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For the purpose of this class, the definition of Epidemiology is
The study of the distribution and determinants of disease in specified populations and application of this study to control health problems
The main (basic) goal of epidemiology is to..
Come up with better study designs to further our understanding of why people get sick
____________ conducted the "first ever" epidemiologic investigation
John Snow's investigation led to the discovery of....
The major course of cholera deaths in London in 1854
Who is considered to be the 21st Century epidemiologist?
According to Kuller, Epidemiology is an important part of ...
According to Kuller the primary goal of epidemiology is..
To improve the design and conduct of studies that test biologically plausible hypotheses that would further the understanding of the interactions in the epidemiologic triad in the evaluation of disease
Kuller believes that there is a decreasing amount of people entering epidemiology who are not...
Well trained in biology and pathophysiology
The epidemiologic triad consists of...
the host, the agent and the environment
In the epidemiologic triad, the agent is the...
Condition or diseases
In the epidemiologic triad, the environment is...
The factors that allow the agent and host to associate
In the epidemiologic triad, the host is the....
Population of individual
The factors that are associated with disease
The four main types of exposures are...
Behavioral, biological, socio(economical), environmental
An example of a behavioral exposure is..
An example of a biological exposure is...
An example of a socio(economic) exposure is...
An example of an environmental exposure is...
The conditions that occur following exposures
The three main types of outcomes are...
Biological, behavioral and disease
An example of a behavioral outcome is..
An example of a biological outcome is..
An example of a "disease outcome" is..
Diabetes (a disease)
Morbidity is the state of..
Having a disease
Mortality is the state of..
The five objectives of epidemiology are..
- 1)Identifying a cause of diseases and predisposing risk factors
- 2)Describing the natural history of the disease [Prognosis]
- 3)Quantify the burden of disease in the population [Subgroup]
- 4)Inform others on public health policy & services
- 5)Inform others on preventive medical guideline & Therapeutic intervention
The definition of "Science" is..
An organized body of knowledge obtained through a systematic method of problem solving & sharing information
The three rules of the epidemiologic method are...
- 1)We never know everything
- 2)We do not set forth to prove anything
- 3)We set to disprove things (Reject challenges to our hypotheses)
The nine steps to the scientific method are...
- 1) Identifying the problem
- 2) Clarifying the problem
- 3) Form the hypothesis
- 4) Devise a research plan
- 5) Sample from the targeted population
- 6) Collect data using standardized methodologies
- 7) Analyze data
- 8) Draw conclusions & generalize to target populations
- 9) Disseminate (Communicate and share) findings for peer-review
The five steps to the epidemiologic approach are..
- 1) Initial observation
- 2) Define outcome and exposure
- 3) Descriptive epidemiology
- 4) Analytic epidemiology
- 5) Experimental epidemiology
Clinical and laboratory findings and anecdotes are examples of _________ in the epidemiologic approach
Pathology, signs and symptoms, behavior and physiology are all examples of __________ in the epidemiologic approach
Defining outcome and exposure
Patterns of exposure and outcome by person, time or place is an example of __________ in the epidemiologic approach
Identifying associations and trying to find evidence of casualty is an example of ___________ in the epidemiologic approach
Clinical and community intervention trials in an example of _________ in the epidemiologic approach
Clinical intervention trials in experimental epidemiology is generally used to test..
Efficacy (To see if we get the expected/desired result)
Community intervention trials in experimental epidemiology is generally used to test..
An example of an initial observation in the epi-approach is..
Seeing that high blood pressure is higher in blacks than whites
An example of defining outcomes and exposures in the epi-approach is..
Saying that a heart attack can be identified by angina or that high blood pressure can be measured or identified with a sphygmomanometer reading
An example of descriptive epidemiology in the epi-approach is..
"The percent of the population who are black and have high blood pressure"
An example of analytic epidemiology in the epi-approach is..
"Risk of high blood pressure in blacks compared to risk of high blood pressure in whites"
An example of a clinical (efficacy) trial in the experimental epidemiology of the epi-approach is..
A trial to test if dietary reform and exercise decreases high blood pressure in black people
An example of a community (effectiveness) trial in the experimental epidemiology of the epi-approach is..
The implementation of a community outreach program that educates about high blood pressure that is offered in predominantly african-american communities
Analytic epidemiology focuses on...
Establishing cause and effect relationships between exposures and diseases
The four questions of analytic epidemiology are..
- 1) Is the exposure associated with the outcome?
- 2) Is association explained by chance, bias or confounding?
- 3) Does risk factor intervention reduce subsequent disease occurrence?
- 4) How much excess risk is associated with the exposure and might be eliminated through effective risk factor intervention?
An excess rate is a measure of...
The number of disease cases associated with exposure to an assumed cause of the disease in the population
The 3 assumptions of epidemiology are
- 1) Disease does not occur at random (in a vacuum)
- 2) There are casual agents that can be identified by studying different populations, places and points in time
- 3) Disease can be controlled and prevented through the application of the first two assumptions
The alpha level is the..
specified "cut off" point of uncertainty we will accept to consider a result statistically significant
The "epidemiological transition" is..
The phenomenon that there has been a shift in the prevalent diseases that burden the population due to agents of chronic disease caused by the industrialization of our population, leading to a transition in the population's life style and environment.
Early epidemiology studies focused on..
Infectious diseases and malnutrition
Despite the epidemiologic transition our genetics as a population has..
Stayed the same.
The four types of prevention are..
- 1) Primordial
- 2) Primary
- 3) Secondary
- 4) Tertiary
An example of primordial prevention would be..
Implementing policies to change the socio-economic status of certain populations so that they have the means to live healthier lifestyles and have access to quality preventive and routine care
Primordial prevention is..
Prevention that eliminates conditions that give rise to risk factors
An example of primary prevention is..
Primary prevention is..
Prevention that reduces disease occurrence by minimizing exposure to risk factors
An example of secondary prevention is..
Screening for cancer
Secondary prevention is..
Prevention that reduces the number of people with the disease at any point in time by shortening the duration (reducing severity and complications)
An example of tertiary prevention is..
rehabilitation after a stroke
Tertiary prevention is..
Prevention that reduces the complication of a disease that is already acquired
What is Geoffrey Rose's big idea?
"A large number of people who are at low risk [for a disease] may give rise to more cases of disease than the small number who are at a high risk"
An example of Rose's big idea is..
"Low-risk" patients, "missing the mark" for screened cholesterol levels and then later developing high cholesterol due to being "under the radar"
The two main prevention approaches are..
High-risk and population-based
The high-risk approach is based (or directed towards)..
An individual who is considered "high-risk"
The population-based approach is directed towards..
A community (population) at large
An example of the high-risk approach is..
Screening high-risk individuals for diseases
An example of the population-based approach is..
Giving medical advice to a community
The LookAhead trial is an example of testing for..
The Stanford 5-Cities trial is an example of testing for..
The traditional and natural medical approach to prevention is..
The "high-risk" strategy
According to Rose, the 5 advantages to using the high-risk strategy for prevention is..
- 1) Intervention appropriate to the individual
- 2) Subject motivation
- 3) Physician motivation
- 4) Cost-effective
- 5) Benefit:Risk ratio favorable
- According to Rose, the 4 disadvantages to using the high-risk strategy for prevention is..
- 1) Difficulties and costs of screening
- 2) Palliative and temporary (Quick fix, takes care of symptoms, but not the actual cause)
- 3) Limited for the individual and population (gives no real insight to pathology of disease)
- 4) Behaviorally inappropriate (can't tell people what to eat, do, etc. b/c of societal norms/constructs)
According to Rose, the 3 advantages to using the population-based strategy for prevention is..
- 1) Radical (Attempts to get rid of underlying cause)
- 2) Large population for population
- 3) Behaviorally appropriate (easier to change habits/social norms, because everyone has to change, not just one individual)
According to Rose, the 4 disadvantages to using the population-based strategy for prevention is..
- 1) Small benefit to individual (prevention paradox)
- 2) Poor motivation of subject
- 3) Poor motivation of physician
- 4) Benefit:Risk ratio is "worrisome"
According to Rose, the population strategy is the attempt to..
Control the determinants of incidence, to lower the mean level of risk factors, to shift the whole distribution of exposure in a favorable direction.
Rose states the big problem with using the high-risk strategy is that..
While effective on an individual level, it can not be applied equally to an entire population. In order to effectively "treat" a population, you need to get to and remove the cause of incidence, which can not be done with the high risk strategy
The main conclusion to Rose's paper is..
High-risk strategy is the best way to find individual susceptibility but fails at a population-scale because it fails to find the cause of incidence which in theory, would be the best way to treat a population, even though the population-based strategy has it's downsides too. The main point though, is that the priority of epidemiology should be to discover and control the causes of incidence
According to Savitz, epidemiology is a _________ and public health is a _________
According to Savitz's paper, the definition of public health is
A mission: The fulfillment of society's interest in assuring the conditions in which people can be healthy: (Improving the health of human populations)
According to Savitz's paper, the substance of public health consists of..
"organized community efforts aimed at the prevention of disease and promotion of health.
According to the Savitz's paper, the "common" definition of epidemiology is..
The study of the distribution and determinants of the distribution and determinants of disease frequency in human populations
Why is epidemiology not the basic science of public health?
Because epidemiology cannot absorb the broader array of scientific and societal concerns that must be considered in the development and implementation of public health policy. Epidemiology is a discipline that draws on other sciences and working research and theories
What is Savitz's main point of explaining the translation of epidemiologic evidence into public health action?
That epidemiologic information needs to be provided clearly and objectively to public health workers and in order to do that, epidemiologist needs to understand the disciplines involved in their evidence. (if topic is about heart attacks, epidemiologist should know a great deal about anatomy, CVD pathology, etc.)
What is the main conclusion from Savitz's paper?
Epidemiology is a discipline that requires team work. You need researchers and doctors to pull data, you need an epidemiologist to be able to use their educational background and knowledge to interpret that data and clearly explain it to public health officials so that the officials can make sense of the data and apply the data properly so that public health laws and policies can be implemented. Epidemiology is extremely important, but it is not the basic science of public health, rather than a multifaceted discipline that can be used to aid in the mission of public health.