Midterm 2 Review

BIG GEMS

B:behavior
I:infection
G:genetics
G:geography
E:environment
M:medical care (access and quality)
S:socioeconomic -cultural (demographics, policies)

Morbidity

Disability: any departure, subjective or objective, from a state of physiological or psychological well-being

Mortality

Death: reported as ____ rates

Confounding variable

a difference in the groups being compared that makes a difference in the outcome being measured and which is not in the chain of causation

Ecological analysis

A hypothesis about the cause of a disease without having information on specific individuals within a group

Case-Fatality Rate

Estimates the chances of dying if one gets the disease

Case-Control Study

(retrospective) study design that compares individuals with a disease (cases) with individuals who do not (controls) to identify possible exposure

Cohort Study

(prospective)compares individuals exposed and individuals not exposed and follows both up over time to compare the incidence of disease

Randomized Control Trial (RCT)

(prospective) Study that randomly assigns individuals to a treatment or control status and follows both up over time to compare the incidence of an outcome

Efficacy

The performance of an intervention under controlled circumstances

Effectiveness

The performance of an intervention under "real world" circumstances

Non-communicable disease (NCDs)

Chronic diseases with slow progression, that are the result of combination of BIGGEMS factors. Usually non-infectious diseases

Primordial Prevention

Targets social and economic policies effective health

Primary prevention

Targets risks factors leading to injury/disease (safety belt laws or vaccinations)

Secondary Prevention

Prevents injury/disease once exposure to risk factors occurs but still in early "pre clinical" stage

Tertiary Prevention

Rehabilitating persons with injury/disease to reduce complications

Multiple risk factor reduction

a strategy to intervene simultaneously on a series of risk factors that contribute to a particular outcome

Cost-effectiveness

combines issues of benefits and harms with issues of financial costs. Measure of the cost relative to its benefit

Net-effectiveness

A measure of the benefits minus the harms of an intervention

Causes of Communicable Disease

1. Bacteria (syphilis, cholera)
2. Viruses(measles, smallpox)
3. Parasites (malaria, pinworms)

Epidemic

an increase in the frequency of a disease about endemic rate

Endemic

usual and expected rate of disease (fluctuates)

Pandemic

an epidemic occurring worldwide, or over a wide area, crossing international boundaries, and usually affecting a large number of people

Koch's Postulates

4 conditions to establish than an organism is a contributory cause of a disease

Koch's 4 Postulates

1. The organism must be shown to be present in every case of the disease by isolation of the organism
2. The organism must not be found in cases of other disease
3. Once isolated, the organism must be capable of replicating the disease in an experimental animal
4. The organism must be recoverable from the animal

R naught (R0)

The # of people that a single infected person can be expected to transmit that disease to. Used to estimate the degree of communicability of a disease & the potential of the disease to lead to an epidemic

Quarantine

separates/restricts movement of people exposed to a contagious disease to see if they develop the disease

Isolation

separates sick people with a contagious disease from those who are not sick

Herd Immunity

Limits the ability for the disease to spread.

Test sensitivity

The probability of a positive test when the disease is present

Test specificity

The probability of a negative test when the disease is absent

False negative

Individuals who have a negative result on a screening test but turn out to have the disease

False positive

Individuals who have a positive result on a screening test but turn out not to have the disease

Public Health tools available to address the burden of communicable diseases

1. Barrier Protections
2. Immunization
3. Screening and case finding
4. Treatment and contact treatment
5. Efforts to maximize effectiveness of treatments and prevent resistance to treatment
6. "Swiss cheese Defense "

Chain of infection

Transmission pattern by which an infections disease is passed from person to person. composed of 4 links

4 links of chain of infection

1. Pathogen (virus, bacteria, parasite)
2. Reservoir (place where pathogen lives)
3. Means of transmission ( from host to new host, reservoir to new host)
4. Susceptible host

Physical environment

1. Unaltered environment: "Natural" environment
2. Altered environment: Result of added chemicals, radiation, and biological products
4. Built environment: Result of human construction

4 approaches to address complex interactions between humans and physical environment

1. Risk assessment
2. Public health assessment
3. Ecological assessment
4. Interaction analysis

1. Risk Assessment

A formal process that aims to measure the potential impact of known hazards

2. Public Health Assessment

Similar to risk assessment but includes data on actual exposure in a community, addresses risk in specific location, large numbers of individuals, and often population as a whole

3. Ecological Risk Assessment

Examines the impacts of contaminants on ecological systems ranging from chemicals, to radiation, to genetically altered crops. Includes contaminats to humans, plants, animals and their ecosystems

4. Interaction analysis

To understand and control the impacts of environmental exposures, it is necessary to take into account the effect of two or more exposures.

Sociological imagination

Enables us to grasp history and biography and the relations betweenthe two within society

Social determinants of health

Condition 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 & quality of life

Socioeconomic Status (SES)

The position of individuals within a socially stratified system that differentially distributes socioeconomic resources that people need to obtain desired outcomes or goals

Social class

Class position determined by degree of possession of 3 types of capital
1. Economic capital
2. Cultural capital
3. Social capital

Race

Classification of humans into one of several subpopulations distinguished by perceived common physical characteristics

Ethicicty

Defined by perceived common ancestry, history, and cultural practices

Cultural racism

Racist beliefs, attitudes, stereotypes ingrained in a culture

Institutional racism

Institutional mechanisms/processes can manifest as discriminatory policies and practices

Interpersonal Racism

Experienced in every day interactions with others (overt, unintended, microaggressions)

How culture can affect Health: Behavior

Social practices may put individuals and groups at increased or reduced risk

How culture can affect Health: Response to symptoms

Such as level of urgency to recognize symptoms, seek care, communicate symptoms

How culture can affect health: types of interventions

Types of interventions people find acceptable

How culture can affect health: response to disease and to interventions

Follow-up, adherence to treatment, acceptance of adverse outcomes

Stress (social)

- Major life events, chronic strains, daily hassles
- Exposure patterned by SES and race- ethnicity
-Mortality increase after death of a spouse, job loss, etc.
-increased risk of heart disease & common cold

Social support

Important means to prevent &/or buffer effects of stress

Self-efficacy: sense of having control over one's life

Increased by:
- previous successful performance
- seeing others successfully perform

Theory

A set of interrelated concepts, definitions, and propositions that explain or predict events or situations by specifying relations among variables

Model

A combination of ideas & concepts taken from multiple theories & applied specific problems in specific settings

Health belief model

People are more likely to take action if they believe:
- they are susceptible to the condition it has serious consequences
- taking action would benefit them, and benefits outweigh the harms
-they have the ability to successfully perform the action

Transtheoretical Model (stages of change)

- Widely useful in health education
- Behavior change as a process
- involves progress through 5 stages:
1. Pre-contemplation: no intention to change yet
2. Contemplation: aware of benefits of changing
3. Preparation: decides to change and planned actions to do so
4. Action: actual behavior change/modification
5. Maintenance: change achieved but must strive to prevent relapse

Theory of Planned Behavior

Focus: intention is the main predictor of behavior
Behavior intention is influenced by:
- Individual's attitude toward performing a behavior
- Their beliefs about whether people important to them approve or disapprove of the behavior (subjective norms)
- Their beliefs about their control over performing the behavior

Social Cognitive Theory

Interaction between individuals and their social systems
Changing behavior requires an understanding of:
- individual characteristics
- Influences in the social and physical environment
- Interaction among all these factors
Reciprocal determinism: dynamic interplay among personal factors, the environments and behavior (changing one of these factors will change them all)

Ecological Model

Describes 5 levels of influence that determine health-related behavior
1. Intrapersonal level: psychology
2. Interpersonal level: Family, friends, coworkers
3. Institutional level: school, workplace
4. Community level: churches, community organizations
5. Public policy level: Government regulations

Fundamental Cause Theory

For SES and race-ethic disparities
Fundamental causes involve:
resources such as: knowledge, money, power, prestige, beneficial social connections that
Determine the extent to which people are able to: avoid risks, adopt protective strings so as to
Reduce morbidity and mortality

Diffusion of Innovation Theory

How a new idea, product, or social practice is disseminated and adopted in a population. Diffusion & adoption/rejection are affected by affributes of the innovation such as,
Relative advantage, comparability, complexity trialability, observability

Diffusion of Innovation Theory Adopters

Early adopters: Those who seek to experiment with innovative ideas
Early majority adopters: often opinion leaders whose social status frequently influences others to adopt the behavior
Late adopters: Those who need support and encouragement to make adoption as easy a possible