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epidemic transtion***
infectious to chronic
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non commuicable diseases should be involved with 5***
- screening
- interventions
- cost effective tx
- counsel
- research
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screening for non commuicable purpose 3
- test for ppl who dont show symptoms
- early dections
- to reduce death
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screening qualifications***
- disease will cause death
- early detection will improve outcome aka LEAD TIME BIAS means early detection w/o benefits
- strategies are possible
- acceptable
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multiple risk factor***
look at lots of risk facts to reduce outcome. DUH
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cost/net effective
benefits must be greater than harms
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counsel 5 types
- like tay sachs-jews
- sickle cell-blacks
- down synd
- pku
- cystic fibrosis-whites
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outbreaks are recognized by....
clinicians, patients, data, media
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why to recognize outbreaks
- prevent more cases
- prevent more outbreaks
- describe/learn/teach the new disease
- evaluate prevention
- talk to the public
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to investigate
- epidemiological
- environmental
- media and legal side
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was grilled above hurricane Isabel, West Nile, and measles
Dr. Gerberding
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note when investigating outbreak
- find source
- quickly tell public
- limit case
- the well publicized outbreaks can be bias
- pressure to investigate > errors
- delays > no samples
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5.A goals of outbreak investigations***
- define
- are they real
- whats the background rate
- case finding
- examine descriptive epi features of cases
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5. B goals of outbreak investigations***
- make hypo
- test hypo
- test samples
- implement control measures
- tell public
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case definitions
- lab confirmed
- clinical
- definitive vs probable
- outbreak associated vs. nonoutbreak
- primary vs. secondary
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case def drives>>>
analysis
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lab confirmed case
gastroenteritis
note: did he even go to the restaurant?
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definitive vs. probable
probable: once confirmed, not needed both
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outbreak associated vs nonoutbreak
outside of school vs. school
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primary vs. secondary
1st wave children vs. teacher
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case confirmation
- some asymptomatic ones have positive tests b/c of lab errors
- deals with emerging disease like legionnaires, aids, SARS
- ex.) vault blood
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case confirmation are based upon
- direct observation
- med records
- provides
- lab results
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background disease rate
- scope of outbreak geographically and temporally
- compare current outbreak vs. current backdrop
- see for additional cases
note: important when Hep C shows in one hospital!!!!
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affect rates
- under/over sampling
- un/over reported
- financial
- media
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endemic***
background/expected cases like mosquito in tx
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epidemic***
EXCEEDS expect disease in defined area like anthrax
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describe outbreak
person, place, time
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epi curve***
- graph shows the number of cases by illness by the date
- data>>>hypo>>>statistics
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cardio disease affects
heart, brain, kidney, extremities>ulcers, eyes
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where of us
more in SE states
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race is most affected
blacks
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health systems level factors***
- financing
- structure of care
- culture barriers
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patient level factors***
- patient preferences
- refusal of tx
- poor adherence
- bio diff
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non modifiable risk
age, gender, heredity
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modifiable risk
smoke, chol, BP, inactivity, obesity, diabetes, stress, alcohol
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there is a relationship with cvd
Blood pressure
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cvd prevention
- cut down salt in communities
- manage hypertension
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challenges
obesity, lazy, stress, diet, genes
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overcome challenges
improve access to care, healthy foods, healthy environments, note disparities, focus preventing
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resources
- centers for disease control and prevention
- american heart association
- american diabetes association
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passive immunity
injections of antibodies>>>short term
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blood samples example
is NOT date on site
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PICU example
there are breaks; no pattern
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epidemic curve can help
pattern, magnitude, outliers, time, exposure
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outliers
where was patient
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epi curve (intermittent)***
foodborn
contamination of ground water
- once we eat it, it's all gone
- we can turn it off/on
therefore, it breaks the epi curve apart
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epi curve (continuous)***
continuous exposure will cause cases to
rise gradually/plateau NOT PEAK
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epi curve (point) 3***
- sharp up and then gradual down
- brief and one period
- blip and lands, then surges
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epi curve (propagated) 4***
ex.
- spread from person to person
- lasts longer
- multiple waves
- taller peaks***
measles in elementary school/doesn't realize
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outbreak time trend considers (3)
- date of illness of first case
- date when peaked
- date of illness of last case
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outbreak outliers (to reduce) 5
- baseline level
- source
- case expose earlier/later
- unrelated
- long incubation
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period of exposure/outbreak
timing of exposure>>>time of incubation
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median incubation period
time btw exposure and the peak of epi curve
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making hypo
- descriptive like ecological, correlation, cross sectional
- see existing data
- open ended interviews
- outliers
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testing hypo 4
- case control
- cohorts
- clinical trials
- natural
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environ investigation
like soil samples, time sensitive, expense
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control measures
to prevent further and protecting the rep is hard
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sequential testing/2 stage***
most cost effective form b/c if one negative test can rule out the disease (takes out the false neg though)
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multiple interaction***
risk of two or more exposures/dependent
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5risk factors of heart disease***
- family hx
- smoking
- diet
- BP
- weight
- waist circumference
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