* winter break starts december 20 th and goes until january 2 nd * over the break, you may...

*Winter Break starts December 20th and goes until January 2nd

*Over the break, you may participate in the Unit 3 Discussion, but this is not required. You will receive full credit for the Unit 3 Discussion. Unit 3 Assignments/Projects/Exams, etc. are due at the end of Unit 4. Unit 4 begins on 1/4/2012

*Project proposals are due tomorrow

*I replied to everyone that emailed me their topics but some people did not receive my replies. Email me again ASAP

*There are flash cards in each unit

*Unit --Reading -- Key Terms

*Two parts to the first assignment for this project

*Email me the person you would like write about

*After you receive approval for the assignment, write a proposal that will address why that particular person is important to public health

*Please review APA style

*Please do not use wikipedia.com, answers.com

*Let me know if you need assistance finding a journal article

*You can also seek help from the KU librarians

*Avoid using first person

* Problem: What is the health problem?

* Etiology: What is/are the contributory cause(s)?

* Recommendations: What works to reduce the health impacts?

* Implementations: How can we get the job done?

* Problem—What is the health problem?

* What is the burden of disease and has it changed over time?

* Are there differences in the distribution of disease and can these differences generate ideas or hypotheses about their etiology?

* Are the differences or changes used to suggest group associations artifactual or real?

* Etiology—What are the contributory cause(s)?

* Has an association been established at the individual level?

* Does the “cause” precede the “effect”?

* Has altering the “cause” been shown to alter the “effect” (if not use ancillary criteria)?

* Recommendations—What works to reduce the health impacts?

* What is the quality of the evidence for the intervention?

* What is the impact of the intervention in terms of benefits and harms?

* What grade should be given indicating the strength of the recommendation?

* Implementation—How can we get the job done?

* When should the implementation occur?

* At whom should the implementation be directed?

* How should the intervention(s) be implemented?

* Burden of disease

* Occurrence of disability and death due to a disease

* Morbidity

* Mortality

* Distribution of disease?

* Incidence vs Prevalence?

* Artifactual?

* Established by investigations that information on groups or population without having information on the specific individuals in the group

* Population comparisons or ecological studies

* Three definitive requirements for contributory cause

* 1. The “cause” is associated with the “effect” at the individual level

* 2. The “cause” precedes the “effect” in time

* 3. Altering the “cause” alters the “effect.”

* Case-control (retrospective studies)

* Cohort studies (prospective studies)

* Randomized clinical trials (experimental studies)

* Randomization – participants are assigned to groups using a chance process

* Supportive or ancillary criteria (Table 2-1, p. 25)

* Strength of the relationship (measured with relative risk)

* Dose-response relationship

* Consistency of the relationship

* Biological plausibility

Magnitude of the impact

Net benefit: substantial

Net benefit:

moderate

Net benefit:small

Net benefit: zero/negative

Quality of the evidence

Good A B C D

Fair B B C D

Poor (insufficient evidence)

I I I I

p. 28: Explanation of grades

When Who How

Levels 1) Primary— Prior to disease or condition

2) Secondary—Prior to symptoms

3) Tertiary— Prior to irreversible complications

1) Individual2) At-risk group3) General

population/community

1) Information (education)

2) Motivation (incentives)

3)Obligation (requirement)

When Who HowMeaning of

levels1) Primary—remove

underlying cause, increase resistance, or reduce exposure

2) Secondary—post-exposure intervention, identify and treat risk factors or screen for asymptomatic disease

3) Tertiary—Reverse the course of disease (cure), prevent complications, restore function

1) Individual often equals patient care

2) At-risk implies groups with common risk factors,

3) General population includes defined populations with and without the risk factor

1) Information—efforts to communicate information and change behavior on basis of information

2) Motivation—rewards to encourage or discourage without legal requirement

3) Obligation—required by law or institutional sanction

When Who How

Cigarettesmokingexample

1) Primary—prevention of smoking, reduction in second-hand exposure

2) Secondary—assistance in quitting, screening for cancer if recommended

3) Tertiary—health care to minimize disease impact

1) Individual smoker2) At-risk—groups

at risk of smoking or disease caused by smoking, e.g., adolescents as well as current and ex-smokers

3) Population—Entire population including those who never have or never will smoke

1) Information—stop smoking campaigns, advertising, warning on package, clinician advice

2) Motivation—taxes on cigarettes, increased cost of insurance

3) Obligation—prohibition on sales to minors, exclusion from athletic eligibility, legal restrictions on indoor public smoking

Type Examples Uses Advantages/Disadvantages

Single case or small series

Case reports of one or a small number of cases, such as SARS, anthrax, mad cow disease and new diseases (e.g., first report of AIDS)

Alert to new disease or resistant disease; alert to potential spread beyond initial area

Useful for dramatic, unusual, and new conditions; requires alert clinicians and rapid ability to disseminate information

The 6 S’s of Sources of Public Health Data


Statistics (“Vital Statistics”) and reportable diseases

Vital statistics: birth, death, marriage, divorce; reporting of key communicable and specially-selected non-communicable diseases (e.g. elevated lead levels, child and spouse abuse, etc.)

Required by law—sometimes penalties imposed for noncompliance; births and deaths key to defining leading causes of disease; reportable disease may be helpful in identifying changes over time

Vital statistics very complete because of social and financial consequences; reportable disease often relies on institutional reporting rather than individual clinicians; frequent delays in reporting data



Surveys -sampling

National Health andNutritionExamination Survey(NHANES);Behavioral RiskFactor SurveillanceSystem (BRFSS)

Drawing conclusionsabout overall populationand subgroups fromrepresentative samples

Well conducted surveysallow inference to bedrawn about largerpopulations; frequentdelays in reporting data



Self-reporting

Adverse effectmonitoring ofdrugs and vaccinesas reported by thoseaffected

May help identifyunrecognized orunusual events

Useful when unusualevents closely followinitial use of drug orvaccine; tends to beincomplete; difficult toevaluate meaning becauseof selective process ofreporting



Sentinelmonitoring

Influenzamonitoring toidentify start ofoutbreak and changes in virustype

Early warnings orwarning of previouslyunrecognized events

Can be used for “realtime” monitoring;Requires considerableknowledge of patterns ofdisease and use ofservices to develop



Syndromicsurveillance

Use of symptompatterns (e.g.,headaches,cough/fever orGastrointestinalsymptoms, plusincreased sales ofover-the-counterdrugs) to raise alertof possible new orincreased disease

May be able to detectunexpected and subtlechanges, such asbioterrorism or newepidemic producingcommon symptoms

May be used for earlywarning even when nodisease is diagnosed; doesnot provide a diagnosisand may have falsepositives

* Population health status measures

* Measurements that summarize the health of the population

* Infant mortality rate

* Life expectancy

* Under-5 mortality

* Health-adjusted life expectancy (HALE)

* What are some of the components of this measure?

* Disability-adjusted life year (DALY)

* Global Burden of Disease

* Examples: Table 3-2, p. 45; Table 3-3, p. 46

Criteria Questions to AskOverall site quality Is the purpose of the site clear?

Is the site easy to navigate? Are the site's sponsors clearly

identified? Are advertising and sales separated

from health information?

Authors Are the authors of the information clearly identified?

Do the authors have health credentials?

Is contact information provided?

Criteria Questions to AskInformation Does the site get its information from

reliable sources? Is the information useful and easy to

understand? Is it easy to tell the difference between

fact and opinion?

Relevance Are there answers to your specific questions?

Timeliness Can you tell when the information was written?

Is it current?

Criteria Questions to AskLinks Do the internal links work?

Are there links to related sites for more information?

Privacy Is your privacy protected? Can you search for information

without providing information about yourself?

* Dread effect* Perception of an increase in the probability of

occurrence of an event due to its ease of visual ability and its feared consequences

* Ex. Fear of a shark attack

* Unfamiliarity effect* Perception of increased probability of an event due to

an individual’s absence of prior experience with the event

* Ex. Not knowing someone that died of lung cancer

* Uncontrollability effect* Perception of increased probability of occurrence of

an event due to the perceived inability of an individual to control or prevent an event from occurring

* Ex. Automobile accident

* How likely?

* How important?

* How soon?

* Utility scale (Figure 3-2, p. 48)

* Used to measure and compare the value of importance that different people place on different outcomes

* Useful when you need to combine potential harms with potential benefits

* Discounting?

Type ofDecisionmaking

Process/Roles Advantages Disadvantages

Inform ofdecision

Clinician has all the essentialinformation to make a decisionthat is in the patient’s best interest

Clinician aims to convey theirdecision as a clear andunambiguous action or order

Patients accept the clinician’srecommendation withoutnecessarily understanding oragreeing with the underlyingreasoning

May be efficient andeffective when patientsseek clear directionprovided by anauthoritative andtrusted source

Patient may favor ifthey do not seek out orfeel they cannot handleindependent decisionmaking responsibilities

Patient may not gaininformation andunderstanding of thenature of the problemor the nature of thetreatment

Patient may not beprepared toparticipate in theimplementation of thedecision

Patient may notaccept responsibilityfor the outcome of thetreatment

Type ofDecisionmaking


Informedconsent

Clinician has the responsibilityto convey a recommendation tothe patient

Harms and benefits oftreatment are weighed by theclinician in making aRecommendation

Clinician has a responsibilityto provide information on theaim of the recommendation,the potential benefits, theknown harms, and the processthat will occur. The patient hasthe right to ask additionalquestions about the treatmentand the availability of otheralternatives

Patient gainsinformation andunderstanding of thenature of theproblem or thenature of theTreatment

Patient may beprepared toparticipate in theimplementation ofthe decision

Patient may acceptresponsibility for theoutcome of thetreatment

Time consumingcompared to informingof the decision

May require elaboratepaper work toimplement formalinformed consentProcess

May increase emphasison legal documents andmalpractice law

Type of decision making


Shared decision making

Clinicians serve as a source of information for patients including providing it directly or identifying means of obtaining informationPatients can expect to be informed of the existence of a range of accepted options and be assisted in their efforts to obtain informationPatients may seek information on experimental or alternative approaches and can discuss the advantages and disadvantages of these approaches with a clinicianConsiderations besides benefits and harms are part of the decision-making process, including such considerations as cost, risk-taking attitudes, and the distress/discomforts associated with the treatmentPatients are often directly involved in the implementation of care

May increase the control of the patients over their own livesMay increase the types of information considered in decision makingMay reduce the adversarial nature of the relationship between clinicians and patientsMay improve the outcome of care by increasing the patient's understanding and commitment to the chosen course of care

May be time consuming for patients and cliniciansMay increase the costs of health careMay increase the stress/anxiety for patientsMay shift the responsibility for bad outcomes from the clinician to the patient, i.e., takes the clinician off the hook/clinician does not need to do the hard work of thinking through the decision and making a recommendation

* winter break starts december 20 th and goes until january 2 nd * over the break, you may...

Documents