Pop health 370 midterm 1, Population Health Midterm Quiz Questions, Pop health 370 Midterm 1

Describe current global health challenges and trends. Again, do not memorize the statistics or years. Focus on general trends like

"aging population", Urbanization, global spreads of tobacco, diets high in sugar, fat, salt. Physical inactivity.

what is epidemiology?

"the study of health and disease in populations"; 1) problem: describes health and disease in human populations 2) etiology: determines health and disease in human populations 3) recommendations: evaluates public health control efforts

Understand the basic model of population health used in the County Health Rankings

(i.e., Policies & Programs → Health Factors → Health Outcomes), including the proportion of health outcomes explained by health factors (i.e., behaviors, health care, SES, and environment)

Be able to define and calculate attack rate, epidemic curve, incidence rate, onset, outbreak, and relative risk

-Attack rate- Cumulative incidence rate of infection or disease in a group over a period of an epidemic. -Epidemic curve- histogram of distribution of cases of disease or condition by time of onset. -Incidence rate- measure of disease frequency that indicates the force of morbidity or the prob that a disease will develop in a given period of time -RR- is measure of association bw disease or condition and a factor under study.

Understand how epidemiologists differentiate between "real" and "artifactual" changes.

-Changes in the interest in identifying disease/ability to diagnose a disease/definition of disease -Differences in the interest in identifying the disease -Differences in the ability to identify the disease -Differences in the definition of the disease e.g. HIV/AIDS epidemic, Zika, breast cancer rates rising, is it because there are more cases or we are just better at screening

Describe methods of transmission and identify factors that affect the transmissibility of a disease

-Insects, Other animals, Airborne, sexual transmission etc. Route of transmission, Asymptomatic transmission and Reproduction ratio. -Insects, other animals, airborne, sexual transmission, water, food, oral, blood, placental, breast feeding, etc. Three Factors: 1) Reproduction rate-the number of new cases an individual with the disease generates on average over the course of its reproductive period. 2) measure of inherent transmissibility 3) route of transmission and absence/presence of asymptomatic transmission(ability to transmit disease while not having symptoms)

Describe the demographic transition. Understand the concepts of "double burden" and "triple burden" of disease.

-Sharp decline in mortality, reduction in fertility, net popl growth. -Double burden: communicable disease burden is reduced but persistent. Non communicable disease burden grows. -Triple burden: Burdens assoc. with globalizations and urbanization are disproportionately borne in lower-income countries due to environmental degradation, water and air quality, social disruptions.

Understand the options for implementation of public health interventions (i.e., the "When-Who-How" approach, and how primary/secondary/tertiary interventions can target individuals/at-risk groups/larger populations through information/motivation/obligation)

-When = primary -Who = secondary Individual, At-risk group, Gen. popl. -How = tertiary Information, Motivation, Obligation

Define "one health" and "planetary health"-

-one health .... To obtain optimal health for people, animals and our environment. Planetary health: the achievement of the highest attainable standard of health, wellbeing, and equity worldwide through judicious attention to the human systems- political, economic and social, that shape the future of humanity and the earth's natural systems.

political nature

-population-based approaches often involve policy and law -balance health protections with individual rights (paternalism)--not able to smoke in the lecture hall -governmental public health officials work for people who are elected

what do we mean by public health?

-the totality of all evidence-based efforts that preserve and promote health and prevent disease, disability, and death -a discipline that addresses health at a population level

selective pressure

1) a bunch of bacteria, including a resistant variety 2) get bathed in antibiotics, most of the normal bacteria die 3) the resistant bacteria multiply and become more common 4) the entire infection evolves into a resistant strain any use of antibiotics can increase selective pressure in a population of bacteria to allow the resistant bacteria to thrive and the susceptible bacteria die off

five unique aspects of infectious disease

1) a case of disease can be the exposure for the next case 2) sub-clinical disease influences epidemiology 3) contact patterns play major role 4) immunity in the host may enhance susceptibility to or even stop infection 5) there is sometimes a need for urgency to respond to transmission

descriptive epidemiology methods

1) define disease 2) define populations 3) measure distributions-by time, person and place

epidemiological transition

1) high stationary-high DR, high BR 2) early expanding-dec DR, high BR 3) late expanding-dec DR, dec BR 4) low stationary-low DR and BR 5) declining-declining BR compared to DR therefore a declining population

pathogens and drug-resistant pathogens concentrate in healthcare environments

1) hospitalized patients often have impaired immunity, impaired defenses against infections or have other risk factors for infection 2) patient with infection may shed microorganisms into the environment 3) patient and healthcare workers share the environment with infected patients 4) antibiotic use select for antibiotic-resistant microorganisms 5) there is distinct hospital flora as compared to the flora found in the community

how do we establish that an organism is a contributory cause of a CD?

1) isolate the pathogen form sick creature 2) grow the pathogen in the lab and obtain a pure culture 3) inoculate a healthy creature with a sample from the pure culture, the pathogen should cause the same disease symptoms that were seen in the first creature 4) reisolate- the same pathogen from the second sick animal

control of infectious diseases

1) sanitation and hygiene-shifts from country to city which lead to overcrowding and repeated outbreaks-public health sanitation improved conditions 2) vaccination-disease eradication 3) antibiotics and other antimicrobial medicines-penicillin was developed into a widely available antibiotic, but then there was emergence drug resistant bacteria

technologic advances

1) serologic testing-blood tests that look for antibodies in your blood, syphilis and gonorrhea were difficult to diagnose (especially in latent stages) 2) viral isolation and tissue culture- large scale production of live or heat-killed viral vaccines 3) molecular techniques-enhanced capacity to track the transmission of new threats and find new ways to prevent and treat them

Describe key categories of social determinants of health

1. Social status 2. Social support or alienation 3. Food 4. Housing 5. Education. 6. Work 7.Stress 8. Transportation. 9. Place. 10. Access to health services.

milestones in the history of vaccination

1796--Jenner inoculates Phipps with cowpox and calls the procedure vaccination; the dawn of vaccine concerns are as old as vaccines themselves

overall views on the health system

25 percent says works well, 69 percent of physicians say that fundamental changes need to be made

rates needed for herd immunity

80 percent--no large disease outbreaks; 90 percent--eradication

comparative highlights

9 out of 18 countries finance health care through government funds/taxation; we spend a lot compared to other countries, we have the highest rate of avoidable deaths, we perform the best with elderly care

Apply the agent-host-environment triangle to understand how people develop CDI and CDAD

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Be able to discern data from an epidemic curve

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Fully understand the concept, strengths and weaknesses of "herd immunity"

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Understand important factors in the investigation and prevention of infectious disease outbreaks on college campus

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Understand the population health model that is used for the County Health Rankings

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basic descriptive epidemiology methods in defining a disease and measuring the burden of disease in a population

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All of the following are risk factors for C. difficile infection (CDI) EXCEPT: A private room for a hospital patient Long-term antibiotic use Previous C. difficile infection Gastrointestinal Surgery

A private room for a hospital patient

summary

ACA has increase access, improved quality, improved equity; the market place is trying to address costs (increase focus on PPO, HMO, HDHPs and more consumer engagement); challenges remain regarding costs control (without major system redesigns)

Disease Eradication (What factors make a disease easier to eradicate?)

Absence of a long term carrier state, easily identified, vaccine

Compared to diseases such as HIV and Hepatitis, what characteristic of Smallpox helped with its eradication from the planet? Absence of a long-term carrier state Effective therapy for infected individuals Decreased immunogenicity of the virus Presence of an animal reservoir which allows for different areas for intervention

Absence of a long-term carrier state

Public health education disadvantages

Access/opportunity to education *education helps those who have opportunity and motivation *Not helpful to those who don't have opportunity or who aren't motivated Disparities are created

Identify and describe sources of excess costs in the U.S. healthcare system and strategies for reducing the costs of healthcare

Admin costs. Drug, procedure and medical supply costs are higher than in other countries. We get more treatments than people do in other countries

Populations

Age, Race, geography Rate= numerator/denominator -physicians count numerators and treat them -Epidemiologist count populations and determine rates

Syndromic surveillance is: Based on symptoms only, such as fever, cough, sore throat Primary method for influenza surveillance Can be used instead of disease surveillance All of the above

All of the above

Which of the following plays an important role in the surveillance of infectious disease outbreaks on a college campus? Individuals who report symptoms to healthcare providers Healthcare providers at the university health services Local and state health departments The Centers for Disease Control and Prevention All of the above

All of the above

Which of the following potential areas impacted by climate change are an opportunity to improve health? Transportation Air pollution Food systems All of the above None of the above

All of the above

Which of the following has been shown to be effective for the prevention of HIV transmission? Screening individuals and informing them about their HIV status. Providing education and resources to prevent uninfected individuals from acquiring HIV. Access to antiretroviral therapy. All of the above are important and effective tools for the prevention of HIV transmission.

All of the above are important and effective tools for the prevention of HIV transmission.

Define global health and discuss how it has evolved over time and how it relates to public health-

An area for study, research and practice that places a priority on improving health and achieving equity in health for all people worldwide.

Describe the roles that diagnosis and treatment can play in preventing transmission of HIV.

Antiviral creams, postcoital treatments and early testing and case finding may become effective interventions. Drug treatment. Safe sex. Early testing can reduce the load of the virus

Describe environmental cleaning strategies to interrupt C. difficile transmission in healthcare settings

Assess adherence to protocols. Assess adequacy of cleaning and disinfection practices. Ensure patient care equip. are cleaned/disinfected. Education for environmental service personnel.

Describe criteria for evaluating health care systems performance across countries. Be able to describe how the United States compares to other countries in key areas. Do not memorize specific numbers but understand where the U.S. does poorly and in which areas it does well

Avg: care process, not good: access, admin efficiency, equity, and health outcomes. Does well on 30 day in hospital mortality, breast cancer and colorectal cancer.

Describe different options for preventing communicable diseases

Barrier protections, Immunizations, Screening and Case finding, Treatment and contact treatment, Efforts to maximize effectiveness of treatments and prevent resistance to treatment. Vaccinations strengthen your immune system by: Passive immunity: inject antibodies into an individual for short term protection Inactivated vaccines: dead organisms injected into patient to build immunity Live vaccine: Attenuation takes an infectious agent and alters it so that it becomes harmless. Stimulate cell mediated immunity and create long term protection.

Determinants of disease (e.g., BIG GEMS) and be able to recognize examples of each

Behavior, Infection, Genetics, Geography, Environment, Medical care, Socioeconomic-cultural

Social Ecologic model

Behavior, family, community, work, broad social-economic, physical environment individual at center (genes) County Health rankings: socio economic weighted more but all important

Become familiar with Universal Health Coverage models and innovations. Understand the basics of the four models - Beveridge, Bismarck, national health insurance, and out of pocket (i.e., who pays for care, who provides care, and how it relates to the U.S. system).

Bismark- Providers and payers are private, private insurance plan, plan covers everyone-- don't make a profit. Tight regulation of medical services. (germany, japan, switzerland etc) Beveridge: Healthcare is provided and financed by govt. through tax. No medical bills. Medical treatment is public service. Govt is sole payer so low costs. NHI- Providers are private. Payer is govt run insurance program that every citizen pays into. National insurance collects monthly premiums and pays medical bills. End to be cheaper and much simpler compared to American style insurance Out of pocket model- only rich get medical care. Medical cares is paid by patient. No insurance or govt plan. Some public health services are provided.

Discuss the role and ethics of school entry requirements as methods to improve immunization rates.

CA laws. Exemption of personal vs religious reasons.

Describe approaches being used to define and measure the quality of health care

Care process, Access,Admin Eff, Equity, HC Outcomes

Social-ecological model

Child weight--child behavior--parent behavior--community and demographic factors

Understand how college population demographics impact public health in the U.S.

College campus is not an island. Many people from various areas come and go to the same place.

Describe the utility and disadvantages of group or "ecologic" associations

Confounding variables can screw everything. Rarely prove a causal association. Best used to generate a hypothesis. -Population comparisons or "ecological associations" exist Ex: Drowning rates are higher in Southern states Ice cream consumption is higher in Southern states Does ice cream consumption cause drowning? -Rarely prove a causal association -Best to generate hypotheses -can be studied in strong research designs

Be able to recognize some potential approaches to improve the performance of the US health system

Consumer directed health plans with a high deductible health plan (hdhp) and a health savings account (hsa)

Describe the features of the ACA that represent key changes to the U.S. health insurance system.

Covering uninsured. Strengthening primary care. Encouraging integration across providers. Stimulating growth in meaningful use of information technology.

Describe the impact of decreased immunization rates for both individuals and populations and the role of school entry requirements

Decreased immunization rates allows diseases to remerge. Legal requirements increases vaccination rate

Identify assets and barriers to better health for individuals living in diverse communities across the globe

Different social backgrounds.Different political ideas.

DALY

Disability adjusted life years, useful because it takes in account years spent in disability

The background, expected occurrence of a disease within a given geographic area: Epidemic Endemic Pandemic Outbreak

Endemic

Know some reasons why outbreak occur and how they end as well as common interventions to stop the spread of disease

Endemic(a disease that exists permanently in a particular region or population. Malaria is a constant worry in parts of Africa), Outbreak, Epidemic(An outbreak of disease that attacks many peoples at about the same time and may spread through one or several communities), Pandemic (When an epidemic spreads throughout the world) Stop: Isolation/ Quarantine/ Incubation---isolation for patients with infectious disease. Quarantine is used to separate and restrict the movement of well persons who may have been exposed to a communicable disease to see if they become ill

Describe the effects and health co-benefits of cross-sector responses to climate change.

Energy sector: Air pollution. Food Systems: Cardiovascular risk. Transportation: Physical inactivity.

Understand the modern criteria for establishing that an organism is the contributory cause of a disease

Evidence of an epidemiological assoc. bw presence of an organism and the presence of a disease in human beings./Isolation of organism from most of those with the disease/ Transmissions to definitively establish that an organism is a contributory cause of the disease.

Which of the following is true about C. Difficile infection? Treating asymptomatic carriers eradicates the bacteria permanently Screening for symptoms at the time of admission to the hospitalis effectivein reducing the risk of transmission There is no effective treatment for persons infected with C. Difficile Fecal transplants can be effective in treating infection with C. Difficile

Fecal transplants can be effective in treating infection with C. Difficile

All of the following are potential health effects due to global climate change, EXCEPT: Increased number of heart attacks due to urban heat islands Fewer water-borne diseases due to warmer water killing potential bacteria Increased number of vector-borne diseases Increased malnutrition due to diminishing food supplies

Fewer water-borne diseases due to warmer water killing potential bacteria

Epidemiologic Transition

First thing that happens: mortality decreases Gap: Population rises Second: Fertility decreases Chronic disease is increasing and so is life expectancy

Sustainable development goals

Focused on more economic development, capacity for health

Illustrate how socioeconomic status affects health, and how culture and religion affect health.

Food cooking preferences, Use of contraceptives,etc.

Geography

Geographic location influences the frequency and even the presence of disease. Ex: Infectious diseases like malaria, lyme disease

Now

HIV infections was the leading cause of death in the 80s/90s then decreased steadily; now--almost all of the deaths are due to non-infectious diseases

Describe the host-specific strategies to prevent CDI and to manage CDAD in healthcare settings.

Hand washing, gloves & gowns, Antibiotic stewardship, Probiotic

What is "one health"?

Health for people, animals, and the planet

Eras of Public Health

Health protection(-1830), Hygiene movement (1840-70), Contagion control (1880-1940), Filling holes in the medical care system (1950-1980), Health promotion/Disease intervention (1980-2000), Pop health (2000)

List risk factors for C. difficile infection (CDI) and C. difficile-associated diarrhea (CDAD)

Hospitalization or residing in a long term care facility. Antibiotic use. Surgery of GI tract. Previous C. Diff infec. Older age. Proton pump inhibitor use

Identify the interplay between genetics and environment on individual health factors and health outcomes-

Housing. US transportation contribute to sedentary lifestyles

Define and describe the utility and limitations of Infant Mortality Rate (IMR), Health Adjusted Life Expectancy (HALE), and Disability Adjusted Life Years (DALYs) as measures of health.

IMR- Number of deaths under one year per 1,000 live births. HALE- Adjusts LE with % of quality of life using data from surveys on quality of life DALY- Number of disability life years lost per 1000 people.

Identify major actors and initiatives in the current climate change policy landscape

IPCC report cut emissions by 45% by 2030. Cleaner energy sources

the scope of global health

ITS BROAD

Describe the role of theory in health behavior. Describe why some behavior change is easier to accomplish than others. Theory can be used to explain health behavior.

Incentives can encourage and motivate behavioral change. Most difficult behaviors to change are those with a physiological component or addictive element.

Calculate and understand the differences between incidence and prevalence of disease.

Incidence measures the chances of developing a disease over a period of time (no. of new cases/no of people in the at-risk popl.) vs Prevalence is the number of individuals who have a disease at a particular time/ the no. of people who could potentially have the disease. -Incidence = (# new cases/Population) * 1000 -Prevalence = (#existing cases/population)*1000

Describe the relationship between income and socioeconomic status.

Income is linked with health regardless of racial or ethnic group.

What explains the drop in meningococcal disease? Better sanitation Increased use of vaccine Better treatment of infections Herd immunity

Increased use of vaccine

As the reproductive rate of an infectious disease become more rapid, the herd immunity threshold for that infectious disease _________. Decreases Remains the same Increases There is no relationship between reproductive rate and the herd immunity threshold.

Increases

There are many factors that affect our ability to eradicate a disease from the globe. Based on these factors, which one of the following diseases is the LEAST likely to be eradicated? Polio Influenza Measles Rubella

Influenza

Identify the three levels of influence in which theories and models are categorized and provide examples of theories and models that correspond to these levels.

Intrapersonal: Health belief model, Stages of change model, Theory of planned behavior. Interpersonal: Social cognitive theory. Popl. and community: Diffusion of Innovation theory

the good news

LE is increasing worldwide, burden due to HIV and malaria are falling, Under 5 mortality has decreased, progress in controlling infectious disease

Describe the burden of communicable diseases

Leading cause of death and disability among all ages, but especially among the young and the old.- May cause great epidemics.-Can also become endemics and become routine causes of death

Be able to recognize individual and population-based approaches to increase the use of vaccines.

Leave door open. Readdress at every apt. Don't ever refuse treatment. Promote healthy practice in other ways. Provide reputable websites.

List and describe the key Global Health Organizations and Actors

Malaria-Endemic countries, OECD donor countries, NGOs, WHO, Private sector, Foundations, Global Fund, Research and academia

Explain how global and local health are related and the value of a global perspective in public health.

Many diseases transcend national boundaries. Learning across local and intl. sites that share similar culture, health challenges or program strategies.

Distribution

Measure by time, person, and place

Describe a public health problem in terms of morbidity and mortality.

Morbidity is disability (being ill, diseased,etc.). Mortality is death.

Millenium Development goals

More content oriented

key actors in global health

NGOs, research, private sector, WHO, global fund, foundation

Identify the conditions that make eradication of a disease feasible

No animal reservoir, Short persistence in environment, Absence of a long term carrier state, The diseases produce long term immunity, Vaccination provides long term immunity, Herd immunity, Easily identified disease, Effec. post exposure vaccination.

Back in 2008, there was an outbreak of Norovirus on the UW campus that affected many students in residence halls but very few required medical treatment at a hospital or clinic. What factors of Norovirus infections caused this? Norovirus has high infectivity, high pathogenicity, and low virulence. Norovirus has high infectivity, low pathogenicity, and low virulence. Norovirus has high infectivity, high pathogenicity, and high virulence. Norovirus has low infectivity, low pathogenicity, and low virulence.

Norovirus has high infectivity, high pathogenicity, and low virulence.

Describe effective strategies for improving immunization rates

Notarization, Health Worker co-signature, Responsibility forms.

Which of the following is the best example of an attack rate? Number of hospital patients contracting C. difficile over number of hospital patients not contracting C. difficile Number of patients contracting C. difficile over time at risk of infection Number of hospital patients contracting C. difficile over total number of hospital patients Number of hospital patients newly diagnosed with C. difficile over total number of hospital patients diagnosed with C. difficile

Number of hospital patients contracting C. difficile over total number of hospital patients

What has happened in the past 50 years in the US?

Our fertility rate has dropped tremendously, lower fertility rate, lower child bearing, more employment opportunities

Be familiar with the WHO building blocks and the Flagship Framework

Overall goals/outcomes for WHO: Improves health, responsiveness, social and financial risk protection, improved efficiency. Flagship framework: M2L2 slides

Identify criteria for evaluating the quality of information presented in news stories about public health issues-

Overall site quality, Authors, Information, Relevance, Timeliness, Links, Privacy

Understand how different surveillance systems are used to track health status in college populations

Passive surveillance: just see what comes in. Syndromic surveillance--Syndromic surveillance has been used for early detection of outbreaks, to follow the size, spread, and tempo of outbreaks, to monitor disease trends, and to provide reassurance that an outbreak has not occurred. US Influenza surveillance systems. CDC US outpatient Influenza- like Illness Surveillance network. Local surveillance @UW Madison.

Understand strategies how patients may be screened for C. difficile

Perirectal swabs, empirical treatment.

Relationship between incidence, prevalence, and duration of a disease

Prevalence= (incidence rate) x (average duration of disease) HIV prevalence going up because people are living longer with HIV

steps in the evidence-based public health process (e.g., PERIE approach)

Problem, Etiology(causes), Recommendations, Implementation, Evaluation

Define herd immunity, herd immunity threshold, and reproductive ratio and understand their importance in preventing the spread of disease.

Protection of an entire popl. from a communicable disease by obtaining indiv. immunity through vaccination or natural infections by a large percentage of the popl. Once threshold has been reached disease can be eliminated from society.

Understand the background and rationale for the County Health Rankings

Provide an annual overview of health outcomes and health determinants across Wisconsin. Sparks discussion of health issue. Stress that there are multiple broad determinants of health.

All of the following have been shown to increase vaccination rates EXCEPT: State laws that create strict exemption policies. Providers that show images of children infected by vaccine-preventable diseases. Hospital systems that implement a refusal form which educates parents. Implementation of vaccination requirements for school entry.

Providers that show images of children infected by vaccine-preventable diseases.

Understand the reasons why some parents are "hesitant" to immunize their children

Pseudoscience, Vaccines might cause harm. Natural disease> Vaccine. Autism. Child not at risk for disease. Vaccines overload the immune system.

Suppose that a person ill with measles came to a POP HLTH 370 lecture in 272 Bascom Hall. The UW Student Health Services contacted all students who had been in the lecture hall at the same time, and told them to remain in their apartments for the next 2 weeks and to monitor their symptoms closely. This is an example of: Quarantine Isolations Outbreak Epidemic

Quarantine

Know how relative risks relate to attack rate and how to describe each using a sentence or two.

RR is a measure of relative relationship bw incidence in the exposed and that in the non-exposed.

Public Health education advantages

Raises awareness, promotes knowledge, attitudes, and practices/behaviors

Understand the relationship between global health and the Sustainable Development Goals. Do not memorize the specifics of the SDGs but be able to describe some of the positive and negative health effects of the SDGs. Understand how the SDGs are an example of "health in all policies" : M2L2

SDGs have helped create several successes in improving overall global health. These include smallpox eradication, Vitamin A supplementation, polio elimination, decrease of under 5 child mortality, overall increase in life expectancy and smaller burden caused by HIV and malaria

"sphere of influence"

SES, culture and religion, many others

Name the routes of transmission of HIV

STD. Breastfeeding. Certain body fluids

Identify the six quantitative sources of public health data.

Single case, Vital Statistics and reportable diseases, Surveys and sampling, self-reporting, Sentinel monitoring--Monitoring of rate of occurrence of specific conditions to assess the stability or change in health levels of a population. It is also the study of disease rates in a specific cohort such as in a geographic area or population subgroup to estimate trends in a larger population, Syndromic surveillance--surveillance using health-related data that precede diagnosis and signal a sufficient probability of a case or an outbreak to warrant further public health response

Identify and describe some global health success stories. Do not memorize the statistics or years but general successes.

Smallpox eradication, Under 5 child mortality decreased, polio eliminated

What is the "Frieden Pyramid?"

Social economic factors on bottom of pyramid

Disease

Study of health and diseases, morbidity, injuries, disability, and mortality, and the multiple determinants of health

characteristics and examples of different approaches to promoting health (health care, traditional public health, and social interventions)

Systems for delivering one on one indiv. health services/ Group and community based interventions directed at health promotion/ Interventions with another non-health-related purpose

old and new threats

TB and malaria killed millions of people, deaths due to cancer increased, high BP is the biggest health risk, increased deaths in young adults..

All of the following are unique aspects of communicable diseases, EXCEPT: A case of disease can be the exposure for the next case Sub-clinical disease influences epidemiology The burden is greatest among the elderly Immunity in the host may enhance susceptibility to or even stop infection There is sometimes a need for urgency to respond to transmission

The burden is greatest among the elderly

Describe the approach used in public health to identify a contributory cause of a disease or other condition and establish the efficacy of an intervention.

The cause is associated with the effect at the individual level. The cause precedes the effect in time. Altering the cause alters the effect

Since the implementation of the MMR (Measles, Mumps, and Rubella) vaccine, vaccination rates for Measles and Mumps have remained the same, yet we see different rates of these infectious diseases in the public. What best explains this phenomenon? The age at the which the vaccines are given. The difference in effectiveness of the vaccines. The difference in demographics of those receiving the vaccines. The diseases are screened for at different rates.

The difference in effectiveness of the vaccines.

Health Determinants

The factors that play into how long and how well you live, Behavior, where you live, job, education

Population Health

The health outcomes of a group of individuals, including the distribution of such outcomes within the group

public health surveillance

The ongoing, systematic collection, analysis, interpretation, and dissemination for use in public health action to reduce morbidity and mortality and to improve health

Health outcomes

The outcome of all things that happen to you over your lifetime (how long and how well you live)

Relative risk is an important concept in epidemiological studies. Which of the following provides the best example of relative risk? The percentage of people with obesity who developed diabetes in the last decade The risk of developing lung cancer among smokers compared to the risk of developing lung cancer among non-smokers The percentage of heart disease in the United States attributable to high cholesterol The percentage of diabetics treated with metformin who develop complications

The risk of developing lung cancer among smokers compared to the risk of developing lung cancer among non-smokers

syndromic surveillance

The use of pre-diagnostic, preliminary, or incomplete healthcare data (e.g. chief complaint, symptom history, working diagnosis) to define a disease syndrome; typically uses electronic data systems, useful to monitor season trends or identify clusters of disease that do not require lab conformation

In epidemiology, it is important to remember that correlation does not equal causation. What needs to be considered when determining if an organism is the contributory cause of an infectious disease in humans? There needs to be evidence of association and the organism should be able to be isolated and shown to be transmissible to humans. There needs to be evidence of association and the organism should be able to be isolated and shown to be transmissible to humans and other animals. There needs to be evidence of association and the organism should be able to be isolated, but demonstrating transmissibility is not important. There needs to be evidence of association and the organism must have been tested in a randomized controlled trial.

There needs to be evidence of association and the organism should be able to be isolated and shown to be transmissible to humans.

Explain relationships between the social and behavioral sciences and public health

These subject areas share a fundamental belief that understanding the organization and motivation behind social forces, along with a better understanding of the behavior of individuals, can be used to improve the lives of individuals, as well as society as a whole

Understand the basis of concerns for parents when considering vaccinations for their children.

They desire knowledge and approach to obtaining information

Understand how the distribution of disease (by time, person, and place) is used by epidemiologists to generate hypotheses about the cause of a disease

Triad" of descriptive epidemiology Calculate rates by: -Time (when) -Person (who) -Place (where)

health outcomes

US ranked last, highest rate of mortality amenable to health care and has the smallest reduction in that measure, we have higher health care spending and lower return

Understand the direct and indirect ways in which climate change threatens global public health

Urban heat island effect. Air pollution. Vector borne diseases. Water borne diseases. Water resources and food supply. Mental health and Env. Refugees.

Describe key messages to emphasize the importance of routine immunizations

Vaccination is one of the most important ways in which parents can keep their kids safe. Vaccines are safe- disease risk is much greater. A parent's decision to withhold vaccination from their child is an active decision to subject the child to the dangers of the disease.

Understand the risk/benefit ratio of deferring vaccines when vaccine-preventable diseases are still present in many communities.

Vaccine schedules are designed to maximize protection at the most vulnerable age.

Describe the impact immunizations have had on communicable diseases in the U.S.

Vaccines have been the number one public health achievement.

Describe the role of asymptomatic carriers of C. difficile in the transmission of CDI in healthcare settings.

Very common in health care settings. Detection of C dif stool may represent transient carriage, low-level colonization, high level colonization with frequent skin and environmental shedding. There is evidence that asymp. Carriers are an important reservoir for ongoing transmission.

Understand models that can be used to describe and compare Global Health Systems.

WHO building blocks and Flagship framework

Be able to compare (generally) the current performance of the US health system to other national health systems

We are spending more but there is no significant improvement.

public health

What we as a society do collectively to assure the conditions in which people can be healthy. Population health is a broader concept that includes all the ways that society as a whole or communities within society are affected by health issues and how they respond to these issues. Goal is to improve the health of populations while reducing health disparities using organized community efforts (versus the goal of medical care, which is to diagnose and treat disease and illness one patient at a time).

Describe the "Action Cycle" and the "What Works" parts of the County Health Rankings

What works- Certain program/policies that can be taken by a community to help with. Action cycle: Assess needs and resources, focus on what's important, choose effective policies and programs, act on what's important, evaluate actions

Isolation and quarantine are often confused in the media and general public. Which statement is the most accurate in addressing these two terms? In the US, we often quarantine individuals who have been exposed to infectious diseases. When someone is infected with an infectious disease one mechanism for preventing transmission of disease is to put them in isolation. After showing symptoms of disease, patients can be placed in quarantine to prevent the transmission of disease. There is no difference between isolation and quarantine and both can be used interchangeably.

When someone is infected with an infectious disease one mechanism for preventing transmission of disease is to put them in isolation.

What is herd immunity? When those who are not immunized are protected from a disease because a high percentage of individuals are immunized. When vaccinations are no longer required because the entire population is immune. When you isolate individuals who have not received vaccinations from those who are contagious. When everyone in a population has received a vaccine and is immune as a result.

When those who are not immunized are protected from a disease because a high percentage of individuals are immunized.

Describe current and future challenges of fecal microbiota transplantation

Who should the donor be? Define screen for healthy gut microbiota. What makes a good match? What regulations?

What does the US system do well? Not so well?

Worst = Costs, administrative inefficiencies, not equitable best= technologies/surgeries

what is meant by population health?

a broader concept of public health that includes all the ways that society as whole or communities within society are affected by health issues and how they respond to these issues, it uses "evidence-based" approach to analyze the determinants of health and disease

Define climate change, its basic mechanisms and the impact of human behavior and lifestyles

a change in global or regional climate patterns, in particular a change apparent from the mid to late 20th century onwards and attributed largely to the increased levels of atmospheric carbon dioxide produced by the use of fossil fuels. Global surface temperature increase. Human caused by burning fossil fuels and deforestation

clinical prediction rules

a clinical prediction rule is a combination of clinical findings that have statistically demonstrated meaningful predictability of a clinical factors of interest

Health is...

a dynamics state of complete physical, mental, spiritual, and social well-being and not merely the absences of disease or infirmity

epidemic curve

a graphic display of the cases of disease according to the time or date of onset of symptoms...bell curve

The "population pyramid" below best represents which country? Wide throughout a. A developed country (e.g., Japan) b. A developing country (e.g., Ethiopia) c. No country could have such a population pyramid d. It is not possible to answer this question without more information about the life expectancy associated with this population pyramid

a. A developed country (e.g., Japan)

A study of fish consumption and coronary heart disease showed lower rates of heart disease in a population that on average consumed fish daily, compared to a population that on average consumed fish about once per month. This association would establish which of the following: a. A group association that may be helpful in generating a hypothesis about the relationship between fish consumption and coronary heart disease. b. An individual association establishing that eating fish is associated with coronary heart disease. c. A cause-and-effect relationship between fish consumption and coronary heart disease. d. None of these are correct.

a. A group association that may be helpful in generating a hypothesis about the relationship between fish consumption and coronary heart disease.

Based on the following figure, which of the following is true? lower income equaled more respondents saying they were in poor/fair health. Charts declined for all races a. Income is linked to health within all racial and ethnic groups b. Differences in income explains all of the differences in health outcomes between racial and ethnic groups c. Individuals with incomes <100% FPL are more likely to report better health than individuals with incomes > 400% FPL d. Income differences are the cause of poor/fair health in individuals making <100% FPL e. All of the above are true

a. Income is linked to health within all racial and ethnic groups

What is "the collaborative effort of improving the lives of people, animals, and our environment"? a. One health b. Planetary health c. Public health d. Health care

a. One health

Which of the following trends has been seen following the passage of the Affordable Care Act? a. Reduction in uninsured rates across the United States b. An elimination of disparities in uninsured rates between states c. No change to the type of people eligible for health insurance d. Decreasing deductibles for all individuals

a. Reduction in uninsured rates across the United States

We learned from the Module 2 Case Study that the United Kingdom ranks #1 in overall health care system performance, but 10th in health outcomes. How is this possible? a. The poor health outcomes may result from factors outside of the health care system b. The high cost of health care c. Inefficient health care d. Poor access to health care

a. The poor health outcomes may result from factors outside of the health care system

Which of the following is the most accurate statement about the determinants of health? a. They reflect underlying forces that are at work in the subsequent development of disease b. Each determinant can usually be traced to specific diseases c. One determinant is operating to bring about each disease d. If a pathogenic organism can be shown to cause a disease, no other determinants are relevant

a. They reflect underlying forces that are at work in the subsequent development of disease

Medical Care

access to and the quality of medical care can be a determinant of disease. Ex: Vaccinations and access to other stuff.

Behavior

actions that increase exposure to the factors that produce disease or protect individuals from diseases. Ex. Smoking cigarettes or exercising to prevent disease

why are healthcare costs so high

administrative cost are high, costs are high for drug and medical supplies, we get more treatments (not primary care( than people do in other countries

access

affordability, timeliness, US ranked last, we have a lot of people who do not have access because of cost

Global health is...

an evolving concept, collaborative transnational research and action for promoting health for all, is public health for the world

searching for causes

analytic epidemiology: the study of the "determinants" of disease in population; basic premise: disease occurrence is not random but can vary depending on a variety of characteristics and predisposing factors; must calculate and compare risks between groups

diffusion of innovation theory

as we become aware of certain factors then adopt

safety: challenges in establishing causality for side effects

association does not equal causation; deciding whether it is a cause? timing of onset, uniqueness of clinical syndrome, biological mechanism, epidemiological studies

A group of motivated leaders are interested in improving the health outcomes of a city's residents by implementing a new program. According to the County Health Rankings model, which of the following approaches would contribute most to improving health outcomes for the city's residents? a. A program that increases access to specialists at the local hospital. b. An initiative that ensures all individuals have a good education that leads to a good job and financial security. c. An educational program that promotes healthy behaviors such smoking cessation, increased physical activity, and healthy eating. d. An initiative to improve both the air and water quality in the city.

b. An initiative that ensures all individuals have a good education that leads to a good job and financial security.

TR Reid describes the American healthcare system as having aspects of many other countries' systems. Which international model is most reflected in the following scenario? A veteran develops chest pain and is taken to the emergency room at his local Veterans Affairs hospital where he is treated by a physician employed by the Veterans Affairs administration. a. Bismark model b. Beveridge model c. National Health Insurance Model d. Out of Pocket Model

b. Beveridge model

An individual realizes that they need to lose weight to reduce their chances of developing diabetes, but is not yet ready to start a diet. Which of the following best describes this stage of behavioral change? a. Pre-Contemplation b. Contemplation c. Preparation d. Action e. Maintenance

b. Contemplation

Which of the following is true of an approach focused exclusively on providing people with information about the risks of certain behaviors? a. Once they become educated about a problem, people will soon alter their behavior b. Different social groups will have different abilities to change behavior, depending on their access to resources c. Education campaigns have proven to be highly successful in reaching the poorest populations d. Information is often provided to the public by major corporations

b. Different social groups will have different abilities to change behavior, depending on their access to resources

The following figure shows the relative risk of lung cancer by the number of cigarettes smoked and the number of years since quitting (compared with non-smokers). Which of the following ancillary or supportive criteria is addressed in this study? a. The risk of lung cancer among smokers b. Dose-response relationship c. Consistency d. Biological plausibility

b. Dose-response relationship

Which target of the following Millennium Development Goals was met as of 2012? a. Decreasing the extreme poverty rate by half b. Halving the proportion of the world's population without access to clean water c. Bringing the ratio of boys to girls in primary education to 1 d. A 2/3 reduction in malaria incidence

b. Halving the proportion of the world's population without access to clean water

Which of the following is the likeliest scenario due to global climate change? a. More hurricanes will make landfall in the U.S. Correct! b. Hurricanes that form will have greater energy and stronger winds c. Environments for mosquitoes will decrease due to lack of standing water d. Crops will increase protein content due to accumulation of CO2 in the air

b. Hurricanes that form will have greater energy and stronger winds

All of the following are true about global health, EXCEPT: a. It is a multidisciplinary effort b. It is limited to sites outside the US c. It involves sectors beyond health care d. It includes a broad definition of health

b. It is limited to sites outside the US

All of the following statements are true regarding the changes following implementation of the Affordable Care Act (ACA), EXCEPT: a. It allowed children to stay on parent's insurance until age 26 b. It reduced funding for public health programs c. It required insurers to cover pre-existing conditions d. It expanded coverage for people in poverty without children

b. It reduced funding for public health programs

How is planetary health related to human health? a. It enables consumers to continue extracting the world's resources at an alarming rate b. It sustains the natural systems upon which human societies depend for their well-being c. It prioritizes only a few aspects of our environment and ignores others d. It ensures the separation between human civilizations and nature

b. It sustains the natural systems upon which human societies depend for their well-being

Which of the following best describes the contributions of social sciences to public health? a. The relationship between social sciences and public health is a recent development b. Public health can be viewed as an application of many of the social sciences c. Public health rarely utilizes social sciences d. Public health is a quantitative discipline while social sciences are qualitative

b. Public health can be viewed as an application of many of the social sciences

High blood pressure is reduced by adding a new salt substitute to a range of foods sold to the public. Which of the following public health strategies does this describe? a. Reducing the high risk b. Reducing the average risk c. Narrowing the spread of the risk d. None of these are correct

b. Reducing the average risk

pertussis

bacteria, moderate contagion risk, large outbreak in US in recent years, vaccines is recommended for all adults--but is short lived, persistent cough, antibiotics if treated early, must isolate for 5 days, can be fatal in young children

why are some individuals health easier to change

behavior change is easier when one behavior can be substituted for a similar one, incentive can encourage rapid acceptance and motivate behavioral change, the most difficult behaviors to change are those that have a psychological component or addictive, physical, social and economic barriers can stand in the way of behavior change

what factors determine the occurrence of disease, disability, and death? BIG GEMS

behavior, infection, genetic, geography, environment, medical care, socioeconomic-cultural

can health behavior be changed

behavioral change is possible (for the better and worse) , some behaviors are easier to change than others

What are the major types of healthcare systems in the world?

beveridge, Bismark (have job, have employee sponsored insurance) VA= (Great Britain) Medicare = Single payer (Canada) Bismarck

WHO health system building blocks

building blocks: service delivery, healthcare workforce information, medical products, financing, leadership/governance; overall goals/outcomes: improved health, responsiveness, social and financial risk protection, improved efficiency

the triple burden

burdens associated with globalization and urbanization are disproportionately burden in low-income countries and among poorer population in all countries (environmental degradation, water and air quality, social disruptions)

All of the following help to explain current trends in global health, EXCEPT a. Increasing rates of urbanization b. Changing diets among populations in developing countries c. An increasing trend toward trade restrictions in food items d. Population growth

c. An increasing trend toward trade restrictions in food items

Which of the following best defines "global public health"? a. Transferring focus from domestic health concerns to international epidemics b. Increasing life expectancy at home and abroad c. Collaborative transnational research and action for promoting health for all people d. Guaranteeing availability of and access to culturally sensitive medical care

c. Collaborative transnational research and action for promoting health for all people

Which of the following distinguishes DALYs from HALEs? a. DALYs include a measure of morbidity b. DALYs include only measures of mortality c. DALYs include disease-specific measurement of morbidity and mortality d. None of these are correct

c. DALYs include disease-specific measurement of morbidity and mortality

All of the following are examples of the "Triple Burden of Disease" EXCEPT a. The backlog of common infections, undernutrition, and maternal mortality. b. The emerging challenges of non-communicable diseases, such as cancer, diabetes, heart disease, and mental illness. c. Rising costs of health care, as a percent of GDP d. Problems directly related to globalization, like pandemics and the health consequences of climate change

c. Rising costs of health care, as a percent of GDP

A random sample of high school students is questioned about their cigarette smoking and use of e-cigarettes. Which of the following types of data does this represent? a. Single case or small number of cases b. Statistics - vital statistics and reportable diseases c. Survey data d. Sentinel surveillance e. Syndromic surveillance

c. Survey data

Which of the following is true of the U.S. healthcare system when compared to the healthcare systems in most other developed countries such as Canada and the United Kingdom? a. The U.S. does not incorporate technical innovations in diagnosis and treatment as actively as Canada and the United Kingdom b. The U.S. generally provides patients with less choice of physicians that Canada and the United Kingdom c. The U.S. has a higher mortality amenable to healthcare than other developed countries such as Canada and the United Kingdom d. The U.S. has a longer life expectancy at birth than most other developed countries such as Canada and France e. None of these options is true

c. The U.S. has a higher mortality amenable to healthcare than other developed countries such as Canada and the United Kingdom

Which of the following is true regarding infant mortality in the United States? a. White Americans have the lowest total infant mortality compared to other racial groups b. All states have similar average infant mortality rates c. The United States has a higher infant mortality rate than other developed countries such as Canada and the United Kingdom d. The U.S. average infant mortality rate has worsened over the last 20 years e. All of the above are true

c. The United States has a higher infant mortality rate than other developed countries such as Canada and the United Kingdom

Which best describes the relationship between poverty and poor health? a. poverty is the cause of poor health b. poor health is the cause of poverty c. poverty and poor health interact and shape each other in a cycle d. They are separate issues and must be evaluated independently

c. poverty and poor health interact and shape each other in a cycle

how is the "performance" of a healthcare system measured?

care process (preventative care, safe care, coordinated care, engagement and patient preferences), access (affordability and timeliness), administrative efficiency, equity and health care outcomes

pandemic

cases are epidemic in multiple regions, usually world-wide, and often involve a novel organism

herd immunity reduces disease

chains of infection disrupted (more immune individuals--less chance of susceptible individuals get infected); outbreaks still occur but fewer infections and shorter duration

how do epidemiologists investigate whether there is another explanation for the difference or changes in the distribution of disease?

changes in the interest in identifying disease, changes in the ability to diagnose a disease, changes in the definition of disease

YLD by category

chronic disease contribute more to disability

public health data, health communication and the flow of information

collect--compile--present--perceive--combine--decision making

precipitation

combined sewer overflows, heavier downpours--warmer air holds more moisture, heavy rainfall and sewage contamination

asymptomatic carriers

common is healthcare facilities, detection of c. diff in stool may represent transient carriage, low-level or high-level colonization with skin shedding, there is evidence that asymptomatic carriers are an important reservoirs for ongoing transmission

what is the burden of disease caused by communicable disease?

communicable disease may be caused by a wide variety of organisms, such as bacteria, viruses, or parasites; for many centuries, communicable disease were the leading cause of death and disability among all ages, but especially young and old--may cause great epidemics and can also become endemic (reoccurring) and become routine causes of death

learning from other systems is essential for local and global improvement

community health workers in Costa Rica (understand health issues in every household), strategies to increase coverage in Mexico, opportunities for joint research and discovery

action cycle for the county health rankings

community members along with organizations need to work together and communication in order to: assess needs and resources, focus on what's important, choose effective programs and policies, act on what's important, evaluate actions

how are social systems related to health

complex interaction, we are constantly interacting with our surroundings, intervention must consider the complex relationship b/t social systems and health; influencing behavior, shaping norms, providing opportunities to engage in certain behaviors, producing stress for certain behaviors

what are the social determinants of health

conditions in which people are born, grow up, live, learn, work, play, worship, and age, as well as the systems put in place to deal with illnesses that affect health and quality of life (they are shaped by a wider set of forces, including economics, social policies and politics)

what changes did ACA bring

covering the uninsured (children to the age of 26, pre-existing conditions), strengthening primary care through the "medical home" model-primary care, encouraging integration across providers, stimulating growth in the meaningful use of IT, it has worked!

evaluation: how do we evaluate the results

critical to measure how much of the problem has been eliminate by the interventions and what is the nature of the problem that remains; RE-AIM is a framework used to evaluate how well specific interventions work and are accepted (reach, effectiveness, adoption, implementation and maintenance)

observational studies

cross-sectional studies: subjected are surveyed at a single point in time; cohort studies: subject are surveyed and then followed over time; case-control studies: subjects are surveyed and asked about past experiences

ways that culture and religion may affect health

cultural preferences-food cooking, female genital mutilation; religious factors- use of contraceptives, role of prayer as a intervention

Which of the following are approaches included in population health? a. Use of the health care delivery system focused on individuals b. Use of governmental public health approaches focused on populations c. Use of social policy interventions d. All of these are correct

d. All of the above

Which of the following are true of behavioral change? a. Positive feedback is important for successful behavioral change b. Peer and/or family support is helpful in achieving behavioral change. c. Population wide efforts are most effective when they complement other efforts aimed at individual behavioral change. d. All of these are correct

d. All of these are correct

A social justice approach to health embraces all of the following, EXCEPT: a. Shared responsibility and concern for the community well-being b. Societal support for those with limited opportunities or resources is encouraged c. Maintains that all persons are entitled equally to basic services d. Focuses on free market approaches to solve problems

d. Focuses on free market approaches to solve problems

All of the following are outcomes of the WHO model for health systems EXCEPT: a. Responsiveness b. Improved efficiency c. Improved health d. International collaboration

d. International collaboration

Which of the following types of behaviors is typically easiest to change? a. Long-standing behaviors that provide short-term satisfaction b. Long-standing behaviors accompanied by physical addiction c. New behaviors that satisfy short-term needs d. New behaviors that can be substituted with an alternative that satisfies short-term needs

d. New behaviors that can be substituted with an alternative that satisfies short-term needs

All of the following are reasons that healthcare costs are so high in the U.S. compared to other countries, EXCEPT: a. High administrative costs in the U.S. b. Costs of drugs and procedures are higher in the U.S. c. Higher number of treatments on average for those in the U.S. d. Prevention costs are a much higher percentage of healthcare spending in the U.S.

d. Prevention costs are a much higher percentage of healthcare spending in the U.S.

A city decides to pass a law that increases tax on sugar sweetened beverages in hopes of decreasing future rates of obesity and diabetes. Which of following statements best describe this implementation approach? a. Primary prevention that imposes a requirement on all individuals. b. Tertiary prevention that educates individuals who consume sugar sweetened beverages. c. Secondary prevention that motivates individuals who are obese. d. Primary prevention that uses motivation aimed at those who consume sugar sweetened beverages.

d. Primary prevention that uses motivation aimed at those who consume sugar sweetened beverages.

Which of the following aspects of the County Health Rankings best explains the media's interest in them? a. The comprehensive model of population health b. The precision of the measures used c. The annual updates d. The use of ranking to compare the health of counties in a state e. The connection with the "What Works for Health" resource

d. The use of ranking to compare the health of counties in a state

supporting immunizations

declination vs. responsibility forms: increasing interest in forms indicating parental refusal to protect their child from potentially serious disease, documentation offers protection for healthcare providers against medicolegal responsibility; the ultimate truth: the decision not to immunize is an active decision to remain susceptible to disease; introducing these forms have worked

summary

decrease skin/ environmental due to shedding of c. diff among: asymptomatic carriers at admission, patients with suspected CDI prior to treatment and lab test results; improve disinfection of contaminated surfaces and environment; promotion of hand hygiene among HCWs, patients and visitors; improve antibiotic stewardship; fecal microbiota transplant-transplant healthy stool so healthy microbiota is restored in the patients colon

asthma and air pollution

decreased traffic and ozone level, asthma related ER visits decreased, children's visit did not change

rapid testing for CDI at admission

delays are common, perirectal swabs can be used in place of stool sample collection

the epidemiological transition

describes underlying reasons for demographic transition, under-5 mortality decreases due to better nutrition and decrease in communicable disease; water, sanitation, health care, improved food supply

Trends in DALYs by category

developing: more HIV/AIDs, mostly consists of communicable disease; developed: more chronic disease burden, declining CDs

where does public health data come from

does not identify specific individuals, date from differing sources is increasingly combined to create integrated health data systems or databases

Which of the following is/are important feature(s) of a high quality Web site? a. The objectivity of the Web site b. Recent updating of the Web site c. The presence of references for the data or conclusions presented on the Web site d. The availability of information on the source of funding for the Web site e. All of these are correct

e. All of these are correct

A UW student is biking the bike path that runs along University Ave when they become distracted. They inadvertently swerve but a curb prevents them from biking into oncoming traffic, which is fortunate because this individual was not wearing a helmet. Which determinants of health played a role in this scenario? a. Behavior b. Genetics c. Environment d. Genetics and Environment e. Behavior and Environment

e. Behavior and Environment

As part of a 'Safe Sleep' campaign, baby boxes were distributed to new parents with the involvement of clinicians, public health officials, and the media. The mortality from SIDS fell by approximately 50% within several years of the beginning of the Safe-Sleep campaign. Which of the following components of the evidence-based public health approach corresponds to this experience? a. Problem description b. Etiology c. Recommendations d. Implementation and Evaluation

e. Implementation and Evaluation

Infection

early or long-standing infections may contribute to the development of disease or even protection against disease. Ex: Gallstones, ulcers, cancer

challenges of the 21st century

emerging and reemerging infection, microbial evolution, better vaccines that are fully administered, better capacity of disease surveillance and outbreak response, better strategies to confront emerging diseases

how can we evaluate the quality of the presentation of health information

examine each of the key quality standards: overall site quality, authors, information, relevance, timeliness, links, privacy

what can we do if we cannot demonstrate all three requirements to definitely establish contributory cause?

examine supportive or ancillary criteria: strength of relationship, dose-response relationship, consistency of the relationship, biological plausibility

what does contributory cause imply

existence of contributory cause implies that the cause increased the chances that the effect will develop, its presence does not guarantee that the disease will develop nor does the absence guarantee that the disease will not develop

find solutions study designs

experimental --clinical trial

natural history of infectious disease

exposure to a pathogen-some are infected or not infected-infectivity (reproductive rate)-what proportion of people are infected; infected-some are ill and some are not ill-pathogenicity and incubation period-some people will not have symptoms when they are infected; ill-some have manageable illness and survive and some have severe case-virulence-of the people who are ill-those who die

outcomes following exposure to c. diff

exposure--asymptomatic carrier, colonized-bacteria but no infection, CDI, nothing; if CDI either mild, moderate or severe-then get treatment

pathophysiology

fecal-oral transmitted bacteria, stomach acid kills bacteria, but spore are resistant, then travels to small intestine and replicates into bacteria then go to large intestine, can cause some damage to the lining of colon

challenges of fecal microbiota transplantation

finding who would be the correct donor for someone, defining who would be a suitable donor, screening for a donor, adequate regulation

integrating surveillance with public health programs

focused on statistics, analyzing data, epidemiology; using stats for programs; then disseminating the success and failures from programs to make descisions

what is being done to bring down healthcare costs?

give you money to spend, consumer directed health plans

global health trends

growing population, aging population manifesting in shifts in disease burden to NCDs, urbanization, changing patterns of consumption with economic development, global spread of tobacco, diets high in sugar fat and salt, physical inactivity, a lot of people are still dying

Alma ata, 1978, 134 countries

health care for all

Beveridge Model

health care is provided and financed by the government through tax payments, many hospital and clinic and doctors are public

what is the scope of health communications

health communications-methods for collecting and presenting health information (addresses how we perceive, combine, and use information to make decisions); health is about information-from its collection to its use

what are the approaches available to protect and promote health?

health-care systems for delivering one-on-one individual health services; traditional public health-group and community based interventions directed at health promotion and disease prevention; social interventions-interventions with another non health related purpose which have secondary impacts on health

temperature

heat wave-thousands of death, crop death; syria- drought increase, most severe drought occurred before the civil war (refugees); people who are at risk of hunger will double due to crop failure, CO2 reduces protein content in crops, temp and malaria (inc temp leads to shorter parasite development time, need warm enough temp for transmission); arboviruses (faster development rate), increased vector capacity for Zika and Dengue, risk can move north without warning, new ticks?

why are we having problems with parental acceptance of vaccines?

high immunization rates lead to low disease incidence; low disease incidence leads to complacency about need to vaccinate; disease re-emergence as pathogens continue to circulate

risk factors for c. diff infection (CDI)

hospitalization or residing in a long-term care facility; antibiotic use; surgery of the gastrointestinal tract, inflammatory bowel or colorectal cancer, weakened immune system; previous c. diff infection, older age, proton-pump inhibitor--reduced stomach acid--creates spores which are immune to stomach acid

fulfilling requirements for establishing contributory cause or efficacy

hypothesis (group association), population/ecological studies (requirement 1), individual association, case control studies (requirement 2), cause precedes effects, cohort studies (requirement 3), altering the cause alters the effect, randomized controlled trials or natural experiments--contributory cause or efficacy `

EIDs relevance to college health

ill person can be infectious for several days, imported cases could result in local transmission, we need to consider this diagnosis in patients with acute fever and joint pain and travelled back from area with a known virus, primary prevention measure is to reduce mosquito exposure: travel health counseling

should we focus on vulnerable group

improving the average and then also to work on vulnerable groups

MDG success

in 2012, halved the number of people who did not have access to clean water

Socioeconomic/cultural

in the US defined as education, income, and occupational status. Ex: Determinants of disease in TB, breast cancer and occupational injuries

outcome associated with CDI

increase hospital stay, higher cost --burden on the healthcare system; patients with CDI are more likely to discharged long-term care facility

artifactual changes

increase or decrease in prevalence or incidence in a population could be from "real" or artifactual changes; artifactual changes include: increase in population size, improved diagnostic procedures, enhanced reporting....real changes are usually large peaks

how can individual behavior be changed

individual behavior has connections with: downstream factors-ex: genetics, mainstream factors-ex: health; upstream factors-ex: politics; behavior change requires more than individual determination and motivation; social policies and expectations may also need to be changed in order to reinforce individual efforts

population health status measure-measurements that summarize the health of population

infant mortality rate, life expectancy, under 5 mortality, HALEs, DALYs

summary

infectious disease continue to be a major public health burden worldwide-especially in developing countries; methods of control exist but barriers exist in their implementation, CDs represent a significant global health burden in every nation

YLL by category

injuries and CDs, people die younger--so more life lost

theory of planned behavior

intention is the main predictor of behavior

summary

intervention can increase disparities in health status, health behavior (SES, educational attainment, access to resources); not all intervention work with all audiences (health literacy, Digital divide)

health belief models

intra-personal model: perceived susceptibility, severity, benefits, barriers, modifying variable-women are strong so i dont need it, cues to actions, self efficacy-would not do anything until i get diagnosed

three levels of influence

intrapersonal- individual characteristics, interpersonal-relationships between people and population and community- focusing on factors within social structures

why do parents refuse vaccines?

is it safe? does it work? do i need it?

what works--county health rankings

it is a tool online that help communities find policies and programs that are for a specific need

WI county health rankings

launched in 2004, annual publication, modeled after America's health rankings, focuses on both health outcomes and health determinants, ranking could be an issues

c. diff epidemiology

leading cause of antibiotic associated nosocomial diarrhea, fecal-oral transmission with contaminated surfaces and asymptomatic carriers serving the reservoirs for transmission, increase in CDI severity

vaccination requirement for school entry

legal requirement increase vaccination rate

the double burden

low-income countries and settings bear a double burden; CDs is reduced but persistent and NCDs burden grows

wide ranges in death rate and DALYs b/t middle and low income countries compared to high income countries

low-middle income countries-higher percent of communicable disease; high income countries-higher percentage of non-communicable disease; good to compare DALYs, a lot of people suffer from a disease but do not die from it

what are the main GBD (global burden of disease) outputs?

main results are presented in terms of DALYs, YLLs and YLDs; one DALY can be thought of as one lost year of "healthy" life

pre-2015 measles outbreaks in US

majority of the people who got measles are unvaccinated, travelers with measles continue to bring the disease into the US, more people coming into the country who have measles

resolution of diarrhea following CDI treatment

many CDI will become asymptomatic carriers--then shedding of spore onto skin; this implies continuation of contact precautions until discharge instead of resolution of diarrhea

summary

many of todays leading public health problems are caused by unhealthy behaviors, but these unhealthy behaviors are "caused by" complex internal and external "upstream" factors, effective intervention need to address both internal and external "root causes"

an alternate philosophy

market justice view: individual's health results from free choice in an unregulated capitalist society; based on principles: individualism and personal responsibility, self-determination, you "get what you work for", you "get what you deserve", with hard work anyone can achieve what they wish, winners and losers, minimal collective action

the globalization of infectious disease

migration, displacement, travel, newest emerging infectious disease (Zika, Chikungunya, Ebola, MERS)

the flagship framework: a policy oriented tool

more public input, more useful to look at legal documents instead of data

measuring health outcomes

mortality and morbidity (death and disease), length of life, premature death-years of potential life lost, quality of life- QALYs, DALYs, and HALEs

number of deaths by category

most deaths are from chronic disease, most people end up dying in old age

c. diff associated diarrhea (CDAD)

most patients develop diarrhea during or shortly after starting antibiotics; symptoms include mild to moderate watery diarrhea, ab pain, anorexia, malaise, and fever; severity ranges

characteristic of a disease that make eradication possible

no animal reservoir, short persistence in environment, absence of long-term immunity, vaccination produces long-term immunity, herd immunity protects those who are susceptible, easily identified disease, effective post exposure vaccination

MMR and autism

no causation between thimersol/ MMR and autism even though "studies" have said there was (Wakefield)

health systems: expanding our view

not just components but relationships between components, the population is an integral part of the system, goal can be expanded to include distribution, equity and fairness, integrate production of human resources with system

defining "disease"

not limited to disease, the study of ..health and disease, morbidity, injuries, disability, and mortality in populations and the "multiple determinants" of health

consequences of public fear on herd immunity and disease incidence

now there are outbreaks

prevalence

number of existing cases/population X1000; typically for a defined period of time

Incidence

number of new cases/ population X 1000; attack rate=incidence in an outbreak, mortality=incidence of death

finding causes study designs

observational--analytical or descriptive; descriptive--cause study/case report, cross sectional, longitudinal, ecological; analytical--cross sectional, case-control, cohort

planetary boundaries: vital signs

ocean acidification, biodiversity loss, phosphorus, etc, making the link between planetary health and people and animal health

limitation of notifiable disease surveillance: the iceberg problem

only a small proportion of the population who are infected are diagnosed and reported

passive surveillance: just see what comes in

only counts if it is reported and if the patient goes to the doctor

`preventing CDI in healthcare settings

patients with CDI have private room, contact precautions, meticulous hand hygiene, maximize dedicated patient care items, environmental decontamination, maintain education of HCWs and admin

stages of change model

people go through a set of incremental stages when changing behavior rather making significant change all at once; 5 stages: precontemplation (never thought of having a bike), contemplation (thinking about getting a bike), preparation (plan to get a bike), action (starts to ride a bike), maintenance (falls off the bike but has to keep riding)

shedding of c. diff during and after treatment

people shed even after resolution of symptoms

where is your "locus of control"

people who base their success on their own work and believe they control their life have an-internal locus of control; people who attribute their success or failure to outside influences have-external locus of control

social-ecologic model

personal and environmental factors influence behavior; population-level and individual-level determinants of health; health is determine by influences at multiple levels

gLocal

perspectives are essential for effective public health

patterns of health determinants over the life course--health outcome in populations

policies and interventions at the individual and populations levels can affect both the determinants and outcomes

measuring population

population are needed in order to calculate a "rate", clinicians count numerators (and treat them), epidemiologist count populations (and determine rates)

what is implication of a group associations?

population comparisons or "ecologic association" exist; drowning rates are higher in southern, higher consumption of ice cream in southern state, is there a link?

conclusions

population health data exist locally and globally, web based systems enable nearly everyone to access the data, the challenge is to use this data to promote public health action

the full spectrum of population health

population health--traditional public health, healthcare systems, social policy

infection of disease reduction and safety concerns

prevaccines--high incidence; increasing coverage--lower incidence rate; loss of incidence--low incidence; resumption of confidence--outbreak then lower rates`

care process

preventative care, safe care-not suffering from a lab mistake, engagement, we are slightly worse in coordinated care, if you have access and can afford it, the US system work well, we have high medication and lab errors

implementation: how do we get the job done

primary-prior to disease or condition, individual, information (education);secondary-prior to symptoms, at-risk group, motivation (incentives); tertiary-prior to irreversible complication, general population/community (requirement)

evidence-based public health: the P.E.R.I.E approach

problem---etiology- the cause, sets of causes, or manner of causation of disease or condition---recommendations---implementation---evaluation

the public health approach

problem--response; surveillance: what is the problem?, risk factor identification: what is the cause?, intervention evaluation: what works?, implementation: how do you do it?

applications of epidemiology

problem: studying how the health and disease are distributed in the population (surveillance, monitoring morbidity, mortality and trends), etiology: studying the "determinants" of disease etiology and natural history (causes-risk factors and prognostic factors), recommendation: finding programs that work (experiments-trials and observations-quasi experiments--study used to estimate the causal impact of an intervention on target population without random assignment)

purpose of rankings

provide an annual overview of health outcomes and health determinants across WI, spark discussion on health issues, stress that there are multiple broad determinants of health, draw insights from high performing counties

how can information be "communicated for action"

public health needs to use information for "collective action", the county health rankings has been developed to "catalyze action" in communities

were the MDGs good for health?

raised profile of the GH and mobilized assistance, considerable progress in low and middle-income countries, MDGs contributed to fragmentation of interventions, further progress will require the reduction of inequality, discrimination and human rights violation

clinical vs. health

randomized experiences are better clinical interventions, its hard to experiment in public health

admin efficiency

ranked 10th, more doctors reporting problem related to coverage restrictions, went to the emergency room for treatment rather than a normal doctors office, less of waiting time due to being able to see a PA or NP

what have we learned?

rankings garner attention by the media, local officials, and health care providers, anecdotal evidence of community engagement, using broad measures engages multiple stakeholders

group (ecologic associations)

rarely prove a causal association, best to generate hypotheses, that can later be studied in strong research designs

treating CDI empirically

recommend empirical treatment without waiting for test results in patients suspected to have severe CDI; specimens for diagnostic testing must be collected prior to starting empirical treatment

relative risk

relative risk: attack rate of people who attended/ attack rate of people who did not attend; if the relative risk is 6 then you are 6 times more likely to get sick if you at the cafe

quarantine

restriction of well persons who have been exposed, extends from time of exposure to end of incubation period

isolation

restrictions of ill person, extends from onset of illness until no longer infectious

why should we care about global health

self-protection/national security, trade economic productivity, inequalities are unethical and unjust, states have humanitarian responsibilities to other states, we are an interconnected world

income is linked with health regardless of racial or ethnic group

self-reported status-major determinant of health

quantitative sources of public health

single case or small cases, stats or reportable disease, surveys, self reporting

public health philosophy

social justice view: individual health is largely determined by their social and environmental conditions; based on the principles of: shared responsibility and concern for the community well-being, societal support for those with limited opportunities or resources is encouraged, maintains that all persons are entitled equally to basic services

how theories can be applied in practice?

social marketing: can be used to change behaviors, to modify an individual's ability to change, opportunities to change and motivation (educational interventions can improve an individual's skills and abilities to behave in a healthy way, environmental and systems interventions can improve an individual's opportunity to behave in a healthy way, law rules and regulation can motivate an individual to behave in a healthy way); precede-proceed (planning and evaluation)

10 key categories of social determinants of health

social status, social support or alienation, food, housing, education, work, stress, access to health services, transportation, place

C. diff

spore forming, emergence of resistant strain (Ribotype O27)

experimental studies

subject in a defined population are allocated to groups, one group is given treatment, the assignment group can be random, sometimes assignment is not random (quasi-experiment)

herd immunity threshold

sufficient proportion of the population is immune to specific disease thereby protecting individuals who are not immune to the disease

transmission of c. diff in healthcare settings

susceptible patient--exposed to c. diff--colonized with c. diff; asymptomatic carriers or diagnosed CDI or undiagnosed CDI then shedding the spores through touch and the environment is contaminated--portable equipment; healthcare workers come in contact with surfaces and new patients

how can understanding the distribution of disease help us generate ideas or hypotheses about the cause of disease?

the "triad" of descriptive epidemiology: calculate rates by: time (when), person (who), place (where)

the post-2015 agenda for health and well-being

the SDGs and finish the MDGs, every part of society is responsible for health, health is linked to every SDG

equity

the US ranked last, the difference between higher income people getting healthcare and lower income people getting healthcare, racial disparities and in educational level in the US

summary

the US: spends much more (less efficient), has worse health outcomes (less effective), has more disparity (less equitable, poorer access), have average care process for those with access; what can we do: improve health outcomes, reduce costs, be more equitable

endemic

the background, expected occurrence of a disease within a given geographic area or population

etiology: how do we establish contributory cause?

the cause is associated with the effect at the individual level, the cause precedes the effect in time, altering the cause alters the effect

one health

the collaborative effort of multiple disciplines working locally and nationally and globally to obtain optimal health for people, animals, and our environment

Genetics

the idea that genetic factors play a role in the development and outcome of disease. Ex: You're more likely to have breast cancer if your mother has it

attack rate

the number of people who are ill/ the number of people who were there/ did or did not eat a food item...how many people got sick from being exposed

epidemic

the occurrence of cases of an illness in a community or region that is clearly in excess of normal expectancy

outbreak

the occurrence of cases of disease in excess of normal or expected numbers, usually localized

Environment

the unaltered or physical world around us may produce disability and death from sudden natural disasters, and altered physical environment produced by human intervention may lead to inhalation of toxic fumes (built environment). Ex: Soil that is iodine deficient and as a result causes low iodine content in food producing soil

planetary health

the whole planet is at risk if there are boundaries we cross, there are some points where we can not go back-point of no return

conclusions

there is no single measure of the burden of a public health problem; death rates are useful for some disease-other disease are best measured by burden of suffering, need to compare burden by: time, person and place

vaccination rates have been slowly going down

there is pockets of refusal, usually not black and white: refusal of only a couple of vaccinations

how is public health related to the social and behavioral sciences

these subject areas share a fundamental belief that understanding the organization and motivation behind social forces, along with a better understanding of the behavior of individuals, can be used to improve society as a whole

how do social determinants affects health

they contribute to a wide variety of disease rooted in lifestyle, environmental, and social factors; connected with disparities a type of difference in health closely linked with social or economic disadvantages, affect both physical and mental health, being poor or stress can lead to health problems

what factors affected the ease with which a CD is transmitted?

three factors have major impact on transmission: 1) route of transmission 2) asymptomatic transmission-ability to transmit the disease while humans or animals are free of symptoms 3) reproductive ratio-the number of new cases one individual with the disease generates on average over the course of its reproductive period, measure of inherent transmissibility, depends heavily on the route of transmission as well as the presence of absence of asymptomatic transmission

incubation period

time frame from moment of infection to onset of disease

vaccine seeking-decision making: promoters of accepting vaccination

trust in the health providers; feeling satisfied by the discussion; feeling that vaccination= cultural norm; believing the social contract; having positive past experiences with vaccines, wanting to prevent disease

routes of transmission of HIV

unprotected sex with someone infected, sharing injection equipment with someone who is infected, injection or transfusion of contaminated blood or blood products, organs, semen etc and from mother to child; more knowledge= less risky behaviors

health affects of climate change

urban heat island effect, air pollution, vector and water Bourne diseases, water resources and food supply, mental health and environmental refugees

CDC US outpatient flu-like illness surveillance network

uses a standard case definition of ILI, weekly reporting of number of ILI patients and number of primary care encounters, definition that would count as flu-like symptoms then tracked

the national health insurance model

uses private sector providers but payment comes from a government run insurance program that citizens pay into; program tends to be cheaper and simpler admin; they also control costs by limiting the services they provides or by making patients wait to be treated

Bismarck model

uses the insurance system, doctors and hospitals tend to be private

supporting immunization: key messages about immunization safety

vaccination is one of the most important ways in which parents can keep their child safe, vaccines are safe and closely scrutinized to make them safer; a parent's decision to withhold vaccination from their child is an active disease to subject the child to the dangers of disease, delaying vaccination is risk, disease spread in home and schools where vaccination is suboptimal, most parents who are concerned about vaccine safety worry about one vaccine, not all; do not refuse treatment to unvaccinated persons, leave the door open, readdress at every appointment

Institute of medicine report adverse effects of vaccines

vaccines do not cause autism, adverse events consistent with what we know and have been informing parents about for years, continue to reinforce to parents that vaccines are not without their risk, the risk of disease is far worse than that of the vaccine, vaccinate for your child

mumps

virus, mostly salvia exposure, population is highly immunized, vaccine is not as effective, mild illness for most, control: isolation of cases (5 days), recurring outbreaks in college students across the midwest, measles vaccine is more effective

extreme weather and storms

warmer ocean--more energy to dissipate--drives the strength of hurricanes

the health transitions template: comparing complex system

ways to compare different countries

social cognitive theory

we are subject to our complex environment

paris agreement

we need to stay below 2 degrees (goal is 1.5); action on climate change-opportunities for health (energy sector, food systems, transportation)

questions to ask...

what are the causes of this problem? what study designs have been used to learn about the causes? how certain are we about the cause of the problem?

how can we describe a health problem?

what is the burden of disease (morbidity- the number of people/incidence/ prevalence and mortality-years of life lost from this problem), how serious is this problem (do people suffer from this problem), are there disparities in the population (are some populations more affected than others)

recommendations: what works to reduce the health impact?

what types of intervention studies have been done to learn about what works?, quality of evidence is scored based on the types of investigations and how well the investigation was conducted (randomized controlled trials are the highest quality)

Public health is..

what we as a society do collectively to assure the condition in which people can be healthy

a college campus is not an island

whatever we do on our campuses will have significant responses and repercussion in our surrounding communities, infectious organisms do not abide by geopolitical boundaries, we are highly mobile population, migration of entire population occurs multiple times

an outbreak ends..

when the number of reported cases drops back to the normally expected number of cases

environmental cleaning and monitoring

works; if you give feedback then it could improve; the best cleaning is being done by the research team

personal conviction waiver

written statement to the school signed by the parent of guardian stating, "for personal conviction reasons this student should not be immunized", incompletely immunized student may be excluded from school if an outbreak of one of these disease occurs