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CODO > Epidemiology > Flashcards

Epidemiology Flashcards

1
Q

public health definition

A

science/art of preventing disease, prolonging life, and promoting physical health and efficiency through organized community efforts; state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity

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2
Q

population health

A

individual group health outcomes, as well as the distribution, including outcomes within the group, patterns of health, and policies and interventions that link these two

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3
Q

how is public health obtained?

A

sanitation

infection control

personal hygiene

prevention

early diagnosis

healthy standard of living

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4
Q

Who was John Snow?

A

early epidemiologist

cholera outbreak in 1854 London

study of two water pumps in the neighborhood

550 deaths in 2 weeks

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5
Q

10 greatest achievements in public health thus far

A
  1. immunizations
  2. motor vehicle safety
  3. work place safety
  4. infectious disease control
  5. declines ind eaths from heart disease and stroke
  6. safer/healthier foods
  7. healthier mom/baby
  8. family planning
  9. fluoridating of drinking water
  10. tobacco is a health hazard
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6
Q

What does the public health office offer?

A

Assessement: environmental and health status to solve problems, diagnose and investiagate envir. health problems

Policy development: inform/edu public, mobilize community to identify and solve health problems, develop policies and plans to support personal and community health efforts

Assurance: enforce laws/regulations, link people to health services and ensure provisions, assure a competent personal and public healthcare workforce, evaluate effectiveness, accessibility, and quality; research/create solutions to health probs

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7
Q

Roles of health department

A

provide preventative services

provide vaccines

provide health edu

provide family planning

provide medical referrals

respond to public health emergencies

conducting disease investigations

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8
Q

epidemiology definition

A

study of factors that determine the occurrence and distribution of disease in a pop

basic science behind population health

basis for evidence base med

latin meaning - epi: upon demos: people logos: study

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9
Q

clinical epidemiology definition

A

science of making predictions about individual pts by counting clinical events (5 Ds) in similar groups and using the scientific method to make sure that those predictions are accurate

helps to make informed decisions about clinical care

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10
Q

5 D’s: outcomes of disease

A

death

disease

discomfort

disability

dissatisfaction

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11
Q

What are the stages of disease

A

pre-disease stage: before pt has, pathophysiological process hasnt begun

latent stage: disease process has started but no s/s

symptomatic stage: s/s and adverse outcomes are occurring

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12
Q

Types of prevention

A

Primary prevention: immunizations, reducing risk factors

Secondary prevention: early detection through screening

Tertiary prevention: reducing the impact, slow progression, reversing, preventing co-morbidities

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13
Q

BEINGS model

A

Biological factors and behavorial factors

environmental factors

immunologic factors

genetic factors

services, social factors, and spiritual factors

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14
Q

health indicator definition

A

measurements that indicated the state of health of a given population; morbidty and mortality rates

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15
Q

Common rates:

A

incidence: number of new causes per population at risk over a given time
prevalence: all cases per population at risk (duration: point prevalence at a certain time or period prevalence for a specific time period)

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16
Q

morbidity and mortality rates (4)

A

crude rate: actual number over a period of time

cause specific: number by a specific cause (CVA mortality)

age specific: by specific age group

adjusted: accounts for differences in pop at different times to allow for comparision; year 2000 is the standard adjusted year (ex: age, race, sex)

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17
Q

morbidity

A

illness, injury, condition, adverse event

birth rate: number of live births during a specific mid period pop x 1000

fertility rate: (# of live births during a specific period/# of women afed 15-44 yo mid period pop) x 1000 women aged 15-44

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18
Q

mortality

A

death

mortality rate: (all deaths/midpoint pop size) x 100,000

infant mortality rate: (mortality for children <1 yo in a given period/live births in a given period) x 1000

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19
Q

social determinants definition

A

conditions in the enviroment in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality of life outcomes and risks

must tackle health inequalities and challenge dominant biomedical and lifestyle theories with better alternatives

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20
Q

What are some social determinants of health?

A

biology and genetics

individual behavior

social environement

physical environment

health services

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21
Q

Upstream vs Downstream social determinants

A

Upstream: policy and programs, social inequities

Midstream: physical environment, behavior

Downstream: disease and injury, mortality

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22
Q

Social determinatnts domains

A

SES

social capital

race

ethnicity

education

lifestyle

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23
Q

What is the life course approach

A

focuses at health at specfic stages of life

child/adolescent

aging adults

womens health

reproductive health

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24
Q

What type of populations can social determinants affect?

A

race, LGBT, rural/urban, poverty

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25
Q

Cliff analogy

A

Population moving away from cliff - addressing social determinants of health

fence: primary prevention

secondary prevention: safety neet

tertiary prevention: ambulance/ acute care

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26
Q

oral health study

A

oral health screening to assess school attendance in elementary and high school students

students with tooth aches were more likely to have a lower GPA

6.4% parents missed work and 5.5% of children missed school due to dental problems

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27
Q

preventative medicine vs public health

A

preventative med promotes health and disease prevention at the individual and population level while public health focuses on just the population

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28
Q

Screening definition

A

identification for an unrecognized disease through tests, examinations, or other procedures;

screening tests sort those persons probably witha disease from those that do not

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29
Q

importance of screening

A

early detection leads to early treatment

decreases morbitiy and mortality

breaks the chain of transmission/development of new cases

usually more cost-effective

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30
Q

when to start screening

A

before the dx through history, physical, lab tests, pre-test probabilities

results from screen may lead to a diagnostic work -up and preventative interventions

screening test is not a diagnostic test

screening identifies asymptomatic people who may have a disease

diagnostic test determines presence or absence of disease when pt shows s/s

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31
Q

characteristics of a good screening test

A

simple, rapid, inexpensive, safe, available, acceptable

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32
Q

common disease screening tests

A

Pap smears - cervical ca

fasting blood sugar - DM

fecal occult blood test - colorectal ca

BP - HTN

bone densitometry - osteoporosis/osteopenia

PSA test - prostate ca

PPD test - TB

mammography - breast ca

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33
Q

common wellness screenings include what?

A

obesity

dental caries, oral ca

drugs, tabacco, etoh

weight, BMI

urine test, NMASSIST, or Flagerstrom Tolerance Test for nicotine dependency

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34
Q

breast ca screening

A

annual mammograms for women 40+

biannual mammograms for women 50 +

earlier if family hx is present

cost-benefit analysis - false positives/unnecessary invasive procedures

35
Q

colon ca screening

A

colonoscopy

sigmoidoscopy

virtual colonoscopy - CT colonoscopy

barium enema

fecal-testing - occult blood/DNA test

36
Q

newborn screening

A

mandatory universal screening in newborns for metabolic, hormonal, hematologic, and infectious disease conditions

states vary in what they screen for

heel prick blood test 24-48 hours post birth - if dones too early, then disease may not show up

family hx may indicate need for additional screens

37
Q

reliability

A

consistency of a test at different times or under different conditions

synonymous to consistency

ability to yield same results with repeated measurements of same construct

degree to which results are free from random error

types of reliability: intra-subject, intra-rater, inter-rater, instrument

38
Q

validity

A

how well test distinguished between who has a disease and who does not

39
Q

Sensitivity

A

trying to find those actually with disease correctly

minimizes false negatives - if test is highly sensitive

SNOUT: sensitive test with Negative results rule OUT disease

true +/ (true + and false -)

40
Q

Specificity

A

trying to find those without the disease correctly

minimizes false positives - if test is highly specific

SPIN: specific test with positive results rules IN disease

true - /(true - and false +)

41
Q

positive predictive value

A

percent of positive tests that are truly positive

what is the probablity that the patient has the disease if the test is positive?

affected by specificity, screening test results, prevalence of disease

not inherent ccharacteristics of a screening test

42
Q

negative predictive value

A

percent of negative tests that are truly negative

what is the probability that the pt doesnt have the disease if the test is negative

not inherent characteristics of a screening test

43
Q

what are constant and what are varible?

A

constant: sensitivity and specificity
variable: low prevalence -> low PPV, high NPV

high prevalence -> high PPV, low NPV

44
Q

What is an example of different tests being used concurrently to screen for the same condition?

A

prenatal marker screening for down syndrome: AFP produced by fetus, hCG produced by placenta, Estriol produced by both fetus and placenta

results of all three tests increase sensitivity and specificity

45
Q

What is two staged screening?

A

used to target testing efforts like in earlt pregnancy gestational diabetes

used to maximize predictive value like in HIV screening in suburban primary care

46
Q

Screening effectiveness evaluation

A

tests characteristics (specificity and sensitivity) alone are never sufficient for a sound decision about whether to use a screening test

other screening considerations:

benefits v risk, prevalence of target condition, inconvenience, costs/resource expenditures pt values and cultural norms

47
Q

Study design - testing a test

A

assessing a screening or diagnostic test

properties and accuracy

comparison of test to gold standard USPSTF recommended: reviews the evidence of effectiveness and develops recommendations for clinical preventive services; recommend screening tests, counseling, preventive medications

48
Q

USPSTF Methodology

A
  1. define analytic framework - outcomes and questions
  2. define and retrieve relevant evidence
  3. evaluated qualtiy of studies (good, fair, poor)
  4. synthesize and judge strength of overall evidence (convincing, adequate, inadequate)
  5. determine balance of benefits and harm
  6. link recommendation to judgment about net benefits: grades A, B, C, D, I (inadequate evidence)
49
Q

comparing screening tools

A

newer tests v gold standard

pick what is best for your population: validity in pop, accessibility, cost, capacity of local health care system, aka need a clinic that can screen AND treat

50
Q

long term outcome screening considerations

A

lead time bias: over estimation of survival rate among screening-detected cases: when survival is calculated from diagnosis point

length bias: over-estimation of survival rate among screening detected cases: due to excess of slowly rogressing cases among those identified by screening

51
Q

pseudodiseasae definition

A

identifying a disease that is unlikely to impact pt over lifetime: identifying pseudodisease is nearly impossible until person dies from unrelated causes; gold standard tests cannot predict future trajectory of a condition

52
Q

What tests are mandatory?

A

newborn screening

syphilis testing for marriage licenses

TB screening for health care workers

drug testing for airline pilots

53
Q

Pros and Cons of mandatory testing

A

Pros: identifying a serious problem that could harm others or where immediate tx is imperative

Cons: potential harm to patient autonomy, confidentiality concerns, testing low risk populations reduces PPV, consequences of false positive tests

54
Q

genetic testing

A

to see if a pt carries a gene for a disease and might pass it on to children

screen unborn fetus for disease

test for genetic disease in children or adults before s/s

concerns: results are difficult to interpret, employment issues, health/life insurance consequences, added stress, costs, confidentiality, ownership of DNA

55
Q

Access to screening disparities

A

geographic region

uninsured or underinsured

minority and immigrant populations

56
Q

attack rate

A

number of people who ate food and got sick

____________________

number of people who ate this food

57
Q

what is the epidemiologic triad

A

host, environment, agent with vector in the middle

58
Q

chain of infection

A

agent leaves reservoir-portal of exit

mode of transmission

enters susceptible hose-portal of entry

59
Q

reportable conditions

A

mandates reporter - local health department - state health department - CDC

required by state

explicit - specifically required by state

implicit - considered reportable due to other state laws

60
Q

epidemic

A

disease in excess of expected

61
Q

endemic

A

continuous occurrence of an agent or disease in a specific geographic area or population

62
Q

pandemic

A

a widespread epidemic (multiple countries) which affects a substantial population

63
Q

secondary attack rate

A

frequency of new cases of a disease among contacts of pts with a disease

64
Q

case fatality rate

A

proportion of person witha condition or disease who die from that condition or disease

65
Q

epidemic curves

A

point curves: brief exposure period, all cases occur in one incubation period

continuous source: intermittent or continuous exposure period, cases occur intermittently over time

propagated source - exposure transmitted person to person, often results in geometric increases inc ase numbers usually in groups

66
Q

R naut as a predictor

A

R < 1 the disease will disappear

R=1 endemic

R > 1 epidemic

67
Q

outbreak investigation

A

confirm - data collection - identify responsible agent - screening prevention, treatment

68
Q

Periodicity of viral diseases

A

Enterovirus: temporal climates, june-october

parainfluenza: type 1 every other fall, type 2 fall, type 3 spring summer can extend to fall

influenza (US): peak jan-feb, range nov-may

RSV -bronchiolitis: temporal climates, winter- early spring

69
Q

nonpolio enteroviruses

A

100 different serotypes: group A coxsackie, Group B coxsackie, echovirus, numbered enteroviruses, parechovirus

picornoviridae: polio, rhino, hapatovirus

70
Q

Types of disease

A

respiratory: herpangia, bronchiolitis, pna

skin - handfootmouth, exanthems

neuro - aspetic meningitis, encephalitis, motor paralysis

GI - vomiting, diarrhea, abd pain, hepatitis

cardiac - myopericarditis, myositis

71
Q

Enterovirus D68

A

first isolated in CA 1962

reports since July 2007

EV 68 is the most common enterovirus

causes severe respiratory disease, hypoxemia, ICU admissions, ussually not febrile

72
Q

health literacy definition

A

the degree to which individuals have the capactiy to obtain, process, and understand basic health information and services

73
Q

How to improve health literacy - a few examples of many

A

form health literacy team

raise awareness, educate staff

communicate clearly

use teach back method

follow up with pt

brown bag medicine reviews - encouraging pts to bring all of ther meds and supplements to their visit and review them and how they are taking them

make referrals and resources available

74
Q

Ten Attributes of a Health Literate Organization

A
  1. leadership makes it a priority, and integrates it into their mission, structure, and operations
  2. Integrates it into planning, evaluation measures, pt safety, and quality improvement
  3. Prepares the workforce to be health literate and monitors progress
  4. includes populations served in the design, implementation, and evaluation of health information
  5. meets the need of pupulations with a range of health literacy skills while avoiding stigmatization
  6. uses health literacy strategies in interpersonal communications and confirms understanding at all points of contact
  7. provides easy access to health information and services and navigation assistance
  8. designs and distributes print, a/v and social media content that is easy to understand and act on
  9. addresses health literacy in high risk situations, including care transitions and communcations about medicines
  10. communicates clearly what health plans cover and what individuals will have to pay for services
75
Q

health promotion definition

A

process of enabling people to increase control over, and to improve their health; it moves beyond a focus on individual behavior towards a wide range of social and environmental interventions

76
Q

ecological models

A

intrapersonal/individual factors

interpersonal factors

institutional and organizational factors

community factors

public policy

multi-level interventions may be most effective in changing behavior

77
Q

HPDP Theories/Model (4 kinds)

A

Relapse prevention method

stages of change - transtheoretical model

social cognitive theory

theory of reasoned action/planned behavior

78
Q

relapse prevention model

A

recognize high risk situations

developing coping skills

increase self efficacy

cues to avoid relapse

view relapse as a mistake, not failure

79
Q

stages of change- transtheoretical model

A

pre contemplation

contemplation

preparation

action

maintenance

termination

80
Q

Social cognitive therapy

A

self efficacy

behavioral capability

expectations

expectancies

self control

observational learning

reinforcements

81
Q

Theory of reasoned action/planned behavior

A

person’s intention to perform a behavior

person’s attitude toward the behavior

subjective norms regarding the behavior: social and environmental surroundings; persons perceived control over behavior

82
Q

HPDP Strategies

A

communication - health fairs, PSAs, community presentations

education - provider, consumer, student, and joint program education

policy - public, health care, business, school policies

environment - green space, health walking space, increased exercise, decreased injuries

83
Q

CDC’s 7 Priority Areas

A
  1. tobacco free living
  2. preventing drug abuse and excessive etoh use
  3. healthy eating
  4. active living
  5. injury and violence free living
  6. reproductive and sexual health
  7. mental and emotional well-being

CODO (2 decks)

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