Japan
The most common condition attributable to occupation is: a. Hearing loss b. Lower back pain c. Chronic obstructive pulmonary disease d. Asthma e. Leukemia
b. Lower back pain
Which of the following is responsible for the most infectious disease deaths globally? a. Diarrheal diseases b. Lower respiratory infections c. Malaria d. Tuberculosis e. Dengue fever
b. Lower respiratory infections
The most frequent mental disorder is: a. Anxiety b. Major depression c. Drug abuse d. Alcohol abuse e. Schizophrenia
b. Major depression
If Catholicism is considered to be a separate religion from Christianity, which religion has the most followers globally? a. Catholicism b. Muslims c. Hinduism d. Buddhism e. Jewish
b. Muslims
Which of the following chronic diseases is affecting African-Americans disproportionally? a. Gastric ulcers b. Obesity c. Atrial fibrillation d. Skin cancer e. Depression
b. Obesity
The U.S. Morbidity and Mortality Weekly Report uses which kind of surveillance? a. Anecdotal b. Passive c. Active d. Voluntary
b. Passive
Which of the following statements about health literacy is/are true? a. Health literacy is the same as health education b. People with low health literacy have poorer overall health c. Health literacy and healthy public policy make up health promotion d. a. and b. above e. All of the above
b. People with low health literacy have poorer overall health
To assess the extent of the current epidemic of HIV/AIDS surveillance systems should identify: a. Persons with current clinical AIDS b. Persons with current HIV infection c. Persons previously infected with HIV d. Recovered AIDS cases
b. Persons with current HIV infection
According to Professor Detels, the greatest cause of poor health is: a. Tobacco b. Poverty c. High blood pressure d. Diabetes e. Poor nutrition
b. Poverty
According to the Transtheoretical Model of Change (TMC) theory, the five stages that guide behavioral change are: a. Contemplation, preparation, inaction, action, reaction b. Precontemplation, contemplation, preparation, action, maintenance c. Precontemplation, contemplation, action, reaction, maintenance d. Contemplation, negotiation, action, inaction, maintenance
b. Pre-contemplation, contemplation, preparation, action, maintainence
Which measure is most useful for estimating the need for a high blood pressure treatment program in the community? a. Incidence b. Prevalence c. Deaths d. Susceptible males e. Susceptible females
b. Prevalence
Breast cancer screening is an example of what type of prevention? a. Primary b. Secondary c. Tertiary
b. Secondary
Regular health examinations and early detection of work-related health problems are examples of: a. Primary prevention b. Secondary prevention c. Tertiary prevention d. a. and b. e. b. and c
b. Secondary prevention
The major objective of the investigation into the unknown disease studied by Professor Detels in northern Luzon, Philippines in the 1960s was to: a. Confirm the causative agent as C. Philippinenesis b. Stop the epidemic c. Construct the diagnostic criteria of a case. d. Identify the affected population e. Select a suitable study site
b. Stop the epidmeic
Regulating air and water quality is an example of what type of public health intervention? a. Biologic b. Structural c. Behavioral d. Personal
b. Structural
The cause of the high lead content in the Flint, Michigan water was: a. The high lead level in the Detroit River b. The high acidity of the new water supply leaching lead from the pipes c. Installing new pipes that had a high lead content d. Leaching of lead into the ground water supply of Flint e. All of the above
b. The high acidity of the new water supply leaching lead from the pipes
The leading cause of death among males 15-24 years in the United States is: a. Stroke b. Unintentional injuries c. Diabetes d. Sickle cell anemia e. Heart disease
b. Unintentional injuries
Which of the following mental disorders is projected to be the second most frequent cause of disability adjusted life years globally by 2020? a. Schizophrenia b. Unipolar major depression c. Bipolar disorders d. Substance abuse disorders e. Obsessive-compulsive disorder
b. Unipolar major depression
The country with the highest prevalence of any mental/substance abuse disorder is: a. New Zealand b. United States c. Ukraine d. France e. Japan
b. United States
The highest proportion of the world' prisoners are in: a. Russia and Iraq b. United States and China c. Brazil and India d. Syria and Saudi Arabia e. England and Germany
b. United States and China
What most likely explains the 'bump' in cancer incidence in males in the U.S. during the early 1990's? a. Historical tobacco use patterns in males b. Utilization of the PSA screening test c. Increasing prevalence of obesity d. Exposure to the chemical Agent Orange during the Vietnam War
b. Utilization of the PSA screening test
Ebola virus is: a. Not very infectious b. Very virulent c. Has a 100% case fatality rate d. Occurs only in Liberia e. All of the above
b. Very virulent
Which of the following groups of agents can only replicate intracellularly? a. Bacteria b. Viruses c. Chlamydia d. Protozoa e. Cestodes
b. Viruses
The most precious resource globally is: a. Oil b. Water c. Forests d. Iron e. Bauxite
b. Water
Elderly Hispanic-Americans are ________________ likely to vote for Democrats than/as elderly European-Americans: a. less b. more c. equally as
b. more
what is a potential benefit of bioinformatics and medical informatics in disease prevention?
based on the individual's profile, it will be possible to formulate individual tailor-made guidelines for a healthier life
What does the Infant Mortality in Genesse County example have to do with Biostatistics?
because statisticians help gather, analyze and interpret the data necessary for convincing the public and policy makers - the infant mortality sparked new policies
what is the highest contributor to premature death?
behavioral patterns (smoking, alcohol, poor diet, lack of exercise, environmental hazards)
environment
biologic and chemical pollution, climate change, deforestation
How was Infectious disease burden driven down in the 20th and 21st century?
by improved living conditions, better sanitation, and piped water supplies in High-income countries (HICs) Mid-20th century: safe, effective, and affordable vaccines and antibiotic availability that further reduced infectious disease toll in HICs late 20th century: ^^same effort to control infectious disease i low and middle income countries
In 2012, ___ million deaths were due to NCDs in the world, accounting for ___% of overall deaths globally: a. 56, 82.1 b. 48, 73.4 c. 38, 67.9 d. 28, 53.6 e. 17.5, 46.2
c. 38 million deaths; 67.9% of overall global deaths
The population of the world as of September 2016 is: a. 2.3 billion b. 4.6 billion c. 7.5 billion d. 15 billion e. 30 billion
c. 7.5 billion
NHANES is: a. A recommended dietary plan for individuals desiring to lose weight b. A recommended dietary plan for athletes trying to "bulk up" c. A national survey measuring health-related factors in a sample of Americans d. A plan to promote the health of Americans e. Health guidelines for Americans
c. A national survey measuring health-related factors in a sample of Americans
To measure the prevalence of breast cancer among women in Los Angeles for the year 2015, what breast cancer cases would we count in the numerator? a. All breast cancer cases reported to the California Cancer Registry in 2015 b. All breast cancer cases ever reported to the California Cancer Registry c. All currently surviving breast cancer cases ever reported to the California Cancer Registry
c. All currently surviving breast cancer cases ever reported to the California Cancer Registry
The Environmental Protection Agency was successful in completely banning all of the pollutants below EXCEPT: a. Lead in gas b. DDT pesticides c. Asbestos from all insulating material
c. Asbestos from all insulating material
The greatest contributor to premature death in the United States in 2007 was/were: a. Genetic predisposition b. Social circumstances c. Behavioral patterns d. Environmental exposures e. Health care errors
c. Behavioral patterns
Life expectancy is increasing in: a. Developed countries only b. Developing countries only c. Both developed and developing countries
c. Both developed and developing countries
The state with the highest incidence of West Nile virus cases recently is: a. Arkansas b. Texas c. California d. Mississippi e. New York
c. California
Which group of diseases were responsible for 17.5 million deaths per year (31% of all deaths) and are the leading causes of death in the world based on 2012 WHO data? a. Cancers b. Cardiovascular diseases c. Chronic respiratory diseases d. Diabetes
c. Cardioavascular diseases
Which of the following sexually transmitted infections is most common in Los Angeles? a. Syphilis b. Gonorrhea c. Chlamydia
c. Chlamydia
The prevalence of depression is: a. Higher in males across age groups b. Closely related to ethnicity c. Closely related to socio-economic status d. None of the above
c. Closely related to socio-economic status
The Transtheoretical Model of Change: a. Suggests individuals engage in assessments of threat and self-efficacy when presented with risk messages b. Includes the concept of "reciprocal determinism" c. Describes five stages individuals progress through when attempting to change a health behavior d. Is not a known health behavior theory
c. Describes (5) stages individuals progress through when attempting to change a health behavior
Which of the following parameters of the reproductive rate affects the reservoir of infection the most? a. Transmission efficiency b. Contact rate c. Duration of infectiousness d. Intensity of love-making
c. Duration of infectiousness
Foods that increase your risk of cancer are: a. Carbohydrates and red meat b. Vitamins and fats c. Fats and red meat d. Carbohydrates and fat e. Carbohydrates and nuts
c. Fats and red meat
The highest proportion of treated mental disorders are seen by: a. Psychiatrists b. Human services providers c. General practitioners d. Nurses e. Alternative medicine practitioners
c. General practioners
The second leading cause of pre-mature death in Los Angeles County is: a. Cardiovascular diseases b. Cancer c. Homicide d. Suicide e. Diabetes
c. Homicide
The cost of adverse health conditions in the United States was highest for which of the following categories? a. Cancer b. Cardiovascular disease c. Injuries d. Diabetes e. Chronic obstructive respiratory diseases
c. Injuries
The relationship between lead content in the body of children and IQ is: a. Direct b. Indirect c. Inverse d. Stable at all levels
c. Inverse
The most important initial requirement for a vaccine is: a. It must be easy to administer b. It must elicit an immune response c. It must be safe d. It must be easy to transport
c. It must be safe
The most common first language globally is: a. English b. Spanish c. Mandarin d. Arabic e. Tagolog
c. Mandarin
The best test to identify chlamydia infection is: a. Serology (antibodies) b. Isolation c. Polymerase chain reaction (PCR)/nucleic acid testing d. Microscopy
c. Polymerase chain reaction (PCR)/nucleic acid testing
Which of the following is NOT a key element of surveillance? a. Timely analysis b. Dissemination of results c. Precise diagnosis d. Action based on results e. Ongoing collection of data
c. Precise diagnosis
Among the following, which caused the highest number of deaths in 2011? a. Firearms b. Illicit drugs c. Prescription drugs d. Tylenol
c. Prescription drugs
The third most common cause of mortality in China in 2010 was: a. Cancer b. Cardiovascular diseases c. Respiratory diseases d. Digestive disease e. Neurologic diseases
c. Respiratory diseases
Which of the following factors in the model presented by Professor Fielding contributes most to ill health? a. Health behaviors b. Clinical care c. Social and economic factors d. The physical environment
c. Social and economic factors
Which region of the US has the highest prevalence of obesity (BMI>29)? a. Pacific Northwest b. Northeast c. South d. West e. Hawaii
c. South
Chlorination of the water supply is an example of: a. Health education b. Health promotion c. Structural intervention d. The theory of planned behavior e. The extended parallel process model
c. Structural intervention
The largest share of health care costs in the United States are paid by: a. Employee-based health insurance plans b. "Out of pocket" by the individual c. The U.S. government d. Kaiser-Permanente e. Blue Shield
c. The U.S. government
Which of the following countries has the highest survival rates for breast cancer? a. Sweden b. United Kingdom c. The United States d. Denmark e. Germany
c. The United States
The "epidemiologic transition" is: a. The continued high incidence of both infectious and chronic diseases in developing countries b. The decline of chronic diseases in developed countries c. The persistence of infectious diseases and the increasing incidence of chronic diseases in developing counties d. The decline in both chronic and infectious diseases in developing countries
c. The persistence of infectious diseases and the increasing incidence of chronic diseases in developing counties
The appeal of formula rather than breast milk for feeding newborns in developing countries is due to: a. Their better nutritional value b. Their higher calorie density c. Their appeal as a status symbol of wealth d. Their great sanitary value e. a. and b. above
c. Their appeal as a status symbol of wealth
Obesity in the adult population is highest in: a. Sweden b. Japan c. United States d. Canada e. United Kingdom
c. United States
What can lead to decreases in vitamin deficiency diseases? a. Less crowding b. Better quality of food c. Year-round access to vegetables and fruit d. All of the above
c. Year-round access to vegetables and fruit
cross- sectional studies
can be used to compare incidence of disease in comparable populations receiving and not receiving the prevention program
The period of greatest growth in the world's population was: a. 1750-1849 b. 1850-1899 c. 1900-1950 d. 1950-2000
d. 1950-2000
A tumor is characterized by: a. Autonomous growth of tissue b. Abnormal growth of cells c. Irreversibility d. All of the above e. a. and c. above
d. All of the above
An epidemic is driven by: a. The reproductive number b. Availability of susceptible individuals c. Transmission probability per contact d. All of the above e. The mortality rate
d. All of the above
Behavioral Intervention planning at the community level requires: a. Assessing the needs and assets of the target population b. Developing program goals and objectives c. Evaluating the effectiveness of the intervention d. All of the above e. a. and b. above
d. All of the above
Behavioral risk factors for cardiovascular diseases include: a. Diet b. Physical inactivity c. Obesity d. All of the above e. b. and c. above
d. All of the above
Belief in the ability of the individual to adopt a new behavior is a component of the: a. Social Cognitive Theory b. Extended Parallel Process Model c. Transtheoretical Model of Change d. All of the above e. a. and c. above
d. All of the above
Cancer mortality rates from 1988-2000 declined among: a. European-Americans b. African-Americans c. Asian-Americans d. All of the above e. a. and c. above
d. All of the above
Chronic diseases are usually characterized by: a. Non-communicability b. Long duration c. Slow progression d. All of the above e. a. and c.
d. All of the above
Epidemiology is useful to: a. Establish the history of a disease in a community b. The natural history of a disease in an individual c. Identifying risk factors for occurrence of a disease d. All of the above e. Which preventive measures should have been used
d. All of the above
HIV incidence can be estimated by: a. Laboratory testing b. Identification of HIV in young (<21 years) sex workers c. Identification of HIV in military recruits (< 21 years) d. All of the above
d. All of the above
Immunizations require: a. Biomedical strategies b. Behavioral strategies c. Susceptible populations d. All of the above e. a. and c. above
d. All of the above
Increasing costs of health care in the United States are due to: a. Aging of the population b. Increasing technology of medical care c. The highly personalized approach to health care in the United States d. All of the above e. a. and b. above
d. All of the above
Insurance coverage in the United States is assisted by: a. Income-based government subsidies b. Employer-mandated coverage c. Individual mandated coverage d. All of the above e. Social Security
d. All of the above
Job disparities impact primarily: a. Older workers b. Minority workers c. Women workers d. All of the above e. b. and c. above
d. All of the above
Methyl mercury: a. Is concentrated in fish. b. Was responsible for the Minamata epidemic in the 1950s c. Primarily affects fetuses and young children d. All of the above e. b. and c. above
d. All of the above
Surveillance can be implemented in: a. Human populations b. Animal populations c. Special groups within a population d. All of the above e. a. and b. above
d. All of the above
Surveillance can be used to monitor: a. Prevalence/incidence of disease b. Emerging diseases c. Distribution of individuals engaging in risk practices for a disease d. All of the above e. a. and b. above
d. All of the above
The Environmental Protection Agency has responsibility for environmental: a. Research b. Monitoring c. Enforcement d. All of the above e. a. and b. above
d. All of the above
The difference between the Guatemalan diet and the typical American diet is: a. More vegetables b. Less meat c. Less processed foods d. All of the above e. a. and c. above
d. All of the above
The epidemiologist describes health/disease occurrence using. a. Time b. Place c. Person d. All of the above e. a. and b. above
d. All of the above
The function of public health is: a. Assessment b. Policy setting c. Assurance d. All of the above e. Research
d. All of the above
The objective of a vaccine can be to prevent: a. Infection b. Disease c. Transmission d. All of the above e. Exposure
d. All of the above
The proportion of which of the following types of workers is projected to increase in the next three years? a. Minorities b. Workers older than 55 years c. Women d. All of the above e. a. and b. above
d. All of the above
The results of surveillance for new strains of influenza should be reported to: a. Decision makers b. The data collectors c. The public d. All of the above e. Only to infectious disease specialists who can understand the results
d. All of the above
The role of the biostatistician in assessment is: a. Deciding what information to collect b. Identifying patterns in collected data c. Summarizing the characteristics of the population and associated problems d. All of the above e. Judging the situation
d. All of the above
The role of the public health professional is to: a. Establish surveillance for unusual diseases and drug resistant agents b. Assure competent laboratory resources c. Develop plans for handling outbreaks of unknown agents d. All of the above e. a and c. above
d. All of the above
To promote health, the U.S. Centers for Disease Control and Prevention emphasizes: a. Smoking cessation b. A healthy diet c. Regular exercise d. All of the above e. b. and c. above
d. All of the above
Which of the following can be used to prevent the spread of a disease? a. Isolation of cases b. Quarantine of exposed individuals c. Culling of diseases flocks, herds d. All of the above e. a. and b. above
d. All of the above
Which of the following drive an epidemic? a. Reproductive number >1 b. Transmission probability per contact c. Availability of susceptible individuals d. All of the above e. b. and c. above
d. All of the above
Which of the following health problems is projected to increase in the next decade? a. Cardiovascular (ischemic heart disease and stroke) b. Cancer c. Road traffic accidents d. All of the above e. a. and b. above
d. All of the above
Which of the following statements about suicide are true? a. Suicide is the primary cause of death among those 15-24 years old b. The majority of suicides occur in men c. Firearms are the most common method of death by suicide d. All of the above
d. All of the above
Breast feeding rates in the United States are highest among: a. European-Americans b. Hispanic-Americans c. African-Americans d. Asian-Americans
d. Asian-American
Below are examples of biomedical interventions, EXCEPT: a. Influenza vaccine b. Nicotine patch (e.g., NicoDerm) c. Antiretroviral therapy (HIV medication) d. Diet and exercise
d. Diet and exercise
What is considered as the most effective ingredient to a successful behavioral intervention? a. Providing information b. Documenting all the training sessions c. Teaching tools and skills d. Framing the issue
d. Framing the issues
What are the four leading risk factors for non-communicable disease deaths? a. High blood pressure, high blood sugar, alcohol abuse, indoor air pollution b. Genetic predisposition, tobacco use, unsafe sex, physical inactivity c. Alcohol abuse, genetic predisposition, tobacco use, unsafe sex d. High blood pressure, high blood sugar, tobacco use, physical inactivity
d. High blood pressure, high blood sugar, tobacco use, physical inactivity
Which global income group has the highest crude cancer mortality rate based on World Bank Income Group in 2012? a. Low income b. Lower-middle income c. Upper-middle income d. High income
d. High income
The country with the longest longevity among males is: a. United States b. Switzerland c. Canada d. Iceland e. Bangladesh
d. Iceland
events & their probabilities
dying from lung cancer = an "event" probabily is the science that describes such events
Which of the following countries has the longest life expectancy for women? a. Luxembourg b. Switzerland c. The United States d. Japan e. Singapore
d. Japan
The most common cancer site in Mongolia is _____________ for men and ______________ for women a. Prostate cancer, breast cancer b. Lung cancer, cervical cancer c. Stomach cancer, esophageal cancer d. Liver cancer, liver cancer
d. Liver cancer, liver cancer
If the outcome is binary (yes/no) and the covariates are on a scale, the appropriate model to use is: a. Correlation analysis b. Chi square test c. Multiple regression analysis d. Logistic regression analysis
d. Logistic regression analysis
The most deadly air pollution in recent history occurred in: a. Meuse River Valley, Belgium in 1930 b. Donora, Pennsylvania in 1948 c. Los Angeles in 1954 d. London in 1952
d. London in 1952
Non-communicable diseases (NCDs) are the following medical conditions or diseases, EXCEPT: a. Most likely not infectious b. Have long duration c. Relatively slow progression d. Mainly diarrheal diseases, tuberculosis, and malaria e. Usually called "chronic disease"
d. Mainly diarrheal diseases, tuberculosis, and malaria
Heart disease death rates for African-Americans older than 35 years of age are lowest in which of the following region(s) of the United States? a. West b. South c. Northeast d. Midwest e. Texas
d. Midwest
The largest outbreak of Middle Eastern respiratory syndrome (MERS) recently was in: a. Saudi Arabia b. Yemen c. Syria d. South Korea
d. South Korea
The largest outbreak of Middle Eastern respiratory syndrome (MERS) recently was in: a. Saudi Arabia b. Yemen c. Syria d. South Korea e. Syria
d. South Korea
On a population basis, the highest cost of health care occurs in: a. Early life b. Adolescence c. Middle age d. The last year of life
d. The last year of life
Which country has the highest per capita expenditure for health care? a. Spain b. Norway c. United Kingdom d. United States e. Japan
d. United States
Which of the countries below spend the most money treating obesity? a. European countries b. Brazil c. India d. United States e. Thailand
d. United States
The diet that will contribute least to climate change is: a. Global average diet b. Mediterranean diet c. High fish diet d. Vegetarian diet
d. Vegetarian diet
Benign tumors do not: a. Penetrate or invade other tissue b. Metastasize to distant sites c. Remain localized d. a. and b above
d. a. and b above
The following is true of fertility rates globally: a. Increasing fertility is associated with decreasing educational attainment for girls b. Increasing fertility is associated with increasing proportion of poverty c. Fertility is not related to either educational attainment or poverty d. a. and b. above
d. a. and b. above
OSHA protection is: a. Under-utilized by eligible workers b. Available for all work-related injuries and workers c. Not available in all situations d. a. and c. above
d. a. and c.
People with positive mental health: a. Think positively b. Keep mentally active c. Participate in social networks d. a., b. and c. above e. See a psychiatrist regularly
d. a., b. and c. above
big data
databases with huge amounts of data
increasing fertility is associated with:
decreasing educational attainment for girls and increasing proportion of poverty
Positive Predictive Value (PPV)
describes the probability of having the disease given a positive screening test (# of true test positives) / (total # of test positives) Higher prevalence in population → higher PV+
Negative Predictive Value (NPV)
describes the probability of not having the disease given a negative screening test result (# of true test negatives) / (total # of test negatives) Higher prevalence in population → lower PV-
Role of Biostatistics in: Policy Setting
develop mathematical tools to: - measure the problems - prioritize the problems - quantify associations of risk factors with disease - estimate cost, including monetary & undesirable side effects of preventative and curative measures
Does the majority of the world's population live in developing or developed countries? Urban or rural areas?
developing (China, India, Bangladesh). rural.
although fertility is declining, increases n population will occur primarily in _____ countries in coming decades
developing countries
where does the majority of the worlds population live?
developing countries
where is population density greatest?
developing countries ( mostly China & india)
DALYs
disability adjusted life years; a single measure to quantify the burden of diseases, injuries, and risk factors sum of YLD and YLL
What metric best measures comprised mental health?
disability-adjusted life years
re-emerging diseases
disease has been known, but now some element is "novel" ex: Ebola, TB, cholera
What is an re-emerging disease?
disease has been known, but now some element is "novel" (e.g. Ebola, TB, cholera)
What is Airborne spread for infection of infectious disease?
dust or droplet nuclei suspended in the air
. A planned approach to health education requires: a. Engaging and understanding the priority population b. Planning an intervention c. Implementing the intervention d. Evaluating the importance of the intervention e. All of the above
e. All of the above
Rapid population growth affects: a. The environment b. Resources and energy c. The economy d. Social structure e. All of the above
e. All of the above
Which of the following contributed to increased life expectancy globally? a. Improved sanitation b. Provision of clean water c. Improved housing d. Universal childhood immunization programs e. All of the above
e. All of the above
Which of the following factors has the highest attributable risk of death? a. Unsafe sex b. Elevated blood glucose c. Physical inactivity d. Smoking e. Elevated blood pressure
e. Elevated blood pressure
The four major preventable risk factors for NCDs defined by WHO are the following, EXCEPT: a. Tobacco use b. Physical inactivity c. Unhealthy diet d. Harmful use of alcohol e. Genetic susceptibility
e. Genetic susceptibility
African-Americans are over-represented in which jobs? a. Garbage collectors b. Nursing home aides c. Police officers d. All of the above e. a. and b. above
e. a. and b. above
An ideal exercise fitness regimen should include: a. 75 minutes of vigorous-intensity aerobic activity per week b. Two or more days a week of muscle-strengthening activity c. Ten minutes of moderate exercise daily d. Drinking high-energy drinks while exercising e. a. and b. above
e. a. and b. above
Epidemiology studies the: a. Frequency of disease b. Distribution of disease c. Molecular profile of an infectious agent d. All of the above e. a. and b. above
e. a. and b. above
Food labeling (for calories, fat, etc. content) has: a. Made Americans more conscious of what and how much they eat b. Prompted restaurants to modify their menus c. Angered Americans who like to think they are getting more for their money d. Encouraged restaurants to increase their portion sizes e. a. and b. above
e. a. and b. above
Most countries of the world have: a. A mental health policy b. A mental health plan c. Sufficient mental health professionals d. All of the above e. a. and b. above
e. a. and b. above
Natural ecosystems provide the following service(s): a. Pollution filtration of water b. Fish c. Electricity d. All of the above e. a. and b. above
e. a. and b. above
Statistical models rely on the assumption(s) that: a. The probability of the event is equally likely for all members of the group b. An event in one person is independent of the event in another person c. Some members of the group are more likely to experience the event d. All of the above e. a. and b. above
e. a. and b. above
The Hispanic-American population in Los Angeles has: a. The lowest levels of health insurance among the major ethnic groups b. Relatively favorable measurements for health indicators c. The highest rates of single-parent families d. All of the above e. a. and b. above
e. a. and b. above
The average age of Americans is increasing because: a. There are fewer babies being born b. Mortality rates are declining c. Americans consume high amounts of red meat and processed meats d. All of the above e. a. and b. above
e. a. and b. above
The biostatistician uses mathematics to: a. Measure the problem b. Predict the effect of changes c. Reduce the non-response rate d. All of the above e. a. and b. above
e. a. and b. above
The following characteristics should be evaluated in assessing quality of surveillance: a. Sensitivity b. Flexibility c. Clinically accurate diagnosis d. All of the above e. a. and b. above
e. a. and b. above
The last cases of wild-type polio virus occurred in: a. Pakistan b. Afghanistan c. Egypt d. Ethiopia e. a. and b. above
e. a. and b. above
The recent outbreak of measles in Los Angeles is due in part to: a. A lack of herd immunity among young people b. Reluctance of parents to have their children vaccinated c. Increased virulence of the measles virus. d. All of the above e. a. and b. above
e. a. and b. above
The strategy of epidemiology is to characterize disease in terms of: a. Time, place, person b. Agent, host, environment c. Incubation period, disease course, outcome d. All of the above e. a. and b. above
e. a. and b. above
Use(s) of surveillance include(s): a. Monitoring changes in prevalence b. Monitoring changes in incidence c. Documenting past clinical disease d. All of the above e. a. and b. above
e. a. and b. above
Examples of structural interventions include: a. Increasing tobacco taxes b. Mandating helmet law in Hanoi, Vietnam c. Teaching patients how to communicate with providers d. All of the above e. a. and b. only
e. a. and b. only
What types of interventions can be applied to promote smoking cessation? a. Behavioral intervention b. Structural intervention c. Biomedical intervention d. All of the above e. a. and b. only
e. a. and b. only
Alzheimer's disease is characterized by: a. Short-term memory loss b. Rapid onset c. Relative preservation of long-term memory d. All of the above e. a. and c. above
e. a. and c. above
The risk of autism is higher in: a. Males b. Females c. Higher socioeconomic groups d. In children of young parents e. a. and c. above
e. a. and c. above
Key elements of surveillance include: a. Timely analysis b. Dissemination of results c. Action based on results d. Accurate diagnosis e. a., b., and c. above
e. a. b. and c. above
Low health literacy: a. Can cause people to wait longer to seek medical care b. Can lead to misuse of medication c. Is associated with a better overall health status d. Can lead to overuse of emergency care e. a., b., and d. above
e. a., b., and d.
According to Dr. Richard Jackson, the purpose of public health is to: ______.
fulfill society's interest in assuring the conditions in which people can be healthy.
Catalytic converters to reduce tailpipe emissions from cars: a. Remove tetraethyl lead from gas b. Become inoperative if tetraethyl leaded gas was used c. Are required in all new cars d. All of the above e. b. and c. above
e. b. and c. above
Evidence in favor of direct person-to-person transmission of C. philippensis include: a. Age-gender distribution of initial cases b. Distribution of cases in multiple households c. The impact of treatment on the reservoir of the parasite d. All of the above e. b. and c. above
e. b. and c. above
The diagnostic criteria for a disease in a surveillance system should be: a. Highly accurate b. Functional to use c. Reasonably accurate d. a. and b. above e. b. and c. above
e. b. and c. above
The total dependency ratio is increasing because: a. More babies are being born b. Americans are living longer c. The proportion of Americans aged 19-64 years is declining d. All of the above e. b. and c. above
e. b. and c. above
Epidemiology is: a. A body of knowledge b. A methodology c. The core science of clinical medicine d. The core strategy of public health e. b. and d. above
e. b. and d. above
The intervention strategy that the Thai's used to reduce the HIV rate in sex workers was: a. Focusing intervention efforts on empowering sex workers b. Focusing prevention efforts on the brothel owners c. Focusing on identifying Astreet walkers d. Making brothel owners implement the 100% condom rule e. b. and d. above
e. b. and d. above
The gender ratio (M:F) globally is greater than 1 until 55 years because: a. Females are more fragile and die earlier b. Males are strong c. The gender ratios (M:F) in the two most populous countries are higher for age groups under 55 years d. In the two post populous countries, girls are less valued and therefore are neglected and many die early or are aborted. e. c. and d. above
e. c. and d above
The average American diet has very little: a. Calories b. Red meat c. Fruits d. Vegetables e. c. and d. above
e. c. and d. above
what does population density promote?
emerging diseases
trinity of disease descriptors of epidemiology
epidemiologists describe diseases/states in terms of time, place and person
Describe the chain of infection
etiologic agent -> reservoir (humans, animals, environment) -> portal of exit -> mode of transmission (direct, indirect, intermediate host) -> portal of entry -> susceptible host
Big Data
ex: microarrays = gene expression patterns are compared between different tissue samples ex: genomics, electronic health records, social media, amazon, target - very large sample
Biological Control for controlling vector borne spread of disease
example: Introducing sterile males, but this is incredibly expensive Problem: if you don't have enough geographic separation like an island, introducing sterile males does not have a large impact
TRUE OR FALSE: the majority of the world's population still lives in rural areas
false
Breast feeding, how long? danger of not breast feeding in developing countries?
first 4-6 months - not breast feeding doubles infant mortality rate (developing countries)
What is a major source of lead for low-income children?
flaking paint from old buildings painted years ago
Rate
frequency with which an event occurs in a defined population over a period of time. Compares across locations, times, and groups and should be reported in some unit of time. Ex= 70 new cases of breast cancer per 1,000 women per year or "Out of people attending a picnic, 20 out of 130 persons developed diarrhea representing the attack rate of diarrhea)
Vitamin D
from the sun - those with dark skin at risk of deficiency
What are some ethical issues of big data?
future availability of individual biological profiles made possible by bioinformatics and medical informatics cause cause ethical issues - discrimination based on whether a person smokes or is overweight - eligibility for health and life insurance can become threatened by whether they fit certain criteria based on genetic profiles - employment opportunities may also be jeopardized
host
genetic profile, immune capacity, poverty, nutritional status
at what rate is the WORLDS population growing?
growing ~1.1% per year
Ottawa Charter for Health Promotion
health as a resource for everyday life, not the objective of living. It is one expression of what is often designated as positive health
Positive/Negative Health
health as a resource for everyday life, not the objective of living. It is one expression of what is often designated as positive health: includes the capacity for living a full and productive life Negative dimension of health includes diseases and their consequences
Trinity of disease characteristics of epidemiology
health is a state of equilibrium between agent, host, and environment
What are the most common causes of death in population age 65+?
heart disease, cancer, stroke, lung conditions, alzheimer's disease, diabetes
Patterns of Environmental related Death by Country Income Level
high income countries have more laws and regulations about limiting air pollution in things like cars Being in the upper + lower middle income countries appears to be problematic for both ambient and household air pollution
how is infant mortality linked to the development of the country
highest child mortality = least developed
What country income level (low, middle, high) has the highest radon levels?
highest income countries but also have fewest deaths
Epidemiologic Triad
host, agent, environment Interaction between an external agent and a susceptible host in an environment that supports transmission=DISEASE
Screening test Sensitivity:
how good is the test at finding all those with disease in a screened population (i.e. more sensitive = fewer false negatives)
What are the most prevalent conditions in population age 65+?
hypertension, arthritis, heart disease, cancer, diabetes, vision limitation
Radon Exposure and health effects
i. Chemically inert radioactive gas ii. Concentrates in enclosed spaces iii. Thought to be the 2nd leading cause of lung cancer
Mercury exposure and health effects
i. Naturally occurring but can be toxic when released into the environment ii. Mercury in fish: 1. Biggest mercury exposure source in U.S. 2. Bigger fish have more
What are some intervention strategies?
immunization programs, health education, behavioral modification strategies, community intervention/mobilization, structural interventions (laws, regulations)
What has increased life expectancy?
improved sanitation, clean water, improved housing, universal immunization, health education/prevention, improved treatment and prevention of chronic diseases
What are the major reasons for increased longevity?
improved sanitation, provision of clean water, improved housing, universal immunization programs, health education and prevention practices, improved treatment and prevention of chronic diseases (for recent advances)
what would you use to measure the spread of an outbreak?
incidence
Prevalence of suicide in US since 1999
increasing for both males and females and across most age groups
global _____ remains a major problem
inequity
Number 1 cause of death in high income countries?
ischaemic heart disease
The top cause of death globally?
ischemic heart disease
Top causes of death worldwide for the past 15 years
ischemic heart disease and stroke
Prevalence of suicide in ages 15-19
it is the 2nd leading cause of death for this age group
What is droplet spread for infection of infectious disease?
spray from sneezing, coughing, talking
The most common cancer site in Mongolia is _____________ for men and ______________ for women
liver cancer, liver cancer
if the outcome is binary (yes/no) and the covariates are on a scale, the appropriate model to use
logistic regression analysis
Changes in any one of these three factors (agent, host, envior) may result in _______
loss of health
Top infectious/communicable cause of death
lower respiratory infection
Number 1 cause of death in low income countries?
lower respiratory infections
What is responsible for the most infectious disease deaths globally?
lower respiratory infections
chain of infection
made up of six different links: - pathogen (infectious agent) - reservoir - portal of exit - means of transmission - portal of entry - the new host.
What is the life expectancy difference between caucasian and african-americans at birth for both males and females?
males: 6.2 females: 4.5
Incidence Rate
measure of incidence that incorporates time directly into the denominator. Each person is observed until 1) disease onset, 2) death, 3) migration out of study, or 4) end of the study. Calculate by (# of new cases of disease during a specified time period) /( Time each person was observed, totaled for all persons) Ex: Incidence rate of heart disease among women in a cohort study was 2.5 cases per 1000 person years
What are the most debilitating conditions in population age 65+?
mental distress, stroke, vision limitation, hearing limitation, diabetes, lung conditions
the worlds wealth is concentrated in a _____ of countries
minority of countries
Use(s) of surveillance include(s):
monitoring changes in prevalence monitoring changes in incidence
why are children particularly vulnerable to environmental exposures (Ex: lead)?
more surface area per weight - lead has negative effect on child brain development
% of children exposed to secondhand smoke
more than 50%
Household Pollution and health effects
mostly open fire and use of coal in spaces with limited/no ventilation. Respiratory infections
how to prevent infection from airborne disease
negative pressure room, mask respirators, limiting patient movement to essential purposes
is the death rate the lowest in the US
no
HIV pattern of infection since 2000
no longer on top 10 of disease. Why? Possibly due to increase in other diseases? Decrease partially due to better medicine (1.5 to 1 million)
incidence
number of NEW cases of disease within a given time period divided by number of people at risk during that time period - rate - needs time period
prevalence
number of cases of EXISTING disease at a point in time divided by number of people in population at the same time - how many people are living with a disease at a given time
Overall trend of global Burden by Age
overall decrease and most dramatic for years 5 and under
What parts of the world have more than 45 DALY years? - lose more than 45 "healthy years"
parts of africa, afganistan, iraq
How was the ACA financed?
payroll tax increase Cadillac tax for most expensive insurance (repealed) Reduce payments to Medicare managed care plans 10% tax on indoor tanning services
Contact precautions
placement in private room, gloves + gown, limiting patient movements to essential transport, dedicating equipment to a single patient only
High Fertility Rate is related to ______
poverty - positive correlation
A model is referred to as having a binomial distribution when the outcome can be expressed as yes/no or as present/not present: a. True b. False
present:
Chemoprophylaxis
prevention of infection or its progression to clinically manifest disease through the administration of chemical substances, including antibiotics
The Functions of Public Health: Policy Setting
prioritize problems, find possible solutions, set regulations to achieve change and predict effect on the population
What are the pros and cons of a case-control study?
pros: Less costly, completed relatively quickly. cons: subject to confounding, difficult to establish exposure timeline, recall of exposure status can vary in accuracy
The Functions of Public Health: Assurance
provide services as determined by policy and monitor compliance
Male vs female suicide rates:
rates for men are 4X higher
Ratio
relative magnitude of two quantities, calculated by dividing rate of one group over rate of another group
what was the 3rd most common cause of mortality in china in 2010?
respiratory diseases
Why was the Nuremberg code created and what does it protect?
response to unethical medical experiments being practiced on Jews, Roma, and political prisoners during WWII by Nazi doctors, the Nuremberg Code was written to protect research participants
Quarantine
separation and restriction of movement of well persons who may have been exposed TO SEE if they become ill
Isolation
separation of infected persons from others to prevent/limit direct or indirect transmission of infectious agents 2 levels: - Standard (universal) precautions for the care of ALL hospitalized patients (ex: handwashing, using gloves) - Transmission Based Precautions level for the care of patients SUSPECTED OR CONFIRMED to be infected by agents of contact, droplet, or airborne
what is the population burden in developed countries?
shrinking productive age group growing elderly pop
What is direct contact for infection of infectious disease?
skin-to-skin contact or sexual intercorse
What is the number 1 cause of preventable deaths?
smoking
what is the #1 cause of preventable deaths?
smoking (446,000/year)
What is "Biostatistics"?
statistics applied to the life and health sciences
Epidemiology
study of how disease is distributed in populations and the factors that influence and determine this distribution
Which countries are poor sanitation and hunger primarily concentrated in?
sub-saharan Africa and South Asia
What is the main goal of public health?
the biologic, physical and mental well being of all members of the global society, regardless of ethnicity, religion, gender, sexual orientation, country or political views
bioinformatics
the field of dealing with biological data
the total fertility rate reflects what? and varies by what?
the rate of population growth varies greatly by country
Epidemiology
the study of the patterns, causes, and effects of health and disease conditions in defined populations. It is the cornerstone of public health, and informs policy decisions and evidence-based medicine by identifying risk factors for disease and targets for preventive medicine.
What is the purpose of public health?
to fulfill society's interest in assuring the conditions in which people can be healthy
What is the key to sorting out variations in data that seemingly form contradictions? ie) smoker lives to 90 nonsmoker lives to 30
to study properly chosen groups of people (samples) - look for the aggregate effect of something of one group on another (lung cancer & smoking) - identify a relationship ( the group of people who smoke are more likely to die of lung cancer than the non smokers BUT does not mean every smoker will die of lung cancer)
Variation from person to person is _____, making it difficult to ....
ubiquitous, making it difficult to identify the effect of a given factor or intervention on ones health ex) a smoker may die at 90 and a person who never smoked may die at 30
What is the #1 cause of child and adolescent mortality in the US?
unintentional injuries
agent
virus, bacteria, parasite, prion, etc.
Probability
we can make a statement about groups of people (but not individual people) ex) the probability that male smokers die from lung cancer is 10/100 but 1/100 for a nonsmoker
have there been successes in lowering the fertility rate?
yes, some -dropped from 5 to 2.5 - avg woman now has 3 kids vs 6 kids
What nutritional deficiency can stunt your growth?
zinc