Genetic epidemiology is considered a newer branch of epidemiology that focuses on the etiology, distribution, and control of diseases in groups of genetically related individuals and those with inherited genetic diseases. It attempts to understand the manner in which genetic factors interact with the environment in the context of population diseases and health conditions. The content area of genetic epidemiology consists of the etiology of inherited diseases, the distribution of inherited disorders, and methods to prevent or alter the impact of inherited disorders. Simply stated, genetic epidemiology examines the role of inherited factors in disease etiology. This chapter describes genetic and environmental epidemiology and differentiates the types of genetic testing. It helps the reader to identify common air, water, and soil pollutants. The chapter provides the means to conduct a personal environmental assessment of air, water, and soil pollutants and an exposure assessment.
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Clinical epidemiology is considered a basic science of medical practice that informs diagnostic, prognostic and therapeutic clinical decisions related to individual healthcare. Healthcare epidemiology broadens the scope of clinical epidemiology to include various types of healthcare settings not limited to the acute care setting. It is a more comprehensive term to use to designate epidemiology of clinical care in both acute and primary care settings. This chapter provides an overview of healthcare epidemiology, inclusive of clinical infectious hospital-acquired infections, and the basis of health care epidemiologic data in evidence-based healthcare. Healthcare epidemiologists are expert clinicians who provide information and education in areas such as but not limited to infectious diseases, infection control and prevention principles, antibiotic stewardship, occupational health and safety, and prevention of hospital- or healthcare-acquired infections or health conditions, along with regulatory compliance guidance.
Field epidemiology is the practical application of epidemiologic knowledge, skills, and methods to resolve population-based public health problems. The core functions of field epidemiology are outbreak investigation, conduct of public health surveillance, collection and analysis of epidemiologic data, engage in epidemiologic judgment, and dissemination and communication of epidemiologic findings. Forensic epidemiology is an area of field epidemiology developing as a specialization. Forensic epidemiology uses epidemiologic field methods to support criminal investigations. Field-based forensic epidemiology is described as the application of public health methods in a field-based setting to investigate health-related criminal events, an integration of public health, epidemiology, and law. Legal epidemiology is an advancing area of epidemiology practice. The legal epidemiology field is an area of scientific study and the deployment of law as a factor in the cause, distribution, determinants, and prevention of health and disease in a population.
Nursing as a practice discipline positions nurses to encounter unique events and situations that can serve as the foundation for future research exploration. Case control studies serve as a catalyst to differentiate the occurrence of disease among cases and controls to generate hypotheses. Nurses should remain astute and vigilant for unique situations encountered that could be the tipping point for exploration of unique cases. A case control study design groups the research subjects into cases or controls. This chapter helps the reader calculate an odds ratio from a case control study design, differentiates prospective and retrospective research designs, and describes other research designs such as historical, exploratory, methodological, and correlational. It also differentiates the types of triangulation. Epidemiologic research study appraisal is the systematic evaluation of a research study’s quality based on scientific merit and methodological rigor. The epidemiologic research study appraisal is dependent upon the research study design.
Advances in population health science and population health management are grounded in the utilization of epidemiologic a information. Epidemiologic studies provide another set of tools to assist the epidemiologist to understand the distribution and determinants of health in a population. Thinking epidemiologically integrates scientific method, epidemiologic reasoning, and the epidemiologic triad into a coherent thought pattern. Epidemiologic thinking uses an integrative investigative approach to understanding the distribution of health conditions and determinants of health conditions within a population to develop preventive and therapeutic population-based strategies. This chapter provides an understanding of the definition and scope of epidemiology. It describes a comparison of descriptive and analytic epidemiology and demonstrates an understanding of the epidemiologic process. The chapter compares the similarities and differences in the epidemiologic approach and scientific methods and analyzes a health or disease-related condition using the epidemiologic triad. It describes the differences in the epidemiologic tools.
Epidemiologic investigations provide evidence regarding the linkage between an exposure and the occurrence of a disease or health condition. This epidemiologic investigation also provides evidence as to the magnitude of risk associated with the exposure as compared to the extent to which the exposure’s relationship to the disease or health condition occurred by chance alone. Risk can be defined as the probability or likelihood that an adverse health event will occur in an individual or population. This chapter describes the steps of a risk assessment. It helps the reader calculate relative risk, odds ratio, and attributable risk. Nurses, as healthcare providers, educate patients on the risk associated with lifestyle behaviors and exposures to various disease-causing agents. During the nursing assessment, various types of risks can be further investigated and explored to determine an individual level risk profile.
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Nurses play a key role in the field of epidemiology and in population health. Population-focused nursing demands application of nursing theory and practice while integrating the tenets of public health to contribute to the improvement of community and population health. While advanced practice nurses may not all specialize in public health, it is essential that advanced practice nurses have a foundational knowledge of concepts on the health and illness continuum from a population perspective. This chapter articulates the meaning of advanced practice nursing. It describes the role of the advanced practice nurse in epidemiology and population health. Consistent themes emerge across all functional roles of advanced practice nursing. Advanced assessment and analytic skills to include use of epidemiologic data and concepts to better understand disease occurrence and distribution are crucial to optimal health outcomes.
The dissemination of epidemiologic knowledge must be of the utmost ethical manner. Epidemiologists have to promote the development of their scientific reputation to advance their professional careers, but most do this in an ethical manner. Meanwhile the public has the right to know their health risks and expect that epidemiologic research is conducted in a manner of scientific rigor while protecting human subjects. Ethical guidelines and principles guide the ethical practice of epidemiology. This chapter helps the reader to integrate ethical principles into the ethical decision-making process. It demonstrates the utilization of personal and professional core values that influence ethical decision-making.
Statistics is all about recognizing and addressing sources of variability, either through study design or statistical analysis. Variability is both essential for understanding associations and a nuisance that encumbers our efforts at measuring them. This chapter provides a description of the properties of variables. Variables are measurable characteristics or traits that vary from object to object. It is useful to classify variables by their scale of measurement. Two goals of research are to characterize attributes or features of a population and assess associations of interest. These activities necessitate the need for observing characteristics of members of a population. Sensitivity can be expressed as the conditional probability that a diagnostic test produces a positive test result given an individual has the disease. Specificity is the conditional probability that a diagnostic test produces a negative test result given an individual is disease free.
Population health has great potential to mitigate health disparities. It is evident that the need for epidemiology to guide population health continues to grow. It is imperative that epidemiology is utilized to not only identify risk factors but use that knowledge to target the right care to the right individuals at the correct time—now called precision medicine. The population health lens can be used at the individual, practice, institutional, systems, and community levels to drive improvements to health outcomes. The United States’ healthcare system is rapidly evolving and tremendously complex. Most would agree there needs to be a solution to address gaps and fragmented services in healthcare delivery. This chapter articulates the defining characteristics of a population and population health. It describes the determinants of health categories. The chapter differentiates population health strategies and population management strategies and describes the relationship of population health and epidemiology.