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EPIDEMIOLOGY Monitor- diseases and health condition Is the study of the distribution and through screening and surveillance determinants of health related state or events in specified population and Evaluation - approaches says and...

EPIDEMIOLOGY Monitor- diseases and health condition Is the study of the distribution and through screening and surveillance determinants of health related state or events in specified population and Evaluation - approaches says and application of the study to the interventions that reduce recent promote prevention and control of the health health. problems Focus - frequency and pattern of health event in a “population” USES: Frequency - refers to the number of health 1. ASSESSMENT OF HEALTH events (i.e. number of case of pneumonia in STATUS OF POPULATIONS: a population / ratio of cases in the population EPIDEMIC OR ENDEMIC Poor nutrition or over Pattern- refers to the occurrence of health nutrition condition or disease by time, place and person 2. Natural history of diseases It gives a picture of the Scope - “health - related states and events” natural history of disease in (frequency/pattern, risk factors/ causes, ind and groups prevention and control) Incubation period Epidemological method - are used to study Period between exposure and onset both communicable and non-communicable of clinical symptoms diseases and other health related state. LATENT PERIOD Period between exposure and PUBLIC HEALTH NURSES USE infection EPIDEMOLOGY TO: INFECTIOUS PERIOD Time during which time the host can infect another suck host. Describe - the distribution and extent of NON-INFECTIOUS PERIOD health condition / disease in the pop. Period when the host ability to transmit the disease to the other IDENTIFY - the risk factors in studying cause cases natural hx of diseases or models of disease causation MODELS OF DISEASE CAUSATION  Risk factors are variables that These are important in identifying increase the rate of disease in people risk factors and monitoring health who have them (e.g genetic and disease conditions in the predisposition) or in people exposed population to them ( e.g an infectious agent or a diet high in saturated fat) SCREENING Therefore their identification is - Screening is the active search or critical to identifying specific process of detection for disease or prevention and control measures. disorder among apparently healthy people. - The primary aim -identifying risk 1. Epidemiological triad or triangle factors and diseases in their earlier The development of disease age depends on the extent of the host exposure to an agent, the strength or 1. Breast CA screening virulence of the agent, and the host 2. Lung CA genetic or immunological 3. Newborn screening suspectability. Agent - refers to microorganism or 2. SURVEILLANCE pathogen or chemical contaminants - Surveillance is the systematic, Host - weaked immune system, dose ongoing and analytic process of and pathogenicity of the agents monitoring to scrutinize disease Environment - climate, unsafe, condition. water or hygiene practice i.e. Rapid detection 2. Iceberg principle Reporting of case of disease Shows that disease situation where the problem is subclinical, LEVELS OF PREVENTION unreported or hided from view - Biblical focus is on health Only tha “TOP OF THE ICEBERG” promotion and disease prevention IS KNOWN - Epidemiologic methods help in measuring the outcomes of i.e - reported cases of HIV/AIDS strategies under the three levels of prevention. 3. Web of causation Shows the relationship between different multiple factors that PRIMODIAL PREVENTION contribute to the cause of disease Seeks to prevent at a very early stage, even before the risk factor is SCREENING AND SURVEILLANCE present.  This includes activities that promote Time- seasonality or days of the week healthy lifestyle and avoiding the Place- Urban or rural development of behaviors and Person- looking into inherent characteristic exposure patterns that contribute to (age, sex) acquired characteristics (marital increase risk of disease. or immune status) activities (occupation, tobacco use etc) and other conditions. PRIMARY PREVENTION Is the prevention through the control BOX 5.7 An Example of Descriptive of exposure to risk factor before Epidemiology disease development. (ex. Vaccination) The person-place-time model is illustrated SECONDARY PREVENTION by two measles outbreaks in Utah: Stop application not available measures to defect early the disease Person: Initially, an unvaccinated 15-year- or health condition before the onset old student had contracted measles, likely of science and symptoms from a (EX. GET REGULAR HEALTH trip to Europe. Subsequently, six more SCREENING) students contracted the illness. TERTIARY PREVENTION Place: Salt Lake County; three cases were Is managing the disease after the "school transmission," and three cases were diagnosis to slow or stop disease "household transmission." progression and liver does disability of complication Time: The index case traveled to Europe during March 3-17, 2011. He attended TYPES OF EPIDEMIOLOGY school on March 21 and subsequently became ill. The other cases occurred 1.Descriptive epidemiology between April 5 and April 17, 2011. Focuses on describing disease distribution by characteristics → relating to ttime person, place and person. From Centers for Disease Control and Prevention: Two measles outbreaks after Thru importation-Utah, March-June 2011, 1. Review of records Morbidity and Mortality Weekly Report 2. Routine data collection 62(12):222-225, 2013. Retrieved from: 3. Ecological Surveys http://www.cdc.gov/mmwr/pdf/wk/mm6212.pdf. 2. Analytical Girls with sterile urine - Women without Aims to understand the quality and renal disease PAST-PRESENT the amount of influence that (BEGINNING)---- → FUTURE determinants have on the occurrence of disease or health related events. Comparison of time factors in prospective design (i.e., cohort) and retrospective design THRU: (i.e., case-control) approaches to studying Group comparisons the possible effect of childhood bacteriuria on renal disease in adult women. Types CROSS SECTIONAL STUDY- examines the relationship between 3. Experimental health problems and other variables Uses an experimental design or of interest. model to confirm a causal relationship suggested by COHORT STUDY- subjects are observational studies. selected based on their exposure status. THRU: CASE-CONTROL STUDY- Control factors subjects are selected based on their disease (health) status. TYPES: case group - subjects with disease control group - have no disease RANDOMIZED CONTROL TRIAL - experiments with patients are subjects to evaluate potential cure for a disease and BOX 5.8 Comparison of Time Factors in prevent disability. Retrospective and Prospective Study Designs FIELD TRIALS - done in the field involving subjects that are free of disease Cohort Study but at high risk of contracting them, Girls with bacteriuria → Women with renal disease COMMUNITY TRIALS - extension of Girls with sterile urine Women without renal field trials involving the whole community disease as the unit of assigment. (i.e. water treatment) Case-Control Study Girls with bacteriuria - Women with renal SOURCES OF DATA IN disease EPIDEMIOLOGY PRIMARY DATA  Refers to the original data collected Are collections of secondary data for a specific purpose by a researcher related to patients with a specific diagnosis, condition or procedure. 1. Interview 2. Getting samples The AHRQ has a significant investment in projects that are SECONDARY DATA evaluating the impact of Epidemiologist use data already computerized disease registries. collected by other individuals and/or institutions for some specific https://healthit. ahrq.gov/ purpose. 4. DISEASE SURVEILLANCE https://psa.gov.ph/ is the continuous scrutiny of occurrence of disease and health- In the Philippines, there is Phil. statistics related events to enable prompt office which serves as the central statistical intervention for the control of authority on primary data collection diseases. 1. POPULATION CENSUS It involves the ongoing systematic collection, collation, analysis and A population census is the total interpretation of data on disease process of collecting, compiling, occurrence and public health related evaluating, analyzing and publishing events and dissemination of the or otherwise disseminationg information obtained from such data DEMOGRAPHIC, ECONOMIC for prompt public health action. AND SOCIAL DATA pertaining at a specified time 5. DISEASE NOTIFICATION The population is enumerated every It involves the official and timely 5 years beggining on ← 1970 reporting of occurrence of a specific diseases and conditions to designated 2. CIVIL REGISTRATION AND VITAL public health authorities by clinicians STATISTICS and other health personnel for action Those systems which produce using designated reporting tools. BIRTHS, DEATHS and CAUSES OF DEATHS information. Philippine Integrated Surveillance and Response (PIDSR) 3. DISEASE OR PATIENT REGISTRIES United Registry Systems on Chronic Noncommunicable Diseases, Injury  Related Cases, Persons with 1. IDENTIFYING HEALTH - RELATED Disabilities and Violence Against CONCERNS Women and Children. 2. PLANNING FOR COMMUNITY 6. POPULATION-BASED SURVEYS INTERVENTIONS Are useful for disease surveillance when they ask people about INDICATORS OF LEVELS OF information for which they may be QUALITY OF LIFE OR LIVING: the most valid and reliable source 1. Expectation of life after birth (own private behaviors, attitudes, or 2. Infant mortality rate mental health status) for which they can report with reasonable reliability. SOCIOECONOMIC AND DEVELOPMENT SECTORS The Behavioral Risk factors Surveillance Systems (BRFSS) 1. Statistics on fertility The Youth Risk Behavior Surveillance System (YRBSS) 2. Statistics on mortality The National Health Interview Survey (NHIS) HEALTH SECTOR The National Nutrition survey (NNS) 1. Patterns and causes of morbidity and mortality VITAL STATISTICS Is the study of the characteristics of human populations. DEFINITION OF VITAL EVENTS The World Health Organization Comprises the number of important (WHO) promulgates a number of events in human life: vital statistics definition as part of the International Classification of 1. Birth Diseases (ICD). 2. Death 3. Fetal death 4. Marriage LIVE BIRTH Live birth is the 5. Divorce complete expulsion 6. Annulment or extraction from 7. Judicial separation its mother of a 8. Adoption product of 9. Legitimation conception, irrespective of the 10. Recognition duration of the pregnancy, which,  after such aggravated by the separation, breathes pregnancy or its or shows any other management, but evidence of life not from accidental such as beating of or accidental the heart, pulsation causes. of the umbilical cord or definite INFANT DEADTH Infant death is the movement of the death of a live born voluntary muscles, infant who dies whether the before completing umbilical cord has its first year of life. been cut of the placenta is attached NEONATAL This is the death DEADTH of a live born infant FETAL DEADTH Fetal death is the who dies during the death prior to first 28 completed complete expulsion days of life. These or extraction from may be subdivided its mother of a into early neonatal product of deaths, occurring conception, during the first irrespective of the seven (7) days of duration of the life and late pregnancy; the neonatal deaths, death after such occurring after the separation, the fetus completion of does not breathe or seventh day but show any other before the evidence of life completion of 28 such as beating of days. the heart, pulsation of the umbilical PERINATAL This is the death cord or definite DEATH of a fetus or movement of the newborn infant voluntary muscles occurring after 22 completed weeks MATERNAL Maternal death is (154 days) of DEATH the death of gestation (the time pregnant woman when the fetal while pregnant, weight is normally irrespective of the about 500 g) but duration and the site prior to completion of the pregnancy, of seven days after from any cause birth. related to or  POPULATION INDICATION while, a level less than or equal to 20/1,000 live births implies low fertility. 1. Crude birth rate 2. General fertility rate GFR = Br 3. Total fertility rate —-- K 4. Annual growth rate Pw 5. Other populations dynamics GFR-General fertility Rate CRUDE BIRTH RATE Br- is the number of registered live births in a year Crude birth rate (CBR) measures how fast Pw- is the midyear population of women 15- people are added to the population through 49 ۷/۰ births. It is most frequently used overall k - is constant (1,000) measure of the REPRODUCTION of a population. POPULATION PYRAMID A CBR greater than or equal to 45/1,000 live births implies high fertility, while; a The population pyramid is graphical level less than or equal to 20/1,000 live representation of the age-sex composition of births implies low fertility. the population. CBR = B The shape of the pyramid provide insights —-- K into the fertility and mortality patterns of the P population as well as the health services likely to be needed based on the sge-sex CBR-Crude Birth Rate composition of the population. B- total number of live births for a given area and time period Large portion of the population belongs to P-total population at the midpoint of the the younger groups time period k-is constant (1,000) This implies that more health services are needed for the young population GENERAL FERTILITY RATE (immunization, nutrition programs and envtl. measure tp prevent common General fertility rate (GFR) is the number of childhood illnessses. live births per 1,000 women aged 15-49 in a given year A CBR greater than or equal to 45/1,000 live births implies high fertility, MORTALITY INDICATORS Mortality indicators provide important information of the health status of the people 5. HYPERTENSIVE DISEASES (33,452) in the community. 6. DIABETIS MELLITUS (33,295) 7. OTHER HEART DISEASES (28,000) MORTALITY RATE - is a measure of the 8. TB RESPIRATORY (24,462) frequenoy of occurrence of death in a 9. CHRONIC LOWER RESPIRATORY defined population during a specified INFECTIONS (24,365) interval. 10. DISEASES OF THE GENITOURINARY SYSTEM (19,759) 1. Crude death rate 2. Specific Death Rate PATTERNS OF OCCURRENCE AND 3. Proportionate Mortality Ratio DISTRIBUTION OF DISEASES 4. MATERNAL Mortality Rate 5. Infant Mortality rate Risk - Refers to the probability or chance of 6. NEONATAL mortality rate an adverse event. 7. Postneonatal mortality Rates 8. Early Postnatal mortality Rates Rate - is a population proportion in which 9. PERINATAL Mortality Rate the NUMERATOR is the number of events occurring at a specified period and the 10 LEADING CAUSES OF DEATHSIN DENOMINATOR consists of those in the THE PHILIPPINES, 2016 population at a specified time period. (per day,per week or per year). SOURCE: PSA Rate = Numerator ÷ Denominator = It shows tha 6 out 10 leading cause of Number of health events in a specified deaths DISEASES. are NON- period ÷ Population in same area in same COMMUNICABLE specified period This means more programs and policies This proportion is multiplied by a constant are needed to prevent and control the (k) that is multiple of 10 (1,000; 10,000 or common rsik factors as well as better 100,000) people in the pop. management of the diseasea dnits complications. MORBIDITY RATES Morbidity - any departure, subjective or 1. ISCHEMIC HEART DISEASE (74,134) objective from a state of physiological or 2. NEOPLASMS (60,470) psychological well-being. 3. PNEUMOΝΙΑ (57,809) 4. CARDIOVASCULAR DISEASES Morbidity rates - refer to either incidence (56,938) or prevalence  10 LEADING CAUSES OF MORBIDITY 1. Prepare for field work IN THE PHILIPPINES, 2010 2. Establish the existence of an outbreak SOURCE: DOH 3. Verify the diagnosis 4. Construct working case The basis for ranking is an approximation 5. Find cases systematically and record of the incidence density divided by the information midyear population (July 01) multiplied by 1 6. Perform descriptive epidemiology year 7. Develop hypothesis 8. Evaluate hypothesis epidemiologically DISEASES /NUMBER 9. As necessary, reconsider refine and re-evaluate hypothesis 1. ACUTE RESPIRATORY INFECTION 10. Compare and record with laboratory (1,289,168) and/or environmental studies 2. ACUTE LOWER RESPIRATORY 11. Implement control and prevention TRACT INFECTION AND PNEUMONIA measures (586,186) 12. Initiate ot maintain surveillance 3. BRONCHITIS/ BRONCHIOLITIS 13. Communicate Findings (351,126) 4. HYPERTENSION (345,412) OUTBREAK INVESTIGATION 5. ACUTE WATERY DIARRHEA PROCESS (326,551) 6. INFLUENZA (272,001) 1.Consultant in Communicable Disease 7. URINARY TRACT INFECTION Control (CCDC)/Consultant in Health (83,569) Protection (CHP) 8. TB RESPIRATORY (72,516) 2. Environmental Health Officer (EHO) 9. INJURIES (51,201) 3. Consultant Microbiologist or Virologist 10. DISEASES OF THE HEART (37,589) 4.Secretarial/Administrative support DISEASE OUTBREAK Is defined as "the occurrence of cases of casese in excess of what would normally be expected in a defined community, geographical area or season" (WHO) STEPS IN CONDUCTING AN OUTBREAK INVESTIGATION  4. SUPPORT SYSTEM MADE AVAILABLE BRINGING HEALTHCARE CLOSER ADVOCACY TO PEOPLE ACCESSIBLE - facilities for PRIMARY HEALTH CARE (PHC) health and services delivered Is an overall approach to providing by health professionals are people access to basic healthcare and situated closer to where ultimately improved of communities people are AVAILABLE - ESSENTIAL MISSION HEALTH SERVICES IN To strengthen healthcare systems by PHC providing and supporting conditions where people manage their own 1. Health Education health and ultimately realize the goal 2. Immunization of the health in their own hands 3. Essential medicines 4. Mother and child DIMENSION OF PRIMARY HEALTH health services CARE 5. Endemic disease control and 1. GOAL - Access to basic health management services 6. Nutrition 2. STRATEGY - promotes 7. Treatment of collaborations among all sectors in simple conditions society and values partnership 8. Sanitation and between public and private access to safe water organization supply. 3. PHILOSOPHY - turali community is to assume responsibility for their Ensuring that essential health and to involve themselves in services are provided to issues affecting their halth. people in communities across all strata of PILLARS/CORNERSTONE OF PHC 1. ACTIVE COMMUNITY AFFORDABLE - this PARTICIPATION necessitates that the expenses 2. INTER AND INTRASECTORAL for healthcare should be LINKAGES within the budgetary capacity 3. USE OF APPROPRIATE of the country TECHNOLOGY ACCEPTABLE -it is imperative that nurses deliver  culture genuinely promote 10. Research for new insights and participation of clientele in innovative solutions to health managing their own health problems APPROPRIATE - Connotes the use of technology based DETERMINANTS OF SUCCESS FOR on express needs of the PHC people that are not only scientifically proven effective 1.Knowledge and capacity building - but at the same time safe shared leadership (example: produce BHW) 10 ESSENTIAL PUBLIC HEALTH - health education activities and SERVICES training seasons - Community Organizing 1. Monitor health status to identify a 2.Human resources for health -Manpower nd solve community health is the most important resource in health problems. care delivery system. 2. Diagnose and investigate health - Majority of health professionals are problems and health hazards in in hospitals and mostly concentrated the community. in urbanized area. 3. Inform, educate and empower - Nurses - 74% - working in hospitals people about health issues. - -26% working in primary care 4. Mobilize community partnerships facilities To address this problem and action to identify and solve of HHR distribution, the health problems. - DOH is continuously deploying 5. Develop policies and plans that health professionals to undeserved support individual and community LGU. health efforts 6. Enforce laws and regulations that DOH RECOMMENDATIONS FOR HRH protect health and ensure safety. AND PRIMARY HEALTH CARE 7. Link people to needed personal FACILITIES RATIO TO POPULATION health services and assure the provision of health care when 1RHU/HC PHYSICIAN ( 20,000 otherwise unavailable. POPULATION RATIO) 8. Assure competent public and 1 PUBLIC HEALTH NURSE (10,000 personal health care workforce. POPULATION RATIO) 9. Evaluate effectiveness, accessibility 1 PUBLIC HEALTH MIDWIFE ( 5,000 and quality of personal and POPULATION RATIO) population-based health services. 1 PUBLIC HEALTH DENTIST (50,000 POPULATION RATIO) 1 RHU (20,000 POPULATION RATIO) 1 BHS (5,000 POPULATION RATIO) HEALTH TECHNOLOGY CHARACTERIZED BY THE FF: 1. EFFECTIVE - it delivers its intended benefits our purpose as DOH HRH PROGRAM proven through scientific 2. SAFE - it assures users of no harm 3. Financing - mixed healthcare systems will result. It minimizes risk of harm (Public and Private org.) 3. AFFORDABLE- the cause of tech Higher Philhealth coverage (No will be a burden both to the ind. Balance billing). consumers and organization R.A. 10351 'SIN TAXES' in 2013 4. SUSTAINABLE - can be (increase tax for Tobacco and maintained, supply to all and alcohol) repaired as needed by the users R.A. 10963 TRAIN LAW' in 2018 5. ACCEPTABLE - in harmony with (increase tax for Tobacco, alcohol community norms and culture and sugar beverage tax) that added 6- 12 pesos per liter tax for soda/bev. ESSENTIAL DRUGS/ MEDICINES WHO recommends that countries spend 5% of GDP/GNP on health The provision of medicines to treat endemic conditions affecting people in the 4..Technology - WHO'application of community. This will contribute to the organized knowledge and skills in the form reduction of unnecessary deaths and of devices, medicines, vaccines, procedures, improve health outcomes. and systems developed to solve a health problem and improve quality of lives Provision of PARACETAMOL and AMOXICILLIN in Primary care facilities CRITERIA FOR APPROPRIATE to address common problems like feverr, HEALTH TECHNOLOGY headache and infections. The WHO defines appropriate health Government efforts to increase people's technology as methods, procedures, access to this vital resource include techniques and equipment that are LEGISLATIVE MEASURES like: scientifically valid, adapted to local needs, acceptable to users and recipients and GENERICS ACT OF 1998 (RA maintainable with local resources. 6675) THE PRICE ACT (RA 7581) ORS MIXED - THE CHEAPER MEDICINE ACT OF 2008 (RA 9502) Government efforts to increase people's traditional and alternative health care and its access to this vital resource include integration into the national health care LEGISLATIVE MEASURES like: delivery system". 1. MEDICINE ACCESS PROGRAM ACCUPRESSURE A method of (MAP) healing and health promotion that uses Complete treatment pack aims to provide the application of marginalized groups monthly supply of pressure on essential medications to treat conditons like acupuncture points without puncturing DIABETES and HYPERTENSION. the skin. Compack: ACUPUNCTURE A method of 1. Amlodipine healing using 2. Losartan special needles to 3. Metformin puncture and stimulate specific 4. Simvastatin anatomical points on the body. 2. BOTIKA SA BARANGAY AROMATHERAP The art and science To offer essential medicines at a Y of the sense of smell whereby cheaper price. essential aromatic oils are combined Philippine institute of traditional and and then applied to alternative health care the body in some agency works under DOH form of treatment coordinates with DOS CHIROPRACTIC A healthcare profession that TRADITIONAL AND ALTERNATIVE cares for your HEALTH CARE neuromusculoskelet al system-the bones, In the Philippines, traditional and nerves, muscles, complimentary medicine has been tendons, and ligaments. institutionalized thru R.A. 8423 HERBAL Finished, labeled, "mandates the Philippine Institute of MEDICINE/PHYT medicinal products Traditional and Alternative Health Care ORMEDICINE that contain as (PITAHC) "to improve the quality and active ingredients aerial or delivery of health care services to the underground parts Filipino people through the development of of the plant or other  materials or pressure to the combination corresponding thereof, either in the reflex area of the crude state or plants body. preparation. MASSAGE A method where the SOURCE: IMPLEMENTING RULES AND superficial soft parts REGULATIONS OF R.A. 8423 of the body are (TRADITIONAL AND ALTERNATIVE rubbed, stroked, MEDICINE ACT OF 1997), PHILIPPINES. kneaded or tapped for remedial, aesthetic, hygeinic or limited Herbal medicine therapeutic This refers to the use of plants or purposes. derivatives from plants for the treatment of specific condition NUTRITIONAL The use of food as In the Philippines, herbal medicines THERAPY medicine and to improve health by are considered as the one of the most enhancing the popular modalities of complimentary nutritional value of medicine. food components Commonly sold on market that reduces the risk regulated by the FDA of a disease PRANIC A holistic approach HEALING of healing that DOH RECOMMENDATION HERBAL follows the MEDICINES principle of balancing energy. LAGUNDI REFLEXOLOGY The application of Use/Indication - Asthma, cough therapeutic pressure and colds, fever. dysentery, pain, on the body reflex skin diseases (scabies, ulcer, eczema) points to enhance wounds the body's natural Preparation - Decoction, Wash healing mechanisms affected site with decoction and balance body functions. It is based on the YERBA BUENA principle that Use/indication - Headache, stomach internal glands and ache, cough and colds, Rheumatism, organs can be arthritis influenced by Preparation - Decoction, Infusion, properly applying and massage spa  Preparation - Decoction and steamed Sambong Use/indication - anti edema, anti urolithiasis METHODS OF HERBAL Preparation - Decoction PREPARATION Tsaang-gubat DECOCTION Use/indication - Diarrhea, and Boil the recommended part of the stomach ache plant material in water. Preparation - Decoction Recommended boiling time is 20 minutes. NIYONG-NIYOGAN Use indication - anti - helminthic INFUSION Preparation - Seeds are used Plant material is soaked in hot water, much like making a tea. Bayabas Recommended period of soaking is Use/ indication - washing wounds, 10-15 minutes diarrhea, gargle, toothache Preparation - Decoction POULTICE Directly apply recommended plant Akapulko material on the part affected, usually Use/indication - antifungal used on bruises, wounds or rashes Preparation - Poultice TINCTURE Ulasimang bato/pansit-pansitan Mix the plant material in alcohol Use/indication- lowers blood uric acid (rheumatism and gout) Preparation - Decoction Bawang Use/indication - hypertension lowers blood cholesterol toothache Preparation - eaten raw/ fried, apply on part Ampalaya Use/indication - Diabetes mellitus (mild- non insulin dependent)