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Specific learning Objectives
At the end of the lecture students should be able
to
 Define disease.
 Enumerate theories of disease causation
 Understand concept of epidemiological triad,
Multi-factorial causation & web of causation
 Understand concepts of Natural history of
disease, Spectrum of disease & Iceberg
phenomenon
Definition of Disease
 Webster “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.”
 Oxford English Dictionary – the condition of body or
some part of organ of body in which its functions are
disrupted or deranged.
Disease
 Ecological point of view disease is
defined A maladjustment of the human
organism to the environment
 The simplest definition of disease is
 Disease is just the opposite of health
 Any deviation from normal
functioning or state of complete
physical or mental well being
WHO
WHO has defined health but not
disease
Disease literally means
“Without ease” (Uneasiness)
Disease is opposite of ease
Disease: Concepts
• Disease # Illness # Sickness
• Disease: Without ease/ uneasiness
• Illness: It is a subjective feeling of not
being well.
• Sickness: - It is a state of 'social
dysfunction' when person assumes
'sickness role' and unable to perform
social role
6
• Difficulties in defining disease
 Spectrum of disease (in-apparent to sever)
Onset acute or gradual
Carrier state
Single organism may cause many clinical
manifestation
Single disease may cause by many organism
Short duration or Prolong duration
7
Impairment/Disability/Handicap
• Impairment: - It is the loss or abnormality of
physiological, psychological function, anatomical
structure or function
• Disability: - It is the inability to carry-out activities
relevant to age and sex
• Handicap: - It is the disadvantage due to impairment
or disability
8
Loss of type writer job
Loss of right upper limb
Un able to hold an object
9
Loss of Rt. Upper Limb Unable to hold an object Loss of Job
Historical Theories for
causation of disease
 “Supernatural causes”& Karma
 Theory of humors (humor means fluid)
 The miasmatic theory of disease
 Theory of contagion
 Theory spontaneous generation
 Germ theory
 Epidemiological Triad
 Multi-factorial causation
 Web of causation
………Supernatural to multi-factorial causes…
Environment
Agent Host
Epidemiological triad
Agent Factors
Host FactorsEnvironmental
Factors
TIME
Advance model of triangle of
epidemiology
Agent
 The disease agent is
A 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.
 Disease may have a single or a number of
independent agents or a complex of two or more
factors
Agent
 Biological agents- living agent of disease Bacteria,
Viruses, protozoa, fungi, rickettsia
 Nutrient agents- Protein, carbohydrate, vitamins,
minerals and water
Any excess or deficiency of the nutrient elements
may result in nutritional disorders, anemia, goiter,
obesity
 Physical agents –Exposure to excessive heat, cold,
humidity, pressure, radiation, sound
Agents
 Chemical agents- metal fumes, dust,
gases, insecticides
 Mechanical agents – exposure to chronic
friction and other mechanical forces
may result in crushing, tearing, sprains,
dislocations
 Social agents – poverty, smoking, abuse
of drugs, unhealthy life style, social
isolation
Host
 Human host is referred as soil and the
disease agent as seed
 Host factors play a major role in
determining the outcome of an individual's
exposure to infection
 Host factors
 Demographic - age, sex, race
 Biological – genetic factors
 Social and economic factors
 Lifestyle factors
Environmental factors
 All that which is external to the individual
human host, living or nonliving and with
which he is in constant interaction
This include all surrounding such as air,
water, food, housing etc
Physical environment
Biological environment
Psychological environment
Multi-factorial causation
 Pettenkofer of Munich was an early
proponent of this concept (1819-1901)
 Factors like Social, economic, cultural,
genetic & psychological are equally
important.
Web of causation
Model suggested by MacMohan
& Pugh
Suits for NCD
Outcome of interaction of
multiple factors
Web of causationChange in life style Stress
Abundance of food Smoking Emotional Aging &
D Disturbance other factor
Obesity Lack of physical activity Hypertension
Hyperlidemia Increase catacholamine Changes in walls of
arteries
thrombotic activity
Coronory atherosclerosis
Coronary occlusion
Myocardial Infarction
Myocardial Infarction
NATURAL HISTORY OF DISEASE
It is the way in which a disease evolves
over time from the earliest stage of its
pre-pathogenesis phase to its
termination as recovery, disability or
death, in the absence of treatment or
prevention
PRE-PATHOGENESIS PHASE
Period preliminary to the onset of
disease in man
The diseases agent has not yet
entered the man.
The factors which favour its
interaction with the human host are
already existing in the environment.
PATHOGENESIS PHASE
The pathogenesis phase
begins with the entry of the
disease agent in the
susceptible human host.
Natural History of Disease
Disease results from a complex
interaction between
man, agent and the environment
Natural History of Disease
Spectrum of health
 Health and disease lie along a continuum, and
there is no single cut off point
 The lowest point on the health-disease spectrum
is death and the highest point positive health
Positive health
Better health
Freedom from sickness
Unrecognized sickness
Mild sickness
Severe sickness
Death
The Health-Sickness spectrum
HEALTH AND ILLNESS
Spectrum of Disease
 Variation in the manifestations of disease
 Disease spectrum are sub clinical infections
(unidentified) to fatal illnesses
 Illnesses ranging in severity from mild to
severe
Disease in many Forms..
 Acute
 Chronic/insidious
 Carrier
Spectrum of disease
Iceberg of Disease
Iceberg of Disease
 Floating tip of the iceberg represents what the
physician sees in the community-clinical cases
 The vast submerged portion of the iceberg
represents the hidden mass of disease- latent,
inapparent, presymptomatic and undiagnosed
cases and carriers in the community
 Water line represents the demarcation between
apparent and inapparent disease
Subclinical Case: ICEBERG PHENONMENON
 E.gHIV, Polio etc
Thank
You………

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3 concept of disease

  • 1.
  • 2. Specific learning Objectives At the end of the lecture students should be able to  Define disease.  Enumerate theories of disease causation  Understand concept of epidemiological triad, Multi-factorial causation & web of causation  Understand concepts of Natural history of disease, Spectrum of disease & Iceberg phenomenon
  • 3. Definition of Disease  Webster “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.”  Oxford English Dictionary – the condition of body or some part of organ of body in which its functions are disrupted or deranged.
  • 4. Disease  Ecological point of view disease is defined A maladjustment of the human organism to the environment  The simplest definition of disease is  Disease is just the opposite of health  Any deviation from normal functioning or state of complete physical or mental well being
  • 5. WHO WHO has defined health but not disease Disease literally means “Without ease” (Uneasiness) Disease is opposite of ease
  • 6. Disease: Concepts • Disease # Illness # Sickness • Disease: Without ease/ uneasiness • Illness: It is a subjective feeling of not being well. • Sickness: - It is a state of 'social dysfunction' when person assumes 'sickness role' and unable to perform social role 6
  • 7. • Difficulties in defining disease  Spectrum of disease (in-apparent to sever) Onset acute or gradual Carrier state Single organism may cause many clinical manifestation Single disease may cause by many organism Short duration or Prolong duration 7
  • 8. Impairment/Disability/Handicap • Impairment: - It is the loss or abnormality of physiological, psychological function, anatomical structure or function • Disability: - It is the inability to carry-out activities relevant to age and sex • Handicap: - It is the disadvantage due to impairment or disability 8 Loss of type writer job Loss of right upper limb Un able to hold an object
  • 9. 9 Loss of Rt. Upper Limb Unable to hold an object Loss of Job
  • 10. Historical Theories for causation of disease  “Supernatural causes”& Karma  Theory of humors (humor means fluid)  The miasmatic theory of disease  Theory of contagion  Theory spontaneous generation  Germ theory  Epidemiological Triad  Multi-factorial causation  Web of causation ………Supernatural to multi-factorial causes… Environment Agent Host
  • 11. Epidemiological triad Agent Factors Host FactorsEnvironmental Factors TIME
  • 12. Advance model of triangle of epidemiology
  • 13. Agent  The disease agent is A 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.  Disease may have a single or a number of independent agents or a complex of two or more factors
  • 14. Agent  Biological agents- living agent of disease Bacteria, Viruses, protozoa, fungi, rickettsia  Nutrient agents- Protein, carbohydrate, vitamins, minerals and water Any excess or deficiency of the nutrient elements may result in nutritional disorders, anemia, goiter, obesity  Physical agents –Exposure to excessive heat, cold, humidity, pressure, radiation, sound
  • 15. Agents  Chemical agents- metal fumes, dust, gases, insecticides  Mechanical agents – exposure to chronic friction and other mechanical forces may result in crushing, tearing, sprains, dislocations  Social agents – poverty, smoking, abuse of drugs, unhealthy life style, social isolation
  • 16. Host  Human host is referred as soil and the disease agent as seed  Host factors play a major role in determining the outcome of an individual's exposure to infection  Host factors  Demographic - age, sex, race  Biological – genetic factors  Social and economic factors  Lifestyle factors
  • 17. Environmental factors  All that which is external to the individual human host, living or nonliving and with which he is in constant interaction This include all surrounding such as air, water, food, housing etc Physical environment Biological environment Psychological environment
  • 18. Multi-factorial causation  Pettenkofer of Munich was an early proponent of this concept (1819-1901)  Factors like Social, economic, cultural, genetic & psychological are equally important.
  • 19. Web of causation Model suggested by MacMohan & Pugh Suits for NCD Outcome of interaction of multiple factors
  • 20. Web of causationChange in life style Stress Abundance of food Smoking Emotional Aging & D Disturbance other factor Obesity Lack of physical activity Hypertension Hyperlidemia Increase catacholamine Changes in walls of arteries thrombotic activity Coronory atherosclerosis Coronary occlusion Myocardial Infarction Myocardial Infarction
  • 21.
  • 22. NATURAL HISTORY OF DISEASE It is the way in which a disease evolves over time from the earliest stage of its pre-pathogenesis phase to its termination as recovery, disability or death, in the absence of treatment or prevention
  • 23.
  • 24. PRE-PATHOGENESIS PHASE Period preliminary to the onset of disease in man The diseases agent has not yet entered the man. The factors which favour its interaction with the human host are already existing in the environment.
  • 25. PATHOGENESIS PHASE The pathogenesis phase begins with the entry of the disease agent in the susceptible human host.
  • 26. Natural History of Disease Disease results from a complex interaction between man, agent and the environment
  • 28. Spectrum of health  Health and disease lie along a continuum, and there is no single cut off point  The lowest point on the health-disease spectrum is death and the highest point positive health Positive health Better health Freedom from sickness Unrecognized sickness Mild sickness Severe sickness Death
  • 31. Spectrum of Disease  Variation in the manifestations of disease  Disease spectrum are sub clinical infections (unidentified) to fatal illnesses  Illnesses ranging in severity from mild to severe
  • 32. Disease in many Forms..  Acute  Chronic/insidious  Carrier Spectrum of disease
  • 34. Iceberg of Disease  Floating tip of the iceberg represents what the physician sees in the community-clinical cases  The vast submerged portion of the iceberg represents the hidden mass of disease- latent, inapparent, presymptomatic and undiagnosed cases and carriers in the community  Water line represents the demarcation between apparent and inapparent disease
  • 35. Subclinical Case: ICEBERG PHENONMENON  E.gHIV, Polio etc