Concept of disease

A condition in which body health is impaired, a departure from a state of health, an alteration of the human body interrupting the performance of vital functions Webster A condition of the body or some part or organ of the body in which its functions are disrupted or deranged. Oxford English Dictionary A maladjustment of the human organism to the environment Ecological view point A social phenomenon, occuring in all societies and defined and fought in terms of the particualr cultural forces prevalent in the society. Sociological view point

 Disease is just the opposite of health i.e, any deviation from normal functioning or state of complete physical or mental wellbeing.

Disease
Physiological or psychological dysfunction.

Illness
Subjective state of the person who feels aware of not being well.

Sickness
A state of social dysfunction, i.e., a role that the individual assumes when ill (sickness role).

Concept of causation

Supernatural theory of disease

Theory of spontaneous generation

Theory of humors

Miasmatic theory

Concept of contagion

 Emphasis shifted from empirical causes (e.g., bad air) to microbes as the sole cause of disease. One-to-one relationship
Disease agent

Man

Disease

Epidemiological triad

Multifactorial causation
Pettenkofer of Munich The single cause idea was an oversimplification. There are other factors in the aetiology of diseases social, economic, cultural, genetic and psychological which are equally important.

Web of causation
Model suggested by MacMohan and Pugh in their book: Epidemiologic Principles and Methods. Ideally suited in the study of chronic disease. Considers all predisposing factors of any type and their complex interrelationship with each other.

Web of causation for myocardial infarction

Natural history of disease

 It signifies the way in which a disease evolves over time from the earliest stage of its pathogenesis phase to its termination as recovery, disability or death, in the absence of treatment or prevention. Best established by Cohort studies. Cross-sectional and retrospective studies.

physician

episode

epidemiologist

Natural history of disease in community setting

Fills the gaps in our knowledge about the natural history of disease.

1. Prepathogenesis phase
Period before the onset of disease in man. man in the midst of disease or man exposed to the risk of disease Causative factors of disease:
Agent Host Environment

Intercation of these three factors

2. Pathogenesis phase
Begins with the entry of the disease agent in the susceptible human host. Infectious diseases:
Clinical or subclinical Typical or atypical Carrier

Chronic diseases:
By the time the signs and symptoms occur the disease phase is already well advanced.

Agent factors
A substance, living or non-living, or a force, tangible or intangible, the excessive prescence or reltive lack of which mey initiate or perpetuate a disease process.

1. Biological agents
i. Infectivity ii. Pathogenecity iii. Virulence

6. Absence or insufficiency or excess of a factor necessary to health

i. ii. iii. iv. Chemical factors Nutrient factors Lack of structure Lack of part of musculature v. Chromosomal factors vi. Immunological factors

2. Nutrient agents 3. Physical agents 4. Chemical agents

i. Endogenous ii. Exogenous

5. Mechanical agents

7. Social agents

Host factors
Human host
Demographic characteristics
Age Sex Ethnicity

soil

Disease agent
Social and economic characteristics Socioeconomic status Education Occupation Stress Marital status housing

seed

Biological characteristics
Genetic factors Biochemical levels of blood Blood groups and enzymes Cellular constituents of blood Immunological factors Physiological function

Lifestyle factors Personality traits Living habits Nutrition Physical exercise Use of alcohol Drugs and smoking Behavioural patterns

Environmental factors
Physical environment Biological environment Psychosocial environment

Non-living things and physical factors (e.g., air, water, soil, housing, climate, geography, heat, light, noise, debris, radiation, etc) with which man is in constant intercation.

Universe of living things which surrounds man, including man himself.

Those factors affecting personal health, health care and community wellbeing that stem from the psychosocial make-up of individuals and the structure and functions of social groups.

Risk factors
Where the disease agent is not firmly established, the aetiology is generally discussed in terms of risk factors.
An attribute or exposure that is significantly associated with the development of a disease. A determinant that can be modified by intervention, thereby reducing the possibility of occurrence of disease or other specified outcomes.

 Risk facotrs may be:

Truly causative Merely contributory Predictive only in a statistical sense Purely additive or synergisitc Modifyable Characteristic of the individual

Risk groups/Target groups

Another approach developed and promoted by WHO risk approach. something for all, but more for those inn need in proportion to the need.

Guidelines for defining at-risk groups

a)

Biological situation:
Age group, e.g., infants (low birth weight), toddlers, elderly Sex, e.g., females in the reproductive age period Physiological state, e.g., pregnancy, cholesterol level, high blood pressure Genetic factors, e.g., family history of genetic disorders Other health conditions (disease, physical functioning, unhealthy behaviour)

b)

Physical situation:
Rural, urban slums Living conditions, overcrowding Environment: water supply, proximity to industries

c)

Sociocultural and cultural situation:

Social class Ethnic and cultural group Family disruption, education, housing Customs, habits and behaviour (e.g., smoking, lack of exercise, over-eating, drug addicts) Access to health services Lifestyles and attitudes

Spectrum of disease
Graphic representation of variations in the manifestations of disease.

Subclinical infections

Severity from mild to severe

Fatal illnesses

Iceberg of disease

Concepts of control

Disease control
Describes operations aimed at reducing:
i. The incidence of disease ii. The duration of disease, and consequently the risk of transmission iii. The effects of infection, including both the physical and psychosocial complications; and iv. The financial burden to the community.

Disease elimiantion
Intermediate goal between control and eradication. Interruption of transmission of disease. Important precursor of eradiaction.

Disease eradication
tear out by roots Termination of all transmission of infection by extermination of the infectious agent. Absolute process, an all or none phenomena.

Monitoring and surveillance

Monitoring:
The performance and analysis of routine measurements aimed at detecting changes in the environment or health status of a poopulation.

Surveillance:
The continuous scrutiny of the factors that determine the occurance and distribution of disease and other conditions of ill-health. Epidemiological, demographic, nutritional, etc.