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Model
Models of Multiple Causation Theory
The Wheel Model Genetic Make-up
Demographic
characteristics;
personal habits
and lifestyles
Physical, social,
economic,
cultural, political
environments
Models of Multiple Causation Theory
Poor
health
habits
Low
Poor housing
educational conditions
status
TB
Poor Bacilli Congestion
and
nutritional environmental
status pollution
Low socio-
Poor
economic environment
status
The Web Model
Basic Epidemiologic Concepts:
Concept of Causal Association
Premises:
Cause of a Disease
A cause must precede
An event, condition, a disease.
characteristic or a
combination of these
factors that plays an
important role in
producing a disease Cause Disease
Concept of Causal Association
A B C
Paternal Age Maternal Age Infant’s Birth
Weight
Concept of Causal Association:
Types of Association
3. Direct or causal Example:
Smoking
Reaction at
Air Pollution Cellular Cancer
Level
Exposure to
asbestos
Concept of Causal Association:
Types of Association
Malnutrition
+
Crowded Reaction
housing at Cholera
+ Cellular
Exposure to Level
contaminated
water
Concept of Causal Association
227
RRR = ----- = 32 The risk of mental illness among abused children is
7 32 times higher compared to children who do not
have child abuse history.
Concept of Causal Association:
Measures of Association between Exposure to
and Risk of Disease
Attributable Risk (AR)
• Provides information about absolute effect of
the exposure or the excess risk of the disease to
a causal agent
• Gives a better idea than the RRR of the impact
of successful preventive or public health
program might have in reducing the problem
• Is the difference in the incidence rates of
disease between exposed and non-exposed
population
Concept of Causal Association:
Measures of Association between Exposure to
and Risk of Disease
Prenatal Clinic Visits and Maternal Complications
Disease Status
Exposure Factor With Disease Without Disease
Exposed a b
Not exposed c d
OR = ad / bc
Concept of Causal Association:
Measures of Association between Exposure to
and Risk of Disease
Tonsillectomy and Development of Hodgkin’s Disease
Prior Cases Controls Total
Tonsillectomy
YES 67 (a) 43 (b) 110
NO 34 (c) 64 (d) 98
UNKNOWN 8 2 10
Total 109 109 218
Ignoring the unknowns, the Odds Ratio from the formula
ad/bc= (67) (64)/(43) (34) = 2.9
PREPATHOGENESIS P A T H O G E N E S I S
Promotes health and wellness and Halts the progress of a disease at Prevents potential consequences of
prevents disease in the population its incipient stage and prevents disease
complications
1. Health Promotion – efforts to 1. Early Diagnosis 1. Disability Limitation
improve the quality of life and - case finding measures
enhance the level of physical (individual and mass) 2. Rehabilitation
and mental health - screening surveys
- periodic examination
2. Specific Protection – specific - selective examination of people
procedures of disease at high risk
prevention
2. Treatment and Disease Control
The Phases of the Epidemiologic Approach
Descriptive Epidemiology
Concerned with disease distribution and frequency;
who, where and when
Analytical Epidemiology
Attempts to analyze the causes or determinants of disease
through hypothesis-testing; how is the disease caused and
why is it continuing
Evaluation Epidemiology
Attempts to measure the effectiveness of different
health services and intervention programs
Strategies of Epidemiology
Descriptive
Studies
Ecologic studies; Case reports;
Case series; Cross sectional
studies
Generate
Modify hypothesis
hypothesis
Experimental
Analytic Studies
Studies
Cohort studies;
Laboratory experiments;
Case-control studies
Clinical trials; Community
trials
Test of Hypothesis
Descriptive Epidemiology
Disease or condition need to be
recognized with reasonable certainty
1. Observation and through SCREENING.
recording of existing
patterns of disease Screening – is the presumptive
identification of unrecognized
occurrence for the disease or defect by the application
condition under study of tests, examinations or other
procedures that can be applied
2. Description of the rapidly and inexpensively to
disease or condition as populations.
to person, place or time
• Mass screening – applied
unselectively to entire population or
3. Analysis of the general selectively to high risk groups
• Casefinding – search for previously
pattern of occurrence of unidentified cases of diseases
the disease or condition • Multiphasic screening – using
variety of screening tests on the
same occasion
Descriptive Epidemiology
Screening tests and procedures are applied to
detect people with risk factors or sub-clinical
disease; thus, consider the following factors:
Sensitivity = Specificity =
TP TN
---------------------- --------------------
TP + FN TN + FP
Descriptive Epidemiology
In a study done in Hospital X in 1998, information was collected on the
heights of 622 women who did or did not require Caesarean Section
(CS) for Cephalopelvic Disproportion (CPD). The results are shown
below:
• Of two types:
• Observational – cohort , case-control
• Experimental – Randomized control trials
Cohort Study: Follow-up or incidence study
Disease
Exposed
No Disease
POPULATION
Disease
Not exposed
No Disease
Exposed
Case
Not exposed
POPULATION
Exposed
Control
Not exposed
Exposed, Diseased
Exposed, No Disease
POPULATION
No exposure, Diseased
No exposure, No Disease