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97 Cards in this Set
- Front
- Back
Eight Americas (general)
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-Chris Murray (Harvard)
-investigating mortality disparities among different "americas" -"americas" defined by county, race, and race-county -census and NCHS data |
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What are the Eight Americas
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-Asian
-North Low-income rural whites -Middle America (~other) -Low-income whites in Appalachia/Mississippi valley -Western Native American -Black Middle America -Southern rural low-income blacks -high risk urban blacks |
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Graphical Data from 8 americas
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-check ups: show that healthcare access is ~ equal, though actual usage varies (men = less)
-still, large disparities in LE between americas -disease burden: smoking, alcohol use, obesity highest percentage |
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Eight Americas (conclusions)
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-21 year gap in LE between 1 and 8
-Since 80s, LE gap for men increased more than 0.5 % per year -Not enough resources for chronic disease prevention or crime, which account for massive health disparities |
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Bernadette
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-Paul Farmers patient with HIV
-accompaniment -She has HIV b/c of gender (relationship dynamics), SES (heath disp.), and biology (women more likely infected) |
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Primary Tobacco prevention
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-increase taxes on cigs
-regulate ads/packaging -education programs |
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Tobacco diseases
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-30% cancer is respiratory/pulmonary
-oral cancer: from tobacco and poor hygiene/diet <-- 50% more likely if black male -also influences chronic disease: heart disease |
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Heart disease (at risk factors)
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-male
-black -uneducated -**same risk factors apply to strokes -POOR DIET/OVERWEIGHT |
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structural violence and health behavior
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-study on education in urban STD clinic suggests that more than education is needed b/c only very slight improvements were found
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major healthcare disparities
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• Income inequity increased since 1980
• Disease 300% in low-income • Men twice as likely to die of accidents and 4 times from guns • Women have 200% depression • Premature adult death is 200% in ppl without some higher education • Infant mortality rate is cut in half for college graduates • African American IMR is 200%, heart disease is 140%, and all cancers is 130% • African Americans are 7 times as likely to die of HIV |
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Global response to HIV/AIDS
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-increase in spending due to global fund, PEPFAR
-disparities in ARV coverage between West and e.g. Africa -coverage increasing, but not targeting most needy -pharma claims virus resistance from noncompliance for avoiding universal coverage |
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US response to HIV
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-stigma, image, assumptions and changes (e.g. Ryan White/Magic Johnson)
- |
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Accompaniment
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-more humanistic approach to treatment
-DOTS -# of factors that prevent adherence: housing, stress, mental, substance abuse |
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Pharma/issues
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-5 meds/American
-expensive to recoup development/marketing -increases healthcare costs -issues of adherence |
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PMR
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-proportional mortality rate: proportion of total mortality
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Modes of disease transmission
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-vertical: mother-->child
-direct: STD, blood transfusion, bite injects disease (requires direct contact) -indirect: air/water resevoir indirectly passes to humans -vector: mosquito, air, water |
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Major communicable diseases
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-get a lot of attention even though only represent 1/3 of PMR
-most widespread: flu/pneumonia, clamidyia, gonnorhea -africa and southeast asia carry 76% of infectious disease burden |
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DALY
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-Disability adjusted life-years
-measure of years lost due to disability -DALY= YLL + YLD -YLL=years life lost=#deaths xlE -YLD=incidence x dis. weight x avg. case duration |
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DALYs
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-measure of years lost due to morbidity and mortality
-calculated for specific disease -DALY=YLL+YLD -YLL=years life lost -YLD=years lost to disability -YLL=N x L -N=# of deaths -L=life expectancy -YLD=I x DW x L -I=incidence -DW=disability weight (0-1) -L=avg. duration of case -also: (YLD[LE-age])*i |
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Major causes of DALYs
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-Heart Disease
-Infectious disease -Mental/neurological -Cancer |
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TB
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-global incidence has been generally increasing since 1980
-54% of cases are XD/MDRTB -MD=resistant to 1st line drugs -XD=resistant to 1st+2nd line drugs -drug resistant cases are very difficult to treat; XD has 50% mortality even w/DOTS -incomplete adherence=key driver of drug resistance -95% or resistant cases are in poor countries -often co-morbid w/HIV |
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PEPFAR
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-GWBush legislation
-voice for HIV/related causes -helps pay for anti-viral treatments -largest global initiative -global legislation |
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HIV in Uganda
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-prevalence decreasing (now 5%)
-high-risk sexual activity, commercial sex work -discordant monogamy -vertical |
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HIV-TB Nexus
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-40% co-occurrence TB/HIV
-lack of primary contributes -STD co-morbid as well--> weakens immune system -stigma/discrim: exacerbates disease, less help-seeking, e.g. anti-gay -leads to shun, avoidance --> non-adherence-->drug resist |
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Integrating HIV/TB care
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-district-level planning: coordinate NGOs and international org.
-94% funding is international -2x as much spent on treat vs. prevent |
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Malaria
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-515 million cases; 20% mort.
-endemic in tropical regions -mosquito: anopheles stephensi -drugs are overRx and poorly adhered-->high drug resist -prevention: DDT spraying -prevention: mosquito nets |
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Mosquito net case study
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-Tanzania
-tech used at night in villages -anthro needed to help understand cultural interpretation of tech -dawa=word that means poison -applied to many western items --> nets labeled dawa, thus people lay them outside -anthro recommend more culturally sensitive approach -confusion about efficacy of nets b/c mosq. don't always die -alcoholism -intermittent NGOs |
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Yellow Fever
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-mosquito vector
-vaccine -"sylvatic"(jungle), savannah, urban -issues of disease resist/genetic drift |
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Jungle yellow fever
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-multiple mosquitos
-Africa/S. America -obstacle to eradication |
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savannah yellow fever
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-aedes mosquito
-most common human transmit -Africa only |
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urban yellow fever
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-aegyptis mosquito
-transmits dengue & Chikungunya -Africa only |
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Typhoid fever
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-common natural course/flue-like
-contaminated water and mechanical infection (<--insects) -5% asymptomatic-->Typhoid Mary -10-30% mort w/out treat -treat/prevent: clean water, vaccine -high burden: S. Am, Africa, SE Asia in ages 5-19 |
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Hep B
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-burden: S.Am, Africa, Asia
-30% prevalence; only 2-8% symptomatic -bloodborne viral liver disease |
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Hep C
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-similar burden to Hep B
-injecting drug use (60% in US) -30% mort. -causes liver cancer/transplants -35% co-infect w/HIV |
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Public health & crime/prisons
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-increasing prison populations
-no public mental, drug laws, privatization -HVC & TB both show especially high rates among prisoners |
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HAIs
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-hospital-acquired infections
-10% of all patients -2x Europe -raises healthcare costs |
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Ebola virus
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-outbreak in Zaire, 1976
-Yambuku mission hospital -quarantine on region -67% mort.; unknown cause -person-to-person; bodily fluids |
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Ecological model of Health behavior
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-describes factors that influence people's health-related behaviors
-intra-personal, interpersonal, institutional, community, public policy |
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Social Cognitive Theory
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-psych model of health behavior
-knowledge, benefits, self-efficacy, expectations, barriers |
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Transtheoretical Model
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-psych model of health behavior
-stages of behavior change -pre-contemplation--> contemplation-->preparation--> action-->maintenance |
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MARCH
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-Modeling And Reinforcement to Combat HIV/AIDS
-Ethiopia, Botswana, Zambia -result of theories of behavior change |
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Avahan
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-aims to improve environmental level factors through community mobilization
-combats AIDS in India |
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Smallpox
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-Major killer in 1700s
-30% mortality rate, 80% for at risk groups -Trend of at-risk populations -Low-tech bifurcated needle -No refrigeration -Targeted Vaccination campaign -Only needed to vaccinate 80% of people for herd immunity -eradicated |
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Ringworm
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-fungal infection
-higher rates in Af. Am and lower SES -outbreaks in urban elementary schools -prevent: hygiene, screen, antifungal -impacts: self-esteem, cost |
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intervention study
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-experimental v. control group
-groups=similar as possible -e.g. Polio trials (Salk) |
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Cohort study
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-tracking large # of ppl over time
-gather health data; no intervention -inform about temporal & dose-response relations -expensive, confounders, difficult to manage/administer |
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Famous Cohort studies
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-Framingham, MA = health behavior of ppl in city
-Nurses Health Study (breast cancer) -Doll & Hill studies (smoking & cancer) |
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Case-Control studies
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-compare group w/disease to healthy group
-max similarities across groups -easy and efficient but lots of bias |
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Randomized clinical trial
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-test drugs vs. placebos
-"gold standard" -ethical, recruitment, managerial issues |
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Confounding factors
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-relationships btwn variables distort links btwn risk and disease
-controlled through design/statistical manipulation: stratification, distribution across groups, exclusion, matching |
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Simpson's Paradox
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-breaking down data is usually more revealing than large groups
-e.g. Jeter vs. Justice batting avg -e.g. treatment A vs. B on kidney stones |
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Framingham Study
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-Heart disease risk by NIH
-4 generations -genetic biomarkers via DNA samples -relationship btwn cholesterol and heart disease -BMI and mortality relation -risk factors (cholesterol, smoking, high BP) --> relative risk for males=3 |
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Helsinki declaration
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-set of ethical principles dealing with human experimentation
-intended to guide regulations established by countries |
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Whitehall Study I,II
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-1967: 18,000 men
-1985: 10,000 men and women -access does not ensure health equality -lower pay grades=higher mortality -dispelled myths e.g. "CEO heart attack" -complex interaction btwn social enviro, physiology, and psych |
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social determinants of health & disease
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-why zebra's don't get ulcers
-low-level chronic stress as major contributor to poor health -Robin-Hood index: steeper inequality-->more distrust--> higher mortality -thus, social conditions shape/predict life expectancy |
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vector transmission
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-any agent (person, animal, insect, microorganism) that carries and transmits infectious disease
-mechanical or biological |
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mechanical transmission
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-type of vector transmission
-passive transfer of infectious agent; never enters vectors body -e.g. housefly lands on feces which it carries and lands on food before it is consumed |
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biological transmission
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-vector transmission
-vector harbors pathogen inside its body -often mosquitos, lice, fleas, ticks |
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Suicide (general)
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-used as measure of overall mental health
-increased in developed countries -8th leading cause of death in the US -1/10 attempts succeed |
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suicide prevention
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-clinical care/meds
-social support/stability -gun control -school/workplace surveillance |
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suicide at-risk/causes
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-adolescents/young-adults
-data about attempts -decreased social trust -increased urbanization -blame of failure individualized -more job impermanence |
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Barriers to public mental health
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-preoccupation w/infectious disease, sanitation, and infrastructure
-mental health difficult to define/measure -diagnoses: high sensitivity, low specificity |
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4 filters for mental health treatment/issues
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-primary care (physician)-limited Rx
-specialized mental health-limited access -hospitalization-$$, harm -psychiatric in-patient-$$, limited acces, alienation/segregation |
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community-based psychiatry
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-focus of psychiatric phealth response
-workplace/unemployment--> stigma, stress -discrimination/stigma--> lead to mental disorders -housing stability -school/comm institutions frontline for screening -access to meds/clinical care |
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mental illness (general)
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-high DALYs/morbidity
-high rates of comorbidity -increased healthcare costs -global prevalence: -anxiety/phobia -mood (depression, bipolar) -personality -substance abuse -organic - alzheimers/ dementia |
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mental health prevalence in US
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-20-30% in a given year
-50% at least one -14% have comorbid conditions -<14% of affected receive no treatment |
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depression
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-DSM-IV=definitions of all disorders and criteria for diagnosis
-provides definition of depression -depression: must have 5 of 9 symptoms & 2 of 3 for at least 2 months |
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dose-response relationship
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-change in effect on organism based on level of exposure to dose/stressor
-linear=any dose toxic, increasing dose is worse -non-linear=threshold past which exposure is toxic (e.g. Radon or Tobacco smoke) |
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Global Disease Burden (5 highest mortality rates)
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1. Heart Disease
2. Infectious disease 3. Cancer 4. Respiratory illness 5. Unintentional injuries/accidents |
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Lead
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-absorbed in body:
-inhalation (industry) -ingestion (child, soil, pottery) -water (pipes) -in-utero -prevention: -remove lead from paint, toys, gas -monitor soil -chelation=treatment that reduces lead in blood -causes decreased mental fxn |
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Risk/Hazard Assessment
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-Hazard ID
-Dose-Response -Exposure Assessment (who? how much? -Risk-characterization |
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Lung Cancer
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-leading causes: Radon & 2nd hand smoke
-15% of homes > 4p/L(EPA limit) -risk multiplies with both present |
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Motor Vehicle Accidents
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-most common injury death
-50% brain/spinal injury -leading cause of death in ages 1-24 in US and world |
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Accident prevention
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-seat belts/helmets
-speed limits -alcohol control -age req. and licensing -road construction/safety |
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Secondhand Smoke
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-Ralph Nader/airline --> sued for clean air as right
-clean indoor legislation -began as workers rights issue |
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Federal PHealth Agency (roles)
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-"Federalist system"
-focus on science, natl security, commerce, & health care -set goals for research -dispersed; lacks uniform structure |
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Government health spending
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-25% of healthcare spending
-mostly medicare and medicaid -largest purchaser in world -federal phealth spending has halved |
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DHHS
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-Dept. of Health and Human Services
-65,000 employed -largest grantmaker in world -CDC, FDA, NIH, ATSDR (Agency for Toxic Substances & Disease Registry), IHS (Indian Health Service - Native Americans) -NIH does most of funding and has much larger budget |
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State Health Agencies
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-Food safety
-collecting vital stats -tobacco prevention -inspecting and monitoring hospitals -professional licensing -environmental health o DISPARITY: # of employees that work in state health agencies • 26 SHAs have <1501 employees • 9 SHAs have >4500 employees |
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Local Public Health Agencies
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-similar to state agencies
-food safe, enviro, tobacco, immunizations, bp screening, infectious disease surveillance -disparities: -small LPHAs don’t have physicians, nutritionists or health educators -small pop. have high % of LPHAs that serve low % of pop. vs. large pop. opposite |
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Tobacco Prevention
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-1=stop new smokers
-1964 surgeon general -2009 Obama family -Truth campaign -Fairness Doctrine -Masters Settlement (no youth) -2=address ppl w/symptoms -public smoke bans -high taxes -masters:co. donate $ to treat |
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Ainsworth article
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-global AIDS
-affects poorer countries -lack of govt. action -too broad is ineffective, narrow focus will have greater impact |
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Cohen article
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-global health org. "soul-searching"
-HIV highly funded -PEPFAR limiting -GAVI=gates |
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Piot article
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-Global impact of HIV/AIDS
-HIV rising in affluent nations b/c increased survival rates -stigma=barrier -effective control=unified national planning, access to care, social inclusion of high-risk & HIV+ |
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Bedford/Elliman article
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-Vaccine concerns
-some parents against vaccines -believe unnecessary/alternate methods, & cause other illnesses |
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Baker article
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-childhood vaccine prob. greatest impact on mort. reduction
-british vs. us immunization methods -british: formal clinical methodology (more resistant) -US: lab tech/research --> widespread application -diptheria, pertussis, polio, measles |
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Gleissberg article
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-Drug resistant TB
-conditions can make it very difficult to treat TB -WHO Global TB: implementing DOTS -MDRTB has only 56% recovery -full course meds needed to treat/prevent |
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Medicare vs. Medicaid
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-medicare=fed. program covering elderly health
-medicaid=inteded to cover poor; also as "medi-gap" covering extra elderly expenses |
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dartmouth study
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-more aggressive care at end of life not better
-medicare costs reduced if more humane end of life care |
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Kastrup article
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-global mental health
-major psych disorder/prevalence -calls for more prevent/treat -developed: depression, alcohol |
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Ommeron article
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-mental/social health during emergencies
-planning, access, long term, monitoring, training, collaboration -acute emergency then post emergency both important -stress best handled w/out meds |
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Costello article
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-poverty & psychopath
-social causation=gene-enviro interaction -"great smokey mountain study" -flaws but saw social causation for oppos/deviant behavior but not depress/anxiety |
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Disasters & Public Health
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-predictable and some unpredictable
-phealth has job of preparing, collaboration/coordination, protection of survivors -9/11 & Katrina reveal weaknesses in govt response |
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Mann article
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-ethics relates to public health
-officials must protect public health rights and human rights -public health should spend more time thinking about ethics/human suffering and rights |
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Henderson article
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-bioterrorism is now more likely than ever
-we are ill-prepared -must be able to detect, diagnose, understand epidem, and respond to bioweapon |
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Tilson & Berkowitz article
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-public health & policy challenges
-US needs competent & prepared phealth infrastructure -policy advocates must align with broader system to create cohesive whole |
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Broadhead article
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-needle exchange closed after controversy blames it for drugs
-interviewed clients of exchange -showed increase in unreliable syringes, reusing, and sharing syringes -closing the exchange didnt decrease drug use, just increased high risk HIV behavior |