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Counting Whales Counting a Disease

Learn about the importance of counting disease rates in epidemiology and how it forms the basis for comparisons between population groups. Discover the challenges in setting up disease registries and the need for accurate surveillance and monitoring. Explore the impact of undercounting and the role of statistics in estimating population numbers. Presented in the language of epidemiology.

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Counting Whales Counting a Disease

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  1. Counting Whales Counting a Disease

  2. Rates are the hallmark for epidemiology for they form the basis of comparisons between population groups Rose and Barker,1986

  3. “The Price of Health, like that of liberty, is Eternal Vigilance”

  4. “An improvement in the treatment of disease, and any addition to medical science, will tend ultimately to the diminution of human suffering; but the registration of the causes of death is calculated to exercise a still more direct influence upon public health. Diseases are more easily prevented than cured, and the first step to their prevention is the discovery of their exciting causes by numerical facts and measure the intensity of their influence.” William Farr, 1839

  5. Norway, 1856 Leprosy Registry Exclusively Rural Areas Doctors sent to rural areas Leper census, 1836 (5), 1845 (8), 1845 (11) Leprosy viewed as inheritable--sexual isolation, hospitals, prohibiting marriage No experience in setting up the registration Local Health officer Royal Decree

  6. Problems Problems with local registration (definition, deadlines, incomplete) Circular letters Chief Medical Officer travelling to each area Over diagnosis initially (acne, scabies) Low prevalence areas, disease overlooked Undercount, Undercount, Undercount Isolation: Areas where isolation practiced, most rapid decline in disease

  7. Definitions Prevention • Reducing the incidence of disease (primary prevention) • Reducing the prevalence of disease (second. prevent.) Control • Ongoing operations or programs aimed at reducing the incidence and/or prevalence of disease Last, Dictionary of Epidemiology

  8. General Motors sold 2,542,455 Automobiles World Wide

  9. 99 Billion Sold

  10. NCDs • What is the incidence of Diabetes? • What is the incidence of CHD? • What is the incidence of Cancer? Nobody Knows

  11. Surveillance Health Dept.

  12. Surveillance Continuous analysis, interpretation, and feedback of systematically collected data, generalized using methods distinguished by their practicality, uniformity, and rapidity, rather than by accuracy or completeness. Last, Dictionary of Epidemiology

  13. CDC Comes in TV says Flu

  14. Registry Academia

  15. Registry …the term register is applied to the file of data concerning all cases of a particular disease or health -relevant condition in a defined population such that the cases can be related to a population base. Last, Dictionary of Epidemiology

  16. Disease Monitoring Systems

  17. Allegheny County Type I Diabetes Registry Criteria for Registration 1. Diagnosed between 1/1/65 and 12/31/99 2. Age at onset <20 3. Diagnosis of Diabetes 4. On Insulin at time of Hospital Discharge 5. Resident of Allegheny County at Diagnosis

  18. 16 /100,000 /100,000 Allegheny County Type I Diabetes Registry Undercount

  19. Chronic Disease Epidemiology Incidence Prevalence Registry

  20. 155 Centers 71 Countries 7% of world's children WHO DiaMond Project

  21. Epidemiologists Cant Count

  22. Epidemiologists Counting Disease

  23. Prairie Chicken

  24. Endangered Species in Africa

  25. Biostatistics

  26. How Many Fish are there in Lake Geneva? 1 2 3 4 5 6 7 8 9

  27. Capture

  28. Mark

  29. RECAPTURE

  30. (M+1)(n+1) N= -1 (m+1) N = Estimate of Number M =Number in First Sample n = Number in Second Sample m =Number of “marked” items in Second Sample (M+1)(n+1)(M-m)(n-m) Var(N)= (m+1) (m+2) Capture-Recapture Sample 2 Sample 1 M m n 2 In Common

  31. Capture-Recapture Methods • Long history of use in Demography • i.e. US Census • The standard for estimating the abundance or shortage of wildlife populations

  32. Lower Extremity Amputation Study Adolescent Injuries Sports injuries Dog Bites

  33. Optimal “Lists” to identify cases • Independent • Reasonable ascertainment • Inexpensive

  34. Pilot Test Pilot Test Pilot Test Comparison of “lists to gold standard” CR to Registry

  35. Good monitoring does not necessarily ensure the making of right decisions, but it reduces the risk of wrong ones. Languimer, 1963

  36. Public Health

  37. Cancer Incidence in Middle East

  38. Good monitoring does not necessarily ensure the making of right decisions, but it reduces the risk of wrong ones. Languimer, 1963

  39. Porpoises can teach Epidemiologists how to count Lecture Available at: www.pitt.edu/~super1/

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