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What is epidemiology?

The study of the distribution and determinants of health-related states among specified populations and the application of that study to the control of health problems.

Which of the following is NOT a purpose of epidemiology in public health practice?

  • Determine the effectiveness of healthcare treatments in improving individual health (correct)
  • Identify segments of the population at highest risk from specific causes of ill health
  • Determine the relative importance of causes of illness, disability, and death
  • Discover the agent, host, and environmental factors that affect health
  • Describe the four steps involved in solving health problems using epidemiological approaches.

    Step 1: Surveillance - determine the time, place, and person affected. Step 2: Assessment - analyze the problem to understand its magnitude and characteristics. Step 3: Hypothesis testing - develop and test hypotheses about the causes and risk factors. Step 4: Intervention - implement strategies to control or prevent the health problem.

    What was an early theory of disease causation?

    <p>The theory that diseases were caused by evil spirits</p> Signup and view all the answers

    The Germ Theory of Disease stated that disease was caused by an imbalance in the body's four humors.

    <p>False</p> Signup and view all the answers

    What are Henle-Koch's postulates?

    <p>Koch's postulates are four criteria that must be fulfilled to establish a causal relationship between a specific microbe and a specific disease.</p> Signup and view all the answers

    What is the concept of multiple causation?

    <p>The idea that disease results from the interaction of multiple ecological factors within a dynamic system made up of an agent of disease, host, and the environment.</p> Signup and view all the answers

    The web of causation is a model that represents the complex interplay of factors contributing to a disease.

    <p>True</p> Signup and view all the answers

    What is the epidemiologic lever, and how does it relate to disease causation?

    <p>It represents a hypothetical lever where the host and the agent are at opposite ends, and the environment serves as the fulcrum. The balance of this lever is affected by the interactions between the agent, host, and environment, which ultimately determine the outcome of disease.</p> Signup and view all the answers

    What is the epidemiologic triangle, and what does each point represent?

    <p>It is a model that depicts the relationship between the agent, host, and environment. The agent represents the causative factor of the disease, the host represents the susceptible individual, and the environment encompasses the surrounding conditions that can influence disease transmission.</p> Signup and view all the answers

    What are some examples of environmental factors that can influence disease?

    <p>Physical factors include water quality, temperature, and geographic location. Social factors encompass population density, socioeconomic status, access to healthcare, and cultural practices.</p> Signup and view all the answers

    Define reservoir of infection.

    <p>A reservoir of infection is a living organism or inanimate matter in which an infectious agent normally lives and multiplies. The agent depends on that reservoir for survival and reproduces in a way that allows it to be transmitted to a susceptible host.</p> Signup and view all the answers

    Which of the following is NOT considered a mode of transmission for infectious agents?

    <p>Environmental transmission</p> Signup and view all the answers

    Which of the following modes of transmission involves the transfer of infectious agents through direct contact with an infected person?

    <p>Direct contact transmission</p> Signup and view all the answers

    Droplet transmission is a type of indirect contact transmission.

    <p>False</p> Signup and view all the answers

    What are fomites?

    <p>Nonliving objects that can harbor and transmit infectious agents.</p> Signup and view all the answers

    Explain the role of vectors in disease transmission.

    <p>Vectors are living organisms, typically insects or arthropods, that transmit infectious agents from one host to another. They can act as mechanical vectors, passively carrying the agent on their body parts, or biological vectors, where the agent multiplies and develops within the vector before transmission.</p> Signup and view all the answers

    What is the range of infection, and why is it important to understand?

    <p>The range of infection encompasses the spectrum of illness, from inapparent infection (asymptomatic) to severe disease. Understanding this range is essential for effective prevention and management of diseases.</p> Signup and view all the answers

    Which of the following factors is LEAST LIKELY to influence the severity of an illness in a host?

    <p>The host's social and cultural background</p> Signup and view all the answers

    What is NOT a potential outcome of an infection?

    <p>Increased susceptibility to other infections</p> Signup and view all the answers

    Non-specific defense mechanisms are the body's first line of defense against pathogens.

    <p>True</p> Signup and view all the answers

    What is the difference between a necessary cause and a sufficient cause?

    <p>A <strong>necessary cause</strong> must be present for the disease to occur, meaning it always precedes the effect. However, it may not be enough to cause the disease on its own. A <strong>sufficient cause</strong> is a factor that inevitably initiates or produces an effect, it alone is capable of causing the disease. In reality, most disease causation involves a combination of necessary and sufficient causes.</p> Signup and view all the answers

    Which of the following is an example of a necessary but not sufficient cause for cancer?

    <p>All of the above</p> Signup and view all the answers

    What is herd immunity?

    <p>Herd immunity is the resistance of a group or community to invasion and spread of an infectious agent, based on the immunity of a high proportion of individuals within that group.</p> Signup and view all the answers

    The natural history of disease describes the progression of a disease in an individual over time, in the absence of treatment

    <p>True</p> Signup and view all the answers

    Which of the following stages is NOT part of the natural history of disease?

    <p>Stage of diagnosis</p> Signup and view all the answers

    What is the stage of susceptibility?

    <p>The pre-exposure period in the natural history of disease during which an individual in the population is vulnerable or at risk to acquire the infection and/or amenable to be harmed by a health determinant. The risk factors are present in the pre-exposure period, although the infection or disease itself is not.</p> Signup and view all the answers

    The stage of susceptibility ends with the effective exposure to the agent.

    <p>True</p> Signup and view all the answers

    What is the stage of adaptation?

    <p>The period following exposure to an agent or risk factor, where the host's immune system responds to the challenge and attempts to prevent or control the disease.</p> Signup and view all the answers

    If adaptation fails, it leads to pathogenesis.

    <p>True</p> Signup and view all the answers

    What is the stage of presymptomatic disease, and what is another name for it?

    <p>The stage of presymptomatic disease, also known as the subclinical stage, is the period when the etiological factors (such as the agent, risk behaviors, or environmental toxins) are present in the body and causing pathological changes, but the host does not yet show any noticeable signs or symptoms.</p> Signup and view all the answers

    What is the incubation period, and where does it occur in the disease process?

    <p>The incubation period is the asymptomatic period between exposure to an infectious agent and the onset of symptoms. It occurs during the presymptomatic or subclinical stage of disease.</p> Signup and view all the answers

    The latency period is primarily associated with infectious diseases.

    <p>False</p> Signup and view all the answers

    What is the stage of clinical disease?

    <p>The stage of clinical disease begins when sufficient end-organ changes occur to produce recognizable signs and symptoms of the disease.</p> Signup and view all the answers

    What are the potential outcomes of the clinical stage of disease?

    <p>All of the above</p> Signup and view all the answers

    What is the stage of disability?

    <p>The final stage in the natural history of disease, which deals with the outcomes: recovery, disability or death. If the disease does not result in death, the individual will recover or experience disability.</p> Signup and view all the answers

    Which of the following is NOT a level of prevention?

    <p>Quaternary prevention</p> Signup and view all the answers

    When does primordial prevention occur in the disease process?

    <p>Primordial prevention focuses on preventing the development of risk factors before they appear, typically before the stage of pre-pathogenesis.</p> Signup and view all the answers

    What is the primary target of primary prevention?

    <p>Primary prevention aims to prevent the onset of disease by targeting the underlying risk factors.</p> Signup and view all the answers

    Describe the primary goal of secondary prevention.

    <p>Secondary prevention focuses on early detection and prompt treatment of disease to prevent progression and reduce complications.</p> Signup and view all the answers

    What is the overarching objective of tertiary prevention?

    <p>Tertiary prevention aims to reduce the impact of existing disease by supporting complete treatment, limiting disability, and providing rehabilitation.</p> Signup and view all the answers

    What are the primary data sources used for epidemiologic studies?

    <p>Primary data is those collected directly by the researcher. Primary data sources include surveys, interviews, questionnaires, and direct observations.</p> Signup and view all the answers

    Secondary data can be obtained from computerized bibliographic databases.

    <p>True</p> Signup and view all the answers

    What are the advantages of using census data for epidemiologic studies?

    <p>Census data provides information on population numbers and distributions by age, sex, and other demographics, which is useful for understanding the characteristics of a population. It also allows for small-area estimation and disaggregation of data, providing insights into the geographic variability of health outcomes.</p> Signup and view all the answers

    What is a major disadvantage of using census data to study health?

    <p>One of the primary limitations is the inclusion of very limited health questions. Therefore, it is not suitable for exploring detailed health patterns or disease prevalence.</p> Signup and view all the answers

    What is the primary purpose of a civil registry?

    <p>The primary aim of civil registries is the establishment of legal documents, such as birth and death certificates, as required by law.</p> Signup and view all the answers

    Civil registries are a major and effective source of vital statistics.

    <p>True</p> Signup and view all the answers

    What is the primary type of data collected by a civil registry?

    <p>Civil registries primarily collect vital statistics, such as birth, death, marriage, and divorce records.</p> Signup and view all the answers

    A major challenge for civil registries in lower-income countries is completeness of data.

    <p>True</p> Signup and view all the answers

    Why is it important to monitor notifiable diseases?

    <p>Monitoring notifiable diseases allows public health officials to track disease outbreaks and identify potential problems early on.</p> Signup and view all the answers

    What are the general advantages of using population surveys for epidemiologic studies?

    <p>Population surveys gather prime data on risk factors, offer the opportunity to study the relationship between health and socio-economic determinants, and provide detailed information on a specific population.</p> Signup and view all the answers

    What are two major disadvantages of using population surveys for epidemiologic studies?

    <p>They may be less efficient, requiring larger sample sizes, to detect rare events. They can be affected by sampling error which can lead to inaccurate estimates of the target population.</p> Signup and view all the answers

    What is institution-based surveillance data?

    <p>Institution-based surveillance data is gathered from institutions such as healthcare facilities, schools, and workplaces.</p> Signup and view all the answers

    What are three main types of institution-based surveillance data?

    <p>Case reporting is the collection of data on individual cases of disease. Morbidity and mortality data refers to the incidence and prevalence of disease, as well as death rates. Availability and quality of services are important factors assessed in institution-based surveillance.</p> Signup and view all the answers

    What are three types of data that can be obtained from beyond the health sector?

    <p>Food and agricultural records provide insights into food safety, production, and potential sources of contamination. Occupational reports offer data on workplace hazards and potential exposures, while police records provide insights into crime patterns and potential health risks associated with certain neighborhoods or populations.</p> Signup and view all the answers

    Which of the following is NOT a consideration in choosing a data source for an epidemiologic study?

    <p>Financial budget</p> Signup and view all the answers

    Primary data is data that is collected firsthand by the researcher.

    <p>True</p> Signup and view all the answers

    What are the two general types of data used in epidemiologic studies?

    <p>Primary data and secondary data are the two general types.</p> Signup and view all the answers

    What are some examples of primary data sources?

    <p>Interviews, questionnaires, surveys, focus groups, and direct observations.</p> Signup and view all the answers

    Secondary data is often used in epidemiologic studies to provide a broader context or historical perspective.

    <p>True</p> Signup and view all the answers

    What are some examples of secondary data sources?

    <p>Computerized bibliographic databases, census data, registries, hospital records, and insurance records.</p> Signup and view all the answers

    Explain the concept of data privacy and confidentiality in epidemiologic studies.

    <p>Data privacy and confidentiality ensure that personal information collected in a study is kept private and securely maintained.</p> Signup and view all the answers

    Which of the following is a general data quality issue?

    <p>All of the above</p> Signup and view all the answers

    What is data sharing in the context of epidemiologic research?

    <p>Data sharing involves the voluntary release of information collected in a study for research purposes.</p> Signup and view all the answers

    What are two key challenges associated with data sharing in epidemiologic research?

    <p>Maintaining control over intellectual property, ensuring the privacy and confidentiality of research subjects.</p> Signup and view all the answers

    What is data linkage, and what are the potential benefits?

    <p>Data linkage involves joining data from two or more sources to obtain a more comprehensive understanding of health outcomes and risk factors.</p> Signup and view all the answers

    What are two key challenges of data linkage?

    <p>Ensuring the compatibility and interoperability of different data sources and safeguarding the confidentiality of individual data records.</p> Signup and view all the answers

    Study Notes

    Introduction to Epidemiology

    • Course offered by Our Lady of Fatima University's College of Medical Laboratory Science, Biostatistics and Epidemiology department.

    Epidemiology - Defined

    • Study of the distribution and determinants of health-related states among specific populations and the application of that study to control health problems.

    Epidemiology Purposes in Public Health Practice

    • Discover the agent, host, and environmental factors affecting health.
    • Determine the relative importance of illness, disability, and death causes.
    • Identify population segments at greatest risk from specific health issues.
    • Evaluate health programs and services' effectiveness in improving population health.

    Solving Health Problems

    • Step 1: Data collection
    • Step 2: Assessment
    • Step 3: Hypothesis testing
    • Step 4: Action
    • Parallel steps: Surveillance; determine time, place, and person (Step 1); Inference (Step 2); Determine how and why (Step 3); Intervention (Step 4).

    Disease Causation

    Theories of Disease Causation

    • Ancient Theories: Disease attributed to evil spirits, recovery to good spirits, and punishment. The control measures included sacrifices and casting out demons.

    • Filth Theory: Associated disease with the physical environment, especially poor sanitation and filth, and factors like seasons, climate, temperature, and overcrowding. Diseases were also attributed to poisonous substances and gases from the earth.

    • Germ or Bacteriological Theory: Koch confirmed Pasteur's claims that germs cause disease; this theory introduced concepts like isolation and quarantine. Measures to control the cause, such as disinfection, fumigation, and cleanliness, were also developed.

    Henle-Koch's Postulates (1877, 1882)

    • Four postulates used to establish a causal relationship between a specific microorganism and a particular disease:
      • presence of the disease agent in every case of the disease
      • absence of the disease agent in other diseases.
      • Agent must replicate in experimental animals.
      • The agent must be recoverable from experimental animals.

    Concept of Multiple Causation

    • Disease results from the interaction of several ecological factors within a dynamic system, encompassing the agent, host, and the environment.

    Web of Causation for the Major Cardiovascular Diseases

    Web of Causation for Myocardial Infarction

    Epidemiologic Lever

    • Agent and host are at opposite ends of a lever, with the environment at the fulcrum. Disease results from an imbalance between the disease agent and man; the nature and extent of the imbalance depend on characteristics of both host and agent.

    The Epidemiologic Triangle

    • Triangular model with agent, host, and environment at the corners, visually representing the interaction of these three factors in disease causation.

    Environmental Factors of Disease

    • External to the host and where the agent exists, survives, or originates. It can be physical, climatological, biological, or socioeconomic.

    Reservoir

    • Living or nonliving entities in which an infectious agent resides and multiplies, ensuring survival until possible transmission to a susceptible host.
      • physical environment
      • animals or insects
      • human beings (main reservoirs)

    Human Reservoirs

    • Cases: infection and disease are both present; Carriers: infection without disease.

    Animal reservoirs

    • Zoonotic Diseases are infectious diseases of animals that can cause disease when transmitted to humans.
      • Rabies
      • Plague

    The Agent Factor of Disease

    • Agent is any living or nonliving element, substance, or force that can initiate or perpetuate a disease process.

    Types of Agents

    • Non-living
    • Living

    Non-Living Agents

    • Physical and mechanical agents: extremes of temperature, light, electricity, physical trauma
    • Chemical agents: exogenous poisons, endogenous toxic products of metabolism.
    • Nutrients: deficiency (anemia from iron deficiency) or excess (obesity from overeating) agents

    Living Agents; types

    • Bacteria: TB, shigellosis
    • Viruses: AIDS, hepatitis
    • Fungi: candidiasis, athlete's foot
    • Protozoans: amoebiasis, giardiasis
    • Helminthes: schistosomiasis, ascariasis

    Characteristics of Agents of Diseases

    • Inherent Characteristics
    • Characteristics Directly Related to Man
    • Characteristics Related to Environment

    Infectivity

    • Ability of an agent to invade and multiply in a host.

    Pathogenicity

    • Ability of an agent to cause clinically apparent illness; dependent on factors like dosage, presence/absence of capsule, toxigenicity, and the host's condition.

    Virulence

    • Severity of the reaction produced; measured in terms of fatality.

    Immunogenicity

    • Ability of an infection to produce specific immunity as in Measles.

    Characteristics in Relation to the Environment

    • Reservoir of Infection
    • Sources of Infection
    • Modes of Transmission

    Modes of Transmission

    • Mechanisms by which an infectious agent moves from reservoir to susceptible human host
      • Contact Transmission
      • Vehicle Transmission
      • Vector Transmission

    Contact Transmission

    • Direct contact (no intermediary between infected and uninfected, touching, kissing, sexual interactions, Hepatitis A, Staphylococcal infections, sexually transmitted diseases)
    • Indirect contact (use of intermediates like tissues, handkerchiefs, towels, bedding, contaminated needles—HIV and hepatitis B)
    • Droplet transmission (transfer of respiratory illnesses like influenza and whooping cough, transfer via sneezing, coughing, and laughing).

    Vehicle Transmission

    • Pathogens spread via contaminated vehicles (e.g., air, food, water, blood, bodily fluids, drugs, intravenous fluids).

    Vector Transmission

    • Pathogens transmitted via carriers (animals like arthropods like fleas, ticks, flies, lice, mosquitoes).
      • Mechanical vectors transmit pathogens passively on their body parts.
      • Biological vectors transmit pathogens inside their body.

    The Host

    • Stages in the chain of events, going from inapparent infection to a clinical case of the disease, range of disease severity (inapparent to severe)
    • Resistance of the host (immunity level) determines illness severity.
    • Infection outcomes (complete recovery, permanent disability/disfigurement, death, chronicity).

    Characteristics of the Host

    • Non-specific defense mechanisms (skin, mucosal surfaces, tears, saliva, acid pH of gastric juice, phagocytes and macrophages, age, nutrition status, genetic factors)
    • Necessary Versus Sufficient Cause

    Types of Causal Relationships

    • Necessary and sufficient
    • Necessary but not sufficient
    • Sufficient but not necessary
    • Neither sufficient nor necessary

    Herd Immunity

    • Resistance of a group to invading infectious agents, based on the immunity of a substantial portion of its members.

    Natural History of the Disease

    • Two Phases: Pre-pathogenesis (before human involvement; agent, host, environment interactions leading to exposure) and pathogenesis (success invasion and establishment of the agent in the host, through different disease stages from incubation to resolution).
      • Exposure: contact with agent
      • Stage of Susceptibility: pre-exposure stage; individual vulnerable or at risk
      • Pre-pathogenesis: interactions of agent, host, and environment before human involvement
      • Adaptation: the body's response to the agent.
      • Stage of Presymptomatic Disease (Subclinical): pathogenic factors in the body causing changes, but no signs yet.
      • Stages of Subclinical Disease (incubation and latency): asymptomatic stages before disease presentation.
      • Stage of Clinical Disease: the onset of signs/symptoms.
      • Stage of Disability: the outcome is recovery, disability, or death.
    • Timelines and stages: Exposure, pathological changes, onset of symptoms, clinical diagnosis, recovery stages (disability or death).

    Who is at Risk?

    Adaptation

    • Failure: If adaptation fails, pathogenesis occurs.
    • Response: Body's immediate response, primarily the immune system.

    Levels of Prevention

    Classifications of Diseases

    • Method of grouping diseases based on specific characteristics.
    • Ensures universal diagnosis criteria.
    • Dependent on current disease knowledge.
    • Classifications: Clinical (signs/symptoms) and Etiologic (presumed cause).

    Sources of Epidemiologic Data

    • Determinants: Socioeconomic and demographic factors, and environmental and behavioral risk factors.
    • Inputs: Policy, financing, human resources, organization, and management of the health system.
    • Outputs: Information, service availability, and quality of the health system.
    • Outcomes: Service coverage; utilization.
    • Health Status: Mortality, morbidity/disability, well-being
    • Data considerations: Research objectives, data quality, and sensitivity issues.
    • Types of Data: Primary (collected firsthand) and secondary (derived from other sources).
    • Data Sources:
      • Primary: Queries (interviews, questionnaires, FGD), Observations (direct, with tools)
      • Secondary: Computerized bibliographic databases, surveillance data (census, registries, hospital records, insurance records).

    Data Quality and Utility

    • Data Characteristics
    • Data Availability
    • Accessibility for researchers
    • Completeness & representativeness
    • Value & limitations

    Data Privacy and Confidentiality

    • Privacy vs. Confidentiality
    • Republic Act 10173 (Data Privacy Act of 2012)
    • Executive Order No. 2 s. 2016

    Sensitive Personal Information

    Data Sharing and Linkage

    • Sharing: Voluntary release of information
      • Advantages
      • Issues (loss of control, privacy)
    • Linkage: Joining data from multiple sources
      • Interoperability requirements

    Thank You!

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