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Slide-1 1- Understand the dread effect, unfamiliarity effect, uncontrollability effect. 2- Dread effect: Perception of an increase in the probability of occurrence of an event due to its ease of being able to be visualized and its feared consequences. The dread effect is present with hazards...

Slide-1 1- Understand the dread effect, unfamiliarity effect, uncontrollability effect. 2- Dread effect: Perception of an increase in the probability of occurrence of an event due to its ease of being able to be visualized and its feared consequences. The dread effect is present with hazards that easily produce very visual and feared consequences. It explains why we often fear shark attacks more than drowning in a swimming pool. The dread effect may also be elicited by the potential for catastrophic events, ranging from nuclear meltdowns to a poisoning of the water supply. 3- Unfamiliarity effect: Perception of increased probability of an event due to an individual’s absence of prior experience with the event. Our degree of familiarity with a potential harm or a potential benefit can greatly influence how we perceive data and translate it for our own situation. Knowing a friend or relative who died of lung cancer may influence how we perceive the information on the hazards of smoking or the presence of radon. 4- Uncontrollability effect: Perception of increased probability of occurrence of an event due to the perceived inability of an individual to control or prevent the event from occurring. The uncontrollability effect may have a major impact on our perceptions and actions. We often consider hazards that we perceive as in our control as less threatening than ones that we perceive as out of our control. Automobile collisions, for instance, are often seen as less hazardous than commercial airplane crashes, despite the fact that statistics show that commercial air travel is far safer than travel by automobile. 2- Know the difference between disability adjusted life expectancy (DALE) vs. life expectancy life year (LELY) vs. disability-adjusted life year (DALY) vs. health-adjusted life expectancy (HALE) and understand the impact of each. Life expectancy life year (LELY): Life expectancy has been used to measure the overall death experience of the population, incorporating the probability of dying at each year of life. (Terms of deaths in a particular year). Life expectancy cannot be used to accurately predict future life spans, especially for newborns. - Life expectancy: The calculation of the average age of death of a certain population. The population may be characterized by such things as gender or ethnicity. Life expectancy at birth is “the average number of additional years a newborn baby can be expected to live if current mortality trends were to continue for the rest of that person’s life. Health-adjusted life expectancy (HALE): A population health status measure that combines life expectancy with a measure of the population’s overall quality of health. ▪ The HALE measurement starts with life expectancy and then incorporates measurements of the quality of health. This measurement incorporates key components, including: - Mobility—the ability to walk without assistance - Cognition—mental function, including memory - Self-care—activities of daily living, including dressing, eating, bathing, ) - Pain—regular pain that limits function - Mood—alteration in mood that limits function - Sensory organ function—impairment in vision or hearing that impairs function  The quality of health measurement is multiplied by the life expectancy at birth to obtain the HALE. The under-5 mortality and HALEs are used by the WHO as the standard measures reflecting child health and the overall health of a population. Disability-Adjusted Life Year (DALY): A population health status measure that incorporates measures of death and disability and allows for measurement of the impact of categories of diseases and risk factors 3- Know example of a specialized technical organization to address diseases. Best known example is the CDC (Centers for Disease Control and Prevention) Assists with planning and carrying out surveillance, prevention, and control across a broad range of disease conditions Also provides technical assistance for disease control programs to build capacity in low- and middle-income countries 4- Know the definition of stewardship. The wide range of functions carried out by governments as they seek to achieve national health policy objectives/The careful and responsible management of something entrusted to one’s care. 5- Understand the scope of quality in the health care sector. The United States Institute of Medicine (IOM) defines quality as “the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.” Issues Health services should be safe, effective, patient-centered, timely, efficient, and equitable Quality varies between and within systems Causes can include poor management, lack of financial resources, poorly trained staff, underpowered patients, and no system for monitoring the performance of the health system Concerns Carry out assessments of quality gaps Better professional oversight, supervision, and continuing training Use of clear guidelines, protocols, and algorithms When contracting out services, link payment to performance Focus on staff being proficient at selected tasks 6- Understand the different types of investigations/study types – for e.g. randomized control trials, observations. Population/ecological studies. Randomized control trials – highest Quality of the evidence investigations and how well the investigation was conducted. observations. Population/ Assess people’s perceptions of their own needs and quality of life through data collection activities such as surveys, interviews, focus groups, and observation. ecological studies- Ecological risk assessment examines the impacts of contaminants on ecological systems ranging from chemicals, to radiation, to genetically altered crops  Slide-2 7- Understand the concept of contributory cause. A definition of causation that is established when all three of the following have been established: 1. The existence of an association between the “cause” and the “effect” at the individual level. 2. The “cause” precedes the “effect” in time. 3. Altering the “cause” alters the probability of the “effect”. Koch’s Postulates: Four Conditions to Establish Contributory Cause of CD 1. The organism must be shown to be present in every case of the disease by isolation of the organism 2. The organism must not be found in cases of other disease 3. Once isolated, the organism must be capable of replicating the disease in an experimental animal 4. The organism must be recoverable from the animal 8- Understand course of disease vs. burden of disease. Burden of disease: Generically, an analysis of the morbidity and mortality produced by disease. Course of a disease: The course of the disease asks how often the disease occurs, how likely it is to be present currently, and what happens once it occurs. - A description of a disease or other condition often using incidence, prevalence, and case-fatality. 9- Know what epidemiologists do for a living. Epidemiologist: An investigator who studies the occurrence and control of disease or other health conditions or events in defined populations. - Investigate factors known as “person” and “place” to see if they can find patterns or associations in the frequency of a disease 10- Know the connection between socioeconomic status and health outcomes. 11- Know examples of social determinants of health. Social determinants of health refer to the conditions in which people are born, grow up, live, learn, work, play, worship, and age, as well as the systems put in place to deal with illnesses that affect health and quality of life. These conditions are shaped by a wider set of forces, including economics, social policies, and politics. - The complex, integrated, and overlapping social structures and economic systems including the social environment, physical environment, health services, and structural and societal factors. 10 Key Categories of Social Determinants of Health: Social status Social support or alienation Food Housing Education Work Stress Transportation Place Access to health services 12- Understand the concept of surveillance. Public health Surveillance: Collection of health data as the basis for monitoring and understanding health problems, generating hypotheses about etiology, and evaluating the success of interventions (Synonym: public health surveillance).  - Data from public health surveillance is collected, published, and distributed without identifying specific individuals. Data of this type come from a growing variety of sources. It is helpful, however, to classify these sources according to the way they are collected 13- Know the scope of credentialing. (Chapter 9 M 10) An individual, not the institution, is evaluated Process of verifying that an individual has the desired or required qualifications to practice a profession Often in the form of certification, where successful completion of formal exams leads to recognition a. Defines specialties and subspecialties within a profession b. Usually a prerequisite for licensure Slide-3 14- Understand downstream factors and upstream factors. The behavior of individuals is often the final common pathway through which disease, disability, and death can be prevented. The forces at work to mold individual behaviors are sometimes referred to as: 1. Downstream factors: that directly involve an individual and can potentially be altered by individual interventions, such as an addiction to nicotine. 2. Mainstream factors: that result from the relationship of an individual with a larger group or population, such as peer pressure to smoke or the level of taxation on cigarettes 3. Upstream factors: often grounded in social structures and policies, such as government sponsored programs that encourage tobacco production. 15 - Know the benefits of hand washing. (chapter 8 M11) o Hygiene promotion can lead to a 33% reduction in diarrhea morbidity o Focus should be on simple messages about handwashing and enabling handwashing o Handwashing associated with significant reductions in acute respiratory infections, as well 16 Know the core public health functions. 1. Assessment: Obtaining data that defines the health of the population overall and specific groups within -Monitor health status to identify and solve community health problems - Diagnose and investigate health problems and health hazards in the community 2. Policy development: -Developing evidence-based recommendations and other analyses of options to guide implementation - 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 3. Assurance: Oversight responsibility for ensuring key components of an effective health system. - Enforce laws and regulations that protect health and ensure safety  - Link people to needed personal services and ensure the provision of health care when otherwise unavailable - Ensure the provision of a competent public and personal healthcare workforce - Evaluate effectiveness, accessibility, and quality of personal and population-based health services All three core functions - Research for new insights and innovative solutions to health problems 17- Know the strategies used to address the rising rate of non-communicable diseases in Saudi Arabia and other regions. o Reduce cardiovascular disease burden related to tobacco o reduce road traffic accidents Strengthen health systems o Adopt models of care that aim to more contacts with patients o public health in KSA focus on behavioral change and lifestyle factors. o Most risk factors, such as unhealthy diets and physical inactivity, 75% -of chronic conditions can be attributed to lifestyle w/ can increase heart disease, diabetes, cancer, and pulmonary diseases, 18- Know the difference between the high-risk approach and the improving the average approach. High-risk approach Focuses on those with the highest probability of developing disease and aims to bring their risk close to the levels experienced by the rest of the population Improving-the-average approach Focuses on the entire population and aims to reduce the risk for everyone 19- Know the history of mandatory vaccination in KSA. 1970s: Mandatory Vaccinations in KSA. which contributed to a steep decline in the under-five mortality rate, which is now fewer than 15 deaths per 1,000 live births (World Bank, 2016). Ministry of Health vaccination recommendations are detailed on its official vaccination certificates. Slide-4 20- Know the top causes of injury in KSA and preventative measures. In KSA, Road accidents are a major cause of injury which causes lost disability-adjusted life years (DALYs). There is a call for raised public awareness and collaboration between the Ministry of Health and citizens to address this issue. Public health systems, composed of government, private, and public entities working together, will continue to address citizens’ healthcare needs through their infrastructure and delivery of care. Robust health systems engaged in constant surveillance and outbreak verification are essential to controlling and managing disease. The Ministry of Health has developed multiple awareness campaigns to educate residents on public health concerns such as tobacco use, vaccinations, and breast cancer. Also, a reporting and collection system for communicable disease has been established to monitor and contain disease outbreaks. This includes: - Collection of local data where the disease occurs. - Collection of data at the district-, state-, or province-level.  - Compilation of data nationally. - Reporting of data to the WHO for certain diseases that are covered by international health regulations - Haddon’s Matrix Theoretical foundation of prevention and control efforts Demonstrates interaction of environment, vector, and host Prevention measures focus on education, enforcement, and engineering efforts within this context Example: Road Traffic Injuries Environment: Roadway Vector: Driver Host: Human driver and behavior Possible Interventions: Make roads safer by improving high-risk intersections and routes, improving medians, and enhancing lighting Make safer vehicles by engineering safety features into them Enforce speed limits and use of helmets 21-Know the difference between communicable and non-communicable diseases and examples for each. Noncommunicable diseases represents a wide range of diseases, from cardiovascular disease, cancers, and depression, to Alzheimer’s and chronic arthritis. - The impact of noncommunicable diseases on death only reflects part of the influence of these diseases on people’s lives. Chronic disabilities, largely due to noncommunicable diseases, are now the most rapidly growing component of morbidity in most developing as well as developed countries. As populations age, noncommunicable diseases increase in frequency. Communicable disease: A disease due to an organism such as bacteria or a virus that is transmitted person-to- person or from animals or the physical environment to humans by a variety of routes, including from air and water, contaminated articles or fomites, and insect bites and animal bites. Here considered a subset of infectious disease - May be caused by a wide variety of organisms, ranging from bacteria, to viruses, to a spectrum of parasites, including malaria and hookworm. 22-Know countries has a complex and fragmented healthcare system. High-Income Countries The United States Complex and fragmented Over half of the population has private insurance, about 37% are covered by government insurance, and about 9% are uninsured  No standard package of insurance benefits 23- Know the modern Koch’s postulates developed by the National Institute of Allergy and Infectious Disease. Koch’s Postulates: Four Conditions to Establish Contributory Cause of CD 1. The organism must be shown to be present in every case of the disease by isolation of the organism 2. The organism must not be found in cases of other disease 3. Once isolated, the organism must be capable of replicating the disease in an experimental animal 4. The organism must be recoverable from the animal 24-Know R naught and role in communicable diseases. R (R naught) has gained wide visibility through movies and the media as an indication of the potential of a disease to cause an epidemic. R is increasingly being used as a measure of the potential for transmission of a communicable disease. - The number of new cases one individual with the disease generates on average over the course of the disease’s communicable period (synonym: reproduction number, reproduction ratio) - R is intended to measure the average number of infections produced by an infected individual exposed to an otherwise entirely susceptible population. - R has been used to estimate the degree of communicability of a disease and the potential of the disease to lead to an epidemic. - When R is greater than 1, it implies that each infected individual will on average infect more than one previously uninfected individual. Therefore, an R of greater than 1 implies that the number of infections will increase over time and produce an epidemic. From slide- R naught has been used to estimate the degree of communicability of a disease and the potential of the disease to lead to an epidemic Factors that have a major impact on R naught: – Route of transmission – Period of communicability Slide-5 25- Understand equity vs. inequality. Health equity: Everyone should have the opportunity to pursue the healthiest life possible, no matter where they live or work, the color of their skin, or the amount of money they have. - Equity: Disparities in health services and health outcomes by racial/minority status and income using such measures as access to preventive and acute services, control of chronic diseases, insurance coverage, and measures of healthy lives Inequality: Differences in health status or in the distribution of health determinants between different population groups. - The World Health Organization (WHO) defines health inequality as “differences in health status or in the distribution of health determinants between different population groups  - Equity is about fairness, equality is about outcomes 26- Understand accreditation vs. credentialing. Accreditation A process applied to educational institutions, healthcare institutions, and governmental health departments, to define and enforce required structures, processes, and outcomes. - Accreditation implies a process of setting standards for educational and training institutions and enforcing these standards using a regularly scheduled institutional self-study and an outside review. Accreditation is used by most health professions to define and enforce educational expectations. At times, these expectations may be laid out in detail down to the level of square footage per student for laboratory space and the number of hours devoted to specific subjects. In other health professions, educational subject areas may be outlined and institutions left to judge how to best implement the curriculum Credentialing: A general term indicating a process of verifying that an individual has the desirable or required qualifications to practice a profession. - Credentialing implies that the individual, rather than the institution, is evaluated. “Credentialing” is a generic term indicating a process of verifying that an individual has the desirable or required qualifications to practice a profession. Credentialing often takes the form of certification. Certification is generally a profession-led process in which applicants who have completed the required educational process take an examination. Successful completion of formal examinations leads to recognition in the form of certification. 27- Understand the impact of natural disasters A disaster is “any occurrence that causes damage, ecological destruction, loss of human lives, or deterioration of health and health services on a scale sufficient to warrant an extraordinary response from outside the affected community area.” - Another way to think of this would be as “an occurrence, either natural or manmade, that causes human suffering and creates human needs that victims cannot alleviate without assistance.” The direct and indirect health effects of natural disasters depend on the type of disaster. - Earthquakes can kill many people quickly. In addition, they can cause a substantial number of injuries in a very short period of time. In the longer term, earthquake survivors face increased risks of permanent orthopedic disabilities, mental health problems, and possibly an increase in the rates of heart disease and other chronic disease long-lasting, such as mental health problems - The indirect effect of earthquakes on health depends on the severity and location of the earthquake and the extent to which it damages infrastructure and forces people out of their homes. 28- Know the role of genetic testing in public health. Genetics—the revolution in genetics has focused our attention on roles that genetic factors play in the development and outcome of disease.  Interventions for diseases with a genetic component have been part of medical and public health practice since at least the 1960s, when it was recognized that abnormalities of single genes for such conditions as sickle-cell anemia could be detected by testing potential parents who could then be counseled on the risks associated with childbearing. Potential uses of genetic testing have been categorized as follows: 1. Predicting the risk of a disease- identifies gene variants that increase an individual’s risk of developing a disease. 2. Pharmacogenetics testing - provides information about how individuals will respond to drugs. 3. Reproductive Genetic Testing - aims to identify people who are at increased risk for having a child who has a genetic disease 29- Know the role of emergency medical services in low-income countries Low-income countries should now examine investments in low-cost but effective ways of improving emergency medical services in their countries: - One important measure would be to arrange for emergency transport. This could be in special vehicles made for low-income or rural communities or it could be advance arrangements with the owner of available transport. - A bicycle ambulance was established in Malawi for the transport of obstetric emergencies and turned out to be used more for medical emergencies and dealing with accident victims. - One could train members of the community who frequently come in contact with road accidents, such as truck drivers, in how to provide first aid and transport to accident victims. - Low-income countries could also begin to invest in better training of healthcare personnel who work in emergency services. They could do the same in emergency transport services based in selected. Slide-6 30- Understand unaltered (natural) vs. altered environments. Environment—Environmental factors determine disease and the course of disease in a number of ways. - The unaltered or “natural” physical world around us may produce disability and death from sudden natural disasters, such as earthquakes and volcanic eruptions, to iodine deficiencies due to low iodine content in the food-producing soil. - The altered physical environment produced by human intervention includes exposures to toxic substances in occupational or nonoccupational settings. The physical environment built for use by humans (the built environment) produces determinants ranging from indoor air pollution, to “infant-proofed” homes, to hazards on the highway 31- Understand the concept of nonintentional injuries – example, common result, indirect costs. Chapter 15 M 12 Unintentional injuries: Harms that occur not on purpose—that is, not by intention, it encompass injuries sustained in motor vehicle collisions, drownings, falls, fires, unintentional poisonings, and many other incidents.  - Unintentional injuries are “that subset of injuries for which there is no evidence of predetermined intent.’. Burden of unintentional injuries: - The economic burden due to such injury includes direct costs such as medical care, hospitalization, rehabilitation, and funeral fees, as well as indirect costs such as lost wages, sick leave from work, disability payments, insurance payouts, and costs associated with family care. - The World Health Organization (WHO) estimated in 2006 that the direct costs due to road traffic injuries alone were about $500 billion annually, with the share borne by the low- and middle-income countries - The consequences of unintentional injury are not limited to financial costs. There are significant social consequences for individuals and families that may be associated with such injury. T - The long-term physical and psychosocial consequences of unintentional injuries. Persisting problems with pain, fatigue, memory, and psychosocial functioning are common in victims of trauma. 32- Know factors Affect How We Perceive Public Health Information Dread effect: Perception of an increase in the probability of occurrence of an event due to its ease of being able to be visualized and its feared consequences. The dread effect is present with hazards that easily produce very visual and feared consequences. It explains why we often fear shark attacks more than drowning in a swimming pool. The dread effect may also be elicited by the potential for catastrophic events, ranging from nuclear meltdowns to a poisoning of the water supply. Unfamiliarity effect: Perception of increased probability of an event due to an individual’s absence of prior experience with the event. Our degree of familiarity with a potential harm or a potential benefit can greatly influence how we perceive data and translate it for our own situation. Knowing a friend or relative who died of lung cancer may influence how we perceive the information on the hazards of smoking or the presence of radon. Uncontrollability effect: Perception of increased probability of occurrence of an event due to the perceived inability of an individual to control or prevent the event from occurring. The uncontrollability effect may have a major impact on our perceptions and actions. We often consider hazards that we perceive as in our control as less threatening than ones that we perceive as out of our control. Automobile collisions, for instance, are often seen as less hazardous than commercial airplane crashes, despite the fact that statistics show that commercial air travel is far safer than travel by automobile. 33- Know WHO’s structure, role, and limitations. 34- Be able to describe the TB alliance. TB Alliance, formally known as The Global Alliance for TB Drug Development, is a non-profit organization founded in 2000, dedicated to discovering and developing new, affordable tuberculosis (TB) treatments. Headquartered in New York City, it manages the largest pipeline of new TB drugs in history, addressing the urgent need for faster and more effective therapies, especially in developing countries where TB is prevalent. TB Alliance collaborates with various sectors to ensure that new treatments are accessible and affordable, aiming to combat the rising threat of drug-resistant TB. 35- Know how public health officials define a health problem: burden of disease, the course of disease, the distribution of disease. Burden of disease – The occurrence of disability (morbidity) and death (mortality) due to a disease Course of disease – How often the disease occurs, how likely it is to be present currently, and what happens once it occurs Distribution of disease – Who? When? Where? More about Distribution of disease: How Can Understanding the Distribution of Disease Help Us Generate Hypotheses About Disease Causation? – Assists epidemiologists in finding group associations or patterns in the frequency of a disease To gain a greater understanding, we examine: – Person: Demographic characteristics, behaviors, exposures – Place: Geographic location and non-physical connections between people – Time How Do Epidemiologists Investigate Explanations For Changes in the Distribution of Disease? Three basic reasons that changes in rates may be artifactual rather than real: – Differences or changes in the interest in identifying the disease – Differences or changes in the ability to identify the disease – Differences or changes in the definition of the disease