REPORTER:

GERALDINE BIRON, R.N.

COURSE:
MASTER OF ARTS IN NURSING
MAJOR IN CLINICAL NURSING
 TOPICS:
Health and illness continuum
Concepts of Disease and its
Causation
Modifiable and Non Modifiable Risk
Factors
LEARNING OBJECTIVES:
Be able to describe the difference between health and
wellness and to understand the HEALTH AND WELLNESS
CONTINUUM.

Identify healthy lifestyle factors to improve

overall health.

Identify risk factors; modifiable and non- modifiable

that affects a person’s health.
 B U T. . .
“ TO O M U C H O F A N Y T H I N G
I S G O O D F O R N OT H I N G .”

YOU CAN STAY

MOTIVATED, BUT YOU
SHOULD KNOW HOW
TO RELAX YOURSEL F
TO PREVENT THE
STRESS BUILDING!
ACCORDING TO THE WORLD HEALTH
ORGANIZATION…

IS THE STATE OF COMPLETE PHYSICAL, MENTAL, AND

SOCIAL WELL BEING AND NOT MERELY THE ABSENCE
OF DISEASE OR INFIRMITY
An integrated method of functioning which is
oriented toward maximizing the potential of
which the individual is capable.
 MODELS OF HEALTH AND ILLNESS:
DUNN’S HIGH- LEVEL WELLNESS AND GRID
MODEL
• X- axis is HEALTH
• Ranges from peak
wellness to death
• Y- axis is ENVIRONMENT
• Ranges from
very favourable to
very unfavourable
HEALTH BELIEF MODEL BY ROSENTOCK
• Concerned with what people perceive about
themselves in relation to their health
• Consider perceptions (influences individuals
motivation toward results)
–Perceived susceptibility
–Perceived seriousness
–Perceived benefit out of the action
TRAVIS’ ILLNESS- WELLNESS CONTINUUM
 NURSING RESPONSIBILITIES:

To help our patients to identify their place on the health-

continuum.
To assist our patients to adopt some measures in order to
reach a well state of health.
CONCEPTS OF DISEASE AND ITS
CAUSATION
 ILLNESS or DISEASE
is defined as a deviation from the
individual’s normal state of physical,
mental, and social well being, leading to
a loss of homeostasis in the body.
 PATHOPHYSIOLOGY
• Involves the study of functional or physiologic
changes in the body that result from disease
processes.
• Builds on the knowledge of the normal structure,
and function of the human body.
• Utilizes knowledge of basic anatomy and
physiology because it is based on a loss of or a
change in normal structure and function.
HOW IS A DISEASE DEVELOPED?
CONCEPTS OF DISEASE OCCURRENCE
ANCIENT VIEWS MODERN VIEWS

• Demonic theory • Germ Theory

• Punitive theory • Epidemiological Triad
• Humoral theory • Multi factorial theory
• Miasmatic theory • BEINGS theory
• Contagion theory • Web of causation theory
• Wheel theory
 ANCIENT VIEWS
1. Demonic theory
• Religion, philosophy and medicine were integral part in the early part of
civilization.
• One concept prevalent was that the evil spirit entering the body directly and
pursuing nefarious actions. Another concept was the evil spirit as a messenger
of Gods giving warnings in the form of diseases.
2. Punitive theory
• Punitive theory has its origin with the religion with the belief that one's attitude
toward the deity is responsible as a cause of sickness.
3. Humoral theory
• The Greeks rejected the super natural theories and looked up on disease as a natural process.
They advocated that the matter is made up of four elements- Earth, Air, Fire and Water and these
elements have the corresponding qualities of being Cold, Dry, Hot and Moist. With this concept
they hypothesized that these qualities are represented in the body by four humors- Phlem, yellow
bile, black bile and blood. According to this theory, the equilibrium among these humours
characterizes health (eucrasia), and disequilibrium (dyscrasia) characterizes disease.
4. Miasmatic theory
• Miasmatic theory is based on the inference that the air arising from certain kinds of ground,
especially low, swampy areas, was a cause of disease. Certain places were thus given a very evil
reputation, because the ground was said to exude some invisible, insensible vapour, called it miasm,
which produced disease.
5. Contagion theory
• This was based on the observation that persons could contract infections even if their humors are
normally balanced. Fracastoro defined a contagion as a "corruption which develops in the
substance of a combination, passes from one thing to another, and is originally caused by infection
of the imperceptible particles”. He called the particles the seminaria (seeds or seedlets) of
contagion.
 MODERN VIEWS
1. Germ Theory
• Germ theory was proposed by Louis Pasteur (1822 –1895) and Robert Koch (1843 –1910).
Germ theory postulates that every human disease is caused by a microbe or germ, which is
specific for that disease and one must be able to isolate the microbe from the diseased human
being.
• The Germ theory viewed diseases in terms of a causal network similar to that of Fracastoro,
but with much more detail about the nature of germs and possible treatments.
• Organisms that cause disease inside the human body are called pathogens. Bacteria and Viruses
are the best know pathogens. Fungi, protozoa’s and parasites can also cause disease. Infectious
diseases are typically classified as bacterial, viral, protozoal and so on. Knowing what bacteria
are responsible for a particular disease indicates what antibiotic treatment to apply. Diseases
are said to be infectious or communicable if pathogens can be passed from one person to
another.
2. Multi factorial theory
• When the knowledge on diseases increased, one theory was not able to explain
the causation of all the diseases. This lead to multi factorial theory to find rational
explanation. Though many diseases are infectious, other causative factors such as
Genetic, Nutritional, Immunological, Metabolic, Cytological factors were identified
as the cause for specific diseases.
3. BEINGS theory
• BEINGS concept postulates that human diseases and its consequences are caused
by a complex interplay of nine different factors. By coining the first letters of these
factors the theory is called BEINGS theory. These are (1) Biological factors innate
in a human being, (2) Behavioural factors concerned with individual lifestyles, (3)
Environmental factors as physical, chemical and biological aspects of
environment,(4) Immunological factors,(5) Nutritional factors, (6) Genetic factors,
(7) Social factors, (8) Spiritual factors and (9) Services factors, related to the
various aspects of health care services.
4. Epidemiological Triad
• The standard model of infectious disease causation under the epidemiological triad
theory states that an external agent can cause diseases on a susceptible host when
there is a conducive environment
• Within the epidemiological triad the agent is known as a ‘necessary’ factor. It has to
be present for morbidity, although it may not inevitably lead to disease. For the
disease to occur it needs the combination of what have been called ‘sufficient’ factors.
These would include a host, which might be an individual or group of individuals who
are susceptible to the agent. Susceptibility might be on the basis of age, sex, ethnic
group or occupation. Environmental factors can also be sufficient factors that combine
with the agent
• The epidemiological triad can be applied to non-infectious diseases where the agent
could be ‘unhealthy behaviors, unsafe practices, or unintended exposures to hazardous
substances’
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.
5. Web of causation theory
• The “epidemiological triad theory” was very effectively used by Leavel and Clark in explaining the
natural history of disease and levels of prevention. The terms primary, secondary and tertiary
prevention were first documented in the late 1940s by Hugh Leavell and E. Guerney Clark from the
Harvard and Columbia University Schools of Public Health, respectively.
• As per their concept, the primary prevention seeks to prevent a disease or condition at a pre-
pathologic state; to stop something from ever happening. Primary prevention strategies emphasize
general health promotion, risk factor reduction, and other health protective measures. These
strategies include health education and health promotion programs designed to foster healthier
lifestyles and environmental health programs designed to improve environmental quality.
• Secondary prevention focuses on individuals who experience health problems or illnesses and who
are at risk of developing complication. Activities are directed at early diagnosis and prompt
intervention, thereby reducing severity and enabling the client to return to normal. Its purpose is to
cure disease, slow its progression, or reduce its impact on individuals or communities.
• Tertiary prevention occurs when a defect or disability is permanent and irreversible. It involves
minimizing the effects of long-term disease or disability by interventions direct at preventing
complications and deteriorations. Tertiary prevention strategies are both therapeutic and rehabilitative
measures once disease is firmly established.
6. Wheel theory
• As medical knowledge advanced, an additional aspect of interest that came into play is the
comparative role of “genetic” and the “environmental” (i.e. extrinsic factors outside the
host) factors in causation of disease.
• The “triad” as well as the “web” theory does not adequately cover up this differential.
• To explain such relative contribution of genetic and environmental factors, the “wheel”
theory has been postulated.
• The theory visualizes human disease in the form of a wheel, which has a central hub
representing the genetic components and the peripheral portion representing the
environmental component.
• Like any wheel, the outer part (environmental component) has spokes (3 in this model) and
the environmental component is thus divided into 3 sub components, representing the
social, biological and physical components of the environment.
• To maintain health one has to take regular exercises and adequate rest, follow personal
hygiene, eat nutritionally balanced diet, abstain from the abuse of drugs and alcohol, take
care of one’s mental well-being and develop social skills to interact in a positive manner
within society.
 TERMS FREQUENTLY USED IN THE
DISCUSSION OF DISEASE PROCESS
Factors of disease causation:
1. Predisposing factors are the factors which create a state of susceptibility, making the host
vulnerable to the agent. These are age, sex and previous illnesses.
2. Enabling factors are those which assist in the development of (or in recovery from) the
disease; e.g. housing conditions, socio-economic status.
3. Precipitating factors are those which are associated with immediate exposure to the
disease agent or onset of disease, e.g. drinking contaminated water, close contact with a case of
pulmonary TB.
4. Reinforcing factors are those which aggravate an already existing disease, e.g. malnutrition,
repeated exposures.
5. Risk factors are the conditions, quality or attributes, the presence of which increases the
chances of an individual to have, develop or be adversely affected by a disease process. The risk
factor need not necessarily cause the disease but does increase the probability that the person
exposed to the factor may get the disease easily.
 TERMS FREQUENTLY USED IN THE
DISCUSSION OF DISEASE PROCESS
6. Diagnosis refers to the identification of a specific disease through evaluation of signs and
symptoms, laboratory tests and diagnostic tests.
7. Etiology concerns the causative factors in a particular disease. There may be one or several
causative factors.
A. ETIOLOGIC AGENTS:
1) Congenital defects 8) Burns
2) Inherited or genetic disorders 9) Trauma
3) Microorganisms such as viruses or bacteria 10) Environmental Factors
4) Immunologic dysfunction 11) Nutritional Deficiencies
5) Metabolic derangements
6) Degenerative changes
7) Malignancy
Other Causative Factors:
Idiopathic- when the cause of a disease is unknown
In some cases, a treatment, a procedure, or an error may cause a disease, which is then
described as iatrogenic.
Example: Bladder infection following catheterization, or bone marrow damage due
to a prescribed drug. Certain forms of chemotherapy and radiation used in the
treatment of cancer.
In some cases, a difficult decision must be made about a treatment that does not
involve an additional serious risk, with careful assessment of the “benefits versus
the risks” of a specific treatment.
MODIFIABLE AND NON-MODIFIABLE RISK FACTORS
• What is a risk factor?
– A risk factor is something that increases your chance of getting a disease.
A. Modifiable risk factors include:
 Smoking
 High blood pressure
 Diabetes
 Physical inactivity
 Obesity
 High blood cholesterol
B. Non- Modifiable risk factors include:
 Age
 Gender
 Family history
 Race
REFERENCES:
http://www.open.edu/openlearn/science-
maths-technology/science/health-
sciences/epidemiology-introduction/content-
section-3.1
With the following references:
Park’s Textbook of Preventive and Social
Medicine, 21st edition
Leon Gordis, Textbook of Epidemiology, 4th
edition.
Textbook of public Health and Community
medicine, AFMC,2009
Measures of prognosis, Bloomberg School of
Public Health,2008
CDC , Principles of Epidemiology in Public
Health Practice, 3rd Edition
The Genius of Homeopathy Lectures and
Essays on Homeopathic Philosophy
By Dr Stuart M. CLOSE
 END OF
REPORT!
THANK YOU!
There are several stages in the development of a single disease:
1. The onset of a disease may be sudden and obvious, or acute, for example,
gastroenteritis with vomiting, cramps, and diarrhea. Or the onset may be insidious, best
described as a gradual progression with only vague or very mild signs.
2. An Acute Disease indicates a short- term illness that develops very quickly with
marked signs such as high fever, or severe pain, for example, acute appendicitis.
3. A Chronic Disease often a milder condition developing gradually, such as rheumatic
arthritis, but it persists for a long time and usually causes more permanent tissue damage.
4. A Subclinical State exists in some conditions where pathologic changes occur, but no
obvious manifestations are exhibited by the patient, perhaps because of the great reserve
capacity of some organs. Example, kidney damage may progress to an advanced stage of
renal failure before signs are manifested.
5. An Initial latent or “silent” stage no clinical signs are evident, characterizes some
diseases. In infectious diseases this stage may be referred to as the incubation period, the
time between exposure to the microorganism and the onset of signs and symptoms; it
may last for a day or so or may be prolonged, perhaps for days or weeks.
6. The Prodromal Period comprises the time in the early development of a
disease when one is aware of a change in the body, but the signs are nonspecific.
For example, fatigue, loss of appetite, or headache. A sense of feeling threatened
often develops in the early stage of infections.
7. The Manifestations of a disease are the clinical evidence or effects, the signs
and symptoms, of disease. These manifestations, such as redness and swelling,
may be local, or found at the site of the problem. Or sings and symptoms may
be systemic, meaning they are general indicators of illness, such as fever.
8. Signs are objective indicators of disease that are obvious to someone other
than the affected individual. Examples of a sign are a fever or skin rash.
9. Symptoms are subjective feelings, such as pain or nausea.
10. Lesion is the term used to describe a specific local change in the tissue.
11. Syndrome is a collection of signs and symptoms that are usually occur
together in response to a certain condition.
12. Remissions and exacerbations may mark the course or progress of a disease. During a
remission, the manifestations of the disease subside, whereas during an exacerbation the
signs increase. Rheumatoid arthritis typically has periods of remission when pain and
swelling are minimal, alternating with acute periods when swelling and pain are severe.
13. A precipitating factor is a condition that triggers an acute episode, such as a seizure in an
individual with a seizure disorder. Note that a precipitating factor differs from a predisposing
factors. For example, a patient may be predisposed to coronary artery disease and angina
because of a high- cholesterol diet.
14. Complications are new secondary or additional problems that arise after the original
disease begins. For example, following a heart attack, a person may develop congestive heart
failure, a complication.
15. Therapy or therapeutic interventions are treatment measures used to promote
recovery or to slow the progress of a disease.
16. Sequelae describe the potential unwanted outcomes of the primary condition, such as
paralysis following recovery from a stroke.
17. Convalescence is the period of recovery and return to the normal healthy state; it may
last for several days or months.
18. Prognosis defines the probability or likelihood for recovery or for other outcomes.
19. Morbidity indicates the disease rates within a group,; this term is sometimes used to
indicate the functional impairment that certain conditions such as stroke inflict on the
population.
20. Mortality figures indicate the relative number of deaths resulting from a particular
disease.
21. The Occurrence of a disease is tracked by recording two factors, the incidence and
the prevalence. The Incidence of a disease indicates the number of new cases in a given
population noted within a stated time period. Prevalence refers to the number of new and
old or existing cases within a specific population and time period.
22. Communicable diseases are infections that can be spread from one person to
another.
23. Notifiable or reportable diseases must be reported by the physician to certain
designated authorities. The requirement of reporting is intended to protect the public
health.
24. Autopsy may be performed after death to determine the exact cause of death, or to
• 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.

• Agent, host, and environmental factors interrelate in a variety of complex ways to produce disease. Different diseases require different
balances and interactions of these three components. Development of appropriate, practical, and effective public health measures to
control or prevent disease usually requires assessment of all three components and their interactions.
•
• Agent originally referred to an infectious microorganism or pathogen: a virus, bacterium, parasite, or other microbe. Generally, the
agent must be present for disease to occur; however, presence of that agent alone is not always sufficient to cause disease. A variety of
factors influence whether exposure to an organism will result in disease, including the organism's pathogenicity (ability to cause
disease) and dose.
•
• Host refers to the human who can get the disease. A variety of factors intrinsic to the host, sometimes called risk factors, can influence
an individual's exposure, susceptibility, or response to a causative agent. Opportunities for exposure are often influenced by behaviors
such as sexual practices, hygiene, and other personal choices as well as by age and sex. Susceptibility and response to an agent are
influenced by factors such as genetic composition, nutritional and immunologic status, anatomic structure, presence of disease or
medications, and psychological makeup.
• Environment refers to extrinsic factors that affect the agent and the opportunity for exposure. Environmental factors include physical
factors such as geology and climate, biologic factors such as insects that transmit the agent, and socioeconomic factors such as
crowding, sanitation, and the availability of health services.
•