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Date Created: 02/09/15
1232015 Intro to Epidemiology Chapter 1 oz Controversies and speculations can sometimes arouse public hysteria oz CDC Center of Disease Control investigates outbreaks of infectious diseases oz 20092010 H1N1 Pandemic 60 million cases in US not including those who don t seek medical care or aren t tested Ages 1864 most heavily affected Was usually only found among swine High prevalence of obesity among in uenzaaffected patients First case 10 year old in California oz Escherichia Coli E Coli SummerFall 2006 lngested in contaminated food Enteric pathogen produces bloody diarrhea amp HUS hemolyticuremic syndrome type of kidney failure Can be fatal 199 people in US 3 deaths 102 hospitalized 31 wHUS mostly female Linked to prepackaged spinach from Natural Selection Foods recalled in 09152006 Cattle feces contained the E Coli that contaminated the spinach 2007 Taco Bell Totino s orJeno s brand frozen pizzas Topp s frozen ground beef patties in US 2008 amp 2009 ground beef prepackaged cookie dough was also infected in US 2010 amp 2011 ground beef cheese romaine lettuce bologna amp hazelnuts 6 US travelers to Germany one died Summer 2012 18 sickened half died oz EPIDEMIOLOGY discipline that describes quali es postulatessuggest existence of causal mechanisms for diseases in populations and develops methods for control of them quotpopulation medicinequot O O 99 99 O O O 99 99 99 O O O 99 99 Closely related to detective work Focuses of population groups instead of individuals DETERMINANTS factors or events that are capable of bringing about change in health Distributions of a disease depend on underlying characteristics such as race amp ethnicity Toxic Shock Syndrome TSSsharp increase in 1980 severe illness associated with vaginal tampon use Clinical description speci c signs and symptoms individual Epidemiologic description which age groups are mostly affected time trends geographic trends amp other variables that affect the distribution of the disease group Morbidity designates illness Mortality refers to death Levels denotes the hierarchy of tasks that epidemiologic studies seek to accomplish scale of importance of each step within the epidemiologic process Four aims of Epidemiology Two different goals distribution amp control 0 Describe enumerate cases and obtain relative frequencies of the disease within subgroups 0 Explain discover causal factors amp determine modes of transmission 0 Predict estimate number of causes that will develop amp identify distribution within populations 0 Control prevent the occurrence of new cases of the disease amp eradicate existing cases amp prolong the lives of those with the disease DEMOGRAPHY study of data related to the structure of human populations QUANTIFICATION translation of qualitative impressions into numbers 0 Sometimes presented as charts maps graphs and tables INTERDISCIPLINARY COMPOSITION draws from microbiology biostatistics social amp behavioral sciences amp clinical medicine EPIDEMIC excessive occurrence of a disease USUAL FREQUENCY diseases typical occurrence at the same time within the same population amp in the same geographic area oz COMMUNICABLE DISEASE caused be infectious agent that is transmitted from one person to another oz OUTBREAK localized disease epidemic oz PANDEMIC epidemic on a worldwide scale oz ENDEMIC disease that is present in a particular geographical region 0 CDC amp vital statistic departments of state amp local governments gather surveillance on a regular basis to assure an epidemic is not occurring SURVEILLANCE systematic collection of data pertaining to the occurrence of speci c diseases analysis amp interpretation of these diseases amp dissemination of consolidated amp processed information oz EPIDEMIC THRESHOLD minimum number of deaths that would support the conclusion that an epidemic is underway oz History of Epidemiology o Began wthe classical period of the Greeks amp Romans 0 Included major developments from the Renaissance medieval period late 18005 amp early 19005 amp midlate 20th century epidemiologic activities exploded Greeks attributed disease causality to environmental factors 0 Early explanation for epidemics o Wrath of the gods 0 Breakdown of religious beliefs amp morality 0 In uence of the weather 0 quotBad airquot 0 Black death killed 25 of European population Medieval 0 Edward Jenner s work led to smallpox vaccination Used scabs from cowpox lesions to create immunity on arms of humans oz Deadly Cholera 19th century life threatening condition caused by bacterium US amp Europe 0 Spread along trade routes from India to Asian the Middle East amp Russia 0 Severe but painless vomiting amp diapers o Eventually die from dehydration amp electrolyte disturbances oz The Black Death between 1346 amp 1352 0 Killed about 14 to 13 of the population in Europe 2030 million people 0 Northern Africa amp the near Middle East also affected severely o Historians attribute this to bubonic plague most common of the 3 types of plague o Caused by bacterium Yersinia pests produces swelling buboes of the lymph nodes in groin amp other sites typical found in small rodents o Swellings followed by high fever amp appearance of black splotches on skin several days later 0 Transmitted through eas 0 Most victims died within a few days 0 No method for treatment existed now treatable wantibiotics oz John Graunt published Natural amp Political Observations Mentioned in a Following Index and Made Upon the Bills of Mortality 1662 0 quotColumbus of Statisticsquot 3 Cows were the source of cowpox virus that was used to create smallpox vaccination Asian method to gain immunity was variolation People wcowpox were immune to smallpox o Variolation conferred immunity by placing dried scabs from smallpox patients into the noses of potential victims 0 Often produced much milder Cassie of disease wmuch lower fatality rate 0 Adapted by Europeans in 17005 but modi ed to injecting infectious material under skin tested among abandoned children amp prisoners o Smallpox eliminated worldwide in 1978 oz NATURAL EXPERIMENT naturally occurring circumstances in which subjects are exposed to different levels of a causal factor in a situation 0 Cholera epidemic in London 0 Residents received contaminated water from Lambeth amp Southwark and Vauxhall Company 0 Water came from most contaminated part of Thames River 1849 Lambeth begins relocated where they were getting water 0 John Snow focused on this epidemic oz William Farr Developed more sophisticated system for codifying medical conditions System provided foundation for the International Classi cation of Diseases Used data such as census reports to study occupational mortality in England Explored linkage between mortality rates amp population densty oz 19181919 In uenza Pandemic quotMother of all PandemicsquotSpanish Flu Killed 50100 million persons worldwide 13 of 15 billion worlds population was affected amp developed observable illness Impacted healthy young adults ages 2040 were half of the mortal Flu is usually more frequent among very old amp very young Europe Asia amp North America Impact so bad is US that healthcare facilities were taxed to the max Bodied accumulated in merges due to lack of cof ns amp morticians oz Historical Developments Alexander Fleming Scottish discovered antimicrobial properties in mold 1928 led to creation of antibiotic penicillin Alexander Langmuir quotFather of infectious disease epidemiologyquot established epidemiology section of the federal agency named CDC 1949 now called Epidemic Intelligence Service Wade Hampton Frost rst professor of Epidemiology in US 1930 atJohns Hopkins University advocated use of quantitative methods 0 Joseph Goldberger discovered cure for pellagra nutritional de ciency disease characterized by dermatitis diarrhea amp dementia oz INFECTIOUS DISEASE EPIDEMIOLOGY one of the most familiar types of Epidemiology investigates the occurrence of epidemics of infectious amp communicable diseases oz NOSOCOMIAL INFECTIONS outbreaks of infectious diseases inside of hospitals oz HIGHLY PATHOGENIC AVIAN INFLUENZA HPAI AVIAN INFLUENZA H5N1 Highly fatal Appeared in Hong Kong 1997 18 cases 6 fatalities Hong Kong authorities destroyed entire chicken population 0 Southeast Asia 2003 primarily Vietnam 0 Central Asia 2005 then Europe Africa amp Middle East 0 Greatest cases in Vietnam Indonesia amp Egypt Caused by human contact winfected pouItry No evidence of person to person transmission 3 Stress social support amp socioeconomic status affect the occurrence amp outcomes of mental amp physical health oz GENETIC EPIDEMIOLOGY studies the distribution of genetically associated diseases among the population 1272015 Intro to Epidemiology Chapter 2 o The seven uses of Epidemiology the only way for asking some questions in medicine 1 Study history of the health of populations rise amp fall on diseases amp changes in character 2 Diagnose health of the community condition of people measure true dimensions amp distribution of ill health identify groups needing special attention 3 Study working of health 4 Estimate individual risks on average of disease accident amp defect amp chances of avoiding them 0000 O O OO 5 Identify syndromes describe distribution amp association of conical phenomena 6 Complete the clinical picture of chronic diseases amp describe their natural history follow up of cohorts is necessary 7 Search for causes Medical journals are being studied because They concentrate on relationship between diseases amp possible lifestyle factors habit type of behavior diet than can be changed Major predominant diseases in the American society are chronic degenerative amp probably have several contributing factors Must rely on observational studies when experimental studies are impractical or unethical CAUSALITY relationship between cause amp effect Secular trends study of changes in disease frequency overtime Leading cause of death was heart disease second was cancer 2009 Deaths due to heart disease cancer amp stroke have shown longterm declining rates Four trends in disorders 1 Disappearing brought under control by means of immunizations improvement in sanitary conditions amp the use of medications 2 Residual contributing factors largely known but control not effectively implemented 3 Persisting remain common because effective method of prevention or cure evades discovery 4 New Epidemic disorders increasing in frequency in comparison w previous time period Population pyramid represents the age amp sex composition of the population of an area or country at a point in time Triangular distribution associated w high death rates from infections high birth rates amp other conditions that take a heavy toll during childhood years Infections take a smaller toll on developing countries than developed countnes Residents of developed countries have better life expectancy Estimated than 15 of the population in 2030 will be 65 years amp older Fixed population distinguished by speci c happening amp consequently adds no new members population decreases are results of death only Dynamic population adds new members through immigration permanent movement in amp births amp loses them through emigration permanent movement out amp deaths Three in uences on population size 1 Births 2 Deaths 3 Migration CO 0000 O 3 factors don t contribute to net increasesdecreases number of members exiting for various reasonsnumber of people entering Net effect caused by the number of people immigrating number of births exceeds the number of people emigrating number of deaths Net effect caused by the number of people emigrating the number of deaths exceeds the number of people immigrating plus the number of births Demographic Transition historical shift from high birth amp death rates found in agrarian societies to much lower birth amp death rates found in developed countries Decline in death rates is partially due to improvement in general hygienic amp social conditions Industrialization amp urbanization contribute to decline in birth rates Epidemiologic transition shift in pattern of morbidity amp mortality from causes related to diseases Chronic diseases increase in prevalence among the elderly Osteoporosis risk of falling Women have a longer life expectancy Unintentional injuries amp deaths are the leading cause of Mortality among young people particularly males Socioeconomic status income level educational attainment amp type of occupation major determinant of community s health Low income usually lacks health insurance amp access to healthcare Possibly low education levels Possibly less aware of practices that promote good health Racial ethnic amp religious composition related to its health pro le Variables related to community infrastructure Availability of health amp social services Quality of housing stock Social stability constant shift amp emigration of residents appears unstable 0 Residents that cater to certain age groups could push others away Health related outcome variables could suggest needed social amp healthrelated services 0 Infant mortality rate Suicide rates also substance amp alcohol abuse 0 Chronic amp Infectious diseases could re ected failure of immunization amp disease surveillance 0 Teenage pregnanciesspread of STDs lack of education amp counseling services O Homicide rates EnvironmentalVariables Six areas of focus of the US Department of Health amp Human Services 1 Infant Mortality 2 Cancer screening amp management 3 Cardiovascular disease 4 Diabetes 5 Human immunode ciency virus infectionAIDS 6 Immunizations Income inequality is one of the factors of health disparities Gini index measures these inequalities O to 1 Highest among developed countries Evidencebased decisions implies the enactment of laws that have empirical support for their need as well as for their effectiveness Five phase the policy cycle 1 Examination of population health 2 Assessment of potential interventions 3 Alternative policy choices 4 Policy Implementation 5 Policy Evaluation Operations Research systematic study by observations amp experiment of the working of a system with a view to improvement Epidemiology in this sense refers to the study of the placement of health services in a community amp the optimum utilization of such services Facilitates research among various healthcare agencies Etiology determines causes and ways to prevent diseases Epidemiologic skepticism because of their inability to prove anything HenleKochs effort to prove causative involvement of microorganism in an infectious disease 1 Agent must be present in every case 2 Must be isolated amp grown in pure culture 3 Must reproduce the disease when reintroduced into a healthy susceptible animal 4 Must be recovered amp grown again in a culture Koch s criterion 1 Agent present in any case Not true 2 One disease on agent Not true 3 Exposures of healthy subjects to suspected agents Can t be tested due to ethics Multiple causality is now widely accepted John Cassel multifactorial proponent quothost agent environmentquot causal model Risk factor exposure that is associated with a disease There are 3 requisite criteria 1 Frequency of exposure O 2 Risk factor must precede the disease 3 Observed association must not be due to any source of error Epidemiologists use two main types of observational studies for research 1 Casecontrol compares group of people with disease cases to group of people without it controls 0 Compared wrespect to a variety of hypothesized exposures 2 Cohort studies group free of disease is w respect to a variety of exposures The rst case of a new disease is usually the most dramatic Prepathogenesis occurs before the precursors of disease have interact with the host Pathogenesis initial appearance of the disease occurs after the precursors have interacted with the host Tissue or physical changes Prevention of prepathogenesis amp pathogenesis Primary during prepathogenesis Health promotion 0 Speci c protection against diseases 0 Primordial prevention concerned with minimizing health hazards in general Seeks to lower the occurrence of disease 0 Could be passive or active Secondary during pathogenesis Encompasses early diagnosis 0 Prompt treatment 0 Disability limitation designed to limited amp shorten period of disability amp prevent death from disease Tertiary during late pathogenesis Disease has already occurred and been clinically treated Rehabilitation is needed to restore patient
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