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Evidence-Based Public Health
Evidence-Based Public Health
Evidence-Based Public Health
Learning Objectives
Explain the steps in evidence-based public health process. Describe a public health problem in terms of morbidity and mortality. Describe the public health approach to identify contributory causes of disease or other conditions and establish the efficacy of an intervention.
Implementation
Etiology
Recommendations
Rates
Incidence: measures the chances of individuals to develop a disease during a particular time period Prevalence: measures the proportion of individuals who have the disease at a point of time (or during a time period).
Incidence Rate
= # of new cases of a disease over a period of time # of people in the at-risk population
Often expressed per 10,000 or per 100,000 Expressed using a time period
Prevalence Rate
# living with a particular disease # in the at-risk population Usually describes a point in time Can use a period of time (period prevalence) Good for describing the total burden or impact of the health problem in the population at a given time
Mortality Rates
Type of incidence that measures the rates of death in a population Cause of death is classified using International Classification of Diseases or (ICD codes)
Age-adjusted death rates for total cardiovascular disease, diseases of the heart, coronary heart disease, and stroke, by yearUnited States, 19001996
Group-level Associations
Determined using Ecologic studies or Population comparisons Associations at a group level may not hold true at the individual level May lead to hypothesis generation and further study to determine the existence of associations at the individual level
Implementation
Etiology
Recommendations
Cohort, Prospective
Implementation
Etiology
Recommendations
Recommendations
What works to reduce the health impact? Built on evidence from studies of interventions Summaries of the evidence of what works to reduce the health impact
Evidence-based Recommendations
Criteria 1: Quality of evidence
Good Fair Poor
Overall Recommendations
AMust BShould CMay DDont IIndeterminant, insufficient, dont know
Other considerations
Cost
Implementation
Etiology
Recommendations
Implementation
When: timing of the intervention
Primary Secondary tertiary
Period of susceptibility
Subclinical disease
Clinical disease
PRIMARY PREVENTION
Questions?
Exposure
Yes No Total
Yes a
c a+c
No b
d b+ d
Total a+b
c+d a+b+c+d
Prevalence or cumulative incidence = a/(a+b) among exposed = c/(c+d) among unexposed = (a+c)/(a+b+c+d) among total population