PH Notes for Final PDF

‫בס"ד‬ Oct 30, 2024 Law Policy and Ethics Health Care - Access - Quality - Cost - What organizations are involved in the delivery of care - Insurances, health care coverage, medicare/medicaid - Hospitals and professional licenses in public health Publ...

‫בס"ד‬ Oct 30, 2024 Law Policy and Ethics Health Care - Access - Quality - Cost - What organizations are involved in the delivery of care - Insurances, health care coverage, medicare/medicaid - Hospitals and professional licenses in public health Public/Private Insurance: No emergency life threatening disease or women in labor is allowed to be turned around at any hospital public or private Public- see anyone who comes un, accept medicare/medicaid Private- dont have to accept both types of insurance, they don't have to accept all types of private insurance License: The state is responsible to license the person who provides treatment or care to people Healthcare- medical professionals, nurses, PA, social work manicure, massage etc. Public Health - Food and Drug, FDA, EPA, epidemiology - Bioethics- people who specialize in the ethics of medicine - Stem cells which are taken from miscarried or aborted babies RL What Legal Principles underline Public health and care - The Constitution governs some issues but - There are legal principles that can be applied to be health related - Police power- we accept that the police can take action to protect individuals and the common good. They can do this through infringing on the rights of a person - Interstate commerce regulations- we apply this to allow us to control healthcare - HIPPA policy Nov 11, 2024 Healthy people is a publication by the government and they go into the issues that affect the health of the US population - It is an effort to prioritize research and funding for what is most important at that time - Directs public health activities Different philosophies towards the role of government affect health policies: 2 categories: 1. Social justice  ‫בס"ד‬ a. Everyone has a right to public health programing and we are the ones who will provide that for everyone b. Health care Social resource 2. Market justice a. People should get what they deserve, if you have money you get health care, i should not have to support health care for other people b. Health care is an economic goal Implications of Market and Social Justice Advanced Directive- what type of treatment would a person want if the person ended up in a specific state - Living will- how would they want to be treated - But you can't foresee every situation, and you won't be able to know what medical advanced will be at that time - Health Care proxy- you appoint a particular person who will make decision about your healthcare, if the person and make it themself Nov 13, 2024 Bioethical Principles - A code of ethics has been prepared through the Public Health Leadership to help guide decisions How does this apply to protecting individuals who participate in research Tusgigi: High population of low income black people and many of them were in the army - Researchers were studying syphilis(sexually transmitted disease) that can be treated with antibiotics - Theyw anted to see what would happen if they didnt treat them - They follows people in this community and monitored their symptoms - In the last stage people experience psychotic symptoms and die from it - There were many men that died from it, right before researchers who were studying their symptoms Clearly this was unethical Guatimala: they brought prostitutes who had syphilis into jails to see what would happen to the men in the prisons and if they would get it - Clearly unethical , but not criminal Prisoners are considered a vulnerable group and we can't really do the same type of studies that we used to do on them Belmont Report- adopted on a federal level, it says that we need to determine what it means to be a research participants and apply certain ethical principles 1. Respect for persons a. People are autonomous  ‫בס"ד‬ i. Protect those with diminished autonomy 1. fetuses, pregnant women, prisoners, minor children 2. Beneficence: do no harm, maximize benefits, minimizing harms as much as possible 3. Justice: fairness in distribution IRB- institutional review board - Any institution that receives federal funding and does research needs to have an IRB. - The IRB needs to approve all research projects before they are conducted and they need to monitor the progress while it is being conducted - It is a group of professionals from the institution Nov 18, 2024 Non-Communicable Diseases - Diseases that are not contageous - Cardiovascular, Cancer, Alzhimers, Mental health - These are the leading causes of death in most developed countries - In underdeveloped countries most deaths are from malnutrition, ebola and other contagious diseases Screening for these diseases - This is what brings early detection (secondary) - This has brought major success in screening for colon cancer and vision screening - Vision Screening: picks up problems with visual problems, but also there are eye conditions that can cause blindness, which can be detected through vision screening Four Criteria for a Screening Program: 1. The disease produce substantial death and/or disability a. They would not screen for the common cold 2. Early detection is possible and improves outcome a. It has to be helpful and able to identify through screening 3. There is a feasible testing strategy for screening a. The easier the better b. Hypertension screening- easy 4. Screening is acceptable Dec 2, 2024 Accuracy of Screenings: False positive or negative results - False negative- someone does have the disease but they get a negative - False positive- they don't have it, but they get a positive result Specificity and sensitivity  ‫בס"ד‬ Being able to catch all cases of the disease, but we don't want to pick up what's not really the disease - Sensitivity- does the test pick up ALL cases without missing cases - Specificity- does the test pick up ONLY cases We want high levels of both, picking up all cases with no false positivity There can be unnecessary procedures, extra cost and anxiety when there are false positives Prostate cancer- PSA- prostate specific antigen - The test is not very specific and picks up many cases that are not real concerns How can Cost-Effective Interventions Help us address the burden of noncommunicable disease? - Cost effectiveness combines issues of benefits and harms with issues financial costs - Cost of intervention, and effectiveness - Compares new interventions to the current ot standard intervention - If we already have one available we ask if the new intervention is more effective than what we already have - The new intervention should be lower cost and also higher effectiveness It might be still worthwhile if it does not have both Genetic Testing to Predict Disease and Disease Outcomes to allow more personalized medicine: Categories of potential uses of genetic testing - Predicting the risk of a disease - A genetic marker that will lead to the development of a disease - Pharmacogenetic testing - Figuring out which medication and treatment will be most effective based on the genetic makeup of the person - Reproductive Genetic Testing - Potential parents will be tested to see if they are carries for a condition Video: Genetic Testing and Mental Illness: Monogenic Diseases: - Easier to test for  ‫בס"ד‬ - You know exactly which gene will have the mutation Multifactorial Diseases - Combination of genetics and lifestyle. - Example: diabetes - Diet and genetics - Mental illness would be a multifactorial disease - NOT the same as other brain disorders such as dementia autism etc - Very common 19% of Americans will have mental disorders - It's not always chronic, sometimes it's isolated to a specific time such as postpartum depression Can you inherit a mental illness? Yes, but not so simple. Its complex and not easy to see Genes contribute to the development of a mental illness, but there are environmental factors that are also present (stress, trauma etc.) Genes only heighten the risk by a little bit Empiric Risk - How common it is in the family No genetic test can tell you with certainty who is at risk and what the chances are Personalized Medicine: which variation of the disease does the person have to decide what the best method of treatment is - Regardless, psychiatrists use population statistics to figure out what is most effective treatment Jewish genetics and Mental Illness: Jews are not more at risk than the rest of the population Schizophrenia in the Jewish Community: Ashkenazi Jews who have a variation of the NDST3 gene are 40 percent more likely to develop schizophrenia, but testing for the gene is still very difficult Huntington's Disease: - Detected between 40-60s - Treatments treat the symptoms that are specific to the person - Testing: There is a Gene test which is presymptomatic - The gene that is dominant Chapter 7: Communicable Diseases - They used to be the leading cause of death, but now we are good at preventing them. We have eradicated many diseases→ but we have seen some diseases return that we thought were eradicated How do we measure potential impact: Have a severe disability 1. Transmission 2. Period of communicability a. From incubation when the agent is in the body and if they are contagious they will spread the disease, and how long they are actually contagious for  ‫בס"ד‬ Modes of transmission of disease to humans: - Insects, animals, airborne, open sores, water, food, oral etc. What Public Health tools are available to address the burden of communicable diseases: - Creating a barrier between the agent and the person - Isolation or quarantine - Immunizations - Screening and case finding- finding infection agents - Not used often, but sometimes- blood donations are screened for HIV - Contact treatment along with treatment of the patient - Ex: chlamydia, a sexual tranmitted disease will be given treatment for both partners - Effort to maximize effectiveness of treatments and prevent resistance to treatment - Infections can mutate and will no longer respond to treatments - When people misuse antibiotics and staking htm when you don't have the disease, this will promote resistance, - Taking antibiotics that were not prescribed to you - Not taking the full dosage of your prescription Immunizations to prevent disease: Insecticide- putting a net around the insect bed in order to decrease the rate of malaria transmission Dec 4, 2024  ‫בס"ד‬ Eradication of a Disease: - No animal reservoir for the disease - Short life in the environment - Absence of long- term carrier state - Having the disease produces long term immunity - Vaccination produces long-term immunity - Herd immunity protects those who are susceptible - Easily identified disease - Effective post exposure vaccination Examples: Smallpox - We were effectively able to eradicate the disease Measles - Almost effectively able to eradicate but not fully - Its difficult to identify symptoms as being unique to the measles - The vaccine is only partially effective Rabies: Deadly unless treated, it is mainly transmitted from rodents. Animals can become infected by rabies There are public health policies to make sure household pets have a rabies vaccine so that if a person is bit by a pet that is owned by someone (than the pet is licensed) and they will know that the animal does not have rabies If a stray animal bites a person, they can get a vaccine after the bite and it will still be effective - You can bring the stray animal into animal control to make sure that the animal doesn't have rabies - Or you can just get the shot in order to be safe Dec 9, 2024 Aging Population (missing maybe) It's very difficult to define the criteria for “old people”. What is old? Breakdown: - Young old: 65-74 - Middle Old: 75-84 - Oldest Old: 85+ - Growing rapidly at this time because more people are living until this age than ever before. Also the baby boomers are this age now Programs for this population never included that many people, but now that population is a lot bigger (medicare social security etc) Research on Aging: Age effects  ‫בס"ד‬ - Underlying processes- biopsychosocial- The body changes - Hair greying Cohort Effects - People are influenced by circumstances unique to their generation - Example: the effects of the great depression Time of measurement effects - differences due to sociocultural , environmental historical events ar the time of data collection - Economic conditions - Something happening at data collection Research: Cross sectional design - Groups of people at different ages - Middle, young and old and you test them on IQ and you find that old people have lowest level of IQ - You can make a correlation between age and IQ Longitudinal Design - Age and time of measure can be confounds, they also get to practice as they get older, selective attrition- dropouts for a specific reason and one of the reasons could be that they are not doing well so they drop out, than you will get better results because the people who are not doing well will drop out Informed Consent - We need to make sure that they can give consent for being in the study but many of them will have conditions that will affect their cognition Types of Aging 1. Primary Aging a. Disease free development i. Slowed reaction time, wrinkling skin 2. Secondary Aging a. Diseases, lifestyle and environment, not inevitable i. Smoking gives more wrinkles 3. Tertiary Aging a. A rapid loss of cognitive/physical abilities that happen right before death i. Terminal drop Influences on Aging:  ‫בס"ד‬ Normative Age Related changes - Biological phenomenon - examples: puberty and menopause - Psychological - raising children is the number one stressor for people who have mental health diagnosis - Sociocultural - social clock factors such as age of retirement - A job creates social support - Jobs also create stress so not working can create a more stress free life Normative History- Graded Influences (cohort related) - Biological - Epidemics - pandemics can influence the aging process - Psychological - Stereotypes of older people - Body image , desired body image, this is influenced by culture and media - Sociocultural - Changing attitudes - Sexuality and drinking - Older people have high rates of HIV HIV is increasing across the board, but a higher increase in elderly people because they grew up at a point that they were not concerned about sexually transmitted infections and because they don't use birth control when they are elderly. Nonnormative Influences - Random rare events for a particular individual Age related Physiological Changes Immune Function - It takes a longer time to build up an immune response. It takes an older person a longer time to become immune to the disease. Older people are told to get vaccines earlier and younger people should wait until Oct-Nov time so that the immune response will last longer  ‫בס"ד‬ Higher Susceptibility to Certain Infections - UTI is very common in the elderly people - Older people will be LESS susceptible to some diseases that they have had in their life and are already immune More prone to serious consequence of illness Increase rates of almost all types of cancers Autoimmune disease are at increased rates in the elderly - Rheumatoid arthritis Common Age related Physiological Conditions - Diabetes Mellitus (type 2) - Bodies inability to use glucose, associated with weight - Osteoporosis - Course bones and easier to break - 65% of women over age 60 (post menopause), can also occur in men - Dexascan- looks at bone density that women do routinely - Osteopenia- a mild case that most women have some form of but the more severe one will turn into osteoporosis Menopause- the stopping of the production of estrogen and associated chemical , perimenopause- is the period before menopause. This also comes with psychological effects such as depression and changes in mental health Dec 16, 2024 - Falls and impaired mobility, vision and balance) - 30 percent over 65 fall annually - 240K hip fracture annually and 90 percent in women 65+ - Many need reading glasses for close vision - Arthritis (most common disorder in the elderly, causes pain and impairment) - 70 percent of older people have arthritis pain - 2 types of Arthritis: - Autoimmune- the body attacks the joints - Osteoarthritis- Wear and tear on your body, cushioning wears away and causes pain - The pain can be very debilitating- causes depression and difficulty sleeping and moving - Cancer - Much more common with age - Many older people have autopsies and they find that they had cancer also that was undiagnosed- Not just people with a diagnosis - Screening for Older population  ‫בס"ד‬ - Prostate screening for elderly men because it's so common in older men, they don't even suggest getting screened for this cancer The Older Driver: Many people continue driving into old age 18.5 million drivers over 70 13% of old traffic fatalities are older drivers 17 % of pedestrian fatalities Physical factors that affect driving ability: - Vision: light/dark adaptation to sensitivity to glare restricts useful field of vision - Changes in psychomotor speed - Trouble inhibiting irrelevant information Very few states make older drivers take a new assessment or road test Medications Patterns - People over 60 take 50% of all medication prescription and over the counter - Polypharmacy- average 6-7 medications per person - Adherence is lower - they forgot to take the medication (pillboxes and timers help with this) - Its expensive - Lack of information and understanding- they don't understand the instructions - Prior to 1990s, randomized clinical trials were not required for older adults Prescription Labeling - Study of 300 healthy elderly, carious reading levels- over 30 percent did not understand the drug info - Warning stickers and potentially dangerous- view and guess rather than read the print - Many bottles have symbols that show information but it's hard to understand (a sun, bread- take on a full stomach) Pharmacology: Physiological changes - Absorption- time to enter the bloodstream is much slower - Mistiming medication can lead to toxicity and side affects - This can cause delirium- temporary loss of awareness, when this happens it can cause other problems Dec 18, 2024 Demographic of the new old people New old people are more educated than old people were in the past The amount of people with college degrees increase as more people become educated There is more ethnically diverse older population and younger population  ‫בס"ד‬ - Increased amount of asian, hispanic and latina old people - Life expectancy for these groups is higher than for white and black people - Black men have the lowest life expectancy - Females have a much higher life expectancy in every ethnic category - This is all in the US Life expectancy: Men are more likely to die, men are “death prone” There are always more older women than men Asian women have less hot flashes than white women Characteristics of the new old: Functional Health Status: - Activities of daily living (ADLs_ - Eating, bathing, walking, bathroom, dressed (walking is the most common) - 20-50 percent over 85 need assistance - There are many devices that can help older people, but many older people are reluctant to using them because of the stigma - Many older people are struggling to take care of themselves because they are not insurance covered for things that would be helpful unless the situation is too dire There is a program that the government will pay the family member to take care of the old person Instrumental Activities of Daily Living (ADLs) Tabacco: Tobacco used to be glamorized and was told to be healthy and everyone was smoking Biomedical Basis of smoking harmful effects - Nicotine is an addictive drug and it is one of the most common drugs that people are addicted to in today's society Regulatory Restrictions: The government tried to take steps to restrict smoking once it was clear that it is bad for you It was a huge company and it was difficult to get legislation passed to limit tobacco - Warning label appear on packaging of ciggerettes - Counter advertising- for any cigarette advertisement, they are mandated to promote anti- smoking - A total ban on smoking advertising (not fully enforced) - Second hand smoking is carcinogenic- they started banning smoking in many public places such as restaurants and airplanes - Non smokers do not want to be affected by second hand smoke - Cigarettes are taxed heavily and they use the tax money to create anti smoking programs  ‫בס"ד‬ - Most states use the money for other things 1990’s Broad attack on tobacco Mr Butts was an executive tobacco company and he leaked documents to the government and this showed that tobacco companies KNEW that nicotine was addictive and harmful. People can now file lawsuits against tobacco companies