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Hows can we describe a health problem?, Strokes in young adults:…
Hows can we describe a health problem?
P
roblem: What is the health problem?
E
tiology: What is/are the contributory causes?
R
ecommendations: What works to reduce the health impacts?
I
mplemntations: How can we get the job done?
E
valuations: How well does/do the interventions work in practice?
These questions provide a framework for defining, analyzing, and addressing public health issues
Burden of disease
: the occurrence of a disability and death due to a disease
Morbidity
: Another word for disability
Mortality
: Another word for death
Course of a disease
: It ask how often a disease occurs, how likely it presents itself, and what happens once it occurs
-rates: measurement to find Burden and course of a disease
Distribution of disease
: It ponders who gets the disease, where are they located, and when it occurs.
Epidemiologist: These are the health professionals that investigate factors known as "person" or "place" to find patterns or associations in the frequency to the disease.
Group associations
: Group associations may suggest ideas or hypothesis about the cause or etiology of a disease
"Person": demographic charateritics that describe age, gender, race, and socieconomic factors
"Place": Geogrphic location like city or state and it also means connections like univeristy community or internt connections.
These are known as risk factors when they start to occur frequently among specific groups being effected by disease
Epidemiologist must determine of the changes are real or artificial based on three main reasons
Difference or changes in the internet in identifying the disease
Difference or changes in the ability to identify the disease
Difference or changes in the definition of the disease
Population comparisons are investigations that use information on groups or a population without having information on the specific individuals within the group
Etiology: reason for disease
Contributory cause
: specific causation for Public Health that requires to go beyond group association and creates 3 requirements
The "cause" is assosiated with "effect" at the individual level
The "cause" goes beyond the "effect" over time
Altering the "cause" alters the "effect"
Case Control or Retrospect studies
: most useful for establishing requirement number one
Cohort Studies or Prospect Studies
: Most useful for requirement two
Randimized controlled trials or Experimental studies
:Best for requirement three
Supportive or ancillary criteria: use to help establish the existence of the contributory cause
Efficacy: implies that an intervention works, if increase of positive outcomes or benefits in the population are being investigated
Criteria
Strength of the relationship: implies the interest in knowing how closely related the risk factors is to the disease
Relative Risk: probability of developing the disease if the risk factor is present compared to the probability of developing the disease if risk factor is not presented
Dose-response relationship
Consistency: implies that studies in different geographic areas and among wide range of people produce similar results
Biological plausibility: can we explain the occurrence of the disease based upon known and accepted biological mechanisms
Recommendations
: summeries of the evidens about which interventuons work to reduce the health impacts and they indicate whether actions should be taken
Interventions range from individual counseling and prescriptions to group efforts
Implementations
:Strong reccommendation based upon the evidence
Naturally occurring implementations itself my be part of the process of establishing causation
Primary
Secondary
Tertiary
Three basic types of interventions for addressing the need of behavioral change is information(education), motivation(incentive), and obligation(requirements)
Evaluation
: Public health problems are rarely completely eliminated with one intervention. The orocess has been extended to attempt to address how well specific interventons work
RE-AIM: framework to evaluate these factors. Its a mnemonic that stands for reach, effectiveness, adoption, implementation, and maintenance
Strokes in young adults: Epidemiology and prevention
Despite primary prevention and diagnostic workup and treatment, stroke is about 2 or 3 on the morality list which makes it the leading cause of disability
Estimated occurrence is 10.8 out of 10,000. Racial and ethnic differences are even greater in younger populations
Risk Factors
: Hypertension, Heart disease, and diabetes mellitus (older gen). dyslipidemia, smoking, and hypertension
Etiology
: Rare genetic and hereditary disease like Fabry disease, CADASIL, and MELAS for younger patients. Vasculitides of central nervous system as well. Primary cerebral angiitis in middle age and vasculitis
Primary stroke prevention: aims to reduce the risk of the stroke in asymptomatic subjects. Focuses on identifying and managing vascular risk factors
Secondary stroke prevention: aimed at reducing the risk of another stroke, identification of the etiologic mechanism of the initial stroke and presence of any additional factors then change lifestyle with more physical activities, low salt diet.