sesi 1_pengantar epidemiologi 2009 final
TRANSCRIPT
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Epidemiologi
Departemen Epidemiologi
Fakultas Kesehatan Masyarakat Universitas Indonesia
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Definisi (1)
Tidak ada definisi tunggal
Epidemiologi
Dari bahasa Greek.
Epi= atas, pada,
demos= penduduk,
logi= studi
Studi distribusi dan determinan peristiwa
kesehatan dalam populasi manusia.
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Definisi (2)
Hirsch(1883)
Suatu gambaran kejadian, distribusi, dan tipe penyakit
manusia, ..
Frost (1927)
Ilmu fenomena masal penyakit infeksius, atau seperti
riwayat alamiah penyakit infeksius suatu ilmu induktif
yang tidak hanya mendeskripsikan distribusi penyakit,melainkan kesesuaiannya dalam suatu filosofi yang
konsisten
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Definisi (3)
Greenwood ( 1934)
Epidemiologi adalah studi penyakit sebagai
fenomena massal
Lilienfeld(1957)
Epidemiologi boleh didefinisikan sebagai studi
distribusi suatu penyakit atau kondisi dalampopulasi dan faktor yang mempengaruhi
distribusi ini
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Definisi (4)
Taylor (1963)
Studi kesehatan atau penyakit dalam populasi
McMahon, Pugh, dan Ipsen (1970)Studi distribusi dan determinan frekuensi
penyakit pada manusia distribusi (epidemiologi deskriptif) dan determinan dari
distribusi yang tercatat (epidemiologi analitik)
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Epidemiology Defined Greek roots
epi = upon (as in epidermis)demos = the people (as in demography)
ology = to speak of, to study
Literally - study of epidemics
Modern definitionsof epidemiologyrefer to
distributionsin populations (statistical)
determinants (pathophysiological, environmental,behavioral)
control of health problems(biological, social,
economic, political, administrative, legal)Gerstman Chapter 1 6
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Epidemiology compared
to medicineMain unit of concern in epi population
Main unit of concern in medicineindividual
public healthEpidemiologystudy of
Public healthorganized effort Epi said to be methodologic backbone of public
health
Gerstman Chapter 1 8
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Definisi (5) Suatu ilmu dasar dari kedokteran pencegahan dan
kesehatan masyarakat yang mempelajari:
Penyakit(atau status kesehatan)
Frekuensi(enumerasi jumlah yang ada atau tingkat
perkembangan dalam periode waktu spesifik)
Determinan(faktor yang mempengaruhi distribusi)
Metode(proses yang dilakukan untuk mendeskripsikanfrekuensi dan distribusi, rasional ilmiah yang digunakanuntuk menentukan kausal distribusi penyakit dalam
populasi
Populasi(populasi manusia tertentu) 9
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EpidemiologiIlmu dasar semua aspek
kesehatan masyarakat: (1)
Penyakit infeksi
Penyakit kronis
Cedera intensional dan tidak intensional
Kesehatan mental
Nutrisi
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EpidemiologiIlmu dasar semua aspek
kesehatan masyarakat: (2)
Pendidikan dan promosi kesehatan
Perencanaan kesehatan
Administrasi kesehatan masyarakat
Pelayanan pengobatan medis
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Ruang lingkup
Definisi penyakit
Kejadian penyakit
Penyebab penyakit
Keluaran penyakit
Pengelolaan penyakit dan pencegahanpenyakit
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Aktivitas epidemiologi (1)
1. Pengumpulan dan analisis pencatatan vital
(kelahiran dan kematian)
2. Pengumpulan dan analisis data morbiditas
dari rumah sakit, lembaga kesehatan, klinik,
dokter dan industri
3. Pemantauan penyakit dan masalah
kesehatan komunitas yang lain13
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Aktivitas epidemiologi (2)4. Investigasi kejadian luar biasa yang
mengarahkan program pemberantasan ataupencegahan epidemik dan masalah kesehatankomunitas yang lain
5. Merancang dan melaksanakan penelitiankesehatan
6. Merancang dan melaksanakan registrasikesehatan untuk masalah yang menjadiperhatian seperti: cacat lahir, insidens kanker,
atau penggunaan napza 14
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Aktivitas epidemiologi (3)7. Skrining (penapisan) untuk penyakit
8. Penilaian efektivitas keberadaan pengobatan
yang baru
9. Mendeskripsikan riwayat alamiah penyakit
10. Identifikasi individu atau kelompok padapopulasi umum terhadap peningkatan risiko
perkembangan penyakit tertentu
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Aktivitas epidemiologi (4)
11. Identifikasi keterkaitan etiologi penyakit
12. Identifikasi masalah kesehatan masyarakat
dan pengukuran besar distribusi,
frekuensi, atau dampak pada kesehatan
masyarakat
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Aktivitas epidemiologi (5)
13. Penilaian program kesehatan
14. Menyediakan data yang diperlukan untuk
perencanaan kesehatan atau pembuatan
keputusan oleh badan administrasi
kesehatan atau pembuat kebijakankesehatan
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Who is an epidemiologist ?
A professional who strives to studyandcontrolthe factors that influence the
occurrence of disease or health-relatedconditions and events in specified populationsand societies, has an experience in populationthinkingand epidemiologic methods, and is
knowledgeable about public healthand causalinferencein health(Porta M, Last J, Greenland S. A Dictionary of Epidemiology, 2008)
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Epidemiologists are required to have someknowledge of:
Public health:because of the emphasis on disease prevention
Clinical medicine:because of the emphasis on disease classification and
diagnosis (numerators)
Pathophysiology:because of the need to understand basic biological
mechanisms in disease (natural history)
Biostatistics:because of the need to quantify disease frequency and its
relationships to antecedents (denominators, testing hypotheses)
Social sciences:because of the need to understand the social context in
which disease occurs and presents (social determinants of health
phenomena)
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1.4 Selected Historical Figuresand Events
Understanding medical history is animportant part of epidemiology
This section divided into three eras
400BC 1850
1850 - 1900
Twentieth century epi
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Gerstman Chapter 121
Historical Figures & Events
400BC 1850
Hippocrates (400BCE)
Age of enlightenment (17th& 18thcenturies)
John Graunt (1620 1674)
1850 -1900
John Snow (1813 1858)
Germ Theory (mid 19
th
century)
Twentieth century epi
Modern epidemiology
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Sejarah perkembangan epidemiologi
Ahli epidemiologi pertama
Hippocrates460377 SM
Ahli Epidemiologi yang pertama Menjelaskan terjadinya penyakit dari dasar yang
rasional
Buku yang ditulis: Epidemic I, Epidemic II, On Airs,
Waters, and Places Memperkenalkan istilah epidemicdan endemic
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The First Epidemiologists
Hippocrates 460 B. C. to 377 B.C.
attempted to explain disease
occurrence on a rational basis instead
of from a supernatural view point
Three major booksEpidemic I
Epidemic II
On Airs, Waters, and Places
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H ippocrates (1)
Recognized the association
of various diseases with
environmental factors
place
water conditions
climate
eating habits
housing
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Hippocrates (2)
Introduced
epidemic
endemic
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H ippocrates (3)
Theory about the cause of disease
personal observation
Greek thinking Disease is the imbalance of body
humors
phlegmblood
yellow bile, black bile
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Sejarah perkembangan epidemiologi
Galen 129
199 M
Ahli bedah tentara romawi
Bapak Fisiologi Eksperimental
Faktor Prokatartik (cara hidup orang) dan temperamenmempengaruhi kesehatan dan penyakit
Pengaruh lingkungan (geografi dan iklim)miasma(istilah umum untuk partikel dalam udara)
Malariaudara buruk Teori miasma
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Galen (1)
129 - 199 A.D. Father of experimental physiology
Health and Disease influenced by
Procataritic factors
the way of life a person led
life style
Temperament
the innate qualities of the body
personality
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Galen (2)
Disease caused by Miasma
particles in the air
from sources waste
stagnant water
decaying animals
theory used to explain the great
plague epidemic in Europe
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Sejarah perkembangan epidemiologi
Age of enlightenment (17th& 18thcenturies)
Thomas Sydenham (16241689)
Hippocrates InggrisBapak Epidemiologi
Atmosfer mengakibatkan perubahan konstitusiepidemik
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Thomas Sydenham (1)
1624 - 1689
Father of Epidemiologyinsisted that observationshould have
precedence over theory in the study
of the natural history of disease
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Demographic Approach(pp. 1214)
John Graunt (1620 1674)
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Sejarah perkembangan epidemiologiDEMOGR PHIC PPRO CH Kelahiran vital statistik
John Graunt
Analisis data mortalitas dalam tahun 1662
Melakukan kuantifikasi yang pertama dari pola
kelahiran, kematian dan kejadian penyakit
Mencatat perbedaan laki-laki dan perempuan,kematian bayi yang tinggi, perbedaan urban-
rural, dan variasi musiman
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Gerstman Chapter 1 34
Demographic Approach17thCentury Life Table
Age % surviving
6 64
16 40
26 25
36 16
46 10
56 6
60 3
76 1
80 0
John Graunt
(162074)
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Epidemiology (Schneider)
Life Table of Deaths in London
Age Deaths Survivors
0 -- 100
6 36 64
16 24 40
26 15 25
36 9 16
46 6 10
56 4 666 3 3
76 2 1
80 1 0Source: Graunts Observations1662
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Epidemiology (Schneider)
Graunts Observations
Excess of male births
High infant mortality
Seasonal variation in mortality
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Sejarah perkembangan epidemiologi
Willian Farr
Melakukan pengumpulan data secara sistematik
dan statistik kematian di Inggris
Bapak Statistik vital moderen dan surveilens
Memperluas analisis data morbidtas dan
mortalitas epidemiologi
Melihat efek status perkawinan, pekerjaan danketinggian
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Sejarah perkembangan epidemiologiKonsep kontagion dan Teorigermpenyakit
Hieronymous Frascastorius (14781553) Sastrawan dan dokter dari Italia
Penyakit disebabkan oleh germ
Penyakit ditransmisikan dari orang ke orang melalui suatu
partikel yang sangat kecil
Igmatz Semmelweis (18181865)
Ahli Obstetri dari Hungaria
Demam nifas dapat direduksi jika para dokter mencuci tangan
sebelum menolong persalinan
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Downloaded from: StudentConsult (on 29 August 2009 12:10 AM)
2005 Elsevier
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Downloaded from: StudentConsult (on 29 August 2009 12:10 AM)
2005 Elsevier
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Sejarah perkembangan epidemiologi
Edward Jenner Mendukung teori Fracastorius
Menerima teori germ penyakit
Penemu vaksin cacar (akhir tahun 1700)
Louis Pasteur Berkontribusi dalam menguatkan teori germ penyakit
dengan mendemonstrasikan efektivitas imunisasi padapencegahan rabies dalam tahun 1885
Belum mampu mengisolasi virus rabiesmenghalauteori miasma
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Sejarah perkembangan epidemiologi
Studi epidemiologi klasik awalJames Lind
Melakukan studi epidemiologi ekperimen pada
etiologi dan pengobatan scurvy (1753) Makan jeruk merupakan obat untuk scurvy
P L Panum
Studi epidemiologi klasik tentang penyakit campak dipulau Faroe (1875)
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Sejarah perkembangan epidemiologi
John Snow (18131858)
Ahli anestesi
Melakukan serial investigasi kolera di London
Bapak Epidemiologi Lapangan
Melakukan studi epidemik kolera (1854)
43
h d
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Snows Methods
Ecological studies compared cholera rates by region
Cohort compared cholera rates in exposed and
non-exposed individuals
Case-control compared water source in cases and
controls
Snows
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Gerstman Chapter 1 45
Snow s
Ecological
Analysis Southwark Water
Company
neighborhoods
high rates
Mixed service
intermediate rates
Lambeth Water Co.neighborhoods
no cases
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46
Deaths from Cholera per according to water company
supplying subdistricts of London, 1853-1854
Water Company Population in1851
Deaths fromCholera
Deaths rateper 100,000
living
Southwark and Vauxhall
Company
Lambeth Company
Both Company
167,654
14,632
301,149
192
0
182
114
0
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The Grand Experiment
A retrospective study
X
O
X
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Deaths from Cholera per 10,000 according to water company supplying
actual houses, London - 1854
Water Supply Number of
Houses
Deaths from
Cholera
Deaths in Each
10,000 Houses
Southwark and Vauxhall
Company
Lambeth Company
Rest of London
40,046
26,107
256,423
1,263
98
1,422
315
37
59
Source: Snow (55)
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Snows Cohort Study (Table 1.7, p. 25)
Cholera mortality per 10,000 household and water
source
Rate Southwark & Vauxhall= 1263 / 40,046
10,000 = 315 Rate Lambeth= 98 / 26107 10,000 = 37.5
Southwark & Vauxhall drew water from fecal
contaminated water region
Supporting evidence for water-borne transmissiontheory
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Snows Cohort AnalysesWater Source Cases Homes
Rate per
10,000
Southwark 1263 40,046 315*
Lambeth 98 26,107 37
Both 1422 256,423 59
* Rate, Southwark = 1263 / 40,046
= .0315 = 315 / 10,000
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Snows Case-Control Study
Epidemic area of Golden Square area (1854 epidemic) Interviewed cases and non-cases to determine water source
Cases
61 used water from Broad St. pump 6 did not use Broad St. pump
6 could not determine if used Broad St. pump
Controls were less likely to use Broad St. pump water
e.g., Among Brewer workers (non-cases), the men were allowed a
certain quantity of malt liquor, and Mr. Huggins [the proprietor]believes they do not drink water at all
Map showing proximity to pump and no. of cases (next slide)
51
Cholera Deaths
Broad St. Outbreak
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Snows Map (Fig 1.14)
Vis ali ation S ccess Stories
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54
Visualization Success Stories
From Visual Explanations by Edward Tufte,
Graphics Press, 1997
Illustration of John
Snows
deduction that a choleraepidemic
was caused by a bad
water pump, circa 1854.
Horizontal lines indicate
location of deaths.
John Snow: A Classic Epidemiologic
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55
John Snow: A Classic Epidemiologic
Study
The Father of field epidemiology
investigating the outbreak of cholera in Gloden Square of London
descriptive epidemology --> hypothesis generation --> hypothesis
testing ---> public health application
G S C O S
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56
Golden Square Cholera Outbreak: John Snow(2)
Theory
Hypothesis
Hypothesis
test
Public Health
Application
Action
Water was the source of
disease
Correlation of the
distribution of cholera case
households and the location
of water pumps
Removed the handle of the
pump in Broad Street
London Cholera Outbreak: John Snow (3)
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London Cholera Outbreak: John Snow(3)
TheoryHypothesis
Hypothesis
test
Public
Health
Application
ActionWater served as vehicle for
transmitting choler
based on time, place, and
person; compared groups
are comparable
changing the location ofwater intake to avoid water
contamination
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Sejarah perkembangan epidemiologi
Studi epidemiologi klasik awal James Lind
Melakukan studi epidemiologi ekperimen
pada etiologi dan pengobatan scurvy (1753)Makan jeruk merupakan obat untuk scurvy
S j h k b id i l i
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Sejarah perkembangan epidemiologi
S j h k b id i l i
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Sejarah perkembangan epidemiologi
S j h k b id i l i
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Sejarah perkembangan epidemiologi
S j h k b id i l i
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Sejarah perkembangan epidemiologi
Goldberger (1923) Menggunakan studi epidemiologi
observasional dan eksperimen tentang
pellagra (defisiensi asam nikotinat)
J h G ldb (1874 1929)
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Joseph Goldberger (1874-1929)
used observational and experimentalepidemiologic methods to identifyvitamin deficiency as the cause ofpellagra;
identified diets high in cereals andcanned food as a risk factor; provedsources of fresh animal protein and
legums were effective in prevention;first nutritional epidemiologist.
S j h k b id i l i
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Sejarah perkembangan epidemiologi
Hill, Doll, Wynder, Cornfield and other Post world warII epidemiologists. World War II is a convenientwatershed to mark the risk of the "modernepidemiologists", since this coincides with theemergence of chronic disease as major causes ofmorbidity and mortality;
focuses on individual risk factors; hallmarked bystudies on :
smoking and lung cancer, The SurgeonGeneral's Report on Smoking and Health,
the Framingham heart studies, water fluoridation trials, and
the poliomyelitis field trials of 1954.
Maturation of Epidemiology
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atu at o o p de o ogy(1910 - 1945)
Key methodologic developments include theadvancement of epidemiologic theory,
outbreak investigation methods,
methods to study non-infectiousdiseases (case-control and cohortmethods),
the introduction of randomized clinicaltrials, and new survey methods
developed by Goldberger in the study ofpellagra).
Also, changes in the education ofphysicians and health care took place inthe 1910s and 1920s, respectively
Last half of 20th Century
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y("Modern Epidemiology")
The epidemiologic transition from acutecontagious to chronic non-contagiouscauses of morbidity effected the wayepidemiologists studied disease
Illustrative examples
British Doctors Study (Doll & Hills studiesof the effects of smoking)
Framingham Heart Study (risk factors forheart disease, many investigators)
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Sejarah perkembangan epidemiologi
Doll dan Hill (1950) Studi Merokok dan kaitannya dengan kanker paru dan studi penyakit
kardiovaskular pada penduduk Framingham, Massachusetts
(Dawber, Kannel, dan Lyell, 1963. Gordon, Castelli,Hjortland, Kannel, dan Dawber, 1977) Riset epidemiologi pada penyakit kronik
(Freedman, Chear, Srinivasan, Webber, dan Berenson, 1985)
Bogalusa Heart Study
(Stamler, Wentworth, dan Neaton, 1986) Multiple Risk Factor Intervention Trial
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Doll and Hill, 1952
Lung cancer
cases
Controls OR
Smoke 25+ per
day
331 (24%) 166 (12%) 17.4
Smoke 5-24 per
day
1019 (75%) 1130 (83%) 7.8
Non-smoker 7 (1%) 61 (5%) 1
Estimated 10-Year CHD Risk in55 Year Old Adults According to Levels of
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55-Year-Old Adults According to Levels of
Various Risk Factors Framingham Heart Study
A B C D
Blood Pressure (mm Hg) 120/80 140/90 140/90 140/90
Total Cholesterol (mg/dL) 200 240 240 240
HDL Cholesterol (mg/dL) 50 50 40 40
Diabetes No No Yes Yes
Cigarettes No No No Yes
5
13
25
58
20
27
37
0
5
10
15
20
25
30
35
40
A B C D
Esti
mated10-YearRate(%
)
Men
Women
Estimated 10-Year Stroke Risk in 55-Year-Old Adults
A di l f V i Ri k F
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2.6 4
5.4
8.4
1.1 2
19.1
22.4
14.8
27
6.3
3.5
0
5
10
15
20
25
30
A B C D E F
Estimated10-YearRate
(%)
Men W omen
According to Levels of Various Risk FactorsFramingham Heart Study
A B C D E F
Systolic BP* 95-105 130-148 130-148 130-148 130-148 130-148Diabetes No No Yes Yes Yes Yes
Cigarettes No No No Yes Yes Yes
Prior Atrial Fib. No No No No Yes Yes
Prior CVD No No No No No Yes
Sou rce: Stro ke 1991;22:312-318. *BP in millimeters of mercury (mmHg)
22 4
27
25
30
(%)
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2.6 4
5.4
8.4
1.1 2
19.1
22.4
14.8
6.3
3.5
0
5
10
15
20
25
A B C D E F
Estimated10-YearRate
Men W omen
A B C D E F
Systolic BP* 95-105 130-148 130-148 130-148 130-148 130-148
Diabetes No No Yes Yes Yes Yes
Cigarettes No No No Yes Yes Yes
Prior Atrial Fib. No No No No Yes Yes
Prior CVD No No No No No Yes
Estimated 10-year stroke risk in 55-year-old adults
according to levels of various risk factors (FHS).Source: Wolf et al., Stroke.1991;22:312-318.
*BP in millimeters of mercury (mmHg)
Offspring CVD Risk by Parental CVDSt t F i h St d
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Status: Framingham Study
0
0,5
1
1,5
2
2,5
MEN WOMEN
NONE
MATERNAL
PATERNAL
Risk Ratio
2.5
2
1.5
1
0.5
0Men Women
1.0
1.7
2.2
1.0
1.7 1.7
Adjusted for: age, total/HDL Chol. ratio, SBP, smoking, diabetes, BMI
Parental CVD
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73
Aplikasi
EpidemiologiAudit
Pelayanan
Kesehatan
Keluaran
dan
Prognosis
LingkunganGenetikLife styleRisikoPenyakit
Riset
Pelayanan
Kesehatan
EtiologiPenyakit
Kebutuhan
kesehatan
penduduk
EPIDEMIOLOGI
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74
Kontribusi epidemiologi (1)
Penyelidikan modus transmisi penyakit baru
Penentuan sebab-sebab penyakit yang dapat dicegah
Penentuan riwayat alamiah penyakit Pengamatan spektrum penyakit
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75
Kontribusi epidemiologi (2)
Penilaian intervensi kesehatan komunitas
Penyusunan prioritas pemberantasan penyakit
Perbaikan diagnosis, pengobatan dan prognosispenyakit klinis
Peningkatan riset pelayanan kesehatan
Penyediaan saksi ahli dalam pengadilan
History of Epidem iology
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y p gy
HIPPOCRATES (400 BC): On A irs, Waters, and
Places Hypothesized that disease might beassociated with the physical environment,including seasonal variation in illness.
JOHN GRAUNT (1662): Nature and Pol i t icalObservat ion s Made Upon the Bi l ls ofMortal i ty First to employ quantitativemethods in describing population vitalstatistics.
JOHN SNOW (1850): Formulated naturalepidemiological experiment to test thehypothesis that cholera was transmitted by
contaminated water.
Histo ry o f Epidem iology (cont .)
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Histo ry o f Epidem iology (cont .)
DOLL & HILL (1950): Used a case-controldesign to describe and test the associationbetween smoking and lung cancer.
FRANCES at al. (1950): Huge formal field trialof the Poliomyelitis vaccine in schoolchildren.
DAWBER et al. (1955): Used the cohortdesign to study risk factors forcardiovascular disease in the FraminghamHeart Study.
Brief History of Epidemiology
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Spring, 1999
Jan
Risser,
PhD
WillRisser,
Brief History of Epidemiology
Classical Infectious Diseases Epidemiology
Edward Jenner (1749-1823)
developed a vaccine against smallpox using cow pox
160 years before virus was identified
John Snow (1813-1858)
described the association between dirty water and cholera
44 years before vibrio was identified
Ignaz Semmelweis (1818-1865)
described the association between childbed fever andphysicians unclean hands
32 years before causal agent was discovered
Brief History of Epidemiology
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Spring, 1999
Jan
Risser,
PhD
WillRisser,
Brief History of Epidemiology
Classical Nutritional Epidemiology
James Lind (1716-1794) conducted an experiment which showed that scurvy could
be treated and prevented with limes, lemons, and oranges
ascorbic acid was discovered 175 years later
Joseph Goldberger (1874-1927)
identified that pellagra was not infectious but nutritional
in origin and could be prevented by increasing the amount
of animal products in the diet and substituting oatmeal for
corn grits niacin was discovered 10 years later
Brief History of Epidemiology
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Spring, 1999
Jan
Risser,
PhD
WillRisser,
Brief History of Epidemiology
Epidemiology of Chronic Diseases
Observational Studies:R Doll & AB Hill. Early case-control study. Smoking and
carcinoma of the lung: Preliminary report. [Br. Med. J. 2:739, 1950]
Cohort Studies:
An approach to longitudinal studies in a community: theFramingham study. 10,000 residents gave baseline
information. Follow-up is now 50 years. [Annals New YorkAcademy of Sciences 107:539;1963]
Brief History of Epidemiology
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Spring, 1999
Jan
Risser,
PhD
Will
Risser,
Brief History of Epidemiology
Epidemiology of Chronic Diseases
Experimental Studies:
Hypertension Detection and Follow-up Program Cooperative
Group. 10,500 subjects randomly assigned to two groups:
1. stepped care - antihypertensive therapy increased stepwise to achieve
and maintain blood pressure reduction to goal.
2. Referred care - subjects were referred to their primary care physician and
treated as usual.
mortality stepped care 9.0/100 referred care 9.7/100
final blood pressure 84.1 in stepped care 89.1 in referred care
Brief History of Epidemiology
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Spring, 1999
Jan
Risser,
PhD
Will
Risser,
Brief History of Epidemiology
Epidemiology of Chronic Diseases
Physician Health Study
randomized, placebo-controlled, double-blind clinical trial
conducted entirely through the mail
22,071 male physicians enrolled to study the effects of aspirin on
cardiovascular disease and the effects of beta-carotene on cancer randomly assigned to one of four groups
aspirin beta carotene
active active
active placebo
placebo active
placebo placebo
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ROOTS OF MODERN EPIDEMIOLOGY
1. ACUTE DISEASE INVESTIGATION
----- Emphasis on empirical systematic
investigation, biology, and
environment/host manipulation
2. MEDICINE
----- All early epidemiologists were
physicians.
ROOTS OF MODERN EPIDEMIOLOGY
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ROOTS OF MODERN EPIDEMIOLOGY
3. STATISTICS
----- Emphasis on the scientific method,
quantification and measurement,
and hypothesis testing. In 1960s, many
epidemiologists were statisticians.
4. SOCIAL SCIENCES
----- Investigation of human behavior in
relation to disease, and methods of
data collection (surveys, etc.)
ROOTS OF MODERN EPIDEMIOLOGY
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ROOTS OF MODERN EPIDEMIOLOGY
5. COMPUTER SCIENCES----- Emergence of chronic disease
epidemiology required the ability to
handle large amounts of data and to
perform complex analyses.
6. MANAGERIAL SCIENCES
----- Management principles for acquisitionof grants, research collaboration, and
management of clinical trials.
ROOTS OF MODERN EPIDEMIOLOGY
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ROOTS OF MODERN EPIDEMIOLOGY
7. GENOMICS----- 2001 marked first publication of
draft sequences of the human
genome. Intensive investigations beingconducted to identify disease
susceptibility genes gene-
environment interactions, and
gene-gene interactions.
Classical e s s Mode n
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Classical versus Modern
Applications
Classical:descriptive, observational, field,analytical, experimental, applied,
healthcare, primary care, hospital, CD,NCD,environmental, occupational,psycho-social, etc
Modern:risk-factor, molecular, genetic,life-course, CVD, nutritional, cancer,disaster, etc