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Trinity College Courses
Caroline Barakat

HLTC07: Patterns of Health, Disease, and Injury Lecture 3: Disease/Injury Classification and Disease Surveillance Lecture Outline  Disease classification  International Classification of Disease  Classification of mental disorders  Classification of injuries  Disease surveillance Disease Classification - Purpose  Classification is putting things in order = essential for science and it defines what the universe is made out of; we study science via classification and for diseases it’s not different o Classify to make sense of what is happening, although there’s differences in how diseases manifest and how humans react to certain diseases o But in general, there’s common symptomology which classifies it under certain category  These are the 5 main purposes for disease classification; other purposes may fall w/in these categories or add onto these categories  *Main reasons why we classify diseases:* o (1) To alert to the emergence of a health problem  Track if prevalence has increased  Example: If a health official reads that there’s an increase in # of cases of SARS (etc;) something needs to be done about it o (2) To assist in planning, operations, or evaluation  Allows people to place things into perspective for the future  Example: We do have a program for the flu, flu surveillance; we look at cases; then see if the system enough, what needs to be changed? How do we evaluate it to make it better? o (3) To allocate resources  Need to know what we’re dealing with, the frequency, is it decreasing/increasing; need to allocate appropriate resources (Health Care workers, programs, hospitals, money, etc.)  Example: Facilities for treatment and prevention of STDs o (4) To inform on where funds need to be used in the most useful way  Certain funds for certain diseases  Now, we’ve moved more away from funding infectious diseases to more funding towards chronic diseases  But there are also advocates that say there are newly emerging infectious disease b/c of resistance, anti-biotics; so need funding for that  So, look at changes that may be possible? What are the changes that can be made to make sure that funds are more useful?  Do we need to take funds away from chronic disease planning and prevention and put it towards infectious diseases? Is this where it would be most useful? o (5) To help in understanding disease pattern  By showing some way to display and report disease patterns in a systematic way (ex: graphs, statistical)  When we classify diseases and there’s a standardization in terms of what diseases we’re looking to classify and then reporting and displaying the data in a systemized way  Then can look at comparative reports; whether it’s comparative among diff places or comparative wrt temporality (time)  Really important to provide info in systematic way Principles of Disease Classification  There are 3 main principles when classifying diseases – reached consensus on this  3 Rules of Disease Classification: 1) Must have a category for every disease  If not, then a new category will be created for it  Some single diseases are represented by individual categories but can also have other categories that group several diseases  Ex) rare disease may have its own category 2) No overlap between the categories  If a disease is its own category then that’s where it would fall  But if it’s not in its own category, then it may fall under other types of diseases  No disease can be placed in 2 different categories at the same time; otherwise, it would lead to double-count, which we don’t want when we’re looking at disease classification 3) At least one disease for every category  So no category is left empty Dimensions of Disease  Health (WHO): ‘a state of physical, mental and social well-being and in the absence of disease/infirmity’  No international definition of disease  Disease defined through a set of dimensions: o Symptomatology - manifestation  Where did it start? Where you’ve been? Symptoms? Does anyone else have these symptoms?  Looking at patterns of symptoms o Anatomy  Is there a reason why this could happen? Is there a reason why the person keeps sneezing (allergens, flue etc;)  But knowing the anatomy of the organism, the organ-organ system that’s primarily affected by those symptoms  Specific organs and whether anything is wrong with them, affected by a disease (ex: looking at the anatomy of the ear) o Histology  Changes in the tissues of a specific organ  Example: diagnosis of cancer o Etiology  Underlying explanatory mechanism  Example: Infection by virus; Dr. OZ – recent infection of bubonic plague of 7 yr old in Colorado – how she was diagnosed with it? Buried dead squirrel, left sweater beside squirrel and she picked it up and tied around waist  Bites around waist – quick diagnosis – where fleas bit her  What is it that could have happened? What led to this?  The bug bites were etiological cause; showed which way it could have happened o Course and outcome  Of a health-related matter  When did this start? What happened as a result of that? In order to figure out what’s causing that certain disease o Age of onset  Diseases are different; some occur in child, some only in adults  Some are there when you’re a child but don’t manifest until you’re older (ex: arrhythmia) o Severity / extent  Diseases may change; may increase/decrease in severity/extent  Heart disease may worsen with exertion/physical activity o Treatment response  Trial and error; these are the symptoms and you’re asked to take it – see if it works or not o Linkage to intrinsic (genetic) factors  Genotype/phenotype of an individual could indicate what the person may have o Gender o Linkage to interacting environmental factors o Other factors  Example: related to pregnancies; may become diabetic during pregnancy but goes away after  Example: old age; dementia, AD  Disease classification is generally based on all of these dimensions of disease put together  First point of contact for disease diagnosis = primary care physician (or you do it yourself)  Not a lot of fragmentation in Canada; physician to specialist; health records are kept  A lot of knowledge from many physicians to get a proper classification of disease International Classification of Disease - ICD-10  Used by most countries if they want to refer to something  ICD-10 is constantly be re-developed due to expanse of knowledge, better diagnosis, imaging o More current: STDs, Autism, In the past, documented at low rates; now at 26% in certain age groups, Mental health, Obesity, Complex diseases like lupus, Diseases of the elderly; more neurological diseases (dementia, AD)  To categorize diseases, health-related conditions, and external causes of disease and injury in order to be able to compile useful statistics in morbidity and mortality o People want to have an idea of what are their prevalence rates, incidence, mortality, case fatalities o Can do that with ICD which also allows for comparison across time and diff places  ICD dates back to the 19th century (1840s) o First conference for the revision of classification occurred in France in Aug 1900 o Every 9-10 yrs, there’s revision o Was very vague and primitive and revisions made until adopted by WHO in 1948; by then, it had gone thru 6 main revisions; ICD 6 by 1948 (=after WWII) o And every 9-10 yrs after, revisions made; ICD 10 – current;  (ICD-10) consists of 3 volumes: o Volume 1 contains a tabular list, definitions, and WHO nomenclature guidelines o Volume 2 contains extensive description of the classification and methods for use in mortality and morbidity, including short lists  Refer to when you want more info about classification and the disease o Volume 3 is the alphabetical index that contains separate indices for diseases, external cases, and drugs / substances  Need to look thru all 3 to ensure that you have consistency b4 classification of a disease take place  ICD10 under revision – ICD11 (started in 2006 – published 2015) o Release new version but say what things were updated o But the principles remain the same; every disease fits in a category, there should be no overlap and no empty categories Modifications and Adaptations  Some countries find ICD to be sufficient and because some countries don’t have the resources so they use the  internationally accepted ICD10 for clinical reporting  But some countries feel that it doesn’t provide adequate detail 4 clinical and administrative use o Canada one of those countries o Canadian Institute for health information has developed and published an enhanced version of the ICD10 for morbidity classification in 2001  Canada – ICD-10-CA and CCI (Canadian Classification of Interventions) o Also use the Canadian Classification of Interventions to classify certain things  These 2 booklets (ICD-10-CA and CCI) are the main sources of classification in Canada ATM  Could be that ICD11 may be sufficient and we may adopt it completely Classification of Mental Disorders  International Classification of Diseases Mental Disorders and the Diagnostic and Statistical Manual (DSM) of Mental Disorders o These 2 manuals are currently being used to be able to classify, define and describe certain diseases  Figure: History o 1948 – ICD was adopted by WHO o At that time, there was also the DSM (first diagnostic and statistical manual of mental disorders) – so that was new o Categorized 106 mental illnesses o 1967 – new diagnosis manual o 1994 – yet another one o Mental illnesses has seen a lot of changes ; lot of disorders added, modified o Most current in the classification of mental disorders is ICD10 and DSM4 o An important feature of those diseases is that while the ICD is the classification of diseases, we still don’t have an explicit agreement on a definition for mental illness  There aren’t many dimensions that can clearly classify the syndromes apart from each other  Status of ‘disorder’ isn’t well-defined and refers to similar groups of syndromes that share certain features o Not based on rigorous scientific standards; rather, it utilizes ppl’s personal point of views (subjective) o May lead to over-diagnosis/mis-diagnosis Classification of Injury  2 important considerations: 1. Identification of the causal event 2. Assessment of the outcome  So we classify it in 2 diff things – (1) what caused it? (2) And what did it lead to? o Ex: Cause could be motor vehicle accident; lead to paralysis  Once again, the principles; one category for each injury, no overlap and each category should be filled  When thinking of injury, one of the most recent debates is about the use of the term ‘accident’ – not wanting to be used b/c of the link that it has to do with chance o So if you say something happened by accident (chance) then there’s very little that can be done to prevent it, which would defeat the purpose of public health o Redefine term ‘accident’ into intentional or unintentional injury  In the current classification, they still use terms like ‘accidental fall’ Injuries: Operational Definition  According to etiological mechanism, unintentional injuries are classified on the basis of their external cause in  the following categories  Basis - external cause in the ICD-10: 1) Motor vehicle traffic accidents 2) Other transport accidents 3) Accidental poisoning 4) Accidental falls 5) Accidents caused by fire and flames 6) Accidental drowning 7) Accidents caused by machinery, cutting, piercing instruments 8) Accidents caused by firearm missile 9) All other accidents, including late effects 10)Drugs, medications causing adverse effects in therapeutic use  When looking at classification of injury, it will fall into one of these categories; if it’s classified into one of these categories, it can’t be put into another category o Sometimes, these injuries can be pathological in that it could lead to something but remember that there can be no double counts o When you go thru volumes 1-3, it will tell you exactly where to place a certain injury o When there’s ambiguity, people sit around and make revisions for next manual; may be create a new category for it Categories for Intentional Injuries(these are more linked to mortality data; suicide, fatal injuries etc) 1. Suicide and self-inflicted injury 2. Homicide and injury purposely inflicted by other persons 3. Other external causes including those fatal injuries of undetermined intent or those related to legal interventions and operations of war Commonly used Terms in Injury Research and Prevention  Safety – refers to the condition of being protected against any failure, damages, error, accidents or harm  Injury prevention – measures to reduce the incidence and severity of injuries o Focuses on the implementation of safety promotion programs that either change people's behavior to make them safer/take less risks o Active behaviors  If an individual is expected to intentionally undertake an action aiming to maximize the effect of a prevention program  Leads to reduction in severity of injury  Ex) need to wear seatbelts and if the person does so, then that’s active behaviour o Passive behaviors  Person doesn’t do anything but there are programs in place to ensure safety  Ex) person doesn’t wear seatbelt but there’s an airbag that saves life Major Categories of Injuries 1) Motor vehicle injuries - defined as ‘a collision involving at least one vehicle in motion on a public or private
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