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Public Health Midterm
Terms in this set (72)
Public health is a very interdisciplinary field. What are the six areas that make up public health? (Chapter 1)
The six areas of public health are: 1) epidemiology, 2) statistics, 3) biomedical sciences, 4) environmental health science, 5) social and behavioral sciences, and 6) health systems policy, management and administration.
What are the three core functions of public health? Briefly describe the responsibilities of each. (Chapter 1)
The three core functions of public health include assessment, policy development and assurance. The assessment function monitors health status in order to identify community health problems. Policy development informs and educates individuals about health problems, and develops policies that support health efforts of the community and individual. The assurance function enforces laws that protect health and ensure safety. Assurance also makes sure that individuals have access to proper health services in order for them to maintain their health.
What is public health's five-step process to approach health problems in a community? (DIDIM)
1. Define the health problem.
2. Identify the risk factors associated with the problem.
3. Develop and test community-level interventions to control or prevent the cause of the problem.
4. Implement interventions to improve the health of the population.
5. Monitor those interventions to assess their effectiveness.
What are some of the major differences between public health and medicine?
Public health focuses on community health and prevention methods whereas medicine focuses on individual patients and healing preexisting conditions. The positive effects of public health programs are less noticeable and are often seen in the lack of illness, whereas medicine has works towards specific goals and health outcomes. Finally, public health must work with a community and the government to implement action whereas a patient may make their own decisions.
Highlight the primary differences and similarities between Public Health and the Medical field.
- Medicine concerned with individual patients, healing patients who are ill
- Public Heath focused on community as patient, preventing illness, and using epidemiology to establish hypothesis and discover trends
- Both assess health, diagnose problems, seek causes to problems, and devise strategies to cure them
- Both depend on epidemiology, biomedical sciences, environmental health science, and social/behavioral sciences in some aspect
Explain the differences between primary, secondary, and tertiary prevention.
Primary prevention prevents an illness from occurring at all, through the prevention of exposure to risk factors. Secondary prevention seeks to minimize the effects of the illness or injury once it has already occurred. Tertiary prevention seeks to minimize disability through medical care or rehabilitation.
Why is public health economically controversial, at times?
New public health programs or regulations might cost jobs, add to the price of a product, require a tax increase, or cut a company's profits. In addition, it is often easy to calculate the costs of public health but not the benefits, making it seem impractical.
Why is public health controversial? List three reasons. (Chapter 2)
Public health is controversial for the following reasons:
1. There is often an economic impact when enforcing public health policies and campaigns.
2. Public health can provoke moral or religious objections.
3. Individuals may be asked to give a small amount of their personal freedom for the common good
What is the most controversial about Public Health and what is the idea associated with that controversy?
Public Health is most controversial when it restricts people's freedom in order to benefit their own health. The idea associated with those restrictions is known as paternalism.
What are some controversies behind public health policies and procedures?
Public health is often faced with opposition and challenges. Most public health measures have negative economic impacts on certain populations or industries. Many of those who pay for public health measures do not directly benefit from them. People oppose public health measures because they are an extension of the government and may restrict individual freedoms. Finally, public health is often confronted with opposition due to moral and religious reasons. Education on safe sexual practices, abortions, and diseases such as HIV/AIDS are usually met with some form of opposition.
How does market justice differ from social justice?
Both market justice and social justice are philosophical theories on how a society can be run. Market just focuses on individual responsibility and minimal obligation to the common good (Introduction to Public Health, 18). Each individual is responsible for his/her own lot. The quality of life and healthcare a person receives is based on income and what they can afford.
Social justice is quite the opposite. Social justice advocates that individuals are entitled to basic income, housing, healthcare and employment. Everyone is given an equal playing field. Although everyone is given an even playing field, social justice does not ensure equal outcomes.
Explain the difference between social justice and market justice.
Market justice "emphasizes individual responsibility, minimal obligation to the
common good, and the fundamental freedom to all individuals to be left alone." People are responsible for their own well being and it is their doing if they are struggling to make ends meet/live well. There is fair distribution of benefits/burdens based on structure of environment/heredity/society.
Social justice "suggests that minimal levels of income, basic housing, employment, education, and health care should be seen as fundamental rights." Society is meant to ensure the well being of each individual, and is responsible to every one of its' members.
What are the three reasons why the police powers of government (that restrict freedoms) may be invoked?
1. to prevent a person from harming others
2. to defend the interests of incompetent persons such as children or the mentally retarded
3. to protect a person from harming himself or herself.
Name the three reasons why Police Powers may be invoked, and provide an example of each.
1. "To prevent a person from harming others." (ex: Smoking harms everyone around the person actually smoking due to second-hand smoke)
2. "To defend the interests of incompetent persons such as children or the mentally retarded." (ex: children protective policies)
3. "To protect a person from harming themselves." (ex: wearing helmets while riding motorcycles)
The CDC, NIH, and FDA are all organizations under what department of the federal government? What is the main purpose of each of these three organizations?
These departments are all a part of the federal government's Department of Health and Human Services, or HHS. The CDC, Centers for Disease Control, works to survey and prevent disease. The NIH, National institute of Health, facilitates research. The FDA, Food and Drug Administration, regulates food and drug production and distribution.
What section of the Constitution highlights the governments role in public health?
The Preamble talks about the fundamental purpose of government being to "promote the general welfare," and its power to collect taxes which are used to aid the public. This portion of the Preamble provides the basis for the federal responsibility in public health services.
What is the main purpose of the Center for Disease Control? (CDC) In what ways does it fulfill this purpose?
• Main assessment and epidemiologic agency for nation
• Mission is to control and prevent human diseases
• Staffed with epidemiologists who travel throughout country and world to detect outbreaks of disease, to track down causes of epidemics, and halt spread
• Traditionally infectious disease oriented
• Expanded role in recent years to chronic disease, genetics, injury and violence, and environmental health
What is an example of a common local public health agency? What is an example of a federal public health agency?
The county health department is an example of the most common public health agency. Examples of federal public health agencies may include the CDC, NIH, and the FDA.
For what are epidemiologic methods used?
1. to investigate causes of diseases
2. to identify trends in disease occurrence that may influence the need for medical and public health services
3. to evaluate the effectiveness of medical and public health interventions
What do epidemiologists do?
Epidemiologists investigate epidemics of known and unknown disease by counting the number of cases and how they are distributed by person, place and time
What was the name of the famous heart disease study that began in the 1950s and what type of study was it?
The name of the study was the Framingham study. It started following people in Massachusetts in the 1950s and has continued for more than three generations. The study was one of the first epidemiologic cohort studies to look at chronic disease and identify risk factors associated with heart disease.
Describe "Shoe leather epidemiology" and how it has been successful.
• Similar to detectives
• Beneficial in that professionals are on site and can personally investigate and interview affected parties
• Allows problem to be solved quickly and efficiently
Shoe leather epidemiology is basically medical detective work. This kind of investigations asks the who, where, and when questions in order to answer the overarching "why" question. This is a frequent task of local and community health departments.
Explain the concept of "shoeleather epidemiology."
Shoeleather epidemiology is investigating the causes of diseases, in a "kind of medical detective work." The investigator starts with the reported cases and works backwards to answer the who, where, and when questions of epidemiology. They interview the victims, assess their risk factors, evaluate the places they have been, and what they have in common with the other victims. Through shoeleather epidemiology, investigators can find the source of an epidemic and stop it before it gets to be a pandemic.
Describe the difference between endemic and epidemic disease levels.
Endemic levels of disease are the expected levels of the disease for a population. An epidemic happens when there is a sudden and significant increase of disease occurrence from the expected levels.
Who was John Snow and what kind of impact did he have on public health?
Snow is known as the father of modern epidemiology. He had a profound impact on the cholera epidemic that struck London in 1848. He tracked water sources for each home in London and found the source of suspected infected water.
What is the difference between cohort studies and case-control studies?
Cohort studies start out by measuring exposure and watching for the development of a disease, whereas case-control studies start with people who are already ill and look back to determine their exposure.
How is disease frequency expressed and what do they mean?
Disease frequency is expressed as an incidence rate or a prevalence rate. An incidence rate is the number of new cases in a defined population at risk over a defined period of time. A prevalence rate is the number of existing cases in a defined population at a single point in time.
What is the difference between incidence and prevalence? What would the incidence and prevalence look like for an acute disease with a high rate of mortality? A chronic disease with a low rate of mortality?
Incidence is the number of new cases that emerge in a defined period of time divided by the total population. Prevalence is the total number of existing cases divided by the total population. For an acute disorder with a high rate of early-onset mortality, the incidence rate will be high but the prevalence rate will be low. Also, if the incidence is high but people recover very quickly, the prevalence will be low. For a chronic disorder with a low rate of mortality, the incidence may be low while the prevalence is high.
What is the difference between incidence and prevalence?
Incidence is the amount of new cases being reported for a certain population over a defined time period. Prevalence, however, refers to the total amount of cases existing in a certain population at a specific time. Incidence could be decreasing, while prevalence is still increasing, since new cases are still being added to the overall population, just at a slower rate.
Differentiate between incidence rate and prevalence rate within epidemiology.
Incidence is the rate of new cases of a disease in a defined population over a defined period of time. Incidence measures the probability that a health person in that population will develop the disease during that time. These rates are useful in identifying causes of a disease. Prevalence is the total number of cases existing in a defined population at a specific time. For most diseases, prevalence rates change slowly and are less useful for epidemiologic studies. They are most useful in assessing the societal impact of a disease and planning for healthcare services.
Compare and contrast prospective and retrospective studies.
• Both types of epidemiologic studies
• Prospective studies start at present and monitor into future
• Retrospective studies look into past for causes of disease
• In both, investigators are looking for association between exposure to suspected causative factor and disease
What are the three most common kinds of epidemiologic studies?
1. Intervention Studies
2. Cohort Studies
3. Case-Control Studies
What are the three different kinds of epidemiologic studies and what is the basic idea behind each study?
1. Case-Control Studies: Start with people who are already ill and look back to
determine their exposure. They focus on a smaller number of people and can
be completed quickly.
2. Cohort Studies: Large numbers of healthy people are observed at the time the study begins and questioned about their exposures. They are then observed over a period of time to see whether those that are exposed are more likely to develop a disease or not.
3. Intervention Studies: This study is normally done to test a new treatment for a disease. There are two groups: a clinical trial exposed to the intervention and a control group not exposed. Then investigators look at each group and determine if the treatment from the clinical trial showed a different response from that of the control group.
What is the ultimate goal of most epidemiologic studies?
To determine the cause of disease.
What is the definition of confounding variables?
Confounding variables are factors that are associated with the exposure and that may independently affect the risk of developing the disease.
What particular types of biases are associated with case-control studies and cohort studies?
Case-control studies have the risk of being affected by selection bias as well as recall bias. Cohort studies, on the other hand, have the risk of people dropping out of a study or being untraceable when results are being sought.
Explain what a randomized controlled trial is and what difficulties they pose in epidemiological studies.
A randomized controlled trial is a type of clinical trial that randomly assigns participants into either a control or experimental group. They potentially pose a problem in epidemiologic studies because it is impossible to control the behavior of human beings over the long periods of time that these take. Participants are usually unwilling to alter their behavior unless they have a special motivation, i.e. a serious disease.
What are 3 ways that epidemiological studies can be flawed? (Give an example for each.)
1. Random variation- (people who got sick were all left handed. The left hand had nothing to do with people getting sick. It was just a coincidence.)
2. Bias- (Drug companies have a financial incentive to overstate the benefits of their drug.)
3. Self report- (Less people will admit to being obese than are actually obese.)
What is the p value?
The probability that the observed result could have occurred by chance alone.
What is a study with low statistical power likely to produce?
They are likely to produce false-negative results, which find no effect when there actually is one.
What type of test is likely to yield few false negatives?
Highly sensitive tests are likely to yield few false negatives, which means to find no effect when there actually is one.
What is the difference between highly specific and highly sensitive screening?
Highly specific screenings yield few false positives and a highly sensitive screen yields few false negatives.
How might a highly sensitive screening test manifest results differently than a highly specific screening test?
Highly sensitive screening tests may yield few false negatives, meaning that the test will not incorrectly diagnose someone with a condition as not having that condition. Highly specific screening tests yield few false positives, meaning that the tests will not incorrectly diagnose someone as having a condition when they really don't.
What is a cause? Name and define the three types of causes.
1. An act, event or state of nature that initiates or permits, alone or in conjunction with other causes, a sequence of events resulting in an effect
2. Sufficient cause: one that always produces the effect; e.g., being at the site of an atomic bomb detonation always causes death
3. Component cause: contributing cause, a member of a cluster of causes that together form the minimum requirement for a sufficient cause, such that lack of any one component cause renders the remaining components insufficient
4. Necessary cause: a component cause, which is a member of every sufficient cause.
What is the difference between a sensitive and a specific test?
A sensitive test yields few false negatives while a specific tests yield few false positive. A false negative occurs when a test comes up negative (not having a condition) when the subject actually has the condition that is being tested for. A false positive occurs when a test comes up positive (having a condition) when the subject actually does not have the condition.
Can science ever prove anything to be true with 100 percent certainty? Why?
Science cannot prove anything. Science will always have a certain degree of uncertainty. Science can fail to disprove an idea and that idea will become accepted until a new idea comes along that fits the data better.
What is the difference between a component cause and a necessary cause?
A component cause is part of a cluster of causes that makes up a sufficient cause. By itself, a component cause is insufficient. A necessary cause, however, is a cause that is always part of a sufficient cause; it doesn't need any other causes to make if sufficient. Component causes contribute to sufficient causes; while necessary causes always contribute to sufficient causes.
What type of people is most likely to be missed in the Census?
The poorest and the marginal members of the population- homeless, illegal immigrants, and fugitives.
What are the vital statistics?
The vital statistics include births, deaths, marriages and divorces, spontaneous fetal deaths, and abortions.
Does the availability of census information breech confidentiality?
No, individuals are protected, because you can never look up census information for a particular address, and a name will never be present. The information is compiled and represents several different households.
Give 5 examples of public health measures that contributed to the decline of infectious diseases.
• Purification of water
• Proper disposal of sewage
• Pasteurization of milk
• Improved personal hygiene
Explain four links at which public health measures could control the spread of a disease via interrupting the links.
1. At link one (pathogen), the aim is to kill the pathogen.
2. At link two (reservoir), the aim is to eliminate a reservoir that the pathogen thrives in.
3. At link 3 (transmission), transmission from one host to another could be combatted via quarantining individuals. Action at link 3 could also include practicing effective hand washing, using condoms, etc., depending on the particular pathogen.
4. At link 4 (susceptible host), action might involve immunizations to increase resistance to the infection.
Robert Koch developed a set of rules that could be used to prove that a specific organism caused a specific disease, these rules are known as Koch's postulates. List Koch's Postulates:
1) The organism must be present in every case of the disease
2) The organism must be isolated and grown in the laboratory
3) When injected with the laboratory grown culture, susceptible animals must develop the disease
4) The organism must be isolated from the newly infected animals and the process repeated
What are the 3 different types of bacteria? Give an example of a disease caused by each.
1. Bacilli (cholera)
2. Cocci (pneumonia)
3. Spirochete (syphilis)
How does herd immunity work and what is an example of it?
1. When a critical portion of a community is immunized against a contagious disease because there is little opportunity for an outbreak.
2. Cancer patients aren't given vaccines because of chemotherapy, so they depend on herd immunity to stay healthy.
What bacterium causes Legionnaires' disease and how is it spread?
Legionnaires' disease is caused by the bacteria Legionella. It is spread through droplets or aerosols. Thus the Legionella bacterium is usually present in the air and then is inhaled by the victims. Legionella thrives in water towers used for air-conditioning so people often inhale the bacteria in this way.
Why did the malaria eradication campaign fail?
Funding ran out for the international campaign, so not all the mosquitoes that carry malaria were killed. Those that were still alive then infected even more than before. Malaria came back from the eradication campaign even stronger than it was before. Also, the malaria pathogen developed immunity to the main drug used to fight malaria.
What makes prions different from typical bacteria and viruses?
Prions do not have any genetic material; they are only made up of proteins.
What are the three functions of the screening test for HIV, which was developed in 1985 and counts the number of antibodies in the blood?
1. Diagnosing individuals at risk to determine whether they are infected so that they may be appropriately counseled and treated.
2. Monitoring the spread of HIV in various populations via epidemiologic studies.
3. Screening donated blood or organs to ensure that they do not transmit HIV to a recipient of a transfusion or transplant.
What are the main uses of the HIV test?
1. Diagnose individuals at risk to determine whether they are infected
2. Monitor the spread of HIV in various populations
3. Screen donated blood or organs to ensure HIV isn't given to their recipient
Why is it dangerous to prescribe antibiotics to people who are stricken with a virus?
1. Antibiotics are not generally effective against viruses, and once introduced into the bloodstream, they can allow stray bacteria to develop resistance, thereby reducing the effectiveness of that antibiotic against that strain of bacteria. The bacteria can pass the resistance on to others, thereby creating strains of bacteria that, in some cases, can be deadly and incredibly difﬁcult to eradicate.!
What are some of the most common means of transmission for disease?
Direct person to person contact, indirectly by water, food, or animals and insects. Also, bacteria and viruses that cause infections are transmitted through the air.
How does people not taking their full antibiotic regimen cause antibiotic resistant bacteria?
When people don't take their antibiotic as directed, not all of the bacteria will die. Only the easiest to kill will be eliminated, leaving the tough ones- natural selection. These tough ones will reproduce and take over, causing an infection in the patient with difficult to kill bacteria.
What are some factors that increase a person's risk of getting a disease from an animal?
Human population growth, human encroachment on farmland and wildlife, environmental changes, increased demand for animal protein, changing patterns of human and animal contact, and increased wealth and mobility.
What are two ethical problems that the Tuskegee study illustrates?
Given that "race" does not represent a biologic/genetic construct, but rather is a social construct, why might it still be important to collect race identifiers in epidemiologic research?
What are four theories of disease causation that were held during the 19th century? Briefly describe each of them.
Write a sentence that explains the meaning of the results of a case control study that showed an odds ratio of 2.0, with the condition being not turning in an assignment and the exposure being participating in AirBand.
What is the demographic transition?
What is the epidemiologic transition?
Write an equation using the terms below to give us a way to measure population growth.
CBR (Crude birth rate)
CDR (Crude death rate)
RNI (Rate of Natural Increase)
List 5 diseases for each category (you may use the same disease more than once):
health care costs, growing environmental concerns, the ever present lifestyle diseases, emerging and reemerging communicable diseases, serious substance abuse problems, and disasters
how does the brain talk to the immune system?
what does relative risk tell us?
What microbe can only live in an environment without oxygen?
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