Summary Introduction to Epidemiology and Public Health

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Summary - Introduction to Epidemiology and Public Health

  • 1 What is epidemiology about?

  • Epidemic, pandemic and endemic
    • epidemic = new cases of a disease in a given population during a given time period occur at a rate that substantially exceeds  what is expected
    • pandemic = epidemic that spreads across a large region
    • endemic = (infectious) disease that is common at a specific place
  • Definitions of epidemiology
    • the study of the distribution and determinants of disease
    • the study of the distribution and determinants of health related states and events in populations and the application of this study to control health problems
    • epidemiology is about measuring health, identifying the causes of ill-health, and intervening to improve health
  • Discovery of patterns 
    • systematically discovering patterns in a large amount of information
    • systematic analysis of data 
    • aimed at understanding the patterns in order to prevent or intervene 
  • 2 Epidemiology: an academic and applied science

  • Types of epidemiologists 
    • clinician: translate scientific knowledge and procedures --> "What is the best treatment for this specific patient?"
    • epidemiologist in academic setting: "How can I be sure about this specific exposure-effect, independent of the context of this person or population?"
    • epidemiologist in Public Health setting: "What is the best prevention strategy for this specific population/risk group?" 
  • Epidemiology in academic setting
    • analysing patterns and causes --> understanding patterns 
    • who, when, where, why, what? 
    • knowledge generation 
  • Epidemiology in Public Health setting
    • knowledge application --> using information for prevention in populations 
    • prevention through policies, programmes, and interventions
  • DISH
    1. Determinants of diet and lifestyle --> production/food chain/social and built environment  
    2. Intake of food and nutrients --> nutrition, nutriens, habits, intake
    3. Status and function of the body 
    4. Health and disease risk --> health and disease in a population
  • 3 History of epidemiology and Public Health

  • History of epidemiology and Public health
    • pre-formal: 1662-1900
    • early: 1900-1940
    • classical: 1940-1980
    • modern: 1980 onwards
    • infectious disease --> chronic disease --> any disease --> human health
  • Preformal epidemiology
    • infectious diseases, nutritional deficiencies
    • key figures: Graunt, Farr, Snow
    • hygiene and sanitation
    • world travelling --> disease imported/exported, puerperal fever, cholera
    • group thinking --> infectious diseases
  • Early epidemiology 
    • transition of acute infectious disease to chronic disease
    • interdisciplinary nature of epidemiology 
    • Major Greenwood as first professor in epidemiology
    • non-communicable diseases, pellagra, vitamins 
  • Classical epidemiology 
    • chronic diseases
    • large-scale epidemiological studies
    • new epidemiologic methods/study designs --> methodology, case-control, cohort, ecological, RCT, stratification and regression
    • academic field in US and UK 
    • TBC, tobacco smoke 
  • Modern epidemiology 
    • theoretical basis in RCT --> intervention trials 
    • differentiation of expertise 
    • prevention strategies  
  • Triumphs in epidemiology 
    • identification of water as reservoir and vehicle of communicable diseases 
    • indentification of arthropod vectors for diseases
    • cigarette smoking as major cause of lung cancer, emphysema, and CVD
    • indentification of the (causation of the) AIDS syndrome
  • Future of epidemiology
    • knowledge about health (determinants) 
    • foundation for Public Health interventions, policies and programmes
  • 4 Descriptive epidemiology

  • Types of epidemiology 
    • descriptive epidemiology: amount/frequency of disease or other conditions in a population (person, time, place)
    • analytical epidemiology: study of the cause of disease (exposure-disease associations) 
  • Descriptive study 
    • purpose: describe groups of people --> demographics, disease status, risk factors, behaviour
    • necessary: representative sample 
  • Descriptive epidemiology 
    • to evaluate the occurrence of health behaviours and health conditions (disease) --> time trends, specific population subgroups 
    • to provide a basis for planning and evaluation of interventions 
    • descriptive data can be used for analytical studies  
  • 5 Measures of disease occurrence

  • Prevalence proportion
    • measures the proportion of people in a population who have the disease at a given point in time 
    • point prevalence versus period prevalence
  • Incidence
    • measure the rate at which people get the disease --> number of new cases 
    • incidence proportion = proportion of people who newly get the disease
    • incidence rate = rate at which new cases of a disease have occurred 
  • Incidence proportion (IP)
    • IP = cumulative incidence (IC)
    • measures the proportion of people who develop the disease during a period
    • estimate of the averige risk of the persons in the cohort --> condition: complete follow-up, no competing mortality 
  • Incidence rate (IR)
    • IR = incidence density, mortality rate 
    • measures the proportion of people who develop the disease per person-years at risk --> time at risk instead of people at risk
  • Incidence in closed and open populations 
    • closed population: based on fixed membership, no addition of people, loss of people (death, loss to follow-up), becomes smaller with time --> IP and IR
    • open cohort/dynamic population: new members with time, people move in and out, numbers remain about the same --> IR 
  • Incidence, prevalence and disease duration
    • prevalence varies directly with incidence and disease duration
    • <incidence = >duration = large prevalence to incidence
    • <prevalence = <duration = small prevalence to incidence
  • Use of incidence and prevalence
    • incidence: acutely acquired diseases, etiology of the disorder
    • prevalence: permanent states/ill-health, societal burden of the disorder
  • Special types of incidence and prevalence measures 
    • morbidity rate
    • mortality rate
    • case-fatality rate 
    • attack rate
    • disease rate at autopsy
    • birth defect rate 
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