[Linabelle Finnegan]

Question #1: A gulf has long existed between the fields of medicine and public health. What are the reasons for this gulf?
The main reason for the gulf between the fields of medicine and public health is the lack of clarity among the epidemiologists on the appropriate role for epidemiology with respect to public health and medicine. According to the article, and I concur , that this lack of clarity may have roots in the fact that until very recently (in the last 50 years or so), nearly all epidemiologists were physicians. As physicians, they focus more on the individual medical needs as opposed to the population needs. And we know that the population need is not a summation of the individual needs .

Question #2: What advantages could be realized through renewed emphasis upon public health epidemiology?

As we learned from our lesson this week, the role of Public Health according to CDC is “to inform and coordinate in order to achieve improved health for all”. Renewed emphasis upon public health epidemiology will do exactly this, “improved health for ALL”. Investigating diseases causes and contexts with focus not just on individuals but on population too, will avoid any “biological fallacy” i.e. an error in inferring that risk factors for diseases in individuals can be summed to understand the causes of diseases in populations. It will also be an error to assume
that the health of the population can be explained in terms of the health characteristics of individuals. Public Health epidemiology will help lessen the problem with the Over-emphasis on medical interventions that may result in missed opportunities for greater impact through population-level improvements in public health. The article cited a good example on the focus on genetic determinants for an individual-level response to obesity that will not address the underlying causes of the epidemic, and therefore will not likely affect change at the population level. Therefore, public health epidemiology will drive the development and implementation of study designs and analysis methods that are better suited to tackle public health-relevant questions. And therefore will fulfill the overall role of public health and every healthcare sectors in providing health for ALL!

[Linabelle Finnegan]

New frontiers for Environmental Epidemiology in a Changing World. Environment International 2017

Question #2: Which three forces in the coming decade will most alter the way our environment influences our health?
The three forces in the coming decade that will most alter the way our environment influences our health are: 1) Longer lifespan which will mean more chronic health conditions and longer life with disability ; 2) Shifting populations by region and from rural areas into more urban areas; and 3) global environmental changes with rapid evolving technologies.
In response, how must environmental epidemiology restructure its priorities to be relevant and effective? Environmental epidemiology must restructure its priorities to be relevant and effective by first focusing on healthy aging. It is not just the US who is facing the problem of the aging population with its aging baby boomers. Lifespans have lengthened across the globe, including important gains in low-income countries where life expectancy has improved from 53 years in 1990 to 62 years in 2012 (WHO, 2014). Adults aged 60 and older comprised 8% of the global population in 1940, which grew to 12% by 2013 and is projected to be 21% in 2050 (UN Department of Economic and Social Affairs, 2013). They also need to focus on evidence gaps, especially in susceptible populations and low-income countries; and prioritize developing approaches to better handle complexity and more formalized analysis.

[Linabelle Finnegan]

Question #1: What are the factors that most compel the use of evidence-based clinical practice guidelines?
The factors that most compel the use of evidence-based clinical practice guidelines are the varying opinions on experts not only between different specialties of expert clinicians but also from within clinicians of the same specialty and between those clinicians who made guidelines and clinicians who actually implemented them. It was also found that the composition of the guideline development group influenced the recommendations and that the recommendations made by clinical experts were often in conflict with the best available research evidence. These factors led to a rigorous process of identifying and evaluating research evidence. These research evidences are adapted to provide a more objective and transparent way to deal with the different expert opinions and the conflict of interests during the guideline development process. Thus giving rise to guidelines that can provide a meaningful framework against which medical quality of care can be measured and important health systems’ decisions be based on.

What are some effective steps that could improve their use in low-resource communities?
Since low-resource communities are dependent on foreign aid , they do not develop their own guidelines. So an effective step to improve their use is to assist them in developing their own guidelines that would be catered to their needs as opposed to following the guidelines developed by their foreign donors or WHO. They can use the locals who are more knowledgeable in regards to the health situation of the community as the main players in the guideline development. They can select a diverse group of individuals who would be given equal inputs so they can come up with a consensus in their recommendations on the most appropriate and effective guidelines to use for their own unique needs.

[Linabelle Finnegan]

Great discussion classmates! Sorry this is late! Hope you all had a blessed Thanksgiving. Had to fly to California to help with my Mom and fly her back to KC this Monday (she flew to Los Angeles from the Philippines last week). We will still be on the air during our class but purchasing WIFI services so I can join our class. Hope it works. Ha ha.. See you guys.. Blessings

[Linabelle Finnegan]

Question #1: From your perspective, what are the major reasons why infectious diseases surged in Iraq?

Wars definitely has a direct correlation in the surge of infectious diseases. This was true in Iraq during the Gulf War and the UN sanctions after the 2003 invasion. Infectious disease outbreaks can spread due to environmental and infrastructure damages resulting from these conflicts. Nutrition deteriorates, problems with clean water supply , as well as the sanitary conditions due to overcrowded camps Not to mention the problem with the administration of vaccines as well as any other infectious disease surveillances and prevention measures.

Question #2: What factors today most contribute to the decline in Iraq’s infectious diseases?

Cessation of wars definitely contributed to the decline if Iraq’s infectious diseases. Post-war reports showing vaccination routines started, rebuilding of infrastructures that helped in improving the water supply, sanitation , and nutrition of Iraq definitely contributed to the decline of infectious diseases. In addition, the restoration of veterinary services after the war also helped in vector-borne and zoomatic diseases in Iraq.

[Linabelle Finnegan]

Reese, loved your last statement “Those of lower socioeconomic status do not have as great of access to nutritious foods.”. IN this upside world we lived in , when going back to the basic :organic, no-added chemicals and processing, is more expensive, do not make sense, unless seen under the lens of profit.

[Linabelle Finnegan]

Question #1: Why was so much resistance encountered against labeling non-communicable diseases as a global health concern?

The resistance is due to the branding of most NCDs as “disease of the rich” (I believe this is more appropriate description than “lifestyle diseases” which is more general). This is no longer the case as the LMIC like Roatan Honduras. The top 2 diseases being treated at the Clinica Esperanza, our INMED team visited two weeks ago, are heart disease and diabetes. I shadowed Dr Susana, their diabetic doctor, who has been there for 5 years, and most of her patients are not changing their eating habits and lifestyle. Talking to one young lady working at the CLinica about the problem, I asked her if she knows that she would develop diabetes if she continues her eating habits and lifestyle, she said YES! SHe will not change since that is their culture. Personal choices win all the time! As our lesson for this week showed, the analysis of the social determinants affecting health shows that medical care influence is only 11% compared to the individual behavior of 38%.

Question #2: What role does epidemiology have today in countering the impact of non-communicable diseases?
Epidemiology already made an impact on NCD in its role in exploding its myth as the “disease of the affluent” and brought wide acceptable of NCD as an impt global health – due to its discipline in dealing with “incidence, distribution and opportunities for control of diseases and their determinants”. Today ,it is even proving to offer greater impact on NCD with the development of its new branch called “implementation science”.
The article describes this as “essentially concerned with knowledge translation, developing and providing evidence for strategies to increase the adoption and sustainable scale-up of evidence-based healthcare (i.e. going
beyond ‘does it work?’).”. That it is about changing behavior which would impact the 38% influence of individual behavior on medical care. This means understanding not just personal choices made by patients, but the behavior and personal choices of all people involved from policy makers, healthcare administrators, to healthcare providers, in making decisions impacting the global health issues at hand.

[Linabelle Finnegan]

Reinventing Biostatistics Education for Basic Scientists. PLOS Biology 2016
Question #1: What problems have you observed in the application of statistical information? What steps are necessary to improve use of reliable statistics in your own profession?
Definitely the main problem is the misuse of statistical methods used in the research which as the authors mentioned stems from the lack of understanding of the statistics. The author mentioned the problem of one-size-fits-all regarding the sample size, I would say the grave mistake in academia is the assumption of “one-test-fits-all” as evidenced by requiring only General Statistics in most graduate study programs.
In my field in Natural Medicine, the important step necessary to improve the use of reliable statistics is definitely in reporting and analyzing more the attrition and outliers in the research. The attrition bias happens when participants drop out from a study. Missing or incomplete outcome data due to attrition can definitely weaken the validity of the study most especially when most of the time you already have a small sample size in the first place. The missing or incomplete data can change the interaction of the variables you are studying. You may erroneously say there is a correlation when there is none or come out with no correlation when there could be one.

Association and Causation in Epidemiology – Half a Century Since Bradford Hill’s Interpretational Guidance. Royal Society of Medicine 2015
Question #2: Which, in your opinion, of Bradford Hills ‘guidelines’ make for the strongest defense for causation? Why do you believe this? I would say ‘temporality’ (the effect follows the potential cause after an appropriate interval) since this is the only one, as even discussed in the lesson, considered to be an essential for the causal inference. It makes sense to expect that if you are looking at the causation, that the effect has to occur after the cause. and if there is an expected delay between the cause and the expected effect, then the effect must occur after the delay

[Linabelle Finnegan]

Question #1: In what ways can drinking behavior confound the measurement of disease status and treatment?

If you are studying the effects of smoking on heart disease, drinking behavior will confound the measurement of heart disease since alcohol consumption is also directly correlated to heart disease. Another example would be the study of a high-fat diet on obesity. Drinking behavior will definitely be a confounder since alcohol consumption affects obesity.

Question #2: What is the proposed simple test to identify confounded epidemiology studies?

The proposed simple test is blocking the effects of the confounders on the given study.
To investigate the effects of alcohol use at baseline on the mortality of chronic disease, the confounding effects on health at baseline by the confounders are blocked. If the effects of alcohol use at baseline by the confounders are blocked (or removed) then any alcohol use prior to the baseline will not affect the mortality of chronic disease at baseline.
If randomized Multivariate analysis is conducted to block confounding effects of H2 and C. If the effect of H2 and C is successfully blocked, the effect of A1 and H1 that passes through H2 will be blocked as well. This means for a given alcohol use level at baseline, the estimated risk will not be different or affected by alcohol use before baseline (A1). In other words, the adjusted risk among participants with the same alcohol use level at baseline is expected to be the same regardless of their alcohol use prior to baseline, if all confounding effects are removed.

[Linabelle Finnegan]

Wow! Great discussion guys! Wished I was able to participate earlier! I will make sure I post earlier next time to get into the discussion. Sorry about that. Thanks for all the great input!

[Linabelle Finnegan]

Question #1: What are some current problems with collecting reliable information about health status?
The problem with collecting reliable information about health status is the high accuracy needed with the high volume of information collected. There is a need to monitor all of the people all of the time most especially with chronic patients then accurately compute their status and accurately sort them into treatment cohorts. The second question offers the solution to this problem

Question #2: What, in your opinion, are some potential advantages and disadvantages of passive electronic health monitoring?
The passive electronic health monitoring offers a solution to the problem of monitoring all of the people all of the time and computing their status. This is a great advantage especially when the passive monitors just run without a lot of additional tasks from the patients. This technology tremendously helps those unable to monitor themselves. The problem posed by this solution is its accuracy. Some monitors have to be worn in the right way with the right position otherwise you get inaccurate information. Wearable fitness devices require compact form to be conveniently used. There is also the issue of limited battery life which limits sampling like measuring cardiopulmonary function.

[Linabelle Finnegan]

Question #1: How must the concepts of epidemics be changed so that our management becomes more effective?
The concepts of epidemics must be changed by moving away from the focus on the epidemic itself, the pathogen and its immediate effect , as Huber, Finelli & Stevens reminded us,” into a much broader effect that the epidemic has not only on the healthcare system- like the economic impact that can be long lasting and devastating for often already fragile communities.”. There has to be a macro approach in managing the epidemic in seeing the whole picture rather than focusing on the micro level of the pathogen alone. There has to be an involvement of all sectors of the society from all global communities most especially the underserved that would be mostly impacted. There has to be a more integrated cycle of preparation, response and recovery , as the article suggested combining the knowledge and skills from other various disciplines and various global communities most especially at-risk and affected communities. This will result in a better communication of the problem and proposed solution. It will provide a better accountability from top to bottom. It also will foster trust that is very important for a more effective management.

Question #2: What disciplines need to be better integrated to create improved prevention and response to disease?

The article mentioned several disciplines that need to be integrated, including not only epidemiology but also social sciences, research and development, diplomacy, logistics and crisis management. It also did an excellent job in explaining how it can be integrated. However, considering the disciplines from rest of the seven major spheres of influence in every society: religion (church, various faith), family, education, government, business (economics, science & technology), media, and entertainment (inc arts and sports) during the integration process from the preparation to prevention to response would be very effective. These 7 spheres of influence principle came from the religious sphere (the church) and is now starting to be widely used by the business and other sectors. We saw how these 7 spheres played its role during the Covid19 pandemic. Most noteworthy is the impact of the Media , most especially the policing of social media (facebook, twitter, instagram) and even the mainstream media, in shutting down any opinions that are opposed to the views served to the public regarding COVID19 (its nature, vaccination, remedy, etc). The Engagement and communication discipline mentioned in the article: Encourage a community-led response, community engagement and health diplomacy “ was definitely not followed and would have been highly beneficial. The Ethics discipline mentioned in the article, would have helped most especially with the mandate of an experimental vaccine. Also, involving pastoral leadership and christian missionaries which had proven effective in previous epidemic scenarios, as part of the religious sector, would be wise. There is also the considerations of the differing levels of risk and priorities emanating from these spheres of influence that will be highly valuable in the integration cycle of preparation, prevention and response. One area that should also be included as part of the research study is natural medicine. This has been largely ignored by our current medical system but recently showing lots of development most especially with the recent developments in the pharma-nutrition interface and shows” some relevant mechanisms, including receptors and other targets, and examples from clinical practice.” (Let thy food be thy medicine….when possible Renger F.WitkampKlaskevan Norren
European Journal of Pharmacology Volume 836, 5 October 2018, Pages 102-114) .

[Linabelle Finnegan]

Nice to meet you Erin! Looking forward to getting to know you in our class and perhaps do mission trips together. And so excited to have you again in the class, Reese! Let me know if you want to do the trip with me Nov! Still waiting though and praying where to go. The doors to go to Nepal is closed so exploring the possibility to go to the Phil or India.

[Linabelle Finnegan]

HI! My name is Linabelle Finnegan.I reside in Lees Summit Missouri. I grew up in the Philippines and came here to the United States for graduate school in business and economics in Illinois. I was invited to teach at the university after a year, then landed a job in Southern California to manage the information systems of a health insurance company, where I would say my healthcare experience began. I worked there for a little over 15 years. I considered those years pivotal in my understanding of our current medical system. I have a heart for missions and have done local and international missions to several countries distributing groceries and school supplies, building homes, putting together free medical and dental clinics, and fighting against human trafficking. My family and I started a non-profit organization called ABBA Helps to respond to the needs of the poor, the abused, the voiceless, and the hopeless. My public health care experience grew in these places as I assisted during medical missions and attending not only to the physical health of the communities we would serve but as well as their spiritual, social and emotional health. It brought back my desire as a young girl in the Phils to help the poor in that respect. I took my pre-med requirements and trained for EMS, and decided for a faster degree as a Physician Assistant. During the process I was reminded of the system that somehow I also helped to create working in the health insurance company. I have always been drawn to complementary and alternative medicine, so that is what I explored. I studied Natural Medicine and Holistic studies, and received a mandate to help a person’s health by looking at the person as a whole, as our Lord Jesus asked his church to do, to be whole: spirit , soul and body until His coming. I opened ABBA Wholeness Center at our home in Lees Summit in 2017 then moved to an office in Blue Springs MO in November 2020. As a mother of 4 grown girls, I am an empty-nester now, so I opened my home in Lees Summit for pregnant trafficked teen girls and got licensed in Dec 2021. My girls and I also decided to continue our family’s vision to have a community that will be a place of refuge, health, and restoration for trafficked children under 12. The ABBA Helps Children’s Ranch in Mountain Grove MO is licensed after two and a half years in Dec 2021 to foster and adopt these children. The’ first home is almost complete and praying for the first foster couple to open.
I came across INMED in June and I thought the further training I can get in International Medicine focusing in public health can open more opportunities for global medical missions as well as find a network of medical and non-medical professionals who can help meet the pressing public health concerns brought about by the billion-dollar human trafficking business that transcends gender, race, social class, and demographics. So, in the future, I hope to continue our local missions here in Missouri for trafficked teens and children as well as continue to do more global missions helping the poor to meet their basic needs for food, shelter and good healthcare, as we share God’s love to them. With the education that I will receive from INMED and the network of professionals I will have the honor to meet and work with here, I hope to help put together medical missions in underserved communities that will not only respond to the physical needs but to the mental, emotional, and spiritual health of the community we are serving. I hope to help put together teams of clinical and non-clinical workers to help in whatever health crises they have at hand and come up with solutions and preventive measures.

[Linabelle Finnegan]

Question #2: Which habit of exemplary clinical teaching is translatable to education in LMIC (low and middle income) settings? Can you provide an example of effective implementation from your own experience?

Being a good listener, Keeping it simple (going down to the level of your patience), wearing your gloves (being personal and more hands-on), being patient-centered rather than disease-oriented and kindling kindness. As the author wisely stated and I quote “kindness makes patients more satisfied, teachers more effective, and learners more receptive, we should kindle it.”. I took EMS to prepare for my pre-med plans, and I had 2 instructors: a male firefighter office and one female paramedic. Perhaps it was also because of my style of learning, but overall the lady paramedic instructor was very effective, She communicated well even during demonstrations of her kindness to the patient. She is always talking about the patient first which i related and loved.

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