Fluent Essays

4 assignments one is a PowerPoint, the others are papers that need to be written. The subject matter is epidemiology. I have attached a breakdown of the chapters that it goes over in PowerPoints.HSA-6520 Managerial Epidemiology: Week 1 Critical Reflection Paper: Chapters 1 to 3 Objective: To critically reflect your understanding of the readings and your ability to apply them to your Health care Setting. ASSIGNMENT GUIDELINES (10\%): Students will disapprovingly evaluate the readings from Chapter 1 to 3 in your textbook. This assignment is designed to help you assessment, inquiry, and apply the readings to your Health Care setting as well as become the foundation for all of your remaining assignments. You need to read the chapter assigned for week 1 and develop a 2-3-page paper reflecting your understanding and ability to apply the readings to your Health Care Setting. Each paper must be typewritten with 12-point font and double-spaced with standard margins. Follow APA style 7th edition format when referring to the selected articles and include a reference page. EACH PAPER SHOULD INCLUDE THE FOLLOWING: 1. Introduction (25\%) Provide a short-lived outline of the denotation (not a description) of each Chapter and articles you read, in your own words. 2. Your Critique (50\%) What is your reaction to the content of the Chapters? What did you absorb about the History and Scope of Epidemiology? What did you acquire about the Practical applications of Epidemiology? Did these Chapters change your thoughts about the Measurement of mortality and Morbidity? If so, how? If not, what remained the same? 3. Conclusion (15\%) Fleetingly summarize your thoughts & deduction to your critique of the Chapters you read. How did these articles and Chapters impact your thoughts on Patient Protection and Affordable Care Act? Evaluation will be based on how clearly you respond to the above, in particular: a) The clarity with which you critique the Chapters. b) The depth, scope, and organization of your paper; and, c) Your conclusions, including a description of the impact of these Chapters on any Health Care Setting.HSA-6520 Managerial Epidemiology: Week 2 Critical Reflection Paper: Chapters 4 &5 Objective: To censoriously reveal your understanding of the readings and your ability to apply them to your Health care Setting. ASSIGNMENT GUIDELINES (10\%): Students will frowningly analyze the readings from Chapter 4 and 5 in your textbook. This assignment is premeditated to help you valuation, analysis, and apply the readings to your Health Care setting as well as become the groundwork for all of your outstanding assignments. You need to read the chapters assigned for week 1 and develop a 2-3-page paper reflecting your understanding and ability to apply the readings to your Health Care Setting. Each paper must be typewritten with 12-point font and double-spaced with standard margins. Follow APA style 7th edition format when referring to the selected articles and include a reference page. EACH PAPER SHOULD INCLUDE THE FOLLOWING: 1. Introduction (25\%) Provide an ephemeral summary of the denotation (not a description) of each Chapters you read, in your own words. 2. Your Critique (50\%) What is your reaction to the content of the Chapters? What did you absorb about Descriptive and analytic epidemiology? What did you acquire about the quality and utility of epidemiologic data? Did these Chapter change your thoughts epidemiologic data sources and its weaknesses? If so, how? If not, what remained the same? 3. Conclusion (15\%) Transiently recapitulate your thoughts & assumption to your critique of the Chapters you read. How did these Chapters impact your thoughts on the difference between secular trends and cohort effects? Evaluation will be based on how clearly you respond to the above, in particular: a) The clarity with which you critique the chapters. b) The depth, scope, and organization of your paper; and, c) Your conclusions, including a description of the impact of these Chapters on any Health Care Setting.HSA-6520 Managerial Epidemiology: Assignment Week 3 Student PowerPoint Presentation: Chapter 6 and 7 Objectives: The presentation assignment has several goals. It requires students to apply concepts of study designs, ecology, cross-sectional and case control. Apply and differentiate cohort studies from other epidemiologic study designs able to be used in any Health Care Facility. Format and Guidelines: The student will create a Power Point Presentation from Chapter 6 and 7 of the Textbook. The Presentation should have a minimum of 12 slides, including Title Page, Introduction, Conclusion, and References. The student must use other textbooks, research papers, and articles as references (minimum 3). Due date: Sunday, March 21, 2021 at 11:30PM. EACH PAPER SHOULD INCLUDE THE FOLLOWING: 1. Title Page: Topic Name, Student Name 2. Introduction: Provide a brief synopsis of the meaning (not a description) of the topic you choose, in your own words 3. Content Body: Progress your theme, provide Material, illustrations and Diagram to explain, describe and clarify the Topic you choose. 4. Conclusion: Briefly summarize your thoughts & conclusion to your critique of the Chapters you read. 5. References: The student must use other textbooks, research papers, and articles as references (minimum 3). HSA-6520 Managerial Epidemiology: Assignment Week 3 Grading Sheet Student Name __________________________________ Date_____________________ Category Possible Points Actual Points Presentation style and content. 3 Distributed bibliography w/ 3 additional readings 2 Inclusion of diversity content Pictures, Graphic, etc. 2 Length: Minimum 12 slides 1 Required Format 2 TOTAL 10HSA-6520 Managerial Epidemiology: Assignment Week 4 Case Study: Chapters 8, 9 and 10 Objective: The students will complete a Case study assignments that give the opportunity to synthesize and apply the thoughts learned in this and previous coursework to examine a real-world scenario. This scenario will illustrate through example the practical importance and implications of various roles and functions of a Health Care Administrator. The investigative trainings will advance students’ understanding and ability to contemplate critically about Experimental Study Designs, Measures of Effect, Data interpretation issues, and their problem-solving skills. As a result of this assignment, students will be better able to comprehend, scrutinize and assess respectable superiority and performance by all institutional employees. ASSIGNMENT GUIDELINES (10\%): Students will critically measure the readings from Chapters 8 to 10 in your textbook. This assignment is planned to help your examination, evaluation, and apply the readings and strategies to your Health Care organization and Managerial Epidemiology. You need to read the Chapters assigned for week 4 and develop a 3–4-page paper reproducing your understanding and capability to apply the readings to your Health Care organization and Epidemiology. Each paper must be typewritten with 12-point font and double-spaced with standard margins. Follow APA style 7th edition format when referring to the selected articles and include a reference page. EACH PAPER SHOULD INCLUDE THE FOLLOWING: 1. Introduction (25\%) Provide a short-lived outline of the significance (not a description) of each Chapter you read, in your own words that will apply to the case study presented. 2. Your Critique (50\%): Case Study  “Gastroenteritis following a retirement party at the State Capitol” 1 Outbreak Summary Approximately 300 persons attended a retirement party at the Nebraska State Capitol held on May 27, 2018. Most of the attendees worked in the Capitol. A private caterer (Caterer A) prepared and served food for the reception. Based on initial telephone interviews of persons reporting illness, the predominant symptoms were nausea and diarrhea, and the incubation period was approximately 24-30 hours. The following foods were served at the retirement reception: Swedish meatballs, taco dip, crab dip, a vegetable tray and herbed ranch dip, cake, nuts and mints. The vegetable tray consisted of cucumbers, broccoli, cauliflower, carrots, celery, green peppers, and radishes. All foods were prepared onsite on the day of the reception with the exception of the nuts, which were purchased by a coworker, and the mints, which were made by a coworker. The Swedish meatballs consisted of ground beef, ground pork, sour cream and flour. The meatballs were cooked twice. The taco dip contained layers of cream cheese mixed with salsa, ground beef, tomatoes, lettuce, onion, cheese and salsa. The taco dip was prepared manually by CatChapter 9 Measures of Effect Learning Objectives Explain the meeting of absolute and relative effects Calculate and interpret the following measures: risk difference, population risk difference, etiologic fraction, and population etiologic fraction Discuss the role of statistical tests in epidemiologic research Apply Hill’s criteria for evaluation of epidemiologic associations Effect Measure A quantity that measures the effect of a factor on the frequency or risk of a health outcome Three Effect Measures Attributable Fractions Measure the fraction of cases due to a factor. Risk and Rate Differences Measure the amount a factor adds to the risk or rate of a disease. Risk and Rate Ratio Measure the amount by which a factor multiplies the risk or rate of disease. Absolute vs. Relative Effects Absolute Attributable risk is also known as a rate difference or risk difference. Population risk difference Relative Relative risk Etiologic fraction Population etiologic fraction Risk Difference (Attributable Risk) Risk difference--the difference between the incidence rate of disease in the exposed group (Ie) and the incidence rate of disease in the nonexposed group (Ine). Risk difference = Ie - Ine 2 Calculation of Risk Difference For women younger than age 75, the incidence (Ie) of hip fractures per 100,000 person-days was highest in the winter (0.41), and the incidence (Ine) was lowest in the summer (0.29). The risk difference between the two seasons (Ie - Ine) was 0.41 - 0.29, or 0.12 per 100,000 person-days. 3 Population Risk Difference Measures the benefit to the population derived by modifying a risk factor. Etiologic Fraction Defined as the proportion of the rate in the exposed group that is due to the exposure. Also termed attributable proportion or attributable fraction. Population Etiologic Fraction Provides an indication of the effect of removing a particular exposure on the burden of disease in the population. Also termed attributable fraction in the population. Statistical Measures of Effect Significance tests The P value Confidence interval 4 Null Hypothesis Underlying all statistical tests is a null hypothesis, which states that there is no difference among the groups being compared. The parameters may consist of the prevalence or incidence of disease in the population. 5 Significance Tests Used to decide whether to reject or fail to reject a null hypothesis. Involves computation of a test statistic, which is compared with a critical value obtained from statistical tables. The critical value is set by the significance level of the test. The significance level is the chance of rejecting the null hypothesis when, in fact, it is true. 6 The P Value Indicates the probability that the findings observed could have occurred by chance alone. However, a nonsignificant difChapter 5 Sources of Data for Use in Epidemiology Learning Objectives Discuss criteria for assessing the quality and utility of epidemiologic data Indicate privacy and confidentiality issues that pertain to epidemiologic data Discuss the uses, strengths, and weaknesses of various epidemiologic data sources Criteria for the Quality and Utility of Epidemiologic Data Nature of the data Availability of the data Completeness of population coverage Representativeness Generalizability (external validity) Thoroughness Strengths versus limitations 2 Nature of the Data Refers to the source of data, e.g., vital statistics, case registries, physicians’ records, surveys of the general population, or hospital and clinic cases. Will affect the types of statistical analyses and inferences that are possible. 3 Availability of the Data Refers to investigator’s access to data. For example, medical records and other data with personal identifiers may not be used without patients’ consent. 4 Completeness of Population Coverage Representativeness—the degree to which a sample resembles a parent population. Generalizability (external validity)— ability to apply findings to a population that did not participate in the study. Thoroughness—the care taken to identify all cases of a given disease. 5 Strengths versus Limitations The utility of the data for various types of epidemiologic research. Factors inherent in the data may limit their usefulness. Incomplete diagnostic information. Case duplication. 6 Online Sources of Epidemiologic Data Online bibliographic databases include MEDLINE, TOXLINE, and commercial databases. National Library of Medicine’s PubMed® MEDLINE is the main part of PubMed® Premier source of health-related literature TOXLINE—keyed to toxicology and includes information on drugs and chemicals 7 Selected Internet Addresses American Public Health Association—http://www.apha.org Centers for Disease Control and Prevention—http://www.cdc.gov PubMed®—http://www.ncbi.nlm.nih.gov/sites/entrez Confidentiality Privacy Act of 1974 Prohibits the release of confidential data without the consent of the individual Freedom of Information Act Mandates the release of government information to the public, except for personal and medical files The Public Health Service Act Protects confidentiality of information collected by some federal agencies, e.g., NCHS 8 The HIPAA Privacy Rule Refers to the Health Insurance Portability and Accountability Act of 1996 Sections of HIPAA “…require the Secretary of HHS to publicize standards for the electronic exchange, privacy and security of health information…” Categories of protected health information pertain to individually identifiable data re: The individual’s physical and mental health Provision of health care to the individual Payment for provision of health care Data Sharing Refers to the voluntary release of information by one investChapter 8 Experimental Study Designs Learning Objectives (abridged) State how study designs compare with respect to validity of causal inference Distinguish between a controlled experiment and a quasi-experiment Describe the scope of intervention studies Define the term controlled clinical trials and give examples Explain the phases in testing a new drug or vaccine Learning Objectives (abridged) Discuss blinding and crossover in clinical trials. Define what is meant by community trials. Discuss ethical aspects of experimentation with human subjects. True Experimental Studies Most convincing for conferring evidence of associations between risk factors and outcomes Manipulation of study factor and randomization of subjects An example is a randomized clinical trial. Women’s Health Initiative Hormone Replacement Therapy (HRT) Epidemiologic studies had shown that HRT use had significant benefits against coronary heart disease. Clinical trials had failed to demonstrate any benefit. Large body of epidemiologic research had observed that women who took HRT had elevated risks of breast cancer. Women’s Health Initiative Hormone Replacement Therapy (HRT) To resolve the question of risks versus benefits of HRT, a clinical trial was conducted. Demonstrated that: the epidemiologic findings on cancer were generally accurate the benefits on cardiovascular disease had been overestimated Results Use of HRT decreased 40\%-80\% after the trial was stopped Quasi-Experiment/Community Trial Ranked immediately below controlled experiments in rigor Investigator is unable to randomly allocate subjects to the conditions. There may be contamination across the conditions of the study. Intervention Studies An investigation involving intentional change in some aspect of the status of subjects Used to test efficacy of preventive or therapeutic measures Manipulation of the study factor and randomization of study subjects Intervention Studies Two categories: Clinical trials (focus on the individual) Community trial or community intervention (focus on the group or community. NOTE: Controlled clinical trials may be conducted both at the individual and community levels. Clinical Trials: Definition A research activity that involves the administration of a test regimen to humans to evaluate its efficacy and safety Wide variation in usage: The first use of the term was for studies in humans without any control treatment Now denotes a rigorously designed and executed experiment involving RANDOM ALLOCATION of test and control treatments Characteristics of Clinical Trials Carefully designed and rigidly enforced protocol Tightly controlled in terms of eligibility, delivery of the intervention, and monitoring out outcomes Duration ranges from days to years Participation is generally restricted to a highly selected group of individuals. Characteristics of Clinical Trials Once subjects agree to participate, they are randomly assigned to one of the studyChapter 2 Practical Applications of Epidemiology 1 Learning Objectives Discuss uses and applications of epidemiology Define the influence of population dynamics on community health State how epidemiology may be used for operations research Discuss the clinical applications of epidemiology Cite causal mechanisms from the epidemiologic perspective 2 Seven Uses for Epidemiology Health Status and Health Services Study history of the health of populations Diagnose the health of the community Examine the working of health services Disease Etiology Estimate the individual risks and chances Identify syndromes Complete the clinical picture Search for causes Health Status and Health Services Describing the occurrence of disease in the community Planning for allocation of resources Public health practitioners Administrators Evaluating programs, e.g., public health service programs 4 Disease Etiology Epidemiologists continue to search for clues as to the nature of disease. Knowledge that is acquired may be helpful in efforts to prevent the occurrence. 5 Historical Use of Epidemiology Refers to the study of past and future trends in health and illness For example: Secular trends--changes in disease frequency over time 6 Examples of Trends Chronic diseases have replaced acute infectious diseases as the major causes of morbidity and mortality. In 2009, the leading causes of U.S. deaths were heart disease, cancer, and chronic lower respiratory disease. Increases were reported for Alzheimer’s disease, kidney disease, and hypertension. 7 Factors Affecting Reliability of Observed Changes Lack of comparability over time due to altered diagnostic criteria Aging of the general population Changes in the fatal course of the condition 9 Four Trends in Disorders Disappearing Residual Persisting New epidemic 10 Disappearing Disorders This category refers to conditions that were once common but are no longer present in epidemic form. Examples include smallpox, poliomyelitis, and measles. Brought under control by immunizations, improvement in sanitary conditions, and the use of antibiotics and other medications led to eradication of these diseases 11 Residual Disorders Conditions for which the key contributing factors are largely known Methods of control not implemented effectively Examples: STDs Perinatal and infant mortality among low SES persons Problems associated with alcohol and tobacco use 12 Persisting Disorders Diseases for which there is no effective method of prevention or no known cure Examples: certain types of cancer and mental disorders 13 New Epidemic Disorders Diseases that are increasing in frequency Examples: Lung cancer, AIDS, Obesity, Type 2 diabetes The emergence of new epidemics of diseases may be a result of increased life expectancy of the population, new environmental exposures, or changes in lifestyle, diet, and other practices. 14 Predictions About the Future A popuChapter 6 Study Designs: Ecologic, Cross-Sectional, Case-Control Learning Objectives Define the basic differences between observational and experimental epidemiology Identify an epidemiologic study design by its description List the main characteristics, advantages, and disadvantages of ecologic, cross-sectional, and case-control studies Describe sample designs used in epidemiologic research Calculate and interpret an odds ratio How Study Designs Differ Number of observations made Directionality of exposure Data collection methods Timing of data collection Unit of observation Availability of subjects Observational vs. Experimental Approaches Manipulation of study factor Was exposure of interest controlled by investigator? Randomization of study subjects Was there use of a random process to determine exposure of study subjects? Typology of Epidemiologic Research Overview of Study Designs Experimental studies Quasi-experimental studies Observational studies Descriptive studies: cross-sectional surveys Analytic studies: many ecologic studies, case-control studies, cohort studies The 2 by 2 Table Represents the Association Between Exposure and Disease Status Ecologic Studies The unit of analysis is the group, not the individual. They can be used for generating hypotheses. The level of exposure for each individual in the unit being studied is unknown. Generally makes use of secondary data. Advantageous with cost and duration. Types of Ecologic Studies Ecologic comparison study—involves an assessment of the correlation between exposure rates and disease rates among different groups over the same time period. Ecologic trend study—involves correlation of changes in exposure with changes in disease within the same community, country, or other aggregate unit. Example of an Ecologic Correlation The association between breast cancer and dietary fat for 39 countries. High intakes of dietary fats associated with high rates of breast cancer mortality. Examples of Questions Investigated by Ecologic Studies Is the ranking of cities by air pollution levels associated with the ranking of cities by mortality from cardiovascular disease, adjusting for differences in average age, percent of the population below poverty level, and occupational structure? What are long-term trends (1950-1995) for mortality from the major cancers in the US, Canada, and Mexico? Applications of Ecologic Approach The effect of fluoridation of the water supply on hip fractures The association of naturally occurring fluoride levels and cancer incidence rates The relationship between neighborhood or local area social characteristics and health outcomes The Ecologic Fallacy: Definition Observations made at the group level may not represent the exposure-disease relationship at the individual level. The ecologic fallacy occurs when incorrect inferences about the individual are made from group level data. Implications of the Ecologic FallacyChapter 10 Data Interpretation Issues Learning Objectives Distinguish between random and systematic errors State and describe sources of bias Identify techniques to reduce bias at the design and analysis phases of a study Define what is meant by the term confounding and provide three examples Describe methods to control confounding Validity of Study Designs The degree to which the inference drawn from a study, is warranted when account it taken of the study, methods, the representativeness of the study sample, and the nature of the population from which it is drawn. 2 Validity of Study Designs Two components of validity: Internal validity External validity 2 Internal Validity A study is said to have internal validity when there have been proper selection of study groups and a lack of error in measurement. Concerned with the appropriate measurement of exposure, outcome, and association between exposure and disease. 3 External Validity External validity implies the ability to generalize beyond a set of observations to some universal statement. A study is externally valid, or generalizable, if it allows unbiased inferences regarding some other target population beyond the subjects in the study. 4 Sources of Error in Epidemiologic Research Random errors Systematic errors (bias) 5 Random Errors Reflect fluctuations around a true value of a parameter because of sampling variability. 6 Factors That Contribute to Random Error Poor precision Sampling error Variability in measurement 7 Poor Precision Occurs when the factor being measured is not measured sharply. Analogous to aiming a rifle at a target that is not in focus. Precision can be increased by increasing sample size or the number of measurements. Example: Bogalusa Heart Study 8 Sampling Error Arises when obtained sample values (statistics) differ from the values (parameters) of the parent population. Although there is no way to prevent a non-representative sample from occurring, increasing the sample size can reduce the likelihood of its happening. 9 Variability in Measurement The lack of agreement in results from time to time reflects random error inherent in the type of measurement procedure employed. 10 Bias (Systematic Errors) “Deviation of results or inferences from the truth, or processes leading to such deviation. Any trend in the collection, analysis, interpretation, publication, or review of data that can lead to conclusions that are systematically different from the truth.” 11 Factors That Contribute to Systematic Errors Selection bias Information bias Confounding 12 Selection Bias Refers to distortions that result from procedures used to select subjects and from factors that influence participation in the study. Arises when the relation between exposure and disease is different for those who participate and those who theoretically would be eligiStudy Designs: Cohort Studies Chapter 7 Learning Objectives Differentiate cohort studies from other study designs List main characteristics, advantages, and disadvantages of cohort studies Describe three research questions that lend themselves to cohort studies Calculate and interpret a relative risk Give three examples of published studies discussed in this chapter Temporality Temporality refers to the timing of information about cause and effect. Did the information about cause and effect refer to the same point in time? Or, was the information about the cause garnered before or after the information about the effect? Limitations of Other Study Designs Demonstrating temporality is a difficulty of most observational studies. Limitations of Other Study Designs (cont’d) Cross-sectional and case-control study designs are based on exposure and disease information that is collected at the same time. Advantage: Efficient for generating and testing hypotheses. Disadvantage: Leads to challenges regarding interpretation of results. Limitations of Other Study Designs (cont’d) Cross-sectional studies: Present difficulties in distinguishing the exposures from the outcomes of the disease, especially if the outcome marker is a biological or physiological parameter. Limitations of Other Study Designs (cont’d) Case-control studies: Raise concerns that recall of past exposures differs between cases and controls. Limitations of Other Study Designs (cont’d) There has been no actual lapse of time between measurement of exposure and disease. None of the previous study designs is well suited for uncommon exposures. What is a cohort? A cohort is defined as a population group, or subset thereof, that is followed over a period of time. The term cohort is said to originate from the Latin cohors, which referred to one of ten divisions of an ancient Roman legion. What is a cohort? (cont’d) Cohort group members experience a common exposure associated with a specific setting (e.g., an occupational cohort or a school cohort) or they share a non-specific exposure associated with a general classification (e.g., a birth cohort—being born in the same year or era). Cohort Effect The influence of membership in a particular cohort. Example: Tobacco use in the U.S. Fewer than 5\% of population smoked around the early 1900s. Free cigarettes for WWI troops increased prevalence of smoking in the population. During WWI, age of onset varied greatly; then people began smoking earlier in life. One net effect was a shift in the distribution of the age of onset of lung cancer. Cohort Analysis The tabulation and analysis of morbidity or mortality rates in relationship to the ages of a specific group of people (cohort) identified at a particular period of time and followed as they pass through different ages during part or all of their life span. Wade Hampton Frost Popularized cohort analysis method. Arranged tuberculosis mortality rates in a table with aChapter 1 The History and Scope of Epidemiology 1 Learning Objectives Define the term epidemiology Define the components of epidemiology (determinants, distribution, morbidity, and mortality) Name and describe characteristics of the epidemiologic approach Discuss the importance of Hippocrates’ hypothesis and how it differed from the common beliefs of the time Discuss Graunt’s contributions to biostatistics and how they affected modern epidemiology Explain what is meant by the term natural experiments, and give at least one example 2 2009 H1N1 Influenza During April 2009, 2 cases of 2009 H1N1 came to the attention of CDC. The initial cases occurred in the U.S. and then expanded rapidly worldwide. By summer 2010, the epidemic subsided and an estimated 60 million cases had occurred in the U.S. Heavily affected people were from 18 to 64 years old. See Exhibit 1-1. 2006 Outbreak of Escherichia coli Outbreak during late summer and fall of 2006 Affected 199 persons and caused 3 deaths Caused 102 (51\%) of ill persons to be hospitalized A total of 31 patients (16\%) were afflicted with hemolytic-uremic syndrome (HUS). Spread across 26 states Fresh spinach linked to the outbreak 4 Epidemiology Defined Epidemiology derives from epidemic, a term which provides an immediate clue to its subject matter. Epidemiology originates from the Greek words, epi (upon) + demos (people) + logy (study of). 6 3 Definition of Epidemiology Epidemiology is concerned with the distribution and determinants of health and diseases, morbidity, injuries, disability, and mortality in populations. Epidemiologic studies are applied to the control of health problems in populations. 7 4 Key Aspects of This Definition Determinants Distribution Population Health phenomena Morbidity and mortality 8 5 Determinants Factors or events that are capable of bringing about a change in health. 9 6 Examples of Determinants Biologic agents--bacteria Chemical agents--carcinogens Less specific factors--stress, drinking, sedentary lifestyle, or high-fat diet 10 The Search for Determinants Outbreak of Fear--Ebola virus in Kikwit, Zaire Fear on Seventh Ave.--Legionnaires’ disease in New York City Red Spots on Airline Flight Attendants--dye from life vests Bioterrorism-Associated Anthrax Cases 11 7 Bioterrorism-Associated Anthrax Cases Index case reported in Florida Additional cases, including fatal cases, reported in New York, New Jersey, Connecticut Contaminated mail linked to some of the cases 12 Distribution Frequency of disease occurrence may vary from one population group to another. 13 8 Disease Distribution Examples In 2006, death rates from CHD and stroke were higher among African-Americans than among American Indians/Alaskan natives, Asian/Pacific Islanders, or whites. Coronary heart disease occurrence differs between Hispanics and non-Hispanics. 14 Population Epidemiology examines disease Chapter 4 Descriptive Epidemiology: Person, Place, Time Learning Objectives State primary objectives of descriptive epidemiology Provide examples of descriptive studies List characteristics of person, place, and time Characterize the differences between descriptive and analytic epidemiology Descriptive vs. Analytic Epidemiology Descriptive studies--used to identify a health problem that may exist. Characterize the amount and distribution of disease Analytic studies--follow descriptive studies, and are used to identify the cause of the health problem 2 Objectives of Descriptive Epidemiology To evaluate and compare trends in health and disease To provide a basis for planning, provision, and evaluation of health services To identify problems for analytic studies (creation of hypotheses) 3 Descriptive Studies and Epidemiologic Hypotheses Hypotheses--theories tested by gathering facts that lead to their acceptance or rejection Three types: Positive declaration (research hypothesis) Negative declaration (null hypothesis) Implicit question (e.g., to study association between infant mortality and region) 4 Mill’s Canons of Inductive Reasoning The method of difference--all the factors in two or more places are the same except for a single factor. The method of agreement--a single factor is common to a variety of settings. Example: air pollution. 5 Mill’s Canons (cont’d) The method of concomitant variation--the frequency of disease varies according to the potency of a factor. The method of residues--involves subtracting potential causal factors to determine which factor(s) has the greatest impact. 6 Method of Analogy (MacMahon and Pugh) The mode of transmission and symptoms of a disease of unknown etiology bear a pattern similar to that of a known disease. This information suggests similar etiologies for both diseases. Three Approaches to Descriptive Epidemiology Case reports--simplest category of descriptive epidemiology Case series Cross-sectional studies Case Reports and Case Series Case reports--astute clinical observations of unusual cases of disease Example: a single occurrence of methylene chloride poisoning Case series--a summary of the characteristics of a consecutive listing of patients from one or more major clinical Example: five cases of hantavirus pulmonary syndrome 7 Cross-sectional Studies Surveys of the population to estimate the prevalence of a disease or exposure Example: National Health Interview Survey Characteristics of Persons Covered in Chapter 4 Age Sex Marital Status Race and ethnicity Nativity and migration Religion Socioeconomic status Age One of the most important factors to consider when describing the occurrence of any disease or illness 8 Trends by Age Subgroup Childhood to early adolescence Leading cause of death, ages 1-14 years—unintentional injuries Infants—mortality from developmental problems, e.g., congenital Chapter 3 Measures of Morbidity and Mortality Used in Epidemiology Learning Objectives Define and distinguish among ratios, proportions, and rates Explain the term population at risk Identify and calculate commonly used rates for morbidity, mortality, and natality State the meanings and applications of incidence rates and prevalence Learning Objectives (cont’d) Discuss limitations of crude rates and alternative measures for crude rates Apply direct and indirect methods to adjust rates List situations where direct and indirect adjustment should be used Overview of Epidemiologic Measures Count The simplest and most frequently performed quantitative measure in epidemiology. Refers to the number of cases of a disease or other health phenomenon being studied. Examples of Counts Cases of influenza reported in Westchester County, New York, during January of a particular year. Traffic fatalities in Manhattan in a 24-hour time period College dorm students who had mono Foreign-born stomach cancer patients Ratio The value obtained by dividing one quantity by another. Consists of a numerator and a denominator. The most general form has no specified relationship between numerator and denominator. Rates, proportions, and percentages are also ratios. Example of a Simple Sex Ratio Calculation A ratio may be expressed at = X/Y Simple sex ratio (data from textbook) Of 1,000 motorcycle fatalities, 950 victims are men and 50 are women. Number of male cases 950 Number of female cases 50 19:1 male to female = = Example of a Demographic Sex Ratio Calculation This ratio refers to the number of males per 100 females. In the U.S., the sex ratio in 2010 for the entire population was 96.7, indicating more females than males. Number of male cases 151,781,326 Number of female cases 156,964,212 96.7 X 100 = = X 100 Example of a Sex Ratio at Birth Calculation The sex ratio at birth is defined as: (the number of male births divided by the number of female births) multiplied by 1,000. Number of male births Number of female births X 1,000 Definition of Proportion A measure that states a count relative to the size of the group. A ratio in which the numerator is part of the denominator. May be expressed as a percentage. Uses of Proportions Can demonstrate the magnitude of a problem. Example: 10 dormitory students develop hepatitis. How important is this problem? If only 20 students live in the dorm, 50\% are ill. If 500 students live in the dorm, 2\% are ill. Example of a Proportion Calculate the proportion of African-American male deaths among African-American and white boys aged 5 to 14 years. Rate Definition: a ratio that consists of a numerator and a denominator and in which time forms part of the denominator. Contains the following elements: disease frequency unit size of population time period during which an event occurs Crude death rate = Number of deaths in