PGI BOARD REVIEW o Clinical trial

October 3, 2020  Therapeutic trial

 Forest plot diagram
PREVENTIVE MEDICINE  Less than 1: favors treatment
 More than 1: favors control
Policarpio B. Joves, Jr. MD, MPH, MOH, FPAFP, FPCHA  Preventive trial
Full Professor, Department of Community and Family o Community trial
Medicine
Chair, Health Professions Education Unit
Head, Quality Assurance Department

DEFINITION

Epidemiology
- Study of the
o Distribution of disease
o In human population, and
o Factors affecting the distribution

- Aims of epidemiology
o Prevention of disease
o Maintenance of health

- Uses of epidemiology
o Elucidation of the cause of disease
o Natural history of disease
o Identify risk factors
o Identify high risk groups
o Health programs to implement
o Evaluation of health programs

- Strategies/approaches in epidemiology
o Descriptive strategy
 Aims to generate hypothesis
o Analytic strategy
 Aims to test the hypothesis

o Descriptive epidemiology
 Case report
 Case series
 Cross-sectional – descriptive

o Analytic strategy *forest plot diagram

 Inferential statistics
 Observational Related Disciplines
 No manipulations - Basic sciences
o Cross sectional – analytic o Anatomy, biochemistry, physiology, parasitology,
 X test, t test, z test, anova microbiology, pathology, pharmacology
 Linear regression analysis - Clinical sciences
o Case control o Genetics
 OR/Cross product - Public health
o Cohort o Biostatistics, research, public health administration
 RR = R+F/R-F
 More than 1: RF Ecologic Concept of Health and Disease
 Less than 1: protective - Multifactorial causation of health and disease
- Models of disease causation
 Analytic o Epidemiologic lever
 Manipulation of factors o Epidemiologic triangle
 o Wheel model o Thru organized community effort
o Web model
Community Diagnosis
- Agent - Statement of
o A substance, an element or a force o Health problems/needs/health status
o The presence or absence of which is capable of o Of the community
initiating or perpetuating a disease process - Steps
 Physical, chemical, biologic, ergonomic o Collect
o Characteristics o Collate
 Physical o Organize
 Chemical o Present
 Viability o Analyse
 Agent-host o Interpret
 Infectivity  Community survey
 Pathogenicity  No program
 Toxigenicity  Community diagnosis
 Immunogenicity  Action program
 Virulence
 Invasiveness
 Agent-environment Data collection
 Reservoir of infection - Demography
 Mode of transmission o Size, composition, distribution in space
 Mode of exit  Arithmetic, geometric, exponential (best
- Host method)
o Characteristics
 Physical barriers - Ecology
 Immunity – cellular, humoral o Environment sanitation
 Sexual behaviour, recreational activities  Housing, water, excreta, refuse, control of
 Habits, customs, traditions, beliefs rodents/insects/vermins, food sanitation
- Environment  Housing sanitation – home
o Anything that surrounds man  Physical needs, psychological needs
 Climate, topography of soil, socio-political o Structure, temperature, noise, water
o Physical sanitation, excreta disposal, refuse
o Biologic storage, collection and disposal, food
o Social environment sanitation
o Political environment  Water sanitation – temporary, permanent
 Water related diseases
Epidemiologic Chain/Levels of Prevention o Water-borne
- Pre pathogenic o Water-washed
o Primordial  Pediculosis capitis, trachoma,
o Primary conjunctivitis
 Health promotion o Water-related vector diseases
 Specific protection  Malaria, dengue, filariasis
- Pathogenic o Water-based
o Spectrum of disease  Schistosomiasis, leptospirosis
o Secondary
 Early diagnosis and treatment - Health status
 screening o Morbidity
o Tertiary  Incidence
 Disability limitation and rehabilitation  New cases
 Period of time
Community Health Care/Public Health  Acute diseases
- Art/science of  Prevalence
o Promoting health  New + old cases = existing cases
o Preventing disease  Point in time
o Prolonging life  Chronic diseases
 Curative o Mortality
 Rehabilitative  Crude death rate
  Number of death / total population or Primary Health Care
midyear population - Strategy/Approach to health development
 Specific death rate - Services
 Specific population o Community-based
 Number of death ages 1-5 yrs old/ total o Accessible
population o ages 1-5 o Acceptable
 Infant mortality rate o Affordable
 Death less than 1 yr old / number of - Aimed at developing self-reliance
livebirths - Part of the socio-economic development of the nation
 Neonatal mortality rate
 Less than 28 days - Primary care provider
 Poor maternal condition o First contact
 Post neonatal o Comprehensive, continuing, coordinated care
 After 28 days o Ex: GP, FP, Gen IM, Ped, Nurse, Midwife, BHW/VHW
 Environmental, infection, sanitation,
nutritional - Elements/services
 Maternal mortality rate o Control of communicable diseases
 Pregnancy or puerperial or post partum o Control of non communicable diseases
causes o Control of endemic diseases
o Maternal and child health care/reproductive health
 Number of deaths due to pregnancy,
care
delivery, puerperium / number of livebirths
o EPI
 Cause of death rate
o Environmental sanitation
 Number of death from certain cause / total
population
- Cornerstones of PHC
 In death certificate, underlying cause is
o Active community participation
used
o Intrasectoral and intersectoral collaboration
 Proportionate mortality rate
o Ways and means to sustain PHC
 / total deaths (part. Cause + other causes)
 Case fatality rate
Community health care/PH
 Number of deaths from a specified cause /
total cases - 5 star roles
o Researcher
- Health resources o Healer
o Health care provider network / Service delivery o Educator
Network / SLA o Social mobilizer
 Community organizer
o Health system building blocks  Steps: Entry, integration, community
 Provincial/city health board (Governance) diagnosis
 Governor, provincial health officer  Core group formation
 Mayor, city health officer o Healthcare manager
 Health facility
 Primary/secondary/tertiary/quarternary Data Collection
(specialized hospital) - Source = WHERE to get data
 Levels 1,2,3 o Primary
 Health manpower  Get data directly from objects of observation
 Primary care provider - First contact o Secondary
provider  Get data from previously collected data
 Specialist - Methods = HOW to get data
 Supply / equipment chain management o Query or asking questions
 Health technology assessment committee o Observation
 Health financing o Review of documents
 PHIC – direct + indirect members - Instruments for collecting data = repository of
 Global health fund information
 Taxes o Questionnaire
 Health information management o Tests/devices
system/intelligence
Data Presentation  2 population group/distribution (ex.
- Textular Educational attainment in rural vs
- Tabular urban)
o Simple tables o Horizontal bar graph
 Frequency distribution table  Ex. Leading causes of
 One-way frequency distribution table consultation/hospitalization/deaths
o One variable - Quantitative
o No total o Vertical bar graph/line graph
 Discrete variables
Disease  Trends, changes in values thru time
Positive Negative  Space in between
Number % Number % o Histogram
 continuous
Total  1 population
 No spaces in between
 Two-way frequency distribution o Frequency polygon
table/correlation table  continuous
o Two variables  2 populations
o With total

Factor Disease total

Positive Negative
Number % Number %
Positive
negative
Total

 2x2 table/four-fold table

 4 cells

***TABLE TITLE
- Above the table
- Roman number
- Indicates what, where, when, how
- Inverted triangle

- Graphical
o Variables
 Qualitative
 Non measurable
 Categories
o Ex. Gender (male, female)
 Income (rich and poor)
 Quantitative
 Measurable
o Discrete
 Whole numbers
 Ex. No of beds, deaths
o Continuous
 Integers

Graphical Presentation
- Qualitative
o Pie graph
 Less than 6 categories (ex. Religion)
o Component bar graph