Introduction to Epidemiology Introduction to Epidemiology

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Introduction to Epidemiology,Understanding Public Health. Series editors Nick Black and Rosalind Raine London School of Hygiene Tropical Medicine. Throughout the world recognition of the importance of public health to sustainable safe and. healthy societies is growing The achievements of public health in nineteenth century Europe were. for much of the twentieth century overshadowed by advances in personal care in particular in. hospital care Now with the dawning of a new century there is increasing understanding of the. inevitable limits of individual health care and of the need to complement such services with effective. public health strategies Major improvements in people s health will come from controlling com. municable diseases eradicating environmental hazards improving people s diets and enhancing the. availability and quality of effective health care To achieve this every country needs a cadre of know. ledgeable public health practitioners with social political and organizational skills to lead and bring. about changes at international national and local levels. This is one of a series of 20 books that provides a foundation for those wishing to join in and. contribute to the twenty first century regeneration of public health helping to put the concerns and. perspectives of public health at the heart of policy making and service provision While each book. stands alone together they provide a comprehensive account of the three main aims of public health. protecting the public from environmental hazards improving the health of the public and ensuring. high quality health services are available to all Some of the books focus on methods others on key. topics They have been written by staff at the London School of Hygiene Tropical Medicine with. considerable experience of teaching public health to students from low middle and high income. countries Much of the material has been developed and tested with postgraduate students both in. face to face teaching and through distance learning. The books are designed for self directed learning Each chapter has explicit learning objectives key. terms are highlighted and the text contains many activities to enable the reader to test their own. understanding of the ideas and material covered Written in a clear and accessible style the series will. be essential reading for students taking postgraduate courses in public health and will also be of. interest to public health practitioners and policy makers. Titles in the series, Analytical models for decision making Colin Sanderson and Reinhold Gruen. Controlling communicable disease Norman Noah, Economic analysis for management and policy Stephen Jan Lilani Kumaranayake. Jenny Roberts Kara Hanson and Kate Archibald, Economic evaluation Julia Fox Rushby and John Cairns eds. Environmental epidemiology Paul Wilkinson ed, Environment health and sustainable development Megan Landon.
Environmental health policy Megan Landon and Tony Fletcher. Financial management in health services Reinhold Gruen and Anne Howarth. Global change and health Kelley Lee and Jeff Collin eds. Health care evaluation Sarah Smith Don Sinclair Rosalind Raine and Barnaby Reeves. Health promotion practice Maggie Davies Wendy Macdowall and Chris Bonell eds. Health promotion theory Maggie Davies and Wendy Macdowall eds. Introduction to epidemiology Lucianne Bailey Katerina Vardulaki Julia Langham and. Daniel Chandramohan, Introduction to health economics David Wonderling Reinhold Gruen and Nick Black. Issues in public health Joceline Pomerleau and Martin McKee eds. Making health policy Kent Buse Nicholas Mays and Gill Walt. Managing health services Nick Goodwin Reinhold Gruen and Valerie Iles. Medical anthropology Robert Pool and Wenzel Geissler. Principles of social research Judith Green and John Browne eds. Understanding health services Nick Black and Reinhold Gruen. Introduction to,Epidemiology,Lucianne Bailey Katerina Vardulaki. Julia Langham and Daniel Chandramohan,Open University Press. Open University Press,McGraw Hill Education,McGraw Hill House. Shoppenhangers Road,Maidenhead,email enquiries openup co uk.
world wide web www openup co uk,and Two Penn Plaza New York NY 10121 2289 USA. First published 2005, Copyright London School of Hygiene Tropical Medicine. All rights reserved Except for the quotation of short passages for the purpose of. criticism and review no part of this publication may be reproduced stored in a. retrieval system or transmitted in any form or by any means electronic. mechanical photocopying recording or otherwise without the prior written. permission of the publisher or a licence from the Copyright Licensing Agency. Limited Details of such licences for reprographic reproduction may be obtained. from the Copyright Licensing Agency Ltd of 90 Tottenham Court Road London. A catalogue record of this book is available from the British Library. ISBN 0 335 21833 4, Library of Congress Cataloging in Publication Data. CIP data applied for,Typeset by RefineCatch Limited Bungay Suffolk. Printed in the UK by Bell Bain Ltd Glasgow,Overview of the book 1.
1 Basic concepts and applications of epidemiology 3. 2 Epidemiological measures of health and disease frequency 19. 3 Epidemiological measures of health and disease association and impact 34. 4 Cross sectional studies 50,5 Ecological studies 58. 6 Cohort studies 64,7 Case control studies 74,8 Intervention studies 86. 9 Interpretation of the results of epidemiological studies 97. 10 Risk assessment and prevention strategies 113, 11 Epidemiological surveillance and routine data 123. 12 Screening and diagnostic tests 138,Glossary 152. Acknowledgements, Open University Press and the London School of Hygiene and Tropical Medicine have.
made every effort to obtain permission from copyright holders to reproduce material in. this book and to acknowledge these sources correctly Any omissions brought to our. attention will be remedied in future editions, We would like to express our grateful thanks to the following copyright holders for. granting permission to reproduce material in this book. p 55 56 S Abdulla J Armstrong Schellenberg R Nathan O Mukasa T Marchant. T Smith M Tanner and C Lengeler British Medical Journal 2001 322 269 273. amended with permission from the BMJ Publishing Group. p 21 Lucianne Bailey 2004 Reproduced with permission from Lucianne Bailey. p 9 Reproduced by permission of the Centers for Disease Control and Prevention. p 116 7 120 1 G Rose The Strategy of Preventive Medicine 1992 Oxford University. p 8 Based on KJ Rothman Causes American Journal of Epidemiology 1976. 104 6 587 592 by permission of Oxford University Press. p 62 A Schatzkin S Piantadosi M Miccozzi and D Bartee Alcohol consumption. and breast cancer a cross national correlation study International Journal of. Epidemiology 1989 18 1 28 31 by permission of Oxford University Press. p 11 17 Snow on Cholera being a reprint of two papers by John Snow M D together with. a Biographical Memoir by B W Richardson M D and an Introduction by Wade. Hampton Frost M D London Oxford University Press 1936. p 59 SV Subramanian S Nandy M Kelly D Gordon and G Davey Smith Patterns and. distribution of tobacco consumption in India cross sectional multilevel evi. dence from the 1998 9 national family health survey British Medical Journal. 2004 328 801 506 with permission from the BMJ Publishing Group. p 6 A Taranta and M Markowitz Rheumatic fever a guide to its recognition prevention. and cure 2nd ed 1989 Kluwer Academic Publishers by permission of Springer. p 27 8 Data from WHO IARC Cancer Mortality Statistics 2004 and CancerMondial. http www dep iarc fr,Overview of the book,Introduction. This book provides a summary of the main methods and concepts of epidemiology. to enable you to understand interpret and apply these basic methods It also aims. to introduce more advanced epidemiological and statistical concepts. It is not the intention that epidemiology should be viewed as a solitary field as it is. integral to much of public health,Why study epidemiology. Epidemiology provides the tools scientific methods to study the causes of disease. and the knowledge base for health care Thus it provides public health profes. sionals the means to study disease and look at the effectiveness of health care. services and more specifically the impact of health care interventions. It provides one key approach to understanding health and disease in individuals. and populations and the forces and factors which influence them This is. important both for health care professionals and for patients The purpose of. epidemiology is to use this information to promote health and reduce disease. Clinical practice and health policy cannot be based on clinical experience alone. They need to be based on scientific evidence Understanding epidemiology and the. methods used to study health and disease is a prerequisite for the ability to appraise. critically the evidence in scientific literature The ability to distinguish good from. poor science and good and poor evidence is an essential skill in promoting. evidence based health care, Epidemiology is one of the key scientific disciplines underlying some of the most. important and rapidly developing areas of inquiry into health and health care. Epidemiological methods are central to clinical research disease prevention health. promotion health protection and health services research The results of epidemi. ological studies are also used by other scientists including health economists. health policy analysts and health services managers. Structure of the book, This book follows the conceptual framework of the basic epidemiology unit at the.
London School of Hygiene Tropical Medicine It is based on materials presented. in the lectures and seminars of the taught course which have been adapted for. distance learning,2 Introduction to epidemiology, The book is structured around the basic concepts and applications of epidemi. ology It starts by looking at definitions of epidemiology introduces the funda. mental strategies for measuring disease frequency and patterns of disease and. associations with exposures or risk factors Chapters 1 3. Chapters 4 8 discuss different study designs and their strengths and weaknesses. Analysis and interpretation of epidemiological studies are addressed in Chapter 9. The final three chapters 10 12 outline the application of epidemiology for. prevention monitoring and screening, The 12 chapters are shown on the contents page Each chapter includes. an overview,a list of learning objectives,a list of key terms. a range of activities,feedback on the activities,Acknowledgements. The authors thank colleagues who developed the original lectures and teaching. materials at the London School of Hygiene Tropical Medicine on which the. contents are based Professor Ross Anderson St George s Hospital Medical School. for reviewing the entire book and Deirdre Byrne series manager for help and. Basic concepts and,1 applications of epidemiology, Epidemiology is a basic science of public health Its principles and methods are.
used to describe the health of populations detect causes of health problems. quantify the association between ill health and determinants test treatments and. public health interventions and monitor changes in states of health over time The. key feature of epidemiology is that it is a study of populations not individuals In. this chapter you will learn the basic concepts and applications of this discipline. Learning objectives, After working through this chapter you will be better able to. describe the key aspects of the epidemiological approach. discuss the models of causation of disease,describe the natural history of disease. discuss the applications of epidemiology in public health practice. Studying epidemiology, Epidemiology is the study of the distribution and determinants of health states or. events in specified populations and the application of this study to control health. problems It is concerned with the collective health of people in a community or an. area and it provides data for directing public health action Given the definition. above it follows that knowledge of the distribution and determinants of health. states and events informs appropriate public health action. What is the distribution of health states or events. The distribution of health states or events is a description of the frequency. and pattern of health events in a population The frequency e g the number of. occurrences of a health event in a population within a given time period is meas. ured by rates and risks of health events in a population and the pattern refers to the. occurrence of health related events by time place and personal characteristics. Rates and risks will be discussed more in Chapters 2 and 3. 4 Introduction to epidemiology,What are determinants of health states or events. Epidemiology seeks to identify the determinants of health and determinants. of disease The determinants of health states or events are definable factors that. influence the occurrence of health related events Determinants are also known as. risk factors or protective factors depending on which health related events they. are associated with Health related events refer to health outcomes e g death. illness and disability as well as positive health states e g survival and reduced risk. Introduction to Epidemiology www openup co uk Cover design Hybert Design www hybertdesign com Introduction to Epidemiology Epidemiology one of the key disciplines in public health is concerned with describing the patterns of diseases identifying their causes and evaluating the effectiveness of health care and public health interventions Such information helps to promote health and

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