Health & Society Midterm

• prescribing too many antibiotics --> diseases mutate a lot, so we have to keep coming up with new medicines for it
• environmental changes --> flooding, changing weather patterns

• father of epidemiology
• british cholera epidemic - inspected water pumps to see what was causing the disease

• 1. establish case definition - specific set of people that fit the disease
• 2. confirm suspected cases - asking questions related to case and try to figure out a reason for disease
• 3. define population denominator - limit it to people within a radius
• 4. review the literature - read about stuff relating to case
• 5. exposure assessment - make sure affected people were contaminated b/c of possible site and not other sites
• 6. generate plausible hypothesis

• incidence = number of new cases / total population
• prevalence = number of all cases / total population

doesn't count all the people who already died

• prospective - begins at beginning and follows people over time
• retrospective - begins today, look backwards to see what happened to people in the past

• descriptive studies --> describes the occurrence of the outcome, examining distribution of disease and observing basic features
• analytic studies --> describes association between exposure and outcome, tests hypothesis about cause by studying how exposure relates to disease

• case report studies - unusual findings
• case series - multiple cases of findings
• description epidemiology studies - population based cases with denominator, look at entire population that are exposed

• observational
• experimental

• case control studies --> determines and compares exposures, not outcomes
• cohort studies --> compares incidence of outcome to see if exposure leads to the outcome (all have been exposed but you observe which ones get affected)
• cross-sectional studies --> aka prevalence study, single period of observation (today), exposure and disease info is collected at the same time
• randomized control trial studies --> planned experiment with group of people, 2 groups (1 is the control), designed to test how effective the intervention/clinical treatment is, completely randomized

• person
• place
• time

• host - person that is affected
• agent - factor that is essential for transmittance of disease
• environment - factor that affects the agent

ability of a test to correctly identify those who have the disease

• the ability of a test to correctly identify those who do not have the disease
• SpPin

few false negatives

few false positives

• specificity - better to test if the treatment is harmful  (chemo for cancer)
• sensitivity - better to have this test when you need to detect something early on (cancer)

• specificity - sometimes so good at finding negatives that it gives false negatives
• sensitivity - sometimes so good at finding positives that it gives false positives

true positive / (true positive + false negative)

true negative / (true negative + false positive)

test indicates disease but there is actually no disease present

test indicated no disease there actually is a disease

• population based - usually a small sample of overall population
• measure wide range of health indicators for a community (entire country or state or county)
• collected/analyzed over a period of time (months, years, etc)
• include different types of data - vital, morbidity, mortality, use & cost of health care

• nature (source) of data
• availability of data
• validity and reliability of measures
• completeness of population coverage
• strengths & limitations of study design

key indicators about life and health in a particular region

• reliability - consistent, meaning it is collected in the same way over multiple years
• validity - accuracy

measurement error or bias

if it measures what it intends to measure without systematic error

representative of entire parent population

network effect, one person can go out and recruit other similar people

ability to apply findings to a people that did not participate in a study

care it take to identify all cases of a given disease

• formulate the question
• choose the best resources for the question
• evaluate the results 
• repeat as necessary

• Infectious (communicable)
• Chronic (non-communicable)

• communicable diseases
• caused by pathogenic microorganisms (bacteria, viruses, parasites, fungi)
• can be spread directly or indirectly

• emerging - newly identified, previously unknown infectious agents that cause public health problems either locally or internationally
• re-emerging - known for some time, fell to low levels, and now showing upward trends in incidence or prevalence worldwide

• non-communicable
• not passed from person to person
• of long duration and generally slow progression

• cardiovascular --> diseases of blood vessels of the heart (stroke, heart disease)
• cancers --> severe health consequences, generally not very treatable
• chronic respiratory diseases 
• diabetes --> increased blood sugar levels

• due to a lack of insulting or an inability or body's tissues to respond properly to insulin
• type 1 --> need for lifelong insulin therapy
• type 2 --> related to insulin resistance, managed with diet and exercise
• gestational diabetes --> develops during pregnancy

• disease - pathological changes within the body which are expressed in various physical signs and symptoms (symptoms during pregnancy)
• illness - an individual's subjective interpretation and response to these signs and symptoms (ancestor coming & possessing body)

a system of thoughts and behaviors shared by a group of people

• communication
• orientation to space & time
• social organization
• family structure
• gender roles
• religion 
• social factors
• stigmatization of illness

• where sufferers claim to have a specific disease that many physicians don't recognize or acknowledge as medical 
• ex: chronic fatigue

• when human problems or experiences become defined as medical problems
• ex: madness, drug & alcohol problems, menopause, baldness

• a conceptual frame work that emphasizes the cultural and historical aspects of phenomena widely thought to be exclusively natural
• AND
• examines how individuals and policy groups contribute to producing perceived social reality and knowledge

• better sanitation, clean water, etc
• diseases of affluence (CHD, stroke, obesity)
• disease patterns are changing

• inequity - unfair or unjust
• inequality - unequal

• fixed --> things that cannot be changed, genetic or biological differences
• fluid --> things that can change and we don't have control over (age, income, where you live)

studies the social distribution and social determinants of health based on things like socioeconomic states, gender & ethnicity

doesn't take genetics or lifestyle into account

factors that influence a person's health/choices

• income --> the amount that can be spent/consumed within a given time
• consumption --> amount of resources actually used within a given time
• wealth --> total value of assets and liabilities at any point in time

the study of overlapping or intersecting social identities and related systems of oppression, domination or discrimination

first generation migrants are generally much healthier than their children (health gets worse over time) -- don't know why

• blacks have a higher rate of infant mortality than other racial groups
• blacks go to the emergency room more than regular doctor's office

• gender --> socially constructed term referring to roles, behaviors, activities, and attributes that a given society considers appropriate for men & women
• sex --> defined biologically & physiologically

a person's emotional, sexual, and/or relational attraction to others

• msm = men who have sex with men
• wsw = women who have sex with women

person's internal sense of being  male, female, or something else

denying any non-heterosexual behavior

fear/hatred of somebody because they are trans

higher your social construct

when everyone, regardless of race, culture, or income enjoys the same degree of protection from environmental and health hazards and equal access to the decision-making process to have a healthy environment in which to live, learn and work

a medically diverse group of tropical infections which are especially common in low-income populations in developing regions of Africa, Asia and the Americas

• primary - reducing the risk and avoiding problems before they start
• secondary - taking action to stop risk behaviors before an actual illness
• tertiary - treatment / rehabilitation after an illness

transtheoretical model

• pre contemplation --> no intention to adopt change within next 6 months, unaware of their issues
• contemplation --> acknowledges there is a problem, intends to make change within the next 6 months but not committed yet
• preparation --> planning on making behavior change within the next month, may doubt their abilities but collects info
• action --> now making changes to modify behaviors, this phase includes a lot of time, money and energy
• maintenance --> sustain changes for 6 months or more, try to prevent relapse and avoid temptations
• relapse --> going back to previous behavior, can happen at any stage throughout the cycle