Misplaced Pages

#815184

97-511: Alexander Langmuir , Chief of the U.S. Public Health Service , proposed the creation of the Epidemic Intelligence Service on March 30, 1951. Langmuir argued that the agency could identify appropriate defense measures against biological warfare germs, develop new detection methods, and train laboratory workers to rapidly recognize biological warfare germs. This justification arose from biological warfare concerns during

194-610: A clinical professor of preventative medicine and community health at Emory University . During the 1957–1958 influenza pandemic , the Association of State and Territorial Health Officials convinced the US Public Health Service (USPHS) to appoint Langmuir to a 14-member technical advisory group that coordinated research between the USPHS and US Department of Defense . In this role, Langmuir instituted

291-437: A causal association does not exist in general. Conversely, it can be (and is in some circumstances) taken by US courts, in an individual case, to justify an inference that a causal association does exist, based upon a balance of probability . The subdiscipline of forensic epidemiology is directed at the investigation of specific causation of disease or injury in individuals or groups of individuals in instances in which causation

388-514: A defined population . It is a cornerstone of public health , and shapes policy decisions and evidence-based practice by identifying risk factors for disease and targets for preventive healthcare . Epidemiologists help with study design, collection, and statistical analysis of data, amend interpretation and dissemination of results (including peer review and occasional systematic review ). Epidemiology has helped develop methodology used in clinical research , public health studies, and, to

485-498: A health system responds to current population health issues but also how a health system can be managed to better respond to future potential population health issues. Examples of organizations that use population-based health management that leverage the work and results of epidemiological practice include Canadian Strategy for Cancer Control, Health Canada Tobacco Control Programs, Rick Hansen Foundation, Canadian Tobacco Control Research Initiative. Each of these organizations uses

582-521: A lesser extent, basic research in the biological sciences. Major areas of epidemiological study include disease causation, transmission , outbreak investigation, disease surveillance , environmental epidemiology , forensic epidemiology , occupational epidemiology , screening , biomonitoring , and comparisons of treatment effects such as in clinical trials . Epidemiologists rely on other scientific disciplines like biology to better understand disease processes, statistics to make efficient use of

679-787: A population (endemic). The term "epidemiology" appears to have first been used to describe the study of epidemics in 1802 by the Spanish physician Joaquín de Villalba  [ es ] in Epidemiología Española . Epidemiologists also study the interaction of diseases in a population, a condition known as a syndemic . The term epidemiology is now widely applied to cover the description and causation of not only epidemic, infectious disease, but of disease in general, including related conditions. Some examples of topics examined through epidemiology include as high blood pressure, mental illness and obesity . Therefore, this epidemiology

776-520: A population-based health management framework called Life at Risk that combines epidemiological quantitative analysis with demographics, health agency operational research and economics to perform: Applied epidemiology is the practice of using epidemiological methods to protect or improve the health of a population. Applied field epidemiology can include investigating communicable and non-communicable disease outbreaks, mortality and morbidity rates, and nutritional status, among other indicators of health, with

873-422: A prospective study, and confounders are more easily controlled for. However, they are more costly, and there is a greater chance of losing subjects to follow-up based on the long time period over which the cohort is followed. Cohort studies also are limited by the same equation for number of cases as for cohort studies, but, if the base incidence rate in the study population is very low, the number of cases required

970-402: A random sample from the original population at risk. This has as a consequence that the control group can contain people with the disease under study when the disease has a high attack rate in a population. A major drawback for case control studies is that, in order to be considered to be statistically significant, the minimum number of cases required at the 95% confidence interval is related to

1067-516: A system of 108 US cities reporting their deaths by cause to the CDC on a weekly basis, which is still utilized for tracking influenza-like illness . In March 1960, Surgeon General Leroy Edgar Burney appointed Langmuir, Albert Sabin , Assistant Surgeon General David E. Price, and NIH Division of Biologics Control Director Roderick Murray to attend a May 1960 conference with Soviet scientists on improving Sabin's live attenuated polio vaccine . However,

SECTION 10

#1732772642816

1164-619: A two-year residency in internal medicine at Boston City Hospital . His first paper was published in The New England Journal of Medicine in 1934, associating a patient's present condition with their stage of tuberculosis upon admission, duration of sanatorium treatment, and extent of Mycobacterium tuberculosis bacterial colonization in their sputum . While attending medical school, Langmuir met with Massachusetts Commissioner of Health George Hoyt Bigelow , who encouraged him to pursue public health by describing

1261-445: A unique disease process different from any other individual ("the unique disease principle"), considering uniqueness of the exposome (a totality of endogenous and exogenous / environmental exposures) and its unique influence on molecular pathologic process in each individual. Studies to examine the relationship between an exposure and molecular pathologic signature of disease (particularly cancer ) became increasingly common throughout

1358-399: Is a core component, that is unified with management science to provide efficient and effective health care and health guidance to a population. This task requires the forward-looking ability of modern risk management approaches that transform health risk factors, incidence, prevalence and mortality statistics (derived from epidemiological analysis) into management metrics that not only guide how

1455-428: Is based upon how the pattern of the disease causes change in the function of human beings. The Greek physician Hippocrates , taught by Democritus, was known as the father of medicine , sought a logic to sickness; he is the first person known to have examined the relationships between the occurrence of disease and environmental influences. Hippocrates believed sickness of the human body to be caused by an imbalance of

1552-479: Is beyond the domain of the science of epidemiology. Epidemiology has its limits at the point where an inference is made that the relationship between an agent and a disease is causal (general causation) and where the magnitude of excess risk attributed to the agent has been determined; that is, epidemiology addresses whether an agent can cause disease, not whether an agent did cause a specific plaintiff's disease. In United States law, epidemiology alone cannot prove that

1649-483: Is disputed or is unclear, for presentation in legal settings. Epidemiological practice and the results of epidemiological analysis make a significant contribution to emerging population-based health management frameworks. Population-based health management encompasses the ability to: Modern population-based health management is complex, requiring a multiple set of skills (medical, political, technological, mathematical, etc.) of which epidemiological practice and analysis

1746-537: Is famous for his investigations into the causes of the 19th-century cholera epidemics, and is also known as the father of (modern) Epidemiology. He began with noticing the significantly higher death rates in two areas supplied by Southwark Company. His identification of the Broad Street pump as the cause of the Soho epidemic is considered the classic example of epidemiology. Snow used chlorine in an attempt to clean

1843-499: Is in the term inference . Correlation, or at least association between two variables, is a necessary but not sufficient criterion for the inference that one variable causes the other. Epidemiologists use gathered data and a broad range of biomedical and psychosocial theories in an iterative way to generate or expand theory, to test hypotheses, and to make educated, informed assertions about which relationships are causal, and about exactly how they are causal. Epidemiologists emphasize that

1940-668: Is included below: In the 2011 film Contagion , the character Doctor Erin Mears (portrayed by Kate Winslet ) is a physician and investigator with the Epidemic Intelligence Service who was tasked by the CDC to discover the origin of a highly contagious and deadly virus known as MEV-1 which was rapidly spreading throughout the world following initial outbreaks in Kowloon , Hong Kong and Minneapolis , Minnesota . Alexander Langmuir Alexander Duncan Langmuir ( / ˈ l æ ŋ m j ʊər / ; September 12, 1910 – November 22, 1993)

2037-418: Is increasing recognition that a wide range of modern data sources, many not originating from healthcare or epidemiology, can be used for epidemiological study. Such digital epidemiology can include data from internet searching, mobile phone records and retail sales of drugs. Epidemiologists employ a range of study designs from the observational to experimental and generally categorized as descriptive (involving

SECTION 20

#1732772642816

2134-404: Is reduced by  1 ⁄ 2 . Although epidemiology is sometimes viewed as a collection of statistical tools used to elucidate the associations of exposures to health outcomes, a deeper understanding of this science is that of discovering causal relationships. " Correlation does not imply causation " is a common theme for much of the epidemiological literature. For epidemiologists, the key

2231-521: Is typically determined using DNA from peripheral blood leukocytes. Since the 2000s, genome-wide association studies (GWAS) have been commonly performed to identify genetic risk factors for many diseases and health conditions. While most molecular epidemiology studies are still using conventional disease diagnosis and classification systems, it is increasingly recognized that disease progression represents inherently heterogeneous processes differing from person to person. Conceptually, each individual has

2328-439: Is used to describe the intersection of Host , Agent , and Environment in analyzing an outbreak. Case-series may refer to the qualitative study of the experience of a single patient, or small group of patients with a similar diagnosis, or to a statistical factor with the potential to produce illness with periods when they are unexposed. The former type of study is purely descriptive and cannot be used to make inferences about

2425-483: The February 1946 New York City tugboat strike led Stebbins to controversially close all businesses and schools to reserve fuel for public utilities, hospitals, and emergency responders. Frustrated with backlash to the 18-hour shutdown, O'Dwyer ignored all eight recommendations proposed on March 1, 1946, including Langmuir, and appointed New York City Hospital Commissioner Edward M. Bernecker . Despite Bernecker lacking

2522-539: The Guttmacher Institute to evaluate family planning programs and the US Agency for International Development to survey international attitudes toward family planning. Many EIS officers focused on improving contraceptive safety, such as identifying that intrauterine devices (IUDs) made with polyurethane reduced the risk of uterine perforation , as compared to IUDs made with polypropylene . During

2619-464: The Korean War . The Epidemic Intelligence Service was organized on September 26, 1951, with the purpose of investigating disease outbreaks that are beyond the control of state and local health departments, enforcing interstate quarantine regulations, and providing epidemic aid at the request of state health agencies. The Epidemic Intelligence Service's first staff members were 21 medical officers of

2716-486: The Korean hemorrhagic fever reported by American soldiers was actually due to endemic Hantaan orthohantavirus . During the 2001 anthrax attacks , EIS officers tracked many cases to mailed envelopes containing Bacillus anthracis spores. After EIS veterinarians had convincingly traced salmonellosis cases to infected poultry and psittacosis cases to infected turkeys during the 1950s, Langmuir helped formulate

2813-575: The National Office of Vital Statistics to the CDC, ensuring that epidemiologic surveillance would be directly reported to the public. Langmuir's 1967 appointment of Michael B. Gregg as editor-in-chief of the MMWR has been retrospectively praised for ushering in plain English explanations. In 1961, the drug thalidomide , popular as a morning sickness treatment among pregnant European women,

2910-624: The Planned Parenthood of Atlanta's Board of Directors in 1965. In 1962, the Population Council tried recruiting Langmuir to create a public health approach to population control , but he chose to instead pursue this goal within the CDC by acquiring funding from the National Institute of Child Health and Human Development's Center for Population Research. Under his tenure, the CDC frequently collaborated with

3007-598: The Poultry Products Inspection Act of 1957 , which requires the US Department of Agriculture's Food Safety and Inspection Service to inspect all domesticated birds when slaughtered and processed into products for human consumption. In January 1976, soldiers at Fort Dix , New Jersey, contracted swine influenza A/H1N1 , prompting comparisons to the 1918–1920 flu pandemic that originated from Camp Funston , Kansas. By September 1976,

Epidemic Intelligence Service - Misplaced Pages Continue

3104-476: The US Department of State blocked the trip over the attendance of Chinese and East German scientists, claiming that the presence of American scientists would lend undue prestige to Communist delegations. In September 1960, Langmuir and William H. Stewart successfully convinced the US Department of Health and Human Services to transfer publication of the Morbidity and Mortality Weekly Report ( MMWR ) from

3201-838: The World Health Organization . Critical of significant variation in the data collection and reporting of doctors and state health officials regarding malaria cases, Langmuir started the Epidemic Intelligence Service (EIS) in 1951 to train doctors, veterinarians, statisticians, and other health workers in epidemiology. The EIS logo depicts a shoe with a hole, referencing Langmuir's philosophy of "shoe-leather epidemiology", in which "disease detectives" conduct on-site fieldwork to understand emerging infectious disease outbreaks, rather than passively relying on local health authorities to report information. The CDC ultimately determined that doctors in

3298-600: The anthrax , hantavirus , West Nile virus in the United States, and the 2013–2016 Ebola outbreak in West Africa . EIS officers begin their fellowship with a one-month training program at CDC headquarters in Atlanta , Georgia ; however, 95% of their two-year term consists of experiential rather than classroom training. For the remainder of their service, EIS officers are assigned to operational branches within

3395-476: The " one cause – one effect " understanding is a simplistic mis-belief. Most outcomes, whether disease or death, are caused by a chain or web consisting of many component causes. Causes can be distinguished as necessary, sufficient or probabilistic conditions. If a necessary condition can be identified and controlled (e.g., antibodies to a disease agent, energy in an injury), the harmful outcome can be avoided (Robertson, 2015). One tool regularly used to conceptualize

3492-459: The "who, what, where and when of health-related state occurrence". However, analytical observations deal more with the 'how' of a health-related event. Experimental epidemiology contains three case types: randomized controlled trials (often used for a new medicine or drug testing), field trials (conducted on those at a high risk of contracting a disease), and community trials (research on social originating diseases). The term 'epidemiologic triad'

3589-587: The 17th recipient of the Royal Society of Medicine 's Edward Jenner Medal . In 1987, the Charles A. Dana Foundation conferred a Pioneer Achievement Award on Langmuir for establishing the United States' public health surveillance during his time as Chief Epidemiologist of the CDC. Epidemiology Epidemiology is the study and analysis of the distribution (who, when, and where), patterns and determinants of health and disease conditions in

3686-532: The 1970s, EIS officers identified that the Dalkon Shield 's tail string allowed bacteria to pass from the cervix to the uterus, resulting in an elevated risk for pelvic inflammatory disease and septic abortion . The EIS' findings led to the product's withdrawal and passage of the 1976 Medical Device Regulation Act that enabled the FDA to regulate medical devices like IUDs. In 1984, EIS alumni collaborated with

3783-515: The 2000s. However, the use of molecular pathology in epidemiology posed unique challenges, including lack of research guidelines and standardized statistical methodologies, and paucity of interdisciplinary experts and training programs. Furthermore, the concept of disease heterogeneity appears to conflict with the long-standing premise in epidemiology that individuals with the same disease name have similar etiologies and disease processes. To resolve these issues and advance population health science in

3880-504: The 2010s. By 2012, it was recognized that many pathogens' evolution is rapid enough to be highly relevant to epidemiology, and that therefore much could be gained from an interdisciplinary approach to infectious disease integrating epidemiology and molecular evolution to "inform control strategies, or even patient treatment." Modern epidemiological studies can use advanced statistics and machine learning to create predictive models as well as to define treatment effects. There

3977-445: The 430 BCE Plague of Athens , dismissing smallpox , bubonic plague , scarlet fever , measles , typhus , typhoid fever , ergotism , and meningitis as potential causes due to differences in the symptomology . Instead, Langmuir proposed that Athens experienced an influenza outbreak from zoonotic spillover of a livestock strain, leading to skin lesions and damaged respiratory mucosa colonized by Staphylococcus . Many of

Epidemic Intelligence Service - Misplaced Pages Continue

4074-538: The CDC and state and territorial epidemiologists. Langmuir has been praised for transferring publication of the Morbidity and Mortality Weekly Report ( MMWR ) to the CDC, ushering in plain English explanations of ongoing health crises that were useful for both scientists and members of the public. Langmuir was born on September 12, 1910, in Santa Monica, California , to New York Life Insurance Company President Charles H. Langmuir and Edith Ruggles Langmuir as

4171-595: The CDC or at state and local health departments around the country. Placement is determined via a highly competitive matching process. The CDC pairs EIS officers with a Public Health Advisor , forming a scientist (EIS officer) and operations (PHA) team. The EIS is a common recruiting pathway into the Public Health Service Commissioned Corps . The EIS is the prototype for Field Epidemiology Training Programs (FETP), which operate in numerous countries with technical assistance provided by

4268-605: The CDC to predict the growth of epidemics and allocate vaccine doses. From 1940 to 1941, Langmuir served as Assistant District Health Officer of the New York State Institute of Health. On January 10, 1941, the Health Commissioner of Westchester County, New York , George H. Ramsey, appointed Langmuir as Deputy Health Commissioner, tasking him with opening a new office in Peekskill to serve

4365-653: The CDC. However, attempts to establish FETPs in Indonesia , Hungary , Ivory Coast , and within the World Health Organization have failed due to insufficient long-term support. Since the inception of the EIS, officers have been involved with treatment, eradication, and disease-control efforts for a variety of medically related crises. Below is an abridged timeline of their work. EIS officers attend an annual conference in Atlanta, Georgia, to present components of their work from

4462-726: The Epidemic Intelligence Service has awarded the Alexander D. Langmuir Prize at its annual conference to the manuscripts of current EIS officers and first-year alumni. The first recipient was a paper on smallpox vaccine complications by John M. Neff, J. Michael Lane , James H. Pert, Richard Moore, J. Donald Millar , and Donald Henderson , which was published in The New England Journal of Medicine . Langmuir received an honorary Doctor of Science degree from Emory University in 1970 and an honorary Doctor of Law degree from Johns Hopkins University in 1978. Since 1972,

4559-591: The Epidemic Intelligence Service's annual conference has included a Alexander D. Langmuir Lecture, the first of which was delivered by Charles H. Rammelkamp Jr. on the prevention of rheumatic heart disease . In 1973, the American College of Physicians selected Langmuir for the James D. Bruce Memorial Award for Distinguished Contributions in Preventative Medicine. In 1979, Langmuir became

4656-581: The FDA's Advisory Committee on Oral Contraceptives to reject a methodologically flawed Lancet study claiming an association between exposure to high- progesterone contraceptives and breast cancer among young women. After retiring from the CDC in 1970, Langmuir taught at Harvard Medical School from 1970 to 1977 and served as a visiting professor at the Johns Hopkins School of Hygiene and Public Health from 1988 until his death in 1993. In 1985, Langmuir reanalyzed Thucydides ' history of

4753-600: The Johns Hopkins School of Hygiene and Public Health, but he quickly grew disillusioned with academia. After New York City Health Commissioner Ernest Lyman Stebbins announced his intent to leave the position and become Director of the Johns Hopkins University School of Hygiene and Public Health in July 1946, Mayor William O'Dwyer tasked a six-person commission led by Surgeon General Thomas Parran with nominating potential replacements. However,

4850-519: The MACDP has identified other cases of drug toxicity, such as the association between exposure to the antidepressant venlafaxine during later stages of pregnancy and birth defects. At the 1968 22nd World Health Assembly held in Boston , Massachusetts, Langmuir and Karel Raška of Czechoslovakia organized the technical discussions around the theme of "National and Global Surveillance" coordinated by

4947-560: The OR, a RR greater than 1 shows association, where the conclusion can be read "those with the exposure were more likely to develop the disease." Prospective studies have many benefits over case control studies. The RR is a more powerful effect measure than the OR, as the OR is just an estimation of the RR, since true incidence cannot be calculated in a case control study where subjects are selected based on disease status. Temporality can be established in

SECTION 50

#1732772642816

5044-681: The Public Health Service. The EIS is operated by the CDC's Center for Surveillance, Epidemiology, and Laboratory Services (CSELS), in the Office of Public Health Scientific Services (OPHSS). Program participants, known colloquially as "disease detectives", are formally called "EIS officers" (or EIS fellows) by the CDC and have been dispatched to investigate hundreds of possible epidemics created by natural and artificial causes. Since 1951, more than 3,000 EIS officers have been involved in domestic and international response efforts, including

5141-700: The Salk polio vaccine had also been contaminated with live poliovirus, seeking to maintain the public's confidence in polio vaccination. During the prior year, Langmuir had similarly shielded Albert Sabin's polio vaccine from public scrutiny, despite its association with polio cases among recipients in Nebraska and Oregon . Inspired by Margaret Sanger 's guest lecture to the Harvard Liberal Club, Langmuir promoted family planning through epidemiologic studies of abortion and birth control , and he joined

5238-553: The Salk polio vaccine using other suppliers, the Pan American Health Organization declared the eradication of wild poliovirus in 1994. In 1963, Langmuir and Neal Nathanson, who Langmuir had appointed to lead the CDC's Polio Surveillance Unit (PSU), published internal documents on the Cutter incident. Controversially, Langmuir refused to include documents showing that one lot of Wyeth 's formulation of

5335-407: The assessment of data covering time, place, and person), analytic (aiming to further examine known associations or hypothesized relationships), and experimental (a term often equated with clinical or community trials of treatments and other interventions). In observational studies, nature is allowed to "take its course", as epidemiologists observe from the sidelines. Conversely, in experimental studies,

5432-414: The case control study. However, the point estimate generated is the relative risk (RR), which is the probability of disease for a person in the exposed group, P e  =  A  / ( A  +  B ) over the probability of disease for a person in the unexposed group, P u  =  C  / ( C  +  D ), i.e. RR  =  P e  /  P u . As with

5529-429: The causation of the disease. Case-control studies are usually faster and more cost-effective than cohort studies but are sensitive to bias (such as recall bias and selection bias ). The main challenge is to identify the appropriate control group; the distribution of exposure among the control group should be representative of the distribution in the population that gave rise to the cases. This can be achieved by drawing

5626-427: The cause-and-effect hypothesis and none can be required sine qua non ." Epidemiological studies can only go to prove that an agent could have caused, but not that it did cause, an effect in any particular case: Epidemiology is concerned with the incidence of disease in populations and does not address the question of the cause of an individual's disease. This question, sometimes referred to as specific causation,

5723-489: The child recipients developed polio two weeks afterward, resulting in 51 cases of permanent paralysis and five deaths. Tasked with identifying the outbreak's source by Surgeon General Leonard A. Scheele , Langmuir ordered each state to designate a public health officer that would report all cases of polio to conduct a case-control study , ultimately finding that two lots of Cutter Laboratories' vaccine had been contaminated with live poliovirus. Following resumed distribution of

5820-445: The data and draw appropriate conclusions, social sciences to better understand proximate and distal causes, and engineering for exposure assessment . Epidemiology , literally meaning "the study of what is upon the people", is derived from Greek epi  'upon, among' demos  'people, district' and logos  'study, word, discourse', suggesting that it applies only to human populations. However,

5917-497: The disease to the cases in the series. A prospective study would involve following the case series over time to evaluate the disease's natural history. The latter type, more formally described as self-controlled case-series studies, divide individual patient follow-up time into exposed and unexposed periods and use fixed-effects Poisson regression processes to compare the incidence rate of a given outcome between exposed and unexposed periods. This technique has been extensively used in

SECTION 60

#1732772642816

6014-612: The epidemiologist is the one in control of all of the factors entering a certain case study. Epidemiological studies are aimed, where possible, at revealing unbiased relationships between exposures such as alcohol or smoking, biological agents , stress , or chemicals to mortality or morbidity . The identification of causal relationships between these exposures and outcomes is an important aspect of epidemiology. Modern epidemiologists use informatics and infodemiology as tools. Observational studies have two components, descriptive and analytical. Descriptive observations pertain to

6111-865: The epidemiology behind an investigation of milk contamination in Lee, Massachusetts , that resulted in cases of sore throats and scarlet fever . After working as a medical consultant on pneumonia control for the New York State Department of Health from 1937 to 1939, Langmuir pursued a Master in Public Health from the Johns Hopkins University School of Hygiene and Public Health , graduating in 1940. Learning from Biostatistics Chair Lowell Reed and Epidemiology Chair Wade Hampton Frost , Langmuir would later adapt their work by introducing compartmental models to

6208-771: The era of molecular precision medicine , "molecular pathology" and "epidemiology" was integrated to create a new interdisciplinary field of " molecular pathological epidemiology " (MPE), defined as "epidemiology of molecular pathology and heterogeneity of disease". In MPE, investigators analyze the relationships between (A) environmental, dietary, lifestyle and genetic factors; (B) alterations in cellular or extracellular molecules; and (C) evolution and progression of disease. A better understanding of heterogeneity of disease pathogenesis will further contribute to elucidate etiologies of disease. The MPE approach can be applied to not only neoplastic diseases but also non-neoplastic diseases. The concept and paradigm of MPE have become widespread in

6305-695: The federal government had begun distributing vaccines to suppress this 1976 swine flu outbreak , but reports of Guillain–Barré syndrome among recipients led to the vaccine's rollout being permanently halted in December 1976. As the US Department of Justice evaluated over 4,000 claims of injury, Langmuir led the EIS in studying the mechanisms by which vaccination can trigger this autoimmune condition to establish clinical case criteria and identify genuine instances of Guillain–Barré syndrome. In April 1955, Cutter Laboratories began distributing Jonas Salk 's polio vaccine containing inactive poliovirus , but many of

6402-518: The federal government. Langmuir graduated from Harvard College with a Bachelor of Arts in Physics in 1931. Despite his initial interest in following his Nobel Prize-winning uncle, Irving Langmuir , by specializing in surface science , Langmuir found advanced mathematics too difficult, leading him to the biomedical statistics of epidemiology. After receiving his Doctor of Medicine from Cornell University Medical College in 1935, he completed

6499-571: The field and advanced methods to study cancer, a disease with patterns and mode of occurrences that could not be suitably studied with the methods developed for epidemics of infectious diseases. Geography pathology eventually combined with infectious disease epidemiology to make the field that is epidemiology today. Another breakthrough was the 1954 publication of the results of a British Doctors Study , led by Richard Doll and Austin Bradford Hill , which lent very strong statistical support to

6596-405: The four humors (black bile, yellow bile, blood, and phlegm). The cure to the sickness was to remove or add the humor in question to balance the body. This belief led to the application of bloodletting and dieting in medicine. He coined the terms endemic (for diseases usually found in some places but not in others) and epidemic (for diseases that are seen at some times but not others). In

6693-1639: The gastrointestinal symptoms described by Thucydides align with toxic shock syndrome caused by the slow release of Staphylococcus toxins. Langmuir argued that the Athenian hoplites experienced a roughly 33% mortality rate , while the Spartans did not contract influenza during the Archidamian War , because overcrowding within the Long Walls of Athens increased the transmissibility of disease. In 1940, Langmuir married Sarah Ann Harper, and they had five children: Ann Ruggles Langmuir (1941–2004), Paul Harper Langmuir (1942–2010), Susan Davis Langmuir (1945–), Lynn Adams Langmuir (1951–2012), and Jane Adams Langmuir (1954–1963). Their marriage lasted until Sarah Ann Harper's death due to lung cancer in February 1969. Langmuir's children have criticized their father for his sexist attitudes and neglecting their development to focus on his epidemiological studies. In 1970, Alexander Langmuir married former New York City Health Commissioner Leona Baumgartner . They lived together in Chilmark, Massachusetts , until her death on January 15, 1991, due to polycythemia . On November 22, 1993, Langmuir died of kidney cancer at his home in Baltimore , Maryland. Langmuir

6790-458: The general population of patients with that disease. These types of studies, in which an astute clinician identifies an unusual feature of a disease or a patient's history, may lead to a formulation of a new hypothesis. Using the data from the series, analytic studies could be done to investigate possible causal factors. These can include case-control studies or prospective studies. A case-control study would involve matching comparable controls without

6887-575: The link between tobacco smoking and lung cancer . In the late 20th century, with the advancement of biomedical sciences, a number of molecular markers in blood, other biospecimens and environment were identified as predictors of development or risk of a certain disease. Epidemiology research to examine the relationship between these biomarkers analyzed at the molecular level and disease was broadly named " molecular epidemiology ". Specifically, " genetic epidemiology " has been used for epidemiology of germline genetic variation and disease. Genetic variation

6984-403: The main etiological work that brought forward the concept. His concepts were still being considered in analysing SARS outbreak by WHO in 2004 in the context of traditional Chinese medicine. Another pioneer, Thomas Sydenham (1624–1689), was the first to distinguish the fevers of Londoners in the later 1600s. His theories on cures of fevers met with much resistance from traditional physicians at

7081-448: The middle of the 16th century, a doctor from Verona named Girolamo Fracastoro was the first to propose a theory that the very small, unseeable, particles that cause disease were alive. They were considered to be able to spread by air, multiply by themselves and to be destroyable by fire. In this way he refuted Galen 's miasma theory (poison gas in sick people). In 1543 he wrote a book De contagione et contagiosis morbis , in which he

7178-506: The multicausality associated with disease is the causal pie model . In 1965, Austin Bradford Hill proposed a series of considerations to help assess evidence of causation, which have come to be commonly known as the " Bradford Hill criteria ". In contrast to the explicit intentions of their author, Hill's considerations are now sometimes taught as a checklist to be implemented for assessing causality. Hill himself said "None of my nine viewpoints can bring indisputable evidence for or against

7275-700: The northern portion of the county. During a visit to Irving Langmuir's home to discuss surface chemistry , John Holmes Dingle admired Alexander Langmuir's papers studying the spread of polio in Westchester County. When Dingle was appointed to lead the US Army's Commission on Acute Respiratory Diseases during World War II , he recruited Alexander Langmuir to serve at Fort Liberty in North Carolina from 1942 to 1946. In 1946, Langmuir began working as an Associate Professor of Epidemiology at

7372-417: The odds of exposure in the cases (A/C) to the odds of exposure in the controls (B/D), i.e. OR = (AD/BC). If the OR is significantly greater than 1, then the conclusion is "those with the disease are more likely to have been exposed", whereas if it is close to 1 then the exposure and disease are not likely associated. If the OR is far less than one, then this suggests that the exposure is a protective factor in

7469-498: The odds ratio by the equation: where N is the ratio of cases to controls. As the odds ratio approaches 1, the number of cases required for statistical significance grows towards infinity; rendering case-control studies all but useless for low odds ratios. For instance, for an odds ratio of 1.5 and cases = controls, the table shown above would look like this: For an odds ratio of 1.1: Cohort studies select subjects based on their exposure status. The study subjects should be at risk of

7566-559: The organization's focus to include the epidemiology of non-communicable diseases like birth defects and cancer , Langmuir's efforts led to the institution's 1980 renaming as the Centers for Disease Control and Prevention (CDC). Additionally, Langmuir's efforts to include environmental health under the CDC's purview led to the 1983 creation of the Agency for Toxic Substances and Disease Registry . During this period, Langmuir also worked as

7663-414: The outcome under investigation at the beginning of the cohort study; this usually means that they should be disease free when the cohort study starts. The cohort is followed through time to assess their later outcome status. An example of a cohort study would be the investigation of a cohort of smokers and non-smokers over time to estimate the incidence of lung cancer. The same 2×2 table is constructed as with

7760-562: The poor economic policies that led to the ongoing Great Depression . In March 1932, Langmuir served on the student honorary board of a Model League of Nations conference with 28 New England universities, overseeing discussions of post-World War One disarmament, conflicts over the Polish Corridor , and the Second Sino-Japanese War . He later credited these political simulations as preparation for his work in

7857-522: The preceding year. During the conference, the Alexander D. Langmuir Prize is awarded "to a current officer or first-year alumnus of the EIS for the best scientific publication. The award consists of a $ 100 cash prize, an engraved paperweight, a case of ale or beer redolent of the John Snow Pub in London , and an inscription on the permanent plaque at CDC." A complete list of Langmuir Prize winners

7954-400: The prevailing Miasma Theory of the time, a model of disease in which poor air quality was blamed for illness. This was used to rationalize high rates of infection in impoverished areas instead of addressing the underlying issues of poor nutrition and sanitation, and was proven false by his work. Other pioneers include Danish physician Peter Anton Schleisner , who in 1849 related his work on

8051-640: The prevention of the epidemic of neonatal tetanus on the Vestmanna Islands in Iceland . Another important pioneer was Hungarian physician Ignaz Semmelweis , who in 1847 brought down infant mortality at a Vienna hospital by instituting a disinfection procedure. His findings were published in 1850, but his work was ill-received by his colleagues, who discontinued the procedure. Disinfection did not become widely practiced until British surgeon Joseph Lister 'discovered' antiseptics in 1865 in light of

8148-628: The public health experience that the New York City Charter requires for the position, O'Dwyer figured that he could control Bernecker more than outsiders like Langmuir, who was then-stationed at Fort Liberty in North Carolina. Recruited by Justin M. Andrews in 1949, Langmuir became Chief Epidemiologist of the Communicable Disease Center in Atlanta , Georgia , a position he held until 1970. Widening

8245-402: The same population that gave rise to the cases. The case-control study looks back through time at potential exposures that both groups (cases and controls) may have encountered. A 2×2 table is constructed, displaying exposed cases (A), exposed controls (B), unexposed cases (C) and unexposed controls (D). The statistic generated to measure association is the odds ratio (OR), which is the ratio of

8342-605: The southeastern United States were incorrectly attributing unexplained fevers to malaria without differential diagnosis . Inspired by Charles V. Chapin 's work convincing Rhode Island public health officials to accept germ theory over miasma theory , Langmuir initially assumed all disease was transmitted through direct contact, rather than airborne transmission . During his time with the Commission on Acute Respiratory Diseases at Fort Liberty, Langmuir found that ultraviolet germicidal irradiation did not significantly reduce

8439-456: The study of adverse reactions to vaccination and has been shown in some circumstances to provide statistical power comparable to that available in cohort studies. Case-control studies select subjects based on their disease status. It is a retrospective study. A group of individuals that are disease positive (the "case" group) is compared with a group of disease negative individuals (the "control" group). The control group should ideally come from

8536-439: The term is widely used in studies of zoological populations (veterinary epidemiology), although the term " epizoology " is available, and it has also been applied to studies of plant populations (botanical or plant disease epidemiology ). The distinction between "epidemic" and "endemic" was first drawn by Hippocrates , to distinguish between diseases that are "visited upon" a population (epidemic) from those that "reside within"

8633-466: The third of five children. From 1921 onward, he was raised in Englewood, New Jersey , with his brothers Peter, Charles, and David and sister Edith. As President of the Harvard Liberal Club, Langmuir led the university's delegation to the 1931 Conference of International Student Service at Mount Holyoke College , denouncing American college students for their detachment from politics, which he blamed for

8730-664: The time. He was not able to find the initial cause of the smallpox fever he researched and treated. John Graunt , a haberdasher and amateur statistician, published Natural and Political Observations ... upon the Bills of Mortality in 1662. In it, he analysed the mortality rolls in London before the Great Plague , presented one of the first life tables , and reported time trends for many diseases, new and old. He provided statistical evidence for many theories on disease, and also refuted some widespread ideas on them. John Snow

8827-461: The transmission of acute respiratory illnesses between recruits. However, once the US biological weapons program at Fort Detrick had demonstrated airborne transmission of many pathogens, Langmuir used the threat of potential biological warfare during the Korean War to justify the training of epidemiologists through the Epidemic Intelligence Service. In 1976, virologist Ho Wang Lee identified that

8924-413: The water and removed the handle; this ended the outbreak. This has been perceived as a major event in the history of public health and regarded as the founding event of the science of epidemiology, having helped shape public health policies around the world. However, Snow's research and preventive measures to avoid further outbreaks were not fully accepted or put into practice until after his death due to

9021-637: The work of Louis Pasteur . In the early 20th century, mathematical methods were introduced into epidemiology by Ronald Ross , Janet Lane-Claypon , Anderson Gray McKendrick , and others. In a parallel development during the 1920s, German-Swiss pathologist Max Askanazy and others founded the International Society for Geographical Pathology to systematically investigate the geographical pathology of cancer and other non-infectious diseases across populations in different regions. After World War II, Richard Doll and other non-pathologists joined

9118-688: Was an atheist who renounced the concept of an afterlife . The October 1996 supplement to volume 144, issue 8 of the American Journal of Epidemiology was dedicated to covering Langmuir's impact on public health with many of the articles written by EIS alumni. In October 1965, Langmuir received the American Public Health Association 's Bronfman Prize for Public Health Achievement alongside New York City Health Commissioner George James and Puerto Rico Department of Health Director Guillermo Arbona. Since 1966,

9215-457: Was an American epidemiologist who served as Chief Epidemiologist of the Centers for Disease Control and Prevention (CDC) from 1949 to 1970, developing the Epidemic Intelligence Service (EIS) as a training program for epidemiologists. During his tenure, Langmuir broadened the CDC's scope to include the epidemiology of non-communicable diseases , environmental health , and family planning . Additionally, Langmuir increased coordination between

9312-586: Was found to cause birth defects and miscarriages . While the thalidomide scandal minimally affected the United States because the Food and Drug Administration (FDA) rejected the drug for failure to test its safety among pregnant women, the incident led Langmuir to support the 1967 creation of the Metropolitan Atlanta Congenital Defects Program (MACDP). Tracking birth defects among infants and children born in Atlanta,

9409-668: Was the first to promote personal and environmental hygiene to prevent disease. The development of a sufficiently powerful microscope by Antonie van Leeuwenhoek in 1675 provided visual evidence of living particles consistent with a germ theory of disease . During the Ming dynasty , Wu Youke (1582–1652) developed the idea that some diseases were caused by transmissible agents, which he called Li Qi (戾气 or pestilential factors) when he observed various epidemics rage around him between 1641 and 1644. His book Wen Yi Lun (瘟疫论, Treatise on Pestilence/Treatise of Epidemic Diseases) can be regarded as

#815184