EPIDEMIOLOGY

MODULE 4

Objectives:

At the end of the module, the students are expected:

y Define epidemiology y Enumerate the importance of epidemiology y Compare the two types of epidemiology y Correlate epidemiology in the field of

agriculture* y Track down diseases with technology* y Differentiate life span from life expectancy y Categorize the different health behaviors.

What is epidemiology?
Epidemiology

is the study of the determinants, distribution, and frequency of disease Who gets disease and why Epidemiologists study sick and well people to determine the crucial difference between those who get disease and those who are spared

Important Issues that Epidemiology can Address

Disease Mortality Hospitalization Disability Quality of Life Health Status Its not just disease!

Epidemiology
Epidemiology weighs and

balances Epidemiology contrasts and compares Epidemiologists use RATES events/population at risk

Epidemiology has a
Numerator y the number of people to whom

something happened (i.e. they got sick, died, etc.)

Denominator y the population at risk -- all the

people at risk for the event

What is epidemiology?
Some

describe it as the study of epidemics What is an epidemic?

y An epidemic occurs when there are

significantly more cases of the same disease than past experience would have predicted.

Uses of Epidemiology

To study the cause (or etiology) of disease(s), or conditions, disorders, disabilities, etc. y determine the primary agent responsible or ascertain causative factors y determine the characteristics of the agent or causative factors y define the mode of transmission y determine contributing factors y identify and determine geographic patterns

Uses of Epidemiology
To

determine, describe, and report on the natural course of disease, disability, injury, and death. To aid in the planning and development of health services and programs To provide administrative and planning data

Example: Use of Epidemiology

In

the United States, the National Center for Health Statistics is a data source for information on health and disease
y http://www.cdc.gov/nchs

Globally,

the World Health Organization is a data source for information on health and disease
y http://www.who.int

Purpose of Epidemiology
To

provide a basis for developing disease control and prevention measures for groups at risk. This translates into developing measures to prevent or control disease.

Two Broad Types of Epidemiology

Descriptive

Epidemiology

y Examining the distribution of disease in

a population, and observing the basic features of its distribution

Analytic

Epidemiology

y Testing a hypothesis about the cause of

disease by studying how exposures relate to the disease

Descriptive Epidemiology is the Antecedent to Analytical Epidemiology

Analytic

epidemiology studies require information to . know where to look know what to control for develop viable hypotheses

Three essential characteristics of disease that we look for in descriptive studies are...

Person Place Time

Person
Age, gender, ethnicity Genetic predisposition Concurrent disease Diet, exercise,

smoking Risk taking behavior SES, education, occupation

Place
Geographic place y presence or agents or vectors y climate y geology y population density y economic development y nutritional practices y medical practices

Time
Calendar Time Time since an

event Physiologic cycles Age (time since birth) Seasonality Temporal trends

Example
You have been

asked to investigate an event in which 2,220 people were exposed and 1,520 of them died. Your role as an epidemiologist is to ask questions about person, place and time.

How do we ask questions?

Surveys of

-survivors - next-of-kin - other related persons

with questions you learn that ...

Person:

Men, women and children were all exposed and at risk. The majority of people who died were wealthy and young men between 18-50 years (when compared to survivors). Place: All those exposed were within 1 block of one another, the climate was cold. Time: Mid April, people died within hours of the precipitating exposure.

Three essential characteristics that are examined to study the cause(s) for disease in analytic epidemiology are...

Host Agent Environment

Epidemiologic Homeostasis
Host

Agent

Environmen t

Host

Host Factors
Personal traits behaviors genetic predisposition immunologic factors

Agent

Environmen t

Influence the chance for disease or its severity

Host

Agents
Biological Physical Chemical

Agent

Environmen t

Necessary for disease to occur

Host

Environment
External conditions Physical Biologic social
Environmen t

Agent

Contribute to the disease process

Epidemics arise when host, agent, and environmental factors are not in balance
Due to new agent 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 or growth of the agent

Epidemiologic Activities

are often framed under the mantle of descriptive and analytic epidemiology y Descriptive epidemiology person,

place & time

Demographic distribution Geographic distribution Seasonal patterns etc. Frequency of disease patterns

y Useful for: Allocating resources Planning programs Hypotheses development

Epidemiologic Activities
Analytic epidemiology y built around the analysis of the

relationship between two items

Exposures Effects (disease)

y looking for determinants or

possible causes of disease y useful for

hypothesis testing

Life Span
The maximum number of years an individual from a given species can live. Jeanne Calment of France (18751997), who died at age 122 years, 164 days, was considered the longest living person on record.

Kinds of Life Span

1.
y

Maximum life span

is the greatest age reached by any member of species.

2.
y y

Average life span

The average age reached by members of a population It has increase from 47 years in the 1900 to 75 years in 1990 to the present.

Life Expectancy
The number of years an individual can expect to live based on average life span. The expected number of years of life remaining at a given age. Life expectancy from birth is used and analyzed for demographic data of different countries.

y It indicates the overall health of a country.

Life Expectancy

High life expectancy indicates low infant and child mortality, an ageing population, and a high quality of healthcare delivery. Life expectancy is also used in public policy planning, especially as an indicator of future population ageing in developed nations.

Decrease in life expectancy are due to famine, war, disease, and poor health. Increase life expectancy are due to improved public health, nutrition, and medicine.

Life Expectancy
89.73 years 2011 # 1 Monaco: # 2 Macau: 84.41 years 2011 # 3 San Marino: 83.01 years 2011 82.43 years 2011 # 4 Andorra: # 5 Japan: 82.25 years 2011 # 6 Guernsey: 82.16 years 2011 # 7 Singapore: 82.14 years 2011 # 8 Hong Kong: 82.04 years 2011 # 9 Australia: 81.81 years 2011 81.77 years 2011 # 10 Italy: # 139 Philippines: 71.66 years 2011

Infant Mortality Rate (IMR)

The number of deaths among infants under one year of age in a calendar year per one thousand live births in the same period.

IMR = deaths under 1 year of age in a calendar year X 1000 Number of live births in the same year

The traditional cause of death of infants was dehydration due to diarrhea. At present, the most common cause of death of infants is pneumonia.

Infant Mortality
Perinatal mortality only includes deaths between the fetal viability (22 weeks gestation) and the end of the 7th day after delivery. Neonatal mortality only includes deaths in the first 28 days of life. Postneonatal mortality only includes deaths after 28 days of life but before one year. Child mortality includes deaths within the first five years after birth

Infant Mortality Rate

High IMR means low levels of health standards which may be due to:
y Poor maternal and child health care y Malnutrition y Poor environmental sanitation y Deficient health service facility

Health Behavior
an action taken by a person to maintain, attain, or regain good health and to prevent illness. It reflects a person's health beliefs. Some common health behaviors are exercising regularly, eating a balanced diet, and obtaining necessary inoculations.

1. Preventive Health Behavior

Involves any activity undertaken by individuals who believe themselves to be health for the purpose of preventing or detecting illness in an asymptomatic state

2. Illness Behavior

Any activity undertaken by individuals who perceive themselves to be ill for the purpose of defining their state of health and discovering a suitable remedy.

3. Sick-Role Behavior
Involves

any activity undertaken by those who consider themselves to be ill for the purpose of getting well.

Stages of Illness Behavior/SickRole Behavior

Stage 1: Symptom Experience The person is aware that something is wrong. A person usually recognizes a physical sensation or a limitation in functioning but does not suspect a specific diagnosis.

Stages of Illness Behavior

Stage 2: Assumption of the Sick People If symptom persist and become severe, clients assume the sick role. At this point, the illness becomes a social phenomenon, and sick people seek confirmation from their families and social groups that they are indeed ill and that they be excused from normal duties and role expectations.

Stages of Illness Behavior

Stage 3: Medical Care Contact If symptoms persist despite the home remedies, become severe or require emergency care, the person is motivated to seek professional health services. In this stage the client seeks expert acknowledgement of the illness as well as the treatment.

Stages of Illness Behavior

Stage 4: Dependent Client Role The client depends on health care professionals for the relief of symptoms. The client accepts care, sympathy and protection from the demands and stresses of life. A client can adopt the dependent role in a health care institution, at home, or in a community setting. The client must also adjust to the disruption of a daily schedule.

Stages of Illness Behavior

Stage 5: Recovery and Rehabilitation This stage can arrive suddenly, such as when the symptoms appeared. In the case of chronic illness, the final stage may involve in an adjustment to a prolong reduction in health and functioning.

4. Behavior and Lifestyle

Something that is done once, or periodically, or over long period of time, such as: Immunization or flu shot Putting on sunscreen, or putting up a shade. Eating healthy diet, getting regular exercise, and avoiding cigarette use.

5. Health-Related and Health-Directed Behavior

Health-related behavior is any action that is related to disease prevention, health maintenance, health improvement, or the restoration of health. It can be voluntary or involuntary

6. Self-Care Behavior
Taking actions to improve or preserve ones health. Action taken to treat symptoms before seeking professional help.

7. Health Care Utilization Behavior

The use of health services, whether it is clinical, public health services, or the services of medical care professionals. It includes immunization, early detection and screening tests, elective surgery, or involuntary hospitalization after an injury.

8. Dietary Behavior

The eating patterns that people engage in, as well as behavior related to consuming foods, such as shopping, eating out, or portion size. It influence the development of many diseases such as coronary heart disease, cancer, diabetes, and osteoporosis.

9. Substance-Use Abuse

Focuses on the use of both licit and illicit mood-altering substances. It includes tobacco, alcohol, caffeine, marijuana, cocaine, heroin, etc. It results to addiction.

10. Sexual Behavior

May or may not involve coitus. Have health implications such as reproduction and child-bearing, sexually transmitted diseases, HIV/AIDS

11. Reckless Behavior

Involves individuals putting themselves in situation not normally required in daily living that substantially increase the chance of illness, injury, or death. Observed in adolescents and young adults, especially young males.