Beruflich Dokumente
Kultur Dokumente
Epidemiology
( 3 credit hr)
May, 2018
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Objectives of the course
– Describe the principles of Epidemiology
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UNIT ONE:
INTRODUCTION TO EPIDEMIOLOGY
EPIDEMIOLOGY
DEMIOS - People
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DEFINITIONS OF EPIDEMIOLOGY
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Key words in the definition are:
1. Frequency- how much? It occur in the population.
2. Distribution- who? where? And when? Is the occurrence of health and health related
events.
3. Determinants- factor which may be event, characteristic or any definable entity that brings
about change in health and health related conditions. It refers to “why diseases occur in
certain places? In a certain period? Or in a certain population groups?”
4. Health and health related events- epidemiology is concerned not only with disease but
events like birth, death, migration e.t.c.
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The central concern of epidemiology is promotion and maintenance of health through the
prevention of diseases. However, we have defined epidemiology in terms of disease.
This is because it is easier to define and measure disease, disability and death than to
produce operational definition of health.
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TWO BROAD TYPES OF EPIDEMIOLOGY
DESCRIPTIVE EPIDEMIOLOGY ANALYTIC EPIDEMIOLOGY
Examining the frequency and distribution of a Testing a specific hypothesis about the
basic features of its distribution in terms of conducting an epidemiologic study that relates
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TWO FUNDAMENTAL ASSUMPTIONS
2. Human disease has causal and protective factors that can be identified through systematic
investigation of different population or subgroups of individuals within population in different
places or at different times.
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SCOPE OF EPIDEMIOLOGY:
Since 5th
▲+ century
Endemic communicable diseases &
Non communicable diseases
▲+
Epidemic of communicable diseases
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HISTORY OF EPIDEMIOLOGY
Hippocrates in the 5th century (500 B.C.) expressed that environmental factors can
influence the occurrence of disease.
John Graunt-In 1662, the first time he quantified deaths and births
William Farr, 1839: Established vital statistics system as a source for health
information.
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DEVELOPMENTS IN MODERN EPIDEMIOLOGY
Observational Studies:
Case-control studies
Doll & Hill: in 1950 investigated the relationship between cigarette smoking
and lung cancer. Preliminary report.
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PURPOSES/USE OF EPIDEMIOLOGY:
1. population/community health diagnosis: To assess health of a community, relevant sources
of data must be identified and analyzed by time, person and place.
2. Individual decision:
• These and hundreds of epidemiologic findings have helped individuals to make decisions.
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3. Completing the clinical picture (elucidation of the natural history of diseases):
Epidemiologic findings contribute to physicians understanding of the clinical
picture & natural history of disease.
4. Search for causes of diseases: It has been said that epidemiology can never
prove causative, but provides enough information for action.
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5. Classification of diseases: e.g. based on route of transmission
- Gonorrhea- as STD
- Shigellosis- under diarrhea diseases based on its clinical manifestation of diarrhea and as
fecal-oral route of transmission.
6. Monitoring of health programs: Efficiency, effectiveness, feasibility and impact any program
designed to prevent and control a disease must be accompanied by methods for assessing
whether the measures are effective in reducing the frequency of the disease.
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CONCEPT OF DISEASE CAUSATION:
Definition:
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WHAT DOES CAUSE DISEASE?
There are different theories :
A. Supernatural
B. Hippocratic
C. Single germ
D. Classic epidemiologic
E. Ecological
F. Multifactorial causation
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SUPERNATURAL THEORY:
• In the early past, disease was thought mainly due to either the curse of God or
due to the evil force of the demons.
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HIPPOCRATIC THEORY:
• Hippocrates is credited with being the first physician to reject superstitions
and beliefs that credited supernatural or divine forces with causing illness.
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THE SINGLE GERM THEORY
HENLE-KOCH POSTULATES:
Sometimes called “pure determinism”
• Each disease will be caused by a germ
• And that germ can again be isolated from that sick animal experimented with.
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CLASSIC EPIDEMIOLOGIC THEORY
Agents
Living organisms
Exogenous chemicals
Genetic traits
Psychological factors and stress
Nutritive elements
Endogenous chemicals
Physical forces
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Host factors:
– Host behavior
Environmental factors:
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THE ECOLOGICAL THEORY
• Since disease arises within an ecological system, a basic principle of epidemiology
is that an ecological approach is necessary to explain the occurrence of disease.
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MULTIFACTORIAL CAUSATION THEORY
• Petten koffer contradicted the unifactorial theory of disease causation and
emphasized that disease is multifactorial in causation.
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CAUSAL RELATIONSHIPS:
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Types of Causal Relationships
Necessary and sufficient – without the factor, disease never
develops
With the factor, disease always develops (this situation rarely
occurs)
Necessary but not sufficient – the factor in and of itself is not enough
to cause disease
Multiple factors are required, usually in a specific temporal
sequence (such as carcinogenesis)
Sufficient but not necessary – the factor alone can cause disease,
but so can other factors in its absence
Benzene or radiation can cause leukemia without the presence of
the other
• There are different disease causation models, the following are the
most widely used ones:
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1. THE EPIDEMIOLOGIC TRIANGLE AND TRIAD (BALANCE
BEAM):
Consists of three components-host, environment, and agent. A change in any of the
components will alter an existing equilibrium to increase or decrease the frequency of the
disease.
This model holds true for infectious disease which has specific agent as necessary cause.
Figure 5.4
Host
The underlying cause of the
disease is a result of the
interaction of several factors,
which can be analysed using
the components of the
Agent Environment
epidemiological triangle.
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EPIDEMIOLOGICAL TRIAD CONT…
• Epidemiological triangle=triad=balance beam
DRAWBACKS:
1. Agents may be many e.g.= lung cancer=>smoking, asbestos
2. One cause---one disease
3. Many causes---one disease=> DD, ARI
4. Many causes—many diseases
E.g.- Bronchitis
- CHD
- Lung cancer
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EPIDEMIOLOGICAL TRIAD CONT…
A. AGENT
• Biological factors- micro organisms
• Nutritional factors
B. HOST FACTORS
• Immune status
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Behavioral factors 30
EPIDEMIOLOGICAL TRIAD CONT…
C. ENVIRONMENT
• Biological environment-rodents
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2. THE WEB OF CAUSATION MODEL:
The process that actually generates disease or leads to injury is much more
complex.
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Web of Causation for the Major Cardiovascular Diseases
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3. THE WHEEL MODEL:
The wheel consists of a hub (the host or human), which has genetic make-
up as its core.
The relative sizes of the different components of the wheel depend upon
the specific disease under consideration.
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Biological env’t
Social env’t
Genetic
core
Physical env’t
Each pieces cause is seen as necessary and sufficient cause in itself to produce the
effect.
Necessary cause: A causal factor whose presence is required for the occurrence of the
disease.
I II III
E J
H I
A
D A G F
B A
C B F C
Fig: Rothman’s causal pieces conceptual scheme for the causes of hypothetical disease.
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THANK YOU!
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