GW PUBH 1101 Henry: Chapter 2 (Evidence-Based Public Health)

burden of disease

occurrence of disability and death due to a disease

morbidity and mortality

disability and death

course of disease

how often the disease occurs, how likely it is to be present, what happens once it occurs; we look at rates to determine this

distribution of disease

looks at who gets the disease, location of these people, when the disease occurs, etc.; focuses on group associations, race/age/gender/SES, urban/rural, risk factors

epidemiologists

public health professionals who look at frequencies of diseases

group associations

these are investigated when epidemiologists look for disease distribution; suggest ideas/hypotheses about etiology of disease

risk indicators

this is when types of a factor occur more frequently among groups w the disease when compared to groups without the disease

artifactual

these are differences or changes in a distribution of disease are not real; could be this if there are differences/changes in interest/ability in identifying the disease or if there are differences/changes in disease definition; Ex: these types of changes can happen w new technology, new interest in detection, changes of definition like with HIV/AIDS

age adjustment

looks at age to see if that is a factor in disease development

incidence

the number of NEW cases over the total population at risk within the same time period

prevalence

when there are new AND preexisting cases within a certain time period within a population; this is typically higher than the incidence

population comparisons

ecological studies; these look at groups or a population without having information on specific individuals in the group

confounding variable

variable in a study/experiment that is never really taken into account when making the experiment, it is usually found afterwards

contributory cause

causation of a disease that is established using research studies, where the cause is associated with the effect, the cause precedes the effect, and altering the cause alters the effect

case-control studies

establish that a cause is associated with an effect for individuals; Ex: show that cigarettes and lung cancer occur together more frequently than by just chance alone

risk factor

when a factor has been shows to be associated with a certain outcome; Ex: smoking cigarettes is associated w the outcome of lung cancer

cohort studies

establish that the cause precedes the effect; these follow individuals with the cause or risk factors and those without the cause/risk factor to see who develops the effect/outcome; Ex: smokers are compared with non-smokers to see which group develops lung cancer

randomized controlled trials

establish that altering the cause alters the effect; individuals are assigned to be exposed or not exposed to the cause to see who develops the effect; Ex: some will smoke and some will not, and they will be tracked to see who develops lung cancer

efficacy

implies that an intervention is effective and it increases positive outcomes

necessary cause

a condition that must be present for the effect to occur; Ex: cigarettes are not this because some never smoke but still develop lung cancer

sufficient cause

a condition that automatically produces the effect in question; Ex: this is not cigarettes because some smoke but do not develop lung cancer

PERIE process

framework for defining/analyzing/addressing public health issues; it is circular and the cycle will repeat itself if need be

problem

P in PERIE; defining what the main health issue is that needs to be addressed

etiology

E in PERIE; what is the contributory cause? we look at the different studies to establish relationships between causes and effects for indivdiuals

recommendations

R in PERIE; works to reduce health impact; evidence-based __________ are built on evidence from intervention studies that indicate whether health outcomes will be improved; these interventions account for benefits as well as safety & harm; scored based on evidence quality

score

part of recommendations; can be good, fair, or poor; criteria for evidence-based recommendations is graded based on the quality of investigation

implementation

I in PERIE; looks at when, who, and how to intervene by focusing on the timing of disease to introduce intervention, who the intervention is for, and the type of intervention; these are done once there are strong recommendations

information intervention

intervention strategy that looks to change behavior through individual encounters, mass media, or group interactions; Ex: Truth campaign for smoking

motivation intervention

intervention strategy that looks to change behavior via incentives that are tangible rewards; Ex: student rewards for not smoking

obligation intervention

intervention strategy that looks to change behavior through laws and regulations; Ex: increasing age to purchase cigarettes, suspension of student athletes who smoke

victim blaming

could happen in motivational interventions; Ex: punishing smokers who smoke could be seen as this bc it implies that smoking is the fault of the smoker

primary interventions

type of intervention; occurs before disease onset and tries to stop disease from every occurring; Ex: yearly checkups, eye doctor

secondary interventions

type of intervention; occurs after the development of disease or when symptoms appear; Ex: pre-diabetes, testing abnormalities, pre-cancerous cells, person in cancer remission, family history for disease

tertiary interventions

type of intervention; occur after the occurrence of symptoms, is the management of disease; Ex: diagnosis of cancer and currently going through chemotherapy, diabetes type II and managing w insulin treatments

evaluation

measures how much of the problem has been eliminated by the interventions, looks at what problem remains; we want to publish this data and if it succeeds w another population, or want the intervention to be adapted to fit different groups

RE-AIM framework

relatively new method of intervention evaluation; reach effectiveness, adoption, implementation, maintenance; used in clinician work/clinic settings