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Bibliography NOTE: The EPID 168 web site (www.sph.unc.edu/courses/epid168/) has links to two web sites devoted to the life, times, and studies of John Snow and to sites on the history of medicine at the National Library of Medicine and the University of Alabama at Birmingham School of Medicine. Brockington, C. Fraser. The history of public health. In: W. Hobson (ed), Theory and practice of public health. NY, Oxford, 1979, 1-8. Committee for the Study of the Future of Public Health. The future of public health. Washington, DC, National Academy Press, 1988. Comstock, George W. Tuberculosis – a bridge to chronic disease epidemiology. Am J Epidemiol 1986; 124:1-16. Dawber, Thomas R.: The Framingham Study. Cambridge, Mass.: Harvard, 1980. (Chapters 1-5 provide an interesting and easy-to-read introduction to this landmark investigation, requiring no prior background in epidemiology or cardiovascular disease. These chapters provide a good introduction to basic epidemiologic concepts.) Dubos, Rene. Man adapting. New Haven, CT, Yale, 1965. Dubos, Rene. The mirage of health. NY, Anchor, 1961 Epidemiology Monitor. The future of epidemiology. Epidemiology Monitor 1999 (February); 21(2) Elmore, Joann G. and Alvan R. Feinstein. Joseph Goldberger: an unsung hero of American clinical epidemiology. Ann. Intern. Med. 1994;121:372-375. Fee, Elizabeth. Improving the people's health: some Hopkins' contributions. Am J Epidemiol 1991;134:1014-1022. Goldberger, J.: Goldberger on pellagra. M. Terris, ed. Baton Rouge, Louisiana State University Press, 1964. Goldberger, J, Wheeler GA, Sydenstricker E: A study of the diet of nonpellagrous and of pellagrous households. JAMA 71:944, 1918. Koplan, Jeffrey P.; Stephen B. Thacker, Nicole A. Lezin. Epidemiology in the 21 st century: calculation, communication, and intervention. Am J Public Health 1999; 89:1153-1155. Krause, Richard M. The origin of plagues: old and new. Science 1992;257:1073-1078. _____________________________________________________________________________________________ www.epidemiolog.net, © Victor J. Schoenbach 1999, 2000 2. Historical perspective - 26 rev. 8/17/1999, 8/21/2000, 3/9/2001
Kuhn, Thomas S. The structure of scientific revolutions, 2nd ed, Chicago, University of Chicago, 1970. Larson, Elaine. Innovations in health care: antisepsis as a case study. Am J Public Health 1989; 79:92- 99. Lilienfeld and Lilienfeld. Foundations of Epidemiology. Chapter 2. Lilienfeld, Abraham M. Ceteris Paribus: the evolution of the clinical trial. Bulletin of the History of Medicine 1982 (Spring); 56:1-18. Lilienfeld, A.M. (ed) Times, Places, and Persons. Baltimore: The Johns Hopkins University Press, 1978. Lind, J.: A treatise of the scurvy. Edinburgh, Sands, Murray, and Cochran for A. Millar, 1753. McNeill, William H. Plagues and peoples. Garden City, NY, 1976 Pott, P.: Chirurgical observations related to the cataract, the polypus of the nose, the cancer of the scrotum, the different kinds of ruptures and the mortification of the toes and feet. London, England, Hawes, Clarke, and Collins, 1775. In: National Cancer Institute Monograph No. 10, 1962, pp. 7-13. Rosen, George. A history of public health. Baltimore, Johns Hopkins Univ, 1993. Rosenberg, Charles E. The Cholera Years. Chicago, University of Chicago. Sartwell, Philip E. and Frances Stark. American Journal of Epidemiology: its evolution since 1965. Am J Epidemiol 1991 (Nov 15); 134(10):1041-1046. Silverman, W.A.: Retrolental Fibroplasia, A Modern Parable. New York: Grune & Stratton, 1980. Snow, John. On the mode of communication of cholera. In: Snow on Cholera. New York, The Commonwealth Fund, 1936. Susser, Mervyn. Epidemiology in the United States after World War II: the evolution of technique. Epidemiologic Reviews 1985; 7:147-177. Terris, Milton. The Society for Epidemiologic Research (SER) and the future of epidemiology. Am J Epidemiol 1992;136:909-915. Vandenbroucke JP, Rooda HME, Beukers H. Who made John Snow a hero? Am J Epidemiol 1991 (May 15); 133(10):967-973? See also letters in Am J Epidemiol 1992 (Feb 15);135(4):450. _____________________________________________________________________________________________ www.epidemiolog.net, © Victor J. Schoenbach 1999, 2000 2. Historical perspective - 27 rev. 8/17/1999, 8/21/2000, 3/9/2001
Page 1 and 2: Understanding the Fundamentals of E
Page 3 and 4: Preface Introductory epidemiology c
Page 5 and 6: Table of Contents Chapter (in Acrob
Page 7 and 8: 1. Introduction Definition, charact
Page 9 and 10: problems (Schwartz and Carpenter, 1
Page 11 and 12: HIV - a new or newly-recognized vir
Page 13 and 14: d = principal investigator's degree
Page 15 and 16: Analytic studies typically involve
Page 17 and 18: Observational sciences especially a
Page 19 and 20: McGavran EG. What is public health?
Page 21 and 22: 2. An evolving historical perspecti
Page 23 and 24: Time line for the history of public
Page 25 and 26: as a one-room bacteriology laborato
Page 27 and 28: − Health surveys − Research fun
Page 29: his scientific peers of the correct
Page 33 and 34: 3. Studying populations - basic dem
Page 35 and 36: The demographic balancing equation
Page 37 and 38: ates. Similarly, bulges in the repr
Page 39 and 40: When the baby boom cohort retires 1
Page 41 and 42: The pervasiveness, strength, viciou
Page 43 and 44: Total fertility rate (TFR) Standard
Page 45 and 46: Life expectancy The technique, of u
Page 47 and 48: Excerpt from the U.S. 1993 abridged
Page 49 and 50: At the other end of the life table,
Page 51 and 52: to change, hopefully to decline. If
Page 53 and 54: Thought question: Professors typica
Page 55 and 56: Descriptive studies and surveillanc
Page 57 and 58: 4. The Phenomenon of Disease Concep
Page 59 and 60: Classification is the foundation As
Page 61 and 62: As we gain more sophisticated under
Page 63 and 64: To recapitulate the above discussio
Page 65 and 66: Classifying cause of death Since mo
Page 67 and 68: Laboratory and other objectively me
Page 69 and 70: distribution but are not diabetic (
Page 71 and 72: program in the general population,
Page 73 and 74: Infectious disease Incubation "time
Page 75 and 76: the direct effects of carcinogenic
Page 77 and 78: patient outcomes. The design and ev
Page 79 and 80: detected by screening will appear b
Page 81 and 82:
Morrison, Alan S. Screening in chro
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e relevant. Compromises might be fo
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educational attainment by the numbe
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Distributions - the fuller picture
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Per capita income: Should health ca
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Deaths of children < 1 year of age
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No. of persons with senile dementia
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Incidence Immigration Relationship
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Examples: arthritis, cholelithiasis
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Cohort - entrance into the populati
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Sample calculation: 200 people free
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• The units of time must be state
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Calculation of person-time in a coh
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Original Calculation of person-time
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average risk for a member of the co
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However: Nurses: 601 cases/89,538 w
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treated. If the rate at which patie
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Incidence and prevalence in a popul
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small prevalence. So if the seropre
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Appendix on weighted averages Becau
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Appendix on exponents and logarithm
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and epidemiology. The notation ln(x
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3. For the following hypothetical d
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c. ________________ 6 fatalities /
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Measuring disease and exposure - As
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5. a. Flow Diagram Population of si
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New cases Q ID = ------------------
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Overview 6. Standardization of rate
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differences between the groups in f
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∑ (stratum-specific rates × stan
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especially important when comparing
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copy this cell to the other columns
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where the RR k are the stratum-spec
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and the observed number of deaths i
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Directly standardized rate for A =
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5,022 Indirectly standardized = —
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the situation among older age group
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Appendix on Standardized Mortality
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across age strata, then the damage
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d. How would you feel about the con
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Cases per 100,000 Mean annual incid
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d. dt Indirectly standardized rates
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The second ingredient for an standa
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Group US rate /100,000 County pop.
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Crude rates are comparable because
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The “Big Picture” 7. Relating r
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CHD and oral contraceptives in Brea
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Some basic measures Before diving i
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esophageal cancer? First, if we did
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ought in here as well. When we cont
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Exposure Disease Yes No Total Yes a
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Relation of the odds ratio to the r
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the case-control study estimates th
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If the data had come from a cross-s
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Excess risk = CIR - 1 = 1.0 (i.e.,
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strength of the relationship (e.g.,
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drawn on ordinary graph paper. Howe
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Measures of Impact Concept Relative
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Attributable risk proportion The AR
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show that a large proportion (i.e.,
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Incidence Diagrammatic representati
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1. high frequency of disease 2. pow
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With this diagram and notation we c
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vaguer) “attributed to”. Incide
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Summary There are three categories
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CIR can be directly estimated if th
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I0 I = ——————— 1 + P1
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PD|e PE (RR - 1) PD|e PE (RR - 1) P
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Walter, Stephen D. Choice of effect
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a. Quit rates were measured as the
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1. Definitions: Relating risk facto
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There is an extremely strong associ
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8. Analytic study designs The archi
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Progression of types of studies In
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Cross-sectional A cross-sectional s
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Follow-up studies Along with case-c
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of interest community-level influen
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ecological approach may be the appr
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What measures can be estimated from
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Ability to estimate risk Ascertainm
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individuals, this relationship does
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Odds Ratio (OR) Exposure odds in ca
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Simple randomization - assignment o
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The relationship of an attribute to
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(a / m1) / (b / m1) ad ORe (Exposur
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Validity The validity of a case-con
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Since the strategic advantage of th
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c = f0N1 = number of exposed noncas
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experienced the event under study.
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approach, the odds ratio computatio
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Exposure Yes No Total Cases A B M1
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Miettinen, Olli S. The clinical tri
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Mantel, N. and Haenszel, W.: Statis
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Peto, R., Pike, M.C., Armitage, P.,
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4. The authors state that "There we
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5. In contrast to many earlier inve
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In this study the use of hospitaliz
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Follow-up must be longer for any gi
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While acknowledging the very import
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world. Even as late as the 1950's,
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Causal Inference Direct observation
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data on the effects of radiation on
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But excluding an explanation based
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Strength of the association Pronou
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Experimental evidence Certain types
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To issue an indictment, the grand j
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10. Sources of error A systematic f
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the data in the table. (Note that t
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associations. So the same terms may
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"Negative bias" - The observed meas
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Classifying sources of bias Inspite
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The study population is a subset of
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This estimate of the prevalence of
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unmatched control groups will presu
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The odds ratio for this table is 3.
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Selection bias in cohort studies Se
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Information bias Information bias r
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following chapter). The concept of
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P h y s i c i a n A Comparison of d
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item). Alpha values of 0.80 are are
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Hypothetical scenario showing effec
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presumably classified as informatio
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Appendix 1 Formulas to see the effe
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Algebraically, _ Pr(E|D') = — the
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Gregorio, David L.; James R. Marsha
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Sources of error - Assignment 1. Th
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Alpha (α) is the probability by wh
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Sources of error - Assignment solut
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3. ii) Selective survival--if OC us
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a. Flow diagram: 1960-1962 1967-196
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Introduction 11. Multicausality: Co
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estimate of what the outcomes would
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A hypothetical example (with apolog
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Questions to ask: There are many as
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Confounding arises from unequal dis
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CHD Incidence by Behavior Pattern a
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In this way, the 1,129 Type A's wit
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exposure. If we assume a baseline r
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Further insight can be gained by co
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Table 7a Colon cancer and drinking
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atio of the observed number of expo
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ural-specific exposure prevalences,
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eing infected, and the more of them
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studies deal with a delimited geogr
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University of Massachusetts at Amhe
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similarly distributed in cases and
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"There have been many important ste
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MAIN POINTS Confounding is a disto
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Greenland, S. and Neutra R.: Contro
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Appendix The following discussion i
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i n1i wi = ----- If exposure is unr
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Multicausality: Confounding - Assig
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4. The following table, published i
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1. Multicausality: Confounding - As
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link between HCS and MI to ensure t
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Multicausality 12. Multicausality:
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Interdependent effects The precedin
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epidemiologic data. Put simply, the
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BP 0 These two lines are parallel;
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ean intake and B representing genet
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Fourth, proportion of disease attri
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Incidence and incidence ratios of f
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% with evidence of impaired red blo
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cancer rate among the light smokers
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Age standardized lung cancer rates
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R11 - R00 = R10 - R00 + R01 - R00 (
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and R111 = R100 × R010 × R001 / (
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R110 = R100 × R010 / R000 (multipl
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Risk ln(risk) 0.19 -1.67 0.13 -2.01
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have clinical or public health sign
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Baseline Characteristics Associated
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Weiss, Noel S. Accounting for the m
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A. Synergism apparently exists in t
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5. Walker (International Journal of
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(or equivalently, the rate for pers
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impact. Synergism in this sense imp
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13. Multicausality - analysis appro
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very far on instruments but needs t
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Summarizing the relationships Often
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We saw in the chapter on effect mod
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So the multiplicative model for joi
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misleading summary. These circumsta
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w1 CID1 + w2 CID2 Summary CID = —
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c d bcn0 + adn1 Var(ln(CIR)) ≈
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Kleinbaum, Kupper, and Morgenstern;
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1 + 1 + 1 3 ORMH = —————
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Risk = R00 + Obesity effect Obesity
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two (or more) factors that "interac
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OR = exp(β3) β3 is the difference
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Other regression models [Optional f
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Know the epidemiologic meaning of t
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14. Data analysis and interpretatio
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and questionable data. Monitoring p
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presence of particular proteins (e.
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4. Count - the number of entities,
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Algorithms - A procedure that uses
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Imputation causes the least distort
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Prenatal exposure to diethylstilbes
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Possible outcomes (Colors of pairs
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In a strict decision-making mode, t
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C = area between -z and +z D = area
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two-tailed 5% significance level).
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If the p-value is not small (i.e.,
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OR we observed was greater than 1.0
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Large trials (e.g., 250 deaths) Tru
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The concept behind the confidence i
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Formulas for confidence intervals f
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Woolf SH, Battista RN, Anderson GM,
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Stallones, Reuel A. The use and abu
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C - Clustered observations, which d
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For example, suppose that n, the sa
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* See previous table Margin of erro
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Even in randomized trials problems
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Pr(H|T) is therefore a function of
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That information gives you pause. C
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Part II 1. In table 2 from the Rose
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If the OR for Current OC use were t
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6. There are no interaction (produc
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24. Submit manuscript from previous
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Cooperative agreement A cooperative
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Assurances by the applicant and her
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The new element is the grant award.
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1. What needs to be done? 2. How lo
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Postaward Final report What to do
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2. maintain close supervision of th
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Publication Epidemiology Working Gr
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Weed, Douglas L. Between science an
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1.3 Specific Objectives of Data Man
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engender a basic conflict between t
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1.4.2 Integration Integrate the dat
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2. Consistency of the protocol's im
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2. Coding of a sample of data forms
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2.3 The steps in the Editing proces
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Although it is rare to use more tha
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The first stages of data analysis s
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have less power to exclude the stat
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greater nonresponse by heavy drinke
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Imputation is then carried out as f
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(normal) distribution in the popula
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Appendix **************************
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___________________________________
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Public health approach The public h
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health, particularly at the world l
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Causative or preventive agents Scur
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Human behavior is also biology The
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crowded, under-resourced urbanized
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Bibliography Annas, George J.; Leon
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18. Overview and Conclusion A look
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Epidemiology is expanding In recen
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More reliance on "soft money" - res
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__________ This is not a new challe
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