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BME 301
Lecture One
Overview of Lecture 1
Course Overview: Course organization Course goals Four questions we will answer Technology assessment – The big
picture Activities we will do
World health: an introduction
Course Organization
People Syllabus Website:
http://www.bme.utexas.edu/faculty/richards-kortum/BME301
BME 301 Roadmap
Design of New health Technologie
s
Health Technolog
y Assessme
nt
Ethics
Management
The Science of Understanding a Disease.
Preclinical Testing
Abandoned due to poor technical performance,
efficacy, efficiency, and safety, ethical, legal, or social
issues.
Clinical Trials
Adoption and Diffusion
Roadmap for BME 301
Four Questions
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
What are the problems in health today? Advance to next unit
Screening and Prevention Diagnosis Treatment and Therapy
Definition of Health
Role of WorldHealth
OrganizationHealth Data
Types and Uses
Sensitivity and
SpecificityPPV
Epidemiology Burden of DiseaseQALY, DALY,HRQL
Mortality Ages 15-44
AIDS/HIVAccidents
Interpersonal Violence
Mortality Ages 45-60
Respiratory Cancers
TB
Heart Disease
Cerebrovascular disease
Developing and Developed World
Contrasts
Who pays to solve problems in health care?
How have health care costs changed over time? Advance
to next unit What contributes to increasing health care costs?
InternationalInternational
Start here
United StatesVendor/Purchaser System – choice dependent on ability to pay
Financing of the system
Health Technology Development
Provider of services
Hospitals Nonprofit Private (for profit) Public
Ambulatory Care Private Practice Public Health Services Voluntary Agencies
University Student
Private insuranceHMOPPO
Public (tax based)Medicare/Medicaid
Military Out of pocket expenses
CanadaUniversal Insurance13 provincial systemsHospitals – nonprofit (all government funded)Government sets ceilings on gross revenue for physician private practices.
IndiaPublic – free treatment health centers Private care – for profit usually urban areasWestern and traditional medicineInternational aid – especially in rural areas
Angola27 year civil war“Near absence” of government Displacement and malnutritionInternational aid only source of health care.
Start here
How can we use science and technology to solve problems in health care?
Advance to next unit
How do we test and refine innovations? Case studies
Technology Assessment: The Big Picture
Biological plausibility
Clinical Trials
Where do innovations come from?
Patient Outcomes
Societal Outcomes
Early Detection of Cancer Prevention of Infectious Diseases
Technical Feasibility
Science Drives Engineering
Scientific Method
Engineering design
Treatment of Heart Disease
Microorganisms
Immunity
Vaccines
HIV Cost effectiveness
Pre-cancer cancer transformationDetection of Morphologic Changes
Gene Chips – molecular changes
CervixBreast Prostate
The circulatory system
Arteriosclerosis
CABGPTCA
Heart Failure
LVADTransplant
OutcomesCost effectiveness
OutcomesCost effectiveness
How are health care technologies managed?
Examples:
MRI
Laparoscopic cholecystectomy
Vitamin C treatment for scurvy
ResearchFunding
RegulatoryApproval
Reimbursement Diffusion
Three Case Studies Prevention of infectious disease
HIV/AIDS Early detection of cancer
Cervical Cancer Ovarian Cancer Prostate Cancer
Treatment of heart disease Atherosclerosis and heart attack Heart failure
Activities
Homework (HW) Web Assignments (WA) Class Activities (CA) Projects Due dates
Technology Assessment
What is it? Why do we need it? Example
Bone marrow transplants for breast cancer
Start here
What are the problems in health today? Advance to next unit
Screening and Prevention Diagnosis Treatment and Therapy
Definition of Health
Role of WorldHealth
OrganizationHealth Data
Types and Uses
Sensitivity and
SpecificityPPV
Epidemiology Burden of DiseaseQALY, DALY,HRQL
Mortality Ages 15-44
AIDS/HIVAccidents
Interpersonal Violence
Mortality Ages 45-60
Respiratory Cancers
TB
Heart Disease
Cerebrovascular disease
Developing and Developed World
Contrasts
What is health?
WHO Definition of Health
“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
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
Pooled figures such as: Infant mortality rates Numbers of deaths and causes Immunization rates
Example of Health Data
Questions about health data
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?
From 1870-1900: Biomedical science advanced more than it had
in previous 3 millennia 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
Established by charter of the UN after World War II
Headquartered in Geneva Mission:
“Attainment by all peoples of the highest possible level of health”
Website: http://www.who.int/en/
Functions of the WHO Services to governments:
Epidemiologic intelligence International standardization of vaccines Reports of expert committees Data on world health problems
Member countries must provide certain info in regular reports Disease outbreaks Health of population Steps to improve health
Uses for health measures Identify emerging problems (early
warning) Rubella during pregnancy Thalidomide during pregnancy AIDS Kaposi’s sarcoma, PCP
Help determine public policy Estimate impact of health problems
# people affected, ages, locations Set priorities for funding Educate legislators
Monitor progress toward goals
Types of health data Data on the population
# of people Age, sex, ethnic origin, urbanization
Vital statistics Live births Deaths (including infant deaths) by sex, age, cause
Health statistics Morbidity by type, severity and outcome Data on reportable diseases Tumor registries
Statistics about health services # and type of facilities # and qualifications of health personnel Services and utilization rates Costs and payment mechanisms
Quantitative measures of health
Incidence Number of new cases of a disease in a
population over a period of time Annual incidence rate
year same that ofyear -midat populationin that #
year onein population defined ain condition defined a of cases new of #denceRateAnnualInci
Quantitative measures of health
Prevalence Number of existing cases of a disease in a
given population at a specific time Point prevalence
in timepoint sameat populationin that #
in timepoint aat population defined ain condition defined a of cases of #Print evalencePo
Quantitative measures of health
Mortality rate Mortality = Death Crude death rate, Infant, Neonatal, Post-
neonatal, Maternal Age adjustment is important because different
populations have very different age distributions
Mortality Rate
Infant mortality rate
year same theofyear -midat populationin that #
year ain population defined ain deaths of #ateMortalityR
year samein populationin that births live of #
year ain population defined ain age ofyr 1under deaths of #alityRateInfantMort
Quantitative measures of health
Morbidity rate Morbidity = a diseased state
Why is it important? Estimate magnitude of health problem Detect epidemics
Mandatory notification Cholera Plague Yellow fever
Evaluate preventive measures
year same theofyear -midat populationin that #
year ain population defined ain condition specific of cases of #ateMorbidityR
Burden of disease Quality adjusted life year (QALY)
Measure of quality adjusted life years gained by an intervention
Disability adjusted life year (DALY) Years of disability free life lost Combines several elements
Levels of mortality by age Levels of morbidity by age Value of a year of life at specific ages
Examples: 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 Epidemiology
The study of the prevalence and spread of disease in a community
Measures of health Vary throughout the world
Burden of disease Varies throughout the world
How can technology impact health and disease? 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 deficienciesGroup 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
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
Course organization What is health? Role of WHO Health data and uses
Assignments Due Next Time
WA1