pbh study guide exam 1

8/13/2019 PBH Study Guide Exam 1

1/11

Public health is about those things that make us sick, keep us healthy, and what we do

together about it. Health is often perceived as individual health and wellness. Public

health focuses on the health of communities and society as a whole. This focus shiftsfrom the individual to the population. It is about examining the impact on individuals

and groups at risk as well as the population as a whole.

United States Federal Executive Departments

Uniformed ervices !" including # $rmed ervices %$rmy, &avy, $ir 'orce, (arine

)orps, )oast *uard+ and &oncombatant ervices%&-$$, PH/-/

0 U $rmy

0 U &avy

0 U $ir 'orce0 U (arine )orps

/H

0 U )oast *uard !U)*

HH0 U Public Health ervice )ommissioned )orps !PH

/-)0 &ational -ceanic and $tmospheric $dministration )ommissioned )orps

!&-$$

Charles-Edward Amory Winslow!1 'ebruary 23"" 4 3 5anuary 26#" was an

$mericanbacteriologistandpublic healthexpert who was a seminal figure in public

health. In 267 he wrote8

Public healthis 9the science and art of preventing disease, prolonging life and promotinghealth through the organi:ed efforts and informed choices of society, organi:ations,

public and private, communities and individuals.;

In 2633, the nstitute o! "edicinecreated a steering committee to describe the !uture o!

public health. They described public health as The substance of public health is the

organized community efforts aimed at the prevention of disease and the promotion of

health.

#ie$elman points out that Public health continues to evolve .

0 based public health is re?uired to @ustify costs associated with

interventions, describing health threats, and raising awareness.0 Alurring of public health and clinical care options re?uire new strategies
http://en.wikipedia.org/wiki/United_Stateshttp://en.wikipedia.org/wiki/United_Stateshttp://en.wikipedia.org/wiki/Bacteriologisthttp://en.wikipedia.org/wiki/Public_healthhttp://en.wikipedia.org/wiki/Public_healthhttp://en.wikipedia.org/wiki/United_Stateshttp://en.wikipedia.org/wiki/Bacteriologisthttp://en.wikipedia.org/wiki/Public_health


2/11

0 Note: IOMnot!for!profit" nongovernmental advisory body established in #$%&

to advise onbiomedical science, medicine, and health, and its mission to serve as

adviser to the nation to improve healthPAH considers environmental% social and economic determinantsof health, even those

not considered part of what we traditionally consider public health and clinical health. It

also would encompass the range of interventions to address health issues including thestructure and function of healthcare delivery systems, and how public policies affect

health.

There are distinct characteristics of public health82. It deals with preventive rather than curative aspects of health

. It deals with population>level, rather than individual>level health issues

Public health is typically divided into core disciplines including80 =pidemiology

0 Aiostatistics

0 =nvironmental health

0 Health management and policy0 ocial and behavioral sciences

Bhile this is a good start to describing public health, in 2661, when the country was

exploring issues related to health care reform, the public health sector felt that a betterde!inition and description o! public healthwas needed. $ &Core Functions o! Public

'ealth Steerin$ Committee(was convened to address this need.

>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>

0 2"17s 5ames Cind, a Aritish &aval commander demonstrated that lemons and

other citrus fruit could prevent and treat scurvy.

0 curvy due to lack of vitamin ).0 Ditamins were unknown in his day

0 Performed one of the first clinical experiments on record

0 =dward 5enner is credited as the pioneer o! smallpox vaccine,

0 Father o! mmunolo$y

0 )n *+ "ay *,., 5enner tested his 'ypothesis/ n!ection with cowpox $ives

immunity to smallpox

0 Inoculated 0ames Phipps, !3 year old son of his gardener, with material from the

cowpox blisters of the hand of Sarah 1elmes% a mil2maid who had caughtcowpox from a cow !Alossom

0 This produced a fever and some uneasiness but no great illness.

0 Phipps was the *,th case described in 0enner3s !irst paper on vaccination40 ubse?uently challenged him with variolous material


3/11

0 n *,% the World 'ealth )r$ani5ation declared smallpox an eradicateddisease4

0 samples still remain in laboratories in )enters for /isease )ontrol and Prevention!)/) in Atlanta% 6eor$ia in the United tates, and tate Eesearch )enter of

Dirology and Aiotechnology D=)T-E in 7oltsovo% 1ovosibirs2 )blast%

#ussia.

The importance of his work does not stop there. His vaccine also laid the groundwork for

modern>day discoveries in immunology

Igna: Philipp emmelweis !5uly 2, 2323 4 $ugust 2F, 23G#+

0 physician who worked in Dienna *eneral Hospitals 'irst -bstetrical )linic

0 -bserved and postulated !231" that the incidenceof puerperal fever !childbedfever could be drastically cut by the use of hand disin!ection !by means of hand

washing with chlorinated lime solution in obstetrical clinics.

0 Puerperal !ever !or childbed !ever was common in mid>26th>century hospitals

and often fatal, with maternal mortality at 274F#.0 /octors wards had three times the mortality o! midwives3 wards.

0 /espite various publications of results where hand>washing reduced mortality tobelow 2, emmelweiss practice earned widespread acceptance only years after

his death, when 8ouis Pasteur con!irmed the $erm theory40 Died *9.: at a$e +,4

In mid>26th century in =ngland, the recording of vital statistics !birth and death records

began.

Edwin Chadwic2%diseasesJpathological condition should be basis for death record

William Farr%risk factors and social should be basis for death record

The work of Couis Pasteur contributed to the *erm Theory of disease. The $erm theoryo! disease laid the $roundwor2 !or modern public health.

Identification of diseases that did not have a 9cure.;

Borked to prevent those from getting the disease in the first place.

Interestingly, sometimes the cause of a disease was not due to germs as noted with

pellagra, which was discovered to be caused by a deficiency of vitamin A>G !niacin.

Advances in disease causation led to methods to prevent disease be!ore they

occurred. The key was still preventing disease. Isolation and ?uarantine were still used.

anatoriums for Tb were established.

0 Sanitation and 'y$iene0 The 26th century shift in population !rom country to city that

accompanied industriali5ation and immi$ration


4/11


5/11

ource of federal authority Tax, spend and regulate interstate commerce -ffer federal funding incentives to states for them to enact certain

types of legislation Alood alcohol levels

5ustify national standards that overrule and limit state rules andregulations ranging from ?uality controls on drugs Permissible exposures to toxic substances

F. U. )onstitution grants individual rights !explicit and inferred

'reedom of speech, religion, assembly, bear arms Eight to procreation privacy, bodily integrity, travel

Eight to utili:e contraception, have an abortion, limit the state and federalauthority to use ?uarantine and other travel restrictions

Constitutional law%Includes U.. )onstitution and all #7 tate constitutions.Eemember responsibilities for health lie with the states unless the federal

constitution grants authority to the federal government. They do not usuallymandate roles of government in area of health. The commerce clause sand dueprocess clauses of the constitution have the basis for extensions of federal

authority in areas of health. tate constitutions are easier to amend.

8e$islative statuteswritten by legislative bodies at fed, state and local level.'ederal statutes typically overrule state and local legislation. Be often see that

state and local legislation may be more restrictive than federal statutes. tatutes

often address directly health issues. (ay be written in general language. Administrative re$ulationsproduced by executive agencies at federal, state,

and local governments in order to implement legislative statutes. Think of them

as operationali:ing the statuteKBho is eligible for services, how are the services

to be provided, what levels of reimbursement are receivedL... =xamples8re?uirements for immuni:ation to enroll in public education, regulation of food

establishments, medical devises 0udicial% case% common law law made by courts when applying constitutional,

statutory, or administrative law to specific cases. (ay fill in holes when statutory

law does not provide guidance. =xamples8 defining 9nuisances; excess noise,disposal of garbage. 5udge 5udyK5udge BapnerK5udges apply previous rulings

or precedence to new cases, and they may consider existing traditions and

customs of society when applying law to cases.

'rom 26GF through 26GG, studies were carried out at the Billowbrook tate

chool, a &ew Mork tate institution for 9mentally defective persons.; These studies were designed to gain an understanding of the natural history of

infectious hepatitis and subse?uently to test the effects of gamma globulin in

preventing or ameliorating the disease. The sub@ects, all children, were deliberately infected with the hepatitis virus+ early

sub@ects were fed extracts of stools from infected individuals and later sub@ects

received in@ections of more purified virus preparations.


6/11

The =ac2 to Sleep campai$n be$an in *+ as a way to educate parents, caregivers, and

health care providers about ways to reduce the ris2 !or Sudden n!ant Death

Syndrome @SDS4 The campaign was named for its recommendation to place healthybabies on their backs to sleep. Placing babies on their backs to sleep reduces the risk for

I/, also known as Ncrib death.N This campaign has been successful in promoting infant

back sleeping and other risk>reduction strategies to parents, family members, child careproviders, health professionals, and all other caregivers of infants. Eeduced deaths by up

to #7 since program was initiated.

/ownstream factors

'ocus directly on individuals and individual behaviors

(ainstream factors

'ocus on relationship of individuals with a larger group or population

Peer pressure

Taxation of cigarettes

Upstream factors

'ocus on social structure and policies

'ive teps individuals go through in changing behavior8 Useful in suggesting ways tohelp individuals change behavior

Sta$es o! chan$e

In the transtheoretical model as of 266", change is a Nprocess involving progress througha series of six stagesN

Precontemplation> Npeople are not intending to take action in the foreseeable

future, usually measured as the next G months9 Precontemplators tend to drop out of programs early

Contemplation> Npeople are intending to change in the next G months9

$ personal problem exists $ttempts to understand in order to regain some control over their lives Perceive a link between overeating and hypertension%seek

dietaryJexercise information

Perceive a link between excessive drinking and marital problems% (ay take months or years

Preparation> Npeople are intending to take action in the immediate future,usually measured as the next monthN

Action> Npeople have made specific overt modifications in their life styles within

the past G months9 (ay try a healthier diet (ay try to increase exercise

(ay take steps to limit alcohol consumption *o to a support group

elf esteem seems to rise because they demonstrate self>efficacy throughaction

"aintenance> Npeople are working to prevent relapse,N a stage which is

estimated to last Nfrom G months to about # years9 )ontinuance of change rather than an absence of change


7/11

Nindividuals have :ero temptation and 277 self>efficacy... they

are sure they will not return to their old unhealthy habit as a way of copingNIn addition, the researchers conceptuali:ed NrelapseN !recycling which is not a stage in

itself but rather the Nreturn from action or maintenance to an earlier stage;

The Health Aelief (odel is a values expectancy model8 people will engage in a healthybehavior if 2 they value the outcome related to the behavior and they think thebehavior is li2ely to result in the outcome4

The 'ealth =elie! "odel is a health behavior chan$e and psycholo$ical modeldeveloped by rwin "4 #osenstoc2in *..for studying and promoting the uptake of

health services. The model was furthered by Aecker and colleagues in the 26"7s and2637s. ubse?uent amendments to the model were made as late as 2633, to accommodate

evolving evidence generated within the health community about the role that knowledge

and perceptions play in personal responsibility. -riginally, the model was designed topredict behavioral response to the treatment received by acutely or chronically ill

patients, but in more recent years the model has been used to predict more general healthbehaviors.

Perceived susceptibility !an individuals assessment of their risk of getting the condition

Perceived severity !an individuals assessment of the seriousness of the condition, and its

potential conse?uences

Perceived barriers !an individuals assessment of the influences that facilitate ordiscourage adoption of the promoted behavior

Perceived bene!its !an individuals assessment of the positive conse?uences of adopting

the behavior.

elf efficacy > $ personOs belief in his or her ability to take action.

ocial (arketing4 the use of marketing theory, skills and practice to achieve social

change. Product%I/ the behavior or innovation being marketed Price%Identifying the benefits, barriers, final costs Place%Identify the target audiences and how to reach them

Promotion4 -rgani:ing a campaign or program to reach the target

audience!s

Early adopters4 those who seek to experiment with innovative ideas

Early "aority Adoptersopinion leaders whose social status fre?uently

influences others to adopt the behavior !5ohn *ummer and daughter )ordeliaeating hamburgers in 2667 in *reat Aritain. It was 9safe; to eat.

8ate adopters or laggards%those who need support and encouragement to make

adoption possible. Promote ease of use and widespread acceptance

Problem/ What is the health ProblemL

0 Bhat is the burden of disease and has it changed over timeL


8/11

0 $re there differences in the distribution of diseaseL )an we use the differences to

generate hypotheses about their etiologyL

0 $re the differences or changes used to suggest group associations artifactual orrealL

Etiolo$y/ What isare the contributory cause@sG

0 Has the association been established at the individual levelL0 /oes the cause precede the effectL

0 Has altering the cause been shown to alter the effectL !if not use ancillaryJHill

)riteria to determine association

#ecommendations/ What wor2s to reduce the health impactsG

0 Bhat is the ?uality of the evidence for the interventionL

0 Bhat is the impact of the intervention in terms of benefits and harmsL

0 Bhat grade should be given indicating the strength of the recommendationL

mplementation/ 'ow can we $et the ob doneG

0 Bhen should the implementation occurL

0 $t who should the implementation be directedL

0 How should the intervention!s be implementedL0 This is an on$oin$ processthat describe the framework for defining, analy:ing

and addressing public health issues0 Be will break this process down to its elements.

0 Aurden of /isease8 Impact it is having on the community+ the occurrence ofdisability and death in the population.

0 (orbidity8 ickness

0 (ortality8 /eath

0 =tiology8 )ause

Using at-ris2 populationsfor calculations are often more precise and should be used

where possible. =xample8 prostate cancer can not occur among women so only men areat risk for developing prostate cancer+ cervical cancer would only include women.

ncidence8 measures the chances of individuals to developa disease during a particular

time period

Prevalence8 measures the proportion of individuals who havethe disease at a point of

time !or during a time period.

ncidence rate

of ne' cases of a disease over a period of time

of people in the at>risk population

Prevalence #ate

living with a particular disease

in the at>risk population

0 Usually describes a point in time0 )an use a period of time !period prevalence


9/11

0 *ood for describing the total burden or impact o! the health problemin the

population at a $iven time

prevalence Q incidence x duration of disease

$rtifactual changes in rates0 )hanges in the interest in identifying the disease

0 )hanges in the ability to identify the disease

0 )hanges in the definition of the disease

*roup Cevel $ssociations and all differences identified at the group level need to be

assessed.

0 /etermined using Ecolo$ic studies or Population comparisonsH!correlationstatistics

0 $ssociations at a group level may not hold true at the individual level

0 (ay lead to hypothesis $enerationand further study to determine the existence

of associations at the individual level

Study Desi$ns

0 Cross-Sectional Studiesassesess a snapshot in time of risk factor and case status

0 Case Controlstudies begin with knowledge of disease status and seeks

associations with a risk factor0 Cohort studiesbegin with assessing those withJwithout the risk factor and follow

them forward in time to see if they develop the disease.

0 #andomi5ed Clinical


10/11

=iolo$ical Plausibility/can accept based on acceptedJknown biologic mechanisms

Criteria */

Iuality o! evidence

*ood8 fulfills re?uirements for ?uality

'air Poor8 fatal flaws in evidenceKinsufficient evidence !under powered

studies

Criteria J

"a$nitude o! the impact4 How much of the disability andJor death due to the disease

be potentially removed by the interventionL !&et Aenefit Q benefits of interventions

minus potential harms0 ubstantial

0 (oderate

0 mall0 ReroJ&egative

)ombined overall core @A$ency !or 'ealthcare #esearch and Iuality $%(ust

A%hould

)%(ay

/%/onOt

I%Indeterminant, insufficient, donOt know

Implementation

When/ timin$ o! the intervention

Primary

econdary

tertiaryWho/ individuals tar$eted !or the intervention

Dulnerable groups

=ntire population

'ow/ process o! implementin$ interventions

Information !=ducation%individual encounters, mass media, group interactions

(otivation !incentives%it implies a tangible reward for changing behavior,

-bligation !re?uirements

Primary/

0 before the onset of disease

0 prevent smokingSecondary/

0 after the development of a disease or risk factor, but before symptoms appear

0 screening programs to detect disease+ smoking cessation programs


11/11

pbh study guide exam 1

Documents