2. Rates are the hallmark for epidemiology for they form the basis of comparisons between population groups Rose and Barker,1986

3. “The Price of Health, like that of liberty, is Eternal Vigilance”

4. “An improvement in the treatment of disease, and any addition to medical science, will tend ultimately to the diminution of human suffering; but the registration of the causes of death is calculated to exercise a still more direct influence upon public health. Diseases are more easily prevented than cured, and the first step to their prevention is the discovery of their exciting causes by numerical facts and measure the intensity of their influence.” William Farr, 1839

5. Exclusively Rural Areas Doctors sent to rural areas Leper census, 1836 (5), 1845 (8), 1845 (11) Leprosy viewed as inheritable--sexual isolation, hospitals, prohibiting marriage No experience in setting up the registration Local Health officer Royal Decree

6. Problems with local registration (definition, deadlines, incomplete) Circular letters Chief Medical Officer travelling to each area Over diagnosis initially (acne, scabies) Low prevalence areas, disease overlooked Undercount, Undercount, Undercount Isolation: Areas where isolation practiced, most rapid decline in disease

7. Definitions `Reducing the incidence of disease (primary prevention) `Reducing the prevalence of disease (second. prevent.) `Ongoing operations or programs aimed at reducing the incidence and/or prevalence of disease Prevention Control Last, Dictionary of Epidemiology

8. General Motors sold 2,542,455 Automobiles World Wide

9. 99 Billion Sold

10. NCDs z What is the incidence of Diabetes? z What is the incidence of CHD? z What is the incidence of Cancer? Nobody Knows

11. Surveillance Health Dept.

12. Continuous analysis, interpretation, and feedback of systematically collected data, generalized using methods distinguished by their practicality, uniformity, and rapidity, rather than by accuracy or completeness. Last, Dictionary of Epidemiology

13. TV says Flu CDC Comes in

14. Registry Academia

15. …the term register is applied to the file of data concerning all cases of a particular disease or health -relevant condition in a defined population such that the cases can be related to a population base. Last, Dictionary of Epidemiology

16. Disease Monitoring Systems

17. Allegheny County Type I Diabetes Registry 1. Diagnosed between 1/1/65 and 12/31/99 2. Age at onset <20 3. Diagnosis of Diabetes 4. On Insulin at time of Hospital Discharge 5. Resident of Allegheny County at Diagnosis

18. /100,000 16 Undercount Allegheny County Type I Diabetes Registry

19. Registry

20. WHO DiaMond Project

22. Epidemiologists Counting Disease

23. Prairie Chicken

25. Biostatistics

28. 1 2 3 4 5 6 7 8 9

29. Capture

30. Mark

32. RECAPTURE

33. N= (M+1)(n+1) (m+1) N = Estimate of Number M =Number in First Sample n = Number in Second Sample m =Number of “marked” items in Second Sample Var(N)= (M+1)(n+1)(M-m)(n-m) (m+1) (m+2) Sample 1 Sample 2 M m n In Common Capture-Recapture 2

34. Capture-Recapture Methods zLong history of use in Demography xi.e. US Census zThe standard for estimating the abundance or shortage of wildlife populations

36. Lower Extremity Amputation Study Adolescent Injuries Sports injuries Dog Bites

37. Optimal “Lists” to identify cases `Independent `Reasonable ascertainment `Inexpensive

38. Comparison of “lists to gold standard” CR to Registry

39. Good monitoring does not necessarily ensure the making of right decisions, but it reduces the risk of wrong ones. Languimer, 1963

40. Public Health

41. Cancer Incidence in Middle East

42. Good monitoring does not necessarily ensure the making of right decisions, but it reduces the risk of wrong ones. Languimer, 1963

43. Porpoises can teach Epidemiologists how to count