Topic 3 - Practical Applications of Epidemiology

Question 1

What are the 2 categories for the 7 uses for epidemiology? What are the 7 uses?

Answer 1

Health Status and Health Services:
1. Study history of the health of populations
2. Diagnose the health of the community
3. Examine the working of health services

Disease Etiology:
1. Estimate the individual risks and chances of
avoiding them
2. Identify syndromes
3. Complete the clinical picture
4. Search for causes of health and disease

Question 2

What are 3 details about health status and health services?

Answer 2

Describing the occurrence of disease in
the community

Planning for allocation of resources: public health practitioners and administrators

Evaluating programs, e.g., public health
service programs

Question 3

What are 2 details about disease etiology?

Answer 3

Epidemiologists continue to search for
clues as to the nature of disease

Knowledge that is acquired may be helpful
in efforts to prevent the occurrence

Question 4

What is the historical use of epidemiology? Give an example.

Answer 4

Refers to the study of past and future
trends in health and illness

For example: secular trends (changes in
disease frequency over time)

Question 5

What are examples of trends?

Answer 5

Chronic diseases have replaced acute infectious diseases as the major causes of morbidity and mortality

2009: the leading causes of U.S. deaths were heart disease, cancer, and chronic lower respiratory disease

Increases were reported for Alzheimer’s disease, kidney disease, and hypertension

2017: leading causes of U.S. deaths are heart disease, cancer, and accidents

Question 6

What are the 3 factors affecting reliability of observed changed?

Answer 6

Lack of comparability over time due to altered diagnostic criteria

Aging of the general population

Changes in the fatal course of the condition

Question 7

What are the 4 trends of disorders? Give examples of disorders for each trend.

Answer 7

Disappearing: smallpox, polio, measles

Residual: STIs, tobacco use, infant mortality

New epidemic: lung cancer, HIV/AIDS, obesity

Persisting: cancer (some forms), mental disorders, cerebrovascular diseases

Question 8

Give 2 details about and examples of disappearing disorders.

Answer 8

This category refers to conditions that were
once common but are no longer present in
epidemic form.

Examples include smallpox, poliomyelitis,
and measles.

Brought under control by immunizations,
improvement in sanitary conditions, and the
use of antibiotics and other medications led
to eradication of these diseases

Question 9

Give 2 details about and examples of residual disorders.

Answer 9

Conditions for which the key contributing factors are largely known

Methods of control not implemented effectively

Examples: STDs, perinatal and infant mortality among low SES persons, problems associated with alcohol and tobacco use

Question 10

Give 1 detail about and examples of persisting disorders.

Answer 10

Diseases for which there is no effective
method of prevention or no known cure

Examples: certain types of cancer and
mental disorders

Question 11

Give 2 details about and examples of new epidemic disorders.

Answer 11

Diseases that are increasing in frequency

The emergence of new epidemics of
diseases may be a result of increased life
expectancy of the population, new
environmental exposures, or changes in
lifestyle, diet, and other practices

Examples: lung cancer, AIDS, Obesity,
Type 2 diabetes

Question 12

What are population dynamics? What are the 2 types of populations?

Answer 12

Denotes changes in the demographic
structure of populations associated
with such factors as births and deaths
and immigration and emigration

Two types of populations: fixed populations and dynamic populations

Question 13

What is a fixed population? Give examples.

Answer 13

Fixed population: adds no new members and, as a result, decreases in size due to deaths only

Examples: survivors of the 9-11 terrorist
attack in New York, residents of New
Orleans during Hurricane Katrina, and
persons who had a medical procedure
such as hip replacement

Question 14

What is a dynamic population? Give examples.

Answer 14

Dynamic population: adds new members through immigration and births or loses members through emigration and deaths

Example: the population of a country,
city, or state in the United States

Question 15

What are the 3 influences on population size?

Answer 15

1. Births
2. Deaths
3. Migration

Question 16

What is the relationship between the three influences and a population that is in a steady state?

Answer 16

The three factors do not contribute to net
increases or decreases in the number of
persons (i.e., the number of members
exiting for various reasons equals the
number entering)

Question 17

What is the relationship between the three influences and a population that is increasing in size?

Answer 17

The number of persons immigrating plus
the number of births exceeds the
number of persons emigrating plus the
number of deaths

Question 18

What is the relationship between the three influences and a population that is decreasing in size?

Answer 18

The number of persons emigrating plus
the number of deaths exceeds the
number of persons immigrating plus the
number of births

Question 19

What is a demographic transition? Give examples of what could cause it.

Answer 19

Shift from high birth and death rates found
in agrarian societies to lower birth and
death rates found in developed countries.

A decline in the death rate attributed to in
part to improvement in general hygienic
and social conditions

Industrialization and urbanization contribute to a decline in birth rate

Question 20

What is an epidemiological transition?

Answer 20

Shift in the pattern of morbidity and
mortality from infectious and communicable diseases to chronic, degenerative diseases

Question 21

How does epidemiology affect the health of the community?

Answer 21

Describes the overall health of a particular community

The resulting description may then provide a key to the types of problems requiring attention

Determines the need for specific health services

Question 22

What descriptive variables are needed for epidemiology when describing the health of the community?

Answer 22

Demographic and social variables

Variables related to community infrastructure

Health-related outcome variables

Environmental variables

Question 23

What are examples of demographic and social variables?

Answer 23

Elderly women have unique health needs (screening and interventions for osteoporosis, risk of falling… associated with aging)

Lower income/employment opportunities lack health insurance and access to health care

Low education (vs. high): less aware of dietary and exercise practices that promote good health

Service employment (vs. professional occupations): does not carry full range of health benefits

Some health outcomes more common in one racial/ethnic group, e.g., diabetes among Latinos

Adherents of some religious denominations may adopt lifestyle and dietary practices that may affect the community health profile

Question 24

What are examples of variables related to community infrastructure?

Answer 24

SES of community relate to such availability and ability to pay for healthcare services

When state and federal funding are cut or reduced, wealthy communities have the means of back fill lost revenue with local funding resources, but the poorer areas
may not have such option

Safe and clean housing

Toxic lead and dangerous environmental exposures in older housing

American Housing Survey (quality of housing)

Community policing programs (reinforce social stability by reducing violent crime)

Employment opportunities

Question 25

What are health-related outcome variables? Give examples.

Answer 25

Measures of health outcomes and suggest
needed social and health-related service

Homicide rates (indicator of adverse
conditions within the community)

Suicide rates (depression, social isolation)

Infant mortality rate (more prenatal care,
maternal diet, etc.)

Teen pregnancy rates/sexually transmitted
diseases (need education and counseling
services)

Question 26

What are examples of environmental variables?

Answer 26

Air pollution from stationary and mobile sources (diesel trucks and other vehicles on freeways; industrial and power plans)

Access to parks/recreational facilities

Availability of clean water

Availability of markets that supply healthful
groceries

Number of liquor stores and fast-food outlets

Nutritional quality of foods and beverages vended to school-children

Question 27

What are health disparities? What is income inequality?

Answer 27

Differences in health outcomes that are closely linked with social, economic, and environmental disadvantage

Income inequality: one of the factors associated with health disparities

Question 28

What is the Gini index?

Answer 28

Gini Index (a common measure of income inequality):

Ranges from 0 (total equality) to 1 (total inequality)

The closer the index is to 1, the greater is the level of inequality

Question 29

How does epidemiology affect policy evaluation? Give examples.

Answer 29

Using epidemiological methodologies to evaluate public health policies

Epidemiologist: development of evidence-based decisions because of their expertise in studying about risks associated with certain exposures, policy-making related to education, research, and publication of
manuscripts, predict future risks based on current trends and knowledge of changing risk factors

Examples: tobacco control, needle distribution
programs, ban on plastic bags, printing of nutritional content on restaurant menus, removal of high fat and high sugar content foods from vending machines in schools, and prohibition of drivers’ use of cell phones

Question 30

What are 2 examples of health services?

Answer 30

Operations research (OR) and program evaluation

Question 31

What is operations research? How does it apply to epidemiology?

Answer 31

The study of the placement and optimum
utilization of health services in a community

A majority contribution of epidemiology to OR
is the development of research designs,
analytic techniques, and measurement
procedures

OR strives to answer: what characteristics of the community, providers, and patients affect service delivery and outcome?

Question 32

What is an example of operational research?

Answer 32

Coordination of programs for the
developmentally disabled

During the 1970s, a project was conducted to improve the coordination of health services to disabled children in a place of the State of New York

Aimed to quantify the characteristics of service utilization

Inform health about the numbers and kinds of services needed in the community and make projections for funding of health services

This shows how the epidemiological approach may be utilized for OR purposes

Question 33

What is program evaluation?

Answer 33

Uses epidemiologic tools to determine how well a health program meets certain stated goals