Question: What does ASSESSMENT entail? (4 THINGS)

Answer: EVALUATE,ASSURE COMPETENCE, LINK TO/ PROVIDE CARE, ENFORCE LAWS

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Question: what does POLICY DEVELOPMENT entail? (2 THINGS)

Answer: MONITOR HEALTH, DIAGNOSE AND INVESTIGATE

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Question: what does ASSURANCE entail? (3 THINGS)

Answer: INFORM, EDUCATE, EMPOWER., MOBILIZE COMMUNITY PARTNERSHIPS, DEVELOP POLICIES.

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Question: what does SYSTEM MANAGEMENT entail? (1 THING)

Answer: RESEARCH

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Question: What are the three core functions of public health?

Answer: assessment, policy development, assurance and system management

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Question: What are the three classification of organizations?

Answer: governmental, non governmental and quasi governmental

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Question: What determines if an organization is governmental? (4 points)

Answer: 1. it is funded by primarily by tax dollars

2. part of a governmental structure such as: state, local, and international (worldwide) or national

3. managed by government officials

4. has authority over some geographical area.

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Question: example of an international health agency

Answer: WHO (world health organization), available to any nation that has enough votes by the world health assembly and a constitution. Goal is to achieve the highest standard of public health. Most recognized.

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Question: example of a local gov. health agency

Answer: focuses on that city or county and its services such as transportation, restaurants, buildings, and collection of vital statistics.

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Question: example of a state gov. health agency

Answer: director of the department would be elected by the governor of that state, would use state governmental funds, provides a link between local and federal agencies and funds.

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Question: example of national gov. agency

Answer: Department of Health and Human RESOURCES WOULD BE THE DEPARTMENT IN THE US responsible for protection and welfare of its nation. Whoever runs it is a member of the US cabinet and elected by the president. FDA and CDC would be others

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Question: What determines if an organization is quasi-governmental?

(two points)

Answer: 1. they operate independently of gov. meaning that they also conduct non gov projects such as blood drives.

2.derive some funding and work from gov. and serve as a liaison for armed forces and families during emergencies.

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Question: examples of quasi governmental?

Answer: American Red Cross, National Academy of sciences, national science foundation.

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Question: What determines a non-governmental agency? (5 points)

Answer: 1. funding by private companies or dues by members

2.they all serve to meet health needs

3.government does not interfere

4.they have a tax status and meet IRS rules

5.there is many types such as religious, voluntary, professional, etc.

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Question: definition of health?

Answer: health is a resource of everyday life, however it is a dynamic state that changes depending of the person and their everyday actions.

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Question: what is community?

Answer: community s a group of people who live in a certain area and share common characteristics such as race, ethnicity, religion, age

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Question: what is public health?

Answer: Public Health is the ability of a community to organize themselves and work to fix issues to better the health standing of the community.

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Question: What are the goals of healthy people 2020?

Answer: Healthy people wants to reduce disparities found in public health by promoting programs that involve more people, are equitable. The have lowered tobacco use, and have defined the nation’s health agenda and guided its heath policy.

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Question: what is morbidity and how is it measured?

Answer: sickness, measured with prevalence and incidence

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Question: what is mortality and how is it measured?

Answer: death, measured with death rates

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Question: what are the four major factors that affect the health of a community? (know an example and description for each)

Answer: 1.individual behavior

2.physical behavior

3.social and cultural factors

4.community organization

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Question: Early civilization historic public health events

Answer: -many community health practices such as rites and taboos were not fully recorded.

-Greece they recorder symptoms and patterns of diseases but there is not exact information of what the cause might have been

-it is believed that it was due to the environment and diet

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Question: What happened in the 18th century?

Answer: There was a great epidemic of small pox and Edward Jenner came up with the smallpox vaccine which would make people immune to the virus. (1796)

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Question: What happened in the 19th century?

Answer: There was a cholera epidemic in London, John Snow mapped out the different locations of the many cases and from that it showed how the cause of the outbreak was due to the contaminated broad street water pump by the Thames river.

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Question: What happened in the Twentieth century ?

Answer: This was a period where life expectancy was less that 50 years due to communicable diseases being the leading cause of death. This led to many periods of taking action to better public health.

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Question: What was the Health Resources development period?

Answer: This period was when the first public health school was established, as well as public health nursing, new funds for public health, public health agencies also rose and the CDC was established.

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Question: What was the Period of Social Engineering?

Answer: During this period, the federal government actually became involved in health matters and medicare and medicaid were established.

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Question: What was the period of health promotion?

Answer: This period linked premature death to unhealthy lifestyles that involved smoking and poor diet. This then led to healthy people 2020 promoting for less eating of saturated fats and red meats, they also reduced smoking and increased physical activity.

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Question: what is the ecologic fallacy?

Answer: Means that just because something is observed at a group level, does not mean this pertains to the whole population. Observations of the group though, are applied to describe and individual but may not always be true.

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Question: what is epidemiology?

Answer: Epidemiology is the study of how a group of people who have a certain disease or state are compared to a control group who were or were not exposed to a certain factor. These studies are filed studies because they include both sick and healthy people.

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Question: what are some underlying assumptions of epidemiology?

Answer: That disease is random, it is not. Some communities or populations are more prone to a certain disease while others may never get it. Doesn’t just happen out of the blue.

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Question: 2 important uses of epidemiology?

Answer: 1.provides a diagnosis for the health of a community

2.from this, then you can plan policies and procedures to fix issues.

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Question: What is descriptive epidemiology?

Answer: -observe/describe the outcomes of a study

-basically characterize and summarize and health event

-most basic form of epidemiology

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Question: what is analytic epidemiology?

Answer: This form of epidemiology compares two groups and analyzes exposures and outcomes of a disease. Tests a hypothesis about potential causes.

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Question: what is prevalence? and its rate

Answer: it is the number of people who HAVE the disease at a particular time (point prevalence) so like right now or time period (period prevalence) like in the past year. tell us the disease burden on our society based on if a disease is increasing or decreasing.

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Question: what is incidence and its rate?

Answer: incidence is the number of new cases that have appeared in a certain time period therefore can tell us if there is an epidemic

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Question: write the prevalence rate for either point or period equation

Answer: people sick (old and new)/ all people (including healthy people)

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Question: write the incidence rate equation

Answer: new cases/total population @RISK (x multiplier)

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Question: What does it mean when prevalence is higher than incidence?

Answer: This means that the disease is more chronic and has been occurring for a longer period of time. ex: back pain

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Question: what does it means if incidence and prevalence are similar?

Answer: It can mean that people are either getting better quickly or dying

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Question: What factors increase prevalence?

Answer: prevalence is increased by longer duration of a disease, prolonged life without cure, increased incidence, improved diagnosis/ reporting, cases in migrate (staying in nation)

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Question: what factors decrease prevalence?

Answer: prevalence is decreased by shorter duration of a disease, increased fatality, decreased incidence, non cases in migrate, out-migrate (leaving nation), increased cure rates.

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Question: What is a crude rate?

Answer: a rate based on unadjusted events that occurred in a population, can pertain to either prevalence or incidence. Be used in caution, should be sued to compare similar places or people because it can rest in systematic error such as comparing death rates in palm springs and UTC, totally different areas.

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Question: What is the equation for a crude rate?

Answer: number of events/ total population(includes everyone applicable) so like in fertility it would include everyone of child bearing age not the whole population.

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Question: what is a specific rate?

Answer: A specific rate is a rate of a disease but WITHIN A CERTAIN GROUP such as a certain age or people who suffered from a certain cause. Example: people who had a heart attack/total population or number of events in a certain group/all people in that age group.

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Question: adjusted rates and how to do them?

Answer: Sometimes what is calculated is not reflective of what is actually happening due to a certain amount of people being very different to the rest. For example if there is a lot of older people in a population, the death rates are going to be higher but it does not mean there is a lot of disease amongst everybody else. Therefore, you find the amount of people that got the disease and then everybody else, and multiply that by the percentage in a bigger population. That way you are not comparing it to just the population in that area, but more of a standard population. then that number obtained if your population was standard, could be divided by the original population to get the actual rate.

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Question: what are ecologic studies ?

Answer: Ecologic studies work at the group level, therefore they use info that is already available and comes up with results for a group. However, results of a group may not be indicative of an individual (ecologic fallacy). Ecologic studies are more of generalizations so they’re not very precise, however they are cheaper and easier to conduct.

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Question: cross sectional studies?

Answer: these mark data at a certain point in time, therefore are not very good at looking at incidence data because it will no be able to show a time period. Cannot measure causality or temporality. Inefficient for studying low prevalence diseases.

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Question: case-control studies?

Answer: they get two groups, one with the disease (cases) and one without it (controls) and compare them to each other in order to see the relationship to exposure. These occur at a SINGLE point in time, and AFTER the exposure. POINT PREVALENCE. GOAL IS TO FIND OUT HOW MUCH MORE OR LESS LIKELY THE CASES WERE EXPOSED TO SOMETHING THAT CAUSED THE DISEASE. (odds ratio)

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Question: what should the control’s characteristics be like?

Answer: The controls should be very similar to the case group, there fore they could be related, or come from the same doctor’s office, but they should NOT have the disease of interest.

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Question: what does an odds ratio value of 1>x or 1<x or 1=x mean?

Answer: An odds ratio value of 1 would equal that there is no association between the exposure and the outcome. less than 1 would mean there is a protective factor, and greater than 1 means there is risk when being exposed.

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Question: some benefits of case control?

Answer: you can use smaller sample sizes therefore they are useful for studying rare diseases because not a lot of people need to be involved.

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Question: some limitations of of case control?

Answer: you cannot really determine the time that the exposure took place and caused the disease.

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Question: what is cohort study?

Answer: cohort study works with only one group of people WITH COMMON CHARACTERISTICS of setting and measures their standing at the beginning and then follows them through some period of time (prevalence) too see if anything develops.

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Question: advantages of cohort

Answer: gives you information about temporality and causality while other studies do not show what happened first

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Question: relative risk

Answer: used in cohort study, it is what you are measuring. comparing what is the risk of getting the disease amongst those who were and exposed and those who were not.

incidence of exposed/ incidence of non exposed

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Question: limitations of cohort studies

Answer: take time, money, and effort

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Question: prevalence can be determined by…

Answer: both case control and cohort study because they both measure the reappearance of a disease

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Question: incidence can be determined by…

Answer: only by cohort studies because they show appearance of new cases since it tells us how much more likely you are to get it.

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Question: what does odds ration mean?

Answer: it measures the odds of actually having a disease

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Question: what is relative risk?

Answer: it measures the risk of getting the disease

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Question: random assignment and blinding

Answer: are both forms of better distributing a group and equalizing it. Blinding reduces potential for bias.

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Question: what do experimental studies consist of?

Answer: Experimental studies consist of manipulation of a variable therefore having a placebo and an experiment. It also consists of random assignment therefore determining who receives the intervention “ttreatment” or not.

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Question: WHAT IS A NULL HYPOTHESIS?

Answer: you start with an assumption and try to disprove it. there is now difference among the groups being compared. The alternative would be the one that challenges it.

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Question: what are significant tests?

Answer: a test statistic is ran through compare it to the critical value. example: t test. to see if you can reject the null hypothesis.

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Question: what is the P-value?

Answer: this is the probability that the findings could have occurred by chance alone. If a test comes out non significant it does not mean it has zero effect because a smaller sample size increases error Scientists accept 5% as being okay.

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Question: what is power?

Answer: power is the ability of a study to demonstrate if an association exists. good power is 0.80-0.90

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Question: what is the confidence interval ?

Answer: it is an interval of values that contains the actual population parameter, it is influenced by variability which means that larger population decreased the interval because it increases variability and makes it more likely to reject the null and cause a significance.

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Question: what are the five key questions to ask in evaluations?

Answer: 1.could the association have been observed by chance?

2.could the association be due to bias?

3.could other variables have accounted for the result?

4.does the effect generalize to other people?

5.does the association reflect a cause and effect relationship?

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Question: external (outside world) validity

Answer: is the ability to generalize beyond the study results to a universal statement about an overall target population

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Question: what are some examples of selection bias?

Answer: selection bias is only favoring one side of the population, therefore it is not random in the form that for example if you put up flyers, yes they are put randomly but those people that chose to pick up the flyer and call are different and therefore it is sectioning them off.

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Question: what is information bias?

Answer: when people misremember information and therefore give out the wrong information. this is an example of systematic error. this form of bias can come in recall bias, prevarication, and interviewer bias.

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Question: what is confounding?

Answer: confounding is mixing up the exposure of interest with another external factor. You can really only statistically control these when they are measured.

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Question: what must a confounder be?

Answer: 1. must be associated with the disease

2. must be a potential risk factor

ex: neighborhood someone lives in and heart disease.

its basically some weird correlation that could seem correct but there are other factors that contribute to its significance. like saying that shoe size correlates to reading ability but obviously kids will have both of these things. age would be the confounder. This is why studies should be random and cases and controls should be similar to each other.

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Question: what is a risk factor?

Answer: a risk factor would be a reliable association between some factor and disease. meaning something is actually causing something else to happen.

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Question: what is an important validation for causation ?

Answer: experimental validation.

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Question: what is primary prevention? example.

Answer: primary prevention is preventing a disease before it actually happens or shows any symptoms to larger groups of people. such as immunizations

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Question: what is secondary prevention? example.

Answer: Conducting tests for people who may be in more risk of getting a certain disease. Therefore, you would be testing a smaller group and can be more efficient is less costly. such as cancer SCREENING.

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Question: what is tertiary prevention? ex.

Answer: once people are already showing symptoms then you take the proper procedures to prevent that disease from upscaling and becoming a larger issue. such as a stroke program

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Question: screening

Answer: to conduct tests in order to detect a disease earlier on than if there was not screening and therefore taking the right procedures to treat it. SCREENING ASSUMES THAT THERE IS TREATMENT THAT IMPROVES OUTCOME WHEN THE DISEASE IS FOUND EARLIER.

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Question: diagnosis

Answer: it is meant to follow up from screening, for example if you are taken tests and you prove positive for one or some of them then you go on to take a diagnosis that fully proves you have a certain disease.

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Question: reliability

Answer: for a test to yield the same result over and over again

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Question: validity

Answer: the ability to correctly test those who do and those who do not have a disease.

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Question: sensitivity

Answer: how likely is test to determine the presence of a disease.

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Question: sensibility

Answer: how likely is a test to determine the absence of a disease

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Question: predictive value positive

Answer: tests how many people who were positive for a disease were actually not sick

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Question: predictive value negative

Answer: tests how many people who were negative for a disease were actually sick

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Question: the cut point

Answer: when the cut point is lowered then more diseased individuals will test positive so the sensitivity will increase therefore the sensibility will decrease.

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Question: for effective screening there must be 3 conditions:

Answer: 1. the condition must have a high prevalence

2. the conditions must be an important cause of mortality and morbidity.

3. the condition must be amendable to treatment if diagnoses at a very early age.

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