Module 1

Question 1

Epidemiology

Answer 1

The study of the distribution and determinants of health and disease in human populations

Assumptions:

• disease is not random
• there are factors that predispose us to or protect us from disease

Question 2

Goals of epidemiological inquiry

Answer 2

1. To find the etiology of disease
2. To find disease burden
3. To study the natural history of disease
4. To evaluate prevention and therapeutic measures and modes of health care delivery
5. To inform public policy and make decisions regarding environmental problems

Question 3

Hippocrates contribution to epidemiology

Answer 3

Wrote “On Airs, Waters, and Places,” suggesting that disease may be associated with the physical environment

Represented a shift from supernatural explanations of disease causation

Miasmatic theory of disease: caused by a miasma (bad air/pollution)

Question 4

Examples of Pandemics

Answer 4

The Black Death (1346-1352)

• 1/4 to 1/3 population of Europe
• caused by Yersinia Pestis

The Spanish Flu (1918-1919)

• 50-100 million deaths worldwide
• influenza A virus

Question 5

Edward Jenner

Answer 5

Developed a method for smallpox vaccine

Question 6

Ignaz Semmelweis

Answer 6

Discovered the importance of hand washing to prevent disease transmission and sepsis

Question 7

John Snow

Answer 7

Investigated a cholera outbreak in London (natural experiment)

Associated cholera with contaminated water
Used spot maps to illustrate cases and found the water pump responsible for the outbreak

Question 8

Applied epidemiology (shoe leather epidemiology)

Answer 8

Putting epidemiological research to use in public health practice (traditional epidemiologic methods)

Question 9

Managerial epidemiology

Answer 9

The application of epidemiology to health promotion, disease treatment and prevention, and public policy

Question 10

Functions of epidemiology in management

Answer 10

Planning- forecasting, needs assessment
Staffing/directing- HR
Controlling- QA, surveillance, total quality man
Organizing- division of work/info systems
Financing- capitation, global budgeting

Question 11

Why managers need epidemiology

Answer 11

Treatment/prevention models
Improved access to care
Outcomes assessment
Capitation and managed care
Anticipate future demand/changing markets 
Redirection of public health activities

Question 12

Contemporary applications of epidemiology

Answer 12

Measuring/monitoring Q of Care
Planning health activities 
Marketing health services 
Tracking disease occurrence, impact, dist.
Infection control programs
Public health

Question 13

Descriptive epidemiology

Answer 13

*person, place, time
Objectives:
-Evaluate and compare trends in health and disease
-Basis for planning, provision, and evaluation of health services
-Identify problems for analytic studies

Question 14

Descriptive Epidemiology: Person

Answer 14

Characteristics or behaviors that increase or decrease risk of disease

Modifiable risk factors: diet, exercise, smoking, SES, marital status

Non-modifiable risk factors: age, sex, race, genetics

Question 15

Descriptive Epidemiology: Place

Answer 15

Patterns across geographic areas

Helps to discern importance of genetic vs. environmental causes of disease

Question 16

Geographic information systems (GIS)

Answer 16

Provide sophisticated tool for spatial analysis

Sophisticated analysis functions:

• interactivity
• layers spatial variables
• queries for defined parameters
• computes new data from existing variables
• measures distance and driving time between points

Question 17

GIS health sector uses

Answer 17

Link patients with providers 
Epidemiology 
-incidence rates by county
-spot maps 
Emergency planning
Managed care and compliance

Question 18

Spatial epidemiology

Answer 18

Used GIS to provide spatial perspective on geographic distribution of health conditions

Produces maps that show variations is disease rates by different degrees of shading/dot clustering

Question 19

Uses of spatial epidemiology

Answer 19

1. Mapping of environmental health risks
2. Portraying geographic distribution of infectious diseases
3. Health policy/planning
   - —risk assessment
   - —intervention evaluation
   - —health services needs assessment
   - —health services accessibility

Question 20

Descriptive Epidemiology: Time

Answer 20

Describing diseases overtime to understand risk factors, etiology, and disease transmission

Question 21

Epidemic curve (short-term trend)

Answer 21

Shows incidence of disease over time for an outbreak

Question 22

Secular trend

Answer 22

Long-term (years, decades)

Cyclical or seasonal

Question 23

Clustering

Answer 23

And unusual aggregation of health events grouped together in space and time

Temporal clustering (time): post-vacc reactions, postpartum depression

Spatial clustering: concentration of diseases in a Geographic area

Question 24

Population health

Answer 24

The distribution of health outcomes among a defined group of people

Question 25

Public health

Answer 25

Societal efforts to protect and promote the health of a population

Question 26

Flu outbreak in healthcare organizations protocol

Answer 26

Isolate infected patients
Disinfect environment
Vaccinate 
Enforce standard and droplet precautions 
** notify health department (req)

Question 27

Natural Experiments

Answer 27

Study of groups who have been exposed for non-study purposes (ex: atomic bomb Japan, poison gas leak India)
Epidemiologist:
-Does not manipulate risk factors
-Observes changes in an outcome as the result of a naturally-occurring situation