INTRO TO EPIDEMIOLOGY

Question 1

Study of factors that determine the occurrence and distribution of disease in a population.

Answer 1

Epidemiology

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Public health professionals who investigate patterns, causes of disease, and injury to humans.

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Epidemiologists

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TYPES OF EPIDEMIOLOGY (CCCSI)

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Classical
Clinical
Chronic Disease
Syndromic
Infectious Disease

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○ Population oriented
○ Studies the community origins of health problems

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Classical Epidemiology

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○ More on community
○ Interested in discovering risk factors

■ Risk factors that might be altered in a population to prevent or delay a disease and even death.

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Classical Epidemiology

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○ Studies patients in health care settings
○ Improve prevention, early detection, diagnosis, treatment, prognosis, and care of illness in individuals

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Clinical Eidemiology

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○ Investigators involved in ______ epidemiology, use the same research designs and statistical tools used in classical epidemiology.

○ More on health care settings

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Clinical Epidemiology

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○ Looks for patterns of signs and symptoms that indicate the origin in bioterrorism.

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Syndromic Epidemiology

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○ Study of the complex relationships among hosts and infectious agents.

○ Dependent more on laboratory support, especially on microbiology and serology.

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Infectious Disease Epidemiology

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○ Addresses the etology, prevention, distribution, natural history, and treatment outcomes of chronic health disorder.

○ Dependent on complex sampling and non-statistical methods.

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Chronic Disease Epidemiology

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• Population oriented
• Focus on health problems in the community (e.g., infectious agents, human behavior; social, economical)

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Classical

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• Patient oriented
• Focus on health problems in the health care settings

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Clinical

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• Patterns of signs and symptoms
• Useful to indicate an origin in bioterrorism

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Syndromic

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Investigates occurrence of epidemics of communicable diseases

-Dependent heavily on laboratory support (microbiology and serology)

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Infectious disease

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• Study long term effects on chronic disease risk of physical and social exposure
• Dependent on sampling and statistical methods

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Chronic disease

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The scientific study of disease can be approached at the following four levels:

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Submolecular or Molecular Level
Tissue or Organ Level
Level of Individual Patients
Level of Populations

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Cell Biology, Genetics, Biochemistry, and Immunology

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Submolecular or Molecular Level

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Anatomic Pathology

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Tissue or Organ Level

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Clinical Medicine

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Level of Individual Patients

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Epidemiology

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Level of Populations

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STAGES OF DISEASE

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Pre-Disease
Latent Disease
Symptomatic Disease

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Before the disease process begins

Primary Prevention -to avert exposure to the agent of disease to prevent the disease process from starting

-Health Promotion
-Specific protection

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Pre-Disease

Question 23

when the disease process has already begun but still asymptomatic

Secondary Prevention -Screening for the disease diagnosis and provide appropriate treatment to prevent progression to symptomatic disease

-Pre - symptomatic
-Diagnosis and Treatment

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Latent Disease

Question 24

when the disease manifestations are evident

Tertiary Prevention -intervention may slow arrest or reverse the progression of the disease

-Disability limitation for early symptomatic disease
-Rehabilitation for late symptomatic disease

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Symptomatic Disease

Question 25

When discussing the heterology of disease, epidemiologists distinguish between ___________ versus ________________________

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biological mechanisms / social, behavioral, and environmental causes of disease

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elevated cholesterol are smoking, excessive fat intake, and lack of exercise

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Behavioral factors

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■ a bone disease which has both biological and social causes ■ Weakening of the bone, usually through the deficiencies of vitamin D.

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Osteomalacia

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EPIDEMIOLOGIC TRIANGLE (HAVE)

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Host Agent Vector Environment

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○ Responsible for the degree to which the individual is able to adapt to the stressors produced by the agent

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Host Factors

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Host Resistance:

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Genotype Nutritional Status Body mass index Immune system Social Behaviour

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Agents of Disease or Illness (BPCS)

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Biological Agents Chemical Agents Physical Agents Social and Psychological Stressors

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Allergens, infectious organisms, biological toxins, foods

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Biological Agents

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Chemical toxins, dusts

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Chemical Agents

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Kinetic energy, radiation, heat, cold, noise, physical wounds

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Physical Agents

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Anxiety, Depression

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Social and Psychological Stressors

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○ Influences the probability and circumstances of contact between host and agent ○ E.g., poor restaurant sanitation, poor roads or adverse weather conditions, crowded homes or schools

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Environment

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○To be an effective transmitter of disease, a ______ must have a specific relationship to the agent, the environment, and the host May include: Insects, arachnids, mammals Human groups Inanimate objects Part of the environment

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Vectors

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RISK FACTORS AND PREVENTABLE CAUSES

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Intrinsic and Extrinsic Factors

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○ Genetics, nutritional status, reproductive activities, personal behavior

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Intrinsic factors

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○ Man–made or naturally occurring carcinogens, viral infections, etc ○ WHO estimates majority of cancer cases are potentially preventable

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Extrinsic factors

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Categories of Preventable Cause of Disease (BEINGS)

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Biologic factors and Behavioral factors Environmental factors Immunologic factors Nutritional factors Genetic factors Services, Social factors, and Spiritual factors

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Influenced by gender, age, weight, bone density, etc. Change in behavior could prevent the outward outcomes

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Biologic factors and Behavioral factors

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Epidemiologists describe the patterns of the disease, develop and test hypotheses about causal factors, and introduce methods to prevent further cases of disease

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Environmental factors

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- the epidemic was caused by an infectious agent which was distributed through the air conditioners and ventilation system

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Legionella Pneumophila

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■ FIrst infectious disease known to have been eradicated from the globe ■ This was possible because vaccination against the disease can cause individual immunity and produced herd immunity

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Smallpox

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When vaccine diminishes and immunized person’s ability to spread the disease, leading to reduced disease transmission If the majority of the population is vaccinated, the disease transmission may be reduced

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Herd Immunity

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■ Genetic abnormalities ■ Infections, certain medications

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Immunodeficiency

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Dietary variations play an important role in producing differences in disease rates among populations Burkitt suggested a mechanism by which high intake of dietary fiber might prevent diseases or greatly reduce their incidence

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Nutritional factors

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■ Addresses the distribution of normal and abnormal genes in a given population

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Genetic epidemiology

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■ Contribution of genes relative to all determinants of disease

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Heritability

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■ Important in identifying problems in newborn and in determining susceptibility genes

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Genetic screening

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■ May be beneficial to health but can also be dangerous

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Medical care services

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■ Occurs when a disease is induced inadvertently by treatment or during a diagnostic procedure

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Iatrogenic disease

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■ Personal beliefs, religious faith ■ Family support, social networks

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Social and Spiritual factors