NUR 431

 A discipline that provides structure for systematically studying health, disease, and conditions related to health status ◦ Distribution of patterns ◦ Description of health outcomes: who, what, where, when, and why? ◦ Etiology of disease ◦ Determinants of health events—how did it occur?

 The death rates from a disease or occurrence ◦ Crude mortality rate  Annual rate that represents the proportion of a pop’n who die from any cause during the time period ◦ Age-specific  Number of deaths among persons of a given age group ◦ Cause-specific  Number of deaths from a specific cause

Case fatality rate – Number of deaths from a specific disease in a given period/Number of persons diagnosed with that disease Infant mortality rate – Number of deaths before age 1 in a year per number of live births that year Neonatal mortality rate – Number of infant deaths from 28 days to 1 year of age per number of live births that year

 Illness rates, usually in prevalence rates  The rates at which sickness and/or injury occur within a group of people

 The number of new cases of an illness or injury that occurs within a specified time What are the incidence rates for breast cancer from 1999 to 2003?  ml/mm5622a1.htm

 Number of new cases per 100,000 people ◦ Smoketown, MD is a city of 200,000 people. A recent survey shows that 500 individuals have lung cancer. During the past two months, 100 persons have been newly diagnosed. What is the incidence of lung cancer in Smoketown during the past two months?  500/100,000  100/100,000  50/100,000

 Measurement of all the existing cases at a given point in time divided by the current population  See prevalence of HIV

 Number of all cases per 100,000 people ◦ Smoketown, MD is a city of 200,000 people. A recent survey shows that 500 individuals have lung cancer. During the past two months, 100 persons have been newly diagnosed. What is the prevalence of lung cancer in Smoketown during the past two months?  500/100,000  100/100,000  250/100,000

 Occurrence of an illness that is in excess of normal expectancy in a community  Descriptive = Distribution ◦ Person, Time, Place  Analytic = Determinants of Outcomes ◦ How, Why ◦ Cohort studies—Prospective and Retrospective

 Habitual presence of a disease or infectious agent within a geographical area  Yellow Fever and Malaria in South America and Sub-saharan Africa

 Epidemics around the world  Influenza epidemic during the Spanish- American War  Concerns about the Avian flu  Remember SARS—Sudden Acute Respiratory Syndrome?

Method of monitoring emerging hazards in the community The National Electronic Disease Surveillance System (NEDSS) is an initiative that promotes the use of data and information system standards to advance the development of efficient, integrated, and interoperable surveillance systems at federal, state and local levels. It is a major component of the Public Health Information Network (PHIN).Public Health Information Network (PHIN This broad initiative is designed to: To detect outbreaks rapidly and to monitor the health of the nation Facilitate the electronic transfer of appropriate information from clinical information systems in the health care system to public health departments Reduce provider burden in the provision of information Enhance both the timeliness and quality of information provided

 The epidemiological triangle that interacts to cause disease: ◦ Host = Who ◦ Agent = What ◦ Environment = Where

The host is the “who” or the organism harboring the disease. The agent is the “what” or the microbe that causes the disease. The environment is the “where” or the external factors that cause or allow disease transmission. Epidemiological Triangle Model Host Agent Environment

 Same factors may cause more than one illness, sometimes called “confounding factors”  Example: Multiple Factors of Chronic Disease ◦ Health status of an area’s population may be determined by:  Location, Geography, Age, Race, Sex, Income Status, Educational Levels, and other variables

 Relates to a lack of susceptibility to infectious agents ◦ Natural immunity refers to species-determined, innate resistance to an infectious agent.  Example: opossums rarely contract rabies. ◦ Acquired immunity is the resistance acquired by a host as a result of previous natural exposure to an infectious agent.  Example: having measles once protects against future infection.

 Attained naturally by infection or artificially by inoculation of vaccine ◦ Characterized by presence of antibodies ◦ Vaccinating children against childhood diseases is an example

 Temporary immunity, obtained through maternal transfer or by inoculation of specific protective antibodies, such as serum globulin ◦ Almost immediate, but short-lived, such as tetanus, influenza, and rabies

 Immunity of a group or community to an infectious agent  This is the basis for immunizing a large group of people for polio or pneumonia.  Only works if there are high rates of immunizations

 Primary Prevention Goal: To prevent the occurrence of disease  Secondary Prevention Goal: To prevent the spread of disease  Tertiary Prevention Goal: To reduce complications and disabilities through treatment and rehabilitation

 Responsible sexual behavior  Malaria chemoprophylaxis  Tetanus boosters, flu shots  Safe food handling  Repellants for preventing vector-borne diseases  Inspections of water supplies and restaurants

 Immunoglobulin after Hepatitis A exposure  Rabies postexposure immunization  TB screening for health care workers  STD partner notification  HIV testing and treatment  Quarantine

 Pneumocystis carinii pneumonia chemoprophylaxis for people with AIDS  Regular inspection of hands and feet as well as protective footwear and gloves to avoid trauma and infection for leprosy clients whohave lost sensation in those areas