Public Health Final EXAM Flashcards

d) All of the above

Public Health as defined field dates back to the renaissance

High Blood Pressure answer: reducing the average risk

Blood sugar level answer: reducing the high risk

Higher smoke stacks answer: Narrowing the spread of the risk

The totality of all evidence-based public and private efforts throughout the life cycle of that preserves and promote health and prevent disease, disability and death.

1) conditions in which people are born

2) grow up

3) live

4) learn

5) work

6) play

7) worship

8) age

1. Inform, educate, and empower people about health issues.
2. Monitor health=status to identify community health problems.
3. Diagnose and investigate health problems and health hazards in the community.
4. Mobilize community partnerships to identify and solve health problems.

1. Develop policies and plans that support individual and community health efforts.
2. Enforce laws and regulations that protect health and ensure safety.
3. Link people to needed personal health services and assure the provision of health care when otherwise unavailable.
4. Assure a competent public health and personal health care workforce.
5. Evaluate effectiveness, accessibility, and quality of personal and population-based health services.
6. Research for new insights and innovative solutions to health problems

• Prevents epidemics and the spread of disease
• Protects against environmental hazards
• Prevents injuries
• Promotes and encourages healthy behaviors
• Responds to disasters and assists in recovery
• Assures the quality and accessibility of health services

_{Monitor health status to identify and solve community health problems
Diagnose and investigate health problems and health hazards in the community
Inform, educate, and empower people about health issues
Mobilize community partnerships and action to identify and solve health problems
Develop policies and plans that support individual and community health efforts
Enforce laws and regulations that protect health and ensure safety
Link people to needed personal health services and assure the provision of health care when otherwise unavailable
Assure competent public and personal health care workforce
Evaluate effectiveness, accessibility, and quality of personal and population-based health services
Research for new insights and innovative solutions to health problems}

Self-determination theory (SDT) is a macro theory of human motivation and personality that concerns people's inherent growth tendencies and innate psychological needs. It is concerned with the motivation behind choices people make without external influence and interference. SDT focuses on the degree to which an individual's behavior is self-motivated and self-determined

P-problem

E-etiology

R-recommendations

I-implementation

E-evaluation

Time Order - The change in X must occur before the change in Y : It is often difficult to establish cause-effect relationships in social research because it can be difficult to determine which came first.

Example - The more severe an individuals substance abuse problem the more likely he/she is to commit crimes. began using drugs at 14 --> began committing crimes at 17

Context - Set of circumstances surrounding an event or situation. No cause has its effect apart from some larger context involving other variables. -When, for whom, and in what
conditions does this effect occur. A cause is really one among a set of interrelated factors require

The cause is associated with the effect- people with lung cancer are more frequently smokers

The cause precedes the effect-smoking comes before development of lung cancer

Altering the cause alters the effect-reducing smoking reduces lung cancer rates

d.Biological plausibility

b.Dose-response relationship

b.Etiology

Takes place before the onset of the disease the aim is to prevent the disease

1. Primary Intervention - Education
2. Primary Intervention - Obligation
3. Secondary Intervention - Education
4. Secondary Intervention - Motivation
5. Tertiary Intervention - Education
6. Tertiary Intervention - Obligation

Information collected on births, deaths,marriages, divorces and some reportable diseases

The objectivity of the web site, recent updating of the web site, the presence of references for the data or conclusions presented on the web site

The availability of information on the source of funding for the Web site

The most important use is the compilation of data to generate summary measurements of the health group or population

Mad cow disease is diagnosed in a cow and the entire herd is subsequently slaughtered? - Single case or small number of cases

d.All of the above are correct

1. Selection bias (area of data was chosen, not random)
2. Outliers in data
3. Overfitting or underfitting data
4. Confounding variables (outside forces that couldn't be controlled)

Inform of decision—has all the information to make the decision

Informed consent---patient needs to give consent before intervention as surgery

Shared decision making---provide information so patient can make a decision

1. A) Public health can be viewed as an application of many of the social sciences

Socioeconomic status includes your family income, educational level or your parents educational level, and professional status or parents professional status

New behaviors that can be substituted with alternative short term needs

World Health Organization document which attempt to restrict Internet advertising of cigarettes is ignored by tobacco companies in the United States. Which principle of United States health law does this apply?

A provision of International law does not apply in the United States unless United States law incorporates the provision such as ratification of a treaty by the United States Congress.

-A local convenience store is fined on the basis of state law for selling cigarettes to minors. Which principle of United States health law does this apply?

Police power allows states to pass legislation and take actions to protect the common good

Constitutional Law - Bill of rights, First Ten Amendments ( The constitution trumps any other law).

Legislative statutes - Statutory law, ex: The entire U.S. Tax code.

Administrative regulations - the regulation and operation of the Social Security Administration (rules and regulation law)

Judicial law - Original Jurisdiction and Appellate Jurisdiction (systems of courts, court hearings) .

The right to be informed of the treatment to which they have been assigned before beginning the treatment

Through legislation, the United States Congress has established a limited right to health care under specific circumstances, such as access to care in emergencies and child birth

_{An example of Constitutional law: the United States Supreme Court determines that there is a right to privacy.}

_{An example of Legislative statutes: Congress authorizes funds for the states to build highways contingent on passage of state law raising the drinking age to 21.}

_{An example of Administrative regulations: The Department of Health and Human Services writes a series of rules to implement a recently passed bill designed to ensure the safety of newly approved drugs.}

_{An example of Judicial law/ Case Law: A state court rules that state law permits a resident physician to testify in a malpractice suit to provide information on the expectations of clinical practice in his future specialty.}

Cause of Death, Morbidity, Behaviors or Environment, SDOH and Policy

d) All of the above

Disease produces substantial death/and or disability, early detection is possible and improves outcome, there is a feasible testing strategy for screening, screening is acceptable in terms of harms , costs, and patient acceptance

An intervention that increases that reduces the cost while increasing the benefit(net effectiveness).

“HIV” (Human Immunodeficiency Virus) is a virus that infects the immune system, decreasing its ability to fight off other infections and diseases (TRUE)

HIV can be transmitted through unprotected sex, transmission of infected blood, sharing infected needles or other sharp instruments, and from a mother to her baby during pregnancy, childbirth, and breastfeeding (TRUE)

Gay and bisexual men of all races are the most radically affected by HIV in the US (TRUE)

_{Insects—Lyme, west nile}

_{Animals—rabies, avian flu}

_{Airborne—avian flu, chickenpox, cold, TB}

_{Unprotected sex—Gonorrhea, hepatitis, herpes, HIV,}

_{Breast milk—HIV}

_{Fomites (on surface of objects)—avian flu, chickenpox, cold}

_{Animal feces—salmonella}

_{Water or food—cholera, hepatitis, salmonellas, other bacteria}

_{Blood—many including HIV and hepatitis}

_{Bacteria—step, staph, e coli, lactobacillus}

_{Fungi —athletes food, ringworm, candidiasis}

Protozoa—malaria, giardia, amebic dysentery

Viruses—cold, flu, HIV

Worms—tapeworm, pinworm, other intestinal worms

Flukes—snail fever, lung, liver flukes

insects—lice, bedbugs, scabies

_{Barrier protections including isolation and quarantine, immunizations to protect individuals as well as populations, screening and case findings, treatment and contact treatment, efforts to maximize the effectiveness of treatments by preventing resistance}

_{Physical barriers—condoms, masks, gloves, even a building –what about the inside of your elbow?}

_{Immunizations—herd immunity}

_{Screening—as name implies, trying to figure out where it started and how its being spread}

_{How will we contain the spread—isolation, barriers, reducing contagiousness}

_{Maximize treatment for those sick and make sure our drugs still work in the future}

Mosquito nets, clean water, immunizations, clean cookstoves, animals for food ex: chickens, goats

Programs to eradicate TB and Malaria have never come close to meeting their goals, getting rid of HIV/AIDS is even more unrealistic.

Influenza, smallpox

Disease is limited to humans, no animal reservoir? YES
Limited persistence in the environment? YES
Absence of long-term carrier state? YES
Long-term immunity results from infection? YES
Vaccination confers long-term immunity? YES
Herd immunity prevents perpetuation of an epidemic? YES
Easily diagnosed disease? YES
Vaccination effective post exposure? YES

POLIO

Disease is limited to humans, no animal reservoir? YES
Limited persistence in the environment? YES
Absence of long-term carrier state? YES- absent but may occur in immunocompromised individuals
Long-term immunity results from infection? YES- but may not be sustained in immunocompromised
Vaccination confers long-term immunity? YES- Virus used for production of live vaccine can produce polio like illness and can revert back to infection.
Herd immunity prevents perpetuation of an epidemic? YES
Easily diagnosed disease? YES/NO - large number of asymptomatic infections
Vaccination effective post exposure? NO

_MEASLES

_{Disease is limited to humans, no animal reservoir? YES
Limited persistence in the environment? YES
Absence of long-term carrier state? YES- absent, but may occur in immunocompromised individuals
Long-term immunity results from infection? YES- but may not be sustained in immunocompromised individuals
Vaccination confers long-term immunity? YES- but may not be sustained in immunocompromised individuals
Herd immunity prevents perpetuation of an epidemic? YES
Easily diagnosed disease? NO- disease may be confused with other diseases
Vaccination effective post exposure? NO}

The ones that are successful are: case findings, contact tracing, isolation, epidemiology treatment or treatment based on exposure

_{Unaltered environment}

_{Examples: AKA Natural environment. Water quality could be poor due to soil contents or natural erosion.}

_{Radon- a common naturally occurring breakdown of product uranium, increases the risk of lung cancer.}

_{Naturally occurring sunlight- increases risk of skin cancer}

_{Altered environment}

_{Examples: Industrial chemicals such as pesticides, benzene and chlorofluorocarbons (CFCs), mercury and lead. Also includes radiation from nuclear energy and medical wastes.}

_{Global warming melting the ice caps, endangering animal species such as bees and other pollinators necessary for crop growth.}

_{Built environment}

_{Examples: Includes all impacts of the physical environment as a result of human construction. Injuries and exposures in the home, the transportation system, and where we work and play. Construction methods can affect air systems leading to exposure of “sick buildings”.}

_{Methods of how we heat our buildings, cook our food and the way we travel.}

_{Risk assessment- aims to measure potential impact
Ex: Risk: of child poking himself with stick 1:10,000}

_{Public Health assessment- show the major impacts on large numbers of people often the population as a whole
Ex: Pub H: 50% of the children in the U.S. will be exposed to candied apple at least one per year}

_{Ecological Assessment- impacts of environmental contamination or pollution on plants and animals and the ecosystem in which they exist cause important long term consequences
Ex: Ecological: 5,000 trees are harvested each year to make sticks, adding 2 million cubic yards to landfills each year}

_{Interaction analysis- controls the impacts of environmental exposures , and taking into account the effect of two or more exposures . the interactions of the exposures have greater impacts. Example ozone layer depletion
Ex: Interaction: with rates of obesity and diabetes increasing do we really want to increase exposure to more sugary foods}

Paint in homes is no longer a source of led exposure since lead is no longer allowed in paint. (in powerpoint).

This is false because older homes still have paint in them that contains lead.

Global assessments (global level)
Policy impact assessment (policy level)
Strategic environmental assessment (programme and plan level)
Environmental impact assessment (project level)

Both young and old: weaker immune systems,
Poor: worse living conditions, less resources, can’t move to better environments
Ill: interaction effects we already talked about (eg asthma)
Disabled: particularly getting around the build environment or avoiding accidents

Graduate public health degrees require previous graduate credentials such as medicine nursing, or law

The 6 c’s of Ideal Primary Care (page 202 in book)
Contact- implies first contact
Comprehensive- ability to completely or least initially address most health issues
Coordinated- primary care should have responsibility to ensure that parts of healthcare system work together
Continuity- primary care teams see themselves hold together the system
Caring- implies personalized relationship
Community- implies primary care provides link with with broader community and with public health institutions and services

There are approximately 2 specialty physicians for every primary care physician in the United States.

Fee for service- paid for covered service
Capitation- paid set amount per time period for each patient
Episode of care- institution or clinician aid set amount for comprehensive services
Salary- set amount per time period
Pay for performance- compensation adjusted based on measures of quality care delivered

All hospitals are operated as not-for-profit institutions

•Group insurance plans (employed)
•Private insurance (self-employed)
•Medicare (retired)
•SSDI (disabled)
•Medicaid (poor)

Employment-based health insurance is the largest single category of health insurance in the United States

The United States has a higher percentage of specialists compared to generalists than most other developed countries.

Spends more per person
Has higher percentage of uninsured individuals, even after ACA
Healthcare system more complex for patients and providers, and costs far more to administer
Places more emphasis on specialized physicians & on nurses and physician assistant to provide primary care
Greater emphasis on giving patients a wider choice of clinicians
More complex system for ensuring quality and unique system of malpractice law

Informed purchaser
Multiple competing providers
Negotiation

<sub>1. Name of Policy-
2. Annual Premium- the amount you pay the insurance company or in some cases the gov. to provide you with healthcare coverage.. Pay it on a monthly basis.. Still have to pay it no matter if you use it or not
3. Annual family deductible (sometimes individual also)- pay up front a certain amount out of your own pocket
4. PCP co-pay and/or co-insurance%- paying out of pocket to receive service and does not count toward deductible
5. Specialist co-pay and/or co-insurance%- same as #4
6. Generic drug co-pay and/or co-insurance%- same as #4
7. ER co-pay and/or co-insurance%- same as #4
8. co-insurance% for everything else- needed to have an mri or other procedures, ex: you pay 20% of whatever the procedure cost
9. Annual family “out of pocket” max (cap)- you pay 20% of these procedures up to a maximum of $10,000 and once you pay this max out of your own pocket then you don’t pay co-insurance anymore and they take care of everything else. When the new year starts you start your max all over again</sub>

_{Copay- fixed dollar amount
Co-insurance- a percentage..ex: if you visit the emergency room you pay 20% of that emergency room visit, if it’s $2,000 you pay $400}

Our doctors, nurses, clinicians, pharmacies, hospitals charge more for the same procedure or drug than comparable countries

But, we also perform more tests, imaging, and prescriptions per person than in most comparable countries.

Many items needed by elderly are not covered such as hearing aids and eyeglasses. Medicare is a complicated program because there are four different parts all covering different things.

_{Center for Disease Control (CDC)- the lead agency for prevention, health data, epidemic investigation, and public health measures aimed at disease control and prevention;outbreaks; PH function
Nation Institute of Health (NIH)- lead research agency; funds training programs and communication of health information to the professional community and public; biomes and health research
Health Services and Resources Administration (HSRA)- provide quality and healthcare to unsure; seeks to ensure equitable access to comprehensive quality healthcare
Substance Abuse and Mental Health Services Administration (SAMHSA)- prevention;works to improve quality and availability of prevention, treatment and rehabilitation for substance abuse and mental illness}

United States Agency for International Development (USAID)- objective is to improve global health by focusing on three strategic priorities: 1) Preventing Child and Maternal Deaths; 2) Controlling the HIV/AIDS Epidemic; and 3) Combating Infectious Diseases
Food & Drug Administration (FDA)- responsible for protecting the public health by assuring the safety, efficacy, and security of human and veterinary drugs, biological products, medical devices, our nation's food supply, cosmetics, and products that emit radiation.
The U.S. Department of Health and Human Services (HHS)- is the U.S. government's principal agency for protecting the health of all Americans and providing essential human services, especially for those who are least able to help themselves. Medicaid, CHIP, women's health, SNAP food, family violence, refugee, disaster assistance
Department of Aging and Disability Services (DADS)- administers long-term services for people who are aging as well as for people with physical, intellectual or

_{Department of assistive and rehabilitative services(DARS)- administers programs that help Texans with disabilities find jobs through vocational rehabilitation, ensure that Texans with disabilities live independently in their communities, and assist families in helping their children under age 3 with disabilities and delays in development to reach their full potential. autistic, blind, deaf, other disabled, working with employers etc.
Department state health services- to improve the health, safety, and well-being of Texans through good stewardship of public resources, and a focus on core public health functions. The department provides state-operated healthcare services, including hospitals, health centers, and health agencies. like the CDC for the state a lot of public health work, infectious, vital records, health data, mental health, substance use, licenses, etc.
Department of Family and Protective Services (DFPS)- is responsible for investigating charges of abuse, neglect or exploitation of children, elderly adults and adults with disabilities. child protective services, elder protection, daycare licensing, etc.}

They may provide direct services or they may delegate services and authority to local health departments depending on decisions made at the state level

https://quizlet.com/106660564/pbh-exam-3-practice-qs-flash-cards/

Phase I studies assess the safety of a drug or device. T

Phase II studies test the efficacy of a drug or device.

Phase III studies involve randomized and blind testing in several hundred to several thousand patients.

Phase IV studies, often called Post Marketing Surveillance Trials, are conducted after a drug or device has been approved for consumer sale.

1.Self prescribing—keeping antibiotics for later use, borrowing from others, (over-the-counter in many countries)
2.Doctors—misdiagnosed or overprescribed (don’t do cultures)
3.Not finishing prescriptions
4.Personal products—soaps, sanitizers, wipes, toothpaste, first aid items, etc., etc.
5.Other products—baby products, school supplies, kitchenware, etc., etc.
6. Livestock production- PRIMARY CULPRIT (⅔ to ¾ of all antibiotics in US are used on livestock to make them bigger) not used to cure a sickness therefore creating antibiotic resistant bac

----the cost for a company to develop a drug is $3-4 billion, so companies sell to meet the desired profit (patent laws in the US to protect their drug so no one can copy it (generic drugs), so US patients are paying more because other places in the world are paying less for the same drug.

-dynamic, constantly changing,

-governed by history and by feedback,

-where the role and influence of stakeholders and context is critical, and

-where new policies and actions (of different stakeholders) often generate counterintuitive and unpredictable effects, sometimes long after policies have been implemented

- policy resistance.

Biologists - human body is a complex set of organ systems, which is why one drug doesn’t work the same for every person
Epidemiologists - ex: H1N1 flu, have to look at whole natural system to understand spread of disease

Health policy - ex: how the FDA has influence of the food industry in the US
Community health workers - stakeholders in a community should be involved in revising a community health system

1. Drug researchers

1. Epidemiologists

1. Community health educators
2. epidemiologists

Positive feedback - green arrow +

Negative feedback - green arrow -

positive/negative feedback loop - blue arrow + / green arrow -

Multiple factors influencing outcome - multiple arrows pointing at one outcome (i.e. speeding, alcohol, slow response all point to collision)