Introduction to epidemiology 8th edition pdf download

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More items to explore. Page 1 of 1 Start over Page 1 of 1. American Psychological Association. Introduction to Public Health. Mary-Jane Schneider. James McKenzie. David B. Robert H. About the Author Ray M.

Merrill, Ph. As a Cancer Prevention Fellow at the National Cancer Institute, he worked with leading researchers in the area of cancer epidemiology. In he joined the faculty in the Department of Health Science at Brigham Young University, Provo, Utah, where he continued his research in epidemiology. Since he has also held an adjunct faculty position in the Department of Family and Preventive Medicine at the University of Utah.

He has won various awards for his research in cancer epidemiology. Merrillcurrently teaches introductory and advanced level classes in epidemiology and biostatistics. He has over professional publications in epidemiology and public health journals. He is currently a full professor of epidemiology and biostatistics at Brigham Young University. Limited-Time Offer. Get this deal. Brief content visible, double tap to read full content. Full content visible, double tap to read brief content.

Help others learn more about this product by uploading a video! About the author Follow authors to get new release updates, plus improved recommendations. Ray M. Read more Read less. Customer reviews. How customer reviews and ratings work Customer Reviews, including Product Star Ratings help customers to learn more about the product and decide whether it is the right product for them.

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I like the book that I used for Epidemiology. However, this book is damaged, and the pages in the front are loose. The book is exactly what I need for my course. However, I am very disappointed in its condition. The cover was sticky eww , some of the pages were stuck together, and most of the pages look as though they were sitting in water.

In addition, it's highlighted all throughout. One person found this helpful. Love renting books I won't ever use again! My had highlighter marks all over it, but otherwise met my expectations : Still really easy to read, and actually helped me with my quizzes! I love it. November 12, Soper GA. The work of a chronic typhoid germ distributor. Thomas CL, ed. Philadelphia: FA Davis; References 15 Rothman KJ. Am J Epidemiol. Centers for Disease Control. Accessed April 18, National Center for Health Statistics, The top 10 causes of death.

Accessed July 6, Picket G, Hanlon JJ. Public Health: Administration and Practice. Epidemiology Principles and Methods. List and describe the contributions made by several key individuals to epidemiology.

Recognize the development and use of certain study designs in the advancement of epidemiology. These individuals also sought to provide information for the prevention and control of healthrelated states and events. They advanced the study of disease from a supernatural viewpoint to a viewpoint based on a scientific foundation; from no approach for assessment to systematic methods for summarizing and describing public health problems; from no clear understanding of the natural course of disease to a knowledge of the probable causes, modes of transmission, and health outcomes; and from no means for preventing and controlling disease to effective approaches for solving public health problems.

Initially, epidemiologic knowledge advanced slowly, with large segments in time where little or no advancement in the field occurred. The time from Hippocrates — BCE , who attempted to explain disease occurrence from a rational viewpoint, to John Graunt — CE , who described disease occurrence and death with the use of systematic methods and who developed and calculated life tables and life expectancy, and Thomas Sydenham — , who approached the study of disease from an observational angle rather than a theoretical one, was 2, years.

Since then, the science of epidemiology has rapidly progressed. Although it is impossible to identify all of the contributors to the field of epidemiology here, several of these individuals and their contributions are considered.

He observed that different diseases occurred in different locations. He noted that malaria and yellow fever most commonly occurred in swampy areas. It was not known, however, that the mosquito was responsible for such diseases until Walter Reed, MD, a U. Accessed December 29, Army physician working in the tropics, made the connection in Hippocrates also introduced terms like epidemic and endemic. He believed the properties of water should be examined and advised that the source of water should be considered.

Is the water brackish and harsh? Did they eat lunch, eat too much, or drink too little? Were they industrious?

For traveling physicians, Hippocrates suggested they become familiar with local diseases and with the nature of those prevailing diseases. He believed that as time passed the physician should be able to tell what epidemic diseases might attack and in what season and that this could be determined by the settings of the stars. Sources of water, smells, and how water sets or flows were always considered in his study of disease states.

Hot diseases were treated with cold treatments, and cold diseases required hot treatments. The process of deciding whether a disease was hot or cold was complex. An example is diarrhea, which was considered a hot disease and was believed to be cured with a cold treatment such as eating fruit.

He theorized that there were four types of atoms: earth atoms solid and cold , air atoms dry , fire atoms hot , and water atoms wet. Additionally, Hippocrates believed that the body was composed of four humors: phlegm earth and water atoms , yellow bile fire and air atoms , blood fire and water atoms , and black bile earth and air atoms. Sickness was thought to be caused by an imbalance of these humors, and fever was thought to be caused by too much blood. The treatment for fever was to reduce the amount of blood in the body through bloodletting or the application of bloodsuckers leeches.

Diet was both a cause of and a cure for disease. Cures for illness and protection from disease came from maintaining a balance and avoiding imbalance in the constitution.

The essentials of epidemiology noted by Hippocrates included observations on how diseases affected populations and how disease spread. He further addressed issues of diseases in relation to time and seasons, place, environmental conditions, and disease control, especially as it related to water and the seasons. The broader contribution to epidemiology made by Hippocrates was that of epidemiologic observation. His teachings about how to observe any and all contributing or causal factors of a disease are still sound epidemiologic concepts.

Sydenham went on to get his medical license, and he spoke out for strong empirical approaches to medicine and close observations of disease.

Sydenham wrote the details of what he observed about diseases without letting various traditional theories of disease and medical treatment influence his work and observations. From this close observation process, he was able to identify and recognize different diseases.

Sydenham published his observations in a book in titled Observationes Medicae. Sydenham came up with three levels or classes of fevers: continued fevers, intermittent fevers, and smallpox. He treated smallpox with bed rest and normal bed covers. The treatment of the time, based on the Hippocratic theory, was to use heat and extensive bed coverings.

He was met with good results but erred in identifying the cause of the disease. Sydenham described and distinguished different diseases, including some psychological maladies. He also advanced useful treatments and remedies, including exercise, fresh air, and a healthy diet, which other physicians rejected at the time.

James Lind — , a Scottish naval surgeon, focused on illnesses in these populations. He observed the effect of time, place, weather, and diet on the spread of disease. His book, A Treatise on Scurvy, identified the symptoms of scurvy and the fact that the disease became common in sailors after as little as a month at sea. He saw that scurvy began to occur after 4 to 6 weeks at sea.

Lind noted that even though the water was good and the provisions were not tainted, the sailors still fell sick. Lind pointed out that the months most common to scurvy were April, May, and June. He also observed that cold, rainy, foggy, and thick weather were often present. Influenced by the Hippocratic theory of medicine, Lind kept looking to the air as the source of disease.

Dampness of the air, damp living arrangements, and life at sea were the main focus of his observations as he searched for an explanation of the cause of disease and, most of all, the cause of scurvy. He then compared their experience with the experiences of those who were healthy. When Lind began to look at the diet of the mariners, he observed that the sea diet was extremely gross and hard on digestion.

Concerned with the extent of sickness in large numbers of sailors, Lind set up some experiments with mariners. In , while serving on the HMS Salisbury, he conducted an experimental study on scurvy wherein he assigned different supplemental dietary interventions to 12 ill patients who had all of the classic symptoms of scurvy.

They all seemed to have a similar level of the illness. He described their symptoms as putrid gums, spots, and lassitude, with weakness in their knees. He put the sailors in six groups of two and, in addition to a common diet of foods like water-gruel sweetened with sugar, fresh mutton broth, puddings, boiled biscuit with sugar, barley and raisins, rice and currants, and sago and wine, each of the groups received an additional dietary intervention.

Two men received a quart of cider a day on an empty stomach. Two men took two spoonfuls of vinegar three times a day on an empty stomach. Two men were given a half-pint of sea water every day. Two men were given lemons and oranges to eat on an empty stomach. Two men received an elixir recommended by a hospital surgeon, and two men were fed a combination of garlic, mustard seed, and horseradish.

In 6 days, the two men eating citrus were fit for duty. All of the others had putrid gums, spots, lassitude, and weakness of the knees.

Thus, Lind observed that oranges and lemons were the most effective remedies for scurvy at sea. He was concerned with the occurrence of disease in large groups of people.

Lind not only participated in the identification of the effect of diet on disease, but he made clinical observations, used experimental design, asked classic epidemiologic questions, observed population changes and their effect on disease, and considered sources of disease, including place, time, and season. Jesty believed there was a link between acquiring cowpox and not getting smallpox.

At the time, smallpox was common in Europe, with , people dying annually from the disease and a third of the cases going blind.

It worked. The exposed family members developed immunity to smallpox. For many centuries, the Chinese had made observations about weaker and stronger strains of smallpox. They learned that it was wise to catch a weaker strain of the disease.

If one had a weak strain of the disease, one would not get the full disease later on. This was termed variolation. Servants were also required to tend to the sores on the heels of horses affected with cowpox.

The cowpox in turn was transmitted to the dairymaids. Jenner observed that when a person had cowpox this same person would not get smallpox if exposed to it. In May , Jenner identified a young dairymaid, Sarah Nelms, who had fresh cowpox lesions on her hand. James developed a mild fever and a loss of appetite, but was soon feeling much better. In July , Jenner inoculated the boy with a fresh smallpox lesion. No disease developed. Cowpox was thus found to shield against smallpox. Jenner invented a vaccination for smallpox with this knowledge.

The vaccine was used to protect populations from this disease. As part of the effort to eradicate smallpox, a photograph was widely distributed in of a small child who had been stricken with the disease FIGURE Two cases of smallpox occurred in as a result of a laboratory accident. Because it is believed that smallpox has been eradicated from the earth, vaccinations have been halted; however, some public health and health care professionals are skeptical and fear that such acts may set the stage for an unexpected future epidemic of smallpox because the pathogen still exists in military and government labs.

As unvaccinated people proliferate, so does the risk of future smallpox epidemics. Epidemiology of Childbed Fever in a Lying-In Hospital Historically, epidemiology was centered on the study of the great epidemics: cholera, bubonic plague, smallpox, and typhus. As the diseases were identified and differentiated, the focus of epidemiology changed. Such a change in focus came through the work of another physician— epidemiologist, Ignaz Semmelweis, in the early to mids.

Picture courtesy of Centers for Disease Control and Prevention, Atlanta, Georgia In the s, one of the greatest fears a pregnant mother had was dying of childbed fever a uterine infection, usually of the placental site, after childbirth. Babies were born to mothers with the usual risks that warranted obstetric assistance, and this often resulted in an uneventful birth; however, after the birth of the child, the mother would get an infection and die of childbed fever, a streptococcal disease.

Many times the child would become infected and die as well. After many years of observing the course of the disease and the symptoms associated with childbed fever, Semmelweis began a series of investigations.

The first clinic consistently had greater numbers of maternal deaths than the second clinic. In , the maternal mortality rate of this clinic was five times greater than that of the second clinic, and over a 6-year period, it was three Epidemiology of Childbed Fever in a Lying-In Hospital 21 times as great.

Semmelweis observed that the mothers became ill either immediately during birth or within 24 to 36 hours after delivery. The mothers died quickly of rapid developing childbed fever.

Often the children would soon die as well. This was not the case in the second clinic. Through clinical observation, retrospective study, collection and analysis of data on maternal deaths and infant deaths, and clinically controlled experimentation, he was able to ascertain that the communication of childbed fever was through germs passed from patient to patient by the physician in the process of doing pelvic examinations.

Semmelweis discovered that, unlike the second clinic, the medical students would come directly from the death house after performing autopsies of infected and decaying dead bodies and then would conduct pelvic exams on the mothers ready to give birth. Hand washing or any form of infection control was not a common practice. There was no reason to be concerned about clean hands because the theory of medicine that was accepted at the time relied on the Hippocratic theory of medicine and the idea that disease developed spontaneously.

Semmelweis observed that a whole row of patients became ill while patients in the adjacent row stayed healthy. To destroy the cadaverous or putrefied matter on the hands, it was necessary that every person, physician or midwife, performing an examination, wash their hands in chlorinated lime upon entering the labor ward in clinic 1.

At first, Semmelweis said it was only necessary to wash during entry to the labor ward; however, a cancerous womb was discovered to also cause the spread of the disease, and thus, Semmelweis required washing with chlorinated lime between each examination.

When strict adherence to hand washing was required of all medical personnel who examined patients in the maternity hospital, mortality rates fell at unbelievable rates. In , the percentage of deaths was What Ignaz Semmelweis discovered is still one of the easiest disease- and infectioncontrol methods known. He is noted for his medical work with the royal family, including the administration of chloroform to the queen at the birth of her children; however, Snow is most famous for his pioneering work in epidemiology.

Among epidemiologists, Snow is considered one of the most important contributors to the field. Many of the approaches, concepts, and methods used by Snow in his epidemiologic work are still useful and valuable in epidemiologic work today.

National Library of Medicine and electrolytes, dehydration, and collapse. From his studies, he established sound and useful epidemiologic methods. He observed and recorded important factors related to the course of disease. In the later part of his career, Snow conducted two major investigative studies of cholera. The first involved a descriptive epidemiologic investigation of a cholera outbreak in the Soho district of London in the Broad Street area.

The second involved an analytic epidemiologic investigation of a cholera epidemic in which he compared death rates from the disease to where the sufferers got their water, either the Lambeth Water Company or the Southwark and Vauxhall Water Company. Within yards of the intersection of Cambridge Street and Broad Street, about fatal attacks of cholera occurred in 10 days.

Many more deaths were averted because of the flight of most of the population. Snow was able to identify incubation times, the length of time from infection until death, modes of transmission of the disease, and the importance of the flight of the population from the dangerous areas.

He also plotted statistics based on dates and mortality rates. He studied sources of contamination of the water, causation and infection, and the flow of the water in the underground aquifer by assessing water from wells and pumps. He found that nearly all deaths had taken place within a short distance of the Broad Street pump.

Snow observed that in the Soho district there were two separate populations not so heavily affected by the cholera epidemic, such that death rates were not equal to those of the surrounding populations. A brewery with its own wells and a workhouse, also with its own water source, were the protected populations. Snow used a spot map sometimes called a dot map to identify the locations of all deaths. He plotted data on the progress of the course of the epidemic and the occurrence of new cases as well as when the epidemic started, peaked, and subsided.

Snow examined the water, movement of people, sources of exposure, transmission of the disease between and among close and distant people, and possible causation. Toward the end of the epidemic, as a control measure, protection from any reoccurrence, and as a political statement to the community, Snow removed the handle from the Broad Street pump. Many of the details he chose to record were epidemiologic in nature, such as various modes of transmission of cholera, incubation times, cause—effect association, clinical observations and clinical manifestations of the disease, scientific observations on water and the different sources including observations made with a microscope , temperature, climate, diet, differences between those who got the disease and those who did not, and immigration and emigration differences.

London had not had a cholera outbreak for about 5 years. During this period, the Lambeth Water Company moved their intake source of water upriver on the Thames, from opposite Hungerford Market to a source above the city, Thames Ditton. The Southwark and Vauxhall Water Company, however, did not relocate its source of water. Throughout the south district of the city, both water companies had pipes down every street. The citizens were free to pick and choose which water company they wanted for their household water.

Thus, by mere coincidence, Snow encountered a populace using water randomly selected throughout the south district. Snow could not have arranged better sampling techniques than those which had occurred by chance. The old supply system of Lambeth and the regular supply of the Southwark and Vauxhall Company were separate systems but drew water from the same area in the river.

The registrar general also published a mortality list from cholera. Snow developed comparison tables on death by source of water by subdistricts. Snow was able to conclude that the water drawn upriver solely by Lambeth Water Company caused no deaths. The water drawn downstream, in areas that were below the sewage inlets, mostly by Southwark and Vauxhall Water Company, was associated with very high death rates.

An estimated 3 to 5 million cholera cases and as many as , cholera deaths occur each year. Provision of safe water and sanitation is the primary way to reduce the impact of cholera and other waterborne diseases.

Oral cholera vaccines may also be taken, but should not be a substitute for conventional control measures. The research hypothesis was that removing the copepods with which Vibrio cholerae is associated from water used for household purposes, including drinking, would significantly reduce the prevalence of cholera.

The study was conducted over a 3-year period. Both the nylon filtration group and the sari filtration group experienced significantly lower cholera rates than the control group. Both Gaining cooperation and permission from the registrar general, Snow was supplied with addresses of persons who had died from cholera. He went into the subdistrict of Kennington One and Kennington Two and found that 38 of 44 deaths in this subdistrict received their water from Southwark and Vauxhall Company.

Each house had randomly selected different water companies, and many households did not know from which one they received water. Snow developed a test that used chloride of silver to identify which water source each household had by sampling water from within the houses of those he contacted.

Snow was eventually able to tell the source of water by appearance and smell. A report to Parliament showed that in the 30, households that were supplied water by the Southwark and Vauxhall Company, people died of cholera.

Of the 26, houses supplied by Lambeth, only 14 died of cholera. The death rate was 71 per 10, in Southwark and Vauxhall households and 5 per 10, for Lambeth households. Given the low cost of sari cloth filtration, this prevention method has considerable potential in lowering the occurrence of cholera in developing countries.

Summarized from World Health Organization. Reduction of cholera in Bangladeshi villages by simple filtration. Proc Natl Acad Sci.

Snow showed that cholera was a waterborne disease that traveled in both surface and groundwater supplies. He identified various modes of transmission and incubation times and, in his second study, employed a comparison group to establish more definitively a cause— effect association.

Epidemiologic Work of Pasteur and Koch In the s, on journeys into the countryside of Europe, it was not uncommon to see dead sheep lying in the fields.

These sheep had died from anthrax, which most commonly occurs in animals e. Anthrax is a serious bacterial infection, usually fatal, caused by Bacillus anthracis. Anthrax was a major epidemic that plagued the farmers and destroyed them economically.

Pasteur had distinguished himself as a scientist and a respected contributor to the field of medicine and public health even though it was not recognized as a separate field at the time. Pasteur had already identified the cause of rabies and many other devastating diseases. Because of his many past successes in microbiology, Pasteur had confidence in his ability to take on the challenge of conquering anthrax.

It was unclear, however, why the course of the disease occurred the way it did. The cause—effect association seemed to have some loopholes in it. How did the sheep get anthrax? How were the sheep disposed of? Why did the anthrax occur in some areas and not in others? How was the disease transmitted? How did the disease survive? All were questions that Louis Pasteur sought to answer. Pasteur observed that the dead sheep were buried. The key and insightful discovery was that anthrax spores or bacteria were brought back to the surface by earthworms.

Koch had previously shown that the anthrax bacteria existed in silkworms and that anthrax was an intestinal disease. Pasteur made the earthworm connection. Pasteur and his assistants had worked on a vaccine for anthrax for months, and in , an anthrax vaccine was discovered. After a presentation at the Academy of Sciences in Paris, Pasteur was challenged to prove that his vaccine was effective.

He put his career and reputation at stake to prove that his vaccine would work, that disease was caused by microorganisms, and that a cause—effect association exists between a particular microbe and a certain disease. Pasteur agreed to the challenge with a public demonstration to prove his vaccination process could prevent sheep from getting anthrax.

He went to a farm in rural France where 60 sheep were provided for the experiment. He was to vaccinate 25 of the sheep with his new vaccine. After the proper waiting time, Pasteur was then to inoculate 50 of the sheep with a virulent injection of anthrax.

Ten sheep were to receive no treatment and were used to compare with the survivors of the experiment a control group. Pasteur was successful. The inoculated sheep lived. The unvaccinated sheep died, and the control group had no changes. Pasteur successfully demonstrated that his method was sound, that vaccinations were effective approaches in disease control, and that bacteria were indeed causes of disease.

Historically, many scientists have contributed to the method used in epidemiology. Koch was a private practice physician and district medical officer. Because of his compelling desire to study disease experimentally, he set up a laboratory in his home and purchased equipment, including photography equipment, out of his meager earnings. Robert Koch became a key medical research scientist in Germany in the period of the explosion of knowledge in medicine and public health, and he used photography to take the first pictures of microbes in order to show the world that microorganisms do in fact exist and that they are what cause disease.

He identified the spore stage of the growth cycle of microorganisms. The epidemiologic significance that Koch demonstrated was that the anthrax bacillus was the only organism that caused anthrax in a susceptible animal.

In , Koch discovered the tubercle bacillus with the use of special culturing and staining methods. Koch and his assistant also perfected the concept of steam sterilization.

In Egypt and India, he and his assistants discovered the cholera bacterium and proved that it was transmitted by drinking water, food, and clothing. Incidental to the cholera investigations, Koch also found the microorganisms that cause infectious conjunctivitis.

One of his major contributions to epidemiology was a paper on waterborne epidemics and how they can largely be prevented by proper water filtration. Some of the major public health Epidemiologic Work of Pasteur and Koch 25 contributions that Koch made were identification of the tuberculosis and cholera microorganisms and establishment of the importance of water purification in disease prevention.

He was the recipient of many honors throughout his lifetime, including the Nobel Prize in for his work in microbiology. The microscope first found scientific use in the s through the work of Cornelius Drebbel — , the Janssen brothers of the Netherlands s , and Antoni Van Leeuwenhoek — The microscope was used for medical and scientific purposes by Athanasius Kircher of Fulda — In in Rome, he wrote Scrutinium Pestis.

He conducted experiments on the nature of putrefaction and showed how microscopic living organisms and maggots develop in decaying matter. Most of the credit goes to Leeuwenhoek for the advancement, development, and perfection of the use of the microscope.

He was the first to effectively apply the microscope in the study of disease and medicine, even though he was not a physician. Because of a driving interest in the microscope, Leeuwenhoek was able to devote much time to microscopy, owning over microscopes and over lenses many of which he ground himself. He was the first to describe the structure of the crystalline lens. Leeuwenhoek made contributions to epidemiology. He did a morphologic study of red corpuscles in the blood.

In addition to epidemiology and microbiology, chemistry and histology were also developed because of the advent of the microscope, which influenced advances in the study and control of diseases.

This was the first major contribution to record-keeping on a population and was the beginning of the vital statistics aspect of epidemiology. When Graunt took over the work, he systematically recorded ages, gender, who died, what killed them, and where and when the deaths occurred. Graunt also recorded how many persons died each year and the cause of death.

From the bills of mortality, Graunt identified variations in death according to gender, residence, season, and age. Graunt was the first to develop and calculate life tables and life expectancy.

He divided deaths into two types of causes: acute struck suddenly and chronic lasted over a long period of time. Farr built on the ideas of Graunt. Another important contribution of Farr was to promote the idea that some diseases, especially chronic diseases, can have a multifactorial etiology. He received his medical training at the University of Parma and did postgraduate studies in Rome. Ramazzini eventually returned to the town of Modena, where he became a professor of medicine at the local university.

He was interested in the practical problems of medicine and not in the study Occupational Health and Industrial Hygiene 27 of ancient theories of medicine, a fact not well received by his colleagues. He tried to associate barometric readings with the cause of disease by taking daily readings during a typhus epidemic infectious disease caused by one of the bacteria in the family rickettsiae characterized by high fever, a transient rash, and severe illness.

In his conversation with the worker, Ramazzini was told that continued work in this environment would cause the worker to go blind. After inquiring about other effects of working in cesspools and privies, he was informed that only the eyes were affected. He began work on a book that would become influential in the area of occupational medicine and provided related epidemiologic implications. He completed The Diseases of Workers in , but it was not published until It was not acceptable to pity the poor or simple laborers in this period of time, which caused Ramazzini to delay the publication because he thought it would not be accepted.

The first, he believed, was the harmful character of the materials that workers handled because the materials often emitted noxious vapors and very fine particles that could be inhaled.

The second cause of disease was ascribed to certain violent and irregular motions and unnatural postures imposed on the body while working. He also identified the danger posed by mercury, which was used by mirror makers, goldsmiths, and others. He observed that very few of these workers reached old age.

He observed that many had palsy of the neck and hands, loss of teeth, vertigo, asthma, and paralysis. Ramazzini also studied those who used or processed organic materials such as mill workers, bakers, starch makers, tobacco workers, and those who processed wool, flax, hemp, cotton, and silk—all of whom suffered from inhaling the fine dust particles in the processing of the materials. Kidney damage was seen to be suffered by couriers and those who rode for long periods, and hernias appeared among bearers of heavy loads.

Ramazzini suggested that the cesspool workers fasten transparent bladders over their eyes to protect them and take long rest periods or, if their eyes were weak, get into a different line of work. In discussing the various trades, he suggested changing posture, exercising, providing adequate ventilation in workplaces, and avoiding extreme temperatures in the workplace.

Ramazzini was an observant epidemiologist. He described the outbreak of lathyrism in Modena in He also described the malaria epidemics of the region and the Paduan cattle plague in She pursued a career in nursing, receiving her initial training in Kaiserworth at a hospital run by an order of Protestant Deaconesses. Two years later, she gained further experience as the superintendent at the Hospital for Invalid Gentlewomen in London, England.

In addition to granting her permission, he also designated her head of an official delegation of nurses. Nightingale worked for the next 2 years to improve the sanitary conditions of army hospitals and to reorganize their administration.

She created a plan for reform, which was compiled into a page report entitled Notes on Matters Affecting the Health, Efficiency, and Hospital Administration of the British Army That same year she established a nursing school at St. She also advocated strict discipline and an attention to cleanliness, and felt that nurses should possess an innate empathy for their patients. Although Nightingale became an invalid after her stay in the Crimea, she remained an influential leader in public health policies related to hospital administration until her death on August 13, She also founded the groundbreaking Nightingale Training School for nurses and in later years published dozens of books and pamphlets on public health.

Nightingale was awarded the Royal Red Cross by Queen Victoria in , and in she became the first woman to receive the Order of Merit. During her time at Scutari, she collected data and systematized record-keeping practices. She used the data as a tool for improving city and military hospitals. She collected and generated data and statistics by developing a Model Hospital Statistical Form for hospitals. Nightingale developed applied statistical methods to display her data, showing that statistics provided an organized way of learning and improving medical and surgical practices.

In , she became a Fellow of the Royal Statistical Society, and in became an honorary member of the American Statistical Association.

Typhoid fever is an infectious disease characterized by a continued fever, physical and mental depression, rose-colored spots on the chest and abdomen, diarrhea, and sometimes intestinal hemorrhage or perforation of the bowel. Soper continued to search for other means of communication of the disease. He began to look to people instead of fomites, food, and water.

He discovered that Mary Mallon had served as a cook in many homes that were stricken with typhoid. The disease always seemed to follow, but never precede, her employment. Mary seemed to sense that she was giving people sickness, because when typhoid appeared, she would leave with no forwarding address.

Mary Mallon illustrated the importance of concern over the chronic typhoid carrier causing and spreading typhoid fever. Epidemiologic investigations have shown that carriers might be overlooked if epidemiologic searches are limited to the water, food, and those with a history of the disease.

Typhoid Mary was released in , through legal action she took, and she disappeared almost immediately. Two years later, typhoid fever occurred in a hospital in New Jersey and a hospital in New York. More than people were affected. It was discovered that Typhoid Mary had worked at both hospitals as a cook but under a different name.

This incident taught public health officials and epidemiologists the importance of keeping track of carriers. It also showed that typhoid carriers should never be allowed to handle food or drink intended for public consumption.

In later years, Typhoid Mary voluntarily accepted isolation. Typhoid Mary died at age 70 years. The importance of protecting public food supplies and the importance of the investigative aspects of disease control were again reinforced and further justified as public health measures.

Today, antibiotic therapy is the only effective treatment for typhoid fever. Vitamins and Nutritional Diseases Vitamins are organic components in food that are needed in very small amounts for metabolism, growth, and for maintaining good health. The discovery of vitamins and the role they play in life and health has an interesting history.

In the mid- to lates, bacteria were being identified as the major causes of disease; however, the discovery of microorganisms and their connection to disease clouded the discovery of the causes of other life-threatening diseases.

Beriberi, rickets, and pellagra were still devastating populations around the world. Biochemistry was being advanced, and new lines of investigation were opening up. In the s, it was observed that when young mice were fed purified diets, they died quickly. When fed milk, they flourished. In , a naval surgeon, T. Takaki, eradicated beriberi from the Japanese navy by adding vegetables, meat, and fish to their diet, which until then had been mostly rice. In , at the London Zoo, it was demonstrated that rickets in lion cubs could be cured by feeding them crushed bone, milk, and cod liver oil.

Pekelharing and Winkler who sent Christian Eijkman — , an army doctor, to the East Indies to investigate the cause of beriberi. Eijkman observed that chickens fed on polished rice developed symptoms of beriberi and recovered promptly when the food was changed to whole rice, but he mistakenly attributed the cause of the disease to a neurotoxin.

Gerrit Grijns — , a physiologist, correctly identified that beriberi was a result of an essential nutrient in the outer layers of grain that is removed by polishing.

In , Frederick Gowland Hopkins — , a British biochemist, did similar studies with a concern for the pathogenesis of rickets and scurvy.

Hopkins suggested that other nutritional factors exist beyond the known ones of protein, carbohydrates, fat, and minerals, and these must be present for good health. In , Casimir Funk — , a Polish chemist, isolated a chemical substance that he believed belonged to a class of chemical compounds called amines. In , E. These discoveries set the stage for labeling vitamins by letters of the alphabet. McCollum in the United States and E.

A heat-stable factor was identified and found to be the one responsible for curing rickets. A heat-labile factor that was capable of healing xerophthalmia dryness of the conjunctiva leading to a diseased state of the mucous membrane of the eye resulting from vitamin A deficiency was also discovered. The heat-stable factor was named vitamin D, and the heat-labile factor was termed vitamin A. Cod liver oil cured rickets because it contains vitamin D.

It was observed that children exposed to sunshine were less likely to get rickets. In Germany in , Kurt Huldschinsky — also showed that exposing children to artificial sunshine cured rickets.

It was found that vitamin D was produced in the body when sunshine acted on its fats. It was later discovered that the antiberiberi substance vitamin B was also effective against pellagra.

Shattuck was a teacher, sociologist, and statistician, and served in the state legislature. He was the chair of a legislative committee to study sanitation and public health. The report set forth many public health programs and needs for the next century. Of the many needs and programs suggested, several of them were epidemiologic in nature. One of the things needed to ensure that epidemiology, its investigations, and the all-important control and prevention aspects of its work be achieved is an organized and structured effort.

The organized effort has to come through an organization sponsored by the government. It recommended that an organized effort to collect and analyze vital statistics be established. Shattuck also recommended the exchange of health information, sanitary inspections, research on tuberculosis, and the teaching of sanitation and prevention in medical schools.

The health of schoolchildren was also of major concern. As a result of the report, boards of health were established, with state departments of health and local public health departments soon to follow—organizations through which epidemiologic activities took place. The first in the United States was in Philadelphia in The prevention of typhus, cholera, and yellow fever was discussed. Port quarantine and the hygiene of immigrants were also of concern.

Public health educational activities began at this time. In , the first major book on public health, which included epidemiologic topics, was published by A.

The book was titled Hygiene and Public Health. Standard methods of water analysis were also adopted in The pasteurization of milk was shown to be effective in controlling the spread of disease in , and in this same year, the first school of public health, the Harvard School of Public Health, was established. She became a leading expert in occupational health and a pioneer in the field of toxicology.

For thousands of years it was not known that the mosquito was responsible for diseases such as yellow fever and malaria. These two diseases are still not fully contained in many parts of the world. Army physician working in the tropics, made the epidemiological connection between the mosquito Aedes aegypti species and yellow fever.

Frost created an epidemiology curriculum for the new academic discipline. He also worked closely with Lowell Reed of the Department of Biostatistics, which established the close working relationship between the two disciplines for addressing public health problems.

He showed that epidemiology is an analytical science closely integrated with biology and medical science. His work focused on the epidemiology of poliomyelitis, influenza, diphtheria, and tuberculosis. In , Frost, along with Edgar Sydenstriker, investigated the impact of the influenza pandemic on 18 different localities in the United States, providing important insights for public health experts.

Because of his contributions to our understanding of the natural history of selected diseases and advances in the methods and scientific discipline of epidemiology, Wade Hampton Frost is often considered to be the Father of Modern Epidemiology.

Development of a morbidity statistics system in the United States was quite slow. One problem was that morbidity statistics cannot be assessed and analyzed in the same manner as death mortality statistics. Sydenstricker struggled with the mere definition of sickness and recognized that to all persons disease is an undeniable and frequent experience. Birth and death come to a person only once, but illness comes often. Interest in disease statistics came only when the demand for them arose from special populations and when the statistics would prove useful socially and economically.

Reports of communicable disease. Notification of those diseases for which reasonably effective administrative controls have been devised.

Hospital and clinical records. These records were viewed as being of little value in identifying incidence or prevalence of illness in populations at this time, most people were treated at home unless they were poor and in need of assistance.

Such records are only of value for clinical studies. Insurance and industrial establishment and school illness records. The absence of records of illnesses in workers in large industries in the United States was of concern because it added to the difficulty of defining and explaining work-related illness.

Criteria for determining disability from illness or injury at work and when sick benefits should be allowed were not well developed. Malingering was also considered, as was its effect on the illness rates of workers. It was suggested that if illness records showing absence from school were kept with a degree of specificity, they could be of value to the understanding of the effect of disease on these populations. Illness surveys. These have been used by major insurance companies to determine the prevalence of illness in a specific population.

House-to-house canvass approaches have been used. Incidence of diseases within a given period is not revealed by such methods, whereas chronic-type diseases are found to be of higher incidence which should be expected and predicted. Records of the incidence of illness in a population continuously or frequently observed. To benefit epidemiologic studies, two study methods have been employed: 1 determination of the annual illness rate in a representative population and 2 development of an epidemiologic method whereby human populations could be observed in order to determine the existence of an incidence of various diseases as they were manifested under normal conditions within the community.

The study involved 16, person-years of observation or an equivalent population of 1, individuals who were observed for 28 months beginning in Illnesses discovered in field investigations, when family members reported being sick or when researchers observed a sick person, were recorded during each family visit.

A fairly accurate record of actual illness was obtained by a community interview method. An accurate data-gathering process was developed from the experience. An annual rate of 1, per 1, person-years was observed, being about one illness per person-year. The illness rate was one hundred times the annual death rate in the same population. When severity of illness was looked at, it was found that the greatest resistance to disease was in children between 5 and 14 years of age. The lowest resistance to disease was in early childhood, zero to 4 years, and toward the end of life.

In her early career she applied her skills in the research lab, investigating the biochemistry of milk and reproductive physiology, but later focused her thinking on the epidemiology of breast cancer.

She also assessed whether confounding factors could explain the difference. She was a strong advocate for breastfeeding, midwife training, and prenatal services in order to reduce premature births, stillbirths, and maternal mortality. She then investigated whether the cases differed from the controls with respect to occupation and infant mortality proxies of social status , nationality, marital status, and age.

She also investigated reproductive health histories. Until this study, no large-scale review of this type had been conducted. The study showed that disease stage at the time of diagnosis was directly related to survival. She recognized the importance of accurate staging and the potential bias inaccurate staging could have on the results. Further, she showed that breast cancer risk was greater for women who did not have children, who married at a laterthan-average age, or who did not breastfeed.

She also recognized that genes could influence cancer risk. The aim of the study was to determine which of the many risk factors contribute most to cardiovascular disease. At the beginning, the study involved 6, people between 30 and 62 years of age.

These people were recruited to participate in a cohort study that spanned 30 years, with 5, residents completing the study. In the 30 years, medical exams and other related testing activities were conducted with the participants. It was implied that Framingham was a cross-section of America and was a typical small American city. Framingham had a fairly stable population. One major hospital was used by most of the people in the community.

An annual updated city population list was kept, and a broad range of occupations, jobs, and industries were represented. The study approach used in the Framingham study was a prospective cohort study. Several clinical categories of heart disease were distinguished in this study: myocardial infarction, angina pectoris, coronary insufficiency, and death from coronary heart disease, as shown by a specific clinical diagnosis. The study advanced understanding of the epidemiology of hypertensive or arteriosclerotic cardiovascular disease.

It also identified much of what we know today about the effects of diet, exercise, and common medications such as aspirin on heart disease. Both studies showed that lung cancer patients were more likely to have been smokers. The first cohort study assessing the association between smoking and lung cancer was conducted in by Doll and Hill.

They were then followed over a year period with death certificate information collected to determine whether deaths were attributed to lung cancer or some other cause. The study found that smokers were ten times more likely to die of lung cancer than nonsmokers. The case-control and cohort study designs used by these researchers remain commonly used in epidemiologic research today. Modern Epidemiology The expanding role of epidemiology has been accompanied by an increasing number of methods for conducting epidemiologic research.

In the s and s, epidemiologists tended to be physicians with a primary interest in disease etiology. Some of these physicians were effective in collaborating with statisticians, like Olli S. Miettinen — , who developed and published several landmark papers on causal, design, and statistical approaches in epidemiology.

Fleiss — , who contributed to mental health statistics and developed a statistical measure of inter-rater reliability called kappa;54,55 Sander Greenland — , who contributed primarily to meta-analysis, Bayesian inference, and causal inference; Norman Breslow — , who developed and promoted greater use of the case-control matched sample research design; Nathan Mantel — who, with William Haenszel, developed the Mantel-Haenszel test and the Mantel-Haenszel odds ratio;56 and William G.

Cochran — , who developed and advanced research in experimental designs and sampling techniques. Individuals were presented who helped shape the discipline as we know it today. These individuals were physicians, statisticians, engineers, sociologists, chemists, and more. Pioneers in the area of epidemiology introduced germ theory, the microscope, vaccination, study designs, evaluation methods, sources and modes of disease transmission, and the importance of monitoring and evaluating health-related states or events.

Match the individuals in the left-hand column with their contributions. Miettinen A. Identified various modes of transmission and incubation times for cholera B. Provided classifications of morbidity statistics to improve the value of morbidity information C. Observed in the 17th century that certain jobs carried a high risk for disease D. Advanced useful treatments and remedies including exercise, fresh air, and a healthy diet, which other physicians rejected at the time F.

Through an experimental study, showed that lemons and oranges were protective against scurvy G. Invented a vaccination for smallpox H. The father of modern epidemiology I. Used data as a tool for improving city and military hospitals J. Conducted the first cohort study investigating the association between smoking and lung cancer K. Promoted the idea that some diseases, especially chronic diseases, can have a multifactorial etiology L.

Observed that milkmaids did not get smallpox, but did get cowpox M. Developed a vaccine for anthrax N. Pioneered the use of cohort and case-control studies to identify risk factors for breast cancer O. A pioneer in the field of toxicology P. Credited for producing the first life table Q.

Used photography to take the first pictures of microbes in order to show the world that microorganisms in fact existed and that they caused many diseases R. A statistician who was a pioneer in developing the theory of epidemiologic study design and causal inference S. Discovered that the incidence of puerperal fever could be drastically cut by the use of hand washing standards in obstetrical clinics Exercises 35 2.

List some of the contributions of the microscope to 4. What type of epidemiologic study was used by James epidemiology. What two individuals contributed to the birth of vital statistics? What types of epidemiologic studies were used by Doll Lind? Airs, waters, places. Dorland WA, ed. Philadelphia, PA: Saunders; Cumston CG.

An Introduction to the History of Medicine. Knopf; Garrison FH. History of Medicine. Barquet N, Domingo P. Smallpox: the triumph over the most terrible of the ministers of death. Ann Intern Med.

Willis NJ. Edward Jenner and the eradication of smallpox. Scott Med J. Jenner E. An inquiry into the causes and effects of the variolae vaccine. Semmelweis I. The etiology, concept, and prophylaxis of childbed fever. Benenson AS, ed. Control of Communicable Diseases in Man, 15th ed. Snow J. On the Mode of Communication of Cholera, 2nd ed. London: John Churchill; Vinten-Johansen, Peter, et al.

Rosen G. A History of Public Health. Microbiology: Molecules, Microbes and Man. Seelig MG. Medicine: An Historical Outline. Baltimore, MD: Williams and Wilkins; Epidemiology: Man and Disease. Cohen IB. Florence Nightingale. Scientific American. New York, NY: W. Kopf EW. Florence Nightingale as a statistician.

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Aci advanced monitoring and troubleshooting pdf download	Several clinical categories of heart disease were distinguished in this study: myocardial infarction, angina pectoris, coronary insufficiency, and death from coronary heart disease, as shown by a specific clinical diagnosis. Advanced useful treatments and remedies including exercise, fresh air, download pdf building microservices 2nd edition a healthy diet, which other physicians rejected at the time F. Amazon Renewed Like-new products you can trust. Sydenham came up with three levels or classes of fevers: continued fevers, intermittent fevers, and smallpox. Ramazzini also studied those who used or processed organic materials such as mill workers, bakers, starch makers, tobacco workers, and those who processed wool, flax, hemp, cotton, and silk—all of whom https://saadpcsoftware.com/lord-of-the-flies-pdf-free-download/7770-adobe-acrobat-dc-current-version.php from inhaling the fine dust particles in the processing of the materials. She then investigated https://saadpcsoftware.com/gba-emulator-ios-download/5883-database-systems-design-implementation-management-13th-edition-pdf-download.php the cases differed from the controls with respect to occupation and infant mortality proxies of social statusnationality, marital status, and age. A Report of the Surgeon General,

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