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Introduction and Role of Epidemiology


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Introduction and Role of Epidemiology

  1. 1. SupattraSrivanichakorn<br />ASEAN Institute for Health Development,<br />Mahidol University<br />Introduction andRole of Epidemiology<br />
  2. 2. What is Epidemiology ?<br />The study of the distribution and determinants of diseases and injuries in human population.(Mausner&Bahn)<br />the study of the distribution and determinants of health related states or events in specified populations, and the application of this study to the control of health problems. (dictionary of epidemiology)<br />
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  4. 4. The Traditional Model of Disease <br />Host<br />Agent<br />Environment<br />Source: G.E. Alan Dever, 1980<br />
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  6. 6. Healthy People in Healthy Communities.<br />Source: U.S Department of Health and Human Services, 2000<br />
  7. 7. Health, Healthy peopleHealth concept model<br />Definition of Health<br />Health concept model <br />
  9. 9. Multi-dimension of health<br />Psychological<br />Social<br />Physical<br />Spiritual<br />Health:A state of complete physical, mental, and social well being - not merely the absence of disease or infirmity (WHO1948)<br />
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  12. 12. Domains in Epidemiological data?<br />TIME - <br />PERSON - <br />PLACE -<br />Distribution and Determinants of Problems<br />
  13. 13. สถานการณ์สุขภาพ <br />อัตราเกิด อัตราตาย <br />อัตราป่วย ความชุกในการป่วยประเภทต่างๆ <br />ความชุกของความพิการ การทำงานไม่ได้ตามภาวะปกติ <br />ความชุกของพฤติกรรมเสี่ยงในการเกิดปัญหาสุขภาพ <br />ลักษณะปัจจัยที่มีผลต่อปัญหาสุขภาพ <br />ทุนและปัจจัยที่มีผลบวกต่อสุขภาพ<br />
  14. 14. เงื่อนไข และเป้าหมายการพัฒนาบริการสาธารณสุข<br />สาธารณสุข<br />แนวใหม่<br />ที่ยังไม่บรรลุผล<br />ภาระเก่า<br />สิ่งแวดล้อม กายภาพ สังคม เศรษฐกิจ<br />สิ่งแวดล้อม กายภาพ สังคม เศรษฐกิจ<br />อาการ<br />โรค<br />ป่วย<br />+<br />สุขภาพ<br />
  15. 15. The Mandala of Health<br />culture<br />community<br />Life style<br />Personal Behavior<br />Economic-<br />social Env.<br />Family<br />Health service system<br />spiritual<br />Work/Occupation<br />Body<br />Mind<br />Physical Environment<br />Biology<br />Human invented Environment<br />Biological world<br />
  16. 16. Alma-Ata Declaration WHO, Geneva,1978Primary Health CareHealth for All by the Year 2000<br />Ottawa Charter for Health Promotion (1986):<br />Birth of the “new” public health<br />Health - a resource for living, not the objective of living; emphasis on social and personal resources, as well as physical capacities<br />
  17. 17. Understand the Whole Person<br />Context<br /><ul><li> Culture
  18. 18. Work
  19. 19. School
  20. 20. HC system</li></ul>Family<br />Person<br /><ul><li> Family system
  21. 21. Family Life cycle
  22. 22. Life cycle
  23. 23. Family of origin
  24. 24. History</li></ul>Disease<br /><ul><li> S & S
  25. 25. Ix</li></ul>Illness<br /><ul><li> Feeling
  26. 26. Ideas
  27. 27. Function
  28. 28. Expectation</li></li></ul><li>อัตราผู้เข้ารักษาเฮโรอีนต่อประชากร 100,000 คนในจังหวัดที่มีการพัฒนาการท่องเที่ยว<br />จังหวัดข้างเคียง<br />กับจังหวัดเป้าหมายพัฒนาฯ<br />จังหวัดเป้าหมายพัฒนาฯ<br />
  29. 29. Why we need Epidemiology ?<br />To understand the nature of diseases/health problems.<br />To find out root causes of health problems<br />To identify options for effective interventions to control/prevent health problems in clinical setting and in the population.<br />To evaluate the output/outcome/effect after the interventions<br />
  30. 30. อนาคต<br />Sentinel information of risk groups for AIDs infection<br />การดูแลรักษา<br />ผู้ติดเชื้อเอดส์<br />Drug injector<br />Male user at STD clinics<br />%<br />%<br />14<br />70<br />โจทย์<br />12<br />10<br />50<br />8<br />6<br />30<br />4<br />10<br />2<br />โจทย์<br />0<br />0<br />Direct Prostitutes<br />Indirect Prostitutes<br />%<br />%<br />40<br />40<br />โจทย์<br />30<br />30<br />20<br />20<br />โจทย์<br />10<br />10<br />โจทย์<br />0<br />0<br />’33<br />’35<br />’37<br />’39<br />’41<br />’43<br />’45<br />’33<br />’35<br />’37<br />’39<br />’41<br />’43<br />’45<br />Bangkok<br />Central<br />North<br />North-east<br />South<br />
  31. 31. How we use Epidemiology ?<br />Epidemiological tools:<br />Surveillance, <br />Out-break investigation <br />Epidemiological studies <br />Descriptive study <br />Analytical study<br />Experimental study <br />
  32. 32. Application of Epidemiology<br />To identify the etiology or causes of a diseases and risk factors.<br />To determine the extent of disease found in the community .<br />To study the natural history and prognosis of diseases<br />To evaluate both existing and new preventive and therapeutic measures and mode of health care delivery. <br />To provide the foundation for developing public policy and making regulatory decisions relating to environmental problems.<br />
  33. 33. National Household Survey<br />2001<br />STATISTICS<br />Area Specific<br />Demographics<br />and<br />Selected Planning<br /> Indicators<br />
  34. 34. NUMBER OF POPULATION<br />National Household Survey<br />2001<br />REPORTED EVER USED SUBSTANCES<br />STATISTICS<br />Stimulant and muscle relaxant<br />Number of substance user population x 1000<br />AREA<br />Yaba<br />Ecstacy<br />Ketamine<br />Cocaine<br />143.7<br />17.2<br />17.4<br />Bangkok<br />36.2<br />36.7<br />3.1<br />1.8<br />Peripheral province<br />7.5<br />402.4<br />7.8<br />10.6<br />Central region<br />66.0<br />283.1<br />0.7<br />4.1<br />Northern region<br />71.3<br />2,564.9<br />8.6<br />11.9<br />Northeastern region<br />161.5<br />60.8<br />3.4<br />7.1<br />Southern region<br />17.6<br />3,491.6<br />40.7<br />52.8<br />Total<br />360.1<br />Yaba: An illicit stimulant commonly contains methamhetamine, ephedrine and/or caffeine.<br />
  35. 35. National Household Survey<br />PERCENTAGE OF SUBSTANCE USER per AREA<br />2001<br />STATISTICS<br />Stimulants and muscle relaxant<br />Percentage of user per area population(%)<br />AREA<br />Yaba<br />Ecstasy<br />Ketamine<br />Cocaine<br />Bangkok<br />0.4<br />0.4<br />0.9<br />3.5<br />Peripheral province<br />0.1<br />0.2<br />0.4<br />2.0<br />Central Region<br />0.1<br />0.1<br />0.8<br />4.8<br />0.1<br />0.0<br />0.8<br />3.3<br />Northern Region<br />Northeastern Region<br />0.1<br />0.1<br />1.0<br />16.1<br />Southern Region<br />0.1<br />0.1<br />0.3<br />1.1<br />7.8<br />Total<br />0.1<br />0.1<br />0.8<br />Yaba: An illicit stimulant commonly contains methamhetamine, ephedrine and caffeine.<br />
  36. 36. AREA SPECIFIC PREVALENCE<br />National Household Survey<br />OF EVER USE SUBSTANCES<br />2001<br />STATISTICS<br />%<br />45<br />MALE RESPONDENTS<br />40<br />35<br />30<br />25<br />20<br />15<br />10<br />5<br />0<br />Ganja<br />Kratom<br />Heroin<br />Inhalant<br />Yaba<br />Bangkok<br />Central Region<br />Northeastern Reg.<br />Bangkok/ Suburb<br />Northern Region<br />Southern Reg.<br />
  37. 37. Epidemiology for health service management and policy development<br />The foundation for problem identification<br />When and how to use epidemiology for policy development <br />Describe the situations: HR, quality of services<br />Identify risks<br />Evaluation performance and outcome of health services<br />Use for assessing planning, forcasting, projecting health needs of population groups<br />Numerators/Denominator <br />Monitor and evaluate process management<br />
  38. 38. Ecology of Medical Care<br />Adult population<br />Age 16+ yrs<br />1000<br />Illness or injury <br />a month<br />750<br />Consulting MD in PC <br />a month<br />250<br />9<br />Admitted a month<br />5<br />Referred TC a month<br />1<br />Referred medical center a month<br />White KL. NEJM 1961;265(18):885-892<br />
  39. 39. Ecology of Medical Care : Revisited<br />1000<br />All Ages<br />Report Symptoms a month<br />800<br />327<br />Consider Seeking Medical Care<br />217<br />Consulting MD in PC <br />Visit CAM provider<br />65<br />Visit OPD Hospital<br />21<br />Receive HHC<br />14<br />Admitted<br />8<br />1<br />Admitted <br />medical center<br />Green LA. NEJM 2001;344(26):2021-5<br />
  40. 40. รพ.รัฐ (26.1)<br />กิน/อยู่<br />รพ.เอกชน<br />(6.4)<br />หมอพื้นบ้าน<br />/สมุนไพร<br />(3.8)<br />ทำงาน<br />ป่วยเรื้อรัง<br />ศูนย์แพทย์<br />(26.1)<br />พึ่งตนเอง<br />ผู้ใหญ่<br />ไม่ป่วย<br />พึ่งบริการ<br />พักผ่อน<br />คลินิคเอกชน<br />(26.1)<br />ซื้อยากินเอง<br />(10.2)<br />ฯลฯ<br />ปล่อยให้<br />หายเอง<br />(1.3)<br />
  41. 41. รพ.รัฐ<br /> (7.4)<br />รพ.เอกชน<br /> (1.5)<br />หมอพื้นบ้าน<br />/สมุนไพร(0.5)<br />กิน/อยู่<br />ศูนย์แพทย์<br />(25.4)<br />ทำงาน<br />คลินิคเอกชน<br />(21.1)<br />children<br />พึ่งตนเอง<br />Not<br /> sick<br />พึ่งบริการ<br />Mild <br />sickness<br />พักผ่อน<br />ซื้อยากินเอง<br />(31.9)<br />ฯลฯ<br />ปล่อยให้หายเอง<br />(31.9)<br />
  42. 42. H<br />EALTH CARE REFORM<br />THE CONCEPTUAL FRAMEWORK OF PRIMARY CARE<br />in<br />Thailand<br />SERVICE DEMAND<br />SELF-CARE<br />Development direction<br />Development direction<br />Health Behaviors<br />Service provider<br />PRIMARY SERVICE<br />Eating<br />Sleeping<br />Working<br />Resting<br />Exercise<br />Alternative healers<br />Village Health Volunteers<br />Health centers<br />Private clinics<br />Private hospitals<br />Public hospitals<br />etc.<br />PERSONAL HEALTH CARE<br />etc.<br />SECONDARY SERVICE<br />Resting<br />Self-prescription<br />Physical remedies<br />SELF-TREATMENT ON ILLNESS<br />TERIATIARY SERVICE<br />(bathing/cleansing/ message/etc.)<br />Socio-economic & environmental context, Area-based & population specific demands<br />and service capacity<br />
  43. 43. Figure 5.20 Incidence of Sexually Transmitted Infections and Condom Use Rate among Female Commercial Sex Workers (CSWs), Thailand, 1977-2003<br />
  44. 44. Top ten mortality in 2004 Source: Thai Working Group on BOD<br />% of Total national deaths 63.9 56.0<br />
  45. 45. Share of public and private financing sources from total health expenditure in Thailand,1994 - 2005<br />
  46. 46. Epidemiology for Population Health<br />To describe situations and trend of human population<br />To investigate the process beneath the surface<br />To interpret, analyze, to find meaning and use for the future<br />
  47. 47.
  48. 48. ความชุกของโรคเบาหวาน6.9 % <br />ผู้ป่วยส่วนใหญ่ได้รับ<br />การดูแลที่โรงพยาบาล<br />ทราบว่าป่วย 43% <br />ควบคุมได้ 12.2 % <br />2547<br />
  49. 49. Microvascular<br />complications<br />Macrovascular<br />complications<br />Postprandial <br />plasma glucose<br />Glucose production<br />Glucose transport<br />TG <br />HDL<br />Lipogenesis<br />Obesity<br />Waist-hip ratio<br />Hypertension<br />Stage III<br />Type 2 Diabetes mellitus<br />Stage II<br />Impaired<br />glucose tolerance<br />Insulin secretory deficiency<br />Stage I<br />Normal<br />glucose <br />tolerance<br />Atherogenesis<br />Hyperinsulinemia<br />Insulin resistance<br />Diabetes Genes เบาหวาน<br />General Population : no risk <br />