kin 440 Exam 1
Alzheimers economic burden
- $236 billion (health care, long term care, hospice) - 15 million Americans provide unpaid care for people with dementia (stressful, financial, emotional)
What are the main PA guidelines for adults 18-64
- 150 min/week moderate intensity - 75 min/week vigorous intensity - 2+days/week muscle strength of all major muscle groups
What are the main PA guidelines for KIDS?
- 60+ min/day moderate to vigorous aerobic PA - 3 days/week bone and muscle strengthening
oldest old population
- 85+ years - Alzheimers, dementia, diabetes, falls, depression, arthritis - social isolation - high cost of retirement - loss of independence
Depression
- symptoms must be present for at least 2 weeks - persistant sad, anxious, empty mood - hopelessness, worthlessness, guilt - fatigue - appetite/weight change - suicidal thoughts - irritability
Older Adults PA Guidelines
- as active as possible - balance improving PA - PA relative to fitness level
Societal sectors
- business industry - community recreation, parks - education - faith - healthcare - mass media - public health - sports - transportation
Heroin Epidemic
- death rates on rise in recent years (quadrupled since 2010) risk factors - addiction to prescription painkillers, cocaine, marijuana, alcohol - no insurance - non hispanic white - males - 18-25 years old
social determinants and poor health outcomes
- high allostatic load - access to health care - access to healthy food/water
mental illness in US
- high prevalence - severe mental illness less common but high burden
Public Health Achievements
- immunizations - motor vehicle safety - workplace safety - control of infectious disease - safer/healthier foods - family planning - healthier mothers/babies - tobacco as health hazard - fluoridation of drinking water - declines in deaths from heart disease and stroke
Intervention studies
- independent variable = what you are manipulating - dependent variable = the outcome of interest - confounding variable = factors that might influence relationship --> control for these
Environmental Health
- where we live, work, play - air, water, food
sarcopenia
- loss of muscle mass, strength, function related to aging - even if you are active you'll have muscle loss - affects balance, gait, overall function
relative vs. absolute intensity
- low fitness level = perceived high intensity - high fitness level = perceived low intensity look @ graph
underserved populations
- low income - disabilities - illness - homeless - drug addiction - old adults
Years lived with disability (YLD)
- measurement of burden of disease - calculated by multiplying prevalence of disorder by short or long term loss of health associated with disability
mental health
- mood disorders - anxiety/depression - addiction - stress - schizophrenia - ADHD - sleep - self esteem
San Francisco Longshoreman 1970
- most active group of cargo handlers had lower coronary artery disease death rates
Symptoms of dementia due to Alzheimers
- most common = worsening ability to remember new information - challenges in planning or solving problems - difficulty completing tasks - confusion w/ time or place - poor judgment - withdrawal from work - changes in mood/personality
Age is a risk factor for
- musculoskeletal conditions - dementia - social isolation many more
What is the leading cause of YLD in the US
- neuropsychiatric disorders followed by musculoskeletal disorders and non communicable diseases
Alzheimers Incidence and Prevalence
- prevalence = 5.4 million - incidence = 476K new cases - 6th leading cause of death in US - at 65 y/o risk of developing AD is 17% for women and 9% for men
The two "P" of public health, which differentiate public health from the field of medicine are
- prevention and population - medicine = individuals and treatment
This theory suggests that performing physical, social and mental activities can delay the onset of dementia despite advancing Alzheimer pathology
Cognitive reserve theory
Study of distribution and determinants of disease and disability in populations
Epidemiology
PA vs. Exercise
Exercise - planned - repetitive - structured - goal of improving fitness PA - any bodily movement - health
Higher rates of cardiovascular disease and other chronic condition among African Americans are largely attributable to these
Social determinants - residential environment - race - accessibility - access to health care - social relations/support
The gold standard study design in PA and public health, or in other words the study design that is capable of producing strongest level of evidence for benefits of PA
Randomized control trials
What is the aging paradox
mental health increases with age despite declines in physical health
Risk Factors CVD
modifiable - diet - PA - Hypertension - smoking status - BMI non modifiable - race/ethnicity - age - gender
PA & Anxiety
more research and studies need to be performed - small trials show benefit of PA and anxiety
Dementia
most common cause = Alzheimer's disease (60-80% of cases)
Alzheimer Risk Factors
non modifiable - age - gender - race/ethnicity - family history - APOE0e4 gene modifiable - smoking - obesity - diabetes - hypertension - high cholesterol - diet / PA - social/cognitive engagement - traumatic brain injury
Southwest Baltimore was a unique neighborhood to study health disparities because
equal percent blacks and whites that have equal high school grads and equal income --> similar socioeconomic status
Health administration and policy
focus on delivery of public health services
Health promotion and health education
genetics, environment, behavior affect health status - promote exercise/healthy food - avoid tobacco - use condoms
Longitudinal/prospective study
group is followed for a defined period of time to ascertain occurrence of health outcome
The wear and tear on the body that results from coping or adapting to a stressor is known as (cost of coping/adapting to a stressor)
allostatic load
What is the difference between the National Physical Activity Guidelines and the National Physical Activity Plan
guidelines = target individuals plan = target policy makers
Quasi-experiment
control group without randomization
To qualify as a public health issue, a condition must be preventable, highly prevalent or increasing in incidence, burdensome, and
costly
PA & depression
cross sectional evidence - people who are more active are less depressed - correlation does not equal causation prospective evidence - less active = greater risk for depression - PA defend against depression
when the exposure of interest and the outcomes of interest are measured at the same time the study is a
cross sectional study
The extent to which conclusions drawn from experimental data are free from confounding issues which cause bias such as reactivity and missing data is known as
internal validity
The major public health message that can be draw from this figure is
less active people benefit more from PA
isolation
pervasive lack of social contact or communication, participation in social activities, confidant
These two pathological features are the hallmarks of Alzheimer's disease in the brain
plaques and tangles
osteoarthritis
prevalece - over 30 million Americans - 1 in 2 adults develop symptoms of knee OA - 1 in 4 develop symptoms of hip OA risk factors - age - gender - obesity - joint injury - family history
osteoporosis
prevalence - 54 million Americans - 1 in 2 women, 1 in 4 men age 50+ will break bone due to osteoporosis - 20% seniors who break hip die within a year risk factors - age (menopause in women) --> peak bone mass around 30 - gender - family history - bone structure/weight - ethnicity - diseases/medications - smoking, drinking, sedentary
purpose of public health
prevent, protect, promote, respond - assure quality and accessibility of services
The changing burden of disease in US over the past 100 years refers to
rising chronic disease, falling infectious disease
Mental Health affect public health
risk of losing job risk of addiction risk of failing school risk of CVD poor diet social relationships decrease quality of life
This PA measurement approach is inexpensive and provides context
self report
medically underserved population (MUP)
specific sub-groups of people living in a defined geographic area with a shortage of primary health care services
Dramatic spike in opioid deaths in 2016 due to this type of opioid drug
synthetic drugs
social determinants
the circumstances in which people are born, grow, live, work, and age and the systems put in place to deal with illness - socioeconomic status - race/ethnicity - social support - culture - access to medical care - residential environments
Stigma can lead to poor health outcomes in people living with HIV/Aids or people with mental illness. These vulnerable populations are considered?
underserved
validity vs. reliability
validity - exact representation of what happened, free from sources of error of bias reliability - tool gives consistent, stable, repeatable measurements
Severe musculoskeletal conditions can limit an older person's ability to function independently and perform these activities, including showering and getting dressed
activities of daily living (ADL)
lonliness
feels of isolation, disconnection, not belonging
The first study to demonstrate the exercise heart hypothesis was the
1953 London bus study - physically active conductors had lower rate of CHD than the sedentary drivers
In 1854, John Snow traced the source of Cholera to this location
Broad street water pump
This infectious disease outbreak led to the collection of the 1st ever public health statistic
Bubonic (black) plague
Socio-ecological model of health behavior
PA behavior influenced by - personal - family - institutional - community - public policy
mechanisms linking social determinants with chronic disease
Psychological - through effects on mental health (stress, anxiety, depression) Behavioral - through effects on poor health (smoke, low PA, poor diet, low medical adherence)
Global - Heart disease National - Obesity Regional - Opioid addiction Local - homelessness Umass - STI
Public Health Issues
Loss of a partner; inability to drive a car, and ageism can cause this, a major risk factor for mortality, among older adults
social isolation
Dementia and PA
- PA delays incidence of dementia and onset of cognitive decline
Generalized Anxiety Disorder
- excessive anxiety or worry for months - restlessness - fatigue - difficulty concentrating - irritability - muscle tension
Little Rock 9 - Sept 25, 1957
Arkansas president sent troops to escort African American students into an all white school
Biostatistics
Quantitative methods to analyse data and interpret study results - look @ trends - determine effectiveness of interventions
experimental validity
determine whether data is free from bias & generalizable to wider populations
measurement of PA
device based measures -accelerometers -pedometers self report -logs -interviews -questionnaire direct observation -watch and record
The extent to which conclusions drawn from the data are generalizable to wider populations. Assessed by examination of age, sex, ethnic origin, socio-economic status of study sample
external validity
medically underserved areas (MUA)
shortage of primary health services for residents within a geographic area