PRINCIPLE OF EPIDEMIOLOGY

USES OF EPIDEMIOLOGY
GENETIC FACTORS
1. Causation

GOOD HEALTH HEALTH

ENVIRONMENTAL FACTORS Death

(incluiding lifestyle)
2. Natural history Subclinical Clinical
Good health changes disease

3. Description of health status Recovery

of populations
Good health
Propotion with III health,
change over time, change III
with age, etc. health Time

Treatment medical care

4. Evaluation of Good health III health

Intervention
Health promotion
Preventive measures
Public health services
 SPECTRUM OF DISEASE

Exposure DEATH
Etiologic Sympton
Pathologic Diagnosis
Agent Changes Time

Subclinical Clinical RECOVERY

Manifestation Manifestation
 FACTUAL DESCRIPTION
(WHAT, WHO, WHEN & WHERE)

TO PROVE OF CONSTRUCTION OF
HYPOTHESIS HYPOTHESIS (WHY &
HOW)

WHAT NOW
 CONCEPT OF HEALTH STATUS

• (1) THE TRADITIONAL (ECOLOGICAL) MODEL : (a)

Agent (b) Host © Environment
• (2) THE HEALTH FIELD CONCEPT (HL
Lamframboise, 1973) : (a) Environment (b) Life
style © Biological (d) System of health service.
• (3) THE ENVIRONMENT OF HEALTH (H.L.Blum,
1974; The Force field and wellbeing paradigms of
health) : (a) Environment (b) Behaviour (Life style)
© Health service and (d) Heridity.
 Epidemiologic Triad

Disease is the
result of forces
within a dynamic
system consisting
of:
agent
host
environment
 AGENT OF HOST
DISEASE
FULCRUM

ENVIRONMET OF
LIFE

BIOLOGY PHYSIC SOCIAL ECONOMIC

DIAGRAM : keseimbangan kesehatan, titik keseimbangan (fulerum) dapat
berubah-ubah karena perubahan lingkungan hidup. (Leavell’s diagram of
healds equilibrium sariable fulerum position by changing envoironment)

Little agent More Agent Weaknes of

(not more) Healthy of and very
host host
virulent

Good Bad
Environment Environment

DIAGRAM : Balance of Health DIAGRAM : Imbalance of Health

BIOLOGICAL INTERACTION
 MODEL ECOLOGY

1 2
H A
A

E E
In crease in the ability of The pproportion of
an agent to infect and susceptiibles in the
cause in men human host population
is increased
A H

E
At equliibrium 4
3
H A
A I
H
E
Environmental change Enviromental change
facilities agent spruad afters host susceptibility
 Epidemiological TRIAD

Host
Intrinsic factors that influence host susceptibility

Agent
Environment Biological characteristic of agent
Extrinsic factors
Opportunity for infection to occur
 TIGA ASPEK EPIDEMIOLOGI
• Agent : Substansi atau tenaga ok.
kurang / lebihnya merupakan hal yang
esensial utk terjadinya penyakit.

•Human Host : Faktor manusia yang

membantu terjadinya penyakit. (daya
tahan, sifat biologik, imunologik, tingkah
laku dll)

•Environment : td. fisik, biologik, sosial,

ekonomik dan budaya.
 Classic Epidemiologic Theory
 Agents
– Living organisms
– Exogenous chemicals
– Genetic traits
– Psychological factors and stress
– Nutritive elements
– Endogenous chemicals
– Physical forces
 ETIOLOGIC FACTORS FOR HUMAN
DISEASES & INJURIES

•Biologic Agent : Certain bacteria; viruses;

parasites, fungus; ricketsia, in utero exposure.

•Chemical agents : Lead; mercury; certain

pesticide; hydrogen cyanide; certain
medications, arsenic, florine gas.

•Physical agents : trauma including burns;

ioninizing/non radiation; high voltage electricity.
 ETIOLOGIC FACTORS FOR HUMAN
DISEASES & INJURIES

•Nutritional factors : Overly high/low

caloric intake; low protein; vitamin
deficiency; calcium intake; sodium
intake; saturated fat intake.
•Life-style choices : Exercise level;
tobacco use; alcoholic beverage intake;
dietary preference; seat belt use; bicycle
helmet use.
 Classic Epidemiologic
Theory
 Agents have characteristics such as
infectivity, pathogenicity and virulence
(ability to cause serious disease)
– They may be transmitted to hosts via
vectors
 ETIOLOGIC FACTORS FOR HUMAN
DISEASES & INJURIES

•Host characteristics : Genetic factors;

immune status; gender; concurent disease;
level and type of natural and suplemented
estrogens, social support; economical
support, cultural support, response of stress.
– Immunity and immunologic response
– Host behavior
 FAKTOR PENYEBAB TERJADINYA
PENYAKIT PADA MANUSIA
•Environmental factors :
Faktor lingkungan pokok untuk terjadinya
penyakit, antara lain faktor lingkungan fisik,
lingkungan kimiawi, lingkungan biologik,
lingkungan ekonomi, sosial dan kultural.
(cuaca panas yang ekstrem, keadaan
dingin yg ekstrem, bahan alergi tertentu,
polusi udara, paparan kaitan dgn
pekerjaan, kontaminasi air, dll.).
Classic Epidemiologic Theory
(cont.)
 Environmental factors:
– Physical environment (heat, cold,
moisture);
– Biological environment (flora, fauna);
– Social environment (economic,
political, culture);
– Chemical environment;
Classic Epidemiologic Theory
(cont.)
 Environmental factors :
Heat; cold; certain allegens;
air pollution ; occupational
exposures; contaminants in
drinking water, etc.
 PERIOD or PRE PATHOGENESIS PERIOD OF PATHOGENESIS
DISEASE BEFORE MAN IS INVOLVED THE COURSE OF THE DISEASE IN MAN

PROCESS DEATH
AGENT HOST
CRONIC STAT
DEFECT
DISABILITY
CLINICAL ILLNESS
AND SIGNS & SYMPTOMS
HORISON
ENVIRONMENTAL
FACTORS
(KNOWN AND UNKNOWN) TISSUE AND
BRING AGENT AND HOST PHYSIOLOGIC IMMUNITY
CHANGES AND
TOGETHER
RESISTANCE
OR SIMULUS on AGENT BECOMES
PRODUCE A DISEASE ESTABLISHED AND INCREASED RECOVERY
PROVOKING BY MULTIPLICATION
S T I M U L U S
IN THE INTERACTION or HOST – HOST REACTION
HUMAN AND STIMULUS
HOST
EARLY DISCERNIBLE ADVANCED CONVALE
PATHOGENESIS EARLY DESIONS DISEASE SCIENCE

LEVELS HEALTH SPECIFIC EARLY DIAGNOSIS DISABILITY REHABILI-

PROMOTION PROTECTION AND TREATMENT LIMMATION TATION
of
PREVEN- PRIMARY SECONDARY TERTIARY PREVENTION
TION PREVENTION PREVENTION