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The authors of Medical Epidemiology are pleased to introduce the fourth edition of this book. Much has transpired in the field of epidemiology since the publication of the previous edition of this book just a few years ago. In September and October of 2001, several letters containing powders with spores of Bacillus anthracis were mailed in the United States, resulting in 22 cases of anthrax and five deaths. This episode emphasized the potential threat to human health that can arise when biological agents are used as weapons by terrorists. It also underscored the role that epidemiology can play in investigating and controlling such exposures.

Not much more than a year later, the world witnessed the dramatic emergence of a novel coronavirus, resulting in an epidemic new illness, Severe Acute Respiratory Syndrome (SARS). The rapid spread of this infection around the globe was aided by the highly contagious nature of this disease and the frequency of international travel. Through global cooperation, epidemiology once again proved to be critical in identifying and controlling an emerging infectious disease.

Accordingly, this new edition of Medical Epidemiology appears at a time when there is great focus on the role of epidemiology in studying both natural and man-made influences on human health. Moreover, the fast pace of external events reminds us of the importance of presenting the most current information possible. As with previous editions, we have updated information on patterns of disease occurrence and presented new self-assessment questions at the end of each chapter.

Although this book has been extensively revised, it remains faithful to the original intent of the authors&#151to provide a text that would serve the basic needs of medical students, as well as students of other health disciplines, such as public health, nursing, pharmacy, and dentistry. It is written concisely and can be used as a course textbook or as a stand-alone study guide.

The aim of this book is to provide the reader with an overview of the principles and concepts of epidemiology. In so doing, it attempts to illustrate the complementary relationship between population-based science and the care of patients. Specific topic areas include:

• Measuring disease frequency
• Describing patterns of disease occurrence
• Investigating outbreaks of disease
• Assessing the utility of diagnostic tests
• Testing the effectiveness of treatments
• Identifying the causes of diseases
• Predicting the outcome of illness
• Decision-making about treatment strategies
• Summarizing evidence on clinical questions

Upon completion of this book, the reader should be able to calculate and interpret basic epidemiologic measures, recognize the various epidemiologic study designs with their respective advantages and limitations, understand the concepts of variability and bias, and characterize the means by which clinical evidence can be systematically summarized for decision-making.

From the first edition of this book to the present version, the authors have taken the viewpoint that epidemiology should be both an understandable and interesting topic for students of the health professions. In order to introduce the topic in that manner, the following elements are emphasized:
• Conceptual topics are explained in nontechnical language.
• Liberal use is made of illustrations to facilitate comprehension and retention of material.
• The most current information available is presented on disease patterns and risk factors.
• Key concepts are highlighted for emphasis, with summaries at the beginning and end of each chapter.
• The relationship between population-based science and patient care is demonstrated through patient profiles.
• A full range of clinical areas of application is shown, including infectious diseases, cancer, Alzheimer's disease, and perinatal disorders.
• Critical formulas and equations are provided without undue emphasis on the mathematical applications of epidemiology.
• Questions are provided in standardized test format at the end of each chapter to help the student assess their knowledge and prepare for examinations.
• An updated glossary is provided to help the student master the vocabulary of epidemiology.

If the response to the first three editions of this book is any indication, this approach is appealing to students of the health professions. The authors hope that the present edition continues to satisfy the demand for an engaging introductory text in epidemiology.

Raymond S. Greenberg, MD, PhD
Charleston, South Carolina
September, 2004

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