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1
Q

What does the word distribution mean in the modern definition of Epidemiology?

A

Frequency - not only just number but relationship to the size of the population.
Pattern - time, place, and person

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2
Q

What was the epidemiologic shift?

A

Shift from high morbidity and mortality (transmissible disease) to low morbidity and mortality (chronic disease).

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3
Q

What does the word study mean in the modern definition of Epidemiology?

A

The basic science behind public health and many medical disciplines, is quantitative and based on the application of statistics and research methodologies.

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4
Q

What does the word determinants mean in the modern definition of Epidemiology?

A

Search for causes or factor that influence risk or probability of disease. How and why of disease.

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5
Q

What does the word application mean in the modern definition of Epidemiology?

A

Science and art, propose appropriate, practical, and acceptable interventions.

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6
Q

What are the 5 objectives of epidemiology?

A
  1. Identify the etiology or cause of a condition.
  2. Determine the extent of a condition.
  3. Study the progression of a condition.
  4. Evaluate preventive and therapeutic measures for a condition.
  5. Develop public health policy.
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7
Q

What is primary prevention?

A

Stop the disease before it develops. Vaccine, check up at the doctor.

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8
Q

What is secondary prevention?

A

Early diagnosis, before the person start experience symptoms. Screening, mammogram.

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9
Q

What is tertiary prevention?

A

Identify health condition, having symptoms, diagnosis, treatment, rehabilitation.

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10
Q

What is quaternary prevention?

A

Prevention of overmedication. Prescribing antibiotics for viral infection. Evidence research based, and mediate based medicine.

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11
Q

What is descriptive epidemiological approach?

A

Generates hypothesis
Disease distribution in a population.
Person, place, time.
Cross-sectional studies.

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12
Q

What is analytical epidemiological approach?

A

Test hypothesis.
Test specific cause and effect relationship.
Exposure, outcome.
Case-control, cohort and experimental studies.

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13
Q

Who was Hippocrates?

A

Father of medicine, first epidemiologist.

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14
Q

Who was John Graunt?

A

Founder of modern statistics. Founded science of demography.

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15
Q

Who was Edward Jenner?

A

Father of immunology. First vaccine developer.

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16
Q

Who was Ignaz Semmelweis?

A

Observation of practice between two different clinics practices, which lead to hypothesis testing.

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17
Q

Who was John Snow?

A

Father of modern epidemiology.

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18
Q

What is spurious association?

A

False association (correlation). Result of sampling error or bias. We collect data for things we think are related but aren’t in real world.

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19
Q

What is a non-causal association?

A

There is a relationship between 2 variables, but the relationship is caused by a third variable.

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20
Q

What is a cofounder association?

A

An unobserved variable that correlates with both the exposure and the outcome variable.

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21
Q

What is a causal relationship?

A

When one variable causes a change in another variable. Real relationships, not accounted by other variables. (the longer you run the more calories you burn).

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22
Q

What does the word necessary mean?

A

The outcome/disease can never happen without the cause/exposure being present.

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23
Q

What does sufficient mean?

A

Every time the cause/exposure is present the outcome/disease will follow.

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24
Q

What are hill’s causal criteria? (9)

A
  1. Temporal relationship.
  2. Strength of the association.
  3. Dose-response relationship.
  4. Replication of findings.
  5. Biological plausibility.
  6. Consideration of alternate explanation.
  7. Cessation of exposure.
  8. Consistency with other knowledge.
  9. Specificity of the association.
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25
Q

What is temporal relationship?

A

For an exposure to be a cause of an outcome, it must precede the outcome.

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26
Q

What is strength of the association?

A

The stronger the mathematical association the more likely a causal relationship.

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27
Q

what is dose-response relationship?

A

increased exposure leads to a greater frequency of the outcome. Vice Versa.

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28
Q

What is replication of the findings?

A

When other investigators studying the same thing in different populations, at different times, in different locations, using different methodologies, find the same thing.

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29
Q

what is biologic plausbility?

A

Is the association credible, given understanding of natural history of disease or possible pathogenic mechanisms.

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30
Q

what is consideration of alternate explanation?

A

What other possible explanations could explain the association?

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31
Q

what is cessation of exposure?

A

If we stop exposure to the factor, we would expect to see a decline in risk of the disease.

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32
Q

what is consistency with other knowledge?

A

Analogy. Commonly accepted phenomenon in one area of medicine/science that can be applied to another area.

33
Q

What is specificity of the association?

A

Certain exposure is associated with only one disease. The weakest guideline.

34
Q

What is the epidemiologic traid?

A

Agent, host, environment, vector/fomite.

35
Q

What is the agent?

A

The pathogen that causes the person to get sick.
Bacteria, virus, parasites, chemicals, radiation.

36
Q

What is the host?

A

This is the human that gets sick.
Immunity, genetics, sex, age, motivation, nutrition, socioeconomic status.

37
Q

What is the environment?

A

The closer people are living together the more opportunity for the agent to multiply.
Weather, living conditions, sanitation, population density, access to health care, social norms.

38
Q

what is the vector?

A

What the agent travels on. Organism that transmits the disease, the mosquito have malaria and they can transmit the disease to a host or between hosts.
Mosquito, ticks, snails, sandflies, fleas, rats, mice.

39
Q

what is the fomite?

A

They are in objects, smallpox can be transmitted through bedding.
Clothing, bedding, door handles, IV drip, catheters.

40
Q

What is immunity?

A

Capacity of organisms to resist harmful microorganisms. Complex biological system that can recognize and tolerate what belongs to the self and reject what is foreign.

41
Q

What is adaptive immunity?

A

something that we can develop over time when we get in contact with a pathogen.

42
Q

What is innate immunity?

A

immunity we are born with. Skin.

43
Q

what is active immunity?

A

Develops as a result of natural infection. Could also acquire from an injection of a vaccine that contains an antigen.
Long duration.

44
Q

What is passive immunity?

A

Natural antibodies from a mother in breast milk. Acquired from antibodies produced by another person or animal. Injection of antibodies. Short duration.

45
Q

what is herd immunity?

A

A large portion of the population becomes immune to a particular infectious disease, so it can no longer spread easily within that population. It is important for people that cannot get vaccinated.

46
Q

What does sporadic mean?

A

Disease that occurs infrequently and irregularly.

47
Q

What does endemic mean?

A

Disease occurrence that is usual/expected in people, geographic area, specific time. Rate of infection is constant.

48
Q

What does epidemic mean? (Disease outbreak)

A

Rapid spread of an infectious disease. Dependent on the disease itself.

49
Q

What does pandemic mean?

A

Has spread over several geographic areas and very fast.

50
Q

why does epidemics occur?

A

Increased contact between people.
Interaction between people and the environment.
Increased contacts between people and animals.

51
Q

What are some examples of disease outbreak?

A

Common-vehicle exposure.
Single exposure (point source).
Multiple exposure (continuing source).
Periodic contamination (intermittent outbreak).
Person-to-person (index or propagated).

52
Q

What is the common-vehicle exposure disease outbreak?

A

Results from exposure of a susceptible group of people to a single “common” agent of disease.

53
Q

what is the single exposure (point source) disease outbreak?

A

Number of cases rises rapidly to a peak, falls gradually. Short lived.

54
Q

What is the multiple exposure (continuing source) disease outbreak?

A

rises gradually, might stay there for a while and keeps going. Typically lasts longer.

55
Q

what is the periodic contamination (intermittent outbreak) disease outbreak?

A

A common exposure that is not well controlled, so outbreaks are irregular. The outbreaks comes in group on the graph.

56
Q

what is the person-to-person spread (index or propagated) disease outbreak?

A

what is the person-to-person spread (index or propagated) disease outbreak?

57
Q

Why are outbreak investigation important?

A

Identify the source.
Help to identify strategies to prevent future outbreaks.
Evaluate existing prevention strategies.
Describe new diseases and learn about known disease.
Address public concerns.

58
Q

when are outbreak investigation carried out?

A

Severity of illness.
Transmissibility.
Unanswered questions.
Ongoing illness/exposure.
Public concern.

59
Q

What are the steps of an outbreak investigation? (10)

A
  1. Identify investigation team and resources.
  2. Establish existence of an outbreak.
  3. Verify the diagnosis.
  4. Construct case definition.
  5. Find cases systematically and record information.
  6. Perform descriptive epidemiology.
  7. Develop hypotheses and evaluate hypotheses.
  8. Implement control and prevention measures.
  9. Communicate findings.
  10. Maintain surveillance.
60
Q

what includes in identify investigation team and resources?

A

Must have appropriate scientific knowledge, supplies, and equipment.
Management and operational issues.

61
Q

what includes in establish existence of an outbreak?

A

Surveillance data, clinicians, hospitals, registrars, hospital investigation, lab, doctors, school.

62
Q

what includes in verify the diagnosis?

A

Important to ensure that the disease is properly identified, rule out laboratory error as the basis for increased cases.
Verification, obtain medical records and lab reports, interviewing clinicians, conduct clinical testing if needed.

63
Q

What includes in construct case definition?

A

Person, place, time, clinical features.
Set of uniform criteria to define who has the disease from those who do not.
Critical in effective disease outbreak investigation.
Must be applied consistently to all persons under investigation.

64
Q

What includes in find cases systematically and record information?

A

find unknown cases, collect information.

65
Q

What includes in perform descriptive epidemiology?

A

summarize data. Time, place, persons.

66
Q

what includes in develop hypotheses and evaluate hypotheses?

A

May address source of agent, mode of transmission, exposure that caused disease.
Comparing the hypotheses with established facts. Using analytic epidemiology to quantify relationships and assess the role of chance. Sometimes evaluation of hypotheses does not yield any clear answers.

67
Q

what includes in implement control and prevention measures?

A

Usually directed at one or more segments in the train of transmission. Agent, source, mode of transmission, portal of entry, host.

68
Q

What includes in communicate findings?

A

Summarize the investigation, oral briefings for local authorities, written reports.

69
Q

What includes in maintain surveillance?

A

continue monitoring.

70
Q

what is passive surveillance?

A

Sending letters to clinicians and asking for reports of similar cases.

71
Q

what is active surveillance?

A

visiting clinical facilities and actively doing something.

72
Q

what is attack rate?

A

compares the risk of disease in groups with different exposures.

73
Q

How to calculate attack rate?

A

of people at risk in whom a certain illness develops / total # of people at risk.

74
Q

What is sensitivity?

A

The ability of the test to correctly identify those who have the disease.

75
Q

what is specificity?

A

The ability to of the test to correctly identify those who do not have disease.

76
Q

if we want to limit False Positive we need to…..

A

Increase/ have high specifcity.

77
Q

If we want to limit False Negative we need to…..

A

Increase/ have high sensitivity.

78
Q

If we select a high cutoff level.

A

Many of the cases will not be identified as positive. But, most of the people who do no have the disease will be correctly identified as negative.

79
Q

If we increase the specificity by raising the cutoff level ……

A

we decrease the sensitivity.

HTH 450 (2 decks)

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