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Evidence-Based Public Health, Strokes in young adults: epidemiology &…
Evidence-Based Public Health
What is the public health approach?
Problem
Evaluation
Etiology (causes)
Implementation
Recommendations
How can we describe a health problem?
Distribution of disease: who, when, where
How can understanding the distribution of disease help us generate ideas or hypotheses about the cause of disease?
Epidemiologists investigate the distribution of disease to find group associations. Knowing who is getting a disease and where can help generate the first hypotheses because geography is so important in health. Time can also play an important role
The rates of burden & course of disease, its morbidity and mortality
How do epidemiologists investigate whether there is another explanation for the difference or changes in the distribution of disease
They base it on whether the differences are real or artifactual:
Difference in ability to identify the disease
Difference in the interest in identifying the disease
Difference in definition of the disease
Age adjustment as well, since an aging population can also explain increases in rates
What is the implication of a group association?
Group associations can act as a ground level hypothesis that will require investigation at the individual level to determine if it is an actual cause or not. This doesn't ensure it is a cause/effect relationship due to confounding factors
Etiology: How to establish contributory cause?
The cause precedes the effect in time (is present at an earlier time)
Altering the cause alters the effect, if the cause is eliminated/reduced the effect is too
The cause is associated with the effect at the individual level.
The above requirements may be established using 3 different types of investigations
Cohort studies
Randomized controlled trials
Case-control studies
What can we do if we cannot determine all 3 requirements to definitively establish contributory cause?
Consistency of the relationship
Biological plausibility
Dose-response relationship
Strength of relationship
What does contributory cause imply?
There are different causes such as necessary and sufficient causes. Some contributory causes are neither but still contribute a noticeable enough effect that they are important, which is why language is important
Recommendations: What works to reduce the health impact?
Harms and safety have to be taken into account, and evidence-based recommendations can help show the benefits and harms of potential interventions.
Evidence can have different levels of quality, and the magnitude of the impact of an intervention is important. This is what evidence-based recommendation combines
This is a detailed process which is why implementation is not at automatic process
Implementation: How do we get the job done?
Strong, evidence-based recommendations are the ideal basis of implementation
Secondary (before symptoms)
Tertiary (after symptoms, before disability)
Primary (before)
Then: on who, when, & how which depends on resources and evidence
Evaluation: How Do We Evaluate Results?
Effectiveness. PERIE is a framework that cycles, so before and after questions are important. There is another, new framework
Adoption
Implementation
Effectiveness
Maintenance
Reach
Strokes in young adults: epidemiology & prevention
Problem
Strokes in young adults are uncommon, but leave those affected with a disproportionately large economic impact due to disability
Etiology
Different than in older patients. Young means those younger than 45-49. Race plays a major factor, with black and hispanic young adults facing higher rights as well as men having a higher incidence than women. Risk factors are the same for older adults, but dyslipidemia, smoking and hypertension are the biggest for the young
TOAST criteria is most commonly used, but there is a high # of young stroke patients with undetermined etiology
Recommendation
Prevention is very important because it is the second/third leading cause of death worldwide.
Implementation
Secondary: identifying the cause of the first stroke and additional risk factors as well as treatment for vascular risk factors, esp for hypertension
Primary: lifestyle changes such as quitting smoking and adopting a healthy diet