Epidemiology Ch. 1 – Flashcards
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epidemic
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the occurrence in a community or region of cases of an illness, specific health-related behavior, or other health related events clearly in excess of normal expectancy
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Can one or two cases of a disease be an epidemic?
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Yes, if the disease normally does not occur at all in that area; ex. if measles was to occur in the U.S.
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pandemic
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an epidemic occurring worldwide, or over a very wide area, crossing international boundaries, and usually affecting a large number of people
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What is a special concern of the field of epidemiology?
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causality
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Epidemiology
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a field concerned with the distribution and determinants of health and diseases, morbidity, injuries, disability, and mortality in populations. Epidemiologic studies are applied to the control of health problems in populations
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population
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all the inhabitants of a given country or area considered together
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Why is epidemiology sometimes referred to as population medicine?
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because it's concerned with the population rather than the individual
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distribution
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the disbursement of disease and health outcomes; implies that the occurrence of disease and health outcomes varies in populations with some subgroups of the population more frequently affected than others
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determinant
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any factor that brings about change in a health condition or other defined characteristic ex. bacteria, viruses, pesticides, stress, poor lifestyle choices
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exposure
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pertain either to contact with a disease-causing factor or to the amount of the factor that impinges upon a group or individuals
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Epidemiology searches for associations between........?
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exposures and health outcomes
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outcomes
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all the possible results that may stem from exposure to a causal factor
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morbidity
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illnesses due to a specific disease or health condition
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mortality
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cause of death
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quantification
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counting of cases of illness or other health outcomes; Quantification means the use of statistical measures to describe the occurrence of health outcomes as well as to measure their association with exposures.
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Is epidemiology a quantitative or qualitative field?
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quantitative; it uses statistics
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natural history of disease
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the course of disease from its beginning to its final clinical endpoints
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period of prepathogenesis
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the time period in the natural history of disease before a disease agent (e.g., a bacterium) has interacted with a host (the person who develops the disease).
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period of pathogenesis
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the period after the agent has interacted with the host
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What are the three types of prevention of disease?
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primary, secondary, and tertiary
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Primary prevention
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the prevention of disease before it occurs; primary prevention targets the stage of prepathogenesis and embodies general health promotion and specific prevention against diseases. Ex. vaccines, health education programs
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Secondary prevention
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takes place during the early phases of pathogenesis and includes activities that limit the progression of disease. Ex. cancer screenings to help catch cancer early before it gets severe
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tertiary prevention
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directed toward the later stages of pathogenesis and includes programs for restoring the patient's optimal functioning Ex. physical therapy for stroke victims or fitness programs for recovering heart attack patients
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interdisciplinary science
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a science that uses information from many fields Ex. Epidemiology is an interdisciplinary science
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observational science
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a science that capitalizes on naturally occurring situations in order to study the occurrence of disease Ex. epidemiologists might look at the frequency of lung cancer in smokers and nonsmokers
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descriptive epidemiology
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epidemiologic studies that are concerned with characterizing the amount and distribution of health and disease within a population classifies the occurence of disease according to person, place, and time
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What is a descriptive epidemiology study concerned with?
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concerned with characterizing the amount and distribution of disease within a population
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What is the aim of descriptive studies?
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Descriptive studies aim to delineate the patterns and manner in which disease occurs in populations. These studies, which are focused on the development of hypotheses, set the stage for subsequent research that examines the etiology of disease.
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According to what three variables are health outcomes classified?
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person, place, and time variables
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Person variables
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race, ethnicity, sex, age
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Place variables
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denote the location of disease, ex. country or state
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Time variables
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year, month, week, day
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analytic epidemiology
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examines causal (etiologic) hypotheses regarding the association between exposures and health conditions
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etiologic studies
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causal studies; aim to find the cause of a disease; planned examinations of causality and the natural history of disease.
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natural experiments
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naturally occurring circumstances in which subsets of the population have different levels of exposure to a supposed causal factor in a situation resembling an actual experiment, where human subjects would be randomly allocated to groups
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Hippocrates
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suggested that environmental factors such as air and water quality could contribute to disease
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Black Death
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epidemic of the bubonic plague; claimed close to a third of the european population; can be transmitted by flees and rats
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Who is known as the founder of toxicology?
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Paracelsus; came up with dose response relationship and target organ specificity of chemicals
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dose response relationship
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discovered by Paracelsus; observation that the effects of a poison are related to the strength of the dose
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toxicology
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a discipline that is used to examine the toxic effects of chemicals found in environmental venues such as the workplace
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Who is known as the Columbus of Statistics?
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Graunt; made mortality statistics and birth statistics; created a mortality table; first to use mortality statistics
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Who is regarded as the founder of of occupational medicine?
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Ramazzini; looked at risks posed in the workforce of various jobs; also looked at danger of certain postures at work; also founder of ergonomics; looked at occupational diseases caused by chemicals, dusts, and metals used in the workforce
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ergonomics
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study of people's efficiency in their working environment
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Sir Percival Pott
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surgeon that is thought to be the first to find an environmental cause for cancer; noticed higher incidence of scrotum cancer in chimney sweepers; recommended hygiene protocol
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Edward Jenner
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came up with a vaccine for smallpox using cowpox virus which was not as dangerous and easily fought off; used material from a dairymade with an active case of cowpox and injected the material into an 8 year old boy who later was exposed to smallpox and didn't develop the disease
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Dutchman Anton van Leeuwenhoek
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used microscopes to observe micro-organisms (bacteria and yeast) but did not find an association with disease
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miasmatic theory of disease
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disease was transmitted by a miasm, or cloud, that clung low on the surface of the earth
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John Snow
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made association of infected water with cholera outbreak by plotting deaths around water pumps; found that the Lambeth company water pump was cleaner because of lower mortality rates; found that if high level exposures weren't affecting people low level environmental exposures shouldn't be dangerous
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William Far
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developed a more sophisticated system for coding medical conditions
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Robert Koch
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verified that disease was caused by a specific living organism; isolated the bacteria that caused cholera and anthrax; also identified the cause of tuberculosis
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Pandemic influenza (Spanish Flu)
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affected one third of the world population; affected healthy young adults; thought to interact with respiratory bacteria making people sick
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Alexander Fleming
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discovered penicillin from a mold
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Framingham study
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looked at the etiology of certain diseases such as coronary heart disease
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Alexander Langmuir
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hired by the CDC to help counter bioterrorism; helped establish EIS
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J.N. Morris
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published 7 uses of epidemiology; Historical use: study the history of the health of populations • Community health use: diagnose the health of the community • Health services use: study the working of health services • Risk assessment use: estimate individuals' risks of dis¬ ease, accident, or defect • Disease causality use: search for the causes of health and disease
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epidemiologic transition
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describes a shift in the patterns of morbidity and mortality from causes related primarily to infectious and communicable diseases to causes associated with chronic, degenerative diseases
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demographic transition
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a shift from high birth rates and death rates found in agrarian societies to much lower birth and death rates in developed countries
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community health use
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described by Morris as the ability to diagnose the health of the community and the condition of the people, to measure the true dimensions and distribution of ill-health in terms of incidence, prevalence, disability and mortality; to set health problems in perspective and define their relative importance; to identify groups needing special attention Ex. age and sex distributions, racial/ethnic makeup, socioeconomic status, employment and unemployment rates
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operations research
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a type of study of the placement of health services in a community and the optimum utilization of such services
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disease management
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a method of reducing healthcare costs by providing integrated care for chronic conditions, e.g., heart disease, hypertension, and diabetes
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risk
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the probability that an event will occur, e.g., that an individual will become ill or die within a stated period of time or by a certain age
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risk factor
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an exposure that is associated with a disease, morbidity, mortality, or adverse health outcome Ex. smoking increases risk of cancer
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risk assessment
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quantitative measurements of risk
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ethics
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norms for conduct that distinguish between acceptable and unacceptable behavior
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American College of Epidemiology Ethics Guidelines
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1. Minimizing risks and protecting the welfare of research subjects 2. Obtaining the informed consent of participants 3. Submitting proposed studies for ethical review 4. Maintaining public trust 5. Meeting obligations to communities
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data cleaning
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reviewing a data set for accuracy and completeness
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What happens after data cleaning?
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counting and tabulating cases
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What happens after counting and tabulating cases?
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plotting the data in a graph
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categorical variable
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a variable that has a fixed number of categories; ex. exposed and unexposed groups
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continuous variable
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a variable that could represent any amount between the end points; ex. if a fire department said that in order to join you have to weigh between 150 and 200 pounds the person could weigh anything between that amount
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discrete variable
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a variable that has set amounts; ex. when flipping a coin you can only get integer numbers of heads or tails - you can't get 2.5 heads
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What are the three epidemiologic measures?
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1. the frequency of disease or condition 2. association between exposure and health outcome 3. strength of the relationship between the exposure and health outcome
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ratio
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the value obtained by dividing one quantity by another
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example of ratios
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rate, proportion, and percentage
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proportion
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a type of ratio where the numerator is part of the denominator - may be expressed as a percentage A/(A+ B)
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percentage
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a proportion that has been multiplied by 100 Ex. A/(A+B) * 100
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rate
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a proportion in which the denominator involves a unit of time
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count
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the number of cases of disease being studied
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incidence
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refers to the new occurence of a disease in a specified time such as in a specified year
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population at risk
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people in a population capable of getting the disease being studied
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incidence rate
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the number of new cases of a disease divided by the population at risk in a given time period
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prevalence
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the number of existing cases of a disease at a specific time
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point prevalence
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the number of people with a disease divided by the number of people in a population at a given point in time; not a rate- only a proportion
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period prevalence
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the number of people with a disease divided by the number of people in a population over a certain period of time; ex from the year 2000-2010
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lifetime prevalence
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cases of disease diagnosed at any point within someone's lifetime
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Would a disease with a long duration or a short duration be more prevalent assuming incidence rates were the same?
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long duration
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crude rate
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a type of rate that has not been modified to take account of any of the factors such as the demographic makeup of the population that may affect the observed rate; includes a time period Ex. crude death rate
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reference population
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the population from which cases of disease were taken; ex. the total population might be counted from the midpoint of the year
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case fatality rate
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number of deaths due to a disease that occur among people afflicted with the disease expressed as number of deaths due to particular disease divided by number of people with disease *100 expressed as a percentage
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proportional mortality ratio
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deaths within a population due to a specific disease divided by the total number of deaths in a population - usually expressed as a percentage
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cause specific rate
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mortality (or frequency of disease) divided by population size at midpoint of time period
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age specific rate
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number of cases of disease per age group during a specific period of time Ex. Number of people 18-24 with asthma divided by number of people age 18-24
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sex specific rate
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number of people in a given gender group with a disease divided by the number of people of that gender
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age adjusted death rates
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shows what the level of mortality would be if age was not a factor
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What are two vital concerns of epidemiology?
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1. the quality of data available for describing the health of populations 2. the appropriate applications of these data
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representativeness (external validity)
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the extent to which the results of the study can be generalized to other situations
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U.S. Bureau of the Census
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gives estimates on population size and subpopulations - conducts a census every 10 years
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What are vital events?
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deaths, births, marriages, divorces, and fetal deaths
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Who collects information on vital events?
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the vital registration system which then sends the information to the National Center for Health Statistics (NCHS)
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public health surveillance
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the systematic and continuous gathering of information about the occurence of disease and other health phenomenon
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syndromic surveillance
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surveillance that uses health related data to signal the probability of a disease outbreak warranting public health response
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Where does the CDC report quarantinable diseases to?
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the World Health Organization
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BRFSS
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state level surveillance system
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registry
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a centralized database for collection of information about a disease
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register
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the document used to collect the information about a disease
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life expectancy
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the number of years that a person is expected to live at any particular year
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maternal mortality
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maternal deaths from causes associated with pregnancy divided by the number of live births in a specified time period
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infant mortality rate
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number of infant deaths (age 0 to 365 days) divided by the number of live births in a specified time period
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fetal death rate
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number of fetal deaths after 20 weeks or more of gestation divided by the number of live births and number of fetal deaths after 20 weeks gestation during a specified time period
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late fetal death rate
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number of fetal deaths after 28 weeks or more of gestation divided by the number of live births and number of fetal deaths after 28 weeks gestation during a specified time period
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crude birth rate
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number of live births divided by the population size in the middle of a specified time period
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general fertility rate
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number of live births divided by the number of women age 15-44 years at the midpoint of the year
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perinatal mortality rate
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number of late fetal deaths after 28 weeks gestation plus infant deaths within 7 days of birth divided by number of live births plus number of late fetal deaths
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Descriptive epidemiologic studies classify diseases in terms of what three variables?
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person, place, and time
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What is a descriptive epidemiologic study concerned with?
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concerned with characterizing the amount and distribution of health and disease within a population
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case report
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account of a single occurence of a noteworthy health related incident or small collection of such events
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case series
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a larger group of case reports
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cross sectional study
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a type of prevalence study that analyses data taken from a population at a specific point in time Ex. how much sleep did you get over the last 30 days? looking at prevalence of insomnia
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nativity
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place of origin of the individual or his relatives
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health disparities
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differences in the occurence of diseases and adverse health conditions in a population
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socioeconomic status (SES)
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a persons position in society; usually based off of income level, education, and type of occupation
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secular trends
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gradual changes in diseases over long time periods
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cyclic trends
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increases or decreases in disease over a year or several years
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point epidemic
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the response of a group of people circumscribed in place to a common source of infection, contamination, or other etiologic factor to which they were exposed almost simultaneously
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clustering
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a closely grouped series of events or cases of disease with well defined distribution patterns in relation to time or place or both usually describes aggregation of uncommon diseases such as leukemia
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spatial clustering
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disease clustering that occurs in a specific geographic region Ex. certain types of cancer
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temporal clustering
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disease clustering that occurs during a specified time period Ex. postpartum depression
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variable
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any quantity that varies. Any attribute, phenomenon, or event that can have different values
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association
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the linkage between variables - positive or negative associations
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positive association
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as one variable increases the other increases
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negative association
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as one variable increases the other decreases
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The closer the correlation is to 1 the stronger...
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the positive association
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The closer the correlation to -1 the stronger....
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the negative association
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An r value near 0 means....
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no association
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dose response curve
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an association between an exposure and outcome that has a higher effect with a higher dosage
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threshold
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the point in a dose response curve at which a particular response occurs
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What happens when the maximum response is reached in a dose response curve?
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the curve flattens out
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multimodal curve
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a curve that has several peaks in the frequency of a condition
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mode
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the category in a frequency distribution that has the highest frequency of cases - there can be more than one mode
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latency
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the time period between initial exposure and measurable response
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epidemic curve
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a graphic plotting of the distribution of cases by time of onset - has one mode that aims to identify the cause of a disease outbreak
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contingency table
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a table that tabulates data according to two dimensions (2 by 2 tables) - the ones with exposed and unexposed and disease and no disease
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A
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A = Exposure is present and disease is present.
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B
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B = Exposure is present and disease is absent.
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C
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C = Exposure is absent and disease is present.
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D
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D = Exposure is absent and disease is absent.
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hypothesis
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any conjecture cast in a form that will allow it to be tested and refuted
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negative declaration (null hypothesis)
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a hypothesis that claims no associaion
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method of difference
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refers to a situation in which all of the factors in two or more domains are the same except for a single factor.
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method of concomitant variation
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refers to a type of association in which the frequency of an outcome increases with the frequency of exposure to a factor
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operationalization
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refers to the process of defining measurement procedures for the variables used in a study
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Hill
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came up with criteria for causality
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strength
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the stronger the association the more likely a relationship
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consistency
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the association can be replicated in different settings with different people
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specificity
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a given disease results from a given exposure and not from other types of exposures
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temporality
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the disease must occur AFTER the exposure not before
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biological gradient
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more exposure increases the severity of the disease
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plausibility
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does the relationship make sense?
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coherence
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does the relationship conflict in any way with basic known science?
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analogy
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is the relationship likely because of a similar known relationship - example one antinausea drug causes miscarriages one in the same class probably does too
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multifactorial or multicausality
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a disease that has multiple causes
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inference
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the process of passing from observations and axioms to generalizations
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population parameter
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the acceptable estimation of disease occurence
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point estimate
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if a random sample of people are gathered the occurence of a disease in the sample - sampling error might make this number different from the population parameter
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confidence interval estimate
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a range of values that with a certain degree of probability contain the population parameter - ex. scientists could say that they're 95% certain the occurence of MS is between 1.5 and 2.5 % of the population
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power
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the ability of a study to demonstrate an association if one exists - a small sample size with a large population of people with a disease might be more significant than a large sample size with a similar occurence
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What are the three types of observational studies in analytic epidemiology?
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cohort studies, case control studies, and ecologic studies
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What are the three types of cohort studies?
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prospective, retrospective, and historical prospective
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What are the two types of intervention studies?
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clinical trials and community interventions
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In observational epidemiologic studies, the investigator_____________ have control over the exposure factor
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does not
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In an expiremental epidemiologic study, the investigator ___________ have control over the exposure factor
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does
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quasi experimental study
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one in which the investigator is able to control the exposure of individuals or units to the factor but is unable to assign participants randomly to the conditions of the study.
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What type of study can be descriptive or analytic?
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ecologic studies
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ecologic comparison study
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involves an assessment of the association between exposure rates and disease rates during the same time period
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restrospective study
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obtaining information about exposure that happened in the past (case control studies)
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prospective study
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information about the study outcome is obtained in the future (expiremental studies and cohort studies)
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Ecologic fallacy
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conclusions that can be drawn about a disease at the group level may not be true at the individual level
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ecologic study
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a study in which the unit of analysis is a group of people rather than individuals Ex. people from the South vs people from the North heart disease risk
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ecologic correlation
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an association between two variables measured at the group level
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aggregate measures
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estimates of the exposure level of a group that has already been calculated previously (ex. percent of people in the south with heart disease
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explanatory variables
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variables studied that may correlate with outcome (ex. income level and heart disease)
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What type of study commonly uses existing data?
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ecologic studies
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What are some advantages of an ecologic study?
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1. provides information about the context of health 2. can be performed when individual data is not available 3. can be conducted rapidly and with minimal resources
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What are some disadvantages of an ecologic study?
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1. the ecologic fallacy 2. imprecise measurement of exposure
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case control study
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a study in which subjects are defined on the basis of the presence or absence of an outcome of interest
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matched case control study
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a study in which subjects are matched on the basis of sex, race, age or other variable
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odds ratio (OR)
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a measure of the association between frequency of exposure and frequency of outcome used in case control studies considered an indirect measure of risk since incidence rate was not used AD/BC
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How would you interpret an odds ratio of 2.4?
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The odds of disease are 2.4 times higher among the exposed than among the unexposed
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An odds ratio of 1.0 indicates....?
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no association between exposure and outcome
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An odds ratio of less than 1.0 indicates...?
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that the exposure may be protective
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What are the advantages of a case control study?
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1. Can be used to study low prevalence conditions 2. Relatively quick and easy to complete 3. usually inexpensive 4. involve smaller number of subjects
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cohort
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a population group or subset thereof that is followed over a period of time
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prospective cohort study
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design, subjects are classified according to their exposure to a factor of interest and then are observed over time to document the occurrence of new cases (incidence) of disease or other health events
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What are the disadvantages of a case control study?
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1. Measurement of exposure may be inaccurate 2. representativeness of cases and controls may be unknown 3. provide indirect estimates of risk using odds ratio` 4. the temporal relationship between exposure factor and outcome cannot always be ascertained
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retrospective cohort study
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makes use of historical data to determine exposure level at some baseline in the past; follow-up for subsequent occurrences of disease between baseline and the present is performed.
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historical prospective cohort study
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combines prospective and retrospective cohort study techniques
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attributable risk %
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(risk difference - 1)/risk difference
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relative risk
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incidence rate in the exposed divided by incidence rate in the unexposed - used in cohort studies (A/A+B)/(C/C+D)
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attributable risk (risk difference)
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difference between the risk in the exposed and unexposed groups - used in cohort studies
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What are the advantages of cohort studies?
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1. permit direct observation of risk 2. exposure factor is well defined 3. can study exposures that are uncommon in the population 4. The temporal relationship between factor and outcome is known
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What are the disadvantages of cohort studies?
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1. expensive and time consuming 2. complicated and difficult to carry out 3. subjects may be lost to follow up during the course of the study 4. exposure can be misclassified
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population risk difference
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incidence rate in total population - incidence rate in unexposed population
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What is the difference between a case control and a cohort study?
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A cohort study uses exposure level to study disease while a case control study uses disease to look at exposure
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intervention study
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an investigation involving intentional change in some aspect of the status of the subjects, e.g., introduction of a preventive or therapeutic intervention)
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randomized control trial
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"an epidemiological experiment in which subjects in a population are randomly allocated into groups, usually called study and control groups, to receive or not to receive an experimental preventive or therapeutic procedure, maneuver, or intervention
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prophylactic trial
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a clinical trial meant to determine whether something can prevent disease
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therapeutic trial
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a clinical trial meant to determine whether something can help treat disease
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clinical trial
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a research activity that involves the administration of a test regimen to humans to evaluate its efficacy and safety
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How many phases do clinical trials generally have?
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at least three (the first two are generally not randomized while the third is)
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crossover design
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a clinical trial in which participants may be switched between treatment groups
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community intervention
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an intervention designed for the purpose of educational and behavioral changes at the population level - usually quasi-experimental design
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program evaluation
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the determination of whether the program meets stated goals and is justified economically
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external validity
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one's ability to generalize from the results of the study to an external population
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quasi-experimental design
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a type of research in which the investigator manipulates the study factor but does not assign individual subjects randomly to the exposed and nonexposed groups (ex. used in public health interventions)
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sampling error
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a type of error that arises when values (statistics) obtained for a sample differ from the values (parameters) of the parent population
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internal validity
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refers to the degree to which the study has used methodologically sound procedures (ex. random sampling)
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bias
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systematic deviation of results or inferences from truth
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hawthorne affect
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a type of bias in which study participants behavior changes because they know they're in a study
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recall bias
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cases often know more about their exposure than the controls
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selection bias
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distortions that result from procedures used to select subjects and from factors that influence participation in the study. A distortion in the estimate of the effect due to the manner in which subjects are selected for the study
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healthy worker affect
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observation that employed populations tend to have a lower mortality experience than the general population
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confounding
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the distortion of a measure of the effect of an exposure on an outcome due to the association of the exposure with other factors that influence the occurrence of the outcome Ex. age
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policy
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a plan or course of action, as of a government, political party, or business, intended to influence and determine decisions, actions, and other matters
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health policy
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a policy that pertains to the health arena, for example, in provision of healthcare services, dentistry, medicine, or public health.
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Policy cycle
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the steps in the policy making process
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policy cycle steps
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1. policy definition, formulation, and reformulation 2. agenda setting 3. policy establishment 4. policy implementation 5. policy assessment
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policy actors
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people involved in making the policies such as legislature
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stakeholders
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individuals, organizations, and members of government who are affected by policy decisions
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policy definition, formulation, and reformulation
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the processes of defining the problem for which the policy actors believe that policies are necessary
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agenda setting
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refers to setting priorities, deciding at what time to deal with a public health problem or issue, and determining who will deal with the problem
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policy establishment
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the formal adoption of policies, programs, and procedures that are designed to protect society from public health hazards
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policy implementation
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the phase of the policy cycle that focuses on achieving the objectives set forth in the policy decision
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policy assessment/evaluation
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the determination of whether the policy has met defined objectives and related goals
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environmental objectives
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statements of policy intended to be assessed using information from a monitoring program Ex. unclean energy sources will be reduced by 10% in the next 5 years
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evidence based public health
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refers to the adoption of policies, laws, and programs that are supported by empirical data
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cost effectiveness analysis
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a procedure that contrasts the costs and health effects of an intervention to determine whether it is economically worthwhile
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risk
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the likelihood of experiencing an adverse affect
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risk assessment
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a process for identifying adverse consequences and their associated probability
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In what two ways do laypeople generally determine risk?
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"dread risk" and "unknown risk"
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What are the four steps of risk assessment?
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1. hazard identification 2. dose-response assessment 3. exposure assessment 4. risk characterization
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hazard identification
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examines the evidence that associates exposure to an agent with its toxicity and produces a qualitative judgment about the strength of that evidence, whether it is derived from human epidemiology or extrapolated from laboratory animal data
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hazard
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the capability of an agent or a situation to have an adverse effect. A factor or exposure that may adversely affect health
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dose response assessment
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the relationship between the amount of exposure and the occurrence of the unwanted health effects
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exposure assessment
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the procedure that identifies populations exposed to the toxicant, describes their composition and size, and examines the roots, magnitudes, frequencies, and durations of such exposures
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risk characterization
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estimates of the number of excess unwarranted health events expected at different time intervals at each level of exposure
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risk management
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steps taken to control exposure to toxic chemicals in the environment Ex. recalling bad products, testing substances before marketing them, etc.
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screening for disease
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the presumptive identification of recognized disease or defects by the application of tasks, examinations, or other procedures that can be applied rapidly - confirmation of disease is still required after screening
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mass screening
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screening the whole population regardless of risk
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selective screening
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screening only those people at risk - generally more efficiency
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reliability (precision)
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the ability of an instrument to give a consistent result
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validity (acuracy)
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the ability of an instrument to give the true measurement
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sensitivity
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the ability of the test to identify correctly all screened individuals who actually have the disease calculated by taking the true positives/ true positives plus true negatives a perfectly sensitive test would be 100%
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gold standard
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a definitive diagnosis that has been determined by biopsy, surgery, autopsy, or other method and has been accepted as the standard
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specificity
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the ability of the test to identify only nondiseased individuals who actually do not have the disease true negatives/ false positives and true negatives
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positive predictive value
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the proportion of individuals screened positive by the test who actually have the disease true positives/ true positives and false positives
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negative predictive value
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the proportion of individuals screened negative by the test who actually are negative true negatives/true negatives and false negatives
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legitimization
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the process of making policies legitimate, meaning to be acceptable to the norms of society
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interest group
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A group of persons working on behalf of or strongly supporting a particular cause, such as an item of legislation, an industry, or a special segment of society
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infectious disease (communicable disease)
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"an illness due to a specific infectious agent or its toxic products that arises through transmission of that agent or its products from an infected person, animal, or reservoir to a susceptible host, either directly or indirectly through an intermediate plant or animal host, vector, or the inanimate environment
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parasitic disease
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a disease caused by a parasite
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infection
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the entry and development or multiplication of an infectious agent in the body of persons or animals
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What are the three components of the epidemiologic triangle? (in infectious epidemiology)
answer
agent, host, and environment
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environment
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where the disease causing agent may exist
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host
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a person or animal that becomes susceptible to the disease agent
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agent
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a factor that causes the infection
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infectivity
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the capacity of an agent to enter and multiply in a susceptible host and thus produce infection or disease
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virulence
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the severity of the disease produced, i.e., whether the disease has severe clinical manifestations or is fatal in a large number of cases
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toxin
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a toxic substance produced by a living organism
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immunity
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the host's ability to resist infection by the agent
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antigen
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an invading substance that stimulates antibody formation
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passive immunity
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immunity that is acquired from antibodies produced by another person or animal - short term immunity
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incubation period
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the time interval between invasion by an infectious agent and the appearance of the first sign or symptom of the disease.
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herd immunity
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the resistance of a community to an agent since the majority are protected
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sub-clinical (inapparent)
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the infection does not show obvious clinical signs or symptoms Ex. HIV - can be transmitted but often doesn't have symptoms
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generation time
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the time interval between lodgment of an infectious agent in a host and the maximal communicability of the host
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What is the difference between generation time and incubation period?
answer
incubation period only refers to clinically apparent cases of disease while generation time applies to both clinically apparent and subclinical cases of disease
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carrier
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a person or animal that harbors a specific infectious agent without discernible clinical disease, and which serves as a potential source of infection
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index case
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the first case of a disease to come to the attention of authorities
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endemic
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when an infectious disease agent is habitually present in an environment
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reservoir
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a place where infectious agents normally live and multiply; the reservoir can be human beings, animals, insects, soils, or plants
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zoonosis
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an infection or infectious agent transmissible under natural conditions from vertebrate animals to humans Ex. rabies
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portal of exit
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the site from which the agent leaves that person's body Ex. respiratory passages, the alimentary canal, the genitourinary system, and skin lesions
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direct transmission
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direct and essentially immediate transfer of infectious agents to a receptive portal of entry through which human or animal infection may take place Ex. touching, kissing, sexual intercourse
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portal of entry
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where the agent enters the body Ex. skin, respiratory system, eyes, etc.
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vehicles
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contaminated, nonmoving objects Ex. blood on unclean needles
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indirect transmission
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intermediary sources of infection such as vehicles, droplet nuclei (particles), and vectors Ex. airborne infections, foodborne diseases
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vector
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living insect or animal that is involved with the transmission of disease agents Ex. ticks - lyme is a vector born disease
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vaccine preventable diseases
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conditions that can be prevented by vaccination (immunization), a procedure in which a vaccine is injected into the body.
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fomite
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an inanimate object that carries infectious disease agents; Ex. the classroom doorknob, used towels found in a locker room, or carelessly discarded tissues.
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emerging infectious disease
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an infectious disease that has newly appeared in a population or that has been known for some time but is rapidly increasing in incidence or geographic range Ex. ebola
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bio-terrorism attack
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the deliberate release of viruses, bacteria, or other germs (agents) used to cause illness or death in people, animals, or plants.
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clinical observations
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symptoms that hint at a disease Ex. fever, nausea, vomiting
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epidemic curve
answer
A graphic plotting of the distribution of cases by time of onset
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common source epidemic
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outbreak due to exposure of a group of persons to a noxious influence that is common to the individuals in the group
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point-source epidemic
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a type of common-source epidemic that occurs when the exposure is brief and essentially simultaneous and the resultant cases all develop within one incubation period of the disease
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attack rate
answer
a type of incidence rate used when the oc¬ currence of disease among a population at risk increases greatly over a short period of time, often related to a specific exposure ill/ill + well *100
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What social and behavioral dimensions affect health?
answer
poverty, discrimination, stress, lifestyle practices
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lifestyle
answer
the choice of behavioral factors that affect how we live; these choices often are a function of social influences
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social epidemiology
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studies the social distribution and social determinants of states of health Ex. effects of support networks on health outcomes, socioeconomic status, etc.
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behavioral epidemiology
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the study of the role of behavioral factors in health Ex. lack of exercise and heart disease
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stress
answer
a physical, chemical, or emotional factor that causes bodily or mental tension and may be a factor in disease causation
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What are the two categories of stressful life events?
answer
positive and negative stress - positive good stress like graduation or negative like the death of a family member - both take a tole on the body though
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chronic strains
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stressful life events that take place over a prolonged period of time - positive or negative
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How long do PTSD symptoms last?
answer
at least one month
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social support
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help that we receive from other people when we are under stress
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coping skills
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techniques for managing or removing sources of stress
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passive smoking
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second hand smoke - the involuntary breathing of cigarette smoke by nonsmokers
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meth mouth
answer
a condition that contributes to decay and loss of teeth. The cause is reduced output of saliva, increased consumption of sugary carbonated beverages, and neglect of personal hygiene
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BMI
answer
body weight in kilograms divided by height in meters squared
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psychiatric epidemiology
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studies the occurrence of mental disorders in the population
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psychiatric comorbidity
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the co-occurrence of two or more mental disorders, for example, major depression and substance use disorder
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black box epidemiology
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epidemiologic associations between exposure and health outcomes in which the cause is unknown
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genetic epidemiology
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the identification of inherited factors that influence disease, and how variation in the genetic material interacts with environmental factors to increase (or decrease) risk of disease Ex. whether diseases cluster in families
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Human Genome Project (HGP)
answer
aimed to identify all of the genes in human DNA -
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molecular epidemiology
answer
a subfield of epidemiology that uses molecular markers in addition to genes to establish exposure-disease relationships.
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genetic marker of susceptibility
answer
a host factor that enhances some step in the progression between exposure and disease such that the downstream step is more likely to occur
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autosomal recessive
answer
denotes those diseases for which two copies of an altered gene are required to increase risk of the disease
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autosomal dominant
answer
refers to a situation in which only a single copy of an altered gene located on a nonsex chromosome is sufficient to cause an increased risk of disease.)
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congenital malfunctions
answer
birth defects
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environmental epidemiology
answer
refers to the study of diseases and conditions (occurring in the population) that are linked to environmental factors Ex. exposure to air pollution, toxic chemicals, drinking water, etc.
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global warming
answer
gradual increase in the earth's temperature
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What three factors must be present to classify something as a major structural birth defect?
answer
1. result from a malformation, deformation, or disruption in one or more parts of the body 2. are present at birth 3. have a serious, adverse effect on health, development, or functional ability Ex. cleft foot
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Who collects information about work related injuries?
answer
The US department of Labor and statistics
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injury epidemiology
answer
the distribution and determinants of injuries (such as intentional and unintentional) in the population.
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accident
answer
an unintentional incident that could not have been prevented - an act of God
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sewage epidemiology
answer
monitoring levels of excreted drugs in the sewer system in order to assess the level of illicit drug use in the community
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forensic epidemiology
answer
the use of epidemiological reasoning, knowledge, and methods in the investigation of public health problems that may have been caused by or associated with intentional and/or criminal acts
