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Community Exam II > Epidemiology, Communicable Diseases, Surveillance > Flashcards

Epidemiology, Communicable Diseases, Surveillance Flashcards

1
Q

Epidemiology is:
page 70

A

The study* (scientific, systematic, and data-driven) *
of the distribution (frequency and pattern) *
and determinants (causes and/or risk factors) *
of health-related states and events* (not just diseases) *
in specified populations (neighborhood, school, city, state, country, global).

Another defn: discipline that describes, quantifies, postulates causal mechanisms for diseases in populations and develops methods for the control of diseases

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2
Q

Purpose of epidemiology in Community Health
page 70

A

To understand health problems in a population and to control health problems or events through the application of this study
* Population (Community) = Patient

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3
Q

Examples of health problems or events:
table 5.1, page 73

A
  • Environmental Exposures
  • Infectious diseases and non-infectious disease
  • Injuries
  • Natural disasters
  • Terrorism
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4
Q

Historical Roots of Epidemiology
no ref

A

Ancient Times
* Hippocrates - Circ 400 BC
600s - tried to explain disease from a rational, rather than supernatural viewpoint - emphasis on epidemiologic observation
John Graunt
* Quantified patterns in healthcare - demographer

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5
Q

Development of the discipline - epidemiology: 1800s

A

John Snow - compared death rates b/n water companies
page 71, box 5.2

(1813 to 1858)
* Cholera in London
* Mapping incidence
* Intervention

Florence Nightingale
page 24-26
(1820 to 1910)
* Crimean War
* Descriptive study of distribution & patterns of disease
* Used graphs to illustrate her findings
* Sanitary Statistics
* detailed records, morbidity statistics, careful description of health conditions
* first nurse researcher
* use “statistics as evidence” to gain the attention of politicians and powerful people in her quest for hospital and public health reforms

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6
Q

Modern Epidemiology

A

Causal Thinking page 80
* Search for causes of diseases that influence one’s risk of disease.
* Health-related outcomes, behaviors, knowledge, and attitudes.

Infectious-Disease Epidemiology chapter 26
* Contagion theory – Germ theory (Pasteur, Henle, Koch)
* Continued focus on new emerging diseases

Chronic-Disease Epidemiology
* Exposure related outcomes
* Advanced pharmacology & interventions
Additional Foci
* Studies of injuries and violence.
* Molecular and genetic epidemiology

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7
Q

Eco-Epidemiology

A

Global Health Patterns
* Route, form, virulence
* Environmental, ecologic, & human considerations
* Technologic and political influences
Advancements in Technology
* Biology/Biomedical interventions and devices
* Genetics
* Telehealth
* Mapping, distributions, surveillance

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8
Q

Theories (epidemiology)

A

The 5Ws: Who, what, when, where, why/how
Epidemiologic triad - Table 5.1 – pg 73

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9
Q

Epidemiologic triad - Table 5.1 – pg 73

A

Host
* Susceptible human or animal who harbors and nourishes a disease-causing agent
Agent
* A factor that causes or contributes to a health problem or condition
Environment
* All the external factors surrounding the host that might influence vulnerability or resistance

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10
Q

Chain of Causation

A

Relationship between a cause and its effect

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11
Q

Modes of Transmission

A
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12
Q

Web of Causation

A

Another common term used for this approach is causal matrix.

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13
Q

Wheel of Human-Environment Interaction

A
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14
Q

Non-linear causation

A

Concepts
* Strength of Association
* Consistency of Association
* Specificity
* Temporality
* Biological Gradient
* Biological Plausibility
* Coherence of explanation
* Analogy
* Experiment Evidence

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15
Q

Methods - Descriptive Epidemiology

A
  • Based on observations
  • Descriptive epidemiology covers time, place, and person.
  • Develop hypotheses
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16
Q

Methods - Analytic Epidemiology

A

Observational
* The exposure and disease status of each study participant is observed.
Experimental
* A controlled process involving exposure for each individual (clinical trial) or community (community trial) and tracking of individuals or communities in the trial over time to detect the effects of the exposure.

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17
Q

Observational Studies

A

Case–control studies
* Compares people with a condition (cases) with those who lack this condition (controls).
Cohort studies:
* A group of people who share a common experience in a specific time period
Cross-sectional study.
* A sample from a population is enrolled and exposures and health outcomes measured simultaneously.
* The cross-sectional study tends to assess the presence (prevalence) of the health outcome at that point of time without regard to duration.

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18
Q

Experimental Studies

A

Research Process:
* Identify the problem
* Review the literature
* Design the study
* Collect the data
* Analyze the findings
* Develop conclusions and applications
* Disseminate the findings

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19
Q

Test reliability and validity

A

Reliability
* Consistency
Validity
* Accuracy

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20
Q

Sensitivity and Specificity

A

Sensitivity
* Correctly identify a person with the disease
Specificity
* Correctly identify a person without the disease

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21
Q

Sources of Epidemiologic Information

A
  • Vital statistics
  • Census data
  • Reportable diseases
  • Disease registries
  • Environmental monitoring
  • National Center for Health Statistics Health surveys
  • Informal observational studies
  • Scientific studies
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22
Q

Risk

A
  • Probability that a disease or unfavorable health condition will develop
  • Directly influenced by biology, environment, lifestyle, and system of health care
  • Risk factors: negative influences
  • Epidemiologists studying populations at risk: Are the risks modifiable?
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23
Q

Frequency

A
  • Prevalence Rate
  • Incidence Rate
  • Crude rates
  • Specific Rates
    Table 5.2 – pg 76
24
Q

Ratio

A

Calculating a ratio
* Number or rate of events, items, persons, etc. in one group OVER -
* Number or rate of events, items, persons, etc. in another group
* ex) Delaware’s infant mortality rate in 2001 was 10.7 per 1,000 live births
* New Hampshire’s infant mortality rate in 2001 was 3.8 per 1,000 live births
* What is the ratio?

25
Q

Proportion

A
26
Q

Rates

A
27
Q

Prevalence VS Incidence

A
28
Q

Additional Epidemiological Terms

A

Morbidity: illness
* Usually prevalence rates
Mortality: death (see image)

29
Q

National Trends in Communicable Disease

A

Emerging diseases are commonly defined as:
* Outbreaks of previously unknown diseases, OR
* Known diseases that are rapidly increasing in incidence or geographic range, OR
* NIAID Category A, B, or C priority pathogens
* https://wwwnc.cdc.gov/eid/
Resurging/Reemerging diseases:
* Diseases that are reappearing after they have been on a significant decline.

30
Q

Emerging diseases - NIAID categories

A

Categories A, B, C

31
Q

Category A

A

Organisms/biological agents that pose the highest risk to national security and public health due to:
* Ease of transmission
* High Mortality
* High public health impact
* Require special preparedness

32
Q

Category B

A

Organisms/biological agents that are:
* Are moderately easy to disseminate
* Moderate morbidity rates and low mortality rates
* Require specific enhancements for diagnostic capacity and enhanced disease surveillance

33
Q

Category C

A

Emerging pathogens that could be engineered for mass dissemination in the future because of:
* Availability
* Ease of production and dissemination
* Potential for high morbidity and mortality rates and major health impact

34
Q

Major communicable diseases in the United States

A
  • Chlamydia
  • Gonorrhea
  • Hepatitis (A, B, C, D)
  • Genital Herpes
  • Human papillomavirus
  • HIV/AIDS
  • Syphilis
  • COVID 19
  • Influenza
  • TB
  • Pneumonia
35
Q

Natural History of a disease

A
36
Q

Example - stages of TB

A

Susceptibility
* Poor nutrition, anemia, chronic illnesses make you more vulnerable
Subclinical stage
* After exposure, the bacteria find a “home” in body tissues and begin to multiply. Symptoms are minimal.
Clinical disease stage
* Depending on the location of the body tissues primarily affected, we see symptoms there- Spinal TB (bone pain) Pulmonary TB (cough, bloody sputum)
Resolution stage
* Depending on the location of the body tissues primarily affected, we see symptoms there- Spinal TB (bone pain) Pulmonary TB (cough, bloody sputum)

37
Q

Spectrum of Disease

A

Outbreak
Epidemic
Endemic
Pandemic

38
Q

Outbreak

A
  • A sudden rise in the number of cases of a disease more than normal expectancy in a community or geographical area.
  • Typically a more limited area than an epidemic.
39
Q

Epidemic

A

An increase, often sudden, in the number of cases of a disease above what is normally expected in that population in that area

40
Q

Endemic

A

Disease or condition present among a population at all times.

41
Q

Pandemic

A

An epidemic that has spread over several countries or continents, usually affecting a large number of people.

42
Q

Passive Immunity

A
43
Q

Active Immunity

A
44
Q

Cross-immunity

A

immunity to one agent providing immunity to another related agent
* Cow pox protected against small pox
* bacille Calmette-Guérin (BCG) for TB protection

45
Q

Herd Immunity

A

immunity level present in a population group
* High herd immunity means the immune people in the group > the susceptible people; consequently, the incidence of a particular disease is reduced
* School & travel immunization requirements

46
Q

Nursing Process for Communicable Disease Control

A

Assessment
* Contact tracing; Community need for surveillance; New or improved control programs

Planning
* Immunizations, Symptom relief, Limiting exposure, Collaboration, Surveillance

Implementation
* Immunizations, Symptom relief, Limiting exposure, Collaboration, Surveillance

Evaluation
* Data analysis and interpretation

47
Q

Strategies for prevention of communicable diseases

A

Primary prevention
* Mass media education campaigns
* One-on-one education
* Immunization

Secondary prevention
* Screening
* Contact Tracing
* Disease investigation

Tertiary prevention
* Quarantine
* Contact Tracing
* Medical Support after infection
* Rehabilitation

48
Q

Covid-19: Levels of prevention

A

Primary prevention
* Hand washing, correct use of masks and shields, social distancing
* Mass Media
* Education

Secondary prevention
* Screening questions
* Testing
* Contact tracing
* Surveillance

Tertiary prevention
* Quarantine,
* Contact tracing
* Pulmonary support and rehab

49
Q

Investigation - process

A

Investigating reportable communicable diseases requires a systematic approach.
* Review the information.
* Clarify that the disease is suspect, or lab confirmed.
* Review the case definition.
* Review the disease information.
* Use specific questionnaires when available.

50
Q

Investigation - methods

A

Outbreak investigation
* 10 steps

Surveillance
* Passive, Active, Sentinel, Syndromic

51
Q

Surveillance - passive

A
  • Diseases are reported by health care providers
  • Simple and inexpensive
  • Limited by incompleteness of reporting and variability of quality
52
Q

Surveillance - active

A
  • Health agencies contact health providers seeking reports
  • More complete reporting
  • Used with specific epidemiologic investigation
53
Q

Surveillance - sentinel

A
  • Reporting of health events by health professionals who are selected to represent a geographic area or a specific reporting group
  • Can be active or passive
54
Q

Surveillance - syndromic

A
  • Focuses on one or more symptoms rather than a physician-diagnosed or laboratory-confirmed disease
55
Q

Reportable vs. Notifiable

A
56
Q

Outbreak Investigation

A
  • Establishing the existence of an outbreak
  • Preparing for fieldwork
  • Verifying the diagnosis
  • Defining and identifying cases
  • Using descriptive epidemiology
  • Developing hypotheses
  • Evaluating the hypotheses
  • Refining the hypotheses
  • Implementing control and prevention measures
  • Communicating findings
57
Q

Resources

A

Center for Disease Control and Prevention (CDC)
* MMWR - Morbidity and Mortality Weekly Report
* HHS.gov
* Texas Health & Human Services

Community Exam II (4 decks)

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