2. CONCEPT OF DISEASE Disease is a physiological/psychological dysfunction. It is departure from the state of health. Illness is a subjective state of the person who feels aware of not being well Sickness is a state of social dysfunction, i.e., a role that the individual assumes when ill (“sickness role”).

3. CONCEPT OF CAUSATION Disease results from a complex interaction between man, an agent (or cause of disease) and the environment, (Epidemiological triad) Disease results from a complex interaction between man, an agent (or cause of disease) and the environment, (Epidemiological triad) Germ theory of disease Disease agent → Man → Disease Multifactorial causation The multifactorial concept offers multiple approaches for the prevention/control of disease. Web of causation The “web of causation” considers all the predisposing factors of any type and their complex interrelationship with each other.

4. NATURAL HISTROY OF DISEASE The natural history of disease is consisting of two phases: The natural history of disease is consisting of two phases: Prepathogenesis (i.e., the process in the environment) Prepathogenesis (i.e., the process in the environment) Pathogenesis (i.e., the process in man). Pathogenesis (i.e., the process in man).

5. Agent factors The disease “agent” is defined as a substance, living or non-living, or a force tangible or intangible, the excessive presence or relative lack of which may initiate or perpetuate a disease process. The disease “agent” is defined as a substance, living or non-living, or a force tangible or intangible, the excessive presence or relative lack of which may initiate or perpetuate a disease process. A disease may have a single agent, a number of independent alternative agents or a complex of two or more factors whose combined presence is essential for the development of the disease. A disease may have a single agent, a number of independent alternative agents or a complex of two or more factors whose combined presence is essential for the development of the disease.

6. Types of Causative Agents Biological agents Biological agents Nutrient agents Nutrient agents Physical agents Physical agents Chemical agents Chemical agents Mechanical agents Mechanical agents Absence or insufficiency of excess of a factor necessary to health Absence or insufficiency of excess of a factor necessary to health Social agents Social agents

7. Host factors The host factors may be classified as Demographic characteristics such as age, sex ethnicity; (ii) Biological characteristics such as genetic factors; (ii) Biological characteristics such as genetic factors; (iii) Social and economic characteristics such as socio- economic status, education, occupation, stress, marital status, housing, etc. and (iii) Social and economic characteristics such as socio- economic status, education, occupation, stress, marital status, housing, etc. and (iv) Lifestyle factors such as personality traits, living habits, nutrition, physical exercise, use of alcohol, drugs and smoking. (iv) Lifestyle factors such as personality traits, living habits, nutrition, physical exercise, use of alcohol, drugs and smoking. Behavioural patterns, etc. The association of a particular disease with a specific set of host factors frequently provides an insight into the cause of disease. Behavioural patterns, etc. The association of a particular disease with a specific set of host factors frequently provides an insight into the cause of disease.

8. Environmental factors The study of disease is really the study of man and his environment. the environment of man has been divided into three components- Physical, Physical, Biological Biological Psychosocial. Psychosocial. It should be emphasized that this separation is artificial. They are closely related to each other and with host factors. It should be emphasized that this separation is artificial. They are closely related to each other and with host factors.

9. Risk factors The term "risk factor" is used by different authors with at least 2 meanings. An attribute or exposure that is significantly associated with the development of a disease An attribute or exposure that is significantly associated with the development of a disease A determinant that can be modified by intervention, thereby reducing the possibility of occurrence of disease or other specified outcomes. A determinant that can be modified by intervention, thereby reducing the possibility of occurrence of disease or other specified outcomes. Some risk factors can be modified; others cannot be modified. The modifiable factors include smoking, hypertension, elevated serum cholesterol, physical activity, obesity, etc. They are amenable to intervention and are useful in the care of the individual. The unmodifiable or immutable. Some risk factors can be modified; others cannot be modified. The modifiable factors include smoking, hypertension, elevated serum cholesterol, physical activity, obesity, etc. They are amenable to intervention and are useful in the care of the individual. The unmodifiable or immutable. Risk factors such as age, sex, race, family history and genetic factors are not subject to change. Risk factors such as age, sex, race, family history and genetic factors are not subject to change.

10. Risk groups Something for all, but more for those in need - in proportion to the need" Therefore it is stated that risk factor is a proxy for need'- indicating the need for promotive and preventive health services.

11. Spectrum of disease At one end of the disease spectrum are subclinical infections which are not ordinarily identified and at the other end are fatal illnesses. At one end of the disease spectrum are subclinical infections which are not ordinarily identified and at the other end are fatal illnesses. The sequence of events in the spectrum of disease can be interrupted by early diagnosis and treatment or by preventive measures. The sequence of events in the spectrum of disease can be interrupted by early diagnosis and treatment or by preventive measures.

12. Iceberg of disease According to this concept, disease in a community may be compared with an iceberg. The floating tip of the iceberg represents what the physician sees in the community, i.e., clinical cases. 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. The "waterline" represents the demarcation between apparent and inapparent disease.

13. Prevalence of risk factors in patients admitted in Cardiology ward Personal profile Reg. No.______________Date of Admission _______ Diagnosis__________________ Name:_____________________Age:_____ Sex ______Education_________________ Occupation:___________Income per month_________No. of Children: ____M___F___ Address:_______________________________________________________________ Number of Rooms:______ Residence: Urban / Rural ____ Type of Family___________ B.P _______Pulse_____Temp_________Weight____________Height_____________ Smoker _Yes / No Form of smoking(cigarettes,huqqa, naswar)any other_____ Smoker _Yes / No Form of smoking(cigarettes,huqqa, naswar)any other_____ Regular / Occasional smoker _______Number of cigarettes _________________ Regular / Occasional smoker _______Number of cigarettes _________________ Duration of smoking _____________Why start smoking ___________________ Duration of smoking _____________Why start smoking ___________________ Did you try to quit smoking Yes / No. Why ________________________ Did you try to quit smoking Yes / No. Why ________________________ Any other addiction ______________Duration ___________________________ Any other addiction ______________Duration ___________________________ Any physical activity ______(inactive, walking 30 minutes in a day Heavy work) Any physical activity ______(inactive, walking 30 minutes in a day Heavy work) Type of diet mostly used (vegetable,meat,fish,rice, broast, etc) weekly/daily_____ Type of diet mostly used (vegetable,meat,fish,rice, broast, etc) weekly/daily_____ Use of Milk frequency ______ Use of Butter, ghee, Oil___________________ Use of Milk frequency ______ Use of Butter, ghee, Oil___________________ Use of Tea frequency___________ Soft drink _________________________ Use of Tea frequency___________ Soft drink _________________________ Frequency of meal :Twice / Thrice a day ______________________________ Frequency of meal :Twice / Thrice a day ______________________________

14. Past History of Illness: Type of disease, Heart, Hypertension, Diabetes, Obesity, Addiction, any other: ___________________________________________________________ Family History: Type of disease ___________________ To whom _____________ Uncertain death ________________________________ any other detail _________ Treatment History: No. of times admitted in hospital __________ for disease_____ Which associated symptoms developed and at what age______________________ Knowledge about the Disease: Do you know about what causes heart attack_____ What are the risk factors ____________How can be prevented from heart attack ___ Do you get better after treatment taken before ______________________________ What preventive care you have adopted after treatment _______________________ What prevention you will adopt after discharge ______________________________ Follow up : Following the instructions of physician Yes / No. Reduce salt intake Yes/No Reduce fat intake Yes / No. Reduce sugar intake Yes No Reduce fat intake Yes / No. Reduce sugar intake Yes No Regular physical activity Yes /No. Regular treatment intake Yes/No Regular physical activity Yes /No. Regular treatment intake Yes/No