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HSS4303B Introduction To Epidemiology Science of the Gods Jan 7, 2010 “Epidemiologic Approaches”

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Presentation on theme: "HSS4303B Introduction To Epidemiology Science of the Gods Jan 7, 2010 “Epidemiologic Approaches”"— Presentation transcript:

1 HSS4303B Introduction To Epidemiology Science of the Gods Jan 7, 2010 “Epidemiologic Approaches”

2 HSS4303B Mondays 8:30AM-10:AM Thursdays 10:AM-11:30AM DMS1150 *No* formal tutorials scheduled for this class But we may create some informal ones

3 Who We Be? Professor – Dr Raywat Deonandan – Templeton 111 x8377 – Teaching Assistant – Ms Erin Russell – Please email For appointments Currently, no regular office hours

4 Everything You Need To Know If you have a question about the class, please check the website before emailing us.

5 Marks, Marks, Marks Written assignment = 10% Midterm = 20% Poster = 25% Final exam = 45%

6 Written Assignment Abstract – Very brief – Test of your reading, research, writing abilities – Test of your ability to follow instructions – Instructions are already on the website – Worth 10% – Due 11:59pm on Jan 28

7 Midterm Currently scheduled for Feb 11 (though I might move it to after Reading Week… stay tuned) – All multiple choice! – Very similar to the one given to HSS4303A

8 Poster Your chance to play scientist! – Test your ability to collaborate, research, summarize and present – Everyone will present on April 10 HSS4303A, HSS4303B and even the French section – Instructions will be uploaded to website real soon – Worth 25%

9 Final Exam During Exam Period – Current plan is to combine HSS4303A and HSS4303B and give both sections the same exam – This plan may change if the content diverges – All multiple choice – Sample questions will be uploaded to website – Worth 45%

10 Textbooks? 1.Medical Epidemiology 4 th Edition, by Greenberg et al and published by McGraw Hills Publications. ($56.95 + tax at Agora Books) 2.Epidemiology, by Gordis L, published by Elsevier Sauders. ($60.11 + tax at Agora Books) The following books are recommended but not required. In syllabus, readings refer to book #1.

11 The Rules of Raywat 1.If you don’t want to be here, don’t come -you are not marked on attendance -I’d rather you not come than to come and talk during lectures 1.Don’t piss me off -I *will* find a way to make you pay for it

12 Lecture Slides Slides are provided as a courtesy Be sure to take your own notes because one day there might not be any slides (I’m tricky like that)

13 Important Dates Jan 28 – written assignments are due! Feb 11 – in-class midterm! Feb 17-20 – Reading Week! Mar 11 – submit your poster topic! Apr 10 – poster presentations! April 15 on – Exam period

14 Homework Previous years have had a mandatory tutorial for working through computational problems together This year, you’ll be given more take-home assignments instead (will not be marked) We will try to arrange 1-2 optional tutorial sessions before exams to go over the problems

15 What Is Epidemiology? “The study of the distribution and determinants of disease or health status in a population” – CDC The Science of the Gods! – R. Deonandan

16 The Origin of Epidemiology  Dr John Snow  1854  Used non-medical means to discover source of cholera outbreak

17 Figure 1-12 Photograph of John Snow. (From the Wellcome Historical Medical Museum and Library, London.) Figure 1-13 A drop of Thames water, as depicted by Punch in 1850. (From Extracts from Appendix (A) to the Report of the General Board of Health on the Epidemic Cholera of 1848 and 1849, published by HMSO, London, 1850. Int J Epidemiol 31:900-907, 2002.) Shoe leather epidemiology

18 Epidemiology Allowed “Miasmatic Theory” to be Displaced Miasmatic theory – Miasma was considered to be a poisonous vapor or mist filled with particles from decomposed matter (miasmata) that caused illnesses. It was identifiable by its foul smell. Supplanted by “Germ theory” – Most diseases caused by an infectious agent

19 HSS4303: Introduction to epidemiology Deaths from cholera and water theory Water supply# of houses Deaths from cholera Deaths per 10,000 houses Southwark and Vauxhall Co 40,0461,263315 Lambeth Co26,1079838 Other districts in London256,4231,42256

20 Types of Epidemiologists Clinical Epidemiologist Public Health Epidemiologist Population Epidemiologist The Face of Brilliance

21 Epidemiology In Pop Culture

22 Village of the Damned (1995)

23 Outbreak (1995)

24 Fringe (2009)

25 ReGenesis (2004) Dr Deonandan? I think not!

26 Some Terminology Clinical research or mathematical relationships: – Variable that predicts/causes an outcome is independent variable Epidemiological research: – Variable that may predict/cause an outcome is exposure

27 Some Terminology Epidemiological research: – Exposures that increase or decrease the likelihood of developing certain disorders, conditions or diseases are called risk factors Eg, research has shown a strong statistical association between the exposure of smoking and the outcome of having lung cancer  smoking is therefore a risk factor for lung cancer.

28 Descriptive Studies A true “descriptive study” is an example of “descriptive epidemiology” – Who – What – Where – When

29 Descriptive Study Who – Students What – Left handedness Where – This class When – Right now Right now, 23% of students in this class are left handed

30 Qualitative vs. Quantitative Descriptive vs. Analytic Observational vs. Experimental Case-control Cohort Cross-sectional Interventions Clinical trials Who gets the disease? When do they get it? Where do they get it?

31 What Is An Experiment? From the internet: “the act of conducting a controlled test or investigation” For our purposes, an experiment differs from other kinds of investigations in that the researcher manipulates something.


33 Historical Triumphs of Epidemiology

34 Smallpox

35 In 1975, two year old Rahima Banu contracted last known case of naturally-occurring variola major Smallpox. - Wikipedia The global eradication of smallpox was certified, based on intense verification activities in countries, by a commission of eminent scientists on 9 December 1979 and subsequently endorsed by the World Health Assembly on 8 May 1980 -“Resolution WHA33.3”

36 “You have erased from the calendar of human afflictions one of its greatest. Yours is the comfortable reflection that mankind can never forget that you have lived. Future nations will know by history only that the loathsome smallpox has existed.” -Thomas Jefferson to Edward Jenner, 1806

37 – 400,000 people died each year in the late 18 th century – 1/3 of the survivors became blind – Survivors also developed immunity to smallpox – Efforts to prevent smallpox Variolation – Edward Jenner took interest in cowpox to find solutions in the prevention of smallpox – WHO and eradication of smallpox In 1967 WHO began the eradication program 15 million people developed smallpox annually 2 million people died In 1980 smallpox was “eradicated”

38 Global eradication was possible because of… Herd immunity

39 More Triumphs of Epidemiology

40 Before HIV was known to cause AIDS We knew it involved the “3 H’s” – Homosexuals – Haemophiliacs – Haitians Epidemiologists figured out: – It was bloodborne – It was probably a virus

41 Observational epidemiology Many a times we do not know the cause of disease but we can associate it with certain exposures – Streptococcal infection follows rheumatic fever and rheumatic heart disease – Rheumatic fever is more frequent in army recruits than in school children Lung cancer and smoking Epidemiology based on observational data leads us to understand the association between the morbidity and mortality from a disease and certain exposures, habits, lifestyle choices

42 Where Do Epidemiologists Work? Universities (ahem) Government Public health agencies Drug companies Hospitals (MDs) Private companies

43 What Are Some Of The Things That Epidemiologists Do?

44 Breast and lung cancer mortality in Canada

45 Prevention and therapy Prevention is integral to public health and also to clinical practice In clinical practice therapy is used to prevent complications, disability and death Prevention in public health is primary prevention Prevention in clinical practice is – Secondary prevention (minimize disease complications) – Tertiary prevention (minimize disability) Epidemiology is the basis for effective prevention programs

46 Diagnostic tests: false positive and false negative tests are used to assess sensitivity and specificity

47 Disease prognosis and changes in therapeutic regimens

48 Disease surveillance Monitoring the patterns of occurrence of a disease within a population is referred to as _____________. There are many potential benefits from the collection of surveillance data: – (1) can help to identify the new outbreak of an illness, such as AIDS, – (2) can provide clues, by considering the population groups that are most affected by the illness, to possible causes of the condition, – (3) can be used to suggest strategies to control or prevent the spread of disease, – (4) can be used to measure the impact of disease prevention and control efforts, and finally, – (5) can provide information on the burden of illness, data that are necessary for determining health and medical service needs

49 Figure 1-14 Breast versus lung cancer mortality: white females versus black females, United States, 1973-1995, age-adjusted to 1970 standard. (From Ries LAG, Kosary CL, Hankey BF, Miller BA, Edwards BK [eds]: SEER Cancer Statistics Review, 1973-1995. Bethesda, MD, National Cancer Institute, 1998.) Trend Analysis


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