Epi Comps

Front 1

Endemic

Back 1

usuall occurrence of the spread of disease or illness

Front 2

Epidemic

Back 2

excess of normal expectancy of spread

Front 3

Pandemic

Back 3

worldwide spread

Front 4

Hyper-endemic

Back 4

high and continued level of incidence

Front 5

Type of disease outbreaks:
Common Source

Back 5

exposure can be continuous and ongoing

Front 6

Type of disease outbreaks:
Progpagated Outbreak

Back 6

gradual from person to person
no common source

Front 7

Type of disease outbreaks:
Mixed Epidemic

Back 7

mixture of common source and propagated

Front 8

Top 5 Causes of Death

Back 8

1. Heart Disease
2. Cancer
3. Stroke
4. Lung Disease
5. Accidents

Front 9

Top 5 Causes of Death Risk Factors

Back 9

modifiable - diet, smoking, exercise
non-modifiable - age, sex, race

Front 10

Types of Prevention: Primary

Back 10

prevention measures seeking to prevent the onset of disease

Front 11

Types of Prevention: Secondary

Back 11

screening to detect disease before signs and symptoms are present

Front 12

Types of Prevention: Tertiary

Back 12

Treatment of disease to prevent worsening of condition

Front 13

Epidemiological Approach

Back 13

basic purpose to identify risk factors and causes

Front 14

Epidemiologic Approach Step 1

Back 14

determine association between exposure and exposure levels as they relate to the disease

Front 15

Epidemiologic Approach Step 2

Back 15

- is association causal > be mindful of confounders
- exposure may not be the culprit

Front 16

Epidemiologic Approach requires

Back 16

characteristics of person and disease
- who
- where
- when
- what
- why

Front 17

Epidemiologic Approach Characterristic: Who

Back 17

- Person
- Age, sex, race, socioeconomic status, health, marital status

Front 18

Types of Prevention: Secondary

Back 18

screening to detect disease before signs and symptoms are present

Front 19

Epidemiologic Approach Characterristic: Where

Back 19

- Place
- Geographic elements of anoutbreak

Front 20

Types of Prevention: Tertiary

Back 20

Treatment of disease to prevent worsening of condition

Front 21

Epidemiologic Approach Characterristic: When

Back 21

- Time
- Usually month or year
- Secular - changes over long periods of time
- Cyclical - frequency > seasonal or yearly

Front 22

Epidemiologic Approach Characterristic: What

Back 22

- Case definition

Front 23

Epidemiological Approach

Back 23

basic purpose to identify risk factors and causes

Front 24

Epidemiologic Approach Step 1

Back 24

determine association between exposure and exposure levels as they relate to the disease

Front 25

Epidemiologic Approach Step 2

Back 25

- is association causal > be mindful of confounders
- exposure may not be the culprit

Front 26

Epidemiologic Approach requires

Back 26

characteristics of person and disease
- who
- where
- when
- what
- why

Front 27

Epidemiologic Approach Characterristic: Who

Back 27

- Person
- Age, sex, race, socioeconomic status, health, marital status

Front 28

Epidemiologic Approach Characterristic: Where

Back 28

- Place
- Geographic elements of anoutbreak

Front 29

Epidemiologic Approach Characterristic: When

Back 29

- Time
- Usually month or year
- Secular - changes over long periods of time
- Cyclical - frequency > seasonal or yearly

Front 30

Epidemiologic Approach Characterristic: What

Back 30

- Case definition

Front 31

Types of Prevention: Secondary

Back 31

screening to detect disease before signs and symptoms are present

Front 32

Types of Prevention: Tertiary

Back 32

Treatment of disease to prevent worsening of condition

Front 33

Epidemiological Approach

Back 33

basic purpose to identify risk factors and causes

Front 34

Types of Prevention: Secondary

Back 34

screening to detect disease before signs and symptoms are present

Front 35

Epidemiologic Approach Step 1

Back 35

determine association between exposure and exposure levels as they relate to the disease

Front 36

Epidemiologic Approach Step 2

Back 36

- is association causal > be mindful of confounders
- exposure may not be the culprit

Front 37

Types of Prevention: Tertiary

Back 37

Treatment of disease to prevent worsening of condition

Front 38

Epidemiologic Approach requires

Back 38

characteristics of person and disease
- who
- where
- when
- what
- why

Front 39

Epidemiological Approach

Back 39

basic purpose to identify risk factors and causes

Front 40

Types of Prevention: Secondary

Back 40

screening to detect disease before signs and symptoms are present

Front 41

Epidemiologic Approach Characterristic: Who

Back 41

- Person
- Age, sex, race, socioeconomic status, health, marital status

Front 42

Epidemiologic Approach Characterristic: Where

Back 42

- Place
- Geographic elements of anoutbreak

Front 43

Types of Prevention: Tertiary

Back 43

Treatment of disease to prevent worsening of condition

Front 44

Epidemiologic Approach Step 1

Back 44

determine association between exposure and exposure levels as they relate to the disease

Front 45

Epidemiologic Approach Characterristic: When

Back 45

- Time
- Usually month or year
- Secular - changes over long periods of time
- Cyclical - frequency > seasonal or yearly

Front 46

Epidemiological Approach

Back 46

basic purpose to identify risk factors and causes

Front 47

Epidemiologic Approach Step 2

Back 47

- is association causal > be mindful of confounders
- exposure may not be the culprit

Front 48

Epidemiologic Approach Characterristic: What

Back 48

- Case definition

Front 49

Epidemiologic Approach Step 1

Back 49

determine association between exposure and exposure levels as they relate to the disease

Front 50

Epidemiologic Approach Step 2

Back 50

- is association causal > be mindful of confounders
- exposure may not be the culprit

Front 51

Epidemiologic Approach requires

Back 51

characteristics of person and disease
- who
- where
- when
- what
- why

Front 52

Epidemiologic Approach requires

Back 52

characteristics of person and disease
- who
- where
- when
- what
- why

Front 53

Epidemiologic Approach Characterristic: Who

Back 53

- Person
- Age, sex, race, socioeconomic status, health, marital status

Front 54

Epidemiologic Approach Characterristic: Who

Back 54

- Person
- Age, sex, race, socioeconomic status, health, marital status

Front 55

Epidemiologic Approach Characterristic: Where

Back 55

- Place
- Geographic elements of anoutbreak

Front 56

Epidemiologic Approach Characterristic: Where

Back 56

- Place
- Geographic elements of anoutbreak

Front 57

Epidemiologic Approach Characterristic: When

Back 57

- Time
- Usually month or year
- Secular - changes over long periods of time
- Cyclical - frequency > seasonal or yearly

Front 58

Epidemiologic Approach Characterristic: When

Back 58

- Time
- Usually month or year
- Secular - changes over long periods of time
- Cyclical - frequency > seasonal or yearly

Front 59

Epidemiologic Approach Characterristic: What

Back 59

- Case definition

Front 60

Epidemiologic Approach Characterristic: What

Back 60

- Case definition

Front 61

Epidemiologic Approach Characteristics: Why

Back 61

- Causes
- Analytic - determines risk factor > determinants
- Descriptive - describes characteristics

Front 62

Gordis - 8 steps to guide outbreak investigation

Back 62

1. Define outbreak and validate existence
2. Examine distributions
3. Look for combinations of variables
4. Develop hypotheses
5. Test hypotheses
6. Recommend control measures
7. Prepare written report
8. Communicate findings

Front 63

Attack Rate

Back 63

People at risk in whom illness develops
________________________________
total number of people at risk
- cumulative incidence of infection in a group observed over the period of an epidemic

Front 64

Case fatality Rate

Back 64

- number of deaths from a specific disease during a specfic time period
__________________________________
number of diagnosed cases of the disease in the same time period
- Not useful for chronic diseases

Front 65

Types of Rates

Back 65

- Crude Rate
- Specific Rate
- Adjusted Rate

Front 66

Validity

Back 66

- Accuracy
- The ability of a test or measurement to correctly identify the variable or disease it is supposed to measure

Front 67

Sensitivity

Back 67

- Correct identification of disease when person has disease
- a/(a+c)

Front 68

Specificity

Back 68

- Correct identification of no disease in those without the disease
- d/(d+b)

Front 69

Reliability

Back 69

- Repeatability
- The degree to which repeated results will be the same

Front 70

Classifying Epidemiologic Studies

Back 70

- descriptive or analytic
- experimental or observational

Front 71

Classifying Epidemiological Studies

Back 71

- descriptive or analytic
- experimental or observational

Front 72

Descriptive Study

Back 72

- describes disease and helps generate causal hypotheses
_ case reports, case series, cross-sectional surveys
- describe individual health characteristics
- person, place, time, things, and estimates disease frequency and time trends

Front 73

Analytic Study

Back 73

- test hypotheses
- ecologic studies, case-control, cohort, experimental
- test different specific etiologic hypotheses

Front 74

Experimental Study

Back 74

- ALWAYS analytic
- investigator controls exposure

Front 75

Observational

Back 75

- either analytic or descriptive
- investigator DOES NOT control exposure

Front 76

Experimental Study Designs

Back 76

- clinical trials (analytic)
- community trials (analytic)

Front 77

Observational Study Designs

Back 77

- Case reports (descriptive)
-ecologic (descriptive or analytic)
- cross-sectional (descriptive)
- case-control (analytic)
cohort (analytic)

Front 78

Randomized Trials

Back 78

- considered BEST DESIGN
- randomized clinical trial

Front 79

Randomized Clinical Trial

Back 79

- evaluate newer drugs, treatments, technology, health organizations, and delivery
- starts with defined population that is randomized to receive either new treatment or the current treatment
- groups are compared to evaluate

Front 80

Subject Selection

Back 80

- Historical controls
- Simultaneous non-randomized controls
- Randomized controls *THE BEST
- Stratified Randomization

Front 81

Historical Controls

Back 81

- data from medical records of groups in past
- records may be inadequate
- generally not a good choice

Front 82

Simultaneous Non-randomized Controls

Back 82

- controls not selected randomly
- selection bias
- better to select randomly

Front 83

Randomized Controls

Back 83

- THE BEST APPROACH
- usually done with a computer

Front 84

Stratified Randomization

Back 84

- breaks groups up into age and gender so that groups can be comparable

Front 85

Masking

Back 85

Involves preventing the subjects and investigators from knowing to which group a subject is assigned
- single blind
- double blind
- triple blind
Masking is very important to get rid of placebo effect
- Masking helps eliminate biases because all people, subject and investigators have subconscious or conscious biases and preconceptions

Front 86

Type 1 Error

Back 86

- Cell C in 2x2 table
- rejecting the Ho when Ho is true
- the study detects a difference in the population (Ha) when there is none

Front 87

Type 2 Error

Back 87

- Cell B in 2x2 table
- accepting the Ho when Ho is false
- the study fails to detect a true difference

Front 88

Power of a study

Back 88

- 1 - Beta
- shows howl likely a study is to correctly show a difference between the populations

Front 89

Deciding Sample Size

Back 89

First, specify the expected difference in response rate
Second, estimate a response rate, rate of cure, for one of the groups
Third, specify alpha, .05 or .01
Fourth, specify the test power, 80% or 90% Last, specify whether the test will be one or two sided

Front 90

Expressing Results

Back 90

- Efficacy = (rate in placebo
) - rate in vaccine / (rate in placebo)
- relative risk

Front 91

External and Internal Validity

Back 91

- Are the basic concerns in the conduct of any randomized trial
- The main objective of a randomized trial is to generate results beyond the study population

Front 92

Internal Validity

Back 92

- If a study is properly done without major methods problems and takes into account all important issues
- The findings correctly report the study population

Front 93

External Validity

Back 93

- Relates to the generalizability of the study
- Can the findings be applied to the larger population that is represented by the study population?
- The population must be representative of all patients with the disease in question, not just one specific demographic, or geographic characteristic

Front 94

Phases of testing new drugs:
Phase 1

Back 94

- small clinical pharmacological studies (20 - 80)
- studies the toxic and pharmacologic effects

Front 95

Phases of testing new drugs:
Phase 2

Back 95

- clinical investigation studies (100 - 200)
- evaluate efficacy and relative safety

Front 96

Phases of testing new drugs:
Phase 3

Back 96

- large scale randomized controlled trials for effectiveness and relative safety
- if the drug passes this phase it can be licensed for marketing

Front 97

Phases of testing new drugs:
Phase 4

Back 97

- post marketing surveillance
- identify long-term or rare occurrences from use of the drug