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Foundations of Epidemiology

Chapter 1

What is Health?

•The absence of illness •6 dimensions of health

What are the 6 Dimensions of Health?
Physical Ability of the human body to function properly; includes physical fitness and activities of
daily living.


Ability to have satisfying relationships; interaction with social institutions and societal


Ability to think clearly, reason objectively, and act properly.


Ability to cope, adjust and adapt; self-efficacy and self-esteem.
Feeling as if part of a greater spectrum of existence; personal beliefs and choices.

Environmental Comprised of external factors (i.e., one’s surroundings such as habitat or occupation) and internal factors (i.e., one’s internal structure such as genetics).

What is Public Health?
• Public health is the science and art of promoting health and extending life on the population level. • Public health is concerned with threats to health in the population (a group of people sharing one or more characteristics). • The mission of public health is to ensure conditions that promote the six dimensions of health in the population as a whole.

What is the Meaning of Population?
• Population refers to a collection of individuals that share one or more observable personal or observational characteristics from which data may be collected and evaluated. • Social • Economic • Family (marriage and divorce) • Work and labor force • Geographic factors

How does Public Health Relate to Epidemiology? •There are many subfields of public health. . including epidemiology. biostatistics. •Because of its central role in public health. epidemiology is commonly referred to as the foundation of public health. and health services.

.What is Epidemiology? • Epidemiology is the study of the distribution and determinants of health-related states or events in human populations. and the application of this study to prevent and control health problems.

epidemiology is the study of what befalls the population. upon.What is Epidemiology? • The word epidemiology is based on the Greek words: • epi—prefix meaning on. . or befall • demos—root meaning the people • logos—suffix meaning the study • In other words.

.Epidemiology involves sound methods of scientific investigation. • Methods rely on careful observation and the use of valid comparison groups to determine whether the observed health events differ from what might be expected.Key Terms in the Definition • Study .

and time characteristics .Key Terms in the Definition • Distribution • Study of frequency and pattern of health events in the population • Frequency – number. and number in relation to the population • Pattern – the health-related state or event by person. place.

Key Terms in the Definition •Determinants •Search for causes and other factors of health-related states or events. .

pneumonia. influenza. and suicide .Key Terms in the Definition • Health-related states or events • Disease states • cholera. seat belt use. nutrition. drug abuse. environmental poisoning. mental illness • Conditions associated with health • Events • physical activity. and provision and use of health services • injury.

.Key Terms in the Definition •Application of this study to prevent and control health problems.

The assessment and monitoring of the health of communities and populations at risk to identify health problems and priorities. .Why is Epidemiology Considered by Many to be the Foundation of Public Health? • Because of its central role in carrying out the three core public health functions: 1. To assure that all populations have access to appropriate and cost-effective care. 3. and evaluation of the effectiveness of that care. 2. including health promotion and disease prevention services. The formulation of public policies designed to solve identified local and national health problems and priorities.

epidemiologic focus .The Epidemiologic Focus •Clinical focus vs.

.Epidemiology and the Scientific Method •Epidemiology uses the scientific method to describe and analyze health-related states or events.

What is the Scientific Method? • The scientific method involves using appropriate study designs and statistical techniques for investigating an observable occurrence and acquiring new knowledge. • The health problem • Hypotheses • Statistical testing • Interpretation • Dissemination .

.Study Designs in Epidemiology • Descriptive epidemiology • Involves study designs used to answer: Who? What? When? Where? • Analytic epidemiology • Involves study designs used to answer: Why? How? • Later chapters will focus on describing these study designs.

The Importance of Descriptive Epidemiology •A means to characterizing the distribution of health-related states or events by •Person – who? •Place – where? •Time – when? •Clinical criteria – what? .

testing hypotheses.The Importance of Analytic Epidemiology • A means to identifying and quantifying associations. and supporting statements about causality • Explains why and how health-related states or events occur .

and death • Describing the natural history of disease • Identifying individuals and populations at greatest risk for disease • Identifying where the public health problem is greatest • Monitoring diseases and other health-related events over time • Evaluating the efficacy and effectiveness of prevention and treatment programs .Selected Activities Performed in Epidemiology • Identifying risk factors for disease. injury.

Selected Activities Performed in Epidemiology • Providing information useful in health planning and decision making for establishing health programs with appropriate priorities • Assisting in carrying out public health programs • Being a resource person • Communicating public health information .

injury. disability. as well as individual health decision making . and death • How? By providing information leading to informed public health policy and planning.Epidemiology in Public Health Practice and Individual Decision Making • Epidemiological findings contribute to • Preventing and controlling disease.

Selected Types of Epidemiologic Information •Public health assessment •Causes of disease •Completing the clinical picture •Program evaluation •Efficacy •Effectiveness .

Questions that Need Epidemiology • Diagnosis • Is there such a problem as myalgic encephalitis? • Is prostate specific antigen a good test for prostate cancer? • Causes • Why did this patient suffer a stroke? • Is obesity the cause of metabolic syndrome? .

Questions that Need Epidemiology • Treatment • Is this the best treatment for Parkinson's disease? • Is my surgery as good as that of everyone else? • Prognosis • What are the chances of a recurrent heart attack? • How long will this knee joint prosthesis last? .

Questions that Need Epidemiology • Health promotion and protection • Do current school meals harm children's future health? • Will the Irish smoking ban in public places work better than the English policy? • Health and disease surveillance • Why are there 10 fold international differences in suicide rates? • When will the next influenza pandemic occur? .

Questions that Need Epidemiology • Health inequalities • Why should life expectancy be nearly five years lower in unskilled manual workers? • Do health services reduce or increase health inequalities? .

many countries. expected healthrelated state or event in a defined population over a given period of time • Pandemic – Epidemic affecting a large number of people.Epidemic. and Pandemic • Epidemic – Health-related state or event in a defined population above the expected over a given period of time • Endemic – Persistent. Endemic. usual. continents. or regions .

Common Source. Propagated. and Mixed Epidemics • Common source • Point • Intermittent • Continuous • Propagated • Spread from person to person • Mixed epidemics • A mixture of common source and mixed .

Common Source • Tend to result in more cases occurring more rapidly and sooner than host-to-host epidemics. . • Identifying and removing exposure to the common source typically causes the epidemic to rapidly decrease.

traced to milk or meat from infected animals • botulism.Common Source • Examples • anthrax. traced to soil-contaminated food • cholera traced to fecal contamination of food and water .

Propagated • Arise from infections being transmitted from one infected person to another • Transmission can be through direct or indirect routes • Host-to-host epidemics rise and fall more slowly than common source epidemics .

Propagated •Examples •tuberculosis •whooping cough •influenza •measles .

subsequent generations of shigella cases spread by person-to-person transmission from festival attendees. .Mixed Epidemics • Occurs when a common source epidemic is followed by person-to-person contact and the disease is spread as a propagated outbreak • Example – Shigellosis occurred among a group of 3000 women attending a music festival. Over the next few weeks.

Disease Transmission • Disease transmission usually occurs by • direct.g.. HIV/AIDS spread through needle sharing drug users) • vector-borne (e.g..g. Hepatitis A spread by a contaminated eating utensil) • vehicle-borne (e. Malaria spread through mosquitoes) . person-to-person contact (e. STDs) • fomite-borne (e.g...

Accurate Assessment Requires a Standard Case Definition • A standard set of criteria. assures that cases are consistently diagnosed. regardless of where or when they were identified and who diagnosed the case . or case definition.

or condition . disorder. injury.Concepts and Principles of Case as Used in Epidemiology • A case is a person who has been diagnosed as having a disease.

• The first disease case brought to the attention of the epidemiologist is the index case. • The index case is not always the primary case. Index Case • The first disease case in the population is the primary case. .Primary Case.

Secondary Case • Those persons who become infected and ill after a disease has been introduced into a population and who become infected from contact with the primary case .

yet not diagnosed • Confirmed • All criteria met .Different Levels of Diagnosis • Suspect • An individual who has all of the signs and symptoms of a disease or condition.

Different Levels of Diagnosis • As more information (such as laboratory results) becomes available to the physician. the case is classified as a confirmed case. he or she generally upgrades the diagnosis. When all criteria are met and they meet the case definition. .

Epidemiology Triangle for Infectious Disease .

life expectancy of the host or the pathogen. that harbors a disease • Environment includes those surroundings and conditions external to the human or animal that cause or allow disease transmission • Time accounts for incubation periods. usually a human or an animal. and duration of the course of the illness or condition. host. environment.Triangle is Based on the Communicable Disease Model • Shows the interaction and interdependence of agent. and time as used in the investigation of diseases and epidemics. . • Agent is the cause of the disease • Host is an organism.

changed.Stopping an Epidemic • An epidemic can be stopped when one of the elements of the triangle is interfered with. so that the disease no longer continues along its mode of transmission and routes of infection . or removed from existence. altered.

usually used in the plural • Example – transmission of cutaneous anthrax from drums to an individual . and utensils that may harbor a disease agent and are capable of transmitting it.Some Disease Transmission Concepts • Fomites • Objects such as clothing. towels.

g. mosquito.Vector • An invertebrate animal (e. mite.. bite. tick. bloodsucking fly) capable of transmitting an infectious agent among vertebrates • Can spread an infectious agent from an infected animal or human to other susceptible animals or humans through its waste products. or indirectly through food contamination . body fluids.

such as prairie dogs. Plague transmission from these infected animals generally occurs in one of three ways: . but occasionally in other wild animals. most commonly in rats.Plague • Yersinia pestis (the bacteria that causes plague) is found in animals throughout certain parts of the world.

people can become directly infected with plague by handling infected rodents. rabbits. or wild carnivores that prey on these animals when plague bacteria enter through the person's skin. • Inhaling infected droplets. .Plague • Bites from infected rodent fleas (85%) • Direct contact with infected tissue or bodily fluids • For example.

and is dependent on for its survival in nature • Humans often serve as both reservoir and host . multiplies. grows.Reservoir • The habitat (living or nonliving) on which an infectious agent lives.

shigellosis .Zoonosis • When an animal transmits a disease to a human • Examples – rabies. Rocky Mountain spotted fever.

spreads. or harbors an infectious organism • Example – Typhoid Mary .Carrier • A carrier contains.

Modes of Disease Transmission • Direct transmission – direct physical contact such as touching with contaminated hands. or process to a susceptible host. skin-to-skin contact. kissing. resulting in disease . organism. means. or sexual intercourse • Indirect transmission – occurs when pathogens or agents are transferred or carried by some intermediate item.

Advanced Epidemiology Triangle for Chronic Diseases and Behavioral Disorders .

Three Levels of Prevention Used in Public Health and Epidemiology • Primary prevention (occurs prior to exposure) • Immunization • Sanitation • Education • Media campaigns • Warning labels .

Active Primary Prevention • Requires behavior change on part of subject • Wearing protective devises • Health promotion • Lifestyle changes • Community health education • Ensuring healthy conditions at home. school and workplace .

Passive Primary Prevention • Does not require behavior change • Vitamin fortified foods • Fluoridation of public water supplies .

Secondary Prevention • Occurs to reduce the progress of disease • The disease already exists in the person • Cancer screening – cancer already present. The goal is to detect the cancer before clinical symptoms arise in order to improve prognosis and prevent conditions from progressing and from spreading .

Tertiary Prevention • To reduce the limitation of disability from disease • The disease has already occurred • Physical therapy for stroke victims • Halfway houses for recovering alcoholics • Shelter homes for the developmentally disabled • Fitness programs for heart attack patients .

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