Lecture Material HLTC07 Notes.doc

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Health Studies
Caroline Barakat

Lecture Material HLTC07 Notes 17/10/2012 17:09:00 ← ← Definitions: ← ← Epidemiology: addresses human populations with respect to their health ← Frequency quantified: is the rate of its occurrence ← Prevalence: proportion of individuals afflicted by the illness at a particular time ← Incidence: proportion of individuals that receive the illness at a particular time / 10 000 person years by incidence density ← Demography: the study of populations ← Public health: health of the public at large, and its more inclusive than medicine ← They provide education, regulation and services ← DALY (disability adjusted life years: measure of overall disease burden, as expressenumber of years lost due to illness, disability or early death ← Safety: refers to the conidition of being protected ← Injury prevention : measure to reduce the incidence and severity of injuries through active and passive behaviours ← Motor Vehicle injuries: collision involving at least one vehicle in motion on a public or private road that results in someone being injured or killed ← Occupational injuries: events that happen during a paid activity that results in the absence of work for at least three days for medical care ← Interpersonal violence: intentional use of physical force and power, threatened or actual on another person or group of people that results or has a high likelihood of resulting in injury, death, psychological harm, maldevelopment and deprivation ← ← What are the features of epidemiology: ← - it can explain diseases that are either endemic, epidemic or pandemic ← - knowledge base for- research and science ← - causation of the disease—the etiology ← - ie cigarette smoking in the etiology of cancer ← - it’s a aggregate of differentiated sub disciplines] ← Past 60 years the population doubled to exceed 7 billion Growth rate: 2% in the late 1960s 1.2/ year with 70 million people each year High projection: 2.6 children per woman Medium: 2.1 children Low: 1.6 children ← ← slide 12 ← ← Youth bulge replacement fertility—represents the number of children a couple needs to have to replace youth ← Ranges from 2.04-3.35 ← ← What influences population growth ← - Contraceptive prevalence ← - government policies ← -gender equity ← - mortality from HIV aids and other infectious diseases ← -migration ← ← Why are the impacts of population growth important ← Health-adverse impact especially on women ← Poverty ← Security and Conflict ← Natural resources ← ← Global Burden of Disease ← - to obtain dyou get individual level data and aggregate them to estimate quantities ← However the problems with them are ← 1) Difficulty comparing indicators—people of different places cant compare indicators ← 2) under-over estimate ← 3) fragmented or partial data—death rates, cause of death not recorded ← 4) comprehensive and detail assessments ← ← Global burden of disease study: ← It was first launched in the 1900s. Went through 8 revisions ← It was used to measure mortality and morbidity by (age sex and region) ← Published in 2004 ← ← New metric- DISABILITY-ADJUSTED LIFE YEAR (DALY) ← Main findings ← 1) neuropsychiatric and injuries were the most common cause of loss in years of a healthy life ← 2) NONCommunicable diseases of neupyschiatric disorders account to 41% of global burden of diseases ← 3) communicable, maternal, perinatal and nutrition conditions was 44% of global burden of disease ← 4) injuries was 15% ← ← How was the GBD study revised ← Study was refined to have 192 WHO member states ← Summary Measures of Public Health (SMPH) • Health expectancies—disability free life expectancy • Health gaps- disability-adjusted life years ← ← The purpose of disease classification is ← 1) To alert the emergence of a health issue ← 2) to assist in planning operations and evaluations ← 3) to allocate resources ← 4) to inform where funds need to be used in the most useful way ← 5) to understand disease pattern ← ← Principles of disease classification ← 1) must have a category for every disease ← 2) no overlapping of categories ← 3) must have at least one disease for every category ← ← Disease does not have an international definition therefore it is classified based on these dimensions ← ← 1) symptomology ← 2) anatomy ← 3) histology ← 4) etiology ← 5) course and outcome ← 6) age at onset ← 7) treatment response ← 8) severity/extent ← 9) intrinsic genetic factors ← 10) environmental factors ← 11)gender ← 12) other ← ← International Classification of Disease is used to categorize diseass, health conditions and other causes of disease and injury in order to compile useful statistics of morbidity and mortality ← ← There are three volumes ← Volume 1: consists of definitions, tabular lists and WHO nomenclature guidelines ← Volume 2: descriptions of classifications, methods on how to use for mortality and morbidity with short lists ← Volume 3: alphabetical list that contains indices of diseases, external causes and substances and drugs ← ← ICD 10 was not enough to be used in CANADA therefore we use the ICD-10-CA CCI—canadian classification interventions ← ← How are mental disorders defined ← International classification of diseases and Mental Disorders and the Diagnostic statistical manual of mental disorder ← Currently disorder is not defined properly ← ← How are injuries defined ← 1) identification of a causal event ← 2) assessment of the outcome ← don’t use accident cause its linked to cause and you cant prevent it due to chance ← ← Operational definitions of injuries ← 1)Motor veichle acidents ← 2) other transport accidents ← 3) Accidental Falls ← 4) accidental poisioning ← 5) accidental fire and flame ← 6) accidents with machinery, cutting and piercing instruments ← 7) accidents with firearms ← 8) accidental drowning ← 9) other accidents from external cause ← 10) drugs medication causing adverse affects in therapeutic use ← ← Intentional injuries ← 1) Suicide or suicidal attempts ← 2) homicide or injury purposely inflicted by other persons ← 3) other external causes of injury including fatal injuries of undetermined intent or those related to legal interventions and operations of war ← ← Home and Leisure injuries ← -development of safety standards ← -enforcing legislation ← -testing and conducting consumer products ← -promoting safety ← -product advisories, warning and recall ← ← Major causes of injuries ← 1) Motor vehicle injuries ← 2) home and leisure injuries ← 3) occupational injuries ← 4) sucicide and self inflicted injuries ← 5) interpersonal violence ← 6) homicide, assulats, child abuse and neglect. Intimate partner violence, elder abuse and sexual assault ← ← Injury data collection and data sources ← Road traffic: county level, government officials, WHO Statistical Information Databases ← Suicidal injuries are hard ← The data on deaths are HIGh and have satisfactory quality ← There are variation in suicide rates all across the world ← Road traffic: international road traffic accidents database(IRTAD) ← The highway national transport administration in the US (HNTA) ← CARE European Union Community Road Traffic Database ← ← Disease surveillance involves ← - epidemiological survelliences ← - chronic diseases and injuries ← ← Alexander Lanmuir from CDC 1963 ← 1) systematic and active collection of pertinent data of target disease ← 2) assessment and practical report of these data ← 3) timely dispatch of such reports to individuals responsible for formulation of action plans ← DOES not include control measures ← ← Surveillence Methods ← Target disease key way of looking at the sensitivity, specificity effectiveness and efficiency ← 1) clear idea of clinical picture ← 2) infectivity ← 3) mode of transmission ← 4) probably frequency or prevelance ← 5) people’s attitude of the disease ← ← Surveillance system is a section with a method or function consisting of ← 1)community based surveillance ← 2) hospital survellience ← 3) passive and active surveillance ← 4)special surveillance- rewarding system no cases NIL ← ← Laboratory diagnosis: results from when the specimen is taken and results reported ← - reliability of the testing technique ← -coallation of surveillance data by time place and person ← ← Outbreak detection: ← -an increasing number of persons who are showing a specific clinical pattern ← ← 1)Active surveillance: normal or contact reporting- ← Whats required?? Sensitive and monitored surveillance system where the data are collected in a timely manner and regularly analyzed ← ← 2) Syndromic Surveillance: ICD 10 and 911 calls monitoring ← ← ← ← Global Outbreak Alert and Response Network (GOARN): a technical collaboration of existing instituations and networks that pool together human and technical resources for rapid identification, confirmation and response to outbreaks of international significance ← ← Core team should be assembled that ← 1) creates objectives ← 2) established a hierarchy for decision and information sharing ← 3) develop plans for re-evaluating the objectives ← 4) delineate roles and responsibilities for the relevant agencies ← 5) lead agency and principal investigator ← 6) assess need for additional human resources ← 7) gaps in expertise ← ← ← What does the laboratory do in an outbreak ← 1) develop specific and shipping protocols ← - involves specimen type, quantity, timing, type of containers, transport media, preservative labels, pre-shipping requirements, instructions for shipping ← 2) develop specimen processing and testing protocols ← - tests each lab will conduct, how the results will be determined and interpreted, how the results will be released ← - obtain materials and supplies and ship to outbreak location ← after collection must ensure proper labeling and trackin ← ← Are there really more cases of a certain disease than normally expected in th time and location ← When in doubt, cases should be treated as an outbreak ← Initial phase-diagnosis of a substantial proportion of cases should be confirmed ← ← ← Case definition is difficult to over come ← - start with a very sensitive but specific definition. Includes person time and place* ← ← Case ascertainment ← - active search for cases ← - contacting labs school authorities or persons that attended a particular event ← Line listing: ← - visualize and summarize important information ← - establish a hypothesis for the outbreak ← ← Descriptive epidemiology: ← - characterization of cases using variables in order to identify risk factors among cases ← - epi curve shows progress of the outbreak over time ← includes geographic distribution ← ← Hypothesis and Testing ← - develop a hypothesis ← - role for in depth interviews ← design the appropriate study to test it • outbreak in well defined population—cohort study • otherwise case control ← RELOOK AT LECTURE 4 in detail** CALCULATIONS 17/10/2012 17:09:00 ← Disability Adjusted Life Years: measure of the overall disease burden expressed as the cumulative number of years lose due to ill-health, disability and early death ← ← DALY= YLD+ YLL ← YLD- Years lived with disability ← YLL: years of life lost (NxL) ← Years of life lost for a given cause age and sex ← N= number of deaths ← L= year lost based on standard life expectancy at age of death in years ← ← YLD (years of lived disability): for a particular cause ← I x DW x L ← ← I= number of incident cases in that period ← DW: weight factor that reflects the severity of the disease—0perfect health 1 dead ← L: average duration of the case until remission or death ← People 17/10/2012 17:09:00 ← Alexander Langmuir—CDC 1963 3 pts for disease survellience Examples 17/10/2012 17:09:00 ← The case of Smallpox Eradication and its Surveillance ← -it was intiated in 1967 ← ← The first task was to report cases from the ← Town/village level ← To the district to national level ← To the WHO level ← And WHO level HQ ← ← It was divided into 2 cases ← 1) small pox endemic countries ← 2) smallpox free countryes (small pox imported countries) ← ← International health regulation ← Weekly reports to national health services ← ← Measures that worked were ← 1) no subclinical manifestation- clinical manifestation was distinct ← 2) did not require laboratory diagnostic procedure ← 3) rewards ← 4) food containment ← ← ← ← ← ← ← ← ← ← ← ← ← ← ← ← ← CIFA- Canadian food inspection agency warn pblic distributors and food service establishments not to consume sell or serve various raw beef products because they may have Ecoli ← - Walkerton wells Readings 17/10/2012 17:09:00 ← The failure of Academic Epidemiology: Witness fror the Prescution ← Carl M Shy ← ← Prosecution statements ← 1.Failure to serve as the basic science of public health ← a. Mission of epi is “organized, community efforts aimed at the prevention of disease and promotion of health • only looked at clinicians interest in understanding why individuals become sick • looks at the individual level not the community • failed to provide public health community with scientific tested choices among alternative community actions for promoting health • failure to develop the methodology and to generate the knowledge require by the public health community to fulfill its fundamental mission of creating and assuring the conditions in which people can be healthy ← Rebutle: two revolutions by epidemiologist 1) epi discovered the causes of disase 2) methods to identify the risk factors of chronic diseases, knowledge has served as a basis for preventive actions both at an individual level and societal level.dramatic decline in CVD and cerbravascular disease. Change in exercise and food consumption decrease in smoking design and analysis strategies that enabled researchers to study the ajor risk factors for the chrnoc diseases that are the leading causes of death in industrialized societies Textbook definition of epi: study of distribution and determinants of disease in populations - should understand disease consequence as a result of how society is organized and behaves, what important societal and economic forces have on incidence rates and what community actions will be effective in reduce incidence rates - but in books it’s the study of determinants of disease in groups of individuals w/ a common characteristic - in order to understand population determinants of disease o demography, economics, sociology and poli scie need to be included ← - narrowness of biomedical disease—has lead to biomedical fallacy— error in inferring that risk factors for disease in individuals can be summed to understand the causes of disease in populations or that the health of population can be explained entirely in terms of characteristics of individuals ← - New definition: study of distribution and societal determinants of health status in populations ← - health status links epi to primary mission of public health ← - common measure of health status is their death status, infant mortality and life expectancy ← Why does epid fail to outline the mission of public health? ← -study of lung cancer epidemic • epid looked at smoking causing cancer but failed to look at why smoking became highly prevalent to help public health officials to effectively reduce it • didn’t look at the underlying societal factors • needs research on population determinants of health** ← Leeds Declaration— a) look at community and sociopolitical system b) include qualitative and participatory research c) lay knowledge and scientific knowledge Epi is really moving toward molecular methods Molecular epi doesn’t give insight into causes of violent society- societal factors Epi has looked at micro and macro - cardiovascular - - how can scientific evidcen be driving force of political agendas - really a failure of public health advocates and policy makers to incorporate epi findings into public promotion of health promotion - - gap between individual risk factors and science based societal interventions WHO –ICD 10 Introduction to ICD 10 -counting of diseases, injuries, symptoms,
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