NS 2600 MIDTERM

Father of epidemiology. Mapped the occurrence of cholera in London

a field of study, research and practice that places a priority on equity in health for all people

Epidemiological
Biomedical
Political-Economic
Sociocultural
Ethical and Human Rights
Health Systems & Interventions

1. High levels and rapid growth of noncommunicable diseases
2. Antimicrobial resistance.
3. Possible influenza pandemic
4. Persistence of high mortality and disability from malaria, TB, HIV, diarrhea & pneumonia
5. Severe shortages in the global health workforce
6. Climate change

potential or clear impact on medical countermeasures but are no longer detected or very low levels in the U.S

specific genetic markers associated with changes to receptor binding, ↓neutralization by antibodies, ↓ efficacy of rx, potential diagnostic impact, or predicted ↑ transmissibility or disease severity.

evidence of ↑ transmissibility, ↑ severe disease significant ↓in neutralization by antibodies, ↓ effectiveness of treatments or vaccines, or diagnostic detection failures

clear evidence that prevention measures or medical countermeasures have significantly ↓ effectiveness

- philosophy that health of all living things is connected
- collaborative effort of multiple disciplines to attain optimal health for people, animals and our environment

I. comparative medicine (models and treatments)
II. transmission of infectious disease among species (humans, wildlife and domestic animals)
III. shared vulnerability to changes in the environment (physical and biological)
IV. reliance of human health and well-being on animals and the environment (mental health, nutrition, livelihoods, ecosystem goods/services)

Infection caused by an organism capable of causing disease only in a host whose resistance is lowered (by other diseases or by drugs)

38 million

Gay men, drug users, blood transfusion patients

1. diseases, conditions, causes, consequences
2. solutions
3. delivery systems: strengths, weaknesses, issues and options
4. actors, interests, politics and governance, from global to local
5. people, cultures and communities

infection that has newly appeared in a population or has existed but is rapidly increasing in incidence or geographic range

- Mass extinction - get rid of larger species that attract parasites like ticks- Illegally imported wildlife products --> Global Bush Meat Trade (each one has lots of viral particles so could start endemic)

- provide decision makers at local, regional, national, and global levels w best and most up to date evidence
- evidence informs health policy, resource allocation, and health priorities

- quantitative disciplines: demography, epidemiology, economics
- common indicator - count deaths

provides a tool to quantify health loss from hundreds of diseases, injuries, and risk factors, so that health systems can be improved and disparities can be eliminated.

- Disability adjusted life year
- allows researchers and policymakers to compare v diff pop and health conditions across time
- 1 DALY thought of as 1 lost year of healthy life- DALY = YLD (years lived w disability) + YLL (years of life lost)
- Leading causes of DALYs lost: non communicable diseases esp heart disease

confined to a particular country or area

A widespread outbreak of an infectious disease.

Disease that occurs over a wide geographic area and affects a very high proportion of the population.

agent, host, environment

- 1981: reports of gay men w PCP, KS, CD4 depletion
- 1987: first ART drug approved (AZT) , 25,000 Americans died
- 1994: AZT prophylaxis for perinatal transmission
- 1996: 3-drug ART introduced into clinical practice
- 2000: Durban conference, move to bring ART to developing world gains momentum
- 2019: more than 22 M people on ART

- Core contains genetic material
- T-cell turns into virus factory which makes more of the virus
- Targets CD4+ T-lymphocyte
-evidence for zoonosis -- originated in animals and then spread to humans

1. sexual transmission - low efficiency
2. injection drug use - low efficiency
3. blood, blood products, tissue - very high
4. perinatal transmission - ~25%
5. needlestick injury - 1/500 exposures

1. suppress HIV RNA (viral load) as low as poss for as long as poss
2. preserve or enhance immune function
3. delay clinical progression of HIV

- Ambitious treatment target to help end AIDS epidemic by 2020
- 90% of all people living w HIV will know their HIV status
- 90% of all people diagnosed w HIV will receive sustained ART
- 90% of all people receiving antiretroviral therapy will have durable suppression

- circumcision
- exposure prophylaxis w ART
- cART
- PrEP

- diaphragms
- female controlled microbicides
- genital tract infection control
- HSV-2 suppressive treatment

a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity

Branch of medical science concerned with the incidence, distribution, and control of diseases that affect large numbers of people.

personal characteristics, behaviors, genetic profile, immune status

biological, nutritional lack/excess, physical,chemical

physical, social, biological

continuous and systematic process of collection, analysis, interpretation and dissemination of descriptive info for monitoring health info

prevalence = proportion of cases at a specified time
incidence = new cases

1. individual w disease
2. system captures info
3. info is analyzed
4. dissemination to relevant stakeholders
5. use info

Refers to ill health in an individual and the levels of ill health in a population or group.

death rate

Exposure and outcome are studied at the same time

A type of epidemiologic study where a group of individuals with the diseases, referred to as cases, are compared to individuals without the disease, referred to as controls

A type of epidemiologic study where a group of exposed individuals (individuals who have been exposed to the potential risk factor) and a group of non-exposed individuals are followed over time to determine the incidence of disease

experimental study with random allocation- assigned exposures

a branch of science that deals with the institutions and functioning of human society and with the interpersonal relationships of individuals as members of society ; includes the fields of psychology, sociology, political science, communication studies, social work, anthropology and economics

0.4% vs 19.1%

Women/adolescent girls, sex
workers, MSM, transgender women

30.7%

1.2 million vs 7.8 million

the segregation of blacks in South Africa from 1948 to 1994. It was created to keep the white minority in power and allow them to have almost total control over the black majority
- Geographical displacement
- Forced migration and labor
-Men couldn't bring families w them; had to live in crowded, bad conditions; needed to seek love elsewhere
- easy to spread sexually transmitted disease
- Inferior and segregated education and health systems

- When Mandela entered office, he had to deal w lots of other issues that were "more important" than the AIDS crisis
- Mbeki denied scientific consensus that virus caused AIDS and didn't believe in ART as remedy
- Govt limited and prevented access of life-saving ARVs for adults and for prevention of perinatal transmission

- mining
- prices of ARVs

- claims that mistake structural violence for "culture" place the blame on the individual- ignore political, economic and historic reasons for the spread of the disease
- ex: president mbeki's denialism

A series of large scale forces - ranging from gender inequality and racism to poverty - which structural unequal access to goods, services, economic opportunities

-people are free to make decisions within the constraints of the structures they live in
-people have different levels of constraints

a mark of disgrace associated with a particular circumstance, quality, or person.

- incidence and prevalence rates
- fatality/mortality rates
- Impact on DALYs
- Impact on economic growth
- Demographic breakdown
- Geographic distribution
- Social movement
- Modes of infection/transmission
- Emotional impact
- Political will

UN, global fund, PEPFAR, bilateral agreements, private donors

- brings together UN system resources for united, coordinated and accountable global effort against AIDS
- guides response

-An international partnership designed to accelerate the end of AIDS, tuberculosis and malaria as epidemics
-Mobilizes and invests more than $4 billion a year to support programs run by local experts in more than 100 countries

President's Emergency Plan for AIDS Relief

2003-2007
- Emergency response
- Delivering prevention, care and treatment services
- Building and strengthening health systems to deliver HIV services
- 1.2 M lives saved

2008-2012
- Shift from emergency to sustainable response
- Shared responsibility and country-driven programs
- Scaling up core interventions for impact
- 6.7 M prs on treatment
- 17 M prs in care

- sustained epidemic control
- Deliver the right things in the right places at the right times
- Focus on areas w highest risk and populations w highest risk
- Goals: maintain and expand levels of lifesaving treatment, provide services to orphans and vulnerable children, accelerate progress to epidemic control
- 50 countries reached --> 13 "Focus" countries

- Switch from sustainability to direct care
- At first it was about focusing on direct care and certain populations, then it was about sustaining the progress made

-research and data
-social movements
-goals, values, and setting priorities
-geopolitics
-political gains

- State and quantify need
- Put out call to action
- Meet, plan
- Identify, reallocate funds
- Identify, reassign staff
- Award funds
- Act
- Assess and improve

- Voluntary consent of subject is essential
- Research must benefit society
- Build on animal experiments and previous knowledge
- Avoid unnecessary mental and physical suffering

1964
- code of research ethics
- Reinterpreted Nuremberg Code and addressed med research w therapeutic intent

- research studies w controversial ethics
-heightened awareness to problem of unethical human subjects research --> spurred debate on research ethics in US

Research study conducted by a branch of the U.S. government, lasting for roughly 50 years (ending in the 1970s), in which a sample of African American men diagnosed with syphilis were deliberately left untreated, without their knowledge, to learn about the lifetime course of the disease.

- Beneficence - duty to protect the welfare of participants (captured in risk benefit assessment)
- Respect for persons
- duty to respect autonomous persons, their choices, and their info (captured in consent process)
- Justice
- duty to distribute benefits and burdens fairly (captured in selection of research subjects)

label given to the federal policy for the protection of human subjects

the ethical prerequisite of RCT
theoretical- no preference between treatments
clinical- genuine uncertainty about benefit or harm of intervention

-The local standard of care
-WHO recommendations
-Standard of practice in high-income countries

helps us to understand, clarify and show the relationship between the immediate, underlying and basic causes of a problem.

-Picture of your program or intervention
-Graphic representation of the "theory of action" — what is invested, what is done, and what results
-Core of planning and evaluation