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Multicausation disease model

22/12/2020 Client: saad24vbs Deadline: 7 Days

Chapter 4


Epidemiology:


Prevention and Control


of Diseases and Health


Conditions


Introduction


• Diseases and other health conditions are classified


in several meaningful ways


• Classification can lead to prevention and control


strategies


Classification of Diseases and Health


Problems • In community health, diseases are usually


classified as:


• Acute or chronic (<3 or >3 months)


• Communicable or noncommunicable


Communicable versus


Noncommunicable Diseases


• Communicable (infectious) diseases – those diseases


for which biological agents or their products are the


cause and that are transmissible from one individual


to another


• Noncommunicable (noninfectious) diseases – those


illnesses that cannot be transmitted from one person


to another


• Identifying cause is difficult because many factors can


contribute


Acute versus Chronic Diseases and


Illnesses • Diseases classified by duration of symptoms


• Acute – diseases in which peak severity of


symptoms occurs and subsides within 3


months


• Can be communicable or noncommunicable


• Chronic – diseases or conditions in which


symptoms continue longer than 3 months


• Can be communicable or noncommunicable


Communicable Diseases


• Infectivity: ability of a biological agent to


enter and grow in the host


• Agent: cause of disease or health problem


• Host: susceptible person or organism invaded


by an infectious agent


• Environment: factors that inhibit or promote


disease transmission


• Pathogenicity: capability of a communicable


agent to cause disease in a susceptible host


Biological Agents of Disease


Communicable Disease Model


Chain of Infection


• Step-by-step model to conceptualize the


transmission of a communicable disease from


its source to a susceptible host


Chain of Infection


• Pathogen: disease causing agent (virus, bacterium,


etc.)


• Reservoir: favorable environment for infectious


agent to live and grow (human, animal, etc.)


• Portal of exit: path by which agent leaves host


Transmission: how pathogens are passed from


reservoir to next host


• Portal of entry: where agent enters susceptible host


New host: susceptible to new infection being


established


Chain of Infection


• Zoonoses – diseases for which the


reservoir resides in animal populations


• Anthroponoses – diseases for which


humans are the only known reservoir


Modes of Transmission


• Direct transmission – immediate transfer of


disease agent between infected and susceptible


individuals


• Touching, biting, kissing, sexual intercourse


• Indirect transmission – transmission involving


an intermediate step


• Airborne, vehicleborne, vectorborne, biological


• Vehicles – nonliving objects by which agents


are transferred to susceptible host


Chain of Infection Example


• Agent (cold virus), leaves reservoir (throat of infected


person), when host sneezes (portal of exit-nose and


mouth). Direct transmission (saliva droplets) enter


respiratory tract of susceptible host at close range


(portal of entry-mouth). New infection possibly


established. If one link is missing, chain is broken.


Noncommunicable Diseases


• Nation’s leading causes of death


• Heart disease, stroke, cancer


• Complex etiologies (causes)


• Multicausation disease model


• Host: inalterable, unique genetic endowment


• Personality, beliefs, behavioral choices: impact


host


• Complex environment: exposes host to risk


factors


Multicausation Disease Model


Noncommunicable Disease Problems


• Diseases of the heart and blood vessels


• Coronary heart disease


• Cerebrovascular disease (stroke)


• Malignant neoplasms (cancer)


• Chronic obstructive pulmonary disease


• Diabetes mellitus


• Chronic liver disease and cirrhosis


Prioritizing Prevention and Control


Efforts • Criteria used to judge importance of disease to


a community


• Number of people who will die from a disease


• Leading causes of death


• Number of years of potential life lost


• Captures issues affiliated with various groups


• Economic costs associated with disease


• Money spent at various levels of government;


ex: alcohol and other drugs


Prevention, Intervention, Control, and


Eradication of Diseases • Prevention: planning for and taking action to


prevent or forestall onset of disease or health


problem


• Intervention: effort to control disease in


progress; taking action during an event


• Control - Containment of a disease;


prevention and intervention measures


• Eradication: total elimination of disease from


human population


Levels of Prevention


• Primary prevention


• Forestall onset of illness or injury during


prepathogenesis period


• Secondary prevention


• Early diagnosis and prompt treatment before


disease becomes advanced and disability severe


• Tertiary prevention


• Aimed at rehabilitation following significant


pathogenesis; retrain, reeducate, rehabilitate


Primary Prevention of


Communicable Diseases


• Strategies at each link in chain of infection


• Individuals


• Hand washing, using condoms, properly


cooking food


• Communities


• Chlorinating water supply, inspecting


restaurants, immunization programs for all


citizens, vector control, solid waste disposal


• Individuals


• Self-diagnosis, self-treatment w/home remedies


• Antibiotics prescribed by a physician


• Communities


• Controlling or limiting extent of an epidemic


• Carefully maintaining records; investigating


cases


• Isolation, quarantine, disinfection


Secondary Prevention of


Communicable Diseases


• Individuals


• Recovery to full health after infection; return to


normal activity


• Communities


• Preventing recurrence of epidemics


• Removal, embalming, burial of dead


• Reapplication of primary and secondary


measures


Tertiary Prevention of


Communicable Diseases


Primary Prevention of


Noncommunicable Diseases • Individuals


• Education and knowledge about health and


disease prevention, eating properly, adequate


exercise, driving safely


• Communities


• Adequate food and energy supplies, efficient


community services, opportunities for


education, employment, and housing


Secondary Prevention of


Noncommunicable Diseases • Individuals


• Personal screenings (mammogram, pap test,


PSA test), regular medical and dental checkups,


pursuit of diagnosis and prompt treatment


• Communities


• Provision of mass screenings for chronic


diseases, case-finding measures, provision of


adequate health personnel, equipment, and


facilities


Tertiary Prevention of


Noncommunicable Diseases • Individuals


• Significant behavioral or lifestyle changes,


adherence to prescribed medications, following


rehabilitation requirements after surgery


• Communities


• Adequate emergency medical personnel and


services: hospitals, surgeons, nurses,


ambulance services


Discussion Questions


• Which components of the Multicausation


Disease Model can communities most


effectively impact?


• Which level of prevention is most important


for better community health outcomes and


why?


• Who plays a more significant role in


preventing diseases, individuals or


communities?


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