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NURS 4540 > Class 5 - Epidemiology > Flashcards

Class 5 - Epidemiology Flashcards

1
Q

What is epidemiology

A

the science of understanding the causes and distribution of population health so that we may intervene to prevent disease and promote health

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2
Q

Epidemiology study populations in order to…

A
  • clarify clinical and demographic characteristics
  • identify who is at risk for illness
  • provide clues to causes of disease
  • guides preventative measures and interventions
  • monitor health of population
  • identify DOH and disease in communities
  • investigate and evaluate interventions to prevent disease and maintain health
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3
Q

What are the 2 sides of epidemiology

A
  1. descriptive
  2. analytical
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4
Q

What is the outline for descriptive epi studies

A

the who, what, when, and where of the health event
- what: disease, injury, death (clinical - case definition)
- who: age, gender, sociodemographic, occupation
- when: time, seasonality, secular trends
- where: place, neighborhood, city, county, census tract
- distribution: frequency of the event and pattern of the frequency

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5
Q

What is the outline for analytical epi studies

A

determinants of disease
- understand factors that influence the occurrence of health-related event (causes, risk factors, modes of transmission)
- understand the “how” and “why” aspects of the event

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6
Q

Epi Descriptive - describing ‘what’

A

Alerts to new problems:
- look for other cases
- develop new surveillance system
- propose hypothesis

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7
Q

Epi Descriptive - describing ‘what’ clinical info includes

A
  • symptoms/signs (case definition)
  • lab results
  • hospitalization
  • lived or died
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8
Q

Epi Descriptive - describing ‘who’ demographic info includes

A

age, sex, marital status

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9
Q

Epi Descriptive - describing ‘who’ socioeconomic info includes

A
  • education
  • occupation, income
  • place of work or residence (postal codes)
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10
Q

Epi Descriptive - describing ‘where’ outline

A
  • where illness began (home, vacation site)
  • where exposure occurred (education, occupation, income, place of work or residence)
  • source of contamination (farm, unwashed produce)
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11
Q

Epi Descriptive - describing ‘when’ includes

A
  • trends (change over time, long-term trends/secular)
  • patterns (cyclical trends seen over several years/seasonal)
  • epidemics
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12
Q

What is an endemic

A

rate of a disease, injury, or other condition is the rate of occurrence that is usual in a population

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13
Q

What is an epidemic

A

occurs when the rate of a disease, injury, or other condition clearly exceeds the usual level for that condition

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14
Q

What is a pandemic

A

rate of a disease, injury, or other condition is the rate of its occurrence in the geographically widespread population

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15
Q

What is our goal with an epidemiological triad of disease

A

break at least 1 side of the triangle to stop the continuation of disease

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16
Q

What are descriptive epi studies used for

A
  • program planning
  • generating hypotheses
  • suggesting ideas for further study
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17
Q

What are analytical epi studies used for

A

to test for hypotheses about the cause of disease and studying how exposure relates to disease

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18
Q

Types of epi studies

A

descriptive and analytic

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19
Q

Types of descriptive studies

A
  • case report: individual case data
  • case series: individual data on a group of cases
  • incidence study: new cases during a specific time
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20
Q

Types of analytic studies

A

experimental (exposure is randomly assigned) and observational

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21
Q

Analytic studies, types of experimental studies

A
  • clinical trial: randomization at the individual level
  • community trial: randomization at the community level
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22
Q

Analytic studies, types of observational studies

A
  • cohort
  • case-control
  • cross-sectional
  • ecological
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23
Q

What is a cohort study

A

Observe groups of people who do and don’t experience an exposure, to compare how many in each group have the disease

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24
Q

What is a case-control study

A

Compares a group of people who have a disease to a similar group who don’t have a disease, and the investigator records who had exposures of interest

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25
Q

What is a cross-sectional study

A

Snapshot of a specific period in time, with the aim of finding the same kind of relationships as experimental studies; describes exposure and disease in a population at some point in time

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26
Q

What is an ecological study

A

Compares populations rather than individual, association at the group level do not always mean association at the individual level

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27
Q

Data for epidemiological studies commonly come from three categories:

A
  • routinely collected data (census data, vital records, surveillance data)
  • data collected for other purposes (medical, health department, insurance records)
  • original data collected for specific epi studies
28
Q

Prevalence =

A

Incidence X Duration of Disease

29
Q

relationship between prevalence and incidence

A

incidence (new cases) increase prevalence above baseline. and vice versa

30
Q

Incidence Proportion =

A

of new cases of disease occurring during a specific period / # of persons at risk of developing the disease during that same period

31
Q

Prevalence Proportion =

A

of cases of disease occurring during a specific period / # of persons in the population at that same period

32
Q

What does incidence proportion capture

A

disease onset

33
Q

What does prevalence proportion capture

A

disease status (present or absent)

34
Q

What increases prevalence

A
  • increase incidence
  • increase duration of disease
  • influx of cases
  • emigration of healthy people
  • influx of susceptible people
  • changes in diagnostic criteria
  • better reporting
35
Q

What decreases prevalence

A
  • decreased incidence
  • decreased duration
  • high case fatality rate
  • influx of healthy people
  • out-migration of cases
  • poorer case detection
  • influx of immune people
36
Q

What are screenings

A

process of classifying people as to whether they are likely to have a disease

37
Q

what are the 3 levels of prevention to consider

A

primary, secondary, tertiary

38
Q

what is primary prevention

A

seeks to prevent new cases of a disease from developing in the population

39
Q

examples of primary prevention

A
  • no smoking campaigns
  • sunscreen
  • PrEP
40
Q

what is secondary prevention

A

seeks to reduce the number of existing cases of a disease

41
Q

examples of secondary prevention

A

Cancer Screenings
- mammography
- colonoscopy

42
Q

what is tertiary prevention

A

seeks to limit the disability resulting from disease and improve functioning

43
Q

examples of tertiary prevention

A
  • cardiac rehab
  • PT, OT
44
Q

What is the natural history of disease

A

refers to the progression of the disease process from onset to recovery:
- pre-clinical (susceptibility to disease)
- clinical (from the preclinical stage to death, disability, or recovery)

45
Q

When are screening tests appropriate

A

(BEFORE symptoms develop)
- disease is an important cause of morbidity and mortality
- tx is available
- impact of disease can be minimized before symptoms develop
- prevalence of preclinical disease is high

46
Q

What makes a good screening test

A
  • easy to admin
  • results can be easily available (automated lab reporting)
  • test is inexpensive
  • test imposes minimal discomfort to the screenee
47
Q

screening tests vs diagnostic tests

A

Screening
- done on asymptomatic, healthy individuals who are encouraged to get screened
- the benefit that early tx conveys in terms of prognosis should outweigh the net costs of screening
Diagnostic
- done on sick people who present with symptoms
- pre-test probability of disease is high (high disease prevalence)
- often performed after a +ve screening test to establish a definitive diagnosis

48
Q

Define the validity of a test

A

its ability to distinguish between who has a disease and who does not

49
Q

What are the two components of validity

A

sensitivity and specificity

50
Q

What is test sensitivity

A
  • The ability to correctly identify individuals who have the disease
  • is it to identify true positive
  • a test with high sensitivity will have few false negatives
51
Q

what is test specificity

A
  • the ability to correctly identify individuals who do not have the disease
  • to call a true negative ‘negative’
  • a test with high specificity has few false positives
52
Q

true positive =

A
  • have disease
  • positive test
53
Q

false positive =

A
  • no disease
  • positive test
54
Q

true negative =

A
  • no disease
  • negative test
55
Q

false negative =

A
  • have disease
  • negative test
56
Q

Sensitivity =

A

TP/ TP + FN

57
Q

Specificity =

A

TN / TN + FP

58
Q

What are sensitive tests good for?

A

ruling disease OUT

59
Q

What are specific tests good for?

A

ruling disease IN

60
Q

What is a positive predictive value?

A

the percent chance that a positive test result I a true positive (i.e. that a person w/ a positive result actually has the condition)

61
Q

PPV =

A

TP/ (TP+FP)
= TP / (all that tested positive)

62
Q

What is a negative predictive value?

A

the percent chance that a negative test result is a true negative (i.e. that person w/ a negative result is actually disease free)

63
Q

NPV =

A

TN/ (TN+FN)
= TN / (all that tested negative)

64
Q

why are we concerned about false positive results?

A
  • additional testing, perhaps more invasive
  • anxiety and distress associated with positive test results
  • impose additional costs on the individual and the health care system
65
Q

why are we concerned about false negative results?

A
  • may delay tx and lead to poorer prognosis
  • public health concerns if the disease is transmissible
66
Q

When do we want a test with high sensitivity

A

if missing a case leads to high penalty, aim is usually to minimize false negatives

67
Q

When do we want a test with high specificity

A

if subsequent diagnostic testing is particularly expensive or invasive, the aim may be to minimize false positives

NURS 4540 (12 decks)

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