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Week 5 CHN
Week 5 CHN
Week 5 CHN
EPIDEMIOLOGY
Learning Outcomes
1 2 3
Describe The Compare, contrast Describe key features
Concept Of the different stages of and applications of
Epidemiology natural history of descriptive
disease epidemiology
Definition of Epidemiology
Greek words
“epi” “Logos”
“demos”
Definition of Epidemiology
Process of Epidemiological
Study
1. Epidemiology is a scientific
discipline with sound methods of
STUDY scientific inquiry at its foundation
• Epidemiology is data-driven
• Comprises of:
• surveillance,
• observation,
• hypothesis testing,
• analytic research then
• experiments
Other Descriptions of Epidemiology
Epidemiology is concerned
2.
DISTRIBUTION
with
the frequency and pattern of
health events in a population:
• Analysis by:
• places
• time and
• classes of people affected
FREQUENCY
Contain all
• biological
• chemical
• physical
• social
• cultural
• economic
• generic behavioral factors that
influence health
Other Descriptions of Epidemiology
DETERMINANTS
REFERS to any factor, whether
event, characteristic, or other
definable entity, that brings about a
change in a health condition or
other defined characteristic.
Other Descriptions of Epidemiology
potential for
number of further spread
identify
other persons in community;
exposure or
who may have & interventions
source that
been similarly to prevent
caused illness;
exposed; additional cases
or recurrences.
Other Descriptions of Epidemiology
6.
APPLICATION
The aim of public-health is to
TO promote, protect & restore
PREVENTION
AND CONTROL good health
• scientific methods of descriptive &
analytic epidemiology in “diagnosing”
health of a community & propose
public health interventions to control
& prevent disease in the community.
Beginnings of
Epidemiology
Beginnings of Epidemiology
● Hippocrates
● John Snow
○ Investigation of Cholera epidemic in 1854
● William Farr
○ Use of census & vital registration of data
○ described pattern of mortality pattern in subgroups such
as occupational group, prisoners & other age-group
Beginnings of Epidemiology
● Framingham Heart Study
○ identified the risk factors for coronary heart disease
● Jonas Salk
○ Developed and introduced in 1955 the Salk Vaccine. Field
trial showed protective effect of the vaccine against
paralytic poliomyelitis.
PRACTICAL APPLICATIONS OF
EPIDEMIOLOGY
EPIDEMIOLOGY is used to
analyze different factors that
contribute to disease
development
Aids in ranking Identify RISK
health problems FACTORS
Practical
applications
for PHN: MONITOR & Design targeted
EVALUATE health
interventions INTERVENTION
Natural Life
History of
Disease
Natural Life History of Disease
its course over time, starting from
pre-pathogenesis stage to
termination
Stages of Natural
History of Disease
Pre-pathogenesis Pathogenesis
Stage
Stage
1. Pre-pathogenesis Stage
• Disease not started yet
• Interrelations of agent, host & environment
• There are factors that favor disease occurrence (ex.
Malnourish)
- stimulus
• Susceptibility stage
Stages of Natural Stage
2. Pathogenesis
History of Disease
• Reaction of HOST & STIMULUS
• Disease has already developed.
• 3 sub – stages:
• Pre-symptomatic
• Discernible lesions
• Advance disease
Natural Life History of Disease
Pathogenesis Stage : 3 sub – stages
Pre-symptomatic
or Early-pathogenesis. Pathologic
changes began, but NO symptom
Discernible lesions
Early s/s developing. Changes
discernible with sophisticated lab test.
Advance disease
Anatomical & functional changes
produced identifiable s/s
Natural Life History of Disease
By Moore &
Williamson
Natural Life History of Disease & Application
of Levels of Disease Prevention
Tertiary Tertiary
Prevention Prevention
Primary Secondary
Prevention Prevention
-Arrest disease
process to -Limit disability,
prevent prevent death
complication
Primary
prevention Directed
to
LEVELS OF
PREVENTION
healthy
people
Primary prevention
PRIMORDIAL SPECIFIC
PREVENTION PROTECTION
focusing on prevention Removal of the risk
of emergence of risk factors of reduction of
factors their levels
LEVELS OF PREVENTION
Primary prevention
HEALTH SPECIFIC
PROMOTION MEASURES
Activities include provision of
proper nutrition, safe water supply Includes provision of
& waste disposal system, vector immunization & prophylaxis to
control, promotion of healthy vulnerable or at-risk groups
lifestyle & good personal habits
LEVELS OF PREVENTION
Secondary Aims to
prevention
identify & treat
existing health
LEVELS OF
problems at
PREVENTION earliest
possible time.
Tertiary Limits disability
prevention progression.
Reduce magnitude
of residual effects
of both infections
LEVELS OF and non-
PREVENTION communicable
disease.
Concept of causality and association
● HENLE-KOCH Postulate
states cause of a disease is
event, condition,
characteristic or
combination of these factors
that play an vital role in
generating disease
Concept of causality and association
● NECESSARY CAUSE
fact that the factor
must be present for the
disease to occur.
Concept of causality and association
● SUFFICIENT CAUSE
if a factor is present, disease
CAN occur, but the factor’s
presence DOES NOT ALWAYS
result in the disease
occurrence.
Concept of causality and association
● RISK
probability of an
unfavorable event,
disease, disability,
defect or even death.
Concept of causality and association
●ASSOCIATION
concurrence of two variables
more often than would be
expected by chance, then two
variables under investigation
are said to be associated.
MODELS OF
DISEASE
CAUSATION
MODELS OF DISEASE
CAUSATION
ecological
wheel web
triad
The Wheel Model of
Disease Causation
Parts
Inner Outer Outer
core Core Edge
MODELS OF DISEASE CAUSATION
Wheel :Inner Core
Host Characteristics
– ex. sex, age,
socioeconomic
status & behaviors
Represents the
biologic, physical
& chemical
environments
MODELS OF DISEASE CAUSATION
The WEB MODEL
OF DISEASE
CAUSATION
shows complex
interrelatedness
of risk factors
The WEB MODEL OF
DISEASE CAUSATION
Applicable For
Non -
Communicable
Disease
The WEB MODEL OF
DISEASE CAUSATION
*external agent,
*susceptible host
*environment that
brings them
together
The Ecological Triad
Depicts the “Multiple Theory of Disease Causation”
occurrence of disease is
balance of host, agent &
environment factors
HOST
a susceptible human host
Non
Specific
specific
AGENT is the
factor / forces that
precipitate disease
occurrence.
AGENT
- vir ulent
- incr ease in
number
Agents are
• Who is sick?
• What are their symptoms?
• When did they get sick?
• Where were they exposed
to the illness?
EPIDEMIOLOGICAL
APPROACH
Descriptive Analytical
Phases Of Epidemiology Epidemiology
Epidemiological
Approach
Intervention or
Experimental Evaluation
Epidemiology
Epidemiology
Descriptive Epidemiology
• Describes frequency &
distribution of disease in given
population
• Observes & records existing
pattern of occurrence of disease.
• Describes disease as to: person,
place & time characteristics.
Analytical
Epidemiology
Attempts to analyze the
causes or determinants
of disease through
hypothesis testing
Intervention or
Experimental
Epidemiology
Answers questions about the
effectiveness of new
methods for controlling
diseases or for improving
underlying conditions
Evaluation
Epidemiology
Attempts to measure
the effectiveness of
different health
services and programs
STEPS OF
EPIDEMIOLOGICAL
INVESTIGATION
Basic steps are:
1. Operationally define what constitute a “case”
Case Definition
It is a set of standard criteria for classifying
whether a person has a particular disease,
syndrome, or other health condition
Basic steps are:
Case classification
Suspected: A case that meets the clinical case definition.
Probable: A suspected case as defined above or ongoing epidemic
and epidemiological link to a confirmed case.
Confirmed: A suspected or probable case with laboratory confirmation.
Basic steps are:
1. Operationally define what constitute a “case”
Cluster
aggregation of cases grouped in place & time
that are suspected to be greater than the
number expected, even though the expected
number may not be known.
Basic steps are:
3. Based on the number of cases identified, verity
the existence of an outbreak
Basic steps are:
3. Based on the number of cases identified, verity
the existence of an outbreak
Basic steps are:
4. Establish the descriptive epidemiologic features
of the cases
EXPOSURE • Depends on
RATE /
CONTACT frequency of
RATE contact
Host
• Depends on
HERD
IMMUNITY the number of
immunes
PATTERN OF
DISEASE
OCCURRENCE
PATTERN OF DISEASE OCCURRENCE
EPIDEMIC
Situation when there is a
marked upward fluctuation
in disease incidence
PATTERN OF DISEASE OCCURRENCE
ENDEMIC
Habitual presence of
disease in a given
geographic location
PATTERN OF DISEASE OCCURRENCE
SPORADIC
When disease occur every now
and then affecting only small
number of people relative to total
population
PATTERN OF DISEASE OCCURRENCE
PANDEMIC
worldwide
occurrence
Nurse characterize
pattern of disease
occurrence in terms of
date or time onset is a visual display
indicated in EPIDEMIC of the onset of
illness among
OR ATTACK CURVE
cases associated
with an outbreak.
“epi curve”
X and Y Axes
two axes that intersect at right
angles.
horizontal x-axis date or time
of illness onset among cases.
vertical y-axis number of cases.
01 Compliance to design of
program
02 Timeliness
01 Assess progress of
program implementation
02 Identify problems
Outcome Evaluation.
Evaluates the extent to which a project
accomplishes its intended results.
It measures program effects in the target
population by assessing the progress in the
outcomes or outcome objectives that the
program is to achieve
EVALUATION
Impact Evaluation.
assesses in interval the program
effectiveness in achieving its ultimate goals
The essence of impact evaluation is for
comparison.
EVALUATION
Impact Evaluation.
Comparisons are based on observations of
different groups at the same time or of the
same group at different points over time.
,
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Cognitive:
1. Describe Epidemiology.
2. Compare and contrast the different stages of natural history of disease
3. Outline process of epidemiological investigation
Affective:
1. Listen attentively during class discussions
2. Demonstrate tact and respect when challenging other people’s opinions and ideas
3. Accept comments and reactions of classmates on one’s opinions openly andgraciously.
4. Develop heightened interest in studying Community Health Nursing.
Psychomotor:
1. Participate actively during class discussions and activities
2. Express opinion and thoughts during class
Famorca, Z. et al., (2013). Nursing Care of the Community, a comprehensive text on community
and public health nursing in the Philippines. Sauders
Agents.
Any element, substance or force, either animate or inanimate which may serve as stimulus to initiate a
disease process.
Case Definition.
It is a set of standard criteria for classifying whether a person has a particular disease,
syndrome, or other health condition.
Epidemiology.
The study of the occurrence and distribution of health condition such as disease, death, deformities on
human population. It is a highly quantitative discipline based on principles of statistics and research
methodologies.
Environment.
Sum total of all external conditions and influence that affect the life and development of an organism.
Herd Immunity.
The probability of a group or community developing an epidemic upon introduction of infectious agent.
Host.
is the actual or potential recipient or victim of the disease. Hosts have characteristics that either
predispose them to or protect them from disease
Risk.
Probability of unfavorable event, disease, disability, defects or even death.
WHAT IS EPIDEMIOLOGY?
Originated from Greek words “epi” meaning “upon” and “demos” meaning people. “Logos” means
“study.”
Epidemiology is the study of the distribution and determinants of health-related states or events
in specified populations and the application of this study to the prevention and control of health
problems. (Last, 1988)
In the process of epidemiological study, it uses variety of concepts from biology, sociology,
demography, geography, environmental science, policy analysis and statistics.
Beginnings of Epidemiology
• Hippocrates
• Disease is associated with climate & physical environment
• John Snow
• Investigation of Cholera epidemic in 1854
• William Farr
• Use of census & vital registration of data
• described pattern of mortality pattern in sdubgroups such as
occupational group, prisoners & other age-group
• Framingham Heart Study
• identified the risk factors for coronary heart disease
• Richard Doll and Bradford Hill
• Doll and Hill's Study
• Provided compelling evidence of the role of smoking in the incidence of
lung cancer
• Jonas Salk
• Developed and introduced in 1955 the Salk Vaccine. field trial showed
protective effect of the vaccine against paracytic poliomyelitis.
Epidemiology is further described in the following terms:
TERM DESCRIPTION
STUDY Comprises of surveillance,
observation, hypothesis testing,
analytic research then
experiments
DISTRIBUTION Denotes to an analysis by time,
places and classes of people
affected
Aids in ranking
health problems
Identify RISK
FACTORS
The natural history of a disease is its course over time, starting from the pre-pathogenesis stage to its
termination. The stages are as follow:
Clinical data of patients with several stages of the disease are typically put together to determine the
natural history of a specific disease.
A prospective cohort
study could plot it better
because of the
advantage of observing
the cohort from the time
that the members are
disease- free to the time
they develop the disease
through its termination.
To understand disease causation in epidemiology, there are several models being utilized in
epidemiological study, these are The Wheel, The Web and Epidemiological Triad.
The simplest of these is the epidemiologic triad or triangle. The triad consists of an
external agent, a susceptible host, and an environment that brings the host and agent
together.
In this model,
disease results
from the
interaction
between the agent
and the susceptible
host in an
environment that
supports
transmission of the
agent from a
source to that host.
EPIDEMIOLOGICAL TRIANGLE
Also known as epidemiologic triad or triangle model views the occurrence of disease as the balance
of host, agent, and environment factors
Epidemiologic triad (or epidemiologic triangle),
The host is the actual or potential recipient or victim of the disease. Hosts have characteristics that
either predispose them to or protect them from disease. Those characteristics may be biological (e.g.,
age, sex, and degree of immunity), behavioral (e.g., habits, culture, and lifestyle), or social (e.g.,
attitudes, norms, and values).
The environment includes all external factors, other than the host and agent, that influence health. It
is categorized as :
Agent can be divided in terms of the following:
EPIDEMIOLOGICAL APPROACHES
Descriptive Epidemiology.
Consist of disease distribution and
frequency.
Analytical Epidemiology
Attempts to analyze the cause or
determinants of disease through
hypothesis testing
Intervention or Experimental
Epidemiology
Answers questions about the effect of
new methods for controlling diseases or
for improving underlying conditions
Evaluation Epidemiology
Attempts to measure the effects of
different health services and program
Descriptive Epidemiology is concerned with describing the frequency and distribution of disease in a
given population. This is by observing & recording existing pattern of occurrence of disease.
Describing disease as to person, place and time characteristics. Host is described in terms of herd
immunity, exposure rate, chance.
Epidemic is a situation when there is a marked upward fluctuation in disease incidence. An endemic.
Is habitual presence of disease in given population. In sporadic, disease occurs every now and then
affecting small number of populations. Pandemic is a worldwide occurrence of disease.
2. SECULAR VARIATION
Changes in the TREND of disease occurrence
over a long period of time.
Monitoring Is an ongoing activity during program implementation to assess the current status of its
implementation.
It is monitor in terms of the following :
❖ Compliance to design of program
❖ Timeliness
❖ Attainment of midterm goals
EVALUATION
This is describe as systematically and objectively assesses compliance to the design of the program,
performance, relevance and success of project
Outcome Evaluation.
Evaluates the extent to which a project accomplishes its intended results.
It measures program effects in the target population by assessing the progress in the outcomes or outcome
objectives that the program is to achieve
Impact Evaluation.
Impact evaluation assesses in interval the program effectiveness in achieving its ultimate goals
The essence of impact evaluation is for comparison.
This comparisons are based on the observations of different groups at the same time or of the same
group at different points over time.
This is done to measure and compare these differences and conclude whether or not observed
differences may be attributes to the project.
Epidemiology - The study of the distribution and determinants of health-related states in
specified populations, and the application of this study to control health problems.
Fomites - articles that are easily contaminated by pathogens from the respiratory, intestinal
tract and skin
Inanimate (Non Living) Reservoirs - air, soil, food, milk, water, fomites
https://olfu.instructure.com/courses/1485/quizzes/124335?module_item_id=2040407
Quiz on Epidemiology