Question | Answer |
Public Health | The totality of all evidence-based public and private efforts that preserve and promote health and prevent disease, disability, and death |
Public Health Changes over Time | Now is the “Era of Population health”. |
Events Germ Theory has led to: | Scientists were able to diagnose TB through skin testing, bacterial culture, and chest X-rays. Concepts of vaccination advanced. Antibiotics and other effective cures come about. |
Germ Theory of Disease | The demonstration of infectious origins of disease |
Health protection | Quarantine for epidemics; sexual prohibitions to reduce disease transmission; dietary restrictions to reduce food-borne disease |
Hygiene movement (1840-1870’s) | Snow on Cholera; Semmelweis and puerperal fever; collection of viral statistics as empirical foundation for public health and epidemiology |
Contagion control (1880-1940’s) | Linkage of epidemiology, bacteriology, and immunology to form TB sanatoriums; outbreak investigation, e.g., Goldberger and pellagra |
Filling holes in the medical care system (1950’s-1980’s) | Antibiotics; randomized clinical trials; concept of risk factors; Surgeon General reports on cigarette smoking; |
Health promotion/ Disease prevention (Mid 1980’s-2000) | AIDS epidemic and need for multiple interventions to reduce risk; reductions in coronary heart disease through multiple interventions |
Population health (21st Century) | Evidence-based medicine and public health; information technology; medical errors; antibiotic resistance; global collaboration, e.g., SARS, tobacco control, climate change |
High Risk approach | focuses on those with the highest probability of developing the disease and aims to bring their risk close to the levels experienced by the rest of the population |
Improving the Average approach | focuses on the entire population and aims to reduce the risk for everyone |
Determinants of Disease | Behavior
Infection
Genetics
Geography
Environment
Medical care
Socio-economic-cultural |
P.E.R.I framework | types of info to describe evidence based public health approach. Drawn as Problem --> Etiology-->Recommendations--> Implementation--> Problem |
PERI | Problem
Etiology
Recommendations
Implementation |
Incidence rate | Measure chances of developing a disease over a period of time, generally one year. Calculated as Incidence rate = # of new cases of a disease in a year/ # of people in the at-risk population |
Prevalance rate | the proportion of individuals who have the disease. # living with a particular disease/ # in the at-risk population |
Case Fatality rates | estimates the chances of dying from a disease once it is diagnosed. (mortality/ incidence) |
3 Requirements to establish contributary clause | 1) The cause is associated with the effect at the individual level
2) The cause precedes the effect
3) Altering the cause alters the effect |
Case Control Study | Establishes "the cause is associated with the effect". |
Cohort Studies | Establish "the cause precedes the effect". |
Randomized Clinical Trials | Establish "Altering the cause alters the effect". |
Hills Criteria for Causation | 1) Strength of relationship
2) Dose-response relationship
3) Consistency of the relationship
4) Biological plausibility |
Recommendation scores | A= Must
B= Should
C= May
D= Don't
I= Indeterminent, insufficient or I don't know |
Primary Intervention | Prior to disease |
Secondary Intervention | Prior to symptoms |
Tertiary Intervention | Prior to irreversible complications |