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Interdisciplinary agglomeration of health sciences that incorproate elements of social, political, environmental and behavioral health science.
Public Health
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Public Health is summarized as
- health promotion
- disease prevention
- Disease intervention activities in human populations
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4 aspects of public health
- social
- political
- environmental
- behavioral
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IOM mission of public health
fulfillment of society's interest in assuring conditions in which people can be healthy
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Secondary prevention
- early detection
- screening
- pharmacists providing drug review
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Tertiary prevention
- cardiac rehabilitation
- medications
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Principles and methods of epidemiology are defined as
- study of the factors that determine the frequency, distribution and etiology of disease
- applications of these studies to control health problems
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Epidemiologic Triangle
- relative health/history of disease in a population
- host
- environment
- agent
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Endemic
habitual presence of a disease within a geographical area
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Epidemic
- disease occurrence in a community or region
- group of illness similar in nature
- excess of normal expectancy
- derived from a common/propagated source
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HIV/AIDS is not only an _____ in the US but a ____.
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State public health
state health department
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National public health
- public health service
- national center for health statistics
- FDA
- Center for disease control & prevention
- NIH
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Areas which state and national public health programs focus
- needs assesment
- environmental health
- mental health
- tobacco
- health literacy/communication
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Healthy people 2010 has ____ objectives for improving health
467
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Healthy people 2020 has ___ objectives for improving health
over 1000
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Public health objectives fall into ____ focus areas
28
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One general goal of national health objectives is
ensure safe and effective use of medical products
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methods of ensuring safe and effective use of medical products
- monitoring adverse medical events
- review of medications
- info from prescribers and dispensers
- pt counseling
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4 aspects of patient counseling
- information about taking medication
- precautions
- side effects
- risk associated with treatment
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association of economic growth in child mortality
- as the country develops, life expectancy increases then levels off
- highly correleated to economic growth
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International organizations formulating health policy
- United nations
- world bank
- WHO
- WTO
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Public health issues
- obesity/nutrition
- smoking cessation
- immunization
- cleanliness
- HIV/illegal drug use
- cost/treatment of disease
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Two main types of epidemiology
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Descriptive epidemiology
- describes disease/exposure and may consist of calculating rates
- studies of drug utilization
- incidence and prevalence
- no control groups
- only generate hypothesis
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Analytic Epidemiology
- compare an exposed group to a control group
- usually designed as hypothesis testing
- observational studies
- experimental studies
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Observational studies
- type of analytic epidemiology
- case control studies
- cohort studies
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Experimental studies
- type of analytic epidemiology
- clinical trials such as randomized clinical trials
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5 core functions of epidemiology
- describe occurrence of exposure to certain population
- conduct disease surveillance/risks of potential disease
- describe differences between populations
- identify/quantify root causes of disease (analytic)
- test interventions that may aid in identification or mitigation of disease
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Pharmacoepidemiology then can also be defined as
study of utilization and effects of drugs in large numbers of people
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Pharmacovigilance
- scientific and data gathering activities related to detection, assesment and understanding of adverse events
- pharmacoepidemiologic studies
- identify adverse events
- understand nature, frequency and potential risk factors
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ADHD and electrocardiac disturbances
short term direct effects
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zyprexa weight gain leading to CV disease
indirect effects
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Viagra and nitrates
drug-drug effects
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Use of vertain anti-diabetes agents in diabetics with kidney disease
drug-disease interactions
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Pharmacovigilance helps to
- detect
- assess
- understand
- prevent
- adverse effects
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Integrated administrative data is an option to
post marketing surveillance studies
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occurrence of a disease can be measured using
- counts
- proportions
- ratios
- rates
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Rates show us
how fast disease is occuring in a population
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Proportions show us
what fraction of the population is affected
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Measures of mortality
- mortality rates
- case fatality rate
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Incidence
- the number of specific events occuring in a specified population/unit time
- new cases of a disease
- measure of risk
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calculation of incidence per 1000
(# of new cases/# of population at risk) x 1000
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Incidence
cumulative incidence/incidence proportion
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Prevalence
- number of cases of a diease existing in a specified population and a given point in time
- measures burden of diease
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Prevalance per 1000 =
(# of cases present/# of persons in the population) x 1000
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Prevalence measures_____ in the community.
burdens of disease
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Incidence measures_____ in the community
risk of disease
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Prevalence shows how many people in the community are ____.
effected
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Incidence shows how many _____ are in the community at a specific time
new cases
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P =
- I x time
- in a steady state situation
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Case fatality rates
shows what percent of people diagnosed as having a certain disease die within a certain time after diagnosis
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Mortality rate
shows death in an entire population
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case fatality rate
shows death in people with that disease
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observational studies
- case control studies
- cohort studies
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Experimental studies
randomized control trials
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7 types of bias
selection, referral, information, recall, reporting, temporal-precedence, wish
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common measures used in screening
- sensitivity
- specificity
- positive predictive value
- negative predictive value
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validity of a test is defined as the ability to of a test to...
distinguish between who has a disease and who doesn't
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Two components of validity
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ability of a test to identify correctly those who have the disease
sensitivity
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The ability of a test to identify correctly those who do not have a disease
selectivity
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Why is it important to know the validity of a test?
- false positives result in the use of more expensive tests
- burden to health care system
- worries
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5 Types of epidemiological studies
- Randomized control trials
- cohort studies
- cross-sectional study
- case control study
- screening
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randomized clinical trials
- experimental studies
- assess efficacy of preventative and therapeutic measures
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Uses of randomized control trials
- evaluating new drugs and treatments of disease
- test new health/medical technology
- assess new ways of organizing health services
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3 types of observational studies
- cohort studies
- case control studies
- cross sectional studies
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Studies in which subjects are selected with respect to the presence and absence of a characteristic suspected of being associated with a particular outcome
cohort study
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cohort study is also known as
a prospective study
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Studies in which subjects are selected on a basis of their status with respect to a given characteristic. Cases show the characteristic and controls do not
- case control studies
- odds ratio
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Cross sectional studies
- also called prevalence study
- exposure and outcomes are determined
- snapshot of population at a point in time
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Case control study =
retrospective study
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cohort study =
- longitudinal study
- perspective study
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prospective cohort study =
- concurrent cohort study
- concurrent prospective study
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retrospective cohort study =
- historical cohort study
- non concurrent prospective study
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Randomized trial =
experimental study
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cross sectional study =
prevalence study
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Measures of association
- relative risk
- odds ratio
- rate ratio
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relative risk
ratio of risk of an outcome among people exposed to a given factor vs. people not exposed
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relative risk is used to
estimate the magnitude of an association between exposure and disease
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RR =
Risk in exposed/risk in not exposed
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relative risk greater than 1 means
suggests strong positive association
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Relative risk = 1
- no association
- less than 1 means exposed individuals have less risk of the outcome than non-exposed
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RR = 0
strong negative association
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Odds ratio
- ratio of the odds of occurrence of an event under certain circumstances vs. other circumstances
- used mostly in case-control studies
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when is the odds ratio obtained a good approximation of the relative risk in a population?
- cases are representative of all people with the disease
- controls are representative of all people without the disease
- when the disease being studied does not occur frequently
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