Uconn PUBH 1001 Gregorio - Midterm

Population health approach

An evidence-based approach to problem solving that considers a range of possible interventions, including health care, traditional public health, and social interventions

Social justice

a philosophy that aims to provide fair treatment and a fair share of the reward of society to individuals and groups

Interventions

the full range of strategies designed to protect health and prevent disease, disability and death

High-risk approach

focuses on those with the highest probability of developing disease and aims to bring their risk close to the levels experienced by the rest of the population

Improving-the-average approach

assumes that everyone is at some degree of risk and the risk increases with the extent of exposure

Risk factor

a characteristic of individuals or an exposure that increases the probability of developing a disease. It does not imply that a contributory cause has been established.

Contributory causes

a definition of causation that is established when all three of the following have been established: (1) the existence of an association between the "cause" and the "effect" at the individual level, (2) the "cause" precedes the "effect" in time, and (3) altering the "cause" alters the probability of the "effect"

Determinants

underlying factors that ultimately bring about disease

BIG GEMS

A mnemonic that summarizes the determinants of disease: behavior, infection, genetics, geography, environment, medical care, socioeconomic-cultural status

Built environment

the physical environment constructed by human beings

Demographic transition

describes the impact of falling childhood death rates and extended life spans on the size of populations and the age distribution of populations

Epidemiological transition or public health transition

a concept indicating the change that has been historically observed as part of social and economic development, from mortality and morbidity dominated by infections, to morbidity and mortality dominated by what has been called noncommunicable disease or degenerative and man-made disease

Nutritional transition

countries frequently move from poorly balanced diets often deficient in nutrients and calories to a diet of highly processed foods including fats, sugars and salt

P.E.R.I.E process

a mnemonic that comes from the first letters of the evidence-based public health approach

Problem

what is the health problem?

Etiology

What is/are the contributory causes

Recommendations

What works to reduce the health impacts?

Implementation

How can we get the job done?

Evaluation

How well does/do the intervention(s) work in practice?

Burden of disease

Generically, an analysis of the morbidity and mortality produced by disease. Often used to refer to the use of DALYs to estimate the burden of morbidity and mortality

Morbidity

a public health term to describe the frequency of impairments or disability produced by a disease or other condition

Mortality

a public health term to describe the frequency of deaths produced by a disease or other condition

Course of a disease

a description of a disease or other condition often using incidence, prevalence and case-fatality

At-risk population

the group of people who have a chance or probability of developing a disease

Incidence rate

rates that measure the chances of occurrence of a disease or other condition over a period of time, usually one year

Prevalence rate

a measurement of the number of individuals who have a disease at a particular point in time divided by the number of individuals who could potentially have the disease

True rate

a measurement that has a numerator that is a subset of the denominator and a unit of time, such as a day or a year, over which the number of events in the numerator is measured

Etiology

the cause of a disease or health condition

Case-fatality

the chances of dying from a condition once it is diagnosed

Distribution of disease

how a disease is spread out in a population, often using factors such as persons, place and time

Epidemiologist

an investigator who studies the occurrence and control of disease or other health conditions or events in defined populations

Associations

the occurrence together of two factors, such as a risk factor and a disease, more often than expected by chance alone

Group associations or ecological associations

Two factors, such as characterization and a disease, occur together more often than expected by chance alone in the same group or population. Does not require that the investigator have data on the characteristics of the individuals that make up the group or population

Risk indicators

A characteristic such as gender or age, that is associated with an outcome but is not considered a contributory cause

Artifactual association

an association observed in the data that is actually the result of the method of data collection

Age adjustment

taking into account age distribution of a population when comparing populations or when comparing the same population at two different points in time

Age distribution:the number of people in each age group in a population

Standard population:The age distribution of a population that is often used as the basis for comparison with other populations. The age distribution of the U.S. population in the year 2000 is often used

Population comparisons

A type of investigation in which groups are compared without having information on the individuals within the group

Ecological studies

a type of investigation in which groups are compared without having information on the individuals within the group

Confounding variable

a difference in the groups being compared that makes a difference in the outcome being measured

Case-control or retrospective studies

a study that begins identifying individuals with a disease and individuals without a disease. Those with and without the disease are identified without knowledge of an individual's exposure or non-exposure to the factors being investigated

Cohort or prospective studies

an investigation that begins identifying a group that has a factor under investigation and a similar group that does not have the factor. The outcome in each group is then assessed.

Randomized controlled trials or experimental studies

an investigation in which individuals are assigned to study or control groups using a process of randomization

Risk fact

a characterization of individuals or an exposure that increases the probability of developing a disease. It does not imply that a contributory cause has been established

Reverse causality

the situation in which the apparent "cause" is actually the "effect"

Randomization or random assignment

as part of a randomized clinical trial, assignment of participants to study and control groups using a chance process in which the participants are assigned to a particular group with a known probability

Ancillary or supportive criteria

criteria that may be used to argue for a cause-and-effect relationship when the definitive requirements have not been fulfilled

Natural experiment

a change that occurs in one particular population but not another similar population without the intervention of an investigator

Efficacy

an intervention increased positive outcomes or benefits in the population on which it is being investigated

Strength of the relationship

supportive or ancillary criteria implying that a measurement of the strength of an association, such as a relative risk or odds ratio, is large or substantial

Relative risk

a ratio of the probability of the outcome if a factor known as a risk factor is present compared to the probability of the outcome if the factor is not present

Absolute risk

the actual changes or probability of developing the disease expressed as a probability

Dose-response relationship

a relationship that is present if changes in levels of an exposure are associated with changes in frequency of the outcome in a consistent direction

Odds ratio

a measure of the strength of the relationship that is often a good approximation of the relative risk. This ratio is calculated as the odds of having the risk factor if the disease is present divided by the odds of having the risk factor is the disease is absent

Consistency

a supportive or ancillary criteria implying that the relationship has been observed in a wide range of populations and settings

Protective factor

a factor that is associated with a reduced probability of disease

Biological plausibility

an ancillary or supportive criteria for contributory cause in which the disease can be explained by what is currently known about the biology of risk factor and the disease

Necessary cause

if the "cause" is not present, the disease or "effect" will not develop

Sufficient cause

If the "cause" is present, the disease or "effect" will occur

Score

In the context of evidence-based recommendation, a measurement of the quality of the evidence and a measurement of the magnitude of the impact

Effectiveness

an intervention has been shown to increase the positive outcomes or benefits in the population or setting in which it will be use

Surrogate outcomes

a measurement of outcome that looks at short-term results, such as changes in laboratory tests, that may not reflect longer term or clinically important decisions

Attribute risk percentage

the percentage of the disease or disability that can potentially be eliminated, among those with the factor of being investigated, assuming a contributory cause and assuming the impact of the "cause" can be immediately and completely eliminated

Primary intervention

an intervention that occurs before the onset of the disease

Secondary intervention

early detection of disease or risk factors and intervention during asymptomatic phase

Tertiary intervention

an intervention that occurs after the initial occurrence of symptoms but before irreversible disability occurs

Victim blaming

placing the responsibility or blame for a bad outcome on the individual who experiences the bad outcome due to his or her behavior

RE-AIM

a mnemonic that comes from the first letters of the steps in a fully developed evaluation process

How well does the intervention work in practice

Reach

who is the intervention being applied to in practice?

Effectiveness

What is the impact in practice on the intended or targeted population

How well is the intervention accepted in practice

Adoption

How well is the intervention accepted?

Implementation

How should the intervention be modified to reach target population?

Maintenance

How can we ensure long-term continuation?

Health communication

the full range of uses of information in health, from data collection to decision making

Public health surveillance

collection of health data as the basis for monitoring and understanding health problems, generating hypotheses about etiology, and evaluating the success of intervention

Databases

a collection of data organized in such a way that a computer program can select and compile the desired pieces of data

Population health status measures

quantitative summary measures of the health of a large population, such as life expectancy, HALEs, and DALYs

Infant mortality rate

a population status measure that estimates the rate of death in the first year of life

Life expectancy

a population health status measure that summarizes the impact of death in an entire population utilizing the probability of death at each age of life in a particular year in a particular population

under-5 mortality

a population health status measure that estimates the probability of dying during the first 5 years of life

Health adjusted life expectancy (HALE)

a population health status measure that combines life expectancy with a measure of the population's overall quality of life

Disability adjusted life year (DALY)

a population health status measure that incorporates measures of death and disability and allows for measurement of the impact of categories of disease and risk factors

Health-related Quality of life (HRQOL)

a health status measure that reflects the number of unhealthy days due to physical plus mental impairment. HRQOL provides an overall quality of health measure, but it does not incorporate the impact of death

Health literacy

the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions

Dread effect

perception of an increase in the probability of occurrence of an event due to its ease of being able to be visualized and its feared consequences

Unfamiliarity effect

perception of increased probability of an event due to an individual's absence of prior experience with the extent

Uncontrollability effect

perception of increased probability of occurrence of an event due to the perceived inability of an individual to control or prevent the event from occurring

Decision analysis

a process that compares the outcomes of two or more interventions based on principles of expected utility

Utility scale

a scale that goes from zero to one, with zero reflecting immediate death and one reflecting full health. This scale is used to measure the value or importance that an individual or a group of places in a particular outcomes

Expected utility

in decision analysis, the probability multiplied by the utility to produce a probability that takes into account the utility of the outcome

Sensitive

in decision analysis, indicates that changes in a particular factor within a realistic high and realistic low range results in changes in the recommendation of the decision analysis

Quality adjusted life years (QALYs)

a measurement that asks about the number of life-years saved by an intervention rather than the number of lives

Discounting

a process in which we place greater importance on events that are expected to occur in the immediate future than on events that are expected to occur in the distant future

Heuristics

rules of thumb for decision making that often allow more rapid decision making based on a limited amount of information

Decision maker

a generic term that can be applied to a range of individuals and organizations that make health decisions, including individuals, health professionals, and organizations ranging from nonprofits to corporations to government agencies

Risk-taking attitudes

a decision-making attitude in which an individual or group consistently favors taking actions or avoiding actions that differ from recommendations of a decision analysis utilizing probabilities, utilities and the timing of events

Certainty effect

a risk-taking attitude in which the decision maker favors the status quo rather than a probability of obtaining a better or worse outcome