Concepts of Epidemiology : An Integrated Introduction to the Ideas, Theories, Principles, and Methods of Epidemiology

Epidemiology concerns the frequency, pattern, and causes of disease in populations. It is one of the most important modern sciences underpinning health and healthcare- including medicine, public health and profession allied to medicine. Concepts in Epidemiology explains and illustrates the key concepts(language, principles and methods) that underpin the science of epidemiology and its applications to policy making, health service planning and health promotion. Richly illustrated, there are exercises to help readers deepen their understanding, with detrailed material captured in tables. Each chapter ends in a summary, and all technical and specialized terminology is explained and defined in a glossary. The book places heavy emphasis on integrating the ideas of epidemiology. Topics include: the nature and scope of epidemiology; the epidemiological concepts of population; variation in disease by time, place and person: error, bias, risk modification and confounding; cause and effect: the concepts of natural history, spectrum, iceberg, population patterns and screening; risk and measures of disease frequency; presentation and interpretation of epidemiological data on risk; study design; and theoretical, ethical, contextual, practical and critical foundations of epidemiology. Contents......Page 16 C......Page 21 E......Page 23 H......Page 24 M......Page 25 P......Page 26 S......Page 27 T......Page 28 Z......Page 29 1.1 The individual and the population......Page 30 1.2 Definition of epidemiology and statement of its central paradigm......Page 31 1.3 Directions in epidemiology and its uses......Page 32 1.4 Epidemiology as a science, practice, and craft......Page 33 1.5 The nature of epidemiological variables......Page 36 1.6 A disease and health problem: an illustration of the interdependence of clinical medicine and epidemiology......Page 40 1.7 Seeking the theoretical foundations of epidemiology......Page 43 Summary......Page 44 2.1 The individual and the population......Page 46 2.2 Harnessing heterogeneity in individual and group level disease and risk factor patterns......Page 50 2.3 Disease patterns as a manifestation of individuals living in changing social groups......Page 51 2.4 Sick populations and sick individuals......Page 55 2.5 Individual and population level epidemiological variables......Page 60 2.6 Epidemiology and demography: interdependent population sciences......Page 62 2.7 The dynamic nature of human population......Page 68 2.8 Applications of the population concept......Page 69 2.9 Conclusion......Page 71 Summary......Page 72 3.1 Introduction......Page 73 3.2 Reasons for analysing disease variations......Page 74 3.3 Variations and associations: real or artefact?......Page 76 3.4 Applying the real-artefact framework......Page 81 3.5 Disease clustering and clusters in epidemiology......Page 88 3.6 Applications of observations of disease variation......Page 96 Summary......Page 97 4.1 Introduction......Page 98 4.2 A classification of error and bias......Page 101 4.2.1 The research question, theme or hypothesis......Page 102 4.2.2 Choice of population......Page 105 4.2.4 Comparing disease patterns and risk factor-disease outcome relationships in populations which differ (confounding)......Page 108 4.2.5 Measurement......Page 115 4.2.6 Misclassification bias......Page 117 4.2.7 Analysis and interpretation......Page 119 4.2.9 Judgement and action......Page 120 4.3 A practical application of the research chronology schema of bias and error......Page 121 4.4 Conclusion......Page 123 Summary......Page 126 5.1 Introduction: causality in science and philosophy......Page 127 5.2 Epidemiological causal strategy and reasoning: the example of Semmelweiss......Page 130 5.3.1 Interplay of host, agent, and environment......Page 132 5.3.2 Necessary and sufficient cause......Page 142 5.4.1 Comparison of epidemiological and other concepts of causal reasoning......Page 144 5.4.2 Application of criteria to associations......Page 150 5.4.3 Interpretation of data, study design, and causal criteria......Page 158 5.6 Conclusion......Page 159 Summary......Page 161 6 Natural history, spectrum, iceberg, population patterns, and screening: Interrelated concepts in the epidemiology of disease......Page 162 6.1 Natural history of disease......Page 163 6.2 The population pattern of disease......Page 168 6.3 Spectrum of disease......Page 169 6.4 The unmeasured burden of disease: the metaphors of the iceberg and the pyramid......Page 171 6.5 Screening......Page 174 6.6 Applications of the concepts of natural history, spectrum, and screening......Page 185 6.7 Epidemiological theory: symbiosis with clinical medicine and social sciences......Page 189 Summary......Page 190 7.1 Introduction: risks, risk factors, and causes......Page 192 7.2 Quantifying disease frequency, risk factors, and their relationships......Page 193 7.3 Incidence and incidence rate: the concepts of incidence density, person-time incidence and cumulative incidence......Page 196 7.4 Numerator......Page 202 7.5 Denominator......Page 207 7.6 Prevalence and prevalence rate......Page 208 7.7 Relationship of incidence and prevalence......Page 214 7.9 Presenting rates......Page 217 7.10 Conclusion......Page 218 Summary......Page 219 8.1 Introduction......Page 220 8.2 Proportional morbidity or mortality ratio (PMR)......Page 221 8.3 Adjusted overall rates: standardization and the calculation of the SMR (Standardized mortality ratio)......Page 223 8.4 Relative measure: relative risk......Page 227 8.5 The odds ratio (OR)......Page 231 8.6 Measurements to assess the impact of a risk factor in groups and populations......Page 236 8.6.1 Attributable risk/exposed group......Page 239 8.6.2 Population attributable risk......Page 241 8.7 Presentation and interpretation of epidemiological data in applied settings......Page 243 8.8 Avoidable morbidity and mortality......Page 246 8.9 Comparison of summary measures of health status......Page 247 8.10 DALY, disability adjusted life years, and QALY, quality adjusted life years......Page 249 8.11 Numbers needed to treat (NNT) or to prevent (NNP)......Page 251 8.12 Describing the health status of a population......Page 252 8.13 The construction and development of health status indicators......Page 255 8.14 Conclusion......Page 257 Summary......Page 259 9.1 Introduction: interdependence of study design......Page 260 9.2 Classifications of study design: five dichotomies......Page 263 9.3 Case-series: clinical and population based......Page 264 9.4 Cross-sectional study......Page 271 9.5 Case-control study......Page 276 9.6 Cohort study......Page 280 9.7 Trials......Page 284 9.8 Overlap in the conceptual basis of the case-series, cross-sectional, case-control, cohort, and trial designs......Page 286 9.9 Ecological studies: design or analysis?......Page 291 9.10 Size of the study......Page 292 9.11 Data analysis and interpretation......Page 293 Summary......Page 294 10.1 The interrelationship of theory, methods, and application: a question of values......Page 296 10.2 Fundamental influences on health......Page 298 10.3 Setting priorities in health and health care......Page 300 10.4 Impact on health of local polluting industries: Teesside study of environment and health......Page 303 10.5 Paradigms: the evolution of epidemiology......Page 305 10.6 Epidemiology: forces for change......Page 306 10.7 Scope of epidemiology and specialization......Page 307 10.8 The context of epidemiological practice—academic and service, USA and UK......Page 308 10.9 The practice of epidemiology in public health......Page 309 10.10.2 Authorship......Page 310 10.10.3 Ethnicity and race......Page 311 10.11 Ethical guidelines......Page 313 10.12 Critical appraisal in epidemiology: separating fact from error and fallacy......Page 314 10.12.3 The fallacy of repeated citation......Page 316 10.12.9 The fallacy of obfuscation......Page 317 10.13 Some questions relevant to the appraisal of epidemiological research......Page 318 10.14 Building on an epidemiological education: role of historical landmarks......Page 320 10.15 Building on an epidemiological education: a reflection on the future of epidemiology......Page 322 Summary......Page 324 References and further reading......Page 326 C......Page 340 E......Page 341 I......Page 342 O......Page 343 R......Page 344 T......Page 345 Z......Page 346 Concepts In Epidemiology Explains And Illustrates The Language, Principles, And Methods Underlying The Science Of Epidemiology, And Its Applications To Policy Making, Health Service Planning And Health Promotion. Illustrated, There Are Exercises To Help Readers Deepen Their Understanding, With Detailed Material Captured In Tables. Each Chapter Ends In A Summary, And All Technical And Specialized Terminology Is Explained And Defined In A Glossary. The Book Places Particular Emphasis On Integrating The Ideas Of Epidemiology.--jacket. What Is Epidemiology? The Nature And Scope Of A Biological, Social, And Ecological Science And Of Epidemiological Variables And Outcomes -- The Individual And The Population -- Definition Of Epidemiology And Statement Of Its Central Paradigm -- Directions In Epidemiology And Its Uses -- Epidemiology As A Science, Practice, And Craft -- The Nature Of Epidemiological Variables -- A Disease And Health Problem: An Illustration Of The Interdependence Of Clinical Medicine And Epidemiology -- Seeking The Theoretical Foundations Of Epidemiology -- The Epidemiological Concept Of Population -- The Individual And The Population -- Harnessing Heterogeneity In Individual And Group Level Disease And Risk Factor Patterns -- Disease Patterns As A Manifestation Of Individuals Living In Changing Social Groups -- Sick Populations And Sick Individuals -- Individual And Population Level Epidemiological Variables -- Epidemiology And Demography: Interdependent Population Sciences -- The Dynamic Nature Of Human Population -- Applications Of The Population Concept -- Variation In Disease By Time, Place, And Person: A Framework For Analysis -- Reasons For Analysing Disease Variations -- Variations And Associations: Real Or Artefact? -- Applying The Real-artefact Framework -- Disease Clustering And Clusters In Epidemiology -- Applications Of Observations Of Disease Variation -- Epidemiological Theory Underpinning Or Arising From This Chapter -- Variation: Role Of Error, Bias, And Confounding -- A Classification Of Error And Bias. Raj S. Bhopal. Includes Bibliographical References (p. [297]-309) And Index Humans cherish the fact that they are unique, not only in their physique but also in their character, personality and behaviour (though identical twins may be excepted here).