The Presentation explains basic models of disease causation, to understand the etiology or causes of disease & altered production and helps to understand the applicability of causal criteria applied to epidemiological studies.
Health is a multifactorial
The factors which determine the health of an individual are many, some are inside the body ( genetic/ intrinsic) and some are outside the body ( environmental factors)
The interaction of these factors may either promote or deteriorate the health.
The important determinants of health are,
The Presentation explains basic models of disease causation, to understand the etiology or causes of disease & altered production and helps to understand the applicability of causal criteria applied to epidemiological studies.
Health is a multifactorial
The factors which determine the health of an individual are many, some are inside the body ( genetic/ intrinsic) and some are outside the body ( environmental factors)
The interaction of these factors may either promote or deteriorate the health.
The important determinants of health are,
population medicine has been referred to as hygiene, public health, preventive medicine, social medicine or community medicine. All these aim for promotion of health and prevention of disease.
“The study of the distribution and determinants of health-related states or events in specified population and the application of the study to control of health problems.”
The concept of prevention is best defined in the context of levels, tradition...hosamELMANNA
Concept of control:
The term disease control describes ongoing operations aimed at reducing:
The incidence of disease
The duration of disease and consequently the risk of transmission
The effects of infection, including both the physical and psychosocial complications
The financial burden to the community.
School Oral Health Programmes (Middle East and Asia)Vineetha K
Schools provide an important setting for oral health promotion, as they reach over a billion children worldwide. Through school children, the school staff, families and the community as a whole are benefited from the oral health programs carried out at schools. This presentation covers major oral health programs implemented in schools across Middle East and Asia
Evidence for Public Health Decision MakingVineetha K
The presentation gives an overview of evidence based public health with emphasis on the seven steps of EBPH Framework. It also includes the data sources to search for evidence and relevant articles explaining the current trend in decision making. One of the sources of the presentation is from EBPH training series by Rocky Mountain foundation. The link is provided in the end slide. Do contact me if you need any help with the resources.
Basics of social stratification including history, concepts and social mobility. How social stratification affects oral health with evidence from literature.
Narrative research and Case study are among the 5 approaches to Qualitative research. The key characteristics with an example is icluded in the slides.
This presentation describes what is new public health with adapted components from the previous eras of public health. Health promotion and evolution of public health is covered here.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
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Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
2. CONTENTS
• INTRODUCTION
• CONCEPTS OF DISEASE
• CONCEPTS OF CAUSATION
• NATURAL HISTORY OF DISEASE
• CONCEPTS OF CONTROL
• CONCEPTS OF PREVENTION
• CHANGING PATTERN OF DISEASE
• DISEASE CLASSIFICATION
• CONCLUSION
2
3. INTRODUCTION
3
• The concept of disease has been the subject of a vast,
vivid and versatile debate.
• Disease is a central notion to modern health care, it
effects society and is important to the process of
discovering and identifying disease entities.
4. CONCEPTS OF DISEASE
4
DEFINITIONS
“A condition in which body function is impaired, departure from a state
of health, an alteration of the human body interrupting the
performance of the vital functions.”
“The condition of body or some part of organ of body
in which its functions are disrupted or deranged.”
“Disease is considered a social phenomenon, occuring in all
societies and defined and fought in terms of the particular
cultural forces prevalent in the society.”
‘a maladjustment of human organism to the environment’
5. TO KEEP IT SIMPLE
Simplest definition – OPPOSITE TO HEALTH .
5
Any deviation from normal functioning or state of
complete physical or mental well-being.
6. DISEASE ILLNESS SICKNESS
6
DISEASE is a physiological/
psychological dysfunction.
ILLNESS
is a subjective state
of the person who
feels aware of not
being well.
SICKNESS
is a state of social
dysfunction i.e. a
role that the
individual assumes
when ill (sickness
role).
Susser
7. CONCEPT OF CAUSATION
Discovery of microbiology - turningpoint
• GERM THEORY OF DISEASE
• Microbes as sole cause of disease
7
EARLIER THEORIES
• Supernatural theory
• Theory of Humors
• Concept of contagion
• Miasmatic theory
• Theory of spontaneous generation
8. EPIDEMIOLOGICAL TRIAD
• Factors relating host and environment
• Mission of epidemiology – break one of the legs of
triangle and disrupt the connection between these and
thereby stopping outbreak. 8
10. MULTIFACTORIAL CAUSATION
• CONCEPT- disease is due to multiple factors and not
a single one.
• PETTENKOFER OF MUNICH(1819-1901)-early
proponent of this concept. “Germ theory of disease
"or “single cause idea "in late 19 century
overshadowed the multiple cause theory.
10
11. 11
Causative Factors
Groups or
populations and
their
characteristics
Environment
behaviour, culture
physiological
factors ecological
elements
TIME
ADVANCED MODEL OF THE TRIANGLE
OF EPIDEMIOLOGY
12. WEB OF CAUSATION
• Suggested by- Mac Mahon and Pugh
• Considers all the predisposing factors of any type and
their complex interaction with each other.
12
13. 13
41
Changes in life style
Stress
Smoking
Lack of Physical exercise
Plenty of food intake
Obesity
HTN
Emotional stress
Aging
Changes in the walls
of arteries
Coronary Occlusion
Myocardial ischemia
Hyperlipidemia
Coronary
Atherosclerosis
Myocardial Ischemia
Fig: Web of causation of MI
14. NATURAL HISTORY OF DISEASE
14
It refers to the progress of a disease process in an
individual over time, in the absence of intervention.
• History of disease is a key concept in epidemiology.
16. PRE PATHOGENESIS PHASE
• Disease agent has not entered man, but factors
favouring disease exist in the environment.
• What required is an interaction of these factors to
initiate the disease process.
Agent Host
Environment
16
17. PATHOGENESIS PHASE
• Entry of disease agent in susceptible human host.
• Disease agent multiplies and induces tissue and
physiological changes.
• final outcome- recovery, disability or death.
• This phase may be modified by intervention measures
such as immunization, chemotherapy
17
18. AGENT FACTORS
18
Substance living or non living , or a force, tangible or
intangible, the excessive presence or relative lack of which
may initiate or perpetuate a disease process.
1. Biological Agents – Infectivity Pathogenicity Virulence
2. Nutrient
3. Physical
4. Chemical
5. Mechanical
6. Absence or insufficiency
of a factor
7. Social
20. ENVIRONMENTAL FACTORS
• All that which is external to the individual
human host, living and non-living, and
with which he is in constant interaction.
-Macro-environment (external)
• Physical
• Biological
• Psycho social
20
21. RISK FACTORS
• Where the disease agent is not
firmly established, the
aetiology is generally
discussed in terms of risk
factors.
• The term risk factor is used
by different authors with at
least two meanings-
An attribute or exposure that is
significantly associated with
development of disease.
A determinant that can be modified
by intervention, thereby reducing
the possibility of occurrence of
disease or other specified outcomes.
21
22. RISK GROUPS
• Something for all but more for those in need- in
proportion to the need.
• Another approach developed and promoted by
WHO is to identify precisely the risk groups or
target groups in population by certain defined
criteria and direct appropriate action to them
first- risk approach.
22
23. SPECTRUM OF DISEASE
• Graphic representation of variations in the
manifestations of disease.
• Infectious disease – gradient of infection
23
25. CONCEPTS OF
CONTROL
The term disease control refers ongoing operation
aimed at reducing:
o The incidence of disease.
o The duration of disease and the consequently the
risk of transmission.
o The effect of infection including physical and
psychological complication.
o The financial burden to the community.
25
26. •DISEASE ELIMINATION: Reduction of case transmission to a
predetermined very low level or interruption in transmission.
E.g. measles, polio, leprosy from the large geographic region or
area.
• DISEASE ERADICATION: Termination of all transmission of
infection by extermination of the infectious agent through
surveillance and containment. “All or none phenomenon”. E.g.
Small pox.
26
27. • DISEASE MONITORING:
• Defined as “the performance and analysis of routine
measurement aimed at detecting changes in the environment
or health status of population.” e.g. growth monitoring of
child, Monitoring of air pollution, monitoring of water quality
etc.
• DISEASE SURVEILLANCE:
• Defined as “the continuous scrutiny of the factors that
determine the occurrence and distribution of disease and
other conditions of ill health.” E.g. Poliomyelitis surveillance
programme of WHO.
27
28. CONCEPTS OF
PREVENTION
The goals of medicine are to
• Promote health,
• To preserve health,
• To restore health when it is
impaired
• And to minimize suffering and
distress.
28
These goals are embodied in the word "prevention"
29. • Actions aimed at eradicating, eliminating or
minimizing the impact of disease and disability,
or if none of these are feasible, retarding the
progress of the disease and disability.
• The concept of prevention is best defined in the
context of levels, traditionally called primary,
secondary and tertiary prevention. A fourth
level, called primordial prevention, was later
added.
29
30. Leavell’s Levels of Prevention
30
Stage of disease Level of prevention Type of response
Pre-disease Primary Prevention Health promotion and
Specific protection
Latent Disease Secondary prevention Pre-symptomatic
Diagnosis and treatment
Symptomatic Disease Tertiary prevention •Disability limitation for
early symptomatic disease
•Rehabilitation for late
Symptomatic disease
31. PRIMORDIAL PREVENTION
• DEFINITION
31
“It is the prevention of the emergence or
development of risk factors in countries or population
groups in which they have not yet appeared.”
• INTERVENTION
The main intervention in primordial prevention is
through individual and mass health education.
32. PRIMARY PREVENTION
• Goal:
• Reduce number of new cases
• Rationale:
• By reducing exposure rates and increasing resistance, can reduce number
of new cases
• Target population:
• Those who are most likely to be exposed and/or could increase their
resistance
• Typical activities:
• Remove or reduce source of the risk
• Educate and make aware of disease risk
o Include behavioral changes to reduce exposure
• Improve general health
• Outcome measure: incidence of exposure; incidence of
disease
32
Primary prevention can be defined as the action
taken prior to the onset of disease, which removes
the possibility that the disease will ever occur.
33. SECONDARY PREVENTION
• Goal:
• Reduce number of new cases; reduce number of severe cases
• Rationale:
• By reducing number of exposures and early disease that progress to more
severe disease, mortality and morbidity can be reduced
• Target population:
• Those who have been exposed to the disease-causing agent or have early
symptoms of the disease
• Typical activities:
• Screening for exposure and/or disease
• Post-exposure prophylaxis
• Early treatment to reduce impact of disease/reverse course
• Outcome measure: incidence of disease
33
Secondary prevention can be defined as the action
which halts the progress of a disease at its incipient
stage and prevents complications.
34. TERTIARY PREVENTION
• Goal:
• Reduce number of complications, deaths
• Rationale:
• By reducing disease severity and increasing recovery, can reduce number of
premature deaths or complications
• Target population:
• Those who have disease and need treatment
• Typical activities:
• Treatment tailored to the patient
• Rehabilitation to promote recovery
• Outcome measure: incidence of death and long-
term disability
34
Tertiary prevention can be defined as all measures
available to reduce or limit impairments and
disabilities, minimize suffering caused by existing
departures from good health and to promote the
patients adjustment to irremediable conditions.
35. MODES OF INTERVENTION
• Intervention is any attempt to intervene or interrupt the usual
sequence in the development of disease.
• Five modes of intervention corresponding to the natural
history of any disease are:
o Health Promotion
o Specific Protection
o Early Diagnosis and Adequate Treatment
o Disability Limitation
o Rehabilitation
35
36. HEALTH PROMOTION
• It is the process of enabling people to increase control over
diseases, and to improve their health. It is not directed against
any particular disease but is intended to strengthen the host
through a variety of approaches(interventions):
o Health Education
o Environmental Modifications
o Nutritional Interventions
o Lifestyle and Behavioral Change
36
37. SPECIFIC PROTECTION
• Some of the currently available interventions aimed at specific
protection are:
immunization,
use of specific nutrients,
chemoprophylaxis,
protection against accidents,
protection from carcinogens,
avoidance of allergens,
control of specific hazards in general environment .eg air
pollution , noise control
Control of consumer product quality and safety of foods,drugs
etc
37
38. EARLY DIAGNOSIS AND TREATMENT
•A WHO defined early detection of health impairment as “the
detection of disturbances of homeostatic and compensatory
mechanism while biochemical, morphological, and functional
changes are still reversible.”
•Early detection and treatment are the main interventions of
disease control.
• Earlier a disease is diagnosed and treated the better it is from
the point of view of prognosis and preventing the occurrence of
further cases or any long-term disability.
•Ex – essential hypertension, cancer of cervix and Breast cancer
38
39. DISABILITY LIMITATION
• Objective- is to prevent or halt the transition of the disease
process from impairment to handicap.
Sequence of events leading to disability & handicap:
• Disease → Impairment → Disability→ Handicap.
WHO defined these terms-
• Impairment: Loss or abnormality of psychological,
physiological/anatomical structure or function.
• Disability: Any restriction or lack of ability to perform an
activity in a manner considered normal for one’s age, sex, etc.
• Handicap: Any disadvantage that prevents one from fulfilling
his role considered normal. 39
40. REHABILITATION
“combined and coordinated use of medical, social,
educational and vocational measures for training and
retraining the individual to the highest possible level of
functional ability”.
• Areas of concern in rehabilitation:
Medical rehabilitation (restoration of function),
Vocational rehabilitation (restoration of the capacity to earn a livelihood),
Social rehabilitation ( restoration of family and social relationships),
Psychological rehabilitation (restoration of personal dignity and
confidence).
40
41. CHANGING PATTERN OF
DISEASE
• Although diseases have not changed significantly
through human history, their patterns have.
• Every decade produces its own patterns of disease.
41
43. EPIDEMIOLOGICAL
TRANSITION.
• A characteristic shift in the disease pattern of a
population as mortality falls during the
demographic transition: acute, infectious
diseases are reduced, while chronic,
degenerative diseases increase in prominence,
causing a gradual shift in the age pattern of
mortality from younger to older ages. (Omran
1970)
43
44. DEVELOPED COUNTRIES
• Causes of diseases and deaths
have shifted from infectious to
chronic diseases.
Common disease- HEART DISEASE - 23.81%
CANCER-22.95%
CVS- 5.16% .
These 3 together- constitutes about 51.92% of deaths in
US.
OTHERS- Alzheimer's disease, lung cancer, environmental
health problems, and microbial diseases
44
45. • DEVELOPING COUNTRIES
45
• Nation with a low level of material well-being.
• In a typical developing country about 40%of
death are from infectious ,parasite, and
respiratory diseases compared with about
8%in developed countries.
• In India ,as in other developing countries ,most
death result from infectious and parasite
disease, abetted by malnutrition.
48. DISEASE CLASSIFICATION
• A system of classification was needed whereby diseases could
be grouped according to certain common characteristics ,
that would facilitate the statistical study of disease
phenomena.
• JOHN GRAUNT in 17th century- in his study of Bills of mortality
– arranged diseases in an alphabetic order.
48
49. ICD CLASSIFICATION
• International classification of disease (ICD)by WHO -
accepted for national and international use.
• Revised once in 10 years.
• The ICD is a classification system developed collaboratively
between the World Health Organization WHO) and 10
international centers so that the medical terms reported by
physicians, medical examiners, and coroners on death
certificates can be grouped together for statistical purposes
49
51. Why we need disease???
• HAEMOCHROMATOSIS - BUBONIC PLAGUE
• DIABETES - YOUNGER DRYAS
• FAVISM - MALARIA
51
Natural selection is maintaining this
genetic defect because it had conferred
some benefit in the past.
52. CONCLUSION
• Understanding disease pathology is the
first step towards formulating preventive
measures.
• As a dentist or public health worker it is
our primary responsibility for the
prevention of diseases in community as
well as individual.
52
53. REFERENCES
• Park, Park’s Textbook of Preventive &Social Medicine, 22nd
Edition, Jabalpur: Banarsidas Bhanot,2013.
• Soben Peter. Essentials of Public Health Dentistry. 4th ed.
New Delhi: Arya Publising House; 2013.
• Epidemiology, L. Gordis, Fourth ed, 2009, Saunders
• Moalem, S., & Prince, J. (2007). Survival of the sickest: A
medical maverick discovers why we need disease. New York:
William Morrow.
53
Spontaneous generation or anomalous generation is an obsolete body of thought on the ordinary formation of living organisms without descent from similar organisms. Typically, the idea was that certain forms such as fleas could arise from inanimate matter such as dust, or that maggots could arise from dead flesh.
The miasma theory (also called the miasmatic theory) held that diseases such as cholera, chlamydia, or the Black Death were caused by a miasma (μίασμα, ancient Greek: "pollution"), a noxious form of "bad air", also known as "night air".
Simple Definition of contagion. : the process by which a disease is passed from one person or animal to another by touching. : a disease that can be passed from one person or animal to another by touching : a contagious disease.
Upon the time of louis pasteur concepts of disease causation - supernatural theory, theory of humors, concept of contagion, miasmatic theory
Turning point discovery of microbiology.
Drawback of germ theory – not every one exposed to tb develops tb.disease is rarely caused by a single agent rather depends on no of factors.
This demanded a broader concept of disease causation that synthesized the basic factors of agent, host and environment.
host- man or animal in which agent harbours
Agent- cause of disease
Environment- surroundings which allow disease transmission
Time- incubation period, life expectancy of host, duration of illness.
Tuberculosis is not merely due to tubercle bacilli; factors such as poverty, overcrowding & malnutrition contribute to its occurrence.
This model is ideally suited for the study of chronic diseases where disease agent is often not known, but is the outcome of interaction of multiple factors.
Predisposing factors of any type and their complex interrelationship with each other.
Each disease has its own unique natural history which is not necessarily same for in all individuals.
What the physician sees in his clinic is just an episode .how disease evolves over time assesed by cohort studies. Helps the epidemiologists to fill the gaps.
Preliminary to onset of disease. Man in the midst of disease.
Biological agents- living agents ex virus fungi bacteria
Infectivity – the ability of an infectious agent to invade and multiply in a host.
Nutritive – proteins fats carbohydrates
Pathogenicity – ability to induce clinically apparent illness
Virulence- proportion of clinical cases resulting in severe clinical manifestations. (case fatality rate)
Demographic characteristics - age, sex, ethnicity
Biologic- genetic factors, biochemical levels of the blood enzymes
Socioeconomis – socio economic status, education, occupation, stress, marital status
Lifestyle –personality traits, living habits, nutrition, exercise alcohol, drugs etc
Diseases where agent is not identified- coronary heart disease, cancer , peptic ulcer, mental illness.
Modern epidemiology is concerned with the identification of risk factors nd high risk groups in population.
Define prioritis and point to those most in need of attention.
Spectrum of leprosy…. Infectious diseases its called gradient of infection.
The Iceberg Theory of Disease is metaphor portraying the idea that clinicians only see a minority of cases of any given disease (tip of the iceberg); for every case that comes to a clinician, there are likely to be many more people with pre-clinical disease in the community (vast submerged part)
Prevention is to stop disease from happening. While control is to stop something that has already happened.
Primary prevention can be defined as the action taken prior to the onset of disease, which removes the possibility that the disease will ever occur.
Of the three levels, the target population that will be the focus of primary prevention will be relatively larger than the populations in other levels. Note that many of these activities will overlap with health promotion activities.
GOAL: Preventing new cases of a disease (reducing incidence of disease) is the ultimate goal of primary prevention.
RATIONALE: Reducing exposure risk will reduce incidence of disease.
This may involve removing the exposure risk so it is not encountered. EXAMPLE: Chlorinating the city water supply to reduce the number of enteric pathogens present in the drinking water; spraying for mosquitoes to reduce risk of exposure to malarial plasmodia; using netting over bed to reduce nocturnal mosquito bites.
May involve removing population so it is not in contact with risk. EXAMPLE: Forbidding public access to sewage treatment water and area; restricting travel to areas where malaria is endemic.
OTHER PART OF RATIONALE: Increasing resistance to disease if exposed will also reduce incidence of disease
If exposure risk cannot be entirely eliminated, may seek ways to strengthen natural defenses. EXAMPLE: Vaccination to promote the development of antibodies so body can prevent the development of disease if it is exposed.
TARGET POPULATION: This will change depending on disease.
TYPICAL ACTIVITIES: Keeping the two rationales in mind, activities will focus on efforts to remove or reduce source of risk as well as prepare the target population to avoid and resist its effects.
Remove source of risk – for malaria, which is transmitted via a mosquito vector, this may include draining standing water where mosquitoes may breed.
Educate about risk/change behaviors – provide exposure risk information along with tips for how to reduce exposures. Netting for bedding, staying indoors during morning and evening hours when mosquitoes are most active, and using a DEET mosquito repellant when outdoors. Other general tips for contagious diseases include handwashing and keeping hands away from eyes or mouth.
Improve general health – this is where disease prevention and health promotion overlap. In general, a healthier person is better able to mount an immune response and avoid disease. Should the person become exposed and sick, they will often have a better chance of recovering.
OUTCOME MEASURE:
Number of exposures to a causative agent or risk factor
Final outcome would be number of new cases of disease (incidence)
Be sure students understand what incidence (incidence rate) means.
Incidence = the number of new cases in a given time period
Incidence rate = ratio of new cases to total population at risk for a given period of time. Allows comparison of incidence to other diseases or other populations.
GOAL: Reducing the severity of a disease (reducing morbidity) and new cases (incidence) are the ultimate goals of secondary prevention. This may apply to the individual case (reduce severity of symptoms or duration of illness) and the community (reduce severity of outbreak – or said another way – reduce the spread of the disease and shorten the length of time the outbreak exists).
RATIONALE: Early detection of a disease-causing exposure or identifying a disease in its early stages can lead to early treatment to either stop the progression of the disease or reduce its severity which will reduce complications. Identifying those who are sick can also aid in reducing the spread of the disease to others in the community.
EXAMPLE: Detecting exposure to lead through blood tests can lead to the removal of the lead source. Screening interviews can be used to identify who has been in close contact with a person diagnosed with an infectious disease and the timely use of post-exposure prophylaxis to “nip” the possible infection in the bud. For chronic diseases like diabetes, early detection via A1c levels can lead to earlier control of blood sugar and a reduction in both short and long term complications of the disease.
TARGET POPULATION: This now becomes the individuals who were in the “risk of exposure” or “risk of disease” group who have been exposed or have early disease. So it is a subset of the primary prevention population for that specific disease.
TYPICAL ACTIVITIES: Like primary prevention, secondary prevention has two key types of activities that help you identify it. SCREENING to detect exposure or early disease is one; the other is EARLY TREATMENT to either prevent or reverse the disease process entirely or reduce the severity of the illness. Another type of early interventions at the population level would be quarantining those who have been exposed so they are not in contact with others; for those with early symptoms of the illness, isolation would be used to minimize contact with healthy folks.
EXAMPLES:
For exposure to a toxic chemical, secondary prevention would use decontamination to remove exposure before it caused harm and/or an antidote to counteract the effects of the toxin. An exposure to an organophosphate pesticide would be treated in both of these ways. If decontamination and the administration of atropine did not completely counteract the effects of the poisoning, then the severity would probably be reduced. At the population level, interventions may involve preventing people from entering a contaminated area and offering methods for removing contaminants.
For an infectious disease like Varicella (chickenpox), screening interviews can be used to determine if a person has likely been exposed. Questions like did they share a drinking glass or kiss? Were they close together for four or more hours? Did they care for someone who had chickenpox, or did they already have immunity to chickenpox through a vaccine or prior illness can be used to identify good candidates for vaccination? Another group would be those who are just beginning to show symptoms – they may be a good candidate for early treatment with an antiviral. At the population level, would encourage sick folks to stay home (self-imposed isolation) and their caregivers to seek vaccination if not already immune.
OUTCOME MEASURE:
Number of cases of disease (compare to number of exposures in primary level)
Be sure students understand what incidence (incidence rate) means.
Incidence = the number of new cases in a given time period
Incidence rate = ratio of new cases to total population at risk for a given period of time. Allows comparison of incidence to other diseases or other populations.
GOAL: Reducing the risk of disease-related premature mortality or long-term morbidity and increasing likelihood of returning to a state of health.
RATIONALE: Once disease occurs, need to work to cure patient and avoid long-term illness or complications. Doing so will reduce mortality and morbidity rates and reduce prevalence rates.
EXAMPLE: Lead poisoning that has resulted in symptoms now requires treatment to address lead toxicity illness and end organ complications. For chronic diseases like diabetes, tertiary prevention will focus on controlling the disease so premature death and complications are avoided. For an infectious disease, the tertiary levels of prevention will use antibiotics or anti-microorganism (viral, protozoan, fungal, etc) medications if available to directly treat infection causing disease and supportive care to allow the disease to run its course while reducing risks of complications created by the infective agent or its by-products (e.g., shock due to toxins released during a gram negative infection).
TARGET POPULATION: This now becomes the individuals who develop the illness. It is a subset of the population identified for secondary prevention.
TYPICAL ACTIVITIES: For individuals, these activities are best described as clinical or THERAPEUTIC interventions – something that should be/will be very familiar to pharmacy students. In addition to treatment, there are REHABILITATION activities that are used for individuals who have permanent or long-term disabilities due to the disease. The goal of rehabilitation is to resume as normal a lifestyle as the person had prior to the disease. At the population level, tertiary activities may include ensuring individuals has access to care sites or professionals, research to find more effective treatments, and support groups for recovering individuals.
EXAMPLES:
Using the toxic exposure example, tertiary prevention would concentrate on supportive care if antidotes were not available or not effective. If the exposure were a venomous snake bite that was not promptly treated with anti-venom, it is possible that the injured person may have surgical intervention to reduce pressure building up in the muscle bundles (fasciitis) or even amputation if damage to a limb is too extensive. Post surgical rehabilitation would be used to help the person resume many of their usual activities. At the population level, ensuring access to anti-venom may be important – because it is so expensive, hospitals
For an infectious disease like varicella (chickenpox), the goal of tertiary prevention will be recovery from the immediate infection without the development of complications. One long-term complication of a varicella infection called shingles would best be addressed through primary prevent efforts involving vaccination of older adults who are at risk of shingles. If this is confusing, consider the development of shingles as a separate disease from chicken pox and it may be easier to think about primary prevention.
OUTCOME MEASURE:
Prevalence rates for disease (cures should lower it)
Mortality rates
Morbidity rates
Essential hypertension, cancer cervix
Table- comparison of leading causes of death worldwide over past decade
A char
Wide variation among countries in criteria and standars adopted for diagnosis of diseases making it difficult to compare national statistics.