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  1. Flashcard Notes for Intro to Public Health Final
  2. ____ are portfolios of observations and data summarizing health priorities needs and resources and are key to establishing to establishing public health budgets
    Community Health Assessments (CHA)
  3. The National Center for Health Statistics (NCHS) is a division of the ____ and conducts ______
    CDC; period surveys of representative samples of the population
  4. National Health Interview Survey is conducted by DHHS _____ on _______ households
    Every other year; 50,000
  5. National Health and Nutrition Examination Survey (NHANES) is conducted ______ on ______. Involves ____
    Every year; 5,000 individuals; full medical work up
  6. in 2005-2006, ___% of American children's parents talked to a healthcare provider about a child's emotional or behavioral problems; __% were prescribed meds for mood disorders; __% for ADHD
    15; 5; 89
  7. Health Informatics info come from (5)
    Clinical studies, standard databases, census (very detailed questions), DHHS, coroner reports.
  8. T/F A comprehensive health information database exists
  9. T/F Medical records are available to foreign hospitals to serve travelers
    False- administrative costs are accrued when these records are gathered manually
  10. Hospital Records contain ____(3)
    Medical, family, diagnostic history
  11. Almost all psychopharm medications prescribed to 4-17 yr olds is for ____ (more ___ than ____0
    ADHD, males than females, older children than younger
  12. For the treatment of ADHD, more children are treated with ___ than ____ and are most commonly treated in _____
    meds than others; private practice or clinic, schools, general medical practice
  13. Current treatment methods of ADHD may indicate these 3 anthropological conclusions (so what?)
    Need for greater access to wider variety of mental health services, more research on non- medical/ combo treatments, community level assessments of quality and scope of school based/ other mental services (follow up studies needed for all)
  14. Notification systems: WHO requires international reporting of ___ (3)
    Yellow fever, cholera, plague
  15. Notification Systems: Reporting is imperfect because there is no universal health care access or use, no universal reporting system, takes time
  16. Notification Systems: CDC requires reporting of disease by ____ and _____ for more urgent conditions
    mail/ internet; phone
  17. Notification Systems: Chain of disease reporting (4)
    Health care professional, local/ state public health agency, federal agency, news media
  18. Notification Systems: : Task of Health care professional
    (diagnosis),
  19. Notification Systems: : Task of local/ state public health care agency
    investigates source/ spread, communicates with CDC
  20. Notification Systems: : Task of federal agency
    disease control and public relations strategies, scientific research
  21. Notification Systems: : Task of news media
    Public notification
  22. Commodity fetishism: Definition and relation to tomato scare
    • Marx- disconnect final product from its sources
    • Even though only canned tomatoes were affected, sales of all mexican produce went down, subtle xenophobia in news (masks accurate assessment of immigration policy and public health),
    • emphasizes need for political sensitivity when issuing press releases
  23. T/F There is no reason for the lax monitoring of produce importation that exist today
    False- economic incentives
  24. Older age groups have higher rates of death by most causes except _____ (3)
    injuries, suicide, homicide, HIV infection
  25. The most common cause of death for children under 19 was _____ is ______
    motor vehicle accidents (occupant or pedestrian); falls
  26. 4 important factors of interpreting public health info
    Single study or meta- analysis, size of study, animal or human study, study of biological markers or actual disease
  27. The DARC gene has been associated with ___ (2)
    Decreased susceptibility to malaria, increased to HIV
  28. ___% of healthy people 2010 goals were accomplished, __% are moving in the right direction, __% moving in wrong direction
    15; 44; 15
  29. Poor perception of health status is inversely related to ____
    Household income
  30. T/F Income inequalities have increased since 1980
    True
  31. Morbidity/ Mortality from chronic disease is ____ higher in low- income citizens compared to high- income citizens
    300%
  32. Men are twice as likely to die from _____ and 4 times more likely to die from _____
    unintentional injuries, fun accidents
  33. Women have ___ as much depression as men
    2x
  34. People lacking higher education are ___ more likely to die from premature death than are people with some higher education; infant mortality rate is reduced by ___ if you graduate from college
    200%
  35. These factors are affected by race, income, education, sex (7)
    morbidity/ mortality from chronic disease, life expectancy, death from unintentional injuries, gun accidents, premature death, depression, infant mortality
  36. Total infant mortality is ___ but African American infant mortality is _____
    decreasing, increasing (2x rate for white Americans)
  37. T/F African Americans are both more likely to get chronic diseases and to die from them
    True- heart disease, prostate cancer, HIV/AIDS
  38. ____ have highest diabetes, depression, suicide rate in world
    African- Americans
  39. __% of Americans live in rural areas (fewer than 2,500 residents) where injury related mortality is __% higher
    25; 40- less likely to have healthcare visits, use seatbelts, be insured or exercise regularly
  40. Gay men have significantly higher rates of ___ (4)
    STDs, substance abuse, major depression, suicide (2-3 times rate of suicide)
  41. Military personnel have higher rates of (3)
    substance abuse , domestic abuse, suicide (veterans are 8x more likely to commit suicide)
  42. T/F more women than men are discharged from the hospital following treatment for cardiovascular disease
  43. ____ make routine doctors visits more regularly, varies ____ among "8 America" classifications
    Females, surprisingly little
  44. According to 8 Americas study ____ and ____ seem have worse health conditions than comparable demos
    males, poor Southern blacks
  45. ___ year difference in life expectancy between America 1 and 8 (Asians, High- Risk urban blacks)
    21
  46. Since 1980, life expectancy gap between sexes has _____ by ____%
    increased, 0.5%
  47. Top 3 contributers to disease burden
    Smoking, alcohol use, overweight and obesity (these affect males more than women)
  48. 8 most cost- effective PH interventions
    tobacco cessation counseling in young adults, anti-tobacco messaging for adolescents, screening elderly for vision impairments, counseling adolescents on alcohol abuse, screening adults for problem drinking, screening adults for colorectal cancer, screening young women for HPV (or providing vaccine), vaccinating older adults against pneumonia.
  49. Age adjusted rates of death due to HIV have _____ between ___ and _____
    declined; 1987-2002
  50. In 1985, ____ had highest death/ case rates due to HIV. Now ____ have highest rates. (____ and ___ have almost no deaths due to HIV)
    White; Black (rates in blacks have gone up while rates in whites have gone down); Asian/ Pacific Islanders, American Indian/ Alaska Native
  51. ___% of AIDS cases are among black people though they make up __% of the population. (for whites __% of cases, __% of population)
    50, 13; 30; 68
  52. Top 3 methods of AIDS transmission for males
    Male-to- male sexual contact (58%), injection drug use, high- risk hetero sex
  53. Top 3 methods of AIDS transmission for females
    High- risk hetero sex (71%), injection drug use, other (other is only 2%)
  54. Percentage of HIV deaths that are of females has ____ by _____ from ___ to _____
    increased, 200%, 1987-2003
  55. Most females who die from AIDS from hetero contact are ____
    Black (probably most in general given prevalence of this mode of transmission)
  56. The _____ region of the U.S. has the highest rates of adults living with AIDS while the ____ region has the lowest.
    South; Midwest
  57. Proportional distribution of AIDS cases in the South have ____ between 1987 and 2003 while rates in the West, Northeast have ______. Cases in the Midwest have more or less stayed the same for that time period.
    Increased; decreased
  58. Most adolescents with AIDS are ____. The proportion of this group has ____ since 1981
    Black, Increased from 50-64% (only 15% of population)
  59. African American household income is ___% of white's, ___% of blacks live in poverty while ___% of whites do
    62; 26, 9
  60. __ of Extremely poor Americans are ____ with ____
    women with no high school diploma
  61. Trio of social suffering
    Gender, Poverty, Biology
  62. STDS acquisition is ____ more likely in male to female vaginal intercourse
    2-5
  63. STD coinfection increases risk of HIV contraction by ___ times
    50x
  64. NIMH Prevention trial (2)
    Best study regarding STD programs in U.S., study of 37 STD clinics with "high- risk" African- American and Hispanic men and women
  65. Procedures of NIMH Prevention Trial (3)
    study of 37 STD clinics with "high- risk" African- American and Hispanic men and women; participants shows 1 hr video or seven weekly 90 minute risk reduction training sessions; focused on behavioral interventin and risk reduction through education, self- esteem building and situational negotiation skills
  66. Results of NIMH Study
    No change in unprotected sex acts/ month (reduction on low- end, slight increase on high- end of intervention group), increased condom use, slightly lower reduction in gonorrhea rates
  67. ____ are least likely to be insured, ____ most likely
    Mexicans, those slightly above poverty line; whites, 200% or more of poverty line
  68. T/F Uninsured are more likely to have undiagnosed high cholesterol/ blood pressure
  69. Modes of Transportation
  70. Modes of transmission (4)
    Direct (airborne), Indirect (bloodborne, waterborne, airborne), transcutaneous, vertical (mother to child)
  71. Transmission cycle (4)
    Agent--> vector--> host--> environment
  72. Three possible steps from vector to human host
    Vector--> intermediary host--> human host
  73. Insect transmission accounts for___ of all vector- borne disease transmission.
    85%
  74. Worldwide resurgence of vector borne diseases since ___ because of ___(2)
    1970's; major environmental changes, low surveillance in tropics and subtropics
  75. Factors influencing spread of vector- borne diseases (4)
    Size of host population, density of agents in host population, environmental conditions such as temperature and humidity, levels of human resistance
  76. Immunity vs. Resistance
    Immunity: Resistance to infection from presence of antibodies or cells that act on a specific microorganism; Resistance- resistance to transmission or development of disease
  77. Factors influencing resistance (8)
    Age, sex, nutrition, pregnancy, trauma, fatigue, mental health, medications
  78. Long- Term Impacts of Communicable Disease (5)
    Living with chronic infectious disease (herpes), weakened immune system, secondary conditions, antibiotics and disease mutation; rheumatic fever
  79. Measuring Disease (4)
    Disease burden (or Burden of Disease), mortality and morbidity, DALYs and QALYs, psychiatric conditions
  80. T/F Globally, communicable disease is more common than non- communicable
    False- Infectious disease causes fewer deaths than heart disease, more than any other singular non- communicable disease
  81. Top 3 Causes of Global Burden of Disease as measured by DALYs
    Perinatal conditions, lower respiratory infections, ischemic heart disease (onset at young age, not immediately fatal)
  82. Regions with highest proportion of infectious disease DALYs
    Africa (48%), Southeast Asia (28%)
  83. In Africa, ___% of deaths are attributable to infectious disease, in Europe __%
    62%, 5%
  84. Most African deaths due to disease are from (3)
    HIV/ AIDS, Malaria, Measles- most deadly diseases vary greatly by region
  85. Types of direct transmission
    Physical contact (leprosy, scabies, anthrax), Sexual contact (STIs), Airborne (measles, strep, Legionnaire's disease, flu)
  86. Anthrax was discovered by ____ in ____, vaccine was developed by _____ in ______
    Robert Koch, 19877; Louis Pasteur, 1881 (not essential part of vaccination programs)
  87. Anthrax: Vaccine
    living, non- virulent strain with 6 doses in infancy and annual booster shots
  88. Anthrax (bacillus anthracis): Treat to end biological weapons development in ___, _____ 1 million residents of major ____ city exposed via ______
    1972; Russian, accidental release from military complex (20 resulting deaths)
  89. Anthrax (bacillus anthracis): Incubation
    0-5 days
  90. Anthrax (bacillus anthracis): Symptoms, diagnosis, prognosis
    flu- like, severe diarrhea; symptoms and chest x- rays, respiratory failure
  91. Anthrax (bacillus anthracis): Systems affected, modes of transmission, mortality rate
    Lymph nodes and tissue; airborne, cutaneous, gastroenteric
  92. Anthrax (bacillus anthracis): Primary, Seconday Tertiary Prevention
    Primary: sanitation, vaccine, protective workplace equipment, surveillance; Secondary; Isolation, chlorination of clothing, PEP (antibiotics); Tertiary: Isolation of corpses, sIte containment and cleanup
  93. Scalp Ringworm: Affects __-__% of children in the U.S., mostly ______. Primary mode of transmission is in _____. ___% of all positive cases are asymptomatic.
    3-8; African- Americans; classrooms; 14
  94. Scalp Ringworm: Symptoms, Diagnosis, Prognosis
    Swollen, itchy scalp, pattern baldness; Diagnosis: Microscopic examination of hairs. Prognosis: 6 week anti- fungal treatment course
  95. Scalp Ringworm: Primary, secondary, tertiary prevention
    Primary: school programs. Secondary: Anti- fungal meds and therapies. Tertiary: monitoring of anti- fungal medication side effects
  96. ____ disease pathogens account for nearly all airborne disease in the U.S.
    20
  97. T/F Smaller sneeze droplets (in microns) are more dangerous as more remain in air for longer.
    True
  98. Rank the following (from shortest to longest) in terms of persistence on air: Bacteria, spores, viruses
    Bacteria, viruses, spores
  99. Rank the following (from most to least) in terms of efficacy of removing spore levels from environment.
    A/C, mechanical ventilation (fans), natural ventilation (open windows), outdoor air
  100. Indirect modes of transmission
    Bloodborne (HIV, Hep B, Hep C); Food and Waterborne (cholera, salmonella, typhoid, botulism. hep A, polio)
  101. _____ and _____ have the highest incidences of foodborne illness. _____ (2) Have the lowest
    restaurants and homes; cafeterias, resorts
  102. Hepatitis B: ___% of all humans are HBV+, __-__% have chronic, symptomatic HPV. ___ annual deaths/ 100,000 in U.S./ Worldwide
    30; 2-8; 2
  103. Hepatitis B: Main transmission methods (4)
    IV drug use, unprotected sex, blood transfusion, perinatal transmission (HBV+ mothers have a 20% chance of transmitting to child. CHild has 5% chance of clearing infection)
  104. Hepatitis B is most prevalent in (3)
    Africa, SE Asia, South America
  105. Hepatitis B: Incubation, Symptoms, Diagnosis, Prognosis
    A couple of days- lifetime Symp: liver inflammation, vomiting, jaundice, fever, aches. Diag: Blood test (after 4 months) Prog: Chronic liver disease, rarely mortality
  106. Hepatitis B: Primary, Secondary, Tertiary Prevention
    Prim: Vaccination, sex and drug education, blood transfusion screening, anti- viral prophylactics for pregnant women; Secondary: at- risk screening, early antiviral treatment, co- morbidity treatment; Tert: viral load testing, anti- viral treatments, substance abuse control and liver health management
  107. Hepatitis C: ____ cases worldwide, ___ new cases/ year worldwide, ___ cases in U.S.
    200 million, 3-4 million, 4 million
  108. Hepatitis C: Leading cause of _____ and ____
    liver cancer and liver transplants
  109. Hepatitis C: ____ co-infection with HIV, ____ of prisoners are positive, ___ of cases in U.S. have been incarcerated
    35, 35, 84
  110. Hepatitis C: Sources of infection (top 3)
    IDU (60%), sexual (15%), Transfusion (before screening) (10%)
  111. Hepatitis C: Incubation, Symptoms, Diagnosis, Prognosis
    Inc: a couple days- lifetime; Symptoms: liver inflammation, vomiting, jaundice, fever, aches; Diag: blood test (4-12 months after exposure); prog: Chronic liver disease, 30% mortality
  112. Hepatitis C: Primary, Secondary, Tertiary Prevention
    Prim: Vaccination, Sex and drug education, screening of blood transfusions, anti- viral prophylactics for pregnant women; Secondary: at- risk screening, early antiviral treatment, co- morbidity treatment; Tertiary: viral load testing, anti- viral treatments, substance abuse control and liver health management
  113. Methods of Indirect (transcutaneous) Transmission (4)
    Insects, Animal bite, Latrogenic (in hospital), self- injeced
  114. Rabies: _____ annual human deaths, __ in Asia, __ in Africa
    55,000; 31,000; 24,00
  115. Rabies: Global epidemic in ____, ____ discovered vaccine, which is now ____. Lack of ___ in East Asia has led to increased incidence, led to development of ___ policy
    1800s; Louis Pasteur; routine for children and animals in developed countries; animal control; one dog policy (2006)
  116. Rabies: Incubation, Symptoms, Diagnosis, Prognosis
    2-12 weeks (up to 2 years); Sympt: anxiety, insomnia, confusion, paranoia, delusion, partial paralysis. Diag: self- reporting, symptoms, viral culture (usually postmortem); Prog: hydrophobia, encephalitis, death in 2-10 days
  117. Rabies: Primary, Secondary, Tertiary Prevention
    Prim: Vaccines, animal control, prophylactics Secon: animal euthanasia, wound hygeine, PEP; Tertiary: Induced coma, anti- viral treatments, months of isolation
  118. Methods of Vertical Transmission (2)
    Genetic (cystic fibrosis), Congenital (HIV, rubella, syph)
  119. Cystic Fibrosis: ___ cases in U.S., most common in ____ (1 in ___ are carriers, 1 in ___ born symptomatic). In 1959, life expectancy was ___
    30,000; 25; 3,000- less common in African Americans, Asians; 6 months
  120. Cystic Fibrosis: Symptoms, Diagnosis, Prognosis
    respiratory problems, pain, fever, headaches, lung disease; Diag: amniocentesis, symptomology, neonatal blood tests. Prog: severe lung disease, gastrointestinal problems, infertility, 36.8 years LE
  121. Cystic Fibrosis: Primary, Secondary, Tertiary Prevention
    Prim: genetic screening, prenatal testing; Secon: lifestyle management, gene therapies, oral antibiotics for acute infections; Tert: long- term lung disease treatments, lung transplantation
  122. Ebola: Outbreak in ____ (yr) in ____ affecting
    1976; Bumba Zone, northern Zaire; patients at Yambuku Mission Hospital, midwives, clinicians, villagers
  123. Ebola: Symptoms
    Fever, vomiting, abdominal pain, bloody stool
  124. Ebola: Mission Hospital founded by ___ in ____, served ____ including ____
    Belgians; 1935; primary source of medical care for 60,000 people; travelers from outlying areas- active prenatal care unit
  125. Ebola: Sequence of events
    Health ministry dispatch epidemiologists and microbiologists to region; 11/17 of hospital staff have died, entire Bumba Zone is quarantined; liver specimens reveal unknown virus, international commission is formed- 500 possible cases identified, link found between exposure to Yambuku Hospital and hemorrhagic fever
  126. Ebola: Most effects people in ____ age
    middle (15-49)
  127. Ebola: Identified cause
    Non- sterile injection conditions at Mission hospital
  128. Ebola: Incubation, Symptoms, Diagnosis, Prognosis
    0-12 days (mostly 10 days), Symp: fever, flu- like; Diag: symptomology, blood tests, biopsies; Prog: multi- organ failure, 67% mortality rate
  129. Ebola: Primary, Secondary, Tertiary Prevention
    Prim: clinical hygiene, case reporting, monitoring of acute fevers, vaccination Secon: hospitalization, specialized anti- viral meds; Tert: ongoing research
  130. Biggest Killers of Poor (Top 4):
    Other causes, AIDS, Diarrhoeal disease, maternal and perinatal conditions, respiratory infections
  131. Leading causes of death in U.S. (3)
    Heart disease, cancer, stroke (proportion of deaths from infectious disease is very small)
  132. Legionnaire's Disease: ___ annual incidence world- wide, risk factors (8)
    32,000; age, smoking, diabetes, chronic lung disease, kidney cancer, lung cancer, sex (male), ac use
  133. Legionnaire's Disease: Initial outbreak (3)
    Most famous case of outbreak control in PH history, 1976 American Legion convention in Philly, >150 cases, 20 deaths in 2 months
  134. Legionnaire's Disease: Incubation, Symptoms, Diagnosis, Prognosis
    2-10 days; flu- like symptoms; lab tests, chest x- rays; pneumonia
  135. Legionnaire's Disease: Primary, Secondary, Tertiary Prevention
    Prim: UV inspection of aerosolized water; Secon: antibiotics; Tert: treatment of comorbidity and immune system compromise
  136. Malaria: ____ cases world wide, most (a little over half) are ____ and in ____.
    515 million, non- symptomatic; Africa
  137. Malaria essentially only effects the ____ hemisphere and the ___
    Southern, poor
  138. Malaria: Pathogenesis
    1) Hepatic infection- microorganisms migrate to liver and multiply for 6-15 days (up to 1 yr) 2) red blood cell infection (adhesive proteins stick to blood vessel walls to avoid immune system cycling)
  139. Malaria: Incubation, Symptoms, Diagnosis, Prognosis
    Inc: 6-14 days; Symp: fever, vomiting, convulsions, headache, fatigue, pain, dry cough, enlarged spleen and liver. Diag: symptomology, blood tests Prog: renal failure, 20% mortality rate
  140. Malaria: Primary, Secondary, Tertiary Prevention
    Prim: Insecticide, bed nets, sheets, protective clothing, prophylactic drugs in high risk groups, genetic modification of mosquitoes Secon: Anti- Malarial drugs, hospitalization; Tertiary; primary care, symptom monitoring
  141. 2 Phases of Mosquito Net Distribution
    1) populations learn how to use and treat nets (nets cost 15 cents- distr for free) 2) retreatment (wash resistant insecticide in fibers lasts 2-3 years, cheaper chems last 6-12 months)
  142. Bagamoyo Tanzania Bed Net Project
    Nets given to 3 villages (different ethic groups) at 6 mo intervals; 91% had no previous experience with nets or insecticide treatments
  143. Mixed Cultural Views of Mosquito Nets in Bagamoyo Tanzania Bed Net Project
    Dawa: word meaning both a substance used in agr or pest control, often regarded as dangeous and linked to colonial history but also used in traditional healing to refer to an herbal treatment- views motivate non-adherence
  144. Downfalls of Mosquito Nets (4)
    Insecticide wears off even if nets are not actively used, insecticide might be weakened even if other insects are dying, mosquitoes are dangerous even out of season and in small numbers, insecticide has noticeable side effects
  145. Effects of Fees of Mosquito Net Use
    Fees deter adherence, if nearby village gets for free, fees deter even more (low adherence associated with alcoholism)
  146. Evidence Based Recommendations to Promote ITN Use
    CHW undergo special training and edu, community level education programs, alcohol abuse programs, financial resources, transportation to and from clinic, multiple distribution days
  147. Yellow Fever: Caused by same mosquitoes as ____ and _____; major epidemics in ____ (yrs- 2)and _____ (notable places-2), prevented French from building _____
    Dengue, Chikungunya; 1700-1800s; New Orleans, Memphis; Panama Canal
  148. Yellow Fever: Currently Endemic in ___ and ____
    Northern South American (Brazil, Bolivia, Paraguay), Central Africa
  149. Yellow Fever: Incubation, Symptoms, Diagnosis, Prognosis
    3-6 days; fever, headache, nausea; Diag: Blood tests; Progn: 15% of cases enter phase II (jaundice, liver damage, 20% mortality)
  150. Yellow Fever: Primary, Secondary, Tertiary Prevention
    Prim: malaria related prevention measures, vaccination Secon: anti- viral meds (not very effective), hospitalization; Tert: ongoing research
  151. Dengue Fever: ___ disease transmitted by _____
    viral, insects
  152. Dengue Fever: Incubation, Symptoms, Diagnosis, Prognosis
    Incubation: 3-5 days; Sympt: fever, headache, rash, nausea, vomiting; Diag: symptomology, blood tests; Progn: Dengue Shock syndrome is rare, 50% mortality
  153. Dengue Fever: Primary, Secondary, Tertiary Prevention
    Prim: all malaria- related prevention measures; secon; oral rehydration, hospitalization, anti- inflammatory meds; Tert: ongoing research
  154. Dengue fever is considered an ______. There are ___ cases/ year worldwide but gets much _____ funding.
    Underrepresented; 50 million; lower funding than other prominent infectious diseases
  155. Tuberculosis: High comorbidity with _____,__,___
    10% of new cases co- occur with HIV, smokers have relative risk of 10, elderly has highest prevalence in U.S.
  156. Tuberculosis: ______ cases worldwide, ____ deaths/ year
    1.7 billion; 2 million
  157. TB Has been on a constant rise except during the period of time between __ and ___
    ~1990 and ~1993
  158. Tuberculosis (bacteria): Incubation, Symptoms, Diagnosis, Prognosis
    Inc: Lifelong Symp: coughing respiratory problems Diag: symptomology, chest x-rays Prog: 5% of all cases become symptomatic, 50% mortality without treatment
  159. Tuberculosis: Primary, Secondary, Tertiary Prevention
    Case identification, vaccination; Secon: Hospitalization, complex antibiotic and med regimes; Tertiary: isolation, DOTS, other kinds of social and ambulatory care
  160. Predictors of Poor Drug Adherence (6)
    Mental illness, drug use, youth, gender, unstable housing, socioeconomic status
  161. MDRTB makes up _-_% of all cases, __% of recovery chances (__% of all forms of TB), ___% of all MDRTB cases in the developing world.
    0-54, 56, 95
  162. DOTS typically leads to a ___ drug compliance rate and a ___% survival rate
  163. Without ART: median progression from HIV infection to AIDS is ____, median survival time after developing AIDS is ____
    9-10 years; 9-10 months
  164. With ARTs mortality, AIDS and hospitalizations decreased __-__%, average life expectancy increased ___ years
    60-80; 15
  165. Requirements for Successful ARV Therapies (3)
    HIV counseling and psychosocial support, treatment adherence (95% adherence required), $$ (300-1500 in low income countries; $10,000 in U.S.)
  166. AIDS therapies require an average of ____ pills to be taken each day; patients can only miss __/week
    3-5 pills, 5
  167. DOTS in Boston: Positive effects on these medical factors (6)
    total inpatient days (decrease), length of hospital stays, medical costs, effectiveness, drug adherence, long- term decrease in CD4 counts
  168. Responsibilities of CHWs
    Monitor treatment/ deliver drugs, give counsel, provide moral support, educate about prevention, monitor co- morbidity and symptoms
  169. DOTS in Haiti: Positive Effects
    decreased mortality, decreased co- infections, weight gain, decreased days in hospital, increased ability to manage life, job creation (CHWs, Non- medical personnel, others)
  170. Perinatal Disease Prevention in HIV: __% transmission rate, most HIV+ mothers have ___ and ___
    7; prenatal care; effective use of prenatal anti-retroviral therapies
  171. Reasons for opening (1), closure (1997) of Windham Needle Exchange (5)
    115 residents diagnosed with HIV (59% were drug users- 39% white, 43% hispanic); state sponsorship of illegal activity, visible location, strong personalities on staff, advocacy for drug users, sensational reporting on needle problem
  172. Effects of Windham Needle Exchange Closure (3)
    Major increase in users exposed to unreliable needles and drugs, major increase in needle sharing, no decrease in bio- waste
  173. Texarcana Measles Outbreak (1971-1971): Attack rate in Texaswas ___, attack rate in Arkansas was ____
    48.2; 4.2
  174. Vaccine types (5)
    Live organisms (measles, yellow fever, plague), Inactivated or killed organisms (influenza, rabies), cellular fraction (meningitis), recombinant DNC engineering (influenza, hep B), toxoids (tetanus, diptheria, botulism)
  175. Vaccine: Chain of Events
    Primary response, secondary response, immunologic memory
  176. Vaccines: Primary response
    Exposure to antigen, 3-14 day lag, Development of antibodies
  177. Vaccines: Secondary Response
    Booster response, subsequent exposure to antigen, shorter lag period
  178. Vaccines: Immunologic Memory
    Long- term immune response to specific disease
  179. Diseases whose incidences were greatly reduced by vaccines (4)
    Diphtheria, polio, measles, pertussis
  180. Smallpox eradication required __% worldwide coverage but herd immunity for measles requires __% coverage. __% of U.S. children recieve all vaccines by recommended age
    80; 95; 75
  181. Diptheria: infectious disease in ____ temperatures. ____ experienced epidemics in _____, which led dosages to go from __ to ___ with ____ and ____ coverage.
    Cold; USSR; 1980's; 3; 4; boosters; higher (93%)
  182. Foundations of Expanded Programme of Immunizations (EPI)
    1970: fewer than 10% of children have basic immunizations; 1980's: WHO and UNICEF launch EPI, 1990's 80% of children receive basic immuns, preventing 3 million deaths annually
  183. Diseases eradicated because of EPI
    tetanus in pregnant women, polio, measles deaths reduced by 95%
  184. Global Alliance for Vaccines and Immunizations (GAVI) goals (3)
    66% reduction in child mortality in 36 designated countries by 2015, into of under- used vaccines (hepatitis, yellow fever) in developing countries, establish effective and comprehensive immunization programs to be integrated into primary health care systems
  185. Pertussis (Whooping Cough) ___ disease of the ____ that causes ____ with possible development of _____
    bacterial, respiratory tract, cold- like symptoms/ crowing sounds, pneuemonia
  186. Limitations of pertussis vaccine (4)
    Lasts only a few years, allergic reactions (seizures) common, high risk of disease in elderly, cases of permanent brain damage
  187. Pertussis prevalence has ____ since ____, especially since ____
    increased; 1980; 2001
  188. Wheel of vaccine related lawsuits
    Tort litigations--> increased price of vaccine/ malpractice insurance--> National Childhood Vaccine Injury Act (1986)
  189. The National Childhood Vaccine Injury Act (1986)
    Reduced risk of tort litigation related to vaccine related injuries by establishing a claim procedure involving the United States Court of Federal Claims
  190. Common claims against vaccinations (5)
    Side effects (studies limit these), vaccines weaken natural immune response (not proven), risk for diseases (influenza vaccine may increase risk of acquiring Guillain- Barre syndrome), Dangerous chemicals used (some evidence at clinical leve, non at population level), individual freedom (lack of herd immunity requirements puts everyone at risk)
  191. HPV: ____ annual deaths from cervical cancer; ___% of women in US will have contracted HPV by age 50 (most will remain subclinical); ___ new cases of cervical pre- cancer ever year (Deaths result)
    233,00; 80; 250,000 (3,700 deaths)
  192. Methods to prevent HPV
    Pap smear (reduces cervical cancer incidence by 50%), Gardasil, Varvarix, Combo of Gardasil and Varvarix (100%)
  193. Suggestions for Effective Vaccination Programs (6)
    Availability/ effectiveness of vaccine, widespread coverage, community education/ promotion and enrollment programs, assessment of need through surveillance, ongoing evaluation, monitoring of antigenic drift
  194. In the epidemiological transition, deaths from ____(2) have increased while ___ has decreased
    circulatory disease, cancer; infectious disease
  195. Diseases of Civilization are characterized by (5)
    Economic growth, demographic changes, relative income inequality and mental health morbidity, preventable disease, lifestyle related
  196. Neonatal, Postneonatal and infant mortality as well as fertility ___ with epi transition
    decline
  197. 4 Stages of Health Transition
    Age of pestilence (infectious) and famine, age of receding pandemics (improved sanitation), age of degenerative and man- made diseases, age of delayed degenerative diseases
  198. Age of Pestilence and famine: Life Expectancy, Changes in broad disease categories
    ~30, infections, nutritional deficiencies
  199. Age of Receding Pandemics: Life Expectancy, Changes in broad disease categories
    ~ 30-50; improved sanitation, fewer infections, better nutrition (salt)
  200. Age of degenerative and man- made disease:Life Expectancy, Changes in broad disease categories
    ~50-55, increased lifestyle deaths (diet, activity, addiction)
  201. Age of delayed degenerative diseases: Life Expectancy, Changes in broad disease categories
    ~70, reduced risk behaviors, new treatments
  202. Of top killers in U.S. today, ___ of them, ____, were in top 8 of 1900.
    4- heart disease (4), injuries (6), cancers (7)
  203. Most common cancers for males are _____, the first of which has seen a significant _____ since _____
    lung/ bronchus, colon; increase; 1950
  204. Tobacco related deaths account for ____ each year
    450,000 (more than homicide, suicide, accidents, HIV, Alzheimer's and diabetes combined)
  205. Cigarette smoking has generally declined except among ___
    high school students in 1990's
  206. 60% of 1-17 yr olds and ~50% of adults eat ___ meals in restaurants/ week; ~27% of middle aged adults eat ___
    1-3 meals; 4 or more
  207. Almost __% of American adults and __% of children are overweight or obese
    70%; 17%
  208. Consequences of Epi Transition and Chronic diseases
    More chronic disease --> increased healthcare costs
  209. The most common source of activity limitation among adults due to chronic conditions is _, among older adults ___ is also problematic
    arthritis/ musculoskeletal conditions, heart/ circulatory
  210. Consequences of Epi Transition on Mental Health
    Increased economic development and life expectancy--> increased mental health morbidity
  211. The Health and Economic Effects of Mental Health Disorders, national substance abuse have ____ over past 20 years
    greatly increased
  212. Anti- depressant use is more common among __ and ___. Use has ___ over past 15 years
    Women, White, not hispanic. ~Tripled
  213. Life expectancy in developed regions has _____ relative to less developed regions
    Stayed relatively constant
  214. Globally, noncommunicable disease accounts for __x the deaths of communicable
    2 times
  215. 3 Most burdensome causes of disease worldwide (measured in DALYs) in 1990 vs 2020:
    LRI, diarrheal disease, perinatal disease; ischemic heart disease, unipolar major depression, road traffic accidents
  216. While rates of smoking have declined in __(3), they are rising sharply in __
    USA, UK, Canada; Asia (developing world will account for almost 3/4 of smokers by 2030)
  217. Diabetes is expected to see a global ___ in next 20 years, esp in ___(3)
    Middle East, India, SE Asia (Most of Asia and Africa, really)
  218. Some countries, such as India, are experiencing ____ transitions
    heterogenous
  219. HIV Rates in South Africas Major cities have __
    risen but stabilized at around 25%
  220. U.S. life expectancy is correlated with __(2)
    Regions, smoking/ tobacco taxation rates
  221. Unintentional injuries are the _____ in some countries- high frequency among _____ people
    leading cause of death; young and middle- aged
  222. Unintentional injuries are the __ largest contributor to the global disease burden/ U.S. mortality burden
    5th
  223. Prevention: Motor Vehicle Accidents
    Mandatory seatbelts, speeding laws, age limits, police enforcement, air bags and safety standards
  224. Prevention: Falls
    Railings in homes/ public buildings, proper medication management
  225. Prevention: Domestic violence
    criminalization, shelters
  226. The most common injury- related cause of death worldwide is ______, which cause ___ of all brain and spinal cord injuries worldwide.
    Motor Vehicle Accidents- also the leading cause of death for ages 1-24
  227. Recommended Public Health Approaches to Motor Vehicle Safety (7)
    Mandatory seatbelts, alcohol regulations, helmets for bicyclists, speed limits of 55 mph, minimum age requirements, training requirements, vehicle and road design standards
  228. Environmental conditions cause __ (3)
    cancers, neurological disorders, chronic pain
  229. Environmental causes cause __ of all cancers in U.S. - especially dangerous because of ____
    5%; long- latency periods
  230. William Farr
    Helped environmental/ workplace safety movement, which started with British metal miners
  231. Types of environmental pollutants (3)
    Chemical, heavy metals, radiation
  232. Types/ Effects of chemical pollutants
    Pesticides; cancer
  233. Types/ Effects of Heavy Metals
    Mercury, lead, arsenic; neurologic disorders, cancers
  234. Types/ effects of radiation pollutants
    Magnetic fields, high- tension power lines; leukemia
  235. Types of Environmental Hazard Agents
    Allergencs and molds, dusts (like coal dusts- cause silicosis, respiratory disease), physical mechanical vectors (industrial machinery--> hearing loss, mortality)
  236. Environmental Health: 4- step risk assessment process
    1) Hazard identification 2/3) Dose- Response assessment; exposure assessment 4) risk characterization
  237. Classifications of Carcinogens
    Category 1- shown to cause cancer in humans; Category 2- causes cancer in animal tests, probably in humans; Category 3: possibly carcinogenic but inconclusive evidence supporting conclusion
  238. Benzene
    250,000 workers exposed annually, cause of acute or chronic neurological disorders, leading cause of leukemia
  239. Non- linear dose response relationship indicates __
    threshold
  240. Workplace safety tree
    Prevention--> Surveillance--> Chemical levels, Cancer rates. Prevention--> regulation--> biological wastes, agr chemicals
  241. Exposure to both radon and cigarettes causes ____
    Multiplicative risk of lung cancer (9-24 for tobacco alone, 5 for radon alone)
  242. First mention of "passive smoking" in ____, Surgeon General's report on second hand smoke in _____- same year as causal link
  243. Landmark paper on second hand smoke pollution found ____, second major study in ____ found that ____
    respirable suspended particles at 250-1000 times legal limit in many workplaces; Japan; SHS increased risk of disease in non- smoking wives in accordance to smoke habits of husband
  244. Causal relationship between smoking and ___ (2) found in over 40 studies
    Lung cancer, heart disease
  245. Nonsmokers in households and workplaces with smoke are ___ more likely to get smoking related disease. Related to __ and ___
    2-30, depending on smoke concentration; lower respiratory infections in infants; asthma
  246. Industry responses to SHS (4)
    promote more vague critiques of indoor air pollution; emphasize "accommodations" (AC fans, etc..) create a bigger monster, fund convenience store and restaurant trade groups
  247. Love Canal and Radiation
    54% of children born in 1970's in Love Canal had at least minor birth defects
  248. Asbestos is related to ___; Regulations against were initiated in ___
    lung cancer, other cancers; 1980's
  249. Lead effects ___ children 1-5, compounds ___ and is most often found in
    310,000; effects of hypertension, diabetes nervous system effects, African Americans
  250. T/F Chronic diseases have more complex causations than infectious disease
    True
  251. Rarely does a ____ cause chronic illness
    Single Cause
  252. Chronic Disease: "Normal" replaced by "_____"
    Optimal
  253. 4 Ways to Prevent Oral Cancer
    Diet rich in fruits and vegetables, safe sex, oral hygiene and dental care, substance abuse control
  254. Which cancer kills the most U.S. citizens?
    Lung (including throat)
  255. _____ people are expected to die from cigarette use by 2100 if consumption stays constant
  256. Tobacco companies new cigarettes were dangerous by _____
    1961
  257. Risk factors for cardiovascular disease combine in ___ ways
  258. Factors causing reduction in number of heart attack deaths (5)
    Reduced fatality, increased awareness, decline in smoking, increased physical activity, pharmaceuticals
  259. Heart disease disparities: heart attacks are more fatal for men or women? higher attack rates in which race? higher risk of stroke in which race?
    women; african- americans, african- americans
  260. 3 social risk factors for heart disease and stroke
    Being male, African- American, under educated
  261. Most common chronic disease in American children
    Asthma
  262. 65% of asthmatic children live in areas where ___
    pollution exceeds recommended levels
  263. ___ increase in asthma mortality since _____
    40%, 1980's
  264. African- American children have __ times more mortality from asthma
    5
  265. What is chronic obstructive pulmonary disorder(COPD)?
    Occurs in advanced stages of chronic disease and obstructs airflow due to chronic bronchitis
  266. COPD affects ___% of males in U.S. and causes _____ deaths/ year
    30; 100,000
  267. _____ Americans will have a cancer in their lifetimes; __% more risk of cancer in African- Americans; ___ more risk of cancer death in African- Americans
    1 in 3; 10; 30 (50% in men)
  268. _____ has highest levels of heart disease
    South
  269. Testing home for radon is a means of primary prevention for the following cancers (3)
    lung, skin, gastrointestinal
  270. Elimination of chemical and toxin exposure is a means of primary prevention for the following cancers (3)
    Lung, leukemia, lymphoma
  271. Eating a low- fat diet reduced risk of the following cancers (3)
    breast, colorectal
  272. ____ is the main cause of gender disparities in cancer; it accounts for __% of all cancers
    Smoking; 15-30%
  273. 6 main causes of cancer
    Smoking, diet, obesity and lack of exercise, alcohol, HPV, environmental and occupational hazards
  274. Reasons why PH might have ignored mental health in the past (3)
    Preoccupation with prevention, emphasis on sanitation and environmental health, difficulties measuring mental health morbidity and preventing complex causal chains
  275. Tools to measure mental health
    General Health Questionnaire (GHQ 12), Hospital Anxiety and Depression Scale (HAD)
  276. Sensitivity and specificity for HAD
    96% sensitivity, 57% specificity for depression
  277. What is the National Comorbidity Survey
    Study of 12- month mental disease prevalence in U.S. population
  278. Findings of the National Comorbidity Survey (4)
    50% report 1 disorder in lifetime, 30% report illness in past 12 month, over half with 1 disorder have 2 or 3 (14% of total population). fewer than 40% of those with at least 1 disorder receive treatment (over 60% untreated)
  279. Mental and neurological disorders account for ___% of global DALYs
    11
  280. Three types of mental disorders
    Neurological, CMDs, Behavioral
  281. 3 Neurological disorders
    Autism, dementia, mental retardation
  282. 3 CMDs
    Schizophrenia, neurosis (anxiety, OCD), mood disorders (depression, bipolar)
  283. 3 Behavioral Disorders
    Eating disorders, personality disorders, substance abuse
  284. Most common mental health disorders (2)
    Neuroses, mood disorders
  285. Globally, ____% of the population experiences unipolar depression every year
    5-10%
  286. ____ phobia is the most common
    Social
  287. Leading cause of years of life lived with disability for both sexes
    Depression
  288. Clinical psychiatry historically has focused on ___ and ____
    tertiary care; clinical management through outpatient services
  289. ___% of countries lack community based mental health approaches
    40
  290. In the 1990s, there was boom in _____
    public health reframing of mental, emotional and behavioral health
  291. The "Four Filters" of Mental Health Epidemiology
    1) population 2) attention in primary care 3) referrals to specialists 4) hospitalization 5) psychiatric inpatients
  292. The most expensive form of mental care is _____, which accounts for ___% of all psychiatric costs. It can also (3)
    Inpatient care; 85%; compound feelings of alienation, segregation, lead to human rights abuses, cause links to criminal justice system

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