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- Herausgeber: Bentham Science Publishers
- Kategorie: Fachliteratur
- Sprache: Englisch
Concise Handbook of Epidemiology is an essential resource introducing readers to core principles, models, and research methods of modern epidemiology. This comprehensive guide covers foundational concepts like health and disease, disease occurrence, epidemiological models, and study designs. It also talks about disease surveillance, outbreak investigations, statistical methods, and advanced epidemiological techniques, including the impact of genomics and community-based epidemiology.
Each chapter incorporates real-world case studies, offering readers practical insights and applications. Ethical considerations, innovative methods, and future directions in the field ensure readers are equipped with foundational knowledge and forward-looking perspectives.
Key Features:
- Foundational Overview: Covers health, disease occurrence, and key epidemiological frameworks.
- Practical Tools: Offers research designs, statistical methods, and real-world case studies.
- Advanced Topics: Explores genomics, statistical advances, and challenges in modern epidemiology.
- Future Focus: Discusses ethics and evolving innovations shaping epidemiological practices.
Readership:
Ideal for undergraduate and graduate students, academic researchers, healthcare professionals, and policy-makers involved in epidemiology, public health, and health policy.
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Seitenzahl: 277
Veröffentlichungsjahr: 2024
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FOREWORD
It is with immense pleasure and anticipation that I introduce the second edition of the "Concise Handbook of Epidemiology." In the ever-evolving landscape of public health and disease prevention, this updated edition stands as a beacon of knowledge, guiding all who seek to comprehend the intricate science of epidemiology.
This comprehensive handbook navigates the entire spectrum of epidemiological inquiry, from foundational principles in Chapter 1 to the exploration of epidemiology in diverse local contexts in Chapter 9. It equips readers with the essential tools to understand and analyze epidemiological data, fostering a sense of responsibility and commitment to improving global health outcomes.
Chapter 1 lays the groundwork by introducing readers to the essence of epidemiological thought and practice, serving as the cornerstone for subsequent chapters. Chapter 2 delves into the heart of epidemiology, exploring essential models and frameworks that underpin our understanding of disease transmission. Chapter 3 acts as a compass, guiding readers through research design paradigms and statistical tools crucial for precise data analysis.
The vigilant eye of epidemiology is exemplified in Chapter 4, where readers explore disease surveillance systems and the art of outbreak detection and response through real-world case studies. Chapter 5 imparts the language fluency required for interpreting data with acumen, delving into foundational statistical concepts. Chapter 6 escorts readers to the frontiers of the discipline, unfolding advanced statistical techniques and addressing emerging challenges.
Chapter 7 showcases the practical dimensions of epidemiological principles, from influencing health policy to real-life case studies, engaging readers in active learning. Chapter 8 invites contemplation of the future of epidemiology, exploring innovations, ethical considerations, and the collective responsibility to shape the field's trajectory.
In a world of diverse regions and communities, Chapter 9 emphasizes the adaptability of epidemiological methods to local contexts, extolling the virtues of community engagement and narrating the stories of local epidemiology through case studies.
As readers embark on this journey, whether as students, researchers, healthcare professionals, or policymakers, I encourage embracing the wisdom within these pages. May this handbook serve as a constant source of guidance, inspiration, and enlightenment, empowering readers to contribute meaningfully to global community well-being.
I extend heartfelt gratitude to the author for crafting this invaluable resource and commend readers for their commitment to public health. With each turn of the page, we enhance our collective ability to address today's health challenges and forge a healthier, more resilient tomorrow.
Welcome to the realm of epidemiology – a convergence of science, compassion, and determination to safeguard and enhance the well-being of our communities.
PREFACE
In the ever-evolving realm of public health and disease prevention, epidemiology stands as a sentinel, diligently observing, analysing, and deciphering the complex patterns of health and disease. The second edition of the "Concise Handbook of Epidemiology" comes with great pleasure and enthusiasm. Building upon the foundations I laid in the first edition, this updated volume embarks on a comprehensive journey through the multifaceted landscape of epidemiology, providing a concise yet robust guide for novice learners and seasoned practitioners.
Chapter 1: Foundations of Epidemiology In this opening chapter, I delve into the fundamental principles that underpin epidemiology. From understanding the nature of health and disease to exploring the various subfields within epidemiology, we lay the groundwork for a deeper exploration of this dynamic discipline.
Chapter 2: Epidemiological Models and Frameworks Chapter 2 introduces the reader to the epidemiological models and frameworks that are scaffolding for understanding disease transmission and progression. We unravel the intricacies of the epidemiologic triad, the chain of infection, and the natural history of the disease, providing the reader with essential tools to analyse health challenges.
Chapter 3: Epidemiological Research Design Research design is the compass that guides epidemiologists in their quest to uncover patterns and causality. Chapter 3 navigates through different research paradigms, study types, and the practical aspects of conducting epidemiological investigations. Statistical tools essential for data analysis are also explored.
Chapter 4: Disease Surveillance and Outbreak Investigations Disease surveillance is the guardian of public health, and in Chapter 4, I explore the mechanisms that underpin this essential function. Discover how outbreaks are detected, investigated, and controlled through insightful case studies and real-world examples.
Chapter 5: Statistical Methods Statistics is the language of epidemiology, and Chapter 5 equips the reader with the vocabulary and tools to interpret data effectively. From fundamental concepts to statistical inference and mathematical modelling, this chapter empowers readers with the skills needed for rigorous analysis.
Chapter 6: Advanced Epidemiological Methods As epidemiology continues to evolve, Chapter 6 guides readers through advanced statistical techniques and the impact of genomics on epidemiological research. It also addresses emerging challenges and opportunities that shape the future of the discipline.
Chapter 7: Applications and Case Studies Epidemiological knowledge comes to life through its application. Chapter 7 immerses readers in the practical aspects of epidemiological practice, from influencing health policy to real-life case studies that illustrate the principles in action. Exercises and questions challenge the reader's understanding.
Chapter 8: Future Directions and Challenges In Chapter 8, I peer into the future of epidemiology. Explore innovations in methods, grapple with ethical considerations, and join in shaping the trajectory of this ever-evolving field.
Chapter 9: Epidemiology in Local Context No two regions are the same, and Chapter 9 emphasises the importance of adapting epidemiological methods to local contexts. Learn how community engagement and case studies in local epidemiology can enhance the relevance and impact of the reader's work.
This handbook is not merely a compilation of facts and figures but an invitation to embark on a journey of discovery and empowerment. Whether the reader is a student, researcher, healthcare practitioner, or policymaker, the "Concise Handbook of Epidemiology" offers a valuable resource to enhance his understanding of the field. I encourage readers to engage with its contents, apply its principles, and contribute to advancing public health worldwide.
As readers turn the pages of this book, it is hoped that the knowledge within ignites their curiosity, inspires their passion for epidemiology, and equips them to make meaningful contributions to the health and well-being of our global community.
Thanks for embarking on this epidemiological journey with this revised edition. I hope this handbook serves as a valuable resource as readers navigate the dynamic and vital field of epidemiology. Together, we can address today's health challenges and shape a healthier future for all.
Disclaimer:
The views expressed in this book are mine and do not reflect the official position or policies of the WHO. Similarly, the content of this book ensured objectivity, avoided being impartial, and was not influenced by my affiliation with the WHO.
DEDICATION
This book is dedicated to the pillars of my life (my dear parents, my loving wife, and my remarkable children) and the global community of epidemiologists who continue to shape our world.
Foundations of Epidemiology
Jalal-Eddeen Abubakar Saleh1Abstract
This chapter lays the groundwork for understanding the principles, methods, and applications of epidemiology. Beginning with an introduction to the field, it delves into the intricacies of health and disease, exploring various epidemiological research fields and methodologies. The chapter elucidates the measurement of disease occurrence and highlights the significance, successes, and real-world applications of epidemiology.
Introduction to Epidemiology
The Role of Epidemiology in Public Health
Epidemiology serves as the cornerstone of public health, playing a pivotal role in understanding, monitoring, and improving the health of populations. It is the science that investigates the patterns, causes, and consequences of health and disease in communities, underscoring that clinical practice and health policy cannot be based on clinical experience alone but on scientific evidence as well. Epidemiologists help to assess the efficiency of health interventions, such as sanitary measures in controlling faeco-oral diseases, the effectiveness and efficiency of health services using specific parameters that include the duration of hospital stay for a particular condition, the impact of reducing unleaded petrol in lead poisoning, etc. It is critical to mention that a wide range of epidemiological methods are used for disease surveillance, outbreak investigations, hazards and risk factor assessment, and other health-related events [1-3].
Epidemiologists are like disease detectives, diligently examining data and evidence to identify health trends, risk factors, and opportunities for intervention. So, there is a need to highlight the significance of epidemiology in medical and public health practice and in the methods used to study health and disease. It is considered critical and a prerequisite to appraise the evidence obtained in the scientific literature, providing scientists with the necessary skills to provide
evidence-based healthcare and clearly distinguish good from flawed science. Likewise, the results of epidemiological studies guide not only public health professionals but also other scientists, including health economists, health policy analysts, and health services managers [1-3].
Epidemiology offers several critical functions in public health:
1.Disease Surveillance: Epidemiologists monitor the occurrence of diseases and health events, tracking outbreaks, and ensuring timely responses to emerging threats.
2.Identifying Risk Factors: By conducting rigorous research, epidemiologists uncover the factors that contribute to the development of diseases, from lifestyle choices to environmental exposures.
3.Evaluating Interventions: Public health programs and policies are assessed for their effectiveness through epidemiological studies, ensuring resources are directed where they are most needed.
4.Shaping Health Policy: Epidemiological evidence guides policymakers in making informed decisions, from setting priorities to allocating resources for healthcare and prevention.
5.Preventing and Controlling Disease: Epidemiologists develop strategies for disease prevention and control, whether through vaccination campaigns, health education, or environmental interventions.
Historical Evolution and Milestones
The roots of epidemiological thinking can be traced back to ancient civilizations, but modern epidemiology has evolved significantly over the centuries. Epidemiological thinking started nearly 2,500 years ago, in 400 BC, when Hippocrates, often regarded as the father of medicine, observed that environmental factors influence disease occurrence. His work laid the foundation for the rational study of disease causation. In his early writings on 'Airs, Waters and Places,' Hippocrates explained disease occurrence using a rational approach and suggested that the development of human disease might be related to an individual's external and personal environment [4-6].
In 1662, the analysis of mortality data by John Graunt in London marked a turning point in epidemiology. He made a remarkable contribution to epidemiology when he published analysed mortality data which quantified the patterns of birth, death, and disease occurrence, pointing out disparities between males and females, high infant mortality, differences between urban and rural settings, and seasonal variations [4-6].
In 1800, William Farr, regarded as the father of modern vital statistics and surveillance, systematically collected vital statistics. He evaluated, analysed, and reported vital statistics to the responsible health authorities and the general public. The work by Farr led to the development of essential practices in today's vital statistics and disease classification [6, 7].
In 1854, John Snow, an anaesthesiologist considered the “father of field epidemiology,” conducted a series of investigations in London to unravel the mystery behind the Golden Square of London cholera epidemic. His investigation, which was twenty years before the advent of the microscope, used classical descriptive epidemiology to unravel the mystery. During the cholera outbreak, Snow believed water to be the source of the infection. He generated and tested a hypothesis using analytical epidemiology. Through the use of 'dots and maps', he investigated the cholera epidemic by determining the locations of people with the disease and the water pump that served them (Table 1) [8].
Snow, taking the biological, chemical, physical, sociological, and political processes into consideration, highlighted the clustering of cases on his spot map; his report showed that most of the cases were people who got their water supply from pump A (the Broad Street pump) as against those whose source of water supply was either pump B or C [4-6]. Similarly, using the 1854 London cholera outbreak data, Snow reported that the districts with the highest death rates had their water supply from the Lambeth Company and the Southwark and Vauxhall Company. These two companies got their water from the Thames River, whose intake points were downstream from London, which had the likelihood of getting contaminated by London sewage discharged into it. The outcome of the research conducted by Snow impacted public health policy as it resulted in improvements in the water supply system. However, despite the advancement in epidemiology, cholera outbreaks are still prevalent in developing countries, especially among poor populations, and often with fatal outcomes [9].
Epidemiology recorded significant successes in the late 19th and early 20th centuries in applying epidemiological methods to investigate disease occurrence; initially, the focus was on acute infectious diseases, but later, it included chronic non-communicable diseases (NCDs) around the mid-20th century. The focus of the NCDs was to look at the causal association between a disease and exposure (e.g., smoking and lung cancer, and cholesterol and cardiovascular diseases) [10, 11]. Similarly, applied epidemiology was extended to cover other related fields, such as injury and molecular genetics, to explore specific pathways and have a clearer picture of the influencers or risks of developing certain diseases [12, 13].
However, despite the advances recorded in the discipline, epidemiologists continue to face increasing challenges in the form of biological warfare and bioterrorism, emerging and reemerging infectious agents, such as the Ebola Virus, Human Immunodeficiency Virus (HIV), Middle East Respiratory Syndrome (MERS), severe acute respiratory syndrome (SARS), Avian Influenza, Multi-drug Resistant Mycobacterium Tuberculosis (MDR-TB), and the COVID-19 pandemic in late 2019 [14-18].
Exercise 1: Reflecting on Local Epidemiological Milestones
This exercise encourages readers to connect the principles of epidemiology to their specific local context, fostering a deeper understanding of its relevance and significance in addressing local health issues.
Now, let us apply these concepts to your local context. Consider the following questions:Are there any notable disease outbreaks or health events that have shaped public health in your region or community?What were the key milestones or discoveries in the history of epidemiology that have had a direct impact on the health of your local population?How have local epidemiologists and public health professionals contributed to addressing health challenges unique to your region?What are the current public health priorities and challenges in your community, and how can epidemiological approaches be used to address them effectively?Exercise 2: Defining Health Challenges in Your Region
This exercise empowers readers to apply epidemiological concepts to their local context, fostering a deeper understanding of the health challenges specific to their region and encouraging critical thinking about potential solutions.
To apply these concepts to your local context, consider the following exercise:Identify Local Health Challenges: Research and document the current health challenges and trends in your region or community. These challenges can include infectious diseases, non-communicable diseases, environmental health issues, or social determinants affecting health.Define the Scope: For each identified health challenge, define its scope by quantifying the incidence, prevalence, and affected populations. If available, gather data and statistics to support your analysis.Identify Risk and Protective Factors: Explore the risk factors contributing to these health challenges, such as lifestyle behaviors, environmental exposures, or socioeconomic factors. Moreover, identify any protective factors that may mitigate the risks.Examine Local Definitions of Health: Investigate how health and disease are perceived and defined within your community. Are there cultural or societal factors that influence these definitions?Propose Interventions: Based on your analysis, propose interventions and strategies to address these health challenges effectively. Consider preventive measures, health promotion campaigns, or policy changes.Understanding Health and Disease
Definition and Scope
Defining health and disease is fundamental to the practice of epidemiology. These definitions serve as the building blocks upon which epidemiologists assess and address public health issues.
Health is a multifaceted concept encompassing physical, mental, and social well-being. The World Health Organization (WHO) defines health as “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.” This holistic perspective emphasizes that health extends beyond the absence of illness to include overall well-being [19].
Disease refers to an abnormal condition or disorder that impairs the normal functioning of the body or mind. Diseases can be acute (short-term) or chronic (long-term), infectious or non-infectious, and they may manifest in various forms, from physical symptoms to mental health challenges [19].
The term epidemiology, derived from Greek, means epi 'upon', demos' people', and logy 'study'. It could be defined as a study that deals with the distribution and determinants of health events in a specified population for appropriate public health actions (i.e., to prevent and control health problems) [16-18].
With disease surveillance at the centre of it all and considered the foundation of epidemiology, the study of diseases could be either through observational or experimental research.
The discipline of epidemiology is unique because it provides an approach for public health professionals to clearly understand health and disease and the forces or factors that influence them. It also enables public health professionals to study diseases and assess the effectiveness of health care services and the impact of health care interventions. The information obtained at the end is then used to prevent disease, protect and promote good health, and conduct clinical and health services research [16, 17].
Although various methods are used in epidemiological investigations, the most common is through surveillance and descriptive studies to look at disease distribution – the 'who, when, and where' and analytical studies – the 'how and why' to help understand the disease determinants. This approach would help to institute preventive and control measures that promote, protect, and restore the health of individuals or groups.
Therefore, it is pertinent to understand the three keywords mentioned in the epidemiology definition – distribution, determinants, and health events [4-6].
1. Distribution refers to the frequency and pattern of health events. The frequency, which is measured by the rates and risk of health events, requires the number of occurrences of the event within a given population and at a given time. In contrast, the pattern refers to the occurrence of health-related events by time (seasonal, annual, daily, weekly, etc.), place (geographical, urban/rural setting, workplace or school, etc.), and people (age, gender, marital status, SES, social behaviours, etc.). Distribution describes the 'who, when, and where' health-related events occur.
2. Determinants refer to the factors that influence health-related events, such as risk factors or protective factors; these include biological, chemical, physical, social, cultural, economic, genetic, and behavioural changes. As assumed by epidemiologists, disease occurrence in a population is only possible when risk factors or determinants come into existence. Epidemiologists search for these determinants, using an analytical approach to the cause and answer the “Why” and “How” of such events. To answer these, epidemiologists look at the risk factors that assess the genetic composition of individuals, their demographic characteristics, social behaviours, and any possible environmental exposure to prompt public health measures.
3. Health-related states and events refer to health outcomes of communicable and non-communicable diseases, occupational health, environmental health, mental health, maternal-child health, congenital anomalies, accidents, injuries, etc. However, the outcome could be a positive outcome (recovery, survival, reduced risk, access, and utilisation of health services) or a negative outcome (illness, disability, or death).
In applied epidemiology, a study population could be a specific group of patients in a hospital, school pupils, health workers, or factory workers. In epidemiological research, a population could be a particular class of people selected from a specific place and time. Furthermore, this set of people could be categorised based on age, gender, or ethnicity. The structures of populations vary between geographical areas and time. However, such variations must be factored in when conducting analyses to have a clearer picture of what is being studied for inference to be drawn at the end.
It is essential to underscore that the critical tasks in applied epidemiology are public health surveillance, field investigation, analytical studies, evaluation, linkages, and policy development.3 It suggests that an epidemiologist must be able to effectively create a study design, develop data collection tools, conduct the study, analyse the results, and interpret the findings. Similarly, he must be skilled in data management and interpretation andmust be able to generate reports and disseminate the findings to a broader audience [17, 18].
Different Fields of Epidemiology
Epidemiology depends much on understanding disease causation, its transmission, outbreak investigations, and effective disease surveillance. There are clinical epidemiologists, environmental epidemiologists, forensic epidemiologists, occupational epidemiologists, infectious disease epidemiologists, and molecular epidemiologists, to mention but a few, to look at the causes of disease, causality, or associations depending on the setting and the increasing applicability of epidemiology. Here are some of the various fields and subfields of epidemiology:
1. Clinical Epidemiology focuses on issues relevant to clinical medicine. Clinical epidemiologists use clinical trials of drugs to know their efficacy and to monitor the side effects to reduce the number of adverse health outcomes in patients [20, 21].
2. Infectious Disease Epidemiology establishes disease patterns through monitoring and tracking the spread of infectious diseases to observe and predict outbreaks, epidemics, and pandemics. Infectious disease epidemiologists use the outcome of their studies to advise governments and policymakers to put in place measures that mitigate health events. In this area, epidemiologists often work on outbreaks, vaccine development, and strategies to prevent the spread of infections [22].
3. Environmental Epidemiology examines how the environment has harmful consequences on human health. In addition to assessing the impact of human exposure to specific environmental hazards, environmental epidemiologists seek to understand the relationship between external risk factors and disease, illness, injury, developmental abnormalities, or death. They study the relationship between environmental exposures (such as air and water quality, toxins, and pollutants) and health outcomes. They assess the impact of environmental factors on diseases like asthma, cancer, and congenital disabilities [23].
4. Forensic Epidemiology helps fill the gap between clinical judgment and epidemiologic data to establish lawsuit causality. It suffices to say that forensic epidemiologists combine forensic medicine and epidemiology, playing an essential role in civil, criminal, or both lawsuits [24].
5. Occupational Epidemiology investigates workers and their workplace, their health outcomes vis-à-vis causal association with the conditions of the area they operate, such as chemicals, pollutants, radiation, heat, and work schedules, to mention but a few. They study occupational hazards, exposure to harmful substances, and work-related injuries and illnesses [25].
6. Molecular Epidemiology, which emerges from molecular biology, studies the contribution of genetic and environmental risk factors at a molecular level. It enables molecular epidemiologists to understand disease causation, distribution, and prevention within families and across populations. Similarly, it helps in understanding the interactions between genetic traits and environmental exposures in disease causation and the specific molecular and genetic pathways in developing disease. They use genetic and molecular techniques to investigate disease outbreaks and patterns. They often work at the intersection of genetics, epidemiology, and microbiology [26-29].
Similarly, there are other fields and subfields within epidemiology, each with a unique focus and methodology. These include chronic disease epidemiology, social epidemiology, reproductive and perinatal epidemiology, nutritional epidemiology, genetic epidemiology, pharmacoepidemiology, cancer epidemiology, global health epidemiology, veterinary epidemiology, and psychiatric epidemiology. Epidemiologists in various areas work to better understand and improve public health by identifying risk factors, developing prevention strategies, and informing healthcare policies and practices.
Epidemiological Research and Methods
Epidemiological research employs various paradigms, which include overarching frameworks that guide the design and conduct of studies [30]. These paradigms help epidemiologists structure their investigations and answer specific research questions:
1. Descriptive Epidemiology
