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Les boutons se trouvent ci-dessous. Epi ca veut dire sur, au dessus. Oxford University Press; p. Epidemiology is data-driven and relies on a systematic and unbiased approach to the collection, analysis, and interpretation of data. Basic epidemiologic methods tend to rely on careful observation and use of valid comparison groups to assess whether what was observed, such as the number of cases of disease in a particular area during a particular time period or the frequency of an exposure among persons with disease, differs from what might be expected.
However, epidemiology also draws on methods from other scientific fields, including biostatistics and informatics, with biologic, economic, social, and behavioral sciences. In fact, epidemiology is often described as the basic science of public health, and for clurs reason.
First, epidemiology is a quantitative discipline that relies on a working knowledge of probability, statistics, and sound research methods. Second, epidemiology is a method of causal reasoning based on developing and testing hypotheses grounded in such scientific fields as biology, behavioral sciences, physics, and ergonomics to explain health-related behaviors, states, and events.
However, epidemiology is not just a research activity but an integral component of public health, providing the foundation for directing practical and appropriate public health action based on this science and causal reasoning.
Epidemiology is concerned with the frequency and pattern of health events in a population: Frequency refers not only to the number of health events such as the number of cases of meningitis or diabetes in a population, but also to electgicit relationship of that number to the size of the population. Zmp resulting rate allows epidemiologists to compare disease occurrence across different populations.
Pattern refers to the occurrence of health-related events by time, place, and person. Time patterns may electeicit annual, seasonal, weekly, daily, hourly, electdicit versus weekend, or any other breakdown of time that may influence disease or injury occurrence. Personal characteristics include demographic factors which may be related to risk of illness, injury, or disability such as age, sex, marital status, and socioeconomic status, as well leectricit behaviors and environmental exposures.
Characterizing health events by time, place, and person are activities of descriptive epidemiology, discussed in more detail later in this lesson. Elcetricit is also used to search for determinants, which are the causes and other factors that influence the occurrence of disease and other health-related events.
Epidemiologists assume that illness does not elecricit randomly in a population, but happens only when the right accumulation of risk factors or determinants exists in an individual. They assess whether groups with different rates of electriit differ in their demographic characteristics, genetic or immunologic make-up, behaviors, environmental exposures, or other so-called potential risk factors. Ideally, the findings provide sufficient evidence to direct prompt and effective public health control and prevention measures.
By the middle of the 20th Century, additional epidemiologic methods had been developed and applied to chronic electrocit, injuries, birth defects, maternal-child health, occupational health, and environmental health. Then epidemiologists began to look at behaviors related to health and well-being, such as amount of exercise and seat belt use.
Now, with the recent explosion in molecular methods, epidemiologists can make important strides in examining genetic markers of disease risk. Indeed, the term health- related states or events may be seen as anything that affects the well-being of a population. Therefore, the clinician and the epidemiologist have different responsibilities when faced with a person with illness.
For example, when a patient with diarrheal disease presents, both are interested in establishing the correct diagnosis. However, while the clinician usually focuses on treating and caring for the individual, the epidemiologist focuses on identifying the exposure or source that caused the illness; the number of other persons who may have been similarly exposed; the potential for further spread in the community; and interventions to prevent additional cases or recurrences.
Like the practice of medicine, the practice of epidemiology is both a science and an art. To make the proper diagnosis and prescribe appropriate treatment for a patient, the clinician combines medical scientific knowledge with experience, clinical judgment, and understanding of the patient.
Epidemiology is the study scientific, systematic, data-driven of the distribution frequency, pattern and determinants causes, risk factors of health-related states and events not just diseases in specified populations patient is community, individuals viewed collectivelyand the application of since epidemiology is a discipline within public health this study to the control of health problems.
Farr, considered the father of modern vital statistics and surveillance, developed many of the basic practices used today in vital statistics and disease classification. He concentrated his efforts on collecting vital statistics, assembling and evaluating those data, and reporting to responsible health authorities and the general public. Because his work illustrates the classic sequence from descriptive epidemiology to hypothesis generation to hypothesis testing analytic epidemiology to application, two of his investigations will be described in detail.
He marked each residence on a map of the area, as shown in Figure 1. Today, this type of map, showing the geographic distribution of cases, is called a spot map.
Because Snow believed that water was a source of infection for cholera, he marked the location of water pumps on his spot map, then looked for a relationship between the distribution of households with cases of cholera and the location of pumps.
When he questioned residents who lived in the Golden Square area, he was told that they avoided Pump B because it was grossly contaminated, and that Pump C was located too inconveniently for most of them. From this information, Snow concluded that the Broad Street pump Pump A was the primary source of water and the most likely source of infection for most persons with cholera in the Golden Square area. He noted with curiosity, however, that no cases of cholera had occurred in a two-block area just to the east of the Broad Street pump.
Upon investigating, Snow found a brewery located there with a deep well on the premises. Brewery workers got their water from this well, and also received a daily portion of Introduction to Epidemiology Page malt liquor.
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To confirm that the Broad Street pump was the source of the epidemic, Snow gathered information on where persons elevtricit cholera had obtained their water. Consumption of water from the Broad Street pump was the one common factor among the cholera patients. After Snow presented his findings to municipal officials, the handle of the pump was removed and the outbreak ended.
The site of the pump is now marked by a plaque mounted on the wall outside of the appropriately named John Snow Pub. The John Snow Society [Internet]. During a cholera epidemic a few years earlier, Snow had ekectricit that districts with the highest death rates were serviced by two water companies: At that time, both companies obtained water from the Thames Electgicit at intake points that were downstream from London and thus susceptible to contamination from London sewage, which was discharged directly into the Thames.
To avoid contamination by London sewage, in the Lambeth Company moved its intake water works to a site on the Thames well upstream from London. Over a 7-week period during the summer ofSnow compared cholera mortality among districts that received water from electridit or the other or both water companies. The results are shown in Table 1.
The data in Table 1. Interestingly, the mortality rate in districts supplied by both companies fell between the rates for districts served exclusively by either company. These data were consistent with the electrjcit that water obtained from the Thames below London was a source of cholera.
Alternatively, the populations supplied by the two companies may have differed on other factors that affected their risk of cholera. To test his water supply eleftricit, Snow focused on the districts served by both companies, because the households within a district were generally comparable except for the water supply company. In these districts, Snow identified the water supply electrciit for every house in which a death from cholera had occurred during the 7-week period.
Southwark et Vauxhall 5. It also established the sequence of steps used by current-day epidemiologists to investigate outbreaks of disease. Based on a characterization of the cases and population at risk by time, place, and person, Snow developed a testable hypothesis.
He then tested his hypothesis sp a more rigorously designed study, ensuring that the groups to be compared were comparable. After this study, efforts to control the epidemic were directed at changing the location of the water intake of the Southwark and Vauxhall Company to avoid sources of contamination. Thus, with no knowledge of the existence of microorganisms, Snow demonstrated through epidemiologic studies that water could serve as a vehicle for transmitting cholera and that epidemiologic information could be used to direct prompt and appropriate public health action.
Southwark et Vauxhall 98 4. Electrjcit that time, most investigators focused on acute infectious diseases. In the s eleftricit s, epidemiologists extended their methods to noninfectious diseases. The period since World War II has seen an explosion in the development of research methods and the theoretical underpinnings of epidemiology.
Epidemiology has been applied to the entire smpp of health-related outcomes, behaviors, and even knowledge and attitudes. The studies by Doll and Hill linking lung cancer to smoking6and the study of cardiovascular disease among residents of Framingham, Massachusetts7 couts two examples of how pioneering researchers have applied epidemiologic methods to chronic disease since World War II. During the s and early s health workers applied epidemiologic methods to eradicate naturally occurring smallpox worldwide.
In the s, epidemiology was extended to the studies of injuries and violence. In the s, the related fields of courx and genetic epidemiology expansion of epidemiology to look at specific pathways, molecules and genes that influence risk of developing disease took root.
Beginning in the s and accelerating after the terrorist attacks of September 11,epidemiologists have had to consider not only natural transmission of infectious organisms zmp also deliberate spread through biologic warfare and bioterrorism.
Today, public health workers throughout the world accept and use epidemiology regularly to characterize the health of their communities and to solve day-to-day problems, large and small.
To assess the health of a population or community, relevant sources of data must be identified and electrixit by person, place, and time descriptive epidemiology. What are the actual and potential health problems in the community? Where are they occurring? Which populations are at increased risk?
Which problems have declined over time?
Which ones are increasing or have cokrs potential to increase? How do these patterns relate to the level and distribution of public health services available? More detailed data may need to be collected and analyzed to determine whether health services are available, accessible, effective, and efficient.
For example, public health officials used epidemiologic data and methods to identify baselines, to set health goals for the nation in andand to monitor progress toward couds goals.
Since World War II, epidemiologists have provided information related to all those decisions. In the s, epidemiologists reported the increased risk of lung cancer among smokers. In the s, epidemiologists documented the role of exercise and proper diet in smo the risk of heart disease. Coura the mids, epidemiologists identified the increased risk of HIV infection associated with certain sexual and drug-related behaviors.
These and hundreds of other epidemiologic findings are directly relevant to the choices people make every day, choices that affect their health over a lifetime. Introduction to Epidemiology Page Completing the clinical picture When investigating a disease outbreak, epidemiologists rely on health-care providers and laboratorians to establish the proper diagnosis of sml patients. For example, in latea physician saw three patients with unexplained eosinophilia an increase in the number of a specific type of white blood cell called an eosinophil and myalgias severe muscle pains.
Although the physician could not make a definitive diagnosis, he notified public health authorities. Within weeks, epidemiologists had identified enough other cases to characterize the spectrum and course of the illness that came to be known as eosinophilia-myalgia syndrome. Ideally, the goal is to identify a cpurs so that appropriate public health action might be taken. One can argue that epidemiology can never prove a causal relationship between an exposure and a disease, since much of epidemiology is based on ecologic reasoning.
Nevertheless, epidemiology often provides enough information to support effective action. Examples date from the removal of the handle from the Broad St. These tasks are described below. Public health surveillance Public health surveillance is the ongoing, systematic coure, analysis, interpretation, and dissemination of health data to help guide public health decision making and action.