Rahman: The study of public health from a pharmacy standpoint.
Rahman: Public health is targeted toward the individual or the population?
Rahman: Immunization - Preventing the condition before it happens.
B. primary prevention
Rahman: Prevention of handicap - condition has already happened.
C. secondary prevention
Rahman: Disability, but prevent from worseing of situation and mortality - prevent the condition to lead to death or worse situation.
A. tertiary prevention
Rahman: The recipient of the causative agent of a disease; The patient.
Rahman: The cause of the disease; Also called as contagion.
Rahman: Consists of the conditions affecting survival of transmission of causative agent.
Rahman: Which part of the host-agent-environment model does public health or epidimiology issue?
Rahman: This model is used in identifying the nature and extent of a drug use associated problem is society. This model can also be used to identify and describe the occurence and development of a disease.
Rahman: Epidemic vs Endemic?
Endemic: a disease state that is constantly present to a greater or lesser degree in people of certain class or in people living in a particular condition
Epidemic: a widespread outbreak of an infectious disease, many people are infected at the same time
Rahman: What organization is responsible for the safety and effectiveness of drugs?
FDA (Food and Drug Administration)
Rahman: What organization's main job is to control public health - responsible for any epidemiological conditions?
CDC (Center for Disease Control)
Rahman: What organization's main task is to do research with funding from Congress and thus preventing and promoting public healh tasks? This organizations main tasks are for research, provides grants from the government and distributes it.
NIH (National Institute of Health)
Rahman: What are the 6 reasons for public health investigation?
1. the number of people affected with the condition is large OR small but growing quickly
2. There are unusual or severe symptoms of a condition
3. An obvious explanation for the symptoms or condition is lacking
4. There is a need to implement controls, given the extent of the illness
5. There is a certain level of public concern about the health problem
6. The results of the investigation would contribute to medical knowledge
Rahman: What are the 5 major classification of diseases?
1. Congenital and Hereditary diseases
2. Allergies and Inflammatory diseases
3. Degenerative or chronic diseases
4. Metabolic diseases
5. Cancer and Infectious diseases
Rahman: What are the 5 means of disease transmission as described by the World Health Organization?
2. Food and Water
Rahman: Data collected = symptoms, demographics.
C. personal data
Rahman: Data collected = clinical exam findings, lab data.
A. clinical data
Rahman: Data collected = exposure, risk factors, causative agents data, chemical and biological data, etc.
A. environmental data
Rahman: ___ is the proportion of people in the population who develop a particular condition during an outbreak.
Rahman: ___ is a disease state that is constantly present to a greater or lesser degree in people of certain class or in people living in a particular condition.
Rahman: ___ is a widespread outbreak of an infectious disease, many poeple are affected at the same time.
Rahman: ___ is the time between exposure and onset of symptoms or signs of infection.
Rahman: ___ is the ability of agent to cause infection. Minimum number of infectious particles required to cause disease. In a person-to-person transmission, the higher this is, the more secondary infections.
Rahman: ___ is the ability of a microbiological agent to induce disease.
Rahman: Describe Pathogenetic Mechanism (5)
1. production of a toxin
2. immunologic enhancement or allergic reaction
3. persistent or latent infection
4. enhancement of host susceptibility to drugs
5. immune suppression
Rahman: ___ is the ability of an organism to cause mortality. Measured by case fatality rate or proportion of clinical cases that develop severe disease. Directly related to mortality.
Rahman: ___ is the ability of an organism to produce an immune response that provides protection against reinfection with the same or similar agent. Can be life long or for limited periods.
Rahman: How do you calculate Attack Rate?
AR = (# of cases with disease) / (# of people at risk)
Rahman: There are 45 students living in the dorms. 35 students become ill. Calculate attack rate.
AR = (# of cases with disease) / (# of people at risk)
AR = 35/45 * 100 = 78%
Rahman: Given the ff., calculate AR for females and AR for males.
- 45 students are living in the dorm
- 35 students are ill
- 20 total females are living in the dorm
- 25 total males are living in the dorm
- 18 females are ill
- 17 males are ill
AR females = 18/20 * 100 = 90%
AR males = 17/25 * 100 = 68%
Rahman: Calculate the risk ratio of female to males if AR for females is 90% and AR for males is 68%.
risk ratio = 90/68 = 1.3
Rahman: ___ is the likelyhood of living for a specified time period after the diagnosis of a particular condition.
Rahman: Calculate fatality rate and survival rate... Of 7 people who develop the disease, 4 people die from it.
CFR = 4/7 *100 = 57%
SR = (7-4)/7 *100 = 43%
Rahman: ___ is the identification and collection of information regarding medications after their approval by the FDA.
Rahman: ___ is a clinical trial stage that is done on animals based on lab results to test for chemical properties.
Rahman: __ is a stage in clinical trials. If within 30 days FDA doesn't reject you can start study.
INDA (investigation new drug application)
Rahman: ___ is a stage in clinical trial that focuses on safety. This is done on healthy volunteres and here, we only look at side effects.
Rahman: ___ is a stage in clinical trial that focuses on safety and efficacy. This is where they determine if the drug is doing what it is intended to do.
Rahman: ___ is a stage in clinical trial that foucses on safety, efficacy and the type of dosage forms. The pharmacokinetics of the drug such as half life are determined.
Rahman: ___ application given to the FDA. Between Phase 3 and Phase 4 of a clinical trial.
NDA (new drug application)
Rahman: ___ is a stage in clinical trial that is called post-marketing. Pregnant women, elderly, children are typically excluded from clinical trials. Mutagenic, teratogenic and co-morbidities are not studied.
Rahman: What are the 5 types of post-marketing surveillance (who does phase 4 trials)?
1. spontaneous reporting systems
2. case reports
3. case-controlled studies
4. database research
5. randomized trials
Rahman: ___ is a formal reporting system designed to record and analyze the occurece of adverse drug reactions. This is when several practitioners report the same adverse reaction to allow for an investigation.
spontaneous reporting systems
Rahman: FDA launced program to encourge drug reaction reporting by practitioners with greatest public health implications. Serves as a central reporting agency for adverse drug reactions. Reported via phione, fax, internet or mail.
Rahman: What are the 4 actions by MEDWatch?
1. addition of new information to drugs label or package
2. mandates manufacturers to distribue letters to all practicioners
3. require manufacturers to initiate a program to monitor the adverse drug reaction formally
4. suggest a withdrawal of drugs from the market (if side effects are so severe)
Rahman: What are some limitations of spontaneous reporting?
1. it's voluntary - resulting in underreporting
2. co morbidities information not available
3. obesrvation and reporting bias
Rahman: ___ is a method to monitor adverse reactions where practitioners share their individual experience in the published medical literature.
Rahman: ___ is a hospital/institution based adverse reaction studies.
Rahman: ___ repeats clinical trials in view of the adverse reactions reported.
randomized clinical trials
Rahman: ___ monitors automated health records such as outpatient visits, pharmacy records, hospital admissions, etc.
database research and monitoring
Rahman: Risk assessment is a science-based approach for communicating effectively in which situations? (4)
1. high concern (virulence, mortality) situations
2. low trust situations
3. sensitive situations
4. controversial situations
Rahman: True or False? Risk assessments are accurate measurements that describe the amount of risk associated with a particular exposure in a population.
Risk assessments are estimates that describe the amount of risk associated with a particular exposure in a population.
Rahman: ___ is an interactive process of exchange of information and opinion among individuals, groups and institutions. It involves multiple messages about the nature of risk and other messages, not strictly about risk, that express concern, opinions or reactions to risk messages or to legal institutisons arrangements for risk managers.
Rahman: What are the 7 rules of risk communication?
1. Accept and involve the recipient of information as a legitimate power
2. Plan carefully and evaluate communication performance
3. Listen to your audience
4. Be honest, frank and open
5. Coordinate and collaborate with other credible sources
6. Plan for media influence
7. Speak clearly and with compassion
Rahman: T/F. We don't need to involve the recipient of information as a legitimate partner.
False. An involved, informed recipient of information that is interested, thoughtful, solution-oriented and collaborative is central to risk communication.
Rahman: T/F. Audiences all have the same goal, therefore, we don't need to evaluate our communcation performace.
False. We need to plan carefully and evaluate or communication performance because we have diff auiences, goals and media that all require different communication strategies.
Rahman: T/F. We need to listen to our audience.
True. People are usually more concerned about trust, credibility, control, voluntariness, fairness, caring and compassion that about technical details.
Rahman: What are the most valuable assets to risk communication?
trust and credibility
these are difficult to obtain, and once lost - almost impossible to regain
Rahman: T/F. We don't need to coordinate and collaborate with other credible sources. Evidence, trust and credibility, are the only things necessary to prove our risk assessment.
False. It is impt to coordinate and collaborate with other credible sources. Few things hurt credibility more than conflicts and disagreements among information sources.
Rahman: Which is better...
a. technical language
b. caring and compassionate language
b. caring and compassionate language
technical language and jargon are BARRIERS to communication. Distant, abstract, unfeeling language puts most people off.
Rahman: T/F. It is okay to scare our audience when communicating risk.
True. Although people don't usually stay very frightened very long, getting them a little frightened for a litle while motivates precautionarly thinking and action.
Rahman: T/F. It's okay to tell our audience that "the situation is under control, everything is going to be fine"?
False. Overconfident over reassurance is terrible risk communication. Share hope, but fear the worst.
Rahman: What can we do in risk communication to humanize the organization by letting the pain of difficult decisions flow? It gives people a chance to make suggestions and be part of the process. It moderates the conflict between opposing recommendations and reduces the outrage if you turn out to be wrong.
Important to Share Dillemmas
Rahman: ENVITE for risk communication?
Rahman: ___ is performed to detect as many people with a disease as possible. These are tools used to prevent disease in a population.
Rahman: ___ is applied to patients on a one-to-one basis by a physician. This uses the results of screening tests as well as signs and symptoms and other subjective measures.
Rahman: Testing or Screening?
-only patients are looked at
-low to high prevalence
Rahman: Testing or Screening?
-non patients are looked at
-early disease/risk factor
-low to low prevalence
Rahman: What are the 6 considerations in planning a screening program?
1. The disease or condition should be a major medical problem
2. Tests and testing procedures should be acceptable to the general population
3. Policy and procedures should be determined to know who should be referred for further testing or treatment
4. The process should be simple enough to encourage large groups of people to participate
5. Screening should be ongoing activity
6. Prevention better than cure
Rahman: ___ is the proportion of positive results among all the patients that have certain disease.
high sensitivte tests are extremely helpful in screening
ex. ELISA to detect HIV in blood donors
Rahman: ___ is a test that is considered the most accurate among all the known tests. All the others should be compared with this test, in order to indicate whether they are reliable.
Rahman: test classification - people who test positive for a disease and who actually have the disease
Rahman: test classification - those who test positive but don't have the disease
Rahman: test classification - those who test negative and don't have the disease
Rahman: test classification - those who test negative but have the disease
Rahman: describe the 2 prong approach to reduce false negatives and positives
1. highly sensitive screening tests to reduce false negatives (rule OUT disease)
2. highly specific screening test on follow-up to reduce false positives (rule IN disease)