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Epidemiological Applications
All items and derived items © 2014, 2010, 2006, 2002 by Mosby, an imprint of Elsevier Inc.
Objectives
Define epidemiology and describe how it has developed
over time.
Describe the essential elements of epidemiology and an
epidemiologic approach.
Discuss the steps in the epidemiologic process.
Explain the basic epidemiologic concepts of population
at risk, natural history of disease, levels of prevention,
host-agent-environment relationships, and the web of
causation model.
Differentiate between descriptive and analytic
epidemiology.
Explain how nurses use epidemiology in community
health practice.
All items and derived items © 2014, 2010, 2006, 2002 by Mosby, an imprint of Elsevier Inc. 2
Introduction
The public health science of epidemiology has
made major contributions to
Understanding the factors that contribute to health
and disease
The development of health promotion and disease-
prevention measures
The detection and characterization of emerging
infectious agents
The evaluation of health services and policies
The practice of nursing in public health
All items and derived items © 2014, 2010, 2006, 2002 by Mosby, an imprint of Elsevier Inc. 3
Definitions
Epidemiology
Descriptive Epidemiology
Determinants of health
For example: What is the disease? Who is affected?
Where are they? When do events occur?
Analytic Epidemiology
Distribution
For example: How does it occur? Why are some
people affected more than others?
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Purpose of Epidemiology
Epidemiology is the study of populations to
Determine the causes of health and disease in a
population
Monitor the health of the population
Identify the determinants of health and disease in
communities
Investigate and evaluate interventions to prevent
disease and maintain health
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History
4th Century BCE: Hippocrates
19th Century:
Louis Pasteur
Joseph Lister
Robert Koch
John Snow
Florence Nightingale
20th Century:
Shifted from looking for single agents to determining the
multifactorial etiology
Development of genetic and molecular techniques
New infectious diseases
Public health preparedness for bioterrorism
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How Nurses Use Epidemiology
Nurses look at health and at disease causation,
and how both prevent and treat illness.
Nurses are involved in the surveillance and
monitoring of disease trends, e.g., homes,
schools, work places, clinics.
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Basic Concepts in Epidemiology
Rates, Proportions, Risk, Ratio
Measures of Morbidity and Mortality
Measures of Incidence
Measures of Prevalence
Epidemic
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More Basic Concepts in
Epidemiology
Epidemiologic Triangle
Agent, host, and environment
Web of Causality
Associations are sometimes mutual, with lines of
causality going in both directions.
Ecological model
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More Basic Concepts in
Epidemiology
Levels of Preventive Interventions
Primary
• i.e., Immunizations
Secondary
• i.e., Screenings
Tertiary
• i.e., Physical and occupational therapy
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Screening
A key component of many secondary prevention
interventions
Involves the testing of groups of individuals who are
at risk for a specific condition but do not have
symptoms.
The goal is to determine the likelihood that these
individuals will develop the disease.
A screening test is not a diagnostic test.
Effective screening programs must include referrals
for diagnostic evaluation for those who screen
positive, to determine if they actually have the
disease and need treatment.
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Screening
Reliability
Precision of the measurement
Consistency or repeatability of the measurement
Validity
Is the measurement really measuring what we think it
is, and how exactly?
Measured by sensitivity and specificity
• Sensitivity
• Specificity
• Positive Predictive Value
• Negative Predictive Value
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Basic Methods in Epidemiology
Sources of Data
Routinely collected data
Data collected for other purposes
Original data
Rate Adjustment
Age-adjusted rate
Direct-adjusted rate
Indirect-adjusted rate
Comparison Groups
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Descriptive Epidemiology
Person
Race, sex, age, education, occupation, income, and
marital status
Place
Examine geographic patterns
Time
Secular trends
Point epidemic
Cyclical time patterns
Nonsimultaneous, event-related clusters
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Analytic Epidemiology
Cohort Studies
Prospective studies
Retrospective studies
Case-Control Studies
Odds ratio
Cross-Sectional Studies (prevalence studies)
Ecological Studies
bridges descriptive and analytic epidemiology
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Experimental Studies
Clinical Trials
Randomization to groups
Masking or “blinding” treatment
Community Trials
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Causality
Statistical Associations
Bias
Confounding factor
Assessing for Causality
Criteria for causality
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Applications of Epidemiology in
Community-Oriented Nursing
Examples of nursing positions that use
epidemiology:
Nurse epidemiologist
School nurses
Communicable disease nurse
Environmental risk communicators
Hospital infections control nurse
All nursing documentation on patient charts and
records is important source of data for epidemiologic
reviews.
All items and derived items © 2014, 2010, 2006, 2002 by Mosby, an imprint of Elsevier Inc. 18