Epidemiology

✍ Scribed by Leon Gordis

• Publisher: El Sevier
• Year: 2014
• Tongue: English
• Leaves: 418
• Edition: 5
• Category: Library

✦ Table of Contents

Front Cover
Inside Front Cover
Epidemiology, 5/e
Copyright Page
For Dassy
Preface
Acknowledgments
Table Of Contents
Second half title page
1 The Epidemiologic Approach to Disease and Intervention
Sectiion 1_text
1 Introduction
What is Epidemiology?
The Objectives of Epidemiology
Changing Patterns of Community Health Problems
Epidemiology and Prevention
Primary, Secondary, and Tertiary Prevention
Two Approaches to Prevention: A Different View
Epidemiology and Clinical Practice
The Epidemiologic Approach
From Observations to Preventive Actions
1. Ignáz Semmelweis and Childbed Fever
2. Edward Jenner and Smallpox
3. John Snow and Cholera
When the Frequency of a Disease Declines, WHO Deserves the Credit?
Integrating Prevention and Treatment
Conclusion
References
2 The Dynamics of Disease Transmission
Learning Objectives
Modes of Transmission
Clinical and Subclinical Disease
Clinical Disease
Nonclinical (Inapparent) Disease
Carrier Status
Endemic, Epidemic, and Pandemic
Disease Outbreaks
Immunity and Susceptibility
Herd Immunity
Incubation Period
Attack Rate
Exploring Occurrence of Disease
Who
Gonorrhea
Pertussis
When
Where
Outbreak Investigation
Cross-Tabulation
Conclusion
References
Review Questions for Chapter 2
3 The Occurrence of Disease:
Learning Objectives
Surveillance
Passive and Active Surveillance
Stages of Disease in an Individual and in a Population
Measures of Morbidity
Incidence Rate
People at Risk Who Are Observed throughout a Defined Time Period
When All People Are Not Observed for the Full Time Period, Person-Time, or Units of Time When Each Person Is Observed
Identifying New Cases in Order to Calculate Incidence
Attack Rate
Prevalence
Problems with Incidence and Prevalence Measurements
Problems with Numerators
Problems with Denominators
Problems with Hospital Data
Relationship between Incidence and Prevalence
Spot Maps
Conclusion
References
Review Questions for Chapter 3
4 The Occurrence of Disease:
Learning Objectives
Measures of Mortality
Mortality Rates
Case-Fatality
Proportionate Mortality
Years of Potential Life Lost
Why Look at Mortality?
Problems with Mortality Data
Comparing Mortality in Different Populations
Direct Age Adjustment
Indirect Age Adjustment (Standardized Mortality Ratios)
The Cohort Effect
Interpreting Observed Changes in Mortality
Other Measures of the Impact of Disease
Quality of Life
Projecting the Future Burden of Disease
Conclusion
References
Review Questions for Chapter 4
5 Assessing the Validity and Reliability of Diagnostic and Screening Tests
Learning Objectives
Biologic Variation of Human Populations
Validity of Screening Tests
Tests with Dichotomous Results (Positive or Negative)
Tests of Continuous Variables
Use of Multiple Tests
Sequential (Two-stage) Testing
Simultaneous Testing
Net Sensitivity Using Two Simultaneous Tests
Net Specificity Using Two Simultaneous Tests
Comparison of Simultaneous and Sequential Testing
Predictive Value of a Test
Relationship between Positive Predictive Value and Disease Prevalence
Relationship between Positive Predictive Value and Specificity of the Test
Reliability (Repeatability) of Tests
Intrasubject Variation
Intraobserver Variation
Interobserver Variation
Percent Agreement
Kappa Statistic
Rationale of the Kappa Statistic.
Calculation of the Kappa Statistic—An Example.
Relationship between Validity and Reliability
Conclusion
References
Appendices to Chapter 5
Review Questions for Chapter 5
6 The Natural History of Disease:
Learning Objectives
Case-Fatality
Person-Years
Five-Year Survival
Observed Survival
Rationale for the Life Table
Calculating a Life Table
The Kaplan-Meier Method
Assumptions Made in Using Life Tables
Example of Use of a Life Table
Apparent Effects on Prognosis of Improvements in Diagnosis
Median Survival Time
Relative Survival
Generalizability of Survival Data
Conclusion
References
Review Questions for Chapter 6
7 Assessing Preventive and Therapeutic Measures:
Learning Objectives
Selection of Subjects
Allocating Subjects to Treatment Groups Without Randomization
Studies without Comparison
Studies with Comparison
Historical Controls
Simultaneous Nonrandomized Controls
Allocating Subjects Using Randomization
What Is the Main Purpose of Randomization?
Stratified Randomization
Data Collection on Subjects
Treatment (Assigned and Received)
Outcome
Prognostic Profile at Entry
Masking (Blinding)
Crossover
Factorial Design
Noncompliance
Conclusion
References
8 Randomized Trials:
Learning Objectives
Sample Size
Recruitment and Retention of Study Participants
Ways of Expressing the Results of Randomized Trials
Interpreting the Results of Randomized Trials
Generalizability of Results beyond the Study Population
What Can the Results of a Randomized Trial Tell a Treating Physician about an Individual Patient?
Comparative Effectiveness Research (CER)
Four Phases in Testing New Drugs in the United States
Three Major Randomized Trials in the United States
The Hypertension Detection and Follow-up Program
The Multiple Risk Factor Intervention Trial
Study of Breast Cancer Prevention Using Tamoxifen
Randomized Trials for Evaluating Widely Accepted Interventions
A Trial of Arthroscopic Knee Surgery for Osteoarthritis
Effect of Group Psychosocial Support on Survival of Patients with Metastatic Breast Cancer
Registration of Clinical Trials
Ethical Considerations
Conclusion
Epilogue
References
Review Questions for Chapters 7 and 8
2 Using Epidemiology to Identify the Causes of Disease
Section 2_text
9 Cohort Studies
Learning Objectives
Design of a Cohort Study
Comparing Cohort Studies with Randomized Trials
Selection of Study Populations
Types of Cohort Studies
Examples of Cohort Studies
Example 1: The Framingham Study
Example 2: Incidence of Breast Cancer and Progesterone Deficiency
Cohort Studies for Investigating Childhood Health and Disease
Potential Biases in Cohort Studies
Selection Biases
Information Biases
When is a Cohort Study Warranted?
Conclusion
References
Review Questions for Chapter 9
10 Case-Control and Other Study Designs
Learning Objectives
Design of a Case-Control Study
Potential Biases in Case-Control Studies
Selection Bias
Sources of Cases
Using Incident or Prevalent Cases.
Selection of Controls
Sources of Controls.
Use of Nonhospitalized People as Controls.
Use of Hospitalized Patients as Controls.
Problems in Control Selection.
Information Bias
Problems of Recall
Limitations in Recall.
Recall Bias.
Other Issues in Case-Control Studies
Matching
Group Matching
Individual Matching
Use of Multiple Controls
Controls of the Same Type
Multiple Controls of Different Types
When is a Case-Control Study Warranted?
Case-Control Studies Based in a Defined Cohort
Nested Case-Control Studies
Case-Cohort Studies
Advantages of Embedding a Case-Control Study in a Defined Cohort
Other Study Designs
Case-Crossover Design
Ecologic Studies
Cross-Sectional Studies
Conclusion
References
Review Questions for Chapter 10
11 Estimating Risk:
Learning Objectives
Absolute Risk
How Do We Determine Whether a Certain Disease is Associated with a Certain Exposure?
Relative Risk
The Concept of Relative Risk
Interpreting the Relative Risk
Calculating the Relative Risk in Cohort Studies
The Odds Ratio (Relative Odds)
Defining the Odds Ratio in Cohort and in Case-Control Studies
The Odds Ratio in Cohort Studies
The Odds Ratio in a Case-Control Study
Interpreting the Odds Ratio
When Is the Odds Ratio a Good Estimate of the Relative Risk?
Examples of Calculating Odds Ratios in Case-Control Studies
Calculating the Odds Ratio in an Unmatched Case-Control Study
Calculating the Odds Ratio in a Matched-Pairs Case-Control Study
Conclusion
Reference
Review Questions for Chapter 11
Appendix to Chapter 11
(1) Formula 1:
(2) Formula 2:
(3) Formula 3:
12 More on Risk:
Learning Objectives
Attributable Risk
Attributable Risk for the Exposed Group
Formula 12-1
Formula 12-2
Attributable Risk for the Total Population—Population Attributable Risk (PAR)
Formula 12-3
Formula 12-4
An Example of an Attributable Risk Calculation for the Exposed Group
Formula 12-1
Formula 12-2
An Example of an Attributable Risk Calculation in the Total Population (Population Attributable Risk—PAR)
Formula 12-3
Formula 12-3
Formula 12-4
Comparison of Relative Risk and Attributable Risk
Conclusion
References
Review Questions for Chapter 12
Appendix to Chapter 12: Levin’s Formula for the Attributable Risk for the Total Population
13 A Pause for Review:
14 From Association to Causation:
Learning Objectives
Approaches for Studying Disease Etiology
Approaches to Etiology in Human Populations
Types of Associations
Real or Spurious Associations
Interpreting Real Associations
Types of Causal Relationships
Necessary and Sufficient
Necessary, But Not Sufficient
Sufficient, But Not Necessary
Neither Sufficient Nor Necessary
Evidence for a Causal Relationship
Guidelines for Judging Whether an Observed Association is Causal
Deriving Causal Inferences: Two Examples
Peptic Ulcers and Gastric Cancer in Relation to Infection with Helicobacter pylori
Age of Onset of Alcohol Use and Lifetime Alcohol Abuse
Modifications of the Guidelines for Causal Inferences
Conclusion
References
Review Questions for Chapter 14
15 More on Causal Inferences:
Learning Objectives
Bias
Selection Bias
Information Bias
Confounding
Interaction
Conclusion
References
Review Questions for Chapter 15
16 Identifying the Roles of Genetic and Environmental Factors in Disease Causation
Learning Objectives
Association with Known Genetic Diseases
Genetic Advances and Their Relationship to Epidemiologic Approaches
The Human Genome Project
Use of Genetic Markers
Gene Expression
Genome-Wide Association Studies (GWAS)
The Promise of the Human Genome Project
The Importance of Epidemiologic Approaches in Applying Genetic Methods to Human Disease
Age at Onset
Family Studies
Risk of the Disease in First-Degree Relatives
Applying Molecular Biological Methods to Family Studies
Twin Studies
Adoption Studies
Time Trends in Disease Incidence
International Studies
Migrant Studies
Interaction of Genetic and Environmental Factors
Prospects for the Future
Conclusion
References
Review Questions for Chapter 16
3 Applying Epidemiology to Evaluation and Policy
Section 3_text
17 Using Epidemiology to Evaluate Health Services
Learning Objectives
Studies of Process and Outcome
Studies of Process
Studies of Outcome
Efficacy, Effectiveness, and Efficiency
Efficacy
Effectiveness
Efficiency
Measures of Outcome
Comparing Epidemiologic Studies of Disease Etiology and Epidemiologic Research Evaluating Effectiveness of Health Services
Evaluation Using Group Data
Outcomes Research
Potential Biases in Evaluating Health Services Using Group Data
Two Indices Used in Ecologic Studies of Health Services
Evaluation Using Individual Data
Randomized Designs
Nonrandomized Designs
Before–After Design (Historical Controls)
Simultaneous Nonrandomized Design (Program–No Program)
Comparison of Utilizers and Non-utilizers
Comparison of Eligible and Non-eligible Populations
Combination Designs
Case-Control Studies
Conclusion
References
Review Questions for Chapter 17
18 The Epidemiologic Approach to Evaluating Screening Programs
Learning Objectives
The Natural History of Disease
The Pattern of Disease Progression
Methodologic Issues
Selection Biases
Referral Bias (Volunteer Bias)
Length-Biased Sampling (Prognostic Selection)
Lead Time Bias
Lead Time and Five-Year Survival
Overdiagnosis Bias
Study Designs for Evaluating Screening: Nonrandomized and Randomized Studies
Nonrandomized Studies
Randomized Studies
Further Examples of Studies Evaluating Screening
Mammography for Women 40 to 49 Years of Age
Screening for Cervical Cancer
Screening for Neuroblastoma
Problems in Assessing the Sensitivity and Specificity of Screening Tests
Interpreting Study Results That Show No Benefit of Screening
Cost-Benefit Analysis of Screening
Conclusion
References
Review Questions for Chapter 18
19 Epidemiology and Public Policy
Learning Objectives
Epidemiology and Prevention
Population approaches Versus High-Risk Approaches to Prevention
Epidemiology and Clinical Medicine: Hormone Replacement Therapy in Postmenopausal Women
Risk Assessment
Assessment of Exposure
Meta-Analysis
Publication Bias
Epidemiology in the Courts
Sources and Impact of Uncertainty
Policy Issues Regarding Risk: What Should the Objectives Be?
Conclusion
References
20 Ethical and Professional Issues in Epidemiology
Learning Objectives
Ethical Issues in Epidemiology
Investigators’ Obligations to Study Subjects
Protecting Privacy and Confidentiality
Access to Data
Race and Ethnicity in Epidemiologic Studies
Conflict of Interest
Interpreting Findings
Conclusion
References
Answers to Review Questions
Chapter 1
Chapter 2
Chapter 3
Chapter 4
Chapter 5
Chapter 6
Chapters 7 and 8
Chapter 9
Chapter 10
Chapter 11
Chapter 12
Chapter 13
Chapter 14
Chapter 15
Chapter 16
Chapter 17
Chapter 18
Chapters 19 and 20
Index
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