DEFINITIONS

APPROACHES OF EPIDEMIOLOGY

The study of the distribution and determinants of health-related states in specified populations, and

the application of this study to control health problems

Distribution: occurrence of cases by time, place andperson

Eg: according to study of deaths in country X in 2008,1034 cervical cancer deaths occurred among womenbetween the ages of 45-54

Determinants: All the causes and risk factors for theoccurrence of a disease, including physical,biological, social, cultural, and behavioral factors

Eg: Smoking was a risk factor or determinant for thegreater number of cancer deaths among women ages45-54

Health related states: Diagnosis of specific disease orcause of death

Eg: according to study of deaths in country X in 2008,1034 cervical cancer deaths occurred among womenbetween the ages of 45-54

Specified population: A measurable group, defined bylocation, time, demographics, and other characteristics

Eg: women aged 45-54 living in a rural village in countryX from 2001 through 2009

Application: analysis, conclusion, distribution, and timely use ofepidemiologic information to protect the health of the population.

Eg: As a result of the country X study, free cervical cancerscreening programs were implemented. They targeted womenliving in remote areas in hopes of finding women with cervicalcancer at an earlier stage of cancer in order to prevent death

Application :

To measure frequency of disease

To asses distribution of disease

- who is getting disease?

- where is disease occurring?

- when is disease occuring?

To form hypotheses about causes and preventive factors

To identify determinants of disease

Purpose of epidemiology

Approach/ Consideration Clinical Medicine Epidemiolgy

Focus Individuals populations

Main goal Diagnosis and treatment Prevention and control

Questions What is wrong with this patient?

What are the leading causes death or disability in this population? Risk factor?

Treatment What treatment is appropriate?

What can be done to reduce or prevent disease or risk factors?

Who is involved? Physician, laboratorian, nurse, and others

Epidemiologists, statisticians, and othersfrom diverse disciplines

Approaches in Medicine vsEpidemiology

Descriptive epidemiology

- Studies the pattern of health events and their frequency in populations in terms of: place, person, time

- Purpose: to identify problems for further study. To plan, provide and evaluate health services

Analytic epidemiology

- Studies the association between risk factors and disease

- Purpose: to determine why disease rates are high in a particular group

Approaches to epidemiology

Public health surveillance

Investigation

Data analysis

Intervention

Evaluation

Communication

Management and team work

Function of Epidemiology

Not communicable, especially with reference to a disease that is NOT

transmitted through contact with an infected or afflicted person (not infectious)

• Non-communicable diseases (NCDs), also known as chronic diseases.

• Long duration and generally slow progression.

• Random genetic abnormalities, heredity, lifestyle or environment can

cause non-communicable diseases, such as cancer, diabetes, asthma,

hypertension and osteoporosis.

• Autoimmune diseases, trauma, fractures, mental disorders, malnutrition,

poisoning and hormonal conditions are in the category of non-

communicable diseases.

DEFINITION

RTA

CANCERS

HEART DISEASES DIABETES MELLITUS

EPILEPSYCHRONIC RESPIRATORY DISEASES

MENTAL ILNESSES

CHRONIC KIDNEY DISEASES

EXAMPLES

Genetic Diseases Environmental Diseases

• Achondroplasia

• Albinism

• Bardet-Biedl syndrome

• Bipolar disorder

• Canavan disease

• Color blindness

• Cystic fibrosis

• Down's syndrome

• Fragile X syndrome

• Galactosemia

• Hemophilia

• Krabbe disease

• Muscular dystrophy

• Neurofibromatosis

• Noonan syndrome

• Osteogenesis

• Patau syndrome

• Sickle-cell disease

• Tay-Sachs disease

• Triple X syndrome

• Turner syndrome

• Usher syndrome

• Von Hippel-Lindau syndrome

• Waardenburg syndrome

• Wilson's disease

• Xeroderma pigmentosum

• Appendicitis

• Anorexia nervosa

• Arteriosclerosis

• Asthma

• Carpal tunnel syndrome

• Chronic obstructive pulmonary

diseases

• Empyema

• Fetal alcohol syndrome

• Glaucoma

• Fibromyalgia

• Hyperthyroidism

• Hypothyroidism

• Irritable Bowel Syndrome

• Liver cirrhosis

• Narcolepsy

• Osteoporosis

• Sudden infant death syndrome

(SIDS)

• Tick paralysis

• Annual Death : 36.25 millions

• 80% of it occurs in low- and middle-income countries

1. Cardiovascular Disease (17.3mil.)

2. Cancer (7.6mil.)

3. Respiratory Disease (4.2mil.)

4. Diabetes (1.3mil.)

Death Causes

MAIN CAUSE OF DEATH IN INDIA

CARDIOVASCULAR DISEASE

DIABETES MELLITUS

CHRONIC OBSTRUCTIVE PULMONARY DISEASE

CANCER

Top 4 NCD

LUNG CANCER

STOMACH CANCER

COLORECTAL CANCER

LIVER

BREAST CANCER

COMMON CANCER

TOBACCO USE

PHYSICAL INACTIVITY

OVERWEIGHT/OBESITY

HIGH BLOOD PRESSURE

HIGH CHOLESTEROL LEVELS

HIGH BLOOD GLUCOSE LEVELS

LEADING RISKS FACTOR

2004 : USD 9.1 Billion out-of-pocket were spent on

test, treatment and medical devices to manage NCD

2005 : India experienced “highest loss in potentially productive years of life”

2006-2015 : the projected cumulative loss of national income for India due to NCD mortality will be USD237 billion

WHY?

In Malaysia

Arthritis was the most common non-communicable disease (NCD), followed by HBP, diabetes, asthma and CHD.

Older females were more likely than males to have arthritis and HBP, but males were more likely to have asthma.

Diabetes and CHD were most prevalent among Indians, while arthritis and HBP were most prevalent among the Indigenous groups.

Older people were more likely to report poor health if they suffered from NCD, especially CHD.

Chinese that had HBP were more likely to report poor health compared to other ethnic groups with the same disease.

Among those with arthritis, Indians were more likely to report poor health.

CARDIOVASCULARDISEASE

CANCER

RESPIRATORYDISEASE

DIABETES

UNINTENTIONALINJURIES

Main NCD

RISK FACTORS

TOBACCO SMOKING

EXCESSIVE ALCOHOL

INTAKE

PHYSICAL INACTIVITY

OBESITY

LIFESTYLE INTERVENTIONS

Replace saturated & trans – fat with unsaturated fat

consumption of vegetables, fruits and whole grains

sodium intake and excessive calories

HEALTHY DIET

Schools :provide not only good nutrition curricula but also healthy meals

Workplace : Not only inform about role of physical activity but also promote use of non-motorized transportation

Mass media : promote healthy lifestyle

Health centres : promote healthy lifestyle etc..

URBAN DESIGN AND TRANSPORTATION POLICY

Use public and non – motorized transport, more walking and using bicycle.

NATIONAL TRANSPORTATION

POLICY

AUTOMOBILE USE

DEPENDENCY

BAD Low taxes on gasoline, free parking, wide street design

QUITE GOOD Narrow streets, limited parking, high gasoline costs

HIGH INCOME COUNTRIES

BAD Lowering taxes, simplify registration procedures, allow foreign finance

QUITE GOOD Restrict funding, down payment 40 to 50 %, high taxes

MIDDLE AND LOW INCOME COUNTRIES

POLICYFortify foods with micronutrients

Limit advertising for unhealthy foods

Provide incentives for food manufacturers to replace unhealthy ingredients with healthy ones

Netherlands reduced the trans fat content of the food supply from about 6 percent of the energy content to approximately 1 percent in a single decade.

government policies replaced commonly used palm oils for cooking with soybean oil, which reduced the intake of fatty acids and lowered serum cholesterol levels.

MEDICAL INTERVENTION

Type 1

•Insulin injection

Type 2

• Insulin injection(severe) + change in diet and lifestyle + oral glucose lowering agents

CHALLENGES: Access to insulin very low in African nations

Glycemic control costs less than managing complications that arises in its absence.

Anticlotting agents (aspirin , heparin) –prevent venous thromboembolismBenzathine penicillin injection –

rheumatic fever

ACE inhibitors : For CHF and HT

Anti coagulants : mitral stenosis and atrial fibrillation

Others

PRIMARY PREVENTION

•Eliminates exposure to cancer causing agent

SECONDARY PREVENTION

•Detecting and treating pre-cancerous lesions

TREATMENT

•Surgery, Chemotheraphy, Radiotheraphy

PALLIATIVE CARE

•Physical and physiological comfort from diagnosis through death

PRIMARY

Immunizing against infectious

agents, dietary interventions,

tobacco control programs,

reducing excessive alcohol

consumption, chemoprophylaxis

SECONDARY

Screening programs to detect and treat

precursors of cancer

TREATMENT

Surgery, radiation therapy,

chemotherapy

PALLIATIVE CARE

End of life care

DEVELOPMENTAL AND CONGENITAL DISORDERS

Genetic screening and counselling for couples

Vaccinating against Hib & Meningitis

(Neurological damage) + Rubella vaccine

Readdressing nutritional deficiencies

among pregnant women

Screening for metabolic disorders

(develop neurological damage after ingesting

certain foods)

Screening for sickle cell anemia + penicillin

prophylaxis

Screening and treatment for

congenital hypothyroidism

Prompt treatment for cerebral malaria

HEALTH INTERVENTIONS

Stop alcohol use during pregnancy

Eliminating environmental

exposure to toxins such as Lead

BEHAVIOURAL INTERVENTION

Treatment ensues

What if Prevention fails?

•Blood transfusion with washed RBCThalassemia

•Treat with analgesics if severe bone pain

•Nutrition, rehabilitation, special education to reduce impairment

Sickle cell disease

Interventions at associated health conditions

Address environmental constraints on participation in family and social life

IF BOTH PREVENTION AND TREATMENT

FAILS..

DOWN SYNDROME

• Therapy for poor vision and hearing

• Congenital heart defect

• Low mental capacity

Wheelchair accessible mass transit, buildings, restrooms

Social support network

Eliminating social stigma, promote inclusiveness

UNINTENTIONAL INJURIES

FIRST

• Manage exposure to risk

• Substitute safe mode of transport from more dangerous one

• Minimize high – risk scenarios (raise legal age for riding motorcycle)

SECOND

• Construct safer roads

• Place speed bumps

• Separate vehicle lanes from paths used by pedestrians and bicycles

• Construct median barriers

• Provide passing lanes

• Improve street lighting

THIRD

• Encourage people to adopt safer behaviors (Education)

• Introduce legislation and enforce it in relation to Speed limit, Blood alcohol level, wearing helmets..

Interventions

TOBACCO USE

Increase tobacco

taxes

Disseminate info about tobacco’s

health risks

Restrict smoking in

public places and workplaces

Banning tobacco

advertising

Increase access to cessation therapies

Interventions

ALCOHOL USE

Legislative measures and taxes

•Increase alcohol taxing

•Restricting sales to a limited number of licensed retail outlets

Improved Law

enforcement

•Strict drunk driving laws

Mass media

campaigns

• Bans on advertising alcohol products

• Manufacturers substitute other methods of marketing Eg: Sponsoring sporting events

Education

POPULATION LEVEL

• School based education about risks of drinking alcohol

Educational sessions

• Discussing risks of drinking alcohol

Psychosocial counselling

PERSONAL LEVEL

MENTAL HEALTH

Mental Health

Depression

Schizophrenia

Bipolar Disorder

Anxiety Disorders

Dementias

Epilepsy

Alzheimer's Disease

Parkinson's Disease

INTERVENTIONS

Pharmacological treatment

Psychosocial therapies

Relieving symptoms

Easing burden on Patient’s

family

Pharmacological Treatment

• Antidepressants

• Antipsychotic

• Antimanic

Psychosocial therapies

• Cognitive behavioural therapy

• Group therapy

Relieving symptoms

• Eg: Hypertension in anxiety( give anti-hypertensives)

Easing burden on patients family

• Training caregivers about proper diet

• Establishing bowel and bladder habits