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.
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- Go to chapter: Advanced Practice Nursing Roles and Competencies in Epidemiology and Population Health
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.
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.
History is the foundation of the future. If one is not to repeat the errors of the past, one must be knowledgeable about the historical developments that have led to the current modern-day state of affairs. The history of epidemiology has been influenced by many historic leaders from a diverse background of professions and disciplines. These historic leaders shared the purposeful mission to prevent and control health-related events with the desire to promote health among populations. This chapter focuses on historic leaders and events that have shaped modern day epidemiology.
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.
Infectious disease epidemiology is a branch of epidemiology that examines the distribution and determinants of diseases of an infectious nature. The essence of infectious disease epidemiology is the focus on the interaction among individuals within a population. An area of prime importance for infectious disease epidemiologists is the interaction between cases and contacts. The fundamentals of infectious disease epidemiology are grounded in the interaction between a causative agent, host, and the environment. Modes of transmission are an integral component to understanding infectious disease epidemiology and are discussed in the chapter. Infectious epidemiology also considers the interaction between individuals within the population group, especially the interaction between infectious cases and potential contacts. Nurses are frequently on the front line of contact with the patient and are essential members of the healthcare team in breaking the chain of infection.
Cohort study designs are a population-based observational epidemiologic study. Cohort studies evolve over time as diagnostic and medical science advances; for example, improved diagnostic screening and testing methods will be integrated into a cohort study design as they are developed or improved. This chapter describes an epidemiologic cohort study design, differentiates a prospective and retrospective cohort study design, and shows how to calculate a risk ratio and rate ratio. Cohort study designs can be developed with an integration of other study designs. A case-control study design can be nested into a cohort study design. In addition, there can be a nested case-control study design within a cohort study design with matching of cases and controls to account for confounding variables. Other study designs can be combined with or integrated into a cohort study design as a strategy to increase internal and external validity of the research study design.
A pandemic impacts the entire health of the community and multiple countries at the same time. During a pandemic, it is imperative to engage the entire community and the healthcare system, and create international exchanges of information and science—a multi-sector approach. To effectively respond to and control a pandemic, it is necessary to have integration of all aspects of the healthcare system inclusive of but not limited to public health, primary care, episodic care, acute care, convalescent or long-term care, and care provided by nontraditional care settings such as community-based or nonprofit organizations. One of the concerns during a pandemic is overstressing the healthcare system to the point of collapse or inability to appropriately and effectively respond to the crisis. In a pandemic situation, clinical disease can range from mild to severe even to the point of causing significant mortality within the population. The chapter also presents brief snapshots of several historical pandemics.
- Go to chapter: Observational Epidemiologic Research: Introduction to Observational Research—Descriptive, Case Studies, Case Series, Ecological, and Cross-Sectional
Observational Epidemiologic Research: Introduction to Observational Research—Descriptive, Case Studies, Case Series, Ecological, and Cross-Sectional
Epidemiologic research studies are conducted to describe the burden of disease in a population, the presence of risk factors, health behaviors, or other characteristics of a population that influence health alterations or disease processes. Epidemiologic studies can determine risk factors associated with disease, causal inferences, and effectiveness of health-related interventions. This chapter differentiates observational research designs and sampling methods and also describes the components of a research proposal, contrasting it with a research report. Epidemiologic research relies on primary and secondary data collection methods: Primary data collection is when the epidemiologist collects the data, such as from medical examinations and direct observations. Secondary data collection is where the data have been collected by others such as medical records, census data, and vital statistics data. Nurse epidemiologists or nurses who engage in epidemiologic research use both primary and secondary data sources to answer the proposed research question.
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.