1,流行病学绪论 Introduction of Epidemiology,哈尔滨医科大学流行病学教研室 Department of epidemiology ，Harbin Medical University,2,医学 Medicine,Basic medicine Clinical medicine 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,基础医学 临床医学 预防医学,3,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. 因为流行病学是从宏观观察问题， 亦即从宏观研究疾病和健康,4,CONTENTS 目录,History Definition Methods Principle Application Features Prospect,历史 定义 方法 原理 应用 特点 展望,5,Brief History of Epidemiology 流行病学简史,学科形成前期 -18世纪 学科形成期 18世纪末-20世纪初 学科发展期（现代流行病学时期） 20世纪40、50年代-,Before the form of Epidemiology -1700s Forming of Epidemiology End of 1700s beginning of 20 century Development of Epidemiology （Modern Epidemiology） 40s-50s of 20 century,6,Earlier stage: - 18th century,-Hippocrates (460-377 BC) A First Epidemiologist,Epidemic Epidemic On Airs, Waters and Places -中国：“疫”、“时疫”、“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.,7,Hippocrates (460-377 BC) 第一个流行病学家,主要的流行病学著作： Epidemic Epidemic On Airs, Waters and Places,中国：“疫”“时疫”“疫疠”,一、学科形成前期-18世纪,自从有人类文明到18世纪. 这期间,该学科（ 分支） 尚未形成，但已形成雏形.,8,The Black Death in Europe ca.1300s 欧洲黑死病,9,1347-1351年 鼠疫导致2400万人死亡,10,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“疠人坊” (leprosy hospital) 隔离麻风病人,11,意大利威尼斯最早的检疫,14世纪 外来船只必须在港外停留检疫40天quadraginta (拉丁语，意思为40) quarantine 1423年成立了首家传染病隔离医院,中国：隋朝开设“疠人坊”以隔离麻风病人,12,-John Graunt (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 idea His contribution is the first time to introduce Statistics to Epidemiology,Natural and Political Observations Made Upon the Bills of Mortality,13,John Graunt (1620-1674),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 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 将统计学引入流行病学领域,Natural and Political Observations Made Upon the Bills of Mortality,14,Graunts Observations,Excess of males over females among births but higher mortality in males High infant mortality rate Seasonal variation in morbidity Acute versus chronic diseases Urban versus rural mortality Rural migration to the city First attempts at a life table,出生时男性多于女性，但男性死亡高 婴儿死亡率高 发病呈季节变动 比较急性与慢性疾病 城市与农村死亡比较 农村象城市流动 首次尝试寿命表,15,Lind .James 17161795 - A surgeon of English navy - By means of Epidemiologic experiment Discovered Orange prevent scurvy,2. Form stage,Start the experimental Epidemiology,16,James Lind (1716-1794),VitC缺乏 坏血病 (1747) 开创了流行病学临床试验的先河,二、学科形成期,17,-Edward Jenner (1796) He used cowpox immunization in preventing smallpox.,18,Edward Jenner (1749-1823),(1796) 接种牛痘 预防天花,开创了主动免疫的先河,施民安. 琴纳发现牛痘预防天花的经过. 见:钱宇平, 主编. 流行病学研究实例 (第1卷). 北京: 人民卫生出版社，1984. p38-42.,19,In 1979 WHO declared that smallpox has been eliminated in the whole world. Smallpox eradication should be attributed to his research .,20,Sir Percivall Pott: 1775,English surgeon in London We all best known for “Potts fracture” He is one of earliest accounts of cause and effect linkage for an occupational carcinogen. He found that the scrotal cancer was particularly in the workers of Chimney (stovepipe) cleaning,21,Sir Percivall Pott: 1775,英国外科医生 以“Potts 骨折著称 他最早将职业致癌物与病因联系起来 他发现阴囊癌为烟筒清洁工所特有,22,William 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=ID,23,William Farr (1807-1883),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：标化死亡率、人年、剂量反应关系、患病率 患病率发病率病程,现代流行病学的奠基人之一 公共卫生运动的领导者之一,24,-London Epidemiological Society (1850) established,It is a first one in the world,It is showed that the discipline already formed,25,London Epidemiological Society (1850),全世界第一个流行病学学会 标志着流行病学学科的形成,26,-John Snow (1848-1854),27,The great French Bacteriologist Louis Pasteur (1822-1895),He established the Germ theory Manufacture animal vaccine: -anthrax, -fowl cholera, -swine erysipelas -Rabies-virus-vaccine Pasteurization 600C 30 the new useful disinfection method,28,伟大的法国微生物学家 Louis Pasteur (1822-1895),微生物理论 (germ theory) 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 提出狂犬病是由一种显微镜看不到的物质传播的（即病毒），并开发疫苗治疗和预防狂犬病 巴斯德杀菌法,第一节 流行病学发展史,29,3, Development stage （发展阶段） (20th Century 40s, 50s -now) Features （特点）: (1) Spectrum of disease : The study area extended from communicable diseases- to Non-communicable /chronic disease - to health 疾病谱 研究领域从 传染病非传染病-健康,30,Ten leading causes of death 1900 and 1990,31,Children of Polio 脊髓灰质炎患儿,32,Fea