HSS4303B

1. HSS4303B Introduction To Epidemiology Science of the Gods Introduction Prof R Deonandan – ray@deonandan.com

2. HSS4303B • Mondays 8:30AM-10:AM • Thursdays 10:AM-11:30AM • MNT 201 • And….

3. Tutorial • Currently we have a tutorial scheduled for Saturdays 10:am-11:30am in CBY C03 • However, neither I nor Tiffany have any desire to come to campus on Saturdays, so.... • Tutorials will be held for the last 30 minutes of the Monday classes, every other week • We will keep the Saturday space for students who wish to use it as meeting space for activities related to this class

4. Who We Be? • Professor • Dr RaywatDeonandan • Templeton 111 x8377 • ray@deonandan.com • Teaching Assistant • Ms Tiffany Locke • locke_tiffany@yahoo.ca Please email For appointments Currently, no regular office hours

5. Everything You Need To Know classes.deonandan.com/hss4303 The Virtual Campus website is not up yet, but will be soon. In the mean time, all class files will be kept here: classes.deonandan.com/faq.html Also, I maintain an FAQ here: If you have a question about the class, please check the website before emailing us. I will not reply to emailed questions for which the answers are on the website or the syllabus.

6. “Not Taking it Seriously” • In the excel spreadsheet in which I keep your marks, there’s a column called “not taking it seriously” • This does not affect your marks, but may affect any leeway I offer you and certainly any references I write for you.

7. “Not Taking it Seriously” • Asking me questions about things that are on the website... • Asking me a question I just answered... • Not paying attention... • Not attending class and then using that as an excuse for not knowing what’s going on... • Mistaking me for your personal assistant... • Etc.

8. Marks, Marks, Marks • Written assignment = 10% • Midterm = 20% • Poster = 25% • Final exam = 45%

9. 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 via email on Saturday Jan 29

10. Midterm • Currently scheduled for Feb 28 • All multiple choice! • Very similar to the one given to HSS4303A

11. Poster • Your chance to play scientist! • Test your ability to collaborate, research, summarize and present • Everyone will present on Saturday, April 9 • HSS4303A, HSS4303B and even the French section • Instructions will be uploaded to website real soon • Worth 25%

12. 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% • Exam period: April 11-28

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

14. The Rules of Raywat • 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 -But you are still responsible for everything presented in class 2. Don’t piss me off -I *will* find a way to make you pay for it

15. 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)

16. Important Dates • Jan 29 – written assignments are due! • Feb 20-24 – Reading Week! • Feb 28 – in-class midterm! • Mar 12 – submit your poster topic! • Apr 9 – poster presentations! • April 11 on – Exam period

17. 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

18. 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

19. The Origin of Epidemiology • Dr John Snow • 1854 • Used non-medical means to discover source of cholera outbreak

20. Shoe leather epidemiology 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.) Figure 1-12 Photograph of John Snow. (From the Wellcome Historical Medical Museum and Library, London.)

21. 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

22. Deaths from cholera and water theory HSS4303: Introduction to epidemiology

23. Types of Epidemiologists • Clinical Epidemiologist • Public Health Epidemiologist • Population Epidemiologist The Face of Brilliance

24. Epidemiology In Pop Culture

25. Village of the Damned (1995)

26. Outbreak (1995)

27. Fringe (2009)

28. ReGenesis (2004) Dr Deonandan? I think not!

29. 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

30. 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.

31. Descriptive Studies • A true “descriptive study” is an example of “descriptive epidemiology” • Who • What • Where • When

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

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

34. 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.

35. EXPERIMENTAL STUDY

36. Historical Triumphs of Epidemiology

37. Smallpox

38. 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” In 1975, two year old Rahima Banu contracted last known case of naturally-occurring variola major Smallpox. -Wikipedia

39. “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

40. 400,000 people died each year in the late 18th 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”

41. Global eradication was possible because of… Herd immunity

42. More Triumphs of Epidemiology

43. 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

44. 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

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

46. What Are Some Of The Things That Epidemiologists Do?

47. Breast and lung cancer mortality in Canada

48. 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

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

50. Disease prognosis and changes in therapeutic regimens