Epidemiology and Population Health

NUR 436: Comm & Population Health

what has been defined as the study of the occurrence and distribution of health-related states or events in specified populations, including the study of the determinants influencing such states, and the application of this knowledge to control the health problems

epidemiology

_____ is the method used to find the causes of health outcomes and diseases in populations

epidemiology

In epidemiology, the _____ is the community and individuals are viewed collectively

patient

_____ epidemiology seeks to describe the occurrence of a disease in terms of person, place, and time

descriptive

_____ of health events are factors, exposures, behaviors, contexts, and characteristics that determine (or influence) the patterns (answers the how and why); may be individual, relational, social, communal, or environmental

determinants

_____ epidemiology focuses on investigation of causes and associations

analytic

_____ _____ is the broad consideration of many levels of potential determinants. Answers the “what” question by defining health outcome including interprofessional collaborations (relationship of behavior, environment and disease)

ecologic approach

_____ determines who has the disease and where and when it occurs.

distribution

_____ occurs when the rate of disease, injury, or other condition exceeds the usual (endemic) level of that condition. Ex: widespread occurrence of the flu

epidemic

The purpose of epidemiology in public health practice is to

•_____ the agent, host, and environmental factors that affect health

discover

The purpose of epidemiology in public health practice is to

_____ the relative importance of causes of illness, disability, and death

determine

The purpose of epidemiology in public health practice is to

_____ those segments of the population that have the greatest risk from specific causes of ill health

identify

The purpose of epidemiology in public health practice is to

_____ the effectiveness of health programs and services in improving population health.

evaluate

By mapping cases that clustered around a single public water pump in one London cholera outbreak, _____ _____ demonstrated a connection between water supply and cholera (in the mid-nineteenth century)

John Snow

_____ _____ _____ influencing epidemiologic studies can be found in data sets such as mortality rates, and immunization compliance

twentieth century factors

what model was originally developed as a way of identifying causative factors, transmission, and risk related to infectious diseases

epidemiological triangle

***Changes in one of the elements of the triangle can influence the occurrence of disease by increasing or decreasing a person’s risk for disease

Data are collected with respect to a triad of elements:

_____- who it affects

host

Data are collected with respect to a triad of elements:

_____- what is affecting the host. The disease or problem itself

agent

Data are collected with respect to a triad of elements:

_____ - factors within the environment such as temperature, water etc.

environment

_____

• Infectious agents (e.g., bacteria, viruses, fungi, parasites)

• Chemical agents (e.g., heavy metals, toxic chemicals, pesticides)

• Physical agents (e.g., radiation, heat, cold, machinery)

agent

_____

• Genetic susceptibility

• Immutable characteristics (e.g., age, sex)

• Acquired characteristics (e.g., immunologic status)

• Lifestyle factors (e.g., diet, exercise)

host

_____ - really impresses on host and agent

• Climate (e.g., temperature, rainfall)

• Plant and animal life (e.g., agents, reservoirs, habitats for agents)

• Human population distribution (e.g., crowding, social support)

• Socioeconomic factors (e.g., education, resources, access to care)

• Working conditions (e.g., levels of stress, noise, satisfaction)

environment

A web of _____ is just that a web, and it should look like an entangled spider web as all causative factors are interconnected and there rarely is one causative factor to any disease or illness

causation

***This web looks at the more complex factors and how they interact with each other, sometimes in subtle ways, to increase or decrease risk of disease

The ecological model approach expands epidemiologic studies both upward to _____ contexts (such as neighborhood characteristics and social context) and downward to the genetic and molecular level

broader

The _____ _____ spans a broader spectrum of systems and etiologic factors than the more traditional web of causality model, and it encompasses determinants at many levels: biologic, mental, behavioral, social, and environmental factors, including policy, culture, and economic environments

ecological model

Another way of thinking of this is that the ecologic model moves from a two-dimensional perspective to a _____ perspective

multidimensional

_____ is the relationship between cause and effect

causality

what is the association between the supposed cause and its effect is consistent and always occurs in the same direction. (same results if repeated in different time, place, person)

consistency

what is the greater the correlation between supposed cause and effect, the greater the possibility the relationship is a causal one.

strength of association

what is the supposed cause always creates the same effect, no multiple or different effects.

specificity

what is the supposed cause always occurs before the effect. (exposure precedes outcome)

temporal relationship

what is the supposition that one event causes another is coherent with other existing knowledge.

coherence

_____ _____

•Employment

•Food Insecurity

•Housing Instability

•Poverty

economic stability

_____

• Early Childhood Education and Development

•Enrollment in Higher Education

•High School Graduation

•Language and Literacy

education

_____ and _____ Context

•Civic Participation

•Discrimination

•Incarceration

•Social Cohesion

social; community

_____ and _____ Care

•Access to Health Care

•Access to Primary Care

•Health Literacy

health; health

_____ and _____ Environment

•Access to Foods that Support Healthy Eating Patterns

•Crime and Violence

•Environmental Conditions

•Quality of Housing

neighborhood; built

Which study model expands epidemiologic studies both upward to broader contexts and downward to the genetic and molecular level?

A.Triangle model

B.Ecologic model

C.Epidemiologic model

D.Web of causality model

B

The principal concern of _____ _____ is the study of how society and different forms of social organization influence the health and well-being of individuals and populations

social epidemiology

_____ prevention refers to interventions aimed at preventing the occurrence of disease, injury, or disability

primary

Interventions at the primary level of prevention are aimed at _____ and _____ who are susceptible to disease but have no discernible pathology

individuals; groups

Example: Counsel clients about low-fat diet and regular physical exercise.

_____ prevention encompasses interventions designed to increase the probability that a person with a disease will have that condition diagnosed at a stage when treatment is likely to result in cure. Screening lives here

secondary

For example: Implement blood pressure and cholesterol screening; give treadmill stress test

_____ prevention includes interventions aimed at disability limitation and rehabilitation from disease, injury, or disability

tertiary

For example: Provide cardiac rehabilitation, medication, surgery

The precision, or _____, of the measure (i.e., its consistency or repeatability) and its _____ or accuracy (i.e., whether it really measures what it is supposed to be measuring, and how exact the measurement is) are important considerations for any measurement.

reliability; validity

_____ in a screening test is measured by sensitivity and specificity

validity

_____ quantifies how accurately the test identifies those with the condition or trait (true positives)

sensitivity

_____ indicates how accurately the test identifies those without the condition or trait (true negatives). Why would a screening test need high specificity? It indicates fewer false positives and better predictions of its measurement. Also helpful when rescreening is impractical.

specificity

_____ _____ is the purposeful, ongoing search for new cases of disease by public health personnel, through personal or telephone contacts or the review of laboratory reports or hospital or clinic records

active surveillance

_____ _____ is the more common form used by most local and state health departments

passive surveillance

_____ _____ is a system by which a health jurisdiction receives reports submitted from hospitals, clinics, public health units, or other sources

passive surveillance

Regular reporting of disease data by all institutions that see patients (or test specimens) and are part of a reporting network is called _____ ______. There is no active search for cases. It involves _____ notification by _____ sites and reports are generated and sent by local staff.

passive surveillance; passive; surveillance

After the frequency of disease is identified, the _____ _____ is calculated by dividing the number of cases of disease for the selected period by the size of the population at risk for that same period. Then, that number is multiplied by 100

illness rate

_____ is the state of having a specific illness (acute or chronic)

morbidity

_____ is the number of deaths that have occurred from that illness

mortality

_____ is a measure of disease that allows us to determine a person's likelihood of having a disease. Therefore, the number of prevalent cases is the total number of cases of disease existing in a population.

prevalence

_____ is a measure of disease that allows us to determine a person's probability of being diagnosed with a disease during a given period of time.

incidence

_____ _____ are informative only for fatal diseases and do not provide direct information about either the level of existing disease in the population or the risk of contracting any particular disease

mortality rates

_____ is a measure of the frequency of a health event in a defined population, usually in a specified period of time; a measure of how rapidly something is happening

rate

_____ refers to the probability that an event will occur within a specified time period

risk

An _____ _____ quantifies the rate of development of new cases in a population at risk

incidence rate

an _____ _____ indicates the proportion of the population at risk who experience the event over some period of time

incidence proportion

The _____ _____ is a measure of existing disease in a population at a particular time (i.e., the number of existing cases divided by the current population)

prevalence proportion

The _____ _____ is defined as the proportion of persons who are exposed to an agent and develop the disease; is often specific to an exposure

attack rate

_____ _____ _____ is the proportion of persons diagnosed with a particular disorder (i.e., cases) who die within a specified period of time

case fatality rate (CFR)

_____ _____ describes the proportion of deaths in a specified population over a period of time attributable to different causes

proportionate mortality

_____ _____ seeks to describe the occurrence of a disease in terms of person, place, and time

descriptive epidemiology

_____ _____ focuses on investigation of causes and associations. It seeks to know the why and the how

analytic epidemiology

_____ _____ is the broad consideration of many levels of potential determinants

ecologic approach

_____ determines who has the disease and where and when it occurs

distribution

In the definition of epidemiology, “distribution” refers to _____ _____

descriptive epidemiology

“determinants” refers to _____ _____

analytic epidemiology

So “_____” covers time (when), place (where), and person (who)

distribution

“_____” covers causes, risk factors, modes of transmission (why and how)

determinants

_____ Epidemiology-Time, place, and person is the mantra of the epidemiologist.

•when the population was affected,

•where they were affected, and

who specifically was affected

Descriptive

To test a hypothesis, epidemiologists must use an _____ epidemiology process in which they ask how and why the population was affected.

Example- identifying how and why a food borne bacteria was spread. Food preparers didn’t wash hands adequately, or food temperature altered

analytic

Lillian Mood is a public health nurse with more than 20 years of experience in South Carolina working with communities to detect and explain the causes of illness and disability. In describing her involvement with specific communities, Mood noted that the contact often began with a telephone call of concern about a planned or existing industrial facility or a firsthand observation of illness, expressed in lay terms as “too many cases of cancer,” “several people have had miscarriages,” or “more respiratory problems.” The citizen’s reasoning behind these observations is that “If I am seeing more health problems in my community, I ask what they have in common. The common factor may be where we live. So it must be the air or the water.” This is basic epidemiologic thinking, not irrational fear. Citizens try to make sense of what they are seeing, and they want professional help to unravel the pattern of illness.