BME%20301

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BME 301

• Lecture One

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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

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Course Organization

• People
• Syllabus
• Website
• http//www.bme.utexas.edu/faculty/richards-kortum/
  BME301
• BME 301 Roadmap

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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
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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

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Start here
What are the problems in health today?

Advance to next unit
Definition of Health
Role of World Health Organization
Health Data Types and Uses
Screening and Prevention
Diagnosis
Treatment and Therapy
Sensitivity and Specificity PPV
Epidemiology
Burden of Disease QALY, DALY,HRQL
Mortality Ages 15-44
Mortality Ages 45-60
AIDS/HIV
Respiratory Cancers
Heart Disease
Accidents
Interpersonal Violence
TB
Cerebrovascular disease
Developing and Developed World Contrasts
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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?


International
Canada Universal Insurance 13 provincial
systems Hospitals nonprofit (all government
funded) Government sets ceilings on gross revenue
for physician private practices.

Start here United States Vendor/Purchaser
System choice dependent on ability to pay
University Student
Provider of services
Financing of the system
Ambulatory Care Private Practice
Public Health Services Voluntary Agencies
Angola 27 year civil war Near absence of
government Displacement and malnutrition Internati
onal aid only source of health care.
Private insurance HMO PPO Public (tax
based) Medicare/Medicaid Military Out of
pocket expenses
Hospitals Nonprofit Private (for
profit) Public
Health Technology Development
India Public free treatment health centers
Private care for profit usually urban
areas Western and traditional medicine Internation
al aid especially in rural areas
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Start here How can we use science
and technology to solve problems in health
care? Advance to next unit
Where do innovations come from?
Technology Assessment The Big Picture
Patient Outcomes
Biological plausibility
Science Drives Engineering
Clinical Trials
Scientific Method
Societal Outcomes
Technical Feasibility
Engineering design

How do we test and refine
innovations? Case studies
Prevention of Infectious Diseases
Early Detection of Cancer
Treatment of Heart Disease
Pre-cancer ? cancer transformation
The circulatory system
Microorganisms
Detection of Morphologic Changes Gene
Chips molecular changes
Arteriosclerosis CABG PTCA
Heart Failure LVAD Transplant
Immunity
Cervix
Breast
Prostate
Vaccines
Outcomes Cost effectiveness
Cost effectiveness
HIV
Outcomes Cost effectiveness
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How are health care technologies managed?
Research Funding
Regulatory Approval
Examples
Vitamin C treatment for scurvy
MRI
Laparoscopic cholecystectomy
Reimbursement
Diffusion
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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

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Activities

• Homework (HW)
• Web Assignments (WA)
• Class Activities (CA)
• Projects
• Due dates

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Technology Assessment

• What is it?
• Why do we need it?
• Example
• Bone marrow transplants for breast cancer

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Start here
What are the problems in health today?

Advance to next unit
Definition of Health
Role of World Health Organization
Health Data Types and Uses
Screening and Prevention
Diagnosis
Treatment and Therapy
Sensitivity and Specificity PPV
Epidemiology
Burden of Disease QALY, DALY,HRQL
Mortality Ages 15-44
Mortality Ages 45-60
AIDS/HIV
Respiratory Cancers
Heart Disease
Accidents
Interpersonal Violence
TB
Cerebrovascular disease
Developing and Developed World Contrasts
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What is health?
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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.

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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

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Individual Health vs. Population Health

• Pooled figures such as
• Infant mortality rates
• Numbers of deaths and causes
• Immunization rates

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Example of Health Data
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Questions about health data

• Why do we need it?
• What data do we need?
• Where do we get it?
• How do we use it?

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Why do we need health data?

• From 1870-1900
• Biomedical science advanced more than it had in
  previous 3 millennia
• Darwins 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.

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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/

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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

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Uses for health measures

• Identify emerging problems (early warning)
• Rubella during pregnancy
• Thalidomide during pregnancy
• AIDS ? Kaposis 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

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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

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Quantitative measures of health

• Incidence
• Number of new cases of a disease in a population
  over a period of time
• Annual incidence rate

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Quantitative measures of health

• Prevalence
• Number of existing cases of a disease in a given
  population at a specific time
• Point prevalence

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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

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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

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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

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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

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Leading causes of mortality in Member States 1998
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(No Transcript)
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Group 1 communicable diseases,
maternal/perinatal conditions, nutritional
deficiencies Group 2 Non-communicable diseases
(cardiovascular, cancer, mental disorders) Group
3 Injuries
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Mortality from cervical cancer in 1990 (per 100
000 age standardized world population) From  
Jones BMJ, Volume 319(7208).August 21,
1999.505-508
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Income
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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

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Summary of Lecture One

• Course organization
• What is health?
• Role of WHO
• Health data and uses

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Assignments Due Next Time

• WA1