COURSE DESCRIPTIONThe epidemiology course covers applicationof epidemiologic procedures to theunderstanding of the occurrence and controlof the conditions such as infections andchronic diseases , mental disorders,community and environmental healthhazards , accidents , and geriatric problems.Credits hours:60
COURSE OBJETIVES► Upon completion of this course, each student should possess the following areas of subject mastery:1. Epidemiology as a tool for assessing potential causal associations, health needs of a population, delivery of services, program planning, and social policy.2. Assessment of the validity and reliability of such data collection mechanisms as death certificates, patient charts, agency records, and personal surveys.3. Measurements of mortality and morbidity (rates, ratios, and adjusted rates) and the major sources of error in measurement of disease.4. Descriptive epidemiology: the amount and distribution of disease within a population by person, place, and time.5. Research designs such as retrospective (case-control), prospective (cohort), historical prospective, cross-sectional, and experimental (clinical and community trials).6. Evaluation of screening programs in the detection of disease; terminology of screening including determinants of sensitivity and specificity.7. Population dynamics and health with respect to the stages in demographic transition and trends in the U.S. and world populations.8. Epidemiologic aspects of infectious disease (variations in severity of illness, components of the infectious disease process, mechanism of disease transmission, and common source versus propagated).9. Epidemiologic aspects of chronic disease (multi-factorial nature of etiology, long latency period, indefinite onset, and differential effect of factors on incidence and course of disease).
ATTENDANCEYour presence at a minimum of 80% of theEpidemiology and Public Health lectures ismandatory. The role will be taken on a dailybasis. Failure to attend 80% of thelectures will result in your withdrawalfrom the course (W) , which will requireyou to repeat the Epidemiology and PublicHealth course.
GRADING► There will be three integrated sectional examinations during the trimester.► Final grades are calculated as follows:► Sectional examination I 33%► Sectional examination II 34%► Sectional examination III 33%► Final grades are determined as follows:► Honors= 90 - 100► Pass= 75 – 89► Fail = 74 and below► Examinations can be postponed only for legitimate reasons including health problems or sickness in the immediate family. Notification of an absence from an exam must be made in advance by contacting the Dean of Students and the Professor of Epidemiology and Public Health.
SCHEDULE IHOURS LECTURE1 Introduction and orientation3 The history and scope of epidemiology.3 Practical applications of epidemiology.4 Measures of morbidity and mortality.4 Descriptive epidemiology :person ,place, time.1 Review.2 EXAM I
SCHEDULE IIHOUR LECTURES2 Sources of data for use in epidemiology.4 Study designs :ecologic and cross- sectional.3 Study designs :case-control3 Study designs : cohort studies.3 Experimental study designs.2 Measures of effect.2 Data interpretation issues.1 Review.
SCHEDULE IIIHOUR LECTURES4 Screening for disease in the community.4 Epidemiology of infectious diseases.3 Epidemiologic aspects of work and environment.3 Molecular and genetic epidemiology.3 Psychologic , behavioral , and social epidemiology.1 Review.2 EXAM III
INTRODUCTION TO EPIDEMIOLOGY.► Epidemiology is a fundamental medical science that focuses on the distribution and determinants of disease frequency in human populations. Specifically , epidemiologist examine patterns of illness in the population and then try to determine why certain groups or individuals develop a particular disease whereas others do not .
The history and scope of epidemiology.► Epidemiology defined.► Foundations of epidemiology .► Historical antecedents of epidemiology.► Recent applications of epidemiology .
EPIDEMIOLOGY DEFINED. Definition of epidemiology is "the study of the distribution and determinants of health-related states in specified populations, and the application of this study to control health problems." A look at the key words will help illuminate the meaning:► Study —Epidemiology is the basic science of public health. Its a highly quantitative discipline based on principles of statistics and research methodologies► Distribution —Epidemiologists study the distribution of frequencies and patterns of health events within groups in a population. To do this, they use descriptive epidemiology, which characterizes health events in terms of time, place, and person► Determinants —Epidemiologists also attempt to search for causes or factors that are associated with increased risk or probability of disease. This type of epidemiology, where we move from questions of "who," "what," "where," and "when" and start trying to answer "how" and "why," is referred to as analytical epidemiology.► Health-related states —Although infectious diseases were clearly the focus of much of the early epidemiological work, this is no longer true. Epidemiology as it is practiced today is applied to the whole spectrum of health-related events, which includes chronic disease, environmental problems, behavioral problems, and injuries in addition to infectious disease.► Populations —One of the most important distinguishing characteristics of epidemiology is that it deals with groups of people rather than with individual patients.► Control —Finally, although epidemiology can be used simply as an analytical tool for studying diseases and their determinants, it serves a more active role. Epidemiological data steers public health decision making and aids in developing and evaluating interventions to control and prevent health problems. This is the primary function of applied, or field
FOUNDATIONS OF EPIDEMIOLOGY.► Epidemiology is an interdisciplinary field that draws from biostatistics and social and behavioral sciences as well as from the medically related fields of toxicology , pathology , virology ,genetics , microbiology , and clinical medical.► To elaborate some of the contributions of microbiology include information about specific disease agents , including their morphology and modes of transmission .
► The investigation of anthrax ,legionnaires disease , and infant botulism utilized microbiologic techniques to identify possible infectious agents . When the infectious agent is virus the expertise of a virologist may be required . Clinical medicine is involved in the diagnosis of the patients state of health , that is defining whether the patient has a particular disease or condition. A pathologist expertise may help differentiate between diagnosed the individuals symptoms or signs of ill health .Astute physicians may suggest epidemiologic research on the basis of clinical observations .Toxicology is concerned with the presence and health effects and chemical agents.
HISTORICAL ANTECEDENTS OF EPIDEMIOLOGY.► The epidemiology began with the Greeks, who in their concern for the ancient epidemics and deadly toll of the diseases , attributed disease casualty to environmental factors . Early causal explanations for epidemics included various events, such as the wrath of the gods , the breakdown of religious beliefs and morality , the influence of the weather , and “bad air” .Much later during the late Renaissance , pioneer biostatisticians quantified morbidity and mortality trends. During the 19th century, early microbiologists formalized the germ theory of disease , which attributed diseases to specific organisms . Each of the stages in the genesis of epidemiology is discussed in turn below .
RECENT APPLICATIONS OF EPIDEMIOLOGY .► The Biological Concept of Race and its Application to Public Health and Epidemiology► Richard Cooper and Richard David Cook County Hospital Childrens Memorial Hospital (Chicago) The category of race is widely used in public health. Although its significance may be clear-cut in some practical situations, an adequate theoretical construct for the concept of race does not exist. Public health appears to lag far behind the other biological sciences in the effort to grapple with the idea of race and its implications for the nature-nurture question. This paper outlines the current anthropological and social perspective on race, and applies this view to problems of disease epidemiology. It is proposed that uncritical use of the traditional biological concept of race has distorted etiological thinking in public health and has proven an obstacle in the development of effective intervention strategies. The pragmatism of medicine and its isolation from social science may account for much of this backwardness.
Molecular Epidemiology and Cancer PreventionMolecular epidemiology: recentadvances and future directions► Recent advances in genomics, microassay technologies and informatics hold promise for rapid identification of polymorphic variants or changes in expression of genes influencing both response and susceptibility to carcinogens. Another emerging area of molecular epidemiology concerns the role of nutrition and specific dietary factors (including studies on antioxidants, energy metabolism, insulin and various growth factors) and the modulating effect of genetic polymorphisms. Finally, molecular epidemiology has enormous potential in cancer prevention through the early identification of `at risk populations and the rapid assessment of intervention efficacy. Its success in fully reaching this potential will depend on the application of validated biomarkers, with adherence to sound epidemiologic and ethical principles.►
An application of density estimation to geographical epidemiology► Relative risk function over a geographical region is defined and it is shown that it can be estimated effectively using kernel density estimation separately for the spatial distribution of disease cases and for a sample of controls. This procedure is demonstrated using data on childhood leukaemia in the vicinity of the Sellafield nuclear reprocessing plant in Cumbria, U.K. Various modifications to the method are proposed, including the use of an adaptive kernel. The final plot demonstrates a sharp peak at Sellafield and a reasonably smooth surface over the rest of the region, despite the small number of cases in the series.
The Biological Concept of Race and its Application to Public Health and Epidemiology► The category of race is widely used in public health. Although its significance may be clear-cut in some practical situations, an adequate theoretical construct for the concept of race does not exist. Public health appears to lag far behind the other biological sciences in the effort to grapple with the idea of race and its implications for the nature-nurture question. This paper outlines the current anthropological and social perspective on race, and applies this view to problems of disease epidemiology. It is proposed that uncritical use of the traditional biological concept of race has distorted etiological thinking in public health and has proven an obstacle in the development of effective intervention strategies. The pragmatism of medicine and its isolation from social science may account for much of this backwardness.►
The Epidemiology of Childhood Psychiatric Disorders:► While sharing a new emphasis upon identifying discrete psychiatric disorders in children and adolescents, epidemiological field studies conducted during the past decade have used diverse methods of case ascertainment and definition. Half used the multimethod-multistage approach to ascertain cases. Severity rating scales and measures of pervasiveness, parent-child concordance, and global functional impairment were employed to enhance the specificity of case definition. The majority of overall prevalence estimates of moderate to severe disorder range from 14 to 20%. Those investigations that use multiple methods to define caseness show greatest promise in identifying true cases in community samples.
Molecular epidemiology of tuberculosis: recentdevelopments and applications► The standard method for the typing of Mycobacterium tuberculosis is still IS 6110 restriction fragment length polymorphism (RFLP). This method has been widely used and has provided information on the variety and distribution of tuberculosis strain types across the globe. Recently, IS 6110 RFLP has been used to investigate the question of reinfection versus reactivation, examine the existence of multiple infection, and track the spread of multidrug- resistant tuberculosis. There have also been efforts to increase our understanding of the biologic characteristics of IS 6110. These studies have resulted in a clearer understanding of fingerprinting data and increased our understanding of the evolution and pathogenicity of this organism.
Recent trends in the epidemiology of sexually transmitted infections in the European Union► Sexually transmitted infections (STIs) are a major public health problem in Europe. We review recent trends in the epidemiology of the major acute STIs in the European Union and Norway, their key determinants, and opportunities for enhancing STI prevention interventions in the region