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Epidemiology Guest Lecturers
Terms in this set (144)
What is the total mortality of the world and the total population of the world
Total mortality= 68.8 million
Total population= 6.5 billion
What percentage of individuals 60 years and over account for total mortality?
30.2 million, or 51%
What percentage of individuals 0-4 years account for total mortality?
10.4 million, or 18%
What percentage of individuals 5-14 years account for total morality?
1.5 million, or 3%
What percentage of individuals 15-59 years account for total mortality?
16.7 million, or 28%
Where do most 0-14 year olds die in the world according to the WHO in 2004?
At what age do most people die in high income nations?
6o years and older
How many non-communicable disease deaths are there worldwide as of information from 2008?
How many infectious disease deaths are there worldwide as of information from 2008?
What are two major cardiovascular disease(s)?
1. Systemic hypertension and its complications
2. Atherosclerosis and its complications
In West and East Europe, what is the highest cause of CVD morality?
Ischemic heart disease
In Latin American, what are the two highest causes of CVD morality? (Tied)
1. Ischemic heart disease
In the Middle East, what is the highest cause of CVD morality?
In India, what are the highest causes of CVD mortality (in descending order)
1. Ischemic heart disease
In China what is the highest cause of CVD morality?
In Sub-Saharan Africa what is the highest cause of CVD morality?
What is the natural history of atherosclerosis? (3 steps)
1. Tear in the artery wall
2. Fatty material is deposited in the vessel wall
3. Narrowed artery becomes blocked by blood clot
What is the standard approach to classification of death in epidemiology?
Use of the WHO International Classification of Diseases coding system
What is ICD coding primarily oriented to classifying?
Underlying cause of death
What are the principal ICD 10 codes for classifying cardiovascular disease?
100-199 (Total CVD or Diseases of the Circulatory System)
What codes are sometimes used from ICD 10 for classifying cardiovascular disease?
100-178 (Major CVD)
What is the code for Acute Rheumatic/Chronic Rheumatic Heart Diseases?
What is the code for hypertensive disease?
What is the code for coronary heart disease? IMPORTANT.
What is the code for pulmonary heart disease and diseases of pulmonary circulation?
What are other forms of heart disease categorized as?
What is the code for congestive heart failure?
What are the codes for cerebrovascular diseases? IMPORTANT.
What are the codes for diseases of arteries, arterioles, and capillaries?
What are the codes for diseases of veins, lymphatic vessels, and lymph nodes?
What are the codes for other and unspecified disorders of the circulatory system?
Death by cardiovascular disease is higher in...(women or men)?
Women, slightly higher
What percentage of CVD mortality is low and middle income?
What percentage of CVD morality is high income?
What does prevalence characterize?
The burden of illness due to a disease/condition at one point in time
What does incidence characterize?
The risk of developing a new disease/condition within a specified period of time
In chronic disease epidemiology, what is often adjusted for? (4 things)
4. Underlying illness
What was the leading cause of death in 1900 in the US?
Pneumonia, followed by TB and diarrhea
What was the leading cause of death in the US in 1998?
Heart disease and cancer
What has been identified in the US in terms of disease shifts?
Transition from infectious diseases to chronic, degenerative diseases
What is the double burden of disease?
During an epidemiological transition, countries go through a period of still relatively high mortality from infectious diseases while facing increasing death rates from non-communicable diseases
What is the expected life expectancy in the USA in 2030?
What is the expected life expectancy in less developed countries in 2030?
Disability-adjusted life years?
-Measure of overall disease burden, expressed as the number of years lost due to ill-health, disability, or early death
What is the formula to calculate disability adjusted life years?
YLL (years of life lost) + YLD (years lost to disability)
What are disability adjusted life years greatly influenced by?
Diseases with severe morbidity, especially those manifesting in early and mid life
What is the highest cause of death for women and men in the United States?
What is the total cost of care for cardiovascular disease and stroke for US adults in billions?
What is the direct cost of care for cardiovascular disease and stroke for US adults in billions?
What is the indirect cost of care for cardiovascular disease and stroke for US adults in billions?
What is the cost in lost productivity?
What is the cost of hospitalizations?
What are the 6 relatively fixed risk factors for CVD?
4. Family history
5. Socioeconomic status
What are some potentially modifiable risk factors for cardiovascular disease?
1. Cigarette smoking
3. Physical activity
What is the Systolic Intervention BP Trial
-Two-arm, multi center, randomized controlled trial
What is the primary question of the Systolic Intervention BP Trial?
Is intensive blood pressure lowing beneficial?
What were the primary outcomes of the Systolic Intervention BP Trial?
Composite of cardiovascular events
What were the secondary outcomes of the Systolic Intervention BP Trial?
Include all-casue mortality, renal disease, dementia, cognitive function, quality of life, and cost-effectiveness
What was the sample of individuals used in the Systolic Intervention BP Trial?
9,361 non-diabetic adults with systolic blood pressure greater than or equal to 130 mm Hg
How long was the follow up in the Systolic Intervention BP Trial?
What is the process of evidence based medicine? (4 things)
1. Translation of uncertainty into answerable question
2. Systematic, objective retrieval of best available evidence
3. Critical appraisal of the evidence (strength and quality)
4. Application of findings in practice
What is the most common underlying cause of death in the world, and the US?
What do the rates of CVD mortality show by world region and within country over time?
Where are there rapidly escalating CVD mortality rates?
Economically developing countries like China and India
Where are there high and increasing CVD mortality rates?
Middle income industrialized nations like Eastern Europe
Where are there high but declining CVD mortality rates?
Economically developed countries like the US
What is the normal range of weight in terms of BMI?
What is considered overweight in terms of BMI?
Greater than or equal to 25
What is considered obese in terms of BMI?
Greater than or equal to 30
What is considered obese class I in terms of BMI?
What is considered obese class II in terms of BMI?
What is considered obese class III in terms of BMI?
Greater than 40
What is considered underweight in terms of BMI?
Less than 18.5
What are 4 anthropometric measures of obesity?
1. Body mass index
2. Waist circumference
3. Waist-to-hip ratio
4. Waist-to-height ratio
What are 7 measures of body composition?
1. Bioelectrical impedance analysis
2. Underwater weighing
3. Air-displacement plethysmography
4. Dilution method
5. Dual-energy x-ray absorptiometry
6. Computed tomography
7. Magnetic resonance imaging
What group shows the highest rates of obesity in the US adult population?
Non-hispanic black women
What group shows the highest rates of obesity in US youth aged 2-19 years?
What are 8 health consequences of obesity?
1. Heart disease
5. Sleep apnea
8. Certain types of cancer
What are 5 good things about fat?
1. Maintain energy homeostasis
2. Essential material in body parts
3. Healthy skin/hair
4. Sex hormones
5. Immune function
What are four individual level obesity prevention/intervention tactics?
1. Regular exercise
2. Healthy diet
3. Drug treatment
What are three population level obesity prevention/intervention tactics?
1. Government policies
2. Built-environment: access to parks, neighborhood safety, etc.
3. Disparities in income, education, and healthcare access addressed
What were five population level prevention/intervention methods advocated for by Dr. Thomas Farley
1. Oversize surgery drinks ban
2. National Salt Reduction Initiative
3. Tobacco use reduction
4. Flu shots mandate
5. Calorie counts labeling
Who is Dr. Thomas Farley?
New York City Health Commissioner, 2009-2013
What are 2 major reasons why substance abuse is difficult to study?
1. Reliance on self report: addiction can lead to under-reporting, substance abuse itself impairs the ability to self-report accurately
2. Clandestine behavior: illegal behavior, web of denial
What do substances affect in the brain?
Substances affect the part of the brain that is linked to memory and learning
What do substances directly affect in the brain?
Diminish dopamine receptors and cause the need for more substances to create the feeling of well-being
What percentage of college students binge drinks or use other drugs?
What proportion of Americans will have an alcohol or other drug problem at some point in their lives?
1 in 4
What direct number and percentage of people in the US meet the medical criteria for addiction?
40.3 million people, or 16%
How many deaths worldwide does the harmful use of alcohol result in?
What proportion of deaths among working-age adults age 20-64 years does excessive drinking account for?
1 in 10
Approximately how many people have drug use disorders?
How many countries report injecting drug use?
How many countries report HIV infection amongst their population?
How many people die from alcohol related causes annually?
What is the third leading preventable cause of death?
Alcohol related issues
What percentage of driving fatalities are alcohol related?
What percentage of US children live with an alcoholic parent?
More than 10%
What are 12 conditions associated with chronic heavy drinking?
3. Cardiovascular disease
9. High blood pressure
10. Infectious disease
11. Nerve damage
What is the top drug for 12th graders?
What is the top drug for 8th graders?
In what group is cigarette smoking most prevalent?
What do e-cigarettes not contain?
What is the main cause of lung cancer from cigarettes?
What are the regulatory controls on e-cigarettes?
There are currently no regulatory controls
What do e-cigarettes contain?
To target teens what do prevention messages have to address?
Negative aesthetic repercussions
Where is illicit drug use most common among persons age 12 and older?
Urban is most prevalent buts its greatly increasing in rural areas
When does alcohol use typically begin?
Which gender typically is more affected by alcoholism?
Fetal Alcohol Spectrum Disorders
Drinking during pregnancy can cause brain damage; an umbrella term for the different diagnoses associated with drinking during pregnancy
What are four examples of Fetal Alcohol Spectrum Disorders?
1. Fetal Alcohol Syndrome
2. Partial Fetal Alcohol Syndrome
3. Alcohol-related neurodevelopment disorder
4. Alcohol-related birth defects
What are 5 areas people with FASD often have difficulty in?
2. Emotional control
3. School work
5. Holding a job
What does alcohol do with HIV meds?
Can interfere with HIV medication and make them not work
What are 6 policy interventions to prevent alcohol related morbidity?
1. Alcohol taxes
2. Drinking age
3. Zero-tolerance laws
4. Administrative license revocation laws
5. Server liability
6. Warning labels
How can transmission of HIV/Hep pertain to injection drug use?
Transmission of HIV/Hep can happen if blood is left in syringe or bevel of the needle
What proportion of new HIV infections result from needle sharing?
1/10 of new HIV infections
How can crack cocaine contribute to the spread of HIV/Hep?
Crack gets hot in the pipe, can blister or burn the mouth and make transmission possible, contaminates the stem and be passed onto the next smoker
What percentage of countries have laws or regulations protecting drug users from discrimination?
How many countries have needle exchange programs?
How many needle exchange programs exist in the US?
184 in 36 US states
In how many countries is methadone substitution therapy used?
What are four reasons that measurement of substance use is difficult?
1. Different definitions between binge and use/abuse
2. Recall bias
3. How to quantify amount
4. Different for different body types
What four things go into alcoholism?
1. Craving: A strong need, or urge, to drink
2. Loss of control: Not being able to stop drinking once drinking has begun
3. Physical dependence: Withdrawal symptoms, such as nausea, sweating, shakiness, and anxiety after stopping drinking
4. Tolerance: the need to drink greater amounts of alcohol to feel the same effect
Pattern of drinking alcohol that brings blood alcohol concentration to 0.08 grams percent or above
What typically brings BAC in an adult male to 0.08?
Consuming five or more drinks in 2 hours
What typically brings BAC in an adult female to 0.08?
4 or more drinks in 2 hours
What are issues that interfere with measuring binge drinking?
What is the CAGE questionnaire?
Annoyed (have people been annoyed by your drinking)
Guilty (have you ever felt guilty about your drinking)
Eye-opener (have you ever felt you needed a drink first thing in the morning)
Yes to 2 or more indicates the possibility of alcoholism
Low risk drinking for men
No more than 4 drinks on a single day and no more than 14 drinks per week
Low risk drinking for women
No more than 3 drinks on any day and no more than 7 drinks per week
Reproductive health definition, WHO
A state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity, in all matters relating to the reproductive system and its function and processes
You Geaux Girl!
Randomized controlled trial of e-curriculum to reduce unintended pregnancy among older teens by Dr. Kissinger
The study of the occurrence and distribution of reproductive outcomes mainly in pregnant women and their partners and infants, including the study of the determinants influencing such states, the application of this knowledge to control of health problems
Pre fertilization factors for men and women (4)
1. Mechanical integrity of reproductive tract
2. Integrity of reproductive hormone system
3. Quality of germ cells
4. Mature sexual function and behavior
Factors near the time of fertilization for men and women (3)
1. Frequency of coitus
2. Immunological compatibility of sperm and female reproductive system
3. Contraceptive practice
What is considered low birth weight?
Less than 2500 grams
What is considered a preterm baby?
Less than 37 completed weeks or 259th day
How big was the smallest baby ready to go home?
8.6 ounces, or 260 grams
What are 5 specific issues to reproductive epidemiology?
1. Individuals are not "ill"
2. Healthy mothers v. repeated abortions/malformed children
3. Pregnancy-induced disorders
4. Chronic hypertension v. preeclampsia
5. If the pregnancy is threatening the life of the mother
High blood pressure during pregnancy; is potentially dangerous
What group of women are at the highest risk for low birthweight, preterm birth, and infant mortality?
African American women
What is one hypothesis as to why African American women are more at risk for low birthweight, preterm birth, and infant mortality?
What are 9 reproductive risk factors?
1. Infectious: rubella, HIV
2. Behavioral/lifestyle: woman's voluntary or involuntary activity such as alcohol, drugs, smoking
3. Attribute/condition: already existing at the moment of conception, age, ethnicity, family history, obesity
4. Biological susceptibility: immunological deficit, gene mutation
5. Psychological/social: stressful life events, poverty
6. Medical: Diabetes mellitus, I or II
7. External environment: polluted air and water, radiation
8. Occupational: Previous occupational histories, suspect substance in ambient air
9. Nutrition: deficit or excess of iron, vitamins, nutrients
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