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Person, Place, Time and Population Perspective

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Эпидемиология: фундаментальная наука о здоровье населения

Университет Северной Каролины в Чапел-Хилл

4.6 (оценок: 1,516) | Зарегистрировано учащихся: 100K

Often called “the cornerstone” of public health, epidemiology is the study of the distribution and determinants of diseases, health conditions, or events among populations and the application of that study to control health problems. By applying the concepts learned in this course to current public health problems and issues, students will understand the practice of epidemiology as it relates to real life and makes for a better appreciation of public health programs and policies. This course explores public health issues like cardiovascular and infectious diseases – both locally and globally – through the lens of epidemiology.

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4.6 (оценок: 1,516)

5 stars
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MM

Oct 13, 2016

The course was fantastic and learned the things which I could not study from many books I had referred. I have spread this message to many of my friends and colleges. Thank you very much.

ST

Jul 28, 2019

very interesting and informative .thank you so much for providing this opportunity. useful those who are willing to enter into public health and learn the basic concepts of epidemiology

Из урока

Course Introduction, History of Epidemiology and Epidemiology Research

This module introduces the history and field of epidemiology.

Examples of Research Areas Using Epidemiology5:56

Definitions5:53

Person, Place, Time and Population Perspective13:01

Преподаватели

Dr. Karin Yeatts
Clinical Associate Professor
Dr. Lorraine Alexander
Clinical Associate Professor, Director of Distance Learning (North Carolina Institute for Public Health)

Текст видео

[SOUND]

[MUSIC]

In this lecture, we'll discuss person, place, time,

and the population perspective of epidemiology.

After you've reviewed this lecture, you should

be able to complete these learning objectives.

Define descriptive and analytic epidemiology and give examples of each.

Characterize two perspectives on

disease in populations, the biomedical perspective and

the population perspective. And apply the population

perspective to an understanding of the global burden of disease.

Descriptive epidemiology refers to characteristics of persons such as age,

sex, race, and socioeconomic status. Characteristics of place

such as country, province, state, city, zip code, or census track.

And characteristics of time such as long term

trends short term variations by week or day.

When we ask what is the distribution or pattern of a disease

or health outcome in the population we are talking about descriptive epidemiology.

Descriptive

Epidemiology deals with the frequency and the

distribution of disease or risk factors in populations.

Descriptive Epidemiology can be used for hypothesis generation, but

Descriptive Epidemiology usually cannot be used to test hypothesis.

This graph shows lung bronchus cancer risk by amount of smoking per day.

This is an example

of looking at a distribution of disease by person.

Personal characteristics include age category and smoking history.

This map shows the estimated tuberculosis incidence rates in 2010 by country.

This graph is an example of examining the distribution of disease by place.

This graph is an example of examining the

distribution of disease by time. It shows trends in obesity among

children and adolescents in the US from 1963 to 2008.

Descriptive epidemiology can be used to evaluate

trends in disease, health, and risk factors

such as smoking or determine if a health status is improving or getting worse.

To determine if new diseases are occurring, and provide

a factual basis for evaluating public health programs and services.

To determine if existing programs are effective,

or if new programs should be developed.

Descriptive epidemiology can also be used to

identify problems to be studied by analytic epidemiology.

Analytic epidemiology

aims to research and study risk factors and preventive factors for diseases.

When we ask the question, what are the underlying causes of this pattern

of disease or health outcome and investigate

the causes we are using Analytic Epidemiology.

Use of a comparison group is a key feature of Analytic Epidemiology.

It focuses on the search

for causes and effects, or the why and the how, of what causes a health outcome.

For example, a study on the causes of obesity

would examine dietary differences among two or more comparison groups.

Let's now briefly discuss two different perspectives on disease and health.

The biomedical perspective and the population perspective.

The biomedical

perspective focuses on biological factors, such as

specific agents that cause disease and their mechanisms.

The biomedical perspective focuses on

individual risk factors for health outcomes.

The biomedical perspective does not include social and environmental factors.

Researchers and clinicians observed and or measure

the events that occur sequentially in someone's

body when they come into contact with a disease agent or exposure.

These observations and measurements help us to understand biological

mechanisms of disease development, and the transmission of disease.

This example shows the mechanism for

transmission of the malaria parasite to humans.

Information about the environment in which a human is exposed to malaria parasites

is not included in this perspective.

Biological parameters for example blood pressure,

body temperature, lung function, heart rate and

laboratory data from blood or tissue samples

are the focus of the biomedical perspective.

Now, let's look at the population perspective.

The population perspective focuses on social, psychological, and

environmental factors that are associated with health outcomes.

The occurrence of health outcomes, or disease in populations, is

impacted by immediate causal agents as well as other factors.

For example, the housing conditions in

which people live can influence their health.

How can

researchers determine which specific factors affect the health of a population?

One way is to examine things from a population perspective.

With the population perspective we look at both

proximal, or downstream, and distal or upstream factors.

Downstream health factors are micro level

factors and include physiological and biological

factors such as, genetic makeup, age, ethnicity, gender and immune status.

Downstream determinants typically are related to illness and disease.

Risk factors that cannot be changed can be used to identify

groups of people at increased risk and to develop targeted interventions.

Upstream health factors are macro level factors.

Such as global forces and government policies.

Upstream public health approaches try to prevent health problems at the

source, so they don't need to be fixed down the stream.

Factors such as community design, education,

employment, living and working conditions and

poverty are major determinants of health that may be addressed upstream.

We can also look at the underlying causes of disease or health outcomes in

populations. For example, underlying environmental,

economic, social, and cultural factors. Such

underlying factors for example, may affect how viruses mutate

over time and adapt to their environment.

When we talk about the population perspective we are referring to a

web of causation where many factors may play a role in disease development.

Factors including family support, social networks, global climate,

labor conditions, tobacco production or even advertising.

Each and everyone of these may all play a

part and should be considered when deciding public health interventions.

A population health perspective can also focus on

health disparities, especially health

disparities related to socioeconomic status.

All epidemiologic research involves some sort of population.

Every population has its own history, culture,

and economic and social context.

Which influences how and why people are exposed to risk factors.

And how people are affected by their exposures.

Population research begins by considering the distribution and

determinants of health outcomes at a population level.

Though population research may also

include individual and micro level analysis.

And understanding of the

historical and social context of health outcomes is important in

order to conduct effective research and to design effective interventions.

So, how do health problems develop?

Health problems can develop in many different ways.

For example, infections may enter the body from the outside, such as

viruses that cause the common cold, or bacteria that cause strep throat.

People may be exposed to toxic chemicals such

as lead or arsenic through their environment or job.

An individual's genetic may lead to improper growth function, and/or

maintenance of their body systems, for example, type one diabetes.

In addition, behaviors or acquired risk factors such

as smoking, alcohol abuse, inadequate exercise, psychological stress, and

poor diet may all contribute to health problems.

Other health problems can develop from the result of accidents such

as head trauma caused during a car accident or a fall.

And social factors such as poverty and

lack of education can expose populations to

risks such as unsafe drinking water or

prevent people from obtaining adequate medical care.

Lung cancer is an example

of a disease that is well understood.

Most cases of lung cancer can be attributed to cigarette smoking.

The biomedical mechanism of lung cancer took cigarette smoking is understood.

It's well known that carcinogens in tobacco smoke cause disease.

But the addictive properties of nicotine make it difficult to quit smoking.

However, there is a social

context to the disease.

Since culture and social factors can

influence who smokes and who doesn't smoke.

We'll now talk about the social factors

involved in lung cancer attributable to cigarette smoking.

In the past, smoking was seen as a status

symbol, and a sign of leisure or stress reduction.

This was enforced in media by showing

movie stars smoking in a way that promoted leisure and stress reduction.

In addition, smoking was ubiquitous in the workplace until the 1980's.

For example, some professors smoked while lecturing

and doctors even smoked in exam rooms.

There's also the example of a cigarette company in the

early 1900's, who changed their packaging and marketing of women's cigarettes

to match the color of the year. To try to entice more women to smoke.

This was done because smoking was initially seen as a masculine pastime.

The women's suffrage movement and the rise of feminism led to more women smoking

and more exposure on the job as more women smoked outside of the home.

These vintage ads for cigarettes and smoking portray

the social context of smoking.

It seemed like everyone, everywhere was smoking.

Now we will discuss a different disease example, diabetes.

The cause of diabetes may have genetic, physiological,

psychological, familial, social, economic, cultural, and political aspects.

For example, events that occur during

fetal development and also maternal factors, may

influence whether someone gets diabetes later in life.

Genetic factors play a role.

Social factors, such as nutritional change to eating higher calorie foods,

and higher fat foods, urbanization, immigration and

cultural perceptions of what it means to be overweight or obese may have an effect.

Economic factors such as changes in the cost and/or availability of food

in certain areas may also play a role in the development of diabetes.

To summarize what we have learned about the population perspective,

we'll now compare it to the mission of public health.

The population perspective focuses on describing patterns, identifying

underlying causes of health problems, and developing interventions

at the population level.

In contrast, the mission of public health is

to provide conditions that promote health, develop interventions

or programs at the community level and to

make sure laws and mass media promote health.

This concludes our lecture on the population perspective of epidemiology.

[MUSIC]

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