Public Health & Medical Humanities Important Points PDF

Public health 01 - What is Public Health: The 5 P’s of Public Health: o Prevention o Promotion o Protection o Population-based. o Preparedness (the newest one) Compare between Public health and Medicine: o Pub...

Public health 01 - What is Public Health: The 5 P’s of Public Health: o Prevention o Promotion o Protection o Population-based. o Preparedness (the newest one) Compare between Public health and Medicine: o Public Health ▪ Population ▪ Disease Prevention ▪ Health Promotion ▪ Interventions: Environment and Human behavior ▪ Government (some Private) o Medicine ▪ Individual ▪ Diagnosis ▪ Treatment ▪ Intervention: Medical care ▪ Private (some Public) Prevention is better than treatment because it’s: o Cheaper o Easier o Safer for the patient A dictionary Definition of Public Health: o the science and practice of protecting and improving the health of the community, as by preventive medicine, health education, control of communicable diseases, application of sanitary measures, and monitoring of environmental hazards. CEA Winslow Definition of Health: o The science and art of preventing disease, prolonging life, and promoting health and efficiency through organized community effort. What are the images of public health: o The System and Social Enterprise (Including the Nation’s Public Health Infrastructure) o The Profession (Professionals and the Workforce)  o The Methods (Knowledge and Techniques Applied to Health-related Problems) o Governmental Services (Especially Medical Care for the Poor) o The Health of the Public (the Intended Results of Public Health Endeavors, as Measured by the Levels of Health and Illness in the Population) 02 – History of Epidemiology: Jhon Snow Formulated a natural epidemiological experiment to test the hypothesis that cholera was transmitted by contaminated water. What are the levels of prevention: o Primary Care: Control of risk factors o Secondary Care: Reduction in diagnosis o Tertiary Care: Reduction of complications 03 - History Of Public Health: When did public health become important? o When health became a social responsibility Quality of life depends on o Education level o Lifestyle o Health o Economic Level What are the requirements of survival: o Air o Water o Food o Shelter o Care Ancient Greeks focused on Personal Hygiene and Fitness and believed in the Naturalistic concept. Hippocrates is the father of medicine. Jhon Snow is the father of Public health and Epidemiology. Jhon Snow created an Epidemiological map of London. The roman empire stopped drinking water due to lead poisoning. Edward Jenner discovered vaccines. William Harvey described blood circulation. What are the 10 greatest achievements of public health? o Vaccination. o Motor-vehicle safety.  o Safer workplaces. o Control of infectious diseases. o Decline in deaths from coronary heart disease and stroke. o Safer and healthier foods. o Healthier mothers and babies. o Family planning. o Fluoridation of drinking water. o Recognition of tobacco use as a health hazard. Sewage means dirty water. Six public health branches: o Epidemiology o Biostatistics o Health Management o Occupational health o Environmental health o Health education What are the Disparities of Health: o Infant / Maternal Mortalities o Life Expectancy at birth o Cancer screening and management o Cardiovascular Diseases o Diabetes o HIV/AIDS o Immunization What are three indicators to manage health levels to influence society? o Infant mortality rate o Maternal mortality rate o Mean duration of life at birth 04- Concepts of health and disease: Compare the Different Concepts of health: Concepts of health Biomedical Ecological Psychosocial Holistic Concept Concept Concept Concept  Biomedical Concept: "absence of disease" o Views the human body as a machine, o Views disease as a consequence of the breakdown of this machine. o The doctor’s task is to repair the machine. o Limitation- it has minimized the role of environmental, social, psychological & cultural determinants of health. Ecological Concept: o Health = is a dynamic equilibrium between man & his environment, o Disease = maladjustment of the human organisms to the environment. o The concept supports the need for clean air, safe water, ozone layer in the atmosphere, etc. To protect us from exposure to unhealthy factors. Psychosocial Concept: o Health is not only a biomedical phenomenon, but one which is influenced by social psychological, cultural, economic and political factors of the people concerned. Holistic Concept: o Comines the biomedical, ecological, and psychosocial concepts. o It has been defined as a unified or multidimensional process involving the well- being of the whole person in the context of his environment. The holistic concept implies that all sectors of society have an effect on health. What is the criticism for WHO definition of health? o It describes health as a static condition, but it’s a dynamic condition that can be improved and promoted. What are The Best indicators to measure health levels? o Infant mortality rate o Maternal mortality rate o Mean duration of life at birth The state of health is reflective of an individual's ability to meet life's challenges & maintain the capacity for optimal functioning.  05- measurements in medicine Illness is subjective, relates to the experience to the patient (symptoms) Disease is objective, relates to the physician and the medical preceptive (Signs) Sickness relates to society and social roles, absence from work, inability to fulfill family obligations, effect on other people. Infirmity is the loss of bodily functions. o Disability: loss of bodily function o Handicapped: Loss of bodily function and social roles Colic: a very intense pain In cross-sectional studies, we only ask participants once, no follow-up. There are two measurements in medicine: o Prevalence: a proportion, includes old and new cases, a well-defined time, population, and situation, static (old cases /total population). ▪ Point Prevalence : "at the moment" question. ▪ Period Prevalence: : "in the past X" Question, Keep it shorter than 5 years to avoid Recall (bias, human memory is unreliable) ▪ Life-time Prevalence" "have you ever" question o Incidence: a proportion, includes only new cases, a well-defined time, population, and situation, dynamic ▪ Risk ( Cumulative Ratio) (new cases/ total population) ▪ Odds (new cases/ total population – new cases) ▪ Incidence Rate (new cases/ total duration diseased people lived) What are the goals of incidence rate? o Stop new cases. o Increase treated cases.  o Reduce death cases What does C.P (Ceteris paribus) mean? o Other things equal 06 – health systems What are the 5 Fundamental Competence of Health Professionals o Providing Patient oriented service o Working as an interdisciplinary team member o Evidence based practice. o Provision of continuous quality improvement o Maximum utilization of information technologies What are the six principles of a health system? o Safe o Effective o Patient-Oriented o Timely o Efficient o Equitable What does “efficiency” mean? o To produce as much health quality as possible for the lowest possible cost. What is the difference between efficiency and effectiveness? o Effectiveness: is under normal (real world) conditions o Efficiency: is under ideal (lab) conditions What are some issues of effectiveness? o Misuse o Overuse o Underuse What are the types of health service delivery? o Preventive care: staying Healthy. o Acute Care: Treatment and curing. o Chronic care: Living with chronic diseases. o Palliative care: Providing Terminal Patients (patients expected to die) with best possible quality of life 07 - introduction into health systems: What are the resources of a health system? o Human resources o Financial resources  o Physical structures o Medical & non-medical devices o Information systems o Drugs o Security What are the three main health models? o The Beveridge model (UK) (taxes) o The Bismarck model (Germany and Turkey) (premium) o The private model (USA) (out of pocket) WHO’s ten main divisions of a health system analysis: o Stewardship o Financing o Human resources o Information o Knowledge o Drugs and health technology o Research o Service provision o Equity o Health and development The Main interests of groups of Health systems are: o Patients o Health Professionals o Funding organizations o Health Service Providers ( Hospitals, clinics) Roles in Health systems: o Regulations: Government o Financing: Government and/or Private o Provision: Government and/or Private What is the difference between Information and knowledge? o Information: statistics and data, o Knowledge: skills and understanding What are the characteristics of a health system? o Interdependent o At least two components o Certain limit o Recognized  o Organized What are the factors of a health system? o Economic factors o Political factors o Cultural factors 08- Health services Definition of Health Care: o All of the work done in order to increase, develop and maintain the health level of community and individuals In the frame of Health protection, Treatment of diseases, and Rehabilitation. What are the types of health services? o Preventive services ▪ Individual based services ▪ Community based services o Curative Services ▪ First step Curative ▪ Second step Curative ▪ Third step Curative o Rehabilitation Services ▪ Physical rehabilitation ▪ Social rehabilitation 09 – healthy urban governance: What does good urban governance lead to? o Better housing and living conditions. o Access to safe water and good sanitation. o Efficient waste management systems. o Safer working environments and neighborhoods o Food security. o Access to services like education, health, welfare. What are the three main aspects to understand the Urban Impacts on Epidemiology and Health Delivery Inequalities? o There are cities in the city (no average) o Interaction between the Different Sectors on the Determinants of health (housing, sanitation, sewage, etc.) And biomedical sector  o Reciprocal Links between Urban Dynamics and Health Dynamics, Urban Health is a cause and a consequence of urban development. 11 - Patient Reported Outcomes and QALY What is the difference between profile and Index? o Profiles describes a single aspect of something, while an Index is the average of several Profiles. Know how to calculate QALY or DALY 12 - Surveillance and Reporting of Communicable Diseases: The most frequently used concepts in hazard estimation: o Infectivity: The ability of the agent to reach the healthy person, settle in the tissue and reproduce (Measured in practice) o Virulence: Defines the severity of the disease that the agent will cause in the human (determined in the laboratory environment) o Pathogenicity: It is the ratio of those showing disease agents among the hosts where the agent is placed Examples of Transmission Modes: Mode of Examples Transmission Air Tuberculosis, Measles Water-Food Typhoid, Cholera, Dysentery Direct contact Trachoma, Leprosy, Skabies Sexually Syphilis, Gonorrhea, HIV / AIDS, HepatitisB  Vector Malaria, Filarzias Free, Plague Animals Anthrax, Rabies, Psittacosis Surveillance was put forward at the beginning of the 19th century For protection, control, follow-up purposes, like: o Continuous and systematic data collection o Data analysis o Feedback o Interpretation of findings Characteristics of Data: o Appropriate o Complete o True o Current Road Bends of Communicable Diseases: Things should be Done Before the Emergence o Reaching the adequate level of health protective measures o Infectious diseases can reach healthy people and threaten society. o The usefulness of the work to be done after the emergence of the disease depends on the adequacy of the measures taken before the outbreak. o If the necessary precautions are not taken, what is done after the disease is out may be ineffective.  Things should be Done After the Emergence (Studies to be Done After the Cases Reported): o Field inspection/filiation o Case studies o Outbreak investigation Why do We Need Filiation against Measles? o Its highly contagious o It has serious complications o It is preventable with a vaccine o All countries are running an elimination program 13 - QALY and DALY Measures: QALY: a criterion by which health-related quality is calculated together for different periods of life. [0 represents death - 1 represents excellent health]. DALY: an absolute measure of health loss that counts the years lost due to early deaths and diseases and injuries that do not result in death but cause long-term loss of function. [0 represents excellent health – 1 death]. If the cost of a medical intervention is to be compared with the gains, the QALY gain due to the intervention and the reduction of the DALY (loss) due to the intervention will yield similar values. DALY: o It is obtained by calculating the years of life with disability (YLD) or the years of life lost (YLL). o YLL is based on the gender and age specific line of a standard human life, "if there was no death, how many years would life continue with which functions?" calculated based on the question. o YLD, on the other hand, is the product of the severity of the disability and the time lived with this disability. The main purpose of this was to reveal the negative burdens of diseases and injuries on the health of countries according to disease classifications. Thus, based on these burdens, more accurate health policies and decisions would be produced. When do we use DALY? o If we are dealing with measuring the burden of injury/disease. 14 - Burden of Disease and Burden Surveys: The Most Common Causes of death: o Cardiovascular (ischemic heart disease, stroke). o Respiratory (chronic obstructive pulmonary disease, lower respiratory tract infections).  o Neonatal conditions (birth asphyxia and birth trauma, neonatal sepsis and infections and complications of preterm birth). Ischemic heart disease caused the most deaths and was responsible for 16% of total deaths. 15 - Women's Health: Fatality=dead/ diagnosed Mortality=dead/ whole population The average life expectancy for women worldwide is four years longer than the average for men, average life expectancy for women in developed countries is over 80, while in the African region is 58. Girls are sexually abused much more often than boys. Traffic accidents are among the most important causes of death for adolescent girls in developed and moderately developed countries. An average of 300,000 maternal deaths occur annually in developing countries. Cardiovascular diseases, which are generally considered to be an important problem for men, are also the number one cause of death in women. Breast cancer is the most important cause of death for women aged 20-59 (fertile women) worldwide. Infancy and Childhood (0-9 age group) o No difference between boys and girls o The main causes of death in the first month of life (0-30 days, the most risky periods of life) are pneumonia, prematurity, birth asphyxia and infectious diseases. o The leading causes of death in children under the age of five are pneumonia, prematurity, birth asphyxia and diarrheal diseases, malnutrition has an effect of 45% on deaths in this period. Adolescent Girls (10-19 years) o Mental Health and Injuries ▪ Self-harm, traffic accidents and drowning are the top causes of death. ▪ Depressive illnesses and schizophrenia are the most common disorders of the 15-19 age group. o HIV/AIDS ▪ In the 15-24 age group, the risk of contracting HIV/AIDS is 2 times higher in girls than in boys, and the most important factor in the emergence of this risk is unsafe/forced sexual intercourse. o Pregnancy in Adolescence ▪ Birth before Maturity is a Risk to the mother and child. ▪ Pregnant adolescents have higher rates of unsafe abortion than pregnant adults. ▪ Unsafe abortions lead to lifelong health problems or death.  ▪ pregnancy and childbirth complications are considered among the most important causes of death in girls aged 15-19 o Substance Abuse o Nutrition ▪ Anemia, especially iron deficiency anemia, increases the risk of bleeding and sepsis during delivery. ▪ Teenage girls and adult women are at the highest risk of developing anemia if they are deficient in iron in their diet due to menstrual bleeding and rapid growth. Maternal Health: o Many women die from Birth Complications o many women do not have access to modern contraceptive methods. Tuberculosis o Tuberculosis is often associated with HIV infection and is one of the top five causes of death in fertile women in underdeveloped countries. Breast Cancer o Breast cancer occurs with uncontrolled proliferation of cells in the breast, These out- of-control cells clump together to form a tumor, which may be palpable or x-rayed. mostly seen in women, rarely in men o the world's most common cancer o Worldwide, the number of DALYs due to breast cancer is higher than any other type of cancer. o Breast cancer occurs in women in all countries of the world at any age after puberty but increases after puberty. Behaviors and interventions that reduce breast cancer risk. o Long-term breastfeeding o Regular physical activity o Control of body weight o Avoiding harmful alcohol use o Avoiding exposure to tobacco smoke o Avoiding long-term hormone use o Avoiding excessive radiation exposure Even if all of the human-manageable risk factors could be controlled, this could reduce the risk of breast cancer by up to 30% Cervical cancer o The cervix is the most common cancer site after breast in women o All types of cervical cancer are associated with HPV.  o Due to the lack of screening and treatment opportunities, 90% of deaths from cervical cancer occur in less or moderately developed countries Breast Cancer Factors That Can Be Controlled: o Obesity o Not Having Children o Breastfeeding o Alcohol o Hormone Replacement Therapy o Exercise Breast Cancer Factors That Can’t Be Controlled o Age o Family/Personal History o Race o Treatment with DES o Radiation o Genetic Factors o Menstrual History o Reproductive History Health Promotion in Women: o Family Planning and Reproductive Life Planning o Keeping body weight at desired levels and preventing obesity o Increasing physical activity o Regular intake of essential nutrients daily o Folate o Prevention of substance and alcohol addiction o Prevention of sexually transmitted diseases o Prevention of depression 16 - Maternal and Child Health: Pregnancy can provide an opportunity to identify existing health risks in women and to prevent future health problems for women and their children. These health risks may include: o Hypertension and heart disease o Diabetes o Depression o Intimate partner violence o Genetic conditions o Sexually transmitted diseases (STDs)  o Tobacco, alcohol, and substance use o Inadequate nutrition o Unhealthy weight Phases of maternal health before pregnancy: o Nutrition ▪ fetal growth ▪ birth weight ▪ nutrition during infancy o Infections ▪ Maternal antibodies – passive immunity ▪ Maternal immunizations – protects against adverse outcomes Phases of maternal health during pregnancy: o Nutrition – weight, anemia o Care of the breast o Infections ▪ Rubella ▪ Syphilis ▪ Malaria ▪ UTI ▪ Tetanus immunization o Smoking o Heavy work and stress o Psychological stress Phases of maternal health during delivery and post partum: o Infections – ophtalmia neonatorum, tetanus neonatorum o Bleeding o Trauma o Asphyxia o Lactation o Birth spacing – family planning Cases of Maternal Mortality:  The 4 pillars of safe motherhood: o Family Planning o Antenatal Care o Clean Safe Delivery o Emergency Obstetric Care The four Pillars of Safe Motherhood is built upon Basic Maternity Care, Primary Health Care, and Equity For Women are Contraception can be: o Effective ▪ Drugs ▪ Vasectomy ▪ Condoms ▪ Tube Ligation ▪ IUD o Non-effective ▪ coitus interruptus ▪ Counting Fertile Days In developing countries 100/1000 (10%) children don’t live past one year, while in developed countries less than 10/1000 (