Disease Control: Concepts, Risk Factors, and Surveillance, Lecture notes of Power Electronics

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NATURAL HISTORY

OF DISEASE

Dr. Sanjeev Gupta MBBS, MD, DA ASSOCIATE PROFESSOR COMMUNITY MEDICINE

• Risk factors

• (^) Single
• (^) Multiple Risk factor.

5

Prominent risk factors

Disease Risk factors

• (^) Heart disease Smoking, high blood pressure, elevated serum cholesterol, diabetes, obesity, lack of exercise, type A personality
• (^) Cancer Smoking, alcohol, solar radiation, ionizing radiation, work-site hazards, environmental pollution, medications, infectious agents, dietary factors
• (^) Stroke High blood pressure, elevated cholesterol, smoking
• (^) Motor vehicle accidents Alcohol, non-use of seat belts, speed, automobile design, roadway design
• (^) Diabetes Obesity, diet
• (^) Cirrhosis of liver Alcohol

Guidelines for defining "at-risk" groups

a. Biological situation:

• (^) - age group, e.g., infants (low birth weight), toddlers, elderly
• (^) - sex, e.g., females in the reproductive age period
• (^) - physiological state, e.g., pregnancy, cholesterol level, high blood pressure
• • genetic factors, e.g. family history of genetic disorders
• • other health conditions (disease, physical functioning, unhealthy behaviour) b. Physical situation:
• (^) - rural, urban slums
• (^) - living conditions, overcrowding
• (^) - environment: water supply, proximity to industrie c. Sociocultural and cultural situation:
• (^) - social class
• (^) - ethnic and cultural group
• (^) - family disruption, education, housing
• (^) - customs, habits and behaviour (e.g., smoking, lack of exercise, over-eating, drug addicts)
• (^) - access to health services
• (^) - lifestyles and attitudes

Spectrum of disease

• (^) Graphic representation of disease
• (^) "gradient of infection“
• (^) sequence of events in the spectrum of disease can be interrupted by early diagnosis and treatment or by
• (^) preventive measures

Ice Berg Phenomenon of Disease

• (^) This concept gives a better idea of progress of disease from its subclinical stages to overt or apparent disease.
• (^) Submerged portion of Ice Berg: Represents the hidden mass of disease ( sub clinical cases, carriers and un diagnosed cases )
• (^) Floating tip: Represents what the physician sees in practice.
• (^) The "waterline" represents the demarcation between apparent and inapparent disease.

• (^) For control of disease only primary and secondary prevention will be more effective as compared to tertiary

Elimination

• (^) Between control and eradication, an intermediate goal has been described, called "regional elimination". term "elimination" is used to describe interruption of transmission of disease, as for example, elimination of measles, polio and diphtheria from large geographic regions or areas. Regional elimination is now seen as an important precursor of eradication.

Monitoring

• (^) "the performance and analysis of routine measurements aimed at detecting changes in the environment or health status of population"
• (^) "the continuous oversight of activities to ensure that they are proceeding according to plan.

Surveillance

• (^) "the continuous scrutiny of the factors that determine the occurrence and distribution of disease and other conditions of ill-health"
• (^) Types- epidemiological surveillance, demographic surveillance, nutritional surveillance Sentinel surveillance-Missing cases