Principles of Public Health midterm

Social justice =

common good

market justice =

individual responsibility

T/F most public health measures have some sort of negative economic impact

True

T/F businesses often resist public health efforts

True

Those who must ___ may not be the ones that ___

Pay, benefit

T/F benefits are easier to calculate than costs

False

Core functions of public health

Assessment, policy development, assurance

Patient in public health vs medicine

community, individual

Goal of public health vs medicine

prevent disease/disability, cure

General pattern of PH pyramid

lower levels = low individual effort, high population impact

Higher levels = high individual effort, low population impact

basic science of public health

epidemiology

shoe-leather epidemiology

fieldwork, on-the-ground investigations

Epidemiologic main goals

causes of new disease, prevents spread of old disease

General public health disciplines

1. Statistics

2. Biomedical sciences

3. Environmental health science

4. Social and behavioral sciences

5. Health policy and management

Primary prevention

prevents illness or injury from even occurring

Secondary prevention

minimizes severity of illness or injury once it has occurred

tertiary prevention

minimizes disability caused by illness or injury through medical care or rehabilitation services

Public health approach

1. define health problem

2. identify risk factors

3. develop/test community-level interventions

4. apply interventions

5. monitor intervention effectiveness

Chain of causation

1. Agent

2. Host

3. Environment

T/F interventions must address all 3 components of chain of causation

False

Tragedy of the commons

freedom of individuals should be restricted for the wellbeing of all

Paternalism

protecting individuals from their own actions

Opposition to PH measures

1. Moral/religious

2. Politics vs science

3. economic impact

4. individual liberty

A policy should only be justified if… (5 parts)

1. significant risk/reason for it

2. intervention is likely to work

3. economic costs are reasonable

4. burden on rights is not excessive

5. benefits and burdens evenly distributed

Is PH responsibility a federal or state issue

State

Federal responsibility (what is in constiution)

promote general welfare

FDA involved in

interstate commerce

how does federal government indirectly control PH

power to tax and spend

legislative role in PH

passes statutes

executive role in PH

public health agencies carry out law, issues regulations consistent with statutes

judicial role in PH

laws and regulations challenged in court

Local agency responsibilities

1. day-to-day PH tasks

2. core PH functions

3. medical care for poor

State department responsibilities

1. collect/analyze local data

2. lab services

3. manage medicaid

4. licensing

5. reimburse hospitals

6. handle environmental, aging, social service, mental health issues

CDC

NIH

Non governmental organization types

1. specific disease focus

2. professional membership

3. define future of public health

Epidemiologic surveillance function

controls spread of diseases, aids in recognizing new diseases

outbreak investigation steps

1. verify diagnosis

2. construct case definition

3. find cases systematically

4. describe the outbreak: pattern of disease

5. look for common exposure source

PAR

Population at risk for illness/injury (who could get the disease)

Incidence

number of NEW cases (who did get the disease)

Prevalance

number of EXISTING cases (who has the disease)

Intervention studies

control and intervention groups chosen by researcher, watched over time for effectiveness

Cohort study

same as intervention except people choose own exposure

Random variation

association between exposure and outcome due to chance

confounding variables

exposure not taken into account affects outcome

selection bias

systemically different comparison groups

reporting/recall bias

groups with same exposure report data differently

observer/interview bias

reseacher’s expectations influence how they collect or report data

Attrition bias

participants who drop out of the study are meaningfully different from those who stay

ecological fallacy

applying group-level data to individuals

funding bias

source of funding influences how a study is designed/analyzed/reported

publication bias

studies with positive or significant results more likely to be published

factors that lend validity to results

1. large sample size

2. known biological explanation

3. strong association

4. consistent results from several studies

5. High relative risk or odds ratio

6. 
   

Statistics allow us to…

interpret the numbers that describe the health of the population

What does difference of 5mmHg at p=0.02 mean

if drug had NO effect, we would see a difference this large or larger only 2% of the time due to random chance

what does a 95% confidence interval mean

If the study were repeated many times, 95% of the confidence intervals would contain the true value

Power of a study

probability of finding an effect if there is an effect

False negative

Null/negative result when there is a positive result

False positive

positive result when there is a null/negative result

sensitivity

How good the test is at catching people with the disease (high sensitivity = low false negatives)

specificity

How good the test is at identifying people who don’t have the disease (high specificity = low false positives)

Crude rates

total cases/population (no breakdown by age, gender, or subgroup)

adjusted rates

population differs in some structural way, take these into account

group specific rates

rate for one specific subgroup like gender or occupation

risk assessment

understanding what/how likely/how bad harm could be

risk perception

how people FEEL about a risk

How much data is too much

never enough

Important qualities of good data

1. quality

2. timeliness

3. relevance

In depth interview

one-on-one semi structured conversation (best for personal experiences, sensitive topics, detailed stories)

Key informant interview

interview with a person who has specialized knowledge or community insight (best for understanding, systems, programs, policies, communities)

Focus group

guided small group discussion with people who have shared characteristics/experiences (best for shared beliefs, community discussion, differing perspectives)

observation

systematically observing behaviors, interactions, environments (best for what people actually do, and how interactions operate)

Visual/participatory methods

participants use photos, videos, maps to communicate experiences (best for experiences that may be difficult to capture through words alone)

credibility

did researchers accurately represent participants experiences

transferability

can these findings apply somewhere else

dependability

could another researcher understand exactly how this study was done

confirmability

are findings supported by data rather than researchers personal opinions

member checking

verify participants agree with researcher interpretation

triangulation

compare information from multiple sources or methods

reflexivity

recognize and document how a researcher’s background/experiences might influence the study

audit trail

keep detailed records of decisions made throughout the research process

thick description

provide enough context for readers to judge whether findings apply elsewhere

peer debriefing

discuss interpretations with other researchers to challenge assumptions

quarantine

for those thought to be of serious exposure to disease

isolation

for those with the disease/exhibiting symptoms

bacteria

single celled organisms, antibiotics are effective

viruses

alive? host cells needed, vaccines critical for control

parasites

complex organisms, transmitted through water, soil, insects

Vectors

disease transmitted by another organism

carriers

people with disease but lack symptoms

pathogen

infectious agent

reservoir

where disease is “stored”: humans, animals, soil, or water

means of transmission

how disease gets transferred from reservoir to host

susceptible host

host without immunity or resistance

Eradication is possible if…

no nonhuman reservoir and a vaccine exists

endemic

constant predictable baseline of a disease in certain area

epidemic

sudden, unexpected spike in cases in a region

Factors that lead to new infectious disease emergence

1. humans activities that lead to ecological damage and more proximity to wildlife

2. international travel during incubation period

3. agricultural practices

4. international distribution of contaminated products

5. limited prevention tools

What leads to antibiotic resistance

1. improper use

2. use in agriculture

T/F chronic disease is leading cause of death/disability

True (70%)