10 steps of outbreak investigation Correct Answers 1. prepare
for field work
2. establish the existence of an outbreak
3. verify the diagnosis
4. define and identify cases
5. perform descriptive epidemiology
6. develop hypothesis
7. person analytical epidemiology
8. refine hypotheses and conduct additional studies
9. implement control and prevention measures
10. communicate findings
18th century Correct Answers - miasma theory = four odors
from decaying body caused diseases
- sanitation emphasis on drainage of sewage and waste
- florence nightingale = crimean war (care of wounded soldiers,
keep detailed records and used statistics to provide the benefits
of nursing care, clean environment, edible food, clean wounds,
improved conditions and decreased death)
19th century Correct Answers - modern epidemiology
- causal thinking = identify cause and attack it
- early 1900s leading cause of death was infectious
(communicable) disease = focus of control was to identify cause
(agent), isolate or quarantine, improve sanitation, and vaccinate,
antibiotics (penicillin) became available in the 1940s
- middle to late 1900s chronic disease (non-infectious, non-
communicable) as leading cause of death = link to risk in the
environment or lifestyle behaviors, develop over time
,2000s Correct Answers - eco-epidemiology (eco social
approach) focus on a comprehensive study of human disease =
conceptual approach to combining molecular, societal, and
population based aspects to study a health related problem
- studies multiple causes of disease = social, economical, and
natural ecological systems
- zip code as a determinant of health outcomes and life
expectancy (geocoding)
- gene environment interactions = human genome project
- exposure over a life course and even over multiple generations
- use advance technology to tract distribution of disease patterns
accountable care organizations (ACOs) Correct Answers -
payment tied to quality metrics and cost of care
- pay for performance
- accountable to patients and payers for appropriateness and
efficiency of services
- ACOs are organizations that agree to be accountable for
quality, cost, and overall care
- medicare beneficiaries who are enrolled in traditional fee for
service programs
active immunity Correct Answers - long term
- sometimes lifelong
- acquired naturally = gets disease
- artificially = live attenuated vaccine
affordable care act (obamacare) Correct Answers -
comprehensive health care reform law enacted in march 2010
,- individual federal mandate = citizens and legal residents must
have health insurance (the shared responsibility payment from
2014-2018), if no insurance pay a fee)(starting in 2019, no
insurance, no fee)
- health insurance marketplace = healthcare.gov
- increase policies and laws for community and preventative
care
- tightened laws and regulations around private health insurance
- preventative services are covered = immunization and
screenings
- regulations around private health insurance = eliminated
denials due to pre-existing conditions
affordable care act 3 primary goals Correct Answers 1. make
health insurance more available = gave subsides (premium tax
credits) to households with incomes between 100% to 400%
FPL
2. expand medicaid programs to include adults with incomes
138% of FLP = not all states expanded their medicaid program
3. support innovative medical care delivery models that lowered
the cost of healthcare
agents Correct Answers - factors that causes or contributed to
disease (or health problem)
- can be infectious or non-infectious
1. biological = virus, bacteria, protozoan, fungi, etc
2. physical = mechanical atmospheric (ex. radiation, radon),
geologic (earthquakes, tsunamis)
3. chemical = toxins, poisons
4. nutrients = excess or deficiencies in diet
5. psychological = stress, mental health
, analytical epidemiology Correct Answers - studies that
strength of association between factors (determinants) and the
probability of getting a particular disease
- uses comparison group who got the disease? who didn't get the
disease?
- why and how? = searches for causes of disease
analytical epidemiology experimental studies Correct Answers
- controlled process
- deign of a randomized study
- investigator randomizes a group of subject to a control and
intervention group
- exposes the intervention group and provides a placebo to the
control group
- observes and compares the results
analytical epidemiology observational studies Correct Answers
- cohort studies (aka longitudinal studies) = track individuals
over a period of time to find associations between risk factors
and health outcomes
- case control studies = compare those with disease and those
without diseases
- cross sectional studies = studies sample of a population and
their health outcome (useful when studying prevalence rate)
ancient times Correct Answers - hippocrates (460 to 375 BC)
= greek physician considered 1st epidemiologist
- diseases are not only affects individuals but also populations
- considered lifestyle, environment, and certain heath conditions
= four body humors (blood, yellow bile, black bilk, phlgem)
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