the study of Epidemic

Epidemiology :

Epidemiologist :

L
investigate diseases
L look for clues in the community

quality of evidence
L
Judge
L Form hypothesis du .

control

↓
Disease Control
↓
→
Elimination
Extinction Eradication

•
Scientific method of disease investigation

↓
Biostatistics medicine
of
• The study of distribution and determinants

disease, or injury in human populations

health ,

and the application of this study to the

control of health problems
disuatudaerah)
.

(penyakitthas
.

Endemic Pandemic
Epidemic ,
,

↓ ↓
Worldwide
constant grafik
di
e. g malaria
timur
• Disease have PATTERN / CLUE and RISK FACTOR

↳ they are not randomly distributed .

Epidemiology = the study of How and Why

%:* ? disease are distributed

wig:{ soffit ? in the
population the
,
um way they are .

such as screening
1. Preventive efforts , programs
for early disease detection .

2. Identify the specific factors that put them high

those factors
risk and then try to modify .

→ an educated guess .

HYPOTHESIS .

Dys-ON due :

→
Tugas

the hypotheses regarding the associ

-
_ . _

1. Find out
 Tugas lecture -1
-

1. Find out the hypotheses regarding the association

between the flue shot vaccine and Dystonia

•
What is dystonia :

↳ dystonia adalah gangguan per gerakan

ditandai Oleh kontratsi
neuro logis Yang
0+0-1 dalam dystonia
.
bisa bersifat
terns -
menerus atau
berulang ulanq dan -

dapatmempengaruhiberbagaibagiantubuhseperti.LI
.ua#..h.smat-9an9gota-UbUh
.
,

"
•
Macari dystonia :

↳ Dystonia Primer ( Primary Dystonia )

= tiddk memiliki Penyebab
yang je / as dan

diyatini memiliki dasar gene -1in Bisa .

dimulai sejak Masa anak Anan atauvemaja -

dan dapatmempengaruhi bagian tub uh

tertentu .

↳ Dystonia sekunderl secondary Dystonia )

= disebabkan Oleh kondisi med is Yang
Mendasarinya, seperti cederaotak efek
,

SamPing Oba-1
-
obatan tertentu ,
infeksi,

ataugangguanneunlog.is/ainnya .
# side note
:

primer bisamempengamhibagian
Dystonia
tubuh tertentu .

↓
tanamleher(cervic91dyston ↓

wajahlblepharospas.MIL
Dystonia Responsdopamin
lpopa -
Responsive Dystonia )
↳ Adalah tipe dystonia yang jarangterjadi
Dan meres Pons bait terhadap pengobatan
deng an levodopa , Oba-1 Yang digunatan
Untuk Mengo bati penyatit Parkinson .

↳ Dystonia Paroksimal ( Paroxysmal Dystonia )

↳ ditandaidengan episode tiba -
tiba
dan singkat dari dystonia yang
dap at dipicu Oleh faktor tertentu ,

seperti stress keleiahan, atau gerakan -

gerakan tertentn .

↳ Dystonia Tugds Spesifik ( Task -

specific Dystonia )
↳ terjadi Saat meld Kukar aktivitas
tertentu ,
seperti Germain at at Musik
1 musician 's dystonia ) at au menu tis
C Writer 's Camp)
 belumsepenunnya
•
Penyebab dystonia
dipahami namun
diyarini me libation

Kombi nasi
Pengobatan dystonia ↓
neuro
•
:
Kimi a
Obd -12 an
father
-

-
injetsi toksin botulinum lingkungan
genetik
untrue melemahkan semen tara
otot Yang terkena
sepertistimuiasi
-
terapi fi sik -
intervensibeddh Otari dalam
stimulation)
ldeen brain

• General Hypotheses
a) Immune Response Hypothesis :

↳ add kemungkinan ,
vaksin flu dapat
memicu response auto imun yang ti date
diinginkan , ygmengakibatkan kerusakan

Pada si stem Saraf dan akhirnya timbal

geiala distonia .

b) Genetic susceptibility Hypothesis / kerentanangenetik

:

mung kin
↳ in divider denganfaktorgenetiktertentu
memilirii Kecenderungan lebih besar un tuk

mengembangkandistoniaseteldhmenerimavakfihl.tn
.

c) Coincidence triggering Hypothesis /

or

torelasi keiadian semen tara

↳ Beberapa kasus distoniamungtinterjadi
 secarakebetuiansetelahindividumenerimavaks.in
, tanpa Kore Iasi febab -
Akiba -1 yang

sebenarnyd . Ini mung kin terjadi Karen a gejala

distonia dan Vaksihari terjadi Pada Wattis

Sama , tetapi hubun 9am

Yang +idak ada

Kamal tang sung .

/ Respons
d) Neuro inflammation Hypothesis
semen tara :
Neuro inflamasi

↳ vatsin flu ddpat

memicu reatisi

neuro inflamasi semen

tara pada beberapa
individu , Yang kemudian dapat '

fung dan berton -1h

-

mempenddruhi si saraf
busi Pada per Kembangan distonia .

2. Do recommend quitting exercise if

you
I want to avoid a heart attack ?
'

= Beberapa Orang Yang secara teratur

No
berolahragatetap bisa mengalami
,

Oleh
seranganjantung Disebabltan .

beberapa father , dan tidal selah

berartibahwaolahragaitu send in
'

menyebabkan seranganjantung .

-
Beberapdlrlemungkinanmeliputi →
a) Faktov resito lainnyq
kebiasaoin mention,
=
riwayat teluarga ,
te Kanan darrah Tinggi , Kole sterol tinggi,
diabetes , dan Pola Makan yang tidat
Senat jugaberkontribusi-erhadaprisikoserang.gs
janturg .

b) Latihan Berkbihan :
beroldh raga dalam intens, + as Yang
-

Saat tinggi atan tanpa istirahat

Yang cutup dap at Menyebdbkan Stress

Paddjantung dan pembuluhdarah .

c) kondisi Medistersembunyi :

memiliki
= beberapa Orang mung tin
tidakterde
-

kondisi medis yang

teksi dtaufartor gene titi Yang
Serangoon
menihgratkanrisitio
jantung , meskipun mereta

terlihatsehat dan berolahragq

second teratur .

% Olahragamemiliki banyan manfaat bag,

'

kesehatan dan dapat membantu mengurangi

sertd
risitoserangdnjantung meningnatkan
kesehatansecarakeseluruhan.me ngurangi
 ataumenghentikanolahragasecara-i.ba -

tiba mungtin bukan folufi terbaik .

itu inflamafi ?
neuro
↳ a Da
) Yang terjadi di
inflamah peradangan
(
'

di Otar
= Saraf terutama
stem Ini Adalah
,

dalam si be / are ang

twang
.

sumsum
dan terhadap
atami tubuh
respons
ceder a, ihfeksi ,
atau
penyareit ,

09/08/2005
1 .
Masa intubasi = Rohtak virus
-

gejald Munch /

2.
Kelainangenetik .

usia Kehamilan .

faktor regino
-
3. of giving
risk down
↑ -1ha , ↑ higher birth to

syndrome babies .

4. virus Zika → deformity in heads

caused of babil e

by
,
a

specific mosquito

5 .
Controllable factors for strokes :

→
↓ ↓ poor
↓ diet .

blood physical
high obesity
pressure activity
 6. Penyebab seranganjantung
darah yang
=
Penyumbatan aiman

Menuju Iantung .

7. Penyakitkronit
↳ father regino yang menimbun -

nimby
Tidak secara long sung .

BLACK DEATH
1. dipercaya Oleh masyaraiat sebagai
hukuman darituhan .

penyeuah sebenamsa
;;!;:!m%
:
2. .

www.ine
fleas .

be
most
&
rodents disease
likely
WHEN to our

3 . Descriptive epidemiology #
•
Scurvy
→
.
yksariawan
*

tapi bisa ↓ WHERE

would the
fatal .

WHO disease be
be
would most likely
most likely to occur

to get the
disease ?
 Epidemiologic triad of
1 Historical )
Disease
causation

Environment
e. g SARS CoV 2
-
-
.

•
Reservoir of infection ( definition . . .

:
garam Analytic EPI
gula
•

I
2 : ↳ relationship
'

- Kau Sal ,

0
ratite .

= Pbl
↳ article 1 , hospital
death !
due date =
mingdep Jamat .
 •
admitting Patients during weekdays
have association with hospital deaths .

Explanation :
The possible benefits of constant
available
staffing and resources
on weekdays are made clear by
the fact that patients
admitted to hospitals during
the week , especially for
illnesses like brain hemorrhage ,

heart attack ,
or hip fracture,

may not experience an increased

risk of death .

b. Person
with acute epiglottitis have
• Patients
association with hospital deaths .

Explanation : Regardless of the day of the

week , people who are taken

with an infection
to the hospital
that causes severe swelling
of their respiratory system ,

run a higher risk of dying .

 •
Patients with a ruptured abdominal
aorticaneurysm have association
with hospital deaths .

of the
Explanation : The severity the risk
condition could increase
the
of death in these patients as

artery wall
the can
tearing in

result in potentially deadly bleeding .

a. Place
lower staffing levels
Hospitals with
•
association with
Felted have
hospital deaths .

Explanation : patients with specific

medical conditions especially
)
could face a higher risk
with
of
dying in hospitals
lower staffing levels -

•
Hospitals operating mainly on
with
weekends have association
hospital deaths .

People who the weekends

work on
Explanation =

may be less experienced than

those

who work during the weekdays As working .

 on weekends is less common and
level of care
may
have an effect on the
delivered .

time table
Place Person
.

, ,

,µy,
↓

,
↓
hospitals
in Canada -
Dr -
Donald A. Red Meier
,

ruang ( study co-author)

gawat
Dr. Chaim M Bell
datura-1
,
_

,,
gym
/emergency
room Toronto)

ii
ON and hospital
patients
'
'
_

µ, µ ,, , ,, µ,

the study .

Over a 10 -

year
period .

due date : Ramis .

 Who
14/08/2023

Descriptive epidemiology 1-what

-
where

<
\ when
•

screening
"%^① associated →
Causal
or not
enapakdn
"
°" causal
* + "
cervix " ↳ how 2 Objects /
nanda subjects are related

association is not

necessarily causal I

Tugas -
Article 2 .
-
add

ldibdhas
tanggai
Juma-1
1g
) netaman .

juma -1
Ming 9h dlpan ) .

( dikumpulkan

Validly vs
Reliability
=
accuracy vs
precise

⑧ :
 Cara find out if 2 associations are causal

or not :

i. Liat Penelitian Orang lain / Hasilnya consistent

)
atau nggak
2. CO founding
Unobssened reverse order
3. 4. time
_

i.
cause
5 .
Bias
chance
.

2.
↓ ""
-

dipi "" " 3 confoundin

"
.

data gang Me 4. Reverse Time

order
-

i day
,
bisa # £ '

+
POP g- . Bias
data

15/08/2023

b- Tipe Asosiafi
-

Heavy coffee Drink → Risk of fnicide

risk
1. Descriptive
→
Identified person → High
Outcome

Place Person Time

- -
-

Pontian male ?
Or
?
female
?
Kids ? parents
depressed
?
Single
people '
people
.
→ High coffee drinking
↳ define ! _
,
nerapa
qeias ?

•
Chance → Liha -1 data /
lkehetulon Peneiition 1am ?
atautidaklapakahkohtis.tw
atautidak ?
• Reverse time order
= apatah Mai ah Orang Yang

risk of suicide menyebabtton

[ minum

suicide
Kopi ?

→ mihum Kopi
risk of
atay

Minium Kopi → risk of

suicide
 dpakdh : cross sectional ?
Design →
•
Studi '

?, g

?
•
Confounding
confounding
-

ex→outw@
tfi
bias Yang
→ Kita seietg
.

Bia, / add

!! !!
•
1
\imaimbi teknik
to
sampling)
nntuk men can
.

selection bias
atautidak
epidemiology
.

↓
Descriptive what '
teknik random
✓ who ,
•

and atautidak
when
where random
?
.

Why
•
Analytical /
epidemiology how
 Types of variables :

1- QUALITATIVE / CATEGORICAL :

→ tihgkat sang
-
Nominal scale

ordinal scale
ada tangs 9 /
-

tingkat
2. QUANT / THE / NUMERICAL

(
_ interval → No absolute 0
- Skala ratio →
a- bsulote O

'
bisadilipatgandakan
terms rasiopriq
• Basic ratio

↳ Ratio
→ 2PM , 3 Wani -19=2-3--95
a-
%
=

↳ proportions ( atb )
beiumsempet
↳ Rate → _

. . .
.
.
nyatati !

↳ Risk Odds)
= Odds / 11-1
Odds .
_
.
.
 "
Design study for clinical research ! pate
risk ! # Exp → outcome
relative
↓
level evidence
paling tinggi !
selected time
subjects
are exposure
1. Cohort
→
based on the
over
are followed
subjects
(f) it has temporality →
the
outcome
see
smoke
(it has time component / may
have
for
CO - 20 Years)
rate
= we get good quality records .
cancer ,
we
smoking
µn ,
follow people
1 for to

f) take a long time

, , mm ,
expensive ,µµmµ
, , , , , , ,
)
µ,
, ,, , , , , select and we select control ! ( ←

↑casesandcon-Ñ
we cases
→
2. Case control back !
↳ subjects are selected based on the outcome / disease status LY Variable)
/
"

It) Good for rare disease f) Lacks temporality / no time component /

retNspec-
.

Quick and inexpensive Recall bias example

we're asking
for
PeopleEins
can't estimate years
old
go
has #
pvevalance or who
about
prevalent incidence -1 .

nasi
-
.

estimate prera
3. Cross sectional 195%)
we can
→
the proportion of a

/ Particular population
↳ data collected at single point in time 1 surveys ) 4
✓ found to be affected
time involved,
Quick to collect f) lack temporality / there is no condition
(f) =

a
medical
and don't know if smoke → " " 9 cancer by
advantage cheap so we
a specific time
at
.

Or

questionnaire,
smoke

↳
lung cancer →

e.9

health tuned .

" & #Peeta

Prospective
←
→
control
Mostly what
case
-
Experimental vs Observational

Randomization
has randomization no randomization

/
cold

, ¥ ¥ ¥
"
¥ # ¥ # ¥
¥
a ¥ ¥ ¥ ,
hot

#¥
,

¥ ¥ I # ¥

Observational
↓
descriptive analytic
-

-
who
what
-

why ?
-
When
-
where

ODDS RATIO cease control study )

odds of being exposed - case

= OR ( Odds
ratio /
É¥,
with disease
OR > I associated

OR 4 Protective 012=1
(no associating
Relative Risk
( cohort)
" =

";÷:::::::::÷,
RR > I l increased risk )

1212=1 ( some )

RR ( lower
risk )
< 1

based on the video i watch

,

numbers between
P -
values are
this example
0-1 that in
, ,
we
how confident
quantify
be that Pwg A is
should
Dors B
different from .

to 0 the more
the closer ,

have that
confidence we

pins A and Dwg B.ae

difc ECU .
201
20¥
10
× =
2.0

2000 = 2x

:#
= 1000 100
✗

1000
T¥ 10
\

2-0

f-¥7m)
↳
=

Jut as 30

÷×
.

" "
%
Reliability
Kon sister a
the degree
validity namesake
_

anneomtlu
'
 Ville
predictive
Region ÷

:#
desaiPIM

→
"
¥:*:÷÷
specify
28/08/2023
BIAS ! i. cause
2. Chance
-

systematic error in the 3. Confounding

4. Time Reverse Order
design / conduct of an
5. Bias
epidemiological study
resulting a conclusion
in
which is different from the tutti .

Internal

⑧ ⑧
> " "" +2

↑ ↑ ↑ validity External

but
Reliable
Reliable Unreliable validity
not valid hence
and valid and
not valid .

fandom Error Systematic Error

' '
Karang
sampled disebabkan
° / eh

2- Teknik sampling

sample file does

the larger sample size ,
not affect
the smaller random error .

systematic error

↓maesen
than randome
error ! because
it can't be
reduced by ↑ sample file .
 Selection bias
↓ bisadicegahdengan
i. Ambit semud Sample population
2. Teknik sampling nya dilakukan

Seara random .

OR > I → positive association

01241 →
negative association
↑
↑
8 ≈
is
is

§ E

Random systematic
error
error

study file →

•
Berksonian Bias
•
Volunteer on Referral Bias

Response bias
Types
Of selection

bias
 Poor sampling method
Potential sources
Questionnaire or measurement
of errors
error

Behavioural effects

Types of Information Briar :

Observer bias
1. Recall bias
- .

#tawThomeef
↳ Orang yang
bewbah Keperlakuan .

their knowledge of
being studied influences
their behaviour

#Placeboet expectation that regimes

will have effect .

1. e. the effect is due

to the power of Susan .
 itnddls
Random went
"
"

experimental
Control
µ

424¥dies q " "

÷¥÷:,"
÷: : ÷:÷{: ¥:
" designs
study
cohort studies

*ive
studies

←
,
Describe the distribution
of disease based on

Person place time

and
.

Why • used to generate

how ?
hypotheses
• Allow of
epidemiologic
hypothesis
 04/09/2023 minggu depan exam !

ada risk factor /add association

OR > I =
Positive association /

012=1 = tidak ada association

012<1 =
negative association
the
strength : the larger the RR, the more likely
of association association is to be casual .

Consistent associations between

Consistency :

and disease observed in

exposure
independent studies indicate tha
the observed associations are

more likely to be casual

specificity : An association that is specific for a

Particular group of individuals or for

to be casual
a disease is more likely .

Temporality : For a factor to be causal , it

the disease
must precede .

Biological "
If the risk of disease increases

Gradient w/ increasing dose exposure ) , then

or the association is more likely to
Dose Response be casual .

If it is plausible that the agent

Plausibility :
could cause the disease based upon ,

current knowledge , then the

assoiciation is more like us to be

causal .
 If the consistent with
Coherence : findings are
other data , example , the known
for
distribution of the disease in the

then association is
population , the
more likely to be casual .

ClinicalQuestio@i.Ab
normality : apakahpasien
Senat ?
Saki -1 atau

2.
Frequency seberapa seeing penyatiit terjadi
3 Risk Faktorapayg berkaitanlmeningkatkan
MAKO ?
.

4. Cause
:
5.
Diagnosis
:
6. Treatment I

7. Prognosis i

8. Prevention
.

9 . Cost .
 Disastificatrn

ca10utgg
11
Death Disease
" Disability

sign symptoms
Daᵈa
apaygPdfienrasaK9n@kn-se.g
→

Obesitas

( social cultural
&
conceptions of this
condition : cultural beliefs
such as
and reactions

fear or rejection , these

affect how the patient
reacts .
Also covers what

is considered a disorder

suitable for medical

treatment ) .
 Prevention
pre disease
Primary →

t .
secondary -

shighr
3.
Tertiary ?⃝