MODULE 6│PHARMCARE 2

PUBLIC HEALTH
PUBLIC HEALTH c. Increase food requirements - childhood, adolescence,
pregnancy, sickness
• the science and art of preventing disease, prolonging life, and
promoting physical and mental health and efficiency thru: 3. Population problem
• Organized Community Effort for: 4. Person's lifestyle
• the sanitation of the environment
• the control of community infections 5. Iatrogenic disease
• the education of the individual in principles of personal
hygiene II. DISEASE CAUSATION AND NATURAL HISTORY OF DISEASE
• the organization of medical service for the
• early diagnosis and treatment of diseases THREE ECOLOGIC FACTORS OF DISEASE
• the development of a social machinery which will ensure
a standard of living adequate for 1. Agent
• the maintenance of health • any element, substance, or force whether living or non-living,
the presence or absence of which can perpetuate a disease.
Agencies set to carry out organized community health
activities: TYPES:

1. Voluntary a. Living
• private, supported wholly or in large part by non-tax funds • plant and animals (bacteria, fungi, molds, yeast, arthropods,
e.g., NGOs, private clinics, private foundations helminths, protozoan)

2. Governmental b. Non-living
• public, official or tax supported e.g., government hospitals, • Physical and Mechanical agents – extremes in temperature,
health centers, district hospitals light, electrocution, physical trauma
• Chemical agents:
I. HEALTH AND DISEASE • exogenous – common poisons
• endogenous - toxic products of metabolism
WHO definition of Health
c. Nutrient
• state of complete physical, mental, and social well-being not • deficiency or excess is bad
merely the absence of disease and infirmity
2. Host
• comprehensive rather than physical
• qualitative than quantitative • a vertebrate or invertebrate capable of getting infected by
• dynamic rather than static and exposed to the agent

DIMENSION OF HEALTH HOST FACTORS OF DISEASE

• Genetic make up
1. Physical
2. Mental • Age
3. Emotional • Sex
• Race
4. Social
5. Spiritual • Habits, customs, and tradition
6. Sexual • Exposure to the agent
• Defense mechanism of the host
CONCEPT OF HEALTH AND DISEASE • State of nutrition

3. Environment
Disease
• a diagnostic category which classifies a particular illness, • sum of the organism's external surrounding conditions and
symptoms, or pathological components of the illness influences that affect its life and development.

Illness THREE CATEGORIES:

• a highly personal stage wherein he fills unwell, person's
1) Physical
experience of his disease
• humidity, weather, topographic features
Normal Health
2) Biologic
• state of well-being in which the individual is free from
disabling effect and has sufficient vigor to carry on the usual • presence of living agent
requirements of life, with social adaptation that produces
3) Socioeconomic
self-gratification and enjoyment
• a range rather than a specific entity • population density, priority is food not health, lack of
awareness, presence of fast food, urbanization, political
commitment
Holistic Health
• views a person being whose psycho-socialcultural-spiritual-
relationships with the environment directly affect health Biological laws for Communicable and Non-Communicable
Disease
DETERMINANTS OF HEALTH AND DISEASE
• disease results from an imbalance between a disease agent
1. Genes and man
• nature and extent of the imbalance depends on the nature
2. Nutrition and characteristics of the host and the agent
• essential causes of malnutrition • the characteristics of the two are influenced considerably by
a. Failure to ingest food – poverty the conditions of the environment.
b. Failure to utilize food – PKU, celiac disease, pernicious
anemia

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 ECOLOGIC MODELS OF DISEASE CAUSATION POSSIBLE RESULTS OF INFECTION

Epidemiologic Triangle • Recovery

• a change in one of the components causes change in the – host can ward off infection or disease agent
other
HOST • Balanced equilibrium
– forces of agent and host are equal so both are not affected;
dangerous because host becomes a healthy carrier (in
apparent infection)
AGENT ENVIRONMENT
• Subclinical conditions
Web of Causation – very mild reaction that escape
• Disease never depends on a single isolated cause but rather
develops as a result of chains of causation • Clinical case
– full-blown case which way either be atypical or typical
Wheel
• depicts the relationship of host with its genetic material and REQUIREMENTS FOR INFECTION TO OCCUR
how it is influenced by the environment
• can be adjusted based on every factor’s involvement 1. Presence of agent
2. Suitable reservoir

INCUBATION PERIOD
• interval between the time of entry of agent into the host and
the onset of signs and symptoms
• time required for the agent to establish itself to multiply or
secrete toxins.

This varies based on the following condition:

• Virulence, dose, and portal of entry

NATURAL HISTORY OF DISEASE • Previous experience of the host
• State of natural resistance
• comprises the body of both qualitative and quantitative • The inherent character of the organism
knowledge of agent, host and environmental factors and
its development from the first forces which initiate the 3. Presence of susceptible host
process in the environment through the resulting changes
that take place in man and continuing until equilibrium is Clinical Horizon
reached, or defect, disability or death ensues. • Clinical manifestation of disease which appear after the
incubation period
TWO PHASES OF THE NATURAL HISTORY OF DISEASE • E.g., Fever- most common symptom: Continuous (dengue)
• Intermittent (malaria) - up and down fever but the
1. Pre-pathogenesis (state of susceptibility) temperature reaches normal range
• phase before man is involved • Remittent (typhoid) – up and down fever but
• preliminary interaction of host, agent, and environmental temperature won’t be reaching normal range.
factors in disease production
4. Suitable portal of entry

PORTAL OF ENTRY
• A suitable portal of entry is requisite for a successful
infection.
• The portal of entry may also be the portal of exit.
• Possible portals of entry:
• Respiratory tract
• Mucous membranes
• Skin and subcutaneous tissue
• GIT
• Conjunctiva
• Placenta
2. Pathogenesis (stage of disability) • GUT
• course of the disease in man from the first interaction with
the disease, provoking stimuli to the changes in the form and 5. Portal exit from the host
function which results until equilibrium is reached or 6. Appropriate means of dissemination
recovery, defect, disability, or death ensues
• changes cause the signs and symptoms ---> diagnosis is Period of Communicability
needed
• period at which the patient is very infectious
• may be short in certain diseases such as SVI or very long for
disease with a carrier state (serves as reservoir of infection
in man), like in typhoid.

TYPES OF CARRIERS:

1. Incubatory
• having an elapsed time between first exposure to pathogen
and first appearance of symptoms (measles)

2. Convalescence
• despite disappearance of symptoms, the patient still contains
the organism (cholera, diphtheria)

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3. Temporary
• patient is infectious only during the period of illness
(influenza)
4. Chronic
• patient continuously sheds off the infectious for a long period
of time (typhoid, HIV, HBV, TB)
Characteristics of the agents directly related to the host:
1. Antigenicity
• ability to induce antibody production
2. Toxicity
• ability to produce toxin
3. Invasiveness
• ability to penetrate or grow within the host away from the
original site of illness
4. Virulence
• ability to cause serious illness
5. Pathogenicity
• ability to cause disease
6. Infectivity
• ability to lodge in the host and multiply in the body of the host
III. LEVELS OF PREVENTION
PREVENTION
• is inhibiting the development of the disease before it occurs
and other measures which will interrupt or slow down the
progression of the disease once it occurs.
A. PRIMARY PREVENTION
• prevention of the disease by altering the susceptibility and
reducing risks for susceptible individuals.
• These are the measures which can be accomplished during
the pre-pathogenesis stage.
GENERAL HEALTH PROMOTION (Primordial Prevention)
• measures employed in promoting health, not directed to any
disease but serve to further the general health and well being
• Health education and motivation are important in this period.
(To increase awareness and the knowledge of people on
how to improve health)
• Examples:
• Good standard of nutrition.
• Counseling and parent education
• Development of good habits of health and hygiene
• Prompt utilization of available health facilities
• Adequate housing and recreation.
• No overcrowding, adequate ventilation
• Cleanliness of the surrounding
• Sports activities
• Sex education and counseling before and during
marriage
• Genetics
SPECIFIC PROTECTION
• Use of measures against specific disease agents by
establishing barriers against agents in the environment
• Altering susceptibility and reducing exposure (risk reduction)
• Use of measures against specific disease agents by
establishing barrier against agents in the environment
• Examples:
• Isolation and quarantine - isolate the cases, quarantine
the exposed.
• Control means of spread
• Spread of the disease through direct/indirect contact,
vector, vehicle, fomite.
• Proper waste disposal
• Food, water, and milk sanitation
• Immunization – increases resistance of host
Module 6 – Public Health
• Avoidance of various carcinogenic agents and
treatment of pre-cancerous lesions
• Protection against occupational hazards.
• Protection from accidents
• Controls of aspects of human behavior such as dietary
habits, tobacco, drugs, and alcohol abuse.
B. SECONDARY PROTECTION
• Measures applied during early pathogenesis
• Early diagnosis and Prompt treatment
• Applies during subclinical (pre-symptomatic) or early clinical
phase of the disease
Objectives:
1. Prevent spread of infection if disease is infectious.
(Eliminate agent and reservoir)
2. To cure or arrest the disease process in order to prevent
complication
3. To prevent prolonged disability
Ex: Case finding in PTB, cancer screening
C. TERTIARY PREVENTION
• Applies to advanced stage of pathogenesis
• To return the individual to a useful place in society and make
maximum use of his remaining capacities.
• Examples: DISABILITY LIMITATION, REHABILITATION,
INTENSIVE FOLLOW-UP, AND TREATMENT OF CASES
IV.DEMOGRAPHY
• Science of Population
• Focuses its attention to three human phenomena:
• Population size
• Composition of the population
• Distribution of the population in space
TOOLS FOR DEMOGRAPHY
1. Counts
• absolute numbers of a population or any demographic event
occurring in a specified area during a specified time period.
• Examples:
• 30,443,287 males in the Phil. in 1990
• 77,322 live births in Manila in 1984
2. Ratio
• single number that represents the relative size of two
numbers
• Relation of one population subgroup to another subgroup in
the same population It takes the form of:
• When K = 100, the proportion becomes a percentage.
• Example:
• 100 number of males sex ratio x number of females
3. Proportion
• special type of ratio in which the numerator is part of the
denominator o Relation of a population subgroup to the
entire population
• It takes the form:
• When K = 100, the proportion becomes a percentage.
4. Rate
• frequency of occurrence of events over a given interval of
time
• Most rates are expressed per 1000 population
• Crude Rate – computed for an entire population
• Examples: Crude Death Rate (CDR), Crude Birth Rate
(CBR)
*Specific Rate – computed for a specific subgroup (e.g.,
General Fertility Rate)
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 V. MEASURES OF CENTRAL TENDENCY AND DISPERSION 2. Specificity
• ability of the test to identify correctly those who do
A. MEASURES OF CENTRAL TENDENCY not have the disease

1. Mean COMPARISON OF RESULT OF A DICHOTOMOUS TEST WITH

• The sum of the scores or values of a variable divided by their ACTUAL DISEASE STATUS
number
𝑆𝑢𝑚 𝑜𝑓 𝑎𝑙𝑙 𝑜𝑏𝑠𝑒𝑟𝑣𝑎𝑡𝑖𝑜𝑛𝑠 Disease Status
𝑀𝑒𝑎𝑛 = Test Result
𝑁𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 𝑜𝑏𝑠𝑒𝑟𝑣𝑎𝑡𝑖𝑜𝑛𝑠 With Disease Without Disease
True Positive (TP) False Positive (FP)
(+) Have disease and have No disease but have (+) test
2. Median (+) test result result
• The value of the middle item when the items are arranged False Negative (FN) True Negative (TN)
according to magnitude (-) Have disease but (-) test No disease and have (-) test
• Middlemost observation in a set of observations arranged in result result
numerical order or in an array
• If n is odd, it is the middlemost observation
• If n is even, it is the mean of the two middlemost 𝑇𝑃
observations 𝑆𝑒𝑛𝑠𝑖𝑡𝑖𝑣𝑖𝑡𝑦 = 𝑥 100
𝑇𝑃 + 𝐹𝑁
• Arrange the observations according to magnitude (array) and
use the corresponding formula 𝑇𝑁
𝑛+1 𝑆𝑝𝑒𝑐𝑖𝑓𝑖𝑐𝑖𝑡𝑦 = 𝑥 100
𝑇𝑁 + 𝐹𝑃
2

3. Mode
• The score of the values which occurs with the greatest
frequency

Location of the measures of central tendency:

• Symmetrical Distribution
• Skewed to the Left
• Skewed to the Right

B. MEASURES OF DISPERSION

1. Range
2. Variance
3. Standard deviation
4. Coefficient of variation

VI. STUDY DESIGN

1. Observational
• observe things happen

a. Descriptive - occurrence and distribution of diseases

b. Analytic - test for hypothesis

2. Experimental
• there is intervention

a. True experiment - with randomization

b. Quasi-experiment - without randomization

TYPES OF DESCRIPTIVE STUDY DESIGN

Descriptive Case Report
Case Series
Ecologic
Analytic Case Control
Cohort
Both Descriptive & Analytic Cross Sectional

VII. VALIDITY OF TEST

• The ability of the test to distinguish between who has the

disease and who doesn’t
• Measured by its ability to do what it is supposed to do
• Components:

1. Sensitivity
• ability of the test to identify correctly those who
have the disease

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