Presentation on theme: "DISEASE DETECTIVES WESO 2015 Supervisors: John Nicklas Kira Berman"— Presentation transcript:
1 DISEASE DETECTIVES WESO 2015 Supervisors: John Nicklas Kira Berman John Nicklas, MD
2 Brief DescriptionObjective: The goal of the Disease Detectives event is to have students make connections between things that they may encounter in daily life and risks for disease and injury, and opportunities for prevention. In addition students should understand specific community health problems.Brief description: Students will be tested on their knowledge, observational, analytical, and investigative skills in the study of disease, risk, spread, and prevention in populations or groups of people with a focus on population growth causes of public health problems.2015 Focus: POPULATION GROWTH
3 Public Health Problems Related to Population Growth Water Quality and Water PollutionSanitation NeedsAir PollutionEnvironmental DegradationRapid Spread of Disease via Public Transportation and Air TravelFood Quality and Food ContaminationPeople moving into uninhabited areas, new pathogens
4 The Competition Grades: 2, 3, 4 and 5 Number of participants: up to 3 studentsTime: 30 minsTest format: A team of 1-3 students will be tested through a written test, analysis of material at observation tables, or a combination of both.Question format: The question format may include, but not be limited to multiple choice questions, fill in the blanks, true or false, matching, and/or short answers. All questions will be grade appropriate. Any calculations and mathematical manipulations will be consistent with grade level math skills. Students do not need to show their work.Observation table format: Students may observe an object, a picture, a table, a graph, a diagram, narrative information, and/or a short video. There will be specified questions in the test regarding the material presented.Event parameters: A standard #2 pencil, lined notepaper, and answer sheets will be provided by the supervisor. Grades 2 and 3 will NOT need calculators. WESO will provide Grades 4 and 5 with a calculator (non-graphing, nonprogrammable). A reference sheet will not be allowed.Scoring: Each test question will be assigned a point value to be earned by teams answering correctly. The highest number of points will determine the winner.Tie Breaker: Pre-selected test questions will be used as tiebreakers.
5 About this PowerPointThis is just a study guide; it does not include all the necessary information students will need to know.Everything that applies only to 4th and 5th Graders is labeled as such on the slide. All other slides are meant for all grades. (Grades 4 and 5) The emphasis this year is on concepts (such as epi-curves and cohort/case control studies), not on memorizing information (general and specific pathogens).
6 STUDY GUIDE FOR DISEASE DETECTIVES 2015 What EVERYONE Needs To Know: Role and Examples of Disease DetectivesOutbreak Investigation (Scientific Method)Problems investigated by Disease DetectivesBasic Epidemiological TermsTypes of PathogensModes of Transmission – Agent/Host/EnvironmentRisk Factors - Time/Person/PlaceInterpreting simple data: narrative, tables, charts, maps, graphs (bar and line)Control, Treatment, and Prevention Strategies
7 Define and Identify Cases Make a Table from a Line Listing STUDY GUIDE FOR DISEASE DETECTIVES 2015 Extra Stuff for 4th and 5th Graders:Define and Identify CasesMake a Table from a Line ListingCohort vs. Case Control - Analytical StudiesCalculate Measures of RiskAnalyze an Epi CurveCharacteristics of Specific Pathogens
8 Role of Disease Detectives Who are Disease detectives? Epidemiologists, medical professionals (physicians, veterinarians, nurses), laboratory scientists, statistician, environmental specialists. Role of a disease detective? Collecting and comparing data on various diseases or infections within communities – health of populations, not individuals. Definition and Role of: EPA - Environmental Protection Agency (USEPA) CDC – Centers for Disease Control and Prevention
9 Scientific Method as Related to Disease Detectives Students need to be familiar with the steps and their importance:(Grades 2 & 3: understand; Grades 4 & 5: understand and apply)Obtain Background InformationDefine the Problem (and confirm its existence by proper diagnosis in case of an infection)Formulate Hypothesis (for infectious agents: agent/host/environment triad = chain of transmission. Agent capable of causing disease + persons susceptible to agent + environment allowing them to get together)Develop a Study to Test the HypothesisCollect Data and ObservationsEvaluate ResultsDetermine if Hypothesis is true/modifyFormulate ConclusionsImplement Control and Preventative MeasuresReport Results
10 Problems Investigated by a Disease Detective chronic diseasesasthma, heart disease, cancer, diabetes…environmental problemsallergies, air and water pollution, radiation, lead, mercury, climate change…behavioral problemsobesity, stress, lack of sleep…injuriesviolence, occupation, sports…transportation accidentsinfectious diseasesbacterial, viral, parasitic, prion…
11 Basic Epidemiological Terms Grades 2 and 3: agent, case report, case series, chain of infection, cluster, contamination, endemic, environment, epidemic, epidemiology, fomite, gram stain, host, hygiene, immunity, infection, infectious, outbreak, outcome, pandemic, pathogen, pathogenic, pattern, public health surveillance, risk, susceptible, symptom, trend, vector, vehicle, virulent. Grades 4 and 5: attack rate, case control, cohort, control group, epi curve, exposure, incidence, incubation, index case, infectivity, mortality, odds ratio, onset, prevalence, relative risk, reservoir, virulence, zoonosis, AND Grade 2/3 terms.
12 Types of Pathogens viruses bacteria protists (protozoa) fungi animals (worms)natural toxins, chemicalsprionsBasic characteristics: definition of pathogen type, structure, morphology, gram stain, motility, habitat, any unique features.Additional Information for Grades 4 & 5 only:Escherichia coli, Campylobacter jejuni, Vibrio cholerae, Giardia intestinalis, Ebolavirus, Norovirus, and Borrelia burgdorferiGrowth requirements, diet, route of entrySymptoms, incubation period, virulence, infectivity, treatments, vaccinesCommon mode of transmission, recent outbreaks.
13 Example of info needed for a general pathogen: BacteriaDefinitionProkaryotic, unicellular microorganisms.StructureHave cell walls but lack organelles and an organized nucleus.Morphology / TypesTypically .5 to 5.0 µm. Can be spherical (cocci), rod-shaped (bacilli), comma (vibrio), or spiral (spirilla). Arranged in pairs (di), lines (strep), or clusters (staph).IdentificationLooks like: orMotilityFlagella – swim through fluids. Bacterial gliding, twitching motility – move across surfaces.HabitatPractically everywhere: our guts, soil, water, acidic hot springs, radioactive waste, the deep portions of Earth's crust.Common ExamplesE. Coli, V. Cholerae, C. jejuni, Salmonella, Tuberculosis, Streptococcus, Pertussis, Borrelia.Unique FeaturesReproduce by binary fission, can be divided into gram positive and gram negative based on cell membrane.DestroyHeat/cold, antibiotics, silver, chlorine, bleach.DietSunlight, inorganic compounds, organic compounds, CO2.Route of EntryOral, respiratory, open wound, bodily fluids.DON’T LEARNAll two-dozen phyla or two hundred genera of bacteria.
14 Modes of TransmissionContact:DirectIndirectDropletNon-contact:AirborneVehicle (foodborne)Vector
15 Agent/Host/Environment Triad pathogen & its sourceHostpersons susceptible to agentEnvironmentallows them to get togetherOutbreak
16 Define and Identify Cases (4th and 5th Grade) Case definition – establish the standard criteria for determining who has the disease or condition – who’s in this outbreak?Clinical information – about the disease or conditionCharacteristics - of the affected peopleLocation or place - as specific as possible as restaurant, county, or geographic areaTime sequence - specific time during which the outbreak or condition occurredIdentification of cases – kind & number – count specific casesConfirmed – have diagnosis with case definition plus lab verificationProbable – many factors point to diagnosis but may lack lab verificationPossible – some factors point to diagnosisNote: Initial reports may be only a small sampling of the total problem. Be sure to expand search to determine the true size and extent of the problem.
17 Make a Table from a Line Listing (4th and 5th Grade) Line Listing – list of all the patients in outbreak, with all the relevant information included.Ex: twelve case report forms on a E. Coli outbreak.ID # Initials Date Diagnosis Age Sex County Physician Weddingof Onset Confirmed1 KR 7/24 E. Coli 29 M Columbia Goodman Yes2 DM 7/27 E. Coli M Columbia Baker Yes3 JG 7/28 E. Coli 26 M Columbia Gibbs Yes4 RD 7/25 E. Coli M King Webster Yes5 NT 7/29 E. Coli F Columbia Stanley YesAM 7/27 No E. Coli F Clayton Mason YesJR 7/24 E. Coli 39 M Clayton Smith NoIH 7/25 No E. Coli 41 F King Gewertz YesTJ 7/31 No E. Coli 49 F Clayton Koller NoAT 7/28 E. Coli 26 F Columbia Kapur YesML 7/29 No E. Coli 36 M King Mohr NoDU 7/30 No E. Coli 50 F Columbia Kaminski NoTurn this Line Listing into:E. ColiNo E. ColiExposed (at wedding)62Unexposed (not at wedding)13
18 Risk Factors: Time/Place/Person Epidemiologic variables: can be observed and/or measured.• Time - the time of illness or of a relevant event.Examples: date of exposure or onset of illness.• Place - the environment in which illness occurs.Examples: place of residence, of work, suspected exposure.• Person - individuals who are infected, ill, or at risk.Examples: age, gender, occupation, high risk condition (AIDS).Look at Possible Risk Factors – Descriptive Studies: (4th and 5th Grade)Analyze distribution of disease by cases or outcome, frequency in population, exposure, time pattern or environmental factor.Case report/case series– case report = single patient, case series = several patientsCorrelative studiesTime series - same population at different timesEcologic relations - specific ecologic factorsCross sectional – survey: participants are selected irrespective of exposure/disease status
19 Data TableEXAMPLE of a simple narrative with a 2 X 2 table format for all grades:An earthquake struck a town of 400 people and destroyed their sanitation system. Some persons became ill. The suspected source was a well near a ruptured sewer line. The town’s population was then surveyed to determine who became ill.SickNot SickExposed (drank water from well)15030Unexposed (did not drink water)50170Total number of people in the town? 400Number of people who were exposed to the well water? = 180Number of people who were not exposed to the well water? = 220Number of people who were exposed to the well water and became ill? 150
20 First divides a group by exposure status, then sees who got sick. (4th and 5th Grade)Cohort vs. Case ControlFirst divides a group by exposure status, then sees who got sick.Retrospective: (historic cohort) starts at exposure in past & moves forward to outcome.Prospective: starts at present exposure and moves forward in time to outcome.Calculate: attack rate and relative riskEx: To determine the effectiveness of influenza vaccines in the elderly, groups of vaccinated and unvaccinated elderly people were studied.Works backward from effect or illness to suspected cause.Control group has similar characteristics to the sick group but is not ill.They are then checked for similar exposures – hard to do retrospectively.Calculate: odds and odds ratioEx: This study looked at heart attack victims and compared their former smoking habits to those of individuals who did not have heart attacks.
21 Calculating Measures of Risk: Cohort (4th and 5th Grade) An earthquake struck a town of 400 people and destroyed their sanitation system. Some persons became ill. The suspected source was a well near a ruptured sewer line. The town’s population was then surveyed to determine who became ill.Attack rate (4th and 5th grades): the rate that a group experienced an illness. (Look for high attack rate in exposed & low rate in unexposed) = number of people sick ÷ total in that group.Attack rate for exposed individuals = 150 ÷ 180 = (83.3%) a/(a+b)Attack rate for unexposed individuals = 50 ÷ 220 = (22.7%) c/(c+d)Relative risk (5th grade): estimates the extent of the association between an exposure and a disease. It estimates the likelihood of developing the disease in the exposed group as compared to the unexposed group.A relative risk > 1.0 indicates a positive association or an increased risk.A relative risk = 1.0 indicates that the incidence rates of disease in the exposed group is equal to the incidence rates in unexposed group. Therefore the data does not provide evidence for an association.Relative risk = Attack rate for exposed ÷ Attack rate for unexposed = 83.3% ÷ 22.7% = 3.66.[a/(a+b)]/[c/(c+d)]=a(c+d)/c(a+b)SickNot SickExposed (drank water from well)150 (a)(b)Unexposed (did not drink water)50 (c)170 (d)
22 Calculating Measures of Risk: Case-Control (4th and 5th Grade) 200 people arrived at the emergency room, all complaining of severe stomach cramps. The suspected cause was contaminated jello-pudding served at a recent dinner party. A control group was then found from among those dinner party guests who did not become ill.Odds (4th and 5th grades): the odds that a certain group was exposed to a risk factor. = number of people exposed ÷ number of people unexposedOdds for cases = 150 ÷ 50 = 3 a/cOdds for controls = 80 ÷ 20 = 4 b/dOdds Ratio (5th grade): It estimates how many times more likely those who were exposed were to develop disease.Odds for cases ÷ odds for controls = 3/4 = [a/c]/[b/d]=ad/bcTherefore, those who ate jello were 0.75 times as likely than those who didn’t eat jello to get sick, or in other words less likely. The real cause of the outbreak was something else.Disease Yes (cases)Disease No (controls)Exposed (ate jello)(a)(b)Unexposed (no jello)(c)(d)
23 Epi- Curves (4th and 5th Grade) An epi-curve is a histogram, displaying frequency of disease on the y-axis and time on the x-axis (units ≈¼ of incubation period).It can tell us about:Pattern of spreadMagnitudeOutliersTime trendExposure and/or disease incubation periodStudents won’t be asked to create epi-curves, but will be asked to interpret epi-curves.
24 Analyzing Epi- Curves (4th and 5th Grade) Average Incubation Period: 10 daysOutlier: Index CaseMinimum Incubation Period: 7 daysLikely Period of Exposure: 3 daysMagnitude: 73 cases totalTime Trend: First case on Day 11, peak # of cases on Day 21, no cases after Day 28
25 Epi- Curves – Patterns of Disease Spread (4th and 5th Grade) (one-time exposure)(person-to-person)
26 Pertussis Infection by 5-Year Age Groups (www.cdc.gov) GraphsEXAMPLE of a Bar Graph:Pertussis Infection by 5-Year Age Groups (www.cdc.gov)Which age group has the largest number of cases? 0-4True or False: As you grow older, the risk of pertussis infection decreases.(True)
27 Line Graphs EXAMPLE of a Line graph: www.cdc.gov How many TB cases were there in the United States in 2001?About 10,000About 25,000About 16,000Cannot tell from the FigureAnswer: cWhich of the following statements is false?There were more Tuberculosis (TB) cases in 1993 than in 1984.For the years shown in the Figure, the year with the fewest TB cases was 2001.For the years shown in the Figure, the only year when there were fewer than 20,000 TB cases was 1999.Answer: c
28 Control and Prevention Strategies Act as soon as source is known – people are sick or hurting and need help; must know agent & source of agent + susceptibility of host + chain of transmissionAim at chain of agent-source-host – break the chain of transmission at any of its 3 pointsInterrupt transmission or exposure – isolate vehicles of transmissionReduce susceptibility – with immunization and education
29 Specific Illnesses (4th and 5th Grade) 4th and 5th Grade: specific questions can be based on the following illnesses:Escherichia coli (E. coli)Campylobacter jejuni (C. jejuni)Vibrio cholerae (V. cholerae)Giardia intestinalis (G. intestinalis)NorovirusBorrelia burgdorferiEbolavirusStudy criteria: type of causative agent, basic characteristics, mode of transmission, foods most associated with the illness, any unique features, symptoms, diagnosis, prevention, treatment, identification, gram stain, incubation period, virulence, infectivity, recent outbreaks, history.
30 An example of information needed for a specific illness: (4th and 5th Grade)An example of information needed for a specific illness:
31 An example of information needed for a specific illness: (4th and 5th Grade)An example of information needed for a specific illness:
32 Useful LinksNational Science Olympiad -The focus is on the training handout/PowerPoint, but the test will not cover everything on this sheet. Make sure that the info is grade-level appropriate and the topic is covered in this PowerPoint before handing the info out.Practice Tests -Again, I won't cover everything asked on these tests. Coaches must check to make sure that each question is grade level appropriate and covered in the WESO DD PowerPoint/Study Guide before they hand out these exams.Public Health Teaching Resources -Links to other sites, teaching exercises, and more. Make sure they are grade-level appropriate and the topic is covered in this PowerPoint before handing them out.(Grades 4 and 5) Cohort / Case Control -The emphasis is on being able to identify a given study as either a cohort or a case control.
33 Fun Links and Questions Fun Links: ANY QUESTIONS?? Please Subject: Disease Detectives