Chapter 9

Epidemiological Applications

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 Objectives
 Define epidemiology and describe how it has developed
over time.
 Describe the essential elements of epidemiology and an
epidemiologic approach.
 Discuss the steps in the epidemiologic process.
 Explain the basic epidemiologic concepts of population
at risk, natural history of disease, levels of prevention,
host-agent-environment relationships, and the web of
causation model.
 Differentiate between descriptive and analytic
epidemiology.
 Explain how nurses use epidemiology in community
health practice.

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 Introduction
 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 and policies
 The practice of nursing in public health

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 Definitions
 Epidemiology
 Descriptive Epidemiology
 Determinants of health
 For example: What is the disease? Who is affected?
Where are they? When do events occur?
 Analytic Epidemiology
 Distribution
 For example: How does it occur? Why are some
people affected more than others?

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 Purpose of Epidemiology
 Epidemiology is the study of populations to
 Determine the causes of health and disease in a
population
 Monitor the health of the population
 Identify the determinants of health and disease in
communities
 Investigate and evaluate interventions to prevent
disease and maintain health

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 History
 4th Century BCE: Hippocrates
 19th Century:
 Louis Pasteur
 Joseph Lister
 Robert Koch
 John Snow
 Florence Nightingale
 20th Century:
 Shifted from looking for single agents to determining the
multifactorial etiology
 Development of genetic and molecular techniques
 New infectious diseases
 Public health preparedness for bioterrorism

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 How 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, e.g., homes,
schools, work places, clinics.

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 Basic Concepts in Epidemiology
 Rates, Proportions, Risk, Ratio
 Measures of Morbidity and Mortality
 Measures of Incidence
 Measures of Prevalence
 Epidemic

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 More Basic Concepts in
Epidemiology
 Epidemiologic Triangle
 Agent, host, and environment
 Web of Causality
 Associations are sometimes mutual, with lines of
causality going in both directions.
 Ecological model

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 More Basic Concepts in
Epidemiology
 Levels of Preventive Interventions
 Primary
• i.e., Immunizations
 Secondary
• i.e., Screenings
 Tertiary
• i.e., Physical and occupational therapy

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 Screening
 A key component of many secondary prevention
interventions
 Involves the testing of groups of individuals who are
at risk for a specific condition but do not have
symptoms.
 The goal is to determine the likelihood that these
individuals will develop the disease.
 A screening test is not a diagnostic test.
 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.

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 Screening
 Reliability
 Precision of the measurement
 Consistency or repeatability of the measurement
 Validity
 Is the measurement really measuring what we think it
is, and how exactly?
 Measured by sensitivity and specificity
• Sensitivity
• Specificity
• Positive Predictive Value
• Negative Predictive Value

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 Basic Methods in Epidemiology
 Sources of Data
 Routinely collected data
 Data collected for other purposes
 Original data

 Rate Adjustment
 Age-adjusted rate
 Direct-adjusted rate
 Indirect-adjusted rate
 Comparison Groups

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 Descriptive Epidemiology
 Person
 Race, sex, age, education, occupation, income, and
marital status
 Place
 Examine geographic patterns
 Time
 Secular trends
 Point epidemic
 Cyclical time patterns
 Nonsimultaneous, event-related clusters

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 Analytic Epidemiology
 Cohort Studies
 Prospective studies
 Retrospective studies

 Case-Control Studies
 Odds ratio
 Cross-Sectional Studies (prevalence studies)
 Ecological Studies
 bridges descriptive and analytic epidemiology

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 Experimental Studies
 Clinical Trials
 Randomization to groups
 Masking or “blinding” treatment

 Community Trials

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 Causality
 Statistical Associations
 Bias
 Confounding factor
 Assessing for Causality
 Criteria for causality

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 Applications of Epidemiology in
Community-Oriented Nursing
 Examples of nursing positions that use
epidemiology:
 Nurse epidemiologist
 School nurses
 Communicable disease nurse
 Environmental risk communicators
 Hospital infections control nurse
 All nursing documentation on patient charts and
records is important source of data for epidemiologic
reviews.

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