HLTC07- Lecture Midterm notes.docx

12 Pages
Unlock Document

Health Studies
Caroline Barakat

HLTC07 - Lecture 1: Introduction  Epidemiology: addresses human populations with respect to their health o Frequency quantified – rate of its occurrence o Prevalence – proportion of individuals afflicted by the illness at a particular time health state o Incidence – proportion of individuals that receive the illness at a particular timeevent o Incidence density –number of cases diagnosed in a given population in time relative to life expectancy of human population year event e.g. 10,000 person-years o Features:  Endemic (one region) versus epidemic(multiple regions) versus pandemic (global)  Knowledge base – research and science  Causation – etiology/etiogenesis or illness  E.g. causal (attributable) rate ratio such as the study of cigarette smoking in the etiology of lung cancer X causes a disease Y if we stop X what does it do for disease Ye.x. cigarette smoking and lung cancer  Aggregate of differentiated sub disciplines  Many different disciplines can be involved in this field of epidemiology  Demography: the study of populations (size, structure, and potential impact) o Structureyounger, older, middle aged population o Most growth occurs in developing countries o Death rates have fall down faster than the birth ratesresulting in rapid population growth o 60 years – population more than doubled to exceed 7 billion o Growth rates (difference between birth rate and death rate) – 2% in the late 1960s o Currently about 1.2%/yr – 70 million people each year o Future population projections  Main dragging force is fertility  average number of children women has  High projection – around 2.6 children per woman  Medium projection – 2.1 children per woman  Lowest projection – 1.6 children per woman o Dynamics of population growth  Immigration and emigration doesn’t matter, birth rates and death rates matter  Natural change=birth – death  Net migration= who is coming – who is leaving o Purpose o Demographic transition:  Transformation of a population  1 stage= Characterized by high birth rates and high death rates, where people live longer and have smaller familiesinverted cone o First stage where demographic transition didn’t occur yet  2 stage= people have a lot of kids, but people also live longer  People are aging triangle  3 stage= death rates continue to go down, birth rate goes down th  4 stage= death rates and birth rates are lowbulging in middle o Lower proportion of people in 0-4 age bracket o Youth bulge o Influences of population growth  Contraceptive prevalence  Mortality from HIV/AIDS and other infectious diseases  Gender equitywoman going into work forcedelaying child bearing, less children impacts population growth  Migration entering a foreign country  key factor in population growth in some places, and population decline in other places  Emigrationleaving your native country  Government policies India and China have one child policy, other countries promote child bearing o Impacts of population growths  Health – adverse impact especially on women and children  529,000 women die from child birth/pregnancy for every woman that dies from pregnancy, others have chronic disabilities  Poverty small families allow for women to apply for work and find workmore investment and growth  Natural resources  as fertility declines government and household have more money per child  We are facing challenged in sustainability. Many people live in conservation lands  Water scarcity causes wars  Conflicts and security all the previous leads to this  Real issue is not having good education, resources, and good life which leads to conflicts and security  Public Health o 2 half of the 2-th century for public health  free health care o ‘Health’ of people at largethe collective level of ill health and disease the population/community are clients of the health care system which should be available to the public and society financed o ‘Health’ - more inclusive than ‘medicine’ o Who are public health professionals  people involved in improving health of population and general conditions that improve the health of certain populations (ex. Nutritionists, nurses, public health educators) o What are the actions of public health  Education  Regulations  Service  Main messages o World is demographically complex and divers o Demography Epidemiology Public Health HLTC07 – Lecture 2: The burden of Disease and Disability  Global burden of disease o Individual – level data are aggregated to generate estimates of quantities o Limitations  Difficulties in comparing indicators  on city, town, country can expect certain categories to estimate mortality, but not the same for another country  These are all estimates, can be as close as possible to reality. There may have been numbers that were hard to compare so people had to use projections  Statistics may be partial or fragmented  Some places are capturing data that are not fatal. No clear reporting of these kinds of conditions  Under – or over- estimates  Ties into the partial fragmented data that is available o People can die and  no record of how they dies o If no reason is sought to why person died then overestimate o Within a region someone may die and its clear they died of respiratory infection but not specific how, so it could be over or underestimation  Required detailed and comprehensive assessments  When governments need to set priorities based on detailed and comprehensive assessments, and lack of it can be a problem in aggregated data and what policies can in place o How do they know that this is the most common assessment so that they can set those priorities  Introduction/ history o First commissioned by WHO in early 1990s to take place o First study took place but wasn’t large scale and eventually expanded (revised in 2002) o Aim is to generate a more comprehensive understanding of mortality and disease o Done by age, sex, and region. Gives idea of who is dying, getting disease, at what age category and regions o Eventually expanded to different regions o New metric – disability-adjusted life year (DALY)  Simultaneously quantifies the burden of disease with mortality  How many years were lost to early death and how many years were lost to premature disability o First study looked at x number of regions and also looked at bigger categories that were later refined and separated o Refines study was based on disease and injuries caused by age, sex, etc. o Main findings:  Neuropsychiatric disorders and injuries were major causes of lost years of healthy life  Non-communicable diseases, including neuropsychiatric disorders were estimated to have caused 41% of the global burden of disease in 1990  Communicable, maternal, perinatal, and nutritional conditions amounted to 44% of the global burden of disease  Injuries amounted to 15% o Refined study on 192 WHO member states o Summary Measures of Population Health (SMPH)  Health expectancies – e.g. disability-free life expectancy  Expanded life expectancy to health life expectancy referring to expectations of various states of health, also active life expectancy and healthy life expectancy o Disability-free life expectancy = concept of life expectancy that existed in the past (people had to look at how many years in certain country lived healthy)  Health gaps – e.g. disability-adjusted life years (DALY)  How many years of lost health did one obtain in a country compared to healthy lifestyles (the disability years) DALY  Measures o DALY: Disability Adjusted Life Years – measure of overall disease burden, expressed as the cumulative number of years lost due to ill health, disability, early death o YLD: Years Lived with Disability  YLD (for a particular cause)= I x DW x L  I  #of incident cases in that period  DW  weight factor that reflects the severity of the disease on a scale from 0 (perfect health) to 1 (dead)  L  average duration of the case until remission or death (years of disability) o YLL: Years of Life Lost  YLL (for a given cause, age and sex)= N x L  N  # of deaths  L  years lost based on standard life expectancy at age of death in years o DALY= YLD + YLL  Example: what is the DALYs of a person who was severely injured in a car accident at the age of 37 and dies when he is 75? (consider a life expectancy of 80 years and a disability weight of 0.65) YLL =N x L= (1)(5) =5 YLD = I x DW x L= (1)(0.65)(38) = 24.7 DALY= YLL +YLD = (N x L) + (I x DW x L) = [1 x (80-75)] + [1 x 0.65 x (75-37)] = (1x5) + (1 x 0.65 x 38) = 5 + 24.7 = 29.7 years HLTC07 – Lecture 3: Disease/ Injury Classification and Disease Surveillance  Disease classification o Purpose  To alert to the emergence of a health problem  To assist in planning, operations, or evaluation  To allocate resources  To inform on where funds need to be used in the most useful way  To help in understanding disease pattern o Principles  Must have a category for every disease  No overlap between the categories  At least on disease for every category  Dimensions of Disease o No international definition of disease o Disease defined through a set of dimensions:  Symptomatology – manifestation  Anatomy  Histology  Etiology  Course and outcome  Age of onset  Severity/ extent  Treatment response  Linkage to intrinsic (genetic) factors  Gender  Linkage to interacting environmental factors  Other factors  International Classification of Disease (ICD-10) o To categorize diseases, health-related conditions, and external causes of disease and injury in order to be able to compile useful statistics in morbidity and mortality o (ICD-10) consists of 3 volumes:  Volume 1: a tabular list, definitions, and WHO nomenclature guidelines  Volume 2: extensive description of the classification and methods for use in mortality and morbidity, including short lists  Volume 3: alphabetical index that contains separate indices for disease, external cases, and drugs/ substances o Canada – ICD-10-CA and CCI (Canadian Classification of Interventions)  Classification of mental disorders o International Classification of Diseases Mental Disorders and the Diagnostic and Statistical Manual (DSM) of Mental Disorders o Status of ‘disorder’ is not well-defined  Classification of injuries o 2 important considerations:  Identification of the casual event  Assessment of the outcome o Operational Definition  Basis – external cause in the ICD – 10:  Motor vehicle traffic accidents  Other transport accidents  Accidental poisoning  Accidental falls  Accidents cause by fire and flames  Accidental drowning  Accident caused by machinery, cutting, piercing instruments  Accidents caused by firearm missile  All other accidents, including late effects  Drugs, medications causing adverse effects in therapeutic use o Categories for intentional injuries  Suicide and self -inflicted injury  Homicide and injury purposely inflicted by other persons  Other external cause including those fatal injuries of undetermined intent or those related to legal interventions and operations of war o Injury research and prevention  Safety –refers to the condition of being protected  Injury prevention – measures to reduce the incidence and severity of the injuries  Active behaviours  Passive behaviours o Major categories of injuries  Motor vehicle injuries – defined as a ‘a collision involving at least one vehicle in motion on a public or private road that results in at least one person being injuries or killed’ (WHO, 2004)  Home and leisure injuries  Development of safety standards  Enforcing legislation  In testing and conducting research on consumer products  Product advisories, warnings, and recalls  Promoting safety  Occupational injuries – ‘events that happen during a paid activity and have resulted in at least 3 days of absence from for medical car’ (Eurostat)  Suicide and self-inflicted injuries  Interpersonal violence – ‘intentional use of physical force or power, threatened or actual, against another person or has a high likelihood of resulting in injury, death, psychological harm, mal-development or deprivation  Homicide, assaults, child abuse and neglect, intimate partner violence, elder abuse, and sexual assault o Injury data collection and data sources  Road traffic – county level, state or federal government, WHO statistical Information database (WHOSIS)  Data on deaths due to injury are of high and satisfactory quality  Dying without suicide  Variation in suicide rated in different parts of the world is so great  E.g. international Road Traffic Accidents Database (IRTAD), and the National Highway Transport Safety Administration (NHTSA) in the US, and the European Union Community Road Traffic Database  Disease surveillance o Epidemiological surveillance o Surveillance activities – include chronic diseases and injuries o Alexander Langmiur from CDC in 1963:  Systemic and active collection of pertinent data of target disease  Assessment and practical report of these data  Timely dispatch od such reports to individuals responsible for formulation of action plans o Surveillance systems does not include control measures, epidemiological research can be included o Surveillance Methods  Target disease – key to defining the sensitivity specificity, effectiveness, and effici
More Less

Related notes for HLTC21H3

Log In


Join OneClass

Access over 10 million pages of study
documents for 1.3 million courses.

Sign up

Join to view


By registering, I agree to the Terms and Privacy Policies
Already have an account?
Just a few more details

So we can recommend you notes for your school.

Reset Password

Please enter below the email address you registered with and we will send you a link to reset your password.

Add your courses

Get notes from the top students in your class.