Chapter 2- Evidence-Based Public Health
Chapter 2- Evidence-Based Public Health BPH206
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This 5 page Class Notes was uploaded by Hannah Rubino on Friday February 6, 2015. The Class Notes belongs to BPH206 at University of Miami taught by Koskan in Fall. Since its upload, it has received 409 views. For similar materials see Introduction to Public Health in Public Health at University of Miami.
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Date Created: 02/06/15
Chapter 2 EvidenceB ased Public Health 0 Evidencebased public health approach PERIE process 0 O O O 0 Problem What is the health problem Etiology What are the contributory causes Recommendations What works to reduce the health impacts Implementation How can we get the job done Evaluation How well do the interventions work in practice 0 Describing health problems 0 O Burden of disease occurrence of disability and death due to a disease Disability is also called morbidity and death is called mortality Course of a disease how often the disease occurs how likely it is to be present currently and what happens once it occurs Distribution of disease Who gets the disease Where are they located When does the disease occur Rate used to describe any type of measurement that has a numerator and denominator where the numerator is a subset of the denominator The numerator measures the number of times an event occurs and the denominator measures the number of times the event could occur Sometimes the atrisk population is used for the denominator instead of the total population I Incidence rates measure the chances of developing a disease over a period of time usually a year Measured by taking the number of new cases of a disease in a year over the number of people in the atrisk population 0 Mortality rates are a type of incidence rate used to measure the burden of diseases The relationship between the mortality rate and incidence rate of a disease estimates the chances of dying from a disease once it is diagnosed which is known as the casefatality I Prevalence number of individuals who have a disease at a particular time divided by the number of individuals who could potentially have the disease Measured by taking the number of people living with a particular disease over the number of people in the at risk population It tells the proportion of individuals who have the disease at a point in time 0 Distribution of disease 0 Epidemiologists public health professionals that investigate factors known as person and place to look for patterns associations in the frequency of a disease These associations are also known as group associations or ecological associations Person demographic characteristics that describe people such as age gender race socioeconomic factors behaViors and exposures 0 Place geographic location and connections between people such as a university community or a shared Internet site 0 Risk indicators or risk markers are factors that occur more frequently among groups with a disease than among groups without that disease Investigating possible other explanations for the difference or changes in the distribution of disease 0 Are the differences or changes real or artifactual There are three basic reasons that changes in rates may be artifactual I Differences or changes in the interest in identifying the disease I Differences or changes in the ability the disease I Differences or changes in the definition of the disease Group associations 0 Studies that use information on groups or a population without having information on the specific individuals within the group They are also called population comparisons or ecological studies 0 Confounding variable factor that misleadingly seems to imply an association 0 Looking at associations at the individual level is key to establishing etiology 0 Age adjustment looking at the rates of disease in each age group and the age distribution the number of people in each age group to take into account age as a factor I Standard population age distribution of the US population in 2000 that is currently used for age adjustment Etiology 0 Contributory cause I The cause is associated with the effect at the individual level The potential cause and potential effect occur more frequently in the same individual than would be expected by chance I The cause precedes the effect in time I Altering the cause alters the effect When the potential cause is reduced or eliminated the potential effect is also reduced or eliminated I Reverse causality effect precedes the cause 0 Casecontrol retrospective studies most useful for establishing that the cause is associated with the effect at the individual level Cases with the disease are compared to controls without the disease to determine whether the cases and controls previously were exposed to the potential cause I Risk factor factor that has been demonstrated to be associated on an individual basis with an outcome 0 Cohort studies prospective studies most useful for establishing that the cause precedes the effect Those with the potential cause or risk factor and those without the potential cause are followed over time to determine who develops the effect I Natural experiment investigator studies the results of a change in one group but not in another similar group that was produced by forces outside the investigator s control 0 Randomized controlled trials experimental studies most useful for establishing that altering the cause alters the effect Using randomization random assignment individuals are assigned to be exposed or not exposed to the potential cause They are followed over time to determine who develops the effect 0 Supportive ancillary data helps establish the existence of contributory cause I Strength of the relationship how closely related the risk factor is to the disease It is measured by relative risk which is calculated as the probability of disease if the risk factor is present over the probability of developing the disease if the risk factor is not present 0 Absolute risk the actual probability of developing the disease in the presence of the risk factor 0 Odds ratio approximation of relative risk I Doseresponse relationship whether or not more of the risk factor increases the changes of developing the disease 0 Protective factor an increase in this factor is associated with reduced probability of developing the disease I Consistency of the relationship studies at the individual level produce similar results in multiple locations among populations of varying socioeconomic and cultural backgrounds I Biological plausibility known biological mechanisms can convincingly explain and a cause and effect relationship 0 Efficacy implies that an intervention increases positive outcomes in the population being investigated The requirements for establishing contributory cause are the same for establishing efficacy 0 Implications of a contributory cause I Necessary cause factor must be present in order for the disease to develop I Sufficient cause factor inevitably causes the disease to develop I A contributory cause increases the chance of the effect but doesn t guarantee that the disease will develop Evidencebased recommendations use research evidence to determine which interventions work to reduce negative health impacts They are based upon the quality of the evidence and the magnitude of the impact both of which are given a score O The quality of the evidence is scored based upon the types of investigations and how well the investigation was conducted Well conducted randomized controlled trials that fully address the health problem are considered the highest quality evidence Highquality evidence needs to be based not only the research but also on the effectiveness of the intervention in the specific population in which it will be used Quality of the evidence is scored as good fair or poor I Surrogate outcomes shortterm outcomes that can t reliably indicate longer term or clinically important outcomes The magnitude of the impact is scored as substantial moderate small and zero negative I Attributable risk percentage percent ef cacy reduction in a bad outcome 0 These two criteria are combined to produce a classification of the strength of the recommendation grading as A B C D and I Implementation 0 Whenwhohow approach I When timing in the course of disease in which an intervention occurs 0 Primary take place before the onset of the disease and aim to prevent the disease from occurring 0 Secondary occur after the development of a disease or risk factor but before symptoms appear They are aimed at early detection of disease or reducing risk factors while the patient is asymptomatic 0 Tertiary occur after the initial occurrence of symptoms but before irreversible disability They aim to prevent irreversible consequences of he disease I At whom should we direct the intervention 0 Individuals 0 Atrisk population 0 Entire population I How should we implement interventions 0 Information education aims to change behavior through individual encounters group interactions or the mass media 0 Motivation incentives use of incentives for changing or maintaining behavior including a tangible reward O Victim blaming regarding the consequences of a disease as the victim s fault I Obligation requirements relies on laws and regulations requiring specific behaviors Evaluation 0 REAIM framework Reach Who is the intervention being applied to in practice Effectiveness What is the impact in practice on the intended or target population including beneficial outcomes as well as harm Adoption How well is the intervention accepted by individuals and providers of services Implementation How should the intervention be modified to reach target population and providers of services but not those for whom the benefits do not exceed the harm Maintenance How can we ensure longterm continuation of use and success of intervention among individuals and providers of services
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