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Department
Public Health
Course
PUBHLTH 1
Professor
Eric Runnerstrom
Semester
Fall

Description
L1 - triclosan - resistant bacteria in streams and rivers - health - state of complete physical, mental, social and spiritual well-being and not merely the absence of disease - WHO determinants of health - social, economic, physical, person’s individual characteristics and behaviors - social ecological model of environment-behavior systems - Weisman, 1981, person is affected by social, physical, and economic environment. - public health - winslow, 1920, science and art of preventing disease, prolonging life, and promoting physical health and efficiency through organized community efforts. - early history - Univ. of Michigan - 1881, sanitary science // 1887, ms in hygiene // 1915 MS in PH // Johns hopkins - 1916 school of hygiene and ph founded // largest ph school in the world - UCI PH - 2003, PH program est. // 2006, students enroll // 2007, population health and disease prevention est. // 2012, accredited by CEPH // future, school of ph - multidisciplinary // assess population health status, reduce burden of disease thru preventative strategies - preconceived notions - conceptualization - disease prevention, nutrition/health education, dev. healthy lifestyles, promote healthiness, create healthy env. - chronic diseases, toxic wastes, behavior-related disorders, infectious diseases, aging population, mother/infant health, natural disasters/env. impact on health + well being - mission - fulfillment of society’s interest in assuring the conditions in which people can be healthy - substance - organized community efforts aimed at the prevention of disease and promotion of health - chronic fatigue syndrome - no known causes, women 30-50 - symptoms - extreme fatigue, inability to remember or concentrate, sore throat, enlarged lymph nodes, muscle pain, headache, unrefreshing sleep - potential causes - exact cause is unknown // viral infection, inflammation of immune system, stress, env. factors - treatment - cognitive-behavioral therapy, mild exercise, healthy diet, sleep management, relaxation/stress reduction, anti-anx. meds, antidepressants L2 - HIV - dramatic drop in infections - 2.3m in 2005 => 1.6m 2012 - new infections amt is decreasing - wide use of antiviral drugs - functions of PH - assessment, policy dev., assurance - PH - patient is community // diagnosis of community // treatment = new policies and interventions in community // goal - prevent disease and disability - medical care - patient is individual // diagnose individual // treatment = plan based on individual and extant knowledge/science // goal - cure - life expectancy - increased, 45-75 over 20th century // only 5 of addition 30 years are from work of med. care system // majority of increase comes from PH improvements - PH science - understand threats to health, determine interventions, evaluate - PH policy - we as a society make decisions about policies - PH disciplines - epidemiology - basic science // epidemics // control spread of infectious diseases // causes of chronic disease // limit harmful exposures - stats - data on population // diagnostic tools // calculate risks and benefits - biomed - infectious disease/pathogens // chronic diseases // genetics - env. health science - env. exposures/health effects // air, water quality // solid/hazardous waste // safe food and drug // env. changes - social/behavioral sci. - behavior affects health the most // social env. affects behavior // tobacco, poor diet, inactivity, injuries are major threats // maternal/child health - policy and management - med care in ph // cost of med care in US // high population w/o access to med care or insurance // measure quality of care - prevention and intervention - primary - prevent risk factor/injury/infection - secondary - minimize severity after illness it occurs - tertiary - dev. of emergency medical services - PH approach - define health problem // identify risks // develop interventions to control/prevent // implement interventions to help population // monitor interventions for effectiveness - chain of causation - agent => host (human) => env. (means of transmission) // interventions can deal with any part - PH and terrorism - 9/11 and anthrax letters - PH response to natural and human-made disasters - bioterrorism - PH controversy - social justice - process, not an outcome // seeks fair dist. of resources, opportunities, responsibilities // challenges oppression and injustice // exercise self-determination and realize full potential // build social solidarity, community capacity, collaborate - market justice - - controversy sources - economics, liberty, moral/religious concerns, politics/science - econ. impact - businesses resist PH measures, affect profits // those who pay may not benefit // costs are short term, benefits long term // costs easily calculated - commons - freedom to pollute - gov’t - prevent harm // paternalism, for children // protect individuals from actions // for “common good”, very controversial - morals/religion opposition - sex, alcohol, drugs, suicide/end of life decisions - politics/science - possible tension // conservative gov’t control intensifies conflict // bush admin. went too far in misrepresenting science L3 - ph in the news - drug ads and purchase - epidemiology - basic ph science // control infectious disease spread // seeks chronic disease causes // ways to limit harmful exposure // observational - disease occurrence - who, when, where => epidemiologists infer why disease is occuring - john snow - cholera, london, mid 1850s // water supply, thames // questioned households where cholera occurred // most deaths associated w/ water supplier - epidemic surveillance - endemic vs. epidemic // notifiable diseases // recognize new diseases // bioterrorism - outbreak investigation - verify diagnosis // case definition // active surveillance of cases // who, where, when, incubation period // common source of exposure - epidemiology and chronic diseases - risk factors // long-term trends - heart disease - leading cause of death in us // framingham, 1948 - lung cancer - early 1950s - epi. principles and methods - define the disease // determine death, certificates w/ cause of death // blood, stool tests to verify // harder to define, SARS // definition changes overtime, aids - disease freq. - people involved in relation to population at risk // par = total population or exposed population, gender, group, census data // incidence/new cases and prevalence, existing cases // incidence => disease causes - determinants - distribution, risk factors, - population - epidemiology, observe humans // biomed sci, experiment on lab animals - studies - find link between exposure and disease // prospective or retrospective - intervention - experiment-like // experimental and control group // compare outcomes in group // sort people into groups, similar as possible // intervention is only change - cohort - when intervention is too unethical or difficult // next most accurate // healthy people, collect their data, track outcomes // people choose exposures - case-control - people already have disease // healthy control // faster, cheaper // least accurate - relative risk - 1.0 no association between disease and exposure // > 1.0 increased risk // < 1.0 decreased risk - breast cancer L4 - ph in the news - olympians and bad oral health - intervention study - people won’t follow the study’s prescribed behavior for the whole study period - cohort study - difficult to isolate all factors that influence health differences - case control study - errors in report, recall // control group isn’t truly comparable - ^^must worry about drop-outs for all these studies - error sources - random variation // confounding variables // bias in selection, report, recall - validity - strong association // dose-response relationship // known biological explanation // large study population // consistent results from other studies - hormone replacement - conflicting results between 2 studies // clinical = gold standard // cohort was confounded by associated factors = women were healthier even without therapy - ethical issues - nazi experiments on prisoners // tuskegee syphilis study // creation of informed consent and institutional review boards // clinical trials // conflict of interest by med providers who wanted profits - drug trial conflicts - drug companies must conduct randomized controlled trials on new drugs before approval // harmful side effects arise after drug approval // evidence of companies suppressing negative drug findings // clinical trials must be registered in advance in database - stats analysis - numbers that describe population health // science to interpret numbers // quantify uncertainty - uncertainty of science - probable natures // ongoing, studies may contradict - probability - aristotle, probable is what usually happens - p value - < 0.05, statistically significant // = 0.05, 5% probability due to chance - confidence interval - express uncertainty degree - law of small probabilities - most improbable are bound to occasionally happen - study power - probability of finding an effect // large numbers = power - screening test stats - mammograms // hiv // newborn screening // sensitivity v. specificity // false positives and negatives - rates - raw data in relation to population // birth, mortality - crude, adjusted (age), group specific (gender) - other stats - life expectancy, years of potential life lost - risk assessment - calculate from historical data, well-known risk // poorly known => make assumptions // psych factors - cost-benefit analysis - terms of money
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