MODULE 1 Determinants =

Introduction to Epidemiology Uses of Epidemiology

To determine, describe, and report on the natural course of disease,
Definition of Epidemiology disability, injury, and death (even mortality).
(D1) Epidemiology is the study of the determinants, distribution, To aid in the planning and development of health services and
and frequency of disease (who gets the disease and why). programs.
o Frequency of disease – the people who gets and o The government uses epidemiology —> these data are
doesn’t have the disease. gathered by epidemiologists.
Epidemiologists study sick people. To provide administrative and planning data.
o They need to study sick people first because they are
To study the cause (or etiology) of disease(s), or conditions,
the ones that require immediate attention.
disorders, disabilities, etc.
o They need treatment, diagnosis, and they could die.
o Etiology = cause or agent
Epidemiologists study healthy people.  Ex. Etiology of Tuberculosis =
This is done to determine the crucial difference between those who Mycobacterium Tuberculosis
get the disease and those who are spared. To determine the primary agent responsible or ascertain causative
Epidemiology studies every diseases, not only COVID-19. factors.
Epidemiology study exposed people.
Additional Uses:
Epidemiology study non-exposed people. Main example. COVID-19
This is done to determine the crucial effect of the exposure. To determine the characteristics of the agent or causative factors.
(D2) The study of the distribution and determinants of health related To determine the mode of transmission.
states or events in specified populations, and the application of this o Ex. airborne or physical contact
study to control of health problems.
To determine contributing factors.
Epidemiology o Ex. Ayuda
o Epi – “Upon”
o Demi – “People” To identify and determine geographic patterns
o Ology – “Study” o Ex. Manila
o Study of specific people in a population (it must be
Purpose of epidemiology
specific).
To provide a basis for developing disease control and prevention
Application: Epidemiology involves applying the knowledge gained
measures for groups at risk (whether or not you are at risk?)
by studies to community-base practice.
This translates into developing measures to prevent or control
Determinants disease.
“risk-factors” or “determinant factors”
Two broad types of epidemiology:
Things that can cause the distribution (people, time, place,
Descriptive epidemiology: Person Place Time
microorganisms etc.).
o Examining the distribution of disease in a population,
You are only talking about the factors that will divide them into two and observing the basic features of its distribution
groups. o Time: it could be a time frame or range ex. for the
Ex. Dengue (+) and Dengue (-) month of February
o Once you have the three factors, therefore, you can
Distribution now analyze.
“pattern” o is antecedent to analytical epidemiology.
History Analytic epidemiology: investigating a hypothesis about the cause
Ex. Different ages of children who got infected with polluted water, of disease by studying how exposures relate to disease.
no clean water. Tabulate from children, adults and senior citizen. o Analytical doesn’t happen without descriptive
epidemiology. Easier to do descriptive, harder to do
Application analysis because analytical needs critical thinking.
o Studies require information to:
If you provide the cure or remedy.
 Know where to look (very important in
Ex. wearing of face masks, washing of hand soaps etc. research paper).
 Know what to control for.
While-Task Activity #1:  Develop viable hypotheses.
1. Compare food histories between persons with staphylococcus food o When you are doing a thesis, be concise and know
poisoning and those without. what you’re doing.
Distribution = o PLACES AND PEOPLE:
Determinants = staphylococcus infection (person with staphylococcus and  Person
those without).  Age, gender (male &
*Deciding factor female), ethnic group
(Ilocano, mangyan etc.)
2. Mark on a map the residences of all children born with birth defects  Genetic predisposition (do
within 2 miles of a hazardous waste site. you have ethnicity of
Distribution = identifying on the map the location of the houses of people thyroidism? Or are one of
or children with birth defects. your family members
Determinants = mongoloid?)
 Concurrent disease (are
3. Graph the number of cases of congenital syphilis by year for the
you currently suffering
country.
from something?)
Distribution = this is the answer.
 Diet (how much do u
Determinants =
eat?) , physical activity (do
you exercise?), smoking
4. Recommend that close contacts of a child recently reported with
meningococcal meningitis receive Rifampin.  Risk taking behaviour
Distribution = not  Education, occupation
Determinants = not  Place
Application = this is the answer.  Presence of sgents or
vectors (covid-19, is
5. Tabulate the frequency of clinical signs, symptoms, and laboratory dominant more on what
findings among children with chickenpox in Antipolo, Rizal. season?)
Distribution = this is the answer.  Climate
*only one component  Geology
  Population density
 Economic development
 Nutritional practices
 Medical practices
 Time
 Calendar time
 Time since an event
 Physiologic cycles (study
like the menstrual cycles,
etc.)
 Age (time since birth)
 Seasonality (flu season,
dengue season, etc.)
 Temporal trends
(temperature trends, the
types of shoes you wear)
The Epidemiologic Triangle
o Three characteristics that are examined to study the
cause(s) for disease in analytic epidemiology.
o Host – personal traits, behaviours, genetic
predisposition, immunologic factors
o Agent – biological, physical, chemical
 Influence the chance for disease or its
society.
o Environment – external conditions,
physical/biological/social. It is the balancing factor
between the host and agent. If not conducive
(favorable) therefore there will be no problem.
 Contribute to the disease process
o Ex.
 AGENT – Coronavirus, Gonorrhea
(STD)
 HOST – Human, multiple sexual partner
 ENVIRONMENT – Typhoon; floods
(for leptos), Party places in BGC (House
party etc.)
o Quiz on Friday: can you give me an example
demonstrating the balance epidemiologic triangle.
Epidemic
o Occur when host, agent and environmental factors are
not in balance.
 Due to new agent I due to change in
existing agent (infectivity, pathogenicity,
virulence)
 Due to change in number of
susceptibles in the population.
 Due to environmental changes that
affect transmission of the agent and
growth of the agent.
History of Epidemiology (Important breakthrough):
o Edward Jenner (1749-1823)
 Father of Immunology
 Developed a vaccine against smallpox
using cow pox 160s years before the
virus was identified.
o John Snow (1813-1858)
 Father of Field Epidemiology
 Described the association between dirty
water and cholera 44 years before the
suspect bacterium, vibrio, cholerae was
identified.
 Also used anesthesia.
 Conducted studies of cholera outbreaks
both to discover the cause of disease and
to prevent its recurrence.
 Determined the cause of infection in
London.
 Descriptive Epidemiology (who, what,
when and where) Hypothesis
Generation (devised a hypothesis) 
Hypothesis Testing
 The Spot Map: Plotting the specific area
of cholera outbreak and
 Hypothesis: If the cluster is happening
around pump A, maybe the source of
infection is pump A. Then, they removed
they pump to avoid usage. The source of
water from pump A was from the 2 main
water distribution in London.
o Ignaz Semmelweis (1818-1865)
o James Lind (1716-1794)
o Joseph Goldberger (1874-1927)
Specialties in Epidemiology:
o Chronic disease – diseases gone for a long period of
time and sudden onset (ex. hypertension, diabetes).
o Acute – sudden infection
o Behavioral –
o Forensic _ integration of crime due to somebody who
died
o Genetic
o Infectious disease
o Injury
o Perinatal – present at birth
o Reproductive health
o Social epidemiology
o M1L1 – PART 2
o Canvas epidemiology
Measuring disease occurrence (morbidity and mortality):
prevalence, incidence, incidence density
o Case – a case is a person in the population or study
group identified as having the particular disease, health
disorder or condition under investigation.
 Case definition
 Suspect case
 Case severity
Example of clinical criterion used for case classification:
o Confirmed case: signs and symptoms plus laboratory
confirmation.
o Probable case: acute onset of at least three of the
following four features: myalgia, fever, facial, edema,
or eosinophil count greater than 500/mm3 of blood.
o Possible case: acute onset of two of the four features
plus a physician diagnosis of trichinosis.
o Suspect case: unexplained eosinophilia.
o Not a case: Failure to fulfill the criteria for a
confirmed, probable, possible, or suspect case.
o Time: onset after October 1, 2015
o Place: Metro Manila
o Person: Any
o Ex. This was done on a Trichinosis outbreak –
Trichinella spiralis is a parasitic worm.
While-Task Activity #2:
INSTRUCTION: Determine the case classification.
1. Confirmed case
2. Probable case
3. Not a case
4. Probable case
5. Possible case
Disease stages
Crucial to recognize diseases if they are acute or chronic.
As long as the investigator knows the correct signs and symptoms
and laboratory results for a disease, it is relatively easy to count
clinical disease occurrence.
In exposure occurrence, counting is equally dependent on a clear
and good definitions of the characteristics that will be classified as
exposure and criteria for measurement.
You know how to categorize and tabulate them to be a great help.
Numerator vs. denominator
 Counting of the exposures and occurrence of disease is referred to as  Cohort studies – It must
the numerator data and more important is the denominator or satisfy a certain goal, there
population size, which is the group of subjects or populations from is a time limit involved
where the numerator comes, or the number of subjects in the study. o Ex. eliminate
those
As a rule, the denominator should be the population or group from
dentistry that
where the cases (or numerator) came from.
are pre-
Ex. 10 people and 2 positive (20%) = alarming result from COVID- clinical
19  Case-control studies –
You have to know both for you to establish or make an assumption. subject them to a certain
Give significance to the denominator always. criteria
o Ex. I will
Epidemiology studies the distribution of diseases in populations and factors inject
related to them: o something
This definition leads to two questions: and they will
o 1. How can we measure diseases and their be categorize
distributions?  Epidemiological measures of effect:
 Morbidity (sick)  Differences in disease risk
 Prevalence – “existing” or  Ratios in disease risk
“nandyan na nakailang  Relative differences in
araw” how many are disease risk.
currently there. Morbidity/Prevalence/Incidence
 NO PREVALENCE OF o One way of evaluating the health of a population is by
MORTALITY (you can measuring the morbidity information in which
only die once so you are diseases are classified as existing or new.
only counted once; pwede o In epidemiology, we refer to existing cases of disease
lang if sa ayuda etc.). as prevalence and to new cases of disease as
 Incidence – “new cases” or incidence.
“new discovery” o A prevalence proportion is the number of existing
 Prevalent Rate: 35, 542 cases of disease at a given time divided by the
 Incidence Rate: 872 observed population in the same time period.
 Mortality (dead) o Comorbidity – Co; together, Morbidity; sick
 Incidence

N umber of existing cases ( all cases−new∧old )

X1
Total observed population at a particular time period
Point prevalence: In a population at one point in time
¿ of cases
¿ of persons
MORBIDITY EQUATION:

About death; you died and considered on the part of mortality; but 18 may dengue
the story doesn’t end there because people continues to investigate X 100 = 18%
the mortality.
o 2. How can we measure differences in disease
100 na tao population
(PREVALENCE RATE (ALL))
occurrence in different populations?
 Epidemiological study types:
 Cross-sectional 5 no . of new cases for today
o Ex. papaya X 100 = 2.5%
(hahatiin mo 200 na tao / population
sa dalawa (INCIDENCE RATE (NO. OF NEW CASES))
(left and
right), Measuring disease occurrence: Prevalence
walang o Prevalence: is the proportion (denoted as p) of a
pipiliin)
specific population having a particular disease. P is a
o Ex. all
number between 0 and 1. If multiplied by 100 it is
surname with percentage.
starting A-L o Examples:
will be group
 In a population of 1000 there are two
I and M-Z
cases of malaria:
will be group
 P = 2/1000 = 0.002 or 2%
II.
 In a population of 10,000 there are 4
 Clinical trials – Trials,
cases of skin cancer:
there is a result
 P = 4/10,000 = 0.0004 or
o Ex. C2; ang
0.04%
pagiinom ay
nakakataba Epidemiological terminology
o Ex. Agustin o In epidemiology, disease occurrence is frequently
susukatin small relative to the population size. Therefore, the
tambok ng proportion figures are multiplied by an appropriate
pisngi kung number such as 10,000. In the above second example,
tumaba ba we have a prevalence of 4 per 10,000 persons.
sya compared o Example:
to acejas na  In a barangay with 23,000 residents there
hindi have occurred 20 cases of COVID-19.
uminom pero Prevalence?
susukatin.  Solution: P = 20/23,000 x 100 = 0.087%
 MODULE 1 LESSON 2

Dental ethics: ethics first of course

o We are all responsible for all – Dostoevsky
 Ethical issues in epidemiology
 Ethics and ethical principles
 Ethical obligations to research subjects
 Ethics of randomized controlled trials
 Professional issues in epidemiology
 Data ownership and sharing
 Public health and bioterrorism CDC,
anthrax and smallpox.

Ethics and Epidemiology

o There is almost no step in the research process in
epidemiology in which ethical issues do not exist.
o In its descriptive sense, the term ethics can be used to
refer to the set of rules, principles, values, and ideals of
a particular group of people (morals). In its analytic
sense, the term ethics can be used to refer to the
systematic study of moral concepts and theories (moral
philosophy).
o Ethics –> moral

Ethical principles: The Georgetown Mantra

o Respect for autonomy – protection of the ability of
persons to act as autonomous agents.
o Non-maleficence – protection of persons from harm.
o Beneficence – provision of benefits or assistance.
o Justice – giving each person their due.
Integration of public health ethical problems into public health
and bioethics
o In program designed to promote health and prevent
disease and injury (e.g. what is the responsibility of
individuals to live health lives?).
o In methods used to reduce or eliminate risk (e.g. what
level or degree of risk is socially acceptable?)
o Ex. Human experimentation
o You know what is good or bad in ethics.

Questions and Protocols on ethics in epidemiology:

o Confidentiality
o Privacy
o Bioterrorism