PHRM700 exam 2 study guide

what are the core functions of public health

assessment, policy development, assurance

assessment

monitoring health status of populaiton

policy development

inform, educate, empower

mobilize community partnerships

develop policies

assurance

enforcement of law and regulations

what are the 3 main components of population health?

distribution of health outcomes within pop, health determinants that influence this distribution, and policies/interventions that impact the determinants

define population health

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

differences between public health and population health (list them)

public is concerned with health of a community as a whole, whereas pop health's goal is to improve health and reduce inequities between populations

public health

broader scope, encompasses health of an entire community and nation

population health

narrower scope, focuses on specific groups of people within a larger population, such as those w chronic diseaasaes, ethnic minorities, or geographic areas

define health promotion

the process of enabling people to increase control over/improve their health

define prevention

strategies and interventions aimed at the deterence, early detection, and minimization/stop of disease/injury

primary, secondary, and tertiary

primary intervention definition and example

eliminating risk factors for a disease

eg. immunization

secondary intervention definition and example

early detection and treatment of disease

eg. pap smear for a cervical cancer screening

tertiary intervention definition and example

minimizing disability associated with advanced disease

eg. a pt with diabetes managing blood sugaar with monitoring/diet/medication

define screening

the identification of unrecognizedd disease or health risks by the paplication of tests or other procedures

define self care

consumers learn to care for themselves, participate in goal setting, and engage in collaaborative decision making

health service utilization is lowered as a result

define health disparity

differences between groups in health insurance coverage, access to and use of care, and quality of care

define health equity

refers to non-clinical factors- social determinants of health- that affect health outcomes for patients

health determinants

an event, characteristic, or any factor that brings about change in health

what factors can lead to health dispararities?

Socioeconomic status Education Age Race Religion Ethnicity Disability (cognitive, sensory, or physical) Sexual orientation/gender identity Mental health Geographic location

3 main categories of health determinants

social, biology/behavioral, environment

example of social health determinant

economic, educational, cultural, isolation

example of biology/behavioral health determinant

genetic, behavioral, lifestyle, immunization

example of environment health determinant

war, disasters, urban corwding, toxic agents, physical agents

federal govt.'s responsibilities for public health

ensure all govt levels have capabilities to provide essential public health services, set goals, contribute financially to federal agencies and states, and respond to emergencies

state govt.'s responsibilities for public health

each state has its own health dept, infectious disease control, health statistic collection, policy development, assuring access to health services, licensing providers, and establishing policies on mental health, substance abuse, and environmental health

local govt.'s responsibilities for public health

heavily involved in "assurance", conducts communicable disease control programs, collect health statistics, provide education services, conduct sanitation, sanitary engingeering, and inspection programs, and provide screening/immunizations

CDC

center for disease control

aim to prevent disease and promote health for entire country, issue policy and behavior recommendations, and main assessment and epidemiologic unit for the nation

FDA

food and drug administration

regulates drugs, medical devices, food, tobacco products, and sets standards for safe use

HRSA

health resources and services adminstration

funds programs and systems that provide healthcare services to uninsured and the medically underserved

define/give example of primary prevention

measures taken to prevent onset of illness/injury

- eliminates causal or risk factors for the disease (risk avoidance)

- increase resistance to the condition (health enhancement)

example: childhood immunizations against communicable diseases and legislation mandating helmets/seatbelts

define/give example of secondary prevention

measures that lead to early diagnosis and prompt treatment of illness or injury

does NOT try to prevent the illness, it does risk reduction and early intervention

example: breast cancer screening with routine mammograms

define/give example of tertiary prevention

measures aimed at minimizing disability following emergence of disease symptoms

treatment and rehabilitation

example: cardiac rehabilitation following diagnosis or HF

describe healthy people

a national initiative within the US department of health and human services

provides model framework to guide health of the public by setting 10-year science based health objectives and goals

What are the goals of Healthy People 2030?

1. Attain healthy, thriving lives free of preventable disease.

2. Eliminate health disparities and achieve health equity.

3. Create environments that support health.

4. Promote health across all stages of life.

5. Engage leadership and the public across sectors.

What is screening and why is it important?

presumptive identification of unrecognized disease in asymptomatic individuals

it catches early disease signs-> earlier treatment-> reduced morbidity/mortality

Common disease screenings

Pap smear

Mammogram

FOBT/colonoscopy

Blood pressure

Fasting glucose

Bone densitometry

PPD/TB test

Why is mandatory newborn screening important?

detects rare but serious conditions early like sickle cell, hypothyroidism, and prevents severe disability or death if treated promptly

What is pseudodisease?

disease that meets the pathologic definition but never progresses or causes symptoms in the person's lifetime

sometimes screening may detect something, but it can be overtreated by accident

screening ethical concerns

false positives

false negatives

cost/access disparitired

informed consent ad=nd autonomy issues.

What is the USPSTF? Its role in health care?

an independent panel of experts in prevention and evidence based medicine

reviews evidence and issues screening recommendations

role: shapes guidelines for clinicians, insurers, and public health policy

define reliability

consistency of a test's results

define validity

accuracy and does it measure what it's supposed to?

Define sensitivity

the % of people with the disease who test positive (the true positive rate)

define specificity

the % of people withOUT the disease who test negative (true negative rate)

define PPV

positive predictive value

probability that someone with a positive test actually has the disease

define NPV

negative predictive value

probability that someone with a negative test truly does NOT have the disease

define epidemiology

the study of distribution and determinants of diseases or othher health-related outcomes in populations; application of this to study and control health problems

goals of epidemiology

define problems, describe illnesses, discover risks, predict trends, intervention strategy, quantify benefits

define pharmacoepidemiology

the study of the use and effects of drugs in large numbers of people

goals of pharmacoepidemiology

describe patterns of use or adverse reactions, compare actual use to guidelines or expected usage patterns, etc

define morbidity

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

define mortality

occurence of death

define incidence

number of new cases of disease in an at risk pop during a specific period of time

define prevalence

total number of given disease cases in the total population at a given point in time

define crude mortality rate

total number of deaths from all causes during a given time frame

define age-specific mortality rate

total number of deaths from all causes among individuals in a specific age category

define cause-specific mortality rate

total number of deaths from a specific cause in a given interval of time

define case fatality

not a true rate, but a proportion

represents proportion of individuals affected with a disease who die from it

what is the major difference between experimental and observational studies?

experimental is when researcher determines the variables, whereas observational is a following and recording of natural courses of exposure and disease development

examples of observational studies

cohort, case control, cross sectional

Experimental study key points

Researcher determines variables/interventions and participants are assigned to treatment or control

Experimental study strengths

Strongest evidence for causality, least bias, detailed data collection, evaluates drugs, technology, screening, care, and delivery

Experimental study limitations

expensive, time consuming, ethical concerns, exclusion may limit generalizability, adherence issues, and sponsorship influence

Case-control study key points

Participants are selected by disease status, always retrospective, and looks back at past exposures to find associations

Case-control study strengths

Cost-effective, relatively quick, useful for rare diseases and long latency, and can evaluate multiple exposures

What is a limitation of case-control studies regarding population representation?

Not representative of population

What is a challenge in determining exposure timing in case-control studies?

Timing of exposure to disease hard to determine

What type of measure is not directly obtained in case-control studies?

No direct incidence measure

What type of bias are case-control studies vulnerable to related to participant memory?

Vulnerable to recall bias

What type of bias can occur during data collection in case-control studies?

Vulnerable to collection bias

What is a cohort study?

A study that follows a well-defined group with shared characteristics longitudinally to observe outcomes.

What are the two types of cohort studies?

Prospective and retrospective.

What is a strength of cohort studies regarding rare exposures?

Useful for rare exposures

What can cohort studies examine in relation to outcomes?

Can examine multiple outcomes

How does the prospective nature of cohort studies benefit the study design?

Ensures temporality

What does a cohort study allow researchers to directly measure?

Direct measure of incidence

What is a bias that cohort studies are less prone to?

Less prone to recall bias

What is a limitation of cohort studies regarding rare diseases?

Inefficient for rare diseases

How do long latent periods affect cohort studies?

They result in long studies

What is a financial limitation of cohort studies?

Generally expensive

What can threaten the validity of cohort studies?

Loss to follow-up

What is a requirement for retrospective cohort studies?

Requires records

What is a key point of a cross-sectional study?

It provides a snapshot in time, measuring exposure and outcome simultaneously.

What is a strength of cross-sectional studies?

They have good generalizability and show the distribution of conditions in a population.

What is a limitation of cross-sectional studies?

They cannot prove causality and have no temporal sequence.

What is an advantage of cross-sectional studies in terms of cost and time?

They are quick and less costly than cohort or case-control studies.

What is a potential bias in cross-sectional studies?

They are very susceptible to bias and possible misclassification in diseases with remissions/exacerbations.

public vs private financing sources for healthcare

public is provided by govt or assisting a certain population, private is private insurance companies separate from the govt

public financing sources examples

medicare, medicaid, chip, federal govt, state/local govt

private financing sources examples

blue cross blue shield, private businesses, households

medicare eligibility

65+, younger w/ disability (after 24 months SS), ESRD(end stage renal disease)

medicare parts and definitions

Part A → Hospital, hospice, skilled nursing, some home health

Part B → Medically necessary care, equipment, preventive services

Part C → Medicare Advantage (private plans bundling A, B, often D)

Part D → Prescription drugs, with deductible, initial coverage, donut hole, catastrophic coverage

low income medicare programs

QMB, SLMB, QI, QDWI help with premiums/deductibles

what are star ratings?

a quality system for medicare advantage and medicare part D

Dates of big changes in medicare policy

1972 → ESRD & disabilities added

1988 → Catastrophic Coverage Act

1997 → CHIP created

2003 → Part D (Rx drugs)

2010 → ACA expanded protections (pre-existing conditions, drug coverage reforms)

What is the difference between medicare and medicaid?

medicare is a federal program funded by federal taxes with parts A, B, C, D specific to certain groups

medicaid varies state by state, with funding from their joint program, covers low income

care for the elderly, aid for the poor

What does the Affordable Care Act (ACA) prohibit regarding health insurance coverage?

It prohibits health insurance companies from denying or charging more for coverage based on an individual's health status.

What program does the Affordable Care Act (ACA) expand?

The Medicaid program.

What type of financial assistance does the Affordable Care Act (ACA) provide?

Subsidies for individual insurance policies purchased through State-based Marketplaces.