10第十章病因与因果推断医学课件.ppt

病因和病因推断;主要内容 (outline);第一节 病因的概念 concepts of causation ;鬼神、上帝、天意;病因模型（causal model）;Model of Disease;宿主;环境;病因;病因;病因;病因;轮状模型（wheel model）;生物环境;生物环境;生物环境;病因网络模型（web of causation）;病因网络模型（web of causation）;BEINGS ModelPreventable causes of disease;A causal relationship would be recognized to exist whenever evidence indicates that the factors form part of the complex of circumstances that increases the probability of the occurrence of disease and that a diminution of one or more of these factors decreases the frequency of that disease. ----Lilienfeld (1980); Lilienfeld AM.（1920-1984） 约翰.霍普金斯大学流行病学教授;第二节 因果关联的推断 inference of causal association;Environmental Exposure or Genetic Background or Combination of Both;一、因果推断的一般过程Common process of causal inference;密尔氏准则 Mill’s canons;密尔氏准则（Mill’s canon) 求同法 （Method of agreement） 差异法 （Method of difference） 共变法 （Method of concomitant variation） 剩余法 （Method of exclusion）;If events or risk factors are common to a variety of different circumstances and the events or risk factors have been positively associated with a disease, then the probability of that factor being the cause is extremely high. ;The frequency of a disease occurrence is extremely different under different situations or conditions. If a risk factor or event can be identified in one condition and not in a second, it may be that factor, or the absence of it, that may be the cause of the disease. ;The frequency or strength of an event or risk factor varies with the frequency of the disease or condition. Increased numbers of children not immunized against measles causes the incidence rate for measles to go up.;Subduct from any phenomenon such part as is known by previous inductions to be the effect of certain antecedents, and the residue of the phenomenon is the remaining antecedents.; 病例对照研究（case-control study） 队列研究（cohort study）;二、病因推断中暴露因素与疾病关联的解释Association between exposure and disease in causal inference;Interpreting Associations- Causa