Pr insip Ep idemiologi ( I )

1. Prinsip Epidemiologi ( I ) DR. Ridwan amiruddin, SKM.M.Kes Jurusan Epidemiologi FKM-Unhas Sept 06

2. Preface • Things should be made as simple As possible, but not any simpler • (Albert Einstein)

3. What is epidemiology ? • Epidemiology studies the causes, transmission, incidence, and prevalence of health and disease in human pupulation. • Medical and public health disciplin use epidemiologic study to solve and control human health problem.

4. Who studies epidemiology ? • Epidemiology is the core science of public health. • Epidemiology provide the objective basis for disease prevention and health promotion. • Epidemiology the allied health professional, community health, occupational health, health education, health services, because its power and utility.

5. Epidemioilogy as a liberal art • A liberal arts education provides general knowledge nd develop overal intellectual capacities. • Epidemiology fits nicesly into an undergraduate liberal arts course of study because (Fraser, 1987). • It is uses the scientific method • It develops and improves one’s ability to reason inductively ( reason from the specific to the general)

6. Epidemioilogy as a liberal art • It develop and improves one’s ability to reason by analogy • It develop one’s concern for aesthetic values (appreciation of elegance, beauty, simplicity, grace). • It emphasize invesitigative methode rather than arcane knowledge and specialized investigative tools.

7. Other reason to study epidemiology • Epidemiologic competencies; • Data collection • Risk/benefit analysis • Survey methodology • Outcoma evaluation

8. Epidemiology past and present

9. 1. Epidemiology, public health and health • What is epidemiology • Epidemiology (greek) • Epi (upon) • Demos ( the people ) • Logia (the study of)

10. Epidemiology definition • Lilienfild (1978); “The study of the distribution and determinant s of diseases and injuries in population” • Mausner &Baum 1974. “The study of occorance of ilness” • Evans 1979.” The study of the distribution and determinants of health –related states or events in specific population, and the application of this study to control of health problems’ (Last, 2001 ; Burt, 2003)

11. What is Public health ? • The Institute of medicine (1988)’ as organized community effort to prevent disease and promote health” • Last (2001)” One of the effort organized by society to protect, promote, and restore the people health” • Epidemiology is a “study of” with many application to the public health mission.

12. What is Health ? • Health ‘ The absence of disease” • “Dis-ease”, literally the absence of ease. • Disease is amedical definable physiological or phsychological dsfunction; • Illness is what the patient experience; • Sickness is tha state of disfunction of the social role of a person with disease (Susser, 1973)

13. Health (WHO) 1948. • “A state of complete physical , mental, and social well-being and not merely the absence of disease or infirmity ,”

14. Uses of epidemiology

15. Epidemiologi transition

16. Demographic transitionMortality trend since 1950 Thn 1900 Thn 1950 Thn 2000

17. Version International of disease

18. Mortality trend evident • mOrtality from cancer decline 1% year • External causes (motor trafic accident, suicide, homocide; important contribution to overall mortality • Cerebral disease (stroke) decrease dramatically. • Chronic obstructve pulmonary disease (COPD) increase steadily. • Pneumonia and influenza be important causes of death • Mortality HIV increased rapidly.

19. Life expectancy (ADR cancers, 1950-1992)

20. Cancer • Respiratory cancer increase by smoking • Colorectal cancer decrease 19/100.000 to 13/100.000 .1992 • Prostat cancer increase 13/100.000 (1950) to 17/100.000, (1992)

21. Historical • Scientific observation and disease • (Hippocrates; 460-388sm) • In Air, Waters, and places, Hipocrates references health to environment, diatary, behavioral, and constitutional condition.

22. The Demographic approach • John Graunt (1620-1674), england. Tallied mortality statistic On tese table in his Natural and political Observation.. Made upon the bills of mortality (1662); 1/3 mortality of the population died before age of 5. Greater mortality in men than women . More boys than girls were born, Growth population was due mostly immigration.

23. Lesson for epidemiologist • From graunt. • 1. He was brief • 2. He made reasoning clear • 3. He subvjected his teories to repeated and varied test • 4. He invited criticism of his work • 5. He was willing to revise his ideas when faced with contradictory data • 6. He avoided mechanical interpretation of data.

24. The demographic approach

25. Germ Theory • Lois Pasteur (1822-1895), refuted doctrine contagius generation by demonstrating that decay was produced by microorganism. • Pasteur able isolate agent responsilbe for epidemic disease in silkworm in 1865.

26. Germ Theory • Robert koch, enabling him visualize the microbe that caused tuberculosis (1843-1910). • Th interaction involved in the maintenance and transmission of the agent in the environment provided the first theory of medical ecology.

27. Distribution of the Boophillus tick before eradication

28. Father of clinical statistic

29. Pierre –Charles Alexandre Louis • “I conceive that without the statistics nothing like real medical science is possible”.

30. William Farr

31. William Farr • Head the branch of his office involve vital statistics.(English) • Farr established a national registration system for the collection, classification, tabulating, analysis and reporting of mortality statistic. = disease surveillance system.

32. John snow (1813-1858)

33. Methode to test his Theories • 1. He compared cholera mortality rates by region (ecology study) • 2. He compared cholera mortality among groups of individual based on water supply (cohort study) • 3.He campared the water source of cholera cases and non cases during an outbreak (case controls study)

34. Snowmap 1854 Golden square cholera outbreak London

35. Penutup • The epidemiology is enjoy, easy, and comfortable. • Sekian dan terima kasih