Prof.DR.Dr.Soeharyo Hadisaputro, Sp.PD.

K-PTI, FINASIM, FISCM, FISPH

dr. Hari Peni Julianti, Mkes, SpKFR, FISCM, FISPH
 FINAL DEVELOPMENT OF
EPIDEMIOLOGY DEFINITION

Originally, epidemiology was concerned with

epidemics of communicable diseases.
More recently, epidemiologic methods have
been applied to chronic diseases, injuries,
violence, birth defects, maternal-child
health, occupational health, environmental
health, disaster, family planning, etc.
 FINAL DEVELOPMENT OF
EPIDEMIOLOGY DEFINITION
•Greek words : epi (upon) and Demos
(people); logos = science.
• Last (1988) :
Includes of the application of this
study to the control of health problems.
Epidemiolgy is often referred to as the
basic science of public health.
 Theories of Disease
Causation
• Supernatural Theories
• Hippocratic Theory
• Miasma
• Theory of Contagion
• Germ Theory (cause shown via Henle-Koch
postulates)
• Classic Epidemiologic Theory
• Multicausality and Webs of Causation (cause
shown via Hill’s postulates)
 SENIOR EPIDEMIOLOGIST
•
IN THE WORLD
• (1) ANTONIO V.LEUWENHOEK (1632)
• (2) ROBERT KOCH (1882)
• (3) MAX VAN PATTERNKOFER
• (4) JOHN SNOW (1854)
• (5) PERVICAL POTT
• (6) JAMES LIND (1747)
• (7) DOLL and HILL
Dr. John Snow (1813-1858)
 PUBLIC HEALTH (Winslow, 1920)
Public Health is the science and art of (1)
preventing disease, (2) prolonging of life, and (3)
promoting of health and efficiency through
organized community effort for (a) the sanitation of
the environment (b) the control of communicable
infections © the education of the individual in
personal hygiene (d) the organization of medical
and nursing service for the early diagnosis and
preventive treatment of disease (e) the development
of the social of living adequate for the maintenance
of health, so organizing these benefits and enable
every citizen to realize his birthright of health and
longevity.
 PERAN EPIDEMIOLOGI DALAM
PELAYANAN KESEHATAN

•1) Pencegahan & Pengendalian peny. (Metoda

mencari sebab)
• 2) Mendiagnosis & mengukur kebutuhan yad.
• 3) Perubahan perawatan
• 4) Merencanakan kegiatan
• 5) Menganalisis status demografi, statistik rutin
(morbiditas & mortalitas)
• 6) Menentukan kecenderungan epidemiologik
(surveilens, LAM dll)
THE RELATION BETWEEN EPIDEMIOLOGY
AND CLINICAL MEDICINE

POPULATION INDIVIDUALS
---------------------- ----------------
Studies/Assesment Diagnosis

Prevention Treatment

Evaluation Curing

Planning Caring
 •
PERKEMBANGAN DEFINISI EPIDEMIOLOGI

MAC MAHON (1970) :

Epidemiologi adalah studi tentang
penyebaran dan penyebab frekuensi
penyakit pada manusia dan menga
pa terjadi distribusi semacam itu.
R.MORTON, JR.HEBEL :
Epidemiology is the study of the
distribution and determinant of
diseases. We try to find out who gets
the disease and why.
 •
PERKEMBANGAN DEFINISI EPIDEMIOLOGI
ELIZABETH BARRETT
Epidemiology is study of the
distribution and causes of diseases.

JS.MAUSNER, A.K.BAHN :
Epidemiology is concerned with the
extend and type of illness and injures
in groups of people and with the
factors which influence their
distribution.
 •
PERKEMBANGAN DEFINISI EPIDEMIOLOGI

LAST (1988)
Epidemiology is study of the
distribution and determinants
of health-related states or
events is specified populations
and the application of this
study to control of problems.
 FINAL DEVELOPMENT OF
EPIDEMIOLOGY DEFINITION

The application of epidemiology to

study behaviors related to health and
well being is known as behavioral
epidemiology.
The applicationn of population based
information to decision making about
individual patients is often reffered to
as clinical epidemiology.
 AREA OF CLINICAL
EPIDEMIOLOGY
• DIAGNOSIS :
(*) Clinical diagnosis strategies
(*) The clinical selection
(*) The selection of diagnostic test
(*) The interprataion of diagnostic data
(*) Early diagnosis.

• MANAGEMENT :
(*) Making prognosis
(*) Deciding on the best therapy
(*) Deciding wether your treatment has done
harm.
 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
 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
 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
 KEY CONCEPTS
Epidemiologic methods can be used to assess the
performance of diagnostic test.

Epidemiology can be used to study the

progression or natural history of diseases.

Epidemiology methods can be used to study

prognostic factors, which are determinants of the
progression of a disease.

Epidemiology can be used to evaluate treatment

for a disease.
 KEY CONCEPTS

Epidemiology is the study of the distribution and

determinants of diseases within human
populations.

Epidemiology can be used for descriptive

purposes, such as surveillance of the occurrence
(incidence) of a particular illness.

Epidemiology can be used for analytic purposes,

such as studying risk factors for disease
development.
 PREMORDIAL PREVENTION

• Tingkat yg paling baru dikenal akibat hasil

peningkatan pengetahuan epidemiologi PKV;

• Penyebab yang mendasar adalah diet yg

mengandung lemak jenuh hewan;

• Kondisi yang mengarah ke penyebab;

• Tujuan : menghindari kemunculan berbagai

bidang yang diketahui mempunyai konstribusi utk
meningkatkan risiko penyakit.
 PRIMARY PREVENTION
(1) Health Promotion :
meningkatkan derajat kesehatan
Individu & masy. secara optimal;
mengurangi peran penyebab /
faktor risiko dan optimalisasi
upaya masalah lingkungan
(2) Specific Protection :
Ditujukan pada host & penyebab
 daya tahan meningkat.
SECONDARY PREVENTION
SASARAN PENC.SEKUNDER : penderita
atau human risk
(a)Chemoprophylaxis : utamanya
mereka dlm proses prepatogenesis
/patogenesis
(b)Pencarian pdrt secara dini :
pemeriksaan berkala calon
kelompok tertentu dan penapisan
(screening) penyakit.
TERTIARY PREVENTION
Tujuan Utama :
(1)Mencegah kecacatan,
kematian.
(2)Mencegah proses penyakit
lanjutan : pengobatan dan
perawatan penderita.
(3)Rehabilitasi : pemulihan
kembali secara fisik, sosial
dan psikologis.