SOME BASIC COMPONENTS IN

EPIDEMIOLOGY
 Learning Objectives
• At the end of the module:
• 1. discuss the importance of studying the causes of disease or health-
related conditions
• 2. explain and differentiate
2.1 causal association from statistical association
2.2 necessary cause from sufficient cause
• 3.Explain and discuss the following
• 3.1 models that explain the biologic aspect of disease causation
• 3.2 statistical aspect of determining disease causation
• 4. discuss the natural history of disease and its importance in prevention
and control
• 5. describe how diseases and disabilities are classified
 The Importance of Studying the
Causes of Disease
• In Epidemiology , the establishment of disease condition is
the ultimate goal such that once cause is established,
prevention and control strategies may be formulated and
directed towards the “cause”. Definition of cause -
something that brings about an effect or a result ( Webster)
• Definition of Cause of disease –an event, condition or
characteristic that plays an essential role in producing an
occurrence of the disease (Rothman)
• As a consequence, good health will be maintained for those
who are not yet affected, prevention of disease among
those who are at risk and management of the disease
process among those who are already ill.
 TYPES OF ASSOCIATION
• A. not statistically associated (independent)
• B. Statistically associated
1. Noncausally (secondarily associated)
2. Causally associated
a. Indirectly associated
b. Directly causal
 Statistical Association
• Definition of Statistical Association – statistical dependence
between two variables, i.e., the degree to which the
disease rate in the exposed group is either higher or lower
than the rate in the unexposed group
• If one category of event occurs in a certain proportion, x, of
a group of persons and another proportion , y, the two
types of events will occur together among some members
of the group – in a proportion, in fact , equal to the product
of the separate proportions, xy.
• Statistical association means that the proportion of persons
exhibiting both events is either significantly higher or
significantly lower than the proportion predicted on the
basis of simultaneous consideration of the separate
frequencies of the two categories of events.
 Statistical Association
• Statistical associations are determined for
categories and not for individual instances.
• Example: 100 persons vaccinated vs. 100 persons
received placebo and not vaccinated against a
particular disease (measles).
• An epidemic occurred: 20 of the vaccinated
persons and 50 of the unvaccinated contract the
disease.
• Question: Is the difference due to chance? If you
are not sure then do a test of hypothesis.
 Statistical Association
• If the difference is statistically significant then
it is unlikely due to chance then we would say
that a statistical association exists between
vaccination and remaining free of the disease.
• QUESTION: Is it possible to say that
vaccination caused any individual person in
the vaccinated group to remain disease –
free?
 Statistical Association
• However, we cannot deny that information
from a group experience may suggest the
likelihood of causal association in an individual
instance.
• The stronger the association between the two
categories of events revealed by the group
experience, the more likely is the assumption
of causal association in a specific instance to
be correct.
 Statistical Association
• Thus, if the disease frequency in the
unvaccinated series had been 99 percent and
that in the vaccinated series 1 percent, there
would be a very high probability that the
absence of disease in any one vaccinated
individual was related to the vaccination, and
the statement that the vaccination of any one
individual was causally related to his freedom
from disease would probably be correct.
 Statistical Association
• The validity of the previous statement would
depend however, on the TOTAL experience
and not any observation made on this one
individual (other than that he was one of
those who were vaccinated and remained free
of the disease).
CAUSAL vs. NONCAUSAL ASSOCIATION
• Definition of Causal Association (of exposure and disease) –
is one in which a change in the frequency and quality of an
exposure or characteristic results in a corresponding
change in the frequency of the disease or outcome of
interest.
• Causally associated – requires that change in one party to
the association alters the other.
• The large number of statistical associations which do not
satisfy this requirement are sometimes referred to as
(Noncausally) secondary associations.
• Noncausal statistical associations usually result from
association of both categories of events with a third
category.
 NONCAUSAL STATISTICAL
ASSOCIATION- Example
• If Category A is causally associated with both
Category B and Category C ( i.e. A precedes
and influences B and C), B and C will also be
associated statistically.
• However, the association between B and C is
noncausal, since there is no prospect of
altering C by manipulating B or altering B by
manipulating C.
 NONCAUSAL STATISTICAL
ASSOCIATION- More Specific Example
• Injection of Neoarsphenamine (B) in
outpatient clinics for venereal disease has
been noted to be associated with jaundice-
salvarsan icterus (C). For a long time the drug
was regarded as the cause of the icterus, until
it was discovered that the association was the
result of causal association of both icterus and
injection of neoarsphenamine with a third
factor- treatment for syphilis (A).
 Neoarsphenamine
A
Treatment of syphilis
C
Icterus
B
C precedes both A & B and since an alteration in C will produce
alterations in both A & B; factors A & B will also show statistical
association with factor C. However, variations in A will never lead to
resulting variations in B and vice –versa. Hence, the statistical
association you find between factors A & B which is statistically
significant) will only be secondary to the association of both A & B
to C. There is no way for icterus to affect neoarsphenamine or vice-
versa. Hence, the two are secondarily associated through their
individual associations with treatment for syphilis.
 CAUSAL ASSOCIATIONS :In the absence of
experimental data, three types of
consideration are useful in distinguishing
between epidemiologic associations that are
causal and those that are secondary:
1. Time sequence. For a relationship to be
considered causal, the events that are
considered causative must precede those
thought to be effects. When the sequence of
events cannot be determined precisely (a
frequent situation in chronic disease), at least
the possibility of such a sequence must exist.
2. Strength of the association. The stronger the
association between two categories of events (for
example, the higher the ratio of the incidence of
B following A to the incidence of B without A),
the more likely it is that the association is causal.
If the suspected cause is a quantitative variable,
the existence of a dose-response relationship –
that is, an association in which the frequency of
the effect increases as the exposure to the cause
increases – is usually considered to favor a causal
relationship, although even in a causal
relationship, such an association may not exist
over the entire range of exposures to the cause.
3. Consonance with existing knowledge. Here
several considerations come into play:
a. A causal hypothesis based on epidemiologic
evidence is supported by knowledge of a
cellular or subcellular mechanism that
makes it reasonable in the light of existing
knowledge in relevant sciences. In the
absence of this support, there should at
least be the belief that such mechanisms
are possible.
b. Evidence that the distribution of the disease
in populations follows the distribution of the
supposed causal factor supports a causal
hypothesis. Major discrepancies between the
two patterns, not reconcilable in terms of
other causal factors or explanations, tend to
weaken a causal hypothesis.
c. Evidence obtained through exclusion may be
pertinent. The more extensive the efforts
have been to identify non-causal explanations
of an association, the more one is likely to
believe, if these efforts have been
unsuccessful, that the association is causal.
 DIRECT & INDIRECT CAUSAL
ASSOCIATION
• Causal Associations may be direct and
indirect:
• Direct Causal Association – no third variable
occupying an intermediate stage between
cause and effect.
• Indirect Causal Association- a third variable
occupies an intermediate stage between
cause and effect.
 Indirect Causal Association
• If A is causally related to D (A being the cause and D the
effect) and D is causally related to B (D the cause and B the
effect ), there will be a causal relationship between A & B,
but the association is indirect.
• Example: Treatment for syphilis is not for itself productive
of icterus, but it is one of the factors associated with the
use of unclean syringes. Further inves. of salvarsan icterus
indicated that the unclean syringe component rather than
the treatment of the syphilis was responsible for the
icterus.
• However, since a certain number of cases of icterus would
presumably be prevented by failure to treat syphilis, the
association of syphilis treatment with icterus is a causal one
, even though indirectly so.
Difference Between Direct and Indirect
Causal Association
• The distinction between direct and indirect causal associations is a
relative one.
• Apparent directness depends on the limitation of current
knowledge.
• Example: The association of icterus with syphilis treatment was
indirect, and that with the use of unclean syringes direct.Further
inves. however revealed that the icterus was associated not with
unclean syringes per se, but with injection of minute amounts of
human serum that remained in unclean syringes after their
previous use. This discovery resulted in a change of the name of the
condition from Salvarsan Icterus to Serum Hepatitis. Still later, the
icterus was found to be associated directly , not with serum, but
with the presence in the serum of a specific virus.
• Thus the association with the virus is currently considered the
direct one and that with serum indirect.
 Significance of Causal Associations in the
Development of Preventive Programs
• The practical significance of causal associations in the
development of preventive programs does not
necessarily depend on the degree of directness.
• First, more direct associations may not yet have been
identified and so there may be no choice but to make
use of obviously indirect associations in preventive
programs. Ex. Knowledge of the association of freedom
from scurvy with diets containing fresh fruit and
vegetables was put to practical use hundreds of years
before the identif. of Vit. C, and prevention of small
pox antedates modern virology by almost 200 years.
 Significance of Causal Associations in the
Development of Preventive Programs
• More recently, regarding HIV/AIDS epidemiologists were
already aware of what type of behavior would lead to the
disease without actually knowing the direct cause of the
disease which is the virus. Based on this knowledge , they
were able to issue warnings regarding these unsafe
behaviors.
• Second, more direct causes, although known , may not be
susceptible to economical alteration, whereas the indirect
ones maybe. Ex. Preventive measures against serum
hepatitis are directed against poor syringe hygiene and not
specifically toward removal of the hepatitis virus. Same
with preventive measures against enteric disease.More
directed toward the provision of clean water and food,
rather than against specific microorganisms.
 Necessary and Sufficient Cause
Study the three circles in the next
three slides:
Question: What sector or component
as denoted by a letter, is common to
all three circles?
Sufficient Cause
I

E A

D B

C
Sufficient Cause
II

H A

G B

F
Sufficient Cause
III

J A

I C

F
 Necessary and Sufficient Cause
• Answer to the Question what sector or component , as
denoted by a letter, is common to all three circles? This is
Sector A.
• In the above three diagrams, A may therefore be
considered as a necessary cause since if one removes A ,
none of the circles or group of factors would be complete
and would now be unable to cause the disease.
• What is interesting about the 3 diagrams is that you don’t
have to know all of the sectors or the contributing
factors.By just eliminating one sector from the circle ( a
sector already known to you) you will successfully eliminate
those group of factors as a sufficient cause. For example
removing D from the first circle, will render that group of
factors inutile in causing the disease.
 Necessary and Sufficient Cause
• Necessary Cause of disease – a cause that must
be present for the disease to occur i.e. , all
cases are exposed to it.
• Sufficient Cause of disease – a cause that
inevitably results in disease, i.e., all exposed
inevitably becomes cases
• For communicable diseases, the necessary
cause is the organism causing the disease.
Sufficient causes may involve an array of factors
which contribute to the condition like like
nutrition, compromised immune system, etc.
 Concept of Sufficient Cause and
Component Cause
• Sufficient Cause – a set of minimal conditions and
events that inevitably produce disease; “minimal”
implies that none of the conditions and events is
superfluous. In disease etiology, completion of a
sufficient cause may be considered equivalent to the
onset of disease.
• Example: Smoking is not a sufficient cause of lung
cancer. Not everyone who are smokers, even heavy
smokers, will develop the disease but only those who
are “ susceptible” to the effects of smoking. In other
words there are other components of the causal
constellation that act together with smoking to
produce lung cancer.
 Concept of Strength of Causes
• The apparent strength of a cause is determined by the
relative prevalence of component causes. A rare factor
becomes a strong cause if its complementary causes
are common. The strength of a cause has little biologic
significance in that the same causal mechanism is
compatible with any of the component causes being
strong or weak.
• The identity of the constituent components of the
cause is the biology of causation; the strength of a
cause is a relative phenomenon that depends on the
time-and place-specific distribution of component
causes in a population.
Concept of Interaction Among Causes
• Two component causes in a single sufficient
cause are considered to have a mutual
biologic interaction. The degree of observable
interaction depends on the actual
mechanisms responsible for the disease. The
extent of biologic interaction between two
factors is a principle dependent on the relative
prevalence of other factors.
Proportion of Disease due to a Specific
Cause

• The total of the proportion of

disease attributable to various
causes is not 100% but INFINITY.
 GENERAL MODELS OF DISEASE
CAUSATON
• The General Models of Disease Causation
include :
1. The Wheel
2. The Epidemiologic Triangle
3. The Epidemiologic Lever
4. Web of Causation
The EPIDEMIOLOGIC LEVER
 The EPIDEMIOLOGIC LEVER
• This concept maintains that there can be no single
cause of disease. The occurrence of disease follows
certain biologic laws which apply to both
communicable and non-communicable diseases. These
laws are:
1. Disease results from an imbalance between a disease
agent and man
2. The nature and extent of the imbalance depends on
the nature and characteristics of the host and the
agents
3. The characteristics of the two are influenced
considerably by the conditions of the environment
The EPIDEMIOLOGIC TRIANGLE
 The EPIDEMIOLOGIC TRIANGLE
• Like the epidemiologic lever this model is made
up of three components. The three components
are the Agent, Host and Environment. It implies
that each component must be analyzed and
understood for comprehension and prediction of
the patterns of disease.
• A change in any of the components will alter an
existing equilibrium and could decrease or
increase the frequency of the disease.
THE WHEEL
 THE WHEEL
• The wheel consists of a Hub (the host or man)
which has genetic make-up as its core.
Surrounding man is the environment,
schematically divided into three sectors –
biological
social
physical
The relative sizes of the components of the wheel
depend upon the specific disease problem under
consideration
 WEB OF CAUSATION
• Concept of Chain Mechanism.
 WEB OF CAUSATION
• This maintains that effects never depend on
single isolated cases but rather develop as the
result of chains of causation in which each link
itself is the result of a complex genealogy and
antecedents. It discourages labelling any of
the individual factors as the cause.
Development of disease may be interrupted
by cutting a link at any point. Knowledge of
even one small component may allow
significant degrees of prevention.
 Judgement of a Cause-Effect
Relationship
• HENLE-KOCH’s POSTULATES (were used to determine if a
specific living organism causes a particular disease ;
however these were found to be inadequate not only for
non-infectious disease but even with some infectious ones).
1. The organism must be found in every case of the disease
under appropriate circumstances
2. It should occur in no other disease as a fortuitous and
non-pathogenic parasites
3. It must be capable of reproducing the disease in
experimental animals.
4. The agent must be recovered from the experimental
disease produced
 Experimental Evidence
• Trials that are sufficiently large,
randomized and carefully designed ,
conducted and analyzed can provide the
strongest and most direct epidemiologic
evidence on which to make a judgment
about the existence of a cause-effect
relationship.
 Process of Causal Inference
• The process of determining whether the
observed association is likely to be causal on the
basis of epidemiologic data involves a chain of
reasoning that addresses two major areas: 1) for
any individual study, validity of observed
association between an exposure and disease
2). For the totality of evidence, whether this
totality of evidence taken from a number of
sources supports the judgment of causality
 Process of Causal Inference

• Bradford Hill’s Criteria for making causal

inferences:
1. Strength of Association – the stronger the
observed association between the exposure and
disease, i.e., the larger the risk/rate ratio, the
less likely due entirely to bias.
2. Dose-Response Gradient – The observation that
disease frequency increases or decreases
monotonically with the dose or level of
exposure usually lends support to a causal
interpretation
 Process of Causal Inference

3. Lack of temporal ambiguity – It is important for the

investigator to establish that the hypothesized cause
preceded the occurrence of the disease. Establishing
the temporal direction of the observed association, i.e,,
ruling out temporal ambiguity is a necessary condition
for making a causal inference.
4. Consistency of the findings – If all studies dealing with
a given relationship produce similar quantitative
results, causal inference is enhanced. This criterion is
particularly important if the studies involve different
populations, methods, and/or time periods
 Process of Causal Inference
5. Biological plausibility of the hypothesis – if the
hypothesized effect makes sense in the context of
current biological theory and knowledge, we are more
likely to accept a causal interpretation.
6. Coherence of the evidence – If the findings do not
seriously conflict with our understanding of the natural
history of the disease or with other accepted facts
about disease occurrence, a causal interpretation is
strengthened. In essence, this criterion combines
aspects of consistency and biological plausibility and is
therefore similarly delineated as described for these
two criteria.
 Process of Causal Inference
• 7. Specificity of the association
If a specific exposure is found to be
associated with only one disease, or if the
disease is found to be associated with only
one exposure (after testing many possible
associations in several studies), a causal
interpretation is suggested. This criterion is
not given much credibility or weight in
contemporary epidemiology.
 THE NATURAL HISTORY OF THE
DISEASE
• The natural history of the disease shows how
interactions and interrelationships among agent, host
and environment allow a disease to develop and
progress.
• It comprises the body of knowledge about the agent,
host and environmental factors relating to the disease
process
• It includes the initial forces/factors which initiated the
process in the environment or elsewhere thru the
resulting changes which took place in man until
continuing equilibrium is reached, or defect, disability
and death ensues
 THE NATURAL HISTORY OF THE
DISEASE
• Advantages in Knowing the Natural History of
a Disease:
1. It prepares the epidemiologist/MHOs to
institute the control measures needed
2. It helps in the analysis of his findings and
guides him in the planning of control
programmes
 THE NATURAL HISTORY OF THE
DISEASE
• Definitions:
• 1. Agent – a factor whose presence or absence
causes a disease. These maybe animate or
inanimate.
• 2. Host – the individual human in whom an agent
produces disease.
• 3. Environment – refers to all external conditions
and influences affecting the life of living things;
the host and the agent exist in the environment
and the environment brings the host and agent
into contact (or non contact) with each other.
 PHASES of the Natural History of
Diseases
1. Prepathogenesis – this is the phase before
man is involved. Thru the interaction of the
agent, the host and environmental factors, the
agent finally reaches man. Thus, it may be said
that everyone is in the period of
prepathogenesis of many diseases because
disease agents are present in the environment
where man lives.
 THE NATURAL HISTORY OF THE
DISEASE
2. Pathogenesis –this phase includes the successful
invasion and establishment of the agent in the host.
After a period of incubation, whereby the agent
multiplies and develops, or gets absorbed and fixed in
the tissues , sufficient tissue or physiologic changes
may have taken place to produce detectable evidence
of the disease process in man.
This is the clinical horizon. This is the stage when
diagnosis can usually be made. The disease process
may never reach the clinical horizon , or it may proceed
until t terminates in recovery, disability, or death, or
until it is interrupted by treatment.
 The Process of Infection – The
Pathogenesis Period
• This is the Pathogenesis Period which is the phase of host
agent interaction. In the case of infections there are 6
requirements:
1. Conditions in the environment must be favorable to the
agent or the agent must be able to adopt to the
environment
2. Suitable reservoirs must be present
3. A susceptible host must be present
4. Satisfactory portal of entry into the host
5. Accessible portal of exit from the host
6. Appropriate means of dissemination and transmission to a
new host
 The Process of Infection – The
Pathogenesis Period
• The host-agent relationship is reflected in the
disease process itself. The signs and symptoms
will vary according to such relationship. Such
manifestations will depend on the following:
1. Characteristics and dosage of the agent
2. Reaction of the tissues of the host to the
introduction of the agent; and
3. Portal of entry and tissues affected
 The Process of Infection – The
Pathogenesis Period
• When the host is infected, it mobilizes its
defenses. The infectious agent on the other hand
tries to multiply to overcome the host’s
resistance, and may elaborate toxins. Four
different reactions can happen:
1. The host successfully wards of the pathogen, by
virtue of its natural resistance, acquired
immunity, state of good health, etc. and by virtue
of a weak agent or smaller dosage
 The Process of Infection – The
Pathogenesis Period
2. Balanced Equilibrium – In this condition, the
forces of the agent and the forces of the host are
equal so that both are not affected. This is a
dangerous condition, the so called inapparent
infection, because the host becomes a healthy
carrier who can readily and easily spread the
disease to others and evade detection. Ex. Out of
a mass srvey of 888 people in the barrios in
Sumunul, Tawi-tawi in November, 1965, 112 were
found positive in malarial parasites, 70% of which
did not have any fever complaint I the past 4
weeks immediately preceding the survey.
 The Process of Infection – The
Pathogenesis Period
• Subclinical Conditions- this refer to reactions
which are very mild that they escape
detection. This can also result in a carrier
state.
• Full Blown Clinical cases – these cases may
may be typical or atypical
 The Process of Infection – The
Pathogenesis Period
• FULL BLOWN CLINICAL CASES. In a clinical
case, the following sequence of events may
happen:
 The Process of Infection – The
Pathogenesis Period
• The Incubation Period (I.P.) – When the infectious
agent gains entry into the host, there is a certain
lapse of time before the disease becomes
manifest. This is the I.P. and represents the time
required for the agent to establish itself, multiply
and produce toxins. This point differentiates the
action of preformed biological or chemical toxins
or poisons which when ingested will cause almost
immediate manifestations as compared with food
infections which take some time.
 The Process of Infection – The
Pathogenesis Period
• The I.P. , except in instances where the agent
needs definite time periods to pass from one
stage to another vary according to the following:
1. Virulence, dose and portal of entry. There is no
question on the first two, but the portal of entry
needs some clarification. Taking for example the
epidemic of rabies in Tawi-tawi in 1964, the first
four fatal cases were those bitten in the faces and
the longest period observed was 35 days. In many
reports of rabid dogs biting people in the leg, the
I.P. Ranged from 60 days and above.
 The Process of Infection – The
Pathogenesis Period
• 2. Previous experience of the host and the
state of natural resistance . Previous
experience affects the I.P. by the development
of either immunity, tolerance or refractoriness
to the disease.
• 3. the inherent character of the organism
itself. Example is the strain of P.vivax with
short I.P. and the P.vivax with protracted I.P.
 LEVELS OF DISEASE PREVENTION-
PRIMARY LEVEL
• Primary Level
This refers to the measures that may be
applied in the pre-pathogenesis phases of the
natural history. This consist of the following:
1. By measures designed to promote positive
general health; development of good habits of
health and hygiene, proper nutrition, proper
attitude towards sickness, proper and prompt
utilization of available health and medical
facilities, etc.
 LEVELS OF DISEASE PREVENTION-
PRIMARY LEVEL
• 2. Specific Protection –By the use of measures against
specific disease agents. This is the protection of man
himself, or the establishment of barriers against agents in
the environment. It consist of the following:
2.1 segregation of the reservoir or source of infection by
isolation or quarantine
2.2 Control of means of spread such as vector control,
sanitation of food, milk, water, and air, proper sewage
disposal, proper disposal and or disinfection of excreta of
sick people, eradication of animal reservoir, etc.
2.3 increasing the resistance of the prospective host by
specific immunization both active and passive
 LEVELS OF DISEASE PREVENTION-
SECONDARY LEVEL
• This is applied in the pathogenesis period.
• This consist of early diagnosis and prompt treatment of
the disease in order to arrest the disease and to
prevent its spread to other people.
• It is necessary that all cases be discovered ASAP in
order to attain said objective.
• It is however unfortunate that early detection is the
exception rather than the rule in our experience with
public health practice in the country.
• By treating the cases , we are actually eradicating the
reservoir.
 LEVELS OF DISEASE PREVENTION-
SECONDARY LEVEL
• In the case of animal reservoirs for fatal
disease like rabies, no attempts are made in
the treatment of these animals. Their
immediate destruction is the rule.
• Ex. In the Tandubas experience (April-May
1964), since it was not possible to identify
which dogs were infected by the rabid
animals, all the dogs in the island were killed
by the marines and concerned citizens.
 LEVELS OF DISEASE PREVENTION-
TERTIARY LEVEL
• This consist of the following:
1. Disability limitation - this indicates failure of
prevention at an earlier level. It requires
treatment of a more or less advanced disease
process.
2. Rehabilitation – this is applied with the
objectives of returning the affected individual
to a useful place in society and make
maximum use of his remaining capacity.
 LEVELS OF DISEASE PREVENTION-
TERTIARY LEVEL
• 3. Intensive, periodic follow-up and
treatment. Done to prevent relapses
in certain diseases; to effect
complete cure in diseases which
have relapse tendency.
 LEVELS OF DISEASE PREVENTION
Attention is called to the fact that thus far, no
mention has been made of health education
as belonging to another level of prevention.
Health Education is of universal application,
and is instrumental in the accomplishment of
all the measures proposed in all levels of
prevention.
 LEVELS OF DISEASE PREVENTION
• With reference to specific protection, the
points of attack depend on which of the three
ecologic factors of disease/health are most
vulnerable to corrective measures,. It is to be
recognized, therefore that such measures to
be applied effectively and efficiently, they
need to be guided properly. For this reason,
knowledge of surveillance and
epidemiological investigation is necessary.
Classification of Disease and Disability
• Grouping of people which will allow the groups to be
distinguished from one another is an important step in
epidemiology. These grouping would provide guidance on
how to treat the disease as well as how to prevent the
disease from developing.
• There are two ways to classify the groups:
• 1. based on manifestational criteria meaning that you
classify according to signs and symptoms being manifested.
• 2. by way of experiential criteria wherein people are
grouped according to an experience they had in common
prior to the development of the disease. One might say
that they had some experience in common during
prepathogenesis of the disease.
Classification of Disease and Disability
• Why is there sometimes poor correspondence
between groupings based on manifestational and
experiential criteria?
• 1. a single specified experience sometimes has
many, varying effects (polymorphous) in many
forms ( different effects or outcomes from a
single experience)
• 2. a particular manifestation at time comes from
diverse experiences (one manifestation from
different experiences).
Classification of Disease and Disability
• How do epidemiological findings contribute
towards classifying disease based on
manifestations? One perfect example is about
cancer of the uterus. Manifestations (as well
as risk factors) for cancer of the cervix are very
much different for those found for cancer of
the corpus. Hence, it is now accepted that
there are two separate disease entities
regarding cancer of the cervix uteri and cancer
of the corpus uteri.
Classification of Disease and Disability
• Regarding infections or communicable
diseases, classification depends on
internalization of the microorganism. This is
an experiential criterion since the persons
have to experience being exposed to the
microorganism first and letting that
microorganism gain hold in their bodies
before the actual disease could develop and
before they can be classified accordingly
Classification of Disease and Disability
• Two practical applications of being able to classify
a disease based on common experience:
• 1. The group of ill individuals at hand have
illnesses highly dependent on a common
experience and the experience becomes a focus
for special therapeutic intervention.
• 2. Means may be devised to prevent exposure to
the microorganism or to limit the ill-effects of the
microorganism.