Chapter 1 History, Philosophy, and Uses of Epidemiology – Flashcards
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Epidemic
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"The occurrence in a community or regions of cases of an illness, specific health-related behavior, or other health-related events clearly in excess of normal expectancy
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Pandemic
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"an epidemic occuring worldwide, or over a very wide area, crossing international boundaries, and usually affecting a large number of people"
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Epidemiology
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Epidemiology is concerned with the distribution and determinants of health and diseases, morbidity, injuries, diability, and mortality in population. Epidemiologic studies are applied to the control of health problem in populations"
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Key characteristics of epidemiology
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-population focus -distribution -determinants -outcomes -quantification -control of health problems
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population focus
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-focus of epidemiology is on the occurrence of health and disease in the population -population aproach contrasts with clinical medicine's concern with the individual
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population
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"all of the inhabitants of a given country or area considered together"
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distribution
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-occurrence of diseases and other health outcomes varies in populations, with some subgroups of the populations more frequently affected than others
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determinants
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"any factor that brings about changes in a health conidtion or other defined characteristic" -any factor that changes/influences an outcome -ex: biologic agents
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Exposures
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-related to determinants -pertain either to contact with a disease-causing factor or to the amount of the factor that impinges upon a group or individual -specific type of determinant
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outcomes
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-"all the possible results that may stem from exposure to a causal factor" -expressed as types and measures of morbitdity and mortality
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morbidity
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illnesses due to a specific disease or health conidtion
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mortality
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death (from various causes)
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quantification
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-counting the cases of illness or other health outcomes -denoted the use of statistics to: describe the occurrence of health outcomes and measure their association with exposures -epidemiology is a quantitative discipline
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control of health problems
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-epidemiology aids with: health promotion, alleviation of adverse health outomes, prevention of disease -ex of health problems to be controlled: infectious and communicable diseases and chronic diseases
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Natural history of disease
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-course of disease from its beginning to its final clinical endpoints -primary - before the disease occures -secondary - during the progression of the disease -tertiary - during later stages of the disease
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Evolving coneption of Epidemiology as a liberal art
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-skills acquired through training in epidemiology: 1 use of the interdeisciplinary aproach 2 use of the scientific method 3 enchancement of critical thinking ability use of quantitative and computer methods 5 communication skills 6 inculcation of aesthetic values
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Interdisciplinary approach
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-epidemiology is an interdisciplinary sicence - many fields includes: mathematics and biostatistics, history, sociology, demography and geography, behavioral sciences, law
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use of scientific method
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-epidemiology is a scientific discipline that makes use of a body of reaserch methods similar to those used the basic sciences and applied fields -utilizes the following study designs: cross-sectional, ecologic, case-control, cohort
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obercational science
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-where epidemiology capitalizes upon naturally occurring situations in order ot study the occurrence of disease
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descriptive epidemiology
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epidemiologic studies concerned with characerizing the amount and distribution of health and disease within a population
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analytic epidemiology
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examines causal (etiologic) hypothese regarding the association between exposures and health conditions
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natural experiments
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-naturally occurring circumstances in which subsets of the population have different levels of exposures to a supposed causal factor in a situation resembling an actual experiment where human subjects would be randomly allocated to groups
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Classical antiquity (before 500 AD)
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Hippocrates (460-360BC) -greek authority departed from superstitious reasons for disease outbreaks Wrote ON AIRS, WATERS, AND PLACES in 400 BS -suggested disease might be associated with environmental factors
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Middle Ages (approx. 500-1450)
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Black Death (between 1346 - 1352) -throught to be causedby bacterial infection of Yersinia pestis transmitted via flea bites -claimed 1/3 of population of Europe (20-30 million people out of 100 million) -characterized by: swollen lymph nodes, fever, appearance of black splotches on the skin
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Renaissance (approx 1200-1699)
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Paracelsus (1493-1541) - founder of field of toxicology -contributions: dose-response relationship and notion of target organ specificity of chemicals John Graunt (1620-1674) published: -NATURAL AND POLITICAL OBSERVATIONS METNTIONE IN A FOLLOWING INDEX & MADE UPON THE BILLS OF MORTALITY (1622) -first to employ quantitavie methods -known as the columbus of statistisc
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Eightheeth Century (1700-1799)
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Edward Jenner (1749-1823) - developed a method for smallpox vaccination
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Nineteenth Century (1800-1899)
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John Snow and cholera in London during the mid-19th century
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John Snow (1813-1858)
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-english anesthesiologist who innocated several of the key epidemiologic mehtods that remian valid and in use today -believed that cholera was transmitted by contaminated water and was able to demonstrate this association
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Miasmatic Theory of Disease
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-disease was transmitted by a miasm, or cloud that clung low on the surface of the earth
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Snow's Natural Experiment
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-Broad Street, London, had a major cholera outbreak in 1849 -two different water companies supplied water from the Thames River to house int he same area -1852 - the Lambeth company relovated its sources of water to a less polluted portion of hte river -Snow noted that those residents served by the Lamther Company had fewer cases of cholera than resident served by the other water company
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John Snow's Contribution
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-Powers of observation and written expression -application of epidemiologic methods:used mapping and used data tables to describe infectious disease outbreaks
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William Farr (1807-1883)
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"Compiler of Abstracts" -developed a more sophisticated system for codifying medical conditions -examined possible linakge between mortality rates and population density
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Contemporary Era (1940 to Present)
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0Framingham study investigates risk factors for coronary heart disease -Epidemic Intelligence Service -publication of the US Suregon General;s report, Smoking and Health (1964) - identified deleterious effects of smoking upon health -smallpox eradication -Discovery of: -human papillomavirus and cervical cancer -bacterium and peptic ulcers - genetic factors and cancer
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Uses of Epidemiology
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-historical -community health -health services -risk assessment -disease causality
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Historical Use
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-historical use of epidemiology documents the patterns, types and causes of morbidity and mortality over time
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Epidemiologic Transition
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describes a shift in the patterns of morbidity and mortality from causes related primarily to infectious and communicable disease to causes associated with chronic, degenerative diseases
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demographic transition
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coincides with the demographic transition, which is a shift from high birth rates and death rates found in agrarian societies to much lower birth rates and death rates in developed countries
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stage of epidemiolgic transition
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pestilence and famine receding pandemics degenerative and man-made disease delayed degernerative disease and emerging infecions
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community health use
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to diagnose the health of the community and the condition of the people, to measure the true dimensions and distributions of ill-health in terms of incidence, prevalence, disability, and mortality
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health serivces use
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to studythe working of health services with a view to their improvement
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operations research
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-type of study of the placement of health services in a community and the otimum utilization of such services -epidemiology helps provide quantitative information regarding the availibility and cost of healthcare services -aid panners in determining what services are needed in the community and what services are duplicated unnecessarily
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disease management
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refers to the method of reducing healthcare costs by providing intergrated care for chronic conditions
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risk assessment use
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to estimate from the group experience what are the individual rissk on a average of disease, accident and defect, and the chances of avoiding them
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risk
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"the probability that an event will occur"
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risk factor
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an exposure that is associated with a disease, morbidity, mortality, or adverse health outcome
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*disease cuasailty use
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-"to search for causes of health and disease by computing the experience of groups defined by their composition, inheritance and experience, their behavior and environments
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ethics
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"norms for conduct that distinguish between acceptable and unacceptable behavior
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ethics in research
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adherence to ethical norms in research: -promotes the aims of resaerch promotes values that are essential to collaboratiave work helps to ensure that researchers can be held accountable ot the public helps build public support for research -promotoes a variety of other important moral and social values, such as social responsisbility, human rights...
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ethical violation
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US Public Health Service Syphilis Study at Tuskegee -Syphilis investigation from 1932-1972 -purpose was to "record the natural history of syphilis in hope of justifying treatment programs for blacks -total of 600 African Americans men participated
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ethics guidlines for epidemiologist
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-minimizing risks and protecting the welfare of research subjects -obtaining the informed consent of participants -submitting proposed studies for ethical review -maintaining public trust -[Meeting] obligations to communities
