Professional Documents
Culture Documents
Epidemiology in the
Communities
Joedo Prihartono
Department of Community Medicine FKUI
What
Who, Where, When
Why, How
Purpose of Epidemiology
Epi - on or upon
Demos - the people
Logos - Knowledge
DESCRIPTIVE ANALYTIC
EPIDEMIOLOGY EPIDEMIOLOGY
Holistic Diagnosis
CLINICAL EPIDEMIOLOGY /
(BIOPSYCHOSOSIAL)
EBM
( Clinical Trial, Etiologic/
Diagnostic/Therapy/Prognostic
Meta Analysis) Therapy, Prognosis
Uses of epidemiology
Search for cause/causes of diseases
Discover the health status of population or groups
Web of Causation
Ecological (or epidemiologic) Model
Example of a Web of Causation
Overcrowding Malnutrition
Exposure to
Mycobacterium
Tissue Invasion
and Reaction
Vaccination Genetic
Host:
Intrinsic factors, physical factors,
psychological factors, immunity
Health
or
Illness
?
Agent:
Amount, infectivity, pathogenicity, Environment:
virulence, chemical composition,
Physical, biological, social
cell reproduction
CAUSATIVE STEPS
A B
Causal Coincidence
Direct Indirect
Examples of Agents of Disease
Nutritive excesses or deficiencies (Cholesterol,
vitamins, proteins)
Chemical agents ( CO2, drugs, medications)
Physical agents (Ionizing radiation)
Infectious agents (hookworm, malaria, tuberculosis)
Biologic
environment (population density,
sources of food, influence of vertebrates and
arthropods)
Medicine Epidemiology
Individual Community
Community Health
Basic Nursing
Nursing/Public Health
Preventive
Levels of Prevention
Primary: Activities to decrease the probability
of specific illnesses or dysfunctions No Disease
Present
Secondary: Early Diagnosis and prompt
intervention allowing early return to ADLs.
Disease has occurred
Tertiary: A defect or disability is fixed, stabilized
or irreversible. Rehabilitation. Disease has
advanced
HEALTHY PARADIGM
Natural History of Disease
The process by which diseases
occur and progress in humans
Exposure to Agent
Symptom
Development
Pre-exposure
Preclinical
Stage:
Stage:
Factors present
leading to Exposure to Clinical
causative
Resolution
problem Stage: Stage:
development agent: no
symptoms Symptoms Problem resolved.
present present Returned to health
or chronic state or
death
1 26 26/7 = 3.7
4+ 40 40/7 = 5.7
Attributable Risk
0 7 7-7 = 0.0
1 26 26-7 = 19.0
4+ 40 40-7 = 33.0
Basic Definitions
Morbidity
Mortality
Epidemic
Endemic
Pandemic
Rates
Prevalence
# of existing cases in a place at a given time
----------------------------------------------------------------------- x C
# of persons in a place at midpoint of year
Crude Mortality Rate
Age-adjusted
Race-adjusted
Gender-adjusted
Education
Socio-economic
Religion
etc
Maternal Mortality Ratio
TIMES 100%
Fertility Rate
Crude Birth Rate : No of birth / population
General Fertility Rate : No of birth / women 15-49
Sensitivity
Specificity
Positive and Negative Predictive Values
The Ideal Screening Test
Normal Diabetic
Blood Glucose
Sensitivity
Positive Result A B
(True positives) (False positives)
Negative Result C D
(False Negatives) (True negatives)
Accidental blood plasma vena < 100 100 - 199 > 200
glucose
Fasting blood plasma vena < 100 100 -125 > 126
glucose
Prevalence
Financial
Availability/ Feasibility of
Treatment
Relative costs of classifying
persons as FN and FP
Surveillance
Epidemiologic Surveillance is an ongoing and systematic
data collection, analysis and interpretation of health data in
the process of describing and monitoring a health event
(CDC). Data collected through health institution using
International Classification of Disease (ICD) 10
Estimating Risk
Association vs causation
Policy
Why non iodinated salt is still in the market?
A cross sectional study on endemic goiter
revealed that its prevalence in the mountainous
area is higher than coastal area
PLACE
The cause of endemic goiter is deficiency of
iodine that highly available in the sea fishes
Sea fishes are not available for people in the
mountain
Findings of a cross sectional study could be used for
health program planning such as:
Planning of health personnel
Determining target population for education or
prevention programs