1. Introduction to Epidemiology Instructor: Guan-Hua Huang, Ph.D. E-mail: ghuang@stat.nctu.edu.twghuang@stat.nctu.edu.tw Class meetings: Wednesday 1:30-4:30 pm Office hours: Wednesday 10:00am-12:00pm Course website: ?

2. Course goals To know epidemiologic methods and study design Can review published epidemiologic papers and assess the validity of their design and inferences To understand how epidemiology is used for identifying the causes of disease To be an informed consumer of epidemiological sources of information (journals, Web Sites, government agencies)

3. Handouts and textbooks Handouts will be available on the class website before each class The required textbook: Leon Gordis (2000), Epidemiology, 2nd edition, W. B. Saunders Co. Supplementary book: David E. Lilienfeld and Paul D. Stolley (1994), Foundations of Epidemiology, 3rd edition, Oxford University Press. Get an English-Chinese medical dictionary

4. Methods of evaluation Three homework assignments (30%) One midterm exam (30%) One final exam (40%)

5. Expectations Do the background reading for class ahead of time Master the specific details of epidemiological strategies and methods For assignments, write at a professional level Please hand-in only typewritten assignments

6. Course outlines 1.Introduction to epidemiologic approach to health and disease 2.Transmission of disease, occurrence of disease, and investigation of an epidemic 3.Indices of morbidity and mortality 4.Evaluation of diagnostic and screening tests: validity and reliability 5.Natural history of disease 6.Study design: clinical trials, cohort studies and case-control studies

7. Course outlines (cont’d) 7.Deriving inferences from epidemiologic studies: association versus causation 8.Interpretation of epidemiologic data: bias, confounding and interaction 9.Genetic epidemiology 10.Psychiatry epidemiology 11.Infectious disease epidemiology 12.Legal, ethical and policy aspects of epidemiologic investigations

8. Lecture 1: Epidemiologic approach to health and disease Reading: Gordis - Chapter 1 Lilienfeld and Stolley - Chapter 1

9. What is epidemiology? Epidemiology is the study of the distribution and determinants of disease frequency in human populations We study Person (who) Place (where) Time (When) To understand WHY

10. Objectives of epidemiology 1.To identify the cause of disease and its risk factors 2.To determine the extent of disease found in the community 3.To study the natural history and prognosis of disease 4.To evaluate new preventative and therapeutic measures 5.To provide a foundation for developing public policy

11. First: To identify the cause of disease and its risk factors This includes field work to identify the causative agents, and know how the disease is transmitted from one person to another. SARS a)Causative agent- coronavirus b)Communicability- contact and droplet

12. Second: To determine the extent of disease found in the community It involves going to the people. Notification of SARS to WHO (Nov. 1, 2002-Jul. 10, 2003): Ref: www.who.int

13. Third: To study the natural history and prognosis of disease It involves an understanding of the disease biology. SARS prognosis: Ref: Joseph SUNG, WHO SARS Conference

14. Fourth: To evaluate new preventative and therapeutic measures This involves examining the effects of health education and tracking the effects of clinical interventions SARS strategy: 1.Enhance surveillance system for case detection 2.Comprehensive public education 3.Prompt isolation & quarantine 4.Environmental hygiene improvement SARS prevention: vaccine

15. Fifth: To provide a foundation for developing public policy This involves research -> risk assessment -> risk management

16. Epidemiology and prevention A major goal of epidemiology is to identify subgroups in the population who are at high risk for disease. Why? a)Can identify the specific factors and modify these factors b)Can direct efforts to populations that are most likely to benefit

17. Level of prevention Primary Prevention Prevention of the occurrence of disease through: –General health promotion –Specific preventive measures Secondary Prevention Involves: Curing disease at the earliest stage possible Slowing disease progression Preventing complication Limiting disability

18. Epidemiologic reasoning Determine whether there is or is not a statistical association between a factor or characteristic and the development of disease Derive appropriate inferences regarding a possible causal relationship from the patterns of statistical association which have been found

19. Epidemiologic approach 1.Initial observation in laboratory or clinical finding 2.Definition of the disease or process by: a)Pathology b)Common clinical characteristics (sign and symptoms) c)Specific etiological agent 3.Descriptive epidemiology- identifying associations of disease in relation to a)Time b)Place c)Persons

20. Epidemiologic approach (cont’d) 4.Analytical epidemiology a)Identifying associations of disease with possible etiological factors- genetic and/or environmental b)Further refine and test hypotheses regarding etiology 5.Experimental epidemiology- evaluate the effectiveness of interventions and preventive and therapeutic programs