Modulo 4
analytic epidemiology
looks at the etiology of the disease and deals with determinants of health and disease
systematic review
most helpful source to research a clinical problem offers comprehensive information on the issue
Epidemiology
the study of the distrubution and factors that determine health-related states or events in a population, and the use of this information to control health problems
determinants of heath events are
those factors, exposures, characteristics, and behaviors, and contexts that determine the patterns
what is the aim of epidemiology?
to describe the distribution (determine how, where, and when the disease occurs) and to look for factors that explain the pattern of disease or the risk for occurence.
Twenty people attended a church picnic the previous weekend. By Monday, four individuals exhibited symptoms of food poisoning. On Tuesday, the nurse in community health records the addition of two new cases. The incidence rate would be:
two new cases divided by 16 at risk
what did john gaunt do in 1662?
used bills of mortality to study patterns of death in various populations in England. He published early form of life table analysis
The nurse epidemiologist notes that the infections are clustered in time, place, and person. She interviews all of the ill nursing students and learns that all of them attended the open house at the Dean's home. What should the nurse do next? A. Close the nursing school. B. Arrange to collect stool specimens. C. Contact the Dean. D. Quarantine all of the open house attendees.
B. Arrange to collect stool specimens
Analytic Epidemiology differs from descriptive epidemiology, because it searches for:
"how & why" of disease patterns
Which of the following tools are used in analytic epidemiology? (Select all that apply.) A. cohort study B. case-control study C. cross-sectional study D. clinical trials E. community trials
*A. cohort study* *B. case-control study* *C. cross-sectional study* Rationale: Analytic epidemiology deals with the factors that influence the observed patterns of health and disease and increase or decrease the risk of adverse outcomes. Analytic study designs include cohort studies, case-control studies, and cross-sectional studies. In experimental or intervention studies, the investigator initiates a treatment or intervention to influence the risk or course of disease. These studies test whether interventions can prevent disease or improve health. Clinical trials and community trials are examples of experimental studies.
A breast cancer screening program screened 8000 women and discovered 35 women previously diagnosed with breast cancer and 20 women with no history of breast cancer diagnosed as a result of the screening. The prevalence proportion would reflect: A. current and past breast cancer events in this population of women. B. newly diagnosed cases of breast cancer in this population of women. C. past breast cancer events in this population of women. D. the population of women that had no evidence of breast cancer.
*A. current and past breast cancer events in this population of women.* Rationale: The prevalence proportion is a measure of existing disease in a population at a particular time (i.e., the number of existing cases divided by the current population). A prevalence proportion is not an estimate of the risk of developing disease, because it is a function of both the rate at which new cases of the disease develop and how long those cases remain in the population. In this example, the prevalence of breast cancer in this population of women is a function of how many new cases develop and how long women live after the diagnosis of breast cancer.
Clinical medicine and epidemiology differ from each other in the major aspect of: A. practice focus. B. health monitoring. C. determinants of health and disease. D. evaluation of interventions.
*A. practice focus.* Rationale: Epidemiology is the study of populations to monitor the health of the population, understand the determinants of health and disease in communities, and investigate and evaluate interventions to prevent disease and maintain health. Epidemiology focuses on populations, whereas clinical medicine focuses on the diagnosis and treatment of disease in individuals. Epidemiology studies populations to determine the causes of health and disease in communities and to investigate and evaluate interventions that will prevent disease and maintain health. Epidemiologic methods are used extensively to determine to what extent the goals of Healthy People 2020 (U.S. Department of Health and Human Services, 2010) have been met and to monitor the progress of those objectives not fully met at present.
Twenty people attended a church picnic the previous weekend. By Monday, four individuals exhibited symptoms of food poisoning. On Tuesday, the nurse in community health records the addition of two new cases. The incidence rate would be: A. two new cases divided by 16 at risk. B. two new cases divided by 20. C. six cases divided by 20. D. four cases divided by 16.
*A. two new cases divided by 16 at risk.* Rationale: An incidence rate quantifies the rate of development of new cases in a population at risk, whereas an incidence proportion indicates the proportion of the population at risk that experiences the event over some period of time (Rothman, 2002). The population at risk is considered to be persons without the event or outcome of interest but who are at risk of experiencing it. People who already have the disease or outcome of interest are excluded from the population at risk for this calculation because they already have the condition and are no longer at risk of developing it.
Nurses in community health often use epidemiology because in the community it is often difficult to control the environment. Which of the following statements demonstrates an epidemiologic strategy for monitoring disease trends? A. A nurse in community health conducts an education class for clients newly diagnosed with diabetes. B. A nurse in community health investigates a breakout of whooping cough in a local middle school. C. A nurse in community health organizes a health fair at the community health center. D. A nurse in community health participates on a county school board that addresses student health issues.
*B. A nurse in community health investigates a breakout of whooping cough in a local middle school.* Rationale: Nurses are a key part of the interdisciplinary team in community settings and often use epidemiology to look at health and at disease causation and how to both prevent and treat illness. Nurses use epidemiology in the community to examine factors that affect the individual, family, and population group because it is more difficult to control these factors in the community than in the hospital. Community health nurses who conduct education classes, organize health fairs and address student health issues are using prevention strategies.
A nurse is concerned about the accuracy of the PPD test in identifying cases of TB exposure for follow-up chest x-ray. The nurse's concern is addressing the validity measure of: A. reliability. B. sensitivity. C. specificity. D. variation.
*B. Sensitivity.* Rationale: Validity of a screening test is measured by sensitivity and specificity. Sensitivity quantifies how accurately the test identifies those with the condition or trait. Sensitivity represents the proportion of persons with the disease whom the test correctly identifies as positive (true positives). High sensitivity is needed when early treatment is important and when identification of every case is important. Reliability is the consistency of repeating a measure and is affected by variation in results. Specificity indicates how accurately the test identifies those without the condition or trait.
A business executive develops symptoms of the flu 1 day after returning by air from a cross-Atlantic business trip that ran for 2 consecutive stressful 10-hour days. This individual's development of flu symptoms illustrates the relationship between: A. host and agent. B. host, agent, and environment. C. risk and causality. D. morbidity and disease.
*B. host, agent, and environment.* Rationale: Epidemiologists understand that disease results from complex relationships among causal agents, susceptible persons, and environmental factors. These three elements—agent, host, and environment—are called the epidemiologic triangle. Changes in one of the elements of the triangle can influence the occurrence of disease by decreasing or increasing a person's risk for disease. The associations between risk and causality, morbidity and disease do not demonstrate the relationship to the development of flu.
One of the basic concepts in epidemiology is the concept of risk. Risk refers to the: A. prevalence of an event occurring. B. probability that an event will occur within a specified time period. C. population most likely to develop a disease. D. rate of development of new cases.
*B. probability that an event will occur within a specified time period.* Rationale: Risk refers to the probability that an event will occur within a specified time period. A population at risk is the population of persons for whom there is some finite probability (even if small) of that event occurring. Incidence rates and proportions measure the rate of new case development in a population and provide an estimate of the risk of disease.
Analytic epidemiology differs from descriptive epidemiology because it searches for: A. "when" of disease patterns. B. "where" of disease patterns. C. "why" of disease patterns. D. "who" of disease patterns.
*C. "why" of disease patterns.* Rationale: Descriptive epidemiology describes the distribution of disease, death, and other health outcomes in the population according to person, place, and time—the who, where, and when of disease patterns. Analytic epidemiology, on the other hand, searches for the determinants of the patterns observed—the how and why of disease patterns.
A nurse in community health who teaches a client with asthma to recognize and avoid exposure to asthma triggers and assists the family in implementing specific protection strategies such as removing carpets and avoiding pets is intervening at the level of: A. assessment. B. primary prevention. C. secondary prevention. D. tertiary prevention.
*C. secondary prevention.* Rationale: Primary prevention refers to interventions that promote health and prevent the occurrence of disease, injury, or disability. Interventions at this level are aimed at individuals and groups who are susceptible to disease but have no discernable pathology (state of prepathogenesis). In this case, the client has already has asthma, so the nurse teaches the client to recognize and avoid exposure to asthma triggers. This is an example of secondary prevention. Health screenings are at the core of secondary prevention. Tertiary prevention includes interventions aimed at limiting disability and interventions that enhance rehabilitation from disease, injury, or disability. Assessment is a component of epidemiology.
epidemiologic triangle
-agent, host, environment -changes in one of the elements of the triangle can influence the occurrence of disease by increasing or decreasing a person's risk for disease
reliability
-how precise the measurement is -the measurement's consistency or repeatability
validity
-is the measurement really measuring what we think it is and how exactly -measure by sensitivity and specificity
how do nurses use epidemiology?
-nurses look at health and at disease causation, and how both prevent and treat illness -nurses are involved in the surveillance and monitoring of disease trends
cohort studies
-prospective studies -retrospective studies
web of causality
-recognizes the complex interrelationships of many factors interacting, sometimes in subtle ways, to increase (or decrease) the risk of disease -associations are sometimes mutual with lines of causality going in both directions
ANS: C Because it is most important to identify every case, the sensitivity of the test is crucial. High sensitivity is needed when early treatment is important and when identification of every case is important.
21. Persons in an auditorium may have been exposed to a disease. If they are infected, it is crucial that they receive immediate treatment and not take the disease home to their families. Which of the following characteristics would be most important to consider when selecting the screening test to be used? a. The negative predictive value b. The positive predictive value c. The sensitivity of the test d. The specificity of the test
what does epidemiology help nurses understand?
-the environment and all living things within the environment are interrelated -the association between exposure and health impact or effects
the public health science of epidemiology has made major contributions to
-understanding the factors that contribute to health and disease -the development of health promotion and disease-prevention measures -the detection and characterization of emerging infectious agents -the evaluation of health services an policies -the practice of nursing in public health
ANS: B Epidemiology refers not only to infectious epidemics but also to other health-related events. Analytic epidemiology looks at the etiology (origins or causes) of disease.
1. A nurse is using analytic epidemiology when conducting a research project. Which of the following projects is the nurse most likely completing? a. Reviewing communicable disease statistics b. Determining factors contributing to childhood obesity c. Analyzing locations where family violence is increasing d. Documenting population characteristics for healthy older citizens
ANS: C If more people are now being diagnosed with diabetes and need support, more ongoing services will be needed for this population. Incidence may go up and down, but prevalence is a fairly stable number.
10. A nursing staff has successfully screened for diabetes in the community. Which of the following might best persuade the health board to increase funding for diabetic clinics in this community? a. An epidemic of diabetes is now recognized and must be addressed. b. The incidence of diabetes is now higher than previously recognized in the community. c. The prevalence of diabetes is now higher than previously recognized in the community. d. The risk for diabetes in the community could decrease if funding is received.
ANS: C The attack rate is the proportion of persons exposed to an agent who develop the disease. Because 63 of the 70 persons became ill, the attack rate is 63:70, or 90%.
11. A public health nurse found that out of the 70 people who ate the potato salad at a school picnic, 63 developed symptoms of food poisoning. Which of the following best describes the attack rate? a. 63% b. 70% c. 90% d. 100%
ANS: B The case fatality rate (CFR) is the proportion of persons diagnosed with a particular disorder (i.e., cases) who die within a specified period. The CFR is considered an estimate of the risk for death within that period for a person newly diagnosed with the disease. Persons diagnosed with a particular disease often want to know the probability of surviving. The CFR provides that information.
12. A man is diagnosed with prostate cancer. Which of the following data should the nurse know to answer the man when he asks, "What are the chances I'll survive this thing?" a. Attack rate b. Case fatality rate c. Cause-specific morbidity rate d. Crude mortality rate
ANS: B Infant mortality is used around the world as an indicator of overall health and availability of health care services.
13. Which of the following statistics is used by countries to compare the success of their health care systems? a. Attack rate b. Infant mortality rate c. Cause-specific morbidity rate d. Cause-specific mortality rate
ANS: A The epidemiologic triangle categorizes factors as agent, host, or environment. The model encourages the health care provider to examine all the influences that lead to increased risk. Levels of prevention are actions taken to improve health outcomes. Health promotion addresses health improvement, not the risk for disease.
14. A nurse is examining all of the various factors which can lead to disease. Which of the following models would the nurse most likely use? a. Epidemiologic triangle b. Health promotion c. Levels of prevention d. Natural history of disease
ANS: D The web of causality model recognizes the complex interrelationships of many factors interacting to increase or decrease the risk for disease. Causal relationships (one thing or event causing another) are often more complex than the epidemiologic triangle conveys. With all the various antecedents identified, the nurse can then decide in which areas interventions are possible.
15. A nurse is examining the various factors that lead to disease and suggests several areas where nurses could intervene to reduce future incidence of disease. Which of the following models would the nurse most likely use? a. Epidemiologic triangle b. Health promotion c. Levels of prevention d. Web of causality
ANS: C Education in schools, the community, and high-risk populations focuses only on primary prevention activities. Online activities focus only on primary and secondary prevention. Efforts focused only on those who already have CAD are not primary prevention. Distributing handouts includes all three levels of prevention to target all members of the population. Targeting all members of the population and implementing all levels of prevention increase the likelihood of positive outcomes for the community as a whole.
16. Which of the following actions would a nurse take to reduce the high incidence of coronary artery disease (CAD) in a community? a. Introduction of a heart-healthy curriculum beginning in the first grade, presentations on diet and exercise for the community at large, and special education sessions for high-risk populations b. Provision of online activities related to prevention of cardiac disease, smoking reduction programs, and blood pressure screenings c. Distribution of handouts, including age-appropriate games, self-assessments, and education on heart-healthy lifestyles; availability of community screenings for hyperlipidemia in persons age 35 and older; and walking programs for those affected with CAD d. Enrollment of clients with CAD into cardiac rehabilitation programs, routine evaluation of effectiveness of CAD treatment regimens, and participation in clinical trials that evaluate interventions for those diagnosed with CAD
ANS: C Secondary prevention refers to interventions that increase the probability that a person with a condition will have the condition diagnosed early. Health screenings are the mainstay of secondary prevention. Weighing students and assessing whether the weight is higher than recommended will allow for early intervention so that obesity may be avoided.
17. A school nurse wants to decrease the incidence of obesity in elementary school children. Which of the following describes a secondary prevention intervention that the nurse could implement? a. Giving a presentation on the importance of exercise and physical fitness b. Designing a game in which students select healthy food choices c. Weighing students to identify those who are overweight d. Putting students on a diet if they weigh greater than 20% of their ideal weight
ANS: C Interventions that prevent worsening of a condition are tertiary prevention activities. In this instance, the client already has a health problem (osteoporosis). By advising adequate dairy intake, the nurse aims to ensure that enough calcium is available to limit worsening of the osteoporosis.
18. A nurse advises a client with osteoporosis to have three servings of milk or dairy products daily. Which of the following levels of prevention is being used by the nurse? a. Primary prevention b. Secondary prevention c. Tertiary prevention d.
ANS: D Validity is the accuracy of a test or measurement, or how closely it measures what it claims to measure. With only one regular BP cuff, the nurse cannot obtain accurate measurements on those who are extremely obese or extremely thin. A thigh cuff and a pediatric cuff would allow the nurse to obtain accurate—that is, valid—measurements.
19. A nurse has only a regular blood pressure cuff when conducting a health screening for all of the residents of a community. Which of the following may be lacking when obtaining blood pressure readings? a. Reliability b. Sensitivity c. Specificity d. Validity
ANS: B Epidemiology differs from clinical medicine, which focuses on the diagnosis and treatment of disease in individuals. Epidemiology monitors the health of the population.
2. A nurse is employed as a nurse epidemiologist. Which of the following activities would most likely be completed by the nurse? a. Eliciting the health history of a client presenting with an illness b. Evaluating the number of clients presenting with similar diseases c. Performing a physical examination of an ill client d. Providing treatment and health education to a client with a disease
ANS: C Persons with immune deficiencies may have a negative tuberculosis skin test even though they are infected. Sensitivity is the extent to which a test identifies those individuals who have the condition being examined. AIDS is an acquired immune deficiency; thus, clients with AIDS may have a false-negative response to TB skin tests; that is, they have the disease but the test is not sensitive enough to detect infection in these individuals. Therefore, there is decreased sensitivity with those clients.
20. A nurse is administering a tuberculosis skin test to a client who has AIDS. Which of the following results should the nurse anticipate when using this screening test? a. Decreased positive predictive value b. Decreased reliability c. Decreased sensitivity d. Decreased specificity
ANS: B The positive predictive value is the proportion of persons with a positive test who actually have the disease, interpreted as the probability that an individual with a positive test has the disease.
22. A woman is sitting in a corner of the clinical waiting room, crying audibly. The nurse asks, "What's wrong? Can I help?" The woman responds, "They just told me I have a positive mammogram and I need to see my doctor for follow-up tests. I know I'm going to die of cancer. How can I tell my family?" Which of the following information does the nurse need to know in order to help the woman cope with this finding? a. The negative predictive value of mammography b. The positive predictive value of mammography c. The reliability of mammography d. The validity of mammography
ANS: A The National Health Interview Survey and the National Hospital Discharge Survey both provide information on the health status and behaviors of the national population. For many studies, however, the only way to obtain the needed information is to collect the required data in a study specifically designed to investigate a particular question.
23. The administration at a local medical center examines the trends in health problems when developing long-range plans for staffing and space allocation. Which of the following sources of information would be most helpful? a. Local data drawn from a professional survey in the city b. The National Health Interview Survey c. The National Hospital Discharge Survey d. The state's vital statistics
ANS: A Although any explanation is possible, the most probable reason is that there is a cultural or ethnic concentration in that particular neighborhood that has a different lifestyle pattern, resulting in different health outcomes.
24. Statistics clearly demonstrate that there are significantly more cases of a disease in one particular neighborhood than in all the rest of the city. Assuming all else is the same, which of the following is the most likely explanation for a single neighborhood having such a different pattern of illness? a. A cultural or ethnic concentration in the neighborhood b. The geographical location of the neighborhood within the city c. A statistical fluke without meaning d. The time of year the different statistics were collected throughout the city
ANS: A Being close friends is probably the result of the similarity rather than the cause. However, being born at about the same time would mean both women have lived through similar social events and media occurrences and therefore would have much in common. Going to the same school or the same church, depending on the size of the institutions, might not result in any personal interaction whatsoever.
25. Two women seem to agree on almost everything from favorite music to favorite media stars to the best way to prepare a meal. Which of the following best explains this similarity in the two women? a. They are both members of the same birth cohort. b. They are close friends. c. They attended the same school. d. They both go the same church.
ANS: C Relative risk is an estimation of the risk of acquiring a problem for those who are exposed compared with those who are unexposed. As the risk for obesity is less for those that are members of Cub Scouts, joining the group is protective and reduces the incidence among members.
26. A nurse reports that in comparison to all the children in a particular school, the children who are members of the Cub Scouts have 0.3 risk for obesity before entering the sixth grade. Which of the following recommendations would the nurse make to the new parents of two boys who had just moved into this school's neighborhood? a. Discourage the parents from enrolling their sons in Cub Scouts because of the risk. b. Don't say anything about Cub Scouts, because it isn't relevant to nursing care. c. Encourage the parents to enroll their sons in Cub Scouts. d. Share the finding and let the parents draw whatever conclusions they feel appropriate.
ANS: D Retrospective cohort studies rely on existing records to define a cohort that is classified as having been exposed or unexposed at some time in the past. In this case, the issue is whether there is some health risk in the new building addition that is increasing frequency of visits to the school nurse because of asthma.
27. A principal comments to the school nurse that it seems there are a lot more problems with asthma among the students than there were before the school was remodeled a couple of years ago. The nurse investigates the principal's observation by reviewing all the school records to determine visits to the health office because of asthma by week and month for the past 5 years. Which of the following best describes the type of study the nurse is conducting? a. Descriptive epidemiological study b. Ecological study c. Prospective cohort study d. Retrospective cohort study
ANS: C The goal of a clinical trial is to evaluate the effectiveness of an intervention. Clinical trials are generally the best way to show causality.
28. Which of the following types of study should the nurse researcher choose if the goal is to identify the long-term benefits and risks of a particular nursing intervention for senior citizens living in the community? a. Cross-sectional study b. Ecologic study c. Clinical trial d. Retrospective analysis
ANS: D Any study is subject to bias resulting from selective choice. There may be a difference between students who choose to belong to an organization and students who choose not to join an organization. Selection bias occurs when selection procedures are not representative of the population as a whole. In this instance, the goal is to determine drug use of all students at the school. If only students who join school organizations are selected, those who do not join organizations will not be represented.
29. A teacher recommends that surveys to obtain data on drug use be given to high school students when they meet for various school organizations. Which of the following best describes why the nurse would reject this suggestion? a. This method of data collection would result in classification bias. b. This method of data collection would result in confounding bias. c. This method of data collection would result in personal bias. d. This method of data collection would result in selection bias.
ANS: D Without doing any actual math, it should be fairly obvious that 23:500, 45:1000, and 90:2000 are all about the same proportion but that 90:1500 is a larger proportion. Doing the math, the pregnancy rates of A, B, and C are 45-46:1000, whereas the rate in Community D is 60:1000.
5. Several small communities have applied for grant funding from the state department of health to help decrease their teenage pregnancy rate. Which of the following communities should the nurse suggest receive funding first? a. Community A—with 23 single teenage pregnancies in a city of 500 b. Community B—with 45 single teenage pregnancies in a city of 1000 c. Community C—with 90 single teenage pregnancies in a city of 2000 d. Community D—with 90 single teenage pregnancies in a city of 1500
ANS: B Nightingale examined the relationship between the environment and the recovery of the soldiers. Using simple epidemiological measures, she was able to show that improving environmental conditions and adding nursing care decreased the mortality rates of the soldiers. Nightingale used statistics to document decreased mortality rates when the environmental factors were improved.
3. Which of the following actions by Florence Nightingale demonstrates her role as an epidemiologist? a. She convinced other women to join her in giving nursing care to all the soldiers. b. She demonstrated that a safer environment resulted in decreased mortality rate. c. She obtained safe water and better food supplies and fought the lice and rats. d. She met with each soldier each evening to say goodnight, thereby giving psychological support.
ANS: C The epidemiologic triangle includes the agent, host, and environment. The bacteria were the agent so chemical and physical agents are not relevant. The environment was apparently the same for everyone, since all were exposed to the bacteria. Therefore, only differences in host factors can explain why some became ill and some were able to fight off the bacterial infestation.
30. A nurse is investigating a bacterial illness that has caused a health problem in the community. Only some of the people exposed to the bacteria have become ill. Which of the following factors best explains why this would have happened? a. Chemical agent factors b. Environmental factors c. Host factors d. Physical agent factors
ANS: C In the community, nurses often use epidemiology, since the factors that affect the individual, family, and population group cannot be as easily controlled as in acute care settings. It is essentially impossible to control the environment in the community.
4. Which of the following statements describes how nursing in the community is more challenging than nursing in an acute care setting? a. There is limited access to information useful to the nurse in giving care in the community. b. More paperwork and forms are required when giving care in the home. c. It is more challenging to control the environment in the community. d. Specialization isn't possible in the community setting.
ANS: D A proportion is a ratio in which the denominator includes the numerator. If the proportion is small, we can express the number per 1000. The answer of 300:1300 adds the total of the numerator to the denominator, which is unnecessary because the gonorrhea cases were already included in the denominator. In the answer of 300:500, the ratio comparing gonorrhea to chlamydia does not meet the epidemiological definition of proportion (i.e., the denominator must contain the numerator). Although proportions may be expressed as percentages, in the answer of 50% the percentage reflects the number of gonorrhea cases to all STIs, which doesn't summarize the total STI problem. The answer of 100:1000 correctly summarizes that 1000 of 10,000 (or 100:1000) young women had the problem
6. Between 2000 and 2005, 1000 of 10,000 young women ages 17 to 20 years at a university tested positive for a sexually transmitted infection (STI). Of the 1000 diagnosed STIs, 300 were gonorrhea and 500 were chlamydia. Which of the following statements best summarizes these findings? a. The proportion of cases of gonorrhea to all STIs was 300:1300. b. The proportion of cases of gonorrhea to chlamydia was 300:500. c. The proportion of cases of gonorrhea to all STIs was 50%. d. The proportion of STIs to the total population was 100:1000.
ANS: B If the screening has been successful, more diabetes will be diagnosed and, hopefully, treated. Thus, the incidence of new cases will increase. Overall, prevalence will also increase, but that is not one of the answer options.
7. The nursing staff has attempted to screen the entire African-American population in the community for diabetes. Which of the following would provide immediate verification of the success of the nursing staff's efforts? a. An epidemic of diabetes will be recognized. b. The incidence of diabetes will increase in the community. c. The prevalence of diabetes will decrease in the community. d. The risk for diabetes in the community will increase.
ANS: B Incidence rates and incidence proportions are the measure of choice to study etiology because incidence is affected only by factors related to the risk of developing disease and not to survival or cure. Prevalence is a fairly stable number over time, but incidence reacts more quickly to changes in risk factors or intervention programs. If the educational programs are having the desired impact, the incidence of diabetes being diagnosed will decrease in future screenings.
8. In a particular community, several high school students were diagnosed with diabetes mellitus Type 2 during the annual high school health fair. Over the next few years, the nursing staff developed and implemented educational programs about the risk factors for diabetes mellitus Type 2 and proper nutrition. Which of the following would be most useful for the nurses to use to determine if they are having any impact? a. The epidemic of diabetes in the high school is gradually ending. b. The incidence of diabetes is slowly decreasing during screening events. c. The prevalence of diabetes is slowly decreasing during screening events. d. The risk for diabetes is slowly increasing over time.
ANS: C Because we do not have baseline data, we have no way to conclude that this is an epidemic with higher-than-normal results from the screening. Incidence refers to new cases, whereas prevalence means all cases. We don't know whether the finding represents the first time a woman was told she had an STI or whether she had previously been diagnosed with the problem. Therefore, we can't say whether these are new cases (incidence), but the results do represent all cases (prevalence). Risk is the probability of developing an STI, but no risk factors are discussed.
9. This year 600 of 8000 young women ages 17 to 20 years at a university health center tested positive for a sexually transmitted infection (STI). Which of the following terms best describes this data? a. An epidemic b. Incidence c. Prevalence d. Risk
Nurses in community health often use epidemiology because in the community it is often difficult to control the environment. Which of the following statements demonstrates an epidemiologic strategy for monitoring disease trends?
A nurse in community health investigates a breakout of whooping cough in a local middle school.
Based on the data analysis, the nurse epidemiologist determines that the fresh vegetable tray is associated with illness. She also learns that two of the food handlers were not feeling well during the event. What measures should she take at this point to control the outbreak? (Select all that apply.) A. Obtain stool specimens from the catering staff. B. Educate catering and serving staff about safe food preparation. C. Encourage food service staff not to prepare or serve food when they are ill with gastrointestinal symptoms. D. Call the Better Business Bureau.
A, B, C
The nurse epidemiologist at the health department develops a line list to organize the data. The line list includes the information reported by the student health nurse. What is the term used to describe the type of epidemiology associated with time, place, and person? A. Descriptive B. Analytic C. Scientific D. Environmental
A. Descriptive
The nurse decides to educate all staff about the organism, including how it is transmitted and prevention strategies. This level of prevention is: A. primary. B. secondary. C. tertiary.
A. primary
The nurse epidemiologist decides to interview everyone (ill and well) who attended the open house. This type of study is called a: A. case-control study. B. cohort study. C. longitudinal study. D. case study.
B. cohort study
For the nurse to evaluate why people at the picnic became sick, what questions should she ask the people who brought the food? A. Cooking time and how they cooked the food B. Hygiene of their equipment C. Sources of the water used in cooking the food D. All of the above
D. All of the abover
The nurse epidemiologist suspects an outbreak and launches an investigation because: A. the situation is an unusual problem. B. there is a potential risk to the public. C. there is a causal pathway. D. all of the above.
D. all of the above
The nurse epidemiologist discovers that all of the infected inmates have their wound dressings changed on the same day of the week in the same treatment room. She notices there is no sink or evidence of hand sanitizer in the treatment room. She recommends the following strategies EXCEPT: A. install hand hygiene stations in convenient locations in treatment rooms. B. clean and disinfect examination tables after each inmate is seen. C. perform medical procedures in the jail. D. recommend antibiotics for all inmates and staff.
D. recommen antibiotics for all inmates and staff
The nurse epidemiologist decides to visit the jail. Based on what she knows about the transmission of A. baumannii, what information could she collect? A. Underlying infections and chronic diseases of inmates B. Medical procedures performed in the jail C. Number of air exchanges in the jail D. All of the above E. A and B only
E. A and B only
The nurse epidemiologist notifies the student health nurse that all the stool specimens were positive for norovirus. Based on the incubation period for norovirus (12-48 hours) and the dates of onset of symptoms, the nurse epidemiologist suspects the students were exposed to the virus at or around the same time. She hypothesizes that the nurses contracted norovirus from a contaminated item consumed at the open house event. She makes arrangements to meet with the Dean to discuss the situation and gather additional information. What information would be useful to the nurse epidemiologist? A. A list of items served at the event. B. A list of persons who prepared and served the refreshments. C. A list of students, faculty, and staff who attended the event. D. A list of faculty and student absences. E. All of the above.
E. All of the above
A business executive develops symptoms of the flu 1 day after returning by air from a cross-Atlantic business trip that ran for 2 consecutive stressful 10 hour day. This individual's development of flu symptoms illustrates the relationship between:
Host, Agent, Environment
who is considered the father of epidemiology?
John Snow
the goal of screening
is to determine the likelihood that these individuals will develop the disease
A nurse in community health who teaches a client with asthma to recognize and avoid exposure to asthma triggers and assists the family in implementing specific protection strategies, such as removing carpets and avoiding pets is intervening at the level of:
Secondary Prevention
A nurse in concerned about the accuracy of the PPD test identifying cases of TB exposure for follow-up chest x-ray. The nurse's concern is addressing the validity measure of:
Sensitivity
Descriptive epidemiology
a form of epidemiology that describes a disease according to its person, place, or time
ecological studies
bridges descriptive and analytic epidemiology
what center was created in 1942 that was the office of malarial control in war areas?
center for disease control
whats the focus of epidemiology vs clinical medicine?
clinical medicine focuses on the diagnosis and treatment of disease in individuals.
A breast cancer screening program screened 8000 women and discovered 35 women previously diagnosed with breast cancer and 20 women with no history of breast cancer diagnosed as a result of the screening. The prevalence proportion would reflect:
current and past breast cancer events in this population of women.
what did william farr do in the 1840s?
developed the forerunner of a modern vital records system in the registrar-general's office in england. study of mortality in liverpool led to a significant public healh reform. pioneered mortality surveillance and anticipated many of the basic concepts in epidemiology. his data provided much of the basis for snow's work on cholera
Descriptive Epidemiology refers to the:
distribution of disease, death, and other health outcomes in the population according to person, place, and time --> who, where, when of disease patterns
how does epidemiology correlate with healthy people 2020?
epidemiology methods are used to determine to what extent the goals of healthy people 2020 have been met and to monitor the progress of those objectives that havent been met.
what is the "what" question in epidemiology?
first step is to answer the "what" question by defining the outcome. the health outcome can be a disease, or it can refer to injuries, accidents, or even wellness
what does analytic epidemiology focus on?
focuses on investigation of causes and associations of an illness
what did John Snow do in the 1850's?
he conducted epidemiologic research on the transmission of cholera. he used mapping and natural experiment, comparing rates in groups exposed to different water supplies.
what did edward jenner do in 1798?
he demonstrated the effectiveness of smallpox vaccination. marine hospital was opened; he was the forerunner of the U.S public health service (1912)
what did robert Koch do in the 1870's-1880's?
he discovered causal agents for anthrax, Tuberculosis, and cholera; development of casual criteria
what did wade hampton frost do in 1921?
he founded the first US academic program in epidemiology at johns Hopkins. the national institutes of health was created.
what did joseph kinyuon do in 1887?
he founded the library of hygiene. forerunner of the national institutes of health (1930). the united states public health service assumed the work previously done by marine hospital service.
what did lemuel shattuck do in 1850?
he reported on sanitation and public health in massachusetts. the london epidemiological society was founded. known for influential reports on smallpox vaccination and studies of cholera
specificity
indicates how accurately the test identifies those without the condition or trait -true negatives
what are determinants of health events?
individual relational social communcal or environmental things
case-control studies
odds ratio
Clinical medicine and epidemiology differ rom each other in the major aspect of:
practice focus.
One of the basic concepts in epidemiology is the concept of risk. Risk refers to the:
probability that an event will occur within a specified time period
sensitivity
quantifies how accurately the test identifies those with the condition or trait -true positives
effective screening programs must include?
referrals for diagnostic evaluation for those who screen positive, to determine if they actually have the disease and need treatment
a key component of many secondary prevention interventions?
screening
screening involves the
testing of groups of individuals who are at risk for a specific condition but do not have symptoms
negative predictive value
the proportion of persons with a negative test who are actually disease free
positive predictive values
the proportion of persons with a positive test who actually have the disease
when using descriptive epidemiology, health outcomes are considered, in terms of what?
who, where, when. who is affected, what is the outcome, where are they?
