INTRODUCTION:

Epidemiology is the basic science of preventive and social medicine.

Although of ancient lineage, it made only slow progress upto the start of
20th century. Epidemiology has evolved rapidly during the past few
decades. Its ramifications cover not only study of disease distribution and
causation (and thereby prevention), but also health and health-related
events occurring in human population. Modern epidemiology has entered
the most exciting phase of its evolution. By identifying risk factors of
chronic disease. Evaluating treatment modalities and health services, it
has provided new opportunities for prevention, treatment. Planning and
improving the effectiveness and efficiency of health services. The current
interest of medical sciences in epidemiology has given rise to newer off-
shoots such as infectious disease epidemiology, chronic disease
epidemiology, clinical epidemiology, serological epidemiology, cancer
epidemiology, malaria epidemiology. Neuro epidemiology, genetic
epidemiology, occupational epidemiology, psychosocial epidemiology,
and so on. This trend is bound to increase in view of the increasing
importance given to the pursuit of epidemiological studies.

HISTORY :

The Greek physician Hippocrates(460BC) has been called the father

of epidemiology. He is the first person known to have examined the
relationships between the occurrence of disease and environmental

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influences. He coined the terms endemic(for diseases usually found in
some places but not in others) and epidemic(for disease that are seen at
some times but not others).

One of the earliest theories on the origin of disease was that it was
primarily the fault of human luxury. This was expressed by philosophers
such as plato and Rousseau, and social critics like Jonathan swift. In the
middle of the 16th century, a doctor from Verona named Girolamo
Fracastero was the first to propose a theory that these very small,
unseeable, particles that cause disease were alive. They were considered
to be able to spread by air, multiply by themselves and to be destroyable
by fire.

The word epidemiology derived from Greek word (‘EPI’ = among;

DEMOS =People; LOGOS = study). Epidemiology is a events that occurs
in community. Epidemiology focuses on population or community to
measure the distribution and determinants of disease for the purpose of
preventing disease occur in different group of people.

John Graunt(1662): Quantified births, deaths and diseases.

Lind(1747): Scurvy could be treated with fresh fruit.

William Farr(1839): Established application of vital statistics for

the evaluation of health problems.

John Snow(1854): Tested a hypothesis on the origin of epidemic of

cholera.
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 Alexander Louis(1872): Systematized application of numerical
thinking(quantitative reasoning).

Bradford Hill(1937): Suggested criteria for establishing causation.

TERMINOLOGIES:

1.) MORBIDITY: The condition of suffering from a disease or

medical condition.
2.) MORTALITY: It is a measure of the number of deaths(in general
or due to a specific cause) in a particular population, scaled to size
of that population, per unit of time.
3.) ILLNESS: A disease or period of sickness affecting the body or
mind.

DEFINITION:

According to MC MOHAN:

Epidemiology is a study of distribution and determinants of

disease frequently in man.

According to JOHN. M ( 1988):

The study of the distribution and deteminants of health related

status or events in specified population and the application of this study
to the control of health problems.

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SCOPE OF EPIDEMIOLOGY:

✓ DISEASE DEFINITION: Characteristics or combination of

character that best discriminate disease from on diseased.
✓ DISEASE OCCURRENCE: The rate of development of new case
in population. The proportion of current disease within population.
✓ DISEASE CAUSATION: The risk factors for disease development
and their relative strength with respect to an individual and
population.
✓ DISEASE OUTCOME: The outcome following disease onset and
of the risk factors.
✓ DISEASE PREVENTION: The relative effectiveness of proposed
preventive strategies including screening.

AIMS OF EPIDEMIOLOGY:

According to the international epidemiological association(IEA)

epidemiology has 3 main aims.

a) To describe the distribution and magnitude of health and

disease problems in human populations.
b) To identify the etiological factors in the pathogenesis of
disease.
c) To provide the data essential to the planning, implementation
and evaluation of services for the prevention, control and

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 treatment of diseases and to the setting up of priorities among
those services.

The ultimate aim of epidemiology is to lead to effective action:

a) To eliminate or reduce the health problem or its consequences.

b) To promote the health and well being of society as a whole.

USES OF EPIDEMIOLOGY:

1) To study historically the rise and fall of disease in the

population. For ex: the first contribution of epidemiology to
the study of coronary heart disease was that it was an
“epidemic”. Later many others such as accidents, cancer and
diabetes were found to be “epidemic”.
2) Community diagnosis: one of the uses of epidemiology is
community diagnosis. It generally refers to the identification
and quantification of health problems in a community in terms
of mortality and morbidity rates and ratios.
3) Planning and evaluation: planning is essential for a rational
allocation of the limited resources. For ex: in developing
countries, too many hospitals have been built and equipped
without knowledge of the particular disease problems in the
community. Evaluation is an equally important concern of
epidemiology. Any measures taken to control or prevent a
disease must be followed by an evaluation to find out whether

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 the measures undertaken are effective in reducing the
frequency of the diseases.
4) Evaluation of individual’s risks and chances: One of the
important tasks of epidemiologists is to make a statement
about the degree of risk in a population. For ex: The risk
assessment for smokers and non-smokers, for selected causes
of death (eg, cancer CHD) is another well-known example.
5) Syndrome identification: Medical syndromes are identified by
observing frequently associated findings in individuals
patients. For ex: Patterson-kelly syndrome of association
between dysphagia and iron-deficiency anaemia, but when the
association was tested by epidemiological methods.
6) Completing the natural history of disease: Describing the
history of disease in the individual. For ex: natural history of
HIV infection in the individual (infection-acute syndrome-
asymptomatic phase-clinical, disease-death).
7) Searching for causes and risk factors: Epidemiology, by
relating disease to inter population differences and other
attributes of the population tries to identify the causes of
disease. For ex: cigarette smoking is a cause of lung cancer.

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EPIDEMIOLOGICAL TRIAD:

The germ theory of disease has many limitations. For example, it

Is well known, that not everyone exposed to tuberculosis develops

tuberculosis. The same exposure, however, in an undernourished or
otherwise susceptible person may result in clinical disease. Similarly, not
everyone exposed to beta-hemolytic streptococci develops acute
rheumatic fever. These are other factors relating to the host and
environment which are equally important to determine whether or not
disease will occur in the exposed host.

ENVIRONMENT

AGENT HOST

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 The above model- agent, host and environment –has been in use for
many years. It helped epidemiologists to focus on different classes of
factors, especially with regard to infectious diseases.

THE TRIANGLE OF EPIDEMIOLOGY:

The traditional triangle of epidemiology is based on the

communicable disease model and is useful in showing the interaction and
interdependence of agent, host, environment, and time as used in the
investigation of diseases and epidemics. The agent is the cause of disease;
the host is an organism, usually a human or an animal, that harbors the
disease, the environment is those surroundings and conditions external to
the human or animal that cause or allow disease transmission; and time
accounts for incubation periods, life expectancy of the host or the
pathogen and duration of the course of illness or condition.

AGENT

TIME

HOST ENVIRONMENT

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The triangle has three corners called vertices:

➢ Agent , or microbes that causes the disease(the “what” of the

triangle) Ex: bacteria, virus, fungi, and protozoa.
➢ Host or organism harboring the disease (the “who” of the
triangle)Ex: Age, sex, race, genetic factors, habits, immunity, social
class, and economic status etc.,
➢ Environment, or those external factors that cause or allow disease
transmission (the “where”of the triangle).

BASIC MEASUREMENTS IN EPIDEMIOLOGY:

Epidemiology focuses, among other things, on measurement of

mortality and morbidity in human populations. The first requirement is
therefore definition of what is to be measured and establishment of criteria
or standards by which it can be measured. This is not only a prerequisite
of epidemiological studies, but also one of its goals.

MEASUREMENTS IN EPIDEMIOLOGY:

The scope of measurements in epidemiology is vey broad and

unlimited and includes the following:

a) Measurement of mortality
b) Measurement of morbidity
c) Measurement of disability

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 d) Measurement of natality
e) Measurement of the presence, absence or distribution of the
characteristic or attribute of the disease
f) Measurement of medical needs, health care facilities, utilization of
health services and other health related events
g) Measurement of the presence, absence or distribution of the
environment and other factors suspected of causing the disease, and
h) Measurement of demographic variables.

METHODS IN EPIDEMIOLOGY:

Epidemiology is not an independent science like physics or

chemistry. It is a method or a diagnostic tool for investigating disease
causation and for applying the existing knowledge in disease prevention.
The epidemiologic methods are

1. DESCRIPTIVE EPIDEMIOLOGY: Descriptive epidemiology is usually

the first phase of an investigation. It involves the collection of facts under
four major headings: (1) disease (2) time (3) place and (4) person. The
signs and symptoms of each case are collected. Laboratory procedures are
frequently employed to confirm the diagnosis. Data regarding the time,
place and person distribution of the disease are collected. The data that is
collected provides the basis for formulating hypotheses concerning the
source of infection and modes of transmission. Thus, if the disease is
observed to be more frequent in a particular group than in others,

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hypotheses are formulated to explain the increased frequency. Once this
has been done, analytical and experimental methods can be used.

The uses of descriptive epidemiology are:

(1) It furnishes the necessary data on the types of disease problems in the
community, incidence and prevalence rates, morbidity and mortality rates

(2) It provides a background for the types of medical facilities required

and the organisation of preventive and curative services

(3) It gives a lead to the direction of medical research and

(4) It provides clues for analytical epidemiology.

2. ANALYTICAL EPIDEMIOLOGY: Analytical epidemiology is often the

second phase of an investigation. The hypotheses or theories developed
by descriptive studies are approved or disproved by analytic tests. Two
methods of investigation are commonly described retrospective studies
and prospective studies.

(a) Retrospective studies: A retrospective study is based on past data or

events. This is also called "case history study". A classical example is the
study by Gregg in Australia, who by interviewing mothers of 78 defective
children, discovered that 68 (87 percent) had german measles in early
pregnancy. He hypothesised that maternal rubella was responsible for the
congenital defects he had observed. But the conventional method of
carrying out a retrospective study is to compare a group of individuals

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with the disease. If smoking is considered an etiologic factor, the
frequency of smoking is compared in both the groups. If the frequency of
smoking is higher among those with cancer lung than among those
without cancer lung, an association is said to exist between lung cancer
and cigarette smoking. The cases and controls may be obtained from
hospital patients. Control groups usually consist of patients with other
diseases admitted to the same hospital. Prospective studies are popular,
they are easy to organise and inexpensive.

(b) Prospective Studies: A prospective study is planned to observe events

that have not yet occurred. These kinds of studies are also called "cohort
studies". A group of individuals (e.g. born the same day or studying in
the same class) is followed over a period of time. In a prospective study
of lung cancer, two groups may be selected from the population in either
a random or non-random manner-one group smokers and the other non-
smokers. Both the groups are followed over a period of time to estimate
the risk of developing cancer lung. Prospective studies are more difficult
to organise and they are more expensive than retrospective studies.

Analytic epidemiology is the most crucial aspect of the discipline, since

it provides the scientific basis for the application of preventive health
preventive medicine to the control and eradication of disease.

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3. EXPERIMENTAL EPIDEMIOLOGY: In experimental epidemiology,
unlike in descriptive and analytic, the environment is manipulated or
controlled to test a particular hypothesis.

This controlled study may be conducted in the laboratory or in the field.

In the laboratory, guinea pigs, mice and other animals have been
frequently used for studying the mechanisms of spread of infectious
diseases. The advantages of these animals is that they multiply rapidly,
and the epidemiologist can carry out experiments which in a human
community would take several years. The disadvantage in animal
experimentations is that all the conclusions drawn may not always be
strictly applicable to human beings Sometimes experiments may have to
be planned in the human herd for furthering knowledge. This is even more
essential in the investigation of diseases that cannot be experimentally
reproduced in animals. The study of the relationship of fluoride in the
water supply and dental cares; the effect of iodised salt in the prevention
of endemic goitre are classical examples of experimental epidemiology.
Other examiners are the controlled field trials of drugs and vaccines. Ex:
controlled trials of BCG in tuberculosis and field trials of cholera vaccine,
etc

4. SEROLOGICAL EPIDEMIOLOGY: It is the study of human health and

disease through examination of blood samples for anti-bodies,
cholesterol, proteins, abnormal haemoglobins, blood groups, etc. The
approaches may be either retrospective or prospective. For long term
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studies, serum specimens are stored along with information describing the
persons from whom they have been collected Storage of serum in this
manner is called a "serum bank". On a world-wide basis, the W.H.O. has
established serum reference banks at several places.

Today, serological epidemiology is being extended along four major lines

(1) Immunological Studies: The application of Wasserman Test in

different population groups is an early example of serological
epidemiology. Geogrpahical surveys for prevalence of antibodies to
yellow fever conducted by the Rocketeller Foundation in the 1940's
showed the existence of jungle yellow fever. Serum surveys have been
used in recent years for mapping of viral encephalitis, and also for the
assessment of the effectiveness of vaccination programmes.

(2) Genetic Studies: The studies of blood groups and abnormal

haemoglobins areexamples of genetic studies through serological
epidemiology.

(3) Studies of Anaemias: Anaemias of varying types and severity occur

among people. By serological studies, our knowledge about the
distribution of anaemias has been widened

(4) Biochemical Studies: Studies of blood proteins, cholesterol and blood

sugar in population groups is another practical use of serological
epidemiology. By such studies, it has been found that
hypercholesterolemia is more frequent among relatives of coronary artery

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disease patients than among others. Similary, a lowered glucose tolerance
is found among the sibs of diabetic persons. Thus, by biochemical studies,
we can more effectively study the natural history of diseases. It is possible
that with the help of serological epidemiology, we may be able understand
more about what constitutes the normal state of health

5. Clinical Epidemiology: Epidemiology should not be considered the

monopoly of those engaged in public health activities, it is also useful to
those engaged in medical practice. Since epidemiology is concerned with
the circumstances under which diseases occur, where diseases tend to
flourish, the physicians have an equal interest in epidemiology Consider
a person who has acquired a particular disease. The disease may produce
symptoms or it may not. If symptomatic, he may complain about those
symptoms or he may tolerate them quickly.

TYPES OF EPIDEMIOLOGICAL STUDY:

PROSPECTIVE STUDIES:- which look forward over a period of time and

normally attempt to examine associations between determinants and the
frequency of occurrence of a disease by comparing attack rates or
incidences of disease in groups of individuals in which the determinant is
either present or absent, or its frequency of occurrence varies.

There are, essentially, two approaches to a prospective study. The first,

which is similar to that used in controlled experiments, can be used when
the investigator has control over the distribution of the determinant that is

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to be studied. The individual animals selected for the study are assigned
to groups or cohorts. (For this reason, prospective studies are often called
cohort studies). The determinant to be studied is then introduced into one
cohort and the other cohort is kept free of the determinant as a control.
The two cohorts are observed over a period of time and the frequencies
with which disease occurs in them are noted and compared.

Often, however, the investigator has no control over the distribution of the
determinant. being studied. In such a case he will select the individuals
that have been or are exposed to the determinant concerned, while another
group of individuals that do not have, or have not been exposed to, that
determinant is used as a control. The frequency of occurrence of the
disease in the different groups is then observed over a period of time and
compared.

In prospective studies, the cohorts being compared should consist, ideally,

of animals of the same age, breed and sex and should be drawn from
within the same herds or flocks, since there may be many differences in
the way that different herds or flocks are kept and managed, which may
be expected to have an effect on the frequency of occurrence of the disease
being investigated. If such cohorts can be selected, prospective studies
cannot demonstrate accurately the association between determinants and
disease, since the cohorts will differ from each other merely in the
presence or absence of the particular determinant being studied.

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Prospective studies have the disadvantage that if the incidence of the
disease is low, or the difference one wishes to demonstrate between
groups is small, the size of the study groups has to be large. The problem
of low disease incidence can sometimes be overcome by artificially
challenging the different cohort groups with the disease in question.
However, this may not be acceptable under field conditions, since
livestock owners take grave exception to having their animals artificially
infected! For these reasons, prospective studies are normally performed
on diseases of high incidence and where the expected difference in disease
frequencies between the groups studied is likely to be large.

RETROSPECTIVE STUDIES:- Which look backward over a period of

time and normally attempt to compare the frequency of occurrence of a
determinant in groups of diseased and non diseased individuals.

Retrospective studies are often referred to as one-control stuities. In

such studies, the normal procedure is to look back through records of
cases of a particular disease in a population and note the presence or the
absence of the determinant being studied. The case group can then be
compared with a group of disease-free individuals in which the frequency
of occurrence of the determinant has been determined. Note that in a case-
control study one is, in effect, comparing the frequency of occurrence of
the determinant in two groups. one diseased (cases) and one not (controls).

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 Retrospective studies have various advantages and disadvantages
when compared with prospective studies. The principal advantage of
retrospective studies is that they make use of data that have already been
collected and can, therefore, be performed quickly and cheaply.

The main disadvantage is that the investigator has no control over how
the original data were collected, unless he or she collected them. If the
data are old, it may not be possible to contact the individuals who had
collected them, and thus there is often no way of knowing whether the
data are biased or incomplete.

The second major disadvantage is that although one knows the

frequency of occurrence of the determinant in the case group, one does
not know its frequency of occurrence in non diseased individuals from the
same population.

A third disadvantage is that historical data on cases of disease that are

sufficiently accurate to merit further study are hard to come by in
veterinary medicine. The opportunities for doing case-control studies are
thus rather limited. They are much more common in human medical
studies.

Cross-sectional studies: which attempt to examine and compare

estimates of disease prevalence between various populations and subsets
of populations at a particular point in time.

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 Frequently, however, these approaches may be combined in a general
study of a disease problem. In such studies, other morbidity and mortality
rates may be compared as well as other variables such as weight gain,
milk yield etc. depending on the objectives of the particular study.

Two types of cross-sectional study are commonly performed.

A) Censuses

A census in effect means sampling every unit in the population in

which one of the interest. If the population is small, this is the most
accurate and effective way to conducting a survey. Unfortunately, in most
instances the populations studied are large and comes become difficult
and expensive to undertake. A further drawback with censuses in large
populations is that, because of the practical constraints of staff and
facilities, each individual unit within a population can be allocated only a
limited amount of time and effort Consequently, the amount of data that
can be obtained from each unit sampled is limited

B) Sample surveys

Sample surveys have the advantage of being cheaper and easier to

perform than censuses Because the population is being sampled, the actual
number of units being measured is relatively small, and as a result more
time and effort can be devoted to each unit. This enables a considerable
amount of data to be collected on each sample unit.

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The question is, how closely do the results of the survey correspond to the
real situation in the population being sampled? If undertaken properly,
sample surveys can generate reliable information at a reasonable cost, if
they are performed in property, the results may be very misleading. This
is also true of censuses.

EPIDEMIOLOGICAL APPROACH TO INVESTINGATING

DISEASE PROBLEMS:

1. A diagnostic phase:-In this phase the presence of the disease is

confirmed.
2. A descriptive phase:- This phase describes the populations at risk
and the distribution of the disease, both in time and space, within
these populations. This may then allow a series of hypotheses to be
formed about the likely determinants of the disease and the effects
of these on the frequency with which the disease occurs in the
populations at risk.
3. An investigative phase:- This phase normally involves the
implementation of a series of field studies designed test these
hypotheses.
4. An experimental phase:- In this phase experiments are performed
under controlled conditions to test these hypotheses in more detail,
should the results of phase 3 prove promising.
5. An analytical phase:- In this phase the results produced by the
above investigations are analyzed. This is often combined with
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 attempts to model the epidemiology of the disease using the
information generated. Such a process often enables the
epidemiologist to determine whether any vital bits of information
about the disease process are missing.
6. An intervention phase:- In this phase appropriate methods for the
control of the disease are examined either under experimental
conditions or in the field. Interventions in the disease process are
affected by manipulating existing determinants or introducing new
one.
7. A decision-making phase:- In this phase knowledge of the
epidemiology of the disease is used to explore the various options
available for its control. This often involves the modeling of the
effects that these different options are likely to have on the incidence
of the disease. These models can be combined with other models
that examine the costs of the various control measures and compare
them with the benefits, in terms of increased productivity, that these
measures are likely to produce. The optimum control strategy can
then be selected as a result of the expected decrease in disease
incidence in the populations of livestock at risk.
8. A monitoring phase:- This phase takes place during the
implementation of the com measures to ensure that these measures
are being properly applied, are having the desired effect on reducing

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 disease incidence, and that developments that has a success of the
control programme are quickly detected.

EPIDEMIOLOGICAL APPROACH:

1. Time Distribution: One of the first elements in an epidemiology

enquiry is to study the time distribution of cases. The time interval
between the first and last case constitutes the duration of the epidemic.
The point of time when the maximum number of cases occur is called the
peak of the epidemic. This method of studying the time distribution of
cases is now applied to the epidemiological study of all diseases and
conditions. Time distribution may be confined to short periods of time or
extended over a period of several years or decades

(a) Secular trends: Changes that occur in disease frequency measured over
a period of several years or decades are referred to as 'secular trends. For
example, in the western countries, typhoid fever and tuberculosis have
shown a downward secular trend during the past 50 years whereas cancer,
diabetes the cardiovascular diseases have shown an upward trend Measles
has shown little change. These are called secular trends.

(b) Seasonal trends: Small pox shows a seasonal trend, maximum

number of cases occuring during the summer months and declining with
the onset of rains. The peak of cholera epidemics occur during the second
six months of the year. Respiratory diseases tend to occur as epidemics in

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winter. These are called 'seasonal trends and are not necessarily directly
related to meterological changes.

(c) Cyclic trends: These are fluctuations over short periods of time, a
decade or less Small pox shows a cycle periodicity once in 5-7 years and
measles every 2-3 years. It has been shown that the periodicity of diseases
is due to naturally occurring variations in the herd immunity of the
population. By a study of the time-distribution trends, we can make useful
projections into the future, and plan for timely action in the prevention or
control of disease.

2. Place Distribution: The second questions: Where did the disease

occur? relates to the place distribution of cases. Knowledge of the
geographic distribution of disease enables us.

(a) To make international comparisons in disease prevalence.

(b) For studying variations in disease prevalence within the same country

(c) For urban-rural comparisons and

(d) For studying local distribution of diseases.

(a) International Comparisons: International comparisons in disease

prevalence are possible by comparing death statistics and statistics
relating to notification of diseases in different countries. Certain diseases
which are present one country may not be present in another. Most
striking in this respect is the frequency of infective and parasitic diseases

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in tropical and temperate zones. Cholera, typhoid fever are endemic in
tropical areas whereas these diseases are now rare in the temperate areas.
Geogrpahic variations are found even in regard to the prevalence of non-
infectious diseases. For example, cancer cervix is excessive in India and
relatively uncommon in the developed countries. In Britain, lung cancer
is the chief cause of death among males, whereas it is relatively
uncommon in India. In the United States and the United Kingdom, cancer
of the breasts is now the commonest cancer in women: this frequency is
not evident in all countries.

(b) Studying variations:The disease prevalence within the same country:

There is variation in disease frequency not only between countries, but
also even within the same country. For example, beriberi is endemic in
Andhra Pradesh where people eat polished rice. Goitre is endemic in the
sub-Himalayan regions whereas the other parts of the country are free
from it.

(c) Urban-Rural comparisons: Differences in disease pattern may be

observed between rural and urban areas. Certain diseases are more
frequent in urban areas, Ex: venereal diseases. On the other hand, certain
diseases such as intestinal infections, eye infections, and skin diseases are
more frequent in the rural areas.

(d) Study local distribution of diseases: By a study of the geographic

distribution of cases in an outbreak of cholera in London in 1848, John

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Snow was able to focus attention on the common water pump in Broad
Street as the source of infection.

3. Person Distribution: The third question: Who were the people

affected? relates to the persons involved. We try to study the relationship
between the disease and population characteristics such as age, sex,
occupation, income, marital status, habits, etc. Age is the most important
characteristic that is considered in descriptive studies. Study of age
incidence curves show that the frequency of degenerative diseases
increases progressively with age. If the attack rate of a disease is uniform
in the population, it implies that all age groups are equally susceptible.
Similarly there are differences in sex distribution of diseases. Certain
diseases such as thyrotoxicosis, diabetes, cholecystitis and gall stones are
more common in women than in men. On the other hand, illnesses such
as peptic ulcer, inguinal hernia, accidents, arteriosclerotic heart disease
and lung cancer appear to be predominantly masculine diseases.
Similarly, social class and occupation may give different exposures to
infection.

4. Determinants of Disease: The fourth question: Why should it appear?

refers to the underlying causes or problems of etiology. In this respect,
epidemiology serves as a diagnostic tool, a public health counterpart of
diagnosis in clinical medicine. From the information gained as a result of
the time, place and person distribution of disease the epidemiologist seeks
to determine the factors or "multiple factors" that brought the disease
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situation into being. These factors are considered in terms of the agent,
host and environment. These three elements are sometimes referred to as
the epidemiologic triad. The causes of diseases are to be found in the
epidemiologic triad. Taking the example of pulmonary tuberculosis, it
cannot be said that the tubercle bacillus is the one and only cause of
tuberculosis, there are other factors- the host, environmental and social
factors which also play etiologic roles. In much of the disease which
affects people in India. Environmental and social factors play a major role.
Diseases such as cholera, diarrhoea, dysentery, typhoid fever, helminthic
infestations are all to bad environmental sanitation conditions. Therefore,
a study of the causative factors of disease in terms of the agent, host and
environment is the backbone in epidemiological studies which shed light
on the origin and mode of spread of the disease.

5. Preventive and Social Measures: The fifth questions: So what should

be done? relates to the implications in terms of preventive and social
medicine. The epidemiologist provides the clues about the origin, nature
and size of the disease problem and the factors which brought the disease
condition into being. The health administrator bases his course of action
on the knowledge provided by the epidemiologist in solving the
community health problem.

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ROLE OF NURSE IN EPIDEMIOLOGY:

1. Health Planner

✓ Nurses use the health planning process to develop, implement, and

evaluate the services for populations at risk.
✓ provide community-wide or population specific health services
Nurses.

2. Care Giver

✓ Provide care to individuals, families, and vulnerable populations in

a variety of settings.
✓ Care Includes
• Educating a patient about health problems.
• Screening for undiagnosed health conditions

3. Case Finder

✓ Conduct targeted outreach programme to identify patients in need

of service
✓ Assist patients in accessing appropriate care.
✓ Observe for patients who may have potential or actual service needs
during their daily course of activities

4. Educator

✓ Nurses apply the principles of teaching and learning to promote

positive health action and to facilitate behavioural change.

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 ✓ Use these principles to help patients to learn about new events &
health functioning

5. Counsellor

✓ Help patients cope with normative and non normative stressors that
could lead to crises
✓ Help to adapt to the changes in the environment.
✓ When assuming this role, they help patients
✓ To express emotions and feelings
✓ To clarify facts in the situation:
✓ To confront the stress in manageable doses To accept assistance if
needed.

6. Advocate

✓ Facilitate patient's efforts obtaining needed health services & in

negotiating an appropriate care management plan
✓ Promote community awareness of significant health problems. •
Stimulate supportive community action for health.

7. Epidemiologist

✓ Nurses use the epidemiological method to analyze health problems

among population groups and to develop population-focussed
interventions.

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8. Manager

✓ Responsible for managing caseload demands in an effective and

efficient manner • Responsible for managing problems and
activities of other members of the health care team.

9. Group Leader

✓ Provide targeted preventive services & to manage caseload

responsibilities. .
✓ Assist small patient or community groups to learn new knowledge
and skills. Support group members during stressful times, or solve
problem around issues important to the community

10. Care Manager

✓ Help patient to make decision about appropriate health care services

& to achieve service delivery integration & coordination.
✓ Advocate for services when needed and make referrals as needed.

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JOURNAL ABSTRACT:

Philippe Grandjean, Esben Budtz-Jørgensen, in Handbook on the

Toxicology of Metals (Fourth Edition), 2015

Abstract

Epidemiological methods are crucial to extract as much valid information

as possible from human metal exposures. Thus, modern epidemiological
approaches have elucidated human health effects that were not apparent
in the past. At the same time, metal toxicology has served as a useful arena
for testing and further refining methods for study design and data analysis.
In contrast to most organic compounds, metals are not broken down, and
many of them are retained in the body for long periods, thereby facilitating
exposure assessment. In conjunction with the use of inexpensive metal
analytical methods, exposures can be characterized from the analysis of
blood, urine, and other biological samples. The availability of multiple
approaches for exposure assessment allows a calculation of the total
imprecision, thus paving the way for adjustment for measurement error.
Likewise, due to their propensity to cause chronic or delayed toxicity,
epidemiological studies of metal toxicity have focused on a wide variety
of organ systems, subtle effects as well as mortality, and differences in
susceptibility. Toxic metals often serve as paradigms of environmental
and occupational toxicity. For these reasons, this chapter highlights the
fields within epidemiology that are most relevant to toxic metals and

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discusses where these substances serve to illustrate important
epidemiological concepts. Chapter sections include subjects such as
epidemiological terms, study design, study population, exposure
assessment, assessment of effects, data analysis, and assessment of
benchmark dose, and inference.

THEORY APPLICATION:

NIGHTINGALE’S ENVIRONMENTAL THEORY:

➢ Born -12 May 1820

➢ Founder of modern nursing.
➢ The first nursing theorist.
➢ Also known as “The Lady with the Lamp”.
➢ She explained her environmental theory in her famous book
notes on nursing: What it is, what it is not.
➢ She was the first to purpose nursing required specific education
and training.
➢ Her contribution during Crimean war is well known.
➢ She was a statistician, using bar and pie charts, highlighting key
points.
➢ International Nurses Day, May 12 is observed in respect to her
contribution to nursing.
➢ Died-13 August 1910.

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ENVIRONMENTAL FACTORS:

She identified 5 environmental factors: Fresh air, pure water, efficient

drainage, cleanliness or sanitation and light or direct sunlight.

1. Pure fresh air: to keep the air he breathes as pure as the external air
without chilling him.
2. Pure water: Well water of a very kind is used for domestic purposes.
And when epidemic disease shows itself, persons using such water
are almost sure to suffer.
3. Effective drainage: All the while the sewer may be nothing but a
laboratory from which epidemic disease and ill health is being
installed into the house.
4. Cleanliness: The greater part of nursing consists in preserving
cleanliness.
5. Light (especially direct sunlight): The usefulness of light in treating
disease is very important.

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NIGHTINGALE’S ENVIRONMENTAL THEORY CONCEPTUAL
FRAMEWORK:

BOOK PICTURE:

Therefore this theory illustrates that with help of 5 environmental factors

given by nightingale has applied in order to control the disease prevention
as epidemiology said.

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SUMMARY:

Till now we have discussed about, introduction, terminologies,

definition, scope of epidemiology, aims of epidemiology, Methods of
epidemiology, Measurement of epidemiology, approaches of
epidemiology, role of nurse in epidemiology.

CONCLUSION:

Epidemiology is a core part of public health. It allows the distribution

of health and ill-health in a population to be described, and possible causal
factors to be identified. It enables public health professionals to
understand health problems and take appropriate action.

BIBLIOGRAPHY:

➢ Neelam kumari, “Advance nursing practice”, pee-vee publication,

1st edition. Pgno:293
➢ Shabeer p, Basheer and S.Yaseen khan, “A concise of text book of
Advanced nursing practice” 2nd edition. Pgno:98
➢ K. park, A Textbook of preventive Medicine , 19th edition.
Jabalpur:m/s Banarsidas Bhanot; 2007 ,pg no:52
➢ Kamalam.S, Essentials in community health nursing practice, first
edition, 2008 , Jaypee brothers, New delhi, pg no: 230.
➢ Basavanthappa.B.T, Community health nursing, first edition,
Jaypee brothers, Mumbai, 2008.

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REFERENCE:

➢ Handbook on the Toxicology of Metals(fourth edition) 2015.

➢ www. Slideshare.net.epidemiology

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