Epi Lecture 1 September 4 2013 A complete physical mental and social well being and not merely absence of dis B Dimensions of health physical social mental emotional spiritual environ I What is health ease or infirmity mental C 6 Dimensions of Health 1 physical ability for body to function properly physical fitness and daily 2 social ability to have satisfying relationships interaction with social institu living tions and societal mores 3 emotional ability to cope adjust and adapt self efficacy and self esteem 4 mental ability to think clearly 5 spiritual feeling as if part of a greater sprctrum of existance personal be liefs and choces 6 environmental comprised of external factors and internal factors 7 II Public Health science and art of promoting health and extending life on the POPULATION level A Population a group of people sharing one or more characteristic B How does public health relate to epidemiology 1 Epidemiology the basic science of public health foundation of public health a 3 core epidemiology functions 1 assessment monitoring health communities at risk to identify prob 2 lems and priorities formulation of public policies designed to solve local nat l health problems 3 assure all populations have access to appropriate and cost ef fective care including health promotion and disease prevention ser vices III Epidemiology A Study of distribution and determinants of health related states or events in hu man populations and the application of this study to prevent and control health problems B Epi upon demos people logy study of C Discipline that describes quantifies and postulates causal mechanisms for health D study of distribution and determinants of health phenomena in popula phenomena in populations tions 1 Determinants factors or events that are capable of bringing about a change in health a biological agents chemical agents less specific factors 2 Distribution frequency of disease occurrence may vary from one popula tion group to another 3 Population collection of individuals that share one or more observable characteristic fro which data may be collected and evaluated a epi commonly referred to as population medicine 4 Health Phenomena a epi investigates many different kinds of health outcomes 1 infectious disease chronic disease disability injury mortality ac tive life expectancy mental health E Often referred to as population medicine F Aims Levels of Epidemiology concerns 4 Describe health state of the population 5 explain etiology of the disease origin cause 6 predict occurrence of disease 7 control distribution of disease G Key Aspects 4 determinants factor event capable of bringing change in health risk factors 5 distribution frequency of disease occurrence may vary from population to an other 6 population collection of individuals that share one or more observable ex social economical family workforce geographic region A human disease does not occur by chance factors can be identified by systematic B interdisciplinary biostatistics social behavioral science toxicology pathology IV Foundation of Epidemiology investigation virology genetics microbiology etc C 10 Uses of Epidemiology 1 Determine 3 possible sets of disease factors host agent environment 2 study occurrence of diseasein a poulation for purposes of community diag nosis and prognosis 3 describe the epi or class of disease 4 measure risk 5 study occurrence of disease or death w time as a variable historical study 6 aid in search for cause of disease 7 disease prevention and control a primary ideal control b secondary diagnosis treatment c tertiary rehabilitation of disabled 8 aid in identification of clinical syndromes 9 aid in detection of presymptomatic and latent disease 10 administrative medicine operations V Quantification Count A Central activity to epidemiology B counting the number of cases of disease C use of special vocab D disease distribution is examined according to demographic variables such as age sex and race E how many are sick out of total population VI The 3 Demics A Epidemic occurrence in the community region of case of Illness clearly in ex cess of expectancy relative to usual frequency of the disease B Infectious disease outbreaks 1 Single case of a long absent communicable disease 2 1st invasion of such a disease associated in time and place are sufficient evi dence of transmission to be considered an epidemic C Epidemic Threshold 1 Minimum number of cases deaths that would support the conclusion that an epidemic was underway D Epidemic and noninfectious disease ex love canal disease associated w lifestyle ex obesity E PAndemic epidemic on a worldwide scale during pandemic a large number of people may be affected by disease and may cross int l borders ex flu pandemic F Endemic characterize a disease that is habitually present in a particular VII geographic region ex typhoid malaria cholera Historical Antecedents A Environmental disease B black death 1 3 pop of Europe 1346 1352 C use of mortality counts D smallpox vaccination E use of natural experiments F G identification of specific agents of disease the 1918 influenza pandemic H The Environment 1 Hippocrates 400BC On Airs Waters and Places a disease may be associated with physical environment b represented movement away from spiritual supernatural 2 The Black Death 1346 1352 aka The Crusades a claimed 1 4 to 1 3 of European population I Modern Epi 1 Epidemiologic transition of the 20th century a shift in focus from acute infectious to chronic lifestyle disease 2 Advance in the following resulted decrease of various infections a nutrition b housing c sanitation d water supply e antibiotics f Individual vs Population immunization 3 for patient c 4 Recent Application a clinician concern for health of individual focuses on treating and caring b epidemiologist concern for collective health of people in community population 1 focus on source of exposure number of ppl exposed potential to spread intervention to prevent additional cases 5 b Framingham heart study 1948 c smoking and lung Doll and Petos s British Dr s survey d AIDS chemical pills breast cancer screening 2nd hand smoke 6 Scientific method b health problem c hypothesis d statistical testing e interpretation f dissemination g 7 analytic epidemiology b study design used to answer why how c means to identify quantify associations test hypothesis and support state ments about causality d explain why and how health related states or events occur 8 descriptive epidemiology