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In The Name of The Almighty: Epidemiology Definition Epidemiology Definition
In The Name of The Almighty: Epidemiology Definition Epidemiology Definition
Epidemiologic Orientation to
In the name of the Almighty
Health and Disease
Alipasha Meysamie, MD, MPH
Professor in CPM
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Alipasha Meysamie, MD, MPH Epidemiologic Orientation to Health and Disease
Professor in Community and Preventive Medicine
Meysamie@tums.ac.ir
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Alipasha Meysamie, MD, MPH Epidemiologic Orientation to Health and Disease
Professor in Community and Preventive Medicine
Meysamie@tums.ac.ir
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Alipasha Meysamie, MD, MPH Epidemiologic Orientation to Health and Disease
Professor in Community and Preventive Medicine
Meysamie@tums.ac.ir
The fallacy of looking the numbers The fallacy of looking the numbers
instead of rates instead of rates
two modes of Automobiles Private • Clinically oriented studies usually focus
transportation Aviation only on the numerator, such as
Number of 1,000 50 – The fatalities in the chart, or
fatalities per – The number of sick persons who seek
year medical care.
Number 100,000 1,000
exposed to
risk
Rate of fatal 0.01 0.05
injury
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Alipasha Meysamie, MD, MPH Epidemiologic Orientation to Health and Disease
Professor in Community and Preventive Medicine
Meysamie@tums.ac.ir
Stage of Susceptibility :
Stage of Susceptibility
Risk factors
• Disease has not developed but • Factors whose presence
– The presence of factors that favor its occurrence. – Associated with an increased probability
– For example, • That disease will develop later.
• Fatigue and acute and chronic alcoholism
– Heighten susceptibility to pneumonia; • The need to identify such factors
• Inadequate maternal nurturing
– More apparent
– Predisposes to emotional illness;
• High serum cholesterol levels • Because chronic diseases represent our major
– Increase the probability of overt coronary heart disease; health challenge.
• Immune suppression • Epidemiologic Transition
– Increase the risk of developing cancer.
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Alipasha Meysamie, MD, MPH Epidemiologic Orientation to Health and Disease
Professor in Community and Preventive Medicine
Meysamie@tums.ac.ir
Stage of Pre-symptomatic
Stage of Clinical Disease
Disease
• No manifestation of disease, • Sufficient end-organ changes have
– But pathogenetic changes have started to occur. occurred
• Changes below – Recognizable signs or symptoms of
– The level of the "clinical horizon," disease.
– The imaginary dividing line
• Above which disease manifests itself
• Several possible bases for classification
– Through detectable signs or symptoms. of this stage
– Examples – Based on
• Atherosclerotic changes in coronary vessels
• Morphological subdivision or
– Prior to any signs or symptoms of illness,
• Pre-malignant and malignant alterations in tissue. • Functional or
• Therapeutic considerations.
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Alipasha Meysamie, MD, MPH Epidemiologic Orientation to Health and Disease
Professor in Community and Preventive Medicine
Meysamie@tums.ac.ir
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Alipasha Meysamie, MD, MPH Epidemiologic Orientation to Health and Disease
Professor in Community and Preventive Medicine
Meysamie@tums.ac.ir
Death
Clinical F
Health status spectrum Disease E Chronicity
Clinical Horizon
D Residual
B In apparent
In apparent or Disability
A Abortive Condition C
Undiagnosed Sub clinical No
Healthy Disease
Overt Disease Condition Disability
Stage of Pre Disability or
Disease Susceptibility symptomatic Clinical disease
Recovery
Insusceptible Susceptible No irreversible Irreversible
Morbidity Morbidity Tissue Resolution or
Pre Pathogenesis Pathogenesis
(Disability) (Disability) Changes Sequel
Level of Secondary
Prevention Primary
Tertiary
Early
Mode of Health Promotion diagnosis Treatment & Rehabilitation
Intervention Specific protection Prompt Limitation of disability
treatment
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Alipasha Meysamie, MD, MPH Epidemiologic Orientation to Health and Disease
Professor in Community and Preventive Medicine
Meysamie@tums.ac.ir
٩
Alipasha Meysamie, MD, MPH Epidemiologic Orientation to Health and Disease
Professor in Community and Preventive Medicine
Meysamie@tums.ac.ir
Death
Clinical F
Disease E Chronicity
Clinical Horizon
D Residual
B In apparent
In apparent or Disability
Sub clinical A Abortive Condition C
No
Condition Disability
Stage of Pre Disability or
Disease Susceptibility symptomatic
Clinical disease
Recovery
Tissue Resolution or
Pre Pathogenesis Pathogenesis
Changes Sequel
Level of Secondary
Prevention Primary
Tertiary
Early
Mode of Health Promotion diagnosis Treatment & Rehabilitation
Intervention Specific protection Prompt Limitation of disability
treatment
١٠
Alipasha Meysamie, MD, MPH Epidemiologic Orientation to Health and Disease
Professor in Community and Preventive Medicine
Meysamie@tums.ac.ir
١١
Alipasha Meysamie, MD, MPH Epidemiologic Orientation to Health and Disease
Professor in Community and Preventive Medicine
Meysamie@tums.ac.ir
١٢
Alipasha Meysamie, MD, MPH Epidemiologic Orientation to Health and Disease
Professor in Community and Preventive Medicine
Meysamie@tums.ac.ir
SUMMARY
• Rates
– Presented as fundamental tools in epidemiology.
• Model of the natural history of disease
• Risk factor
– Increase the likelihood of disease development
• Personal and societal impacts of the stages of
disability.
• Levels of prevention
– Primary, secondary and tertiary
– Outlined and developed in relation to the natural
history
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