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component in the definition it allows us to understand the distribution in one or more populations or localities. Because dis- eases are not randomly distributed, understanding the distribution of a disease in people (i.e., person), place, and time is important to develop hypotheses about its etiology, understand the magnitude of the prob- lem, plan medical and nonmedical interventions, and estimate the need for health services. Descriptive epi- demiology answers questions about who, where, and when in the distribution or occurrence of a disease. To answer these questions, decision makers, analysts, or policy makers can use existing data from various sources, or they may need to conduct targeted inves- tigations to collect necessary information about the disease of interest. Either way, epidemiological studies that are done to describe the distribution of a disease or health problem are accordingly known as descrip- associ there tions lower nity, and grea dise pro con Cle hig an in ti 0 e tive studies. In this chapter, we will first discuss the impor- tance of understanding the distribution of diseases in person, place, and time, and then describe how such information is gathered through descriptive studies such as case reports and cross-sectional studies so that it can be used by healthcare providers, administrators, and policy makers. 5.2 Person Demographic characteristics of a person such as age, race, sex, occupation, and income allow us to group ple into different categories. Apart from or health problem are accordingly tive studies. In this chapter, we will first discuss the impor- tance of understanding the distribution of diseases in person, place, and time, and then describe how such information is gathered through descriptive studies such as case reports and cross-sectional studies so that it can be used by healthcare providers, administrators, and policy makers. 5.2 Person t 86 Chapter 5 Descriptive Epidemi T: 5.1 Introduction Yo estimate the need for different kinds of services and to conduct market analysis, healthcare man- agers need to understand the nature of health problems and the characteristics of patient populations in their service area. For example, knowing the magni- tude and distribution of problems such as Alzheimer’s disease, hepatitis B, or substance abuse in their service area, managers can assess the need for screening, vacci- nation, detoxification, and rehabilitation services, Descriptive epidemiology deals with the distributive component in the definition of epidemiology–that is, it allows us to understand the distribution of disease in one or more populations or localities. Because dis- cases are not randomly distributed, understanding the distribution of a disease in people (i.e., person), place, and time is important to develop hypotheses about its etiology, understand the magnitude of the prob- lem, plan medical and nonmedical interventions, and estimate the need for health services. Descriptive epi- demiology answers questions about who, where, and when in the distribution or occurrence of a disease. To answer these questions, decision makers, analysts, or policy makers can use existing data from various sources, or they may need to conduct targeted inves- tigations to collect necessary information about the disease of interest. Either way, epidemiological studies that are done to describe the distribution of a disease or health problem are accordingly known as descrip- tive studies. In this chapter, we will first discuss the impor- tance of understanding the distribution of diseases in person, place, and time, and then describe how such information is gathered through descriptive studies such as case reports and cross-sectional studies so that it can be used by healthcare providers, administrators, and policy makers. T: 106 Chapter leavioral Epidemiology 6.1 Introduction The use of digital behavior change interventions (DRC), including smartphone apps (e. applications, smartwatches, wearable sensors, and Internet websites to promote healthy lifestyles and to monitor and reduce high risk activities is an emerging area of research in behavioral epidemiol ogs In the last few years, there has been an explo son in startup technology companies developing self-management skills training, therapist supported liness management symptom tracking and bio- feedback apps and devices. The use of mobile health technologies generally known as mHealth to monitor and improve health outcomes is becoming increas- ingly common. Between 2013 and 2015, the number of Health apps available on the Apple operating sys- tem known as iOS more than doubled, from about 43,700 to more than 90,000. By some estimates, more than 165,000 mHealth apps are currently available.’ Most of these apps are geared toward wellness pro- motion and disease management. Numerous smart- phone apps are currently available to reduce excessive consumption of alcohol, increase physical activity, improve women’s health, promote weight loss, and enhance treatment compliance for chronic condi- tions. However, the real impact of this new approach to influence health-related behaviors and lifestyle choices is not fully known. Some of the negative effects of electronic entertainment technologies such as video games, interactive social media such as Face- book, and mobile technologies such as smartphones on the physical and psychosocial health of individuals have been reported in recent literature and are now an active area of research. Studies on health-related behaviors have also found that physicians, residents, and medical students get insufficient sleep. exercise insufficiently and have depression, substance abuse, and alcohol dependence problems at higher rates than the rest of the population.” For healthcare mangers, these technological developments are highly relevant because of the high prevalence of lifestyle and behavior-related health problems and their ramifications for the healthcare system in terms of cost, healthcare utilization, work force training, and additional services to be provided. On one hand, healthcare managers have to tackle issues arising from the diverse needs of patients with lifestyle-related health problems. On the other hand, they face administrative challenges posed by the exis- tence of the same problems in their employees. The challenges of making special arrangements to meet patient needs range from having armless chairs and sofas, larger stretchers, and motorized wheelchain Environment H Η 7.1 Introduction *ealthcare-associated infections (HAIs) are a source of concern for healthcare managers. – They reflect poorly on the quality of care, and avoidance of HAIs is an important part of a healthcare organization’s risk management strategy. Every year, hundreds of millions of patients all over the world fall victim to HAIs. 12 It has been estimated that 7 out of every 100 hospitalized patients in developed countries and 10 of 100 in developing countries acquire at least one HAI. Approximately 30% of patients in intensive care units (ICUS) in high-income countries develop at least one HAI. The frequency of HAIs in ICU patients in low-income countries is estimated to be 2-3 times greater than in developed countries.34 The European Center for Disease Control and Prevention estimates that in Europe, every year, about 4.1 million patients are affected by 4.54 million episodes of HAIS that are directly responsible for 37,000 deaths. In 2013, the total annual cost of five major HAIs in the United States-central line-associated bloodstream infections, ventilator-associated pneumonias, surgi- cal site infections, Clostridium difficile infections, and catheter-associated urinary tract infections-was esti- mated to be about $9.8 billion, with surgical site infec- tions accounting for 33.7% of the total cost. Humans and other animals have had a complex and intimate relationship with microbial organisms for thousands of years. Mostly this relationship has been

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