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Epidemiology and Evidence Based Public Health - Coggle Diagram
Epidemiology and Evidence Based Public Health
Colorectal Cancer
Incidence in younger populations has increased while decreasing in older populations
No increase in family history with increase in younger populations with CRC
10-12% of new diagnosis now
Increase seen in the west, not just US
Dropped in total populations by more thant 35%
Increases in early onset CRC by birth cohort are seen world wide
i.e. 40-49 y.o born in 1970 more likely than those born in 1950
Clinical Features for early onset CRC
Most don't have any obvious risk factors, actually have average risk
Few have first degree relatives or conditions that predispose incidence
Lack of clinical features makes CRC not considered in younger populations and delays diagnosis and treatments
Diagnosis and survival differ by race and ethnicity in younger populations
Genetics
Genetic Factors are a cause of early CRC
Many have genetic variants, not all have been tied to CRC though
Lynch syndrome is a large genetic marker
Mutations of APC also indicate
All young people with CRC are recommended to get genetic testing now
This testing didn't find genetic variants in 80% of young people
Types of cell mutation are different depending on age of development of CRC
Risks Associated with CRC
obesity
smoking
Alcohol
red/processed meat
non-steroidal inflammatory drugs
diet
Micronutrients
physical activity
Chronic Conditions
Timing and duration of risk factors important to consider
Reducing Incidence
Screening has been moved to 45
We need to redefine what we consider persons at risk to be
Risk prediction models
Identify red flag symptoms
5 basic questions in evidence based public health
P - problem: What is the health problem
E - etiology: what is/are the contributory causes
how to establish contributory cause
cause is associated with effect
cause precedes effect
altering cause alters effect
case control studies
cohort studies
randomized controlled trials
Once determined we need stronger evidence
strength of relationship
dose response relationship
consistency of relationship
biological plausibility
R - recommendations: What works to reduce the health impacts
quality of evidence and magnitude of impact
I - Implementation: how can we get the job done?
Primary
Secondary
Tertiary
E - evaluation: How well does/do the interventions work in practice?
efficacy
RE-AIM
Multiple approaches
Describing a health problem
address burden
occurrence of disability and death because of the disease
Course of disease important in addressing the burden
both create rate to measure the burden
true rate includes a measure of time
distribution of disease
Associations
Group
may hypothesize or suggest cause of dieases
Person factors
population comparisons
A hypothesis that requires investigation
Doesn't ensure a cause and effect relationship exists
confounding variables
Ecological
Place factors
Also include non physical connections between people
Is there another explanation?
Look at 3 things to determine if differences and changes are real or artifactual
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
Artifactual differences can produce real changes in the long run