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Questions and Answers
What is epidemiology?
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?
Which of the following is NOT a purpose of epidemiology in public health practice?
Describe the four steps involved in solving health problems using epidemiological approaches.
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?
What was an early theory of disease causation?
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The Germ Theory of Disease stated that disease was caused by an imbalance in the body's four humors.
The Germ Theory of Disease stated that disease was caused by an imbalance in the body's four humors.
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What are Henle-Koch's postulates?
What are Henle-Koch's postulates?
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What is the concept of multiple causation?
What is the concept of multiple causation?
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The web of causation is a model that represents the complex interplay of factors contributing to a disease.
The web of causation is a model that represents the complex interplay of factors contributing to a disease.
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What is the epidemiologic lever, and how does it relate to disease causation?
What is the epidemiologic lever, and how does it relate to disease causation?
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What is the epidemiologic triangle, and what does each point represent?
What is the epidemiologic triangle, and what does each point represent?
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What are some examples of environmental factors that can influence disease?
What are some examples of environmental factors that can influence disease?
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Define reservoir of infection.
Define reservoir of infection.
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Which of the following is NOT considered a mode of transmission for infectious agents?
Which of the following is NOT considered a mode of transmission for infectious agents?
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Which of the following modes of transmission involves the transfer of infectious agents through direct contact with an infected person?
Which of the following modes of transmission involves the transfer of infectious agents through direct contact with an infected person?
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Droplet transmission is a type of indirect contact transmission.
Droplet transmission is a type of indirect contact transmission.
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What are fomites?
What are fomites?
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Explain the role of vectors in disease transmission.
Explain the role of vectors in disease transmission.
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What is the range of infection, and why is it important to understand?
What is the range of infection, and why is it important to understand?
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Which of the following factors is LEAST LIKELY to influence the severity of an illness in a host?
Which of the following factors is LEAST LIKELY to influence the severity of an illness in a host?
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What is NOT a potential outcome of an infection?
What is NOT a potential outcome of an infection?
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Non-specific defense mechanisms are the body's first line of defense against pathogens.
Non-specific defense mechanisms are the body's first line of defense against pathogens.
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What is the difference between a necessary cause and a sufficient cause?
What is the difference between a necessary cause and a sufficient cause?
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Which of the following is an example of a necessary but not sufficient cause for cancer?
Which of the following is an example of a necessary but not sufficient cause for cancer?
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What is herd immunity?
What is herd immunity?
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The natural history of disease describes the progression of a disease in an individual over time, in the absence of treatment
The natural history of disease describes the progression of a disease in an individual over time, in the absence of treatment
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Which of the following stages is NOT part of the natural history of disease?
Which of the following stages is NOT part of the natural history of disease?
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What is the stage of susceptibility?
What is the stage of susceptibility?
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The stage of susceptibility ends with the effective exposure to the agent.
The stage of susceptibility ends with the effective exposure to the agent.
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What is the stage of adaptation?
What is the stage of adaptation?
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If adaptation fails, it leads to pathogenesis.
If adaptation fails, it leads to pathogenesis.
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What is the stage of presymptomatic disease, and what is another name for it?
What is the stage of presymptomatic disease, and what is another name for it?
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What is the incubation period, and where does it occur in the disease process?
What is the incubation period, and where does it occur in the disease process?
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The latency period is primarily associated with infectious diseases.
The latency period is primarily associated with infectious diseases.
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What is the stage of clinical disease?
What is the stage of clinical disease?
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What are the potential outcomes of the clinical stage of disease?
What are the potential outcomes of the clinical stage of disease?
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What is the stage of disability?
What is the stage of disability?
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Which of the following is NOT a level of prevention?
Which of the following is NOT a level of prevention?
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When does primordial prevention occur in the disease process?
When does primordial prevention occur in the disease process?
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What is the primary target of primary prevention?
What is the primary target of primary prevention?
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Describe the primary goal of secondary prevention.
Describe the primary goal of secondary prevention.
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What is the overarching objective of tertiary prevention?
What is the overarching objective of tertiary prevention?
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What are the primary data sources used for epidemiologic studies?
What are the primary data sources used for epidemiologic studies?
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Secondary data can be obtained from computerized bibliographic databases.
Secondary data can be obtained from computerized bibliographic databases.
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What are the advantages of using census data for epidemiologic studies?
What are the advantages of using census data for epidemiologic studies?
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What is a major disadvantage of using census data to study health?
What is a major disadvantage of using census data to study health?
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What is the primary purpose of a civil registry?
What is the primary purpose of a civil registry?
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Civil registries are a major and effective source of vital statistics.
Civil registries are a major and effective source of vital statistics.
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What is the primary type of data collected by a civil registry?
What is the primary type of data collected by a civil registry?
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A major challenge for civil registries in lower-income countries is completeness of data.
A major challenge for civil registries in lower-income countries is completeness of data.
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Why is it important to monitor notifiable diseases?
Why is it important to monitor notifiable diseases?
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What are the general advantages of using population surveys for epidemiologic studies?
What are the general advantages of using population surveys for epidemiologic studies?
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What are two major disadvantages of using population surveys for epidemiologic studies?
What are two major disadvantages of using population surveys for epidemiologic studies?
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What is institution-based surveillance data?
What is institution-based surveillance data?
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What are three main types of institution-based surveillance data?
What are three main types of institution-based surveillance data?
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What are three types of data that can be obtained from beyond the health sector?
What are three types of data that can be obtained from beyond the health sector?
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Which of the following is NOT a consideration in choosing a data source for an epidemiologic study?
Which of the following is NOT a consideration in choosing a data source for an epidemiologic study?
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Primary data is data that is collected firsthand by the researcher.
Primary data is data that is collected firsthand by the researcher.
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What are the two general types of data used in epidemiologic studies?
What are the two general types of data used in epidemiologic studies?
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What are some examples of primary data sources?
What are some examples of primary data sources?
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Secondary data is often used in epidemiologic studies to provide a broader context or historical perspective.
Secondary data is often used in epidemiologic studies to provide a broader context or historical perspective.
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What are some examples of secondary data sources?
What are some examples of secondary data sources?
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Explain the concept of data privacy and confidentiality in epidemiologic studies.
Explain the concept of data privacy and confidentiality in epidemiologic studies.
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Which of the following is a general data quality issue?
Which of the following is a general data quality issue?
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What is data sharing in the context of epidemiologic research?
What is data sharing in the context of epidemiologic research?
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What are two key challenges associated with data sharing in epidemiologic research?
What are two key challenges associated with data sharing in epidemiologic research?
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What is data linkage, and what are the potential benefits?
What is data linkage, and what are the potential benefits?
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What are two key challenges of data linkage?
What are two key challenges of data linkage?
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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
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Ancient Theories: Disease attributed to evil spirits, recovery to good spirits, and punishment. The control measures included sacrifices and casting out demons.
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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.
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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)
Other Concepts Related to Causation
- 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).
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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
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Sharing: Voluntary release of information
- Advantages
- Issues (loss of control, privacy)
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Linkage: Joining data from multiple sources
- Interoperability requirements
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