study guide part two
study guide part two PSYC_3150_10
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This 9 page Study Guide was uploaded by Gabriela Saint-Louis on Tuesday February 24, 2015. The Study Guide belongs to PSYC_3150_10 at George Washington University taught by Forssell in Spring2015. Since its upload, it has received 161 views. For similar materials see Psychology of Sex Differences in Psychlogy at George Washington University.
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Date Created: 02/24/15
Introduction to Public Health BIGGEMS framework used to use determinants to identify underlying factors quot causes of causesquot that ultimately bring about disease 1 Behavior 0 Implies actions that increase exposure to the factors that produce disease or protect individuals 0 HIV unprotected sex multiple sex partners 2 Infection 0 Often the direct cause of disease Early or longstanding exposures to infections may contribute to the development of disease or even protection against disease 0 Early exposure to infections may actually reduce disease ranging from polio to asthma 3 Genetics 0 Focus on roles that genetic factors play in the development and outcome of disease 0 Even when contributory causes such as cigarettes have been clearly established as producing lung cancer genetic factors also play a role in the development and progression of the disease 0 While genetic factors play a role in many diseases they are only occasionally the most important determinant of disease 4 Geography 0 Geographic location in uences the frequency and even the presence of disease 0 Geography implies that special locations are required to produce disease such as frostbite in the arctic or snake bites in the tropics 5 Environment 0 Environmental factors determine disease and the course of disease in a number of ways Natural physical world around us natural disasters iodine de ciencies due to low iodine content in the foodproducing soil Built environment physical environment built for use by humans produces determinants ranging from indoor air pollution to quotinfant proofedquot homes to hazards on the highway 6 Medical Care 0 Access to and the quality of medical care can be a determinant of disease When a high percentage of individuals is protected by vaccination nonvaccinated individuals in the population may be protected as well 0 Medical care often has its major impact on the course of disease by attempting to prevent or minimize disability and death once disease develops 7 Socioeconomiccultural O In US socioeconomic factors have been de ned as education income and occupational statusall been shown to be determinants of diseases as varied as breast cancer tuberculosis and occupational injuries Cultural and religious factors are increasingly being recognized as determinants of disease because beliefs sometimes in uence decisions about treatments in turn affecting the outcome of the disease HIVAIDS connection pg 45 0 Wide range of current and developing applications of genetics including Genetic prevention incorporates efforts to prevent the occurrence of signle genes or multiple gene combinations that are likely to produce disease Genetic detection prior to disease approach includes efforts aimed at the detection of genetic defects and the implementation of early intervention to prevent phenotypic expression of genes Geneenvironmental protection genetic testing holds out the possibility of de ning combinations of genes that identify individuals who are especially likely to develop disease when they experience speci c environmental exposures Genotypicbased screening for early disease combinations of genes may identify groups that are at high risk of common diseases and that can be targeted for screening Socio ecological framework a concentric circle with different levels P PWF Individual level speci c high risk diseases lifestyle etc Interpersonal level Organizational level ex school worksite etc Community level Public policy level issues cost time Important for researchers start looking at the interpersonal level people who directly in uence your behavior 10 key categories of social determinants of health in uences in health The evidencebased public health approach 5 basic questions that we need to ask that together make up what we will call the evidencebased public health approach 1 Problem what is the health problem i What Is the burden of a disease or other health problem ii What is the course of disease or other health problem iii Does the distribution of the health problem help generate hypothesis 2 Etiology what isare the contributory cause 5 i Has an association been established at the individual level ii Does the quotcause quotprecede the quoteffectquot iii Has altering the quotcausequot been shown to alter the quoteffectquot 3 Recommendations what works to reduce the health impacts i What is the quality of the evidence for the intervention ii What is the impact of the intervention in terms of bene ts and harms iii What grade should be given to indicate the strength of the recommendations 4 lmplementation How can we get the Job done i When should the implantation occur ii At whom should the implementation be directed iii How should the interventions be implemented 5 Evaluation How well doesdo the interventions work in practice i How well does the intervention work in practice on the intended or target population ii How well does the intervention work in practice as actually sued iii How well is the intervention accepted in practice Circular process if the evaluation suggests that more needs to be done the cycle can and should be repeated The inform of decision approach implies that the clinician has all the essential information and can make decisions that are in the patient s best interest Role of the clinician is then merely to inform he patient of what needs to be done and to prescribe the treatment or write the orders Informed consent approach relies on the principal that ultimately patients need to give their permission or consent before major interventions such as surgery radiation or chemotherapy can be undertake Informed consent may be written spoken or implied Clinically informed consent implies that individuals have the right to know what will be done why it will be done and what the known bene ts and harms are Shared decision making approach In this approach the clinician39s job is to provide information to the patient with which he or she can make a decision This approach places a far greater burden on the patient to seek out understand and use information Clinicians are not required to provide recommendations on speci c interventions though patients are free to ask for a clinician39s opinion Social justice vs Market Justice 0 two ways health care is looked at in us social iustice equal distribution of care as a social responsibility everyone is entitled to basic care ability to pay is inconsequential implies that the government plays a signi cant role in health care market svstem less emphasis on collective good views health care as economic good based on one39s ability to pay assumes free market conditions for health care delivery individual responsibility for health emphasis on individual well being Costeffective In terventions a concept that combines issues of bene ts and harms with issues of nancial costs starts by considering the bene ts and harms of an intervention to determine its neteffectiveness or net bene t implies that the bene ts are substantially greater than the harms even after the value or utility as well as the timing of the harms and bene ts are taken into account 0 Costeffectiveness compares a new intervention to the current or standard intervention Usually asks is the additional neteffectiveness of an intervention worth the additional cost QUALY S QualityadjustedLifeYear Most experts in costeffectiveness prefer the use of measurement called qualityadjusted life years or QALys Asks about the number of lifeyears rather than the number of lives saved by an intervention One QALY may be thought of as one year of life at full health compared to immediate death In costeffectiveness analysis a nancial value is usually placed on a QALY re ecting what a society can afford to pay for the average QALY as measured by its per capita gross domestic product The ideal intervention is one in which the coast goes down and the effectiveness goes up costsaving qualityincreasing interventions have a negative incremental costeffectiveness ration o QALYs go up while the costs go down HALE Health Adiusted Life exnectancv all the things that you ve been doing that impact your life used by WHO to summarize the health of populations This measurement starts with life expectancy and then incorporates measurements of the quality of health Incorporates key components including o Mobility ability to walk without assistance 0 Cognition mental function including memory 0 SelfCare activities of daily living including dressing eating bathing and use of the toilet 0 Pain regular pain that limits function 0 Mood alteration in mood that limits function 0 Sensory organ functionimpairment in vision or hearing that impairs functions DALY Disabilitv adiusted life veg we are looking at disabilities that impact your life used by WHO to allow for comparisons and changes based on categories of diseases and conditions designed to examine the impacts that speci c diseases and risk factors have on populations as well as provide an overall measure of population health status The DALY compares a country S performance to the country with the longest life expectancy currently Japan 0 In a country with zero DALYs t the average person would live approximately 83 years without any disability and would then die suddenly Modern eld of bioethics in general and research ethics in particular grew out of the Nuremberg trials of German physicians who performed experiments on prisoners in Nazi concentration camps Tuskegee syphilis study used disadvantaged rural black men to study the untreated course of syphilis o Deprived of penicillin treatment 0 A major reason for the creation of the National Commission for the protection of human subjects of biomedical and behavioral research Belmont Report Institutional review boards IRB must approve most human research 0 Respect for persons Bene cence Justice 0 IRB were created to ensure the ethical conduct of research 0 In order to approve research the IRB shall determine that all of the following requirements are satis ed Risks to subjects are minimized Risks to subjects are reasonable in relation to anticipated bene ts Selection of subjects is equitable Informed consent will be sought from each prospective subject or the subject39s legally authorized representative The research plan makes adequate provision for monitoring the data collected to ensure the safety of subjects When appropriate here are adequate provisions to protect the privacy of subjects and to maintain the con dentiality of data When some or all of the subjects are likely to be vulnerable to coercion or undue in uence such as children prisoners pregnant women mentally disabled persons or economically or educationally disadvantaged persons additional safeguards have been included in the study to protect the rights and welfare of these subjects The most dif cult behaviors to change are those that have a physiological component 0 such as obesity or an addictive element such as cigarette smoking Physical social and economic barriers can stand in the way of behavior change even if individuals themselves are motivated o If health care is not accessible or if survival needs require individuals to engage in risks they might not take otherwise change in behavior may be impeded 1 Stages of change theory an individual level theory a Precontemplation iindividual has no idea hisher behavior is a problemunaware he is engaging in an unhealthy behavior iilndividual not considering change bContemplation ihas a more heightened sense of knowing his or her behavior may be unhealthy iilndividual thinks actively about the health risk and action required to reduce that risk Lissue of change is on the individual39s mind but no action is planned c Preparation iacknowledging and thinks maybe they should get help getting doctor card iiprepare for action including developing a plan and setting a timetable d Action i active decision to refrain from action ii observable changes in behavior with potential for relapse e Maintenance i idea that individual has eliminated behavior and decided to not doing it anymore and able to maintain not engaging in behavior for a greater than six month period ii new behavior needs to be consolidated as part of permanent lifestyle change f Relapse i Almost inevitable returning to previous action and has to start the process over again Model doesn39t take into consideration that we are at different stages and doesn39t take into account any external factors used for alcohol weight watchers cigarettes very linear we don39t tend to thinkprocess that way 4 P5 of social marketing Social marketing incorporates the 4 Ps which are widely used to structure traditional marketing efforts 0 Product identifying the behavior or innovation that is being marketed 0 Price identifying the bene ts the barriers and the nancial costs 0 Place identifying the target audiences and how to reach them 0 Promotion organizing a campaign or program to reach the target audience DOI Primary Occurs before onset of disease quality carehome InformationEducation Secondary Occurs during early stages of disease primarily deals with screening challenge here is the followup Efforts to communicate information and change behavior on basis of information MotivationRewards to encourage or discourage without legal requirement Tertia ry Management of disease Prior to irreversible complications
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