Epidemiology Chapter 1 and 2 – Flashcards
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Hippocrates
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Ancient Greek physician. 1st epidemiologist and father of medicine. Coined term epidemic and endemic. Realized illness wasn't supernatural.
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James Lind
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1st clinical trial study to discover cause/remedy for scurvy among sailors. Had a control group, one with veggies and fruits and one without. Made British Navy require sailors to eat lime
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John Graunt
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"Bills of Mortality" recorded age, sex, who died, where, and when. First to chart that.
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William Farr
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Continued Graunts work by calculating life tables, life expectancy and other vital statistics. Said some diseases had Multifunctional etiology (multiple cases).
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Benjamin Jesty
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English dairy farmer that realized Milkmaids with infected cowpox never got smallpox so he infected his wife and children . People thought he was crazy so he wasn't given my credit.
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Edward Jenner
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Did same thing as Jesty (cowpox), got a money prize for "first" vaccine
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What is the first and only eradicated disease?
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Smallpox
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Ignaz Semmelweis
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Noticed high mortality rate in a clinic so conducted an epidemiological study between two different clinics. Discovered one had students coming from the morgue and infecting mothers. Implemented HAND WASHING. Death rate dropped significantly.
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Koch and Pasteur
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Founders of germ theory. Looked at bacteria/protozoa under microscope. Founded Koch's Postulates
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Koch's Postulates
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Determines if pathogen causes an infection 1. Found only in diseased individuals 2. Must be isolated and grown in culture 3. Cultured microorganism must be able to reinfect healthy organism 4. Re-isolated and cultured again
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John Snow
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"Father of modern epidemiology." Cholera epidemic caused by microbes (people didn't know this). People thought it was bad air. Plotted cases on a map. Asked them, dressed as a priest, about their life and work. Found all victims got water from same central pump and removed handle. First to do field epidemiology
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Framingham Heart study
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Cohort study linking genetic and lifestyle roles in diseases. Identified major risk factors for cardiovascular diseases such as high blood pressure, high blood cholesterol, smoking, obesity, diabetes, and physical in-activeness.
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Cohort study
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Following people throughout life for generations
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Who coined the term "risk factor"?
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Framingham Heart study
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Who noted that malaria and yellow fever most commonly occurred in swampy areas?
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Hippocrates
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What is epidemiology?
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scientific study of the distribution and determinants of health-related states or events in human populations, and the application of this study to the prevention and control health problems.
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What is a word that is synonymous with "disease"
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Health outcome
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True or False Epidemiology only studies infectious disease
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False, it studies ANYTHING that can happen to a human ex: Infectious/chronic diseases, disability, injury, limitation of activity, mental illness, suicide, drug addiction, violence, teen pregnancy
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Morbidity
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disease/illness
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Mortality
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death
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What does "distribution" in the epidemiology definition mean?
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The three W's= Who, Where, When Must be as quantitative as possible. Can map it to indicate where cases are found and see where the most cases are
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Why study patterns?
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suggests determinants/causes for a given health problem and how to control it
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Why can looking for patterns be bad?
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Correlation does not equal causation. ex: vaccines and autism BUT If lots of X happens in a location, we think something must cause it. Example: Clusters of cancer.
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What do many patterns turn out to be?
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random variation
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What does "determinants" in the epidemiology definition mean?
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Factors or events that are capable of bringing about a change in health
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Types of determinants?
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Pathogens, Chemicals/Toxins, Lifestyle, Genes
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True or False Only one determinant is the reason for a cause
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False, can be multiple
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Exposures
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When we focus on a specific determinant
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The goal of finding "patterns" is to see if there are possible ________ links between exposure and outcome. However most PH research finds _____.
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Casual, correlation
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Often more than one cause leads to a given outcome, especially for ________.
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Non-infectious diseases (cancer)
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Causal Pie
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demonstrates more than one factor, and a different combination of factors, leads to a given outcome If an outcome can't occur without X, then X is a necessary factor
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Problem when going from population to individual?
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conclusions of epidemiological studies only apply to the "average" person in the population under study. But such an average person does not exist in reality. Groups can have wildly varying risks but have the same average, need to know more about individuals
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True or False If smokers are on average 20 times more likely to get lung cancer than non-smokers, you can say to an individual smoker "you are 20 times more likely to get lung cancer because you smoke".
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False
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What does "scientific study" in the epidemiology definition mean?
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Hypothesis/question, collect data to test hypothesis, analyze to look for patterns, if correlation is strong, do further studies
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In a scientific/epidemiology study, it is important to be qualitative or quantitative?
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Quantitative, Get good numbers/measurements, perform statistical analyses of data, etc
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What should should be done next when a strong risk factor, correlation, or even cause is identified?
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Implement control
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Primary Prevention/intervention
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occurs prior to exposure, promotes overall healthy habits and environments (healthy diet, clean water, access to health care)
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Secondary Prevention/intervention
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occurs during pathogenesis (after agent reacts with host), so the disease already exists in the person. Designed to reduce the progress of disease and detect disease before clinical symptoms arise in order to imporve prognosis and prevent conditions from progressing/worsening. (screening for cancer and diabetes)
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Tertiary Prevention/intervention
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occurs when disease has already occurred. Designed to limit disability from disease and restore optimal functioning (physical therapy for stroke patients, halfway houses for alcohol abuse recovery, and fitness programs for heart attack patients)
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Specific Primary Prevention
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targets a certain disease/condition (condom use, eating habits to lower blood pressure, immunization)
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Active Prevention
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behavior change on the part of the subject (lifestyle changes, vaccinations, wearing protective devices)
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Passive Prevention
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does not require any behavioral change (fluoridation of public water and vitamin fortifications of milk and bread products) can be more efficient/easier, but limits freedom of choice for individuals
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Descriptive Epidemiology
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answering the who,where, when questions is prerequisite to effective education, screening, prevention, and control programs.
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Analytic Epidemiology
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involves identifying and quantifying associations, testing hypothesis, and identifying causes of health related states or events. Explains why and how health related states or events occur. A part of descriptive
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Morbidity
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disease, "lack of health"
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Disease/Illness
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a "lack of perfect health", a health outcome of interest
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Prevalence
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the level of a disease in a population. Straight numbers (ex: 5% of students at UGA have depression)
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Incidence
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the rate of new disease cases in a population (since that study, 500 more students have gotten depression)
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Efficacy
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magnitude of change in outcome among individuals
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Effectiveness
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magnitude of change in outcome among population
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What is, historically, the first area of epidemiological study?
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Infectious Disease Epidemiology, more important in less developed countries
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Epidemic
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health related state or event in a defined population above the expected over a given period of time
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Endemic
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persistent, usual, expected health-related state or event in a defined population over a given period of time
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Pandemic
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epidemic affecting a large number of people, many countries, continents, or regions
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Outbreak
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an unusually large number of cases in a circumscribed area/time period. Often used interchangeably or in conjunction with epidemic or pandemic (an epidemic outbreak, a pandemic outbreak
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True or false A large outbreak conveys the severity of the outbreak
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False, H1N1 (swine flu) pandemic, was very large but not super deadly
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WHO Phase 5
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epidemic, at least 2 countries in one region
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WHO Phase 6
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pandemic, at least 2 countries in one region, and at least one more country in another region
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Direct transmission
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direct physical contact such as touching contaminated hands, skin to skin contact, kissing, sexual intercourse, sneezing (also indirect)
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Indirect transmission
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occurs when pathogens or agents are transferred or carried by some intermediate item, organism, means, or process to a susceptible host, resulting in disease (bitten by bug, food poisoning)
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Two ways epidemics are spread?
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Common source and Propagated
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Common source epidemics
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result in more cases occurring more rapidly and sooner than than propagated epidemics. Identify and removing exposure to the common source typically causes the epidemic to rapidly decrease (anthrax- traced to milk or meat from infected animals, cholera- traced to fecal contamination of food and water)
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Propagated epidemics
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infection is transmitted from one infected person to another directly (i cough on your face) or indirectly (I cough on hand, touch doorknob, you touch doorknob, then touch your mouth) rise and fall more slowly than common source epidemics, often in waves (flu, measles, TB, HIV, SARS)
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Case
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a person who has been diagnosed as having a disease, disorder, injury, or condition
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Suspect Case
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an individual who has most/all of the signs and symptoms of a disease or condition but has not been clinically diagnosed
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Confirmed Case
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all criteria met that are needed for case definition (lab confirmed presence of pathogen)
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Primary Case
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the first disease case in the population
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Index case
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the first disease case brought to the attention of the epidemiologist/health personnel
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Secondary cases
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persons who become infected and ill after a disease has been introduced into a population and who became infected from contact with the primary case
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Host
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a living being who harbors a parasite, usually the parasite replicates in the host
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Carrier
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a host who contains, spreads, or harbors an infectious organism. Often show little or no symptoms (typhoid mary)
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Fomite
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object such as clothing, towels, surfaces that may harbor a disease agent and is capable of transmitting it (staph in hospitals)
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Vector
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an invertebrate animal (tick, mite, mosquito, bloodsucking fly) capable of transmitting an infectious agent among vertebrates (anopheles and malaria)
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Reservoir
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The habitat (living or nonliving) on which an infectious agent lives, grows, and multiplies and is dependent on for its survival in nature. Examples: Humans often serve as both reservoir and host, water contaminated with cholera
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Zoonosis
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When an animal transmits a disease/pathogen to a human. Examples -Rabies, Hantavirus
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Reverse Zoonosis
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when a pathogen is spread from humans to animals. Example: influenza
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Why are infectious disease studies less important in developed countries?
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Less people die of that. They die more of non-infectious diseases (cardiovascular)
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Epidemiological Triangle
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Agent, Disease, environment
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Environment
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external area where the agent and host exist that can affect transmission and host reactions to disease
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What kind of triangle is used for developed countries?
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Causative factors, time, groups or populations and their characteristics, environment behavior culture physiological factors and ecological elements
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Epidemiology involves the study of more than just infectious diseases. Explain.
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health-related events include anything that can happen to the human population. Determinants are anything that can bring about a change in health, not just infectious diseases. Can involve suicide, disabilities, mental illness, drug addiction, violence, and teen pregnancy. This is because infectious diseases have been controlled and life expectancy is higher, so people are dying more of noninfectious disease and conditions. So need to study those causes of death
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Chain of Infection
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1. disease transmission starts when pathogen leaves the reservoir through the portal of exit and is spread by one of several modes of transmission 2. Pathogen or disease causing agents enters the body through a portal of entry and infects the host if they're susceptible. Infectious Agent--> Reservoir-->Portal of Exit-->Mode of Transmission-->Portal of Entry--> Susceptible Host
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Portal of Exit
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nose, mouth, rectum, urinary tract, blood, other bodily fluids
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Portal of Entry
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mucous membrane, wounds
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What makes a host susceptible?
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Weakened immune system (elderly, children, underlying chronic disease such as diabetes and asthma) If protection doesn't work (skin, mucous membrane, physiological responses)
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List four types of epidemiological information useful for influencing public health policy and for planning individual health decisions?
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role of host, agent or disease causing organism, time, environmental circumstances needed for disease to thrive
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Give an example of something that has efficacy but not efficency
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Efficacy- an after-school program that raises kids overall test score by 10 points, so its efficace Efficiency- most kids cannot afford it, so it's no effective
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In what ways does epidemiology play a foundational role in public health?
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Central role in carrying out the three core public health functions: 1. assess and monitor the health of at-risk populations and identify health problems and priorities 2. identify risk factors for health promotion 3. provide a basis for predicting the effects of certain exposures Useful in allocating scarce health resources for preventing, protecting, and promoting public health
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Name a primary, secondary, and tertiary prevention for cancer
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1. exercise, eating healthy, not working around harmful toxins, don't smoke 2. screening to catch it early, chemo 3. diet change, stop smoking
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List some of the contributions of the microscope to epidemiology.
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Pasteurs anthrax vaccination, Koch discovering waterborne epidemics can be prevented by proper water filtration and identifying tuberculosis and cholera microorganisms, John Snow identifying cholera transmission and incubation times Helped prove microorganisms caused disease, not spontaneous generation
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What two individuals contributed to the birth of vital statistics?
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John Graunt and William Farr
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What type of epidemiological study was used by James lind?
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experimental study (Unlike a descriptive study, an experiment is a study in which a treatment, procedure, or program is intentionally introduced and a result or outcome is observe)
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What type of epidemiological study was used by Doll and Hill?
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case control and cohort
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Thomas Sydenham
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advanced useful treatments and remedies including exercise, fresh air, and a healthy diet, which other physicians rejected at the time
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Louis Pasteur
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developed a vaccine for anthrax
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Robert Koch
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used photography to take the first pictures of microbes in order to show the world that microorganism in fact existed and that they caused many diseases
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Bernardino Ramazzini
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observed in 17th century that certain jobs carried a high risk for disease
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Edgar Sydenstricker
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provided classifications of morbidity stats to improve the value or morbidity info
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Doll and hill
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conducted first cohort study investigating the association between smoking and lung cancer
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Florence Nightingale
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used data as a tool for improving city and military hospitals
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Janet Lane-Claypon
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pioneered the use of cohort and case control studies to identify risk factors for breast cancer
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Alice hamilton
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pioneer in field of toxicology
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Olli Mietitnen
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a statistician who was a pioneer in developing the theory of epidemiological study design and causal interference
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case-control study
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A study that compares patients who have a disease or outcome of interest (cases) with patients who do not have the disease or outcome (controls), and looks back retrospectively to compare how frequently the exposure to a risk factor is present in each group to determine the relationship between the risk factor and the outcome
