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Epi Lecture 1 Part II

Epidemiology is the study of disease occurrence and distribution in populations. Originally focused on infectious epidemics, epidemiology has expanded to include chronic diseases and health-related events. As the basic science of community medicine, epidemiology aims to define health problems, identify associated risk factors, develop and test interventions, and monitor effectiveness. Specifically, epidemiology seeks to determine disease burden, study disease progression, identify causes and risk factors, and evaluate preventive and treatment measures. Understanding disease patterns in populations informs public health policies and clinical practice guidelines.

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67 views36 pages

Epi Lecture 1 Part II

Epidemiology is the study of disease occurrence and distribution in populations. Originally focused on infectious epidemics, epidemiology has expanded to include chronic diseases and health-related events. As the basic science of community medicine, epidemiology aims to define health problems, identify associated risk factors, develop and test interventions, and monitor effectiveness. Specifically, epidemiology seeks to determine disease burden, study disease progression, identify causes and risk factors, and evaluate preventive and treatment measures. Understanding disease patterns in populations informs public health policies and clinical practice guidelines.

Uploaded by

MowlidAbdirahman Ali madaale
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Introduction cont…

Mohamed Hussein
Scope of Epidemiology

Originally, Epidemiology was concerned with


investigation & management of epidemics of
communicable diseases

Lately, Epidemiology was extended to endemic


communicable diseases and non-communicable
infectious diseases

Recently, Epidemiology can be applied to all


diseases and other health related events
2
Why is Epidemiology the basic science of
Community Medicine?
Community Medicine Works By:

• Defining a health problem


• Identifying risk factors associated with the
problem
• Developing and testing community-level
interventions to control or prevent the causes of
the problem
• Implementing interventions to improve the
health of the population; and
• Monitoring those interventions to assess their
effectiveness
EPIDEMIOLOGY HAS THE METHODOLOGY TO:
(THE OBJECTIVES OF EPIDEMIOLOGY)

5
What are the specific objectives of Epidemiology?

• First, to determine the extent of disease found in the


community.
 What is the burden of disease in the community?
 How much disease and type of disease is there in our
community?
 This question is critical for planning health services and
facilities, and for training future health care providers.
 Second, to study the natural history and prognosis of
disease.
 Clearly, certain diseases are more severe than others;
some may be rapidly lethal while others may have
longer durations of survival. Still others are not fatal.
 Third, to identify associations and potential etiology
(causes) of a disease and risk factors for disease----
that is, factors that increase a person’s risk for a disease.
 We want to know how the disease is transmitted from
one person to another or from a nonhuman reservoir to a
human population.
 Our ultimate aim is to intervene to reduce morbidity and
mortality from the disease. We want to develop a
rational basis for prevention programs.
 If we can identify the etiology or causal factors for
disease and reduce or eliminate exposure to those
factors, we can develop a basis for prevention
programs.
 In addition, we can develop appropriate vaccines and
treatments, which can prevent the transmission of the
disease to others.
 Fourth,to evaluate both existing and newly
developed preventive and therapeutic measures and
modes of health care delivery.
for example, does screening men for prostate
cancer using the prostate-specific antigen (PSA)
test improve survival in people found to have
prostate cancer?
Has the growth of managed care and other new
systems of health care delivery and health care
insurance had impact on the health outcomes of
the patients involved and on their quality of life?
If so, what has been the nature of this impact
and how can it be measured?
 Fifth, To provide the foundation for developing
public policy relating to environmental problems,
genetic issues, and other considerations regarding
disease prevention and health promotion.
 For example, is the electromagnetic radiation that is
emitted by electric blankets, heating pads, and other
household appliances a hazard to human health?
 Are high levels of atmospheric ozone or particulate
matter a cause of adverse acute or chronic health effects
in human populations?
 Which occupations are associated with increased risk
factors in workers and what type of regulation are
required?
• In short, the primary goal of epidemiology is to
measure relationships between “exposures” and
health outcomes – these may provide a basis for
public health initiatives and policies.

14
Two approaches to prevention

1. Population based approach:


 In the population based approach, a preventive
measure is widely applied to an entire population.
For example, prudent dietary advice for
preventing coronary disease or advice against
smoking may be provided to an entire population.
2. Targeting high-risk groups approach:
 An alternative approach is to target a high-risk
group with the preventive measure. Thus,
screening for cholesterol in children might be
restricted to children from high-risk families.
Discussion Question

Why do we study the epidemiology of


diseases in large populations, such as the
community, rather than focusing on
treatment settings?

18
Discussion Question
Because:

1. Early development of disease can be


assessed more readily in the community.

2. Many individuals with disease do not seek


treatment.

3. Many individuals with disease do not have


access to or the resources to receive
treatment.
19
THE RELATIONSHIP BETWEEN EPIDEMIOLOGY
AND CLINICAL PRACTICE

Clinical Practice Uses Population Data


• Diagnoses are defined and determined from large
groups of patients.
• Prognosis is based on experience of large groups
of patients with the same disease, stage of
disease, and treatments.
• Selection of therapy is based on the results of
large treatment studies, such as clinical trials.
Basic Epidemiological assumptions

1. Human diseases doesn’t occur at random or by


chance

2. Human diseases have causal and preventive


factors

21
Types of Epidemiological Studies

Two major categories of Epidemiology

1.Descriptive Epidemiology

Defines frequency and distribution of diseases


and other health related events

Answers the four major questions: how many,


who, where, and when?

22
Types…

2. Analytic Epidemiology

Analyses determinants of health problems

Answers two other major questions: how? and


why?

Generally, Epidemiology answers six major


questions: how many, who, where, when, how and
why?
23
Epidemiological studies

Descriptive Analytic

Experimental
Case Report

Clinical Trial
Case Series
Community Trial

Observational
Cross-sectional
Cohort

Ecological Case Control


Descriptive or Analytic Studies?

 Descriptive
studies
Generate hypotheses
Answer what, who, where, and when

 Analytic studies
•Test hypotheses
•Answer why and how
Descriptive Studies

 Characterize who, where, or when in relation


to what (outcome)
Person: characteristics (age, sex, occupation)
of the individuals affected by the outcome
Place: geography (residence, work, hospital)
of the affected individuals
Time: when events (diagnosis, reporting;
testing) occurred
Types of Descriptive Studies

Population Individual

Case Report
Ecological

Case Series

Cross-Sectional
Analytic Studies

Analytic studies test hypotheses about


exposure-outcome relationships
Measure the association between
exposure and outcome
Include a comparison group
Developing Hypotheses
A hypothesis is an educated guess about
an association that is testable in a
scientific investigation.
Descriptive data (Who? What? Where?
When?) provide information to develop
hypotheses.
Developing Hypotheses Example

Hypothesis: People who smoke shisha are


more likely to get lung cancer than people
who do not smoke shisha.
Exposure: smoking shisha
Outcome: lung cancer

Hypothesis: ?
•Exposure: ?
•Outcome: ?
Types of Analytic Studies

Experimental Observational

Clinical Trials Cohort

Community Trials
Case Control
Self-Assessment
Define Epidemiology?
Describe the scope of Epidemiology?
What are objectives of Epidemiology?
Discuss the relationship between
Epidemiology and clinical practice?
Indicate all that apply
1. In the definition of epidemiology,
"distribution" refers to:
A. Who
B. When
C. Where
D. Why
2. In the definition of epidemiology,
"determinants" generally includes:
A. Agents
B. Causes
C. Control measures
D. Risk factors
2. For each of the following, identify the appropriate letter
from the time line in Figure 1.27 representing the
natural history of disease
 Natural History of Disease Timeline

1.____ Onset of symptoms


2.____ Usual time of diagnosis
3.____ Exposure
THANKS

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