PBH Q3-ch.6 and cardiovascular .txt

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MelodyRodsuwan
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164095
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PBH Q3-ch.6 and cardiovascular .txt
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2012-08-01 18:13:22
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PBH Q3 cardiovascular
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PBH Q3-ch.6 and cardiovascular
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  1. epidemic transtion***
    infectious to chronic
  2. non commuicable diseases should be involved with 5***
    • screening
    • interventions
    • cost effective tx
    • counsel
    • research
  3. screening for non commuicable purpose 3
    • test for ppl who dont show symptoms
    • early dections
    • to reduce death
  4. screening qualifications***
    • disease will cause death
    • early detection will improve outcome aka LEAD TIME BIAS means early detection w/o benefits
    • strategies are possible
    • acceptable
  5. multiple risk factor***
    look at lots of risk facts to reduce outcome. DUH
  6. cost/net effective
    benefits must be greater than harms
  7. counsel 5 types 
    • like tay sachs-jews
    • sickle cell-blacks
    • down synd
    • pku
    • cystic fibrosis-whites
  8. outbreaks are recognized by....
    clinicians, patients, data, media
  9. why to recognize outbreaks
    • prevent more cases
    • prevent more outbreaks
    • describe/learn/teach the new disease
    • evaluate prevention
    • talk to the public 
  10. to investigate 
    • epidemiological
    • environmental
    • media and legal side
  11. was grilled above hurricane Isabel, West Nile, and measles 
    Dr. Gerberding
  12. note when investigating outbreak
    • find source
    • quickly tell public
    • limit case 
    • the well publicized outbreaks can be bias
    • pressure to investigate > errors
    • delays > no samples
  13. 5.A goals of outbreak investigations***
    • define
    • are they real
    • whats the background rate
    • case finding
    • examine descriptive epi features of cases
  14. 5. B goals of outbreak investigations***
    • make hypo
    • test hypo
    • test samples
    • implement control measures
    • tell public
  15. case definitions
    • lab confirmed 
    • clinical
    • definitive vs probable
    • outbreak associated vs. nonoutbreak
    • primary vs. secondary
  16. case def drives>>>
    analysis
  17. lab confirmed case
    gastroenteritis

    note: did he even go to the restaurant? 
  18. definitive vs. probable
    probable: once confirmed, not needed both
  19. outbreak associated vs nonoutbreak
    outside of school vs. school 
  20. primary vs. secondary
    1st wave children vs. teacher
  21. case confirmation
    • some asymptomatic ones have positive tests b/c of lab errors
    • deals with emerging disease like legionnaires, aids, SARS
    • ex.) vault blood 
  22. case confirmation are based upon
    • direct observation
    • med records
    • provides
    • lab results 
  23. background disease rate
    • scope of outbreak geographically and temporally 
    • compare current outbreak vs. current backdrop
    • see for additional cases

    note: important when Hep C shows in one hospital!!!! 
  24. affect rates
    • under/over sampling
    • un/over reported 
    • financial 
    • media 
  25. endemic***
    background/expected cases like mosquito in tx
  26. epidemic***
    EXCEEDS expect disease in defined area like anthrax
  27. pandemic***
    global
  28. describe outbreak
    person, place, time 
  29. epi curve***
    • graph shows the number of cases by illness by the date
    • data>>>hypo>>>statistics
  30. cardio disease affects 
    heart, brain, kidney, extremities>ulcers, eyes
  31. where of us
    more in SE states
  32. cost of cvd
    475 billion
  33. race is most affected
    blacks
  34. health systems level factors***
    • financing
    • structure of care
    • culture barriers
  35. patient level factors***
    • patient preferences
    • refusal of tx
    • poor adherence
    • bio diff
  36. non modifiable risk
    age, gender, heredity 
  37. modifiable risk 
    smoke, chol, BP, inactivity, obesity, diabetes, stress, alcohol
  38. how many with HBP 
    50 mil 
  39. there is a relationship with cvd
    Blood pressure
  40. cvd prevention
    • cut down salt in communities
    • manage hypertension 
  41. challenges
    obesity, lazy, stress, diet, genes
  42. overcome challenges
    improve access to care, healthy foods, healthy environments, note disparities, focus preventing 
  43. resources
    • centers for disease control and prevention
    • american heart association
    • american diabetes association 
  44. passive immunity
    injections of antibodies>>>short term
  45. blood samples example
    is NOT date on site
  46. PICU example
    there are breaks; no pattern
  47. epidemic curve can help
    pattern, magnitude, outliers, time, exposure
  48. magnitude 
    how many cases
  49. outliers
    where was patient
  50. epi curve  (intermittent)***

    foodborn
    contamination of ground water
    • once we eat it, it's all gone
    • we can turn it off/on

    therefore, it breaks the epi curve apart
  51. epi curve (continuous)***

    continuous exposure will cause cases to
    rise gradually/plateau NOT PEAK
  52. epi curve (point) 3***
    • sharp up and then gradual down
    • brief and one period 
    • blip and lands, then surges
  53. epi curve (propagated) 4***

    ex.
    • spread from person to person 
    • lasts longer
    • multiple waves
    • taller peaks***

    measles in elementary school/doesn't realize
  54. outbreak time trend considers (3)
    • date of illness of first case
    • date when peaked
    • date of illness of last case
  55. outbreak outliers (to reduce) 5
    • baseline level 
    • source
    • case expose earlier/later
    • unrelated
    • long incubation
  56. period of exposure/outbreak
    timing of exposure>>>time of incubation
  57. median incubation period
    time btw exposure and the peak of epi curve
  58. making hypo
    • descriptive like ecological, correlation, cross sectional
    • see existing data
    • open ended interviews
    • outliers
  59. testing hypo 4
    • case control
    • cohorts
    • clinical trials
    • natural
  60. environ investigation
    like soil samples, time sensitive, expense
  61. control measures
    to prevent further and protecting the rep is hard
  62. sequential testing/2 stage***
    most cost effective form b/c if one negative test can rule out the disease (takes out the false neg though)
  63. multiple interaction***
    risk of two or more exposures/dependent
  64. 5risk factors of heart disease***
    • family hx
    • smoking
    • diet
    • BP
    • weight
    • waist circumference

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