Public health definition - Answer- organized efforts of society to keep people healthy and prevent injury, illness and premature death. It is a
... [Show More] combination of programs, services and policies that protect and promote the health of all Canadians
A typical list of public health responsibilities includes - Answer- A typical list of public health responsibilities includes
Surveillance
Health promotion
Health protection
Disease and Injury Prevention
Screening
Population Health Assessment
Emergency preparedness
Vulnerable Populations
Definition of sureillance - Answer- collecting, interpreting and communicating health data and acting upon it in order to identify disease trends, emerging pathogens, etc
Definition of health promotion - Answer- encouraging healthy behaviors (e.g., smoking legislation), building healthy environments (bicycle paths, etc).
Definition of health protection - Answer- more specific than health promotion, this targets particular health hazards and reduces people's exposure to them. Drug safety regulations; food inspections; hazardous substances and pollution; vector control and smoke-free spaces are examples
Population Health Assessment: - Answer- monitoring underlying social trends that affect health (poverty, homelessness, drug use, etc.) and encouraging government s to address these. This relates to health promotion, but moves the focus of attention upstream, to address underlying determinants.
Disease and Injury prevention: - Answer- Closely related to health protection, this focuses on particular diseases/conditions. Many approaches are best implemented at the population level: food safety; immunization; outbreak control; road safety; playground design, etc.
Emergency Preparedness: - Answer- Natural disasters, infectious disease, bioterrorism, etc. An aspect of health protection, but more generic as we do not know precisely what we must protect against
Vulnerable Groups: - Answer- protecting the health of particular groups such as maternal and infant health, refugees, etc.
Differece between passive and active surveillance - Answer- Surveillance may be passive, in which the system waits for cases to be reported, or active, in which you search out the cases of disease. Active surveillance may be necessary with an outbreak of a new disease (such as SARS), in which physicians in the community would not routinely be reporting cases. Active surveillance might (for example) involve calling hospital staff who took sick leave from work to see whether they had symptoms compatible with SARS.
Reportable conditions - Answer- COmmunicable disease, driving, any conditon calusing LOC, alcohol or drug addiction, seizures/ vonculsions, corrected vision less than 20/50 imapired judgement ( dementia)
Examples of primary prevention - Answer- Primary prevention may be aimed at individuals or at whole communities. Individual approaches (encouraging your patient to stop smoking) have the advantages that the clinician's personal contact should be motivational; the message can be tailored to the patient, and you can support him in actually making the decision to stop. But the limitation is that your advice does not tackle underlying forces driving his behaviour in the first place or the context in which his behaviour occurs (his friends may continue to smoke). Therefore, a community or population approach (e.g. via mass media advertising, increasing taxes, or banning smoking in public places) tries to change risk factors in the whole population. It is more radical and may produce cultural and contextual changes that support individual efforts.
Primordial prevention - Answer- which seeks ways to "avoid the emergence and establishment of the social, economic and cultural patterns of living that are known to contribute to an elevated risk of disease" (Beaglehole, Bonita & Kjellstrom, Basic Epidemiology). This would include environmental control of disease vectors, and eliminating predisposing factors such as illiteracy and maternal deprivation and other social determinants of health (JM Last, Dictionary of Public Health).
Secondary prevention - Answer- An example is the Pap test to screen for cancer of the cervix, or a PSA blood test for prostate cancer; other instances include teaching people about the early signs of disease that they should watch for, and what type of treatment to seek. This is the task of preventive medicine.
who are the canadian task force - Answer- It is an advisory group that produces sets of recommendations on preventive care according to the age and sex of a patient, all based on solid evidence of effectivenes
What are the four types of screening - Answer- mass screening, multiple/multiphasic screening, targeted screening, case-finding
What are the definitons of screening - Answer- Mass screening involves screening a large population (e.g., chest x-rays for TB)
Multiple or multiphasic screening involves the use of several screening tests on the same occasion (e.g., an annual health check-up)
Targeted screening of groups with specific exposures is often used in environmental and occupational health (e.g., battery workers)
Proactive or systematic screening: population registers are used to invite members of the population at risk to be screened at appropriate intervals
Case-finding (or opportunistic screening) is a form of screening restricted to patients who consult a health practitioner for some other purpose (the GP may take your blood pressure when you come for your 'flu shot).
Implementing screening- regarding the disease - Answer- The disease should be serious - e.g., it causes death, disability, or discomfort;
The natural history should be understood;
The disease must have a latent period during which it can be detected before symptoms appear;
The latent period between first signs and overt disease should be long enough that screening significantly advances the detection of disease.
Implementing screening- regarding the screening - Answer- Should be sensitive (and ideally also specific), and have good predictive value (see below);
Simple and cheap;
Safe and acceptable;
Should be reliable.
Implementing screening- regarding the diagnosis and treatment - Answer- There is an available, effective, acceptable, and safe treatment;
Early treatment should be more effective than later;
Facilities need to be adequate.
Sensitivity - Answer- Sensitivity is the proportion of truly diseased persons in the screened population who are identified as diseased by the screening test. Sensitivity is a measure of the probability of correctly identifying a case, or the probability that any given case will be identified by the test (Syn: true positive rate). You can remember the term "sensitivity" because being sensitive to something means you can detect it.
Specificty - Answer- Specificity is the proportion of persons without the disease who are classified as such by the screening test. It is a measure of the probability of correctly identifying a non-diseased person with the screening test (Synonym: true negative rate). To help you remember the term, a specific test is one that picks up only the disease in question, so has a narrow focus, which explains the term 'specific'.
predictive value - Answer- Predictive value: The likelihood that someone with a positive score on the test really does have the disease is called the "predictive value of a positive test result," or "positive predictive value," or PPV for short. The equivalent measure for a negative result is the "negative predictive value" or NPV.
injuries in canada - Answer- Based on 2009-2010 data, Statistics Canada reported that approximately 15% of the Canadian population suffers an injury each year that is "severe enough to limit their usual activity". The likelihood and type of injury varies by age group. Young people aged 12-19 have the highest likelihood of injury, followed by working age adults (20-64) and then seniors (64+). Many (66%) of injuries in 12-19 y.o. were linked to sports, while 47% of the injuries of working adults were linked to sports and work. Seniors most often got injuries while walking or doing household chores.
what is the Injury prevention haddox matrix - Answer- The "Haddon Matrix" shows the host, agent and environmental factors involved, set against the time sequence of an incident
Pre-event
(→ primary prevention) in terms of the haddox matrix- host - Answer- Host
(person affected)
Driving skill;
Time pressures
(in a rush to get home?);
Inebriated?
Pre-event
(→ primary prevention) in terms of the haddox matrix- agent or vehicle - Answer- Car design & handling;
Anti-lock brakes, etc;
Maintenance of car
Pre-event
(→ primary prevention) in terms of the haddox matrix- environment - Answer- Road design;
Speed limits
Reliance on private, rather than public transportation raises traffic load;
Compliance with seatbelt laws
During the event
(→ secondary prevention)- host, agent, envionrment - Answer- host-Wearing seatbelt?
agent-Air bags working?
Size of car & crash resistance
environment-Weather conditions;
ice on road?, social-Quality of emergency assistance;
Assistance from bystanders
Post-event
(→ tertiary prevention) - Answer- h0st-Ability to call for help
(phone available?);
Knows first aid?
agent-Tendency of car to catch on fire
eviornment:Emergency vehicle access to collision site, Continued funding for emergency services
Source-path receiver model - Answer- The Source - Path - Receiver model offers a useful guide to intervention points to prevent industrial injuries. It is a bit simpler than the Haddon model but also useful. Interventions either modify the source (machine or chemical). Some approaches are mentioned in the diagram. Where this is not possible (or in addition), interventions can break the pathway between the source and the person. A third approach is to work on shielding the worker - examples include hearing or eye protection, or simply moving the person away from the source of danger.
What is health promotion - Answer- Health promotion: The process of enabling people to increase control over their health and its determinants, and thereby improve their health. It includes encouraging healthy behaviors (e.g., via smoking legislation), building healthy environments (bicycle paths, etc).
Health promotion does not target a single risk factor or disease, but tries to enhance each person's ability to improve their own health. A central goal is to create environments that support healthiness, from which came the metaphor of 'upstream' and 'downstream' interventions.
what is health protection - Answer- Health protection: more specific than health promotion, this targets particular health hazards and reduces people's exposure to them. Drug safety regulations; food inspections; hazardous substances and pollution; vector control and smoke-free spaces are examples.
For example, health protection can refer to "ensuring safe food and water supplies, providing advice to national food and drug safety regulators, protecting people from environmental threats, and having a regulatory framework for controlling infectious diseases in place. Ensuring proper food handling in restaurants and establishing smoke-free bylaws are examples of health protection measures." (Health Canada, 2005).
differnce between health promotion and protection - Answer- You can think of health promotion, health protection and disease prevention in relation to each other. Health promotion encourages healthy behaviours and living styles (increase positives), health protection targets general health hazards (decreases negatives) and disease prevention targets particular risk factors to halt the development or consequences of specific diseases (decreases targeted negatives).
What is the ottawa charter- 5 components - Answer- 1. Building healthy public policy. This puts health on the agenda for all policymakers, directing them to be aware of the health consequences of their decisions
2. Creating supportive environments. (e.g. encouraging a family to support their relative who is trying to lose weight) This recognized the importance of environment for health, and proposed a socio-ecological approach to health
3. Strengthening community action. Health promotion requires community empowerment and involvement in setting priorities, planning and implementing strategies to achieve better health
4. Developing personal skills. Health promotion supports personal and social development through providing information and enhancing life skills
5. Reorienting health services. Health promotion argues for shifting health resources towards a more equal distribution between health care and preventing disease. Essentially, health services should be expanded to include the four strategies above in addition to conventional medical care. Responsibility for health promotion services should be shared among individuals, community groups, health professionals, health services and governments.
Seven prerequisities for adult health - Answer- seven prerequisites for adult health: peace, shelter, education, food, income, a stable eco-system, and sustainable resources
Stages of change model - Answer- Precontemplation: People in this stage are not intending to change their behaviour (e.g., a person who has no interest in quitting smoking). For practical purposes, the time horizon is defined as not planning to change within the next six months
Your role as physician might include suggesting that they think about how they feel about the behavior in question, and how they would feel about changing it. Suggest they talk to their spouse, etc.
Contemplation: The individual has not begun to change their behaviour, but intends to do so within the next six months (e.g., has talked about stopping smoking with family physician)
Here the physician's role may become more focused: applaud the fact that they are thinking about change; provide information and encouragement to work towards actually preparing to change.
Preparation: The individual has not begun to change their behaviour, but intends to do so in the next thirty days (e.g., has set a quit date)
Here the physician may assist by putting the patient in touch with support programs (weight loss, quit smoking, etc); you can write that prescription for nicotine gum or the patch, etc. Encourage them to set a date to begin the actual change; set up an appointment for them to come back and see you once they have begun the change to address any side-effects. Consider contacting the spouse to reach an explicit agreement over plans for the change.
Action: The individual has changed their behaviour within the past thirty days (e.g., has quit);
Here encouragement and support are the major roles for the physician; arrange follow-up visits [Show Less]