W16 PH1 midterm study guide
W16 PH1 midterm study guide Public Health 1
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This 6 page Study Guide was uploaded by YUWEI LIU on Wednesday February 10, 2016. The Study Guide belongs to Public Health 1 at University of California - Irvine taught by DR BIC in Winter 2016. Since its upload, it has received 76 views. For similar materials see Intro to Public Health in Public Health at University of California - Irvine.
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Date Created: 02/10/16
Sensitivity: among patients with disease, the probability of a positive test Specificity: among patients without disease (i.e. healthy patients), the probability of a negative test Ch10 Resistant Tuberculosis Much higher risk for people with HIV; transmitted by aerosol; problem of resurgence with resistance to antibiotics because lower socioeconomic level population not able to afford the medication. Improper use of antibiotics leads to resistance, including multi drug resistance, when mortality rate can be 50%. Directly observed therapy works—best approach to preventing antibiotic resistance. Prions—particles contain protein New variant CJD, or mad cow disease, in Britain in younger people, thought to be caused by eating infected beef. Regulations have been tightened on animal feed, such as PH surveillance. Bioterrorism Approach to bioterrorism is the same as that for natural disease outbreaks (find pathogen and who is affecting the disease); will probably first be recognized by surveillance; best defended against by same methods as natural outbreaks. Discussion Question 1: what are three PH measures that could reduce the probability that bacteria will develop resistance to antibiotics? —increase dosage in a person —decrease the rate of taking antibiotics —-develop new medical drugs to destroy the bacteria Ch11 The Biomedical Basis of Chronic Diseases Cardiovascular disease Connected with low levels of good HDL(high density lipoprotein) and high levels of bad LDL (low density lipoprotein); genetics are a major factor; exercise lowers total cholesterol and increases HDL; smoking lowers HDL; widespread use of Statins for secondary prevention. Hypertension, or high blood pressure, is an important risk factor for cardiovascular disease. Atherosclerosis—deposition of plaques of fatty material on the inner wall in the arteries—causes heart disease and stroke. Plaque begins at an early age in U.S.American diet raises risk. Diet, high blood pressure, diabetes, smoking interact to cause injury of artery walls. Cancer Not one disease, but many; each has different risk factors, treatments, etc; arises from mutations in DNA; mutations caused by chemicals, viruses, radiation…lifestyle? Diet and hormones play a role; tobacco use causes one-third of cancer deaths; testing chemicals for carcinogenicity. Vegetarians that eat less fat and more antioxidants and phytochemical show increased immune system level and decreased risk of developing cancer. Caloric restrictions inhibit tumor-genesis cells. Diabetes Major cause of disability; prevalence is rising in US along with obesity; deficiency in the body’s ability to metabolize sugar; Type 1 diabetes—childhood onset; failure of insulin-producing cells of pancreas; Type 2 diabetes—adult onset (more than 50 yr old), insulin resistance; Type 2 diabetes closely correlated with obesity; treatable, but need long-term monitoring; need good access to medical use. Higher risk increasing inAsia. Vegetarian diet prevent development of diabetes. Complication: blindness, kidney failure, poor wound healing, amputations of the extremities. Discussion Question 1: how do epidemiology and biomedical science complement each other in improving people’s understanding of chronic diseases? —think about the Framingham study and cardiovascular diseases —find out the risk factor from both approach to prevent early onset of chronic disease Discussion Question 2: How do these websites (ACS,AHA,ALA,ADA) differ from those of the NIH institute for the same disease? —these websites provide ways of preventing the disease onset and educational function. (Epidemiology approach) —NIH bases on biomedical research. (BMS approach) Ch12 Genetic Diseases and Other Inborn Errors Environmental Teratogens Infectious pathogens or toxins that affect development of new born babies; Syphilis (bacteria passed through placenta), blindness and mental retardation; Rubella (deafness), vaccination; Toxoplasmosis (parasitic disease, neurological damage), cats are reservoir; environmental chemicals—Mercury (1950: Minamata disease, Japan, brain damage, neurological problems). Genetic Diseases Chromosomal abnormalities—e.g Down syndrome (mental retardation); may be caused by new mutations Mendelian genetics —autosomal dominant (one parent has it, non-sex chromosome, 50%). Huntington’s disease—mid-life deterioration; Marfan’s syndrome—extremely high, cardiovascular abnormalities —autosomal recessive (both parents have it), inherit two copies of the gene, Tay-Sachs disease —X-linked (Hemophilia, Duchenne’s Muscular dystrophy) Screening Newborn screening only when benefits the newborn, when can confirm diagnosis and when treatment and follow-up are available for infants; carrier identification should be voluntary and confidential and include counseling; prenatal diagnosis should include education and counseling; all tests of high quality, evaluated by FDA; governmental oversight of laboratory proficiency; more education for the general public about genetics. Newborn screening Test drop pf blood from newborns for metabolic abnormalities; all newborns in US are screened for at least two conditions: PKU, if it’s missing (phenylketonuria, metabolism of amino acid phenylalanine) and hypothyroidism (risk of mental retardation); states vary in conditions screened for; early diagnosis can prevent or reduce permanent damage. Ethical issue raises if considering abortion. Carrier screening Screen for recessive genes in high-risk populations; Tay-Sachs disease in Jews (encouraged by Jewish leaders) Human genome project In breast cancer, if someone was find out to have more presence of BRCA1 and BRCA2 genes, that person has a higher risk of developing breast cancer. Modifications are change in lifestyle or providing genomic medicine to reduce the risk. Discussion Question 1: what would be the benefits and drawbacks of including tests for BRCA1 and BRCA2 in newborn screening programs? —drawbacks: ethical issue considering health insurance coverage and employment if high risk for breast cancer is found out. —benefits: start preventive measure; public education needed to have the population see from the positive perspective. Discussion Question 2: visit website www.hhs.gov/familyhistory/ download a form for recording your family’s health history. Think of any benefits and drawbacks. Discussion Question 3: visit website www.genome.gov —ELSI: Ethical Legal and Social Implications is “an integral part of the Human Genome Project (HGP) to foster basic and applied research on the ethical, legal and social implications of genetic and genomic research for individuals, families and communities.” —Ethical, legal, and social issues: genetic testing and screening, genetic discrimination and health insurance, interactions among social, behavioral and genetics, etc. Ch13 Do people choose their own health? Actual causes of death Tobacco, poor diet and physical inactivity, alcohol consumption, microbial agents, toxic agents, motor vehicles, sexual behavior, illicit drug use.Account for almost half go all death, most are preventable and premature, most are caused by individual behavior, targets for public health intervention. Health promotion strategies Walk for cancer; healthy diet: is rich in whole, natural foods, fruit, vegetables, grains, beans, seeds, nuts; low in fats, omega 6 / omega 3 5:1, low in refined sugars; adequate but not excessive amounts of protein, preferable plant origin, around 0.8g/kg; drink plenty of water; sleep at least 7 hours; regular exercise— physical activity 15-30min; regular exercise—meditation 15min. Prohibition Seems to work at first, but causes development of black market. Cannot do prohibition without education and regulation, which are the two that are always better to do. Education Provide information: smoking is bad, recommended dietary allowances, health education in schools, physicians’recommendations can be effective. Regulation Laws against murder and assault; traffic regulations; restrictions on alcohol, drugs, and tobacco; age restrictions on many behaviors; sexual behavior is hard to regulate. Ch14 How psychological factors affect health behavior Social environment Most important predictor of health is socioeconomic status: less access to medical care, more strss, not healthy nutrition, air pollution, lead paint, crime, violence…; health also affected by gender, marital status, race and ethnicity; In U.S., racial and ethnic minorities have poorer health than whites—health disparities are a big concern of public health. SES Affects nutrition and sanitation, conditions of the physical environment so higher raises of crime; higher SES leads to healthier behavior and access to medical care. Social support Alameda study—association between certain unhealthy behaviors and higher mortality rates; strong association with social network; social support can buffer stress. Theories are used for programs to promote behavior change: Health belief model I am vulnerable to the threat; the threat is serious; by taking action I can protect myself. Locus of control theory (self-efficacy) Self-efficacy is increased by previous successful performance and by seeing others successfully perform, especially if model is a peer. Ecological model Intra-personal level (psychology); inter-personal level—family, friends, coworkers; institutional level— school, workplace; community level—churches, community organizations; public policy level— government regulations. Transtheoretical model—Dr. Prochaska Sometimes from relapse to contemplation directly. Ch15 Tobacco 1954—smoking and health—first medical research on connection between smoking and lung cancer Death caused by smoking: cardiovascular disease, lung cancer, respiratory disease—pneumonia, influenza, bronchitis, emphysema, chronic airway obstruction, other cancers—laryngeal, oral, esophageal, pancreatic, urinary, diseases among infants, burns. Prevalence of smoking (1980—health consequences of smoking for women) Fallacy of women’s immunity: women started smoking later than men; women’s lung cancer rates began rising later; lung cancer among women surpassed breast cancer in the 1980s. Black men had higher rates but have declined; higher rates inAmerican Indians andAlaska Natives; strong association with lack of education; now in U.S., about 23% of adults smoke. Biomedical basis of smoking’s harmful effects Nicotine is an addictive drug—raises blood pressure and heart rate; may cause spasms in blood vessels of heart. Tars—provide flavor—damage cilia and irritate respiratory tract Carbon monoxide—interfere with oxygen carrying capacity of blood. Other ingredients—arsenic, benzene, are also carcinogenic; alter clotting properties of blood; raise blood cholesterol and reduce HDL. Health improvements with smoking cessation Serotonin Serotoninergic system maybe involved in smoking behavior: Nicotine increases brain serotonin secretion and nicotine withdrawal decreases certain levels. smoking is associated with reduced lipoprotein lipase activity. Chronic smoking aggravates insulin resistance. Non-smokers rights movement 1990s Class action lawsuit by state attorneys general; FDAcommissioner Kessler proposed to regulate tobacco; “Mr. Butts” leaked tobacco company documents; tobacco industry on the defensive. Master SettlementAgreement 1997-1998—agreed on a settlement; $206 billion to 46 states over 25 years; industry agreed to restriction on advertising; $1.7 billion toAmerican Legacy Foundation—“truth campaign” (to learn manipulations by the tobacco companies) used lessons learned from California campaign; disappointingly, states used very little of settlement money for tobacco control. CAtobacco control program Funded by 1989 tax increase of 25% back; cigarette consumption immediately began to decline; media campaign in 1990 and 1991; 1994—smoking ban in all workplaces; cigarette consumption declined by 60 since 1988; lessons on effective anti-tobacco messages.
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