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Jekel's Epidemiology, Biostatistics and Preventive Medicine E-Book

Jekel's Epidemiology, Biostatistics and Preventive Medicine E-Book

David L. Katz | Joann G. Elmore | Dorothea Wild | Sean C Lucan

(2013)

Additional Information

Book Details

Abstract

Succinct yet thorough, Epidemiology, Biostatistics, and Preventive Medicine, 3rd Edition brings you today's best knowledge on epidemiology, biostatistics, preventive medicine, and public health—in one convenient source. You'll find the latest on healthcare policy and financing · infectious diseases · chronic disease · and disease prevention technology. This text also serves as an outstanding resource for preparing for the USMLE, and the American Board of Preventive Medicine recommends it as a top review source for its core specialty examination.

  • Discusses the financial concerns and the use and limitations of screening in the prevention of symptomatic disease.
  • Emphasizes the application of epidemiologic and biostatistical concepts to everyday clinical problem solving and decision making.
  • Showcases important concepts and calculations inside quick-reference boxes.
  • Presents abundant illustrations and well-organized tables to clarify and summarize complex concepts.
  • Includes 350 USMLE-style questions and answers, complete with detailed explanations about why various choices are correct or incorrect.
  • This book comes with STUDENT CONSULT at no extra charge! Register at www.studentconsult.com today...so you can learn and study more powerfully than ever before!
    • Access the complete contents of the book online, anywhere you go...perform quick searches...and add your own notes and bookmarks.
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  • Includes the latest information on Bovine Spongiform Encephalopathy (BSE) · SARS · avian form of H5N1 influenza · the obesity epidemic · and more.

Table of Contents

Section Title Page Action Price
Front cover cover
Inside front cover ifc1
Jekel's Epidemiology, Biostatistics, Preventive Medicine, and Public Health, 4/e i
Copyright page iv
About the Authors v
Guest Authors vii
Acknowledgments ix
Preface xi
Preface to the Third Edition xii
Table of Contents xiii
1 Epidemiology 1
1 Basic Epidemiologic Concepts and Principles 3
Chapter Outline 3
I. What is Epidemiology? 3
II. Etiology and Natural History of Disease 4
A. Stages of Disease 4
B. Mechanisms and Causes of Disease 4
C. Host, Agent, Environment, and Vector 4
D. Risk Factors and Preventable Causes 5
1. BEINGS Model 5
“B”—Biologic and Behavioral Factors 6
“E”—Environmental Factors 6
“I”—Immunologic Factors 6
“N”—Nutritional Factors 7
“G”—Genetic Factors 7
“S”—Services, Social Factors, and Spiritual Factors 7
III. Ecological Issues in Epidemiology 8
A. Solution of Public Health Problems and Unintended Creation of New Problems 8
1. Vaccination and Patterns of Immunity 8
Diphtheria 9
Smallpox 9
Poliomyelitis 10
Syphilis 10
2. Effects of Sanitation 10
3. Vector Control and Land Use Patterns 11
4. River Dam Construction and Patterns of Disease 11
B. Synergism of Factors Predisposing to Disease 11
IV. Contributions of Epidemiologists 11
A. Investigating Epidemics and New Diseases 11
B. Studying the Biologic Spectrum of Disease 12
C. Surveillance of Community Health Interventions 12
D. Setting Disease Control Priorities 13
E. Improving Diagnosis, Treatment, and Prognosis of Clinical Disease 13
F. Improving Health Services Research 14
G. Providing Expert Testimony in Courts of Law 14
V. Summary 14
References 14
Select Readings 15
Websites 15
2 Epidemiologic Data Measurements 16
Chapter Outline 16
I. Frequency 16
A. Incidence (Incident Cases) 16
B. Prevalence (Prevalent Cases) 16
1. Difference between Point Prevalence and Period Prevalence 16
C. Illustration of Morbidity Concepts 16
D. Relationship between Incidence and Prevalence 17
II. Risk 19
A. Definition 19
B. Limitations of the Concept of Risk 19
III. Rates 20
A. Definition 20
B. Relationship between Risk and Rate 20
C. Quantitative Relationship between Risk and Rate 21
D. Criteria for Valid Use of the Term Rate 21
E. Specific Types of Rates 22
1. Incidence Rate 22
2. Prevalence Rate 23
3. Incidence Density 23
IV. Special Issues on Use of Rates 23
A. Crude Rates versus Specific Rates 23
B. Standardization of Death Rates 25
1. Direct Standardization 25
2. Indirect Standardization 26
C. Cause-Specific Rates 27
V. Commonly Used Rates That Reflect Maternal and Infant Health 27
A. Definitions of Terms 27
B. Definitions of Specific Types of Rates 27
1. Crude Birth Rate 27
2. Infant Mortality Rate 27
3. Neonatal and Postneonatal Mortality Rates 28
4. Perinatal Mortality Rate and Ratio 28
5. Maternal Mortality Rate 28
VI. Summary 29
References 30
Select Readings 31
3 Epidemiologic Surveillance and Epidemic Outbreak Investigation 32
Chapter Outline 32
I. Surveillance of Disease 32
A. Responsibility for Surveillance 32
B. Creating a Surveillance System 32
C. Methods and Functions of Disease Surveillance 33
1. Establishment of Baseline Data 33
2. Evaluation of Time Trends 33
Secular (Long-term) Trends 33
Seasonal Variation 33
Other Types of Variation 35
3. Identification and Documentation of Outbreaks 35
Surveillance for Bioterrorism 37
4. Evaluation of Public Health and Disease Interventions 38
5. Setting of Disease Control Priorities 39
6. Study of Changing Patterns of Disease 39
II. Investigation of Epidemics 39
A. Nature of Epidemics 39
B. Procedures for Investigating an Epidemic 40
1. Establish the Diagnosis 40
2. Establish Epidemiologic Case Definition 40
3. Is an Epidemic Occurring? 40
4. Characterize Epidemic by Time, Place, and Person 40
Time 40
Place 43
Person 45
5. Develop Hypotheses Regarding Source, Patterns of Spread, and Mode of Transmission 45
6. Test Hypotheses 46
7. Initiate Control Measures 46
8. Initiate Specific Follow-up Surveillance to Evaluate Control Measures 47
C. Example of Investigation of an Outbreak 47
D. Example of Preparedness and Response to a Global Health Threat 48
III. Summary 49
References 49
Select Readings 49
Websites 49
4 The Study of Risk Factors and Causation 50
Chapter Outline 50
I. Types of Causal Relationships 50
A. Sufficient Cause 50
B. Necessary Cause 50
C. Risk Factor 50
D. Causal and Noncausal Associations 51
II. Steps in Determination of Cause and Effect 52
A. Investigation of Statistical Association 52
B. Investigation of Temporal Relationship 53
C. Elimination of All Known Alternative Explanations 53
1. Alternative Explanation for Cholera in 1849 54
2. Alternative Explanations for Coronary Heart Disease 54
III. Common Pitfalls in Causal Research 54
A. Bias 54
1. Assembly Bias 55
Selection Bias 55
Allocation Bias 55
Associated Problems of Validity 55
2. Detection Bias 56
Measurement Bias 56
Recall Bias 56
B. Random Error 56
C. Confounding 56
D. Synergism 57
E. Effect Modification (Interaction) 57
IV. Important Reminders About Risk Factors and Disease 57
V. Summary 58
References 58
Select Readings 58
5 Common Research Designs and Issues in Epidemiology 59
Chapter Outline 59
I. Functions of Research Design 59
II. Types of Research Design 59
A. Observational Designs for Generating Hypotheses 60
1. Qualitative Studies 60
2. Cross-Sectional Surveys 60
3. Cross-Sectional Ecological Studies 62
4. Longitudinal Ecological Studies 62
B. Observational Designs for Generating or Testing Hypotheses 63
1. Cohort Studies 63
Prospective Cohort Studies 63
Retrospective Cohort Studies 64
2. Case-Control Studies 64
3. Nested Case-Control Studies 65
C. Experimental Designs for Testing Hypotheses 65
1. Randomized Controlled Clinical Trials 65
2. Randomized Controlled Field Trials 67
D. Techniques for Data Summary, Cost-Effectiveness Analysis, and Postapproval Surveillance 67
III. Research Issues in Epidemiology 68
A. Dangers of Data Dredging 68
B. Ethical Issues 69
IV. Summary 69
References 70
Select Readings 70
Websites 70
6 Assessment of Risk and Benefit in Epidemiologic Studies 71
Chapter Outline 71
I. Definition of Study Groups 71
II. Comparison of Risks in Different Study Groups 71
A. Absolute Differences in Risk 72
B. Relative Differences in Risk 72
1. Relative Risk (Risk Ratio) 72
2. Odds Ratio 73
3. Which Side Is Up in the Risk Ratio and Odds Ratio? 73
III. Other Measures of Impact of Risk Factors 74
A. Attributable Risk Percent in the Exposed 75
B. Population Attributable Risk 75
C. Population Attributable Risk Percent 75
IV. Uses of Risk Assessment Data 76
A. Application of Risk Data to Policy Analysis 76
1. Estimating Benefit of Interventions in Populations 76
2. Cost-Effectiveness Analysis 77
3. Cost-Benefit Analysis 77
4. Other Methods of Describing the Value of Interventions 77
Absolute and Relative Risk Reduction 77
Reduction in Incidence Density 77
Number Needed to Treat or Harm 79
B. Application of Risk Measures to Counseling Patients 79
V. Summary 79
References 79
Select Readings 80
7 Understanding the Quality of Data in Clinical Medicine 81
Chapter Outline 81
I. Goals of Data Collection and Analysis 81
A. Promoting Accuracy and Precision 81
B. Reducing Differential and Nondifferential Errors 81
C. Reducing Intraobserver and Interobserver Variability 82
II. Studying the Accuracy and Usefulness of Screening and Diagnostic Tests 82
A. False-Positive and False-Negative Results 82
B. Sensitivity and Specificity 84
C. Predictive Values 85
D. Likelihood Ratios, Odds Ratios, and Cutoff Points 85
E. Receiver Operating Characteristic Curves 87
III. Measuring Agreement 89
A. Overall Percent Agreement 89
B. Kappa Test Ratio 89
IV. Summary 90
References 90
Select Reading 90
2 Biostatistics 91
8 Statistical Foundations of Clinical Decisions 93
Chapter Outline 93
I. Bayes Theorem 93
A. Community Screening Programs 94
B. Individual Patient Care 94
C. Influence of the Sequence of Testing 95
II. Decision Analysis 97
A. Steps in Creating a Decision Tree 97
1. Identify the Problem 97
2. Diagram the Options 97
3. Obtain Information on Each Option 98
4. Compare Utility Values and Perform Sensitivity Analysis 98
B. Applications of Decision Trees 99
III. Data Synthesis 99
A. Systematic Review 99
B. Meta-Analysis 99
C. Evidence Mapping 101
IV. Elementary Probability Theory 101
A. Independence Rule 101
B. Product Rule 102
C. Addition Rule 102
V. Summary 102
References 103
Select Readings 104
9 Describing Variation in Data 105
Chapter Outline 105
I. Sources of Variation in Medicine 105
II. Statistics and Variables 106
A. Quantitative and Qualitative Data 106
B. Types of Variables 106
1. Nominal Variables 106
2. Dichotomous (Binary) Variables 107
3. Ordinal (Ranked) Variables 107
4. Continuous (Dimensional) Variables 107
5. Ratio Variables 108
6. Risks and Proportions as Variables 108
C. Counts and Units of Observation 108
D. Combining Data 108
III. Frequency Distributions 108
A. Frequency Distributions of Continuous Variables 108
1. Range of a Variable 108
2. Real and Theoretical Frequency Distributions 108
3. Histograms, Frequency Polygons, and Line Graphs 110
4. Parameters of a Frequency Distribution 111
Measures of Central Tendency 111
Mode 111
Median 111
Mean 112
Measures of Dispersion 112
Measures of Dispersion Based on Percentiles 112
Measures of Dispersion Based on the Mean 112
Mean Deviation 112
Variance 112
Standard Deviation 114
5. Problems in Analyzing a Frequency Distribution 114
Skewness and Kurtosis 114
Extreme Values (Outliers) 115
6. Methods of Depicting a Frequency Distribution 115
Stem and Leaf Diagrams 115
Quantiles 115
Boxplots 115
7. Use of Unit-Free (Normalized) Data 116
B. Frequency Distributions of Dichotomous Data and Proportions 117
C. Frequency Distributions of Other Types of Data 117
IV. Summary 117
References 118
Select Reading 118
10 Statistical Inference and Hypothesis Testing 119
Chapter Outline 119
I. Nature and Purpose of Statistical Inference 119
A. Differences between Deductive and Inductive Reasoning 119
B. Differences between Mathematics and Statistics 120
II. Process of Testing Hypotheses 120
A. False-Positive and False-Negative Errors 120
1. Develop Null Hypothesis and Alternative Hypothesis 120
2. Establish Alpha Level 121
3. Perform Test of Statistical Significance 121
4. Compare p Value Obtained with Alpha 121
5. Reject or Fail to Reject Null Hypothesis 121
B. Variation in Individual Observations and in Multiple Samples 122
1. Standard Deviation and Standard Error 122
2. Confidence Intervals 123
III. Tests of Statistical Significance 123
A. Critical Ratios 123
B. Degrees of Freedom 124
C. Use of t-Tests 124
1. Sample Populations and Sizes 124
2. t Distribution 125
3. Student’s t-Test 126
Calculation of the Value of t 126
Interpretation of the Results 129
One-Tailed and Two-Tailed ± t-Tests 129
4. Paired t-Test 129
Calculation of the Value of t 130
3 Preventive Medicine and Public Health 171
14 Introduction to Preventive Medicine 173
Chapter Outline 173
I. Basic Concepts 173
A. Health Defined 173
B. Health as Successful Adaptation 173
C. Health as Satisfactory Functioning 174
II. Measures of Health Status 174
III. Natural History of Disease 175
IV. Levels of Prevention 175
A. Primary Prevention and Predisease Stage 175
1. Health Promotion 176
2. Specific Protection 176
B. Secondary Prevention and Latent Disease 176
C. Tertiary Prevention and Symptomatic Disease 176
1. Disability Limitation 176
2. Rehabilitation 177
V. Economics of Prevention 177
A. Demonstration of Benefits 177
B. Delay of Benefits 177
C. Accrual of Benefits 177
D. Discounting 178
E. Priorities 178
VI. Preventive Medicine Training 179
VII. Summary 179
References 179
Select Readings 180
Websites 180
15 Methods of Primary Prevention: 181
Chapter Outline 181
I. Society’s Contribution to Health 181
II. General Health Promotion 182
III. Behavioral Factors in Health Promotion 182
A. Theories of Behavior Change 182
1. Health Belief Model 182
2. Stages of Change (Transtheoretical Model) 184
3. Theory of Planned Behavior and Theory of Reasoned Action 184
4. Precaution Adoption Process Model 184
5. Social Learning Theory and Social Cognitive Theory 185
B. Behavioral Counseling 185
1. Motivational Interviewing 185
2. Shared Decision Making 185
IV. Prevention of Disease Through Specific Protection 186
A. Prevention of Disease by Use of Vaccines 186
1. Types of Immunity 186
2. Types of Vaccines 186
3. Immunization Recommendations and Schedules 187
Active Immunization of Adults 187
4. Passive Immunization 187
B. Vaccine Surveillance and Testing 187
1. Randomized Field Trials 188
2. Retrospective Cohort Studies 189
3. Case-Control Studies 190
4. Incidence Density Measures 190
C. Immunization Goals 191
1. Vaccine-Related Supplies and Lawsuits 191
D. Prevention of Disease by Use of Antimicrobial Drugs 191
E. Prevention of Deficiency States 192
V. Effecting Behavior Change in Underserved Populations 192
A. Cultural Competency 192
B. Health Literacy 193
VI. Summary 193
References 193
Select Readings 194
Websites 195
16 Principles and Practice of Secondary Prevention 196
Chapter Outline 196
I. Community Screening 196
A. Objectives of Screening 196
B. Minimum Requirements for Community Screening Programs 197
1. Disease Requirements 197
2. Screening Test Requirements 198
3. Health Care System Requirements 198
4. Application of Minimum Screening Requirements to Specific Programs 199
C. Ethical Concerns about Community Screening 199
D. Potential Benefits and Harms of Screening Programs 199
E. Bias in Screening Programs 200
F. Repetition of Screening Programs 201
G. Simultaneous Screening for Multiple Diseases (Multiphasic Screening) 201
H. Genetic Screening 202
II. Individual Case Finding 202
A. Periodic Health Examination 202
B. Health Risk Assessments 203
III. Screening Guidelines and Recommendations 203
IV. Summary 204
References 204
Select Readings 205
Website 205
17 Methods of Tertiary Prevention 206
Chapter Outline 206
I. Disease, Illness, Disability, and Disease Perceptions 206
II. Opportunities for Tertiary Prevention 206
III. Disability Limitation 207
A. Cardiovascular Disease 207
1. Risk Factor Modification 207
Cigarette Smoking 207
Diabetes Mellitus 207
Hypertension 207
Sedentary Lifestyle 208
Excess Weight 208
Dyslipidemia 208
2. Therapy 208
3. Symptomatic Stage Prevention 208
Behavior Modification 208
Other Measures 208
B. Dyslipidemia 208
1. Assessment 209
Total Cholesterol Level 209
High-Density Lipoprotein Level 209
Low-Density Lipoprotein Level 209
Triglyceride and Very-Low-Density Lipoprotein Levels 210
Total Cholesterol–to–High-Density Lipoprotein Ratio 210
Triglyceride–High-Density Lipoprotein Relationship 210
Homocysteine Level 210
4 Public Health 289
24 Introduction to Public Health 291
Chapter Outline 291
I. Definitions of Public Health 291
II. Health in the United States 292
A. Major Sources of Mortality and Morbidity 292
B. Actual Causes of Death 292
C. Disability-adjusted Life Years 292
D. Health Care Disparities 294
III. Data Sources in Public Health 294
A. Surveillance and Databases 295
B. Summary Measures of Health 297
C. Census Data 297
1. U.S. Census 297
D. Numerator Data 297
1. U.S. Vital Statistics System 297
2. Death Certificates 297
E. Leading Health Indicators 298
1. National Notifiable Disease Surveillance System 299
2. National Center for Health Statistics 300
3. Behavioral Risk Factor Surveillance System 300
4. National Health and Nutrition Examination Survey 300
F. Other Health-Related Registries 300
G. Other Data Sources 301
1. Third-party Payers and Insurance 301
2. Health of Special Populations 302
3. Environmental and Specialized Data 302
IV. Injuries 303
A. Motor Vehicle Crashes 304
1. Risk Factors in Preinjury Phase 304
Human Factors 304
30 Supplement One Health: e1
Applications of One Health to Millennium Development Goals e1
One Health Case Study 1 Deforestation, Intensive Livestock Production, and Nipah Virus Emergence e1
One Health Case Study 2 Biodiversity Loss, Land Use, and Lyme Disease e2
Animal-Human-Ecosystem Dynamics e2
Response and Conclusions e2
One Health Case Study 3 Rift Valley Fever at the Interface of Humans, Domestic Animals, and the Environment e3
The Disease e3
Animal-Human-Ecosystem Dynamics e3
Response and Conclusions e3
One Health Case Study 4 Origins of Human Immunodeficiency Virus e3
One Health Case Study 5 Brucellosis: Vaccinating Animals for Human Health e4
The Disease e4
Animal-Human-Ecosystem Dynamics e4
Response and Conclusions e4
Policy Implications e5
One Health Case Study 6 Schistosomiasis and Three Gorges Dam in China e5
Integrative Approaches to One Health e5
One Health in Action I Animal & Human Health for the Environment And Development e5
One Health in Action II Emerging Pandemic Threats Program e6
One Health in Action III HealthMap and Technology for Global Disease Surveillance e7
Implementation of One Health Framework e7
Communication e7
Institutional e8
Technical/Educational e8
References e10
Appendix e11
Outline e11
Epidemiologic and Medical Glossary 378
Index 391
A 391
B 391
C 392
D 393
E 394
F 395
G 396
H 396
I 397
J 397
K 397
L 397
M 398
N 399
O 399
P 400
Q 401
R 401
S 402
T 404
U 404
V 404
W 404
Y 405
Z 405
Inside back cover ibc1