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Kin 1C03 Epi Test 1 Review.docx

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Krista Howarth

Test One Review Lecture One: Epidemiology:  Epidemiology is the study of the causes of illness with regards to health in a population, how illness spreads in a population and how illness can be controlled. o “The study of the districution and determinants of health-related states or events in specified populations and the application of this study to control health problems”  Epidemic: Is more then the usual amount of people contracting an illness  Pandemic: An epidemic spread over a larger population Goals of Epidemiology (x3)  Describe the distribution of the disease o Where did it spread to? Where did if come from?  Identify Risk Factors for the disease o Risk factors are related to the cause and increase susceptibility to the disease  Prevent the disease (changing the occurrence) o Usually involves modifying the risk factors Example: H1N1  An increasing number of people were infected with the virus over a large population and H1N1 was declared a pandemic  It is thought that older populations were exposed to it when they were younger meaning less of them got sick  0-4 years and more then 65 years were the ones most hospitalized because they were more prone to complications  25-29 accounted for the greatest amount of deaths because they thought they were fine until they were very sick Uses of Epidemiology (x4)  Biologist: the germs and vaccines used to prevent it  Medical doctors: treat and help the patients (present info)  Public Health: population approach to epi to prevent spread  Health Policy Makers: what can we do to stop the spread of diseases Historical Underpinnings and John Snow  John Snow is the “Father of Modern Epidemiology”  London Cholera Epidemic (of 1854) where snow related chorea (a GI tract infection) back to the Broad Street water pump  It was known that people died rapidly after being infected and people thought that the disease was airborne  Snow believed that it was being spread through the water because of outbreak 5 years earlier and linked the illness to water supplies in the region  127 people died causing Snow to go door to door interviewing families  Snow created a map that linked the Broad Street water pump to the disease  When the handle was removed from the pump people stopped getting sick  Snow paved the way for cleaning water supply, founding the germ theory and population and preventative medicine Test One Review New century brought new medicine; current diseases are chronic not pathogenic Lecture Two: Behavioral Epidemiology: the behaviour being physical activity in this course  The observation and study of behaviours that lead to health related states and the distribution of these behaviours (Eg. Smoking and lung cancer) Goals of Physical Activity Epidemiology (x3)  Examine the relationship physical activity and morbidity and mortality o Morbidity: Having the disease o Mortality: Dying of the disease  Identifying patterns and determinants of physical activity o Age, gender, ethnicity, race, etc. o Who is active? o Are levels of activity changing?  Use evidence to determine o How PA can be changed o Extent to which PA is a risk factor o Impact of changes in PA Example: The Burden of Physical Activity in Canada  Canada is impacted by direct ad indirect costs  Direct costs: antibiotics, hospital and care  Indirect costs: disability from the government  $5.31 billion attributed to inactivity in Canada (direct and indirect) Exercise and Morbidity  Physical Consequences o Decreased risk of colon cancer, type 2 diabetes and cardiovascular disease o Protect against breast and prostate cancer and osteoporosis o Reduces obesity  Psychological Consequences o Relieves symptoms of depression and anxiety o Improves mood, body image and quality of life Origins of the Link Between Health and Physical Activity  Exercise as medicine o Ancient Indians 9 Century B.C: used exercise and message to help rheumatism o Greek Physician Herodicus 480 B.C: thereputic gymnastics  Influences Hippocrates and Aristotle  Exercise and Health Education o Italy 14 Century: exercise as a part of education o North America 1700s: physicians didn’t support PA for good health until after the civil war  Links between PA and chronic diseases found in 1800s causing PA to be promoted as preventative medicine  1954 ACSM founded “Modern History” Test One Review  Higher activity is associated with lower mortality and morbidity  We know this through the “landmark studies” Landmark Studies London Bus Study  Designed to look at the link between occupational physical activity and health by measuring heart disease in the bus drivers and conductors of double decker buses.  Conductors were at lower risk then drivers  Limited because the study occurred over many age categories and there are many risk factors. Also, a retrospective study (interviews) can be inaccurate Framingham Heart Study  Designed to examine the link between lifestyle and health prospectively by taking a healthy population and take measures on them and follow them over time to see what has happened o Look at risk factors and what diseases outcomes they may have acquired  Methods: Over 5,000 people enrolled, with tests and surveys every 2 years. The population was male and female and ranged between 30 and 60 years old  Results: o Uncontrolled risk factors: something you cannot change  Genetic predisposition  Ethnicity  Gender  Environment  Disease (diabetic) o Controlled risk factors: something you can change  PA level  Diet  Cholesterol  Smoking  Obesity  Greatest predictor of heart disease were direct consequences of a persons behaviour/ lifestyle  Limited because people could easily lie  Study is still going on today with the children of original participants o Less then 1% of people dropped out of the study Longshoremen Study  3500 Longshoremen Studied between 1951-1072  Looked at the difference between cargo handlers and dockworkers versus supervisors  8500kcal/week at work can reduce coronary heart disease mortality by 50%  Limitations: o All men o Working their way up: supervisors started as longshoremen Test One Review Harvard Alumni Study  Surveyed graduates of Harvard over time (prospective)  3 Hours of sport a week reduces all cause of mortality by 53%  More then 15 km a week of walking (compared to 5km a week) decreases all cause mortality by 33#  Active men live 2 years longer then inactive  Limitations o All men o Were not accounting for diets o Not representative of an entire population (high economic status due to the fact they all went to Harvard) o Collected data via survey (retrospective study)  Was it accurate?  Were they being honest?  The way they measure PA comes into question Lecture 3/4 International Consensus of the Importance of Physical Activity  World Health Organization o Adults 18-64 should do 150 mins moderate intensity aerobic activity a week OR 75 mins of vigorous aerobic activity o Minimum bouts of 10 mins o Increase over time to 300 minus of moderate intensity and 150 of vigorous intensity o Resistance 2x a week  American College of Sports Medicine o More then 30 mins a day for 5 days a week (total 150 a week) o Vigorous intensity for 20 minutes a day three days a week (total 75 a week) o Resistance 2-3 times a week o Flexibility 2 days a week  Canada Physical Activity Guideline o 150 minutes a week for 10 minutes or more Active 2010: Ontario’s Physical Activity Strategy  Released the year of the Olympics  By 2012 increase to 55% of population is active defined by 30 minutes a day walking  Enhance sport development before the Olympics  Get resources to strengthen physical activity and sports center Key Concepts  A risk factor is a characteristic that increases the probability of disease in a group of individuals. Epidemiologic Measures  Incidence is the number of new cases of health related states that occur during a specific period of time  Prevalence is the number of existing cases at a specific point in time Test One Review Calculating Prevalence Rates  Expressed as a percentage or as a per 100 etc Calculating Incidence Rates  Expressed as a percentage or as a per 100 etc Categories of Rates  Crude rates are based on total population without considering population characteristics  Specific rates are computed separately for different subsets of the population  Standardized (adjusted) rates are adjusted by factoring in the effects of some known population characteristics o We standardize to compare populations Lecture 5 Research Design  An analytic approach used to evaluate a research question  How you set up a study to examine the association between variables  In epidemiology research design is meant to clearly answer the question and estabilish if physical activity is a determinant or consequence o Determinant: health status, injury, health state etc o Consequence: of the environment, genetics, personality etc  Variables are either independent or dependent Types of Designs (x2)  Observational Studies that examine the associating between the variables as they naturally occur o Cross Sectional: observes the population at a specific point in time  Advantages:  Fast and easy to conduct  Hints at associations for further inquiry  Disadvantages  Cannot determine direction of associations  Cannot determine cause and effect o Case-Control: looking at the uninfected and the infected and ask them about their past history  Advantages:  Inexpensive and easy to conduct  Good study for “rare” events  Hints at associations for further inquiry  Disadvantages  Cannot determine cause and effect  Cannot determine incidence rates  Recall bias (will it be accurate?) o Prospective Cohort Study: looks at outcomes Test One Review  Advantages:  Can study many outcomes at once  Can measure incidence  Disadvantages  Cannot determine cause and effect  Resource intensive  Loss to follow up is an issue  Experimental Designs require the investigator to manipulate the independent variable and look at the effect on the dependent variable o Randomized Controlled Trials: Make a control and experimental group and measure variables at the start and end of training  Advantages  The “gold standard”  Can establish cause and effect  Disadvantages  Costly  Ethical concerns  Loss to follow up  Hard to examine rare outcomes Lecture 6 Evaluating Evidence  How much impact do risk factors have on the probability of a disease? Calculation Relative/Risk Ratio (RR)  Risk of disease in people exposed to the risk factor compared to people who are not exposed  Requires 2 calculations o Calculate the incidence (absolute risk) of people with and without the disease o Calculate the risk ratio  The risk of getting the disease is _____% greater when you have the risk factor Calculating Risk Difference/ Attributable Risk  Subtract the incidence for people with the risk factor and without it  _____% of the risk of the disease is attributable to the risk factor Determining Cause in Epidemiology Studies  To what extend does “A” cause “B”  There are 5 Criteria (Mills Cannons) o Temporal Sequence: there is time for something to cause something else because time is needed for a disease to develop o Strength of Association: is there a strong enough relationship? o Consistency: if you have more exposure to a risk factor does it increase your risk even more o Dose – response relationship o Biological Plausi
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