Hsci 130 Final Exam

Front 1

What is epidemiology?

Back 1

The study of the distribution and determinants of health-related states, and the application of this study to control health related problems.

Front 2

Who is John Snow?

Back 2

The first to contribute pioneering work on the transmission of cholera through epidemiological detection. Through natural experimentation, he was able to link cases and attribute causation to a source of polluted drinking water.

Front 3

What were 2 initial theories about cholera?

Back 3

Miasma (bad air/pollution) and germ theory.

Front 4

What is descriptive vs. analytical epidemiology?

Back 4

Descriptive epidemiology answers the 5 W questions, describ8ng the occurrence of disease and/or exposure, whereas analytical epidemiology uses ideas generated by descriptive work to test for associations between agents and diseases.

Front 5

What are the agents of disease?

Back 5

1. Nutritive

2. Physical

3. Infectious

4. Chemical

Front 6

What are the applications of epidemiology?

Back 6

1. Identifying the cause of a new syndrome.

2. Assessing risks of exposure.

3. Determining whether treatment "x" is effective?

4. Identifying needs and trends of health services.

5. Identifying practical prevention strategies.

Front 7

What is an endemic?

Back 7

A disease in which cases are continually occurring in the population.

Front 8

What is a pandemic?

Back 8

Epidemics that have spread beyond their local region and are affecting people in various/all parts of the world.

Front 9

What is an epidemic?

Back 9

Outbreak of a disease in a localized group of people, spread by: vectors, carriers, or the sudden intro of a new pathogen; more cases than usually expected.

Front 10

What is an outbreak?

Back 10

Term used to avoid sensationalism associated with "epidemic".

Front 11

What is prevalence?

Back 11

The proportion of individuals in a population with the disease at a given point in time.

prevalence = number of cases of disease / total population

Reported as a percentage with time period.

Front 12

What is point prevalence vs. period prevalence?

Back 12

Point prevalence is the proportion if individuals in a population with the disease at a given point in time (subtract missing/dead). Period prevalence is the proportion of individuals in a population with the disease at any time during the specified time period (consider total population).

Front 13

What is cumulative incidence?

Back 13

The proportion of people who became diseased during a specific time period.

CI = number of new cases of disease in specific time period / number of people in the population at risk of developing the disease at the beginning of the period

Front 14

What is incidence rate?

Back 14

Measure of the rate of development of a disease in a population. Instead of calculating the number of people at risk, we count up the length of time they were at risk.

IR = number of new cases of disease during given time period / number of person time when people were at risk of developing the disease (during observation)

Front 15

How do you establish causality?

Back 15

Using Sir Austin Bradford Hill's Criteria:

• temporality (exposure)

• strength of association

• biological plausability

• consistency

• dose response (level and duration of exposure)

Front 16

How do you measure crude mortality?

Back 16

number of new deaths / average population during year ( ×10^5 )

Front 17

What are Rothman's pies?

Back 17

They represent the components of causation (sufficient, component, and necessary)

Front 18

What are standardized incidence/mortality ratios?

Back 18

Compare incidence or mortality with a standard population using indirect standardization (observed/expected)

Front 19

What is proportional mortality ratio?

Back 19

Compares the proportion of deaths with a standard population (proportion observed/proportion expected)

Front 20

What is a cross-sectional study?

Back 20

A study group is chosen to representative of a subgroup of society. Data is then gathered on exposure and disease.

Front 21

What is a case control study?

Back 21

Individuals with disease or outcome of interest (cases) are chosen and compared to a group without the disease (control) in order to determine the odds of exposure. The study is retrospective, inquiring about past exposures.

Front 22

What are prospective cohort studies?

Back 22

Follow-up studies comparing rates of occurrence of disease in people with or without a particular exposure. Direction of inquiry is synonymous with time

Front 23

Who was Friedrick Engel?

Back 23

He studied the conditions of the working class in England in the 1840s. By examining the observed differences in mortality rates in the suburbs of Manchester, he found that death rates were correlated with quality of housing and streets.

Front 24

Who was Rudolf Virchow?

Back 24

He investigated the typhus epidemic in Poland, and found that feudalism, unfair tax policies and lack of democracy leads to poor living conditions, inadequate diet, and poor hygiene, all which lead to typhus. He recommended that preserving health and preventing disease requires full and unlimited democracy and measures require more than palliatives.

Front 25

What are the types of health promotion?

Back 25

• traditional - the most common biomedical model that focuses on pathogenesis approaches and personal factors

• alternative - upstream, salutogenesis approach, emphasizing social determinants of health and structural factors

Front 26

What are the key determinants of health?

Back 26

1. Socioeconomic status

2. Social support

3. Education

4. Employment and conditions

5. Social environment

6. Physical environment

7. Personal health practices and skills

8. Childhood development

9. Biology

10. Health servives

11. Gender

12. Culture

Front 27

What are the measures of socioeconomic position (SEP)?

Back 27

• individual measures: occupation, income, and education

• area-based measures (geographic)

Front 28

How does SEP impact health?

Back 28

Location in society impacts exposure and resources used for health.

Front 29

What is the social gradient?

Back 29

A graded association between the indicator of socioeconomic status and population health; where you stand in the social hierarchy is related to your chances of getting ill.

Front 30

What are the explanations of the social gradient?

Back 30

• materialist explanations - greater exposure to psychosocial stressors from financial problems, neighborhood issues, and social isolation

• cultural behavioural explanations - greater vulnerability to stressors due to low SES and bad coping skills

• psychosocial explanations - people's interpretation of their standing in the social hierarchy matters

Front 31

What is the material vs. social pathway in understanding the social gradient?

Back 31

• material - differences in exposure to stress indicate advantages and disadvantages, which influence biological factors that determine health

• social - perception if hierarchy leads to stress because comparisons lead to shame, envy and other mental health or behavioural outcomes

Front 32

What is the role accumulation hypothesis?

Back 32

• more roles result in better health

• improved financial resources (married + employed = good); increased self-esteem, satisfaction, sources, and social support

• fails to account for role conflict

Front 33

What is the role strain hypothesis?

Back 33

Multiple roles result in role overload and conflict due to stress and excessive demands.

Front 34

What is the social acceptability hypothesis?

Back 34

Due to socialization into traditionalnroles, women are more willing go adopt the sick role, thus, they discuss health more freely. Men have been socialized to deny experiencing symptoms, and are unlikely to seek help until their health issues are impossible to ignore.

Front 35

What is the risk-taking hypothesis?

Back 35

Men are socialized to take more risks, whereas women are socialized to he cautious and health concerned.

Front 36

What is the nurturant hypothesis?

Back 36

Women experience more ill health because of acting as the primary caregiver. Stress and time constraints result in neglect of their own health.

Front 37

What is the biological determinist explanation?

Back 37

The attempt to treat race as purely biological variable, without considering the effects of racism on health. However, there are no race-based biological differences among human beings.

Front 38

What are the 4 CIHR priority areas for Aboriginal people?

Back 38

• suicide prevention

• diabetes and obesity

• tuberculosis

• oral health

Front 39

What is the healthy immigrant effect?

Back 39

When immigrants arrive to Canada, they typically arrive in better average health than those born in Canada. Explanations include:

• immigration policy favours healthy people

• deterioration due to converging lifestyles, stress associated with settlement, differential access to culturally competent and appropriate health care, and discrimination

Front 40

What is the Lalonde Report?

Back 40

Health report that emphasizes lifestyle and personal responsibility. Warns people of self-imposed risks through diet, drugs, exercise and others. Focuses on determinants of health outside of the health care system.

Front 41

Who is Hans Selye?

Back 41

An endocrinologist who was a pioneer in uncovering the biological effects of stress. He came up with the General Adaptation Syndrome (GAS).

Front 42

What is the General Adaptation Syndrome?

Back 42

The chain of reactions following the exposure to a stressful stimuli:

• alarm - body recognizes a stressor and is in a state of alarm, in which the fight-or-flight response and HPA axis are activated

• resistance - following alarm reaction is the removal or disappearance of symptoms, in which the alarm phase reactions are reversed

• exhaustion - body's resources are depleted and unable to function normally

Front 43

According to Selye, what is stress?

Back 43

The non-specific response of the body to any demand.

Front 44

What are the two biological stress responses?

Back 44

1. Sympathetic-adrenal-medullary (SAM) Activation: The autonomic nervous system activates the sympathetic system, which secretes hormones in response to stressful situation. This leads to the supression of immune function and neurochemical imbalances.

2. The HPA axis sends message to the pituitary gland, which secretes ACTH, activating the adrenal cortex to produce cortisol. Excess cortisol leads to consequences such as cognitive decline, immuno-suppression, and insulin resistance.

Front 45

What is allostasis and the allostatic load?

Back 45

Allostasis is how the organism achieves homestasis through continual change (survival). The allostatic load is the consequence of sustained activation of primary regulatory systems serving to burden on bodily systems. Cortisol is a primary mediator.

Front 46

What are the ways to measure stress?

Back 46

1. Biologically (cortisol levels)

2. Life events checklist - self-reported (prone to errors) or interview-based (e.g. LEDS-Life Events and Difficulties Scale)

3. Perceived stress scales (e.g. cognitive appraisal theory)

Front 47

What is the cognitive appraisal theory?

Back 47

1. Individuals constantly evaluate their relationship with the environment.

2. Behavioural and emotional responses are determined by meaning attached to situation/experience.

3. Psychological stress occurs when individuals appraise a transaction between themselves and their environment as greater than their resources, thus a threat.

4. Three types of stress appraisals - harm or loss, threat, or challenge.

Front 48

What are the main points in the Cohen et. al article on 'Psychological Stress and Disease'?

Back 48

• the biomedical community is skeptical on the belief that psychological stress leads to disease

• article summarizes the role of stress in 4 major diseases: clinical depression, cardiovascular disease, HIV/AIDS, and cancer

• the effects of stress due to the extended activation of the SAM and HPA axis on immune and inflammatory processes have the potential to influence disease

• increased stress predicts the clinical course of major depression, including features such as longer duration, symptom exacerbation, and relapse

• prospective research provides considerable support for a link between psychological stress and CVD morbidity and mortality

• evidence since 2000 generally supported a link between stress and HIV progression to AIDS

• stress contributes to the initiation, growth and metastasis of select tumors

Front 49

What are the implications made by Wickrama et al. on 'Stressful Life Experiences in Adolescence and Cardiometabolic Risk Factors in Young Adulthood'?

Back 49

Experimental findings support the influence of multiple early socioeconomic adversities and adolescents' stressful life transitions on their cardiometabolic disease risk as young adults.

Front 50

What are the implications made by Walsemann et al. in 'Sick of our loans: Student borrowing and the mental health of young adults in the United States'?

Back 50

• student loans were associated with poorer psychological functioning

• lead to stress and worries related to repayment

• this association varied by level of parental wealth and not enrollment history or attainmemt

• less wealthy families 》better psychological functioning, possibly because it reflects an improvement in social standing (education providing upward mobility)

• student loans may generate other circumstances that alter and constrain one's life (e.g. forgoing particular expenses, job choice, delayed transitions)

Front 51

What is visceral vs. peripheral fat?

Back 51

Visceral fat is stored in the abdominal cavity around a number of important internal organs. Peripheral fat is evenly distributed.

Front 52

What BMI ranges indicate health risk?

Back 52

• underweight < 18.5

• overweight 25 to 29.9

• obese > 30 (different classes differ by 5 points)

Front 53

What factors explain socioeconomic patterns in obesity?

Back 53

• dietary energy density and energy costs are inversely related

• neighborhood density of fast food restaurants

• physical activity patterns

• sleep duration

• stress

Front 54

What did the Elliot study (2007) uncover about nutritional profiles and packaging assessments of fun foods?

Back 54

• 326/367 of products classified as poor nutritional value

• fun foods found in dry goods, frozen food, and dairy sections

• 2/3 made nutritional claims

• almost 20% of the products used cartoon image engaged in physical activity

Front 55

What where the findings of the Ontario Happy Meal Study (2012)

Back 55

• girls were more likely than boys to select the healthy option when all meals have toys (still a small proportion though)

• numbers closer and higher when the healthy option is the only one with a toy

Front 56

What are some problems with the DSM-IV criteria for eating disorders?

Back 56

• may not be entirely applicable to adolescents

• the wide variability and lack of psychological awareness regarding abstract concepts owing to cognitive development likit the application of these formal diagnostic criteria for adolescents

• the strict criteria may preclude recognition of early stages and subclinical forms of eating disorders

• the diagnosis should be considerent of an adolescent patient who engages unhealtjy weight control and/or obsessive thinking about food, weight, shape, or exercise

Front 57

What are some of the complications associated with eating disorders?

Back 57

• growth retardation

• loss of dental enamel with chronic purging

• structural brain changes

• pubertal delay or arrest

• impaired acquisition of peak bone mass, increasing the risk for osteoporosis and fracture

• mortality - 20% of people without treatment

• nutritional deficiencies

Front 58

What are the factors associated with weight-related outcomes?

Back 58

Socioenvironmental:

• norms

• media exposure

• home food environment

Personal:

• body image and weight concerns

• psychological well-being

• knowledge and attitudes

Behavioural:

• weight-control practices

• eating patterns

• physical activity engagement

Front 59

What are some of the implications made by the Quebec Charter for a Healthy and Diverse Body Image?

Back 59

1. Promote a diversity of body images

2. Encourage healthy eating and habits

3. Discourage excessive weight-control practices

4. Refuse to conform with ideal of thinnes

5. Remain vigilent and diligent to minimize risks of eating disorders

6. Act as agents of change

7. Promote this charter amongst others

Front 60

What are the challenges associated with developing an HIV vaccine?

Back 60

1. Correlates of immune protection are unknown: the naturally-occuring immune response to HIV is insufficient to protect from infection or eliminate the virus from the body once a person becomes infected

2. HIV evolution and immune evasion: HIV mutates extremely rapidy, allowing to stay one step ahead of the natural immune response

3. HIV evolution and sequence diversity: HIV'S ability to mutate rapidy has also led to an extraordinary amount of sequence diversity worldwide

4. HIV kills immune cells: HIV infects and kills CD4+ T-lymphocytes, whose purpose is to coordinate the immune response, thus rendering the entire immune response dysfunctional

Front 61

What are the leading global causes of death?

Back 61

• cardiovascular diseases

• malignant neoplasms (prevalent in high income countries)

• infectious and parasitic diseases (prevalent in low income countries)

• respiratory disease

Front 62

What were the two sources that indicated potential links between environmental exposures and human health?

Back 62

1. Observations of unusually high rates of morbidity or mortality among some occupational

2. Disasters or accidentals

Front 63

What were two important factors of the Global Burden of Disease Project?

Back 63

1. Looks at death and illness

2. Looks at causes and risk factors (upstream forces)

Front 64

What are the global leading causes of death linked to the environment?

Back 64

1. Air pollution

2. Household air pollution from solid fuels

3. Unsafe water source

4. No handwashing with soap

5. Unsafe sanitation

Front 65

The impact of an exposure on public health depends on:

Back 65

• the magnitude of the risk

• the number of people exposed

The magnitude of the risk is usually small and the number of people exposed is often very large.

Front 66

What are the five principles of the Canada Health Act?

Back 66

1. Public Administration: plans must be administered and oprrated on a not-for-profit basis by a public authority accountable to the provincial or territorial government

2. Comprehensiveness: plans must insure all medically necessary services provided by hospitals, medical practitioners and dentists working within a hospital setting

3. Universality: plans must entitle all insured persons to health insurance coverage on uniform terms and conditions

4. Accessibility: plans must provide all insured perdons reasonable access to medically necessary hospital and physician services without financial or other barriers

5. Portability: plans must cover all insuref person when they move to another province or territory within Canada and when they travel abroad

Front 67

What are the key features of the Canadian Health Care System?

Back 67

• health care delivery is the responsibility of the provinces

• publicly funded and privately delivered (privately allocate their budgets)

• private providers as well as public not-for-profit hospitals

• fee-for-servive funding and global budgets

• universal coverage applies to less than half of total health care expenditures

Front 68

What is the structural-functionalist paradigm?

Back 68

• social roles

• views society as a harmonious social system made up of a number of interconnected parts or institutions that function to maintain oder and stability

• social structure supported by culture, leading to institutions

• insititution organizes behaviour

• Talcott's sick role

Front 69

What is the conflict paradigm?

Back 69

• capitalist society composed a number of interest groups

• focuses on group power struggles

• interprets social relations in terms of political and economic dimensions of social inequality

• medical dominance - physicians as ultimate authorities

• individualizes causes of ill health by taking the focus off how capitalist society makes people sick and robs us of control over our health by reliance on products and services

Front 70

What is the symbolic interactionist paradigm?

Back 70

• society as the socially constructed products of everyday interactions of individuals

• need to underdtand the individual's social construction of reality and definition of the situayion to be able to understand behaviour

Front 71

What is the feminist paradigm?

Back 71

• how patriarchy differentially makes men and women sick

• women's bodies have been subjected to far greater control and regulation by medical profession

• transformation of child birth into a medical even that placed men in control of women's bodies in the context of the hospital maternity ward

Front 72

What are the rights and duties of Talcott Parsons sick role?

Back 72

Rights:

1. You are exempt from responsibility for illness

2. You are temporarily exempt from regular role responsibilities

Duties:

1. You have a duty to try and get well and resume responsbilities

2. You need to seek technically competent help and cooperate in the process of getting well

Criticisms:

1. Acute > chronic

2. Physical > psychosocial

3. Medio-centric > lay

4. Failing to consider influence of upstream forces

Front 73

What is the biomedical model?

Back 73

1. Doctrine of Specific Etiology: assumes each disease has a particular cause; concentration on parasites

2. Physical Reductionism: breaks phenomena into smaller parts to understand them

3. Generic Disease

4. Ill health as deviation from normal

5. Scientific neutrality

6. Mechanistic/Machine Metaphor: understands the human body as a machine made up of biophysical processes operating within measurable parameters

7. Individualistic Regimen: personal responsibility for care and maintenance

8. Mind-Body Dualism: seperation of mind and body led health care to focus on biophysical aspects of illness

Front 74

What are the 2 most influential factors for establishment of ticks?

Back 74

1. Warmer climate

2. Dispersion of ticks on animal hosts

Front 75

What are the 4 D's of pellagra?

Back 75

1. Dermatitis

2. Diarrhea

3. Dementia

4. Death

Front 76

Who is Dr. Goldberger?

Back 76

Physician who ran epidemiological studies of pellagra to understand cause. He ran many experiments such as the Rankin Prison Farm and Filthing Parties. He discovered the pellagra preventive factor (PPF) - a small amount of yeat

Front 77

3 areas deemed essential for tuberculosis prevention:

Back 77

1. Improved testing and diagnostics

2. Develop better vaccination

3. Better and easier treatment

Front 78

Most cases of TB were in which provinces?

Back 78

Ontario, BC, and Quebec

Front 79

DOTS stands for:

Back 79

Directly observed therapy short course

Front 80

Why is treatment of TB difficult?

Back 80

• duration pf treatment

• asymptomatic early

• regimen of pills

Front 81

What are the pros and cons of XPERT MTB/RIF

Back 81

Strength: • better sensitivity and specificity• rapid• operators don't need laboratory training• multifunctionalWeakness:• expensive• computer training needed• need air supply and conditioning• cannot differentiate between live and dead