community health lecture notes | Lecture notes Community Health

■Chapter 9 Epidemiological Applications

■Do you think Community health nursing is more challenging than nursing in an acute care setting?

■Yes: No

■Information for evidence based practice?? CDC, WHO, Human Genome Project,

■Paperwork = Paperwork

■LOTS of paperwork in community health

■Specialization =

■There is so much information available to the nurse giving care in the community, paperwork is paperwork, specialization is very possible.

■Objectives

1. Define epidemiology and describe how it has developed over time.

■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

■Define epidemiology and describe how it has developed over time.

■Obj 1

-Epidemiology

-The study of the distribution and factors that determine health-related states or events in a population, and the use of this information

to control health problems

-TB spreads rapidy in prisons, HIV-positive populations, homeless. Share drinks=TB spread

-Descriptive Epidemiology: a form of epidemiology that describes a disease according to its person, place, or time.

-Determinants of health events, are those factors, exposures, characteristics, and behaviors, and contexts that determine (or influence) the

patterns

-For example: What is the disease? Who is affected? Where are they? When do events occur?

-Analytic Epidemiology: looks at the etiology (origins or causes) of the disease and deals with determinants of health and disease.

-For example: How does it occur? Why are some people affected more than others?

■Purpose of Epidemiology

–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

■History

■4th Century BCE, Hippocrates was the 1st person to use the ideas that are now part of epidemiology.

■19th Century:

■Louis Pasteur developed both the germ theory and pasteurization

■Joseph Lister developed antiseptic surgery, Listerine

■Robert Koch developed pure culture and identified the organisms that cause TB, anthrax, and cholera disease.

■John Snow “father of epidemiology” water pump cholera outbreak map

■Florence Nightingale – environmental conditions during Crimean War

■20th Century:

■Shifted from looking for single agents (i.e., causes of cholera) to determining the multifactorial etiology (i.e.,

contributing factors of cardiovascular disease)

■Didn’t just look for one thing. Looked at multiple causes. There are multiple determinants of health.

■Development of genetic and molecular techniques

■New infectious diseases (i.e., HIV/AIDS, SARS)

■Public health preparedness for bioterrorism

2. Describe the essential elements of epidemiology and an epidemiologic approach.

–Elements of epidemiology

■Basic Concepts in Epidemiology

-Measures of Morbidity and Mortality

–Rates, Proportions, Risk, Ratio

–Measures of Incidence

–Incidence proportion (or attack rate or risk)

–Number of new cases of disease during specified time interval (numerator)

–Population at start of time interval (denominator)

–Incidence Rate (or person-time rate)

–Number of new cases of disease during specified time interval (numerator)

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■ Chapter 9 Epidemiological Applications ■ Do you think Community health nursing is more challenging than nursing in an acute care setting? ■ Yes: No ■ Information for evidence based practice?? CDC, WHO, Human Genome Project, ■ Paperwork = Paperwork ■ LOTS of paperwork in community health ■ Specialization = ■ There is so much information available to the nurse giving care in the community, paperwork is paperwork, specialization is very possible. ■ Objectives

1. Define epidemiology and describe how it has developed over time. ■ 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 ■ Define epidemiology and describe how it has developed over time. ■ Obj 1 -Epidemiology -The study of the distribution and factors that determine health-related states or events in a population, and the use of this information to control health problems -TB spreads rapidy in prisons, HIV-positive populations, homeless. Share drinks=TB spread -Descriptive Epidemiology: a form of epidemiology that describes a disease according to its person, place, or time. - Determinants of health events , are those factors, exposures, characteristics, and behaviors, and contexts that determine (or influence) the patterns -For example: What is the disease? Who is affected? Where are they? When do events occur? -Analytic Epidemiology: looks at the etiology (origins or causes) of the disease and deals with determinants of health and disease. -For example: How does it occur? Why are some people affected more than others? ■ Purpose of Epidemiology - 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 ■ History ■ 4 th^ Century BCE, Hippocrates was the 1st^ person to use the ideas that are now part of epidemiology. ■ 19 th^ Century: ■ Louis Pasteur developed both the germ theory and pasteurization ■ Joseph Lister developed antiseptic surgery, Listerine ■ Robert Koch developed pure culture and identified the organisms that cause TB, anthrax, and cholera disease. ■ John Snow “father of epidemiology” water pump cholera outbreak map ■ Florence Nightingale – environmental conditions during Crimean War ■ 20 th^ Century: ■ Shifted from looking for single agents (i.e., causes of cholera) to determining the multifactorial etiology (i.e., contributing factors of cardiovascular disease) ■ Didn’t just look for one thing. Looked at multiple causes. There are multiple determinants of health. ■ Development of genetic and molecular techniques ■ New infectious diseases (i.e., HIV/AIDS, SARS) ■ Public health preparedness for bioterrorism 2. Describe the essential elements of epidemiology and an epidemiologic approach. - Elements of epidemiology ■ Basic Concepts in Epidemiology -Measures of Morbidity and Mortality - Rates, Proportions, Risk, Ratio - Measures of Incidence - Incidence proportion (or attack rate or risk) - Number of new cases of disease during specified time interval (numerator) - Population at start of time interval (denominator) - Incidence Rate (or person-time rate) - Number of new cases of disease during specified time interval (numerator)

- Summed person-years of observation or average population during time interval (denominator)

Measures of Prevalence
Prevalence Proportion
Attack Rates
Mortality Rates **- Point prevalence: how many people have TB that one day
Number of current cases (new & preexisting) at a specified point in time (numerator)
Population at the same specified point in time (denominator)**
Period prevalence
Number of current cases (new & preexisting) over a specified period of time (numerator)
Average or mid-interval population (denominator)
Examples
In the study of diabetics, 100 of the 189 diabetic men died during the 13-year follow-up period. Calculate the risk of death for these men.
Incidence proportion (or attack rate or risk)
Number of new cases of disease during specified time interval/Population at start of time interval
Numerator=100 deaths among the diabetic men
Denominator=189 diabetic men
10 10 =
Risk=(100/189) x 100=52.9%
Outbreak of gastroenteritis among attendees of corporate picnic, 99 persons ate potato salad, 30 of whom developed gastroenteritis. Calculate risk of illness among persons who ate potato salad
Numerator=30 persons who ate potato salad and developed gastroenteritis
Denominator=99 persons who at potato salad
10 10 =
Risk=”Food-specific attack rate” =(30/99) x 100=0.303 x 100=30.3%
Notify MD, ER, corporation, picnic caterer, CDC
In 2003, 44,232 new cases of AIDS were reported in U.S. The estimated mid-year population of the U.S. in 2003 was approx.. 290,809,777.. Calculate incidence rate of AIDS in 2003.
Numerator=44,232 new cases of AIDS
Denominator=290,809,777 estimated mid-year population
10n=100,
Incidence rate (or person-time rate)=Number of new cases of disease during specified time interval/Average population during time interval
44.232/290,809,777)x100,
15.21 new cases of AIDS per 100,000 population
Find who started it and trace partners
Frequently Used Measures of Mortality Measure **- Crude death rate ■ Total number of deaths during a given time interval (NUM) ■ Mid-interval population (DENOM) ■ 1,000 or 100,
Infant mortality rate ■ Number of deaths among children < 1 year of age during a given time interval (NUM) ■ Number of live births during the same time interval (DENOM) ■ 1, ■ The most commonly used measure for comparing health status among nations. :** ■ (Number of deaths among children < 1 year of age reported during a given time period/Number of live births reported during the same time period) X 1, ■ Calculated Annually ■ Reflects the health of the mother and infant during pregnancy and the year thereafter. ■ Which reflects a wide variety of factors, including access to prenatal care, prevalence of prenatal maternal health behaviors (such as alcohol or tobacco use and proper nutrition during pregnancy, etc.), postnatal care and behaviors (including childhood immunizations and proper nutrition), sanitation, and infection control ■ The infant mortality rate is generally calculated on an annual basis. It is a widely used measure of health status because it reflects the health of the mother and infant during pregnancy and the year thereafter. The health of the mother and infant, in turn, reflects a wide variety of factors, including access to prenatal care, prevalence of prenatal maternal health behaviors (such as alcohol or tobacco use and proper nutrition during pregnancy, etc.), postnatal care and behaviors (including childhood immunizations and proper nutrition), sanitation, and infection control 3. Discuss the steps in the epidemiologic process.

-Changes in one of the elements of the triangle can influence the occurrence of disease by increasing or decreasing a person’s risk for disease -Web of Causality -Recognizes the complex interrelationships of many factors interacting, sometimes in subtle ways, to increase (or decrease) the risk of disease. -Associations are sometimes mutual, with lines of causality going in both directions. Ecological model ■ 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. ■ 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 ■ Measured by sensitivity and specificity ■ Sensitivity: quantifies how accurately the test identifies those with the condition or trait; true positives ■ Specificity: indicates how accurately the test identifies those without the condition or trait; true negatives ■ Positive Predictive Value: the proportion of persons with a positive test who actually have the disease ■ Negative Predictive Value: the proportion of persons with a negative test who are actually **disease-free

Differentiate between descriptive and analytic epidemiology.
OBJ 5** Differentiate between Descriptive and analytic Epidemiology
Descriptive Epidemiology
Determinants of health
factors, exposures, characteristics, and behaviors, and contexts that determine (or influence) the patterns
For example: What is the disease? Who is affected? Where are they? When do events occur?
Analytic Epidemiology
Distribution
looks at the etiology (origins or causes) of the disease and deals with determinants of health and disease
For example: How does it occur? Why are some people affected more than others?
Descriptive Epidemiology The What, Where, When, and Who of Diseases
Person
Race, sex, age, education, occupation, income, and marital status
Place
Examine geographic patterns
Time
Secular trends
Point epidemic
Cyclical time patterns (seasonal fluctuation; calendar events)
Nonsimultaneous, event-related clusters
Provides a picture of how things are or have been
Person
Race, sex, age, education, occupation, income, and marital status
Place
Examine geographical patterns
Time
Secular trends
Point epidemic
Cyclical time patterns (seasonal fluctuation; calendar events)
Nonsimultaneous, event-related clusters
Analytic Epidemiology Examines the how and why of observed patterns of health and disease

Types of research studies used in Analytic Epidemiology
1. Cohort Studies
2. Prospective studies
3. Retrospective studies
4. Case-Control Studies
  1. Odds ratio
5. Cross-Sectional Studies (prevalence studies)
6. Ecological Studies
  1. bridges descriptive and analytic epidemiology
7. Clinical Trials
  1. Randomization to groups
  2. Masking or “blinding” treatment
8. Community Trials
Causality
1. Statistical Associations-Chi square, logistical regression
2. Bias
  1. Confounding factor
    1. Something that slips into your study that causes the results to come out in an unexpected manner
    2. Ex: Studying stress in a population then Katrina happens in NOLA. Affects results.
3. Assessing for Causality
  1. Criteria for causality
    1. Statistical Associations
    2. Bias
      1. Selection or the way subjects enter a study
      2. Misclassification of subjects once they are in the study
      3. Confounding factor
    3. Assessing for Causality
      1. Criteria for causality **How Nurses Use Epidemiology
Explain how nurses use epidemiology in community health practice. ■ OBJ 6** ■ 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.
- 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. Summary ■ Define Epidemiology. ■ The study of the distribution and factors that determine health-related states or events in a population, and the use of this information to control health problems ■ Who is the father of epidemiology? ■ John Snow “father of epidemiology” water pump cholera outbreak map ■ Descriptive Epidemiology: a form of epidemiology that describes a disease according to its person, place, or time. ■ Determinants of health events, are those factors, exposures, characteristics, and behaviors, and contexts that determine (or influence) the patterns ■ For example: What is the disease? Who is affected? Where are they? When do events occur? ■ Analytic Epidemiology: looks at the etiology (origins or causes) of the disease and deals with determinants of health and disease. ■ Analytic Epidemiology: looks at the etiology (origins or causes) of the disease and deals with determinants of health and disease. ■ For example: How does it occur? Why are some people affected more than others? ■ List the 5 most commonly used formulas… ■ Infant Mortality Rate ■ Crude Death Rate (these are the two for mortality) ■ Incidence rate ■ Incidence proportion ■ Point Prevalence (morbidity) ■ What is the Web of Causation and why is it important? ■ It’s never just one thing. HP 2020. Multiple determinants of health. ■ What are the steps in the epidemiological process? ■ Determine the nature, extent and possible significance of the problem ■ Using the gathered data, formulate a possible theory ■ Gather information from a variety of sources in order to narrow down the possibilities ■ Make a plan ■ Put the plan into action ■ Evaluate the plan ■ Report and follow up

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