Transcript L1 Intro - Rice University

BME 301
Lecture One
Overview of Lecture 1
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Course Overview:
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Course organization
Course goals
Four questions we will answer
Technology assessment – The big picture
Activities we will do
World health: an introduction
Course Organization
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People
Syllabus
Website:
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http://www.bme.utexas.edu/faculty/richardskortum/BME301
BME 301 Roadmap
The Science of Understanding
a Disease.
Design of
New health
Technologies
Preclinical
Testing
Ethics
Abandoned due to
poor technical
performance,
efficacy,
efficiency, and
safety, ethical,
legal, or social
issues.
Clinical Trials
Health
Technology
Assessment
Adoption and
Diffusion
Management
Roadmap for BME 301
Four Questions
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What are the major health problems
worldwide?
Who pays to solve problems in health care?
How can technology solve health care
problems?
How are health care technologies
managed?
BME 301 Concept map
Start here
Definition of Health
Role of
World
Health
Organization
Screening and Prevention
Health Data
Types and Uses
Diagnosis
Sensitivity
and
Specificity
PPV
Treatment and Therapy
Epidemiology
Burden of Disease
QALY, DALY,HRQL
Mortality Ages 15-44
Mortality Ages 45-60
AIDS/HIV
Interpersonal
Violence
Respiratory Cancers
Heart Disease
Accidents
TB
Cerebrovascular disease
Developing and
Developed World
Contrasts
What are the problems in health today?
Advance to next unit
Who pays to solve problems in health care?
Canada
Start here
University Student
United States
Vendor/Purchaser System – choice dependent on ability to pay
Provider of services
Ambulatory Care
Private Practice
Public Health Services
Voluntary Agencies
Universal Insurance
13 provincial systems
Hospitals – nonprofit (all government funded)
Government sets ceilings on gross revenue for
physician private practices.
Financing of the system
Private insurance
HMO
PPO
Public (tax based)
Medicare/Medicaid
Military
Hospitals
Nonprofit
Private (for profit)
Public
Angola
27 year civil war
“Near absence” of government
Displacement and malnutrition
International aid only source of
health care.
Out of pocket expenses
International
Health Technology
Development
India
Public – free treatment health centers
Private care – for profit usually urban areas
Western and traditional medicine
International aid – especially in rural areas
How have health care costs changed over time?
What contributes to increasing health care costs?
Advance to next unit
Start here
Technology Assessment: The Big Picture
Where do innovations come from?
Patient
Outcomes
Biological
plausibility
Science Drives Engineering
Scientific
Method
Clinical Trials
Societal
Outcomes
Technical
Feasibility
Engineering
design
How can we use science and technology to solve problems in health care?
How do we test and refine innovations? Case studies
Treatment of Heart Disease
The circulatory system
Arteriosclerosis
Heart Failure
CABG
PTCA
LVAD
Transplant
Outcomes
Cost effectiveness
Early Detection of Cancer
Pre-cancer 
cancer transformation
Detection of Morphologic Changes
Breast
Cervix
Microorganisms
Immunity
Prostate
Outcomes
Cost effectiveness
Gene Chips – molecular changes
Advance to next unit
Prevention of Infectious Diseases
Vaccines
HIV
Cost effectiveness
How are health care technologies managed?
Research
Funding
Regulatory
Approval
Examples:
Vitamin C treatment for scurvy
MRI
Laparoscopic cholecystectomy
Reimbursement
Diffusion
Three Case Studies
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Prevention of infectious disease
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Early detection of cancer
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HIV/AIDS
Cervical Cancer
Ovarian Cancer
Prostate Cancer
Treatment of heart disease
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Atherosclerosis and heart attack
Heart failure
Activities
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Homework (HW)
Web Assignments (WA)
Class Activities (CA)
Projects
Due dates
Technology Assessment
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What is it?
Why do we need it?
Example
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Bone marrow transplants for breast cancer
Start here
Definition of Health
Role of
World
Health
Organization
Screening and Prevention
Health Data
Types and Uses
Diagnosis
Sensitivity
and
Specificity
PPV
Treatment and Therapy
Epidemiology
Burden of Disease
QALY, DALY,HRQL
Mortality Ages 15-44
Mortality Ages 45-60
AIDS/HIV
Interpersonal
Violence
Respiratory Cancers
Heart Disease
Accidents
TB
Cerebrovascular disease
Developing and
Developed World
Contrasts
What are the problems in health today?
Advance to next unit
What is health?
WHO Definition of Health
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“Health is a state of complete physical,
mental and social well being and not
merely the absence of disease or
infirmity.”
Some Perceptions of Health
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Pain, fever, symptoms of illness
Interference with normal activities
Deviation from a pre-determined norm
Ability to respond to stress and physical
insult
Individual Health vs. Population Health
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Pooled figures such as:
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Infant mortality rates
Numbers of deaths and causes
Immunization rates
Example of Health Data
Questions about health data
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Why do we need it?
What data do we need?
Where do we get it?
How do we use it?
Why do we need health data?
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From 1870-1900:
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Biomedical science advanced more than it had in
previous 3 millennia
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Darwin’s concept of evolution
Chemistry
Microscopy
Field based research around the world
Means, transmission, causative agent of almost every
important infectious disease
In this period, governmental health agencies
were first established.
World Health Organization
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Established by charter of the UN after
World War II
Headquartered in Geneva
Mission:
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“Attainment by all peoples of the highest
possible level of health”
Website:
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http://www.who.int/en/
Functions of the WHO
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Services to governments:
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Epidemiologic intelligence
International standardization of vaccines
Reports of expert committees
Data on world health problems
Member countries must provide certain
info in regular reports
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Disease outbreaks
Health of population
Steps to improve health
Uses for health measures
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Identify emerging problems (early warning)
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Rubella during pregnancy
Thalidomide during pregnancy
AIDS  Kaposi’s sarcoma, PCP
Help determine public policy
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Estimate impact of health problems
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# people affected, ages, locations
Set priorities for funding
Educate legislators
Monitor progress toward goals
Types of health data
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Data on the population
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Vital statistics
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Live births
Deaths (including infant deaths) by sex, age, cause
Health statistics
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# of people
Age, sex, ethnic origin, urbanization
Morbidity by type, severity and outcome
Data on reportable diseases
Tumor registries
Statistics about health services
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# and type of facilities
# and qualifications of health personnel
Services and utilization rates
Costs and payment mechanisms
Quantitative measures of health
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Incidence
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Number of new cases of a disease in a population
over a period of time
Annual incidence rate
AnnualInci denceRate 
# of new cases of a defined condition in a defined population in one year
# in that population at mid - year of that same year
Quantitative measures of health
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Prevalence
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Number of existing cases of a disease in a given
population at a specific time
Point prevalence
Po int Pr evalence 
# of cases of a defined condition in a defined population at a point in time
# in that population at same point in time
Quantitative measures of health
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Mortality rate
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Mortality = Death
Crude death rate, Infant, Neonatal, Post-neonatal,
Maternal
Age adjustment is important because different
populations have very different age distributions
Mortality Rate
# of deaths in a defined population in a year
MortalityRate 
# in that population at mid - year of the same year
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Infant mortality rate
InfantMortalityRate 
# of deaths under 1 yr of age in a defined population in a year
# of live births in that population in same year
Quantitative measures of health
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Morbidity rate
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Morbidity = a diseased state
# of cases of specific condition in a defined population in a year
MorbidityR ate 
# in that population at mid - year of the same year
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Why is it important?
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Estimate magnitude of health problem
Detect epidemics
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Mandatory notification
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Cholera
Plague
Yellow fever
Evaluate preventive measures
Burden of disease
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Quality adjusted life year (QALY)
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Measure of quality adjusted life years gained by an intervention
Disability adjusted life year (DALY)
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Years of disability free life lost
Combines several elements
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Levels of mortality by age
Levels of morbidity by age
Value of a year of life at specific ages
Examples:
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Stroke: 6 DALYs
Car accidents: 9 DALYs
Self inflicted injuries: 17 DALYs
Violence: 9 DALYs
Lower respiratory infections: 1 DALY
HIV: 28 DALYs
The study of global health
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Epidemiology
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Measures of health
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Varies throughout the world
How can technology impact health and disease?
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Vary throughout the world
Burden of disease
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The study of the prevalence and spread of disease in
a community
Varies throughout the world
We will examine in detail in BME 301
Leading causes of mortality in Member States 1998
Group 1 = communicable diseases, maternal/perinatal conditions, nutritional deficiencies
Group 2 = Non-communicable diseases (cardiovascular, cancer, mental disorders)
Group 3 = Injuries
Mortality from cervical cancer in 1990
(per 100 000 age standardized world population)
From: Jones: BMJ, Volume 319(7208).August 21, 1999.505-508
Income
Sources of World Health Data
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The global burden of disease: a comprehensive
assessment of mortality and disability from
diseases, injuries and risk factors in 1990 and
projected to 2020. Murray CJL, Lopez AD, eds.
Harvard School of Public Health on behalf of the
World Health Organization and the World Bank,
1996.
World Health Organization Annual Reports
International Agency for Research in Cancer
Summary of Lecture One
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Course organization
What is health?
Role of WHO
Health data and uses
Assignments Due Next Time
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WA1