HLTC07- Lecture Midterm notes.docx

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Department
Health Studies
Course
HLTC21H3
Professor
Caroline Barakat
Semester
Fall

Description
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
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