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SESI 1 - Pengantar Epidemiologi 2009 Final
SESI 1 - Pengantar Epidemiologi 2009 Final
Departemen Epidemiologi
Fakultas Kesehatan Masyarakat Universitas Indonesia
1
Definisi (1)
• Tidak ada definisi tunggal
• Epidemiologi
– Dari bahasa Greek.
– Epi = atas, pada,
– demos = penduduk,
– logi = studi
2
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
3
Definisi (3)
• Greenwood ( 1934)
– Epidemiologi adalah studi penyakit sebagai
fenomena massal
• Lilienfeld (1957)
– Epidemiologi boleh didefinisikan sebagai studi
distribusi suatu penyakit atau kondisi dalam
populasi dan faktor yang mempengaruhi distribusi
ini
4
Definisi (4)
• Taylor (1963)
– Studi kesehatan atau penyakit dalam populasi
5
Epidemiology Defined
• Greek roots
epi = upon (as in “epidermis”)
demos = the people (as in demography)
ology = “to speak of”, “to study”
Gerstman Chapter 1 7
Epidemiology compared
•
to…
… medicine
– Main unit of concern in epi population
– Main unit of concern in medicine individual
• … public health
– Epidemiology “study of”
– Public health “organized effort”
– Epi said to be “methodologic backbone” of public
health
Gerstman Chapter 1 8
Definisi (5)
• Suatu ilmu dasar dari kedokteran pencegahan dan
kesehatan masyarakat yang mempelajari:
– Penyakit infeksi
– Penyakit kronis
– Cedera intensional dan tidak intensional
– Kesehatan mental
– Nutrisi
10
Epidemiologi Ilmu dasar semua aspek
kesehatan masyarakat: (2)
11
Ruang lingkup
• Definisi penyakit
• Kejadian penyakit
• Penyebab penyakit
• Keluaran penyakit
• Pengelolaan penyakit dan pencegahan
penyakit
12
Aktivitas epidemiologi (1)
1. Pengumpulan dan analisis pencatatan vital
(kelahiran dan kematian)
16
Aktivitas epidemiologi (5)
13. Penilaian program kesehatan
17
Who is an epidemiologist ?
A professional who strives to study and
control the factors that influence the
occurrence of disease or health-related
conditions and events in specified populations
and societies, has an experience in population
thinking and epidemiologic methods, and is
knowledgeable about public health and causal
inference in health
(Porta M, Last J, Greenland S. A Dictionary of Epidemiology, 2008)
Epidemiologists are required to have some
knowledge of:
• 1850 -1900
• John Snow (1813 – 1858)
• Germ Theory (mid 19th century)
22
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 books
– Epidemic I
– Epidemic II
– On Airs, Waters, and Places 23
Hippocrates (1)
• Recognized the association
of various diseases with
environmental factors
– place
– water conditions
– climate
– eating habits
– housing
24
Hippocrates (2)
• Introduced
– epidemic
– endemic
25
Hippocrates (3)
• Theory about the cause of disease
– personal observation
– Greek thinking
• Disease is the imbalance of body
humors
– phlegm
– blood
– yellow bile, black bile
26
Sejarah perkembangan epidemiologi
• Galen 129 – 199 M
27
Galen (1)
– “Hippocrates Inggris”
– Bapak Epidemiologi
– Atmosfer mengakibatkan perubahan konstitusi
epidemik
30
Thomas Sydenham (1)
• 1624 - 1689
• Father of Epidemiology
•insisted that observation should have
precedence over theory in the study
of the natural history of disease
31
Demographic Approach
(pp. 12–14)
33
Demographic Approach
17th Century Life Table
Age % surviving
6 64
16 40
26 25
36 16
46 10
56 6
John Graunt
60 3
(1620–74)
76 1
Gerstman Chapter 1 34
80 0
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 6
66 3 3
76 2 1
80
Source: 1
Graunt’s Observations 0
1662
Epidemiology (Schneider)
Graunt’s Observations
Epidemiology (Schneider)
Sejarah perkembangan epidemiologi
Willian Farr
37
Sejarah perkembangan epidemiologi
Konsep kontagion dan Teori germ penyakit
38
Downloaded from: StudentConsult (on 29 August 2009 12:10 AM)
© 2005 Elsevier
Downloaded from: StudentConsult (on 29 August 2009 12:10 AM)
© 2005 Elsevier
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 pada
pencegahan rabies dalam tahun 1885
– Belum mampu mengisolasi virus rabies menghalau
teori miasma
41
Sejarah perkembangan epidemiologi
– P L Panum
• Studi epidemiologi klasik tentang penyakit campak di
pulau Faroe (1875)
42
Sejarah perkembangan epidemiologi
– Ahli anestesi
– Melakukan serial investigasi kolera di London
– Bapak Epidemiologi Lapangan
– Melakukan studi epidemik kolera (1854)
43
Snow’s 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
Snow’s
Ecological
Analysis
• Southwark Water
Company
neighborhoods
high rates
• Mixed service
intermediate rates
• Lambeth Water Co.
neighborhoods
no cases
Gerstman Chapter 1 45
Deaths from Cholera per according to water company
supplying subdistricts of London, 1853-1854
46
The Grand Experiment
– A retrospective study
X
Deaths from Cholera per 10,000 according to water company supplying
actual houses, London - 1854
48
Snow’s 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 transmission
theory
49
Snow’s Cohort Analyses
Rate per
Water Source Cases Homes 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
Snow’s 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
Snow’s Map (Fig 1.14)
Visualization Success Stories
Illustration of John
Snow’s
deduction that a cholera
epidemic
was caused by a bad
water pump, circa 1854.
55
Golden Square Cholera Outbreak: John Snow (2)
• Theory • Action
– Hypothesis – Water was the source of
– Hypothesis disease
test – Correlation of the
– Public Health distribution of cholera case
Application households and the location
of water pumps
– Removed the handle of the
pump in Broad Street
56
London Cholera Outbreak: John Snow (3)
• Theory • Action
– Hypothesis – Water served as vehicle for
– Hypothesis transmitting choler
test – based on time, place, and
– Public person; compared groups
Health are comparable
Application – changing the location of
water intake to avoid water
contamination
57
Sejarah perkembangan epidemiologi
58
Sejarah perkembangan epidemiologi
Sejarah perkembangan epidemiologi
Sejarah perkembangan epidemiologi
Sejarah perkembangan epidemiologi
Goldberger (1923)
Menggunakan studi epidemiologi
observasional dan eksperimen tentang
pellagra (defisiensi asam nikotinat)
62
Joseph Goldberger (1874-1929)
Illustrative examples
British Doctors Study (Doll & Hills studies
of the effects of smoking)
Framingham Heart Study (risk factors for
heart disease, many investigators)
Sejarah perkembangan epidemiologi
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
Estimated 10-Year Stroke Risk in 55-Year-Old Adults
According to Levels of Various Risk Factors
Estimated 10-Year Rate (%)
Framingham Heart Study
30 27
25 22.4
19.1
20
14.8
15
10 8.4
5.4 6.3
4 3.5
5 2.6 2
1.1
0
A B C D E F
Men Women
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
2.5
2.5 NONE
MATERNAL
22 PATERNAL
2.2
1.5
1.7 1.7 1.7
11
1.0 1.0
0.5
0.5
00
Men
MEN Women
WOMEN
Adjusted for: age, total/HDL Chol. ratio, SBP, smoking, diabetes, BMI
Kebutuhan
Aplikasi kesehatan
Epidemiologi Audit
penduduk
Etiologi
Pelayanan
Penyakit
Kesehatan
EPIDEMIOLOGI
Keluaran Riset
dan Pelayanan
Prognosis Kesehatan
Lingkungan
Risiko
Genetik
Penyakit
Life style
73
Kontribusi epidemiologi (1)
74
Kontribusi epidemiologi (2)
75
History of Epidemiology
HIPPOCRATES (400 BC): “On Airs, Waters, and
Places” –Hypothesized that disease might be
associated with the physical environment,
including seasonal variation in illness.
JOHN GRAUNT (1662): “Nature and Political
Observations Made Upon the Bills of Mortality” –
First to employ quantitative methods in
describing population vital statistics.
JOHN SNOW (1850): Formulated natural
epidemiological experiment to test the
hypothesis that cholera was transmitted by
contaminated water.
History of Epidemiology (cont.)
Jan
Risser,
PhD
Spring, 1999 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.
2. MEDICINE
----- All early epidemiologists were
physicians.
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
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 acquisition
of grants, research collaboration, and
management of clinical trials.
ROOTS OF MODERN EPIDEMIOLOGY
7. GENOMICS
----- 2001 marked first publication of
draft sequences of the human genome.
Intensive investigations being
conducted to identify “disease
susceptibility genes” “gene-
environment” interactions, and “gene-
gene” interactions.
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