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UNIT 1 - Slides S
UNIT 1 - Slides S
Unit 1
1
EPIDEMIOLOGY
Definition
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EPIDEMIOLOGY
Consists of Three Greek Words
• Epi = among
• Demos = people
• Logos = doctrine
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EPIDEMIOLOGY
Two Fundamental Assumptions
1900 2000
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Ten Leading Causes of Death in World, Developed (European
countries, former Soviet countries, Canada, USA, Japan, Australia, and New
Zealand) and Developing Countries - 2000
8
(Source: Beaglehole R et al. Lancet 362:903-908, 2003)
WHO
9
Life Expectancy at Birth, United States
(Source: U.S. Census Bureau)
Years
90
1900 2000 79.5
80 74.1
70
60
46.3 48.3
50
40
30
20
10
0
Males Females
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Ten Great Public Heath Achievements –
U.S., 1900-99
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Ten Great Public Heath Achievements –
U.S., 2001-2010
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Source: Beaglehole R et al. Lancet 362:903-908, 2003
Levels of Disease Prevention
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EPIDEMIOLOGY
Two Approaches to Prevention
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EPIDEMIOLOGY
Usual Pattern of Reasoning
• Develop a hypothesis
• Test the hypothesis on an exposed human
population and include an appropriate
comparison group
• Systematically collect and analyze the data
to determine whether a statistical association
exists
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EPIDEMIOLOGY
Usual Pattern of Reasoning
• Assess the validity of any observed
statistical association by excluding possible
alternative explanations such as
– Chance (random error)
– Bias (systematic error)
– Effects of additional variables that might
be responsible for the observed
association (confounding)
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EPIDEMIOLOGY
Usual Pattern of Reasoning
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History of Epidemiology
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History of Epidemiology
• 1662 - John Graunt - a petty merchandiser in
London, publishes The Nature and Political
Observations Made Upon the Bills of
Mortality in which he:
– Analyzes the weekly reports of births and
deaths in London
– For the first time, quantifies patterns of
disease in a population
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24
History of Epidemiology
• 1796 - Edward Jenner, convinced through reported
observations that cowpox vaccination protects against
smallpox, took cowpox material from a lesion on the hand of
a dairy maid and inoculated an 8 year old “volunteer”, then
exposed this child to smallpox 6 weeks later; the child did
not contract smallpox.
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History of Epidemiology
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William Farr’s Hypothesis on Cholera (cholera is transmitted by a cloud (miasma)
that clings low to the ground surface)
20 – 40 65
40 – 60 34
60 – 80 27
80 – 100 22
100 – 120 17
340 – 360 8
27
Source: Textbook, p. 14
Death Rates from Cholera, 1853-1854, London
by water company supplying actual house
Lambeth 26,107 98 37
Source: Snow J. On the Mode of Communication of Cholera (2nd ed). London: Churchill, 1855. Reproduced in
Snow on Cholera. New York: Hafner, 1965.
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In addition, Snow found that the
water coming from the Broad Street
pump was cloudy; people had
reported that it smelt bad in the
days preceding the outbreak. The
well was nine meters deep, but a
sewer only seven meters below
ground was just above it. On 7
September 1854, a week after the
outbreak began, Snow got the
authorities to remove the pump
handle. The number of infections
and deaths fell rapidly.
http://www.makingthemodernworld.org.uk/learning_module
s/geography/05.TU.01/?section=2
Illustration of the contents of a pail of water
sourced from a cistern, around the time of the
1854 cholera epidemic in the UK. 29
Examples of Scientists who have
Questioned Existing Pathogenesis
• 1850s - John Snow (a British physician) and cholera in
London, England
– Pathogenesis questioned – Cholera is not caused by London
fog (Miasm)
– Showed drinking water contamination was important to
pathogenesis
– Reward: called Father of Epidemiology – first investigator to
draw together all three components (frequency, distribution,
determinants) of the definition of epidemiology
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