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Epidemiology Part 1

Epidemiology Nursing

Epidemiology data is used to formulate... public health policy and law
List 2 goals of epidemiology 1. eliminate or reduce risk factors that cause disease 2. Promote health in the community setting
Suggested that environmental and host factors such as behaviors might influence development of disease. Hippocrates
Attempted to explain disease occurrence from a rational rather that a supernatural viewpoint Hippocrates
He published a landmark analysis of mortality data in 1662. His publication was first to quantify patterns of birth, death and disease occurrence. Noted disparities between m/f. high infant mortality, urban/rural differences and seasonal variations John Graunt
Considered to be the Father of Modern Vital Statistics and Surveillance. He developed many of the basic principles used today in vital statistics and disease classification William Farr
He built upon Graunt's work by systematically collecting and analyzing Britain's mortality statistics. William Farr
"Father of Field Epidemiology" Anesthesiologist who conducted studies of cholera outbreaks both to discover the cause of disease and to prevent its recurrence John Snow
Snow classic sequence 4 Steps 1. Descriptive Epidemiology 2. Generation of Hypothesis 3. Analytic Epidemiology (testing of hypothesis) 4. Application of Epidemiologyw
what was studied in the 1930-1940 non-infectious diseases
what was studied Post World War II (2 things) Lung Cancer associated with smoking Framingham Heart study
What was done in the 1960-1970's eradication of smallpox
what was studied in the 1980's injuries and violence
2 distinct facts about smallpox campaing 1. Global vaccination campaigns 2. Did not focus on the epidemiological approach such as interrupting the transmission of the virus.
4 principle methods of eradication of smallpox 1. active surveillance 2. outbreak investigation 3. outbreak control 4. rapid communication of disease intelligence
List 2 effects of nuclear radiation on the survivors of hiroshima and Nagasaki near the bombing site 1. Higher incidence of acute leukemia in victims younger than 30 2. Chronic leukemia at a young age
4 Disease transmission dynamics 1. communicable 2. emergency 3. disease control 4. dynamic mode of transmission
responsible for the ongoing systematic collection, analysis and interpretation of data that is then disseminated to those responsible for preventing diseases and other health conditions. CDC
routine reporting of cases of diseases reaching health care facilities for treatment or service passive surveillance
a special search done for finding cases in the community mainly through door to door surveys active surveillance
What is the classic epidemiological triad? Host Agent Environment (vector acting between the agent and environment)
List 4 agent factors 1. Biological (bacteria/genetic) 2. Chemical (poison/ETOH) 3. Physical (Radiation/Fire) 4. Nutritional (Lack vs Excess)
List 7 Host Factors 1. Age 2. Sex 3. Race/Ethnicity 4. Religion 5. Occupation 6. Marital Status 7. Family Background
What are the 2 modes of disease transmission 1. Horizontal 2. Vertical
List the 2 types of horizontal transmission 1. Direct (person to person STI) 2. Indirect (Vector - moquito) (Common vehicle - water)
Disease that is prevalent in a population in a certain area for a long period of time. Usual prevalence of a disease within an area. Usual or expected rate of disease over time. Appears as a flat line, steady state. Endemic
9 risk factors for endemic disease 1. lack of personal hygiene 2. Malnutrition 3. Poor sanitation 4. Contaminated water or food 5. Unclean surrondings 6. Low socioeconomic status 7. Climatic changes 8. Presence of other diseases 9. Unresponsive political climate
Occurrence in a community or region of cases of an illness, specified health behavior or other health related event clearly in excess of normal expectance in the community or region and the time period in which cases occur are specified precisely (WHO) epidemic (epidemic curve)
4 examples of epidemics 1. cigarette smoking habit by women during WWII 2. Emergence of VRE strains 3. Outbreak of Ebola in Kikwit Ziarer 5/95 4. Outbreak of multiple drug resistance mycobacterium TB (MDRTB)
A worldwide epidemic. An epidemic that "goes global" crossing national boundaries. Pandemic
Occurs when the rate of disease is the usual rate of disease in one geographic area that appears to be very high rate of disease from an observer's vantage point in another locale. Hyperendemic
A hyperendemic rate of disease appears as a flat line over time
An American NP would regard the rate of HBV in China as being an unusually high rate, an a chinese health official would view the rate of homicide as high rate is an example of hyperendemic
the inherent or acquired immune resistance offered by populations to the prevalence of a disease in a community Herd Immunity
In Herd Immunity, vaccinations of populations play an important role in the development of.... immunological barriers toward the entry of a disease into the community.
In Herd Immunity, the immune resistance effectively reduces the... efficiency of the microbe to transmit from person to person.
Two vaccines that are examples of herd protection 1. Oral polio vaccine (herd immunity and herd protection) 2. Tetanus vaccine
explain primary, secondary and tertiary prevention in regard to cervical cancer 1. Primary: Reduce HPV infection 2. Secondary: Pap smear 3. Tertiary: SX, Treat for Cure, CTX
promotion of health at both individual and community levels by facilitation health-enhancing behaviors, preventing the onset of risk behaviors and diminishing exposure to environmental hazards Primary Prevention
These efforts diminish disease incidence Primary prevention
screening for risk factors and early detection of asymptomatic or mild disease permitting timely and effective intervention and curative treatment Secondary prevention
these efforts diminish disease prevalence secondary prevention
what are the 3 earlier of secondary prevention 1. early detection 2. early diagnosis 3. early treatment
reduction of long-term impairment and disabilities and prevention of reported episodes of clinical illness tertiary prevention
Sanitation and sewer system, prenatal care, immunization programs are an example of... primary prevention
community screening for chronic disease risk factors, lifestyle change intervention programs are examples of.... secondary prevention
physical rehabilitation programs, lifestyle change programs for persons after recovery from an episode of clinical disease are an example of... tertiary prevention
Physical separation of healthy individuals who have been exposed to a contagious disease Quarantine
segregation and confinement of infected individuals from others who are known to be suffering from disease Isolation
Describe the process of epidemiological research (six steps) 1. identify need for research 2. understand concept of epidemiology 3. plan a study design 4. collect data 5. statistical analysis 6. interpret findings towards conclusions to improve health
unexpected rise in the number of cases of a particular identified or unidentified disease alerts public health officials to respond to the situation through focused investigation. Outbreak investigation
First 5 steps in epidemic field investigation of infectious disease outbreaks 1. determine existence of an epidemic 2. confirm diagnosis 3. determine number or cases 4. describe the epidemic in terms of person, place and time 5. determine who is at risk of becoming ill
Second 4 steps in epidemic field investigation of infectious disease outbreaks 6. develop and test hypothesis regarding the causal exposure 7. compare the hypothesis to the established facts 8. Plan a more systematic study 9. Prepare a written report
Quoted that "epidemiology is fundamentally engaged in a broader quest for social justice and equality" John C Cassel, MD
Study of the health and disease of the body politic - the population epidemiology
what is the basic science of public health in epidemiology 4 questions 1. What causes disease 2. How does disease spread 3. What prevents disease 4. What works in controlling disease?
3 elements of how epidemiology is the study of distribution and determinants of disease frequency 1. How DZ occur in different groups and why 2. Applying knowledge gained to community base practice 3. quantitative
Any factors that brings about a change in a health condition. It's causes and risk factors. determinants
In distribution, the number of health events and the relationships of those infected/impacted to the size of the population (rate) Frequency
How does descriptive epidemiology describe Pattern Person, place and time
the initial investigation of outbreaks of disease. Disease incidence, calculation or rates, ID population at higher risk descriptive epidemiology
Use valid comparison group. Design, conduct, analysis and interpretaion. Analytic epidemiology
Allow comparisons of "event per identical number" of person in two or more populations. Comparison of events over time in a single population is also possible. Rate
measure of the frequency with which an event occurs in a defined population over a specified period of time. A measure of risk. Enables review of the frequency of a disease in the perspective size of population rate
The proportion of the population that develops illness during an outbreak. New cases. It is always expressed as a PERCENTAGE Attack rate
Number of deaths attributed to a particular disease during a specified period divided by the number of new cases of that disease (during the same period) Death to case ration
The proportion of persons with the disease who die from it. A measure of the severity of the condition Case fatality rate: SARS
The frequency with which something, such as disease, appears in a particular population or area Incidence
In disease epidemiology, the number of newly diagnosed cases during a specific time period Incidence
The number of cases alive on a certain date prevalence
The proportion of an initially disease-free population that develops disease during a species period of time. The measurement of risk. Simplest measure of risk is a probability. Incidence Proportion
Risk = N = number of new cases of disease in time period D = Size of population at start of period Incidence Proportion
Bed Sore Example, Inc. Proportion. 120 its enter a study and none have bed sores. Over next 6 months, 30 pts develop bedsores. Calculate the risk or incidence proportion 30/120 = 0.25 (25%)
Risk = N =number of new cases of disease in time period D = Time each person was observed, totaled for all persons incidence rate
Bedsore example, Inc Rate. Of the 120 pt beginning study of 6 months duration...110 its stayed 6 months, 5 d/c at end of month 1 and 5 d/c at end of month 6. What is the total exposure? (110X6) + (5X!) + (5X6) = 685 person months Incidence rate = 30/685 = 0.0438 per person month
Incidence rates are multiplied by a time factor. The time unit is something familiar. Person years
Give two methods of counting cases 1. Count only the first cases 2. Count all the cases (enables one person to have multiple episodes)
3 facts of epidemiology 1. investigates risk factors that cause disease through retrospective and prospective 2. HX of dz and frequency of occurance or transmission 3. explores preventable and therapeutic measures.
measures how rapidly cases are occuring. Used to compare results from studies with different length of follow up. Based on person-time. incidence rate
Cumulative, when you only care about the "bottom line" (i.e. what has happened by the end of given period) Or if risk period is long (Cancer) and a portion is measured or risk period is short and all is measured incidence proportion
Measures a phenomenon at an instant in time. Indicates how wide spread is the dz. A snapshot of the dz at some pt in time. Much easier to understand. prevalence proportion
Number of live births per 1000 crude birth rate (CBR)
Crude birth rate calculation CBR: No of births x 1000/est midyear population
Most countries with very high fertility are.. poor and least developed countries
Fertility has reached below replacement levels in... 25% of the world population and in all developed countries in the area.
Number of deaths per 1000 population crude death rate CDR
crude death rate calculation number of deaths x 1000/est midyear group
Number of fetal deaths (>20weeks) per 1000 live births plus fetal deaths Fetal death rate
Fetal death rate calculation Number of fetal deaths x 1000/number of live births + number of fetal deaths.
infant mortality rate calculation number of infant deaths/number of live births x 1000
4 roles as an APN 1. Know epidemiology in your community, educate about specific health topics, 3. Identify risk factors for your community, 4. Detect health problems early!
phenomenom divided by a specific period of time rate
Piece of the pie proportion
comparing apples to oranges ratio
what are the 5 types of observational studies Cohort, Case Control, Cross-sectional, case series, case report
In epidemiological research, investigators study the inter-relationships among what 3 things? Frequency, Intensity and duration of disease
Having found an association between exposure and disease, epidemiologist then embark on a search for... cause and effect relationships
Having substantiated a casual relationship, epidemiologist may then devise.... interventions to control or prevent disease occurrance
Basic Question in Epidemiological Research? Are exposure and disease linked.
Describe independent vs dependent variable in terms of exposure and disease Exposure: Independent variable (Risk factor, agent, treatment water.) Disease: Dependent variable (Disease/Healthstate, outcome cholera)
An example of an experimental design study randomized control trial
Follow people over time to measure E and development of D (Lung cancer and smokers) Cohort
identify cases of D and match them with non-cases and ask about E (asbestos) Case control
ask population about both E & D at the same time. Go to cancer unit and ask all lung CA patients did you smoke Y or N? Cross Sectional
Sample is assigend to E and follow development of D (Tuskegee with Syphyillis) Randomized control trial
Describe observational studies in regard to epidemiology study of diseases and exposure in free-living populations without interventions. Nature is allowed to take its course.
describe experimental studies in regard to epidemiology interventions are applied