1. BY JOHN SNOW IN 1854. The key

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Last updated: September 14, 2019

1.

  MAIN EPIDEMIOLOGICAL CHARACTERISTICS IN SHOE-LEATHER EPIDEMIOLOGYCONDUCTED BY JOHN SNOW IN 1854.The key characteristics in Shoe-Leather Epidemiology by John Snowconducted in 1854 consists of the following:·        PopulationFocus: The Shoe-Leather Epidemiologyconducted by John Snow focused on the population that died due to Cholera dueto the source of water supply in London during 1849 – 1854.Furthermore, John Snow focused his study on the population which was supplied water by Southwark & VauxhallCompany which drew water from the polluted part of Thames River. Next, LambethCompany which relocated its water intake to less contaminated part of theThames. (Table: 1-5 Snow. J: modes of communication of Cholera).

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·        Distribution:The distribution pattern of Shoe Leather Epidemiology of John Snowwas on the number of deaths that occurred in London during 1849 – 1854 due toCholera.·        Determinants:The determinants which were studied included firstly those homeswhich received water from Southwark & Vauxhall Company; secondly the homesreceiving water by Lambeth Company.·        Outcome:The outcome of the natural experiment conducted by John Snowconcluded high deaths were the consequent result of contaminated water whichwas associated with Cholera.·        Association:In his natural experiment John Snow focused on finding theassociation between the deaths that were caused due to Cholera in London during1849 – 1854 and the source of drinking water to these homes of London.·        Epidemic: John Snow studied the occurrence of deaths due to Cholera inassociation with the source of water supply in one district of London, plottingit against similar deaths in another district.·        FrequencyDistribution: John Snowlisted the water supply company wise against the number of houses, deaths fromCholera and deaths per 10,000 houses. 2.

  HIGHER RISK OF CARDIOVASCULARDISEASE:Accordingto World Health Organization (WHO), the Cardiovascular Disease are the group ofdisorders of heart and blood vessels that may lead to Hypertension, CoronaryHeart Disease, Stroke, Heart failure to name a few.·        Risk Factors: TheRisk Factors in this study would be as follows:o   Age: According to the study conducted by Moazaffarian.D et.al (2015)and published by American Heart Association, Americans aged 60 years &above stand at a very higher level of prevalence of Cardiovascular Disease.

o   Sex: According to the study conducted by Moazaffarian.D et.al (2015) andpublished by American Heart Association (AHA), Men above the age of 60 yearsstand at a significantly higherprevalence rate when compared to Women of the same age.o   High Blood Pressure: American Heart Association (AHA) reported as per the studiesconducted, the people with higher blood pressure (b.p) stands at higher riskthan people with normal blood pressures.Also, people with high blood pressurealong with Diabetes Mellitus Type – II have twice higher chances of developingCardiovascular Disease.o   Diabetes: Especially Diabetes Mellitus Type – II is a known risk factor forCardiovascular Disease.

Diabetes Mellitus Type – II along with co-risk factor& comorbidity significantly increases the risk of Cardiovascular Disease.o   Abnormal Cholesterol &Triglycerides: American HeartAssociation (AHA) reported patients with high LDL Cholesterol (badcholesterol), low HDL Cholesterol (good cholesterol) and high triglycerides areat significant risk to develop Cardiovascular Disease.o   Obesity: As per the Centre for Disease Control & Prevention (CDC) obesityis a major risk factor for Cardiovascular Disease & it has been stronglyassociated with Diabetes Mellitus Type – II.o   Excessive Alcohol & Smoking: For each respectively American Heart Association (AHA) & Centrefor Disease Control & Prevention (CDC) has put individuals who consumeexcessive alcohol & smokes at higher risk for Cardiovascular Diseaseirrespective of their Diabetes status.·        Exposures: The Exposure of the subjects in the study will be mapped bystudying the exposed groups which would be as follows:o   Age: As per the report of WHO published in the year 2015, higher theage; higher are the prevalence rates of Cardiovascular Disease.

o   Sex: As per the study conducted by Moazaffarian.D et.al (2015) &published by American Heart Association (AHA), the prevalence rate of Men inthe age group of 60-79 years is higher than Females in same age group. Whereasin the age group of 80+, Females were at higher risk to develop CardiovascularDisease.

o   Diabetes: As per the data published by WHO, AHA, CDC; diabetic population alongwith cofactor & comorbidity is higher prevalent for Cardiovascular Disease.o   Obesity: WHO reports people with higher body weight, less physical activityare a major exposed group to Cardiovascular Disease.·        Outcome: The outcome of this study have to be clearly defined to maphow common Cardiovascular Diseases are inthe population as per measurement of morbidity & mortality trends.       The measurement aspect shall be defined forspecific signs, symptoms & emphasis on diagnostic tests for respectiveCardiovascular Disease.     Accordingto Developing a Protocol for observational & Effective Research: User Guideby Velentgs.P et.al (2013) the outcomes of epidemiological study are to bedivided as follows;o   Clinical Outcomes Are veryimportant outcomes to be considered as per medical treatments provided tosubjective patients which are to be mapped effectively. Apart from the blood tests, few other diagnostic tests which aredone include X-Ray, ECG, Cardiac Catheterization, Cardiac CT, Cardiac MRI, etc.

o   Patient Reported Outcomes: These are the outcomes which are based on the patient’s ownperspective ex: uneasiness, giddiness, pain elevation. 3.     MY MAJOR AT WKU:My Major at WKU is Healthcare Administration.

In my view, the roleof the Hospital Administrator have elaborated in the current healthcarescenario as Administrators are responsible to present an environment toclinicians in which there is prominent, qualified & competent staff,correct systems & workable models are in place, smooth functional machineryinstalled, adequate supply of medicines & related consumables with properinfrastructure which is taken care round the clock. Most importantlyinteracting with patients, doctors, nurses & other allied staff catering tothe community, finding the answers for the betterment of community has made mechoose Healthcare Administration as my major.With rapid changes in healthcare delivery systems specializedunderstanding of Epidemiology is a necessary for Hospital Administrators whoshall focus on delivering care to populations than the specific patient needcare P.

J Et.al Healthcare Adm. Edu (1998).USE OFEPIDEMIOLOGY IN MY AREA:Thetextbook definition of Epidemiology is “the science/studyof the distribution & determinants of disease in a human population.”Asper the definition Epidemiology is;      Study: it is thestudy of the health of the population.

Distribution: who, when, where it occurs.Determinants: searching for the causes.Populations: geographically defined population.Quantification:cases of illness.Control: health promotion/preventionof disease.      Morris JN. “Uses of Epidemiology” 3rdEd. Edinburg, the UK lists the usesof Epidemiology as follows;·        Tostudy history of health population·        Todiagnose health community·        Tostudy working of health services·        Toestimate individual risks of disease·        Toidentify syndromes·        Tocompute clinical picture·        Tosearch for causesThe WHOHealth System Delivery published 2007 gives the Epidemiology Model for HealthSystem which is as;The incidence of Hypertension in Patients with Diabetes Mellitus –Epidemiological Study in My Area:      As per the data of WHO, during the year 2000, South-East Asia had 46 Million Diabeticpopulation of which India accounted for 31 Million diabetics, it is expectedthat Indian Diabetic Population will reach 79 Million by the year 2030.

WHO data of2008 shows 32.5% of the Indian population is Hypertensive. Hypertension is aknown cause of Cardiovascular Diseases, stroke, ischemicheart disease. Hypertension with comorbidity of Diabetes doubles the rate of thesediseases El. Ataf et.al 2004.Indian HeartAssociation data of 2015 says the Indian city of Hyderabad, Telangana was thethen diabetic capital of the world.

Therefore thisEpidemiological study to find the incidence of Hypertension in diabeticpatients is rightly needed.Key Characteristics of the Study:·        The objective ofstudy: To find the incidence ofhypertension in the diabetic population.·        Distribution:The distribution of the study is as follows;o   Who: Diabetic Patients who visit ABC Hospital – Hyderabad,Telangana – India, aged between 18 – 80 years, both males & females patients who do not suffer from any other chronic disease.o    Where: Patientsvisiting ABC Hospital – Hyderabad, Telangana – India.

o   When: During 01-01-2014 & 31-12-2017 are included in the study.·        Determinants:To monitor subjects (patients) included in the study especially for;o  Physicalexaminationo  Bloodsugar test resultso  Bloodpressure measuremento  Lipidprofile studyThe subjectscan be divided into two groups – one diabetic patientWithout Hypertension & in another Diabeticpatient With Hypertension.Each month asthe patients (subjects) visits the ABC Hospital for their monthly examination, he/she is to be mapped for all above criteria& deviation if any found shall be noted accordingly.·        Population:All patients who visit ABC Hospital – Hyderabad, India during thestudy period aged between 18 – 80 years either male/female& who are free from other chronic diseases.·        Quantification:o  CaseDefinition: Patients withDiabetes Mellitus Type-II who show deviations from normal systolic blood pressures are to be added toa subject group named Diabetes & whodevelop Hypertension.o  IncidenceProportion (Cumulative Incidence) considering the deaths/loss follow-up is calculated as;I           =          No.

of new cases of DM Type-II & HTN during the study periodNo.of persons at risk of developing – 0.5 * No. of deaths/loss follow-up                                      atbeginning of the study o  Person-time will becalculated as = total follow-up * time contributed by each persono  IncidenceRate (IR) is calculated as;IR        =          No.

of New cases                        Totalperson-time

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