Introduction to Epidemiology
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Questions and Answers

What is the primary focus of epidemiology?

  • The development of new medical treatments
  • The distribution and determinants of health-related events in populations (correct)
  • Individual health assessments for clinical practices
  • The study of economic impacts of health policies

Which of the following is NOT identified as a core function of epidemiology?

  • Patient diagnosis (correct)
  • Policy formulation
  • Field investigations
  • Surveillance

What aspect does measurement in epidemiology primarily focus on?

  • The timing and place of health-related events (correct)
  • Personality traits of healthcare providers
  • Understanding the cost of healthcare
  • Patient satisfaction levels

Which of the following does NOT belong to the 5 W's of epidemiology?

<p>How much? (D)</p> Signup and view all the answers

Epidemiology is primarily considered which type of science?

<p>Quantitative science (B)</p> Signup and view all the answers

What characteristic distinguishes a proportion from a ratio?

<p>The numerator is always part of the denominator in proportions. (B)</p> Signup and view all the answers

Which of the following statements is true regarding rates?

<p>Rates are measures of occurrence related to a specific time period. (D)</p> Signup and view all the answers

How is a percentage calculated from a proportion?

<p>By dividing the numerator by the denominator and multiplying by 100. (A)</p> Signup and view all the answers

Which of the following is NOT a measure of disease occurrence?

<p>Fractions (C)</p> Signup and view all the answers

What does a mortality rate measure?

<p>The frequency of occurrence of death in a specified population over time. (C)</p> Signup and view all the answers

Which of the following correctly describes a ratio?

<p>A comparison of two related parts. (D)</p> Signup and view all the answers

In the context of proportions, if A is 1 and B is 7, what is the proportion expressed as a decimal?

<p>0.125 (B)</p> Signup and view all the answers

Which statement best describes counts in the context of disease occurrence?

<p>Counts can provide insights into the severity of an outbreak. (A)</p> Signup and view all the answers

What is the denominator used to calculate the crude mortality rate?

<p>Estimated population size (A)</p> Signup and view all the answers

Which statement correctly defines the infant mortality rate?

<p>Deaths of infants less than 1 year of age per 1,000 live births (C)</p> Signup and view all the answers

What does the neonatal mortality rate specifically measure?

<p>Deaths of infants &lt; 28 days of age (C)</p> Signup and view all the answers

What is the maternal mortality rate calculated from?

<p>Deaths due to pregnancy-related causes per 100,000 live births (C)</p> Signup and view all the answers

Which of the following statements best describes morbidity?

<p>Frequency of occurrence of disease or injury in a defined population (A)</p> Signup and view all the answers

How is the infant mortality rate expressed?

<p>Per 1,000 live births (A)</p> Signup and view all the answers

Which of the following is NOT a definition used for calculating mortality rates?

<p>Infant morbidity rate (C)</p> Signup and view all the answers

What measure gives an overview of the occurrence of new cases of diseases in a population?

<p>Incidence (D)</p> Signup and view all the answers

What is the purpose of calculating crude mortality rates?

<p>To compare health indicators between different nations (A)</p> Signup and view all the answers

What does a higher morbidity rate indicate about a population?

<p>Increased occurrence of disease or injury (B)</p> Signup and view all the answers

What is the first step in establishing the existence of an epidemic?

<p>Establish the existence of an epidemic (C)</p> Signup and view all the answers

Which type of case definition would allow for the identification of more cases, albeit with potential imprecision?

<p>Loose case definition (C)</p> Signup and view all the answers

What key characteristic does 'Person' refer to when orienting data for an epidemic?

<p>Inherent and acquired characteristics (B)</p> Signup and view all the answers

Which type of epidemic classification is characterized by the spread of disease from person to person?

<p>Propagated epidemic (D)</p> Signup and view all the answers

When analyzing data for an epidemic, what does the epidemic curve primarily display?

<p>Temporal distribution of cases (D)</p> Signup and view all the answers

Which of the following is NOT an element of control measures implemented during an outbreak?

<p>Compliance monitoring (A)</p> Signup and view all the answers

What is the purpose of classifying an epidemic using an epidemic curve?

<p>To understand the transmission dynamics (A)</p> Signup and view all the answers

Which statement best describes the process of searching for missing cases during an epidemic investigation?

<p>Additional outreach efforts may be required to identify undiagnosed cases (B)</p> Signup and view all the answers

In the stage of case definition, what is the significance of distinguishing between exposure status and disease frequency?

<p>To identify actual risk factors associated with the epidemic (B)</p> Signup and view all the answers

When analyzing data for an epidemic, which method is commonly used for visual representation?

<p>Spot Map (D)</p> Signup and view all the answers

Which aspect does analytic epidemiology primarily seek to explore?

<p>Causal relationships between exposures and outcomes (D)</p> Signup and view all the answers

What model is included in the three models used to understand the occurrence of disease?

<p>Web of Causation (A)</p> Signup and view all the answers

Which stage of disease is characterized by not being apparent and showing pathological changes?

<p>Stage of Subclinical Disease (C)</p> Signup and view all the answers

Which of the following is considered a determinant of health?

<p>Social determinants (B)</p> Signup and view all the answers

What type of prevention is used during the advanced stage of clinical disease?

<p>Tertiary Prevention (C)</p> Signup and view all the answers

Which of the following best describes the Bradford Hill criteria for causation?

<p>It includes evaluating the strength and consistency of the association. (B)</p> Signup and view all the answers

What is the primary role of public health surveillance?

<p>To monitor health problems for prevention or control (A)</p> Signup and view all the answers

Which of the following is an example of a biological source of disease?

<p>Infectious organisms (D)</p> Signup and view all the answers

Which stage occurs after the onset of symptoms in the natural history of a disease?

<p>Stage of Clinical Disease (D)</p> Signup and view all the answers

In the context of disease transmission, what is the term for the initial habitat where the agent lives?

<p>Reservoir (A)</p> Signup and view all the answers

What does herd immunity rely on in a population?

<p>Immunization of at least 85% of the population (A)</p> Signup and view all the answers

Which of the following is NOT a mode of transmission for communicable diseases?

<p>Environmental transmission (A)</p> Signup and view all the answers

What is the goal of secondary prevention in public health?

<p>To control disease progression and minimize complications (C)</p> Signup and view all the answers

What does Absolute Risk measure in a population?

<p>The overall incidence of the disease in a specified population (D)</p> Signup and view all the answers

When is Relative Risk (RR) most accurately calculated?

<p>From prospective studies (B)</p> Signup and view all the answers

What does it mean if the Confidence Interval (CI) includes 1?

<p>There is no difference in risk between the exposed and non-exposed groups (A)</p> Signup and view all the answers

Which statement describes an Odds Ratio (OR)?

<p>It represents the ratio of the odds of exposure in cases to the odds of exposure in controls (C)</p> Signup and view all the answers

What does Positive Predictive Value estimate?

<p>Proportion of people with a positive test result who actually have the disease (C)</p> Signup and view all the answers

What does a Relative Risk (RR) of less than 1 indicate?

<p>Reduced risk of disease in the exposed group (A)</p> Signup and view all the answers

What is the definition of a Primary case in an outbreak?

<p>The first case identified by epidemiologists (C)</p> Signup and view all the answers

What term describes a disease occurring at persistent high levels within a community?

<p>Hyperendemic (B)</p> Signup and view all the answers

Which characteristic of screening tests indicates their ability to correctly identify those without the disease?

<p>Specificity (D)</p> Signup and view all the answers

A test with a high sensitivity will significantly reduce which type of error?

<p>False Negative (A)</p> Signup and view all the answers

In a mixed epidemic, what does the initial infection spread from, after common source exposure?

<p>Person to person contact (D)</p> Signup and view all the answers

What is the purpose of health screening activities?

<p>To identify diseases in the preclinical stage (D)</p> Signup and view all the answers

What does an OR (Odds Ratio) equal to 1 indicate?

<p>No difference in odds of exposure between groups (A)</p> Signup and view all the answers

How is Attributable Risk defined?

<p>Difference in incidence rates between exposed and non-exposed groups (A)</p> Signup and view all the answers

Flashcards

What is Epidemiology?

Epidemiology is the study of how diseases and health conditions are distributed in populations and what factors influence this distribution.

Core Epidemiological Functions

These are the key activities that epidemiologists perform to understand and control health problems. They include surveillance, field investigations, analytic studies, evaluation, linkages, and policy.

Surveillance

Ongoing systematic collection, analysis, and interpretation of health data to monitor health events and identify public health problems.

Field Investigations

In-depth studies of outbreaks or clusters of disease to identify the cause and control further spread.

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5 W's of Epidemiology

These are the key questions epidemiologists ask to understand health events: What? When? Where? Who? Why?

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Disease

A condition that causes serious illness or death, has the potential to spread, and can be controlled with intervention.

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Counts

A numerical representation of the frequency of an event, like the number of cases or deaths in a specified population.

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Ratios

A comparison of two quantities, expressed as a fraction or a colon.

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Proportions

A specific type of ratio where the numerator is part of the denominator, often expressed as a decimal.

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Percentages

Proportions multiplied by 100, representing a part of the whole expressed out of 100.

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Rates

Measures the frequency of an event in a specific population over a defined period, considering both population and time.

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Vital Statistics

Data about key life events like births, deaths, and marriages, used to track population health and trends.

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Mortality Rate

A measure of the frequency of death in a specific population during a defined time period.

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Analytic Epidemiology

A branch of epidemiology that focuses on identifying the causes and effects of health-related events by examining the association between exposures and outcomes. It helps understand the 'why' behind health events, aiming to determine causal relationships.

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Descriptive Epidemiology

The study of the distribution of health-related events in a population, focusing on the frequency, pattern, and characteristics of events. It answers the questions of 'who, where, and when' related to health issues.

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Determinants of Health

Factors that influence the health of individuals and populations. These factors can be biological, environmental, social, or related to health behaviors.

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Multicausality

The principle that most diseases have multiple contributing factors, rather than a single cause. The combination and interaction of these factors contribute to the development of disease.

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Bradford Hill Criteria

A set of guidelines used to evaluate the strength of evidence for a causal relationship between an exposure and an outcome. They help determine whether an observed association is likely to be causal.

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Epidemiological Triad or Triangle

A model that describes the interaction between the host, agent, and environment in the development of disease. This interaction is essential for the disease process to occur.

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BEINGS Model

A framework that considers various factors contributing to disease causation. It includes Biological, Environmental, Immunological, Nutritional, Genetic, and Social/Services/Spiritual factors.

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Web of Causation

A model that depicts the complex interconnectedness of different factors contributing to disease. It highlights the multifactorial nature of disease causation and emphasizes the role of interactions.

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Spectrum of Disease

The range of severity of a disease, from mild symptoms to fatal outcomes. It describes the different levels of illness an individual can experience.

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Natural History of Disease

The progression of a disease over time in an untreated individual, from the initial stage of susceptibility to the eventual outcome. It describes the stages of disease development.

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Stage of Susceptibility

The initial stage of disease development, where the host is at risk of developing the disease but has not yet been exposed.

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Stage of Preclinical, Subclinical, Presymptomatic, or Latent Disease

A stage where the disease process has begun but no symptoms are yet apparent. Pathological changes occur but are not detectable by clinical methods.

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Stage of Clinical Disease

The stage of the disease where symptoms appear and the individual typically seeks medical attention. Diagnosis usually occurs during this stage.

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Stage of Recovery, Disability, or Death

The final stage of disease development, where the individual may experience recovery, permanent disability, or death.

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Primary Prevention

Preventive measures used during the stage of susceptibility to protect against the onset of disease. It aims to prevent the disease from occurring in the first place.

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Secondary Prevention

Preventive measures used during the preclinical and early clinical stages of disease to detect and intervene early, aiming to control the disease and minimize or eliminate complications.

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Crude Mortality Rate

The overall death rate in a population, including deaths from all causes, calculated by dividing the total number of deaths by the population size during a specific time period.

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Infant Mortality Rate

The number of deaths of infants under one year of age per 1,000 live births in a given time period.

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Neonatal Mortality Rate

The number of deaths of infants under 28 days old per 1,000 live births in a given time period.

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Maternal Mortality Rate

The number of deaths of women related to pregnancy or childbirth per 100,000 live births in a given time period.

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Incidence

The number of new cases of a disease or condition in a population during a specific time period.

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Prevalence

The total number of cases of a disease or condition in a population at a specific time point.

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What is the denominator for calculating Mortality Rates?

The denominator for calculating mortality rates is the population size in which the deaths occurred. It's usually expressed per 1,000 or 100,000 people.

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How does the CDC calculate Mortality Rates

The CDC calculates mortality rates by dividing the number of deaths during a specific time period by the population size during that same time period. The result is then multiplied by 1,000 or 100,000 to make it easier to interpret.

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Why are Infant Mortality Rates Important?

Infant mortality rates are commonly recognized as a significant indicator of a country's overall health status. A high infant mortality rate often reflects inadequate access to healthcare, poor sanitation, and malnutrition.

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Case Definition

A set of criteria used to identify individuals who have a specific disease or health condition. It describes the characteristics of the disease and the methods for diagnosing it.

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Loose vs. Strict Case Definition

A loose case definition is broad, including possible cases, while a strict case definition requires more specific criteria, focusing on confirmed cases.

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Epidemic Curve

A graph showing the number of cases of a disease over time. It helps identify the pattern of the outbreak and determine the type of epidemic.

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Common Source Epidemic

An outbreak where all cases can be traced back to a single source of infection. This source may be contaminated food, water, or a place.

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Propagated Epidemic

An outbreak where the infection spreads from person to person. Each infected person can transmit it to others, creating a chain of transmission.

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Spot Map

A map used in epidemiology to visualize the locations of cases of a disease. It shows the geographic distribution of the outbreak.

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Descriptive Statistics

Numbers that summarize and describe data about a population. They provide information on the characteristics of the disease and the affected population.

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Testing for Relationships

Analyzing data to identify potential associations or correlations between factors and the occurrence of a disease. This helps determine risk factors and potential causes.

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Risk Factor Prevention

Strategies to modify or eliminate factors that increase the likelihood of contracting a disease.

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Behavior Change Programs

Initiatives designed to encourage individuals to adopt healthier behaviors that reduce the risk of disease.

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What is Risk?

The probability of a specific event, like getting a disease, happening within a particular time period. It's calculated as a proportion.

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What is Absolute Risk?

The total number of people who develop a disease within a specific population.

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What is Attributable Risk?

The amount of disease that can be specifically linked to a certain factor, like exposure to a harmful substance, within a defined population.

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What is Relative Risk (RR)?

Compares the risk of developing a disease in an exposed group to the risk in a non-exposed group.

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What is Odds Ratio (OR)?

Estimates the Relative Risk when it's not possible to calculate it directly. Used in retrospective studies.

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Interpreting RR and OR: What does RR/OR = 1 mean?

The risk or odds of developing the disease are the same in the exposed group and the non-exposed group.

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Interpreting RR and OR: What does RR/OR > 1 mean?

The risk or odds of developing the disease are higher in the exposed group compared to the non-exposed group.

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Interpreting RR and OR: What does RR/OR < 1 mean?

The risk or odds of developing the disease are lower in the exposed group compared to the non-exposed group.

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What are Confidence Intervals (CI) for RR and OR?

A range of values within which the true population risk or odds ratio is likely to fall.

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Interpreting CI for RR and OR: What does it mean if the CI includes 1?

The difference in risk or odds between the exposed and non-exposed groups is not statistically significant (no meaningful difference).

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Interpreting CI for RR and OR: What does it mean if the CI does not include 1?

There is a statistically significant difference in risk or odds between the exposed and non-exposed groups. The exposure might be associated with increased or decreased risk depending on whether RR/OR is greater or less than 1.

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What is Sensitivity?

The ability of a test to correctly identify people who actually have the disease.

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What is Specificity?

The ability of a test to correctly identify people who don't have the disease.

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What is Positive Predictive Value (PPV)?

The probability that someone who tests positive for the disease actually has the disease.

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What is Negative Predictive Value (NPV)?

The probability that someone who tests negative for the disease actually doesn't have the disease.

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Study Notes

Introduction to Epidemiology

  • Epidemiology is the study of the distribution and determinants of health-related states or events in specified populations, and the application of this knowledge to control health problems.
  • Epidemiology is a quantitative science.
  • Measurements are important in epidemiology, focusing on the distribution and determinants of health-related states and events.
  • Epidemiology is a story about health-related states and events supported by data.

Core Epidemiological Functions

  • Surveillance
  • Field investigations
  • Analytic studies
  • Evaluation
  • Linkages
  • Policy

5 W's of Epidemiology

  • What?
  • When?
  • Where?
  • Who?
  • Why?

Descriptive Epidemiology

  • Describes the distribution of health-related states and events, as well as the frequency and pattern of these events.
  • Key elements are time, place, and person.

Analytic Epidemiology

  • Examines the cause-and-effect relationship between exposures and health outcomes.
  • Investigates the determinants/causes of health issues.
  • Quantifies associations to determine causal relationships.

Determinants of Health

  • Biological sources: Congenital, hereditary, infectious, inflammatory, metabolic, nutritional, tumors, vascular.
  • Environmental sources: Allergens, chemical exposures, infectious organisms, nutrition, physical agents, trauma.
  • Social determinants: Neighborhood & built environment, economic stability, health and health care, education, social and community context.
  • Health behaviors: Nutrition, physical activity, rest and relaxation, tobacco use, alcohol use, illicit substance use, immunizations.

Models of Disease Causation

  • Multicausality: Etiology of all diseases is multifactorial
  • The Causal Pie Model
  • Epidemiological Triad or Triangle (Agent, Host, Environment)
  • BEINGS Model (Biological, Behavioral, Environmental, Immunological, Nutritional, Genetic, Services, Social, Spiritual)
  • Web of Causation

Spectrum and Natural History of Disease

  • Describes the severity of a disease, and variations from mild to fatal.
  • Stages of disease: Susceptibility, preclinical, subclinical, clinical, recovery/disability/death.

Levels of Prevention

  • Primary prevention: Protection in the stage of susceptibility, aimed at preventing exposure/disease.
  • Secondary prevention: Early detection, used during preclinical and early stages to control disease.
  • Tertiary prevention: Aimed at reducing long-term consequences of disease/disability.

Communicable Diseases: Chain of Infection

  • Communicability: The ability of a disease to be transmitted from one person to another or to spread through a population
  • Reservoir
  • Portal of exit
  • Transmission: Direct, indirect (vehicleborne, vectorborne), airborne
  • Portal of entry
  • Susceptible host
  • Isolation
  • Quarantine
  • Herd immunity
  • Cocooning

Health Screening

  • Used to identify diseases in early stages, when treatment is most effective.
  • Screening as a form of secondary prevention.

Characteristics of Screening Tests

  • Sensitivity
  • Specificity
  • Positive predictive value
  • Negative predictive value

Investigation of an Outbreak - Terminology

  • Cases: Primary, secondary, suspect, confirmed.
  • Epidemiological Investigation steps: Establish criteria, count cases, examine data, classify, analyze.

Epidemiology Study Designs

  • Experimental: Randomized controlled trials, non-randomized trials
  • Observational: Cohort studies, case-control studies, cross-sectional studies.
  • Levels of evidence: Systematic reviews, Randomized controlled trials, observational studies, case reports, expert opinion.
  • Prospective vs Retrospective Cohort studies.
  • Case-control studies.
  • Cross-sectional studies.

Risk

  • Risk: Probability that an event will occur
  • Absolute risk
  • Attributable risk
  • Relative risk
  • Odds ratio
  • Confidence intervals for risk and odds ratios.

Measures of Association

  • Risk ratio or relative risk (RR)
  • Odds ratio (OR)

Public Health Surveillance

  • Ongoing, systematic collection, analysis, and interpretation of health-related data.
  • Use the data for planning and controlling disease.
  • Measures/occurrence of disease: Counts, frequencies, proportions, percentages, rates (incidence , mortality)

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