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🏛 | [Detailed report] The usage rate of secured beds is the highest in Shimane. Governor Maruyama requests "Priority measures to prevent spread" 


Governor Tatsuya Maruyama = 19th, Tonomachi Prefectural Office, Matsue City, showing the idea of ​​requesting the government to apply priority measures such as prevention of spread

[Detailed report] The usage rate of secured beds is the highest in Shimane, and Governor Maruyama requests "Priority measures such as prevention of spread". 

 
If you write the contents roughly
Active epidemiological surveys, such as behavioral surveys of infected persons and identification of close contacts by health centers, are becoming difficult to catch up with, and based on these points, the request for application of priority measures was decided.
 

Following the spread of the new coronavirus, Governor Tatsuya Maruyama of Shimane Prefecture is suitable for the government to take "priority measures such as prevention of spread" on the 19th. → Continue reading

 Sanin Chuo Shimpo

San-in Chuo Shimpo delivers news from both Sanin prefectures


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Request for application of priority measures

Epidemiology

Epidemiology(Exercise,English:Epidemiology)IndividualnotGroupTargetingsick(disease) Study of the cause, epidemic state, prevention, etc. OriginallyEpidemicStarted as a research object, but after that,Pollution diseaseAnd accidentsMan-made disaster,EarthquakeSuch asNatural disaster,Traffic accident,cancerな どLifestyle-related diseasesResearch targets are diversifying. Epidemiologypublic healthPreventive medicineAs an area that provides a basis for disease and also as an empirical approach to disease risk factors and optimal treatment decisions.Evidence-based medicine(Evidence-based medicine, EBM).

The scope of epidemiologic studies, including infectious and non-infectious diseases, isMedical scienceResearch, research planning, data collection and analysis, hypothesis testing by devising statistical models, etc.statisticsResearch. In epidemiological studies,analysisAs a technical methodunitIs placed on a single organism rather than a microscopic one. Have illness in a groupindividualBy measuring the number, the epidemic state (PrevalenceAnd quantify it as). Epidemiology also helps to understand the disease processBiologyTo find the near and far causes of risk factorsSociology哲学To use.

Epidemiology earlyAcute illness(Infection) Has made great strides in controlling the epidemic. With this achievement, the disease structure of society has changed from acuteChronic illness(Lifestyle-related diseases) Has been changed to ).

Epidemiology also refers to animals that live in groups (eg家畜,Industrial animals) Is also applied to diseases that are prevalent inVeterinary medicineOften used in the field of. However, it is difficult to understand as a groupWild animalsEpidemiology is difficult to apply to.

Definition

The definition of the International Epidemiological Society is "a study of the distribution or determinants of health-related situations or events in a particular population, and the application of epidemiology to control health problems".[2].

An example of another definition is "epidemiology is the study of epidemics of diseases in biological populations". That is, when a certain disease spreads in a certain population at a certain time point/one period, the cause of the epidemic is investigated, and the cause is removed to control (end, prevent) the epidemic itself. It is a study for. Also known as "epidemic".

"Epidemiology in human populationssickRegarding the occurrence ofLearningIs defined as[3].

In addition, there is a definition that "epidemiology is a study on the outbreak of disease" is an extended theory that extends beyond humans.[4][5][6][7].

Epidemiology is because the character of epidemiology has a sickness.Medical scienceIs misunderstood asEnglishThen.E(Epi; upon broad, -demos; people human, -logos; study scholarship), a scholarship used to confirm all causal relationships to human populations.[8].

History

John Snow

The beginning of epidemiologyJohn Snow OfcholeraSaid to be in research[9].. Cholera invades England (1831/October) At that time, choleraAirborneIt was thought and feared. However, Snow wondered about the airborne infection theory by finding that the houses where patients are present are the same even in the same epidemic area, and questioned the theory of airborne infection, "said that drinking contaminated water causes cholera".Oral infectionBased on the hypothesis, we conducted epidemiological surveys and prevention activities.

1854/January,Outbreak of cholera on Broad StreetHappened.UKWater companiesRiver ThamesWas taken from theRiver ThamesIt was extremely polluted and not hygienic. Snow had a large number of cholera patientsUKWe conducted a survey on the occurrence of patients in Broad Street. Snow compares and collates the patient occurrence map with the water supply area of ​​each water company, and in the water supply area of ​​a specific water companycholeraI found out that there were many patients. The intake of the company isManureIt was said to have been in a position affected by the dumping. Snow suspected that a well was a source of pollution and investigated cases that did not apply, and concluded that "people who drink contaminated well water will get sick." The administration accordingly closed the well in question, preventing the epidemic from spreading. This event is summarized in a historical fiction called "Twelve Days in Broad Street".

Snow cholera research1883/ToRobert Koch CholeraIt was thirty years ago to discover. The epidemiological study of snowSource of infection-Transmission routeEven if the biological factors (pathogens, etc.) are unknown by the epidemiological method of elucidation, the infectious disease epidemic can be stopped by observing social factors and situations. Modern epidemiological research is essentially no different from snow research.

Robert Koch

Robert Koch The1876/,AnthraxSucceeded in pure culture ofAnthrax OfPathogenProve thatBacteria AnimalProved to be the pathogen of (Koch's principle).1882/ToMycobacterium tuberculosisFoundHuman capitalIt was proved that the bacteria are pathogens.1883/,IndiaInCholeraI have found1890/, Koch from the culture supernatant of Mycobacterium tuberculosisTuberculin(M. tuberculosis vaccine) was created.1905/, KochNobel Prize in Physiology or MedicineWas awarded. KochLouis PasteurTogether with the founder of modern bacteriology.

KochUniversity of BerlinTo raise disciples,typhoidI found the fungusGeorg Gavky,diphtheriaSucceeded in separating the fungus,Foot-and-mouth disease virusFoundFriedrich Leffler,Serum therapyStudiedEmile Bering,chemical treatmentStudiedPaul Ehrlich,Tetanus fungusPure culture,Plague bacteriumFoundKitasato Shiba SaburoAnd so on.

Japanese epidemiology

It is said to be the founder of Japanese epidemiologyTakagi KanehiroIt is,Japanese NavyFrequently occurredberiberiIt is famous for advocating the nutritional theory that rice is a diet centered on white rice and demonstrating it experimentally and epidemiologically. Boiled rice was introduced into the Navy diet based on the results of voyage experiments, resulting in a sharp decrease in the Navy's beriberi in 1885.[10].. In 1905 (Meiji 38) by these achievementsBaronAnd was later called the "baron of barley rice"[11].

this is1912/ToUmetaro Suzuki Oryzanin(Vitamin B1) Was discovered 27 years ago.

Kitasato Shiba Saburo TheTetanus fungusPure culture and established serum therapyPlague bacteriumI have found

Classification of methods

There are the following categories of research methods.

  • ObservationAs a type study,Descriptive epidemiologyAnalytical epidemiologyThere is. For example, it can be said that descriptive epidemiology is to target only those who have symptoms, and analytical epidemiology is to investigate and compare all persons with or without symptoms.[12].
  • ExperimentAs a type study,Intervention research,Field test,Community intervention researchThere is.

The relationship between these research fields is as follows.

Descriptive epidemiology; Describe a hypothesis
Analytical epidemiology; Analyzing and verifying hypotheses
Intervention researchConfirm the hypothesis (by intervention experiment)

Descriptive epidemiology

Descriptive epidemiology examines the frequency and distribution of results to characterize the cause and effect and to develop a hypothesis of the cause.statisticsIs. It is called descriptive epidemiology because it describes a hypothesis that "the cause of XX is XX". Epidemiology is the study of the validity of causal relationships. To make this judgmentMetrologyApply.

  • As an advantage, only the characteristics concerning the cause and effect need to be known, so even if the cause is unknown, countermeasures can be devised and it can be done only by individual investigation.
  • On the downside, descriptive epidemiology alone is just a hypothesis and unreliable. If you make a hypothesis with descriptive epidemiology,Validity of causalityI have to look up.

Validity of causality

Criteria of causal association is a criterion that "at least this is wrong as a hypothesis if not satisfied" before the results of descriptive epidemiology are analyzed by analytical epidemiology. There are various theories regarding the validity, including Koch's 3 (4) principle, Evans's 8 conditions, and Hill's 9 standards (viewpoint).[13].. The five standards of Surgeon General (American Public Health Advisory Board) are shown below.

  • Relationship consistency
    Does the same thing happen in different countries and different times (is there universality in the relationship between people, places, and times)?
  • Relationship strength
    Whether the effect is quantitative (whether the quantity-response relationship holds)
  • Relationship specificity
    Is there a cause where there is a cause and a cause where there is a result?
  • Related temporality
    Is the order of cause → result
  • Association coherence
    Is it consistent with the known knowledge system?

If the hypothesis established by descriptive epidemiology satisfies the validity of the causal relationship, then it is analyzed by analytical epidemiology.

Analytical epidemiology

Analytic epidemiology is a study that verifies the hypothesis established in descriptive epidemiology. There are several classification methods.

  • Classification by how to examine the results
    • Prospective study: investigating whether results will come out
    • Retrospective study: find out if results are already available

Any wayConfounding,Systematic error,Accidental errorBe careful.

Results control study

Case control studies are divided into those who have the desired results and those who do not. It is divided into two, one that is considered to be "○○ is the result" and one that is thought to have been unsuccessful.

This is called a control, because the people with no results XX are the criteria when compared with the people with results. What is considered to be "△△"Exposure factorSay,Exposure factorTo be affected byExposedSay to be done. The table above is further divided into those who were exposed to the exposure factors and those who were not.

Results The control study is a study to investigate the causal relationship using this quadrant.

  • The advantage is that outcome-controlled studies are generally less costly as there are more retrospective studies. You can also conduct research at the individual level because you only collect people who have already obtained results (=).
  • The downside isSelection system errorIs easy to enter. Therefore, the objects to be observed must be even so that they are balanced with the world average.

Factor control study (cohort study)

In a factor control study, we collected the same number of groups that had a factor (exposed group) and groups that did not have a factor (non-exposed group), and observed for a certain period of time. A study to find out if the result is XX. Factor control studiesCohort studyAlso known as (cohort study), an observation to investigate the relationship between factors and disease occurrence by following a certain period of time between the population exposed to a specific factor and the group not exposed, and comparing the incidence of the studied disease. Research.

  • Disadvantage
    → is used
    • →You have to check whether the result information is correct.
    • There will be a cost
    • It cannot handle rare phenomena. For rare phenomenaResults control studyI have no choice but to do

Factor control studies can be further divided into the following two types.

Prospective factor control study
  • Prospective factor control study
Retrospective factor control study
  • Retro-spective factor control study
    This is a factor-control study that divides into groups that had factors (exposed group) and groups that did not have them (non-exposed group) based on past data such as medical records. The term "retrospective" is avoided because the analysis is done "forwardly" from the past to the present, and the words historical and nonconcurrent are often used in place of retro-spective overseas.
    • 利 点
      • This is a factor control study, but it does not cost much or take time.
      • It is not possible to study the factors that do not originally remain as data.

Intervention research

An intervention study is a study that examines the incidence of results by artificially adjusting what is considered to be the cause for the observation group.

  • Benefits Highly convincing results
  • Drawbacks take time and effort

Application to medicine

Applies to a well-defined human population when applied to medicineMedical scienceThe above events aredistributedIt is a discipline that clarifies, and studies effective countermeasures against medical events. Epidemiology does not reveal the direct etiology.

  • The frequency mainly investigates morbidity, incidence and mortality.
  • PrevalenceIs a certain point in timepopulationThe percentage of people who are sick. Represents the static frequency of illness.
  • Incidence is the rate of newly affected people, and the unit is "person/year". Represents the dynamic frequency of illness.
  • The prevalence is expressed as the product of the incidence.[Source required]
  • Mortality is the number of deaths divided by the populationCrude mortalitynot,Age-adjusted mortalityTo use.

Descriptive epidemiology

By investigating the frequency and distribution of disease, we investigate the etiology and characteristics of the disease, and make hypotheses about the etiology.

  • Advantages: Descriptive epidemiology is the simplest research method that can be performed only by individual research.
  • Disadvantages: Descriptive epidemiology alone is just a hypothesis and is extremely unreliable.
    • Example 2:AIDSInitial measures
      In 1981, five patients with unexplained symptoms were reported to the US Centers for Disease Control (CDC). When I investigated this unknown disease, all the patients were male homosexuals, so I hypothesized that "male homosexuality causes AIDS." However, in fact, it was found that it was transmitted even in heterosexual intercourse, and disease prevention measures fell far behind.

Validity of causality

  • Relationship consistency
    Does the same thing happen in different countries and different times (is there universality in the relationship between people, places, and times)?
    • Example 1: Do both A and B get cholera as long as they drink tap water?
    • Example 2: Does A or B have AIDS as long as he is a male homosexual?
  • Relationship strength
    Whether the effect is quantitative (whether the quantity-response relationship holds)
    • Example 1: The more you drink tap water, the more choleraMorbidityWill go up
    • Example 2: The more you do homosexuality, the more AIDSMorbidityWill go up
  • Relationship specificity
    Is there a cause where there is a cause and a cause where there is a result?
    • Example 1: Is the person who drank tap water affected by cholera and is the cholera patient drinking tap water?
    • Example 2: Male homosexuals have AIDS, and is AIDS male homosexual?
  • Related temporality
    Is the order of cause → result
    • Example 1: Tap water → Cholera
      Wasn't it just drinking tap water after having cholera?
    • Example 2: Male homosexuality → AIDS
      Isn't it just that I became a male gay after I got AIDS?
  • Association coherence
    Is it consistent with the known knowledge system?
    • Example 1: Is there a consistency between previous research on tap water and cholera and this hypothesis?
    • Example 2: Is there a consistency between previous research on male homosexuality and AIDS and this hypothesis?

Analytical epidemiology

Patient Control Study (Case Control Study)

Outcome control studies in medicinePatient-control studyThat.Case-control study Both are also called results-controlled studies. First, for one illness, patients and non-patients are collected to form two groups.

patientContrast
PeoplePeople

Each of them is further divided into two whether or not they were exposed to the exposure factor, and the causal relationship between the etiology and the disease is investigated using a quadrant.


patientContrast
Exposed to △△PeoplePeople
Not exposed to △△PeoplePeople


  • 利 点
    • Individuals can also conduct research by collecting patients (and their medical records). (())
      • Example 1: A cholera patient and a healthy person (=control) are extracted from the population, and then it is examined whether or not they are drinking tap water.
patientContrast
Drinking tap waterWasPeoplePeople
Not inPeoplePeople
  • Information system errorIs hard to enter
    • Example 1: If you ask the residents, you will almost certainly know if you are drinking tap water or well water.
  • Can handle rare diseases
  • Disadvantage
    • Selection system errorIs easy to enter
      • Example: Initially reported AIDS patients do not have the average composition of the world, and since they are only male homosexuals, the incidence is higher than the average. →We have to extract AIDS patients and controls (healthy people, etc.) from the population and check if they are male homosexuals.
patientContrast
Male gaythere werePeoplePeople
AbsentPeoplePeople

Factor control study

Factor is
There wasThere was no
PeoplePeople
Of the person
Affected

A study that collects the same number of people with etiology (exposure group) and people without etiology (non-exposure group) to find out how many are ill or will get sick in the future. Especially in the case of prospective studies with follow-up studies in the future.Cohort studySay (cohort study). A cohort study in medicine will be a national project to follow large numbers of people for many years.

Clinical trial

Intervention research in medicineClinical trialSay. Among clinical trials, there are clinical trials conducted by pharmaceutical companies in order to approve new drugs or apply for new applications of existing drugs.Clinical trialSay In a companyClinical development departmentWill do this. In JapanDoctorThere are few conducted clinical trials,Clinical researchIt was pointed out that thePharmaceutical Affairs LawFrom July 7, the following yearEnforcementThen, doctors and medical institutions have become able to carry out clinical trials. All clinical trialsExperiments targeting humansIs. Experiments with animals are called basic research before clinical trials.

  • Phase I study: drug safety in healthy subjectsPharmacokineticsConsider.Anti-cancer drugSuch obviously harmful drugs are targeted at patients as exceptions.
  • Phase II study: A study that evaluates whether a drug is effective in patients.
  • Phase III study: Find out if it is more effective than traditional medicines.At this stageRandomizedAnd are required.
  • Phase IV study: Collect information on efficacy and safety from general clinicians after launch of new drug.

Clinical epidemiology

Applying epidemiology to problems encountered in clinical medicine is called clinical epidemiology. It is a discipline that examines clinical parameters for the purpose of making clinical predictions for individual patients. classicphysicsProbability evaluation is used instead of deterministic prediction such as the equation of motion of.

Epidemiology of health

What is health epidemiology?Evidence-based medicineTheory and practice of evidence-based nutrition as part of[15].. Also called nutritional epidemiology.

Epidemiology of traffic accidents

Academics that analyze the causes of traffic accidents and help prevent them.

Business epidemiology

An academic study that analyzes the reasons for selling products and helps promote sales. However, epidemiology makes little use of this field in its fundamental sense. Because epidemiology is a natural scienceReproducibilityAlthough it is targeted at certain phenomena, in the social phenomenon of product salesReproducibilityBecause it is extremely difficult to find.

footnote

[How to use footnotes]
  1. ^ Pioneers of clinical research Vol.1 "Cholera"National Cardiovascular Research CenterLast updated 2010 years 12 month 01 Date
  2. ^ Japanese Epidemiological Society Translation, "Epidemiological Dictionary 3rd edition, International Epidemiological Society sponsored books" Japan Public Health Association, 2000,ISBN 978-4-8192-0167-4 .
  3. ^ Anders Ahlbom, Staffan Norell,Introduction to modern epidemiology 2nd ed, America: Epidemiology Resources ,1990/07/01,p.1,ISBN-0 917-22706-9
  4. ^ Kenneth J. Rothman, Sander Greenland,Modern epidemiology 2nd ed, America: Lippincott Williams & Wilkins, 1998/01/15,ISBN-0 316-75780-2
  5. ^
  6. ^ [1]
  7. ^ [2]
  8. ^ Japanese Epidemiology SocietySupervised "Easy learning for the first time-Invitation to epidemiology"Nankodo, 2002-10-10,ISBN-4 524-22468-8
  9. ^ R. Bonita: Basic Epidemiology, Second Edition, WHO,ISBN-978 9241547079
  10. ^ Makoto Matsuda "Ken Takagi, a man who lost beriberi" Kodansha ISBN-4 06-204487-0
  11. ^ Kurasako Kazunari "Let's see a sick person without illness, Baron Meihan -Kanehiro Takagi's life-" ISBN-4 906008-31-3
  12. ^ Uterine cervical cancer, side reactions, buried investigation Interview with Professor, Nagoya StudyJiji Medical 2019/06/11 16:45
  13. ^ [3]
  14. ^ "SUNY Downstate EBM Tutorial". library.downstate.edu. 2015/9/3Browse.
  15. ^ Others "Introduction to EBN-To understand lifestyle-related diseases", 2000/09,ISBN-4 804-10933-1

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