Disease Detectives (3) (1) (2) PDF

EPIDEMIOLOGY Cons: DALY (Disability-Adjusted Life-Years): YLL + YLD Epidemiology: Study of distribution and determinants of...

EPIDEMIOLOGY Cons: DALY (Disability-Adjusted Life-Years): YLL + YLD Epidemiology: Study of distribution and determinants of Case/Clinical Report/Series: Detailed report about one Survivorship: Concentration of those who survive a process. vitamin B deficiency, pollutants in water. 1, Accuracy depend on prior knowledge Death-to-Case Ratio: [deaths over period] / [cases] (report) or several (series) patients from doctor. Susceptibility (: When one disease predisposes for a second; Detection Limit: Lowest concentration distinguishable from health conditions or events among pops and application of that study to control health problems. 2, Do not convey magnitude of effect between Error: (FP + FN) / (TP + TN + FP + FN) Retrospective or prospective. Usually fewer patients than when people susceptible to outcome are also prone to zero. Four Purposes: Control and prevention, research components Etiologic Fraction: [exposed cases – unexposed cases] / case control/trial. exposure. E.g. women with threatened abortion have a high DFLE: Disability-free life expectancy. opportunities,training, legal concerns. 3, Time-ordering of feedback loops must be [exposed cases] Pros: Report new/unique finding. Rare disease. probability of delivering a malformed fetus and/or receiving Diagnosis: Determines disease and explains symptoms. Two Basic Types: Classical and clinical. stated; sometimes Excess Risk: [risk among exposed] - [risk among Cross Sectional/Prevalence: Study with individual-level hormone treatment. Could lead to spurious association Admitting: Given as reason for hospital admission. Six Tasks: Public health surveillance, field investigation, feedback occurs faster than time-scale of data unexposed] analytic studies, evaluation, linkages, policy development. variables that measures exposure and disease at one point between hormones and congenital malformations. Clinical: Based on medical symptoms. collection Fertility Rate: [live births] / [females 15-44 mid-interval] in Undercoverage: Respondents don’t cover whole population; Dual: Diagnosing two related but separate conditions. Five Objectives: Identify etiology, determine extent in community, study natural history, evaluate preventive (e.g. antibody response to antigen) Herd Immunity Threshold/Level (Ic): 1 – 1/R0. Proportion time. E.g., surveys. exclude or underrepresented some subpopulations Overdiagnosis: Diagnosis of “disease” that won’t cause methods, provide base for public policy. 4, Assumes treatments of one subject does not of Pros: Fastest and cheapest; study several outcomes; cover Verification: Patients w/ negative preliminary tests don’t have symptoms or distress during patient’s life. Types of Epidemiology: affect other pop needed to be immune to avoid widespread outbreaks. large population; generalizable. tests verified. Disease: Harmful deviation from health. Analytic: Concerned w/ how and why health problem subjects (i.e. need to adjust for population Incidence: [new cases] / [person-time] occurs;evaluates association b/w exposure and disease by Cons: Time-order confusion; selection and recall bias; least Volunteer: Those who volunteer differ from others. Acute: With rapid onset and/or short course. immunity) Infectivity: [infected] / [exposed]. Ability to cause infection. confidence; overrepresents long duration; no cause and Reporting: Results are cherry-picked. Chronic: Long-lasting. Controlled but not cured. Causes 36 testing hypotheses. Applied: Application or practice of epidemiology to 5, Primarily used in causal settings, not Likelihood Ratio: effect. Citation: Base analysis on studies found in citations. million deaths per year. Most prevalent include cardiovascular control/prevent health problems. predictive/diagnostic Positive: sensitivity / (1 – specificity); probability person with Ecological/Correlational: Disease rates and exposures Duplicate Publication: Get more weighting than others. (17.5 mil deaths), cancer (7.5 mil), respiratory (4 mil), and Field: Epidemiologist travels to where health problem models disease tested positive compared to person without measured in series of populations and their relation is Language: Ignores studies not published in native. diabetes (1.1 mil). occurs. 6, Not a replacement for analysis and statistical disease. I.e. TP/FP examined. Compare different places at same time or same Location: Some studies are harder to find. Clinical: Manifested by symptoms and features. Classical: Population oriented. Studies community origins of modeling Negative: (1 – sensitivity) / specificity; probability person health problems and sociological, environmental, & population/place at different times. Pros: Fast and cheap Publication: Studies w/ positive findings more likely published. Communicable: Caused by transmission of specific GRADE (Grading of Recommendations, with disease tested negative compared to person without Cons: Hard to interpret; rely on different data sets; Time-Lag: Some studies take years to be published. pathogenic agent to susceptible host. Transmitted directly or behavioral aspects. Clinical: Studies patients in healthcare settings to improve Assessments, Development, and Evaluations): disease. I.e. FN/TN confounding. Simpson’s/Amalgamation Paradox (Yule-Simpson); indirectly. ~30% global deaths. diagnosis and treatment of diseases and prognosis for Evaluates the quality of evidence behind clinical Low Birth Weight Ratio: [births < 2500g] / [births] Experimental/Intervention: Involve active attempt to Trends disappear when groups are pooled. Avoided by Contagious: Capable of transmission from one to another by patients already affected by disease. practice recommendations. Morbidity: Incidence or prevalence of disease. change Mantel-Haenszel test. contact or proximity. E.g. malaria is communicable but not Chronic: Uses complex sampling and statistics. 1) Decide clinical questions: population, >1 Natality: birth rate; shown as crude birth rate or specific Infectious: Relies on lab support. disease determinant or progress through treatment. Combating Bias: Bigger sample size, stringent protocols, contagious. alternative hypotheses, and outcomes that matter birth Preventative or therapeutic. multiple control groups, blinding, dummy variables w/ known Idiopathic: With unknown origin. Descriptive: Organizes and summarizes health-related data by person, place, time. Cannot establish causation. most; systematic review provides best estimate rate Pros: Good internal validity; easier to blind; results can be associations, corroboration of multiple sources, proper Infectious: Change from state of health to which part or all of Environmental: Studies and interprets relationships b/w for absolute effect size (difference of means) of Natural Increase Rate: [birth rate – death rate] analyzed statistically; truly measures efficacy; best for randomization, carefully worded questions (w/o emotional host's body can’t function normally due to presence of environment and health of population. each outcome from treatments. Number Needed to Harm (NNH): Number of people for showing triggers) infectious agent or its products. Experimental: Tests epidemiological hypotheses regarding Effect size = difference of means, correlation whom causation; more easily repeatable. Combatting Confounding: Randomization, matching, Pseudodisease: causative exposures, treatments, etc. E.g., clinical trial coefficient, odds ratio one additional patient experiences a bad outcome. Cons: Time consuming; most expensive; bad external stratification, adjustment, restriction (outlier removal), Type 1: Disease doesn’t progress. Occupational: Studies environmental factors in workplace. Rate evidence; best applied to each outcome Number Needed to Treat (NNT): 1/[absolute risk Shoe Leather: Direct collection of data in field. validity/less generalizable; not good for rare disease; multivariate analysis, statistical modeling. Type 2: Progresses slowly; never becomes clinically evident. because quality of evidence varies between reduction]. sometimes unethical; difficult to find volunteers. GLOSSARY Sporadic: Normally absent from pop but occurs rarely and Theoretical: Uses mathematical and computer models. outcomes. Overall GRADE quality applicable Number of people needed to follow a treatment regimen to Randomized Controlled Trial (RCT)/Clinical Trial: Accuracy: Degree to which measurement is correct on avg. unpredictably. DISEASE OCCURRENCE Cluster: Aggregation of cases closely grouped in space/time across body by taking lowest quality of evidence prevent one bad outcome. Studies Smaller systematic error = higher accuracy. Not affected by Distribution: Frequency, pattern of health event. Analysis of regardless of whether more than expected. (Expected often from all outcomes critical for decisions GRADE Odds Ratio: ad/bc. Used in case control when data doesn’t effects of an intervention (usually treatment). Subjects sample size. places, times, etc. of affected. unknown.) is (1) subjective and rates body of evidence at encompass the whole population. If p-value >0.05 or randomly assigned to treatment or control groups; often Adjustment: Differences in populations being compared Dose Commitment: Total dose equivalent that body, organ, or Epidemic: More cases of disease than expected in large area (2) outcome level, not study level. confidence interval inc. 1, OR is not statistically significant. or group of people over specified period. Does not need to used to test efficacy/effectiveness of intervention. minimized via math. E.g. age-standardized rates. tissue would receive during specified period from radiological affect large number of people. Lowers Tend to overestimate risk; similar to RR when disease Field Trial: Subjects are healthy but presumed at risk; data Agent: Factor or form of energy whose presence, excessive treatment. Epizootic: Outbreak or epidemic in animal populations 1. Risk of Bias (honest): judge if risk of bias in is rare amongst exposed collection “in field”. Aims to prevent disease that may occur presence, or relative absence is essential for occurrence of Dose: Total amount of factor that reaches individual. Endemic: Agent or health condition constantly present at individual studies is sufficiently large that Cohort: disease odds in exposed group (A/B) ÷ disease w/low frequency. Can evaluate interventions aimed at disease/adverse health (see chain of infection). Infective: Amount required to cause infection. continuous level throughout population or geographic area confidence in the estimated treatment effect is odds in unexposed group (C/D) reducing Biological: E.g. virus, bacteria, parasite. Dose-Response Relationship: Amount of exposure has direct Holoendemic: High prevalent infection level begins early in lower. Case-Control: odds cases were exposed (A/C) ÷ odds life & affects majority of child population. exposure w/o measuring occurrence of health effects. Not Chemical: E.g. toxins, alcohol, smoke relationship w/ severity/likelihood of health outcome. 2.Imprecision(accuracy): 95% confidence controls were exposed (B/D) randomized. Cons: Logistically complicated; expensive. Nutritional: E.g. deficiency or excess Typically s-shaped curve. Hyperendemic: High and continued incidence and prevalence. interval for best estimate of absolute effect. Pathogenicity: [ill] / [infected]. Ability to cause disease. Community Trial: Units of study are healthy communities. Physical: E.g. noise, heat, climate, light, weather, radiation DPSEEA: Driving forces, pressure, state, exposure, effect, Hypoendemic: Constantly present at low incidence & Certainty is lower when (1) the clinical decision Person-Time: sum of- person observed x time observed Disease is influenced by social conditions; prevention Characteristics and Calculations: action. Multilayer framework that analyzes different elements prevalence. is likely to be different if the true effect was at Population Attributable Risk Fraction: [incidence total – targets Infectivity: Ability to cause infection. [infected] / [exposed] of causation, prevention, and indicators of environmental Mesoendemic: Affects moderate proportion of population at the upper versus the lower end of the confidence incidence unexposed] / [incidence total] x 100% = group behavior. Not randomized. Cons: Only small number Pathogenicity: Ability to cause disease. [ill] / [infected] health hazards. risk. interval; (2) if the effect estimate comes from prevalence(RR – 1) / Pandemic: Epidemic over very wide area (several countries of Virulence: Ability to cause severe disease. [severely ill or Effects (of Drugs): only one or two small studies; (3) or if there were [1 + prevalence(RR-1)]. Incidence attributed to an communities is included; random allocation isn’t practicable dead]/ [illness] Additive: Response to multiple drugs equals sum of or continents) that affects large proportion of pop. Outbreak: More cases of disease than expected in given few events (for observation). exposure. Useful for (causes bias); difficult to isolate communities from general pathogenicity / virulence = infectivity independent responses. area or group of people over specified period. 3.Inconsistency (reputability): Certainty highest relative importance of exposures to entire pop. social changes; definitive conclusions aren’t always Age-Standardized Rates: Adjusts calculation to standard Antagonistic: Response less than sum of independent —------------------------------------- when there are several studies that show Population Prevented Fraction: Prevalence (1-RR); possible. age structure. Based on Segi’s world pop, European standard responses. Types of Sources: consistent effects. Consider point estimate proportion of disease hypothetically prevented by treatment Quasi-Experimental Study: Investigator manipulates (Swedish pop), WHO world standard pop, etc. Synergistic: Response greater than sum of independent Bimodal: Two peaks similarity, confidence interval overlap, and Precision: Common Source: Cases all exposed to one source. study Antibiotic: Microbial product that kills/inhibits growth of responses. chi-squared tests for homogeneity. Positive Predictive Value: TP/(TP+FP) factor but does not assign individual subjects randomly to susceptible microorganisms Effectiveness: Ability to produce results in field. Continuous: Prolonged exposure. Plateau & more than one incubation period. 4.Indirectness (applicability): Certainty highest Negative Predictive Value: TN/(TN+FN) exposed and unexposed groups. Researcher can control Antibody: Proteins in blood produced in response to antigen. Efficacy: Ability to produce results under ideal conditions. Intermittent Common Source: Exposures to common when study directly compares interventions of Prevalence: [cases] / [average population] or [incidence] the Antigen: Substance (e.g. toxin or surface of microorganism) Efficiency: Ability to produce results w/ minimal resources. source at relatively random intervals. Jagged irregular peaks. interest in the population of interest. Certainty [duration] assignment to treatment condition using some criterion recognized as foreign that stimulates antibody production. Elimination: When incidence is zero (within area) Mixed: Common source followed by propagated spread. lowers when (1) test patients aren't population of Relative Risk: (a/(a+b))/(c/(c+d)). how many times (e.g. Antigenic Drift: Small changes in viruses’ surface proteins Emergence: Pathogen becomes present in new host species. Point-Source: Common source. Cases within one incubation interest, (2) outcomes aren’t realistically exposure changes incidence for individual. Only in cohort period. Has clear peak and sharp decline. Food-borne eligibility cutoff). Cons: Hard to demonstrate cause b/w over time. Produces new strains mostly unrecognized by Emerging Disease: New in population, rapidly increasing in applicable (surgery in highly specialized center studies; can’t be used if incidence can’t be calculated; Can treatment and outcome, membership bias immune system. Previously infected hosts retain some incidence or geographic range, or reappeared. illnesses are often point-source because they often have one source, patients heal relatively quickly, contagion is easy to indirectly applies to general facilities), or (3) also compare a vaccinated (“safer”) group to controls, not ERRORS AND BIAS immunity to drifted strain. Endotoxin (Lipopolysaccharide): Present on surface of stop, and food doesn’t last long enough for more exposure. when studied outcome is a substitute for a just risk groups to controls. Random Error: Sample measurement diverges from true Antigenic Shift: Multiple strains of virus combine. New gramnegative bacteria; released when cells are destroyed by Propagated/Person-to-Person/Progressive: Cases are different Reproductive Rate/Reproduction Number (R0): value subtype has mixture of surface antigens. infection. sources for later cases. Successively larger peaks one outcome – one that’s typically more important to Measles: 12–18. Pertussis: 12–17. Diphtheria: 6–7. incubation period apart. by chance. Can’t be eliminated. Antitoxin: Antibody to microbial toxin. Binds w/ and Environment: Domain where agents exist, survive, or originate the patient. Smallpox: Sampling Error/Variability: Random sample not neutralizes toxin. or all that which is external to individual human host. NATURAL HISTORY OF DISEASE Subclinical Disease: From exposure to symptoms. Factors 5. Publication Bias (transparency)- missing 5–7. Polio: 5-7. Rubella: 5–7. Mumps: 4–7. HIV/AIDS: 2–5. representative. Attribute: Risk factor intrinsic to individual person, plant, etc. Environmental Antecedent: Spectrum of circumstances that that affect length include dosage, host susceptibility, immune evidence SARS: 2–5. Influenza 1918: 2–3. Validity: Systematic Error (Bias): Results differ from true values Background Level: Expected amount of substance. set the stage for illness or outbreak. reaction magnitude, R0 for infectious agent. Raises Sensitivity: TP/(TP + FN); proportion of the positive cases consistently. Can’t be corrected in analysis. Coccus: Spherical. Bacilli: Rod. Spirilla: Spiral. Vibrio: Environmental Audit: Assessment of extent to which an Incubation (Prodromal) Period: Subclinical for infectious. 1.Large magnitude of effect: can imply there’s at recorded Latency Period: Subclinical period for chronic diseases. Confounding: Distorts association b/w exposure & Comma. Spirochete: Corkscrew organization observes practices that minimize harm to least a small effect Specificity: TN/(TN + FP); proportion of the negative cases outcome via third variable related to both. Age & social Biological Marker: Traceable substance introduced into environment. Symptom Onset: Doesn’t always align w/ diagnosis. 2. Dose-response gradient: clear relationship Exacerbation: Period where signs and symptoms increase recorded class often confound. Doesn’t result from errors in research organism to examine organ function/health. Epidemic-Curve: Histogram showing course of disease or Convalescent Period: Recovery from disease. between dosage and response Virulence: [dead/severely ill] / [ill]. Ability to cause severe design. Confounder must be determinant of occurrence of Biosafety Level (BSL): Biocontainment precautions required outbreak to identify source of exposure. X-axis-units of time = 3. All residual confounding would decrease disease. DS. e.g. pollution causes cancer and associated with for isolating dangerous biological agents in enclosed lab 1/3-1/4 of incubation time. Y-axis-# of new cases 10/13 STEPS OF OUTBREAK INVESTIGATION magnitude of effect (in situations with an effect) Vaccination Level (Critical): Vc=(1 – 1/R0) / E exposure (smoking) facilities. Ranges from BSL-1 (lowest) to BSL-4 (highest). Epidemic Investigation: Determines causes & possible 1/1) Prepare for Field Work: research disease, gather SURVEILLANCE Needed to reach herd immunity. E=reduction in Positive Confounding: Observed association biased away Body Burden: Total amount/concentration of substance in control measures for outbreaks of disease. supplies, administrative+travel arrangements, contact local Surveillance: Ongoing systematic collection, transmission to and from vaccinated compared with control sources. from body. Epidemic Threshold: Point where disease in question analysis, interpretation, and dissemination of group. null. Broad-Spectrum Drug: Chemotherapeutic agent effective becomes epidemic. 2/2) Establish Outbreak Existence: Saves resources and prevents unnecessary public panic. Examine past death & health data. Vaccine Efficacy/Effectiveness: 1 – RR Negative Confounding: Biased toward null. across wide range of pathogens. Equipoise: Ethical basis that presumes all treatment or hospital records for expected # of cases. May exceed normal Steps: YLD (Years Lost to Disability): [incident cases][disability Hawthorne/Observer Effect (Performance Bias): Individuals Carrier: Harbors infectious agent. control groups within clinical study are roughly equal or there due to season, population, better reporting. 1 Data Collection: Reported disease, clinical weight][average duration before death] modify or improve behavior in response to awareness of Asymptomatic/Healthy/Passive/True: Never experience is no significant prior knowledge that one will provide 3/3) Verify Diagnosis: Double checking methods & for health records, vital YLL (Years of Lost Life): sum of - [deaths at each errors; interviewing for commonalities; determining agent. being symptoms despite being infected. substantial benefit/harm. records, registries, surveys. age][expected observed. Incubatory: Transmits agent during incubation period before Eradication: Termination of transmission of an agent. 4/4) Construct Case Definition: (1) Clinical info, demographics, location, time (2) Identify: Confirmed (lab), 2 Analysis: By location. remaining years left] Measurement/Information/Misclassification Bias: Info clinical illness. Etiology: Study of cause of disease. Probable, Possible + expand search (3) Line Listing: 3 Interpretation: Person, place, time. STATISTICS collected differently b/w study group or individual Convalescent: Recovered from illness but remains capable of Etiologic Agents: Materials known or expected to contain Name,onset,symptom,diagnosis,gender,sex,adress,doctor,@ 4 Dissemination to public health practitioners, Cochran-Mantel-Haenszel (CMH) Test: Analyzes stratified x event measurements/classifications of disease/exposure are transmitting. pathogen. healthcare ormatched categorical data in K strata (each w/ inaccurate. Must be systematic. Chronic: Harbor pathogen for months or years after initial Exclusion Criteria: Conditions that prevent entrance of 5/5) Find Cases Systematically and Record Data:Identifying information:patient providers, policymakers, the public via health contingency table). Assumes effect of other variables on Ascertainment: Measurement bias in frequency of situation. Infection. candidates into an experiment. contact,Demographic:persons,Clinical:development,sympto agency confounding variable is homogenous across stratas. Compliance: Participants compliant w/ intervention differ Transient: can transmit for short/limited period of time Exposure: contact or characteristic that puts at risk ms,Risk Factor:tailor to situation,Reporter:source(may need newsletters/bulletins/alerts, surveillance from Genetic: Recessive carrier. Acute: Up to fourteen days. to report back or request more) summaries/reports, 6/6) Perform Descriptive Epidemiology: time-epi those not. Case: Instance of disease or health condition that meets case Intermediate: Over fourteen days and less than one year. journals, press release, social media, etc. Confirmation: Search for and use of information to support definition. Chronic: Over a year. curve,place-spot maps,person 6/7) Develop Hypotheses:epi triad->transmission chain. 5 Link to Action: Monitor/evaluate usefulness of an Confirmed: Has laboratory confirmation. Exposure Assessment: Estimates or measures current knowledge, testable surveillance. individual’s ideas, beliefs, or hypotheses. Probable: likely do to symptoms or lab evidence, but not magnitude,frequency, and duration of exposure to agent. 7/8) Evaluate Hypotheses: observational or experimental Objectives: Identify public health priorities, Contamination: intervention-like things make their way into reach criteria to be confirmed. Extinction: Agent no longer exists in nature or lab. (only lab can confirm); false relationships: random error, monitor severity of McNemar’s Test: Applied to paired contingency tables. bias - internal/external validity, information, control groups Index: First case coming to attention of health authorities. FAT TOM: Food, acidity (Ph 4.6-7.5, thrive in 6.6-7.5), time selection(systematic); non-causal: confounding. emergency, detect outbreaks and monitor Checks consistency of paired data e.g. patients reporting Early-Diagnosis/Intervention: Overestimates survival Primary: First disease case in an epidemic (2-4 hrs), temp (41-135, thrive in 70-104 F), oxygen, moisture 7/9) Reconsider, Refine, Re-evaluate Hypotheses: no response, provide info knee pain before and after surgery -> did the distribution of duration Secondary/Epidemiologically Linked: Infected from contact w/ (activity.95-1) confirmation= find new vehicle; find source: “how did it to ministry of health, etc. responses change? among cases detected by screening. Caused by lead-time, primary/source case. Conditions required for growth of foodborne pathogens. happen?”; increase scrutiny Types: length time, or overdiagnosis. Source: Patient or thing responsible for transmitting infection Fomite: Inanimate object that transmits pathogen. Excludes: 7/10) Compare and Reconcile w/ Studies: verify w/ Active: Investigator solicits reports. Used w/ lab/environmental studies. Apply causation criteria Lead-Time: Earlier diagnosis leads to longer perceived to others; gives rise to outbreak or epidemic. food, air, liquids. specific survival Case Definition: Set of criteria for determining whether Framingham Study (1948-2001): Cohort study by Doll and 8/11) Implement Control and Prevention: Start/continue active surveillance, break transmission chain, reduce epidemiologic investigation (e.g. epidemics). duration. Use mortality (not survival rate) to reduce. person should be identified as having a particular disease. Hill. Studied risk factors for variety of diseases susceptibility: laws, immunization, education. Pros: Most Length: Slowly-progressing cases (long latency) are more Specifies clinical criteria (symptoms) and details of person, (cardiovascular, respiratory, musculoskeletal). 9/13) Communicate Findings: (1) Oral briefing, (2) Written complete. Cons: Expensive. likely place, time. Frequency Polygon: Graph of frequency distribution with report for future. Often part of previous step Medical: Monitors those exposed to detect early Fisher's Exact Test: Test non-random associations between to be detected & increase average survival time. Sensitive: Detects many cases but may also include values of variable on x-axis and number of observations on 10/12) Initiate/Maintain Surveillance: See if strategy is symptoms. working 2 categorical variables. Use if >20% of expected cell counts Overdiagnosis: Inclusion of pseudodisease (disease non-cases. y-axis. Middle of top of bars are connected with a straight PREVENTION Passive: Healthcare providers send data to 15kb, electrodes usually at 4 corners (120 d), Funding/Sponsorship: Study’s outcome more likely to Case Report: Detailed record of symptoms, signs, diagnosis, accepted as best available; ideally perfect sensitivity and to disease. Most effective in youth Primary: Prevents exposure in at-risk individuals. Sentinel: Preselected sources (e.g. physicians, (-) to (+), shorter = longer fragment support treatment, follow-up of individual patient. May contain patient specificity. Examples: hospitals, clinics) SNP (single substitution of DNA base pair) Mapping: helps interests of group funding study. demographic. Usually describes unusual/novel occurrence. Gram Staining: Positive: Purple. Stain interacts w/ Vaccine, education, general sanitation, etc. agree to report all cases of notifiable disease. find disease causing genes and variations in drug treatment Instrumentation: Improperly calibrated measuring devices. Census: Enumeration of population usually w/ details of peptidoglycan layer (lacks outer membrane). Negative: Secondary: Before symptom onset. Screening and Pros: Consistent effects. treatment. Interviewer: Different interview styles cause different residence, age, etc. Pink.Outer endotoxin membrane layer over peptidoglycan high quality, rapid, economical. Cons: PulseNet: Uses whole genome sequencing to record responses. Chain of Infection: Infectious agent, reservoir/host, portal of layer. Smoothness increases virulence and helps resist Pros: Prevents large impact. Cons: More expensive than Unrepresentative bacteria; implement metagenomics to directly extract from Misclassification: Subjects incorrectly categorized w/ exit, mode of transmission, portal of entry, infects susceptible antibiotics. primary; primary is more effective. Examples: PCR (polymerase chain rxn) testing, samples, less effective for rare disease. stool without culture-> can analyze genetic similarities respect to host. HDI: Human development index. Ranks countries by combo notify other exposed, etc. Syndromic: Focuses on symptoms (not (might be part of the same outbreak) and exposure status or outcome. Due to incomplete medical Chain of Food Production: of Tertiary: During symptomatic stage. More effective when diagnosed or lab confirmed). Analyze medical catch future outbreaks. Largest library is salmonella. 83 records, recording errors, misinterpretation, etc. Production: Growing plants/animals. Contam: irrigation economic development, literacy, education, life expectancy, early. Examples: Treating secondary infections and data to detect/anticipate outbreaks. labrotatores. Est. 1996 symptoms Nondifferential: Incorrect info is same across groups; water, animals consume toxins. etc.. Good when diagnosis is difficult/expensive. Pros: Line Listing - List of people and various variables unrelated Processing: Washing, sorting, trimming, slicing, shredding, Healthcare Approaches: (painkillers), antibiotic, etc. Quick. Quaternary: Mitigate future intervention. Examples: Rehab STUDIES to occurrence/presence of disease. Bias usually goes pasteurizing, cooking, freezing, combining, etc. Contam: Clinical: Diagnosis, prevention, and treatment of illness in for TRANSMISSION Observational: Descriptive or analytical. toward null. water, germs from animal hide, surfaces. individuals. E.g. prescribing drugs. addiction prevents further issues, physical therapy prevents Contact: Analytical: Identifies/quantifies associations and tests Differential: Errors differ for study vs comparison groups. Distribution: Transport from farm/plant to food service facility. Public Health: Control and prevention of disease in surgery. Direct: Through touching. Prevent w/ gloves etc. hypotheses. Has a control group. Observer/Research/Experimenter: Differences info Contam: truck, warm weather (bacterial growth). populations CAUSATION Droplet: When coughed on etc. Droplets must Cohort: Grouped by exposure status and monitored for collection for groups due to investigator’s prior knowledge Preparation: Getting food ready to eat. Contam: not washing or groups of individuals. E.g. handwashing awareness Cause: Directly influences occurrence of disease. travel at velocity disease outcome. Retrospective or prospective. Uses RR. Rothman’s Sufficient Cause: of hypothesis or of individual’s exposure/disease status. hands, surfaces, cross-contamination. campaign. nearly equal to initial (~1 m away). Mostly Cannot establish causation but can suggest association. Observation: Flawed measurement of exposure/outcome Chemotherapeutic Agent: Compound used in disease Health Disparity: preventable differences in disease burden Component: Contributes to sufficient cause. Not always necessary to individually identify because outcome will not respiratory disease. Pros: Most accurate observational study; good for rare data treatment that kills/inhibits growth of microorganisms at due to low socioeconomic status. occur if any one component is blocked. (E.g., flu, SARS). exposures, multiple exposures, small and well defined that causes different info quality b/w comparison groups. concentrations low enough to avoid damage to host. Health Indicator: Variable measured to reflect state of health. Necessary: Component that must be present for health Indirect: populations, long term studies, etc; can calculate incidence; Recall: Cases tend to have better recall. Clinical Criteria: Medical features (E.g. symptoms, medical Health Information System: Combination of health statistics problem to occur. Airborne: Liquid droplets remain as aerosols are no Sufficient Cause: Synonymous w/ biological occurrence. Response: Question wording or social desirability cause examination findings, laboratory results) used in a case from different sources. Data are used to learn about health associate w/ dust. Requires more durability than selection or recall bias; usually generalizable; bias in definition. status, Total causal pie droplet. ambidirectional. responses. Cohort: Well-defined group with common exposure. health care, provision and use of services, and impact of makes up one sufficient cause. Components need not act simultaneously. Food-Borne: Through food. E.g. salmonella. Cons: More expensive; bad for rare diseases; attrition (low Courtesy: overstate positive and understate negative Cohort Effect: Membership bias; groups with shared life services Bradford Hill’s Criteria for Causation: Water-Borne: Through fecal contaminated water. follow-up) bias. Question-Order: serial position effect; order of questions experience or generation (shared exposures) tend to possess and programs on health. Strength of Association: Relationship clear; risk estimate Vector: Transmission of agent via living Ambidirectional: Both retrospective and prospective affects responses similar characteristics. Health Planning Cycle: Assessing burden, identifying causes, high. intermediary. phases. Consistency: Observation of association repeatable in Social Desirability: answering in accordance to social Contingency Table: Exposure on left; disease on top measuring effectiveness of existing interventions, Arthropod: Insect. Through proboscis/feet or Case Control: Identifies individuals who develop disease norms Co-Interventions: Interventions other than treatment under determining different populations at different times. biologically. (cases) and individuals without (controls); determines Demand: answering falsely due to awareness of being study possibly applied differently for study & control groups. efficiency, implementing interventions, monitoring activities, Specificity: Single cause produces single effect. Biological: Agent undergoes previous studied Serious problem when double-blinding is absent or when very and measuring progress. Alternative Explanations: Multiple explanations considered. maturation/multiplication within exposure(s) for each case and control. Control group is Acquiescence: People tend to say yes or agree effective non-study treatments are used. Healthy Worker Effect: Employed people have lower Temporality: Cause/exposure precedes effect/outcome. vector. drawn Dissent: People tend to disagree Comorbidity: Presence of disease in patient other than mortality. Dose-Response: More exposure means more risk. Colostral: Vertical transmission via successive from comparable population. Uses odds ratio because Extreme Responding: Rater tends to give extreme answers studied disease. Homeopathy: System of alternative medicine. Developed Biological Plausibility: Association agrees w/ currently generations. information isn’t from entire population. Longitudinal accepted Neutral Responding/Central Tendency: Rater tends to rate Complement System: Group of circulating plasma proteins 1776 Cyclopropagative: Agent undergoes development retrospective. most items in middle of scale. that plays major role in an animal’s immune response. by Samuel Hahnemann. States substance that causes understanding of biology and pathology. Experimental Evidence: Condition can be altered (prevented and multiplication in vector. Pros: Good for rare diseases/long latency; cheaper and Texas Sharpshooter Fallacy: Differences in data are Compliance: Extent to which patients follow medical advice. symptoms or Developmental: Agent undergoes some quicker ignored but similarities are stressed. Contact Tracing: Finds individuals w/ close contact w/ in healthy people will cure similar symptoms in sick people. accelerated) by experimental processes. development in vector. than cohort; less loss to follow up; study many risk factors Selection Bias: Systematic difference b/w subjects infected and monitors them for incubation period. Host: Person/organism that can be infected by agent. Coherence: Association compatible w/ current theory and Fecal-Oral: Agent shed in feces and acquired at selected for study or between groups. E.g. people with Contamination: Agent within host but has not invaded Compromised: Lowered resistance to infection & DS knowledge. through ingestion. once. Koch’s Postulates: symptoms (confounding) or suspicion of cervical cancer tissues. Definitive: Hosts adult (reproductive) form of agent. Harborage: Agent doesn’t undergo physiologic Cons: Selection and recall bias; time-order confusion; can’t selected to test sexual activity effect on cervical cancer. Counterfactual Ideal: Exposed and unexposed cohorts have Intermediate/Secondary: Hosts immature or nonreproductive 1 The microbe must be present in abundance in all cases of the disease, but not in healthy organisms. change in vector. calculate incidence; can’t establish causal relationship; less Symptoms or cancer might have nothing to do with sex. equal size. forms. 2.The microbe must be isolated from the diseased organism Iatrogenic: Due to medical procedures (or in generalizable. Allocation: Improper randomization. Cox Proportional Hazards Models: can predict the effect Paratenic: Intermediate host required for parasite’s life cycle and grown in pure culture. hospital). Nested Case-Control (NCC): Cases and controls drawn Attrition: Difference b/w initial and ending samples (clinical). of several variables upon the time a specified event takes to but agent doesn’t grow there 3.The cultured microorganism should cause disease when Parenteral: Transmission other than through from introduced into a healthy organism. Collider/Berkson’s Paradox: Cases and controls same happen. The response variable is the hazard function λ(t), Reservoir: Primary host that shows no symptoms. Agent mouth (e.g., syringe). cohort study. from same subpopulation (e.g., hospital, autopsy sample, which assesses the probability that the event of interest grows there. Source of infection. 4.The microbe must be reisolated from the inoculated, Propagative: Agent multiplies in vector. diseased experimental host and identified as identical to the Pros: Cheaper and more efficient; less selection and etc.) occurred before t. Susceptible: Can’t effectively resist invasion. Incl. children original specific causative agent. Transovarial: Transfer of pathogens to successive information People w/ multiple diseases are more likely to be Culture-Independent Diagnostic Test (CIDT): Identifies under five, the elderly, immunocompromised. Cons: generations bias. hospitalized. bacteria without having to culture in lab. Faster than typical Host Factor: Traits of individual that affect susceptibility. E.g. 1.Not all stages of diseases have live agent through invasion of ovary and of eggs. Primarily Cons: Reduces power from parent cohort (reduced sample Chronological: Study participants are subjected to different testing but cannot perform tests on bacteria. sge, religion, marital status, nutrition, previous exposure, race, 2.Not all agents can be cultured arthropods size). 3.Some agents are unique to certain organisms exposures w/ different risk from participants who got Declaration of Helsinki (1964): Developed by World Medical substance abuse history. (ticks and mites). Matched: Match cases/controls according to baseline recruited Association. Set of ethical principles when researching Hypothesis: Testable statement of relationship (between 4.Slow growing agents may lose to faster one. Transstadial: Pathogen remains w/ vector from 5.Not all organisms exposed will acquire disease measurements of confounding variables. earlier. human populations. exposure and disease). Should be clear, testable/resolvable, Evan’s Postulates: one life stage to Case-Cohort: Cases and controls are drawn from Diagnostic Suspicion/Provider: Perceptions, prejudices Determinant: Underlying social, economic, cultural, state 1.The prevalence of the disease should be significantly next. E.g., Borrelia burgdorferi (Lyme) infected prospective affect environmental factors that affect health/disease changes. relationship, specific, consistent with known facts, supported higher in those exposed to the risk factor than those not. tick vector as study. Cases who developed outcome during follow-up are 2.Exposure to the risk factor should be more frequent among diagnosis. Often when knowledge of exposure is used as Environmental: Extrinsic factor (E.g. geology, climate, insects, by larva. compared with random sample of cohort. The randomly diagnostic criterion. sanitation, health services) that affects agent & opportunity research or theory. those with the disease. Vertical: Between generations. selected Exclusion: Exclude participants to prevent confounding; for exposure. Alternative: H1: Association (between exposure and disease). 3.In prospective studies, the incidence of the disease should be higher in those exposed to the risk factor. CALCULATIONS control group could include cases and is selected causes Extrinsic: Normally associated w/ some environmental Null: H0: No association (between exposure and disease). 4.The disease should follow exposure to the risk factor with Absolute Risk: [affected] / [at-risk]. Similar to beforehand. skew. influence on host or agent (or intermediate host or vector). ID50: Median infective dose; infects 50% of experimental a normal or log-normal distribution of incubation periods. incidence. Case-Crossover: Self-matched; used when risk Exposure Suspicion: Health outcome/diagnosis leads to Accidental: hazardous situations, speed, influence of group. Measures pathogenicity. 5.A spectrum of host responses along a logical biological Doesn’t consider different risk factors. factor/exposure gradient from mild to severe should follow exposure to the more drugs/alcohol. Biological: Bacteria, viruses, etc. Chemical: Immunoassay: Measures presence/concentration of risk factor. Absolute Risk Reduction: P(Disease w/o is transient. Each person has case window and control intense hunt for exposure. tobacco, chemicals, dust, skin irritants, CO macromolecule in solution through antibody or 6.A measurable host response should follow exposure to the treatment) - P(Disease w/ treat) window; Healthy Worker Effect: Those who work are healthier; poisoning.Reinforcing: Repeated exposure, environmental immunoglobulin. risk factor in those lacking a response before the exposure or Accuracy: (TP + TN) / (TP + TN + FP + FN) risk exposure during each window is compared. doctors conditions, etc. aggravate established disease/injury. Ex: Impairment: Any loss/abnormality of psychological, increase the response in those with a response before Attack Rate: [ill] / [at-risk]. Measures speed of Pros: Efficient; self-matching and select only cases; can exposure. A host response should be infrequent in those not are more likely to be healthy. excessively hard work. Physical: E.g. climate, noise, radiation physiological, or anatomical structure/function. spread in at-risk use Hospital Admission Rate: Samples come from hospital. Precipitating: Exposure to agent associated w/onset of Immunity: State of protection against infectious disease. exposed to the risk factor. 7.In experiments, the disease should occur more frequently population. Usually associated w/ epidemic multiple control windows for one case window. Severe disease..Intrinsic: Physical or physiological characteristics of Conferred either through immune response generated by in those exposed to the risk factor than in the control group. situation. Actually a Cons: Information bias; inaccurate recall; must select cases are more likely to be hospitalized. host or agent (or intermediate host or vector); generally immunization, previous infection, or other non-immunological 8.Reduction or elimination of the risk factor should reduce proportion. control Membership: Groups are based on characteristics that genetic. Predisposing: Non-environmental. E.g. age, sex, factors. the risk of disease. Secondary: [cases among contacts] / [total window carefully; care in choosing length and timing of 9.Modifying or preventing host response should eliminate or affect genetic traits.Enabling/Disabling: Relating to environment Acquired: Develops after exposure to antigen or antibodies contacts] windows. outcome. E.g. quasi-experiments that alter risk. E.g. low income, poor nutrition, housing, transfer from one to another. decrease disease. Attributable Number: [number Etiologic: Planned examination of casualty and natural Loss to Follow Up: Those who exit study differ from exercise, diet. Psychological: stress, unemployment. Active: Long-term. Immune memory(E.g. vaccine). 10.All findings should make biological and epidemiological sense. exposed][incidence exposed – history remaining. Nutritional: E.g. iron deficiency, [Inoculation: Purposeful infection of weak antigenic Direct Acyclic Graphs: incidence unexposed]. Gives cases attributable to of disease; require increasingly sophisticated analytic Neyman’s/Prevalence-Incidence: Very sick/very well substance exposure. methods excluded; to stimulate antibody production (vaccine).] Attributable Proportion: [risk exposed – risk as importance of low-level exposures is explored and skews toward average. Usually when time has passed b/w Cross: Immunity to agent provides immunity to another unexposed] / greater exposure and investigation. Common w/ case-control & related [risk exposed]. Measures a factor’s impact on refinement in exposure-effect relationships is sought. cross sectional. E.g. Case-control only inc. hospital agent. Ex. cowpox/smallpox; TB/leprosy. public health. Panel: Longitudinal study of cohort w/ something in admission. Very sick die before admission and mild cases Herd (Community): Resistance an entire group; result of Assumes one risk factor. common aren’t admitted. Thus severe cases are studied, but not many Attributable Risk: P(Disease w/ exposure) - w/ multiple measures over time. Limited sampling with fatal ones in population being immune. P(Disease w/o exp); a/(a+b) - c/(c+d); how respect Nonresponse: Respondents differ from others (often w/ Inherited: Develops before birth. many times exposure increases incidence of to exposure; not necessarily disease-free at initial. No sensitive info). Passive: Through IgG antibodies via placenta; maternal group; cannot calculate in retrospective study, specified Publicity/Awareness: Media attention increases reporting. antibody but population AR can be estimated. outcome of interest. Referral/Admission Rate: Referrals lead patients to tertiary transfer. Short-term (~6 months). Birth Rate: [live births] / [mid-period pop]. Longitudinal: Follows groups across time to watch for centers that treat specific exposure/disease; raises Infection: Usually expressed development of disease. Repeatedly observes same proportion of more severe/unusual cases. Iatrogenic: Caused by medical examination or treatment. per 1,000. variables Streetlights Effect: Data is collected where data collection is Nosocomial: From a hospital. C: Ice Cream causes Case Fatality Rate / Lethality: [deaths] / over long periods. easy e.g. during convenience sampling In Silico: Experiment done in computer simulation. shark attacks. CF: Hot [cases]. Measures Descriptive: Describes occurrence in population; studies In Situ: Experiment done in nature. weather makes people disease severity. distribution of problem by cases/outcome, frequency, In Vitro: Experiment in artificial environment outside living get ice cream and go to Crude Rate: Without adjustment. exposure, In Vivo: Experiment within living organism. beach. Death Rate/Mortality: [deaths] / [mid-interval time pattern, or environmental factors. First step in Coll: Lung cancer pop] outbreak increases HIV Age-Adjusted: Statistically modified to eliminate investigation. CF: study done in effect of different age distributions among hospital; more likely different pop. to be hospitalized Adult: For age 15-60 Child: Under five.Infant: w/ multiple diseases Under one year.Maternal: Maternal deaths from puerperal causes.Neonatal: Before 28 days.Postneonatal: Between 28 and 365 days..Disease--Microbe/Virus-Incubatory/Latency-Symptom-Transmission-Prevention MISCELLANEOUS Chickenpox-varicella-zoster virus-14 to 16 days-itchy blister rash appears 10 to 21 days after Index Test: Test offered to contacts or children of HIV 10 Most Important Public Health Issues: Alcohol-related harms, food safety, healthcare exposure and usually lasts about five to 10 days, fever loss of appetite, headache, positives Induction Time: Time for accumulation of exposure until associated infections, heart tiredness-direct contact, inhalation of aerosols from vesicular fluid of skin lesions-chickenpox disease. disease/stroke, HIV, motor vehicle injury, nutrition/physical activities/obesity, prescription vaccine Shingles-varicella zoster-2–3 weeks and is usually 14–16 days-Shingles causes a Infection: Invasion of bodily tissues of host by infectious drug overdose, teen pregnancy, tobacco use. painful rash that may appear as a stripe of blisters on the trunk of the body. Pain can persist agent Visual Data: even after the rash is gone (this is called postherpetic neuralgia)-direct contact with fluid from regardless of whether it causes disease. Bar Chart: Compares categorical data Autogenous: Results from patient’s own microflora the rash blisters.-shingles vaccine Common cold-rhinoviruses-24 to 72 hours-Sneezing.Stuffy Histogram: Summarizes discrete or continuous data w/ intervals nose.Runny nose.Sore throat.Coughing. Mucus dripping down your throat (post-nasal drip) Watery eyes. International Health Regulations: Adopted 1969 to control cholera, plague, yellow fever, smallpox. Revised 2005. Pie Chart: Represents part-to-whole relationship Fever (although most people with colds do not have fever)-contact with infected secretions from Obliges People: contaminated surfaces, inhaling the airborne virus after sneeze or cough Lyme-Borrelia burgdorferi countries to notify WHO of “public health emergencies of int’l Surgeon General: Vivek Murthy and rarely, Borrelia mayonii-1 to 32 days-causes a rash, bull's-eye pattern flu-like symptoms. Joint pain, concern”, verify outbreaks at WHO’s request, maintain CDC Director: Mandy Cohen national Jonas Salk- Largest field trial (1954); Polio weakness in limbs-infected ticks-using insect repellent, removing ticks promptly, applying pesticides, core capacity for early warning and response, cooperate w/ Edward Jenner - Vaccines, smallpox reducing tick habitat. HIV/AIDS-human immunodeficiency virus-about 9 months to 20 years or rapid international risk assessment & assistance. Worldwide Smallpox Eradication: 1960-1977, last in Somalia, Ali Maow Maui longer, with a median of 12 years-Rapid weight loss, fever, night sweats, tiredness swelling of lymph Intoxication: Caused by ingestion of food already contaminated Louis Pasteur 1822-95- Lab techniques, rabies, anthrax, pasteurization of wine, germ glands in armpits, groin, neck, Diarrhea, Sores of mouth, anus, or genitals, Pneumonia, Red, brown, pink, by toxins. E.g. Clostridium botulinum. theory purplish blotches on the skin/inside the mouth, nose, or eyelids, Memory loss, depressio,infected blood, Isolation: Separation of infected persons to prevent William Farr (1807-83) - Father of Medical Statistics; mortality rates in Cholera semen, or vaginal fluids-HIV antivirals, Use condoms.Get tested. Be sure you and your partner are transmission. outbreak tested for HIV and other STIs. Be monogamous. Limit your number of sexual partners. Get vaccinated. Job Exposure Matrix (JEM): Measures relative exposure. Pros: Available for wide range of occupational exposures; no John Snow (1813-58) - Father of Epidemiology, descriptive Don't douche. Do not abuse alcohol or drugs. Meningitis-Streptococcus pneumoniae, Haemophilus recall bias; estimates of probability can be used to stratify John Graunt 1620-74- Columbus of Statistics, Royal Society of London influenzae, Neisseria meningitidis ae the most frequent ones-1-10 days after exposure, but usually relative risk or odds ratio calculation. Cons: Categories may Robert Koch (1834-1910)- Tuberculosis bacterium (1905), anthrax growth, germ less than 4 days-a high temperature, cold hands/ feet, Vomiting, confusion, breathing quickly, muscle and not be comparable across studies; misclassification risk; time theory joint pain, pale, mottled or blotchy skin, spots or a rash, headache, a stiff neck, a dislike of bright lights, consuming. Hippocrates (460-377)- introduced epidemic and endemic. Epidemic 1, 2, and Ons being very sleepy,difficult to wake, fits (seizures)-sharing saliva or spit-meningitis vaccine LD50: Median lethal dose; required to kill half of tested pop. Airs, Waters, Places Lead Time: Interval between when disease can be Pneumonia-influenza, respiratory syncytial virus (RSV), and SARS-CoV-2-2-5 days-Pain types: can Thomas Sydenham 1624-1689: Classify fevers in London (60-70), treatments inc. diagnosed be sharp in the chest. Whole body: fever, chills, dehydration, fatigue, loss of appetite, malaise, clammy fresh air, exercise, diet and when it’s usually diagnosed in patients w/ symptoms. James Lind: Scurvy on HMS Salisbury 1764 skin, or sweating, Respiratory: fast breathing, shallow breathing, shortness of breath, or wheezing. Also Life Expectancy: Average number of years person of given age is expected to live if current mortality rates continue. Benjamin Jesty 1736-1816: Inoculation, cowpox resistant to smallpox common: coughing or fast heart rate-Inhaling the infection-Get the flu vaccine each year. People can Lines of Defense: Ignaz Semmelweis 1818-65: father of infection control; hand washing; mothers w/ develop bacterial pneumonia after a case of the flu.Get the pneumococcal vaccine. Practice good Skin and Secretions: Initial barrier. Mucus catches pathogens childbed fever hygiene. Don't smoke. Practice a healthy lifestyle. Avoid sick people.(more respiratory than flu;flu has and enzymes kill them. Antoni Van Leeuwenhoek (1632-23) - perfect microscopes, animalcules (microbes) more body aches,can be caused by bacteria or virus, flu=only virus) Malaria-Plasmodium, which is Inflammatory Response: Injury/tissue damage releases chemical signal and blood flow increases. Heat, redness, Bernardino Ramazzini 1633-14 - Father of Ergonomics normally spread through infected mosquitoes-7 to 30 days-Fever and sweating.Chills that shake pain, swelling. Florence Nightingale (1820-10) - Nursing the whole body.Headache and muscle aches.Fatigue. Chest pain, breathing problems and cough.Diarrhea, Phagocytosis, Natural Killer Cells, Interferon Mary Mallon - asymptomatic typhoid cook infected 250 people nausea and vomiting.As malaria progresses, it can cause anemia and jaundice (yellowing of the skin and Lowest Observed Adverse Effect Level (LOAEL): Lowest Lemuel Shattuck (1793-59) - state legislator MA, sanitization standards, tuberculosis whites of the eyes).-bitten by an infective female Anopheles mosquito-using insect repellent, covering dose observed that causes harmful effects. research Maps: your arms and legs, and using a mosquito net Measles-Measles morbillivirus-11 to 12 days-high Alice Hamilton 1869-1970: First female faculty of Harvard, First occupational disease fever (may spike to more than 104°),cough,runny nose (coryza), and red, watery eyes Choropleth: Pre-defined areas (usually political boundaries) are colored or patterned in proportion to a variable. investigator, Toxicology (conjunctivitis),direct contact with infectious droplets or by airborne spread when an infected person Cons: Falsely interpreting sharp differences at borders; Edgar Sydenstricker (1881-36)- Morbidity statistics system in U.S. breathes, coughs, or sneezes- no treatment to get rid of established measles infection, but shaded Wade Hampton Frost (1880-38) - Father of Modern Epidemiology, analytical over-the-counter fever reducers/ vitamin A help with symptoms. Tetanus-Clostridium tetani- areas aren’t uniform; interval sizes can be misleading. Jane Lane Claypon 1877-1967 - Breast Cancer Epidemiology Heat: Uses geographic information systems. Walter Reed - cause of yellow fever in 1900 (arbo or mosquito virus) within 14 days-painful muscle contractions( jaw, neck) It can interfere with the ability to breathe, Spot: One dot represents one case. Framingham Study - National Heart Institute Study on Cardiovascular Disease launched eventually causing death-direct transfer of C. tetani spores from soil and excreta of animals and humans Miasmatic Theory: States miasma (bad air emanating from 1948, currently in 3rd generation to wounds and cuts-antibiotics and supportive care. Vaccination,good wound care rotting organic matter) causes disease. Replaced in 1800s by germ theory. 1857: Quarantine conventions held in Philadelphia for preventing cholera, typhoid, and Tuberculosis-Mycobacterium tuberculosis-2 to 12 weeks-don't have symptoms may cough Millennium Development Goals (MDGs): Officially yellow fever (sometimes blood-tinged), weight loss, night sweats, and fever-n inhales droplet nuclei containing M. established following Millennium Summit of United Nations in 1879: Hygiene and Public Health by A.H. Buck tuberculosis, droplet nuclei traverse the mouth or nasal passages, upper respiratory tract, and bronchi to 2000 to achieve by 2015. 1902: U.S. Public Health Service Est. reach the alveoli of the lungs mask on the patient, appropriate patient placement in airborne infection 1 Eradicating extreme poverty and hunger. 2 Achieving universal primary education. 1906 - Pure Food and Drug Act -> FDA, first standards of water analysis isolation room West Nile fever-West Nile virus-2 to 6 days-No symptoms in most,.symptoms such as 3 Promoting gender equality and empowering women. 1913 - Harvard Univ starts first school of public health, pasteurization found to help milk headache, body aches, joint pains, vomiting, diarrhea, or rash..Serious symptoms in a few people. severe 4 Reducing child mortality rates. illness affecting the central nervous system such as encephalitis (inflammation of the brain) or meningitis 5 Improving maternal health. AAP American Academy of Pediatrics AAFP American Academy of Family Physicians (inflammation of the membranes that surround the brain and spinal cord)-Mosquitoes become infected 6 Combating HIV/AIDS, malaria, and other diseases. AAHP American Association of Health Plans ABCs – Active Bacterial Core when they feed on infected birds. Infected mosquitoes then spread West Nile virus to people and other 7 Ensuring environmental sustainability. Surveillance ACASA Adult Clinic Assessment Software Application ACET – Advisory 8 Developing global partnership for development. animals by biting them-West Nile is to protect yourself from mosquito bites Whooping cough Council for the Elimination of Tuberculosis ACIP Advisory Committee on Misclassification: (pertussis)-Bordetella pertussis-7 through 10 days-Cough: can be chronic or severe, Nasal: congestion, Immunization Practices ACOG American College of Obstetricians and Gynecologists Differential: Extent of misclassification different between study AFIX Assessment, Feedback and Incentives Exchange AGISAR-Advisory Group on runny nose, or sneezing, Whole