Introduction to Epidemiology and Public
Health– HNH24806
,Table of Contents
Week 1 What is epidemiology?..........................................................................................3
Week 2 Standardization & burden of disease.....................................................................8
Week 2 Clips...............................................................................................................................16
Week 3 Descriptive epidemiology, study designs & optional basic statistics.....................24
Week 3 Clips...............................................................................................................................30
Week 4 Measures of association, measures of public health impact & errors...................41
Week 4 Clips...............................................................................................................................50
Week 5 Confounding, validity & association, and causation.............................................56
Week 5 Clips...............................................................................................................................59
Week 5 E-modules......................................................................................................................64
Week 6 Disease prevention, prevention strategies & early detection................................65
Week 6 Clips...............................................................................................................................68
,Week 1 What is epidemiology?
Learning goals:
1. describe how epidemiology is applied in nutritional sciences and its implications for public
health.
2. have a global knowledge of the history of epidemiology, including the work by John Snow.
3. understand and calculate disease frequency measures used in descriptive epidemiology and
public health (e.g., point prevalence, period prevalence, prevalence proportion, incidence,
incidence proportion, cumulative incidence, incidence rate, attack rate, mortality rate,
morbidity rate).
4. describe a dynamic, closed, and 'at risk' population.
Meaning of epidemiology is upon people study. 5W (What, who, where, when, why)
It is about populations not about individuals.
Het doel van epidemiology is het voorkomen van ziektes en bevorderen van de gezondheid.
Door:
Elucidating of the natural history of disease
Describing the health status of populations
Establishing determinants of diseases
Evaluating the effectiveness of interventions
Reading gide by course materials
Essential epidemiology chapter 1 Epidemiology is ..
The study of distribution and determinants of disease. Who is developing disease (and where
and when), and why they developing it?
Attack rate is the precentage of people who became sick.
Relative risk is the precentage of sick people from for example chicken divided by the
percentage of sick people who didn't eat the chicken.
Occupational epidemiology has the longest history. They often have records of exposure and
outbreak.
Seminal contributions are about the pulmonary hazards (lungs)
Modern are molecular and clinical epidemiology. Clinical focus on enhancing clinical decisions
to benefit individual patients, rather than improving the health of populations.
SES = socioeconomic status
John Snow (1813-1858) physicican known for pioneering work in elucidating the mode of
transmission of cholera (infection of the intestine with a bacteria). Found out that the disease
could spread from person to person and through polluted water. First descriptive
epidemiology. Used observed numbers with illness and expected number of illness.
, Public health is about monitoring the health of a community, identifying health problems,
identifying what is causing the problems and then testing possible solutions to resolve or
reduce the problem.
Environmental factors are all non-genetic factors, including psychological, behavarioural, social
and cultural traits, as well as obvious environmental exposures such as air pollution.
Descriptive studies: person, place and time
Standardished mortality ratio (SMR): number of deaths observed in a study population over a
specified period of time compared with the number that would have been expected if the
study population had the same mortality rates as a standard or comparison population (often
the general population).
Descriptive studies can be tested further in analytic studies, looking for assocations between
potential causal agents and diseases.
Clip: Epidemiology: an academic and applied science
Clinician: what is the best treatment for this specific patient.
Epidemiologist in academic setting (detective 5W): how can you be sure that the specific
exposure effect, indepent of the context of this person or population. About analysing
patterns and causes. Generating knowlegde. Relevant to mankind, anytime, anyplace.
Validity & precision, causation. Looking at causes of disease at a biomedical way.
Epidemiologist in public health setting (crime prevention) : what is the best prevention
strategy for this specific population/risk group? This is the health situation these are the
exposures, what are the actions to prevent this from happening? Combines knowledge.
About using this information for prevention in populations. Prevention through policies,
programmes, and interventions. Applying knowledge. Generalizability & importance. Best
practise and relevant to me, here and now. More focused on the environment, human
behavior.
DISH:
Diterminants of diet and lifestyle
Intake of food and nutritients
Status and fuction of the body
Health and disease risk
Clip: History of epidemiology and public health
Pre-formal (1662-1900) started counting people who became ill. Important people are graunt,
farr (systematically recorded the causes of death in England and Wales) and snow in this time.
People started travelling and health and diseases had a pattern and group thickening started
to emerge: infectious diseases.
Early (1900-1940) first prof in epidemology. Focused on non-communicable disease like
pellagra and vitamines. More chronic diseases.
Classical (1940) academic field in US and UK. Tobacco smoke. Chronic disease, large-scale
epidemiological studies and new epi-methods, study designs. Infection disease. This time large
epidemical studies started like cohort, RCT etc. Cased-control where invented and used.
Modern (1980) all different study designs are theoretical basis in RCT, differentiation of
expertise. Intervention trials started.