流行病学 绪论.ppt
Department of Epidemiology Public Health College of Harbin Medical University流行病学绪论流行病学绪论Introduction of Epidemiology哈尔滨医科大学流行病学教研室哈尔滨医科大学流行病学教研室 Department of epidemiology，Harbin Medical University1Department of Epidemiology Public Health College of Harbin Medical University医学医学 Medicinep Basic medicine p Clinical medicine p Preventive medicine Epidemiology has always been a necessary part of medicine practice.流行病学一直医学实践必不可少的部分流行病学一直医学实践必不可少的部分p基础医学基础医学p临床医学临床医学p预防医学预防医学2Department of Epidemiology Public Health College of Harbin Medical University医学之母医学之母 The mother of medicine Because,the epidemiology is from macro point of view to observe the any question.e.g.from macro point of view to study the disease and health.因为流行病学是从因为流行病学是从宏观宏观观察问题，观察问题，亦即从宏观研究疾病和健康亦即从宏观研究疾病和健康3Department of Epidemiology Public Health College of Harbin Medical UniversityCONTENTS 目录目录pHistorypDefinition pMethodspPrinciplepApplication pFeaturespProspectp历史历史p定义定义p方法方法p原理原理p应用应用p特点特点p展望展望4Department of Epidemiology Public Health College of Harbin Medical University Brief History of EpidemiologyBrief History of Epidemiology 流行病学简史流行病学简史 p学科形成前期学科形成前期 -18-18世纪世纪p学科形成期学科形成期 1818世纪末世纪末-20-20世纪初世纪初p学科发展期学科发展期（现代（现代流行病学时期）流行病学时期）2020世纪世纪4040、5050年代年代-pBefore the form of Before the form of EpidemiologyEpidemiology -1700s-1700spForming ofForming of EpidemiologyEpidemiology End of 1700sEnd of 1700s beginning of 20 century beginning of 20 century pDevelopment of EpidemiologyDevelopment of Epidemiology （Modern EpidemiologyModern Epidemiology）40s-50s of 20 century40s-50s of 20 century 5Department of Epidemiology Public Health College of Harbin Medical UniversityEarlier stage:-18th century-Hippocrates(460-377 BC)-Hippocrates(460-377 BC)A First Epidemiologist Epidemic Epidemic On Airs,Waters and Places-中国：中国：“疫疫”、“时疫时疫”、“疫疠疫疠”From there is the human history of civilization to the 18th century.During this time,This discipline(branch)not yet forms,but had its embryonic form.6Department of Epidemiology Public Health College of Harbin Medical UniversityHippocrates(460-377 BC)Hippocrates(460-377 BC)第一个流行病学家第一个流行病学家主要的流行病学著作：主要的流行病学著作：Epidemic Epidemic On Airs,Waters and Places中国：中国：“疫疫”“”“时疫时疫”“”“疫疠疫疠”一、一、学科形成前期学科形成前期-18世纪世纪 自从有自从有人类文明人类文明到到18世纪世纪.这期间这期间,该该学科（学科（分支）分支）尚未形成，但已形成雏形尚未形成，但已形成雏形.7Department of Epidemiology Public Health College of Harbin Medical UniversityThe Black Death in Europe ca.1300s 欧洲黑死病欧洲黑死病8Department of Epidemiology Public Health College of Harbin Medical University 1347-13511347-1351年年年年 鼠疫导致鼠疫导致鼠疫导致鼠疫导致24002400万人死亡万人死亡万人死亡万人死亡9Department of Epidemiology Public Health College of Harbin Medical University Italy-Venice-the earliest quarantine 15th Century:The people in order to avoid the infectious disease spreading,the request external ships must Away(outside)from the port 40 days.That is(quadraginta(latin=40).1423:set up first infectious diseases hospital中国：隋朝开设中国：隋朝开设“疠人坊疠人坊”(leprosy hospital)(leprosy hospital)隔离麻风病人隔离麻风病人10Department of Epidemiology Public Health College of Harbin Medical University意大利威尼斯最早的检疫意大利威尼斯最早的检疫14世纪世纪 外来船只必须在港外停留检疫外来船只必须在港外停留检疫40天天quadraginta(拉丁语，意思为拉丁语，意思为40)quarantine1423年成立了首家传染病隔离医院年成立了首家传染病隔离医院中国：隋朝开设中国：隋朝开设“疠人坊疠人坊”以隔以隔离麻风病人离麻风病人11Department of Epidemiology Public Health College of Harbin Medical University-John-John GrauntGraunt(1620-1674)(1620-1674)Use death data to study distribution of disease Make first life table calculate expectation of life Summarizes death process with probability of survival and death Producce control group ideaHis contribution is the first time to introduceHis contribution is the first time to introduceStatistics to Epidemiology Statistics to Epidemiology Natural and Political Observations Made Upon the Bills of Mortality12Department of Epidemiology Public Health College of Harbin Medical UniversityJohn Graunt(1620-1674)利用死亡数据进行死亡分布及规律性研究利用死亡数据进行死亡分布及规律性研究创制了第一张寿命表，计算期望寿命创制了第一张寿命表，计算期望寿命用生存概率和死亡概率来概括死亡经历用生存概率和死亡概率来概括死亡经历提出设立比较组的思想提出设立比较组的思想将统计学引入流行病学领域将统计学引入流行病学领域将统计学引入流行病学领域将统计学引入流行病学领域Natural and Political Observations Made Upon the Bills of Mortality13Department of Epidemiology Public Health College of Harbin Medical UniversityGraunts ObservationspExcess of males over females among births but higher mortality in malespHigh infant mortality ratepSeasonal variation in morbiditypAcute versus chronic diseasespUrban versus rural mortalitypRural migration to the citypFirst attempts at a life tablep出生时男性多于女性，出生时男性多于女性，但男性死亡高但男性死亡高p婴儿死亡率高婴儿死亡率高p发病呈季节变动发病呈季节变动p比较急性与慢性疾病比较急性与慢性疾病p城市与农村死亡比较城市与农村死亡比较p农村象城市流动农村象城市流动p首次尝试寿命表首次尝试寿命表14Department of Epidemiology Public Health College of Harbin Medical University Lind.James 17161795Lind.James 17161795-A surgeon of English navy -By means of Epidemiologic experiment Discovered Orange prevent scurvy 2.Form stage Start the experimental Start the experimental EpidemiologyEpidemiology15Department of Epidemiology Public Health College of Harbin Medical UniversityJames Lind(1716-1794)James Lind(1716-1794)VitC缺乏缺乏 坏血病坏血病(1747)(1747)开创了流行病学临床试验的先河开创了流行病学临床试验的先河开创了流行病学临床试验的先河开创了流行病学临床试验的先河二、学科形成期二、学科形成期16Department of Epidemiology Public Health College of Harbin Medical University-Edward Jenner-Edward Jenner(1796)(1796)He used cowpox immunization in preventing He used cowpox immunization in preventing smallpoxsmallpox.17Department of Epidemiology Public Health College of Harbin Medical UniversityEdward Jenner(1749-1823)(1796)(1796)接种牛痘接种牛痘预防天花预防天花开创了主动免疫的先河开创了主动免疫的先河开创了主动免疫的先河开创了主动免疫的先河施民安施民安.琴纳发现牛痘预防天花的经过琴纳发现牛痘预防天花的经过.见见:钱宇平钱宇平,主编主编.流行流行病学研究实例病学研究实例(第第1卷卷).北京北京:人民卫生出版社，人民卫生出版社，1984.p38-42.18Department of Epidemiology Public Health College of Harbin Medical UniversityIn 1979 WHO declared that smallpox has been In 1979 WHO declared that smallpox has been eliminated in the whole world.eliminated in the whole world.Smallpox eradication should be attributed to his Smallpox eradication should be attributed to his research.research.19Department of Epidemiology Public Health College of Harbin Medical UniversitySir Percivall Pott:1775pEnglish surgeon in LondonpWe all best known for“Potts fracture”pHe is one of earliest accounts of cause and effect linkage for an occupational carcinogen.pHe found that the scrotal cancer was particularly in the workers of Chimney(stovepipe)cleaning 20Department of Epidemiology Public Health College of Harbin Medical UniversitySir Percivall Pott:1775英国外科医生英国外科医生以“Potts 骨折著称 他最早将职业致癌物与病他最早将职业致癌物与病因联系起来因联系起来他发现阴囊癌为烟筒清洁他发现阴囊癌为烟筒清洁工所特有工所特有21Department of Epidemiology Public Health College of Harbin Medical UniversityWilliam Farr(1807-1883)Statistician(English)First person who routine collect population and death data in England Put important words:Standard mortality,Person year、Dose-response relationship、P=ID22Department of Epidemiology Public Health College of Harbin Medical UniversityWilliam Farr(1807-1883)在英国首创人口和死亡的常规资料收集在英国首创人口和死亡的常规资料收集提出许多流行病学的重要概念：标化死提出许多流行病学的重要概念：标化死亡率、人年、剂量反应关系、患病率亡率、人年、剂量反应关系、患病率 患病率发病率患病率发病率病程病程现代流行病学的奠基人之一现代流行病学的奠基人之一现代流行病学的奠基人之一现代流行病学的奠基人之一公共卫生运动的领导者之一公共卫生运动的领导者之一公共卫生运动的领导者之一公共卫生运动的领导者之一23Department of Epidemiology Public Health College of Harbin Medical University-London Epidemiological Society(1850)establishedestablishedIt is a first one in the worldIt is showed that the discipline already formed 24Department of Epidemiology Public Health College of Harbin Medical UniversityLondon Epidemiological Society(1850)全世界全世界第一个第一个流行病学学会流行病学学会标志着标志着流行病学学科流行病学学科的的形成形成 25Department of Epidemiology Public Health College of Harbin Medical University-John Snow(1848-1854)-John Snow(1848-1854)26Department of Epidemiology Public Health College of Harbin Medical UniversityThe great French Bacteriologist The great French Bacteriologist Louis Pasteur(1822-1895)Louis Pasteur(1822-1895)He established the Germ theoryManufacture animal vaccine:-anthrax,-fowl cholera,-swine erysipelas -Rabies-virus-vaccine Pasteurization 600C 30 the new useful disinfection method 27Department of Epidemiology Public Health College of Harbin Medical University伟大的法国微生物学家伟大的法国微生物学家Louis Pasteur(1822-1895)微生物理论微生物理论(germ theory)开发了鸡霍乱、炭疽、猪丹毒疫苗开发了鸡霍乱、炭疽、猪丹毒疫苗减毒的微生物可以用作免疫减毒的微生物可以用作免疫提出狂犬病是由一种显微镜看不到提出狂犬病是由一种显微镜看不到的物质传播的（即病毒），并开发的物质传播的（即病毒），并开发疫苗治疗和预防狂犬病疫苗治疗和预防狂犬病巴斯德杀菌法巴斯德杀菌法第一节第一节第一节第一节 流行病学发展史流行病学发展史流行病学发展史流行病学发展史28Department of Epidemiology Public Health College of Harbin Medical University3,Development stage（发展阶段）（发展阶段）(20th Century 40s,50s-now)Features（特点）（特点）:(1)Spectrum of disease :The study area extended from communicable diseases-to Non-communicable/chronic disease-to health 疾病谱疾病谱 研究领域从研究领域从 传染病传染病非传染病非传染病-健康健康29Department of Epidemiology Public Health College of Harbin Medical UniversityTen leading causes of death 1900 and 1990 30Department of Epidemiology Public Health College of Harbin Medical UniversityChildren of Polio脊髓灰质炎患儿脊髓灰质炎患儿 31Department of Epidemiology Public Health College of Harbin Medical UniversityFeatures（特点）（特点）:（2）Research method from Survey and analysis to qualitative and quantitative combined,and macroscopic and microscopic combined 研究方法从研究方法从调查分析到定性和定量结合调查分析到定性和定量结合，宏观与微观结合宏观与微观结合 (3)Social behavior factors is very important 社会行为因素社会行为因素非常重要非常重要 (4)There are more other related Branch of epidemiology emerge 有更多的有更多的流行病学相关分支出现分支出现32Department of Epidemiology Public Health College of Harbin Medical UniversityREVIVAL OF EPIDEMIOLOGY:BEGINNING OF MODERN EPIDEMIOLOGYMain characteristic:From communicable diseases to non-communicable diseasesTime:Mid 20th Century First RCTs:streptomycin and respiratory tuberculosis in 1948Early case-control studies:smoking and lung cancer in 1950Early cohort studies:Framingham Study in 1948 British Doctors Study in 1951 Sir Austin B.Hill:Sir Austin B.Hill:The Father of ModernThe Father of Modern Epidemiology EpidemiologySir Richard Doll:The Godfather of EpidemiologySir Richard Doll:The Godfather of Epidemiology33Department of Epidemiology Public Health College of Harbin Medical University流行病学复兴：现代流行病学的开始流行病学复兴：现代流行病学的开始主要特点主要特点:从传染病倒非传染病从传染病倒非传染病时间时间:20th世纪中叶世纪中叶 第一个第一个 RCTsRCTs:链霉素与肺结核链霉素与肺结核 19481948早期病例对照研究：吸烟和肺癌的关系早期病例对照研究：吸烟和肺癌的关系 19501950早期队列研究早期队列研究:Framingham 研究研究1948 英国医生研究英国医生研究 1951 1951 Sir Austin B.Hill:Sir Austin B.Hill:The Father of ModernThe Father of Modern Epidemiology EpidemiologySir Richard Doll:The Godfather of EpidemiologySir Richard Doll:The Godfather of Epidemiology34Department of Epidemiology Public Health College of Harbin Medical UniversityKenneth Rothman:The Philosopher in Epidemiology现代流行病学中的哲学家现代流行病学中的哲学家 Kenneth Rothman 35Department of Epidemiology Public Health College of Harbin Medical UniversityROTHMAN AND MODERN ROTHMAN AND MODERN EPIDEMIOLOGYEPIDEMIOLOGYFrom Study of distributions to study of causes of diseaseIn humans and observational:case-control&cohort studiesIn order o avoid the Confounding bias he suggested:By means of the *Restriction and matching *Standardization *Stratified analysis *Adjustment by regression can be control the confounding bias 36Department of Epidemiology Public Health College of Harbin Medical University 1992:BIRTH OF EVIDENCE-BASED MEDICINE1992年：年：循证医学诞生循证医学诞生“A new paradigm for medical practice is emerging in 1992”出现医学实践进模式出现医学实践进模式-A New Approach to Teaching the Practice of Medicine医学教育新方法医学教育新方法37Department of Epidemiology Public Health College of Harbin Medical UniversityDAVID SACKETTActivist in clinical epidemiology 临床流行病学活动家临床流行病学活动家The pioneer in EBM 循证医学先驱循证医学先驱The first book on EBM 第一本循证医学书第一本循证医学书 McMaster University Health Science Centre Chairman of Oxford Centre for EBM 38Department of Epidemiology Public Health College of Harbin Medical University WORLD COCHRANE COLLABORATION国际国际COCHRANECOCHRANE合作合作In 1992,the very first Cochrane centre was established in Oxford.Mission:Collecting,summarizing and disseminating evidence from organized research.19921992年第一个年第一个COCHRANECOCHRANE中心在牛中心在牛津建立津建立使命：收集、总结使命：收集、总结和传播研究证据和传播研究证据39Department of Epidemiology Public Health College of Harbin Medical UniversityToday there is a total of 15 national or regional Cochrane centers and over 40 review groups world wide.Chinese national Cochrane/EBM Centre is in Sichuan Universityp目前，全球有目前，全球有1515个国个国家和地区家和地区COCHRANE COCHRANE 中中心和心和4040多个评价组多个评价组p中国国家循证医学中中国国家循证医学中心在四川大学心在四川大学WORLD COCHRANE COLLABORATION国际国际COCHRANECOCHRANE合作合作40Department of Epidemiology Public Health College of Harbin Medical UniversityDefinition of EpidemiologyDefinition of Epidemiology流行病学定义流行病学定义 Epidemiology:the study of the distribution and determinants and the occurrence of health-related states or events in specified and the application of this study to control health problems.(Last)41Department of Epidemiology Public Health College of Harbin Medical Universitythe meaning of this definitionpDiseasepPopulationpDistribution prevention&controlpSocial medicine p疾病疾病p人群人群p分布分布预防空中预防空中p社会医学社会医学42Department of Epidemiology Public Health College of Harbin Medical UniversityThe relationship between epidemiology and clinical medicinePopulationspStudies/assessmentspPreventionpEvaluationpPlanningIndividualspDiagnosispTreatmentpCuringpCaring43Department of Epidemiology Public Health College of Harbin Medical UniversityStudy methodsStudy methods 研究方法研究方法-Observation -Experimental-Theoretical 44Department of Epidemiology Public Health College of Harbin Medical UniversitySTUDY p Surveillancep Observationp Hypothesis testing p Analytic researchp Experimentsp Theoretical epidemiology p监测监测p观察观察p假设检验假设检验p分析研究分析研究p实验实验p理论流行病学理论流行病学45Department of Epidemiology Public Health College of Harbin Medical UniversityDistribution p Place p Timep Persons46Department of Epidemiology Public Health College of Harbin Medical UniversityDeterminantsby means of:pPhysical pBiological pSocial pCultural pBehavioral Factors47Department of Epidemiology Public Health College of Harbin Medical UniversityHealth-related states and events 健康相关状态和事件健康相关状态和事件 pDiseases pCauses of death pBehavior:Tobacco,Alcohol,Drug usepReactions to preventive regimenspProvision and use of health services48Department of Epidemiology Public Health College of Harbin Medical UniversityEpidemiologyEpidemiology p Population MedicinePopulation Medicine群体医学群体医学p The Language of QuantificationThe Language of Quantification定量语言定量语言49Department of Epidemiology Public Health College of Harbin Medical UniversityFactors influencing the spread of diseasepSocioeconomic conditionspSanitationpNutritionpLifestylepAgepGenderp社会经济状况社会经济状况p卫生卫生p营养营养p生活方式生活方式p年龄性别年龄性别50Department of Epidemiology Public Health College of Harbin Medical University Principle of epidemiologyPrinciple of epidemiology 流行病学原理流行病学原理 pDistribution pEpidemic processpRelationship of human and environment pCausationpCausal inference pPrevention pTheoretical epidemiologyp流行流行p分布分布p人语自然关系人语自然关系p病因病因p病因推断病因推断p预防预防p理论流行病学理论流行病学 51Department of Epidemiology Public Health College of Harbin Medical UniversityApplication of epidemiology流行病学应用1.Determine great public health Problems2.Response and deal with emergency event 3.Surveillance of disease relatedp重大公共卫生问题重大公共卫生问题的确定的确定p突发事件的应
