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By
DR. MUMIN
CONCEPT OF DISEASE DEPARTMENT
OF PUBLIC
HEALTH
DENTISTRY
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CONTENTS
INTRODUCTION
CONCEPT OF CAUSATION
EPIDEMOLOGICAL TRIAD
MULTIFACTORIAL CAUSATION
WEB OF CAUSATION
CONCLUSION
REFERENCES
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INTRODUCTION
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DISEASE - WEBSTER’S DEFINITION
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DISEASE - OXFORD DEFINITION
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DISEASE - ECOLOGICAL DEFINITION
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DISEASE - SOCIOLOGICAL DEFINITION
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DISEASE - SIMPLEST DEFINITION
“OPPOSITE OF HEALTH”
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A VAST SPECTRUM OF DISEASE
Carrier state
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DISEASE / ILLNESS /SICKNESS
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CONCEPT OF CAUSATION
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Ancient civilization in the east or the west applied its
rational to understand the concept of disease.
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VARIOUS THEORIES OF DISEASE
CAUSATION
The demonic theory
The punitive theory
Tridosha theory
The theory of humors,
Miasmatic theory of disease
Germ theory of disease
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THE DEMONIC THEORY
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PUNITIVE THEORY
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TRIDOSHA THEORY
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THE THEORY OF HUMORS
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This gave the basis for the UNANI (Greco-Arabian)
system of medicine which gave a great importance
to temperament for the causation of disease which
may be correlated with the most of the metabolic
disorders.
The people, who believed in this, said that the air arising
from certain kinds of ground, especially low, swampy
areas, was a cause of disease.
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GERM THEORY OF DISEASE
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PROBLEMS OF GERM THEORY
Environment
Agent Host
Environment
Time
Agent Host
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Surroundings or conditions external to the human or
animal, that cause or allow the disease transmission
Environment
Time
Agent Host
Agent Host
Factors determining the disease:
• Level of immunity
• Genetic makeup
• Level of exposure
• State of health
• Overall fitness
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• Biological aspects
• Social aspects
• Cultural aspects
• Physical aspects
Environment
Time
Agent Host
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MULTIFACTORIAL CAUSATION
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ADVANCED MODEL OF TRIANGLE OF EPIDEMIOLOGY
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The advanced model of the triangle of epidemiology
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The purpose of knowing the multiple factors of
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WEB OF CAUSATION
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Sometimes removal or elimination of just only one
link or chain may be sufficient to control the disease,
provided that link is sufficiently important in the
pathogenic process.
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NATURAL HISTORY OF DISEASE
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TWO PHASES OF NATURAL HISTORY OF
DISEASE
1. Prepathogenesis phase
2. Pathogenesis phase
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PREPATHOGENESIS PHASE
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"man in the midst of disease" or
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The mere presence of agent, host and favorable
environmental factors in the prepathogenesis period
is not sufficient to start the disease in man. What is
required is an interaction of these three factors to
initiate the disease process in man.
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Environment
Agent Host
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PATHOGENESIS PHASE
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In chronic diseases (e.g., coronary heart disease
hypertension, cancer), the early pathogenesis phase
is less dramatic.
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The pathological changes are essentially below the level
of the "clinical horizon".
Biological agents
Pathogenicity
(viruses, fungi, bacteria, etc.)
Virulence
Proteins, fats,
Nutrient agents carbohydrates, vitamins,
minerals and water
Exogenous
Agents arising outside of human host,
e.g. allergens, metals, fumes, dust, gases,
insecticides, etc.
These may be acquired by inhalation,
ingestion or inoculation
Nutrient factors
Chromosomal factors:
eg, syndromes
Immunological factors
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Agent factors Poverty
Smoking
Abuse of drugs
Unhealthy lifestyles
Social isolation
Maternal deprivation 55
HOST FACTORS (INTRINSIC)
In epidemiological terms
AGENT
HOST
SEED
SOIL
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Demographic Age, sex, ethnicity
characteristics
Host factors
Biochemical levels of blood
Immunological factors
Physiological functions
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Socioeconomic status
Host factors
Education
Occupation
Social and economic
characteristics
Stress
Marital status
housing
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Personality traits
Host factors
Living habits
Nutrition
Lifestyle factors
Physical exercise
Behavioral patterns
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ENVIRONMENTAL FACTORS (EXTRINSIC)
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Environmental factors
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PHYSICAL ENVIRONMENT
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The increasing use of electrical and electronic
devices, including the rapid growth of
telecommunication system (e.g., satellite systems),
radio-broadcasting, television transmitters and radar
installations have increased the possibility of human
exposure to electromagnetic energy.
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PSYCHOSOCIAL ENVIRONMENT
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They include cultural values, customs, habits, beliefs,
attitudes, morals, religion, education, lifestyles,
community life, health services, social and political
organization.
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PSYCHOSOCIAL FACTORS
poverty, urbanization, migration and exposure to stressful
situations
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From a psychosocial point of view, disease may be
viewed as a maladjustment of the human organism
to his psychosocial environment resulting from
misperception, misinterpretation and misbehaviour.
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RISK FACTORS
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The term risk factor is defined as;
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The presence of a risk factor does not imply that the
disease will occur, and in its absence, the disease
will not occur.
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Risk factors
Smoking +
occupational Lung cancer
exposure Smoking +
hypertention
Bladder + high blood
cancer cholesterol
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Smoking
Hypertention
Elevated serum
Modifiable
cholestorol
Risk factors
Physical activity
obesity
Age
Sex
Un-modifiable Race
Family history
Genetic factors 75
SPECTRUM OF DISEASE
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ICEBERG OF DISEASE
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ICEBERG OF DISEASE
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The vast submerged portion of the iceberg represents the
hidden mass of disease, i.e., latent, inapparent.
presymptomatic and undiagnosed cases and carriers in the
community.
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CONCLUSION
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With the advent of growing intellect and latest
technological advancement this concept has greatly
been improved upon but still there is a sea of
diseases and their submerged concepts which needs
to be unveiled so as to find better ways of treatment.
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REFERENCES
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THANK-YOU
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