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The study of the distribution and determinants of health-related states or events in specified populations, and the application of this study to control of health problems.

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Epidemiology

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Epidemiology is an ______________ science that capitalizes upon naturally occurring situations in order to study the occurrence of disease.

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observational

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_______________ epidemiology refers to epidemiologic studies concerned with characterizing amount and distribution of health and disease within a population. - concerned with characterizing amount and distribution of health and disease within a population.

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Descriptive

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____________ epidemiology examines casual (etiologic) hypotheses regarding association between exposures and health conditions. - examines causal (etiologic) hypotheses regarding association between exposures and health conditions

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Analytic

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_______________: Contact with a disease-causing factor or amount of that factor that impinges on group or individual.

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Exposure

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_____________: All possible results that may occur from exposure to casual factor.

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Outcome

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_____________: Person who has been diagnosed with health-related state or event.

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Case

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____________: Ability of a program to produce desired effect among those who participate in program compared to those who do not.

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Efficacy

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_____________: Ability of a program to produce benefits among those who are offered the program.

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Effectiveness

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____________: Occurrence of cases of an illness, specific health-related behavior or other health-related events clearly in excess of normal expectancy.

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Epidemic

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_____________: Occurrence of diseases and other health outcomes vary in population, with some subgroups more affected than others.

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Distribution

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_____________: Any factor that brings about change in a health condition or other defined characteristics.

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Determinant

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______________: Illnesses due to specific disease or health outcome.

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Morbidity

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_____________: Causes of death.

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Mortality

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What Causes Disease: Three Factors: 1. ____________: What caused the disease? Microbes, toxins, carcinogens, blunt force, etc. 2. ___________: Who has the disease? Genetic or personal characteristics. 3. ____________: Where was the disease transmitted? Air pollution, weather, climate, social situations, etc. A.K.A. Three Concepts of Epidemiologic Triangle

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Agent, Host, Environment

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_______________ ______________: Host Environment Agent

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Epidemiological Triangle

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____________: Object that can be infectious agent and capable of being means of production.

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Fomite

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____________: Invertebrate animal capable of transmitting infectious agent from infected or human to other susceptible animals or humans.

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Vector

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____________: Habitat in or on which infectious agent lives, grows, and multiplies and on which depends for survival.

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Reservoir

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_____________: Infection that travels from animals to humans.

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Zoonosis

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__________ Transmission: Direct and usually immediate transfer of infectious agents to portal of entry.

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Direct

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Indirect Disease Transmission: __________-Borne Infections: infection results from contact with vehicles (contaminated, non-moving objects) Ex. Unsanitary food, objects. __________ Infections: Spread of droplet particles present in the air. Ex. classrooms, airplanes. __________-Borne Infections: Infection resulting from vector. Ex. animal, human.

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Vehicle, Airborne, Vector

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Chain of __________ ___________: - Pathogen - Human reservoir - Portal of exit - Transmission - Establish disease in new host

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Infection Model

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What are the four stages of the naturally history of disease? 1. ____________ 2. ____________ Disease 3. ____________ Disease 4. Recovery, Disability, _________

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Susceptibility, Presymptomatic, Clinical, Death

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____________-causation Disease __________: Primarily relates to chronic diseases that take years to present and are caused by multiple factors. Example: Risk of heart disease increases for people with multiple risk factors such as: smoker, overweight, etc.

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Multi, Model

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Types of Prevention: _______________: Pre-pathogenesis, prevention of disease before it occurs (Health Promotion) ______________: Early phases of pathogenesis, activities to limit progression of disease (screening) _____________: later stages of pathogenesis, slow or block progression of disability (rehabilitation)

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Primary, Secondary, Tertiary

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Ice/__________ Theory: Unrecognized cases outnumber recognized cases. - Exceptions are severe, easily diagnosed diseases.

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Pyramid

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History: - Greek writer and physician ___________ wrote "On Airs, Waters, and Places", which suggested that environmental factors implicated in disease causation. - Epidemic of _________ plague killed up to 1/3 of the population of Europe during 1346-1352. - Edward Jenner finds __________ vaccine in 1789.

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Hippocrates, smallpox

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History: - 1918 ______ Pandemic, killed 50-100 million people around the world. - Alexander Fleming discovered ___________ in 1928. - 1948 Framingham Study: Longitudinal cohorts study. - Center For Disease Control and Prevention created in _______. - 1964 Smoking and Lung Cancer.

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Flu, penicillin, 1949

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_______________ ________________: - Describes a shift in patterns of morbidity and mortality from causes related primarily to infectious and communicable diseases to causes associated with chronic, degenerative disease.

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Epidemiological 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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Demographic Transition

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__________ ___________: - A large number of people exposed to a small risk may generate many more cases than a small number exposed to a large risk.

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Rose's Theorem

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Three Most Important Epi Questions: ___________: How do personal characteristics of members of population affect disease pattern? ___________: How does place in which population lives affect disease pattern? ___________: How does pattern of this disease vary over time in this population?

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Person, place, time

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Epidemiologic Variables: - ___________ Variables: Have no value difference, groups people into nominal categories. I.e. sex, college status - Numerical/Quantitative: 1. ____________ Variables: categories that do not represent numerical value. Ex. age group (10-14 yrs, 15-29 yrs), race, blood type, BMI (underweight, healthy, overweight, obese) *think categories* 2. _____________ Variables: have numerical value and infinite possible responses. Gives best info. Ex. age, weight, yearly rainfall, annual salary. *think numbers* 3. Dichotomous: yes/no

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Discrete, Categorical, Continuous

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_____________ _____________: Naturally occurring circumstances in which subsets of population have different levels of exposure to a supposed casual factor in situation resembling an actual experiment, where human subjects would be randomly allocated to groups.

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Natural Experiments

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Immunization: Developing antibodies to disease. ___________ Immunity: body produces its own antibodies. _________ Immunity: transfer of antibodies from one person to another (typically in breastfeeding). _________ Immunity: We can protect the herd by the majority of people getting immunized.

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Active, passive, herd

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_____________ _____________: - Classifies disease according to variables of person (who), place (where), and time (when) - Characterizes amount and distribution of health & disease within a population - Provides info for disease prevention, intervention, and future research. - Provides clues to identify new disease - Identify population at greatest risk --> assist in planning and resource allocation --> identify future research to understand relationships between exposure and health outcome.

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Descriptive Epidemiology

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Types of _______________ Epidemiologic Studies: - Case Reports - Case Series - Cross-Sectional Studies - Ecologic Studies

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Descriptive

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________ __________: - Accounts of a single occurrence or small number of noteworthy event

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Case Reports

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________ _________: - Large collection of cases of disease 1. Grouped consecutively 2. Lists common features

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Case Series

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___________-___________ Studies: - Examines relationship between disease and other variables of interest as they exist in particular population at particular point in time - presence/absence of disease and other variables - Can't determine causality - Prevalence study - exposures and outcomes assessed at same point in time. - Used to formulate hypotheses for follow up in analytic studies.

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Cross-Sectional

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___________ Studies: - Study where units of analysis are populations or groups of people not individuals. 1. Unit of analysis at the group level - May be used when individual measurements are not available, but group-level data can be obtained. 1. Ecologic fallacy - predicting individual results based off group studies.

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Ecologic

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___________ ____________: - Frequency of disease or condition - Associations between exposures and outcomes - Strength of relationship between exposure and outcome

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Epidemiologic Measures

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___________ Rate: # of new cases/total population AT RISK

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Incidence

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__________ Rate: - Rate not modified to take into account any other factors. - Numerator = frequency of disease over time - Denominator = unit size of population

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Crude

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____________ ____________ Rate: - Number of deaths due to disease among people afflicted with disease. - # of deaths due to disease / # of cases of disease

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Case Fatality

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____________ Rate: - Number of deaths within a population due to specific disease or cause divided by total number of deaths in population - # of deaths occurring during a specific time period / Population from which deaths occurred

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Mortality

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__________-_________ Rate: - Mortality (or frequency of disease) divided by population size at midpoint of time period. - Mortality (or frequency of disease) / Population size at midpoint of time period

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Cause-Specific

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______-_________ Rate: - Number of cases of disease per age group of population during a specific time period - # of cases among age group / # of people in age group

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Age-Specific

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__________ Rates: - Statistical procedures have been used to allow for fair comparisons across populations by removing effect of differences in composition of different populations. - Ex. age adjustment

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Adjusted

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Graphing Epi. Data: - _________ chart: frequency of cases - _________ graph: trends in data - _________ chart: proportion of cases

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Bar, line, pie

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Numerical Methods: Arithmetic _________: Average ____________: Middle ___________: Most common

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Mean, median, mode

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Numerical Methods: __________: Difference between largest and smallest values. __________: What's the spread from lowest to highest; average of squared differences of observations from mean. __________ Deviation, square root of the variance.

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Range, variance, standard

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Role of Chance: _____________: Taking observation & making generalizations. Sample to population. Point _________: Single value which represents population parameter. Confidence ____________ Estimate: Range of values that with certain degree of probability contain population parameter. ____________: Ability of a study to demonstrate an association if one exists.

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Inference, estimate, interval, power

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Dose Response Relationship: - As level of __________ increases, level of outcome increases. - ____________: Lowest dose where a particular response occurs; when maximum response reached curves flattens out.

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Exposure, threshold

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Multi-modal Curve: - Several peaks in frequency of an ____________. - May be due to latency period, changes in ___________ status, changes in lifestyle.

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outcome, immune

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____________ Curve: - Graph plotting distribution of cases by time of onset. - Related to point epidemic

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Epidemic

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Epidemiologic Research Strategies: - Examine existing facts & _____________. - Formulate new or more specific hypotheses. - Get more facts to test new _____________.

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hypotheses, hypotheses

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_________________: - Defining measurement procedure for variables used in a study. Ex. defining things like smoking, alcohol use, etc.

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Operationalization

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Public _________ Surveillance: - Systematic, ongoing collection, analysis, interpretation, and dissemination of health data. Ex. CDC

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Health

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____________ Validity: Refers to degree which study has used methodologically sound procedures. ____________: how well can you repeatedly measure the same thing? ____________: is it measuring the same thing you want to measure? (think accuracy) __________/outcome: accurately classifying people.

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Internal, reliability, validity, exposure

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____________ Validity: Ability to generalize from results of study to an external population. - Convenience sample may not have this. - Random samples more likely to have this than convenient (not always guaranteed).

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External

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___________ Error: Often due to variability (imprecision) in measurement. I.e. How certain are you of a waist:hip ratio? Results in larger standard deviations and confidence intervals. - More error, less confident you are in your estimate. ____________ Error: Values for sample differ from values in population. Variability in Measurements: Reliable, valid, reproducible measurements

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Random, sampling

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___________: systematic error that will lead results away from the truth. Example: Group of obese cases and normal weight controls in a weight loss study. - During your follow-up measurements, the scale is accurate up to 210 lbs, then increasingly over-estimates weight above 210 lbs.

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Bias

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Types of Bias: ___________ Effect: people act different when they know they are being watched. ____________ Worker Effect: healthier people participate more. ____________ Bias: Who chooses to participate & who doesn't. _____________ Bias: Not good at remembering details. _____________ Bias: May ask more detailed questions of cases.

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Hawthorne, Healthy, Selection, Recall, Interviewer

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Misclassification Bias: _____________ Misclassification: Exposure classification influences differential accuracy in ascertaining outcome information. _____-______________ Misclassification: Inaccuracies in classifying exposure status of individuals, but these misclassifications occur similarly between exposed and unexposed groups.

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Differential, Non-differential

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______________ Bias: Tendency to "trash" studies with negative results - no findings or opposite of what you were trying to find. - Weak or variable associations may appear stronger in publication literature than they actually are.

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Publication

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_________________: - Associated with the outcome. - Associated with the exposure. - Not on the casual pathway between exposure and outcome. - Influences both variables <--- Exposure Outcome

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Confounding

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Ways to Reduce __________: - Develop explicit definitions of exposures and outcomes. - Enroll all cases in a defined time and region. - Try for high participation rates. - Do what you can to ensure reps. - Use valid and Reliable measures.

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Bias

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_____________gives information on new and existing cases,while ______ gives information on new cases.

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Prevalence, Incidence

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Name the three concepts of the epidemiologic triangle.

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Agent, Host, Environment

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Provide a different variable for each of the following key epidemiologic concepts that are used to describe patterns of diseases or exposures.

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Person, Place, Time

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Epidemiologic measures of association provide what three types of information? - ___________ of disease or condition - ____________ between exposures and outcomes - Strength of ___________ between exposure and outcome

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Frequency, associations, relationship

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When a country shifts to higher rates of chronic disease from infectious disease, this is called the ___________ Transition. This usually happens along with the ______________ transition which is a shift from high birth and death rates to much lower birth and death rates.

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Epidemiologic, Demographic

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When a disease occurs in number greater than would be expected, this is called a/an ____________. When this is worldwide it is called a/an ___________.

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Epidemic, Pandemic

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A program to promote quitting among those with lung cancer is an example of __________ prevention. A smoking prevention program with adolescents is an example of ___________ prevention. An x‐ray to diagnose lung cancer early is an example of ____________ prevention.

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tertiary, primary, secondary

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__________ ___________: He was considered the father of epidemiology because he was one of the first to use descriptive and analytic approaches to determine the cause of disease.

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John Snow

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What are the three aims of Descriptive Epidemiology? 1. Evaluation of trends in health and __________. 2. Provide bases for planning, provision, and evaluation of _________ services 3. Identify problems to be studied by ___________ epidemiology

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Disease, health, analytic

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