W2 Causal Concept

Monday, 6 November, 2023 3:03 AM

Web of causation
Causal Concept & Dynamics of Disease
Transmission - Represent The complex and interconnected nature of factors influencing health outcome
- Direct & indirect cause
- Must involve multiple cause

The level in WoC

i. Macrolevel ( social, economic)

ii. Invidual lvl ( personal, beahviour, physiological)
iii. Microlevel ( organ, system etc)

Theory of dzs causation Risk factor

 Supernatural
Causality  Theory of contagion - being close to other spreads - factor that is associated with a given health outcome
 Miasmatic theory - noxious air & vapors - risk factor precede the occurrence Direct - susceptible host contracts an infection , discahrges ( example ; cannine
 Germ theory of dzs - Louis Pastteur ( bact in air) - must not be due to any source of error or even sampling error distemper)
• Relationship event/exposure and effect or outcome  Weakness - Mus repersent sample population
• Cause & effect dealing Indirect - involves intermediate vehicle (vector), living or inanimate
Koch Postulates
• Exposure to certain factor = health outcome
Epidemic Curve
Organism is causal if • Present in all cases Factors affecting the shape of the curve Vector
• X occur in other dzs
Case : infxs dzs under investigation • Isolated in pure culture an animal, repeatedlly passaged
number of new cases on the vertical axis Mechanical vector - animal (usually an arthropod) that physically carries an infectious agent to its Primary
time on the horizontal axis - incubation period host
& induced other animal - infectivity of the agent
Exposure : any potential causal charactersitic such as behaviour , en, - - proportion of susceptible animals in population Biological vector - vector (usually an arthropod infectious agent undergoes either necessary part of its life-
Weakness  Some microbes cant culture in media & lab - distance between animals
tx, occupation, genetic  Cant explain polymicrobial infx
cycle, before transmission to 2ndary host
 Cant deterimine other factor cause dzs
Outcome : dzs.  Not all host develop similar dzs
3 types biological transmission
• Association does not necessarily imply causation 1. developmental transmission ( essential phase development in vector) dirofilaria
Epidemiologic triad
• Final conclusion can only done w combination result multiple 2. propagative transmission - agent multiplies in the vector
3. cyclopropagative transmission - combination above two - babesia
scientific studies like meta analysis  3 CORNERS of triangle
○ Agent : what
○ Host : who
If asscoication not causal? ○ Env : where ( external factos or cause)

 Mission is to break! Factors associated with the spread of infection

 Bias
 Chance Characteristics of hosts - susceptibility (vulnerability) and infectiousness

 Confounding Common source epidemic

Characteristics of pathogens - Infectivity, Virulence, Stability
 Reverse causality all cases are infected from a source

Guideline for establishing causal association (BRADFORD HILL CRITERIA) - If exposure brief (skjp), - point-source epidemic EFFECTIVE CONTACT
○ Cth food poisoning
1. Strength of asscoiation ○ Occur within one incubation period of
- If factor causal = strong +ve association factor & dzs
Propagating epidemic
2. Bilogical gradient/ dose response
- Incremental cg in dzs rate in cojuntiuon w changes in exposdure
- infectious agent in which initial (i.e., primary) excrete agent - infect susceptible invidu -
then become secondary cases
3. Temporal relationship
- Ability establish exposure to putative cause - Cth - fmd

4. Reproducibility/consitency Basic reproduction number (Ro)

- Replication fidingins of different investigator

5. Biological plausibility - ability of an infectious disease to spread in a population

- Relationsuip consitent w general knowledge & beleifs - Ro is the average number of secondary cases caused by one typical
Infectious

• R0 > 1 invasion
• R0 < 1 no invasion

Factors determining Ro

- Mode of disease transmission

- Population density
- Agent Infectiousness
- Course of disease -stages

Causal Models

Two types : sufficient & necessary

 Cause sufficeint = inevetible prodcues effect

 Sufficinet cause = comprises range component causes dzs which multifactorial
- Ex : CDV - although sufficeint cause involve exposure : but lack immune alsom other fact
counts

Rothman’s causal pies model (1976)

- Analyze complex interlplay factors contribute to causation of particular disease

- Individual factor contribution - as piece of pie
- All pie complete = dzs

Necessary cause
- Factor must presenmt for particular event to occur
- W/o this it wont occur
- Component appears in every pie or pathway is called ---> necessary cause

Sufficient Cause
- set conditions when all present together = inevitably produce outcome/dzs
- ANY of these condition present alone may enough
- Unlike necessary cause, 1 is enough

Component cause
- Individual factor within SUFFICIENT CAUSE
- Multiple componetns cause together ---> form SUFFICENT CAUSE = outcomes
- Include factors classified as
 Predisposing factors
 Enabling factors
 Precipitating factors
 Reinforcing factoprs