Principles of Epidemiology - Up

Principles of
Epidemiology.
INTRODUCTION AND BLOCK 1
Unit 1.1
HISTORY OF EPIDEMIOLOGY
Introduction
Definition:
Epidemiologist study of patterns causes and effects of health and disease conditions in a defined
population.
Corner stone of public health.
Informs policy decisions and evidence-based medicine by identifying risk factors and targets for
preventive medicine.
Has helped to develop methodology used in clinical research & public health studies.
Introduction
•Hippocrates, known as the father of medicine, is considered the first
epidemiologist.
•logical explanations for illness and was the first to explore the relationship between disease and
environmental factors.
•His theory:
•imbalance of the four Humors (air, fire, water, and earth), believed to cause sickness.
•First to differentiate between epidemic diseases (temporary outbreaks) and
endemic diseases (continuous presence within a population).
•The term "epidemiology" was coined in 1802 by Spanish physician Joaquín
de Villalba to describe the study of epidemics.
•Modern epidemiology also includes the study of how multiple diseases
interact within a population, known as syndemics.
John Snow- Case of Cholera on
Broad St
“Typhoid Mary”
Mary Mallon was born in 1869 in Ireland and emigrated to the US in 1884.
She had worked in a variety of domestic positions for wealthy families prior to settling into
her career as a cook.
It is not clear when she became a carrier of the typhoid bacterium
(Salmonella typhi).
As a healthy carrier of Salmonella typhi her nickname of “Typhoid Mary” had become
synonymous with the spread of disease, as many were infected due to her denial of being ill.
She was forced into quarantine on two separate occasions on North Brother Island for a
total of 26 years and died alone without friends, having evidently found consolation in her
religion to which she gave her faith and loyalty.
Unit 2
APPROACH AND EVOLUTION OF EPIDEMIOLOGY
Sources of scientific knowledge in
Public Health
Basic Sciences
◦ Controlled lab environment
Clinical or medical sciences

◦ Research question is focused on disease diagnosis, treatment and prognosis
◦ Labs etc.
Public health sciences

◦ Prevent disease and promote health on large scale
Objectives of Epidemiology
Study the natural course of disease from onset to resolution
Determine the extent of disease in a population
Identify patterns and trend in disease occurrence
Identify the cause of disease
Evaluative the effectiveness of preventative and treatment measures
Population
Population refers to a group of people with a
common characteristic such as place of residence,
gender, age, or use of certain medical services.
Determining the size of the population in which
disease occurs is as important as counting the
cases of the disease, because it is only when the
number of cases is related to the size of the
population that we know the true frequency of
disease.
Sources:
◦ census
Disease Frequency
Disease frequency refers to quantifying how often a disease arises in a population.

Counting, includes three steps:
◦ (1) developing a definition of disease,
◦ (2) instituting a mechanism for counting cases of disease within a specified population, and
◦ (3)determining the size of that population.
Diseases must be clearly defined in order to determine accurately who should be counted. Usually,
disease definitions are based on a combination of physical and pathological examinations, diagnostic test
results, and signs and symptoms.
For example, a case definition of breast cancer might include findings of a palpable lump during a
physical exam and mammographic and pathological evidence of malignant disease.
Sources
◦ hospital patient rosters, death certificates, special reporting systems such as registries of cancer and birth defects,
and special surveys.
Disease Distribution
Disease distribution refers to the analysis of

disease patterns according to the characteristics
of person, place, and time; in other words,
who is getting the disease, where it is occurring,
and how it is changing over time.
Variations in disease frequency helps us to
understand the health status of a population;
formulate hypotheses about the determinants of
a disease; and plan, implement, and evaluate
public health programs to control and prevent
adverse health events.
Disease Determinants
Disease determinants are factors that bring about a change in a person’s health or make a
difference in a person’s health.
Thus, determinants consist of both causal and preventive factors.
Determinants also include individual, environmental, and societal characteristics.
Individual determinants consist of a person’s genetic makeup, gender, age, immunity level, diet,
behaviors, and existing diseases.
Disease Control
Epidemiologists accomplish disease control through epidemiologic research, as described
previously, and through surveillance.
The purpose of surveillance is to monitor aspects of disease occurrence that are pertinent to
effective control.
Doll and Hill’s Studies on
Smoking and Lung Cancer
The study was conducted by Richard Doll and Austin Bradford Hill (English
epidemiologist and statistician, 1897–1991) who demonstrated that the risk of lung
cancer was related to the number of cigarettes smoked per day (the risk was 25
times higher in those who smoked >25 cigarettes a day than in nonsmokers).
Sent questionnaires to doctors
Compared smoking rates among hospital patients with lung cancer and those without.
The Framingham Study
•Another study focused o shift: infectious diseases to non-infectious diseases
post-WWII.
•Cohort studies and foundational for understanding risk factors, especially for
ischemic heart disease.
•Identified key cardiovascular risk factors: high blood pressure, elevated
cholesterol, physical inactivity, and stress.
•Initially started in 1947 to detect latent cardiovascular disease, it expanded to
study causes of various diseases, including stroke, diabetes, Alzheimer’s, and
cancer.
•The study enrolled 5,000 healthy residents of Framingham, Massachusetts,
and followed them for over 50 years, collecting data through interviews,
physical exams, and lab tests.
Unit 3
Dahlgren and Whitehead’s
model of health
Uses of Epidemiology
Determine disease factors
Study occurrence of disease (diagnosis and prognosis)
Measure risk
Measure rates: incidence, morbidity, mortality
Disease prevention and control
Screening
Administrative medicine and operational research
Study cause of disease
Epidemiological Triad
Question for forum discussion
Name two historical figures and list their contributions to the field of Epidemiology.
Do not repeat discussion from webinar.

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Clinical or medical sciences

Public health sciences

Disease frequency refers to quantifying how often a disease arises in a population.

Disease distribution refers to the analysis of

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