HTH 231 Notes since first week of school
HTH 231 Notes since first week of school HTH231
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This 11 page Class Notes was uploaded by Kristin Coggins on Wednesday February 10, 2016. The Class Notes belongs to HTH231 at James Madison University taught by Dr. Mary Ott Walter in Winter 2016. Since its upload, it has received 115 views. For similar materials see population health determinents in Health Sciences at James Madison University.
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Date Created: 02/10/16
HTH 231 Unit 1 Lecture 1/13/16 What is Health? World Health Organization ● A state of complete physical, mental, and social wellbeing and not merely the absence of disease or infirmity (1948) Medical Perspective ● Ensures that a human can maintain a balance physical perspective Sociocultural Perspective ● Who you are, where you come from, ● Are you able to obtain or achieve or commit to certain obligations that you have based on the state that you are in at that time Psychological Perspective ● Stability, satisfaction, having the ability to cope ○ PTSD Ottawa Charter for Health Promotion ● The process of enabling people to increase control over, and to improve, their health ○ Complete physical, mental and social well being = Must be able to identify and to realize aspirations, to satisfy needs, and to change or cope in an environment ● 7 Dimensions of Health ● Emotional: Attentive to feelings, thoughts, behavior ● Occupational: Leisure and work time balance ● Intellectual: Stimulation activities that expand your knowledge ● Physical: Aspects needed to keep your body in top condition ● Spiritual: Discovering a set of beliefs and values that brings purpose to your life ● Social: Ability to interact w people ● Environmental: Overall feelings about the environment What is Public Health? ● The science of protecting and improving the health of families and community through promotion of healthy lifestyles, research for disease and injury prevention and detection and control of infectious diseases WHat is Population Health? ● Health outcomes of a group of individuals, including the distribution of such outcomes within the group. ○ Geographical populations ■ Nations ■ Communities ○ Employees ○ Ethnic Groups ○ Disables person ○ Prisoners Measurements of Health Mortality YPLL (Years of Potential Life Loss) The Number of deaths from a particular cause per 100,000 persons ● 2nd highest risk of dying from non communicable diseases can’t get it from someone else. Ex. cancer, diabetes ● 2nd highest death from injuries (firearms) ● 3rd lowest death from stroke ● 4th highest incidence rate for cancer ● 4th highest risk of dying from communicable diseases Neuropsychiatric conditions Respiratory Disease Diabetes Other endocrine disorders, genitourinary disease, congenital anomalies, infectious diseases, and perinatal conditions ● Highest death rate from transportationrelated accidents among the 17 countries ● U.S. homicide rate is 6.9 times higher than other highincome countries ● Suicide average lower than 16 peer countries ● Certain cancer deaths (cervical and colorectal) are lower than most peer countries ● Highest incidence of AIDS in high income countries ○ Almost 9x the OECD average ● Infant Mortality Rate ○ Of 1,000 babies born alive, the number who will die before their first birthday ● Maternal Mortality Rate ○ Of 100,000 women giving birth, the number who will die as a result of complications during the birthing process Morbidity the diseases and illness, injuries, and disabilities in a population ● Prevalence Rate ○ Number of person who have a particular disease/condition at a given point in time per 1,000 population ● Highest prevalence of ○ Diabetes ○ Obesity ○ Lipid disorders ○ Asthma ● Females ○ Hypertension ○ Heart attack/angina ○ Stroke Life Expectancy number of years, on average, a person born in the year for which the data are reported is expected to live. Could be based on location / environment ● Male: 75.64 (last of the 17 countries) ● Female: 80.78 (3rd to last of the 17 countries) DisabilityAdjusted Life Year (DALY) ● A means of estimating the magnitude of the burden created by a disease/condition that reduces one’s level of functioning by 50% would mean a loss of . 50 DALY ● Dying 5 years prematurely would create a loss of the same number of DALY as living with a disease for 10 years with a loss of 50% of one’s functional ability QualityAdjusted Life Year (QUALY) ● Evaluate the effectiveness of a specific treatment in prolonging the lives of those with specific diseases ● Estimates the number of years a person’s life is extended by treatment and then estimates the health related quality of life experienced in those additional years Years of Potential Life Lost ● Average age of death in U.S. = 78 ● Death that occur before 75 (gov’t number) calculate how many more years the person would have lived had they lived to be 75 Socialecological Influence: Determinants of Health: ● Broad social, economic, cultural, health, and end environmental conditions and policies at the global, national, state and local levels ● Living and working conditions ● Social, family, and community networks ● Individual behavior ● Innate individual traits: ○ age, sex, race and biological factors Interventions: ● Policies ● Programs ● Information Outcomes: ● Behavioral outcomes ● Specific risk factors, diseases, and conditions ● Injuries ● Well being and health related quality of life ● Health equity 5 General Causal Pathways That Link Early Experiences w Later Disease 1. Association between early and adult health conditions results from the persistence of material, social and cultural conditions over time. a. Children who grow up in poverty endure poor nutritions, exposure to lead, allergens, and other pollutants b. More likely to face poverty and its consequences as adults 2. Biological exposures during early life can produce clinical complications later in life a. From human papillomavirus to HIV 3. Adverse experiences and stimuli can result in biological embedding a. Nutritional status in utero and during infancy and early childhood can cause organ damage that is responsible for hypertension, heart disease, metabolic syndrome, insulin resistance, obesity, and diabetes much later in life 4. The field of epigenetics has documented geneenvironment interactions a. Permanent changes in gene expression, triggered by environmental cues, are thought to precipitate chronic conditions b. May be inherited by offspring 5. Adversities during childhood and adolescence may cultivate dysfunctional traits, maladjusted personalities, and susceptibility to antisocial behavior a. Poor selfcontrol, limited social skills, lack of perseverance and resilience, and shortsightedness i. May influence physical activity, diet, and risky behaviors (unprotected sex) ii. May exacerbate propensities for selfabuse, mental illness, suicide, violence, unintended pregnancy, obesity, and diabetes Ten Great Public Health Achievements increased life expectancy, decreased mortality rate 1. Vaccinations and Immunizations a. 1900: 21,064 smallpox cases were reported, and 894 patients died b. 1920: 469,924 measles cases were reported, and 7,575 patients died; 147,991 diphtheria cases were reported, 13,170 patients died c. Although the smallpox vaccine was developed in 1796, it wasn’t until the 1900s that its use was widespread enough to fully control the disease 2. Control of Infectious Diseases a. 1900: Leading causes of death pneumonia, tuberculosis, diarrhea and enteritis b. Improvements in sanitation and hygiene, the discovery of antibiotics, and the implementations of universal childhood vaccination programs have helped, but the emergence of disease is still unpredictable 3. Family Planning a. Family size declined between 1800 and 1900……. 4. Fluoridation of water a. Decline in tooth decay 5. Healthy Mothers and Babies a. Environmental interventions b. Advances in clinical medicine c. Improvements in access to healthcare, surveillance and monitoring of disease, educational levels, nutrition, and in standards of living 6. Motor Vehicle Safety (seat belts, airbags, car seats) a. 1966: Highway Safety Act and the National Traffic and Motor Vehicle Safety Act i. Safety features in vehicles ii. Road improvements 7. Workplace Safety a. Asbestos, Construction safety, Carcinogens Standards, Chemical Exposure Safety, Emission Standards exc. 8. Safer and healthy foods a. During the early 20th century: Contaminated food, milk, and water caused many foodborne infections. b. Once identified, these could be controlled by hand washing, sanitizing, refrigeration, pasteurization, pesticide application c. The rate of infection has declined markedly 9. Tobacco consequences a. Smoking is the leading preventable cause of death and disability in the US 10. Decrease in Heart Disease and Stroke a. Since 1921: i. Heart disease has been the leading cause of death in the Unites States ii. Stroke has been the 3rd leading cause since 1938 iii. Together they account for appoc. 40% of all deaths b. Since …………………… LifeCourse Perspective ● Health as a development process influenced by multiple nested social, environmental, and biological spheres that continually interact over the course of one’s life and shape the quality and nature of each person’s growth, health, and development ● health early in life “lays out the foundation for a lifetime of wellbeing Causal Pathways ● Persistence of material, social, and cultural condition over time ● Biological exposures during early life (infectious diseases) ● Adverse experiences and stimuli can result in biological embedding ● Epigenetics ● Adversities during childhood and adolescents may cultivate dysfunctional traits, maladjusted personalities, and susceptibility to antisocial pathways Determinants explanation for broad patterns of disease in whole groups of people Individual ● Tobacco use cigars, pipe, hookah, snuff, chewing, ecigs ○ More than 480,000 deaths annually ○ Second hand smoke causes and estimates 41,000 deaths ○ Life expectancy for smokers is at least 10 years shorter than for nonsmokers ○ Quitting smoking before the age of 40 reduces the risk of dying from smoking related disease by about 90% ○ Smoking may result in shorter life expectancy for adults 50+, but not for younger people ● Smoking and Pregnancy ○ Increased risk of miscarriage, low birth weight, and SIDS ○ Later effects on physical and intellectual development ○ Neurological problems, problems with certain reading and mathematical skills, and hyperactivity ○ Effects are of the same type and magnitude as those reported for “crack babies,” and many more pregnancy women smoke than use cocaine ● Nicotine ○ Nicotine = a naturally occurring liquid alkaloid that is colorless and volatile ○ Tolerance and dependence develop quickly ○ Highly toxic ○ Typically not delivered fast enough or in a high enough dose to be lethal ○ Lethal dose = 60 mg (a cigar contains twice that much) ○ Nicotine replacements no tar or carbon monoxide ■ patches, gum, nasal spray, inhaler, lozenge ■ Bupropion (Zyban) ■ Chantix ● Diet ○ High caloric intake, low energy expenditure; leads to obesity or obesity related diseases → HBP, high cholesterol, type 2 diabetes, stroke, gallbladder disease, sleep apnea, depression, anxiety, body pain, difficulty with physical functioning, osteoarthritis, ○ 78.6 million of U.S. adults are obese ■ BMI <18.5 = underweight ■ BMI 18.524.9 = normal/healthy weight ■ BMI 2529.9 = overweight ■ BMI >30 = obese ● Physical inactivity ○ Difficult to break out from diet ○ Americans spend 157.9 minutes watching TV or listening to radio > any other country ● Alcohol and other drugs ○ Moderate alc consumption: 1 for women, 2 for men ○ 3rd leading preventable cause of death in the US ○ More than half of Americans aged 12 or older report being current drinkers of alcohol ○ Men are more likely to report heavy alcohol use (binge drinking for 5 or more of the past 30 days) ○ Binge Drinking: men 5 drinks / women 4 drinks ○ 7.7% of adults with alc disorder received treatment in the past years ● Sexual Practices ○ US more likely to have sex before 15 compared to Canada, France and the U.K ○ US more likely to have multiple partners (2 or more past year) ○ US females less likely to use contraceptive at first or more recent intecourse compared to France, UK, Sweden ○ Condom use at first sexual intercourse was lower in U.S. than France, but higher than Sweden ○ Condom use at last intercourse was higher in U.S. than any other study country ○ Dual use (condoms and oral contraceptives) 4% of adolescents females in U.S. compared to 16% in other countries ○ Higher rates of pregnancies and STDs among US adolescents ○ Bacterial Infections ■ Chlamydia ■ Gonorrhea ■ Syphilis ○ Viral infections ■ Hepatitis ■ Herpes (1&2) ■ HPV can cause cancers due to infections ■ HIV- chronic, terminal disease, mom → baby ● Injurious Behaviors ○ Leading cause of death from ages 145 ○ Heavy burden of lifelong neurologic and other disabilities ○ Unintentional Injuries poison, gas, ○ Less likely to fasten front seat belts in US Social Biological/Genetic ● Age ○ Need for longterm care is rising ■ Limited mobility ■ Frailty or other physical or mental health problem ○ Effective, communitylevel primary health care is crucial (HCP not trained in elder care) ○ Supportive, “age friendly” environments allow older people to live fuller lives and maximize conditions ○ Healthy ageing starts early with healthy behaviors ○ Reinvent assumptions of old age ● Sex ○ Men and women may show diff. symptomology for diseases and conditions ○ May respond differently to drugs and therapeutics due to physiological and hormonal differences as well as differences in body composition ○ Diseases More Common in Men ■ Prostate Cancer after skin cancer, most common cancer among men ■ Alport Syndrome kidney problems (carried among x gene) ■ Redgreen color blindness ■ Hemophilia ■ Fragile X ○ Diseases More Common in Women ■ MS affects CNS ■ Turner’s Syndrome ■ Lupus chronic disease ■ 1.5 mil are affects, 90% are women (1584yo) ○ Rheumatoid arthritis ■ causes pain, stiffness, loss of appetite ○ Scleroderma ■ Skin tightening and hardening of patches of skin ■ Fingers or toes numbness, pain, color changes ■ Digestive system ○ Rett Syndrome ■ 1 and 10,000 infants ■ Emotional and behavioral issues and cognitive defects ○ Breast Cancer ■ 12.3% of women will be diagnosed with females ■ Survival rate dependent on when it is found ■ Stage 4 is most severe much, much lower survival rate ● HIV ■ Female challenges ● family care: ● dealing with social stigma, ● finding access to medical care and treatment ■ Gynecological care: ● Cervical dysplasia (abnormal Pap smear) ● Anal/Rectal cervical cancer ● Extensive herpes simplex 2 ● Recurrent yeast infections ● Recurrent genital warts ■ Pregnancy ● Tested early ● Medications ■ Additional Issues ● Caring for children ● Finding appropriate and skilled medical care ● Handling relationship issues with your intimate partner (abuse, financial) ● Inherited Conditions ○ Monogenetic Disorders ■ Sickle Cell Disease (recessive both parents have to have the gene) ● Cell is shaped like a sickle ● Deals with dysfunction within red blood cells ● More common in African Americans ● Symptoms: ○ Jaundice ■ Cystic Fibrosis (recessive) ● Symptoms: ○ Salty tasting skin ○ Male infertility ○ Wheezing and shortness of breath ■ Polycystic Kidney Disease (dominant required on one gene) ■ TaySachs Disease (recessive) ■ Huntington’s Disease (dominant) ● Inherited disease that causes the progressive breakdown of nerve cells in the brain ● Impact on a person’s functional abilities and usually results in movement, thinking (cognitive) and psychiatric disorders ● Symptoms before age 20 ● Movement and Cognitive disorders ■ Marfan Syndrome (dominant) ● Long arms, legs, fingers ● Curved spine ● Chest stinks in or sticks out ● Flat feet ● Crowded teeth ● Stretch marks not related to weight gain ○ Multifactorial Inheritance Disorders ■ Heart Disease ■ Diabetes ■ Most Cancers ■ Behaviors ● Alcoholism ● Obesity ● Mental Illness ● Alzheimer’s disease ○ Chromosome Disorders ■ Down Syndrome ● individual has a full or partial extra copy of a chromosome ● 1/691 babies in US have DS ■ PraderWilli Syndrome ■ Chronic Myloid Leukemia Health Services Environmental Policies Health Disparities/Inequality: Systematic differences in health status that occur among population groups Health inequity: Those inequalities in health that are deemed unfair or that stem from some form of injustice ○
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