The document discusses the epidemiology course which covers applying epidemiological procedures to understand occurrences and control of various health conditions. The course objectives are to provide mastery in various epidemiological assessment tools and research designs. It details the grading system, schedule, attendance policy and introduces concepts of epidemiology like descriptive epidemiology and epidemiology of infectious diseases.

1. EPIDEMIOLOGY
COURSE.
LECTURER :Dra Tania Morejon.

2. COURSE DESCRIPTION
The epidemiology course covers application
of epidemiologic procedures to the
understanding of the occurrence and control
of the conditions such as infections and
chronic diseases , mental disorders,
community and environmental health
hazards , accidents , and geriatric problems.
Credits hours:60

3. 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).

4. ATTENDANCE
Your presence at a minimum of 80% of the
Epidemiology and Public Health lectures is
mandatory. The role will be taken on a daily
basis. Failure to attend 80% of the
lectures will result in your withdrawal
from the course (W) , which will require
you to repeat the Epidemiology and Public
Health course.

5. 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.

6. SCHEDULE I
HOURS LECTURE
1 Introduction and orientation
3 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

7. SCHEDULE II
HOUR LECTURE
S
2 Sources of data for use in epidemiology.
4 Study designs :ecologic and cross-
sectional.
3 Study designs :case-control
3 Study designs : cohort studies.
3 Experimental study designs.
2 Measures of effect.
2 Data interpretation issues.
1 Review.

8. SCHEDULE III
HOUR LECTURE
S
4 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

9. 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 .

10. The history and scope of
epidemiology.
► Epidemiology defined.
► Foundations of epidemiology .
► Historical antecedents of epidemiology.
► Recent applications of epidemiology .

11. 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. It's 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

12. 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 .

13. ► 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.

14. 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 .

15. 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
Children's 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.

16. Molecular Epidemiology and
Cancer Prevention
Molecular epidemiology: recent
advances 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.
►

17. 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.

18. 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.
►

19. 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.

20. Molecular epidemiology of
tuberculosis: recent
developments 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.

21. 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