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primary prevention

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prevents an illness or injury from occurring at all by preventing exposure to risk factors Example:

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secondary prevention

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seeks to minimize the severity of the illness/disease or the damage due to an injury-causing event once the event has occurred. Example:

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tertiary prevention

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seeks to minimize disability by providing medical care and rehabilitation services

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tragedy of the commons

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a situation in which multiple individuals, acting independently in their own self-interest, will ultimately deplete a shared limited resource. Example: air, water, environment we share

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intervention study

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closest to traditional lab experiment experimental group receives exposure or intervention control group does NOT receive exposure or intervention Investigator assigns subjects to the treatment group or control group and watches over time and compares outcomes the two groups should be as similar as possible so that the intervention is the only difference between them Examples: double-blind, randomized, single blind with a behavior DIFFICULT BECAUSE it is unrealistic to expect people to alter their behavior over a significant period of time, ethical implications

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Top 10 Public Health Achievements

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Vaccination, Motor Vehicle Safety, Workplace safety, Control of Infectious Disease, Decline in deaths from heart disease and stroke, safer and healthier foods, healthier mothers and babies, access to family planning and contraception, fluoridation of drinking water, recognition of tobacco use as a health hazard.

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epidemiology

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the study of disease occurrence in human populations and factors that influence these patterns. the diagnostic discipline of public health and the primary component of the assessment function.

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Cholera Epidemic London

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Snow formulated the hypothesis that cholera was spread by polluted drinking water. It was found that households who had their water supplied by Southwark and Vauxhall had much higher rates of cholera.

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Why is epidemiologic surveillance important?

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1) Detection at an early stage 2) Recognition of a new disease 3) Threats of bioterrorism

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Steps in an Outbreak Investigation

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1) Verify the diagnosis 2) Construct a working case definition 3) Find cases systematically - active surveillance 4) Ask "who, where, and when" to describe the epidemic by person, place, and time. 5) Consider the incubation period. 6) Look for common source of exposure.

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chronic disease epidemiology

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multiple and complex causes, develop over time, rather than rapidly fatal goal: prevent or slow their onset and identify cause of progression... need to identify risk factors and observe long-term trends.

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incidence

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number of new cases in a defined population over a defined time period - most helpful in trying to link to the cause

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prevalence

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number of existing cases - most helpful for having an overall sense of societal impacts and planning for healthcare

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WHO

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characterizes people with the disease outcome by gender, age, occupation, race, etc.

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WHEN

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looks for trends in disease frequency over time

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WHERE

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looks at comparisons of disease frequency in different countries, states, counties, or other geographical areas.

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descriptive epidemiology

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analysis of disease causes provided from the who, why, and where questions. hypotheses are generated from this type of epidemiology and tested through formal studies. these studies are designed to confirm/disprove hypotheses derived from this type of epidemiology.

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case-control study

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people who have the disease are questioned about past exposures and compared with exposures of persons who do not have the disease. control group consists of healthy individuals chosen to match the cases as much as possible. (similar in age, sex, and other relevant factors) more efficient than cohort studies because they focus on a smaller number of people and can be completed relatively quickly

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cohort study

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for situations when doing an intervention would be unethical or too difficult considered the most accurate choose a large number of healthy people, collect data on their exposures, and track outcomes over time major differences from intervention is that people choose their own exposures

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random variation

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results are due to chance and not a relationship between the variables of interest - if the group being studied is too small, a cause-and-effect relationship is likely to be missed or a false relationship may show up. common source of error in small epidemiological studies.

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confounding variables

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factors associated with an exposure that may independently affect the risk of developing the disease. common source of error in large cohort studies.

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bias

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systematic error in the design or conduct of a study that leads to a false association between exposure and disease

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selection bias

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an error due to systematic differences in characteristics between those who are selected for a study and those who are not. (hospital selection... people in hospitals are sicker...phone and internet surveys... access to internet not always viable for elderly and those in the working class)

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recall bias

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error that occurs when there is a differential level of accuracy in the information provided by compared groups

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validity factors

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1) Large study population 2) Strong association.. high relative risk 3) Dose-response relationship... x-ray exposure - the higher the dose of radiation, the greater effect on lifespan 4) known biological explanation 5) Consistent results from several studies

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Tuskegee Syphilis Study (1932)

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Purpose was to observe the course of the disease, but investigators did not explain the experiment to the men or seek permission/consent. In 1940s, penicillin was discovered to treat syphilis, but researchers WITHHELD the antibiotic from the Tuskegee subjects. They also had to have a spinal tap done, which is a painful procedure with potential harmful side effects.

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informed consent

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subjects must freely consent to participate

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definition of public health

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mission: the 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 the promotion of health framework: activities undertaken within the formal structure of the government and the associated efforts of private and voluntary organizations and individuals functions: assessment, policy development, assurance

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Assessment

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the diagnostic function, in which an agency collects, assembles, analyzes, and makes available information on the health of a population.

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Policy development

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the use of scientific knowledge to develop a strategic approach to improving the community's health.

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Assurance

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ensuring that the services needed for the protection of the community's health are available and accessible to everyone

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responsibility of public health

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educate the public and politicians about crucial role in maintaining and improving the health of the public

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science of public health

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how we understand threats to health, determine what interventions might work, and evaluate whether the interventions worked

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politics of public health

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how we as a society make decisions about what policies to implement

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biomedical sciences

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study of biological processes underlying human health and disease; prevention/control of diseases require an understanding of how infectious agents are spread or disease development process... also involves genetics, providing insights into people's inherent susceptibility to diseases.

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The Wakefield Study

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Weak study design: no controls, only 12 in sample size, questionable recruitment, recall bias, conflicts of interest

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"Beating up the Data"

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although the subject matter is the same, the art is in how you present it

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statistics

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collection, analysis, interpretation, and presentation of numerical data; a collection of quantitative data; important to public health because it is concerned with populations, so it relies on ____ to provide and interpret data

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uncertainty of science

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results are not always certain, stats quantify a degree of uncertainty, contradictory results are common. the public sometimes demands certainty where it does not exist

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p-value

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the probability of obtaining the observed result by chance alone <0.05 = statistically significant

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probability

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what usually happens - however, as statisticians know, the improbable happens more often than people think

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confidence interval

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range of values within which the true result narrower = lower likelihood of random error wider = higher likelihood of random error

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law of small probabilities

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the most improbable things are bound to happen occasionally (throwing heads on a coin flip 100 times in a row) (few people with fatal illness recover)

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Power of a study

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