as 92 EPIDEMIOLOGY *” be pened Definition of Epidemiology Greek words a “epi” “Logos” “upent ee setuay “people: “demos” Learning Outcomes @ ® 5 > — ae a. oor “SS E ‘A Definition of Epidemiology easSTUDY OF... oN / Definition of Epidemiology C Definition of Epidemiology distribution, application of this determinants of study to q : health-related prevention & Uses variety of concepts: states / events in control of health + Biology x sociology problems * Demography x geography + environmental science * statistics spi opulations (Last, pI J ao! \* Policy analysis Other Descriptions of Epidemiology Epidemiology is a scientific “mg, Key terms that HERE) reflect important —:ctrenerd*™ DIES O + surveillance, | C + observation + hypothesis testing, + analytic research then + experiments a(~~ Other Descriptions of Epidemiology FREQUEN! Epidemiology fe concemed + Frequency refers to the number of le frequency and pattern of health events & the relationship of —————E—————— that number to the size of the . one by: population. + time and * compare disease occurrence across * classes of people affected different populations. Een (> Other Descriptions of Epidemiology + refers to occurrence of health-related events by time, place, and person. ontain all Time patterns may be annual, 1 Betocteat seasonal, weekly, daily, hourly, + physical weekday versus weekend, or any other + social breakdown of time that may influence =a disease or injury occurrence * generic behavioral factors that rBE Other Descriptions of Epidemiology Other Descriptions of Epidemiology PaO Nurse epidemiologists us® analytic epidemiology or epidemiologic studies to provide the “Why” and “How” of such events. + Focus & investigates cause of death, behaviors such as use of tobacco, positive health states, reactions to preventive regimens & provision / use of health services ‘pidemiologist is concemed about the ecive heath of people ins commundy or ulation. Jogist’s ‘patient’ is the community. + Comprise those with identifiable characteristics such as \ ‘occupational groups:Other Descriptions of Epidemiology peer Descriptions of Epidemiology ‘The aim of public-health is to promote, protect & restore potential for identity number of further spread good health otherpersons in community; * scientific methods of descriptive & analytic epidemiology in “diagnosing” health of a community & propose public health interventions to control & prevent disease in the community. kee Beginnings of Epidemiology Hippocrates exposure or who may have —_& interventions source that Been similar to prevent caused liness; “expos additional cases or recurrences, Beginnings of Disease associated wih cist & physica + Jom snow Investigation of Cola epiamicin 854 seat census & val eisaton of data esc pater moat ptr atePRACTICAL APPLICATIONS OF EPIDEMIOLOGY we Beginn [GH)pssessmentorneaim — [EB] Prevention & contro! Slee sah pay ea cance 4 Oa (excision | Montorng . ee ide atieni natal soy of valuation heath ‘mal showed protectwe effect ofthe vacone against (Seas causation {°F Policy formulation ano = Practical applications for PHN: Nurse epidemiologist measures frequency & distribution of heath Conditions using VITAL. ® “Geese Nurse epidemiologist raci rt pplication: EPIDEMIOLOGY is used to N ir PHN: ey analyze different factors that yr a - Contribute to disease developmentNatural Life History of Disease its course over time, starting from pre-pathogenesis stage to termination Natural Life History of a _ = Sm Disease [Esper Jae (ns) [aan [death _] Stages of Natural Stages of Natural History of Disease History of Disease preraiorenene Pathogenesis 1. Pre-pathogenesis Stage Stage Stage * Disease not started yet + Interrelations of agent, host & environment + There are factors that favor disease occurrence (ex. Malnourish) iy Oe + stimulus \ sSusceptibilty stage \Y+ Reaction of HOST & STIMULUS + Disease has already developed. + 3 sub — stages: + Discernible lesions + Advance disease Natural Life History of Disease Clinical data of patients with several stages of the disease are put together to determine its natural history aan A Disease Severity onset Natural Life History of Disease Pathogenesis Stage : 3 sub — stages 2. "creaomomnn, Penioge “hanger togan BNO emg arya log, Charger cet wth pated bet rsaiesientanes COVID-19 Natural history deathplot better because of Cohort study advantage in observing cohort FROM the time members are { = — disease- free to the time they =. develop the disease through its termination san — Natural Life History of Disease Natural Life History of Disease Prospective Cohort Study \~ Prospective Cohort Study | \ Natural Life History of Disease =) PREVENTION \ go Refers to identification of potential problems to minimize or eradicate possible disability or deformity eur Uf MiterLEVEL OF PREVENTION administered to patient is dependent ) LEVELS OF Jo PREVENTION on the stage of the disease when a me SA Moore & patient was diagnosed S Williamson LEVELS OF PREVENTION OF HEALTH PROBLEMS. Natural Life History of Disease & Application Z of Levels of Disease Prevention i Discernible Advanced! Prepathogenesis panageness iesons \ “Diseasea Directed Primary prevention to PRIMORDIAL SPECIFIC EVES OF healthy ‘ Phases Of Epidemiological Approach EPIDEMIOLOGICAL “——— _ APPROACHDescriptive Epidemiology Analytical Epidemiology Intervention or Experimental Evaluation Epidemiology EpidemiologyBasic steps are: Case finding / screening activites: | ‘Screening is the presumptive identifications of unrecognized diseases or defects Case finding is done to look for previously (_ identified cases of diseases Basic steps are: 2. Based on the operational definition, identify the cases Case classification A case that meets the clinical case defniton. xobable: A suspected case as defined above or ongoing epider i epidemiological lnk to a confirmed case. 0 ‘A suspected or probable case with laboratory confirmation Sensitivity is the proportion of persons with a disease who test positive on a screening test. Specificity is the proportion of persons without a disease who have negative results na screening test. Basic steps are: + Operationally define what consttute a “case” “case " classified as suspected probable while waiting for the laboratory results to become available, If laboratory provides report, case can is reclassified as either confirmed or “not a case”Basic steps are: 3, Based on the number of cases identified, verity 3. Based on the number of cases identified, verity re ee Aa os the existence of an outbreak Outbreak carries the same definition of epidemic but is often used for a more limited geographic area Cluster aggregation of cases grouped in place & time that are suspected to be greater than the umber expected, even though the expected \_ lumber may not be known. Basic stops are: 3. Based on the number of cases identified, verity Basic stops are: the existence of an outbreak 3, Based on the number of cases identied, verity EES A AETY ——_Meisloncectanoutbreak = 0000 oui ea Greenhills mall acts asPH records? "gg" 103259 10 eee new Goran virus cases Eh iyJ Basic stops are: + Operationally define what constitute a “case” STEPS OF Case Definition EPIDEMIOLOGICAL Itis a set of standard criteria for classifying INVESTIGATION whether a person has a particular disease, syndrome, or other heaith condition isBasic steps are: { 4. Establish the descriptive epidemiologic featur of the cases Time Variations CYCLICAL, VARIATION Correlate : char. Of grp of persons, place, Time \ , The occurrence of disease changes over, ae ime. Some of these changes occur Ow VARIATION gularly, while others are unpredictable. Basic steps are: a { Time Variations Place ( > Simultaneous exposure of a Tatge number of poopl to 8 ‘conmon nfechous agent b) PROPAGATED EPIDEM > Petsonto-person tansmiss shor Me: FLUCTURTIONS * geographic scope of the problem * geographic variation, Basic stops are: |- ero ng pod ot tre { + refers not only to place: ofresidence butte any geographic site K Berinentio diseaseBasic steps are: ey | infection MANS > Location of source of infection / host Host Host HERD *Depends on Exaesia) * Depends on mMivitNiea the number of au frequency of immunes contactPATTERN OF DISEASE OCCURRENCE SEASE OF EPIDEMIC | OCCURRENCE Situation when there is a marked upward fluctuation tae lisset-ts\ Male (1012) PATTERN OF DISEASE OCCURRENCE PATTERN OF DISEASE OCCURRENCE ENDEMIC ( ‘ Habitual presence of SPORADIC (ole om eRe Nola) geographic location enh eos Geen Oey i number of people relative to total ( PosteoPATTERN OF DISEASE OCCURRENCE Nurse characterize PANDEMIC worldwide occurrence X and ¥ bear to axes hat intersect at ight angie horgontl xa date or ne ines onset among cases ertcal ans number of cases ch ans i vided int equally ced intents eva for 2 aves may ier, pattern of disease ‘occurrence in terms of date or time onset | Indicated in EPIDEMIC OR ATTACK CURVE RVI toll) of the onset of illness among cases associated Pita oD sehr. Number of Cases Date of Onset of ness‘STEPS OF EPIDEMIOLOGICAL INVESTIGATION Basic steps are: rie toiesea 6. Based on cinical manifestations, incubation 5, Record the clinical manifestation of cases Period, available laboratory fnaings & other information gathered, formulate a hypothesis regarding probable etiologic agent. sources of infection, mode of vansmission & the best approach for controling an outbreak 7. Test hypotheses by collecting relevant specimens yn patients and from environment Formulate hypothesis about probable es e ar controling an outro etiologic agent, sources of infection, mode of transmission outbreak __ ee | 3398 22/0" Re has [me =F |‘STEPS OF EPIDEMIOLOGICAL INVESTIGATION the bes “MONITORING & 1e ic steps : 8. Based on the results of EVALUATION OF y / i investigation, implement prevention HEALTH and control measures to prevent INTERVENTIONS recurrence of a similar outbreak. 9. Disseminate findings of investigation through media and other forms to inform ublicMonitoring (Ongoing actvty during program implementation to assess currnt status ofits implementation, Mentor ints af: 01 | comer o desiano 02 |) tensiness Despite being red Mars 03 | stata cota place Monitoring result enables team to: Have tool or quay assurance & 04 nenageet Measure achievement of mito 05 program objectives: 06 | | Lavine groundwork tor program evaluation Monitoring result enables team to: 01 | | poor wptomeriaton 02 entity problems 03. | | Toke corrective action EVALUATION 0,ae EVALUATION Describe as systematically & objectively nan Outcome Evaluation. Evaluates the extent to which a project accomplishes its intended results. petemance WY retenrce @ It measures program effects in the target population by assessing the progress in the ‘outcomes or outcome objectives that the program is to achieve 4 EVALUATION EVALUATION Impact Evaluation. Comparisons are based on observations of Impact Evaluation. different groups at the same time or of the a same group at different points over time. assesses in interval the program ca G effectiveness in achieving its ultimate goals Done to measure & compare these The essence of impact evaluation is for differences & conclude whether or not fcompericonl ‘observed differences may be attributes to 4 A the project