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Epidemiology: Principles and Practice
Susmita Bhattacharya
1:
Introduction to Epidemiology
DEFINITION, SCOPE AND USES OF EPIDEMIOLOGY
Definition
Scope of Epidemiology
Uses of Epidemiology
Historical Study
Community Assessment
Working of Health Services
Assessment of Individual Risks and Chances
Identification of Syndromes
Completing the Natural History of Disease
Search for Causes
Other Uses
2:
Epidemiological Studies
DESCRIPTIVE EPIDEMIOLOGY
PERSONS
Age
Gender
Place
DIAGRAM-SPOT MAP (FIG. 2.1)
Time
TYPE OF DESCRIPTIVE STUDIES
Co-relational Studies
Merits
Limitations
Case Reports and Case Series
Limitations
Cross-sectional Surveys
Merits of Cross-sectional Studies
Limitations
HOW TO PLAN A DESCRIPTIVE STUDY
ANALYTICAL EPIDEMIOLOGY
Case Control Studies
Basic Design of Case Control Study
THE STEPS IN CASE CONTROL STUDY ARE AS FOLLOWS
Selection of Cases
Hospital-based Case Control Study
Population-based Case Control Studies
Selection of Controls
Matching
Individual Matching
Group Matching
Assessment of Disease Status and Exposure Status
Analysis and Interpretation of Case Control Studies
BIAS IN CASE CONTROL STUDIES
Bias: How it Occurs?
Selection Bias
Prevention of Selection Bias
Information Bias
Recall Bias
Prevention of Recall Bias
Interviewer Bias
Prevention of Interviewer Bias
Analysis of Case Control Study
Presentation of Data
Estimation of Risk
ADVANTAGES AND DISADVANTAGES OF CASE CONTROL STUDY
Advantages
Disadvantages
Cohort Studies
Types of Cohort Studies
Prospective Cohort Study
Advantages of Prospective Cohort Study
Disadvantages
Retrospective Cohort Studies
Retrospective and Prospective Cohort Study
Nested Case Control Studies
DESIGN OF COHORT STUDIES
Selection of Study Cohort
Selection of Comparison Group
Obtaining Information
Sources of Information
Sources of Information of Exposure
INFORMATION FROM RECORDS
Advantages
Disadvantages
INTERVIEW OF COHORT MEMBERS
INFORMATION FROM MEDICAL EXAMINATION
ENVIRONMENTAL INFORMATION
Information on Outcome
Sources of Outcome Information
Follow-up
Analysis and Interpretation
Relative Risk
Attributable Risk
Advantages of Cohort Study
Disadvantages of Cohort Study
EXPERIMENTAL EPIDEMIOLOGY
CLINICAL TRIALS
TYPES OF RANDOMIZED CLINICAL TRIAL
Therapeutic Trials
Intervention Trials
Preventive Trials
Diagrammatic Presentation of Clinical Trials
Special Issues and Challenges in Clinical Trials
Why Conduct a Clinical Trial?
Ethical Issues in Clinical Trials
Steps in Conducting Clinical Trials
Planning and Conducting Clinical Trial
STEPS IN CLINICAL TRIAL ARE AS FOLLOWS
Defining Aim and Objectives
Selection of Study Group
Sample Size
Inclusion and Exclusion Criteria
Exclusion Criteria
Consent for Participation is Clinical Trial
Allocation of Participants
Comparison Group in Clinical Trials
Patient as His Own Control
HISTORICAL CONTROL
Matched Pairs
Follow-up and Compliance
Ascertaining Results
Blinding in Randomized Clinical Trials
Following Types of Blinding Techniques are Used in Clinical Trials
ADVANTAGES OF BLINDING
Participant
Investigator
Assessor or Evaluator
COMMUNITY TRIALS
Special Preventive Agent
Environmental Modifications
PLANNING AND CONDUCTING COMMUNITY TRIAL
Development of Protocol
Community Selection
Collection of Baseline Information
Intervention Assignment
Collection of Data
Interpretation of Results
ADVANTAGES OF COMMUNITY TRIAL
3:
Measurement of Disease Frequency and Association
MEASURES OF DISEASE FREQUENCY
Ratio
Proportion
Rate
Incidence
Cumulative Incidence
Incidence Rate or Density
MEASURES OF PREVALENCE
FACTORS DETERMINING PREVALENCE
Uses of Prevalence Rate
MEASURES OF ASSOCIATION
Measuring Association in Cohort Studies
RELATIVE RISK
Definition
Example
ATTRIBUTABLE RISK
Definition
Population Attributable Risk
MEASUREMENT OF ASSOCIATION IN CASE CONTROL STUDIES
4:
Causal Association/Cause Effect Relationship
CAUSAL ASSOCIATION
CONCEPT OF CAUSE AND CAUSAL ASSOCIATION
CONCEPT OF SUFFICIENCY
TYPES OF ASSOCIATION
Spurious Association or Non-causal Association
Association Due to Interrelated Variables or Factors (Non-causal)
Association Due to Confounding Factors
ASSESSING CAUSALITY
Strength of Association
Consistency of Association
Specificity of Association
Time Sequence or Temporal Sequence
Biological Credibility or Plausibility
Experimental Evidence
Dose Response Relationship
5:
Epidemiological Concept of Disease and Natural History of Disease
EPIDEMIOLOGICAL TRIAD
Agents of Disease
A. Biological Agents
B. Physical Agents
C. Chemical Agents
D. Nutritive Agents
HOST FACTORS
Demographic Factors
Age
Gender
Biological Factors
Lifestyle Factors
ENVIRONMENTAL FACTORS
SOCIOECONOMIC ENVIRONMENT
NATURAL HISTORY OF DISEASE
Dynamics of Disease Transmission
Reservoir of Infection
Sources of Infection
HUMAN RESERVOIR OF INFECTION
Animal Reservoir
MODES OF TRANSMISSION
Direct Transmission
Indirect Transmission
Vector Borne Transmission
Vehicle Borne
Incubation Period (Fig. 5.3)
USES OF INCUBATION PERIOD IN EPIDEMIOLOGY
EPIDEMIOLOGICAL CONCEPT OF PREVENTION AND INTERVENTION
Primordial Prevention
Primary Prevention
Secondary Prevention
Tertiary Prevention
Interventions for Disease Prevention
Primary Prevention
Promotion of Positive Health
Specific Protection Against Diseases
Secondary Prevention
Early Diagnosis and Treatment
TERTIARY PREVENTION
HERD IMMUNITY
CONTROL OF COMMUNICABLE DISEASE
General Principles of Control
Control of Reservoir and Source
Interruption of Transmission
Protection of Susceptible Host
Personal Measures
6:
Epidemiological Investigations
INVESTIGATION OF AN EPIDEMIC
INVESTIGATION OF NON-COMMUNICABLE DISEASES
EPIDEMIOLOGICAL SURVEILLANCE
ACTIVE SURVEILLANCE
Advantages of Active Surveillance
Disadvantage
PASSIVE SURVEILLANCE
Advantages
Disadvantages
SENTINEL SURVEILLANCE
USES OF SURVEILLANCE DATA
7:
Screening for Disease
HOW TO TEST VALIDITY OF A SCREENING TEST
When an Individual is False Negative
Importance of Predictive Value
Reliability
Source of Variations
TYPES OF SCREENING
BENEFITS OF SCREENING
Limitations of Screening
Screening Procedures and Studies and Biases
Selection Bias
Incidence-prevalence Bias and Length Bias
Lead-time Bias
8:
Mortality Statistics
SOURCES OF MORTALITY DATA
Measures of Mortality
CRUDE DEATH RATE
SPECIFIC DEATH RATE
Examples:
ADJUSTED OR STANDARDIZED DEATH RATES
DIRECT METHOD OF AGE ADJUSTMENT
Indirect Method of Standardization
MORTALITY TRENDS OF DISEASE: CAUSES OF VARIATIONS
Time Trends
Geographical Variation in Mortality
CHANGES IN RELATION TO PERSONS
Uses of Mortality Statistics
Limitations of Mortality Statistics
9:
Morbidity Statistics
SOURCES OF MORBIDITY STATISTICS COULD BE FOLLOWING
MEASUREMENT OF MORBIDITY
USES OF MORBIDITY STATISTICS
LIMITATION OF MORBIDITY STATISTICS
10:
How to Design an Epidemiological Study
RESEARCH HAS DEFINITE CHARACTERISTICS
STEPS CAN BE AS FOLLOWS
Annexure
Bibliography
INDEX
TOC
Index
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