Week Two Notes: Chapters 3-6
Week Two Notes: Chapters 3-6 PBHL 3100
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This 7 page Class Notes was uploaded by Ali on Thursday September 17, 2015. The Class Notes belongs to PBHL 3100 at University of Georgia taught by Sabrina Cherry in Fall 2015. Since its upload, it has received 68 views. For similar materials see Intro to Public Health in Public Health at University of Georgia.
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Date Created: 09/17/15
Introduction to Public Health PBHL 3100 Professor Sabrina Cherry University of Georgia Chapter Three 0 While the US Constitution does not mention health speci cally the tenth amendment states that quotthe powers not delegated to the United States by the constitution are reserved to the states respectivelyquot This statement places the resoonsibilitv of public health primarily on the states 0 The Constitution in the preamble however states a fundamental purpose of the government is quotto promote general welfarequot giving the federal government some role in public health 0 Interstate Commerce it is more efficient and economical to have one set of national rules for products distributed across state lines Power to tax the power to tax and spend allows the federal government to achieve goals it other was does not have the authority to achieve directly 0 Each branch of the government federal state and local plays a different role in public health laws 0 0 Legislative passes the status after perceiving a need Executive Carries out the law particularly public health agencies 0 Judicial laws and regulations can be challenged in court 0 The most common local agency is the county health department 0 Large cities may have their own municipal health department while rural areas may be served by multicounty health departments 0 The extent to which a local health department must 0 respond to mandates from state or federal government depends on how much funding they have accepted from them Local agencies often have the responsibility of providing medical care for the poor 0 Since states have the primary constitutional authority over public health the state health department carries a large responsibility 0 Roles of state health departments include Manage Medicaid Collect and analyze data from the local agencies and report it to the CDC Coordinate the activities of local agencies and provide funding in some cases Laboratory services License and certify medical personnel facilities and services 0 Environmental mental health social services and aging may be handled by different agencies Most traditional public health activities at the federal level fall under the jurisdiction of the Department of Health and Human Services HHS including ones listed 0 The Center for Disease Control and Prevention CDC Main assessment and epidemiological agencies for the nation Mission to control and prevent human disease 0 Center for health statistics collects data on US populations concerning all areas of health Traditionally crisis oriented because it focused on infectious diseases but the CDC has expanded mission over recent decades to also include chronic disease genetics injury and violence and environmental health Issues a weekly report call Morbidity and Mortality Weekly Report MM WR o Morbidity rate of illness 0 Mortality rate of deaths 0 The National Institute of Health Greatest biological research agency in the world Provide grants to biomedical scientists at universities and research centers throughout the United States Includes the national Library of Medicine which serves as a reference library for medical centers around the world NlH s clinical center in Bethesda serves as a research hospital where medical researchers test experimental theories 0 Food and Drug Administration FDA Oversees federal regulation of food drug medical devices and cosmetics Evaluates new drugs and regulated vaccinations Ensures food supply is safe and nutritious Does NOT evaluate vitamins and supplements 0 Environmental Protection Agency EPA Carries out programs dealing with water pollution air pollution toxic substance control and other issues of environmental contamination 0 Many nongovernmental organizations play important roles especially in the areas of education lobbying and research Examples include American HeartAssociaton American Cancer Society Alzheimer s Disease and Related Disorders Association American Diabetes Association American public health Association American Medical Association American Nurses Association 0 Several major philanthropic foundations provide funding to support research or special projects related to public health Chapter Four 0 Epidemiology studies the patterns of disease occurrence in human populations and the factors that in uence these patterns 0 An epidemic is an increase in the frequency of a disease above the usual and expected rate also known as endemic rate 0 John Snow is known as the father of modern epidemiology because of his use of epidemiology to track down the source of a cholera outbreak in London in 1848 0 Major part of public health s assessment function Investigates causes of disease Identi es trends in disease occurrence Evaluates effectiveness of medicine and public health interventions o Epidemiology and the causes of chronic disease 0 Chronic diseases do not have a single cause tend to develop over a period of time are often disabling rather than rapidly fatal and cannot be prevented or cured by any vaccine or magic bullet The long period over which these diseases develop and the fact that they don t have a single cause contributes to the difficulty of determining the causative factors 0 Epidemiologists try to identify risk factors then observe long term trends Heart disease is the leading cause of death in the US 0 It was studied in the Framingham study that started in 1948 Lung Cancer was linked to smoking in early 19505 0 This was studied rst in the British Physicians Study and then the HammondHorn Study in the US 0 A sudden increase in the number of cases signi es an epidemic and calls for an epidemiologic investigation to determine why it is occurring 0 Verify the diagnosis 0 Construct a working case de nition 0 Find cases systematically using active surveillance 0 Ask the who where and when questions to describe the epidemic by person place and time Consider the incubation period 0 Epidemiology Terms 0 Cluster An aggregation of cases over a particular period closely grouped in time and space regardless of whether the number is more than the expected number 0 Outbreak More cases of a particular disease than expected in a given area or among a specialized group of people over a particular period of time o Epidemic Large numbers of people over a wide geographical area are affected 0 Pandemic An epidemic occurring over several countries or continents and affecting a large proportion of the population 0 Surveillance The systematic and ongoing collection analysis interpretation and dissemination of health data The purpose of public health surveillance is to gain knowledge of the patterns of disease injury and other health problems in a community so that we can work towards their prevention and control 0 Risk The probability that an individual will be affected by or die from an illness or injury within a stated time or age span 0 Incubation Period Time in between when a person comes into contact with a pathogen and when they rst show symptoms or signs of disease 0 Endemic Disease Present at a continuous level throughout a populationgeographic area constant presence of an agenthealth condition within a given geographic areapopulation refers to the usual prevalence of an agentcondition o INCIDENCE is the number of new instances of disease in a population over a given time period 0 PREVALENCE of an illness is total number of affected persons in the population at any given point in time Chapter Five 0 Epidemiology is the study of the distribution and determinants of disease frequency in human populations 0 Unlike biomedical medical sciences which can conduct experiments on animals epidemiology only deals with humans In measuring disease freguency it is necessary not only to count the number of cases but to relate that number to the size of the population being studied giving a w o In calculating rate the denominator is generally the population at risk PAR May be total population or exposed population or one gender or age group 0 Incidence is used more over prevalence for studying causes of disease Distribution of disease 0 Who sex age occupation race socioeconomic 0 When season year time since exposure 0 Where neighborhood cluster latitude climate urban vs rural national variations Determinants of a disease are the risk factors This could include genetics lifestyle environmental factors health behaviors Kinds of epidemiological studies Goal is to determine an association between an exposure and a disease or other health outcome 0 Prospective Cohort Study Start by looking at a group with certain exposure These are exposures that have already been chosen by the participant and are not assigned to them The participants are then followed and outcomes are studied risksljoutcomes Can look a multiple outcomes but can only look a one exposure Measure of association Relative Risk ratio of the incidence rate for persons exposed to the factor to the incidence rate for persons in the unexposed group 0 Retrospective Cohort Study Choose a group of people who were previously exposed to a certain risk factor Use medical records questionnaires etc and look at come to outcomes risksljloutcomes Good for rare and highly speci c exposures Measure of association Relative Risk ratio of the incidence rate for persons exposed to the factor to the incidence rate for persons in the unexposed group 0 Clinical Trial Start with two groups experimental group gets the intervention or exposure and control group does not get the intervention or exposure Know as the Gold Standard Closest thing to an experiment Randomized double blind placebo control is best o CaseControl Start with people who are ill Look back at health records give questionnaires etc to determine risk factors outcomeljlrisks Good for rare diseases Can look for multiple exposures but cannot look at multiple disease from a singular exposure Measure of Association Odds Ratio an estimate of what the relative risk would have been had a cohort study been done Relatively quick and economical Chapter Six 0 Problems with studying humans 0 Clinical Trial Ethical issues and subjects may not follow prescribed behavior throughout study period 0 Cohort study Sometimes hard to isolate which of many factors are responsible for health differences 0 Casecontrol study Control group may not be truly comparable also errors in reporting or recall 0 For all studies must worry about differential dropouts attrition 0 Sources of Error 0 Random variation association due to chance 0 Confounding variables associated with exposure that may affect the risk independently o Bias or selection errors Selection bias can occur in controls and cases Reporting or recall bias a person may report higher or lower than the actuality intentionally for various reasons or because of forgetfulness Publication bias only studies that have favorable results or come out as planned may get published 0 Factors that lend to valid results ndings are only as good as a studies design 0 Statistically strong associations 0 Dose response relationship the medicine or exposure correlation with the desired response 0 Known biological reasoning 0 Large study population 0 Consistent results from several studies 0 Sometimes there are con icts of interest in drug trials 0 Drug companies are required to conduct RCTs on all new drugs before they can be FDA approved 0 Harmful side effects have become known AFTER the drug has been approved 0 Evidence that some drug companies suppress negative information is present 0 All clinical trials must now be registered in advance in a public database These notes are taken from class slides by professor Sabrina Cherry and supplemented by the book Introduction to Public Health Fourth Edition by Maryjane Schneider
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