Professional Documents
Culture Documents
Nigel Paneth
--------------------------------------
5. DYSFUNCTION
6. DISCOMFORT
Human health states perhaps indicative of a biological effect, but which do not, in themselves, constitute public health entities
5. DYSFUNCTION - Poor or subnormal performance on a test of some single or complex biological function.
6. DISCOMFORT Uncomfortable symptoms such as dizziness, nausea, fatigue, but short of a specific disease.
DISEASE A cluster of signs, symptoms and laboratory findings linked by a common patho-physiologic sequence. Most epidemiology is about disease. ILLNESS The subjective state of the individual who feels aware of not being well. The ill individual may or may not be suffering from disease.
SPECTRUM OF DISEASE
The point at which disease comes to medical attention may be anywhere along a SPECTRUM. Characteristically, population-based studies see a BROADER SPECTRUM OF DISEASE than do studies based on cases diagnosed in medical settings. This is important when we consider sampling next.
SPECTRUM OF DISEASE
1. EXPOSURE
2. SUBCLINICAL PATHOLOGIC CHANGES (in apparent infection especially important) 3. FIRST SYMPTOMS OR SIGNS/MILD DISEASE (usually diagnosed in outpatient setting)
4. MORE SEVERE DISEASE (may first be diagnosed in in-patient setting) 5. DEATH OR RECOVERY
MANIFESTATIONAL
(or CLINICAL)
ETIOLOGICAL
Presumed cause
Manifestation classifications are often more useful for treatment and management. Etiologic classifications are more useful for prevention.
EXAMPLE
Arthritis
HANDICAP Inability to perform Cannot work as (participation a social role a seamstress restriction)
Because epidemiology is interested in CASES OF DISEASE, it does not (usually) study the epidemiology of :
symptom inventories abnormal laboratory tests health behaviors medical care
Major exceptions: where the test or behavior is closely linked to the disease, or a major risk factor for disease.
Example 1 - SEROEPIDEMIOLOGY - the study of the prevalence of antibodies to a specific infectious agent.
How is disease defined for such normally distributed measures? Because epidemiology is interested in cases of illness, it is generally more interested in TAILS OF THE DISTRIBUTION than in the entire distribution. Disease states are linked to the tails of the distribution of some normally distributed phenomena.