2. Applied Epidemiology PU 520-6 Unit 9

3. Overview  Epidemiologic specializations  Research design  Global Burden of Disease Study  Disability-adjusted life year  Test Your Knowledge  Breslow’s study  Overview of Exam 3

4. Psychologic  What might psychological epidemiology be?  What are psychological processes and how do they influence health?

5. Behavioral  Studies the role of behavioral factors in health Examples  tobacco use  physical activity  risky sexual behavior  consumption of unhealthy foods

6. Social  The influence of a person’s position in the social structure upon the development of disease

7. Research Designs Used Case Control Cohort Cross sectional Experimental

8. Global Burden of Disease Study  Measures burden of disease  Combines years of life lost  Due to premature mortality  Years of life lost  Comprehensive regional and global assessment

9. Disability-Adjusted Life Year  Metric that assess the burden of disease  Measures the gap between current health and ideal health  Sum of the Years of Life Lost  What are the 10 leading specific causes of global DALYs?

10. Test Your Knowledge  What is the person-environment fit model?  What is stress?  What is the stress press model?  Name a stressful life event. What are ways you deal with stress?  What is the Social Readjustment Rating Scale?

11. Healthy People 2010  What is healthy people 2010?  What are the overarching goals?  Give me two focus areas!

12. Breslow's study Moderate food intake Eating regularly Eating breakfast Not Smoking Cigarettes Moderate or no use of alcohol Moderate exercise 7 to 8 hours of sleep daily

13. Exam 3 Review  Sensitivity  Specificity  Reliability  Validity  Direct Transmission  Indirect Transmission  Case Fatality Rate  Mortality Rate  Major resurgence of measles  TB rates in recent years  Passive Immunity  Selective Screening  Mass Screening  Ad hoc Screening  Multiphasic Screening

14. What am I?  Epidemiology Monitor  Lyme Disease is consider what type of vector?  How many specialties are in the field of epidemiology?  What is virulent virus?  Foods that transmit salmonella

15. Other Terms to Know  High subclinical/clinical ratio  Portal of exit  Portal of entry  Asbestos Exposure  Electronic & Mechanic Fields Exposure  Threshold  Latency  Synergism

16. Difference Between Studies  Experimental  Retrospective Cohort  Prospective Cohort  Case -Control  Cross-Sectional

17. Test Your Knowledge  What is person-environment fit model ?  What is the most important methodological problems in the measurement of life events?  According to The Association of Schools of Public Health, What competencies in epidemiology is need to be achieved by Master of Public Health degree candidates?

18. What is sensitivity?  The sensitivity of a test is the probability that the test is positive when given to a group of patients with the disease. Sensitivity is sometimes abbreviated Sn.  The formula for sensitivity is Sn = True Positive Test____ All Patients With Disease

19. Sensitivity Formula  In a study of 5,113 subjects checked for gastric cancer by endoscopy There were 13 patients with gastric cancer confirmed by endoscopy. 11 of these patients were positive on the test.  The sensitivity is 11/13 = 85%.

20. Predictive Value of a Positive Test  Proportion of persons with positive test who have condition.  PPV= True Positive___ True + False Positive (All Positive)

21. Predictive Value Formula  1000 patients in a clinic, being tested for syphilis 100 have the characteristics and 900 don’t.  Among the 100 patients with syphilis, 95 of them tested positive, and 5 tested negative. Among the 900 patients without syphilis, 90 tested positive, and 810 tested negative. In this case, TP=95, FN=5, FP=90, and TN=810.  In the case above, that would be 95/(95+90)= 51.4%. The positive predictive value tells us how likely someone is to have the characteristic if the test is positive. Among all people that test positive, what proportion truly has the characteristic? 51.4% PPV means that if you test positive, you have a 51.4% chance of actually having the disease.

22. Last Thoughts